102d CONGRESS
2d Session
S. 1306
AMENDMENTS
S 1306 EAH
In the House of Representatives, U. S.,
March 24, 1992.
Resolved, That the bill from the Senate (S. 1306) entitled `An Act to
amend title V of the Public Health Service Act to revise and extend
certain programs, to restructure the Alcohol, Drug Abuse, and Mental
Health Administration, and for other purposes', do pass with the following
AMENDMENTS:
Strike out all after the enacting clause, and insert:

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(a) SHORT TITLE- This Act may be cited as the `Community Mental Health
and Substance Abuse Services Improvement Act of 1992'.
(b) TABLE OF CONTENTS- The table of contents for this Act is as follows:

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TITLE I

-BLOCK GRANTS TO STATES REGARDING MENTAL HEALTH AND SUBSTANCE ABUSE

Subtitle B--Substance Abuse
Part I--Office for Treatment Improvement

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TITLE II

-OTHER PROGRAMS OF ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH

Part II--Office for Substance Abuse Prevention

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Part III--Other Provisions Regarding Substance Abuse

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Part B of title XIX of the Public Health Service Act, as amended by section
102 of this Act, is amended by adding at the end the following:
`Subpart III--General Provisions
`SEC. 1941. SUBMISSION OF DESCRIPTION OF INTENDED USES OF BLOCK GRANT.
`(a) ANNUAL APPROVAL BY SECRETARY- The Secretary may not make a grant
under subpart I or II for a fiscal year unless--
`(1)(A) the State involved submits to the Secretary a description of the
purposes for which the State intends to expend the grant for the fiscal year;
`(B) the description identifies the populations, areas, and localities
in the State with a need for the services or activities authorized in the
program involved; and
`(C) the description provides information relating to the programs and
activities to be supported and services to be provided; and
`(2) the Secretary approves the description.
`(b) OPPORTUNITY FOR PUBLIC COMMENT- The Secretary may not make a grant
under subpart I or II for a fiscal year unless the State involved agrees
to make the description required in subsection (a) public within the State
in such manner as to facilitate comment from any person (including any
Federal or other public agency) during the development of the description
(including any revisions) and after the submission of the description
pursuant to such subsection.
`SEC. 1942. REQUIREMENT OF REPORTS AND AUDITS BY STATES.
`(a) REPORT- The Secretary may not make a grant under subpart I or II for
a fiscal year unless the State involved submits to the Secretary a report
in such form and containing such information as the Secretary determines
(after consultation with the States and the Comptroller General) to be
necessary for securing a record and a description of--
`(1) the purposes for which the grant received by the State for the preceding
fiscal year under the program involved were expended and a description of
the activities of the State under the program;
`(2) the recipients of amounts provided in the grant; and
`(3) determining whether the grant was expended in accordance with the
program involved and consistent with the needs within the State identified
pursuant to section 1941(a)(1)(B).
`(b) AUDITS- The Secretary may not make a grant under subpart I or II
unless, with respect to the grant, the State involved agrees to comply
with chapter 75 of title 31, United States Code.
`(c) PERFORMANCE REVIEWS- For fiscal year 1994 and subsequent fiscal years,
the Secretary may not make a grant under subpart I or II for a fiscal
year unless the expenditures of the grant made to the State for the second
fiscal year preceding such fiscal year have undergone a thorough performance
review in accordance with standards established by the Comptroller General.
`(d) AVAILABILITY TO PUBLIC- The Secretary may not make a grant under
subpart I or II unless the State involved agrees--
`(1) to make copies of the reports and audits described in this section
available for public inspection within the State;
`(2) to provide copies of the report under subsection (a), upon request,
to any interested person (including any public agency); and
`(3) to make available for public inspection a copy of any audit report
under paragraph (2) not later than 30 days after the completion of an
audit under such paragraph.
`SEC. 1943. ADDITIONAL REQUIREMENTS.
`(a) IN GENERAL- The Secretary may not, except as provided in subsection
(c), make a grant under subpart I or II for a fiscal year unless the State
involved agrees that--
`(1) the legislature of the State will conduct public hearings on the
proposed use and distribution of the grant to be received for the fiscal
year;
`(2) the State will provide for annual independent peer review to
assess the quality and appropriateness of treatment services provided
by a representative sample of entities that receive funds from the State
pursuant to the program involved;
`(3) the State will permit and cooperate with Federal investigations
undertaken in accordance with section 1947; and
`(4) the State will provide to the Secretary any data required by the
Secretary pursuant to section 509D and will cooperate with the Secretary
in the development of uniform criteria for the collection of data pursuant
to such section.
`(b) PATIENT RECORDS- The Secretary may not make a grant under subpart I
or II unless the State involved has in effect a system to protect from
inappropriate disclosure patient records maintained by the State in
connection with an activity funded under the program involved or by any
entity which is receiving amounts from the grant.
`SEC. 1944. CONSOLIDATION OF APPLICATIONS REGARDING SUBPARTS I AND II.
`The Secretary may, for any fiscal year, authorize any State to submit
to the Secretary a single application through which the State requests
funds under both subparts I and II, subject to the application meeting
the requirements of sections 1915 and 1930, respectively.
`SEC. 1945. DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR ALLOTMENTS.
`(a) IN GENERAL- Amounts described in subsection (b) and available for
a fiscal year pursuant to subpart I or II, as the case may be, shall be
allotted by the Secretary to States receiving a grant under the program
involved, other than any State referred to in paragraph (1)(C) of subsection
(b), any State with respect to which paragraph (2) of such subsection
applies, and in the case of the program established in subpart I, any State
to which paragraph (3) of such subsection applies. Such amounts shall be
allotted in a manner equivalent to the manner in which the allotment under
the program involved was determined.
`(b) SPECIFICATION OF AMOUNTS- The amounts referred to in subsection (a)
are any amounts that--
`(1) are not paid to States under the program involved as a result of--
`(A) the failure of any State to submit an application in accordance with
the program;
`(B) the failure of any State to prepare, within a reasonable period of
time, such application in compliance with the program; or
`(C) any State informing the Secretary that the State does not intend to
expend the full amount of the allotment made to the State under the program;
`(2) are terminated, repaid, or offset under section 1946; or
`(3) in the case of the program established in subpart I, are withheld from
allotments under section 1911 pursuant to reductions under section 1912(c).
`SEC. 1946. FAILURE TO COMPLY WITH AGREEMENTS.
`(a) SUSPENSION OR TERMINATION OF PAYMENTS- Subject to subsection (d),
if the Secretary determines that a State has materially failed to comply
with the agreements required as a condition of receiving a grant under
the program involved, the Secretary may suspend payments under the grant,
terminate the grant for cause, or employ such other remedies (in addition
to remedies provided for in subsections (b) and (c)) as may be legally
available and appropriate in the circumstances involved.
`(b) REPAYMENT OF PAYMENTS-
`(1) IN GENERAL- Subject to subsection (d), the Secretary may require
a State to repay with interest any payments received by the State under
subpart I or II that the Secretary determines were not expended by the
State in accordance with the agreements required under the program involved.
`(2) OFFSET AGAINST PAYMENTS- If a State fails to make a repayment required
in paragraph (1), the Secretary may offset the amount of the repayment
against the amount of any payment due to be paid to the State under the
program involved.
`(c) WITHHOLDING OF PAYMENTS-
`(1) IN GENERAL- Subject to subsections (d) and (f)(4), the Secretary may
withhold payments due under subpart I or II if the Secretary determines
that the State involved is not expending amounts received under the program
involved in accordance with the agreements required under the program.
`(2) TERMINATION OF WITHHOLDING- The Secretary shall cease withholding
payments from a State under paragraph (1) if the Secretary determines
that there are reasonable assurances that the State will expend amounts
received under the program involved in accordance with the agreements
required under the program.
`(d) OPPORTUNITY FOR HEARING- Before taking action against a State under
any of subsections (a) through (c), the Secretary shall provide to the
State involved adequate notice and an opportunity for a hearing.
`(e) PROMPT RESPONSE TO SERIOUS COMPLAINTS- The Secretary shall promptly
respond to any complaint of a substantial or serious nature that a State
is in violation of any of the agreements required in the program involved
as a condition of receiving a grant under the program, and shall promptly
determine whether a hearing under subsection (d) should be held regarding
the alleged violation.
`(f) INVESTIGATIONS-
`(1) REQUIREMENT REGARDING SECRETARY- The Secretary shall each fiscal year
conduct in not less than 15 States investigations of the expenditure of
grants received by the States under subpart I or II in order to evaluate
compliance with the agreements required under in the program involved.
`(2) AUTHORITY REGARDING COMPTROLLER GENERAL- The Comptroller General may
conduct investigations of the expenditure of grants received by the States
under subpart I or II in order to ensure compliance with the agreements
required under the program involved.
`(3) PROVISION OF RECORDS ETC. UPON REQUEST- Each State receiving a grant
under subpart I or II, and each entity receiving funds from the grant,
shall make appropriate books, documents, papers, and records available to
the Secretary or the Comptroller General, or any of their duly authorized
representatives, for examination, copying, or mechanical reproduction on
or off the premises of the appropriate entity upon a reasonable request
therefor.
`(4) LIMITATIONS ON AUTHORITY- The Secretary may not institute proceedings
to withhold funds under subsection (c) unless the Secretary has conducted
an investigation concerning whether the State has expended payments under
the program involved in accordance with the agreements required under the
program. Any such investigation shall be conducted within the State by
qualified investigators.
`SEC. 1947. PROHIBITIONS REGARDING RECEIPT OF FUNDS.
`(a) ESTABLISHMENT-
`(1) CERTAIN FALSE STATEMENTS AND REPRESENTATIONS- A person shall not
knowingly and willfully make or cause to be made any false statement or
representation of a material fact in connection with the furnishing of
items or services for which payments may be made by a State from the grant
made to the State under subpart I or II.
`(2) CONCEALING OR FAILING TO DISCLOSE CERTAIN EVENTS- A person with
knowledge of the occurrence of any event affecting the initial or continued
right of the person to receive any payments from a grant made to a State
under subpart I or II shall not conceal or fail to disclose any such event
with an intent fraudulently to secure such payment either in a greater
amount than is due or when no such amount is due.
`(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION- Any person who violates
any prohibition established in subsection (a) shall for each violation be
fined in accordance with title 18, United States Code, or imprisoned for
not more than 5 years, or both.
`SEC. 1948. NONDISCRIMINATION.
`(a) IN GENERAL-
`(1) RULE OF CONSTRUCTION REGARDING CERTAIN CIVIL RIGHTS LAWS- For the
purpose of applying the prohibitions against discrimination on the basis
of age under the Age Discrimination Act of 1975, on the basis of handicap
under section 504 of the Rehabilitation Act of 1973, on the basis of sex
under title IX of the Education Amendments of 1972, or on the basis of
race, color, or national origin under title VI of the Civil Rights Act of
1964, programs and activities funded in whole or in part with funds made
available under subpart I or II shall be considered to be programs and
activities receiving Federal financial assistance.
`(2) PROHIBITION- No person shall on the ground of sex or religion be
excluded from participation in, be denied the benefits of, or be subjected
to discrimination under, any program or activity funded in whole or in
part with funds made available under subpart I or II.
`(b) ENFORCEMENT-
`(1) REFERRALS TO ATTORNEY GENERAL AFTER NOTICE- Whenever the Secretary
finds that a State, or an entity that has received a payment pursuant to
subpart I or II, has failed to comply with a provision of law referred
to in subsection (a)(1), with subsection (a)(2), or with an applicable
regulation (including one prescribed to carry out subsection (a)(2)),
the Secretary shall notify the chief executive officer of the State and
shall request the chief executive officer to secure compliance. If within
a reasonable period of time, not to exceed 60 days, the chief executive
officer fails or refuses to secure compliance, the Secretary may--
`(A) refer the matter to the Attorney General with a recommendation that
an appropriate civil action be instituted;
`(B) exercise the powers and functions provided by the Age Discrimination
Act of 1975, section 504 of the Rehabilitation Act of 1973, title IX of the
Education Amendments of 1972, or title VI of the Civil Rights Act of 1964,
as may be applicable; or
`(C) take such other actions as may be authorized by law.
`(2) AUTHORITY OF ATTORNEY GENERAL- When a matter is referred to the Attorney
General pursuant to paragraph (1)(A), or whenever the Attorney General
has reason to believe that a State or an entity is engaged in a pattern
or practice in violation of a provision of law referred to in subsection
(a)(1) or in violation of subsection (a)(2), the Attorney General may bring
a civil action in any appropriate district court of the United States for
such relief as may be appropriate, including injunctive relief.
`SEC. 1949. TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND SERVICES IN
LIEU OF GRANT FUNDS.
`(a) TECHNICAL ASSISTANCE- The Secretary shall, without charge to a State
receiving a grant under subpart I or II, provide to the State (or to any
public or nonprofit private entity within the State) technical assistance
with respect to the planning, development, and operation of any program
or service carried out pursuant to the program involved. The Secretary
may provide such technical assistance directly, through contract, or
through grants.
`(b) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS-
`(1) IN GENERAL- Upon the request of a State receiving a grant under subpart
I or II, the Secretary may, subject to paragraph (2), provide supplies,
equipment, and services for the purpose of aiding the State in carrying
out the program involved and, for such purpose, may detail to the State
any officer or employee of the Department of Health and Human Services.
`(2) CORRESPONDING REDUCTION IN PAYMENTS- With respect to a request described
in paragraph (1), the Secretary shall reduce the amount of payments under the
program involved to the State by an amount equal to the costs of detailing
personnel and the fair market value of any supplies, equipment, or services
provided by the Secretary. The Secretary shall, for the payment of expenses
incurred in complying with such request, expend the amounts withheld.
`SEC. 1950. REPORT BY SECRETARY.
`Not later than October 1, 1993, 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 subparts I and II. Such report may include
any recommendations of the Secretary for appropriate changes in legislation.
`SEC. 1951. RULE OF CONSTRUCTION REGARDING DELEGATION OF AUTHORITY TO STATES.
`With respect to States receiving grants under any of the subparts of this
part, this part may not be construed to authorize the Secretary to delegate
to the States the primary responsibility for interpreting the governing
provisions of this part, including delegating authority with the result
that different States are permitted to reach different interpretations of
any provision of this part.
`SEC. 1952. DEFINITIONS.
`(a) DEFINITIONS FOR SUBPART III- For purposes of this subpart, the term
`program involved' means the program of allotments established in subpart
I or II, or both, as indicated by whether the State involved is receiving
or is applying to receive a grant under subpart I or II, or both.
`(b) DEFINITIONS FOR PART B- For purposes of this part:
`(1) The term `Comptroller General' means the Comptroller General of the
United States.
`(2) The term `State', except as provided in sections 1916(c)(5) and
1931(c)(5), means each of the several States, the District of Columbia,
and each of the territories of the United States.
`(3) The term `territories of the United States' means each of the
Commonwealth of Puerto Rico, American Samoa, Guam, the Commonwealth of the
Northern Mariana Islands, the Virgin Islands, Palau, the Marshall Islands,
and Micronesia.'.

