[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4430 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 4430
To amend title XIX of the Social Security Act to establish a Health
Engagement Hub demonstration program to increase access to treatment
for opiate use disorder and other drug use treatment, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 23, 2024
Ms. Cantwell (for herself and Mr. Cassidy) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to establish a Health
Engagement Hub demonstration program to increase access to treatment
for opiate use disorder and other drug use 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 ``Fatal Overdose Reduction Act of
2024''.
SEC. 2. HEALTH ENGAGEMENT HUB DEMONSTRATION PROGRAM UNDER MEDICAID.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(cc) Health Engagement Hub Demonstration Program.--
``(1) Authority.--The Secretary shall conduct a
demonstration program (referred to in this subsection as the
`demonstration program') for the purpose of increasing access
to treatment for opiate use disorder and other drug use
treatment through the establishment of Health Engagement Hubs
that meet the criteria published by the Secretary under
paragraph (2)(A).
``(2) Publication of guidance.--Not later than 6 months
after the date of enactment of this subsection, the Secretary
shall publish the following:
``(A) Certification criteria.--The criteria
described in paragraph (3) for an organization to be
certified by a State as a Health Engagement Hub for
purposes of participating in the demonstration program.
``(B) Prospective payment system.--Guidance for
States selected to participate in the demonstration
program to use to establish a prospective payment
system for services permitted under paragraph (3)(B)
that are provided by a certified Health Engagement Hub
participating in the demonstration program.
``(3) Criteria for certification of health engagement
hubs.--
``(A) General requirements.--In order to be
certified as a Health Engagement Hub, an organization
shall--
``(i) demonstrate that the organization is
able to serve as an all-in-one location where
individuals who are eligible for medical
assistance under a State plan under this title
or under a waiver of such plan who seek
treatment for opiate use disorder or other drug
use may access a range of social and medical
services, in a drop-in manner and without prior
appointment or proof of payment;
``(ii) provide the services specified in
subparagraph (B) (in a manner reflecting
person-centered care) which, if not available
directly through the organization, shall be
provided through formal relationships with
other providers;
``(iii) demonstrate that in selecting the
location for the Health Engagement Hub, the
organization prioritized placement in
communities disproportionately impacted by
overdose, health issues, and other harms
related to drug use, as well as areas that are
medically underserved, rural, geographically
isolated areas, tribal areas, or urban centers
with under-resourced behavioral health
infrastructure, including disadvantaged
communities based on race, individuals
experiencing homelessness, and communities
negatively impacted by the criminal-legal
system;
``(iv) give priority to establishing or
adopting evidence-based models to increase
engagement or improve outcomes for individuals
with active, ongoing substance use, such as
social work empowerment models approved by the
Secretary, motivational interviewing models
approved by the Secretary, or shared decision
making models approved by the Secretary; and
``(v) meet--
``(I) the minimum staffing
requirements described in subparagraph
(C);
``(II) the experience requirement
described in subparagraph (D); and
``(III) the community advisory
board requirement described in
subparagraph (E).
``(B) Scope of services.--The services specified in
this subparagraph are the following:
``(i) Required services.--
``(I) Harm reduction services and
supplies provided directly by the
organization or under an arrangement
with an organization that offers harm
reduction services (which may include a
syringe service program, a Federally-
qualified health center, a community
health center, a Tribal health program,
or an opioid treatment program that
offers such services), that include--
``(aa) overdose education
and naloxone distribution;
``(bb) safer drug use
education and supplies;
``(cc) safer-sex supplies;
``(dd) emotional support
and counseling services to
reduce harms associated with
substance use, including
trauma-informed care; and
``(ee) access or referral
to medications and drugs
approved by the Food and Drug
Administration for treatment of
opioid use disorder with a
strong evidence base of
significantly reducing
mortality (such as methadone
and buprenorphine) and other
substances, including
stimulants, within 4 hours.
``(II) Substance use disorder
screening and brief intervention.
