S3663-118

1. Short title This Act may be cited as the Turn the Tide Act.

714. Authorization of appropriations; appropriations To carry out this title, except activities otherwise specified, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $50,000,000 for each of fiscal years 2024 through 2027, to remain available until expended.

6. Eliminating insurance barriers to medication-assisted treatment Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended— in paragraph (26), by striking ; or and inserting a semicolon; in paragraph (27), by striking the period at the end and inserting ; or; and by inserting after paragraph (27) the following new paragraph: with respect to any amount expended for medical assistance for medication-assisted treatment (as defined in section 1905(ee)) if the State imposes any utilization control policies or procedures (as defined by the Secretary), including any prior authorization requirements, with respect to the provision of such assistance; or Section 1905(a)(29) of the Social Security Act (42 U.S.C. 1396d(a)(29)) is amended by inserting and section 1903(i)(28) after subsection (ee). The amendments made by this subsection take effect on October 1, 2024. (28)with respect to any amount expended for medical assistance for medication-assisted treatment (as defined in section 1905(ee)) if the State imposes any utilization control policies or procedures (as defined by the Secretary), including any prior authorization requirements, with respect to the provision of such assistance; or.

7. Limitations on cost-sharing for opioid overdose reversal medications Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following: A group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide coverage for, and shall not impose any cost-sharing requirement under the plan or coverage with respect to at least one formulation of an opioid overdose reversal agent. A group health plan or health insurance issuer offering group or individual health insurance coverage shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan or coverage. Such a plan or issuer may apply medical management practices in providing the benefits described in subsection (a). In this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use): Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids. Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression. Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amend by adding at the end the following: A group health plan or a health insurance issuer offering group health insurance coverage shall provide coverage for, and shall not impose any cost-sharing requirement under the plan or coverage with respect to at least one formulation of an opioid overdose reversal agent. A group health plan or health insurance issuer offering group health insurance coverage shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan or coverage. Such a plan or issuer may apply medical management practices in providing the benefits described in subsection (a). In this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use): Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids. Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression. The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following new item: Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following: A group health plan shall provide coverage for, and shall not impose any cost-sharing requirement under the plan with respect to at least one formulation of an opioid overdose reversal agent. A group health plan shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan. Such a plan may apply medical management practices in providing the benefits described in subsection (a). In this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use): Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids. Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression. The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: The amendments made by this subsection shall apply to plan years beginning on or after January 1, 2025. Paragraph (2) of section 223(c) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph: A plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for opioid overdose reversal agents (as defined in section 9826(c)). The amendment made by this section shall apply to plan years beginning on or after January 1, 2025. Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is amended— in subsection (b)— in paragraph (1)(A), in the matter preceding clause (i), by striking and (9) and inserting , (9), and (10); in paragraph (2)(A), in the matter preceding clause (i), by striking and (9) and inserting , (9), and (10); and by adding at the end the following new paragraph: For plan year 2025 and each subsequent plan year, each prescription drug plan and MA–PD plan shall not impose any cost-sharing requirement under the plan with respect to at least one brand or generic version of an opioid overdose reversal agent (as defined in section 2799A–11 of the Public Health Service Act). The requirement under the preceding sentence shall also apply to cost-sharing applicable to subsidy eligible individuals under section 1814D–14. For purposes of subparagraph (A), the elimination of cost-sharing shall include the following: The waiver of the deductible under paragraph (1). The waiver of coinsurance under paragraph (2). in subsection (c), by adding at the end the following new paragraph: The coverage is provided in accordance with subsection (b)(10). Section 1860D–14(a) of the Social Security Act (42 U.S.C. 1395w–114(a)) is amended— in paragraph (1), in the matter preceding subparagraph (A), by striking In the case and inserting Subject to section 1860D–2(b)(10), in the case; and in paragraph (2), in the matter preceding subparagraph (A), by striking In the case and inserting Subject to section 1860D–2(b)(10), in the case. 2799A–11.Limitations on cost-sharing for opioid overdose reversal agents(a)In generalA group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide coverage for, and shall not impose any cost-sharing requirement under the plan or coverage with respect to at least one formulation of an opioid overdose reversal agent.