[Senate Report 106-196]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 332
106th Congress                                                   Report
                                 SENATE
 1st Session                                                    106-196

======================================================================



 
         THE YOUTH DRUG AND MENTAL HEALTH SERVICES ACT OF 1999

                                _______
                                

                October 19, 1999.--Ordered to be printed

                                _______
                                

   Mr. Jeffords, from the Committee on Health, Education, Labor, and 
                   Pensions, submitted the following

                              R E P O R T

                             together with

                            ADDITIONAL VIEWS

                         [To accompany S. 976]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 976) to amend title V of the 
Public Health Service Act to focus the authority of the 
Substance Abuse and Mental Health Services Administration on 
community-based services for children and adolescents, to 
enhance flexibility and accountability, to establish programs 
for youth treatment, and to respond to crises, especially those 
related to children and violence, 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..................................2
 II. Background and need for legislation.............................10
III. Legislative history and committee action........................12
 IV. Committee views.................................................13
  V. Cost estimate...................................................38
 VI. Regulatory impact statement.....................................38
VII. Section-by-section analysis.....................................38
VIII.Additional views................................................43

 IX. Changes in existing law.........................................45

                   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 main purposes of the ``Youth 
Drug and Mental Health Services Act'' are to focus attention on 
the needs of children and adolescents, to develop flexibility 
for the States and the Secretary in addressing mental health 
and substance abuse services, and to strengthen accountability 
for the States' use of Federal substance abuse and mental 
health service funds.

                        children and adolescents

    The Committee is well aware of the increase in drug use 
among our youth over the past seven years. Nearly a quarter of 
our 8th graders and about half of all high school seniors have 
tried marijuana. Even though the latest survey suggests a 
leveling off of this trend, there will be many more drug-
related problems due simply to the growing number of 12-20-
year-olds as demographics point to a surge in the youth 
population.
    At least 9 to 13 million children or 14 to 20 percent of 
all children in the United States experience one or more 
emotional, behavioral, or mental disorders. An estimated 3.5 
million have a serious emotional disturbance.
    The Nation will long remember the chilling violence in 
unexpected areas of the country where children killed children. 
Despite the recent statistics on reductions in youth violence 
in schools, we cannot afford to have our children exposed to 
such violence, whether it is in schools, in their 
neighborhoods, or in their houses.
    Thus the first focus of this bill is to address violence 
among children and adolescents and their need for mental health 
and substance abuse services. The Committee addresses issues of 
violence by authorizing a program that researchers and service 
providers support. It is a program sponsored jointly by the 
Departments of Education and Justice and the Center for Mental 
Health Services in the SAMHSA. Further, the bill authorizes a 
program to provide mental health research and services for 
those who have been victims of violence or witnessed it.
    With regard to substance abuse, the bill reauthorizes a 
program to focus substance abuse prevention services on youth 
and creates a specific authority to address the surge in 
methamphetamine and inhalant abuse in many rural and frontier 
States. Further, the Committee authorizes a program which will 
help foster the development of a treatment system in the United 
States to work with youth and to expand early intervention 
services to address the needs of youth who have become involved 
with alcohol and/or drugs but who are not yet addicted.
    Besides reclaiming our children and adolescents from 
alcohol and drugs and reducing crime, the Committee is also 
concerned about our children and adolescents who have serious 
emotional disturbances. Therefore, the bill reauthorizes the 
Comprehensive Community Based Mental Health Services for 
Children with Serious Emotional Disturbance. The bill also 
demonstrates the Committee's concern for children and 
adolescents who have a serious emotional disturbance and who 
are involved in the juvenile justice system by authorizing a 
program to provide wraparound services to ensure that children 
and adolescents involved with the juvenile justice system 
receive the mental health services they need. Besides helping a 
child or teen handle their problems, these services will help 
keep these children out of the juvenile justice system.

                     flexibility and accountability

    President Reagan in 1981 made a major shift in how the 
Federal government would provide support for mental health and 
substance abuse services by creating a block grant program 
built on the assumption that States knew how best to provide 
for the needs of their citizens. The current Substance Abuse 
Prevention and Treatment Block Grant and the Community Mental 
Health Services Block Grant are the descendants of the program 
that President Reagan started. His block grant program provided 
funding to States with a limited number of restrictions and 
requirements and held States accountable based on their 
expenditure of funds. Over the years, Congress made many 
changes to the block grant legislation including imposing 
several new requirements on States where Congress felt that 
public health issues such as services for pregnant addicts, 
drug resistant tuberculosis and HIV transmission, were not 
being adequately provided. In addition, Congress is concerned 
about whether the States are using Federal funds efficiently 
and effectively. In order to determine that, the Committee 
believes it is necessary to change the accountability system 
which has been used since 1981 from one based on State 
expenditures to a performance based system. This bill begins 
the process of making that shift while restoring much of the 
original flexibility that States enjoyed under President 
Reagan. More flexibility will result when a performance based 
system is fully implemented in three years.
    The move to a performance based system, however, will not 
be easy. In 1995, this Committee considered and passed 
legislation that would have changed the system immediately. 
That bill never passed the Senate and at the end of that 
Congress, Federal and State officials met to discuss this 
shift. Those discussions led to a compromise, supported by the 
Administration and the States, that would make the block grants 
more flexible and would implement a performance based 
accountability system. That compromise had three parts, all of 
which are included in S. 976.
    The first part creates added flexibility for the States as 
we move to a performance system by reducing the requirements on 
States in their use of block grant funds. In the Substance 
Abuse Prevention and Treatment Block Grant, the bill repeals a 
requirement that States spend 35 percent of their allotment on 
alcohol related activities and 35 percent on drug related 
activities. The requirement that States maintain a $100,000 
revolving fund for recovery homes is made optional. In 
addition, the Secretary is given authority to waive seven 
different requirements for use of funds if the State meets 
certain criteria. This criteria will be established in 
regulation and developed with States and other interested 
parties, including providers and consumers. Governors would be 
free to add, during improved economic financial times, one-time 
infusions of funds for substance abuse without affecting the 
calculations for future year maintenance of effort 
requirements. States would be permitted to obligate their funds 
over two years instead of one, as is currently required.
    The seven requirements that may be waived if certain 
criteria are met include section 1922(b) which requires the 
State to maintain a level of expenditure for pregnant addicts 
and women with children, section 1923 which requires mandatory 
services for persons who use intravenous drugs, section 1924(a) 
requiring services for tuberculosis, section 1924(b) requiring 
designated States to use a prescribed portion of their 
allotment for HIV early intervention services, section 1928(a) 
which requires the States to detail improvement in their 
referral systems, section 1928(b) which requires the States to 
provide continuing education to counselors, and finally section 
1928(c) which requires the States to ensure coordination of 
services among several service organizations. The committee 
believes that all of these requirements are important 
priorities that should be addressed, however, the goal is to 
give the state the flexibility to identify their own priority 
needs.
    There are very few requirements in the Community Mental 
Health Services Block Grant, and yet the bill restores more 
flexibility by decreasing the number of mandatory criteria in 
the plan from 12 to 5. This permits the States to submit more 
cohesive plans and reduce their administrative burden. The bill 
delays the submission of State reports to December 1, permits 
the Governor the ability to give one-time infusions of funds 
into mental health services without those funds increasing the 
calculation of future year maintenance of effort requirements, 
and allows the States to obligate funds over two years, instead 
of one as required in current law.
    The second part requires the Secretary to submit to 
Congress, within two years of enactment of this bill, a plan 
developed in conjunction with State and local governments, 
communities, providers and consumers detailing the flexibility 
that will be given to the States and measures for 
accountability. The plan will include the performance measures 
that will be used (including measures to be used for vulnerable 
populations like pregnant addicts, persons affected by 
tuberculosis or HIV, and those with co-occurring mental health 
and addictive disorders); the data elements to be collected and 
reported on, and the definitions of those data elements; the 
obstacles to be expected in implementing this program, and how 
those obstacles will be dealt with; the resources needed to 
implement the plan; and recommendations for legislative 
language to implement the system. The Committee is pleased that 
SAMHSA has been working with States in the development of the 
measures and that some States are piloting the use of those 
measures this year. The Committee looks forward to receiving 
that plan so that when the Committee next considers SAMHSA 
reauthorization, we can implement the shift to a performance 
based system in federal statute.
    The third part addresses the issue of how to fund the 
implementation of a performance-based system. While some States 
have very good data collection systems in place, many would be 
unable to implement a performance-based system without 
considerable financial assistance to improve their data 
infrastructure. S. 976 includes in Section 404 an authority for 
the Secretary to make awards to States for the purpose of 
improving data collection and reporting capabilities. The 
Committee does not believe, however, that only the Federal 
government should be paying for the implementation of a 
performance system. Many State legislatures are implementing 
such systems on their own in an effort to hold State agencies 
accountable. The States have a role to play in establishing and 
implementing this new system.
    The Committee fully supports the move to grant states 
flexibility and a performance-based accountability system and 
looks forward to submission of the performance plan established 
by the Secretary within two years.

             summary of children and adolescents provisions

    The children and adolescents provisions of S. 976 would:
    1. Authorize the Secretary to make grants to public 
entities in consultation with the Attorney General and the 
Secretary of Education to assist local communities in 
developing ways to assist children in dealing with violence. 
Four different types of grants are permitted under the 
authority: grants to provide financial support to enable the 
communities to implement the programs; to provide technical 
assistance to local communities; to provide technical 
assistance in the development of policies; and to assist in the 
creation of community partnerships among the schools, law 
enforcement and mental health services. Funding for this 
program is authorized at $100 million for fiscal year 2000 and 
``such sums'' as necessary for each of the fiscal years 2001 
and 2002.
    2. Authorize the Secretary to develop knowledge with regard 
to evidence-based practices for treating psychiatric disorders 
resulting from witnessing or surviving domestic, school and 
community violence and terrorism. Establishes centers of 
excellence to provide research, training, and technical 
assistance to communities in dealing with the emotional burden 
of domestic, school and community violence and terrorism if and 
when indicate occur. Funding for this program is authorized at 
$50 million for fiscal year 2000 and ``such sums'' as necessary 
for each of the fiscal years 2001 and 2002.
    3. Permit the Secretary to use up to 3% of the funds 
appropriated for discretionary grants for responding to 
emergencies. The authority would permit an objective review 
instead of peer review to allow for an expedited process for 
making awards. Provides additional confidentiality protection 
for the information collected from individuals who participate 
in national surveys conducted by the Substance Abuse and Mental 
Health Services Administration.
    4. Reauthorize the High Risk Youth Program which provides 
funds to public and non-profit private entities to establish 
programs for the prevention of drug abuse among high risk 
youth.
    5. Authorize the Secretary to make grants, contracts or 
cooperative agreements to public and non-profit private 
entities for the purpose of providing substance abuse treatment 
services for children and adolescents. Funding for these 
programs is authorized at $40 million for fiscal year 2000 and 
``such sums'' as necessary for each of the fiscal years 2001 
and 2002.
    6. Authorize the Secretary to make grants, contracts or 
cooperative agreements to public and non-profit private 
entities including local educational agencies for the purposes 
of providing early intervention substance abuse services for 
children and adolescents. Funding for these programs is 
authorized at $20 million for fiscal year 2000 and ``such 
sums'' as necessary for each of the fiscal years 2001 and 2002.
    7. Authorize the creation of research training and 
technical assistance centers to assist States and local 
jurisdictions in providing appropriate care for adolescents who 
are involved with the juvenile justice system and have a 
serious emotional disturbance. Funding for these programs is 
authorized at $4 million for fiscal year 2000 and ``such sums'' 
as necessary for each of the fiscal years 2001 and 2002.
    8. Authorize the Secretary to make grants, contracts, or 
cooperative agreements to carry out school based as well as 
community based programs to prevent the use of methamphetamine 
and inhalants. Funding for these programs is authorized at $10 
million for fiscal year 2000 and ``such sums'' as necessary for 
each of the fiscal years 2001 and 2002.
    9. Reauthorize the Comprehensive Community Mental Health 
Services for Children with Serious Emotional Disturbances 
program to provide seed money to local communities to develop 
systems of care for children with serious emotional 
disturbances thus improving the quality of care and increasing 
the likelihood that these children would remain in local 
communities rather than being sent to residential facilities.
    10. Reauthorize the Services for Children of Substance 
Abusers Act and transfer, for better coordination, this program 
from Health Resources and Services Administration (HRSA) to 
SAMHSA. This program authorizes the Secretary to make grants to 
public and non-profit private entities to provide the following 
services to children of substance abusers; periodic 
evaluations, primary pediatric care, other health and mental 
health services, therapeutic interventions, preventive 
counseling, counseling related to witnessing of chronic 
violence, referrals for and assistance in establishing 
eligibility for services under other programs, and other 
developmental services. Funding for these programs is 
authorized at $50 million for fiscal year 2000 and ``such 
sums'' as necessary for each of the fiscal years 2001 and 2002.
    11. Authorize the Secretary to make grants, contracts or 
cooperative agreements to State and local juvenile justice 
agencies to help such agencies provide aftercare services for 
youth offenders who have or are at risk of a serious emotional 
disturbance and who have been discharged from juvenile justice 
facilities. Funding for these programs is authorized at $40 
million for fiscal year 2000 and ``such sums'' as necessary for 
each of the fiscal years 2001 and 2002.
    12. Amend the sections that establish the responsibilities 
of the Centers for Substance Abuse Treatment, Substance Abuse 
Prevention, and the Mental Health Services to include an 
emphasis on children. The Director of the Center for Mental 
Health Services is required to collaborate with the Attorney 
General and the Secretary of Education on programs that assist 
local communities in developing programs to address violence 
among children in schools.

                SUMMARY OF THE MENTAL HEALTH PROVISIONS

    The mental health provisions of S. 976 would:
    1. Repeal several specific authorities related to mental 
health services in favor of a broad authority that gives the 
Secretary and the States more flexibility in responding to 
individuals in need of mental health services. The bill 
authorizes four types of grants: (1) knowledge development and 
application grants which are used to develop more information 
of how best to serve those in need; (2) training grants to 
disseminate the information that the agency garners through its 
knowledge development; (3) targeted capacity response which 
enables the agency to respond to service needs in local 
communities; and (4) systems change grants and grants to 
support family and consumer networks in States. Repealed in 
this section are sections 303, 520A and 520B of the Public 
Health Service Act and section 612 of the Stewart B. McKinney 
Act. Funding for this program is authorized at $300 million for 
fiscal year 2000 and ``such sums'' as necessary for each of the 
fiscal years 2001 and 2002. The bill encourages the interface 
between mental health and primary care as a high priority for 
funding.
    2. Reauthorize the Grants for the Benefit of Homeless of 
individuals program which provides grants to develop and expand 
mental health and substance abuse treatment services to 
homeless individuals. Preference is maintained for 
organizations that provide integrated primary health care, 
substance abuse and mental health services to homeless 
individuals, programs that demonstrate effectiveness in serving 
homeless individuals, and programs that have experience in 
providing housing for individuals who are homeless. Funding for 
this program is to be authorized at $50 million for fiscal year 
2000 and ``such sums'' as necessary for each of the fiscal 
years 2001 and 2002.
    3. Reauthorize the Projects for Assistance in Transition 
from Homelessness program which provides funds to States under 
a formula for the provision of mental health services to 
homeless individuals. Preference is maintained for 
organizations with demonstrated effectiveness in serving 
homeless veterans. Funding for this program is authorized at 
``such sums'' as necessary for fiscal years 2000 through 2002.
    4. Reauthorize the Community Mental Health Services (CMHS) 
Block Grant as a Performance Partnership Block Grant. Each 
State and the Federal Government would work in partnership to 
develop goals and performance objectives to improve mental 
health of adults with serious mental illness and children with 
serious emotional disturbances. State accountability under 
these programs is built upon with State expenditure of funds. 
Provisions in this section and other sections of this bill 
provide for the first steps in increasing State flexibility in 
the use of funds while establishing an accountability system 
based on performance. The number of elements that States must 
include in their plan for use of CMHS Block Grant funds are 
reduced from 12 to 5, thus providing additional flexibility for 
the States and reducing administrative costs. Funding for this 
program is authorized at $450 million for fiscal year 2000 and 
``such sums'' as necessary for each of the fiscal years 2001 
and 2002.
    5. Establish minimum allotment for States in the 
determination of allocations under the CMHS Block Grant such 
that no State will receive less funding than it did in fiscal 
year 1998.
    6. Reauthorize the Protection and Advocacy for Mentally Ill 
Individuals Act of 1986 by making technical changes to the 
formula for distribution of funds under this program to correct 
a provision that would have inappropriately reduced minimum 
State allotments. It also provides for the renaming of the Act 
to conform with changes made in previous laws, and makes a 
technical change to the provision on territories. The bill 
permits an American Indian Consortia to receive direct funding 
after the appropriation exceeds $25 million. The legislation 
extends the responsibilities of the Protection and Advocacy 
program to individuals living in the communities when the 
appropriation exceeds $30 million. Funding for this program is 
authorized at ``such sums'' as necessary for fiscal years 2000 
through 2002.
    7. Require facilities that are both within the purview of 
the Protection and Advocacy program and which receive 
appropriated funding from the Federal government to protect and 
promote the rights of individuals with regard to the 
appropriate use of seclusion and restraint. Such covered 
facilities are required to inform the Secretary of each death 
that occurs while a patient is restrained or in seclusion, or 
each death that occurs 24 hours after a patient is restrained 
or in seclusion, or where it is reasonable to assume that a 
patient's death is a result of seclusion or restraint. The 
Secretary is required to issue regulations within one year of 
enactment on appropriate staff levels and appropriate training 
for staff in the use of restraints and seclusions.

               summary of the substance abuse provisions

    The substance abuse provisions of S. 976 would:
    1. Consolidate by repealing several specific authorities 
related to substance abuse treatment services and by creating a 
broad authority that gives the Secretary and the States more 
flexibility in responding to individuals in need of substance 
abuse treatment. The legislation authorizes three types of 
grants: (1) knowledge development and application grants which 
are used to develop more information on how best to serve those 
in need; (2) training grants to disseminate the information 
that the agency garners through its knowledge development; and 
(3) targeted capacity response which enables the agency to 
respond to services needs in local communities. Repealed in 
this section are sections 508, 509, 510, 511, 512, 571 and 1971 
of the Public Health Service Act. Funding for this program is 
authorized at $300 million for fiscal year 2000 and ``such 
sums'' as necessary for each of the fiscal years 2001 and 2002. 
The bill encourages the interface between substance abuse 
treatment and primary care as a high priority for funding.
    2. Consolidate by repealing several specific authorities 
related to substance abuse prevention services and by creating 
a broad authority that gives the Secretary and the states more 
flexibility in responding to individual needs, especially youth 
substance abuse prevention services. It would authorize three 
types of grants: (1) knowledge development and application 
grants which are used to develop more information on how best 
to serve those in need; (2) training grants to disseminate the 
information that the agency garners through its knowledge 
development; and (3) targeted capacity response which enables 
the agency to respond to services needs in local communities. 
Sections 516 and 518 of the Public Health Service Act are 
repealed. Funding for this program is authorized at $300 
million for fiscal year 2000 and ``such sums'' as necessary for 
each of the fiscal years 2001 and 2002. The bill encourages the 
interface between substance abuse prevention and primary care 
as a high priority for funding.
    3. Reauthorize the Substance Abuse Prevention and Treatment 
(SAPT) block grants as a Performance Partnership Block Grant. 
Each State and the Federal Government would work in partnership 
to develop goals and performance objectives to improve 
substance abuse services for adults and children. While there 
is considerable flexibility provided for States' use of funds, 
there are a number of requirements which ensure public health 
needs are met. This provision would begin the process of giving 
States greater flexibility in their use of funds and 
accountability based on performance instead of expenditures. 
Greater flexibility is enhanced by the repeal of a requirement 
that States spend 35 percent of their allotment on drug related 
activities and 35 percent on alcohol related activities. A 
provision requiring States to maintain a $100,000 revolving 
fund to support homes for persons recovering from substance 
abuse would be made optional, thus permitting States to 
continue such efforts or to use those funds for other services 
as they deem necessary. By permitting States the ability to use 
funds for screening and testing of conditions such as HIV, 
hepatitis C, and mental illness, they are given the latitude to 
develop a comprehensive treatment program for individuals 
coming into the substance abuse treatment system. Funding for 
this program is authorized at $2 billion for fiscal year 2000 
and ``such sums'' as necessary for each of the fiscal years 
2001 and 2002.
    4. Establish minimum growth and small State minimums in 
determining the allocation of funds under the SAPT Block Grant. 
The provision includes a Proportional Scale Down Rule if 
appropriations decline in future years.
    5. Permit religious organizations to receive Federal 
assistance either through the SAPT Block Grant or discretionary 
grants through the SAMHSA to provide substance abuse services 
while maintaining their religious character, including 
retaining autonomy over employment decisions. Such programs may 
not discriminate against anyone interested in treatment at the 
facility. If a person who is referred for services needs or 
would prefer to be served in a different facility, the program 
will refer that person to an appropriate alternative treatment 
program.
    6. Authorize the Secretary to make grants, contracts or 
cooperative agreements with public and private non-profit 
private entities including American Indian tribes and tribal 
organizations and Native Alaskans for the purpose of providing 
alcohol and drug prevention or treatment services for Indians 
and Native Alaskans. Funding for this program is authorized at 
$15 million for fiscal year 2000 and ``such sums'' as necessary 
for each of the fiscal years 2001 and 2002.
    7. Authorize the establishment of a Commission on Indian 
and Native Alaskan Health Care that shall carry out a 
comprehensive examination of the health concerns of Indians and 
Native Alaskans living on reservations or tribal lands. Funding 
for this program is authorized at $5 million for fiscal year 
2000 and ``such sums'' as necessary for each of the fiscal 
years 2001 and 2002.

          summary of flexibility and accountability provisions

    The flexibility and accountability provisions of S. 976 
would:
    1. Remove the requirement that there be an Associate 
Administrator for Alcohol Policy, and makes necessary 
corrections to the peer review requirements.
    2. Reduce the number of times that Advisory Councils for 
SAMHSA's Centers are mandated to meet from three to two times a 
year.
    3. Require the Secretary to submit a plan to Congress 
within two years describing the performance based system that 
would be developed by the CMHS and SAPT Block Grants. This plan 
would include how the States will receive greater flexibility, 
what performance measures would be used in holding States 
accountable, definitions for the data elements that would be 
collected, the funds needed to implement this system and where 
those funds would come from, and needed legislative changes. 
The bill provides the committees of jurisdiction one year to 
consider the plan and implement any necessary changes in the 
next reauthorization of SAMHSA in 2002.
    4. Create authority for the Secretary to make grants to 
States to assist them in developing the data infrastructure 
necessary to implement a performance based system.
    5. Repeal certain obsolete provisions of the Narcotic 
Addict Rehabilitation Act of 1966.
    6. Require the Secretary to report to the committees of 
jurisdiction on how services are currently being provided to 
those with co-occurring mental health and substance abuse 
disorders, what improvements are needed to ensure that they 
receive appropriate services, and a summary of best practices 
on how to provide those services including prevention of 
substance abuse among individuals who have a mental illness and 
treatment for those with co-occurring disorders.
    7. Clarify that both SAPT and CMHS Block Grant funds may be 
used to provide services to those with co-occurring mental 
health and substance abuse disorders as long as substance abuse 
funds are used for the substance abuse aspect of treatment and 
the mental health funds are used for the mental health aspect 
of treatment.

