The Restoring Hope for Mental Health and Well-Being Act of 2022 (Division FF, Title I of P.L. 117-328, the Consolidated Appropriations Act, 2023): Section-by-Section Summary

January 29, 2024 R47910

The Restoring Hope for Mental Health and
January 29, 2024
Well-Being Act of 2022 (Division FF, Title I of
Johnathan H. Duff
P.L. 117-328, the Consolidated Appropriations Analyst in Health Policy

Act, 2023): Section-by-Section Summary

The Restoring Hope for Mental Health and Well-Being Act was enacted on December 29, 2022,
as Division FF, Title I of the Consolidated Appropriations Act, 2023 (P.L. 117-328). The act primarily reauthorized or
amended behavioral health (i.e., mental health and substance use) program authorizations expiring in FY2023. The act
reauthorized many behavioral health programs established or reauthorized in 2016 by the 21st Century Cures (P.L. 114-255)
or the Comprehensive Addiction and Recovery Act (P.L. 114-198). The act also amended or reauthorized federal programs or
regulations related to mental health (e.g., mental health crisis response, suicide prevention, children’s mental health) and
substance use (e.g., alcohol use, opioid use disorder, recovery housing). Most of the amended provisions authorize grant
programs administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the
Department of Health and Human Services (HHS).
The Restoring Hope for Mental Health and Well-Being Act is organized into five titles. Each title focuses on a different
aspect of behavioral health:
• Subtitle A (“Mental Health and Crisis Care Needs”) focuses on federal mental health program authorizations,
including programs supporting specific services (e.g., crisis response, peer support) or targeting certain populations
(e.g., pregnant and postpartum women, individuals with eating disorders or serious mental illness). A reauthorization
for SAMHSA’s mental health block grant is also included.
• Subtitle B (“Substance Use Disorder Prevention, Treatment, and Recovery Services”) focuses on federal
substance use program authorizations, including programs supporting specific services (e.g., medications for opioid
use disorder, recovery housing) or targeting certain populations (e.g., homeless individuals, Indian Tribes or tribal
organizations). A reauthorization for SAMHSA’s substance use block grant is also included.
• Subtitle C (“Access to Mental Health Care and Coverage”) focuses on federal authorizations related to the
mental health care workforce, access to integrated care services, and private health insurance coverage of behavioral
health services (i.e., mental health parity).
• Subtitle D (“Children and Youth”) focuses on federal mental health program authorizations specifically
addressing the mental health and well-being of children and youth. These authorizations address support for school-
based programming, suicide prevention activities (e.g., Garrett Lee Smith program reauthorizations), and children
with serious emotional disturbances, among others.
• Subtitle E (“Miscellaneous Provisions”) prohibits the HHS Secretary from allocating funding to carry out any
program authorized or amended by the Restoring Hope for Mental Health and Well-Being Act without considering
the incidence, prevalence, or determinants of behavioral health issues.
This report provides a section-by-section summary of the Restoring Hope for Mental Health and Well-Being Act, organized
by subtitle and chapter of the act. It includes relevant background information, followed by a summary of each provision.

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The Restoring Hope for Mental Health and Well-Being Act of 2022

Introduction
The Restoring Hope for Mental Health and Well-Being Act was enacted on December 29, 2022,
as Division FF, Title I of the Consolidated Appropriations Act, 2023 (P.L. 117-328). The act
primarily reauthorized or amended behavioral health (i.e., mental health and substance use)
program authorizations expiring in FY2023. The act reauthorized many programs established or
reauthorized in 2016 by the 21st Century Cures Act (Cures Act; P.L. 114-255 )1 or the
Comprehensive Addiction and Recovery Act (P.L. 114-198).2 The act amended or reauthorized
specific federal programs related to mental health (e.g., mental health crisis response, suicide
prevention, children’s mental health) and substance use (e.g., alcohol use, opioid use disorder,
recovery housing).
Most of the amended provisions authorize grant programs administered by the Substance Abuse
and Mental Health Services Administration (SAMHSA) within the Department of Health and
Human Services (HHS). SAMHSA is the federal agency primarily responsible for supporting
community-based mental health and substance abuse treatment and prevention services.
SAMHSA provides federal funding to states, local communities, and individual organizations
through block grants and other formula and discretionary grants. Through such grants, SAMHSA
supports activities that include education and training, prevention programs, early intervention
activities, treatment services, and technical assistance. SAMHSA does not provide mental health
or substance abuse treatment. Rather, the agency supports states’ efforts in providing community-
based behavioral health services. SAMHSA derives most of its statutory authority from the Public
Health Service Act (PHSA). More specifically, Title V and Title XIX of the PHSA contain most
authorities for SAMHSA programs and activities.3
The Restoring Hope for Mental Health and Well-Being Act (H.R. 7666) passed the House as a
standalone bill in June 2022. After being received in the Senate and referred to the Committee on
Health, Education, Labor, and Pensions, the bill was ultimately incorporated into the
Consolidated Appropriations Act, 2023, and enacted on December 29, 2022, as Division FF, Title
I of P.L. 117-328.
This report provides a section-by-section summary of the Restoring Hope for Mental Health and
Well-Being Act, organized by subtitle and chapter of the act. It includes relevant background
information, followed by a summary of each provision.

1 The 21st Century Cures Act (P.L. 114-255) was signed into law on December 13, 2016. Division B, entitled “Helping
Families in Mental Health Crisis,” established or reauthorized many federal programs—and amended several
regulations—related to mental health. For more information on the behavioral health authorizations in the 21st Century
Cures Act, see CRS Report R44718, The Helping Families in Mental Health Crisis Reform Act of 2016 (Division B of
P.L. 114-255).
2 In a couple of cases, the act reauthorized programs established or amended by the SUPPORT for Patients and
Communities Act (SUPPORT Act; P.L. 115-271). For more information on the behavioral health authorizations in the
SUPPORT Act, see CRS Report R45423, Public Health and Other Related Provisions in P.L 115-271, the SUPPORT
for Patients and Communities Act.
3 For more information on SAMHSA, see CRS Report R46426, Substance Abuse and Mental Health Services
Administration (SAMHSA): Overview of the Agency and Major Programs.
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The Restoring Hope for Mental Health and Well-
Being Act: At a Glance
In summary, the subtitles of the Restoring Hope for Mental Health and Well-Being Act address
the following:
• Subtitle A (“Mental Health and Crisis Care Needs”) focuses on federal mental
health program authorizations, including programs supporting specific services
(e.g., crisis response, peer support) or targeting certain populations (e.g., pregnant
and postpartum women, individuals with eating disorders or serious mental
illness). A reauthorization for SAMHSA’s mental health block grant is also
included.
• Subtitle B (“Substance Use Disorder Prevention, Treatment, and Recovery
Services”) focuses on federal substance use program authorizations, including
programs supporting specific services (e.g., medications for opioid use disorder,
recovery housing) or targeting certain populations (e.g., homeless individuals,
Indian Tribes or Tribal organizations). A reauthorization for SAMHSA’s
substance use block grant is also included.
• Subtitle C (“Access to Mental Health Care and Coverage”) focuses on federal
authorizations related to the mental health care workforce, access to integrated
care services, and private health insurance coverage of behavioral health services
(i.e., mental health parity).
• Subtitle D (“Children and Youth”) focuses on federal mental health program
authorizations specifically addressing the mental health and well-being of
children and youth. These authorizations address support for school-based
programming, suicide prevention activities (e.g., Garrett Lee Smith program
reauthorizations), and children with serious emotional disturbances, among
others.
• Subtitle E (“Miscellaneous Provisions”) prohibits the HHS Secretary from
allocating funding to carry out any program authorized or amended by the
Restoring Hope for Mental Health and Well-Being Act without considering the
incidence, prevalence, or determinants of behavioral health issues.
The Restoring Hope for Mental Health and Well-Being Act is an authorizing law; it does not
appropriate any funds. Some of the programs amended or reauthorized by the law have not
received explicit appropriations.
In this report, “Secretary” refers to the HHS Secretary unless otherwise noted.4

4 A table of the abbreviations used in this report appears in the Appendix.
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The Restoring Hope for Mental Health and Well-
Being Act: Summary of Provisions5
Technical Edits in the Restoring Hope for Mental Health and Well-Being Act
Many of the provisions in the Restoring Hope for Mental Health and Well-Being Act make similar amendments to
language throughout Title V of the Public Health Service Act (PHSA). For example, several provisions replace the
terms “addiction” and “abuse” with “use disorders” to describe substance use. The changes align the legislative
language with current clinical and diagnostic terminology related to substance use disorders. The Restoring Hope
for Mental Health and Well-Being provisions also capitalize “Tribes” and “Tribal” in places the terms appear in
Title V of the PHSA. When technical edits are referenced in the current report, it usually describes these changes.
Subtitle A—Mental Health and Crisis Care Needs
Chapter 1—Crisis Care Services and 9-8-8 Implementation
Section 1101. Behavioral Health Crisis Coordinating Office
Background
The Department of Health and Human Services (HHS)—primarily through the Substance Abuse
and Mental Health Services Administration (SAMHSA)—supports state and local response
efforts to individuals experiencing a mental health crisis. For example, SAMHSA supports the
operation of the 988 Suicide & Crisis Lifeline (Lifeline). In July 2022, the Lifeline transitioned
from a 10-digit number (1-800-273-TALK) to a three-digit 9-8-8 hotline. In its published 988
appropriations report, SAMHSA articulated a long-term goal of situating the Lifeline in the center
of a broader, more robust crisis response system capable of dispatching mobile response services
and providing adequate follow-up care.6 At the direction of Congress via report language
accompanying annual appropriations, SAMHSA established the 988 Behavioral Health Crisis
Coordinating Office in 2022 through their general authorities derived from Title V of the Public
Health Service Act (PHSA).7 The purpose of the office is to provide leadership and facilitate
coordination of behavioral health crisis services across the nation.8
Provision
Section 1101 adds a new PHSA Section 501B establishing a behavioral health crisis coordinating
office to “coordinate work relating to behavioral health crisis care” across HHS agencies and
departments, including SAMHSA, the Centers for Medicare & Medicaid Services (CMS), and the
Health Resources and Services Administration (HRSA). Specified duties of the office include (1)

5 Section 1001 introduces Title I of Division FF as the “Restoring Hope for Mental Health and Well-Being Act of
2022.”
6 Substance Abuse and Mental Health Services Administration (SAMHSA), 988 Appropriations Report, Rockville,
MD, December 2021, https://www.samhsa.gov/sites/default/files/988-appropriations-report.pdf.
7 H.Rept. 117-96; see also “Explanatory Statement Submitted by Ms. DeLauro, Chair of the House Committee on
Appropriations, Regarding the House Amendment to the Senate Amendment to H.R. 2471, Consolidated Appropriated
Act, 2022,” Congressional Record, vol. 168, part 42, book IV (March 9, 2022), p. H2679.
8 SAMHSA, 988 & Behavioral Health Crisis Coordinating Office, https://www.samhsa.gov/about-us/who-we-are/
offices-centers/988-behavioral-crisis-coordinating-office.
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convening stakeholders, (2) operating federal workgroups to make best practices
recommendations, and (3) supporting technical assistance, data analysis, and evaluation functions
of behavioral health crisis providers, such as the 988 Suicide & Crisis Lifeline, community mental
health centers, Certified Community Behavioral Health Clinics (CCBHCs), and other community
behavioral health providers. Section 1101 codifies SAMHSA’s 988 Behavioral Health Crisis
Coordinating Office, initially established in 2022 under SAMHSA’s general authorities.9
New PHSA Section 501B authorizes $5 million to be appropriated for each of FY2023-FY2027.
Section 1102. Crisis Response Continuum of Care
Background
During the 2022 transition of the National Suicide Prevention Lifeline from the 10-digit number
to the new three-digit 988 Suicide & Crisis Lifeline, the Biden Administration, executive agencies
overseeing the Lifeline, and mental health advocacy groups referred to an opportunity to leverage
the launch of 988 to enhance the national mental health crisis response system more broadly.10 In
its National Guidelines for Behavioral Health Crisis Care for instance, SAMHSA described an
effective mental health crisis system as a continuum of care that includes crisis contact centers
(“someone to talk to”), mobile crisis services (“someone to respond”), and crisis stabilization
facilities such as psychiatric receiving centers (“a safe place for help”).11 SAMHSA established
the 988 Behavioral Health Crisis Coordinating Office in 2022 to provide leadership and technical
assistance related to behavioral health crisis services.12
Provision
Section 1102 requires the Secretary, acting through the SAMHSA Assistant Secretary, to identify
and publish best practices for a behavioral health crisis response continuum of care. These best
practices are to consider (1) the range of service providers (i.e., those that do not require prior
authorization from insurance, provide services regardless of ability to pay, operate 24/7, provide
services through stabilization or transfer to the next level of care, or address psychiatric
stabilization), (2) functions of services (i.e., referral and enrollment in behavioral health care,
access points to services within the continuum of care, transfer and receipt of individuals
throughout the continuum of care, workforce qualifications, and collaboration with community
partners), and (3) service capacity and quality (i.e., volume of services to meet population need,
timely responsiveness, capacity to serve different patient populations).

9 Ibid.
10 See, for example, HHS, “HHS Awards More Than $130 Million in 988 Lifeline Grants From the Bipartisan Safer
Communities Act to Address Nation’s Ongoing Mental Health and Substance Use Crises,” press release, December 16,
2022, https://www.hhs.gov/about/news/2022/12/16/hhs-awards-more-than-130-million-988-lifeline-grants-bipartisan-
safer-communities-act-address-nations-ongoing-mental-health-substance-use-crises.html; and National Council for
Mental Wellbeing, Roadmap to the Ideal Crisis System: Essential Elements, Measurable Standards and Best Practices
for Behavioral Health Crisis Response, March 2021, https://www.thenationalcouncil.org/resources/roadmap-to-the-
ideal-crisis-system/.
11 SAMHSA, National Guidelines for Behavioral Health Crisis Care, Best Practice Toolkit, Rockville, MD, 2020,
https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf. See
also, SAMHSA, 988 Appropriations Report, Rockville, MD, December 2021, https://www.samhsa.gov/sites/default/
files/988-appropriations-report.pdf.
12 SAMHSA, 988 & Behavioral Health Crisis Coordinating Office, https://www.samhsa.gov/about-us/who-we-are/
offices-centers/988-behavioral-crisis-coordinating-office. The authority for this office was codified in Section 1101 of
the Restoring Hope for Mental Health and Well-Being Act, as described above.
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The provision requires SAMHSA to publish the best practices no later than one year after
enactment (i.e., December 29, 2023). The provision requires GAO to submit an assessment of
behavioral health crisis programs to specified congressional committees no later than three years
after enactment (i.e., December 29, 2025) to evaluate which programs meet objectives and
performance metrics (with potential data metrics specified).
Section 1103. Suicide Prevention Lifeline Improvement
Background
PHSA Section 520E-3 (“The National Suicide Prevention Lifeline Program”) authorizes the
National Suicide Prevention Lifeline, a national hotline providing crisis counseling and referral
services to individuals experiencing suicidal thoughts or other mental distress. The 21st Century
Cures Act codified the program in PHSA Section 520E-3 in 2016, though the Lifeline had
operated since 2005.13 The authorization for the Lifeline specifies that SAMHSA coordinate a
network of 24-hour crisis centers and maintain the suicide prevention hotline to connect callers
with local emergency services. Lifeline services have consisted primarily of immediate crisis
counseling through the hotline, along with referrals, as needed, to local follow-up services. In
2022, the Lifeline transitioned from a 10-digit phone number to a three-digit 9-8-8 hotline (and
rebranded as the 988 Suicide & Crisis Lifeline).14 Many saw the launch of 988 as an opportunity
to enhance SAMHSA’s role in more broadly building and maintaining the national mental health
crisis response system.15
Section 520E-3 previously authorized $7.2 million (rounded) to be appropriated for each of
FY2018-FY2022.
Provision
Section 1103 amends PHSA Section 520E-3 by adding more requirements to the National Suicide
Prevention Lifeline authorization.16 Specifically, Section 1101 authorizes the Secretary, acting
through the SAMHSA Assistant Secretary, to support and coordinate a national network of crisis
centers for suicide prevention and “mental health crisis intervention services, including
appropriate follow-up services.”17 The provision requires SAMHSA to develop and implement a
plan to support crisis centers and maintain the Lifeline. Contents of the plan include (1) program
evaluation using performance measures to assess progress and improve responsiveness of the
Lifeline; (2) crisis center requirements related to participation, call responsiveness, and best
practices; (3) recommendations on implementing evidence-based practices; and (4) criteria for
periodic testing of the Lifeline. The provision requires SAMHSA to develop the initial plan no
later than one year after enactment (i.e., December 29, 2023).
Section 1103 requires the Secretary to complete a study and issue a report on the implementation
of the Lifeline plan (specified above), and options to improve data on the Lifeline, no later than

