ADAMHA Reorganization Act
PL 102-321 (S.1306), enacted 07/10/1992

PUBLIC LAW 102-321—JULY 10. 1992 
106 STAT. 323 
Public Law 102-321 
102d Congress 
An Act 
To amend the Public Health Service Act to restructure the Alcohol, Drug Abuse, 
and Mental Health Administration and the authorities of such Administration, 
July 10, 1992 
including establishing separate block grants to enhance the delivery of services 
[g 1306] 
regarding substance abuse and mental health, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
ADAMHA 
Reorganization 
SECTION 1. SHORT TITLE AND TABLE OF CONTENTS. 
Act. 
(a) SHORT TITLE.—This Act may be cited as the "ADAMHA 42 use 201 note. 
Reorganization Act". 
(b) TABLE OF CONTENTS.—The table of contents for this Act is 
as follows: 
Sec. 1. Short title and table of contents. 
T I T L E I—REORGANIZATION OF ADMINISTRATION AND INSTITUTES 
Subtitle A—^Administration 
Sec. 101. Substance Abuse and Mental Health Services Administration. 
Sec. 102. Advisory councils. 
Sec. 103. Reports on alcoholism, alcohol abuse, and drug abuse. 
Sec. 104. Peer review. 
Sec. 105. Data collection. 
Sec. 106. Grants for the benefit of homeless individuals. 
Sec. 107. Center for substance abuse treatment. 
Sec. 108. Programs for pregnant and postpartum women. 
Sec. 109. Demonstration projects of national significance. 
Sec. 110. Grants for substance abuse treatment in State and local criminal justice 
systems. 
Sec. 111. Training in provision of treatment services. 
Sec. 112. Alternative utilization of military facilities. 
Sec. 113. Center for Substance Abuse Prevention. 
Sec. 114. Prevention, treatment, and rehabilitation model projects for high risk 
youth. 
Sec. 115. Center for Mental Health Services. 
Sec. 116. Grant program for demonstration projects. 
Sec. 117. National mental health education. 
Sec. 118. Demonstration projects with respect to certain individuals. 
Sec. 119. Childhood mental health. 
Sec. 120. Striking of certain provisions and technical and conforming amendments. 
Subtitle B—Institutes 
Sec. 121. Organization of National Institutes of Health. 
Sec. 122. National Institute on Alcohol Abuse and Alcoholism. 
Sec. 123. National Institute on Drug Abuse. 
Sec. 124. National Institute of Mental Health. 
Sec. 125. Collaborative use of certain health services research funds. 
Subtitle C—Miscellaneous Provisions Relating to Substance Abuse and Mental 
Health 
Sec. 131. Miscellaneous provisions relating to substance abuse and mental health. 
Subtitle D—Transfer Provisions 
Sec. 141. Transfers. 
Sec. 142. Transfer and allocations of appropriations and personnel. 
Sec. 143. Incidental transfers. 
Sec. 144. Effect on personnel. 
106 STAT. 324 
PUBLIC LAW 102-321—JULY 10, 1992 
Sec. 145. Savings provisions. 
Sec. 146. Transition. 
Sec. 147. Peer review. 
Sec. 148. Mergers. 
Sec. 149. Conduct of multi-year research projects. 
Sec. 150. Separability. 
Sec. 151. Budgetary authority. 
Subtitle E—References and Conforming Amendments 
Sec. 161. References. 
Sec. 162. Transition from homelessness. 
Sec. 163. Conforming amendments. 
Subtitle F—Employee Assistance Programs 
Sec. 171. Program of grants under Center for Substance Abuse Treatment. 
TITLE II—BLOCK GRANTS TO STATES REGARDING MENTAL HEALTH AND 
SUBSTANCE ABUSE 
Sec. 201. Establishment of separate block grant regarding mental health. 
Sec. 202. Estabhshment of separate block grant regarding substance abuse. 
Sec. 203. General provisions regarding block grants. 
Sec. 204. Related programs. 
Sec. 205. Temporary provisions regarding funding. 
TITLE III—MODEL COMPREHENSIVE PROGRAM FOR TREATMENT OF 
SUBSTANCE ABUSE 
Sec. 301. Demonstration program in national capital area. 
TITLE IV—CHILDREN OF SUBSTANCE ABUSERS 
Sec. 401. Establishment of program of services. 
TITLE V—HOME-VISITING SERVICES FOR AT-RISK FAMILIES 
Sec. 501. Statement of purpose. 
Sec. 502. Establishment of program of grants. 
TITLE VI—TRAUMA CENTERS AND DRUG-RELATED VIOLENCE 
Sec. 601. Establishment of program of grants. 
Sec. 602. Conforming amendments. 
TITLE VII—STUDIES 
Sec. 701. Report by the institute on medicine. 
Sec. 702. Sense of the Senate. 
Sec. 703. Provision of mental health services to individuals in correctional facilities. 
Sec. 704. Studv of barriers to insurance coverage of treatment for mental illness 
and substance abuse. 
Sec. 705. Study on fetal alcohol effect and fetal alcohol sjmdrome. 
Sec. 706. Study by National Academy of Sciences. 
Sec. 707. Report on allotment formula. 
Sec. 708. Report by Substance Abuse and Mental Health Services Administration. 
TITLE VIII—GENERAL PROVISIONS 
Sec. 801. Effective dates. 
TITLE I—REORGANIZATION OF 
ADMINISTRATION AND INSTITUTES 
Subtitle A—^Administration 
SEC. 
101. SUBSTANCE 
ABUSE AND MENTAL HEALTH 
SERVICES 
ADMINISTRATION. 
(a) IN GENERAL.—Section 501 of the Public Health Service Act 
(42 U.S.C. 290aa) is amended to read as follows: 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 325 
*«EC. 501. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 
ADMINISTRATION. 
"(a) ESTABLISHMENT.—The Substance Abuse and Mental Health 
Services Administration (hereafter referred to in this title as the 
'Administration') is an agency of the Service. 
"(b) AGENCIES.—^The following entities are agencies of the 
Administration: 
"(1) The Center for Substance Abuse Treatment. 
"(2) The Center for Substance Abuse Prevention. 
"(3) The Center for Mental Health Services. 
"(c) ADMINISTRATOR AND DEPUTY ADMINISTRATOR.— 
"(1) ADMINISTRATOR.—The Administration shall be headed President, 
by £in Administrator (hereinafter in this title referred to as 
the 'Administrator') who shall be appointed by the President, 
by and with the advice and consent of the Senate. 
"(2) DEPUTY ADMINISTRATOR.—The Administrator, with the 
approval of the Secretary, may appoint a Deputy Administrator 
and may employ and prescribe the functions of such officers 
£ind employees, including attorneys, as are necessary to admin-
ister the activities to be c£irried out through the Administration. 
"(d) AUTHORITIES.—The Secretary, acting through the Adminis-
trator, shall— 
"(1) supervise the functions of the agencies of the Administra-
tion in order to assure that the programs CEuried out through 
each such agency receive appropriate and equitable support 
and that there is cooperation among the agencies in the 
implementation of such programs; 
"(2) estabhsh and implement, through the respective agencies, 
a comprehensive program to improve the provision of treatment 
and related services to individuals with respect to substance 
abuse and mental illness and to improve prevention services, 
promote mental health and protect the legal rights of individ-
uals with mental illnesses and individuals who are substance 
abusers; 
"(3) carry out the administrative and financial management, 
policy development and planning, evaluation, knowledge dis-
semination, and public information functions that are required 
for the implementation of this title; 
"(4) assure that the Administration conduct and coordinate 
demonstration projects, evaluations, and service system assess-
ments and other activities necessary to improve the availability 
and quality of treatment, prevention and related services; 
"(5) support activities that will improve the provision of treat-
ment, prevention and related services, including the develop-
ment of national mental health and substance abuse goals 
and model programs; 
"(6) in cooperation with the National Institutes of Health, 
the Centers for Disease Control and the Health Resources 
and Services Administration develop educational materials and 
intervention strategies to reduce the risks of HIV or tuber-
culosis among substance abusers and individuals with mental 
illness and to develop appropriate mental health services for 
individuals with such illnesses; 
"(7) coordinate Federal policy with respect to the provision 
of treatment services for substance abuse utilizing anti-addic-
tion medications, including methadone; 
106 STAT. 326 
PUBLIC LAW 102-321—JULY 10, 1992 
"(8) conduct programs, and assure the coordination of such 
programs with activities of the National Institutes of Health 
and the Agency for Health Care Pohcy Research, as appropriate, 
to evaluate the process, outcomes and community impact of 
treatment and prevention services and systems of care in order 
to identify the msinner in which such services can most effec-
tively be provided; 
"(9) collaborate with the Director of the National Institutes 
of Health in the development of a system by which the relevguit 
research findings of the National Institute on Drug Abuse, 
the National Institute on Alcohol Abuse and Alcoholism, the 
National Institute of Mental Health, and, as appropriate, the 
Agency for Health Care Policy Research are disseminated to 
service providers in a msinner designed to improve the delivery 
and effectiveness of treatment and prevention services; 
"(10) encourage public and private entities that provide health 
insurance to provide benefits for substance abuse and mental 
health services; 
"(11) promote the integration of substance abuse and mental 
health services into the mainstream of the health care delivery 
system of the United States; 
"(12) monitor compliance by hospitals and other facilities 
with the requirements of sections 542 and 543; 
"(13) with respect to grant programs authorized under this 
title, assure that— 
"(A) all grants that are awarded for the provision of 
services are subject to performance and outcome evalua-
tions; and 
"(B) all grants that are awarded to entities other than 
States are awarded only after the State in which the entity 
intends to provide services— 
"(i) is notified of the pendency of the grant appUca-
tion; and 
"(ii) is afforded an opportunity to comment on the 
merits of the application; 
"(14) assure that services provided with amounts appro-
priated under this title are provided bilingually, if appropriate; 
"(15) improve coordination among prevention programs, treat-
ment facilities and nonhealth care systems such as employers, 
labor unions, and schools, and encourage the adoption of 
employee assistance programs and student assistsince pro-
grams; 
"(16) maintain a clearinghouse for substance abuse and men-
tal health information to assure the widespread dissemination 
of such information to States, political subdivisions, educational 
agencies and institutions, treatment providers, and the general 
public; 
"(17) in collaboration with the National Institute on Aging, 
and in consultation with the National Institute on Drug Abuse, 
the National Institute on Alcohol Abuse and AlcohoUsm and 
the National Institute of Mental Health, as appropriate, pro-
mote and evaluate substance abuse services for older Americans 
in need of such services, and mental health services for older 
Americans who are seriously mentally ill; and 
"(18) promote the coordination of service programs conducted 
by other departments, agencies, organizations and individuals 
that are or may be related to the problems of individuals 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 327 
suffering from mental illness or substance abuse, including 
liaisons with the Social Security Administration, Health Care 
Financing Administration, and other programs of the Depart-
ment, as well as liaisons with the Department of Education, 
Department of Justice, and other Federal Departments and 
offices, as appropriate. 
"(e) ASSOCIATE ADMINISTRATOR FOR ALCOHOL PREVENTION AND 
TREATMENT POLICY.— 
"(1) IN GENERAL.—There shall be in the Administration an 
Associate Administrator for Alcohol Prevention and Treatment 
Policy to whom the Administrator shall delegate the functions 
of promoting, monitoring, and evaluating service programs for 
the prevention and treatment of alcoholism and alcohol abuse 
within the Center for Substance Abuse Prevention, the Center 
for Substance Abuse Treatment, and the Center for Mental 
Health Services, and coordinating such programs among the 
Centers, and among the Centers and other public and private 
entities. The Associate Administrator also shall ensure that 
alcohol prevention, 
education, 
and 
policy strategies 
are 
integrated into all programs of the Centers that address sub-
stance abuse prevention, education, and policy, and that the 
Center for Substance Abuse Prevention addresses the Healthy 
People 2000 goals and the National Dietary Guidelines of the 
Department of Health and Human Services and the Department 
of Agriculture related to alcohol consumption. 
"(2) PLAN.— 
"(A) The Administrator, acting through the Associate 
Administrator for Alcohol Prevention eind Treatment Policy, 
shall develop, and periodically review and as appropriate 
revise, a plan for programs and policies to treat and prevent 
alcoholism and alcohol abuse. The plan shall be developed 
(and reviewed and revised) in collaboration with the Direc-
tors of the Centers of the Administration and in con-
sultation with members of other Federal agencies and pub-
lic and private entities. 
"(B) Not later than 1 year after the date of the enactment 
of the ADAMHA Reorganization Act, the Administrator 
shall submit to the Congress the first plan developed under 
subparagraph (A). 
"(3) REPORT.— 
"(A) Not less than once during each 2 years, the Adminis-
trator, acting through the Associate Administrator for Alco-
hol Prevention and Treatment Policy, shall prepare a report 
describing the alcoholism and alcohol abuse prevention and 
| 
treatment programs undertaken by the Administration and 
its agencies, and the report shall include a detailed state-
ment of the expenditures made for the activities reported 
on £ind the personnel used in connection with such activi-
ties. 
"(B) Each report under subparagraph (A) shall include 
a description of any revisions in the plan imder paragraph 
(2) made during the preceding 2 years. 
"(C) Each report under subparagraph (A) shall be submit-
ted to the Administrator for inclusion in the biennial report 
under subsection (k). 
"(f) ASSOCIATE ADMINISTRATOR FOR WOMEN'S SERVICES.— 
106 STAT. 328 
PUBLIC LAW 102-321—JULY 10, 1992 
"(1) APPOINTMENT.—^The Administrator, with the approval 
of the Secretary, shall appoint an Associate Administrator for 
Women's Services. 
"(2) DUTIES.—The Associate Administrator appointed under 
paragraph (1) shall— 
"(A) establish a committee to be known as the Coordinat-
ing Committee for Women's Services (hereafter in this sub-
paragraph referred to as the 'Coordinating Committee*), 
which shall be composed of the Directors of the agencies 
of the Administration (or the designees of the Directors); 
"(B) acting through the Coordinating Committee, with 
respect to women's substance abuse and mental health 
services— 
"(i) identify the need for such services, and make 
an estimate each fiscal year of the funds needed to 
adequately support the services; 
"(ii) identify needs regarding the coordination of serv-
ices; 
"(iii) encourage the agencies of the Administration 
to support such services; and 
"(iv) assure that the unique needs of minority 
women, including Native American, Hispanic, Afiican-
American and Asian women, are recognized and 
addressed within the activities of the Administration; 
and 
"(C) establish an advisory committee to be known as 
the Advisory Committee for Women's Services, which shall 
be composed of not more than 10 individuals, a majority 
of whom shall be women, who are not officers or employees 
of the Federal Government, to be appointed by the Adminis-
trator from among physicians, practitioners, treatment pro-
viders, and other health professionals, whose clinical prac-
tice, specialization, or professional expertise includes a sig-
nificant focus on women's substance abuse and mental 
health conditions, that shall— 
"(i) advise the Associate Administrator on appro-
priate activities to be undertaken by the agencies of 
the Administration with respect to women's substance 
abuse and mental health services, including services 
which require a multidisciplinary approach; 
"(ii) collect and review data, including information 
provided by the Secretary (including the material 
referred to in paragraph (3)), and report biannually 
to the Administrator regarding the extent to which 
women are represented among senior personnel, and 
make recommendations regarding improvement in the 
participation of women in the workforce of the Adminis-
tration; and 
"(iii) prepare, for inclusion in the biennial report 
required pursuant to subsection (k), a description of 
activities of the Committee, including findings made 
by the Committee regarding— 
"(I) the extent of expenditures made for women's 
substance abuse and mental health services by 
the agencies of the Administration; and 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 329 
"(II) the estimated level of funding needed for 
substance abuse and mental health services to 
meet the needs of 
women; 
"(D) improve the collection of data on women's health 
b y -
"(i) reviewing the current data at the Administration 
to determine its uniformity and appUcabihty; 
"(ii) developing standards for all programs funded 
by the Administration so that data are, to the extent 
practicable, collected and reported using common 
reporting formats, linkages and definitions; and 
"(iii) reporting to the Administrator a plan for incor-
porating the standards developed under clause (ii) in 
all Administration programs and a plan to £issure that 
the data so collected are accessible to health profes-
sion£ds, providers, researchers, and members of the 
public; and 
"(E) shcdl estabUsh, maintain, and operate a program 
to provide information on women's substance abuse and 
mental health services. 
"(3) STUDY.— 
"(A) The Secretary, acting through the Assistant Sec-
retary for Personnel, shall conduct a study to evaluate 
the extent to which women are represented among senior 
personnel at the Administration. 
"(B) Not later than 90 days after the date of the enact-
ment of the ADAMHA Reorganization Act, the Assistant 
Secretary for Personnel shall provide the Advisory Commit-
tee for Women's Services with a study plan, including 
the methodology of the study and any sampling frames. 
Not later than 180 days after such date of enactment, Reports-
the Assistant Secretary shall prepare and submit directly 
to the Advisory Committee a report concerning the results 
of the study conducted imder subparagraph (A). 
"(C) The Secretary shall prepare and provide to the 
Advisory Committee for Women's Services any additional 
data as requested. 
"(4) DEFINITION.—For purposes of this subsection, the term 
Vomen's substance abuse and mental health conditions', with 
respect to women of all age, ethnic, and racial groups, means 
all aspects of substance abuse and mental illness— 
"(A) unique to or more prevalent among women; or 
"(B) with respect to which there have been insufficient 
services involving women or insufScient data. 
"(g) SERVICES OF EXPERTS.— 
"(1) IN GENERAL.—^The Administrator may obtain (in accord-
ance with section 3109 of title 5, Unitea States Code, but 
without regard to the limitation in such section on the number 
of da3rs or the period of service) the services of not more than 
20 experts or consultants who have professional qualifications. 
Such experts and consultants shall be obtained for the Adminis-
tration and for each of its agencies. 
"(2) COMPENSATION AND EXPENSES.— 
"(A) Experts and consultants whose services are obtained 
under paragraph (1) shall be paid or reimbursed for their 
expenses associated with traveling to and 
firom 
their assign-
106 STAT. 330 
PUBLIC LAW 102-321—JULY 10, 1992 
ment location in accordance with sections 5724, 5724a(a)(l), 
5724a(a)(3), and 5726(c) of title 5, United States Code. 
"(B) Expenses specified in subparagraph (A) may not 
be allowed in connection with the assignment of an expert 
or consultant whose services are obtained under paragraph 
(1), unless and until the expert or consultant agrees in 
writing to complete the entire period of assignment or 
one year, whichever is shorter, unless separated or 
reassigned for reasons beyond the control of the expert 
or consultant that are acceptable to the Secretary. If the 
expert or consultant violates the agreement, the money 
spent by the United States for the expenses specified in 
subparagraph (A) is recoverable fi*om the expert or consult-
ant as a debt of the United States. The Secretary may 
waive in whole or in part a right of recovery imder this 
subparagraph. 
"(h) PEER REVIEW GROUPS.—The Administrator shall, without 
regard to the provisions of title 5, United States Code, governing 
appointments in the competitive service, and without regard to 
the provisions of chapter 51 and subchapter III of chapter 53 
of such title, relating to classification and General Schedule pay 
rates, establish such peer review groups and program advisory 
committees as are needed to carry out the requirements of this 
title and appoint and pay members of such groups, except that 
officers and employees of the United States shall not receive addi-
tional compensation for services as members of such groups. The 
Federal Advisory Committee Act shall not apply to the duration 
of a peer review group appointed under this subsection. 
"(i) VOLUNTARY SERVICES.—The Administrator may accept vol-
untary and imcompensated services. 
"(j) ADMINISTRATION.—The Administrator shall ensure that pro-
grams and activities assigned under this title to the Administration 
are fully administered by the respective Centers to which such 
programs and activities are assigned. 
"(k) REPORT CONCERNING ACTIVITIES AND PROGRESS.—Not later 
than February 10, 1994, and once every 2 years thereafter, the 
Administrator shall prepare and submit to the Committee on 
Energy and Commerce of the House of Representatives, and to 
the Committee on Labor and Human Resources of the Senate, 
the report containing— 
"(1) a description of the activities carried out by the Adminis-
tration; 
"(2) a description of any measurable progress made in improv-
ing the availability and quality of substance abuse and mental 
health services; 
"(3) a description of the mechanisms by which relevant 
research findings of the National Institute on Drug Abuse, 
the National Institute on Alcohol Abuse and Alcoholism, and 
the National Institute of Mental Health have been disseminated 
to service providers or otherwise utilized by the Administration 
to further the purposes of this title; and 
"(4) any report required in this title to be submitted to 
the Adminstrator for inclusion in the report under this sub-
section. 
"(1) APPLICATIONS FOR GRANTS AND CoNTRACTS.^With respect 
to awards of grants, cooperative agreements, and contracts imder 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 331 
this title, the Administrator, or the Director of the Center involved, 
as the case may be, may not make such an award imless— 
"(1) an application for the award is submitted to the officisJ 
involved; 
"(2) with respect to canying out the purpose for which the 
award is to be provided, the application provides assurances 
of compliance satisfactory to such official; and 
"(3) the application is otherwise in such form, is made in 
such manner, and contains such agreements, assurances, £ind 
information as the official determines to be necessary to carry 
out the purpose for which the award is to be provided. 
"(m) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
providing grants, cooperative agreements, and contracts under this 
section, there are autiiorized to be appropriated $25,000,000 for 
fiscal year 1993, and such sums as may be necessary for fiscal 
year 1994.". 
(b) REPEALS.—Sections 502, 503, and 504 of the PubHc Health 
Service Act (42 U.S.C. 290aa-l, 290aa-2, and 290aa-3) are 
repealed. 
SEC. 102. ADVISORY COUNCILS. 
Section 505 of the Pubhc Health Service Act (42 U.S.C. 290aa-
3a) is amended— 
(1) by redesignating such section as section 502; and 
42 use 290aa-i. 
(2) to read as follows: 
"ADVISORY COUNCILS 
"SEC. 502. (a) APPOINTMENT.— 
"(1) IN GENERAL.—^The Secretary shall appoint an advisory 
council for— 
"(A) the Substance Abuse and Mented Health Services 
Administration; 
"(B) the Center for Substance Abuse Treatment; 
"(C) the Center for Substance Abuse Prevention; Eind 
"(D) the Center for Mental Health Services. 
Each such advisory council shall advise, consult with, and 
make recommendations to the Secretary and the Administrator 
or Director of the Administration or Center for which the 
advisory council is established concerning matters relating to 
the activities carried out by and through the Administration 
or Center and the policies respecting such activities. 
"(2) FUNCTION AND ACTIVITIES.—An advisory council— 
"(A)(i) may on the basis of the materials provided by 
the organization respecting activities conducted at the 
organization, make recommendations to the Administrator 
or Director of the Administration or Center for which it 
was established respecting such activities; 
"(ii) shall review appHcations submitted for grants and 
cooperative agreements for activities for which advisory 
council approval is required under section 504(d)(2) and 
recommend for approval appUcations for projects that show 
promise of making valuable contributions to the Adminis-
tration's mission; and 
"(iii) may review any grant, contract, or cooperative 
agreement proposed to be made or entered into by the 
organization; 
106 STAT. 332 
PUBLIC LAW 102-321—JULY 10, 1992 
"(B) may collect, by correspondence or by personal inves-
tigation, information as to studies and services that are 
being carried on in the United States or £iny other country 
as to the diseases, disorders, or other aspects of human 
heedth with respect to which the organization was estab-
lished and with the approval of the Administrator or Direc-
tor, whichever is appropriate, make such information avail-
able through appropriate publications for the benefit of 
public and private health entities and health professions 
personnel and for the information of the general public; 
£ind 
"(C) may appoint subcommittees and convene workshops 
and conferences. 
"(b) MEMBERSHIP.— 
"(1) IN GENERAL.—Each advisory council shall consist of 
nonvoting ex officio members and not more than 12 members 
to be appointed by the Secretary under paragraph (3). 
"(2) Ex OFFICIO MEMBERS.—The ex officio members of an 
advisory council shall consist of— 
"(A) the Secretary; 
"(B) the Administrator; 
"(C) the Director of the Center for which the council 
is established; 
"(D) the Chief Medical Director of the Veter£ins Adminis-
tration; and 
"(E) the Assistant Secretary for Defense for Health 
Affairs (or the designates of such officers); and 
"(F) such additional officers or employees of the United 
States as the Secretary determines necessary for the 
advisory council to effectively carry out its functions. 
"(3) APPOINTED MEMBERS.—Individuals shall be appointed 
to an advisory council under paragraph (1) as follows: 
"(A) Nine of the members shall be appointed by the 
Secretary from among the leading representatives of the 
health disciplines (including public health and behavioral 
and soci£d sciences) relevant to the activities of the 
Administration or Center for which the advisory council 
is established. 
"(B) Three of the members shall be appointed by the 
Secretary from the general public and shall include leaders 
in fields of public policy, public relations, law, health poUcy 
economics, and management. 
"(4) COMPENSATION.—Members of an advisory council who 
are officers or employees of the United States shall not receive 
any compensation for service on the advisory council. TTie 
remaining members of an advisory council shall receive, for 
each day (including travel time) they are engaged in the per-
formsince of the functions of the advisory council, compensation 
at rates not to exceed the daily equivalent to the sinnual rate 
in effect for grade GS-18 of the Greneral Schedule. 
"(c) TERMS OF OFFICE.— 
"(1) IN GENERAL.—The term of office of a member of an 
advisory council appointed under subsection (b) shall be 4 years, 
except that any member appointed to fill a vacancy for an 
xines^ired term shall serve for the remainder of such term. 
The Secretary shall make appointments to an advisory council 
in such a manner as to ensure that the terms of the members 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 333 
not all expire in the same year. A member of an advisory 
council may serve after the expiration of such member's term 
until a successor has been appointed and teiken office. 
"(2) REAPPOINTMENTS.—^A member who has been appointed 
to an advisory council for a term of 4 years may not be 
reappointed to an advisory coimcil during the 2-year period 
beginning on the date on which such 4-year term expired. 
"(3) TIME FOR APPOINTMENT.—If a vacancy occurs in an 
advisory council among the members under subsection (b), the 
Secretary shall make an appointment to fill such vacancy within 
90 days from the date the vacancy occurs. 
"(d) CHAIR.—The Secretary shall select a member of an advisory 
council to serve as the chair of the council. The Secretary may 
so select an individual from among the appointed members, or 
may select the Administrator or the Director of the Center involved. 
The term of office of the chair shall be 2 years. 
"(e) MEETINGS.—^An advisory council shall meet at the call of 
the chairperson or upon the request of the Administrator or Director 
of the Administration or Center for which the advisory council 
is established, but in no event less than 3 times during each 
fiscal year. The location of the meetings of each advisory council 
shall be subject to the approved of the Administrator or Director 
of Administration or Center for which the council was established. 
"(f) EXECUTIVE SECRETARY AND STAFF.—The Administrator or 
Director of the Administration or Center for which the advisory 
council is established shall designate a member of the staff of 
the Administration or Center for which the advisory coiuicil is 
established to serve as the Executive Secretary of the advisory 
council. The Administrator or Director shall make available to 
the advisory council such staff, information, and other assistance 
as it may require to carry out its functions. The Administrator 
or Director shall provide orientation and training for new members 
of the advisory council to provide for their effective participation 
in the functions of the advisory coimcil.". 
SEC. 103. REPORTS ON ALCOHOLISM, ALCOHOL ABUSE, AND DRUG 
ABUSE. 
Section 506 of the PubUc Health Service Act (42 U.S.C. 290aa-
4) is amended by redesignating such section as section 503. 
42 use 290aa-2. 
SEC. 104. P E E R REVIEW. 
Section 507 of the Pubhc Health Service Act (42 U.S.C. 290aa-
5) is amended— 
(1) by redesignating such section as section 504; and 
42 use 290aa-3. 
(2) to read as follows: 
"PEER REVIEW 
"SEC 504. (a) IN GENERAL.—The Secretary, after consultation Regulations, 
with the Directors of the Center for Substance Abuse Treatment, 
the Center for Substance Abuse Prevention, £ind the Center for 
Mental Health Services, shall by regulation require appropriate 
E
eer review of grants, cooperative agreements, and contracts to 
e administered through such Centers. 
"(b) MEMBERS.—The members of any peer review group estab-
lished under regulations imder subsection (a) shall be individuals 
who by virtue of their training or experience are eminently qualified 
to perform the review functions of the group. Not more than one-
106 STAT. 334 
PUBLIC LAW 102-321—JULY 10, 1992 
42 use 
290aa-ll. 
42 use 290aa-4. 
42 use 
290bb-la. 
42 use 290aa-5. 
fourth of the members of any peer review group established under 
such regulation shall be officers or employees of the United States. 
"(c) REQUIREMENTS.—Regulations promulgated pursuant to sub-
section (a)— 
"(1) shall require that the reviewing entity be provided a 
written description of the matter to be reviewed; 
"(2) shall require that the reviewing entity provide the 
advisory council of the Center involved with such description 
and the results of the review by the entity; and 
"(3) may specify the conditions imder which limited excep-
tions may be granted to the limitations contained in the last 
sentence of subsection (b) and subsection (d). 
"(d) RECOMMENDATIONS.— 
"(1) IN GENERAL.—If the direct cost of a grant, cooperative 
agreement, or contract (described in subsection (a)) to be made 
does not exceed $50,000, the Secretary may make such grant, 
cooperative agreement, or contract only if such grant, coopera-
tive agreement, or contract is recommended after peer review 
required by regulations under subsection (a). 
'\2) BY APPROPRIATE ADVISORY COUNCIL.—If the direct cost 
of a grant, cooperative agreement, or contract (described in 
subsection (a)) to be made exceeds $50,000, the Secretary may 
make such grant, cooperative agreement, or contract only if 
such 
grant, 
cooperative 
agreement, 
or 
contract 
is 
recommended— 
"(A) after peer review required by regulations under sub-
section (a), and 
"(B) by the appropriate advisory council.". 
SEC. 105. DATA COLLECTION. 
Section 509D of the PubUc Health Service Act (42 U.S.C. 290cc-
11)-
(1) is transferred to part A of title V of such Act; 
(2) is redesignated as section 505; and 
(3) is inserted after section 504 (as redesignated by section 
104). 
SEC. 106. GRANTS FOR THE BENEFIT OF HOMELESS INDIVIDUALS. 
(a) TRANSFER.—Section 512 of the Public Health Service Act 
(42 U.S.C. 290bb-lb)— 
(1) is transferred to part A of title V of such Act; 
(2) is redesignated as section 506; and 
(3) is inserted after section 505 (as redesignated by section 
105). 
(b) AMENDMENTS.—Section 506 of the Public Health Service Act 
(as transferred and redesignated under subsection (a)) is amended 
to read as follows: 
"GRANTS FOR THE BENEFIT OF HOMELESS INDIVIDUALS 
"SEC. 506. (a) GRANTS FOR THE BENEFIT OF HOMELESS INDIVID-
UALS.—TTie Secretary, acting through the Administrator, may make 
grants to, and enter into contracts and cooperative agreements 
with, community-based public and private nonprofit entities for 
the purpose of developing and expanding mental health and sub-
stance abuse treatment services for homeless individuals. In carry-
ing out this subsection, the Administrator shsdl consult vdth the 
Amninistrator of the Health Resources and Services Administration, 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 335 
the Directors of the National Institute on Alcohol Abuse and 
Alcoholism, the National Institute on Drug Abuse, and the National 
Institute of Mental Health, and the Commissioner of the Adminis-
tration for Children, Youth and Families. 
"(b) PREFERENCE.—In awarding grants under subsection (a), the 
Secretary shall give preference to entities that provide integrated 
primary health care, substance abuse and mental health services 
to homeless individuals. 
"(c) SERVICES FOR CERTAIN INDIVIDUALS.—In making awards 
under subsection (a), the Secretary may not prohibit the provision 
of services imder such subsection to homeless individuals who have 
a primary diagnosis of substance abuse and are not suffering from 
mental illness. 
"(d) TERM OF GRANT.—No entity may receive grants under sub-
section (a) for more than 5 years although such grants may be 
renewed. 
"(e) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated to carry out this section, $50,000,000 for fiscal 
year 1993, and such sums as may be necessary for fiscal year 
1994.". 
SEC. 107. CENTER FOR SUBSTANCE ABUSE TREATMENT. 
Title V of the PubHc Health Service Act (42 U.S.C. 290aa et 
seq.) is amended— 
(1) by striking the heading for part B and each subpart 
heading in such part; and 
(2) by inserting after section 506 (as transferred and redesig-
nated by section 106) the following new part: 
"PART B—CENTERS AND PROGRAMS 
"Subpart 1—Center for Substance Abuse Treatment 
"CENTER FOR SUBSTANCE ABUSE TREATMENT 
"SEC. 507. (a) ESTABLISHMENT.—There is estabUshed in the 42USC290bb. 
Administration a Center for Substsince Abuse Treatment (hereafter 
in this section referred to as the 'Center'). The Center shall be 
headed by a Director (hereafter in this section referred to as the 
'Director') appointed by the Secretary fi*om among individuals with 
extensive experience or academic qualifications in the treatment 
of substance abuse or in the evaluation of substance abuse treat-
ment systems. 
"(b) DUTIES.—The Director of the Center shall— 
"(1) administer the substance abuse treatment block grant 
progrgim authorized in section 1921; 
"(2) collaborate with the Director of the Center for Substance 
Abuse Prevention in order to provide outreach services to iden-
tify individuals in need of treatment services, with emphasis 
on the provision of such services to pregnant and postpartum 
women and their infants £ind to individuals who abuse drugs 
intravenously; 
"(3) 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 pro-
mote the study, dissemination, and implementation of research 
findings that will improve the delivery and effectiveness of 
treatment services; 
106 STAT. 336 
PUBLIC LAW 102-321—JULY 10, 1992 
"(4) collaborate with the Administrator of the Health 
Resources and Services Administration and the Administrator 
of the Health Care Financing Administration to promote the 
increased integration into the mainstream of the health care 
system of the United States of programs for providing treatment 
services; 
"(5) evaluate plans submitted by the States pursuant to sec-
tion 1932(a)(6) m order to determine whether the plans ade-
quately provide for the availability, allocation, and effectiveness 
of treatment services, and monitor the use of revolving loan 
funds pursuant to section 1925; 
"(6) sponsor regional workshops on improving the quality 
and availability of treatment services; 
"(7) provide technical assistance to public and nonprofit pri-
vate entities that provide treatment services, including tech-
nical assistance with respect to the process of submitting to 
the Director applications for any program of grants or contracts 
carried out by the Director; 
"(8) encourage the States to expand the availability (relative 
to fiscal yeeir 1992) of programs providing treatment services 
through self-nm, self-supported recovery based on the programs 
of housing operated pursuant to section 1925; 
"(9) cany 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 noimospital-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 estabhshed 
imder section 1925, which shall be carried out through grants, 
contracts, or cooperative agreements provided to pubuc or non-
profit private entities; and 
"(12) in carrying out paragraph (11), assess the quality, 
appropriateness, and costs of various treatment forms for spe-
cific patient groups. 
"(c) GRANTS AND CONTRACTS.—In carrying out the duties estab-
lished in subsection (b), the Director may make grants to and 
enter into contracts and cooperative agreements with public and 
nonprofit private entities.". 
SEC. 108. PROGRAMS FOR PREGNANT AND POSTPARTUM WOMEN. 
(a) IN GENERAL.—Subpart 1 of part B of title V (as added by 
section 107) is amended by adding at the end thereof the following 
new sections: 
"RESIDENTIAL TREATMENT PROGRAMS FOR PREGNANT AND 
POSTPARTUM WOMEN 
Contracts. 
«SEC. 508. (a) IN GENERAL.—The Director of the Center for Sub-
42 use 290bb-l. gtance Abuse Treatment shall provide awards of grants, cooperative 
agreement, or contracts to public and nonprofit private entities 
for the purpose of providing to pregnant and postpartum women 
treatment for substance abuse through programs in which, during 
the course of receiving treatment— 
"(1) the women reside in facilities provided by the programs; 
"(2) the minor children of the women reside witii the women 
in such facilities, if the women so request; and 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 337 
"(3) the services described in subsection (d) are available 
to or on behalf of the women. 
"(b) AVAILABILITY OF SERVICES FOR EACH PARTICIPANT.—A fund-
ing agreement for an award under subsection (a) for an applicant 
is that, in the program operated pursuant to such subsection— 
"(1) treatment services and each supplemental service will 
be available through the appUcant, either directly or through 
agreements with other public or nonprofit private entities; and 
"(2) the services will be made available to each woman admit-
ted to the program. 
"(c) INDIVIDUALIZED PLAN OF SERVICES.—A funding agreement 
for an award under subsection (a) for an applicant is that— 
"(1) in providing authorized services for an eligible woman 
pursuant to such subsection, the appUcant will, in consultation 
with the women, prepare an individualized pleui for the provi-
sion to the woman of the services; and 
"(2) treatment services under the plan will include— 
"(A) individual, group, and family coxinseling, as appro-
priate, 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 
ehgible 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 infents 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 rehabiUtative activities. 
