CARA 3.0 Act of 2021

II 117TH CONGRESS 1ST SESSION S. 987 To provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder. IN THE SENATE OF THE UNITED STATES MARCH 25, 2021 Mr. PORTMAN (for himself, Mr. WHITEHOUSE, Ms. KLOBUCHAR, Mrs. SHA- HEEN, Ms. CANTWELL, and Mrs. CAPITO) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘CARA 3.0 Act of 2021’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. Sec. 2. Findings. TITLE I—EDUCATION, PREVENTION, AND RESEARCH VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 2 •S 987 IS Sec. 101. National Education Campaign. Sec. 102. Research into non-opioid pain management. Sec. 103. Long-term treatment and recovery support services outcomes re- search. Sec. 104. National Commission for Excellence on Post-Overdose Response. Sec. 105. Workforce for prevention, treatment, and recovery support services. Sec. 106. Reauthorization of community-based coalition enhancement grants to address local drug crises. Sec. 107. Access to non-opioid treatments for pain. TITLE II—TREATMENT Sec. 201. Evidence-based substance use disorder treatment and intervention demonstrations. Sec. 202. Improving treatment for pregnant, postpartum, and parenting women. Sec. 203. Require the use of prescription drug monitoring programs. Sec. 204. Prescriber education. Sec. 205. Prohibition of utilization control policies or procedures for medica- tion-assisted treatment under Medicaid. Sec. 206. Medication-assisted treatment for recovery from substance use dis- order. Sec. 207. Telehealth response for e-prescribing addiction therapy services. Sec. 208. Pilot program on expanding access to treatment. Sec. 209. Reauthorization of PRAC Ed grant program. Sec. 210. GAO study on parity. Sec. 211. Improving substance use disorder prevention workforce act. TITLE III—RECOVERY Subtitle A—General Provisions Sec. 301. Building communities of recovery. Sec. 302. Recovery in the workplace. Sec. 303. National youth and young adult recovery initiative. Subtitle B—Recovery Housing Sec. 311. Clarifying the role of SAMHSA in promoting the availability of high- quality recovery housing. Sec. 312. Developing guidelines for States to promote the availability of high- quality recovery housing. Sec. 313. Coordination of Federal activities to promote the availability of high- quality recovery housing. Sec. 314. NAS study. Sec. 315. Grants for States to promote the availability of high quality recovery housing. Sec. 316. Authorization of appropriations. Sec. 317. Reputable providers and analysts of recovery housing services defini- tion. Sec. 318. Technical correction. TITLE IV—CRIMINAL JUSTICE Sec. 401. Medication-Assisted Treatment Corrections and Community Reentry Program. Sec. 402. Deflection and pre-arrest diversion. VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 3 •S 987 IS Sec. 403. Housing. Sec. 404. Veterans treatment courts. Sec. 405. Infrastructure for reentry. SEC. 2. FINDINGS. 1 Congress finds as follows: 2 (1) In the 1980s and 1990s, pharmaceutical 3 companies began developing new drugs for pain 4 treatment, including extended release oxycodone. 5 These companies aggressively marketed these drugs 6 to the medical community as a way to address 7 ‘‘under-treatment’’ of physical pain. Drug companies 8 distributed 76,000,000,000 oxycodone and 9 hydrocodone pain pills nationwide from 2006 to 10 2012. 11 (2) The combination of a rising number of pre- 12 scriptions, misinformation about the addictive prop- 13 erties of prescription opioids, and the perception 14 that prescription drugs are less harmful than illicit 15 drugs has caused an increase in drug misuse. 16 (3) As legitimate production and illegal diver- 17 sion of opioids skyrocketed, so did the number of 18 opioid overdose deaths. From 1999 to 2017, almost 19 218,000 people died in the United States from 20 overdoses related to prescription opioids. More re- 21 cently, fentanyl, a powerful synthetic opioid, sur- 22 passed prescription opioids as the most lethal over- 23 VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 4 •S 987 IS dose substance and now is linked to nearly 3 times 1 as many deaths. 2 (4) The scale of the opioid crisis is staggering: 3 (A) In 2018, approximately 10,300,000 4 people in the United States age 12 and older 5 misused opioids. 6 (B) On average, 130 people in the United 7 States die every day from an opioid overdose. 8 (C) The opioid crisis has cost the United 9 States economy at least $631,000,000,000. 