``(III) Patient-centered and
patient-driven physical and behavioral
health care that has walk-in
availability, is offered during non-
traditional hours, including evenings
and weekends, and includes--
``(aa) shared decision
making for patients and
providers for opioid use
disorder, stimulant use
disorder, or both, under which
a patient and provider discuss
the patient's diagnosis and
condition together and evaluate
treatment options together;
``(bb) primary mental
health and substance use
disorder services, including
screening, assessment, and
referrals to higher levels of
care;
``(cc) wound care;
``(dd) infectious disease
vaccination, screening,
testing, and, to the extent
practicable, treatment
(including for HIV, sexually
transmitted infections, and
hepatitis testing and
treatment);
``(ee) access or referral
to sexual and reproductive
health services;
``(ff) assessment and
linkage or referrals to
psychiatric services and other
specialty care; and
``(gg) secure medication
storage and inventory policies
and procedures for patients
experiencing homelessness or
housing insecurity.
``(IV) Care coordination, complex
case management, and other case
management, care navigation, and care
coordination services that may
include--
``(aa) education and
assistance with obtaining
housing, transportation, and
other public assistance
benefits, including enrollment
in the State plan under this
title or under a waiver of such
plan;
``(bb) identification
services (such as assistance
with obtaining a government-
recognized form of
identification);
``(cc) employment
counseling;
``(dd) recovery support
counseling;
``(ee) family reunification
services; and
``(ff) criminal-legal
services.
``(V) All services that may be
provided under the Outreach Site/Street
Place of Service code (POS Code 27 as
of October 1, 2023) (or a successor
place of service code).
``(VI) Community health outreach
and navigation services to engage with
and conduct outreach to community
members that is provided by outreach
and engagement staff described in
subparagraph (C)(i)(IV).
``(ii) Optional services.--
``(I) Services and supplies to meet
basic needs, including food, clothing,
and hygiene supplies.
``(II) Evidence-based and
culturally appropriate behavioral
health services.
``(III) Medication management for
physical and mental health conditions.
``(C) Minimum staffing requirements.--
``(i) In general.--The minimum staffing
requirements specified in this subparagraph are
the following:
``(I) At least 1 part-time or full-
time health care provider who is
licensed to practice in the State and
is licensed, registered, or otherwise
permitted, by the United States to
prescribe controlled substances (as
defined in section 102 of the
Controlled Substances Act) in the
course of professional practice.
``(II) At least 1 part-time or
full-time registered professional nurse
or licensed practical nurse who can
provide medication management, medical
case management, care coordination,
wound care, vaccine administration, and
community-based outreach.
``(III) At least 1 part-time or
full-time licensed behavioral health
staff who is qualified to assess and
provide counseling and treatment
recommendations for substance use and
mental health diagnoses.
``(IV) Full-time outreach,
engagement, and ongoing care navigation
staff, including peer counselors,
community health workers, and recovery
coaches. At least 50 percent of such
staff shall be individuals with a
personal history of drug use.
``(ii) Staffing through arrangements with
partner agencies.--An organization may enter
into an arrangement with a partner agency, such
as a Federally-qualified health center, to
satisfy the minimum staffing requirements
specified in clause (i).
``(D) Experience.--An organization shall have a
demonstrated history of at least 12 months of service
provision to individuals who use drugs, including those
who continue with substance use while receiving health
and social services.
``(E) Community advisory board.--An organization
shall have a community advisory board composed of
individuals with a history of substance use, or who
continue with substance use, that meets, at a minimum,
on--
``(i) a monthly basis, to review program
utilization data and provide feedback to the
organization; and
``(ii) on a quarterly basis, with the
executives or board of directors of the
organization to provide input on service
delivery and receive feedback on actions taken
based on previous feedback provided by the
community advisory board.
``(4) Planning grants.--
``(A) In general.--Not later than 1 year after the
date of enactment of this subsection, the Secretary
shall award planning grants to States for the purpose
of developing proposals to participate in the
demonstration program.
``(B) Amount of grant.--The amount of a grant
awarded to a State under this paragraph shall be
sufficient to pay 100 percent of the actual costs
expended by a State to carry out the activities
required under subparagraph (C).
``(C) Use of funds.--A State awarded a planning
grant under this paragraph shall solicit input on the
development of a proposal to participate in the
demonstration program from patients, providers, harm
reduction service providers, social service providers,
and other stakeholders, with respect to--
``(i) identifying and certifying
organizations as Health Engagement Hubs for
purposes of participating in the demonstration
program; and
``(ii) establishing a prospective payment
system for services provided by a certified
Health Engagement Hub participating in the
demonstration program, in accordance with the
guidance issued under paragraph (2)(B).