"(5) Training in parenting. 
"(6) Counseling on the human immimodeficiency virus and 
on acquired immune deficiency syndrome. 
"(7) Counseling on domestic violence and sexual abuse. 
"(8) Coimseling 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 £uid counseling to assist reentry into soci-
ety, 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 chil-
dren of the women. 
"(11) Case management services, including— 
"(A) assessing the extent to which authorized services 
are appropriate for the women and their children; 
106 STAT. 338 
PUBLIC LAW 102-321—JULY 10, 1992 
.;;: i 
"(B) in the case of the services that are appropriate, 
ensuring that the services Eire provided in a coordinated 
manner; and 
"(C) assistance in establishing eUgibiUty for assistance 
under Federal, State, and local programs providing health 
services, mental health services, housing services, employ-
ment services, educational services, or social services. 
"(e) MINIMUM QUALIFICATIONS FOR RECEIPT OF AWARD.— 
"(1) 
CERTIFICATION BY RELEVANT STATE AGENCY.—With 
respect to the principal agency of the State involved that admin-
isters programs relating to substance abuse, the Director may 
make an award under subsection (a) to an applicant only if 
the agency has certified to the Director that— 
"(A) the applicant has the capacity to carry out a program 
described in subsection (a); 
"(B) the plans of the applicant for such a program are 
consistent with the policies of such agency regarding the 
treatment of substance abuse; and 
"(C) the applicant, or any entity through which the 
applicant will provide authorized services, meets all 
applicable State licensure or certification requirements 
regarding the provision of the services involved. 
"(2) STATUS AS MEDICAID PROVIDER.— 
"(A) Subject to subparagraphs (B) and (C), the Director 
may make an award under subsection (a) only if, in the 
case of any authorized service that is available pursuant 
to the State plan approved imder title XDC of the Social 
Security Act for the State involved— 
"(i) the applicant for the award will provide the 
service directly, and the appliceint 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 pa3maents. 
"(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 subpara-
graph 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 fi'om any third-party payor, including reimburse-
ment 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 volimtsiry donations regarding the provi-
sion of services to the public. 
"(C) With respect to any authorized service that is avail-
able pursuant to the State plan described in subparagraph 
(A), the requirements established in such subparagraph 
shaU 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 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 339 
65 years of age. For purposes of the preceding sentence, 
the term 'institution for mental diseases' has the meaning 
given such term in section 1905(i) of the Social Security 
Act. 
"(f) REQUIREMENT OF MATCHING FUNDS.— 
"(1) IN GENERAL.—^With respect to the costs of the program 
to be carried out by an applicant pursuant to subsection (a), 
a funding agreement for an award under such subsection is 
that the appUcant will make available (directly or through 
donations from public or private entities) non-Federal con-
tributions toward such costs in an amoimt that— 
"(A) for the first fiscal year for which the applicant 
receives pa5nnents under an award under such subsection, 
is not less than $1 for each $9 of Federal funds provided 
in the award; 
"(B) for anv second such fiscal year, is not less than 
$1 for each $9 of Federal funds provided in the award; 
and 
"(C) for any subsequent such fiscal year, is not less 
than $1 for each $3 of Federal funds provided in the 
award. 
"(2) DETERMINATION OF AMOUNT CONTRIBUTED.—Non-Federal 
contributions required in paragraph (1) may be in cash or 
in kind, fairly evaluated, including plant, equipment, or serv-
ices. Amounts provided by the Federal Government, or services 
assisted or subsidized to any significant extent by the Federal 
Government, may not be included in determining the amount 
of such non-Federal contributions. 
"(g) OUTREACH.—^A funding agreement for an award under sub-
section (a) for an applicant is that the applicant will provide out-
reach 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 SERV-
ICES.—^A funding agreement for an award under subsection (a) 
for an applicant is that— 
"(1) the program operated pursuant to such subsection will 
be operated at a location that is accessible to low-income preg-
nant and postpartum women; and 
"(2) authorized services will be provided in the language 
and the cultural context that is most appropriate, 
"(i) CONTINUING EDUCATION.—A funding agreement for an award 
under subsection (a) is that the applicant involved will provide 
for continuing education in treatment services for the individuals 
who will provide treatment in the program to be operated by the 
applicant pursuant to such subsection. 
"(j) IMPOSITION OF CHARGES.—^A funding a^eement for an award 
under subsection (a) for an applicant is that, if a charge is imposed 
for the provision of authorized services to on behalf of an eligible 
woman, such charge— 
"(1) will be made according to a schedule of charges that Public 
is made available to the public; 
information. 
"(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 estab-
lished by the Director of the Office for Management and Budget 
106 STAT. 340 
PUBLIC LAW 102-321—JULY 10, 1992 
and revised by the Secretary in accordance with section 673(2) 
of the Omnibus Budget ReconciUation Act of 1981. 
"(k) REPORTS TO DIRECTOR.—^A funding agreement for an award 
imder subsection (a) is that the applicant involved will submit 
to the Director a report— 
"(1) describing the utilization and costs of services provided 
under the award; 
"(2) specifying the number of women served, the number 
of infants served, and the type and costs of services provided; 
and 
"(3) providing such other information as the Director deter-
mines to be appropriate. 
"(1) REQUIREMENT OF APPLICATION.—The Director may make an 
award under subsection (a) only if an application for the award 
is submitted to the Director containing such agreements, and the 
application is in such form, is made in such manner, and contains 
such other agreements and such assurances and information as 
the Director determines to be necessary to carry out this section, 
"(m) EQUITABLE ALLOCATION OF AWARDS.—In making awards 
under subsection (a), the Director shall ensure that the awards 
are equitably allocated among the principal geographic regions of 
the United States, subject to the availability of qualified applicants 
for the awards. 
"(n) DURATION OF AWARD.—The period during which payments 
are made to an entity from an award imder subsection (a) may 
not exceed 5 years. The provision of such pa3anents shall be subject 
to annual approval by the Director of the pa3nnents and subject 
to the availability of appropriations for the fiscal year involved 
to make the payments. This subsection may not be construed to 
establish a limitation on the number of awards under such sub-
section that may be made to an entity. 
"(o) EVALUATIONS; DISSEMINATION OF FINDINGS.—The Director 
shall, directly or through contract, provide for the conduct of evalua-
tions of programs carried out pursuant to subsection (a). The Direc-
tor shall disseminate to the States the findings made as a result 
of the evaluations. 
"(p) REPORTS TO CONGRESS.—Not later than October 1, 1994, 
the Director shall submit to the Committee on Energy and Com-
merce of the House of Representatives, and to the Committee on 
Labor and Human Resources of the Senate, a report describing 
programs carried out pursuant to this section. Every 2 years there-
after, the Director shall prepare a report describing such programs 
carried out during the preceding 2 years, and shall submit the 
report to the Administrator for inclusion in the biennial report 
under section 501(k). Each report under this subsection shsdl 
include a summary of any evaluations conducted under subsection 
(m) during the period with respect to which the report is prepared, 
"(q) DEFINITIONS.—For purposes of this section: 
"(1) The term 'authorized services' means treatment services 
and supplemental services. 
• 
"(2) The term 'eligible woman' means a woman who has 
been admitted to a program operated pursuant to subsection 
(a). 
"(3) The term 'funding agreement under subsection (a)', with 
respect to an award under subsection (a), means that the Direc-
tor may make the award only if the applicant makes the 
agreement involved. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 341 
"(4) The term 'treatment services' means treatment for sub-
stance 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 
I 
and section 509, there are authorized to be appropriated 
$100,000,000 for fiscal year 1993, and such sums as may be 
necessary for fiscal year 1994. 
"(2) TRANSFER.—For the purpose described in paragraph (1), 
in addition to the amounts authorized in such paragraph to 
be appropriated for a fiscal year, there is authorized to be 
appropriated for the fiscal year from the special forfeiture fund 
of the Director of the Office of National Drug Control Policy 
such sums as may be necesssiry. 
"(3) RULE OF CONSTRUCTION.—The amoimts authorized in 
this subsection to be appropriated are in addition to any other 
amounts that are authorized to be appropriated and are avail-
able for the purpose described in paragraph (1), 
"OUTPATIENT 
TREATMENT 
PROGRAMS 
FOR 
PREGNANT 
AND 
POSTPARTUM 
WOMEN 
"SEC. 509. (a) GRANTS.—The Secretary, acting through the Direc-
tor of the Treatment Center, shall make grants to establish projects 
for the outpatient treatment of substance abuse among pregnant 
and postpartum women, and in the case of conditions sirising in 
the infants of such women as a result of such abuse by the women, 
the outpatient treatment of the infants for such conditions. 
"(b) PREVENTION.—Entities receiving grants under this section 
shall engage in activities to prevent substance abuse among preg-
nant ana postpartum women. 
"(c) EVALUATION.—The Secretary shall evaluate projects carried 
out under subsection (a) and shall disseminate to appropriate public 
and private entities information on effective projects.". 
(b) 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 1992, the Secretary of Health and Human 
Services may continue in effect the grant for fiscal year 
1993 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. Subject to 
approval by the Administrator, such grsints may be 
administered by the Center for Substance Abuse Ift-even-
tion. 
(B) Subparagraph (A) shall apply with respect to a project 
notwithstanding that the project is not eligible to receive 
a grant under current section 508 or 509. 
(2) LIMITATION ON FUNDING FOR CERTAIN PROJECTS.—With 
respect to the amounts appropriated for any fisc£il year under 
current section 508, £uiy such amounts appropriated in excess 
of the amoimt appropriated for fiscal year 1992 under former 
section 509F shall be available only for grants under current 
section 508. 
42 u s e 290bb-2. 
42 u s e 290bb-2 
note. 
106 STAT. 342 
PUBLIC LAW 102-321—JULY 10, 1992 
(3) DEFINITIONS.—For purposes of this subsection: 
(A) The term "former section 509F" means section 509F 
of the PubUc Health Service Act, as in effect for fiscal 
year 1992. 
(B) The term "current section 508" means section 508 
of the PubUc Health Service Act, as in effect for fiscal 
year 1993 and subsequent fiscal years. 
(C) The term "current section 509" mesuis section 509 
of the PubHc Health Service Act, as in effect for fisc£il 
year 1993 and subsequent fiscsd years. 
SEC. 109. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE. 
Subpart 1 of part B of title V (as amended by section 108) 
is fiirther amended by adding at the end thereof the following 
new section: 
"DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE 
AIDS. 
" S E C 510. (a) GRANTS FOR TREATMENT IMPROVEMENT.—The Direc-
Childrenand 
tor of the Center for Substance Abuse Treatment shall provide 
Riinorities 
grants to public and nonprofit private entities for the purpose 
Rural and urban of estabUshing demonstration projects that will improve the provi-
areas. 
sion of treatment services for substance abuse. 
^°"l?^-^^^,. o 
"(b) NATURE OF PROJECTS.—Grants imder subsection (a) shall 
42USC290bb-3. foe awarded t o -
"(1) projects that provide treatment to adolescents, female 
addicts and their children, racial and ethnic minorities, or 
individuals in rural areas, with preference given to such 
projects that provide treatment for substance abuse to women 
with dependent children, which treatment is provided in set-
tings in which both primary health services for the women 
and pediatric care are aveiilable; 
"(2) projects that provide treatment in exchange for public 
service; 
"(3) projects that provide treatment services and which are 
operated by public and nonprofit private entities receiving 
grants imder section 329, 330, 340, 340A, or other public or 
nonprofit private entities that provide primary health services; 
"(4) 'treatment campus' projects that— 
"(A) serve a significant number of individuals simulta-
neously; 
"(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 leirge metropohtan areas to identify individ-
uals in need of treatment services and to improve the avsdlabil-
ity and delivery of such services in the areas; 
"(6) in the case of drug abusers who are at risk of HIV 
infection, projects to conduct outreach activities to the individ-
uals regarding the prevention of exposure to and the trans-
mission of the human immimodefiency virus, and to encourage 
the individuals to seek treatment for such abuse; and 
"(7) projects to determine the long-term efficacy of the projects 
described in this section and to disseminate to appropriate 
E
ublic and private entities information on the projects that 
ave been effective. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 343 
"(c) PREFERENCES IN MAKING GRANTS.—In awarding grants under 
subsection (a), the Director of the Treatment Center shall give 
preference to projects that— 
"(1) demonstrate a comprehensive approach to the problems 
associated with substance abuse and provide evidence of broad 
community involvement and support; or 
"(2) initiate and esqjand programs for the provision of treat-
ment services (including renovation of facilities, but not con-
struction) in locahties in which, and among populations for 
which, there is a public health crisis as a result of the inad-
equate availabiUty of such services and a substanti£d rate of 
substance abuse. 
"(d) DURATION OF GRANTS.—The period during which payments 
are made under a grant under subsection (a) may not exceed 
5 years. 
"(e) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) IN GENERAL.—For the purpose of canying out this sec-
tion, there are authorized to be appropriated $175,000,000 for 
fiscal year 1993, and such sums as may be necessary for fiscal 
year 1994. The amounts so authorizea are in addition to any 
other amoimts that are authorized to be appropriated and 
available for such purpose. 
"(2) ALLOCATION.—Of the amounts appropriated under para-
graph (1) for a fiscal year, the Director of the Treatment Center 
shall reserve not less than 5 percent for carrying out projects 
described in subsections (b)(2) and (b)(3).". 
SEC. 110. GRANTS FOR SUBSTANCE ABUSE TREATMENT IN STATE AND 
LOCAL CRIMINAL JUSTICE SYSTEMS. 
Subpart 1 of part B of title V (as amended by section 109) 
is further amended by adding at the end thereof the following 
new section: 
"GRANTS FOR SUBSTANCE ABUSE TREATMENT IN STATE AND LOCAL 
CRIMINAL JUSTICE SYSTEMS 
"SEC. 511. (a) IN GENERAL.—The Director of the Center for Sub- 42 use 290bb-4. 
stance Abuse Treatment shall provide grants to public and nonprofit 
private entities that provide treatment for substance abuse to 
individuals under criminal justice supervision. 
"(b) ELIGIBILITY.—In awarding grants under subsection (a), the 
Director shall ensure that the grants are reasonably distributed 
among— 
"(1) projects that provide treatment services to individuals 
who are incarcerated in prisons, jails, or community correctional 
settings; and 
"(2) projects that provide treatment services to individuals 
who are not incarcerated, but who are under criminal justice 
supervision because of their status as pretrial releasees, post-
trial releasees, probationers, parolees, or supervised releasees. 
"(c) PRIORITY.—In awarding grants under subsection (a), the 
Director shall give priority to programs commensurate with the 
extent to which such programs provide, directly or in conjxmction 
with other public or private nonprofit entities, one or more of 
the following— 
"(1) a continuum of offender management services as individ-
uals enter, proceed through, and leave tiie criminal justice 
system, including identification and assessment, substance 
106 STAT. 344 
PUBLIC LAW 102-321—JULY 10, 1992 
abuse treatment, pre-release counseling and pre-release refer-
rals with respect to housing, emplojnnent and treatment; 
"(2) comprehensive treatment services for juvenile offenders; 
"(3) comprehensive treatment services for female offenders, 
including related services such as violence coimseling, parenting 
and child development classes, and perinatal care; 
"(4) outreach services to identify individuals imder criminal 
justice supervision who would benefit fi-om substance abuse 
treatment and to encourage such individuals to seek treatment; 
or 
"(5) treatment services that function as an alternative to 
incarceration for appropriate categories of offenders or that 
otherwise enable incuviduals to remain imder criminal justice 
supervision in the least restrictive setting consistent with pubUc 
safety. 
"(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rying out this section, there are authorized to be appropriated 
$50,000,000 for fiscal year 1993, and such sums as may be necessary 
for fiscal year 1994.". 
SEC. 111. TRAINING IN PROVISION OF TREATMENT SERVICES. 
Subpart 1 of part B of title V of the Public Health Service 
Act (as amended by section 110) is further amended by adding 
at the end tiiereof the following new section: 
''TRAINING IN PROVISION OF TREATMENT SERVICES 
42 use 290bb-5. 
"SEC. 512. (a) IN GENERAL.—The Director of the Center for Sub-
stance Abuse Treatment shall develop programs to increase the 
number of substance abuse treatment professionals and the number 
of health professionals providing treatment services through the 
awarding of grants to appropriate public and nonprofit private 
entities, including agencies of State and local governments, hos-
pitals, schools of medicine, schools of osteopathic medicine, schools 
of nursing, schools of social work, and graduate programs in mar-
riage and family therapy. 
"(b) PRIORITY.—^In awsirding grants under subsection (a), the 
Director shall give priority to projects that train fiill-time substance 
abuse treatment professionals and projects that will receive finan-
cial sum)ort 
fi*om 
public entities for c£mrying out the projects. 
"(c) HEALTH PROFESSIONS EDUCATION.—In awarding grants under 
subsection (a), the Director may make grants— 
"(1) to train individuals in the diagnosis and treatment of 
alcohol abuse and other drug abuse; and 
"(2) to develop appropriate curricula and materials for the 
training described in paragraph (1). 
"(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rsdng out this section, there are authorized to be appropriated 
$30,000,000 for fiscal year 1993, and such sums as may be necessary 
for fiscal year 1994.". 
SEC. 112. ALTERNATIVE UTILIZATION OF MILITARY FACIUTIES. 
(a) TRANSFER.—Section 561 of the Public Health Service Act 
(42 U.S.C. 290ff>-
(1) is transferred to subpart 1 of part B of title V of sudh 
Act; 
42 use 290bb-6. 
(2) is redesignated as section 513; and 
(3) is inserted after section 512 (as added by section 111). 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 345 
(b) AMENDMENTS.— 
(1) Section 513(a) of the Public Health Service Act (as trans-
ferred and redesignated under subsection (a)) is amended by 
striking out "NATIONAL INSTITUTE ON DRUG ABUSE.—The Direc-
tor of the National Institute on Drug Abuse" and inserting 
in lieu thereof "CENTER FOR SUBSTANCE ABUSE TREATMENT.— 
The Director of the Center for Substance Abuse Treatment". 
(2) Part E of title V of the Public Health Service Act (42 
U.S.C. 290ff) is amended by striking out the part heading. 
SEC. 113. CENTER FOR SUBSTANCE ABUSE PREVENTION. 
(a) IN GENERAL.—Part B of title V of the Public Health Service 
Act (as amended by section 112) is amended by inserting after 
section 513 the following new subp£irt: 
"Subpart 2—Center for Substance Abuse Prevention". 
(b) TRANSFER.—Section 508 of the Public Health Service Act 
(42 U.S.C. 290aa-^), as such section existed 1 day prior to the 
date of enactment of this Act— 
(1) is transferred to subpart 2 of part B of title V; 
(2) is redesignated as section 515; and 
(3) is inserted after the subpart heading (as added by sub-
section (a)). 
(c) AMENDMENTS.—Section 515(b) of the Public Health Service 
Act (as transferred 
and redesignated 
by subsection (b)) is 
amended— 
(1) in paragraph (5), by striking "and intervention"; 
(2) by striMng paragraphs (10) and (11); 
(3) by redesignating paragraph (12) as paragraph (10); and 
(4) in paragraph (9), by adding "and" eifter the semicolon 
at the end. 
(d) NATIONAL DATA BASE.—Section 515 of the Public Health Serv-
ice Act (as amended by subsection (c)) is amended by amending 
subsection (d) to read as follows: 
"(d) The Director of the Prevention Center shall establish a 
national data base providing information on programs for the pre-
vention of substance abuse. The data base shall contain information 
appropriate for use by public entities and information appropriate 
for use by nonprofit private entities.". 
(e) REFERENCES.—Section 515 of the Public Health Service Act 
(as amended by subsection (e)) is amended— 
(1) in subsection (a), in the first sentence, by striking "(here-
after" and aU that follows and inserting "(hereafter referred 
to in this part as the 'Prevention Center')."; and 
(2) in subsection (b), in the matter preceding paragraph (1), 
by striking "Office" and inserting "Prevention Center". 
(f) COMMUNITY PROGRAMS.—Section 509 of the PubHc Health 
Service Act (42 U.S.C. 290aa-7) as such section existed 1 day 
prior to the date of enactment of this Act— 
(1) is transferred to subpart 2 of part B of title V of such 
Act (as added by subsection (a)); 
(2) is redesignated as section 516; 
(3) is inserted after section 515 (as transferred and redesig-
nated by subsection (b)); and 
(4) is amended to read as follows: 
42 use 
290bb-21. 
42 use 
290bb-22. 
106 STAT. 346 
PUBLIC LAW 102-321—JULY 10, 1992 
"COMMUNITY PROGRAMS 
"SEC. 516. (a) IN GENERAL.—The Secretary, acting through the 
Director of the Prevention Center, shall— 
"(1) provide assistance to communities to develop com-
prehensive long-term strategies for the prevention of substance 
abuse; and 
"(2) evaluate the success of different community approaches 
toward the prevention of such abuse. 
"(b) STRATEGIES FOR REDUCING USE.—The Director of the Preven-
tion Center shall ensure that strategies developed under subsection 
(a)(1) include strategies for reducing the use of alcoholic beverages 
and tobacco products by individuals to whom it is unlawful to 
sell or distribute such beverages or products. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rying out subsection (a), there are authorized to be appropriated 
$120,000,000 for fiscal year 1993, such sums as may be necessary 
for fiscal year 1994.". 
SEC. 114. PREVENTION, TREATMENT, AND REHABILITATION MODEL 
PROJECTS FOR ffiGH RISK YOUTH. 
(a) TRANSFER.—Section 509A of the PubUc Health Service Act 
(42 U.S.C. 290aa-8)— 
(1) is transferred to subpart 2 of part B of title V of such 
Act (as added by section 113(a)); 
42 use 
(2) is redesignated as section 517; £ind 
290bb-23. 
(3) ig inserted after section 516 (as transferred and redesig-
nated by section 113(g)). 
(b) AMENDMENTS.—Section 517 (as transferred and redesignated 
by subsection (a)) is amended— 
(1) by redesignating subsections (c) through (f) as subsections 
(d) through (g), respectively; and 
(2) by inserting after subsection (b) the following new sub-
section: 
"(c) The Secretary shall ensure that projects under subsection 
(a) include strategies for reducing the use of alcoholic beverages 
and tobacco products by individuals to whom it is unlawful to 
sell or distribute such beverages or products.". 
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 517 (as trans-
ferred and redesignated by subsection (a) and amended by sub-
section (b)) is further amended by adding at the end the following 
new subsection: 
"(h) For the purpose of canning out this section, there are author-
ized to be appropriated $70,000,000 for fiscal year 1993, and such 
svmis as may be necessary for fiscal year 1994.". 
(d) REFERENCES.—Section 517(a) (as transferred and redesignated 
by subsection (a) and amended by subsection (b)) is further amended 
by striking "Office" each time that such appears and inserting 
"Prevention Center". 
SEC. 116. CENTER FOR MENTAL HEALTH SERVICES. 
(a) IN GENERAL.—Part B of title V of the Public Health Service 
Act (as amended by section 114) is amended by inserting after 
section 517 the following new subpart: 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 347 
"Subpart 3—Center for Mental Health Services 
"CENTER FOR MENTAL HEALTH SERVICES 
"SEC. 520. (a) ESTABLISHMENT.—There is established in the 42 use 
Administration a Center for Mental Health Services (hereafter in 290bb-3i. 
this section referred to as the 'Center'). The Center shall be headed 
by a Director (hereafter in this section referred to as the 'Director') 
appointed by the Secretary from among individuals with extensive 
experience or academic quaHfications in the provision of mental 
health services or in the evaluation of mental health service sys-
tems. 
"(b) DUTIES.—The Director of the Center shall— 
"(1) design national goals and establish national priorities 
for— 
"(A) the prevention of mental illness; and 
"(B) the promotion of mental health; 
"(2) encourage and assist local entities and State agencies 
to achieve the goals and priorities described in paragraph (1); 
"(3) develop and coordinate Federal prevention policies and 
programs and to assure increased focus on the prevention of 
mental illness and the promotion of mental health; 
"(4) develop improved methods of treating individuals with 
mental health problems and improved methods of assisting 
the families of such individuals; 
"(5) administer the mental health services block grant pro-
gram authorized in section 1911; 
"(6) promote policies and programs at Federal, State, and 
local levels and in the private sector that foster independence 
and protect the legal rights of persons with mental illness, 
including carrying out the provisions of the Protection and 
Advocacy of Monthly 1
1
1 Individuals Act; 
"(7) carry out the programs authorized under sections 520A 
and 521, including the Community Support Program and the 
Child and Adolescent Service System Programs; 
"(8) carry out responsibiUties for the Human Resource Devel-
opment program, and programs of clinical training for profes-
sional and paraprofessional personnel pursuant to section 303; 
"(9) conduct services-related assessments, including evalua-
tions of the organization and financing of care, self-help and 
consumer-run programs, mental health economics, mental 
health service systems, rural mental health, and improve the 
capacity of State to conduct evaluations of publicly funded 
mental health programs; 
"(10) establish a clearinghouse for mental health information 
to assure the widespread dissemination of such information 
to States, political subdivisions, educational agencies and 
institutions, treatment and prevention service providers, and 
the general public, including information concerning the prac-
tical application of research supported by the National Institute 
of Mental Health that is applicable to improving the delivery 
of services; 
"(11) provide technical assistance to public and private enti-
ties that are providers of mental health services; 
"(12) monitor and enforce obligations incurred by commxinity 
mental heedth centers pursuant to the Community Mental 
Health Centers Act (as in effect prior to the repeal of such 
106 STAT. 348 
PUBLIC LAW 102-321—JULY 10, 1992 
42 use 
290bb-32. 
Appropriation 
authorization. 
42 use 
290bb-33. 
42 use 300dd-31 
et seq. 
42 use 
300dd-32. 
Act on August 13, 1981, by section 902(e)(2)(B) of Public Law 
97-35 (95 Stat. 560)); 
"(13) conduct surveys with respect to mental health, such 
as the National Reporting Program; and 
"(14) assist States in improving their mental health data 
collection. 
"(c) GRANTS AND CONTRAexs.—In carrying out the duties estab-
lished in subsection (b), the Director may make grants to and 
enter into contracts and cooperative agreements with public and 
nonprofit private entities.". 
(b) CONFORMING 
AMENDMENTS.—Section 303(a) of the Public 
Health Service Act (42 U.S.C. 242a(a)) is amended— 
(1) by striking out ", the Surgeon General is authorized" 
in the matter preceding paragraph (1); 
(2) by inserting "the Secretary, acting through the Director 
of the Center for Mental Health Services, is authorized" after 
the paragraph designation in paragraph (1); and 
(3) by inserting "the Surgeon General is authorized" after 
the paragraph designation in paragraph (2). 
SEC. 116. GRANT PROGRAM FOR DEMONSTRATION PROJECTS. 
(a) TRANSFER.—Section 520 of the Public Health Service Act 
(42 U.S.C. 290CC-13) as such section existed 1 day prior to the 
date of enactment of this Act— 
(1) is transferred to subpart 3 of part B of title V of such 
Act; 
(2) is redesignated as section 520A; and 
(3) is inserted after section 520 (as added by section 115). 
(b) AMENDMENTS.—Section 520A (as transferred and redesignated 
under subsection (a)) is amended— 
(1) in subsection (a)(1), by striking out "National Institute 
of Mental Health" and inserting in lieu thereof "Center for 
Mental Health Services"; 
(2) in subsection (c), by striking out "three" and inserting 
in lieu thereof "five"; and 
(3) in subsection (e)(1), to read as follows: 
"(1) For the purposes of carrying out this section, there are 
authorized to be appropriated $50,000,000 for fiscal year 1993, 
and such sums as may be necessary for fiscal year 1994.". 
SEC. 117. NATIONAL MENTAL HEALTH EDUCATION. 
Section 519 of the PubUc Health Service Act (42 U.S.C. 290cc-
12) is repealed. 
SEC. 118. DEMONSTRATION PROJECTS WITH RESPECT TO CERTAIN 
INDIVIDUALS. 
(a) IN GENERAL.—Section 2441 of the Public Health Service Act 
(42 U.S.C. 300dd-41)— 
(1) is transferred to subpart 3 of part B of title V of such 
Act (as added by section 115); 
(2) is redesignated as section 520B; and 
(3) is inserted after section 520A (as added by section 116). 
(b) CONFORMING AMENDMENTS.—^The Public Health Service Act 
(as amended by subsection (a)), is amended— 
(1) in part C of title XXIV— 
(A) by striking out the heading for subpart I; 
(B) in section 2432(a), by striking out "subpart" each 
place such term appears and inserting "part"; and 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 349 
(C) by striking out the heading for subpart II; and 
(2) in section 520B (as transferred and added by subsection 
(a))-
(A) in subsection (a), in the matter preceding paragraph 
(1), by inserting after "Secretary" the following: ", acting 
through the Director of the Center for Mental Health Serv-
ices,"; £ind 
(B) in subsection (j), by striking out "1991" and inserting 
in lieu thereof "1994". 
SEC. 
1
1
9
. 
CHILDHOOD 
MENTAL 
HEALTH. 
Title V of the Public Health Service Act, as amended by the 
preceding provisions of this title, is amended by adding at the 
end the following new part: 
"PART E—CHILDREN WITH SERIOUS EMOTIONAL DISTLTRBANCES 
"SEC. 561. COMPREHENSIVE COMMUNITY MENTAL HEALTH SERVICES 42 USC 290FF. 
FOR CHILDREN WITH SERIOUS EMOTIONAL DISTURB-
ANCES. 
"(a) GRANTS TO CERTAIN PUBLIC ENTITIES.— 
"(1) IN GENERAL.—The Secretary, acting through the Director 
of the Center for Mental Health Services, shall make grants 
to public entities for the purpose of providing comprehensive 
community mental health services to children with a serious 
emotional disturbance. 
"(2) DEFINITION OF PUBLIC ENTITY,—For purposes of this sub-
part, the term *pubUc entity* means any State, £iny political 
subdivision of a State, and any Indian tribe or tribal organiza-
tion (as defined in section 4(b) and section 4(c) of the Indiein 
Self-Determination and Education Assistance Act). 
"(b) CONSIDERATIONS IN MAKING GRANTS.— 
"(1) REQUIREMENT OF STATUS AS GRANTEE UNDER PART B 
OF TITLE XIX.—The Secretary may make a grant under sub-
section (a) to a public entity only if— 
"(A) in the case of a public entity that is a State, the 
State is a grantee under section 1911; 
"(B) in the case of a pubUc entity that is a political 
subdivision of a State, the State in which the political 
subdivision is located is receiving such pa5nnents; and 
"(C) in the case of a pubUc entity that is an Indian 
tribe or tribal organization, the State in which the tribe 
or tribal organization is located is receiving such payments. 
"(2) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.— 
"(A) Subject to subparagraph (B), the Secretary may 
m£ike a grant under subsection (a) only if, in the case 
of any service under such subsection that is covered in 
the State plan approved under title XIX of the Social Secu-
rity Act for the State involved— 
"(i) the public entity involved will provide the service 
directly, £ind the entity has entered into a participation 
agreement imder the State plan and is qualified to 
receive pajmaents under such plan; or 
"(ii) the pubhc entity will enter into an agreement 
with an organization under which the organization 
will provide the service, and the organization has 
106 STAT. 350 
PUBLIC LAW 102-321—JULY 10, 1992 
entered into such a participation agreement and is 
qualified to receive such pa3niients. 
"(B)(i) In the case of an organization making an agree-
ment under subparagraph (A)(ii) regarding the provision 
of services under subsection (a), the requirement estab-
hshed in such subparagraph regarding a peirticipation 
agreement shall be waived by the Secretary if the organiza-
tion does not, in providing health or mental health 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 program. 
"(ii) A determination by the Secretary of whether an 
organization referred to in clause (i) meets the criteria 
for a waiver under such clause shall be made without 
regard to whether the organization accepts volxintary dona-
tions regarding the provision of services to the public. 
"(3) CERTAIN CONSIDERATIONS.—In making grants under sub-
section (a), the Secretary shall— 
"(A) equitably allocate such assistance among the prin-
cipal geographic regions of the United States; 
"(B) consider the extent to which the pubUc entity 
involved has a need for the grant; and 
"(C) in the case of any pubUc entity that is a political 
subdivision of a State or that is an Indian tribe or tribal 
organization— 
"(i) shall consider any comments regarding the 
application of the entity for such a grant that are 
received by the Secretary from the State in which 
the entity is located; and 
"(ii) shall give special consideration to the entity 
if the State agrees to provide a portion of the non-
Federal contributions required in subsection (c) regard-
ing such a grant. 
"(c) MATCHING FUNDS.— 
"(1) IN GENERAL.—^A funding agreement for a grant under 
subsection (a) is that the public entity involved will, with 
respect to the costs to be incurred by the entity in carrying 
out the purpose described in such subsection, make available 
(directly or through donations from public or private entities) 
non-Federal contributions toward such costs in an amount 
t h a t ^ 
"(A) for the first fiscal year for which the entity receives 
payments from a grant under such subsection, is not less 
than $1 for each $3 of Federal funds provided in the 
grant; 
"(B) for any second or third such fiscal year, is not 
less than $1 for each $3 of Federal funds provided in 
the grant; 
"(C) for any fourth such fiscal year, is not less than 
$1 for each $1 of Federal funds provided in the grant; 
and 
"(D) for any fifth such fiscal year, is not less than $2 
for each $1 of Federal fiinds provided in the grant. 
"(2) DETERMINATION OF AMOUNT CONTRIBUTED.— 
"(A) Non-Federal contributions required in paragraph (1) 
may be in cash or in kind, fairly evaluated, including 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 351 
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. 
"(B) In making a determination of the amoiuit of non-
Federal contributions for purposes of subpsiragraph (A), 
the Secretary may include only non-Federal contributions 
in excess of the average amount of non-Federal con-
tributions made by the public entity involved toward the 
purpose described in subsection (a) for the 2-year period 
preceding the first fiscal year for which the entity receives 
a grant under such section. 
"SEC. 562. REQUIREMENTS WITH RESPECT TO CARRYING OUT PUR- 42 USC 290ff-l. 
POSE OF GRANTS. 
"(a) SYSTEMS OF COMPREHENSIVE CARE.— 
i 
"(1) IN GENERAL.—^A funding agreement for a grant under 
section 561(a) is that, with respect to children with a serious 
emotional disturbance, the public entity involved will carry 
out the purpose described in such section only through 
establishing and operating 1 or more systems of care for making 
each of the mental health services specified in subsection (c) 
available to each child provided access to the system. In provid-
ing for such a system, the public entity may make grants 
to, and enter into contracts with, public and nonprofit private 
entities. 
"(2) STRUCTURE OF SYSTEM.—^A funding agreement for a grant 
under section 561(a) is that a system of care under paragraph 
(1) will— 
"(A) be established in a community selected by the public 
entity involved; 
"(B) consist of such public agencies and nonprofit private 
entities in the commimity as are necessary to ensure that 
, 
each of the services specified in subsection (c) is available 
to each child provided access to the system; 
\ 
"(C) be established pursuant to agreements that the pub-
lic entity enters into with the agencies and entities 
described in subparagraph (B); 
"(D) coordinate the provision of the services of the system; 
and 
"(E) establish an office whose functions are to serve as 
the location through which children are provided access 
to the system, to coordinate the provision of services of 
the system, and to provide information to the public regard-
ing the system. 
"(3) COLLABORATION OF LOCAL PUBLIC ENTITIES.—A fiinding 
agreement for a grant under section 561(a) is that, for purposes 
of the establishment £uid operation of a system of care under 
paragraph (1), the public entity involved will seek collaboration 
among all pubhc agencies that provide human services in the 
commimity in which the system is established, including but 
not limited to those providing mental health services, edu-
cational services, child welfare services, or juvenile justice serv-
ices. 
"(b) LIMITATION ON AGE OF CHILDREN PROVIDED ACCESS TO SYS-
TEM.—^A funding agreement for a grant under section 561(a) is 
106 STAT. 352 
PUBLIC LAW 102-321—JULY 10, 1992 
that a system of care under subsection (a) will not provide an 
individual with access to the S3rstem if the individual is more 
than 21 years of age. 
"(c) REQUIRED MENTAL HEALTH SERVICES OF SYSTEM.—A funding 
agreement for a grant under section 561(a) is that mental health 
services provided by a system of care under subsection (a) will 
include, with respect to a serious emotional disturbance in a child— 
(1) diagnostic and evaluation services; 
"(2) ou^atient services provided in a clinic, office, school 
or other appropriate location, including individual, group and 
family coimseling services, professional consultation, and 
review and management of medications; 
"(3) emergency services, available 24-hoiirs a day, 7 days 
a week; 
"(4) intensive home-based services for children and their fami-
lies when the child is at imminent risk of out-of-home place-
ment; 
"(5) intensive day-treatment services; 
"(6) respite care; 
**(7) therapeutic foster care services, and services in thera-
peutic foster family homes or individusQ therapeutic residential 
homes, and groups homes caring for not more than 10 children; 
and 
''(8) assisting the child in making the transition from the 
services received as a child to the services to be received as 
an adult. 
