[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 1180 Introduced in Senate (IS)]


104th CONGRESS
  1st Session
                                S. 1180

  To amend title XIX of the Public Health Service Act to provide for 
        health performance partnerships, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

               August 10 (legislative day, July 10), 1995

Mrs. Kassebaum introduced the following bill; which was read twice and 
         referred to the Committee on Labor and Human Resources

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Public Health Service Act to provide for 
        health performance partnerships, and for other purposes.
    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE, REFERENCES, AND TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``SAMHSA 
Reauthorization, Flexibility Enhancement, and Consolidation Act of 
1995''.
    (b) References in Act.--Except as otherwise expressly provided, 
whenever in this Act an amendment or repeal is expressed in terms of an 
amendment to, or repeal of, a section or other provision, the reference 
shall be considered to be made to a section or other provision of the 
Public Health Service Act (42 U.S.C. 201 et seq.).
    (c) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title, references, and table of contents.
                         TITLE I--MENTAL HEALTH

Sec. 101. Replacement of State plan program with performance 
                            partnerships.
Sec. 102. Review by planning council of State's report.
Sec. 103. State opportunity to correct or mitigate failure to maintain 
                            effort.
Sec. 104. Funding for organizations that are for-profit.
Sec. 105. Authorization of appropriation.
Sec. 106. Data collection, technical assistance, and evaluations.
Sec. 107. Projects for assistance in transition from homelessness.
Sec. 108. Priority mental health needs of regional and national 
                            significance.
Sec. 109. Repeals.
Sec. 110. Comprehensive community services for children with a serious 
                            emotional disturbance.
Sec. 111. Reauthorization of the Access Program.
                       TITLE II--SUBSTANCE ABUSE

Sec. 201. Replacement of State plan program with performance 
                            partnerships.
Sec. 202. Allocations regarding primary prevention and womens programs.
Sec. 203. Tuberculosis and HIV.
Sec. 204. Group homes for recovering substance abusers.
Sec. 205. State substance abuse prevention and treatment planning 
                            council.
Sec. 206. Additional agreements.
Sec. 207. State opportunity to correct or mitigate failure to maintain 
                            effort.
Sec. 208. Funding for organizations that are for-profit.
Sec. 209. Authorization of appropriations.
Sec. 210. Data collection, technical assistance, and evaluations.
Sec. 211. Priority substance abuse prevention and treatment needs of 
                            regional and national significance.
Sec. 212. Repeals.
                     TITLE III--GENERAL PROVISIONS

Sec. 301. Reporting by States on performance.
Sec. 302. On site performance reviews.
Sec. 303. Additional year for obligation by State.
Sec. 304. Definitions.
Sec. 305. Repeal of obsolete provisions concerning allocations.
Sec. 306. Repeal of obsolete addict referral provisions.
Sec. 307. Regulations.
Sec. 308. Advisory councils.
Sec. 309. Report on development of partnerships and use of grants.
 TITLE IV--REAUTHORIZATION OF PROTECTION AND ADVOCACY FOR MENTALLY ILL 
                        INDIVIDUALS ACT OF 1986

Sec. 401. Short title.
Sec. 402. Reauthorization.
Sec. 403. Allotment formula.
             TITLE V--REAUTHORIZATION OF CERTAIN INSTITUTES

Sec. 501. Reauthorization of certain Institutes.
          TITLE VI--TRANSITION PROVISIONS AND EFFECTIVE DATES

Sec. 601. Transition provisions and effective dates.
                         TITLE I--MENTAL HEALTH

SEC. 101. REPLACEMENT OF STATE PLAN PROGRAM WITH PERFORMANCE 
              PARTNERSHIPS.

    (a) Elimination of State Plan Program Requirements.--Subpart I of 
Part B of title XIX (42 U.S.C. 300x-1 et seq.) is amended by repealing 
sections 1911, 1912, and 1913.
    (b) Performance Partnership Framework.--Subpart I of Part B of 
title XIX (as amended by subsection (a) is further amended by inserting 
after the subpart heading the following new sections:

``SEC. 1911. PERFORMANCE PARTNERSHIP GOALS AND OBJECTIVES.

    ``(a) Goals.--
            ``(1) In general.--It is the goal of this subpart for the 
        States and the Federal Government, working together in a 
        partnership, to improve the quality of life of adults with a 
        serious mental illness and children with a serious emotional 
        disturbance, and to improve the overall mental health of United 
        States citizens, by--
                    ``(A) promoting access to comprehensive community 
                mental health services for adults with a serious mental 
                illness and children with a serious emotional 
                disturbance; and
                    ``(B) increasing the development of systems of 
                integrated comprehensive community based services for 
                adults with a serious mental illness and children with 
                a serious emotional disturbance.
            ``(2) Systems of integrated comprehensive community based 
        services.--As used in paragraph (1)(B), the term `systems of 
        integrated comprehensive community based services' means 
        integrated systems of care that would enable children and 
        adults to receive care appropriate for their multiple needs. 
        With respect to children, such integrated systems of care shall 
        ensure the provision, in a collaborative manner, of mental 
        health, substance abuse, education and special education, 
        juvenile justice, health, and child welfare services. With 
        respect to adults, such integrated systems of care shall ensure 
        the provision, in a collaborative manner, of mental health, 
        vocational rehabilitation, housing, criminal justice, health, 
        and substance abuse services.
    ``(b) Performance Partnership Objectives.--
            ``(1) Establishment.--Not later than October 1 of the 
        fiscal year prior to the fiscal year in which this section 
        becomes effective as provided for in section 601(c) of the 
        SAMHSA Reauthorization, Flexibility Enhancement, and 
        Consolidation Act of 1995, the Secretary, in consultation with 
        the States, local governments, Indian tribes, health care 
        providers, consumers, and families, shall establish, and as 
        necessary, periodically revise--
                    ``(A) a list of performance partnership objectives 
                to carry out the goals of this subpart, and
                    ``(B) a core set of not more than five of such 
                objectives that address mental health problems of 
                national significance.
            ``(2) Requirements.--Each performance partnership objective 
        established under paragraph (1) shall include--
                    ``(A) a performance indicator;
                    ``(B) the specific population being addressed;
                    ``(C) a performance target; and
                    ``(D) a date by which the target level is to be 
                achieved.
            ``(3) Principles.--In establishing the performance 
        partnership objectives under paragraph (1), the Secretary shall 
        be guided by the following principles:
                    ``(A) The objectives should be closely related to 
                the goals of this subpart, and be viewed as important 
                by and understandable to State policymakers and the 
                general public.
                    ``(B) Objectives should be results-oriented, 
                including a suitable mix of outcome, process and 
                capacity measures.
                    ``(C) In the case of an objective that has suitable 
                outcome measures, measurable progress in achieving the 
                objective should be expected over the period of the 
                grant.
                    ``(D) In the case of an objective that has suitable 
                process or capacity measures, such objective should be 
                demonstrably linked to the achievement of, or 
                demonstrate the potential to achieve, a mental health 
                outcome.
                    ``(E) Data to track the objective should, to the 
                extent practicable, be comparable for all grant 
                recipients, meet reasonable statistical standards for 
                quality, and be available in a
                 timely fashion, at appropriate periodicity, and at 
reasonable cost.
    ``(c) Definitions.--
            ``(1) Establishment by secretary of definitions; 
        dissemination.--For purposes of this subpart, the definitions 
        established on May 20, 1993, for the terms `adults with a 
        serious mental illness' and `children with a serious emotional 
        disturbance' shall apply unless such definitions are revised by 
        the Secretary. The Secretary shall disseminate the definitions 
        to the States.
            ``(2) Standardized methods.--The Secretary shall establish 
        standardized methods for applying the definitions in paragraph 
        (1). A funding agreement for a grant under this subpart for the 
        State is that the State will utilize such methods in making 
        such estimates.
            ``(3) Date certain for compliance by secretary.--Not later 
        than 90 days after the date of the enactment of this section, 
        the Secretary shall establish the standardized methods 
        described in paragraph (2).

``SEC. 1912. STATE PERFORMANCE PARTNERSHIP PROPOSAL.

    ``(a) In General.--To be eligible to receive a grant under this 
subpart, a State shall, in accordance with this section, prepare and 
submit to the Secretary a performance partnership proposal.
    ``(b) Elements Related to Performance Objectives.--A State proposal 
submitted under subsection (a) shall contain--
            ``(1) a list of one or more objectives (derived from the 
        performance partnership objectives established under section 
        1911(b)), including at least one objective in the children's 
        area, toward which the State will work and a performance target 
        for each objective which the State will seek to achieve by the 
        end of the partnership period;
            ``(2) a rationale for the State's selection of objectives, 
        including any performance targets, and timeframes;
            ``(3) a statement of the State's strategies for achieving 
        the objectives over the course of the grant period and evidence 
        that the actions taken under a partnership agreement will have 
        an impact on the objective;
            ``(4) a statement of the amount to be expended to carry out 
        each strategy; and
            ``(5) an assurance that the State will report annually on 
        all core performance objectives established under section 
        1911(b)(1)(B) (regardless of whether it is working toward those 
        objectives) and the specific objectives toward which the State 
        will work under the performance partnership.
A State may select an objective that is not an established performance 
partnership objective under section 1911 if the State demonstrates to 
the Secretary that the objective relates to a significant mental health 
problem in the State that would not otherwise be appropriately 
addressed. The Secretary may require that objectives and requirements 
be developed by the State in a manner consistent with the requirements 
of paragraphs (2) and (3) of section 1911(b).
    ``(c) Transition Provision.--A State may select objectives under 
this section which have solely process or capacity measures until such 
time as data sets are determined by the Secretary to be readily 
available, sufficient, and relevant under section 601(a) of the SAMHSA 
Reauthorization, Flexibility Enhancement, and Consolidation Act of 
1995, to make outcome measurements for objectives developed by the 
Secretary.

