1. Short title This Act may be cited as the Opioid Settlement Accountability Act . 2. Prohibition on treating any Medicaid-related funds recovered from one or more pharmaceutical companies or drug distributors with respect to opioid litigation as an overpayment (a) In general Section 1903(d)(3) of the Social Security Act ( 42 U.S.C. 1396(d)(3) ) is amended by adding at the end the following new subparagraph: (C) (i) Subparagraph (A) and paragraph (2)(B) may not apply to any amount recovered or paid to a State on or after December 31, 2025, as a part of a comprehensive settlement of opioid litigation between pharmaceutical manufacturers (as defined in the second sentence of section 102(15) of the Controlled Substances Act) or drug distributors (as defined in the second sentence of section 102(12) of such Act) and State attorneys general, or as a part of any individual State settlement or judgement reached in such litigation initiated or pursued by a State against one or more such companies or distributors. (ii) A State shall use amounts recovered or paid to the State as a part of comprehensive or individual settlement, or a judgement, described in clause (i) for— (I) supporting access to treatment (including medication assisted treatment) and health care services (including services provided by federally certified opioid treatment programs or other appropriate health care providers to treat individuals with opioid use disorder and subsequent support and wrap around services that encourage employment and reintegration to society); (II) education related to opioid use disorder; (III) implementing prevention activities, including the reduction of the furnishing of opioids by health care practitioners and introduction of non-opioid pain management approaches