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114th Congress }                                      { Rept. 114-667
                        HOUSE OF REPRESENTATIVES
 2d Session    }                                      { Part 1

======================================================================
 
          HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT OF 2016

                                _______
                                

  July 6, 2016.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Upton, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2646]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2646) to make available needed psychiatric, 
psychological, and supportive services for individuals with 
mental illness and families in mental health crisis, and for 
other purposes, having considered the same, report favorably 
thereon with an amendment and recommend that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................    39
Background and Need for Legislation..............................    40
Hearings.........................................................    40
Committee Consideration..........................................    40
Committee Votes..................................................    41
Committee Oversight Findings.....................................    44
Statement of General Performance Goals and Objectives............    44
New Budget Authority, Entitlement Authority, and Tax Expenditures    44
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......    44
Committee Cost Estimate..........................................    44
Congressional Budget Office Estimate.............................    44
Federal Mandates Statement.......................................    47
Duplication of Federal Programs..................................    47
Disclosure of Directed Rule Makings..............................    47
Advisory Committee Statement.....................................    47
Applicability to Legislative Branch..............................    47
Section-by-Section Analysis of the Legislation...................    47
Changes in Existing Law Made by the Bill, as Reported............    56

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Helping Families in 
Mental Health Crisis Act of 2016''.
  (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

    TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE

Sec. 101. Assistant Secretary for Mental Health and Substance Use.
Sec. 102. Improving oversight of mental health and substance use 
programs.
Sec. 103. National Mental Health and Substance Use Policy Laboratory.
Sec. 104. Peer-support specialist programs.
Sec. 105. Prohibition against lobbying using Federal funds by systems 
accepting Federal funds to protect and advocate the rights of 
individuals with mental illness.
Sec. 106. Reporting for protection and advocacy organizations.
Sec. 107. Grievance procedure.
Sec. 108. Center for Behavioral Health Statistics and Quality.
Sec. 109. Strategic plan.
Sec. 110. Authorities of centers for mental health services and 
substance abuse treatment.
Sec. 111. Advisory councils.
Sec. 112. Peer review.

               TITLE II--MEDICAID MENTAL HEALTH COVERAGE

Sec. 201. Rule of construction related to Medicaid coverage of mental 
health services and primary care services furnished on the same day.
Sec. 202. Optional limited coverage of inpatient services furnished in 
institutions for mental diseases.
Sec. 203. Study and report related to Medicaid managed care regulation.
Sec. 204. Guidance on opportunities for innovation.
Sec. 205. Study and report on Medicaid emergency psychiatric 
demonstration project.
Sec. 206. Providing full-range of EPSDT services to children in IMDs.
Sec. 207. Electronic visit verification system required for personal 
care services and home health care services under Medicaid.

   TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING 
                               COMMITTEE

Sec. 301. Interdepartmental Serious Mental Illness Coordinating 
Committee.

             TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA

Sec. 401. Sense of Congress.
Sec. 402. Confidentiality of records.
Sec. 403. Clarification of circumstances under which disclosure of 
protected health information is permitted.
Sec. 404. Development and dissemination of model training programs.

   TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS

Sec. 501. Assertive community treatment grant program for individuals 
with serious mental illness.
Sec. 502. Strengthening community crisis response systems.
Sec. 503. Increased and extended funding for assisted outpatient grant 
program for individuals with serious mental illness.
Sec. 504. Liability protections for health professional volunteers at 
community health centers.

      TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS

Subtitle A--Encouraging the Advancement, Incorporation, and Development 
                      of Evidence-Based Practices

Sec. 601. Encouraging innovation and evidence-based programs.
Sec. 602. Promoting access to information on evidence-based programs 
and practices.
Sec. 603. Sense of Congress.

    Subtitle B--Supporting the State Response to Mental Health Needs

Sec. 611. Community Mental Health Services Block Grant.

     Subtitle C--Strengthening Mental Health Care for Children and 
                              Adolescents

Sec. 621. Telehealth child psychiatry access grants.
Sec. 622. Infant and early childhood mental health promotion, 
intervention, and treatment.
Sec. 623. National Child Traumatic Stress Initiative.

         TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATION

       Subtitle A--Garrett Lee Smith Memorial Act Reauthorization

Sec. 701. Youth interagency research, training, and technical 
assistance centers.
Sec. 702. Youth suicide early intervention and prevention strategies.
Sec. 703. Mental health and substance use disorder services on campus.

                      Subtitle B--Other Provisions

Sec. 711. National Suicide Prevention Lifeline Program.
Sec. 712. Workforce development studies and reports.
Sec. 713. Minority Fellowship Program.
Sec. 714. Center and program repeals.
Sec. 715. National violent death reporting system.
Sec. 716. Sense of Congress on prioritizing Native American youth and 
suicide prevention programs.
Sec. 717. Peer professional workforce development grant program.
Sec. 718. National Health Service Corps.
Sec. 719. Adult suicide prevention.
Sec. 720. Crisis intervention grants for police officers and first 
responders.
Sec. 721. Demonstration grant program to train health service 
psychologists in community-based mental health.
Sec. 722. Investment in tomorrow's pediatric health care workforce.
Sec. 723. CUTGO compliance.

                    TITLE VIII--MENTAL HEALTH PARITY

Sec. 801. Enhanced compliance with mental health and substance use 
disorder coverage requirements.
Sec. 802. Action plan for enhanced enforcement of mental health and 
substance use disorder coverage.
Sec. 803. Report on investigations regarding parity in mental health 
and substance use disorder benefits.
Sec. 804. GAO study on parity in mental health and substance use 
disorder benefits.
Sec. 805. Information and awareness on eating disorders.
Sec. 806. Education and training on eating disorders.
Sec. 807. GAO study on preventing discriminatory coverage limitations 
for individuals with serious mental illness and substance use 
disorders.
Sec. 808. Clarification of existing parity rules.

    TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE

SEC. 101. ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE.

  (a) Assistant Secretary.--Section 501(c) of the Public Health Service 
Act (42 U.S.C. 290aa) is amended to read as follows:
  ``(c) Assistant Secretary and Deputy Assistant Secretary.--
          ``(1) Assistant secretary.--
                  ``(A) Appointment.--The Administration shall be 
                headed by an official to be known as the Assistant 
                Secretary for Mental Health and Substance Use 
                (hereinafter in this title referred to as the 
                `Assistant Secretary') who shall be appointed by the 
                President, by and with the advice and consent of the 
                Senate.
                  ``(B) Qualifications.--In selecting the Assistant 
                Secretary, the President shall give preference to 
                individuals who have--
                          ``(i) a doctoral degree in medicine, 
                        osteopathic medicine, or psychology;
                          ``(ii) clinical and research experience 
                        regarding mental health and substance use 
                        disorders; and
                          ``(iii) an understanding of biological, 
                        psychosocial, and pharmaceutical treatments of 
                        mental illness and substance use disorders.
          ``(2) Deputy assistant secretary.--The Assistant Secretary, 
        with the approval of the Secretary, may appoint a Deputy 
        Assistant Secretary and may employ and prescribe the functions 
        of such officers and employees, including attorneys, as are 
        necessary to administer the activities to be carried out 
        through the Administration.''.
  (b) Transfer of Authorities.--The Secretary of Health and Human 
Services shall delegate to the Assistant Secretary for Mental Health 
and Substance Use all duties and authorities that--
          (1) as of the day before the date of enactment of this Act, 
        were vested in the Administrator of the Substance Abuse and 
        Mental Health Services Administration; and
          (2) are not terminated by this Act.
  (c) Evaluation.--Section 501(d) of the Public Health Service Act (42 
U.S.C. 290aa(d)) is amended--
          (1) in paragraph (17), by striking ``and'' at the end;
          (2) in paragraph (18), by striking the period at the end and 
        inserting a semicolon; and
          (3) by adding at the end the following:
          ``(19) evaluate, in consultation with the Assistant Secretary 
        for Financial Resources, the information used for oversight of 
        grants under programs related to mental and substance use 
        disorders, including co-occurring disorders, administered by 
        the Center for Mental Health Services;
          ``(20) periodically review Federal programs and activities 
        relating to the diagnosis or prevention of, or treatment or 
        rehabilitation for, mental illness and substance use disorders 
        to identify any such programs or activities that have proven to 
        be effective or efficient in improving outcomes or increasing 
        access to evidence-based programs;
          ``(21) establish standards for the appointment of peer-review 
        panels to evaluate grant applications and recommend standards 
        for mental health grant programs; and''.
  (d) Standards for Grant Programs.--Section 501(d) of the Public 
Health Service Act (42 U.S.C. 290aa(d)), as amended by subsection (c), 
is further amended by adding at the end the following:
          ``(22) in consultation with the National Mental Health and 
        Substance Use Policy Laboratory, and after providing an 
        opportunity for public input, set standards for grant programs 
        under this title for mental health and substance use services, 
        which may address--
                  ``(A) the capacity of the grantee to implement the 
                award;
                  ``(B) requirements for the description of the program 
                implementation approach;
                  ``(C) the extent to which the grant plan submitted by 
                the grantee as part of its application must explain how 
                the grantee will reach the population of focus and 
                provide a statement of need, including to what extent 
                the grantee will increase the number of clients served 
                and the estimated percentage of clients receiving 
                services who report positive functioning after 6 months 
                or no past-month substance use, as applicable;
                  ``(D) the extent to which the grantee must collect 
                and report on required performance measures; and
                  ``(E) the extent to which the grantee is proposing 
                evidence-based practices and the extent to which--
                          ``(i) those evidence-based practices must be 
                        used with respect to a population similar to 
                        the population for which the evidence-based 
                        practices were shown to be effective; or
                          ``(ii) if no evidence-based practice exists 
                        for a population of focus, the way in which the 
                        grantee will implement adaptations of evidence-
                        based practices, promising practices, or 
                        cultural practices.''.
  (e) Member of Council on Graduate Medical Education.--Section 762 of 
the Public Health Service Act (42 U.S.C. 290o) is amended--
          (1) in subsection (b)--
                  (A) by redesignating paragraphs (4), (5), and (6) as 
                paragraphs (5), (6), and (7), respectively; and
                  (B) by inserting after paragraph (3) the following:
          ``(4) the Assistant Secretary for Mental Health and Substance 
        Use;''; and
          (2) in subsection (c), by striking ``(4), (5), and (6)'' each 
        place it appears and inserting ``(5), (6), and (7)''.
  (f) Conforming Amendments.--Title V of the Public Health Service Act 
(42 U.S.C. 290aa et seq.), as amended by the previous provisions of 
this section, is further amended--
          (1) by striking ``Administrator of the Substance Abuse and 
        Mental Health Services Administration'' each place it appears 
        and inserting ``Assistant Secretary for Mental Health and 
        Substance Use''; and
          (2) by striking ``Administrator'' each place it appears 
        (including in any headings) and inserting ``Assistant 
        Secretary'', except where the term ``Administrator'' appears--
                  (A) in each of subsections (e) and (f) of section 501 
                of such Act (42 U.S.C. 290aa), including the headings 
                of such subsections, within the term ``Associate 
                Administrator'';
                  (B) in section 507(b)(6) of such Act (42 U.S.C. 
                290bb(b)(6)), within the term ``Administrator of the 
                Health Resources and Services Administration'';
                  (C) in section 507(b)(6) of such Act (42 U.S.C. 
                290bb(b)(6)), within the term ``Administrator of the 
                Centers for Medicare & Medicaid Services'';
                  (D) in section 519B(c)(1)(B) of such Act (42 U.S.C. 
                290bb-25b(c)(1)(B)), within the term ``Administrator of 
                the National Highway Traffic Safety Administration''; 
                or
                  (E) in each of sections 519B(c)(1)(B), 520C(a), and 
                520D(a) of such Act (42 U.S.C. 290bb-25b(c)(1)(B), 
                290bb-34(a), 290bb-35(a)), within the term 
                ``Administrator of the Office of Juvenile Justice and 
                Delinquency Prevention''.
  (g) References.--After executing subsections (a), (b), and (f), any 
reference in statute, regulation, or guidance to the Administrator of 
the Substance Abuse and Mental Health Services Administration shall be 
construed to be a reference to the Assistant Secretary for Mental 
Health and Substance Use.

SEC. 102. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE USE 
                    PROGRAMS.

  Title V of the Public Health Service Act is amended by inserting 
after section 501 of such Act (42 U.S.C. 290aa) the following:

``SEC. 501A. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE USE 
                    PROGRAMS.

  ``(a) Activities.--For the purpose of ensuring efficient and 
effective planning and evaluation of mental and substance use disorder 
programs and related activities, the Assistant Secretary for Planning 
and Evaluation, in consultation with the Assistant Secretary for Mental 
Health and Substance Use, shall--
          ``(1) collect and organize relevant data on homelessness, 
        involvement with the criminal justice system, hospitalizations, 
        mortality outcomes, and other measures the Secretary deems 
        appropriate from across Federal departments and agencies;
          ``(2) evaluate programs related to mental and substance use 
        disorders, including co-occurring disorders, across Federal 
        departments and agencies, as appropriate, including programs 
        related to--
                  ``(A) prevention, intervention, treatment, and 
                recovery support services, including such services for 
                individuals with a serious mental illness or serious 
                emotional disturbance;
                  ``(B) the reduction of homelessness and involvement 
                with the criminal justice system among individuals with 
                a mental or substance use disorder; and
                  ``(C) public health and health services; and
          ``(3) consult, as appropriate, with the Assistant Secretary, 
        the Behavioral Health Coordinating Council of the Department of 
        Health and Human Services, other agencies within the Department 
        of Health and Human Services, and other relevant Federal 
        departments.
  ``(b) Recommendations.--The Assistant Secretary for Planning and 
Evaluation shall develop an evaluation strategy that identifies 
priority programs to be evaluated by the Assistant Secretary and 
priority programs to be evaluated by other relevant agencies within the 
Department of Health and Human Services. The Assistant Secretary for 
Planning and Evaluation shall provide recommendations on improving 
programs and activities based on the evaluation described in subsection 
(a)(2) as needing improvement.''.

SEC. 103. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY LABORATORY.

  Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is 
amended by inserting after section 501A, as added by section 102 of 
this Act, the following:

``SEC. 501B. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY 
                    LABORATORY.

  ``(a) In General.--There shall be established within the 
Administration a National Mental Health and Substance Use Policy 
Laboratory (referred to in this section as the `Laboratory').
  ``(b) Responsibilities.--The Laboratory shall--
          ``(1) continue to carry out the authorities and activities 
        that were in effect for the Office of Policy, Planning, and 
        Innovation as such Office existed prior to the date of 
        enactment of the Helping Families in Mental Health Crisis Act 
        of 2016;
          ``(2) identify, coordinate, and facilitate the implementation 
        of policy changes likely to have a significant effect on mental 
        health, mental illness, and the prevention and treatment of 
        substance use disorder services;
          ``(3) collect, as appropriate, information from grantees 
        under programs operated by the Administration in order to 
        evaluate and disseminate information on evidence-based 
        practices, including culturally and linguistically appropriate 
        services, as appropriate, and service delivery models;
          ``(4) provide leadership in identifying and coordinating 
        policies and programs, including evidence-based programs, 
        related to mental and substance use disorders;
          ``(5) recommend ways in which payers may implement program 
        and policy findings of the Administration and the Laboratory to 
        improve outcomes and reduce per capita program costs;
          ``(6) in consultation with the Assistant Secretary for 
        Planning and Evaluation, as appropriate, periodically review 
        Federal programs and activities relating to the diagnosis or 
        prevention of, or treatment or rehabilitation for, mental 
        illness and substance use disorders, including by--
                  ``(A) identifying any such programs or activities 
                that are duplicative;
                  ``(B) identifying any such programs or activities 
                that are not evidence-based, effective, or efficient; 
                and
                  ``(C) formulating recommendations for coordinating, 
                eliminating, or improving programs or activities 
                identified under subparagraph (A) or (B) and merging 
                such programs or activities into other successful 
                programs or activities; and
          ``(7) carry out other activities as deemed necessary to 
        continue to encourage innovation and disseminate evidence-based 
        programs and practices, including programs and practices with 
        scientific merit.
  ``(c) Evidence-Based Practices and Service Delivery Models.--
          ``(1) In general.--In selecting evidence-based best practices 
        and service delivery models for evaluation and dissemination, 
        the Laboratory--
                  ``(A) shall give preference to models that improve--
                          ``(i) the coordination between mental health 
                        and physical health providers;
                          ``(ii) the coordination among such providers 
                        and the justice and corrections system; and
                          ``(iii) the cost effectiveness, quality, 
                        effectiveness, and efficiency of health care 
                        services furnished to individuals with serious 
                        mental illness or serious emotional 
                        disturbance, in mental health crisis, or at 
                        risk to themselves, their families, and the 
                        general public; and
                  ``(B) may include clinical protocols and practices 
                used in the Recovery After Initial Schizophrenia 
                Episode (RAISE) project and the North American Prodrome 
                Longitudinal Study (NAPLS) of the National Institute of 
                Mental Health.
          ``(2) Deadline for beginning implementation.--The Laboratory 
        shall begin implementation of the duties described in this 
        subsection not later than January 1, 2018.
          ``(3) Consultation.--In carrying out the duties under this 
        subsection, the Laboratory shall consult with--
                  ``(A) representatives of the National Institute of 
                Mental Health, the National Institute on Drug Abuse, 
                and the National Institute on Alcohol Abuse and 
                Alcoholism, on an ongoing basis;
                  ``(B) other appropriate Federal agencies;
                  ``(C) clinical and analytical experts with expertise 
                in psychiatric medical care and clinical psychological 
                care, health care management, education, corrections 
                health care, and mental health court systems, as 
                appropriate; and
                  ``(D) other individuals and agencies as determined 
                appropriate by the Assistant Secretary.''.

SEC. 104. PEER-SUPPORT SPECIALIST PROGRAMS.

  (a) In General.--Not later than 2 years after the date of enactment 
of this Act, the Comptroller General of the United States shall conduct 
a study on peer-support specialist programs in up to 10 States (to be 
selected by the Comptroller General) that receive funding from the 
Substance Abuse and Mental Health Services Administration and submit to 
the Committee on Health, Education, Labor, and Pensions of the Senate 
and the Committee on Energy and Commerce of the House of 
Representatives a report containing the results of such study.
  (b) Contents of Study.--In conducting the study under subsection (a), 
the Comptroller General of the United States shall examine and identify 
best practices in the selected States related to training and 
credential requirements for peer-specialist programs, such as--
          (1) hours of formal work or volunteer experience related to 
        mental and substance use disorders conducted through such 
        programs;
          (2) types of peer support specialist exams required for such 
        programs in the States;
          (3) codes of ethics used by such programs in the States;
          (4) required or recommended skill sets of such programs in 
        the State; and
          (5) requirements for continuing education.