``SEC. 1913. FEDERAL-STATE PERFORMANCE PARTNERSHIP.

    ``(a) Negotiations Concerning State Proposal.--
            ``(1) Reasonable efforts to agree.--A State submitting a 
        proposal under section 1912 and the Secretary shall make all 
        reasonable efforts to agree on a performance partnership 
        pursuant to which the State shall expend amounts received under 
        a grant provided under this subpart.
            ``(2) Duties of secretary.--In negotiations conducted under 
        paragraph (1) concerning the proposal of a State, the Secretary 
        shall consider the extent to which the proposed objectives, 
        performance targets, timeframes, and strategies of the State 
        are likely to address appropriately the most significant mental 
        health problems (as measured by applicable indicators) within 
        the State.
    ``(b) Partnership Period.--The Secretary, in consultation with a 
State receiving a grant under this subpart, shall set the duration of 
the partnership with the State. Initial and subsequent partnership 
periods shall not be less than 3 nor more than 5 years, except that the 
Secretary may agree to a partnership period of less than 3 years where 
a State demonstrates to the satisfaction of the Secretary that such 
shorter period is appropriate in light of the particular circumstances 
of that State.
    ``(c) Assessment and Adjustment.--
            ``(1) Assessments.--The Secretary shall annually assess--
                    ``(A) the progress achieved nationally toward each 
                of the core objectives established under section 
                1911(b)(1)(B); and
                    ``(B) in consultation with each State, the progress 
                of the State toward each objective agreed upon in the 
                performance partnership under subsection (a);
        and make such assessment publicly available.
            ``(2) State assessments.--In carrying out paragraph (1)(B), 
        the Secretary shall take into consideration such qualitative 
        assessments of performance as may be provided by each State 
        pursuant to section 1942(a)(3).
            ``(3) Adjustments.--With respect to a performance 
        partnership under subsection (a), the Secretary and the State 
        may at any time in the course of the partnership period 
        renegotiate, and revise by mutual agreement, the elements of 
        the partnership to account for new information or changed 
        circumstances (including information or changes identified 
        during assessments under paragraph (1)).
    ``(d) Grants to States; Use of Funds.--
            ``(1) Grants.--The Secretary shall award a grant to each 
        State that--
                    ``(A) has reached a performance partnership 
                agreement with the Secretary under subsection (a); and
                    ``(B) is carrying out activities in accordance with 
                the terms of such partnership;
        in an amount that is equal to the allotment of the State under 
        section 1918. Grants shall be awarded for each fiscal year for 
        which the partnership is in effect.
            ``(2) Use of funds.--Funds paid to a State under a grant 
        described in paragraph (1) may be used by the State only for 
        the purpose of carrying out this subpart (including related 
        data collection, evaluation, planning, administration, and 
        educational activities).''.
    (c) Additional General Provisions Concerning Partnerships.--Section 
1917 (42 U.S.C. 300x-6) is amended--
            (1) by striking the section heading;
            (2) by striking ``application'' each place that such term 
        appears and inserting ``proposal'';
            (3) in subsection (a)--
                    (A) in the subsection heading, by striking ``(a) In 
                General.--'' and all that follows through paragraph (1) 
                and inserting ``(d) Additional Elements.--A State 
                proposal is in accordance with this subsection if--'';
                    (B) in paragraph (3), by inserting ``proposed 
                performance partnership and'' before ``agreements'';
                    (C) in paragraph (5), by striking ``the application 
                contains the plan required in section 1912(a),'';
                    (D) in paragraph (7), by striking ``including the 
                plan under section 1912(a))'';
                    (E) by redesignating paragraphs (2) through (4), 
                and paragraphs (6) and (7) as paragraphs (1) through 
                (5), respectively; and
                    (F) by transferring such subsection to section 1912 
                (as added by subsection (b)) and inserting such 
                subsection at the end of such section; and
            (4) in subsection (b)--
                    (A) by transferring such subsection to section 1913 
                (as added by subsection (b));
                    (B) by inserting such subsection at the end of such 
                section 1913; and
                    (C) by redesignating such subsection as subsection 
                (e).
    (d) Definitions.--Section 1919 (42 U.S.C. 300x-8) is amended by 
adding at the end thereof the following new paragraphs:
            ``(3) The term `performance indicator' means a quantifiable 
        characteristic used as a measurement.
            ``(4) The term `performance target' means a numerical value 
        sought to be achieved within a specified period of time.''.
    (e) Conforming Amendments.--Title XIX is amended--
            (1) in the heading to subpart I of part B (42 U.S.C. 300x-
        1), by striking ``Block'' and inserting ``Performance 
        Partnership'';
            (2) in section 1914(b)(1) (42 U.S.C. 300x-3(b)(1)), by 
        striking ``plans'' each place that such appears and inserting 
        ``performance partnerships'';
            (3) in section 1915(a) (42 U.S.C. 300x-4(a))--
                    (A) in the subsection heading, by striking ``Plan'' 
                in the subsection heading and inserting ``Performance 
                Partnership''; and
                    (B) by striking ``plan'' each place that such 
                appears and inserting ``performance partnership'';
            (4) in subpart III of part B (300x-51 et seq.), by striking 
        ``section 1911'' each place that such appears, and inserting 
        ``subpart I''.
            (5) in section 1941 (42 U.S.C. 300x-51)--
                    (A) in the section heading, by striking ``plans'' 
                and inserting ``performance partnerships''; and
                    (B) by striking ``plan'' each place that such 
                appears and inserting ``performance partnership'';
            (6) in section 1944(b)(3) (42 U.S.C. 300x-54(b)(3)), by 
        striking ``1912(d) or''; and
            (7) in section 1945(d)(2)(A) (42 U.S.C. 300x-55(d)(2)(A)), 
        by striking ``the condition established in section 1912(d) 
        and''.
    (f) Conforming Amendment to Title V.--Section 520(b) (42 U.S.C. 
2900bb-31(b)) is amended--
            (1) by striking paragraph (5); and
            (2) by redesignating paragraphs (6) through (14) as 
        paragraphs (5) through (13), respectively.

SEC. 102. REVIEW BY PLANNING COUNCIL OF STATE'S REPORT.

    Section 1915(a)(1) (42 U.S.C. 300x-4(a)(1)) is amended by inserting 
``(and the report of the State under section 1942(a) concerning the 
preceding fiscal year)'' after ``to the grant''.

SEC. 103. STATE OPPORTUNITY TO CORRECT OR MITIGATE FAILURE TO MAINTAIN 
              EFFORT.

    Section 1915(b)(3)(A) (42 U.S.C. 300x-4(b)(3)(A)) is amended by 
striking the second sentence and inserting the following new sentences: 
``If the Secretary determines that a State has failed to maintain such 
compliance, the Secretary may permit the State, not later than 1 year 
after notification, to correct or mitigate the noncompliance. If the 
State does not carry out a correction or mitigation as specified by the 
Secretary (or if the Secretary decided it was not appropriate to 
provide that opportunity), the Secretary shall reduce the amount of the 
grant under this subpart for the State for the current fiscal year by 
an amount equal to the amount constituting such failure.''.

SEC. 104. FUNDING FOR ORGANIZATIONS THAT ARE FOR-PROFIT.

    Section 1916(a)(5) (42 U.S.C. 300x-5(a)(5)) is amended by inserting 
before the period the following: ``, unless the State determines that 
it is appropriate and beneficial for a for-profit private entity to 
receive assistance to facilitate the integration of the State Medicaid 
program or mental health managed care programs under title XIX of the 
Social Security Act)''.

SEC. 105. AUTHORIZATION OF APPROPRIATION.

    Section 1920(a) (42 U.S.C. 300x-9(a)) is amended by striking 
``$450,000,000'' and all that follows through the end thereof and 
inserting ``$280,000,000 for fiscal year 1996, and such sums as may be 
necessary for each of the fiscal years 1997 through 1999.''.

SEC. 106. DATA COLLECTION, TECHNICAL ASSISTANCE, AND EVALUATIONS.

    (a) Reserved Funds.--Section 1920(b) (42 U.S.C. 300x-9(b)) is 
amended to read as follows:
    ``(b) Reserved Funds.--
            ``(1) In general.--The Secretary shall reserve 5 percent of 
        the amounts appropriated for a fiscal year under subsection 
        (a)--
                    ``(A) to carry out sections 505 (providing for data 
                collection) and 1948(a) (providing for technical 
                assistance to States) with respect to mental health; 
                and
                    ``(B) to conduct evaluations concerning programs 
                supported under this subpart.
        The Secretary may carry out activities funded pursuant to this 
        subsection directly, or through grants, contracts, or 
        cooperative agreements.
            ``(2) Data collection infrastructure.--In carrying out this 
        subsection, the Secretary shall make available grants and 
        contracts to States for the development and strengthening of 
        State core capacity (including infrastructure) for data 
        collection and evaluation.''.
    (b) Data Collection Authority.--Section 505(a) (42 U.S.C. 290aa-
4(a)) is amended--
            (1) in paragraph (1), by striking ``and'' at the end 
        thereof;
            (2) in paragraph (2), by striking the period at the end 
        thereof and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(3) other factors as needed to carry out part B of title 
        XIX.
The Secretary may conduct activities under this subsection directly, or 
through grants, contracts, or cooperative agreements.''.
    (c) Conforming Amendment.--Section 1948(a) (42 U.S.C. 300x-58(a)) 
is amended by striking ``through contract, or through grants'' and 
inserting ``or through grants, contracts, or cooperative agreements''.
SEC. 107. PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS.