                II. Background and Need for Legislation

    Substance abuse and mental health illness remain major 
issues in the United States. The 1998 National Household Survey 
on Drug Abuse estimated that more than 78 million persons or 
35.6 percent of the household population aged 12 and older in 
the U.S. reported that they had used illicit drugs at some time 
during their lives. 72 million persons reported using 
marijuana, 23 million reported using cocaine, 4.5 million 
reported using crack cocaine, 21.6 million reported using 
hallucinogens, and more than 2.4 million reported using heroin 
at some time during their lives. According to this survey, an 
estimated 10.6 percent of the household population 12 and older 
had used illicit drugs in the past year and 6.2 percent had 
used them in the last month. Nearly 9.9 percent of the 
population 12-17 used drugs in the past month, which is a 
decrease from 11.4 percent in 1997, however, this number is 
still dramatically higher that the 1992 rate of 5.3 percent. An 
estimated 8.3 percent used marijuana, 0.8 percent used cocaine 
and 19.1 percent used alcohol in the past month. Nearly 3 
percent of 12-17-year-olds drink 5 or more drinks at a time 
more than once a month.
    Almost one in three people suffer from mental illness in a 
given year while more than one in two people will experience a 
mental disorder during his or her lifetime. Each year 5.5 
million Americans are disabled by severe mental illness. At 
least 9 to 13 million children--14 to 20 percent of all 
American children--experience one or more emotional, 
behavioral, or mental disorders. An estimated 3.5 million 
children and adolescents have a serious emotional disturbance. 
Only about one in every three of these children receive any 
mental health care.
    In 1994 the estimated economic cost to society of mental 
illness was approximately $204.4 billion. About $91.7 billion 
of the total was due to the costs of treatment and other direct 
costs for medical care. The remaining costs were morbidity and 
mortality costs, or, the costs associated with loss of 
productivity due to illness and premature death.
    Throughout the last 30 years, 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 services. 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 research 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 prevention 
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 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. The goal was 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 
include formula grants to States and project grants for alcohol 
and drug abuse treatment and prevention programs. These two 
pieces of legislation also created two institutes, 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 and ADAMHA, which became the 
lead agency in the Department of Health and Human Services 
(HHS) focusing 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. This program 
also provides funds to States for 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 authorized 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. 103-321, 
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 and their research and related activities to the 
National Institutes of Health. ADAMHA was renamed the Substance 
Abuse and Mental Health Services Administration (SAMHSA), to 
focus on prevention and treatment services.

             III. Legislative History and Committee Action

    The Youth Drug and Mental Health Services Act, S. 976, was 
introduced on May 6, 1999, by Senator Frist. The bill was 
referred to the Senate Committee on Health, Education, Labor, 
and Pensions.
    On July 28, 1999, the committee held an executive session 
to consider S. 976. An amendment in the nature of a substitute 
was offered for consideration by Senator Frist. No further 
amendments were adopted in executive session, and S. 976 was 
ordered to be reported favorably to the full Senate by a 
rollcall vote 17 to 1.

                rollcall votes during executive session

    1. Senator Reed offered an amendment to delete Section 
305(d), relating to nondiscrimination and institutional 
safeguards for religious providers regarding employment 
practices. It failed by a rollcall vote of 8 to 10.
        YEAS                          NAYS
Kennedy                             Jeffords
Dodd                                Gregg
Harkin                              Frist
Mikulski                            DeWine
Bingaman                            Enzi
Wellstone                           Hutchinson
Murray                              Collins
Reed                                Brownback
                                    Hagel
                                    Sessions
    2. The Frist substitute was ordered to be reported 
favorably to the full Senate by a rollcall vote of 17 to 1.
        YEAS                          NAYS
Jeffords                            Wellstone
Gregg
Frist
DeWine
Enzi
Hutchinson
Collins
Brownback
Hagel
Sessions
Kennedy
Dodd
Harkin
Mikulski
Bingaman
Murray
Reed

                          IV. Committee Views


Section 101. Children and violence

    The Committee has been concerned for some time about 
violence in schools. Despite the recent statistics from the 
Department of Education on the decrease in violence in schools 
across the nation, there have been all too many violent crimes 
committed by school aged children upon their own classmates. 
The violence at Littleton, Colorado and many other schools has 
forced us as a nation to reexamine our federal and state 
efforts to combat violence in our schools and gain a better 
understanding of the underlying reasons for this violence.
    In response, the Committee is authorizing a new program to 
address these issues. The Safe Schools Healthy Students grant 
program developed by the Center for Mental Health Services 
within the Substance Abuse and Mental Health Services 
Administration in conjunction with the Departments of Education 
and Justice was created specifically to address concerns of 
communities and parents about the level of violence in schools. 
This program provides funding to local school districts to 
decrease the rate of violence in schools. School districts that 
receive an award will implement a wide range of early childhood 
development, early intervention and prevention, suicide 
prevention, and mental health treatment services that have the 
greatest likelihood of preventing violence among children.
    Each project will have six components: mental health 
treatment services, early childhood development services, 
prevention and early intervention, school security, safe school 
policies, and educational reform.
    The Committee commends the Center as well as the 
Departments of Education and Justice, for the development of 
this program to address school violence.
    The Committee also recognizes the pervasive and devastating 
effects that psychological trauma has on our communities, 
especially women and children, who are the most frequent 
victims of community and domestic violence, as well as the 
majority of those who are witnesses and survivors of such 
violence.
    Post Traumatic Stress Disorder (PTSD) is a psychiatric 
diagnosis, with a constellation of anxiety and behavioral 
symptoms, precipitated by some extreme event in a person's 
life. Some cases of PTSD are acute and related to single 
events, such as a natural disaster, the trauma of combat, or 
the sudden loss of a loved one in a terrible incident (criminal 
or accidental). Some cases develop over extended periods of 
time, such as spousal or child abuse.
    Millions of people have been directly victimized by 
violence, or have witnessed violent or other extremely 
traumatic events. Exposure to traumatic events such as domestic 
violence, child abuse, criminal assaults, natural and 
technological disasters, or war-related trauma, can result in 
severe psychological and physical harm. The Committee notes 
that the recent shootings and bombings in public institutions 
emphatically underscore the seriousness of a problem that is 
widespread throughout our country.
    The Committee acknowledges that a number of federal 
initiatives currently focus on the problem of child exposure of 
violence. Emergency funding for disasters, crisis counseling 
for some major tragedies, and service programs funded through 
the Federal Emergency Management Agency, Health and Human 
Services (especially through the Center for Mental Health 
Services within the Substance Abuse and Mental Health Services 
Administration), the Department of Education, and the 
Department of Justice, have helped direct much needed resources 
to this problem. Nonetheless, there is a need for better 
coordination of the identification and intervention process to 
ensure the overall quality of service delivery.
    Both private and public health systems can help by 
directing support quickly to children who are exposed to 
violence, and are identified through a number of institutions 
as being at risk for needed support and treatment.
    The provision in the legislation, entitled ``Services for 
persons who experience violence-related stress,'' is a new 
program of grants that would establish one national and several 
regional centers of excellence that would provide special 
training and research in the area of psychological trauma and 
its treatment. The centers could also serve as the hub of a 
broader referral network for coordinating and referring 
children and families to skilled clinicians close to their 
communities. Another feature of this section is to stimulate 
research into effective methods of case finding and treatment 
for women, children, and others who are witnesses or survivors 
of community or domestic violence.

Section 102. Emergency response

    The Committee is concerned that SAMHSA does not have the 
authority to make grants to local jurisdictions and communities 
in time to address emergency needs. The peer review process 
adds countless weeks and months to the agency's ability to 
respond. The Committee wants to make it clear that it supports 
peer reviews of grants, but it also believes that the agency 
should have the opportunity to respond to emergencies. 
Therefore, the Committee in this section grants the Secretary 
authority to use up to, but no more than, 3 percent of 
discretionary grants appropriate to programs authorized in 
title V of the Public Health Service Act to respond to 
emergencies and to award those funds using an objective review, 
by establishing internal objective criteria, instead of peer 
review. The Committee is confident that this will provide an 
adequate balance between the need to have funds available for 
such emergencies and to ensure that the funds are spent 
responsibly.
    The Committee has been reviewing the issue of 
confidentiality of medical information and the development of 
federal legislation to protect patients medical records. The 
Committee is concerned that persons who respond to interviews 
conducted as part of the National Household Survey on Drug 
Abuse and facilities that participate in other national surveys 
know that the information that is collected will be used only 
for the purposes for which the information is gathered and that 
the information will be held confidential. SAMHSA is given the 
same authority as the Administration on Health Care Policy and 
Research and the National Center for Health Statistics to 
protect patient information.

Section 103. High risk youth reauthorization

    The Committee has reviewed the results of the latest 
``Monitoring the Future'' study from NIDA that shows that the 
perceived harm of marijuana has gone down from 1996 to 1997. 
This reflects a continued decline in perceived risk that has 
occurred since 1990 which mirrors the trend in the increased 
use of marijuana among youth. As perceived risk decreases, use 
increases. The Committee believes that we need to find new and 
creative ways of getting the message out to youth about the 
harm in using drugs and alcohol that speak to each new 
generation of children. We need to continue our commitment to 
prevention of drug and alcohol abuse among youth so that the 
message continues. We need to send appropriate messages to 
children earlier in life so they grow up hearing about the harm 
of drugs and alcohol. We need a comprehensive approach to such 
prevention to ensure that this message is getting across. Thus 
the Committee is reauthorizing the High Risk Youth Program.

Section 104. Substance abuse treatment services for children and 
        adolescents

    This section of the legislation creates a dedicated funding 
source for treating youth with alcohol and drug problems. The 
Committee is aware that at least 80% of teens with severe 
alcohol and drug treatment problems do not receive treatment 
because it is either unavailable or unaffordable. Therefore, 
the Committee seeks to provide youth greater access to 
effective substance abuse treatment, to increase their rates of 
recovery and better prevent relapses.
    The Committee intends that the grants, contracts or 
cooperative agreements awarded under this section be used to 
provide teens with access to research-based, culturally, 
developmentally and age-appropriate alcohol and drug treatment 
services. The Committee also intends that funding be used to 
address the particular issues of youth involved with the 
juvenile justice system, those who are at risk for exhibiting 
aggressive, anti-social, and violent behaviors, and those with 
mental health or other special needs. Finally, the Committee 
believes that the provision of these treatment services should 
include coordination with social service agencies in the 
youth's community, collaboration with the family during 
treatment, and development of a comprehensive plan for 
aftercare services for the entire family.
    The Committee shares the concern of many in this country 
that substance abuse is a serious national problem and that 
very few of the 648,000 of our nation's youth with severe 
substance abuse problems receive any treatment. Clearly, more 
must be done to prevent substance abuse and to intervene 
earlier in cases in which children have been exposed to the use 
of alcohol and other drugs. The Committee intends for the 
grants under this provision to be used to design innovative 
programs with special emphasis on and preference for projects 
that involve collaborative efforts between educational, 
juvenile justice, social service, and other interested 
agencies.
    The Committee is alarmed at the escalation in 
methamphetamine and inhalant abuse in a number of regions of 
the country, especially in certain rural areas. Methamphetamine 
and inhalant abuse are particularly dangerous and troublesome 
drug problems. These are very inexpensive drugs of abuse, which 
are easily obtained or easy to manufacture. They are very 
potent stimulants that can cause psychotic and violent 
behavior. The abuse of these drugs is being reported in 
significant numbers of children and adolescents.
    Critical to any successful comprehensive effort to combat 
methamphetamine and inhalant abuse are strong school and 
community-based prevention activities that stop the problem 
before it starts. This legislation authorizes $10 million to 
expand and improve school and community-based prevention 
efforts at the state and local level. Activities funded include 
education of children, parents, local law enforcement, 
businesses and others about the dangers of methamphetamine and/
or inhalants and how to identify likely users and producers of 
the drug. The Committee intends for priority in funding to go 
to areas that are experiencing a high incidence or rapid 
increases in methamphetamine and/or inhalant abuse.
    The Committee recognizes that more understanding is needed 
about the links between mental illness, drug addiction, and 
involvement with the juvenile justice system. The Committee 
also recognizes that this provision providing federal support 
is an important supplement to other sections of this bill which 
address local needs for programs for youth who suffer from drug 
addiction and mental illness before, during, and after their 
incarceration.
    The Committee strongly supports SAMHSA's early 
collaborative efforts to develop high quality programs to serve 
this population, particularly those programs with a community-
based, prevention, and diversion approach toward identifying 
and treating those youth who come into contact with the 
juvenile criminal justice system. To build upon this effort, 
the Committee authorizes the Secretary to award grants for the 
establishment of up to four research, training, and technical 
assistance Centers that would be administered by SAMHSA, in 
collaboration with Office of Juvenile Justice and Delinquence 
Prevention, the Bureau of Justice Assistance, and the National 
Institutes of Health. The Centers will be authorized to engage 
in research and evaluations, provide direct technical 
assistance to grantees, and provide information to local 
governmental officials on appropriate services for juveniles 
with mental health and substance abuse disorders.

Section 105. Comprehensive community services for children with serious 
        emotional disturbance

    This program was implemented first in 1993 to encourage the 
development of intensive community-based services for children 
with serious emotional disturbance and their families. To date 
61 grants have been awarded to State, political subdivisions of 
States, territories and Indian tribal organizations to provide 
seed funds for the building of a comprehensive system of care 
using the existing service infrastructure in local communities.
    The Committee received reports, however, that the first and 
second sets of grantees in focusing on the development of the 
system of care failed to pay enough attention to the 
requirements that they become self sufficient within five 
years. This bill extends the grant period one year and requires 
that for that additional year the matching requirement remain 
the same as it currently is for their fifth year. The Committee 
continues to support that this program is to provide seed funds 
and that ultimately the States and local communities are 
responsible for the continuation of the program.
    The Secretary is permitted to waive any of the required 
services in the program for Territories and American Indian 
tribes and tribal organizations where those services are deemed 
either unnecessary or financially impossible for the entities 
to provide.

Section 106. Services for children of substance abusers

    This section is intended to modify the existing grants for 
Services for Children of Substance Abusers program and to 
transfer program authority from the Health Resources and 
Services Administration (HRSA) to SAMHSA.
    This section authorizes the Secretary to make grants to 
public and private non-profit entities for the purpose of 
providing a broad range of services to families in which the 
parents are substance abusers. The Committee recognizes that 
children with substance abusing parents face serious health 
risks, including congenital birth defects, psychological, 
emotional, and developmental problems, and the increased 
likelihood of becoming substance abusers themselves. The 
Committee is also aware of research documenting that children 
whose parents abuse drugs and/or alcohol are three times more 
likely to be abused and four times more likely to be neglected 
than children whose parents are not substance abusers. 
Therefore, the Committee intends that the grants under this 
section be used to help parents overcome their substance abuse 
and to assess and address the health, mental health, and 
substance abuse needs of their children. The Committee also 
intends that this funding be used to train and educate 
providers who serve vulnerable children and parents by 
assisting providers in identifying substance abuse and 
obtaining substance abuse services for affected families. 
Finally, the Committee expects that the Secretary will conduct 
a timely evaluation of the value of this program in reducing 
substance abuse among parents participating in the program and 
improving the health, mental health and developmental outcomes 
for their children.

Section 107. Services for youth offenders

    Under this section, the Secretary of Health and Human 
Services may award grants to provide comprehensive, community-
based services such as mental health and substance abuse 
treatment, job training, vocational services, and membership 
programs to juvenile offenders with a serious emotional 
disturbance or are at risk of developing a serious emotional 
disturbance. The Committee has authorized appropriations for 
this program at $40 million for fiscal year 2000 and such sums 
as may be necessary for fiscal years 2001 and 2002. The 
Committee believes that the inclusion of this proposal will 
provide desperately needed Federal grant aid to local juvenile 
justice agencies to prevent re-offending and re-incarceration.
    Studies have found that the juvenile offender population 
has an acute need for mental health and substance abuse 
treatment. According to a 1994 Department of Justice study, 73% 
of juvenile offenders reported mental health problems. In 
addition, over 60% of this population is estimated to have 
substance abuse problems.
    The Committee believes that the current system of medical, 
mental health, and social services for incarcerated youth is 
fragmented, disorganized, and lacks collaboration, coordination 
and continuity of care. Many States are currently struggling to 
piece together services for youngsters whose treatment was 
discontinued after they were released from the juvenile justice 
system. This lapse in treatment often results in youngsters 
returning to the justice system, sometimes for more egregious 
crimes. In fact, the Committee found in a study by the National 
Center for Juvenile Justice, of the 4 million youngsters 
arrested each year, 30% are likely to recidivate within the 
year of arrest. This section will facilitate the rehabilitation 
and successful transition of youth into their communities by 
ensuring continuity in treatment and access to other supportive 
services.
    This section also seeks to improve collaboration among the 
many agencies serving the youth offender population. At the 
federal level, the administration of the program is assigned to 
the Secretary, through the Center for Mental Health Services, 
in consultation with, the Center for Substance Abuse Treatment, 
the Office of Juvenile Justice and Delinquency Prevention, and 
the Office of Special Education Programs. Similarly, at the 
local level, this section requires close coordination between 
grant recipients and other State and local agencies in order to 
pool existing resources and programs that offer recreational, 
social, educational, vocational, and other services for youth.
    The Committee would like to underscore the importance of 
planning for aftercare while youth offenders are detained or 
incarcerated. Although this section's emphasis is foremost on 
the aftercare needs of youth offenders, up to 20 percent of 
funds may be used to provide planning and transition services. 
The Committee encourages the Secretary to use this funding to 
expand efforts to identify mental health and substance abuse 
disorders from the time that the youth enters the juvenile 
justice system with the hope that early screening and 
identification will yield more timely diagnosis and treatment.
    Evaluations of the handful of existing transitional 
programs for juvenile offenders suggest that the programs 
effectively reduce re-offending and re-incarceration. Yale 
University, in its evaluation of a Rhode Island program called 
Project Reach, found that children receiving transitional 
services had significant increases in their school attendance 
and grades, as well as a 60% reduction in encounters with the 
police. A similar program in Milwaukee, Wisconsin reported over 
a 30% decline in the number of misdemeanors and felonies 
committed by program recipients after receiving services for 
one year and a decline of nearly 50% in inpatient psychiatric 
Medicaid hospital days.
    These are examples of programs that encourage partnerships 
between the behavioral health and juvenile corrections systems 
to develop a single, culturally competent, community-based 
system of care for youth offenders to prevent offending and re-
incarceration that the Secretary should draw upon in awarding 
grants under this section.
    In adopting this provision, the Committee reiterates its 
commitment to the needs of our nation's youth. More 
importantly, it makes a prudent Federal investment in services 
for youth offenders that will yield substantial benefits by 
preventing recidivism, reducing juvenile delinquency, promoting 
teen health, and fostering safe communities.

