S. 2121 — SUPPORT for Patients and Communities Reauthorization Act of 2025

This section authorizes appropriations of $4,250,000 for prenatal and postnatal health programs for each of FY2026 through 2030 (previously, such sums as may be necessary for FY2019 through 2023). (The programs provide grants to eligible entities for projects to improve maternal health outcomes, including home visitation services for at-risk pregnant women and mothers of young children.)

This section revises the Overdose Data to Action grant program (i.e., CDC grants to states, localities, and Indian tribes for surveillance and prevention of drug overdose morbidity and mortality) by (1) broadening statutory language in subsections (a)(2) and (b)(2) from opioids to substances causing overdose and adding references to associated risks and risk factors; (2) expanding subsection (a)(3)(A) to authorize innovative projects detecting, identifying, and responding to controlled substance misuse, abuse, overdoses, and changes in use patterns—including evidence-based strategies such as wastewater surveillance if proven to support prevention and compliant with privacy laws; and (3) authorizing 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 new sections 399H and 399I to address fetal alcohol spectrum disorders (FASD), a range of lifelong physical, behavioral, and cognitive impairments caused by prenatal alcohol exposure. Section 399H establishes a comprehensive FASD prevention, intervention, and services delivery program requiring the Secretary of Health and Human Services to support or conduct activities including (1) education and public awareness programs for professionals, youth, communities, and service coordination across sectors such as health, education, foster care, and justice; (2) research on diagnostics and evidence-based interventions to prevent prenatal alcohol exposure (potentially with other substances); (3) state and tribal capacity-building through program adaptation, screening expansion, interventions, training, and information dissemination; and (4) applied research via service demonstration projects integrating advocacy, education, vocational training, counseling, and health services. The Secretary may award grants, cooperative agreements, contracts, and technical assistance to eligible entities (i.e., states, Indian Tribes or Tribal organizations, local governments, scientific or academic institutions, or nonprofits) that submit applications potentially designating an FASD coordinator and establishing an advisory committee for strategic planning; it defines "FASD-informed" support or interventions as culturally and linguistically appropriate evidence- or practice-based approaches improving quality of life for affected individuals and families. Section 399I directs the Secretary to award grants, contracts, or cooperative agreements to public or nonprofit private entities with FASD expertise to build local, tribal, state, and national capacities for FASD prevention through (1) public education and outreach on alcohol risks during pregnancy, (2) serving as a clearinghouse for evidence-based resources on prevention, identification, and best practices across the lifespan, and (3) increasing awareness of evidence-based screening tools and culturally and linguistically appropriate practices.

This section clarifies that nothing in the Prescription Drug Monitoring Program (PDMP) grant provisions authorizes the Secretary to require states to use a specific vendor or interoperability connection, other than alignment with nationally recognized, consensus-based open standards (e.g., as specified in PHSA sections 3001 and 3004). (Thus, this promotes state choice in selecting PDMP systems.)

This section modifies the first responder training program—which provides competitive grants to state, local, and tribal public safety departments for training law enforcement, fire department, and emergency medical services personnel to safely administer FDA-approved, cleared, or legally marketed drugs or devices for emergency treatment of overdoses—by (1) expanding references throughout from "approved or cleared" to "approved, cleared, or otherwise legally marketed" under the Federal Food, Drug, and Cosmetic Act; (2) removing the opioid-specific limitation in multiple subsections; (3) in the training content requirements, broadening references from "opioid and heroin" to "opioid, heroin, and other drug" and from "opioid overdose" to "overdose"; and (4) increasing authorized funding to $57 million for each of FY2026 through FY2030 (from $36 million for FY2019 through FY2023).

