[Congressional Record (Bound Edition), Volume 145 (1999), Part 19]
[Senate]
[Pages 26977-26980]
[From the U.S. Government Publishing Office, www.gpo.gov]



                           CBO COST ESTIMATE

  Mr. JEFFORDS. Mr. President, on October 19, 1999, I filed Report No. 
106-196 to accompany S. 976, a bill to amend title V of the Public 
Health Service Act to focus the authority of the Substance Abuse and 
Mental Health Services Administration on community-based services for 
children and adolescents, to enhance flexibility and accountability, to 
establish programs for youth treatment, and to respond to crises, 
especially those related to children and violence. At the time the 
report was filed, the estimate by the Congressional Budget Office was 
not available. I ask unanimous consent that a copy of the CBO estimate 
be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                    U.S. Congress,


                                  Congressional Budget Office,

                                 Washington, DC, October 26, 1999.
     Hon. James M. Jeffords,
     Chairman, Committee on Health, Education, Labor, and 
         Pensions, U.S. Senate, Washington, DC.
       Dear Mr. Chairman: The Congressional Budget Office has 
     prepared the enclosed cost estimate for S. 976, the Youth 
     Drug and Mental Health Services Act.
       If you wish further details on this estimate, we will be 
     pleased to provide them. The CBO staff contacts are Julia 
     Christensen (for federal costs), who can be reached at 226-
     9010, and Leo Lex (for the state and local impact), who can 
     be reached at 225-3220.
           Sincerely,
                                                 Barry B. Anderson
                                   (For Dan L. Crippen, Director).
       Enclosure.
     S. 976--Youth Drug and Mental Health Services Act
       Summary: S. 976 would reauthorize certain programs of the 
     Substance Abuse and Mental Health Services Administration 
     (SAMHSA) through fiscal year 2002. The bill would consolidate 
     programs currently operated under the Knowledge and 
     Development Application (KDA) and Targeted Capacity Expansion 
     (TCE) programs into three programs that target priorities for 
     mental health and prevention and treatment of substance 
     abuse. The bill would explicitly repeal certain programs and 
     would transfer general discretionary grant authority for 
     demonstrations, training, and other purposes to these new 
     programs. In addition, the bill would reauthorize SAMHSA's 
     Mental Health and Substance Abuse Prevention and Treatment 
     Block Grants and would continue the transition of those block 
     grant programs into federal-state performance partnerships. 
     S. 976 also would create several new programs that focus on 
     children and adolescents.
       To fund programs administered by SAMHSA, the bill would 
     authorize the appropriation of about $4.1 billion for 2000 
     and such sums as may be necessary for 2001 and 2002. Assuming 
     the appropriation of the necessary amounts, CBO estimates 
     that implementing S. 976 would cost about $1.5 billion in 
     2000 and $12.2 billion over the 2000-2004 period. Enacting S. 
     976 would not affect direct spending or receipts; therefore, 
     pay-as-you-go procedures would not apply.
       S. 976 contains no intergovernmental or private-sector 
     mandates as defined in the Unfunded Mandates Reform Act 
     (UMRA). However, the bill would provide significant funding 
     to both public and private entities for programs dealing with 
     substance abuse and mental health.
       Estimated cost to the Federal Government: The estimated 
     budgetary impact of S. 976 is shown in the following table. 
     For the purposes of this estimate, CBO assumes that the bill 
     will be enacted this fall and that the necessary 
     appropriations will be provided for each fiscal year. The 
     table summarizes the budgetary impact of the legislation 
     under two different sets of assumptions. The first set of 
     assumptions provides the estimated levels of authorizations 
     with annual adjustments for anticipated inflation, when 
     appropriate, after fiscal year 2000. The second set of 
     assumptions does not include any such inflation adjustments. 
     The costs of this legislation would fall within budget 
     function 550 (health).

[[Page 26978]]



----------------------------------------------------------------------------------------------------------------
                                                      By fiscal years, in millions of dollars--
                                   -----------------------------------------------------------------------------
                                        1999         2000         2001         2002         2003         2004
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION
 
                                         With Adjustments for Inflation
 
SAMHSA Spending Under Current Law:
    Budget Authority \1\..........        2,488        (\2\)            0            0            0            0
    Estimated Outlays.............        2,235        1,427          182           75            0            0
Proposed Changes:
    Estimated Authorization Level.            0        4,122        4,266        4,358            0            0
    Estimated Outlays.............            0        1,452        3,317        3,976        2,634          787
SAMHSA Spending Under S. 976:
    Estimated Authorization Level         2,488        4,122        4,266        4,358            0            0
     \1\..........................
    Estimated Outlays.............        2,235        2,879        3,499        4,050        2,634          787
 