Section 108. General provisions

    This section is added by the Committee to ensure that the 
duties of the Directors of the Centers for Substance Abuse 
Treatment, Substance Abuse Prevention and Mental Health 
Services reflect their responsibility for focusing on the 
substance abuse and mental health services for youth

Section 201. Priority mental health needs of regional and national 
        significance

    The intent of the Committee is to consolidate several 
separate discretionary grant authorities into one authority for 
the Secretary to use in making grants for mental health 
services. This consolidation will provide the Secretary with 
the flexibility of responding to the needs of the States, local 
communities and governments, providers and consumers. It will 
permit the Secretary to examine the effect that changes in the 
delivery of mental health services are having on those in need 
of these services.
    The Committee also believes that this authority will foster 
the partnerships that exist among the Federal and State 
governments, as well as local governments, providers and 
consumers as together they develop the focus of SAMHSA mental 
health discretionary grant funding. The Committee expects the 
Secretary to annually engage these parties in the development 
of the agency's discretionary grant agenda.
    The authority given to the Secretary permits several types 
of grants. The first are grants to improve our knowledge base 
on how best to provide mental health services; second, to train 
individuals to provide better mental health care; third, to 
provide additional funds to States, local governments and 
communities and providers to address pressing mental health 
needs; and, fourth, to support the creation and maintenance of 
family and consumer networks to provide training and technical 
assistance to consumers and families. The Committee supports 
SAMHSA's efforts to examine the effect of managed care on those 
with mental illness and clarifies in statute that this 
provision gives the agency clear authority to carry out such 
activities. At the same time, family physicians and other 
primary care providers see a large number of people in their 
practices who have a wide range of psychiatric and 
psychological problems. Cost containment strategies place ever 
greater pressure on those providers to take care of the less 
severe mental health problems of their patients without 
referring them to specialists. In some cases, this may be 
appropriate, but too often primary care providers do not 
recognize the mental health problems that their patients have. 
If they do recognize the problems, they usually do not provide 
enough medication or counseling. When they do try to refer 
patients they often cannot find a willing clinician to take the 
referral.
    It is important that the Federal government not spend 
limited resources without the benefit of learning from the use 
of those resources. Thus the Secretary is instructed to ensure 
that each grant, contract or cooperative agreement awarded 
under this authority be evaluated so that we can learn from 
each proposal undertaken.
    The Committee emphasizes the importance of improving our 
knowledge about what works and the development of best 
practices for mental health services. SAMHSA's role is not 
merely to provide access but also to provide access to quality 
care. But discovering new and improved techniques in the 
provision of services, SAMHSA makes a tremendous contribution 
to the mental health service delivery system in America.
    Of critical importance is to ensure that the information 
gained from the knowledge development grants and the research 
from the National Institute of Mental Health are disseminated 
to States, local governments and communities, providers and 
consumers so they can improve their services. The ability to 
make grants for the training of mental health professionals is 
one mechanism to disseminate the findings which the Committee 
strongly supports.
    Considering our nation's rapidly changing demographics, the 
Committee recognizes the need for a diversified mental health 
workforce. This is particularly important since there is a 
severe shortage of minority psychologists and other mental 
health professionals, especially in underserved rural areas. In 
light of the fact that SAMHSA's Minority Fellowship Program is 
the only federal program providing funding to increase the 
number of ethnic and racial minorities in our nation's mental 
health workforce, it is the intention of the Committee that the 
Minority Fellowship Program continue.
    The Committee recognizes that there are many issues related 
to how well the primary care system and its providers deal with 
the needs of persons with psychiatric disorders. People who 
suffer from schizophrenia and other major psychiatric illnesses 
often have many serious physical health problems, but too often 
are not treated with sufficient respect or understanding, so 
their non-psychiatric health problems are not effectively cared 
for. In fact, the Committee has learned that many persons with 
severe psychiatric disorders never even see a primary care 
physician.
    The Committee encourages the Secretary to make funding 
available for projects that address the interface between the 
mental health and primary care systems a priority among 
knowledge, development, and application grants. Such projects 
may include efforts to identify best practices, encourage the 
development and implementation of effective consultation, and 
collaboration models.
    The Committee recognizes the need to broaden discretionary 
funds beyond a research service system to allow for innovative 
programs and ideas that have not undergone the rigors of 
service research. Such funds to stimulate those ideas have been 
characterized by the term ``systems change grants.'' The 
Committee intends that these systems change grants should 
foster non-traditional service development, such as peer 
support programs, the development of family networks, consumer 
run alternative programs, and other innovative concepts. The 
Committee also directs the Secretary, in funding these 
projects, to widely disseminate descriptions of projects that 
have been evaluated and determined to be effective and 
successful.
    The Committee recognizes the special mental health needs of 
rural areas. Persons who live in rural areas often have 
difficulties that may be complicated by problems of rural 
living, such as the current farm crisis, but also have reduced 
access to qualified mental health care providers. The Committee 
encourages the Secretary to consider rural factors when 
awarding grants for various mental health knowledge 
development, and application projects.

Section 202. Grants for the benefit of homeless individuals

    As an exception to the general direction of this bill of 
consolidating discretionary grants, the Committee chooses to 
reauthorize and amend section 506 of the Public Health Service 
Act which authorizes grants to provide substance abuse and 
mental health services to homeless individuals.
    It is estimated that on any one day over 600,000 people are 
homeless, one-third of whom have a serious and persistent 
mental illness and one-half have a co-occurring alcohol or drug 
abuse problem. This population is particularly vulnerable. They 
are homeless for a longer period of time, are in poor physical 
health, and are more likely than other homeless people to be 
involved with the criminal justice system.
    Many mainstream providers of services to the homeless are 
not equipped to handle the complex social and health conditions 
that the homeless population presents. This provision offers 
funds to develop the systems of care that the homeless need as 
it relates to mental health and substance abuse disorders.
    It is the Committee's expectation that the Secretary, when 
developing the homeless grant program, will utilize the 
expertise of both SAMHSA and the Health Resources and Services 
Administration (HRSA). SAMHSA has strengths in the areas of 
mental health and substance abuse prevention and treatment. 
HRSA has strengths in the areas of primary health care, service 
delivery to homeless and other medically underserved 
populations, and health services integration. The active 
collaboration of both agencies will help assure that program 
beneficiaries have access to the full range of health services 
in an integrated manner. The Committee also encourages the 
Secretary to consult with the Interagency Council on the 
Homeless which includes among other agencies the Administration 
on Children and Families (which administers the Department's 
Runaway and Homeless Youth Act programs, among other duties), 
the Health Care Financing Administration, and the National 
Institutes of Health, each of which has valuable contributions 
to offer with regard to research about or services to homeless 
persons.
    The Committee encourages the Secretary to assure that 
awards under the homeless grant program are made to entities 
that plan to provide, either through direct delivery or by 
arrangement, the following continuum of services: substance 
abuse treatment, mental health services and primary health care 
as well as demonstrated expertise in services for runaway 
homeless and street youth.
    The Committee has included providing preference in grants 
to entities with demonstrated effectiveness in serving homeless 
veterans. The Committee instructs the Secretary to make 
assurances that awards made available under the homeless grant 
program to such entities are used to supplement, not supplant, 
funds for services that are the responsibility of the U.S. 
Department of Veterans' Affairs.
    The Committee wants to ensure that we learn from these 
grants to better serve the population and also that the 
findings are disseminated to State, local governments, 
communities and providers to improve our systems of care.

Section 203. Projects for assistance in transition from homelessness 
        (PATH)

    The PATH program was authorized as part of the Stewart B. 
McKinney homeless provisions in 1990. Under the program funds 
are allocated using a statutorial prescribed formula to States 
to provide community based mental health services for people 
with serious mental illnesses who are homeless or at imminent 
risk of becoming homeless.
    This program reaches some of the most vulnerable members of 
society, including those with several disabilities. Among all 
clients who received PATH funded services and for whom a 
diagnosis was reported, 44 percent had schizophrenia and other 
psychotic disorders and another 28 percent had affective 
disorders including depression and bipolar disorder.
    SAMHSA has been issuing yearly reports on the impact of the 
program despite the fact that no such report is required in 
statute. The Committee applauds the efforts of the agency and 
encourages the agency to keep producing these reports so that 
States, local governments, providers and Congress can access 
the impact of the program.
    The Committee has received reports that the non-profit 
providers and local governments are having difficulty obtaining 
information about the process used by States to allocate PATH 
funds. This information shortfall inhibits public participation 
in and monitoring of fund allocation. The Committee urges the 
Secretary to request States to include in their annual PATH 
grant applications a description of the process used to 
allocate funds to service providers.
    The Secretary is permitted to waive certain requirements 
for territories where the Secretary believes a waiver is 
warranted. The Committee recognizes that the Secretary needs 
some flexibility in working with the territories, because of 
their unique needs and financial constraints.

Section 204. Community mental health services performance partnership 
        block grant

    In the ADAMHA Reorganization Act of 1992 (P.L. 102-321) the 
Alcohol, Drug and Mental Health Services Block Grant was split 
into two block grant programs--one focusing on substance abuse 
(see section 303) and the Community Mental Health Services 
(CMHS) Block Grant. Under the CMHS Block Grant funds are 
allocated to States according to a formula prescribed in 
statute to use in providing community based mental health 
services to adults with a serious mental illness and children 
with a serious emotional disturbance.
    The Block Grant program represents roughly 2 to 3 percent 
of all expenditures on mental health services including mental 
institutions but between 10 and 15 percent of funds spent on 
community-based mental health services in the country. The 
requirements in the statute are minimal largely because the 
Federal government through Medicaid and State funds support the 
vast amount of overall mental health services provided in the 
country.
    As discussed previously, the Block Grant program under this 
bill is being transitioned into a performance partnership under 
which States will obtain more flexibility in the use of the 
funds but be held accountable for their use of those funds 
based on their performance. The earlier discussion in this 
report in Title I focused on the development of performance 
measures. The Committee believes building in flexibility is an 
important goal in allowing States to determine what works best 
in providing mental health services to their citizens.
    This bill reduces the number of mandated criteria for the 
State plans that are required on a yearly basis from 12 to 5 
with the expectation that States will be able to produce a more 
comprehensive and coherent plan and reduce administrative 
burdens. This change is accomplished without any compromise to 
the breadth and scope of the States' efforts under the program.
    The provision creates flexibility for the States' in the 
Maintenance of Effort requirements in current statute. The 
current law punishes a State if it wanted to take available 
funds in any fiscal year and put them into mental health 
services for a one time non-recurring project by including 
those funds in the calculation of future year maintenance of 
effort requirements. This bill exempts any such funding 
increase from the calculation of future maintenance of effort 
requirements.
    The statute requires each State to submit an application on 
a yearly basis for funding. The application consists of both a 
plan on what the States intend to use the funds for and a 
report on what it did with the funds in the previous year. This 
provision recognizes the States often submit reports on 
expenditures until their fiscal year books are closed and 
therefore requires the State plans to be submitted by September 
1 of the year prior to the year for which they are seeking 
funds and the report by December 1 of the fiscal year of the 
grant.
    The bill also changes current statute which requires the 
State to obligate the funds in the year in which they are 
received and to spend the trusts by the end of the following 
Federal fiscal year. This bill will give the States two years 
to obligate and spend their funds.
    The Committee is disappointed that only 22 state mental 
health authorities are currently able to accurately provide an 
unduplicated count of persons served in the public mental 
health system. Without the ability to provide an unduplicated 
count of persons served by age, diagnosis, and services 
utilized, States are at a distinct disadvantage in knowing 
whether their Federal block grant funds are being appropriately 
used for the highest priority consumers.
    The Committee encourages the States to target their funds 
to evidence-based programs, affirmed through research supported 
by the National Institutes of Health and through SAMHSA's 
knowledge development and application grants program, 
psychiatric rehabilitation services for adults with severe and 
persistent mental illness, and comprehensive wrap-around 
services for children with serious emotional disorders.
    It is the Committee's intent and hope that the new 
Performance Partnership will make State systems more publicly 
accountable for the expenditure of Federal block grant funds 
while moving toward the capacity to provide outcomes based data 
regarding the type and quality of the services provided as well 
as the pertinent demographic and clinical data about the 
persons who are served.

Section 205. Determination of allotment

    This provision makes permanent a compromise reached on the 
fiscal year 1999 appropriation with regard to the distribution 
of funds under the Community Mental Health Services Block 
Grant.
    In August of 1997 the Secretary of Health and Human 
Services made a decision to replace the use of manufacturing 
wages in the cost of service index for the formula for 
distribution with non-manufacturing wages. Congress believed 
that the change was appropriate but was concerned about the 
result this change would cause in State allotments. Some States 
would have lost funds which support much needed services. 
Therefore, in the fiscal year 1999 appropriation bill for the 
Department of Health and Human Services, Congress permitted the 
Secretary to make the change but instructed the Secretary to 
ensure that State allotments under the Community Mental Health 
Services Block Grant for fiscal year 1999 were held harmless at 
the amount they received in fiscal year 1998.
    That provision only addressed fiscal year 1999 funding. 
Without a permanent fix to the formula, many States could lose 
funding in future fiscal years. This section makes the hold 
harmless provision agreed to in the fiscal year 1999 
appropriation bill permanent.

Section 206. Protection and Advocacy for Mentally Ill Individuals Act 
        of 1986

    The Protection and Advocacy (P&A) for individuals with 
Mental Illness Act authorizes formula grants to Protection and 
Advocacy systems that have been designated by each of the 50 
States, the District of Columbia and the United States 
Territories. The funds are to be used for the protection of and 
advocacy for the rights of individuals with serious mental 
illness who are residing in facilities where mental health 
services are provided. This program has, since its inception in 
1986, improved services for such individuals through its 
proactive work on behalf of individuals with serious mental 
illness, its monitoring of covered families and investigations 
into violations of their rights.
    This section expands the list of direct recipients of funds 
to include a single consortium of American Indians living at 
the corners of New Mexico and Arizona. This consortium also 
receives funding under the other three Protection and Advocacy 
systems supported by the Federal government through the 
Departments of Education and Health and Human Services. Funding 
for the consortium will be available only when the total 
appropriation for the program reaches $25,000,000. Its funding 
in fiscal year 1999 was $22,957,000. The allotment for the 
consortium will be the same as the minimum allotment for 
States.
    When the appropriation for the program reaches $30,000,000, 
this section also expands the authority of the systems to 
include protecting and advocating on behalf of the rights of 
individuals with a serious mental illness or emotional 
impairment who are living in communities and who may be subject 
to abuse or neglect or discrimination in housing, health care, 
employment or benefits. The P&A systems would still give 
priority to those individuals residing in facilities that 
provide mental health services but would also be able to work 
on behalf of persons living at home. Over the past twenty years 
tremendous advances in treatment services for mental illness 
have allowed persons with mental illness to receive needed 
treatment in the community. Unfortunately, there has not been a 
mechanism to ensure that they are receiving the care and 
advocacy services they need. This amendment to the current 
statute would allow the current P&A systems to work on their 
behalf as well. The Committee hastens to add, however, that the 
top priority of the P&A systems remains the protection of and 
the advocacy for the rights of individuals with serious mental 
illness residing in facilities that provide mental health 
services.
    In addition, the Committee intends that P&A systems, under 
the Protection and Advocacy for Individuals with Mental Illness 
Act, when the appropriation for the program reaches 
$30,000,000, shall have no less authority to access records to 
investigate abuse and neglect than is provided to the systems 
under the Developmental Disabilities Assistance and Bill of 
Rights Act. Similarly, P&A systems shall have no less authority 
to gain access to community settings, such as group homes, to 
conduct investigations and monitoring activities, when the 
systems are acting under their expanded authority to provide 
advocacy services to persons with a serious mental illness or 
emotional impairment who are living in the community. Further, 
the Committee intends that the membership of P&A systems' 
governing boards be subject to term limits set by the systems 
to ensure rotating memberships.

Section 207. Requirement relating to the rights of residents of certain 
        facilities

    The Committee is greatly concerned about the inappropriate 
use of restraints and seclusion with facilities who receive 
funds under this Act. In October 1998, the Hartford Courant 
printed a five-part series investigating the use of physical 
restraints on individuals with mental health and mental 
retardation disabilities. The Courant's investigation found 
instances of 142 deaths, in the past decade, during or shortly 
after restraints were applied. The Harvard Center for Risk 
Analysis estimates that between 50 and 150 restraint or 
seclusion related deaths may occur each year. Additionally, 
more than 26 percent of the deaths related to restraint or 
seclusion reported in the series were children--nearly twice 
the proportion they constitute in mental health facilities. The 
Committee finds that Federal oversight of restraint use is 
essential.
    The Committee believes strongly that restraints and 
seclusion should never be used as a disciplinary measure or for 
the convenience of health care providers. The Committee 
specifies that restraints and seclusion may only be used to 
protect the patient, staff, or others from immediate harm, to 
conduct routine physical examinations, and only upon the order 
of a physician or licensed independent health care 
practitioner. Such intervention would require routine physical 
examinations, and should only be done in response to an order 
by a physician or licensed independent health care 
practitioner. The Committee's intent is not to prohibit the use 
of devices such as protective helmets, orthopedically 
prescribed devices, surgical dressings or bandages, or devices 
designed to protect the patient from falling out of bed or to 
permit a patient to participate in activities without risk of 
physical harm. The Committee's intent is to prohibit the 
inappropriate use of restraints and seclusions.
    The Committee is concerned that facilities funded under 
this Act that serve individuals with psychiatric disorders are 
not presently required to identify all deaths associated with 
the use of restraints or seclusion. Due to this concern, this 
act requires that all deaths that occur while a patient is 
restrained or in seclusion, all deaths that occur within 24 
hours after a patient has been removed from restraints or 
seclusion and all deaths that can reasonably be assumed to have 
been caused by restraint or seclusion are reported to the 
appropriate oversight agency, as determined by the Secretary of 
Health and Human Services.
    The Committee believes that health care providers should be 
adequately trained in the proper use of restraints and 
alternatives to their use. Additionally, the Committee believes 
that facilities covered under this Act should maintain adequate 
staff levels to optimally ensure the safety of patients. For 
this reason, the Committee requires the Secretary of Health and 
Human Services to promulgate regulations requiring facilities 
under this act to maintain adequate staff levels and to provide 
sufficient training in the proper use of restraints and 
alternatives to their use.
    The Committee intends that facilities found in violation of 
this Act shall be subject to the loss of Federal funds. It is 
expected that the Secretary of Health and Human Services will 
promulgate regulations regarding failure to comply with the 
provisions of this act.

Section 301. Priority substance abuse treatment needs of regional and 
        national significance

    In order to grant the Secretary flexibility in the use of 
discretionary grant funds, the Committee consolidates several 
current provisions focusing on substance abuse treatment in the 
criminal justice system, outpatient services for pregnant 
addicts, residential treatment for pregnant addicts, treatment 
expansion grants, the District of Columbia initiative and 
others into a single broad authority to make grants, contracts 
or cooperative agreements to develop knowledge on best 
practices in substance abuse treatment, provide funding for 
local communities to address emerging needs in the community, 
and to train professionals in what we have learned from 
previous grants and the research at the National Institute on 
Drug Abuse and the National Institute on Alcohol Abuse and 
Alcoholism.
    The needs of the field of substance abuse treatment have 
changed considerably since the creation of SAMHSA and this 
authority will give the Secretary the ability to respond to 
those needs. One area of critical importance is to monitor and 
report on what is happening to individuals in need of treatment 
in the shift to managed care. The Committee is concerned that 
individuals receive good quality substance abuse treatment 
services.
    It is important that the Federal government not spend 
limited resources without the benefit of learning from the use 
of those resources. Thus the Secretary is instructed to ensure 
that each grant, contract or cooperative agreement awarded 
under this authority be evaluated so that we can learn from the 
proposals undertaken.
    The Committee acknowledges and supports the efforts by 
SAMHSA through the Center of Substance Abuse Treatment to 
identify best practices and expects that it will continue to 
use its authority to improve our knowledge base on how best to 
treat individuals. Further, the agency shall disseminate that 
information and the information gained from the National 
Institute on Drug Abuse and the National Institute on Alcohol 
Abuse and Alcoholism to States, local governments, communities, 
providers and consumers so that these findings can be used to 
improve their treatment systems. Increased knowledge without 
dissemination of information offers the community little.
    The Committee also supports recent efforts by SAMHSA to 
provide targeted capacity response funds to local communities 
to address their treatment needs that cannot be otherwise 
filled by Federal block grant or State funding. The Committee 
notes how fast the drug culture can change. Methamphetamine has 
become a major issue in many of our towns and cities and the 
increasing us use of drugs among youth at a time when there is 
a shortage of treatment focused on youth are examples of where 
the targeted capacity grants are important.
    In developing an agenda for substance abuse discretionary 
grants the Committee fully expects that SAMHSA will continue to 
meet with State, local government, and community 
representatives as well as providers and consumers on an annual 
basis to access the needs of the field.
    The Committee encourages the Secretary to give priority to 
programs that address the interface between substance abuse 
treatment and primary care systems. Such projects should 
include efforts to identify best practices and to encourage the 
development and implementation of effective consultation and 
collaboration models.

Section 302. Priority substance abuse prevention needs of regional and 
        national significance

    The Committee is consolidating several discretionary grant 
authorities into one authority for the Secretary to use in 
making grants for substance abuse prevention. This 
consolidation will provide the Secretary with the flexibility 
of responding to the needs of the States, local communities and 
governments, providers and consumers. More importantly it will 
provide the Secretary the flexibility to respond to the 
changing needs of each generation of individuals who come face 
to face with drugs as they grow up in American society.
    The Committee realizes that each generation of adolescents 
presents new challenges to those trying desperately to prevent 
drug abuse. Where one model of prevention might work with one 
generation, it fails in preventing drug use in another. Surveys 
such as Monitoring the Future, tell us that the perception of 
youth/adolescents that drugs are harmful has gone down and 
history has shown us that this is the precursor of increased 
drug use. The Secretary needs the flexibility to respond to 
these changes.
    The Committee encourages the Secretary to support community 
activities geared toward reducing drug use where community 
resources from religious organizations, schools, law 
enforcement, the business community, recreational 
organizations, and families work together to develop and 
implement a community wide strategy to prevent drugs. We also 
support recent efforts by SAMHSA to focus on strengthening 
families and to implement early childhood programs to reduce 
long term health, social, economic costs of addiction, 
violence, mental illness and crime.
    The Committee encourages SAMHSA to foster partnerships with 
State governments, as well as local governments, providers and 
consumers and therefore wants the agency to meet with these 
groups on an annual basis to determine the direction of 
discretionary grant funding.
    It is important that the Federal government not spend 
limited resources without the benefit of learning from the use 
of those resources. Thus the Secretary is instructed to ensure 
that each grant, contract or cooperative agreement awarded 
under this authority be evaluated so that we can learn from the 
proposals undertaken.
    The Committee emphasizes the importance of improving our 
knowledge about what works and the development of best 
practices. SAMHSA's role is not merely to provide prevention 
services but to ensure the use of best practices in prevention. 
By discovering new and improved techniques in the provision of 
services SAMHSA makes a tremendous contribution to the 
substance abuse prevention system in America.
    The Committee also supports the ability of SAMHSA to 
address service needs in communities as well. Federal block 
grant and State funds are not always enough to address 
community needs and therefore competitive or discretionary 
funds through SAMHSA assist States in providing additional 
services.
    It is critically important to ensure that the information 
gained from the knowledge development grants and the research 
from the National Institute on Drug Abuse and the National 
Institute on Alcohol Abuse and Alcoholism are disseminated to 
States, local governments and communities, providers and 
consumers so they can improve their services. The ability to 
make grants for the training of health professionals is one 
mechanism to disseminate the findings. SAMHSA should also make 
sure that the findings are published, that the publications are 
thoroughly distributed and that steps are being taken to 
implement the findings in the service delivery system.
    The Committee encourages the Secretary to give priority to 
projects that address the interface between substance abuse 
prevention and primary care systems. Such projects should 
include efforts to identify best practices and to encourage the 
development and implementation of effective consultation and 
collaboration models.

