Comprehensive Addiction Resources Emergency Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1365 To provide emergency assistance to States, territories, Tribal nations, and local areas affected by the opioid epidemic and to make financial assist- ance available to States, territories, Tribal nations, local areas, and public or private nonprofit entities to provide for the development, organi- zation, coordination, and operation of more effective and cost efficient systems for the delivery of essential services to individuals with substance use disorder and their families. IN THE SENATE OF THE UNITED STATES MAY 8, 2019 Ms. WARREN (for herself, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BOOKER, Ms. HARRIS, Mr. MARKEY, Mr. SANDERS, Mr. UDALL, and Mr. VAN HOLLEN) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To provide emergency assistance to States, territories, Tribal nations, and local areas affected by the opioid epidemic and to make financial assistance available to States, ter- ritories, Tribal nations, local areas, and public or private nonprofit entities to provide for the development, organi- zation, coordination, and operation of more effective and cost efficient systems for the delivery of essential services to individuals with substance use disorder and their fami- lies. VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 2 •S 1365 IS 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 ‘‘Comprehensive Addiction Resources Emergency Act of 5 2019’’. 6 (b) TABLE OF CONTENTS.—The table of contents of 7 this Act is as follows: 8 Sec. 1. Short title; table of contents. Sec. 2. Purpose. Sec. 3. Amendment to the Public Health Service Act. ‘‘TITLE XXXIV—SUBSTANCE USE AND OPIOID HEALTH RESOURCES ‘‘Subtitle A—Local Substance Use and Opioid Emergency Relief Grant Program ‘‘Sec. 3401. Establishment of program of grants. ‘‘Sec. 3402. Planning council. ‘‘Sec. 3403. Amount of grant, use of amounts, and funding agreement. ‘‘Sec. 3404. Application. ‘‘Sec. 3405. Technical assistance. ‘‘Sec. 3406. Authorization of appropriations. ‘‘Subtitle B—State and Tribal Substance Use Disorder Prevention and Intervention Grant Program ‘‘Sec. 3411. Establishment of program of grants. ‘‘Sec. 3412. Amount of grant, use of amounts, and funding agreement. ‘‘Sec. 3413. Application. ‘‘Sec. 3414. Technical assistance. ‘‘Sec. 3415. Authorization of appropriations. ‘‘Subtitle C—Other Grant Program ‘‘Sec. 3421. Establishment of grant program. ‘‘Sec. 3422. Use of amounts. ‘‘Sec. 3423. Technical assistance. ‘‘Sec. 3424. Planning and development grants. ‘‘Sec. 3425. Authorization of appropriations. ‘‘Subtitle D—Innovation, Training, and Health Systems Strengthening ‘‘Sec. 3431. Special projects of national significance. ‘‘Sec. 3432. Education and training centers. ‘‘Sec. 3433. Substance use disorder treatment provider capacity under the Medicaid program. VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 3 •S 1365 IS ‘‘Sec. 3434. Programs to support employees. ‘‘Sec. 3435. Improving and expanding care. ‘‘Sec. 3436. Naloxone distribution program. ‘‘Sec. 3437. Additional funding for the National Institutes of Health. ‘‘Sec. 3438. Additional funding for the Centers for Disease Control and Prevention. ‘‘Sec. 3439. Definitions. Sec. 4. Amendments to the Controlled Substances Act. SEC. 2. PURPOSE. 1 It is the purpose of this Act to provide emergency 2 assistance to States, territories, Tribal nations, and local 3 areas that are disproportionately affected by the opioid 4 epidemic and to make financial assistance available to 5 States, territories, Tribal nations, local areas, and other 6 public or private nonprofit entities to provide for the devel- 7 opment, organization, coordination, and operation of more 8 effective and cost efficient systems for the delivery of es- 9 sential services to individuals with substance use disorder, 10 including with co-occurring mental health and substance 11 use disorders, and their families. 12 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 13 ACT. 14 The Public Health Service Act (42 U.S.C. 201 et 15 seq.) is amended by adding at the end the following: 16 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 4 •S 1365 IS ‘‘TITLE XXXIV—SUBSTANCE USE 1 AND OPIOID HEALTH RE- 2 SOURCES 3 ‘‘Subtitle A—Local Substance Use 4 and Opioid Emergency Relief 5 Grant Program 6 ‘‘SEC. 3401. ESTABLISHMENT OF PROGRAM OF GRANTS. 7 ‘‘(a) IN GENERAL.—The Secretary shall award 8 grants to eligible localities for the purpose of addressing 9 substance use within such localities. 