[Congressional Record (Bound Edition), Volume 145 (1999), Part 19]
[Senate]
[Pages 28160-28176]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 28160]]

               YOUTH DRUG AND MENTAL HEALTH SERVICES ACT

  Mr. GRAMM. Mr. President, I ask unanimous consent the Senate now 
proceed to the consideration of Calendar No. 332, S. 976.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 976) 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.

  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Health, Education, Labor, 
and Pensions, with an amendment to strike all after the enacting clause 
and inserting in lieu thereof the following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Youth Drug 
     and Mental Health Services Act''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

 TITLE I--PROVISIONS RELATING TO SERVICES FOR CHILDREN AND ADOLESCENTS

Sec. 101. Children and violence.
Sec. 102. Emergency response.
Sec. 103. High risk youth reauthorization.
Sec. 104. Substance abuse treatment services for children and 
              adolescents.
Sec. 105. Comprehensive community services for children with serious 
              emotional disturbance.
Sec. 106. Services for children of substance abusers.
Sec. 107. Services for youth offenders.
Sec. 108. General provisions.

             TITLE II--PROVISIONS RELATING TO MENTAL HEALTH

Sec. 201. Priority mental health needs of regional and national 
              significance.
Sec. 202. Grants for the benefit of homeless individuals.
Sec. 203. Projects for assistance in transition from homelessness.
Sec. 204. Community mental health services performance partnership 
              block grant.
Sec. 205. Determination of allotment.
Sec. 206. Protection and Advocacy for Mentally Ill Individuals Act of 
              1986.
Sec. 207. Requirement relating to the rights of residents of certain 
              facilities.

           TITLE III--PROVISIONS RELATING TO SUBSTANCE ABUSE

Sec. 301. Priority substance abuse treatment needs of regional and 
              national significance.
Sec. 302. Priority substance abuse prevention needs of regional and 
              national significance.
Sec. 303. Substance abuse prevention and treatment performance 
              partnership block grant.
Sec. 304. Determination of allotments.
Sec. 305. Nondiscrimination and institutional safeguards for religious 
              providers.
Sec. 306. Alcohol and drug prevention or treatment services for Indians 
              and Native Alaskans.

    TITLE IV--PROVISIONS RELATING TO FLEXIBILITY AND ACCOUNTABILITY

Sec. 401. General authorities and peer review.
Sec. 402. Advisory councils.
Sec. 403. General provisions for the performance partnership block 
              grants.
Sec. 404. Data infrastructure projects.
Sec. 405. Repeal of obsolete addict referral provisions.
Sec. 406. Individuals with co-occurring disorders.
Sec. 407. Services for individuals with co-occurring disorders.

 TITLE I--PROVISIONS RELATING TO SERVICES FOR CHILDREN AND ADOLESCENTS

     SEC. 101. CHILDREN AND VIOLENCE.

       Title V of the Public Health Service Act (42 U.S.C. 290aa 
     et seq.) is amended by adding at the end the following:

              ``Part G--Projects for Children and Violence

     ``SEC. 581. CHILDREN AND VIOLENCE.

       ``(a) In General.--The Secretary, in consultation with the 
     Secretary of Education and the Attorney General, shall carry 
     out directly or through grants, contracts or cooperative 
     agreements with public entities a program to assist local 
     communities in developing ways to assist children in dealing 
     with violence.
       ``(b) Activities.--Under the program under subsection (a), 
     the Secretary may--
       ``(1) provide financial support to enable local communities 
     to implement programs to foster the health and development of 
     children;
       ``(2) provide technical assistance to local communities 
     with respect to the development of programs described in 
     paragraph (1);
       ``(3) provide assistance to local communities in the 
     development of policies to address violence when and if it 
     occurs; and
       ``(4) assist in the creation of community partnerships 
     among law enforcement, education systems and mental health 
     and substance abuse service systems.
       ``(c) Requirements.--An application for a grant, contract 
     or cooperative agreement under subsection (a) shall 
     demonstrate that--
       ``(1) the applicant will use amounts received to create a 
     partnership described in subsection (b)(4) to address issues 
     of violence in schools;
       ``(2) the activities carried out by the applicant will 
     provide a comprehensive method for addressing violence, that 
     will include--
       ``(A) security;
       ``(B) educational reform;
       ``(C) the review and updating of school policies;
       ``(D) alcohol and drug abuse prevention and early 
     intervention services;
       ``(E) mental health prevention and treatment services; and
       ``(F) early childhood development and psychosocial 
     services; and
       ``(3) the applicant will use amounts received only for the 
     services described in subparagraphs (D), (E), and (F) of 
     paragraph (2).
       ``(d) Geographical Distribution.--The Secretary shall 
     ensure that grants, contracts or cooperative agreements under 
     subsection (a) will be distributed equitably among the 
     regions of the country and among urban and rural areas.
       ``(e) Duration of Awards.--With respect to a grant, 
     contract or cooperative agreement under subsection (a), the 
     period during which payments under such an award will be made 
     to the recipient may not exceed 5 years.
       ``(f) Evaluation.--The Secretary shall conduct an 
     evaluation of each project carried out under this section and 
     shall disseminate the results of such evaluations to 
     appropriate public and private entities.
       ``(g) Information and Education.--The Secretary shall 
     establish comprehensive information and education programs to 
     disseminate the findings of the knowledge development and 
     application under this section to the general public and to 
     health care professionals.
       ``(h) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $100,000,000 
     for fiscal year 2000, and such sums as may be necessary for 
     each of fiscal years 2001 and 2002.

     ``SEC. 582. GRANTS TO ADDRESS THE PROBLEMS OF PERSONS WHO 
                   EXPERIENCE VIOLENCE RELATED STRESS.

       ``(a) In General.--The Secretary shall award grants, 
     contracts or cooperative agreements to public and nonprofit 
     private entities, as well as to Indian tribes and tribal 
     organizations, for the purpose of establishing a national and 
     regional centers of excellence on psychological trauma 
     response and for developing knowledge with regard to 
     evidence-based practices for treating psychiatric disorders 
     resulting from witnessing or experiencing such stress.
       ``(b) Priorities.--In awarding grants, contracts or 
     cooperative agreements under subsection (a) related to the 
     development of knowledge on evidence-based practices for 
     treating disorders associated with psychological trauma, the 
     Secretary shall give priority to programs that work with 
     children, adolescents, adults, and families who are survivors 
     and witnesses of domestic, school and community violence and 
     terrorism.
       ``(c) Geographical Distribution.--The Secretary shall 
     ensure that grants, contracts or cooperative agreements under 
     subsection (a) with respect to centers of excellence are 
     distributed equitably among the regions of the country and 
     among urban and rural areas.
       ``(d) Evaluation.--The Secretary, as part of the 
     application process, shall require that each applicant for a 
     grant, contract or cooperative agreement under subsection (a) 
     submit a plan for the rigorous evaluation of the activities 
     funded under the grant, contract or agreement, including both 
     process and outcomes evaluation, and the submission of an 
     evaluation at the end of the project period.
       ``(e) Duration of Awards.--With respect to a grant, 
     contract or cooperative agreement under subsection (a), the 
     period during which payments under such an award will be made 
     to the recipient may not exceed 5 years. Such grants, 
     contracts or agreements may be renewed.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $50,000,000 for 
     fiscal year 2000, and such sums as may be necessary for each 
     of fiscal years 2001 and 2002.''.

     SEC. 102. EMERGENCY RESPONSE.

       Section 501 of the Public Health Service Act (42 U.S.C. 
     290aa) is amended--
       (1) by redesignating subsection (m) as subsection (o);
       (2) by inserting after subsection (l) the following:
       ``(m) Emergency Response.--
       ``(1) In general.--Notwithstanding section 504 and except 
     as provided in paragraph (2), the Secretary may use not to 
     exceed 3 percent of all amounts appropriated under this title 
     for a fiscal year to make noncompetitive grants, contracts or 
     cooperative agreements to public entities to enable such 
     entities to address emergency substance abuse or mental 
     health needs in local communities.
       ``(2) Exceptions.--Amounts appropriated under part C shall 
     not be subject to paragraph (1).
       ``(3) Emergencies.--The Secretary shall establish criteria 
     for determining that a substance

[[Page 28161]]

     abuse or mental health emergency exists and publish such 
     criteria in the Federal Register prior to providing funds 
     under this subsection.
       ``(n) Limitation on the Use of Certain Information.--No 
     information, if an establishment or person supplying the 
     information or described in it is identifiable, obtained in 
     the course of activities undertaken or supported under this 
     title may be used for any purpose other than the purpose for 
     which it was supplied unless such establishment or person has 
     consented (as determined under regulations of the Secretary) 
     to its use for such other purpose. Such information may not 
     be published or released in other form if the person who 
     supplied the information or who is described in it is 
     identifiable unless such person has consented (as determined 
     under regulations of the Secretary) to its publication or 
     release in other form.''; and
       (3) in subsection (o) (as so redesignated), by striking 
     ``1993'' and all that follows through the period and 
     inserting ``2000, and such sums as may be necessary for each 
     of the fiscal years 2001 and 2002.''.

     SEC. 103. HIGH RISK YOUTH REAUTHORIZATION.

       Section 517(h) of the Public Health Service Act (42 U.S.C. 
     290bb-23(h)) is amended by striking ``$70,000,000'' and all 
     that follows through ``1994'' and inserting ``such sums as 
     may be necessary for each of the fiscal years 2000 through 
     2002''.

     SEC. 104. SUBSTANCE ABUSE TREATMENT SERVICES FOR CHILDREN AND 
                   ADOLESCENTS.

       Subpart 1 of part B of title V of the Public Health Service 
     Act (42 U.S.C. 290bb et seq.) is amended by adding at the end 
     the following:

     ``SEC. 514. SUBSTANCE ABUSE TREATMENT SERVICES FOR CHILDREN 
                   AND ADOLESCENTS.

       ``(a) In General.--The Secretary shall award grants, 
     contracts, or cooperative agreements to public and private 
     nonprofit entities, including Native Alaskan entities and 
     Indian tribes and tribal organizations, for the purpose of 
     providing substance abuse treatment services for children and 
     adolescents.
       ``(b) Priority.--In awarding grants, contracts, or 
     cooperative agreements under subsection (a), the Secretary 
     shall give priority to applicants who propose to--
       ``(1) apply evidenced-based and cost effective methods for 
     the treatment of substance abuse among children and 
     adolescents;
       ``(2) coordinate the provision of treatment services with 
     other social service agencies in the community, including 
     educational, juvenile justice, child welfare, and mental 
     health agencies;
       ``(3) provide a continuum of integrated treatment services, 
     including case management, for children and adolescents with 
     substance abuse disorders and their families;
       ``(4) provide treatment that is gender-specific and 
     culturally appropriate;
       ``(5) involve and work with families of children and 
     adolescents receiving treatment;
       ``(6) provide aftercare services for children and 
     adolescents and their families after completion of substance 
     abuse treatment; and
       ``(7) address the relationship between substance abuse and 
     violence.
       ``(c) Duration of Grants.--The Secretary shall award 
     grants, contracts, or cooperative agreements under subsection 
     (a) for periods not to exceed 5 fiscal years.
       ``(d) Application.--An entity desiring a grant, contract, 
     or cooperative agreement under subsection (a) shall submit an 
     application to the Secretary at such time, in such manner, 
     and accompanied by such information as the Secretary may 
     reasonably require.
       ``(e) Evaluation.--An entity that receives a grant, 
     contract, or cooperative agreement under subsection (a) shall 
     submit, in the application for such grant, contract, or 
     cooperative agreement, a plan for the evaluation of any 
     project undertaken with funds provided under this section. 
     Such entity shall provide the Secretary with periodic 
     evaluations of the progress of such project and such 
     evaluation at the completion of such project as the Secretary 
     determines to be appropriate.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $40,000,000 for fiscal year 2000, and such sums as may be 
     necessary for fiscal years 2001 and 2002.

     ``SEC. 514A. EARLY INTERVENTION SERVICES FOR CHILDREN AND 
                   ADOLESCENTS.

       ``(a) In General.--The Secretary shall award grants, 
     contracts, or cooperative agreements to public and private 
     nonprofit entities, including local educational agencies (as 
     defined in section 14101 of the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 8801)), for the purpose of 
     providing early intervention substance abuse services for 
     children and adolescents.
       ``(b) Priority.--In awarding grants, contracts, or 
     cooperative agreements under subsection (a), the Secretary 
     shall give priority to applicants who demonstrate an ability 
     to--
       ``(1) screen for and assess substance use and abuse by 
     children and adolescents;
       ``(2) make appropriate referrals for children and 
     adolescents who are in need of treatment for substance abuse;
       ``(3) provide early intervention services, including 
     counseling and ancillary services, that are designed to meet 
     the developmental needs of children and adolescents who are 
     at risk for substance abuse; and
       ``(4) develop networks with the educational, juvenile 
     justice, social services, and other agencies and 
     organizations in the State or local community involved that 
     will work to identify children and adolescents who are in 
     need of substance abuse treatment services.
       ``(c) Condition.--In awarding grants, contracts, or 
     cooperative agreements under subsection (a), the Secretary 
     shall ensure that such grants, contracts, or cooperative 
     agreements are allocated, subject to the availability of 
     qualified applicants, among the principal geographic regions 
     of the United States, to Indian tribes and tribal 
     organizations, and to urban and rural areas.
       ``(d) Duration of Grants.--The Secretary shall award 
     grants, contracts, or cooperative agreements under subsection 
     (a) for periods not to exceed 5 fiscal years.
       ``(e) Application.--An entity desiring a grant, contract, 
     or cooperative agreement under subsection (a) shall submit an 
     application to the Secretary at such time, in such manner, 
     and accompanied by such information as the Secretary may 
     reasonably require.
       ``(f) Evaluation.--An entity that receives a grant, 
     contract, or cooperative agreement under subsection (a) shall 
     submit, in the application for such grant, contract, or 
     cooperative agreement, a plan for the evaluation of any 
     project undertaken with funds provided under this section. 
     Such entity shall provide the Secretary with periodic 
     evaluations of the progress of such project and such 
     evaluation at the completion of such project as the Secretary 
     determines to be appropriate.
       ``(g) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $20,000,000 for fiscal year 2000, and such sums as may be 
     necessary for fiscal years 2001 and 2002.

     ``SEC. 514B. YOUTH INTERAGENCY RESEARCH, TRAINING, AND 
                   TECHNICAL ASSISTANCE CENTERS.

       ``(a) Program Authorized.--The Secretary, acting through 
     the Administrator of the Substance Abuse and Mental Health 
     Services Administration, and in consultation with the 
     Administrator of the Office of Juvenile Justice and 
     Delinquency Prevention, the Director of the Bureau of Justice 
     Assistance and the Director of the National Institutes of 
     Health, shall award grants or contracts to public or 
     nonprofit private entities to establish not more than 4 
     research, training, and technical assistance centers to carry 
     out the activities described in subsection (c).
       ``(b) Application.--A public or private nonprofit entity 
     desiring a grant or contract under subsection (a) shall 
     prepare and submit an application to the Secretary at such 
     time, in such manner, and containing such information as the 
     Secretary may require.
       ``(c) Authorized Activities.--A center established under a 
     grant or contract under subsection (a) shall--
       ``(1) provide training with respect to state-of-the-art 
     mental health and justice-related services and successful 
     mental health and substance abuse-justice collaborations that 
     focus on children and adolescents, to public policymakers, 
     law enforcement administrators, public defenders, police, 
     probation officers, judges, parole officials, jail 
     administrators and mental health and substance abuse 
     providers and administrators;
       ``(2) engage in research and evaluations concerning State 
     and local justice and mental health systems, including system 
     redesign initiatives, and disseminate information concerning 
     the results of such evaluations;
       ``(3) provide direct technical assistance, including 
     assistance provided through toll-free telephone numbers, 
     concerning issues such as how to accommodate individuals who 
     are being processed through the courts under the Americans 
     with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.), what 
     types of mental health or substance abuse service approaches 
     are effective within the judicial system, and how community-
     based mental health or substance abuse services can be more 
     effective, including relevant regional, ethnic, and gender-
     related considerations; and
       ``(4) provide information, training, and technical 
     assistance to State and local governmental officials to 
     enhance the capacity of such officials to provide appropriate 
     services relating to mental health or substance abuse.
       ``(d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated $4,000,000 for fiscal year 2000, and such sums 
     as may be necessary for fiscal years 2001 and 2002.

     ``SEC. 514C. PREVENTION OF METHAMPHETAMINE AND INHALANT ABUSE 
                   AND ADDICTION.