SEC. 105. PROHIBITION AGAINST LOBBYING USING FEDERAL FUNDS BY SYSTEMS 
                    ACCEPTING FEDERAL FUNDS TO PROTECT AND ADVOCATE THE 
                    RIGHTS OF INDIVIDUALS WITH MENTAL ILLNESS.

  Section 105(a) of the Protection and Advocacy for Individuals with 
Mental Illness Act (42 U.S.C. 10805(a)) is amended--
          (1) in paragraph (9), by striking ``and'' at the end;
          (2) in paragraph (10), by striking the period at the end and 
        inserting ``; and''; and
          (3) by adding at the end the following:
          ``(11) agree to refrain, during any period for which funding 
        is provided to the system under this part, from using Federal 
        funds to pay the salary or expenses of any grant or contract 
        recipient, or agent acting for such recipient, related to any 
        activity designed to influence the enactment of legislation, 
        appropriations, regulation, administrative action, or Executive 
        order proposed or pending before the Congress or any State 
        government, State legislature or local legislature or 
        legislative body, other than for normal and recognized 
        executive-legislative relationships or participation by an 
        agency or officer of a State, local, or tribal government in 
        policymaking and administrative processes within the executive 
        branch of that government.''.

SEC. 106. REPORTING FOR PROTECTION AND ADVOCACY ORGANIZATIONS.

  (a) Public Availability of Reports.--Section 105(a)(7) of the 
Protection and Advocacy for Individuals with Mental Illness Act (42 
U.S.C. 10805(a)(7)) is amended by striking ``is located a report'' and 
inserting ``is located, and make publicly available, a report''.
  (b) Detailed Accounting.--Section 114(a) of the Protection and 
Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10824(a)) 
is amended--
          (1) in paragraph (3), by striking ``and'' at the end;
          (2) in paragraph (4), by striking the period at the end and 
        inserting ``; and''; and
          (3) by adding at the end the following:
          ``(5) using data from the existing required annual program 
        progress reports submitted by each system funded under this 
        title, a detailed accounting for each such system of how funds 
        are spent, disaggregated according to whether the funds were 
        received from the Federal Government, the State government, a 
        local government, or a private entity.''.

SEC. 107. GRIEVANCE PROCEDURE.

  Section 105 of the Protection and Advocacy for Individuals with 
Mental Illness Act (42 U.S.C. 10805), as amended, is further amended by 
adding at the end the following:
  ``(d) Grievance Procedure.--The Secretary shall establish an 
independent grievance procedure for persons described in subsection 
(a)(9).''.

SEC. 108. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.

  Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is 
amended--
          (1) in section 501(b) (42 U.S.C. 290aa(b)), by adding at the 
        end the following:
          ``(4) The Center for Behavioral Health Statistics and 
        Quality.'';
          (2) in section 502(a)(1) (42 U.S.C. 290aa-1(a)(1))--
                  (A) in subparagraph (C), by striking ``and'' at the 
                end;
                  (B) in subparagraph (D), by striking the period at 
                the end and inserting ``; and''; and
                  (C) by inserting after subparagraph (D) the 
                following:
                  ``(E) the Center for Behavioral Health Statistics and 
                Quality.''; and
          (3) in part B (42 U.S.C. 290bb et seq.) by adding at the end 
        the following new subpart:

    ``Subpart 4--Center for Behavioral Health Statistics and Quality

``SEC. 520L. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.

  ``(a) Establishment.--There is established in the Administration a 
Center for Behavioral Health Statistics and Quality (in this section 
referred to as the `Center'). The Center shall be headed by a Director 
(in this section referred to as the `Director') appointed by the 
Secretary from among individuals with extensive experience and academic 
qualifications in research and analysis in behavioral health care or 
related fields.
  ``(b) Duties.--The Director of the Center shall--
          ``(1) coordinate the Administration's integrated data 
        strategy by coordinating--
                  ``(A) surveillance and data collection (including 
                that authorized by section 505);
                  ``(B) evaluation;
                  ``(C) statistical and analytic support;
                  ``(D) service systems research; and
                  ``(E) performance and quality information systems;
          ``(2) recommend a core set of measurement standards for grant 
        programs administered by the Administration; and
          ``(3) coordinate evaluation efforts for the grant programs, 
        contracts, and collaborative agreements of the Administration.
  ``(c) Biannual Report to Congress.--Not later than 2 years after the 
date of enactment of this section, and every 2 years thereafter, the 
Director of the Center shall submit to Congress a report on the quality 
of services furnished through grant programs of the Administration, 
including applicable measures of outcomes for individuals and public 
outcomes such as--
          ``(1) the number of patients screened positive for unhealthy 
        alcohol use who receive brief counseling as appropriate; the 
        number of patients screened positive for tobacco use and 
        receiving smoking cessation interventions; the number of 
        patients with a new diagnosis of major depressive episode who 
        are assessed for suicide risk; the number of patients screened 
        positive for clinical depression with a documented followup 
        plan; and the number of patients with a documented pain 
        assessment that have a followup treatment plan when pain is 
        present; and satisfaction with care;
          ``(2) the incidence and prevalence of substance use and 
        mental disorders; the number of suicide attempts and suicide 
        completions; overdoses seen in emergency rooms resulting from 
        alcohol and drug use; emergency room boarding; overdose deaths; 
        emergency psychiatric hospitalizations; new criminal justice 
        involvement while in treatment; stable housing; and rates of 
        involvement in employment, education, and training; and
          ``(3) such other measures for outcomes of services as the 
        Director may determine.
  ``(d) Staffing Composition.--The staff of the Center may include 
individuals with advanced degrees and field expertise as well as 
clinical and research experience in mental and substance use disorders 
such as--
          ``(1) professionals with clinical and research expertise in 
        the prevention and treatment of, and recovery from, substance 
        use and mental disorders;
          ``(2) professionals with training and expertise in statistics 
        or research and survey design and methodologies; and
          ``(3) other related fields in the social and behavioral 
        sciences, as specified by relevant position descriptions.
  ``(e) Grants and Contracts.--In carrying out the duties established 
in subsection (b), the Director may make grants to and enter into 
contracts and cooperative agreements with public and nonprofit private 
entities.
  ``(f) Definition.--In this section, the term `emergency room 
boarding' means the practice of admitting patients to an emergency 
department and holding such patients in the department until inpatient 
psychiatric beds become available.''.

SEC. 109. STRATEGIC PLAN.

  Section 501 of the Public Health Service Act (42 U.S.C. 290aa) is 
amended--
          (1) by redesignating subsections (l) through (o) as 
        subsections (m) through (p), respectively; and
          (2) by inserting after subsection (k) the following:
  ``(l) Strategic Plan.--
          ``(1) In general.--Not later than December 1, 2017, and every 
        5 years thereafter, the Assistant Secretary shall develop and 
        carry out a strategic plan in accordance with this subsection 
        for the planning and operation of evidence-based programs and 
        grants carried out by the Administration.
          ``(2) Coordination.--In developing and carrying out the 
        strategic plan under this section, the Assistant Secretary 
        shall take into consideration the report of the 
        Interdepartmental Serious Mental Illness Coordinating Committee 
        under section 301 of the Helping Families in Mental Health 
        Crisis Act of 2016.
          ``(3) Publication of plan.--Not later than December 1, 2017, 
        and every 5 years thereafter, the Assistant Secretary shall--
                  ``(A) submit the strategic plan developed under 
                paragraph (1) to the appropriate committees of 
                Congress; and
                  ``(B) post such plan on the Internet website of the 
                Administration.
          ``(4) Contents.--The strategic plan developed under paragraph 
        (1) shall--
                  ``(A) identify strategic priorities, goals, and 
                measurable objectives for mental and substance use 
                disorder activities and programs operated and supported 
                by the Administration, including priorities to prevent 
                or eliminate the burden of mental illness and substance 
                use disorders;
                  ``(B) identify ways to improve services for 
                individuals with a mental or substance use disorder, 
                including services related to the prevention of, 
                diagnosis of, intervention in, treatment of, and 
                recovery from, mental or substance use disorders, 
                including serious mental illness or serious emotional 
                disturbance, and access to services and supports for 
                individuals with a serious mental illness or serious 
                emotional disturbance;
                  ``(C) ensure that programs provide, as appropriate, 
                access to effective and evidence-based prevention, 
                diagnosis, intervention, treatment, and recovery 
                services, including culturally and linguistically 
                appropriate services, as appropriate, for individuals 
                with a mental or substance use disorder;
                  ``(D) identify opportunities to collaborate with the 
                Health Resources and Services Administration to develop 
                or improve--
                          ``(i) initiatives to encourage individuals to 
                        pursue careers (especially in rural and 
                        underserved areas and populations) as 
                        psychiatrists, psychologists, psychiatric nurse 
                        practitioners, physician assistants, 
                        occupational therapists, clinical social 
                        workers, certified peer support specialists, 
                        licensed professional counselors, or other 
                        licensed or certified mental health 
                        professionals, including such professionals 
                        specializing in the diagnosis, evaluation, or 
                        treatment of individuals with a serious mental 
                        illness or serious emotional disturbance; and
                          ``(ii) a strategy to improve the recruitment, 
                        training, and retention of a workforce for the 
                        treatment of individuals with mental or 
                        substance use disorders, or co-occurring 
                        disorders;
                  ``(E) identify opportunities to improve collaboration 
                with States, local governments, communities, and Indian 
                tribes and tribal organizations (as such terms are 
                defined in section 4 of the Indian Self-Determination 
                and Education Assistance Act (25 U.S.C. 450b)); and
                  ``(F) specify a strategy to disseminate evidenced-
                based and promising best practices related to 
                prevention, diagnosis, early intervention, treatment, 
                and recovery services related to mental illness, 
                particularly for individuals with a serious mental 
                illness and children and adolescents with a serious 
                emotional disturbance, and substance use disorders.''.

SEC. 110. AUTHORITIES OF CENTERS FOR MENTAL HEALTH SERVICES AND 
                    SUBSTANCE ABUSE TREATMENT.

  (a) Center for Mental Health Services.--Section 520(b) of the Public 
Health Service Act (42 U.S.C. 290bb-31(b)) is amended--
          (1) by redesignating paragraphs (3) through (15) as 
        paragraphs (4) through (16), respectively;
          (2) by inserting after paragraph (2) the following:
          ``(3) collaborate with the Director of the National Institute 
        of Mental Health to ensure that, as appropriate, programs 
        related to the prevention and treatment of mental illness and 
        the promotion of mental health are carried out in a manner that 
        reflects the best available science and evidence-based 
        practices, including culturally and linguistically appropriate 
        services;'';
          (3) in paragraph (5), as so redesignated, by inserting 
        ``through policies and programs that reduce risk and promote 
        resiliency'' before the semicolon;
          (4) in paragraph (6), as so redesignated, by inserting ``in 
        collaboration with the Director of the National Institute of 
        Mental Health,'' before ``develop'';
          (5) in paragraph (8), as so redesignated, by inserting ``, 
        increase meaningful participation of individuals with mental 
        illness in programs and activities of the Administration,'' 
        before ``and protect the legal'';
          (6) in paragraph (10), as so redesignated, by striking 
        ``professional and paraprofessional personnel pursuant to 
        section 303'' and inserting ``paraprofessional personnel and 
        health professionals'';
          (7) in paragraph (11), as so redesignated, by inserting ``and 
        telemental health,'' after ``rural mental health,'';
          (8) in paragraph (12), as so redesignated, by striking 
        ``establish a clearinghouse for mental health information to 
        assure the widespread dissemination of such information'' and 
        inserting ``disseminate mental health information, including 
        evidenced-based practices,'';
          (9) in paragraph (15), as so redesignated, by striking 
        ``and'' at the end;
          (10) in paragraph (16), as so redesignated, by striking the 
        period and inserting ``; and''; and
          (11) by adding at the end the following:
          ``(17) consult with other agencies and offices of the 
        Department of Health and Human Services to ensure, with respect 
        to each grant awarded by the Center for Mental Health Services, 
        the consistent documentation of the application of criteria 
        when awarding grants and the ongoing oversight of grantees 
        after such grants are awarded.''.
  (b) Director of the Center for Substance Abuse Treatment.--Section 
507 of the Public Health Service Act (42 U.S.C. 290bb) is amended--
          (1) in subsection (a)--
                  (A) by striking ``treatment of substance abuse'' and 
                inserting ``treatment of substance use disorders''; and
                  (B) by striking ``abuse treatment systems'' and 
                inserting ``use disorder treatment systems''; and
          (2) in subsection (b)--
                  (A) in paragraph (3), by striking ``abuse'' and 
                inserting ``use disorder'';
                  (B) in paragraph (4), by striking ``individuals who 
                abuse drugs'' and inserting ``individuals who use 
                drugs'';
                  (C) in paragraph (9), by striking ``carried out by 
                the Director'';
                  (D) by striking paragraph (10);
                  (E) by redesignating paragraphs (11) through (14) as 
                paragraphs (10) through (13), respectively;
                  (F) in paragraph (12), as so redesignated, by 
                striking ``; and'' and inserting a semicolon; and
                  (G) by striking paragraph (13), as so redesignated, 
                and inserting the following:
          ``(13) ensure the consistent documentation of the application 
        of criteria when awarding grants and the ongoing oversight of 
        grantees after such grants are awarded; and
          ``(14) work with States, providers, and individuals in 
        recovery, and their families, to promote the expansion of 
        recovery support services and systems of care oriented towards 
        recovery.''.

SEC. 111. ADVISORY COUNCILS.

  Section 502(b) of the Public Health Service Act (42 U.S.C. 290aa-
1(b)) is amended--
          (1) in paragraph (2)--
                  (A) in subparagraph (E), by striking ``and'' after 
                the semicolon;
                  (B) by redesignating subparagraph (F) as subparagraph 
                (I); and
                  (C) by inserting after subparagraph (E), the 
                following:
                  ``(F) for the advisory councils appointed under 
                subsections (a)(1)(A) and (a)(1)(D), the Director of 
                the National Institute of Mental Health;
                  ``(G) for the advisory councils appointed under 
                subsections (a)(1)(A), (a)(1)(B), and (a)(1)(C), the 
                Director of the National Institute on Drug Abuse;
                  ``(H) for the advisory councils appointed under 
                subsections (a)(1)(A), (a)(1)(B), and (a)(1)(C), the 
                Director of the National Institute on Alcohol Abuse and 
                Alcoholism; and''; and
          (2) in paragraph (3), by adding at the end the following:
                  ``(C) Not less than half of the members of the 
                advisory council appointed under subsection (a)(1)(D)--
                          ``(i) shall have--
                                  ``(I) a medical degree;
                                  ``(II) a doctoral degree in 
                                psychology; or
                                  ``(III) an advanced degree in nursing 
                                or social work from an accredited 
                                graduate school or be a certified 
                                physician assistant; and
                          ``(ii) shall specialize in the mental health 
                        field.''.

SEC. 112. PEER REVIEW.

  Section 504(b) of the Public Health Service Act (42 U.S.C. 290aa-
3(b)) is amended by adding at the end the following: ``In the case of 
any such peer review group that is reviewing a grant, cooperative 
agreement, or contract related to mental illness treatment, not less 
than half of the members of such peer review group shall be licensed 
and experienced professionals in the prevention, diagnosis, or 
treatment of, or recovery from, mental or substance use disorders and 
have a medical degree, a doctoral degree in psychology, or an advanced 
degree in nursing or social work from an accredited program.''.

               TITLE II--MEDICAID MENTAL HEALTH COVERAGE

SEC. 201. RULE OF CONSTRUCTION RELATED TO MEDICAID COVERAGE OF MENTAL 
                    HEALTH SERVICES AND PRIMARY CARE SERVICES FURNISHED 
                    ON THE SAME DAY.

  Nothing in title XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) shall be construed as prohibiting separate payment under the 
State plan under such title (or under a waiver of the plan) for the 
provision of a mental health service or primary care service under such 
plan, with respect to an individual, because such service is--
          (1) a primary care service furnished to the individual by a 
        provider at a facility on the same day a mental health service 
        is furnished to such individual by such provider (or another 
        provider) at the facility; or
          (2) a mental health service furnished to the individual by a 
        provider at a facility on the same day a primary care service 
        is furnished to such individual by such provider (or another 
        provider) at the facility.

SEC. 202. OPTIONAL LIMITED COVERAGE OF INPATIENT SERVICES FURNISHED IN 
                    INSTITUTIONS FOR MENTAL DISEASES.

  (a) In General.--Section 1903(m)(2) of the Social Security Act (42 
U.S.C. 1396b(m)(2)) is amended by adding at the end the following new 
subparagraph:
  ``(I)(i) Notwithstanding the limitation specified in the subdivision 
(B) following paragraph (29) of section 1905(a) and subject to clause 
(ii), a State may, under a risk contract entered into by the State 
under this title (or under section 1115) with a medicaid managed care 
organization or a prepaid inpatient health plan (as defined in section 
438.2 of title 42, Code of Federal Regulations (or any successor 
regulation)), make a monthly capitation payment to such organization or 
plan for enrollees with the organization or plan who are over 21 years 
of age and under 65 years of age and are receiving inpatient treatment 
in an institution for mental diseases (as defined in section 1905(i)), 
so long as each of the following conditions is met:
          ``(I) The institution is a hospital providing inpatient 
        psychiatric or substance use disorder services or a sub-acute 
        facility providing psychiatric or substance use disorder crisis 
        residential services.
          ``(II) The length of stay in such an institution for such 
        treatment is for a short-term stay of no more than 15 days 
        during the period of the monthly capitation payment.
          ``(III) The provision of such treatment meets the following 
        criteria for consideration as services or settings that are in 
        lieu of services or settings covered under the State plan:
                  ``(aa) The State determines that the alternative 
                service or setting is a medically appropriate and cost-
                effective substitute for the covered service or setting 
                under the State plan.
                  ``(bb) The enrollee is not required by the managed 
                care organization or prepaid inpatient health plan to 
                use the alternative service or setting.
                  ``(cc) Such treatment is authorized and identified in 
                such contract, and will be offered to such enrollees at 
                the option of the managed care organization or prepaid 
                inpatient health plan.
  ``(ii) For purposes of setting the amount of such a monthly 
capitation payment, a State may use the utilization of services 
provided to an individual under this subparagraph when developing the 
inpatient psychiatric or substance use disorder component of such 
payment, but the amount of such payment for such services may not 
exceed the cost of the same services furnished through providers 
included under the State plan.''.
  (b) Effective Date.--The amendment made by subsection (a) shall apply 
beginning on July 5, 2016, or the date of the enactment of this Act, 
whichever is later.

