Turn the Tide Act

This Act may be cited as the “Turn the Tide Act”.

(a) Grants To enhance access to substance use disorder treatment.— Section 3203 of the SUPPORT for Patients and Communities Act (Public Law 115–271) is amended—

(1) by striking “The Secretary” and inserting the following:

“(a) In general.— The Secretary”; and

(2) by adding at the end the following:

“(b) Appropriations.— For grants under subsection (a), there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $4,000,000 for each of fiscal years 2027 through 2030.”.

(b) Access to increased drug disposal.— Section 3260 of the SUPPORT for Patients and Communities Act (Public Law 115–271) is amended to read as follows:

“3260. Appropriations.— To carry out this chapter, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $10,000,000 for each of fiscal years 2027 through 2030.”.

(a) First responder training.— Section 546(h) of the Public Health Service Act (42 U.S.C. 290ee–1(h)) is amended to read as follows:

“(h) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $77,000,000 for each of fiscal years 2027 through 2030.”.

(b) Public health laboratories pilot program.— Section 7011(d) of the SUPPORT for Patients and Communities Act (Public Law 115–271) is amended to read as follows:

“(d) Appropriations.— To carry out this section, 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 2027 through 2030.”.

(c) Model training programs for substance use disorder patient records.— Section 7053 of the SUPPORT for Patients and Communities Act (Public Law 115–271) is amended by adding at the end the following:

“(e) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated—

(1) $4,000,000 for fiscal year 2027;

(2) $2,000,000 for fiscal year 2028; and

(3) $1,000,000 for each of fiscal years 2029 and 2030.”.

(d) Residential treatment programs for pregnant and postpartum women.— Section 508(s) of the Public Health Service Act (42 U.S.C. 290bb–1(s)) is amended by striking the first sentence and inserting the following: “To carry out this section, 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 2027 through 2030.”.

(e) Mental and behavioral health education and training grants.— Section 756(f) of the Public Health Service Act (42 U.S.C. 294e–1(f)) is amended to read as follows:

“(f) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $75,000,000 for each of fiscal years 2027 through 2030.”.

(f) Coordination and continuation of care for drug overdose patients.— Section 7081(f) of the SUPPORT for Patients and Communities Act (42 U.S.C. 290dd–4) is amended to read as follows:

“(f) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $10,000,000 for each of fiscal years 2027 through 2030.”.

(g) Emergency department alternatives to opioids demonstration program.— Section 7091(g) of the SUPPORT for Patients and Communities Act (Public Law 115–271) is amended to read as follows:

“(g) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $10,000,000 for each of fiscal years 2027 through 2030.”.

(h) Regional centers of excellence in substance use disorder education.— Section 551(f) of the Public Health Service Act (42 U.S.C. 290ee–6(f)) is amended to read as follows:

“(f) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $4,000,000 for each of fiscal years 2027 through 2030.”.

(i) Youth prevention and recovery.— Section 7102(c)(9) of the SUPPORT for Patients and Communities Act (Public Law 115–271) is amended to read as follows:

“(9) Appropriations.— To carry out this subsection, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $20,000,000 for each of fiscal years 2027 through 2030.”.

(j) Comprehensive opioid recovery centers.— Section 552(j) of the Public Health Service Act (42 U.S.C. 290ee–7(j)) is amended to read as follows:

“(j) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $10,000,000 for each of fiscal years 2027 through 2030.”.

(k) CDC surveillance and data collection.— Section 7131(e) of the SUPPORT for Patients and Communities Act (42 U.S.C. 242t(e)) is amended to read as follows:

“(e) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $2,000,000 for each of fiscal years 2027 through 2030.”.

(l) National child traumatic stress initiative.— Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh–1(j)) is amended to read as follows:

“(j) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $112,000,000 for each of fiscal years 2027 through 2030.”.

(m) Trauma support services and mental health care.— Section 7134(l) of the SUPPORT for Patients and Communities Act (42 U.S.C. 280h–7(l)) is amended to read as follows:

“(l) Appropriations.— To carry out this section, 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 2027 through 2030.”.

