[Senate Report 104-193]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 292
104th Congress                                                   Report
                                 SENATE

 1st Session                                                    104-193
_______________________________________________________________________


 
 SAMHSA REAUTHORIZATION, FLEXIBILITY ENHANCEMENT AND CONSOLIDATION ACT 
                                OF 1995

                                _______


               December 19, 1995.--Ordered to be printed

_______________________________________________________________________


   Mrs. Kassebaum, from the Committee on Labor and Human Resources, 
                        submitted the following

                              R E P O R T

                             together with

                            ADDITIONAL VIEWS

                         [To accompany S. 1180]

    The Committee on Labor and Human Resources, to which was 
referred the bill (S. 1180), to amend Title XIX of the Public 
Health Service Act to provide for health performance 
partnerships, and for other purposes, having considered the 
same, reports favorably thereon with an amendment in the nature 
of a substitute and recommends that the bill, as amended, do 
pass.

                                CONTENTS

                                                                   Page
  I. Purpose and summary of the bill..................................1
 II. Background and need for legislation..............................7
III. Legislative history and committee action.........................9
 IV. Committee views.................................................12
  V. Cost estimate...................................................25
 VI. Regulatory impact statement.....................................29
VII. Section-by-section analysis.....................................29
VIII.Additional views................................................44

 IX. Changes in existing law.........................................50

                   I. Purpose and Summary of the Bill

    The Substance Abuse and Mental Health Services 
Administration (SAMHSA), was created in October 1992 by ``The 
Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) 
Reorganization Act'' (P.L. 102-321) to reduce the incidence of 
substance abuse and mental illness.
    The fields of substance abuse treatment and prevention and 
mental health have changed considerably. So must the Federal 
approach in addressing these major public health issues. The 
purpose of ``The SAMHSA Reauthorization, Flexibility 
Enhancement, and Consolidation Act'' is to:
          Reauthorize the SAMHSA to continue to improve the 
        quality and availability of substance abuse prevention 
        and treatment and mental health services to the people 
        most in need;
          Consolidate 26 separate categorical authorities to 
        streamline Federal management;
          Strengthen the relationship between the Federal 
        Government and States in improving the health of 
        individuals with these illnesses;
          Increase the flexibility of States and local 
        communities to administer service programs needed in 
        their communities to improve the health of their 
        constituents; and
          Improve program effectiveness and accountability 
        through data collection and ``benchmarking.''
    Presently, many are debating the merits of traditional 
block grants and categorical grants. Traditional block grants 
are broader in scope and offer greater State discretion in the 
use of funds. However, accountability may be a problem because 
of the limited type of information available to allow Congress 
and program managers to effectively oversee block grants. On 
the other hand, categorical grants are narrower in scope, with 
greater Federal control; yet they provide more accountability.
    Nevertheless, both block grants and categorical grants have 
led to some concerns. There has been concern about 
accountability among members of Congress on where Federal 
resources were going and what they were buying. Categorical 
grant funds could provide accountability but they could not 
provide flexibility to address most State-specific priorities. 
Conversely, block grants provided States with greater 
flexibility to address State-specific needs but could not 
demonstrate accountability.
    The current Substance Abuse Prevention and Treatment (SAPT) 
and the Community Mental Health (MH) Block Grants are a 
combination of traditional block grants and categorical grants. 
The SAPT and MH Block Grants have numerous set-asides and 
mandates which provide limited accountability and flexibility 
for States to address State-specific priorities.
    According to a General Accounting Office report (``Block 
Grants Characteristics, Experience, and Lessons Learned'' GAO/
HEHS-95-74) on block grants ``there clearly is a need to focus 
on accountability for results.'' Consequently, many have been 
thinking about blending the two approaches--``no strings'' 
block grants and categorical grants.
    As a result, the committee considered legislation to 
promote active participation between the States and Federal 
Government into what are called performance partnerships. Thus, 
the centerpiece of this legislation is the establishment of 
Performance Partnership Grants (PPGs). PPGs provide the 
opportunity for the Federal Government and States to focus on 
meeting the needs of persons who suffer from mental illness and 
substance abuse. These ``partnership'' block grants would 
increase State flexibility in the use of mental health and 
substance abuse block grant funds while improving program 
accountability.
    PPGs would establish a new basis for grant relationships 
between the Federal Government and States. This modification to 
the traditional block grants would direct the States and 
Federal Government to develop a continuing Federal-State 
partnership to make significant improvements in health outcomes 
for their constituents. Further, the PPGs would:
          Provide States with increased control over setting 
        their priorities for the expenditure of grant funds and 
        managing their grant programs. In exchange, both States 
        and the Federal Government will accept greater 
        accountability for achieving results;
          Support improvement in Federal and State data systems 
        so that officials at all levels will be able to make 
        decisions based on clearer and more quantifiable 
        measures of the public's health;
          Provide taxpayers and their representatives in State 
        legislatures and the Congress with better information 
        about the results that are achieved from program 
        expenditures. This will document clearly how our 
        investment in public health is improving the health of 
        the American people.

                summary of the mental health provisions

    The mental health provisions of S. 1180 would:
    1. Reauthorize the mental health block grant as a 
Performance Partnership Block Grant (PPG). Each State and the 
Federal Government would work in partnership to develop goals 
and performance objectives to improve the mental health of 
adults with serious mental illness and children with serious 
emotional disturbances. Each State would submit a performance 
partnership proposal based on the State-selected goals and 
objectives for which the State would be held accountable. 
Funding for this PPG would be authorized at $280 million in 
fiscal year 1996 and ``such sums'' as necessary for each of the 
fiscal years 1997 through 1999.
    2. Establish a transition provision for implementing the 
PPGs. States would begin the PPGs no sooner than October 1, 
1997. This transition period would allow for the development of 
partnerships between the Federal Government and the States to: 
(1) develop the menu of objectives; (2) carry out a technical 
analysis of the availability, relevancy, and sufficiency of 
existing data sets; and (3) develop a plan to address 
insufficient data systems.
    3. Eliminate set-asides. The current 10 percent set-aside 
to provide services for children with serious emotional 
disturbances would be repealed.
    4. Consolidate 4 demonstration authorities into a general 
authority for priority mental health needs of regional and 
national significance. This section repeals separate 
categorical authorities for programs relating to: (1) clinical 
training and AIDS training; (2) community support programs; (3) 
homeless demonstrations; and (4) AIDS demonstrations. Each 
current demonstration grant would continue under the same terms 
and conditions until the expiration of the grant period.
    Through this single demonstration and training authority, 
the SAMHSA could provide technical assistance, conduct applied 
research, or conduct demonstration projects to address 
compelling mental health prevention and treatment needs of 
regional and national importance. All support for a specific 
project would be limited to 5 years.
    Funding for this authority would be authorized at $50 
million for each of the fiscal years 1996 and 1997 and $30 
million for each of the fiscal years 1998 and 1999. This 
reduction reflects the expiration of the Access to Community 
Care and Effective Services and Supports (ACCESS) program at 
the end of fiscal year 1997 and transfers the authorized 
funding of approximately $21 million to the Projects for 
Assistance in Transition from Homelessness (PATH) program in 
fiscal year 1998. This funding level represents a 10 percent 
reduction from the combined totals of the 4 demonstration 
programs consolidated.
    5. Continue the current PATH provisions. This provision 
will retain a focus on the expansion of services for the 
mentally ill homeless. The major problem currently facing the 
mentally ill homeless, regardless of whether they receive 
outpatient commitment is the lack of adequate treatment 
capacity. Continuation of the PATH program would assure that 
services for the mentally ill homeless are either maintained or 
expanded. Funding for this block grant would be authorized at 
$29 million for each of the fiscal years 1996 and 1997 and $50 
million for each of the fiscal years 1998 and 1999. The 
increase in funding reflects the transfer of approximately $21 
million from the ACCESS program to the PATH program beginning 
in fiscal year 1998.
    6. Continue the Children's Mental Health Services Program. 
Through this separate demonstration and training authority, 
appropriate community services for children suffering from 
severe mental disorders would continue as provided for under 
current law. Funding for this authority would be authorized at 
$60 million in fiscal year 1996 and ``such sums'' as necessary 
for each of the fiscal years 1997 through 1999.
    7. Permit States to provide funding to for-profit 
organizations in order to facilitate integration of services. 
This provision would provide flexibility for States to utilize 
the services of mental health managed care programs to operate 
Medicaid-managed mental health programs.
    8. Permit the Secretary to reserve up to 5 percent of funds 
for data collection, technical assistance, and evaluations. 
This provision would permit the Secretary to reserve up to 5 
percent of the amount appropriated in any fiscal year for 
necessary data collection development and strengthening, 
technical assistance, and program evaluation.

   SUMMARY OF THE SUBSTANCE ABUSE TREATMENT AND PREVENTION PROVISIONS

    The substance abuse prevention and treatment provisions of 
S. 1180 would:
    1. Reauthorize the substance abuse prevention and treatment 
services block grant as a Performance Partnership Block Grant 
(PPG). Each State and the Federal Government would work in 
partnership to develop goals and performance objectives. The 
State needs-assessments could be utilized to assist States in 
selection of their objectives. State-selected objectives would: 
(1) reduce the incidence and prevalence of substance abuse and 
dependence; (2) improve access to appropriate prevention and 
treatment programs for targeted populations; (3) enhance the 
effectiveness of substance abuse prevention and treatment 
programs; and (4) reduce the personal and community risks for 
substance abuse. Funding for this authority would be authorized 
at $1.3 billion in fiscal year 1996 and ``such sums'' as 
necessary for each of the fiscal years 1997 through 1999.
    2. Establish a transition provision for implementing the 
PPGs. States would begin the PPGs no sooner than October 1, 
1997. This transition period would allow for the development of 
partnerships between the Federal Government and the States to: 
(1) develop the menu of objectives; (2) carry out a technical 
analysis of the availability, relevancy, and sufficiency of 
existing data sets; and (3) develop a plan to address 
insufficient data systems.
    3. Repeal certain set-asides and mandates. Set-asides for 
alcohol and drug prevention and treatment activities would be 
repealed upon enactment of this legislation. Also, States would 
be required to follow current law for other set-asides until 
the PPGs begin in fiscal year 1998, and the following mandates 
and set-asides are repealed:
          A minimum allocation of funds for services to 
        pregnant women and women with dependent children;
          Timely access to treatment for injecting drug users;
          Provision of tuberculosis and HIV early intervention 
        services;
          Submission of an annual Statewide assessment of 
        needs;
          Establishment of State revolving loans for group 
        homes for recovering substance abusers.
    Because the PPGs are designed to ensure accountability 
through State-selected objectives and data-driven decision 
making, these provisions are no longer needed to assure 
accountability when the PPGs are implemented.
    4. Maintain a treatment focus for women and injecting drug 
users (IDUs). This provision would require a substance abuse 
treatment preference for women and a priority admission for 
IDUs and others who are at greatest risk for HIV infection. 
Because IDUs and other types of substance abusers (i.e., crack-
cocaine users) are among the highest at-risk exposure 
categories for HIV infection, this provision would require 
grantees to grant IDUs and other substance abusers determined 
to be at risk for HIV infection priority admission to treatment 
services.
    Further, because pregnant substance-abusing women require 
immediate and unique services, this provision would require 
grantees to continue to grant pregnant women preference in 
admission to treatment services and program.
    5. Retain the 20 percent set-aside for primary prevention 
activities.
    6. Consolidate 13 demonstration programs into 2 separate 
authorities for substance abuse prevention and treatment needs 
of regional and national significance. This section would 
repeal separate categorical authorities for programs relating 
to: (1) residential treatment programs for pregnant women, (2) 
demonstration projects of national significance, (3) substance 
abuse treatment in State and local criminal justice systems, 
(4) training in the provision of treatment services, (5) 
outpatient treatment programs for pregnant and postpartum 
women, (6) employee assistance programs, (7) national capital 
area demonstration, (8) capacity expansion (categorical grant) 
programs, (9) community prevention programs, (10) national 
capital area demonstrations, (11) clinical training of 
substance abuse prevention professionals, (12) high-risk youth, 
and (13) public education and information dissemination. 
Through these separate consolidated demonstration and training 
authorities, the SAMHSA could provide technical assistance, 
conduct applied research, or conduct demonstration projects to 
address compelling substance abuse prevention and treatment 
needs of regional and national importance. All support for a 
specific project would be limited to 5 years.
    Funding for the prevention authority would be authorized at 
$215 million and for treatment, $195 million in fiscal year 
1996 and ``such sums'' as necessary for each of the fiscal 
years 1997 through 1999. These funding levels represent a 10 
percent reduction from the combined total of the 13 
demonstration programs consolidated in these authorities. In 
the event of reductions in the appropriations for the 
demonstration and training programs, the Secretary would decide 
which existing programs to reduce or eliminate.
    7. Permit States to provide funding to for-profit 
organizations in order to facilitate integration of services. 
This provision would provide flexibility for States to utilize 
the services of substance abuse treatment managed care programs 
to operate Medicaid-managed substance abuse treatment programs.
    8. Permit the Secretary to reserve up to 5 percent of funds 
for data collection, technical assistance, and evaluations. 
This provision would permit the Secretary to reserve up to 5 
percent of the amount appropriated in any fiscal year to assist 
States with developing and strengthening their capacity for 
data collection. Also, the Secretary could use these funds for 
necessary data collection, technical assistance, and program 
evaluation.
    9. Reduce the tobacco regulation penalty. This provision 
would reduce the current penalty applied to a State when it 
fails to prohibit effectively the sale of tobacco products to 
individuals under the age of 18. This provision would reduce 
the current penalties by one-half.

SUMMARY OF GENERAL PROVISIONS, PROTECTION AND ADVOCACY, AND INSTITUTES 
                  OF THE NATIONAL INSTITUTES OF HEALTH

    Other provisions of S. 1180 would:
    1. Permit the transfer between substance abuse and mental 
health allotments. This provision would permit States to 
transfer up to 10 percent of their funds between the mental 
health and the substance abuse PPGs.
    2. Reauthorize Protection and Advocacy for Mentally Ill 
Individuals. This program would be reauthorized for 3 years and 
is renamed the ``Protection and Advocacy for Individuals with 
Mental Illnesses Act of 1986.''
    3. Reauthorize the National Institute on Alcohol Abuse and 
Alcoholism (NIAA), the National Institute on Drug Abuse (NIDA) 
and the National Institute of Mental Health (NIMH). This 
provision reauthorizes each of the Institutes and programs for 
only 1 year in order to correspond with the reauthorization of 
the entire National Institutes of Health in 1996.

                II. Background and Need for Legislation

    The incidence of substance abuse--the abuse of alcohol and 
illicit drugs--and of mental illness has been for many years a 
matter of concern in the United States. The 1993 National 
Household Survey on Drug Abuse showed that more than 77 million 
persons reported that they had used illicit drugs at some time 
during their lives. The most commonly used illicit drug was 
marijuana, and the next most commonly used drugs were 
prescription-type psychotherapeutic drugs and cocaine. Almost 
70 million persons reported using marijuana, 23 million 
reported using cocaine, 4 million reported using crack cocaine, 
18 million reported using hallucinogens, and more than 2 
million reported using heroin at some time during their lives. 
According to this survey, an estimated 37.2 percent of the 
household population aged 12 and older in the United States 
reported that they had used one or more illicit drugs in their 
lifetimes, 11.8 percent had used illicit drugs in the past 
year, and 5.6 percent had used them in the last month. 
Estimates indicate that nearly 18 million persons aged 18 and 
older have problems related to alcohol abuse and alcoholism.
    The Office of National Drug Control Policy, in its 1995 
National Drug Control Strategy report, reports increasing 
evidence of two disturbing trends in substance abuse in the 
United States. First, surveys indicate that rates of illicit 
drug use are rising among the Nation's youth, and second, the 
use of heroin is increasing, particularly because those who 
already are drug users are adding heroin to the list of drugs 
they consume. In addition, there are new users of heroin, many 
of them young people. This increase of drug use among youth 
threatens the progress that has been made in recent years and 
could lead to an upsurge in the number of chronic, hardcore 
drug users and the problems they create.
    Antidrug messages appear to be losing their potency among 
young people. Drug-use surveys report that adolescents are 
increasing their use of illicit drugs, particularly marijuana 
and hallucinogens. The Monitoring the Future study, also known 
as the High School Seniors Survey, found evidence in its 1991 
study that attitudes against regular use of marijuana were 
weakening among youth, and this attitude change was followed by 
an increase in reported drug use in the 1992 survey. For the 
second year in a row, past-month use of marijuana, as well as 
other drugs such as stimulants, hallucinogens, and inhalants, 
continued to increase among this population.
    Concerning mental illness, almost one in three people will 
have a mental illness in a given year while more than one in 
two people will have a mental disorder during his or her 
lifetime. Mental disorders can strike cruelly, producing 
hallucinations, paranoia, depression, panic, and obsessions. 
Some persons with serious mental illness experience moderate 
problems, while others have severe problems that continue over 
a long period of time. The population of persons with serious 
mental illness is a heterogeneous group with different 
diagnoses, different levels and duration of disability, and 
therefore, different needs. Because of these disorders, many 
individuals are unable to complete their education, maintain 
employment, or lead productive lives. A 1992 survey conducted 
by the National Center for Health Statistics and the National 
Institute of Mental Health (NIMH) estimated that there are 
approximately 3.3 million persons 18 years old or older in the 
civilian noninstitutionalized population of the United States 
who had a serious mental illness in the years preceding the 
survey. Approximately 2.6 million of these adults are limited 
by their disorder in work, personal care, social functioning, 
concentrating, and coping with day-to-day stress.
    Approximately 77 percent of persons with a serious mental 
illness saw a mental health professional in the year before the 
survey. Among those who did not see a mental health 
professional, most had seen a doctor or other health 
professional. Serious mental illnesses comprise a wide range of 
disorders including psychoses, neuroses, schizophrenia, 
personality disorders, organic brain syndrome, depression, and 
others. The prevalence of mental disorders is high. Over 8 
percent of Americans will experience a depressive illness in 
their lifetime. Almost 15 percent will be diagnosed with an 
anxiety disorder such as panic disorder or obsessive-compulsive 
disorder. Approximately 1.7 million to 2.8 million Americans 
currently suffer from a persistent and severely disabling 
mental disorder such as schizophrenia or bipolar disorder 
(formerly known as manic depressive illness).
    Throughout the last 30 years, the Congress has enacted 
legislation to create and support a variety of Federal programs 
to support research into the causes and treatment of substance 
abuse and mental illness and to establish and support programs 
of prevention and treatment. These programs, formerly under the 
Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), 
are currently administered by the National Institutes of Health 
(NIH) in 3 institutes--the National Institute of Mental Health 
(NIMH), the National Institute on Drug Abuse (NIDA), and the 
National Institute of Alcohol Abuse and Alcoholism (NIAAA). The 
Substance Abuse and Mental Health Services Administration 
(SAMHSA) of the Department of Health and Human Services (HHS), 
focuses on treatment and services for individuals who are 
mentally ill or chemically dependent.
    The first legislation to establish a Federal program for 
the support of treatment in this area was the Community Mental 
Health Centers Construction Act of 1963 (P.L. 88-164) which 
authorized Federal grants to the States for the construction 
and expansion of community centers for the treatment of persons 
with mental illness. Funds were allocated to the States on the 
basis of population, extent of facility need, and State 
financial need. Amendments to the legislation in 1965 added 
Federal support for the initial staffing of community mental 
health centers. Additional amendments in the subsequent years 
expanded the program further.
    The 1968 Alcohol and Narcotic Addict Rehabilitation 
Amendments broadened the mental health centers program by 
adding construction and initial staffing assistance for centers 
and other specialized facilities for the treatment of 
alcoholism and narcotics addiction. This was intended to 
provide an incentive for localities to initiate new services 
for persons with alcohol or other substance abuse problems. In 
subsequent years, the Comprehensive Alcohol Abuse and 
Alcoholism Prevention, Treatment, and Rehabilitation Act of 
1970, (P.L. 91-616) and the Drug Abuse Office and Treatment Act 
of 1972 (P.L. 92-255) established separate programs to focus 
Federal activities on research, prevention, treatment, and 
rehabilitation of persons with substance abuse problems. These 
included formula grants to States and project grants for 
alcohol and drug abuse treatment and prevention programs. These 
two pieces of legislation also established two agencies, the 
National Institute on Alcoholism and Alcohol Abuse (NIAAA) and 
the National Institute on Drug Abuse (NIDA), to administer the 
respective grant programs and related activities in research, 
training, prevention, and public information. In 1974, the two 
institutes were combined with NIMH under ADAMHA, which became 
the lead agency in the Department of Health and Human Services 
(HHS) on substance abuse and mental health activities.
    In 1981, the separate alcohol and drug abuse project and 
formula grants to the States, along with the community mental 
health centers grant program, were consolidated, under the 
Omnibus Budget Reconciliation Act (P.L. 97-35), into the 
Alcohol, Drug Abuse, and Mental Health Services Block Grant. 
This block grant authorized, under title XIX of the Public 
Health Service (PHS) Act, the provision of funds to States for 
prevention, treatment, and rehabilitation programs and 
activities to deal with alcohol and drug abuse. Also, grants 
were provided to community mental health centers for the 
provision of mental health services, including services for 
individuals with serious mental illness, children and 
adolescents with severe mental disturbances, elderly 
individuals with mental illness, and other underserved 
populations.
    ADAMHA continued to administer title XIX as well as title V 
of the PHS Act, which authorizes related substance abuse and 
mental health programs and activities in the areas of 
prevention and biomedical, clinical, and services-related 
research, through October 1, 1992. The ADAMHA Reorganization 
Act of 1992, signed into law on July 10, 1992, as P.L. 102-321, 
split the block grant into two separate block grants--one for 
substance abuse prevention and treatment and the other focusing 
on community mental health services. It also transferred NIAAA, 
NIDA, and NIMH with their research and related activities to 
the National Institutes of Health. ADAMHA was renamed the 
Substance Abuse and Mental Health Services Administration 
(SAMHSA), with its program focus on prevention and treatment 
services.

             III. Legislative History and Committee Action

    The SAMHSA Reauthorization, Flexibility Enhancement and 
Consolidation Act of 1995, S. 1180, was introduced on August 
10, 1995, by Senator Kassebaum. The bill was referred to the 
Senate Committee on Labor and Human Resources, which held a 
hearing to consider the legislation on July 27.
    On October 12, 1995, the committee held an executive 
session to consider S. 1180. An amendment in the nature of a 
substitute was brought up for consideration by Chairman 
Kassebaum. Three amendments were adopted in executive session, 
and S. 1180 was ordered to be reported favorably to the full 
Senate by a rollcall vote of 16 yeas.

      a. amendments adopted by voice vote during executive session

    One amendment was adopted in executive session by voice 
vote.
    1. Senator Wellstone offered an amendment to provide for 
separate authorities for priority substance abuse prevention 
and treatment demonstration and training needs of regional and 
national significance.

       b. four rollcall votes were taken during executive session

    1. The Kassebaum amendment replaced the homeless mentally 
ill provisions with a provision to reauthorize the Projects for 
Assistance in Transition from Homelessness (PATH) program. The 
committee unanimously adopted the amendment by a rollcall vote 
of 16 yeas.
        YEAS                          NAYS
Kassebaum
Jeffords
Coats
Gregg
Frist
DeWine
Ashcroft
Abraham
Gorton
Kennedy
Pell
Dodd
Simon
Harkin
Mikulski
Wellstone
    2. Senator Kennedy offered an amendment to delete section 
312, relating to nondiscrimination and institutional safeguards 
for religious providers. It failed by a rollcall vote of 8 to 
8.
        YEAS                          NAYS
Kassebaum                           Kennedy
Coats                               Pell
Gregg                               Dodd
Frist                               Simon
DeWine                              Harkin
Ashcroft                            Mikulski
Abraham                             Wellstone
Gorton                              Jeffords

    3. Initially, the chairman's substitute failed by a tie 
rollcall vote of 8 to 8.
        YEAS                          NAYS
Kassebaum                           Kennedy
Coats                               Pell
Gregg                               Dodd
Frist                               Simon
DeWine                              Harkin
Ashcroft                            Mikulski
Abraham                             Wellstone
Gorton                              Jeffords

    4. Senator Ashcroft then asked unanimous consent to strike 
section 312 of the substitute, relating to nondiscrimination 
and institutional safeguards for religious providers. There was 
no objection to Senator Ashcroft's request, and subsequently, 
the chairman's substitute was ordered to be reported favorably 
to the full Senate by a rollcall vote of 16 yeas.
        YEAS                          NAYS
Kassebaum
Jeffords
Coats
Gregg
Frist
DeWine
Ashcroft
Abraham
Gorton
Kennedy
Pell
Dodd
Simon
Harkin
Mikulski
Wellstone

                          IV. Committee Views

                                general

    The committee is particularly interested in the issues of 
accountability and flexibility as they relate to Federal and 
State efforts to address problems of substance abuse and mental 
illness. Unfortunately, there has been limited success in 
defining the State and Federal roles in a way which 
satisfactorily meet both of these objectives.
    The ``no-strings-attached'' block grant approach offers 
substantial State flexibility and is based on the philosophy 
that States are in the best position to understand and respond 
to the public health problems they face. Frequently, however, 
block grants provide no means by which to assure accountability 
for Federal dollars.
    Greater accountability can be obtained through categorical 
grant programs, but it is gained at the expense of limiting the 
ability of States to provide services specific for their 
constituents. Substance abuse and mental health priorities are 
set, and grantees are funded according to Federal--not State--
priorities.
    In addition, neither the block grant nor the categorical 
grant approach generates the kind of data necessary for either 
the States or the Federal Government to adequately identify and 
address substance abuse and mental health concerns or to 
document what the Federal Government's investment is actually 
achieving.
    In an environment of increasing fiscal constraints, 
substance abuse and mental health programs that lack 
information about their effectiveness--whether they are 
categorical programs or block grants--risk serious reductions 
in funding or even elimination. The committee believes that 
accountability based on solid information is essential to the 
continued existence of mental health and substance abuse 
prevention and treatment programs.
    In an effort to develop a better means for achieving the 
twin objectives of accountability and flexibility, the 
committee has developed legislation to promote ``performance 
partnerships'' between the States and the Federal Government. 
The Performance Partnership Grants (PPGs) authorized by S. 1180 
are designed to enhance the role of the Federal, State, and 
local governments in improving the health of their people by 
increasing flexibility and reducing administrative burdens; 
streamlining Federal management; and creating new relationships 
between the States and Federal Government through outcome-
oriented performance measures.
    Block grants and PPGs are similar in that they both 
authorize Federal formula assistance to States to support 
activities in certain general program areas. However, there are 
important differences between the two. The most significant 
differences are in the areas of State responsibility and 
flexibility, performance measures and accountability, and 
earmarks and set-asides.
    PPGs are designed to reduce the role of the Federal 
Government in setting State priorities and specifying how 
States must spend block grant funds, promoting instead a 
``partnership'' relationship between the Federal Government and 
the State in addressing these priorities. The new partnership 
would allow States greater flexibility in selecting objectives 
that meet State-determined needs.
    PPGs would also provide the States with increased control 
over setting their own priorities for the expenditure of funds 
and the management of grant programs by focusing on the results 
achieved from those expenditures. State selection of 
performance objectives would provide the States and Federal 
Government with information about results--whether the State 
programs are effective in improving health outcomes. As a 
result, taxpayers and their representatives in State 
legislatures and the Congress will have better information 
about the results achieved from program expenditures--results 
measured in actual improvements in the health of the American 
people.
    The committee recognizes that accountability is essential 
to the continued existence and effectiveness of mental health 
and substance abuse prevention and treatment programs. The 
committee also recognizes that States require a greater degree 
of flexibility in order to address the problems specific to 
their constituents.
    As such, the purpose of this legislation is two-fold:
          1. To achieve a continuing ``partnership'' between 
        the States and Federal Government aimed at improving 
        prevention and treatment services for individuals with 
        or at risk for substance abuse and mental illnesses; 
        and
          2. To strengthen the Federal and State capacity to 
        obtain useful information. Such information is needed 
        to monitor the nation's health; detect the emergence of 
        health problems at an early stage--before they become 
        dangerous and expensive; identify where to target 
        limited resources; document program accomplishments; 
        and evaluate program effectiveness.

Section 101. Replacement of the State plan program with performance 
        partnerships

    The committee expects the Secretary to work in partnership 
with the States, Indian tribes, local governments, providers, 
consumers, and families of consumers. The aim of this 
partnership is to develop and update national benchmarks--
measures for determining a State's performance in the provision 
of community-based mental health services for adults with 
serious mental illness and children with serious emotional 
disturbance.
    The committee wishes to underscore the need for linkages 
between grantees and other relevant providers in such areas as 
juvenile justice, housing, and criminal justice. In addition, 
the committee believes that coordination between grantees, 
States, and other relevant providers is critical in order to 
avoid duplication of services and strengthening systemic 
efforts to deal effectively with related issues. The committee 
encourages SAMHSA to monitor a grantee's demonstrated 
development of such integrated, comprehensive community-based 
services for adults with serious mental illness and children 
with serious emotional disturbances.
    The committee expects the Secretary to negotiate individual 
performance agreements with each State specifying State-
specific program goals, performance targets, and time frames. 
The committee recognizes that States lack uniform data systems 
which are relevant, sufficient, and appropriate to measure 
mental health outcomes. Until such data systems become 
available to measure uniformly mental health outcomes, States 
may select process or capacity objectives to measure. No State 
is obligated to enter into a performance partnership agreement 
before October 1, 1997.
    The committee believes effective substance abuse and mental 
health programs would benefit from relevant, sufficient, and 
effective data collection activities. The committee recognizes 
that it is also vital for the States and Federal Government to 
gather such information as efficiently as possible so that the 
States and Federal Government do not divert scarce resources 
from the delivery of mental health services that communities 
need.
    The committee acknowledges the need for the Secretary of 
Health and Human Services to consult with the States and others 
in preparation for the implementation of the Performance 
Partnership Grants. Further, the committee expects the 
Secretary and the States to take into account all available 
information for identifying high-priority mental health 
problems such as the special needs of those who are homeless, 
dually diagnosed, and/or pregnant. The committee intends for 
States to meet the health needs of American Indians/Alaskan 
Natives who live within their boundaries.
            Negotiations on performance partnerships
    The committee emphasizes that the new formula grants 
authorized by this legislation are truly partnerships. Each 
State has the authority to negotiate with the Secretary and the 
flexibility to select the most significant problems in the 
State that it intends to address. The committee expects that 
the States and the Secretary will make all reasonable efforts 
to agree on the Performance Partnerships to ensure that the 
most significant mental health needs of the States are 
appropriately addressed.
            Community participation
    The committee believes that, under the Performance 
Partnerships, individuals will receive the greatest benefit 
when States consider the viewpoints of local governments, 
providers, consumers, and families of consumers. Thus, the 
legislation retains mental health planning councils and section 
1941 of the Public Health Service Act.

Section 103. State opportunity to correct or mitigate failure to 
        maintain effort

    The committee remains concerned that States may redirect 
funds previously allocated for mental health programs to meet 
other State priorities. The committee strongly discourages such 
a practice.
    The intent of this provision is to allow States which are 
not in compliance with the maintenance-of-effort requirements 1 
year, after being informed, to correct or mitigate the 
situation. If the Secretary determines that a State is not in 
compliance, the committee expects that any penalty will be 
first imposed to allowances that would not detract from the 
provision of mental health services for the people most in 
need.

Section 104. Funding for organizations that are for-profit

    The committee recognizes that, since 1981, for-profit 
entities have not been eligible for block grant or categorical 
funding authorized under this act. The committee believes that 
in order to improve the quality and comprehensiveness of care, 
States may need to integrate further their public and private 
health systems.
    As such, it is the intent of the committee for this 
provision to provide flexibility for States to utilize the 
services of mental health managed care programs. This will 
allow States to operate Medicaid and other managed mental 
health programs to facilitate integration of mental health 
services within each State to achieve standardization of care 
and cost reductions while continuing to ensure quality service. 
Further, for the first time, this provision would allow the 
Secretary to look at the relationship between the public and 
nonprofit entities and the private for-profit sector.

Section 106. Data collection, technical assistance, and evaluations

    The committee recognizes the need for States to develop and 
strengthen their capacity for data collection in order to 
measure mental health outcomes. The intent of the committee is 
to permit the Secretary to reserve up to 5 percent of the 
amount appropriated in any fiscal year for necessary data 
collection, technical assistance, and program evaluation. The 
committee encourages the Secretary in partnership with the 
States, Indian tribes, local governments, providers, consumers, 
and families of consumers to develop data systems which are 
relevant, sufficient, and appropriate to measure State-specific 
and national outcomes.

Section 107. Projects for assistance in Transition From Homelessness 
        Program

    The committee strongly endorses the need for and 
reauthorization of the Projects to Assist in the Transition 
from Homeless Program (PATH). The committee recognizes the need 
to retain a focus on the expansion of services for the mentally 
ill homeless. The decision of the committee to continue the 
PATH program would assure that services for the mentally ill 
homeless are either maintained or expanded.
    On July 27, 1995, the Committee on Labor and Human 
Resources held a hearing on the Substance Abuse and Mental 
Health Services programs. Based on testimony presented on the 
outpatient commitment of the gravely disabled mentally ill 
homeless proposal, the committee believes the major problem 
currently facing the mentally ill homeless, regardless of 
whether they receive outpatient commitment or not, is the lack 
of adequate treatment capacity.
    Because existing programs do not provide adequate treatment 
options for the gravely disabled mentally ill homeless, the 
committee strongly encourages States, in partnership with 
physicians and judges, to build outpatient capacity for those 
gravely disabled mentally ill homeless who have been committed. 
The committee recommends the inclusion of intensive case 
management, technical assistance, training for judges, and 
procedures to protect patients' civil rights as some of the 
areas to consider. The intent of the committee in increasing 
the authorization level of the PATH program is to assist States 
with increasing their outpatient treatment capacity for the 
gravely disabled mentally ill homeless.

