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                                                Union Calendar No. 466
116th Congress   }                                       {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                       {     116-568

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

 
         STATE OPIOID RESPONSE GRANT AUTHORIZATION ACT OF 2020

                                _______
                                

 November 12, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 2466]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2466) to extend the State Opioid Response Grants 
program, and for other purposes, having considered the same, 
reports favorably thereon with amendments and recommends that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................3
 II. Background and Need for the Legislation..........................4
III. Committee Hearings...............................................5
 IV. Committee Consideration..........................................6
  V. Committee Votes..................................................6
 VI. Oversight Findings...............................................6
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures6
VIII.Federal Mandates Statement.......................................7

 IX. Statement of General Performance Goals and Objectives............7
  X. Duplication of Federal Programs..................................7
 XI. Committee Cost Estimate..........................................7
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......7
XIII.Advisory Committee Statement.....................................7

XIV. Applicability to Legislative Branch..............................7
 XV. Section-by-Section Analysis of the Legislation...................7
XVI. Changes in Existing Law Made by the Bill, as Reported............8

    The amendments are as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``State Opioid Response Grant 
Authorization Act of 2020''.

SEC. 2. GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO SUBSTANCE USE 
                    DISORDERS OF SIGNIFICANCE.

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

``SEC. 1003. GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO SUBSTANCE 
                    USE DISORDERS OF SIGNIFICANCE.