SEC. 203. STUDY AND REPORT RELATED TO MEDICAID MANAGED CARE REGULATION.

  (a) Study.--The Secretary of Health and Human Services, acting 
through the Administrator of the Centers for Medicare & Medicaid 
Services, shall conduct a study on coverage under the Medicaid program 
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) of 
services provided through a medicaid managed care organization (as 
defined in section 1903(m) of such Act (42 U.S.C. 1396b(m)) or a 
prepaid inpatient health plan (as defined in section 438.2 of title 42, 
Code of Federal Regulations (or any successor regulation)) with respect 
to individuals over the age of 21 and under the age of 65 for the 
treatment of a mental health disorder in institutions for mental 
diseases (as defined in section 1905(i) of such Act (42 U.S.C. 
1396d(i))). Such study shall include information on the following:
          (1) The extent to which States, including the District of 
        Columbia and each territory or possession of the United States, 
        are providing capitated payments to such organizations or plans 
        for enrollees who are receiving services in institutions for 
        mental diseases.
          (2) The number of individuals receiving medical assistance 
        under a State plan under such title XIX, or a waiver of such 
        plan, who receive services in institutions for mental diseases 
        through such organizations and plans.
          (3) The range of and average number of months, and the length 
        of stay during such months, that such individuals are receiving 
        such services in such institutions.
          (4) How such organizations or plans determine when to provide 
        for the furnishing of such services through an institution for 
        mental diseases in lieu of other benefits (including the full 
        range of community-based services) under their contract with 
        the State agency administering the State plan under such title 
        XIX, or a waiver of such plan, to address psychiatric or 
        substance use disorder treatment.
          (5) The extent to which the provision of services within such 
        institutions has affected the capitated payments for such 
        organizations or plans.
  (b) Report.--Not later than three years after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
on the study conducted under subsection (a).

SEC. 204. GUIDANCE ON OPPORTUNITIES FOR INNOVATION.

  Not later than one year after the date of the enactment of this Act, 
the Administrator of the Centers for Medicare & Medicaid Services shall 
issue a State Medicaid Director letter regarding opportunities to 
design innovative service delivery systems, including systems for 
providing community-based services, for individuals with serious mental 
illness or serious emotional disturbance who are receiving medical 
assistance under title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.). The letter shall include opportunities for demonstration 
projects under section 1115 of such Act (42 U.S.C. 1315), to improve 
care for such individuals.

SEC. 205. STUDY AND REPORT ON MEDICAID EMERGENCY PSYCHIATRIC 
                    DEMONSTRATION PROJECT.

  (a) Collection of Information.--The Secretary of Health and Human 
Services, acting through the Administrator of the Centers for Medicare 
& Medicaid Services, shall, with respect to each State that has 
participated in the demonstration project established under section 
2707 of the Patient Protection and Affordable Care Act (42 U.S.C. 1396a 
note), collect from each such State information on the following:
          (1) The number of institutions for mental diseases (as 
        defined in section 1905(i) of the Social Security Act (42 
        U.S.C. 1396d(i))) and beds in such institutions that received 
        payment for the provision of services to individuals who 
        receive medical assistance under a State plan under the 
        Medicaid program under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) (or under a waiver of such plan) through 
        the demonstration project in each such State as compared to the 
        total number of institutions for mental diseases and beds in 
        the State.
          (2) The extent to which there is a reduction in expenditures 
        under the Medicaid program under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) or other spending on the 
        full continuum of physical or mental health care for 
        individuals who receive treatment in an institution for mental 
        diseases under the demonstration project, including outpatient, 
        inpatient, emergency, and ambulatory care, that is attributable 
        to such individuals receiving treatment in institutions for 
        mental diseases under the demonstration project.
          (3) The number of forensic psychiatric hospitals, the number 
        of beds in such hospitals, and the number of forensic 
        psychiatric beds in other hospitals in such State, based on the 
        most recent data available, to the extent practical, as 
        determined by such Administrator.
          (4) The amount of any disproportionate share hospital 
        payments under section 1923 of the Social Security Act (42 
        U.S.C. 1396r-4) that institutions for mental diseases in the 
        State received during the period beginning on July 1, 2012, and 
        ending on June 30, 2015, and the extent to which the 
        demonstration project reduced the amount of such payments.
          (5) The most recent data regarding all facilities or sites in 
        the State in which any individuals with serious mental illness 
        who are receiving medical assistance under a State plan under 
        the Medicaid program under title XIX of the Social Security Act 
        (42 U.S.C. 1396 et seq.) (or under a waiver of such plan) are 
        treated during the period referred to in paragraph (4), to the 
        extent practical, as determined by the Administrator, 
        including--
                  (A) the types of such facilities or sites (such as an 
                institution for mental diseases, a hospital emergency 
                department, or other inpatient hospital);
                  (B) the average length of stay in such a facility or 
                site by such an individual, disaggregated by facility 
                type; and
                  (C) the payment rate under the State plan (or a 
                waivers of such plan) for services furnished to such an 
                individual for that treatment, disaggregated by 
                facility type, during the period in which the 
                demonstration project is in operation.
          (6) The extent to which the utilization of hospital emergency 
        departments during the period in which the demonstration 
        project was is in operation differed, with respect to 
        individuals who are receiving medical assistance under a State 
        plan under the Medicaid program under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) (or under a waiver of 
        such plan), between--
                  (A) those individuals who received treatment in an 
                institution for mental diseases under the demonstration 
                project;
                  (B) those individuals who met the eligibility 
                requirements for the demonstration project but who did 
                not receive treatment in an institution for mental 
                diseases under the demonstration project; and
                  (C) those individuals with serious mental illness who 
                did not meet such eligibility requirements and did not 
                receive treatment for such illness in an institution 
                for mental diseases.
  (b) Report.--Not later than two years after the date of the enactment 
of this Act, the Secretary of Health and Human Services shall submit to 
Congress a report that summarizes and analyzes the information 
collected under subsection (a). Such report may be submitted as part of 
the report required under section 2707(f) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 1396a note) or separately.

SEC. 206. PROVIDING FULL-RANGE OF EPSDT SERVICES TO CHILDREN IN IMDS.

  Section 1905(a)(16) of the Social Security Act (42 U.S.C. 
1396d(a)(16)) is amended by inserting before the semicolon at the end 
the following: ``, and, effective January 1, 2019, the full-range of 
early and periodic screening, diagnostic, and treatment services (as 
defined in subsection (r)) for such individuals whether or not such 
screening, diagnostic, and treatment services are furnished by the 
provider of inpatient psychiatric hospital services for individuals 
under age 21''.

SEC. 207. ELECTRONIC VISIT VERIFICATION SYSTEM REQUIRED FOR PERSONAL 
                    CARE SERVICES AND HOME HEALTH CARE SERVICES UNDER 
                    MEDICAID.

  (a) In General.--Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by inserting after subsection (k) the following new 
subsection:
  ``(l)(1) Subject to paragraphs (3) and (4), with respect to any 
amount expended for personal care services or home health care services 
requiring an in-home visit by a provider that are provided under a 
State plan under this title (or under a waiver of the plan) and 
furnished in a calendar quarter beginning on or after January 1, 2019 
(or, in the case of home health care services, on or after January 1, 
2023), unless a State requires the use of an electronic visit 
verification system for such services furnished in such quarter under 
the plan or such waiver, the Federal medical assistance percentage 
shall be reduced--
          ``(A) in the case of personal care services--
                  ``(i) for calendar quarters in 2019 and 2020, by .25 
                percentage points;
                  ``(ii) for calendar quarters in 2021, by .5 
                percentage points;
                  ``(iii) for calendar quarters in 2022, by .75 
                percentage points; and
                  ``(iv) for calendar quarters in 2023 and each year 
                thereafter, by 1 percentage point; and
          ``(B) in the case of home health care services--
                  ``(i) for calendar quarters in 2023 and 2024, by .25 
                percentage points;
                  ``(ii) for calendar quarters in 2025, by .5 
                percentage points;
                  ``(iii) for calendar quarters in 2026, by .75 
                percentage points; and
                  ``(iv) for calendar quarters in 2027 and each year 
                thereafter, by 1 percentage point.
  ``(2) Subject to paragraphs (3) and (4), in implementing the 
requirement for the use of an electronic visit verification system 
under paragraph (1), a State shall--
          ``(A) consult with agencies and entities that provide 
        personal care services, home health care services, or both 
        under the State plan (or under a waiver of the plan) to ensure 
        that such system--
                  ``(i) is minimally burdensome;
                  ``(ii) takes into account existing best practices and 
                electronic visit verification systems in use in the 
                State; and
                  ``(iii) is conducted in accordance with the 
                requirements of HIPAA privacy and security law (as 
                defined in section 3009 of the Public Health Service 
                Act);
          ``(B) take into account a stakeholder process that includes 
        input from beneficiaries, family caregivers, personal care or 
        home health care services workers, and other stakeholders, as 
        determined by the State in accordance with guidance from the 
        Secretary; and
          ``(C) ensure that individuals who furnish personal care 
        services, home health care services, or both under the State 
        plan (or under a waiver of the plan) are provided the 
        opportunity for training on the use of such system.
  ``(3) Paragraphs (1) and (2) shall not apply in the case of a State 
that, as of the date of the enactment of this subsection, requires the 
use of any system for the electronic verification of visits conducted 
as part of both personal care services and home health care services.
  ``(4)(A) In the case of a State described in subparagraph (B), the 
reduction under paragraph (1) shall not apply--
          ``(i) in the case of personal care services, for calendar 
        quarters in 2019; and
          ``(ii) in the case of home health care services, for calendar 
        quarters in 2023.
  ``(B) For purposes of subparagraph (A), a State described in this 
subparagraph is a State that demonstrates to the Secretary that the 
State--
          ``(i) has made a good faith effort to comply with the 
        requirements of paragraphs (1) and (2) (including by taking 
        steps to adopt the technology used for an electronic visit 
        verification system); or
          ``(ii) in implementing such a system, has encountered 
        unavoidable system delays.
  ``(5) In this subsection:
          ``(A) The term `electronic visit verification system' means, 
        with respect to personal care services or home health care 
        services, a system under which visits conducted as part of such 
        services are electronically verified with respect to--
                  ``(i) the type of service performed;
                  ``(ii) the individual receiving the service;
                  ``(iii) the date of the service;
                  ``(iv) the location of service delivery;
                  ``(v) the individual providing the service; and
                  ``(vi) the time the service begins and ends.
          ``(B) The term `home health care services' means services 
        described in section 1905(a)(7) provided under a State plan 
        under this title (or under a waiver of the plan).
          ``(C) The term `personal care services' means personal care 
        services provided under a State plan under this title (or under 
        a waiver of the plan), including services provided under 
        section 1905(a)(24), 1915(c), 1915(i), 1915(j), or 1915(k) or 
        under a wavier under section 1115.
  ``(6)(A) In the case in which a State requires personal care service 
and home health care service providers to utilize an electronic visit 
verification system operated by the State or a contractor on behalf of 
the State, the Secretary shall pay to the State, for each quarter, an 
amount equal to 90 per centum of so much of the sums expended during 
such quarter as are attributable to the design, development, or 
installation of such system, and 75 per centum of so much of the sums 
for the operation and maintenance of such system.
  ``(B) Subparagraph (A) shall not apply in the case in which a State 
requires personal care service and home health care service providers 
to utilize an electronic visit verification system that is not operated 
by the State or a contractor on behalf of the State.''.
  (b) Collection and Dissemination of Best Practices.--Not later than 
January 1, 2018, the Secretary of Health and Human Services shall, with 
respect to electronic visit verification systems (as defined in 
subsection (l)(5) of section 1903 of the Social Security Act (42 U.S.C. 
1396b), as inserted by subsection (a)), collect and disseminate best 
practices to State Medicaid Directors with respect to--
          (1) training individuals who furnish personal care services, 
        home health care services, or both under the State plan under 
        title XIX of such Act (or under a waiver of the plan) on such 
        systems and the operation of such systems and the prevention of 
        fraud with respect to the provision of personal care services 
        or home health care services (as defined in such subsection 
        (l)(5)); and
          (2) the provision of notice and educational materials to 
        family caregivers and beneficiaries with respect to the use of 
        such electronic visit verification systems and other means to 
        prevent such fraud.
  (c) Rules of Construction.--
          (1) No employer-employee relationship established.--Nothing 
        in the amendment made by this section may be construed as 
        establishing an employer-employee relationship between the 
        agency or entity that provides for personal care services or 
        home health care services and the individuals who, under a 
        contract with such an agency or entity, furnish such services 
        for purposes of part 552 of title 29, Code of Federal 
        Regulations (or any successor regulations).
          (2) No particular or uniform electronic visit verification 
        system required.--Nothing in the amendment made by this section 
        shall be construed to require the use of a particular or 
        uniform electronic visit verification system (as defined in 
        subsection (l)(5) of section 1903 of the Social Security Act 
        (42 U.S.C. 1396b), as inserted by subsection (a)) by all 
        agencies or entities that provide personal care services or 
        home health care under a State plan under title XIX of the 
        Social Security Act (or under a waiver of the plan) (42 U.S.C. 
        1396 et seq.).
          (3) No limits on provision of care.--Nothing in the amendment 
        made by this section may be construed to limit, with respect to 
        personal care services or home health care services provided 
        under a State plan under title XIX of the Social Security Act 
        (or under a waiver of the plan) (42 U.S.C. 1396 et seq.), 
        provider selection, constrain beneficiaries' selection of a 
        caregiver, or impede the manner in which care is delivered.
          (4) No prohibition on state quality measures requirements.--
        Nothing in the amendment made by this section shall be 
        construed as prohibiting a State, in implementing an electronic 
        visit verification system (as defined in subsection (l)(5) of 
        section 1903 of the Social Security Act (42 U.S.C. 1396b), as 
        inserted by subsection (a)), from establishing requirements 
        related to quality measures for such system.

   TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING 
                               COMMITTEE

SEC. 301. INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING 
                    COMMITTEE.

  (a) Establishment.--
          (1) In general.--Not later than 3 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services, or the designee of the Secretary, shall establish a 
        committee to be known as the ``Interdepartmental Serious Mental 
        Illness Coordinating Committee'' (in this section referred to 
        as the ``Committee'').
          (2) Federal advisory committee act.--Except as provided in 
        this section, the provisions of the Federal Advisory Committee 
        Act (5 U.S.C. App.) shall apply to the Committee.
  (b) Meetings.--The Committee shall meet not fewer than 2 times each 
year.
  (c) Responsibilities.--Not later than 1 year after the date of 
enactment of this Act, and 5 years after such date of enactment, the 
Committee shall submit to Congress a report including--
          (1) a summary of advances in serious mental illness and 
        serious emotional disturbance research related to the 
        prevention of, diagnosis of, intervention in, and treatment and 
        recovery of, serious mental illnesses, serious emotional 
        disturbances, and advances in access to services and support 
        for individuals with a serious mental illness or serious 
        emotional disturbance;
          (2) an evaluation of the effect on public health of Federal 
        programs related to serious mental illness or serious emotional 
        disturbance, including measurements of public health outcomes 
        such as--
                  (A) rates of suicide, suicide attempts, prevalence of 
                serious mental illness, serious emotional disturbances, 
                and substance use disorders, overdose, overdose deaths, 
                emergency hospitalizations, emergency room boarding, 
                preventable emergency room visits, involvement with the 
                criminal justice system, crime, homelessness, and 
                unemployment;
                  (B) increased rates of employment and enrollment in 
                educational and vocational programs;
                  (C) quality of mental and substance use disorder 
                treatment services; and
                  (D) any other criteria as may be determined by the 
                Secretary;
          (3) a plan to improve outcomes for individuals with serious 
        mental illness or serious emotional disturbances, including 
        reducing incarceration for such individuals, reducing 
        homelessness, and increasing employment; and
          (4) specific recommendations for actions that agencies can 
        take to better coordinate the administration of mental health 
        services for people with serious mental illness or serious 
        emotional disturbances.
  (d) Committee Extension.--Upon the submission of the second report 
under subsection (c), the Secretary shall submit a recommendation to 
Congress on whether to extend the operation of the Committee.
  (e) Membership.--
          (1) Federal members.--The Committee shall be composed of the 
        following Federal representatives, or their designees:
                  (A) The Secretary of Health and Human Services, who 
                shall serve as the Chair of the Committee.
                  (B) The Director of the National Institutes of 
                Health.
                  (C) The Assistant Secretary for Health of the 
                Department of Health and Human Services.
                  (D) The Assistant Secretary for Mental Health and 
                Substance Use.
                  (E) The Attorney General of the United States.
                  (F) The Secretary of Veterans Affairs.
                  (G) The Secretary of Defense.
                  (H) The Secretary of Housing and Urban Development.
                  (I) The Secretary of Education.
                  (J) The Secretary of Labor.
                  (K) The Commissioner of Social Security.
                  (L) The Administrator of the Centers for Medicare & 
                Medicaid Services.
          (2) Non-federal members.--The Committee shall also include 
        not less than 14 non-Federal public members appointed by the 
        Secretary of Health and Human Services, of which--
                  (A) at least 2 members shall be individuals with 
                lived experience with serious mental illness or serious 
                emotional disturbance;
                  (B) at least 1 member shall be a parent or legal 
                guardian of an individual with a history of a serious 
                mental illness or serious emotional disturbance;
                  (C) at least 1 member shall be a representative of a 
                leading research, advocacy, or service organization for 
                individuals with serious mental illness or serious 
                emotional disturbance;
                  (D) at least 2 members shall be--
                          (i) a licensed psychiatrist with experience 
                        treating serious mental illnesses or serious 
                        emotional disturbances;
                          (ii) a licensed psychologist with experience 
                        treating serious mental illnesses or serious 
                        emotional disturbances;
                          (iii) a licensed clinical social worker with 
                        experience treating serious mental illness or 
                        serious emotional disturbances; or
                          (iv) a licensed psychiatric nurse, nurse 
                        practitioner, or physician assistant with 
                        experience treating serious mental illnesses or 
                        serious emotional disturbances;
                  (E) at least 1 member shall be a licensed mental 
                health professional with a specialty in treating 
                children and adolescents with serious emotional 
                disturbances;
                  (F) at least 1 member shall be a mental health 
                professional who has research or clinical mental health 
                experience working with minorities;
                  (G) at least 1 member shall be a mental health 
                professional who has research or clinical mental health 
                experience working with medically underserved 
                populations;
                  (H) at least 1 member shall be a State certified 
                mental health peer specialist;
                  (I) at least 1 member shall be a judge with 
                experience adjudicating cases within a mental health 
                court;
                  (J) at least 1 member shall be a law enforcement 
                officer or corrections officer with extensive 
                experience in interfacing with individuals with a 
                serious mental illness or serious emotional 
                disturbance, or in a mental health crisis; and
                  (K) at least 1 member shall be a homeless services 
                provider with experience working with individuals with 
                serious mental illness, with serious emotional 
                disturbance, or having mental health crisis.
          (3) Terms.--A member of the Committee appointed under 
        paragraph (2) shall serve for a term of 3 years, and may be 
        reappointed for one or more additional 3-year terms. Any member 
        appointed to fill a vacancy for an unexpired term shall be 
        appointed for the remainder of such term. A member may serve 
        after the expiration of the member's term until a successor has 
        been appointed.
  (f) Working Groups.--In carrying out its functions, the Committee may 
establish working groups. Such working groups shall be composed of 
Committee members, or their designees, and may hold such meetings as 
are necessary.
  (g) Sunset.--The Committee shall terminate on the date that is 6 
years after the date on which the Committee is established under 
subsection (a)(1).

             TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA

SEC. 401. SENSE OF CONGRESS.

  (a) Findings.--Congress finds the following:
          (1) The vast majority of individuals with mental illness are 
        capable of understanding their illness and caring for 
        themselves.
          (2) Persons with serious mental illness (in this section 
        referred to as ``SMI''), including schizophrenia spectrum, 
        bipolar disorders, and major depressive disorder, may be 
        significantly impaired in their ability to understand or make 
        sound decisions for their care and needs. By nature of their 
        illness, cognitive impairments in reasoning and judgment, as 
        well as the presence of hallucinations, delusions, and severe 
        emotional distortions, they may lack the awareness they even 
        have a mental illness (a condition known as anosognosia), and 
        thus may be unable to make sound decisions regarding their 
        care, nor follow through consistently and effectively on their 
        care needs.
          (3) Persons with mental illness or SMI may require and 
        benefit from mental health treatment in order to recover to the 
        fullest extent of their ability; these beneficial interventions 
        may include psychiatric care, psychological care, medication, 
        peer support, educational support, employment support, and 
        housing support.
          (4) Persons with SMI who are provided with professional and 
        supportive services may still experience times when their 
        symptoms may greatly impair their abilities to make sound 
        decisions for their personal care or may discontinue their care 
        as a result of this impaired decisionmaking resulting in a 
        further deterioration of their condition. They may experience a 
        temporary or prolonged impairment as a result of their 
        diminished capacity to care for themselves.
          (5) Episodes of psychiatric crises among those with SMI can 
        result in neurological harm to the individual's brain.
          (6) Persons with SMI--
                  (A) are at high risk for other chronic physical 
                illnesses, with approximately 50 percent having two or 
                more co-occurring chronic physical illnesses such as 
                cardiac, pulmonary, cancer, and endocrine disorders; 
                and
                  (B) have three times the odds of having chronic 
                bronchitis, five times the odds of having emphysema, 
                and four times the odds of having COPD, are more than 
                four times as likely to have fluid and electrolyte 
                disorders, and are nearly three times as likely to be 
                nicotine dependent.
          (7) Some psychotropic medications, such as second generation 
        antipsychotics, significantly increase risk for chronic 
        illnesses such as diabetes and cardiovascular disease.
          (8) When the individual fails to seek or maintain treatment 
        for these physical conditions over a long term, it can result 
        in the individual becoming gravely disabled, or developing 
        life-threatening illnesses. Early and consistent treatment can 
        ameliorate or reduce symptoms or cure the disease.
          (9) Persons with SMI die 7 to 24 years earlier than their age 
        cohorts primarily because of complications from their chronic 
        physical illness and failure to seek or maintain treatment 
        resulting from emotional and cognitive impairments from their 
        SMI.
          (10) It is beneficial to the person with SMI and chronic 
        illness to seek and maintain continuity of medical care and 
        treatment for their mental illness to prevent further 
        deterioration and harm to their own safety.
          (11) When the individual with SMI is significantly diminished 
        in their capacity to care for themselves long term or acutely, 
        other supportive interventions to assist their care may be 
        necessary to protect their health and safety.
          (12) Prognosis for the physical and psychiatric health of 
        those with SMI may improve when responsible caregivers 
        facilitate and participate in care.
          (13) When an individual with SMI is chronically incapacitated 
        in their ability to care for themselves, caregivers can pursue 
        legal guardianship to facilitate care in appropriate areas 
        while being mindful to allow the individual to make decisions 
        for themselves in areas where they are capable.
          (14) Individuals with SMI who have prolonged periods of being 
        significantly functional can, during such periods, design and 
        sign an advanced directive to predefine and choose medications, 
        providers, treatment plans, and hospitals, and provide 
        caregivers with guardianship the ability to help in those times 
        when a patient's psychiatric symptoms worsen to the point of 
        making them incapacitated or leaving them with a severely 
        diminished capacity to make informed decisions about their care 
        which may result in harm to their physical and mental health.
          (15) All professional and support efforts should be made to 
        help the individual with SMI and acute or chronic physical 
        illnesses to understand and follow through on treatment.
          (16) When individuals with SMI, even after efforts to help 
        them understand, have failed to care for themselves, there 
        exists confusion in the health care community around what is 
        currently permissible under HIPAA rules. This confusion may 
        hinder communication with responsible caregivers who may be 
        able to facilitate care for the patient with SMI in instances 
        when the individual does not give permission for disclosure.
  (b) Sense of Congress.--It is the sense of the Congress that, for the 
sake of the health and safety of persons with serious mental illness, 
more clarity is needed surrounding the existing HIPAA privacy rule 
promulgated pursuant to section 264(c) of the Health Insurance 
Portability and Accountability Act (42 U.S.C. 1320d-2 note) to permit 
health care professionals to communicate, when necessary, with 
responsible known caregivers of such persons, the limited, appropriate 
protected health information of such persons in order to facilitate 
treatment, but not including psychotherapy notes.

SEC. 402. CONFIDENTIALITY OF RECORDS.

  Not later than one year after the date on which the Secretary of 
Health and Human Services first finalizes regulations updating part 2 
of title 42, Code of Federal Regulations (relating to confidentiality 
of alcohol and drug abuse patient records) after the date of enactment 
of this Act, the Secretary shall convene relevant stakeholders to 
determine the effect of such regulations on patient care, health 
outcomes, and patient privacy. The Secretary shall submit to the 
Committee on Energy and Commerce of the House of Representatives and 
the Committee on Health, Education, Labor, and Pensions of the Senate, 
and make publicly available, a report on the findings of such 
stakeholders.

SEC. 403. CLARIFICATION OF CIRCUMSTANCES UNDER WHICH DISCLOSURE OF 
                    PROTECTED HEALTH INFORMATION IS PERMITTED.

  (a) In General.--Not later than one year after the date of enactment 
of this section, the Secretary of Health and Human Services shall 
promulgate final regulations clarifying the circumstances under which, 
consistent with the provisions of subpart C of title XI of the Social 
Security Act (42 U.S.C. 1320d et seq.) and regulations promulgated 
pursuant to section 264(c) of the Health Insurance Portability and 
Accountability Act of 1996 (42 U.S.C. 1320d-2 note), a health care 
provider or covered entity may disclose the protected health 
information of a patient with a mental illness, including for purposes 
of--
          (1) communicating (including with respect to treatment, side 
        effects, risk factors, and the availability of community 
        resources) with a family member of such patient, caregiver of 
        such patient, or other individual to the extent that such 
        family member, caregiver, or individual is involved in the care 
        of the patient;
          (2) communicating with a family member of the patient, 
        caregiver of such patient, or other individual involved in the 
        care of the patient in the case that the patient is an adult;
          (3) communicating with the parent or caregiver of a patient 
        in the case that the patient is a minor;
          (4) considering the patient's capacity to agree or object to 
        the sharing of the protected health information of the patient;
          (5) communicating and sharing information with the family or 
        caregivers of the patient when--
                  (A) the patient consents;
                  (B) the patient does not consent, but the patient 
                lacks the capacity to agree or object and the 
                communication or sharing of information is in the 
                patient's best interest;
                  (C) the patient does not consent and the patient is 
                not incapacitated or in an emergency circumstance, but 
                the ability of the patient to make rational health care 
                decisions is significantly diminished by reason of the 
                physical or mental health condition of the patient; and
                  (D) the patient does not consent, but such 
                communication and sharing of information is necessary 
                to prevent impending and serious deterioration of the 
                patient's mental or physical health;
          (6) involving a patient's family members, caregivers, or 
        others involved in the patient's care or care plan, including 
        facilitating treatment and medication adherence, in dealing 
        with patient failures to adhere to medication or other therapy;
          (7) listening to or receiving information with respect to the 
        patient from the family or caregiver of such patient receiving 
        mental illness treatment;
          (8) communicating with family members of the patient, 
        caregivers of the patient, law enforcement, or others when the 
        patient presents a serious and imminent threat of harm to self 
        or others; and
          (9) communicating to law enforcement and family members of 
        the patient or caregivers of the patient about the admission of 
        the patient to receive care at a facility or the release of a 
        patient who was admitted to a facility for an emergency 
        psychiatric hold or involuntary treatment.
  (b) Coordination.--The Secretary of Health and Human Services shall 
carry out this section in coordination with the Director of the Office 
for Civil Rights within the Department of Health and Human Services.
  (c) Consistency With Guidance.--The Secretary of Health and Human 
Services shall ensure that the regulations under this section are 
consistent with the guidance entitled ``HIPAA Privacy Rule and Sharing 
Information Related to Mental Health'', issued by the Department of 
Health and Human Services on February 20, 2014.

SEC. 404. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING PROGRAMS.

  (a) Initial Programs and Materials.--Not later than one year after 
the date of the enactment of this Act, the Secretary of Health and 
Human Services (in this section referred to as the ``Secretary'') shall 
develop and disseminate--
          (1) a model program and materials for training health care 
        providers (including physicians, emergency medical personnel, 
        psychologists, counselors, therapists, behavioral health 
        facilities and clinics, care managers, and hospitals) regarding 
        the circumstances under which, consistent with the standards 
        governing the privacy and security of individually identifiable 
        health information promulgated by the Secretary under subpart C 
        of title XI of the Social Security Act (42 U.S.C. 1320d et 
        seq.) and regulations promulgated pursuant to section 264(c) of 
        the Health Insurance Portability and Accountability Act of 1996 
        (42 U.S.C. 1320d-2 note), the protected health information of 
        patients with a mental illness may be disclosed with and 
        without patient consent;
          (2) a model program and materials for training lawyers and 
        others in the legal profession on such circumstances; and
          (3) a model program and materials for training patients and 
        their families regarding their rights to protect and obtain 
        information under the standards specified in paragraph (1).
  (b) Periodic Updates.--The Secretary shall--
          (1) periodically review and update the model programs and 
        materials developed under subsection (a); and
          (2) disseminate the updated model programs and materials.
  (c) Contents.--The programs and materials developed under subsection 
(a) shall address the guidance entitled ``HIPAA Privacy Rule and 
Sharing Information Related to Mental Health'', issued by the 
Department of Health and Human Services on February 20, 2014.
  (d) Coordination.--The Secretary shall carry out this section in 
coordination with the Director of the Office for Civil Rights within 
the Department of Health and Human Services, the Assistant Secretary 
for Mental Health and Substance Use, the Administrator of the Health 
Resources and Services Administration, and the heads of other relevant 
agencies within the Department of Health and Human Services.
  (e) Input of Certain Entities.--In developing the model programs and 
materials required by subsections (a) and (b), the Secretary shall 
solicit the input of relevant national, State, and local associations, 
medical societies, and licensing boards.
  (f) Funding.--There are authorized to be appropriated to carry out 
this section $4,000,000 for fiscal year 2018, $2,000,000 for each of 
fiscal years 2019 and 2020, and $1,000,000 for each of fiscal years 
2021 and 2022.

   TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS

SEC. 501. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR INDIVIDUALS 
                    WITH SERIOUS MENTAL ILLNESS.

  Part B of title V of the Public Health Service Act (42 U.S.C. 290bb 
et seq.) is amended by inserting after section 520L the following:

``SEC. 520M. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR 
                    INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.

  ``(a) In General.--The Assistant Secretary shall award grants to 
eligible entities--
          ``(1) to establish assertive community treatment programs for 
        individuals with serious mental illness; or
          ``(2) to maintain or expand such programs.
  ``(b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be a State, county, city, tribe, tribal 
organization, mental health system, health care facility, or any other 
entity the Assistant Secretary deems appropriate.
  ``(c) Special Consideration.--In selecting among applicants for a 
grant under this section, the Assistant Secretary may give special 
consideration to the potential of the applicant's program to reduce 
hospitalization, homelessness, and involvement with the criminal 
justice system while improving the health and social outcomes of the 
patient.
  ``(d) Additional Activities.--The Assistant Secretary shall--
          ``(1) not later than the end of fiscal year 2021, submit a 
        report to the appropriate congressional committees on the grant 
        program under this section, including an evaluation of--
                  ``(A) cost savings and public health outcomes such as 
                mortality, suicide, substance abuse, hospitalization, 
                and use of services;
                  ``(B) rates of involvement with the criminal justice 
                system of patients;
                  ``(C) rates of homelessness among patients; and
                  ``(D) patient and family satisfaction with program 
                participation; and
          ``(2) provide appropriate information, training, and 
        technical assistance to grant recipients under this section to 
        help such recipients to establish, maintain, or expand their 
        assertive community treatment programs.
  ``(e) Authorization of Appropriations.--
          ``(1) In general.--To carry out this section, there is 
        authorized to be appropriated $5,000,000 for the period of 
        fiscal years 2018 through 2022.
          ``(2) Use of certain funds.--Of the funds appropriated to 
        carry out this section in any fiscal year, no more than 5 
        percent shall be available to the Assistant Secretary for 
        carrying out subsection (d).''.

SEC. 502. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.

  Section 520F of the Public Health Service Act (42 U.S.C. 290bb-37) is 
amended to read as follows:

``SEC. 520F. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.

  ``(a) In General.--The Secretary shall award competitive grants--
          ``(1) to State and local governments and Indian tribes and 
        tribal organizations to enhance community-based crisis response 
        systems; or
          ``(2) to States to develop, maintain, or enhance a database 
        of beds at inpatient psychiatric facilities, crisis 
        stabilization units, and residential community mental health 
        and residential substance use disorder treatment facilities, 
        for individuals with serious mental illness, serious emotional 
        disturbance, or substance use disorders.
  ``(b) Application.--
          ``(1) In general.--To receive a grant or cooperative 
        agreement under subsection (a), an entity shall submit to the 
        Secretary an application, at such time, in such manner, and 
        containing such information as the Secretary may require.
          ``(2) Community-based crisis response plan.--An application 
        for a grant under subsection (a)(1) shall include a plan for--
                  ``(A) promoting integration and coordination between 
                local public and private entities engaged in crisis 
                response, including first responders, emergency health 
                care providers, primary care providers, law 
                enforcement, court systems, health care payers, social 
                service providers, and behavioral health providers;
                  ``(B) developing a plan for entering into memoranda 
                of understanding with public and private entities to 
                implement crisis response services;
                  ``(C) expanding the continuum of community-based 
                services to address crisis intervention and prevention; 
                and
                  ``(D) developing models for minimizing hospital 
                readmissions, including through appropriate discharge 
                planning.
          ``(3) Beds database plan.--An application for a grant under 
        subsection (a)(2) shall include a plan for developing, 
        maintaining, or enhancing a real-time Internet-based bed 
        database to collect, aggregate, and display information about 
        beds in inpatient psychiatric facilities and crisis 
        stabilization units, and residential community mental health 
        and residential substance use disorder treatment facilities, to 
        facilitate the identification and designation of facilities for 
        the temporary treatment of individuals in mental or substance 
        use disorder crisis.
  ``(c) Database Requirements.--A bed database described in this 
section is a database that--
          ``(1) includes information on inpatient psychiatric 
        facilities, crisis stabilization units, and residential 
        community mental health and residential substance use disorder 
        facilities in the State involved, including contact information 
        for the facility or unit;
          ``(2) provides real-time information about the number of beds 
        available at each facility or unit and, for each available bed, 
        the type of patient that may be admitted, the level of security 
        provided, and any other information that may be necessary to 
        allow for the proper identification of appropriate facilities 
        for treatment of individuals in mental or substance use 
        disorder crisis; and
          ``(3) enables searches of the database to identify available 
        beds that are appropriate for the treatment of individuals in 
        mental or substance use disorder crisis.
  ``(d) Evaluation.--An entity receiving a grant under subsection 
(a)(1) shall submit to the Secretary, at such time, in such manner, and 
containing such information as the Secretary may reasonably require, a 
report, including an evaluation of the effect of such grant on--
          ``(1) local crisis response services and measures of 
        individuals receiving crisis planning and early intervention 
        supports;
          ``(2) individuals reporting improved functional outcomes; and
          ``(3) individuals receiving regular followup care following a 
        crisis.
  ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for the period of 
fiscal years 2018 through 2022.''.

SEC. 503. INCREASED AND EXTENDED FUNDING FOR ASSISTED OUTPATIENT GRANT 
                    PROGRAM FOR INDIVIDUALS WITH SERIOUS MENTAL 
                    ILLNESS.

  Section 224(g) of the Protecting Access to Medicare Act of 2014 (42 
U.S.C. 290aa note) is amended--
          (1) in paragraph (1), by striking ``2018'' and inserting 
        ``2022''; and
          (2) in paragraph (2), by striking ``is authorized to be 
        appropriated to carry out this section $15,000,000 for each of 
        fiscal years 2015 through 2018'' and inserting ``are authorized 
        to be appropriated to carry out this section $15,000,000 for 
        each of fiscal years 2015 through 2017, $20,000,000 for fiscal 
        year 2018, $19,000,000 for each of fiscal years 2019 and 2020, 
        and $18,000,000 for each of fiscal years 2021 and 2022''.