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(a) CONTINGENT AUTHORITY FOR TRANSFERS BETWEEN ALLOTMENTS-
(1) SUBPART II TO SUBPART I- In the case of any State for which an
allotment for fiscal year 1992, 1993, or 1994 under section 1911 of the
Public Health Service Act (as added by section 101 of this Act) is made
in an amount that is less than the mental health portion of the allotment
under former section 1912A for fiscal year 1991, the Secretary of Health
and Human Services shall, upon the request of the State, transfer from the
allotment under section 1921 of such Act (as added by section 102 of this
Act) for the fiscal year involved to the allotment under such section 1911
for the fiscal year such amounts as the State may direct, subject to the
allotment under such section 1911 not exceeding the amount of such portion.
(2) SUBPART I TO SUBPART II- In the case of any State for which an
allotment for fiscal year 1992, 1993, or 1994 under section 1921 of the
Public Health Service Act (as added by section 102 of this Act) is made in
an amount that is less than the substance-abuse portion of the allotment
under former section 1912A for fiscal year 1991, the Secretary of Health
and Human Services shall, upon the request of the State, transfer from the
allotment under section 1911 of such Act (as added by section 101 of this
Act) for the fiscal year involved to the allotment under such section 1921
for the fiscal year such amounts as the State may direct, subject to the
allotment under such section 1921 not exceeding the amount of such portion.
(3) DEFINITIONS- For purposes of this subsection:
(A) The term `mental health portion', with respect to an allotment under
former section 1912A, means the portion of the allotment reserved with
respect to mental health pursuant to former section 1916(c)(6).
(B) The term `substance-abuse portion', with respect to an allotment under
former section 1912A, means the portion of the allotment reserved with
respect to alcohol and drug abuse pursuant to former section 1916(c)(6).
(C) The term `former section 1912A' means section 1912A of the Public
Health Service Act, as such section was in effect for fiscal year 1991.
(D) The term `former section 1919(c)(6)' means section 1916(c)(6) of
the Public Health Service Act, as such section was in effect for fiscal
year 1991.
(b) ALLOCATION FOR CERTAIN PROGRAM REGARDING MENTAL HEALTH- Of the amounts
appropriated for fiscal year 1992 under 1917(a) of the Public Health
Service Act (as added by section 101 of this Act), the Secretary of Health
and Human Services shall obligate 10 percent for the purpose of carrying
out subpart I of part C of title XIX of the Public Health Service Act
(as added by section 104 of this Act).
ADMINISTRATION
Subtitle A--Mental Health

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(a) TRANSFER OF AUTHORITY REGARDING MODEL PLANS-
(1) IN GENERAL- Subpart 3 of part B of title V of the Public Health Service
Act, as amended by section 101(a)(1) of this Act, is amended--
(A) by transferring subsection (c) of section 518A to section 518;
(B) by redesignating the subsection as subsection (b); and
(C) by adding the subsection at the end of section 518.
(2) CONFORMING AMENDMENT- Section 518 of the Public Health Service Act,
as amended by paragraph (1) of this subsection, is amended in the first
sentence by striking `The Secretary' and inserting `(a) The Secretary'.
(b) AUTHORIZATION OF APPROPRIATIONS- Section 518A of the Public Health
Service Act, as amended by subsection (a) of this section, is amended by
adding at the end the following new subsection:
`(c) Of the amounts appropriated under this Act for any fiscal year for
conducting or supporting research regarding mental health, the Secretary
shall make available not less than 15 percent for carrying out this
section.'.

