H.R. 2483 — SUPPORT for Patients and Communities Reauthorization Act of 2025

This section revises the authorization of appropriations for prenatal and postnatal health to $4,250,000 for each of fiscal years 2026 through 2030 (from such sums as may be necessary for fiscal years 2019 through 2023).

This section revises the overdose data-to-action grant program (i.e., competitive grants to state and local health departments, territories, and Indian Tribes to improve data collection, surveillance, and public health responses to drug overdoses) by (1) broadening statutory language throughout subsections (a)(2) and (b)(2) from references to "opioids" to "substances causing overdose," adding "associated risks" and "risk factors," expanding surveillance activities to "monitoring and identifying," and including "other emerging substances related" to analogues; and (2) expanding eligible activities under subsection (a)(3)(A) to include innovative, evidence-based projects to detect, identify, rapidly respond to controlled substance misuse, abuse, overdoses, and changes in usage patterns (e.g., using wastewater surveillance if it supports actionable prevention consistent with privacy laws). The section also authorizes appropriations of $505,579,000 for each of FY2026 through 2030 (from $496,000,000 for FY2019 through 2023).

This section revises Part O of title III of the Public Health Service Act (42 U.S.C. 280f et seq.) by replacing it with two new sections on fetal alcohol spectrum disorders (FASD), which are lifelong physical, behavioral, and cognitive effects resulting from prenatal alcohol exposure. Section 399H establishes a comprehensive FASD education, prevention, identification, intervention, and services delivery program. The Secretary of Health and Human Services must establish or continue activities that include (1) education and public awareness programs targeting health professionals, educators, service providers, school-age children, and communities; (2) research on FASD diagnostics and evidence-based interventions to prevent prenatal alcohol exposure; (3) building State and Tribal capacity through screening, training, and support services; and (4) applied research via service demonstration projects providing advocacy, education, vocational training, counseling, and integrated supports. The Secretary may award grants, cooperative agreements, or contracts to States, Indian Tribes or Tribal organizations, local governments, scientific or academic institutions, or nonprofits, which must submit applications potentially designating an FASD coordinator and establishing an advisory committee for a strategic plan. The section defines "FASD-informed" support or interventions as culturally and linguistically appropriate, evidence-based or practice-based programs improving quality of life for individuals with FASD and their families. Section 399I directs the Secretary to award grants, contracts, or cooperative agreements to public or nonprofit private entities with FASD expertise to build capacities for FASD prevention, including public education on alcohol risks during pregnancy, serving as a clearinghouse for evidence-based resources and best practices across the lifespan, and increasing awareness of evidence-based screening.

This section prohibits the Secretary from requiring states to use a specific vendor or interoperability connection under the prescription drug monitoring program (PDMP) grant program—i.e., grants to states to implement or enhance PDMPs that track controlled substance prescriptions—except to align with nationally recognized, consensus-based open standards (such as under PHSA sections 3001 and 3004). (Thus, states retain flexibility in selecting PDMP system vendors.)

This section revises the first responder training program—under which the Department of Health and Human Services (HHS) Secretary awards grants to state, local, and tribal public safety departments to train first responders (e.g., firefighters, emergency medical services personnel, and law enforcement) to administer overdose reversal drugs—by (1) expanding references to drugs or devices eligible for training from those "approved or cleared" by the Food and Drug Administration (FDA) to those "approved, cleared, or otherwise legally marketed" under the Federal Food, Drug, and Cosmetic Act; (2) broadening the program's scope from opioid overdoses to overdoses generally, including adding training related to "other drug" overdoses beyond opioids and heroin; and (3) increasing authorized funding to $57 million annually for FY2026 through FY2030 (from $36 million for FY2019 through FY2023).