SEC. 504. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL VOLUNTEERS AT 
                    COMMUNITY HEALTH CENTERS.

  Section 224 of the Public Health Service Act (42 U.S.C. 233) is 
amended by adding at the end the following:
  ``(q)(1) For purposes of this section, a health professional 
volunteer at an entity described in subsection (g)(4) shall, in 
providing a health professional service eligible for funding under 
section 330 to an individual, be deemed to be an employee of the Public 
Health Service for a calendar year that begins during a fiscal year for 
which a transfer was made under paragraph (4)(C). The preceding 
sentence is subject to the provisions of this subsection.
  ``(2) In providing a health service to an individual, a health care 
practitioner shall for purposes of this subsection be considered to be 
a health professional volunteer at an entity described in subsection 
(g)(4) if the following conditions are met:
          ``(A) The service is provided to the individual at the 
        facilities of an entity described in subsection (g)(4), or 
        through offsite programs or events carried out by the entity.
          ``(B) The entity is sponsoring the health care practitioner 
        pursuant to paragraph (3)(B).
          ``(C) The health care practitioner does not receive any 
        compensation for the service from the individual or from any 
        third-party payer (including reimbursement under any insurance 
        policy or health plan, or under any Federal or State health 
        benefits program), except that the health care practitioner may 
        receive repayment from the entity described in subsection 
        (g)(4) for reasonable expenses incurred by the health care 
        practitioner in the provision of the service to the individual.
          ``(D) Before the service is provided, the health care 
        practitioner or the entity described in subsection (g)(4) posts 
        a clear and conspicuous notice at the site where the service is 
        provided of the extent to which the legal liability of the 
        health care practitioner is limited pursuant to this 
        subsection.
          ``(E) At the time the service is provided, the health care 
        practitioner is licensed or certified in accordance with 
        applicable law regarding the provision of the service.
  ``(3) Subsection (g) (other than paragraphs (3) and (5)) and 
subsections (h), (i), and (l) apply to a health care practitioner for 
purposes of this subsection to the same extent and in the same manner 
as such subsections apply to an officer, governing board member, 
employee, or contractor of an entity described in subsection (g)(4), 
subject to paragraph (4) and subject to the following:
          ``(A) The first sentence of paragraph (1) applies in lieu of 
        the first sentence of subsection (g)(1)(A).
          ``(B) With respect to an entity described in subsection 
        (g)(4), a health care practitioner is not a health professional 
        volunteer at such entity unless the entity sponsors the health 
        care practitioner. For purposes of this subsection, the entity 
        shall be considered to be sponsoring the health care 
        practitioner if--
                  ``(i) with respect to the health care practitioner, 
                the entity submits to the Secretary an application 
                meeting the requirements of subsection (g)(1)(D); and
                  ``(ii) the Secretary, pursuant to subsection 
                (g)(1)(E), determines that the health care practitioner 
                is deemed to be an employee of the Public Health 
                Service.
          ``(C) In the case of a health care practitioner who is 
        determined by the Secretary pursuant to subsection (g)(1)(E) to 
        be a health professional volunteer at such entity, this 
        subsection applies to the health care practitioner (with 
        respect to services performed on behalf of the entity 
        sponsoring the health care practitioner pursuant to 
        subparagraph (B)) for any cause of action arising from an act 
        or omission of the health care practitioner occurring on or 
        after the date on which the Secretary makes such determination.
          ``(D) Subsection (g)(1)(F) applies to a health care 
        practitioner for purposes of this subsection only to the extent 
        that, in providing health services to an individual, each of 
        the conditions specified in paragraph (2) is met.
  ``(4)(A) Amounts in the fund established under subsection (k)(2) 
shall be available for transfer under subparagraph (C) for purposes of 
carrying out this subsection.
  ``(B) Not later May 1 of each fiscal year, the Attorney General, in 
consultation with the Secretary, shall submit to the Congress a report 
providing an estimate of the amount of claims (together with related 
fees and expenses of witnesses) that, by reason of the acts or 
omissions of health professional volunteers, will be paid pursuant to 
this section during the calendar year that begins in the following 
fiscal year. Subsection (k)(1)(B) applies to the estimate under the 
preceding sentence regarding health professional volunteers to the same 
extent and in the same manner as such subsection applies to the 
estimate under such subsection regarding officers, governing board 
members, employees, and contractors of entities described in subsection 
(g)(4).
  ``(C) Not later than December 31 of each fiscal year, the Secretary 
shall transfer from the fund under subsection (k)(2) to the appropriate 
accounts in the Treasury an amount equal to the estimate made under 
subparagraph (B) for the calendar year beginning in such fiscal year, 
subject to the extent of amounts in the fund.
  ``(5)(A) This subsection takes effect on October 1, 2017, except as 
provided in subparagraph (B).
  ``(B) Effective on the date of the enactment of this subsection--
          ``(i) the Secretary may issue regulations for carrying out 
        this subsection, and the Secretary may accept and consider 
        applications submitted pursuant to paragraph (3)(B); and
          ``(ii) reports under paragraph (4)(B) may be submitted to the 
        Congress.''.

      TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS

Subtitle A--Encouraging the Advancement, Incorporation, and Development 
                      of Evidence-Based Practices

SEC. 601. ENCOURAGING INNOVATION AND EVIDENCE-BASED PROGRAMS.

  Section 501B of the Public Health Service Act, as inserted by section 
103, is further amended, by inserting after subsection (c) the 
following new subsection:
  ``(d) Promoting Innovation.--
          ``(1) In general.--The Assistant Secretary, in coordination 
        with the Laboratory, may award grants to States, local 
        governments, Indian tribes or tribal organizations (as such 
        terms are defined in section 4 of the Indian Self-Determination 
        and Education Assistance Act), educational institutions, and 
        nonprofit organizations to develop evidence-based 
        interventions, including culturally and linguistically 
        appropriate services, as appropriate, for--
                  ``(A) evaluating a model that has been scientifically 
                demonstrated to show promise, but would benefit from 
                further applied development, for--
                          ``(i) enhancing the prevention, diagnosis, 
                        intervention, treatment, and recovery of mental 
                        illness, serious emotional disturbance, 
                        substance use disorders, and co-occurring 
                        disorders; or
                          ``(ii) integrating or coordinating physical 
                        health services and mental and substance use 
                        disorder services; and
                  ``(B) expanding, replicating, or scaling evidence-
                based programs across a wider area to enhance effective 
                screening, early diagnosis, intervention, and treatment 
                with respect to mental illness, serious mental illness, 
                and serious emotional disturbance, primarily by--
                          ``(i) applying delivery of care, including 
                        training staff in effective evidence-based 
                        treatment; or
                          ``(ii) integrating models of care across 
                        specialties and jurisdictions.
          ``(2) Consultation.--In awarding grants under this paragraph, 
        the Assistant Secretary shall, as appropriate, consult with the 
        advisory councils described in section 502, the National 
        Institute of Mental Health, the National Institute on Drug 
        Abuse, and the National Institute on Alcohol Abuse and 
        Alcoholism, as appropriate.
          ``(3) Authorization of appropriations.--There are authorized 
        to be appropriated--
                  ``(A) to carry out paragraph (1)(A), $7,000,000 for 
                the period of fiscal years 2018 through 2020; and
                  ``(B) to carry out paragraph (1)(B), $7,000,000 for 
                the period of fiscal years 2018 through 2020.''.

SEC. 602. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED PROGRAMS 
                    AND PRACTICES.

  Part D of title V of the Public Health Service Act is amended by 
inserting after section 543 of such Act (42 U.S.C. 290dd-2 ) the 
following:

``SEC. 544. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED PROGRAMS 
                    AND PRACTICES.

  ``(a) In General.--The Assistant Secretary shall improve access to 
reliable and valid information on evidence-based programs and 
practices, including information on the strength of evidence associated 
with such programs and practices, related to mental and substance use 
disorders for States, local communities, nonprofit entities, and other 
stakeholders by posting on the website of the National Registry of 
Evidence-Based Programs and Practices evidence-based programs and 
practices that have been reviewed by the Assistant Secretary pursuant 
to the requirements of this section.
  ``(b) Notice.--
          ``(1) Periods.--In carrying out subsection (a), the Assistant 
        Secretary may establish an initial period for the submission of 
        applications for evidence-based programs and practices to be 
        posted publicly in accordance with subsection (a) (and may 
        establish subsequent such periods). The Assistant Secretary 
        shall publish notice of such application periods in the Federal 
        Register.
          ``(2) Addressing gaps.--Such notice may solicit applications 
        for evidence-based practices and programs to address gaps in 
        information identified by the Assistant Secretary, the 
        Assistant Secretary for Planning and Evaluation, the Assistant 
        Secretary for Financial Resources, or the National Mental 
        Health and Substance Use Policy Laboratory, including pursuant 
        to priorities identified in the strategic plan established 
        under section 501(l).
  ``(c) Requirements.--The Assistant Secretary shall establish minimum 
requirements for applications referred to in this section, including 
applications related to the submission of research and evaluation.
  ``(d) Review and Rating.--The Assistant Secretary shall review 
applications prior to public posting, and may prioritize the review of 
applications for evidence-based practices and programs that are related 
to topics included in the notice established under subsection (b). The 
Assistant Secretary shall utilize a rating and review system, which 
shall include information on the strength of evidence associated with 
such programs and practices and a rating of the methodological rigor of 
the research supporting the application. The Assistant Secretary shall 
make the metrics used to evaluate applications and the resulting 
ratings publicly available.''.

SEC. 603. SENSE OF CONGRESS.

  It is the sense of the Congress that the National Institute of Mental 
Health should conduct or support research on the determinants of self-
directed and other violence connected to mental illness.

    Subtitle B--Supporting the State Response to Mental Health Needs

SEC. 611. COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT.

  (a) Formula Grants.--Section 1911(b) of the Public Health Service Act 
(42 U.S.C. 300x(b)) is amended--
          (1) by redesignating paragraphs (1) through (3) as paragraphs 
        (2) through (4), respectively; and
          (2) by inserting before paragraph (2) (as so redesignated), 
        the following:
          ``(1) providing community mental health services for adults 
        with a serious mental illness and children with a serious 
        emotional disturbance as defined in accordance with section 
        1912(c);''.
  (b) State Plan.--Subsection (b) of section 1912 of the Public Health 
Service Act (42 U.S.C. 300x-1) is amended to read as follows:
  ``(b) Criteria for Plan.--In accordance with subsection (a), a State 
shall submit to the Secretary a plan that, at a minimum, satisfies the 
following criteria:
          ``(1) System of care.--The plan provides a description of the 
        system of care of the State, including as follows:
                  ``(A) Comprehensive community-based health systems.--
                The plan shall--
                          ``(i) identify the single State agency to be 
                        responsible for the administration of the 
                        program under the grant, including any third 
                        party who administers mental health services 
                        and is responsible for complying with the 
                        requirements of this part with respect to the 
                        grant;
                          ``(ii) provide for an organized community-
                        based system of care for individuals with 
                        mental illness, and describe available services 
                        and resources in a comprehensive system of 
                        care, including services for individuals with 
                        mental health and behavioral health co-
                        occurring disorders;
                          ``(iii) include a description of the manner 
                        in which the State and local entities will 
                        coordinate services to maximize the efficiency, 
                        effectiveness, quality, and cost effectiveness 
                        of services and programs to produce the best 
                        possible outcomes (including health services, 
                        rehabilitation services, employment services, 
                        housing services, educational services, 
                        substance use disorder services, legal 
                        services, law enforcement services, social 
                        services, child welfare services, medical and 
                        dental care services, and other support 
                        services to be provided with Federal, State, 
                        and local public and private resources) with 
                        other agencies to enable individuals receiving 
                        services to function outside of inpatient or 
                        residential institutions, to the maximum extent 
                        of their capabilities, including services to be 
                        provided by local school systems under the 
                        Individuals with Disabilities Education Act;
                          ``(iv) include a description of how the 
                        State--
                                  ``(I) promotes evidence-based 
                                practices, including those evidence-
                                based programs that address the needs 
                                of individuals with early serious 
                                mental illness regardless of the age of 
                                the individual at onset;
                                  ``(II) provides comprehensive 
                                individualized treatment; or
                                  ``(III) integrates mental and 
                                physical health services;
                          ``(v) include a description of case 
                        management services;
                          ``(vi) include a description of activities 
                        that seek to engage individuals with serious 
                        mental illness or serious emotional disturbance 
                        and their caregivers where appropriate in 
                        making health care decisions, including 
                        activities that enhance communication between 
                        individuals, families, caregivers, and 
                        treatment providers; and
                          ``(vii) as appropriate to and reflective of 
                        the uses the State proposes for the block grant 
                        monies--
                                  ``(I) a description of the activities 
                                intended to reduce hospitalizations and 
                                hospital stays using the block grant 
                                monies;
                                  ``(II) a description of the 
                                activities intended to reduce incidents 
                                of suicide using the block grant 
                                monies; and
                                  ``(III) a description of how the 
                                State integrates mental health and 
                                primary care using the block grant 
                                monies.
                  ``(B) Mental health system data and epidemiology.--
                The plan shall contain an estimate of the incidence and 
                prevalence in the State of serious mental illness among 
                adults and serious emotional disturbance among children 
                and presents quantitative targets and outcome measures 
                for programs and services provided under this subpart.
                  ``(C) Children's services.--In the case of children 
                with serious emotional disturbance (as defined in 
                accordance with subsection (c)), the plan shall provide 
                for a system of integrated social services, educational 
                services, child welfare services, juvenile justice 
                services, law enforcement services, and substance use 
                disorder services that, together with health and mental 
                health services, will be provided in order for such 
                children to receive care appropriate for their multiple 
                needs (such system to include services provided under 
                the Individuals with Disabilities Education Act).
                  ``(D) Targeted services to rural and homeless 
                populations.--The plan shall describe the State's 
                outreach to and services for individuals who are 
                homeless and how community-based services will be 
                provided to individuals residing in rural areas.
                  ``(E) Management services.--The plan shall--
                          ``(i) describe the financial resources 
                        available, the existing mental health 
                        workforce, and the workforce trained in 
                        treating individuals with co-occurring mental 
                        and substance use disorders;
                          ``(ii) provide for the training of providers 
                        of emergency health services regarding mental 
                        health;
                          ``(iii) describe the manner in which the 
                        State intends to expend the grant under section 
                        1911 for the fiscal year involved; and
                          ``(iv) describe the manner in which the State 
                        intends to comply with each of the funding 
                        agreements in this subpart and subpart III.
          ``(2) Goals and objectives.--The plan establishes goals and 
        objectives for the period of the plan, including targets and 
        milestones that are intended to be met, and the activities that 
        will be undertaken to achieve those targets.''.
  (c) Best Practices in Clinical Care Models.--Section 1920 of the 
Public Health Service Act (42 U.S.C. 300x-9) is amended by adding at 
the end the following:
  ``(c) Best Practices in Clinical Care Models.--A State shall expend 
not less than 10 percent of the amount the State receives for carrying 
out this subpart in each fiscal year to support evidence-based programs 
that address the needs of individuals with early serious mental 
illness, including psychotic disorders, regardless of the age of the 
individual at onset.''.
  (d) Additional Provisions.--Section 1915(b) of the Public Health 
Service Act (42 U.S.C. 300x-4(b)) is amended--
          (1) by amending paragraph (1) to read as follows:
          ``(1) In general.--A funding agreement for a grant under 
        section 1911 is that the State involved will maintain State 
        expenditures for community mental health services at a level 
        that is not less than the average of the amounts prescribed by 
        this paragraph (prior to any waiver under paragraph (3)) for 
        such expenditures by such State for each of the two fiscal 
        years immediately preceding the fiscal year for which the State 
        is applying for the grant.'';
          (2) in paragraph (2)--
                  (A) by striking ``subsection (a)'' and inserting 
                ``paragraph (1)''; and
                  (B) by striking ``principle'' and inserting 
                ``principal'';
          (3) by amending paragraph (3) to read as follows:
          ``(3) Waiver.--
                  ``(A) In general.--The Secretary may, upon the 
                request of a State, waive the requirement established 
                in paragraph (1) in whole or in part, if the Secretary 
                determines that extraordinary economic conditions in 
                the State in the fiscal year involved or in the 
                previous fiscal year justify the waiver.
                  ``(B) Date certain for action upon request.--The 
                Secretary shall approve or deny a request for a waiver 
                under this paragraph not later than 120 days after the 
                date on which the request is made.
                  ``(C) Applicability of waiver.--A waiver provided by 
                the Secretary under this paragraph shall be applicable 
                only to the fiscal year involved.''; and
          (4) in paragraph (4)--
                  (A) by amending subparagraph (A) to read as follows:
                  ``(A) In general.--
                          ``(i) Determination and reduction.--The 
                        Secretary shall determine, in the case of each 
                        State, and for each fiscal year, whether the 
                        State maintained material compliance with the 
                        agreement made under paragraph (1). If the 
                        Secretary determines that a State has failed to 
                        maintain such compliance for a fiscal year, the 
                        Secretary shall reduce the amount of the 
                        allotment under section 1911 for the State, for 
                        the first fiscal year beginning after such 
                        determination is final, by an amount equal to 
                        the amount constituting such failure for the 
                        previous fiscal year about which the 
                        determination was made.
                          ``(ii) Alternative sanction.--The Secretary 
                        may by regulation provide for an alternative 
                        method of imposing a sanction for a failure by 
                        a State to maintain material compliance with 
                        the agreement under paragraph (1) if the 
                        Secretary determines that such alternative 
                        method would be more equitable and would be a 
                        more effective incentive for States to maintain 
                        such material compliance.''; and
                  (B) in subparagraph (B)--
                          (i) by inserting after the subparagraph 
                        designation the following: ``Submission of 
                        information to the secretary.--''; and
                          (ii) by striking ``subparagraph (A)'' and 
                        inserting ``subparagraph (A)(i)''.
  (e) Application for Grant.--Section 1917(a) of the Public Health 
Service Act (42 U.S.C. 300x-6(a)) is amended--
          (1) in paragraph (1), by striking ``1941'' and inserting 
        ``1942(a)''; and
          (2) in paragraph (5), by striking ``1915(b)(3)(B)'' and 
        inserting ``1915(b)''.