(n) Surveillance and education regarding infections associated with illicit drug use and other risk factors.— Section 317N(d) of the Public Health Service Act (42 U.S.C. 247b–15(d)) is amended to read as follows:

“(d) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $40,000,000 for each of fiscal years 2027 through 2030.”.

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

“(f) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $28,000,000 for each of fiscal years 2027 through 2030.”.

(p) Peer support technical assistance center.— Section 547A(f) of the Public Health Service Act (42 U.S.C. 290ee–2a(f)) is amended to read as follows:

“(f) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $4,000,000 for each of fiscal years 2027 through 2030.”.

(q) Preventing overdoses of controlled substances.— Section 392A(e) of the Public Health Service Act (42 U.S.C. 280b–1(e)) is amended to read as follows:

“(e) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $516,000,000 for each of fiscal years 2027 through 2030.”.

(r) Career Act.— Section 7183(k) of the SUPPORT for Patients and Communities Act (42 U.S.C. 290ee–8(k)) is amended to read as follows:

“(k) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $19,000,000 for each of fiscal years 2027 through 2030.”.

(a) Reauthorization and improvement of recovery housing program.— Section 8071 of the SUPPORT for Patients and Communities Act (42 U.S.C. 5301 note; Public Law 115–271) is amended—

(1) in subsection (a), by striking “such sums as may be necessary for each of fiscal years 2019 through 2030” and inserting “$60,000,000 for each of fiscal years 2027 through 2032”;

(2) in subsection (b)—

(A) in paragraph (1), by striking “date of enactment of the SUPPORT for Patients and Communities Reauthorization Act of 2025” and inserting “date of enactment of the Turn the Tide Act”; and

(B) by striking paragraph (2) and inserting the following:

“(2) Priority.—

(A) In general.— The funding formula required under paragraph (1) shall ensure that priority for amounts appropriated or otherwise made available under this section is given to States with the greatest need, as such need is determined by the Secretary based on the following factors, and weighting such factors as described in subparagraph (B):

(i) The highest average rates of unemployment based on data provided by the Bureau of Labor Statistics for calendar years 2023 through 2027.

(ii) The lowest average labor force participation rates based on data provided by the Bureau of Labor Statistics for calendar years 2023 through 2027.

(iii) The highest average age-adjusted rates of drug overdose deaths based on data from the Centers for Disease Control and Prevention for the 3 most recent calendar years.

(B) Weighting.— The factors described in subparagraph (A) shall be weighted as follows:

(i) The rate described in subparagraph (A)(i) shall be weighted at 15 percent.

(ii) The rate described in subparagraph (A)(ii) shall be weighted at 15 percent.

(iii) The rate described in subparagraph (A)(iii) shall be weighted at 70 percent.”; and

(3) in subsection (c)(1), by striking “at least 30 percent of such funds within one year” and inserting “at least 50 percent of such funds within 2 years”.

(b) Building capacity for family-Focused residential treatment.— Section 8083(c) of the SUPPORT for Patients and Communities Act (Public Law 115–271) is amended to read as follows:

“(c) Appropriations.— To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $20,000,000 for fiscal year 2027, which shall remain available through fiscal year 2030.”.

(c) Comprehensive Opioid Abuse Grant Program.— Section 1001(a)(27) of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10261(a)(27)) is amended to read as follows:

“(27) To carry out part LL, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $500,000,000 for each of fiscal years 2027 through 2030.”.

(d) Office of National Drug Control Policy.— Section 714 of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1711) is amended to read as follows:

“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 2027 through 2030, to remain available until expended.”.

(e) Drug-Free Communities Program.— Section 1024 of the Anti-Drug Abuse Act of 1988 (21 U.S.C. 1524) is amended—

(1) in the heading, by inserting “; appropriations” after “Authorization of appropriations”; and

(2) by striking subsection (a) and inserting the following:

“(a) In general.— To carry out this chapter, there is authorized to be appropriated to the Office of National Drug Control Policy, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $175,000,000 for each of fiscal years 2027 through 2030.”.