"(d) REQUIRED ARRANGEMENTS REGARDING OTHER APPROPRIATE 
SERVICES.— 
"(1) IN GENERAL.—^A funding agreement for a grant under 
section 561(a) is that— 
"(A) a system of care under subsection (a) will enter 
into a memorandimi of imderstanding with each of the 
providers specified in paragraph (2) in order to facilitate 
the availability of the services of the provider involved 
to each child provided access to the system; and 
"(B) the grant under such section 561(a), and the non-
Federal contributions made with respect to the grant, will 
not be expended to pay the costs of providing such non-
mental health services to any individual. 
"(2) SPECIFICATION OF NON-MENTAL HEALTH SERVICES.—The 
providers referred to in paragraph (1) are providers of medical 
services other than mental health services, providers of edu-
cational services, providers of vocational counseling and voca-
tional rehabilitation services, and providers of protection and 
advocacy services with respect to mental health. 
"(3) FACILITATION OF SERVICES OF CERTAIN PROGRAMS.—A 
funding agreement for a grant under section 561(a) is that 
a system of care under subsection (a) will, for purposes of 
paragraph (1), enter into a memorandum of understanding 
regarding facUitation o
f
— 
"(A) services available pursuant to title XIX of the Social 
Security Act, including services regarding early periodic 
screening, diagnosis, and treatment; 
"(B) services avsolable under parts B and H of the 
Individuals with Disabilities Education Act; and 
"(C) services available under other appropriate programs, 
as identified by the Secretary. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 353 
"(e) GENERAL PROVISIONS REGARDING SERVICES OP SYSTEM.— 
"(1) CASE MANAGEMENT SERVICES.—A funding agreement for 
a grant under section 561(a) is that a system of care under 
subsection (a) will provide for the case management of each 
child provided access to the S3r8tem in order to ensure that— 
"(A) the services provided through the sjrstem to the 
child are coordinated and that the need of each such child 
for the services is periodically reassessed; 
"(B) information is provided to the family of the child 
on the extent of progress being made toward the objectives 
estabUshed for the child under the plan of services imple-
mented for the child pursuant to section 563; and 
"(C) the system provides assistance with respect to— 
"(i) estabUshing the eligibiUty of the child, and the 
famUy of the child, for financial assistance and services 
under Federal, State, or local programs providing for 
health services, mental health services, educational 
services, social services, or other services; and 
"(ii) seeking to ensure that the child receives appro-
priate services available under such programs. 
"(2) OTHER PROVISIONS.—^A funding agreement for a grant 
under section 561(a) is that a system of care under subsection 
(a), in providing the services of the system, will— 
"(A) provide the services of the system in the cultural 
context that is most appropriate for the child and family 
involved; 
"(B) ensure that individuals providing such services to 
the child can effectively commimicate with the child and 
family in the most direct manner; 
"(C) provide the services without discriminating against 
the child or the family of the child on the basis of race, 
religion, national origin, sex, disability, or age; 
"(D) seek to ensure that each child provided access to 
the system of care remains in the least restrictive, most 
normative environment that is clinically appropriate; and 
"(E) provide outreach services to inform individuals, as 
appropriate, of the services available from the system, 
inclucung identifying children with a serious emotional dis-
turbance who are in the early stages of such disturbance. 
"(3) RULE OF CONSTRUCTION.—An agreement made imder 
paragraph (2) may not be construed— 
"(A) with 
respect to subparagraph 
(C) of such 
paragraph— 
"(i) to prohibit a system of care under subsection 
(a) from requiring that, in housing provided by the 
grantee for purposes of residential treatment services 
authorized under subsection (c), males and females 
be segregated to the extent appropriate in the treat-
ment of the children involved; or 
"(ii) to prohibit the system of CEire from compl3dng 
with the agreement made under subsection (b); or 
"(B) with respect to subparagraph (D) of such paragraph, 
to authorize the system of care to expend the grant under 
section 561(a) (or the non-Federal contributions made with 
respect to the grant) to provide legal services or any service 
with respect to which expenditures regarding tiiie grant 
are prohibited under subsection (d)(1)(B). 
59-194 O—93 
13 : QL 3 (Pt. 1) 
106 STAT. 354 
PUBLIC LAW 102-321—JULY 10, 1992 
"(f) RESTRICTIONS ON USE OF GRANT.—A funding agreement for 
a grant under section 561(a) is that the grant, and the non-Federal 
contributions made with respect to the grant, will not be expended— 
"(1) to purchase or improve real property (including the con-
struction or renovation of facilities); 
"(2) to provide for room and board in residential programs 
serving 10 or fewer children; 
"(3) to provide for room and board or other services or 
expenditures associated with care of children in residential 
' 
treatment centers serving more than 10 children or in inpatient 
hospital settings, except intensive home-based services and 
other services provided on an ambulatory or outpatient basis; 
or 
"(4) to provide for the training of any individual, except 
training authorized in section 564(a)(2) and training provided 
through any appropriate course in continuing education whose 
duration does not exceed 2 days. 
42 use 290ff-2. 
"SEC. 563. INDIVTOUALIZED PLAN FOR SERVICES. 
"(a) IN GENERAL.—^A funding agreement for a grant under section 
561(a) is that a system of care under section 562(a) will develop 
and carry out an individualized plan of services for each child 
provided access to the system, and that the plan will be developed 
and carried out with the participation of the family of the child 
and, unless clinically inappropriate, with the participation of the 
child. 
"(b) MULTIDISCIPLINARY T E A M . ^ A funding agreement for a grant 
under section 561(a) is that the plan required in subsection (a) 
will be developed, £m.d reviewed and as appropriate revised not 
less than once each year, by a multidisciplinary team of appro-
priately qugJified individuals who provide services through the sys-
tem, including as appropriate mental health services, other health 
services, educationgJ services, social services, and vocational coun-
seling and rehabilitation; 
"(c) COORDINATION WITH SERVICES UNDER INDIVIDUALS WITH DIS-
ABILITIES EDUCATION ACT.—^A funding agreement for a grant under 
section 561(a) is that, with respect to a plan under subsection 
(a) for a child, the multidisciplinary team required in subsection 
(b) will— 
"(1) in developing, carrying out, reviewing, and revising the 
plan consider any individualized education program in effect 
for the child pursuant to part B of the Individuals with Disabil-
ities Education Act; 
"(2) ensure that the plan is consistent with such individual-
ized education program and provides for coordinating services 
under the plan with services under such program; and 
"(3) ensure that the memorandum of understanding entered 
into under section 562(d)(3)(B) regarding such Act includes 
provisions regarding compliance with this subsection. 
"(d) CONTENTS OF PLAN.—^A funding agreement for a grant under 
section 561(a) is that the plan required in subsection (a) for a 
child will— 
"(1) identify £ind state the needs of the child for the services 
available pursuant to section 562 through the system; 
"(2) provide for each of such services that is appropriate 
to the circumstances of the child, including, except in the case 
of children who are less than 14 years of age, the provision 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 355 
of appropriate vocationeil counseling and rehabilitation, and 
trsinsition services (as defined in section 602(a)(19) of the 
Individuals with DisabiHties Education Act); 
"(3) establish objectives to be achieved regarding the needs 
of the child and the methodology for achieving the objectives; 
and 
"(4) designate an individu£d to be responsible for providing 
the case management required in section 562(e)(1) or certify 
that case management services will be provided to the child 
as part of the individualized education program of the child 
under the Individuals with Disabilities Education Act. 
"SEC. 564. ADDITIONAL PROVISIONS. 
42 USC 290ff-3. 
"(a) OPTIONAL SERVICES.—In addition to services described in 
subsection (c) of section 562, a system of care under subsection 
(a) of such section may, in expending a grant xmder section 561(a), 
provide for— 
"(1) preliminary assessments to determine whether a child 
should be provided access to the system; 
**(2) training in— 
"(A) the administration of the system; 
"(B) the provision of intensive home-based services under 
paragraph (4) of section 562(c), intensive day treatment 
under paragraph (5) of such section, and foster care or 
groiip homes under paragraph (7) of such section; and 
"(C) the development of individualized plans for purposes 
of section 563; 
"(3) recreational activities for children provided access to 
the system; and 
"(4) such other services as may be appropriate in providing 
for the comprehensive needs with respect to mental health 
of children with a serious emotional disturbance. 
"(b) COMPREHENSIVE PLAN.—The Secretary may make a grant 
imder section 561(a) only if, with respect to the jurisdiction of 
the public entity involved, the entity has submitted to the Secretary, 
and has had approved by the Secretary, a plan for the development 
of a jurisdiction-wide system of care for community-based services 
for children with a serious emotional disturbance that specifies 
the progress the pubHc entity has made in developing the jurisdic-
tion-wide system, the extent of cooperation across agencies serving 
children in the establishment of the system, the Federal and non-
Federal resources currently committed to the estabhshment of the 
system, and the current gaps in commimity services and the manner 
in which the grant under section 561(a) will be expended to address 
such gaps and estabUsh local systems of care. 
"(c) LIMITATION O
N IMPOSITION OF FEES FOR SERVICES.—A funding 
agreement for a grant under section 561(a) is that, if a charge 
is imposed for the provision of services under the grant, such 
charge— 
"(1) will be made according to a schedule of charges that Public 
is made available to the public; 
information. 
"(2) will be adjusted to reflect the income of the family 
of the child involved; and 
"(3) will not be imposed on any child whose family has 
income and resources of equal to or less than 100 percent 
of the official poverty line, as established by the Director of 
the Office of Management and Budget and revised by the 
106 STAT. 356 
PUBLIC LAW 102-321—JULY 10, 1992 
Secretary in accordance with section 673(2) of the Omnibus 
Budget Reconciliation Act of 1981. 
"(d) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PRO-
GRAMS.—A funding agreement for a grant under section 561(a) 
is that the grant, and the non-Federal contributions made with 
respect to the grant, will not be expended to make pajnnent for 
any item or service to the extent that payment has been made, 
or can reasonably be expected to be made, with respect to such 
item or service— 
"(1) under any State compensation program, under an insiu*-
ance policy, or under any Federal or State health benefits 
program; or 
"(2) by an entity that provides health services on a prepaid 
basis. 
"(e) LIMITATION ON ADMINISTRATIVE EXPENSES.—A funding agree-
ment for a grant under section 561(a) is that not more than 2 
percent of the grant will be expended for administrative expenses 
incurred with respect to the grant by the public entity involved. 
"(f) REPORTS TO SECRETARY.—^A funding agreement for a grant 
under section 561(a) is that the public entity involved will annually 
submit to the Secretary a report on the activities of the entity 
under the grant that includes a description of the number of chil-
dren provided access to systems of care operated pursuant to the 
grant, the demographic characteristics of the children, the types 
and costs of services provided pursuant to the grant, the availability 
and use of third-party reimbursements, estimates of the unmet 
need for such services in the jurisdiction of the entity, and the 
manner in which the grant has been expended toward the establish-
ment of a jurisdiction-wide system of care for children with a 
serious emotional disturbance, and such other information as the 
Secretary may require with respect to the grant. 
"(g) DESCRIPTION OF INTENDED USES OF GRANT.—The Secretary 
may make a grant under section 561(a) only if— 
"(1) the public entity involved submits to the Secretary a 
description of the purposes for which the entity intends to 
expend the grant; 
"(2) the description identifies the populations, areas, and 
localities in the jurisdiction of the entity with a need for services 
under this section; and 
"(3) the description provides information relating to the serv-
ices and activities to be provided, including a description of 
the manner in which the services and activities will be coordi-
nated with any similar services or activities of public or non-
profit entities. 
"(h) REQUIREMENT OF APPLICATION.—The Secretary may make 
a grgint under section 561(a) only if an application for the grant 
is submitted to the Secretary, the application contains the descrip-
tion of intended uses required in subsection (g), and the application 
is in such form, is made in such manner, and contains such agree-
ments, assurances, and information as the Secretary determines 
* 
to be necessary to carry out this section. 
42 use 290ff-4. 
**SEC. 565. GENERAL PROVISIONS. 
"(3) DURATION OF SUPPORT.—^The period during which payments 
are made to a public entity from a grant under section 561(a) 
may not exceed 5 fiscal years. 
"(b) TECHNICAL ASSISTANCE.— 
^ 
r. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 357 
"(1) IN GENERAL.—The Secretary shall, upon the request of 
a public entity receiving a grant under section 561(a)— 
"(A) provide technical assistance to the entity regarding 
the process of submitting to the Secretary applications 
for grants under section 561(a); and 
"(B) provide to the entity training and technical assist-
ance with respect to the planning, development, and oper-
ation of systems of care pursuant to section 562. 
"(2) AUTHORITY FOR GRANTS AND CONTRACTS.—The Secretary 
may provide technical assistance imder subsection (a) directly 
or through grants to, or contracts with, public and nonprofit 
private entities. 
"(c) EVALUATIONS AND REPORTS BY SECRETARY.— 
"(1) IN GENERAL.—The Secretary shall, directly or through 
contracts with public or private entities, provide for annual 
evaluations of programs carried out pursuant to section 561(a). 
The evaluations shall assess the effectiveness of the systems 
of care operated pursuant to such section, including longitudinal 
studies of outcomes of services provided by such systems, other 
studies regarding such outcomes, the effect of activities under 
this subpart on the utilization of hospital and other institutional 
settings, the barriers to and achievements resulting from inter-
agency collaboration in providing community-based services to 
children with a serious emotional disturbance, and assessments 
by parents of the effectiveness of the systems of care. 
"(2) REPORT TO CONGRESS.—^The Secretary shall, not later 
than 1 year after the date on which amounts are first appro-
priated under subsection (c), and annually thereafter, submit 
to the Congress a report summarizing evaluations carried out 
pursuant to paragraph (1) during the preceding fiscal year 
and making such recommendations for administrative and legis-
lative initiatives with respect to this section as the Secretary 
determines to be appropriate. 
"(d) DEFINITIONS.—For purposes of this subpart: 
"(1) The term 'child' means an individual not more than 
21 years of age. 
"(2) The term 'family*, with respect to a child provided access 
to a system of care imder section 562(a), means— 
"(A) the legal guardian of the child; and 
"(B) as appropriate regarding mental health services for 
the child, the parents of the child (biological or adoptive, 
as the case may be) and any foster parents of the child. 
"(3) The term 'funding agreement', with respect to a grant 
under section 561(a) to a public entity, means that the Secretary 
may make such a grant only if the public entity makes the 
agreement involved. 
"(4) The term 'serious emotional disturbance' includes, with 
respect to a child, any child who has a serious emotional 
disorder, a serious behavioral disorder, or a serious mental 
disorder. 
"(e) RULE OF CONSTRUCTION.—Nothing in this part shall be con-
strued as limiting the rights of a child with a serious emotional 
disturbance imder the Individuals with Disabilities Education Act. 
"(f) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of carrying out this subpart, there are authorized to be appro-
106 STAT. 358 
PUBLIC LAW 102-321—JULY 10, 1992 
priated $100,000,000 for fiscal year 1993, and such sums as 
may be necessary for fiscal year 1994. 
"(2) SET-ASIDE REGARDING TECHNICAL ASSISTANCE.—Of the 
amounts appropriated under paragraph (1) for a fiscal year, 
the Secreta^ shall make avaQable not less than $3,000,000 
for the purpose of carrying out subsection (b).". 
SEC. 120. STRIKING OF CERTAIN PROVISIONS AND TECHNICAL AND 
CONFORMING AMENDMENTS. 
(a) IN GENERAL.—Title V of the Public Health Service Act (42 
U.S.C. 290aa et seq.) as such title existed 1 day prior to the 
date of enactment of this Act, is amended by striking out sections 
509B, 509C, 509E, 509F and 509G (42 U.S.C. 290aa-9, 290aa-
10, 290aa-12, 290aa-13, and 290aa-14). 
(b) TECHNICAL AND CONFORMING AMENDMENTS.—Title V of the 
Public Health Service Act (42 U.S.C. 290aa et seq.) is amended— 
(1) in the heading for such title, to read as follows: 
TITLE V—SUBSTANCE ABUSE AND MENTAL HEALTH 
SERVICES ADMINISTRATION"; 
- 
(2) in the heading for part A, to read as follows: 
"PART A—ORGANIZATION A
N
D GENERAL AUTHORITIES"; and 
42 use 
(3) by striking out section 518. 
290CC-11. 
'' 
^ 
Subtitle B—Institutes 
SEC. 121. ORGANIZATION OF NATIONAL INSTITUTES OF HEALTH. 
(a) IN GENERAL.—Section 401(bXl) of the Public Health Service 
Act (42 U.S.C. 281(b)(1)) is amended by adding at the end thereof 
the following new subparagraphs: 
"(N) TTie National Institute on Alcohol Abuse and Alcoholism. 
"(O) The National Institute on Drug Abuse. 
"(P) The National Institute of Mental Health.". 
(b) DEFINITION.-Part B of title IV of the PubUc Health Service 
Act (42 U.S.C. 284 et seq.) is amended by adding at the end 
thereof the following new section: 
"DEFINITIONS 
42 use 284d. 
"SEC. 409. For purposes of this title, the term "health services 
research' means research endeavors that study the impact of the 
organization, financing and management of health services on the 
quality, cost, access to and outcomes of care.". 
SEC. 122. NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOL-
ISM. 
(a) CREATION OF SUBPART.—Part C of title IV of the PubHc 
Health Service Act (42 U.S.C. 285 et seq.) is amended by adding 
at the end thereof the following new subpart: 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 359 
"Subpart 14—National Institute on Alcohol Abuse and Alcoholism 
"PURPOSE OF INSTITUTE 
"SEC. 464H. (a) IN GENERAL.—The general purpose of the 42USC285n. 
National Institute of Alcohol Abuse and AlcohoHsm (hereafter in 
this subpart referred to as the 'Institute') is the conduct and support 
of biomedical and behavioral research, health services research, 
research training, and health information dissemination with 
respect to the prevention of alcohol abuse £ind the treatment of 
alcohoUsm.". 
(b) ADDITIONAL PROVISIONS.— 
(1) RESEARCH PROGRAM.—Subsection (b) of section 510 of 
the PubUc Health Service^ Act (42 U.S.C. 290bb and 290bb- 42 USC 290bb. 
1), as such section existed 1 day prior to the date of the 
enactment of this Act— 
(A) is transferred to section 464H of the Public Health 
Service Act, as added by subsection (a) of this section; 
and 
(B) is inserted after subsection (a) of such section 464H. 
Such section 510, as so amended, is repealed. 
(2) ADDITIONAL PROVISIONS.—Section 464H of the Public 
Health Service Act (as £imended by paragraph (1)) is amended— 
(A) in subsection (b)— 
(i) in the matter preceding paragraph (1), by striking 
"(b) In carrying out the program" and all that follows 
through "Institute, is authorized" and inserting the 
following: "(b) RESEARCH PROGRAM.—The research pro-
gr£im established under this subpart shall encompass 
the social, behavioral, and biomedical etiology, mental 
and physical health consequences, and social and eco-
nomic consequences of alcohol abuse and alcoholism. 
In carrying out the program, the Director of the 
Institute is authorized"; and 
(ii) in paragraph (3)(H), by striking out the period 
and inserting in lieu thereof a semicolon; and 
(B) by adding at the end the following subsections: 
"(c) COLLABORATION.—The Director of the Institute shall collabo-
rate with the Administrator of the Substance Abuse and Mental 
HegQth Services Administration in focusing the services research 
activities of the Institute £ind in disseminating the results of such 
research to health professionals and the general public. 
"(d) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of canying out this subpart, there are authorized to be appro-
priated $300,000,000 for fiscal year 1993, and such sums as 
may be necessary for fiscal year 1994. 
"(2) ALLOCATION FOR HEALTH SERVICES RESEARCH.—Of the 
amoimts appropriated under paragraph (1) for a fiscal year, 
the Director shall obligate not less than 15 percent to carry 
out health services research relating to alcohol abuse and 
alcoholism.". 
(c) ASSOCIATE DIRECTOR FOR PREVENTION.—Subpart 14 of part 
C of title IV (as added by subsection (a)) is amended by adding 
at the end thereof the following new section: 
106 STAT. 360 
PUBLIC LAW 102-321—JULY 10, 1992 
'^ASSOCIATE DIRECTOR FOR PREVENTION 
42USC285n-i. 
"SEC. 464L (a) IN GENERAL.—There shall be in the Institute 
an Associate Director for Prevention who shall be responsible for 
the full-time coordination and promotion of the programs in the 
Institute concerning the prevention of alcohol abuse and alcoholism. 
The Associate Director shall be appointed by the Director of the 
Institute from individuals who because of their professional training 
or expertise are experts in alcohol abuse and gJcoholism or the 
prevention of such. 
"(b) BIENNIAL REPORT.—The Associate Director for Prevention 
shall prepare for inclusion in the biennial report made under section 
407 a description of the prevention activities of the Institute, includ-
ing a description of the staff and resources allocated to those activi-
ties.". 
(d) NATIONAL CENTER FOR RESEARCH.— 
(1) IN GENERAL.—Section 511 of the Public Health Service 
42USC290bb-L 
Act (42 U.S.C. 290bb and 290bb-l) as such section existed 
1 day prior to the date of enactment of this Act— 
(A) is transferred to subpart 14 of part C of title IV 
of such Act (as added by subsection (a)); 
42 use 285n-2. 
(B) is redesignated as section 464J; and 
(C) is inserted after section 4641 (as added by subsection 
(0). 
(2) TECHNICAL CORRECTION.—Section 464J of the PubUc 
Health Service Act (as added by paragraph (1)) is amended 
in subsection (b) by striking "or rental". 
(d) CONFORMING AMENDMENT.—Section 513 of the PubUc Health 
Service Act (42 U.S.C. 290bb-2), as such section existed 1 day 
prior to the date of enactment of this Act, is repealed. 
SEC. 123. NATIONAL INSTITUTE ON DRUG ABUSE. 
(a) CREATION OF SUBPART.—Part C of title IV of the Public 
Health Service Act (42 U.S.C. 285 et seq.) (as amended by section 
122) is further amended by adding at the end thereof the following 
new subpart: 
"Subpart 15—National Institute on Drug Abuse 
"PURPOSE OF INSTITUTE 
42USC2850. 
"SEC. 464L. (a) IN GENERAL.—The general purpose of the National 
Institute on Drug Abuse (hereafter in this subpart referred to 
as the Institute') is the conduct and support of biomedical and 
behavioral research, health services research, research training, 
£ind health information dissemination with respect to the prevention 
of drug abuse and the treatment of drug abusers. 
"(b) RESEARCH PROGRAM.—^The research program established 
under this subpart shall encompass the social, behavioral, and 
biomedical etiology, mental and physical health consequences, and 
social and economic consequences of drug abuse. In carrying out 
the program, the Director of the Institute shall give special consider-
ation to projects relating to drug abuse among women (particularly 
with respect to pregnant women). 
"(c) COLLABORATION.—The Director of the Institute shall collabo-
rate with the Substance Abuse and Mental Health Services 
Administration in focusing the services research activities of the 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 361 
Institute and in disseminating the results of such research to health 
professionals and the genereil pubUc. 
"(d) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of carndng out this subpart, there are authorized to be appro-
priated $440,000,000 for fiscal year 1993, and such sums as 
may be necessary for fiscal year 1994. 
"(2) ALLOCATION FOR HEALTH SERVICES RESEARCH.—Of the 
amounts appropriated under paragraph (1) for a fiscal year, 
the Director shall obligate not less than 15 percent to carry 
out health services research relating to drug abuse.". 
(b) ADDITIONAL PROVISIONS.—Subpart 15 of part C of title IV 
of the Pubhc Health Service Act (as added by subsection (a)) is 
amended by adding at the end thereof the following new sections: 
"ASSOCIATE DIRECTOR FOR PREVENTION 
"SEC. 464M. (a) IN GENERAL.—There shall be in the Institute 42USC285O-L 
an Associate Director for Prevention who shall be responsible for 
the ftdl-time coordination and promotion of the programs in the 
Institute concerning the prevention of drug abuse. The Associate 
Director shall be appointed by the Director of the Institute fi'om 
individuals who because of their professional training or expertise 
are experts in drug abuse and the prevention of such abuse. 
"(b) REPORT.—^T^e Associate Director for Prevention shall prepare 
for inclusion in the biennial report made under section 407 a 
description of the prevention activities of the Institute, including 
a description of the staff and resources allocated to those activities. 
"DRUG ABUSE RESEARCH CENTERS 
"SEC. 464N. (a) AUTHORITY.—The Director of the Institute may 42 use 285o-2. 
designate National Drug Abuse Research Centers for the purpose 
of interdisciplinary research relating to drug abuse and other bio-
medical, behavioral, and social issues related to drug abuse. No 
entity may be designated as a Center unless an appUcation therefore 
has been submitted to, and approved by, the Secretary. Such an 
application shall be submitted in such manner and contain such 
information as the Secretary may reasonably require. The Secretary 
may not approve such an appUcation unless— 
"(1) the appUcation contains or is supported by reasonable 
assurances that— 
"(A) the applicant has the experience, or capabiUty, to 
conduct, through biomedical, behavioral, social, and related 
disciplines, long-term research on drug abuse and to pro-
vide coordination of such research among such disciplines; 
"(B) the appUcant has available to it sufficient facilities 
(including laboratory, reference, and data analysis faciU-
ties) to carry out the research plan contained in the appUca-
tion; 
"(C) the appUcant has facilities and personnel to provide 
training in the prevention and treatment of drug abuse; 
"(D) the appUcant has the capacity to train predoctoral 
and postdoctoral students for careers in research on drug 
abuse; 
"(E) the applicant has the capacity to conduct courses 
on drug abuse problems and research on drug abuse for 
undergraduate and graduate students, and medical and 
106 STAT. 362 
PUBLIC LAW 102-321—JULY 10, 1992 
osteopathic, nursing, social work, and other specialized 
graduate students; and 
"(F) the appUcant has the capacity to conduct programs 
of continuing education in such medical, legal, Eind social 
service fields as the Secretary may require. 
"(2) the application contains a detailed five-year plan for 
research relating to drug abuse. 
"(b) GRANTS.—The Director of the Institute shall, under such 
conditions as the Secretary may reasonably require, make annual 
grants to Centers which have been designated under this section. 
No funds provided luider a grant under this subsection may be 
used for the purchase of any land or the purchase, construction, 
preservation, or repair of any building. For the purposes of the 
preceding sentence, the term 'construction' has the meaning given 
that term by section 701(2). 
_
, • .K-:^,::.. .K- 
tv-• 
, - . « • • - • - - , • 
^••^\',,-.- 
l^-, 
" O F F I C E O N A I D S 
• 
^ 
f.- 
,-:r.--
Establishment. 
"SEC. 4640. The Director of the Institute shall establish within 
42USC2850-3. 
^j^e Institute an Office on AIDS. The Office shall be responsible 
^ 
for the coordination of research and determining the direction of 
the Institute with respect to AIDS research related to— 
"(1) primary prevention of the spread of HIV, including trans-
mission via drug abuse; 
"(2) drug abuse services research; and 
"(3) other matters determined appropriate by the Director. 
"MEDICATION DEVELOPMENT PROGRAM 
42USC2850-4. 
«SEC. 464P. (a) ESTABLISHMENT.—There is established in the 
Institute a Medication Development Program through which the 
Director of such Institute shall— 
"(1) conduct periodic meetings with the Commissioner of Food 
and Drugs to discuss measures that may facilitate the approval 
process of drug abuse treatments; 
"(2) encourage and promote (through grants, contracts, inter-
national collaboration, or otherwise) expanded research pro-
grams, investigations, experiments, community trials, and 
studies, into the development and use of medications to treat 
drug addiction; 
"(3) establish or provide for the establishment of research 
faciUties; 
"(4) report on the activities of other relevant agencies relating 
to the development and use of pharmacotherapeutic treatments 
for drug addiction; 
"(5) collect, analyze, and disseminate data useful in the devel-
opment and use of pharmacotherapeutic treatments for drug 
addiction and collect, catalog, analyze, and disseminate through 
international channels, the results of such research; 
"(6) directly or through grants, contracts, or cooperative 
agreements, support training in the fundamental sciences and 
cUnical disciplines related to the pharmacotherapeutic treat-
ment of drug abuse, including the use of training stipends, 
fellowships, and awards where appropriate; and 
"(7) coordinate the activities conducted under this section 
: with related activities conducted within the National Institute 
on Alcohol Abuse and Alcoholism, the National Institute of 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 363 
Mental Health, and other appropriate institutes and shall con-
sult with the Directors of such Institutes. 
"(b) DUTIES.—In carrjdng out the activities described in subsection 
(a), the Director of the Institute— 
"(1) shall collect and disseminate through publications and 
other appropriate means, information pertaining to the research 
and other activities under this section; 
"(2) shall make grants to or enter into contracts £ind coopera- Contracts, 
tive agreements with individuals and public and private entities 
to further the goals of the program; 
"(3) may, in accordance with section 496, and in consultation 
with the National Advisory Council on Drug Abuse, acquire, 
construct, 
improve, 
repair, 
operate, 
and 
maintain 
pharmacotherapeutic research centers, laboratories, and other 
necessEiry facilities and equipment, and such other real or per-
sonal property as the Director determines necessary, and may, 
in consultation with such Advisory Council, make grants for 
the construction or renovation of facilities to carry out the 
purposes of this section; 
"(4) may accept voluntary and uncompensated services; 
"(5) may accept gifts, or donations of services, money, or 
property, real, personal, or mixed, tangible or intangible; and 
"(6) shall take necessary action to ensure that all cheinnels 
for the dissemination and exchange of scientific knowledge 
and information are maintained between the Administration 
£ind the other scientific, medical, and biomedical disciplines 
and organizations nationally and internationally. 
"(c) REPORT.— 
"(1) IN GENERAL.—Not later than December 31, 1992, and 
each December 31 thereafter, the Director of the Institute shall 
submit to the Office of National Drug Control Policy established 
under section 1002 of the Anti-Drug Abuse Act of 1988 (21 
U.S.C. 1501) a report, in accordance with paragraph (3), that 
describes the objectives and activities of the progrsim assisted 
under this section. 
"(2) NATIONAL DRUG CONTROL STRATEGY.—The Director of 
National Drug Control PoHcy shall incorporate, by reference 
or otherwise, each report suomitted under this subsection in 
the National Drug Control Strategy submitted the following 
February 1 under section 1005 of the Anti-Drug Abuse Act 
ofl988(21U.S.C. 1504). 
"(d) DEFINITION.—For purposes of this section, the term 
'pharmacotherapeutics'means medications used to treat the s>inp-
toms and disease of drug abuse, including medications to— 
"(1) block the effects of abused drugs; 
"(2) reduce the craving for abused drugs; 
"(3) moderate or eliminate withdrawars3m[iptoms; 
"(4) block or reverse the toxic effect of abused drugs; or 
"(5) prevent relapse in persons who have been detoxified 
from drugs of abuse. 
"(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rjdng out this section, there are authorized to be appropriated 
$85,000,000 for fiscal year 1993, and $95,000,000 for fiscal year 
1994.". 
(c) CONFORMING AMENDMENTS.—Section 515, 516, and 517 of 
the Public Health Service Act (42 U.S.C. 290cc) as such sections 42USC290cc, 
existed 1 day prior to the date of enactment of this Act are repealed. 290cc-l, 290cc-2. 
106 STAT. 364 
PUBLIC LAW 102-321—JULY 10, 1992 
SEC. 124. NATIONAL INSTITUTE OF MENTAL HEALTH. 
(a) CREATION OF SUBPART.—Part C of title IV of the Public 
Health Service Act (42 U.S.C. 285 et seq.) (as amended by section 
123) is further eimended by adding at the end thereof the following 
new subpart: 
"Subpart 16—National Institute of Mental Health 
"PURPOSE OF INSTITUTE 
42 use 285p. 
"SEC. 464R. (a) IN GENERAL.—The general purpose of the National 
Institute of Mental Health (hereafter in this subpart referred to 
as the 'Institute') is the conduct and support of biomedical and 
behavioral research, health services research, research training, 
and health information dissemination with respect to the cause, 
diagnosis, treatment, control and prevention of mental illness. 
"(b) RESEARCH PROGRAM.—The research program established 
under this subpart shall include support for biomedical and behav-
ioral neuroscience and shall be designed to further the treatment 
and prevention of mental illness, the promotion of mental health, 
and the study of the psychological, social and legal factors that 
influence behavior. 
"(c) COLLABORATION.—The Director of the Institute shall collabo-
rate with the Administrator of the Substance Abuse and Mental 
Health Services Administration in focusing the services research 
activities of the Institute and in disseminating the results of such 
research to health professionals and the general public. 
"(d) INFORMATION WITH RESPECT TO SUICIDE.— 
"(1) IN GENERAL.—The Director of the Institute shall— 
"(A) develop and publish information with respect to 
the causes of suicide and the means of preventing suicide; 
and 
Public 
"(B) make such information generally available to the 
information. 
public and to health professionals. 
"(2) YOUTH SUICIDE.—Information described in paragraph (1) 
shall especially relate to suicide among individuals under 24 
years of age. 
"(e) ASSOCIATE DIRECTOR FOR SPECIAL POPULATIONS.— 
"(1) IN GENERAL.—The Director of the Institute shall des-
ignate an Associate Director for Special Populations. 
"(2) DUTIES.—^The Associate Director for Special Populations 
shall— 
"(A) develop and coordinate research policies and pro-
grams to assure increased emphasis on the mental health 
needs of women and minority populations; 
"(B) support programs of basic and applied social and 
behavioral research on the mental health problems of 
• 
, women and minority populations; 
"(C) study the effects of discrimination on institutions 
and individuals, including majority institutions and individ-
uals; 
"(D) support and develop research designed to eliminate 
institutional discrimination; and 
"(E) provide increased emphasis on the concerns of 
women and minority populations in training programs, 
service delivery programs, and research endeavors of the 
Institute. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 365 
"(f) FUNDING.— 
"(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of carrying out this subpart other than section 464P, there 
are authorized to be appropriated $675,000,000 for fiscal year 
1993, and such sums as may be necessary for fiscal year 1994. 
"(2) ALLOCATION FOR HEALTH SERVICES RESEARCH.—Of the 
amounts appropriated imder paragraph (1) for a fiscal year, 
the Director shall obligate not less than 15 percent to c£irry 
out health services research relating to mental health..". 
(b) ADDITIONAL PROVISIONS.—Subpart 16 of part C of title IV 
(as added by subsection (a)) is further amended by adding at the 
end thereof the following new section: 
"ASSOCIATE DIRECTOR FOR PREVENTION 
"SEC. 464S. (a) IN GENERAL.—There shall be in the Institute 42 USC 285p-l. 
an Associate Director for Prevention who shall be responsible for 
the full-time coordination and promotion of the programs in the 
Institute concerning the prevention of mental disorder. The Associ-
ate Director shall be appointed by the Director of the Institute 
fi*om individuEds who because of their professional training or exper-
tise are experts in mental disorder and the prevention of such. 
"(b) REPORT.—The Associate Director for Prevention shall prepare 
for inclusion in the biennial report made under section 407 a 
description of the prevention activities of the Institute, including 
a description of the staff and resources allocated to those activities. 
"OFFICE OF RURAL MENTAL HEALTH RESEARCH 
"SEC. 464T. (a) IN GENERAL.—There is estabUshed within the Establishment. 
Institute an office to be known as the Office of Rural Mental 42USC285p-2. 
Health Research (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 fi-om among individuals experi-
enced or knowledgeable in the provision of mental health services 
in rural areas. The Secretary shall carry out the authorities estab-
lished 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 research 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 activi-
ties of public and nonprofit private entities. 
"(c) RESEARCH, DEMONSTRATIONS, EVALUATIONS, AND DISSEMINA-
TION.—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; and 
"(3) disseminate information to appropriate public and non-
profit private entities. 
"(d) AUTHORITY REGARDING GRANTS AND CONTRACTS.—The Direc-
tor of the Office may carry out the authorities established in sub-
106 STAT. 366 
PUBLIC LAW 102-321—JULY 10, 1992 
section (c) directly and through grants, cooperative agreements, 
or contracts with public or nonprofit private entities. 
"(e) REPORT TO CONGRESS.—Not later than February 1, 1993, 
and each fiscal year thereafter, the Director 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, includLig a summary of the activities of demonstration 
projects and a summary of evaluations of the projects. 
"OFFICE ON AIDS 
Establishment. 
"SEC. 464U. The Director of the Institute shall establish within 
42 use 285p-3. 
the Institute an Office on AIDS. The Office shall be responsible 
for the coordination of research and determining the direction of 
the Institute with respect to AIDS research related to— 
"(1) primary prevention of the spread of HIV, including trans-
mission via sexual behavior; 
"(2) mental health services research; and 
"(3) other matters determined appropriate by the Director.". 
SEC. 1
2
6
. 
COLLABORATIVE USE OF CERTAIN HEALTH SERVICES 
RESEARCH 
FUNDS. 
