Title VII — Public Health Provisions

115th Congress · Approved Oct 24, 2018 · 132 Stat. 3894

TITLE VII Public Health Provisions

Subtitle A Awareness and Training

SEC. 7001. Report on Effects on Public Health of Synthetic Drug Use.

(a)

In General.— Not later than 3 years after the date of the enactment of this Act, the Secretary of Health and Human Services, in coordination with the Surgeon General of the Public Health Service, shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the health effects of new psychoactive substances, including synthetic drugs, used by adolescents and young adults.

(b)

New Psychoactive Substance Defined.— For purposes of subsection (a), the term “new psychoactive substance” means a controlled substance analogue (as defined in section 102(32) of the Controlled Substances Act (21 U.S.C. 802(32)).

SEC. 7002. First Responder Training.

Section 546 of the Public Health Service Act (42 U.S.C. 290ee–1) is amended—

(1)

in subsection (c)—

(A)

in paragraph (2), by striking “ and” at the end;

(B)

in paragraph (3), by striking the period and inserting “ ; and”; and

(C)

by adding at the end the following:

“(4) train and provide resources for first responders and members of other key community sectors on safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs to protect themselves from exposure to such drugs and respond appropriately when exposure occurs.”

(2)

in subsection (d), by striking “ and mechanisms for referral to appropriate treatment for an entity receiving a grant under this section” and inserting “ mechanisms for referral to appropriate treatment, and safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs”;

(3)

in subsection (f)—

(A)

in paragraph (3), by striking “ and” at the end;

(B)

in paragraph (4), by striking the period and inserting “ ; and”; and

(C)

by adding at the end the following:

“(5) the number of first responders and members of other key community sectors trained on safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs.”

(4)

by redesignating subsection (g) as subsection (h);

(5)

by inserting after subsection (f) the following:

“(g) Other Key Community Sectors.—In this section, the term ‘other key community sectors’ includes substance use disorder treatment providers, emergency medical services agencies, agencies and organizations working with prison and jail populations and offender reentry programs, health care providers, harm reduction groups, pharmacies, community health centers, tribal health facilities, and mental health providers.”

; and

(6)

in subsection (h), as so redesignated, by striking “ $12,000,000 for each of fiscal years 2017 through 2021” and inserting “ $36,000,000 for each of fiscal years 2019 through 2023”.

Subtitle B Pilot Program for Public Health Laboratories To Detect Fentanyl and Other Synthetic Opioids

SEC. 7011. Pilot Program for Public Health Laboratories to Detect Fentanyl and Other Synthetic Opioids.

(a)

Grants.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall award grants to, or enter into cooperative agreements with, Federal, State, and local agencies to improve coordination between public health laboratories and laboratories operated by law enforcement agencies, such as Customs and Border Protection and the Drug Enforcement Administration, to improve detection of synthetic opioids, including fentanyl and its analogues, as described in subsection (b).

(b)

Detection Activities.— The Secretary, in consultation with the Director of the National Institute of Standards and Technology, the Director of the Centers for Disease Control and Prevention, the Attorney General of the United States, and the Administrator of the Drug Enforcement Administration, shall, for purposes of this section, develop or identify—

(1)

best practices for safely handling and testing synthetic opioids, including fentanyl and its analogues, including with respect to reference materials, instrument calibration, and quality control protocols;

(2)

reference materials and quality control standards related to synthetic opioids, including fentanyl and its analogues, to enhance—

(A)

clinical diagnostics;

(B)

postmortem data collection; and

(C)

portable testing equipment utilized by law enforcement and public health officials; and

(3)

procedures for the identification of new and emerging synthetic opioid formulations and procedures for reporting those findings to appropriate law enforcement agencies and Federal, State, and local public health laboratories and health departments, as appropriate.

(c)

Laboratories.— The Secretary shall require recipients of grants or cooperative agreements under subsection (a) to—

(1)

follow the best practices established under subsection (b) and have the appropriate capabilities to provide laboratory testing of controlled substances, such as synthetic fentanyl, and biospecimens for the purposes of aggregating and reporting public health information to Federal, State, and local public health officials, laboratories, and other entities the Secretary deems appropriate;

(2)

work with law enforcement agencies and public health authorities, as practicable;

(3)

provide early warning information to Federal, State, and local law enforcement agencies and public health authorities regarding trends or other data related to the supply of synthetic opioids, including fentanyl and its analogues;

(4)

provide biosurveillance capabilities with respect to identifying trends in adverse health outcomes associated with non-fatal exposures; and

(5)

provide diagnostic testing, as appropriate and practicable, for non-fatal exposures of emergency personnel, first responders, and other individuals.

(d)

Authorization of Appropriations.— To carry out this section, there is authorized to be appropriated $15,000,000 for each of fiscal years 2019 through 2023.

Subtitle C Indexing Narcotics, Fentanyl, and Opioids

SEC. 7021. Establishment of Substance Use Disorder Information Dashboard.

Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) is amended by adding at the end the following new section:

“SEC. 1711. ESTABLISHMENT OF SUBSTANCE USE DISORDER INFORMATION DASHBOARD.

“(a) In General.—Not later than 6 months after the date of the enactment of this section, the Secretary of Health and Human Services shall, in consultation with the Director of National Drug Control Policy, establish and periodically update, on the Internet website of the Department of Health and Human Services, a public information dashboard that—

“(1) provides links to information on programs within the Department of Health and Human Services related to the reduction of opioid and other substance use disorders;

“(2) provides access, to the extent practicable and appropriate, to publicly available data, which may include data from agencies within the Department of Health and Human Services and—

“(A) other Federal agencies;

“(B) State, local, and Tribal governments;

“(C) nonprofit organizations;

“(D) law enforcement;

“(E) medical experts;

“(F) public health educators; and

“(G) research institutions regarding prevention, treatment, recovery, and other services for opioid and other substance use disorders;

“(3) provides data on substance use disorder prevention and treatment strategies in different regions of and populations in the United States;

“(4) identifies information on alternatives to controlled substances for pain management, such as approaches studied by the National Institutes of Health Pain Consortium, the National Center for Complimentary and Integrative Health, and other institutes and centers at the National Institutes of Health, as appropriate; and

“(5) identifies guidelines and best practices for health care providers regarding treatment of substance use disorders.

“(b) Controlled Substance Defined.—In this section, the term ‘controlled substance’ has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).”

SEC. 7022. Interdepartmental Substance Use Disorders Coordinating Committee.

(a)

Establishment.— Not later than 3 months after the date of the enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall, in coordination with the Director of National Drug Control Policy, establish a committee, to be known as the Interdepartmental Substance Use Disorders Coordinating Committee (in this section referred to as the “Committee”), to coordinate Federal activities related to substance use disorders.

(b)

Membership.—

(1)

Federal members.— The Committee shall be composed of the following Federal representatives, or the designees of such representatives:

(A)

The Secretary, who shall serve as the Chair of the Committee.

(B)

The Attorney General of the United States.

(C)

The Secretary of Labor.

(D)

The Secretary of Housing and Urban Development.

(E)

The Secretary of Education.

(F)

The Secretary of Veterans Affairs.

(G)

The Commissioner of Social Security.

(H)

The Assistant Secretary for Mental Health and Substance Use.

(I)

The Director of National Drug Control Policy.

(J)

Representatives of other Federal agencies that support or conduct activities or programs related to substance use disorders, as determined appropriate by the Secretary.

(2)

Non-federal members.— The Committee shall include a minimum of 15 non-Federal members appointed by the Secretary, of which—

(A)

at least two such members shall be an individual who has received treatment for a diagnosis of a substance use disorder;

(B)

at least two such members shall be a director of a State substance abuse agency;

(C)

at least two such members shall be a representative of a leading research, advocacy, or service organization for adults with substance use disorder;

(D)

at least two such members shall—

(i)

be a physician, licensed mental health professional, advance practice registered nurse, or physician assistant; and

(ii)

have experience in treating individuals with substance use disorders;

(E)

at least one such member shall be a substance use disorder treatment professional who provides treatment services at a certified opioid treatment program;

(F)

at least one such member shall be a substance use disorder treatment professional who has research or clinical experience in working with racial and ethnic minority populations;

(G)

at least one such member shall be a substance use disorder treatment professional who has research or clinical mental health experience in working with medically underserved populations;

(H)

at least one such member shall be a State-certified substance use disorder peer support specialist;

(I)

at least one such member shall be a drug court judge or a judge with experience in adjudicating cases related to substance use disorder;

(J)

at least one such member shall be a public safety officer with extensive experience in interacting with adults with a substance use disorder; and

(K)

at least one such member shall be an individual with experience providing services for homeless individuals with a substance use disorder.

(c)

Terms.—

(1)

In general.— A member of the Committee appointed under subsection (b)(2) shall be appointed for a term of 3 years and may be reappointed for one or more 3-year terms.

(2)

Vacancies.— A vacancy on the Committee shall be filled in the same manner in which the original appointment was made. Any individual appointed to fill a vacancy for an unexpired term shall be appointed for the remainder of such term and may serve after the expiration of such term until a successor has been appointed.

(d)

Meetings.— The Committee shall meet not fewer than two times each year.

(e)

Duties.— The Committee shall—

(1)

identify areas for improved coordination of activities, if any, related to substance use disorders, including research, services, supports, and prevention activities across all relevant Federal agencies;

(2)

identify and provide to the Secretary recommendations for improving Federal programs for the prevention and treatment of, and recovery from, substance use disorders, including by expanding access to prevention, treatment, and recovery services;

(3)

analyze substance use disorder prevention and treatment strategies in different regions of and populations in the United States and evaluate the extent to which Federal substance use disorder prevention and treatment strategies are aligned with State and local substance use disorder prevention and treatment strategies;

(4)

make recommendations to the Secretary regarding any appropriate changes with respect to the activities and strategies described in paragraphs (1) through (3);

(5)

make recommendations to the Secretary regarding public participation in decisions relating to substance use disorders and the process by which public feedback can be better integrated into such decisions; and

(6)

make recommendations to ensure that substance use disorder research, services, supports, and prevention activities of the Department of Health and Human Services and other Federal agencies are not unnecessarily duplicative.

(f)

Annual Report.— Not later than 1 year after the date of the enactment of this Act, and annually thereafter for the life of the Committee, the Committee shall publish on the Internet website of the Department of Health and Human Services, which may include the public information dashboard established under section 1711 of the Public Health Service Act, as added by section 7021, a report summarizing the activities carried out by the Committee pursuant to subsection (e), including any findings resulting from such activities.

(g)

Working Groups.— The Committee may establish working groups for purposes of carrying out the duties described in subsection (e). Any such working group shall be composed of members of the Committee (or the designees of such members) and may hold such meetings as are necessary to enable the working group to carry out the duties delegated to the working group.

(h)

Federal Advisory Committee Act.— The Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the Committee only to the extent that the provisions of such Act do not conflict with the requirements of this section.

(i)

Sunset.— The Committee shall terminate on the date that is 6 years after the date on which the Committee is established under subsection (a).

SEC. 7023. National Milestones to Measure Success in Curtailing the Opioid Crisis.

(a)

In General.— Not later than 180 days after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the “Secretary”), in coordination with the Administrator of the Drug Enforcement Administration and the Director of the Office of National Drug Control Policy, shall develop or identify existing national indicators (referred to in this section as the “national milestones”) to measure success in curtailing the opioid crisis, with the goal of significantly reversing the incidence and prevalence of opioid misuse and abuse, and opioid-related morbidity and mortality in the United States within 5 years of such date of enactment.

(b)

National Milestones to End the Opioid Crisis.— The national milestones under subsection (a) shall include the following:

(1)

Not fewer than 10 indicators or metrics to accurately and expediently measure progress in meeting the goal described in subsection (a), which shall, as appropriate, include, indicators or metrics related to—

(A)

the number of fatal and non-fatal opioid overdoses;

(B)

the number of emergency room visits related to opioid misuse and abuse;

(C)

the number of individuals in sustained recovery from opioid use disorder;

(D)

the number of infections associated with illicit drug use, such as HIV, viral hepatitis, and infective endocarditis, and available capacity for treating such infections;

(E)

the number of providers prescribing medication-assisted treatment for opioid use disorders, including in primary care settings, community health centers, jails, and prisons;

(F)

the number of individuals receiving treatment for opioid use disorder; and

(G)

additional indicators or metrics, as appropriate, such as metrics pertaining to specific populations, including women and children, American Indians and Alaskan Natives, individuals living in rural and non-urban areas, and justice-involved populations, that would further clarify the progress made in addressing the opioid crisis.

(2)

A reasonable goal, such as a percentage decrease or other specified metric, that signifies progress in meeting the goal described in subsection (a), and annual targets to help achieve that goal.

(c)

Consideration of Other Substance Use Disorders.— In developing the national milestones under subsection (b), the Secretary shall, as appropriate, consider other substance use disorders in addition to opioid use disorder.

(d)

Extension of Period.— If the Secretary determines that the goal described in subsection (a) will not be achieved with respect to any indicator or metric established under subsection (b)(2) within 5 years of the date of enactment of this Act, the Secretary may extend the timeline for meeting such goal with respect to that indicator or metric. The Secretary shall include with any such extension a rationale for why additional time is needed and information on whether significant changes are needed in order to achieve such goal with respect to the indicator or metric.

(e)

Annual Status Update.— Not later than one year after the date of enactment of this Act, the Secretary shall make available on the Internet website of the Department of Health and Human Services, and 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, an update on the progress, including expected progress in the subsequent year, in achieving the goals detailed in the national milestones. Each such update shall include the progress made in the first year or since the previous report, as applicable, in meeting each indicator or metric in the national milestones.

SEC. 7024. Study on Prescribing Limits.

Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services, in consultation with the Attorney General of the United States, 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 on the impact of Federal and State laws and regulations that limit the length, quantity, or dosage of opioid prescriptions. Such report shall address—

(1)

the impact of such limits on—

(A)

the incidence and prevalence of overdose related to prescription opioids;

(B)

the incidence and prevalence of overdose related to illicit opioids;

(C)

the prevalence of opioid use disorders;

(D)

medically appropriate use of, and access to, opioids, including any impact on travel expenses and pain management outcomes for patients, whether such limits are associated with significantly higher rates of negative health outcomes, including suicide, and whether the impact of such limits differs based on the clinical indication for which opioids are prescribed;

(2)

whether such limits lead to a significant increase in burden for prescribers of opioids or prescribers of treatments for opioid use disorder, including any impact on patient access to treatment, and whether any such burden is mitigated by any factors such as electronic prescribing or telemedicine; and

(3)

the impact of such limits on diversion or misuse of any controlled substance in schedule II, III, or IV of section 202(c) of the Controlled Substances Act (21 U.S.C. 812(c)).

Subtitle D Ensuring Access to Quality Sober Living

SEC. 7031. National Recovery Housing Best Practices.

Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is amended by adding at the end the following new section:

“SEC. 550. NATIONAL RECOVERY HOUSING BEST PRACTICES.

“(a) Best Practices for Operating Recovery Housing.—

“(1) In general.—The Secretary, in consultation with the individuals and entities specified in paragraph (2), shall identify or facilitate the development of best practices, which may include model laws for implementing suggested minimum standards, for operating recovery housing.

“(2) Consultation.—In carrying out the activities described in paragraph (1), the Secretary shall consult with, as appropriate—

“(A) relevant divisions of the Department of Health and Human Services, including the Substance Abuse and Mental Health Services Administration, the Office of Inspector General, the Indian Health Service, and the Centers for Medicare & Medicaid Services;

“(B) the Secretary of Housing and Urban Development;

“(C) directors or commissioners, as applicable, of State health departments, tribal health departments, State Medicaid programs, and State insurance agencies;

“(D) representatives of health insurance issuers;

“(E) national accrediting entities and reputable providers of, and analysts of, recovery housing services, including Indian tribes, tribal organizations, and tribally designated housing entities that provide recovery housing services, as applicable;

“(F) individuals with a history of substance use disorder; and

“(G) other stakeholders identified by the Secretary.

“(b) Identification of Fraudulent Recovery Housing Operators.—

“(1) In general.—The Secretary, in consultation with the individuals and entities described in paragraph (2), shall identify or facilitate the development of common indicators that could be used to identify potentially fraudulent recovery housing operators.

“(2) Consultation.—In carrying out the activities described in paragraph (1), the Secretary shall consult with, as appropriate, the individuals and entities specified in subsection (a)(2) and the Attorney General of the United States.

“(3) Requirements.—

“(A) Practices for identification and reporting.—In carrying out the activities described in paragraph (1), the Secretary shall consider how law enforcement, public and private payers, and the public can best identify and report fraudulent recovery housing operators.