       ``(a) Grants.--The Director of the Center for Substance 
     Abuse Prevention (referred to in this section as the 
     `Director') may make grants to and enter into contracts and 
     cooperative agreements with public and nonprofit private 
     entities to enable such entities--
       ``(1) to carry out school-based programs concerning the 
     dangers of methamphetamine or inhalant abuse and addiction, 
     using methods that are effective and evidence-based, 
     including initiatives that give students the responsibility 
     to create their own anti-drug abuse education programs for 
     their schools; and
       ``(2) to carry out community-based methamphetamine or 
     inhalant abuse and addiction prevention programs that are 
     effective and evidence-based.
       ``(b) Use of Funds.--Amounts made available under a grant, 
     contract or cooperative agreement under subsection (a) shall 
     be used for planning, establishing, or administering 
     methamphetamine or inhalant prevention programs in accordance 
     with subsection (c).
       ``(c) Prevention Programs and Activities.--

[[Page 28162]]

       ``(1) In general.--Amounts provided under this section may 
     be used--
       ``(A) to carry out school-based programs that are focused 
     on those districts with high or increasing rates of 
     methamphetamine or inhalant abuse and addiction and targeted 
     at populations which are most at risk to start 
     methamphetamine or inhalant abuse;
       ``(B) to carry out community-based prevention programs that 
     are focused on those populations within the community that 
     are most at-risk for methamphetamine or inhalant abuse and 
     addiction;
       ``(C) to assist local government entities to conduct 
     appropriate methamphetamine or inhalant prevention 
     activities;
       ``(D) to train and educate State and local law enforcement 
     officials, prevention and education officials, members of 
     community anti-drug coalitions and parents on the signs of 
     methamphetamine or inhalant abuse and addiction and the 
     options for treatment and prevention;
       ``(E) for planning, administration, and educational 
     activities related to the prevention of methamphetamine or 
     inhalant abuse and addiction;
       ``(F) for the monitoring and evaluation of methamphetamine 
     or inhalant prevention activities, and reporting and 
     disseminating resulting information to the public; and
       ``(G) for targeted pilot programs with evaluation 
     components to encourage innovation and experimentation with 
     new methodologies.
       ``(2) Priority.--The Director shall give priority in making 
     grants under this section to rural and urban areas that are 
     experiencing a high rate or rapid increases in 
     methamphetamine or inhalant abuse and addiction.
       ``(d) Analyses and Evaluation.--
       ``(1) In general.--Up to $500,000 of the amount available 
     in each fiscal year to carry out this section shall be made 
     available to the Director, acting in consultation with other 
     Federal agencies, to support and conduct periodic analyses 
     and evaluations of effective prevention programs for 
     methamphetamine or inhalant abuse and addiction and the 
     development of appropriate strategies for disseminating 
     information about and implementing these programs.
       ``(2) Annual reports.--The Director shall submit to the 
     Committee on Health, Education, Labor, and Pensions and the 
     Committee on Appropriations of the Senate and the Committee 
     on Commerce and Committee on Appropriations of the House of 
     Representatives, an annual report with the results of the 
     analyses and evaluation under paragraph (1).
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out subsection (a), $10,000,000 
     for fiscal year 2000, and such sums as may be necessary for 
     each of fiscal years 2001 and 2002.''.

     SEC. 105. COMPREHENSIVE COMMUNITY SERVICES FOR CHILDREN WITH 
                   SERIOUS EMOTIONAL DISTURBANCE.

       (a) Matching Funds.--Section 561(c)(1)(D) of the Public 
     Health Service Act (42 U.S.C. 290ff(c)(1)(D)) is amended by 
     striking ``fifth'' and inserting ``fifth and sixth''.
       (b) Flexibility for Indian Tribes and Territories.--Section 
     562 of the Public Health Service Act (42 U.S.C. 290ff-1) is 
     amended by adding at the end the following:
       ``(g) Waivers.--The Secretary may waive 1 or more of the 
     requirements of subsection (c) 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.''.
       (c) Duration of Grants.--Section 565(a) of the Public 
     Health Service Act (42 U.S.C. 290ff-4(a)) is amended by 
     striking ``5 fiscal'' and inserting ``6 fiscal''.
       (d) Authorization of Appropriations.--Section 565(f)(1) of 
     the Public Health Service Act (42 U.S.C. 290ff-4(f)(1)) is 
     amended by striking ``1993'' and all that follows and 
     inserting ``2000, and such sums as may be necessary for each 
     of the fiscal years 2001 and 2002.''.
       (e) Current Grantees.--
       (1) In general.--Entities with active grants under section 
     561 of the Public Health Service Act (42 U.S.C. 290ff) on the 
     date of enactment of this Act shall be eligible to receive a 
     6th year of funding under the grant in an amount not to 
     exceed the amount that such grantee received in the 5th year 
     of funding under such grant. Such 6th year may be funded 
     without requiring peer and Advisory Council review as 
     required under section 504 of such Act (42 U.S.C. 290aa-3).
       (2) Limitation.--Paragraph (1) shall apply with respect to 
     a grantee only if the grantee agrees to comply with the 
     provisions of section 561 as amended by subsection (a).

     SEC. 106. SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS.

       (a) Administration and Activities.--
       (1) Administration.--Section 399D(a) of the Public Health 
     Service Act (42 U.S.C. 280d(a)(1)) is amended--
       (A) in paragraph (1), by striking ``Administrator'' and all 
     that follows through ``Administration'' and insert 
     ``Administrator of the Substance Abuse and Mental Health 
     Services Administration''; and
       (B) in paragraph (2), by striking ``Administrator of the 
     Substance Abuse and Mental Health Services Administration'' 
     and inserting ``Administrator of the Health Resources and 
     Services Administration''.
       (2) Activities.--Section 399D(a)(1) of the Public Health 
     Service Act (42 U.S.C. 280d(a)(1)) is amended--
       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) in subparagraph (C), by striking the period and 
     inserting the following: ``through youth service agencies, 
     family social services, child care providers, Head Start, 
     schools and after-school programs, early childhood 
     development programs, community-based family resource and 
     support centers, the criminal justice system, health, 
     substance abuse and mental health providers through 
     screenings conducted during regular childhood examinations 
     and other examinations, self and family member referrals, 
     substance abuse treatment services, and other providers of 
     services to children and families; and''; and
       (C) by adding at the end the following:
       ``(D) to provide education and training to health, 
     substance abuse and mental health professionals, and other 
     providers of services to children and families through youth 
     service agencies, family social services, child care, Head 
     Start, schools and after-school programs, early childhood 
     development programs, community-based family resource and 
     support centers, the criminal justice system, and other 
     providers of services to children and families.''.
       (3) Identification of certain children.--Section 
     399D(a)(3)(A) of the Public Health Service Act (42 U.S.C. 
     280d(a)(3)(A)) is amended--
       (A) in clause (i), by striking ``(i) the entity'' and 
     inserting ``(i)(I) the entity'';
       (B) in clause (ii)--
       (i) by striking ``(ii) the entity'' and inserting ``(II) 
     the entity''; and
       (ii) by striking the period and inserting ``; and''; and
       (C) by adding at the end the following:
       ``(ii) the entity will identify children who may be 
     eligible for medical assistance under a State program under 
     title XIX or XXI of the Social Security Act.''.
       (b) Services for Children.--Section 399D(b) of the Public 
     Health Service Act (42 U.S.C. 280d(b)) is amended--
       (1) in paragraph (1), by inserting ``alcohol and drug,'' 
     after ``psychological,'';
       (2) by striking paragraph (5) and inserting the following:
       ``(5) Developmentally and age-appropriate drug and alcohol 
     early intervention, treatment and prevention services.''; and
       (3) by inserting after paragraph (8), the following:

     ``Services shall be provided under paragraphs (2) through (8) 
     by a public health nurse, social worker, or similar 
     professional, or by a trained worker from the community who 
     is supervised by a professional, or by an entity, where the 
     professional or entity provides assurances that the 
     professional or entity is licensed or certified by the State 
     if required and is complying with applicable licensure or 
     certification requirements.''.
       (c) Services for Affected Families.--Section 399D(c) of the 
     Public Health Service Act (42 U.S.C. 280d(c)) is amended--
       (1) in paragraph (1)--
       (A) in the matter preceding subparagraph (A), by inserting 
     before the colon the following: ``, or by an entity, where 
     the professional or entity provides assurances that the 
     professional or entity is licensed or certified by the State 
     if required and is complying with applicable licensure or 
     certification requirements''; and
       (B) by adding at the end the following:
       ``(D) Aggressive outreach to family members with substance 
     abuse problems.
       ``(E) Inclusion of consumer in the development, 
     implementation, and monitoring of Family Services Plan.'';
       (2) in paragraph (2)--
       (A) by striking subparagraph (A) and inserting the 
     following:
       ``(A) Alcohol and drug treatment services, including 
     screening and assessment, diagnosis, detoxification, 
     individual, group and family counseling, relapse prevention, 
     pharmacotherapy treatment, after-care services, and case 
     management.'';
       (B) in subparagraph (C), by striking ``, including 
     educational and career planning'' and inserting ``and 
     counseling on the human immunodeficiency virus and acquired 
     immune deficiency syndrome'';
       (C) in subparagraph (D), by striking ``conflict and''; and
       (D) in subparagraph (E), by striking ``Remedial'' and 
     inserting ``Career planning and''; and
       (3) in paragraph (3)(D), by inserting ``which include child 
     abuse and neglect prevention techniques'' before the period.
       (d) Eligible Entities.--Section 399D(d) of the Public 
     Health Service Act (42 U.S.C. 280d(d)) is amended--
       (1) by striking the matter preceding paragraph (1) and 
     inserting:
       ``(d) Eligible Entities.--The Secretary shall distribute 
     the grants through the following types of entities:'';
       (2) in paragraph (1), by striking ``drug treatment'' and 
     inserting ``drug early intervention, prevention or treatment; 
     and
       (3) in paragraph (2)--
       (A) in subparagraph (A), by striking ``; and'' and 
     inserting ``; or''; and
       (B) in subparagraph (B), by inserting ``or pediatric health 
     or mental health providers and family mental health 
     providers'' before the period.
       (e) Submission of Information.--Section 399D(h) of the 
     Public Health Service Act (42 U.S.C. 280d(h)) is amended--
       (1) in paragraph (2)--

[[Page 28163]]

       (A) by inserting ``including maternal and child health'' 
     before ``mental'';
       (B) by striking ``treatment programs''; and
       (C) by striking ``and the State agency responsible for 
     administering public maternal and child health services'' and 
     inserting ``, the State agency responsible for administering 
     alcohol and drug programs, the State lead agency, and the 
     State Interagency Coordinating Council under part H of the 
     Individuals with Disabilities Education Act; and''; and
       (2) by striking paragraph (3) and redesignating paragraph 
     (4) as paragraph (3).
       (f) Reports to the Secretary.--Section 399D(i)(6) of the 
     Public Health Service Act (42 U.S.C. 280d(i)(6)) is amended--
       (1) in subparagraph (B), by adding ``and'' at the end; and
       (2) by striking subparagraphs (C), (D), and (E) and 
     inserting the following:
       ``(C) the number of case workers or other professionals 
     trained to identify and address substance abuse issues.''.
       (g) Evaluations.--Section 399D(l) of the Public Health 
     Service Act (42 U.S.C. 280d(l)) is amended--
       (1) in paragraph (3), by adding ``and'' at the end;
       (2) in paragraph (4), by striking the semicolon and 
     inserting the following: ``, including increased 
     participation in work or employment-related activities and 
     decreased participation in welfare programs.''; and
       (3) by striking paragraphs (5) and (6).
       (h) Report to Congress.--Section 399D(m) of the Public 
     Health Service Act (42 U.S.C. 280d(m)) is amended--
       (1) in paragraph (2), by adding ``and'' at the end;
       (2) in paragraph (3)--
       (A) in subparagraph (A), by adding ``and'' at the end;
       (B) in subparagraph (B), by striking the semicolon and 
     inserting a period; and
       (C) by striking subparagraphs (C), (D), and (E); and
       (3) by striking paragraphs (4) and (5).
       (i) Data Collection.--Section 399D(n) of the Public Health 
     Service Act (42 U.S.C. 280d(n)) is amended by adding at the 
     end the following: ``The periodic report shall include a 
     quantitative estimate of the prevalence of alcohol and drug 
     problems in families involved in the child welfare system, 
     the barriers to treatment and prevention services facing 
     these families, and policy recommendations for removing the 
     identified barriers, including training for child welfare 
     workers.''.
       (j) Definition.--Section 399D(o)(2)(B) of the Public Health 
     Service Act (42 U.S.C. 280d(o)(2)(B)) is amended by striking 
     ``dangerous''.
       (k) Authorization of Appropriations.--Section 399D(p) of 
     the Public Health Service Act (42 U.S.C. 280d(p)) is amended 
     to read as follows:
       ``(p) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $50,000,000 for fiscal year 2000, and such sums 
     as may be necessary for each of fiscal years 2001 and 
     2002.''.
       (l) Grants for Training and Conforming Amendments.--Section 
     399D of the Public Health Service Act (42 U.S.C. 280d) is 
     amended--
       (1) by striking subsection (f);
       (2) by striking subsection (k);
       (3) by redesignating subsections (d), (e), (g), (h), (i), 
     (j), (l), (m), (n), (o), and (p) as subsections (e) through 
     (o), respectively;
       (4) by inserting after subsection (c), the following:
       ``(d) Training for Providers of Services to Children and 
     Families.--The Secretary may make a grant under subsection 
     (a) for the training of health, substance abuse and mental 
     health professionals and other providers of services to 
     children and families through youth service agencies, family 
     social services, child care providers, Head Start, schools 
     and after-school programs, early childhood development 
     programs, community-based family resource centers, the 
     criminal justice system, and other providers of services to 
     children and families. Such training shall be to assist 
     professionals in recognizing the drug and alcohol problems of 
     their clients and to enhance their skills in identifying and 
     understanding the nature of substance abuse, and obtaining 
     substance abuse early intervention, prevention and treatment 
     resources.'';
       (5) in subsection (k)(2) (as so redesignated), by striking 
     ``(h)'' and inserting ``(i)''; and
       (6) in paragraphs (3)(E) and (5) of subsection (m) (as so 
     redesignated), by striking ``(d)'' and inserting ``(e)''.
       (m) Transfer and Redesignation.--Section 399D of the Public 
     Health Service Act (42 U.S.C. 280d), as amended by this 
     section--
       (1) is transferred to title V;
       (2) is redesignated as section 519; and
       (3) is inserted after section 518.
       (n) Conforming Amendment.--Title III of the Public Health 
     Service Act (42 U.S.C. 241 et seq.) is amended by striking 
     the heading of part L.

     SEC. 107. SERVICES FOR YOUTH OFFENDERS.

       Subpart 3 of part B of title V of the Public Health Service 
     Act (42 U.S.C. 290bb-31 et seq.) is amended by adding at the 
     end the following:

     ``SEC. 520C. SERVICES FOR YOUTH OFFENDERS.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Center for Mental Health Services, and in 
     consultation with the Director of the Center for Substance 
     Abuse Treatment, the Administrator of the Office of Juvenile 
     Justice and Delinquency Prevention, and the Director of the 
     Special Education Programs, shall award grants on a 
     competitive basis to State or local juvenile justice agencies 
     to enable such agencies to provide aftercare services for 
     youth offenders who have been discharged from facilities in 
     the juvenile or criminal justice system and have serious 
     emotional disturbances or are at risk of developing such 
     disturbances.
       ``(b) Use of Funds.--A State or local juvenile justice 
     agency receiving a grant under subsection (a) shall use the 
     amounts provided under the grant--
       ``(1) to develop a plan describing the manner in which the 
     agency will provide services for each youth offender who has 
     a serious emotional disturbance and has been detained or 
     incarcerated in facilities within the juvenile or criminal 
     justice system;
       ``(2) to provide a network of core or aftercare services or 
     access to such services for each youth offender, including 
     diagnostic and evaluation services, substance abuse treatment 
     services, outpatient mental health care services, medication 
     management services, intensive home-based therapy, intensive 
     day treatment services, respite care, and therapeutic foster 
     care;
       ``(3) to establish a program that coordinates with other 
     State and local agencies providing recreational, social, 
     educational, vocational, or operational services for youth, 
     to enable the agency receiving a grant under this section to 
     provide community-based system of care services for each 
     youth offender that addresses the special needs of the youth 
     and helps the youth access all of the aforementioned 
     services; and
       ``(4) using not more than 20 percent of funds received, to 
     provide planning and transition services as described in 
     paragraph (3) for youth offenders while such youth are 
     incarcerated or detained.
       ``(c) Application.--A State or local juvenile justice 
     agency that desires a grant under subsection (a) shall submit 
     an application to the Secretary at such time, in such manner, 
     and accompanied by such information as the Secretary may 
     reasonably require.
       ``(d) Report.--Not later than 1 year after the date of 
     enactment of this section and annually thereafter, a State or 
     local juvenile justice agency receiving a grant under 
     subsection (a) shall submit to the Secretary a report 
     describing the programs carried out pursuant to this section.
       ``(e) Definitions.--In this section:
       ``(1) Serious emotional disturbance.--The term `serious 
     emotional disturbance' with respect to a youth offender means 
     an offender who currently, or at any time within the 1-year 
     period ending on the day on which services are sought under 
     this section, has a diagnosable mental, behavioral, or 
     emotional disorder that functionally impairs the offender's 
     life by substantially limiting the offender's role in family, 
     school, or community activities, and interfering with the 
     offender's ability to achieve or maintain 1 or more 
     developmentally-appropriate social, behavior, cognitive, 
     communicative, or adaptive skills.
       ``(2) Community-based system of care.--The term `community-
     based system of care' means the provision of services for the 
     youth offender by various State or local agencies that in an 
     interagency fashion or operating as a network addresses the 
     recreational, social, educational, vocational, mental health, 
     substance abuse, and operational needs of the youth offender.
       ``(3) Youth offender.--The term `youth offender' means an 
     individual who is 21 years of age or younger who has been 
     discharged from a State or local juvenile or criminal justice 
     system, except that if the individual is between the ages of 
     18 and 21 years, such individual has had contact with the 
     State or local juvenile or criminal justice system prior to 
     attaining 18 years of age and is under the jurisdiction of 
     such a system at the time services are sought.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $40,000,000 for 
     fiscal year 2000, and such sums as may be necessary for each 
     of fiscal years 2001 and 2002.''.