10 ‘‘(b) ELIGIBILITY.— 11 ‘‘(1) IN GENERAL.—To be eligible to receive a 12 grant under subsection (a) a locality shall— 13 ‘‘(A) be— 14 ‘‘(i) a county that can demonstrate 15 that the rate of drug overdose deaths per 16 100,000 population in the county during 17 the most recent 3-year period for which 18 such data are available was not less than 19 the rate of such deaths for the county that 20 ranked at the 67th percentile of all coun- 21 ties, as determined by the Secretary; 22 ‘‘(ii) a county that can demonstrate 23 that the number of drug overdose deaths 24 during the most recent 3-year period for 25 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 5 •S 1365 IS which such data are available was not less 1 than the number of such deaths for the 2 county that ranked at the 90th percentile 3 of all counties, as determined by the Sec- 4 retary; or 5 ‘‘(iii) a city that is located within a 6 county described in clause (i) or (ii), that 7 meets the requirements of paragraph (3); 8 and 9 ‘‘(B) submit to the Secretary an applica- 10 tion in accordance with section 3404. 11 ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.—In 12 the case of an eligible county that is contiguous to 13 one or more other eligible counties within the same 14 State, the group of counties shall— 15 ‘‘(A) be considered as a single eligible 16 county for purposes of a grant under this sec- 17 tion; 18 ‘‘(B) submit a single application under sec- 19 tion 3404; 20 ‘‘(C) form a joint planning council (for the 21 purposes of section 3402); and 22 ‘‘(D) establish, through intergovernmental 23 agreements, an administrative mechanism to al- 24 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 6 •S 1365 IS locate funds and substance use disorder treat- 1 ment services under the grant based on— 2 ‘‘(i) the number and rate of drug 3 overdose deaths and nonfatal drug 4 overdoses in each of the counties that com- 5 pose the eligible county; 6 ‘‘(ii) the severity of need for services 7 in each such county; and 8 ‘‘(iii) the health and support per- 9 sonnel needs of each such county. 10 ‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE 11 CONTIGUOUS COUNTIES.— 12 ‘‘(A) IN GENERAL.—A city that is within 13 an eligible county described in paragraph (1), 14 or a county or group of counties that is within 15 a group of counties determined to be an eligible 16 county under paragraph (2), shall be eligible to 17 receive a grant under section 3401 if such city 18 or county or group of counties meets the re- 19 quirements of subparagraph (B). 20 ‘‘(B) REQUIREMENTS.—A city or county 21 meets the requirements of this subparagraph if 22 such city or county— 23 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 7 •S 1365 IS ‘‘(i) except as provided in subpara- 1 graph (C), has a population of not less 2 than 50,000 residents; 3 ‘‘(ii) meets the requirements of para- 4 graph (1)(A); 5 ‘‘(iii) submits an application under 6 section 3404; 7 ‘‘(iv) establishes a planning council 8 (for purposes of section 3402); and 9 ‘‘(v) establishes an administrative 10 mechanism to allocate funds and services 11 under the grant based on— 12 ‘‘(I) the number and rate of drug 13 overdose deaths and nonfatal drug 14 overdoses in the city or county; 15 ‘‘(II) the severity of need for sub- 16 stance use disorder treatment services 17 in the city or county; and 18 ‘‘(III) the health and support 19 personnel needs of the city or county. 20 ‘‘(C) POPULATION EXCEPTION.—A city or 21 county or group of counties that does not meet 22 the requirements of subparagraph (B)(i) may 23 apply to the Secretary for a waiver of such re- 24 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 8 •S 1365 IS quirement. Such application shall dem- 1 onstrate— 2 ‘‘(i) that the needs of the population 3 to be served are distinct or that addressing 4 substance use in the service area would be 5 best served by the formation of an inde- 6 pendent council; and 7 ‘‘(ii) that the city or county or group 8 of counties has the capacity to administer 9 the funding received under this subtitle. 10 ‘‘(D) MINIMUM FUNDING.—A city or coun- 11 ty that meets the requirement of this paragraph 12 and receives a grant under section 3401 shall 13 be entitled to an amount of funding under the 14 grant in an amount that is not less than the 15 amount determined under section 3403(a) with 16 respect to such city or county. 17 ‘‘(4) INDEPENDENT CITY.—Independent cities 18 that are not located within the territory of a county 19 shall be treated as eligible counties for purposes of 20 this subtitle. 