``(D) Funding.--Out of any funds in the Treasury
not otherwise appropriated, there are appropriated to
the Secretary such sums as are necessary to carry out
this paragraph, to remain available until expended.
``(5) State demonstration programs.--
``(A) In general.--Not later than 2 years after the
date of enactment of this subsection, the Secretary
shall solicit applications solely from the States
awarded a planning grant under paragraph (4) to
participate in the demonstration program.
``(B) Application requirements.--An application to
participate in the demonstration program shall include
the following:
``(i) A description of, including the
estimated number of individuals in, the target
population to be served by the State under the
demonstration program.
``(ii) An assurance that at least \1/2\ of
the Health Engagement Hubs in the State shall
be located in--
``(I) a county (or a municipality,
if not contained within any county)
where the mean drug overdose death rate
per 100,000 people over the past 3
years for which official data is
available from the State, is higher
than the most recent available national
average overdose death rate per 100,000
people, as reported by the Centers for
Disease Control and Prevention; or
``(II) an area of the State that is
designated under section 332(a)(1)(A)
of the Public Health Service Act as a
mental health professional shortage
area.
``(iii) A description of the prospective
payment system that is to be tested under the
demonstration program.
``(iv) A list of the certified Health
Engagement Hubs located in the State that will
participate in the demonstration program.
``(v) Verification that each such certified
Health Engagement Hub satisfies the
requirements described in paragraph (3)(A).
``(vi) A description of the scope of the
services that will be paid for under the
prospective payment system (which includes at a
minimum the required services described in
paragraph (3)(B)(i)) that is to be tested under
the demonstration program.
``(vii) Verification that the State has
agreed to pay for such services at the at the
rate established under the prospective payment
system.
``(viii) Any other information that the
Secretary may require relating to the
demonstration program with respect to
determining the soundness of the proposed
prospective payment system.
``(C) Selection criteria.--
``(i) In general.--The Secretary shall
select from among the applications submitted at
least 10 States to participate in the
demonstration program based on geographic and
demographic diversity.
``(ii) Priority.--In addition to the
criteria specified in clause (i), the Secretary
shall prioritize selecting States with the
highest rates of opioid- or stimulant-involved
overdose death rates.
``(D) Length of demonstration programs.--A State
selected to participate in the demonstration program
shall participate in the program for a 2-year period.
``(E) Waiver of certain requirements.--The
Secretary shall waive section 1902(a)(1) (relating to
statewideness), section 1902(a)(10)(B) (relating to
comparability), and any other provision of this title
which would be directly contrary to the authority under
this subsection as may be necessary for a State to
participate in the demonstration program in accordance
with this paragraph.
``(F) Payments to states.--
``(i) In general.--The Secretary shall pay
a State participating in the demonstration
program the Federal matching percentage
specified in clause (ii) for amounts expended
by the State for medical assistance for
services provided through certified Health
Engagement Hubs to individuals enrolled under
the State plan (or under a waiver of such plan)
consisting of medications and drugs approved by
the Food and Drug Administration for treatment
of opioid use disorder and other substances,
including stimulants, and the services
specified by the State in its application under
subparagraph (B)(vi), at the rate established
under the prospective payment system
established by the State for purposes of the
demonstration program.
``(ii) Federal matching percentage.--The
Federal matching percentage specified in this
clause is--
``(I) with respect to medical
assistance described in clause (i) that
is furnished to a newly eligible
individual described in paragraph (2)
of section 1905(y), the matching rate
applicable under paragraph (1) of that
section; and
``(II) with respect to medical
assistance described in clause (i) that
is furnished to an individual who is
not a newly eligible individual (as so
described), but who is eligible for
medical assistance under the State plan
under this title or under a waiver of
such plan, the enhanced FMAP applicable
to the State under section 2105(b).
``(iii) Application.--Payments to States
made under this subparagraph shall be
considered to have been made under, and are
subject to, the requirements of this section.