This section redesignates part G of title V of the Public Health Service Act as part J (i.e., Donald J. Cohen National Child Traumatic Stress Initiative) and conforming sections 581 through 584 as sections 596 through 596C, respectively. It revises Section 582 (42 U.S.C. 290hh-1), including (1) changing the section heading from "Violence Related Stress" to "Traumatic Events"; (2) emphasizing dissemination activities in subsections (a) and (b); (3) requiring the NCTSI coordinating center and grantees to develop trainings and resources for evidence-based practices and to collaborate on dissemination, implementation, and evaluation under subsections (d) and (e); (4) strengthening grant application requirements for process/outcomes evaluations and support for Secretary-led assessments under subsection (h); and (5) authorizing appropriations of $98,887,000 for FY2026 through FY2028 and $100,000,000 for FY2029 and FY2030. (As background, NCTSI funds a network of centers to develop, deliver, and disseminate trauma-focused treatments and services for children and families affected by traumatic events.)

This section amends the National Suicide Prevention Lifeline program (i.e., 9-8-8, operated through a network of local and regional crisis centers) to (1) require the program to take steps necessary to protect the suicide prevention hotline from cybersecurity incidents and eliminate known cybersecurity vulnerabilities; and (2) establish reporting requirements under which the program's federally funded network administrator notifies the Assistant Secretary for Mental Health and Substance Use of identified cybersecurity vulnerabilities and incidents within a reasonable amount of time after identification (with local and regional crisis centers reporting such matters to the network administrator, which then notifies the Assistant Secretary), clarifies oversight responsibilities for program technology, and specifies that these requirements supplement (and do not supplant) other applicable federal cybersecurity reporting laws. This section further directs the Comptroller General of the United States to evaluate cybersecurity risks and vulnerabilities associated with the 9-8-8 lifeline and submit a report on the findings to the Senate Committee on Health, Education, Labor, and Pensions and the House Committee on Energy and Commerce within 180 days of enactment.

This section increases the authorization of appropriations for CDC data collection on adverse childhood experiences to $9 million for each of FY2026 through 2030 (from $2 million for FY2019 through 2023).

This section amends the SUPPORT for Patients and Communities Act (2018) to expand authorized activities under youth substance use disorder prevention and recovery grants—provided to support comprehensive opioid recovery programs for youth, including high school or equivalent educational supports—to include strategies increasing education and awareness of the potency and dangers of synthetic opioids (including drugs contaminated with fentanyl) and, as appropriate, emerging drug use or misuse issues. The section further revises the Interdepartmental Substance Use Disorders Coordinating Committee—which coordinates federal efforts on substance use disorders across agencies—by (1) authorizing working groups and requiring establishment of a Federal Interagency Work Group on Fentanyl Contamination of Illegal Drugs composed of relevant federal representatives that consults with state, tribal, and local experts on fentanyl overdoses and family members of overdose victims (both adult and youth); examines federal efforts to reduce and prevent overdoses from fentanyl-contaminated illicit drugs; identifies strategies to improve state, tribal, and local responses; coordinates public awareness activities on synthetic opioids and emerging issues; makes recommendations to Congress on improving and coordinating federal programs and on educating youth about fentanyl-contaminated drugs; and submits annual reports to the Secretary and specified congressional committees containing such recommendations; and (2) extends the committee's sunset to September 30, 2030.

This section directs the Secretary of Health and Human Services (HHS), in consultation with the Drug Enforcement Administration (DEA) Administrator, to publish guidance within one year of enactment to facilitate the use of at-home safe disposal systems for applicable drugs. The guidance must include (1) recommended standards for effective at-home drug disposal systems to meet Food and Drug Administration (FDA) requirements, (2) recommended instructions for use to disseminate with such systems, (3) best practices and educational tools to support their use, and (4) recommendations for using licensed health providers to disseminate education, instructions, and systems.

