119-s665

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 665 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 665

 To amend title XIX of the Social Security Act to establish the Health 
 Engagement Hub Demonstration Program to increase access to treatment 
 for opioid use disorder and other substance use disorders, and for 
 other purposes.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 February 20, 2025

 Ms. Cantwell (for herself and Mr. Cassidy) introduced the following 
 bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

 A BILL

 To amend title XIX of the Social Security Act to establish the Health 
 Engagement Hub Demonstration Program to increase access to treatment 
 for opioid use disorder and other substance use disorders, and for 
 other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Fatal Overdose Reduction Act of 
2025''.

SEC. 2. HEALTH ENGAGEMENT HUB DEMONSTRATION PROGRAM UNDER MEDICAID.

 

Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
 ``
            (cc) Health Engagement Hub Demonstration Program.--
 ``

    (1) Authority.--The Secretary shall conduct a 
 demonstration program (referred to in this subsection as the 
 `demonstration program') for the purpose of increasing access 
 to treatment for opioid use disorder and other substance use 
 disorders through the establishment of Health Engagement Hubs 
 that meet the criteria published by the Secretary under 
 paragraph

    (2)
        (A) .
 ``

    (2) Publication of guidance.--Not later than 6 months 
 after the date of enactment of this subsection, the Secretary 
 shall publish the following:
 ``
        (A) Certification criteria.--The criteria 
 described in paragraph

    (3)
        (A) (which may be further 
 defined and interpreted by the Secretary as necessary 
 to carry out the demonstration program) for an 
 organization to be certified by a State as a Health 
 Engagement Hub for purposes of participating in the 
 demonstration program.
 ``
        (B) Prospective payment system.--Guidance for 
 States selected to participate in the demonstration 
 program to use to establish a prospective payment 
 system for the required items and services described in 
 paragraph

    (3)
        (B) (which may be further defined and 
 interpreted by the Secretary as necessary to carry out 
 the demonstration program) that are provided by a 
 certified Health Engagement Hub participating in the 
 demonstration program to individuals who are eligible 
 for medical assistance under a State plan under this 
 title or under a waiver of such plan. Such guidance 
 shall specify that the prospective payment system 
 established by a State shall only apply to the required 
 items and services described in paragraph

    (3)
        (B)
            (i) that are provided in accordance with the requirements 
 applicable under this title to the provision of such 
 services to individuals who are eligible for medical 
 assistance under the State plan under this title or 
 under a waiver of such plan.
 ``
            (C) Clarification regarding payment for 
 furnishing medical assistance for prescribed drugs or 
 covered outpatient drugs.--Statements that, with 
 respect to the provision of medical assistance for 
 prescribed drugs or covered outpatient drugs (as 
 defined in 

section 1927

    (k) ) by a certified Health 
 Engagement Hub to individuals who are eligible for 
 medical assistance under the State plan under this 
 title or under a waiver of such plan and in accordance 
 with the requirements applicable under this title--
 ``
            (i) the prospective payment system 
 established by a State for purposes of the 
 demonstration program shall not include payment 
 for such medical assistance (other than with 
 respect to the service of providing a 
 prescription or administering a drug if 
 needed); and
 ``
            (ii) a certified Health Engagement Hub 
 that provides medical assistance for prescribed 
 drugs or covered outpatient drugs (as so 
 defined) shall not be precluded from receiving 
 payment under the State plan under this title 
 or under a waiver of such plan for the 
 provision of such medical assistance, that is 
 in addition to, and separate from, any payment 
 made to the certified Health Engagement Hub 
 under such prospective payment system.
 ``
            (D) Eligibility of an indian tribe, tribal 
 organization, urban indian organization, or 
 consortia.--Such requirements as the Secretary 
 determines appropriate for an Indian Tribe or Tribal 
 organization, (as such terms are defined in 

section 4 
 of the Indian Self-Determination and Education 
 Assistance Act), a tribal consortia, or an Urban Indian 
 organization (as defined in 

section 4 of the Indian 
 Health Care Improvement Act), to apply for, and be 
 selected to participate in, the demonstration program. 
 To the extent practicable, such requirements shall be 
 similar to the requirements applicable to a State 
 desiring to participate in the demonstration program.
 ``