     Subtitle C--Strengthening Mental Health Care for Children and 
                              Adolescents

SEC. 621. TELEHEALTH CHILD PSYCHIATRY ACCESS GRANTS.

  Title III of the Public Health Service Act is amended by inserting 
after section 330L of such Act (42 U.S.C. 254c-18) the following new 
section:

``SEC. 330M. TELEHEALTH CHILD PSYCHIATRY ACCESS GRANTS.

  ``(a) In General.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration and in coordination 
with other relevant Federal agencies, shall award grants to States, 
political subdivisions of States, Indian tribes, and tribal 
organizations (for purposes of this section, as such terms are defined 
in section 4 of the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450b)) to promote behavioral health integration in 
pediatric primary care by--
          ``(1) supporting the development of statewide child 
        psychiatry access programs; and
          ``(2) supporting the improvement of existing statewide child 
        psychiatry access programs.
  ``(b) Program Requirements.--
          ``(1) In general.--A child psychiatry access program referred 
        to in subsection (a), with respect to which a grant under such 
        subsection may be used, shall--
                  ``(A) be a statewide network of pediatric mental 
                health teams that provide support to pediatric primary 
                care sites as an integrated team;
                  ``(B) support and further develop organized State 
                networks of child and adolescent psychiatrists to 
                provide consultative support to pediatric primary care 
                sites;
                  ``(C) conduct an assessment of critical behavioral 
                consultation needs among pediatric providers and such 
                providers' preferred mechanisms for receiving 
                consultation and training and technical assistance;
                  ``(D) develop an online database and communication 
                mechanisms, including telehealth, to facilitate 
                consultation support to pediatric practices;
                  ``(E) provide rapid statewide clinical telephone or 
                telehealth consultations when requested between the 
                pediatric mental health teams and pediatric primary 
                care providers;
                  ``(F) conduct training and provide technical 
                assistance to pediatric primary care providers to 
                support the early identification, diagnosis, treatment, 
                and referral of children with behavioral health 
                conditions or co-occurring intellectual and other 
                developmental disabilities;
                  ``(G) inform and assist pediatric providers in 
                accessing child psychiatry consultations and in 
                scheduling and conducting technical assistance;
                  ``(H) assist with referrals to specialty care and 
                community or behavioral health resources; and
                  ``(I) establish mechanisms for measuring and 
                monitoring increased access to child and adolescent 
                psychiatric services by pediatric primary care 
                providers and expanded capacity of pediatric primary 
                care providers to identify, treat, and refer children 
                with mental health problems.
          ``(2) Pediatric mental health teams.--In this subsection, the 
        term `pediatric mental health team' means a team of case 
        coordinators, child and adolescent psychiatrists, and licensed 
        clinical mental health professionals, such as a psychologist, 
        social worker, or mental health counselor.
  ``(c) Application.--A State, political subdivision of a State, Indian 
tribe, or tribal organization seeking a grant under this section shall 
submit an application to the Secretary at such time, in such manner, 
and containing such information as the Secretary may require, including 
a plan for the rigorous evaluation of activities that are carried out 
with funds received under such grant.
  ``(d) Evaluation.--A State, political subdivision of a State, Indian 
tribe, or tribal organization that receives a grant under this section 
shall prepare and submit an evaluation of activities carried out with 
funds received under such grant to the Secretary at such time, in such 
manner, and containing such information as the Secretary may reasonably 
require, including a process and outcome evaluation.
  ``(e) Matching Requirement.--The Secretary may not award a grant 
under this section unless the State, political subdivision of a State, 
Indian tribe, or tribal organization involved agrees, with respect to 
the costs to be incurred by the State, political subdivision of a 
State, Indian tribe, or tribal organization in carrying out the purpose 
described in this section, to make available non-Federal contributions 
(in cash or in kind) toward such costs in an amount that is not less 
than 20 percent of Federal funds provided in the grant.
  ``(f) Authorization of Appropriations.--To carry this section, there 
are authorized to be appropriated $9,000,000 for the period of fiscal 
years 2018 through 2020.''.

SEC. 622. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION, 
                    INTERVENTION, AND TREATMENT.

  Part Q of title III of the Public Health Service Act (42 U.S.C. 290h 
et seq.) is amended by adding at the end the following:

``SEC. 399Z-2. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION, 
                    INTERVENTION, AND TREATMENT.

  ``(a) Grants.--The Secretary shall--
          ``(1) award grants to eligible entities, including human 
        services agencies, to develop, maintain, or enhance infant and 
        early childhood mental health promotion, intervention, and 
        treatment programs, including--
                  ``(A) programs for infants and children at 
                significant risk of developing, showing early signs of, 
                or having been diagnosed with mental disorders 
                including serious emotional disturbance; and
                  ``(B) multigenerational therapy and other services 
                that support the caregiving relationship; and
          ``(2) ensure that programs funded through grants under this 
        section are evidence-informed or evidence-based models, 
        practices, and methods that are, as appropriate, culturally and 
        linguistically appropriate, and can be replicated in other 
        appropriate settings.
  ``(b) Eligible Children and Entities.--In this section:
          ``(1) Eligible child.--The term `eligible child' means a 
        child from birth to not more than 5 years of age who--
                  ``(A) is at risk for, shows early signs of, or has 
                been diagnosed with a mental disorder, including 
                serious emotional disturbance; and
                  ``(B) may benefit from infant and early childhood 
                intervention or treatment programs or specialized 
                preschool or elementary school programs that are 
                evidence-based or that have been scientifically 
                demonstrated to show promise but would benefit from 
                further applied development.
          ``(2) Eligible entity.--The term `eligible entity' means a 
        nonprofit institution that--
                  ``(A) is accredited or approved by a State mental 
                health or education agency, as applicable, to provide 
                for children from infancy to 5 years of age mental 
                health promotion, intervention, or treatment services 
                that are evidence-based or that have been 
                scientifically demonstrated to show promise but would 
                benefit from further applied development; and
                  ``(B) provides programs described in subsection (a) 
                that are evidence-based or that have been 
                scientifically demonstrated to show promise but would 
                benefit from further applied development.
  ``(c) Application.--An eligible entity seeking a grant under 
subsection (a) shall submit to the Secretary an application at such 
time, in such manner, and containing such information as the Secretary 
may require.
  ``(d) Use of Funds for Early Intervention and Treatment Programs.--An 
eligible entity may use amounts awarded under a grant under subsection 
(a)(1) to carry out the following:
          ``(1) Provide age-appropriate mental health promotion and 
        early intervention services or mental disorder treatment 
        services, which may include specialized programs, for eligible 
        children at significant risk of developing, showing early signs 
        of, or having been diagnosed with a mental disorder, including 
        serious emotional disturbance. Such services may include social 
        and behavioral services as well as multigenerational therapy 
        and other services ?that support the caregiving relationship.
          ``(2) Provide training for health care professionals with 
        expertise in infant and early childhood mental health care with 
        respect to appropriate and relevant integration with other 
        disciplines such as primary care clinicians, early intervention 
        specialists, child welfare staff, home visitors, early care and 
        education providers, and others who work with young children 
        and families.
          ``(3) Provide mental health consultation to personnel of 
        early care and education programs (including licensed or 
        regulated center-based and home-based child care, home 
        visiting, preschool special education, and early intervention 
        programs) who work with children and families.
          ``(4) Provide training for mental health clinicians in infant 
        and early childhood promising and evidence-based practices and 
        models for mental health treatment and early intervention, 
        including with regard to practices for identifying and treating 
        mental and behavioral disorders of infants and children 
        resulting from exposure or repeated exposure to adverse 
        childhood experiences or childhood trauma.
          ``(5) Provide age-appropriate assessment, diagnostic, and 
        intervention services for eligible children, including early 
        mental health promotion, intervention, and treatment services.
  ``(e) Matching Funds.--The Secretary may not award a grant under this 
section to an eligible entity unless the eligible entity agrees, with 
respect to the costs to be incurred by the eligible entity in carrying 
out the activities described in subsection (d), to make available non-
Federal contributions (in cash or in kind) toward such costs in an 
amount that is not less than 10 percent of the total amount of Federal 
funds provided in the grant.
  ``(f) Authorization of Appropriations.--To carry this section, there 
are authorized to be appropriated $20,000,000 for the period of fiscal 
years 2018 through 2022.''.

SEC. 623. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.

  Section 582 of the Public Health Service Act (42 U.S.C. 290hh-1; 
relating to grants to address the problems of persons who experience 
violence related stress) is amended--
          (1) in subsection (a), by striking ``developing programs'' 
        and all that follows and inserting the following: ``developing 
        and maintaining programs that provide for--
          ``(1) the continued operation of the National Child Traumatic 
        Stress Initiative (referred to in this section as the `NCTSI'), 
        which includes a coordinating center that focuses on the 
        mental, behavioral, and biological aspects of psychological 
        trauma response; and
          ``(2) the development of knowledge with regard to evidence-
        based practices for identifying and treating mental disorders, 
        behavioral disorders, and physical health conditions of 
        children and youth resulting from witnessing or experiencing a 
        traumatic event.'';
          (2) in subsection (b)--
                  (A) by striking ``subsection (a) related'' and 
                inserting ``subsection (a)(2) (related'';
                  (B) by striking ``treating disorders associated with 
                psychological trauma'' and inserting ``treating mental, 
                behavioral, and biological disorders associated with 
                psychological trauma)''; and
                  (C) by striking ``mental health agencies and programs 
                that have established clinical and basic research'' and 
                inserting ``universities, hospitals, mental health 
                agencies, and other programs that have established 
                clinical expertise and research'';
          (3) by redesignating subsections (c) through (g) as 
        subsections (g) through (k), respectively;
          (4) by inserting after subsection (b), the following:
  ``(c) Child Outcome Data.--The NCTSI coordinating center shall 
collect, analyze, report, and make publicly available NCTSI-wide child 
treatment process and outcome data regarding the early identification 
and delivery of evidence-based treatment and services for children and 
families served by the NCTSI grantees.
  ``(d) Training.--The NCTSI coordinating center shall facilitate the 
coordination of training initiatives in evidence-based and trauma-
informed treatments, interventions, and practices offered to NCTSI 
grantees, providers, and partners.
  ``(e) Dissemination.--The NCTSI coordinating center shall, as 
appropriate, collaborate with the Secretary in the dissemination of 
evidence-based and trauma-informed interventions, treatments, products, 
and other resources to appropriate stakeholders.
  ``(f) Review.--The Secretary shall, consistent with the peer-review 
process, ensure that NCTSI applications are reviewed by appropriate 
experts in the field as part of a consensus review process. The 
Secretary shall include review criteria related to expertise and 
experience in child trauma and evidence-based practices.'';
          (5) in subsection (g) (as so redesignated), by striking 
        ``with respect to centers of excellence are distributed 
        equitably among the regions of the country'' and inserting 
        ``are distributed equitably among the regions of the United 
        States'';
          (6) in subsection (i) (as so redesignated), by striking 
        ``recipient may not exceed 5 years'' and inserting ``recipient 
        shall not be less than 4 years, but shall not exceed 5 years''; 
        and
          (7) in subsection (j) (as so redesignated), by striking 
        ``$50,000,000'' and all that follows through ``2006'' and 
        inserting ``$46,887,000 for each of fiscal years 2017 through 
        2021''.

         TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATION

       Subtitle A--Garrett Lee Smith Memorial Act Reauthorization

SEC. 701. YOUTH INTERAGENCY RESEARCH, TRAINING, AND TECHNICAL 
                    ASSISTANCE CENTERS.

  Section 520C of the Public Health Service Act (42 U.S.C. 290bb-34) is 
amended--
          (1) by striking the section heading and inserting ``suicide 
        prevention technical assistance center.'';
          (2) in subsection (a), by striking ``and in consultation 
        with'' and all that follows through the period at the end of 
        paragraph (2) and inserting ``shall establish a research, 
        training, and technical assistance resource center to provide 
        appropriate information, training, and technical assistance to 
        States, political subdivisions of States, federally recognized 
        Indian tribes, tribal organizations, institutions of higher 
        education, public organizations, or private nonprofit 
        organizations regarding the prevention of suicide among all 
        ages, particularly among groups that are at high risk for 
        suicide.'';
          (3) by striking subsections (b) and (c);
          (4) by redesignating subsection (d) as subsection (b);
          (5) in subsection (b), as so redesignated--
                  (A) by striking the subsection heading and inserting 
                ``Responsibilities of the Center.--'';
                  (B) in the matter preceding paragraph (1), by 
                striking ``The additional research'' and all that 
                follows through ``nonprofit organizations for'' and 
                inserting ``The center established under subsection (a) 
                shall conduct activities for the purpose of'';
                  (C) by striking ``youth suicide'' each place such 
                term appears and inserting ``suicide'';
                  (D) in paragraph (1)--
                          (i) by striking ``the development or 
                        continuation of'' and inserting ``developing 
                        and continuing''; and
                          (ii) by inserting ``for all ages, 
                        particularly among groups that are at high risk 
                        for suicide'' before the semicolon at the end;
                  (E) in paragraph (2), by inserting ``for all ages, 
                particularly among groups that are at high risk for 
                suicide'' before the semicolon at the end;
                  (F) in paragraph (3), by inserting ``and tribal'' 
                after ``statewide'';
                  (G) in paragraph (5), by inserting ``and prevention'' 
                after ``intervention'';
                  (H) in paragraph (8), by striking ``in youth'';
                  (I) in paragraph (9), by striking ``and behavioral 
                health'' and inserting ``health and substance use 
                disorder''; and
                  (J) in paragraph (10), by inserting ``conducting'' 
                before ``other''; and
          (6) by striking subsection (e) and inserting the following:
  ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $5,988,000 
for each of fiscal years 2017 through 2021.
  ``(d) Report.--Not later than 2 years after the date of enactment of 
the Helping Families in Mental Health Crisis Act of 2016, the Secretary 
shall submit to Congress a report on the activities carried out by the 
center established under subsection (a) during the year involved, 
including the potential effects of such activities, and the States, 
organizations, and institutions that have worked with the center.''.

SEC. 702. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.

  Section 520E of the Public Health Service Act (42 U.S.C. 290bb-36) is 
amended--
          (1) in paragraph (1) of subsection (a) and in subsection (c), 
        by striking ``substance abuse'' each place such term appears 
        and inserting ``substance use disorder'';
          (2) in subsection (b)(2)--
                  (A) by striking ``each State is awarded only 1 grant 
                or cooperative agreement under this section'' and 
                inserting ``a State does not receive more than 1 grant 
                or cooperative agreement under this section at any 1 
                time''; and
                  (B) by striking ``been awarded'' and inserting 
                ``received''; and
          (3) by striking subsection (m) and inserting the following:
  ``(m) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $35,427,000 
for each of fiscal years 2017 through 2021.''.

SEC. 703. MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES ON CAMPUS.

  Section 520E-2 of the Public Health Service Act (42 U.S.C. 290bb-36b) 
is amended--
          (1) in the section heading, by striking ``and behavioral 
        health'' and inserting ``health and substance use disorder'';
          (2) in subsection (a)--
                  (A) by striking ``Services,'' and inserting 
                ``Services and'';
                  (B) by striking ``and behavioral health problems'' 
                and inserting ``health or substance use disorders''; 
                and
                  (C) by striking ``substance abuse'' and inserting 
                ``substance use disorders'';
          (3) in subsection (b)--
                  (A) in the matter preceding paragraph (1), by 
                striking ``for--'' and inserting ``for one or more of 
                the following:''; and
                  (B) by striking paragraphs (1) through (6) and 
                inserting the following:
          ``(1) Educating students, families, faculty, and staff to 
        increase awareness of mental health and substance use 
        disorders.
          ``(2) The operation of hotlines.
          ``(3) Preparing informational material.
          ``(4) Providing outreach services to notify students about 
        available mental health and substance use disorder services.
          ``(5) Administering voluntary mental health and substance use 
        disorder screenings and assessments.
          ``(6) Supporting the training of students, faculty, and staff 
        to respond effectively to students with mental health and 
        substance use disorders.
          ``(7) Creating a network infrastructure to link colleges and 
        universities with health care providers who treat mental health 
        and substance use disorders.'';
          (4) in subsection (c)(5), by striking ``substance abuse'' and 
        inserting ``substance use disorder'';
          (5) in subsection (d)--
                  (A) in the matter preceding paragraph (1), by 
                striking ``An institution of higher education desiring 
                a grant under this section'' and inserting ``To be 
                eligible to receive a grant under this section, an 
                institution of higher education'';
                  (B) in paragraph (1)--
                          (i) by striking ``and behavioral health'' and 
                        inserting ``health and substance use 
                        disorder''; and
                          (ii) by inserting ``, including veterans 
                        whenever possible and appropriate,'' after 
                        ``students''; and
                  (C) in paragraph (2), by inserting ``, which may 
                include, as appropriate and in accordance with 
                subsection (b)(7), a plan to seek input from relevant 
                stakeholders in the community, including appropriate 
                public and private entities, in order to carry out the 
                program under the grant'' before the period at the end;
          (6) in subsection (e)(1), by striking ``and behavioral health 
        problems'' and inserting ``health and substance use 
        disorders'';
          (7) in subsection (f)(2)--
                  (A) by striking ``and behavioral health'' and 
                inserting ``health and substance use disorder''; and
                  (B) by striking ``suicide and substance abuse'' and 
                inserting ``suicide and substance use disorders''; and
          (8) in subsection (h), by striking ``$5,000,000 for fiscal 
        year 2005'' and all that follows through the period at the end 
        and inserting ``$6,488,000 for each of fiscal years 2017 
        through 2021.''.

                      Subtitle B--Other Provisions

SEC. 711. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.

  Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31 et seq.) is amended by inserting after section 520E-2 
(42 U.S.C. 290bb-36b) the following:

``SEC. 520E-3. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.

  ``(a) In General.--The Secretary, acting through the Assistant 
Secretary, shall maintain the National Suicide Prevention Lifeline 
Program (referred to in this section as the `Program'), authorized 
under section 520A and in effect prior to the date of enactment of the 
Helping Families in Mental Health Crisis Act of 2016.
  ``(b) Activities.--In maintaining the Program, the activities of the 
Secretary shall include--
          ``(1) coordinating a network of crisis centers across the 
        United States for providing suicide prevention and crisis 
        intervention services to individuals seeking help at any time, 
        day or night;
          ``(2) maintaining a suicide prevention hotline to link 
        callers to local emergency, mental health, and social services 
        resources; and
          ``(3) consulting with the Secretary of Veterans Affairs to 
        ensure that veterans calling the suicide prevention hotline 
        have access to a specialized veterans' suicide prevention 
        hotline.
  ``(c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $7,198,000 for each of fiscal 
years 2017 through 2021.''.