Section 108. Priority mental health needs of regional and national 
        significance and section 109 repeals

    The intent of the committee is to consolidate programs by 
eliminating separate categorical funding. Approximately 4 
separate categorical programs would be consolidated into a 
mental health prevention and treatment demonstration and 
training authority. This consolidation will streamline program 
operations and provide enhanced flexibility to both States and 
the Federal Government. Further, the committee believes a 
targeted demonstration agenda will allow for the development of 
partnerships between the State, local, and Federal Government 
to identify and prioritize major issues facing the mental 
health treatment fields.
    The intent of this provision is to provide the Secretary 
with flexibility to develop information and knowledge of 
immediate use to service providers and policy makers. The 
committee expects the Secretary in partnership with the State, 
local government, community representatives, Indian tribes and 
tribal organizations to develop projects that will be helpful 
to the State based on input from these organizations.
    The Secretary may make grants to and enter into contracts 
and cooperative agreements with States, political divisions of 
States, and private entities (including nonprofit, Indian 
tribes and tribal organizations), and may establish financial 
matching, maintenance-of-effort, nonsupplantation requirements. 
Each project will be required to have a strong evaluation 
component and to compare outcomes against anticipated results. 
The committee expects that outcomes will be reported on an 
ongoing basis throughout projects and that results will be 
quickly disseminated to the States, local jurisdictions, 
providers, consumers, and families of consumers.
    The committee believes the mental health authority will 
provide the Secretary the opportunity to assess innovative 
systems of providing comprehensive, integrated services to 
priority populations such as the homeless, the dually 
diagnosed, and others. It will permit the exploration into the 
provision of mental health services through managed care 
systems and the development of quality standards.
    Further, the mental health provision allows the Secretary 
to develop and evaluate new technologies. It also provides 
authority for the Secretary to assess methods to train 
specialty and primary care personnel to meet the needs of the 
mental health service system. This authority would permit the 
Secretary to develop and evaluate public and consumer education 
programs.

Section 201. Replacement of State Plan Program with Performance 
        Partnerships

    The committee expects the Secretary to work in partnership 
with the States, Indian tribes, local governments, providers, 
consumers, and families of consumers. The aim of this 
partnership is to develop and update national benchmarks--
measures for determining a State's performance in the provision 
of substance abuse treatment and prevention services to: (1) 
reduce the incidence and prevalence of substance abuse and 
dependence; (2) improve access to appropriate prevention and 
treatment programs for targeted populations; (3) enhance the 
effectiveness of substance abuse prevention and treatment 
programs; and (4) reduce the personal and community risks for 
substance abuse.
    The committee wishes to underscore the need for linkages 
between grantees and other relevant providers in areas such as 
public health, HIV/AIDS, tuberculosis and immunization, 
juvenile and criminal justice, and social services. In 
addition, the committee believes that coordination between 
grantees, States, and other relevant providers is critical in 
order to avoid duplication of services and strengthening 
systemic efforts to deal effectively with related issues. The 
committee encourages SAMHSA to monitor a grantee's demonstrated 
development of such integrated comprehensive community-based 
services for substance abusers.
    The committee expects the Secretary to negotiate individual 
performance agreements with each State specifying State-
specific program goals, performance targets, and time frames. 
The committee recognizes that States lack uniform data systems 
which are relevant, sufficient, and appropriate to measure 
substance abuse outcomes. Until such data systems become 
available to measure uniformly substance abuse treatment 
outcomes, States may select process or capacity objectives to 
measure. No State is obligated to enter into a Performance 
Partnership agreement before October 1, 1997.
    The committee believes effective substance abuse and mental 
health programs would benefit from relevant, sufficient, and 
effective data collection activities. Thus, the committee 
recognizes it is also vital for the State and Federal 
Government to gather such information as efficiently as 
possible so that the State and Federal Government do not divert 
scarce resources from the delivery of substance abuse 
prevention and treatment services.
    The committee acknowledges the need for the Secretary of 
Health and Human Services to consult with the State and others 
in preparation for the implementation of the Performance 
Partnership Grants. Further, the committee expects the 
Secretary and the States to take into account all available 
information for identifying high-priority substance abuse 
problems in each State--such as the special needs of those who 
are co-morbid, crack-cocaine users, injecting drug users, 
dually diagnosed, and/or pregnant. The committee intends for 
the States to meet the health needs of American Indians/Alaskan 
Natives who live within their boundaries.
            Negotiations on Performance Partnerships
    The committee emphasizes that the new formula grants 
authorized by this legislation are truly partnerships. Each 
State has the authority to negotiate with the Secretary and the 
flexibility to select the most significant problems in the 
State that it intends to address. The committee expects that 
the States and the Secretary will make all reasonable efforts 
to agree on the Performance Partnerships to ensure that the 
most significant substance abuse treatment and prevention needs 
of the States are appropriately addressed.
            Community participation
    The committee believes that, under the Performance 
Partnerships, individuals will receive the most benefit when 
States consider the viewpoints of local governments, providers, 
consumers, and families of consumers. Thus, the legislation 
retains section 1941 of the Public Health Service Act.
    Section 1941 requires States to make their performance 
agreements public within the State in such a manner to 
facilitate comment from any person or organization. As such, 
the committee believes that local governments, providers, 
consumers, and families of consumers are assured an opportunity 
to comment on the Performance Partnership agreements. The 
committee strongly urges States to continue to follow this 
provision.

Section 203. Tuberculosis and HIV

    The tuberculosis and HIV provisions modify current law 
requirements. These modifications of current law provisions 
will be required only until a State begins its first PPG.
    The tuberculosis provision revises the minimum threshold 
from 10 per 100,000 cases of AIDS to 15 per 100,000 at which 
point a State is required to carry out HIV early intervention 
services. It is the intent of the committee to raise the AIDS 
case-rate threshold requirement for the provision of HIV early 
intervention services to target resources more effectively to 
States with the greatest need in addressing co-morbid 
conditions of substance abusers.
    The committee recognizes the importance of screening 
substance abusers for tuberculosis infection through conducting 
risk assessments and testing for tuberculosis infection. The 
committee expects States to establish linkages with State and 
local tuberculosis and HIV/AIDS health providers in order to 
appropriately refer infected substance abusers for medical 
evaluation and treatment.
    The committee provides a ``payor of last resort'' provision 
to ensure that substance abuse treatment funds are used 
appropriately and effectively for those activities and that 
other related activities are provided through other appropriate 
providers and resources.

Section 204. Group homes for recovering substance abusers

    It is the intent of the committee to provide greater 
flexibility to States by requiring only States that have 
current obligations under the revolving loan fund to continue 
their loan funds for group homes for substance abusers. States 
which have not utilized or are not currently providing for 
their loan fund would be exempt from maintaining the 
establishment of such loan funds. The committee encourages 
States which are eligible for this exemption to use funds 
established under this provision to provide other substance 
abuse treatment services.
    Although the requirement for such funds to be maintained in 
any State would be repealed on September 30, 1998, it is not 
the intent of the committee to preclude any State from making 
funds available for this loan from other non-Federal resources.

Section 205. Sale of tobacco products to certain individuals

    The committee reduces the tobacco regulation penalties for 
a State found out of compliance with laws prohibiting the sale 
of tobacco products to individuals under the age of 18. This 
provision would reduce the penalties by half from 10 percent to 
5 percent in the first year; 20 percent to 10 percent in the 
second year; 30 percent to 15 percent in the third year; and 40 
percent to 20 percent in the fourth year. The committee has 
been told by the States that this penalty is overly burdensome 
and reduction in these penalties will not lessen their efforts 
to comply with this statute.
    The committee emphasizes that while the penalties for the 
tobacco (Synar) requirements have been reduced, a State's 
obligation under current statute has not been amended. Further, 
this reduction does not reflect the views of the committee 
regarding the seriousness and efforts of States enforcing this 
requirement.
    As such, the committee strongly encourages the States to 
increase their efforts in reviewing and monitoring the 
compliance with these laws within their State. Also, the 
committee reemphasizes that the Secretary should ensure that 
all States have in effect laws prohibiting the sale of tobacco 
products to individuals under the age of 18.
    The committee believes that promulgation of regulations 
implementing these laws, which were passed nearly 4 years ago 
and are known as the Synar Amendment, is of paramount 
importance. The committee calls on the Secretary promptly to 
publish final regulations implementing these laws.

Section 206(c). Priority admission

    The committee bill repeals section 1923 of the Public 
Health Service Act, which requires States to ensure that 
injecting drug abusers who seek treatment are admitted for 
treatment within 14 days or are provided with interim services 
and treatment within 120 days if program capacity is full.
    The committee recognizes a continuing need to place a 
Federal priority on treatment and admission of injecting drug 
users (IDUs) and others, such as crack-cocaine users, at 
greatest risk of contracting HIV infection. Almost three 
quarters of new HIV infections in 1994 occurred among substance 
abusers, mainly injecting drug users and crack-cocaine addicts 
(unpublished data, Centers for Disease Control and Prevention, 
as reported in the New York Times, February 28, 1995).
    The committee included a provision to replace the 
aforementioned provision with a requirement that States will 
ensure that, in the provision of substance abuse treatment, 
priority admission will be given to IDUs and others at greatest 
risk for HIV infection.
    The committee defines ``priority'' to mean that States 
would give additional consideration to IDUs and others at 
greatest risk for HIV infection. The committee encourages 
States to develop a system to identify all IDUs and others at-
risk of HIV infection who seek treatment in order to place all 
such persons identified in treatment in a timely manner. This 
definition was not included in S. 1180 as originally drafted 
nor was it included the ADAMHA Reorganization Act (P.L. 102-
321).
    The committee expects States to apportion their PPG funds 
to provide for activities for their State-specific populations 
and, if appropriate, IDUs and crack-cocaine users to prevent 
the spread of HIV infection.
    It is not the intent of the committee to mandate how States 
implement such priority, to impose set-asides, or to impose a 
minimum allocation. The intent of the committee in repealing 
this section along with a number of other provisions and set-
asides is to promote greater flexibility and discretion for 
States in the manner in which they administer their PPG funds.

Section 207. State opportunity to correct or mitigate failure to 
        maintain effort

    The committee remains concerned that States may redirect 
funds previously allocated for substance abuse treatment 
programs to meet other State priorities. The committee strongly 
discourages such a practice.
    The intent of this provision is to allow States who are not 
in compliance with the maintenance-of-effort requirements, 1 
year after being informed, to correct or mitigate the 
situation. If the Secretary determines that a State is not in 
compliance, the committee expects that any penalty will be 
first imposed to allowances that would not detract from the 
provision of substance abuse prevention and treatment services 
for the people most in need.

Section 208. Funding for organizations that are for-profit

    The committee recognizes that, since 1981, for-profit 
entities have not been eligible for block grant or categorical 
funding authorized under this act. The intent of the committee 
in establishing certain ``safeguards is not to preclude for-
profits from receiving block grant funds but to ensure that the 
quality and comprehensiveness of care is strengthened.
    The committee believes that, in order to improve the 
quality and comprehensiveness of care, States may need to 
integrate further their public and private health systems. As 
such, it is the intent of the committee that this provision 
would provide flexibility for States to utilize the services of 
substance abuse treatment managed care programs. This will 
allow States to operate Medicaid and other managed substance 
abuse treatment programs to facilitate integration of substance 
abuse treatment services within each State to achieve 
standardization of care and cost reductions while continuing to 
ensure quality service. Further, for the first time, this 
provision would allow the Secretary to look at the relationship 
between the public and nonprofit entities and the private for-
profit sector.

Section 210. Data collection, technical assistance, and evaluations

    The committee recognizes the need for States to develop and 
strengthen their capacity for data collection in order to 
measure substance abuse prevention and treatment outcomes. The 
intent of the committee is to permit the Secretary to reserve 
up to 5 percent of the amount appropriated in any fiscal year 
for necessary data collection, technical assistance, and 
program evaluation. The committee encourages the Secretary in 
partnership with the States, Indian tribes, local governments, 
providers, consumers, and families of consumers to develop data 
systems which are relevant, sufficient, and appropriate to 
measure State-specific and national outcomes.

Sections 211 and 213. Priority substance abuse treatment and prevention 
        needs of regional and national significance and section 212 
        repeals

    The committee recognizes that substance abuse treatment and 
prevention are integral parts of a continuum of care for 
substance abusers. The committee also acknowledges that 
substance abuse prevention and treatment are very different 
specialties that involve different skills, procedures, and 
populations served. The committee also recognizes these 
discrete disciplines each demand their own independent 
consolidated research, demonstration, and evaluation.
    The intent of the committee is to consolidate programs by 
eliminating separate categorical funding. Approximately 13 
separate categorical programs would be consolidated into a 
substance abuse prevention demonstration and training authority 
and a substance abuse treatment demonstration and training 
authority. This consolidation will streamline program 
operations and enhance flexibility to both States and the 
Federal Government. Further, the committee believes a targeted 
demonstration agenda will allow for the development of 
partnerships between the State, local, and Federal Government 
to identify and prioritize major issues facing the substance 
abuse prevention fields.
    The intent of this provision is to provide the Secretary 
with flexibility to develop information and knowledge of 
immediate use to service providers and policy makers. The 
committee expects the Secretary in partnership with the State, 
local government, community representatives, Indian tribes, and 
tribal organizations to develop projects that will be helpful 
to the States based on information from these organizations.
    The Secretary may make grants to and enter into contracts 
and cooperative agreements with States, political divisions of 
States, and private entities (including nonprofit, Indian 
tribes and tribal organizations) and may establish financial 
matching, maintenance-of-effort, and nonsupplantation 
requirements. Each project will be required to have a strong 
evaluation component and to compare outcomes against 
anticipated results. The committee expects that outcomes will 
be reported on an ongoing basis throughout projects and that 
results will be quickly disseminated to the States, local 
jurisdictions, providers, consumers, and families of consumers.
    The committee believes the treatment authority will provide 
the Secretary with the opportunity to assess innovative systems 
of providing comprehensive, integrated services to priority 
populations such as pregnant substance abusers, crack-cocaine 
users, injecting drug users, the dually diagnosed, and others. 
It will permit the exploration of the provision of substance 
abuse services through managed care systems and the development 
of quality standards.
    Further, the treatment provision allows the Secretary to 
develop and evaluate new technologies. It also provides 
authority for the Secretary to assess methods to train 
specialty and primary care personnel to meet the needs of the 
substance abuse service system. This authority would permit the 
Secretary to develop and evaluate public and consumer education 
programs.
    The committee believes the prevention authority will 
provide the Secretary with the opportunity to assess innovative 
systems of providing comprehensive, integrated service for 
priority populations such as high-risk youth, children of 
substance abusers, and others. It will permit the exploration 
of the provision of substance abuse prevention services through 
managed care system and the development of quality standards.
    Several General Accounting Office reports have concluded 
that the Center for Substance Abuse Prevention (CSAP) is not 
using Federal funds for lobbying or excluding specific 
qualified grantees. However, the committee is concerned that 
the CSAP may have adopted an informal policy of funding only 
grantees which have not received funding from sources within 
the alcohol or tobacco industries. The committee directs CSAP 
to provide grants solely on the basis of merit.

Treatment preference for pregnant women

    The committee recognizes a continuing need to place a 
Federal preference on the treatment of pregnant substance-
abusing women. Because pregnant substance-abusing women require 
unique services, such as prenatal care and child care in 
conjunction with drug treatment and because both the life and 
health of the pregnant woman and her child are threatened, the 
committee has maintained the requirement for States to ensure 
that pregnant substance-abusing women are given preference in 
admission to substance abuse treatment facilities.
    The committee defines ``preference'' to mean that States 
would place pregnant substance-abusing women above all other 
State-specific populations in admissions to substance abuse 
treatment facilities. This definition was not included in S. 
1180 as originally drafted nor was it included in the ADAMHA 
Reorganization Act (P.L. 102-321).
    It is not the intent of the committee to mandate how States 
implement such preference, to impose set-asides, or to impose a 
minimum allocation. The intent of the committee in maintaining 
section 1927 of P.L. 102-321 is to maintain a national focus on 
the impact of maternal drug use on infants and children and the 
preferential availability of substance abuse treatment for 
women.

Formula grants to States

    The ADAMHA Reorganization Act of 1992 revised the formula 
by which the Federal Government allocates funds to the States 
for the provision of substance abuse treatment and prevention 
and mental health services. Many of these changes were the 
subject of debate in the Senate. There are many issues 
regarding the formula, but the major issue concerning the 
formula is one of equity.
    The ADAMHA Reorganization Act authorized a study to review 
the ``validity and relevance'' of factors currently included in 
the Substance Abuse Prevention and Treatment and the Community 
Mental Health Block Grant formula in order to assess the 
appropriateness of these factors and to identify additional 
factors that Congress may wish to consider to attain greater 
equity among the States. The RAND Corporation was awarded a 
contract by the Substance Abuse and Mental Health Services 
Administration to examine the current factors of the formula in 
an attempt to resolve this issue. Because this report is not 
yet available, this legislation maintains the current formula.
    Further, the committee is aware of the Secretary's decision 
to make refinements in the methodology of the ``data proxy for 
labor'' of the ``cost of services index'' in the Substance 
Abuse Prevention and Treatment and Community Mental Health 
Services Block Grant formulae.
    The committee recognizes the discretion the current 
legislation grants the Secretary to make such refinements, in 
consultation with appropriate personnel. However, the 
legislation also requires the Secretary to publish this change 
in the Federal Register. The committee expects the Secretary to 
publish this change in the Federal Register immediately.

                     Title III: General provisions

Section 302. Additional requirements

    States are given greater flexibility and discretion in 
conducting a review of their treatment programs. States may use 
existing State accreditation and certification standards to 
assess the quality, appropriateness, and efficacy of federally 
funded treatment programs. The committee recognizes that a 
significant number of States which support prevention programs 
and some mental health programs do not have accreditation and 
certification standards in place. The committee strongly 
encourages these States to establish these procedures to carry 
out this provision.

Section 303. On-site performance reviews

    The committee included a provision to replace the current 
requirement for annual investigations by the Secretary of 
expenditures in at least 10 States with a requirement that the 
Secretary perform on-site performance reviews in each State 
every 3 to 5 years. The purpose of this provision is to ensure 
that States are not subject to burdensome requirements and to 
streamline Federal management.

Section 304. Additional year for obligation by States

    The committee included this provision to provide States 
with greater flexibility to obligate and spend their PPG 
allotments within 2 years and to replace the current 
requirements of 1 year to obligate funds and 1 year for direct 
spending.

Section 309. Advisory councils

    The committee amended current advisory council membership 
requirements to include leading representatives from State and 
local governments to ensure that all interested parties have an 
opportunity to participate effectively in the functions and 
activities of the advisory council.

          TITLE IV: REAUTHORIZATION OF PROTECTION AND ADVOCACY

    Title IV includes several amendments. The committee has 
amended the title of the Protection and Advocacy For Mentally 
Ill Individuals Act of 1986 to the Protection and Advocacy for 
Individuals with Mental Illnesses Act. The program is 
reauthorized through fiscal year 1999.
    The committee has amended the minimum allotment formula in 
Section 112 of Public Law 99-319 to match the change in the 
Developmental Disabilities Act. The recommended language is 
consistent with the change made to the formula of the 
Protection and Advocacy Systems authorized in the Developmental 
Disabilities Act. The committee recognizes that this amendment 
would prevent the loss of already limited funding to States and 
territories in providing the vital investigative and protective 
services for individuals who may have suffered abuses while 
undergoing care or treatment in mental health facilities.
    The intent of the committee in amending this legislation is 
to change the current statute to require the State minimum of 
$260 thousand to be reduced to $140 thousand. The minimum 
allotment would be based in any fiscal year on the percentage 
increase/decrease over the fiscal year 1995 appropriation. The 
amended formula prescribes a minimum allotment for States as 
being $260 thousand and for the Pacific Islands and 
Territories, $139,300.

             TITLE V: REAUTHORIZATION OF CERTAIN INSTITUTES

    Title V extends the authorities for the National Institute 
of Alcohol Abuse and Alcoholism (NIAAA), the National Institute 
on Drug Abuse (NIDA), the National Institute of Mental Health 
(NIMH), and the medication development program through fiscal 
year 1996. The intent of the committee is to reauthorize each 
of the institutes and programs for only 1 year in order to 
correspond with the reauthorization of the entire National 
Institutes of Health.

          TITLE VI: TRANSITION PROVISIONS AND EFFECTIVE DATES

    Title VI is intended to provide substantial leeway to 
States and the Secretary of Health and Human Services in 
developing and implementing a process to develop the PPGs. In 
carrying out this new authority, the committee expects the 
Secretary to establish an advisory process. The Secretary in 
partnership with the States, local governments, Indian Tribes, 
substance abuse and mental health providers, consumers and 
their families, researchers, and all other individuals who have 
technical expertise will be included in the advisory process to 
develop the model set of mental health and substance abuse 
prevention and treatment objectives and performance measures. 
Further, these partnerships will be consulted in determining 
and establishing relevant, sufficient, and available data 
systems.
    In addition, this provision provides the Secretary with the 
flexibility to award a contract to an independent entity to 
conduct a technical review panel to determine the availability, 
relevancy, and sufficiency of data sets currently existing to 
measure the model set of mental health and substance abuse 
prevention and treatment objectives. The committee expects the 
Secretary to take into account all available information during 
this analysis. The committee emphasizes the importance of 
partnerships in developing the model set of objectives and data 
systems.
    The committee recognizes the complexity of implementing new 
approaches and does not intend for the Performance Partnerships 
negotiation process to be burdensome. The committee has 
included a minimum 2-year transition period before States are 
required to negotiate the Performance Partnership Grants. Also, 
this provision provides flexibility for those States that would 
like to negotiate their PPGs sooner.
    To provide States with even greater flexibility in 
establishing State-specific objectives, set-asides requiring 
States to spend at least 35 percent of their allocation for 
activities related to alcohol and 35 percent for drug 
activities are repealed upon enactment of the legislation. 
Also, States would be required to follow current law for other 
set-asides until all mandates and set-asides are repealed when 
the Performance Partnership Grants (PPGs) begin in fiscal year 
1998.
    However, separate provisions relating to a substance abuse 
treatment preference for women, priority admission for 
injecting drug users and others who are at greatest risk for 
HIV infection, tobacco regulations, and the 20 percent set-
aside for substance abuse prevention would be maintained.
    Repealed mandates and set-asides include requirements 
relating to:
          A minimum allocation of funds for services to 
        pregnant women and women with dependent children.
          Timely access to treatment for injecting drug users.
          Provision of tuberculosis and HIV early intervention 
        services.
          Submission of an annual statewide assessment of 
        needs.
          Establishment of State revolving loans for group 
        homes for recovering substance abusers.
    Because the PPGs are designed to ensure accountability 
through State-selected objectives and data-driven decision 
making, these provisions will no longer be needed to assure 
accountability when the PPGs are implemented.

                            V. Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, December 7, 1995.
Hon. Nancy Landon Kassebaum,
Chairman, Committee on Labor and Human Resources, U.S. Senate, 
        Washington, DC.
    Dear Madam Chairman: The Congressional Budget Office has 
reviewed S. 1180, the SAMHSA Reauthorization, Flexibility 
Enhancement and Consolidation Act of 1995, as ordered reported 
by the Senate Committee on Labor and Human Resources on October 
12, 1995.
    Enactment of S. 1180 would not affect direct spending or 
receipts. Therefore, pay-as-you-go procedures would not apply 
to the bill.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contacts are Anne Hunt 
and Marc Nicole.
            Sincerely,
                                         June E. O'Neill, Director.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    1. Bill number: S. 1180.
    2. Bill title: SAMHSA Reauthorization, Flexibility 
Enhancement and Consolidation Act of 1995.
    3. Bill status: As ordered reported by the Senate Committee 
on Labor and Human Resources on October 12, 1995.
    4. Bill purpose: S. 1180 would reauthorize select programs 
of the Substance Abuse and Mental Health Services 
Administration (SAMHSA), and would consolidate the agency's 
multiple demonstration and training programs into three 
programs. The proposal would also replace SAMHSA's Mental 
Health and Substance Abuse Block Grants with Mental Health and 
Substance Abuse Performance Partnerships. Finally, the bill 
would reauthorize three institutes within the National 
Institutes of Health: the National Institute of Alcohol Abuse 
and Alcoholism (NIAAA), the National Institute on Drug Abuse 
(NIDA) and the National Institute of Mental Health (NIMH).
    5. Estimated cost to the Federal Government: The table 
below summarizes the budgetary impact of the legislation under 
two different sets of assumptions. The first set of assumptions 
adjusts the estimated amounts for discretionary inflation after 
fiscal year 1996; the second set of assumptions does not 
account for projected inflation. Most of the spending that 
would occur under S. 1180 would be subject to the availability 
of appropriated funds. For the purposes of this estimate, CBO 
assumes that all funds authorized by the bill for the 1996-1999 
period will be appropriated. For 1996, the additional costs 
represent funding above the levels provided in the continuing 
resolution through December 15, 1995.
    Estimated outlays summarized below are based on historical 
spending patterns of existing programs administered by SAMHSA, 
NIAAA, NIDA, and NIMH.

----------------------------------------------------------------------------------------------------------------
                                                              1995     1996     1997     1998     1999     2000 
----------------------------------------------------------------------------------------------------------------
                                          With Discretionary Inflation                                          
                                                                                                                
Spending Under Current Law:                                                                                     
    Budget authority......................................    3,162      911      370      383      396      411
    Estimated outlays.....................................    3,140    2,124    1,118      484      386      400
Change in Spending Resulting from the Proposal:                                                                 
    Budget authority......................................  .......    2,402    1,853    1,917    1,981     -411
    Estimated outlays.....................................  .......    1,134    1,722    1,979    1,932      952
Spending Under Proposal:                                                                                        
    Budget authority......................................  .......    3,313    2,223    2,300    2,377        0
    Estimated outlays.....................................  .......    3,258    2,840    2,463    2,318    1,352
                                                                                                                
                                         Without Discretionary Inflation                                        
                                                                                                                
Spending Under Current Law:                                                                                     
    Budget authority......................................    3,162      900      346      346      346      346
    Estimated outlays.....................................    3,140    2,119    1,103      457      346      346
Change in Spending Resulting from the Proposal:                                                                 
    Budget authority......................................  .......    2,376    1,805    1,806    1,806     -346
    Estimated outlays.....................................  .......    1,123    1,691    1,908    1,805      891
Spending Under Proposal:                                                                                        
    Budget authority......................................  .......    3,275    2,151    2,152    2,152        0
    Estimated outlays.....................................  .......    3,242    2,795    2,365    2,152    1,237
----------------------------------------------------------------------------------------------------------------

    The cost of this bill falls within budget function 550.
    6. Basis of the estimate: Mental Health Performance 
Partnerships. S. 1180 would replace SAMHSA's state Mental 
Health Block Grant with a Mental Health Performance Partnership 
program. The proposal would authorize $280 million for this 
program in 1996 and such sums as necessary through 1999. 
Accounting for discretionary inflation, this program would cost 
$310 million in 1999. The Secretary must reserve 5 percent of 
the funds appropriated in a fiscal year for data collection, 
program evaluation and the provision of technical assistance to 
the States.
    The Performance Partnership program is intended to 
facilitate access to comprehensive community mental health 
services and to foster the development of networks of 
integrated comprehensive community-based mental health 
services. States could enter into performance partnerships with 
the Secretary of Health and Human Services. The Secretary, in 
conjunction with these States and other groups, would develop 
objectives to help States and grant recipients fulfill specific 
programmatic goals. States applying for Mental Health 
Performance Partnership grants must submit a proposal to the 
Secretary that addresses one or more of these objectives.
    S. 1180 would also change the penalty imposed on a State 
that does not maintain ``material compliance'' with its 
performance partnership. Under current law, the Secretary 
reduces the amount allocated to a noncompliant state by the 
amount of its material failure for the previous fiscal year. 
Under the proposal, the Secretary could give a noncompliant 
State one year in which to correct or mitigate its 
noncompliance. If the State failed to correct or mitigate the 
situation within 1 year, the Secretary could reduce the State's 
grant by an amount equal to its material failure.
    Additionally, the bill would prohibit States from using 
more than 10 percent of their mental health grants funds for 
carrying out substance abuse programs.
    Priority Mental Health Needs of Regional and National 
Significance. The proposal would merge SAMHSA's current mental 
health demonstration and training programs into a single 
program--the Priority Mental Health Needs of Regional and 
National Significance program. S. 1180 would authorize $50 
million for the program in 1996 and 1997, $30 million in 1998, 
and such sums as necessary in 1999. Accounting for 
discretionary inflation, $31 million would be authorized in 
1999. States could apply to the program for grants to provide 
training; prevention, treatment and rehabilitation 
demonstration programs; and evaluations of these demonstration 
programs.
    PATH Program. The Projects for Assistance in Transition 
from Homelessness (PATH) program would be reauthorized through 
1999. The proposed legislation would authorize $29 million in 
1996 and $50 million in 1999. In reauthorizing the PATH 
program, the bill would eliminate funding for the Access to 
Community Care and Effective Services and Supports (ACCESS) 
program.
    Comprehensive Community Services for Children. S. 1180 
would reauthorize the Comprehensive Community Services for 
Children with a Serious Emotional Disturbance program through 
1999. The bill would authorize $60 million for the program in 
1996 and such sums as necessary for 1997 through 1999. 
Accounting for discretionary inflation, this amount would 
increase to $66 million by 1999.
    Substance Abuse Performance Partnerships. S. 1180 would 
replace the Substance Abuse and Treatment Block Grant and the 
Capacity Expansion Program with a Substance Abuse Performance 
Partnership program. The bill would authorize $1.3 billion for 
1996 and such sums as necessary for 1997 through 1999. Allowing 
for inflation, 1999 authorizations would total $1.4 billion. Of 
the funds appropriated each fiscal year, the Secretary must 
reserve five percent for the purpose of data collection and the 
provision of technical assistance to the states.
    Under this program, the Secretary would work with the 
States and other groups to develop a list of programmatic 
objectives, with the goal of reducing the prevalence of 
substance abuse and improving community access to preventive 
and treatment services. States applying for grants under this 
provision would be required to submit plans addressing one or 
more of these performance partnership objectives. S. 1180 would 
retain the current method for determining the amount of States' 
funding allocations, although it would repeal the current 
minimum grant amounts.
    This provision would repeal or amend some of the specific 
set-asides and allocations required under current law, while 
retaining others. For example, S. 1180 would repeal current 
set-asides for funding services to pregnant women and 
tuberculosis services for individuals receiving substance abuse 
treatment.
    Priority Substance Abuse Treatment Needs of Significance. 
S. 1180 would replace SAMHSA's substance abuse treatment 
demonstration and training programs with a single program--the 
Priority Substance Abuse Treatment Needs of Regional and 
National Significance program. The proposal would authorize 
$195 million for this program in 1996 and such sums as 
necessary through 1999. Accounting for inflation, 1999 
authorizations would be $216 million. The bill would also 
require that the Secretary create education and information 
programs to publicly disseminate the findings of the 
demonstration programs funded under this provision.
    Priority Substance Abuse Prevention Needs of Significance. 
The bill would similarly consolidate SAMHSA's substance abuse 
prevention demonstration and training programs into the 
Priority Substance Abuse Prevention Needs of Regional and 
National Significance program. This program would have 
essentially the same features and requirements as the program 
discussed above. This program would be authorized at $215 
million for 1996 and such sums as necessary through 1999. 
Accounting for discretionary inflation, 1999 authorizations 
would be $238 million.
    Finally, S. 1180 would prohibit States from using more than 
10 percent of their substance abuse grant funds for carrying 
out mental health programs.
    Protection and Advocacy. S. 1180 would reauthorize the 
Protection and Advocacy for Mentally Ill Individuals Act of 
1986 (Public Law 99-319) at such sums as necessary for 1996 
through 1999. Adjusting 1995 appropriations for inflation, CBO 
estimates that $23 million would be authorized in 1996 and $25 
million in 1999. This provision would also revise the formula 
currently used to determine the minimum grant amounts to be 
allocated to the States and territories.
    Reauthorization of NIAAA, NIDA and NIMH. S. 1180 would 
reauthorize three institutes within the National Institutes of 
Health through 1996. NIAAA would be reauthorized at $181 
million, while NIMH would be reauthorized at $588 million. The 
bill would authorize $292 million for NIDA and $101 million for 
the institute's Medication Development Program.
    7. Pay-as-you-go considerations: None.
    8. Estimated cost to State and local governments: S. 1180 
would consolidate and reauthorize various SAMHSA programs. 
These programs, which are all voluntary, provide grants to 
State governments and other nonprofit entities. The primary 
effect of these changes would be to provide States with 
additional flexibility in using grant funds. The authorized 
funding levels for fiscal year 1996 would be roughly equivalent 
to the fiscal year 1995 appropriations.
    In particular, the bill would replace the Substance Abuse 
and Mental Health Block Grant programs with Performance 
Partnership programs. The bill would also provide States with 
flexibility in allocating these funds and an additional year to 
obligate them. In addition, the bill would consolidate more 
than a dozen training, treatment, and prevention programs that 
address mental health and substance abuse needs into three 
programs. Finally, the bill would reauthorize a number of other 
mental health and substance abuse programs and three institutes 
within NIH that address these problems.
    9. Estimate comparison: None.
    10. Previous CBO estimate: None.
    11. Estimate prepared by: Anne Hunt and Marc Nicole.
    12. Estimate approved by: Paul N. Van de Water, Assistant 
Director for Budget Analysis.

                    VI. Regulatory Impact Statement

    The committee has determined that there will be no increase 
in the regulatory burden of paperwork as the result of this 
bill.

                    VII. Section-by-Section Analysis

    Section 1 of the bill cites the short title of the act, 
provides that references in the bill are to the Public Health 
Service (PHS) Act, and provides a table of contents for the 
bill.

