[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 Secre