(b)Utilization control policies; medical managementA group health plan or health insurance issuer offering group or individual health insurance coverage shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan or coverage. Such a plan or issuer may apply medical management practices in providing the benefits described in subsection (a).(c)DefinitionIn this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use):(1)Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids.(2)Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression.. 726.Limitations on cost-sharing for opioid overdose reversal agents(a)In generalA group health plan or a health insurance issuer offering group health insurance coverage shall provide coverage for, and shall not impose any cost-sharing requirement under the plan or coverage with respect to at least one formulation of an opioid overdose reversal agent.(b)Utilization control policies; medical managementA group health plan or health insurance issuer offering group health insurance coverage shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan or coverage. Such a plan or issuer may apply medical management practices in providing the benefits described in subsection (a).(c)DefinitionIn this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use):(1)Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids.(2)Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression.. Sec. 726. Limitations on cost-sharing for opioid overdose reversal agents.. 9826.Limitations on cost-sharing for opioid overdose reversal agents(a)In generalA group health plan shall provide coverage for, and shall not impose any cost-sharing requirement under the plan with respect to at least one formulation of an opioid overdose reversal agent.(b)Utilization control policies; medical managementA group health plan shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan. Such a plan may apply medical management practices in providing the benefits described in subsection (a).(c)DefinitionIn this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use):(1)Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids.(2)Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression.. Sec. 9826. Limitations on cost-sharing for opioid overdose reversal agents.. (H)Safe harbor for absence of deductible for opioid overdose reversal agentsA plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for opioid overdose reversal agents (as defined in section 9826(c)).. (10)Limitations on cost-sharing for opioid overdose reversal agents(A)In generalFor plan year 2025 and each subsequent plan year, each prescription drug plan and MA–PD plan shall not impose any cost-sharing requirement under the plan with respect to at least one brand or generic version of an opioid overdose reversal agent (as defined in section 2799A–11 of the Public Health Service Act). The requirement under the preceding sentence shall also apply to cost-sharing applicable to subsidy eligible individuals under section 1814D–14.(B)Cost-sharingFor purposes of subparagraph (A), the elimination of cost-sharing shall include the following:(i)No application of deductibleThe waiver of the deductible under paragraph (1).(ii)No application of coinsuranceThe waiver of coinsurance under paragraph (2).; and (7)Treatment of cost-sharing for opioid overdose reversal agentsThe coverage is provided in accordance with subsection (b)(10)..

2799A–11. Limitations on cost-sharing for opioid overdose reversal agents A group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide coverage for, and shall not impose any cost-sharing requirement under the plan or coverage with respect to at least one formulation of an opioid overdose reversal agent. A group health plan or health insurance issuer offering group or individual health insurance coverage shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan or coverage. Such a plan or issuer may apply medical management practices in providing the benefits described in subsection (a). In this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use): Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids. Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression.

726. Limitations on cost-sharing for opioid overdose reversal agents A group health plan or a health insurance issuer offering group health insurance coverage shall provide coverage for, and shall not impose any cost-sharing requirement under the plan or coverage with respect to at least one formulation of an opioid overdose reversal agent. A group health plan or health insurance issuer offering group health insurance coverage shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan or coverage. Such a plan or issuer may apply medical management practices in providing the benefits described in subsection (a). In this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use): Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids. Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression.

9826. Limitations on cost-sharing for opioid overdose reversal agents A group health plan shall provide coverage for, and shall not impose any cost-sharing requirement under the plan with respect to at least one formulation of an opioid overdose reversal agent. A group health plan shall not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to opioid overdose reversal agents covered under the plan. Such a plan may apply medical management practices in providing the benefits described in subsection (a). In this section, the term opioid overdose reversal agent means a drug or biological product approved by the Food and Drug Administration for one of the following uses (or a similar use): Complete or partial reversal of opioid depression, including respiratory depression, induced by opioids. Emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression.

