[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.]
* * * * * * *