    (a) Purpose of Grants.--Section 522(b) of the Public Health Service 
Act (42 U.S.C. 290cc-22(b)) is amended--
            (1) in paragraph (10)--
                    (A) in subparagraph (F), by striking ``and'' at the 
                end thereof; and
                    (B) by adding at the end thereof the following new 
                subparagraph:
                    ``(H) providing ongoing assistance for rental 
                payments and the costs of living in such settings when 
                such housing is considered to be integral for the 
                treatment of mentally ill homeless individuals 
                committed to treatment in outpatient settings; and'';
            (2) by redesignating paragraph (11) as paragraph (12); and
            (3) by inserting after paragraph (10), the following new 
        paragraph:
            ``(11) education of the judiciary regarding the 
        manifestations of mental illness which are indications for 
        committing the mentally ill homeless to inpatient or outpatient 
        treatment in accordance with existing State commitment statutes 
        for the mentally ill; and''.
    (b) Incentive Grants.--Part C of title V of the Public Health 
Service Act (42 U.S.C. 290cc-21 et seq.) is amended--
            (1) by inserting after the part heading the following:

``SUBPART I--FORMULA GRANTS FOR MEDICAL AND SUPPORTIVE SERVICES FOR THE 
                      MENTALLY ILL HOMELESS''; and

            (2) by inserting after section 529 (42 U.S.C. 290cc-29) the 
        following:

  SUBPART II--INCENTIVE GRANTS FOR STATE TO IMPROVE THEIR OUTPATIENT 
            COMMITMENT TREATMENT SYSTEMS AND COMMITMENT LAWS

``SEC. 529A. INCENTIVE GRANTS FOR STATE TO IMPROVE THEIR OUTPATIENT 
              COMMITMENT TREATMENT SYSTEMS AND COMMITMENT LAWS.

    ``(a) In General.--Beginning in fiscal year 1998, the Secretary may 
make a grant to or enter into a contract with a State or territory 
under this section for the purpose of providing the services described 
in subsection (b) to individuals who--
            ``(1) are suffering from serious mental illness; and
            ``(2) have been committed to outpatient treatment in 
        accordance with State or territory commitment laws for the 
        mentally ill because such individuals have been found to be 
        gravely disabled as a result of their mental illness.
    ``(b) Specification of Services.--The services described in this 
subsection are--
            ``(1) mental health services in outpatient settings;
            ``(2) outreach services; and
            ``(3) case management to assure that individuals remain in 
        treatment and to assist individuals with supportive and 
        supervisory residential settings.
    ``(c) Application.--To be eligible to receive a grant or contract 
under this section, a State or territory shall prepare and submit to 
the Secretary an application at such time, in such manner, and 
containing such information as the Secretary may require, including--
            ``(1) an agreement that the State or territory will ensure 
        that payments under the grant will be expended by the State or 
        territory or through grants made by the State or territory to 
        political subdivisions of the State or territory and to 
        nonprofit private entities;
            ``(2) a description of the performance objectives that the 
        project to be funded under the grant will be measured against, 
        and that a recipient of the grant under this section shall 
        meet; and
            ``(3) an assurance that the State or territory will meet 
        information requirements as specified by the Secretary.
    ``(d) Special Rule.--
            ``(1) In general.--The Secretary may not award a grant or 
        contract to a State or territory under this subpart unless the 
        State or territory involved has in effect on the date of the 
        award a law--
                    ``(A) which provides for the commitment of the 
                gravely disabled; and
                    ``(B) that provides for intensive case management 
                to monitor compliance and reconnect the gravely 
                disabled to treatment services, a court hearing prior 
                to a gravely disabled individual being re-committed to 
                an inpatient or outpatient setting, or the involvement 
                of outpatient mental health care providers in the 
                initial treatment planning as well as the monitoring 
                and case management aspects of follow-up care for the 
                gravely disabled individual.
            ``(2) Definition.--For the purpose of this section, the 
        term `gravely disabled' means an individual who, as a result of 
        mental illness, fails to meet his or her essential needs 
        including the need for food, clothing, shelter or medical care, 
        to the degree that such individual poses a real, present and 
        substantial threat of serious physical harm to self, except 
        that the failure of an individual to meet essential needs shall 
        not, in and of itself, be sufficient grounds to establish that 
        such person is mentally ill.
    ``(e) Administrative Expenses.--The Secretary may not award a grant 
or contract to a State or territory under this section unless the State 
or territory involved agrees that not more than 4 percent of the 
amounts received under the award will be expended for administrative 
expenses regarding the amounts.
    ``(f) Maintenance Requirements.--
            ``(1) Maintenance of effort.--The Secretary may not award a 
        grant or contract to a State or territory under this section 
        unless the State involved agrees that the State or territory 
        will maintain State or territory expenditures for services 
        described in subsection (b) at a level that is not less than 
        the average level of such expenditures maintained by the State 
        or territory for the 2-year period preceding the fiscal year 
        for which the State or territory is applying to receive such an 
        award.
            ``(2) Matching funds.--The Secretary may require that a 
        State or territory that applies for a grant or contract under 
        this section provide non-Federal matching funds, as 
        appropriate, to ensure the State or territory commitment to the 
        programs funded under this section. Such non-Federal matching 
        funds may be provided directly or through donations from public 
        or private entities and may be in cash or in-kind, fairly 
        evaluated, including plant, equipment, or services.
    ``(g) Generally Applicable Provisions.--
            ``(1) Competitive basis.--The Secretary shall ensure that 
        grants and contract are awarded under this section on a 
        competitive basis, as appropriate, to States or territories 
        that demonstrate a potential to retain, or a history of 
        retaining, the gravely disabled mentally ill who have been 
        committed to outpatient treatment in outpatient treatment in 
        accordance with court ordered treatment plans.
            ``(2) Terms.--The period under which payments are made 
        under a grant or contract under this section may not exceed 5 
        years. Such payments shall be subject to annual approval by the 
        Secretary
         and subject to the availability of appropriations for the 
fiscal year involved. Nothing in this paragraph shall be construed as 
limiting the number of awards that may be made to a State or territory 
under this section.
            ``(3) Peer review.--An application received by the 
        Secretary under this section shall be submitted to a peer 
        review group for an evaluation of the merits of the proposals 
        made in the application. The Secretary may not approve such an 
        application unless a peer review group has recommended the 
        application for approval.

           ``SUBPART III--GENERALLY APPLICABLE PROVISIONS''.

    (c) Funding.--Section 535(a) of the Public Health Service Act (42 
U.S.C. 290cc-35(a)) is amended--
            (1) by striking ``this part'' and inserting ``section 
        521''; and
            (2) by striking ``$75,000,000'' and all that follows 
        through the period and inserting ``$29,000,000 for each of the 
        fiscal years 1996 and 1997, and $50,000,000 for each of the 
        fiscal years 1998 and 1999. With respect to amounts 
        appropriated under this subsection for fiscal year 1998, the 
        Secretary shall allocate such amounts between subparts I and II 
        based on the ratio of the amounts allocated under section 521 
        and under sections 520A(e) and 506(e) for the program known as 
        the `Access to Community Care and Effective Services and 
        Supports' (ACCESS) program for fiscal year 1997.''.
    (d) Repeal.--Effective on October 1, 1997--
            (1) section 506 (42 U.S.C. 290aa-5) is repealed; and
            (2) the Secretary shall not allocate funds under section 
        520A (as amended by section 108) (42 U.S.C. 290bb-32) or under 
        any other authority for the program known as the ``Access to 
        Community Care and Effective Services and Supports'' (ACCESS) 
        program.

SEC. 108. PRIORITY MENTAL HEALTH NEEDS OF REGIONAL AND NATIONAL 
              SIGNIFICANCE.

    Section 520A (42 U.S.C. 290bb-32) is amended to read as follows:

``SEC. 520A. PRIORITY MENTAL HEALTH NEEDS OF REGIONAL AND NATIONAL 
              SIGNIFICANCE.