    (3) Criteria for certification of health engagement 
 hubs.--
 ``
        (A) General requirements.--In order to be 
 certified as a Health Engagement Hub, an organization 
 shall satisfy the following requirements:
 ``
            (i) The organization demonstrates that 
 the organization is equipped to serve 
 individuals who are eligible for medical 
 assistance under a State plan under this title 
 or under a waiver of such plan (including 
 individuals who are eligible for such 
 assistance but are not enrolled in such State 
 plan or waiver), as well as uninsured 
 individuals (as defined in 

section 1902

    (ss) ), 
 and provide such populations with access to a 
 range of social and medical services, in a 
 drop-in manner and without prior appointment.
 ``
            (ii) The organization provides (in a 
 manner reflecting person-centered care) the 
 services specified in subparagraph
        (B) which, 
 if not available directly through the 
 organization, are provided or referred through 
 partnerships or formal contracts with other 
 providers.
 ``
            (iii) The organization demonstrates that 
 in selecting the location for the Health 
 Engagement Hub, the organization prioritized 
 placement in communities disproportionately 
 impacted by overdose and other harms related to 
 substance use disorder (as further defined by 
 the Secretary), including rural areas, 
 geographically isolated areas within the State, 
 tribal areas, urban centers with under-
 resourced behavioral health infrastructure, 
 communities with significant numbers of 
 individuals experiencing homelessness, and 
 communities negatively impacted by the 
 criminal-legal system.
 ``
            (iv) The organization uses evidence-based 
 models to increase engagement and improve 
 outcomes for individuals with opioid use 
 disorder or other substance use disorders, such 
 as social work empowerment models, motivational 
 interviewing models, shared decision-making 
 models, and other evidence-based recovery and 
 support services.
 ``
            (v) The organization demonstrates that 
 the organization is equipped to provide--
 ``
            (I) overdose education and 
 distribution of a drug or device 
 approved or cleared under the Federal 
 Food, Drug, and Cosmetic Act for 
 emergency reversal of known or 
 suspected opioid overdose (such as 
 naloxone);
 ``
            (II) safer substance use 
 education and supplies;
 ``
            (III) safer-sex supplies;
 ``
            (IV) emotional support and 
 counseling services to reduce harms 
 associated with substance use, using a 
 trauma-informed approach; and
 ``
            (V) access, within 4 hours of the 
 arrival of an individual with opioid 
 use disorder or other substance use 
 disorder at a Health Engagement Hub, to 
 drugs approved under 

section 505 of the 
 Federal Food, Drug, and Cosmetic Act 
 and biological products licensed under 
 

section 351 of the Public Health 
 Service Act (42 U.S.C. 262) for 
 treatment of opioid use disorder or 
 substance use disorder with a strong 
 evidence base of significantly reducing 
 mortality, directly or through 
 partnerships or formal contracts with 
 other providers in a manner that 
 insures consistency of care and care 
 coordination.
 ``
            (vi) The organization demonstrates that 
 the organization is equipped to provide, as 
 selected by the organization, 1 or more 
 services to address health-related social 
 needs, which may include--
 ``
            (I) identification services (such 
 as assistance with obtaining a 
 government-recognized form of 
 identification);
 ``
            (II) employment counseling;
 ``
            (III) recovery support services, 
 including services that promote a 
 process of change through which 
 individuals improve their health and 
 wellness, live self-directed lives, and 
 strive to reach their full potential 
 through career, education, or 
 community-building;
 ``
            (IV) family reunification 
 services, including services that help 
 the reunification of family members 
 separated by the legal system or foster 
 system; and
 ``
            (V) criminal-legal services, 
 including the provision of legal 
 clinical consultation, legal 
 information and advice, legal 
 referrals, and legal advocacy or 
 retainer.
 ``
            (vii) The organization demonstrates that 
 the organization is equipped to meet--
 ``
            (I) the minimum staffing 
 requirements described in subparagraph
            (C) ;
 ``
            (II) the experience requirement 
 described in subparagraph
            (D) ; and
 ``
            (III) the community advisory 
 board requirement described in 
 subparagraph
        (E) .
 ``
            (viii) The organization agrees to provide 
 services to an uninsured individual (as defined 
 in 