9. Medicaid payments for behavioral health and mental health providers Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended— in subsection (a)(13)— by striking and at the end of subparagraph (B); by adding and at the end of subparagraph (C); and by adding at the end the following new subparagraph: payment for mental health and behavioral health services (as defined in subsection (uu)(1)) furnished on or after October 1, 2024, and before October 1, 2028, by a physician or applicable professional (as defined in subsection (uu)(2)) at a rate that is not less than 100 percent of the payment rate that applies to such services and physician or applicable professional under part B of title XVIII (or, if greater, the payment rate that would be applicable under such part if the conversion factor under section 1848(d) for the year involved were the conversion factor under such section for 2024, and, if such services are not covered under such part, the reasonable and customary rate the Secretary determines would apply to such services and physician or applicable professional); by adding at the end the following new subsection: For purposes of subsection (a)(13)(D): The term mental health and behavioral health services means the following services, when provided to a patient with a diagnosis of substance use disorder (as defined in subparagraph (B)) as a part of the management or treatment of the patient’s substance use disorder (as determined in accordance with regulations promulgated by the Secretary under subparagraph (C)): Evaluation and management services that are procedure codes (for services covered under title XVIII) for services in the category designated Evaluation and Management in the Healthcare Common Procedure Coding System (established by the Secretary under section 1848(c)(5) as of December 31, 2020, and as subsequently modified). Counseling services, as defined by the Secretary. Payment codes established by the Secretary for opioid use disorder treatment services under section 1866F. Any other services the Secretary determines are necessary for the management or treatment of a patient with a diagnosis of substance use disorder. For purposes of subparagraph (A), the term patient with a diagnosis of substance use disorder means an individual who has been diagnosed with 1 or more diagnosis codes within the code set entitled the Mental health and behavioral disorders due to psychoactive substance use under the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Not later than 90 days after the enactment of this subsection, the Secretary shall promulgate regulations regarding when services are sufficiently related to part of the management or treatment of a patient’s substance use disorder. The term applicable professional means— a clinical psychologist (as defined for purposes of section 1861(ii)); a clinical social worker (as defined in section 1861(hh)(1)); a medical professional approved to furnish medication-assisted treatment under section 303(g)(2) of the Controlled Substances Act; or a medical professional that is authorized under the State plan or under a waiver of such plan to furnish mental and behavioral health services (as defined in paragraph (1)). Section 1932(f) of such Act (42 U.S.C. 1396u–2(f)) is amended— in the subsection heading, by inserting and mental health and behavioral health services after care services; and by inserting before the period at the end the following: , and, in the case of mental health and behavioral health services described in section 1902(a)(13)(D), consistent with the minimum payment rates specified in such section (regardless of the manner in which such payments are made, including in the form of capitation or partial capitation). Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— in subsection (b), by striking and (ii) and inserting (ii), and (jj); and by adding at the end the following new subsection: Notwithstanding subsection (b), with respect to the portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(D) furnished on or after October 1, 2024, and before October 1, 2028, that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan or a waiver of such plan as of July 1, 2024, the Federal medical assistance percentage for a State shall be equal to 100 percent. The preceding sentence shall not be construed as prohibiting the payment of Federal financial participation based on the Federal medical assistance percentage for the portion of the amounts expended for medical assistance for such services that is attributable to the amount (if any) by which the payment rate applicable to such