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(a) ADMINISTRATION-
(1) IN GENERAL- Section 518 of the Public Health Service Act, as amended
by section 201 of this Act, is amended--
(A) in subsection (a), by striking `the Administrator,' and inserting
the following: `the Director of the National Institute of Mental Health
(in this subpart referred to as the `Director'),'; and
(B) in subsection (b)--
(i) by striking `Administrator' each place such term appears and inserting
`Director'; and
(ii) in paragraph (2), in the second sentence, by striking `Secretary'
and inserting `Director'.
(2) CONFORMING AMENDMENT- Section 519 of the Public Health Service Act
(42 U.S.C. 290cc-12) is amended by striking `Administrator' and inserting
`Director'.
(b) CERTAIN AUTHORITIES- Section 518 of the Public Health Service Act,
as amended by section 201, is amended in subsection (a)--
(1) by inserting before the period the following: `, and relative to the
promotion of mental health'; and
(2) by adding at the end the following new sentence: `Activities under
the preceding sentence may include studies of the psychological, social,
and legal factors that influence behavior.'.
(c) AUTHORIZATION OF APPROPRIATIONS- Section 518 of the Public Health
Service Act, as amended by section 201 of this Act, is amended by adding
at the end the following new subsection:
`(c) For the purpose of carrying out this section, there are authorized
to be appropriated $500,000,000 for fiscal year 1992, $600,000,000 for
fiscal year 1993, and $675,000,000 for fiscal year 1992.'.

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(a) DESIGNATION OF SUBPART 4- Part B of title V of the Public Health
Service Act (42 U.S.C. 290bb et seq.) is amended--
(1) by inserting before section 520 the following:
`Subpart 4--Demonstration Projects'; and
(2) in the heading for section 520, by amending the heading to read
as follows:
`CERTAIN PROJECTS'.
(b) DURATION OF SUPPORT FOR CERTAIN DEMONSTRATION PROJECTS- Section 520(c) of
the Public Health Service Act (42 U.S.C. 290cc-13(c)) is amended by inserting
before the period the following: `, except that grants under subsection (a)
for demonstration projects described in paragraph (1)(A) of such subsection
may be made for not more than five consecutive one-year periods'.

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Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290cc-11 et seq.) is amended by inserting after section 519 the
following new section:
`OFFICE OF RURAL MENTAL HEALTH
`SEC. 519A. (a) IN GENERAL- There is established within the National
Institute of Mental Health an office to be known as the Office of Rural
Mental Health (hereafter in this section referred to as the `Office'). The
Office shall be headed by a director, who shall be appointed by the Director
of such Institute from among individuals experienced or knowledgeable in
the provision of mental health services in rural areas. The Secretary shall
carry out the authorities established in this section acting through the
Director of the Office.
`(b) COORDINATION OF ACTIVITIES- The Director of the Office, in consultation
with the Director of the Institute and with the Director of the Office of
Rural Health Policy, shall--
`(1) coordinate the activities of the Department of Health and Human
Services as such activities relate to the mental health of residents of
rural areas; and
`(2) coordinate the activities of the Office with similar activities of
public and nonprofit private entities.
`(c) RESEARCH, DEMONSTRATIONS, EVALUATIONS, AND DISSEMINATION- The Director
of the Office may, with respect to the mental health of adults and children
residing in rural areas--
`(1) conduct research on conditions that are unique to the residents of
rural areas, or more serious or prevalent in such residents;
`(2) conduct research on improving the delivery of services in such areas;
`(3) carry out demonstration projects for the provision of services in
such areas, including such projects regarding outreach, interventions,
and the provision of off-site services;
`(4) establish model programs, and carry out demonstrations of such models
(at 1 or more sites);
`(5) conduct evaluations of projects and programs carried out by the
Director under this subsection; and
`(6) disseminate information to appropriate public and nonprofit private
entities.
`(d) AUTHORITY REGARDING GRANTS AND CONTRACTS- The Director of the Office
may carry out the authorities established in subsection (c) directly
and through grants, cooperative agreements, or contracts with public or
nonprofit private entities.
`(e) DEMONSTRATIONS REGARDING LINKAGE OF MENTAL HEALTH AND OTHER SERVICES-
In carrying out subsection (c), the Director of the Office shall make grants
to public or nonprofit private entities for the purpose of carrying out,
in rural areas, demonstration projects to improve the availability of
mental health services by providing such services in the same facilities
as other health or social services are provided, and through otherwise
integrating the provision of mental health services, other health services,
and social services.
`(f) REPORT TO CONGRESS- Not later than February 1 of fiscal year 1993 and
each fiscal year thereafter, the Director of the Office shall submit to the
Subcommittee on Health and the Environment of 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 the activities
of the Office during the preceding fiscal year, including a summary of
the activities of demonstration projects and a summary of evaluations of
the projects.
`(g) FUNDING- Of the amounts appropriated under this Act for fiscal year
1992, fiscal year 1993, and fiscal year 1994 for research regarding mental
health, the Secretary shall make available for carrying out this section
not less than $5,000,000, $8,000,000, and $10,000,000, respectively.'.

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(a) CERTAIN SERVICES-
(1) IN GENERAL- Section 2441 of the Public Health Service Act (42
U.S.C. 300dd-41)--
(A) is transferred to part B of title V of such Act;
(B) is redesignated as section 520A; and
(C) is inserted after section 520 of such part.
(2) CONFORMING AMENDMENTS- The Public Health Service Act (42 U.S.C. 201
et seq.), as amended by paragraph (1), is amended--
(A) in part C of title XXIV--
(i) by striking the heading for subpart I;
(ii) in section 2432(e), by striking `subpart' each place such term appears
and inserting `part'; and
(iii) by striking the heading for subpart II; and
(B) in section 520A--
(i) in subsection (a), in the matter preceding paragraph (1), by inserting
after `Secretary' the following: `, acting through the Director of the
National Institute of Mental Health,';
(ii) in subsection (j), by striking `1991' and inserting `1994'; and
(iii) by striking `SEC.' and all that follows through `(a) IN GENERAL-
' and inserting the following:
`CERTAIN COUNSELING AND MENTAL HEALTH SERVICES
`SEC. 520A. (a) IN GENERAL- '.
(b) FEDERAL ACCOUNTABILITY- Any rule or regulation of the Department of
Health and Human Services that is inconsistent with the amendments made
by this Act shall not have any legal effect, including section 50(e)
of part 96 of title 45, Code of Federal Regulations (45 CFR 96.50(e)).
Subtitle B--Substance Abuse
PART I--OFFICE FOR TREATMENT IMPROVEMENT

