301 
‘‘(1) the plan submitted under section 1912(a) 
with respect to the grant and the report of the State 
under section 1942(a) concerning the preceding fis-
cal year has been reviewed by the State mental 
health planning council under section 1914; and 
‘‘(2) the State submits to the Secretary any 
recommendations received by the State from such 
council for modifications to the plan (without regard 
to whether the State has made the recommended 
modifications) and any comments concerning the an-
nual report. 
‘‘(b) MAINTENANCE OF EFFORT REGARDING STATE 
EXPENDITURES FOR MENTAL HEALTH.— 
‘‘(1) REQUIREMENT.— 
‘‘(A) IN GENERAL.—A funding agreement 
for a grant under section 1911 is that the State 
involved will maintain State expenditures for 
community mental health services at a level 
that is not less than the average level of such 
expenditures maintained by the State for the 2- 
year period preceding the fiscal year for which 
the State is applying for the grant. 
‘‘(B) 
CONDITION.—A 
State 
shall 
be 
deemed to be in compliance with subparagraph 
(A) for a fiscal year if State expenditures of the 
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type described in subparagraph (A) for such fis-
cal year are at least 97 percent of the average 
of such State expenditures for the preceding 2- 
year period. 
‘‘(2) FUTURE FISCAL YEARS.—Determinations 
of whether a State has complied with paragraph (1) 
for each fiscal year shall be based on the State fund-
ing level for the preceding 2-year period as required 
under paragraph (1)(A) without regard to reduction 
in the actual amount of State expenditures as per-
mitted under paragraph (1)(B) or under a waiver 
under paragraph (4). 
‘‘(3) EXCLUSION
OF
CERTAIN
FUNDS.—The 
Secretary may exclude from the aggregate State ex-
penditures under paragraph (1), funds appropriated 
for authorized activities which are of a non-recurring 
nature and for a specific purpose. 
‘‘(4) WAIVER.— 
‘‘(A) IN
GENERAL.—The Secretary may, 
upon the request of a State, waive the require-
ments established in paragraph (1), in whole or 
in part, if— 
‘‘(i) the Secretary determines that ex-
traordinary economic conditions in the 
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State in the year involved or in the pre-
vious year justify the waiver; or 
‘‘(ii) the State or any part of the 
State has experienced a natural disaster 
that has received a Presidential Disaster 
Declaration under section 102 of the Rob-
ert T. Stafford Disaster Relief and Emer-
gency Assistance Act. 
‘‘(B) DATE
CERTAIN
FOR
ACTING
UPON 
REQUEST.—The Secretary shall approve or 
deny a request for a waiver under subparagraph 
(A) not later than 120 days after the date on 
which the request is made. 
‘‘(C) APPLICABILITY OF WAIVER.—A waiv-
er provided by the Secretary under subpara-
graph (A) shall be applicable only to the fiscal 
year involved. 
‘‘(5) NONCOMPLIANCE BY STATE.— 
‘‘(A) IN
GENERAL.—In making a grant 
under section 1911 to a State for a fiscal year, 
the Secretary shall make a determination of 
whether, for the previous fiscal year, the State 
complied with the agreement made under para-
graph (1). If the Secretary determines that a 
State has failed to maintain such compliance, 
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the Secretary shall reduce the amount of the al-
lotment under section 1911 for the State in the 
year in which the determination is made by an 
amount equal to the amount constituting such 
failure for the previous fiscal year. 
‘‘(B) ALTERNATIVE
PENALTY.—A State 
that has failed to comply with this section and 
that would otherwise be subject to a reduction 
in the State’s allotment under section 1911, 
may, with the approval of the Secretary, in lieu 
of having the State’s allotment under section 
1911 reduced, agree to comply with the results 
of a negotiated agreement that is approved by 
the Secretary and carried out in accordance 
with guidelines issued by the Secretary. 
‘‘(C) SUBMISSION
OF
INFORMATION
TO 
THE SECRETARY.—The Secretary may make a 
grant under section 1911 for a fiscal year only 
if the State involved submits to the Secretary 
information sufficient to enable the Secretary to 
make the determination required in subpara-
graph (A). 
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305 
‘‘SEC. 1916. RESTRICTIONS ON USE OF PAYMENTS. 
‘‘(a) IN GENERAL.—A funding agreement for a grant 
under section 1911 is that the State involved will not ex-
pend the grant— 
‘‘(1) to provide inpatient services; 
‘‘(2) to make cash payments to intended recipi-
ents of health services; 
‘‘(3) to purchase or improve land, purchase, 
construct, or permanently improve (other than minor 
remodeling) any building or other facility, or pur-
chase major medical equipment; 
‘‘(4) to satisfy any requirement for the expendi-
ture of non-Federal funds as a condition for the re-
ceipt of Federal funds; or 
‘‘(5) to provide financial assistance to any enti-
ty other than a public or nonprofit private entity. 
‘‘(b) LIMITATION ON ADMINISTRATIVE EXPENSES.— 
A funding agreement for a grant under section 1911 is 
that the State involved will not expend more than 5 per-
cent of the grant for administrative expenses with respect 
to the grant. 
‘‘SEC. 1917. APPLICATION FOR GRANT. 
‘‘(a) IN GENERAL.—For purposes of section 1911, an 
application for a grant under such section for a fiscal year 
is in accordance with this section if, subject to subsection 
(b)— 
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‘‘(1) the plan is received by the Secretary not 
later than September 1 of the fiscal year prior to the 
fiscal year for which a State is seeking funds, and 
the report from the previous fiscal year as required 
under section 1942(a) is received by December 1 of 
the fiscal year of the grant; 
‘‘(2) the application contains each funding 
agreement that is described in this subpart or sub-
part III for such a grant (other than any such 
agreement that is not applicable to the State); 
‘‘(3) the agreements are made through certifi-
cation from the chief executive officer of the State; 
‘‘(4) with respect to such agreements, the appli-
cation provides assurances of compliance satisfactory 
to the Secretary; 
‘‘(5) the application contains the plan required 
in section 1912(a), the information required in sec-
tion 1915(b), and the report required in section 
1942(a); 
‘‘(6) the application contains recommendations 
in compliance with section 1915(a), or if no such 
recommendations are received by the State, the ap-
plication otherwise demonstrates compliance with 
such section; and 
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‘‘(7) the application (including the plan under 
section 1912(a)) is otherwise in such form, is made 
in such manner, and contains such agreements, as-
surances, and information as the Secretary deter-
mines to be necessary to carry out this subpart. 