    ``(a) Grants.--The Secretary shall address priority mental health 
needs of regional and national significance through--
            ``(1) the provision of--
                    ``(A) training; or
                    ``(B) demonstration projects for prevention, 
                treatment, and rehabilitation; and
            ``(2) the conduct or support of evaluations of such 
        demonstration projects.
In carrying out this section, the Secretary may make grants to, or 
enter into cooperative agreements with, States, political subdivisions 
of States, Indian Tribes and tribal organizations, and public or 
private nonprofit entities.
    ``(b) Priority Mental Health Needs.--Priority mental health needs 
of regional and national significance shall include child mental health 
services, and may include managed care, systems and partnerships, 
client-oriented and consumer-run self-help services, training, and 
other priority populations and conditions as determined appropriate by 
the Secretary.
    ``(c) Requirements.--
            ``(1) In general.--Recipients of grants, cooperative 
        agreements, and contracts under this section shall comply with 
        information and application requirements determined appropriate 
        by the Secretary.
            ``(2) Payments.--With respect to a grant, cooperative 
        agreement, or contract awarded under this section, the period 
        during which payments under such award are made to the 
        recipient may not exceed 5 years. The provision of such 
        payments shall be subject to annual approval by the Secretary 
        and the availability of appropriations for the fiscal year 
        involved. This paragraph may not be construed as limiting the 
        number of awards under the program involved that may be made to 
        an entity.
            ``(3) Matching funds.--The Secretary may require that an 
        entity that applies for a grant, contract, or cooperative 
        agreement under this section provide non-Federal matching 
        funds, as determined appropriate by the Secretary, to ensure 
        the institutional commitment of the entity to the projects 
        funded under the grant, contract, or cooperative agreement. 
        Such non-Federal matching funds may be provided directly or 
        through donations from public or private entities and may be in 
        cash or in kind, fairly evaluated, including plant, equipment, 
        or services.
            ``(4) Maintenance of effort.--With respect to activities 
        for which a grant, cooperative agreement, or contract is 
        awarded under this section, the Secretary may require that the 
        recipient agree to maintain expenditures of non-Federal amounts 
        for such activities at a level that is not less than the level 
        of such expenditures maintained by the entity for such fiscal 
        year preceding the fiscal year for which the entity receives 
        such a grant, contract, or cooperative agreement.
            ``(5) Application and funding agreements.--
                    ``(A) Application.--An application for a grant, 
                contract, or cooperative agreement under this section 
                shall ensure that amounts received under such grant, 
                contract, or agreement will not be expended--
                            ``(i) to provide inpatient services;
                            ``(ii) to make cash payments to intended 
                        recipients of services;
                            ``(iii) to purchase or improve land, 
                        purchase, construct, or permanently improve 
                        (other than minor remodeling) any building or 
                        other facility, or purchase major medical 
                        equipment; or
                            ``(iv) to satisfy any requirement for the 
                        expenditure of non-Federal funds as a condition 
                        for the receipt of Federal funds.
                    ``(B) Funding agreement.--A funding agreement for a 
                grant, contract, or cooperative agreement under this 
                section is that the entity involved will not expend 
                more than 10 percent of the grant, contract, or 
                agreement for administrative expenses with respect to 
                the grant, contract, or agreement.
    ``(d) Reduction in Payments.--The Secretary, at the request of a 
State or a political subdivision of a State, or a public or private 
nonprofit entity, may reduce the amount of payments under this section 
by--
            ``(1) the fair market value of any supplies or equipment 
        furnished the State, political subdivision of the State, or a 
        public or private nonprofit entity; and
            ``(2) the amount of the pay, allowances, and travel 
        expenses of any officer, fellow, or employee of the Government 
        when detailed to the State, a political subdivision of the 
        State, or a public or private non-profit entity, and the amount 
        of any other costs incurred in connection with the detail of 
        such officer, fellow, or employee;
when the furnishing of such officer, fellow, or employee is for the 
convenience of and at the request of the State, political subdivision 
of the State, or public or private non-profit entity and for the 
purpose of conducting activities described in this section. The amount 
by which any payment is so reduced shall be available for payment by 
the Secretary of the costs incurred in furnishing the supplies or 
equipment or in detailing the personnel, on which the
 reduction of the payment is based, and the amount shall be deemed to 
have been paid to the State, political subdivision of the State, or 
public or private non-profit entity.
    ``(e) Evaluation.--The Secretary shall evaluate each project 
carried out under section (a)(1)(B) and shall disseminate the findings 
with respect to each such evaluation to appropriate public and private 
entities.
    ``(f) Information and Education.--
            ``(1) In general.--The Secretary shall establish 
        information and education programs to disseminate the findings 
        of the demonstration and training programs under this section 
        to the general public and to health professionals.
            ``(2) Dissemination.--The Secretary shall take such action 
        as may be necessary to insure that all methods of dissemination 
        and exchange of information are maintained between the 
        Substance Abuse and Mental Health Services Administration and 
        the public, and such Administration and other scientific 
        organizations, both nationally and internationally.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $50,000,000 for each of the 
fiscal years 1996 and 1997, $30,000,000 for fiscal year 1998, and such 
sums as may be necessary for fiscal year 1999.''.

SEC. 109. REPEALS.

    (a) In General.--The following provisions of the Public Health 
Service Act are repealed:
            (1) Subsections (a), (c), and (d) of section 303 (42 U.S.C. 
        242a (a), (c), and (d)) relating to clinical training and AIDS 
        training.
            (2) Section 520B (42 U.S.C. 290bb-33) relating to AIDS 
        demonstrations.
            (3) Section 612 of the Stewart B. McKinney Homeless 
        Assistance Act.
    (b) Conforming Amendment.--Section 303 (42 U.S.C. 242a) as amended 
by subsection (a)(1), is further amended by striking the remaining 
subsection designation.

SEC. 110. COMPREHENSIVE COMMUNITY SERVICES FOR CHILDREN WITH A SERIOUS 
              EMOTIONAL DISTURBANCE.

    (a) Authorization of Appropriations.--Section 565(f)(1) (42 U.S.C. 
290ff-4(f)(1)) is amended--
            (1) by striking ``and'' after ``1993''; and
            (2) by inserting before the period the following: ``, 
        $60,000,000 for fiscal year 1996, and such sums as may be 
        necessary for each of the 3 succeeding fiscal years''.
    (b) Flexibility for Indian Tribes and Territories.--Section 562(c) 
(42 U.S.C. 290ff-1(c)) is amended by adding at the end the following 
new flush sentence:
``The Secretary may waive one or more of the requirements of the 
preceding sentence (for a public entity that is an Indian Tribe or 
tribal organization, or American Samoa, Guam, the Marshall Islands, the 
Federated States of Micronesia, the Commonwealth of the Northern 
Mariana Islands, the Republic of Palau, or the United States Virgin 
Islands) if the Secretary determines, after peer review, that the 
system of care is family-centered and uses the least restrictive 
environment that is clinically appropriate.''.

                       TITLE II--SUBSTANCE ABUSE

SEC. 201. REPLACEMENT OF STATE PLAN PROGRAM WITH PERFORMANCE 
              PARTNERSHIPS.

    (a) Repeals.--Section 1921 (42 U.S.C. 300x-21) is repealed.
    (b) Performance Partnership Framework.--Subpart II of part B of 
title XIX (42 U.S.C. 300x-21 et seq.) (as amended by subsection (a)) is 
further amended by inserting after the subpart heading the following 
new sections:

``SEC. 1921. PERFORMANCE PARTNERSHIP GOALS AND OBJECTIVES.

    ``(a) Goals.--It is the goal of this subpart for the States and the 
Federal Government, working together in a partnership--
            ``(1) to reduce the incidence and prevalence of substance 
        abuse and dependence;
            ``(2) to improve access to appropriate prevention and 
        treatment programs for targeted populations;
            ``(3) to enhance the effectiveness of substance abuse 
        prevention and treatment programs; and
            ``(4) to reduce the personal and community risks for 
        substance abuse.
    ``(b) Performance Partnership Objectives.--
            ``(1) Establishment.--Not later than October 1 of the 
        fiscal year prior to the fiscal year in which this section 
        becomes effective as provided for in section 601(c) of the 
        SAMHSA Reauthorization, Flexibility Enhancement, and 
        Consolidation Act of 1995, the Secretary, in consultation with 
        the States, local governments, Indian tribes, providers, and 
        consumers, and in accordance with paragraph (4), shall 
        establish, and as necessary, periodically revise--
                    ``(A) a list of performance partnership objectives 
                to carry out the goals of this subpart; and
                    ``(B) a core set of not more than five of such 
                objectives that address substance abuse problems of 
                national significance.
            ``(2) Requirements.--Each performance partnership objective 
        established under paragraph (1) shall include--
                    ``(A) a performance indicator;
                    ``(B) the specific population being addressed;
                    ``(C) a performance target; and
                    ``(D) a date by which the target level is to be 
                achieved.
            ``(3) Principles.--In establishing the performance 
        partnership objectives under paragraph (1), the Secretary shall 
        be guided by the following principles:
                    ``(A) The objectives should be closely related to 
                the goals of this subpart, and be viewed as important 
                by and understandable to State policymakers and the 
                general public.
                    ``(B) Objectives should be results-oriented, 
                including a suitable mix of outcome, process and 
                capacity measures.
                    ``(C) In the case of an objective that has suitable 
                outcome measures, measurable progress in achieving the 
                objective should be expected over the period of the 
                grant.
                    ``(D) In the case of an objective that has suitable 
                process or capacity measures, such objective should be 
                demonstrably linked to the achievement of, or 
                demonstrate a potential to achieve, a substance abuse 
                treatment outcome.
                    ``(E) Data to track the objective should, to the 
                extent practicable, be comparable for all grant 
                recipients, meet reasonable statistical standards for 
                quality, and be available in a timely fashion, at 
                appropriate periodicity, and at reasonable cost.

``SEC. 1921A. STATE PERFORMANCE PARTNERSHIP PROPOSAL.

    ``(a) In General.--To be eligible to receive a grant under this 
subpart, a State shall, in accordance with this section, prepare and 
submit to the Secretary a performance partnership proposal in 
accordance with the provisions of this subpart .
    ``(b) Elements Related to Performance Objectives.--A State proposal 
submitted under subsection (a) shall contain--
            ``(1) a list of one or more objectives (derived from the 
        performance partnership objectives specified under section 
        1921(b)) toward which the State will work and a performance 
        target for each objective which the State will seek to achieve 
        by the end of the partnership period;
            ``(2) a rationale for the State's selection of objectives, 
        including any performance targets, and timeframes;
            ``(3) a statement of the State's strategies for achieving 
        the objectives over the course of the grant period and evidence 
        that the actions taken under a partnership agreement will have 
        an impact on the objective;
            ``(4) a statement of the amount to be expended to carry out 
        each strategy; and
            ``(5) an assurance that the State will report annually on 
        all core performance objectives established under section 
        1921(b)(1)(B) (regardless of whether it is working toward those 
        objectives) and the specific objectives toward which the State 
        will work under the performance partnership.
A State may select an objective that is not an established performance 
partnership objective under section 1921 if the State demonstrates to 
the Secretary that the objective relates to a significant health 
problem related to substance abuse in the State that would not 
otherwise be addressed appropriately. The Secretary may require that 
objectives developed by the State under this subsection be consistent 
with the requirements of paragraphs (2) and (3) of section 1921(b).
    ``(c) Transition Provision.--A State may select objectives under 
this section which solely have process or capacity measures until such 
time as data sets are determined by the Secretary to be readily 
available, sufficient, and relevant under section 601(a) of the SAMHSA 
Reauthorization, Flexibility Enhancement, and Consolidation Act of 
1995, to make outcome measurements for objectives developed by the 
Secretary.