“(B) Factors to be considered.—In carrying out the activities described in paragraph (1), the Secretary shall identify or develop indicators, which may include indicators related to—

“(i) unusual billing practices;

“(ii) average lengths of stays;

“(iii) excessive levels of drug testing (in terms of cost or frequency); and

“(iv) unusually high levels of recidivism.

“(c) Dissemination.—The Secretary shall, as appropriate, disseminate the best practices identified or developed under subsection (a) and the common indicators identified or developed under subsection (b) to—

“(1) State agencies, which may include the provision of technical assistance to State agencies seeking to adopt or implement such best practices;

“(2) Indian tribes, tribal organizations, and tribally designated housing entities;

“(3) the Attorney General of the United States;

“(4) the Secretary of Labor;

“(5) the Secretary of Housing and Urban Development;

“(6) State and local law enforcement agencies;

“(7) health insurance issuers;

“(8) recovery housing entities; and

“(9) the public.

“(d) Requirements.—In carrying out the activities described in subsections (a) and (b), the Secretary, in consultation with appropriate individuals and entities described in subsections (a)(2) and (b)(2), shall consider how recovery housing is able to support recovery and prevent relapse, recidivism, or overdose (including overdose death), including by improving access and adherence to treatment, including medication-assisted treatment.

“(e) Rule of Construction.—Nothing in this section shall be construed to provide the Secretary with the authority to require States to adhere to minimum standards in the State oversight of recovery housing.

“(f) Definitions.—In this section:

“(1) The term ‘recovery housing’ means a shared living environment free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders.

“(2) The terms ‘Indian tribe’ and ‘tribal organization’ have the meanings given those terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

“(3) The term ‘tribally designated housing entity’ has the meaning given that term in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103).

“(g) Authorization of Appropriations.—To carry out this section, there is authorized to be appropriated $3,000,000 for the period of fiscal years 2019 through 2021.”

Subtitle E Advancing Cutting Edge Research

SEC. 7041. Unique Research Initiatives.

Section 402(n)(1) of the Public Health Service Act (42 U.S.C. 282(n)(1)) is amended—

(1)

in subparagraph (A), by striking “ or”;

(2)

in subparagraph (B), by striking the period and inserting “ ; or”; and

(3)

by adding at the end the following:

“(C) high impact cutting-edge research that fosters scientific creativity and increases fundamental biological understanding leading to the prevention, diagnosis, or treatment of diseases and disorders, or research urgently required to respond to a public health threat.”

SEC. 7042. Pain Research.

Section 409J(b) of the Public Health Service Act (42 U.S.C. 284q(b)) is amended—

(1)

in paragraph (5)—

(A)

in subparagraph (A), by striking “ and treatment of pain and diseases and disorders associated with pain” and inserting “ treatment, and management of pain and diseases and disorders associated with pain, including information on best practices for the utilization of non-pharmacologic treatments, non-addictive medical products, and other drugs or devices approved or cleared by the Food and Drug Administration”;

(B)

in subparagraph (B), by striking “ on the symptoms and causes of pain;” and inserting the following:

“(i) the symptoms and causes of pain, including the identification of relevant biomarkers and screening models and the epidemiology of acute and chronic pain;

“(ii) the diagnosis, prevention, treatment, and management of acute and chronic pain, including with respect to non-pharmacologic treatments, non-addictive medical products, and other drugs or devices approved or cleared by the Food and Drug Administration; and

“(iii) risk factors for, and early warning signs of, substance use disorders in populations with acute and chronic pain; and”

; and

(C)

by striking subparagraphs (C) through (E) and inserting the following:

“(C) make recommendations to the Director of NIH—

“(i) to ensure that the activities of the National Institutes of Health and other Federal agencies are free of unnecessary duplication of effort;

“(ii) on how best to disseminate information on pain care and epidemiological data related to acute and chronic pain; and

“(iii) on how to expand partnerships between public entities and private entities to expand collaborative, cross-cutting research.”

(2)

by redesignating paragraph (6) as paragraph (7); and

(3)

by inserting after paragraph (5) the following:

“(6) Report.—The Secretary shall ensure that recommendations and actions taken by the Director with respect to the topics discussed at the meetings described in paragraph (4) are included in appropriate reports to Congress.”

Subtitle F Jessie’s Law

SEC. 7051. Inclusion of Opioid Addiction History in Patient Records.

(a)

Best Practices.—

(1)

In general.— Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the “Secretary”), in consultation with appropriate stakeholders, including a patient with a history of opioid use disorder, an expert in electronic health records, an expert in the confidentiality of patient health information and records, and a health care provider, shall identify or facilitate the development of best practices regarding—

(A)

the circumstances under which information that a patient has provided to a health care provider regarding such patient’s history of opioid use disorder should, only at the patient’s request, be prominently displayed in the medical records (including electronic health records) of such patient;

(B)

what constitutes the patient’s request for the purpose described in subparagraph (A); and

(C)

the process and methods by which the information should be so displayed.

(2)

Dissemination.— The Secretary shall disseminate the best practices developed under paragraph (1) to health care providers and State agencies.

(b)

Requirements.— In identifying or facilitating the development of best practices under subsection (a), as applicable, the Secretary, in consultation with appropriate stakeholders, shall consider the following:

(1)

The potential for addiction relapse or overdose, including overdose death, when opioid medications are prescribed to a patient recovering from opioid use disorder.

(2)

The benefits of displaying information about a patient’s opioid use disorder history in a manner similar to other potentially lethal medical concerns, including drug allergies and contraindications.

(3)

The importance of prominently displaying information about a patient’s opioid use disorder when a physician or medical professional is prescribing medication, including methods for avoiding alert fatigue in providers.

(4)

The importance of a variety of appropriate medical professionals, including physicians, nurses, and pharmacists, having access to information described in this section when prescribing or dispensing opioid medication, consistent with Federal and State laws and regulations.

(5)

The importance of protecting patient privacy, including the requirements related to consent for disclosure of substance use disorder information under all applicable laws and regulations.

(6)

All applicable Federal and State laws and regulations.

SEC. 7052. Communication with Families During Emergencies.

(a)

Promoting Awareness of Authorized Disclosures During Emergencies.— The Secretary of Health and Human Services shall annually notify health care providers regarding permitted disclosures under Federal health care privacy law during emergencies, including overdoses, of certain health information to families, caregivers, and health care providers.

(b)

Use of Material.— For the purposes of carrying out subsection (a), the Secretary of Health and Human Services may use material produced under section 7053 of this Act or section 11004 of the 21st Century Cures Act (42 U.S.C. 1320d–2 note).

SEC. 7053. Development and Dissemination of Model Training Programs for Substance Use Disorder Patient Records.

(a)

Initial Programs and Materials.— Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the “Secretary”), in consultation with appropriate experts, shall identify the following model programs and materials (or if no such programs or materials exist, recognize private or public entities to develop and disseminate such programs and materials):

(1)

Model programs and materials for training health care providers (including physicians, emergency medical personnel, psychiatrists, psychologists, counselors, therapists, nurse practitioners, physician assistants, behavioral health facilities and clinics, care managers, and hospitals, including individuals such as general counsels or regulatory compliance staff who are responsible for establishing provider privacy policies) concerning the permitted uses and disclosures, consistent with the standards and regulations governing the privacy and security of substance use disorder patient records promulgated by the Secretary under section 543 of the Public Health Service Act (42 U.S.C. 290dd–2) for the confidentiality of patient records.

(2)

Model programs and materials for training patients and their families regarding their rights to protect and obtain information under the standards and regulations described in paragraph (1).

(b)

Requirements.— The model programs and materials described in paragraphs (1) and (2) of subsection (a) shall address circumstances under which disclosure of substance use disorder patient records is needed to—

(1)

facilitate communication between substance use disorder treatment providers and other health care providers to promote and provide the best possible integrated care;

(2)

avoid inappropriate prescribing that can lead to dangerous drug interactions, overdose, or relapse; and

(3)

notify and involve families and caregivers when individuals experience an overdose.

(c)

Periodic Updates.— The Secretary shall—

(1)

periodically review and update the model program and materials identified or developed under subsection (a); and

(2)

disseminate such updated programs and materials to the individuals described in subsection (a)(1).

(d)

Input of Certain Entities.— In identifying, reviewing, or updating the model programs and materials under this section, the Secretary shall solicit the input of relevant stakeholders.

(e)

Authorization of Appropriations.— There is authorized to be appropriated to carry out this section—

(1)

$4,000,000 for fiscal year 2019;

(2)

$2,000,000 for each of fiscal years 2020 and 2021; and

(3)

$1,000,000 for each of fiscal years 2022 and 2023.

Subtitle G Protecting Pregnant Women and Infants

SEC. 7061. Report on Addressing Maternal and Infant Health in the Opioid Crisis.

(a)

In General.— Not later than 18 months after the date of the enactment of this Act, the Secretary of Health and Human Services, in coordination with the Centers for Disease Control and Prevention, the National Institutes of Health, the Indian Health Service, and the Substance Abuse and Mental Health Services Administration, shall develop and 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 that includes—

(1)

information on opioid, non-opioid, and non-pharmacologic pain management practices during pregnancy and after pregnancy;

(2)

recommendations for increasing public awareness and education about substance use disorders, including opioid use disorders, during and after pregnancy, including available treatment resources in urban and rural areas;

(3)

recommendations to prevent, identify, and reduce substance use disorders, including opioid use disorders, during pregnancy to improve care for pregnant women with substance use disorders and their infants; and

(4)

an identification of areas in need of further research with respect to acute and chronic pain management during and after pregnancy.

(b)

No Additional Funds.— No additional funds are authorized to be appropriated for purposes of carrying out subsection (a).

SEC. 7062. Protecting Moms and Infants.

(a)

Report.—

(1)

In general.— Not later than 60 days after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as 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 make available to the public on the Internet website of the Department of Health and Human Services, a report regarding the implementation of the recommendations in the strategy relating to prenatal opioid use, including neonatal abstinence syndrome, developed pursuant to section 2 of the Protecting Our Infants Act of 2015 (Public Law 114–91). Such report shall include—

(A)

an update on the implementation of the recommendations in the strategy, including information regarding the agencies involved in the implementation; and

(B)

information on additional funding or authority the Secretary requires, if any, to implement the strategy, which may include authorities needed to coordinate implementation of such strategy across the Department of Health and Human Services.

(2)

Periodic updates.— The Secretary shall periodically update the report under paragraph (1).

(b)

Residential Treatment Programs for Pregnant and Postpartum Women.— Section 508(s) of the Public Health Service Act (42 U.S.C. 290bb–1(s)) is amended by striking “ $16,900,000 for each of fiscal years 2017 through 2021” and inserting “ $29,931,000 for each of fiscal years 2019 through 2023”.

SEC. 7063. Early Interventions for Pregnant Women and Infants.

(a)

Development of Educational Materials by Center for Substance Abuse Prevention.— Section 515(b) of the Public Health Service Act (42 U.S.C. 290bb–21(b)) is amended—

(1)

in paragraph (13), by striking “ and” at the end;

(2)

in paragraph (14), by striking the period at the end and inserting “ ; and”; and

(3)

by adding at the end the following:

“(15) in consultation with relevant stakeholders and in collaboration with the Director of the Centers for Disease Control and Prevention, develop educational materials for clinicians to use with pregnant women for shared decision making regarding pain management and the prevention of substance use disorders during pregnancy.”

(b)

Guidelines and Recommendations by Center for Substance Abuse Treatment.— Section 507(b) of the Public Health Service Act (42 U.S.C. 290bb(b)) is amended—

(1)

in paragraph (13), by striking “ and” at the end;

(2)

in paragraph (14), by striking the period at the end and inserting a semicolon; and

(3)

by adding at the end the following:

“(15) in cooperation with the Secretary, implement and disseminate, as appropriate, the recommendations in the report entitled ‘Protecting Our Infants Act: Final Strategy’ issued by the Department of Health and Human Services in 2017; and”

(c)

Support of Partnerships by Center for Substance Abuse Treatment.— Section 507(b) of the Public Health Service Act (42 U.S.C. 290bb(b)), as amended by subsection (b), is further amended by adding at the end the following:

“(16) in cooperation with relevant stakeholders, and through public-private partnerships, encourage education about substance use disorders for pregnant women and health care providers who treat pregnant women and babies.”

SEC. 7064. Prenatal and Postnatal Health.

Section 317L of the Public Health Service Act (42 U.S.C. 247b–13) is amended—

(1)

in subsection (a)—

(A)

by amending paragraph (1) to read as follows:

“(1) to collect, analyze, and make available data on prenatal smoking and alcohol and other substance abuse and misuse, including—

“(A) data on—

“(i) the incidence, prevalence, and implications of such activities; and

“(ii) the incidence and prevalence of implications and outcomes, including neonatal abstinence syndrome and other maternal and child health outcomes associated with such activities; and

“(B) additional information or data, as appropriate, on family health history, medication exposures during pregnancy, demographic information, such as race, ethnicity, geographic location, and family history, and other relevant information, to inform such analysis;”

(B)

in paragraph (2)—

(i)

by striking “ prevention of” and inserting “ prevention and long-term outcomes associated with”; and

(ii)

by striking “ illegal drug use” and inserting “ other substance abuse and misuse”;

(C)

in paragraph (3), by striking “ and cessation programs; and” and inserting “ , treatment, and cessation programs;”;

(D)

in paragraph (4), by striking “ illegal drug use.” and inserting “ other substance abuse and misuse; and”; and

(E)

by adding at the end the following:

“(5) to issue public reports on the analysis of data described in paragraph (1), including analysis of—

“(A) long-term outcomes of children affected by neonatal abstinence syndrome;

“(B) health outcomes associated with prenatal smoking, alcohol, and substance abuse and misuse; and

“(C) relevant studies, evaluations, or information the Secretary determines to be appropriate.”

(2)

in subsection (b), by inserting “ tribal entities,” after “ local governments,”;

(3)

by redesignating subsection (c) as subsection (d);

(4)

by inserting after subsection (b) the following:

“(c) Coordinating Activities.—To carry out this section, the Secretary may—

“(1) provide technical and consultative assistance to entities receiving grants under subsection (b);

“(2) ensure a pathway for data sharing between States, tribal entities, and the Centers for Disease Control and Prevention;

“(3) ensure data collection under this section is consistent with applicable State, Federal, and Tribal privacy laws; and

“(4) coordinate with the National Coordinator for Health Information Technology, as appropriate, to assist States and Tribes in implementing systems that use standards recognized by such National Coordinator, as such recognized standards are available, in order to facilitate interoperability between such systems and health information technology systems, including certified health information technology.”

; and

(5)

in subsection (d), as so redesignated, by striking “ 2001 through 2005” and inserting “ 2019 through 2023”.

SEC. 7065. Plans of Safe Care.

(a)

In General.— Section 105(a) of the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106(a)) is amended by adding at the end the following:

“(7) Grants to states to improve and coordinate their response to ensure the safety, permanency, and well-being of infants affected by substance use.—

“(A) Program authorized.—The Secretary is authorized to make grants to States for the purpose of assisting child welfare agencies, social services agencies, substance use disorder treatment agencies, hospitals with labor and delivery units, medical staff, public health and mental health agencies, and maternal and child health agencies to facilitate collaboration in developing, updating, implementing, and monitoring plans of safe care described in section 106(b)(2)(B)(iii). Section 112(a)(2) shall not apply to the program authorized under this paragraph.

“(B) Distribution of funds.—

“(i) Reservations.—Of the amounts made available to carry out subparagraph (A), the Secretary shall reserve—

“(I) no more than 3 percent for the purposes described in subparagraph (G); and

“(II) up to 3 percent for grants to Indian Tribes and tribal organizations to address the needs of infants born with, and identified as being affected by, substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder and their families or caregivers, which to the extent practicable, shall be consistent with the uses of funds described under subparagraph (D).

“(ii) Allotments to states and territories.—The Secretary shall allot the amount made available to carry out subparagraph (A) that remains after application of clause (i) to each State that applies for such a grant, in an amount equal to the sum of—

“(I) $500,000; and

“(II) an amount that bears the same relationship to any funds made available to carry out subparagraph (A) and remaining after application of clause (i), as the number of live births in the State in the previous calendar year bears to the number of live births in all States in such year.

“(iii) Ratable reduction.—If the amount made available to carry out subparagraph (A) is insufficient to satisfy the requirements of clause (ii), the Secretary shall ratably reduce each allotment to a State.