section 1902

    (ss) ), with fees for such 
 services imposed on a sliding scale basis 
 that--
 ``
            (I) is developed at the 
 discretion of a certified Health 
 Engagement Hub or the State;
 ``
            (II) is based on an individual's 
 ability to pay; and
 ``
            (III) provides that the 
 organization shall not reject or limit 
 services on the basis of an 
 individual's ability to pay or place of 
 residence.
 ``
        (B) Scope of items and services.--The items and 
 services specified in this subparagraph are the 
 following, subject to the requirements applicable under 
 this title to the provision of such items and services:
 ``
            (i) Required items and services paid for 
 through the prospective payment system.--
 ``
            (I) Harm reduction services and 
 supplies.
 ``
            (II) Patient-centered and 
 patient-driven physical and behavioral 
 health care that has walk-in 
 availability, is offered during non-
 traditional hours, including evenings 
 and weekends, and includes--
 ``

    (aa) primary mental 
 health and substance use 
 disorder services, as defined 
 by the Secretary, including 
 screening, assessment, and 
 referrals to higher levels of 
 care;
 ``

    (bb) shared decision-
 making for patients and 
 providers for opioid use 
 disorder or substance use 
 disorder under which a patient 
 and provider discuss the 
 patient's diagnosis and 
 condition together and evaluate 
 treatment options together;
 ``
            (cc) wound care and 
 supplies;
 ``
            (dd) infectious disease 
 vaccination, screening, 
 testing, and, to the extent 
 practicable, treatment 
 (including for HIV, sexually 
 transmitted infections, and 
 hepatitis);
 ``

    (ee) sexual and 
 reproductive health services 
 provided directly or through 
 partnerships or formal 
 contracts with other providers; 
 and
 ``

    (ff) secure medication 
 storage and inventory policies 
 and procedures for patients 
 experiencing homelessness or 
 housing insecurity.
 ``
            (III) Medication management, as 
 specified by the State, including with 
 respect to the types of conditions for 
 which medication management must be at 
 a minimum available.
 ``
            (IV) Targeted case management.
 ``
            (V) Peer support services.
 ``
            (VI) Community health outreach 
 and navigation services, including 
 services that guide patients through 
 social and health care systems to 
 connect with services and service 
 providers that the patients need.
 ``
            (ii) Prescribed drugs and covered 
 outpatient drugs paid separate from the 
 prospective payment system.--Directly or 
 through partnerships or formal contracts with 
 other providers, prescribed drugs and covered 
 outpatient drugs (as defined in 

section 1927

    (k) ) for which medical assistance is 
 available under the State plan under this title 
 or under a waiver of such plan that are 
 provided in accordance with requirements 
 applicable under this title and, if applicable, 
 a rebate agreement in effect under 

section 1927.
 ``
            (C) Minimum staffing requirements.--
 ``
            (i) In general.--The minimum staffing 
 requirements specified in this subparagraph are 
 the following:
 ``
            (I) At least 1 part-time or full-
 time health care provider who is 
 licensed to practice in the State where 
 the Health Engagement Hub is located 
 and is licensed, registered, or 
 otherwise permitted, by the United 
 States to prescribe controlled 
 substances (as defined in 