Section 303. Substance abuse prevention and treatment performance 
        partnership block grant

    This section reauthorizes and amends certain provisions in 
the Substance Abuse Prevention and Treatment Block Grant (SAPT) 
which was funded at approximately $1.6 billion in fiscal year 
1999. This program accounts for 40 percent nationally of all 
funds used for the prevention and treatment of substance abuse. 
It remains the focal point of Federal assistance for such 
services.
    Fashioned by President Reagan and passed by Congress in 
1981, the block grant represented a new approach to Federal 
involvement. This approach acknowledged that the States better 
understood what services to provide and how to provide them in 
the States. The block grants were meant to provide States with 
flexibility. Unfortunately, some of that flexibility has been 
lost over the years as Congress began dictating how funds 
should be spent and thus tying States' hands. In addition, 
Congress has become increasingly concerned about accountability 
by States for the use of Federal funds.
    As a result, this section along with other sections in the 
bill, begin to move this block grant into a performance 
partnership which will increase State flexibility while holding 
States accountable for their performance.
    When the performance partnerships are enacted in three 
years, the States will have full flexibility in their use of 
funds. In the meantime, flexibility for the States is enhanced 
by repealing a requirement that States spend 35 percent of 
their funds on alcohol related activities and 35 percent on 
drug related activities and by making the current requirement 
that States maintain a $100,000 revolving fund to support 
recovery homes optional. In addition, the section authorizes 
the Secretary to waive certain requirements where States show 
that they have met criteria established by the Secretary in 
conjunction with the States and others including providers and 
consumers and published in the Federal Register. These 
requirements that could be waived include the following: the 
set aside for pregnant addicts and women with children; 
mandatory services for intravenous drug users; tuberculosis 
services; early intervention services for HIV; improvement of 
referral services; continuing education requirements; and 
coordination requirements. Especially with regard to services 
for pregnant addicts and women with children, services for 
tuberculosis and early intervention services for HIV and 
mandatory services for intravenous drug users, the Committee 
continues to believe that these requirements which were added 
to the block grant over time represent concerns by Congress for 
public health issues that must be addressed. We have come to 
believe, however, that the better way to address them is by 
allowing States to respond to their greatest public health 
needs.
    These waivers are merely a stepping stone to the final 
enactment of a performance based system. To ensure that these 
populations are addressed in the performance based system, the 
Committee has instructed the Secretary in developing the 
performance measures that measures must be developed with 
regard to each of these populations.
    The section creates flexibility for the States in the 
Maintenance of Effort requirements in current statute. The 
current law punishes a State if it wanted to take some 
available funds in the fiscal year and put them into substance 
abuse services for a one time non-recurring project by 
effecting the calculation of future maintenance of effort 
requirements. This bill exempts any such funding increase from 
the calculation of future maintenance of effort requirements.
    Section 303 also would require States to submit their 
applications for this program by October 1 of the fiscal year 
for which they are requesting funds. Under current law, the 
Secretary has the authority to set an appropriate due date for 
applications.
    The section changes what constitutes data collection under 
the Secretary's 5 percent set aside by including support for 
data infrastructure development and it also requires that 
States that receive funding from the set aside for needs 
assessments after enactment of this bill, must report back to 
the Secretary on a core set of data.
    The legislation governing the Substance Abuse Prevention 
and Treatment Block Grant (Sections 1921 through 1954 of the 
Public Health Service Act) prohibits States that do not meet 
the definition of ``designated'' State, as defined in section 
1924 of the Public Health Service Act, from using block grant 
funds for activities related to HIV. The statutory language has 
also called into question whether States can use the funds for 
testing for HIV, or hepatitis C. However, these conditions are 
prevalent among persons with substance abuse disorders and must 
be included as a component of a comprehensive treatment plan 
for those individuals who test positive for such comorbid 
conditions.
    This provision gives States the option to use block grant 
funds to carry out screening and testing of any condition 
necessary for the development of comprehensive treatment plans 
for individuals with substance abuse disorders. A substantial 
portion of persons who seek and receive services from substance 
abuse treatment programs have comorbid mental health problems 
of varying degrees of severity. Allowing States to use some of 
their funds for the assessment of such problems is consistent 
with the notion of addressing the needs of persons with co-
occurring disorders and is consistent with the committee's 
intent to allow the State more flexibility in the use of block 
grant funds. So that States do not jeopardize ongoing 
treatment, Block Grant funds must be the funding of last resort 
and they are limited to using no more than 2 percent of their 
allotment on such assessments. The language is permissive, and 
does not require States to use funds under this program for 
screening and testing.

Section 304. Determination of allotment

    This provision makes permanent a compromise reached on the 
fiscal year 1999 appropriation with regard to the distribution 
of funds under the Substance Abuse Prevention and Treatment 
(SAPT) Block Grant.
    In August of 1997, the Secretary of Health and Human 
Services made a decision to replace the use of manufacturing 
wages in the cost of service index for the formula for 
distribution with non-manufacturing wages. Congress believed 
that the change was appropriate but was concerned about the 
result this change would cause in State allotments. Some States 
would have lost funds which support much needed services. 
Therefore, in the fiscal year 1999 appropriation bill for the 
Department of Health and Human Services, Congress permitted the 
Secretary to make the change while ensuring that each State 
would receive no less than 30.65 percent of the percentage 
increase of the overall block grant amount. It also ensures 
that small States will receive a minimum allotment of 0.375 
percent of the amount appropriated for the program except that 
no small State's allotment would increase in 1999 more than 300 
percent of the percentage increase in the overall funding for 
the block grant.
    The agreement reached on the fiscal year 1999 appropriation 
only applied to fiscal year 1999. Without a permanent fix to 
the formula, many States could lose funding in future fiscal 
years. This provision makes that agreement permanent.

Section 305. Nondiscrimination and institutional safeguards for 
        religious providers

    The Committee is aware of the success of faith-based 
substance abuse programs across the nation in helping 
individuals overcome drug and alcohol addictions. For example, 
Teen Challenge has shown that 86% of its graduates remain drug-
free. The Bowery Mission in New York City has had the most 
effective free-standing substance abuse shelter in the city-
wide system, serving its clients to approximately 42% of the 
cost of some other city-sponsored men's substance abuse 
shelters. Mel Trotter Ministries in Grand Rapids, Michigan has 
a 70% long-term success rate in its faith-based rehabilitation 
program. San Antonio's Victory Fellowship has served more than 
13,000 people and has a success rate of over 80%.
    Much of the success of these faith-based programs has been 
attributed to the fact that they address the deeper needs of 
people and use a holistic approach, dealing with the moral and 
spiritual causes of addiction rather than treating only the 
symptoms.
    Because of the effectiveness of these organizations, the 
Committee believe that greater participation of faith-based 
programs in treating substance abuse problems is critical, and 
that individuals, if they desire, should have greater access to 
these programs. Therefore, the Committee included in Section 
305 the ``Charitable Choice'' provision, modeled closely after 
a provision in the ``Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996,'' to encourage the 
greater involvement of religious organizations in providing 
substance abuse treatment and prevention services with 
government funding. The provision reflects the Committee's 
belief that government should exercise neutrality when inviting 
the participation of non-governmental organizations to be 
service providers by considering all organizations--even 
religious ones--on an equal basis, and by focusing on whether 
the organization can provide the requested service, rather than 
on the religious or non-religious character of the 
organization.
    Faith-based organizations have often been unwilling to 
accept governmental funds to provide social services for fear 
of having to compromise the religious character which motivates 
them to reach out to people in the first place. At the same 
time, some government officials have been unclear as to what is 
constitutionally permissible when religious organizations 
receive government funding to provide social services.
    The Charitable Choice provision clarifies the 
constitutional framework for enabling cooperation between the 
government and religious organizations, spelling out 
protections for both participating organizations and 
beneficiaries. It is the Committee's hope that these statutory 
protections will encourage successful faith-based organizations 
to expand their substance abuse treatment services while 
assuring them that they will not have to compromise their 
religious character upon receiving government funds.
    Under Charitable Choice, if a State chooses to use 
nongovernmental organizations to provide services, it may not 
discriminate on account of a provider's religious character. 
Moreover, a participating organization retains its independence 
from Federal, State, and local governments, including the 
organization's control over the definition, development, 
practice, and expression of is religious beliefs. Additionally, 
a participating religious organization cannot be required to 
alter its form of internal governance, or to remove art, icons, 
scripture, or other symbols from its premises because it is 
religious.
    One of the most important protections in Charitable Choice 
concerns the ability of religious organizations to maintain 
their autonomy over employment decisions. Many organizations, 
including groups such as the Salvation Army, have indicated 
that without such a protection, they would be unwilling to 
receive government funds to provide social services.
    The provision makes clear that a religious organization's 
receipt of government funds to provide substance abuse 
treatment services does not act as a waiver of the 
organization's current exemption from Title VII of the Civil 
Rights Act regarding employment discrimination. Title VII 
exempts religious organizations from the law's prohibition on 
employment discrimination based on religion (but does not 
exempt religious organizations from the duty not to 
discriminate based upon race, color, national origin, or sex), 
and allows religious organizations to make employment decisions 
based upon religious reasons. The Committee believes this 
protection is necessary to encourage effective religious 
organizations to apply for government funds to help individuals 
overcome substance abuse problems.
    Religious organizations are expected to use government 
funds for the secular purpose of the legislation, i.e., to 
provide effective treatment for substance abuse problems. 
Religious organizations are not allowed to use government 
contract or grant funds for religious worship, instruction, or 
proselytization. It is the understanding of the Committee that 
SAMHSA currently has sufficient enforcement ability to enforce 
this provision. However, nothing prohibits religious 
organizations from using monies received from other sources, 
such as private donations, for inherently religious activities, 
as long as beneficiary participation is voluntary.
    The Charitable Choice provision also protects the free-
exercise rights of beneficiaries, ensuring that they may not be 
discriminated against on the basis of religion, a religious 
belief, or a refusal to actively participate in a religious 
practice. Also, beneficiaries have the right to object to 
receiving services from a religious service provider and to 
demand that the State provide them with accessible services 
from an alternative provider.

Section 306. Alcohol and drug prevention and treatment services for 
        Indians and Native Alaskans

    This section is designed to address the high incidence and 
unique nature of substance abuse among Indians and Alaska 
Natives. Substance abuse in these populations results from 
distinctive social, cultural, economic and biological causes, 
and specialized and innovative approaches to prevention and 
treatment are necessary. A targeted grant program is consistent 
with the emerging national policy of self-determination, 
because it will help fund and promote programs designed by and 
for Indians and Alaska Natives in their own communities.
    The priorities were developed to ensure that entities 
receiving grants under the new Section 544 of the Public Health 
Service Act have a strong relationship with those being served 
and a clear understanding of political and cultural issues of 
the area. The Committee urges the Secretary to give 
consideration to the long-term viability of funded projects and 
the relative severity of the problems being addressed. The 
Secretary should give priority to the areas with highest need 
and should work with grantees to develop plans for long-term 
financial viability, including identifying alternate sources of 
federal funding, working with grantees to develop private 
partnerships, and locating state funding opportunities. The 
Committee encourages the Secretary to provide technical 
assistance if necessary to improve the grant-writing, 
evaluation and data collection ability of promising and 
successful applicants.
    The Commission on Indian and Native Alaskan Health Care is 
being established to take a comprehensive look at the state of 
health of Indians and Native Alaskans living on reservations, 
particularly related to mental health and substance abuse. The 
Committee expects the Commission to study current practice 
methods, evaluate their effectiveness, and identify ways 
outcomes can be improved as they relate to Indians and Native 
Alaskans. The Commission, if practical, should participate in 
the development of the performance measures being developed 
under the Substance Abuse Prevention and Treatment Block Grant 
as required under section 403 of this Act, however, the 
Committee does not expect that the development of the plan 
shall in any way be delayed because the Commission is unable to 
participate.
    Of particular concern to the Committee is the prevalence of 
substance abuse among this population, therefore we have 
required the Commission to focus first on this issue. The 
report on alcohol and drug abuse should include similar 
measurements and indicators as the report outlined in section 
545(i)(1).

Section 401. General authorities and peer review

    This section makes the position of Associate Administrator 
for Alcohol Prevention and Treatment Policy at SAMHSA optional. 
The Committee believes that the agency is committed to 
addressing alcohol abuse and alcoholism and is committed to 
having someone fulfilling the responsibilities for this 
position. Current limitations on personnel and funding for 
salaries have required the agency to combine positions and 
responsibilities in order to meet its mission and yet stay 
within the limits of personnel and salaries stipulated by 
Congress.
    The section also rewrites the current peer review 
requirements to accomplish the following: it removes mention of 
regulation since the requirement for regulations was removed in 
1993, and it raises the level for when peer review and Advisory 
Council review of grants are required from $50,000 to the 
single acquisition threshold level which is currently $100,000.

Section 402. Advisory councils

    SAMHSA, each of its three Centers and the Office of Women's 
Services are required to have an advisory council. Under 
current law each of these councils are required to meet three 
times a year. Experience over the past five years has indicated 
that these councils do not necessarily have to meet three times 
a year in order to carry out their responsibilities and 
therefore the Committee is reducing the requirement to twice a 
year. This in no way limits the Administrator from calling 
meetings more often during any one year.

Section 403. General provisions for the performance partnership block 
        grants

    This section contains two provisions, the first of which 
requires the Secretary to submit to Congress within two years 
of passage of the bill a report detailing the specifics of how 
the performance partnerships would work. The Committee 
reiterates once again its concern for the vulnerable 
populations addressed in current law and instructs the 
Secretary to make sure that the list of performance measures to 
be used include measures related to pregnant addicts, women 
with children who are addicts, intravenous drug users because 
of the relationship to HIV, tuberculosis because of increasing 
drug resistance, those with or at risk of HIV, and those with a 
co-occurring mental health and substance abuse disorder. With 
regard to mental health, the performance measures must include 
measures related to children and those with co-occurring 
disorders.
    The second provision would give the States more flexibility 
in the use of funds by permitting them to take two years to 
obligate funds. Currently the States must obligate the funds in 
the year in which they receive them.

Section 404. Data infrastructure projects

    This section creates a discretionary grant authority for 
the Secretary to give grants to States for the purposes of 
improving their data infrastructure so that each State would be 
prepared to implement a performance based system. Under the 
provision 50 percent of the funds appropriated must be used for 
mental health and 50 percent for substance abuse.
    The Committee believes that the effort to change the block 
grants into performance based systems is to the advantage of 
both the States and the federal government and that both levels 
of government should provide funding to ensure that the program 
is implemented. This provision only addresses the Federal 
contribution. The Committee looks forward to the next 
reauthorization of SAMHSA to review the level of State support 
for this effort.

Section 405. Repeal of obsolete addict referral provisions

    This section merely repeals provisions of the Narcotic 
Addict Rehabilitation Act of 1966. This Act was passed at a 
time when the Federal government ran several treatment programs 
for substance abuse which no longer exist.

Section 406. Individuals with co-occurring disorders

    While there are many different health problems that co-
occur with alcoholism and drug dependence such as HIV disease, 
heart disease, liver disease, and diabetes, the co-occurring 
diseases of alcoholism and drug dependence and mental illness 
have come to the special attention of the Committee. It has 
become increasingly clear to the Committee that many persons 
with serious mental health conditions also struggle with 
substance abuse. The illness which developed first is less 
important than the fact that the person is suffering from two 
significant problems. Many treatment providers are concerned 
that there are insufficient resources available to serve this 
populations of clients, and that there may be other obstacles 
to providing appropriate care. The Committee is impressed with 
the evidence-based research supported by the National 
Institutes of Mental Health, Alcoholism and Alcohol Abuse, and 
Drug Abuse (NIMH, NIAAA, and NIDA) that persons with co-
occurring substance abuse and mental health disorders can be 
successfully treated, frequently to a status of recovery. 
Without effective treatment, individuals with co-occurring 
disorders may become homeless or involved in the criminal 
justice system, often with their medical conditions going 
untreated. Untreated individuals may become the victims or 
perpetrators of violence and may suffer from other health and 
social problems. Investing in the treatment of these 
individuals is paramount, both to improve their quality of life 
and to reduce the costs associated with the collateral 
consequences of increased illness, incarceration, and lost 
wages from unemployment. Each of these conditions by itself is 
difficult enough to treat. But in combination, they pose major 
challenges to the mental health and substance abuse treatment 
communities. Some providers of services to this population have 
expressed their concern that funding channels present an 
unnecessary burden to them in the provision of services by 
requiring them to maintain separate accounts for each 
individual to record the substance abuse and mental health 
services provided. While the Committee is not convinced that 
these separate recording tracks are required by any Federal 
statute, it is concerned that there are some barriers to the 
provision of services to this population that must be 
addressed.
    Each of these conditions by itself is difficult enough to 
treat, therefore, this provision requires the Secretary, within 
2 years of the passage of the reauthorization, to report to the 
Senate Committee on Health, Education, Labor and Pensions and 
the House Committee on Commerce on how services are being 
provided to those with co-occurring mental health and substance 
abuse disorders. The report would identify which funds are used 
for such services, how they are used, and what obstacles to the 
receipt of such care exist, taking into account that there is a 
range of treatment options available for serving these clients, 
and different treatment options may encounter different 
obstacles. The report would also identify best practices in 
serving such individuals and make recommendations with regard 
to how to facilitate and promote the expansion of the services 
which are most effective.
    The Committee encourages the Secretary in doing the 
research and making recommendations with regard to services for 
those with a co-occurring disorder that the Secretary look at 
obstacles that might exist with regard to all sources of 
funding and not just federal funds under the Substance Abuse 
Prevention and Treatment and the Community Mental Health 
Services Block Grants. The Committee also encourages the 
Secretary to examine obstacles that do not result from sources 
of funding, such as program certification requirements, and 
auditing and reporting requirements. In addition, we encourage 
the Secretary to consult with the States, community-based 
providers, and consumer representatives in the development to 
the report.
    The Committee commends SAMHSA for its position statement of 
June 11, 1999, which recognizes that SAMHSA rules and 
procedures should not be undue barriers to the provision of 
services, especially integrated treatment, for persons with co-
occurring disorders. The Committee is encouraged that SAMHSA is 
committed to providing technical assistance for States to more 
effectively use block grant funds for serving such individuals. 
We continue to believe that SAMHSA funded services should be 
based on evidence-based practice, and applaud the dedication of 
the treatment community to adopting these practices, wherever 
possible. The Committee also thanks the State mental health and 
substance abuse directors, community-based alcohol and drug and 
mental health organizations, and consumer advocates for 
educating the Committee about the importance of providing 
appropriate services to individuals with co-occurring disorders 
and for sharing information about both the barriers and 
successes associated with providing these services.

Section 407. Services for individuals with co-occurring disorder

    This provision reiterates current law that a State may use 
funds from the Substance Abuse Prevention and Treatment and the 
Community Mental Health Services Block Grants to provide 
services for those who have a serious mental illness as defined 
in accordance with section 1912(c) of the Public Health Service 
Act on the condition that funds available under these programs 
are used in accordance with the statutory and regulatory 
guidance which govern their use.
    The Secretary shall ensure that the reporting and auditing 
requirements of the Substance Abuse Prevention and Treatment 
(SAPT) Block Grant and the Community Mental Health Services 
(CMHS) Block Grant do not present an undue barrier to providing 
comprehensive treatment services to people with co-occurring 
mental health and substance abuse disorders. Co-occurring 
disorders should be conceptualized in terms of symptom 
multiplicity and severity rather than specific diagnosis, 
thereby encompassing the full range of people who have co-
occurring mental health and substance abuse disorders. 
Appropriate levels of coordination--including consultation, 
collaboration, and/or integration--are needed to improve 
consumer outcomes.
    There is no single set of treatment interventions that 
constitute integrated treatment for people with severe or other 
levels of co-occurring substance abuse and mental health 
disorders. Integrated treatment includes an array of 
appropriate substance abuse and mental health interventions 
identified in a single treatment plan based on an individual's 
needs and appropriate clinical standards and provided or 
coordinated by a single treatment team.
    The National Association of State Mental Health Program 
Directors and the National Association of State Alcohol and 
Drug Abuse Directors, with the support of SAMHSA, have 
developed a conceptual framework for the delivery of 
coordinated care, including but not limited to integrated 
treatment, to people with co-occurring disorders. SAMHSA should 
continue to be guided by and support this framework in joint 
federal and State efforts to facilitate the delivery of the 
most effective services to this population.

                            V. Cost Estimate

    Because of time constraints the Congressional Budget Office 
cost estimate will appear in the Congressional Record.

                    VI. Regulatory Impact Statement

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

                    VII. Section-by-Section Analysis


                   TITLE I--CHILDREN AND ADOLESCENTS

    Section 101 authorizes the Secretary to make grants to 
public entities in consultation with the Attorney General and 
the Secretary of Education to assist local communities in 
developing ways to assist children in dealing with violence. 
The section also authorizes the Secretary to develop knowledge 
with regard to evidence-based practices for treating 
psychiatric disorders resulting from witnessing or experiencing 
domestic, school and community violence and terrorism.
    Section 103 authorizes the Secretary to use up to 3% of the 
funds appropriated for discretionary grants for responding to 
emergencies. The authority would permit an objective review 
instead of peer review. This would permit an expedited process 
for making awards. The Secretary is required to define an 
emergency in the Federal Register subject to public comment. 
The section also includes language that provides additional 
confidentiality protection for the information collected from 
individuals who participate in national surveys conducted by 
the Substance Abuse and Mental Health Services Administration.
    Section 102 reauthorizes the High Risk Youth Program which 
provides funds to public and non-profit private entities to 
establish programs for the prevention of drug abuse among high 
risk youth.
    Section 104 authorizes four new programs. The first 
authorizes the Secretary to make grants, contracts or 
cooperative agreements to public and non-profit private 
entities for the purpose of providing substance abuse treatment 
services for children and adolescents. The second authorizes 
the Secretary to make grants, contracts or cooperative 
agreements to public and non-profit private entities including 
local educational agencies for the purposes of providing early 
intervention substance abuse services for children and 
adolescents. The third authorizes centers to assist States and 
local jurisdictions in providing appropriate care for 
adolescents who are involved with the juvenile justice system 
and have a serious emotional disturbance. The last program 
authorizes the Secretary to make grants, contracts, or 
cooperative agreements to carry out school based as well as 
community based programs to prevent the use of methamphetamine 
and inhalants.
    Section 105 reauthorizes the Comprehensive Community 
Services for Children with Serious Emotional Disturbance 
program which provides seed money to local communities to 
develop systems of care for children with serious emotional 
disturbances thus improving the quality of care and increasing 
the likelihood that these children would remain in local 
communities rather than being sent to residential facilities. 
This section provides authority for the Secretary to waive 
certain requirements for territories and American Indian 
tribes. This section also would extend grants under this 
program from 5 to 6 years. The intent of the program is to 
provide seed funding for comprehensive systems of care.
    Section 106 transfers the Children of Substance Abusers Act 
from Health Resources and Services Administration (HRSA) to 
SAMHSA. The section is updated to include changes that have 
occurred since its original enactment in connection to the 
Temporary Assistance for Needy Families (TANF) and the 
Children's Health Insurance Program (CHIP) programs.
    Sdction 107 authorizes for the Secretary to make grants, 
contracts or cooperative agreements to State and local juvenile 
justice agencies to help such agencies provide aftercare 
services for youth offenders who have or are at risk of a 
serious emotional disturbance and who have been discharged from 
juvenile justice facilities.
    Section 108 amends the sections that establish the 
responsibilities of the Centers for Substance Abuse Treatment, 
Substance Abuse Prevention and the Mental Health Services to 
include an emphasis on children. In the case of the Center for 
Mental Health Services, the Director is required to collaborate 
with the Attorney General and the Secretary of Education on 
programs that assist local communities in developing programs 
to address violence among children in schools.