“(C) Application.—A State desiring a grant under this paragraph shall submit an application to the Secretary at such time and in such manner as the Secretary may require. Such application shall include—

“(i) a description of—

“(I) the impact of substance use disorder in such State, including with respect to the substance or class of substances with the highest incidence of abuse in the previous year in such State, including—

“(aa) the prevalence of substance use disorder in such State;

“(bb) the aggregate rate of births in the State of infants affected by substance abuse or withdrawal symptoms or a fetal alcohol spectrum disorder (as determined by hospitals, insurance claims, claims submitted to the State Medicaid program, or other records), if available and to the extent practicable; and

“(cc) the number of infants identified, for whom a plan of safe care was developed, and for whom a referral was made for appropriate services, as reported under section 106(d)(18);

“(II) the challenges the State faces in developing, implementing, and monitoring plans of safe care in accordance with section 106(b)(2)(B)(iii);

“(III) the State’s lead agency for the grant program and how that agency will coordinate with relevant State entities and programs, including the child welfare agency, the substance use disorder treatment agency, hospitals with labor and delivery units, health care providers, the public health and mental health agencies, programs funded by the Substance Abuse and Mental Health Services Administration that provide substance use disorder treatment for women, the State Medicaid program, the State agency administering the block grant program under title V of the Social Security Act (42 U.S.C. 701 et seq.), the State agency administering the programs funded under part C of the Individuals with Disabilities Education Act (20 U.S.C. 1431 et seq.), the maternal, infant, and early childhood home visiting program under section 511 of the Social Security Act (42 U.S.C. 711), the State judicial system, and other agencies, as determined by the Secretary, and Indian Tribes and tribal organizations, as appropriate, to implement the activities under this paragraph;

“(IV) how the State will monitor local development and implementation of plans of safe care, in accordance with section 106(b)(2)(B)(iii)(II), including how the State will monitor to ensure plans of safe care address differences between substance use disorder and medically supervised substance use, including for the treatment of a substance use disorder;

“(V) if applicable, how the State plans to utilize funding authorized under part E of title IV of the Social Security Act (42 U.S.C. 670 et seq.) to assist in carrying out any plan of safe care, including such funding authorized under section 471(e) of such Act (as in effect on October 1, 2018) for mental health and substance abuse prevention and treatment services and in-home parent skill-based programs and funding authorized under such section 472(j) (as in effect on October 1, 2018) for children with a parent in a licensed residential family-based treatment facility for substance abuse; and

“(VI) an assessment of the treatment and other services and programs available in the State to effectively carry out any plan of safe care developed, including identification of needed treatment, and other services and programs to ensure the well-being of young children and their families affected by substance use disorder, such as programs carried out under part C of the Individuals with Disabilities Education Act (20 U.S.C. 1431 et seq.) and comprehensive early childhood development services and programs such as Head Start programs;

“(ii) a description of how the State plans to use funds for activities described in subparagraph (D) for the purposes of ensuring State compliance with requirements under clauses (ii) and (iii) of section 106(b)(2)(B); and

“(iii) an assurance that the State will comply with requirements to refer a child identified as substance-exposed to early intervention services as required pursuant to a grant under part C of the Individuals with Disabilities Education Act (20 U.S.C. 1431 et seq.).

“(D) Uses of funds.—Funds awarded to a State under this paragraph may be used for the following activities, which may be carried out by the State directly, or through grants or subgrants, contracts, or cooperative agreements:

“(i) Improving State and local systems with respect to the development and implementation of plans of safe care, which—

“(I) shall include parent and caregiver engagement, as required under section 106(b)(2)(B)(iii)(I), regarding available treatment and service options, which may include resources available for pregnant, perinatal, and postnatal women; and

“(II) may include activities such as—

“(aa) developing policies, procedures, or protocols for the administration or development of evidence-based and validated screening tools for infants who may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder and pregnant, perinatal, and postnatal women whose infants may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder;

“(bb) improving assessments used to determine the needs of the infant and family;

“(cc) improving ongoing case management services;

“(dd) improving access to treatment services, which may be prior to the pregnant woman’s delivery date; and

“(ee) keeping families safely together when it is in the best interest of the child.

“(ii) Developing policies, procedures, or protocols in consultation and coordination with health professionals, public and private health facilities, and substance use disorder treatment agencies to ensure that—

“(I) appropriate notification to child protective services is made in a timely manner, as required under section 106(b)(2)(B)(ii);

“(II) a plan of safe care is in place, in accordance with section 106(b)(2)(B)(iii), before the infant is discharged from the birth or health care facility; and

“(III) such health and related agency professionals are trained on how to follow such protocols and are aware of the supports that may be provided under a plan of safe care.

“(iii) Training health professionals and health system leaders, child welfare workers, substance use disorder treatment agencies, and other related professionals such as home visiting agency staff and law enforcement in relevant topics including—

“(I) State mandatory reporting laws established under section 106(b)(2)(B)(i) and the referral and process requirements for notification to child protective services when child abuse or neglect reporting is not mandated;

“(II) the co-occurrence of pregnancy and substance use disorder, and implications of prenatal exposure;

“(III) the clinical guidance about treating substance use disorder in pregnant and postpartum women;

“(IV) appropriate screening and interventions for infants affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder and the requirements under section 106(b)(2)(B)(iii); and

“(V) appropriate multigenerational strategies to address the mental health needs of the parent and child together.

“(iv) Establishing partnerships, agreements, or memoranda of understanding between the lead agency and other entities (including health professionals, health facilities, child welfare professionals, juvenile and family court judges, substance use and mental disorder treatment programs, early childhood education programs, maternal and child health and early intervention professionals (including home visiting providers), peer-to-peer recovery programs such as parent mentoring programs, and housing agencies) to facilitate the implementation of, and compliance with, section 106(b)(2) and clause (ii) of this subparagraph, in areas which may include—

“(I) developing a comprehensive, multi-disciplinary assessment and intervention process for infants, pregnant women, and their families who are affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder, that includes meaningful engagement with and takes into account the unique needs of each family and addresses differences between medically supervised substance use, including for the treatment of substance use disorder, and substance use disorder;

“(II) ensuring that treatment approaches for serving infants, pregnant women, and perinatal and postnatal women whose infants may be affected by substance use, withdrawal symptoms, or a fetal alcohol spectrum disorder, are designed to, where appropriate, keep infants with their mothers during both inpatient and outpatient treatment; and

“(III) increasing access to all evidence-based medication-assisted treatment approved by the Food and Drug Administration, behavioral therapy, and counseling services for the treatment of substance use disorders, as appropriate.

“(v) Developing and updating systems of technology for improved data collection and monitoring under section 106(b)(2)(B)(iii), including existing electronic medical records, to measure the outcomes achieved through the plans of safe care, including monitoring systems to meet the requirements of this Act and submission of performance measures.

“(E) Reporting.—Each State that receives funds under this paragraph, for each year such funds are received, shall submit a report to the Secretary, disaggregated by geographic location, economic status, and major racial and ethnic groups, except that such disaggregation shall not be required if the results would reveal personally identifiable information on, with respect to infants identified under section 106(b)(2)(B)(ii)—

“(i) the number who experienced removal associated with parental substance use;

“(ii) the number who experienced removal and subsequently are reunified with parents, and the length of time between such removal and reunification;

“(iii) the number who are referred to community providers without a child protection case;

“(iv) the number who receive services while in the care of their birth parents;

“(v) the number who receive post-reunification services within 1 year after a reunification has occurred; and

“(vi) the number who experienced a return to out-of-home care within 1 year after reunification.

“(F) Secretary’s report to congress.—The Secretary shall submit an annual report to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Education and the Workforce and the Committee on Appropriations of the House of Representatives that includes the information described in subparagraph (E) and recommendations or observations on the challenges, successes, and lessons derived from implementation of the grant program.

“(G) Assisting states’ implementation.—The Secretary shall use the amount reserved under subparagraph (B)(i)(I) to provide written guidance and technical assistance to support States in complying with and implementing this paragraph, which shall include—

“(i) technical assistance, including programs of in-depth technical assistance, to additional States, territories, and Indian Tribes and tribal organizations in accordance with the substance-exposed infant initiative developed by the National Center on Substance Abuse and Child Welfare;

“(ii) guidance on the requirements of this Act with respect to infants born with and identified as being affected by substance use or withdrawal symptoms or fetal alcohol spectrum disorder, as described in clauses (ii) and (iii) of section 106(b)(2)(B), including by—

“(I) enhancing States’ understanding of requirements and flexibilities under the law, including by clarifying key terms;

“(II) addressing state-identified challenges with developing, implementing, and monitoring plans of safe care, including those reported under subparagraph (C)(i)(II);

“(III) disseminating best practices on implementation of plans of safe care, on such topics as differential response, collaboration and coordination, and identification and delivery of services for different populations, while recognizing needs of different populations and varying community approaches across States; and

“(IV) helping States improve the long-term safety and well-being of young children and their families;

“(iii) supporting State efforts to develop information technology systems to manage plans of safe care; and

“(iv) preparing the Secretary’s report to Congress described in subparagraph (F).

“(H) Sunset.—The authority under this paragraph shall sunset on September 30, 2023.”

(b)

Repeal.— The Abandoned Infants Assistance Act of 1988 (42 U.S.C. 5117aa et seq.) is repealed.

Subtitle H Substance Use Disorder Treatment Workforce

SEC. 7071. Loan Repayment Program for Substance Use Disorder Treatment Workforce.

Title VII of the Public Health Service Act is amended—

(1)

by redesignating part F as part G; and

(2)

by inserting after part E (42 U.S.C. 294n et seq.) the following:

“PART F— SUBSTANCE USE DISORDER TREATMENT WORKFORCE

“SEC. 781. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER TREATMENT WORKFORCE.

“(a) In General.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall carry out a program under which—

“(1) the Secretary enters into agreements with individuals to make payments in accordance with subsection (b) on the principal of and interest on any eligible loan; and

“(2) the individuals each agree to the requirements of service in substance use disorder treatment employment, as described in subsection (d).

“(b) Payments.—For each year of obligated service by an individual pursuant to an agreement under subsection (a), the Secretary shall make a payment to such individual as follows:

“(1) Service in a shortage area.—The Secretary shall pay—

“(A) for each year of obligated service by an individual pursuant to an agreement under subsection (a), ⅙ of the principal of and interest on each eligible loan of the individual which is outstanding on the date the individual began service pursuant to the agreement; and

“(B) for completion of the sixth and final year of such service, the remainder of such principal and interest.

“(2) Maximum amount.—The total amount of payments under this section to any individual shall not exceed $250,000.

“(c) Eligible Loans.—The loans eligible for repayment under this section are each of the following:

“(1) Any loan for education or training for a substance use disorder treatment employment.

“(2) Any loan under part E of title VIII (relating to nursing student loans).

“(3) Any Federal Direct Stafford Loan, Federal Direct PLUS Loan, Federal Direct Unsubsidized Stafford Loan, or Federal Direct Consolidation Loan (as such terms are used in section 455 of the Higher Education Act of 1965).

“(4) Any Federal Perkins Loan under part E of title I of the Higher Education Act of 1965.

“(5) Any other Federal loan as determined appropriate by the Secretary.

“(d) Requirements of Service.—Any individual receiving payments under this program as required by an agreement under subsection (a) shall agree to an annual commitment to full-time employment, with no more than 1 year passing between any 2 years of covered employment, in substance use disorder treatment employment in the United States in—

“(1) a Mental Health Professional Shortage Area, as designated under section 332; or

“(2) a county (or a municipality, if not contained within any county) where the mean drug overdose death rate per 100,000 people over the past 3 years for which official data is available from the State, is higher than the most recent available national average overdose death rate per 100,000 people, as reported by the Centers for Disease Control and Prevention.

“(e) Ineligibility for Double Benefits.—No borrower may, for the same service, receive a reduction of loan obligations or a loan repayment under both—

“(1) this section; and

“(2) any Federally supported loan forgiveness program, including under section 338B, 338I, or 846 of this Act, or section 428J, 428L, 455(m), or 460 of the Higher Education Act of 1965.

“(f) Breach.—

“(1) Liquidated damages formula.—The Secretary may establish a liquidated damages formula to be used in the event of a breach of an agreement entered into under subsection (a).

“(2) Limitation.—The failure by an individual to complete the full period of service obligated pursuant to such an agreement, taken alone, shall not constitute a breach of the agreement, so long as the individual completed in good faith the years of service for which payments were made to the individual under this section.

“(g) Additional Criteria.—The Secretary—

“(1) may establish such criteria and rules to carry out this section as the Secretary determines are needed and in addition to the criteria and rules specified in this section; and

“(2) shall give notice to the committees specified in subsection (h) of any criteria and rules so established.

“(h) Report to Congress.—Not later than 5 years after the date of enactment of this section, and every other year thereafter, the Secretary shall prepare and submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on—

“(1) the number and location of borrowers who have qualified for loan repayments under this section; and

“(2) the impact of this section on the availability of substance use disorder treatment employees nationally and in shortage areas and counties described in subsection (d).

“(i) Definition.—In this section:

“(1) The terms ‘Indian tribe’ and ‘tribal organization’ have the meanings given those terms in section 4 of the Indian Self-Determination and Education Assistance Act.

“(2) The term ‘municipality’ means a city, town, or other public body created by or pursuant to State law, or an Indian tribe.

“(3) The term ‘substance use disorder treatment employment’ means full-time employment (including a fellowship)—

“(A) where the primary intent and function of the position is the direct treatment or recovery support of patients with or in recovery from a substance use disorder, including master’s level social workers, psychologists, counselors, marriage and family therapists, psychiatric mental health practitioners, occupational therapists, psychology doctoral interns, and behavioral health paraprofessionals and physicians, physician assistants, and nurses, who are licensed or certified in accordance with applicable State and Federal laws; and

“(B) which is located at a substance use disorder treatment program, private physician practice, hospital or health system-affiliated inpatient treatment center or outpatient clinic (including an academic medical center-affiliated treatment program), correctional facility or program, youth detention center or program, inpatient psychiatric facility, crisis stabilization unit, community health center, community mental health or other specialty community behavioral health center, recovery center, school, community-based organization, telehealth platform, migrant health center, health program or facility operated by an Indian tribe or tribal organization, Federal medical facility, or any other facility as determined appropriate for purposes of this section by the Secretary.

“(j) Authorization of Appropriations.—There are authorized to be appropriated to carry out this section $25,000,000 for each of fiscal years 2019 through 2023.”

SEC. 7072. Clarification Regarding Service in Schools and Other Community-Based Settings.

Subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.) is amended by adding at the end the following:

“SEC. 338N. CLARIFICATION REGARDING SERVICE IN SCHOOLS AND OTHER COMMUNITY-BASED SETTINGS.

“(a) Schools and Community-based Settings.—An entity to which a participant in the Scholarship Program or the Loan Repayment Program (referred to in this section as a ‘participant’) is assigned under section 333 may direct such participant to provide service as a behavioral or mental health professional at a school or other community-based setting located in a health professional shortage area.

“(b) Obligated Service.—

“(1) In general.—Any service described in subsection (a) that a participant provides may count towards such participant’s completion of any obligated service requirements under the Scholarship Program or the Loan Repayment Program, subject to any limitation imposed under paragraph (2).

“(2) Limitation.—The Secretary may impose a limitation on the number of hours of service described in subsection (a) that a participant may credit towards completing obligated service requirements, provided that the limitation allows a member to credit service described in subsection (a) for not less than 50 percent of the total hours required to complete such obligated service requirements.

“(c) Rule of Construction.—The authorization under subsection (a) shall be notwithstanding any other provision of this subpart or subpart II.”

SEC. 7073. Programs for Health Care Workforce.

(a)

Program for Education and Training in Pain Care.— Section 759 of the Public Health Service Act (42 U.S.C. 294i) is amended—

(1)

in subsection (a), by striking “ hospices, and other public and private entities” and inserting “ hospices, tribal health programs (as defined in section 4 of the Indian Health Care Improvement Act), and other public and nonprofit private entities”;

(2)

in subsection (b)—

(A)

in the matter preceding paragraph (1), by striking “ award may be made under subsection (a) only if the applicant for the award agrees that the program carried out with the award will include” and inserting “ entity receiving an award under this section shall develop a comprehensive education and training plan that includes”;

(B)

in paragraph (1)—

(i)

by inserting “ preventing,” after “ diagnosing,”; and

(ii)

by inserting “ non-addictive medical products and non-pharmacologic treatments and” after “ including”;

(C)

in paragraph (2)—

(i)

by inserting “ Federal, State, and local” after “ applicable”; and

(ii)

by striking “ the degree to which” and all that follows through “ effective pain care” and inserting “ opioids”;

(D)

in paragraph (3), by inserting “ , integrated, evidence-based pain management, and, as appropriate, non-pharmacotherapy” before the semicolon;

(E)

in paragraph (4), by striking “ ; and” and inserting “ ;”; and

(F)

by striking paragraph (5) and inserting the following:

“(5) recent findings, developments, and advancements in pain care research and the provision of pain care, which may include non-addictive medical products and non-pharmacologic treatments intended to treat pain; and

“(6) the dangers of opioid abuse and misuse, detection of early warning signs of opioid use disorders (which may include best practices related to screening for opioid use disorders, training on screening, brief intervention, and referral to treatment), and safe disposal options for prescription medications (including such options provided by law enforcement or other innovative deactivation mechanisms).”