``(6) Reports.--
``(A) Annual state reports.--
``(i) In general.--Each State selected to
participate in the demonstration program under
paragraph (5) shall submit an annual report to
the Secretary on the demonstration program that
includes the following:
``(I) An assessment of the extent
to which Health Engagement Hubs funded
under the demonstration program have
increased access to treatment for
opiate use disorder and other drug use
treatment, health services for
individuals who use drugs, and other
social services under State plans under
this title or under waivers of such
plans in the area or areas of States
targeted by the demonstration program
compared to other areas of the State.
``(II) An assessment on the impact
of Health Engagement Hubs on reducing
opioid and stimulant overdose mortality
rates and the rate of adherence to
prescribed medication for opioid use,
hospitalization rates, and housing
status for the population served by a
Health Engagement Hub as compared to
populations that are not served by a
Health Engagement Hub.
``(III) A description of the
successes of the demonstration program.
``(IV) Recommendations for
improvements to the demonstration
program, including whether the
demonstration program should be
continued, expanded, modified, or
terminated.
``(ii) Funding.--Out of any funds in the
Treasury not otherwise appropriated, there are
appropriated such sums as are necessary, to
remain available until expended, for purposes
of making payments to States for expenditures
attributable to collecting and reporting the
information required under this subparagraph.
``(B) Reports to congress.--
``(i) In general.--The Secretary shall
submit an annual report to Congress that
describes the information, findings, and
recommendations in the annual State reports
submitted to the Secretary under subparagraph
(A).
``(ii) Implementation evaluation results.--
The Secretary shall include with the first 3
annual reports submitted by the Secretary under
this subparagraph the findings and conclusions
of the implementation evaluation required by
paragraph (7).
``(7) Implementation evaluation.--
``(A) In general.--The Secretary shall solicit
public input and fund an implementation evaluation of
the planning grants awarded under paragraph (4) and the
initial set of States selected for the demonstration
program under paragraph (5) to determine the reach,
effectiveness, adoption, and implementation of the
demonstration program in each such State to document
the degree to which the services were implemented as
intended and allow for a complete assessment of the
impact of the Health Engagement Hubs in each such
State.
``(B) Requirements.--
``(i) Information.--The evaluation shall
include information on the characteristics of
the individuals who receive services, service
utilization metrics over time (including by
staff role), and input from interviews with
such individuals and staff.
``(ii) Eligible entities.--In order to be
eligible to conduct the evaluation, an entity
shall have documented experience conducting
implementation evaluations of health and social
services programs for individuals who use
drugs.
``(C) Funding.--Out of any funds in the Treasury
not otherwise appropriated, there are appropriated to
the Secretary such sums as are necessary to carry out
this paragraph, to remain available until expended.''.
SEC. 3. GOVERNMENT ACCOUNTABILITY OFFICE REPORT.
(a) In General.--Not later than 6 months after the conclusion of
the demonstration program established under subsection (cc) of section
1903 of the Social Security Act (42 U.S.C. 1396b), as added by section
2, the Comptroller General of the United States shall conduct and
publish a comparative analysis on the impacts of the health engagement
hubs certified under such program (in this section referred to as
``health engagement hubs'') compared to the impacts of other opioid
treatment programs and health care organizations that offer behavioral
health care or substance use disorder services.
(b) Content of Analysis.--The analysis required under this section
shall include the following:
(1) Data and information analyzing differences in rates
among individuals who receive behavioral health care or
substance use disorder services through a health engagement hub
and among individuals who receive such care or services through
a program or organization referred to in subsection (a) for
each of the following factors:
(A) Changes in rates of mortality.
(B) Changes in rates of recidivism.
(C) Rates of relapse.
(D) Rates of hospital and emergency department
utilization.
(E) Frequency of visits for care or services.
(F) Rates of successful intervention through the
administration of buprenorphine or other medication
approved by the Food and Drug Administration for the
treatment of substance use disorder.
(2) Data and information comparing the racial and
socioeconomic demographics, housing status, employment, and
other metrics, as recommended by the Secretary of Health and
Human Services, of the population groups that receive
behavioral health care or substance use disorder services
through a health engagement hub or through a program or
organization referred to in subsection (a).
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