                         TITLE I--MENTAL HEALTH

    Section 101(a) of the bill repeals Sections 1911, 1912, and 
1913 of the PHS Act referring to Formula Grants to States for 
Mental Health Services, State Plan for Comprehensive Community 
Mental Health Services, and Certain Agreements, respectively.
    Section 101(b) inserts new Sections 1911, 1912, and 1913 of 
the PHS Act. The new section 1911(a) describes the goal of the 
Performance Partnership authorized in this bill--for the States 
and the Federal Government, working together, to improve the 
overall mental health of U.S. citizens and the quality of life 
of adults with serious illness and children with serious 
emotional disturbance, by promoting access to comprehensive 
community mental services for these populations; and to 
increase the development of systems of integrated comprehensive 
community-based services for such individuals.
    Systems of integrated comprehensive community-based 
services are defined to mean ``integrated systems of care that 
would enable children and adults to receive care appropriate 
for their multiple needs.'' With respect to children, such 
integrated systems of care would ensure the provision, in a 
collaborative manner, of mental health, substance abuse, 
education and special education, juvenile justice, and child 
welfare services. For adults, such integrated systems would 
ensure the provision, in a collaborative manner, of mental 
health, vocational rehabilitation, housing, criminal justice, 
health, and substance abuse services.
    The new section 1911(b) directs the Secretary, no earlier 
than October 1, 1997, in consultation with the States, local 
governments, Indian tribes, health care providers, consumers, 
and families, to establish, and as necessary periodically 
revise, a list of Performance Partnership objectives and a core 
set of not more than 5 such objectives that address mental 
health problems of national significance. Each such objective 
shall include a qualitative or quantitative performance 
indicator; the specific population being addressed; a 
performance target; and a date by which the target level is to 
be achieved.
    In establishing objectives, the Secretary shall be guided 
by the following principles: (A) the objectives should be 
closely related to the goals of this subpart and be viewed as 
important by and understandable to the State policy makers and 
the general public; (B) the actions taken under a partnership 
agreement should be expected to have an impact on the 
objective; (C) the objectives should be results-oriented, 
including a suitable mix of outcome, process, and capacity 
measures; (D) in the case of an objective that has suitable 
outcome measures, measurable progress in achieving the 
objective should be expected over the period of the grant; (E) 
in the case of an objective that has suitable process or 
capacity measures, such objective should be demonstrably linked 
to the achievement of, or demonstrate the potential to achieve, 
a mental health outcome; and (F) data to track the objective 
should, to the extent practicable, be comparable for all grant 
recipients, meet reasonable statistical standards for quality, 
and be available in a timely fashion, at appropriate 
periodicity, and at reasonable cost.
    The new Section 1912 of the PHS Act as authorized by the 
bill requires a State, in order to be eligible for a grant, to 
prepare and submit a Performance Partnership proposal that 
would appropriately address the most significant mental health 
problems (as measured by applicable indicators) within the 
State. Such a proposal would contain: (1) a list of one or more 
objectives (derived from the objectives under section 1911(b)), 
including at least one objective in the children's area, toward 
which the State will work and a performance target for each 
objective which the State will seek to achieve by the end of 
the partnership period; (2) a rationale for the State's 
selection of objectives, including any performance targets, and 
time frames; (3) a statement of the State's strategies for 
achieving the objectives over the course of the grant period 
and evidence that the actions taken under a partnership 
agreement will have an impact on the objective; (4) a statement 
of the amount to be expended to carry out the strategy; and (5) 
an assurance that the State will report annually on all core 
performance objectives established under section 1911(b) and 
the specific objectives toward which the State will work under 
the Performance Partnership. A State may select an objective 
that is not an established objective under section 1911 if it 
demonstrates to the Secretary that the objective relates to a 
significant mental health problem in the State that would not 
otherwise be appropriately addressed. The Secretary may require 
that objectives and requirements be developed by the State in a 
manner consistent with requirements of section 1911(b).
    The new section 1912(c) allows the State to select 
objectives which have only process or capacity measures until 
the Secretary determines that data sets are readily available, 
sufficient, and relevant to make outcome measures for 
objectives developed by the Secretary.
    The new section 1913(a) deals with negotiations concerning 
State Performance Partnership proposals. It requires the State 
and the Secretary to make all reasonable efforts to agree on a 
Performance Partnership under which the State expends grant 
amounts. It requires the Secretary to consider the extent to 
which the proposed objectives, performance targets, time 
frames, and strategies of the State are likely to address the 
most significant mental health problems (as measured by 
applicable quantitative or qualitative indicators) within the 
State.
    Subsection (b) of the new section 1913 requires the 
Secretary, in consultation with the State, to set the duration 
of the partnership with the State. Initial and subsequent 
partnership periods shall not be less than 3 nor more than 5 
years, except that the Secretary may agree to a partnership of 
less than 3 years where a State demonstrates that a shorter 
period is appropriate in light of the State's particular 
circumstances.
    Subsection (c) requires the Secretary to assess annually 
the progress achieved nationally toward each of the core 
objectives established under section 1911 and the progress of 
each State toward each objective agreed upon in the Performance 
Partnership, and make such assessment publicly available. The 
Secretary and State may at any time renegotiate and revise, by 
mutual agreement, the elements of the partnership to account 
for new information or changed circumstances.
    Section 1913(d) directs the Secretary to award a grant 
under the allotment formula under section 1918 to each State 
that has reached a Performance Partnership agreement with the 
Secretary and is carrying out activities in accordance with the 
terms of the partnership. Such funds may be used by the State 
only for carrying out the Performance Partnership (including 
related data collection, evaluation, planning, administration, 
and educational activities).
    Section 101(c) of the bill amends Section 1917 of the PHS 
Act to require that a State proposal include the additional 
elements in order to be in accordance with the partnership 
agreement.
    Section 101(d) of the bill amends Section 1919 of the PHS 
Act to add definitions of the term performance indicator to 
mean a quantifiable characteristic used as a measurement and 
the term performance target to mean a numerical value sought to 
be achieved within a specified period of time.
    Section 101(e) substitutes ``Performance Partnership'' for 
``block'' and for ``plan'' in sections of title XIX and makes 
other conforming amendments.
    Section 101(f) makes conforming amendments to Title V of 
the PHS Act eliminating the requirement that the Director of 
the Center for Mental Health Services administer the mental 
health services block grant program.
    Section 102 of the bill amends Section 1915(a)(1) of the 
PHS Act, regarding review of the State plan by the State Mental 
Health Planning Council, to include reference to a report 
required under Section 1942 of the PHS Act.
    Section 103 of the bill amends Section 1915(b) of the PHS 
Act to provide a State with the opportunity to correct or 
mitigate its failure to meet existing requirements regarding 
maintenance of effort regarding State expenditures for mental 
health.
    Section 104 of the bill amends Section 1916(a)(5) of the 
PHS Act prohibiting use of Federal grant funds for 
organizations that are for-profit to permit funding of such 
organizations if the State determines that, because of special 
circumstances existing within the State (including the 
operation of the State medicaid program or mental health 
managed care programs under Title XIX of the Social Security 
Act), it is appropriate and beneficial for a for-profit private 
entity to receive assistance.
    Section 105 of the bill amends Section 1920(a) of the Act 
to authorize appropriations of $280 million for fiscal year 
1996 and such sums as may be necessary for each of the fiscal 
years 1997 through 1999 for this subpart.
    Section 106(a) of the bill amends Section 1920(b) of the 
PHS Act to require the Secretary to reserve 5 percent of the 
appropriation for a fiscal year to carry out data collection, 
as authorized under Section 505 of the act as amended, and 
technical assistance to States, as authorized under Section 
1948(a) of the PHS Act as amended, and to carry out evaluations 
concerning programs supported under this subpart. The Secretary 
may carry out these activities directly, or through grants, 
contracts, or cooperative agreements.
    Section 106(b) amends Section 505(a) of the PHS Act to 
include the collection of data on ``other factors as needed to 
carry out part B of title XIX'' in the data collection 
activities authorized under the section. Such activities may be 
carried out directly, or through grants, contracts, or 
cooperative agreements.
    Section 106(c) amends Section 1948(a) of the PHS Act to 
allow the Secretary to provide technical assistance through 
cooperative agreements. Such assistance may also be provided 
directly or through grants or contracts, as currently 
authorized.
    Section 107(a) of the bill amends the section for Projects 
for Assistance in Transition From Homelessness (PATH) program 
for homeless individuals with mental illness to authorize 
appropriations of $29 million for each of the fiscal years 1996 
and 1997 and $50 million for each of the fiscal years 1998 and 
1999.
    Section 107(b) repeals Section 506 and directs the 
Secretary not to allocate funds under the authority for the 
program known as the ``Access to Community Care and Effective 
Services and Supports'' (ACCESS) program.
    Section 108 of the bill amends Section 520A of the PHS Act 
by replacing it with a program to provide support for priority 
mental health needs of regional and national significance. 
Under Section 520A, the Secretary would be required to address 
priority mental health needs of regional and national 
significance through the provision of training or demonstration 
projects for prevention, treatment, and rehabilitation and 
through the conduct or support of evaluations of such 
demonstration projects.
    The Secretary would be authorized to make grants to or 
enter into cooperative agreements with States, political 
subdivisions of States, Indian Tribes and tribal organizations, 
and public or private nonprofit entities. Subsection (b) 
defines priority mental health needs to include child mental 
health services, and may include managed care, systems and 
partnerships, client-oriented and consumer-run self-help 
services, training, and other priority populations and 
conditions determined appropriate by the Secretary.
    Subsection (c) of Section 108 requires recipients of 
assistance under this section to comply with information and 
applications requirements determined appropriate by the 
Secretary. Assistance to a recipient under this section may not 
exceed 5 years, with the provision that payment is subject to 
annual approval by the Secretary and the availability of 
appropriations. This provision does not limit the number of 
awards under the program that may be made to an entity.
    The Secretary may require that an entity applying for a 
grant, contract, or cooperative agreement provide non-Federal 
matching funds, as determined appropriate, to ensure the 
institutional commitment of the entity to the projects funded. 
Such 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. The recipient shall agree to maintenance-of-effort 
requirements.
    The application for a grant, contract, or cooperative 
agreement under this section shall ensure that amounts received 
will not be spent to provide inpatient services; to make cash 
payments to intended recipients of services; to purchase or 
improve land, building or other facility, or purchase major 
medical equipment; or to satisfy any requirement for 
expenditure of non-Federal funds as a condition for the receipt 
of Federal funds. A funding agreement for a grant, contract, or 
cooperative agreement under this section will provide that the 
entity will not spend more than 10 percent of the amount for 
administrative expenses.
    Section 108(d) provides that the Secretary, at the request 
of a State or political subdivision or of a public or private 
nonprofit entity, may reduce the amount of payments under this 
section by the fair market value of any supplies or equipment 
furnished to the State or political subdivision or public or 
private nonprofit entity; and the amount of the expenses of any 
officer, fellow, or employee of the government when detailed to 
the State or political subdivision, or public or private 
nonprofit entity, and the amount of any other costs incurred in 
connection with such detail, when the detail is for the 
convenience and at the request of the State or political 
subdivision or public or private nonprofit entity and is for 
the purpose of conducting activities described in this section.
    Section 108(e) requires the Secretary to evaluate each 
project carried out and to disseminate the findings for each 
such evaluation to appropriate public and private entities.
    Section 108(f) would require the Secretary to establish 
information and education programs to disseminate the findings 
of research, demonstrations, and training programs under this 
section to the general public and to health professionals. The 
Secretary shall take necessary action to ensure that all 
methods of dissemination and exchange of information are 
maintained between SAMHSA and the public and between SAMHSA and 
other scientific organizations, both nationally and 
internationally.
    Section 108(g) authorizes appropriations of $50 million for 
each of the fiscal years 1996 and 1997, $30 million for fiscal 
year 1998, and such sums as may be necessary for fiscal year 
1999.
    Section 109 of the bill repeals the following provisions of 
the PHS Act: section 303, relating to clinical training and 
AIDS training; section 520A, relating to community support 
programs and homeless demonstrations; section 520B, relating to 
AIDS demonstrations; and section 612 of the Stewart B. McKinney 
Homeless Assistance Act.
    Section 110(a) of the bill authorizes appropriations for 
section 565(f)(1), Comprehensive Community Services for 
Children with a Serious Emotional Disturbance, of $60 million 
for fiscal year 1996; and such sums as may be necessary for 
each of the 3 succeeding fiscal years. Section 110(b) 
authorizes the Secretary to waive one or more of the 
requirements for a system of care for a public entity that is 
an Indian Tribe or tribal organization, or for American Samoa, 
Guam, the Marshall Islands, the Federated States of Micronesia, 
the Commonwealth of the Northern Mariana Islands, the Republic 
of Palau, or the U.S. Virgin Islands, if the Secretary 
determines, after peer review, that the system of care is 
family-centered and uses the least restrictive environment that 
is clinically appropriate.

                       TITLE II--SUBSTANCE ABUSE

    Section 201(a) of the bill repeals the current Section 1921 
of the PHS Act, which authorizes formula grants to the States 
for the prevention and treatment of substance abuse. Section 
201(b) amends subpart II of part B of title XIX by inserting 
the new sections 1921, 1921A, and 1921B.
    The new section 1921(a) states the goals of this subpart 
for the States and the Federal Government, working together in 
a partnership are to: (a) reduce the incidence and prevalence 
of substance abuse and dependence; (b) improve access to 
appropriate prevention and treatment programs for targeted 
populations; (c) enhance the effectiveness of substance abuse 
prevention and treatment programs; and (d) reduce the personal 
and community risks for substance abuse.
    Subsection (b) of the new section 1921 directs the 
Secretary, no earlier than October 1, 1997, in consultation 
with the States, local governments, Indian tribes, providers, 
and consumers, to establish, and as necessary periodically 
revise, a list of Performance Partnership objectives; a core 
set of not more than 5 such objectives that address substance 
abuse problems of national significance; and a list of proxy 
objectives that are consistent with the intent of the 
requirements of the bill and, at the option of the State, can 
be implemented in place of requirements provided in the bill. 
Each such objective shall include a performance indicator; the 
specific population being addressed; a performance target; and 
a date by which the target level is to be achieved.
    In establishing objectives for the Performance Partnership, 
the Secretary shall be guided by certain principles: (a) the 
objectives should be closely related to the goals of this 
subpart and be viewed as important by and understandable to 
State policy makers and the general public; (b) the objectives 
should be results-oriented, including a suitable mix of 
outcome, process and capacity measures; (c) in the case of an 
objective that has suitable outcome measures, measurable 
progress in achieving the objective should be expected over the 
period of the grant; (d) in the case of an objective that has 
suitable process or capacity measures, such objective should be 
demonstrably linked to the achievement of, or demonstrate a 
potential to achieve, a substance abuse treatment outcome; and 
(e) data to track the objective should, to the extent 
practicable, be comparable for all grant recipients, meet 
reasonable statistical standards for quality, and be available 
in a timely fashion, at appropriate periodicity, and at 
reasonable cost.
    Section 1921A of the PHS Act as authorized by the bill 
requires a State, to be eligible for a grant, to prepare and 
submit a Performance Partnership proposal in accordance with 
the provisions of the bill. Such a State proposal would be 
required to appropriately address the most significant health 
problems associated with substance abuse within the State and 
contain: (1) a list of one or more objectives (derived from the 
objectives under section 1921(b)) toward which the State will 
work and a performance target for each objective which the 
State will seek to achieve by the end of the partnership 
period; (2) a rationale for the State's selection of 
objectives, including any performance targets, and time frames; 
(3) a statement of the State's strategies for achieving the 
objectives over the course of the grant period and evidence 
that the actions taken under a partnership agreement will have 
an impact on the objective; (4) a statement of the amount to be 
expended to carry out the strategy; and (5) an assurance that 
the State will report annually on all core performance 
objectives established under section 1921(b), regardless of 
whether it is working toward those objectives, and the specific 
objectives toward which the State will work under the 
Performance Partnership. A State may select an objective that 
is not an established objective under section 1921 if the 
objective relates to a significant health problem related to 
substance abuse in the State that would not otherwise be 
appropriately addressed. The Secretary may require that 
objectives and requirements be developed by the State in a 
manner consistent with requirements of section 1921(b). A State 
may select objectives which solely have process or capacity 
measures until such time as data sets are determined by the 
Secretary to be readily available, sufficient, and relevant 
under section 601(a) of the bill to make outcome measurements 
for objectives developed by the Secretary.
    Section 1921B of the PHS Act as authorized by the bill 
requires the Secretary, upon determining that the State meets 
the requirements, to approve the State proposal for a 
Performance Partnership under which the State is required to 
expend amounts received under a grant provided for substance 
abuse prevention and treatment.
    Subsection (b) of the new section 1921B requires the 
Secretary, in consultation with the State, to set the duration 
of the partnership with the State. Initial and subsequent 
partnership periods shall not be less than 3 nor more than 5 
years, except that the Secretary may agree to a partnership of 
less than 3 years where a State demonstrates that a shorter 
period is appropriate in light of the State's particular 
circumstances.
    Subsection (c) requires the Secretary to assess annually 
the progress achieved nationally toward each of the core 
objectives established under section 1921 and the progress of 
each State toward each objective agreed upon in the Performance 
Partnership, and make such assessment publicly available. The 
Secretary and State may at any time renegotiate and revise by 
mutual agreement the elements of the partnership to incorporate 
for new information or changed circumstances.
    Section 1921B(d) directs the Secretary to award a grant 
under the allotment formula under section 1933 to each State 
that has reached a Performance Partnership agreement with the 
Secretary and is carrying out activities in accordance with the 
terms of the partnership. Such funds may be used by the State 
only for carrying out the Performance Partnership (including 
related data collection, evaluation, planning, administration, 
and educational activities).
    Section 201(c) of the bill amends Section 1932 of the PHS 
Act to include additional general provisions concerning 
partnerships.
    Section 201(d) of the bill amends Section 1934 of the PHS 
Act to add definitions of the term performance indicator to 
mean a quantifiable characteristic used as a measurement and 
the term performance target to mean a numerical value sought to 
be achieved within a specified period of time.
    Section 201(e) of the bill substitutes ``Performance 
Partnership'' for ``block'' and for ``plan'' in sections of 
title XIX and makes other conforming amendments.
    Section 202 of the bill amends Section 1922 of the PHS Act 
to strike the current requirement under the substance abuse 
block grant that each State spend at least 35 percent of its 
allocation for activities regarding alcohol and 35 percent for 
activities regarding other drugs. It also amends the current 
provision requiring States to spend a certain amount of their 
allocations for programs and services to pregnant women and 
women with dependent children to require that States in fiscal 
year 1996 spend no less than the amount spent in fiscal year 
1995 on such programs and services. In the event of a reduction 
in appropriations for this subpart, the Secretary is directed 
to permit a State to prorate its funding for such services 
based on the amount provided to the State under the block grant 
in fiscal year 1995.
    Section 203(a) of the bill amends Section 1924(a) of the 
PHS Act to alter the current block grant requirement that any 
entity receiving funds under the block grant for operating a 
substance abuse treatment program must provide counseling, 
testing, and treatment services for tuberculosis to each 
individual receiving treatment for substance abuse. Under the 
amendment, a treatment program would be required to provide 
tuberculosis testing and counseling services. Testing, as 
included in this provision, would be based on the tuberculosis 
risk assessment conducted by the State, to determine whether 
the individual has contracted the disease, with such testing to 
be based on usual standards as determined appropriate by the 
State medical director for substance abuse services in 
cooperation with State and local health agencies for 
tuberculosis or other relevant private nonprofit entities. 
Counseling, as included in this provision, is defined to mean 
the provision of information to individuals or communities 
about risk factors for tuberculosis and conducting tuberculosis 
risk assessments to determine if tuberculosis testing is 
required.
    Section 203(b) amends Section 1924(b) of the PHS Act to 
amend the current block grant requirement regarding State 
provision of HIV Early Intervention services. It increases the 
current minimum threshold from 10 to 15 AIDS cases per 100,000 
population for a State to be required to carry out HIV Early 
Intervention services among individuals undergoing treatment 
for substance abuse. It also requires that the testing be based 
on usual standards determined to be appropriate by the State 
health director in cooperation with State and local health 
agencies for HIV and other relevant private nonprofit entities.
    Section 203(c) amends section 1924(c) to replace the term 
``agreements'' with ``partnerships.''
    Section 203(d) amends Section 1924 of the PHS Act by adding 
a new subsection (f) providing that amounts made available 
under this section may only be used as a payment of last resort 
for tuberculosis and may not be used for the medical evaluation 
and treatment of such diseases.
    Section 204 of the bill amends Section 1925 of the PHS Act 
relating to the requirement in current law for each State to 
use at least $100 thousand of its block grant allocation for 
the establishment of a revolving fund for operation of group 
homes for recovering substance abusers. The bill amends this 
provision so that, for fiscal years 1996 through 1998, it would 
apply only to States that have established and are providing 
for the ongoing operation of such a revolving fund. A State 
that is not, as of the date of enactment, utilizing such a 
revolving fund would no longer be subject to the provision. 
Such a State may use amounts set aside under this section, or 
amounts remaining in the revolving fund, to provide other 
treatment services. Section 1925 shall be repealed effective 
September 30, 1998.
    Section 205 of the bill amends Section 1926(c) of the PHS 
Act to amend the provisions related to reducing State grants 
for substance abuse for States found to be in noncompliance 
with laws prohibiting the sale of tobacco products to 
individuals under the age of 18. The bill would reduce the 
grant reductions by half from 10 percent to 5 percent in the 
first year; 20 percent to 10 percent in the second year; 30 
percent to 15 percent in the third year; and 40 percent to 20 
percent in the fourth year.
    Section 206 of the bill amends Section 1928 of the PHS Act, 
striking the requirement that the State will improve the 
process for referring individuals to treatment facilities and 
striking the provision authorizing the Secretary to provide 
States with a waiver for the additional requirements in the 
section.
    The new Section 206(c) directs the State, no earlier than 
October 1, 1997, to ensure that priority admission will be 
given to injecting drug users and others at greatest risk for 
HIV infection.
    Section 207 of the bill amends section 1930(c)(1) regarding 
maintenance-of-effort regarding State expenditures. The bill 
would provide that, if the Secretary determines that a State 
failed to maintain such compliance, the Secretary may permit 
the State, not later than 1 year after notification, to correct 
or mitigate the noncompliance. If the State did not carry out a 
correction or mitigation, the Secretary would reduce the amount 
of the grant under this subpart for the State for the current 
fiscal year by an amount equal to the amount constituting such 
failure.
    Section 208 of the bill amends Section 1931(a) of the PHS 
Act prohibiting use of Federal grant funds for organizations 
that are for-profit to permit funding of such organizations if 
the State determines that, because of special circumstances 
existing within the State (including the operation of the State 
Medicaid program of mental health managed care programs under 
title XIX of the Social Security Act), it is appropriate and 
beneficial for a for-profit private entity to receive 
assistance. In addition, the State would be required to ensure 
that such an entity is certified or licensed by the State; all 
profits earned by such entity as a result of assistance 
provided under this subpart are redistributed by the entity for 
the provision of treatment or prevention services; and in the 
case of an entity that is a private for-profit entity, such 
entity is the only available provider of substance abuse 
treatment in the area served.
    Section 209 of the bill amends Section 1935(a) of the Act 
to authorize appropriations of $1.3 billion for fiscal year 
1996 and such sums as may be necessary for each of the fiscal 
years 1997 through 1999 for this subpart.
    Section 210 of the bill amends section 1935(b) to direct 
the Secretary to reserve 5 percent of the amounts appropriated 
for a fiscal year to carry out section 505 (providing for data 
collection) and section 1948(a) (providing for technical 
assistance to States) with respect to substance abuse; to carry 
out section 515(d) (providing for a performance substance abuse 
data base); and to conduct evaluations concerning programs 
under this subpart. The Secretary may carry out such activities 
directly, or through grants, contracts, or cooperative 
agreements. The Secretary would be required to make available 
grants and contracts to States for the development and 
strengthening of States' core capacity (including 
infrastructure) for data collection and evaluation. Of the 
amounts reserved for these purposes, 20 percent shall be used 
for activities related to prevention.
    Section 211 of the bill amends section 510 to authorize the 
Secretary to address the substance abuse health needs of 
regional and national significance through the provision of 
training or demonstration projects for treatment and to conduct 
or support evaluations of such demonstration projects. To carry 
out this section, the Secretary would be authorized to make 
grants to, or enter into cooperative agreements with, States, 
political subdivisions of States, Indian Tribes and tribal 
organization, and public or private nonprofit entities. 
Subsection (b) defines substance abuse health needs of regional 
and national significance to include prevention activities and 
may include managed care, systems and partnerships, client-
oriented services, and other priority populations (including 
pregnant substance abusers, women with dependent children, 
crack cocaine and injecting drug users, and patients with dual 
disorders) and conditions as determined appropriate by the 
Secretary.
    Subsection (c) of the new section 510 requires recipients 
of grants, cooperative agreements, and contracts under this 
section to comply with information and application requirements 
determined appropriate by the Secretary. Assistance to a 
recipient under this section may not exceed 5 years, with the 
provision of payments subject to annual approval by the 
Secretary and the availability of appropriations. This does not 
limit the number of awards under the program that may be made 
to an entity. The Secretary may require that an entity applying 
for a grant, contract, or cooperative agreement provide non-
Federal matching funds, as determined appropriate, to ensure 
the institutional commitment of the entity to the projects 
funded. Such 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. The recipient shall agree to maintenance-of-effort 
requirements. The application for a grant, contract, or 
cooperative agreement under this section shall ensure that 
amounts received will not be spent to provide inpatient 
services; to make cash payments to intended recipients of 
services; to purchase or improve land, building or other 
facility, or purchase major medical equipment; or to satisfy 
any requirement for expenditure of non-Federal funds as a 
condition for the receipt of Federal funds. A funding agreement 
for a grant, contract, or cooperative agreement under this 
section will provide that the entity will not spend more than 
10 percent of the amount for administrative expenses.
    Section 510(d) provides that the Secretary, at the request 
of a State or political subdivision or a public or private 
nonprofit entity may reduce the amount of payments under this 
section by the fair market value of any supplies or equipment 
furnished to the State or political subdivision or public or 
private nonprofit entity; and the amount of the pay allowances 
and travel expenses of any officer, fellow, or employee of the 
Government when detailed to the State or political subdivision 
of the State, or public or private nonprofit entity, and the 
amount of any other costs incurred in connection with such 
detail; when the detail is for the convenience and at the 
request of the State or political subdivision or public or 
private nonprofit entity and for the purpose of conducting 
activities described in this section. The amount by which any 
payment is so reduced is required to be available for payment 
by the Secretary of the costs incurred in furnishing the 
supplies or equipment or detailing the personnel on which the 
payment is based, and the amount is required to be deemed to 
have been paid to the State or political subdivision, or public 
or private non-profit entity.
    Section 510(e) requires the Secretary to evaluate each 
project carried out and to disseminate the findings for each 
such evaluation to appropriate public and private entities.
    Section 510(f) directs the Secretary to establish 
information and education programs to disseminate the findings 
of research, demonstrations, and training programs under this 
section to the general public and to health professionals. The 
Secretary shall take necessary action to ensure that all 
methods of dissemination and exchange of information are 
maintained between SAMHSA and the public and between SAMHSA and 
other scientific organizations, both nationally and 
internationally.
    Section 510(g) authorizes appropriations of $195 million 
for fiscal year 1996 and such sums as may be necessary for each 
of the fiscal years 1997 through 1999 to carry out this 
section.
    Section 212(a) of the bill repeals the following provisions 
of the PHS Act: section 508, relating to residential treatment 
programs for pregnant women; section 510, relating to 
demonstration projects of national significance; section 511, 
relating to substance abuse treatment in State and local 
criminal justice systems; section 512, relating to training in 
the provision of treatment services; paragraph (5) of section 
515(b), relating to the activities of the Office of Substance 
Abuse Prevention; section 516, relating to community prevention 
programs; section 517, relating to high-risk youth and national 
capital area demonstrations; section 518, relating to employee 
assistance programs; section 571, relating to the National 
Capital Area Demonstration Program; section 1943, relating to 
peer review; and section 1971, relating to categorical grants 
to States.
    Section 213 of the bill amends section 516 to authorize the 
Secretary to address the substance abuse health needs of 
regional and national significance through the provision of 
training or demonstration projects for prevention and to 
conduct or support evaluations of such demonstration projects. 
To carry out this section, the Secretary would be authorized to 
make grants to, or enter into cooperative agreements with, 
States, political subdivisions of States, Indian Tribes and 
tribal organization, and public or private nonprofit entities. 
Subsection (b) defines substance abuse prevention health needs 
of regional and national significance to include prevention 
activities and may include managed care, systems and 
partnerships, client-oriented services, and other priority 
populations (including youth, high-risk youth, and children of 
substance abusers) and conditions as determined appropriate by 
the Secretary.

                     TITLE III--GENERAL PROVISIONS

    Section 301 of the bill amends Section 1942(a) of the PHS 
Act to require each State to submit an annual report and to 
include data concerning its performance in relation to the core 
set of partnership objectives.
    Section 302 of the bill amends section 1943(a) to replace a 
current requirement for annual peer review by the Secretary in 
at least 5 percent of the entities providing services in the 
State with a new requirement for reviews to be conducted by the 
State in accordance with the State's accreditation and 
certification standards not more frequently than once every 2 
nor less frequently than once every year.
    Section 303 of the bill amends section 1945(g)(1) to 
replace a current requirement for annual investigations by the 
Secretary in at least 10 States with a new requirement for on-
site performance reviews in each State not more frequently than 
once every 3 years nor less frequently than once every 5 years.
    Section 304 of the bill amends section 1952(a) to allow 
States an additional year in which to obligate grant funds.
    Section 305 defines the term performance indicator to mean 
a quantifiable characteristic used as a measurement and 
performance target to mean a numerical value sought to be 
achieved within a specified period of time.
    Section 306 repeals certain obsolete provisions concerning 
allocations in Section 1933 of the PHS Act.
    Section 307 repeals certain obsolete addict referral 
provisions in part E of Title III of the PHS Act, Titles III 
and IV of the Narcotic Addict Rehabilitation Act of 1966, and 
Chapter 175 of Title 28 of the U.S. Code.
    Section 308 of the bill amends Section 1949 of the PHS Act 
to direct the Secretary to promulgate regulations as necessary 
to carry out this part.
    Section 309 amends section 502(b)(3)(A) to add that the 
Secretary, in selecting members for the Advisory Councils may 
consider including leading representatives from State and local 
governments.
    Section 310 directs the Secretary, not later than January 
1, 1999, to prepare and submit to the appropriate congressional 
committees a report containing: (1) information concerning the 
adequacy of outcome data sets to measure State performance with 
respect to amounts received by the State under the Performance 
Partnerships as authorized by this act; (2) information 
concerning the range and types of Performance Partnership 
objectives and measures utilized by the State; and (3) a plan, 
if determined feasible by the Secretary after considering 
information received under this authority, for the 
implementation of incentive-based Performance Partnership 
Grants that shall include a disclosure of public comments.
    Section 311 of the bill amends subpart III of part B of 
title XIX by adding a new section prohibiting a State from 
using more than 10 percent of the annual amount paid to the 
State under subpart I or subpart II in a fiscal year to carry 
out activities authorized in subpart II using amounts from 
subpart I or activities in subpart I using amounts from subpart 
II. Any amount paid to the State under this part that is used 
to carry out such activities would be required to comply with 
requirements that apply to the funds provided directly under 
either subpart I or II to carry out the activities.

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

    Section 401 of the bill amends the title of the Protection 
And Advocacy For Mentally Ill Individuals Act of 1986 to the 
Protection and Advocacy For Individuals with Mental Illnesses 
Act, and section 402 of the bill extends its authorization 
through fiscal year 1999.
    Section 403 of the bill amends section 112(a)(2) to provide 
for a minimum amount of the allotment of an eligible system of 
the product (rounded to the nearest $1 hundred) of the 
appropriate base amount specified in subparagraph (B) and the 
factor specified in subparagraph (C). Subparagraph (B) sets the 
appropriate base amount at $139,300 for American Samoa, Guam, 
the Marshall Islands, the Federated States of Micronesia, the 
Commonwealth of Northern Mariana Islands, the Republic of 
Palau, and the Virgin Islands; and $260 thousand for any other 
State. Subparagraph (C) specifies the factor as 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. The bill 
also makes technical amendments to section 112(a) specifying 
the Trust Territory of the Pacific Islands as Marshall Islands, 
the Federated States of Micronesia, and the Republic of Palau; 
and strikes paragraph (3).

             TITLE V--REAUTHORIZATION OF CERTAIN INSTITUTES

    Section 501 of the bill extends the authorities for the 
National Institute of Alcohol Abuse and Alcoholism (NIAAA) 
(section 464H(d)(1) of the PHS Act); the National Institute on 
Drug Abuse (NIDA) (section 464L(d)(1)) and its medication 
development program (section 464P(e)), and provides 
appropriations of such sums as may be necessary for each of the 
fiscal years 1995 and 1996; and the National Institute of 
Mental Health (section 464R(f)(1)) through fiscal year 1996.