This section redesignates part G of title V of the Public Health Service Act—pertaining to the National Child Traumatic Stress Initiative (NCTSI), which supports a network of centers to develop, disseminate, and implement evidence-based treatments for children and families affected by trauma—as part J and redesignates sections 581 through 584 as sections 596 through 596C, respectively. The section further revises section 582 by (1) updating its heading to refer to traumatic events (from violence-related stress); (2) inserting references to dissemination after development in subsections (a)(2) and (b) and to implementation after dissemination in subsection (e)(1)(A), as redesignated; (3) requiring the NCTSI coordinating center to oversee such activities and NCTSI grantees to develop trainings and resources for evidence-based practices and collaborate with the center and Secretary, per new subsections (d)(2) and (e)(2); (4) requiring grant applications to include process and outcomes evaluation plans and commitments to support Secretary- or center-led evaluations, per amended subsection (h); and (5) authorizing appropriations of $98,887,000 for FY2026, FY2027, and FY2028 and $100,000,000 for FY2029 and FY2030, per amended subsection (j).

This section amends the duties of the National Suicide Prevention Lifeline (988) program to require taking necessary steps to protect the suicide prevention hotline from cybersecurity incidents and eliminate known cybersecurity vulnerabilities. It further establishes cybersecurity reporting requirements whereby the program's federally funded network administrator must notify the Assistant Secretary for Mental Health and Substance Use of identified vulnerabilities or incidents within a reasonable time, with local and regional crisis centers reporting such matters to the network administrator (which in turn notifies the Assistant Secretary); requires crisis centers to oversee their own program-related technology (unless oversight is assigned to the network administrator via participation agreement); and clarifies that these requirements supplement (and do not supplant) other applicable federal cybersecurity reporting laws. Additionally, this section directs the Comptroller General of the United States to evaluate cybersecurity risks and vulnerabilities associated with the 988 Lifeline and submit a report to the Senate Committee on Health, Education, Labor, and Pensions and the House Committee on Energy and Commerce not later than 180 days after enactment of this Act.

This section revises the authorization of appropriations for CDC data collection and reporting on adverse childhood experiences (i.e., traumatic events such as abuse or household dysfunction that can lead to long-term health risks) to $9 million annually for FY2026 through 2030 (from $2 million annually for FY2019 through 2023).

This section amends the SUPPORT for Patients and Communities Act as follows: (1) expands authorized strategies under grants for opioid use disorder prevention, recovery, and treatment services for children and adolescents (42 U.S.C. 290bb–7a(c)) to include 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; and (2) for the Interdepartmental Substance Use Disorders Coordinating Committee (42 U.S.C. 290aa note), (A) requires establishment of a Federal Interagency Work Group on Fentanyl Contamination of Illegal Drugs, composed of federal agency representatives, to consult with state, Tribal, and local experts and family members of overdose victims; examine federal efforts and strategies to improve responses to fentanyl-contaminated illicit drug overdoses; coordinate public awareness activities; make recommendations to Congress on federal programs and youth education; and submit annual reports to the Secretary and specified congressional committees; and (B) extends the Committee's sunset to September 30, 2030.

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

This section directs the Secretary of Health and Human Services, not later than one year after enactment, to publish on the FDA website a report outlining a plan for assessing opioid analgesic drugs approved under the new drug application process (21 U.S.C. 355). The report must address public health effects of such drugs as part of the FDA's benefit-risk assessment and FDA activities facilitating development of nonaddictive medical products to treat pain or addiction, and must include (1) an update on FDA actions considering the effectiveness, safety, benefit-risk profile, and use of approved opioid analgesics; (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 treatments; and (4) an overview of FDA consideration of clinical trial methodologies for analgesics—including enriched enrollment randomized withdrawal—along with benefits, drawbacks, and public input. The section further requires the Secretary to provide an opportunity for public input on FDA regulation of opioid analgesics, including scientific evidence related to conditions of use, safety, or benefit-risk assessment (incorporating public health effects).

This section expands permissible activities under the grant program for State and Tribal response to opioid use disorders to include facilitating access to products—such as fentanyl and xylazine test strips—that detect the presence of substances to prevent overdose deaths, to the extent the purchase and possession of such products is consistent with federal and state law. (The program provides grants to states, localities, Indian tribes, and tribal organizations for opioid response strategies, including increasing access to overdose reversal medications such as naloxone.)