     SEC. 108. GENERAL PROVISIONS.

       (a) Duties of the Center for Substance Abuse Treatment.--
     Section 507(b) of the Public Health Service Act (42 U.S.C. 
     290bb(b)) is amended--
       (1) by redesignating paragraphs (2) through (12) as 
     paragraphs (3) through (13), respectively; and
       (2) by inserting after paragraph (1), the following:
       ``(2) ensure that emphasis is placed on children and 
     adolescents in the development of treatment programs;''.
       (b) Duties of the Office for Substance Abuse Prevention.--
     Section 515(b)(9) of the Public Health Service Act (42 U.S.C. 
     290bb-2(b)(9)) is amended by striking ``public concerning'' 
     and inserting ``public, especially adolescent audiences, 
     concerning''.
       (c) Duties of the Center for Mental Health Services.--
     Section 520(b) of the Public Health Service Act (42 U.S.C. 
     290bb-3(b)) is amended--
       (1) by redesignating paragraphs (3) through (14) as 
     paragraphs (4) through (15), respectively; and
       (2) by inserting after paragraph (2), the following:
       ``(3) collaborate with the Department of Education and the 
     Department of Justice to develop programs to assist local 
     communities in addressing violence among children and 
     adolescents;''.

[[Page 28164]]



             TITLE II--PROVISIONS RELATING TO MENTAL HEALTH

     SEC. 201. PRIORITY MENTAL HEALTH NEEDS OF REGIONAL AND 
                   NATIONAL SIGNIFICANCE.

       (a) In General.--Section 520A of the Public Health Service 
     Act (42 U.S.C. 290bb-32) is amended to read as follows:

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

       ``(a) Projects.--The Secretary shall address priority 
     mental health needs of regional and national significance (as 
     determined under subsection (b)) through the provision of or 
     through assistance for--
       ``(1) knowledge development and application projects for 
     prevention, treatment, and rehabilitation, and the conduct or 
     support of evaluations of such projects;
       ``(2) training and technical assistance programs;
       ``(3) targeted capacity response programs; and
       ``(4) systems change grants including statewide family 
     network grants and client-oriented and consumer run self-help 
     activities.

     The Secretary may carry out the activities described in this 
     subsection directly or through grants, contracts, or 
     cooperative agreements with States, political subdivisions of 
     States, Indian tribes and tribal organizations, other public 
     or private nonprofit entities.
       ``(b) Priority Mental Health Needs.--
       ``(1) Determination of needs.--Priority mental health needs 
     of regional and national significance shall be determined by 
     the Secretary in consultation with States and other 
     interested groups. The Secretary shall meet with the States 
     and interested groups on an annual basis to discuss program 
     priorities.
       ``(2) Special consideration.--In developing program 
     priorities described in paragraph (1), the Secretary, in 
     conjunction with the Director of the Center for Mental Health 
     Services, the Director of the Center for Substance Abuse 
     Treatment, and the Administrator of the Health Resources and 
     Services Administration, shall give special consideration to 
     promoting the integration of mental health services into 
     primary health care systems.
       ``(c) Requirements.--
       ``(1) In general.--Recipients of grants, contracts, and 
     cooperative agreements under this section shall comply with 
     information and application requirements determined 
     appropriate by the Secretary.
       ``(2) Duration of award.--With respect to a grant, 
     contract, or cooperative agreement awarded under this 
     section, the period during which payments under such award 
     are made to the recipient may not exceed 5 years.
       ``(3) Matching funds.--The Secretary may, for projects 
     carried out under subsection (a), require that entities that 
     apply for grants, contracts, or cooperative agreements 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, contract or cooperative agreement is 
     awarded under this section, the Secretary may require that 
     recipients for specific projects under subsection (a) 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 the fiscal year 
     preceding the fiscal year for which the entity receives such 
     a grant, contract, or cooperative agreement.
       ``(d) Evaluation.--The Secretary shall evaluate each 
     project carried out under subsection (a)(1) and shall 
     disseminate the findings with respect to each such evaluation 
     to appropriate public and private entities.
       ``(e) Information and Education.--The Secretary shall 
     establish information and education programs to disseminate 
     and apply the findings of the knowledge development and 
     application, training, and technical assistance programs, and 
     targeted capacity response programs, under this section to 
     the general public, to health care professionals, and to 
     interested groups. The Secretary shall make every effort to 
     provide linkages between the findings of supported projects 
     and State agencies responsible for carrying out mental health 
     services.
       ``(f) Authorization of Appropriation.--
       ``(1) In general.--There are authorized to be appropriated 
     to carry out this section, $300,000,000 for fiscal year 2000, 
     and such sums as may be necessary for each of the fiscal 
     years 2001 and 2002.
       ``(2) Data infrastructure.--If amounts are not appropriated 
     for a fiscal year to carry out section 1971 with respect to 
     mental health, then the Secretary shall make available, from 
     the amounts appropriated for such fiscal year under paragraph 
     (1), an amount equal to the sum of $6,000,000 and 10 percent 
     of all amounts appropriated for such fiscal year under such 
     paragraph in excess of $100,000,000, to carry out such 
     section 1971.''.
       (b) Conforming Amendments.--
       (1) Section 303 of the Public Health Service Act (42 U.S.C. 
     242a) is repealed.
       (2) Section 520B of the Public Health Service Act (42 
     U.S.C. 290bb-33) is repealed.
       (3) Section 612 of the Stewart B. McKinney Homeless 
     Assistance Act (42 U.S.C. 290aa-3 note) is repealed.

     SEC. 202. GRANTS FOR THE BENEFIT OF HOMELESS INDIVIDUALS.

       Section 506 of the Public Health Service Act (42 U.S.C. 
     290aa-5) is amended to read as follows:

     ``SEC. 506. GRANTS FOR THE BENEFIT OF HOMELESS INDIVIDUALS.

       ``(a) In General.--The Secretary shall award grants, 
     contracts and cooperative agreements to community-based 
     public and private nonprofit entities for the purposes of 
     providing mental health and substance abuse services for 
     homeless individuals. In carrying out this section, the 
     Secretary shall consult with the Interagency Council on the 
     Homeless, established under section 201 of the Stewart B. 
     McKinney Homeless Assistance Act (42 U.S.C. 11311).
       ``(b) Preferences.--In awarding grants, contracts, and 
     cooperative agreements under subsection (a), the Secretary 
     shall give a preference to--
       ``(1) entities that provide integrated primary health, 
     substance abuse, and mental health services to homeless 
     individuals;
       ``(2) entities that demonstrate effectiveness in serving 
     runaway, homeless, and street youth;
       ``(3) entities that have experience in providing substance 
     abuse and mental health services to homeless individuals;
       ``(4) entities that demonstrate experience in providing 
     housing for individuals in treatment for or in recovery from 
     mental illness or substance abuse; and
       ``(5) entities that demonstrate effectiveness in serving 
     homeless veterans.
       ``(c) Services for Certain Individuals.--In awarding 
     grants, contracts, and cooperative agreements under 
     subsection (a), the Secretary shall not--
       ``(1) prohibit the provision of services under such 
     subsection to homeless individuals who are suffering from a 
     substance abuse disorder and are not suffering from a mental 
     health disorder; and
       ``(2) make payments under subsection (a) to any entity that 
     has a policy of--
       ``(A) excluding individuals from mental health services due 
     to the existence or suspicion of substance abuse; or
       ``(B) has a policy of excluding individuals from substance 
     abuse services due to the existence or suspicion of mental 
     illness.
       ``(d) Term of the Awards.--No entity may receive a grant, 
     contract, or cooperative agreement under subsection (a) for 
     more than 5 years.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $50,000,000 for 
     fiscal year 2000, and such sums as may be necessary for each 
     of the fiscal years 2001 and 2002.''.

     SEC. 203. PROJECTS FOR ASSISTANCE IN TRANSITION FROM 
                   HOMELESSNESS.

       (a) Waivers for Territories.--Section 522 of the Public 
     Health Service Act (42 U.S.C. 290cc-22) is amended by adding 
     at the end the following:
       ``(i) Waiver for Territories.--With respect to the United 
     States Virgin Islands, Guam, American Samoa, Palau, the 
     Marshall Islands, and the Commonwealth of the Northern 
     Mariana Islands, the Secretary may waive the provisions of 
     this part that the Secretary determines to be appropriate.''.
       (b) Authorization of Appropriation.--Section 535(a) of the 
     Public Health Service Act (42 U.S.C. 290cc-35(a)) is amended 
     by striking ``1991 through 1994'' and inserting ``2000 
     through 2002''.

     SEC. 204. COMMUNITY MENTAL HEALTH SERVICES PERFORMANCE 
                   PARTNERSHIP BLOCK GRANT.

       (a) Criteria for Plan.--Section 1912(b) of the Public 
     Health Service Act (42 U.S.C. 300x-2(b)) is amended by 
     striking paragraphs (1) through (12) and inserting the 
     following:
       ``(1) Comprehensive community-based mental health 
     systems.--The plan provides for an organized community-based 
     system of care for individuals with mental illness and 
     describes available services and resources in a comprehensive 
     system of care, including services for dually diagnosed 
     individuals. The description of the system of care shall 
     include health and mental health services, rehabilitation 
     services, employment services, housing services, educational 
     services, substance abuse services, medical and dental care, 
     and other support services to be provided to individuals with 
     Federal, State and local public and private resources to 
     enable such individuals to function outside of inpatient or 
     residential institutions to the maximum extent of their 
     capabilities, including services to be provided by local 
     school systems under the Individuals with Disabilities 
     Education Act. The plan shall include a separate description 
     of case management services and provide for activities 
     leading to reduction of hospitalization.
       ``(2) Mental health system data and epidemiology.--The plan 
     contains an estimate of the incidence and prevalence in the 
     State of serious mental illness among adults and serious 
     emotional disturbance among children and presents 
     quantitative targets to be achieved in the implementation of 
     the system described in paragraph (1).
       ``(3) Children's services.--In the case of children with 
     serious emotional disturbance, the plan--
       ``(A) subject to subparagraph (B), provides for a system of 
     integrated social services, educational services, juvenile 
     services, and substance abuse services that, together with 
     health and mental health services, will be provided in order 
     for such children to receive care appropriate for their 
     multiple needs (such system to include services provided 
     under the Individuals with Disabilities Education Act);

[[Page 28165]]

       ``(B) provides that the grant under section 1911 for the 
     fiscal year involved will not be expended to provide any 
     service under such system other than comprehensive community 
     mental health services; and
       ``(C) provides for the establishment of a defined 
     geographic area for the provision of the services of such 
     system.
       ``(4) Targeted services to rural and homeless 
     populations.--The plan describes the State's outreach to and 
     services for individuals who are homeless and how community-
     based services will be provided to individuals residing in 
     rural areas.
       ``(5) Management systems.--The plan describes the financial 
     resources, staffing and training for mental health providers 
     that is necessary to implement the plan, and provides for the 
     training of providers of emergency health services regarding 
     mental health. The plan further describes the manner in which 
     the State intends to expend the grant under section 1911 for 
     the fiscal year involved.

     Except as provided for in paragraph (3), the State plan shall 
     contain the information required under this subsection with 
     respect to both adults with serious mental illness and 
     children with serious emotional disturbance.''.
       (b) Review of Planning Council of State's Report.--Section 
     1915(a) of the Public Health Service Act (42 U.S.C. 300x-
     4(a)) is amended--
       (1) in paragraph (1), by inserting ``and the report of the 
     State under section 1942(a) concerning the preceding fiscal 
     year'' after ``to the grant''; and
       (2) in paragraph (2), by inserting before the period ``and 
     any comments concerning the annual report''.
       (c) Maintenance of Effort.--Section 1915(b) of the Public 
     Health Service Act (42 U.S.C. 300x-4(b)) is amended--
       (1) by redesignating paragraphs (2) and (3) as paragraphs 
     (3) and (4), respectively; and
       (2) by inserting after paragraph (1), the following:
       ``(2) Exclusion of certain funds.--The Secretary may 
     exclude from the aggregate State expenditures under 
     subsection (a), funds appropriated to the principle agency 
     for authorized activities which are of a non-recurring nature 
     and for a specific purpose.''.
       (d) Application for Grants.--Section 1917(a)(1) of the 
     Public Health Service Act (42 U.S.C. 300x-6(a)(1)) is amended 
     to read as follows:
       ``(1) the plan is received by the Secretary not later than 
     September 1 of the fiscal year prior to the fiscal year for 
     which a State is seeking funds, and the report from the 
     previous fiscal year as required under section 1941 is 
     received by December 1 of the fiscal year of the grant;''.
       (e) Waivers for Territories.--Section 1917(b) of the Public 
     Health Service Act (42 U.S.C. 300x-6(b)) is amended by 
     striking ``whose allotment under section 1911 for the fiscal 
     year is the amount specified in section 1918(c)(2)(B)'' and 
     inserting in its place ``except Puerto Rico''.
       (f) Authorization of Appropriation.--Section 1920 of the 
     Public Health Service Act (42 U.S.C. 300x-9) is amended--
       (1) in subsection (a), by striking ``$450,000,000'' and all 
     that follows through the end and inserting ``$450,000,000 for 
     fiscal year 2000, and such sums as may be necessary for each 
     of the fiscal years 2001 and 2002.''; and
       (2) in subsection (b)(2), by striking ``section 505'' and 
     inserting ``sections 505 and 1971''.

     SEC. 205. DETERMINATION OF ALLOTMENT.

       Section 1918(b) of the Public Health Service Act (42 U.S.C. 
     300x-7(b)) is amended to read as follows:
       ``(b) Minimum Allotments for States.--With respect to 
     fiscal year 2000, and subsequent fiscal years, the amount of 
     the allotment of a State under section 1911 shall not be less 
     than the amount the State received under such section for 
     fiscal year 1998.''.

     SEC. 206. PROTECTION AND ADVOCACY FOR MENTALLY ILL 
                   INDIVIDUALS ACT OF 1986.

       (a) 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 Illness Act'.''.
       (b) Definitions.--Section 102 of the Protection and 
     Advocacy for Individuals with Mental Illness Act (as amended 
     by subsection (a)) (42 U.S.C. 10802) is amended--
       (1) in paragraph (4)--
       (A) in the matter preceding subparagraph (A), by inserting 
     ``, except as provided in section 104(d),'' after ``means'';
       (B) in subparagraph (B)--
       (i) by striking ``(i)'' who'' and inserting ``(i)(I) who'';
       (ii) by redesignating clauses (ii) and (iii) as subclauses 
     (II) and (III);
       (iii) in subclause (III) (as so redesignated), by striking 
     the period and inserting ``; or''; and
       (iv) by adding at the end the following:
       ``(ii) who satisfies the requirements of subparagraph (A) 
     and lives in a community setting, including their own 
     home.''; and
       (2) by adding at the end the following:
       ``(8) The term `American Indian consortium' means a 
     consortium established under part C of the Developmental 
     Disabilities Assistance and Bill of Rights Act (42 U.S.C. 
     6042 et seq.).''.
       (c) Use of Allotments.--Section 104 of the Protection and 
     Advocacy for Individuals with Mental Illness Act (as amended 
     by subsection (a)) (42 U.S.C. 10804) is amended by adding at 
     the end the following:
       ``(d) The definition of `individual with a mental illness' 
     contained in section 102(4)(B)(iii) shall apply, and thus an 
     eligible system may use its allotment under this title to 
     provide representation to such individuals, only if the total 
     allotment under this title for any fiscal year is $30,000,000 
     or more, and in such case, an eligible system must give 
     priority to representing persons with mental illness as 
     defined in subparagraphs (A) and (B)(i) of section 102(4).''.
       (d) Minimum Amount.--Paragraph (2) of section 112(a) of the 
     Protection and Advocacy for Individuals with Mental Illness 
     Act (as amended by subsection (a)) (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 determined under 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) 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 appropriated under such section for fiscal year 1995.
       ``(D) If the total amount appropriated for a fiscal year is 
     at least $25,000,000, the Secretary shall make an allotment 
     in accordance with subparagraph (A) to the eligible system 
     serving the American Indian consortium.''.
       (e) Technical Amendments.--Section 112(a) of the Protection 
     and Advocacy for Individuals with Mental Illness Act (as 
     amended by subsection (a)) (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).
       (f) Reauthorization.--Section 117 of the Protection and 
     Advocacy for Individuals with Mental Illness Act (as amended 
     by subsection (a)) (42 U.S.C. 10827) is amended by striking 
     ``1995'' and inserting ``2002''.

     SEC. 207. REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF 
                   CERTAIN FACILITIES.

       Title V of the Public Health Service Act (42 U.S.C. 290aa 
     et seq.) is amended by adding at the end the following:

 ``PART H--REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF CERTAIN 
                               FACILITIES

     ``SEC. 591. REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS 
                   OF CERTAIN FACILITIES.