13 Cures Act §9005.
14 While the Lifeline is now known as the 988 Suicide & Crisis Lifeline, the authorizing provision in Title V of the
PHSA (§520E-3; 42 U.S.C. §290bb-36c) maintains the “National Suicide Prevention Lifeline Program” title.
15 See SAMHSA, 988 Appropriations Report, Rockville, MD, December 2021, https://www.samhsa.gov/sites/default/
files/988-appropriations-report.pdf; and National Council for Mental Wellbeing, Roadmap to the Ideal Crisis System:
Essential Elements, Measurable Standards and Best Practices for Behavioral Health Crisis Response, March 2021,
https://www.thenationalcouncil.org/resources/roadmap-to-the-ideal-crisis-system/.
16 §520E-3; 42 U.S.C. §290bb-36c.
17 42 U.S.C. §290bb-36c.
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two years after development of the plan. The provision requires GAO to complete a study and
submit a report to Congress with specified information on implementation of the Lifeline plan,
recommendations for improving the Lifeline, and specified issues related to access to the Lifeline
no later than two years after implementation of the plan begins.
Section 1103 also adds requirements to the Lifeline authorization related to sharing data with the
Centers for Disease Control and Prevention (CDC) and state and local agencies. More
specifically, the provision requires the Secretary to formalize an arrangement between the
Lifeline and CDC related to sharing de-identified epidemiological data. It also requires the
Secretary to ensure that aggregated data are available to state and local agencies to inform suicide
prevention activities.
The provision authorizes the Secretary to carry out a pilot program to research, analyze, and
employ various technologies or communication platforms (e.g., social media, texting, and email)
for suicide prevention, in addition to the Lifeline telephone and chat services. The Secretary is
required to submit a report with specified information on the pilot program no later than 24
months after the pilot program commences.
Section 1103 reauthorizes the National Suicide Prevention Lifeline. PHSA Section 520E-3(f) now
authorizes $101.6 million (rounded) to be appropriated for each of FY2023-FY2027.
Chapter 2—Into the Light for Maternal Mental Health and
Substance Use Disorders
Section 1111. Screening and Treatment for Maternal Mental Health and
Substance Use Disorders
Background
PHSA Section 317L-1 (“Screening and Treatment for Maternal Depression”) authorizes a grant
program to states for screening, assessment, and treatment of maternal depression. The Health
Resources and Services Administration (HRSA) administers the Screening and Treatment for
Maternal Depression and Related Behavioral Disorders grant program. HRSA provides grants to
states for programs that expand the capacity to assess, treat, and refer pregnant and postpartum
women for services for maternal depression and related behavioral health disorders. In FY2018,
for example, HRSA funded seven states for programs training health care providers in assessing
and treating maternal mental health conditions.18
Section 317L-1(e) previously authorized $5 million to be appropriated for each of FY2018-
FY2022.
Provision
Section 1111 amends PHSA Section 317L-1 by changing the title to “Screening and Treatment for
Maternal Mental Health and Substance Use Disorders.” The provision adds Tribes and Tribal
organizations as eligible grant recipients. It also expands the purpose of the grants (from
“maternal depression” to “maternal mental health”) and amends the definition of the population

18 HRSA, Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program (MDRBD),
https://mchb.hrsa.gov/programs-impact/screening-treatment-maternal-depression-related-behavioral-disorders-
program-mdrbd.
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served. The provision makes similar conforming changes throughout Section 317L-1. It requires
the Secretary to prioritize eligible entities providing screening and treatment for maternal
behavioral health issues through partnerships with community-based organizations in areas with
disproportionate need or in health professional shortage areas.
Section 1111 specifies training requirements and amends the types of professionals served
through training and resources. It also expands the eligible uses of funds, adding several activities
supported by the grant: (1) screening, brief intervention, and treatment; (2) psychiatric
consultation; (3) coordination with maternal and child health programs, including child
psychiatric access programs; (4) public outreach and awareness; (5) creation of a multistate
consortia; and (6) training primary care providers on trauma-informed care, culturally appropriate
services, and other best practices. Section 1111 also requires the Secretary to provide technical
assistance to grantees and other states and Tribes, and to disseminate best practices based on
program evaluation. The provision further adds a new subsection limiting the federal share of
grant-supported activities to 90%.
Section 1111 reauthorizes the (renamed) Screening and Treatment for Maternal Mental Health
and Substance Use Disorders grant program. PHSA Section 317L-1 now authorizes $24 million
to be appropriated for each of FY2023-FY2027.
Section 1112. Maternal Mental Health Hotline
Background
In May 2022, HRSA launched a new Maternal Mental Health Hotline for expecting and new
mothers experiencing mental health challenges.19 The confidential, toll-free hotline connects
callers with counselors available to provide mental health support. Individuals who contact the
hotline receive brief interventions from trained counselors, or referrals to community-based and
telehealth providers for further services. HRSA originally operated the hotline under its general
authorities with an explicit appropriation from Congress.20 PHSA Title III (“General Powers and
Duties of the Public Health Service”) contains many of the authorizations for HHS Public Health
Service agency programs, including several HRSA maternal and child health initiatives.
Provision
Section 1112 amends PHSA Title III Part P (“Additional Programs”) by adding a new Section
399V-7 (“Maternal Mental Health Hotline”), which requires the Secretary to maintain a national
maternal mental health hotline. The new authorization requires that the hotline provide emotional
support, information, brief intervention, and resources to pregnant and postpartum women with
behavioral health needs (and to their families or household members). Section 1112 effectively
codifies the Maternal Mental Health Hotline launched by HRSA in 2022.
Section 1112 specifies requirements for the hotline (e.g., hours of operation, staffing, services
provided). It also requires the Secretary to conduct a public awareness campaign for the hotline
and consult with state and local officials, federal agencies, and other related national hotlines,

19 U.S. Department of Health and Human Services, “HHS Launches New Maternal Mental Health Hotline,” press
release, May 6, 2022, https://www.hhs.gov/about/news/2022/05/06/hhs-launches-new-maternal-mental-health-
hotline.html.
20 H.Rept. 116-450 and “Explanatory Statement Submitted by Mrs. Lowey, Chairwoman of the House Committee on
Appropriations, Regarding the House Amendment to the Senate Amendment to H.R. 133, Consolidated Appropriations
Act, 2021,” Congressional Record, vol. 166, part 218, book IV (December 21, 2020), p. H8620.
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such as the National Suicide Prevention Lifeline.21 The provision requires the Secretary to submit
an annual report to Congress that includes an evaluation of the effectiveness of the hotline and a
directory of referral organizations.
New PHSA Section 399V-7 authorizes $10 million to be appropriated for each of FY2023-
FY2027.
Section 1113. Task Force on Maternal Mental Health
Background
HHS—primarily through SAMHSA and HRSA—provides resources and administers grants
related to maternal behavioral health. For example, HRSA operates the Maternal Mental Health
Hotline for expecting and new mothers experiencing mental health challenges.22 Similarly,
SAMHSA offers clinical guidance for practitioners treating pregnant and parenting women,23
toolkits and technical assistance related to maternal mental health,24 and grant programs
addressing health needs of pregnant women affected by substance use.25 Prior to enactment of the
Restoring Hope for Mental Health and Well-Being Act, no authorization for a maternal mental
health task force existed.
Provision
Section 1113 requires the Secretary—no later than 180 days after enactment (i.e., June 30,
2023)—to establish a Task Force on Maternal Mental Health (or incorporate the duties specified
in the provision into the responsibilities of an existing federal committee or working group). The
provision specifies task force membership, which includes the heads of several HHS agencies and
other nonfederal members representing various relevant organizations to be appointed by the
Secretary. The provision requires designees to be appointed no later than 90 days after enactment
(i.e., March 30, 2023).
Section 1113 specifies the duties of the task force, which include preparing and updating a report
that evaluates federal maternal mental health programs and identifies best practices related to
prevention, diagnosis, and treatment; referral to supports; and implementation of community-
based or multigenerational support for maternal mental health conditions. The task force must
also develop a national strategy for maternal mental health, which is to include how federal
agencies coordinate efforts to address maternal mental health conditions. The task force is
required to solicit public comments and consider the latest research in preparing the report and
national strategy.

21 The statutory authorization for the National Suicide Prevention Lifeline uses that title; however, as of 2022, the
program is more commonly referred to as the 988 Suicide & Crisis Lifeline.
22 HRSA, National Maternal Mental Health Hotline, May 2023, https://mchb.hrsa.gov/national-maternal-mental-
health-hotline.
23 SAMHSA, Clinical Guidance for Treatment Pregnant and Parenting Women With Opioid Use Disorder and Their
Infants, SMA18-5054, January 2018, https://store.samhsa.gov/product/Clinical-Guidance-for-Treating-Pregnant-and-
Parenting-Women-With-Opioid-Use-Disorder-and-Their-Infants/SMA18-5054.
24 SAMHSA, Depression in Mothers: More Than the Blues, SMA14-4878, March 2016, https://store.samhsa.gov/
product/Depression-in-Mothers-More-Than-the-Blues/sma14-4878.
25 SAMHSA, “HHS Announces New Reports and Grant Programs Addressing the Health Needs of Pregnant Women
and Children Affected by Substance Use,” press release, February 3, 2022, https://www.samhsa.gov/newsroom/press-
announcements/20220203/grants-pregnant-women.
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The provision requires the task force to meet at least two times each year and convene public
meetings, as appropriate. The provision also requires the task force to submit a report to specified
entities, including federal agencies and certain congressional committees, no later than one year
after the first task force meeting (and an updated report annually thereafter). It requires the task
force to submit an initial national strategy no later than two years after the first task force
meeting, and an updated national strategy annually thereafter. The provision requires the task
force to submit a report to governors of all states describing opportunities for local and state
partnerships.
Section 1113 requires the task force to terminate on September 30, 2027, and specifies that the
task force may not duplicate others HHS efforts.
Section 1114. Residential Treatment Program for Pregnant and Postpartum
Women Pilot Program Reauthorization
Background
PHSA Section 508 (“Residential Treatment Programs for Pregnant and Postpartum Women”)
authorizes SAMHSA’s Pregnant and Postpartum Women (PPW) program, which supports
residential substance use disorder treatment and recovery support services to pregnant and
postpartum women, their children, and other family members.26 In 2016, the Comprehensive
Addiction and Recovery Act (CARA; P.L. 114-198) added an authorization for a pilot program
for state substance abuse agencies to support new models of service delivery, family-based
approaches, and activities addressing other gaps in care.27 The new provision added by CARA
included a five-year limit on the pilot program.
In 2018, the SUPPORT Act reauthorized PHSA Section 508, amending the authorization for
appropriations to $29.9 million (rounded) for each of FY2019-FY2023.28
Provision
Section 1114 amends PHSA Section 508 to remove the five-year limit on the pilot program
authorized in subsection (r). Additionally, the provision now requires that the pilot program report
be submitted to specified congressional committees no later than September 30, 2026.
Chapter 3—Reaching Improved Mental Health Outcomes
for Patients
Section 1121. Innovation for Mental Health
Background
In 2016, the 21st Century Cures Act created several new behavioral health authorizations,
including for a new National Mental Health and Substance Use Policy Laboratory within
SAMHSA, and an Interdepartmental Serious Mental Illness Coordinating Committee established
by the Secretary.

26 HHS, SAMHSA, Justification of Estimates for Appropriations Committees, FY2024.
27 CARA §501; 42 U.S.C. §290bb-1(r).
28 42 U.S.C. §290bb-1(s).
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Section 7001 of the Cures Act added a new PHSA Section 501A establishing within SAMHSA
the National Mental Health Policy Laboratory. The Laboratory’s responsibilities include
coordinating the implementation of policy changes to improve certain behavioral health-related
outcomes, identifying evidence-based practices, reviewing SAMHSA programs to identify
duplicative programs or programs that are not evidence-based, and providing recommendations
for improving SAMHSA programs. The provision authorized SAMHSA, via the Laboratory, to
award grants for (1) evaluating promising service delivery models and (2) expanding the use of
evidence-based programs. In 2018, the SUPPORT Act added another responsibility, requiring the
Laboratory to provide information to SAMHSA grant applicants regarding the implementation of
evidence-based practices and to provide technical assistance to applicants for funding. SAMHSA
appointed its first Director of the National Mental Health and Substance Use Policy Laboratory in
January 2018.29 SAMHSA announced its third and most recent director in June 2023.30
PHSA Section 501A previously authorized $7 million to be appropriated for the period of
FY2018-FY2020 to carry out each of the two grant programs (i.e., $14 million total).
Section 6031 of the Cures Act required the Secretary to establish an Interdepartmental Serious
Mental Illness Coordinating Committee. The provision specified committee membership,
membership terms, and the frequency of committee meetings. It required the committee to
produce a report—no later than one year after enactment (i.e., December 2017) and again five
years after enactment (i.e., December 2021)—summarizing advances, evaluating federal
programs, and recommending services for individuals with serious mental illness (SMI). The
Cures Act provision specified that the committee shall terminate six years after it is established;
however, it also required the Secretary, upon submission of the committee’s second report, to
make a recommendation to Congress as to whether operation of the committee should be
extended.
SAMHSA administers numerous grants and activities under authorities commonly known as
Programs of Regional and National Significance (PRNS) in three areas: mental health, substance
abuse treatment, and substance abuse prevention.31 The mental health PRNS are authorized under
PHSA Section 520A (“Priority Mental Health Needs of Regional and National Significance”).
Previously, Section 520A authorized $395.6 million (rounded) to be appropriated for each of
FY2018-FY2022 for the mental health PRNS.
Provision
Section 1121 amends PHSA Section 501A to reauthorize the National Mental Health and
Substance Use Policy Laboratory. The provision requires GAO to prepare a report no later than
18 months after enactment (i.e., June 29, 2024) on the work of the Laboratory, including the
extent to which it is meeting its statutory responsibilities and any recommendations for
improvement. The provision makes other technical edits.
PHSA Section 501A(f) now authorizes $10 million to be appropriated for each of FY2023-
FY2027 for all activities authorized under the section.

29 SAMHSA, SAMHSA Blog, Leadership Announcement, January 9, 2018, https://blog.samhsa.gov/tag/policy.
30 SAMHSA, About Us/Who We Are/Leadership/Brian Altman, June 5, 2023, https://www.samhsa.gov/about-us/who-
we-are/leadership/biographies/brian-altman.
31 Under PHSA Title V Part B, the HHS Secretary is required to “address priority ... needs of regional and national
significance” in mental health (PHSA §520A), substance abuse treatment (PHSA §509), and substance abuse
prevention (PHSA §516); the HHS Secretary may do so “directly or through grants or cooperative agreements with
States, political subdivisions of States, Indian tribes and tribal organizations, other public or private nonprofit entities.”
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Section 1121 adds a new PHSA Section 501C codifying in the PHSA an authorization for the
Interdepartmental Serious Mental Illness Coordinating Committee (and reauthorizing the
committee through 2027). The new PHSA provision specifies committee responsibilities and
membership (including term duration). The provision requires the committee to produce reports
no later than one year and five years after enactment (i.e., December 29, 2023, and December 29,
2027) summarizing research on the prevention, diagnosis, and treatment of SMI and evaluating
federal programs for SMI (with specified information to include in the reports). New Section
501C specifies that the committee shall terminate on September 30, 2027. Section 1121 repeals
the previous authorization for the committee included in the Cures Act.
Section 1121 reauthorizes SAMHSA’s Priority Mental Health Needs of Regional and National
Significance (PRNS). PHSA Section 520A now authorizes $599 million (rounded) to be
appropriated for each of FY2023-FY2027.
Section 1122. Crisis Care Coordination
Background
Prior to being amended by the Restoring Hope for Mental Health and Well-Being Act, PHSA
Section 520F (“Strengthening Community Crisis Response Systems”) required the Secretary to
award competitive grants (1) to states, localities, Indian Tribes, and Tribal Organizations to
enhance community-based crisis response systems, or (2) to states to develop, maintain, or
enhance a database of beds at specified inpatient behavioral health treatment facilities. It specified
application procedures, defined the requirements of a database of inpatient beds, and required an
evaluation. The provision required applicants to include a community-based crisis response plan
(as defined) but did not explicitly require mobile crisis services.
In FY2022, SAMHSA established the Cooperative Agreements for Innovative Community Crisis
Response Partnerships program under this authority.32 The purpose of this program is to create or
enhance existing mobile crisis response teams that divert individuals experiencing mental health
crises from law enforcement in high-need communities. The program supports mobile crisis team
services (including co-responder teams) that offer community-based intervention to individuals in
need wherever they are located.33
PHSA Section 520F previously authorized $12.5 million to be appropriated for the period of
FY2018-FY2022 to carry out the program.
PHSA Section 502J (“Mental Health Awareness Training Grants”) authorizes a grant program to
train teachers, emergency services personnel, law enforcement, and other individuals to identify
and appropriately respond to children and adults with a mental disorder. Grants often support
training through Mental Health First Aid, a formal eight-hour course on how to identify,
understand, and respond to the signs of a crisis, mental health condition, or substance use issue.
Section 520J previously authorized $14.7 million (rounded) to be appropriated annually for each
of FY2018-FY2022.
PHSA Section 520L (“Adult Suicide Prevention”) authorizes the National Strategy for Suicide
Prevention and the Zero Suicide grant programs. The National Strategy for Suicide Prevention
grant program supports states and community partners in implementing the National Strategy for

32 SAMHSA, Justification of Estimates for Appropriations Committees, FY2024, p. 80.
33 For more information on co-responder teams, see CRS Report R47285, Issues in Law Enforcement Reform:
Responding to Mental Health Crises.
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Suicide Prevention—a coordinated guide to the nation’s suicide prevention efforts.34 The Zero
Suicide program funds evidence-based suicide prevention interventions in health systems.
Section 520L previously authorized $30 million to be appropriated for the period of FY2018-
FY2022.
Provision
Section 1122 replaces PHSA Section 520F with a new provision (“Mental Health Crisis Response
Partnership Pilot Program”) authorizing a pilot program requiring the Secretary to award grants to
establish or enhance mobile crisis response teams. The provision effectively codifies SAMHSA’s
Cooperative Agreements for Innovative Community Crisis Response Partnerships program.35
Mobile crisis response teams are defined as a team of individuals available to respond to people
in behavioral health crises and provide immediate stabilization, referrals to service, and triage to a
higher level of care, if necessary. The provision requires the Secretary to submit a report to
Congress no later than September 30, 2024, on previous steps taken by states and localities to
strengthen partnerships among specified members of the behavioral health care community,
including first responders, primary care providers, and law enforcement, among others. The
provision requires the Secretary to submit annual progress reports with specified information on
the grant program, including populations served and related outcomes.
New PHSA Section 520F authorizes $10 million to be appropriated for each of FY2023-FY2027.
Section 1122 amends PHSA Section 502J by making several technical edits. It adds evidence-
based training and education on suicide intervention and prevention to the list of allowable uses
of funds. It also allows SAMHSA to provide technical assistance to grantees.
Section 1122 reauthorizes the mental health awareness training grant program. PHSA Section
502J now authorizes $25 million (rounded) to be appropriated for each of FY2023-FY2027.
Section 1122 amends PHSA Section 520L by making changes to the purpose of the suicide
prevention grant programs. It expands the intended population served to all adults instead of those
25 years of age or older, further emphasizes suicide prevention in the purpose of the grant, and
adds suicide prevention resources and the promotion of help seeking for those at risk for suicide
as allowable components of activities. The provision adds a third technical assistance
requirement, in which the Secretary is to identify best practices for referrals and coordination of
follow-up care for individuals in the emergency department who are at risk for suicide, and
coordination of care after discharge.
Section 1122 reauthorizes the adult suicide prevention grant programs in PHSA Section 520L.
PHSA Section 520L now authorizes $30 million to be appropriated for each of FY2023-FY2027.