          TITLE VI--TRANSITION PROVISIONS AND EFFECTIVE DATES

    Section 601(a) requires the Secretary to develop and 
implement a process to: (a) establish a model set of mental 
health and substance abuse prevention and treatment objectives 
that meet the requirements of the Performance Partnership 
Grants; (b) determine the availability, relevancy, and 
sufficiency of data necessary to measure capacity, process, or 
outcomes with respect to such model set of objectives; and (c) 
establish a plan to improve the availability, relevancy, and 
sufficiency of data if the data sets that are being developed 
are determined to be inadequate. The Secretary would be 
required to consult with representatives from State and local 
governments, Indian Tribes, mental health and substance abuse 
service providers, consumers and families, researchers, and 
other individuals who have technical relevancy with respect to 
the development of such objectives and data strategies.
    In implementing the process, the Secretary is authorized to 
award a contract to an independent entity for the conduct or a 
technical analysis of the availability, relevancy, and 
sufficiency of data sets existing on the date the contract is 
awarded; and for the development of a strategy if such existing 
data sets are determined to be insufficient to measure the 
model set of mental health and substance abuse prevention and 
treatment objectives developed by the Secretary.
    Section 601(b) provides for a general effective date of the 
enactment of the act or October 1, 1995, whichever occurs 
later. Section 601(c) requires that the Performance 
Partnerships take effect on the date on which the Secretary 
determines that the model set of objectives and the data sets 
in subsection (a) have been developed and are sufficient and 
available to measure process, capacity, or outcomes but no 
earlier than October 1, 1997. In preparing for the 
implementation of the Performance Partnership Grants, the 
Secretary may consult with States and others, but the Secretary 
is prohibited from requiring a State to begin the negotiation 
process for the implementation of a Performance Partnership 
Grant prior to fiscal year 1998. The bill specifies that the 
effective date for the following sections will be as if enacted 
on October 1, 1994: 103 and 207, related to maintenance-of-
effort; 104 and 208, related to for-profit eligibility; 203, 
related to tuberculosis and HIV; 204, related to group home 
revolving loan funds; and 303, related to the additional year 
for obligation.
    The bill also repeals the following sections of the PHS 
Act: (a) subsection (b) of section 1922, related to minimum 
allocation of funds for services to pregnant women and women 
with dependent children; (b) section 1923, related to whether 
injecting drug users have timely access to treatment upon 
request; section 1924, dealing with requirements related to 
tuberculosis and HIV; and (d) section 1929, related to the 
needs assessments.
    A project that receives support for fiscal years 1996, 
1997, or 1998 under Section 506 or 520A of the PHS Act as 
amended by this act, and that previously received support under 
title V of the PHS Act for fiscal year 1995, shall be subject 
to requirements which the project was subject to for fiscal 
year 1995 unless the Secretary determines otherwise. The bill 
authorizes the Secretary to grant a State a waiver to permit 
such State to operate a Performance Partnership program prior 
to fiscal year 1998. Such programs would be required to operate 
under the requirements described in the amendment made by the 
bill and would be funded using amounts appropriated for the 
fiscal years involved under part B of title XIX of the PHS Act.
VIII. ADDITIONAL VIEWS OF SENATORS KENNEDY, PELL, DODD, SIMON, HARKIN, 
                        MIKULSKI, AND WELLSTONE

    We voted to report this bill to the full Senate with a 
favorable recommendation despite reservations about several 
matters, including the structure of the substance abuse and 
mental health block grants reauthorized in the bill. We write 
separately to amplify those concerns.

                   i. recent history of block grants

    Congress created the Substance Abuse and Mental Health 
Services Administration (SAMHSA) in 1992 as part of a 
comprehensive law reorganizing and improving the Federal 
Government's efforts to research, prevent and treat substance 
abuse and mental illness (Pub. L. 102-321). The 1992 law was 
the product of substantial bipartisan and bicameral 
deliberation over a period of many years, and we remain proud 
of the accomplishment it represents.
    The centerpiece of the 1992 legislation was the transfer of 
three research institutes (the National Institutes of Mental 
Health, Drug Abuse and Alcoholism and Alcohol Abuse) from what 
has been the Alcohol, Drug Abuse and Mental Health 
Administration (ADAMHA) to the National Institutes of Health. 
At the same time, Congress reconstituted ADAMHA as SAMHSA, an 
agency dedicated to the proposition that the Federal Government 
must play a leading role in providing services for the 
prevention and treatment of mental illness and substance abuse. 
We are pleased that the current legislation does not challenge 
or undercut these structural decisions reached in 1992.
    A second and equally important component of the 1992 Act 
was the transformation of the largely unaccountable Alcohol, 
Drug Abuse and Mental Health Services block grant that had been 
in existence since 1981 into separate mental health and 
substance abuse block grants. We split these block grants in 
order to better target Federal resources, and at the same time 
seized the opportunity to rewrite the rules governing the block 
grants. We sought to create a new model of Federal funding in 
which States played the leading role in administering Federal 
funds in a manner that reflected Federal priorities. We 
envisioned a true partnership between State and Federal 
Governments, one that represented an appropriate balance 
between the sometimes competing goals of flexibility and 
accountability.
    In this respect as well, we are proud of the 
accomplishments of the 1992 legislation. We gave States 
considerable flexibility in choosing how to utilize their 
mental health and substance abuse block grants. At the same 
time, we provided meaningful accountability through the State 
plan mechanism. We also identified a small number of Federal 
priority populations--including pregnant substance abusing 
women, the homeless mentally ill, and substance abusers most at 
risk for HIV disease--and required States to demonstrate that 
they were using Federal funds to address the needs of these 
vulnerable populations.
    Some of these Federal priorities were enforced through the 
use of ``set-asides'' or ``mandates'' within the block grants. 
These mechanisms have fallen into disrepute in the current 
Congress, and most will eventually be terminated under the 
current reauthorization bill if it becomes law. But they 
deserve a more respectful burial than they receive in the 
committee views section of this report.
    Critics of mandates and set-asides assert that States know 
best how to serve their citizens. We do not in any way dispute 
the competence or good intentions of States. But that criticism 
ignores the fact that these block grants are composed of 
Federal funds. They derive from the taxes Congress collects 
from the citizens of all 50 States. It would be silly and 
inefficient for Congress to require citizens to send their 
money to Washington, only to then disburse the money to the 
Governor of each State for whatever purpose each Governor sees 
fit. (That would constitute ``revenue sharing'', a concept in 
even deeper disrepute these days than set-asides or mandates.) 
A citizen of Alaska should not have to pay for the salary of a 
drug treatment provider in Maine unless he or she does so as 
part of a carefully constructed system that advances the 
national interest. In short, Congress should use Federal tax 
money to further legitimate goals of the Federal Government.
    What are legitimate Federal goals in the fields of 
substance abuse and mental health? Clearly the Federal 
Government should create model programs that can be replicated 
throughout the Nation. Federal funds should also be used to 
disseminate research findings that may improve the quality of 
treatment and prevention efforts in each State. The Federal 
Government can centralize and make uniform the collection of 
data. Finally, we believe that the Federal Government has an 
obligation to ensure that vulnerable, hard-to-reach populations 
are served by treatment and prevention programs financed by the 
Federal block grant.
    The history of these programs demonstrates that set-asides 
and mandates are sometimes necessary to achieve these 
legitimate Federal goals. Again, this observation is not 
intended to denigrate States. It is simply a reality that any 
unit of government will be less vigilant to spend money for 
which it is not directly accountable with respect to goals that 
it may not consider its own. States must, as a matter of good 
government, be held accountable for Federal funds and Federal 
goals.
    We continue to believe that the 1992 block grant 
requirements represent a reasonable and responsible means of 
achieving accountability. Contrary to popular opinion, not all 
set-asides and mandates are overly burdensome, and we 
specifically believe that those in the 1992 law are reasonable 
and easy to meet. Nor are they ``unfunded mandates.'' To the 
contrary, the SAMHSA block grants provided over $1.5 billion to 
States in fiscal year 1995; States are in no way ``unfunded'' 
when they are asked to provide services to vulnerable 
populations, or to undertake various planning activities to 
determine the most effective way to use limited resources.
    In light of the above discussion, it might well be asked 
why we support this reauthorization bill, which in important 
respects reverses the approach of the 1992 Act. First, we 
recognize the need to reauthorize SAMHSA itself in a timely 
manner. At a time when resources for discretionary programs are 
diminishing, it is important to communicate to the Senate and 
House Appropriations Committees that this Committee strongly 
supports the vital activities within the jurisdiction of 
SAMHSA.
    We also recognize the advantages of moving the fields of 
mental health and substance abuse prevention and treatment 
toward better measurement of health outcomes. The ability to 
directly measure the impact of programs and expenditures on 
public health will become increasingly important in the current 
budgetary climate. Demonstrating program effectiveness will be 
critical to maintaining adequate funding.
    Third, through negotiation, the committee agreed to 
preserve certain Federal priorities in the block grants. We are 
pleased, for example, that pregnant substance abusers and 
injecting drug users and others at greatest risk of HIV disease 
will continue to receive preference or priority in treatment 
placement decisions under this bill. Obvious public health 
considerations justify these priorities, namely the need to 
protect the fetuses of pregnant women from exposure to drugs, 
and the need to limit the spread of HIV, respectively. We note 
that these populations exist in every State.
    Fourth, we are pleased that the ``Synar amendment'' to the 
1992 law has been preserved. This landmark initiative authored 
by the former Congressman from Oklahoma represents a major step 
forward in the effort to restrict youth access to tobacco. We 
regret, however, that the committee has chosen to reduce the 
penalties for non-compliance with the Synar requirements at a 
time of renewed focus on this issue by both the executive and 
legislative branches.
    Finally, we hope that the Performance Partnership Grants 
(PPGs) authorized in this bill will eventually further the 
legitimate Federal goals we have identified as effectively as 
the structure they replace.

                   ii. performance partnership grants

    We note that there is currently little agreement on the 
best definitions and ways to measure health outcomes in the 
respective fields of mental health and substance abuse, and to 
the extent that this legislation will stimulate their 
development, we encourage such progress. We believe that the 
accountability advantages of performance partnership grants 
that have been asserted in this report and elsewhere will only 
materialize with the development of a consensus on how best to 
conceptualize and measure improvements in health outcomes 
resulting from federally supported treatment and prevention 
programs.
    Absent such consensus, we see little difference or 
advantage in reporting on the progress made on process and 
capacity measures, as compared to the current reporting 
requirements associated with set-asides and priorities. It is 
essential that the elimination of set-asides and priorities in 
favor of the new PPG approach, not result in inadequate 
services to vulnerable populations.
    Regarding the state selection of performance objectives for 
PPG agreements, we wish to emphasize that the bill calls for 
states to select objectives from the ``menu'' developed by the 
Secretary, in consultation with a broad array of interested 
parties (see sections 1911-1912, and sections 1921-1921A). We 
anticipate that the vast majority of objectives that States 
will wish to address will be found on the Federal ``menu''; 
exceptions should be rare and the Secretary and states are 
reminded that off-menu objectives should be consistent with 
those on-menu (see sections 1912 and 1921A).
    We expect states to select a sufficient number of 
performance objectives to reflect the full spectrum of mental 
health and substance abuse prevention and treatment needs. The 
bill allows States to choose as few as one objective to 
concentrate its efforts on for a 3 to 5 year PPG period, but we 
hope that States choose more.
    We wish to remind the Secretary and the States that, during 
the PPG negotiation process, the Secretary is empowered to 
ensure that States are meeting their most significant substance 
abuse and mental health needs (see sections 1912 and 1921A). We 
interpret this to mean that states must have in place a system 
by which to assess what their most significant needs are, so 
that they may justify to the Secretary why they selected 
particular performance objectives from the menu.
    As the majority notes earlier in this report, PPG are 
intended to be true partnerships. As such, both partners play a 
role--States select performance objectives from the menu, based 
on their assessment of their most significant mental health and 
substance abuse prevention and treatment needs, and the Federal 
Government must agree with the appropriateness of these 
objectives in meeting the particular needs of the State and its 
vulnerable populations before Federal funds are granted. 
Despite the committee's rush to enhance State flexibility, it 
is not our--and we do not believe it is the committee's--
intention to merely transfer Federal funds to States.
    Finally, we are disappointed with a provision added to the 
bill at a late stage of the committee's deliberations which 
allows States to continue to transfer up to 10 percent of the 
mental health PPG to substance abuse PPG and vice versa. The 
1992 legislation contained such transfer authority in order to 
give States time to adjust to new funding formulas. It was not 
intended to be a permanent accommodation; Congress allocates 
the funds it deems appropriate for each grant, and if it wanted 
10 percent less dedicated to mental health services, it would 
act accordingly.
    The two grants are of very different sizes, and a 10 
percent transfer could cause huge swings in mental health and 
substance abuse funding. In fiscal year 1995, a 10 percent 
transfer from the mental health block grant would have meant a 
loss of $27 million for mental health services, while a 10 
percent transfer from the substance abuse block grant would 
have meant a $123 million loss for substance abuse services.
    Accordingly, we encourage states to utilize their transfer 
authority sparingly, and we hope that the authority is 
eventually removed from Federal law.

  iii. consolidated demonstration authorities/specialized populations

    At the same time that this bill expands state discretion in 
administering the SAMHSA block grants, it also expands SAMHSA's 
discretion in administering the agency's mental health and 
substance abuse demonstration programs by consolidating those 
authorities.
    We support the principle of consolidation, but we are 
pleased that the committee adopted Senator Wellstone's 
amendment separating the substance abuse demonstration 
authority into two authorities, one for prevention and one for 
treatment. The fields of prevention and treatment are different 
disciplines, with different techniques and target populations, 
and deserve to be considered separately. The separate 
demonstration authorities would be most appropriately 
administered by the Centers within SAMHSA that specialize in 
these fields; namely, the Center for Substance Abuse Treatment 
(CSAT) and the Center for Substance Abuse Prevention (CSAP).
    We are also pleased that the committee chose to maintain 
programs designed to serve certain particularly vulnerable 
populations. In the mental health field, both the Children's 
Mental Health Program and the Projects for Assistance in the 
Transition from Homelessness (PATH) program were preserved as 
separate authorities. Both programs serve some of the most 
vulnerable citizens in our society. We agree with the 
majority's sentiment that mental health treatment capacity 
should be expanded for the homeless mentally ill who have been 
civilly committed, but suggest that it needs to be expanded for 
all mentally ill persons. Indeed, treatment capacity should be 
expanded in the substance abuse field as well.

                        iv. for-profit providers

    The bill allows for Federal funds to be awarded to for-
profit entities, in order to facilitate the implementation of 
Medicaid managed care systems. We have serious reservations 
about Federal funds being awarded to such companies, and we 
stress here that the purposes are limited and that, for 
substance abuse services, profits are to be redirected to 
provision of more services--taxpayer dollars must not be used 
to pay stockholder dividends. Further, we are concerned that 
the health care providers who participate in managed care have 
not historically served the populations SAMHSA funds are 
intended for, and we strongly urge these providers to develop 
community linkages with the criminal justice and child welfare 
systems that refer the majority of publicly funded clients.

                         v. religious providers

    Commendably, the committee decided to remove a provision 
from the Chairman's Mark that would have allowed Federal funds 
to be awarded directly to religious organizations for the 
delivery of mental health and substance abuse prevention and 
treatment services. This provision was added to the bill at a 
very late date, and there was not adequate time for the 
committee to consider its implications, either through public 
hearings or through conversations with citizens of our states 
and other affected parties. We also believe that the provision 
may be unconstitutional. This provision merits far closer 
scrutiny before it is inserted into this or any other public 
health reauthorization bill.

                                   Ted Kennedy.
                                   Paul D. Wellstone.
                                   Chris Dodd.
                                   Tom Harkin.
                                   Barbara A. Mikulski.
                                   Claiborne Pell.
                                   Paul Simon.
                      IX. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT

          * * * * * * *

                             [mental health

    [Sec. 303. [242a] (a) In carrying out the purposes of 
section 301 with respect to mental health--
          [(1) the Secretary, acting through the Director of 
        the Center for Mental Health Services, is authorized to 
        provide clinical training and instruction and to 
        establish and maintain clinical traineeships (with such 
        stipends and allowances (including travel and 
        subsistence expenses and dependency allowances) for the 
        trainees as the Secretary may deem necessary);
          [(2) the Surgeon General is authorized to make grants 
        to State or local agencies, laboratories, and other 
        public or nonprofit agencies and institutions, and to 
        individuals for investigations, experiments, 
        demonstrations, studies, and research projects with 
        respect to the development of improved methods of 
        diagnosing mental illness, and of care, treatment, and 
        rehabilitation of the mentally ill, including grants to 
        State agencies responsible for administration of State 
        institutions for care, or care and treatment, of 
        mentally ill persons for developing and establishing 
        improved methods of operation and administration of 
        such institutions.
    [(b) Nothing in the Single Convention on Narcotic Drugs, 
the Convention on Psychotropic Substances, or other treaties or 
international agreements shall be construed to limit, modify, 
or prevent the protection of the confidentiality of patient 
records or of the names and other identifying characteristics 
of research subjects as provided by any Federal, State, or 
local law or regulation.
    [(c) The Secretary may provide for training instruction, 
and traineeships under subsection (a)(1) through grants to 
public and other nonprofit institutions. Grants under paragraph 
(2) of subsection (a) may be made only upon recommendation of 
the National Advisory Mental Health Council. Such grants may be 
paid in advance or by way of reimbursement, as may be 
determined by the Surgeon General; and shall be made on such 
conditions as the Surgeon General finds necessary.
    [(d)(1) Any individual who has received a clinical 
traineeship, in psychology, psychiatry, nursing, marital and 
family therapy, or social work, under subsection (a)(1) that 
was not of a limited duration or experimental nature (as 
determined by the Secretary) is obligated to serve, in service 
determined by the Secretary to be appropriate in the light of 
the individual's training and experience, at the rate of one 
year for each year (or academic year, whichever the Secretary 
determines to be appropriate) of the traineeship.
    [(2) The service required under paragraph (1) shall be 
performed--
          [(A) for a public inpatient mental institution 
        providing inpatient care or any entity receiving a 
        grant under the Mental Health Systems Act,
          [(B) in a health professional shortage area (as 
        determined under subpart II of part D of this title),
          [(C) in any other area or for any other entity 
        designated by the Secretary, or
          [(D) in a Federal or State correctional facility,
and shall begin within such period after the termination of the 
traineeship as the Secretary may determine. In developing 
criteria for determining for which institutions or entities or 
in which areas, referred to in the preceding sentence, 
individuals must perform service under paragraph (1), the 
Secretary shall give preference to institutions, entities, or 
areas which in his judgment have the greatest need for 
personnel to perform that service. The Secretary may permit 
service for or in other institutions, entities, or areas if the 
Secretary determines that the request for such service is 
supported by good cause.
    [(3) Any individual who fails to perform the service 
required under this subsection within the period prescribed by 
the Secretary is obligated to repay to the United States an 
amount equal to three times the cost of the traineeship 
(including stipends and allowances) plus interest at the 
maximum legal rate at the time of payment of the traineeship, 
multiplied, in any case in which the service so required has 
been performed in part, by the percentage which the length of 
the service not no performed is of the length of the service so 
required to be performed.
    [(4)(A) In the case of any individual any part of whose 
obligation to perform service under this subsection exists at 
the same time as any part of the individual's obligation to 
perform service under section 338C or 338D (because of receipt 
of a scholarship under subpart II of part D) or the 
individual's obligation to perform service under section 472 
(because of receipt of a National Research Service Award), or 
both, the same service may not be used to any extent to meet 
more than one of those obligations.
    [(B) In any case to which subparagraph (A) is applicable 
and in which one of the obligations is to perform service under 
section 338C or 338D, the obligation to perform service under 
that section must be met (by performance of the required 
service or payment of damages) before the obligation to perform 
service under this subsection or under section 472.
    [(C) In any case to which subparagraph (A) is applicable, 
if any part of the obligation to perform service under section 
472 exists at the same time as any part of the obligation to 
perform service under this subsection, the manner and time of 
meeting each obligation shall be prescribed by the Secretary.
    [(5) In disseminating application forms to individuals 
desiring traineeships, the Secretary shall include with such 
forms a fair summary of the liabilities under this subsection 
of an individual who receives a traineeship.

            [Part E--Narcotic Addicts and Other Drug Abusers

                          [care and treatment

    [Sec. 341. [257] (a) The Surgeon General is authorized to 
provide for the confinement, care, protection, treatment, and 
discipline of persons addicted to the use of habit-forming 
narcotic drugs who are civilly committed to treatment under the 
Narcotic Addict Rehabilitation Act of 1966, addicts and other 
persons with drug abuse and drug dependence problems who 
voluntarily submit themselves for treatment, and addicts 
convicted of offenses against the United States, including 
persons convicted by general courts-martial and consular 
courts. Such care and treatment shall be provided at hospitals 
of the Service especially equipped for the accommodation of 
such patients or elsewhere where authorized under other 
provisions of law, and shall be designed to rehabilitate such 
persons, to restore them to health, and, where necessary, to 
train them to be self-supporting and self-reliant; but nothing 
in this section or in this part shall be construed to limit the 
authority of the Surgeon General under other provisions of law 
to provide for the conditional release of patients and for 
aftercare under supervision. In carrying out this subsection, 
the Secretary shall establish in each hospital and other 
appropriate medical facility of the Service a treatment and 
rehabilitation program for drug addicts and other persons with 
drug abuse and drug dependence problems who are in the area 
served by such hospital or other facility; except that the 
requirement of this sentence shall not apply in the case of any 
such hospital or other facility with respect to which the 
Secretary determines that there is not sufficient need for such 
a program in such hospital or other facility.
    [(b) Upon the admittance to, and departure from, a hospital 
of the Service of a person who voluntarily submitted himself 
for treatment pursuant to the provisions of this section, and 
who at the time of his admittance to such hospital was a 
resident of the District of Columbia, the Surgeon General shall 
furnish to the Commissioners of the District of Columbia or 
their designated agent, the name, address, and such other 
pertinent information as may be useful in the rehabilitation to 
society of such person.
    [(c) The Secretary may enter into agreements with the 
Secretary of Veterans Affairs, the Secretary of Defense, and 
the head of any other department or agency of the Government 
under which agreements hospitals and other appropriate medical 
facilities of the Service may be used in treatment and 
rehabilitation programs provided by such department or agency 
for drug addicts and other persons with drug abuse and other 
drug dependence problems who are in areas served by such 
hospitals or other facilities.

   [employment of addicts or other persons with drug abuse and drug 
                          dependence problems

    [Sec. 342. [258] narcotic addicts or other persons with 
drug abuse and drug dependence problems in hospitals of the 
Service designated for their care shall be employed in such 
manner and under such conditions as the Surgeon General may 
direct. In such hospitals the Surgeon General may, in his 
discretion, establish industries, plants, factories, or shops 
for the production and manufacture of articles, commodities, 
and supplies for the United States Government. The Secretary of 
the Treasury may require any Government department, 
establishment, or other institution, for whom appropriations 
are made directly or indirectly by the Congress of the United 
States, to purchase at current market prices, as determined by 
him or his authorized representative, such of the articles, 
commodities, or supplies so produced or manufactured as meet 
their specifications; and the Surgeon General shall provide for 
payment to the inmates or their dependents of such pecuniary 
earnings as he may deem proper. The Secretary shall establish a 
working-capital fund for such industries, plants, factories, 
and shops out of any funds appropriated for Public Health 
Service hospitals at which addicts or other persons with drug 
abuse and drug dependence problems are treated and cared for; 
and such fund shall be available for the purchase, repair, or 
replacement of machinery or equipment, for the purchase of raw 
materials and supplies, for the purchase of uniforms and other 
distinctive wearing apparel of employees in the performance of 
their official duties, and for the employment of necessary 
civilian officers and employees. The Surgeon General may 
provide for the disposal of products of the industrial 
activities conducted pursuant to this section, and the proceeds 
of any sales thereof shall be covered into the Treasury of the 
United States to the credit of the working-capital fund.

                               [convicts

    [Sec. 343. [259] (a) The authority vested with the power to 
designate the place of confinement of a prisoner shall transfer 
to hospitals of the Service especially equipped for the 
accommodation of addicts or other persons with drug abuse and 
drug dependence problems, if accommodations are available, all 
addicts or other persons with drug abuse and drug dependence 
problems who have been or are hereafter sentenced to 
confinement, or who are now or shall hereafter be confined, in 
any penal, correctional, disciplinary, or reformatory 
institution of the United States, including those addicts or 
other persons with drug abuse and drug dependence problems 
convicted of offenses against the United States who are 
confined in State and Territorial prisons, penitentiaries, and 
reformatories, except that no addict or other person with a 
drug abuse or other drug dependence problem shall be 
transferred to a hospital of the Service who, in the opinion of 
the officer authorized to direct the transfer, is not a proper 
subject for confinement in such an institution either because 
of the nature of the crime he has committed or because of his 
apparent incorrigibility. The authority vested with the power 
to designate the place of confinement of a prisoner shall 
transfer from a hospital of the Service to the institution from 
which he was received, or to such other institution as may be 
designated by the proper authority, any addict or other person 
with a drug abuse or other drug dependence problem whose 
presence at a hospital of the Service is detrimental to the 
well-being of the hospital or who does not continue to be a 
narcotic addict or other person with a drug abuse or other drug 
dependence problem. All transfers of such prisoners to or from 
a hospital of the Service shall be accompanied by necessary 
attendants as directed by the officer in charge of such 
hospital and the actual and necessary expenses incident to such 
transfers shall be paid from the appropriation for the 
maintenance of such Service hospital except to the extent that 
other Federal agencies are authorized or required by law to pay 
expenses incident to such transfers. When sentence is 
pronounced against any person whom the prosecuting officer 
believes to be an addict or other person with a drug abuse or 
other drug dependence problem such officer shall report to the 
authority vested with the power to designate the place of 
confinement, the name of such person, the reasons for his 
belief, all pertinent facts bearing on such addiction, drug 
abuse, or drug dependence and the nature of the offense 
committed. Whenever an alien addict or other person with a drug 
abuse or other drug dependence problem transferred to a Service 
hospital pursuant to this subsection is entitled to his 
discharge but is subject to deportation, in lieu of being 
returned to the penal institution from which he came he shall 
be deported by the authority vested by law with power over 
deportation.
    [(b) [Repealed.]
    [(c) Not later than one month prior to the expiration of 
the sentence of any addict or other person with a drug abuse or 
other drug dependence problem confined in a Service hospital, 
he shall be examined by the Surgeon General or his authorized 
representative. If the Surgeon General believes the person to 
be discharged is still an addict or other person with a drug 
abuse or other drug dependence problem and that he may be 
further treatment in a Service hospital be cured of his 
addiction, drug abuse, or drug dependence the addict or other 
person with a drug abuse or other drug dependence problem shall 
be informed, in accordance with regulations, of the 
advisability of his submitting himself to further treatment. 
The addict or other person with a drug abuse or other drug 
dependence problem may then apply in writing to the Surgeon 
General for further treatment in a Service hospital for period 
not exceeding the maximum length of time considered necessary 
by the Surgeon General. Upon approval of the application by the 
Surgeon General or his authorized agent, the addict or other 
person with a drug abuse or other drug dependence problem may 
be given such further treatment as is necessary to cure him of 
his addiction, drug abuse, or drug dependence.
    [(d) Every person convicted of an offense against the 
United States, upon discharge, or upon release on parole or 
supervised release from a hospital of the Service, shall be 
furnished with the gratuities and transportation authorized by 
law to be furnished to prisoners upon release from a penal, 
correctional, disciplinary, or reformatory institution.
    [(e) Any court of the United States having the power to 
suspend the imposition or execution of sentence and to place a 
defendant on probation under any existing laws may impose as 
one of the conditions of such probation that the defendant, if 
an addict, or other person with a drug abuse or other drug 
dependence problem shall submit himself for treatment at a 
hospital of the Service especially equipped for the 
accommodation of addicts or other persons with drug abuse and 
drug dependence problems until discharged therefrom as cured 
and that he shall be admitted thereto for such purpose. Upon 
the discharge of any such probationer from a hospital of the 
Service, he shall be furnished with the gratuities and 
transportation authorized by law to be furnished to prisoners 
upon release from a penal, correctional, disciplinary, or 
reformatory institution. The actual and necessary expense 
incident to transporting such probationer to such hospital and 
to furnishing such transportation and gratuities shall be paid 
from the appropriation for the maintenance of such hospital 
except to the extent that other Federal agencies are authorized 
or required by law to pay the cost of such transportation: 
Provided, That where existing law vests a discretion in any 
officer as to the place to which transportation shall be 
furnished or as to the amount of clothing and gratuities to be 
furnished, such discretion shall be exercised by the Surgeon 
General with respect to addicts or other persons with drug 
abuse and drug dependence problems discharged from hospitals of 
the Service.

                          [voluntary patients

    [Sec. 344. [260] (a) Any addict, or other person with a 
drug abuse or other drug dependence problem whether or not he 
shall have been convicted of an offense against the United 
States, may apply to the Surgeon General for admission to a 
hospital of the Service especially equipped for the 
accommodation of addicts or other persons with drug abuse and 
drug dependence problems.
    [(b) Any applicant shall be examined by the Surgeon General 
who shall determine whether the applicant is an addict, or 
other person with a drug abuse or other drug dependence problem 
whether by treatment in a hospital of the Service he may 
probably be cured of his addiction, drug abuse, or drug 
dependence and the estimated length of time necessary to effect 
his cure. The Surgeon General may, in his discretion, admit the 
applicant to a Service hospital. No such addict or other person 
with drug abuse or other drug dependence problem shall be 
admitted unless he agrees to submit to treatment for the 
maximum amount of time estimated by the Surgeon General to be 
necessary to effect a cure, and unless suitable accommodations 
are available after all eligible addicts or other persons with 
drug abuse and drug dependence problems convicted of offenses 
against the United States have been admitted. Any such addict 
or other person with a drug abuse or other drug dependence 
problem may be required to pay for his substance, care, and 
treatment at rates fixed by the Surgeon General and amounts so 
paid shall be covered into the Treasury of the United States to 
the credit of the appropriation from which the expenditure for 
his subsistence, care, and treatment was made. Appropriations 
available for the care and treatment of addicts or other 
persons with drug abuse and drug dependence problems admitted 
to a hospital of the Service under this section shall be 
available, subject to regulations, for paying the cost of 
transportation to any place within the continental United 
States, including subsistence allowance while traveling, for 
any indigent addict or other person with a drug abuse or other 
drug dependence problem who is discharged as cured.
    [(c) Any addict or other person with a drug abuse or other 
drug dependence problem admitted for treatment under this 
section, including any addict, or other person with a drug 
abuse or other drug dependence problem not convicted of an 
offense, who voluntarily submits himself for treatment, may be 
confined in a hospital of the Service for a period not 
exceeding the maximum amount of time estimated by the Surgeon 
General as necessary to effect a cure of the addiction, drug 
abuse, or drug dependence or until such time as he ceases to be 
an addict or other person with a drug abuse or other drug 
dependence problem.
    [(d) Any addict or other person with a drug abuse or other 
drug dependence problem admitted for treatment under this 
section shall not thereby forfeit or abridge any of his rights 
as a citizen of the United States; nor shall such admission or 
treatment be used against him in any proceeding in any court; 
and the record of his voluntary commitment shall, except as 
otherwise provided by this Act, be confidential and shall not 
be divulged.

              [persons committed from district of columbia

    [Sec. 345. [260a] (a) The Surgeon General is authorized to 
admit for care and treatment in any hospital of the Service 
suitably equipped therefor, and thereafter to transfer between 
hospital of the Service in accordance with section 321(b), any 
addict who is committed, under the provisions of the Act of 
June 24, 1953 (Public Law 76, Eighty-third Congress, to the 
Service or to a hospital thereof for care and treatment and who 
the Surgeon General determines is a proper subject for care and 
treatment. No such addict shall be admitted unless (1) 
committed prior to July 1, 1958; and (2) at the time of 
commitment, the number of persons in hospitals of the Service 
who have been admitted pursuant to this subsection is less than 
100; and (3) suitable accommodations are available after all 
eligible addicts convicted of offenses against the United 
States have been admitted.
    [(b) Any person admitted to a hospital of the Service 
pursuant to subsection (a) shall be discharged therefrom (1) 
upon order of the Superior Court of the District of Columbia, 
or (2) when he is found by the Surgeon General to be cured and 
rehabilitated. When any such person is so discharged, the 
Surgeon General shall give notice thereof to the Superior Court 
of the District of Columbia and shall deliver such person to 
such court for such further action as such court may deem 
necessary and proper under the provisions of the Act of June 
24, 1953 (Public Law 76, Eighty-third Congress).
    [(c) With respect to the detention, transfer, parole, or 
discharge of any person committed to a hospital of the Service 
in accordance with subsection (a), the Surgeon General and the 
officer in charge of the hospital, in addition to authority 
otherwise vested in them, shall have such authority as may be 
conferred upon them respectively, by the order of the 
committing court.
    [(d) The cost of providing care and treatment for persons 
admitted to a hospital of the Service pursuant to subsection 
(a) shall be a charge upon the District of Columbia and shall 
be paid by the District of Columbia to the Public Health 
Service, either in advance or otherwise, as may be determined 
by the Surgeon General. Such cost may be determined for each 
addict or on the basis of rates established for all or 
particular classes of patients, and shall include the cost of 
transportation to and from facilities of the Public Health 
Service. Moneys so paid to the Public Health Service shall be 
covered into the Treasury of the United States as miscellaneous 
receipts. Appropriations available for the care and treatment 
of addicts admitted to a hospital of the Service under this 
section shall be available, subject to regulations, for paying 
the cost of transportation to the District of Columbia, 
including subsistence allowance while traveling, for any such 
addict who is discharged.

                               [penalties

    [Sec. 346. [261] (a) Any person not authorized by law or by 
the Surgeon General who introduces or attempts to introduce 
into or upon the grounds of any hospital of the Service at 
which addicts or other persons with drug abuse and drug 
dependence problems are treated and cared for, any habit-
forming narcotic drug, or substance controlled under the 
Controlled Substances Act, weapon, or any other contraband 
article or thing, or any contraband letter or message intended 
to be received by an inmate thereof, shall be guilty of a 
felony and, upon conviction thereof, shall be punished by 
imprisonment for not more than ten years.
    [(b) It shall be unlawful for any person properly committed 
thereto to escape or attempt to escape from a hospital of the 
Service at which addicts or other persons with drug abuse and 
drug dependence problems are treated and cared for, and any 
such person upon apprehension and conviction in a United States 
court shall be punished by imprisonment for not more than five 
years, such sentence to begin upon the expiration of the 
sentence for which such person was originally confined.
    [(c) Any person who procures the escape of any person 
admitted to a hospital of the Service at which addicts or other 
persons with drug abuse and drug dependence problems are 
treated and cared for, or who advises, connives at, aids, or 
assists in such escape, or who conceals any such inmate after 
such escape, shall be punished upon conviction in a United 
States court by imprisonment in the penitentiary for not more 
than three years.

                          [release of patients

    [Sec. 347. [261a] For purposes of this Act, an individual 
shall be deemed cured of his addiction, drug abuse, or drug 
dependence, and rehabilitated if the Surgeon General determines 
that he has received the maximum benefits of treatment and care 
by the Service for his addiction, drug abuse, or drug 
dependence, or if the Surgeon General determines that his 
further treatment and care for such purpose would be 
detrimental to the interests of the Service.]
          * * * * * * *

     Subpart 14--National Institute on Alcohol Abuse and Alcoholism

                          purpose of institute

    Sec. 464H. [285n] (a) In General.--* * *
          * * * * * * *
    (d) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of carrying out this subpart, there are authorized to 
        be appropriated $300,000,000 for fiscal year 1993, and 
        such sums as may be necessary [for fiscal year 1994] 
        for each of the fiscal years 1994 through 1996.
          * * * * * * *

              Subpart 15--National Institute on Drug Abuse

                          purpose of institute

    Sec. 464L. [285o] (a) In General.--* * *
          * * * * * * *
    (d) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of carrying out this subpart, other than section 464P, 
        there are authorized to be appropriated $440,000,000 
        for fiscal year 1993, and such sums as may be necessary 
        [for fiscal year 1994] for each of the fiscal years 
        1995 and 1996.
          * * * * * * *

                     medication development program

    Sec. 464P. [285o-4] (a) Establishment.--* * *
          * * * * * * *
    (e) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $85,000,000 for fiscal year 1993, [and $95,000,000 
for fiscal year 1994] $95,000,000 for fiscal year 1994, and 
such as may be necessary for each of the fiscal years 1995 and 
1996.

            Subpart 16--National Institute of Mental Health

                          purpose of institute

    Sec. 464R. [285p] (a) In General.--* * *
          * * * * * * *
    (f) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of carrying out this subpart, there are authorized to 
        be appropriated $675,000,000 for fiscal year 1993, and 
        such sums as may be necessary [for fiscal year 1994] 
        for each of the fiscal years 1994 through 1996.
          * * * * * * *

                           advisory councils

    Sec. 502. [290aa-1] (a) Appointment.--
          (1) In general.--The Secretary shall appoint an 
        advisory council for--
          * * * * * * *
                  (A) Nine of the members shall be appointed by 
                the Secretary from among the leading 
                representatives of the health disciplines 
                (including public health and behavioral and 
                social sciences and leading representatives 
                from State and local governments) relevant to 
                the activities of the Administration or Center 
                for which the advisory council is established.