                                        Without Adjustments for Inflation
 
SAMHSA Spending Under Current Law:
    Budget Authority \1\..........        2,488        (\2\)            0            0            0            0
    Estimated Outlays.............        2,235        1,427          182           75            0            0
Proposed Changes:
    Estimated Authorization Level.            0        4,122        4,122        4,122            0            0
    Estimated Outlays.............            0        1,452        3,267        3,828        2,510          750
SAMHSA Spending Under S. 976:
    Estimated Authorization Level         2,488        4,122        4,122        4,122            0            0
     \1\..........................
    Estimated Outlays.............        2,235        2,879        3,449        3,903        2,510          750
----------------------------------------------------------------------------------------------------------------
\1\ The 1999 level is the amount appropriated for that year.
\2\ Amounts appropriated for SAMHSA in Public Laws 106-62 and 106-75, the fiscal year 2000 continuing
  resolutions that provide funding through October 29, 1999, are not included in this estimate. Thus far, no
  full-year appropriations for SAMHSA programs have been provided for 2000.

     Basis of Estimate
       Provisions relating to services for children and 
           adolescents
       Projects for Children and Violence. S. 976 would authorize 
     two discretionary grant programs that focus on issues 
     surrounding children and violence. The bill would authorize 
     the appropriation of $100 million in 2000 and such sums as 
     necessary for 2001 and 2002 for making grants to public 
     entities in support of local community programs. The bill 
     also would allow the Secretary of Health and Human Services 
     (HHS) to use those funds to carry out community assistance 
     programs. Projects supported by grants must adopt a 
     comprehensive approach to helping children deal with 
     violence. S. 976 also would authorize $50 million in 2000 and 
     such sums as necessary for 2001 and 2002 for a grant program 
     to sponsor the development of best practices for treating 
     psychiatric disorders associated with violence-related 
     stress. Grant assistance would also be available to establish 
     technical assistance centers that would directly help 
     communities deal with violence. These programs would cost $18 
     million in 2000 and $422 million during the 2000-2004 period, 
     assuming appropriation of the necessary amounts.
       High-Risk Youth. The bill would reauthorize the High-Risk 
     Youth Program at such sums as necessary for 2000 through 
     2002. Based on the amount spent on this activity in the past, 
     CBO estimates that continuing the program would require 
     appropriations of about $7 million a year for 2000 through 
     2002. Subject to the appropriation of the estimated amounts, 
     CBO estimates that implementing this provision would cost $2 
     million in 2000 and $21 million during the 2000-2004 period.
       Substance Abuse Treatment Services for Children and 
     Adolescents. Section 104 of S. 976 would authorize three 
     grant programs that would provide assistance to public and 
     private nonprofit entities for substance abuse services for 
     children and adolescents. Those programs would increase 
     access to substance abuse treatment and early intervention 
     services for children and adolescents and target prevention 
     activities against methamphetamine or inhalant abuse and 
     addiction among youths. The bill would require that SAMHSA 
     conduct an evaluation of methamphetamine and inhalant 
     prevention programs and submit to the Congress an annual 
     report on the effectiveness of those programs. The bill also 
     would authorize a grant program that would fund up to four 
     youth interagency research, training, and technical 
     assistance centers. S. 976 would authorize $74 million in 
     2000 for these programs and such sums as necessary amounts, 
     CBO estimates that these programs would cost $7 million in 
     2000 and $205 million during the 2000-2004 period.
       Comprehensive Community Services for Children with Serious 
     Emotional Disturbances. S. 976 would reauthorize the 
     Comprehensive Community Mental Health Services for Children 
     and Their Families Program through 2002. The bill would allow 
     the Secretary of HHS to waive certain program requirements 
     for territories, Indian tribes, and tribal organizations. The 
     bill also would increase the grant duration from five years 