34 U.S. Surgeon General and the National Action Alliance for Suicide Prevention, 2012 National Strategy for Suicide
Prevention: Goals and Objectives for Action, PEP12=NSSPGOALS, September 2012, https://www.hhs.gov/
surgeongeneral/reports-and-publications/suicide-prevention/index.html.
35 For more information on some mobile crisis response approaches, see CRS Report R47285, Issues in Law
Enforcement Reform: Responding to Mental Health Crises.
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Section 1123. Treatment of Serious Mental Illness
Background
PHSA Section 520M (“Assertive Community Treatment Grant Program”) authorizes SAMHSA’s
Assertive Community Treatment (ACT) for Individuals with Serious Mental Illness (SMI) grant
program.36 Originally authorized by the Cures Act,37 the ACT for SMI grant program supports a
multidisciplinary intervention designed to reduce rehospitalization and improve outcomes in
community settings for individuals with serious mental illness.38
PHSA Section 520M previously authorized $5 million to be appropriations for the period of
FY2018-FY2022.
The Protecting Access to Medicare Act of 2014 (PAMA; P.L. 113-93) Section 224 (“Assisted
Outpatient Treatment Grant Program for Individuals with Serious Mental Illness”) authorized a
four-year pilot program to award grants for Assisted Outpatient Treatment (AOT) programs for
individuals with SMI. It limited grant amounts to not exceed $1 million in each year. It originally
authorized $15 million to be appropriated annually for each of FY2015-FY2018. In 2018, the
Cures Act extended the program’s authorization through FY2022.39
The Cures Act amended PAMA Section 224 to authorize $15 million to be appropriated annually
for each of FY2015-FY2017, $20 million for FY2018, $19 million annually for each of FY2019-
FY2020, and $18 million annually for each of FY2021-FY2022.
Provision
Section 1123 amends PHSA Section 520M. The provision requires the Secretary to provide a
report on the grant program to specified congressional committees no later than September 30,
2026.
Section 1123 reauthorizes the ACT for SMI grant program. PHSA Section 520M now authorizes
$9 million to be appropriated for each of FY2023-FY2027.
Section 1123 amends PAMA Section 224 to remove the four-year pilot aspect of the program. It
makes the annual report biennial, specifies to which congressional committees the report is due,
and adds demographic information of the population served to the reporting requirements.
Section 1123 requires GAO to provide a report to specified congressional committees on the
efficacy of the assisted outpatient treatment programs funded under PAMA Section 224.
Section 1123 reauthorizes the AOT grant program. PAMA Section 224 now authorizes $22
million to be appropriated for each of FY2023-2027.40

36 42 U.S.C. §290bb-44.
37 Cures Act §9015.
38 SAMHSA, Justification of Estimates for Appropriations Committees, FY2023.
39 Cures Act §9014.
40 42. U.S.C. §290aa-17. (Previously 42 U.S.C. §290aa note.)
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Section 1124. Study on the Costs of Serious Mental Illness
Background
Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder that
substantially interferes with or limits one or more major life activities.41 According to SAMHSA’s
National Survey on Drug Use and Health (NSDUH), an estimated 14 million adults in the United
States had a serious mental illness in 2021. SMI causes significant functional impairment, often
disrupting an individual’s social functioning, capacity to participate in the labor force, and ability
to maintain stable housing, among other areas of life. The estimated per individual economic
burden from SMI can be substantial—comparable to other major health conditions such as cancer
and diabetes.42
Provision
Section 1124 requires the Secretary, in consultation with SAMHSA, the HHS Assistant Secretary
for Planning and Education (ASPE), the Department of Justice (DOJ), the Department of Labor
(DOL), and the Department of Housing and Urban Development (HUD), to conduct a study on
the costs of serious mental illness with respect to nongovernmental entities, the federal
government, and state, local, and Tribal governments.
The provision specifies considerations for the study, which include costs (1) to the health care
system for health services, (2) of homelessness, (3) of residential facilities and other supportive
housing, (4) of law enforcement and criminal justice system encounters, (5) of serious mental
illness on employment, (6) of caring for individual with SMI by family members and caregivers,
and (7) any other relevant costs for programs. The provision specifies disaggregation of the data
by costs to governments, types of medical and behavioral health conditions, demographic
characteristics, prevalence of serious mental illness, and housing status. The Secretary is required
to prepare a report on the study’s results no later than two years after enactment of the Restoring
Hope for Mental Health and Well-Being Act (i.e., December 29, 2024).
Chapter 4—Anna Westin Legacy
Section 1131. Maintaining Education and Training on Eating Disorders
Background
As part of its mission, SAMHSA supports health practitioners through technical assistance and
training. Since 2018, SAMHSA has supported a National Center of Excellence for Eating
Disorders (NCEED), located at the University of North Carolina at Chapel Hill.43 The purpose of
the program is to develop and disseminate training and technical assistance for health care

41 Excluding developmental disorders and substance use disorders. Common SMI includes psychoses, major depressive
disorder, and bipolar disorder. Substance Abuse and Mental Health Services Administration, Key Substance Use and
Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health, HHS
Publication No. PEP22-07-01-005, NSDUH Series H‑57, Rockville, MD, December 2022.
42 Seth A. Seabury, Sarah Axeen, Gwyn Pauley, et al., “Measuring the Lifetime Costs of Serious Mental Illness and the
Mitigating Effects of Educational Attainment,” Health Affairs, vol. 38, no. 4 (April 2019).
43 National Center of Excellence for Eating Disorders, National Center of Excellence for Eating Disorders: Our
Mission, https://www.nceedus.org/about/.
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practitioners on issues related to addressing eating disorders.44 This center for excellence
facilitates the identification of model programs, develops and updates materials related to eating
disorders, and ensures that high-quality training is provided to health professionals.
Provision
Section 1131 adds a new PHSA 520N entitled “Center for Excellence for Eating Disorders for
Education and Training on Eating Disorders.” The provision effectively codifies the NCEED
program, requiring the Secretary acting through the SAMHSA Assistant Secretary, by grant or
contract, to maintain a Center of Excellence for Eating Disorders to improve diagnosis and
treatment of eating disorders.
The center’s specified activities include (1) training and technical assistance for medical
providers in screening and referral for treatment for individuals with eating disorders, and for
other paraprofessionals in nonclinical community services; (2) developing and disseminating
training materials to health care providers regarding effective treatments for eating disorders; (3)
collaborating and coordinating with other SAMHSA entities regarding eating disorders; (4)
coordinating with CDC, HRSA, and other federal agencies to disseminate training to primary care
and mental health care providers; and (5) conducting other activities as determined by the
Secretary. The provision also states that the Secretary may support the integration of eating
disorder screening, brief intervention, and referral to treatment (SBIRT) with health information
technology systems, provide resources to members of the military and veterans, and consult with
DOD and VA on SBIRT for eating disorders.
The new PHSA Section 520N authorizes $1 million to be appropriated for each of FY2023-
FY2027.
Chapter 5—Community Mental Health Services Block
Grant Reauthorization
Section 1141. Reauthorization of Block Grants for Community Mental
Health Services
Background
PHSA Title XIX Subpart I (“Block Grants for Community Mental Health Services”) authorizes
SAMHSA’s Community Mental Health Services Block Grant (MHBG). The MHBG supports
state efforts in providing community mental health services for adults with serious mental illness
(SMI) and children with serious emotional disturbance (SED).45 SAMHSA distributes MHBG
funds to states (including the District of Columbia and specified territories) according to a
formula specified in Title XIX of the PHSA.46 Each state may distribute MHBG funds to local
government entities and nongovernmental organizations to provide community mental health
services in accordance with the state’s plan. States have flexibility in the use of MHBG funds

44 SAMHSA, National Center of Excellence for Eating Disorders (NCEED), November 2, 2022,
https://www.samhsa.gov/national-center-excellence-eating-disorders-nceed. See also SAMHSA, “SAMHSA announces
up to $3.75 million in funding to enhance training efforts to address eating disorders,” press release, July 18, 2018,
https://www.samhsa.gov/newsroom/press-announcements/20180718.
45 SAMHSA’s definitions of adults with SMI and children with SED were provided in a 1993 Federal Register notice
(May 20, 1993; 58 Federal Register 29422).
46 42 U.S.C. §300x et seq.
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within the framework of the state plan and federal requirements. The state must designate a
Single State Agency responsible for administering the grant and submit the state plan to the
Secretary every two years.47 The statutory authorization for the MHBG contains funding set-
asides, such as the requirement that a state must expend 10% of the funds to support early SMI.48
Beginning in FY2021, Congress has included a set-aside for “evidence-based crisis systems” in
annual appropriations for the MHBG 49 This set-aside reflects Congress’s recent intentions to
support the development and maintenance of a robust mental health crisis response system.50 The
set-aside is intended to support core elements of crisis care programs, such as mobile crisis units,
psychiatric stabilization beds, and crisis call centers.51
PHSA Section 1920 previously authorized $532.6 million (rounded) to be appropriated for each
of FY2018-FY2022 for the MHBG.
Provision
Section 1141 adds a new subsection to PHSA Section 1920 to codify the 5% set-aside of the
MHBG for “Evidence-Based Crisis Care Services.”52 Set-aside funding for crisis care services
may be used to support crisis call centers, 24/7 mobile crisis services, or crisis stabilization
programs.53 Section 1141 requires the Secretary to provide a report to Congress no later than
September 20, 2025 (and biennially thereafter), on the crisis care strategies and programs
supported by the MHBG set-aside. The report must include a description of crisis care activities,
populations served, and outcomes of activities, including the program’s effects on hospitalization
and hospital stays, onset of serious mental illness, and incidents of suicidal ideation and
behaviors.
Section 1141 amends PHSA Section 1920 (“Funding”) to reauthorize the Community Mental
Health Services Block Grant program. PHSA Section 1920 now authorizes $857.6 million
(rounded) to be appropriated for each of FY2023-FY2027.
Chapter 6—Peer-Supported Mental Health Services
Section 1151. Peer-Supported Mental Health Services
Background
Support services provided by individuals with lived experiences with mental health and substance
use disorders have been recognized as an essential component of comprehensive behavioral

47 For more information, see CRS Report R46426, Substance Abuse and Mental Health Services Administration
(SAMHSA): Overview of the Agency and Major Programs.
48 PHSA §1920(c); 42 U.S.C. §300x-9(c).
49 Rep. Rosa DeLauro, “Explanatory Statement Submitted by Ms. DeLauro, Chair of the House Committee on
Appropriations, Regarding the House Amendment to the Senate Amendment to H.R. 2471, Consolidated
Appropriations Act, 2022,” Proceedings and Debates of the 117th Congress, Second Session, Congressional Record,
vol. 168, part No. 42, Book IV (March 9, 2022), pp. H2477-H3215.
50 See, for example, H.Rept. 117-96 and SAMHSA, Justification of Estimates for Appropriations Committees, FY2023.
51 Ibid.
52 42 U.S.C. §300x-9(d).
53 According to the provision, a state may instead elect to expend not less than 10% of the MHBG funds over two fiscal
years.
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health care.54 Although SAMHSA supports peer involvement in mental health care through
activities such as its Consumer-Supporter Technical Assistance Centers, no explicit SAMHSA
authority to fund peer-support services in mental health treatment existed prior to enactment of
the Restoring Hope for Mental Health and Well-Being Act.55
Provision
Section 1151 adds a new PHSA Section 520H entitled “Peer-Supported Mental Health Services.”
The provision authorizes SAMHSA to administer a new grant program to develop, expand, and
enhance access to peer-delivered mental health services.
Specified use of funds for the new grant program include (1) initiating workforce development
activities to recruit and train peer-workforce providers; (2) building connections between various
treatment programs; (3) reducing stigma associated with mental health disorders; (4) expanding
virtual peer mental health support services; and (5) researching peer-support and mental illness.
Eligible entities include consumer-run nonprofit organizations and Indian Tribes and Tribal
organizations.
New PHSA Section 520H authorizes $13 million to be appropriated for each of FY2023-FY2027.
Subtitle B—Substance Use Disorder Prevention,
Treatment, and Recovery Services
Chapter 1—Native Behavioral Health Resources
Section 1201. Behavioral Health and Substance Use Disorder Resources for
Native Americans
Background
PHSA 506A (“Alcohol and Drug Prevention or Treatment Services for Indians and Native
Alaskans”) authorized a grant program for Native Alaskan entities and Indian Tribes and Tribal
organizations for substance use prevention and treatment services. Originally added by the
Children’s Health Act of 2000 (P.L. 106-310), the program authorization never received an
explicit appropriation. SAMHSA reported in its annual Congressional Budget Justification that
the activities authorized in Section 506A may be supported with funding from other Programs of

54 SAMHSA, for example, funds a Peer Support Technical Assistance Center and operates a Recovery Community
Services Program to strengthen the infrastructure of recovery communities and provide peer recovery support services
for individuals with substance use disorders and co-occurring mental health disorders. See SAMHSA, Recovery
Community Services Program, 2023 Notice of Funding Opportunity, https://www.samhsa.gov/grants/grant-
announcements/ti-23-018. See also SAMHSA, Peer Support Services in Crisis Care, SAMHSA Advisory, Rockville,
MD, June 2022, https://store.samhsa.gov/sites/default/files/pep22-06-04-001.pdf; and SAMHSA, Peers Supporting
Recovery from Mental Health Conditions, BRSS TACS Infographic, Rockville, MD, 2017, https://www.samhsa.gov/
sites/default/files/programs_campaigns/brss_tacs/peers-supporting-recovery-mental-health-conditions-2017.pdf.
55 SAMHSA, Justification of Estimates for Appropriations Committees, FY2024.
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Regional or National Significance (PRNS) or block grants.56 SAMHSA also noted that the agency
has the authority to carry out these programs in their general authorities.57
PHSA 506A previously authorized $15 million to be appropriated for FY2001, and such sums as
necessary for FY2002 and FY2003.
Provision
Section 1201 replaces PHSA Section 506A with a new provision entitled “Behavioral Health and
Substance Use Disorder Resources for Native Americans.” The provision authorizes a grant
program for services for mental health and substance use disorder prevention and treatment
among American Indians, Alaska Natives, and Native Hawaiians.
The provision authorizes the Secretary, acting through the SAMHSA Assistant Secretary in
coordination with the Indian Health Service (IHS) as appropriate, to administer grant funds
through a contract or compact under Title I or V of the Indian Self-Determination and Education
Assistance Act.58 Award amounts are determined by a formula developed by HHS, with
consultation from Indian Tribes and Tribal organizations. Eligible entities are required to apply
for awards. The authorization requires the Secretary to provide technical assistance to grantees
and to assist with program evaluation data and reporting requirements. The provision requires the
Secretary to submit a report describing the services supported by the grant program to specified
congressional committees no later than three years after enactment (i.e., December 29, 2025).
PHSA Section 506A now authorizes $80 million to be appropriated for each of FY2023-FY2027
for the grant program.
Chapter 2—Summer Barrow Prevention, Treatment, and
Recovery Services
Section 1211. Grants for the Benefit of Homeless Individuals
Background
PHSA Section 506 (“Grants for the Benefit of Homeless Individuals”) authorizes SAMHSA’s
Treatment Systems for Homeless program. Reauthorized in 2016 by the Cures Act,59 PHSA
Section 506 requires the Secretary to award grants, contracts, and cooperative agreements to
eligible entities, as specified, to provide mental health and substance abuse services to homeless
individuals. The section specifies granting preferences, conditions for services provided under the
grant, and terms of awards, among other factors.
PHSA Section 506 previously authorized $41.3 million (rounded) to be appropriated for each of
FY2018-FY2022.