21 ‘‘(5) POLITICAL SUBDIVISIONS.—With respect 22 to States that do not have a local county system of 23 governance, the Secretary shall determine the local 24 political subdivisions within such States that are eli- 25 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 9 •S 1365 IS gible to receive a grant under section 3401 and such 1 subdivisions shall be treated as eligible counties for 2 purposes of this subtitle. 3 ‘‘(6) DETERMINATIONS WHERE THERE IS A 4 LACK OF DATA.—The Secretary shall establish eligi- 5 bility and allocation criteria related to the prevalence 6 of drug overdose deaths, the mortality rate from 7 drug overdoses, and that provides an equivalent 8 measure of need for funding for cities and counties 9 for which the data described in paragraph (1)(A) or 10 (2)(D)(i) is not available. 11 ‘‘(7) DATA FROM TRIBAL AREAS.—The Sec- 12 retary, acting through the Indian Health Service, 13 shall consult with Indian tribes to establish eligibility 14 and allocation criteria that provide an equivalent 15 measure of need for Tribal areas for which the data 16 described in paragraph (1)(A) or (2)(D)(i) are not 17 available or do not apply. 18 ‘‘(8) STUDY.—Not later than 3 years after the 19 date of enactment of this title, the Comptroller Gen- 20 eral shall conduct a study to determine whether the 21 data utilized for purposes of paragraph (1)(A) pro- 22 vide the most precise measure of local area need re- 23 lated to substance use and addiction prevalence and 24 whether additional data would provide more precise 25 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 10 •S 1365 IS measures of substance use and addiction prevalence 1 in local areas. Such study shall identify barriers to 2 collecting or analyzing such data, and make rec- 3 ommendations for revising the indicators used under 4 such paragraph to determine eligibility in order to 5 direct funds to the local areas in most need of fund- 6 ing to provide assistance related to substance use 7 and addiction. 8 ‘‘(9) REFERENCE.—For purposes of this sub- 9 title, the term ‘eligible local area’ includes— 10 ‘‘(A) a city or county described in para- 11 graph (1); 12 ‘‘(B) multiple contiguous counties de- 13 scribed in paragraph (2); 14 ‘‘(C) cities or counties within multiple con- 15 tiguous counties described in paragraph (3); 16 ‘‘(D) an independent city described in 17 paragraph (4); and 18 ‘‘(E) a political subdivision described in 19 paragraph (5). 20 ‘‘(c) ADMINISTRATION.— 21 ‘‘(1) IN GENERAL.—Assistance made available 22 under a grant awarded under this section shall be 23 directed to the chief elected official of the eligible 24 local area who shall administer the grant funds. 25 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 11 •S 1365 IS ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.— 1 ‘‘(A) IN GENERAL.—Except as provided in 2 subparagraph (B), in the case of an eligible 3 county described in subsection (b)(2), assist- 4 ance made available under a grant awarded 5 under this section shall be directed to the chief 6 elected official of the particular county des- 7 ignated in the application submitted for the 8 grant under section 3404. Such chief elected of- 9 ficial shall be the administrator of the grant. 10 ‘‘(B) STATE ADMINISTRATION.—Notwith- 11 standing subparagraph (A), the eligible county 12 described in subsection (b)(2) may elect to des- 13 ignate the chief elected State official of the 14 State in which the eligible county is located as 15 the administrator of the grant funds. 16 ‘‘SEC. 3402. PLANNING COUNCIL. 17 ‘‘(a) ESTABLISHMENT.—To be eligible to receive a 18 grant under section 3401, the chief elected official of the 19 eligible local area shall establish or designate a substance 20 use disorder treatment and services planning council that 21 shall, to the maximum extent practicable— 22 ‘‘(1) be representative of the demographics of 23 the population of individuals with substance use dis- 24 order in the area; 25 VerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365 pbinns on DSK79D2C42PROD with BILLS 12 •S 1365 IS ‘‘(2) include representatives of— 1 ‘‘(A) health care providers, including feder- 2 ally qualified health centers, rural health clinics, 3 Indian health programs as defined in section 4 4 of the Indian Health Care Improvement Act, 5 urban Indian organizations as defined in section 6 4 of the Indian Health Care Improvement Act, 7 Native Hawaiian organizations as defined in 8 sect [Text truncated for display. Full text available on Congress.gov.]