  ``(a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the `Secretary') shall carry out the 
grant program described in subsection (b) for purposes of addressing 
substance use disorders of significance, including opioid and stimulant 
use disorders, within States, Indian Tribes, and populations served by 
Tribal organizations.
  ``(b) Grants Program.--
          ``(1) In general.--Subject to the availability of 
        appropriations, the Secretary shall award grants to States, 
        Indian Tribes, and Tribal organizations for the purpose of 
        addressing substance use disorders of significance, including 
        opioid and stimulant use disorders, within such States, such 
        Indian Tribes, and populations served by such Tribal 
        organizations, in accordance with paragraph (2).
          ``(2) Minimum allocations; preference.--In awarding grants 
        under paragraph (1), the Secretary shall--
                  ``(A) ensure that each State and the District of 
                Columbia receives not less than $4,000,000; and
                  ``(B) give preference to States, Indian Tribes, and 
                Tribal organizations with an incidence or prevalence of 
                opioid use disorders that is substantially higher 
                relative to other States, other Indian Tribes, or other 
                Tribal organizations, as applicable.
          ``(3) Formula methodology.--Not less than 15 days before 
        publishing a funding opportunity announcement with respect to 
        grants under this section, the Secretary shall--
                  ``(A) develop a formula methodology to be followed in 
                allocating grant funds awarded under this section among 
                grantees; and
                  ``(B) submit the formula methodology to--
                          ``(I) the Committee on Energy and Commerce 
                        and the Committee on Appropriations of the 
                        House of Representatives; and
                          ``(ii) the Committee on Health, Education, 
                        Labor and Pensions and the Committee on 
                        Appropriations of the Senate.
          ``(4) Use of funds.--Grants awarded under this subsection 
        shall be used for carrying out activities that supplement 
        activities pertaining to substance use disorders of 
        significance, including opioid and stimulant use disorders, 
        undertaken by the State agency responsible for administering 
        the substance abuse prevention and treatment block grant under 
        subpart II of part B of title XIX of the Public Health Service 
        Act (42 U.S.C. 300x-21 et seq.), which may include public 
        health-related activities such as the following:
                  ``(A) Implementing prevention activities, and 
                evaluating such activities to identify effective 
                strategies to prevent substance use disorders.
                  ``(B) Establishing or improving prescription drug 
                monitoring programs.
                  ``(C) Training for health care practitioners, such as 
                best practices for prescribing opioids, pain 
                management, recognizing potential cases of substance 
                abuse, referral of patients to treatment programs, 
                preventing diversion of controlled substances, and 
                overdose prevention.
                  ``(D) Supporting access to health care services, 
                including--
                          ``(i) services provided by federally 
                        certified opioid treatment programs;
                          ``(ii) outpatient and residential substance 
                        use disorder treatment services that utilize 
                        medication-assisted treatment, as appropriate; 
                        or
                          ``(iii) other appropriate health care 
                        providers to treat substance use disorders.
                  ``(E) Other public health-related activities, as the 
                State, Indian Tribe, or Tribal organization determines 
                appropriate, related to addressing substance use 
                disorders within the State, Indian Tribe, or Tribal 
                organization, including directing resources in 
                accordance with local needs related to substance use 
                disorders.
  ``(c) Accountability and Oversight.--A State receiving a grant under 
subsection (b) shall include in reporting related to substance abuse 
submitted to the Secretary pursuant to section 1942 of the Public 
Health Service Act (42 U.S.C. 300x-52), a description of--
          ``(1) the purposes for which the grant funds received by the 
        State under such subsection for the preceding fiscal year were 
        expended and a description of the activities of the State under 
        the grant; and
          ``(2) the ultimate recipients of amounts provided to the 
        State through the grant.
  ``(d) Limitations.--Any funds made available pursuant to subsection 
(i)--
          ``(1) notwithstanding any transfer authority in any 
        appropriations Act, shall not be used for any purpose other 
        than the grant program in subsection (b); and
          ``(2) shall be subject to the same requirements as substance 
        abuse prevention and treatment programs under titles V and XIX 
        of the Public Health Service Act (42 U.S.C. 290aa et seq., 300w 
        et seq.).
  ``(e) Indian Tribes and Tribal Organizations.--The Secretary, in 
consultation with Indian Tribes and Tribal organizations, shall 
identify and establish appropriate mechanisms for Indian Tribes and 
Tribal organizations to demonstrate or report the information as 
required under subsections (b), (c), and (d).
  ``(f) Report to Congress.--Not later than September 30, 2022, and 
biennially thereafter, the Secretary shall submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representatives, and the 
Committees on Appropriations of the House of Representatives and the 
Senate, a report summarizing the information provided to the Secretary 
in reports made pursuant to subsections (c) and (e), including the 
purposes for which grant funds are awarded under this section and the 
activities of such grant recipients.
  ``(g) Technical Assistance.--The Secretary, including through the 
Tribal Training and Technical Assistance Center of the Substance Abuse 
and Mental Health Services Administration, shall provide States, Indian 
Tribes, and Tribal organizations, as applicable, with technical 
assistance concerning grant application and submission procedures under 
this section, award management activities, and enhancing outreach and 
direct support to rural and underserved communities and providers in 
addressing substance use disorders.
  ``(h) Definitions.--In this section:
          ``(1) Indian tribe.--The term `Indian Tribe' has the meaning 
        given the term `Indian tribe' in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304).
          ``(2) Tribal organization.--The term `Tribal organization' 
        has the meaning given the term `tribal organization' in such 
        section 4.
          ``(3) State.--The term `State' has the meaning given such 
        term in section 1954(b) of the Public Health Service Act (42 
        U.S.C. 300x-64(b)).
  ``(i) Authorization of Appropriations.--
          ``(1) In general.--For purposes of carrying out the grant 
        program under subsection (b), there is authorized to be 
        appropriated $1,500,000,000 for each of fiscal years 2020 
        through 2026, to remain available until expended.
          ``(2) Federal administrative expenses.--Of the amounts made 
        available for each fiscal year to award grants under subsection 
        (b), the Secretary shall not use more than 2 percent for 
        Federal administrative expenses, training, technical 
        assistance, and evaluation.
          ``(3) Set aside.--Of the amounts made available for each 
        fiscal year to award grants under subsection (b) for a fiscal 
        year, the Secretary shall--
                  ``(A) award 5 percent to Indian Tribes and Tribal 
                organizations; and
                  ``(B) of the remaining amount, set aside up to 15 
                percent for States with the highest age-adjusted rate 
                of drug overdose death based on the ordinal ranking of 
                States according to the Director of the Centers for 
                Disease Control and Prevention.''.
  (b) Clerical Amendment.--The table of sections in section 1(b) of 
such Act is amended by striking the item relating to section 1003 and 
inserting the following:

``Sec. 1003. Grant program for State and Tribal response to substance 
use disorders of significance.''.

    Amend the title so as to read:
    A bill to amend the 21st Century Cures Act to reauthorize 
and expand a grant program for State response to the opioid 
abuse crisis, and for other purposes.