       ``(a) In General.--A public or private general hospital, 
     nursing facility, intermediate care facility, residential 
     treatment center, or other health care facility, that 
     receives support in any form from any program supported in 
     whole or in part with funds appropriated to any Federal 
     department or agency shall protect and promote the rights of 
     each resident of the facility, including the right to be free 
     from physical or mental abuse, corporal punishment, and any 
     physical or chemical restraints or involuntary seclusions 
     imposed for purposes of discipline or convenience.
       ``(b) Requirements.--Physical or chemical restraints and 
     seclusion may only be imposed on a resident of a facility 
     described in subsection (a) if--
       ``(1) the restraints or seclusion are imposed to ensure the 
     physical safety of the resident, a staff member, or others; 
     and
       ``(2) the restraints or seclusion are imposed only upon the 
     written order of a physician, or other licensed independent 
     practitioner permitted by the State and the facility to order 
     such restraint or seclusion, that specifies the duration and 
     circumstances under which the restraints are to be used 
     (except in emergency circumstances specified by the Secretary 
     until such an order could reasonably be obtained).
       ``(c) Construction.--Nothing in this section shall be 
     construed as prohibiting the use of restraints for medical 
     immobilization, adaptive support, or medical protection.
       ``(d) Definitions.--In this section:
       ``(1) Chemical restraint.--The term `chemical restraint' 
     means the non-therapeutic use of a medication that--
       ``(A) is unrelated to the patient's medical condition; and
       ``(B) is imposed for disciplinary purposes or the 
     convenience of staff.
       ``(2) Physical restraint.--The term `physical restraint' 
     means any mechanical or personal restriction that immobilizes 
     or reduces the ability of an individual to move his or her 
     arms, legs, or head freely. Such term does not include 
     devices, such as orthopedically prescribed devices, surgical 
     dressings or bandages, protective helmets, and other methods 
     involving the physical holding of a resident for the purpose 
     of conducting routine physical examinations or tests or to 
     protect the patient from falling out of bed or to permit a 
     patient to participate in activities without the risk of 
     physical harm to the patient.
       ``(3) Seclusion.--The term `seclusion' means any separation 
     of the resident from the general population of the facility 
     that prevents the resident from returning to such population 
     when he or she desires.

[[Page 28166]]



     ``SEC. 592. REPORTING REQUIREMENT.

       ``(a) In General.-- Each facility to which the Protection 
     and Advocacy for Mentally Ill Individuals Act of 1986 applies 
     shall notify the appropriate agency, as determined by the 
     Secretary, of each death that occurs at each such facility 
     while a patient is restrained, of each death occurring within 
     24 hours of the deceased patient being restrained or placed 
     in seclusion, or where it is reasonable to assume that a 
     patient's death is a result of such seclusion or restraint. A 
     notification under this section shall include the name of the 
     resident and shall be provided not later than 7 days after 
     the date of the death of the individual involved.
       ``(b) Facility.--In this section, the term `facility' has 
     the meaning given the term `facilities' in section 102(3) of 
     the Protection and Advocacy for Mentally Ill Individuals Act 
     of 1986 (42 U.S.C. 10802(3)).''.

     ``SEC. 593. REGULATIONS AND ENFORCEMENT.

       ``(a) Training.--Not later than 1 year after the date of 
     enactment of this part, the Secretary, after consultation 
     with appropriate State and local protection and advocacy 
     organizations, physicians, facilities, and other health care 
     professionals and patients, shall promulgate regulations that 
     require facilities to which the Protection and Advocacy for 
     Mentally Ill Individuals Act of 1986 (42 U.S.C. 10801 et 
     seq.) applies, to meet the requirements of subsection (b).
       ``(b) Requirements.--The regulations promulgated under 
     subsection (a) shall require that--
       ``(1) facilities described in subsection (a) ensure that 
     there is an adequate number of qualified professional and 
     supportive staff to evaluate patients, formulate written 
     individualized, comprehensive treatment plans, and to provide 
     active treatment measures;
       ``(2) appropriate training be provided for the staff of 
     such facilities in the use of restraints and any alternatives 
     to the use of restraints; and
       ``(3) such facilities provide complete and accurate 
     notification of deaths, as required under section 582(a).
       ``(c) Enforcement.--A facility to which this part applies 
     that fails to comply with any requirement of this part, 
     including a failure to provide appropriate training, shall 
     not be eligible for participation in any program supported in 
     whole or in part by funds appropriated to any Federal 
     department or agency.''.

           TITLE III--PROVISIONS RELATING TO SUBSTANCE ABUSE

     SEC. 301. PRIORITY SUBSTANCE ABUSE TREATMENT NEEDS OF 
                   REGIONAL AND NATIONAL SIGNIFICANCE.

       (a) In General.--Section 508 of the Public Health Service 
     Act (42 U.S.C. 290bb-1) is amended to read as follows:

     ``SEC. 508. PRIORITY SUBSTANCE ABUSE TREATMENT NEEDS OF 
                   REGIONAL AND NATIONAL SIGNIFICANCE.

       ``(a) Projects.--The Secretary shall address priority 
     substance abuse treatment needs of regional and national 
     significance (as determined under subsection (b)) through the 
     provision of or through assistance for--
       ``(1) knowledge development and application projects for 
     treatment and rehabilitation and the conduct or support of 
     evaluations of such projects;
       ``(2) training and technical assistance; and
       ``(3) targeted capacity response programs.

     The Secretary may carry out the activities described in this 
     section directly or through grants, contracts, or cooperative 
     agreements with States, political subdivisions of States, 
     Indian tribes and tribal organizations, other public or 
     nonprofit private entities.
       ``(b) Priority Substance Abuse Treatment Needs.--
       ``(1) In general.--Priority substance abuse treatment needs 
     of regional and national significance shall be determined by 
     the Secretary after consultation with States and other 
     interested groups. The Secretary shall meet with the States 
     and interested groups on an annual basis to discuss program 
     priorities.
       ``(2) Special consideration.--In developing program 
     priorities under paragraph (1), the Secretary, in conjunction 
     with the Director of the Center for Substance Abuse 
     Treatment, the Director of the Center for Mental Health 
     Services, and the Administrator of the Health Resources and 
     Services Administration, shall give special consideration to 
     promoting the integration of substance abuse treatment 
     services into primary health care systems.
       ``(c) Requirements.--
       ``(1) In general.--Recipients of grants, contracts, or 
     cooperative agreements under this section shall comply with 
     information and application requirements determined 
     appropriate by the Secretary.
       ``(2) Duration of award.--With respect to a grant, 
     contract, or cooperative agreement awarded under this 
     section, the period during which payments under such award 
     are made to the recipient may not exceed 5 years.
       ``(3) Matching funds.--The Secretary may, for projects 
     carried out under subsection (a), require that entities that 
     apply for grants, contracts, or cooperative agreements under 
     that project 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, contract, or cooperative agreement is 
     awarded under this section, the Secretary may require that 
     recipients for specific projects under subsection (a) 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 the fiscal year 
     preceding the fiscal year for which the entity receives such 
     a grant, contract, or cooperative agreement.
       ``(d) Evaluation.--The Secretary shall evaluate each 
     project carried out under subsection (a)(1) and shall 
     disseminate the findings with respect to each such evaluation 
     to appropriate public and private entities.
       ``(e) Information and Education.--The Secretary shall 
     establish comprehensive information and education programs to 
     disseminate and apply the findings of the knowledge 
     development and application, training and technical 
     assistance programs, and targeted capacity response programs 
     under this section to the general public, to health 
     professionals and other interested groups. The Secretary 
     shall make every effort to provide linkages between the 
     findings of supported projects and State agencies responsible 
     for carrying out substance abuse prevention and treatment 
     programs.
       ``(f) Authorization of Appropriation.--There are authorized 
     to be appropriated to carry out this section, $300,000,000 
     for fiscal year 2000 and such sums as may be necessary for 
     each of the fiscal years 2001 and 2002.''.
       (b) Conforming Amendments.--The following sections of the 
     Public Health Service Act are repealed:
       (1) Section 509 (42 U.S.C. 290bb-2).
       (2) Section 510 (42 U.S.C. 290bb-3).
       (3) Section 511 (42 U.S.C. 290bb-4).
       (4) Section 512 (42 U.S.C. 290bb-5).
       (5) Section 571 (42 U.S.C. 290gg).

     SEC. 302. PRIORITY SUBSTANCE ABUSE PREVENTION NEEDS OF 
                   REGIONAL AND NATIONAL SIGNIFICANCE.

       (a) In General.--Section 516 of the Public Health Service 
     Act (42 U.S.C. 290bb-1) is amended to read as follows:

     ``SEC. 516. PRIORITY SUBSTANCE ABUSE PREVENTION NEEDS OF 
                   REGIONAL AND NATIONAL SIGNIFICANCE.

       ``(a) Projects.--The Secretary shall address priority 
     substance abuse prevention needs of regional and national 
     significance (as determined under subsection (b)) through the 
     provision of or through assistance for--
       ``(1) knowledge development and application projects for 
     prevention and the conduct or support of evaluations of such 
     projects;
       ``(2) training and technical assistance; and
       ``(3) targeted capacity response programs.

     The Secretary may carry out the activities described in this 
     section directly or through grants, contracts, or cooperative 
     agreements with States, political subdivisions of States, 
     Indian tribes and tribal organizations, or other public or 
     nonprofit private entities.
       ``(b) Priority Substance Abuse Prevention Needs.--
       ``(1) In general.--Priority substance abuse prevention 
     needs of regional and national significance shall be 
     determined by the Secretary in consultation with the States 
     and other interested groups. The Secretary shall meet with 
     the States and interested groups on an annual basis to 
     discuss program priorities.
       ``(2) Special consideration.--In developing program 
     priorities under paragraph (1), the Secretary shall give 
     special consideration to--
       ``(A) applying the most promising strategies and research-
     based primary prevention approaches; and
       ``(B) promoting the integration of substance abuse 
     prevention services into primary health care systems.
       ``(c) Requirements.--
       ``(1) In general.--Recipients of grants, contracts, and 
     cooperative agreements under this section shall comply with 
     information and application requirements determined 
     appropriate by the Secretary.
       ``(2) Duration of award.--With respect to a grant, 
     contract, or cooperative agreement awarded under this 
     section, the period during which payments under such award 
     are made to the recipient may not exceed 5 years.
       ``(3) Matching funds.--The Secretary may, for projects 
     carried out under subsection (a), require that entities that 
     apply for grants, contracts, or cooperative agreements under 
     that project 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, contract, or cooperative agreement is 
     awarded under this section, the Secretary may require that 
     recipients for specific projects under subsection (a) 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 the fiscal year 
     preceding the fiscal year for which the entity receives such 
     a grant, contract, or cooperative agreement.
       ``(d) Evaluation.--The Secretary shall evaluate each 
     project carried out under subsection (a)(1) and shall 
     disseminate the findings with respect to each such evaluation 
     to appropriate public and private entities.
       ``(e) Information and Education.--The Secretary shall 
     establish comprehensive information

[[Page 28167]]

     and education programs to disseminate the findings of the 
     knowledge development and application, training and technical 
     assistance programs, and targeted capacity response programs 
     under this section to the general public and to health 
     professionals. The Secretary shall make every effort to 
     provide linkages between the findings of supported projects 
     and State agencies responsible for carrying out substance 
     abuse prevention and treatment programs.
       ``(f) Authorization of Appropriation.--There are authorized 
     to be appropriated to carry out this section, $300,000,000 
     for fiscal year 2000, and such sums as may be necessary for 
     each of the fiscal years 2001 and 2002.''.
       (b) Conforming Amendments.--Section 518 of the Public 
     Health Service Act (42 U.S.C. 290bb-24) is repealed.

     SEC. 303. SUBSTANCE ABUSE PREVENTION AND TREATMENT 
                   PERFORMANCE PARTNERSHIP BLOCK GRANT.

       (a) Authorized Activities.--Section 1921(b) of the Public 
     Health Service Act (42 U.S.C. 300x-21(b)) is amended to read 
     as follows:
       ``(b) Authorized Activities.--
       ``(1) In general.--A funding agreement for a grant under 
     subsection (a) is that, subject to section 1931, the State 
     involved shall expend the grant only for the purpose of--
       ``(A) planning, carrying out, and evaluating activities to 
     prevent and treat substance abuse in accordance with this 
     subpart and for related activities authorized in section 
     1924; and
       ``(B) screening and testing for HIV, tuberculosis, 
     hepatitis C, sexually transmitted diseases, mental health 
     disorders, and other screening and testing necessary to 
     determine a comprehensive substance abuse treatment plan.
       ``(2) Screening and testing.--A State may not use more than 
     2 percent of a State allotment for a fiscal year to carry out 
     activities under paragraph (1)(B), except that the State 
     shall be considered the payer of last resort and may not 
     expend such funds for such activities to the extent that 
     payment has been made, or can reasonably be expected to be 
     made, with respect to such service under any Federal or State 
     program, an insurance policy, or a Federal or State health 
     benefits program (including programs established under title 
     XVIII or XIX of the Social Security Act), or by an entity 
     that provides health services on a prepaid basis.''.
       (b) Allocation Regarding Alcohol and Other Drugs.--Section 
     1922 of the Public Health Service Act (42 U.S.C. 300x-22) is 
     amended by--
       (1) striking subsection (a); and
       (2) redesignating subsections (b) and (c) as subsections 
     (a) and (b).
       (c) Group Homes for Recovering Substance Abusers.--Section 
     1925(a) of the Public Health Service Act (42 U.S.C. 300x-
     25(a)) is amended by striking ``For fiscal year 1993'' and 
     all that follows through the colon and inserting the 
     following: ``A State, using funds available under section 
     1921, may establish and maintain the ongoing operation of a 
     revolving fund in accordance with this section to support 
     group homes for recovering substance abusers as follows:''.
       (d) Maintenance of Effort.--Section 1930 of the Public 
     Health Service Act (42 U.S.C. 300x-30) is amended--
       (1) by redesignating subsections (b) and (c) as subsections 
     (c) and (d) respectively; and
       (2) by inserting after subsection (a), the following:
       ``(b) Exclusion of Certain Funds.--The Secretary may 
     exclude from the aggregate State expenditures under 
     subsection (a), funds appropriated to the principle agency 
     for authorized activities which are of a non-recurring nature 
     and for a specific purpose.''.
       (e) Applications for Grants.--Section 1932(a)(1) of the 
     Public Health Service Act (42 U.S.C. 300x-32(a)(1)) is 
     amended to read as follows:
       ``(1) the application is received by the Secretary not 
     later than October 1 of the fiscal year prior to the fiscal 
     year for which the State is seeking funds;''.
       (f) Waiver for Territories.--Section 1932(c) of the Public 
     Health Service Act (42 U.S.C. 300x-32(c)) is amended by 
     striking ``whose allotment under section 1921 for the fiscal 
     year is the amount specified in section 1933(c)(2)(B)'' and 
     inserting ``except Puerto Rico''.
       (g) Waiver Authority for Certain Requirements.--
       (1) In general.--Section 1932 of the Public Health Service 
     Act (42 U.S.C. 300x-32) is amended by adding at the end the 
     following:
       ``(e) Waiver Authority for Certain Requirements.--
       ``(1) In general.--Upon the request of a State, the 
     Secretary may waive the requirements of all or part of the 
     sections described in paragraph (2) using objective criteria 
     established by the Secretary by regulation after consultation 
     with the States and other interested parties including 
     consumers and providers.
       ``(2) Sections.--The sections described in paragraph (1) 
     are sections 1922(c), 1923, 1924 and 1928.
       ``(3) Date certain for acting upon request.--The Secretary 
     shall approve or deny a request for a waiver under paragraph 
     (1) and inform the State of that decision not later than 120 
     days after the date on which the request and all the 
     information needed to support the request are submitted.
       ``(4) Annual reporting requirement.--The Secretary shall 
     annually report to the general public on the States that 
     receive a waiver under this subsection.''.
       (2) Conforming amendments.--Effective upon the publication 
     of the regulations developed in accordance with section 
     1932(e)(1) of the Public Health Service Act (42 U.S.C. 300x-
     32(d))--
       (A) section 1922(c) of the Public Health Service Act (42 
     U.S.C. 300x-22(c)) is amended by--
       (i) striking paragraph (2); and
       (ii) redesignating paragraph (3) as paragraph (2); and
       (B) section 1928(d) of the Public Health Service Act (42 
     U.S.C. 300x-28(d)) is repealed.
       (h) Authorization of Appropriation.--Section 1935 of the 
     Public Health Service Act (42 U.S.C. 300x-35) is amended--
       (1) in subsection (a), by striking ``$1,500,000,000'' and 
     all that follows through the end and inserting 
     ``$2,000,000,000 for fiscal year 2000, and such sums as may 
     be necessary for each of the fiscal years 2001 and 2002.'';
       (2) in subsection (b)(1), by striking ``section 505'' and 
     inserting ``sections 505 and 1971'';
       (3) in subsection (b)(2), by striking ``1949(a)'' and 
     inserting ``1948(a)''; and
       (4) in subsection (b), by adding at the end the following:
       ``(3) Core data set.--A State that receives a new grant, 
     contract, or cooperative agreement from amounts available to 
     the Secretary under paragraph (1), for the purposes of 
     improving the data collection, analysis and reporting 
     capabilities of the State, shall be required, as a condition 
     of receipt of funds, to collect, analyze, and report to the 
     Secretary for each fiscal year subsequent to receiving such 
     funds a core data set to be determined by the Secretary in 
     conjunction with the States.''.