services under the State plan or waiver exceeds such minimum payment rate. The amount of any payment made for expenditures on medical assistance that is attributable to the application of the Federal medical assistance percentage described in paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108. (D)payment for mental health and behavioral health services (as defined in subsection (uu)(1)) furnished on or after October 1, 2024, and before October 1, 2028, by a physician or applicable professional (as defined in subsection (uu)(2)) at a rate that is not less than 100 percent of the payment rate that applies to such services and physician or applicable professional under part B of title XVIII (or, if greater, the payment rate that would be applicable under such part if the conversion factor under section 1848(d) for the year involved were the conversion factor under such section for 2024, and, if such services are not covered under such part, the reasonable and customary rate the Secretary determines would apply to such services and physician or applicable professional);; and (uu)Mental health and behavioral health servicesFor purposes of subsection (a)(13)(D):(1)Mental health and behavioral health services(A)In generalThe term mental health and behavioral health services means the following services, when provided to a patient with a diagnosis of substance use disorder (as defined in subparagraph (B)) as a part of the management or treatment of the patient’s substance use disorder (as determined in accordance with regulations promulgated by the Secretary under subparagraph (C)):(i)Evaluation and management services that are procedure codes (for services covered under title XVIII) for services in the category designated Evaluation and Management in the Healthcare Common Procedure Coding System (established by the Secretary under section 1848(c)(5) as of December 31, 2020, and as subsequently modified).(ii)Counseling services, as defined by the Secretary.(iii)Payment codes established by the Secretary for opioid use disorder treatment services under section 1866F.(iv)Any other services the Secretary determines are necessary for the management or treatment of a patient with a diagnosis of substance use disorder.(B)Patient with a diagnosis of substance use disorderFor purposes of subparagraph (A), the term patient with a diagnosis of substance use disorder means an individual who has been diagnosed with 1 or more diagnosis codes within the code set entitled the Mental health and behavioral disorders due to psychoactive substance use under the 10th revision of the International Statistical Classification of Diseases and Related Health Problems.(C)RegulationsNot later than 90 days after the enactment of this subsection, the Secretary shall promulgate regulations regarding when services are sufficiently related to part of the management or treatment of a patient’s substance use disorder.(2)Applicable professionalThe term applicable professional means—(A)a clinical psychologist (as defined for purposes of section 1861(ii));(B)a clinical social worker (as defined in section 1861(hh)(1));(C)a medical professional approved to furnish medication-assisted treatment under section 303(g)(2) of the Controlled Substances Act; or(D)a medical professional that is authorized under the State plan or under a waiver of such plan to furnish mental and behavioral health services (as defined in paragraph (1)).. (jj)Increased FMAP for additional expenditures for mental health and behavioral health services(1)In generalNotwithstanding subsection (b), with respect to the portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(D) furnished on or after October 1, 2024, and before October 1, 2028, that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan or a waiver of such plan as of July 1, 2024, the Federal medical assistance percentage for a State shall be equal to 100 percent. The preceding sentence shall not be construed as prohibiting the payment of Federal financial participation based on the Federal medical assistance percentage for the portion of the amounts expended for medical assistance for such services that is attributable to the amount (if any) by which the payment rate applicable to such services under the State plan or waiver exceeds such minimum payment rate.(2)Disregard of enhanced payments for purposes of territorial limitsThe amount of any payment made for expenditures on medical assistance that is attributable to the application of the Federal medical assistance percentage described in paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108..