Part G of title IV of the PubUc Health Service Act is amended 
by inserting after section 494 (42 U.S.C. 289c) the following new 
section: 
"COLLABORATIVE 
USE 
OF 
CERTAIN 
HEALTH 
SERVICES 
RESEARCH 
FUNDS 
42 use 289C-L 
"SEC. 494A. (a) IN GENERAL.—The Secretary shall ensure that 
amounts made available under subparts 14, 15 and 16 of part 
C for health services research relating to alcohol abuse and alcohol-
ism, drug abuse and mental health be used collaboratively, as 
appropriate, and in consultation with the Agency for Health CEu-e 
Policy Research. 
"(b) REPORT.—Not later than May 3, 1993, and annually there-
after, the Secretary shall prepare and submit to the Committee 
on Energy and Commerce of the House of Representatives and 
the Committee on Labor and Human Resources of the Senate, 
a report concerning the activities carried out with the amounts 
referred to in subsection (a).". 
Subtitle C—^Miscellaneous Provisions Re-
lating to Substance Abuse and Mental 
Health 
SEC 131. MISCELLANEOUS PROVISIONS RELATING TO SUBSTANCE 
ABUSE AND MENTAL HEALTH. 
42 use 290dd-3, 
Part D of title V of the PubUc Health Service Act (42 U.S.C. 
290ee—290ee-3. 290dd et seq.) is amended to read aa follows: 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 367 
"PART D—MISCELLANEOUS PROVISIONS RELATING TO SUBSTANCE 
ABUSE AND MENTAL HEALTH 
''SEC. 641. SUBSTANCE ABUSE AMONG GOVERNMENT AND OTHER 
EMPLOYEES. 
"(a) PROGRAMS AND SERVICES.— 
"(1) DEVELOPMENT.—The Secretary, acting through the 
Administrator of the Substance Abuse and Mental Health Serv-
ices Administration, shall be responsible for fostering substance 
abuse prevention and treatment programs and services in State 
and local governments and in private industry. 
"(2) MODEL PROGRAMS.— 
"(A) IN GENERAL.—Consistent with the responsibilities 
described in paragraph (1), the Secretary, acting through 
the Administrator of the Substance Abuse £ind Mental 
Health Services Administration, shall develop a variety 
of model programs suitable for replication on a cost-effective 
basis in different tj^es of business concerns and State 
and local governmental entities. 
"(B) DISSEMINATION OF INFORMATION.—The Secretary, 
acting through the Administrator of the Substance Abuse 
£ind Mental Health Services Administration, shall dissemi-
nate information and materials relative to such model pro-
grams to the State agencies responsible for the administra-
tion of substance abuse prevention, treatment, and 
rehabilitation activities and shall, to the extent feasible 
provide technical assistance to such agencies as requested. 
"(b) DEPRIVATION OF EMPLOYMENT.— 
"(1) PROHIBITION.—No person may be denied or deprived 
of Federal civilian employment or a Federal professional or 
other license or right solely on the grounds of prior substance 
abuse. 
"(2) APPLICATION.—This subsection shall not apply to employ-
ment in— 
"(A) the Central Intelligence Agency; 
"(B) the Federal Bureau of Investigation; 
"(C) the National Security Agency; 
"(D) any other department or agency of the Federal Gov-
ernment designated for purposes of national security by 
the President; or 
"(E) in any position in any department or agency of 
the Federal (Government, not referred to in subparagraphs 
(A) through (D), which position is determined pursuant 
to regulations prescribed by the head of such agengy or 
department to be a sensitive position. 
"(3) REHABILITATION ACT.—The inapplicability of the prohibi-
tion described in paragraph (1) to the emplo5anent described 
in paragraph (2) shall not be construed to reflect on the 
applicability of the Rehabilitation Act of 1973 or other anti-
discrimination laws to such emplojnnent. 
"(c) CONSTRUCTION.—This section shall not be construed to pro-
hibit the dismissal from emplo5mient of a Federal civilian employee 
who C£innot properly function in his employment. 
Inter-
governmental 
relations. 
Business and 
industry. 
42 use 290dd. 
106 STAT. 368 
PUBLIC LAW 102-321—JULY 10, 1992 
42 use 290dd-l. "SEC. 542. ADMISSION OF SUBSTANCE ABUSERS TO PRIVATE AND PUB-
Lie HOSPITALS AND OUTPATIENT FACIUTIES. 
"(a) NONDISCRIMINATION.—Substance abusers who are suffering 
from medical conditions shall not be discriminated against in admis-
sion or treatment, solely because of their substance abuse, by any 
private or public general hospital, or outpatient facility (as defined 
in section 1624(4)) which receives support in any form from any 
program supported in whole or in part by funds appropriated to 
any Federal department or agency. 
"(b) REGULATIONS.— 
"(1) IN GENERAL.—The Secretary shall issue regulations for 
the enforcement of the policy of subsection (a) with respect 
to the admission and treatment of substance abusers in hos-
pitals and outpatient facilities which receive support of any 
kind from any program administered by the Secretary. Such 
regulations shall include procedures for determining (after 
opportunity for a hearing if requested) if a violation of sub-
section (a) has occurred, notification of failure to comply with 
such subsection, and opportunity for a violator to comply with 
such subsection. If the Secretary determines that a hospital 
or outpatient facility subject to such regulations has violated 
subsection (a) and such violation continues sifter an opportunity 
has been afforded for compliance, the Secretary may suspend 
or revoke, after opportunity for a hearing, all or part of any 
support of any kind received by such hospital from any program 
administered by the Secretary. The Secretary may consult with 
the officials responsible for the administration of any other 
Federal program from which such hospital or outpatient facility 
receives support of any kind, with respect to the suspension 
or revocation of such other Federal support for such hospital 
or outpatient facility. 
"(2) DEPARTMENT OF VETERANS AFFAIRS.—The Secretary of 
Veterans Affairs, acting through the Chief Medical Director, 
shall, to the maximum feasible extent consistent with their 
responsibilities under title 38, United States Code, prescribe 
regulations making applicable the regulations prescribed by 
the Secretary under paragraph (1) to the provision of hospital 
care, nursing home care, domiciliary care, and medical services 
under such title 38 to veterans suffering from substance abuse. 
In prescribing and implementing regulations pursuant to this 
paragraph, the Secretary shall, from time to time, consult with 
the Secretary of Health and Human Services in order to achieve 
the maximum possible coordination of the regulations, and 
the implementation thereof, which they each prescribe. 
42 use 290dd-2. "SEC. 543. CONFIDENTIALITY OF RECORDS. 
"(a) REQUIREMENT.—Records of the identity, diagnosis, prognosis, 
or treatment of any patient which are maintained in connection 
with the performance of £iny program or activity relating to sub-
stance abuse education, prevention, training, treatment, rehabilita-
tion, or research, which is conducted, regulated, or directly or 
indirectly assisted by any department or agency of the United 
States shall, except as provided in subsection (e), be confidential 
and be disclosed only for the purposes and under the circumstances 
expressly authorized under subsection (b). 
"(b) PERMITTED DISCLOSURE.— 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 369 
"(1) CONSENT.—^The content of any record referred to in sub-
section (a) may be disclosed in accordance with the prior written 
consent of the patient with respect to whom such record is 
maintained, but only to such extent, under such circumstances, 
and for such purposes as may be allowed under regulations 
prescribed pursuant to subsection (g). 
"(2) METHOD FOR DISCLOSURE.—-Whether or not the patient, 
with respect to whom any given record referred to in subsection 
(a) is maintained, gives written consent, the content of such 
record may be disclosed as follows: 
"(A) To medical personnel to the extent necessary to 
meet a bona fide medical emergency. 
"(B) To qualified personnel for the purpose of conducting 
scientific research, management audits, financial audits, 
or program evaluation, but such personnel may not identify, 
directly or indirectly, any individual patient in any report 
of such research, audit, or evaluation, or otherwise disclose 
patient identities in any manner. 
"(C) If authorized by an appropriate order of a court 
of competent jurisdiction granted after application showing 
good cause therefor, including the need to avert a substan-
tisQ risk of death or serious bodily harm. In assessing 
good cause the court shall weigh the public interest and 
the need for disclosure against the injury to the patient, 
to the physician-patient relationship, and to the treatment 
services. Upon the granting of such order, the court, in 
determining the extent to which any disclosure of all or 
any part of any record is necessary, shall impose appro-
priate safeguards against unauthorized disclosure. 
"(c) USE OF RECORDS IN CRIMINAL PROCEEDINGS.—Except as 
authorized by a court order granted under subsection (b)(2)(C), 
no record referred to in subsection (a) may be used to initiate 
or substantiate any criminal charges against a patient or to conduct 
any investigation of a patient. 
"(d) APPLICATION.—^The prohibitions of this section continue to 
apply to records concerning any individusQ who has been a patient, 
irrespective of whether or when such individual ceases to be a 
patient. 
"(e) NONAPPLICABILITY.—The prohibitions of this section do not 
apply to any interchange of records— 
"(1) within the Armed Forces or within those components 
of the Department of Veterans Affairs furnishing health care 
to veterans; or 
"(2) between such components and the Armed Forces. 
The prohibitions of this section do not apply to the reporting under 
State law of incidents of suspected child abuse and neglect to 
the appropriate State or local authorities. 
"(f) PENALTIES.—^Aay person who violates any provision of this 
section or any regulation issued pursuant to this section shall 
be fined in accordance with title 18, United States Code. 
"(g) REGULATIONS.—Except as provided in subsection (h), the 
Secretary shall prescribe regulations to csirry out the purposes 
of this section. Such regulations may contain such definitions, and 
may provide for such safeguards and procedures, including proce-
dures and criteria for the issuance and scope of orders under sub-
section (b)(2)(C), as in the judgment of the Secretary are necessary 
or proper to effectuate the purposes of this section, to prevent 
106 STAT. 370 
PUBLIC LAW 102-321—JULY 10, 1992 
42 use 290aa 
note. 
circumvention or evasion thereof, or to facilitate compliance there-
with. 
"(h) APPLICATION TO DEPARTMENT OF VETERANS AFFAIRS.—The 
Secretary of Veterans Affairs, acting through the Chief Medical 
Director, shall, to the maximum feasible extent consistent with 
their responsibilities under title 38, United States Code, prescribe 
regulations making applicable the regulations prescribed by the 
Secretary of Health and Human Services under subsection (g) of 
this section to records maintained in connection with the provision 
of hospital care, nursing home care, domiciliary care, and medical 
services under such title 38 to veterans suffering from substance 
abuse. In prescribing and implementing regulations pursuant to 
this subsection, the Secretary of Veterans i'^airs shall, from time 
to time, consult with the Secretary of Health and Human Services 
in order to achieve the maximum possible coordination of the regula-
tions, and the implementation thereof, which they each prescribe.". 
Subtitle D—Transfer Provisions 
SEC. 141. TRANSFERS. 
^-
(a) SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINIS-
TRATION.—Except as specifically provided otherwise in this Act or 
an amendment made by this Act, there are transferred to the 
Administrator of the Substance Abuse and Mental Health Services 
Administration all service related functions which the Adminis-
trator of the Alcohol, Drug Abuse and Mental Health Administra-
tion, or the Director of any entity within the Alcohol, Drug Abuse 
and Mental Health Administration, exercised before the date of 
the enactment of this Act and all related functions of any officer 
or employee of the Alcohol, Drug Abuse and MentcJ Health Adminis-
tration. 
(b) NATIONAL INSTITUTES.—Except as specifically provided other-
wise in this Act or an amendment made by this Act, there are 
treinsferred to the appropriate Directors of the National Institute 
on Alcohol Abuse and Alcoholism, the National Institute on Drug 
Abuse and the National Institute of Mental Health, through the 
Director of the National Institutes of Health, all research related 
functions which the Administrator of the Alcohol, Drug Abuse and 
Mental Health Administration exercised before the date of the 
enactment of this Act and all related functions of any officer or 
employee of the Alcohol, Drug Abuse, and Mental Health Adminis-
tration. 
(c) ADEQUATE PERSONNEL AND RESOURCES.—The transfers 
required xinder this subtitle shall be effectuated in a manner that 
ensures that the Substance Abuse and Mental Health Services 
Administration has adequate personnel and resources to carry out 
its statutory responsibilities and that the National Institute on 
Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse 
and the National Institute of Mental Health have adequate person-
nel and resources to enable such institutes to carry out their respec-
tive statutoryj*esponsibilities. 
SEC. 142. 
TRANSFER AND ALLOCATIONS OF 
APPROPRIATIONS AND 
PERSONNEL. 
(a) SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINIS-
TRATION.—Except as otherwise provided in the Public Health Serv-
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 371 
ice Act, all personnel employed in connection with, and all assets, 
liabilities, contracts, property, records, and unexpended balances 
of appropriations, authorizations, allocations, and other funds 
employed, used, held, arising from, available to, or to be made 
availaole in connection with the functions transferred to the 
Administrator of the Substance Abuse and Mental Health Services 
Administration by this subtitle, subject to section 1531 of title 
31, United States Code, shall be transferred to the Substance Abuse 
and Mental Health Services Administration. Unexpended funds 
transferred pursuant to this subsection shall be used only for the 
purposes for which the funds were originally authorized and appro-
priated. 
(b) NATIONAL INSTITUTES.—Except as otherwise provided in the 
Public Health Service Act, all personnel employed in connection 
with, and all assets, liabilities, contracts, property, records, and 
unexpended balances of appropriations, authorizations, allocations, 
and other funds employed, used, held, arising from, available to, 
or to be made available in connection with the mnctions transferred 
to the Directors of the National Institute on Alcohol Abuse and 
Alcoholism, the National Institute on Drug Abuse and the National 
Institute of Mental Health by this subtitle, subject to section 1531 
of title 31, United States Code, shall be transferred to the National 
Institute on Alcohol Abuse and Alcoholism, the National Institute 
on Drug Abuse and the National Institute of Mental Health. Unex-
pended funds transferred pursuant to this subsection shall be used 
only for the purposes for which the funds were originally authorized 
and appropriated. 
(c) CUSTODY OF BALANCES.—The actual transfer of custody of 
obligation balances is not required in order to implement this sec-
tion. 
SEC. 143. INCIDENTAL TRANSFERS. 
Prior to October 1, 1992, the Secretary of Health and Human 
Services is authorized to make such determinations as may be 
necessary with regard to the functions transferred by this subtitle, 
and to make such additional incidental dispositions of personnel, 
assets, liabilities, grants, contracts, property, records, and unex-
pended balances of appropriations, authorizations, allocations, and 
other funds held, used, arising from, available to, or to be made 
available in connection with such functions, as may be necessarv 
to carry out the provisions of this subtitle and the Public Healtn 
Service Act. Such Secretary shall provide for the termination of 
the affairs of all entities terminated by this subtitle and for such 
further measures and dispositions as may be necessary to effectuate 
the purposes of this subtitle. 
SEC. 144. EFFECT ON PERSONNEL. 
(a) IN GENERAL.—Except as otherwise provided by this subtitle 
and the Public Health Service Act, the transfer pursuant to tiiis 
subtitle of full-time personnel (except special Grovemment employ-
ees) and part-time personnel holdmg permanent positions shall 
not cause any such employee to be separated or reduced in grade 
or compensation for one vear after me date of transfer of such 
employee under this subtitle. 
(b) EXECUTIVE SCHEDULE POSITIONS.—Any person who, on the 
day preceding the effective date of this Act, held a position com-
pensated in accordance with the Executive Schedule prescribed 
in chapter 53 of title 5, United States Code, and who, witiiout 
106 STAT. 372 
PUBLIC LAW 102-321—JULY 10, 1992 
a break in service, is appointed in the Substance Abuse and Mental 
Health Services Administration to a position having duties com-
parable to the duties performed immediately preceding such 
appointment shall continue to be compensated in such new position 
at not less than the rate provided for such previous position, for 
the duration of the service of such person in such new position. 
SEC. 145. SAVINGS PROVISIONS. 
(a) EFFECT ON PREVIOUS DETERMINATIONS.—All orders, deter-
minations, rules, regulations, permits, contracts, certificates, 
licenses, and privileges that— 
(1) have been issued, made, granted, or allowed to become 
effective by the President, any Federal agency or official thereof, 
or by a court of competent jurisdiction, in the performance 
of functions which are transferred by this subtitle; and 
(2) are in effect on the date of enactment of this Act; 
shall continue in effect according to their terms imtil modified, 
terminated, superseded, set aside, or revoked in accordance with 
law by the President, the Director of the National Institutes of 
Health, or the Administrator of the Substance Abuse and Mental 
Health Services Administration, as appropriate, a court of com-
petent jurisdiction, or by operation of law. 
(b) CONTINUATION OF PROCEEDINGS.— 
(1) IN GENERAL.—The provisions of this subtitle shall not 
affect any proceedings, including notices of proposed rule mak-
ing, or any application for any license, permit, certificate, or 
financial assistance pending on the date of enactment of this 
Act before the Department of Health and Human Services, 
which relates to the Alcohol, Drug Abuse and Mental Health 
Administration or the National Institute on Alcohol Abuse and 
Alcoholism, the National Institute on Drug Abuse, or the 
National Institute of Mental Health, or any office thereof with 
respect to functions transferred by this subtitle. Such proceed-
ings or applications, to the extent that they relate to functions 
transferred, shall be continued. Orders shall be issued in such 
proceedings, appeals shall be taken therefi"om, and payments 
shall be made under such orders, as if this Act had not been 
enacted, and orders issued in any such proceedings shall con-
tinue in effect until modified, terminated, superseded, or 
revoked by the Administrator of the Substance Abuse and 
Mental Health Services Administration or the Directors of the 
National Institute on Alcohol Abuse and Alcoholism, the 
National Institute on Drug Abuse and the National Institute 
of Mental Health by a court of competent jurisdiction, or by 
operation of law. Nothing in this subsection prohibits the dis-
continuance or modification of any such proceeding under the 
same terms and conditions and to the same extent that such 
proceeding could have been discontinued or modified if this 
subtitle had not been enacted. 
(2) REGULATIONS.—The Secretary of Health and Human Serv-
ices is authorized to issue regulations providing for the orderly 
transfer of proceedings continued under paragraph (1). 
(c) EFFECT ON LEGAL ACTIONS.—Except as provided in subsection 
(e)— 
(1) the provisions of this subtitle do not affect actions com-
menced prior to the date of enactment of this Act; and 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 373 
(2) in all such actions, proceedings shall be had, appeals 
taken, and judgments rendered in the same manner and effect 
as if this Act had not been enacted. 
(d) No ABATEMENT OP ACTIONS OR PROCEEDINGS.—No action 
or other proceeding commenced by or against any officer in his 
official capacity as an officer of the Department of Health and 
Human Services with respect to functions transferred by this sub-
title shall abate by reason of the enactment of this Act. No cause 
of action by or against the Department of Health and Human 
Services with respect to functions transferred by this subtitle, or 
by or against any officer thereof in his official capacity, shall abate 
by reason of the enactment of this Act. Causes of action and actions 
with respect to a function transferred by this subtitle, or other 
proceedings may be asserted by or against the United States or 
the Administrator of the Alcohol, Drug Abuse and Mental Health 
Administration or the Directors of the National Institute on Alcohol 
Abuse and Alcoholism, the National Institute on Drug Abuse, and 
the National Institute of Mental Health, as may be appropriate, 
and, in an action pending when this Act takes effect, the court 
may at any time, on its own motion or that of any party, enter 
an order which will give effect to the provisions of this subsection. 
(e) SUBSTITUTION.—If, before the date of enactment of this Act, 
the Depeirtment of Health and Human Services, or any officer 
thereof in the official capacity of such officer, is a party to an 
action, and under this subtitle any function of such Department, 
Office, or officer is transferred to the Administrator of the Substance 
Abuse and Mental Health Services Administration or the Directors 
of the National Institute on Alcohol Abuse and Alcoholism, the 
National Institute on Drug Abuse and the National Institute of 
Mental Health, then such action shall be continued with the 
Administrator of the Substance Abuse and Mental Health Services 
Administration or the Directors of the National Institute on Alcohol 
Abuse and Alcoholism, the National Institute on Drug Abuse and 
the National Institute of Mental Health, as the case may be, sub-
stituted or added as a party. 
(f) JUDICIAL REVIEW.—Orders and actions of the Administrator 
of the Substance Abuse and Mental Health Services Administration 
or the Directors of the National Institute on Alcohol Abuse and 
AlcohoUsm, the National Institute on Drug Abuse and the National 
Institute of Mental Health in the exercise of functions transferred 
to the Directors by this subtitle shall be subject to judicial review 
to the same extent and in the same manner as if such orders 
and actions had been by the Administrator of the Alcohol, Drug 
Abuse and Mental Health Administration or the Directors of the 
National Institute on Alcohol Abuse and Alcoholism, the National 
Institute on Drug Abuse, and the National Institute of Mentsd 
Health, or any office or officer thereof, in the exercise of such 
functions immediately preceding their transfer. Any statutory 
requirements relating to notice, hearings, action upon the record, 
or administrative review that apply to any function trsinsferred 
by this subtitle shall apply to the exercise of such function by 
the Administrator of the Substance Abuse £uid Mental Health Serv-
ices Administration or the Directors. 
SEC. 146. TRANSITION. 
With the consent of the Secretary of Health £uid Human Services, 
the Administrator of the Substance Abuse and Mental Health Serv-
106 STAT. 374 
PUBLIC LAW 102-321—JULY 10, 1992 
ices Administration and the Directors of the Nationgd Institute 
on Alcohol Abuse and Alcoholism, the National Institute on Drug 
Abuse and the National Institute of Mental Health are authorized 
to utilize— 
(1) the services of such officers, employees, and other person-
nel of the Department with respect to functions transferred 
to the Administrator of the Substance Abuse and Mental Health 
Services Administration and the Director of the National 
Institute on Alcohol Abuse and Alcoholism, the National 
Institute on Drug Abuse and the National Institute of Mental 
Health by this subtitle; and 
(2) funds appropriated to such functions for such period of 
time as may reasonably be needed to facilitate the orderly 
implementation of this subtitle. 
SEC. 147. PEER REVIEW. 
With respect to fiscal years 1993 through 1996^ the peer review 
systems, advisory councils and scientific advisory committees uti-
lized, or approved for utilization, by the National Institute on Alco-
hol Abuse and Alcoholism, the National Institute on Drug Abuse 
and the National Institute of Mental Health prior to the transfer 
of such Institutes to the National Institute of Health shall be 
utilized by such Institutes. 
SEC. 148. MERGERS. 
Notwithstanding the provisions of section 401(c)(2) of the Public 
Health Service Act (42 U.S.C. 281(c)(2)), the Secretary of Health 
and Human Services may not merge the National Institute on 
Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse 
or the National Institute of Mental Health with any other institute 
or entity (or with each other) within the national research institutes 
for a 5-year period beginning on the date of enactment of this 
Act. 
SEC. 149. CONDUCT OF MULTI-YEAR RESEARCH PROJECTS. 
With respect to multi-year grants awarded prior to fiscal year 
1993 by the National Institute on Alcohol Abuse and Alcoholism, 
the National Institute on Drug Abuse, and the National Institute 
of Mental Health with amounts received under section 1911(b), 
as such section existed one day prior to the date of enactment 
of this Act, such grants shall be continued for the entire period 
of the grant through the utilization of funds made available pursu-
ant to sections 4641, 4640, or 464T, as appropriate, subject to 
satisfactory performance. 
SEC. 150. SEPARABILITY. 
If a provision of this subtitle or its application to any person 
or circumstance is held invaHd, neither tiie remainder of this Act 
nor the application of the provision to other persons or cir-
cumstances shall be affected. 
SEC. 161. BUDGETARY AUTHORITY. 
With respect to fiscal years 1994 and 1995, the Directors of 
the National Institute on Alcohol Abuse and Alcoholism, the 
National Institute on Drug Abuse, and the National Institute of 
Mental Health shall notwithstanding section 405(a), prepare and 
submit, directly to the President for review and ^ansmittal to 
Congress, an annual budget estimate (including an estimate of 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 375 
the number and type of personnel needs for the Institute) for 
their respective Institutes, after reasonable opportunity for com-
ment (but without change) by the Secretary of Health and Human 
Services, the Director of the National Institutes of Hesilth, and 
the Institute's advisory coimcil. 
Subtitle E—References and Conforming 
Amendments 
SEC. 161. REFERENCES. 
42 USC 290aa 
note. 
Reference in any other Federal law, Executive order, rule, regula-
tion, or delegation of authority, or any document of or pertaining 
to the Alcohol, Drug Abuse and Ment£d Health Administration 
or to the Administrator of the Alcohol, Drug Abuse and Mental 
Health Administration shall be deemed to refer to the Substsince 
Abuse and Mental Health Services Administration or to the 
Administrator of the Substance Abuse and Mental Hesilth Services 
Administration. 
SEC. 162. TRANSITION FROM HOMELESSNESS. 
Part C of title V of the Public Health Service Act is amended— 
(1) in section 521 (42 U.S.C. 290cc-21), by striking out 
"National Institute of Mental Health" sind inserting in lieu 
thereof "Center for Mental Health Services"; and 
(2) in section 530 (42 U.S.C. 290cc-30), by striking out 
"through the National" and all that follows tlu*ough "Abuse" 
and inserting in lieu thereof "through the agencies of the 
Administration". 
SEC. 163. CONFORMING AMENDMENTS. 
(a) TITLE V.—Title V of the PubHc Health Service Act is 
amended— 
(1) in section 521 (42 U.S.C. 290cc-21), by striking "Director 
of the National Institute of Mental Health" and inserting in 
lieu thereof "Administrator of the Substance Abuse and Mental 
Health Services Administration"; 
(2) in section 528 (42 U.S.C. 290CC-28)— 
(A) by striking "the National Institute of Mental Health, 
the National Institute on Alcohol Abuse and Alcoholism, 
and the National Institute on Drug Abuse" and inserting 
in lieu thereof "and the Administrator of the Substance 
Abuse and Mental Health Services Administration" in sub-
section (a); and 
(B) by striking "National Institute of Mental Health" 
and inserting in lieu thereof "Administrator of the Sub-
stance Abuse and Mental Health Services Administration" 
in subsection (c); and 
(3) in section 530 (42 U.S.C. 290cc-30), by striking "the 
National Institute of Mental Health, the National Institute 
on Alcohol Abuse and Alcoholism, and the National Institute 
on Drug Abuse" and inserting in lieu thereof "the Administrator 
of the Substance Abuse and Mental Health Services Adminis-
tration". 
(b) GENERAL PUBLIC HEALTH SERVICE ACT AMENDMENTS.—The 
Public Health Service Act (42 U.S.C. 201 et seq.) is amended— 
(1) in section 227 (42 U.S.C. 236)— 
106 STAT. 376 
PUBLIC LAW 102-321—JULY 10, 1992 
(A) by striking out ", and the Alcohol, Drug Abuse, and 
Mental Health Administration" in subsection (c)(2); 
(B) by striking out ", the Alcohol, Drug Abuse, and Men-
tal Health Administration," in subsection (c)(3); 
(C) by striking out "and the Administrator of the Alcohol, 
_. 
Drug Abuse, and Mental Health Administration" in sub-
\ i section (e); and 
(D) by striking out "and the Alcohol, Drug Abuse, and 
Mental Health Administration" each place such term 
appears in subsection (e); 
(2) in section 319(a) (42 U.S.C. 247d(a))— 
(A) by striking out "the Administrator of the Alcohol, 
Drug Abuse, and Mental Health Administration" and 
inserting in lieu thereof "the Administrator of the Sub-
stance Abuse and Mental Health Services Administration"; 
and 
(B) by striking out "Director, Administrator" in the mat-
ter following paragraph (2) and inserting in lieu thereof 
"Directors, Administrator"; 
(3) in section 402(d)(1) (42 U.S.C. 282(d)(1)), by striking out 
"two hundred" and inserting in Keu thereof "220"; 
(4) in section 487(a)(1) (42 U.S.C. 288(a)(1))— 
(A) by striking out "and the Alcohol, Drug Abuse, and 
Mental Health Administration" in subparagraph (A)(i); and 
(B) by striking out "or the Alcohol, Drug Abuse, and 
Mental Health Administration" in the matter immediately 
following subparagraph (B); 
(5) in section 489(a)(2) (42 U.S.C. 288b(a)(2)), by striking 
out "and institutes xmder the Alcohol, Drug Abuse, and Mentsd 
Health Administration"; 
(6) in section 499A(g)(9) (42 U.S.C. 290b(g)(9))— 
(A) by striking out "or the Administa*ator of the Alcohol, 
Drug Abuse, and Mental Health Administration"; and 
(B) by striking out "and the Alcohol, Drug Abuse, and 
Mental Health Administration"; and 
(7) in section 2303 (42 U.S.C. 300CC-2)— 
(A) by striking out "Administrator of the Alcohol, Drug 
Abuse, and Mental Health Administration" in subsection 
(b), and inserting in lieu thereof "Administrator of the 
Substance Abuse and Mental Health Services Administra-
tion"; and 
(B) by striking out "Administrator of the Alcohol, Drug 
Abuse, and Mental Health Administration" in subsection 
(c), and inserting in Ueu thereof "Administrator of the 
Substance Abuse and Mental Health Services Administra-
tion". 
(c) OTHER LAWS.— 
(1) Section 4 of the Orphan Drug Amendments of 1985 (42 
U.S.C. 236 note) is amended— 
(A) in subsection (b), by striking out "the Alcohol, Drug 
Abuse, and Mental Health Administration,"; 
(B) in subsection (c)— 
(i) by striking out "the Alcohol, Drug Abuse, and 
Mental Health Administration," in the matter preced-
ing paragraph (1); and 
.^ 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 377 
(ii) by striking out "the institutes of the Alcohol, 
Drug Abuse, and Mental Health Administration," in 
paragraph (7); and 
(C) in subsection (d)— 
(i) by striking out paragraph (3) and inserting in 
lieu thereof the following new paragraph: 
"(3) Four nonvoting members shall be appointed for the direc-
tors of the national research institutes of the National Institutes 
of Health which the Secretary determines are involved with 
rare diseases."; and 
(ii) by striking out "or an institute of the Alcohol, 
Drug Abuse, and Mental Health Administration" in 
the matter immediately following paragraph (3). 
(2) The Older Americans Act of 1965 (42 U.S.C. 3001 et 
seq.) is amended— 
(A) in section 202(b)(1) (42 U.S.C. 3012(b)(1)), by striking 
out "the Alcohol, Drug Abuse, and Mental Health Adminis-
tration" and inserting in lieu thereof "the Substance Abuse 
and Mentad Health Services Administration"; 
(B) in section 301(b)(2) (42 U.S.C. 3021(b)(2)), by striking 
out "the Alcohol, Drug Abuse, and Mental Health Adminis-
tration" and inserting in lieu thereof "the Substance Abuse 
and Mental Health Services Administration"; and 
(C) in section 402(b) (42 U.S.C. 3030bb(b)), by striking 
out "the Alcohol, Drug Abuse, and Mental Health Adminis-
tration" and inserting in lieu thereof "the Substance Abuse 
and Mental Health Services Administration". 
(3) The Protection and Advocacy for Mentally 1
1
1 Individuals 
Act of 1986 is amended— 
(A) in section 111(c) (42 U.S.C. 10821(c)), by striking 
out "3-year" each place that such appears and inserting 
in lieu thereof "4-year"; and 
(B) in section 116 (42 U.S.C. 10826), by striking out 
"the Alcohol, Drug Abuse, and Mental Health Administra-
tion" and inserting in lieu thereof "the Substance Abuse 
and Mental Health Services Administration". 
Subtitle F—^Employee Assistance Programs 
SEC. 171. PROGRAM OF GRANTS UNDER CENTER FOR SUBSTANCE 
ABUSE PREVENTION. 
Title V of the Public Health Service Act (as amended by section 
114 and 120) is amended by adding at the end of subpart 2 of 
part B the following new section: 
"SEC. 518. EMPLOYEE ASSISTANCE PROGRAMS. 
42 USC 
"(a) IN GENERAL.—^The Director of the Prevention Center may 
make grants to public and nonprofit private entities for the purpose 
of assisting business organizations in establishing employee assist-
ance programs to provide appropriate services for employees of 
the organizations regarding substance abuse, including education 
and prevention services and referrals for treatment. 
"(b) CERTAIN REQUIREMENTS.—^A business organization may not 
be assisted under subsection (a) if the organization has an employee 
assistance program in operation. The organization may receive such 
106 STAT. 378 
PUBLIC LAW 102-321—JULY 10, 1992 
assistance only if the organization lacks the financial resources 
for operating such a program. 
"(c) SPECIAL CONSIDERATION FOR CERTAIN SMALL BUSINESSES.— 
In making grants under subsection (a), the Director of the Preven-
tion Office shall give special consideration to business organizations 
with 50 or fewer employers. 
"(d) CONSULTATION AND TECHNICAL ASSISTANCE.—In the case of 
small businesses being assisted under subsection (a), the Secretary 
shall consult with the entities and organizations involved and pro-
vide technical assistance and training with respect to establishing 
and operating employee assistance programs in accordance with 
this subtitle. Such assistance shall include technical assistance 
in establishing workplace substance abuse programs. 
"(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rjdng out this section, there are authorized to be appropriated 
$3,000,000 for fiscal year 1993, and such sums as may be necessary 
for fiscal year 1994.". 
TITLE II—BLOCK GRANTS TO STATES 
REGARDING MENTAL HEALTH AND 
SUBSTANCE ABUSE 
SEC. 201. ESTABLISHMENT OF SEPARATE BLOCK GRANT REGARDING 
MENTAL HEALTH. 
Part B of title XIX of the PubUc Health Service Act (42 U.S.C. 
300x et seq.) is amended— 
(1) by amending the heading for the part to read as follows: 
"PART B—BLOCK GRANTS REGARDING MENTAL HEALTH AND 
SUBSTANCE ABUSE"; and 
(2) by striking subparts 1 and 2 and inserting the following: 
"Subpart I—Block Grants for Community Mental 
Health Services 
42 use 300x. 
"SEC. 1911. FORMULA GRANTS TO STATES. 
"(a) IN GENERAL.—For the purpose described in subsection (b), 
the Secretary, acting through the Director of the Center for Mental 
Health Services, shall make an allotment each fiscal year for each 
State in an amount determined in accordance with section 1918. 
The Secretary shall make a grant to the State of the allotment 
made for the State for the fiscal year if the State submits to 
the Secretary an application in accordance with section 1917. 
"(b) PURPOSE OF GRANTS.—^A funding agreement for a grant under 
subsection (a) is that, suWect to section 1916, the State involved 
will expend the grant only ror the purpose of— 
"(1) carrying out the plan submitted under section 1912(a) 
by the State for the fiscal year involved; 
"(2) evaluating programs and services carried out under the 
plan; and 
"(3) plginning, administration, and educational activities 
related to providing services under the plan. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 379 
'^EC. 1912. STATE PLAN FOR COMPREHENSIVE COMMUNITY MENTAL 42 USC 300x-l. 
HEALTH SERVICES FOR CERTAIN INDIVIDUALS. 
"(a) IN GENERAL.—^The Secretary may make a grant under section 
1911 only i
f
— 
**(1) the State involved submits to the Secretary a plan for 
providing comprehensive community mental health services to 
adults with a serious mental illness and to children with a 
serious emotional disturbance; 
"(2) the plan meets the criteria specified in subsection (b); 
and 
"(3) the plan is approved by the Secretary. 
"(b) CRITERIA FOR PLAN.—^Witii respect to the provision of com-
prehensive community mental health services to individuals who 
are either adults with a serious mental illness or children with 
a serious emotional disturbance, the criteria referred to in sub-
section (a) regarding a plan £ire as follows: 
"(1) The plan provides for the estabUshment and implementa-
tion of an org£uiized commimity-based system of care for such 
individuals. 
"(2) The plan contains quantitative targets to be achieved 
in the implementation of such system, including the numbers 
of such individuals residing in the areas to be served under 
such system. 
"(3) The plan describes available services, available treatment 
options, and available resources (including Federal, State and 
local public services and resources, and to the extent prac-
ticable, private services and resources) to be provided such 
individuals. 
"(4) The plan describes health and mental health services, 
rehabiUtation services, employment services, housing services, 
educational services, medical and dental care, and other support 
services to be provided to such individuals with Federal, State 
and local public and private resources to enable such individ-
uals to function outside of inpatient or residential institutions 
to the maximimi extent of their capabiUties, including services 
to be provided by local school systems under the Individuals 
with Disabilities Education Act. 
"(5) The plan describes the financial resources and staffing 
necessary to implement the requirements of such plan, includ-
ing progrsuns to train individuals as providers of mental health 
services, and the plan emphasizes training of providers of emer-
gency health services regarding mental health. 
"(6) The plan provides for activities to reduce the rate of 
hospitalization of such individuals. 
"(7)(A) Subject to subparagraph (B), the plan requires the 
provision of case management services to each such individual 
in the State who receives substantial amounts of public fimds 
or services. 
"(B) The plan may provide that the requirement of subpara-
graph (A) will not be substantially completed until the end 
of fiscal year 1993. 