10 (D) From 2013 to 2017, the number of 11 children in foster care nationwide increased 10 12 percent to nearly 442,995. Parental drug use 13 was cited as a factor in 36 percent of cases. 14 (5) The opioid crisis has also led to a cascade 15 of other negative health impacts. For example, sy- 16 ringe sharing among people who inject drugs has led 17 to increases in hepatitis C virus infections and infec- 18 tive endocarditis, as well as localized HIV outbreaks. 19 (6) The United States health care system has 20 struggled to catch up to the crisis: 21 (A) The majority of people in the United 22 States with an opioid use disorder do not re- 23 ceive substance use treatment, and many who 24 do receive such treatment do not receive evi- 25 VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 5 •S 987 IS dence-based treatment. Although medication-as- 1 sisted treatment has been endorsed by the Na- 2 tional Institutes of Health and the World 3 Health Organization, only one-third of treat- 4 ment programs offer any of the 3 drugs ap- 5 proved by the Food and Drug Administration 6 for the treatment of opioid use disorder, and 7 just 6 percent of medication-offering facilities 8 provide all 3. 9 (B) Facilities that provide medications for 10 the treatment of opioid disorder are con- 11 centrated in the Northeast and Southwest, leav- 12 ing many of the areas hit hardest by the opioid 13 crisis without access to evidence-based treat- 14 ment. The need is particularly acute in rural 15 areas, which often do not have enough providers 16 to meet the demand. 17 (C) Unlike other health care needs, sub- 18 stance use treatment is largely funded by State 19 and local revenues and Federal block grants, 20 rather than the Medicare program, the Med- 21 icaid program, and private insurance. 22 (D) While new substances, particularly 23 synthetic drugs, continue to make inroads into 24 communities in the United States, funding 25 VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 6 •S 987 IS streams are often dedicated to particular sub- 1 stances, limiting providers’ ability to adapt to 2 changing needs. 3 (E) The stigma associated with substance 4 use disorder prevents people from seeking treat- 5 ment. Too often, people enter substance use 6 treatment only after committing a criminal of- 7 fense, whether through a court mandate, as a 8 condition of parole or probation supervision, or 9 as a condition of regaining employment after 10 conviction. In 2003, 36 percent of all substance 11 use treatment admissions, 40 percent of all al- 12 cohol abuse treatment admissions, and 57 per- 13 cent of all marijuana use treatment admissions 14 were referrals from the criminal justice system. 15 (F) The stigma of substance use disorder 16 also limits people’s ability to find jobs and 17 housing. These obstacles are exacerbated by the 18 criminalization of substance use disorder—even 19 convictions for drug possession for personal use 20 can create lifelong collateral consequences. The 21 absence of stable housing and employment 22 make it even more difficult for people to live 23 drug free. 24 VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 7 •S 987 IS (7) Not all people in the United States have 1 equal access to substance use treatment in the com- 2 munity. Current research has found that Black and 3 Latinx Americans are less likely to receive substance 4 use treatment when controlling for other relevant 5 factors, like socioeconomic status. 6 (8) Inadequate access to substance use treat- 7 ment can exacerbate other health disparities. Indi- 8 viduals with substance use disorders have higher 9 rates of suicide attempts than individuals in the gen- 10 eral population, high health care expenses, and sig- 11 nificant disability. 12 (9) A comprehensive public health approach 13 that tackles both the causes and the consequences of 14 substance use disorder is necessary to stem the tide. 15 TITLE I—EDUCATION, 16 PREVENTION, AND RESEARCH 17 SEC. 101. NATIONAL EDUCATION CAMPAIGN. 