‘‘(b) 
WAIVERS
REGARDING
CERTAIN
TERRI-
TORIES.—In the case of any territory of the United States 
except Puerto Rico, the Secretary may waive such provi-
sions of this subpart and subpart III as the Secretary de-
termines to be appropriate, other than the provisions of 
section 1916. 
‘‘SEC. 1918. DETERMINATION OF AMOUNT OF ALLOTMENT. 
‘‘(a) STATES.— 
‘‘(1) DETERMINATION UNDER FORMULA.—Sub-
ject to subsection (b), the Secretary shall determine 
the amount of the allotment required in section 
1911 for a State for a fiscal year in accordance with 
the following formula: 
‘‘x 
A 
(——) 
u 
‘‘(2) DETERMINATION OF TERM ‘A’.—For pur-
poses of paragraph (1), the term ‘A’ means the dif-
ference between— 
‘‘(A) the amount appropriated under sec-
tion 1920(a) for allotments under section 1911 
for the fiscal year involved; and 
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‘‘(B) an amount equal to 1.5 percent of 
the amount referred to in subparagraph (A). 
‘‘(3) DETERMINATION OF TERM ‘U’.—For pur-
poses of paragraph (1), the term ‘U’ means the sum 
of the respective terms ‘X’ determined for the States 
under paragraph (4). 
‘‘(4) DETERMINATION OF TERM ‘X’.—For pur-
poses of paragraph (1), the term ‘X’ means the 
product of— 
‘‘(A) an amount equal to the product of— 
‘‘(i) the term ‘P’, as determined for 
the State involved under paragraph (5); 
and 
‘‘(ii) the factor determined under 
paragraph (8) for the State; and 
‘‘(B) the greater of— 
‘‘(i) 0.4; and 
‘‘(ii) an amount equal to an amount 
determined for the State in accordance 
with the following formula: 
‘‘R% 
1 = .35 
(——) 
P% 
‘‘(5) DETERMINATION OF TERM ‘P’.— 
‘‘(A) For purposes of paragraph (4), the 
term ‘P’ means the sum of— 
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‘‘(i) an amount equal to the product 
of 0.107 and the number of individuals in 
the State who are between 18 and 24 years 
of age (inclusive); 
‘‘(ii) an amount equal to the product 
of 0.166 and the number of individuals in 
the State who are between 25 and 44 years 
of age (inclusive); 
‘‘(iii) an amount equal to the product 
of 0.099 and the number of individuals in 
the State who are between 45 and 64 years 
of age (inclusive); and 
‘‘(iv) an amount equal to the product 
of 0.082 and the number of individuals in 
the State who are 65 years of age or older. 
‘‘(B) With respect to data on population 
that is necessary for purposes of making a de-
termination under subparagraph (A), the Sec-
retary shall use the most recent data that is 
available from the Secretary of Commerce pur-
suant to the decennial census and pursuant to 
reasonable estimates by such Secretary of 
changes occurring in the data in the ensuing 
period. 
‘‘(6) DETERMINATION OF TERM ‘R%’.— 
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‘‘(A) For purposes of paragraph (4), the 
term ‘R%’, except as provided in subparagraph 
(D), means the percentage constituted by the 
ratio of the amount determined under subpara-
graph (B) for the State involved to the amount 
determined under subparagraph (C). 
‘‘(B) The amount determined under this 
subparagraph for the State involved is the 
quotient of— 
‘‘(i) the most recent 3-year arithmetic 
mean of the total taxable resources of the 
State, as determined by the Secretary of 
the Treasury; divided by 
‘‘(ii) the factor determined under 
paragraph (8) for the State. 
‘‘(C) The amount determined under this 
subparagraph is the sum of the respective 
amounts determined for the States under sub-
paragraph (B) (including the District of Colum-
bia). 
‘‘(D)(i) In the case of the District of Co-
lumbia, for purposes of paragraph (4), the term 
‘R%’ means the percentage constituted by the 
ratio of the amount determined under clause 
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(ii) for such District to the amount determined 
under clause (iii). 
‘‘(ii) The amount determined under this 
clause for the District of Columbia is the 
quotient of— 
‘‘(I) the most recent 3-year arithmetic 
mean of total personal income in such Dis-
trict, as determined by the Secretary of 
Commerce; divided by 
‘‘(II) the factor determined under 
paragraph (8) for the District. 
‘‘(iii) The amount determined under this 
clause is the sum of the respective amounts de-
termined for the States (including the District 
of Columbia) by making, for each State, the 
same determination as is described in clause (ii) 
for the District of Columbia. 
‘‘(7) DETERMINATION
OF
TERM ‘P%’.—For 
purposes of paragraph (4), the term ‘P%’ means the 
percentage constituted by the ratio of the term ‘P’ 
determined under paragraph (5) for the State in-
volved to the sum of the respective terms ‘P’ deter-
mined for the States. 
‘‘(8) DETERMINATION OF CERTAIN FACTOR.— 
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‘‘(A) The factor determined under this 
paragraph for the State involved is a factor 
whose purpose is to adjust the amount deter-
mined under clause (i) of paragraph (4)(A), 
and the amounts determined under each of sub-
paragraphs (B)(i) and (D)(ii)(I) of paragraph 
(6), to reflect the differences that exist between 
the State and other States in the costs of pro-
viding comprehensive community mental health 
services to adults with a serious mental illness 
and to children with a serious emotional dis-
turbance. 
‘‘(B) Subject to subparagraph (C), the fac-
tor determined under this paragraph and in ef-
fect for the fiscal year involved shall be deter-
mined according to the methodology described 
in the report entitled ‘Adjusting the Alcohol, 
Drug Abuse and Mental Health Services Block 
Grant Allocations for Poverty Populations and 
Cost of Service’, dated March 30, 1990, and 
prepared by Health Economics Research, a cor-
poration, pursuant to a contract with the Na-
tional Institute on Drug Abuse. 