This section directs the Secretary of Health and Human Services, acting through the FDA, to publish a report on the FDA website not later than one year after enactment outlining a plan to assess opioid analgesic drugs approved under the new drug application process, incorporating public health effects into benefit-risk assessments and FDA activities to facilitate nonaddictive pain or addiction treatments. The report must include (1) an update on FDA actions considering the effectiveness, safety, benefit-risk profile, and use of such drugs; (2) a timeline for assessing potential needs for labeling changes, revised or additional postmarketing requirements, enforcement actions, or withdrawals; (3) an overview of FDA steps taken and planned to support development and approval of nonaddictive pain or addiction products; and (4) FDA consideration of clinical trial methodologies for analgesics—including enriched enrollment randomized withdrawal—along with their benefits and drawbacks, incorporating public input on opioid regulation solicited under subsection (b).

This section expands allowable activities under the State and Tribal Opioid Response grant program (42 U.S.C. 290ee-3a) to include facilitating access to products that detect substances such as fentanyl or xylazine (e.g., test strips) to prevent overdose deaths, to the extent consistent with federal and state law. (The program provides grants to states, localities, Indian tribes, and tribal organizations to address opioid use disorders, including by increasing access to approved opioid overdose reversal drugs and devices.)

This section amends the Residential Treatment Program for Pregnant and Postpartum Women (i.e., grants to public and nonprofit private entities for residential substance use disorder treatment services for pregnant and postpartum women) as follows: (1) replaces "providing health services" with "providing health care services" in grant eligibility criteria under subsection (d)(11)(C); (2) revises application requirements under subsection (g) by inserting "a plan describing" after "will provide" and adding that such plan may include a description of targeted outreach to women disproportionately impacted by maternal substance use disorder; and (3) increases authorized funding to $38,931,000 for FY2026 through 2030 (from $29,931,000 for FY2019 through 2023).

This section modifies the Minority Fellowship Program by (1) expanding the purposes of fellowships to increase practitioners' knowledge of issues related to diagnosis, prevention, treatment, and recovery support (adding diagnosis) for racial and ethnic minority populations with mental or substance use disorders; and (2) adding addiction medicine to the list of covered postbaccalaureate training fields (i.e., after psychiatry, before nursing, social work, psychology, marriage and family therapy, mental health counseling, and substance use disorder and addiction counseling). (As background, the program awards fellowships, which may include stipends, to develop culturally competent professionals who teach, administer services, conduct research, or provide direct services to such populations.)

This section increases the authorization of appropriations for the loan repayment program for substance use disorder treatment workforce—which provides payments of up to $250,000 toward principal and interest on eligible loans for individuals serving full-time in such employment in designated shortage areas—to $40 million for each of FY2026 through 2030 (from $25 million for each of FY2019 through 2023).

This section revises the Task Force on Best Practices for Trauma-Informed Identification, Referral, and Support under the SUPPORT for Patients and Communities Act—(1) by adding the Administration for Community Living to task force membership; (2) by including developmental disability service providers among the entities for which the task force must develop best practices; and (3) by extending the task force through 2030 (from 2023). (As background, the task force develops recommendations for federal, state, and local entities to improve trauma-informed care for individuals with substance use disorders who have histories of trauma.)

This section modifies Section 3203 of the SUPPORT for Patients and Communities Act by (1) striking subsection (b); and (2) striking “(a) In general.—The Secretary” and inserting “The Secretary”.

This section directs the Secretary of Health and Human Services (HHS), acting through the Assistant Secretary for Mental Health and Substance Use, to review—not later than one year after enactment of this Act—states' use of funds from the Community Mental Health Services Block Grant program (i.e., formula grants to states for community mental health services targeting adults with serious mental illness and children with serious emotional disturbance) for first episode psychosis activities, including adherence to evidence-based treatment standards of care, percentages of such funding expended on early serious mental illness and first episode psychosis, and numbers of individuals served. Not later than 180 days after completing the review, HHS must submit a report to the Senate Committees on Health, Education, Labor, and Pensions and Appropriations and the House Committees on Energy and Commerce and Appropriations describing the review findings and recommendations to improve block grant outcomes for those populations. Not later than one year after submitting the report, HHS must update guidance to states on coordinated specialty care and other evidence-based mental health services for individuals with serious mental illness and children with serious emotional disturbance.