SEC. 712. WORKFORCE DEVELOPMENT STUDIES AND REPORTS.

  (a) In General.--Not later than 2 years after the date of enactment 
of this Act, the Assistant Secretary for Mental Health and Substance 
Use, in consultation with the Administrator of the Health Resources and 
Services Administration, shall conduct a study, and publicly post on 
the appropriate Internet website of the Department of Health and Human 
Services a report, on the mental health and substance use disorder 
workforce in order to inform Federal, State, and local efforts related 
to workforce enhancement.
  (b) Contents.--The report under this section shall contain--
          (1) national and State-level projections of the supply and 
        demand of mental health and substance use disorder health 
        workers, including the number of individuals practicing in 
        fields deemed relevant by the Secretary;
          (2) an assessment of the mental health and substance use 
        disorder workforce capacity, strengths, and weaknesses as of 
        the date of the report, including the capacity of primary care 
        to prevent, screen, treat, or refer for mental health and 
        substance use disorders;
          (3) information on trends within the mental health and 
        substance use disorder provider workforce, including the number 
        of individuals entering the mental health workforce over the 
        next five years;
          (4) information on the gaps in workforce development for 
        mental health providers and professionals, including those who 
        serve pediatric, adult, and geriatric patients; and
          (5) any additional information determined by the Assistant 
        Secretary for Mental Health and Substance Use, in consultation 
        with the Administrator of the Health Resources and Services 
        Administration, to be relevant to the mental health and 
        substance use disorder provider workforce.

SEC. 713. MINORITY FELLOWSHIP PROGRAM.

  Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is 
amended by adding at the end the following:

                 ``PART K--MINORITY FELLOWSHIP PROGRAM

``SEC. 597. FELLOWSHIPS.

  ``(a) In General.--The Secretary shall maintain a program, to be 
known as the Minority Fellowship Program, under which the Secretary 
awards fellowships, which may include stipends, for the purposes of--
          ``(1) increasing behavioral health practitioners' knowledge 
        of issues related to prevention, treatment, and recovery 
        support for mental and substance use disorders among racial and 
        ethnic minority populations;
          ``(2) improving the quality of mental and substance use 
        disorder prevention and treatment delivered to racial and 
        ethnic minorities; and
          ``(3) increasing the number of culturally competent 
        behavioral health professionals and school personnel who teach, 
        administer, conduct services research, and provide direct 
        mental health or substance use services to racial and ethnic 
        minority populations.
  ``(b) Training Covered.--The fellowships under subsection (a) shall 
be for postbaccalaureate training (including for master's and doctoral 
degrees) for mental health professionals, including in the fields of 
psychiatry, nursing, social work, psychology, marriage and family 
therapy, mental health counseling, and substance use and addiction 
counseling.
  ``(c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $12,669,000 for each of fiscal 
years 2017, 2018, and 2019 and $13,669,000 for each of fiscal years 
2020 and 2021.''.

SEC. 714. CENTER AND PROGRAM REPEALS.

  Part B of title V of the Public Health Service Act (42 U.S.C. 290bb 
et seq.) is amended by striking the second section 514 (42 U.S.C. 
290bb-9), relating to methamphetamine and amphetamine treatment 
initiatives, and sections 514A, 517, 519A, 519C, 519E, 520D, and 520H 
(42 U.S.C. 290bb-8, 290bb-23, 290bb-25a, 290bb-25c, 290bb-25e, 290bb-
35, and 290bb-39).

SEC. 715. NATIONAL VIOLENT DEATH REPORTING SYSTEM.

  The Secretary of Health and Human Services, acting through the 
Director of the Centers for Disease Control and Prevention, is 
encouraged to improve, particularly through the inclusion of additional 
States, the National Violent Death Reporting System as authorized by 
title III of the Public Health Service Act (42 U.S.C. 241 et seq.). 
Participation in the system by the States shall be voluntary.

SEC. 716. SENSE OF CONGRESS ON PRIORITIZING NATIVE AMERICAN YOUTH AND 
                    SUICIDE PREVENTION PROGRAMS.

  (a) Findings.--The Congress finds as follows:
          (1) Suicide is the eighth leading cause of death among 
        American Indians and Alaska Natives across all ages.
          (2) Among American Indians and Alaska Natives who are 10 to 
        34 years of age, suicide is the second leading cause of death.
          (3) The suicide rate among American Indian and Alaska Native 
        adolescents and young adults ages 15 to 34 (19.5 per 100,000) 
        is 1.5 times higher than the national average for that age 
        group (12.9 per 100,000).
  (b) Sense of Congress.--It is the sense of Congress that the 
Secretary of Health and Human Services, in carrying out programs for 
Native American youth and suicide prevention programs for youth suicide 
intervention, should prioritize programs and activities for individuals 
who have a high risk or disproportional burden of suicide, such as 
Native Americans.

SEC. 717. PEER PROFESSIONAL WORKFORCE DEVELOPMENT GRANT PROGRAM.

  (a) In General.--For the purposes described in subsection (b), the 
Secretary of Health and Human Services shall award grants to develop 
and sustain behavioral health paraprofessional training and education 
programs, including through tuition support.
  (b) Purposes.--The purposes of grants under this section are--
          (1) to increase the number of behavioral health 
        paraprofessionals, including trained peers, recovery coaches, 
        mental health and addiction specialists, prevention 
        specialists, and pre-masters-level addiction counselors; and
          (2) to help communities develop the infrastructure to train 
        and certify peers as behavioral health paraprofessionals.
  (c) Eligible Entities.--To be eligible to receive a grant under this 
section, an entity shall be a community college or other entity the 
Secretary deems appropriate.
  (d) Geographic Distribution.--In awarding grants under this section, 
the Secretary shall seek to achieve an appropriate national balance in 
the geographic distribution of such awards.
  (e) Special Consideration.--In awarding grants under this section, 
the Secretary may give special consideration to proposed and existing 
programs targeting peer professionals serving youth ages 16 to 25.
  (f) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for the period of 
fiscal years 2018 through 2022.

SEC. 718. NATIONAL HEALTH SERVICE CORPS.

  (a) Definitions.--
          (1) Primary health services.--Section 331(a)(3)(D) of the 
        Public Health Service Act (42 U.S.C. 254d(a)(3)) is amended by 
        inserting ``(including pediatric mental health subspecialty 
        services)'' after ``pediatrics''.
          (2) Behavioral and mental health professionals.--Clause (i) 
        of section 331(a)(3)(E) of the Public Health Service Act (42 
        U.S.C. 254d(a)(3)(E)) is amended by inserting ``(and pediatric 
        subspecialists thereof)'' before the period at the end.
  (b) Eligibility To Participate in Loan Repayment Program.--Section 
338B(b)(1)(B) of the Public Health Service Act (42 U.S.C. 254l-
1(b)(1)(B)) is amended by inserting ``, including any physician child 
and adolescent psychiatry residency or fellowship training program'' 
after ``be enrolled in an approved graduate training program in 
medicine, osteopathic medicine, dentistry, behavioral and mental 
health, or other health profession''.

SEC. 719. ADULT SUICIDE PREVENTION.

  (a) Grants.--
          (1) Authority.--The Assistant Secretary for Mental Health and 
        Substance Use (referred to in this section as the ``Assistant 
        Secretary'') may award grants to eligible entities in order to 
        implement suicide prevention efforts amongst adults 25 and 
        older.
          (2) Purpose.--The grant program under this section shall be 
        designed to raise suicide awareness, establish referral 
        processes, and improve clinical care practice standards for 
        treating suicide ideation, plans, and attempts among adults.
          (3) Recipients.--To be eligible to receive a grant under this 
        section, an entity shall be a community-based primary care or 
        behavioral health care setting, an emergency department, a 
        State mental health agency, an Indian tribe, a tribal 
        organization, or any other entity the Assistant Secretary deems 
        appropriate.
          (4) Nature of activities.--The grants awarded under paragraph 
        (1) shall be used to implement programs that--
                  (A) screen for suicide risk in adults and provide 
                intervention and referral to treatment;
                  (B) implement evidence-based practices to treat 
                individuals who are at suicide risk, including 
                appropriate followup services; and
                  (C) raise awareness, reduce stigma, and foster open 
                dialogue about suicide prevention.
  (b) Additional Activities.--The Assistant Secretary shall--
          (1) evaluate the activities supported by grants awarded under 
        subsection (a) in order to further the Nation's understanding 
        of effective interventions to prevent suicide in adults;
          (2) disseminate the findings from the evaluation as the 
        Assistant Secretary considers appropriate; and
          (3) provide appropriate information, training, and technical 
        assistance to eligible entities that receive a grant under this 
        section, in order to help such entities to meet the 
        requirements of this section, including assistance with--
                  (A) selection and implementation of evidence-based 
                interventions and frameworks to prevent suicide, such 
                as the Zero Suicide framework; and
                  (B) other activities as the Assistant Secretary 
                determines appropriate.
  (c) Duration.--A grant under this section shall be for a period of 
not more than 5 years.
  (d) Authorization of Appropriations.--
          (1) In general.--There is authorized to be appropriated to 
        carry out this section $30,000,000 for the period of fiscal 
        years 2018 through 2022.
          (2) Use of certain funds.--Of the funds appropriated to carry 
        out this section in any fiscal year, the lesser of 5 percent of 
        such funds or $500,000 shall be available to the Assistant 
        Secretary for purposes of carrying out subsection (b).

SEC. 720. CRISIS INTERVENTION GRANTS FOR POLICE OFFICERS AND FIRST 
                    RESPONDERS.

  (a) In General.--The Assistant Secretary for Mental Health and 
Substance Use may award grants to entities such as law enforcement 
agencies and first responders--
          (1) to provide specialized training to law enforcement 
        officers, corrections officers, paramedics, emergency medical 
        services workers, and other first responders (including village 
        public safety officers (as defined in section 247 of the Indian 
        Arts and Crafts Amendments Act of 2010 (42 U.S.C. 3796dd 
        note)))--
                  (A) to recognize individuals who have mental illness 
                and how to properly intervene with individuals with 
                mental illness; and
                  (B) to establish programs that enhance the ability of 
                law enforcement agencies to address the mental health, 
                behavioral, and substance use problems of individuals 
                encountered in the line of duty; and
          (2) to establish collaborative law enforcement and mental 
        health programs, including behavioral health response teams and 
        mental health crisis intervention teams comprised of mental 
        health professionals, law enforcement officers, and other first 
        responders, as appropriate, to provide on-site, face-to-face, 
        mental and behavioral health care services during a mental 
        health crisis, and to connect the individual in crisis to 
        appropriate community-based treatment services in lieu of 
        unnecessary hospitalization or further involvement with the 
        criminal justice system.
  (b) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $9,000,000 for the period of 
fiscal years 2018 through 2020.

SEC. 721. DEMONSTRATION GRANT PROGRAM TO TRAIN HEALTH SERVICE 
                    PSYCHOLOGISTS IN COMMUNITY-BASED MENTAL HEALTH.

  (a) Establishment.--The Secretary of Health and Human Services shall 
establish a grant program under which the Assistant Secretary of Mental 
Health and Substance Use Disorders may award grants to eligible 
institutions to support the recruitment, education, and clinical 
training experiences of health services psychology students, interns, 
and postdoctoral residents for education and clinical experience in 
community mental health settings.
  (b) Eligible Institutions.--For purposes of this section, the term 
``eligible institutions'' includes American Psychological Association-
accredited doctoral, internship, and postdoctoral residency schools or 
programs in health service psychology that--
          (1) are focused on the development and implementation of 
        interdisciplinary training of psychology graduate students and 
        postdoctoral fellows in providing mental and behavioral health 
        services to address substance use disorders, serious emotional 
        disturbance, and serious illness, as well as developing faculty 
        and implementing curriculum to prepare psychologists to work 
        with underserved populations; and
          (2) demonstrate an ability to train health service 
        psychologists in psychiatric hospitals, forensic hospitals, 
        community mental health centers, community health centers, 
        federally qualified health centers, or adult and juvenile 
        correctional facilities.
  (c) Priorities.--In selecting grant recipients under this section, 
the Secretary shall give priority to eligible institutions in which 
training focuses on the needs of individuals with serious mental 
illness, serious emotional disturbance, justice-involved youth, and 
individuals with or at high risk for substance use disorders.
  (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $12,000,000 for the period of 
fiscal years 2018 through 2022.

SEC. 722. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.

  Section 775(e) of the Public Health Service Act (42 U.S.C 295f(e)) is 
amended to read as follows:
  ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $12,000,000 for the period of 
fiscal years 2018 through 2022.''.

SEC. 723. CUTGO COMPLIANCE.

  Section 319D(f) of the Public Health Service Act (42 U.S.C. 247d-
4(f)) is amended by striking ``$138,300,000 for each of fiscal years 
2014 through 2018'' and inserting ``$138,300,000 for each of fiscal 
years 2014 through 2016 and $58,000,000 for each of fiscal years 2017 
and 2018''.

                    TITLE VIII--MENTAL HEALTH PARITY

SEC. 801. ENHANCED COMPLIANCE WITH MENTAL HEALTH AND SUBSTANCE USE 
                    DISORDER COVERAGE REQUIREMENTS.

  (a) Compliance Program Guidance Document.--Section 2726(a) of the 
Public Health Service Act (42 U.S.C. 300gg-26(a)) is amended by adding 
at the end the following:
          ``(6) Compliance program guidance document.--
                  ``(A) In general.--Not later than 6 months after the 
                date of enactment of the Helping Families in Mental 
                Health Crisis Act of 2016, the Inspector General of the 
                Department of Health and Human Services, in 
                coordination with the Secretary, the Secretary of 
                Labor, or the Secretary of the Treasury, shall issue a 
                compliance program guidance document to help improve 
                compliance with this section.
                  ``(B) Examples illustrating compliance and 
                noncompliance.--
                          ``(i) In general.--The compliance program 
                        guidance document required under this paragraph 
                        shall provide illustrative, de-identified 
                        examples (that do not disclose any protected 
                        health information or individually identifiable 
                        information) of previous findings of compliance 
                        and noncompliance with this section, section 
                        712 of the Employee Retirement Income Security 
                        Act of 1974, or section 9812 of the Internal 
                        Revenue Code of 1986 based on investigations of 
                        violations of such sections, including--
                                  ``(I) examples illustrating 
                                requirements for information 
                                disclosures and nonquantitative 
                                treatment limitations; and
                                  ``(II) descriptions of the violations 
                                uncovered during the course of such 
                                investigations.
                          ``(ii) Nonquantitative treatment 
                        limitations.--To the extent that any example 
                        described in clause (i) involves a finding of 
                        compliance or noncompliance with regard to any 
                        requirement for nonquantitative treatment 
                        limitations, the example shall provide 
                        sufficient detail to fully explain such 
                        finding, including a full description of the 
                        criteria involved for medical and surgical 
                        benefits and the criteria involved for mental 
                        health and substance use disorder benefits.
                          ``(iii) Access to additional information 
                        regarding compliance.--In developing and 
                        issuing the compliance program guidance 
                        document required under this paragraph, the 
                        Inspector General of the Department of Health 
                        and Human Services may--
                                  ``(I) enter into interagency 
                                agreements with the Inspector General 
                                of the Department of Labor and the 
                                Inspector General of the Department of 
                                the Treasury to share findings of 
                                compliance and noncompliance with this 
                                section, section 712 of the Employee 
                                Retirement Income Security Act of 1974, 
                                or section 9812 of the Internal Revenue 
                                Code of 1986; and
                                  ``(II) enter into an agreement with a 
                                State to share information on findings 
                                of compliance and noncompliance with 
                                this section, section 712 of the 
                                Employee Retirement Income Security Act 
                                of 1974, or section 9812 of the 
                                Internal Revenue Code of 1986.
                  ``(C) Recommendations.--The compliance program 
                guidance document shall include recommendations to 
                avoid violations of this section and encourage the 
                development and use of internal controls to monitor 
                adherence to applicable statutes, regulations, and 
                program requirements. Such internal controls may 
                include a compliance checklist with illustrative 
                examples of nonquantitative treatment limitations on 
                mental health and substance use disorder benefits, 
                which may fail to comply with this section in relation 
                to nonquantitative treatment limitations on medical and 
                surgical benefits.
                  ``(D) Updating the compliance program guidance 
                document.--The compliance program guidance document 
                shall be updated every 2 years to include illustrative, 
                de-identified examples (that do not disclose any 
                protected health information or individually 
                identifiable information) of previous findings of 
                compliance and noncompliance with this section, section 
                712 of the Employee Retirement Income Security Act of 
                1974, or section 9812 of the Internal Revenue Code of 
                1986.''.
  (b) Additional Guidance.--Section 2726(a) of the Public Health 
Service Act (42 U.S.C. 300gg-26(a)) is amended by adding at the end the 
following:
          ``(7) Additional guidance.--
                  ``(A) In general.--Not later than 6 months after the 
                date of enactment of the Helping Families in Mental 
                Health Crisis Act of 2016, the Secretary, in 
                coordination with the Secretary of Labor and the 
                Secretary of the Treasury, shall issue guidance to 
                group health plans and health insurance issuers 
                offering group or individual health insurance coverage 
                to assist such plans and issuers in satisfying the 
                requirements of this section.
                  ``(B) Disclosure.--
                          ``(i) Guidance for plans and issuers.--The 
                        guidance issued under this paragraph shall 
                        include clarifying information and illustrative 
                        examples of methods that group health plans and 
                        health insurance issuers offering group or 
                        individual health insurance coverage may use 
                        for disclosing information to ensure compliance 
                        with the requirements under this section (and 
                        any regulations promulgated pursuant to this 
                        section).
                          ``(ii) Documents for participants, 
                        beneficiaries, contracting providers, or 
                        authorized representatives.--The guidance 
                        issued under this paragraph may include 
                        clarifying information and illustrative 
                        examples of methods that group health plans and 
                        health insurance issuers offering group or 
                        individual health insurance coverage may use to 
                        provide any participant, beneficiary, 
                        contracting provider, or authorized 
                        representative, as applicable, with documents 
                        containing information that the health plans or 
                        issuers are required to disclose to 
                        participants, beneficiaries, contracting 
                        providers, or authorized representatives to 
                        ensure compliance with this section, any 
                        regulation issued pursuant to this section, or 
                        any other applicable law or regulation, 
                        including information that is comparative in 
                        nature with respect to--
                                  ``(I) nonquantitative treatment 
                                limitations for both medical and 
                                surgical benefits and mental health and 
                                substance use disorder benefits;
                                  ``(II) the processes, strategies, 
                                evidentiary standards, and other 
                                factors used to apply the limitations 
                                described in subclause (I); and
                                  ``(III) the application of the 
                                limitations described in subclause (I) 
                                to ensure that such limitations are 
                                applied in parity with respect to both 
                                medical and surgical benefits and 
                                mental health and substance use 
                                disorder benefits.
                  ``(C) Nonquantitative treatment limitations.--The 
                guidance issued under this paragraph shall include 
                clarifying information and illustrative examples of 
                methods, processes, strategies, evidentiary standards, 
                and other factors that group health plans and health 
                insurance issuers offering group or individual health 
                insurance coverage may use regarding the development 
                and application of nonquantitative treatment 
                limitations to ensure compliance with this section (and 
                any regulations promulgated pursuant to this section), 
                including--
                          ``(i) examples of methods of determining 
                        appropriate types of nonquantitative treatment 
                        limitations with respect to both medical and 
                        surgical benefits and mental health and 
                        substance use disorder benefits, including 
                        nonquantitative treatment limitations 
                        pertaining to--
                                  ``(I) medical management standards 
                                based on medical necessity or 
                                appropriateness, or whether a treatment 
                                is experimental or investigative;
                                  ``(II) limitations with respect to 
                                prescription drug formulary design; and
                                  ``(III) use of fail-first or step 
                                therapy protocols;
                          ``(ii) examples of methods of determining--
                                  ``(I) network admission standards 
                                (such as credentialing); and
                                  ``(II) factors used in provider 
                                reimbursement methodologies (such as 
                                service type, geographic market, demand 
                                for services, and provider supply, 
                                practice size, training, experience, 
                                and licensure) as such factors apply to 
                                network adequacy;
                          ``(iii) examples of sources of information 
                        that may serve as evidentiary standards for the 
                        purposes of making determinations regarding the 
                        development and application of nonquantitative 
                        treatment limitations;
                          ``(iv) examples of specific factors, and the 
                        evidentiary standards used to evaluate such 
                        factors, used by such plans or issuers in 
                        performing a nonquantitative treatment 
                        limitation analysis;
                          ``(v) examples of how specific evidentiary 
                        standards may be used to determine whether 
                        treatments are considered experimental or 
                        investigative;
                          ``(vi) examples of how specific evidentiary 
                        standards may be applied to each service 
                        category or classification of benefits;
                          ``(vii) examples of methods of reaching 
                        appropriate coverage determinations for new 
                        mental health or substance use disorder 
                        treatments, such as evidence-based early 
                        intervention programs for individuals with a 
                        serious mental illness and types of medical 
                        management techniques;
                          ``(viii) examples of methods of reaching 
                        appropriate coverage determinations for which 
                        there is an indirect relationship between the 
                        covered mental health or substance use disorder 
                        benefit and a traditional covered medical and 
                        surgical benefit, such as residential treatment 
                        or hospitalizations involving voluntary or 
                        involuntary commitment; and
                          ``(ix) additional illustrative examples of 
                        methods, processes, strategies, evidentiary 
                        standards, and other factors for which the 
                        Secretary determines that additional guidance 
                        is necessary to improve compliance with this 
                        section.
                  ``(D) Public comment.--Prior to issuing any final 
                guidance under this paragraph, the Secretary shall 
                provide a public comment period of not less than 60 
                days during which any member of the public may provide 
                comments on a draft of the guidance.''.
  (c) Improving Compliance.--
          (1) In general.--In the case that the Secretary of Health and 
        Human Services, the Secretary of Labor, or the Secretary of the 
        Treasury determines that a group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage has violated, at least 5 times, section 2726 of the 
        Public Health Service Act (42 U.S.C. 300gg-26), section 712 of 
        the Employee Retirement Income Security Act of 1974 (29 U.S.C. 
        1185a), or section 9812 of the Internal Revenue Code, the 
        appropriate Secretary shall audit plan documents for such 
        health plan or issuer in the plan year following the 
        Secretary's determination in order to help improve compliance 
        with such section.
          (2) Rule of construction.--Nothing in this subsection shall 
        be construed to limit the authority, as in effect on the day 
        before the date of enactment of this Act, of the Secretary of 
        Health and Human Services, the Secretary of Labor, or the 
        Secretary of the Treasury to audit documents of health plans or 
        health insurance issuers.