d2b2afe13f0ad6f717ba5f0ea95f571b078594439095eb58307acf6b160d6bdf

Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is
amended by adding at the end the following new part:
`PART F--OFFICE FOR TREATMENT IMPROVEMENT
`Subpart 1--Establishment and General Authorities
`SEC. 571. ESTABLISHMENT AND GENERAL AUTHORITIES.
`(a) IN GENERAL- There is established in the Administration an Office for
Treatment Improvement, which shall be headed by a director appointed by
the Secretary. The Secretary shall carry out this part acting through the
Director of the Treatment Office.
`(b) DUTIES- With respect to the treatment of substance abuse, the Director
shall carry out the following duties:
`(1) Collaborate with the Director of the Office 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.
`(2) 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.
`(3) Collaborate with the Administrator of the Health Resources and Services
Administration to promote the increased integration into the mainstream
of the health care system of the United States of programs for providing
treatment services.
`(4) Evaluate plans submitted by the States pursuant to section 1930(a)(6) in
order to determine whether the plans adequately provide for the availability,
allocation, and effectiveness of treatment services.
`(5) Sponsor regional workshops on improving the quality and availability
of treatment services.
`(6) 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.
`(7) Improve coordination between treatment facilities and nonhealth care
systems such as employers, labor unions, and schools, and encourage the
adoption of employee assistance programs and student assistance programs.
`(8) 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 1924.
`(9) Carry out activities to educate individuals on the need for establishing
treatment facilities within their communities.
`(10) Encourage public and private entities that provide health
insurance to provide benefits for outpatient treatment services and other
nonhospital-based treatment services.
`(11) 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 1924. Such
evaluations shall be carried out through grants, contracts, or cooperative
agreements provided to public or nonprofit private entities. In carrying
out this paragraph, the Director shall assess the quality, appropriateness,
and costs of various treatment forms for specific patient groups.
`(c) GRANTS AND CONTRACTS REGARDING GENERAL DUTIES- In carrying out the
duties established in subsection (b), the Director may make grants to and
enter into contracts with public and nonprofit private entities.
`SEC. 572. GENERAL PROVISIONS.
`(a) APPLICATIONS FOR FINANCIAL ASSISTANCE- The Director may not provide
a grant or contract under this part unless--
`(1) an application for such financial assistance is submitted to the
Secretary;
`(2) with respect to carrying out the purpose for which the assistance
is to be provided, the application provides assurances of compliance
satisfactory to the Secretary; and
`(3) 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 the purpose for which the assistance
is to be provided.
`(b) DEFINITIONS- For purposes of this part:
`(1) The term `Director' means the Director of the Treatment Office,
unless the context of usage indicates otherwise.
`(2) The term `substance abuse' means the abuse of alcohol or other drugs.
`(3) The term `treatment' means treatment for substance abuse, unless
the context of usage indicates that the meaning of the term is limited to
providing treatment only for the abuse of alcohol, or only for the abuse
of another drug or drugs, as the case may be.
`(4) The term `Treatment Office' means the Office for Treatment Improvement.
`Subpart 2--Certain Programs
`SEC. 576. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.
`(a) GRANTS FOR TREATMENT IMPROVEMENT- The Director of the Treatment
Office 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 focus on providing treatment to adolescents, female
addicts and their children, racial and ethnic minorities, or individuals
in rural areas;
`(2) projects that provide treatment and vocational training 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 or 340;
`(4) `treatment campus' projects that--
`(A) serve a significant number of individuals simultaneously;
`(B) provide residential, non-community based drug treatment;
`(C) provide patients with ancillary social services and referrals to
community-based aftercare; and
`(D) provide services on a voluntary basis;
`(5) projects in large metropolitan areas to identify individuals in need
of treatment services and to improve the availability and delivery of such
services in the areas;
`(6) in the case of individuals who engage in intravenous drug abuse,
projects to conduct outreach activities to the individuals regarding the
prevention of exposure to and the transmission of the etiologic agent for
acquired immune deficiency syndrome, 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 Office shall give preference to projects that--
`(1) demonstrate a comprehensive approach to the problems associated with
substance abuse and provide evidence of broad community involvement and
support; or
`(2) initiate and expand programs for the provision of treatment services
(including renovation of facilities, but not construction) in localities in
which, and among populations for which, there is a public health crisis as
a result of the inadequate availability of such services and a substantial
rate of drug abuse.
`(d) DURATION OF GRANTS- The period during which payments are made under
a grant under subsection (a) may not exceed 5 years.
`(e) EVALUATIONS- The Director of the Treatment Office shall require, as a
condition of awarding grants under subsection (a), a systematic evaluation
of the projects funded under such subsection.
`(f) AUTHORIZATION OF APPROPRIATIONS-
`(1) IN GENERAL- For the purpose of carrying out this section, there are
authorized to be appropriated $240,000,000 for fiscal year 1992, $300,000,000
for fiscal year 1993, and $400,000,000 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 Office shall reserve not less
than 10 percent for carrying out projects described in subsection (b)(3).
`SEC. 577. MODEL DEMONSTRATION PROGRAMS FOR TREATMENT SERVICES IN PENAL AND
CORRECTIONAL INSTITUTIONS.
`(a) IN GENERAL- The Director of the Treatment Office may make grants
to public and nonprofit private entities for the purpose of carrying out
demonstration programs to provide treatment services for substance abuse
to inmates of penal or correctional institutions of States or political
subdivisions of States.
`(b) REQUIREMENTS FOR PROGRAMS- With respect to a program of treatment
established pursuant to subsection (a), the Director may not make a grant
unless the applicant involved agrees as follows:
`(1) The goal of treatment will be for the inmate involved to overcome any
dependency on alcohol or other drugs, to cease engaging in substance abuse
and make a commitment not to relapse into such abuse, and to acquire the
minimum skills necessary for obtaining and maintaining employment.
`(2) Participation in the program by an inmate will be voluntary. An inmate
will be admitted to the program only if--
`(A) the applicant has determined that the individual is in need of
treatment;
`(B) the term or terms of incarceration of the inmate are scheduled to be
completed not later than 1 year after the date on which the individual is
to be admitted to the program;  and
`(C) there is a reasonable basis for believing that the inmate will make
significant progress toward achieving the goal described in paragraph (1)
before the end of such term.
`(3) If an inmate is admitted to the program, the applicant will make
available to the inmate, directly or through arrangements with other
public or nonprofit private entities, such services as may be necessary
to provide the inmate with a reasonable opportunity to make significant
progress toward the goal described in paragraph (1).
`(4) For purposes of facilitating treatment, the applicant will, to the
extent practicable, separate inmates participating in the program from
other inmates.
`(5) In the case of an inmate participating in the program whose date of
release from incarceration is nearing, the applicant will make reasonable
efforts to refer the individual (the former inmate), upon such release,
to public or nonprofit private entities that can make available to the
individual services that will assist the individual with respect to the
goal described in paragraph (1).
`(c) AGREEMENT REGARDING INSTITUTION INVOLVED- With respect to any penal or
correctional institution in which an applicant for a grant under subsection
(a) proposes to carry out a program under such subsection, the Director
may not make the grant to the applicant unless the State or political
subdivision administering the institution has agreed to cooperate with
the applicant regarding the establishment and operation of the program.
`(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
section, there are authorized to be appropriated $50,000,000 for each of
the fiscal years 1992 through 1994.
`Subpart 3--Model Comprehensive Program for Treatment of Substance Abuse
`SEC. 581. DEMONSTRATION PROGRAM IN NATIONAL CAPITAL AREA.
`(a) IN GENERAL- The Director of the Treatment Office 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 Director 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
with respect to substance abuse, including education on the appropriate
involvement of parents and sexual partners 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 abuse drugs
intravenously, 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 inquires 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 Director 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 Director assurances
satisfactory to the Director 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 Director may not make the grant under subsection (a) unless--
`(i) an application for the grant is submitted to the Director;
`(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 Director; and
`(iii) the application otherwise is in such form, is made in such manner,
and contains such agreements, assurances, and information as the Director
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 Director 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 equal to not less than $1 for each $4 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- The Director shall make a grant or enter into a contract
for the conduct of an evaluation of the effectiveness of the program
carried out under subsection (a). The grant or contract shall provide for
an evaluation of 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.
`(f) REPORTS-
`(1) INITIAL CRITERIA- The Director 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
Community Mental Health and Substance Abuse Services Improvement Act of
1992, the Director shall submit to the Congress a report describing the
findings made as a result of the determination.
`(2) ANNUAL REPORTS- Not later than 1 year after the date on which the
grant is made under subsection (a), and annually thereafter, the Director
shall submit to the Congress a report describing the extent to which the
program carried out under subsection (a) 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
subdivisions located in such counties).
`(h) FUNDING- Of the amounts made available in appropriations Acts
for the fiscal years 1992 through 1994 for carrying out the programs
administered by the Administrator of the Alcohol, Drug Abuse, and Mental
Health Administration, the Secretary, acting through the Director of the
Treatment Office, shall reserve for carrying out this section, respectively,
$10,000,000, for fiscal year 1992, $10,000,000, for fiscal year 1993,
and $5,000,000, for fiscal year 1994.'.

a90b86e20c5baddbff164de664b6db93cf8a94946da194f7f5499c1327dc8233

Section 501(b) of the Public Health Service Act (42 U.S.C. 290aa(b))
is amended by adding at the end the following new paragraph:
`(5) The Office for Treatment Improvement.'.
PART II--OFFICE FOR SUBSTANCE ABUSE PREVENTION