                         I. Purpose and Summary

    H.R. 2466, the ``State Opioid Response Grant Authorization 
Act'', was introduced by Representatives David Trone (D-MD), 
Kelly Armstrong (R-ND), Mikie Sherrill (D-NJ), and Denver 
Riggleman (R-VA). This bill would authorize the Substance Abuse 
and Mental Health Services Administration (SAMHSA) State Opioid 
Response (SOR) Grant program by placing the program under the 
substance use disorder grant statutory authorities in the 21st 
Century Cures Act.\1\ This grant program would support efforts 
in the States, Tribes, populations served by tribal 
organizations, territories, and Washington, D.C. to address 
substance use disorders, including opioid and stimulant use 
disorders. Funding from this authorization may support public 
health-related activities such as substance use disorder 
prevention efforts, establishing or improving prescription drug 
monitoring programs, health care practitioner training, and 
substance use disorder treatment, among other items. The 
Secretary of Health and Human Services (the Secretary) is 
required to submit a biennial report to Congress on the 
program. H.R. 2466 authorizes $1.5 billion for each of the 
fiscal years (FY) 2020 through 2026.
---------------------------------------------------------------------------
    \1\Public Law 114-255.
---------------------------------------------------------------------------

                II. Background and Need for Legislation

    The 2019 National Survey on Drug Use and Health indicates 
that over twenty million Americans have a substance use 
disorder.\2\ Unfortunately, this survey found that only four 
million individuals received substance use treatment.\3\ This 
treatment gap has unfortunate consequences. According to the 
Centers for Disease Control and Prevention (CDC), more than 
750,000 Americans have died since 1999 from a drug overdose, 
with two out of three drug overdose deaths in 2018 involving an 
opioid.\4\
---------------------------------------------------------------------------
    \2\Substance Abuse and Mental Health Services Administration. Key 
substance use and mental health indicators in the United States: 
Results from the 2019 National Survey on Drug Use and Health (2020).
    \3\Id.
    \4\Centers for Disease Control and Prevention, Data Overview The 
Drug Overdose Epidemic: Behind the Numbers (www.cdc.gov/drugoverdose/
data/index.html) (accessed October 20, 2020).
---------------------------------------------------------------------------
    The SAMHSA SOR grant program has been funded through 
appropriations legislation since FY 2018.\5\ This grant program 
does not have a statutory authorization, however. As Admiral 
Brett Giroir, Assistant Secretary for Health, stated in 
testimony, SAMHSA's SOR grants provide a high degree of 
flexibility to States.\6\ Currently, SOR grants aim to address 
the opioid crisis by increasing access to medication-assisted 
treatment using the three Food and Drug Administration-approved 
medications for the treatment of opioid use disorder, reducing 
unmet treatment needs, and reducing opioid overdose related 
deaths through the provision of prevention, treatment, and 
recovery activities for opioid use disorder.\7\
---------------------------------------------------------------------------
    \5\Public Law 115-141.
    \6\House Committee on Energy and Commerce, Testimony of ADM Brett 
P. Giroir, M.D., Assistant Secretary for Health and Senior Adviser to 
the Secretary on Opioid Policy, Department of Health and Human 
Services, Hearing on Combatting an Epidemic: Legislation to Help 
Patients with Substance Use Disorders, 116th Cong. (March 3, 2020).
    \7\Substance Abuse and Mental Health Services Administration, State 
Opioid Response Grants Funding Opportunity Announcement (FOA) 
Information (accessed October 19, 2020).
---------------------------------------------------------------------------
    Robert Morrison, executive director and director of 
legislative affairs for the National Association of State 
Alcohol and Drug Abuse Directors, noted in testimony that SOR 
grant program ``provides a substantial level of support for 
innovative and lifesaving programs in States across the 
country.''\8\ For example, SOR grants have supported New 
Jersey's efforts to increase practitioner training and allow 
the State to train an additional 640 practitioners to provide 
substance use disorder treatment to date.\9\ Additionally, in 
Oregon, SOR grants have allowed the State to purchase and 
distribute 44,000 naloxone kits, which have been reported to 
reverse over 3,378 overdoses.\10\
---------------------------------------------------------------------------
    \8\House Committee on Energy and Commerce, Testimony of Robert I.L. 
Morrison, Executive Director/Director of Legislative Affairs, National 
Association of State Alcohol and Drug Abuse Directors, Hearing on 
Combatting an Epidemic: Legislation to Help Patients with Substance Use 
Disorders, 116th Cong. (March 3, 2020).
    \9\Id.
    \10\Id.
---------------------------------------------------------------------------
    The need for continued support is evident in preliminary 
data suggesting that death rates climbed by nearly five percent 
in 2019, with more than 71,148 additional deaths predicted.\11\ 
Scattered reports from States and counties across the country 
suggest that numbers continue to rise in 2020 during the COVID-
19 pandemic.\12\ H.R. 2466 would ensure continued, predictable 
support for substance use disorder prevention, treatment, and 
recovery efforts through 2026.
---------------------------------------------------------------------------
    \11\Centers for Disease Control and Prevention, National Center for 
Health Statistics, Provisional Drug Overdose Death Counts (https://
www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) (August 20, 2020).
    \12\In shadow of Pandemic, U.S. Drug Overdose Resurge to Records, 
New York Times, (https://www.nytimes.com/interactive/2020/07/15/upshot/
drug-overdose-deaths.html?referringSource= articleShare) (July 15, 
2020).
---------------------------------------------------------------------------