"(8) The plan provides for the estabUshment and implementa-
tion of a program of outreach to, and services for, sucn individ-
uals who are homeless. 
"(9) In tiie case of children with a serious emotional disturb-
ance, the plan— 
106 STAT. 380 
PUBLIC LAW 102-321—JULY 10, 1992 
"(A) subject to subparagraph (B), provides for a system 
of integrated social services, educational services, juvenile 
services, and substance abuse services that, together with 
health and mental health services, will be provided in 
order for such children to receive care appropriate for their 
multiple needs (which system includes services provided 
under the Individuals with Disabilities Education Act); 
"(B) provides that the grant under section 1911 for the 
^ 
fisc£il 
year involved will not be expended to provide any 
service of such system other than comprehensive commu-
nity mented health services; and 
"(C) provides for the 
establishment 
of a 
defined 
geographic area for the provision of the services of such 
system. 
"(10) The plan describes the manner in which mental health 
services will be provided to individuals residing in rural areas. 
"(11) The plan contedns an estimate of the incidence and 
prevalence in the State of serious mental illness among adults 
and serious emotional disturbance among children. 
"(12) The plan contains a description of the manner in which 
the State intends to expend the grant under section 1911 for 
the fiscal year involved to carry out the provisions of the 
plan required in paragraphs (1) through (11). 
"(c) DEFINITIONS REGARDING MENTAL ILLNESS AND EMOTIONAL 
DISTURBANCE; METHODS FOR ESTIMATE OF INCIDENCE AND PREVA-
LENCE.— 
"(1) ESTABLISHMENT BY SECRETARY OF DEFINITIONS; DISSEMI-
NATION.—For purposes of this subpart, the Secretary shall 
establish definitions for the terms 'adults with a serious mental 
illness' and 'children with a serious emotional disturbance'. 
The Secretary shall disseminate the definitions to the States. 
"(2) STANDARDIZED METHODS.—The Secretary shall estabHsh 
standardized methods for making the estimates required in 
subsection (b)(ll) with respect to a State. A funding agreement 
for a grant under section 1911 for the State is that the State 
will utilize such methods in making the estimates. 
"(3) DATE CERTAIN FOR COMPLIANCE BY SECRETARY.—Not later 
than 90 days after the date of the enactment of the ADAMHA 
Reorganization Act, the Secretary shall establish the definitions 
described in paragraph (1), shall begin dissemination of the 
definitions to the States, and shall establish the standardized 
methods described in paragraph (2). 
"(d) REQUIREMENT OF IMPLEMENTATION OF PLAN.— 
"(1) 
COMPLETE IMPLEMENTATION.—Except as provided 
in 
paragraph (2), in making a grant under section 1911 to a 
State for a fiscal year, the Secretary shall make a determination 
of the extent to which the State has implemented the plan 
required in subsection (a). If the Secretary determines that 
a State has not completely implemented the plan, the Secretary 
shall reduce the amount of the allotment under section 1911 
for the State for the fiscal year involved by an amount equal 
to 10 percent of the amount determined under section 1918 
for the State for the fiscal year. 
"(2) SUBSTANTLU. IMPLEMENTATION AND GOOD FAITH EFFORT 
REGARDING FISCAL YEAR 1993.— 
"(A) In making a grant under section 1911 to a State 
for fiscal year 1993, the Secretary shall make a determina-
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 381 
tion of the extent to which the State has implemented 
the plan required in subsection (a). If the Secretary deter-
mines that the State has not substantially implemented 
the plan, the Secreteiry shall, subject to subparagraph (B), 
reduce the amount of the allotment under section 1911 
for the State for such fiscal year by an amount equal 
to 10 percent of the amount determined under section 
1918 for the State for the fiscal year. 
"(B) In carrying out subparagraph (A), if the Secretary 
determines that the State is making a good faith effort 
to implement the plan required in subsection (a), the Sec-
retary may make a reduction under such subparagraph 
in an amount that is less than the amount specified in 
such subparagraph, except that the reduction may not be 
made in an amount that is less than 5 percent of the 
amount determined under section 1918 for the State for 
fiscal year 1993. 
"SEC. 1913. CERTAIN AGREEMENTS. 
42 USC 300x-2. 
"(a) ALLOCATION FOR SYSTEMS OF INTEGRATED SERVICES FOR CHIL-
DREN.— 
"(1) IN GENERAL.—^With respect to children with a serious 
emotional disturbance, a funding agreement for a grant under 
section 1911 is that— 
"(A) in the case of a grant for fiscal year 1993, the 
State involved will expend not less than 10 percent of 
the grant to increase (relative to fiscal year 1992) funding 
for the system of integrated services described in section 
1912(b)(9); 
"(B) in the case of a grant for fiscal year 1994, the 
State will expend not less than 10 percent of the grant 
to increase (relative to fiscal year 1993) funding for such 
system; £uid 
"(C) in the case of a grant for any subsequent fiscal 
year, the State will expend for such system not less than 
an amount equal to the amount expended by the State 
for fiscal year 1994. 
"(2) WAIVER.— 
- , 
"(A) Upon the request of a State, the Secretary may 
provide to the State a waiver of all or part of the require-
ment established in paragraph (1) if the Secretary deter-
mines that the State is providing an adequate level of 
comprehensive community mental he£dth services for chil-
dren with a serious emotional distrubance, as indicated 
by a comparison of the number of such children for which 
such services are sought with the availability in the State 
of the services. 
"(B) The Secretary shall approve or deny a request for 
a waiver under subparagraph (A) not later than 120 days 
after the date on which the request is made. 
"(C) Any waiver provided by the Secretary imder sub-
paragraph (A) shall be applicable only to the fiscal year 
involved. 
"(b) PROVIDERS OF SERVICES.—A funding agreement for a grant 
under section 1911 for a State is that, with respect to the plan 
submitted under section 1912(a) for the fiscal year involved— 
106 STAT. 382 
PUBLIC LAW 102-321—JULY 10, 1992 
"(1) services under the plan will be provided only through 
appropriate, qualified community programs (which may include 
community mental health centers, child mental-health pro-
grams, psychosocial rehabilitation programs, mental health 
peer-support programs, and mental-health primary consimier-
directed programs); and 
"(2) services under the plan will be provided through commu-
nity mental health centers only if the centers meet the criteria 
specified in subsection (c). 
"(c) CRITERIA FOR MENTAL HEALTH CENTERS.—The criteria 
referred to in subsection (b)(2) regarding community mental health 
centers are as follows: 
"(1) With respect to mental health services, the centers pro-
vide services as follows: 
"(A) Services principally to individuals residing in a 
defined geographic area (hereafter in this subsection 
referred to as a 'service area'). 
"(B) Outpatient services, including specialized outpatient 
services for children, the elderly, individuals with a serious 
mental illness, and residents of the service areas of the 
centers who have been discharged 
fi-om 
inpatient treatment 
at a mental health facility. 
"(C) 24-hour-a-day emergency care services. 
"(D) Day treatment or other partial hospitalization serv-
ices, or psychosocial rehabilitation services. 
"(E) Screening for patients being considered for admission 
to State mental health facilities to determine the appro-
priateness of such admission. 
"(2) The mentgJ health services of the centers are provided, 
within the limits of the capacities of the centers, to any individ-
ual residing or employed in the service area of the center 
regardless of ability to pay for such services. 
"(3) The mental health services of the centers are available 
and accessible promptly, as appropriate and in a manner which 
preserves human dignity and assures continuity and high qual-
ity care. 
42 use 300X-3. 
*«EC. 1914. STATE MENTAL HEALTH PLANNING COUNCH.. 
"(a) IN GENERAL.—^A fiinding agreement for a grant under section 
1911 is that the State involved will establish and maintain a 
State mental health planning council in accordance with the condi-
tions described in this section. 
"(b) DUTIES.—^A condition under subsection (a) for a Council is 
that the duties of the Coimcil are— 
"(1) to review plans provided to the Coimcil pursuant to 
section 1915(a) by the State involved and to submit to the 
State any recommendations of the Council for modifications 
to the plans; 
"(2) to serve as an advocate for adults with a serious mental 
illness, children with a severe emotional disturbance, and other 
individuals with mental illnesses or emotion£d problems; and 
"(3) to monitor, review, and evaluate, not less than once 
each yeeu-, the allocation and adequacy of mental health services 
within the State. 
"(c) MEMBERSHIP.— 
-
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 383 
"(1) IN GENERAL.—^A condition under subsection (a) for a 
Council is that the Council be composed of residents of the 
State, including representatives o
f
— 
"(A) the principal State agencies with respect to— 
"(i) mental health, education, vocationed rehabilita-
tion, criminal justice, housing, and social services; and 
"(ii) the development of the plan submitted pursuant 
to title XIX of the Social Security Act; 
"(B) public and private entities concerned with the need, 
planning, operation, funding, and use of mental health 
services and related support services; 
"(C) adults with serious mental ilhiesses who are receiv-
ing (or have received) mental health services; and 
"(D) the families of such adults or families of children 
with emotional disturbance. 
"(2) CERTAIN REQUIREMENTS.—A condition under subsection 
(a) for a Council is that— 
"(A) with respect to the membership of the Coimcil, the 
ratio of parents of children with a serious emotional dis-
turbance to other members of the Council is sufficient 
to provide adequate representation of such children in the 
deliberations of the Coxmcil; and 
"(B) not less than 50 percent of the members of the 
Council are individuals who are not State employees or 
providers of mental health services. 
"(d) DEFINITION.—For purposes of this section, the term 'Council' 
means a State mental health pl£inning council. 
"SEC. 1915. ADDITIONAL PROVISIONS. 
42 USC 300x-4. 
"(a) REVIEW OF STATE PLAN BY MENTAL HEALTH PLANNING COUN-
CIL.—^The Secretary may make a grant under section 1911 to a 
State only i
f
— 
"(1) the plan submitted imder section 1912(a) with respect 
to the grant has been reviewed by the State mental health 
planning council under section 1914; and 
"(2) the State submits to the Secretary £iny recommendations 
received by the State from such council for modifications to 
the plan (without regard to whether the State has made the 
recommended modifications). 
"(b) MAINTENANCE OF EFFORT REGARDING STATE EXPENDITURES 
FOR M E N T A L H E A L T H . — 
"(1) IN GENERAL.—^A fiinding 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. 
"(2) WAIVER.—^The Secretary may, upon the request of a 
State, waive the requirement established in paragraph (1) if 
the Secretary determines that extraordinary economic condi-
tions in the State justify the waiver. 
"(3) NONCOMPLIANCE BY STATE.— 
"(A) In making a grant imder section 1911 to a State 
for a fiscal year, the Secretary shgdl make a determination 
•
• 
of whether, for the previous fiscal year, the State main-
tained material compliance with the agreement made under 
paragraph (1). If the Secretary determines that a State 
106 STAT. 384 
PUBLIC LAW 102-321—JULY 10, 1992 
has failed to maintain such compliance, the Secretary shall 
reduce the amoimt of the allotment under section 1911 
for the State for the fiscal year for which the grant is 
being made by £in amount equal to the amount constituting 
such failure for the previous fiscal year. 
"(B) The Secretary may make a grant under section 
1911 for a fiscal year only if the State involved submits 
to the Secretary information sufficient for the Secretary 
to make the determination required in subparagraph (A). 
42 use 300X-5. 
"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 expend the grant— 
"(1) to provide inpatient services; 
"(2) to make cash pa3nnents to intended recipients of health 
services; 
"(3) to purchase or improve land, purchase, construct, or 
permanently improve (other than minor remodeling) any build-
mg or other facility, or purchase major medical equipment; 
"(4) to satisfy any requirement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds; 
or 
"(5) to provide financial assistance to any entity other than 
a public or nonprofit private entity. 
"(b) LIMITATION ON ADMINISTRATIVE EXPENSES.—A fiinding agree-
ment for a grant under section 1911 is that the State involved 
will not expend more than 5 percent of the grant for administrative 
expenses with respect to the grant. 
42USC300X-6. 
*«EC. 1917. APPLICATION FOR GRANT. 
"(a) IN GENERAL.—For purposes of section 1911, an application 
for a ^ a n t under such section for a fiscal year in accordance 
with tms section if, subject to subsection (b)— 
"(1) the State involved submits the application not later 
th£in the date specified by the Secretary as being the date 
after which appUcations for such a grant will not be considered 
(in £iny case m which the Secretary specifies such a date); 
"(2) the application contains each fimding agreement that 
is described m this subpart or subpart III for such a grant 
(other than any such agreement that is not applicable to the 
State); 
"(3) the agreements are made through certification fi-om the 
chief executive officer of the State; 
"(4) with respect to such agreements, the application provides 
assurances of compliance satisfactory to the Secretary; 
"(5) the application contains the plan required in section 
1912(a), the information required in section 1915(b)(3XB), and 
the report required in section 1942(a); 
"(6) the appUcation contains recommendations in compliance 
with section 1915(a), or if no such recommendations are 
received by the State, the appUcation otherwise demonstrates 
compliance with such section; and 
"(7) the application (including the plan imder section 1912(a)) 
is otherwise in such form, is made in such manner, and contains 
such agreements, assurances, and information as the Secretary 
determines to be necessary to carry out this subpart. 
"(b) WAIVERS REGARDING CERTAIN TERRITORIES.—In the case of 
any territory of the United States whose allotment under section 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 385 
1911 for the fiscal year is the amount specified in section 
1918(c)(2)(B), the Secretary may waive such provisions of this sub-
part and subpart III as the Secretary determines to be appropriate, 
other than the provisions of section 1916. 
**SEC. 1918. DETERMINATION OF AMOUNT OF ALLOTMENT. 
42 USC 300x-7. 
"(a) STATES.— 
"(1) DETERMINATION UNDER FORMULA.—Subject to subsection 
(b), the Secretary shall determine the amount of the allotment 
required in section 1911 for a State for a fiscal year in accord-
ance with the following formula: 
(i) 
"(2) DETERMINATION OP TERM *A'.—^For purposes of paragraph 
(1), the term *A' means the difference between— 
"(A) the amount appropriated imder section 1920(a) for 
allotments under section 1911 for the fiscal year involved; 
and 
"(B) an amount equal to 1.5 percent of the amount 
referred to in subparagraph (A). 
"(3) DETERMINATION OF TERM *U'.—For purposes of paragraph 
(1), the term TJ' means the sum of the respective terms *
X
* 
determined for the States under paragraph (4). 
"(4) DETERMINATION OF TERM *X'.—For purposes of paragraph 
(1), the term *X' means the product o
f
— 
"(A) an amount equal to the product o
f
— 
"(i) the term *F, as determined for the State involved 
imder paragraph (5); and 
"(ii) the factor determined imder paragraph (8) for 
the State; and 
"(B) the greater o
f
— 
"(i) 0.4; and 
"(ii) an amount equal to an amount determined for 
the State in accordance with the following formula: 
1-.35 ( ^ ) 
"(5) DETERMINATION OF TERM 'P'.— 
"(A) For purposes of paragraph (4), the term *F means 
the sum o
f
— 
"(i) an £uno\uit 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) £in amoimt 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 
25 and 64 years of age (inclusive); and 
59-194 0-98 
14:QL3(I>tl) 
106 STAT. 386 
PUBLIC LAW 102-321—JULY 10, 1992 
"(iv) an amount equal to the product of 0.082 and 
the niunber 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 determination under subpara-
graph (A), the Secretary shall use the most recent data 
that is available from the Secretary of Commerce pursuant 
to the decennial census and pursuant to reasonable esti-
mates by such Secretary of changes occurring in the data 
in the ensuing period. 
"(6) DETERMINATION OF TERM *R%'.— 
"(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 
subpEiragraph (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 o
f
—
• 
"(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 imder paragraph (8) for 
the State. 
"(C) The amoimt determined under this subparagraph 
is the sum of the respective amounts determined for the 
States under subparagraph (B) (including the District of 
Columbia). 
"(D)(i) In the case of the District of Columbia, for pur-
poses of pEiragraph (4), the term *R%' means the percentage 
constituted by the ratio of the amount determined under 
clause (ii) for such District to the amoimt determined under 
clause (iii). 
"(ii) The amount determined under this clause for the 
District of Columbia is the quotient o
f
— 
"(I) the most recent 3-year arithmetic mean of total 
personal income in such District, 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 determined 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 para-
graph (4), the term *P%' means the percentage constituted 
by the ratio of the term T' determined under paragraph (5) 
for the State involved to the sum of the respective terms *F 
determined for the States. 
"(8) DETERMINATION OF CERTAIN FACTOR.— 
"(A) The factor determined under this paragraph for 
the State involved is a factor whose purpose is to adjust 
the amount determined under clause (i) of paragraph (4)(A), 
and the amounts determined under each of subparagraphs 
(B)(i) and (D)(ii)(I) of paragraph (6), to reflect the dif-
ferences that exist between the State and other States 
in the costs of providing comprehensive community mental 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 387 
hesilth services to adults with a serious mental illness 
and to children with a serious emotional disturbance. 
"(B) Subject to subparagraph (C), the factor determined 
under this paragraph and in effect for the fiscal year 
involved shall be determined 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 corporation, pursuant to a contract with the National 
Institute on Drug Abuse. 
"(C) The factor determined under this paragraph for 
the State involved may not for 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 Gener£il, shall in 
accordEince 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 determined shall 
remain in effect through fiscal year 1994, £ind shall be 
recalculated every third fiscal year thereafter. 
"(ii) After consultation with the Comptroller General, Federal 
the Secretary shall, through publication in the Federal ^flication 
Register, periodically make such refinements in the meth- ^ 
odology referred to in subparagraph (B) as are consistent 
with the purpose described in subparagraph (A). 
"(b) MINIMUM ALLOTMENTS FOR STATES.—For each of the fiscal 
years 1993 and 1994, the amoiint of the allotment required in 
section 1911 for a State for the fiscal year involved shall be the 
greater o
f
— 
"(1) the amoimt determined under subsection (a) for the 
State for the fiscal year; and 
"(2) an amoimt equal to 20.6 percent of the amoimt received 
by the State from allotments made pursuant to this part for 
fiscal year 1992 (including reallotments under section 205(a) 
of the ADAMHA Reorganization Act). 
"(c) TERRITORIES.— 
"(1) DETERMINATION UNDER FORMULA.—Subject to paragraphs 
(2) and (4), the Eimount of an allotment under section 1911 
for a territory of the United States for a fiscal year shall 
be the product o
f
— 
"(A) an amount equal to the amoimts reserved under 
paragraph (3) for the fiscal year; and 
"(B) a percentage equal to the quotient o
f
— 
"(i) the civilian population of the territory, as 
indicated by the most recently available data; divided 
by 
"(ii) the aggregate civihan population of the terri-
tories of the United States, as indicated by such data. 
"(2) MINIMUM ALLOTMENT FOR TERRITORIES.—The amount of 
an allotment imder section 1911 for a territory of the United 
States for a fiscal yesir shall be the greater o
f
— 
"(A) the amount determined under paragraph (1) for 
the territory for the fiscal year; and 
"(B) $50,000. 
"(3) RESERVATION OF AMOUNTS.—The Secretary shall each 
fiscal year reserve for the territories of the United States 1.5 
106 STAT. 388 
PUBLIC LAW 102-321—JULY 10, 1992 
. ; percent of the amounts appropriated under section 1920(a) 
for allotments iinder section 1911 for the fiscal year, 
"(4) AVAILABILITY OF DATA ON POPULATION.—With respect 
' 
to data on the civilisin population 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 ch£inge 
occurring during the ensuing period in the population of all 
territories with respect to which recent such data do exist. 
"(5) APPLICABILITY OF CERTAIN PROVISIONS.—For purposes 
of subsection (a), the term 'State' does not include the territories 
of the United States. 
42USC300X-8. 
"SEC. 1919. DEFINITIONS. 
"For purposes of this subpart: 
"(1) The terms 'adults with a serious mental illness' and 
'children with a serious emotional disturbance' have the mean-
ings given such terms under section 1912(c)(1). 
"(2) The term 'funding agreement', with respect to a greuit 
under section 1911 to a State, means that the Secretary may 
make such a grant only if the State makes the agreement 
involved. 
42 use 300X-9. 
"SEC. 1920. FUNDING. 
"(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rying out this subpart, and subpart III and section 505 with respect 
to mental health, there are authorized to be appropriated 
$450,000,000 for fiscal year 1993, and such sums as may be nec-
essary for fiscal year 1994. 
"(b) ALLOCATIONS FOR TECHNICAL ASSISTANCE, DATA COLLECTION, 
AND PROGRAM EVALUATION.— 
"(1) IN GENERAL.—For the purpose of carrying out section 
1948(a) with respect to mental health and the purposes speci-
fied in paragraphs (2) and (3), the Secretary shall obligate 
5 percent of the amounts appropriated imder subsection (a) 
for a 
fiscEil 
year. 
"(2) DATA COLLECTION.—The purpose specified in this para-
graph is carrying out section 505 with respect to mental health. 
"(3) PROGRAM EVALUATION.—The purpose specified in this 
paragraph is the conduct of evaluations of prevention and treat-
ment programs and services with respect to mentsd health 
to determine methods for improving the availability and quality 
of such programs and services.". 
SEC. 202. ESTABLISHMENT OF SEPARATE BLOCK GRANT REGARDING 
SUBSTANCE ABUSE. 
Part B of title XIX of the Public Health Service Act, as amended 
by section 201 of this Act, is amended by adding at the end the 
following: 
^ 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 389 
"Subpart II—Block Grants for Prevention and 
Treatment of Substance Abuse 
"SEC. 1921. FORMULA GRANTS TO STATES. 
42 USC 300x-21. 
"(a) IN GENERAL.—For the purpose described in subsection (b), 
the Secretary, acting through the Center for Substance Abuse Treat-
ment, shall make an allotment each fiscal year for each State 
in an amount determined in accordeince with section 1933. The 
Secretary shall make a grant to the State of the allotment made 
for the State for the fiscal year if the State submits to the Secretary 
an application in accordance with section 1932. 
"(b) AUTHORIZED ACTIVITIES.—^A funding agreement for a grant 
under subsection (a) is that, subject to section 1931, the State 
involved will expend the grant only for the purpose of planning, 
carrying out, and evaluating activities to prevent and treat sub-
stance abuse and for related activities authorized in section 1924. 
"SEC. 1922. CERTAIN ALLOCATIONS. 
42 USC 300x-22. 
"(a) ALLOCATIONS REGARDING ALCOHOL AND OTHER DRUGS.—A 
funding agreement for a grant under section 1921 is that, in expend-
ing the grant, the State involved will expend— 
"(1) not less than 35 percent for prevention and treatment 
activities regarding gilcohol; and 
"(2) not less than 35 percent for prevention and treatment 
activities regarding other drugs. 
"(b) ALLOCATION REGARDING PRIMARY PREVENTION PROGRAMS.— 
A funding agreement for a grant under section 1921 is that, in 
expending the grant, the State involved— 
"(1) will expend not less than 20 percent for programs for 
individuals who do not require treatment for substance abuse, 
which programs— 
"(A) educate and counsel the individuals on such abuse; 
and 
"(B) provide for activities to reduce the risk of such 
abuse by the individu£ils; 
"(2) will, in canying out paragraph (1)— 
"(A) give priority to programs for populations that are 
at risk of developing a pattern of such abuse; and 
"(B) ensure that programs receiving priority imder sub-
paragraph (A) develop community-based strategies for the 
prevention of such abuse, including strategies to discourage 
the use of alcoholic beverages and tobacco products by 
individuals to whom it is unlawful to sell or distribute 
such beverages or products. 
"(c) ALLOCATIONS REGARDING WOMEN.— 
"(1) IN GENERAL.—Subject to peiragraph (2), a funding agree-
ment for a grant imder section 1921 for a fiscal year is that— 
"(A) in the case of a grant for fiscal year 1993, the 
State involved will expend not less than 5 percent of the 
grant to increase (relative to fiscal year 1992) the availabil-
ity of treatment services designed for pregnant women 
and women with dependent children (either by establishing 
new programs or expanding the capacity of existing pro-
grams); 
"(B) in the case of a grant for fiscal year 1994, the 
State will expend not less than 5 percent of the grant 
106 STAT. 390 
PUBLIC LAW 102-321—JULY 10, 1992 
to so increase (relative to fiscal ye£ir 1993) the availability 
of such services for such women; and 
"(C) in the case of a grant for any subsequent fiscal 
year, the State will expend for such services for such women 
not less than an amoiint equal to the amount expended 
by the State for fiscal year 1994. 
"(2) WAIVER.— 
"(A) Upon the request of a State, the Secretary may 
provide to the State a waiver of all or part of the require-
ment established in paragraph (1) if the Secretary deter-
mines that the State is providing an adequate level of 
treatments services for women described in such para-
graph, as indicated by a comparison of the number of 
such women seeking the services with the availability in 
the State of the services. 
"(B) TTie Secretsiry 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 sub-
paragraph (A) shall be applicable only to the fiscal year 
involved. 
"(3) CHILDCARE AND PRENATAL CARE.—A fiinding 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 arrange-
ments with other public or nonprofit private entities, maJce 
available prenatal care to women receiving such services and, 
while the women are receiving the services, childcare. 
42 use 300X-23. 
"SEC. 1923. INTRAVENOUS SUBSTANCE ABUSE. 
"(a) CAPACITY OF TREATMENT PROGRAMS.— 
"(1) NOTIFICATION OF REACHING CAPACITY.—A fimding agree-
ment for a grant under section 1921 is that the State involved 
will, in the case of programs of treatment for intravenous 
drug abuse, require that any such program receiving amoimts 
fi-om the grant, upon reaching 90 percent of its capacity to 
admit individuals to the program, provide to the State a 
notification of such fact. 
"(2) PROVISION OF TREATMENT.—A fimding agreement for a 
grant under section 1921 is that the State involved will, with 
respect to notifications under paragraph (1), ensure that each 
individual who requests and is in need of treatment for intra-
venous drug abuse is admitted to a program of such treatment 
not later than— 
"(A) 14 days after making the request for admission 
to such a program; or 
"(B) 120 days after the date of such request, if no such 
program has the capacity to admit the individual on the 
date of such request and if interim services are made 
available to the mdividual not later than 48 hours after 
such request. 
"(b) OUTREACH REGARDING INTRAVENOUS SUBSTANCE ABUSE.— 
A funding agreement for a grant under section 1921 is that the 
State involved, in providing amounts 
fi*om 
the grant to any entity 
for treatment services for intravenous drug abuse, will require 
the entity to carry out activities to encourage individuals in need 
of such treatment to undergo treatment. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 391 
**SEC. 1924. REQUIREMENTS REGARDING TUBERCULOSIS AND HUMAN 42 USC 300x-24. 
IMMUNODEFICIENCY VIRUS. 
"(a) TUBERCULOSIS.— 
"(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 pro-
gram of treatment for substance abuse— 
"(A) will, directly or through arrangements with other 
public or nonprofit private entities, routinely make avail-
able tuberculosis services to each individual receiving treat-
ment for such abuse; and 
"(B) in the case of an individusd in need of such treatment 
who is denied admission to the program on the basis of 
the lack of the capacity of the progrsim to admit the individ-
ual, will refer the individual to another provider of tuber-
culosis services. 
"(2) TUBERCULOSIS SERVICES.—For purposes of paragraph (1), 
the term 'tuberculosis services', with respect to an individual, 
means— 
"(A) counseling the individual with respect to tuber-
culosis; 
"(B) testing to determine whether the individual has 
contracted such disease and testing to determine the form 
of treatment for the disease that is appropriate for the 
individual; and 
"(C) providing such treatment to the individual. 
"(b) HUMAN IMMUNODEFICIENCY VIRUS.— 
"(1) REQUIREMENT FOR CERTAIN STATES.—In the case of a 
State described in paragraph (2), a funding agreement for a 
grant under section 1921 is that— 
"(A) with respect to individuals undergoing treatment 
for substance abuse, the State will, subject to paragraph 
(3), carry out 1 or more projects to make available to 
the individuals early intervention services for HIV disease 
at the sites at which the individuals are undergoing such 
treatment; 
"(B) for the purpose of providing such early intervention 
services through such projects, the State will make avail-
able from the grant the percentage that is applicable for 
the State under paragraph (4); and 
"(C) the State will, subject to paragraph (5), carry out 
such projects only in geographic areas of the State that 
have the greatest need for the projects. 
"(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 Director of 
the Centers for Disease Control for the most recent calendar 
year for which such data are available). 
"(3) 
USE OF EXISTING PROGRAMS REGARDING SUBSTANCE 
ABUSE.—^With respect to programs that provide treatment serv-
ices for substance abuse, a funding agreement for a grant 
under section 1921 for a designated State is that each such 
program participating in a project imder paragraph (1) will 
be a program that began operation prior to the fiscal yesir 
for which the State is appljong to receive the grant. A program 
106 STAT. 392 
PUBLIC LAW 102-321—JULY 10, 1992 
that so began operation may participate in a project under 
paragraph (1) without regard to whether the program has been 
providing early intervention services for HIV disease. 
"(4) APPLICABLE PERCENTAGE REGARDING EXPENDITURES FOR 
SERVICES.— 
"(A)(i) For purposes of paragraph (1)(B), the percentage 
that is appUcable under this paragraph for a designated 
State is, subject to subparagraph (B), the percentage by 
which the amount of the grant under section 1921 for 
the State for the fiscal year involved is an increase over 
the amount specified in clause (ii). 
"(ii) The amount specified in this clause is the amount 
that was reserved by the designated State involved fi*om 
the allotment of the State under section 1912A for fiscal 
year 1991 in compliance with section 1916(c)(6)(A)(ii) (as 
such sections were in effect for such fiscal year). 
"(B) If the percentage determined under subparagraph 
(A) for a designated State for a fiscal year is less than 
2 percent (including a negative percentage, in the case 
of a State for which there is no increase for purposes 
of such subparagraph), the percentage applicable imder 
this paragraph for the State is 2 percent. If the percentage 
so determined is 2 percent or more, the percentage 
applicable under this paragraph for the State is the per-
centage determined under subparagraph (A), subject to 
not exceeding 5 percent. 
"(5) REQUIREMENT REGARDING RURAL AREAS.— 
"(A) A fimding agreement for a grant under section 1921 
for a designated State is that, if the State will carry out 
2 or more projects \mder paragraph (1), the State will 
carry out 1 such project in a rural area of the State, 
subject to subparagraph (B). 
"(B) The Secretary shall waive the requirement estab-
lished in subparagraph (A) if the State involved certifies 
to the Secretary that— 
"(i) there is insufficient demand in the State to carry 
out a project under paragraph (1) in any rural area 
of the State; or 
"(ii) there are no rural areas in the State. 
"(6) MANNER OF PROVIDING SERVICES.—With respect to the 
provision of early intervention services for HIV disease to an 
individual, a fiinding agreement for a grant under section 1921 
for a designated State is that— 
"(A) such services will be undertaken voluntarily by, 
and with the informed consent of, the individual; and 
"(B) undergoing such services will not be required as 
a condition of receiving treatment services for substance 
abuse or any other services. 
"(7) DEFINITIONS.—For purposes of this subsection: 
"(A) The term 'designated State' means a State described 
in paragraph (2). 
"(B) The term 'early intervention services', with respect 
to HIV disease, means— 
"(i) appropriate pretest counseling; 
"(ii) testing individusds with respect to such disease, 
including tests to confirm the presence of the disease, 
tests to diagnose the extent of the deficiency in the 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 393 
immune system, and tests to provide information on 
appropriate therapeutic measures for preventing and 
treating the deterioration of the immune system and 
for preventing and treating conditions arising from 
the disease; 
"(iii) appropriate post-test counseling; and 
"(iv) providing the therapeutic measures described 
in clause (ii). 
"(C) The term 'HIV disease' means infection with the 
etiologic agent for acquired immune deficiency syndrome. 
"(c) EXPENDITURE OF GRANT FOR COMPLIANCE WITH AGREE-
MENTS.— 
"(1) IN GENERAL.—A grant imder 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 pajrment for any service provided for purposes of 
compliance with this section to the extent that payment has 
been made, or can reasonably be expected to be made, with 
respect to such service— 
"(A) under any State compensation program, imder any 
insurance policy, or vmder any Federal or State health 
benefits program (including the program established in 
title XVIII of the Social Security Act and the program 
established in title XJX of such Act); or 
"(B) by an entity that provides health services on a 
prepaid basis. 
"(d) MAINTENANCE OF EFFORT.—^With respect to services provided 
for by a State for purposes of compliance with this section, a 
funding agreement for a grant under section 1921 is that the 
State will maintain expenditures of non-Federal amounts for such 
services at a level that is not less than average level of such 
expenditures maintained by the State for 2-year period preceding 
the first fiscal year for which the State receives such a grant. 
"(e) APPLICABILITY OF CERTAIN PROVISION.—Section 1931 applies 
to this section (and to each other provision of this subpart). 
''SEC. 1925. GROUP HOMES FOR RECOVERING SUBSTANCE ABUSERS. 42 USC 300x-25. 
"(a) STATE REVOLVING FUNDS FOR ESTABLISHMENT OF HOMES.— 
For fiscal year 1993 and subsequent fiscal years, the Secretary 
may make a grant under section 1921 only if the State involved 
has estabUshed, and is providing for the ongoing operation of, 
a revolving fiind as follows: 
"(1) The purpose of the fund is to make loans for the costs 
of estabUshing programs for the provision of housing in which 
individuals recovering from alcohol or drug abuse may reside 
in groups of not less than 6 individuals. The fund is estabUshed 
directly by the State or through the provision of a grant or 
contract to a nonprofit private entity. 
"(2) The programs are carried out in accordance with guide-
lines issued under subsection (b). 
"(3) Not less than $100,000 is available for the fimd. 
"(4) Loans made from the revolving fiind do not exceed $4,000 
and each such loan is repaid to tiie revolving fiind by the 
residents of the housing involved not later than 2 years after 
the date on which the loan is made. 
106 STAT. 394 
PUBLIC LAW 102-321—JULY 10, 1992 
"(5) Each such loan is repaid by such residents through 
monthly installments, £ind a reasonable penalty is assessed 
for each failure to pay such periodic instsdlments by the date 
specified in the loan agreement involved, 
"(6) Such loans are made only to nonprofit private 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 violates such pro-
hibition will be expelled 
fi*om 
the housing; 
"(C) the costs of the housing, including fees for rent 
and utilities, wiU be paid by the residents of the housing; 
and 
"(D) the residents of the housing will, through a majority 
vote of the residents, otherwise establish policies governing 
residence in the housing, including the manner in which 
applications for residence in the housing are approved. 
"(b) ISSUANCE BY SECRETARY OF GUIDELINES.—The Secretary shall 
ensure that there are in effect guidelines under this subpart for 
the operation of programs described in subsection (a). 
"(c) APPLICABILITY TO TERRITORIES.—The requirements estab-
lished in subsection (a) shall not apply to any territory of the 
United States other than the Commonwealth of Puerto Rico. 
42 use 300X-26. 
"SEC. 1926. STATE LAW REGARDING SALE OF TOBACCO PRODUCTS 
TO INDIVroUALS UNDER AGE OF 18. 
"(a) RELEVANT LAW.— 
"(1) IN GENERAL.—Subject to paragraph (2), for fiscal year 
1994 and subsequent fiscal yesirs, 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 manufac-
turer, retailer, or distributor of tobacco products to sell or 
distribute any such product to any individual under the age 
of 18. 
"(2) DELAYED APPLICABILITY FOR CERTAIN STATES.—In the 
case of a State whose legislature does not convene a regular 
session in fiscal year 1993, and in the case of a State whose 
legislature does not convene a regular session in fiscal year 
1994, the requirement described in paragraph (1) as a condition 
of a receipt of a grant under section 1921 shall apply only 
for fiscal year 1995 and subsequent fiscal years. 
"(b) ENFORCEMENT.— 
"(1) IN GENERAL.—For the first applicable fiscsd year and 
for subsequent fiscal years, 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. 
"(2) ACTIVITIES AND REPORTS REGARDING ENFORCEMENT.—For 
the first applicable fiscal year and for subsequent fiscal years, 
a funding agreement for a grant under section 1921 is that 
the State involved will— 
"(A) annually conduct random, unannounced inspections 
to ensure compliance with the law described in subsection 
(a); and 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 395 
"(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 
individugJs under the age of 18; £ind 
"(iii) the strategies to be utihzed by the State for 
enforcing such law during the fiscal year for which 
the grant is sought. 
"(c) NONCOMPLIANCE OF STATE.—Before making a grant under 
section 1921 to a State for the first applicable fiscal year or any 
subsequent fiscal year, the Secretary shall make a determination 
of whether the State has maintained compliance with subsections 
(a) and (b). If, after notice to the State and an opportunity for 
a hearing, the Secretary determines that the State is not in comph-
ance with such subsections, the Secretary shall reduce the amount 
of the allotment under such section for the State for the fiscal 
year involved by an amount equal to— 
"(1) in the case of the first applicable fiscal year, 10 percent 
of the amoimt determiued under section 1933 for the State 
for the fiscal year; 
"(2) in the case of the first fiscal yeeir following such 
applicable fiscal year, 20 percent of the amount determined 
under section 1933 for the State for the fiscal year; 
"(3) in the case of the second such fiscal year, 30 percent 
of the amount determined under section 1933 for the State 
for the fiscal year; and 
"(4) in the case of the third such fiscal year or any subsequent 
fiscal year, 40 percent of the amount determined under section 
1933 for the State for the fiscal year. 