section 102 
 of the Controlled Substances Act) in 
 the course of professional practice.
 ``
            (II) At least 1 part-time or 
 full-time registered nurse or licensed 
 practical nurse who can provide or 
 supervise staff providing medication 
 management, targeted case management, 
 wound care, and vaccine administration.
 ``
            (III) At least 1 part-time or 
 full-time licensed behavioral health 
 staff who is qualified to assess or 
 provide counseling about potential 
 treatment options or about the need for 
 treatment.
 ``
            (IV) At least 1 full-time 
 equivalent staff who is a peer support 
 specialist, community health worker, or 
 recovery coach, with priority for 
 hiring staff for such positions who are 
 individuals with lived and living 
 experience with substance use.
 ``
            (V) Full-time outreach, 
 engagement, and ongoing care navigation 
 staff, including peer support 
 specialists, community health workers, 
 and recovery coaches. At least 50 
 percent of such staff shall be 
 individuals with lived and living 
 experience with substance use.
 ``
            (ii) Staffing through contractual 
 arrangements with partner agencies.--An 
 organization may enter into a contractual 
 arrangement with a partner agency, such as a 
 Federally-qualified health center, to satisfy 
 the minimum staffing requirements specified in 
 clause
            (i) with staff who are on-site at the 
 Health Engagement Hub.
 ``
            (D) Experience.--An organization shall have a 
 demonstrated history of at least 12 months of providing 
 opioid use disorder or substance use disorder treatment 
 services to individuals.
 ``
        (E) Community advisory board.--An organization 
 shall have a community advisory board composed of 
 individuals with lived and living experience with 
 substance use that meets, at a minimum--
 ``
            (i) on a monthly basis, to review program 
 utilization data and provide feedback to the 
 organization; and
 ``
            (ii) on a quarterly basis, with the 
 executives or board of directors of the 
 organization to provide input on service 
 delivery and receive feedback on actions taken 
 based on previous feedback provided by the 
 community advisory board.
 ``

    (4) Planning grants; administration.--There is 
 appropriated, out of any funds in the Treasury not otherwise 
 appropriated, $60,000,000 to the Secretary for purposes of 
 implementing, administering, and making planning grants to 
 States as soon as practicable for purposes of developing 
 proposals to participate in the demonstration program and 
 obtaining technical assistance from the Secretary with respect 
 to the design and implementation of the demonstration program, 
 for expenditures attributable to collecting and reporting the 
 information and data required under paragraph

    (6)
        (B) , and for 
 administrative expenses of the Secretary to carry out this 
 subsection, to remain available until expended.
 ``

    (5) State demonstration programs.--
 ``
        (A) In general.--Not later than 9 months after 
 the date on which the Secretary first awards a planning 
 grant under paragraph

    (4) , the Secretary shall solicit 
 applications to participate in the demonstration 
 program solely from States awarded such a grant.
 ``
        (B) Application requirements.--An application to 
 participate in the demonstration program shall include 
 the following:
 ``
            (i) A description of the target 
 population (including the estimated number of 
 individuals in such population) to be served by 
 the State under the demonstration program.
 ``
            (ii) An assurance that at least 50 
 percent of the Health Engagement Hubs in the 
 State shall be located in--
 ``
            (I) a county (or municipality or 
 other unit of local government, 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 are available 
 from the State, is higher than the most 
 recent available national average 
 overdose death rate per 100,000 people 
 over the past 3 years, as reported by 
 the Centers for Disease Control and 
 Prevention; or
 ``
            (II) an area of the State that is 
 designated under 

section 332

    (a)

    (1)
        (A) of the Public Health Service Act as a 
 mental health professional shortage 
 area.
 ``
            (iii) A description of the prospective 
 payment system that is to be tested under the 
 demonstration program.
 ``
            (iv) A list of the certified Health 
 Engagement Hubs located in the State that will 
 participate in the demonstration program.
 ``
            (v) Verification that each such certified 
 Health Engagement Hub satisfies the 
 requirements described in paragraph