                        TITLE II--MENTAL HEALTH

    Section 201 of the bill repeals sections 303, 520A and 520B 
of the Public Health Service Act and section 612 of the Stewart 
B. McKinney Act, in favor of a broad authority that gives the 
Secretary more flexibility to respond to individuals in need of 
mental health services. It would authorize four types of 
grants: (1) Knowledge development and application grants which 
are used to develop more information on how best to serve those 
in need; (2) training grants to disseminate the information 
that the agency garners through its knowledge development; (3) 
targeted capacity response which enables the agency to respond 
to service needs in local communities; and (4) systems change 
grants and grants to support family and consumer networks in 
States. This section includes a provision that would permit 
$6,000,000 of the first $100,000,000 appropriated to the 
program and 10 percent of all funds above $100,000,000 to be 
given competitively to States to assist them in developing data 
infrastructures for collecting and reporting on performance 
measures.
    Section 202 reauthorizes the Grants for the Benefit of 
Homeless Individuals program which provides funds to develop 
and expand mental health and substance abuse treatment services 
to homeless individuals and gives priority in the awarding of 
grants to programs which also provide for primary health care, 
have experience in providing mental health and substance abuse 
services and who serve homeless youth.
    Section 203 reauthorizes the Projects for Assistance in 
Transition from Homelessness program which provides funds to 
States under a formula for the provision of mental health 
services to homeless individuals.
    Section 204 provides funds for the States to provide 
community based mental health services for adults with a 
serious mental illness and children with a serious emotional 
disturbance. In this section, the number of elements that 
States must include in their plan for use of CMHS Block Grant 
funds are reduced from 12 to 5. This section also expands the 
responsibilities of the already existing State Planning 
Councils by requiring them to review and comment on State 
reports on the outcomes of their activities. This section 
includes a provision that would exempt from maintenance of 
effort requirements any one time infusion of funds which are 
for a singular purpose.
    Section 205 makes permanent minimum allotment requirements 
for the formula for distribution of the Community Mental Health 
Services Block Grant in Public Law 105-277.
    Section 206 extends the authorization of the Protection and 
Advocacy for the Mentally Ill Individuals Act of 1986 through 
fiscal year 2002 and makes technical changes to the formula for 
distribution of funds under this program to correct a provision 
that would have inappropriately reduced minimum State 
allotments. This section permits an American Indian Consortia 
to receive direct funding after the appropriation exceeds $25 
million. It would also extend the responsibilities of the 
Protection and Advocacy program to individuals living in 
communities when the appropriation exceeds $30 million.
    Section 207 requires facilities that are both within the 
purview of the Protection and Advocacy program and which 
receive appropriated funding from the Federal government to 
protect and promote the rights of individuals with regard to 
the appropriate use of seclusion and restraints.

                       title iii--substance abuse

    Section 301 of the bill repeals sections 508, 509, 510, 
511, 512, 571 and 1971 of the Public Health Service Act, in 
favor of a broad authority that gives the Secretary more 
flexibility to respond to individuals in need of substance 
abuse treatment. It would authorize three types of grants: (1) 
knowledge development and application grants which are used to 
develop more information on how best to serve those in need; 
(2) training grants to disseminate the information that the 
agency garners through its knowledge development; and (3) 
targeted capacity response which enables the agency to respond 
to services needs in local communities.
    Section 302 repeals sections 516 and 518 of the Public 
Health Service Act in favor of a broad authority that gives the 
Secretary more flexibility under SAMHSA's general authority 
(Section 501) instead of specific programs in responding to 
individuals in need of substance abuse prevention. It would 
authorize three types of grants: (1) knowledge development and 
application grants which are used to develop more information 
on how best to serve those in need; (2) training grants to 
disseminate the information that the agency garners through its 
knowledge development; and (3) targeted capacity response which 
enables the agency to respond to services needs in local 
communities.
    Section 303 provides funds to States for their use in 
providing substance abuse prevention and treatment services. 
This provision would begin the process of giving States greater 
flexibility in their use of funds and accountability based on 
performance instead of expenditures. Greater flexibility is 
enhanced by the repeal of a requirement that States spend 35 
percent of their allotment on drug related activities and 35 
percent on alcohol related activities. A provision requiring 
States to maintain a $100,000 revolving fund to support homes 
for persons recovering from substance abuse would be made 
optional thus permitting States to continue such efforts or to 
use those funds for other services as they deem necessary. 
States are permitted to use funds for screening and testing of 
conditions such as HIV and hepatitis C. They are given the 
latitude to develop a comprehensive treatment program for 
individuals coming into the substance abuse treatment system. 
This section also creates authority for the Secretary to waive 
certain requirements for States who meet established criteria. 
Those criteria would be established in regulation after 
consultation with the States, providers and consumers. This 
section includes a provision that would exempt from maintenance 
of effort requirements any one time infusion of funds which are 
for a singular purpose.
    Section 304 makes permanent minimum growth and small state 
minimums which were adopted for the formula for distribution of 
the Substance Abuse Prevention and Treatment Block Grant in 
Public Law 105-277.
    Section 305 permits religious organizations to receive 
federal assistance either through the Substance Abuse 
Prevention and Treatment Block Grant or discretionary grants 
through the Substance Abuse and Mental Health Services 
Administration to provide substance abuse services while 
maintaining their religious character, including retaining 
autonomy over employment decisions.
    Section 306 authorizes the Secretary to make grants, 
contracts or cooperative agreements with public and private 
non-profit private entities including American Indian tribes 
and tribal organizations and native Alaskans for the purpose of 
providing alcohol and drug prevention or treatment services for 
Indians and Native Alaskans. This section also establishes a 
Commission on Indian and Native Alaskan Health Care that shall 
carry out a comprehensive examination of the health concerns of 
Indians and Native Alaskans living on reservations or tribal 
lands.

                title iv--flexibility and accountability

    Section 401 of the bill removes the requirement that there 
be an Associate Administrator for Alcohol Policy, and makes 
necessary corrections to the peer review requirements.
    Section 402 reduces the number of times the advisory 
councils meet each year for each of the centers and SAMHSA from 
three times to two.
    Section 403 requires the Secretary to submit to Congress 
within two years a plan on how what the performance based 
programs under the CMHS and SAPT Block Grants would operate. 
This plan would include how the States would receive greater 
flexibility, what performance measures would be used in holding 
States accountable, definitions for the data elements that 
would be collected, the funds needed to implement this system 
and where those funds would come from, and needed legislative 
changes. The committees of jurisdiction are given one year to 
consider the plan and implement any necessary changes in the 
next reauthorization of SAMHSA in 2002.
    Section 404 creates an authority for the Secretary to make 
grants to States to assist them in developing the data 
infrastructure necessary to implement a performance based 
system.
    Section 405 repeals certain obsolete provisions of the 
Narcotic Addict Rehabilitation Act of 1966.
    Section 406 requires the Secretary to report to the 
committees of jurisdiction on how services are currently being 
provided to those with a co-occurring mental health and 
substance abuse disorders, what improvements are needed to 
ensure that they receive the services they need, and a summary 
of best practices on how to provide those services including 
prevention of substance abuse among individuals who have a 
mental illness and treatment for those with a co-occurring 
disorder.
    Section 407 clarifies that both Substance Abuse Prevention 
and Treatment and Community Mental Health Service Block Grant 
funds may be used to provide services to those with co-
occurring mental health and substance abuse disorders as long 
as substance abuse funds are used for the substance abuse 
aspect of treatment and the mental health funds are used for 
the mental health aspect of treatment.

                         VIII. Additional Views

Nondiscrimination and institutional safeguards for religious providers
    We agree with the Majority that faith-based organizations 
have an important and necessary role to play in combating many 
of our Nation's social ills, including youth violence, 
homelessness, and substance abuse. In fact, we have seen first-
hand the impact that faith-based organizations such as Catholic 
Charities have on delivering certain services to people in 
need. By enabling faith-based organizations to join in the 
battle against substance abuse, we add another powerful tool in 
our ongoing efforts to help people move from dependence to 
independence.
    However, we were very disappointed that the committee chose 
to include in Section 305 the ``Charitable Choice'' provision 
that would permit all religious institutions, including 
pervasively religious organizations, such as churches and other 
houses of worship, to use taxpayer dollars to advance their 
religious mission. Given the Supreme Court precedent we believe 
this provision is Constitutionally suspect.
    Although charitable choice has already become law as a part 
of welfare reform and the Community Services Block Grant (CSBG) 
portion of the Human Services Reauthorization Act, efforts are 
being made to expand charitable choice to every program that 
receives federal financial assistance. The inclusion of 
charitable choice in this legislation is particularly 
disturbing since, unlike its application to the intermittent 
services provided under Welfare Reform and CSBG, Substance 
Abuse and Mental Health Services Administration (SAMHSA) funds 
are used to provide substance abuse treatment which is ongoing 
and involves direct counseling of beneficiaries. In the context 
of these programs it would be difficult if not impossible to 
segregate religious indoctrination from the social service.
    In addition, as the 1998 GAO Report on drug abuse treatment 
stated, ``Regardless of how faith-based treatment is defined, 
there has not been sufficient research to determine the results 
of this type of treatment.''
    As Dr. Alan Leshner, Director of the National Institute on 
Drug Abuse, reported to the Committee last year, ``the many 
advances in our scientific understanding of drug abuse have 
revolutionized the medical care of those who are addicted. 
These advances have helped us to understand addiction as a 
chronic illness caused by the effects of prolonged drug use on 
the brain, contributed to the development of numerous 
effective, science-based, and tested treatments, and helped to 
dispel the belief that addiction is a moral failing.'' \1\
---------------------------------------------------------------------------
    \1\ Senate Hearing Rpt. 105-645, ``Substance Abuse: The Science of 
Addiction and Options for Treatment,'' July 28, 1998.
---------------------------------------------------------------------------
    These findings lead the Minority to believe that successful 
substance abuse programs must have a strong link to clinical 
care and that treatment for addiction should be based on the 
latest scientific information to ensure the best possible care. 
The Minority also believes that more peer-reviewed research 
should be conducted to evaluate the effectiveness of programs 
involving untrained non-scientific methods and that clear 
scientific information be provided when claims are made 
regarding the effectiveness of such programs.
    In addition, the Minority is also deeply disappointed that 
language was included in the bill that creates a new avenue for 
employment discrimination and proselytization in programs 
funded by SAMHSA. Under current law, many religiously-
affiliated nonprofit organizations already provide government-
funded social services without employment discrimination and 
without proselytization. However, the legislation extends title 
VII's religious exemption to cover the hiring practices of 
organizations participating in SAMHSA funded programs. As the 
Majority's report language points out, even if the organization 
is solely funded by SAMHSA, they may ``make employment 
decisions based upon religious reasons.''
    So, for example, a federally funded substance abuse 
treatment program run by a church could fire or refuse to hire 
an individual who has remarried without properly validating his 
or her second marriage, in the eyes of that church--even if he 
or she is a well-trained and successful substance abuse 
counselor.
    This is not an entirely hypothetical example. In Little v. 
Wuerl, 929 F.2d 944 (3d Circ. 1991) the Court held that 
``Congress intended the explicit exemptions to title VII to 
enable religious organizations to create and maintain 
communities composed solely of individuals faithful to their 
doctrinal practices, whether or not every individual plays a 
direct role in the organization's religious activities.'' The 
Court concluded that ``the permission to employ persons of `a 
particular region' includes permission to employ only persons 
whose beliefs and conduct are consistent with the employer's 
religious precepts.'' This may be acceptable when the religious 
organization is using its own money, but when it is using 
federal funds, with explicit prohibitions against 
proselytization, this kind of discrimination is objectionable.
    Thus, while there are great benefits that come with 
allowing religious organizations to provide social services 
with federal funds, as the Vice President recently reminded us, 
``clear and strict safeguards'' must exist to ensure that the 
dividing line between church and state is not erased.
    Even the front runner for the Republican Presidential 
nomination, Governor George W. Bush, acknowledged to the New 
York Times that these safeguards are necessary: ``Bush said . . 
. that federal money would pay for services delivered by faith-
based groups, not for the religious teachings espoused by the 
groups.'' \2\
---------------------------------------------------------------------------
    \2\ New York Times, July 22, 1999.
---------------------------------------------------------------------------
    In view of these concerns, we were disappointed that the 
Majority chose to vote against including these important 
safeguards proposed in an amendment to section 305 by Senators 
Reed and Kennedy.
    First, the Reed-Kennedy amendment would have removed the 
provision of the bill that allows religious organizations to 
require that employees hired for SAMHSA funded programs must 
subscribe to the organization's religious tenets and teachings. 
Since section 305 prohibits religious organizations from 
proselytizing in conjunction with the dissemination of social 
services under SAMHSA programs, we believe it is contradictory 
to permit religious organizations to require that their 
employees subscribe to the organization's tenets and teachings. 
Second, the amendment would have eliminated the bill's 
provision that extends title VII's religious exemption to cover 
the hiring practices of organizations participating in SAMHSA 
funded programs.
    Ultimately, the modest proposal offered by Senators Reed 
and Kennedy would not have reduced the ability of religious 
groups to hire co-religionists. It merely would have eliminated 
the explicit ability to discriminate in taxpayer funded 
employment and left to the courts the decision of whether 
employees who work on, or are paid through, government grants 
or contracts are exempt from the prohibition on religious 
employment discrimination.
    Without these safeguards, well-intentioned proposals to 
help religious organizations aid needy populations, might 
actually harm the First Amendment's principle of separation of 
church and state.
    For the last 30 years, federal civil rights laws have 
expanded employment opportunities and sought to counter 
discrimination in the workplace. We recognize that we need the 
assistance of religious organizations in the battle against 
substance abuse, but we don't need--nor should we tolerate--the 
federal government endorsing discrimination and 
proselytization.
    We are disappointed with the Majority report language 
particularly because we believe religious organizations are 
helpful allies in the battle against substance abuse. However, 
it is our view that we should enlist the assistance of such 
organizations without undermining constitutional principles and 
civil rights law. Accordingly, we are concerned that the 
charitable choice provision, though laudable in concept, would 
have disturbing practical and constitutional consequences.

                                   Edward Kennedy.
                                   Chris Dodd.
                                   Tom Harkin.
                                   Jeff Bingaman.
                                   Jack Reed.
                                   Barbara A. Mikulski.
                                   Patty Murray.

                      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

           *       *       *       *       *       *       *


    Section 1. [201 note] * * *

           *       *       *       *       *       *       *

    [Section 303 of the Public Health Service Act is repealed]

           *       *       *       *       *       *       *

    [Part E of title III of the Obsolete Public Health Service 
Act Authorities is repealed.]

          [Part L--Services for Children of Substance Abusers]


SEC. 399D. [280D] GRANTS FOR SERVICES FOR CHILDREN OF SUBSTANCE 
                    ABUSERS.

    (a) Establishment.--
          (1) In general.--The Secretary, acting through the 
        [Administrator of the Health Resources and Services 
        Administration] Administrator of the Substance Abuse 
        and Mental Health Services Administration shall make 
        grants to public and nonprofit private entities for the 
        purpose of carrying out programs--

           *       *       *       *       *       *       *

                  (B) to provide the applicable services 
                described in subsection (c) to families in 
                which a member is a substance abuser; [and]
                  (C) to identify such children and such 
                families[.] through youth service agencies, 
                family social services, child care providers, 
                Head Start, schools and after-school programs, 
                early chldhood development programs, community-
                based family resource and support centers, the 
                criminal justice system, health, substance 
                abuse and mental health providers through 
                screenings conducted during regular childhood 
                examinations and other examinations, self and 
                family member referrals, substance abuse 
                treatment services, and other providers of 
                services to children and families; and
                  (D) to provide education and training to 
                health, substance abuse and mental health 
                professionals, and other providers of services 
                to children and families through youth service 
                agencies, family social services, child care, 
                Head Start, schools and after-school programs, 
                early childhood development programs, 
                community-based family resource and support 
                centers, the criminal justice system, and other 
                providers of services to children and families.
          (2) Administrative consultations.--The Administrator 
        of the Administration for Children, Youth, and Families 
        and the [Administrator of the Substance Abuse and 
        Mental Health Services Administration] Administrator of 
        the Health Resources and Services Administration shall 
        be consulted regarding the promulgation of program 
        guidelines and funding priorities under this section.
          (3) Requirement of status as medicaid provider.--
                  (A) * * *

           *       *       *       *       *       *       *

                          [(i) the entity] (i)(I) the entity 
                        involved will provide the service 
                        directly, and the entity has entered 
                        into a participation agreement under 
                        the State plan and is qualified to 
                        receive payments under such plan; or
                          [(ii) the entity] (II) the entity 
                        will enter into an agreement with an 
                        organization under which the 
                        organization will provide the service, 
                        and the organization has entered into 
                        such a participation agreement and is 
                        qualified to receive such payments[.] ; 
                        and
                          (ii) the entity will identify 
                        children who may be eligible for 
                        medical assistance under a State 
                        program under title XIX or XXI of the 
                        Social Security Act.

           *       *       *       *       *       *       *

    (b) * * *

           *       *       *       *       *       *       *

          (1) Periodic evaluation of children for 
        developmental, psychological, alcohol and drug, and 
        medical problems.

           *       *       *       *       *       *       *

          [(5) Preventive counseling services.]
          (5) Developmentally and age-appropriate drug and 
        alcohol early intervention, treatment and prevention 
        services.

           *       *       *       *       *       *       *

        Services shall be provided under paragraphs (2) through 
        (8) by a public health nurse, social worker, or similar 
        professional, or by a trained worker from the community 
        who is supervised by a professional, or by an entity, 
        where the professional or entity provides assurances 
        that the professional or entity is licensed or 
        certified by the State if required and is complying 
        with applicable licensure or certification 
        requirements.
    (c) * * *

           *       *       *       *       *       *       *

          (1) Services as follows, to be provided by a public 
        health nurse, social worker, or similar professional, 
        or by a trained worker from the community who is 
        supervised by a professional, or by an entity, where 
        the professional or entity provides assurances that the 
        professional or entity is licensed or certified by the 
        State if required and is complying with applicable 
        licensure or certification requirements:

           *       *       *       *       *       *       *

                  (D) Aggressive outreach to family members 
                with substance abuse problems.
                  (E) Inclusion of consumer in the development, 
                implementation, and monitoring of Family 
                Services Plan.
          (2) In the case of substance abusers:
                  [(A) Encouragement and, where necessary, 
                referrals to participate in appropriate 
                substance abuse treatment.]
                  (A) Alcohol and drug treatment services, 
                including screening and assessment, diagnosis, 
                detoxification, individual, group and family 
                counseling, relapse prevention, pharmacotherapy 
                treatment, after-care services, and case 
                management.

           *       *       *       *       *       *       *

                  (C) Consultation and referral regarding 
                subsequent pregnancies and life options[, 
                including education and career planning] and 
                counseling on the human immunodeficiency virus 
                and acquired immune deficiency syndrome.
                  (D) Where appropriate, counseling regarding 
                family [conflict and] violence.
                  (E) [Remedial] Career planning and education 
                services.

           *       *       *       *       *       *       *

          (3) * * *

           *       *       *       *       *       *       *

                  (D) Parenting education services and parent 
                support groups which include child abuse and 
                neglect prevention techniques.

           *       *       *       *       *       *       *

    (d) Training for Providers of Services to Children and 
Families.--The Secretary may make a grant under subsection (a) 
for the training of health, substance abuse and mental health 
professionals and other providers of services to children and 
families through youth service agencies, family social 
services, child care providers, Head Start, schools and after-
school programs, early childhood development programs, 
community-based family resource centers, the criminal justice 
system, and other providers of services to children and 
families. Such training shall be to assist professionals in 
recognizing the drug and alcohol problems of their clients and 
to enhance their skills in identifying and understanding the 
nature of substance abuse, and obtaining substance abuse early 
intervention, prevention and treatment resources.
    [(d) Considerations in Making Grants.--In making grants 
under subsection (a), the Secretary shall ensure that the 
grants are reasonably distributed among the following types of 
entities:]
    (e) Eligible Entities.--The Secretary shall distribute the 
grants through the following types of entities:
          (1) Alcohol and [drug treatment] drug early 
        intervention, prevention or treatment programs, 
        especially those providing treatment to pregnant women 
        and mothers and their children.

           *       *       *       *       *       *       *

                  (A) expertise in applying the services to the 
                particular problems of substance abusers and 
                the children of substance abusers; [and]; or
                  (B) an affiliation or contractual 
                relationship with one or more substance abuse 
                treatment programs or pediatric health or 
                mental health providers and family mental 
                health providers.

           *       *       *       *       *       *       *

    [(e)](f) Federal Share.--The Federal share of a program 
carried out under subsection (a) shall be 90 percent. The 
Secretary shall accept the value of in-kind contributions, 
including facilities and personnel, made by the grant recipient 
as a part or all of the non-Federal share of grants.
    [(f) Coordination With Other Providers.--The Secretary may 
make a grant under subsection (a) only if the applicant 
involved agrees to coordinate its activities with those of the 
State lead agency, and the State Interagency Coordinating 
Council, under part H of the Individuals with Disabilities 
Education Act.]