This section directs the Secretary of Health and Human Services (HHS), consistent with the procedures in ss. 201 and 202 of the Controlled Substances Act (CSA), to review data on the scheduling of products containing a combination of buprenorphine and naloxone that have been approved as new drugs under the Federal Food, Drug, and Cosmetic Act (FDCA). If appropriate, the Secretary is to request that the Attorney General initiate CSA rulemaking to revise such schedules, and the Attorney General is to review any such request and determine whether to initiate proceedings.

This section directs the Secretary of Health and Human Services to ensure that future regulations and guidance for any HHS grant program addressing opioid misuse and use disorders use references to opioid overdose reversal drugs (such as naloxone) that include all such drugs approved under section 505 of the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdoses. Not later than one year after enactment, the Secretary must update existing pre-enactment references in regulations and guidance for (1) the State Opioid Response Grants and Tribal Opioid Response Grants programs under section 1003 of the 21st Century Cures Act and (2) the priority substance use disorder prevention needs of regional and national significance grant program under section 516 of the Public Health Service Act.

This section directs the National Coordinator for Health Information Technology to convene, not later than 180 days after the date of enactment, a public roundtable with public- and private-sector stakeholders—including patients, inpatient and outpatient providers, payors, health information exchanges, professional associations, health information technology vendors, certification organizations, and state and federal agencies—to examine how expanded electronic health record (EHR) use by mental health and substance use disorder providers can improve patient outcomes and how best to increase EHR adoption among such providers. Not later than 180 days after the roundtable, the Coordinator must submit to the Senate Committee on Health, Education, Labor, and Pensions and the House Committee on Energy and Commerce a report on roundtable information, including recommendations; unique considerations for EHRs and certification in these settings; current EHR usage by such providers; examples of coordinated care; connectivity to systems such as the 988 Suicide and Crisis Lifeline; existing adoption programs and limitations; adoption costs; and state and other best practices.

This section reauthorizes and increases appropriations for the Building Communities of Recovery program to $17 million for each of fiscal years 2026 through 2030 (from $5 million for each of fiscal years 2019 through 2023). The program provides grants to states, localities, and nonprofit recovery community organizations to develop and sustain peer recovery support networks for individuals and families affected by substance use disorders.

This section revises the Peer Support Technical Assistance Center, which provides training and technical assistance to support the integration of peer recovery specialists (i.e., individuals with lived experience of substance use disorder recovery) into substance use disorder treatment and recovery services, by (1) expanding authorized activities under subsection (b)(4) to expressly include professional development for peer support specialists and provision of recovery support services in nonclinical settings; (2) authorizing the Secretary to establish, using existing resources, one regional technical assistance center to support center activities tailored to regional needs, requiring an evaluation report to Congress four years after enactment of the SUPPORT for Patients and Communities Reauthorization Act of 2025, with the provision terminating on September 30, 2030; and (3) increasing annual appropriations to $2 million for FY2026 through 2030 (from $1 million for FY2019 through 2023).

This section modifies application and reporting requirements for grants to establish and operate comprehensive opioid recovery centers—which provide integrated outpatient treatment for opioid use disorder, including medication-assisted therapies, counseling, peer recovery support, and care coordination—and extends the authorization of appropriations through 2030 (from 2023). (1) In subsection (d)(2), revises grant application requirements to specify that applications must be in such manner and contain such information and assurances, including relevant documentation (previously, in such manner); and requires applicants to demonstrate capability to carry out required activities through referral or contractual arrangements (previously, capable of coordinating with other entities). (2) In subsection (h), restructures existing reporting requirements as paragraph (1) and adds paragraph (2) requiring entities using referral or contractual arrangements to report on the status of such arrangements, including an assessment of whether they support the entity's ability to carry out activities under subsection (g). (3) In subsection (j), extends the authorization of appropriations from 2019 through 2023 to 2026 through 2030.