18 Section 102 of the Comprehensive Addiction and Re- 19 covery Act of 2016 (42 U.S.C. 290bb–25g) is amended— 20 (1) in subsection (a), by inserting ‘‘or other 21 controlled substances (as defined in section 102 of 22 the Controlled Substances Act (21 U.S.C. 802))’’ 23 after ‘‘opioids’’ each place such term appears; 24 VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 8 •S 987 IS (2) in subsection (b), by striking ‘‘opioid’’ each 1 place it appears and inserting ‘‘substance’’; 2 (3) in subsection (c)— 3 (A) in paragraph (2), by striking ‘‘and’’ at 4 the end; 5 (B) in paragraph (3), by striking the pe- 6 riod and inserting a semicolon; and 7 (C) by adding at the end the following: 8 ‘‘(4) use destigmatizing language promoting hu- 9 mane and culturally competent (as defined in section 10 102 of the Developmental Disabilities Assistance 11 and Bill of Rights Act of 2000 (42 U.S.C. 15002)) 12 treatment of all individuals who face substance use 13 disorder, including such individuals who use medica- 14 tion-assisted treatment for recovery purposes; 15 ‘‘(5) educate stakeholders on the evidence base 16 and validation of harm reduction and where to ob- 17 tain harm reduction services; 18 ‘‘(6) include information about polysubstance 19 use; and 20 ‘‘(7) include information about prevention and 21 treatment using medication-assisted treatment and 22 recovery support.’’; and 23 (4) by adding at the end the following: 24 VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 9 •S 987 IS ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2021 through 2026.’’. 4 SEC. 102. RESEARCH INTO NON-OPIOID PAIN MANAGE- 5 MENT. 6 (a) IN GENERAL.—The Secretary of Health and 7 Human Services, acting through the Director of the Na- 8 tional Institutes of Health and the Director of the Centers 9 for Disease Control and Prevention, shall carry out re- 10 search with respect to non-opioid methods of pain manage- 11 ment, including non-pharmaceutical remedies for pain and 12 integrative medicine solutions. 13 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 14 out this section, there are authorized to be appropriated 15 such sums as may be necessary for each of fiscal years 16 2021 through 2026. 17 SEC. 103. LONG-TERM TREATMENT AND RECOVERY SUP- 18 PORT SERVICES OUTCOMES RESEARCH. 19 (a) IN GENERAL.—The Secretary of Health and 20 Human Services shall award grants to eligible entities to 21 carry out evidence-based, long-term outcomes research, 22 over 5-year periods, for different modalities of treatment 23 and recovery support for substance use disorder, including 24 culturally competent (as defined in section 102 of the De- 25 VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 10 •S 987 IS velopmental Disabilities Assistance and Bill of Rights Act 1 of 2001 (42 U.S.C. 15002)) treatment. Such research 2 shall measure mortality, morbidity, physical and emotional 3 health, employment, stable housing, criminal justice in- 4 volvement, family relationships, and other quality-of-life 5 measures. Such research shall distinguish outcomes based 6 on race, gender, and socioeconomic status, as well as any 7 other relevant characteristics. 8 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 9 out this section, there are authorized to be appropriated 10 such sums as may be necessary. 11 SEC. 104. NATIONAL COMMISSION FOR EXCELLENCE ON 12 POST-OVERDOSE RESPONSE. 13 (a) IN GENERAL.—The Assistant Secretary of Health 14 and Human Services for Mental Health and Substance 15 Use (referred to in this section as the ‘‘Assistant Sec- 16 retary’’), in consultation with the Director of the Office 17 of National Drug Control Policy, and the President of the 18 National Academy of Medicine, shall establish an advisory 19 commission, to be known as the ‘‘National Commission for 20 Excellence on Post-Overdose Response’’, that— 21 (1) provides evidence, practical tools, and other 22 resources for researchers and evaluators, clinicians 23 and clinical teams, quality improvement experts, and 24 healthcare decision makers to improve the quality 25 VerDate Sep 11 2014 22:12 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S987.IS S987 kjohnson on DSK79L0C42PROD with BILLS 11 •S 987 IS and safety of care for drug overdoses and substance 1 use disorder; 2 (2) advises the individuals described in para- 3 graph (1) on— 4 (A) how to achieve equitable outcomes 5 across race and socioeconomic status; and 6 (B) how to effectively and appropriately 7 control avoidable hospital admissions, emer- 8 gency department admissions, and other ad- 9 verse events related to substance use disorder 10 care; and 11 (3) develops culturally competent (as defined in 12 section 102 of the Developmental Disabilities Assist- 13 ance and Bill of Rights Act of 2000 (42 U. 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