Fatal Overdose Reduction Act of 2025
This bill establishes a five-year Medicaid demonstration program to support the provision of comprehensive and accessible services to treat opioid use and substance use disorders.
Specifically, the bill establishes a demonstration program through which states may receive a Federal Medical Assistance Percentage (i.e., federal matching rate) of at least 90% for services provided by organizations that serve as Health Engagement Hubs. States must certify that these organizations provide a certain level of services, including physical and behavioral health services that are easily and quickly accessible, peer support services, and targeted case management. Organizations must also meet specified minimum staffing requirements, have a community advisory board, and be equipped to provide certain social services (e.g., employment counseling).
The Centers for Medicare & Medicaid Services (CMS) may select up to 10 states to participate in the program. The bill provides funds for state planning grants and administration of the program.
The CMS must contract with an entity to evaluate the program, and the Government Accountability Office must report on this evaluation.
[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>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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