(f) High-Intensity Drug Trafficking Area Program.— Section 707(p) of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1706(p)) is amended—

(1) by redesignating paragraphs (1) through (6) as subparagraphs (A) through (F), respectively, and adjusting the margins accordingly;

(2) by striking “There is authorized” and inserting the following:

“(1) In general.— There is authorized”;

(3) in paragraph (1), as so designated—

(A) in subparagraph (E), as so redesignated, by striking “each of”; and

(B) in subparagraph (F), as so redesignated, by striking “2018 through 2023” and inserting “2027 through 2030”; and

(4) by adding at the end the following:

“(2) Appropriations.— To carry out this section, there is authorized to be appropriated to the Office of National Drug Control Policy, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $350,000,000 for each of fiscal years 2027 through 2030.”.

(g) Drug Court Program.— Section 1001(a)(25)(A) of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10261(a)(25)(A)) is amended to read as follows:

“(25)

(A) Except as provided in subparagraph (C), to carry out part EE, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $125,000,000 for each of fiscal years 2027 through 2030.”.

(h) Drug Court Training and Technical Assistance.— Section 705(e)(2) of Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1704(e)(2)) is amended to read as follows:

“(2) Authorization of appropriations; appropriations.— To carry out this subsection, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $5,000,000 for each of fiscal years 2027 through 2030.”.

(i) Administration of the Office of National Drug Control Policy.— Section 704(i)(2) of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1703(i)(2)) is amended to read as follows:

“(2) Authorization of appropriations; appropriations.— To carry out this subsection, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $1,750,000 for each of fiscal years 2027 through 2030.”.

(j) Emerging Threats Committee, Plan, and Media Campaign.— Section 709(g) of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1708(g)) is amended to read as follows:

“(g) Authorization of appropriations; appropriations.— To carry out this section, there is authorized to be appropriated to the Office, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $35,000,000 for each of fiscal years 2027 through 2030.”.

(a) State opioid response grants.—

(1) In general.— To carry out activities under section 1003 of the 21st Century Cures Act (42 U.S.C. 290ee–3 note) relating to opioids by the State agency responsible for administering the substance abuse prevention and treatment block grant under subpart II of part B of title XIX of the Public Health Service Act (42 U.S.C. 300x–21 et seq.), there is authorized to be appropriated, and there is appropriated, $5,500,000,000 for each of fiscal years 2027 through 2031.

(2) Flexibility in use of funds.— Section 1003(b) of the 21st Century Cures Act (42 U.S.C. 290ee–3a(b)) is amended by adding at the end the following:

“(5) Flexibility.— States and Indian Tribes may use amounts provided under grants under this subsection to support substance use disorder treatment care and related services regardless of whether the patient involved has a primary diagnosis of opioid use disorder, so long as the individual has a substance use disorder diagnosis.

(6) Rule of construction.— Nothing in this subsection shall be construed to prohibit States from using grant funds under this subsection to allocate amounts to local governments to establish subgrantee awards in such localities.”.

(3) Substance abuse prevention and treatment block grants.— Section 1935(a) of the Public Health Service Act (42 U.S.C. 300x–35(a)) is amended to read as follows:

“(a) Appropriations.— To carry out this subpart, subpart III, and section 505(d), there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $3,000,000,000 for each of fiscal years 2027 through 2031, and $2,500,000,000 for each of fiscal years 2032 through 2036.”.

(b) Requirements.— For the purposes of carrying out activities with amounts appropriated under this section (and the amendment made by this section), the Secretary of Health and Human Services shall ensure that the following requirements are complied with:

(1) Of the amount appropriated for each fiscal year under subsection (a) (and the amendment made by such subsection), $50,000,000 shall be made available to Indian Tribes or Tribal organizations.

