[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4286 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 4286
To provide emergency assistance to States, territories, Tribal nations,
and local areas affected by substance use disorder, including the use
of opioids and stimulants, and to make financial assistance available
to States, territories, Tribal nations, local areas, public or private
nonprofit entities, and certain health providers, to provide for the
development, organization, 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, 2024
Ms. Warren (for herself, Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mr.
Markey, Mr. Van Hollen, Mr. Casey, Ms. Klobuchar, Mr. Schatz, Mr.
Padilla, Ms. Smith, Mr. Merkley, Mr. Heinrich, Mr. Brown, Mr. Welch,
Mr. Fetterman, and Ms. Butler) 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 substance use disorder, including the use
of opioids and stimulants, and to make financial assistance available
to States, territories, Tribal nations, local areas, public or private
nonprofit entities, and certain health providers, to provide for the
development, organization, 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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Comprehensive
Addiction Resources Emergency Act of 2024''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Purpose.
Sec. 3. Amendment to the Public Health Service Act.
``TITLE XXXIV--SUBSTANCE USE RESOURCES
``Subtitle A--Local Substance Use 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.
``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. 5. General limitation on use of funds.
Sec. 6. Federal drug demand reduction activities.
SEC. 2. PURPOSE.
It is the purpose of this Act to provide emergency assistance to
States, territories, Tribal nations, and local areas that are
disproportionately affected by substance use disorder, including the
use of opioids and stimulants, and to make financial assistance
available to States, territories, Tribal nations, local areas, public
or private nonprofit entities, and certain health providers, to provide
for the development, organization, coordination, and operation of more
effective and cost efficient systems for the delivery of essential
services to individuals with substance use disorder, including with co-
occurring mental health and substance use disorders, and their
families.
SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:
``TITLE XXXIV--SUBSTANCE USE RESOURCES
``Subtitle A--Local Substance Use Emergency Relief Grant Program
``SEC. 3401. ESTABLISHMENT OF PROGRAM OF GRANTS.
``(a) In General.--The Secretary shall award grants to eligible
localities for the purpose of addressing substance use within such
localities.
``(b) Eligibility.--
``(1) In general.--To be eligible to receive a grant under
subsection (a) a locality shall--
``(A) be--
``(i) a county that can demonstrate that
the rate of drug overdose deaths per 100,000
population in the county during the most recent
3-year period for which such data are available
was not less than the rate of such deaths for
the county that ranked at the 67th percentile
of all counties, as determined by the
Secretary;
``(ii) a county that can demonstrate that
the number of drug overdose deaths during the
most recent 3-year period for which such data
are available was not less than the number of
such deaths for the county that ranked at the
90th percentile of all counties, as determined
by the Secretary;
``(iii) a county that encompasses an
undeserved area, defined as a health
professional shortage area (as defined in
section 332(a)(1)(A)) and a medically
underserved area (according to a designation
under section 330(b)(3)(A)), that can
demonstrate a high burden of both fatal and
non-fatal drug overdoses in a manner determined
by the Secretary; or
``(iv) a city that is located within a
county described in clause (i), (ii), or (iii)
that meets the requirements of paragraph (3);
and
``(B) submit to the Secretary an application in
accordance with section 3404.
``(2) Multiple contiguous counties.--In the case of an
eligible county that is contiguous to one or more other
eligible counties within the same State, the group of counties
shall--
``(A) be considered as a single eligible county for
purposes of a grant under this section;
``(B) submit a single application under section
3404;
``(C) form a joint planning council (for the
purposes of section 3402); and
``(D) establish, through intergovernmental
agreements, an administrative mechanism to allocate
funds and substance use disorder treatment services
under the grant based on--
``(i) the number and rate of drug overdose
deaths and nonfatal drug overdoses in each of
the counties that compose the eligible county;
``(ii) the severity of need for services in
each such county; and
``(iii) the health and support personnel
needs of each such county.
``(3) Cities and counties within multiple contiguous
counties.--
``(A) In general.--A city that is within an
eligible county described in paragraph (1), or a county
or group of counties that is within a group of counties
determined to be an eligible county under paragraph
(2), shall be eligible to receive a grant under this
section if such city or county or group of counties
meets the requirements of subparagraph (B).
``(B) Requirements.--A city or county meets the
requirements of this subparagraph if such city or
county--
``(i) except as provided in subparagraph
(C), has a population of not less than 50,000
residents;
``(ii) meets the requirements of paragraph
(1)(A);
``(iii) submits an application under
section 3404;
``(iv) establishes a planning council (for
purposes of section 3402); and
``(v) establishes an administrative
mechanism to allocate funds and services under
the grant based on--
``(I) the number and rate of drug
overdose deaths and nonfatal drug
overdoses in the city or county;
``(II) the severity of need for
substance use disorder treatment
services in the city or county; and
``(III) the health and support
personnel needs of the city or county.
``(C) Population exception.--A city or county or
group of counties that does not meet the requirements
of subparagraph (B)(i) may apply to the Secretary for a
waiver of such requirement. Such application shall
demonstrate--
``(i) that the needs of the population to
be served are distinct or that addressing
substance use in the service area would be best
served by the formation of an independent
council; and
``(ii) that the city or county or group of
counties has the capacity to administer the
funding received under this subtitle.