"(d) DEFINITION.—For purposes of this section, the term 'first 
applicable fiscal year' mesins— 
"(1) fiscal year 1995, in the case of any State described 
in subsection (a)(2); and 
"(2) fiscal year 1994, in the case of any other State. 
"SEC. 1927. TREATMENT SERVICES FOR PREGNANT WOMEN. 
42 USC 300x-27. 
"(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 
fi*om 
such serv-
ices is given preference in admissions to treatment facilities 
receiving funds pursuant to the grant; and 
"(2) will, in carrying out paragraph (1), publicize the availabil-
ity to such women of services fi-om the facilities and the fact 
that the women receive such preference. 
"(b) REFERRALS REGARDING STATES.—A fimding agreement for 
a grant under section 1921 is that, in canying out subsection 
(a)(1)-
"(1) the State involved will require that, in the event that 
a treatment facility has insufficient capacity to provide treat-
ment services to any womein described in such subsection who 
seeks the services 
fi*om 
the facihty, the facility refer the womcin 
to the State; and 
106 STAT. 396 
PUBLIC LAW 102-321—JULY 10, 1992 
• 
"(2) the State, in the case of each woman for whom a referral 
under paragraph (1) is made to the State— 
i 
"(A) will refer the woman to a treatment facility that 
has the capacity to provide treatment services to the 
woman; or 
"(B) will, if no treatment facility has the capacity to 
admit the woman, make available interim services avail-
able to the woman not later than 48 hours after the women 
seeks the treatment services. 
42 use 300X-28. "SEC. 1928. ADDITIONAL AGREEMENTS. 
"(a) IMPROVEMENT OF PROCESS FOR APPROPRIATE REFERRALS FOR 
TREATMENT.—With respect to individuals seeking treatment serv-
ices, a funding agreement for a grant under section 1921 is that 
the State involved will improve (relative to fiscal year 1992) the 
process in the State for referring the individuals to treatixient 
facilities that can provide to the individuals the treatment modahty 
that is most appropriate for the individuals. 
"(b) CONTINUING EDUCATION.—With respect to any facility for 
treatment services or prevention actitivities that is receiving 
amounts fi*om a grant under section 1921, a funding agreement 
for a State for a grant under such section is that continuing edu-
cation in such services or activities (or both, as the case may 
be) will be made available to employees of the facility who provide 
the services or activities. 
"(c) COORDINATION OF VARIOUS ACTIVITIES AND SERVICES.—A 
funding agreement for a grant under section 1921 is that the 
State involved will coordinate prevention and treatment activities 
with the provision of other appropriate services (including health, 
social, correctional and criminal justice, educational, vocational 
rehabilitation, and employment services). 
"(d) WAIVER OF REQUIREMENT.— 
"(1) IN GENERAL.—Upon the request of a State, the Secretary 
may provide to a State a waiver of any or all of the require-
ments established in this section if the Secretary determines 
that, with respect to services for the prevention and treatment 
of substance abuse, the requirement involved is lumecessary 
for maintaining quality in the provision of such services in 
the State. 
"(2) DATE CERTAIN FOR ACTING UPON REQUEST.—The Sec-
retary shall approve or deny a request for a waiver imder 
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 peiragraph (1) shall be appUcable only to the 
fiscal year involved. 
42 use 300X-29. 
"SEC. 1929. SUBMISSION TO SECRETARY OF STATEWIDE ASSESSMENT 
OF NEEDS. 
"The Secretary may make a grant imder section 1921 only if 
the State submits to the Secreteiry an assessment of the need 
in the State for authorized activities (which assessment is conducted 
in accordance with criteria issued by the Secretary), both by locahty 
and by the State in general, which assessment includes a description 
o
f
— 
"(1) the incidence and prevalence in the State of drug abuse 
and tiie incidence and prevalence in the State of alcohol abuse 
and alcoholism; 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 397 
"(2) current prevention and treatment activities in the State; 
"(3) the need of the State for technical assistance to carry 
out such activities; 
"(4) efforts by the State to improve such activities; and 
"(5) the extent to which the availabiUty of such activities 
is insufficient to meet the need for the activities, the interim 
services to be made available under sections 1923(a) and 
1927(b), and the manner in which such services are to be 
so av£dlable. 
««EC. 1930. MAINTENANCE OF EFFORT REGARDING STATE EXPENDI- 42 USC 300x-30. 
TURES. 
"(a) IN GENERAL.—^With respect to the principal agency of a 
State for carrying out authorized activities, a funding agreement 
for a grant under section 1921 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 esqpenditures maintained by the 
State for the 2-year period preceding the fiscal year for which 
the State is applying for the grant. 
"(b) WAIVER.— 
"(1) IN GENERAL.—Upon the request of a State, the Secretary 
may waive all or part of the requirement established in sub-
section (a) if the Secretary determines that extraordinary eco-
nomic conditions in the State justify the waiver. 
"(2) DATE CERTAIN FOR ACTING UPON REQUEST.—The Sec-
retary sh£dl approve or deny a request for a waiver under 
paragraph (1) not later than 120 days after the date on which 
the request is made. 
"(3) APPLICABILITY OF WAIVER.—^Any waiver provided by the 
Secretary under paragraph (1) shall be applicable only to the 
fiscal year involved. 
"(c) NONCOMPLIANCE BY STATE.— 
"(1) IN GENERAL.—In making a grant under section 1921 
to a State for a fiscal year, the Secretary shall make a deter-
mination of whether, for the previous fiscal year, the State 
maintained material compliance with any agreement made 
under subsection (a). If the Secretary determines that a State 
has failed to maintain such compliance, the Secretary shall 
reduce the simount of the allotment under section 1921 for 
the State for the fiscal year for which the grant is being 
made by an amount equal to the amount constituting such 
failure for the previous fiscal year. 
"(2) SUBMISSION OF INFORMATION TO SECRETARY.—The Sec-
retary may make a grant imder section 1921 for a fiscal year 
only if the State involved submits to the Secretary information 
sufficient for the Secretary to make the determination required 
in paragraph (1). 
"SEC 1931. RESTRICTIONS ON EXPENDITURE OF GRANT. 
42 USC 300x-31. 
"(a) IN GENERAL.— 
"(1) CERTAIN RESTRICTIONS.—^A funding agreement for a grant 
imder section 1921 is that the State involved will not expend 
the grant— 
"(A) to provide rapatient hospital services, except as pro-
vided in subsection (b); 
"(B) to make cash payments to intended recipients of 
health services; 
106 STAT. 398 
PUBLIC LAW 102-321—JULY 10, 1992 
"(C) to purchase or improve leind, purchase, 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 expenditure of 
non-Federal funds as a condition for the receipt of Federal 
funds; 
"(E) to provide financial assistance to any entity other 
than a public or nonprofit private entity; or 
"(F) to cany out any progrema prohibited by section 256(b) 
of the Health Omnibus Programs Extension of 1988 (42 
U.S.C. 300ee-5). 
"(2) LIMITATION ON ADMINISTRATIVE EXPENSES.—A funding 
agreement for a grant under section 1921 is that the State 
involved will not expend more than 5 percent of the grant 
to pay the costs of administering the grant. 
"(3) 
LIMITATION REGARDING PENAL AND CORRECTIONAL 
INSTITUTIONS,—^A fimding 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 
mstitutions of the State, the State will not expend more than 
an amoimt equal to the amount expended for such purpose 
by the State fi'om the grant made imder 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.— 
"(1) MEDICAL NECESSITY AS PRECONDITION.—With respect to 
compUance 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 abuse 
only if it has been determined, in accordance with guidelines 
issued by the Secretary, that such treatment is a medical 
necessity for the individual involved, and that the individusd 
cannot be effectively treated in a commimity-based, nonhospital, 
residential program of treatment. 
"(2) RATE OF PAYMENT.—In the case of £ui individual for 
whom a grant imder section 1921 is expended to provide 
inpatient hospital services described in paragraph (1), a mnding 
agreement for the grant for the State involved is that the 
daily rate of payment provided to the hospital for providing 
the services to the individual will not exceed the comparable 
daily rate provided for community-based, nonhospital, residen-
tial programs of treatment for substance abuse. 
"(c) WAIVER REGARDING CONSTRUCTION OF FACILITIES.— 
"(1) IN GENERAL.—^The Secretary may provide to any State 
a wsdver of the restriction established in subsection (a)(1)(C) 
for the purpose of authorizing the State to expend a grant 
under section 1921 for the construction of a new facility or 
rehabilitation of an existing facility, but not for land acquisition. 
"(2) STANDARD REGARDING NEED FOR WAIVER.—The Secretary 
may approve a waiver under paragraph (1) only if the State 
demonstrates to the Secretary that adequate treatment cannot 
be provided through the use of existing facilities and that 
alternative facilities in existing suitable buildings are not avail-
able. 
"(3) AMOUNT.—In greinting a waiver under paragraph (1), 
the Secretary shall allow the use of a specified amoimt of 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 399 
fiinds to construct or rehabilitate a specified number of beds 
for residential treatment and a specified number of slots for 
outpatient treatment, based on reasonable estimates by the 
State of the costs of construction or rehabilitation. In consider-
ing 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 
imder paragraph (1) only if the State 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 con-
tributions in cash toward such costs in an amount equal to 
not less than $1 for each $1 of Federal funds provided imder 
section 1921. 
"(5) DATE CERTAIN FOR ACTING UPON REQUEST.—The Sec-
retary shall act upon a request for a waiver imder paragraph 
(1) not later than 120 days after the date on which the request 
is made. 
"SEC. 1932. APPLICATION FOR GRANT; APPROVAL OF STATE PLAN. 42 USC 300x-32. 
"(a) IN GENERAL.—For purposes of section 1921, an application 
for a grant under such section for a fiscal year is in accordsince 
with this section if, subject to subsections (c) £ind (d)(2)— 
"(1) the State involved submits the application not later 
than the date specified by the Secretary; 
"(2) the application contains each funding agreement that 
is described in this subpart or subpart III for such a grant 
(other than any such agreement that is not applicable to the 
State); 
"(3) the agreements are made through certification fi*om the 
chief executive officer of the State; 
"(4) with respect to such agreements, the application provides 
assurances of compliance satisfactory to the Secretary; 
"(5) the application contains the information required in sec-
tion 1929, the information required in section 1930(c)(2), and 
the report required in section 1942(a); 
"(6)(A) the application contains a plan in accordance with 
subsection (b) and the plsin is approved by the Secretary; and 
"(B) the State provides assurances satisfactory to the Sec-
retary 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, assurances, and information as the Secreteiry 
determines to be necessary to carry out this subpart. 
"(b) STATE PLAN.— 
"(1) IN GENERAL.—^A plan submitted by a State under sub-
section (a)(6) is in accordance with this subsection if the plan 
contains detailed provisions for compl3dng with each funding 
agreement for a grant under section 1921 that is applicable 
to the State, including a description of the manner m which 
the State intends to expend the grant. 
"(2) AUTHORITY OF SECRETARY REGARDING MODIFICATIONS.— 
As a condition of making a grant under section 1921 to a 
State for a fiscal year, the Secretary may require tiiat the 
106 STAT. 400 
PUBLIC LAW 102-321—JULY 10, 1992 
State modify any provision of the plan submitted by the State 
imder subsection (a)(6) (including provisions on priorities in 
carrying out authorized activities). If the Secretary approves 
the plan and makes the grant to the State for the fiscal year, 
the Secretary may not during such year require the State 
to modify the plan. 
"(3) AUTHORITY OF CENTER FOR SUBSTANCE ABUSE PREVEN-
TION.—^With respect to plans submitted by the States imder 
subsection (a)(6), the Secretary, acting through the Director 
of the Center for Substance Abuse Prevention, shall review 
and approve or disapprove the provisions of the plans that 
relate to prevention activities. 
"(c) WAIVERS REGARDING CERTAIN TERRITORIES.—In the case of 
any territory of the United States whose allotment under section 
1921 for the fiscal year is the amount specified in section 
1933(c)(2)(B), the Secretary may waive such provisions of this sub-
part and subpart III as the Secretary determines to be appropriate, 
other than the provisions of section 1931. 
"(d) 
ISSUANCE OF REGULATIONS; PRECONDITION TO MAKING 
GRANTS.— 
"(1) REGULATIONS.—Not later than August 25, 1992, the Sec-
retary, acting as appropriate through the Director of the Center 
for Treatment Improvement or the Director of the Center for 
Substance Abuse Prevention, shall by regulation estabhsh 
standards specifying the circumstances in which the Secreteiry 
will consider an application for a grant imder section 1921 
to be in accordance with this section. 
"(2) ISSUANCE AS PRECONDITION TO MAKING GRANTS.—The 
Secretary may not make payments under any grsint under 
section 1921 tor fiscal year 1993 on or after January 1, 1993, 
imless the Secretary has issued standards under paragraph 
(1). 
42 use 300X-33. 
**SEC. 1933. DETERMINATION OF AMOUNT OF ALLOTMENT. 
"(a) STATES.— 
"(1) IN GENERAL.^Subject to subsection (b), the Secretary 
shall determine the amount of the allotment required in section 
1921 for a State for a fiscal year as follows: 
"(A) The formula established in paragraph (1) of section 
1918(a) shall apply to this subsection to the same extent 
and in the same manner as the formula applies for purposes 
of section 1918(a), except that, in the appUcation of such 
formula for purposes of this subsection, me modifications 
described in subparagraph (B) shall apply. 
"(B) For purposes of subparagraph (A), the modifications 
described in this subparagraph are as follows: 
"(i) The amoimt specified in paragraph (2)(A) of sec-
tion 1918(a) is deemed to be the amount appropriated 
imder section 1935(a) for allotments under section 1921 
for the fiscal year involved. 
"(ii) The term T' is deemed to have the meaning 
given in paragraph (2) of this subsection. Section 
1918(a)(5)(B) applies to the data used in determining 
such term for the States. 
"(iii) The factor determined under paragraph (8) of 
section 1918(a) is deemed to have the purpose of reflect-
ing the differences that exist between the State 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT, 401 
involved and other States in the costs of providing 
authorized services. 
"(2) DETERMINATION OF TERM 'P*.—For purposes of this sub-
section, the term T'means the percentage that is the arithmetic 
mean of the percentage determined imder subparagraph (A) 
and the percentage determined under subparagraph (B), as 
follows: 
"(A) The percentage constituted by the ratio o
f
— 
"(i) an amount equal to the sum of the total number 
of individuals who reside in the State involved and 
are between 18 and 24 years of age (inclusive) and 
the number of individuals in the State who reside 
in urbanized areas of the State and are between such 
years of age; to 
"(ii) an amount equal to the total of the respective 
simis determined for the States under clause (i). 
"(B) The percentage constituted by the ratio o
f
— 
"(i) the total niunber of individuals in the State 
who are between 25 and 64 years of age (inclusive); 
to 
"(ii) an amount equal to the sum of the respective 
amounts determined for the States under clause (i). 
"(b) MINIMUM ALLOTMENTS FOR STATES.—For each of the fiscal 
years 1993 and 1994, the amount of the allotment required in 
section 1921 for a State for the fiscal year involved shall be the 
greater o
f
— 
"(1) the amount determined under subsection (a) for the 
State for the fiscal year; and 
"(2) an amount equal to 79.4 percent of the amoimt received 
by the State fi-om allotments made pursuant to this part for 
fiscal year 1992 (including reallotments under section 205(a) 
of the ADAMHA Reorganization Act). 
"(c) TERRITORIES.— 
"(1) DETERMINATION UNDER FORMULA.—Subject to paragraphs 
(2) and (4), the amount of an allotment under section 1921 
for a territory of the United States for a fiscal year shall 
be the product o
f
— 
"(A) an amoimt equal to the amoimts reserved xinder 
pgiragraph (3) for the fiscal year; and 
"(B) a percentage equal to the quotient o
f
— 
"(i) the civilian population of the territory, as 
indicated by the most recently available data; divided 
by 
"(ii) the aggregate civilian population of the terri-
tories of the United States, as indicated by such data. 
"(2) MINIMUM ALLOTMENT FOR TERRITORIES.—The amount of 
an allotment under section 1921 for a territory of the United 
States for a fiscal year shall be the greater o
f
— 
"(A) the amount determined under paragraph (1) for 
the territory for the fiscal year; and 
"(B) $50,000. 
"(3) RESERVATION OF AMOUNTS.—The Secretary shall each 
fiscal year reserve for the territories of the United States 1.5 
percent of the amounts appropriated imder section 1935(a) 
for allotments under section 1921 for the fiscal year. 
"(4) AVAILABILITY OF DATA ON POPULATION.—With respect 
to data on the civilian population of the territories of the 
106 STAT. 402 
PUBLIC LAW 102-321—JULY 10, 1992 
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 PROVISIONS.—For purposes 
of subsections (a) and (b), the term 'State' does not include 
the territories of the United States. 
"(d) INDIAN TRIBES AND TRIBAL ORGANIZATIONS.— 
"(1) IN GENERAL.—If the Secretary— 
"(A) receives a request from the governing body of an 
Indian tribe or tribal organization within any State that 
• 
funds under this subpart be provided directly by the Sec-
retary to such tribe or organization; and 
J 
"(B) makes a determination that the members of such 
tribe or tribal organization would be better served by means 
of grants made directly by the Secret£iry under this; 
the Secretary shall reserve from the allotment under section 
1921 for the State for the fiscal year involved £in amount 
that bears the same ratio to the allotment as the gimount 
provided under this subpart to the tribe or tribal organization 
for fiscal year 1991 for activities relating to the prevention 
and treatment of the abuse of alcohol and other drugs bore 
to the amount of the portion of the allotment under this subpart 
for the State for such fiscal year that was expended for such 
activities. 
"(2) 
TRIBE OR TRIBAL ORGANIZATION AS GRANTEE.—The 
amount reserved by the Secretary on the basis of a determina-
tion under this paragraph shall be granted to the Indian tribe 
or tribal organization serving the individuals for whom such 
a determination has been made. 
"(3) APPLICATION.—In order for an Indian tribe or tribal 
organization to be eligible for a grant for a fiscal year under 
this paragraph, it shall submit to the Secretary a plan for 
- 
such fiscal year that meets such criteria as the Secretary may 
prescribe. 
"(4) DEFINITION.—The terms 'Indian tribe' and tribal 
organization' have the same meaning given such terms in sub-
sections (b) and (c) of section 4 of the Indian Self-Determination 
and Education Assistance Act. 
42 use 300X-34. <«SEC. 1934. DEFINITIONS. 
"For purposes of this subpart: 
"(1) ITie term 'authorized activities', subject to section 1931, 
means the activities described in section 1921(b). 
"(2) The term funding agreement', with respect to a grant 
under section 1921 to a State, means that the Secretary may 
make such a grant only if the State makes the agreement 
involved. 
"(3) The term 'prevention activities', subject to section 1931, 
means activities to prevent substance abuse. 
"(4) The term 'substance abuse' means the abuse of alcohol 
or other drugs. 
, 
-^ 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 403 
"(5) The term 'treatment activities' mesms treatment services 
and, subject to section 1931, authorized activities that are 
related to treatment services. 
"(6) The term 'treatment facility* means an entity that pro-
vides treatment services. 
"(7) The term 'treatment services', subject to section 1931, 
means treatment for substance abuse. 
"SEC. 1935. FUNDING. 
42 USC 300x-35. 
"(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rying out this subpart, subpart III and section 505 with respect 
to substsuice abuse, and section 515(d), there are authorized to 
be appropriated $1,500,000,000 for fiscal year 1993, and such sums 
as may be necessary for fiscal year 1994. 
"(b) ALLOCATIONS FOR TECHNICAL ASSISTANCE, NATIONAL DATA 
BASE, DATA COLLECTION, AND PROGRAM EVALUATIONS.— 
"(1) IN GENERAL.— 
"(A) For the purpose of carrying out section 1948(a) with 
respect to substance abuse, section 515(d), and the purposes 
specified in subparagraphs (B) and (C), the Secretary shall 
obligate 5 percent of the amounts appropriated under sub-
section (a) each 
fiscsil 
yesir. 
"(B) The purpose specified in this subparagraph is the 
collection of data in this paragraph is carrying out section 
505 with respect to substance abuse. 
"(C) The purpose specified in this subparagraph is the 
conduct of evaluations of authorized activities to determine 
methods for improving the availabihty and quality of such 
activities. 
"(2) ACTIVITIES OF CENTER FOR SUBSTANCE ABUSE PREVEN-
TION.—Of the amoimts reserved xinder paragraph (1) for a 
fiscal year, the Secretary, acting through the Director of the 
Center for Substance Abuse Prevention, shall obligate 20 per-
cent for carrying out paragraph (1)(C), section 1949(a) with 
respect to prevention activities, and section 515(d).". 
SEC. 
203. 
GENERAL 
PROVISIONS 
REGARDING 
BLOCK 
GRANTS. 
(a) IN GENERAL.—Part B of title X
D
C of the Public Health Service 
Act, as amended by section 202 of this Act, is amended by adding 
at ttie end the following: 
^Subpart III—General Provisions 
"SEC. 1941. OPPORTUNITY FOR PUBUC COMMENT ON STATE PLANS. 
42 USC 300x-51. 
"A fimding agreement for a grant under section 1911 or 1921 
is that the State involved will make the plan required in section 
1912, and the plan required in section 1932, respectively, public 
within the State in such manner as to facilitate comment fi-om 
any person (including any Federal or other pubUc agency) during 
the development of the plan (including any revisions) and after 
the submission of the plan to the Secretary. 
«SEC. 1942. REQUIREMENT OF REPORTS AND AUDITS BY STATES. 
42 USC 300x-52. 
"(a) REPORT.—^A fimding agreement for a grant under section 
1911 or 1921 is that the State involved will submit to the Secretary 
a report in such form and containing such information as the 
Secretary determines (aft»r consultation with the States and the 
106 STAT. 404 
PUBLIC LAW 102-321—JULY 10, 1992 
Comptroller General) to be necessary for securing a record and 
a description o
f
— 
"(1) the purposes for which the grant received by the State 
for the preceding fiscal year under the program involved were 
expended and a description of the activities of the State under 
the program; and 
"(2) the recipients of amounts provided in the grant. 
"(b) AUDITS.—^A funding agreement for a grant under section 
1911 or 1921 is that the State will, with respect to the grant, 
comply with chapter 75 of title 31, United States Code. 
"(c) AVAILABILITY TO PUBLIC.—^A funding agreement for a grant 
under section 1911 or 1921 is that the State involved will— 
"(1) make copies of the reports and audits described in this 
section available for public inspection within the State; and 
"(2) provide copies of the report imder subsection (a), upon 
request, to any interested person (including any public agency). 
42 use 300X-53. «SEC. 1943. ADDITIONAL REQUIREMENTS. 
"(a) IN GENERAL.—^A funding agreement for a grant under section 
1911 or 1921 is that the State involved will— 
"(1)(A) for the fiscal year for which the grant involved is 
provided, provide for independent peer review to assess the 
quality, appropriateness, and efficacy of treatment services pro-
vided in the State to individuals under the program involved; 
and 
"(B) ensure that, in the conduct of such peer review, not 
fewer than 5 percent of the entities providing services in the 
State under such program are reviewed (wMch 5 percent is 
representative of the total population of such entities); 
"(2) permit and cooperate with Federal investigations under-
taken m accordance with section 1945; and 
"(3) provide to the Secretary any data required by the Sec-
retary pursuant to section 515 and will cooperate with the 
Secretary in the development of uniform criteria for the collec-
tion of data pursuant to such section. 
"(b) PATIENT RECORDS.—The Secretary may make a grant under 
section 1911 or 1921 only if the State involved has in effect a 
system to protect fi*om inappropriate disclosure patient records 
maintained by the State in connection with an activity fiinded 
under the program involved or by any entity which is receiving 
amounts 
fi*om 
me grsuit. 
42 use 300X-54. "SEC. 1944. DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR 
ALLOTMENTS. 
"(a) IN GENERAL.—^Amounts described in subsection (b) and avail-
able for a fiscal year pursuant to section 1911 or 1921, as the 
case may be, shall be allotted by the Secretary and paid to the 
States receiving a grant imder the program involved, other than 
any State referred to in subsection (b) with respect to such program. 
Such amounts shall be allotted in a manner equivalent to the 
meinner in which the allotment imder 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 o
f
— 
"(A) the failure of any State to submit an application 
in accordance with the program; 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 405 
"(B) the failure of any State to prepare 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 1945; 
"(3) in the case of the program established in section 1911, 
are aveiilable as a result of reductions in gdlotments imder 
such section pursuant to section 1912(d) or 1915(b); or 
"(4) in the case of the program established in section 1921, 
are available as a result of reductions in allotments under 
such section pursuant to section 1926 or 1930. 
"SEC. 1945. FAILURE TO COMPLY WITH AGREEMENTS. 
42 USC 300x-55. 
"(a) SUSPENSION OR TERMINATION OF PAYMENTS.—Subject to sub-
section (e), if the Secretary determines that a State has materially 
failed to comply with the agreements or other conditions required 
for the receipt of a grant under the program involved, the Secretary 
may in whole or in part suspend payments under the grant, termi-
nate the grant for cause, or employ such other remedies (including 
the remedies provided for in subsections (b) and (c)) as may be 
legally available Eind appropriate in the circumstances involved. 
"(b) REPAYMENT OF PAYMENTS.— 
"(1) IN GENERAL.—Subject to subsection (e), the Secretary 
' 
may require a State to repay with interest any pa5nnents 
received by the State under section 1911 or 1921 that the 
Secretary determines were not expended by the State in accord-
ance with the agreements required imder the program involved. 
"(2) OFFSET AGAINST PAYMENTS.—If a State fails to make 
a repajonent required in paragraph (1), the Secretary may 
offset the amount of the repajonent against the amount of 
any pajonent due to be paid to the State imder the program 
involved. 
"(c) WITHHOLDING OF PAYMENTS.— 
"(1) IN GENERAL.—Subject to subsections (e) and (g)(3), the 
Secretary may withhold pa5anents due \inder section 1911 or 
1921 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 psiragraph 
(1) if the Secretary determines that there are reasonable assur-
ances that the State will expend amounts received under the 
program involved in accordance with the agreements required 
under the progrsim. 
"(d) APPLICABILITY OF REMEDIES TO CERTAIN VIOLATIONS.— 
"(1) IN GENERAL.—^With respect to agreements or other condi-
tions for receiving a grant under the progr£im involved, in 
the case of the failure of a State to maintain material compli-
ance with a conation referred to in paragraph (2), the provi-
sions for noncompUance with the condition that are provided 
in the section estabUshing the condition shall apply in lieu 
of subsections (a) through (c) of this section. 
"(2) RELEVANT CONDITIONS.—For purposes of paragraph (1): 
"(A) In the case of the program estabhshed in section 
1911, a condition referred to in this paragraph is the condi-
106 STAT. 406 
PUBLIC LAW 102-321—JULY 10, 1992 
tion established in section 1912(d) and the condition estab-
Hshed in section 1915(b). 
"(B) In the case of the program estabUshed in section 
1921, a condition referred to in this paragraph is the condi-
tion estabhshed in section 1926 and the condition estab-
Hshed in section 1930. 
"(e) OPPORTUNITY FOR HEARING.—Before taking action against 
a State luider any of subsections (a) through (c) (or under a section 
referred to in subsection (d)(2), as the case may be), the Secretary 
shall provide to the State involved adequate notice and an oppor-
tunity for a hearing. 
"(f) REQUIREMENT OF HEARING IN CERTAIN CIRCUMSTANCES.— 
"(1) IN GENERAL.—If the Secretary receives a complaint that 
a State has failed to maintain material compliance with the 
agreements or other conditions required for receiving a grant 
under the program involved (including any condition referred 
to for purposes of subsection (d)), and there appears to be 
reasonable evidence to support the complaint, the Secretary 
shall promptly conduct a hearing with respect to the complaint. 
"(2) FINDING OF MATERIAL NONCOMPLIANCE.—If in a hearing 
luider paragraph (1) the Secretary finds that the State involved 
has failed to maintain material compliance with the agreement 
or other condition involved, the Secretary shall take such action 
\mder this section as may be appropriate to ensure that mate-
rial compliance is so maintained, or such action as may be 
required in a section referred to in subsection (d)(2), as the 
case may be. 
"(g) CERTAIN INVESTIGATIONS.— 
"(1) REQUIREMENT REGARDING SECRETARY.—The Secretary 
shall in fiscal year 1994 and each subsequent fiscal year conduct 
in not less than 10 States investigations of the expenditure 
of grants received by the States under section 1911 or 1921 
in order to evaluate compliance with the agreements required 
under the program involved. 
"(2) PROVISION OF RECORDS ETC. UPON REQUEST.—Each State 
receiving a greint under section 1911 or 1921, and each entity 
receiving funds fi-om the grant, shall make appropriate books, 
documents, papers, and records available to the Secretary or 
the Comptroller General, or any of their duly authorized rep-
resentatives, for examination, copying, or mechanical reproduc-
tion on or off the premises of the appropriate entity upon 
a reasonable request therefor. 
"(3) LIMITATIONS ON AUTHORITY.—The Secretary may not 
institute proceedings under subsection (c) imless the Secretary 
has conducted an investigation concerning whether the State 
has expended pajonents under the program involved in accord-
ance with the agreements required \mder the program. Any 
such investigation shall be conducted within the State by quali-
fied investigators. 
42 use 300X-56. 
"SEC. 1946. 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 fiimislung of items or services ^ 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 407 
for which payments may be made by a State from a grant 
made to the State under section 1911 or 1921. 
"(2) CONCEALING OR FAILING TO DISCLOSE CERTAIN EVENTS.— 
A person with knowledge of the occurrence of any event affect-
ing the initial or continued right of the person to receive any 
pajmaents from a grant made to a State imder section 1911 
or 1921 shall not conceal or fail to disclose any such event 
with an intent fraudulently to secure such pa5rment 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. 1947. NONDISCRIMINATION. 
42 USC 300x-57. 
"(a) IN GENERAL.— 
"(1) RULE OF CONSTRUCTION REGARDING CERTAIN CIVIL RIGHTS 
LAWS.—For the purpose of appl5dng the prohibitions against 
discrimination on the basis of age imder the Age Discrimination 
Act of 1975, on the basis of handicap imder section 504 of 
the Rehabilitation Act of 1973, on the basis of sex under title 
IX of the Education Amendments of 1972, or on the basis 
of race, color, or national origin under title VI of the Civil 
Rights Act of 1964, programs and activities funded in whole 
or in part with funds made available under section 1911 or 
1921 shall be considered to be programs and activities receiving 
Federal financial assistance. 
"(2) PROHIBITION.—No person shall on the ground of sex 
(including, in the case of a woman, on the ground that the 
woman is pregnant), or on the ground of religion, be excluded 
from participation in, be denied the benefits of, or be subjected 
to discrimination under, any progrsun or activity funded in 
whole or in part with funds made available under section 
1911 or 1921. 
"(b) ENFORCEMENT.— 
"(1) REFERRALS TO ATTORNEY GENERAL AFTER NOTICE.—When-
ever the Secretary finds that a State, or an entity that has 
received a payment pursuant to section 1911 or 1921, 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 compli-
ance. If within a reasonable period of time, not to exceed 
60 days, the chief executive officer fails or refuses to secure 
complieuice, 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 Amend-
ments 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. 
106 STAT. 408 
PUBLIC LAW 102-321—JULY 10, 1992 
"(2) AUTHORITY OF ATTORNEY GENERAL.—When a matter is 
referred to the Attorney General pursuant to paragraph (IXA), 
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. 
42 u s e 300X-58. «SEC. 1948. TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES 
AND SERVICES IN LIEU OF GRANT FUNDS. 
"(a) TECHNICAL ASSISTANCE.—The Secretary shall, without charge 
to a State receiving a grant under section 1911 or 1921, provide 
to the State (or to any public or nonprofit private entity within 
the State) technical assistance with respect to the planning, develop-
ment, 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 section 1911 or 1921, the Secretary may, subject 
to paragraph (2), provide supplies, equipment, and services 
for the purpose of aiding the State in canying out the program 
involved and, for such purpose, may detail to the State any 
officer or employee of the Department of Health and Himian 
Services. 
"(2) CORRESPONDING REDUCTION IN PAYMENTS.—With respect 
to a request described in paragraph (1), the Secretly shall 
reduce the amount of pajrments under the program involved 
to the State by an amount equal to the costs of detailing 
personnel and the fsdr 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. 
42 u s e 300X-59. 
^^EC. 1949. REPORT BY SECRETARY. 
"Not later than January 24, 1994, the Secretary shall submit 
to the Committee on Energy and Commerce of the House of Rep-
resentatives, and to the Committee on Labor and Human Resources 
of the Senate, a report on the activities of the States carried 
out pursuant to the programs established in sections 1911 and 
1921. Such report may include any recommendations of the Sec-
retary for appropriate changes in legislation. 
42 u s e 300X-60. 
«SEC. 1960. RULE OF CONSTRUCTION REGARDING DELEGATION OF 
AUTHORITY TO STATES. 
"With respect to States receiving grants under section 1911 or 
1921, 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. 
42 u s e 300X-61. 
'<SEC. 1961. SOLICITATION OF VIEWS OF CERTAIN ENTITIES. 
"In carrying out this part, the Secretary, as appropriate, shall 
soUcit the views of the States and other appropriate entities. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 409 
Hawaii. 
42 use 300X-63. 
'^EC. 1952. AVAILABILITY TO STATES OF GRANT PAYMENTS. 
42 USC 300x-62. 
"(a) IN GENERAL.—Subject to subsection (b), any amounts paid 
to a State under the program involved shall be available for obliga-
tion imtil the end of the fiscal year for which the amounts were 
paid, and if obUgated by the end of such year, shall remain available 
for expenditure until the end of the succeeding fiscal year. 
"(b) EXCEPTION REGARDING NONCOMPLIANCE OF SUBGRANTEES.— 
If a State has in accordance with subsection (a) obUgated amounts 
paid to the State under the program involved, in any case in 
which the Secretary determines that the obligation consists of a 
grant or contract awarded by the State, and that the State has 
terminated or reduced the amount of such financial assistance 
on the basis of the failure of the recipient of the assistance to 
comply with the terms upon which the assistance was conditioned— 
"(1) the amoimts mvolved shall be available for reobUgation 
by the State through September 30 of the fiscal year following 
the fiscal year for which the amoimts were paid to the State; 
and 
"(2) any of such amoimts that are obligated by the State 
in accordance with paragraph (1) shall be available for expendi-
ture through such date. 
•«EC. 1953. CONTINUATION OF CERTAIN PROGRAMS. 
"(a) IN GENERAL.—Of the simount sJlotted to the State of Hawaii 
under section 1911, and the amount allotted to such State under 
section 1921, an amount equal to the proportion of Native Hawai-
ians residing in the State to the total population of the State 
shall be available, respectively, for carrying out the program 
involved for Native Hawaiians. 
"(b) EXPENDITURE OF AMOUNTS.—The amount made available 
under subsection (a) may be expended only through contracts 
entered into by the State of Hawaii with public and private non-
profit organizations to enable such organizations to plan, conduct, 
and administer comprehensive substance abuse and treatment pro-
grams for the benefit of Native Hawaiians. In entering into contracts 
under this section, the State of Hawaii shall give preference to 
Native Hawaiian organizations and Native Hawaiian health cen-
ters. 
"(c) DEFINITIONS.—For the purposes of this subsection, the terms 
*Native Hawaiian', 'Native Hawaiian organization', and 'Native 
Hawaiian health center' have the meaning given such terms in 
section 2308 of subtitle D of title II of the Anti-Drug Abuse Act 
of 1988. 
"SEC. 1954. DEFINITIONS. 
42 USC 300x-64. 
"(a) DEFINITIONS FOR SUBPART III.—For purposes of this subpart: 
"(1) The term 'program involved' means the program of grants 
established in section 1911 or 1921, or both, as indicated by 
whether the State involved is receiving or is applying to receive 
a grant under section 1911 or 1921, or both. 
"(2)(A) The term 'fimding agreement', with respect to a grant 
under section 1911, has the meaning given such term in section 
1919. 
"(B) The term 'funding agreement', with respect to a grant 
under section 1921, has the meaning given such term in section 
1934. 
"(b) DEFINITIONS FOR PART B.—For purposes of this part: 
106 STAT. 410 
PUBLIC LAW 102-321—JULY 10, 1992 
"(1) The term 'Comptroller General' means the Comptroller 
General of the United States. 
"(2) The term 'State', except as provided in sections 1918(c)(5) 
and 1933(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. 