(2) Of such remaining amounts for each such fiscal year, 15 percent shall be made available to the States with the highest mortality rate related to opioid use disorders. For purposes of allocating such funds, the Secretary shall develop a formula that avoids a significant cliff between States with similar mortality rates to prevent unusually large changes in certain States when compared to prior year allocations, including consideration of new formula methodologies to avoid such funding cliffs.

(3) Of the amount made available for each fiscal year under subsection (a)(1) for State Opioid Response Grants, not more than 2 percent of such amount shall be available for Federal administrative expenses, training, technical assistance, and evaluation.

(4) Of the amounts not reserved under paragraphs (1) through (3), the Secretary shall make allocations to States, territories, and the District of Columbia according to a formula using national survey results that the Secretary determines are the most objective and reliable measure of drug use and drug-related deaths.

(5) The formula methodology under paragraph (4) shall be submitted to the Committees on Appropriations of the House of Representatives and the Committee on Appropriations of the Senate not less than 15 days prior to publishing a Funding Opportunity Announcement.

(6) The prevention and treatment activities funded through grants under this section may include education, treatment (including the provision of medication), behavioral health services for individuals in treatment programs, referral to treatment services, recovery support, and medical screening associated with such treatment.

(7) Each State, including the District of Columbia, shall receive not less than $4,000,000 under grants under this section.

(8) In addition to amounts appropriated under this section (and the amendment made by this section), the following amounts shall be available under section 241 of the Public Health Service Act (42 U.S.C. 238j):

(A) In addition to amounts appropriated under section 1935(a) of the Public Health Service Act (42 U.S.C. 300x–35(a)), an additional $79,200,000 to carry out the provisions referred to in such section 1935(a) (relating to technical assistance, national data, data collection and evaluation activities) and the total available under this Act for activities under section 1935(b) of such Act shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX of such Act.

(B) $2,000,000 to evaluate substance abuse treatment programs.

(9) None of the funds provided for under section 1921 of the Public Health Service Act (42 U.S.C. 300x–21) or for State Opioid Response Grants under section 1003 of the 21st Century Cures Act (42 U.S.C. 290ee–3a) shall be subject to section 241 of the Public Health Service Act (42 U.S.C. 238j).

(a) Prohibition.— Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended—

(1) in paragraph (26), by striking “; or” and inserting a semicolon;

(2) in paragraph (27), by striking the period at the end and inserting “; or”; and

(3) by inserting after paragraph (27) the following new paragraph:

“(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.”.

(b) Conforming amendment.— 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)”.

(c) Effective date.— The amendments made by this subsection take effect on October 1, 2026.

(a) Limitations on cost-Sharing.—

(1) Public Health Service Act.— 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:

“2799A–12. Limitations on cost-sharing for opioid overdose reversal agents.—

(a) In general.— 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.

(b) Utilization control policies; medical management.— 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).

(c) Definition.— 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):

(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.”.

(2) Employee Retirement Income Security Act of 1974.—

(A) In general.— 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:

“727. Limitations on cost-sharing for opioid overdose reversal agents.—

(a) In general.— 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.

(b) Utilization control policies; medical management.— 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).

(c) Definition.— 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):

(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.”.

(B) Clerical amendment.— 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 726 the following new item:

(3) Internal Revenue Code of 1986.—

(A) In general.— Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following:

“9827. Limitations on cost-sharing for opioid overdose reversal agents.—

(a) In general.— 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.

(b) Utilization control policies; medical management.— 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).

(c) Definition.— 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):

(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.”.

(B) Clerical amendment.— 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:

(4) Effective date.— The amendments made by this subsection shall apply to plan years beginning on or after January 1, 2027.

(b) Safe harbor for absence of deductible for opioid overdose reversal agents.—

(1) In general.— Paragraph (2) of section 223(c) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:

“(I) Safe harbor for absence of deductible for opioid overdose reversal agents.— 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 9827(c)).”.