56 See, for example, SAMHSA, Justification of Estimates for Appropriations Committees, FY2002, pp. 37-39.
57 See, for example, SAMHSA, Justification of Estimates for Appropriations Committees, FY2005, pp. 27-29.
58 P.L. 93-638, as amended (25 U.S.C. Chapter 46 et seq.).
59 Cures Act §9001.
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Provision
Section 1211 amends PHSA Section 506 by reauthorizing $41.3 million for each of FY2023-
FY2027 for the Treatment Systems for Homeless program.
Section 1212. Priority Substance Use Disorder Treatment Needs of Regional
and National Significance
Background
PHSA Section 509 (“Priority Substance Abuse Treatment Needs of Regional and National
Significance”) provides the authorities for SAMHSA’s substance abuse treatment grants and
activities commonly known as Programs of Regional and National Significance (PRNS).60
Reauthorized in 2016 by the Cures Act,61 the substance abuse treatment PRNS includes grant
program authorizations, technical assistance, and other activities supporting treatment for
substance use disorders. Some PRNS are explicitly authorized in statute; others are carried out
under the general authorities included in PHSA Section 509.
PHSA Section 509 previously authorized $333.8 million (rounded) for each of FY2018-FY2022.
Provision
Section 1212 amends PHSA Section 509 by replacing the term “abuse” with “substance use
disorder” wherever it appears.62 The provision makes other technical edits.
Section 1212 reauthorizes SAMHSA’s substance use disorder treatment PRNS. PHSA Section
509 now authorizes $521.5 million (rounded) to be appropriated for each of FY2023-FY2027.
Section 1213. Evidence-Based Prescription Opioid and Heroin Treatment and
Interventions Demonstration
Background
PHSA Section 514B (“Evidence-Based Prescription Opioid and Heroin Treatment and
Interventions Demonstration”) authorizes a competitive grant program to expand treatment of
substance use disorders in geographic areas with a high rate or rapid increase of heroin and other
opioid use.63 The provision was originally added by CARA in 2016.64 The program authorized
under PHSA 514B has never received an explicit appropriation.65

60 Under PHSA Title V Part B, Section 509, the HHS Secretary is required to “address priority substance use disorder
treatment needs of regional and national significance”; the Secretary may do so “directly or through grants or
cooperative agreements with States, political subdivisions of States, Indian tribes or tribal organizations, … or other
public or private nonprofit entities” (42 U.S.C. §290bb-2). PRNS authorizations exist for mental health (PHSA §520A)
and substance abuse prevention (PHSA §516) also.
61 Cures Act §7004.
62 For example, the provision changes the section title to “Priority Substance Use Disorder Treatment Needs of
Regional and National Significance.”
63 42 U.S.C. §290bb-10.
64 CARA §301.
65 Through FY2023.
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PHSA Section 514B previously authorized $25 million to be appropriated for each of FY2017-
FY2021.
Provision
Section 1213 amends PHSA Section 514B by replacing the terms “substance abuse” and
“addiction” with “substance use disorder.” The provision makes other technical edits.
Section 1213 amends PHSA Section 514B by reauthorizing $25 million to be appropriated for
each of FY2023-FY2027.
Section 1214. Priority Substance Use Disorder Prevention Needs of Regional
and National Significance
Background
PHSA Section 516 (“Priority Substance Use Disorder Prevention Needs of Regional and National
Significance”) provides the authorities for SAMHSA’s substance use disorder prevention grants
and activities, commonly known as Programs of Regional and National Significance (PRNS).66
Reauthorized in 2016 by the Cures Act,67 the substance use disorder treatment PRNS includes
grant program authorizations, technical assistance, and other activities supporting prevention of
substance use disorders. Some PRNS are explicitly authorized in statute; others are carried out
under the general authorities included in PHSA Section 516.
Provision
Section 1214 amends PHSA Section 516 by making technical edits.
Section 1214 reauthorizes SAMHSA’s substance use disorder prevention PRNS. PHSA Section
516 now authorizes $218.2 million (rounded) to be appropriated for each of FY2023-FY2027.
Section 1215. Sober Truth on Preventing (STOP) Underage
Drinking Authorization
Background
PHSA Section 519B (“Programs to Reduce Underage Drinking”) authorizes SAMHSA’s Sober
Truth on Preventing Underage Drinking Act (STOP Act) programs. Originally added by the STOP
Act of 2006 (P.L. 109-422) and reauthorized in 2016 by the Cures Act,68 PHSA Section 519B
authorizes a range of activities aimed at reducing underage drinking. The provision provides
separate authorizations of appropriations for each specified activity.
PHSA Section 519B previously authorized the following amounts for each of FY2018-FY2022:

66 Under PHSA Title V Part B, Section 516, the HHS Secretary is required to “address priority substance use disorder
prevention needs of regional and national significance”; the Secretary may do so “directly or through grants or
cooperative agreements with States, political subdivisions of States, Indian tribes or tribal organizations, … or other
public or private nonprofit entities” (42 U.S.C. §290bb-22). PRNS authorizations exist for substance use disorder
treatment (PHSA §509) and mental health (PHSA §520A) also.
67 Cures Act §7005.
68 Cures Act §9016.
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• $1 million to support an Interagency Coordinating Committee on the Prevention
of Underage Drinking and an annual report on state underage drinking prevention
and enforcement activities;
• $1 million for a national media campaign to prevent underage drinking;
• $5 million for ‘‘enhancement grants’’ aimed at maximizing the effectiveness of
community-wide approaches to preventing and reducing underage drinking; and
• $6 million for research on underage drinking.
There was no explicit authorization of appropriations for grants to pediatric health care providers
for screening and brief intervention to reduce underage drinking.
Provision
Section 1215 amends PHSA Section 519B by:
• amending the definitions subsection and removing a reference to a 2003 report by
the former Institute of Medicine. The provision now requires the National
Academies of Sciences, Engineering, and Medicine (NASEM)69 to report to
Congress with the results of a review on research related to underage alcohol use
no later than 12 months after enactment (i.e., December 29, 2023);
• replacing subsection (c) to add a new authorization for the interagency
coordinating committee on the prevention of underage drinking and adding
specified information to the Secretary’s annual report to Congress on state
underage drinking prevention and enforcement activities, including certain
specified surveillance data. New subsection (c) adds further direction for the
Secretary’s annual collaborative report on each state’s performance preventing or
reducing underage drinking. The new provision clarifies the contents of the
report including performance measures developed by the Secretary and other
specified details;
• replacing subsection (d) with a new authority for the national media campaign to
prevent underage drinking. The provision requires the Secretary in consultation
with the National Highway Traffic Safety Administration to continue a media
campaign aimed at adults to reduce underage drinking. The provision specifies
the purpose of the campaign, describes campaign components, and requires the
Secretary to consult with various specified stakeholders. It requires the Secretary
to produce an annual report on the media campaign. The provision also provides
the Secretary with the authority, based on the availability of funds, to support
research on the potential for a youth-oriented national media campaign, with
requirements to share such information with Congress;
• replacing subsection (e) with a new authorization for the community-based
coalition enhancement grants to prevent underage drinking. The provision
increases the maximum amount of each grant, for example, from $50,000 (the
previous amount) to $60,000. It removes the authorization for grants directed at
preventing and reducing alcohol abuse at institutions of higher education;

69 The National Academies of Sciences, Engineering, and Medicine (NASEM) is a private, nonprofit organization that
provides “independent, objective advice to inform policy with evidence, spark progress and innovation, and confront
challenging issues for the benefit of society.” For more information, see https://www.nationalacademies.org/about.
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• replacing subsection (f) to include an authorization for grants to pediatric health
care providers to reduce underage drinking through screening and brief
intervention. The provision amends the previous authorization by narrowing the
intended population served to adolescents (removing “children”). The provision
adds a definition for the term “screening”; and
• replacing subsection (g) to include the authority to collect data and conduct or
support research on underage drinking. The provision amends the specified
characteristics of the authorized research and includes (1) evaluation of the
effectiveness of community-based programs and statewide systems, (2) the
reporting of more precise information on the scope of underage drinking and
patterns of underage alcohol consumption, (3) development and identification of
evidence-based strategies to reduce underage drinking, and (4) improvement of
public health data collection on alcohol use and alcohol-related conditions.
Section 1215 reauthorizes the STOP Act programs. PHSA Section 519B now authorizes the
following amounts to be appropriated for each subsection:
• subsection (c): $1 million for each of FY2023-FY2027 to support the Interagency
Coordinating Committee on the Prevention of Underage Drinking and an annual
report on state underage drinking prevention and enforcement activities;
• subsection (d): $2.5 million for each of FY2023-FY2027 for a national media
campaign to prevent underage drinking;
• subsection (e): $11.5 million for each of FY2023-FY2027 for community-based
coalition enhancement grants to prevent underage drinking;
• subsection (f): $3 million for each of FY2023-FY2027 for grants to pediatric
health care providers to reduce underage drinking through screening and brief
intervention;
• subsection (g): $5 million for each of FY2023-FY2027 for research on underage
drinking; and $500,000 for FY2023 to contract with NASEM regarding a report
on underage drinking.

Section 1216. Grants for Jail Diversion Programs
Background
PHSA Section 520G (“Grants for Jail Diversion Programs”) authorizes SAMHSA’s Criminal and
Juvenile Justice Programs. Reauthorized in 2016 by the Cures Act,70 PHSA Section 520G requires
the Secretary to make grants to states, political subdivisions of states, Indian Tribes, and Tribal
organizations, directly or through agreements, for jail diversion programs (i.e., programs to divert
individuals with mental illness from the criminal justice system to community-based services).
Section 520G previously authorized $4.3 million (rounded) to be appropriated annually for each
of FY2018-FY2022.

70 Cures Act §9002.
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Provision
Section 1216 amends PHSA 520G by removing the cap on the number of grants administered,
allowing eligible health facilities or nonprofit entities to apply for the grants directly, ensuring
peer recovery support services are mentioned in the application, and adding paraprofessional
training to the allowable uses of funds. The provision makes other technical edits to the grant
authorization.
Section 1216 reauthorizes the Criminal and Juvenile Justice Programs. PHSA Section 520G now
authorizes $14 million to be appropriated for each of FY2023-FY2027.
Section 1217. Formula Grants to States
Background
PHSA Section 521 (“Formula Grants to States”) authorizes SAMHSA’s Projects for Assistance in
Transition from Homelessness (PATH) grant program.71 Reauthorized in 2016 by the Cures Act,72
the PATH program is a formula grant program that distributes funds to states to support local
organizations providing services for people with serious mental illness (including those with co-
occurring substance use disorders) who are homeless or at imminent risk of becoming homeless.73
Up to 20% of the federal payments may be used for housing-related assistance. Other services
include (but are not limited to) outreach, mental health and substance use disorder treatment, case
management, and job training.74
Provision
Section 1217 amends PHSA Section 521 by reauthorizing the PATH formula grant program for
FY2023 through FY2027.
Section 1218. Projects for Assistance in Transition from Homelessness
Background
PHSA Section 535 (“Funding”) authorizes the appropriations for the PATH program. PHSA
Section 535 previously authorized to be appropriated $64.6 million (rounded) for each of
FY2018-FY2022 for the PATH program.
Provision
Section 1218 amends PHSA Section 535 by reauthorizing $64.6 million (rounded) to be
appropriated for each of FY2023-FY2024.

71 Authorizations for various aspects of the PATH program are included in PHSA Sections 521-535 (42 U.S.C. §290cc-
21 through §290cc-35).
72 Cures Act §9004.
73 The minimum allotment is $300,000 for each of the 50 states, the District of Columbia, and Puerto Rico, and $50,000
for each of Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands. Funds are distributed
to states in amounts proportional to their populations living in urbanized areas. The formula to determine allotments is
included in PHSA Section 524 (42 U.S.C. §290cc-24).
74 For more about PATH, see http://www.samhsa.gov/homelessness-programs-resources/grant-programs-services/path.
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Section 1219. Grants for Reducing Overdose Deaths
Background
PHSA Section 544 (“Grants for Reducing Overdose Deaths”) authorizes SAMHSA’s Improving
Access to Overdose Treatment grant program. Originally added by CARA in 2016,75 PHSA
Section 544 authorizes a grant program to expand access to FDA-approved drugs for emergency
treatment of opioid overdoses. Grants provided a maximum amount of $200,000 per grant year to
federally qualified health centers (FQHCs)76 and federally certified opioid treatment programs
(OTPs)77 for prescribing, purchasing, or training health care providers in the use of FDA-
approved overdose reversal medications such as naloxone.78
PHSA Section 544 previously authorized $5 million to be appropriated for the period of FY2017-
FY2021.
Provision
Section 1219 amends PHSA Section 544 by repealing the $200,000 maximum amount for each
grant and changing eligibility for the grant program from FQHCs and OTPs to states, territories,
localities, and Tribes. The provision adds an authority for grantees to award subgrants to FQHCs,
OTPs, and other practitioners using medications for opioid use disorder. The provision adds
individuals co-prescribed benzodiazepines to the specified populations served, includes
connecting patients to overdose reversal medications in the use of funds, and makes other
technical edits. The provision also adds authorities to PHSA Section 544 for the Secretary to
provide best practices to specified stakeholders (including prescribers within the VA and DOD)
for prescribing FDA-approved drugs for opioid overdoses.
Section 1219 amends PHSA Section 544 to reauthorize $5 million to be appropriated for the
period of FY2023-FY2027 for the Improving Access to Overdose program.
Section 1220. Opioid Overdose Reversal Medication Access and Education
Grant Programs
Background
PHSA Section 545 (“Opioid Overdose Reversal Medication Access and Education Grant
Programs”) authorizes a grant program to implement strategies to dispense FDA-approved drugs
for emergency treatment of opioid overdose. Originally added by CARA,79 PHSA Section 545
authorized grants to states to encourage pharmacies to dispense opioid overdose reversal
medications, such as naloxone, pursuant to a standing order.80 The program authorized under
PHSA 545 has never received an explicit appropriation as of FY2023.

75 CARA §107 (42 U.S.C. §290dd-3).
76 For more information on FQHCs, see CRS Report R43937, Federal Health Centers: An Overview.
77 For more information on OTPs, see CRS In Focus IF12348, Medications for Opioid Use Disorder.
78 For more information on naloxone, see CRS In Focus IF12490, Naloxone for Opioid Overdose: Considerations for
Congress.
79 CARA §110 “Opioid Overdose Reversal Medication Access and Education Grant Program” (42 U.S.C. §290ee).
80 For more information on FDA-approved opioid overdose reversal medications and standing orders, see CRS In
Focus IF12490, Naloxone for Opioid Overdose: Considerations for Congress.
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PHSA Section 545 previously authorized $5 million to be appropriated for the period of FY2017-
FY2019.
Provision
Section 1220 amends PHSA Section 545 by amending the title to include “Co-Prescribing” and
adding localities and Tribes to the list of eligible grantees.81 The provision adds co-prescribing
FDA-approved medications for opioid overdose to the list of required grant activities and
removes the specification for pharmacists to be the dispensers of such drugs.82 The provision also
expands the time period for the grant from three years to five years. It amends the limit for using
grant funds for public education from 20% to 10% and requires that not less than 20% of the
grant be used to offset cost sharing for emergency overdose reversal medications. The provision
makes other technical edits regarding language describing FDA approval of opioid overdose
reversal medications.
Section 1220 amends PHSA Section 545 to reauthorize $5 million to be appropriated for the
period of FY2023-FY2027.
Section 1221. Emergency Department Alternatives to Opioids
Background
SUPPORT for Patients and Communities Act Section 7091 (“Emergency Department Alternatives
to Opioids Demonstration Program”) authorized SAMHSA’s Emergency Department Alternatives
to Opioids program. Through this program, SAMHSA provides grants to hospitals and emergency
departments to develop, implement, or study alternatives to opioids for pain management in
hospital or emergency department settings. The authorizing provision requires SAMHSA to
facilitate the development of best practices on opioid alternatives and to provide technical
assistance to hospitals and other acute care settings. It also requires the Secretary to submit a
report to Congress on the results of the program one year after the completion of the
demonstration program.
SUPPORT Act Section 7091 previously authorized $10 million to be appropriated for each of
FY2019-FY2021.
Provision
Section 1221 amends SUPPORT Act Section 7091 by removing the demonstration label and
making the required report to specified congressional committees annual, due at the end of each
year from FY2024 through FY2028.
Section 1221 amends SUPPORT Act Section 7091 by reauthorizing $10 million to be
appropriated for each of FY2023-FY2027 for the Emergency Department Alternatives to Opioids
program.