           *       *       *       *       *       *       *

    (g) * * *

           *       *       *       *       *       *       *

          (2) a description of the mechanism that will be used 
        to involve the local public agencies responsible for 
        health, including maternal and child health, mental 
        health, child welfare, education, juvenile justice, 
        developmental disabilities, and substance abuse 
        [treatment programs] in planning and providing services 
        under this section, as well as evidence that the 
        proposal has been coordinated with the State agencies 
        responsible for administering those programs [and the 
        State agency responsible for administering public 
        maternal and child health services;], the State agency 
        responsible for administering alcohol and drug 
        programs, the State lead agency, and the State 
        Interagency Coordinating Council under part H of the 
        Individuals with Disabilities Education Act; and
          [(3) information demonstrating that the applicant has 
        established a collaborative relationship with child 
        welfare agencies and child protective services that 
        will enable the applicant, where appropriate, to--
                  [(A) provide advocacy on behalf of substance 
                abusers and the children of substance abusers 
                in child protective services cases;
                  [(B) provide services to help prevent the 
                unnecessary placement of children in substitute 
                care; and
                  [(C) promote reunification of families or 
                permanent plans for the placement of the child; 
                and]
          [(4)] (3) such other information as the Secretary 
        determines to be appropriate.

           *       *       *       *       *       *       *

    (i) * * *

           *       *       *       *       *       *       *

                  (B) the number of children served who 
                remained with their parents during the period 
                in which entities provided services under this 
                section; and
                  [(C) the number of children served who were 
                placed in out-of-home care during the period in 
                which entities provided services under this 
                section;
                  [(D) the number of children described in 
                subparagraph (C) who were reunited with their 
                families; and
                  [(E) the number of children described in 
                subparagraph (C) for whom a permanent plan has 
                not been made or for whom the permanent plan is 
                other than family reunification;]
                  (C) the number of case workers or other 
                professionals trained to identify and address 
                substance abuse issues.

           *       *       *       *       *       *       *

    (j) Requirement of Application.--The Secretary may make any 
grant under subsection (a) only if--

           *       *       *       *       *       *       *

          (2) the application contains the agreements required 
        in this section and the information required in 
        subsection [(h)] (i); and

           *       *       *       *       *       *       *

    [(k) Peer Review.--
          [(1) Requirement.--In making determinations for 
        awarding grants under subsection (a), the Secretary 
        shall rely on the recommendations of the peer review 
        panel established under paragraph (2).
          [(2) Composition.--The Secretary shall establish a 
        review panel to make recommendations under paragraph 
        (1) that shall be composed of--
                  [(A) national experts in the fields of 
                maternal and child health, substance abuse 
                treatment, and child welfare; and
                  [(B) representatives of relevant Federal 
                agencies, including the Health Resources and 
                Services Administration, the Substance Abuse 
                and Mental Health Services Administration, and 
                the Administration for Children, Youth, and 
                Families.
    [(l)](k) Evaluations.--The Secretary shall periodically 
conduct evaluations to determine the effectiveness of programs 
supported under subsection (a)--

           *       *       *       *       *       *       *

          (3) in promoting better utilization of health and 
        developmental services and improving the health, 
        developmental, and psychological status of children 
        receiving services under the program; and
          (4) in improving parental and family functioning[;], 
        including increased participation in work or 
        employment-related activities and decreased 
        participation in welfare programs.
          [(5) in reducing the incidence of out-of-home 
        placement for children whose parents receive services 
        under the program; and
          [(6) in facilitating the reunification of families 
        after children have been placed in out-of-home care.]
    [(m)] (l) Report to Congress.--Not later than 2 years after 
the date on which amounts are first appropriated under 
subsection (o), the Secretary shall prepare and 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 that contains a description 
of programs carried out under this section. At a minimum, the 
report shall contain--

           *       *       *       *       *       *       *

          (2) information concerning the type and use of 
        services offered; and
          (3) information concerning--
                  (A) the number and characteristics of 
                families, parents, and children served; and
                  (B) the number of children served who 
                remained with their parents during or after the 
                period in which entities provided services 
                under this section[;].
                  [(C) the number of children served who were 
                placed in out-of-home care during the period in 
                which entities provided services under this 
                section;
                  [(D) the number of children described in 
                subparagraph (C) who were reunited with their 
                families; and
                  [(E) the number of children described in 
                subparagraph (C) who were permanently placed in 
                out-of-home care;
        analyzed by the type of entity described in subsection 
        [(d)] (e) that provided services;
          [(4) an analysis of the access provided to, and use 
        of, related services and alcohol and drug treatment 
        through programs carried out under this section; and
          [(5) a comparison of the costs of providing services 
        through each of the types of entities described in 
        subsection [(d)] (e).
    [(n)] (m) Data Collection.--The Secretary shall 
periodically collect and report on information concerning the 
numbers of children in substance abusing families, including 
information on the age, gender and ethnicity of the children, 
the composition and income of the family, and the source of 
health care finances. The periodic report shall include a 
quantitative estimate of the prevalence of alcohol and drug 
problems in families involved in the child welfare system, the 
barriers to treatment and prevention services facing these 
families, and policy recommendations for removing the 
identified barriers, including training for child welfare 
workers.
    [(o)](n) Definitions.--For purposes of this section:

           *       *       *       *       *       *       *

                  (B) children who have been prenatally exposed 
                to alcohol or other [dangerous] drugs.

           *       *       *       *       *       *       *

    [(p) Funding.--
          [(1) 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.
          [(2) Contingent authority regarding training of 
        certain individuals.--Of the amounts appropriated under 
        paragraph (1) for a fiscal year in excess of 
        $25,000,000, the Secretary may make available not more 
        than 15 percent for the training of health care 
        professionals and other personnel (including child 
        welfare providers) who provide services to children and 
        families of substance abusers.]
    (o) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $50,000,000 for fiscal year 2000, and such sums as 
may be necessary for each of fiscal years 2001 and 2002.

           *       *       *       *       *       *       *


   TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION


              Part A--Organization and General Authorities


SEC. 501. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION.

    (a) Establishment.--* * *

           *       *       *       *       *       *       *

    (e) Associate Administrator for Alcohol Prevention and 
Treatment Policy.--
          [(1) In general.--There shall be in the 
        Administration an Associate Administrator for Alcohol 
        Prevention and Treatment Policy to whom the 
        Administrator shall delegate the functions of 
        promoting, monitoring, and evaluating service programs 
        for the prevention and treatment of alcoholism and 
        alcohol abuse within the Center for Substance Abuse 
        Prevention, the Center for Substance Abuse Treatment, 
        and the Center for Mental Health Services, and 
        coordinating such programs among the Centers, and among 
        the Centers and other public and private entities. The 
        Associate Administrator also shall ensure that alcohol 
        prevention, education, and policy strategies are 
        integrated into all programs of the Centers that 
        address substance abuse prevention, education, and 
        policy, and that the Center for Substance Abuse 
        Prevention addresses the Healthy People 2000 goals and 
        the National Dietary Guidelines of the Department of 
        Health and Human Services and the Department of 
        Agriculture related to alcohol consumption.]
          (1) In general.--There may be in the Administration 
        an Associate Administrator for Alcohol Prevention and 
        Treatment Policy to whom the Administrator may delegate 
        the functions of promoting, monitoring, and evaluating 
        service programs for the prevention and treatment of 
        alcoholism and alcohol abuse within the Center for 
        Substance Abuse Prevention, the Center for Substance 
        Abuse Treatment and the Center for Mental Health 
        Services, and coordinating such programs among the 
        Centers, and among the Centers and other public and 
        private entities. The Associate Administrator also may 
        ensure that alcohol prevention, education, and policy 
        strategies are integrated into all programs of the 
        Centers that address substance abuse prevention, 
        education, and policy, and that the Center for 
        Substance Abuse Prevention addresses the Healthy People 
        2010 goals and the National Dietary Guidelines of the 
        Department of Health and Human Services and the 
        Department of Agriculture related to alcohol 
        consumption.

           *       *       *       *       *       *       *


   TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION


              Part A--Organization and General Authorities


SEC. 501. [290AA] SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 
                    ADMINISTRATION.

    (a) * * *

           *       *       *       *       *       *       *

    (m) Emergency Response.--
          (1) In general.--Notwithstanding section 504 and 
        except as provided in paragraph (2), the Secretary may 
        use not to exceed 3 percent of all amounts appropriated 
        under this title for a fiscal year to make 
        noncompetitive grants, contracts or cooperative 
        agreements to public entities to enable such entities 
        to address emergency substance abuse or mental health 
        needs in local communities.
          (2) Exceptions.--Amounts appropriated under part C 
        shall not be subject to paragraph (1).
          (3) Emergencies.--The Secretary shall establish 
        criteria for determining that a substance abuse or 
        mental health emergency exits and publish such criteria 
        in the Federal Register prior to prior to providing 
        funds under this subsection.
    (n) Limitation on the Use of Certain Information.--No 
information, if an establishment or person supplying the 
information or described in it is identifiable, obtained in the 
course of activities undertaken or supported under this title 
may be used for any purpose other than the purpose for which it 
was supplied unless such establishment or person has consented 
(as determined under regulations of the Secretary) to its use 
for such other purpose. Such information may not be published 
or released in other form if the person who supplied the 
information or who is described in it is identifiable unless 
such person has consented (as determined under regulations of 
the Secretary) to its publication or release in other form.
    [(m)] (o) Authorization of Appropriations.--For the purpose 
of providing grants, cooperative agreements, and contracts 
under this section, there are authorized to be appropriated 
$25,000,000 for fiscal year [1993, and such sums as may be 
necessary for fiscal year 1994.] 2000, and such sums as may be 
necessary for each of the fiscal years 2001 and 2002.

           *       *       *       *       *       *       *


                           advisory councils

    Sec. 502. (a) Appointment.--

           *       *       *       *       *       *       *

    (e) Meetings.--An advisory council shall meet at the call 
of the chairperson or upon the request of the Administrator or 
Director of the Administration or Center for which the advisory 
council is established, but in no event less than [3 times] 2 
times during each fiscal year. The location of the meetings of 
each advisory council shall be subject to the approval of the 
Administrator or Director of Administration or Center for which 
the council was established.

           *       *       *       *       *       *       *


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

    (a) In General.--Not later than 2 years after the date of 
enactment of this section, the Secretary shall, after 
consultation with organizations representing States, mental 
health and substance abuse treatment providers, prevention 
specialists, individuals receiving treatment services, and 
family members of such individuals, prepare and submit to the 
Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Commerce of the House of 
Representatives, a report on prevention and treatment services 
for individuals who have co-occurring mental illness and 
substance abuse disorders.
    (b) Report Content.--The report under subsection (a) shall 
be based on data collected from existing Federal and State 
surveys regarding the treatment of co-occurring mental illness 
and substance abuse disorders and shall include--
          (1) a summary of the manner in which individuals with 
        co-occurring disorders are receiving treatment, 
        including the most up-to-date information available 
        regarding the number of children and adults with co-
        occurring mental illness and substance abuse disorders 
        and the manner in which funds provided under sections 
        1911 and 1921 are being utilized, including the number 
        of such children and adults served with such funds;
          (2) a summary of improvements necessary to ensure 
        that individuals with co-occurring mental illness and 
        substance abuse disorders receive the services they 
        need;
          (3) a summary of practices for preventing substance 
        abuse among individuals who have a mental illness and 
        are at risk of having or acquiring a substance abuse 
        disorder; and
          (4) a summary of evidenced-based practices for 
        treating individuals with co-occurring mental illness 
        and substance abuse disorders and recommendations for 
        implementing such practices.
    (c) Funds for Report.--The Secretary may obligate funds to 
carry out this section with such appropriations as are 
available.
    Sec. 504. (a) In General.--The Secretary, after 
consultation with the Directors of the Center for Substance 
Abuse Treatment, the Center for Substance Abuse Prevention, and 
the Center for Mental Health Services, shall require 
appropriate peer review of grants, cooperative agreements, and 
contracts to be administered through such Centers.
    (b) Members.--The members of any peer review group 
established under regulations under subsection (a) shall be 
individuals who by virtue of their training or experience are 
eminently qualified to perform the review functions of the 
group. Not more than one-fourth of the members of any peer 
review group established under such regulation shall be 
officers or employees of the United States.
    (c) Requirements.--Regulatoins promulgated pursuant to 
subsection (a)--
          (1) shall require that the reviewing entity be 
        provided a written description of the matter to be 
        reviewed;
          (2) shall require that the reviewing entity provide 
        the advisory council of the Center involved with such 
        description and the results of the review by the 
        entity; and
          (3) may specify the conditions under which limited 
        exceptions may be granted to the limitations contained 
        in the last sentence of subsection (b) and subsection 
        (d).
    (d) Recommendations.--
          (1) In general.--If the direct cost of a grant, 
        cooperative agreement, or contract (described in 
        subsection (a)) to be made does not exceed $50,000, the 
        Secretary may make such grant, cooperative agreement, 
        or contract only if such grant, cooperative agreement, 
        or contract is recommended after peer review required 
        by regulations under subsection (a).
          (2) By appropriate advisory council.--If the direct 
        cost of a grant, or cooperative agreement (described in 
        subsection (a)) to be made exceeds $50,000, the 
        Secretary may make such grant, or cooperative agreement 
        only if such grant, cooperative agreement, or contract 
        is recommended--
                  (A) after peer review required by regulations 
                under subsection (a), and
                  (B) by the appropriate advisory council.

SEC. 504. PEER REVIEW.

    (a) In General.--The Secretary, after consultation with the 
Administrator, shall require appropriate peer review of grants, 
cooperative agreements, and contracts to be administered 
through the agency which exceed the simple acquisition 
threshold as defined in section 4(11) of the Office of Federal 
Procurement Policy Act.
    (b) Members.--The members of any peer review group 
established under subsection (a) shall be individuals who by 
virtue of their training or experience are eminently qualified 
to perform the review functions of the group. Not more than \1/
4\ of the members of any such peer review group shall be 
officers or employees of the United States.
    (c) Advisory Council Review.--If the direct cost of a grant 
or cooperative agreement (described in subsection (a)) exceeds 
the simple acquisition threshold as defined by section 4(11) of 
the Office of Federal Procurement Policy Act, the Secretary may 
make such a grant or cooperative agreement only if such grant 
or cooperative agreement is recommended--
          (1) after peer review required under subsection (a); 
        and
          (2) by the appropriate advisory council.
    (d) Conditions.--The Secretary may establish limited 
exceptions to the limitations contained in this section 
regarding participation of Federal employees and advisory 
council approval. The circumstances under which the Secretary 
may make such an exception shall be made public.
    [Sec. 506. (a) Grants for the Benefit of Homeless 
Individuals.--The Secretary, acting through the Administrator, 
may make grants to, and enter into contracts and cooperative 
agreements with, community-based public and private nonprofit 
entities for the purpose of developing and expanding mental 
health and substance abuse treatment services for homeless 
individuals. In carrying out this subsection, the Administrator 
shall consult with the Administrator of the Health Resources 
and Services Administration, the Directors of the National 
Institute on Alcohol Abuse and Alcoholism, the National 
Institute on Drug Abuse, and the National Institute of Mental 
Health, and the Commissioner of the Administration for 
Children, Youth and Families.
    [(b) Preference.--In awarding grants under subsection (a), 
the Secretary shall give preference to entities that provide 
integrated primary health care, substance abuse and mental 
health services to homeless individuals.
    [(c) Services for Certain Individuals.--In making awards 
under subsection (a), the Secretary may not prohibit the 
provision of services under such subsection to homeless 
individuals who have a primary diagnosis of substance abuse and 
are not suffering from mental illness.
    [(d) Term of Grant.--No entity may receive grants under 
subsection (a) for more than 5 years although such grants may 
be renewed.
    [(e) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section, $50,000,000 for 
fiscal year 1993, and such sums as may be necessary for fiscal 
year 1994.]

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

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

                      Part B--Centers and Programs


            Subpart 1--Center for Substance Abuse Treatment


                  center for substance abuse treatment

    Sec. 507. [290bb] (a) * * *

           *       *       *       *       *       *       *

          (2) ensure that emphasis is placed on children and 
        adolescents in the development of treatment programs;
          [(2)] (3) collaborate with the Director of the Center 
        for Substance Abuse Prevention in order to provide 
        outreach services to identify individuals in need of 
        treatment services, with emphasis on the provision of 
        such services to pregnant and postpartum women and 
        their infants and to individuals who abuse drugs 
        intravenously;
          [(3)] (4) collaborate with the Director of the 
        National Institute on Drug Abuse, with the Director of 
        the National Institute on Alcohol Abuse and Alcoholism, 
        and with the States to promote the study, 
        dissemination, and implementation of research findings 
        that will improve the delivery and effectiveness of 
        treatment services;
          [(4)] (5) collaborate with the Administrator of the 
        Health Resources and Services Administration and the 
        Administrator of the Health Care Financing 
        Administration to promote the increased integration 
        into the mainstream of the health care system of the 
        United States of programs for providing treatment 
        services;
          [(5)] (6) evaluate plans submitted by the States 
        pursuant to section 1932(a)(6) in order to determine 
        whether the plans adequately provided for the 
        availability, allocation, and effectiveness of 
        treatment services, and monitor the use of revolving 
        loan funds pursuant to section 1925;
          [(6)] (7) sponsor regional workshops on improving the 
        quality and availability of treatment services;
          [(7)] (8) provide technical assistance to public and 
        nonprofit private entities that provide treatment 
        services, including technical assistance with respect 
        to the process of submitting to the Director 
        applications for any program of grants or contracts 
        carried out by the Director.
          [(8)] (9) encourage the States to expand the 
        availability (relative to fiscal year 1992) of programs 
        providing treatment services through self-run, self-
        supported recovery based on the programs of housing 
        operated pursuant to section 1925;
          [(9)] (10) carry out activities to educate 
        individuals on the need for establishing treatment 
        facilities within their communities;
          [(10)] (11) encourage public and private entities 
        that provide health insurance to provide benefits for 
        outpatient treatment services and other nonhospital-
        based treatment services;
          [(11)] (12) evaluate treatment programs to determine 
        the quality and appropriateness of various forms of 
        treatment, including the effect of living in housing 
        provided by programs established under section 1925, 
        which shall be carried out through grants, contracts, 
        or cooperative agreements provided to public or 
        nonprofit private entities; and
          [(12)] (13) in carrying out paragraph [(11)] (12), 
        assess the quality, appropriateness, and costs of 
        various treatment forms for specific patient groups.

           *       *       *       *       *       *       *


   [residential treatment programs for pregnant and postpartum women

    [Sec. 508. (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 Service.--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 form 
                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) for 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) for 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 will 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 and 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).]

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

    (a) Projects.--The Secretary shall address priority 
substance abuse treatment needs of regional and national 
significance (as determined under subsection (b)) through the 
provision of or through assistance for--
          (1) knowledge development and application projects 
        for treatment and rehabilitation and the conduct or 
        support of evaluations of such projects;
          (2) training and technical assistance; and
          (3) targeted capacity response programs.
The Secretary may carry out the activities described in this 
section directly or through grants, contracts, or cooperative 
agreements with States, political subdivisions of States, 
Indian tribes and tribal organizations, other public or non-
profit private entities.
    (b) Priority Substance Abuse Treatment Needs.--
          (1) In general.--Priority substance abuse treatment 
        needs of regional and national significance shall be 
        determined by the Secretary after consultation with 
        States and other interested groups. The Secretary shall 
        meet with the States and interested groups on an annual 
        basis to discuss program priorities.
          (2) Special consideration.--In developing program 
        priorities under paragraph (1), the Secretary, in 
        conjunction with the Director of the Center for 
        Substance Abuse Treatment, the Director of the Center 
        for Mental Health Services, and the Administrator of 
        the Health Resources and Services Administration, shall 
        give special consideration to promoting the integration 
        of substance abuse treatment services into primary 
        health care systems.
    (c) Requirements.--
          (1) In general.--Recipients of grants, contracts, or 
        cooperative agreements under this section shall comply 
        with information and application requirements 
        determined appropriate by the Secretary.
          (2) Duration or award.--With respect to a grant, 
        contract, or cooperative agreement awarded under this 
        section, the period during which payments under such 
        award are made to the recipient may not exceed 5 years.
          (3) Matching funds.--The Secretary may, for projects 
        carried out under subsection (a), require that entities 
        that apply for grants, contracts, or cooperative 
        agreements under that project provide non-federal 
        matching funds, as determined appropriate by the 
        Secretary, to ensure the institutional commitment of 
        the entity to the projects funded under the grant, 
        contract, or cooperative agreement. Such non-Federal 
        matching funds may be provided directly or through 
        donations from public or private entities and may be in 
        cash or in kind, fairly evaluated, including plant, 
        equipment, or services.
          (4) Maintenance of effort.--With respect to 
        activities for which a grant, contract, or cooperative 
        agreement is awarded under this section, the Secretary 
        may require that recipients for specific projects under 
        subsection (a) agree to maintain expenditures of non-
        Federal amounts for such activities at a level that is 
        not less than the level of such expenditures maintained 
        by the entity for the fiscal year proceding the fiscal 
        year for which the entity receives such a grant, 
        contract, or cooperative agreement.
    (d) Evaluation.--The Secretary shall evaluate each project 
carried out under subsection (a)(1) and shall disseminate the 
findings with respect to each such evaluation to appropriate 
public and private entities.
    (e) Information and Education.--The Secretary shall 
establish comprehensive information and education programs to 
disseminate and apply the findings of the knowledge development 
and application, training and technical assistance programs, 
and targeted capacity response programs under this section to 
the general public, to health professionals and other 
interested groups. The Secretary shall make every effort to 
provide linkages between the findings of supported projects and 
State agencies responsible for carrying out substance abuse 
prevention and treatment programs.
    (f) Authorization of Appropriation.--There are authorized 
to be appropriated to carry out this section, $300,000,000 for 
fiscal year 2000 and such sums as may be necessary for each of 
the fiscal years 2001 and 2002.

    [outpatient treatment programs for pregnant and postpartum women

    [Sec. 509. (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 infants 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. (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, or 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 ares 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 provisions 
        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).

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

    [Sec. 511. (a) In General.--The Director of the Center or 
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 pretrial 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 prenatal 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. (a) In General.--The Director of the Center for 
Substance Abuse Treatment shall develop programs to increase 
the number of substance abuse treatment professionals and the 
number of health professionals providing treatment services 
through the awarding of grants to appropriate public and 
nonprofit 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.]