(2) Effective date.— The amendment made by this section shall apply to plan years beginning on or after January 1, 2027.

(c) Limitations on cost-Sharing under Medicare part D.—

(1) In general.— Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is amended—

(A) in subsection (b)—

(i) in paragraph (1)(A), in the matter preceding clause (i), by striking “and (9)” and inserting “, (9), and (10)”;

(ii) in paragraph (2)(A), in the matter preceding clause (i), by striking “and (9)” and inserting “, (9), and (10)”; and

(iii) by adding at the end the following new paragraph:

“(10) Limitations on cost-sharing for opioid overdose reversal agents.—

(A) In general.— For plan year 2027 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-sharing.— For purposes of subparagraph (A), the elimination of cost-sharing shall include the following:

(i) No application of deductible.— The waiver of the deductible under paragraph (1).

(ii) No application of coinsurance.— The waiver of coinsurance under paragraph (2).”; and

(B) in subsection (c), by adding at the end the following new paragraph:

“(7) Treatment of cost-sharing for opioid overdose reversal agents.— The coverage is provided in accordance with subsection (b)(10).”.

(2) Conforming amendments to cost-sharing for low-income individuals.— Section 1860D–14(a)(1) of the Social Security Act (42 U.S.C. 1395w–114(a)(1)) is amended, in the matter preceding subparagraph (A), by striking “In the case” and inserting “Subject to section 1860D–2(b)(10), in the case”.

(a) Loan repayment program for substance use disorder treatment workforce.— Section 781 of the Public Health Service Act (42 U.S.C. 295h) is amended—

(1) in subsection (b), by adding at the end the following:

“(3) Tax liability.— The amount of a payment made under this section on behalf of an individual shall not be considered income for any purpose under the Internal Revenue Code of 1986.”; and

(2) in subsection (j), by striking “$40,000,000 for each of fiscal years 2026 through 2030” and inserting “$65,000,000 for each of fiscal years 2027 through 2031”.

(b) Training demonstration program.— Section 760(g) of the Public Health Service Act (42 U.S.C. 294k(g)) is amended to read as follows:

“(g) Appropriations.—

(1) In general.— To carry out this section (other than paragraph (2)), there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $10,000,000 for each of fiscal years 2027 through 2030.

(2) States with highest drug overdose death rates.—

(A) In general.— To carry out the program under this section with respect to grantees located in States described in subparagraph (B), there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, $20,000,000 for each of fiscal years 2027 through 2030.

(B) States described.— A State described in this subparagraph is a State that is among the top 10 States in terms of highest per capita drug poisoning deaths in each of calendar years 2023, 2024, and 2025, based on the most recent data available from the Centers for Disease Control and Prevention.

(C) Application of section.— Except as provided in this paragraph, the requirements of this section otherwise applicable to grantees under this section shall apply to grantees receiving assistance under this paragraph.”.

(a) In general.—

(1) Fee-for-service.— Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—

(A) in subsection (a)(13)—

(i) by striking “and” at the end of subparagraph (B);

(ii) by adding “and” at the end of subparagraph (C); and

(iii) by adding at the end the following new subparagraph:

“(D) payment for mental health and behavioral health services (as defined in subsection (zz)(1)) furnished on or after October 1, 2026, and before October 1, 2030, by a physician or applicable professional (as defined in subsection (zz)(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 2026, 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

(B) by adding at the end the following new subsection:

“(zz) Mental health and behavioral health services.— For purposes of subsection (a)(13)(D):

(1) Mental health and behavioral health services.—

(A) In general.— 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)):

(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 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.

(C) Regulations.— 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.

(2) Applicable professional.— The 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)).”.

(2) Managed care.— Section 1932(f) of such Act (42 U.S.C. 1396u–2(f)) is amended—

(A) in the subsection heading, by inserting “and mental health and behavioral health services” after “care services”; and

(B) 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)”.