10. CMI demonstration to test the provision of recovery housing for individuals with opioid use disorder under Medicaid Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended— in subsection (b)(2)(A), by adding at the end the following new sentence: The models selected under this subparagraph shall include the demonstration described in subsection (h) (which shall be implemented not later than 18 months after the date of enactment of such subsection).; and by adding at the end the following new subsection: The CMI, in consultation with the Secretary of Housing and Urban Development and other agencies, as the Secretary determines appropriate, shall conduct a demonstration project (referred to in this subsection as the demonstration) to test whether providing Medicaid managed care entities with an elevated global capitated budget for eligible Medicaid beneficiaries, paired with flexibilities to allow States to provide medical assistance for recovery housing for such beneficiaries, would result in reduced emergency department visits, hospitalizations, and program expenditures under per beneficiary, or improve quality of care for the such beneficiaries without increasing expenditures under the Medicaid program under title XIX. Under the demonstration, each eligible State that is selected by the CMI to participate in the demonstration shall enter into an agreement with a Medicaid managed care entity under which the entity agrees to provide services (including recovery housing) to eligible Medicaid beneficiaries under a payment model that meets the requirements of subparagraph (B). The CMI shall establish a capitated payments system for Medicaid managed care entities under the demonstration that is based on the demonstration budget determined under clause (ii). For purposes of clause (i), the demonstration budget of a Medicaid managed care entity for each year of a demonstration period shall be determined by the CMI based on the number of eligible Medicaid beneficiaries enrolled with the entity and the average annual spending under title XIX in the State involved on individuals who are enrolled in the State plan under such title (or a waiver of such plan) and who— have a diagnosis of opioid use disorder; are in the top quartile of per beneficiary spending for such plan or waiver for the most recent year; and have attained age 21 but have not attained age 65. The CMI may adjust the demonstration budget determined for a Medicaid managed care entity and a year under this clause using a risk adjustment model selected by the CMI to account for differences in age and clinical conditions of the eligible Medicaid beneficiaries enrolled with the entity compared to the overall population upon which the demonstration budget is based. Not later than 1 year after the date of enactment of this subsection, the CMI shall select not less than 2 eligible States to participate in the demonstration. In addition to the authority described in subsection (d)(1), the Secretary may waive such requirements of title XIX as necessary to carry out the demonstration. In this subsection: The term eligible Medicaid beneficiary means an individual who— is eligible for medical assistance under a State plan under title XIX or a waiver of such a plan; has a diagnosis of opioid use disorder; does not have a permanent residence (as certified by the individual); is currently receiving medication-assisted treatment or completed a course of medication-assisted treatment during the 3-month period preceding the individual's participation in the demonstration; and has attained age 21 but has not attained age 65. The term eligible State means a State that— makes medical assistance available to all individuals described in section 1902(a)(10)(A)(i)(VIII); and agrees to participate in the demonstration. In selecting eligible States to participate in the demonstration, the CMI shall give priority to States that are— among the top 10 States in terms of highest per capita drug poisoning deaths in each of calendar years 2019, 2020, and 2021, based on the most recent data available from the Centers for Disease Control and Prevention; and among the 10 States with the lowest physician reimbursement rates for services furnished under title XIX (as determined by the Secretary) in each of calendar years 2019, 2020, and 2021. The term managed care entity means a medicaid managed care organization described in section 1932(a)(1)(B)(i). 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. The term State includes the 50 States and the District of Columbia. (h)Demonstration To test the provision of recovery housing for individuals with opioid use disorder under Medicaid(1)In generalThe CMI, in consultation with the Secretary of Housing and Urban Development and other agencies, as the Secretary determines appropriate, shall conduct a demonstration project (referred to in this subsection as the demonstration) to test whether providing Medicaid managed care entities with an elevated global capitated budget for eligible Medicaid beneficiaries, paired with flexibilities to allow States to provide medical assistance for recovery housing for such beneficiaries, would result in reduced emergency department visits, hospitalizations, and program expenditures under per beneficiary, or improve quality of care for the such beneficiaries without increasing expenditures under the Medicaid program under title XIX.