9c4b83484d2d139d598f618834a67ecbaf14ecd307138cee3de2e4948e97e629

(a) IN GENERAL- Section 508(b) of the Public Health Service Act (42
U.S.C. 290aa-6(b)) is amended--
(1) by striking paragraphs (5), (10), and (11);
(2) by redesignating paragraphs (6) through (9) as paragraphs (5) through
(8), respectively;
(3) by redesignating paragraph (12) as paragraph (9); and
(4) in paragraph (8) (as so redesignated), by adding `and' after the
semicolon at the end.
(b) AUTHORIZATION OF APPROPRIATIONS- Section 508 of the Public Health
Service Act (42 U.S.C. 290aa-6) is amended by striking subsection (d).
(c) NATIONAL DATA BASE- Section 508 of the Public Health Service Act,
as amended by subsection (b) of this section, is amended by adding at the
end the following new subsection:
`(d) The Director of the Prevention Office shall establish a national data
base providing information on programs for the prevention of substance
abuse. The data base shall contain information appropriate for use by
public entities and information appropriate for use by private entities.'.
(d) REFERENCES- Part A of title V of the Public Health Service Act (42
U.S.C. 290aa et seq.) is amended--
(1) in section 508--
(A) in subsection (a), in the first sentence, by striking `(hereafter'
and all that follows and inserting `(hereafter referred to in this part
as the `Prevention Office').'; and
(B) in subsection (b), in the matter preceding paragraph (1), by striking
`Office' and inserting `Prevention Office'; and
(2) in section 509, in the first sentence, by striking `Office' and inserting
`Prevention Office'.
(e) COMMUNITY PROGRAMS- Part A of title V of the Public Health Service Act
(42 U.S.C. 290aa et seq.) is amended by inserting after section 508 the
following new section:
`COMMUNITY PROGRAMS
`SEC. 508A. (a) The Secretary, acting through the Director of the Prevention
Office, 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) The Director of the Prevention Office 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) For the purpose of carrying out subsection (a), there are authorized
to be appropriated $114,000,000 for fiscal year 1992, $165,000,000 for
fiscal year 1993, and $215,000,000 for fiscal year 1994.'.

df25ed04e8c9d1b49aad796013a7de0821abfe0fcf44812da2dc23c8b31299a9

RISK YOUTH.
(a) IN GENERAL- Section 509A of the Public Health Service Act (42
U.S.C. 290aa-8) is amended--
(1) redesignating subsections (c) through (f) as subsections (d) through
(g), respectively; and
(2) by inserting after subsection (b) the following new subsection:
`(c) The Secretary shall ensure that projects under subsection (a) include
projects to develop 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.'.
(b) AUTHORIZATION OF APPROPRIATIONS- Section 509A of the Public Health
Service Act, as amended by subsection (a) of this subsection, is amended
by adding at the end the following new subsection:
`(h) For the purpose of carrying out this section, there are authorized to
be appropriated $60,000,000 for fiscal year 1992, $80,000,000 for fiscal
year 1993, and $100,000,000 for fiscal year 1994.'.
(c) REFERENCES- Section 509A(a) of the Public Health Service Act
(42 U.S.C. 290aa-8(a)) is amended by striking `Office' and inserting
`Prevention Office'.

6a0525fb3c80bc9c5cc38c2d6d820b273ca61d6d1c90d6ed675ec84a9a27e531

AND POSTPARTUM WOMEN.
(a) IN GENERAL- Part A of title V of the Public Health Service Act (42
U.S.C. 290aa et seq.) is amended--
(1) by striking section 509G; and
(2) by amending section 509F to read as follows:
`RESIDENTIAL TREATMENT PROGRAMS FOR PREGNANT AND POSTPARTUM WOMEN
`SEC. 509F. (a) IN GENERAL- The Director of the Prevention Office shall
make grants 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, and any minor children of the women, reside in facilities
provided by the programs;
`(2) the programs provide ongoing supervision of the women; 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
under subsection (a) for an applicant is that, in the program operated
pursuant to such subsection--
`(1) treatment services and each supplemental service will be available
through the applicant, either directly or through agreements with other
public or nonprofit private entities; and
`(2) the services will be made available to each woman admitted to the
program.
`(c) INDIVIDUALIZED PLAN OF SERVICES- A funding agreement 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 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 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 OF GRANTEES-
`(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 a grant 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 a grant
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 grant will provide the service directly, and
the applicant has entered into a participation agreement under the State
plan and is qualified to receive payments under such plan; or
`(ii) the applicant will enter into an agreement with a public or nonprofit
private entity under which the entity will provide the service, and the
entity has entered into such a participation agreement plan and is qualified
to receive such payments.
`(B)(i) In the case of an entity making an agreement pursuant to subparagraph
(A)(ii) regarding the provision of services, the requirement established
in such subparagraph regarding a participation agreement shall be waived
by the Director if the entity does not, in providing health care services,
impose a charge or accept reimbursement available from any third-party
payor, including reimbursement under any insurance policy or under any
Federal or State health benefits plan.
`(ii) A determination by the Director of whether an entity referred to in
clause (i) meets the criteria for a waiver under such clause shall be made
without regard to whether the entity accepts voluntary donations regarding
the provision of services to the public.
`(C) With respect to any authorized service that is available pursuant to
the State plan described in subparagraph (A), the requirements established
in such subparagraph shall not apply to the provision of any such service
by an institution for mental diseases to an individual who has attained
21 years of age and who has not attained 65 years of age. For purposes
of the preceding sentence, the term `institution for mental diseases' has
the meaning given such term in section 1905(i) of the Social Security Act.
`(f) REQUIREMENT OF MATCHING FUNDS-
`(1) IN GENERAL- With respect to the costs of the program to be carried out
by an applicant pursuant to subsection (a), a funding agreement 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 is not less than--
`(A) $1 for each $9 of Federal funds provided for the first year of payments
under the grant; and
`(B) $1 for each $3 of Federal funds provided in any subsequent year of
payments under any such 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.
`(g) OUTREACH- A funding agreement 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 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 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 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 with an income of less than 185
percent of the official poverty line, as established by the Director of the
Office for Management and Budget and revised by the Secretary in accordance
with section 673(2) of the Omnibus Budget Reconciliation Act of 1981.
`(k) REPORTS TO DIRECTOR- A funding agreement 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 grant;
`(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 a grant under
subsection (a) only if the applicant involved makes each of the agreements
described in this section. Such a grant may be made only if an application
for the grant 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 GRANTS- In making grants under subsection
(a), the Director shall ensure that the grants are equitably allocated
among the principal geographic regions of the United States, subject to
the availability of qualified applicants for the grants.
`(n) DURATION OF GRANT- The period during which payments are made to an
entity 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. This subsection may not
be construed to establish a limitation on the number of grants 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, 1993 and every 2 years
thereafter, the Director shall submit to the Congress a report describing
programs carried out pursuant to this section. Each such report shall
include any evaluations conducted under subsection (m) during the preceding
fiscal year.
`(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)' means an agreement
required in subsection (l) as a condition of receiving a grant under
subsection (a).
`(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
509G, there are authorized to be appropriated $100,000,000 for fiscal
year 1992, $125,000,000 for fiscal year 1993, and $175,000,000 for fiscal
year 1994.
`(2) TRANSFER- In addition to the amounts authorized in paragraph (1)
to be appropriated for the fiscal year involved, there is authorized to
be appropriated for the fiscal year for the purpose described in such
paragraph $31,000,000 from the special forfeiture fund of the Director of
the Office of National Drug Control Policy.
`(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).'.
(b) PREVENTION PROGRAMS- Part A of title V of the Public Health Service
Act, as amended by subsection (a) of this section, is amended by adding
at the end the following:
`PREVENTION PROGRAMS FOR PREGNANT AND POSTPARTUM WOMEN
`SEC. 509G. (a) The Secretary, acting through the Director of the Prevention
Office, shall make grants to establish projects for prevention and education
activities, and outpatient treatment, regarding the effects of drug and
alcohol abuse on pregnant and postpartum women and their infants.
`(b) The Secretary shall evaluate projects carried out under subsection
(a) and shall disseminate to appropriate public and private entities
information on effective projects.'.
(c) TRANSITIONAL AND SAVINGS PROVISIONS-
(1) SAVINGS PROVISION FOR COMPLETION OF CURRENT PROJECTS-
(A) Subject to paragraph (2), in the case of any project for which a
grant under former section 509F was provided for fiscal year 1991, the
Secretary of Health and Human Services may continue in effect the grant
for fiscal year 1992 and subsequent fiscal years, subject to the duration
of any such grant not exceeding the period determined by the Secretary in
first approving the grant.
(B) Subparagraph (A) shall apply with respect to a project notwithstanding
that the project is not eligible to receive a grant under current section
509F or 509G.
(2) LIMITATION ON FUNDING FOR CERTAIN PROJECTS- With respect to the
amounts appropriated for any fiscal year under current section 509F,
any such amounts appropriated in excess of the amount appropriated for
fiscal year 1991 under former section 509F shall be available only for
grants under current section 509F.
(3) DEFINITIONS- For purposes of this subsection:
(A) The term `former section 509F' means section 509F of the Public Health
Service Act, as in effect for fiscal year 1991.
(B) The term `current section 509G' means section 509G of the Public Health
Service Act, as in effect for fiscal year 1992 and subsequent fiscal years.
(C) The term `current section 509F' means section 509F of the Public Health
Service Act, as in effect for fiscal year 1992 and subsequent fiscal years.

f902b7cb323ce1e1825f38cf1650ef4e4f375f72ca0f9006ecba2b9c0e5243e8

Part A of title V of the Public Health Service Act, as amended by section
223(b) of this Act, is amended by adding at the end the following new
section:
`TRAINING IN PROVISION OF TREATMENT SERVICES FOR SUBSTANCE ABUSE
`SEC. 509H. (a) IN GENERAL- The Director of the Prevention Office
shall develop programs to increase the number of full-time 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 of
the Prevention Office 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 Secretary may make grants to health professions schools (including
schools of nursing and allied health professions schools) and schools of
social work for programs--
`(1) to train individuals in the diagnosis and treatment of substance
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 $26,000,000 for fiscal
year 1992, $28,000,000 for fiscal year 1993, and $30,000,000 for fiscal
year 1994.'.
PART III--OTHER PROVISIONS REGARDING SUBSTANCE ABUSE

38e05ef52b2bafda754c80da426975184dbe8b66a9314f5aa47c6e9ddc36b268

Section 513(a) of the Public Health Service Act (42 U.S.C. 290bb-2(a))
is amended--
(1) by inserting `(other than section 512(c))' after `subpart';
(2) by striking `and' after `1987,'; and
(3) by inserting before the period the following: `,  $160,000,000 for
fiscal year 1992, $210,000,000 for fiscal year 1993, and $310,000,000 for
fiscal year 1994'.