(3)

in subsection (d), by inserting “ prevention,” after “ diagnosis,”; and

(4)

in subsection (e), by striking “ 2010 through 2012” and inserting “ 2019 through 2023”.

(b)

Mental and Behavioral Health Education and Training Program.— Section 756 of the Public Health Service Act (42 U.S.C. 294e–1) is amended—

(1)

in subsection (a)—

(A)

in paragraph (1), by inserting “ , trauma,” after “ focus on child and adolescent mental health”; and

(B)

in paragraphs (2) and (3), by inserting “ trauma-informed care and” before “ substance use disorder prevention and treatment services”; and

(2)

in subsection (f), by striking “ 2018 through 2022” and inserting “ 2019 through 2023”.

Subtitle I Preventing Overdoses While in Emergency Rooms

SEC. 7081. Program to Support Coordination and Continuation of Care for Drug Overdose Patients.

(a)

In General.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall identify or facilitate the development of best practices for—

(1)

emergency treatment of known or suspected drug overdose;

(2)

the use of recovery coaches, as appropriate, to encourage individuals who experience a non-fatal overdose to seek treatment for substance use disorder and to support coordination and continuation of care;

(3)

coordination and continuation of care and treatment, including, as appropriate, through referrals, of individuals after a drug overdose; and

(4)

the provision or prescribing of overdose reversal medication, as appropriate.

(b)

Grant Establishment and Participation.—

(1)

In general.— The Secretary shall award grants on a competitive basis to eligible entities to support implementation of voluntary programs for care and treatment of individuals after a drug overdose, as appropriate, which may include implementation of the best practices described in subsection (a).

(2)

Eligible entity.— In this section, the term “eligible entity” means—

(A)

a State substance abuse agency;

(B)

an Indian Tribe or tribal organization; or

(C)

an entity that offers treatment or other services for individuals in response to, or following, drug overdoses or a drug overdose, such as an emergency department, in consultation with a State substance abuse agency.

(3)

Application.— An eligible entity desiring a grant under this section shall submit an application to the Secretary, at such time and in such manner as the Secretary may require, that includes—

(A)

evidence that such eligible entity carries out, or is capable of contracting and coordinating with other community entities to carry out, the activities described in paragraph (4);

(B)

evidence that such eligible entity will work with a recovery community organization to recruit, train, hire, mentor, and supervise recovery coaches and fulfill the requirements described in paragraph (4)(A); and

(C)

such additional information as the Secretary may require.

(4)

Use of grant funds.— An eligible entity awarded a grant under this section shall use such grant funds to—

(A)

hire or utilize recovery coaches to help support recovery, including by—

(i)

connecting patients to a continuum of care services, such as—

(I)

treatment and recovery support programs;

(II)

programs that provide non-clinical recovery support services;

(III)

peer support networks;

(IV)

recovery community organizations;

(V)

health care providers, including physicians and other providers of behavioral health and primary care;

(VI)

education and training providers;

(VII)

employers;

(VIII)

housing services; and

(IX)

child welfare agencies;

(ii)

providing education on overdose prevention and overdose reversal to patients and families, as appropriate;

(iii)

providing follow-up services for patients after an overdose to ensure continued recovery and connection to support services;

(iv)

collecting and evaluating outcome data for patients receiving recovery coaching services; and

(v)

providing other services the Secretary determines necessary to help ensure continued connection with recovery support services, including culturally appropriate services, as applicable;

(B)

establish policies and procedures, pursuant to Federal and State law, that address the provision of overdose reversal medication, the administration of all drugs or devices approved or cleared under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) and all biological products licensed under section 351 of the Public Health Service Act (42 U.S.C. 262) to treat substance use disorder, and subsequent continuation of, or referral to, evidence-based treatment for patients with a substance use disorder who have experienced a non-fatal drug overdose, in order to support long-term treatment, prevent relapse, and reduce recidivism and future overdose; and

(C)

establish integrated models of care for individuals who have experienced a non-fatal drug overdose which may include patient assessment, follow up, and transportation to and from treatment facilities.

(5)

Additional permissible uses.— In addition to the uses described in paragraph (4), a grant awarded under this section may be used, directly or through contractual arrangements, to provide—

(A)

all drugs or devices approved or cleared under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) and all biological products licensed under section 351 of the Public Health Service Act (42 U.S.C. 262) to treat substance use disorders or reverse overdose, pursuant to Federal and State law;

(B)

withdrawal and detoxification services that include patient evaluation, stabilization, and preparation for treatment of substance use disorder, including treatment described in subparagraph (A), as appropriate; or

(C)

mental health services provided by a certified professional who is licensed and qualified by education, training, or experience to assess the psychosocial background of patients, to contribute to the appropriate treatment plan for patients with substance use disorder, and to monitor patient progress.

(6)

Preference.— In awarding grants under this section, the Secretary shall give preference to eligible entities that meet any or all of the following criteria:

(A)

The eligible entity is a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act (42 U.S.C. 1395x(mm)(1))), a low volume hospital (as defined in section 1886(d)(12)(C)(i) of such Act (42 U.S.C. 1395ww(d)(12)(C)(i))), a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))), or a hospital that receives disproportionate share hospital payments under section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)).

(B)

The eligible entity is located in a State with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention, or under the jurisdiction of an Indian Tribe with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined through appropriate mechanisms as determined by the Secretary in consultation with Indian Tribes.

(C)

The eligible entity demonstrates that recovery coaches will be placed in both health care settings and community settings.

(7)

Period of grant.— A grant awarded to an eligible entity under this section shall be for a period of not more than 5 years.

(c)

Definitions.— In this section:

(1)

Indian tribe; tribal organization.— The terms “Indian Tribe” and “tribal organization” have the meanings given the terms “Indian tribe” and “tribal organization” in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

(2)

Recovery coach.— the term “recovery coach” means an individual—

(A)

with knowledge of, or experience with, recovery from a substance use disorder; and

(B)

who has completed training from, and is determined to be in good standing by, a recovery services organization capable of conducting such training and making such determination.

(3)

Recovery community organization.— The term “recovery community organization” has the meaning given such term in section 547(a) of the Public Health Service Act (42 U.S.C. 290ee–2(a)).

(d)

Reporting Requirements.—

(1)

Reports by grantees.— Each eligible entity awarded a grant under this section shall submit to the Secretary an annual report for each year for which the entity has received such grant that includes information on—

(A)

the number of individuals treated by the entity for non-fatal overdoses, including the number of non-fatal overdoses where overdose reversal medication was administered;

(B)

the number of individuals administered medication-assisted treatment by the entity;

(C)

the number of individuals referred by the entity to other treatment facilities after a non-fatal overdose, the types of such other facilities, and the number of such individuals admitted to such other facilities pursuant to such referrals; and

(D)

the frequency and number of patients with reoccurrences, including readmissions for non-fatal overdoses and evidence of relapse related to substance use disorder.

(2)

Report by secretary.— Not later than 5 years after the date of enactment of this Act, the Secretary shall submit to Congress a report that includes an evaluation of the effectiveness of the grant program carried out under this section with respect to long term health outcomes of the population of individuals who have experienced a drug overdose, the percentage of patients treated or referred to treatment by grantees, and the frequency and number of patients who experienced relapse, were readmitted for treatment, or experienced another overdose.

(e)

Privacy.— The requirements of this section, including with respect to data reporting and program oversight, shall be subject to all applicable Federal and State privacy laws.

(f)

Authorization of Appropriations.— There is authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2019 through 2023.

Subtitle J Alternatives to Opioids in the Emergency Department

SEC. 7091. Emergency Department Alternatives to Opioids Demonstration Program.

(a)

Demonstration Program Grants.—

(1)

In general.— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall carry out a demonstration program for purposes of awarding grants to hospitals and emergency departments, including freestanding emergency departments, to develop, implement, enhance, or study alternatives to opioids for pain management in such settings.

(2)

Eligibility.— To be eligible to receive a grant under paragraph (1), a hospital or emergency department shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

(3)

Geographic distribution.— In awarding grants under this section, the Secretary shall seek to ensure geographical distribution among grant recipients.

(4)

Use of funds.— Grants under paragraph (1) shall be used to—

(A)

target treatment approaches for painful conditions frequently treated in such settings;

(B)

train providers and other hospital personnel on protocols or best practices related to the use and prescription of opioids and alternatives to opioids for pain management in the emergency department; and

(C)

develop or continue strategies to provide alternatives to opioids, as appropriate.

(b)

Additional Demonstration Program.— The Secretary may carry out a demonstration program similar to the program under subsection (a) for other acute care settings.

(c)

Consultation.— The Secretary shall implement a process for recipients of grants under subsection (a) or (b) to share evidence-based and best practices and promote consultation with persons having robust knowledge, including emergency departments and physicians that have successfully implemented programs that use alternatives to opioids for pain management, as appropriate, such as approaches studied through the National Center for Complimentary and Integrative Health or other institutes and centers at the National Institutes of Health, as appropriate. The Secretary shall offer to each recipient of a grant under subsection (a) or (b) technical assistance as necessary.

(d)

Technical Assistance.— The Secretary shall identify or facilitate the development of best practices on alternatives to opioids for pain management and provide technical assistance to hospitals and other acute care settings on alternatives to opioids for pain management. The technical assistance provided shall be for the purpose of—

(1)

utilizing information from recipients of a grant under subsection (a) or (b) that have successfully implemented alternatives to opioids programs;

(2)

identifying or facilitating the development of best practices on the use of alternatives to opioids, which may include pain-management strategies that involve non-addictive medical products, non-pharmacologic treatments, and technologies or techniques to identify patients at risk for opioid use disorder;

(3)

identifying or facilitating the development of best practices on the use of alternatives to opioids that target common painful conditions and include certain patient populations, such as geriatric patients, pregnant women, and children; and

(4)

disseminating information on the use of alternatives to opioids to providers in acute care settings, which may include emergency departments, outpatient clinics, critical access hospitals, Federally qualified health centers, Indian Health Service health facilities, and tribal hospitals.

(e)

Report to the Secretary.— Each recipient of a grant under this section shall submit to the Secretary (during the period of such grant) annual reports on the progress of the program funded through the grant. These reports shall include, in accordance with all applicable State and Federal privacy laws—

(1)

a description of and specific information about the opioid alternative pain management programs, including the demographic characteristics of patients who were treated with an alternative pain management protocol, implemented in hospitals, emergency departments, and other acute care settings;

(2)

data on the opioid alternative pain management strategies used, including the number of opioid prescriptions written—

(A)

during a baseline period before the program began; or

(B)

at various stages of the program; and

(3)

data on patients who were eventually prescribed opioids after alternative pain management protocols and treatments were utilized; and

(4)

any other information the Secretary determines appropriate.

(f)

Report to Congress.— Not later than 1 year after completion of the demonstration program under this section, the Secretary shall submit a report to the Congress on the results of the demonstration program and include in the report—

(1)

the number of applications received and the number funded;

(2)

a summary of the reports described in subsection (e), including data that allows for comparison of programs; and

(3)

recommendations for broader implementation of pain management strategies that encourage the use of alternatives to opioids in hospitals, emergency departments, or other acute care settings.

(g)

Authorization of Appropriations.— To carry out this section, there is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2021.

Subtitle K Treatment, Education, and Community Help To Combat Addiction

SEC. 7101. Establishment of Regional Centers of Excellence in Substance Use Disorder Education.

Part D of title V of the Public Health Service Act, as amended by section 7031, is further amended by adding at the end the following new section:

“SEC. 551. REGIONAL CENTERS OF EXCELLENCE IN SUBSTANCE USE DISORDER EDUCATION.

“(a) In General.—The Secretary, in consultation with appropriate agencies, shall award cooperative agreements to eligible entities for the designation of such entities as Regional Centers of Excellence in Substance Use Disorder Education for purposes of improving health professional training resources with respect to substance use disorder prevention, treatment, and recovery.

“(b) Eligibility.—To be eligible to receive a cooperative agreement under subsection (a), an entity shall—

“(1) be an accredited entity that offers education to students in various health professions, which may include—

“(A) a teaching hospital;

“(B) a medical school;

“(C) a certified behavioral health clinic; or

“(D) any other health professions school, school of public health, or Cooperative Extension Program at institutions of higher education, as defined in section 101 of the Higher Education Act of 1965, engaged in the prevention, treatment, or recovery of substance use disorders;

“(2) demonstrate community engagement and partnerships with community stakeholders, including entities that train health professionals, mental health counselors, social workers, peer recovery specialists, substance use treatment programs, community health centers, physician offices, certified behavioral health clinics, research institutions, and law enforcement; and

“(3) submit to the Secretary an application containing such information, at such time, and in such manner, as the Secretary may require.

“(c) Activities.—An entity receiving an award under this section shall develop, evaluate, and distribute evidence-based resources regarding the prevention and treatment of, and recovery from, substance use disorders. Such resources may include information on—

“(1) the neurology and pathology of substance use disorders;

“(2) advancements in the treatment of substance use disorders;

“(3) techniques and best practices to support recovery from substance use disorders;

“(4) strategies for the prevention and treatment of, and recovery from substance use disorders across patient populations; and

“(5) other topic areas that are relevant to the objectives described in subsection (a).

“(d) Geographic Distribution.—In awarding cooperative agreements under subsection (a), the Secretary shall take into account regional differences among eligible entities and shall make an effort to ensure geographic distribution.

“(e) Evaluation.—The Secretary shall evaluate each project carried out by an entity receiving an award under this section and shall disseminate the findings with respect to each such evaluation to appropriate public and private entities.

“(f) Funding.—There is authorized to be appropriated to carry out this section, $4,000,000 for each of fiscal years 2019 through 2023.”

SEC. 7102. Youth Prevention and Recovery.

(a)

Substance Abuse Treatment Services for Children, Adolescents, and Young Adults.— Section 514 of the Public Health Service Act (42 U.S.C. 290bb–7) is amended—

(1)

in the section heading, by striking “ children and adolescents” and inserting “ children, adolescents, and young adults”;

(2)

in subsection (a)(2), by striking “ children, including” and inserting “ children, adolescents, and young adults, including”; and

(3)

by striking “ children and adolescents” each place it appears and inserting “ children, adolescents, and young adults”.

(b)

Resource Center.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”, except as otherwise provided), in consultation with the Secretary of Education and other heads of agencies, including the Assistant Secretary for Mental Health and Substance Use and the Administrator of the Health Resources and Services Administration, as appropriate, shall establish a resource center to provide technical support to recipients of grants under subsection (c).

(c)

Youth Prevention and Recovery Initiative.—

(1)

In general.— The Secretary, in consultation with the Secretary of Education, shall administer a program to provide support for communities to support the prevention of, treatment of, and recovery from, substance use disorders for children, adolescents, and young adults.

(2)

Definitions.— In this subsection:

(A)

Eligible entity.— The term “eligible entity” means—

(i)

a local educational agency that is seeking to establish or expand substance use prevention or recovery support services at one or more high schools;

(ii)

a State educational agency;

(iii)

an institution of higher education (or consortia of such institutions), which may include a recovery program at an institution of higher education;

(iv)

a local board or one-stop operator;

(v)

a nonprofit organization with appropriate expertise in providing services or programs for children, adolescents, or young adults, excluding a school;

(vi)

a State, political subdivision of a State, Indian tribe, or tribal organization; or

(vii)

a high school or dormitory serving high school students that receives funding from the Bureau of Indian Education.

(B)

Foster care.— The term “foster care” has the meaning given such term in section 1355.20(a) of title 45, Code of Federal Regulations (or any successor regulations).

(C)

High school.— The term “high school” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(D)

Homeless youth.— The term “homeless youth” has the meaning given the term “homeless children or youths” in section 725 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a).