(2)Demonstration requirements(A)In generalUnder the demonstration, each eligible State that is selected by the CMI to participate in the demonstration shall enter into an agreement with a Medicaid managed care entity under which the entity agrees to provide services (including recovery housing) to eligible Medicaid beneficiaries under a payment model that meets the requirements of subparagraph (B).(B)Capitated payments(i)In generalThe CMI shall establish a capitated payments system for Medicaid managed care entities under the demonstration that is based on the demonstration budget determined under clause (ii).(ii)Demonstration budget(I)In generalFor purposes of clause (i), the demonstration budget of a Medicaid managed care entity for each year of a demonstration period shall be determined by the CMI based on the number of eligible Medicaid beneficiaries enrolled with the entity and the average annual spending under title XIX in the State involved on individuals who are enrolled in the State plan under such title (or a waiver of such plan) and who—(aa)have a diagnosis of opioid use disorder; (bb)are in the top quartile of per beneficiary spending for such plan or waiver for the most recent year; and (cc)have attained age 21 but have not attained age 65.(II)Risk adjustmentThe CMI may adjust the demonstration budget determined for a Medicaid managed care entity and a year under this clause using a risk adjustment model selected by the CMI to account for differences in age and clinical conditions of the eligible Medicaid beneficiaries enrolled with the entity compared to the overall population upon which the demonstration budget is based.(C)Selection of eligible StatesNot later than 1 year after the date of enactment of this subsection, the CMI shall select not less than 2 eligible States to participate in the demonstration.(3)Additional waiver authorityIn addition to the authority described in subsection (d)(1), the Secretary may waive such requirements of title XIX as necessary to carry out the demonstration.(4)DefinitionsIn this subsection:(A)Eligible Medicaid beneficiaryThe term eligible Medicaid beneficiary means an individual who— (i)is eligible for medical assistance under a State plan under title XIX or a waiver of such a plan;(ii)has a diagnosis of opioid use disorder; (iii)does not have a permanent residence (as certified by the individual); (iv)is currently receiving medication-assisted treatment or completed a course of medication-assisted treatment during the 3-month period preceding the individual's participation in the demonstration; and(v)has attained age 21 but has not attained age 65.(B)Eligible State(i)In generalThe term eligible State means a State that— (I)makes medical assistance available to all individuals described in section 1902(a)(10)(A)(i)(VIII); and(II)agrees to participate in the demonstration.(ii)Selection of eligible StatesIn selecting eligible States to participate in the demonstration, the CMI shall give priority to States that are—(I)among the top 10 States in terms of highest per capita drug poisoning deaths in each of calendar years 2019, 2020, and 2021, based on the most recent data available from the Centers for Disease Control and Prevention; and(II)among the 10 States with the lowest physician reimbursement rates for services furnished under title XIX (as determined by the Secretary) in each of calendar years 2019, 2020, and 2021.(C)Managed care entityThe term managed care entity means a medicaid managed care organization described in section 1932(a)(1)(B)(i).(D)Recovery housingThe 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. (E)StateThe term State includes the 50 States and the District of Columbia..

11. Extension of Medicaid delivery system reform and incentive payment waivers In the case of a Medicaid section 1115 waiver described in subsection (b), not later than 60 days after the date of enactment of this Act, the Secretary of Health and Human Services shall— extend the termination date for the waiver to December 31, 2026 (or such earlier date as the State conducting the waiver may elect); apply the same annual dollar allotment for the period for which the waiver is extended under paragraph (1) as the annual dollar allotment that applied to the waiver period in effect on the date of enactment of this Act; and allow any State with such a waiver to use funds provided during the period for which the waiver is extended under paragraph (1) to support the training of direct service workers that provide home and community-based services. The Medicaid section 1115 waiver described in this subsection is a waiver approved under section 1115 of the Social Security Act (42 U.S.C. 1315) relating to delivery system reform incentive payments that— as of the date of enactment of this Act, is to terminate on or before December 31, 2024; was in effect as of January 1, 2022; and was approved for any State that is among the top 10 States in terms of highest per capita drug poisoning deaths in each of calendar years 2019, 2020, and 2021, based on the most recent data available from the Centers for Disease Control and Prevention.