     to six years. It would permit current grantees to receive a 
     noncompetitive award in the sixth year equal to the amount 
     awarded in the fifth year. The bill would authorize $100 
     million for the program in 2000 and such sums as necessary 
     for 2001 and 2002. Subject to appropriation of the necessary 
     amounts, CBO estimates that implementing this provision would 
     cost $16 million in 2000 and $290 million over the 2000-2004 
     period.
       Services for Children of Substance Abusers. S. 976 would 
     reauthorize the Services for Children of Substance Abusers 
     Program and transfer its authority within HHS from the Health 
     Resources and Services Administration (HRSA) to SAMHSA. This 
     program was never directly funded under HRSA. The 
     reauthorized program would provide grants to public and 
     private nonprofit entities to support a range of services for 
     children of substance abusers, including primary health care, 
     counseling, and referral services. It also would provide 
     services to affected families and would allow funds to be 
     used for training certain providers of services covered under 
     the program. For this program, S. 976 would authorize 
     appropriations of $50 million in 2000 and such sums as 
     necessary for 2001 and 2002. Implementing this program would 
     cost $5 million in 2000 and $148 million during the 2000-2004 
     period.
       Services for Youth Offenders. Section 107 of the bill would 
     authorize a program to award competitive grants to state and 
     local juvenile justice agencies. Funds would support services 
     for youth offenders following their discharge from juvenile 
     or criminal justice facilities. Individuals qualifying for 
     those services also must have or be at risk of developing a 
     serious and diagnosable mental, behavioral, or emotional 
     disorder. The bill would limit spending on funds used toward 
     planning and transition costs for youths during their 
     incarceration to 20 percent of the amount of each grant. S. 
     976 would authorize $40 million in 2000 and such sums as 
     necessary for 2001 and 2002. CBO estimates that implementing 
     this program would cost $4 million in 2000 and $111 million 
     during the 2000-2004 period.
       Emergency Response. S. 976 would permit the Secretary of 
     HHS to use up to 3 percent of discretionary funds 
     appropriated to SAMHSA under title V of the Public Health 
     Service Act, excluding amounts appropriated to the Project 
     for Assistance in Transition from Homeless (PATH) Program, to 
     make noncompetitive grants to address emergency situations. 
     The bill would require that the Secretary publish objective 
     criteria that would be used to establish the appropriate uses 
     for the emergency funds.
       Other Provisions. The bill also would reauthorize the 
     general authorities of SAMHSA under section 501 of the Public 
     Health Service Act. S. 976 would authorize $25 million in 
     2000 and such sums as necessary for 2001 and 2002 for the 
     purpose of providing grants, cooperative agreements, and 
     contracts under section 501. According to SAMHSA, 
     authorizations for this program are intended as a safety-net 
     mechanism for the agency; therefore, CBO estimates that no 
     additional amounts would be required for 2001 and 2002. 
     However, assuming the appropriation of the authorized amount 
     in 2000, CBO estimates that minimal spending would arise from 
     this authority--about $1 million in 2000 and $8 million over 
     the 2000-2004 period.
       Provisions relating to mental health
       Priority Mental Health Needs of Regional and National 
     Significance. S. 976 would consolidate SAMHSA's discretionary 
     authorities for certain mental health activities, including 
     those currently funded through its KDA program, under a new 
     program. The bill would repeal certain programs and would 
     transfer general discretionary grant authority for 
     demonstrations, training, and other purposes to the new 
     program. Under the consolidated program, competitive grants 
     would be disbursed to states, political subdivisions of 
     states, Indian tribes and tribal organizations, other public 
     entities, and private nonprofit organizations. Funds could be 
     used to provide training and technical assistance, develop 
     best practices in the mental health field for prevention, 
     treatment and rehabilitation (and evaluations), establish 
     programs to help states and communities target gaps in 
     prevention services, and develop family

[[Page 26979]]