(E)

Indian tribe; tribal organization.— The terms “Indian tribe” and “tribal organization” have the meanings given such terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

(F)

Institution of higher education.— The term “institution of higher education” has the meaning given such term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001) and includes a “postsecondary vocational institution” as defined in section 102(c) of such Act (20 U.S.C. 1002(c)).

(G)

Local educational agency.— The term “local educational agency” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(H)

Local board; one-stop operator.— The terms “local board” and “one-stop operator” have the meanings given such terms in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102).

(I)

Out-of-school youth.— The term “out-of-school youth” has the meaning given such term in section 129(a)(1)(B) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3164(a)(1)(B)).

(J)

Recovery program.— The term “recovery program” means a program—

(i)

to help children, adolescents, or young adults who are recovering from substance use disorders to initiate, stabilize, and maintain healthy and productive lives in the community; and

(ii)

that includes peer-to-peer support delivered by individuals with lived experience in recovery, and communal activities to build recovery skills and supportive social networks.

(K)

State educational agency.— The term “State educational agency” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act (20 U.S.C. 7801).

(3)

Best practices.— The Secretary, in consultation with the Secretary of Education, shall—

(A)

identify or facilitate the development of evidence-based best practices for prevention of substance misuse and abuse by children, adolescents, and young adults, including for specific populations such as youth in foster care, homeless youth, out-of-school youth, and youth who are at risk of or have experienced trafficking that address—

(i)

primary prevention;

(ii)

appropriate recovery support services;

(iii)

appropriate use of medication-assisted treatment for such individuals, if applicable, and ways of overcoming barriers to the use of medication-assisted treatment in such population; and

(iv)

efficient and effective communication, which may include the use of social media, to maximize outreach efforts;

(B)

disseminate such best practices to State educational agencies, local educational agencies, schools and dormitories funded by the Bureau of Indian Education, institutions of higher education, recovery programs at institutions of higher education, local boards, one-stop operators, family and youth homeless providers, and nonprofit organizations, as appropriate;

(C)

conduct a rigorous evaluation of each grant funded under this subsection, particularly its impact on the indicators described in paragraph (7)(B); and

(D)

provide technical assistance for grantees under this subsection.

(4)

Grants authorized.— The Secretary, in consultation with the Secretary of Education, shall award 3-year grants, on a competitive basis, to eligible entities to enable such entities, in coordination with Indian tribes, if applicable, and State agencies responsible for carrying out substance use disorder prevention and treatment programs, to carry out evidence-based programs for—

(A)

prevention of substance misuse and abuse by children, adolescents, and young adults, which may include primary prevention;

(B)

recovery support services for children, adolescents, and young adults, which may include counseling, job training, linkages to community-based services, family support groups, peer mentoring, and recovery coaching; or

(C)

treatment or referrals for treatment of substance use disorders, which may include the use of medication-assisted treatment, as appropriate.

(5)

Special consideration.— In awarding grants under this subsection, the Secretary shall give special consideration to the unique needs of tribal, urban, suburban, and rural populations.

(6)

Application.— To be eligible for a grant under this subsection, an entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. Such application shall include—

(A)

a description of—

(i)

the impact of substance use disorders in the population that will be served by the grant program;

(ii)

how the eligible entity has solicited input from relevant stakeholders, which may include faculty, teachers, staff, families, students, and experts in substance use disorder prevention, treatment, and recovery in developing such application;

(iii)

the goals of the proposed project, including the intended outcomes;

(iv)

how the eligible entity plans to use grant funds for evidence-based activities, in accordance with this subsection to prevent, provide recovery support for, or treat substance use disorders amongst such individuals, or a combination of such activities; and

(v)

how the eligible entity will collaborate with relevant partners, which may include State educational agencies, local educational agencies, institutions of higher education, juvenile justice agencies, prevention and recovery support providers, local service providers, including substance use disorder treatment programs, providers of mental health services, youth serving organizations, family and youth homeless providers, child welfare agencies, and primary care providers, in carrying out the grant program; and

(B)

an assurance that the eligible entity will participate in the evaluation described in paragraph (3)(C).

(7)

Reports to the secretary.— Each eligible entity awarded a grant under this subsection shall submit to the Secretary a report at such time and in such manner as the Secretary may require. Such report shall include—

(A)

a description of how the eligible entity used grant funds, in accordance with this subsection, including the number of children, adolescents, and young adults reached through programming; and

(B)

a description, including relevant data, of how the grant program has made an impact on the intended outcomes described in paragraph (6)(A)(iii), including—

(i)

indicators of student success, which, if the eligible entity is an educational institution, shall include student well-being and academic achievement;

(ii)

substance use disorders amongst children, adolescents, and young adults, including the number of overdoses and deaths amongst children, adolescents, and young adults served by the grant during the grant period; and

(iii)

other indicators, as the Secretary determines appropriate.

(8)

Report to congress.— The Secretary shall, not later than October 1, 2022, submit a report to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce and the Committee on Education and the Workforce of the House of Representatives a report summarizing the effectiveness of the grant program under this subsection, based on the information submitted in reports required under paragraph (7).

(9)

Authorization of appropriations.— There is authorized to be appropriated $10,000,000 to carry out this subsection for each of fiscal years 2019 through 2023.

Subtitle L Information From National Mental Health and Substance Use Policy Laboratory

SEC. 7111. Information from National Mental Health and Substance Use Policy Laboratory.

Section 501A(b) of the Public Health Service Act (42 U.S.C. 290aa–0(b)) is amended—

(1)

in paragraph (5)(C), by striking “ ; and” at the end and inserting a semicolon;

(2)

by redesignating paragraph (6) as paragraph (7); and

(3)

by inserting after paragraph (5) the following:

“(6) issue and periodically update information for entities applying for grants or cooperative agreements from the Substance Abuse and Mental Health Services Administration in order to—

“(A) encourage the implementation and replication of evidence-based practices; and

“(B) provide technical assistance to applicants for funding, including with respect to justifications for such programs and activities; and”

Subtitle M Comprehensive Opioid Recovery Centers

SEC. 7121. Comprehensive Opioid Recovery Centers.

(a)

In General.— Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.), as amended by sections 7031 and 7101, is further amended by adding at the end the following new section:

“SEC. 552. COMPREHENSIVE OPIOID RECOVERY CENTERS.

“(a) In General.—The Secretary shall award grants on a competitive basis to eligible entities to establish or operate a comprehensive opioid recovery center (referred to in this section as a ‘Center’). A Center may be a single entity or an integrated delivery network.

“(b) Grant Period.—

“(1) In general.—A grant awarded under subsection (a) shall be for a period of not less than 3 years and not more than 5 years.

“(2) Renewal.—A grant awarded under subsection (a) may be renewed, on a competitive basis, for additional periods of time, as determined by the Secretary. In determining whether to renew a grant under this paragraph, the Secretary shall consider the data submitted under subsection (h).

“(c) Minimum Number of Centers.—The Secretary shall allocate the amounts made available under subsection (j) such that not fewer than 10 grants may be awarded. Not more than one grant shall be made to entities in a single State for any one period.

“(d) Application.—

“(1) Eligible entity.—An entity is eligible for a grant under this section if the entity offers treatment and other services for individuals with a substance use disorder.

“(2) Submission of application.—In order to be eligible for a grant under subsection (a), an entity shall submit an application to the Secretary at such time and in such manner as the Secretary may require. Such application shall include—

“(A) evidence that such entity carries out, or is capable of coordinating with other entities to carry out, the activities described in subsection (g); and

“(B) such other information as the Secretary may require.

“(e) Priority.—In awarding grants under subsection (a), the Secretary shall give priority to eligible entities—

“(1) located in a State with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention; or

“(2) serving an Indian Tribe (as defined in section 4 of the Indian Self-Determination and Education Assistance Act) with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined through appropriate mechanisms determined by the Secretary in consultation with Indian Tribes.

“(f) Preference.—In awarding grants under subsection (a), the Secretary may give preference to eligible entities utilizing technology-enabled collaborative learning and capacity building models, including such models as defined in section 2 of the Expanding Capacity for Health Outcomes Act (Public Law 114–270; 130 Stat. 1395), to conduct the activities described in this section.

“(g) Center Activities.—Each Center shall, at a minimum, carry out the following activities directly, through referral, or through contractual arrangements, which may include carrying out such activities through technology-enabled collaborative learning and capacity building models described in subsection (f):

“(1) Treatment and recovery services.—Each Center shall—

“(A) Ensure that intake, evaluations, and periodic patient assessments meet the individualized clinical needs of patients, including by reviewing patient placement in treatment settings to support meaningful recovery.

“(B) Provide the full continuum of treatment services, including—

“(i) all drugs and devices approved or cleared under the Federal Food, Drug, and Cosmetic Act and all biological products licensed under section 351 of this Act to treat substance use disorders or reverse overdoses, pursuant to Federal and State law;

“(ii) medically supervised withdrawal management, that includes patient evaluation, stabilization, and readiness for and entry into treatment;

“(iii) counseling provided by a program counselor or other certified professional who is licensed and qualified by education, training, or experience to assess the psychological and sociological background of patients, to contribute to the appropriate treatment plan for the patient, and to monitor patient progress;

“(iv) treatment, as appropriate, for patients with co-occurring substance use and mental disorders;

“(v) testing, as appropriate, for infections commonly associated with illicit drug use;

“(vi) residential rehabilitation, and outpatient and intensive outpatient programs;

“(vii) recovery housing;

“(viii) community-based and peer recovery support services;

“(ix) job training, job placement assistance, and continuing education assistance to support reintegration into the workforce; and

“(x) other best practices to provide the full continuum of treatment and services, as determined by the Secretary.

“(C) Ensure that all programs covered by the Center include medication-assisted treatment, as appropriate, and do not exclude individuals receiving medication-assisted treatment from any service.

“(D) Periodically conduct patient assessments to support sustained and clinically significant recovery, as defined by the Assistant Secretary for Mental Health and Substance Use.

“(E) Provide onsite access to medication, as appropriate, and toxicology services; for purposes of carrying out this section.

“(F) Operate a secure, confidential, and interoperable electronic health information system.

“(G) Offer family support services such as child care, family counseling, and parenting interventions to help stabilize families impacted by substance use disorder, as appropriate.

“(2) Outreach.—Each Center shall carry out outreach activities regarding the services offered through the Centers, which may include—

“(A) training and supervising outreach staff, as appropriate, to work with State and local health departments, health care providers, the Indian Health Service, State and local educational agencies, schools funded by the Indian Bureau of Education, institutions of higher education, State and local workforce development boards, State and local community action agencies, public safety officials, first responders, Indian Tribes, child welfare agencies, as appropriate, and other community partners and the public, including patients, to identify and respond to community needs;

“(B) ensuring that the entities described in subparagraph (A) are aware of the services of the Center; and

“(C) disseminating and making publicly available, including through the internet, evidence-based resources that educate professionals and the public on opioid use disorder and other substance use disorders, including co-occurring substance use and mental disorders.

“(h) Data Reporting and Program Oversight.—With respect to a grant awarded under subsection (a), not later than 90 days after the end of the first year of the grant period, and annually thereafter for the duration of the grant period (including the duration of any renewal period for such grant), the entity shall submit data, as appropriate, to the Secretary regarding—

“(1) the programs and activities funded by the grant;

“(2) health outcomes of the population of individuals with a substance use disorder who received services from the Center, evaluated by an independent program evaluator through the use of outcomes measures, as determined by the Secretary;

“(3) the retention rate of program participants; and

“(4) any other information that the Secretary may require for the purpose of—ensuring that the Center is complying with all the requirements of the grant, including providing the full continuum of services described in subsection (g)(1)(B).

“(i) Privacy.—The provisions of this section, including with respect to data reporting and program oversight, shall be subject to all applicable Federal and State privacy laws.

“(j) Authorization of Appropriations.—There is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2023 for purposes of carrying out this section.”

(b)

Reports to Congress.—

(1)

Preliminary report.— Not later than 3 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a preliminary report that analyzes data submitted under section 552(h) of the Public Health Service Act, as added by subsection (a).

(2)

Final report.— Not later than 2 years after submitting the preliminary report required under paragraph (1), the Secretary of Health and Human Services shall submit to Congress a final report that includes—

(A)

an evaluation of the effectiveness of the comprehensive services provided by the Centers established or operated pursuant to section 552 of the Public Health Service Act, as added by subsection (a), with respect to health outcomes of the population of individuals with substance use disorder who receive services from the Center, which shall include an evaluation of the effectiveness of services for treatment and recovery support and to reduce relapse, recidivism, and overdose; and

(B)

recommendations, as appropriate, regarding ways to improve Federal programs related to substance use disorders, which may include dissemination of best practices for the treatment of substance use disorders to health care professionals.

Subtitle N Trauma-Informed Care

SEC. 7131. Cdc Surveillance and Data Collection for Child, Youth, and Adult Trauma.

(a)

Data Collection.— The Director of the Centers for Disease Control and Prevention (referred to in this section as the “Director”) may, in cooperation with the States, collect and report data on adverse childhood experiences through the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System, and other relevant public health surveys or questionnaires.

(b)

Timing.— The collection of data under subsection (a) may occur biennially.

(c)

Data From Rural Areas.— The Director shall encourage each State that participates in collecting and reporting data under subsection (a) to collect and report data from rural areas within such State, in order to generate a statistically reliable representation of such areas.

(d)

Data From Tribal Areas.— The Director may, in cooperation with Indian Tribes (as defined in section 4 of the Indian Self-Determination and Education Assistance Act) and pursuant to a written request from an Indian Tribe, provide technical assistance to such Indian Tribe to collect and report data on adverse childhood experiences through the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System, or another relevant public health survey or questionnaire.

(e)

Authorization of Appropriations.— To carry out this section, there is authorized to be appropriated $2,000,000 for each of fiscal years 2019 through 2023.

SEC. 7132. Task Force to Develop Best Practices for Trauma-Informed Identification, Referral, and Support.

(a)

Establishment.— There is established a task force, to be known as the Interagency Task Force on Trauma-Informed Care (in this section referred to as the “task force”) that shall identify, evaluate, and make recommendations regarding—

(1)

best practices with respect to children and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma; and

(2)

ways in which Federal agencies can better coordinate to improve the Federal response to families impacted by substance use disorders and other forms of trauma.

(b)

Membership.—

(1)

Composition.— The task force shall be composed of the heads of the following Federal departments and agencies, or their designees:

(A)

The Centers for Medicare & Medicaid Services.

(B)

The Substance Abuse and Mental Health Services Administration.

(C)

The Agency for Healthcare Research and Quality.

(D)

The Centers for Disease Control and Prevention.

(E)

The Indian Health Service.

(F)

The Department of Veterans Affairs.

(G)

The National Institutes of Health.

(H)

The Food and Drug Administration.

(I)

The Health Resources and Services Administration.

(J)

The Department of Defense.

(K)

The Office of Minority Health of the Department of Health and Human Services.

(L)

The Administration for Children and Families.

(M)

The Office of the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services.

(N)

The Office for Civil Rights of the Department of Health and Human Services.

(O)

The Office of Juvenile Justice and Delinquency Prevention of the Department of Justice.

(P)

The Office of Community Oriented Policing Services of the Department of Justice.

(Q)

The Office on Violence Against Women of the Department of Justice.

(R)

The National Center for Education Evaluation and Regional Assistance of the Department of Education.

(S)

The National Center for Special Education Research of the Institute of Education Science.

(T)

The Office of Elementary and Secondary Education of the Department of Education.

(U)

The Office for Civil Rights of the Department of Education.

(V)

The Office of Special Education and Rehabilitative Services of the Department of Education.

(W)

The Bureau of Indian Affairs of the Department of the Interior.

(X)

The Veterans Health Administration of the Department of Veterans Affairs.

(Y)

The Office of Special Needs Assistance Programs of the Department of Housing and Urban Development.

(Z)

The Office of Head Start of the Administration for Children and Families.

(AA)

The Children’s Bureau of the Administration for Children and Families.

(BB)

The Bureau of Indian Education of the Department of the Interior.

(CC)

Such other Federal agencies as the Secretaries determine to be appropriate.

(2)

Date of appointments.— The heads of Federal departments and agencies shall appoint the corresponding members of the task force not later than 60 days after the date of enactment of this Act.

(3)

Chairperson.— The task force shall be chaired by the Assistant Secretary for Mental Health and Substance Use, or the Assistant Secretary’s designee.