81 The title for PHSA Section 545 is now “Opioid Overdose Reversal Medication Access, Education, and Co-
Prescribing Grant Program.”
82 The provision describes “drugs or devices approved, cleared, or otherwise legally marketed under the Federal Food,
Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose” (42 U.S.C. §290ee). For
more information, see CRS Report R41983, How FDA Approves Drugs and Regulates Their Safety and Effectiveness.
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Chapter 3—Excellence in Recovery Housing
Background
PHSA Section 550 (“National Recovery Housing Best Practices)” requires the Secretary to
develop best practices for operating substance use recovery housing. Originally added by the
SUPPORT Act in 2018,83 PHSA Section 550 defines recovery housing to mean 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.”84 In identifying these
best practices, the Secretary is required to consult with other entities such as SAMHSA, CMS, the
HUD Secretary, state health commissioners, health insurers, and individuals with a history of
substance use disorder (SUD), among others. The provision requires the Secretary, in consultation
with the same specified entities and the Attorney General, to identify common indicators that
could be used to identify potentially fraudulent recovery housing operators, as described.
The Secretary is required to disseminate the best practices and common indicators to specified
entities, which include state agencies, Tribal organizations, the Attorney General, recovery
housing entities, and the public, among others. In carrying out these activities, the Secretary is
required to consult with specified entities and to consider how recovery housing supports
recovery, prevents relapse and overdose, and improves access to treatment such as medications
for opioid use disorder. This provision does not give the Secretary the authority to require states
to adhere to minimum standards, though the best practices may include model laws for states to
implement suggested minimum standards. SAMHSA published recovery housing best practices in
2019.85
PHSA Section 550 previously authorized $3 million to be appropriated for the period of FY2019-
FY2021.
PHSA Section 501 (“Substance Abuse and Mental Health Services Administration”) provides
SAMHSA’s general authorities, including those related to the Assistant Secretary and the agency
organization.
Section 1231. Clarifying the Role of SAMHSA in Promoting the Availability of
High-Quality Recovery Housing
Section 1231 amends PHSA Section 501 by adding a new authority requiring the SAMHSA
Assistant Secretary to collaborate with states, federal agencies, and other specified stakeholders
with expertise in recovery housing to promote the availability of recovery housing for individuals
with substance use disorders.
Section 1232. Developing Guidelines for States to Promote the Availability of
High-Quality Recovery Housing
Section 1232 amends PHSA Section 550 by requiring the Secretary to continue to identify,
develop, and periodically update best practices for operating recovery housing. The provision

83 SUPPORT Act §7031.
84 42 U.S.C. §290ee-5.
85 Substance Abuse and Mental Health Services Administration (SAMHSA), Recovery Housing: Best Practices and
Suggested Guidelines, 2019. SAMHSA updated these best practices in 2023 subsequent to P.L. 117-328. See
SAMHSA, Best Practices for Recovery Housing, PEP23-10-00-002, Rockville, MD, 2023, https://www.samhsa.gov/
resource/ebp/best-practices-recovery-housing.
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adds specifics regarding whom the Secretary must consult with for the best practices. It adds a
requirement that the best practices be made publicly available and published on SAMHSA’s
website. Lastly, it prohibits the Secretary from including best practices for substance use disorder
treatment services in the recovery housing best practices.
Section 1233. Coordination of Federal Activities to Promote the Availability of
Recovery Housing
Section 1233 amends PHSA Section 550 by adding a new subsection (e) requiring the Secretary,
acting through the SAMHSA Assistant Secretary and HUD Secretary, to convene an interagency
working group to increase collaboration among federal agencies regarding the promotion of
recovery housing for individuals in need.
The new subsection tasks the working group with aligning efforts of federal agencies and
avoiding duplication. It also requires the working group to develop a long-term plan for
supporting state and local efforts to operate recovery housing consistent with the best practices.
The provision specifies the composition of the interagency working group. The working group is
required to meet on a quarterly basis and submit a report to specified congressional committees
on the work of the group and any recommendations no later than four years after enactment (i.e.,
December 30, 2026). The provision makes other technical edits.
Section 1234. National Academies of Sciences, Engineering, and Medicine
Study and Report
Section 1234 requires the Secretary, acting through the SAMHSA Assistant Secretary, to contract
with the National Academies of Sciences, Engineering, and Medicine (NASEM) to study the
quality and effectiveness of recovery housing in the United States. The provision tasks NASEM
with determining whether the availability of recovery housing meets demand and providing
recommendations to promote the availability of recovery housing. It requires the Secretary to
contract with NASEM no later than 60 days after enactment (i.e., February 27, 2023) and report
to Congress on the results of the review.
Section 1234 authorizes $1.5 million to be appropriated for FY2023.
Section 1235. Grants for States to Promote the Availability of Recovery
Housing and Services
Section 1235 amends PHSA Section 550 by authorizing a grant program to support
implementation of the national recovery housing best practices.
The provision authorizes the Secretary to award grants to states, Tribes, and territories for
technical assistance to implement the national recovery housing best practices and to promote the
availability of recovery housing. States receiving such grants are required to submit to SAMHSA,
and publish on their state website, a state plan for promotion of recovery housing.
Section 1236. Funding
Section 1235 amends PHSA Section 550 by reauthorizing funding for National Recovery
Housing Best Practices activities. PHSA Section 550 now authorizes $5 million to be
appropriated for the period of FY2023-FY2027.
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Section 1237. Technical Corrections
Section 1237 makes technical corrections to PHSA Title V by redesignating the second PHSA
Section 550 (entitled “Sobriety Treatment and Recovery Teams”86) as Section 550A and locating
it after Section 550.
Chapter 4—Substance Use Prevention, Treatment, and Recovery
Services Block Grant
Background
PHSA Title XIX Subpart II (“Block Grants for Prevention and Treatment of Substance Abuse”)
authorizes SAMHSA’s Substance Abuse Prevention and Treatment Block Grant (referred to as the
SABG, or sometimes SAPT).87 The SABG supports state efforts in providing community-based
services to prevent and treat substance use disorders. SAMHSA distributes SABG funds to states
(including the District of Columbia and specified territories) and one Tribal entity according to a
formula specified in Title XIX of the PHSA.88 Each state may distribute SABG funds to local
government entities, administrative service organizations, and prevention and treatment service
providers (among others) in accordance with the state’s plan.89 States must designate a Single
State Agency responsible for administering the grant and submit an application containing the
state plan to the HHS Secretary by the first of October preceding the fiscal year.90 States have
flexibility in the use of SABG funds within the framework of the state plan and federal
requirements. While the use of funds is generally determined by states, each SABG grantee must
expend at least 20% of its SABG allotment on primary prevention strategies.91
PHSA Section 1935 authorizes $1.86 billion (rounded) to be appropriated annually for each of
FY2018-FY2022 for the SABG.
Section 1241. Eliminating Stigmatizing Language Relating to Substance Use
Section 1241 amends PHSA Title XIX Subpart II (Sections 1921-1935) by replacing the terms
“substance abuse” with “substance use disorders.” The provision amends the subpart heading to
read “Block Grants for Substance Use Prevention, Treatment, and Recovery Services,” effectively
renaming it the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) block

86 The SUPPORT Act Section 8214 inserted a second PHSA Section 550 at the end of title V.
87 PHSA §§1921-1935. Some provisions in PHSA Title XIX, Part B, Subpart III, also apply to the substance use block
grant.
88 42 U.S.C. §300x et seq.
89 PHSA §1932(b) (42 U.S.C. §300x-32(b)).
90 PHSA §1932 (42 U.S.C. §300x-32). Of note, PHSA Section 1958 allows the Assistant Secretary to permit a joint
application for the MHBG and SABG.
91 PHSA §1922(a)(1) (42 U.S.C. §300x-22(a)(1)). Primary prevention strategies refer to interventions designed to avoid
manifestations of a disease before the health condition occurs or, in the case of the SABG authorization, “for
individuals who do not require treatment for substance abuse.” For more information, see CRS Report R46426,
Substance Abuse and Mental Health Services Administration (SAMHSA): Overview of the Agency and Major
Programs.
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grant program.92 It amends PHSA Section 1934 (“Definitions”) to define substance use disorder
to mean the recurrent use of alcohol or other drugs that causes clinically significant impairment.93
Section 1242. Authorizes Activities
Section 1242 amends PHSA Section 1921 (“Formula Grants to States”) by adding “recovery
support services” to the authorized grant activities stated in subsection (b).
Section 1243. State Plan Requirements
Section 1243 amends PHSA Section 1932 (“Application for Grant; Approval of State Plan”) by
requiring states submitting a plan for the block grants to describe the state’s recovery support
services and the amount of block grant funds expended for these activities. The provision also
makes a conforming edit.
Section 1244. Updating Certain Language Relating to Tribes
Section 1244 amends PHSA Section 1933 (“Determination of Amount of Allotment”) by making
technical edits, including several related to language pertaining to Tribes.
Section 1245. Block Grants for Substance Use Prevention, Treatment, and
Recovery Services
Section 1245 amends PHSA Section 1935 (“Funding”) by reauthorizing funding for the substance
use block grant. The provision also makes a technical correction.
PHSA Section 1935 now authorizes $1.9 billion (rounded) to be appropriated for each of
FY2023-FY2027.
Section 1246. Requirements of Reports and Audits by States
Section 1246 amends PHSA Section 1942 (“Requirement of Reports and Audits by States”) by
requiring states to include in the report to the Secretary the amount provided to recipients of block
grant funds in the state in the previous fiscal year.
Section 1247. Study on Assessment for Use of State Resources
Section 1247 requires the Secretary, acting through the SAMHSA Assistant Secretary and in
consultation with states and local service providers, to conduct a study on strategies to assess
community needs related to substance use prevention, treatment, and recovery support services.
The study is to facilitate state use of the substance use block grant. The provision requires the
Secretary to submit results of the study to specified congressional committees no later than two
years after enactment (i.e., December 29, 2024).

92 Now referred to by SAMHSA as the SUPTRS block grant, or sometimes SUBG for short. See SAMHSA, Substance
Use Prevention, Treatment, and Recovery Services Block Grant, updated April, 2023, available at
https://www.samhsa.gov/grants/block-grants/subg.
93 42 U.S.C. §300x-34.
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Chapter 5—Timely Treatment for Opioid Use Disorder
Section 1251. Study on Exemptions for Treatment of Opioid Use Disorder
Through Opioid Treatment Programs During the COVID-19 Public Health
Emergency
Background
Social distancing measures and temporary stay-at-home orders associated with the COVID-19
pandemic influenced changes in service delivery for substance use treatment. For substance use
treatment that uses certain medications for opioid use disorder (MOUD)—specifically opioid
agonist treatments such as methadone and buprenorphine—patients are required by law to attend
in person for at least the initial visit for buprenorphine, and daily for methadone.94 Methadone is
typically administered on a daily basis onsite at federally certified opioid treatment programs
(OTPs, sometimes known as methadone clinics), with some short-term take-home doses allowed
for stable patients.95
During the pandemic, SAMHSA and DEA allowed stable patients to receive up to 28 days of
take-home medication.96 DEA also allowed alternative methods for the delivery of methadone to
patients under stay-at-home orders,97 as well as interstate prescribing privileges for providers.98
Other changes included relaxing privacy requirements mandated by the Health Insurance
Portability and Accountability Act (HIPAA) rules and increasing the use of telehealth to deliver
substance use treatment services. In addition, some states employed other methods of service
delivery (e.g., mobile units) for treatments that cannot be administered via telehealth, such as
MOUD.
In addition to these flexibilities allowed by DEA and SAMHSA during the public health
emergency, CFR Title 42 Part 8 allows OTPs to apply for exceptions to certain regulations,
including during the COVID-19 pandemic.99 The public health emergency declaration for the
COVID-19 pandemic expired on May 11, 2023.100

94 See CRS In Focus IF12348, Medications for Opioid Use Disorder.
95 As outlined in 42 CFR §8.12. See also Drug Enforcement Administration, Use of Telemedicine While Providing
Medication Assisted Treatment (MAT), Diversion Control, May 15, 2018, https://www.samhsa.gov/sites/default/files/
programs_campaigns/medication_assisted/telemedicine-dea-guidance.pdf.
96 Substance Abuse and Mental Health Services Administration, Opioid Treatment Program (OTP) Guidance,
Rockville, MD, March 16, 2020, https://www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf. See also CRS
Report R46831, Behavioral Health During the COVID-19 Pandemic: Overview and Issues for Congress.
97 Letter from Thomas Prevoznik, Deputy Assistant Administrator, Drug Enforcement Administration, to Registered
Narcotic Treatment Program, April 7, 2020, https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-025)(DEA078)_Off-
site_OTP_delivery_method_(Final)+_esign.pdf.
98 Letter from William McDermott, Assistant Administrator, Drug Enforcement Administration, to DEA Registrants,
March 25, 2020, https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-
018)(DEA067)%20DEA%20state%20reciprocity%20(final)(Signed).pdf. For more information and resources related
to the COVID-19 pandemic from the Drug Enforcement Administration, see “COVID-19 Information Page,”
https://www.deadiversion.usdoj.gov/coronavirus.html.
99 42 C.F.R. §8.11(h).
100 See CRS Insight IN12088, Effects of Terminating the Coronavirus Disease 2019 (COVID-19) PHE and NEA
Declarations; and Press Release, U.S. Department of Health and Human Services, Fact Sheet: COVID-19 Public
Health Emergency Transition Roadmap, February 9, 2023, at https://www.hhs.gov/about/news/2023/02/09/fact-sheet-
covid-19-public-health-emergency-transition-roadmap.html.
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Provision
Section 1251 requires the SAMHSA Assistant Secretary—in consultation with patients and other
stakeholders—to conduct a study on activities carried out pursuant to exemptions granted to
states or OTPs during the COVID-19 public health emergency. The provision requires SAMHSA
to gather feedback from states and OTPs regarding their experiences implementing exemptions. It
also requires that SAMHSA publish a report on the results of the study no later than 180 days
after the termination of the COVID-19 public health emergency or at the end of calendar year
2022, whichever is sooner.101
Section 1252. Changes to Federal Opioid Treatment Standards
Background
Section 302 of the Controlled Substance Act (CSA; “Persons Required to Register”) requires
every person who manufactures or distributes controlled substances to register with the Attorney
General (via DEA).102 Section 302(e) requires a separate DEA registration for each principal
place of business or professional practice where the applicant distributes or dispenses controlled
substances.
Federally certified opioid treatment programs (OTPs) generally administer methadone (a schedule
II controlled substance) to patients on a daily basis, with staff observing as a patient takes an oral
dose of liquid methadone. Some OTPs have operated mobile medication units, in which
methadone is dispensed at a remote location to individuals receiving treatment from the OTP.103
DEA has approved mobile medication units in the past, but it ceased registering these mobile
units beginning in 2007.104 DEA announced in 2021 that it would lift the 14-year moratorium on
mobile methadone units, removing the requirement that mobile components of OTPs receive a
separate registration.105
Title 42, Part 8, of the Code of Federal Regulations, which includes most of the regulations for
OTPs, specified that patients admitted to OTPs must “be addicted to opioids for at least one
year”, prohibiting individuals with opioid use disorder for less than a year from receiving
treatment at an OTP.106
Provision
Section 1252 amends CSA Section 302(e) by making an exception to the separate registration for
OTPs operating mobile methadone units, so long as the mobile unit meets such standards as the
Attorney General may establish, effectively codifying in statute DEA’s 2021 rule.

101 As declared under PHSA §319 (42 U.S.C. §247d). The public health emergency declaration for the COVID-19
pandemic expired on May 11, 2023.
102 21 U.S.C. §822(e).
103 Brian Chan, Kim Hoffman, Christina Bougatsos, et al., “Mobile Methadone Medication Units: A Brief History,
Scoping Review, and Research Opportunity,” Journal of Substance Abuse Treatment, October 2021.
104 U.S. Department of Justice, Bureau of Justice Assistance, “DEA Expands Access to Mobile Narcotic Treatment
Programs,” press release, August 2021, https://bja.ojp.gov/library/publications/dea-expands-access-mobile-narcotic-
treatment-programs.
105 Drug Enforcement Administration, “Registration Requirements for Narcotic Treatment Programs With Mobile
Components,” 86 Federal Register 33861, June 28, 2021. DEA refers to OTPs as “narcotic treatment programs.”
106 42 C.F.R. §8.12(e).
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Section 1252 also requires the Secretary to revise the Code of Federal Regulations (42 C.F.R.
8.12(e)(1)) to eliminate the requirement that OTPs admit an individual for treatment only if the
individual became “addicted to opioids” at least one year before admission for treatment.
Chapter 6—Additional Provisions Relating to Addiction Treatment
Section 1261. Prohibition
Background
The federal government supports certain harm reduction strategies that emphasize prevention of
adverse events associated with substance use, such as overdose and disease transmission. For
example, the American Rescue Plan Act (P.L. 117-2) appropriated $30 million for grants to
support “community-based overdose prevention programs, syringe services programs, and other
harm reduction services.”107 The provision required grants be used for preventing and controlling
the spread of infectious diseases, distributing opioid overdose reversal medications, connecting
individuals with education and services, and encouraging individuals with substance use disorders
to reduce the negative health impacts of substance use. SAMHSA announced the grant program
in December 2021.108
Provision
Section 1261 prohibits funding from any provision in the Restoring Hope for Mental Health and
Well-Being Act from being used to purchase or distribute “pipes or cylindrical objects” intended
to be used to smoke or inhale illegal drugs.
Section 1262. Eliminating Additional Requirements for Dispensing Narcotic
Drugs in Schedule III, IV, and V for Maintenance or Detoxification Treatment
Background
CSA Section 303 (“Registration Requirements”) specifies the requirements for practitioners
registering with DEA to dispense (i.e., prescribe or administer) controlled substances.109
The Drug Addiction Treatment Act of 2000 (DATA 2000; P.L. 106-310) amended the CSA to
allow qualifying practitioners to dispense schedule III-V narcotic drugs for the purposes of
maintenance or detoxification treatment for opioid use disorder (i.e., buprenorphine) outside of
federally certified OTPs if they obtained a separate waiver from DEA and SAMHSA (known as a
DATA waiver or X waiver).110 Practitioners with DATA waivers treating opioid use disorder using

107 ARPA §2706.
108 Substance Abuse and Mental Health Services Administration, “SAMHSA Announced Unprecedented $30 Million
Harm Reduction Grant Funding Opportunity to Help Address the Nation’s Substance Use and Overdose Epidemic,”
press release, December 8, 2021, https://www.samhsa.gov/newsroom/press-announcements/202112081000. The HHS
Secretary and ONDCP Director released a subsequent statement indicating that no federal funding would be used
directly to put pipes in safe smoking kits distributed as part of harm reduction efforts. See U.S. Department of Health
and Human Services, “Statement by HHS Secretary Xavier Becerra and ONDCP Director Rahul Gupta,” press release,
February 9, 2022, https://www.hhs.gov/about/news/2022/02/09/statement-hhs-secretary-xavier-becerra-and-ondcp-
director-rahul-gupta.html.
109 21 U.S.C. §823.
110 Buprenorphine was (and remains) the only schedule III controlled substance meeting the conditions for the waiver.
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buprenorphine were subject to certain training requirements and limits on the number of patients
they could treat at any time. Most requirements for DATA waivers were outlined in regulations
pursuant to the Secretary’s rulemaking authority. In 2018, the SUPPORT Act amended the CSA,
codifying several DATA waiver policies in CSA Section 303(g).111
Provision
Section 1262 amends CSA Section 303 by exempting practitioners who dispense schedule III-V
narcotic drugs (i.e., buprenorphine) from obtaining a separate DEA registration.112 Subsequently,
it removes the waiver initially required by the DATA 2000 Act for practitioners using schedule
III-IV drugs for maintenance or detoxification treatment for opioid use disorder outside of an
OTP, striking all of the specified requirements for obtaining such waiver.
Thus, under current law, any practitioner registered with DEA to dispense (i.e., prescribe or
administer) controlled substances is authorized to use buprenorphine to treat OUD outside of an
OTP, subject to state laws. Section 1262 makes other technical and conforming edits.
Section 1263. Requiring Prescribers of Controlled Substances to
Complete Training
Background
CSA Section 303 (“Registration Requirements”) specifies the requirements for practitioners
registering with DEA to dispense (i.e., prescribe or administer) controlled substances.113 Prior to
enactment of the Restoring Hope for Mental Health and Well-Being Act, only practitioners who
dispensed narcotic drugs to individuals for maintenance or detoxification treatment (e.g.,
medications for opioid use disorder) had specific qualification or training requirements related to
treating individuals with substance use disorders. For instance, one of the conditions for certain
physicians included completing an eight-hour training on treatment and management of patients
with opioid use disorder (OUD).114 Section 1262 removed the requirements for practitioners
dispensing schedule III-V narcotics in detoxification or maintenance treatment of OUD. The act
thus allows any practitioner registered with DEA to treat OUD using buprenorphine, subject to
state laws, and removes the previous additional training requirements for treating individuals with
OUD.