     and consumer networks. S. 976 would authorize $300 million in 
     2000 and such sums as necessary for 2001 through 2002. 
     Subject to appropriation of the necessary amounts, CBO 
     estimates that this program would cost $30 million in 2000 
     and $862 million during the 2000-2004 period.
       Community Mental Health Services Performance Partnership 
     Block Grant. S. 976 would provide for a full transition of 
     SAMHSA's Block Grants for Community Mental Health Services 
     Program to the Community Mental Health Services Performance 
     Partnership model. The bill would authorize the appropriation 
     of $450 million for the program in 2000 and such sums as 
     necessary for 2001 and 2002. Subject to appropriation of the 
     necessary amounts, CBO estimates that this provision would 
     cost $189 million in 2000 and $1.3 billion during 2000 
     through 2004.
       Under the performance partnership grant program, states 
     enter into agreements, or ``performance partnerships,'' with 
     the Secretary of HHS. The federal-state partnership 
     identifies goals and objectives and develops performance 
     indicators, that will be used to help states and grant 
     recipients ultimately reach their programmatic targets. The 
     program is designed to foster the development of networks 
     that promote a comprehensive approach to community-based 
     mental health care. The bill would replace the current 
     requirements for state plan submissions with five broad 
     criteria. In addition, S. 976 would establish the amount each 
     state received in 1998 as the minimum for 2000 and subsequent 
     years.
       Grants for the Benefit of Homeless Individuals. The bill 
     would authorize $50 million for this program in 2000 and such 
     sums as necessary for 2001 and 2002. The program received no 
     appropriation in 1999. This program would cost $8 million in 
     2000 and $146 million over the 2000-2004 period, assuming 
     appropriation of the necessary amounts.
       PATH Program. The Projects for Assistance in Transition 
     from Homelessness Program would be reauthorized through 2002. 
     The bill also would provide the Secretary of HHS with new 
     authority to waive requirements for entities to provide 
     certain services under the program. The bill would authorize 
     the appropriation of $75 million a year from 2000 through 
     2002. Subject to the appropriation of the authorized amounts, 
     this program would cost $29 million in 2000 and $218 million 
     during 2000 through 2004.
       Protection and Advocacy. S. 976 would reauthorize the 
     Protection and Advocacy for Mentally Ill Individuals Act of 
     1986 at such sums as necessary for 2000 through 2002. The 
     provision also would revise the minimum allotment formula 
     under the formula grant. In addition, the bill would change 
     the name of the act to the ``Protection and Advocacy for 
     Individuals with Mental Illnesses Act.'' CBO estimates that 
     carrying out this provision would require appropriations of 
     $23 million a year, adjusted for inflation. Implementing this 
     program would cost $12 million in 2000 and $70 million during 
     the 2000-2004 period, assuming appropriation of the estimated 
     amounts.
       Provisions relating to substance abuse
       Priority Substance Abuse Treatment Needs of Regional and 
     National Significance. S. 976 would replace SAMHSA's 
     substance abuse treatment projects as currently funded under 
     the KDA and TCE programs with a new program that targets 
     treatment needs. The bill would repeal certain programs and 
     would consolidate general discretionary grant authority for 
     demonstrations, training, and other purposes under the new 
     program. The bill would authorize $300 million in 2000 and 
     such sums as necessary for 2001 and 2002. Assuming 
     appropriation of the necessary amounts, this program would 
     cost $39 million in 2000 and $870 million during 2000 through 
     2004.
       Priority Substance Abuse Prevention Needs of Regional and 
     National Significance. Similarly, S. 976 would replace 
     SAMHSA's substance abuse prevention activities as currently 
     funded under the KDA and TCE programs with a new program that 
     funds projects targeting prevention needs. The new program 
     would consolidate SAMHSA's discretionary grant authority for 
     certain substance abuse prevention programs within a single 
     program. The bill would authorize $300 million in 2000 and 
     such sums as necessary for 2001 and 2002. Subject to the 
     appropriation of necessary funds, this program would cost $36 
     million in 2000 and $869 million during the 2000-2004 period.
       Substance Abuse Prevention and Treatment Performance 
     Partnership Block Grant. S. 976 would provide for a full 
     transition of the Substance Abuse Prevention and Treatment 
     Block Grant to the Substance Abuse Prevention and Treatment 
     Performance Partnership Block Grant model. The bill would 
     authorize $2 billion for 2000 and such sums as necessary for 
     2001 and 2002. We estimate that this provision would cost 
     $988 million in 2000 and $6.1 billion over the 2000-2004 
     period, assuming appropriation of the necessary funds.
       Under the performance partnership model, the Secretary 
     works with the states and other interested groups to develop 
     programmatic goals, objectives, and performance measures with 
     the intent of reducing the prevalence of substance abuse and 
     improving access to preventive and treatment services.
       S. 976 would repeal or amend some of the requirements under 
     current law, while retaining others. For example, the bill 
     would remove the mandate that states use 35 percent of funds 
     for alcohol abuse prevention and treatment activities and 35 
     percent of funds for other drug abuse prevention and 
     treatment activities. In addition, the bill would allow 
     states to request waivers of certain other spending 