(c)

Task Force Duties.— The task force shall—

(1)

solicit input from stakeholders, including frontline service providers, educators, mental health professionals, researchers, experts in infant, child, and youth trauma, child welfare professionals, and the public, in order to inform the activities under paragraph (2); and

(2)

identify, evaluate, make recommendations, and update such recommendations not less than annually, to the general public, the Secretary of Education, the Secretary of Health and Human Services, the Secretary of Labor, the Secretary of the Interior, the Attorney General, and other relevant cabinet Secretaries, and Congress regarding—

(A)

a set of evidence-based, evidence-informed, and promising best practices with respect to—

(i)

prevention strategies for individuals at risk of experiencing or being exposed to trauma, including trauma as a result of exposure to substance use;

(ii)

the identification of infants, children and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma;

(iii)

the expeditious referral to and implementation of trauma-informed practices and supports that prevent and mitigate the effects of trauma, which may include whole-family and multi-generational approaches; and

(iv)

community based or multi-generational practices that support children and their families;

(B)

a national strategy on how the task force and member agencies will collaborate, prioritize options for, and implement a coordinated approach, which may include—

(i)

data sharing;

(ii)

providing support to infants, children, and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma;

(iii)

identifying options for coordinating existing grants that support infants, children, and youth, and their families as appropriate, who have experienced, or are at risk of experiencing, exposure to substance use or other trauma, including trauma related to substance use; and

(iv)

other ways to improve coordination, planning, and communication within and across Federal agencies, offices, and programs, to better serve children and families impacted by substance use disorders; and

(C)

existing Federal authorities at the Department of Education, Department of Health and Human Services, Department of Justice, Department of Labor, Department of the Interior, and other relevant agencies, and specific Federal grant programs to disseminate best practices on, provide training in, or deliver services through, trauma-informed practices, and disseminate such information—

(i)

in writing to relevant program offices at such agencies to encourage grant applicants in writing to use such funds, where appropriate, for trauma-informed practices; and

(ii)

to the general public through the internet website of the task force.

(d)

Best Practices.— In identifying, evaluating, and recommending the set of best practices under subsection (c), the task force shall—

(1)

include guidelines for providing professional development and education for front-line services providers, including school personnel, early childhood education program providers, providers from child- or youth-serving organizations, housing and homeless providers, primary and behavioral health care providers, child welfare and social services providers, juvenile and family court personnel, health care providers, individuals who are mandatory reporters of child abuse or neglect, trained nonclinical providers (including peer mentors and clergy), and first responders, in—

(A)

understanding and identifying early signs and risk factors of trauma in infants, children, and youth, and their families as appropriate, including through screening processes and services;

(B)

providing practices to prevent and mitigate the impact of trauma, including by fostering safe and stable environments and relationships; and

(C)

developing and implementing policies, procedures, or systems that—

(i)

are designed to quickly refer infants, children, youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma to the appropriate trauma-informed screening and support and age-appropriate treatment, and to ensure such infants, children, youth, and family members receive such support;

(ii)

utilize and develop partnerships with early childhood education programs, local social services organizations, such as organizations serving youth, and clinical mental health or other health care providers with expertise in providing support services and age-appropriate trauma-informed and evidence-based treatment aimed at preventing or mitigating the effects of trauma;

(iii)

educate children and youth to—

(I)

understand and identify the signs, effects, or symptoms of trauma; and

(II)

build the resilience and coping skills to mitigate the effects of experiencing trauma;

(iv)

promote and support multi-generational practices that assist parents, foster parents, and kinship and other caregivers in accessing resources related to, and developing environments conducive to, the prevention and mitigation of trauma; and

(v)

collect and utilize data from screenings, referrals, or the provision of services and supports to evaluate outcomes and improve processes for trauma-informed services and supports that are culturally sensitive, linguistically appropriate, and specific to age ranges and sex, as applicable;

(2)

recommend best practices that are designed to avoid unwarranted custody loss or criminal penalties for parents or guardians in connection with infants, children, and youth who have experienced or are at risk of experiencing trauma; and

(3)

recommend opportunities for local- and State-level partnerships that—

(A)

are designed to quickly identify and refer children and families, as appropriate, who have experienced or are at risk of experiencing exposure to trauma, including related to substance use;

(B)

utilize and develop partnerships with early childhood education programs, local social services organizations, and health care services aimed at preventing or mitigating the effects of exposure to trauma, including related to substance use;

(C)

offer community-based prevention activities, including educating families and children on the effects of exposure to trauma, such as trauma related to substance use, and how to build resilience and coping skills to mitigate those effects;

(D)

in accordance with Federal privacy protections, utilize non-personally-identifiable data from screenings, referrals, or the provision of services and supports to evaluate and improve processes addressing exposure to trauma, including related to substance use; and

(E)

are designed to prevent separation and support reunification of families if in the best interest of the child.

(e)

Operating Plan.— Not later than 120 days after the date of enactment of this Act, the task force shall hold the first meeting. Not later than 2 years after such date of enactment, the task force shall submit to the Secretary of Education, Secretary of Health and Human Services, Secretary of Labor, Secretary of the Interior, the Attorney General, and Congress an operating plan for carrying out the activities of the task force described in subsection (c)(2). Such operating plan shall include—

(1)

a list of specific activities that the task force plans to carry out for purposes of carrying out duties described in subsection (c)(2), which may include public engagement;

(2)

a plan for carrying out the activities under subsection (c)(2);

(3)

a list of members of the task force and other individuals who are not members of the task force that may be consulted to carry out such activities;

(4)

an explanation of Federal agency involvement and coordination needed to carry out such activities, including any statutory or regulatory barriers to such coordination;

(5)

a budget for carrying out such activities;

(6)

a proposed timeline for implementing recommendations and efforts identified under subsection (c); and

(7)

other information that the task force determines appropriate as related to its duties.

(f)

Final Report.— Not later than 3 years after the date of the first meeting of the task force, the task force shall submit to the general public, Secretary of Education, Secretary of Health and Human Services, Secretary of Labor, Secretary of the Interior, the Attorney General, other relevant cabinet Secretaries, the Committee on Energy and Commerce and the Committee on Education and the Workforce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate, and Congress, a final report containing all of the findings and recommendations required under this section, and shall make such report available online in an accessible format.

(g)

Additional Reports.— In addition to the final report under subsection (f). the task force shall submit—

(1)

a report to Congress identifying any recommendations identified under subsection (c) that require additional legislative authority to implement; and

(2)

a report to the Governors describing the opportunities for local- and State-level partnerships, professional development, or best practices recommended under subsection (d)(3).

(h)

Definitions.— In this section—

(1)

the term “early childhood education program” has the meaning given such term in section 103 of the Higher Education Act of 1965 (20 U.S.C. 1003);

(2)

The term “Governor” means the chief executive officer of a State; and

(3)

the term “State” means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.

(i)

Sunset.— The task force shall sunset on the date that is 60 days after the submission of the final report under subsection (f), but not later than September 30, 2023.

SEC. 7133. National Child Traumatic Stress Initiative.

Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh–1(j)) (relating to grants to address the problems of persons who experience violence-related stress) is amended by striking “ $46,887,000 for each of fiscal years 2018 through 2022” and inserting “ $63,887,000 for each of fiscal years 2019 through 2023”.

SEC. 7134. Grants to Improve Trauma Support Services and Mental Health Care for Children and Youth in Educational Settings.

(a)

Grants, Contracts, and Cooperative Agreements Authorized.— The Secretary, in coordination with the Assistant Secretary for Mental Health and Substance Use, is authorized to award grants to, or enter into contracts or cooperative agreements with, State educational agencies, local educational agencies, Indian Tribes (as defined in section 4 of the Indian Self-Determination and Education Assistance Act) or their tribal educational agencies, a school operated by the Bureau of Indian Education, a Regional Corporation, or a Native Hawaiian educational organization, for the purpose of increasing student access to evidence-based trauma support services and mental health care by developing innovative initiatives, activities, or programs to link local school systems with local trauma-informed support and mental health systems, including those under the Indian Health Service.

(b)

Duration.— With respect to a grant, contract, or cooperative agreement awarded or entered into under this section, the period during which payments under such grant, contract or agreement are made to the recipient may not exceed 4 years.

(c)

Use of Funds.— An entity that receives a grant, contract, or cooperative agreement under this section shall use amounts made available through such grant, contract, or cooperative agreement for evidence-based activities, which shall include any of the following:

(1)

Collaborative efforts between school-based service systems and trauma-informed support and mental health service systems to provide, develop, or improve prevention, screening, referral, and treatment and support services to students, such as providing trauma screenings to identify students in need of specialized support.

(2)

To implement schoolwide positive behavioral interventions and supports, or other trauma-informed models of support.

(3)

To provide professional development to teachers, teacher assistants, school leaders, specialized instructional support personnel, and mental health professionals that—

(A)

fosters safe and stable learning environments that prevent and mitigate the effects of trauma, including through social and emotional learning;

(B)

improves school capacity to identify, refer, and provide services to students in need of trauma support or behavioral health services; or

(C)

reflects the best practices for trauma-informed identification, referral, and support developed by the Task Force under section 7132.

(4)

Services at a full-service community school that focuses on trauma-informed supports, which may include a full-time site coordinator, or other activities consistent with section 4625 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7275).

(5)

Engaging families and communities in efforts to increase awareness of child and youth trauma, which may include sharing best practices with law enforcement regarding trauma-informed care and working with mental health professionals to provide interventions, as well as longer term coordinated care within the community for children and youth who have experienced trauma and their families.

(6)

To provide technical assistance to school systems and mental health agencies.

(7)

To evaluate the effectiveness of the program carried out under this section in increasing student access to evidence-based trauma support services and mental health care.

(8)

To establish partnerships with or provide subgrants to Head Start agencies (including Early Head Start agencies), public and private preschool programs, child care programs (including home-based providers), or other entities described in subsection (a), to include such entities described in this paragraph in the evidence-based trauma initiatives, activities, support services, and mental health systems established under this section in order to provide, develop, or improve prevention, screening, referral, and treatment and support services to young children and their families.

(d)

Applications.— To be eligible to receive a grant, contract, or cooperative agreement under this section, an entity described in subsection (a) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require, which shall include the following:

(1)

A description of the innovative initiatives, activities, or programs to be funded under the grant, contract, or cooperative agreement, including how such program will increase access to evidence-based trauma support services and mental health care for students, and, as applicable, the families of such students.

(2)

A description of how the program will provide linguistically appropriate and culturally competent services.

(3)

A description of how the program will support students and the school in improving the school climate in order to support an environment conducive to learning.

(4)

An assurance that—

(A)

persons providing services under the grant, contract, or cooperative agreement are adequately trained to provide such services; and

(B)

teachers, school leaders, administrators, specialized instructional support personnel, representatives of local Indian Tribes or tribal organizations as appropriate, other school personnel, and parents or guardians of students participating in services under this section will be engaged and involved in the design and implementation of the services.

(5)

A description of how the applicant will support and integrate existing school-based services with the program in order to provide mental health services for students, as appropriate.

(6)

A description of the entities in the community with which the applicant will partner or to which the applicant will provide subgrants in accordance with subsection (c)(8).

(e)

Interagency Agreements.—

(1)

Local interagency agreements.— To ensure the provision of the services described in subsection (c), a recipient of a grant, contract, or cooperative agreement under this section, or their designee, shall establish a local interagency agreement among local educational agencies, agencies responsible for early childhood education programs, Head Start agencies (including Early Head Start agencies), juvenile justice authorities, mental health agencies, child welfare agencies, and other relevant agencies, authorities, or entities in the community that will be involved in the provision of such services.

(2)

Contents.— In ensuring the provision of the services described in subsection (c), the local interagency agreement shall specify with respect to each agency, authority, or entity that is a party to such agreement—

(A)

the financial responsibility for the services;

(B)

the conditions and terms of responsibility for the services, including quality, accountability, and coordination of the services; and

(C)

the conditions and terms of reimbursement among such agencies, authorities, or entities, including procedures for dispute resolution.

(f)

Evaluation.— The Secretary shall reserve not more than 3 percent of the funds made available under subsection (l) for each fiscal year to—

(1)

conduct a rigorous, independent evaluation of the activities funded under this section; and

(2)

disseminate and promote the utilization of evidence-based practices regarding trauma support services and mental health care.

(g)

Distribution of Awards.— The Secretary shall ensure that grants, contracts, and cooperative agreements awarded or entered into under this section are equitably distributed among the geographical regions of the United States and among tribal, urban, suburban, and rural populations.

(h)

Rule of Construction.— Nothing in this section shall be construed—

(1)

to prohibit an entity involved with a program carried out under this section from reporting a crime that is committed by a student to appropriate authorities; or

(2)

to prevent Federal, State, and tribal law enforcement and judicial authorities from exercising their responsibilities with regard to the application of Federal, tribal, and State law to crimes committed by a student.

(i)

Supplement, Not Supplant.— Any services provided through programs carried out under this section shall supplement, and not supplant, existing mental health services, including any special education and related services provided under the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.).

(j)

Consultation With Indian Tribes.— In carrying out subsection (a), the Secretary shall, in a timely manner, meaningfully consult with Indian Tribes and their representatives to ensure notice of eligibility.

(k)

Definitions.— In this section:

(1)

Elementary school.— The term “elementary school” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(2)

Evidence-based.— The term “evidence-based” has the meaning given such term in section 8101(21)(A)(i) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801(21)(A)(i)).

(3)

Native hawaiian educational organization.— The term “Native Hawaiian educational organization” has the meaning given such term in section 6207 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7517).

(4)

Local educational agency.— The term “local educational agency” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(5)

Regional corporation.— The term “Regional Corporation” has the meaning given the term in section 3 of the Alaska Native Claims Settlement Act (43 U.S.C. 1602)).

(6)

School.— The term “school” means a public elementary school or public secondary school.

(7)

School leader.— The term “school leader” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(8)

Secondary school.— The term “secondary school” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(9)

Secretary.— The term “Secretary” means the Secretary of Education.

(10)

Specialized instructional support personnel.— The term “specialized instructional support personnel” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(11)

State educational agency.— The term “State educational agency” has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(l)

Authorization of Appropriations.— There is authorized to be appropriated to carry out this section, $50,000,000 for each of fiscal years 2019 through 2023.

SEC. 7135. Recognizing Early Childhood Trauma Related to Substance Abuse.

(a)

Dissemination of Information.— The Secretary of Health and Human Services shall disseminate information, resources, and, if requested, technical assistance to early childhood care and education providers and professionals working with young children on—

(1)

ways to properly recognize children who may be impacted by trauma, including trauma related to substance use by a family member or other adult; and

(2)

how to respond appropriately in order to provide for the safety and well-being of young children and their families.

(b)

Goals.— The information, resources, and technical assistance provided under subsection (a) shall—

(1)

educate early childhood care and education providers and professionals working with young children on understanding and identifying the early signs and risk factors of children who might be impacted by trauma, including trauma due to exposure to substance use;

(2)

suggest age-appropriate communication tools, procedures, and practices for trauma-informed care, including ways to prevent or mitigate the effects of trauma;

(3)

provide options for responding to children impacted by trauma, including due to exposure to substance use, that consider the needs of the child and family, including recommending resources and referrals for evidence-based services to support such family; and

(4)

promote whole-family and multi-generational approaches to keep families safely together when it is in the best interest of the child.

(c)

Coordination.— The Secretary of Health and Human Services shall coordinate with the task force to develop best practices for trauma-informed identification, referral, and support authorized under section 7132 in disseminating the information, resources, and technical assistance described under subsection (b).

(d)

Rule of Construction.— Such information, resources, and if applicable, technical assistance, shall not be construed to amend the requirements under—

(1)

the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858 et seq.);

(2)

the Head Start Act (42 U.S.C. 9831 et seq.); or

(3)

the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.).

Subtitle O Eliminating Opioid Related Infectious Diseases

SEC. 7141. Reauthorization and Expansion of Program of Surveillance and Education Regarding Infections Associated with Illicit Drug Use and Other Risk Factors.

Section 317N of the Public Health Service Act (42 U.S.C. 247b–15) is amended to read as follows:

“SEC. 317N. SURVEILLANCE AND EDUCATION REGARDING INFECTIONS ASSOCIATED WITH ILLICIT DRUG USE AND OTHER RISK FACTORS.

“(a) In General.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may (directly or through grants to public and nonprofit private entities) provide for programs for the following:

“(1) To cooperate with States and Indian tribes in implementing or maintaining a national system to determine the incidence of infections commonly associated with illicit drug use, such as viral hepatitis, human immunodeficiency virus, and infective endocarditis, and to assist the States in determining the prevalence of such infections, which may include the reporting of cases of such infections.