``SEC. 1921B. FEDERAL-STATE PERFORMANCE PARTNERSHIP.

    ``(a) Negotiations Concerning State Proposal.--
            ``(1) Reasonable efforts to agree.--A State submitting a 
        proposal under section 1921A and the Secretary shall make all 
        reasonable efforts to agree on a performance partnership 
        pursuant to which the State shall expend amounts received under 
        a grant provided under this subpart.
            ``(2) Duties of secretary.--In negotiations conducted under 
        paragraph (1) concerning the proposal of a State, the Secretary 
        shall consider the extent to which the proposed objectives, 
        performance targets, timeframes, and strategies of the State 
        are likely to address appropriately the most significant health 
        problems associated with substance abuse (as measured by 
        applicable indicators) within the State, including the health 
        problems associated with substance abuse of vulnerable 
        populations (such as pregnant women, women with dependent 
        children, and crack-cocaine and injecting drug users).
    ``(b) Partnership Period.--The Secretary, in consultation with a 
State receiving a grant under this subpart, shall set the duration of 
the partnership with the State. Initial and subsequent partnership 
periods shall not be less than 3 nor more than 5 years, except that the 
Secretary may agree to a partnership period of less than 3 years where 
a State demonstrates to the satisfaction of the Secretary that such 
shorter period is appropriate in light of the particular circumstances 
of that State.
    ``(c) Assessment and Adjustment.--
            ``(1) Assessments.--The Secretary shall annually assess--
                    ``(A) the progress achieved nationally toward each 
                of the core objectives established under section 
                1921(b)(1)(B); and
                    ``(B) in consultation with each State, the progress 
                of the State toward each objective agreed upon in the 
                performance partnership under subsection (a);
        and make such assessment publicly available.
            ``(2) State assessments.--In carrying out paragraph (1)(B), 
        the Secretary shall take into consideration such qualitative 
        assessments of performance as may be provided by each State 
        pursuant to section 1942(a)(3).
            ``(3) Adjustments.--With respect to a performance 
        partnership under subsection (a), the Secretary and the State 
        may at any time in the course of the partnership period 
        renegotiate, and revise by mutual agreement, the elements of 
        the partnership to account for new information or changed 
        circumstances (including information or changes identified 
        during assessments under paragraph (1)).
    ``(d) Grants to States; Use of Funds.--
            ``(1) Grants.--The Secretary shall award a grant to each 
        State that--
                    ``(A) has reached a performance partnership 
                agreement with the Secretary under subsection (a); and
                    ``(B) is carrying out activities in accordance with 
                the terms of such partnership;
        in an amount that is equal to the allotment of the State under 
        section 1933. Grants shall be awarded for each fiscal year for 
        which the partnership is in effect.
            ``(2) Use of funds.--Funds paid to a State under a grant 
        described in paragraph (1) may be used by the State only for 
        the purpose of carrying out this subpart (including related 
        data collection, evaluation, planning, administration, and 
        educational activities).''.
    (c) Additional General Provisions Concerning Partnerships.--Section 
1932 (42 U.S.C. 300x-32) is amended--
            (1) by striking the section heading;
            (2) by striking ``application'' each place that such term 
        appears and inserting ``proposal'';
            (3) in subsection (a)--
                    (A) in the subsection heading, by striking ``(a) In 
                General.--'' and all that follows through paragraph (1) 
                and inserting ``(c) Additional Elements.--A State 
                proposal is in accordance with this subsection if--'';
                    (B) in paragraph (3), by inserting ``proposed 
                performance partnership and'' before ``agreements'';
                    (C) by striking paragraphs (5) and (6)
                    (D) in paragraph (7), by striking ``including the 
                plan under paragraph (6)'';
                    (E) by redesignating paragraphs (2) through (4), 
                and paragraph (7) as paragraphs (1) through (4), 
                respectively; and
                    (F) by transferring such subsection to section 
                1921A (as added by subsection (b)) and inserting such 
                subsection at the end of such section; and
            (4) in subsection (c)--
                    (A) by transferring such subsection to section 
                1921B (as added by subsection (b));
                    (B) by inserting such subsection at the end of such 
                section 1921B; and
                    (C) by redesignating such subsection as subsection 
                (h); and
            (5) by striking subsections (b) and (d).
    (d) Definitions.--Section 1934 (42 U.S.C. 300x-34) is amended--
            (1) by redesignating paragraphs (3) through (7) as 
        paragraphs (5) through (9), respectively; and
            (2) by inserting after paragraph (2), the following new 
        paragraphs:
            ``(3) The term `performance indicator' means a quantifiable 
        characteristic used as a measurement.
            ``(4) The term `performance target' means a numerical value 
        sought to be achieved within a specified period of time.''.
    (e) Conforming Amendments.--Title XIX is amended--
            (1) in the heading of subpart II of part B (42 U.S.C. 300x-
        21 et seq.) by striking ``Block'' and inserting ``Performance 
        Partnership'';
            (2) in subpart II of part B (42 U.S.C. 300x-21 et seq.), by 
        striking ``section 1921'' each place that such appears and 
        inserting ``this subpart'';
            (3) in section 1933(a)(1)(A) (42 U.S.C. 300x-33(a)(1)(A)), 
        by inserting ``(as in effect on January l, 1995)'' after 
        ``section 1918(a)''; and
            (4) in subpart III of part B (42 U.S.C. 300x-51 et seq.), 
        by striking ``section 1921'' each place that such appears and 
        inserting ``subpart II''.

SEC. 202. ALLOCATIONS REGARDING PRIMARY PREVENTION AND WOMENS PROGRAMS.

    Section 1922 (42 U.S.C. 300x-22) is amended--
            (1) by striking subsection (a);
            (2) by redesignating subsections (b) and (c) as subsections 
        (a) and (b), respectively; and
            (3) in subsection (b) (as so redesignated)--
                    (A) by striking paragraph (1) and inserting the 
                following new paragraph:
            ``(1) In general.--A funding agreement for a grant under 
        section 1921 for a fiscal year is that in the case of a grant 
        for fiscal year 1996, or a subsequent fiscal year, the State 
        will expend not less than an amount equal to the amount 
        expended by the State for fiscal year 1995 to increase the 
        availability of treatment services designed for pregnant women 
        and women with dependent children (either by establishing new 
        programs or expanding the capacity of existing programs).''; 
        and
                    (B) by adding at the end thereof the following new 
                paragraph:
            ``(4) Insufficient amounts.--If the Secretary determines 
        that, as a result of a reduction in the amount of Federal funds 
        provided to State under this subpart, a State will be unable to 
        meet the requirement of paragraph (1), the Secretary shall 
        permit the State to prorate amounts provided under such 
        paragraph based on the amount provided to the State under this 
        subpart in fiscal year 1995.''.

SEC. 203. TUBERCULOSIS AND HIV.

    (a) Tuberculosis.--Section 1924(a) (42 U.S.C. 300x-24(a)) is 
amended--
            (1) in paragraph (1), to read as follows:
            ``(1) In general.--A funding agreement for a grant under 
        section 1921 is that the State involved will--
                    ``(A)(i) directly or through arrangements with 
                other public or nonprofit private entities, ensure that 
                activities are routinely carried out under 
                subparagraphs (A) and (B) of paragraph (2); and
                    ``(ii) ensure that arrangements are made with other 
                public or nonprofit private entities to make available 
                tuberculosis services, including services under 
                subparagraphs (C) and (D) of paragraph (2), to each 
                individual receiving treatment for substance abuse 
                under this subpart; and
                    ``(B) require that any entity receiving amounts 
                from the grant for operating a program of treatment for 
                substance abuse, in the case of an individual in need 
                of such treatment who is denied admission to the 
                program on the basis of the lack of the capacity of the 
                program to admit the individual, will refer the 
                individual to another provider of tuberculosis 
                services.
        Nothing in subparagraph (A)(ii) shall be construed to require 
        that the State expend funds under this Act to make available 
        such services.'';
            (2) in paragraph (2)--
                    (A) by redesignating subparagraph (C) as 
                subparagraph (D); and
                    (B) in subparagraph (B), to read as follows:
                    ``(B) tuberculosis testing, based on the risk 
                assessment conducted by the State, to determine whether 
                the individual has contracted such disease, such 
                testing to be based on usual standards as determined to 
                be appropriate by the State health director in 
                cooperation with State and local health agencies for 
                tuberculosis and with other relevant private nonprofit 
                entities;
                    ``(C) testing to determine the form of treatment 
                for the disease that is appropriate for the individual; 
                and''; and
            (3) by adding at the end thereof the following new 
        paragraph:
            ``(3) Counseling.--For purposes of paragraph (2), the term 
        `counseling' with respect to an individual means--
                    ``(A) the provision of information to individuals 
                or communities about risk factors for tuberculosis; and
                    ``(B) conducting tuberculosis risk assessments to 
                determine if tuberculosis testing is required.''.
    (b) HIV.--Section 1924(b) (42 U.S.C. 300x-24(b)) is amended--
            (1) in paragraph (1)(A), insert ``routinely'' after 
        ``projects to'';
            (2) in paragraph (2), by striking ``10'' and inserting 
        ``15''; and
            (3) in paragraph (7)(B)(ii), by inserting before the 
        semicolon the following: ``, such testing to be based on usual 
        standards as determined to be appropriate by the State health 
        director in cooperation with State and local health agencies 
        for HIV and with other relevant private nonprofit entities; 
        and'';
    (c) Expenditure.--Section 1924(c) (42 U.S.C. 300x-24(c)) is 
amended--
            (1) in the subsection heading, by striking ``Agreements'' 
        and inserting ``Partnerships''; and
            (2) in paragraph (1), by striking ``agreements'' and 
        inserting ``partnerships''.
    (d) Payor of Last Resort.--Section 1924 (42 U.S.C. 300x-24) is 
amended by adding at the end thereof the following new subsection:
    ``(f) Payor of Last Resort.--Amounts made available under this 
section may only be used as a payment of last resort for tuberculosis 
and may not be used for the medical evaluation and treatment of such 
disease.''.