                            data collection

    Sec. 505. [290aa-4] (a) The Secretary, acting through the 
Administrator, shall collect data each year on--
          (1) the national incidence and prevalence of the 
        various forms of mental illness and substance abuse; 
        [and]
          (2) the incidence and prevalence of such various 
        forms in major metropolitan areas selected by the 
        Administrator[.]; and
          (3) other factors as needed to carry out part B of 
        title XIX.
The Secretary may conduct activities under this subsection 
directly, or through grants, contracts, or cooperative 
agreements.
          * * * * * * *

   [residential treatment programs for pregnant and postpartum women

    [Sec. 508. [290bb-1] (a) In General.--The Director of the 
Center for Substance Abuse Treatment shall provide awards of 
grants, cooperative agreement, or contracts to public and 
nonprofit private entities for the purpose of providing to 
pregnant and postpartum women treatment for substance abuse 
through programs in which, during the course of receiving 
treatment--
          [(1) the women reside in facilities provided by the 
        programs;
          [(2) the minor children of the women reside with the 
        women in such facilities, if the women so request; and
          [(3) the services described in subsection (d) are 
        available to or on behalf of the women.
    [(b) Availability of Services for Each Participant.--A 
funding agreement for an award under subsection (a) for an 
applicant is that, in the program operated pursuant to such 
subsection--
          [(1) treatment services and each supplemental service 
        will be available through the applicant, either 
        directly or through agreements with other public or 
        nonprofit private entities; and
          [(2) the services will be made available to each 
        woman admitted to the program.
    [(c) Individualized Plan of Services.--A funding agreement 
for an award under subsection (a) for an applicant is that--
          [(1) in providing authorized services for an eligible 
        woman pursuant to such subsection, the applicant will, 
        in consultation with the women, prepare an 
        individualized plan for the provision to the woman of 
        the services; and
          [(2) treatment services under the plan will include--
                  [(A) individual, group, and family 
                counseling, as appropriate, regarding substance 
                abuse; and
                  [(B) follow-up services to assist the woman 
                in preventing a relapse into such abuse.
    [(d) Required Supplemental Services.--In the case of an 
eligible woman, the services referred to in subsection (a)(3) 
are as follows:
          [(1) Prenatal and postpartum health care.
          [(2) Referrals for necessary hospital services.
          [(3) For the infants and children of the woman--
                  [(A) pediatric health care, including 
                treatment for any perinatal effects of maternal 
                substance abuse and including screenings 
                regarding the physical and mental development 
                of the infants and children;
                  [(B) counseling and other mental health 
                services, in the case of children; and
                  [(C) comprehensive social services.
          [(4) Providing supervision of children during periods 
        in which the woman is engaged in therapy or in other 
        necessary health or rehabilitative activities.
          [(5) Training in parenting.
          [(6) Counseling on the human immunodeficiency virus 
        and on acquired immune deficiency syndrome.
          [(7) Counseling on domestic violence and sexual 
        abuse.
          [(8) Counseling on obtaining employment, including 
        the importance of graduating from a secondary school.
          [(9) Reasonable efforts to preserve and support the 
        family units of the women, including promoting the 
        appropriate involvement of parents and others, and 
        counseling the children of the women.
          [(10) Planning for and counseling to assist reentry 
        into society, both before and after discharge, 
        including referrals to any public or nonprofit private 
        entities in the community involved that provide 
        services appropriate for the women and the children of 
        the women.
          [(11) Case management services, including--
                  [(A) assessing the extent to which authorized 
                services are appropriate for the women and 
                their children;
                  [(B) in the case of the services that are 
                appropriate, ensuring that the services are 
                provided in a coordinated manner; and
                  [(C) assistance in establishing eligibility 
                for assistance under Federal, State, and local 
                programs providing health services, mental 
                health services, housing services, employment 
                services, educational services, or social 
                services.
    [(e) Minimum Qualifications for Receipt of Award.--
          [(1) Certification by relevant state agency.--With 
        respect to the principal agency of the State involved 
        that administers programs relating to substance abuse, 
        the Director may make an award under subsection (a) to 
        an applicant only if the agency has certified to the 
        Director that--
                  [(A) the applicant has the capacity to carry 
                out a program described in subsection (a);
                  [(B) the plans of the applicant for such a 
                program are consistent with the policies of 
                such agency regarding the treatment of 
                substance abuse; and
                  [(C) the applicant, or any entity through 
                which the applicant will provide authorized 
                services, meets all applicable State licensure 
                or certification requirements regarding the 
                provision of the services involved.
          [(2) Status as medicaid provider.--
                  [(A) Subject to subparagraphs (B) and (C), 
                the Director may make an award under subsection 
                (a) only if, in the case of any authorized 
                service that is available pursuant to the State 
                plan approved under title XIX of the Social 
                Security Act for the State involved--
                          [(i) the applicant for the award will 
                        provide the service directly, and the 
                        applicant has entered into a 
                        participation agreement under the State 
                        plan and is qualified to receive 
                        payments under such plan; or
                          [(ii) the applicant will enter into 
                        an agreement with a public or nonprofit 
                        private entity under which the entity 
                        will provide the service, and the 
                        entity has entered into such a 
                        participation agreement plan and is 
                        qualified to receive such payments.
                  [(B)(i) In the case of an entity making an 
                agreement pursuant to subparagraph (A)(ii) 
                regarding the provision of services, the 
                requirement established in such subparagraph 
                regarding a participation agreement shall be 
                waived by the Director if the entity does not, 
                in providing health care services, impose a 
                charge or accept reimbursement available from 
                any third-party payor, including reimbursement 
                under any insurance policy or under any Federal 
                or State health benefits plan.
                  [(ii) A determination by the Director of 
                whether an entity referred to in clause (i) 
                meets the criteria for a waiver under such 
                clause shall be made without regard to whether 
                the entity accepts voluntary donations 
                regarding the provision of services to the 
                public.
                  [(C) With respect to any authorized service 
                that is available pursuant to the State plan 
                described in subparagraph (A), the requirements 
                established in such subparagraph shall not 
                apply to the provision of any such service by 
                an institution for mental diseases to an 
                individual who has attained 21 years of age and 
                who has not attained 65 years of age. For 
                purposes of the preceding sentence, the term 
                ``institution for mental diseases'' has the 
                meaning given such term in section 1905(i) of 
                the Social Security Act.
  [(f) Requirement of Matching Funds.--
          [(1) In general.--With respect to the costs of the 
        program to be carried out by an applicant pursuant to 
        subsection (a), a funding agreement for an award under 
        such subsection is that the applicant will make 
        available (directly or through donations from public or 
        private entities) non-Federal contributions toward such 
        costs in an amount that--
                  [(A) for the first fiscal year for which the 
                applicant receives payments under an award 
                under such subsection, is not less than $1 for 
                each $9 of Federal funds provided in the award;
                  [(B) for any second such fiscal year, is not 
                less than $1 for each $9 of Federal funds 
                provided in the award; and
                  [(C) for any subsequent such fiscal year, is 
                not less than $1 for each $3 of Federal Funds 
                provided in the award.
          [(2) Determination of amount contributed.--Non-
        Federal contributions required in paragraph (1) may be 
        in cash or in kind, fairly, evaluated, including plant, 
        equipment, or services. Amounts provided by the Federal 
        Government, or services assisted or subsidized to any 
        significant extent by the Federal Government, may not 
        be included in determining the amount of such non-
        Federal contributions.
  [(g) Outreach.--A funding agreement for an award under 
subsection (a) of an applicant is that the applicant will 
provide outreach services in the community involved to identify 
women who are engaging in substance abuse and to encourage the 
women to undergo treatment for such abuse.
  [(h) Accessibility of Program; Cultural Context of 
Services.--A funding agreement for an award under subsection 
(a) for an applicant is that--
          [(1) the program operated pursuant to such subsection 
        will be operated at a location that is accessible to 
        low-income pregnant and postpartum women; and
          [(2) authorized services will be provided in the 
        language and the cultural context that is most 
        appropriate.
  [(i) Continuing Education.--A funding agreement for an award 
under subsection (a) is that the applicant involved will 
provide for continuing education in treatment services for the 
individuals who will provide treatment in the program to be 
operated by the applicant pursuant to such subsection.
  [(j) Imposition of Charges.--A funding agreement for an award 
under subsection (a) of an applicant is that, if a charge is 
imposed for the provision of authorized services to on behalf 
of an eligible woman, such charge--
          [(1) will be made according to a schedule of charges 
        that is made available to the public;
          [(2) will be adjusted to reflect the income of the 
        woman involved; and
          [(3) will not be imposed on any such woman with an 
        income of less than 185 percent of the official poverty 
        line, as established by the Director of the Office for 
        Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981.
  [(k) Reports to Director.--A funding agreement for an award 
under subsection (a) is that the applicant involved will submit 
to the Director a report--
          [(1) describing the utilization and costs of services 
        provided under the award;
          [(2) specifying the number of women served, the 
        number of infants served, and the type of costs of 
        services provided; and
          [(3) providing such other information as the Director 
        determines to be appropriate.
  [(l) Requirement of Application.--The Director may make an 
award under subsection (a) only if an application for the award 
is submitted to the Director containing such agreements, and 
the application is in such form, is made in such manner, and 
contains such other agreements and such assurances and 
information as the Director determines to be necessary to carry 
out this section.
    [(m) Equitable Allocation of Awards.--In making awards 
under subsection (a), the Director shall ensure that the awards 
are equitably allocated among the principal geographic regions 
of the United States, subject to the availability of qualified 
applicants for the awards.
    [(n) Duration of Award.--The period during which payments 
are made to an entity from an award under subsection (a) may 
not exceed 5 years. The provision of such payments shall be 
subject to annual approval by the Director of the payments and 
subject to the availability of appropriations for the fiscal 
year involved to make the payments. This subsection may not be 
construed to establish a limitation on the number of awards 
under such subsection that may be made to an entity.
    [(o) Evaluations; Dissemination of Findings.--The Director 
shall, directly or through contract, provide for the conduct of 
evaluations of programs carried out pursuant to subsection (a). 
The Director shall disseminate to the States the findings made 
as a result of the evaluations.
    [(p) Reports to Congress.--Not later than October 1, 1994, 
the Director shall submit to the Committee on Energy and 
Commerce of the House of Representatives, and to the Committee 
on Labor and Human Resources of the Senate, a report describing 
programs carried out pursuant to this section. Every 2 years 
thereafter, the Director shall prepare a report describing such 
programs carried out during the preceding 2 years, and shall 
submit the report to the Administrator for inclusion in the 
biennial report under section 501(k). Each report under this 
subsection shall include a summary of any evaluations conducted 
under subsection (m) during the period with respect to which 
the report is prepared.
    [(q) Definitions.--For purposes of this section:
          [(1) The term ``authorized services'' means treatment 
        services and supplemental services.
          [(2) The term ``eligible woman'' means a woman who 
        has been admitted to a program operated pursuant to 
        subsection (a).
          [(3) The term ``funding agreement under subsection 
        (a)'', with respect to an award under subsection (a), 
        means that the Director may make the award only if the 
        applicant makes the agreement involved.
          [(4) The term ``treatment services'' means treatment 
        for substance abuse, including the counseling and 
        services described in subsection (c)(2).
          [(5) The term ``supplemental services'' means the 
        services described in subsection (d).
    [(r) Authorization of Appropriations.--
           [(1) In general.--For the purpose of carrying out 
        this section and section 509, there are authorized to 
        be appropriated $100,000,000 for fiscal year 1993, and 
        such sums as may be necessary for fiscal year 1994.
           [(2) Transfer.--For the purpose described in 
        paragraph (1), in addition to the amounts authorized in 
        such paragraph to be appropriated for a fiscal year, 
        there is authorized to be appropriated for the fiscal 
        year from the special forfeiture fund of the Director 
        of the Office of National Drug Control Policy such sums 
        as may be necessary.
           [(3) Rule of construction.--The amounts authorized 
        in this subsection to be appropriated are in addition 
        to any other amounts that are authorized to be 
        appropriated and are available for the purpose 
        described in paragraph (1).]

    [outpatient treatment programs for pregnant and postpartum women

    [Sec. 509. [290bb-2] (a) Grants.--The Secretary, acting 
through the Director of the Treatment Center, shall make grants 
to establish projects for the outpatient treatment of substance 
abuse among pregnant and postpartum women, and in the case of 
conditions arising in the infant of such women as a result of 
such abuse by the women, the outpatient treatment of the 
infants for such conditions.
    [(b) Prevention.--Entities receiving grants under this 
section shall engage in activities to prevent substance abuse 
among pregnant and postpartum women.
    [(c) Evaluation.--The Secretary shall evaluate projects 
carried out under subsection (a) and shall disseminate to 
appropriate public and private entities information on 
effective projects.

            [demonstration projects of national significance

    [Sec. 510. [290bb-3] (a) Grants for Treatment 
Improvement.--The Director of the Center for Substance Abuse 
Treatment shall provide grants to public and nonprofit private 
entities for the purpose of establishing demonstration projects 
that will improve the provision of treatment services for 
substance abuse.
    [(b) Nature of Projects.--Grants under subsection (a) shall 
be awarded to--
          [(1) projects that provide treatment to adolescents, 
        female addicts and their children, racial and ethnic 
        minorities, or individuals in rural areas, with 
        preference given to such projects that provide 
        treatment for substance abuse to women with dependent 
        children, which treatment is provided in settings in 
        which both primary health services for the women and 
        pediatric care are available.
          [(2) projects that provide treatment in exchange for 
        public service;
          [(3) projects that provide treatment services and 
        which are operated by public and nonprofit private 
        entities receiving grants under section 329, 330, 340, 
        340A, and other public or nonprofit private entities 
        that provide primary health services;
          [(4) ``treatment campus'' projects that--
                  [(A) serve a significant number of 
                individuals simultaneously;
                  [(B) provide residential, non-community based 
                drug treatment;
                  [(C) provide patients with ancillary social 
                services and referrals to community-based 
                aftercare; and
                  [(D) provide services on a voluntary basis;
          [(5) projects in large metropolitan areas to identify 
        individuals in need of treatment services and to 
        improve the availability and delivery of such services 
        in the areas;
          [(6) in the case of drug abusers who are at risk of 
        HIV infection, projects to conduct outreach activities 
        to the individuals regarding the prevention of exposure 
        to and the transmission of the human immunodeficiency 
        virus, and to encourage the individuals to seek 
        treatment for such abuse; and
          [(7) projects to determine the long-term efficacy of 
        the projects described in this section and to 
        disseminate to appropriate public and private entities 
        information on the projects that have been effective.
    [(c) Preferences in Making Grants.--In awarding grants 
under subsection (a), the Director of the Treatment Center 
shall give preference to projects that--
          [(1) demonstrate a comprehensive approach to the 
        problems associated with substance abuse and provide 
        evidence of broad community involvement and support; or
          [(2) initiate and expand programs for the provision 
        of treatment services (including renovation of 
        facilities, but not construction) in localities in 
        which, and among populations for which, there is a 
        public health crisis as a result of the inadequate 
        availability of such services and a substantial rate of 
        substance abuse.
    [(d) Duration of Grants.--The period during which payments 
are made under a grant under subsection (a) may not exceed 5 
years.
    [(e) Authorization of Appropriations.--
          [(1) In general.--For the purpose of carrying out 
        this section, there are authorized to be appropriated 
        $175,000,000 for fiscal year 1993, and such sums as may 
        be necessary for fiscal year 1994. The amounts so 
        authorized are in addition to any other amounts that 
        are authorized to be appropriated and available for 
        such purpose.
          [(2) Allocation.--Of the amounts appropriated under 
        paragraph (1) for a fiscal year, the Director of the 
        Treatment Center shall reserve not less than 5 percent 
        for carrying out projects described in subsections 
        (b)(2) and (b)(3).]

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

  (a) Grants.--The Secretary shall address the substance abuse 
treatment health needs of regional and national significance 
through--
          (1) the provision of
                  (A) training; or
                  (B) demonstration projects for prevention and 
                treatment; and
          (2) the conduct or support of evaluations of such 
        demonstration projects.
In carrying out this section, the Secretary may make grants to, 
or enter into cooperative agreements with, States, political 
subdivisions of States, Indian Tribes and tribal organizations, 
and public or private nonprofit entities.
  (b) Substance Abuse Treatment Health Needs.--Substance abuse 
health needs of regional and national significance may include 
managed care, systems and partnerships, client-oriented 
services, and other priority populations (including pregnant 
substance abusers, women with dependent children, crack cocaine 
and injecting drug users, and patients with dual disorders) and 
conditions as determined appropriate by the Secretary.
  (c) Requirements.--
          (1) In general.--Recipients of grants, cooperative 
        agreements, and contracts under this section shall 
        comply with information and application requirements 
        determined appropriate by the Secretary.
          (2) Payments.--With respect to a grant, cooperative 
        agreement, or contract awarded under this section, the 
        period during which payments under such award are made 
        to the recipient may not exceed 5 years. The provision 
        of such payments shall be subject to annual approval by 
        the Secretary and the availability of appropriations 
        for the fiscal year involved. This paragraph may not be 
        construed as limiting the number of awards under the 
        program involved that may be made to an entity.
          (3) Matching funds.--The Secretary may require that 
        an entity that applies for a grant, contract, or 
        cooperative agreement under this section provide non-
        Federal matching funds, as determined appropriate by 
        the Secretary, to ensure the institutional commitment 
        of the entity to the projects funded under the grant, 
        contract, or cooperative agreement. Such non-Federal 
        matching funds may be provided directly or through 
        donations from public or private entities and may be in 
        cash or in kind, fairly evaluated, including plant, 
        equipment, or services.
          (4) Maintenance of effort.--With respect to 
        activities for which a grant, cooperative agreement, or 
        contract is awarded under this section, the Secretary 
        may require the recipient to agree to maintain 
        expenditures of non-Federal amounts for such activities 
        at a level that is not less than the level of such 
        expenditures maintained by the entity for such fiscal 
        year preceding the fiscal year for which the entity 
        receives such a grant, contract, or cooperative 
        agreement.
          (5) Application and funding agreements.--
                  (A) Application.--An application for a grant, 
                contract, or cooperative agreement under this 
                section shall ensure that amounts received 
                under such grant, contract, or agreement will 
                not be expended--
                          (i) to provide inpatient services;
                          (ii) to make cash payments to 
                        intended recipients of services;
                          (iii) to purchase or improve land, 
                        purchase, construct, or permanently 
                        improve (other than minor remodeling) 
                        any building or other facility, or 
                        purchase major medical equipment; or
                          (iv) to satisfy any requirement for 
                        the expenditure of non-Federal funds as 
                        a condition for the receipt of Federal 
                        funds.
                  (B) Funding agreement.--A funding agreement 
                for a grant, contract, or cooperative agreement 
                under this section is that the entity involved 
                will not expend more than 10 percent of the 
                grant, contract, or agreement for 
                administrative expenses with respect to the 
                grant, contract, or agreement.
  (d) Reduction in Payments.--The Secretary, at the request of 
a State or a political subdivision of a State, or a public or 
private nonprofit entity, may reduce the amount of payments 
under this section by--
          (1) the fair market value of any supplies or 
        equipment furnished the State, political subdivision of 
        the State, or a public or private nonprofit entity; and
          (2) the amount of the pay, allowances, and travel 
        expenses of any officer, fellow, or employee of the 
        Government when detailed to the State, a political 
        subdivision of the State, or a public or private non-
        profit entity, and the amount of any other costs 
        incurred in connection with the detail of such officer, 
        fellow, or employee;
when the furnishing of such officer, fellow, or employee is for 
the convenience of and at the request of the State, political 
subdivision of the State, or public or private non-profit 
entity and for the purpose of conducting activities described 
in this section. The amount by which any payment is so reduced 
shall be available for payment by the Secretary of the costs 
incurred in furnishing the supplies or equipment or in 
detailing the personnel, on which the reduction of the payment 
is based, and the amount shall be deemed to have been paid to 
the State, political subdivision of the State, or public or 
private non-profit entity.
  (e) Evaluation.--The Secretary shall evaluate each project 
carried out under section (a)(1)(B) and shalldisseminate the 
findings with respect to each such evaluation to appropriate public and 
private entities.
  (f) Information and Education.--
          (1) In general.--The Secretary shall establish 
        information and education programs to disseminate the 
        findings of the research, demonstration, and training 
        programs under this section to the general public and 
        to health professionals.
          (2) Dissemination.--The Secretary shall take such 
        action as may be necessary to insure that all methods 
        of dissemination and exchange of information are 
        maintained between the Substance Abuse and Mental 
        Health Services Administration and the public, and the 
        Administration and other scientific organizations, both 
        nationally and internationally.
  (g) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section, $195,000,000 for 
fiscal year 1996, and such sums as may be necessary for each of 
the fiscal years 1997 through 1999.
          * * * * * * *

   [grants for substance abuse treatment in state and local criminal 
                            justice systems

    [Sec. 511. [290bb-4] (a) In General.--The Director of the 
Center for Substance Abuse Treatment shall provide grants to 
public and nonprofit private entities that provide treatment 
for substance abuse to individuals under criminal justice 
supervision.
    [(b) Eligibility.--In awarding grants under subsection (a), 
the Director shall ensure that the grants are reasonably 
distributed among--
          [(1) projects that provide treatment services to 
        individuals who are incarcerated in prisons, jails, or 
        community correctional settings; and
          [(2) projects that provide treatment services to 
        individuals who are not incarcerated, but who are under 
        criminal justice supervision because of their status as 
        pretrial releasees, post-trial releasees, probationers, 
        parolees, or supervised releasees.
    [(c) Priority.--In awarding grants under subsection (a), 
the Director shall give priority to programs commensurate with 
the extent to which such programs provide, directly or in 
conjunction with other public or private nonprofit entities, 
one or more of the following--
          [(1) a continuum of offender management services as 
        individuals enter, proceed through, and leave the 
        criminal justice system, including identification and 
        assessment, substance abuse treatment, pre-release 
        counseling and pre-release referrals with respect to 
        housing, employment and treatment;
          [(2) comprehensive treatment services for juvenile 
        offenders;
          [(3) comprehensive treatment services for female 
        offenders, including related services such as violence 
        counseling, parenting and child development classes, 
        and perinatal care;
          [(4) outreach services to identify individuals under 
        criminal justice supervision who would benefit from 
        substance abuse treatment and to encourage such 
        individuals to seek treatment; or
          [(5) treatment services that function as an 
        alternative to incarceration for appropriate categories 
        of offenders or that otherwise enable individuals to 
        remain under criminal justice supervision in the least 
        restrictive setting consistent with public safety.
    [(d) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $50,000,000 for fiscal year 1993, and such sums as 
may be necessary for fiscal year 1994.

              [training in provision of treatment services

    [Sec. 512. [290bb-5] (a) In General.--The Director of the 
Center for Substance Abuse Treatment shall develop programs to 
increase the number of health professionals providing 
treatment, services through the awarding of grants to 
appropriate public and non-profit private entities, including 
agencies of State and local governments, hospitals, schools of 
medicine, schools of osteopathic medicine, schools of nursing, 
schools of social work, and graduate programs in marriage and 
family therapy.
    [(b) Priority.--In awarding grants under subsection (a), 
the Director shall give priority to projects that train full-
time substance abuse treatment professionals and projects that 
will receive financial support from public entities for 
carrying out the projects.
    [(c) Health Professions Education.--In awarding grants 
under subsection (a), the Director may make grants--
          [(1) to train individuals in the diagnosis and 
        treatment of alcohol abuse and other drug abuse; and
          [(2) to develop appropriate curricula and materials 
        for the training described in paragraph (1).
    [(d) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $30,000,000 for fiscal year 1993, and such sums as 
may be necessary for fiscal year 1994.]
          * * * * * * *

            Subpart 2--Center for Substance Abuse Prevention

                 office for substance abuse prevention

    Sec. 515. [290bb-21] (a) There is established in the 
Administration an Office for Substance Abuse Prevention 
(hereafter referred to in this part as the ``Prevention 
Center'').
    (b) The Director of the Prevention Center shall--
          (1) * * *
           * * * * * * *
          [(5) support clinical training programs for substance 
        abuse counselors and other health professionals 
        involved in drug abuse education, prevention;]
          [(6)] (5) in cooperation with the Director of the 
        Centers for Disease Control, develop education 
        materials to reduce the risks of acquired immune 
        deficiency syndrome among intravenous drug abusers;
          [(7)] (6) conduct training, technical assistance, 
        data collection, and evaluation activities of programs 
        supported under the Drug Free Schools and Communities 
        Act of 1986;
          [(8)] (7) support the development of model, 
        innovative, community-based programs to discourage 
        alcohol and drug abuse among young people;
          [(9)] (8) prepare for distribution documentary films 
        and public service announcements for television and 
        radio to educate the public concerning the dangers to 
        health resulting from the consumption of alcohol and 
        drugs and, to the extent feasible, use appropriate 
        private organizations and business concerns in the 
        preparation of such announcements; and
          [(10)] (9) develop and support innovative 
        demonstration programs designed to identify and deter 
        the improper use or abuse of anabolic steroids by 
        students, especially students in secondary schools.
           * * * * * * *

                          [community programs

    [Sec. 516. [290bb-22] (a) In General.--The Secretary, 
acting through the Director of the Prevention Center, shall--
          [(1) provide assistance to communities to develop 
        comprehensive long-term strategies for the prevention 
        of substance abuse; and
          [(2) evaluate the success of different community 
        approaches toward the prevention of such abuse.
    [(b) Strategies for Reducing Use.--The Director of the 
Prevention Center shall ensure that strategies developed under 
subsection (a)(1) include strategies for reducing the use of 
alcoholic beverages and tobacco products by individuals to whom 
it is unlawful to sell or distribute such beverages or 
products.
    [(c) Authorization of Appropriations.--For the purpose of 
carrying out subsection (a), there are authorized to be 
appropriated $120,000,000 for fiscal year 1993, such sums as 
may be necessary for fiscal year 1994.]

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

  (a) Grants.--The Secretary shall address the substance abuse 
prevention health needs of regional and national significance 
through--
          (1) the provision of
                  (A) training; or
                  (B) demonstration projects for prevention; 
                and
          (2) conduct or support of evaluations of such 
        demonstration projects.
  In carrying out this section, the Secretary may make grants 
to, or enter into cooperative agreements with, States, 
political subdivisions of States, Indian tribes and tribal 
organizations and public or private nonprofit entities.
  (b) Substance Abuse Prevention Health Needs.--Substance abuse 
prevention health needs of regional and national significance 
may include managed care, systems and partnerships, client 
oriented services, and other priority populations (including 
youth, high risk youth, and children of substance abusers) and 
conditions as considered appropriate by the Secretary.
  (c) Requirements.--
          (1) In general.--Recipients of grants, cooperative 
        agreements, and contracts under this section shall 
        comply with information and application requirements 
        determined appropriate by the Secretary.
          (2) Payments.--With respect to a grant, cooperative 
        agreement, or contract awarded under this section, the 
        period during which payments under such award are made 
        to the recipient may not exceed 5 years. The provision 
        of such payments shall be subject to annual approval by 
        the Secretary and the availability of appropriations 
        for the fiscal year involved. This paragraph may not be 
        construed as limiting the number of awards under the 
        program involved that may be made to an entity.
          (3) Matching funds.--The Secretary may require that 
        an entity that applies for a grant, contract, or 
        cooperative agreement under this section provide non-
        Federal matching funds, as determined appropriate by 
        the Secretary, to ensure the institutional commitment 
        of the entity to the projects funded under the grant, 
        contract, or cooperative agreement. Such non-Federal 
        matching funds may be provided directly or through 
        donations from public or private entities and may be in 
        cash or in kind, fairly evaluated, including plant, 
        equipment, or services.
          (4) Maintenance of effort.--With respect to 
        activities for which a grant, cooperative agreement, or 
        contract is awarded under this section, the Secretary 
        may require the recipient to agree to maintain 
        expenditures of non-Federal amounts for such activities 
        at a level that is not less than the level of such 
        expenditures maintained by the entity for such fiscal 
        year preceding the fiscal year for which the entity 
        receives such a grant, contract, or cooperative 
        agreement.
          (5) Application and funding agreements.--
                  (A) Application.--An application for a grant, 
                contract, or cooperative agreement under this 
                section shall ensure that amounts received 
                under such grant, contract, or agreement will 
                not be expended--
                          (i) to provide inpatient services;
                          (ii) to make cash payments to 
                        intended recipients of services;
                          (iii) to purchase or improve land, 
                        purchase, construct, or permanently 
                        improve (other than minor remodeling) 
                        any building or other facility, or 
                        purchase major medical equipment; or
                          (iv) to satisfy any requirement for 
                        the expenditure of non-Federal funds as 
                        a condition for the receipt of Federal 
                        funds.
                  (B) Funding agreement.--A funding agreement 
                for a grant, contract, or cooperative agreement 
                under this section is that the entity involved 
                will not expend more than 10 percent of the 
                grant, contract, or agreement for 
                administrative expenses with respect to the 
                grant, contract, or agreement.
  (d) Reduction in Payments.--The Secretary, at the request of 
a State or a political subdivision of a State, or a public or 
private nonprofit entity, may reduce the amount of payments 
under this section by--
          (1) the fair market value of any supplies or 
        equipment furnished the State, political subdivision of 
        the State, or a public or private nonprofit entity; and
          (2) the amount of the pay, allowances, and travel 
        expenses of any officer, fellow, or employee of the 
        Government when detailed to the State, a political 
        subdivision of the State, or a public or private non-
        profit entity, and the amount of any other costs 
        incurred in connection with the detail of such officer, 
        fellow, or employee;
when the furnishing of such officer, fellow, or employee is for 
the convenience of and at the request of the State, political 
subdivision of the State, or public or private non-profit 
entity and for the purpose of conducting activities described 
in this section. The amount by which any payment is so reduced 
shall be available for payment by the Secretary of the costs 
incurred in furnishing the supplies or equipment or in 
detailing the personnel, on which the reduction of the payment 
is based, and the amount shall be deemed to have been paid to 
the State, political subdivision of the State, or public or 
private non-profit entity.
  (e) Evaluations.--The Secretary shall evaluate each project 
carried out under section (a)(1)(B) and shall disseminate the 
findings with respect to each such evaluation to appropriate 
public and private entities.
  (f) Information and Education.--
          (1) In general.--The Secretary shall establish 
        information and education programs to disseminate the 
        findings of the research, demonstration, and training 
        programs under this section to the general public and 
        to health professionals.
          (2) Dissemination.--The Secretary shall take such 
        action as may be necessary to insure that all methods 
        of dissemination and exchange of information are 
        maintained between the Substance Abuse and Mental 
        Health Services Administration and the public, and the 
        Administration and other scientific organizations, both 
        nationally and internationally.
  (g) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section $215,000,000 for 
fiscal year 1996, and such sums as may be necessary for each of 
the fiscal years 1997 through 1999.

[prevention, treatment, and rehabilitation model projects for high risk 
                                 youth

    [Sec. 517. [290bb-23] (a) The Secretary, through the 
Director of the Prevention Center, shall make grants to public 
and nonprofit private entities for projects to demonstrate 
effective models for the prevention, treatment, and 
rehabilitation of drug abuse and alcohol abuse among high risk 
youth.
    [(b)(1) In making grants for drug abuse an alcohol abuse 
prevention projects under this section, the Secretary shall 
give priority to applications for projects directed at children 
of substance abusers, latchkey children, children at risk of 
abuse or neglect, preschool children eligible for services 
under the Head Start Act, children at risk of dropping out of 
school, children at risk of becoming adolescent parents, and 
children who do not attend school and who are at risk of being 
unemployed.
    [(2) In making grants for drug abuse and alcohol abuse 
treatment and rehabilitation projects under this section, the 
Secretary shall give priority to projects which address the 
relationship between drug abuse or alcohol abuse and physical 
child abuse, sexual child abuse, emotional child abuse, 
dropping out of school, unemployment, delinquency, pregnancy, 
violence, suicide, or mental health problems.
    [(3) In making grants under this section, the Secretary 
shall give priority to applications from community based 
organizations for projects to develop innovative models with 
multiple, coordinated services for the prevention or for the 
treatment and rehabilitation of drug abuse or alcohol abuse by 
high risk youth.
    [(4) In making grants under this section, the Secretary 
shall give priority to applications for projects to demonstrate 
effective models with multiple, coordinated services which may 
be replicated and which are for the prevention or for the 
treatment and rehabilitation of drug abuse or alcohol abuse by 
high risk youth.
    [(5) In making grants under this section, the Secretary 
shall give priority to applications that employ research 
designs adequate for evaluating the effectiveness of the 
program.
    [(c) The Secretary shall ensure that projects under 
subsection (a) include strategies for reducing the use of 
alcoholic beverages and tobacco products by individuals to whom 
it is unlawful to sell or distribute such beverages or 
products.
    [(d) To the extent feasible, the Secretary shall make 
grants under this section in all regions of the United States, 
and shall ensure the distribution of grants under this section 
among urban and rural areas.
    [(e) In order to receive a grant for a project under this 
section for a fiscal year, a public or nonprofit private entity 
shall submit an application to the Secretary, acting through 
the Office. The Secretary may provide to the Governor of the 
State the opportunity to review and comment on such 
application. Such application shall be in such form, shall 
contain such information, and shall be submitted at such time 
as the Secretary may by regulation prescribe.
    [(f) The Director of the Office shall evaluate projects 
conducted with grants under this section.
    [(g) For purposes of this section, the term ``high risk 
youth'' means an individual who has not attained the age of 21 
years, who is at high risk of becoming, or who has become, a 
drug abuser or an alcohol abuser, and who--
          [(1) is identified as a child of a substance abuser;
          [(2) is a victim of physical, sexual, or 
        psychological abuse;
          [(3) has dropped out of school;
          [(4) has become pregnant;
          [(5) is economically disadvantaged;
          [(6) has committed a violent or delinquent act;
          [(7) has experienced mental health problems;
          [(8) has attempted suicide;
          [(9) has experienced long-term physical pain due to 
        injury; or
          [(10) has experienced chronic failure in school.
    [(h) For the purpose of carrying out this section, there 
are authorized to be appropriated $70,000,000 for fiscal year 
1993, and such sums as may be necessary for fiscal year 1994.

[SEC. 518. [290bb-24] EMPLOYEE ASSISTANCE PROGRAMS.