‘‘(C) The factor determined under this 
paragraph for the State involved may not for 
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313 
any fiscal year be greater than 1.1 or less than 
0.9. 
‘‘(D)(i) Not later than October 1, 1992, 
the Secretary, after consultation with the 
Comptroller General, shall in accordance with 
this section make a determination for each 
State of the factor that is to be in effect for the 
State under this paragraph. The factor so de-
termined shall remain in effect through fiscal 
year 1994, and shall be recalculated every third 
fiscal year thereafter. 
‘‘(ii) After consultation with the Comp-
troller General, the Secretary shall, through 
publication in the Federal Register, periodically 
make such refinements in the methodology re-
ferred to in subparagraph (B) as are consistent 
with the purpose described in subparagraph 
(A). 
‘‘(b) MINIMUM ALLOTMENTS FOR STATES.—With re-
spect to fiscal year 2000, and subsequent fiscal years, the 
amount of the allotment of a State under section 1911 
shall not be less than the amount the State received under 
such section for fiscal year 1998. 
‘‘(c) TERRITORIES.— 
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‘‘(1) DETERMINATION UNDER FORMULA.—Sub-
ject to paragraphs (2) and (4), the amount of an al-
lotment under section 1911 for a territory of the 
United States for a fiscal year shall be the product 
of— 
‘‘(A) an amount equal to the amounts re-
served under paragraph (3) for the fiscal year; 
and 
‘‘(B) a percentage equal to the quotient 
of— 
‘‘(i) the civilian population of the ter-
ritory, as indicated by the most recently 
available data; divided by 
‘‘(ii) the aggregate civilian population 
of the territories of the United States, as 
indicated by such data. 
‘‘(2) 
MINIMUM
ALLOTMENT
FOR
TERRI-
TORIES.—The amount of an allotment under section 
1911 for a territory of the United States for a fiscal 
year shall be the greater of— 
‘‘(A) the amount determined under para-
graph (1) for the territory for the fiscal year; 
‘‘(B) $50,000; and 
‘‘(C) with respect to fiscal years 1993 and 
1994, an amount equal to 20.6 percent of the 
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amount received by the territory from allot-
ments made pursuant to this part for fiscal 
year 1992. 
‘‘(3) RESERVATION
OF
AMOUNTS.—The Sec-
retary shall each fiscal year reserve for the terri-
tories of the United States 1.5 percent of the 
amounts appropriated under section 1920(a) for al-
lotments under section 1911 for the fiscal year. 
‘‘(4) 
AVAILABILITY
OF
DATA
ON
POPU-
LATION.—With respect to data on the civilian popu-
lation of the territories of the United States, if the 
Secretary determines for a fiscal year that recent 
such data for purposes of paragraph (1)(B) do not 
exist regarding a territory, the Secretary shall for 
such purposes estimate the civilian population of the 
territory by modifying the data on the territory to 
reflect the average extent of change occurring during 
the ensuing period in the population of all territories 
with respect to which recent such data do exist. 
‘‘(5) 
APPLICABILITY
OF
CERTAIN
PROVI-
SIONS.—For purposes of subsection (a), the term 
‘State’ does not include the territories of the United 
States. 
‘‘SEC. 1919. DEFINITIONS. 
‘‘For purposes of this subpart: 
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‘‘(1) The terms ‘adults with a serious mental 
illness’ and ‘children with a serious emotional dis-
turbance’ have the meanings given such terms under 
section 1912(c)(1). 
‘‘(2) The term ‘funding agreement’, with re-
spect to a grant under section 1911 to a State, 
means that the Secretary may make such a grant 
only if the State makes the agreement involved. 
‘‘SEC. 1920. FUNDING. 
‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this subpart, and subpart III and 
section 504 with respect to mental health, there are au-
thorized to be appropriated $450,000,000 for fiscal year 
2011, and such sums as may be necessary for each of the 
fiscal years 2012 through 2015. 
‘‘(b) ALLOCATIONS
FOR TECHNICAL ASSISTANCE, 
DATA COLLECTION, AND PROGRAM EVALUATION.— 
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out section 1948(a) and 1945(g) with respect 
to mental health and the purposes specified in para-
graphs (2) and (3), the Secretary shall obligate 5 
percent of the amounts appropriated under sub-
section (a) for a fiscal year. 
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‘‘(2) DATA COLLECTION.—The purpose speci-
fied in this paragraph is carrying out section 504 
with respect to mental health. 
‘‘(3) PROGRAM
EVALUATION.—The purpose 
specified in this paragraph is the conduct of evalua-
tions of prevention and treatment programs and 
services with respect to mental health to determine 
methods for improving the availability and quality of 
such programs and services. 
‘‘Subpart II—Block Grants for Prevention and 
Treatment of Substance Use Disorders 
‘‘SEC. 1921. FORMULA GRANTS TO STATES. 
‘‘(a) IN GENERAL.—For the purpose described in 
subsection (b), the Secretary, acting through the Center 
for Substance Abuse Treatment, shall make an allotment 
each fiscal year for each State in an amount determined 
in accordance with section 1932. The Secretary shall make 
a grant to the State of the allotment made for the State 
for the fiscal year if the State submits to the Secretary 
an application in accordance with section 1931. 
‘‘(b) AUTHORIZED ACTIVITIES.—A funding agree-
ment for a grant under subsection (a) is that, subject to 
section 1930, the State involved will expend the grant only 
for the purpose of carrying out the plan developed in ac-
cordance with section 1931(b) and for planning, carrying 
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out, and evaluating activities to prevent and treat sub-
stance use disorders and for related activities authorized 
in section 1924. 
‘‘SEC. 1922. CERTAIN ALLOCATIONS. 
‘‘(a) ALLOCATION REGARDING PRIMARY PREVEN-
TION PROGRAMS.—A funding agreement for a grant under 
section 1921 is that, in expending the grant, the State 
involved will expend not less than 20 percent for programs 
to prevent the abuse of alcohol and drugs that are— 
‘‘(1) designed to reach an entire population or 
large audience, including activities intended to ad-
dress environmental issues related to the use of alco-
hol and drugs; 
‘‘(2) designed to target subgroups that may be 
at risk of using substances; and 
‘‘(3) designed to identify and intervene with in-
dividuals who are experiencing early signs of sub-
stance use or abuse. 