"(4) The term 'interim services', in the case of an individual 
in need of treatment for substance abuse who has been denied 
admission to a program of such treatment on the basis of 
the lack of the capacity of the program to admit the individual, 
means services for reducing the adverse health effects of such 
abuse, for promoting the health of the individual, and for reduc-
ing the risk of transmission of disease, which services are 
provided until the individual is admitted to such a program.". 
42 use 201 note. 
(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)). 
SEC. 204. RELATED PROGRAMS. 
Title XIX of the PubHc Health Service Act (42 U.S.C. 300w 
et seq.) is amended by adding at the end the following new part: 
"PART C—CERTAIN PROGRAMS REGARDING SUBSTANCE ABUSE 
''Subpart I—^Expansion of Capacity for Providing 
Treatment 
42USC300y. 
"SEC. 1971. CATEGORICAL GRANTS TO STATES. 
"(a) GRANTS FOR STATES WITH INSUFFICIENT CAPACITY.— 
"(1) IN GENERAL.—The Secretary, acting through the Director 
of the Center for Substance Abuse Treatment, may make grants 
to States for the purpose of increasing the maximum number 
of individu£ds to whom public and nonprofit private entities 
in the States are capable of providing effective treatment for 
substance abuse. 
"(2) ELIGIBLE STATES.—The Director may not make a grant 
under subsection (a) to a State unless the number of individuals 
seeking treatment services in the State significantly exceeds 
the maximum number described in paragraph (1) that is 
applicable to the State. 
"(b) PRIORITY IN MAKING GRANTS.— 
"(1) 
RESIDENTIAL 
TREATMENT 
SERVICES 
FOR PREGNANT 
WOMEN.—In making grants under subsection (a), the Director 
shall give priority to States that agree to give priority in the 
expenditure of the grant to carrying out the purpose described 
in such subsection as the purpose relates to the provision 
of residential treatment services to pregnant women. 
"(2) ADDITIONAL PRIORITY REGARDING MATCHING FUNDS.—In 
the case of any application for a grant under subsection (a) 
that is receiving priority under paragraph (1), the Director 
shall give further priority to the application if the State involved 
agrees as a condition of receiving the grant to provide non-
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 411 
Federal contributions under subsection (c) in a greater amount 
than the amount required under such subsection for the 
appKcable fiscal year, 
"(c) REQUIREMENT OF MATCHING FUNDS.— 
"(1) IN GENERAL.—Subject to paragraph (3), the Director may 
not make a grsint under subsection (a) unless the State agrees, 
with respect to the costs of the program to be carried out 
by the State pursuant to such subsection, to make available 
(directly or through donations fi"om public or private entities) 
non-Federal contributions toward such costs in an amount that 
is— 
"(A) for the first fiscal year for which the State receives 
such a grant, not less than $1 for each $9 of Federal 
fimds provided in the grant; 
"(B) for any second or third such fiscal year, not less 
than $1 for each $9 of Federal fimds provided in the 
grant; and 
"(C) for any subsequent such fiscal year, not less than 
$1 for each $3 of Federal fiinds provided in the grant. 
"(2) 
DETERMINATION OF AMOUNT OF NON-FEDERAL CON-
TRIBUTION.—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 Gov-
ernment, or services assisted or subsidized to any significant 
extent by the Federal Government, may not be included in 
determining the amount of such non-Federal contributions. 
"(3) WAIVER.—The Director may waive the requirement estab-
lished in paragraph (1) if the Director determines that extraor-
dinary economic conditions in the State justify the waiver. 
"(d) LIMITATION REGARDING DIRECT TREATMENT SERVICES.—The 
Director may not make a grant under subsection (a) unless the 
State involved agrees that the grant will be expended only for 
the direct provision of treatment services. The preceding sentence 
may not be construed to authorize the expenditure of such a grant 
for the planning or evaluation of treatment services. 
"(e) REQUIREMENT OF APPLICATION.—The Secretary may not make 
a grant under subsection (a) unless an application for the grant 
is submitted to the Secretary and the application is in such form, 
is made in such manner, and contains such agreements, assurances, 
and information as the Secretary determines to be necessary to 
cany out this section. 
"(f) DURATION OF GRANT.—^The period during which pajnnents 
are made to a State fi*om 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 pajonents and subject 
to the availability of appropriations for the fiscal year involved 
to make the pa5anents. 
"(g) MAINTENANCE OF EFFORT.—The Director may not make a 
grant under subsection (a) unless the State involved agrees to 
maintain State expenditures for treatment services at a level that 
is not less than the average level of such expenditures maintained 
by the State for the 2-year period preceding the first fiscal year 
for which the State receives such a grant. 
"(h) RESTRICTIONS ON USE OF GRANT.—The Director may not 
make a grant under subsection (a) unless the State involved agrees 
that the grant will not be expended— 
"(1) to provide inpatient hospital services; 
106 STAT. 412 
PUBLIC LAW 102-321—JULY 10, 1992 
"(2) to make cash pa5mients to intended recipients of health 
; services; 
"(3) to purchase or improve land, purchase, construct, or 
permanently improve (other than minor remodeling) any build-
ing or other facility, or purchase major medical equipment; 
(4) to satisfy any reqmrement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds; 
or 
"(5) to provide financial assistance to any entity other than 
a public or nonprofit private entity, 
"(i) DEFINITIONS.—For purposes of this section— 
"(1) The term 'Director' means the Director of the Center 
for Substance Abuse Treatment. 
"(2) The term 'substance abuse' means the abuse of sdcohol 
or other drugs, 
"(j) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rying out this section, there are authorized to be appropriated 
$86,000,000 for fiscal year 1993, and such sums as may be necessary 
for fisc^ year 1994. 
AIDS. 
^'Subpart II—Interim Maintenance Treatment of 
Narcotics Dependence 
42 use 300y-ll. 
"SEC. 1976. INTERIM MAINTENANCE TREATMENT. 
"(a) REQUIREMENT REGARDING SECRETARY.—Subject to the fol-
lowing subsections of this section, for the purpose of reducing the 
incidence of the transmission of HIV disease pursuant to the intra-
venous abuse of heroin or other morphine-like drugs, the Secreteiry, 
in establishing conditions for the use of methadone in public or 
nonprofit private programs of treatment for dependence on such 
drugs, shall authorize such programs— 
"(1) to dispense methadone for treatment purposes to individ-
uals who— 
"(A) meet the conditions for admission to such programs 
that dispense methadone as part of comprehensive treat-
ment for such dependence; and 
"(B) are seekmg admission to such programs that so 
dispense methadone, but as a result of the limited capacity 
of the programs, will not gain such admission imtil 14 
or more days after seeking admission to the programs; 
and 
"(2) in dispensing methadone to such individuals, to provide 
only minimum ancillary services during the period in which 
the individuals are waiting for admission to programs of com-
prehensive treatment. 
"(b) 
INAPPLICABILITY 
OF 
REQUIREMENT 
IN 
CERTAIN 
CIR-
CUMSTANCES.— 
"(1) IN GENERAL.—The requirement established in subsection 
(a) for the Secretary does not apply if any or all of the following 
conditions are met: 
"(A) The preponderance of scientific research indicates 
that the risk of the transmission of HIV disease pursueint 
to the intravenous abuse of drugs is minimal. 
"(B) The preponderance of scientific research indicates 
that the medically supervised dispensing of methadone is 
not an effective method of reducing the extent of depend-
ence on heroin and other morphine-like drugs. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 413 
"(C) The preponderance of available data indicates that, 
of treatment programs that dispense methadone as part 
of comprehensive treatment, a substantial majority admit 
all individuals seeking services to the programs not later 
than 14 days after the individuals seek admission to the 
programs. 
"(2) EVALUATION BY SECRETARY.—In evaluating whether any 
or all of the conditions described in paragraph (1) have been 
met, the Secretary shall consult with the National Commission 
on Acquired Immune Deficiency Syndrome. 
"(c) CONDITIONS FOR OBTAINING AUTHORIZATION FROM 
SEC-
RETARY.— 
"(1) IN GENERAL.—In carrying out the requirement estab-
lished in subsection (a), the Secretary shall, after consultation 
with the National Commission on Acquired Immune Deficiency 
Syndrome, by regulation issue such conditions for treatment 
programs to obtain authorization fi-om the Secretary to provide 
interim maintenance treatment as may be necessary to carry 
out the purpose described in such subsection. Such conditions 
shall include conditions for preventing the unauthorized use 
of methadone. 
"(2) COUNSELING ON HIV DISEASE.—The regulations issued 
under paragraph (1) shall provide that an authorization 
described in such paragraph may not be issued to a treatment 
program unless the program provides to recipients of the treat-
ment counseling on preventing exposure to and the trans-
mission of HIV disease. 
"(3) PERMISSION OF RELEVANT STATE AS CONDITION OF 
AUTHORIZATION.—The regulations issued under paragraph (1) 
shall provide that the Secretary may not provide an authoriza-
tion described in such paragraph to any treatment program 
in a State unless the chief public health officer of the State 
has certified to the Secretary that— 
"(A) such officer does not object to the provision of such 
authorizations to treatment programs in the State; and 
"(B) the provision of interim maintenance services in 
the State will not reduce the capacity of comprehensive 
treatment programs in the State to admit individuals to 
the programs (relative to the date on which such officer 
so certifies). 
"(4) DATE CERTAIN FOR ISSUANCE OF REGULATIONS; FAILURE Effective date. 
OF SECRETARY.—The Secretary shall issue the final rule for 
purposes of the regulations required in paragraph (1), and 
such rule shall be effective, not later than the expiration of 
the 180-day period beginning on the date of the enactment 
of the ADAMHA Reorganization Act. If the Secretary fails 
to meet the requirement of the preceding sentence, the proposed 
rule issued on March 2, 1989, with respect to part 291 of 
title 21, Code of Federal Regulations (docket numbered 88N-
0444; 54 Fed. Reg. 8973 et seq.) is deemed to take effect 
as a final rule upon the expiration of such period, and the 
provisions of paragraph (3) of this subsection are deemed to 
be incorporated into such rule. 
"(d) DEFINITIONS.—For purposes of this section: 
"(1) The term 'interim maintenance services' means the provi-
sion of methadone in a treatment program under tiie cir-
106 STAT. 414 
PUBLIC LAW 102-321—JULY 10, 1992 
cumstances described in paragraphs (1) and (2) of subsection 
(a). 
"(2) The term *HIV disease' means infection with the etiologic 
agent for acquired immune deficiency syndrome. 
"(3) The term 'treatment program' means a pubhc or nonprofit 
private program of treatment for dependence on heroin or other 
morphine-lflke drugs.". 
42USC300X 
SEC. 205. TEMPORARY PROVISIONS REGARDING FUNDING. 
"°*®' 
(a) REALLOTMENT OF UNPAID PORTION OF ALLOTMENT FOR FISCAL 
YEAR 1992.— 
(1) IN GENERAL.—^With respect to allotments made for fiscal 
year 1992 under part B of titie XDC of the Public Health 
Service Act (as in effect on the day before the date of the 
enactment of this Act), any portion of the total of such allot-
ments that has not been paid to the States as of the first 
day of the fourth quarter of such fiscal year shall be reallotted 
with the result that, subject to paragraph (2), the total allot-
ment made for a State for fiscal year 1992 pursuant to such 
part (including reallotments imder this paragraph) is the 
amount indicated for the State in the following table: 
State 
Amount 
Alabama 
$18,751,646 
Alaska 
$2,734,000 
Arizona 
$19,352,828 
Arkansas 
$8,927,066 
California 
$186,245,891 
Colorado 
$17,873,097 
Connecticut 
$16,576,000 
Delaware 
$3,329,654 
District of Columbia 
$4,896,000 
Florida 
$63,093,000 
Georgia 
$28,383,202 
Hawaii 
$6,279,545 
Idaho 
$3,422,626 
Illinois 
$62,631,938 
Indiana 
$28,563,000 
Iowa 
$10,017,948 
Kansas 
$8,929,313 
Kentucky 
$14,691,461 
Louisiana 
$19,625,929 
Maine 
$5,466,524 
Maryland 
$24,896,906 
Massachusetts 
$36,009,000 
Michigan 
$47,968,489 
Minnesota 
$19,061,274 
Mississippi 
$10,215,502 
Missoun 
$22,952,468 
Montana 
$3,523,100 
Nebraska 
$6,019,775 
Nevada 
$6,975,991 
New Hampshire 
$5,290,704 
New Jersey 
$47,170,000 
New Mexico 
$7,079,374 
New York 
$103,643,000 
North Carolina 
$27,237,938 
North Dakota 
$2,456,891 
Ohio 
$56,647,000 
Oklahoma 
$13,801,384 
Oregon 
$13,824,013 
Pennsylvania 
$61,799,000 
Rhode Island 
$7,336,000 
South Carolina 
$15,403,164 
South Dakota 
$3,759,000 
Tennessee 
$20,490,809 
Texas 
$80,194,508 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 415 
Utah 
$10,705,633 
Vermont 
$3,918,000 
Virginia 
$27,883,059 
Washington 
$27,284,210 
West Virginia 
$7,475,330 
Wisconsin 
$20,222,918 
Wyoming 
$1,584,892 
(2) GRANTS FROM ALLOTMENTS; CERTAIN CONDITIONS REGARD-
ING ALL PAYMENTS PURSUANT TO PART B FOR FISCAL YEAR 1992.— 
The Secretary shall make a grant to a State of the reallotment 
made for the State imder paragraph (1) if the State agrees 
that the grant is subject to all conditions upon which allotments 
and pajnnents under part B of title XIX of the Public Health 
Service Act are made for fisceJ year 1992 (as in effect on 
the day before the date of the enactment of this Act), except 
as follows: 
(A) Notwithstanding section 1916(c)(6)(A) of such part— 
(i) the percentage of the total allotment referred 
to in paragraph (1) that is expended for mentsd health 
activities will be not less than the percentage deter-
mined under clause (i) of such section 1916(c)(6)(A) 
for fiscal year 1991; and 
(ii) the percentage of such total allotment that is 
expended for alcohol and drug abuse activities will 
be not less than the percentage determined under 
clause (ii) of such section 1916(c)(6)(A) for fiscal year 
1991. 
(B)(i) In the case of such a grant to the State of Califor-
nia: With respect to any entity that received a grant under 
section 509E of the Public Health Service Act for fiscal 
year 1991 (as such section was in effect for such year) 
to carry out a program of services in such State— 
(I) the State will expend the grant to provide finan-
cial assisteince to the entity for the purpose of continu-
ing the program in such State, subject to clause (ii); 
and 
(II) the emaount of such assistance for the fiscal year 
"^ 
will be an amount equal to the amount the entity 
received under such section 509E for fiscal year 1991. 
(ii) The Secretary shall waive the requirement estab-
lished in clause (i) with respect to a program described 
in such clause if the State of California certifies to the 
Secretary that the level of services provided by the program 
is not needed, or that the program has not provided services 
in an effective manner (as determined imder State quality 
standards). 
(3) INAPPLICABILITY TO TERRITORIES.—For purposes of this 
subsection, the term "State" means each of the several States 
and the District of Columbia. 
(b) 
CONTINGENT AUTHORITY FOR TRANSFERS BETWEEN ALLOT-
MENTS.— 
(1) SUBPART II TO SUBPART L—In the case of any State for 
which an allotment for fiscal year 1993 or 1994 under section 
1911 is made in £in amount that is less than the mental 
health portion of the allotment under former section 1912A 
for fiscal year 1991, the Secretary shall, upon the request 
of the chief executive officer of the State, transfer fi-om the 
allotment under section 1921 for the fiscal year involved to 
106 STAT. 416 
PUBLIC LAW 102-321—JULY 10, 1992 
the allotment under section 1911 for the fiscal year such 
J • 
amounts as the State may direct, subject to the allotment 
^ 
under section 1911 not exceeding the amount of such mental 
health portion. 
(2) SUBPART I TO SUBPART IL—In the case of any State for 
which an allotment for fiscal year 1993 or 1994 under section 
1921 is made in an amoimt that is less than the substance-
abuse portion of the edlotment under former section 1912A 
for fiscal year 1991, the Secretary shall, upon the request 
of the chief executive officer of the State, transfer from the 
allotment under section 1911 for the fiscal year involved to 
the allotment under section 1921 for the fiscal year such 
amounts as the State may direct, subject to the allotment 
under section 1921 not exceeding the amount of such substance-
abuse portion. 
(3) DEFINITIONS.—For purposes of 
this subsection: 
(A) The term "section 1911" means section 1911 of the 
Public Health Service Act. 
(B) The term "section 1921" means section 1921 of the 
Public Health Service Act. 
(C) The term "former section 1912A" means section 
1912A of the PubUc Health Service Act, as such section 
was in effect for fiscal year 1991. 
(D) The term "former section 1916(c)(6)(A)" means section 
1916(c)(6)(A) of the PubUc Health Service Act, as such 
section was in effect for fiscal year 1991. 
(E) The term "mental health portion", with respect to 
an allotment under former section 1912A for fiscal year 
1991, means the amount of such allotment that was 
reserved by the State for such year in compliance with 
clause (i) of former section 1916(c)(6)(A). 
(F) The term "substance-abuse portion", with respect to 
an allotment under former section 1912A for fiscal year 
1991, means the amount of such allotment that was 
reserved by the State for such year in compUance with 
clause (ii) of former section 1916(c)(6)(A). 
(c) PROGRAM FOR PREGNANT A
N
D POSTPARTUM WOMEN.— 
(1) IN GENERAL.—Subject to paragraph (2), for the purpose 
of carrying out section 508 of the Pubhc Health Service Act 
^ 
for fiscal year 1993, the Secretary shall obligate 40 percent 
of the amounts made available pursuant to section 1935(b) 
of such Act for such fiscal year. 
(2) LIMITATION.—Paragraph (1) shall apply only to the extent 
necessary to ensure that $80,000,000 is available for fisccQ 
year 1993 to carry out section 508 of the Public Health Service 
Act. 
(d) DEFINITION OF SECRETARY.—For purposes of this section, the 
term "Secretary** means the Secretary of Health and Human Serv-
ices. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 417 
TITLE 
III—MODEL 
COMPREHENSIVE 
PROGRAM FOR TREATMENT OF SUB-
STANCE ABUSE 
SEC. 301. DEMONSTRATION PROGRAM IN NATIONAL CAPITAL AREA. 
Title V of the Public Health Service Act, as amended by section 
119 of this Act, is amended by adding at the end the following 
part: 
"PART F—MODEL COMPREHENSIVE PROGRAM FOR TREATMENT OF 
SUBSTANCE ABUSE 
"DEMONSTRATION PROGRAM IN NATIONAL CAPITAL AREA 
"SEC. 571. (a) IN GENERAL.—The Secretary, in collaboration with 42 use 290gg. 
the Director of the Treatment Center, shall make a demonstration 
grant for the estabUshment, within the national capital area, of 
a model program for providing comprehensive treatment services 
for substance abuse. 
"(b) PURPOSES.—^The Secretary may not make a grant under 
subsection (a) unless, with respect to the comprehensive treatment 
services to be offered by the program imder such subsection, the 
appUc£uit 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 employ-
ment and other matters with respect to assisting the individuals 
in preventing any relapse into substance abuse, including edu-
cation on the appropriate involvement of parents and others 
in preventing such a relapse; 
"(3) to provide services in locations accessible to substance 
abusers and, to the extent practicable, to provide services 
through mobile facilities; 
"(4) to give priority to providing services to individuals who 
are intravenous drug abusers, to pregnant women, to homeless 
individuals, and to residents of pubUcly-assisted housing; 
"(5) with respect to women with dependent children, to pro-
vide 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 c£ise management services, including services 
to determine eUgibility for assistance imder Federal, State, 
and local programs providing healtii 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 pubUc is informed that the offices are the locations 
at which individuals may make inquiries concerning the pro-
gram, including the location of available treatment services 
within the national capital area; and 
59-194 O—93 
15 : QL 3 (Pt. 1) 
106 STAT. 418 
PUBLIC LAW 102-321—JULY 10, 1992 
": 
"(9) to develop and utilize standards for certifying the knowl-
edge and training of individuals, and the quality of programs, 
to provide treatment services for substance abuse. 
"(c) CERTAIN REQUIREMENTS.— 
"(1) REGARDING ELIGIBILITY FOR GRANT.— 
"(A) The Secretary may not make the grsint under sub-
section (a) unless the applicant involved is an organization 
of the general-purpose local governments within the 
national capital area, or another public or nonprofit private 
entity, and the applicant submits to the Secretary assur-
ances satisfactory to the Secretary that, with respect to 
the communities in which services will be offered, the local 
governments of the communities will participate in the 
program. 
"(B) The Secretary may not make the grant under sub-
section (a) unless— 
"(i) an application for the grant is submitted to the 
Secretary; 
"(ii) with respect to carrying out the purpose for 
which the grant is to be made, the application provides 
assurances of compliance satisfactory to the Secretary; 
and 
"(iii) the application otherwise is in such form, is 
made in such msinner, and contains such agreements, 
assurances, and information as the Secretary deter-
mines to be necessary to carry out this section. 
"(2) AUTHORITY FOR COOPERATIVE AGREEMENTS.—The grantee 
under subsection (a) may provide the services required by such 
subsection directly or through arrangements with public and 
nonprofit private entities. 
"(d) REQUIREMENT OF NON-FEDERAL CONTRIBUTIONS.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
subsection (a) unless the applicant for the grant agrees, with 
respect to the costs to be incurred by the applicgint in carrying 
. out the purpose described in such subsection, to make available 
(directly or through donations fi-om public or private entities) 
non-Federal contributions toward such costs in an amount not 
less than $1 for each $2 of Federal funds provided under 
the grant. 
"(2) DETERMINATION OF AMOUNT CONTRIBUTED.—Non-Federal 
contributions required in paragraph (1) may be in cash or 
in kind, fairly evaluated, including plant, equipment, or serv-
ices. 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 amoimt 
of such non-Federal contributions. 
"(e) EVALUATIONS.— 
"(1) BY SECRETARY.—The Secretary shall independently 
evaluate the effectiveness of the program carried out under 
subsection (a) £Uid determine its suitability as a model for 
the United States, particulsirly regarding the provision of high 
quality, patient-oriented, coordinated and accessible drug treat-
ment services across jurisdictional lines. The Secretary shall 
consider the extent to which the program has improved patient 
retention, accessibility of services, staff retention and quality, 
reduced patient relapse, and provided a full range of drug 
treatment and related health and himian services. The Sec-
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 419 
retary shall evaluate the extent to which the program has 
effectively utilized innovative methods for overcoming the 
resistance of the residents of communities to the establishment 
of treatment facilities within the communities. 
"(2) BY GRANTEE.—^The Secretary may require the grantee 
under subsection (a) to evaluate any aspect of the program 
carried out under such subsection, and such evaluation shall, 
to the extent appropriate, be coordinated with the independent 
evaluation required in paragraph (1). 
"(3) LIMITATION.—Fimds made available imder subsection (h) 
may not be utilized to conduct the independent evaluation 
required in paragraph (1). 
"(f) REPORTS.— 
"(1) INITIAL CRITERIA.—The Secretary shall make a deter-
mination of the appropriate criteria for carrying out the pro-
gram required in subsection (a), including the anticipated need 
for, and range of, services imder the program in the commu-
nities involved and the anticipated costs of the program. Not 
later than 90 days after the date of the enactment of the 
ADAMHA Reorganization Act, the Secretary shall submit to 
the Congress a report describing the findings made as a result 
of the determination. 
"(2) ANNUAL REPORTS.—Not later than 2 years after the date 
on which the grant is made under subsection (a), and annually 
thereafter, the Secretary shall submit to the Congress a report 
describing the extent to which the program carried out imder 
such subsection has been effective in canying out the purposes 
of the program. 
"(g) DEFINITION.—For purposes of this section, the term 'national 
capital £irea' 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 tiie pohtical subdivisions located 
in such coimties), and the coimties of Montgomery and Prince 
George's in the State of Maryland (and the political subdivisions 
located in such counties). 
"(h) OBLIGATION OF FUNDS.—Of the amoimts appropriated for 
each of the fiscal years 1993 and 1994 for the programs of the 
Department of Health and Human Services, the Secretsiry shall 
m£d^e available $10,000,000 for carrying out this section. Of the 
amounts appropriated for fiscal year 1995 for the programs of 
such Department, the Secretary s h ^ make available $5,000,000 
for carrying out this section.". 
TITLE IV—CHILDREN OF SUBSTANCE 
ABUSERS 
SEC. 
401. 
ESTABLISHMENT 
OF 
PROGRAM 
OF 
SERVICES. 
(a) IN GENERAL.—Titie 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: 
106 STAT. 420 
PUBLIC LAW 102-321—JULY 10, 1992 
"PART M—SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS 
42 USE 280D. 
"SEC. 399D. GRANTS FOR SERVICES FOR CHILDREN OF SUBSTANCE 
ABUSERS. 
"(a) ESTABLISHMENT.— 
"(1) IN GENERAL.—^The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, 
shall make grants to public and nonprofit private entities for 
the purpose of carrying out programs— 
"(A) to provide the services described in subsection (b) 
to children of substance abusers; 
"(B) to provide the applicable services described in sub-
section (c) to families in which a member is a substance 
abuser; and 
"(C) to identify such children and such families. 
"(2) ADMINISTRATIVE CONSULTATIONS.—The Administrator of 
the Administration for Children, Youth, and Families and the 
Administrator of the Substance Abuse and Mental Health Serv-
ices Administration shall be consulted regarding the promulga-
tion of program guidelines and funding priorities under this 
section. 
"(3) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.— 
"(A) Subject to subparagraph (B), the Secretary may 
mgike a grsint under paragraph (1) only if, in the case 
of any service under such paragraph that is covered in 
the State plan approved imder title XIX of the Social Secu-
rity Act for the State involved— 
"(i) the entity involved will provide the service 
directly, and the entity has entered into a participation 
agreement under the State plan and is quaUfied to 
receive pajmaents under such plan; or 
"(ii) the entity will enter into an agreement with 
an organization under which the organization will pro-
vide the service, and the organization has entered into 
such a participation agreement and is qualified to 
receive such pa3niients. 
"(B)(i) In the case of an organization making an agree-
ment under subparagraph (A)(ii) regarding the provision 
of services under paragraph (1), the requirement estab-
lished in such subparagraph regarding a participation 
agreement shall be waived by the Secretary if the organiza-
tion does not, in providing health or mental heeilth services, 
impose a charge or accept reimbursement available fi-om 
any third-party payor, including reimbursement under any 
insurance policy or under any Federal or State health 
benefits program. 
"(ii) A determination by the Secretary of whether an 
organization referred to in clause (i) meets the criteria 
for a waiver under such clause shall be made without 
regard to whether the organization accepts voluntary dona-
tions regarding the provision of services to the public. 
"(b) SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS.—The Sec-
retary may make a grant/under subsection (a) only if the applicsmt 
involved agrees to make £ivailable (directly or through agreements 
with other entities) to children of substance abusers each of the 
following services: 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 421 
"(1) Periodic evaluation of children for developmental, psycho-
logical, and medical problems. 
"(2) Primeiry pediatric care. 
"(3) Other necessary health 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) Referrals for, and assistance in establishing eligibility 
for, services provided under— 
"(A) education and special education programs; 
"(B) Head Start programs established luider the Head 
Start Act; 
"(C) other early childhood programs; 
"(D) employment and training programs; 
"(E) public assistance programs provided by Federal, 
State, or local governments; and 
"(F) programs offered by vocational rehabilitation agen-
cies, recreation departments, and housing agencies. 
"(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 Edu-
cation Act. 
"(c) SERVICES FOR AFFECTED FAMILIES.—The Secretary may make 
a grant imder subsection (a) only if, in the case of famiUes in 
wWch 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) Services as follows, to be provided by a pubhc health 
nurse, social worker, or similar professional, or by a trained 
worker 
fi*om 
the commimity who is supervised by a professional: 
"(A) Counseling to substance abusers on the benefits 
and availability of substance abuse treatment services and 
services for children of substance abusers. 
"(B) Assistance to substance abusers in obtaining and 
using substance abuse treatment services and in obtaining 
the services described in subsection (b) for their children. 
"(C) Visiting and providing support to substance abusers, 
especially pregnant women, who are receiving substance 
abuse treatment services or whose children are receiving 
services under subsection (b). 
"(2) In the case of substance abusers: 
"(A) Encouragement and, where necessary, referrals to 
participate in appropriate substance abuse treatment. 
"(B) Primary health care and mental health services, 
including prenatal and post partum care for pregnant 
women. 
"(C) Consultation and referral regarding subsequent 
pregnancies and life options, including education and career 
planning. 
"(D) Where appropriate, counseling regarding family con-
flict and violence. 
"(E) Remedial education services. 
"(F) Referrals for, and assistance in establishing eligi-
bility for, services described in subsection (b)(7). 
106 STAT. 422 
PUBLIC LAW 102-321—JULY 10, 1992 
"(3) In the case of substance abusers, spouses of substance 
abusers, extended family members of substance abusers, care-
takers of children of substance abusers, and other people signifi-
cantly 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 eissignment of a case manager who 
will coordinate services for the family. 
"(B) Therapeutic intervention services, such as parental 
counseling, joint counseling sessions for famiUes and chil-
dren, and family therapy. 
K " f' 
"(C) Child care or other care for the child to enable 
the parent to attend treatment or other activities and res-
pite 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.—In making grants 
under subsection (a), the Secretary shall ensure that the grants 
are reasonably distributed among the following types of entities: 
"(1) Alcohol and drug treatment programs, especially those 
providing treatment to pregnant women and mothers and their 
children. 
"(2) PubUc or nonprofit private entities that provide health 
or social services to (hsadvantaged populations, and that have— 
"(A) expertise in applying the services to the particular 
problems of substance abusers and the children of sub-
stance abusers; and 
"(B) an affiliation or contractual relationship with one 
or more substance abuse treatment programs. 
"(3) Consortia of public or nonprofit private entities that 
include at least one substance abuse treatment program. 
"(4) Indian tribes. 
"(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, including faciUties and 
personnel, made by the grant recipient as a part or all of the 
non-Federal share of grants. 
"(f) COORDINATION WITH OTHER PROVIDERS.—The Secretary may 
make a grant imder subsection (a) only if the applicant involved 
agrees to coordinate its activities with those of the State lead 
agency, and the State Interagency Coordinating Council, under 
part H of the Individuals with Disabilities Education Act. 
"(g) RESTRICTIONS ON USE OF GRANT.—The Secretary may make 
a grant imder subsection (a) only if the applicant involved agrees 
that the grant will not be expended— 
"(1) to provide inpatient hospital services; 
"(2) to make cash payments to intended recipients of services; 
"(3) to purchase or improve land, purchase, construct, or 
permanently improve (other than minor remodeling) any build-
ing or other faciUty, or purchase mcgor medical equipment; 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 423 
"(4) to satisfy any reqmrement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds; 
or 
"(5) to provide financial assistance to any entity other than 
a public or nonprofit private entity. 
"(h) SUBMISSION TO SECRETARY OF CERTAIN INFORMATION.—The 
Secretary may make a grant imder subsection (a) only if the 
applicant involved submits to the Secretary— 
"(1) a description of the population that is to receive services 
under this section and a description of such services that are 
to be provided and measurable goals and objectives; 
"(2) a description of the mechanism that will be used to 
involve the locsd public agencies responsible for health, mental 
health, child welfare, education, juvenile justice, developmental 
disabilities, and substance abuse treatment programs in plan-
ning and providing services under this section, as well as evi-
dence that the proposal has been coordinated with the State 
agencies responsible for administering those programs and the 
State agency responsible for administering public maternal and 
child health services; 
"(3) information demonstrating that the applicant has estab-
lished a collaborative relationslup with child welfare agencies 
and child protective services that will enable the applicant, 
where appropriate, to— 
"(A) provide advocacy on behalf of substance abusers 
and the children of substance abusers in child protective 
services cases; 
"(B) provide services to help prevent the \innecessary 
placement of children in substitute care; £uid 
"(C) promote reunification of families or permanent plans 
for the placement of the child; and 
"(4) such other information as the Secretary determines to 
be appropriate. 
"(i) REPORTS TO SECRETARY.—^The Secretary may make a grant 
imder subsection (a) only if the applicant involved agrees that 
for each fiscal year for which the applicant receives such a grant 
the applicsuit, in accordance with uniform standards developed by 
the Secretary, will submit to the Secretary a report containing— 
"(1) a description of specific services and activities provided 
under the grant; 
"(2) information regeu-ding progress toward meeting the pro-
gram's stated goals and objectives; 
"(3) information concerning the extent of use of services pro-
vided under the grant, including the number of referrals to 
related services and information on other programs or services 
accessed by children, parents, and other caretal:ers; 
"(4) information concerning the extent to which parents were 
able to access and receive treatment for alcohol and drug abuse 
and sustain p£ui;icipation in treatment over time until the 
provider and the individual receiving treatment agree to end 
such treatment, and the extent to which parents re-enter treat-
ment after the successful or unsuccessful termination of treat-
ment; 
"(5) information concerning the costs of the services provided 
and the source of financing for health care services; 
"(6) information concerning— 
106 STAT. 424 
PUBLIC LAW 102-321—JULY 10, 1992 
"(A) the number and characteristics of families, parents, 
and children served, including a description of the type 
and severity of childhood disabilities, and an analysis of 
i; 
the number of children served by age; 
"(B) the number of children served who remained with 
their parents during the period in which entities provided 
services under this section; 
"(C) the niunber of children served who were placed 
in out-of-home C£ire during the period in which entities 
provided services under this section; 
"(D) the number of children described in subparagraph 
(C) who were reunited with their families; and 
"(E) the number of children described in subparagraph 
(C) for whom a permanent plan has not been made or 
for whom the permsinent plan is other than family reunifi-
cation; 
"(7) information on hospitahzation or emergency room use 
by the family members participating in the program; and 
"(8) such other information as the Secretary determines to 
be appropriate. 
"(j) REQUIREMENT OF APPLICATION.—The Secretary may make 
any grant under subsection (a) only i
f
—
-
"(1) an application for the grant is submitted to the Secretary; 
"(2) the application contains the agreements required in this 
section and the information required in subsection (h); and 
"(3) 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. 
"(k) PEER REVIEW.— 
"(1) REQUIREMENT.—In making determinations for awarding 
grants under subsection (a), the Secretary shall rely on the 
recommendations of the peer review panel established under 
paragraph (2). 
"(2) COMPOSITION.—The Secretary shall establish a review 
panel to make recommendations under paragraph (1) that shall 
be composed o
f
— 
"(A) national experts in the fields of maternal and child 
health, substance abuse treatment, and child welfare; and 
"(B) representatives of relevant Federal agencies, includ-
ing the Health Resources and Services Administration, the 
Substance Abuse and Mental Health Services Administra-
tion, and the Administration for Children, Youth, and Fam-
ilies. 
"(1) EVALUATIONS.—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 developmen-
tal services and improving the health, developmental, and psy-
chological status of children receiving services under the pro-
gram; 
"(4) in improving parental and family functioning; 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 425 
"(5) in reducing the incidence of out-of-home placement for 
children whose parents receive services under the program; 
and 
"(6) in facilitating the reimification of families after children 
have been placed in out-of-home care, 
"(m) REPORT TO CONGRESS.—Not later than 2 years after the 
date on which amounts are first appropriated under subjection 
(o), the Secretary shall prepare and submit to the Committee on 
Energy and Commerce of the House of Representatives, and to 
the Committee on Labor and Himian 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 famiUes, 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 famihes; and 
"(E) the number of children described in subparagraph 
(C) who were permanently placed in out-of-home care; 
analyzed by the type of entity described in subsection (d) 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 imder this section; and 
"(5) a comparison of the costs of providing services through 
each of the types of entities described in subsection (d). 
"(n) 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, gen-
der and ethnicity of the children, the composition and income of 
the family, and the source of health care finances, 
"(o) DEFINITIONS.—For purposes of this section: 
"(1) The term 'caretaker', with respect to a child of a sub-
stance abuser, means any individual acting in a parental role 
regarding the child (including any birth parent, roster parent, 
adoptive parent, relative of such a child, or other individual 
acting in such a role). 
"(2) The term'children of substance abusers* means— 
"(A) children who have Kved or are living in a household 
with a substance abuser who is acting in a parental role 
regarding the children; and 
"(B) cluldren who have been prenatally exposed to alcohol 
or other dangerous drugs. 
"(3) The term 'Indian tribe' means any tribe, band, nation, 
or other organized group or community of Indians, including 
any Alaska Native village (as defined in, or established pursu-
ant to, the Alaska Native Claims Settlement Act), that is rec-
106 STAT. 426 
PUBLIC LAW 102-321—JULY 10, 1992 
ognized as eligible for the special programs and services pro-
vided by the United States to Indians because of their status 
as Indians. 
"(4) The term 'public or nonprofit private entities that provide 
health or social services to disadvantaged populations' includes 
community-based organizations, local public health depart-
ments, community action agencies, hospitals, community health 
';^ centers, child welfare agencies, developmental disabilities serv-
' ice providers, and family resource and support programs. 