1bb56be6a6ffae62f6ab41013d738ac75a5db5960a2a2bc6297411afd3de6b8f

(a) IN GENERAL- Section 515(a) of the Public Health Service Act (42
U.S.C. 290cc(a)) is amended--
(1) in paragraph (5), by striking `and' after the semicolon at the end;
(2) in paragraph (6), by striking the period at the end and inserting a
semicolon; and
(3) by adding at the end the following:
`(7) the development and demonstration of new and improved methods of
screening and early detection, referral, and diagnosis of individuals with
a risk of drug abuse; and
`(8) the development and demonstration of new and improved methods for the
dissemination of findings of research on drug abuse, and of information
on the prevention and treatment of such abuse.'.
(b) AUTHORIZATION OF APPROPRIATIONS- Section 515 of the Public Health
Service Act (42 U.S.C. 290cc) is amended by adding at the end the following
new subsection:
`(c) For the purpose of carrying out this section, there are authorized
to be appropriated $293,000,000 for fiscal year 1992, $330,000,000 for
fiscal year 1993, and $360,000,000 for fiscal year 1994.'.
(c) STRIKING OF CERTAIN AUTHORITIES- Subpart 2 of part B of title V of the
Public Health Service Act (290cc et seq.) is amended by striking sections
516 and 517.

d602461a5069f6348cbd4966a4645ad3f09b8cdb46550dc4772bc39cba5a78d2

(a) IN GENERAL- In the case of programs in the United States that provide
both sterile hypodermic needles and bleach to individuals in order to provide
for a reduction in the risk of the individuals contracting acquired immune
deficiency syndrome or related conditions, the Secretary of Health and
Human Services, acting through the Director of the National Institute on
Drug Abuse, shall enter into a contract with a public or nonprofit private
entity, subject to subsection (b), for the purpose of conducting a study
to make determinations of the following:
(1) The extent to which the programs promote, directly or indirectly,
the abuse of drugs through providing information or devices (or both)
regarding the manner in which the adverse health consequences of such
abuse can be minimized.
(2) In the case of individuals participating in the programs, the number
of individuals who have engaged in the abuse of drugs prior to admission
to the programs and the number of individuals who have not engaged in such
abuse prior to such admission.
(3) The extent to which participation in the programs has altered any
behaviors constituting a substantial risk of contracting acquired immune
deficiency syndrome or hepatitis B, or of transmitting either of the
diseases.
(4) The number of programs that provide referrals for the treatment of
such abuse and the number of programs that do not provide such referrals.
(5) The extent to which programs safely dispose of used hypodermic syringes
and needles.
(b) NATIONAL ACADEMY OF SCIENCES- The Secretary shall request the National
Academy of Sciences to enter into the contract under subsection (a) to
conduct the study described in such subsection. If such Academy declines
to conduct the study, the Secretary shall carry out such subsection through
another public or nonprofit private entity.
(c) LIMITATION REGARDING EXISTING PROGRAMS- The study required in subsection
(a) may not be conducted with respect to programs established after the
date of the enactment of this Act.
(d) DATE FOR COMPLETION- The Secretary shall ensure that, not later than 18
months after the date of the enactment of this Act, the study required in
subsection (a) is completed and a report describing the findings made as a
result of the study is submitted to the Committee on Energy and Commerce
of the House of Representatives and to the Committee on Labor and Human
Resources of the Senate.
(e) DEFINITION- For purposes of this section, the term `Secretary' means
the Secretary of Health and Human Services.
(f) FUNDING- Of the aggregate amounts appropriated under the Public Health
Service Act for fiscal years 1992 and 1993 for research on drug abuse,
the Secretary shall make available $5,000,000 for conducting the study
required in subsection (a).

76a76ecf35c86c53c5a30203e40d90a3afe37e745418198921637085bc985abf

ABUSE.
(a) STUDY- The Secretary of Health and Human Services shall conduct a
study of the barriers to insurance coverage for the treatment of substance
abuse. The study shall include an assessment of the effect of managed care
on the quality and financing of such treatment.
(b) REPORT TO CONGRESS- Not later than 1 year after the date of the enactment
of this Act, the Secretary shall complete the study required in subsection
(a) 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 describing the findings made as a result of the study.

01b631e9b783abd115302740d152e30e46f8d45b21d328615840c6040f796ce4

(a) IN GENERAL- The Secretary of Health and Human Services (in this section
referred to as the `Secretary') shall enter into a contract with a public
or nonprofit private entity to conduct a study on the prevalence of fetal
alcohol effect and fetal alcohol syndrome in the general population of the
United States and on the adequacy of Federal efforts to reduce the incidence
of such conditions (including efforts regarding appropriate training for
health care providers). The Secretary shall ensure that the study--
(1) describes diagnostic tools for identifying such conditions;
(2) compares the rate of each of such conditions with the rates of other
drug-related conditions;
(3) evaluates the adequacy of available treatment for such conditions; and
(4) evaluates the plans of Federal agencies to conduct research on the
conditions and determines the adequacy of such plans in relation to the
impact on public health of the conditions.
(b) NATIONAL ACADEMY OF SCIENCES- The Secretary shall request the National
Academy of Sciences to enter into the contract under subsection (a) to
conduct the study described in such subsection. If such Academy declines
to conduct the study, the Secretary shall carry out such subsection through
another public or nonprofit private entity.,
(c) REPORT- The Secretary shall ensure that, not later than 18 months after
the date of the enactment of this Act, the study required in subsection
(a) is completed and a report describing the findings made as a result
of the study is submitted to the Committee on Energy and Commerce of the
House of Representatives and to the Committee on Labor and Human Resources
of the Senate.
PART IV--CHILDREN OF SUBSTANCE ABUSERS