     SEC. 304. DETERMINATION OF ALLOTMENTS.

       Section 1933(b) of the Public Health Service Act (42 U.S.C. 
     300x-33(b)) is amended to read as follows:
       ``(b) Minimum Allotments for States.--
       ``(1) In general.--With respect to fiscal year 2000, and 
     each subsequent fiscal year, the amount of the allotment of a 
     State under section 1921 shall not be less than the amount 
     the State received under such section for the previous fiscal 
     year increased by an amount equal to 30.65 percent of the 
     percentage by which the aggregate amount allotted to all 
     States for such fiscal year exceeds the aggregate amount 
     allotted to all States for the previous fiscal year.
       ``(2) Limitations.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     a State shall not receive an allotment under section 1921 for 
     a fiscal year in an amount that is less than an amount equal 
     to 0.375 percent of the amount appropriated under section 
     1935(a) for such fiscal year.
       ``(B) Exception.--In applying subparagraph (A), the 
     Secretary shall ensure that no State receives an increase in 
     its allotment under section 1921 for a fiscal year (as 
     compared to the amount allotted to the State in the prior 
     fiscal year) that is in excess of an amount equal to 300 
     percent of the percentage by which the amount appropriated 
     under section 1935(a) for such fiscal year exceeds the amount 
     appropriated for the prior fiscal year.
       ``(3) Decrease in or equal appropriations.--If the amount 
     appropriated under section 1935(a) for a fiscal year is equal 
     to or less than the amount appropriated under such section 
     for the prior fiscal year, the amount of the State allotment 
     under section 1921 shall be equal to the amount that the 
     State received under section 1921 in the prior fiscal year 
     decreased by the percentage by which the amount appropriated 
     for such fiscal year is less than the amount appropriated or 
     such section for the prior fiscal year.''.

     SEC. 305. NONDISCRIMINATION AND INSTITUTIONAL SAFEGUARDS FOR 
                   RELIGIOUS PROVIDERS.

       Subpart III of part B of title XIX of the Public Health 
     Service Act (42 U.S.C. 300x-51 et seq.) is amended by adding 
     at the end the following:

     ``SEC. 1955. SERVICES PROVIDED BY NONGOVERNMENTAL 
                   ORGANIZATIONS.

       ``(a) Purposes.--The purposes of this section are--
       ``(1) to prohibit discrimination against nongovernmental 
     organizations and certain individuals on the basis of 
     religion in the distribution of government funds to provide 
     substance abuse services under this title and title V, and 
     the receipt of services under such titles; and
       ``(2) to allow the organizations to accept the funds to 
     provide the services to the individuals without impairing the 
     religious character of the organizations or the religious 
     freedom of the individuals.
       ``(b) Religious Organizations Included as Nongovernmental 
     Providers.--
       ``(1) In general.--A State may administer and provide 
     substance abuse services under any program under this title 
     or title V through grants, contracts, or cooperative 
     agreements to provide assistance to beneficiaries under such 
     titles with nongovernmental organizations.
       ``(2) Requirement.--A State that elects to utilize 
     nongovernmental organizations as provided for under paragraph 
     (1) shall consider, on the same basis as other 
     nongovernmental organizations, religious organizations to 
     provide services under substance abuse programs under this 
     title or title V, so long as the programs under such titles 
     are implemented in a manner consistent with the Establishment 
     Clause of the first amendment to the Constitution. Neither 
     the Federal Government nor a State or local government 
     receiving funds under such programs shall discriminate 
     against an organization that provides services under, or 
     applies to provide services under, such programs, on the 
     basis that the organization has a religious character.
       ``(c) Religious Character and Independence.--

[[Page 28168]]

       ``(1) In general.--A religious organization that provides 
     services under any substance abuse program under this title 
     or title V shall retain its independence from Federal, State, 
     and local governments, including such organization's control 
     over the definition, development, practice, and expression of 
     its religious beliefs.
       ``(2) Additional safeguards.--Neither the Federal 
     Government nor a State or local government shall require a 
     religious organization--
       ``(A) to alter its form of internal governance; or
       ``(B) to remove religious art, icons, scripture, or other 
     symbols;
     in order to be eligible to provide services under any 
     substance abuse program under this title or title V.
       ``(d) Employment Practices.--
       ``(1) Tenets and teachings.--A religious organization that 
     provides services under any substance abuse program under 
     this title or title V may require that its employees 
     providing services under such program adhere to the religious 
     tenets and teachings of such organization, and such 
     organization may require that those employees adhere to rules 
     forbidding the use of drugs or alcohol.
       ``(2) Title vii exemption.--The exemption of a religious 
     organization provided under section 702 or 703(e)(2) of the 
     Civil Rights Act of 1964 (42 U.S.C. 2000e-1, 2000e-2(e)(2)) 
     regarding employment practices shall not be affected by the 
     religious organization's provision of services under, or 
     receipt of funds from, any substance abuse program under this 
     title or title V.
       ``(e) Rights of Beneficiaries of Assistance.--
       ``(1) In general.--If an individual described in paragraph 
     (3) has an objection to the religious character of the 
     organization from which the individual receives, or would 
     receive, services funded under any substance abuse program 
     under this title or title V, the appropriate Federal, State, 
     or local governmental entity shall provide to such individual 
     (if otherwise eligible for such services) within a reasonable 
     period of time after the date of such objection, services 
     that--
       ``(A) are from an alternative provider that is accessible 
     to the individual; and
       ``(B) have a value that is not less than the value of the 
     services that the individual would have received from such 
     organization.
       ``(2) Notice.--The appropriate Federal, State, or local 
     governmental entity shall ensure that notice is provided to 
     individuals described in paragraph (3) of the rights of such 
     individuals under this section.
       ``(3) Individual described.--An individual described in 
     this paragraph is an individual who receives or applies for 
     services under any substance abuse program under this title 
     or title V.
       ``(f) Nondiscrimination Against Beneficiaries.--A religious 
     organization providing services through a grant, contract, or 
     cooperative agreement under any substance abuse program under 
     this title or title V shall not discriminate, in carrying out 
     such program, against an individual described in subsection 
     (e)(3) on the basis of religion, a religious belief, a 
     refusal to hold a religious belief, or a refusal to actively 
     participate in a religious practice.
       ``(g) Fiscal Accountability.--
       ``(1) In general.--Except as provided in paragraph (2), any 
     religious organization providing services under any substance 
     abuse program under this title or title V shall be subject to 
     the same regulations as other nongovernmental organizations 
     to account in accord with generally accepted accounting 
     principles for the use of such funds provided under such 
     program.
       ``(2) Limited audit.--Such organization shall segregate 
     government funds provided under such substance abuse program 
     into a separate account. Only the government funds shall be 
     subject to audit by the government.
       ``(h) Compliance.--Any party that seeks to enforce such 
     party's rights under this section may assert a civil action 
     for injunctive relief exclusively in an appropriate Federal 
     or State court against the entity or agency that allegedly 
     commits such violation.
       ``(i) Limitations on Use of Funds for Certain Purposes.--No 
     funds provided through a grant or contract to a religious 
     organization to provide services under any substance abuse 
     program under this title or title V shall be expended for 
     sectarian worship, instruction, or proselytization.
       ``(j) Effect on State and Local Funds.--If a State or local 
     government contributes State or local funds to carry out any 
     substance abuse program under this title or title V, the 
     State or local government may segregate the State or local 
     funds from the Federal funds provided to carry out the 
     program or may commingle the State or local funds with the 
     Federal funds. If the State or local government commingles 
     the State or local funds, the provisions of this section 
     shall apply to the commingled funds in the same manner, and 
     to the same extent, as the provisions apply to the Federal 
     funds.
       ``(k) Treatment of Intermediate Contractors.--If a 
     nongovernmental organization (referred to in this subsection 
     as an `intermediate organization'), acting under a contract 
     or other agreement with the Federal Government or a State or 
     local government, is given the authority under the contract 
     or agreement to select nongovernmental organizations to 
     provide services under any substance abuse program under this 
     title or title V, the intermediate organization shall have 
     the same duties under this section as the government but 
     shall retain all other rights of a nongovernmental 
     organization under this section.''.

     SEC. 306. ALCOHOL AND DRUG PREVENTION OR TREATMENT SERVICES 
                   FOR INDIANS AND NATIVE ALASKANS.

       Part D of title V of the Public Health Service Act (42 
     U.S.C. 290dd et seq.) is amended by adding at the end the 
     following:

     ``SEC. 544. ALCOHOL AND DRUG PREVENTION OR TREATMENT SERVICES 
                   FOR INDIANS AND NATIVE ALASKANS.

       ``(a) In General.--The Secretary shall award grants, 
     contracts, or cooperative agreements to public and private 
     nonprofit entities, including Native Alaskan entities and 
     Indian tribes and tribal organizations, for the purpose of 
     providing alcohol and drug prevention or treatment services 
     for Indians and Native Alaskans.
       ``(b) Priority.--In awarding grants, contracts, or 
     cooperative agreements under subsection (a), the Secretary 
     shall give priority to applicants that--
       ``(1) propose to provide alcohol and drug prevention or 
     treatment services on reservations;
       ``(2) propose to employ culturally-appropriate approaches, 
     as determined by the Secretary, in providing such services; 
     and
       ``(3) have provided prevention or treatment services to 
     Native Alaskan entities and Indian tribes and tribal 
     organizations for at least 1 year prior to applying for a 
     grant under this section.
       ``(c) Duration.--The Secretary shall award grants, 
     contracts, or cooperative agreements under subsection (a) for 
     a period not to exceed 5 years.
       ``(d) Application.--An entity desiring a grant, contract, 
     or cooperative agreement under subsection (a) shall submit an 
     application to the Secretary at such time, in such manner, 
     and accompanied by such information as the Secretary may 
     reasonably require.
       ``(e) Evaluation.--An entity that receives a grant, 
     contract, or cooperative agreement under subsection (a) shall 
     submit, in the application for such grant, a plan for the 
     evaluation of any project undertaken with funds provided 
     under this section. Such entity shall provide the Secretary 
     with periodic evaluations of the progress of such project and 
     such evaluation at the completion of such project as the 
     Secretary determines to be appropriate. The final evaluation 
     submitted by such entity shall include a recommendation as to 
     whether such project shall continue.
       ``(f) Report.--Not later than 3 years after the date of 
     enactment of this section and annually thereafter, the 
     Secretary shall prepare and submit, to the Committee on 
     Health, Education, Labor, and Pensions of the Senate, a 
     report describing the services provided pursuant to this 
     section.
       ``(g) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $15,000,000 for fiscal year 2000, and such sums as may be 
     necessary for fiscal years 2001 and 2002.

     ``SEC. 545. ESTABLISHMENT OF COMMISSION.

       ``(a) In General.--There is established a commission to be 
     known as the Commission on Indian and Native Alaskan Health 
     Care that shall examine the health concerns of Indians and 
     Native Alaskans who reside on reservations and tribal lands 
     (hereafter in this section referred to as the `Commission').
       ``(b) Membership.--
       ``(1) In general.--The Commission established under 
     subsection (a) shall consist of--
       ``(A) the Secretary;
       ``(B) 15 members who are experts in the health care field 
     and issues that the Commission is established to examine; and
       ``(C) the Director of the Indian Health Service and the 
     Commissioner of Indian Affairs, who shall be nonvoting 
     members.
       ``(2) Appointing authority.--Of the 15 members of the 
     Commission described in paragraph (1)(B)--
       ``(A) 2 shall be appointed by the Speaker of the House of 
     Representatives;
       ``(B) 2 shall be appointed by the Minority Leader of the 
     House of Representatives;
       ``(C) 2 shall be appointed by the Majority Leader of the 
     Senate;
       ``(D) 2 shall be appointed by the Minority Leader of the 
     Senate; and
       ``(E) 7 shall be appointed by the Secretary.
       ``(3) Limitation.--Not fewer than 10 of the members 
     appointed to the Commission shall be Indians or Native 
     Alaskans.
       ``(4) Chairperson.--The Secretary shall serve as the 
     Chairperson of the Commission.
       ``(5) Experts.--The Commission may seek the expertise of 
     any expert in the health care field to carry out its duties.
       ``(c) Period of Appointment.--Members shall be appointed 
     for the life of the Commission. Any vacancy in the Commission 
     shall not affect its powers, but shall be filed in the same 
     manner as the original appointment.
       ``(d) Duties of the Commission.--The Commission shall--
       ``(1) study the health concerns of Indians and Native 
     Alaskans; and
       ``(2) prepare the reports described in subsection (i).
       ``(e) Powers of the Commission.--
       ``(1) Hearings.--The Commission may hold such hearings, 
     including hearings on reservations, sit and act at such times 
     and places, take such testimony, and receive such information 
     as the Commission considers advisable to carry out the 
     purpose for which the Commission was established.
       ``(2) Information from federal agencies.--The Commission 
     may secure directly from any Federal department or agency 
     such information as the Commission considers necessary to 
     carry

[[Page 28169]]

     out the purpose for which the Commission was established. 
     Upon request of the Chairperson of the Commission, the head 
     of such department or agency shall furnish such information 
     to the Commission.
       ``(f) Compensation of Members.--
       ``(1) In general.--Except as provided in subparagraph (B), 
     each member of the Commission may be compensated at a rate 
     not to exceed the daily equivalent of the annual rate of 
     basic pay prescribed for level IV of the Executive Schedule 
     under section 5315 of title 5, United States Code, for each 
     day (including travel time), during which that member is 
     engaged in the actual performance of the duties of the 
     Commission.
       ``(2) Limitation.--Members of the Commission who are 
     officers or employees of the United States shall receive no 
     additional pay on account of their service on the Commission.
       ``(g) Travel Expenses of Members.--The members of the 
     Commission shall be allowed travel expenses, including per 
     diem in lieu of subsistence, at rates authorized for 
     employees of agencies under section 5703 of title 5, United 
     States Code, while away from their homes or regular places of 
     business in the performance of services for the Commission.
       ``(h) Commission Personnel Matters.--
       ``(1) In general.--The Secretary, in accordance with rules 
     established by the Commission, may select and appoint a staff 
     director and other personnel necessary to enable the 
     Commission to carry out its duties.
       ``(2) Compensation of personnel.--The Secretary, in 
     accordance with rules established by the Commission, may set 
     the amount of compensation to be paid to the staff director 
     and any other personnel that serve the Commission.
       ``(3) Detail of government employees.--Any Federal 
     Government employee may be detailed to the Commission without 
     reimbursement, and the detail shall be without interruption 
     or loss of civil service status or privilege.
       ``(4) Consultant services.--The Chairperson of the 
     Commission is authorized to procure the temporary and 
     intermittent services of experts and consultants in 
     accordance with section 3109 of title 5, United States Code, 
     at rates not to exceed the daily equivalent of the annual 
     rate of basic pay prescribed for level IV of the Executive 
     Schedule under section 5315 of such title.
       ``(i) Report.--
       ``(1) In general.--Not later than 3 years after the date of 
     enactment of the Youth Drug and Mental Health Services Act, 
     the Secretary shall prepare and submit, to the Committee on 
     Health, Education, Labor, and Pensions of the Senate, a 
     report that shall--
       ``(A) detail the health problems faced by Indians and 
     Native Alaskans who reside on reservations;
       ``(B) examine and explain the causes of such problems;
       ``(C) describe the health care services available to 
     Indians and Native Alaskans who reside on reservations and 
     the adequacy of such services;
       ``(D) identify the reasons for the provision of inadequate 
     health care services for Indians and Native Alaskans who 
     reside on reservations, including the availability of 
     resources;
       ``(E) develop measures for tracking the health status of 
     Indians and Native Americans who reside on reservations; and
       ``(F) make recommendations for improvements in the health 
     care services provided for Indians and Native Alaskans who 
     reside on reservations, including recommendations for 
     legislative change.
       ``(2) Exception.--In addition to the report required under 
     paragraph (1), not later than 2 years after the date of 
     enactment of the Youth Drug and Mental Health Services Act, 
     the Secretary shall prepare and submit, to the Committee on 
     Health, Education, Labor, and Pensions of the Senate, a 
     report that describes any alcohol and drug abuse among 
     Indians and Native Alaskans who reside on reservations.
       ``(j) Permanent Commission.--Section 14 of the Federal 
     Advisory Committee Act (5 U.S.C. App.) shall not apply to the 
     Commission.
       ``(k) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $5,000,000 for 
     fiscal year 2000, and such sums as may be necessary for 
     fiscal years 2001 and 2002.''.

    TITLE IV--PROVISIONS RELATING TO FLEXIBILITY AND ACCOUNTABILITY

     SEC. 401. GENERAL AUTHORITIES AND PEER REVIEW.