     allocation requirements. S. 976 would provide states with 
     greater flexibility in allocating grant funds and allows an 
     additional year to obligate and spend them. The bill also 
     would permanently revise the minimum allotment determination.
       Alcohol and Drug Prevention or Treatment Services for 
     Indians and Native Alaskans. S. 976 would authorize grants to 
     provide substance abuse prevention and treatment services for 
     Indian tribes, tribal organizations, and Native Alaskans. The 
     bill also would establish a commission to study and report on 
     health care issues in these populations. It would authorize 
     $15 million for the prevention and treatment program and $5 
     million for the commission in 2000 and such sums as necessary 
     in 2001 and 2002. Subject to appropriation of the necessary 
     amounts, these provisions would cost $2 million in 2000 and 
     $55 million during 2000 through 2004.
       Other provisions
       Data Infrastructure. S. 976 would authorize such sums as 
     necessary for 2000 through 2002 for a new grant program to 
     support data infrastructure development in the states. To 
     facilitate compliance with performance partnership 
     requirements, the bill would provide financial assistance for 
     states to develop and operate mental health and substance 
     abuse data collection, analysis, and reporting systems. CBO 
     estimates that the necessary authorization would be $100 
     million in each year, adjusted for inflation. Assuming 
     appropriation of the estimated amounts, implementing this 
     provision would cost $10 million in 2000 and $271 million 
     over the 2000-2004 period.
       Miscellaneous Provisions. The bill would provide states 
     with additional flexibility in their use of federal grant 
     funds while enhancing accountability through effective 
     performance measurements. The bill also would reduce some of 
     SAMHSA's administrative costs associated with managing its 
     programs. On balance, CBO estimates that the administrative 
     burden associated with the proposed expansion of programs 
     under SAMHSA's management, including the costs of 
     promulgating new regulations and submitting additional 
     reports to the Congress, would exceed any savings that would 
     be generated by the bill. Although S. 976 does not explicitly 
     authorize funding for program management, CBO estimates 
     authorizations of appropriations for SAMHSA program 
     administration under S. 976 at $58 million in 2000 and 
     subsequent years, adjusted for inflation. Assuming 
     appropriation of the necessary amounts, such administrative 
     expenses would cost $57 million in 2000 and $180 million over 
     the 2000-2004 period.
       S. 976 also would require the Secretary of HHS to develop 
     and implement new rules concerning use of seclusion and 
     restraints on residents of certain facilities supported by 
     federal funds. The bill also would apply nondiscrimination 
     and institutional safeguards to religious providers of 
     substance abuse services. In cases where a client objects to 
     the religious nature of the organization, the bill would 
     require that appropriate referral services be provided. CBO 
     assumes that, as a condition of grant assistance, states 
     would bear the cost of enforcing compliance with the referral 
     requirement. Finally, the bill would require that the 
     Secretary of HHS submit a report to the Congress within two 
     years of enactment on the issue of prevention and treatment 
     of individuals with co-occurring mental health and substance 
     abuse disorders.
       Pay-as-you-go considerations: The Balanced Budget and 
     Emergency Deficit Control Act sets up pay-as-you-go 
     procedures for legislation affecting direct spending or 
     receipts. Enacting S. 976 as amended by the managers' 
     amendment of October 22, 1999, would not affect direct 
     spending or receipts; therefore, pay-as-you-go procedures 
     would not apply.
       Estimated impact on state, local, and tribal governments: 
     The bill would provide grants to state, local, and tribal 
     governments, as well as other private and nonprofit entities, 
     for substance abuse and mental health programs. The grant 
     programs cover a variety of activities including prevention, 
     intervention, training, counseling, mental health, and 
     community and youth services.
       In most cases, the funds authorized by this bill would be 
     available for grants to both public and private (including 
     nonprofit) entities. However, two large block grants would 
     make funds available to states: the Community Mental Health 
     Services Performance Partnership Block Grant ($450 million in 
     fiscal year 2000) and the Substance Abuse Prevention and 
     Treatment Performance Partnership Block Grant ($2 billion in 
     fiscal year 2000). The bill also would authorize $40 million 
     in fiscal year 2000 for grants to state and local juvenile 
     justice agencies that provide services to youth offenders who 
     have or who may be at risk of developing mental, behavioral, 
     or emotional disorders.
       In some cases, additional conditions of assistance would be 
     placed on grant programs.

[[Page 26980]]

     However, these conditions would not be intergovernmental 
     mandates as defined in UMRA, and overall, state, local, and 
     tribal governments would benefit from increased funding, the 
     extension of existing grant programs, and in many cases a 
     greater degree of flexibility in administering substance 
     abuse programs.
       Estimated impact on the private sector: The bill contains 
     no private-sector mandates as defined in UMRA.
       Estimate prepared by: Federal Costs: Julia Christensen. 
     Impact on State, Local, and Tribal Governments: Leo Lex.
       Estimate approved by: Peter H. Fontaine, Deputy Assistant 
     Director for Budget Analysis.

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