SEC. 204. GROUP HOMES FOR RECOVERING SUBSTANCE ABUSERS.

    (a) In General.--Section 1925 (42 U.S.C. 300x-25) is amended--
            (1) in subsection (a), by striking ``For fiscal year 1993'' 
        and all that follows through the colon and inserting ``Except 
        as provided in subsection (d), for each of the fiscal years 
        1996 through 1999, the Secretary may make a grant under section 
        1921
         only if the State involved has established and is providing 
for the ongoing operation of a revolving fund as follows:''; and
            (2) by adding at the end thereof the following new 
        subsection:
    ``(d) Nonapplication of Section.--
            ``(1) In general.--The requirements of this section shall 
        not apply to a State that is not, as of the date of enactment 
        of this subsection, utilizing a revolving fund under this 
        section. Such a State shall not be required to maintain such a 
        fund after such date of enactment.
            ``(2) Use of funds.--A State described in paragraph (1), 
        may use amounts set aside under this section, or amounts 
        remaining in the revolving fund, to provide other services 
        under this part.''.
    (b) Repeal.--Section 1925 (42 U.S.C. 300x-25) shall be repealed 
effective on September 30, 1998.

SEC. 205. STATE SUBSTANCE ABUSE PREVENTION AND TREATMENT PLANNING 
              COUNCIL.

    Subpart II of part B of title XIX is amended by inserting after 
section 1927 (42 U.S.C. 300x-27) the following new section:

``SEC. 1927A. STATE SUBSTANCE ABUSE PREVENTION AND TREATMENT PLANNING 
              COUNCIL.

    ``(a) In General.--A funding agreement for a grant under this 
subpart is that the State involved will establish and maintain a State 
substance abuse prevention and treatment planning council in accordance 
with the conditions described in this section.
    ``(b) Duties.--A condition under subsection (a) for a council is 
that the duties of the council are--
            ``(1) to review performance partnerships and related 
        reports provided to the council by the State involved and to 
        submit to the State any recommendations of the council for 
        modifications;
            ``(2) to serve as an advocate for individuals suffering 
        from substance abuse; and
            ``(3) to monitor, review, and evaluate, not less than once 
        each year, the allocation and adequacy of substance abuse 
        prevention and treatment services within the State.
    ``(c) Membership.--
            ``(1) In general.--A condition under subsection (a) for a 
        council is that the council be composed of residents of the 
        State, including representatives of--
                    ``(A) the principal State agencies with respect 
                to--
                            ``(i) substance abuse prevention and 
                        treatment, education, vocational 
                        rehabilitation, criminal justice, housing, and 
                        social services; and
                            ``(ii) the development of the plan 
                        submitted pursuant to title XIX of the Social 
                        Security Act;
                    ``(B) public and private entities concerned with 
                the need, planning, operation, funding, and use of 
                substance abuse prevention and treatment services and 
                related support services;
                    ``(C) individuals who are receiving (or have 
                received) substance abuse prevention or treatment 
                services; and
                    ``(D) the families of such individuals.
            ``(2) Limitation on state employees and providers.--A 
        condition under subsection (a) for a council is that not less 
        that 50 percent of the members of the council are individuals 
        who are not State employees or providers of substance abuse 
        prevention or treatment services.
    ``(d) Review of State Performance Partnership by Planning 
Council.--The Secretary may make a grant under this subpart only if--
            ``(1) the performance partnership submitted under this 
        subpart with respect to the grant (and the State's report under 
        section 1942(a) concerning the preceding fiscal year) has been 
        reviewed by the council; and
            ``(2) the State submits to the Secretary any 
        recommendations received by the State from the council for 
        modifications to the performance partnership (without regard to 
        whether the State has made the recommended modifications).
    ``(e) Waivers.--In the case of a State that has other existing 
processes for complying with the duties required under subsection (b), 
the Secretary, upon the request of the State, may waive the 
requirements of such subsection. Such waiver shall be deemed to be 
granted if the Secretary fails to act within 90 days of the date of the 
submission of such a request.''.

SEC. 206. ADDITIONAL AGREEMENTS.

    Section 1928 (42 U.S.C. 300x-28) is amended--
            (1) by striking subsections (a) and (d); and
            (2) by redesignating subsections (b) and (c) as subsections 
        (a) and (b), respectively.

SEC. 207. STATE OPPORTUNITY TO CORRECT OR MITIGATE FAILURE TO MAINTAIN 
              EFFORT.

    Section 1930(c)(1) (42 U.S.C. 300x-30(c)(1)) is amended by striking 
the second sentence and inserting the following new sentences: ``If the 
Secretary determines that a State has failed to maintain such 
compliance, the Secretary may permit the State, not later than 1 year 
after notification, to correct or mitigate the noncompliance. If the 
State does not carry out a correction or mitigation as specified by the 
Secretary (or if the Secretary decided it was not appropriate to 
provide that opportunity), the Secretary shall reduce the amount of the 
grant under this subpart for the State for the current fiscal year by 
an amount equal to the amount constituting such failure.''.

SEC. 208. FUNDING FOR ORGANIZATIONS THAT ARE FOR-PROFIT.

    Section 1931(a) (42 U.S.C. 300x-31(a)) is amended--
            (1) in paragraph (1)(E), by inserting before the semicolon 
        the following: ``, unless the State determines that it is 
        appropriate and beneficial for a for-profit private entity to 
        receive assistance to facilitate the integration of the State 
        Medicaid program or substance abuse managed care programs under 
        title XIX of the Social Security Act)''; and
            (2) by adding at the end thereof the following new 
        paragraph:
            ``(4) For-profit restrictions.--For purposes of providing 
        assistance to a for-profit entity under paragraph (1)(E), the 
        State shall ensure that--
                    ``(A) such an entity is certified or licensed by 
                the State;
                    ``(B) all profits earned by such entity as a result 
                of assistance provided under this subpart are 
                redistributed by the entity to the community served by 
                the entity for the provision of treatment or prevention 
                services; and
                    ``(C) in the case of an entity that is a private 
                for-profit entity, such entity is the only available 
                provider of substance abuse treatment in the area 
                served.''.

SEC. 209. AUTHORIZATION OF APPROPRIATIONS.

    Section 1935(a) (42 U.S.C. 300x-35(a)) is amended by striking 
``$1,500,000,000'' and all that follows through the end thereof and 
inserting ``$1,300,000,000 for fiscal year 1996, and such sums as may 
be necessary for each of the fiscal years 1997 through 1999.''.
SEC. 210. DATA COLLECTION, TECHNICAL ASSISTANCE, AND EVALUATIONS.

    Section 1935(b) (42 U.S.C. 300x-35(b)) is amended to read as 
follows:
    ``(b) Reserved Funds.--
            ``(1) In general.--The Secretary shall reserve 5 percent of 
        the amounts appropriated for a fiscal year under subsection 
        (a)--
                    ``(A) to carry out sections 505 (providing for data 
                collection) and 1948(a) (providing for technical 
                assistance to States) with respect to substance abuse;
                    ``(B) to carry out section 515(d) (providing for a 
                performance substance abuse data base); and
                    ``(C) to conduct evaluations concerning programs 
                supported under this subpart.
        The Secretary may carry out activities funded pursuant to this 
        paragraph directly, or through grants, contracts, or 
        cooperative agreements.
            ``(2) Data collection infrastructure.--In carrying out this 
        subsection, the Secretary shall make available grants and 
        contracts to States for the development and strengthening of 
        State core capacity (including infrastructure) for data 
        collection and evaluation.
            ``(3) Prevention.--Of the amounts reserved under paragraph 
        (1) for a fiscal year, the Secretary shall ensure that 20 
        percent of such amounts shall be used for activities related to 
        prevention.''.

SEC. 211. PRIORITY SUBSTANCE ABUSE PREVENTION AND TREATMENT NEEDS OF 
              REGIONAL AND NATIONAL SIGNIFICANCE.

    Section 510 (42 U.S.C. 290bb-3) is amended to read as follows:

``SEC. 510. PRIORITY SUBSTANCE ABUSE PREVENTION AND TREATMENT NEEDS OF 
              REGIONAL AND NATIONAL SIGNIFICANCE.