       (a) General Authorities.--Paragraph (1) of section 501(e) 
     of the Public Health Service Act (42 U.S.C. 290aa(e)) is 
     amended to read as follows:
       ``(1) In general.--There may be in the Administration an 
     Associate Administrator for Alcohol Prevention and Treatment 
     Policy to whom the Administrator may delegate the functions 
     of promoting, monitoring, and evaluating service programs for 
     the prevention and treatment of alcoholism and alcohol abuse 
     within the Center for Substance Abuse Prevention, the Center 
     for Substance Abuse Treatment and the Center for Mental 
     Health Services, and coordinating such programs among the 
     Centers, and among the Centers and other public and private 
     entities. The Associate Administrator also may ensure that 
     alcohol prevention, education, and policy strategies are 
     integrated into all programs of the Centers that address 
     substance abuse prevention, education, and policy, and that 
     the Center for Substance Abuse Prevention addresses the 
     Healthy People 2010 goals and the National Dietary Guidelines 
     of the Department of Health and Human Services and the 
     Department of Agriculture related to alcohol consumption.''.
       (b) Peer Review.--Section 504 of the Public Health Service 
     (42 U.S.C. 290aa-3) is amended as follows:

     ``SEC. 504. PEER REVIEW.

       ``(a) In General.--The Secretary, after consultation with 
     the Administrator, shall require appropriate peer review of 
     grants, cooperative agreements, and contracts to be 
     administered through the agency which exceed the simple 
     acquisition threshold as defined in section 4(11) of the 
     Office of Federal Procurement Policy Act.
       ``(b) Members.--The members of any peer review group 
     established under subsection (a) shall be individuals who by 
     virtue of their training or experience are eminently 
     qualified to perform the review functions of the group. Not 
     more than \1/4\ of the members of any such peer review group 
     shall be officers or employees of the United States.
       ``(c) Advisory Council Review.--If the direct cost of a 
     grant or cooperative agreement (described in subsection (a)) 
     exceeds the simple acquisition threshold as defined by 
     section 4(11) of the Office of Federal Procurement Policy 
     Act, the Secretary may make such a grant or cooperative 
     agreement only if such grant or cooperative agreement is 
     recommended--
       ``(1) after peer review required under subsection (a); and
       ``(2) by the appropriate advisory council.
       ``(d) Conditions.--The Secretary may establish limited 
     exceptions to the limitations contained in this section 
     regarding participation of Federal employees and advisory 
     council approval. The circumstances under which the Secretary 
     may make such an exception shall be made public.''.

     SEC. 402. ADVISORY COUNCILS.

       Section 502(e) of the Public Health Service Act (42 U.S.C. 
     290aa-1(e)) is amended in the first sentence by striking ``3 
     times'' and inserting ``2 times''.

     SEC. 403. GENERAL PROVISIONS FOR THE PERFORMANCE PARTNERSHIP 
                   BLOCK GRANTS.

       (a) Plans for Performance Partnerships.--Section 1949 of 
     the Public Health Service Act (42 U.S.C. 300x-59) is amended 
     as follows:

     ``SEC. 1949. PLANS FOR PERFORMANCE PARTNERSHIPS.

       ``(a) Development.--The Secretary in conjunction with 
     States and other interested groups shall develop separate 
     plans for the programs authorized under subparts I and II for 
     creating more flexibility for States and accountability based 
     on outcome and other performance measures. The plans shall 
     each include--
       ``(1) a description of the flexibility that would be given 
     to the States under the plan;
       ``(2) the common set of performance measures that would be 
     used for accountability, including measures that would be 
     used for the program under subpart II for pregnant addicts, 
     HIV transmission, tuberculosis, and those with a co-occurring 
     substance abuse and mental disorders, and for programs under 
     subpart I for children with serious emotional disturbance and 
     adults with serious mental illness and for individuals with 
     co-occurring mental health and substance abuse disorders;
       ``(3) the definitions for the data elements to be used 
     under the plan;
       ``(4) the obstacles to implementation of the plan and the 
     manner in which such obstacles would be resolved;
       ``(5) the resources needed to implement the performance 
     partnerships under the plan; and
       ``(6) an implementation strategy complete with 
     recommendations for any necessary legislation.
       ``(b) Submission.--Not later than 2 years after the date of 
     enactment of this Act, the plans developed under subsection 
     (a) shall be submitted to the Committee on Health, Education, 
     Labor, and Pensions of the Senate and the Committee on 
     Commerce of the House of Representatives.
       ``(c) Information.--As the elements of the plans described 
     in subsection (a) are developed, States are encouraged to 
     provide information to the Secretary on a voluntary basis.''.
       (b) Availability to States of Grant Programs.--Section 1952 
     of the Public Health Service Act (42 U.S.C. 300x-62) is 
     amended as follows:

     ``SEC. 1952. AVAILABILITY TO STATES OF GRANT PAYMENTS.

       ``Any amounts paid to a State for a fiscal year under 
     section 1911 or 1921 shall be available for obligation and 
     expenditure until the end of the fiscal year following the 
     fiscal year for which the amounts were paid.''.

     SEC. 404. DATA INFRASTRUCTURE PROJECTS.

       Part C of title XIX of the Public Health Service Act (42 
     U.S.C. 300y et seq.) is amended--
       (1) by striking the headings for part C and subpart I and 
     inserting the following:

 ``PART C--CERTAIN PROGRAMS REGARDING MENTAL HEALTH AND SUBSTANCE ABUSE

            ``Subpart I--Data Infrastructure Development'';

       (2) by striking section 1971 (42 U.S.C. 300y) and inserting 
     the following:

     ``SEC. 1971. DATA INFRASTRUCTURE DEVELOPMENT.

       ``(a) In General.--The Secretary may make grants to, and 
     enter into contracts or cooperative agreements with States 
     for the purpose of developing and operating mental health or 
     substance abuse data collection, analysis, and reporting 
     systems with regard to performance measures including 
     capacity, process, and outcomes measures.
       ``(b) Projects.--The Secretary shall establish criteria to 
     ensure that services will be available under this section to 
     States that have a fundamental basis for the collection, 
     analysis, and reporting of mental health and substance abuse

[[Page 28170]]

     performance measures and States that do not have such basis. 
     The Secretary will establish criteria for determining whether 
     a State has a fundamental basis for the collection, analysis, 
     and reporting of data.
       ``(c) Condition of Receipt of Funds.--As a condition of the 
     receipt of an award under this section a State shall agree to 
     collect, analyze, and report to the Secretary within 2 years 
     of the date of the award on a core set of performance 
     measures to be determined by the Secretary in conjunction 
     with the States.
       ``(d) Duration of Support.--The period during which 
     payments may be made for a project under subsection (a) may 
     be not less than 3 years nor more than 5 years.
       ``(e) Authorization of Appropriation.--
       ``(1) In general.--For the purpose of carrying out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2000, 2001 and 
     2002.
       ``(2) Allocation.--Of the amounts appropriated under 
     paragraph (1) for a fiscal year, 50 percent shall be expended 
     to support data infrastructure development for mental health 
     and 50 percent shall be expended to support data 
     infrastructure development for substance abuse.''.

     SEC. 405. 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 (Public Law 
     89-793) 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. 406. INDIVIDUALS WITH CO-OCCURRING DISORDERS.

       The Public Health Service Act is amended by inserting after 
     section 503 (42 U.S.C. 290aa-2) the following:

     ``SEC. 503A. REPORT ON INDIVIDUALS WITH CO-OCCURRING MENTAL 
                   ILLNESS AND SUBSTANCE ABUSE DISORDERS.

       ``(a) In General.--Not later than 2 years after the date of 
     enactment of this section, the Secretary shall, after 
     consultation with organizations representing States, mental 
     health and substance abuse treatment providers, prevention 
     specialists, individuals receiving treatment services, and 
     family members of such individuals, prepare and submit to the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate and the Committee on Commerce of the House of 
     Representatives, a report on prevention and treatment 
     services for individuals who have co-occurring mental illness 
     and substance abuse disorders.
       ``(b) Report Content.--The report under subsection (a) 
     shall be based on data collected from existing Federal and 
     State surveys regarding the treatment of co-occurring mental 
     illness and substance abuse disorders and shall include--
       ``(1) a summary of the manner in which individuals with co-
     occurring disorders are receiving treatment, including the 
     most up-to-date information available regarding the number of 
     children and adults with co-occurring mental illness and 
     substance abuse disorders and the manner in which funds 
     provided under sections 1911 and 1921 are being utilized, 
     including the number of such children and adults served with 
     such funds;
       ``(2) a summary of improvements necessary to ensure that 
     individuals with co-occurring mental illness and substance 
     abuse disorders receive the services they need;
       ``(3) a summary of practices for preventing substance abuse 
     among individuals who have a mental illness and are at risk 
     of having or acquiring a substance abuse disorder; and
       ``(4) a summary of evidenced-based practices for treating 
     individuals with co-occurring mental illness and substance 
     abuse disorders and recommendations for implementing such 
     practices.
       ``(c) Funds for Report.--The Secretary may obligate funds 
     to carry out this section with such appropriations as are 
     available.''.

     SEC. 407. SERVICES FOR INDIVIDUALS WITH CO-OCCURRING 
                   DISORDERS.

       Subpart III of part B of title XIX of the Public Health 
     Service Act (42 U.S.C. 300x-51 et seq.) (as amended by 
     section 305) is further amended by adding at the end the 
     following:

     ``SEC. 1956. SERVICES FOR INDIVIDUALS WITH CO-OCCURRING 
                   DISORDERS.

       ``States may use funds available for treatment under 
     sections 1911 and 1921 to treat persons with co-occurring 
     substance abuse and mental disorders as long as funds 
     available under such sections are used for the purposes for 
     which they were authorized by law and can be tracked for 
     accounting purposes.''.


                           Amendment No. 2507

(Purpose: To provide a grant program for strengthening families and to 
  modify other provisions, and to make various technical corrections)

  Mr. GRAMM. Senator Frist has an amendment at the desk. I ask for its 
consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Texas [Mr. Gramm], for Mr. Frist, proposes 
     an amendment numbered 2507.

  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. FRIST. Mr. President, I am pleased that the United States Senate 
will pass today, S. 976, the ``Youth Drug and Mental Health Services 
Act,'' which I introduced on May 6, 1999. This action follows the 
overwhelming endorsement of the Health, Education, Labor and Pensions 
Committee, which passed this bill by a vote of 17 to 1 on July 28, 
1999.
  S. 976 represents a comprehensive attempt to address the tragedy of 
increasing drug use by our children. The 1998 National Household Survey 
on Drug Abuse, conducted by the Substance Abuse and Mental Health 
Services Administration (SAMHSA) estimated that nearly 9.9 percent of 
12-17 year olds used drugs in the past month, which is dramatically 
higher that the 1992 rate of 5.3 percent. An estimated 8.3 percent of 
12 to 17 year olds have used marijuana in the past month and nearly a 
quarter of our 8th graders and about half of all high school seniors 
have tried marijuana.
  Let us not forget about the drug of choice for our youth and 
adolescents, alcohol. Although the legal drinking age is 21 in all 
States, SAMHSA reports that more than 50 percent of young adults age 
eighteen to twenty are consuming alcohol and more than 25 percent 
report having five or more drinks at one time during the past month.
  There are many factors for this increase in youth substance abuse, 
but the factor that I, as a father, am most concerned with is the 
overall decline of the disapproval of drug use and the decline of the 
perception of the risk of drug use among our youth.
  To help address this problem, the ``Youth Drug'' bill reauthorizes 
and improves SAMHSA by placing a renewed focus on youth and adolescent 
substance abuse and mental health services, while providing greater 
flexibility for States and new accountability in the use of funds based 
on performance.
  SAMHSA, formerly known as the Alcohol, Drug Abuse, and Mental Health 
Services Administration (ADAMHA) was created in 1992 by the Public Law 
102-321, the ADAMHA Reorganization Act. SAMHSA's purpose is to assist 
States in addressing the importance of reducing the incidence of 
substance abuse and mental illness by supporting programs for 
prevention and treatment. SAMHSA provides funds to States for alcohol 
and drug abuse prevention and treatment programs and activities, and 
mental health services through the Substance Abuse Prevention and 
Treatment and the Community Mental Health Services Block Grants.
  SAMHSA's block grants are a major portion of this nation's response 
to substance abuse and mental health service needs, accounting for 40 
percent and 15 percent respectively of all substance abuse and 
community mental health services funding in the States. In my own State 
of Tennessee, SAMHSA provides over 70 percent of overall funding for 
the Tennessee Department of Health's Bureau of Alcohol and Drug Abuse 
Services, which is headed by Dr. Stephanie Perry.
  Last year Tennessee received over $25 million from the Substance 
Abuse Prevention and Treatment Block Grant to spend on treatment and 
prevention activities. With this funding the Tennessee Bureau of 
Alcohol and Drug Abuse Services provides funding to community-based 
programs that offer a wide range of services throughout the State. In 
all, the block grant funds provided under this bill permits nearly 
6,500 Tennesseans to receive the substance abuse treatment they 
desperately need.
  Today, we in part finish an effort in the Senate that began several 
years ago to reform and improve our Nation's substance abuse and mental 
health services. While working on this effort, I have targeted six main 
goals which I am pleased to report has been accomplished by this 
legislation. These goals include: promoting State flexibility in block 
grant and discretionary funding by eliminating or stripping back the

[[Page 28171]]

numerous outdated or unneeded requirements which Congress has mandated 
on the States in their expenditure of Federal block grant and 
discretionary funds; ensuring accountability for the expenditure of 
Federal funds by beginning the process of moving away from the 
inefficiency of a system based on expenditure of funds to a performance 
based system determined in consultation with the States and based upon 
States' needs; developing and supporting youth and adolescent substance 
abuse prevention and treatment initiatives by including provisions to 
provide substance abuse treatment services and early intervention 
substance abuse services for children and adolescents; developing and 
supporting mental health initiatives that are designed to prevent and 
respond to incidents of teen violence by authorizing provisions that 
will assist local communities in developing ways to treat violent youth 
and minimize outbreaks of youth violence by forming partnerships among 
the schools, law enforcement and mental health services; ensuring the 
availability of Federal funding for substance abuse or mental health 
emergencies by giving the Secretary the authority to use up to 3 
percent of discretionary funding to respond to substance abuse or 
mental health emergencies, such as an outbreak of methamphetamine 
activity, without having to go through the peer review process which 
adds countless weeks and months to the agency's ability to respond; and 
supporting programs targeted for the homeless in treating mental health 
and substance abuse by reauthorizing programs which develop and expand 
mental health and substance abuse treatment services for homeless 
individuals, including outreach, screening and treatment, habilitation 
and rehabilitation to homeless individuals suffering from substance 
abuse or mental illness.
  In addition to meeting these six goals, the bill that the Senate 
passed today addresses several additional important substance abuse and 
mental health issues.
  S. 976 addresses the very crucial issue of how to treat individuals 
with a co-occurring mental health and substance abuse disorder. There 
has been considerable debate on how to treat these individuals, and I 
am pleased that the National Association of State Alcohol and Drug 
Abuse Directors and the National Association of State Mental Health 
Program Directors reached a consensus on this issue. This agreement 
includes language which acknowledges that both substance abuse and 
mental health block grant funds can be used to treat individuals with 
co-occurring disorders as long as the funds used can be tracked to show 
that substance abuse dollars were used for substance abuse services and 
mental health dollars were used for mental health services.
  Another very important issue that is addressed in S. 976 is the 
proper and safe use of restraints and seclusions in mental health 
facilities. I would like to acknowledge the important work done on this 
issue by Senator Dodd, who drafted the provisions included in the bill. 
He has been a true leader on this issue in the Senate and should be 
commended for bringing this issue to our attention.
  There are also provisions in S. 976 to address the inadequacy of 
substance abuse services for American Indians and Native Alaskans. The 
bill establishes a Commission on Indian and Native Alaskan Health Care 
that shall carry out a comprehensive examination of the health concerns 
of Indians and Native Alaskans living on reservations or tribal lands.
  And last, but not least, the bill has an important provision called 
``charitable choice.'' This provision would permit religious 
organizations which provide substance abuse services to be eligible for 
Federal assistance either through the Substance Abuse Prevention and 
Treatment Block Grant or discretionary grants through SAMHSA. 
``Charitable choice'' acknowledges that no one approach works for 
everyone who needs and wants substance abuse treatment and that faith-
based programs have strong records of successful rehabilitation. 
Despite this success, faith-based programs are currently not allowed to 
receive to federal funds. The ``charitable choice'' provisions in this 
bill will not allow the Federal government to continue to discriminate 
against faith-based providers regarding substance abuse services. I 
will not outline all the provisions of the amendment at this time, but 
would instead like to point out that this provision is similar to the 
charitable choice provisions that Senator Ashcroft offered to the 
Welfare Reform Act of 1996. I would like to thank the leadership of 
Senators Ashcroft and Abraham on this critical issue, and especially 
thank the hard work and dedication of Annie Billings of Senator 
Ashcroft's staff.
  I would like to thank all the Members of the Health, Education, Labor 
and Pensions Committee and their staffs for their help on this 
bipartisan piece of legislation, especially Senator Kennedy and his 
staff Dr. David Pollack, Debra DeBruin and David Nexon who have been 
instrumental in helping to draft this legislation. I would also like to 
thank the contributions of the Chairman of the Committee, Senator 
Jeffords, and his staff members Philo Hall and Sean Donohue, Senator 
DeWine and his staff member Karla Carpenter, Senator Gregg and his 
staff Alan Gilbert and Shalla Ross, Senator Dodd and his staff Jeanne 
Ireland and Jim Fenton, Senator Harkin and his staff Bryan Johnson, 
Senator Mikulski and her staff, Rhonda Richards, Senator Bingaman and 
his staff Dr. Robert Mendoza, Senator Reed and his staff Rebecca Morley 
and Lisa German, and Senator Wellstone and his staff Ellen Gerrity and 
John Gilman. I would also like to thank my staff, Anne Phelps, the 
Staff Director of my Subcommittee on Public Health, and Dave Larson, my 
Health Policy Analyst, for their efforts on this bill. I would also 
like to thank Daphne Edwards of the Office of Legislative Counsel and 
Julia Christensen of the Congressional Budget Office for their 
contributions. Finally, I would like to thank an individual who has 
worked tirelessly in assisting us in getting this process to where we 
are today, Joe Faha, the Director of Legislation and External Affairs 
for SAMHSA.
  Mr. President, the bill we passed today will ensure that Tennessee 
and other states will continue to receive critically needed Federal 
funds for community based programs to help individuals with substance 
abuse and mental health disorders. The changes within this bill will 
dramatically increase State flexibility in the use of Federal funds and 
ensure that each State is able to address its unique needs. The bill 
will also provide a much needed focus on the troubling issue of the 
recent increase in drug use by our youth and address how we can be 
helpful to local communities in regard to the issue of children and 
violence. I am pleased to see this bill pass the Senate and I look 
forward to its ultimate enactment into law.
  Mr. KENNEDY. Mr. President, this bill is the result of a concerted 
and cooperative bipartisan effort. It is an important and timely piece 
of legislation that is long overdue, and I urge the Senate to support 
it.
  Mental illness and substance abuse are national problems that need 
comprehensive and compassionate attention. These conditions do not 
respect party affiliation or race or age. They are equal opportunity 
destroyers, but they don't have to destroy at all.
  States and local communities provide some of the most critical and 
ongoing services for persons who struggle with mental illness and 
substance abuse. This bill enables these dedicated providers to do an 
even better job with limited resources to accomplish their prevention 
and treatment goals.
  Since we passed the original authorizing legislation for the 
Substance Abuse and Mental Health Services Administration in 1992, a 
number of major clinical and service delivery issues have emerged which 
require legislative attention. Now we have crafted a bill that 
accomplishes a great deal and that includes significant compromises on 
a number of key issues.
  The bill addresses three important clinical issues that have emerged 
in recent years: the growing problem of co-occurring mental health and 
substance abuse disorders, the distressing and