                        III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 2466 and 13 other bills:
    The Subcommittee on Health held a legislative hearing on 
Tuesday, March 3, 2020, entitled, ``Combatting an Epidemic: 
Legislation to Help Patients with Substance Use Disorders.'' 
The Subcommittee received testimony from the following 
witnesses:
    Panel I:
           ADM Brett P. Giroir, M.D., Assistant 
        Secretary for Health and Senior Adviser to the 
        Secretary on Opioid Policy, Department of Health and 
        Human Services
           Kimberly Brandt, Principal Deputy 
        Administrator for Policy & Operations, Centers for 
        Medicare & Medicaid Services
           Thomas W. Prevoznik, Deputy Assistant 
        Administrator, Diversion Control Division, Drug 
        Enforcement Administration
    Panel II:
           Michael P. Botticelli, Executive Director, 
        Grayken Center for Addiction, Boston Medical Center
           Smita Das, M.D., Ph.D., M.P.H., Addiction 
        Psychiatrist, Dual Diagnosis Clinic, Clinical Assistant 
        Professor, Psychiatry and Behavioral Sciences, Stanford 
        University School of Medicine
           Patty McCarthy, Chief Executive Officer, 
        Faces & Voices of Recovery
           Robert I.L. Morrison, Executive Director/
        Director of Legislative Affairs, National Association 
        of State Alcohol and Drug Abuse Directors
           Margaret B. Rizzo, Executive Director, JSAS 
        HealthCare, Inc.
           Shawn A. Ryan, M.D., M.B.A., Chair, 
        Legislative Advocacy Committee, American Society of 
        Addiction Medicine

                      IV. Committee Consideration

    Representatives Trone, Armstrong, Sherrill, and Riggleman 
introduced H.R. 2466 on May 1, 2019, and the bill was referred 
to the Committee on Energy and Commerce. H.R. 2466 was then 
referred to the Subcommittee on Health on May 2, 2019. A 
legislative hearing was held by the Subcommittee on March 3, 
2020.
    On September 9, 2020, H.R. 2466 was discharged from further 
consideration by the Subcommittee on Health as it was called up 
for consideration by the full Committee on Energy and Commerce. 
The full Committee met in virtual open markup session on 
September 9, 2020, pursuant to notice, to consider H.R. 2466 
and thirty-seven other bills. During consideration of the bill, 
an amendment in the nature of a substitute offered by Ms. 
Kuster (D-NH), on behalf of herself and Mr. Lujan (D-NM), was 
agreed to by a voice vote. Upon conclusion of consideration of 
the bill, the full Committee agreed to a motion on final 
passage offered by Mr. Pallone, Chairman of the committee, to 
order H.R. 2466 reported favorably to the House, amended, by a 
voice vote, a quorum being present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
2466, including the motion for final passage of the bill.

                         VI. Oversight Findings

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

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

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

                    VIII. Federal Mandates Statement

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

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
authorize the State Opioid Response Grants program, which 
provides support for States, Tribes, and the territories to 
respond to substance use disorder needs, and to extend such 
funding through FY 2026.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 2466 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

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

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

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 2466 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

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

                XIV. Applicability to Legislative Branch

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

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``State Opioid Response Grant Authorization Act of 2020''.

Sec. 2. Grant program for state and tribal response to substance use 
        disorders of significance.