‘‘(b) ALLOCATIONS REGARDING WOMEN.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 
funding agreement for a grant under section 1921 
for a fiscal year is that the State will expend not less 
than it expended in fiscal year 2006 on treatment 
services for pregnant women and women with de-
pendent children. 
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‘‘(2) WAIVER.— 
‘‘(A) Upon the request of a State, the Sec-
retary may provide to the State a waiver of all 
or part of the requirement established in para-
graph (1) if the Secretary determines that the 
State is providing an adequate level of treat-
ments services for women described in such 
paragraph, as indicated by a comparison of the 
number of such women seeking the services 
with the availability in the State of the services. 
‘‘(B) The Secretary shall approve or deny 
a request for a waiver under subparagraph (A) 
not later than 120 days after the date on which 
the request is made. 
‘‘(C) Any waiver provided by the Secretary 
under subparagraph (A) shall be applicable only 
to the fiscal year involved. 
‘‘(3) CHILDCARE
AND
PRENATAL
CARE.—A 
funding agreement for a grant under section 1921 
for a State is that each entity providing treatment 
services with amounts reserved under paragraph (1) 
by the State will, directly or through arrangements 
with other public or nonprofit private entities, make 
available prenatal care to women receiving such serv-
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ices and, while the women are receiving the services, 
childcare. 
‘‘SEC. 1923. INTRAVENOUS SUBSTANCE ABUSE. 
‘‘A funding agreement for a grant under section 1921 
is that the State involved, in providing amounts from the 
grant to any entity for treatment services, will require the 
entity to carry out activities to encourage individuals in 
need of such treatment who are intravenous drug users 
to undergo treatment. 
‘‘SEC. 1924. REQUIREMENTS REGARDING TUBERCULOSIS 
AND OTHER COMMUNICABLE DISEASES, AND 
THE HUMAN IMMUNODEFICIENCY VIRUS. 
‘‘(a) TUBERCULOSIS
AND OTHER COMMUNICABLE 
DISEASES.— 
‘‘(1) IN GENERAL.—A funding agreement for a 
grant under section 1921 is that the State involved 
will require that any entity receiving amounts from 
the grant for operating a program of treatment for 
substance use disorders— 
‘‘(A) will, directly or through arrangements 
with other public or nonprofit private entities, 
routinely make available services for tuber-
culosis and other communicable diseases to each 
individual receiving treatment for such abuse; 
and 
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‘‘(B) in the case of an individual in need 
of such treatment who is denied admission to 
the program on the basis of the lack of the ca-
pacity of the program to admit the individual, 
will refer the individual to another provider of 
tuberculosis and other communicable diseases 
services. 
‘‘(2) SERVICES.—For purposes of paragraph 
(1), the term ‘tuberculosis and other communicable 
diseases services’, with respect to an individual, 
means— 
‘‘(A) counseling the individual with respect 
to tuberculosis and other communicable dis-
eases; 
‘‘(B) testing to determine whether the indi-
vidual has contracted and of such diseases and 
testing to determine the form of treatment for 
the disease that is appropriate for the indi-
vidual; and 
‘‘(C) providing such treatment to the indi-
vidual. 
‘‘(b) HUMAN IMMUNODEFICIENCY VIRUS.— 
‘‘(1) REQUIREMENT FOR CERTAIN STATES.— 
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‘‘(A) IN GENERAL.—In the case of a State 
described in paragraph (2), a funding agree-
ment for a grant under section 1921 is that— 
‘‘(i) with respect to individuals under-
going treatment for substance use dis-
orders, the State will, subject to subsection 
(c), carry out 1 or more projects to make 
available to the individuals early interven-
tion services for HIV disease at the sites at 
which the individuals are undergoing such 
treatment; 
‘‘(ii) for the purpose of providing such 
early intervention services through such 
projects, the State will make available 5 
percent of the amount of the grant; and 
‘‘(iii) the State will, subject to sub-
section (d), carry out such projects only in 
geographic areas of the State that have the 
greatest need for the projects. 
‘‘(B) OTHER STATES.—In the case of a 
State that is not a designated State as de-
scribed in paragraph (2), the State may expend 
not to exceed 5 percent of the amount of the 
grant for the provision of HIV early interven-
tion services on the condition that the State 
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provides such services in accordance with this 
subsection. 
‘‘(2) DESIGNATED
STATES.—For purposes of 
this subsection, a State described in this paragraph 
is any State whose rate of cases of acquired immune 
deficiency syndrome is 10 or more such cases per 
100,000 individuals (as indicated by the number of 
such cases reported to and confirmed by the Direc-
tor of the Centers for Disease Control and Preven-
tion for the most recent calendar year for which 
such data are available). 
‘‘(3) USE OF EXISTING PROGRAMS REGARDING 
SUBSTANCE USE DISORDERS.—With respect to pro-
grams that provide treatment services for substance 
use disorders, a funding agreement for a grant 
under section 1921 for a designated State is that 
each such program participating in a project under 
paragraph (1) will be a program that began oper-
ation prior to the fiscal year for which the State is 
applying to receive the grant. A program that so 
began operation may participate in a project under 
paragraph (1) without regard to whether the pro-
gram has been providing early intervention services 
for HIV disease. 
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‘‘(4) 
REQUIREMENT
REGARDING
RURAL 
AREAS.— 
‘‘(1) IN GENERAL.—A funding agreement 
for a grant under section 1921 for a designated 
State is that, if the State will carry out 2 or 
more projects under subsection (a), the State 
will carry out 1 such project in a rural area of 
the State, subject to subparagraph (B). 
‘‘(2) WAIVER.—The Secretary shall waive 
the requirement established in subparagraph 
(A) if the State involved certifies to the Sec-
retary that— 
‘‘(A) there is insufficient demand in 
the State to carry out a project under sub-
section (a) in any rural area of the State; 
or 
‘‘(B) there are no rural areas in the 
State. 
‘‘(5) MANNER OF PROVIDING SERVICES.—With 
respect to the provision of early intervention services 
for HIV disease to an individual, a funding agree-
ment for a grant under section 1921 for a des-
ignated State is that— 
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‘‘(1) such services will be undertaken vol-
untarily by, and with the informed consent of, 
the individual; and 
‘‘(2) undergoing such services will not be 
required as a condition of receiving treatment 
services for substance use disorders or any 
other services. 