    (3) .
 ``
            (vi) Verification that the State has 
 agreed to pay for the items and services 
 required to be paid for through the prospective 
 payment system at the rate established under 
 the prospective payment system.
 ``
            (vii) Any other information that the 
 Secretary may require relating to the 
 demonstration program with respect to 
 determining the soundness of the proposed 
 prospective payment system.
 ``
            (C) Selection criteria.--
 ``
            (i) In general.--The Secretary shall 
 select from among the applications submitted up 
 to 10 States to participate in the 
 demonstration program.
 ``
            (ii) Priority.--In selecting States to 
 participate in the demonstration program, the 
 Secretary shall prioritize selecting States--
 ``
            (I) with the highest opioid- or 
 stimulant-involved overdose death 
 rates; and
 ``
            (II) in a manner that ensures, to 
 the extent practicable, geographic 
 diversity across the United States.
 ``
            (D) Length of demonstration programs.--A State 
 selected to participate in the demonstration program 
 shall participate in the program for a 5-year period.
 ``
        (E) Waiver of certain requirements.--The 
 Secretary shall waive 

section 1902

    (a)

    (1) (relating to 
 statewideness) and 

section 1902

    (a)

    (10)
        (B) (relating to 
 comparability) as may be necessary for a State to 
 participate in the demonstration program in accordance 
 with this paragraph.
 ``
        (F) Payments to states.--
 ``
            (i) In general.--For each quarter 
 occurring during the period for which the 
 demonstration program is conducted, the 
 Secretary shall pay a State participating in 
 the demonstration program an amount equal to 90 
 percent (or, if higher, the Federal medical 
 assistance percentage otherwise applicable to 
 the State and year under 

section 1905 (without 
 regard to this subparagraph)) of the amounts 
 expended by the State for the quarter for items 
 and services provided by certified Health 
 Engagement Hubs (directly or through 
 partnerships or formal contracts with other 
 providers) at the rate established under the 
 prospective payment system established by the 
 State for purposes of the demonstration program 
 to individuals who are eligible for, and 
 enrolled under, the State plan or under a 
 waiver of such plan.
 ``
            (ii) Ensuring no duplicate pps 
 payments.--The guidance required under 
 paragraph

    (2)
        (B) shall include guidance on how 
 the Secretary will determine, if 2 or more 
 prospective payment systems may apply to a 
 service provided by a certified Health 
 Engagement Hub (directly or through 
 partnerships or formal contracts with other 
 providers) to an individual who is eligible 
 for, and enrolled under, the State plan or 
 under a waiver of such plan, which prospective 
 payment systems shall apply for purposes of 
 determining the amount to be paid to a State 
 for a quarter under clause
            (i) .
 ``
            (iii) Application.--Payments made to 
 States made under this subparagraph shall be 
 considered to have been made under, and are 
 subject to, the requirements of this section.
 ``

    (6) Reports.--
 ``
        (A) Initial implementation.--During the first 2 
 years in which a State participates in the 
 demonstration program under paragraph

    (5) , the State 
 shall submit to the Secretary such information as the 
 Secretary may require relating to the implementation 
 and initial operation of the demonstration program.
 ``
        (B) Annual state reports.--
 ``
            (i) In general.--Beginning with the 3rd 
 year in which a State participates in the 
 demonstration program under paragraph