    Section 2 amends the 21st Century Cures Act to authorize 
the Secretary to carry out a grant program that addresses 
substance use disorders of significance, including opioid and 
stimulant use disorders, within States, Indian Tribes, 
populations served by tribal organizations, territories, and 
Washington, D.C. The minimum allocation for eligible entities 
is $4 million, with preference given to entities with an 
incidence or prevalence of opioid use disorders that is 
substantially higher relative to other entities. The formula 
methodologies for allocating grant funds must be submitted to 
Congress no later than fifteen days prior to publishing a 
funding opportunity for grants under this section.
    Activities under this grant may include implementing 
substance use disorder prevention activities, establishing or 
improving prescription drug monitoring programs, providing 
training for health care practitioners, and supporting access 
to health care through Federally certified opioid treatment 
programs and outpatient and residential substance use disorder 
treatment services that utilize medication-assisted treatment. 
Grantees may also direct resources in accordance with local 
needs related to substance use disorders. Grantees are required 
to report activities and ultimate recipients of the grant to 
the Secretary not later than September 30, 2022, and biennially 
thereafter. The Secretary is directed to provide technical 
assistance to eligible entities.
    Indian Tribes and tribal organizations are given the 
meaning under the Indian Self-Determination and Education 
Assistance Act. States in this Act include each of the several 
States, the District of Columbia, and each of the territories 
of the United States.
    The authorization for appropriations is $1.5 billion for 
each of the FYs 2020 through 2026. The legislation sets a two 
percent cap for administrative expenses, training, technical 
assistance, and evaluations. A set aside of five percent is 
available for Indian Tribes and tribal organizations and, of 
the remaining amount, fifteen percent is reserved for the 
States with the highest age-adjusted rate of drug overdose 
deaths.

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

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

                         21ST CENTURY CURES ACT


SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``21st Century 
Cures Act''.
  (b) Table of Contents.--The table of contents for this Act is 
as follows:


Sec. 1. Short title; table of contents.

                 section DIVISION A--21ST CENTURY CURES

     * * * * * * *

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

     * * * * * * *
[Sec. 1003. Account for the state response to the opioid abuse crisis.]
Sec. 1003. Grant program for State and Tribal response to substance use 
          disorders of significance.

           *       *       *       *       *       *       *


DIVISION A--21ST CENTURY CURES

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *


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

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

SEC. 1003. GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO SUBSTANCE USE 
                    DISORDERS OF SIGNIFICANCE.