    ``(a) Grants.--The Secretary shall address the substance abuse 
health needs of regional and national significance through--
            ``(1) the provision of
                    ``(A) training; or
                    ``(B) demonstration projects for prevention and 
                treatment; and
            ``(2) the conduct or support of evaluations of such 
        demonstration projects.
In carrying out this section, the Secretary may make grants to, or 
enter into cooperative agreements with, States, political subdivisions 
of States, Indian Tribes and tribal organizations, and public or 
private nonprofit entities.
    ``(b) Substance Abuse Health Needs.--Substance abuse health needs 
of regional and national significance shall include prevention 
activities and may include managed care, systems and partnerships, 
client-oriented services, and other priority populations (including 
pregnant substance abusers, women with dependent children, and crack 
cocaine and injecting drug users) and conditions as determined 
appropriate by the Secretary.
    ``(c) Requirements.--
            ``(1) In general.--Recipients of grants, cooperative 
        agreements, and contracts under this section shall comply with 
        information and application requirements determined appropriate 
        by the Secretary.
            ``(2) Payments.--With respect to a grant, cooperative 
        agreement, or contract awarded under this section, the period 
        during which payments under such award are made to the 
        recipient may not exceed 5 years. The provision of such 
        payments shall be subject to annual approval by the Secretary 
        and the availability of appropriations for the fiscal year 
        involved. This paragraph may not be construed as limiting the 
        number of awards under the program involved that may be made to 
        an entity.
            ``(3) Matching funds.--The Secretary may require that an 
        entity that applies for a grant, contract, or cooperative 
        agreement under this section provide non-Federal matching 
        funds, as determined appropriate by the Secretary, to ensure 
        the institutional commitment of the entity to the projects 
        funded under the grant, contract, or cooperative agreement. 
        Such non-Federal matching funds may be provided directly or 
        through donations from public or private entities and may be in 
        cash or in kind, fairly evaluated, including plant, equipment, 
        or services.
            ``(4) Maintenance of effort.--With respect to activities 
        for which a grant, cooperative agreement, or contract is 
        awarded under this section, the Secretary may require the 
        recipient to agree to maintain expenditures of non-Federal 
        amounts for such activities at a level that is not less than 
        the level of such expenditures maintained by the entity for 
        such fiscal year preceding the fiscal year for which the entity 
        receives such a grant, contract, or cooperative agreement.
            ``(5) Application and funding agreements.--
                    ``(A) Application.--An application for a grant, 
                contract, or cooperative agreement under this section 
                shall ensure that amounts received under such grant, 
                contract, or agreement will not be expended--
                            ``(i) to provide inpatient services;
                            ``(ii) to make cash payments to intended 
                        recipients of services;
                            ``(iii) to purchase or improve land, 
                        purchase, construct, or permanently improve 
                        (other than minor remodeling) any building or 
                        other facility, or purchase major medical 
                        equipment; or
                            ``(iv) to satisfy any requirement for the 
                        expenditure of non-Federal funds as a condition 
                        for the receipt of Federal funds.
                    ``(B) Funding agreement.--A funding agreement for a 
                grant, contract, or cooperative agreement under this 
                section is that the entity involved will not expend 
                more than 10 percent of the grant, contract, or 
                agreement for administrative expenses with respect to 
                the grant, contract, or agreement.
    ``(d) Reduction in Payments.--The Secretary, at the request of a 
State or a political subdivision of a State, or a public or private 
nonprofit entity, may reduce the amount of payments under this section 
by--
            ``(1) the fair market value of any supplies or equipment 
        furnished the State, political subdivision of the State, or a 
        public or private nonprofit entity; and
            ``(2) the amount of the pay, allowances, and travel 
        expenses of any officer, fellow, or employee of the Government 
        when detailed to the State, a political subdivision of the 
        State, or a public or private non-profit entity, and the amount 
        of any other costs incurred in connection with the detail of 
        such officer, fellow, or employee;
when the furnishing of such officer, fellow, or employee is for the 
convenience of and at the request of the State, political subdivision 
of the State, or public or private non-profit entity and for the 
purpose of conducting activities described in this section. The amount 
by which any payment is so reduced shall be available for payment by 
the Secretary of the costs incurred in furnishing the supplies or 
equipment or in detailing the personnel, on which the reduction of the 
payment is based, and the amount shall be deemed to have been paid to 
the State, political subdivision of the State, or public or private 
non-profit entity.
    ``(e) Evaluation.--The Secretary shall evaluate each project 
carried out under section (a)(1)(B) and shall
 disseminate the findings with respect to each such evaluation to 
appropriate public and private entities.
    ``(f) Information and Education.--
            ``(1) In general.--The Secretary shall establish 
        information and education programs to disseminate the findings 
        of the research, demonstration, and training programs under 
        this section to the general public and to health professionals.
            ``(2) Dissemination.--The Secretary shall take such action 
        as may be necessary to insure that all methods of dissemination 
        and exchange of information are maintained between the 
        Substance Abuse and Mental Health Services Administration and 
        the public, and the Administration and other scientific 
        organizations, both nationally and internationally.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $352,000,000 for fiscal year 
1996, and such sums as may be necessary for each of the fiscal years 
1997 through 1999.''.

SEC. 212. REPEALS.

    The following provisions of the Public Health Service Act are 
repealed:
            (1) Section 508 (42 U.S.C. 290bb-1) relating to residential 
        treatment programs for pregnant women.
            (2) Section 509 (42 U.S.C. 290bb-2) relating to outpatient 
        treatment programs for pregnant and postpartum women.
            (3) Section 511 (42 U.S.C. 290bb-4) relating to substance 
        abuse treatment in State and local criminal justice systems.
            (4) Section 512 (42 U.S.C. 290bb-5) relating to training in 
        the provision of treatment services.
            (5) Paragraph (5) of section 515(b) (42 U.S.C. 290bb-
        21(b)(5)) relating to the activities of the Office of Substance 
        Abuse Prevention. Paragraphs (6) through (10) of such section 
        shall be redesignated as paragraphs (5) through (9), 
        respectively.
            (6) Section 516 (42 U.S.C. 290bb-22) relating to community 
        prevention programs.
            (7) Section 517 (42 U.S.C. 290bb-23) relating to high risk 
        youth demonstrations.
            (8) Section 518 (42 U.S.C. 290bb-24) relating to employee 
        assistance programs.
            (9) Section 571 (42 U.S.C. 290gg) relating to the National 
        Capital Area Demonstration Program.
            (10) Section 1943(a)(1) (42 U.S.C. 300x-53(a)(1)) relating 
        to peer review.
            (11) Section 1971 (42 U.S.C. 300y) relating to categorical 
        grants to States.

                     TITLE III--GENERAL PROVISIONS

SEC. 301. REPORTING BY STATES ON PERFORMANCE.

    Section 1942(a) (42 U.S.C. 300x-52(a)) is amended--
            (1) in paragraph (1), by striking ``and'' at the end 
        thereof;
            (2) in paragraph (2), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end thereof the following:
            ``(3) the performance of the State in relation to the 
        objectives specified or agreed upon under sections 1912(b)(5) 
        or section 1921A(b)(5), as applicable.''.

SEC. 302. ON SITE PERFORMANCE REVIEWS.

    Section 1945(g)(1) (42 U.S.C. 300x-55(g)(1)) is amended by striking 
``in fiscal year 1994'' and all that follows through the end thereof 
and inserting ``, not more frequently than once every 3 nor less 
frequently than once every 5 years, conduct an on-site performance 
review of a State's activities supported under this part.''.

SEC. 303. ADDITIONAL YEAR FOR OBLIGATION BY STATE.

    Section 1952(a) (42 U.S.C. 300x-62(a)) is amended by striking 
``until the end'' and all that follows through the end thereof and 
inserting ``and expenditure until the end of the fiscal year following 
the fiscal year for which the amounts were paid.''.

SEC. 304. DEFINITIONS.

    Section 1954(b) (42 U.S.C. 300x-64(B)) is amended by adding the 
following new paragraphs at the end thereof:
            ``(5) The term `performance indicator' means a quantifiable 
        characteristic used as a measurement.
            ``(6) The term `performance target' means a numerical value 
        sought to be achieved within a specified period of time.''.

SEC. 305. REPEAL OF OBSOLETE PROVISIONS CONCERNING ALLOCATIONS.

    (a) In General.--Section 1933 (42 U.S.C. 300x-33) is amended--
            (1) by striking subsection (b);
            (2) in subsection (c)(2)--
                    (A) in subparagraph (A), by adding ``and'' at the 
                end thereof;
                    (B) in subparagraph (B), by striking ``; and'' at 
                the end of subparagraph (B) and inserting a period; and
                    (C) by striking subparagraph (C); and
            (3) by redesignating subsections (c) and (d) as subsection 
        (b) and (c), respectively.
    (b) Conforming Amendment.--Section 1923(h) (as so redesignated by 
section 201(c)(4)(A)) is amended by striking ``section 1933(c)(2)(B)'' 
and inserting ``section 1933(b)(2)(B)''.

SEC. 306. REPEAL OF OBSOLETE ADDICT REFERRAL PROVISIONS.

    (a) Repeal of Obsolete Public Health Service Act Authorities.-- 
Part E of title III (42 U.S.C. 257 et seq.) is repealed.
    (b) Repeal of Obsolete NARA Authorities.--Titles III and IV of the 
Narcotic Addict Rehabilitation Act of 1966 are repealed.
    (c) Repeal of Obsolete Title 28 Authorities.--
            (1) In general.--Chapter 175 of title 28, United States 
        Code, is repealed.
            (2) Table of contents.--The table of contents to part VI of 
        title 28, United States Code, is amended by striking the items 
        relating to chapter 175.

SEC. 307. REGULATIONS.

    Section 1949 (42 U.S.C. 300x-59) is amended to read as follows:

``SEC. 1949. REGULATIONS.

    ``The Secretary shall promulgate regulations as the Secretary 
determines are necessary to carry out this part.''.

SEC. 308. ADVISORY COUNCILS.

    Section 502(b)(3)(A) (42 U.S.C. 290aa-1(b)(3)(A)) is amended by 
inserting ``and leading representatives from State and local 
governments'' after ``sciences)''.

SEC. 309. REPORT ON DEVELOPMENT OF PARTNERSHIPS AND USE OF GRANTS.