‘‘(c) EXPENDITURE
OF GRANT
FOR COMPLIANCE 
WITH AGREEMENTS.— 
‘‘(1) IN GENERAL.—A grant under section 1921 
may be expended for purposes of compliance with 
the agreements required in this section, subject to 
paragraph (2). 
‘‘(2) LIMITATION.—A funding agreement for a 
grant under section 1921 for a State is that the 
grant will not be expended to make payment for any 
service provided for purposes of compliance with this 
section to the extent that payment has been made, 
or can reasonably be expected to be made, with re-
spect to such service— 
‘‘(A) under any State compensation pro-
gram, under any insurance policy, or under any 
Federal or State health benefits program (in-
cluding the program established in title XVIII 
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of the Social Security Act and the program es-
tablished in title XIX of such Act); or 
‘‘(B) by an entity that provides health 
services on a prepaid basis. 
‘‘(d) APPLICABILITY OF CERTAIN PROVISION.—Sec-
tion 1930 applies to this section (and to each other provi-
sion of this subpart). 
‘‘(e) DEFINITIONS.—For purposes of this section: 
‘‘(1) EARLY
INTERVENTION
SERVICES.—The 
term ‘early intervention services’, with respect to 
HIV disease, means— 
‘‘(A) appropriate pretest counseling; 
‘‘(B) testing individuals with respect to 
such disease, including tests to confirm the 
presence of the disease, tests to diagnose the 
extent of the deficiency in the immune system, 
and tests to provide information on appropriate 
therapeutic measures for preventing and treat-
ing the deterioration of the immune system and 
for preventing and treating conditions arising 
from the disease; 
‘‘(C) appropriate post-test counseling; and 
‘‘(D) providing the therapeutic measures 
described in subparagraph (B). 
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‘‘(2) HIV DISEASE.—The term ‘HIV disease’ 
means infection with the etiologic agent for acquired 
immune deficiency syndrome. 
‘‘SEC. 1925. GROUP HOMES FOR RECOVERING SUBSTANCE 
ABUSERS. 
‘‘(a) STATE REVOLVING FUNDS
FOR ESTABLISH-
MENT OF HOMES.—A State, using funds available under 
section 1921, may establish and maintain the ongoing op-
eration of a revolving fund in accordance with this section 
to support group homes for recovering substance abusers 
as follows: 
‘‘(1) The purpose of the fund is to make loans 
for the costs of establishing programs for the provi-
sion of housing in which individuals recovering from 
alcohol or drug abuse may reside in groups of not 
less than 6 individuals. The fund is established di-
rectly by the State or through the provision of a 
grant or contract to a nonprofit private entity. 
‘‘(2) The programs are carried out in accord-
ance with guidelines issued under subsection (b). 
‘‘(3) Not less than $100,000 is available for the 
fund. 
‘‘(4) Loans made from the revolving fund do 
not exceed $4,000 and each such loan is repaid to 
the revolving fund by the residents of the housing 
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involved not later than 2 years after the date on 
which the loan is made. 
‘‘(5) Each such loan is repaid by such residents 
through monthly installments, and a reasonable pen-
alty is assessed for each failure to pay such periodic 
installments by the date specified in the loan agree-
ment involved. 
‘‘(6) Such loans are made only to nonprofit pri-
vate entities agreeing that, in the operation of the 
program established pursuant to the loan— 
‘‘(A) the use of alcohol or any illegal drug 
in the housing provided by the program will be 
prohibited; 
‘‘(B) any resident of the housing who vio-
lates such prohibition will be expelled from the 
housing; 
‘‘(C) the costs of the housing, including 
fees for rent and utilities, will be paid by the 
residents of the housing; and 
‘‘(D) the residents of the housing will, 
through a majority vote of the residents, other-
wise establish policies governing residence in 
the housing, including the manner in which ap-
plications for residence in the housing are ap-
proved. 
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‘‘(b) ISSUANCE BY SECRETARY OF GUIDELINES.— 
The Secretary shall ensure that there are in effect guide-
lines under this subpart for the operation of programs de-
scribed in subsection (a). 
‘‘(c) APPLICABILITY TO TERRITORIES.—The require-
ments established in subsection (a) shall not apply to any 
territory of the United States other than the Common-
wealth of Puerto Rico. 
‘‘SEC. 1926. STATE LAW REGARDING SALE OF TOBACCO 
PRODUCTS TO INDIVIDUALS UNDER AGE OF 
18. 
‘‘(a) RELEVANT LAW.—The Secretary may make a 
grant under section 1921 only if the State involved has 
in effect a law providing that it is unlawful for any manu-
facturer, retailer, or distributor of tobacco products to sell 
or distribute any such product to any individual under the 
age of 18. 
‘‘(b) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—A funding agreement for a 
grant under section 1921 is that the State involved 
will enforce the law described in subsection (a) in a 
manner that can reasonably be expected to reduce 
the extent to which tobacco products are available to 
individuals under the age of 18. 
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‘‘(2) ACTIVITIES AND REPORTS REGARDING EN-
FORCEMENT.—A funding agreement for a grant 
under section 1921 is that the State involved will— 
‘‘(A) annually conduct random, unan-
nounced inspections to ensure compliance with 
the law described in subsection (a); and 
‘‘(B) annually submit to the Secretary a 
report describing— 
‘‘(i) the activities carried out by the 
State to enforce such law during the fiscal 
year preceding the fiscal year for which the 
State is seeking the grant; 
‘‘(ii) the extent of success the State 
has achieved in reducing the availability of 
tobacco products to individuals under the 
age of 18; and 
‘‘(iii) the strategies to be utilized by 
the State for enforcing such law during the 
fiscal year for which the grant is sought. 
‘‘(c) NONCOMPLIANCE OF STATE.— 
‘‘(1) IN
GENERAL.—Before making a grant 
under section 1921 to a State, the Secretary shall 
make a determination of whether the State has 
maintained compliance with subsection (b). If, after 
notice to the State and an opportunity for a hearing, 
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‘‘(I) 1 percent of such State’s al-
location under section 1921 for the 
fiscal year; and 
‘‘(II) the number of percentage 
points by which the State has failed to 
achieve the retailer compliance rate 
goal established by the Secretary for 
such State under this section. 
