[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.]