  (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall carry 
out the grant program described in subsection (b) for purposes 
of addressing substance use disorders of significance, 
including opioid and stimulant use disorders, within States, 
Indian Tribes, and populations served by Tribal organizations.
  (b) Grants Program.--
          (1) In general.--Subject to the availability of 
        appropriations, the Secretary shall award grants to 
        States, Indian Tribes, and Tribal organizations for the 
        purpose of addressing substance use disorders of 
        significance, including opioid and stimulant use 
        disorders, within such States, such Indian Tribes, and 
        populations served by such Tribal organizations, in 
        accordance with paragraph (2).
          (2) Minimum allocations; preference.--In awarding 
        grants under paragraph (1), the Secretary shall--
                  (A) ensure that each State and the District 
                of Columbia receives not less than $4,000,000; 
                and
                  (B) give preference to States, Indian Tribes, 
                and Tribal organizations with an incidence or 
                prevalence of opioid use disorders that is 
                substantially higher relative to other States, 
                other Indian Tribes, or other Tribal 
                organizations, as applicable.
          (3) Formula methodology.--Not less than 15 days 
        before publishing a funding opportunity announcement 
        with respect to grants under this section, the 
        Secretary shall--
                  (A) develop a formula methodology to be 
                followed in allocating grant funds awarded 
                under this section among grantees; and
                  (B) submit the formula methodology to--
                          (i) the Committee on Energy and 
                        Commerce and the Committee on 
                        Appropriations of the House of 
                        Representatives; and
                          (ii) the Committee on Health, 
                        Education, Labor and Pensions and the 
                        Committee on Appropriations of the 
                        Senate.
          (4) Use of funds.--Grants awarded under this 
        subsection shall be used for carrying out activities 
        that supplement activities pertaining to substance use 
        disorders of significance, including opioid and 
        stimulant use disorders, undertaken by the State agency 
        responsible for administering the substance abuse 
        prevention and treatment block grant under subpart II 
        of part B of title XIX of the Public Health Service Act 
        (42 U.S.C. 300x-21 et seq.), which may include public 
        health-related activities such as the following:
                  (A) Implementing prevention activities, and 
                evaluating such activities to identify 
                effective strategies to prevent substance use 
                disorders.
                  (B) Establishing or improving prescription 
                drug monitoring programs.
                  (C) Training for health care practitioners, 
                such as best practices for prescribing opioids, 
                pain management, recognizing potential cases of 
                substance abuse, referral of patients to 
                treatment programs, preventing diversion of 
                controlled substances, and overdose prevention.
                  (D) Supporting access to health care 
                services, including--
                          (i) services provided by federally 
                        certified opioid treatment programs;
                          (ii) outpatient and residential 
                        substance use disorder treatment 
                        services that utilize medication-
                        assisted treatment, as appropriate; or
                          (iii) other appropriate health care 
                        providers to treat substance use 
                        disorders.
                  (E) Other public health-related activities, 
                as the State, Indian Tribe, or Tribal 
                organization determines appropriate, related to 
                addressing substance use disorders within the 
                State, Indian Tribe, or Tribal organization, 
                including directing resources in accordance 
                with local needs related to substance use 
                disorders.
  (c) Accountability and Oversight.--A State receiving a grant 
under subsection (b) shall include in reporting related to 
substance abuse submitted to the Secretary pursuant to section 
1942 of the Public Health Service Act (42 U.S.C. 300x-52), a 
description of--
          (1) the purposes for which the grant funds received 
        by the State under such subsection for the preceding 
        fiscal year were expended and a description of the 
        activities of the State under the grant; and
          (2) the ultimate recipients of amounts provided to 
        the State through the grant.
  (d) Limitations.--Any funds made available pursuant to 
subsection (i)--
          (1) notwithstanding any transfer authority in any 
        appropriations Act, shall not be used for any purpose 
        other than the grant program in subsection (b); and
          (2) shall be subject to the same requirements as 
        substance abuse prevention and treatment programs under 
        titles V and XIX of the Public Health Service Act (42 
        U.S.C. 290aa et seq., 300w et seq.).
  (e) Indian Tribes and Tribal Organizations.--The Secretary, 
in consultation with Indian Tribes and Tribal organizations, 
shall identify and establish appropriate mechanisms for Indian 
Tribes and Tribal organizations to demonstrate or report the 
information as required under subsections (b), (c), and (d).
  (f) Report to Congress.--Not later than September 30, 2022, 
and biennially thereafter, the Secretary shall submit to the 
Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the House of 
Representatives, and the Committees on Appropriations of the 
House of Representatives and the Senate, a report summarizing 
the information provided to the Secretary in reports made 
pursuant to subsections (c) and (e), including the purposes for 
which grant funds are awarded under this section and the 
activities of such grant recipients.
  (g) Technical Assistance.--The Secretary, including through 
the Tribal Training and Technical Assistance Center of the 
Substance Abuse and Mental Health Services Administration, 
shall provide States, Indian Tribes, and Tribal organizations, 
as applicable, with technical assistance concerning grant 
application and submission procedures under this section, award 
management activities, and enhancing outreach and direct 
support to rural and underserved communities and providers in 
addressing substance use disorders.
  (h) Definitions.--In this section:
          (1) Indian tribe.--The term ``Indian Tribe'' has the 
        meaning given the term ``Indian tribe'' in section 4 of 
        the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 5304).
          (2) Tribal organization.--The term ``Tribal 
        organization'' has the meaning given the term ``tribal 
        organization'' in such section 4.
          (3) State.--The term ``State'' has the meaning given 
        such term in section 1954(b) of the Public Health 
        Service Act (42 U.S.C. 300x-64(b)).
  (i) Authorization of Appropriations.--
          (1) In general.--For purposes of carrying out the 
        grant program under subsection (b), there is authorized 
        to be appropriated $1,500,000,000 for each of fiscal 
        years 2020 through 2026, to remain available until 
        expended.
          (2) Federal administrative expenses.--Of the amounts 
        made available for each fiscal year to award grants 
        under subsection (b), the Secretary shall not use more 
        than 2 percent for Federal administrative expenses, 
        training, technical assistance, and evaluation.
          (3) Set aside.--Of the amounts made available for 
        each fiscal year to award grants under subsection (b) 
        for a fiscal year, the Secretary shall--
                  (A) award 5 percent to Indian Tribes and 
                Tribal organizations; and
                  (B) of the remaining amount, set aside up to 
                15 percent for States with the highest age-
                adjusted rate of drug overdose death based on 
                the ordinal ranking of States according to the 
                Director of the Centers for Disease Control and 
                Prevention.

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