(b) Increased FMAP for additional costs.— Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—

(1) in subsection (b), by striking “and (ii)” and inserting “(ii), and (ll)”; and

(2) by adding at the end the following new subsection:

“(ll) Increased FMAP for additional expenditures for mental health and behavioral health services.—

(1) In general.— 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, 2026, and before October 1, 2030, 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, 2026, 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 limits.— 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.”.

Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended—

(1) 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

(2) by adding at the end the following new subsection:

“(h) Demonstration To test the provision of recovery housing for individuals with opioid use disorder under Medicaid.—

(1) In general.— 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.

(2) Demonstration requirements.—

(A) In general.— 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).

(B) Capitated payments.—

(i) In general.— 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).

(ii) Demonstration budget.—

(I) In general.— 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—

(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 adjustment.— 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.

(C) Selection of eligible States.— 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.

(3) Additional waiver authority.— 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.

(4) Definitions.— In this subsection:

(A) Eligible Medicaid beneficiary.— The 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 general.— The 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 States.— In 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 2023, 2024, and 2025, 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 2023, 2024, and 2025.

(C) Managed care entity.— The term managed care entity means a medicaid managed care organization described in section 1932(a)(1)(B)(i).

(D) Recovery housing.— 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.

(E) State.— The term State includes the 50 States and the District of Columbia.”.

(a) Extension of 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—

(1) extend the termination date for the waiver to December 31, 2028 (or such earlier date as the State conducting the waiver may elect);

(2) 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

(3) 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.

(b) Medicaid section 1115 waiver described.— 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—

(1) as of the date of enactment of this Act, is to terminate on or before December 31, 2026;

(2) was in effect as of January 1, 2022; and

(3) 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 2023, 2024, and 2025, based on the most recent data available from the Centers for Disease Control and Prevention.

Section 1032 of the Anti-Drug Abuse Act of 1988 (21 U.S.C. 1532) is amended—

(1) in subsection (b)—

(A) in paragraph (3)—

(i) in subparagraph (A), by striking “subparagraph (F)” and inserting “subparagraph (H)”;

(ii) by redesignating subparagraphs (D), (E), and (F) as subparagraphs (F), (G), and (H), respectively;

(iii) by inserting after subparagraph (C) the following:

“(D) Subsequent additional grants.— 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.

(E) Renewal grants.— 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.”; and

(iv) in subparagraph (F), as so redesignated—

(I) in the subparagraph heading, by striking “renewal” and inserting “subsequent renewal”; and

(II) in the matter preceding clause (i)—

(aa) by striking “clause (iv)” and inserting “subparagraph (H)”;

(bb) by striking “renewal grant to a grant recipient under this subparagraph” and inserting “subsequent renewal grant to a grant recipient under subparagraph (E)”; and

(cc) by striking “initial additional grant” and inserting “renewal grant under subparagraph (E)”; and

(B) in paragraph (4), by striking “(3)(E)” and inserting “(3)(G)”;

(2) in subsection (d)—

(A) by striking “In awarding” and inserting the following:

“(1) Priority for economically disadvantaged areas.— In awarding”; and

(B) by adding at the end the following:

“(2) Priority for states demonstrating high mortality rates relating to opioid use disorder.—

(A) Grants to more than 1 eligible coalition representing a community.— 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.

(B) Subsequent additional grants.— 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.”; and

(3) by adding at the end the following:

“(e) Limitation on subsequent renewal grants.— A recipient of a subsequent renewal grant awarded under subsection (b)(3)(F) may not be awarded any further grant under this section.”.

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 2027 through 2030 for grants under section 1701(b)(25) of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10381(b)(25)) to establish peer mentoring mental health and wellness pilot programs within State, Tribal, and local law enforcement agencies.

(a) In general.— 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:

“(a) Grants authorized.— 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.

(b) Use of funds.— Amounts 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) Application.— 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.”.

(b) Authorization of appropriations.— 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:

“(29) There are authorized to be appropriated to carry out part PP $10,000,000 for each of fiscal years 2027 through 2030.”.