    Not later than January 1, 1999, the Secretary of Health and Human 
Services shall prepare and submit to the appropriate committees of 
Congress a report that contains--
            (1) information concerning the adequacy of outcome data 
        sets to measure State performance with respect to amounts 
        received by the State under subparts I and II of part B of 
        title XIX of the Public Health Service Act (as amended by this 
        Act);
            (2) information concerning the range and types of 
        performance partnership objectives and measures utilized by the 
        State under such subparts; and
            (3) a plan, if determined by the Secretary to be feasible 
        after considering information received under such subparts, for 
        the implementation of incentive-based performance partnership 
        grants that shall include a disclosure of public comments.

 TITLE IV--REAUTHORIZATION OF PROTECTION AND ADVOCACY FOR MENTALLY ILL 
                        INDIVIDUALS ACT OF 1986

SEC. 401. SHORT TITLE.

    The first section of the Protection and Advocacy for Mentally Ill 
Individuals Act of 1986 (Public Law 99-319) is amended to read as 
follows:

``SECTION 1. SHORT TITLE.

    ``This Act may be cited as the `Protection and Advocacy for 
Individuals With Mental Illnesses Act'.''.

SEC. 402. REAUTHORIZATION.

    Section 117 of the Protection and Advocacy for Individuals With 
Mental Illnesses Act (as amended by section 401) (42 U.S.C. 10827) is 
amended by striking ``1995'' and inserting ``1999''.

SEC. 403. ALLOTMENT FORMULA.

    (a) Minimum Amount.--Section 112(a)(2) of the Protection and 
Advocacy for Mentally Ill Individuals Act (as amended by section 401) 
(42 U.S.C. 10822(a)(2)) is amended to read as follows:
    ``(2)(A) The minimum amount of the allotment of an eligible system 
shall be the product (rounded to the nearest $100) of the appropriate 
base amount specified in subparagraph (B) and the factor specified in 
subparagraph (C).
    ``(B) For purposes of subparagraph (A), the appropriate base 
amount--
            ``(i) for American Samoa, Guam, the Marshall Islands, the 
        Federated States of Micronesia, the Commonwealth of the 
        Northern Mariana Islands, the Republic of Palau, and the Virgin 
        Islands, is $139,300; and
            ``(ii) for any other State, is $260,000.
    ``(C) For purposes of subparagraph (A), the factor specified in 
this subparagraph is the ratio of the amount appropriated under section 
117 for the fiscal year for which the allotment is being made to the 
amount appropriation under such section for fiscal year 1995.''.
    (b) Technical Amendments.--Section 112(a) of such Act (42 U.S.C. 
10822(a)) is amended--
            (1) in paragraph (1)(B), by striking ``Trust Territory of 
        the Pacific Islands'' and inserting ``Marshall Islands, the 
        Federated States of Micronesia, the Republic of Palau''; and
            (2) by striking paragraph (3).
             TITLE V--REAUTHORIZATION OF CERTAIN INSTITUTES

SEC. 501. REAUTHORIZATION OF CERTAIN INSTITUTES.

    (a) National Institute on Alcohol Abuse and Alcoholism.--Section 
464H(d)(1) (42 U.S.C. 285m(d)(1)) is amended by striking ``for fiscal 
year 1994'' and inserting ``for each of the fiscal years 1994 through 
1996''.
    (b) National Institute on Drug Abuse.--
            (1) In general.--Section 464L(d)(1) (42 U.S.C. 285o(d)(1)) 
        is amended by striking ``for fiscal year 1994'' and inserting 
        ``for each of the fiscal years 1995 and 1996''.
            (2) Medication development program.--Section 464P(e) (42 
        U.S.C. 285o-4(e)) is amended by striking ``and $95,000,000 for 
        fiscal year 1994'' and inserting ``$95,000,000 for fiscal year 
        1994, and such as may be necessary for each of the fiscal years 
        1995 and 1996''.
    (c) National Institute of Mental Health.--Section 464R(f)(1) (42 
U.S.C. 285p(f)(1)) is amended by striking ``for fiscal year 1994'' and 
inserting ``for each of the fiscal years 1994 through 1996''.

          TITLE VI--TRANSITION PROVISIONS AND EFFECTIVE DATES

SEC. 601. TRANSITION PROVISIONS AND EFFECTIVE DATES.

    (a) Objective and Data Development Process.--
            (1) In general.--The Secretary of Health and Human Services 
        (hereafter referred to in this section as the ``Secretary'') 
        shall develop and implement a process to--
                    (A) establish a model set of mental health and 
                substance abuse prevention and treatment objectives 
                that, to the extent practicable, meet the requirements 
                of sections 1911 and 1921 of the Public Health Service 
                Act (as amended by sections 101(b) and 201(b) of this 
                Act);
                    (B) determine the availability, relevancy, and 
                sufficiency of data necessary to measure capacity, 
                process, or outcomes with respect to such model set of 
                objectives; and
                    (C) establish a plan to improve the availability, 
                relevancy, and sufficiency of data if the data sets 
                that are available at the time such process is being 
                developed are determined to be inadequate.
            (2) Consultation.--In carrying out paragraph (1), the 
        Secretary shall consult with representatives from State and 
        local governments, Indian Tribes, mental health and substance 
        abuse service providers, consumers and families, researchers, 
        and other individuals who have technical relevancy with respect 
        to the development of the process under such paragraph.
            (3) Implementation.--In implementing the process under 
        paragraph (1), the Secretary may award a contract to an 
        independent entity for--
                    (A) the conduct of a technical analysis of the 
                availability, relevancy, and sufficiency of data sets 
                existing on the date on which such contract is awarded; 
                and
                    (B) the development of a data strategy if such 
                existing data sets are determined to be insufficient to 
                measure the model set of mental health and substance 
                abuse prevention and treatment objectives developed 
                under paragraph (1)(A).
    (b) General Effective Date.--Except as provided in subsection (c), 
this Act shall take effect on the date of enactment of this Act or 
October 1, 1995, whichever occurs later.
    (c) Exceptions.--
            (1) Performance partnerships.--The amendments made by 
        sections 101 and 201 shall take effect on the date on which the 
        Secretary of Health and Human Services determines that the 
        model set of objectives and the data sets described in 
        subsection (a) have been developed and are sufficient and 
        available to measure process/capacity or outcomes, but in no 
        event earlier than October 1, 1997.
            (2) Preparation and negotiation.--The Secretary of Health 
        and Human Services may consult with the States, and others, in 
        preparing for the implementation of the performance partnership 
        grants under the amendments made by this Act. In no event shall 
        such Secretary require a State to begin the negotiation process 
        for the implementation of a performance partnership grant for a 
        fiscal year prior to fiscal year 1998.
            (3) Specific effective dates.--Sections 103 and 207 
        (relating to maintenance of effort), sections 104 and 208 
        (relating to for-profit eligibility), section 203 (relating to 
        tuberculosis and HIV), section 204 (relating to group home 
        revolving loan funds), and section 303 (relating to the 
        additional year for obligation), shall become effective as if 
        enacted on October 1, 1994.
            (4) Mandatory exemptions.--
                    (A) In general.--Effective on the date on which the 
                Secretary of Health and Human Services determines that 
                the objectives and data described in subsection (a) 
                have been developed and are relevant, sufficient, and 
                available to measure performance in each State, a State 
                shall be exempt from the requirements described in 
                subparagraph (C). If the Secretary determines, using 
                data with respect to the intended purpose of any such 
                requirement, that the State has a significant need to 
                improve the outcomes related to the intended purposes 
                of any such requirements, the Secretary may require the 
                State to utilize an objective that addresses the 
                intended purpose of any such requirement.
                    (B) Consultation process.--Until the Secretary 
                makes the determination described in subparagraph (A), 
                a State shall--
                            (i) comply with the requirements described 
                        in subparagraph (C); or
                            (ii) select objectives to be measured that 
                        would address the intended purpose of each of 
                        such requirements.
                    (C) Requirements.--The requirements described in 
                this subparagraph are the requirements contained in the 
                following:
                            (i) Section 1922(b) (42 U.S.C. 300x-21) (as 
                        amended by this Act), relating to minimum 
                        allocation of funds for services to pregnant 
                        women and women with dependent children.
                            (ii) Section 1923 (42 U.S.C. 300x-23), 
                        relating to whether injecting drug users have 
                        timely access to treatment upon request.
                            (iii) Section 1924 (42 U.S.C. 300x-24), 
                        relating to requirements related to 
                        tuberculosis and HIV.
                            (iv) Section 1926 (42 U.S.C. 300x-26), 
                        relating to curtailing the sale of tobacco 
                        products to persons under the age of 18.
                            (v) Section 1927 (42 U.S.C. 300x-27), 
                        relating to preference in the admission of 
                        pregnant women for treatment.
                            (vi) Section 1929 (42 U.S.C. 300x-29), 
                        relating to the needs assessments.
    (d) Existing Projects.--A project that receives support for fiscal 
year 1996, 1997, 1998, or 1999 under section 506 or 520A of the Public 
Health Service Act (as amended by section 108 or 109(2), respectively), 
and that previously received support under title V of the Public Health 
Service Act for fiscal year 1995, shall be subject to the requirements 
to which that project was subject to for fiscal year 1995 unless the 
Secretary of Health and Human Services determines otherwise.
    (e) Waivers.--Notwithstanding any other provision of this Act, or 
an amendment made by this Act, the Secretary of Health and Human 
Services may grant a State a waiver to permit such State to operate a 
performance partnership program prior to fiscal year 1998. Such 
programs shall be operated under the requirements described in the 
amendments made by sections 101 and 201 and shall be funded using 
amounts appropriated for the fiscal year involved under part B of title 
XIX of the Public Health Service Act.
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