111 SUPPORT Act §§3201-3203. For more information, see CRS Report R45405, The SUPPORT for Patients and
Communities Act (P.L. 115-271): Food and Drug Administration and Controlled Substance Provisions.
112 Section 1262 amends CSA Section 303(g) (21 U.S.C. §823(g)), where the requirements for a separate registration
for OTPs and the description of waiver requirements for the use of schedule III-V drugs in the treatment of opioid use
disorder (the DATA waiver) had existed. More specifically, the provision removes CSA Section 303(g)(2), which
specified the requirements to obtain a waiver. However, Section 103 of P.L. 117-215, enacted on December 2, 2022,
several weeks before the Restoring Hope for Mental Health and Well-Being Act was signed into law (but after the bill
had initially passed the House), redesignated CSA Section 303 subsection (f) as (g) and subsection (g) as (h). Restoring
Hope for Mental Health and Well-Being Act Section 1262 did not reflect these changes. DEA and SAMHSA have
interpreted the act to eliminate the DATA waiver requirement. In codifying the amendment, the Office of Law
Revision Counsel also executed the revisions in the act to Title 21, Section 823(h), of the U.S. Code, noting that this
was the “probable intent of Congress.”
113 21 U.S.C. §823.
114 Prior to enactment of the Restoring Hope for Mental Health and Well-Being Act, requirements for DATA waivers
were outlined in CSA Section 303(g)(2)(G); 21 U.S.C. §823(g)(2)(G). Between enactment of P.L. 117-215 on
December 2, 2022 and enactment of P.L. 117-328 on December 29, 2022, DATA waiver requirements were organized
under CSA Section 303(h)(2)(G) (21 U.S.C. §823(h)(2)(G)).
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Provision
Section 1263 amends CSA Section 303 by adding a requirement for practitioners registering with
DEA to prescribe controlled substances to complete a one-time training on treatment and
management of patients with opioid or other substance use disorders.115 The provision specifies
time requirements (no less than eight hours) and allowable training providers. The provision
exempts physicians and other practitioners who meet certain specified requirements from the
training.
Section 1263 requires the Secretary, in consultation with the Attorney General, to submit a report
to specified congressional committees on the effects of the elimination of the DATA waiver (from
Section 1262) no later than five years after enactment (i.e., December 29, 2027).
Section 1264. Increase in Number of Days Before Which Certain Controlled
Substances Must Be Administered
Background
CSA Section 309A (“Delivery of a Controlled Substance by a Pharmacy to an Administering
Practitioner”) specifies the conditions for which a pharmacy may deliver a controlled substance to
a practitioner for administration. Prior to the enactment of the Restoring Hope for Mental Health
and Well-Being Act, a controlled substance had to be administered to a patient no later than 14
days after a practitioner had received it.
Provision
Section 1264 amends CSA Section 309A by extending the allowable timeline between delivery of
a controlled substance by a pharmacy to a prescribing practitioner and its administration to a
patient, from 14 days to 45 days.
Chapter 7—Opioid Crisis Response
Section 1271. Opioid Prescription Verification
Background
SUPPORT Act Section 3212 (“Programs and Materials for Training on Certain Circumstances
Under Which a Pharmacist May Decline to Fill a Prescription”) required the Secretary, in
consultation with the DEA Administrator, the FDA Commissioner, the CDC Director, and the
SAMHSA Assistant Secretary, and with input from relevant stakeholders, to develop and
disseminate materials for pharmacists, health care providers, and patients. The purpose of these
materials is to describe (1) the circumstances under which a pharmacist may deny filling a
prescription for a controlled substance because the pharmacist suspects the prescription is
fraudulent, forged, or suspicious, and (2) other federal requirements pertaining to declining a
prescription for a controlled substance. The Secretary is required to include instructions for the

115 The safe management of dental pain and screening, brief intervention, and referral for treatment for patients with
opioid and other substance use disorders is also included in the training. The provision exempts veterinarians from the
training requirement.
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pharmacist on how to decline to fill a prescription, as well as information for health care
practitioners and the public on the pharmacist’s ability to decline to fill a prescription.
PHSA Section 392A authorizes the CDC Director to award grants and provide training and
technical assistance to states, localities, and Indian Tribes to carry out and expand evidence-based
prevention activities, which may include (1) improving the efficiency and use of a prescription
drug monitoring program (PDMP); (2) promoting community or health system interventions; (3)
evaluating interventions to prevent controlled substance overdoses; and (4) implementing projects
to advance an innovative prevention approach with respect to new and emerging public health
crises. Originally added by the SUPPORT Act,116 PHSA Section 392A also authorizes the CDC
Director to conduct controlled substance overdose data collection activities, and to assist states
and localities in doing so through grants, training, and technical assistance.
Provision
Section 1271 amends SUPPORT Act Section 3212 by requiring the Secretary—in consultation
with specified federal agencies—to update and disseminate the materials for pharmacists, health
care providers, and patients related to the circumstances under which a pharmacist may deny
filling a prescription for a controlled substance no later than one year after enactment (i.e.,
December 29, 2023), and periodically thereafter. The provision specifies that this includes
updating and disseminating materials with information for pharmacists on how to verify the
identity of the patient.
Section 1271 amends PHSA Section 392A by adding a new subsection (c) that allows the CDC
Director to prioritize jurisdictions with a disproportionately high rate of drug overdoses or
overdose deaths in awarding the opioid overdose prevention and data collection grants authorized
in PHSA Section 392A subsections (a) and (b). The provision also makes a technical edit.
Section 1272. Synthetic Opioid and Emerging Drug Misuse Danger Awareness
Background
Led by fentanyl, a synthetic opioid 50-100 times more potent than morphine, synthetic opioids
emerged as the leading cause of opioid-related overdose deaths in the United States beginning in
2016.117 Although the Secretary—and SAMHSA Assistant Secretary and CDC Director—can
conduct public awareness campaigns on various issues of public health through general and other
specific authorities, no explicit authorization to conduct a campaign for synthetic opioids existed
prior to enactment of the Restoring Hope for Mental Health and Well-Being Act.
Provision
Section 1272 requires the Secretary to plan and implement a public education campaign to raise
awareness of synthetic opioids, such as fentanyl and fentanyl analogues. That campaign must
include disseminating information on the potency of fentanyl and on the services provided by
SAMHSA and CDC related to opioid misuse. The provision also requires the campaign to include

116 SUPPORT Act §7161.
117 Merianne Rose Spencer, Arialdi M. Minino, and Margaret Warner, Drug Overdose Deaths in the United States,
2001-2021, Centers for Disease Control and Prevention, National Center for Health Statistics, NCHS Data Brief No.
457, December 2022, https://www.cdc.gov/nchs/products/databriefs/db457.htm. Fentanyl, heroin, and some
prescription pain medications (such as morphine and oxycodone) belong to the class of drugs known as opioids, which
act on receptors in the brain that regulate pain and emotion.
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information on nonopioid pain management treatments. The campaign must be carried out no
later than one year after enactment (i.e., December 29, 2023) and be updated as needed to address
emerging drug misuse issues. The provision requires an independent evaluation and
accompanying report to Congress regarding the effectiveness of the campaign beginning two
years after enactment (i.e., December 2024) and two years thereafter (i.e., December 2026).
Section 1272 also requires the Secretary, no later than 18 months after enactment (i.e., June
2024), to disseminate information related to synthetic opioids to health care providers
participating in federal programs, publish a training guide for first responders detailing measures
to prevent exposure to synthetic opioids, and conduct outreach to first responders about the
availability of the training guide.
Section 1273. Grant Program for State and Tribal Response to Opioid
Use Disorders
Background
Section 1003 of the 21st Century Cures Act established the “Account for the State Response to the
Opioid Abuse Crisis” in the Treasury, to which $500 million was transferred and deposited for
each of FY2017 and FY2018. The resulting grant—the State Targeted Response (STR) to the
Opioid Crisis grant program—supplemented state activities related to the opioid crisis. The
purpose of the grant program was to increase access to treatment, decrease unmet treatment need,
and reduce overdose deaths through prevention, treatment, and recovery activities.
In FY2018, Congress provided $1 billion for similar activities through a new State Opioid
Response (SOR) grant program. The appropriation, located in the annual Departments of Labor,
Health and Human Services, and Education and Related Agencies (Labor-HHS-ED)
Appropriations Act, included a $50 million set-aside for Indian Tribes and an additional 15% set-
aside for states with the highest opioid-related mortality rates. Program goals were similar to the
STR grants with an emphasis on expanding access to medications for opioid use disorder.
The STR grant authorization expired in FY2018, and the program did not receive any further
funding. Rather, Congress increased the SOR grant appropriation by $500 million—the same
amount as the STR grants—for a total of $1.5 billion for FY2019.118 Prior to the Restoring Hope
for Mental Health and Well-Being Act, the SOR grants did not have a statutory authorization;
grants were authorized annually through that Labor-HHS-ED Appropriations Act.119
Provision
Section 1273 replaces Section 1003 of the Cures Act with a new provision authorizing the State
Opioid Response grants, effectively codifying the SOR grant program and removing the
authorization for the STR grants.
Section 1273 authorizes grants to address opioid and stimulant misuse for states and Tribes.120
Grants are awarded to the Single State Agency responsible for administering SAMHSA’s annual

118 Subsequent annual appropriations for the SOR grants maintained this increase.
119 For more information on the history of the STR and SOR grants, see CRS In Focus IF12116, Opioid Block Grants.
120 The SOR grant appropriation has included set-aside for Indian Tribes and Tribal organizations—known as the TOR
grants. TOR grants are not distributed by a formula. Instead, Tribes and Tribal organizations apply individually, as a
consortia, or in partnership with an urban Indian organization. Funds are distributed noncompetitively based on Tribal
population. Other grant requirements are similar to the SOR grant program. Section 1273 codifies authority for the
TOR grants.
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substance use block grant.121 The provision codifies minimum amounts of $4 million for states
and $250,000 for territories. It specifies that the Secretary shall develop a formula for funding
allocations and submit it to specified congressional committees. The formula methodology must
provide preference to states with a higher relative prevalence of opioid use disorders and
overdose deaths. It should include performance assessments for continuation awards and avoid “a
funding cliff between States with similar overdose mortality rates to prevent funding reductions
when compared to prior year allocations.”122 The authorization codifies the 15% set-aside for
states with the highest age-adjusted rate of drug overdose deaths. It caps the amount for Tribes at
5%.
The new statutory authorization for the SOR grants provides more specified uses of funds.
According to the provision, SOR-supported activities may include the following:
• Implementing substance use disorder prevention activities (including primary
prevention).
• Improving prescription drug monitoring programs (PDMPs).
• Training health care practitioners in pain management, best practices for
prescribing opioids, identification of SUDs, referral to treatment programs,
preventing diversion, and overdose prevention.
• Supporting access to SUD services, including those provided at opioid treatment
programs (OTPs) or other outpatient or residential facilities providing MOUD,123
or in integrated care settings.
• Recovery support services, including peer support, mutual aid programs, housing
services, and family support.
• Other public health-related activities addressing substance misuse and use
disorders.
Section 1273 specifies reporting requirements for grantees and the Secretary. States receiving
funds must report a description of the activities supported by the grant and the population served.
The Secretary must submit a report to specified congressional committees no later than
September 30, 2024, that summarizes the information provided by the states. The authorization
also requires the Secretary to provide technical assistance, including regarding grant applications,
to grantees. The provision requires GAO to submit a report to specified congressional committees
no later than two years after enactment (i.e., December 29, 2024) that assesses funding allocations
and use of funds.
Cures Act Section 1003 now authorizes $1.75 billion to be appropriated for each of FY2023-
FY2027.

121 Authorized in Title XIX of the PHSA (42 U.S.C. 300x-21 et seq.). Section 1241 of the Restoring Hope for Mental
Health and Well-Being Act renamed this grant the Substance Use Prevention, Treatment, and Recovery (SUPTRS)
block grant.
122 Report language accompanying appropriations laws authorizing the SOR grant included similar language. Initially,
states receiving additional funding through the 15% set-aside for states with the highest overdose mortality could
receive significant reductions in funds in subsequent years if they significantly reduced (or slowed) mortality relative to
other states.
123 For more information, see CRS In Focus IF12348, Medications for Opioid Use Disorder.
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Subtitle C—Access to Mental Health Care
and Coverage
Chapter 1—Improving Uptake and Patient Access to Integrated
Care Services
Section 1301. Improving Uptake and Patient Access to Integrated Care Services
Background
PHSA Section 520K (“Integration Incentive Grants and Cooperative Agreements”) authorizes
SAMHSA’s Primary and Behavioral Health Care Integration program. Amended in 2016 by the
Cures Act,124 the provision authorizes the Secretary to fund demonstration projects that provide
coordinated and integrated mental health and primary care services. The program provides grants
to states and community mental health centers to engage in collaboration, expand infrastructure,
and increase the availability of primary health care and wellness services for individuals with
serious mental illness or co-occurring mental illness and substance use disorders.125
PHSA Section 520K previously authorized $51.9 million (rounded) to be appropriated for each of
FY2018-FY2022.
Provision
Section 1301 replaces PHSA Section 520K with a new provision authorizing similar activities,
entitled “Improving Uptake and Patient Access to Integrated Care Services.” The new
authorization makes the following changes:
• Expands eligible entities to include rural health clinics, FQHCs, or primary care
practices.
• Amends the definition of integrated care to include the psychiatric collaborative
care model and other evidence-based or evidence-informed models, and specifies
that integrated care includes coordinating and jointly delivering behavioral and
physical health services.
• Adds a definition of the psychiatric collaborative care model.
• Adds a definition for bidirectional integrated care, which means integration of
behavioral health care and specialty health care, or primary care into specialty
behavioral health settings.
• Adds to the definition of “special population” adults with co-occurring mental
health and substance use disorders.
• Changes “Purposes” of the program to “Use of Funds” and expands the use of
funds beyond primary care and for all special populations (as now defined). It
specifies that the grants support evidence-based or evidence-informed activities;
adds recovery services; adds bidirectional integrated care services; adds greater

124 Cures Act §9003.
125 SAMHSA, Justification of Estimates for Appropriations Committees, FY2023.
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specifications for use of funds (hiring staff, formalizing contractual relationships,
purchasing software and other resources, etc.).
• Specifies greater detail regarding the application and partnerships with Tribal,
rural, or medically underserved communities, and a description of evidence-
based integrated care models other than the psychiatric care model.
• Further specifies that awards are for no more than $2 million (as opposed to
exactly $2 million previously), with adjustments by the Secretary permitted.
• Broadens the information included in annual grantee reports and removes
requirements to report certain specific outcomes.
• Adds training and information on the psychiatric collaborative care model to the
technical assistance authorization for grantees.
The new authorization requires a report to specified congressional committees no later than 18
months after enactment (i.e., June 29, 2024), and annually thereafter, summarizing the annual
grantee reports and including other specified information on outcomes. The provision specifies no
less than 10% of funds are for implementing the psychiatric collaborative care model (provided
the annual appropriation is not less than the FY2022 level).
PHSA Section 520K now authorizes $60 million to be appropriated for each of FY2023-FY2027.
Chapter 2—Helping Enable Access to Lifesaving Services
Section 1311. Reauthorization and Provision of Certain Programs to Strengthen
the Health Care Workforce
Background
PHSA Section 756 (“Mental and Behavioral Health Education and Training Grants”) authorizes
the Behavioral Health Workforce Education and Training (BHWET) Program. Administered by
HRSA, this program provides grants to support the training of the behavioral health workforce,
including paraprofessionals. Grants are awarded to eligible institutions of higher education,
training programs, and other organizations involved in training specified behavioral health service
professionals in fields such as psychiatry, psychology, psychiatric nursing, social work, and
occupational therapy, among others. Codified by the Cures Act in 2016,126 the program
authorization was subsequently amended by the SUPPORT Act in 2018,127 which added language
specifying that providers trained in trauma-informed care are eligible to participate.
PHSA Section 756 previously authorized $50 million to be appropriated for each of FY2019-
FY2023
PHSA Section 760 (“Training Demonstration Program”) requires the Secretary to establish a
demonstration program that awards grants to eligible entities to (1) support training for psychiatry
residents and fellows, nurse practitioners, physician assistants, and social workers in underserved
community-based settings integrating primary care and mental and substance use disorder
treatment, and (2) support academic units or programs that provide training for students or faculty
in the ability to recognize, diagnose, and treat mental and substance use disorders or develop
evidence-based practices or recommendations for curricula content standards. Originally added

126 Cures Act §9021 (42 U.S.C. §294e-1).
127 SUPPORT Act §7073.
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by the Cures Act in 2016,128 PHSA Section 760 specifies acceptable use of grant funds, eligible
entities, granting priority, and required studies and reports.
PHSA Section 760 previously authorized $10 million to be appropriated annually for each of
FY2018-FY2022.
Provision
Section 1311 amends PHSA Section 756 to specify that occupational therapy master’s or doctoral
level programs are grant eligible. The provision also adds trauma-informed training for
paraprofessionals to allowable uses of funds.
Section 1311 extends the authorization of appropriations for the BHWET program. PHSA Section
756 now authorizes $50 million to be appropriated for each of FY2023-FY2027 (with specified
allocations for each activity).
Section 1311 amends PHSA Section 760 by making technical corrections to language related to
mental health disorders and by specifying that individuals completing clinical training
requirements for licensure are eligible for training. It also adds counselors and nurses to the list of
eligible professionals, as well as programs that focus on pediatric populations or trauma-informed
care to the eligibility list. It adds health service psychologists, nurses, counselors, and physician
assistants to the prioritized eligible grantees.
Section 1311 extends authorizations of appropriations for the Training Demonstration program,
authorizing $31.7 million to be appropriated for each of FY2023-FY2027.
Section 1312. Reauthorization of Minority Fellowship Program
Background
PHSA Section 597 (“Fellowships”) requires the Secretary to maintain a “Minority Fellowship
Program” to award fellowships, which may include stipends, for post-baccalaureate training for
mental health professionals in the fields of psychiatry, nursing, social work, marriage and family
therapy, mental health counseling, and substance use disorder and addiction counseling. The
SAMHSA-administered Minority Fellowship Program provides grants to professional
associations (e.g., the American Psychiatric Association and the American Nurses Association) to
offer stipends to minority doctoral students who are studying for degrees in a mental or
behavioral health profession.129
PHSA Section 597 previously authorized $12.7 million (rounded) to be appropriated for each of
FY2018-FY2022.130
Provision
Section 1312 amends PHSA Section 597 to reauthorize SAMHSA’s Minority Fellowship
Program. PHSA Section 597 now authorizes $25 million to be appropriated for each of FY2023-
2027.