‘‘(2) EXPENDITURE REPORT.—A State to which 
paragraph (1)(B) applies shall, not later than July 
31 of the fiscal year for which such paragraph is 
being applied, submit to the Secretary a report con-
cerning— 
‘‘(A) all expenditures of the State for to-
bacco prevention and compliance activities, in-
cluding enforcement, during the fiscal year im-
mediately preceding such fiscal year; and 
‘‘(B) all obligations for such activities (list-
ed by program) for the fiscal year for which 
such paragraph is being applied. 
‘‘(3) DISCRETION
OF
SECRETARY.—The Sec-
retary shall have discretion relating to the timing of 
the State’s obligation of the additional funds as re-
quired under the State certification described in 
paragraph (1)(B)(ii). 
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‘‘(d) TERRITORIES.—A funding agreement for a 
grant under section 1921 is that a territory involved will 
submit to the Secretary for approval, a comprehensive to-
bacco prevention and control plan to reduce the avail-
ability of tobacco products to minors within the territory. 
‘‘(e) DEFINITION.—For purposes of this section: 
‘‘(1) STATE.—The term ‘State’ includes the 
States, the District of Columbia, and the Common-
wealth of Puerto Rico. 
‘‘(2) TERRITORY.—The term ‘territory’ means 
American Samoa, the Republic of Palau, the Fed-
erated States of Micronesia, the Marshall Islands, 
the Commonwealth of the Northern Mariana Is-
lands, the United States Virgin Islands, and Guam. 
‘‘SEC. 1927. TREATMENT SERVICES FOR PREGNANT WOMEN. 
‘‘(a) IN GENERAL.—A funding agreement for a grant 
under section 1921 is that the State involved— 
‘‘(1) will ensure that each pregnant woman in 
the State who seeks or is referred for and would 
benefit from such services is given preference in ad-
missions to treatment facilities receiving funds pur-
suant to the grant; and 
‘‘(2) will, in carrying out paragraph (1), pub-
licize the availability to such women of services from 
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the facilities and the fact that the women receive 
such preference. 
‘‘(b) REFERRALS REGARDING STATES.—A funding 
agreement for a grant under section 1921 is that, in car-
rying out subsection (a)(1)— 
‘‘(1) the State involved will require that, in the 
event that a treatment facility has insufficient ca-
pacity to provide treatment services to any woman 
described in such subsection who seeks the services 
from the facility, the facility refer the woman to the 
State; and 
‘‘(2) the State, in the case of each woman for 
whom a referral under paragraph (1) is made to the 
State— 
‘‘(A) will refer the woman to a treatment 
facility that has the capacity to provide treat-
ment services to the woman; or 
‘‘(B) will, if no treatment facility has the 
capacity to admit the woman, make interim 
services available to the woman not later than 
48 hours after the women seeks the treatment 
services. 
‘‘SEC. 1928. ADDITIONAL AGREEMENTS. 
‘‘(a) IMPROVEMENT OF PROCESS FOR APPROPRIATE 
REFERRALS FOR TREATMENT.—With respect to individ-
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uals seeking treatment services, a funding agreement for 
a grant under section 1921 is that the State involved will 
improve the process in the State for referring the individ-
uals to treatment facilities that can provide to the individ-
uals the treatment modality that is most appropriate for 
the individuals. 
‘‘(b) PROFESSIONAL
DEVELOPMENT.—A funding 
agreement for a grant under section 1921 is that the State 
involved will ensure that prevention and treatment profes-
sionals operating in the State’s substance use disorder 
prevention and treatment system have an opportunity to 
receive training, on an ongoing basis, concerning— 
‘‘(1) recent trends in drug abuse in the State; 
‘‘(2) improved methods and evidence-based 
practices for providing substance use disorder pre-
vention and treatment services; 
‘‘(3) performance-based accountability; 
‘‘(4) data collection and reporting requirements; 
‘‘(5) any other matters that would serve to fur-
ther improve the delivery of substance use disorder 
prevention and treatment services with the State; 
and 
‘‘(6) innovative practices developed under sec-
tion 581. 
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‘‘(c) COORDINATION OF VARIOUS ACTIVITIES AND 
SERVICES.—A funding agreement for a grant under sec-
tion 1921 is that the State involved will coordinate preven-
tion and treatment activities with the provision of other 
appropriate services (including health, social, correctional 
and criminal justice, educational, vocational rehabilitation, 
housing, and employment services). 
‘‘(d) WAIVER OF REQUIREMENT.— 
‘‘(1) IN
GENERAL.—Upon the request of a 
State, the Secretary may provide to a State a waiver 
of any or all of the requirements established in this 
section if the Secretary determines that, with respect 
to services for the prevention and treatment of sub-
stance use disorders, the requirement involved is un-
necessary for maintaining quality in the provision of 
such services in the State. 
‘‘(2) DATE
CERTAIN
FOR
ACTING
UPON
RE-
QUEST.—The Secretary shall approve or deny a re-
quest for a waiver under paragraph (1) not later 
than 120 days after the date on which the request 
is made. 
‘‘(3) APPLICABILITY OF WAIVER.—Any waiver 
provided by the Secretary under paragraph (1) shall 
be applicable only to the fiscal year involved. 
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‘‘SEC. 1929. MAINTENANCE OF EFFORT REGARDING STATE 
EXPENDITURES. 
‘‘(a) REQUIREMENT.— 
‘‘(1) IN GENERAL.—With respect to the prin-
cipal agency of a State for carrying out authorized 
activities, a funding agreement for a grant under 
section 1921 for the State for a fiscal year is that 
such agency will for such year maintain aggregate 
State expenditures for authorized activities at a level 
that is not less than the average level of such ex-
penditures maintained by the State for the 2-year 
period preceding the fiscal year for which the State 
is applying for the grant. 
‘‘(2) MATERIAL COMPLIANCE.—A State shall be 
deemed to be in compliance with paragraph (1) for 
a fiscal year if State expenditures of the type de-
scribed in such paragraph for such fiscal year are at 
least 97 percent of such State expenditures for the 
preceding 2-year period. 