12. Expanding Drug-Free Communities support grants Section 1032 of the Anti-Drug Abuse Act of 1988 (21 U.S.C. 1532) is amended— in subsection (b)— in paragraph (3)— in subparagraph (A), by striking subparagraph (F) and inserting subparagraph (H); by redesignating subparagraphs (D), (E), and (F) as subparagraphs (F), (G), and (H), respectively; by inserting after subparagraph (C) the following: Subject to subparagraph (H), the Administrator may award a subsequent additional grant to a grant recipient under subparagraph (A), for each fiscal year during the 4-fiscal-year period following the fiscal year for which the initial additional grant under subparagraph (A) is awarded, in an amount not to exceed the amount of non-Federal funds, including in-kind contributions, raised by the grant recipient for the fiscal year for which the subsequent additional grant is awarded. Subject to subparagraph (H), the Administrator may award a renewal grant to a grant recipient under subparagraph (D), for the first fiscal year following the 4-fiscal-year period for which the subsequent additional grant under subparagraph (D) is awarded, in an amount not to exceed the amount of non-Federal funds, including in-kind contributions, raised by the grant recipient for the fiscal year for which the renewal grant is awarded. in subparagraph (F), as so redesignated— in the subparagraph heading, by striking renewal and inserting subsequent renewal; and in the matter preceding clause (i)— by striking clause (iv) and inserting subparagraph (H); by striking renewal grant to a grant recipient under this subparagraph and inserting subsequent renewal grant to a grant recipient under subparagraph (E); and by striking initial additional grant and inserting renewal grant under subparagraph (E); and in paragraph (4), by striking (3)(E) and inserting (3)(G); in subsection (d)— by striking In awarding and inserting the following: In awarding by adding at the end the following: In awarding grants under subsection (b)(1)(B)(ii), the Administrator shall give priority to eligible coalitions that serve 1 or more communities in a State that has a high mortality rate relating to opioid use disorder. In awarding subsequent additional grants under subsection (b)(3)(D), the Administrator shall give priority to an eligible coalition that serves 1 or more communities in a State that has a high mortality rate relating to opioid use disorder. by adding at the end the following: A recipient of a subsequent renewal grant awarded under subsection (b)(3)(F) may not be awarded any further grant under this section. (D)Subsequent additional grantsSubject to subparagraph (H), the Administrator may award a subsequent additional grant to a grant recipient under subparagraph (A), for each fiscal year during the 4-fiscal-year period following the fiscal year for which the initial additional grant under subparagraph (A) is awarded, in an amount not to exceed the amount of non-Federal funds, including in-kind contributions, raised by the grant recipient for the fiscal year for which the subsequent additional grant is awarded.(E)Renewal grantsSubject to subparagraph (H), the Administrator may award a renewal grant to a grant recipient under subparagraph (D), for the first fiscal year following the 4-fiscal-year period for which the subsequent additional grant under subparagraph (D) is awarded, in an amount not to exceed the amount of non-Federal funds, including in-kind contributions, raised by the grant recipient for the fiscal year for which the renewal grant is awarded.; and (1)Priority for economically disadvantaged areasIn awarding; and (2)Priority for states demonstrating high mortality rates relating to opioid use disorder(A)Grants to more than 1 eligible coalition representing a communityIn awarding grants under subsection (b)(1)(B)(ii), the Administrator shall give priority to eligible coalitions that serve 1 or more communities in a State that has a high mortality rate relating to opioid use disorder.(B)Subsequent additional grantsIn awarding subsequent additional grants under subsection (b)(3)(D), the Administrator shall give priority to an eligible coalition that serves 1 or more communities in a State that has a high mortality rate relating to opioid use disorder.; and (e)Limitation on subsequent renewal grantsA recipient of a subsequent renewal grant awarded under subsection (b)(3)(F) may not be awarded any further grant under this section..

13. Support for law enforcement mental health and wellness There is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $15,000,000 for each of fiscal years 2024 through 2027 for grants under section 1701(b)(23) of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10381(b)(23)) to establish peer mentoring mental health and wellness pilot programs within State, Tribal, and local law enforcement agencies.