    [(a) In General.--The Director of the Prevention Center may 
make grants to public and nonprofit private entities for the 
purpose of assisting business organizations in establishing 
employee assistance programs to provide appropriate services 
for employees of the organizations regarding substance abuse, 
including education and prevention services and referrals for 
treatment.
    [(b) Certain Requirements.--A business organization may not 
be assisted under subsection (a) if the organization has an 
employee assistance program in operation. The organization may 
receive such assistance only if the organization lacks the 
financial resources for operating such a program.
    [(c) Special Consideration for Certain Small Businesses.--
In making grants under subsection (a), the Director of the 
Prevention Office shall give special consideration to business 
organizations with 50 or fewer employers.
    [(d) Consultation and Technical Assistance.--In the case of 
small businesses being assisted under subsection (a), the 
Secretary shall consult with the entities and organizations 
involved and provide technical assistance and training with 
respect to establishing and operating employee assistance 
programs in accordance with this subtitle. Such assistance 
shall include technical assistance in establishing workplace 
substance abuse programs.
    [(e) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $3,000,000 for fiscal year 1993, and such sums as 
may be necessary for fiscal year 1994.]
          * * * * * * *

              Subpart 3--Center for Mental Health Services

                   Center for Mental Health Services

    Sec. 520. [290bb-31] (a) * * *
          * * * * * * *
    (b) Duties.--The Director of the Center shall--
          (1) * * *
          * * * * * * *
          [(5) administer the mental health services block 
        grant program authorized in section 1911;]
          [(6)] (5) promote policies and programs at Federal, 
        State and local levels and in the private sector that 
        foster independence and protect the legal rights of 
        persons with mental illness, including carrying out the 
        provisions of the Protection and Advocacy of Mentally 
        Ill Individuals Act;
          [(7)] (6) carry out the programs authorized under 
        sections 520A and 521, including the Community Support 
        Program and the Child and Adolescent Service System 
        Programs;
          [(8)] (7) carry out responsibilities for the Human 
        Resource Development program, and programs of clinical 
        training for professional and paraprofessional 
        personnel pursuant to section 303;
          [(9)] (8) conduct services-related assessments, 
        including evaluations of the organization and financing 
        of care, self-help and consumer-run programs, mental 
        health economics, mental health service systems, rural 
        mental health, and improve the capacity of State to 
        conduct evaluations of publicly funded mental health 
        programs;
          [(10)] (9) establish a clearinghouse for mental 
        health information to assure the widespread 
        dissemination of such information to States, political 
        subdivisions, educational agencies and institutions, 
        treatment and prevention service providers, and the 
        general public, including information concerning the 
        practical application of research supported by the 
        National Institute of Mental Health that is applicable 
        to improving the delivery of services;
          [(11)] (10) provide technical assistance to public 
        and private entities that are providers of mental 
        health services;
          [(12)] (11) monitor and enforce obligations incurred 
        by community mental health centers pursuant to the 
        Community Mental Health Centers Act (as in effect prior 
        to the repeal of such Act on August 13, 1981, by 
        section 902(e)(2)(B) of Public Law 97-35 (95 Stat. 
        560));
          [(13)] (12) conduct surveys with respect to mental 
        health, such as the National Reporting Program; and
          [(14)] (13) assist States in improving their mental 
        health data collection.
          * * * * * * *

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

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

[SEC. 520B. [290bb-33] DEMONSTRATION PROJECTS FOR INDIVIDUALS WITH 
                    POSITIVE TEST RESULTS.

    [(a) In General.--The Secretary, acting through the 
Director of the Center for Mental Health Services, may make 
grants to public and nonprofit private entities for 
demonstration projects for the development, establishment, or 
expansion of programs to provide counseling and mental health 
treatment--
          [(1) for individuals who experience serious 
        psychological reactions as a result of being informed 
        that the results of testing for the etiologic agent for 
        acquired immune deficiency syndrome indicate that the 
        individuals are infected with such etiologic agent; and
          [(2) for the families of such individuals, and for 
        others, who experience serious psychological reactions 
        as a result of being informed of the results of such 
        testing of such individuals.
    [(b) Preferences in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to 
applicants that are based at, or have relationships with, 
entities providing comprehensive health services to individuals 
who are infected with the etiologic agent for acquired immune 
deficiency syndrome.
    [(c) Requirement of Provision of Information on 
Prevention.--The Secretary may not make a grant under 
subsection (a) unless the applicant for the grant agrees that 
counseling provided pursuant to such subsection will include 
counseling relating to measures for the prevention of exposure 
to, and the transmission of, the etiologic agent for acquired 
immune deficiency syndrome.
    [(d) Authority for Training.--A grantee under subsection 
(a) may expend the grant to train individuals to provide the 
services described in such subsection.
    [(e) Requirement of Identification of Needs and 
Objectives.--The secretary may not make a grant under 
subsection (a) unless the applicant for the grant submits to 
the Secretary--
          [(1) information demonstrating that the applicant 
        has, with respect to mental health treatment related to 
        the etiologic agent for acquired immune deficiency 
        syndrome, identified the need for such treatment in the 
        area in which the program will be developed, 
        established, or expanded; and
          [(2) a description of--
                  [(A) the objectives established by the 
                applicant for the conduct of the program; and
                  [(B) the method the applicant will use to 
                evaluate the activities conducted under the 
                program and to determine the extent to which 
                such objectives have been met.
    [(f) Requirement of Application.--The Secretary may not 
make a grant under subsection (a) unless--
          [(1) an application for the grant is submitted to the 
        Secretary;
          [(2) with respect to carrying out the purpose for 
        which the grant is to be made, the application provides 
        assurances of compliance satisfactory to the Secretary;
          [(3) the application contains the information 
        required to be submitted under subsection (e); and
          [(4) the application otherwise is in such form, is 
        made in such manner, and contains such agreements, 
        assurances, and information as the Secretary determines 
        to be necessary to carry out this section.
    [(g) Requirement of Minimum Number of Grants for Fiscal 
Year 1989.--Subject to the extent of amounts made available in 
appropriations Acts, the Secretary shall, for fiscal year 1989, 
make not less than 6 grants under subsection (a).
    [(h) Technical Assistance and Administrative Support.--The 
Secretary, acting through the Director of the National 
Institute of Mental Health, may provide technical assistance 
and administrative support to grantees under subsection (a).
    [(i) Definition.--For purposes of this section, the term 
``mental health treatment'' means individual, family or group 
services designed to alleviate distress, improve functional 
ability, or assist in changing dysfunctional behavior patterns.
    [(j) Authorization of Appropriations.--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 1989 through 1994.]
          * * * * * * *

SEC. 535. [290cc-35] FUNDING.

    (a) Authorization of Appropriations.--For the purpose of 
carrying out [this part]; section 521 there is authorized to be 
appropriated [$75,000,000 for each of the fiscal years 1991 
through 1994.] $29,000,000 for each of the fiscal years 1996 
and 1997, and $50,000,000 for each of the fiscal years 1998 and 
1999.

SEC. 562. [290ff-1] REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE 
                    OF GRANTS.

    (a) Systems of Comprehensive Care.--
          * * * * * * *
    (c) Required Mental Health Services of System.--A funding 
agreement for a grant under section 561(a) is that mental 
health services provided by a system of care under subsection 
(a) will include, with respect to a serious emotional 
disturbance in a child--
          * * * * * * *
The Secretary may waive one or more of the requirements of the 
preceding sentence (for a public entity that is an Indian Tribe 
or tribal organization, or American Samoa, Guam, the Marshall 
Islands, the Federated States of Micronesia, the Commonwealth 
of the Northern Mariana Islands, the Republic of Palau, or the 
United States Virgin Islands) if the Secretary determines, 
after peer review, that the system of care is family-centered 
and uses the least restrictive environment that is clinically 
appropriate.
          * * * * * * *

SEC. 565. [29Off-4] GENERAL PROVISIONS.

    (a) Duration of Support.--* * *
          * * * * * * *
    (f) Funding.--
          (1) Authorization of appropriations.--For the purpose 
        of carrying out this part, there are authorized to be 
        appropriated $100,000,000 for fiscal year 1993, [and] 
        such sums as may be necessary for fiscal year 1994, 
        $60,000,000 for fiscal year 1996, and such sums as may 
        be necessary for each of the 3 succeeding fiscal years.
          * * * * * * *

 [Part F--Model Comprehensive Program for Treatment of Substance Abuse

            [demonstration program in national capital area

    [Sec. 571. [290gg] (a) In General.--The Secretary, in 
collaboration with the Director of the Treatment Center, shall 
make a demonstration grant for the establishment, within the 
national capital area, of a model program for providing 
comprehensive treatment services for substance abuse.
    [(b) Purposes.--The Secretary may not make a grant under 
subsection (a) unless, with respect to the comprehensive 
treatment services to be offered by the program under such 
subsection, the applicant for the grant agrees--
          [(1) to ensure, to the extent practicable, that the 
        program has the capacity to provide the services to all 
        individuals who seek and would benefit from the 
        services;
          [(2) as appropriate, to provide education on 
        obtaining employment and other matters with respect to 
        assisting the individuals in preventing any relapse 
        into substance abuse, including education on the 
        appropriate involvement of parents and others in 
        preventing such a relapse;
          [(3) to provide services in locations accessible to 
        substance abusers and, to the extent practicable, to 
        provide services through mobile facilities;
          [(4) to give priority to providing services to 
        individuals who are intravenous drug abusers, to 
        pregnant women, to homeless individuals, and to 
        residents of publicly-assisted housing;
          [(5) with respect to women with dependent children, 
        to provide child care to such women seeking treatment 
        services for substance abuse;
          [(6) to conduct outreach activities to inform 
        individuals of the availability of the services of the 
        program;
          [(7) to provide case management services, including 
        services to determine eligibility for assistance under 
        Federal, State, and local programs providing health 
        services, mental health services, or social services;
          [(8) to ensure the establishment of one or more 
        offices to oversee the coordination of the activities 
        of the program, to ensure that treatment is available 
        to those seeking it, to ensure that the program is 
        administered efficiently, and to ensure that the public 
        is informed that the offices are the locations at which 
        individuals may make inquiries concerning the program, 
        including the location of available treatment services 
        within the national capital area; and
          [(9) to develop and utilize standards for certifying 
        the knowledge and training of individuals, and the 
        quality of programs, to provide treatment services for 
        substance abuse.
    [(c) Certain Requirements.--
          [(1) Regarding eligibility for grant.--
                  [(A) The Secretary may not make the grant 
                under subsection (a) unless the applicant 
                involved is an organization of the general-
                purpose local governments within the national 
                capital area, or another public or nonprofit 
                private entity, and the applicant submits to 
                the Secretary assurances satisfactory to the 
                Secretary that, with respect to the communities 
                in which services will be offered, the local 
                governments of the communities will participate 
                in the program.
                  [(B) The Secretary may not make the grant 
                under subsection (a) unless--
                          [(i) an application for the grant is 
                        submitted to the Secretary;
                          [(ii) with respect to carrying out 
                        the purpose for which the grant is to 
                        be made, the application provides 
                        assurances of compliance satisfactory 
                        to the Secretary; and
                          [(iii) the application otherwise is 
                        in such form, is made in such manner, 
                        and contains such agreements, 
                        assurances, and information as the 
                        Secretary determines to be necessary to 
                        carry out this section.
          [(2) Authority for cooperative agreements.--The 
        grantee under subsection (a) may provide the services 
        required by such subsection directly or through 
        arrangements with public and nonprofit private 
        entities.
    [(d) Requirement of Non-Federal Contributions.--
          [(1) In general.--The Secretary may not make a grant 
        under subsection (a) unless the applicant for the grant 
        agrees, with respect to the costs to be incurred by the 
        applicant in carrying out the purpose described in such 
        subsection, to make available (directly or through 
        donations from public or private entities) non-Federal 
        contributions toward such costs in an amount not less 
        than $1 for each $2 of Federal funds provided under the 
        grant.
          [(2) Determination of amount contributed.--Non-
        Federal contributions required in paragraph (1) may be 
        in cash or in kind, fairly evaluated, including plant, 
        equipment, or services. Amounts provided by the Federal 
        Government, or services assisted or subsidized to any 
        significant extent by the Federal Government, may not 
        be included in determining the amount of such non-
        Federal contributions.
    [(e) Evaluations.--
          [(1) By secretary.--The Secretary shall independently 
        evaluate the effectiveness of the program carried out 
        under subsection (a) and determine its suitability as a 
        model for the United States, particularly regarding the 
        provision of high quality, patient-oriented, 
        coordinated and accessible drug treatment services 
        across jurisdictional lines. The Secretary shall 
        consider the extent to which the program has improved 
        patient retention, accessibility of services, staff 
        retention and quality, reduced patient relapse, and 
        provided a full range of drug treatment and related 
        health and human services. The Secretary shall evaluate 
        the extent to which the program has effectively 
        utilized innovative methods for overcoming the 
        resistance of the residents of communities to the 
        establishment of treatment facilities within the 
        communities.
          [(2) By grantee.--The Secretary may require the 
        grantee under subsection (a) to evaluate any aspect of 
        the program carried out under such subsection, and such 
        evaluation shall, to the extent appropriate, be 
        coordinated with the independent evaluation required in 
        paragraph (1).
          [(3) Limitation.--Funds made available under 
        subsection (h) may not be utilized to conduct the 
        independent evaluation required in paragraph (1).
    [(f) Reports.--
          [(1) Initial criteria.--The Secretary shall make a 
        determination of the appropriate criteria for carrying 
        out the program required in subsection (a), including 
        the anticipated need for, and range of, services under 
        the program in the communities involved and the 
        anticipated costs of the program. Not later than 90 
        days after the date of the enactment of the ADAMHA 
        Reorganization Act, the Secretary shall submit to the 
        Congress a report describing the findings made as a 
        result of the determination.
          [(2) Annual reports.--Not later than 2 years after 
        the date on which the grant is made under subsection 
        (a), and annually thereafter, the Secretary shall 
        submit to the Congress a report describing the extent 
        to which the program carried out under such subsection 
        has been effective in carrying out the purposes of the 
        program.
    [(g) Definition.--For purposes of this section, the term 
``national capital area'' means the metropolitan Washington 
area, including the District of Columbia, the cities of 
Alexandria, Falls Church, and Fairfax in the State of Virginia, 
the counties of Arlington and Fairfax in such State (and the 
political subdivisions located in such counties), and the 
counties of Montgomery and Prince Georges in the State of 
Maryland (and the political subdivisions located in such 
counties).
    [(h) Obligation of Funds.--Of the amounts appropriated for 
each of the fiscal years 1993 and 1994 for the programs of the 
Department of Health and Human Services, the Secretary shall 
make available $10,000,000 for carrying out this section. Of 
the amounts appropriated for fiscal year 1995 for the programs 
of such Department, the Secretary shall make available 
$5,000,000 for carrying out this section.]
          * * * * * * *

    Part B--Block Grants Regarding Mental Health and Substance Abuse

Subpart I--[Block] Performance Partnership Grants for Community Mental 
                            Health Services

[SEC. 1911. [300x-1] FORMULA GRANTS TO STATES.

    [(a) In General.-- For the purpose described in subsection 
(b), the Secretary, acting through the Director of the Center 
for Mental Health Services, shall make an allotment each fiscal 
year for each State in an amount determined in accordance with 
section 1918. The Secretary shall make a grant to the State of 
the allotment made for the State for the fiscal year if the 
State submits to the Secretary an application in accordance 
with section 1917.
    [(b) Purpose of Grants.--A funding agreement for a grant 
under subsection (a) is that, subject to section 1916, the 
State involved will expend the grant only for the purpose of--
          [(1) carrying out the plan submitted under section 
        1912(a) by the State for the fiscal year involved;
          [(2) evaluating programs and services carried out 
        under the plain; and
          [(3) planning, administration, and educational 
        activities related to providing services under the 
        plan.

[SEC. 1912. [300x-2] STATE PLAN FOR COMPREHENSIVE COMMUNITY MENTAL 
                    HEALTH SERVICES FOR CERTAIN INDIVIDUALS.

    [(a) In General.--The Secretary may make a grant under 
section 1911 only if--
          [(1) the State involved submits to the Secretary a 
        plan for providing comprehensive community mental 
        health services to adults with a serious mental illness 
        and to children with a serious emotional disturbance;
          [(2) the plan meets the criteria specified in 
        subsection (b); and
          [(3) the plan is approved by the Secretary.
    [(b) Criteria for Plan.--With respect to the provision of 
comprehensive community mental health services to individuals 
who are either adults with a serious mental illness or children 
with a serious emotional disturbance, the criteria referred to 
in subsection (a) regarding a plan are as follows:
          [(1) The plan provides for the establishment and 
        implementation of an organized community-based system 
        of care for such individuals.
          [(2) The plan contains quantitative targets to be 
        achieved in the implementation of such system, 
        including the numbers of such individuals residing in 
        the areas to be served under such system.
          [(3) The plan describes available services, available 
        treatment options, and available resources (including 
        Federal, State and local public services and resources, 
        and to the extent practicable, private services and 
        resources) to be provided such individuals.
          [(4) The plan describes health and mental health 
        services, rehabilitation services, employment services, 
        housing services, educational services, medical and 
        dental care, and other support services to be provided 
        to such 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.
          [(5) The plan describes the financial resources and 
        staffing necessary to implement the requirements of 
        such plan, including programs to train individuals as 
        providers of mental health services, and the plan 
        emphasizes training of providers of emergency health 
        services regarding mental health.
          [(6) The plan provides for activities to reduce the 
        rate of hospitalization of such individuals.
          [(7)(A) Subject to subparagraph (B), the plan 
        requires the provision of case management services to 
        each such individual in the State who receives 
        substantial amounts of public funds or services.
          [(B) The plan may provide that the requirement of 
        subparagraph (A) will not be substantially completed 
        until the end of fiscal year 1993.
          [(8) The plan provides for the establishment and 
        implementation of a program of outreach to, and 
        services for, such individuals who are homeless.
          [(9) In the case of children with a 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 
                (which system includes services provided under 
                the Individuals with Disabilities Education 
                Act);
                  [(B) provides that the grant under section 
                1911 for the fiscal year involved will not be 
                expended to provide any service of 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.
          [(10) The plan describes the manner in which mental 
        health services will be provided to individuals 
        residing in rural areas.
          [(11) 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.
          [(12) The plan contains a description of the manner 
        in which the State intends to expend the grant under 
        section 1911 for the fiscal year involved to carry out 
        the provisions of the plan required in paragraphs (1) 
        through (11).
    [(c) Definitions Regarding Mental Illness and Emotional 
Disturbance; Methods for Estimate of Incidence and 
Prevalence.--
          [(1) Establishment by secretary of definitions; 
        dissemination.--For purposes of this subpart, the 
        Secretary shall establish definitions for the terms 
        ``adults with a serious mental illness'' and ``children 
        with a serious emotional disturbance''. The Secretary 
        shall disseminate the definitions to the States.
          [(2) Standardized methods.--The Secretary shall 
        establish standardized methods for making the estimates 
        required in subsection (b)(11) with respect to a State. 
        A funding agreement for a grant under section 1911 for 
        the State is that the State will utilize such methods 
        in making the estimates.
          [(3) Date certain for compliance by secretary.--Not 
        later than 90 days after the date of the enactment of 
        the ADAMHA Reorganization Act, the Secretary shall 
        establish the definitions described in paragraph (1), 
        shall begin dissemination of the definitions to the 
        States, and shall establish the standardized methods 
        described in paragraph (2).
    [(d) Requirement of Implementation of Plan.--
          [(1) Complete implementation.--Except as provided in 
        paragraph (2), in making a grant under section 1911 to 
        a State for a fiscal year, the Secretary shall make a 
        determination of the extent to which the State has 
        implemented the plan required in subsection (a). If the 
        Secretary determines that a State has not completely 
        implemented the plan, the Secretary shall reduce the 
        amount of the allotment under section 1911 for the 
        State for the fiscal year involved by an amount equal 
        to 10 percent of the amount determined under section 
        1918 for the State for the fiscal year.
          [(2) Substantial implementation and good faith effort 
        regarding fiscal year 1993.--
                  [(A) In making a grant under section 1911 to 
                a State for fiscal year 1993, the Secretary 
                shall make a determination of the extent to 
                which the State has implemented the plan 
                required in subsection (a). If the Secretary 
                determines that the State has not substantially 
                implemented the plan, the Secretary shall, 
                subject to subparagraph (B), reduce the amount 
                of the allotment under section 1911 for the 
                State for such fiscal year by an amount equal 
                to 10 percent of the amount determined under 
                section 1918 for the State for the fiscal year.
                  [(B) In carrying out subparagraph (A), if the 
                Secretary determines that the State is making a 
                good faith effort to implement the plan 
                required in subsection (a), the Secretary may 
                make a reduction under such subparagraph in an 
                amount that is less than the amount specified 
                in such subparagraph, except that the reduction 
                may not be made in an amount that is less than 
                5 percent of the amount determined under 
                section 1918 for the State for fiscal year 
                1993.

SEC. 1913. [300x-3] CERTAIN AGREEMENTS.

    [(a) Allocation for Systems of Integrated Services for 
Children.--
          [(1) In general.--With respect to children with a 
        serious emotional disturbance, a funding agreement for 
        a grant under section 1911 is that--
                  [(A) in the case of a grant for fiscal year 
                1993, the State involved will expend not less 
                than 10 percent of the grant to increase 
                (relative to fiscal year 1992) funding for the 
                system of integrated services described in 
                section 1912(b)(9);
                  [(B) in the case of a grant for fiscal year 
                1994, the State will expend not less than 10 
                percent of the grant to increase (relative to 
                fiscal year 1993) funding for such system; and
                  [(C) in the case of a grant for any 
                subsequent fiscal year, the State will expend 
                for such system not less than an amount equal 
                to the amount expended by the State for fiscal 
                year 1994.
          [(2) Waiver.--
                  [(A) Upon the request of a State, the 
                Secretary may provide to the State a waiver of 
                all or part of the requirement established in 
                paragraph (1) if the Secretary determines that 
                the State is providing an adequate level of 
                comprehensive community mental health services 
                for children with a serious emotional 
                disturbance, as indicated by a comparison of 
                the number of such children for which such 
                services are sought with the availability in 
                the State of the services.
                  [(B) The Secretary shall approve or deny a 
                request for a waiver under subparagraph (A) not 
                later than 120 days after the date on which the 
                request is made.
                  [(C) Any waiver provided by the Secretary 
                under subparagraph (A) shall be applicable only 
                to the fiscal year involved.
    [(b) Providers of Services.--A funding agreement for a 
grant under section 1911 for a State is that, with respect to 
the plan submitted under section 1912(a) for the fiscal year 
involved--
          [(1) services under the plan will be provided only 
        through appropriate, qualified community programs 
        (which may include community mental health centers, 
        child mental-health programs, psychosocial 
        rehabilitation programs, mental health peer-support 
        programs, and mental-health primary consumer-directed 
        programs); and
          [(2) services under the plan will be provided through 
        community mental health centers only if the centers 
        meet the criteria specified in subsection (c).
    [(c) Criteria for Mental Health Centers.--The criteria 
referred to in subsection (b)(2) regarding community mental 
health centers are as follows:
          [(1) With respect to mental health services, the 
        centers provide services as follows:
                  [(A) Services principally to individuals 
                residing in a defined geographic area 
                (hereafter in this subsection referred to as a 
                ``service area'').
                  [(B) Outpatient services, including 
                specialized outpatient services for children, 
                the elderly, individuals with a serious mental 
                illness, and residents of the service areas of 
                the centers who have been discharged from 
                inpatient treatment at a mental health 
                facility.
                  [(C) 24-hour-a-day emergency care services.
                  [(D) Day treatment or other partial 
                hospitalization services, or psychosocial 
                rehabilitation services.
                  [(E) Screening for patients being considered 
                for admission to State mental health facilities 
                to determine the appropriateness of such 
                admission.
          [(2) The mental health services of the centers are 
        provided, within the limits of the capacities of the 
        centers, to any individual residing or employed in the 
        service area of the center regardless of ability to pay 
        for such services.
          [(3) The mental health services of the centers are 
        available and accessible promptly, as appropriate and 
        in a manner which preserves human dignity and assures 
        continuity and high quality care.]

SEC. 1911. PERFORMANCE PARTNERSHIP GOALS AND OBJECTIVES.

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

SEC. 1912. STATE PERFORMANCE PARTNERSHIP PROPOSAL.

  (a) In General.--To be eligible to receive a grant under this 
subpart, a State shall, in accordance with this section, 
prepare and submit to the Secretary a performance partnership 
proposal.
  (b) Elements Related to Performance Objectives.--A State 
proposal submitted under subsection (a) shall appropriately 
address the most significant mental health problems (as 
measured by applicable indicators) within the State and 
contain--
          (1) a list of one or more objectives (derived from 
        the performance partnership objectives established 
        under section 1911(b)), including at least one 
        objective in the children's area, toward which the 
        State will work and a performance target for each 
        objective which the State will seek to achieve by the 
        end of the partnership period;
          (2) a rationale for the State's selection of 
        objectives, including any performance targets, and 
        timeframes;
          (3) a statement of the State's strategies for 
        achieving the objectives over the course of the grant 
        period and evidence that the actions taken under a 
        partnership agreement will have an impact on the 
        objective;
          (4) a statement of the amount to be expended to carry 
        out each strategy; and
          (5) an assurance that the State will report annually 
        on all core performance objectives established under 
        section 1911(b)(1)(B) (regardless of whether it is 
        working toward those objectives) and the specific 
        objectives toward which the State will work under the 
        performance partnership.
A State may select an objective that is not an established 
performance partnership objective under section 1911 if the 
objective relates to a significant mental health problem in the 
State that would not otherwise be appropriately addressed. The 
Secretary may require that objectives and requirements be 
developed by the State in a manner consistent with the 
requirements of paragraphs (2) and (3) of section 1911(b).
  (c) Transition Provision.--A State may select objectives 
under this section which have solely process or capacity 
measures until such time as data sets are determined by the 
Secretary to be readily available, sufficient, and relevant 
under section 601(a) of the SAMHSA Reauthorization, Flexibility 
Enhancement, and Consolidation Act of 1995, to make outcome 
measurements for objectives developed by the Secretary.
    [(a) In General.--For purposes of section 1911, an 
application for a grant under such section for a fiscal year in 
accordance with this section if, subject to subsection (b)--
          [(1) the State involved submits the application not 
        later than the date specified by the Secretary as being 
        the date after which applications for such a grant will 
        not be considered (in any case in which the Secretary 
        specifies such a date);]
          * * * * * * *
    (d) Additional Elements.--A State proposal is in accordance 
with this subsection if--
          [(2)] (1) The [application] proposal contains each 
        funding agreement that is described in this subpart or 
        subpart III for such a grant (other than any such 
        agreement that is not applicable to the State);
          [(3)] (2) the proposed performance partnership and 
        agreements are made through certification from the 
        chief executive officer of the State;
          [(4)] (3) with respect to such agreements, the 
        [application] proposal provides assurances of 
        compliance satisfactory to the Secretary;
          [(5)] (4) [the application contains the plan required 
        in section 1912(a),] the information required in 
        section 1915(b)(3)(B), and the report required in 
        section 1942(a);
          [(6)] (5) the [application] proposal contains 
        recommendations in compliance with section 1915(a), or 
        if no such recommendations are received by the Senate, 
        the application otherwise demonstrates compliance with 
        such section; and
          [(7)] (6) the [application] proposal [(including the 
        plan under section 1912(a))] is otherwise in such form, 
        is made in such manner, and contains such agreements, 
        assurances, and information as the Secretary determines 
        to be necessary to carry out this subpart.

SEC. 1913. FEDERAL-STATE PERFORMANCE PARTNERSHIP.

  (a) Approval of State Proposal.--With respect to a State that 
submits a proposal in accordance with section 1912, the 
Secretary, upon a determination that the State meets the 
requirements of such section, shall approve the State proposal 
for a performance partnership under which the State shall 
expend amounts received under a grant provided for under this 
subpart.
  (b) Partnership Period.--The Secretary, in consultation with 
a State receiving a grant under this subpart, shall set the 
duration of the partnership with the State. Initial and 
subsequent partnership periods shall not be less than 3 nor 
more than 5 years, except that the Secretary may agree to a 
partnership period of less than 3 years where a State 
demonstrates to the satisfaction of the Secretary that such 
shorter period is appropriate in light of the particular 
circumstances of that State.
  (c) Assessment and Adjustment.--
          (1) Assessments.--The Secretary shall annually 
        assess--
                  (A) the progress achieved nationally toward 
                each of the core objectives established under 
                section 1911(b)(1)(B); and
                  (B) in consultation with each State, the 
                progress of the State toward each objective 
                agreed upon in the performance partnership 
                under subsection (a);
        and make such assessment publicly available.
          (2) State assessments.--In carrying out paragraph 
        (1)(B), the Secretary shall take into consideration 
        such qualitative assessments of performance as may be 
        provided by each State pursuant to section 1942(a)(3).
          (3) Adjustments.--With respect to a performance 
        partnership under subsection (a), the Secretary and the 
        State may at any time in the course of the partnership 
        period renegotiate, and revise by mutual agreement, the 
        elements of the partnership to account for new 
        information or changed circumstances (including 
        information or changes identified during assessments 
        under paragraph (1)).
  (d) Grants to States; Use of Funds.--
          (1) Grants.--The Secretary shall award a grant to 
        each State that--
                  (A) has reached a performance partnership 
                agreement with the Secretary under subsection 
                (a); and
                  (B) is carrying out activities in accordance 
                with the terms of such partnership;
        in an amount that is equal to the allotment of the 
        State under section 1918. Grants shall be awarded for 
        each fiscal year for which the partnership is in 
        effect.
          (2) Use of funds.--Funds paid to a State under a 
        grant described in paragraph (1) may be used by the 
        State only for the purpose of carrying out this subpart 
        (including related data collection, evaluation, 
        planning, administration, and educational activities).
    [(b)] (e) Waivers Regarding Certain Territories.--In the 
case of any territory of the United States whose allotment 
under section 1911 for the fiscal year is the amount specified 
in section 1918(c)(2)(B), the Secretary may waive such 
provisions of this subpart and subpart III as the Secretary 
determines to be appropriate, other than the provisions of 
section 1916.

SEC. 1914. [300x-4] STATE MENTAL HEALTH PLANNING COUNCIL.

          * * * * * * *
    (b) Duties.--A condition under subsection (a) for a Council 
is that the duties of the Council are--
          (1) to review [plans] performance partnerships 
        provided to the Council pursuant to section 1915(a) by 
        the State involved and to submit to the State any 
        recommendations of the Council for modifications to the 
        [plans] performance partnerships;

SEC. 1915. [300x-4] ADDITIONAL PROVISIONS.

    (a) Review of State [Plan] Performance Partnership by 
Mental Health Planning Council.--The Secretary may make a grant 
under section 1911 to a State only if--
          (1) the plan submitted under section 1912(a) with 
        respect to the grant (and the report of the State under 
        section 1942(a) concerning the preceding fiscal year) 
        has been reviewed by the State mental health planning 
        council under section 1914; and
          (2) the State submits to the Secretary any 
        recommendations received by the State from such council 
        for modifications to the [plan] performance 
        partnerships (without regard to whether the State has 
        made the recommended modifications).
    (b) Maintenance of Effort Regarding State Expenditures for 
Mental Health.--
          (1) In general.--* * *
          * * * * * * *
          (3) Noncompliance by state.--
                  (A) In making a grant under section 1911 to a 
                State for a fiscal year, the Secretary shall 
                make a determination of whether, for the 
                previous fiscal year, the State maintained 
                material compliance with the agreement made 
                under paragraph (1). [If the Secretary 
                determines that a State has failed to maintain 
                such compliance, the Secretary shall reduce the 
                amount of the allotment under section 1911 for 
                the State for the fiscal year for which the 
                grant is being made by an amount equal to the 
                amount constituting such failure for the 
                previous fiscal year.] If the Secretary 
                determines that a State has failed to maintain 
                such compliance, the Secretary may permit the 
                State, not later than 1 year after 
                notification, to correct or mitigate the 
                noncompliance. If the State does not carry out 
                a correction or mitigation as specified by the 
                Secretary (or if the Secretary decided it was 
                not appropriate to provide that opportunity), 
                the Secretary shall reduce the amount of the 
                grant under this subpart for the State for the 
                current fiscal year by an amount equal to the 
                amount constituting such failure.

SEC. 1916. [300x-5] RESTRICTIONS ON USE OF PAYMENTS.

    (a) In General.--A funding agreement for a grant under 
section 1911 is that the State involved will not expand the 
grant--
          (1) * * *
          * * * * * * *
          (5) to provide financial assistance to any entity 
        other than a public or nonprofit private entity unless 
        the State determines that it is appropriate and 
        beneficial for a for-profit private entity to receive 
        assistance to facilitate the integration of the State 
        Medicaid program or mental health managed care programs 
        under title XIX of the Social Security Act).
          * * * * * * *

[SEC. 1917. [300x-6] APPLICATION FOR GRANT.]

          * * * * * * *

SEC. 1919. [300x-8] DEFINITIONS.

    For purposes of this subpart:
          (1) * * *
          * * * * * * *
          (3) The term ``performance indicator'' means a 
        quantifiable characteristic used as a measurement.
          (4) The term ``performance target'' means a numerical 
        value sought to be achieved within a specified period 
        of time.
          * * * * * * *

SEC. 1920. [300x-9] FUNDING.

    (a) Authorization of Appropriations.--For the purpose of 
carrying out this subpart, and subpart III and section 505 with 
respect to mental health, there are authorized to be 
appropriated [$45,000,000 for fiscal year 1993, and such sums 
as may be necessary for fiscal year 1994.] $280,000,000 for 
fiscal year 1996, and such sums as may be necessary for each of 
the fiscal year 1997 through 1999.
    [(b) Allocations for Technical Assistance, Data Collection, 
and Program Evaluation.--
          [(1) In general.--For the purpose of carrying out 
        section 1948(a) with respect to mental health and the 
        purposes specified in paragraphs (2) and (3), the 
        Secretary shall obligate 5 percent of the amounts 
        appropriated under subsection (a) for a fiscal year.
          [(2) Data collection.--The purpose specified in this 
        paragraph is carrying out section 505 with respect to 
        mental health.
          [(3) Program evaluation.--The purpose specified in 
        this paragraph is the conduct of evaluations of 
        prevention and treatment programs and services with 
        respect to mental health to determine methods for 
        improving the availability and quality of such programs 
        and services.]
    (b) Reserved Funds.--
          (1) In general.--The Secretary shall reserve 5 
        percent of the amounts appropriated for a fiscal year 
        under subsection (a)--
                  (A) to carry out sections 505 (providing for 
                data collection) and 1948(a) (providing for 
                technical assistance to States) with respect to 
                mental health; and
                  (B) to conduct evaluations concerning 
                programs supported under this subpart.
        The Secretary may carry out activities funded pursuant 
        to this subsection directly, or through grants, 
        contracts, or cooperative agreements.
          (2) Data collection infrastructure.--In carrying out 
        this subsection, the Secretary shall make available 
        grants and contracts to States for the development and 
        strengthening of State core capacity (including 
        infrastructure) for data collection and evaluation.

 Subpart II--[Block] Performance Partnership Grants for Prevention and 
                      Treatment of Substance Abuse

[SEC. 1921. [300x-21] FORMULA GRANTS TO STATES.

    [(a) In General.--For the purpose described in subsection 
(b), the Secretary, acting through the Center for Substance 
Abuse Treatment, shall make an allotment each fiscal year for 
each State in an amount determined in accordance with section 
1933. The Secretary shall make a grant to the State of the 
allotment made for the State for the fiscal year if the State 
submits to the Secretary and application in accordance with 
section 1932.
    [(b) Authorized Activities.--A funding agreement for a 
grant under subsection (a) is that, subject to section 1931, 
the State involved will expend the grant only for the purpose 
of planning, carrying out, and evaluating activities to prevent 
and treat substance abuse and for related activities authorized 
in section 1924.]

SEC. 1921. PERFORMANCE PARTNERSHIP GOALS AND OBJECTIVES.