``(D) Minimum funding.--A city or county that meets
the requirement of this paragraph and receives a grant
under this section shall be entitled to an amount of
funding under the grant in an amount that is not less
than the amount determined under section 3403(a) with
respect to such city or county.
``(4) Independent city.--Independent cities that are not
located within the territory of a county shall be treated as
eligible counties for purposes of this subtitle.
``(5) Political subdivisions.--With respect to States that
do not have a local county system of governance, the Secretary
shall determine the local political subdivisions within such
States that are eligible to receive a grant under this section
and such subdivisions shall be treated as eligible counties for
purposes of this subtitle.
``(6) Determinations where there is a lack of data.--The
Secretary shall establish eligibility and allocation criteria
related to the prevalence of drug overdose deaths, the
mortality rate from drug overdoses, and that provides an
equivalent measure of need for funding for cities and counties
for which the data described in paragraph (1)(A) or (2)(D)(i)
is not available.
``(7) Data from tribal areas.--The Secretary, acting
through the Indian Health Service, shall consult with Indian
Tribes and confer with urban Indian organizations to establish
eligibility and allocation criteria that provide an equivalent
measure of need for Tribal and urban Indian areas for which the
data described in paragraph (1)(A) or (2)(D)(i) are not
available or do not apply.
``(8) Study.--Not later than 3 years after the date of
enactment of this title, the Comptroller General shall conduct
a study to determine whether the data utilized for purposes of
paragraph (1)(A) provide the most precise measure of local area
need related to substance use and addiction prevalence and
whether additional data would provide more precise measures of
substance use and addiction prevalence in local areas. Such
study shall identify barriers to collecting or analyzing such
data, and make recommendations for revising the indicators used
under such paragraph to determine eligibility in order to
direct funds to the local areas in most need of funding to
provide assistance related to substance use and addiction.
``(9) Reference.--For purposes of this subtitle, the term
`eligible local area' includes--
``(A) a city or county described in paragraph (1);
``(B) multiple contiguous counties described in
paragraph (2);
``(C) cities or counties within multiple contiguous
counties described in paragraph (3);
``(D) an independent city described in paragraph
(4); and
``(E) a political subdivision described in
paragraph (5).
``(c) Administration.--
``(1) In general.--Assistance made available under a grant
awarded under this section shall be directed to the chief
elected official of the eligible local area who shall
administer the grant funds.
``(2) Multiple contiguous counties.--
``(A) In general.--Except as provided in
subparagraph (B), in the case of an eligible county
described in subsection (b)(2), assistance made
available under a grant awarded under this section
shall be directed to the chief elected official of the
particular county designated in the application
submitted for the grant under section 3404. Such chief
elected official shall be the administrator of the
grant.
``(B) State administration.--Notwithstanding
subparagraph (A), the eligible county described in
subsection (b)(2) may elect to designate the chief
elected State official of the State in which the
eligible county is located as the administrator of the
grant funds.
``SEC. 3402. PLANNING COUNCIL.
``(a) Establishment.--To be eligible to receive a grant under
section 3401, the chief elected official of the eligible local area
shall establish or designate a substance use disorder treatment and
services planning council that shall--
``(1) be representative of the demographics of the
population of individuals with substance use disorder in the
area;
``(2) include individuals with substance use disorder,
individuals who use drugs, and individuals in recovery from
substance use disorders; and
``(3) include, to the maximum extent practicable,
representatives of--
``(A) health care providers, including Federally-
qualified health centers, rural health clinics, Indian
health programs as defined in section 4 of the Indian
Health Care Improvement Act, urban Indian organizations
as defined in section 4 of the Indian Health Care
Improvement Act, and facilities operated by the
Department of Veterans Affairs;
``(B) Native Hawaiian organizations as defined in
section 11 of the Native Hawaiian Health Care Act of
1988;
``(C) community-based health, harm reduction, and
addiction service organizations, including, where
applicable, representatives of Drug Free Communities
Coalition grantees;
``(D) social service providers, including providers
of housing and homelessness services and recovery
residence providers;
``(E) mental health care providers;
``(F) local public health agencies;
``(G) State governments, including the State
Medicaid agency and the Single State Agency for
Substance Abuse Services;
``(H) local governments;
``(I) non-elected community leaders;
``(J) substance use disorder treatment providers,
including physician addiction specialists;
``(K) Indian tribes and tribal organizations as
defined in section 4 of the Indian Self-Determination
and Education Assistance Act;
``(L) Urban Indians as defined in section 4 of the
Indian Health Care Improvement Act;
``(M) historically underserved groups and
subpopulations;
``(N) individuals who were formerly incarcerated;
``(O) organizations serving individuals who are
currently incarcerated or in pre-trial detention or
were formerly incarcerated;
``(P) Federal agencies;
``(Q) organizations that provide drug prevention
programs and services to youth at risk of substance
use;
``(R) medical examiners or coroners;
``(S) labor unions and the workplace community;
``(T) local fire departments and emergency medical
services;
``(U) the lesbian, gay, bisexual, transgender,
queer (LGBTQ) community; and
``(V) certified or accredi