This section revises the youth prevention and recovery grant program (i.e., grants to local educational agencies, Indian Tribes, and others to prevent substance misuse and promote recovery among youth at increased risk) as follows: (1) in the definitions, expands eligibility to include a consortium of local educational agencies (in addition to a single agency), replaces "high schools" with "secondary schools," defines "secondary school" by reference to the Elementary and Secondary Education Act of 1965, defines "Indian Tribe" and "Tribal organization" by reference to the Indian Self-Determination and Education Assistance Act, and makes conforming capitalization changes for "Tribe" and "Tribal"; (2) replaces references to "abuse" with "misuse" or omits them and specifies targeting "specific populations at increased risk for substance misuse"; (3) replaces "peer mentoring" with "peer-to-peer support"; (4) requires grant applications to include a plan to sustain activities after the grant ends; (5) extends the program authorization through 2028 (from 2022); and (6) authorizes appropriations of $10 million for FY2026, $12 million for FY2027, $13 million for FY2028, $14 million for FY2029, and $15 million for FY2030.

This section reauthorizes the CAREER Act grants program (i.e., grants to promote employment, education, reentry, treatment, and recovery services for individuals with substance use disorder histories) at $12 million annually for FY2026 through 2030 (from $5 million for FY2019 through 2023) and makes related changes, including (1) updating state eligibility criteria to the highest age-adjusted average drug overdose death rates, highest average unemployment rates, and lowest average labor force participation rates for calendar years 2018 through 2022 (from prior years); (2) authorizing grantees to use up to 5% of funds for transportation to work, vocational education, job training, or substance use disorder treatment/recovery services; (3) prohibiting the Secretary of HHS from requiring or prioritizing unspecified activities; and (4) requiring grantee performance reports to include specified Workforce Innovation and Opportunity Act (WIOA) measures—the percentage of participants in unsubsidized employment during the second quarter after program exit and median earnings of those participants. The section also reauthorizes the Recovery Housing Pilot Program through 2030 (from 2023), updates its state selection criteria to 2018-2022 data, and makes conforming and clerical amendments to headings and the table of contents.

This section directs the Secretary of Health and Human Services, not later than one year after enactment, to convene a public meeting to improve awareness of and access to funding opportunities under programs administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). The meeting must address (1) improving websites such as Grants.gov that provide SAMHSA funding information, (2) alternative dissemination models such as interactive dashboards, and (3) strategies to enhance application ability for all entities, including non-traditional applicants. The section further requires the Secretary to implement feasible improvements to Grants.gov based on stakeholder feedback and, not later than one year after the meeting, to submit a report to the Senate Committee on Health, Education, Labor, and Pensions and the House Committee on Energy and Commerce summarizing the meeting findings and related implementation actions.

This section revises conditions in the Controlled Substances Act (CSA) under which a pharmacy may deliver a schedule III, IV, or V controlled substance directly to a prescribing practitioner (rather than the patient). The revision limits such delivery to instances where (1) the drug is to be administered by injection or implantation for maintenance or detoxification treatment or (2) the drug is subject to a risk evaluation and mitigation strategy (REMS) under the Federal Food, Drug, and Cosmetic Act that includes elements to assure safe use requiring post-administration monitoring by a health care provider.

This section expands the list of organizations and accrediting bodies whose training programs qualify practitioners for a waiver from mandatory DEA registration training requirements on pain management and safe pharmacological management of opioid use disorder (i.e., 8 hours of training otherwise required for prescribers of controlled substances in Schedules II through V). Specifically, it adds the American Academy of Family Physicians, American Podiatric Medical Association, Academy of General Dentistry, American Optometric Association, Council on Podiatric Medical Education, American Pharmacists Association, Accreditation Council on Pharmacy Education, American Psychiatric Nurses Association, and American Academy of Nursing to the list of approved providers; explicitly includes podiatric medicine curricula alongside osteopathic medicine, dental surgery, and dental medicine curricula; and recognizes accredited schools of pharmacy. The amendments take effect as if enacted on December 29, 2022.