    (5) , the 
 State shall submit an annual report to the 
 Secretary on the demonstration program that 
 includes the following:
 ``
            (I) An assessment of the extent 
 to which Health Engagement Hubs funded 
 under the demonstration program have 
 increased access to treatment for 
 opioid use disorder and other substance 
 use disorders, health services for 
 individuals who use drugs, and other 
 social services under the State's plan 
 under this title or under a waiver of 
 such plan in the area or areas of the 
 State targeted by the demonstration 
 program, as compared to other areas of 
 the State.
 ``
            (II) An assessment of the extent 
 to which Health Engagement Hubs are 
 reducing opioid and stimulant overdose 
 mortality rates and the rate of 
 adherence to prescribed medication for 
 opioid use, hospitalization rates, 
 recovery rates, and housing status for 
 the populations served by the Health 
 Engagement Hubs as compared to 
 populations that are not served by the 
 Health Engagement Hubs.
 ``
            (III) Data and information 
 comparing for populations served by the 
 Health Engagement Hubs the racial and 
 socioeconomic demographics, housing 
 status, employment, and other metrics, 
 as recommended by the Secretary, of 
 such populations.
 ``
            (IV) A description of the 
 successes of the demonstration program.
 ``
            (V) Recommendations for 
 improvements to the demonstration 
 program, including whether the 
 demonstration program should be 
 continued, expanded, modified, or 
 terminated.
 ``
            (ii) Data availability.--Each State 
 selected to participate in the demonstration 
 program under paragraph

    (5) shall agree, as a 
 condition of such selection, to cooperate with 
 data collection for purposes of the national 
 implementation evaluation under paragraph

    (7) .
 ``
            (iii) Information and data collection and 
 reporting expenditures.--From amounts made 
 available under paragraph

    (4)
        (A)
            (i) , the 
 Secretary shall make payments to States for 
 expenditures attributable to collecting and 
 reporting the information and data required 
 under this subparagraph.
 ``
            (C) Reports to congress and the comptroller 
 general.--
 ``
            (i) In general.--Beginning with the 3rd 
 year in which a State participates in the 
 demonstration program under paragraph

    (5) , the 
 Secretary shall submit to Congress and the 
 Comptroller General of the United States, and 
 make publicly available, an annual report that 
 describes the information, findings, and 
 recommendations in the annual State reports 
 submitted to the Secretary under subparagraph
        (A) .
 ``
            (ii) Implementation evaluation results.--
 The Secretary shall include with the first 3 
 annual reports submitted by the Secretary under 
 this subparagraph the findings and conclusions 
 of the national implementation evaluation 
 required by paragraph

    (7) .
 ``

    (7) National implementation evaluation.--
 ``
        (A) In general.--The Secretary shall contract 
 with an entity that meets the requirements of 
 subparagraph
        (B)
            (ii) to solicit public input and 
 conduct a national implementation evaluation of the 
 planning grants awarded under paragraph

    (4) and the 
 State demonstration programs under paragraph

    (5) to 
 determine the reach, effectiveness, adoption, and 
 implementation of the demonstration program in each 
 such State and to allow for a complete assessment of 
 the impact of Health Engagement Hubs in each State 
 participating in the demonstration program.
 ``
        (B) Requirements.--
 ``
            (i) Information.--The evaluation shall 
 include information on the characteristics of 
 the individuals who received services, service 
 utilization metrics over time (including by 
 staff role), and input from interviews with 
 such individuals and staff.
 ``
            (ii) Eligible entities.--In order to be 
 eligible to conduct the evaluation, an entity 
 shall--
 ``
            (I) have documented experience 
 conducting implementation evaluations 
 of health and social services programs; 
 and
 ``
            (II) satisfy such additional 
 eligibility criteria as the Secretary 
 may establish.''.

SEC. 3. GOVERNMENT ACCOUNTABILITY OFFICE REPORT.

 Not later than 18 months after receipt of the annual State reports 
and the findings and conclusions of the national implementation 
evaluation under paragraph

    (6)
            (C) of 

section 1903
            (cc) of the Social 
Security Act (as added by 

section 2), the Comptroller General of the 
United States shall provide to the Committee on Finance of the Senate 
and the Committee on Energy and Commerce of the House of 
Representatives a report assessing the Secretary's evaluation of the 
Health Engagement Hub Demonstration Program established under such 
section.
 <all>