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

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

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

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

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

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

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

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

           *       *       *       *       *       *       *


            Subpart 2--Center for Substance Abuse Prevention


                 OFFICE FOR SUBSTANCE ABUSE PREVENTION

    Sec. 515. [290bb-21] (a) * * *

           *       *       *       *       *       *       *

          (9) prepare for distribution documentary films and 
        public service announcements for television and radio 
        to educate the [public concerning] public, especially 
        adolescent audiences, 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

           *       *       *       *       *       *       *


                          [COMMUNITY PROGRAMS

    [Sec. 516. (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) Projects.--The Secretary shall address priority 
substance abuse prevention needs of regional and national 
significance (as determined under subsection (b)) through the 
provision of or through assistance for--
          (1) knowledge development and application projects 
        for prevention and the conduct or support of 
        evaluations of such projects;
          (2) training and technical assistance; and
          (3) targeted capacity response programs.
The Secretary may carry out the activities described in this 
section directly or through grants, contracts, or cooperative 
agreements with States, political subdivisions of States, 
Indian tribes and tribal organizations, or other public or 
nonprofit private entities.
    (b) Priority Substance Abuse Prevention Needs.--
          (1) In general.--Priority substance abuse prevention 
        needs of regional and national significance shall be 
        determined by the Secretary in consultation with the 
        States and other interested groups. The Secretary shall 
        meet with the States and interested groups on an annual 
        basis to discuss program priorities.
          (2) Special consideration.--In developing program 
        priorities under paragraph (1), the Secretary shall 
        give special consideration to--
                  (A) applying the most promising strategies 
                and research-based primary prevention 
                approaches; and
                  (B) promoting the integration of substance 
                abuse prevention services into primary health 
                care systems.
    (c) Requirements.--
          (1) In general.--Recipients of grants, contracts, and 
        cooperative agreements under this section shall comply 
        with information and application requirements 
        determined appropriate by the Secretary.
          (2) Duration of award.--With respect to a grant, 
        contract, or cooperative agreement awarded under this 
        section, the period during which payments under such 
        award are made to the recipient may not exceed 5 years.
          (3) Matching funds.--The Secretary may, for projects 
        carried out under subsection (a), require that entities 
        that apply for grants, contracts, or cooperative 
        agreements under that project provide non-Federal 
        matching funds, as determined appropriate by the 
        Secretary, to ensure the institutional commitment of 
        the entity to the projects funded under the grant, 
        contract, or cooperative agreement. Such non-Federal 
        matching funds may be provided directly or through 
        donations from public or private entities and may be in 
        cash or in kind, fairly evaluated, including plant, 
        equipment, or services.
          (4) Maintenance of effort.--With respect to 
        activities for which a grant, contract, or cooperative 
        agreement is awarded under this section, the Secretary 
        may require that recipients for specific projects under 
        subsection (a) agree to maintain expenditures of non-
        Federal amounts for such activities at a level that is 
        not less than the level of such expenditures maintained 
        by the entity for the fiscal year preceding the fiscal 
        year for which the entity receives such a grant, 
        contract, or cooperative agreement.
    (d) Evaluation.--The Secretary shall evaluate each project 
carried out under subsection (a)(1) and shall disseminate the 
findings with respect to each such evaluation to appropriate 
public and private entities.
    (e) Information and education.--The Secretary shall 
establish comprehensive information and education programs to 
disseminate the findings of the knowledge development and 
application, training and technical assistance programs, and 
targeted capacity response programs under this section to the 
general public and to health professionals. The Secretary shall 
make every effort to provide linkages between the findings of 
supported projects and State agencies responsible for carrying 
out substance abuse prevention and treatment programs.
    (f) Authorization of appropriation.--There are authorized 
to be appropriated to carry out this section, $300,000,000 for 
fiscal year 2000, and such sums as may be necessary for each of 
the fiscal years 2001 and 2002.

Prevention, Treatment, and Rehabilitation model, projects for high risk 
                                 youth

    Sec. 517. [290bb-23] (a) * * *

           *       *       *       *       *       *       *

    (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.] 
such sums as may be necessary for each of the fiscal years 2000 
through 2002.

           *       *       *       *       *       *       *


[SEC. 518. 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.\1\
    [(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.\2\ 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) * * *

           *       *       *       *       *       *       *

          (3) collaborate with the Department of Education and 
        the Department of Justice to develop programs to assist 
        local communities in addressing violence among children 
        and adolescents;
          [(3)] (4) develop and coordinate Federal prevention 
        policies and programs and to assure increased focus on 
        the prevention of mental illness and the promotion of 
        mental health;
          [(4)] (5) develop improved methods of treating 
        individuals with mental health problems and improved 
        methods of assisting the families of such individuals;
          [(5)] (6) administer the mental health services block 
        grant program authorized in section 1911;
          [(6)] (7) 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)] (8) carry out the programs authorized under 
        sections 520A and 521, including the Community Support 
        Program and the Child and Adolescent Service System 
        Programs;
          [(8)] (9) carry out responsibilities for the Human 
        Resource Development program, and programs of clinical 
        training for professional and paraprofessional 
        personnel pursuant to section 303;
          [(9)] (10) 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)] (11) 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)] (12) provide technical assistance to public 
        and private entities that are providers of mental 
        health services;
          [(12)] (13) 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)] (14) conduct surveys with respect to mental 
        health, such as the National Reporting Program; and
          [(14)] (15) assist States in improving their mental 
        health data collection.

           *       *       *       *       *       *       *

    [Sec. 520A. (a) Seriously Mentally Ill Individuals and 
Children and Adolescents With Serious Emotional and Mental 
Disturbances.--
          [(1) In general.--The Secretary, acting through the 
        Director of the Center for Mental Health Services, may 
        make grants to States, political subdivisions of 
        States, and nonprofit private agencies for--
                  [(A) mental health services demonstration 
                projects for the planning, coordination and 
                improvement of community services (including 
                outreach and consumer-run self-help services) 
                for seriously mentally ill individuals and 
                their families, seriously emotionally and 
                mentally disturbed children and youth and their 
                families, and seriously mentally ill homeless 
                and elderly individuals;
                  [(B) demonstration projects for the 
                prevention of youth suicide;
                  [(C) demonstration projects for the 
                improvement of the recognition, assessment, 
                treatment and clinical management of depressive 
                disorders;
                  [(D) demonstration projects for programs to 
                prevent the occurrence of sex offenses, and for 
                the provision of treatment and psychological 
                assistance to the victims of sex offenses; and
                  [(E) demonstration projects for programs to 
                provide mental health services to victims of 
                family violence.
          [(2) Mental health services.--Mental health services 
        provided under paragraph (1)(A) should encompass a 
        range of delivery systems designed to permit 
        individuals to receive treatment in the most 
        therapeutically appropriate, least restrictive setting. 
        Grants shall be awarded under such paragraph for--
                  [(A) research demonstration programs 
                concerning such services; and
                  [(B) systems improvements to assist state and 
                local entities to develop appropriate 
                comprehensive mental health systems for adults 
                with serious long-term mental illness and 
                children and adolescents with serious emotional 
                and mental disturbance.
    [(b) Individuals At Risk of Mental Illness.--
          [(1) The Secretary, acting through the Director, may 
        make grants to States, political subdivisions of 
        States, and private nonprofit agencies for prevention 
        services demonstration projects for the provision of 
        prevention services for individuals who, in the 
        determination of the Secretary, are at risk of 
        developing mental illness.
          [(2) Demonstration projects under paragraph (1) may 
        include--
                  [(A) prevention services for populations at 
                risk of developing mental illness, particularly 
                displaced workers, young children, and 
                adolescent;
                  [(B) the development and dissemination of 
                education materials;
                  [(C) the sponsoring of local, regional, or 
                national workshops or conferences;
                  [(D) the conducting of training programs with 
                respect to the provision of mental health 
                services to individuals described in paragraph 
                (1); and
                  [(E) the provision of technical assistance to 
                providers of such services.
    [(c) Limitation on Duration of Grant.--The Secretary may 
make a grant under subsection (a) or (b) for not more than five 
consecutive one-year periods.
    [(d) Limitation on Administrative Expenses.--The Secretary 
may not make a grant under subsection (a) or (b) to an 
applicant unless the applicant agrees that not more than 10 
percent of such a grant will be expended for administrative 
expenses.
    [(e) Authorizations of Appropriations.--
          [(1) For the purposes 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.
          [(2) Of the amounts appropriated pursuant to 
        paragraph (1), the Secretary shall make available 15 
        percent for demonstration projects to carry out the 
        purposes of this section in rural areas.]

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

    (a) Projects.--The Secretary shall address priority mental 
health needs of regional and national significance (as 
determined under subsection (b) through the provision of or 
through assistance for--
          (1) knowledge development and application projects 
        for prevention, treatment, and rehabilitation, and the 
        conduct or support of evaluations of such projects;
          (2) training and technical assistance programs;
          (3) targeted capacity response programs; and
          (4) systems change grants including statewide family 
        network grants and client-oriented and consumer run 
        self-help activities.
The Secretary may carry out the activities described in this 
subsection directly or through grants, contracts, or 
cooperative agreements with States, political subdivisions of 
States, Indian tribes and tribal organizations, other public or 
private nonprofit entities.
    (b) Priority Mental Health Needs.--
          (1) Determination of needs.--Priority mental health 
        needs of regional and national significance shall be 
        determined by the Secretary in consultation with States 
        and other interested groups. The Secretary shall meet 
        with the States and interested groups on an annual 
        basis to discuss program priorities.
          (2) Special consideration.--In developing program 
        priorities described in paragraph (1), the Secretary, 
        in conjunction with the Director of the Center for 
        Mental Health Services, the Director of the Center for 
        Substance Abuse Treatment, and the Administrator of the 
        Health Resources and Services Administration, shall 
        give special consideration to promoting the integration 
        of mental health services into primary health care 
        systems.
    (c) Requirements.--
          (1) In general.--Recipients of grants, contracts, and 
        cooperative agreements under this section shall comply 
        with information and application requirements 
        determined appropriate by the Secretary.
          (2) Duration of award.--With respect to a grant, 
        contract, or cooperative agreement awarded under this 
        section, the period during which payments under such 
        award are made to the recipient may not exceed 5 years.
          (3) Matching funds.--The Secretary may, for projects 
        carried out under subsection (a), require that entities 
        that apply for grants, contracts, or cooperative 
        agreements under this section provide non-Federal 
        matching funds, as determined appropriate by the 
        Secretary, to ensure the institutional commitment of 
        the entity to the projects funded under the grant, 
        contract, or cooperative agreement. Such non-Federal 
        matching funds may be provided directly or through 
        donations from public or private entities and may be in 
        cash or in kind, fairly evaluated, including plant, 
        equipment, or services.
          (4) Maintenance of effort.--With respect to 
        activities for which a grant, contract or cooperative 
        agreement is awarded under this section, the Secretary 
        may require that recipients for specific projects under 
        subsection (a) agree to maintain expenditures of non-
        Federal amounts for such activities at a level that is 
        not less than the level of such expenditures maintained 
        by the entity for the fiscal year preceding the fiscal 
        year for which the entity receives such a grant, 
        contract, or cooperative agreement.
    (d) Evaluation.--The Secretary shall evaluate each project 
carried out under subsection (a)(1) and shall disseminate the 
findings with respect to each such evaluation to appropriate 
public and private entities.
    (e) Information and Education.--The Secretary shall 
establish information and education programs to disseminate and 
apply the findings of the knowledge development and 
application, training, and technical assistance programs, and 
targeted capacity response programs, under this section to the 
general public, to health care professionals, and to interested 
groups. The Secretary shall make every effort to provide 
linkages between the findings of supported projects and State 
agencies responsible for carrying out mental health services.
    (f) Authorization of Appropriation.--
          (1) In general.--There are authorized to be 
        appropriated to carry out this section, $300,000,000 
        for fiscal year 2000, and such sums as may be necessary 
        for each of the fiscal years 2001 and 2002.
          (2) Data infrastructure.--If amounts are not 
        appropriated for a fiscal year to carry out section 
        1971 with respect to mental health, then the Secretary 
        shall make available, from the amounts appropriated for 
        such fiscal year under paragraph (1), an amount equal 
        to the sum of $6,000,000 and 10 percent of all amounts 
        appropriated for such fiscal year under such paragraph 
        in excess of $100,000,000, to carry out such section 
        1971.
    [Section 520B of the Public Health Service Act is 
repealed.]

SEC. 502C. SERVICES FOR YOUTH OFFENDERS.

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

           *       *       *       *       *       *       *


SEC. 522. PURPOSE OF GRANTS.

    (A) In General.--* * *

           *       *       *       *       *       *       *

    (i) Waiver for Territories.--With respect to the United 
States Virgin Islands, Guam, American Samoa, Palau, the 
Marshall Islands, and the Commonwealth of the Northern Mariana 
Islands, the Secretary may waive the provisions of this part 
that the Secretary determines to be appropriate.

SEC. 535. FUNDING.

    (a) Authorization of Appropriations.--For the purpose of 
carrying out this part, there is authorized to be appropriated 
$75,000,000 for each of the fiscal years [1991 through 1994] 
2000 through 2002.

           *       *       *       *       *       *       *


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

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

SEC. 545. ESTABLISHMENT OF COMMISSION.

    (a) In General.--There is established a commission to be 
known as the Commission on Indian and Native Alaskan Health 
Care that shall examine the health concerns of Indians and 
Native Alaskans who reside on reservations and tribal lands 
(hereafter in this section referred to as the ``Commission''.
    (b) Membership.--
          (1) In general.--The Commission established under 
        subsection (a) shall consist of--
                  (A) the Secretary;
                  (B) 15 members who are experts in the health 
                care field and issues that the Commission is 
                established to examine; and
                  (C) the Director of the Indian Health Service 
                and the Commissioner of Indian Affairs, who 
                shall be nonvoting members.
          (2) Appointing authority.--Of the 15 members of the 
        Commission described in paragraph (1)(B)--
                  (A) 2 shall be appointed by the Speaker of 
                the House of Representatives;
                  (B) 2 shall be appointed by the Minority 
                Leader of the House of Representatives;
                  (C) 2 shall be appointed by the Majority 
                Leader of the Senate;
                  (D) 2 shall be appointed by the Minority 
                Leader of the Senate; and
                  (E) 7 shall be appointed by the Secretary.
          (3) Limitation.--Not fewer than 10 of the members 
        appointed to the Commission shall be Indians or Native 
        Alaskans.
          (4) Chairperson.--The Secretary shall serve as the 
        Chairperson of the Commission.
          (5) Experts.--The Commission may seek the expertise 
        of any expert in the health care field in carry out its 
        duties.
    (c) Period of Appointment.--Members shall be appointed for 
the life of the Commission. Any vacancy in the Commission shall 
not affect its powers, but shall be filed in the same manner as 
the original appointment.
    (d) Duties of the Commission.--The Commission shall--
          (1) study the health concerns of Indians and Native 
        Alaskans; and
          (2) prepare the reports described in subsection (i).
    (e) Powers of the Commission.--
          (1) Hearings.--The Commission may hold such hearings, 
        including hearings on reservations, sit and act at such 
        times and places, take such testimony, and receive such 
        information as the Commission considers advisable to 
        carry out the purpose for which the Commission was 
        established.
          (2) Informaton from federal agencies.--The Commission 
        may secure directly from any Federal department or 
        agency such information as the Commission considers 
        necessary to carry out the purpose for which the 
        Commission was established. Upon request of the 
        Chairperson of the Commission, the head of such 
        department or agency shall furnish such information to 
        the Commission.
    (f) Compensation of Members.--
          (1) In general.--Except as provided in subparagraph 
        (B), each member of the Commission may be compensated 
        at a rate not to exceed the daily equivalent of the 
        annual rate of basic pay prescribed for level IV of the 
        Executive Schedule under section 5315 of title 5, 
        United States Code, for each day (including travel 
        time), during which that member is engaged in the 
        actual performance of the duties of the Commission.
          (2) Limitation.--Members of the Commission who are 
        officers or employees of the United States shall 
        receive no additional pay on account of their service 
        on the Commission.
    (g) Travel Expenses of Members.--The members of the 
Commission shall be allowed travel expenses, including per diem 
in lieu of subsistence, at rates authorized for employees of 
agencies under section 5703 of title 5, United States Code, 
while away from their homes or regular places of business in 
the performance of services for the Commission.
    (h) Commission Personnel Matters.--
          (1) In General.--The Secretary, in accordance with 
        rules established by the Commission, may select and 
        appoint a staff director and other personnel necessary 
        to enable the Commission to carry out its duties.
          (2) Compensation of personnel.--The Secretary, in 
        accordance with rules established by the Commission, 
        may set the amount of compensation to be paid to the 
        staff director and any other personnel that serve the 
        Commission.
          (3) Detail of government employees.--Any Federal 
        Government employee may be detailed to the Commission 
        without reimbursement, and the detail shall be without 
        interruption or loss of civil service status or 
        privilege.
          (4) Consultant services.--The Chairperson of the 
        Commission is authorized to procure the temporary and 
        intermittent services of experts and consultants in 
        accordance with section 3109 of title 5, United States 
        Code, at rates not to exceed the daily equivalent of 
        the annual rate of basic pay prescribed for level IV of 
        the Executive Schedule under section 5315 of such 
        title.
    (i) Report.--
          (1) In general.--Not later than 3 years after the 
        date of enactment of the Youth Drug and Mental Health 
        Services Act, the Secretary shall prepare and submit, 
        to the Committee on Health, Education, Labor, and 
        Pensions of the Senate, a report that shall--
                  (A) Detail the health problems faced by 
                Indians and Native Alaskans who reside on 
                reservations;
                  (B) examine and explain the causes of such 
                problems;
                  (C) describe the health care services 
                available to Indians and Native Alaskans who 
                reside on reservations and the adequacy of such 
                services;
                  (D) identify the reasons for the provision of 
                inadequate health care services for Indians and 
                Native Alaskans who reside on reservations, 
                including the availability of resources;
                  (E) develop measures for tracking the health 
                status of Indians and Native Americans who 
                reside on reservations; and
                  (F) make recommendations for improvements in 
                the health care services provided for Indians 
                and Native Alaskans who reside on reservations, 
                including recommendations for legislative 
                change.
          (2) Exception.--In addition to the report required 
        under paragraph(1), not later than 2 years after the 
        date of enactment of the Youth Drug and Mental Health 
        Services Act, the Secretary shall prepare and submit, 
        to the Committee on Health, Education, Labor, and 
        Pensions of the Senate, a report that describes any 
        alcohol and drug abuse among Indians and Native 
        Alaskans who reside on reservations.
    (j) Permanent Commission.--Section 14 of the Federal 
Advisory Committee Act (5 U.S.C. App.) shall not apply to the 
Commission.
    (k) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section $5,000,000 or 
fiscal year 2000, and such sums as may be necessary for fiscal 
years 2001, and 2002.

          Part E--Children With Serious Emotional Disturbances


SEC. 561. [290FF] COMPREHENSIVE COMMUNITY MENTAL HEALTH SERVICES FOR 
                    CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCES.

    (a) Grants to Certain Public Entities.--

           *       *       *       *       *       *       *

    (c) Matching Funds.--
                  (D) for any [fifth] fifth and sixth such 
                fiscal year, is not less than $2 for each $1 of 
                Federal funds provided in the grant.

           *       *       *       *       *       *       *


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

    (a) Systems of Comprehensive Care.--

           *       *       *       *       *       *       *

    (g) Waivers.--The Secretary may waive 1 or more of the 
requirements of subsection (c) for 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. [290FF-4] GENERAL PROVISIONS.

    (a) Duration of Support.--The period during which payments 
are made to a public entity from a grant under section 561(a) 
may not exceed [5 fiscal] 6 fiscal years.

           *       *       *       *       *       *       *

    (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.] 
        2000, and such sums as may be necessary for each of the 
        fiscal years 2001 and 2002.

           *       *       *       *       *       *       *


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


            [demonstration program in national capital area

    [Sec. 571. (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 abuses, 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 critiera.--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 George's in the State of 
Maryland (and the political subdivision 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 G--Projects for Children and Violence

SEC. 581. CHILDREN AND VIOLENCE

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

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

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

           *       *       *       *       *       *       *


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

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

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

SEC. 592. REPORTING REQUIREMENT.

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

SEC. 593. REGULATIONS AND ENFORCEMENT.

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

SEC. 1915. ADDITIONAL PROVISIONS.

    (a) Review of State Plan 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 (without regard to 
        whether the State has made the recommended 
        modifications) and any comments concerning the annual 
        report.
    (b) Maintenance of Effort Regarding State Expenditures for 
Mental Health.--
          (1) In general.--* * *

           *       *       *       *       *       *       *

          (2) Exclusion of certain funds.--The Secretary may 
        exclude from the aggregate State expenditures under 
        subsection (a), funds appropriated to the principal 
        agency for authorized activities which are of a non-
        recurring nature and for a specific purpose.
          [(2)] (3) Waiver.--The Secretary may, upon the 
        request of a State, waive the requirement established 
        in paragraph (1) if the Secretary determines that 
        extraordinary economic conditions in the State justify 
        the waiver.
          [(3)] (4) Noncompliance by state.--

           *       *       *       *       *       *       *


SEC. 1912. STATE PLAN FOR COMPREHENSIVE COMMUNITY MENTAL HEALTH 
                    SERVICES FOR CERTAIN INDIVIDUALS.

    (a) In General.--* * *

           *       *       *       *       *       *       *

    (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 an 
        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).]
          (1) Comprehensive community-based mental health 
        systems.--The plan provides for an organized community-
        based system of care for individuals with mental 
        illness and describes available services and resources 
        in a comprehensive system of care, including services 
        for dually diagnosed individuals. The description of 
        the system of care shall include health and mental 
        health services, rehabilitation services, employment 
        services, housing services, educational services, 
        substance abuse services, medical and dental care, and 
        other support services to be provided to individuals 
        with Federal, State and local public and private 
        resources to enable such individuals to function 
        outside of inpatient or residential institutions to the 
        maximum extent of their capabilities, including 
        services to be provided by local school systems under 
        the Individuals with Disabilities Education Act. The 
        plan shall include a separate description of case 
        management services and provide for activities leading 
        to reduction of hospitalization.
          (2) Mental health system data and epidemiology.--The 
        plan contains an estimate of the incidence and 
        prevalence in the State of serious mental illness among 
        adults and serious emotional disturbance among children 
        and presents quantitative targets to be achieved in the 
        implementation of the system described in paragraph 
        (1).
          (3) Children's services.--In the case of children 
        with serious emotional disturbance, the plan--
                  (A) subject to subsection (B), provides for a 
                system of integrated social services, 
                educational services, juvenile services, and 
                substance abuse services that, together with 
                health and mental health services, will be 
                provided in order for such children to receive 
                care appropriate for their multiple needs (such 
                system to include services provided under the 
                Individuals with Disabilities Education Act);
                  (B) provides that the grant under section 
                1911 for the fiscal year involved will not be 
                expended to provide any service under such 
                system other than comprehensive community 
                mental health services; and
                  (C) provides for the establishment of a 
                defined geographic area for the provision of 
                the services of such system.
          (4) Targeted services to rural and homeless 
        populations.--The plan describes the State's outreach 
        to and services for individuals who are homeless and 
        how community-based services will be provided to 
        individuals residing in rural areas.
          (5) Management systems.--The plan describes the 
        financial resources, staffing and training for mental 
        health providers that is necessary to implement the 
        plan, and provides for the training of providers of 
        emergency health services regarding mental health. The 
        plan further describes the manner in which the State 
        intends to expend the grant under section 1911 for the 
        fiscal year involved.
        Except as provided for in paragraph (3), the State plan 
        shall contain the information required under this 
        subsection with respect to both adults with serious 
        mental illness and children with serious emotional 
        disturbance.