‘‘(3) FUTURE OBLIGATIONS.—In applying para-
graph (1) to a State, the Secretary shall determine 
such State’s compliance with such paragraph based 
on the amount of State expenditures that con-
stituted actual compliance, not material compliance 
(as provided for in paragraph (2)), or that would 
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have been required if the State had not been granted 
a waiver under subsection (c). 
‘‘(b) EXCLUSION
OF CERTAIN FUNDS.—The Sec-
retary may exclude from the aggregate State expenditures 
under subsection (a), funds appropriated to the principle 
agency for authorized activities which are of a non-recur-
ring nature and for a specific purpose. 
‘‘(c) WAIVER.— 
‘‘(1) IN
GENERAL.—Upon the request of a 
State, the Secretary may waive all or part of the re-
quirement established in subsection (a)(1)— 
‘‘(A) if the Secretary determines that ex-
traordinary economic conditions in the State in 
the fiscal year involved or in the previous fiscal 
year justify the waiver; and 
‘‘(B) if the State or any part of the State 
has experienced an emergency or a natural dis-
aster that has received a Presidential Disaster 
Declaration under section 102 of the Robert T. 
Stafford Disaster Relief and Emergency Assist-
ance Act. 
‘‘(2) DATE
CERTAIN
FOR
ACTING
UPON
RE-
QUEST.—The Secretary shall approve or deny a re-
quest for a waiver under paragraph (1) not later 
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than 120 days after the date on which the request 
is made. 
‘‘(3) APPLICABILITY OF WAIVER.—Any waiver 
provided by the Secretary under paragraph (1) shall 
be applicable only to the fiscal year involved. 
‘‘(d) NONCOMPLIANCE BY STATE.— 
‘‘(1) IN GENERAL.—In making a grant under 
section 1921 to a State for a fiscal year, the Sec-
retary shall make a determination of whether, for 
the previous fiscal year, the State complied with any 
agreement made under subsection (a). If the Sec-
retary determines that a State has failed to main-
tain such compliance, the Secretary shall reduce the 
amount of the allotment under section 1921 for the 
State for the year in which a final determination is 
made, by an amount equal to the amount consti-
tuting such failure. 
‘‘(2) ALTERNATIVE
PENALTY.—A State that 
has failed to comply with this section and that would 
otherwise be subject to a reduction in the State’s al-
lotment under section 1921, may, with the approval 
of the Secretary, in lieu of having the State’s allot-
ment under section 1921 reduced, agree to comply 
with a negotiated agreement that is approved by the 
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Secretary and carried out in accordance with guide-
lines issued by the Secretary. 
‘‘(3) SUBMISSION
OF
INFORMATION
TO
SEC-
RETARY.—The Secretary may make a grant under 
section 1921 for a fiscal year only if the State in-
volved submits to the Secretary information suffi-
cient for the Secretary to make the determination 
required in paragraph (1). 
‘‘SEC. 1930. RESTRICTIONS ON EXPENDITURE OF GRANT. 
‘‘(a) IN GENERAL.— 
‘‘(1) 
CERTAIN
RESTRICTIONS.—A 
funding 
agreement for a grant under section 1921 is that the 
State involved will not expend the grant— 
‘‘(A) to provide inpatient hospital services, 
except as provided in subsection (b); 
‘‘(B) to make cash payments to intended 
recipients of health services; 
‘‘(C) to purchase or improve land, pur-
chase, construct, or permanently improve (other 
than minor remodeling) any building or other 
facility, or purchase major medical equipment; 
‘‘(D) to satisfy any requirement for the ex-
penditure of non-Federal funds as a condition 
for the receipt of Federal funds; 
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‘‘(E) to provide financial assistance to any 
entity other than a public or nonprofit private 
entity; or 
‘‘(F) to carry out any program prohibited 
by section 256(b) of the Health Omnibus Pro-
grams Extension of 1988 (42 U.S.C. 300ee–5). 
‘‘(2) LIMITATION
ON
ADMINISTRATIVE
EX-
PENSES.—A funding agreement for a grant under 
section 1921 is that the State involved will not ex-
pend more than 5 percent of the grant to pay the 
costs of administering the grant. 
‘‘(3) LIMITATION REGARDING PENAL AND COR-
RECTIONAL
INSTITUTIONS.—A funding agreement 
for a State for a grant under section 1921 is that, 
in expending the grant for the purpose of providing 
treatment services in penal or correctional institu-
tions of the State, the State will not expend more 
than an amount equal to the amount expended for 
such purpose by the State from the grant made 
under section 1912A to the State for fiscal year 
1991 (as section 1912A was in effect for such fiscal 
year). 
‘‘(b) EXCEPTION REGARDING INPATIENT HOSPITAL 
SERVICES.— 
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‘‘(1) MEDICAL NECESSITY AS PRECONDITION.— 
With respect to compliance with the agreement made 
under subsection (a), a State may expend a grant 
under section 1921 to provide inpatient hospital 
services as treatment for substance use disorders 
only if it has been determined, in accordance with 
guidelines issued by the Secretary, that such treat-
ment is a medical necessity for the individual in-
volved, and that the individual cannot be effectively 
treated in a community-based, nonhospital, residen-
tial program of treatment. 
‘‘(2) RATE OF PAYMENT.—In the case of an in-
dividual for whom a grant under section 1921 is ex-
pended to provide inpatient hospital services de-
scribed in paragraph (1), a funding agreement for 
the grant for the State involved is that the daily rate 
of payment provided to the hospital for providing the 
services to the individual will not exceed the com-
parable daily rate provided for community-based, 
nonhospital, residential programs of treatment for 
substance use disorders. 
‘‘(c) WAIVER REGARDING CONSTRUCTION OF FACILI-
TIES.— 
‘‘(1) IN GENERAL.—The Secretary may provide 
to any State a waiver of the restriction established 
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in subsection (a)(1)(C) for the purpose of author-
izing the State to expend a grant under section 1921 
for the construction of a new facility or rehabilita-
tion of an existing facility, but not for land acquisi-
tion. 