[[Page 28172]]

pervasive impact of psychological trauma especially on our younger 
citizens, and the important relationship between mental health or 
substance abuse and primary care providers. It also places much greater 
emphasis on preventing and treating mental health and substance abuse 
problems in children and adolescents.
  The provisions for children demonstrate the breadth and depth of this 
bill. It contains a children and violence initiative, centers of 
excellence for psychological trauma, grants for persons who experience 
violence-related stress, comprehensive substance abuse prevention and 
treatment for children and adolescents, special attention for children 
of substance abusers, wrap-around services for youth offenders, and 
special training centers to increase the sensitivity and competency of 
staff who work on these issues in the juvenile justice system.
  The bill also addresses special problems that adults face. It 
maintains and expands support for critical programs that serve the 
homeless, extends its protection to persons who are served in 
community-based facilities, limits the use of seclusion and restraints 
in psychiatric facilities, and addresses the special circumstances of 
Native Americans.
  I am particularly pleased with the initiatives to meet the intense 
service needs of persons with co-occurring mental health and substance 
abuse disorders. Often, they need innovative treatment approaches, 
including integrated mental health and addiction treatment facilities. 
Over the next two years, the Secretary will compile a report that 
establishes the best practices for helping this very challenging but 
treatable group.
  The bill authorizes the Secretary to provide additional funding for 
projects on the increasingly important ties linking mental health or 
substance abuse and primary care. Family physicians and other primary 
care providers see many patients with a wide range of psychiatric and 
psychological problems. Too often, however, they do not recognize the 
mental health problems of their patients. Even if they do, they are 
often ill-prepared to provide adequate treatment or counseling. We can 
do much more to help primary care physicians do a better job of caring 
for patients with serious mental illnesses. This bill seeks to do that.
  The bill also accomplishes several important organizational goals. It 
gives States more flexibility in administering their grant funds, and 
removes a number of bureaucratic obstacles to greater efficiency. In 
exchange for this easing of certain mandates, the States will enter 
into a cooperative agreement with the Administration in developing 
outcomes-based accountability measures.
  The bill also gives the SAMHSA Administrator greater authority in 
managing discretionary grant funds. It enables the Administrator to 
make emergency grants to deal with immediate problems that cannot be 
addressed by the standard grant-making process.
  In spite of the many excellent features in this bill, one provision 
is seriously flawed. The section that allows religious organizations to 
compete for public funds for the provision of substance abuse services 
violates the prohibition against certain forms of discrimination. I 
recognize the valuable role that faith-based organizations can play in 
helping to address a wide array of social problems. However, the recent 
proliferation of charitable choice provisions in federal social service 
programs runs the risk of creating a religious litmus test for those 
who provide these services, thus barring many trained, qualified 
professionals from providing services for faith-based organizations. We 
need to do more to avoid that discrimination.
  Our goal is to help many of those in communities across the country 
who have received inadequate care in the past. The many excellent 
provisions in this bill will help to ensure that these children and 
adults will finally receive the care they need and deserve--without 
stigma or shame, but with dignity and respect--and America will be a 
better nation because of it.
  I commend my colleagues for this important action to reauthorize the 
Substance Abuse and Mental Health Services Administration. I want to 
thank Senator Frist and his Republican colleagues and their staffs for 
their skillful work for this genuine bipartisan achievement. I commend 
Senator Dodd, who worked effectively on children's issues and the 
seclusion and restraint provision. Senator Harkin contributed his 
important initiative on methamphetamine and inhalant abuse, and Senator 
Durbin contributed his critical provision on residential treatment for 
pregnant women and women who have given birth. Senators Bingaman, 
Wellstone, and Reed effectively collaborated on a series of significant 
child and adolescent provisions, and Senator Bingaman worked 
effectively on the needs of Native Americans. Senators Mikulski and 
Murray provided excellent counsel on many issues, especially the mental 
health and substance abuse treatment needs of women. I thank Joe Faha, 
SAMHSA's Director of Legislation, for his generous assistance 
throughout the process, as well as Nelba Chavez, the Administrator of 
SAMHSA. I especially thank David Pollack, David Nexon and Debra DeBruin 
on my staff, for their dedication and excellent work in bringing this 
bill to passage.
  Mr. DODD. Mr. President, I rise in support of S. 976, Youth Drug and 
Mental Health Services Act, and to express my appreciation for the 
leadership that Senator Frist has shown in moving this long-overdue 
legislation forward. At a time when so many other worthy legislative 
efforts have been derailed by partisan politics, the unanimous support 
for this measure in the Senate is particularly noteworthy.
  Substance abuse and mental illness take a terrible toll on 
individuals, families and on society at-large. Each year, approximately 
5.5 million Americans are disabled by severe mental illness and an 
estimated 4.1 million individuals are addicted to drugs, including 1.1 
million of our children. In Connecticut alone, an estimated 130,000 
adults suffer from severe mental illness and 224,000 are in need of 
substance abuse treatment. Among Connecticut's youth, an estimated 
23,000 have a serious emotional or behavioral disorder.
  Given that so many of our Nation's most intransigent social ills--
poverty, violence, child abuse, premature death, and homelessness--have 
their roots in untreated substance abuse and mental illness, it is 
critical that we do all that we can to ensure that states, communities 
and families have the resources they need to combat these devastating 
conditions. This reauthorization of the Substance Abuse and Mental 
Health Services Act (SAMHSA) represents an important step in expanding 
and improving early intervention, prevention, and treatment services. 
Through S. 976, States are given the flexibility to develop innovative 
systems of care for substance abuse and mental health, but will also be 
required to improve accountability by developing performance measures 
and enhancing their data collection efforts.
  I am particularly pleased that this reauthorization contains 
legislation that I introduced earlier this year, the Compassionate Care 
Act, which will address a critical issue that a Hartford Courant series 
brought to national attention last year--the inappropriate use of 
seclusion and restraint within mental health care facilities. The 5-day 
investigative series documented more than 140 deaths directly 
attributable to abusive seclusion and restraint practices. An 
additional investigation conducted by the General Accounting Office 
determined that 24 deaths of individuals with mental illnesses resulted 
from restraint or seclusion. However, both the Hartford Courant and the 
GAO report determined that these figures most likely represent just the 
tip of the iceberg of restraint and seclusion related deaths. In fact, 
the Harvard Center for Risk Analysis estimated that as many as 100-150 
deaths each year may be caused by the inappropriate use of restraint 
and seclusion. This is a tragedy that must be stopped.
  The Compassionate Care Act creates tough new limits on the use of 
potentially lethal restraints--whether physical or chemical in nature--
sets rules for training mental health care workers; and increases the 
likelihood that a

[[Page 28173]]

wrongful death of a mental health patient will be investigated and 
prosecuted--not ignored. The legislation simply seeks to put an end to 
a shameful record of neglect and abuse of some our Nation's most 
vulnerable and least cared for individuals. Specifically, the 
Compassionate Care Act will ensure that physical restraints are no 
longer used for discipline or for the convenience of mental health 
facility staff by extending to the mental health population a standard 
that has been demonstrated to be effective in reducing the use of 
restraints and seclusion in nursing homes. This legislation will ensure 
that restraint and seclusion will only be used when a mentally ill 
individual poses an imminent threat either to himself or others.
  Further, this legislation will require that all restraint and 
seclusion related deaths be reported to an appropriate oversight agency 
as determined by the Secretary of Health and Human Services. Presently, 
there is no standard federal reporting requirement for deaths as result 
of seclusion or restraint. The simple reporting measure in this 
legislation will greatly aid the federal government, as well as state 
and local oversight agencies, in tracking and investigating abusive 
treatment practices. The Compassionate Care Act will also require 
mental health care facilities to maintain adequate staffing levels and 
provide appropriate training for mental health care staff, who are 
often the least paid and least trained of all health care workers. 
These safeguards will hopefully prevent further harm to individuals who 
may be unable to protect themselves from abuse by those entrusted with 
their care. I thank Senator Frist for working closely with my office in 
crafting this critically important part of SAMHSA's reauthorization.
  I am also pleased that S. 976 incorporates legislation that I have 
cosponsored with Senator Jeffords, the Children of Substance Abusers 
Act (COSA). Children with substance abusing parents face serious health 
risks, including congenital birth defects and psychological, emotional, 
and developmental problems. We also know that substance abuse plays a 
major role in child abuse and neglect. In fact, it is estimated that 
children whose parents abuse drugs and/or alcohol are three times more 
likely to be abused and four times more likely to be neglected than 
children whose parents are not substance abusers. In an effort to 
lessen the terrible toll that substance abuse takes on children, COSA 
will promote aggressive outreach, early intervention, prevention, and 
treatment services to families struggling with addiction. In addition, 
COSA will strengthen the systems which provide these services by 
training professionals serving children and families in recognizing and 
addressing substance abuse.
  I am also grateful that Senator Frist agreed to include my Teen 
Substance Abuse Treatment Act of 1999 within this reauthorization. Each 
year, 400,000 teens and their families, including 7,000 in the state of 
Connecticut alone, will seek substance abuse treatment but find that it 
is either unavailable or unaffordable. At best only 20 percent of 
adolescents with severe alcohol and drug treatment problems who ask for 
help will receive any form of treatment. Without help, substance abuse 
puts young people's health at risk and exacerbates anti-social and 
violent behaviors. This legislation will provide grants to give youth 
substance abusers access to effective, age-appropriate treatment. It 
will also address the particular issues of youth involved with the 
juvenile justice system and those with mental health or other special 
needs. In short, this legislation will go a long way toward ensuring 
that no young person who seeks substance abuse treatment will be denied 
help.
  I would also like to thank Senator Frist for working with me and 
Senator Gregg on the Strengthening Families through Community 
Partnerships program, which will promote healthy early childhood 
development by intervening with at-risk families with young children 
and their communities. This legislation will support demonstrations to 
test the efficacy of deterring substance use and abuse and other high 
risk behaviors through a comprehensive substance abuse prevention 
program that targets the child's family.
  I do have reservations, however, on one aspect of this legislation. 
While I support the ability of faith-based organizations to provide 
substance abuse services, I am concerned about provisions in this 
legislation that would allow religiously based facilities providing 
substance abuse services to hire only adherents to their own religion. 
The ability of faith-based providers to participate in providing 
valuable federally funded programs is a laudable goal. I firmly believe 
that faith-based substance abuse services can offer critical help in 
overcoming drug dependency. However, the ability of religiously based 
entities to provide federally funded programs within this legislation 
should not be allowed to blur the line between church and state and to 
erode crucial anti-discrimination protections.
  S. 976 represents a bipartisan commitment to reducing the devastating 
impact of substance abuse and mental illness of our Nation's families. 
I want to again applaud Senator Frist, Senator Kennedy, Senator 
Jeffords, and other members of the Health and Education committee and 
their staffs for their efforts in developing this legislation and urge 
the House of Representatives to follow the Senate's lead by acting on 
this bill expeditiously.
  Mr. ASHCROFT. Mr. President, I would like to take this opportunity to 
commend the members of the Senate Health, Education, Labor, and 
Pensions Committee for their efforts in crafting S. 976, the ``Youth 
Drug and Mental Health Services Act,'' which reauthorizes programs 
under the Substance Abuse and Mental Health Services Administration. In 
particular, I want to recognize the Chairman of the Subcommittee on 
Public Health, the Senator from Tennessee, Mr. Frist, for his 
tremendous leadership in drafting this legislation.
  I am especially pleased that this legislation contains the Charitable 
Choice provision--modeled after my Charitable Choice provision in the 
1996 welfare reform law--which will expand the opportunities for 
religious organizations to provide substance abuse treatment services 
with SAMHSA block grant funds. This provision is also very similar to 
language contained in Senator Abraham's legislation, the ``Faith-Based 
Drug Treatment Enhancement Act.''
  While government substance abuse programs have not succeeded very 
well in helping people break free from addictions, faith-based drug 
treatment programs have been transforming shattered lives for years by 
addressing the deeper needs of people--by instilling hope and values 
which change destructive behavior and attitudes.
  What results have they achieved? We have heard countless stories of 
the efficiency and effectiveness of these faith-based programs. Teen 
Challenge has shown that 86% of its graduates remain drug-free. These 
are individuals who finally broke free of addictions after being routed 
through a number of government drug treatment programs. The Bowery 
Mission in New York City has had the most effective free-standing 
substance abuse shelter in the city-wide system. Bowery also serves its 
clients at approximately 42% of the cost of some other city-sponsored 
men's substance abuse shelters. Mel Trotter Ministries in Grand Rapids, 
Michigan, named for its former alcoholic founder, has an astounding 70 
percent long-term success rate in its faith-based rehabilitation 
program. According to director Thomas Laymon, government programs leave 
addicts without ``spiritual support.'' Worse, addicts ``are not held 
accountable for addictions, and they have no incentive to change their 
behavior.'' Meanwhile, Trotter Ministries provides guidance, a 
supportive community, and integration into a life beyond drugs. San 
Antonio's Victory Fellowship, run by Pastor Freddie Garcia, has saved 
thousands of addicts in some of the city's toughest neighborhoods. The 
program offers addicts a safe haven, a chance to recover, job training, 
and a chance to provide for themselves and their families. It has 
served more than 13,000 people and has a success rate of over 80%.