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

SEC. 1921A. STATE PERFORMANCE PARTNERSHIP PROPOSAL.

  (a) In General.--To be eligible to receive a grant under this 
subpart, a State shall, in accordance with this section, 
prepare and submit to the Secretary a performance partnership 
proposal in accordance with the provisions of this subpart.
  (b) Elements Related to Performance Objectives.--A State 
proposal submitted under subsection (a) shall appropriately 
address the most significant health problems associated with 
substance abuse (as measured by applicable indicators) within 
the State and contain--
          (1) a list of one or more objectives (derived from 
        the performance partnership objectives specified under 
        section 1921(b)) toward which the State will work and a 
        performance target for each objective which the State 
        will seek to achieve by the end of thepartnership 
period;
          (2) a rationale for the State's selection of 
        objectives, including any performance targets, and 
        timeframes;
          (3) a statement of the State's strategies for 
        achieving the objectives over the course of the grant 
        period and evidence that the actions taken under a 
        partnership agreement will have an impact on the 
        objective;
          (4) a statement of the amount to be expended to carry 
        out each strategy; and
          (5) an assurance that the State will report annually 
        on all core performance objectives established under 
        section 1921(b)(1)(B) (regardless of whether it is 
        working toward those objectives) and the specific 
        objectives toward which the State will work under the 
        performance partnership.
A State may select an objective that is not an established 
performance partnership objective under section 1921 if the 
objective relates to a significant health problem related to 
substance abuse in the State that would not otherwise be 
addressed appropriately. The Secretary may require that 
objectives developed by the State under this subsection be 
consistent with the requirements of paragraphs (2) and (3) of 
section 1921(b).
    (c) Transition Provision.--A State may select objectives 
under this section which solely have process or capacity 
measures until such time as data sets are determined by the 
Secretary to be readily available, sufficient, and relevant 
under section 601(a) of the SAMHSA Reauthorization, Flexibility 
Enhancement, and Consolidation Act of 1995, to make outcome 
measurements for objectives developed by the Secretary.
    [(a) In General.--For purposes of [section 192] this 
subpart, an application for a grant under such section for a 
fiscal year is in accordance with this section if, subject to 
subsections (c) and (d)(2)--
          [(1) the State involved submits the application not 
        later than the date specified by the Secretary;]
          * * * * * * *
    (d) Additional Elements.--A State proposal is in accordance 
with this subsection if--
          [(2)] (1) [application] proposal contains each 
        funding agreement that is described in this subpart or 
        subpart III for such a grant (other than any such 
        agreement that is not applicable to the State);
          [(3)] (2) the proposed performance partnership and 
        agreements are made through certification from the 
        chief executive officer of the State;
          [(4)] (3) with respect to such agreements, the 
        [application] proposal provides assurances of 
        compliance satisfactory to the Secretary;
          [(7)] (4) the [application] proposal [(including the 
        plan under paragraph (6))] is otherwise in such form, 
        is made in such manner, and contains such agreements, 
        assurances, and information as the Secretary determines 
        to be necessary to carry out this subpart.

SEC. 1921B. FEDERAL-STATE PERFORMANCE PARTNERSHIP.

  (a) Approval of State Proposal.--With respect to a State that 
submits a proposal in accordance with section 1921A, the 
Secretary, upon a determination that the State meets the 
requirements of such section, shall approve the State proposal 
for a performance partnership under which the State shall 
expend amounts received under a grant provided for under this 
subpart.
  (b) Partnership Period.--The Secretary, in consultation with 
a State receiving a grant under this subpart, shall set the 
duration of the partnership with the State. Initial and 
subsequent partnership periods shall not be less than 3 nor 
more than 5 years, except that the Secretary may agree to a 
partnership period of less than 3 years where a State 
demonstrates to the satisfaction of the Secretary that such 
shorter period is appropriate in light of the particular 
circumstances of that State.
  (c) Assessment and Adjustment.--
          (1) Assessments.--The Secretary shall annually 
        assess--
                  (A) the progress achieved nationally toward 
                each of the core objectives established under 
                section 1921(b)(1)(B); and
                  (B) in consultation with each State, the 
                progress of the State toward each objective 
                agreed upon in the performance partnership 
                under subsection (a);
        and make such assessment publicly available.
          (2) State assessments.--In carrying out paragraph 
        (1)(B), the Secretary shall take into consideration 
        such qualitative assessments of performance as may be 
        provided by each State pursuant to section 1942(a)(3).
          (3) Adjustments.--With respect to a performance 
        partnership under subsection (a), the Secretary and the 
        State may at any time in the course of the partnership 
        period renegotiate, and revise by mutual agreement, the 
        elements of the partnership to account for new 
        information or changed circumstances (including 
        information or changes identified during assessments 
        under paragraph (1)).
  (d) Grants to States; Use of Funds.--
          (1) Grants.--The Secretary shall award a grant to 
        each State that--
                  (A) has reached a performance partnership 
                agreement with the Secretary under subsection 
                (a); and
                  (B) is carrying out activities in accordance 
                with the terms of such partnership;
        in an amount that is equal to the allotment of the 
        State under section 1933. Grants shall be awarded for 
        each fiscal year for which the partnership is in 
        effect.
          (2) Use of funds.--Funds paid to a State under a 
        grant described in paragraph (1) may be used by the 
        State only for the purpose of carrying out this subpart 
        (including related data collection, evaluation, 
        planning, administration, and educational activities).
          * * * * * * *
    [(c)] (e) Waivers Regarding Certain Territories.--In the 
case of any territory of the United States whose allotment 
under [section 1921] this subpart for the fiscal year is the 
amount specified in section 1933(c)(2)(B), the Secretary may 
waive such provisions of this subpart and subpart III as the 
Secretary determines to be appropriate, other than the 
provisions of section 1931.

SEC. 1922. [300x-22] CERTAIN ALLOCATIONS.

    [(a) Allocations Regarding Alcohol, and Other Drugs.--A 
funding agreement for a grant under [section 1921] this subpart 
is that, in expending the grant, the State involved will 
expend--
          [(1) not less than 35 percent for prevention and 
        treatment activities regarding alcohol; and
          [(2) not less than 35 percent for prevention and 
        treatment activities regarding other drugs.]
    [(b)] (a) Allocation Regarding Primary Prevention 
Programs.--A funding agreement for a grant under [section 1921] 
this subpart is that, in expending the grant, the State 
involved--
          [(1) will expend not less than 20 percent for 
        programs for individuals who do not require treatment 
        for substance abuse, which programs--
                  [(A) educate and counsel the individuals on 
                such abuse; and
                  [(B) provide for activities to reduce the 
                risk of such abuse by the individuals;]
          * * * * * * *
          (1) In general.--A funding agreement for a grant 
        under section 1921 for a fiscal year is that in the 
        case of a grant for fiscal year 1996, or a subsequent 
        fiscal year, the State will expend not less than an 
        amount equal to the amount expended by the State for 
        fiscal year 1995 to increase the availability of 
        treatment services designed for pregnant women and 
        women with dependent children (either by establishing 
        new programs or expanding the capacity of existing 
        programs).
    [(c)] (b) Allocations Regarding Women.--
          [(1) In general.--Subject to paragraph (2), a funding 
        agreement for a grant under [section 1921] this subpart 
        for a fiscal year is that--
          * * * * * * *
          (3) Childcare and prenatal care.--A funding agreement 
        for a grant under [section 1921] this subpart for a 
        State is that each entity providing treatment services 
        with amounts reserved under paragraph (1) by the State 
        will, directly or through arrangements with other 
        public or nonprofit private entities, make available 
        prenatal care to women receiving such services and, 
        while the women are receiving the services, childcare.
          (4) Insufficient amounts.--If the Secretary 
        determines that, as a result of a reduction in the 
        amount of Federal funds provided to State under this 
        subpart, a State will be unable to meet the requirement 
        of paragraph (1), the Secretary shall permit the State 
        to prorate amounts provided under such paragraph based 
        on the amount provided to the State under this subpart 
        in fiscal year 1995.

    Note: Sec. 1922(b) shall be repealed on the date referred 
to in Sec. 601(c).

SEC. 1923. [300x-23] INTRAVENOUS SUBSTANCE ABUSE.

    (a) Capacity of Treatment Programs.--
          (1) Notification of reaching capacity.--A funding 
        agreement for a grant under [section 1921] this 
        supbaprt is that the State involved will, in the case 
        of programs of treatment for intravenous drug abuse, 
        require that any such program receiving amounts from 
        the grant, upon reaching 90 percent of its capacity to 
        admit individuals to the program, provide to the State 
        a notification of such fact.
          (2) Provision of treatment.--A funding agreement for 
        a grant under [section 1921] this supbaprt is that the 
        State involved will, with respect to notifications 
        under paragraph (1), ensure that each individual who 
        requests and is in need of treatment for intravenous 
        drug abuse is admitted to a program of such treatment 
        not later than--
          * * * * * * *
    (b) Outreach Regarding Intravenous Substance Abuse.--A 
funding agreement for a grant under [section 1921] this 
supbaprt is that the State involved, in providing amounts from 
the grant to any entity for treatment services for intravenous 
drug abuse, will require the entity to carry out activities to 
encourage individuals in need of such treatment to undergo 
treatment.

    Note: Sec. 1923 shall be repealed on the date referred to 
in Sec. 601(c).

SEC. 1924. [300x-24] REQUIREMENTS REGARDING TUBERCULOSIS AND HUMAN 
                    IMMUNODEFICIENCY VIRUS.

    (a) Tuberculosis.--
          [(1) In general.--A funding agreement for a grant 
        under [section 1921] this supbaprt is that the State 
        involved will require that any entity receiving amounts 
        from the grant for operating a program of treatment for 
        substance abuse--
                  [(A) will, directly or through arrangements 
                with other public or nonprofit private 
                entities, routinely make available tuberculosis 
                services to each individual receiving treatment 
                of such abuse; and
                  [(B) in the case of an individual in need of 
                such treatment who is denied admission to the 
                program on the basis of the lack of the 
                capacity of the program to admit the 
                individual, will refer the individual to 
                another provider of tuberculosis services.]
          (1) In general.--A funding agreement for a grant 
        under section 1921 is that the State involved will--
                  (A)(i) directly or through arrangements with 
                other public or nonprofit private entities, 
                ensure that activities are routinely carried 
                out under subparagraphs (a) and (B) of 
                paragraph (2); and
                  (ii) ensure that arrangements are made with 
                other public or nonprofit private entities to 
                make available tuberculosis services, including 
                services under subparagraphs (C) and (D) of 
                paragraph (2), to each individual receiving 
                treatment for substance abuse under this 
                subpart; and
                  (B) require that any entity receiving amounts 
                from the grant for operating a program of 
                treatment for substance abuse, in the case of 
                an individual in need of such treatment who is 
                denied admission to the program on the basis of 
                the lack of the capacity of the program to 
                admit the individual, will refer the individual 
                to another provider of tuberculosis services.
        Nothing in subparagraph (A)(ii) shall be construed to 
        require that the State expend funds under this Act to 
        make available such services.
          (2) Tuberculosis services.--For purposes of paragraph 
        (1), the term ``tuberculosis services'', with respect 
        to an individual, means)
                  (A) counseling the individual with respect to 
                tuberculosis;
                  [(B) testing to determine whether the 
                individual has contracted such disease and 
                testing to determine the form of treatment for 
                the disease that is appropriate for the 
                individual; and]
                  (B) tuberculosis testing, based on the risk 
                assessment conducted by the State, to determine 
                whether the individual has contracted such 
                disease, such testing to be based on usual 
                standards as determined to be appropriate by 
                the State health director in cooperation with 
                State and local health agencies for 
                tuberculosis and with other relevant private 
                nonprofit entities;
                  (C) testing to determine the form of 
                treatment for the disease that is appropriate 
                for the individual; and
          (3) Counseling.--For purposes of paragraph (2), the 
        term ``counseling'' with respect to an individual 
        means--
                  (A) the provision of information to 
                individuals or communities about risk factors 
                for tuberculosis; and
                  (B) conducting tuberculosis risk assessments 
                to determine if tuberculosis testing is 
                required.
                  [(C)] (D) providing such treatment to the 
                individual.
    (b) Human Immunodeficiency Virus.--
          (1) Requirement for certain states.--In the case of a 
        State described in paragraph (2), a funding agreement 
        for a grant under [section 1921] this subpart is that--
                  (A) with respect to individuals undergoing 
                treatment for substance abuse, the State will, 
                subject to paragraph (3), carry out 1 or more 
                projects to routinely make available to the 
                individuals early intervention services for HIV 
                disease at the sites at which the individuals 
                are undergoing such treatment;
          * * * * * * *
          (2) Designated states.--For purposes of this 
        subsection, a State described in this paragraph is any 
        State whose rate of cases of acquired immune deficiency 
        syndrome is [10] 15 or more such cases per 100,000 
        individuals (as indicated by the number of such cases 
        reported to and confirmed by the Director of the 
        Centers for Disease Control for the most recent 
        calendar year for which such data are available).
          (3) Use of existing programs regarding substance 
        abuse.--With respect to programs that provide treatment 
        services for substance abuse, a funding agreement for a 
        grant under [section 1921] this subpart for a 
        designated State is that each such program 
        participating in a project under paragraph (1) will be 
        a program that began operation may participate in a 
        project under paragraph (1) without regard to whether 
        the program has been providing early intervention 
        services for HIV disease.
          (4) Applicable percentage regarding expenditures for 
        services.--
                  (A)(i) For purposes of paragraph (1)(B), the 
                percentage that is applicable under this 
                paragraph for a designated State is, subject to 
                subparagraph (B), the percentage by which the 
                amount of the grant under [section 1921] this 
                subpart for the State for the fiscal year 
                involved is an increase over the amount 
                specified in clause (ii).
          * * * * * * *
          (5) Requirement regarding rural areas.--
                  (A) A funding agreement for a grant under 
                [section 1921] this subpart for a designated 
                State is that, if the State will carry out 2 or 
                more projects under paragraph (1), the State 
                will carry out 1 such project in a rural area 
                of the State, subject to subparagraph (B).
          * * * * * * *
          (6) Manner of providing services.--With respect to 
        the provision of early intervention services for HIV 
        disease to an individual, a funding agreement for a 
        grant under [section 1921] this subpart for a 
        designated State is that--
          * * * * * * *
          (7) Definitions.--For purposes of this subsection:
                  (A) The term ``designated State'' means a 
                State described in paragraph (2).
                  (B) The term ``early intervention services'', 
                with respect to HIV disease, means--
                          (i) appropriate pretest counseling;
                          (ii) testing individuals with respect 
                        to such disease, including tests to 
                        confirm the presence of the disease, 
                        tests to diagnose the extent of the 
                        deficiency in the immune system, and 
                        tests to provide information on 
                        appropriate therapeutic measures for 
                        preventing and treating the 
                        deterioration of the immune system and 
                        for preventing and treating conditions 
                        arising from the disease, such testing 
                        to be based on usual standards as 
                        determined to be appropriate by the 
                        State health director in cooperation 
                        with State and local health agencies 
                        for HIV and with other relevant private 
                        nonprofit entities; and;
          * * * * * * *
    (c) Expenditure of Grant for Compliance With [Agreements] 
Partnerships.--
          (1) In general.--A grant under [section 1921] this 
        subpart may be expended for purposes of compliance with 
        the [agreements] partnerships required in this section, 
        subject to paragraph (2).
          * * * * * * *
          (2) Limitation.--A funding agreement for a grant 
        under [section 1921] this subpart for a State is that 
        the grant will not be expended to make payment for any 
        service provided for purposes of compliance with this 
        section to the extent that payment has been made, or 
        can reasonably be expected to be made, with respect to 
        such service--
          * * * * * * *
    (d) Maintenance of Effort.--With respect to services 
provided for by a State for purposes of compliance with this 
section, a funding agreement for a grant under [section 1921] 
this subpart is that the State will maintain expenditures of 
non-Federal amounts for such services at a level that is not 
less than average level of such expenditures maintained by the 
State for 2-year period preceding the first fiscal year for 
which the State receives such a grant.
          * * * * * * *
    (f) Payor of Last Resort.--Amounts made available under 
this section may only be used as a payment of last resort for 
tuberculosis and may not be used for the medical evaluation and 
treatment of such disease.

    Note: Sec. 1924 shall be repealed on the date referred to 
in Sec. 601(c).

SEC. 1925. [800x-25] GROUP HOMES FOR RECOVERING SUBSTANCE ABUSERS.

    (a) State Revolving Funds for Establishment of Homes.--[For 
fiscal year 1993 and subsequent fiscal years, the Secretary may 
make a grant under [section 1921] this subpart only if the 
State involved has established, and is providing for the 
ongoing operation of, a revolving fund as follows:] Except as 
provided in subsection (d), for each of the fiscal years 1996 
through 1999, the Secretary may make a grant under section 1921 
only if the State involved has established and is providing for 
the ongoing operation of a revolving fund as follows:
           * * * * * * *
    (d) Nonapplication of Section.--
          (1) In general.--The requirements of this section 
        shall not apply to a State that is not, as of the date 
        of enactment of this subsection, utilizing a revolving 
        fund under this section. Such a State shall be required 
        to maintain such a fund after such date of enactment.
          (2) Use of funds.--A State described in paragraph 
        (1), may use amounts set aside under this section, or 
        amounts remaining in the revolving fund, to provide 
        other services under this part.

SEC. 1926. [300x-26] STATE LAW REGARDING SALE OF TOBACCO PRODUCTS TO 
                    INDIVIDUALS UNDER AGE OF 18.

    (a) Relevant Law.--
          (1) In general.--Subject to paragraph (2), for fiscal 
        year 1994 and subsequent fiscal years, the Secretary 
        may make a grant under [section 1921] this subpart only 
        if the State involved has in effect a law providing 
        that it is unlawful for any manufacturer, retailer, or 
        distributor of tobacco products to sell or distribute 
        any such product to any individual under the age of 18.
          (2) Delayed applicability for certain States.--In the 
        case of a State whose legislature does not convene a 
        regular session in fiscal year 1993, and in the case of 
        a State whose legislature does not convene a regular 
        session in fiscal year 1994, the requirement described 
        in paragraph (1) as a condition of a receipt of a grant 
        under [section 1921] this subpart shall apply only for 
        fiscal year 1995 and subsequent fiscal years.
    (b) Enforcement.--
          (1) In general.--For the first applicable fiscal year 
        and for subsequent fiscal years, a funding agreement 
        for a grant under [section 1921] this subpart is that 
        the State involved will enforce this law described in 
        subsection (a) in a manner that can reasonably be 
        expected to reduce the extent to which tobacco products 
        are available to individuals under the age of 18.
           * * * * * * *
    (c) Noncompliance of State.--Before making a grant under 
[section 1921] this subpart to a State for the first applicable 
fiscal year or any subsequent fiscal year, the Secretary shall 
make a determination of whether the State has maintained 
compliance with subsections (a) and (b). If, after notice to 
the State and an opportunity for a hearing, the Secretary 
determines that the State is not in compliance with such 
subsections, the Secretary shall reduce the amount of the 
allotment under such section for the State for the fiscal year 
involved by an amount equal to--
          (1) in the case of the first applicable fiscal year 
        [10] 5 percent of the amount determined under section 
        1933 for the State for the fiscal year;
          (2) in the case of the first fiscal year following 
        such applicable fiscal year, 10 [20] percent of the 
        amount determined under section 1933 for the State for 
        the fiscal year.
          (3) in the case of the second such fiscal year, [30] 
        15 percent of the amount determined under section 1933 
        for the State for the fiscal year; and
          (4) in the case of the third such fiscal year or any 
        subsequent fiscal year [40] 20 percent of the amount 
        determined under section 1933 for the State for the 
        fiscal year.

SEC. 1927. [300x-27] TREATMENT SERVICES FOR PREGNANT WOMEN.

    (a) In General.--A funding agreement for a grant under 
[section 1921] this subpart is that the State involved--
          * * * * * * *
    (b) Referrals Regarding States.--A funding agreement for a 
grant under [section 1921] this subpart is that, in carrying 
out subsection (a)(1)--
          * * * * * * *

SEC. 1928. [300x-28] ADDITIONAL AGREEMENTS.

    [(a) Improvement of Process for Appropriate Referrals for 
Treatment.--With respect to individuals seeking treatment 
services, a funding agreement for a grant under [section 1921] 
this subpart is that the State involved will improve (relative 
to fiscal year 1992) the process in the State for referring the 
individuals to treatment facilities that can provide to the 
individuals the treatment modality that is most appropriate for 
the individuals.]
    [(b)] (a) Continuing Education.--With respect to any 
facility for treatment services or prevention activities that 
is receiving amounts from a grant under [section 1921] this 
subpart, a funding agreement for a State for a grant under such 
section is that continuing education in such services or 
activities (or both, as the case may be) will be made available 
to employees of the facility who provide the services or 
activities.
     [(c)] (b) Coordination of Various Activities and 
Services.--A funding agreement for a grant under [section 1921] 
this subpart is that the State involved will coordinate 
prevention and treatment activities with the provision of other 
appropriate services (including health, social, correctional 
and criminal justice, educational, vocational rehabilitation, 
and employment services).
    [(d) Waiver of Requirement.--
          [(1) In general.--Upon the request of a State, the 
        Secretary may provide to a State a waiver of any or all 
        of the requirements established in this section if the 
        Secretary determines that, with respect to services for 
        the prevention and treatment of substance abuse, the 
        requirement involved is unnecessary for maintaining 
        quality in the provision of such services in the State.
          [(2) Date certain for acting upon request.--The 
        Secretary shall approve or deny a request for a waiver 
        under paragraph (1) not later than 120 days after the 
        date on which the request is made.
          [(3) Applicability of waiver.--Any waiver provided by 
        the Secretary under paragraph (1) shall be applicable 
        only to the fiscal year involved.]
          * * * * * * *

SEC. 1929. [300x-29] SUBMISSION TO SECRETARY OF STATEWIDE ASSESSMENT OF 
                    NEEDS.

    The Secretary may make a grant under [section 1921] this 
subpart only if the State submits to the Secretary an 
assessment of the need in the State for authorized activities 
(which assessment is conducted in accordance with criteria 
issued by the Secretary), both by locality and by the State in 
general, which assessment includes a description of--
          * * * * * * *
    Note: Sec. 1929 shall be repealed on the date referred to 
in Sec. 601(c).

SEC. 1930. [300x-30] MAINTENANCE OF EFFORT REGARDING STATE 
                    EXPENDITURES.

    (a) In General.--With respect to the principal agency of a 
State for carrying out authorized activities, a funding 
agreement for a grant under [section 1921] this subpart for the 
State for a fiscal year is that such agency will for such year 
maintain aggregate State expenditures for authorized activities 
at a level that is not less than the average level of such 
expenditures maintained by the State for the 2-year period 
preceding the fiscal year for which the State is applying for 
the grant.
          * * * * * * *
    (c) Noncompliance by State.--
          (1) In general.--In making a grant under [section 
        1921] this subpart to a State for a fiscal year, the 
        Secretary shall make a determination of whether, for 
        the previous fiscal year, the State maintained material 
        compliance with any agreement made under subsection 
        (a). [If the Secretary determines that a State has 
        failed to maintain such compliance, the Secretary shall 
        reduce the amount of the allotment under section 1921 
        for the State for the fiscal year for which the grant 
        is being made by an amount equal to the amount 
        constituting such failure for the previous fiscal 
        year.] If the Secretary determines that a State has 
        failed to maintain such compliance, the Secretary may 
        permit the State, not later than 1 year after 
        notification, to correct or mitigate the noncompliance. 
        If the State does not carry out a correction or 
        mitigation as specified by the Secretary (or if the 
        Secretary decided it was not appropriate to provide 
        that opportunity), the Secretary shall reduce the 
        amount of the grant under this subpart for the State 
        for the current fiscal year by an amount equal to the 
        amount constituting such failure.
          (2) Submission of information to secretary.--The 
        Secretary may make a grant under [section 1921] this 
        subpart for a fiscal year only if the State involved 
        submits to the Secretary information sufficient for the 
        Secretary to make the determination required in 
        paragraph (1).

SEC. 1931. [300x-31] RESTRICTIONS ON EXPENDITURE OF GRANT.

    (a) In General.--
          (1) Certain restrictions.--A funding agreement for a 
        grant under [section 1921] this subpart is that the 
        State involved will not expend the grant--
                  (A) * * *
          * * * * * * *
                  (E) to provide financial assistance to any 
                entity other than a public or nonprofit private 
                entity, unless the State determines that it is 
                appropriate and beneficial for a for-profit 
                private entity to receive assistance to 
                facilitate the integration of the State 
                Medicaid program or substance abuse managed 
                care programs under title XIX of the Social 
                Security Act; or
          * * * * * * *
          (2) Limitation on administrative expenses.--A funding 
        agreement for a grant under [section 1921] this subpart 
        is that the State involved will not expend more than 5 
        percent of the grant to pay the costs of administering 
        the grant.
          (3) Limitation regarding penal and correctional 
        institutions.--A funding agreement for a State for a 
        grant under [section 1921] this subpart is that, in 
        expending the grant for the purpose of providing 
        treatment services in penal or correctional 
        institutions of the State, the State will not expend 
        more than an amount equal to the amount expended for 
        such purpose by the State from the grant made under 
        section 1912A to the State for fiscal year 1991 (as 
        section 1912A was in effect for such fiscal year).
          (4) For-profit restrictions.--For purposes of 
        providing assistance to a for-profit entity under 
        paragraph (1)(E), the State shall ensure that--
                  (A) such an entity is certified or licensed 
                by the State;
                  (B) all profits earned by such entity as a 
                result of assistance provided under this 
                subpart are redistributed by the entity to the 
                community served by the entity for the 
                provision of treatment or prevention services; 
                and
                  (C) in the case of an entity that is a 
                private for-profit entity, such entity is the 
                only available provider of substance abuse 
                treatment in the area served.
    (b) Exception Regarding Inpatient Hospital Services.--
           (1) Medical necessity as precondition.--With respect 
        to compliance with the agreement made under subsection 
        (a), a State may expend a grant under [section 1921] 
        this subpart to provide inpatient hospital services as 
        treatment for substance abuse only if it has been 
        determined, in accordance with guidelines issued by the 
        Secretary, that such treatment is a medical necessity 
        for the individual involved, and that the individual 
        cannot be effectively treated in a community-based, 
        nonhospital, residential program of treatment.
          (2) Rate of payment.--In the case of an individual 
        for whom a grant under [section 1921] this subpart is 
        expended to provide inpatient hospital services 
        described in paragraph (1), a funding agreement for the 
        grant for the State involved is that the daily rate of 
        payment provided to the hospital for providing the 
        services to the individual will not exceed the 
        comparable daily rate provided for community-based, 
        nonhospital, residential programs of treatment for 
        substance abuse.
    (c) Waiver Regarding Construction of Facilities.--
          (1) In general.--The Secretary may provide to any 
        State a waiver of the restriction established in 
        subsection (a)(1)(C) for the purpose of authorizing the 
        State to expend a grant under [section 1921] this 
        subpart for the construction of a new facility or 
        rehabilitation of an existing facility, but not for 
        land acquisition.
          * * * * * * *

[SEC. 1932. [300x-32] APPLICATION FOR GRANT; APPROVAL OF STATE PLAN.]

          * * * * * * *
          [(5) the application contains the information 
        required in section 1929] this subpart, the information 
        required in section 1930(c)(2), and the report required 
        in section 1942(a);
          [(6)(A) the application contains a plan in accordance 
        with subsection (b) and the plan is approved by the 
        Secretary; and
          [(B) the State provides assurances satisfactory to 
        the Secretary that the State complied with the 
        provisions of the plan under subparagraph (A) that was 
        approved by the Secretary for the most recent fiscal 
        year for which the State received a grant under 
        [section 1921] this subpart; and]
          * * * * * * *
    [(b) State Plan.--
          [(1) In general.--A plan submitted by a State under 
        subsection (a)(6) is in accordance with this subsection 
        if the plan contains detailed provisions for complying 
        with each funding agreement for a grant under [section 
        1921] this subpart that is applicable to the State, 
        including a description of the manner in which the 
        State intends to expend the grant.
          [(2) Authority of secretary regarding 
        modifications.--As a condition of making a grant under 
        [section 1921] this subpart to a State for a fiscal 
        year, the Secretary may require that the State modify 
        any provision of the plan submitted by the State under 
        subsection (a)(6) (including provisions on priorities 
        in carrying out authorized activities). If the 
        Secretary approves the plan and makes the grant to the 
        State for the fiscal year, the Secretary may not during 
        such year require the State to modify the plan.
          [(3) Authority of center for substance abuse 
        prevention.--With respect to plans submitted by the 
        States under subsection (a)(6), the Secretary, acting 
        through the Director of the Center for Substance Abuse 
        Prevention, shall review and approve or disapprove the 
        provisions of the plans that relate to prevention 
        activities.
          * * * * * * *
    [(d) Issuance of Regulations; Precondition to Making 
Grants.--
          [(1) Regulations.--Not later than August 25, 1992, 
        the Secretary, acting as appropriate through the 
        Director of the Center for Treatment Improvement or the 
        Director of the Center for Substance Abuse Prevention, 
        shall by regulation establish standards specifying the 
        circumstances in which the Secretary will consider an 
        application for a grant under [section 1921] this 
        subpart to be in accordance with this section.
          [(2) Issuance as precondition to making grants.--The 
        Secretary may not make payments under any grant under 
        [section 1921] this subpart for fiscal year 1993 on or 
        after January 1, 1993, unless the Secretary has issued 
        standards under paragraph (1).]

SEC. 1933. [300x-33] DETERMINATION OF AMOUNT OF ALLOTMENT.

    (a) States.--
          (1) In general.--Subject to subsection (b), the 
        Secretary shall determine the amount of the allotment 
        required in [section 1921] this subpart for a State for 
        a fiscal year as follows:
                  [(A) The formula established in paragraph (1) 
                of section 1918(a) shall apply to this 
                subsection to the same extent and in the same 
                manner as a formula applies for purposes of 
                section 1918(a) as in effect on January 1, 
                1995, except that, in the application of such 
                formula for purposes of this subsection, the 
                modifications described in subparagraph (B) 
                shall apply.
                  (B) For purposes of subparagraph (A), the 
                modifications described in this subparagraph 
                are as follows:
                          (i) The amount specified in paragraph 
                        (2)(A) of section 1918(a) is deemed to 
                        be the amount appropriated under 
                        section 1935(a) for allotments under 
                        [section 1921] this subpart for the 
                        fiscal year involved.
          * * * * * * *
    [(b) Minimum Allotments for States.--For each of the fiscal 
years 1993 and 1994, the amount of the allotment required in 
[section 1921] this subpart for a State for the fiscal year 
involved shall be the greater of--
          [(1) the amount determined under subsection (a) for 
        the State for the fiscal year; and
          [(2) an amount equal to 79.4 percent of the amount 
        received by the State from allotments made pursuant to 
        this part for fiscal year 1992 (including reallotments 
        under section 205(a) of the ADAMHA Reorganization 
        Act).]
    [(c)] (b) Territories.--
          (1) Determination under formula.--Subject to 
        paragraphs (2) and (4), the amount of an allotment 
        under [section 1921] this subpart for a territory of 
        the United States for a fiscal year shall be the 
        product of--
          * * * * * * *
                          (ii) the aggregate civilian 
                        population of the territories of the 
                        United States, as indicated by such 
                        data.
          (2) Minimum allotment for territories.--The amount of 
        an allotment under [section 1921] this subpart for a 
        territory of the United States for a fiscal year shall 
        be the greater of--
                  (A) the amount determined under paragraph (1) 
                for the territory for the fiscal year; and
                  (B) $50,000[; and].
                  [(C) with respect to fiscal years 1993 and 
                1994, an amount equal to 79.4 percent of the 
                amount received by the territory from 
                allotments made pursuant to this part for 
                fiscal year 1992.]
          (3) Reservation of amounts.--The Secretary shall each 
        fiscal year reserve for the territories of the United 
        States 1.5 percent of the amounts appropriated under 
        section 1935(a) for allotments under [section 1921] 
        this subpart for the fiscal year.
          * * * * * * *
    [(d)] (c) Indian Tribes and Tribal Organizations.--
          (1) In general.--If the Secretary--
                (A) * * *
          * * * * * * *
        the Secretary shall reserve from the allotment under 
        [section 1921] this subpart for the State for the 
        fiscal year involved an amount that bears the same 
        ratio to the allotment as the amount provided under 
        this subpart to the tribe or tribal organization for 
        fiscal year 1991 for activities relating to the 
        prevention and treatment of the abuse of alcohol and 
        other drugs bore to the amount of the portion of the 
        allotment under this subpart for the State for such 
        fiscal year that was expended for such activities.
          * * * * * * *

SEC. 1934. [300x-34] DEFINITIONS.

    For purposes of this subpart:
          (1) The term ``authorized activities'', subject to 
        section 1931, means the activities described in section 
        1921(b).
          (2) The term ``funding agreement'', with respect to a 
        grant under [section 1921] this subpart to a State, 
        means that the Secretary may make such a grant only if 
        the State makes the agreement involved.
          * * * * * * *
          (3) The term ``performance indicator'' means a 
        quantifiable characteristic used as a measurement.
          (4) The term ``performance target'' means a numerical 
        value sought to be achieved within a specified period 
        of time.
          [(3)] (5) The term ``prevention activities'', subject 
        to section 1931 means activities to prevent substance 
        abuse.
          [(4)] (6) The term ``substance abuse'' means the 
        abuse of alcohol or other drugs.
          [(5)] (7) The term ``treatment activities'' means 
        treatment services and, subject to section 1931, 
        authorized activities that are related to treatment 
        services.
          [(6)] (8) The term ``treatment facility'' means an 
        entity that provides treatment services.
          [(7)] (9) The term ``treatment services'', subject to 
        section 1931, means treatment for substance abuse.
          * * * * * * *

SEC. 1935. [300x-35] FUNDING.