This section revises the residential treatment program for pregnant and postpartum women, which provides grants to expand or develop residential substance use disorder treatment for such women (including their children), by (1) replacing "health services" with "health care services" in subsection (d)(11)(C); (2) in subsection (g), inserting a requirement for "a plan describing" services to be provided and authorizing applicants to describe targeted outreach to women disproportionately impacted by maternal substance use disorder; and (3) increasing the authorization of appropriations to $38,931,000 for each of FY2026 through 2030 (from $29,931,000 for FY2019 through 2023).

This section modifies the Minority Fellowship Program (i.e., a program awarding fellowships, which may include stipends, to increase culturally competent mental and substance use disorder professionals serving racial and ethnic minority populations) by (1) inserting "diagnosis" in subsection (a)(1), to expand practitioner training on issues related to diagnosis, prevention, treatment, and recovery support (from prevention, treatment, and recovery support); and (2) inserting "addiction medicine" in subsection (b), to expand covered postbaccalaureate training fields to include psychiatry, addiction medicine, nursing, social work, psychology, marriage and family therapy, mental health counseling, and substance use disorder and addiction counseling (from the prior fields excluding addiction medicine).

This section increases the authorization of appropriations for the Loan Repayment Program for Substance Use Disorder Treatment Workforce to $40 million for each of FY2026 through 2030 (from $25 million for each of FY2019 through 2023). The program repays up to $250,000 in principal and interest on eligible loans (e.g., federal student loans) for individuals committing to at least six years of full-time employment in substance use disorder treatment in mental health professional shortage areas or high drug overdose death rate counties.

This section modifies the task force on best practices for trauma-informed identification, referral, and support (established under the SUPPORT for Patients and Communities Act) by (1) adding the Administration for Community Living as a member, (2) requiring consultation with developmental disability service providers, and (3) extending the task force through 2030 (from 2023).

This section strikes subsection (b) of Section 3203 of the SUPPORT for Patients and Communities Act (i.e., grants to enhance access to substance use disorder treatment).

This section directs the Secretary of Health and Human Services (HHS), acting through the Assistant Secretary for Mental Health and Substance Use, to conduct a review, not later than one year after enactment, of states' use of funds from the Community Mental Health Services Block Grant program (i.e., formula grants to states for community mental health services for adults with serious mental illnesses and children with serious emotional disturbances) for first episode psychosis activities. The review must assess states' provision of evidence-based treatments and services per standards of care for early serious mental illness and children's serious emotional disturbance, as well as percentages of block grant funds spent on these purposes and the number 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 findings and recommending changes to the block grant program to improve outcomes. Not later than one year after submitting the report, HHS must update guidance to states on coordinated specialty care and other evidence-based services for individuals with serious mental illness and children with serious emotional disturbance, based on the report's findings and recommendations.

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

This section increases the authorization of appropriations for Building Communities of Recovery grants to $17 million for each of FY2026 through FY2030 (from $5 million for each of FY2019 through FY2023). (As background, the program provides grants to support community-based recovery hubs offering peer-to-peer services, education, and other assistance to promote long-term recovery from substance use disorders.)

This section revises the Peer Support Technical Assistance Center, which provides training and technical assistance to states and providers on peer recovery support services for substance use disorder treatment, by (1) expanding authorized activities to include, as examples, professional development for peer support specialists and making recovery support services available in nonclinical settings; (2) authorizing the Secretary to establish, using existing resources, one regional technical assistance center to support the Center's activities in a manner 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 regional center terminating on September 30, 2030; and (3) increasing authorized funding to $2 million for each of FY2026 through FY2030 (from $1 million for each of FY2019 through FY2023).