4a4f15d5af16e4fef1c1247aac9135a3403e2085f43f26da78ef8c082b0c7a56

Title III of the Public Health Service Act (42 U.S.C. 301 et seq.) is
amended by adding at the end the following new part:
`Part M--Services for Children of Substance Abusers
`SEC. 399D. GRANTS FOR SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS.
`(a) ESTABLISHMENT- The Secretary, acting through the Administrator of the
Health Resources and Services Administration, shall make grants to public
and nonprofit private entities for the purpose of carrying out programs to
provide the services described in subsection (b) to children of substance
abusers and to provide the applicable services described in subsection
(c) to families in which a member is a substance abuser.
`(b) SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS- The Secretary may make a
grant under subsection (a) only if the applicant involved agrees to make
available (directly or through agreements with other entities) to children
of substance abusers each of the following services:
`(1) Periodic evaluation of children for developmental, psychological,
and medical problems.
`(2) Primary pediatric care, consistent with early and periodic screening,
diagnostic, and treatment services described in section 1905(r) of the
Social Security Act.
`(3) Other necessary and mental health services.
`(4) Therapeutic intervention services for children, including provision
of therapeutic child care.
`(5) Preventive counseling services.
`(6) Counseling related to the witnessing of chronic violence.
`(7) Referral to related services, and assistance in establishing eligibility
for related services.
`(8) Additional developmental services that are consistent with the provision
of early intervention services, as such term is defined in part H of the
Individuals with Disabilities Education Act.
`(c) SERVICES FOR AFFECTED FAMILIES- The Secretary may make a grant under
subsection (a) only if, in the case of families in which a member is a
substance abuser, the applicant involved agrees to make available (directly
or through agreements with other entities) each of the following services,
as applicable to the family member involved:
`(1)(A) Services to--
`(i) Accomplish early identification of families where substance abuse
is present.
`(ii) Accomplish early identification of children affected by parental
substance abuse.
`(iii) Provide counseling to substance abusers on the benefits and
availability of substance abuse treatment services and services for children
of substance abusers.
`(iv) Assist substance abusers in obtaining and using substance abuse
treatment services and services for children of substance abusers.
`(v) Visit and provide support to substance abusers, especially pregnant
women, who are receiving substance abuse treatment services or services
for children of substance abusers.
`(B) The Secretary may make a grant under subsection (a) only if the
applicant involved agrees that services under subparagraph (A) will, the
program carried out under subsection (a), be provided by a public health
nurse, social worker, or similar professional, or by a trained worker from
the community supervised by a professional.
`(2) In the case of substance abusers:
`(A) Encouragement and, where necessary, referrals to participate in
appropriate substance abuse treatment.
`(B) Assessment of adult roles other than parenting, including periodic
evaluation of social status, economic status, educational level,
psychological condition, and skill level.
`(C) Primary health care and mental health services, including prenatal
and post partum care for pregnant women.
`(D) Consultation and referral regarding subsequent pregnancies and life
options, including education and career planning.
`(E) Where appropriate, counseling regarding family conflict and violence.
`(F) Remedial education services.
`(G) Referral to related services, and assistance in establishing eligibility
for related services.
`(3) In the case of substance abusers, spouses of substance abusers,
extended family members of substance abusers, caretakers of children of
substance abusers, and other people significantly involved in the lives
of substance abusers or the children of substance abusers:
`(A) An assessment of the strengths and service needs of the family and
the assignment of a case manager who will coordinate services for the family.
`(B) Therapeutic intervention services, such as parental counseling,
joint counseling sessions for families and children, and family therapy.
`(C) Child care or other care for the child to enable the parent to attend
treatment or other activities and respite care services.
`(D) Parenting education services and parent support groups.
`(E) Support services, including, where appropriate, transportation services.
`(F) where appropriate, referral of other family members to related services
such as job training.
`(G) Aftercare services, including continued support through parent groups
and home visits.
`(d) CONSIDERATIONS IN MAKING GRANTS-
`(1) IN GENERAL- In making grants under subsection (a), the Secretary
shall ensure that the grants are reasonably distributed among the following
types of entities:
`(A) Alcohol and drug treatment programs, especially those providing
treatment to pregnant women and mothers and their children.
`(B) Public or private nonprofit entities that provide health or
social services to disadvantaged populations, including community-based
organizations, local public health departments, community action agencies,
hospitals, community health centers, child welfare agencies, developmental
disabilities service providers, and family resource and support programs,
and that have--
`(i) expertise in applying the services to the particular problems of
substance abusers and the children of substance abusers; and
`(ii) an affiliation or contractual relationship with one or more substance
abuse treatment programs.
`(C) Consortia of public or private nonprofit entities that include at
least one substance abuse treatment program.
`(D) Indian tribes, Indian organizations, and Alaska Native villages.
`(2) ADDITIONAL CONSIDERATIONS- In making grants under subsection (a),
the Secretary shall ensure that the grants are--
`(A) distributed to an adequate number of eligible entities that--
`(i) provide residential treatment to substance abusers and provide
appropriate therapeutic services to meet the needs of children of substance
abusers while they reside with their parents during treatment;
`(ii) provide in-home and community-based services on an out-patient basis
or in a primary pediatric care setting; or
`(iii) provide residential care for the parent with the child participating
in the provision of such care while residing with a caretaker, and
provide outreach, supportive, and therapeutic services for the child and
the caretaker;
`(B) distributed to give priority to areas with a high incidence of poverty
and a high incidence of children of substance abusers, infant mortality,
infant morbidity, or child abuse;
`(C) distributed to ensure that entities serving Native American and Native
Hawaiian communities are represented among the grantees; and
`(D) equitably distributed between urban and rural States and among all
geographic regions of the country.
`(e) 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 made by the grant recipient as a part or all of
the non-Federal share of grants.
`(f) EVALUATION- The Secretary shall periodically conduct evaluations to
determine the effectiveness of programs supported under subsection (a)--
`(1) in reducing the incidence of alcohol and drug abuse among substance
abusers participating in the programs;
`(2) in preventing adverse health conditions in children of substance
abusers;
`(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;
`(4) in improving parental and family functioning;
`(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.
`(g) REPORT- The Secretary shall annually 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--
`(1) information concerning the number and type of programs receiving grants;
`(2) information concerning the type and use of services offered;
`(3) information concerning--
`(A) the number and characteristics of families, parents, and children
served;
`(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 (D) who were
permanently placed in out-of-home care;
analyzed by the type of eligible entity described in subsection (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 eligible entities described in subsection (e).
`(h)  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 and the composition and income of the family.
`(i) REQUIREMENT OF APPLICATION- The Secretary may not make any grant
under this section 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.
`(j) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
section, there is authorized to be appropriated $50,000,000 for each of
the fiscal years 1992 through 1994.'.
PART V--MISCELLANEOUS PROVISIONS

9ae655c9361c96ddac302bc905ce55f2c3c55c9ede37bf02b05a5ff20b8ce6c0

SUBSTANCE ABUSE.
Section 501(m)(5) of the Public Health Service Act (42 U.S.C. 290aa(m)(5))
is amended by striking `1991' and inserting `1994'.

faeb1eb5e171a724a041168747e6e9a6ca3c70033b833d469abb67f01eadc353

Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.), as
added by section 3 of Public Law 101-590 (104 Stat. 2915), is amended by
adding at the end the following new part:
`Part D--Trauma Centers Operating in Areas Severely Affected by Drug-Related
Violence
`SEC. 1241. GRANTS FOR CERTAIN TRAUMA CENTERS.
`(a) IN GENERAL- The Secretary may make grants for the purpose of providing
for the operating expenses of trauma centers that have incurred substantial
uncompensated costs in providing trauma care in geographic areas with a
significant incidence of violence arising from the abuse of drugs. Grants
under this subsection may be made only to such trauma centers.
`(b) MINIMUM QUALIFICATIONS OF CENTERS-
`(1) SIGNIFICANT INCIDENCE OF TREATING PENETRATION WOUNDS-
`(A) The Secretary may not make a grant under subsection (a) to a trauma
center unless the population of patients that has been served by the center
for the period specified in subparagraph (B) includes a significant number
of patients who were treated for wounds resulting from the penetration of
the skin by knives, bullets, or other weapons.
`(B) The period specified in this subparagraph is the 2-year period preceding
the fiscal year for which the trauma center involved is applying to receive
a grant under subsection (a).
`(2) PARTICIPATION IN TRAUMA CARE SYSTEM OPERATING UNDER CERTAIN PROFESSIONAL
GUIDELINES- The Secretary may not make a grant under subsection (a) unless
the trauma center involved is a participant in a system that--
`(A) provides comprehensive medical care to victims of trauma in the
geographic area in which the trauma center is located;
`(B) is established by the State or political subdivision in which such
center is located; and
`(C) has adopted guidelines for the designation of trauma centers, and
for triage, transfer, and transportation policies, equivalent to (or more
protective than) the applicable guidelines developed by the American College
of Surgeons or utilized in the model plan established under section 1213(c).
`SEC. 1242. PREFERENCES IN MAKING GRANTS.
`(a) IN GENERAL- In making grants under section 1241(a), the Secretary
shall give preference to any application--
`(1) made by a trauma center that, for the purpose specified in such section,
will receive financial assistance from the State or political subdivision
involved for each fiscal year during which payments are made to the center
from the grant, which financial assistance is exclusive of any assistance
provided by the State or political subdivision as a non-Federal contribution
under any Federal program requiring such a contribution; or
`(2) made by a trauma center that, with respect to the system described
in section 1241(b)(2) in which the center is a participant--
`(A) is providing trauma care in a geographic area in which the availability
of trauma care has significantly decreased as a result of a trauma center
in the area permanently ceasing participation in such system as of a date
occurring during the 2-year period specified in section 1241(b)(1)(B); or
`(B) will, in providing trauma care during the 1-year period beginning
on the date on which the application for the grant is submitted, incur
uncompensated costs in an amount rendering the center unable to continue
participation in such system, resulting in a significant decrease in the
availability of trauma care in the geographic area.
`(b) FURTHER PREFERENCE FOR CERTAIN APPLICATIONS- With respect to
applications for grants under section 1241 that are receiving preference for
purposes of subsection (a), the Secretary shall give further preference to
any such application made by a trauma center for which a disproportionate
percentage of the uncompensated costs of the center result from the
provision of trauma care to individuals who are undocumented aliens.
`SEC. 1243. COMMITMENT REGARDING CONTINUED PARTICIPATION IN TRAUMA CARE SYSTEM.
`The Secretary may not make a grant under subsection (a) of section 1241
unless the trauma center involved agrees that--
`(1) the center will continue participation in the system described in
subsection (b) of such section throughout the 3-year period beginning on
the date that the center first receives payments under the grant; and
`(2) if the agreement made pursuant to paragraph (1) is violated by the
center, the center will be liable to the United States for an amount equal
to the sum of--
`(A) the amount of assistance provided to the center under subsection (a)
of such section; and
`(B) an amount representing interest on the amount specified in subparagraph
(A).
`SEC. 1244. GENERAL PROVISIONS.
`(a) APPLICATION- The Secretary may not make a grant under section 1241(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 part.
`(b) LIMITATION ON DURATION OF SUPPORT- The period during which a trauma
center receives payments under section 1241(a) may not exceed 3 fiscal years,
except that the Secretary may waive such requirement for the center and
authorize the center to receive such payments for 1 additional fiscal year.
`SEC. 1245. AUTHORIZATION OF APPROPRIATIONS.
`For the purpose of carrying out this part, there are authorized to be
appropriated $50,000,000 for fiscal year 1992, $75,000,000 for fiscal year
1993, and $100,000,000 for fiscal year 1994.'.