"(5) The term 'substance abuse' means the abuse of alcohol 
or other drugs, 
"(p) FUNDING.— 
"(1) 
AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of canying out this section, there are authorized to be appro-
priated $50,000,000 for fiscal year 1993, and such sums as 
may be necessary for fiscal year 1994. 
"(2) CONTINGENT AUTHORITY REGARDING TRAINING OF CERTAIN 
INDIVIDUALS.—Of the amounts appropriated under paragraph 
(1) for a fiscal year in excess of $25,000,000, the Secretary 
may make available not more than 15 percent for the training 
of health care professionals and other personnel (including child 
welfare providers) who provide services to children and families 
of substance abusers. 
42 use 280d 
(b) RuLE OF CONSTRUCTION.-With respect to the program estab-
"°*®- 
lished in section 399D of the Public Health Service Act (as added 
by subsection (a) of this section), nothing in such section 399D 
may be construed as establishing for any other Federal program 
any requirement, authority, or prohibition, including with respect 
to recipients of funds under such other Federal programs. 
TITLE V—HOME VISITING SERVICES 
FOR AT-RISK FAMILIES 
42USC280C-6 
SEC. 501. STATEMENT OF PURPOSE. 
Thepurposeof this title is— 
(1) to increase the use of, and to provide information on 
the availability of early, continuous and comprehensive prenatal 
care; 
(2) to reduce the incidence of infant mortality and of infants 
bom prematurely, with low birthweight, or with other impair-
ments including those associated with maternal substance 
abuse; 
(3) for pregnant women and mothers of children below the 
age of 3 whose children have experienced or are at risk of 
experiencing a health or developmental complication, to provide 
assistance in obtaining health and related social services nec-
essary to meet the special needs of the women and their chil-
dren; 
(4) to assist, when requested, women who are pregnant and 
at-risk for poor birth outcomes, or who have young children 
and are abusing alcohol or other drugs, in obtaining appropriate 
treatment; and 
(5) to reduce the incidence of child abuse and neglect. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 427 
SEC. 602. ESTABLISHMENT OF PROGRAM OF GRANTS. 
_ . 
Part L of title III of the Public Health Service Act (42 U.S.C. 
280c et seq.) is amended— 
(1) by redesignating sections 399 and 399A as sections 398A 42 u ^ 280c-4, 
and 398B, respectively; and 
280c-5. 
(2) by adding at the end the following subpart: 
"Subpart III—Grants for Home Visiting Services for At-Risk 
Families 
"SEC. 399. PROJECTS TO IMPROVE MATERNAL, INFANT, AND CHILD 
42 USC 280c-6. 
HEALTH. 
"(a) iN GENERAL.— 
"(1) ESTABLISHMENT OF PROGRAM.—The Secretary, acting 
through the Administrator of the Health Resources ana Services 
Administration, shall make grants to eligible entities to pay 
the Federal share of the cost of providing the services specified 
in subsection (b) to famiUes in which a member is— 
"(A) a pregnant woman at risk of delivering an infant 
with a health or developmental complication; or 
"(B) a child less than 3 years of age— 
"(i) who is experiencing or is at risk of a health 
or developmental compUcation, or of child abuse or 
neglect; or 
*Xii) who has been prenataUy exposed to maternal 
substance abuse. 
"(2) 
MINIMUM PERIOD OF AWARDS; ADMINISTRATIVE CON-
SULTATIONS.— 
"(A) The Secretary shall award grants under paragraph 
(1) for periods of at least three years. 
"(B) The Administrator of the Administration for Chil-
dren, Youth, and FamiUes and the Director of the National 
Commission to Prevent Infant MortaUty shall be consulted 
regarding the promulgation of program guidelines and 
funding priorities under this section. 
"(3) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.— 
"(A) Subject to subparagraph (B), the Secretary may 
make a grant under paragraph (1) only if, in the case 
of any service under such paragraph that is covered in 
the State plan approved under titie XIX of the Social Secu-
rity Act for the State involved— 
"(i) the entity involved will provide the service 
directly, and the entity has entered into a participation 
agreement under the State plan and is qualified to 
receive pajonents under such plan; or 
"(ii) the entity will enter into an agreement with 
an organization under which the organization will pro-
vide the service, and tiie organization has entered into 
such a participation agreement and is qualified to 
receive such pa3anents. 
"(BXi) In the case of an organization making an agree-
ment imder subparagraph (A)(ii) regarding the provision 
of services under paragraph (1), the requirement estab-
lished in such subparagraph regarding a participation 
agreement shall be waived by the Secretary if the organiza-
tion does not, in providing health or mental healtii services, 
impose a charge or accept reimbursement available fi*om 
106 STAT. 428 
PUBLIC LAW 102-321—JULY 10, 1992 
any third-party payor, including reimbursement under any 
insurance policy or xmder any Federal or State health 
benefits program. 
"(ii) A determination by the Secretary of whether an 
organization referred to in clause (i) meets the criteria 
for a waiver under such clause shall be made without 
regard to whether the organization accepts voluntary dona-
tions regarding the provision of services to the pubHc. 
"(b) HOME VISITING SERVICES FOR ELIGIBLE FAMILIES.—With 
respect to an eligible family, each of the following services shgJl, 
directly or through arrangement with other public or nonprofit 
private entities, be available (as applicable to the family member 
involved) in each project operated with a grant under subsection 
(a): 
"(1) Prenatal and postnatal health care. 
"(2) PrimEiry health care for the children, including devel-
opmental assessments. 
"(3) Education for the parents concerning infant care and 
child development, including the development and utilization 
of parent and teacher resource networks and other family 
resource and support networks where such networks are avail-
able. 
"(4) Upon the request of a parent, providing the education 
described in paragraph (3) to other individuals who have 
: . responsibility for caring for the children. 
"(5) Education for the parents concerning behaviors that 
. adversely affect health. 
"(6) Assistance in obtaining necessary health, mental health, 
developmental, social, housing, and nutrition services and other 
assistance, including services and other assistance imder mater-
nal and child healtii programs; the special supplemental food 
program for women, infants, and children; section 17 of the 
Child Nutrition Act of 1966; title V of the Social Security 
. Act; title XIX of such Act (including the program for early 
and periodic screening, diagnostic, and treatment services 
described in section 1905(r) of such Act); titles IV and XIX 
of the Social Security Act; housing programs; other food assist-
emce programs; and appropriate alcohol and drug dependency 
treatment programs, according to need. 
"(c) CONSIDERATIONS IN MAKING GRANTS.—In awarding grants 
under subsection (a), the Secretary shall take into consideration— 
"(1) the ability of the entity involved to provide, either directly 
or through linkages, a broad range of preventive and primary 
health care services and related social, family support, and 
developmental services; 
"(2) different combinations of professional and lay home visi-
tors utilized within programs that are reflective of the identified 
service needs and characteristics of target populations; 
"(3) the extent to which the population to be targeted has 
limited access to health care, and related social, family support, 
and developmental services; and 
"(4) whether such grants are equitably distributed among 
urban and rural settings and whether entities serving Native 
American communities are represented among the grantees. 
"(d) FEDERAL SHARE.—^With respect to the costs of carrying out 
a project under subsection (a), a grant under such subsection for 
the project may not exceed 90 percent of such costs. To be eUgible 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 429 
to receive such a grsint, an applicant must provide assurances 
that the appUcant will obtain at least 10 percent of such costs 
from non-Federal funds (and such contributions to such costs may 
be in cash or in-kind, including facilities and personnel). 
"(e) RULE OF CONSTRUCTION REGARDING AT-RISK BIRTHS.—For 
purposes of subsection (a)(1), a pregnant womcin shall be considered 
to be at risk of deUvering an infant with a health or developmental 
complication if during the pregnsmcy the woman— 
"(1) lacks appropriate access to, or information concerning, 
early and routine prenatal care; 
"(2) lacks the transportation necessary to gain access to the 
services described in subsection (b); 
"(3) lacks appropriate child care assistance, which results 
in impeding the ability of such woman to utilize health and 
related social services; 
"(4) is fearful of accessing substemce abuse services or child 
and family support services; or 
"(5) is a minor with a low income. 
"(f) DELIVERY OF SERVICES AND CASE MANAGEMENT.— 
"(1) CASE MANAGEMENT MODEL.—Home visiting services pro-
vided under this section shall be delivered according to a case 
management model, and a registered nurse, licensed social 
worker, or other licensed health care professional with experi-
ence and expertise in providing health and related socicd serv-
ices in home and community settings shall be assigned as 
the case manager for individual cases under such model. 
"(2) CASE MANAGER.—^A case manager assigned under para-
graph (1) shgJl have primary responsibility for coordinating 
and overseeing the development of a plan for each family that 
is to receive home visiting services under this section, and 
for coordinating the delivery of such services provided through 
appropriate personnel. 
"(3) APPROPRIATE PERSONNEL.—In determining which person-
nel shall be utilized in the delivery of services, the case manager 
shall consider— 
"(A) the stated objective of the project to be operated 
with the grant, as determined after considering identified 
gaps in the current service delivery system; and 
"(B) the nature of the needs of the family to be served, 
as determined at the initial assessment of the family that 
is conducted by the case manager, and through follow-
up contacts by other providers of home visiting services. 
"(4) FAMILY SERVICE PLAN.—^A case manager, in consultation 
with a team established in accordance with paragraph (5) for 
the family involved, shall develop a plan for the family following 
the initial visit to the home of the family. Such plan shall 
reflect— 
"(A) an assessment of the health and related social serv-
ice needs of the family; 
"(B) a structured plan for the delivery of home visiting 
services to meet the identified needs of the family; 
"(C) the frequency with which such services are to be 
provided to the family; 
"(D) ongoing revisions made as the needs of family mem-
bers change; and 
"(E) the continuing voluntary participation of the family 
in the plan. 
106 STAT. 430 
PUBLIC LAW 102-321—JULY 10,1992 
"(5) HOME VISITING SERVICES TEAM.—The team to be con-
sulted under paragraph (4) on behalf of a family shall include, 
as appropriate, other nursing professionals, physician assist-
ants, social workers, child welfare professionals, infant and 
early childhood specialists, nutritionists, and laj^ersons trained 
as home visitors. The case manager shedl ensure that the 
E
lan is coordinated with those physician services that may 
e required by the mother or child. 
**(g) OUTREACH.—Each grantee under subsection (a) shall provide 
outreach and casefinding services to inform eligible families of 
the availability of home visiting services from the project. 
"(h) CONFIDENTIALITY.—In accordance with appUcable State law, 
an entity receiving a grant imder subsection (a) shall maintain 
confidentiality with respect to services provided to famiUes imder 
this section. 
"(i) CERTAIN ASSURANCES.—^The Secretary may award a grant 
under subsection (a) only if the entity involved provides assurances 
satisfactory to the Secretary that— 
"(1) the entity will provide home visiting services with reason-
able frequency— 
"(A) to families with pregnant women, as early in the 
pregnancy as is practicable, and until the infant reaches 
at least 2 years of age; and 
"(B) to other eUgible families, for at least 2 years; and 
"(2) the entity will coordinate with public health and related 
social service agencies to prevent aupUcation of effort and 
improve the delivery of comprehensive health and related social 
services, 
"(j) SUBMISSION TO SECRETARY OF CERTAIN INFORMATION.—The 
Secretary may award a grant imder subsection (a) only if the 
entity involved submits to the Secretary— 
"(1) a description of the population to be targeted for home 
visiting services and methods of outreach and casefinding for 
identifying eligible families, including the use of lay home visi-
tors where appropriate; 
"(2) a description of the types and qualifications of home 
visitors used by the entity and the process by which the entity 
will provide continuing training and sufficient support to the 
home visitors; and 
"(3) such other information as the Secretary determines to 
be appropriate, 
"(k) 
LIMITATION REGARDING ADMINISTRATIVE EXPENSES.—Not 
more than 10 percent of a grant under subsection (a) may be 
expended for administrative expenses with respect to the grant. 
The costs of training individuals to serve in the project involved 
are not subject to the preceding sentence. 
"(1) RESTRICTIONS ON USE OF GRANT.—TO be eligible to receive 
a grant imder this section, an entity must agree that the grant 
will not be expended— 
"(1) to provide inpatient hospital services; 
"(2) to make cash payments to intended recipients of services; 
"(3) to purchase or improve land, purchase, construct, or 
permanently improve (other than minor remodeling) any build-
mg or other facility, or purchase m£gor medical equipment; 
"(4) to satisfy any requirement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds; 
or 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 431 
"(5) to provide financial assistance to any entity other than 
a pubhc or nonprofit private entity, 
"(m) REPORTS TO SECRETARY.—TO be eligible to receive a grant 
under this section, an entity must agree to submit an annual 
report on the services provided under this section to the Secretary 
in such manner and contsdning such information as the Secretaiy 
by regulation requires. At a minimum, the entity shall report 
information concerning eligible families, including— 
"(1) the chgiracteristics of the families and children receiving 
services under this section; 
"(2) the usage, nature, and location of the provider, of preven-
tive health services, including prenatal, primary infant, and 
child health care; 
"(3) the incidence of low birthweight and premature infants; 
"(4) the length of hospital stays for pre- and post-partimi 
women and their children; 
"(5) the incidence of substantiated child abuse and neglect 
for all children within participating families; 
"(6) the number of emergency room visits for routine health 
care; 
"(7) the source of payment for health care services and the 
extent to which the utilization of health care services, other 
than routine screening and medical care, available to the 
individuals under the program established under title XIX of 
the Social Security Act, and under other Federal, State, and 
local programs, is reduced; 
"(8) the number and type of referrals made for health and 
related social services, including alcohol and drug treatment 
services, and the utihzation of such services provided by the 
grantee; eind 
"(9) the incidence of developmental disabilities. 
"(n) REQUIREMENT OF APPLICATION.—The Secretary may make 
a grant under subsection (a) only i
f
— 
"(1) an application for the grant is submitted to the Secretary; 
"(2) the application contains the agreements and assurances 
required in this section, £ind the information required in sub-
section (j); 
"(3) the appUcation contains evidence that the preparation 
of the application has been coordinated with the State agencies 
responsible for maternal and child health and child welfare, 
and coordinated with services provided under part H of the 
Individuals with Disabilities Education Act; and 
"(4) 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, 
"(o) PEER REVIEW.— 
"(1) REQUIREMENT.—In making determinations for awarding 
grants under subsection (a), the Secretary shall rely on the 
recommendations of the peer review peinel established luider 
paragraph (2). 
"(2) COMPOSITION.—The Secretary shall estabUsh a review 
panel to make recommendations under paragraph (1) that shall 
be composed o
f
— 
"(A) national experts in the fields of maternal and child 
he£dth, child abuse and neglect, and the provision of com-
munity-based primary health services; and 
106 STAT. 432 
PUBLIC LAW 102-321—JULY 10, 1992 
"(B) representatives of relevant Federal agencies, includ-
ing the Health Resources and Services Administration, the 
Substance Abuse and Mental Health Services Administra-
tion, the Administration for Children, Youth, and Families, 
the U.S. Advisory Board on Child Abuse and Neglect, and 
the National Commission to Prevent Infant Mortality, 
"(p) EVALUATIONS.— 
"(1) IN GENERAL.—The Secretary shall, directly or through 
• 
contracts with public or private entities— 
"(A) conduct evaluations to determine the effectiveness 
of projects under subsection (a) in reducing the incidence 
of children bom with health or developmental com-
plications, the incidence among children less than 3 years 
of age of such complications, and the incidence of child 
abuse and neglect; and 
"(B) not less than once during each 3-year period, prepare 
and submit to the appropriate committees of Congress a 
report concerning the results of such evaluations. 
"(2) CONTENTS.—Ttie evaluations conducted under paragraph 
(1) shall— 
"(A) include a summary of the data contained in the 
annual reports submitted under subsection (m); 
"(B) assess the relative effectiveness of projects under 
subsection (a) in urban and rural areas, and among pro-
grams utilizing differing combinations of professionals and 
trained home visitors recruited from the community to 
meet the needs of defined target service populations; and 
"(C) make further recommendations necessary or desir-
able to increase the effectiveness of such projects, 
"(q) DEFINITIONS.—For purposes of this section: 
"(1) The term 'eligible entity* includes public and nonprofit 
private entities that provide health or related social services, 
including community-based 
organizations, visiting 
nurse 
organizations, hospitals, local hesQth departments, community 
health centers. Native Hawaiian health centers, nurse managed 
clinics, family service agencies, child welfare agencies, devel-
opmental service providers, family resource and support pro-
grams, and resource mothers projects. 
"(2) The term 'eligible famil/ means a family described in 
subsection (a). 
"(3) The term liealth or developmental comphcation', with 
respect to a child, means— 
"(A) being bom in an unhealthy or potentially unhealthy 
condition, including premature birth, low birthweight, and 
prenatal exposure to maternal substance abuse; 
"(B) a condition arising from a condition described in 
subparagraph (A); 
"(C) a physical disability or delay; and 
"(D) a developmental disability or delay. 
"(4) The term 'home visiting services' means the services 
specified in subsection (b), provided at the residence of the 
eligible family involved or provided pursuant to arrangements 
made for the family (including arrangements for services in 
community settings). 
"(5) The term 'home visitors' means providers of home visiting 
services. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 433 
"(r) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of car-
rying out this section, there is authorized to be appropriated 
$30,000,000 for each of the fiscal years 1993 and 1994.". 
TITLE VI—TRAUMA CENTERS AND 
DRUG-RELATED VIOLENCE 
SEC. 601. ESTABLISHMENT OF PROGRAM OF GRANTS. 
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 CERTAM TRAUMA CENTERS. 
42 USC 300D-4L 
"(a) IN GENERAL.—^The Secretary may make grants for the pur-
pose 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 directly or indirectly from illicit trafficking in drugs. 
Grants imder this subsection may be made only to such trauma 
centers. 
"(b) MINIMUM QUALIFICATIONS OF CENTERS.— 
"(1) SIGNIFICANT INCIDENCE OF TREATING CERTAIN PATIENTS.— 
"(A) The Secretary may not make a grant under sub-
section (a) to a trauma center unless me population of 
patients that has been served by the center for the period 
specified in subpsiragraph (B) includes a significant number 
of patients who were treated for— 
"(i) trauma resulting from the penetration of the 
skin by knives, bullets, or any other implement that 
can be used as a weapon; or 
"(ii) trauma that the center reasonably believes 
results 
fi-om 
violence arising directly or indirectly fi-om 
illicit trafficking in drugs. 
"(B) The period specified in this subparagraph is the 
2-year period preceding the fiscal year for which the trauma 
center involved is appl5dng to receive a grant under sub-
section (a). 
"(2) 
PARTICIPATION IN TRAUMA CARE SYSTEM OPERATING 
U
N
D
E
R 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 estabUshed by the State or political subdivision 
in which such center is located; and 
"(C)(i) 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 plein established imder 
section 1213(c); or 
106 STAT. 434 
PUBLIC LAW 102-321—JULY 10, 1992 
"(ii) agrees that such guideHnes will be adopted by the 
'-> , 
system not later than 6 months after the date on which 
the trauma center submits to the Secretary the application 
for the grant. 
"(3) 
SUBMISSION AND APPROVAL OF LONG-TERM PLAN.—The 
Secretary may not make a grant imder subsection (a) unless 
the trauma center involved— 
"(A) submits to the Secretary a plan satisfactory to the 
Secretary that— 
"(i) is developed on the assumption that the center 
will continue to incur substantial uncompensated costs 
in providing trauma care; and 
"(ii) provides for the long-term continued operation 
of the center with an acceptable standard of medical 
care, notwithstanding such imcompensated costs; and 
"(B) agrees to implement the plan according to a schedule 
approved by the Secretary. 
42 u s e 300d-42. 
"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 traimia 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 pa3mients are made to the center from the grant, which 
financial assistemce 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 perma-
nently 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 imcompensated costs in 
an amoiuit rendering the center unable to continue partici-
pation 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 receiv-
ing 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 uncompen-
sated costs of the center result from the provision of trauma care 
to individuals who neither are citizens nor aliens lawfully admitted 
to the United States for permanent residence. 
42 use 300d-43. 
"SEC. 1243. CERTAIN AGREEMENTS. 
"(a) 
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— 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 435 
"(1) the center will continue participation in the system 
described in subsection (b) of sucn section throughout the 3-
year period beginning on the date that the center first receives 
pajnnente under the grant; and 
**(2) if the agreement made pursuant to paragraph (1) is 
violated by the center, the center will be Uable to the United 
States for an amount equal to the simi o
f
— 
"(A) the amount of assistance provided to the center 
under subsection (a) of such section; and 
"(B) an amount representing interest on the amoimt 
specified in subparagraph (A). 
"(b) MAINTENANCE OF FINANCIAL SUPPORT.—With respect to 
activities for which a grant under section 1241 is authorized to 
be expended, the Secretary may not make such a grant unless 
the trauma center involved agrees that, during the period in which 
the center is receiving pajnnents under the grant, the center will 
maintain expenditures for such activities at a level that is not 
less than the level maintained by the center during the fiscal 
year preceding the first fiscal year for which the center receives 
such payments. 
"(c) TRAUMA CARE REGISTRY.—The Secretary may not make a 
grant imder section 1241(a) unless the trauma center involved 
agrees that— 
"(1) the center will operate a registry of trauma cases in 
accordance with the applicable guidelines described in section 
1241(b)(2)(C), and will begin operation of the registry not later 
than 6 months after the date on which the center submits 
to the Secretary the application for the grant; and 
"(2) in carrying out paragraph (1), the center will maintain 
information on the number of trauma cases treated by the 
center and, for each such case, the extent to which the center 
incurs uncompensated costs in providing trauma care. 
•«EC. 1244. GENERAL PROVISIONS. 
42 USC 300d-44. 
"(a) APPLICATION.—^The Secretary may not make a grant under 
section 1241(a) imless an appUcation 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 pajmaents for 1 additional fiscalyear. 
"(c) LIMITATION ON AMOUNT OF GRANT.—A grant under section 
1241 may not be made in an amount exceeding $2,000,000. 
•«EC. 1246. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 300d-45. 
"For the purpose of carrying out this part, there are authorized 
to be appropriated $100,000,000 for fiscal year 1993, and such 
sums as may be necessary for fiscal year 1994. Such authorization 
of appropriations is in addition to any other authorization of appro-
priations or amounts that are available for such purpose.". 
SEC. 602. CONFORMING AMENDMENTS. 
Title XII of the PubUc Health Service Act (42 U.S.C. 300d et 
seq.) is amended— 
106 STAT. 436 
PUBLIC LAW 102-321—JULY 10, 1992 
(1) in the heading for part C, by inserting "REGARDING PARTS 
A A
N
D B" after "PROVISIONS"; 
42 use 300d-3l. 
(2) in section 1231, in the matter preceding paragraph (1), 
by striking "this title" and inserting "this part and parts A 
and B"; and 
42 use 300d-32. 
(3) in section 1232(a), by striking "this title" and inserting 
"parts A and B". 
TITLE VII—STUDIES 
42 u s e 2850-4 
SEC. 701. REPORT BY THE INSTITUTE ON MEDICINE. 
(a) STUDY.—^The Secretary of Health and Human Services shall 
enter into a contract with a public or nonprofit private entity 
to conduct a study concerning— 
(1) the role of the private sector in the development of anti-
addiction medications, including legislative proposals designed 
to encourage private sector development of such medications; 
(2) the process by which anti-addiction medications receive 
marketing approval from the Food and Drug Administration, 
including an assessment of the feasibility of expediting the 
marketing approval process in a manner consistent with 
maintaining the safety and effectiveness of such medications; 
(3) with respect to pharmacotherapeutic treatments for drug 
addiction— 
(A) recommendations with respect to a national strategy 
for developing such treatments and improvements in such 
strategy; 
(B) the state of the scientific knowledge concerning such 
treatments; and 
(C) an assessment of the progress toward the develop-
ment of safe, effective pharmacological treatments for drug 
;
> . 
addiction; and 
(4) other related information determined appropriate by the 
authors of the study. 
(b) NATIONAL ACADEMY OF SCIENCES.—The Secretary of Health 
and Human Services shall request the Institute of Medicine of 
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 pri-
vate entity. 
(c) REPORT.—^The Secretary of Health and Human Services shall 
ensure that, not later than 18 months after the date of 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 
fli ;- ^ 
fe 
House of Representatives and to the Committee on Labor and 
Human Resources of the Senate. 
(d) AVAILABILITY.—The report prepared under subsection (c) shall 
be made available for use by the general public. 
SEC. 702. SENSE OF THE SENATE. 
It is the sense of the Senate that the Medications Development 
Division of the National Institute on Drug Abuse shall devote 
special attention and adequate resources to achieve the following 
urgent goals— 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 437 
(1) the development of medications in addition to methadone; 
(2) the development of a long-acting narcotic antagonist; 
(3) the development of agents for the treatment of cocaine 
abuse and dependency, including those that act as a narcotic 
eintagonist; 
(4) the development of medications to treat addiction to drugs 
that are becoming increasingly prevgJent, such as methamphet-
amine; 
(5) the development of additional medications to treat safely 
pregnant addicts and their fetuses; and 
(6) the development of medications to treat the offspring 
of addicted mothers. 
SEC. 703. PROVISION OF MENTAL HEALTH SERVICES TO INDIVIDUALS Reports. 
IN CORRECTIONAL FAdLITIES. 
42 USC 290bb-31 
note. 
Not later than 18 months after the date of enactment of this 
Act, the Secretary of Health and Human Services, acting through 
the Director of the Center for Mented Health Services, shadl prepare 
and submit to the appropriate committees of Congress a report 
concerning the most effective methods for providing mental health 
services to individuals who come into contact with the criminal 
justice system, including those individuals incarcerated in correc-
tional facilities (including local jails and detention facilities), and 
the obstacles to providing such services. Such study shall be carried 
out in consultation with the National Institute of Mental Health, 
the Department of Justice, and other appropriate public and private 
entities. 
SEC. 704. STUDY OF BARRIERS TO INSURANCE COVERAGE OF TREAT- 42 USC 285p 
MENT FOR MENTAL ILLNESS AND SUBSTANCE ABUSE, note. 
(a) IN GENERAL.—^The Secretary of Health and Human Services, 
acting through the Director of the National Institute of Mental 
Health and in consultation with the Administrator of the Health 
Care Financing Administration, shall conduct a study of the barriers 
to insurance coverage for the treatment of mental illness and sub-
stance abuse. The study shall include— 
(1) £ui assessment of the effect of managed C£ire on the quaUty 
and financing of such treatment; 
(2) an assessment of the appropriateness £uid cost effective-
ness of treatment provided in non-profit, non-hospital settings; 
£ind 
(3) an assessment of the need for equitable coverage of severe 
mental illnesses as part of national health care reform. 
(b) ASSESSMENT REGARDING MENTAL ILLNESS.—In making an 
assessment under paragraph (3) of subsection (a), the study required 
in such subsection shall provide for the following: 
(1) The clarification of what is meant by mental health cov-
erage differentiating between the need of individuals with 
severe, long-term mental illnesses and individuals with mental 
health problems of situational nature. 
(2) Identification of the particular treatments and services 
required by persons with severe mental illnesses to maintain 
optimum functioning in the community. 
(3) Evsduation of various approaches to providing equitable 
coverage of severe mental illnesses in private insurance and 
public health care financing programs. These approaches should 
mclude the following: 
106 STAT. 438 
PUBLIC LAW 102-321—JULY 10, 1992 
(A) The diagnostic approach as exempUfied by certain 
State legislation (e.g., California State Code, section 
101123.15; Texas Employers Uniform Group Insurance 
Benefits Act, section 11.106-11.113 (Insurance for Serious 
Mental Illnesses); £ind Maine, H.P. 1064: An Act to provide 
equitable insurance coverage for mental illnesses). 
(B) The Service-Based Approach, as exemplified in the 
Model Mental Health Benefit developed the auspices of 
NIMH Grant MH43703. 
(C) The Fimctional (Severity of Disability) Approach. 
(4) Evaluation of the cost benefit to insurers and the Federal 
Government of providing equal coverage for severe mental ill-
ness. 
: 
(5) Financing mechanisms for coverage of the rehabilitative 
and long-term care needs of persons with severe mental ill-
nesses, 
(c) REPORT TO CONGRESS.—Not later than October 1, 1993, 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. 
42 use 285n 
SEC. 705. STUDY ON FETAL ALCOHOL EFFECT AND FETAL ALCOHOL 
note. 
SYNDROME. 
(a) IN GENERAL.—The Secretary of Health and Human Services 
(in this section referred to as the "Secretary") shaU 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 in identifymg such effect or syndrome). 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 congenital conditions; 
(3) evaluates the effectiveness and availability of treatment 
for such conditions; and 
(4) evaluates the plans of Federal agencies to conduct 
research on such 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 sub-
section. If such Academy declines to conduct the study, the Sec-
retary 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 Rep-
resentatives and to the Committee on Labor and Human Resources 
of 
the Senate. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 439 
S^C. 706. STUDY BY NATIONAL ACADEMY OF SCIENCES. 
(a) IN GENERAL.—In the case of programs in the United States 
that provide both sterile hjrpodermic needles and bleach to individ-
uals in order to provide for a reduction in the risk of the individuals 
contracting acquired immune deficiency sjnidrome or related condi-
tions, the Secretary of Health and Human Services (in this section 
referred to as the "Secretary"), 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 or studies 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 contract-
ing acquired immune deficiency sjnidrome or hepatitis, 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 or studies described 
in such subsection. If such Academy declines to conduct the study, 
the Secretary shall carry out such subsection through other public 
or nonprofit private entities. 
(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 tWs Act. 
(d) DATE FOR COMPLETION.—The Secretary shall ensure that, 
not later than 18 months after the date of tne enactment of tins 
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 Rep-
resentatives and to the Committee on Labor and Human Resources 
of the Senate. 
(e) FUNDING.—Of the aggregate amounts appropriated under the 
Pubhc Health Service Act for 
fisc£d 
years 1993 and 1994 for research 
on drug abuse, the Secretary shall make available $5,000,000 for 
conducting the study required in subsection (a). 
SEC. 707. REPORT ON ALLOTMENT FORMULA. 
(a) STUDY.—The Secretary of Health and Human Services (in 
this section referred to as the "Secretary") shall enter into a contract 
with a pubUc or nonprofit private entity, subject to subsection 
(b), for the purpose of conducting a study or studies concerning 
the statutory formulae under which funds made available under 
sections 1911 and 1921 of the PubUc Health Service Act are allo-
42 u s e 2850-3 
note. 
Contracts. 
Reports. 
42 u s e 300x 
note. 
Contracts. 
106 STAT. 440 
PUBLIC LAW 102-321—JULY 10, 1992 
cated among the States and territories. Such study or studies shall 
include— 
(1) an assessment of the degree to which the formula allocates 
funds according to the respective needs of the States and terri-
tories; 
(2) a review of relevant epidemiological research regarding 
the incidence of substance abuse and mental illness among 
various age groups and geographic regions of the coimtry; 
(3) the identification of factors not included in the formula 
that are reUable predictors of the incidence of substance abuse 
and mental illness; 
(4) an assessment of the validity and relevance of factors 
currently included in the formula, such as age, urban population 
and cost; and 
(5) any other information that would contribute to a thorough 
assessment of 
the appropriateness of the current formula. 
Contracts. 
(b) NATIONAL A
C
A
D
E
M
Y OF SCIENCES.—The Secretary shall 
request the National Academy of Sciences to enter into the contract 
imder subsection (a) to conduct the study described in such sub-
section. If such Academy declines to conduct the study, the Sec-
retary shall carry out such subsection through another public or 
nonprofit private entity. 
(c) REPORT.—The Secretary shall ensure that not later than 6 
months after the date of enactment of this Act, the study required 
under subsection (a) is completed and a report describing the find-
ings made as a result of such study is submitted to the Committee 
on Energy and Commerce of the House of Representatives and 
the Committee on Labor and Human Resources of the Senate. 
(d) CONSULTATION.—^The entity preparing the report required 
imder subsection (c), shall consiilt with the Comptroller General 
of the United States. The Comptroller Greneral shall review the 
study after its transmittal to the committees described in subsection 
(c) and within three months make appropriate recommendations 
concerning such report to such committees. 
42 use 290aa 
SEC. 708. REPORT BY SUBSTANCE ABUSE AND MENTAL HEALTH SERV-
note. 
ICES ADMINISTRATION. 
(a) INTERIM REPORT.—Not later than 6 months after the date 
of the enactment of this Act, the Administrator of the Substance 
Abuse and MentsQ HeeJth Services Administration shall compile 
and directly transmit to the Committee on Energy and Commerce 
of the House of Representatives and the Committee on Labor and 
Human Resources of the Senate an interim report that includes 
the following information: 
(1) A compilation and summary of the scientific literature 
and research concerning the provision of health insurance, by 
both public and private entities, for substance abuse (including 
alcohol abuse) and mental health services. 
(2) A review of the scientific literature evaluating the medical 
effectiveness of substance abuse (including alcohol abuse) and 
mental health services. 
(3) An examination of past practices and emerging trends 
of health insurance coverage for substance abuse (including 
alcohol abuse) and mental health services, including an exam-
ination of trends in copayments, lifetime coverage maximums, 
number of visits, and inclusion or exclusion of such services. 
PUBLIC LAW 102-321—JULY 10, 1992 
106 STAT. 441 
(4) An identification of issues attendant to and analysis of 
barriers to health insurance coverage for substance abuse 
(including alcohol abuse) and mental illness services. Such 
analysis shall include a discussion of how substance abuse 
(including alcohol abuse) and mental health services would 
be £iffected by the various hesJth care reform under consider-
ation in Congress. 
(5) An examination of the issues attendant to limitations 
placed on the use of Medicaid program funds for adults receiv-
ing substance abuse (including alcoholism services) and mental 
health services in intermediate care residential settings. 
(b) FINAL REPORT.—Not later than October 1,1993, such Adminis-
trator shall compile and transmit directly to the Committee on 
Energy £ind Commerce of the House of Representatives and the 
Committee on Labor and Human Resources of the Senate a report 
that identifies the relevant policy issues and research questions 
that need to be answered to address current barriers to the provision 
of substance abuse and mental health services. The Administrator 
shall design a research and demonstration strategy that examines 
such barriers and tests alternative solutions to the problems of 
providing health insurance and treatment services for substance 
abuse and mental health services. As soon as practicable but not 
later than January 1, 1994, the Secretary shall initiate research 
and demonstration projects that, consistent with the information 
contsiined in the reports required imder this section, will study 
the issues identified with, and possible edtemative mechanisms 
of, providing health insurance £ind treatment services for substance 
abuse (including alcohol abuse) and mental illness. 
TITLE VIII—GENERAL PROVISIONS 
SEC. 801. EFFECTIVE DATES. 
42 USC 236 note. 
(a) IN GENERAL.—^This Act takes effect on the date of the enact-
ment of this Act, subject to subsections (b) through (d). 
(b) AMENDMENTS.—^The amendments described in this Act are 
made on the date of the enactment of this Act and take effect 
on such date, except as provided in subsections (c) £ind (d). 
(c) REORGANIZATION UNDER TITLE I.—Title I takes effect on Octo-
ber 1, 1992. The amendments described in such title are made 
on such date and take effect on such date. 
(d) PROGRAMS PROVIDING FINANCIAL ASSISTANCE .— 
(1) FISCAL YEAR 1993 AND SUBSEQUENT YEARS.—In the case 
of any program making aw£irds of grants, cooperative agree-
ments, or contracts, the amendments made by this Act are 
effective for awards made on or after October 1,1992. 
(2) PRIOR FISCAL YEARS.— 
(A) Except as provided in subparagraph (B), in the case 
of any program making awards of grants, cooperative agree-
ments, or contracts, if the program began operation prior 
to the date of the enactment of this Act and the program 
is amended by this Act, awards made prior to October 
1, 1992, shall continue to be subject to the terms and 
conditions upon which such awards were made, not-
withstanding the amendments made by this Act. 
106 STAT. 442 
PUBLIC LAW 102-321—JULY 10, 1992 
(B) Subparagraph (A) does not apply with respect to 
the amendments made by this Act to part B of title XIX 
of the Public Health Service Act. Section 205(a) applies 
with respect to the program established in such part. 
Approved July 10, 1992. 
LEGISLATIVE HISTORY—S. 1306 (H.R. 3698): 
HOUSE REPORTS: Nos. 102-464 accompanying H.R. 3698 (Comm. on Energy and 
Commerce) and 102-522 and 102-546 (both from Comm. of 
Conference). 
SENATE REPORTS: No. 102-131 (Comm. on Labor and Human Resources). 
CONGRESSIONAL RECORD: 
Vol. 137 (1991): Aug. 2, considered and passed Senate. 
Vol. 138 (1992): Mar. 24, H.R. 3698 considered and passed House; S. 1306, 
amended, passed in lieu. 
May 19, House failed to agree to conference report. 
May 28, House recommitted conference report. 
June 4, 9, Senate considered and agreed to conference report. 
July 1, House agreed to conference report. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 28 (1992): 
July 10, Presidential statement.