Opioid Settlement Accountability Act This bill establishes certain requirements with respect to the disposition of funds received by states from litigation against opioid manufacturers and distributors. Specifically, the bill requires states to use such funds to address opioid use, such as through (1) opioid prevention and treatment services, (2) health care practitioner training, (3) first responder equipment, and (4) social support services. Additionally, the bill prohibits the Centers for Medicare & Medicaid Services from considering such funds that are recovered or paid to a state on or after December 31, 2025, as an overpayment that reduces the state's payment, or that is subject to recoupment, under Medicaid. The bill applies retroactively.