128 Cures Act §9022 (42 U.S.C. §294k).
129 Of note, the Health Resources and Services Administration (HRSA) within HHS also provides workforce
development programming for behavioral health providers. See, for instance, HRSA; Grants; Behavioral Health at
https://bhw.hrsa.gov/grants/behavioral-health.
130 42 U.S.C. §290ll(c).
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Chapter 3—Eliminating the Opt-Out for Nonfederal Governmental
Health Plans
Section 1321. Eliminating the Opt-Out for Nonfederal Governmental
Health Plans
Background
Private health insurance—offered by private-sector insurance companies or sponsored by
employers and other entities, such as unions—is the most common form of health coverage in the
United States. Both private-sector employers and governmental employers may offer private
health insurance to their employees and their dependents.
A nonfederal governmental plan is a governmental group health plan that is sponsored by entities
such as states, counties, school districts, and municipalities.131 Like private employers, sponsors
of nonfederal governmental plans can choose to offer self-insured or fully insured plans.132
Per PHSA Section 2722, if a sponsor of a nonfederal governmental plan offers a self-insured plan,
the sponsor may elect to exempt the plan from certain federal requirements that otherwise apply
to self-insured group health plans. The exemption for self-insured, nonfederal governmental plans
was established in the PHSA under the Health Insurance Portability and Accountability Act
(HIPAA; P.L. 104-191) and later modified by the Patient Protection and Affordable Care Act
(ACA; P.L. 111-148, as amended).133 Per the ACA, self-insured, nonfederal plans may opt out of
some or all of the following federal requirements:
• Coverage of Minimum Hospital Stay After Childbirth (42 U.S.C. §300gg-25);
• Mental Health Parity (42 U.S.C. §300gg-26);
• Coverage of Reconstruction After Mastectomy (42 U.S.C. §300gg-27); and
• Coverage for Students Who Take a Medically Necessary Leave of Absence (42
U.S.C. §300gg-28).134
Federal mental health parity law does not require applicable plans to cover mental health and
substance use disorder (MH/SUD) benefits when such coverage is not otherwise required by
federal or state law.135 However, when a plan does cover both MH/SUD benefits and
medical/surgical (M/S) benefits, parity law generally prohibits the imposition of more restrictive
limitations on the MH/SUD as compared with the M/S benefits.

131 Nonfederal governmental plan is defined at 42 U.S.C. §300gg-91(d)(8)(C) and uses the definition of governmental
plan at 29 U.S.C. §1002(32).
132 When group plan sponsors purchase coverage from insurers and offer it to their employees or other groups, these
plans are referred to as fully insured. When group plan sponsors provide health benefits directly (instead of purchasing
coverage from an insurer), these plans are referred to as self-insured or self-funded. For more information, see “Federal
and State Regulation of Private Health Insurance” in CRS Report R47507, Private Health Insurance: A Primer.
133 For additional background on the exemption for self-insured, nonfederal governmental plans, see the relevant
section in CRS Report R46003, Applicability of Federal Requirements to Selected Health Coverage Arrangements.
134 For discussions of these and other provisions, see CRS Report R45146, Federal Requirements on Private Health
Insurance Plans.
135 Federal mental health parity law includes the Paul Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008 (MHPAEA; P.L. 110-343), as it amended prior parity law and has since been amended.
For more information, see CRS Report R47402, Mental Health Parity and Coverage in Private Health Insurance:
Federal Requirements.
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In 2021, approximately 13 million state and local government employees were enrolled through
their employer’s health plan (i.e., a nonfederal governmental plan).136 Among those employees
enrolled, 64.4% (or 8.4 million) were in a self-insured plan. For reference, 72.6 million private-
sector employees were enrolled through their employer’s health plan in 2021, and among those
enrollees, an estimated 57.9% (or 42 million) were in a self-insured plan.
According to data published by the Center for Consumer Information & Insurance Oversight
(CCIIO), as of June 2019, at least 174 nonfederal governmental entities across 35 states had
elected to exempt at least one self-insured plan they offer from one or more of the four
requirements above.137 Nearly all of the 174 entities offered at least one plan that was exempt
from the mental health parity requirement; significantly fewer entities offered plans that were
exempt from each of the other three requirements. Overall, it is unclear how many nonfederal
governmental entities offered plans that covered MH/SUD benefits at that time, nor is it clear
how many such self-insured plans had not opted out of parity requirements.
Provision
Section 1321 amends PHSA Section 2722 to provide that self-insured, nonfederal governmental
plans can no longer opt out of mental health parity requirements.138 Such plans may not elect this
exemption on or after the date of enactment (i.e., December 29, 2022), and they may not renew a
mental health parity exemption that expires on or after 180 days after enactment (i.e., June 27,
2023).
There is an exception in Section 1321 for certain collectively bargained plans. As explained in
subsequent guidance regarding this provision:
Specifically, a self-funded, non-Federal governmental group health plan that is subject to
multiple collective bargaining agreements (CBAs) of varying lengths and that has a
MHPAEA opt-out election in effect on December 29, 2022, that expires on or after June
27, 2023, may extend such election until the date on which the term of the last collective
bargaining agreement expires.139
Per CCIIO data updated as of July 2023 (i.e., after the enactment of this provision), at least 186
nonfederal governmental entities across 26 states had elected to exempt at least one self-insured
plan they offer from one or more of the four requirements above—all but one of which included a

136 Estimates in this paragraph are based on Congressional Research Service (CRS) analysis of Medical Expenditure
Panel Survey (MEPS) Insurance Component (IC) data from the U.S. Agency for Healthcare Research and Quality
(AHRQ). See “Employee” data in the “Public Sector” and “Private Sector – National” tabs at https://datatools.ahrq.gov/
meps-ic/. The MEPS-IC public sector data (available through 2021 at the time of this report) include state and local
governmental entities. The MEPS-IC private sector data (available through 2022, but 2021 data used for comparison)
include nongovernmental employers, the self-employed with employees, and the incorporated, self-employed with no
employees. While employers may offer coverage to employees and their dependents, the MEPS-IC enrollment data
include covered employees only. See “covered persons” in the glossary at the MEPS-IC webpage linked in this
footnote.
137 Centers for Medicare & Medicaid Services (CMS), Center for Consumer Information and Insurance Oversight
(CCIIO), “List of HIPAA Opt-Out Elections for Self-Funded Non-Federal Governmental Plans,” June 21, 2019, at
https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/HIPAAOptOuts.pdf.
138 42 U.S.C. §300gg-21(a)(2)(F).
139 CMS, CCIIO, “Insurance Standards Bulletin Series – Information: Sunset of MHPAEA opt-out provision for self-
funded, non-Federal governmental group health plans,” June 7, 2023, at https://www.cms.gov/files/document/hipaa-
opt-out-bulletin.pdf. MHPAEA refers to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008 (P.L. 110-343).
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parity exemption.140 The details of all of these parity exemptions are not provided, but some of
the plans were elected prior to December 29, 2022, and some are indicated as collectively
bargained plans.141
Chapter 4—Mental Health and Substance Use Disorder
Parity Implementation
Section 1331. Grants to Support Mental Health and Substance Use Disorder
Parity Implementation
Background
Both the federal and state governments regulate private health insurance.142 Federal health
insurance requirements typically follow the model of federalism: federal law establishes
standards, and states are primarily responsible for monitoring compliance with and enforcement
of those standards. States may impose additional requirements on insurers and the plans they
offer (i.e., fully insured group and nongroup plans), provided the state requirements neither
conflict with federal law nor prevent the implementation of federal requirements. In general, self-
insured group plans are regulated by the federal government but not by state governments.
Per federal mental health parity law, applicable plans are generally prohibited from imposing
more restrictive coverage limits, including nonquantitative treatment limitations (NQTLs), on
their mental health and substance use disorder (MH/SUD) benefits as compared with their
medical/surgical (M/S) benefits.143 NQTLs include nonnumeric coverage restrictions or plan
attributes, such as prior authorization requirements.
Per mental health parity provisions in the Consolidated Appropriations Act, 2021 (CAA, 2021;
P.L. 116-260), plans also are required to “perform and document comparative analyses of the
design and application of NQTLs” and to make such analyses available to applicable federal
agencies or state authority, upon request.144 The Secretaries of HHS, Labor, and the Treasury must
annually request and review at least 20 of the NQTL analyses described above from plans that
“involve potential [parity] violations” or complaints of noncompliance, or in “any other instances
in which the Secretary determines appropriate.”145 States are not required to request and review
the NQTL analyses.

140 CMS, CCIIO, “HIPAA Opt-Out Elections for Self-Funded Non-Federal Governmental Plans,” July 31, 2023, at
https://www.cms.gov/files/document/hipaaoptouts03182021.pdf. (The document itself indicates it has been updated,
but the URL retains a prior date.)
141 In August 2023, a proposed federal rule on mental health parity topics included proposed amendments to existing
regulations as related to implementation of Section 1321. See Internal Revenue Service (IRS), Department of the
Treasury; Employee Benefits Security Administration (EBSA), Department of Labor (DOL); CMS, Department of
Health and Human Services (HHS), “Requirements Related to the Mental Health Parity and Addiction Equity Act,”
August 3, 2023, at 88 Federal Register 51552.
142 See “Federal and State Regulation of Private Health Insurance” in CRS Report R47507, Private Health Insurance:
A Primer.
143 See “Parity Requirements Related to Coverage Limits and Benefit Classifications” in CRS Report R47402, Mental
Health Parity and Coverage in Private Health Insurance: Federal Requirements.
144 Consolidated Appropriations Act, 2021 (CAA, 2021; P.L. 116-260), Division BB, Title II, Section 203. Also see
“NQTL Comparative Analyses” in CRS Report R47402, Mental Health Parity and Coverage in Private Health
Insurance: Federal Requirements.
145 Ibid.
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Separately, Section 1003 of the ACA added a new PHSA Section 2794 (42 U.S.C. §300gg-94),
establishing a $250 million grant program, to be awarded during the five-year period beginning
with FY2010, to assist states in carrying out premium rate review activities and related activities
as specified.146 ACA Section 1003 further specified that if there were remaining funds at the end
of FY2014, those funds were available to the Secretary for additional grants to states for
“planning and implementing the insurance reforms and consumer protections under part A” (of
Title XXVII of the PHSA).
Separately, Section 6603 of the ACA also added PHSA Section 2794, “Uniform fraud and abuse
referral format.” It was codified at Title 42, Section 300gg-95, of the U.S. Code.
Provision
Section 1331 amends PHSA Section 2794 to establish new grants for states “to enforce and
ensure compliance with” mental health parity requirements.147 To be eligible for the grants, states
must agree to request and review (an unspecified number of) the NQTL comparative analyses
required of group and individual health insurance issuers. The Secretary is otherwise required to
specify the timing, manner, and information requirements for state applications for the grants.
The amended PHSA Section 2794 authorizes $10 million to be appropriated for each of the first
five fiscal years beginning after the date of enactment (i.e., December 29, 2022), to remain
available until expended, for purposes of awarding these grants.
Section 1331 also includes a technical amendment regarding the PHSA Section 2794 that was
added by ACA Section 6603. This provision is redesignated as PHSA Section 2795.148
Subtitle D—Children and Youth
Chapter 1—Supporting Children’s Mental Health Care Access
Section 1401. Technical Assistance for School-Based Health Centers
Background
PHSA Section 399Z-1 (“School-Based Health Centers”) requires the Secretary to award grants
for the operating costs of school-based health centers (SBHCs). School-based health centers are
health clinics located in schools that provide primary health services to children.149 The section’s
authorization of appropriation was extended in P.L. 116-260 in 2020, which authorized to be
appropriated such sums as necessary for each of FY2022-FY2026. Prior to the law’s enactment in
2020, authorizations of appropriations had lapsed in FY2014.
Grants have never been explicitly awarded under the PHSA Section 399Z-1 authority since the
section was enacted in 2010. Instead, HRSA has awarded grants to health centers authorized
under PHSA Section 330 to establish school sites. Funding for this purpose has been made

146 See 42 U.S.C. §300gg-94(c)(1-2) regarding the initial premium rate review grants and the additional grants. The
premium rate review requirements are at 42 U.S.C. 300gg-94(a-b). Regarding premium rate review requirements, see
“Rate Review” in CRS Report R45146, Federal Requirements on Private Health Insurance Plans.
147 42 U.S.C. §300gg-94(c)(3).
148 42 U.S.C. §300gg-95.
149 For complete definition, see Social Security Act Section 2110(c)(9)(A) (42 U.S.C. 1397jj(c)(9)(A)).
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available in annual appropriations act. For example, the part of this law—the Consolidated
Appropriations Act, 2023 (P.L. 117-328)—that provided appropriations for HRSA (in Division H)
included $55 million for school-based health centers as part of the funds made available for the
general Health Center program.
Provision
Section 1401 amends PHSA Section 399Z-1 by adding a new subsection requiring the Secretary
to provide technical assistance to SBHCs by grants or contracts to private, nonprofit entities with
expertise in school-based health centers. New subsection (l) specifies the purpose and
requirements for such technical assistance, including support for program operations and
implementation of evidence-based or evidence-informed best practices.
Section 1402. Infant and Early Childhood Mental Health Promotion,
Intervention, and Treatment
Background
PHSA Section 399Z-2 (“Infant and Early Childhood Mental Health Promotion, Intervention, and
Treatment”) authorizes SAMHSA’s Infant Early Childhood Mental Health grant program.
Originally added by the Cures Act,150 PHSA Section 399Z-2 authorizes grants to support
programs for infant and early childhood mental health promotion, intervention, and treatment.
The program targets children up to age 12 who are at risk for, show early signs of, or have been
diagnosed with a serious mental illness (including a serious emotional disturbance) and who
would benefit from specified programs. Eligible entities are human services agencies or nonprofit
institutions meeting specified criteria.
PHSA Section 399Z-2 previously authorized $20 million to be appropriated for the period
FY2018-FY2022 to carry out the grant program.
Provision
Section 1402 amends PHSA Section 399Z-2 by adding a new subsection allowing the Secretary
(directly or via grants or contracts) to provide technical assistance to eligible entities to provide
mental health services for children, training for health care professionals, and consultation to
early child care and education programs.
Section 1402 reauthorizes the Infant Early Childhood Mental Health grant program. PHSA
Section 399Z-2 now authorizes $50 million to be appropriated for the period of FY2023-FY2027.
Section 1403. Co-Occurring Chronic Conditions and Mental Health in
Youth Study
Background
Research has found that children with chronic health conditions exhibit symptoms of mental
health disorders at higher rates than their healthier peers.151 Previous HHS studies investigating