“(2) To identify, counsel, and offer testing to individuals who are at risk of infections described in paragraph (1) resulting from illicit drug use, receiving blood transfusions prior to July 1992, or other risk factors.

“(3) To provide appropriate referrals for counseling, testing, and medical treatment of individuals identified under paragraph (2) and to ensure, to the extent practicable, the provision of appropriate follow-up services.

“(4) To develop and disseminate public information and education programs for the detection and control of infections described in paragraph (1), with priority given to high-risk populations as determined by the Secretary.

“(5) To improve the education, training, and skills of health professionals in the detection and control of infections described in paragraph (1), including to improve coordination of treatment of substance use disorders and infectious diseases, with priority given to substance use disorder treatment providers, pediatricians and other primary care providers, obstetrician-gynecologists, and infectious disease clinicians, including HIV clinicians.

“(b) Laboratory Procedures.—The Secretary may (directly or through grants to public and nonprofit private entities) carry out programs to provide for improvements in the quality of clinical- laboratory procedures regarding infections described in subsection (a)(1).

“(c) Definition.—In this section, the term ‘Indian tribe’ has the meaning given that term in section 4 of the Indian Self-Determination and Education Assistance Act.

“(d) Authorization of Appropriations.—For the purpose of carrying out this section, there are authorized to be appropriated $40,000,000 for each of the fiscal years 2019 through 2023.”

Subtitle P Peer Support Communities of Recovery

SEC. 7151. Building Communities of Recovery.

Section 547 of the Public Health Service Act (42 U.S.C. 290ee–2) is amended to read as follows:

“SEC. 547. BUILDING COMMUNITIES OF RECOVERY.

“(a) Definition.—In this section, the term ‘recovery community organization’ means an independent nonprofit organization that—

“(1) mobilizes resources within and outside of the recovery community, which may include through a peer support network, to increase the prevalence and quality of long-term recovery from substance use disorders; and

“(2) is wholly or principally governed by people in recovery for substance use disorders who reflect the community served.

“(b) Grants Authorized.—The Secretary shall award grants to recovery community organizations to enable such organizations to develop, expand, and enhance recovery services.

“(c) Federal Share.—The Federal share of the costs of a program funded by a grant under this section may not exceed 85 percent.

“(d) Use of Funds.—Grants awarded under subsection (b)—

“(1) shall be used to develop, expand, and enhance community and statewide recovery support services; and

“(2) may be used to—

“(A) build connections between recovery networks, including between recovery community organizations and peer support networks, and with other recovery support services, including—

“(i) behavioral health providers;

“(ii) primary care providers and physicians;

“(iii) educational and vocational schools;

“(iv) employers;

“(v) housing services;

“(vi) child welfare agencies; and

“(vii) other recovery support services that facilitate recovery from substance use disorders, including non-clinical community services;

“(B) reduce stigma associated with substance use disorders; and

“(C) conduct outreach on issues relating to substance use disorders and recovery, including—

“(i) identifying the signs of substance use disorder;

“(ii) the resources available to individuals with substance use disorder and to families of an individual with a substance use disorder, including programs that mentor and provide support services to children;

“(iii) the resources available to help support individuals in recovery; and

“(iv) related medical outcomes of substance use disorders, the potential of acquiring an infection commonly associated with illicit drug use, and neonatal abstinence syndrome among infants exposed to opioids during pregnancy.

“(e) Special Consideration.—In carrying out this section, the Secretary shall give special consideration to the unique needs of rural areas, including areas with an age-adjusted rate of drug overdose deaths that is above the national average and areas with a shortage of prevention and treatment services.

“(f) Authorization of Appropriations.—There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2019 through 2023.”

SEC. 7152. Peer Support Technical Assistance Center.

Title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is amended by inserting after section 547 the following:

“SEC. 547A. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

“(a) Establishment.—The Secretary, acting through the Assistant Secretary, shall establish or operate a National Peer-Run Training and Technical Assistance Center for Addiction Recovery Support (referred to in this section as the ‘Center’).

“(b) Functions.—The Center established under subsection (a) shall provide technical assistance and support to recovery community organizations and peer support networks, including such assistance and support related to—

“(1) training on identifying—

“(A) signs of substance use disorder;

“(B) resources to assist individuals with a substance use disorder, or resources for families of an individual with a substance use disorder; and

“(C) best practices for the delivery of recovery support services;

“(2) the provision of translation services, interpretation, or other such services for clients with limited English speaking proficiency;

“(3) data collection to support research, including for translational research;

“(4) capacity building; and

“(5) evaluation and improvement, as necessary, of the effectiveness of such services provided by recovery community organizations.

“(c) Best Practices.—The Center established under subsection (a) shall periodically issue best practices for use by recovery community organizations and peer support networks.

“(d) Recovery Community Organization.—In this section, the term ‘recovery community organization’ has the meaning given such term in section 547.

“(e) Authorization of Appropriations.—There is authorized to be appropriated to carry out this section $1,000,000 for each of fiscal years 2019 through 2023.”

Subtitle Q Creating Opportunities That Necessitate New and Enhanced Connections That Improve Opioid Navigation Strategies

SEC. 7161. Preventing Overdoses of Controlled Substances.

(a)

In General.— Part J of title III of the Public Health Service Act (42 U.S.C. 280b et seq.) is amended by inserting after section 392 (42 U.S.C. 280b–1) the following:

“SEC. 392A. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

“(a) Evidence-Based Prevention Grants.—

“(1) In general.—The Director of the Centers for Disease Control and Prevention may—

“(A) to the extent practicable, carry out and expand any evidence-based prevention activities described in paragraph (2);

“(B) provide training and technical assistance to States, localities, and Indian tribes for purposes of carrying out such activity; and

“(C) award grants to States, localities, and Indian tribes for purposes of carrying out such activity.

“(2) Evidence-based prevention activities.—An evidence-based prevention activity described in this paragraph is any of the following activities:

“(A) Improving the efficiency and use of a new or currently operating prescription drug monitoring program, including by—

“(i) encouraging all authorized users (as specified by the State or other entity) to register with and use the program;

“(ii) enabling such users to access any updates to information collected by the program in as close to real-time as possible;

“(iii) improving the ease of use of such program;

“(iv) providing for a mechanism for the program to notify authorized users of any potential misuse or abuse of controlled substances and any detection of inappropriate prescribing or dispensing practices relating to such substances;

“(v) encouraging the analysis of prescription drug monitoring data for purposes of providing de-identified, aggregate reports based on such analysis to State public health agencies, State substance abuse agencies, State licensing boards, and other appropriate State agencies, as permitted under applicable Federal and State law and the policies of the prescription drug monitoring program and not containing any protected health information, to prevent inappropriate prescribing, drug diversion, or abuse and misuse of controlled substances, and to facilitate better coordination among agencies;

“(vi) enhancing interoperability between the program and any health information technology (including certified health information technology), including by integrating program data into such technology;

“(vii) updating program capabilities to respond to technological innovation for purposes of appropriately addressing the occurrence and evolution of controlled substance overdoses;

“(viii) facilitating and encouraging data exchange between the program and the prescription drug monitoring programs of other States;

“(ix) enhancing data collection and quality, including improving patient matching and proactively monitoring data quality;

“(x) providing prescriber and dispenser practice tools, including prescriber practice insight reports for practitioners to review their prescribing patterns in comparison to such patterns of other practitioners in the specialty; and

“(xi) meeting the purpose of the program established under section 399O, as described in section 399O(a).

“(B) Promoting community or health system interventions.

“(C) Evaluating interventions to prevent controlled substance overdoses.

“(D) Implementing projects to advance an innovative prevention approach with respect to new and emerging public health crises and opportunities to address such crises, such as enhancing public education and awareness on the risks associated with opioids.

“(3) Additional grants.—The Director may award grants to States, localities, and Indian Tribes—

“(A) to carry out innovative projects for grantees to rapidly respond to controlled substance misuse, abuse, and overdoses, including changes in patterns of controlled substance use; and

“(B) for any other evidence-based activity for preventing controlled substance misuse, abuse, and overdoses as the Director determines appropriate.

“(4) Research.—The Director, in coordination with the Assistant Secretary for Mental Health and Substance Use and the National Mental Health and Substance Use Policy Laboratory established under section 501A, as appropriate and applicable, may conduct studies and evaluations to address substance use disorders, including preventing substance use disorders or other related topics the Director determines appropriate.

“(b) Enhanced Controlled Substance Overdose Data Collection, Analysis, and Dissemination Grants.—

“(1) In general.—The Director of the Centers for Disease Control and Prevention may—

“(A) to the extent practicable, carry out any controlled substance overdose data collection activities described in paragraph (2);

“(B) provide training and technical assistance to States, localities, and Indian tribes for purposes of carrying out such activity;

“(C) award grants to States, localities, and Indian tribes for purposes of carrying out such activity; and

“(D) coordinate with the Assistant Secretary for Mental Health and Substance Use to collect data pursuant to section 505(d)(1)(A) (relating to the number of individuals admitted to emergency departments as a result of the abuse of alcohol or other drugs).

“(2) Controlled substance overdose data collection and analysis activities.—A controlled substance overdose data collection, analysis, and dissemination activity described in this paragraph is any of the following activities:

“(A) Improving the timeliness of reporting data to the public, including data on fatal and nonfatal overdoses of controlled substances.

“(B) Enhancing the comprehensiveness of controlled substance overdose data by collecting information on such overdoses from appropriate sources such as toxicology reports, autopsy reports, death scene investigations, and emergency departments.

“(C) Modernizing the system for coding causes of death related to controlled substance overdoses to use an electronic-based system.

“(D) Using data to help identify risk factors associated with controlled substance overdoses.

“(E) Supporting entities involved in providing information on controlled substance overdoses, such as coroners, medical examiners, and public health laboratories to improve accurate testing and standardized reporting of causes and contributing factors to controlled substances overdoses and analysis of various opioid analogues to controlled substance overdoses.

“(F) Working to enable and encourage the access, exchange, and use of information regarding controlled substance overdoses among data sources and entities.

“(c) Definitions.—In this section:

“(1) Controlled substance.—The term ‘controlled substance’ has the meaning given that term in section 102 of the Controlled Substances Act.

“(2) Indian tribe.—The term ‘Indian tribe’ has the meaning given that term in section 4 of the Indian Self-Determination and Education Assistance Act.

“(d) Authorization of Appropriations.—For purposes of carrying out this section, section 399O of this Act, and section 102 of the Comprehensive Addiction and Recovery Act of 2016 (Public Law 114–198), there is authorized to be appropriated $496,000,000 for each of fiscal years 2019 through 2023.”

(b)

Education and Awareness.— Section 102 of the Comprehensive Addiction and Recovery Act of 2016 (Public Law 114–198) is amended—

(1)

by amending subsection (a) to read as follows:

“(a) In General.—The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention and in coordination with the heads of other departments and agencies, shall advance education and awareness regarding the risks related to misuse and abuse of opioids, as appropriate, which may include developing or improving existing programs, conducting activities, and awarding grants that advance the education and awareness of—

“(1) the public, including patients and consumers—

“(A) generally; and

“(B) regarding such risks related to unused opioids and the dispensing options under section 309(f) of the Controlled Substances Act, as applicable; and

“(2) providers, which may include—

“(A) providing for continuing education on appropriate prescribing practices;

“(B) education related to applicable State or local prescriber limit laws, information on the use of non-addictive alternatives for pain management, and the use of overdose reversal drugs, as appropriate;

“(C) disseminating and improving the use of evidence-based opioid prescribing guidelines across relevant health care settings, as appropriate, and updating guidelines as necessary;

“(D) implementing strategies, such as best practices, to encourage and facilitate the use of prescriber guidelines, in accordance with State and local law;

“(E) disseminating information to providers about prescribing options for controlled substances, including such options under section 309(f) of the Controlled Substances Act, as applicable; and

“(F) disseminating information, as appropriate, on the National Pain Strategy developed by or in consultation with the Assistant Secretary for Health; and

“(3) other appropriate entities.”

; and

(2)

in subsection (b)—

(A)

by striking “ opioid abuse” each place such term appears and inserting “ opioid misuse and abuse”; and

(B)

in paragraph (2), by striking “ safe disposal of prescription medications and other” and inserting “ non-addictive treatment options, safe disposal options for prescription medications, and other applicable”.

SEC. 7162. Prescription Drug Monitoring Program.

Section 399O of the Public Health Service Act (42 U.S.C. 280g–3) is amended to read as follows:

“SEC. 399O. PRESCRIPTION DRUG MONITORING PROGRAM.

“(a) Program.—

“(1) In general.—Each fiscal year, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, in coordination with the heads of other departments and agencies as appropriate, shall support States or localities for the purpose of improving the efficiency and use of PDMPs, including—

“(A) establishment and implementation of a PDMP;

“(B) maintenance of a PDMP;

“(C) improvements to a PDMP by—

“(i) enhancing functional components to work toward—

“(I) universal use of PDMPs among providers and their delegates, to the extent that State laws allow;

“(II) more timely inclusion of data within a PDMP;

“(III) active management of the PDMP, in part by sending proactive or unsolicited reports to providers to inform prescribing; and

“(IV) ensuring the highest level of ease in use of and access to PDMPs by providers and their delegates, to the extent that State laws allow;

“(ii) in consultation with the Office of the National Coordinator for Health Information Technology, improving the intrastate interoperability of PDMPs by—

“(I) making PDMPs more actionable by integrating PDMPs within electronic health records and health information technology infrastructure; and

“(II) linking PDMP data to other data systems within the State, including—

“(aa) the data of pharmacy benefit managers, medical examiners and coroners, and the State’s Medicaid program;

“(bb) worker’s compensation data; and

“(cc) prescribing data of providers of the Department of Veterans Affairs and the Indian Health Service within the State;

“(iii) in consultation with the Office of the National Coordinator for Health Information Technology, improving the interstate interoperability of PDMPs through—

“(I) sharing of dispensing data in near-real time across State lines; and

“(II) integration of automated queries for multistate PDMP data and analytics into clinical workflow to improve the use of such data and analytics by practitioners and dispensers; or

“(iv) improving the ability to include treatment availability resources and referral capabilities within the PDMP.

“(2) Legislation.—As a condition on the receipt of support under this section, the Secretary shall require a State or locality to demonstrate that it has enacted legislation or regulations—

“(A) to provide for the implementation of the PDMP; and

“(B) to permit the imposition of appropriate penalties for the unauthorized use and disclosure of information maintained by the PDMP.

“(b) PDMP Strategies.—The Secretary shall encourage a State or locality, in establishing, improving, or maintaining a PDMP, to implement strategies that improve—

“(1) the reporting of dispensing in the State or locality of a controlled substance to an ultimate user so the reporting occurs not later than 24 hours after the dispensing event;

“(2) the consultation of the PDMP by each prescribing practitioner, or their designee, in the State or locality before initiating treatment with a controlled substance, or any substance as required by the State to be reported to the PDMP, and over the course of ongoing treatment for each prescribing event;

“(3) the consultation of the PDMP before dispensing a controlled substance, or any substance as required by the State to be reported to the PDMP;

“(4) the proactive notification to a practitioner when patterns indicative of controlled substance misuse by a patient, including opioid misuse, are detected;

“(5) the availability of data in the PDMP to other States, as allowable under State law; and

“(6) the availability of nonidentifiable information to the Centers for Disease Control and Prevention for surveillance, epidemiology, statistical research, or educational purposes.

“(c) Drug Misuse and Abuse.—In consultation with practitioners, dispensers, and other relevant and interested stakeholders, a State receiving support under this section—

“(1) shall establish a program to notify practitioners and dispensers of information that will help to identify and prevent the unlawful diversion or misuse of controlled substances;

“(2) may, to the extent permitted under State law, notify the appropriate authorities responsible for carrying out drug diversion investigations if the State determines that information in the PDMP maintained by the State indicates an unlawful diversion or abuse of a controlled substance;

“(3) may conduct analyses of controlled substance program data for purposes of providing appropriate State agencies with aggregate reports based on such analyses in as close to real-time as practicable, regarding prescription patterns flagged as potentially presenting a risk of misuse, abuse, addiction, overdose, and other aggregate information, as appropriate and in compliance with applicable Federal and State laws and provided that such reports shall not include protected health information; and

“(4) may access information about prescriptions, such as claims data, to ensure that such prescribing and dispensing history is updated in as close to real-time as practicable, in compliance with applicable Federal and State laws and provided that such information shall not include protected health information.