           *       *       *       *       *       *       *


SEC. 1917. APPLICATION FOR GRANT.

    (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);]
          (1) the plan is received by the Secretary not later 
        than September 1 of the fiscal year prior to the fiscal 
        year for which a State is seeking funds, and the report 
        from the previous fiscal year as required under section 
        1941 is received by December 1 of the fiscal year of 
        the grant;

           *       *       *       *       *       *       *

    (b) 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)] except Puerto Rico, 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. 1918. DETERMINATION OF AMOUNT OF ALLOTMENT.

    (a) States.--* * *

           *       *       *       *       *       *       *

    [(b) Minimum Allotments for States.--
          [(1) In general.--With respect to fiscal year 1999, 
        the amount of the allotment of a State under section 
        1911 shall not be less than the amount the State 
        received under section 1911 for fiscal year 1998.]
    (b) Minimum Allotments for States.--With respect to fiscal 
year 2000, and subsequent fiscal years, the amount of the 
allotment of a State under section 1911 shall not be less than 
the amount the State received under such section for fiscal 
year 1998.

           *       *       *       *       *       *       *


SEC. 1920. 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 [$450,000,000 for fiscal year 1993, and such sums 
as may be necessary for fiscal year 1994.] $450,000,000 for 
fiscal year 2000, and such sums as may be necessary for each of 
the fiscal years 2001 and 2002.
    (b) Allocations for Technical Assistance, Data Collection, 
and Program Evaluation.--
          (1) In general.--* * *
          (2) Data collection.--The purpose specified in this 
        paragraph is carrying out [section 505] sections 505 
        and 1971 with respect to mental health.

           *       *       *       *       *       *       *


  Subpart II--Block Grants for Prevention and Treatment of Substance 
                                 Abuse


SEC. 1921. FORMULA GRANTS TO STATES.

    (a) In General.--* * *
    [(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.]
    (b) Authorized Activities.--
          (1) In general.--A funding agreement for a grant 
        under subsection (a) is that, subject to section 1931, 
        the State involved shall expend the grant only for the 
        purpose of--
                  (A) planning, carrying out, and evaluating 
                activities to prevent and treat substance abuse 
                in accordance with this subpart and for related 
                activities authorized in section 1924; and
                  (B) screening and testing for HIV, 
                tuberculosis, hepatitis C, sexually transmitted 
                diseases, mental health disorders, and other 
                screening and testing necessary to determine a 
                comprehensive substance abuse treatment plan.
          (2) Screening and testing.--A State may not use more 
        than 2 percent of a State allotment for a fiscal year 
        to carry out activities under paragraph (1)(B), except 
        that the State shall be considered the payer of last 
        resort and may not expend such funds for such 
        activities to the extent that payment has been made, or 
        can reasonably be expected to be made, with respect to 
        such service under any Federal or State program, an 
        insurance policy, or a Federal or State health benefits 
        program (including programs established under title 
        XVIII or XIX of the Social Security Act), or by an 
        entity that provides health services on a prepaid 
        basis.

SEC. 1922. CERTAIN ALLOCATIONS.

    [(a) Allocations Regarding Alcohol and Other Drugs.--A 
funding agreement for a grant under section 1921 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 
is that, in expending the grant, the State involved--

           *       *       *       *       *       *       *

    [(c)] (b) Allocations Regarding Women.--

           *       *       *       *       *       *       *

          [(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 
                treatments services for women described in such 
                paragraph, as indicated by a comparison of the 
                number of such women seeking the services 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.]
          [(3)] (2) Childcare and prenatal care.--A funding 
        agreement for a grant under section 1921 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.

SEC. 1925. 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 only if the State involved has 
established, and is providing for the ongoing operation of, a 
revolving fund as follows:] A State, using funds available 
under section 1921, may establish and maintain the ongoing 
operation of a revolving fund in accordance with this section 
to support group homes for recovering substance abusers as 
follows:

           *       *       *       *       *       *       *


[SEC. 1928. 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 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) Continuing Education.--With respect to any facility 
for treatment services or prevention activities that is 
receiving amounts from a grant under section 1921, 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) Coordination of Various Activities and Services.--A 
funding agreement for a grant under section 1921 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. 1930. MAINTENANCE OF EFFORT REGARDING STATE EXPENDITURES.

    (a) In General.--* * *
    (b) Exclusion of Certain Funds.--The Secretary may exclude 
from the aggregate State expenditures under subsection (a), 
funds appropriated to the principle agency for authorized 
activities which are a non-recurring nature and for a specific 
purpose.
    [(b)] (c) Waiver.--
          (1) In general.--Upon the request of a State, the 
        Secretary may waive all or part of the requirement 
        established in subsection (a) if the Secretary 
        determines that extraordinary economic conditions in 
        the State justify the waiver.
          (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.
    [(c)] (d) Noncompliance by State.--
          (1) In general.--In making a grant under section 1921 
        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.
          (2) Submission of information to secretary.--The 
        Secretary may make a grant under section 1921 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. 1932. APPLICATION FOR GRANT; APPROVAL OF STATE PLAN.

    (a) In General.--For purposes of section 1921, 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;]
          (1) the application is received by the Secretary not 
        later than October 1 of the fiscal year prior to the 
        fiscal year for which the State is seeking funds;

           *       *       *       *       *       *       *

    (c) Waivers Regarding Certain Territories.--In the case of 
any territory of the United States [whose allotment under 
section 1921 for the fiscal year is the amount specified in 
section 1933(c)(2)(B)] except Puerto Rico, 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.

           *       *       *       *       *       *       *

    (e) Waiver Authority for Certain Requirements.--
          (1) In general.--Upon the request of a State, the 
        Secretary may waive the requirements of all or part of 
        the sections described in paragraph (2) using objective 
        criteria established by the Secretary by regulation 
        after consultation with the States and other interested 
        parties including consumers and providers.
          (2) Sections.--The sections described in paragraph 
        (1) are sections 1922(c), 1923, 1924, and 1928.
          (3) Date certain for acting upon request.--The 
        Secretary shall approve or deny a request for waiver 
        under paragraph (1) and inform the State of that 
        decision not later than 120 days after the date on 
        which the request and all the information needed to 
        support the request are submitted.
          (4) Annual reporting requirement.--The Secretary 
        shall annually report to the general public on the 
        States that receive a waiver under this subsection.

SEC. 1933. DETERMINATION OF AMOUNT OF ALLOTMENT.

    (a) States.--

           *       *       *       *       *       *       *

    [(b) Minimum Allotments for States.--
          [(1) In general.--With respect to fiscal year 1999, 
        the amount of the allotment of a State under section 
        1921 shall not be less than the amount the State 
        received under section 1921 for fiscal year 1998 
        increased by 30.65 percent of the percentage by which 
        the amount allotted to the States for fiscal year 1999 
        exceeds the amount allotted to the States for fiscal 
        year 1998.
          [(2) Limitation.--
                  [(A)In general.--Except as provided in 
                subparagraph (B), a State shall not receive an 
                allotment under section 1921 for fiscal year 
                1999 in an amount that is less than an amount 
                equal to 0.375 percent of the amount 
                appropriated under section 1935(a) for such 
                fiscal year.
                  [(B)Exception.--In applying subparagraph (A), 
                the Secretary shall ensure that no State 
                receives an increase in its allotment under 
                section 1921 for fiscal year 1999 (as compared 
                to the amount allotted to the States in the 
                fiscal year 1998) that is in excess of an 
                amount equal to 300 percent of the percentage 
                by which the amount appropriated under section 
                1935(a) for fiscal year 1999 exceeds the amount 
                appropriated for the prior fiscal year.
          [(3) Only for the purposes of calculating minimum 
        allotments under this subsection, any reference to the 
        amount appropriated under section 1935(a) for fiscal 
        year 1998, allotments to States under section 21 and 
        any references to amounts received by States in fiscal 
        year 1998 shall include amounts appropriated or 
        received under the amendments made by section 105 of 
        the contract with America Advancement Act of 1996 
        (Public Law 104-121).]
    (b) Minimum Allotments for States.--
          (1) In general.--With respect to fiscal year 2000, 
        and each subsequent fiscal year, the amount of the 
        allotment of a State under section 1921 shall not be 
        less than the amount the State received under such 
        section for the previous fiscal year increased by an 
        amount equal to 30.65 percent of the percentage by 
        which the aggregate amount allotted to all States for 
        such fiscal year exceeds the aggregate amount allotted 
        to all States for the previous fiscal year.
          (2) Limitations.--
                  (A) In general.--Except as provided in 
                subparagraph (B), a State shall not receive an 
                allotment under section 1921 for a fiscal year 
                in an amount that is less than an amount equal 
                to 0.375 percent of the amount appropriated 
                under section 1935(a) for such fiscal year.
                  (B) Exception.--In applying subparagraph (A), 
                the Secretary shall ensure that no State 
                receives an increase in its allotment under 
                section 1921 for a fiscal year (as compared to 
                the amount allotted to the State in the prior 
                fiscal year) that is in excess of an amount 
                equal to 300 percent of the percentage by which 
                the amount appropriated under section 1935(a) 
                for such fiscal year exceeds the amount 
                appropriated for the prior fiscal year.
          (3) Decrease in or equal appropriations.--If the 
        amount appropriated under section 1935(a) for a fiscal 
        year is equal to or less than the amount appropriated 
        under such section for the prior fiscal year, the 
        amount of the State allotment under section 1921 shall 
        be equal to the amount that the State received under 
        section 1921 in the prior fiscal year decreased by the 
        percentage by which the amount appropriated for such 
        fiscal year is less than the amount appropriated or 
        such section for the prior fiscal year.

SEC. 1935. 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 for fiscal year 1993, 
and such sums as may be necessary for fiscal year 1994.] 
$2,000,000,000 for fiscal year 2000, and such sums as may be 
necessary for each of the fiscal years 2001 and 2002.
    (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] 
                sections 505 and 1971 with respect to substance 
                abuse.

           *       *       *       *       *       *       *

          (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)] 1948(a) with 
        respect to prevention activities, and section 515(d).
          (3) Core data set.--A State that receives a new 
        grant, contract, or cooperative agreement from amounts 
        available to the Secretary under paragraph (1), for the 
        purposes of improving the data collection, analysis and 
        reporting capabilities of the State, shall be required, 
        as a condition of receipt of funds, to collect, 
        analyze, and report to the Secretary for each fiscal 
        year subsequent to receiving such funds a core data set 
        to be determined by the Secretary in conjunction with 
        the States.

[SEC. 1949. 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. Such report may include any 
recommendations of the Secretary for appropriate changes in 
legislation.]

SEC. 1949. PLANS FOR PERFORMANCE PARTNERSHIPS.

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

[SEC. 1952. 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.
    [(b) Exception Regarding Noncompliance of Subgrantees.--If 
a State has in accordance with subsection (a) obligated amounts 
paid to the State under the program involved, in any case in 
which the Secretary determines that the obligation consists of 
a grant or contract awarded by the State, and that the State 
has terminated or reduced the amount of such financial 
assistance on the basis of the failure of the recipient of the 
assistance to comply with the terms upon which the assistance 
was conditioned--
          [(1) the amounts involved shall be available for 
        reobligation by the State through September 30 of the 
        fiscal year following the fiscal year for which the 
        amounts were paid to the State; and
          [(2) any of such amounts that are obligated by the 
        State in accordance with paragraph (1) shall be 
        available for expenditure through such date.]

SEC. 1952. AVAILABILITY TO STATES OF GRANT PAYMENTS.

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

           *       *       *       *       *       *       *


SEC. 1955. SERVICES PROVIDED BY NONGOVERNMENTAL ORGANIZATIONS.

    (a) Purposes.--The purposes of this section are--
          (1) to prohibit discrimination against 
        nongovernmental organizations and certain individuals 
        on the basis of religion in the distribution of 
        government funds to provide substance abuse services 
        under this title and title V, and the receipt of 
        services under such titles; and
          (2) to allow the organizations to accept the funds to 
        provide the services to the individuals without 
        impairing the religious character of the organizations 
        or the religious freedom of the individuals.
    (b) Religious Organizations Included as Nongovernmental 
Providers.--
          (1) In general.--A State may administer and provide 
        substance abuse services under any program under this 
        title or title V through grants, contracts, or 
        cooperative agreements to provide assistance to 
        beneficiaries under such titles with nongovernmental 
        organizations.
          (2) Requirement.--A State that elects to utilize 
        nongovernmental organizations as provided for under 
        paragraph (a) shall consider, on the same basis as 
        other nongovernmental organizations, religious 
        organizations to provide services under substance abuse 
        programs under this title or title V, so long as the 
        programs under such titles are implemented in a manner 
        consistent with the Establishment Clause of the first 
        amendment to the Constitution. Neither the Federal 
        Government nor a State or local government receiving 
        funds under such programs shall discriminate against an 
        organization that provides services under, or applies 
        to provide services under, such programs, on the basis 
        that the organization has a religious character.
    (c) Religious Character and Independence.--
          (1) In general.--A religious organization that 
        provides services under any substance abuse program 
        under this title or title V shall retain its 
        independence from Federal, State, and local 
        governments, including such organization's control over 
        the definition, development, practice, and expression 
        of its religious beliefs.
          (2) Additional safeguards.--Neither the Federal 
        Government nor a State or local government shall 
        require a religious organization--
                  (A) to alter its form of internal governance; 
                or
                  (B) to remove religious art, icons, 
                scripture, or other symbols;
        in order to be eligible to provide services under any 
        substance abuse program under this title or title V.
    (d) Employment Practices.--
          (1) Tenets and teaching.--A religious organization 
        that provides services under any substance abuse 
        program under this title or title V may require that 
        its employees providing services under such program 
        adhere to the religious tenets and teachings of such 
        organization, and such organization may require that 
        those employees adhere to rules forbidding the use of 
        drugs or alcohol.
          (2) Title vii exemption.--The exemption of a 
        religious organization provided under section 702 or 
        703(e)(2) of the Civil Rights Act of 1964 (42 U.S.C. 
        2000e-1, 2000e-2(e)(2)) regarding employment practices 
        shall not be affected by the religious organization's 
        provision of services under, or receipt of funds from, 
        any substance abuse program under this title or title 
        V.
    (e) Rights of Beneficiaries of Assistance.--
          (1) In general.--If an individual described in 
        paragraph (3) has an objection to the religious 
        character of the organization from which the individual 
        receives, or would receive, services funded under any 
        substance abuse program under this title or title V, 
        the appropriate Federal, State, or local governmental 
        entity shall provide to such individual (if otherwise 
        eligible for such services) within a reasonable period 
        of time after the date of such objection, services 
        that--
                  (A) are from an alternative provider that is 
                accessible to the individual; and
                  (B) have a value that is not less than the 
                value of the services that the individual would 
                have received from such organization.
          (2) Notice.--The appropriate Federal, State, or local 
        governmental entity shall ensure that notice is 
        provided to individuals described in paragraph (3) of 
        the rights of such individuals under this section.
          (3) Individual described.--An individual described in 
        this paragraph is an individual who receives or applies 
        for services under any substance abuse program under 
        this title or title V.
    (f) Nondiscrimination Against Beneficiaries.--A religious 
organization providing services through a grant, contract, or 
cooperative agreement under any substance abuse program under 
this title or title V shall not discriminate, in carrying out 
such program, against an individual described in subsection 
(e)(3) on the basis of religion, a religious belief, a refusal 
to hold a religious belief, or a refusal to actively 
participate in a religious practice.
    (g) Fiscal Accountability.--
          (1) In general.--Except as provided in paragraph (2), 
        any religious organization providing services under any 
        substance abuse program under this title or title V 
        shall be subject to the same regulations as other 
        nongovernmental organizations to account in accord with 
        generally accepted accounting principles for the use of 
        such funds provided under such program.
          (2) Limited audit.--Such organization shall segregate 
        government funds provided under such substance abuse 
        program into a separate account. Only the government 
        funds shall be subject to audit by the government.
    (h) Compliance.--Any party that seeks to enforce such 
party's rights under this section may assert a civil action for 
injunctive relief exclusively in an appropriate Federal or 
State court against the entity or agency that allegedly commits 
such violation.
    (i) Limitations on Use of Funds for Certain Purposes.--No 
funds provided through a grant or contract to a religious 
organization to provide services under any substance abuse 
program under this title or title V shall be expended for 
sectarian worship, instruction, or proselytization.
    (j) Effect on State and Local Funds.--If a State or local 
government contributes State or local funds to carry out any 
substance abuse program under this title or title V, the State 
or local government may segregate the State or local funds from 
the Federal funds provided to carry out the program or may 
commingle the State or local funds with the Federal funds. If 
the State or local government commingles the State or local 
funds, the provisions of this section shall apply to the 
commingled funds in the same manner, and to the same extent, as 
the provisions apply to the Federal funds.
    (k) Treatment of Intermediate Contractors.--If a 
nongovernmental organization (referred to in this subsection as 
an `intermediate organization'), acting under a contract or 
other agreement with the Federal Government or a state or local 
government, is given the authority under the contract or 
agreement to select nongovernmental organizations to provide 
services under any substance abuse program under this title or 
title V, the intermediate organization shall have the same 
duties under this section as the government but shall retain 
all other rights of a nongovernmental organization under this 
section.

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

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

          [Part C--Certain Programs Regarding substance Abuse


       [Subpart I--Expansion of Capacity for Providing Treatment


[SEC. 1971. 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 of 
        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 authorized to 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.]

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

               Subpart I--Data Infrastructure Development

SEC. 1971. DATA INFRASTRUCTURE DEVELOPMENT.

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

 [PROTECTION AND ADVOCACY FOR MENTALLY ILL INDIVIDUALS ACT OF 1986 \1\]

    Protection and Advocacy for Individuals with Mental Illness 
Act

                TITLE I--PROTECTION AND ADVOCACY SYSTEMS


                    Part A--Establishment of Systems


                          findings and purpose

    Sec. 101. (a) The Congress finds that--

           *       *       *       *       *       *       *


                              definitions

    Sec. 102. For purposes of this title:
          (1) * * *

           *       *       *       *       *       *       *

          (4) The term ``individual with mental illness'' 
        means, except as provided in section 104(d), an 
        individual--

           *       *       *       *       *       *       *

                  (B)[(i) who] (i)(I) who is an inpatient or 
                resident in a facility rendering care or 
                treatment, even if the whereabouts of such 
                inpatient or resident are unknown;
                  [(ii)] (II) who is in the process of being 
                admitted to a facility rendering care or 
                treatment, including persons being transported 
                to such a facility; [or'';]
                  [(iii)] (III) who is involuntarily confined 
                in a municipal detention facility for reasons 
                other than serving a sentence resulting from 
                conviction for a criminal offense[.]; or
                  (ii) who satisfies the requirements of 
                subparagraph (A) and lives in a community 
                setting, including their own home.

           *       *       *       *       *       *       *

          (8) The term ``American Indian consortium'' means a 
        consortium established under part C of the 
        Developmental Disabilities Assistance and Bill of 
        Rights Act (42 U.S.C. 6042 et seq.).

           *       *       *       *       *       *       *


                           use of allotments

    Sec. 104. (a)(1) * * *

           *       *       *       *       *       *       *

    (d) The definition of ``individual with a mental illness'' 
contained in section 102(4)(b)(iii) shall apply, and thus an 
eligible system may use its allotment under this title to 
provide representation to such individuals, only if the total 
allotment under this title for any fiscal year is $30,000,000 
or more, and in such case, an eligible system must give 
priority to representing persons with mental illness as defined 
in subparagraphs (A) and (B)(i) of section 102(4).

                   allotment formula and reallotments

    Sec. 112. (a)(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 Samoa, 
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 117--
                  [(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 determined 
        under subparagraph (B) and the factor specified in 
        subparagraph (C).
          (B) For purposes of subparagraph (A), the appropriate 
        base amount--
                  (i) for American Samoa, Guam, the Marshall 
                Islands, Federated States of Micronesia, 
                Commonwealth of the Northern Mariana Islands, 
                the Republic of Palau, and the Virgin Islands, 
                is $139,000; and
                  (ii) for any State, is $260,000.
          (C) The factor specified in this subparagraph is the 
        ratio of the amount appropriated under section 117 for 
        the fiscal year for which the allotment is being made 
        to the amount appropriated under such section for 
        fiscal year 1995.
          (D) If the total amount appropriated for a fiscal 
        year is at least $25,000,000, the Secretary shall make 
        an allotment in accordance with subparagraph (A) to the 
        eligible system serving the American Indian consortium.

SEC. 117. AUTHORIZATION OF APPROPRIATIONS.

    There are authorized to be appropriated for allotments 
under this title, $19,500,000 for fiscal year 1992, and such 
sums as may be necessary for each of the fiscal years 1993 
through [1995] 2002.
    [Section 612 of the Stewart B. McKinney Homeless Assistance 
Act is repealed.]
    [Titles III and IV of the Narcotic Addict Rehabilitation 
Act of 1966 are repealed.]
    [Chapter 175 of title 28, United States Code, of the 
Obsolete Title 28 Authorities, is repealed.]

                      Title 28, United States Code

    [The table of contents to part VI of title 28, United 
States Code, is amended by striking the items relating to 
chapter 175.]

                                  
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