150 Cures Act §10006.
151 See Ann Marie Brady, Jessica Deighton, and Stephen Stansfeld, “Chronic Illness in Childhood and Early
(continued...)
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mental and physical health issues, such as suicidal ideation in medical populations, have focused
primarily on adults.152
Provision
Section 1403 requires the Secretary to complete a study on the rates of suicidal behaviors among
youth with chronic medical illnesses no later than 12 months after enactment (i.e., December 29,
2023). The provision requires the Secretary to submit a report to Congress on the results of the
study, including recommendations for early intervention, dissemination of best practices, and
strategies to reduce suicidal behaviors.
Section 1404. Best Practices for Behavioral and Mental Health
Intervention Teams
Background
The federal government supports state and local efforts in promoting school safety and security.153
For example, the U.S. Secret Service National Threat Assessment Center (NTAC) published an
operational guide identifying how schools can enhance their safety using a threat assessment
model.154 School threat assessment interventions seek to identify students at risk of violence to
self or others, assess their risk for engaging in violence or other harmful activities, and identify
strategies to manage that risk.155 According to NTAC, the first step in a targeted violence
prevention plan is establishing a threat assessment team, sometimes referred to as a behavioral
intervention team.156 Composed of personnel in a variety of disciplines—including mental health
professionals—behavioral intervention teams receive reports about students of concern, gather
additional information, assess the risk posed to the school community, and develop strategies to
mitigate any risk of harm.
Provision
Section 1404 adds a new PHSA Section 520H-1 (“Best Practices for Behavioral and Mental
Health Intervention Teams”) that requires the SAMHSA Assistant Secretary, in consultation with
the U.S. Department of Education (ED), DOJ, and the Director of the NTAC, to submit to
specified congressional committees a report on best practices for using school-based behavioral
and mental health intervention teams. The provision defines a behavioral and mental health
intervention team as a multidisciplinary team of trained individuals who can assess the behavioral

Adolescence: A Longitudinal Exploration of Co-Occurring Mental Illness,” Development and Psychopathology, vol.
33, no. 3 (May 4, 2020), pp. 885-898; and Andrew J. Barnes, Marla E. Eisenberg, and Michaal Resnick, “Suicide and
Self-Injury Among Children and Youth With Chronic Health Conditions,” Pediatrics, vol. 124, no. 5 (May 2010), pp.
889-895.
152 For example, Pamela L. Owens, Kevin Heslin, Kathryn Fingar, et al., “Co-occurrence of Physical Health Conditions
and Mental Health and Substance Use Conditions Among Adult Inpatient Stays, 2010 Versus 2014,” Agency for
Healthcare Research and Quality, Statistical Brief #240, Rockville, MD, June 2018, https://hcup-us.ahrq.gov/reports/
statbriefs/sb240-Co-occurring-Physical-Mental-Substance-Conditions-Hospital-Stays.jsp.
153 For more information, see CRS Report R46872, Federal Support for School Safety and Security.
154 U.S. Department of Homeland Security, United States Secret Service, National Threat Assessment Center,
Enhancing School Safety Using a Threat Assessment Model: An Operational Guide for , July 2018,
https://www.cisa.gov/sites/default/files/publications/18_0711_USSS_NTAC-Enhancing-School-Safety-Guide.pdf.
155 Ibid., p. 1.
156 Ibid., p. 3.
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health needs of youth, connect at-risk youth with appropriate services, and implement evidence-
based interventions to mitigate threats of harm and support safe, supportive learning
environments in K-12 and higher education settings.
Chapter 2—Continuing Systems of Care for Children
Section 1411. Comprehensive Community Mental Health Services for Children
with Serious Emotional Disturbances
Background
PHSA Title V, Part E (Sections 561-565), authorizes SAMHSA’s Children’s Mental Health
Services. PHSA Title V, Part E, requires the Secretary to award grants to support “comprehensive
community mental health services for children with a serious emotional disturbance.” 157
Reauthorized by the Cures Act,158 the authorization specifies reporting requirements, technical
assistance requirements, and the ages of children to be served, among other things. PHSA Section
565 (“General Provisions”) provides definitions for terms used in the Title V, Part E,
authorizations and includes the authorization of appropriations, among other things.
PHSA Section 565 previously authorized $119 million (rounded) to be appropriated for each of
FY2018-FY2022.
Provision
Section 1411 amends PHSA Section by adding “kinship caregivers” to the definition of “family”
and reauthorizing SAMHSA’s Children’s Mental Health Services.
PHSA Section 565 now authorizes $125 million to be appropriated for each of FY2023-FY2027.
Section. 1412. Substance Use Disorder Treatment and Early Intervention
Services for Children and Adolescents
Background
PHSA Section 514 (“Substance Use Disorder Treatment and Early Intervention Services for
Children, Adolescents, and Young Adults”) authorizes SAMHSA’s Children and Families
program. PHSA Section 514 requires the Secretary to award grants, contracts, or cooperative
agreements to support substance use disorder services for children and adolescents. Eligible
entities include public and private nonprofit entities, including Native Alaskan entities and Indian
Tribes and Tribal organizations. PHSA Section 514 requires the Secretary to give priority to
applicants meeting specified criteria (e.g., providing gender-specific and culturally appropriate
treatment). The Cures Act reauthorized the activities in this provision in 2016, further specifying
definitions for Indian Tribes or Tribal Organizations and Indian Health Service facilities, among
other things. 159

157 42 U.S.C. §290ff.
158 Cures Act §10001.
159 Cures Act §10003.
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PHSA Section 514 previously authorized $29.6 million (rounded) to be appropriated for each of
FY2018-FY2022.
Provision
Section 1412 amends PHSA Section 514 by making technical edits to Tribal terms and
reauthorizing $29.6 million (rounded) for each of FY2023-2027 for SAMHSA’s Children and
Families program.
Chapter 3—Garrett Lee Smith Memorial Reauthorization
Sections 1421-1424
Background
SAMHSA supports several suicide prevention initiatives, including the National Strategy for
Suicide Prevention, a suicide prevention technical assistance center, and the Garrett Lee Smith
(GLS) State and Campus suicide grant programs, among others. In 2004, the Garrett Lee Smith
Memorial Act (P.L. 108-355 ) explicitly authorized three of these suicide prevention programs in
PHSA Title V.
PHSA Section 520C (“Suicide Prevention Technical Assistance Center”) authorizes the Garrett
Lee Smith (GLS) Suicide Prevention Resource Center. Amended by the Cures Act,160 PHSA
Section 520C requires the Secretary, acting through the SAMHSA Assistant Secretary, to operate
a technical assistance center focused on suicide prevention. The provision specifies the program’s
focus on suicide prevention across the lifespan and requires the Secretary to submit to Congress a
report on the activities carried out by the center.
PHSA Section 520C previously authorized $6 million (rounded) to be appropriated annually for
each of FY2018-FY2022 for the center.
PHSA Sections 520E (“Youth Suicide Early Intervention and Prevention Strategies”) and 520E-2
(“Mental Health and Substance Use Disorder Services on Campus”) authorize the Garrett Lee
Smith (GLS) State and Campus suicide grant programs. The GLS State grant program—entitled
the GLS State/Tribal Youth Suicide Prevention and Early Intervention grant program—awards
grants to states to support comprehensive statewide youth suicide prevention and early
intervention strategies. The GLS Campus Suicide Prevention grant program provides institutions
of higher education with grants to implement an array of suicide prevention initiatives on
campus.161 Both authorizing provisions were previously amended by the Cures Act in 2016.162
PHSA Section 520E previously authorized $30 million for each of FY2018-FY2022.
PHSA Section 520E-2 previously authorized $7 million for each of FY2018-FY2022.
Section 1421. Suicide Prevention Technical Assistance Center
Section 1421 amends PHSA Section 520C by making technical edits to Tribal terms and by
requiring the Secretary to collaborate with DOD and VA when providing technical assistance to
entities serving members of the Armed Forces and veterans. The provision amends the

160 Cures Act §9008.
161 SAMHSA Justification of Estimates for Appropriations Committees, FY2024.
162 Cures Act §9008 and §9031.
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authorization for an annual report, requiring the Secretary to submit to Congress a report on the
activities carried out by the center no later than two years after enactment (i.e., December 29,
2024).
Section 1421 reauthorizes the Suicide Prevention Technical Assistance Center. PHSA Section
520C now authorizes $9 million to be appropriated for each of FY2023-FY2027.
Section 1422. Youth Suicide Early Intervention and Prevention Strategies
Section 1422 amends PHSA Section 520E by adding pediatric health programs to the list of
applicable service-delivery settings and adding Tribe-designated organizations to the list of
eligible grantees. The provision adds pediatric health programs that provide families with
supplies to securely store means commonly used in suicide to the list of service delivery settings
receiving preference.
Section 1422 amends the requirement in PHSA Section 520E that no less than 85% of funds be
used for “direct services,” instead requiring no less than that amount to be used for “suicide
prevention activities.”163 It also adds the Department of Education to the list of entities the
Secretary is required to consult with in carrying out this program. It extends the deadline for
grantees to submit an evaluation of grant-funded activities to 24 months (from 18 months). It
amends the date the Secretary must submit a report to congressional committees on the
effectiveness of program activities to December 31, 2025. The provision makes technical edits to
Tribal terms and amends the definition of “youth” to include individuals younger than 10 years
old and up to 24 years old.
Section 1422 reauthorizes the GLS State/Tribal Youth Suicide Prevention and Early Intervention
Grant Program. PHSA Section 520E now authorizes $40 million to be appropriated for each of
FY2023-2027.
Section 1423. Mental Health and Substance Use Disorder Services for Students
in Higher Education
Section 1423 amends PHSA Section 520E-2 by changing the title to “Mental Health and
Substance Use Disorder Services for Students in Higher Education.” The provision adds
promoting resiliency to the goals of the program and adds providing resources (in addition to
services) to allowable uses of funds. The provision makes other technical changes to language
related to mental health promotion and service provision. It also specifies the congressional
committees to receive the program’s annual report to Congress, and requires the report to include
a needs assessment of the population served by grant recipients.
Section 1423 amends PHSA Section 520E-2 by reauthorizing $7 million for each of FY2023-
FY2027 for the GLS Campus Suicide Prevention grant program.
Section 1424. Mental and Behavioral Health Outreach and Education at
Institutions of Higher Education
Background
PHSA Section 549 (“Mental and Behavioral Health Outreach and Education on College
Campuses”) requires the Secretary, acting through the SAMHSA Assistant Secretary in

163 42 U.S.C. §290bb-36(d).
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collaboration with the CDC Director, to convene an interagency, public-private sector working
group composed of representatives of certain specified groups. The working group is required to
plan, establish, and coordinate a public education campaign, as specified, focused on mental and
behavioral health on the campuses of institutions of higher education, as defined. Originally
added by the Cures Act in 2016,164 PHSA Section 549 specifies the elements required in the
working group’s plan.
PHSA Section 549 previously authorized $1 million to be appropriated for the period of FY2018-
FY2022.
Provision
Section 1424 amends PHSA Section 549 by changing the heading to “Mental and Behavioral
Health Outreach and Education at Institutions of Higher Education” and adding representatives of
minority-serving institutions and community colleges to the working group authorized in the
section.165
Section 1424 amends PHSA Section 549 by reauthorizing $1 million for the period of FY2023-
FY2027 for the national public education campaign.
Chapter 4—Media and Mental Health
Background
Emerging research suggests that smartphone and social media use may pose risks of harm to
youth and adolescents.166 For example, some studies have shown smartphone and social media
use is associated with increases in depression, anxiety, and suicidality (among other mental and
behavioral issues) for youth and adolescents, particularly girls.167 Other studies suggest only
moderate negative effects,168 or even possible benefits of social media use.169 A greater
understanding of the range of possible health effects of smartphone and social media on youth
and adolescents awaits further research.

164 Cures Act §9033.
165 For more information on minority-serving institutions, see CRS Report R43237, Programs for Minority-Serving
Institutions Under the Higher Education Act.
166 See, for example, Kira E. Riehm, Kenneth A. Feder, and Kayla N. Tormohlen, et al., “Associations Between Time
Spent Using Social Media and Internalizing and Externalizing Problems Among US,” JAMA Psychiatry, vol. 76, no. 12
(September 11, 2019), pp. 1266-1273; and Chirag Gupta, Sangita Jogdand, and Mayank Kumar, “Reviewing the
Impact of Social Media on the Mental Health of Adolescents and Youth Adults,” Cureus, vol. 14, no. 10 (October
2022), p. e30143.
167 See, for example, Yvonne Kelly, Afshin Zilanawala, and Cara Booker, et al., “Social Media Use and Adolescent
Mental Health: Findings from the UK Millenium Cohort Study,” eClinicalMedicine, vol. 6 (2018), pp. 59-68; and Jean
M. Twenge and Eric Farley, “Not All Screen Time Is Created Equal: Associations with Mental Health Vary by Activity
and Gender,” Social Psychiatry and Psychiatric Epidemiology, vol. 56 (2021), pp. 207-217.
168 See, for example, Amy Orben and Andrew K. Przybylski, “The Association Between Adolescent Well-Being and
Digital Technology Use,” Nature Human Behavior, vol. 3 (2019), pp. 173-182.
169 See, for instance, Yalda T. Uhls, Nicole B. Ellison, and Kavri Subrahmanyam, “Benefits and Costs of Social Media
in Adolescence,” Pediatrics, vol. 140 (November 1, 2017).
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Section 1431. Study on the Effects of Smartphone and Social Media Use
on Adolescents
Section 1431 allows the Secretary to conduct or support research on smartphone and social media
use by adolescents and the effects of use on emotional, behavioral, and physical health and
development, and mental health disparities. The provision requires the Secretary to submit a
report to Congress on the findings of the research no later than five years after enactment (i.e.,
December 29, 2027).
Section 1432. Research on the Health and Development Effects of Media and
Related Technology on Infants, Children, and Adolescents
Section 1432 requires the Secretary to conduct or support research related to the health and
developmental effects of specified media and technology use on infant, children, and adolescents.
The provision requires the Secretary, acting through Director of the National Institutes of Health
(NIH), to develop a research agenda assessing the effects of media and technology use on the
cognitive development, physical health, and mental health of infants, children, and adolescents.
The provision requires the NIH Director to submit a report to specific congressional committees
no later than two years after enactment (i.e., December 29, 2024) on the progress made on this
research program and a summary of research projects funded under this section.
Subtitle E—Miscellaneous Provisions
Section 1501. Limitations on Authority
Section 1501 prohibits the Secretary from allocating funding to any program authorized or
amended by the Restoring Hope for Mental Health and Well-Being Act without considering the
incidence, prevalence, or determinants of behavioral health issues (unless otherwise required by
law).
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Appendix. Abbreviations Used in This Report
Abbreviation
Definition
ACA
Patient Protection and Affordable Care Act (P.L. 111-148)
ACT
Assertive Community Treatment
AOT
Assisted Outpatient Treatment
ASPE
Assistant Secretary for Planning and Evaluation
BHWET
Behavioral Health Workforce Education and Training
CAA
Consolidated Appropriations Act
CARA
Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-198)
CBAs
Col ective Bargaining Agreements
CCBHC
Certified Community Behavioral Health Clinic
CCIIO
Center for Consumer Information & Insurance Oversight
CDC
Centers for Disease Control and Prevention
C.F.R.
Code of Federal Regulations
CMS
Centers for Medicare & Medicaid Services
COVID-19
Coronavirus Disease 2019
CSA
Control ed Substances Act
Cures Act
21st Century Cures Act of 2016 (P.L. 114-244)
DATA
Drug Addiction Treatment Act of 2000 (P.L. 106-310)
DEA
Drug Enforcement Administration
DOJ
U.S. Department of Justice
DOL
U.S. Department of Labor
ED
U.S. Department of Education
FDA
U.S. Food and Drug Administration
FQHC
Federally Qualified Health Centers
GAO
Government Accountability Office
GLS
Garrett Lee Smith
HHS
U.S. Department of Health and Human Services
HIPAA
Health Insurance Portability and Accountability Act (P.L. 104-191)
HRSA
Health Resources and Services Administration
HUD
U.S. Department of Housing and Urban Development
IHS
Indian Health Service
MHBG
Community Mental Health Services Block Grant
MHPAEA
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008 (P.L. 110-343 )
MH/SUD
Mental Health/Substance Use Disorder
MOUD
Medications for Opioid Use Disorder
M/S
Medical/Surgical
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Abbreviation
Definition
NASEM
National Academies of Sciences, Engineering, and Medicine
NCEED
National Center of Excellence for Eating Disorders
NIH
National Institutes of Health
NQTLs
Non-Quantitative Treatment Limitations
NTAC
National Threat Assessment Center
OTPs
Opioid Treatment Program
PATH
Projects for Assistance in Transition from Homelessness
PHSA
Public Health Service Act
PRNS
Programs of Regional and National Significance
SABG
Substance Use Prevention and Treatment Block Grant
SAMHSA
Substance Abuse and Mental Health Services Administration
SBIRT
Screening, Brief Intervention, and Referral to Treatment
SED
Serious Emotional Disturbance
SMI
Serious Mental Il ness
SOR
State Opioid Response
STOP Act
Sober Truth on Preventing Underage Drinking Act (P.L. 109-422)
SUD
Substance Use Disorders
SUPPORT Act
Substance Use Disorder Prevention that Promotes Opioid Recovery
and Treatment for Patients and Communities Act (P.L. 115-271)
SUPTRS
Substance Use Prevention, Treatment, and Recovery Services
ONDCP
Office of National Drug Control Policy
OUD
Opioid Use Disorder
U.S.C.
U.S. Code
VA
U.S. Department for Veterans Affairs
Source: CRS.

Author Information

Johnathan H. Duff

Analyst in Health Policy

Acknowledgments
Vanessa Forsberg, CRS Analyst in Health Policy, authored “Section 1321. Eliminating the Opt-Out for
Nonfederal Governmental Health Plans” and “Section 1331. Grants to Support Mental Health and
Substance Use Disorder Parity Implementation” in this report.
Congressional Research Service

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The Restoring Hope for Mental Health and Well-Being Act of 2022

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Congressional Research Service
R47910 · VERSION 2 · NEW
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Jan. 29, 2024

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Topic areas

Health Policy

Appropriations

Report Type: CRS Report

Source: CRSReports.Congress.gov

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