14. Adverse childhood experiences response team grant program Title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10101 et seq.) is amended by adding at the end the following: From amounts made available to carry out this section, the Attorney General, in coordination with the Secretary of Health and Human Services, shall make grants to States, units of local government, Indian Tribes, and neighborhood or community-based organizations to address adverse childhood experiences associated with exposure to trauma. Amounts received under a grant under this section may be used to establish an adverse childhood experiences response team, including by— establishing protocols to follow when encountering a child or youth exposed to trauma to facilitate access to services; developing referral partnership agreements with behavioral health providers, substance treatment facilities, and recovery services for family members of children exposed to trauma; integrating law enforcement, mental health, and crisis services to respond to situations where children have been exposed to trauma; implementing comprehensive programs and practices to support children exposed to trauma; identifying barriers for children to access trauma-informed care in their communities; providing training in trauma-informed care to emergency response providers, victim service providers, child protective service professionals, educational institutions, and other community partners; supporting cross-system planning and collaboration among officers and employees who work in law enforcement, court systems, child welfare services, correctional reentry programs, emergency medical services, health care services, public health, and substance abuse treatment and recovery support; and providing technical assistance to communities, organizations, and public agencies on how to prevent and mitigate the impact of exposure to trauma and violence. A State, unit of local government, Indian Tribe, or neighborhood or community-based organization desiring a grant under this section shall submit to the Attorney General an application in such form, and containing such information, as the Attorney General may reasonably require. Section 1001(a) of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10261(a)) is amended by adding at the end the following: There are authorized to be appropriated to carry out part PP $10,000,000 for each of fiscal years 2024 through 2027. PPAdverse childhood experiences response team grant program3061.Grants for adverse childhood experiences response teams(a)Grants authorizedFrom amounts made available to carry out this section, the Attorney General, in coordination with the Secretary of Health and Human Services, shall make grants to States, units of local government, Indian Tribes, and neighborhood or community-based organizations to address adverse childhood experiences associated with exposure to trauma.(b)Use of fundsAmounts received under a grant under this section may be used to establish an adverse childhood experiences response team, including by—(1)establishing protocols to follow when encountering a child or youth exposed to trauma to facilitate access to services;(2)developing referral partnership agreements with behavioral health providers, substance treatment facilities, and recovery services for family members of children exposed to trauma;(3)integrating law enforcement, mental health, and crisis services to respond to situations where children have been exposed to trauma;(4)implementing comprehensive programs and practices to support children exposed to trauma;(5)identifying barriers for children to access trauma-informed care in their communities;(6)providing training in trauma-informed care to emergency response providers, victim service providers, child protective service professionals, educational institutions, and other community partners; (7)supporting cross-system planning and collaboration among officers and employees who work in law enforcement, court systems, child welfare services, correctional reentry programs, emergency medical services, health care services, public health, and substance abuse treatment and recovery support; and(8)providing technical assistance to communities, organizations, and public agencies on how to prevent and mitigate the impact of exposure to trauma and violence. (c)ApplicationA State, unit of local government, Indian Tribe, or neighborhood or community-based organization desiring a grant under this section shall submit to the Attorney General an application in such form, and containing such information, as the Attorney General may reasonably require.. (29)There are authorized to be appropriated to carry out part PP $10,000,000 for each of fiscal years 2024 through 2027..

3061. Grants for adverse childhood experiences response teams From amounts made available to carry out this section, the Attorney General, in coordination with the Secretary of Health and Human Services, shall make grants to States, units of local government, Indian Tribes, and neighborhood or community-based organizations to address adverse childhood experiences associated with exposure to trauma. Amounts received under a grant under this section may be used to establish an adverse childhood experiences response team, including by— establishing protocols to follow when encountering a child or youth exposed to trauma to facilitate access to services; developing referral partnership agreements with behavioral health providers, substance treatment facilities, and recovery services for family members of children exposed to trauma; integrating law enforcement, mental health, and crisis services to respond to situations where children have been exposed to trauma; implementing comprehensive programs and practices to support children exposed to trauma; identifying barriers for children to access trauma-informed care in their communities; providing training in trauma-informed care to emergency response providers, victim service providers, child protective service professionals, educational institutions, and other community partners; supporting cross-system planning and collaboration among officers and employees who work in law enforcement, court systems, child welfare services, correctional reentry programs, emergency medical services, health care services, public health, and substance abuse treatment and recovery support; and providing technical assistance to communities, organizations, and public agencies on how to prevent and mitigate the impact of exposure to trauma and violence. A State, unit of local government, Indian Tribe, or neighborhood or community-based organization desiring a grant under this section shall submit to the Attorney General an application in such form, and containing such information, as the Attorney General may reasonably require.