S 665119th CongressIn Committee

Fatal Overdose Reduction Act of 2025

Introduced: Feb 20, 2025

Standard Summary

Comprehensive overview in 1-2 paragraphs

The Fatal Overdose Reduction Act of 2025 would add a new Health Engagement Hub Demonstration Program to Medicaid (Title XIX) to expand access to treatment for opioid use disorder and other substance use disorders. The program creates certified Health Engagement Hubs that operate in communities with high overdose impacts or where access to behavioral health services is limited. States would select up to 10 for a 5-year demonstration, funded by planning grants and federal support, with a special payment system (a prospective payment system) to reimburse these hubs for certain services. The bill emphasizes drop-in, low-barrier access, evidence-based treatment, harm reduction, co-located social services, transportation, and strong staff with lived experience. It also requires robust data collection, reporting, and national evaluation to determine reach, effectiveness, and any need to continue or expand the program. The aim is to reduce overdose deaths and improve overall outcomes for people with OUD/SUD, including increased engagement in care, better housing and social supports, and enhanced access to medications and other services.

Key Points

1Establishment of Health Engagement Hub Demonstration Program under Medicaid to increase access to treatment for opioid use disorder and other substance use disorders, via certified Health Engagement Hubs that meet criteria set by the Secretary of Health and Human Services.
2Certification criteria for hubs, including:
3- Ability to serve Medicaid-eligible individuals and uninsured people, offering walk-in, person-centered care.
4- Use of evidence-based engagement and treatment models; access to overdose reversal tools (e.g., naloxone) and safer-use supplies; trauma-informed care; and access within 4 hours to medications approved for OUD/SUD treatment or other evidence-based options through partnerships.
5- Targeted location choices in overdose-prone or underserved areas (rural, tribal, urban with limited behavioral health infrastructure, homelessness, or areas affected by the criminal-legal system).
6- Minimum staffing requirements (licensed clinician, nurse, behavioral health clinician, peer support/recovery coach, and outreach/navigation staff; at least half of outreach staff with lived experience; ability to contract with partner agencies if needed).
7- Community advisory board with members who have lived experience, meeting monthly and providing quarterly feedback to leadership.
8- Sliding-scale fees for uninsured individuals to ensure no one is denied services due to inability to pay.
9Scope of items and services under the program, including:
10- Harm reduction services and supplies; walk-in primary mental health and SUD services; shared decision-making; wound care; infectious disease services; reproductive health services; safe storage for medications for people who are homeless; medication management; targeted case management; peer supports; outreach and care navigation.
11- Prescribed drugs and other covered outpatient drugs for which Medicaid is available, paid separately from the prospective payment system, with rules about when PPS applies and when separate payments can be used.
12Planning and implementation funding, state participation, and administration:
13- $60 million appropriated for planning grants, technical assistance, and related administrative costs, available until expended.
14- States awarded planning grants must apply to participate; up to 10 States will be selected to implement the demonstration for 5 years.
15- Waivers of certain Medicaid requirements (e.g., statewideness, comparability) may be granted to facilitate participation.
16- Payment to states: for each quarter, the state receives 90% of the amount expended for items and services delivered by certified Health Engagement Hubs at the rate set by the state’s PPS, with rules to prevent duplicate PPS payments.
17State applications and selection criteria:
18- States must describe target populations, ensure at least 50% of hubs are in high-overdose or health-professional-shortage areas, outline the PPS model, list participating hubs, verify hub certifications, and provide other required information.
19- Selection prioritizes states with high overdose death rates and geographic diversity.
20Reporting and evaluation:
21- States must report on implementation in years 1-2 and provide annual reports starting in year 3, including metrics on access, overdose mortality, medication adherence, hospitalizations, housing, and demographics, plus successes and improvement recommendations.
22- A national implementation evaluation will be conducted by an eligible entity, examining reach, effectiveness, adoption, and implementation, with results reported to Congress and publicly available.
23- The Government Accountability Office (GAO) will produce an additional performance assessment 18 months after the initial state reports and national evaluation findings.

Impact Areas

Primary group/area affected- Medicaid-eligible individuals with opioid use disorder or other substance use disorders, including uninsured individuals served by Health Engagement Hubs, across participating states.- Communities with high overdose death rates or limited behavioral health infrastructure (rural areas, tribal lands, urban centers with gaps in care, areas with homelessness, and communities affected by the criminal-legal system).Secondary group/area affected- States implementing the demonstration (up to 10), Medicaid programs, and partner providers working with Health Engagement Hubs (including Federally Qualified Health Centers via contracts).Additional impacts- Potential shifts in how Medicaid pays for SUD services, with PPS payments to hubs and separate drug payments; possible administrative complexity to coordinate multiple payment streams and ensure no duplicate payments.- Emphasis on trauma-informed, person-centered care and inclusion of social determinants of health services (e.g., employment counseling, identification assistance, family reunification, legal services), which could broaden the scope of services beyond medical treatment.- Increased data collection and evaluation activity to track outcomes, equity, and program effectiveness, informing future policy decisions about scaling or altering the model.

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