f3217b17ca954ec5f7e5b43e2e640785e4d86f18efc730315a4107a244b5b079

TITLE III

-TRAUMA CENTERS AND DRUG-RELATED VIOLENCE

Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.),
as added by section 3 of Public Law 101-590 (104 Stat. 2915), is amended--
(1) in the heading for part C, by inserting `REGARDING PARTS A AND B'
after `PROVISIONS';
(2) in section 1231, in the matter preceding paragraph (1), by striking
`this title' and inserting `this part and parts A and B'; and
(3) in section 1232(a), by striking `this title' and inserting `parts A
and B'.

700f0f596b360a791ba2a9235e79d91de4c9e2234c2c6aefd3c1d35dd3c85e1a

The Secretary of Health and Human Services shall establish a commission to
be known as the National Commission on Alcohol and Tobacco Use By Children.

e2b4fa8df2d4a52c0343d5e64235936928dff9511fffa8305f56f12876089d99

TITLE IV

-NATIONAL COMMISSION ON ALCOHOL AND TOBACCO USE BY CHILDREN

The Commission shall--
(1) identify the factors that encourage the initial use of tobacco products
and alcoholic beverages by children, and the factors that influence the
duration and extent of such use;
(2) assess the direct and indirect health consequences of such use by
children;
(3) examine the effect and adequacy of efforts by manufacturers of such
products and beverages to discourage such use, including an assessment of
any activities of the manufacturers that may appeal to children and may
promote such use;
(4) examine the adequacy and effect of Federal, State and local laws to
prevent such use; and
(5) develop recommendations on the policies that should be established by
public and private entities in order to reduce such use.

79b6f04a8eb6324edf412d038de56fe4b46a47ed54b1c43b368dea5bc46412e2

(a) COMPOSITION-
(1) IN GENERAL- The Commission shall be composed of 19 members. Of such
members--
(A) 5 shall be ex officio members designated in accordance with subsection
(b);
(B) 4 shall be members of the Congress designated in accordance with
subsection (c); and
(C) 10 shall be appointed in accordance with subsection (d) from among
individuals who are not officers or employees of the Federal Government.
(2) VOTING MEMBERS- Each member of the Commission shall be a voting member.
(b) EX OFFICIO MEMBERS- The following officials shall serve as ex officio
members of the Commission:
(1) The Secretary.
(2) The Surgeon General of the Public Health Service.
(3) The Director of the Centers for Disease Control.
(4) The Director of the Office of National Drug Control Policy.
(5) The Chairman of the Federal Trade Commission.
(c) CONGRESSIONAL MEMBERS- The congressional members of the Commission
shall be appointed as follows:
(1) The Speaker of the House of Representatives shall appoint 2 members
from the Members of the House, after consideration of the recommendations
made by the Majority Leader and the Minority Leader of the House.
(2) The President Pro Tempore shall appoint 2 members from among the
Members of the Senate, after consideration of the recommendations made by
the Majority Leader and the Minority Leader of the Senate.
(d) APPOINTED MEMBERS- The appointed members of the Commission shall be
appointed by the Secretary, and shall be individuals who are specially
qualified to serve as members of the Commission by virtue of the education,
training, or experience of the individuals.
(e) TERMS-
(1) IN GENERAL- Each Member shall be appointed for the life of the
Commission.
(2) VACANCIES- A vacancy in the Commission shall be filled in the manner
in which the original appointment was made.
(f) BASIC PAY- Members shall serve without pay.
(g) TRAVEL EXPENSES- Each member shall receive travel expenses, including
per diem in lieu of subsistence, in accordance with sections 5702 and 5703
of title 5, United States Code.
(h) QUORUM- A majority of the members of the Commission shall constitute
a quorum for the transaction of business.
(i) CHAIR- The Secretary shall serve as the chair of the Commission .
(j) MEETINGS- The Commission shall meet at the call of the Chairperson or
a majority of its members.

2ffaf2be506bcb5257dfad92f784d88b82131c6c903cd58f42097f26dbcfb8f5

(a) IN GENERAL- The Secretary shall appoint a director for the
Commission. Such director shall be paid at a rate equal to the maximum
rate of basic pay payable for GS-18 of the General Schedule under section
5332 of title 5, United States Code. The Secretary shall provide to the
Commission such other staff, and such information and other assistance
(including quarters, and experts and consultants) as may be necessary to
carry out the duties of the Commission.
(b) APPLICABILITY OF CERTAIN CIVIL SERVICE LAWS- The Director and staff
of the Commission may be appointed without regard to the provisions of
title 5, United States Code, governing appointments in the competitive
service, and may be paid without regard to the provisions of chapter 51
and subchapter III of chapter 53 of that title relating to classification
and General Schedule pay rates, except that an individual so appointed
may not receive pay in excess of the annual rate of basic pay payable for
GS-18 of the General Schedule.
(c) STAFF OF FEDERAL AGENCIES- Upon request of the Secretary, the head
of any Federal agency may detail, on a reimbursable basis, any of the
personnel of the agency to the Commission to assist the Commission in
carrying out its duties under this Act.

5644e7c531765ccd273cf4f76d82edca4f4fbf572adf32ab7b02788bc557c2f9

Not later than 18 months after the date on which the process of establishing
the membership of the Commission in accordance with section 403 is completed,
the Commission shall submit to the President and the Congress a report
describing the findings and recommendations made by the Commission under
section 402.

5b5b88c88c1da31be84512fb9f6f9cd132e94b172e72f9665c886a6ad14392b4

The Commission shall terminate 6 months after the date on which the
Commission submits its final report pursuant to section 405.

eaa3c0db976419c50f7ba8488dbcef56805f3fcbab168cbd2ea082c4f6388329

For purposes of this title:
(1) The term `Commission' means the National Commission on Alcohol and
Tobacco Use by Children established under section 401.
(2) The term `Secretary' means the Secretary of Health and Human Services.

756c2baf0c79720f8b7d571fbdeb102d7de2ad0f20c1db39339fba08ec37f5a2

Section 1003 of the Anti-Drug Abuse Act of 1988 (21 U.S.C. 1502) is amended
by adding at the end the following new subsection:
`(f) COMPENSATION OF DEPUTY DIRECTOR FOR DEMAND REDUCTION- The position
of Deputy Director for Demand Reduction, when occupied by a physician,
shall be considered a Government physician for purposes of eligibility
for the physicians comparability allowance, as defined in section 5948 of
title 5, United States Code. For purposes of determining the amount of
such allowance, such Deputy Director shall be deemed to have served as
a Government physician for more than twenty-four months, and the amount
necessary to deal with the recruitment and retention problem for such
position shall be deemed to be $20,000.'.

9eed91373b1a5486bf30586f69610914dd960aee60c575b2645cc49befd2ea26

TITLE V

-MISCELLANEOUS

Subpart 2 of part F of title V of the Public Health Service Act, as added
by section 211 of this Act, is amended by adding at the end the following
new section:
`SEC. 578. TREATMENT SERVICES FOR EMPLOYEES OF SMALL BUSINESSES.
`(a) IN GENERAL- The Secretary may make grants to public and nonprofit
private entities for the purpose of carrying out programs to assist
business organizations that have 500 or fewer employees with the costs
of providing to the employees of the organizations, and the families of
the employees, prevention and treatment services regarding the abuse of
alcohol and drugs (including counseling on interacting with individuals
who engage in such abuse).
`(b) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
subsection (a), there is authorized to be appropriated $3,000,000 for each
of the fiscal years 1992 through 1994.'.
Amend the title so as to read: `An Act to amend the Public Health Service
Act with respect to services for mental health and substance abuse,
including establishing separate block grants to enhance the delivery of
such services.'.
Attest:
Clerk.

ddf698b1795d889786d14820d42a7c2214a40d1b3a90e0613765da0594ddd9b6

Alcohol, Drug Abuse & Mental Health Admin. Reorganization bill — S. 1306

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

TITLE V

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