    (a) Authorization of Appropriations.--For the purpose of 
carrying out this subpart, subpart III and section 505 with 
respect to substance abuse, and section 515(d), there are 
authorized to be appropriated [$1,500,000,000 for fiscal year 
1993, and such sums as may be necessary for fiscal year 1994.] 
$1,300,000,000 for fiscal year 1996, and such sums as may be 
necessary for each of the fiscal years 1997 through 1999.
    [(b) Allocations for Technical Assistance, National Data 
Base, Data Collection, and Program Evaluations.--
          [(1) In general.--
                  [(A) For the purpose of carrying out section 
                1948(a) with respect to substance abuse, 
                section 515(d), and the purposes specified in 
                subparagraphs (B) and (C), the Secretary shall 
                obligate 5 percent of the amounts appropriated 
                under subsection (a) each fiscal year.
                  [(B) The purpose specified in this 
                subparagraph is the collection of data in this 
                paragraph is carrying out section 505 with 
                respect to substance abuse.
                  [(C) The purpose specified in this 
                subparagraph is the conduct of evaluations of 
                authorized activities to determine methods for 
                improving the availability and quality of such 
                activities.
          [(2) Activities of center for substance abuse 
        prevention.--Of the amounts reserved under paragraph 
        (1) for a fiscal year, the Secretary, acting through 
        the Director of the Center for Substance Abuse 
        Prevention, shall obligate 20 percent for carrying out 
        paragraph (1)(C), section 1949(a) with respect to 
        prevention activities, and section 515(d).]
    (b) Reserved Funds.--
          (1) In general.--The Secretary shall reserve 5 
        percent of the amount appropriated for a fiscal year 
        under subsection (a)--
                  (A) to carry out sections 505 (providing for 
                data collection) and 1948(a) (providing for 
                technical assistance to States) with respect to 
                substance abuse;
                  (B) to carry out section 515(d) (providing 
                for a performance substance abuse data base); 
                and
                  (C) to conduct evaluations concerning 
                programs supported under this subpart.
        The Secretary may carry out activities funded pursuant 
        to this paragraph directly, or through grants, 
        contracts, or cooperative agreements.
          (2) Date collection infrastructure.--In carrying out 
        this subsection, the Secretary shall make available 
        grants and contracts to States for development and 
        strengthening of State core capacity (including 
        infrastructure) for data collection and evaluation.
          (3) Prevention.--Of the amounts reserved under 
        paragraph (1) for a fiscal year, the Secretary shall 
        ensure that 20 percent of such amounts shall be used 
        for activities related to prevention.
          * * * * * * *

SEC. 1942. [300x-52] REQUIREMENT OF REPORTS AND AUDITS BY STATES.

    (a) Reports.--A funding agreement for a grant under 
[section 1911 or 1921] subpart I or II is that the State 
involved will submit to the Secretary a report in such form and 
containing such information as the Secretary determines (after 
consultation with the States and the Comptroller General) to be 
necessary for securing a record and a description of--
          (1) the purposes for which the grant received by the 
        State for the preceding fiscal year under the program 
        involved were expended and a description of the 
        activities of the State under the program; [and]
          (2) the recipients of amounts provided in the 
        grant[.]; and
          (3) the performance of the State in relation to the 
        objectives specified or agreed upon under sections 
        1912(b)(5) or section 1921A(b)(5), as applicable.
    (b) Audits.--A funding agreement for a grant under [section 
1911 or 1921] subpart I or II is that the State will, with 
respect to the grant, comply with chapter 75 of title 31, 
United States Code.
    (c) Availability to Public.--A funding agreement for a 
grant under [section 1911 or 1921] subpart I or II is that the 
State involved will--
          * * * * * * *

SEC. 1943. [300x-53] ADDITIONAL REQUIREMENTS.

    (a) In General.--A funding agreement for a grant under 
[section 1911 or 1921] subpart I or II is that the State 
involved will--
          [(1)(A) for the fiscal year for which the grant 
        involved is provided, provide for independent peer 
        review to assess the quality, appropriateness, and 
        efficacy of treatment services provided in the State to 
        individuals under the program involved; and
          [(B) ensure that, in the conduct of such peer review, 
        not fewer than 5 percent of the entities providing 
        services in the State under such program are reviewed 
        (which 5 percent is representative of the total 
        population of such entities);]
          (1) provide for a review (the conduct of which shall 
        to extent practicable be completed annually, but in any 
        event not less than once every 2 years) to assess the 
        quality, appropriateness, and efficacy of treatment 
        through existing State accreditation and certification 
        standards, processes, and procedures of the services 
        provided under the State program;
          (2) permit and cooperate with Federal investigations 
        undertaken in accordance with section 1945; and
          (3) provide to the Secretary any data required by the 
        Secretary pursuant to section 505 and will cooperate 
        with the Secretary in the development of uniform 
        criteria for the collection of data pursuant to such 
        section.
          * * * * * * *
    (b) Patient Records.--The Secretary may make a grant under 
[section 1911 or 1921] subpart I or II only if the State 
involved has in effect a system to protect from inappropriate 
disclosure patient records maintained by the State in 
connection with an activity funded under the program involved 
or by any entity which is receiving amounts from the grant.

SEC. 1944. [300x-54] DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR 
                    ALLOTMENTS.

    (a) In General.--Amounts described in subsection (b) and 
available for a fiscal year pursuant to [section 1911 or 1921] 
subpart I or II, as the case may be, shall be allotted by the 
Secretary and paid to the States receiving a grant under the 
program involved, other than any State referred to in 
subsection (b) with respect to such program. Such amounts shall 
be allotted in a manner equivalent to the manner in which the 
allotment under the program involved was determined.
          * * * * * * *
          (3) in the case of the program established in 
        [section 1911] subpart I, are available as a result of 
        reductions in allotments under such section pursuant to 
        section [1912(d) or] 1915(b); or
          (4) in the case of the program established in 
        [section 1921] subpart II, are available as a result of 
        reductions in allotments under such section pursuant to 
        section 1926 or 1930.

SEC. 1945. [300x-55] FAILURE TO COMPLY WITH AGREEMENTS.

    (a) Suspension or Termination of Payments.--* * *
          * * * * * * *
    (b) Repayment of Payments.--
          (1) In general.--Subject to subsection (e), the 
        Secretary may require a State to repay with interest 
        any payments received by the State under [section 1911 
        or 1921] subpart I or II that the Secretary determines 
        were not expended by the State in accordance with the 
        agreements required under the program involved.
          * * * * * * *
    (c) Withholding of Payments.--
          (1) In general.--Subject to subsections (e) and 
        (g)(3), the Secretary may withhold payments due under 
        [section 1911 or 1921] subpart I or II if the Secretary 
        determines that the State involved is not expending 
        amounts received under the program involved in 
        accordance with the agreements required under the 
        program.
          * * * * * * *
          (2) Relevant conditions.--For purposes of paragraph 
        (1):
                  (A) In the case of the program established in 
                [section 1911] subpart I, a condition referred 
                to in this paragraph is [the condition 
                established in section 1912(d) and] the 
                condition established in section 1915(b).
                  (B) In the case of the program established in 
                [section 1921] subpart II, a condition referred 
                to in this paragraph is the condition 
                established in [section 1926] subpart II and 
                the condition established in section 1930.
    (g) Certain Investigations.--
          (1) Requirement regarding secretary.--The Secretary 
        shall [in fiscal year 1994 and each subsequent fiscal 
        year conduct in not less than 10 States investigations 
        of the expenditure of grants received by the States] 
        under section 1911 or 1921 subpart I or II [in order to 
        evaluate compliance with the agreements required under 
        the program involved.], not more frequently than once 
        every 3 nor less frequently than once every 5 years, 
        conduct an on-site performance review of a State's 
        activities supported under this part.
          (2) Provision of records etc. upon request.--Each 
        State receiving a grant under [section 1911 or 1921] 
        subpart I or II, and each entity receiving funds from 
        the grant, shall make appropriate books, documents, 
        papers, and records available to the Secretary or the 
        Comptroller General, or any of their duly authorized 
        representatives, for examination, copying, or 
        mechanical reproduction on or off the premises of the 
        appropriate entity upon a reasonable request therefor.
          * * * * * * *

SEC. 1946. [300x-56] PROHIBITIONS REGARDING RECEIPT OF FUNDS.

    (a) Establishment.--
          (1) Certain false statements and representations.--A 
        person shall not knowingly and willfully make or cause 
        to be made any false statement or representation of a 
        material fact in connection with the furnishing of 
        items or services for which payments may be made by a 
        State from a grant made to the State under [section 
        1911 or 1921] subpart I or II.
          (2) Concealing or failing to disclose certain 
        events.--A person with knowledge of the occurrence of 
        any event affecting the initial or continued right of 
        the person to receive any payments from a grant made to 
        a State under [section 1911 or 1921] subpart I or II 
        shall not conceal or fail to disclose any such event 
        with an intent fraudulently to secure such payment 
        either in a greater amount than is due or when no such 
        amount is due.
          * * * * * * *

SEC. 1947. [300x-57] NONDISCRIMINATION.

    (a) In General.--
          (1) Rule of construction regarding certain civil 
        rights laws.--For the purpose of applying the 
        prohibitions against discrimination on the basis of age 
        under the Age Discrimination Act of 1975, on the basis 
        of handicap under section 504 of the Rehabilitation Act 
        of 1973, on the basis of sex under title IX of the 
        Education Amendments of 1972, or on the basis of race, 
        color, or national origin under title VI of the Civil 
        Rights Act of 1964, programs and activities funded in 
        whole or in part with funds made available under 
        [section 1911 or 1921] subpart I or II shall be 
        considered to be programs and activities receiving 
        Federal financial assistance.
          (2) Prohibition.--No person shall on the ground of 
        sex (including, in the case of a woman, on the ground 
        that the woman is pregnant), or on the ground of 
        religion, be excluded from participation in, be denied 
        the benefits of, or be subjected to discrimination 
        under, any program or activity funded in whole or in 
        part with funds made available under [section 1911 or 
        1921] subpart I or II.
    (b) Enforcement.--
          (1) Referrals to attorney general after notice.--
        Whenever the Secretary finds that a State, or an entity 
        that has received a payment pursuant to [section 1911 
        or 1921] subpart I or II, has failed to comply with a 
        provision of law referred to in subsection (a)(1) with 
        subsection (a)(2), or with an applicable regulation 
        (including one prescribed to carry out subsection 
        (a)(2)), the Secretary shall notify the chief executive 
        officer of the State and shall request the chief 
        executive officer to secure compliance. If within a 
        reasonable period of time, not to exceed 60 days, the 
        chief executive officer fails or refuses to secure 
        compliance, the Secretary may--
          * * * * * * *

SEC. 1948. [300x-58] TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND 
                    SERVICES IN LIEU OF GRANT FUNDS.

    (a) Technical Assistance.--The Secretary shall, without 
charge to a State receiving a grant under [section 1911 or 
1921], subpart I or II provide to the State (or to any public 
or nonprofit private entity within the State) technical 
assistance with respect to the planning, development, and 
operation of any program or service carried out pursuant to the 
program involved. The Secretary may provide such technical 
assistance directly, [through contract, or through grants] or 
through grants, contracts, or cooperative agreements.
    (b) Provision of Supplies and Services in Lieu of Grant 
Funds.--
          (1) In general.--Upon the request of a State 
        receiving a grant under [section 1911 or 1921] subpart 
        I or II, the Secretary may, subject to paragraph (2), 
        provide supplies, equipment, and services for the 
        purpose of aiding the State in carrying out the program 
        involved and, for such purpose, may detail to the State 
        any officer or employee of the Department of Health and 
        Human Services.
          * * * * * * *

[SEC. 1949. [300x-59] REPORT BY SECRETARY.

    [Not later than January 24, 1994, the Secretary shall 
submit to the Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human 
Resources of the Senate, a report on the activities of the 
States carried out pursuant to the programs established in 
[sections 1911 and 1921] subparts I and II. Such report may 
include any recommendations of the Secretary for appropriate 
changes in legislation.]

SEC. 1949. REGULATIONS.

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

SEC. 1950. [300x-60] RULE OF CONSTRUCTION REGARDING DELEGATION OF 
                    AUTHORITY TO STATES.

    With respect to States receiving grants under [section 1911 
or 1921] subpart I or II, this part may not be construed to 
authorize the Secretary to delegate to the States the primary 
responsibility for interpreting the governing provisions of 
this part.

SEC. 1952. [300x-62] AVAILABILITY TO STATES OF GRANT PAYMENTS.

    (a) In General.--Subject to subsection (b), any amounts 
paid to a State under the program involved shall be available 
for obligation [until the end of the fiscal year for which the 
amounts were paid, and if obligated by the end of such year, 
shall remain available for expenditure until the end of the 
succeeding fiscal year.] and expenditure until the end of the 
fiscal year following the fiscal year for which the amounts 
were paid.
          * * * * * * *

SEC. 1953. [300x-63] CONTINUATION OF CERTAIN PROGRAMS.

    (a) In General.--Of the amount allotted to the State of 
Hawaii under [section 1911] subpart I, and the amount allotted 
to such State under [section 1921] subpart II, an amount equal 
to the proportion of Native Hawaiians residing in the State to 
the total population of the State shall be available, 
respectively, for carrying out the program involved for Native 
Hawaiians.
          * * * * * * *

SEC. 1954. [300x-64] DEFINITIONS.

    (a) Definitions for Subpart III.--For purposes of this 
subpart:
          (1) The term ``program involved'' mans the program of 
        grants established in [section 1911 or 1922] subpart I 
        or II, or both, as indicated by whether the State 
        involved is receiving or is applying to receive a grant 
        under [section 1911 or 1912] subpart I or II, or both.
          (2)(A) The term ``funding agreement'', with respect 
        to a grant under [section 1911] subpart I, has the 
        meaning given such term in section 1911.
          (B) The term ``funding agreement'', with respect to a 
        grant under [section 1921] subpart II, has the meaning 
        given such term in section 1934.
          * * * * * * *
          (5) The term ``performance indicator'' means a 
        quantifiable characteristic used as a measurement.
          (6) The term ``performance target'' means a numerical 
        value sought to be achieved within a specified period 
        of time.
          * * * * * * *

SEC. 1955. AUTHORITY TO USE PORTION OF GRANT FOR OTHER PURPOSES.

    (a) In General.--A State may use not more than 10 percent 
of the annual amount paid to the State under subpart I or 
subpart II for a fiscal year to carry out--
          (1) in the case of amounts from subpart I, activities 
        pursuant to subpart II; or
          (2) in the case of amounts from subpart II, 
        activities pursuant to subpart I.
    (b) Applicable Rules.--Any amount paid to the State under 
this part that is used to carry out activities as provided for 
under subsection (a) shall comply with the requirements that 
apply to funds provided directly under either subpart I or II, 
as the case may be, to carry out the activities.
          * * * * * * *

           Part C--Certain Programs Regarding Substance Abuse

        Subpart I--Expansion of Capacity for Providing Treatment

[SEC. 1971. [300y] CATEGORICAL GRANTS TO STATES.

    [(a) Grants for States With Insufficient Capacity.--
          [(1) In general.--The Secretary, acting through the 
        Director of the Center for Substance Abuse Treatment, 
        may make grants to States for the purpose of increasing 
        the maximum number of individuals to whom public and 
        nonprofit private entities in the States are capable in 
        providing effective treatment for substance abuse.
          [(2) Eligible states.--The Director may not make a 
        grant under subsection (a) to a State unless the number 
        of individuals seeking treatment services in the State 
        significantly exceeds the maximum number described in 
        paragraph (1) that is applicable to the State.
    [(b) Priority in Making Grants.--
          [(1) Residential treatment services for pregnant 
        women.--In making grants under subsection (a), the 
        Director shall give priority to States that agree to 
        give priority in the expenditure of the grant to 
        carrying out the purpose described in such subsection 
        as the purpose relates to the provision of residential 
        treatment services to pregnant women.
          [(2) Additional priority regarding matching funds.--
        In the case of any application for a grant under 
        subsection (a) that is receiving priority under 
        paragraph (1), the Director shall give further priority 
        to the application if the State involved agrees as a 
        condition of receiving the grant to provide non-Federal 
        contributions under subsection (c) in a greater amount 
        than the amount required under such subsection for the 
        applicable fiscal year.
    [(c) Requirement of Matching Funds.--
          [(1) In general.--Subject to paragraph (3), the 
        Director may not make a grant under subsection (a) 
        unless the State agrees, with respect to the costs of 
        the program to be carried out by the State pursuant to 
        such subsection, to make available (directly or through 
        donations from public or private entities) non-Federal 
        contributions toward such costs in an amount that is--
                  [(A) for the first fiscal year for which the 
                State receives such a grant, not less than $1 
                for each $9 of Federal funds provided in the 
                grant;
                  [(B) for any second or third such fiscal 
                year, not less than $1 for each $9 of Federal 
                funds provided in the grant; and
                  [(C) for any subsequent such fiscal year, not 
                less than $1 for each $3 of Federal funds 
                provided in the grant.
          [(2) Determination of amount of non-federal 
        contribution.--Non-Federal contributions required in 
        paragraph (1) may be in cash or in kind, fairly 
        evaluated, including plant, equipment, or services. 
        Amounts provided by the Federal Government, or services 
        assisted or subsidized to any significant extent by the 
        Federal Government, may not be included in determining 
        the amount of such non-Federal contributions.
          [(3) Waiver.--The Director may waive the requirement 
        established in paragraph (1) if the Director determines 
        that extraordinary economic conditions in the State 
        justify the waiver.
    [(d) Limitation Regarding Direct Treatment Services.--The 
Director may not make a grant under subsection (a) unless the 
State involved agrees that the grant will be expended only for 
the direct provision of treatment services. The preceding 
sentence may not be construed to authorize the expenditure of 
such a grant for the planning or evaluation of treatment 
services.
    [(e) Requirement of Application.--The Secretary may not 
make a grant under subsection (a) unless an application for the 
grant is submitted to the Secretary and the application is in 
such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary 
determines to be necessary to carry out this section.
    [(f) Duration of Grant.--The period during which payments 
are made to a State from a grant under subsection (a) may not 
exceed 5 years. The provision of such payments shall be subject 
to annual approval by the Director of the payments and subject 
to the availability of appropriations for the fiscal year 
involved to make the payments.
    [(g) Maintenance of Effort.--The Director may not make a 
grant under subsection (a) unless the State involved agrees to 
maintain State expenditures for substance abuse treatment 
services at a level that is not less than the average level of 
such expenditures maintained by the State for the 2-year period 
preceding the first fiscal year for which the State receives 
such a grant.
    [(h) Restrictions on Use of Grant.--The Director may not 
make a grant under subsection (a) unless the State involved 
agrees that the grant will not be expended--
          [(1) to provide inpatient hospital services;
          [(2) to make cash payments to intended recipients of 
        health services;
          [(3) to purchase or improve land, purchase, 
        construct, or permanently improve (other than minor 
        remodeling) any building or other facility, or purchase 
        major medical equipment;
          [(4) to satisfy any requirement for the expenditure 
        of non-Federal funds as a condition for the receipt of 
        Federal funds; or
          [(5) to provide financial assistance to any entity 
        other than a public or nonprofit private entity.
    [(i) Definitions.--For purposes of this section--
          [(1) The term ``Director'' means the Director of the 
        Center for Substance Abuse Treatment.
          [(2) The term ``substance abuse'' means the abuse of 
        alcohol or other drugs.
    [(j) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $86,000,000 for fiscal year 1993, and such sums as 
may be necessary for fiscal year 1994.]
          * * * * * * *

                      TITLE 28, UNITED STATES CODE

          * * * * * * *

 [CHAPTER 175--CIVIL COMMITMENT AND REHABILITATION OF NARCOTIC ADDICTS

[Sec.

[2901. Definitions.
[2902. Discretionary authority of court; examination, report, and 
          determination by court; termination of civil commitments.
[2903. Authority and responsibilities of the Surgeon General; 
          institutional custody; aftercare; maximum period of civil 
          commitment; credit toward sentence.
[2904. Civil commitment not a conviction; use of test; results.
[2905. Delegation of functions by Surgeon General; use of Federal, 
          State, and private facilities.
[2906. Absence of offer by the court to a defendant of an election under 
          section 2902(a) or any determination as to civil commitment, 
          not reviewable on appeal or otherwise.

[Sec. 2901. Definitions

    [As used in this chapter--
          [(a) ``Addict'' means any individual who habitually 
        uses any narcotic drug as defined by section 4731 of 
        the Internal Revenue Code of 1954, as amended, so as to 
        endanger the public morals, health, safety, or welfare, 
        or who is so far addicted to the use of such narcotic 
        drugs a to have lost the power of self-control with 
        reference to his addiction.
          [(b) ``Surgeon General'' means the Surgeon General of 
        the Public Health Service.
          [(c) ``Crime of violence'' includes voluntary 
        manslaughter, murder, rape, mayhem, kidnaping, robbery, 
        burglary or housebreaking in the nighttime, extortion 
        accompanied by threats of violence, assault with a 
        dangerous weapon or assault with intent to commit any 
        offense punishable by imprisonment for more than one 
        year, arson punishable as a felony, or an attempt or 
        conspiracy to commit any of the foregoing offenses.
          [(d) ``Treatment'' includes confinement and treatment 
        in an institution and under supervised aftercare in the 
        community and includes, but is not limited to, medical, 
        educational, social, psychological, and vocational 
        services, corrective and preventive guidance and 
        training, and other rehabilitative services designed to 
        protect the public and benefit the addict by correcting 
        his antisocial tendencies and ending his dependence on 
        addicting drugs and his susceptibility to addiction.
          [(e) ``Felony'' includes any offense in violation of 
        a law of the United States classified as a felony under 
        section 1 of title 38 of the United States Code, and 
        further includes any offense in violation of a law of 
        any State, any possession or territory of the United 
        States, the District of Columbia, the Canal Zone, or 
        the Commonwealth of Puerto Rico, which at the time of 
        the offense was classified as a felony by the law of 
        the place where that offense was committed.
          [(f) ``Conviction'' and ``convicted'' mean the final 
        judgment on a verdict or finding of guilty, a plea of 
        guilty, or a plea of nolo contendere, but do not 
        include a final judgment which has been expunged by 
        pardon, reversed, set aside or otherwise rendered 
        nugatory.
          [(g) ``Eligible individual'' means any individual who 
        is charged with an offense against the United States, 
        but does not include--
                  [(1) an individual charged with a crime of 
                violence.
                  [(2) an individual charged with unlawfully 
                importing, selling, or conspiring to import or 
                sell, a narcotic drug.
                  [(3) an individual against whom there is 
                pending a prior charge of a felony which has 
                not been finally determined or who is on 
                probation or whose sentence following 
                conviction of such a charge, including any time 
                on parole or mandatory release, has not been 
                fully served: Provided, That an individual on 
                probation, parole, or mandatory release shall 
                be included if the authority authorized to 
                require his return to custody consents to his 
                commitment.
                  [(4) an individual who has been convicted of 
                a felony on two or more occasions.
                  [(5) an individual who has been civilly 
                committed under this Act, under the District of 
                Columbia Code, or any State proceeding because 
                of narcotic addiction on three or more 
                occasions.

[Sec. 2902. Discretionary authority of court; examination, report, and 
                    determination by court; termination of civil 
                    commitment

    [(a) If the United States district court believes that an 
eligible individual is an addict, the court may advise him at 
his first appearance or thereafter at the sole discretion of 
the court that the prosecution of the criminal charge will be 
held in abeyance if he elects to submit to an immediate 
examination to determine whether he is an addict and is likely 
to be rehabilitated through treatment. In offering an 
individual an election, the court shall advise him that if he 
elects to be examined, he will be confined during the 
examination for a period not to exceed sixty days; that if he 
is determined to be an addict who is likely to be 
rehabilitated, he will be civilly committed to the Surgeon 
General for treatment; that he may not voluntarily withdraw 
from the examination or any treatment which may follow; that 
the treatment may last for thirty-six months; that during 
treatment, he will be confined in an institution and, at the 
discretion of the Surgeon General, he may be conditionally 
released for supervised aftercare treatment in the community; 
and that if he successfully completes treatment the charge will 
be dismissed, but if he does not, prosecution on the charge 
will be resumed. An individual upon being advised that he may 
elect to submit to an examination shall be permitted a maximum 
of five days within which to make his election. Except on a 
showing that a timely election could not have been made, an 
individual shall be barred from an election after the 
prescribed period. An individual who elects civil commitment 
shall be placed in the custody of the Attorney General or the 
Surgeon General, as the court directs, for an examination by 
the Surgeon General during a period not to exceed thirty days. 
This period, may, upon notice to the court and the appropriate 
United States attorney, be extended by the Surgeon General for 
an addition thirty days.
    [(b) The Surgeon General shall report to the court the 
results of the examination and recommend whether the individual 
should be civilly committed. A copy of the report shall be made 
available to the individual and the United States attorney. If 
the court, acting on the report and other information coming to 
its attention, determines that the individual is not an addict 
or is an addict not likely to be rehabilitated through 
treatment, the individual shall be held to answer the abeyant 
charge. If the court determines that the individual is an 
addict and is likely to be rehabilitated through treatment, the 
court shall commit him to the custody of the Surgeon General 
for treatment, except that no individual shall be committed 
under this chapter if the Surgeon General certifies that 
adequate facilities or personnel for treatment are unavailable.
    [(c) Whenever an individual is committed to the custody of 
the Surgeon General for treatment under this chapter the 
criminal charge against him shall be continued without final 
disposition and shall be dismissed if the Surgeon General 
certifies to the court that the individual has successfully 
completed the treatment program. On receipt of such 
certification, the court shall discharge the individual from 
custody and dismiss the charge against him. If prior to such 
certification the Surgeon General determines that the 
individual cannot be further treated as a medical problem, he 
shall advise the court. The court shall thereupon terminate the 
commitment, and the pending criminal proceeding shall be 
resumed.
    [(d) An individual committed for examination or treatment 
shall not be released on bail or on his own recognizance.
    [(e) Whoever escapes or attempts to escape while committed 
to institutional custody for examination or treatment, or 
whoever rescues or attempts to rescue or instigates, aids, or 
assists the escape or attempt to escape of such a person, shall 
be subject to the penalties provided in sections 751 and 752 of 
title 18, United States Code.

[Sec. 2903. Authority and responsibilities of the Surgeon General; 
                    institutional custody; aftercare; maximum period of 
                    civil commitment; credit toward sentence

    [(a) An individual who is committed to the custody of the 
Surgeon General for treatment under this chapter shall not be 
conditionally released from institutional custody until the 
Surgeon General determines that he has made sufficient progress 
to warrant release to a supervisory aftercare authority. If the 
Surgeon General is unable to make such a determination at the 
expiration of twenty-four months after the commencement of 
institutional custody, he shall advise the court and the 
appropriate United States attorney whether treatment should be 
continued. The court may affirm the commitment or terminate it 
and resume the pending criminal proceeding.
    [(b) An individual who is conditionally released from 
institutional custody shall, while on release, remain in the 
legal custody of the Surgeon General and shall report for such 
supervised aftercare treatment as the Surgeon General directs. 
He shall be subject to home visits and to such physical 
examination and reasonable regulation of his conduct as the 
supervisory aftercare authority establishes, subject to the 
approval of the Surgeon General. The Surgeon General may, at 
any time, order a conditionally release individual to return 
for institutional treatment. The Surgeon General's order shall 
be a sufficient warrant for the supervisory aftercare 
authority, a probation officer, or any Federal officer 
authorized to serve criminal process within the United States 
to apprehend and return the individual to institutional custody 
as directed. If it is determined that an individual has 
returned to the use of narcotics, the Surgeon General shall 
inform the court of the conditions under which the return 
occurred and make a recommendation as to whether treatment 
should be continued. The court may affirm the commitment or 
terminate it and resume the pending criminal proceeding.
    [(c) The total period of treatment for any individual 
committed to the custody of the Surgeon General shall not 
exceed thirty-six months. If, at the expiration of such maximum 
period, the Surgeon General is unable to certify that the 
individual has successfully completed his treatment program the 
pending criminal proceeding shall be resumed.
    [(d) Whenever a pending criminal proceeding against an 
individual is resumed under this chapter, he shall receive full 
credit toward the service of any sentence which may be imposed 
for any time spent in the institutional custody of the Surgeon 
General or the Attorney General or any other time spent in 
institutional custody in connection with the matter for which 
sentence is imposed.

[Sec. 2904. Civil commitment not a conviction; use of test results

    [The determination of narcotic addiction and the subsequent 
civil commitment under this chapter shall not be deemed a 
criminal conviction. The results of any tests or procedures 
conducted by the Surgeon General or the supervisory aftercare 
authority to determine narcotic addiction may only be used in a 
further proceeding under this chapter. They shall not be used 
against the examined individual in any criminal proceeding 
except that the fact that he is a narcotic addict may be 
elicited on his cross-examination as bearing on his credibility 
as a witness.

[Sec. 2905. Delegation of functions by Surgeon General; use of Federal, 
                    State, and private facilities

    [(a) The Surgeon General may from time to time make such 
provision as he deems appropriate authorizing the performance 
of any of his functions under this chapter by any other officer 
or employee of the Public Health Service, or with the consent 
of the head of the Department or Agency concerned, by any 
Federal or other public or private agency or officer or 
employee thereof.
    [(b) The Surgeon General is authorized to enter into 
arrangements with any public or private agency or any person 
under which appropriate facilities or services of such agency 
or person will be made available, on a reimbursable basis or 
otherwise, for the examination or treatment of individuals who 
elect civil commitment under this chapter.

[Sec. 2906. Absence of offer by the court to a defendant of an election 
                    under section 2902(a) or any determination as to 
                    civil commitment, not reviewable on appeal or 
                    otherwise

    [The failure of a court to offer a defendant an election 
under section 2902(a) of this chapter, or a determination 
relative to civil commitment under this chapter shall not be 
reviewable on appeal or otherwise.]
          * * * * * * *

                      TITLE 42, UNITED STATES CODE

          * * * * * * *

SEC. 10822. ALLOTMENTS.

    (a) Formula * * *
          (1)(A) * * *
          * * * * * * *
          (B) For purposes of subparagraph (A)(ii), the term 
        ``relative per capita income'' means the quotient of 
        the per capita income of the United States and the per 
        capita income of the State, except that if the State is 
        Guam, American Samona, the Commonwealth of the Northern 
        Mariana Islands, the [Trust Territory of the Pacific 
        Islands] Marshall Islands, the Federated States of 
        Micronesia, the Republic of Palau, or the Virgin 
        Islands, the quotient shall be considered to be one.
          [(2) Notwithstanding paragraph (1) and subject to the 
        availability of appropriations under section 10827 of 
        this title--
                  [(A) if the total amount appropriated in a 
                fiscal year is at least $13,000,000--
                          [(i) the amount of the allotment of 
                        the eligible system of each of the 
                        several States, the District of 
                        Columbia, and the Commonwealth of 
                        Puerto Rico shall be the greater of--
                                  [(I) $140,000; or
                                  [(II) $125,000 in addition to 
                                the amount determined under 
                                paragraph (3); and
                          [(ii) the amount of the allotment of 
                        the eligible system of Guam, American 
                        Samoa, the Commonwealth of the Northern 
                        Mariana Islands, the Trust Territory of 
                        the Pacific Islands, and the Virgin 
                        Islands shall be the greater of--
                                  [(I) $75,000; or
                                  [(II) $67,000 in addition to 
                                the amount determined under 
                                paragraph (3); and
                  [(B) if the total amount appropriated in a 
                fiscal year is less than $13,000,000, the 
                amount of the allotment of the eligible 
                system--
                          [(i) of each of the several States, 
                        the District of Columbia, and the 
                        Commonwealth of Puerto Rico shall not 
                        be less than $125,000 in addition to 
                        the amount determined under paragraph 
                        (3); and
                          [(ii) of Guam, American Samoa, the 
                        Commonwealth of the Northern Mariana 
                        Islands, the Trust Territory of the 
                        Pacific Islands, and the Virgin Islands 
                        shall not be less than $67,000 in 
                        addition to the amount determined under 
                        paragraph (3).]
          (2)(A) The minimum amount of the allotment of an 
        eligible system shall be the product (rounded to the 
        nearest $100) of the appropriate base amount specified 
        in subparagraph (B) and the factor specified in 
        subparagraph (C).
          (B) For purposes of subparagraph (A), the appropriate 
        base amount--
                  (i) for American Samoa, Guam, the Marshall 
                Islands, the Federated States of Micronesia, 
                the Commonwealth of the Northern Mariana 
                Islands, the Republic of Palau, and the Virgin 
                Islands, is $139,300; and
                  (ii) for any other State, is $260,000.
          (C) For purposes of subparagraph (A), the factor 
        specified in this subparagraph is the ratio of the 
        amount appropriated under section 117 for the fiscal 
        year for which the allotment is being made to the 
        amount appropriation under such section for fiscal year 
        1995.
          [(3) In any case in which the total amount 
        appropriated under section 10827 of this title for a 
        fiscal year exceeds the total amount appropriated under 
        such section, as in effect on October 19, 1988, for the 
        preceding fiscal year by a percentage greater than the 
        most recent percentage change in the Consumer Price 
        Index published by the Secretary of Labor under section 
        720(c)(1) of Title 29, the Secretary shall increase 
        each of the allotments under clauses (i)(II) and 
        (ii)(II) of subparagraph (A) and clauses (i) and (ii) 
        of subparagraph (B) of paragraph (2) by an amount which 
        bears the same ratio to the amount of such minimum 
        allotment (including any increases in such minimum 
        allotment under this paragraph for prior fiscal years) 
        as the amount which is equal to the difference 
        between--
                  [(A) the total amount appropriated under 
                section 10827 of this title for the fiscal year 
                for which the increase in minimum allotment is 
                made, minus;
                  [(B) the total amount appropriated under 
                section 10827 of this title for the immediately 
                preceding fiscal year,
        bears to the total amount appropriated under section 
        10827 of this title for such preceding fiscal year.]
          * * * * * * *

Sec. 10827. Authorization of appropriations

    There are authorized to be appropriated for allotments 
under this subchapter, $19,500,000 for fiscal year 1992, and 
such sums as may be necessary for each of the fiscal years 1993 
through [1995] 1999.
          * * * * * * *

               NARCOTIC ADDICT REHABILITATION ACT OF 1966

          * * * * * * *
    Titles III and IV of the Narcotic Addict Rehabilitation Act 
of 1966 are repealed.
          * * * * * * *

                           PUBLIC LAW 99-319

          * * * * * * *
    Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, [That this 
Act may be cited as the ``Protection and Advocacy for Mentally 
Ill Individuals Act of 1986''.]

SECTION 1. SHORT TITLE.

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

              STEWART B. McKINNEY HOMELESS ASSISTANCE ACT

          * * * * * * *

[SEC. 612. COMMUNITY MENTAL HEALTH SERVICES DEMONSTRATION PROJECTS FOR 
                    HOMELESS INDIVIDUALS WHO ARE CHRONICALLY MENTALLY 
                    ILL.

    [(a) In General.--For payments pursuant to section 520 of 
the Public Health Service Act, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 1991 through 1993, in addition to any other 
amounts authorized to be appropriated for such payments for 
each of such fiscal years. Such additional amounts shall be 
available only for the provision of community-based mental 
health services to homeless individuals who are chronically 
mentally ill.
    [(b) Availability.--Amounts paid to a grantee under section 
520 of the Public Health Service Act pursuant to subsection (a) 
remaining unobligated at the end of the fiscal year in which 
the amounts were received shall remain available to the grantee 
during the succeeding fiscal year for the purposes for which 
the payments were made.]
          * * * * * * *

                                
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