‘‘(2) STANDARD REGARDING NEED FOR WAIV-
ER.—The Secretary may approve a waiver under 
paragraph (1) only if the State demonstrates to the 
Secretary that adequate treatment cannot be pro-
vided through the use of existing facilities and that 
alternative facilities in existing suitable buildings are 
not available. 
‘‘(3) AMOUNT.—In granting a waiver under 
paragraph (1), the Secretary shall allow the use of 
a specified amount of funds to construct or rehabili-
tate a specified number of beds for residential treat-
ment and a specified number of slots for outpatient 
treatment, based on reasonable estimates by the 
State of the costs of construction or rehabilitation. 
In considering waiver applications, the Secretary 
shall ensure that the State has carefully designed a 
program that will minimize the costs of additional 
beds. 
‘‘(4) MATCHING
FUNDS.—The Secretary may 
grant a waiver under paragraph (1) only if the State 
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agrees, with respect to the costs to be incurred by 
the State in carrying out the purpose of the waiver, 
to make available non-Federal contributions in cash 
toward such costs in an amount equal to not less 
than $1 for each $1 of Federal funds provided under 
section 1921. 
‘‘(5) DATE
CERTAIN
FOR
ACTING
UPON
RE-
QUEST.—The Secretary shall act upon a request for 
a waiver under paragraph (1) not later than 120 
days after the date on which the request is made. 
‘‘SEC. 1931. APPLICATION FOR GRANT; APPROVAL OF 
STATE PLAN. 
‘‘(a) IN GENERAL.—For purposes of section 1921, an 
application for a grant under such section for a fiscal year 
is in accordance with this section if, subject to subsection 
(c)— 
‘‘(1) the application is received by the Secretary 
not later than October 1 of the fiscal year for which 
the State is seeking funds; 
‘‘(2) the application contains each funding 
agreement that is described in this subpart or sub-
part III for such a grant (other than any such 
agreement that is not applicable to the State); 
‘‘(3) the agreements are made through certifi-
cation from the chief executive officer of the State; 
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‘‘(4) with respect to such agreements, the appli-
cation provides assurances of compliance satisfactory 
to the Secretary; 
‘‘(5) the application contains the information 
required in section 1929 and the report required in 
section 1942; 
‘‘(6)(A) the application contains a plan in ac-
cordance with subsection (b) and the plan is ap-
proved by the Secretary; and 
‘‘(B) the State provides assurances satisfactory 
to the Secretary that the State complied with the 
provisions of the plan under subparagraph (A) that 
was approved by the Secretary for the most recent 
fiscal year for which the State received a grant 
under section 1921; and 
‘‘(7) the application (including the plan under 
paragraph (6)) is otherwise in such form, is made in 
such manner, and contains such agreements, assur-
ances, and information as the Secretary determines 
to be necessary to carry out this subpart. 
‘‘(b) STATE PLANS.— 
‘‘(1) IN GENERAL.—In order for a State to be 
in compliance with subsection (a)(6), the State shall 
submit to the Secretary, every 3 years, a plan that, 
at a minimum, includes the following: 
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‘‘(A) A description of the State’s system of 
care that— 
‘‘(i) identifies the single State agency 
responsible for the administration of the 
program, including any third party who 
administers substance use disorder services 
and is responsible for complying with the 
requirements of the grant; 
‘‘(ii) provides information on the need 
for substance use disorder prevention and 
treatment services in the State by age, sex, 
race, and ethnicity including estimates on 
the number of individuals who need treat-
ment, who are women, who are pregnant, 
who are women with children, who are in-
dividuals with a co-occurring mental health 
and substance use disorder, who are intra-
venous drug users and who are homeless 
individuals; 
‘‘(iii) provides a description of con-
sequences and consumption patterns by lo-
cation, age, sex, race, and ethnicity; 
‘‘(iv) provides information on the cur-
rent number of individuals in treatment 
within the State by age, sex, race, and eth-
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nicity including the number of such indi-
viduals who are women, who are pregnant, 
who have children, individuals with a co-oc-
curring mental health and substance use 
disorder, intravenous drug users and who 
are homeless individuals; 
‘‘(v) provides a description of the sys-
tem that is available to provide services by 
modality, including the provision of recov-
ery support services; 
‘‘(vi) provides an assessment on the 
adequacy of the system to respond to the 
need; 
‘‘(vii) provides the latest performance 
outcome data, including outcome data de-
termined 
in 
accordance 
with 
section 
504(b); 
‘‘(viii) provides a description of the 
State’s comprehensive statewide prevention 
effort, including the number of individuals 
being served in the system, and provides a 
description of the amount of funds from 
the prevention set-aside expended on pri-
mary prevention; 
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‘‘(ix) identifies target populations and 
priority needs for prevention services; 
‘‘(x) provides a description of the re-
sources available in the State to pay for 
the services, including funding under Med-
icaid, title XXVI, and other Federal pro-
grams such as grants to the State, local 
jurisdiction of the State or nonprofit pri-
vate entities awarded under title V and 
how the State is maximizing these re-
sources; 
‘‘(xi) provides a description of the 
manner in which the State and local enti-
ties coordinate prevention and treatment 
services with other agencies, including 
health, mental health, juvenile justice, law 
enforcement, education, social services, and 
child welfare; 
‘‘(xii) describes the existing mental 
health and substance use disorders work-
force, including data on the number of in-
dividuals who serve in the system of care 
designated by profession, the need for ad-
ditional 
professionals 
and 
paraprofes-
sionals, the efforts of the State to recruit 
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and retain a qualified mental health and 
substance use disorders workforce, and a 
copy of the standards the State uses in 
certifying or licensing facilities and coun-
selors for prevention and treatment facili-
ties; 
‘‘(xiii) includes a description of how 
the State promotes evidenced-based prac-
tices; and 
‘‘(xiv) a description of how the State 
integrates mental health and substance use 
disorder services and primary health care, 
which may include providing mental health 
and substance use disorder services in pri-
mary care settings or providing primary 
and specialty care services in community- 
based mental health and substance use dis-
order service settings. 
‘‘(B) An analysis of the system that identi-
fies the strengths and weaknesses of the system 
of care, and an assessment of the adequacy of 
the system to respond to the need for services. 
‘‘(C) The establishment of goals and objec-
tives, including goals and objectives for the out-
come 
measures 
established 
under 
section 
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