“(d) Evaluation and Reporting.—As a condition on receipt of support under this section, the State shall report on interoperability with PDMPs of other States and Federal agencies, where appropriate, intrastate interoperability with health information technology systems such as electronic health records, health information exchanges, and e-prescribing, where appropriate, and whether or not the State provides automatic, up-to-date, or daily information about a patient when a practitioner (or the designee of a practitioner, where permitted) requests information about such patient.

“(e) Evaluation and Reporting.—A State receiving support under this section shall provide the Secretary with aggregate nonidentifiable information, as permitted by State law, to enable the Secretary—

“(1) to evaluate the success of the State’s program in achieving the purpose described in subsection (a); or

“(2) to prepare and submit to the Congress the report required by subsection (i)(2).

“(f) Education and Access to the Monitoring System.—A State receiving support under this section shall take steps to—

“(1) facilitate prescribers and dispensers, and their delegates, as permitted by State law, to use the PDMP, to the extent practicable; and

“(2) educate prescribers and dispensers, and their delegates on the benefits of the use of PDMPs.

“(g) Electronic Format.—The Secretary may issue guidelines specifying a uniform electronic format for the reporting, sharing, and disclosure of information pursuant to PDMPs. To the extent possible, such guidelines shall be consistent with standards recognized by the Office of the National Coordinator for Health Information Technology.

“(h) Rules of Construction.—

“(1) Functions otherwise authorized by law.—Nothing in this section shall be construed to restrict the ability of any authority, including any local, State, or Federal law enforcement, narcotics control, licensure, disciplinary, or program authority, to perform functions otherwise authorized by law.

“(2) Additional privacy protections.—Nothing in this section shall be construed as preempting any State from imposing any additional privacy protections.

“(3) Federal privacy requirements.—Nothing in this section shall be construed to supersede any Federal privacy or confidentiality requirement, including the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 2033) and section 543 of this Act.

“(4) No federal private cause of action.—Nothing in this section shall be construed to create a Federal private cause of action.

“(i) Progress Report.—Not later than 3 years after the date of enactment of this section, the Secretary shall—

“(1) complete a study that—

“(A) determines the progress of grantees in establishing and implementing PDMPs consistent with this section;

“(B) provides an analysis of the extent to which the operation of PDMPs has—

“(i) reduced inappropriate use, abuse, diversion of, and overdose with, controlled substances;

“(ii) established or strengthened initiatives to ensure linkages to substance use disorder treatment services; or

“(iii) affected patient access to appropriate care in States operating PDMPs;

“(C) determine the progress of grantees in achieving interstate interoperability and intrastate interoperability of PDMPs, including an assessment of technical, legal, and financial barriers to such progress and recommendations for addressing these barriers;

“(D) determines the progress of grantees in implementing near real-time electronic PDMPs;

“(E) provides an analysis of the privacy protections in place for the information reported to the PDMP in each State or locality receiving support under this section and any recommendations of the Secretary for additional Federal or State requirements for protection of this information;

“(F) determines the progress of States or localities in implementing technological alternatives to centralized data storage, such as peer-to-peer file sharing or data pointer systems, in PDMPs and the potential for such alternatives to enhance the privacy and security of individually identifiable data; and

“(G) evaluates the penalties that States or localities have enacted for the unauthorized use and disclosure of information maintained in PDMPs, and the criteria used by the Secretary to determine whether such penalties qualify as appropriate for purposes of subsection (a)(2); and

“(2) submit a report to the Congress on the results of the study.

“(j) Advisory Council.—

“(1) Establishment.—A State or locality may establish an advisory council to assist in the establishment, improvement, or maintenance of a PDMP consistent with this section.

“(2) Limitation.—A State or locality may not use Federal funds for the operations of an advisory council to assist in the establishment, improvement, or maintenance of a PDMP.

“(3) Sense of congress.—It is the sense of the Congress that, in establishing an advisory council to assist in the establishment, improvement, or maintenance of a PDMP, a State or locality should consult with appropriate professional boards and other interested parties.

“(k) Definitions.—For purposes of this section:

“(1) The term ‘controlled substance’ means a controlled substance (as defined in section 102 of the Controlled Substances Act) in schedule II, III, or IV of section 202 of such Act.

“(2) The term ‘dispense’ means to deliver a controlled substance to an ultimate user by, or pursuant to the lawful order of, a practitioner, irrespective of whether the dispenser uses the Internet or other means to effect such delivery.

“(3) The term ‘dispenser’ means a physician, pharmacist, or other person that dispenses a controlled substance to an ultimate user.

“(4) The term ‘interstate interoperability’ with respect to a PDMP means the ability of the PDMP to electronically share reported information with another State if the information concerns either the dispensing of a controlled substance to an ultimate user who resides in such other State, or the dispensing of a controlled substance prescribed by a practitioner whose principal place of business is located in such other State.

“(5) The term ‘intrastate interoperability’ with respect to a PDMP means the integration of PDMP data within electronic health records and health information technology infrastructure or linking of a PDMP to other data systems within the State, including the State’s Medicaid program, workers’ compensation programs, and medical examiners or coroners.

“(6) The term ‘nonidentifiable information’ means information that does not identify a practitioner, dispenser, or an ultimate user and with respect to which there is no reasonable basis to believe that the information can be used to identify a practitioner, dispenser, or an ultimate user.

“(7) The term ‘PDMP’ means a prescription drug monitoring program that is State-controlled.

“(8) The term ‘practitioner’ means a physician, dentist, veterinarian, scientific investigator, pharmacy, hospital, or other person licensed, registered, or otherwise permitted, by the United States or the jurisdiction in which the individual practices or does research, to distribute, dispense, conduct research with respect to, administer, or use in teaching or chemical analysis, a controlled substance in the course of professional practice or research.

“(9) The term ‘State’ means each of the 50 States, the District of Columbia, and any commonwealth or territory of the United States.

“(10) The term ‘ultimate user’ means a person who has obtained from a dispenser, and who possesses, a controlled substance for the person’s own use, for the use of a member of the person’s household, or for the use of an animal owned by the person or by a member of the person’s household.

“(11) The term ‘clinical workflow’ means the integration of automated queries for prescription drug monitoring programs data and analytics into health information technologies such as electronic health record systems, health information exchanges, and/or pharmacy dispensing software systems, thus streamlining provider access through automated queries.”

Subtitle R Review of Substance Use Disorder Treatment Providers Receiving Federal Funding

SEC. 7171. Review of Substance Use Disorder Treatment Providers Receiving Federal Funding.

(a)

In General.— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall conduct a review of entities that receive Federal funding for the provision of substance use disorder treatment services. The review shall include:

(1)

The length of time the entity has provided substance use disorder treatment services and the geographic area served by the entity.

(2)

A detailed analysis of the patient population served by the entity, including but not limited to the number of patients, types of diagnosed substance use disorders and the demographic information of such patients, including sex, race, ethnicity, and socioeconomic status.

(3)

Detailed information on the types of substance use disorders for which the entity has the experience, capability, and capacity to provide such services.

(4)

An analysis of how the entity handles patients requiring treatment for a substance use disorder that the organization is not able to treat.

(5)

An analysis of what is needed in order to improve the entity’s ability to meet the addiction treatment needs of the communities served by that entity.

(6)

Based on the identified needs of the communities served, a description of unmet needs and inadequate services and how such needs and services could be better addressed to treat individuals with methamphetamine, cocaine, including crack cocaine, heroin, opioid, and other substance use disorders.

(b)

Report.— Not later than 2 years after the date of the enactment of this Act, the Secretary shall develop and submit to Congress a plan to direct appropriate resources to entities that provide substance use disorder treatment services in order to address inadequacies in services or funding identified through the survey described in subsection (a).

Subtitle S Other Health Provisions

SEC. 7181. State Response to the Opioid Abuse Crisis.

(a)

In General.— Section 1003 of the 21st Century Cures Act (Public Law 114–255) is amended—

(1)

in subsection (a)—

(A)

by striking “ the authorization of appropriations under subsection (b) to carry out the grant program described in subsection (c)” and inserting “ subsection (h) to carry out the grant program described in subsection (b)”; and

(B)

by inserting “ and Indian Tribes” after “ States”;

(2)

by striking subsection (b);

(3)

by redesignating subsections (c) through (e) as subsections (b) through (d), respectively;

(4)

by redesignating subsection (f) as subsection (j);

(5)

in subsection (b), as so redesignated—

(A)

in paragraph (1)—

(i)

in the paragraph heading, by inserting “ and tribal” after “ State”;

(ii)

by striking “ States for the purpose of addressing the opioid abuse crisis within such States” and inserting “ States and Indian Tribes for the purpose of addressing the opioid abuse crisis within such States and Indian Tribes”;

(iii)

by inserting “ or Indian Tribes” after “ preference to States”; and

(iv)

by inserting before the period of the second sentence “ or other Indian Tribes, as applicable”; and

(B)

in paragraph (2)—

(i)

in the matter preceding subparagraph (A), by striking “ to a State”;

(ii)

in subparagraph (A), by striking “ Improving State” and inserting “ Establishing or improving”;

(iii)

in subparagraph (C), by inserting “ preventing diversion of controlled substances,” after “ treatment programs,”; and

(iv)

in subparagraph (E), by striking “ as the State determines appropriate, related to addressing the opioid abuse crisis within the State” and inserting “ 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”;

(6)

in subsection (c), as so redesignated, by striking “ subsection (c)” and inserting “ subsection (b)”;

(7)

in subsection (d), as so redesignated—

(A)

in the matter preceding paragraph (1), by striking “ the authorization of appropriations under subsection (b)” and inserting “ subsection (h)”; and

(B)

in paragraph (1), by striking “ subsection (c)” and inserting “ subsection (b)”; and

(8)

by inserting after subsection (d), as so redesignated, the following:

“(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.”

(b)

Conforming Amendment.— Section 1004(c) of the 21st Century Cures Act (Public Law 114–255) is amended by striking “ , the FDA Innovation Account, or the Account For the State Response to the Opioid Abuse Crisis” and inserting “ or the FDA Innovation Account”.

SEC. 7182. Report on Investigations Regarding Parity in Mental Health and Substance Use Disorder Benefits.

(a)

In General.— Section 13003 of the 21st Century Cures Act (Public Law 114–255) is amended—

(1)

in subsection (a)—

(A)

by striking “ with findings of any serious violation regarding” and inserting “ concerning”; and

(B)

by inserting “ and the Committee on Education and the Workforce” after “ Energy and Commerce”; and

(2)

in subsection (b)(1)—

(A)

by inserting “ complaints received and number of” before “ closed”; and

(B)

by inserting before the period “ , and, for each such investigation closed, which agency conducted the investigation, whether the health plan that is the subject of the investigation is fully insured or not fully insured and a summary of any coordination between the applicable State regulators and the Department of Labor, the Department of Health and Human Services, or the Department of the Treasury, and references to any guidance provided by the agencies addressing the category of violation committed”.

(b)

Applicability.— The amendments made by subsection (a) shall apply with respect to the second annual report required under such section 13003 and each such annual report thereafter.

SEC. 7183. Career Act.

(a)

In General.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”), in consultation with the Secretary of Labor, shall continue or establish a program to support individuals in substance use disorder treatment and recovery to live independently and participate in the workforce.

(b)

Grants Authorized.— In carrying out the activities under this section, the Secretary shall, on a competitive basis, award grants for a period of not more than 5 years to entities to enable such entities to carry out evidence-based programs to help individuals in substance use disorder treatment and recovery to live independently and participate in the workforce. Such entities shall coordinate, as applicable, with Indian tribes or tribal organizations (as applicable), State boards and local boards (as defined in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102), lead State agencies with responsibility for a workforce investment activity (as defined in such section 3), and State agencies responsible for carrying out substance use disorder prevention and treatment programs.

(c)

Priority.—

(1)

In general.— In awarding grants under this section, the Secretary shall give priority based on the State in which the entity is located. Priority shall be given among States according to a formula based on the rates described in paragraph (2) and weighted as described in paragraph (3).

(2)

Rates.— The rates described in this paragraph are the following:

(A)

The amount by which the rate of drug overdose deaths in the State, adjusted for age, is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention.

(B)

The amount by which the rate of unemployment for the State, based on data provided by the Bureau of Labor Statistics for the preceding 5 calendar years for which there is available data, is above the national average.

(C)

The amount by which rate of labor force participation in the State, based on data provided by the Bureau of Labor Statistics for the preceding 5 calendar years for which there is available data, is below the national average.

(3)

Weighting.— The rates described in paragraph (2) shall be weighted as follows:

(A)

The rate described in paragraph (2)(A) shall be weighted 70 percent.

(B)

The rate described in paragraph (2)(B) shall be weighted 15 percent.

(C)

The rate described in paragraph (2)(C) shall be weighted 15 percent.

(d)

Preference.— In awarding grants under this section, the Secretary shall give preference to entities located in areas within States with the greatest need, with such need based on the highest mortality rate related to substance use disorder.

(e)

Definitions.— In this section:

(1)

Eligible entity.— The term “eligible entity” means an entity that offers treatment or recovery services for individuals with substance use disorders, and partners with one or more local or State stakeholders, which may include local employers, community organizations, the local workforce development board, local and State governments, and Indian Tribes or tribal organizations, to support recovery, independent living, and participation in the workforce.

(2)

Indian tribes; tribal organization.— The terms “Indian Tribe” and “tribal organization” have the meanings given the terms “Indian tribe” and “tribal organization” in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

(3)

State.— The term “State” includes only the several States and the District of Columbia.

(f)

Applications.— An eligible entity shall submit an application at such time and in such manner as the Secretary may require. In submitting an application, the entity shall demonstrate the ability to partner with local stakeholders, which may include local employers, community stakeholders, the local workforce development board, local and State governments, and Indian Tribes or tribal organizations, as applicable, to—

(1)

identify gaps in the workforce due to the prevalence of substance use disorders;

(2)

in coordination with statewide employment and training activities, including coordination and alignment of activities carried out by entities provided grant funds under section 8041, help individuals in recovery from a substance use disorder transition into the workforce, including by providing career services, training services as described in paragraph (2) of section 134(c) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3174(c)), and related services described in section 134(a)(3) of such Act (42 U.S.C. 3174(a)); and

(3)

assist employers with informing their employees of the resources, such as resources related to substance use disorders that are available to their employees.

(g)

Use of Funds.— An entity receiving a grant under this section shall use the funds to conduct one or more of the following activities:

(1)

Hire case managers, care coordinators, providers of peer recovery support services, as described in section 547(a) of the Public Health Service Act (42 U.S.C. 290ee–2(a)), or other professionals, as appropriate, to provide services that support treatment, recovery, and rehabilitation, and prevent relapse, recidivism, and overdose, including by encouraging—

(A)

the development and strengthening of daily living skills; and

(B)

the use of counseling, care coordination, and other services, as appropriate, to support recovery from substance use disorders.

(2)

Implement or utilize innovative technologies, which may include the use of telemedicine.

(3)

In coordination with the lead State agency with responsibility for a workforce investment activity or local board described in subsection (b), provide—

(A)

short-term prevocational training services; and

(B)

training services that are directly linked to the employment opportunities in the local area or the planning region.

(h)

Support for State Strategy.— An eligible entity shall include in its application under subsection (f) information describing how the services and activities proposed in such application are aligned with the State, outlying area, or Tribal strategy, as applicable, for addressing issues described in such application and how such entity will coordinate with existing systems to deliver services as described in such application.

(i)

Data Reporting and Program Oversight.— Each eligible entity awarded a grant under this section shall submit to the Secretary a report at such time and in such manner as the Secretary may require. Such report shall include a description of—

(1)

the programs and activities funded by the grant;

(2)

outcomes of the population of individuals with a substance use disorder the grantee served through activities described in subsection (g); and

(3)

any other information that the Secretary may require for the purpose of ensuring that the grantee is complying with all of the requirements of the grant.

(j)

Reports to Congress.—

(1)

Preliminary report.— Not later than 2 years after the end of the first year of the grant period under this section, the Secretary shall submit to Congress a preliminary report that analyzes reports submitted under subsection (i).

(2)

Final report.— Not later than 2 years after submitting the preliminary report required under paragraph (1), the Secretary shall submit to Congress a final report that includes—

(A)

a description of how the grant funding was used, including the number of individuals who received services under subsection (g)(3) and an evaluation of the effectiveness of the activities conducted by the grantee with respect to outcomes of the population of individuals with substance use disorder who receive services from the grantee; and

(B)

recommendations related to best practices for health care professionals to support individuals in substance use disorder treatment or recovery to live independently and participate in the workforce.

(k)

Authorization of Appropriations.— There is authorized to be appropriated $5,000,000 for each of fiscal years 2019 through 2023 for purposes of carrying out this section.