[[Page 28174]]

  USA Today cited a study from Georgetown University Medical Center 
regarding recovery from opiate addiction. The study found that 45% of 
those who participated in a religious program were drug-free after one 
year, while only 5% of those who participated in a non-religious 
program remained drug-free after a year.
  Why are faith-based organizations successful? Because they see those 
they serve as people, not profiles. They come at this with a holistic 
approach. They address the moral and spiritual cause of the problems 
rather than simply dealing with the symptoms.
  While some states may already collaborate with religious and 
charitable organizations in the area of substance abuse programs, 
Charitable Choice is intended to expand the use of these partnerships 
by clarifying to government officials and religious organizations alike 
what the constitutional ground rules are for these partnerships. If we 
know that faith-based substance abuse programs are successful in 
helping people break destructive addictions, government should 
encourage their expanded use. That is precisely what this legislation 
does.
  The Charitable Choice provision in this legislation makes clear that 
states may direct SAMHSA block grant funds to religious organizations 
through contracts, grants, or cooperative agreements to provide 
substance abuse treatment services to beneficiaries. The provision 
reflects our belief in Congress that government should exercise 
neutrality when inviting the participation of non-governmental 
organizations to be service providers by considering all 
organizations--even religious ones--on an equal basis, and by focusing 
on whether the organization can provide the requested service, rather 
than on the religious or non-religious character of the organization.
  Unfortunately, in the past, many faith-based organizations have been 
afraid--often rightfully so--of accepting governmental funds in order 
to help the poor and downtrodden. They fear that participation in 
government programs would not only require them to alter their 
buildings, internal governance, and employment practices, but also make 
them compromise the very religious character which motivates them to 
reach out to people in the first place.
  Charitable Choice is intended to allay such fears and to prevent 
government officials from misconstruing constitutional law by banning 
faith-based organizations from the mix of private providers for fear of 
violating the Establishment Clause. Even when religious organizations 
are permitted to participate, government officials have often gone 
overboard by requiring such organizations to sterilize buildings or 
property of religious character and to remove any sectarian connections 
from their programs. This discrimination can destroy the character of 
many faith-based programs and diminish their effectiveness in helping 
people climb from despair and dependence to dignity and independence.
  Charitable Choice embodies existing U.S. Supreme Court case 
precedents in an effort to clarify to government officials and 
charitable organizations alike what is constitutionally permissible 
when involving religiously-affiliated institutions. Based upon these 
precedents, the legislation provides specific protections for religious 
organizations when they provide services with government funds. For 
example, the government cannot discriminate against an organization on 
the basis of its religious character. A participating faith-based 
organization also retains its religious character and its control over 
the definition, development, practice, and expression of its religious 
beliefs.
  Additionally, the government cannot require a religious organization 
to alter its form of internal governance or remove religious art, 
icons, or symbols to be eligible to participate. Finally, religious 
organizations may consider religious beliefs and practices in their 
employment decisions. I have been told by numerous faith-based entities 
and attorneys representing them that autonomy in employment decisions 
is crucial in maintaining an organization's mission and character.
  Charitable Choice also states that funds going directly to religious 
organizations cannot be used for sectarian worship, instruction, or 
proselytization. Government dollars are to be used for the secular 
purpose of the legislation: providing effective treatment for substance 
abuse problems.
  The Charitable Choice provision also contains important and necessary 
protections for beneficiaries of services, ensuring that they may not 
be discriminated against on the basis of religion. Also, if a 
beneficiary objects to receiving services from a religious provider, he 
has the right to demand that the State provide him with services from 
an alternative provider.
  Mr. President, the Charitable Choice provision is truly bipartisan in 
nature. Shortly after passage of the federal welfare law, Texas 
Governor Bush signed an executive order directing ``all pertinent 
executive branch agencies to take all necessary steps to implement the 
`charitable choice' provision of the federal welfare law.'' And earlier 
this year, Vice President Gore stated that Charitable Choice should be 
extended ``to other vital services where faith-based organizations can 
play a role, such as drug treatment, homelessness, and youth 
violence.'' The Vice President described why faith-based approaches 
have shown special promise with challenges such as drug addiction. He 
said that overcoming these types of problems ``takes something more 
than money or assistance--it requires an inner discipline and courage, 
deep within the individual. I believe that faith in itself is sometimes 
essential to spark a personal transformation--and to keep that person 
from falling back into addiction, delinquency, or dependency.''
  Mr. President, I am pleased to say that today we are responding to 
the Vice President's call for expanding Charitable Choice to drug 
treatment programs. We are ready to provide people with resources 
needed to experience a personal transformation and break free from drug 
or alcohol addiction. Through the bipartisan effort of the Senate 
Health, Education, Labor, and Pensions Committee, we have legislation 
that will provide greater opportunities to those in our society who are 
fighting to overcome substance abuse problems.
  Again, I want to thank Senator Frist, his staff, Chairman Jeffords, 
and the rest of the Committee for their fine work on this legislation.
  Mr. REED. Mr. President, today I would like to express my 
disappointment about a provision that the Majority chose to include in 
the Youth Drug and Mental Health Services Act, S.976. In Section 305 of 
the Act, the ``Charitable Choice'' provision permits all religious 
institutions, including pervasively religious organizations, such as 
churches and other houses of worship, to use taxpayer dollars to 
advance their religious mission. Given the Supreme Court precedent, I 
believe this provision is Constitutionally suspect and be subject to 
greater review when this bill goes to Conference with its House 
counterpart.
  Although charitable choice has already become law as a part of 
welfare reform and the Community Services Block Grant, CSBG, portion of 
the Human Services Reauthorization Act, efforts are being made to 
expand this change to every program that receives federal financial 
assistance. The inclusion of charitable choice in this legislation is 
particularly disturbing since, unlike its application to the 
intermittent services provided under Welfare Reform and CSBG, Substance 
Abuse and Mental Health Services Administration (SAMHSA) funds are used 
to provide substance abuse treatment which is ongoing, involves direct 
counseling of beneficiaries and is often clinical in nature. In the 
context of these programs it would be difficult if not impossible to 
segregate religious indoctrination from the social service.
  I agree with the Majority that faith-based organizations have an 
important and necessary role to play in combating many of our nation's 
social ills, including youth violence, homelessness, and substance 
abuse. In fact, I have seen first-hand the impact that faith-based 
organizations such as

[[Page 28175]]

Catholic Charities have on delivering certain services to people in 
need in my own state. By enabling faith-based organizations to join in 
the battle against substance abuse, we add another powerful tool in our 
ongoing efforts to help people move from dependence to independence.
  However, although there are great benefits that come with allowing 
religious organizations to provide social services with federal funds, 
the Vice President recently reminded us that ``clear and strict 
safeguards'' must exist to ensure that the dividing line between church 
and state is not erased. Even the front runner for the Republican 
Presidential nomination, Governor George W. Bush, acknowledged to the 
New York Times that these safeguards are necessary: ``Bush said . . . 
that federal money would pay for services delivered by faith-based 
groups, not for the religious teachings espoused by the groups.''
  In my home state of Rhode Island there is a tradition of religious 
tolerance and respect for the boundaries of religion and government. 
Indeed, Roger Williams, who was banished from the Massachusetts Bay 
Colony for his religious beliefs, founded Providence in 1636. The 
colony served as a refuge where all could come to worship as their 
conscience dictated without interference from the state. 
Understandably, Rhode Islanders remain mindful of mixing religion with 
its political system.
  Mr. President, I am particularly concerned that without proper 
safeguards, well-intentioned proposals to help religious organizations 
aid needy populations, might actually harm the First Amendment's 
principle of separation of church and state. For example, the 
charitable choice provision creates a disturbing new avenue for 
employment discrimination and proselytization in programs funded by the 
Substance Abuse and Mental Health Services Administration. Under 
current law, many religiously-affiliated nonprofit organizations 
already provide government-funded social services without employment 
discrimination and without proselytization. However, the legislation 
before us extends title VII's religious exemption to cover the hiring 
practices of organizations participating in SAMHSA funded programs. As 
the Majority's report language points out, even if the organization is 
solely funded by SAMHSA, it may ``make employment decisions based upon 
religious reasons.''
  For example, a federally funded substance abuse treatment program run 
by a church could fire or refuse to hire an individual who has 
remarried without properly validating his or her second marriage in the 
eyes of that church--even if he or she is a well-trained and successful 
substance abuse counselor.
  This is not an entirely hypothetical example. In Little v. Wuerl, 929 
F.2d 944 (3d Circ. 1991) the Court held that ``Congress intended the 
explicit exemptions to title VII to enable religious organizations to 
create and maintain communities composed solely of individuals faithful 
to their doctrinal practices, whether or not every individual plays a 
direct role in the organization's religious activities.'' The Court 
concluded that ``the permission to employ persons `of a particular 
religion' includes permission to employ only persons whose beliefs and 
conduct are consistent with the employer's religious precepts.'' This 
may be acceptable when the religious organization is using its own 
money, but when it is using federal funds, with explicit prohibitions 
against proselytization, this kind of discrimination is a cause of 
considerable concern.
  During markup, Senator Kennedy and I introduced an amendment that 
would have addressed this issue by including important safeguards and 
protections for beneficiaries and employees of SAMHSA funded programs.
  The Reed-Kennedy amendment would have removed the bill's provision 
that allows religious organizations to require that employees hired for 
SAMHSA funded programs must subscribe to the organization's religious 
tenets and teachings. Since section 305 prohibits religious 
organizations from proselytizing in conjunction with the dissemination 
of social services under SAMHSA programs, it is contradictory to permit 
religious organizations to require that their employees subscribe to 
the organization's tenets and teachings. Second, the amendment would 
have eliminated the bill's provision that extends title VII's religious 
exemption to cover the hiring practices of organizations participating 
in SAMHSA funded programs.
  Ultimately, the modest proposal would not have reduced the ability of 
religious groups to hire co-religionists or more actively participate 
in SAMHSA funded programs. It merely would have eliminated the explicit 
ability to discriminate in taxpayer funded employment and left to the 
courts the decision of whether employees who work on, or are paid 
through, government grants or contracts are exempt from the prohibition 
on religious employment discrimination. Unfortunately, the Majority 
chose to vote against including the important safeguards proposed in 
the Reed-Kennedy amendment.
  For the last 30 years, federal civil rights laws have expanded 
employment opportunities and sought to counter discrimination in the 
workplace. I recognize that we need the assistance of religious 
organizations in the battle against substance abuse, but without a far 
more robust and informed debate must be far more circumspect of efforts 
to expand current exemptions to title VII.
  Mr. President, I believe we should enlist the assistance of religious 
organizations without undermining constitutional principles and civil 
rights law. Accordingly, I am concerned that the charitable choice 
provision, though laudable in concept, would have disturbing practical 
and constitutional consequences. Mr. President, I ask unanimous consent 
that letters expressing the view of the Unitarian Universalist 
Association of Congregations and the American Jewish Committee be 
printed in the Record so my colleagues may become more aware of these 
organizations' views on this matter.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                          Office of Government and


                                        International Affairs,

                                 Washington, DC, November 2, 1999.
     Hon. Jack Reed,
     U.S. Senate, 320 Hart Senate Office Building, Washington, DC.
       Dear Senator Reed: I write on behalf of the American Jewish 
     Committee, the nation's oldest human relations organization 
     with more than 100,000 members and supporters, to urge you to 
     place a hold on S. 976, the Substance Abuse Mental Health 
     Reauthorization Act, which includes ``charitable choice'' 
     provisions that are both constitutionally flawed and bad 
     public policy.
       The ``charitable choice'' provisions in S. 976 constitute 
     an unacceptable breach in the separation of church and state 
     that has played so crucial a role in ensuring the strength of 
     religion in America, and places a risk the quality of 
     healthcare services provided to individuals with chemical 
     abuse and dependency behavioral disorders.
       To be sure, the history of social services in this country 
     began with religious institutions, and the partnership 
     between religiously affiliated institutions and government in 
     the provision of those services is a venerable one. Catholic 
     Charities, not to mention many Jewish agencies across this 
     land, have engaged in such partnerships for many years. Far 
     from objecting to that partnership, the American Jewish 
     Committee, in its 1990 Report on Sectarian Social Services 
     and Public Funding, termed the involvement of the religious 
     sector in publicly-funded social service provision as 
     ``desirable to the extent it is consistent with the 
     Establishment Clause. It creates options for those who wish 
     to receive the services, involves agencies and individuals 
     motivated to provide the services, and helps to avoid making 
     the government the sole provider of social benefits.''
       What is new in the ``charitable choice'' arena is not the 
     notion of a partnership of faith-based organizations and 
     government. Rather the innovation of a ``charitable choice'' 
     as a structure that seeks to ignore binding constitutional 
     law, not to mention sound public policy, by permitting 
     pervasively religious institutions, such as churches and 
     other houses of worship, to receive taxpayer dollars for 
     programs that have not been made discrete and institutionally 
     separate. In so doing, and in failing to include other 
     appropriate church-state safeguards, ``charitable choice'' 
     opens the door to publicly funded programs in which 
     recipients of social services may be proselytized. 
     ``Charitable choice'' also creates a real possibility

[[Page 28176]]

     of creating rifts among the various faith groups as they 
     compete for public funding and allows religious providers to 
     engage in religious discrimination against employers who are 
     paid with taxpayers dollars. (Although religious institutions 
     are permitted to hire co-religionists in the contest of 
     private religious activity, it is simply improper for 
     taxpayer dollars to be used to fund religious 
     discrimination.)
       There is yet another aspect of the ``charitable choice'' 
     initiative that is cause for concern. With government dollars 
     comes government oversight. But this kind of intrusion into 
     the affairs of religious organizations, at least in the case 
     of pervasively sectarian organizations, is exactly the type 
     of entangelememt of religious and state against which the 
     Constitution guards. Such intrusion can have no effect but to 
     undermine the distinctiveness, indeed the very mission, of 
     religious institutions.
       In addition to the foregoing, we are greatly concerned by 
     the portion of S. 976's ``charitable choice'' provisions that 
     allow sectarian providers of treatment for chronic substance 
     abuse conditions, such as alcoholism, and drug addiction, to 
     avoid clinically based certification and licensure standards. 
     This legislation should not be allowed to go forward without 
     necessary improvements to the bill to provide essential 
     church-state protections, and without closer examination of 
     the consequences of allowing sectarian care providers to 
     avoid compliance with applicable state education, training 
     and credentialing standards.
       Thank you for your consideration of our views on this very 
     important matter.
           Sincerely,
                                                Richard T. Foltin,
     Legislative Director and Counsel.
                                  ____

                                            Unitarian Universalist


                                 Association of Congregations,

                                 Washington, DC, November 2, 1999.


 Statement of the Unitarian Universalist Association of Congregations 
      opposition to the ``Charitable Choice'' provisions of S. 976

       The Unitarian Universalist Association of Congregations has 
     a long, proud record of support for both religious freedom 
     and the separation of church and state. Our General Assembly 
     has issued 10 resolutions since 1961 to this effect. It is 
     thus with little hesitation that we voice our strong 
     opposition to the ``Charitable Choice'' provisions of S. 976, 
     SAMHSA, the Youth, Drug, and Mental Health Services Act.
       These and other similar Charitable Choice provisions 
     undermine the separation of church and state by (1) promoting 
     excessive entanglement between church and state; and (2) 
     privileging certain religions and religious institutions 
     above others.
       It does this in the following ways:
       By channeling government money into ``pervasively 
     sectarian'' institutions. The Supreme Court has already 
     clearly ruled that the government cannot fund ``pervasively 
     sectarian'' institutions.
       By fostering inappropriate competition among religious 
     groups for government money. With limited funding available 
     for any one service, governments will be required to decide 
     which religious institutions will receive funding and which 
     will not. This necessarily puts those governments in the 
     wholly un-Constitutional position of discriminating among 
     religious groups.
       By allowing government-funded institutions to discriminate 
     in their employment on the basis of religion. This amounts to 
     federally-funded employment discrimination, thus violating 
     myriad employment and civil rights laws.
       By subjecting service-recipients to government-sanctioned 
     proselytization and religious oppression. Individuals 
     receiving government services should not have ``religious 
     strings'' attached to those services.
       By encouraging religious institutions to ``follow the 
     dollars'' when deciding what type of social services to 
     provide. As a result, it may encourage these organizations to 
     move away from their historic commitment to providing social 
     services designed to meet basic human needs. We believe that 
     religious groups are better suited to address these urgent 
     human needs than they are to deal with the more complex 
     mental and other health services that require trained 
     professionals. These services are best left to government 
     agencies or institutions closely regulated by governments.
       We in the faith community speak often of ``right 
     relationship.'' We strive for ``right relationship'' in the 
     world on many levels, both personal (such as between 
     worshipper and God) and political (such as between church and 
     state). To the Unitarian Universalist Association of 
     Congregations, Charitable Choice legislation violates the 
     right relationship between church and state.
       In our vision of ``right'' church-state relations, 
     ``pervasively sectarian'' institutions have the freedom to 
     provide whatever services they chose with their own financial 
     resources. ``Religiously affiliated'' institutions can accept 
     government funding to provide basic human needs services, so 
     long as they do so with no ``religious strings'' attached.
       If mental and other health-related human needs are not 
     being met by government agencies, than those agencies should 
     adopt new strategies and approaches. Rather than throwing 
     money at religious groups--who are not situated to handle 
     such needs--adequate freedom and resources should be given to 
     the relevant government agencies so that they may innovate 
     and expand in the necessary ways.
       Many Americans struggle with disease, drug addiction, 
     hunger, and poverty. Both religious groups and the government 
     have a responsibility to help those in need. Each is best 
     suited to provide a particular kind of service. Rather than 
     blurring the lines of responsibility, each should re-examine 
     how it can do better what it is better suited to do.
       The information available now indicates that very few 
     religious institutions are pursuing funding under the 
     ``Charitable Choice'' provisions of the 1996 Welfare Reform 
     Law. Wisely, they are wary of the problems associated with 
     government funding of religious institutions. Congress should 
     take this as a clear sign that ``Charitable Choice'' is not 
     an appropriate answer to the problems of adequate service 
     provision.
       Like others in the religious world, the Unitarian 
     Universalist Association of Congregations is fully committed 
     to helping those in need. We are concerned, however, that the 
     public policies relating to these issues are good ones--
     appropriate and responsible--that fully respect both the 
     needs and rights of those people receiving services. For the 
     reasons stated above, we do not believe that ``Charitable 
     Choice'' provisions are appropriate or responsible policy.
       The Unitarian Universalist Association of Congregations 
     opposes ``Charitable Choice'' and urges Congress to do the 
     same.
           Sincerely,
                                                    Rob Cavenaugh,
                                             Legislative Director.

  Mr. GRAMM. Mr. President, I ask unanimous consent the amendment be 
agreed to, the committee substitute be agreed to, the bill be read a 
third time and passed as amended, the motion to reconsider be laid upon 
the table, and that any statement relating to the bill be printed in 
the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 2507) was agreed to.
  The committee substitute amendment was agreed to.
  The bill (S. 976), as amended, was read the third time and passed.
  (The bill will be printed in a future edition of the Record.)

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