This section revises grant requirements and reporting for comprehensive opioid recovery centers (i.e., eligible entities providing integrated medication-assisted treatment, counseling, recovery housing, and other services for opioid use disorder) and reauthorizes appropriations through 2030 (from 2019 through 2023). Specifically, it (1) requires grant applications under subsection (d)(2) to include specified information, assurances, and documentation and revises eligibility criteria in subparagraph (A) to require demonstrated capability to carry out activities through referral or contractual arrangements (from capability to coordinate with other entities); and (2) restructures subsection (h) as a numbered paragraph and adds paragraph (2) requiring entities using such referrals or arrangements to report on their status and effectiveness in supporting program activities.

This section revises the youth prevention and recovery grant program—awarding competitive grants to local educational agencies (including consortia), Indian Tribes, health care providers, and others to prevent youth suicide and address substance misuse among at-risk youth—under Section 7102(c) of the SUPPORT for Patients and Communities Act, as follows: (1) expanding eligible grantees and activities to include consortia of local educational agencies and secondary schools (previously high schools); (2) striking references to "abuse" and inserting references to substance misuse and peer-to-peer support (previously peer mentoring); (3) requiring grantees to develop a plan to sustain activities after the grant ends; (4) extending the program through 2028 (from 2022); and (5) authorizing 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 revises the CAREER Act grant program (42 U.S.C. 290ee–8), which provides competitive grants to states and localities in areas with high drug overdose deaths, unemployment, and low labor force participation to deliver substance use disorder (SUD) treatment, recovery, and workforce services, as follows: (1) updates grant eligibility criteria in subsections (c) and related provisions to use average rates for calendar years 2018 through 2022 (from prior years such as 2013 through 2017) for age-adjusted drug overdose deaths (CDC data), unemployment, and labor force participation (BLS data); (2) authorizes grantees to use up to 5% of funds for transportation to work, vocational education or job training, or SUD treatment or recovery services and prohibits the Secretary from requiring or prioritizing unspecified activities; (3) requires performance reporting to include WIOA primary indicators of employment in the second quarter after program exit and median earnings in that quarter for grant participants with SUD; (4) sets the final report due date as September 30, 2030; and (5) increases authorization of appropriations to $12 million annually for FY2026 through 2030 (from $5 million for FY2019 through 2023). The section also reauthorizes the CAREER Act and Recovery Housing Pilot Program through 2030 (from 2023), applies the updated 2018-2022 eligibility criteria to the pilot program, and makes conforming and clerical amendments to headings and the table of contents.

This section revises paragraph (2) of section 309A(a) of the Controlled Substances Act (CSA) by limiting pharmacy delivery of schedule III, IV, or V controlled substances to prescribing practitioners to those drugs to be administered—(1) by injection or implantation for maintenance or detoxification treatment; or (2) subject to a risk evaluation and mitigation strategy (REMS) under section 505-1 of the Federal Food, Drug, and Cosmetic Act (FDCA) (21 U.S.C. 355-1) that includes elements to assure safe use described in subsection (f)(3)(E), including post-administration monitoring by a health care provider. (CSA section 309A authorizes pharmacies, including central fill pharmacies, to deliver controlled substances to prescribing practitioners for administration or dispensing to patients.)

This section revises the list of approved organizations and curricula for the training requirement that practitioners must satisfy for initial or renewal registration with the Drug Enforcement Administration (DEA) to prescribe controlled substances. Specifically, in subsection (m)(1), as redesignated from a second subsection (l), it (1) adds the American Academy of Family Physicians, American Podiatric Medical Association, Academy of General Dentistry, American Optometric Association, American Pharmacists Association, Accreditation Council on Pharmacy Education, American Psychiatric Nurses Association, and American Academy of Nursing to the list of recognized organizations in subparagraphs (A)(iv)(I) and (B)(i); (2) includes podiatric medicine curricula alongside osteopathic medicine, dental surgery, and dental medicine curricula in subparagraph (A)(v); and (3) makes conforming changes to references to the Commission on Dental Accreditation and Council on Podiatric Medical Education. The amendments apply as if enacted on December 29, 2022.