SEC. 802. ACTION PLAN FOR ENHANCED ENFORCEMENT OF MENTAL HEALTH AND 
                    SUBSTANCE USE DISORDER COVERAGE.

  (a) Public Meeting.--
          (1) In general.--Not later than 6 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall convene a public meeting of stakeholders 
        described in paragraph (2) to produce an action plan for 
        improved Federal and State coordination related to the 
        enforcement of mental health parity and addiction equity 
        requirements.
          (2) Stakeholders.--The stakeholders described in this 
        paragraph shall include each of the following:
                  (A) The Federal Government, including representatives 
                from--
                          (i) the Department of Health and Human 
                        Services;
                          (ii) the Department of the Treasury;
                          (iii) the Department of Labor; and
                          (iv) the Department of Justice.
                  (B) State governments, including--
                          (i) State health insurance commissioners;
                          (ii) appropriate State agencies, including 
                        agencies on public health or mental health; and
                          (iii) State attorneys general or other 
                        representatives of State entities involved in 
                        the enforcement of mental health parity laws.
                  (C) Representatives from key stakeholder groups, 
                including--
                          (i) the National Association of Insurance 
                        Commissioners;
                          (ii) health insurance providers;
                          (iii) providers of mental health and 
                        substance use disorder treatment;
                          (iv) employers; and
                          (v) patients or their advocates.
  (b) Action Plan.--Not later than 6 months after the public meeting 
under subsection (a), the Secretary of Health and Human Services shall 
finalize the action plan described in such subsection and make it 
plainly available on the Internet website of the Department of Health 
and Human Services.
  (c) Content.--The action plan under this section shall--
          (1) reflect the input of the stakeholders invited to the 
        public meeting under subsection (a);
          (2) identify specific strategic objectives regarding how the 
        various Federal and State agencies charged with enforcement of 
        mental health parity and addiction equity requirements will 
        collaborate to improve enforcement of such requirements;
          (3) provide a timeline for implementing the action plan; and
          (4) provide specific examples of how such objectives may be 
        met, which may include--
                  (A) providing common educational information and 
                documents to patients about their rights under Federal 
                or State mental health parity and addiction equity 
                requirements;
                  (B) facilitating the centralized collection of, 
                monitoring of, and response to patient complaints or 
                inquiries relating to Federal or State mental health 
                parity and addiction equity requirements, which may be 
                through the development and administration of a single, 
                toll-free telephone number and an Internet website 
                portal;
                  (C) Federal and State law enforcement agencies 
                entering into memoranda of understanding to better 
                coordinate enforcement responsibilities and information 
                sharing, including whether such agencies should make 
                the results of enforcement actions related to mental 
                health parity and addiction equity requirements 
                publicly available; and
                  (D) recommendations to the Secretary and Congress 
                regarding the need for additional legal authority to 
                improve enforcement of mental health parity and 
                addiction equity requirements, including the need for 
                additional legal authority to ensure that 
                nonquantitative treatment limitations are applied, and 
                the extent and frequency of the applications of such 
                limitations, both to medical and surgical benefits and 
                to mental health and substance use disorder benefits in 
                a comparable manner.

SEC. 803. REPORT ON INVESTIGATIONS REGARDING PARITY IN MENTAL HEALTH 
                    AND SUBSTANCE USE DISORDER BENEFITS.

  (a) In General.--Not later than 1 year after the date of enactment of 
this Act, and annually thereafter for the subsequent 5 years, the 
Administrator of the Centers for Medicare & Medicaid Services, in 
collaboration with the Assistant Secretary of Labor of the Employee 
Benefits Security Administration and the Secretary of the Treasury, 
shall submit to the Committee on Energy and Commerce of the House of 
Representatives and the Committee on Health, Education, Labor, and 
Pensions of the Senate a report summarizing the results of all closed 
Federal investigations completed during the preceding 12-month period 
with findings of any serious violation regarding compliance with mental 
health and substance use disorder coverage requirements under section 
2726 of the Public Health Service Act (42 U.S.C. 300gg-26), section 712 
of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 
1185a), and section 9812 of the Internal Revenue Code of 1986.
  (b) Contents.--Subject to subsection (c), a report under subsection 
(a) shall, with respect to investigations described in such subsection, 
include each of the following:
          (1) The number of open or closed Federal investigations 
        conducted during the covered reporting period.
          (2) Each benefit classification examined by any such 
        investigation conducted during the covered reporting period.
          (3) Each subject matter, including compliance with 
        requirements for quantitative and nonquantitative treatment 
        limitations, of any such investigation conducted during the 
        covered reporting period.
          (4) A summary of the basis of the final decision rendered for 
        each closed investigation conducted during the covered 
        reporting period that resulted in a finding of a serious 
        violation.
  (c) Limitation.--Any individually identifiable information shall be 
excluded from reports under subsection (a) consistent with protections 
under the health privacy and security rules promulgated under section 
264(c) of the Health Insurance Portability and Accountability Act of 
1996 (42 U.S.C. 1320d-2 note).

SEC. 804. GAO STUDY ON PARITY IN MENTAL HEALTH AND SUBSTANCE USE 
                    DISORDER BENEFITS.

  Not later than 3 years after the date of enactment of this Act, the 
Comptroller General of the United States, in consultation with the 
Secretary of Health and Human Services, the Secretary of Labor, and the 
Secretary of the Treasury, shall submit to the Committee on Energy and 
Commerce of the House of Representatives and the Committee on Health, 
Education, Labor, and Pensions of the Senate a report detailing the 
extent to which group health plans or health insurance issuers offering 
group or individual health insurance coverage that provides both 
medical and surgical benefits and mental health or substance use 
disorder benefits, medicaid managed care organizations with a contract 
under section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)), 
and health plans provided under the State Children's Health Insurance 
Program under title XXI of the Social Security Act (42 U.S.C. 1397aa et 
seq.) comply with section 2726 of the Public Health Service Act (42 
U.S.C. 300gg-26), section 712 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185a), and section 9812 of the 
Internal Revenue Code of 1986, including--
          (1) how nonquantitative treatment limitations, including 
        medical necessity criteria, of such plans or issuers comply 
        with such sections;
          (2) how the responsible Federal departments and agencies 
        ensure that such plans or issuers comply with such sections, 
        including an assessment of how the Secretary of Health and 
        Human Services has used its authority to conduct audits of such 
        plans to ensure compliance;
          (3) a review of how the various Federal and State agencies 
        responsible for enforcing mental health parity requirements 
        have improved enforcement of such requirements in accordance 
        with the objectives and timeline described in the action plan 
        under section 802; and
          (4) recommendations for how additional enforcement, 
        education, and coordination activities by responsible Federal 
        and State departments and agencies could better ensure 
        compliance with such sections, including recommendations 
        regarding the need for additional legal authority.

SEC. 805. INFORMATION AND AWARENESS ON EATING DISORDERS.

  (a) Information.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') may--
          (1) update information, related fact sheets, and resource 
        lists related to eating disorders that are available on the 
        public Internet website of the National Women's Health 
        Information Center sponsored by the Office on Women's Health, 
        to include--
                  (A) updated findings and current research related to 
                eating disorders, as appropriate; and
                  (B) information about eating disorders, including 
                information related to males and females;
          (2) incorporate, as appropriate, and in coordination with the 
        Secretary of Education, information from publicly available 
        resources into appropriate obesity prevention programs 
        developed by the Office on Women's Health; and
          (3) make publicly available (through a public Internet 
        website or other method) information, related fact sheets and 
        resource lists, as updated under paragraph (1), and the 
        information incorporated into appropriate obesity prevention 
        programs, as updated under paragraph (2).
  (b) Awareness.--The Secretary may advance public awareness on--
          (1) the types of eating disorders;
          (2) the seriousness of eating disorders, including 
        prevalence, comorbidities, and physical and mental health 
        consequences;
          (3) methods to identify, intervene, refer for treatment, and 
        prevent behaviors that may lead to the development of eating 
        disorders;
          (4) discrimination and bullying based on body size;
          (5) the effects of media on self-esteem and body image; and
          (6) the signs and symptoms of eating disorders.

SEC. 806. EDUCATION AND TRAINING ON EATING DISORDERS.

  The Secretary of Health and Human Services may facilitate the 
identification of programs to educate and train health professionals 
and school personnel in effective strategies to--
          (1) identify individuals with eating disorders;
          (2) provide early intervention services for individuals with 
        eating disorders;
          (3) refer patients with eating disorders for appropriate 
        treatment;
          (4) prevent the development of eating disorders; or
          (5) provide appropriate treatment services for individuals 
        with eating disorders.

SEC. 807. GAO STUDY ON PREVENTING DISCRIMINATORY COVERAGE LIMITATIONS 
                    FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS AND 
                    SUBSTANCE USE DISORDERS.

  Not later than 2 years after the date of the enactment of this Act, 
the Comptroller General of the United States shall submit to Congress 
and make publicly available a report detailing Federal oversight of 
group health plans and health insurance coverage offered in connection 
with such plans (as such terms are defined in section 2791 of the 
Public Health Service Act (42 U.S.C. 300gg-91), including Medicaid 
managed care plans under section 1903 of the Social Security Act (42 
U.S.C. 1396b), to ensure compliance of such plans and coverage with 
sections 2726 of the Public Health Service Act (42 U.S.C. 300gg-26), 
712 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 
1185a), and 9812 of the Internal Revenue Code of 1986 (in this section 
collectively referred to as the ``parity law''), including--
          (1) a description of how Federal regulations and guidance 
        consider nonquantitative treatment limitations, including 
        medical necessity criteria and application of such criteria to 
        medical, surgical, and primary care, of such plans and coverage 
        in ensuring compliance by such plans and coverage with the 
        parity law;
          (2) a description of actions that Federal departments and 
        agencies are taking to ensure that such plans and coverage 
        comply with the parity law; and
          (3) the identification of enforcement, education, and 
        coordination activities within Federal departments and 
        agencies, including educational activities directed to State 
        insurance commissioners, and a description of how such proper 
        activities can be used to ensure full compliance with the 
        parity law.

SEC. 808. CLARIFICATION OF EXISTING PARITY RULES.

   If a group health plan or a health insurance issuer offering group 
or individual health insurance coverage provides coverage for eating 
disorder benefits, including residential treatment, such group health 
plan or health insurance issuer shall provide such benefits consistent 
with the requirements of section 2726 of the Public Health Service Act 
(42 U.S.C. 300gg-26), section 712 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185a), and section 9812 of the 
Internal Revenue Code of 1986.

                          Purpose and Summary

    H.R. 2646, the ``Helping Families in Mental Health Crisis 
Act of 2016,'' was introduced on June 4, 2015, by Rep. Tim 
Murphy (R-PA) and Rep. Eddie Bernice Johnson (D-TX). H.R. 2646 
seeks to direct the Substance Abuse and Mental Health Services 
Administration to utilize evidence-based approaches when 
awarding grants. The bill also codifies a provision from a 
recently finalized Medicaid managed care regulation related to 
payments for short term stays for adults in institutions for 
mental diseases (IMD) and extends the availability of the full 
range of early and periodic screening, diagnostic, and 
treatment (EPSDT) services to Medicaid children receiving 
services in an IMD. The cost of the EPSDT policy is offset by 
requiring the use of electronic visit verification systems for 
Medicaid-provided personal care services and home health 
services. H.R. 2646 also directs the Secretary of Health and 
Human Services (HHS) to undertake rulemaking to clarify when 
disclosure to families and loved ones is allowed under HIPAA. 
This legislation provides for targeted, fully CUTGO compliant 
mental health reauthorizations and authorizations of select new 
grant programs. Finally, the proposal provides improvements for 
mental health payment parity through better compliance guidance 
and disclosure support. Inter-agency officials must meet with 
public stakeholders--including patient advocates and third-
party groups--to build a strategy for improving mental health 
parity and addiction equity requirements.

                  Background and Need for Legislation

    The Energy and Commerce Committee, through the Oversight 
and Investigation Subcommittee led by Congressman Tim Murphy, 
undertook a yearlong investigation that spanned the 113th and 
114th Congress that examined the state of our mental health 
care system. In particular, the focus was on untreated serious 
mental illness (SMI). The Committee inquiry focused 
specifically on three areas of critical public policy interest: 
the scope of society's problem that is untreated serious mental 
illness, how privacy laws may interfere with patient care and 
public safety, including in the mental health context, and how 
certain federal resources appropriated for services and 
treatment of mental illness are currently being spent. This 
investigation included numerous hearings, bipartisan forums, 
GAO reports, and culminated in a comprehensive committee 
report. The main finding was that the patients with serious 
mental illness, such as schizophrenia, bipolar disorder, or 
major depression, are often the least likely to be engaged in 
medical care.
    In response to this finding in the second session of the 
113th Congress, Rep. Murphy introduced H.R. 3717, the ``Helping 
Families in Mental Health Crisis Act.'' In the first session of 
the 114th Congress, Rep. Murphy reintroduced the ``Helping 
Families in Mental Health Crisis Act'' as H.R. 2646.

                                Hearings

    The Subcommittee on Health held a hearing on H.R. 2646 on 
June 16, 2015. The hearing was entitled, ``Examining H.R. 2646, 
the Helping Families in Mental Health Crisis Act of 2015'' and 
witnesses included the following:
           Creigh Deeds, Senator, Senate of Virginia;
           Patrick J. Kennedy, Former U.S. 
        Representative (RI), Founder, Kennedy Forum;
           Jeffrey A. Lieberman, M.D., Chairman, 
        Department of Psychiatry, Columbia University College 
        of Physicians and Surgeons;
           Paul Gionfriddo, President and CEO; Mental 
        Health America;
           Steve Coe, Chief Executive Officer, 
        Community Access;
           Mary Jean Billingsley, Parent, National 
        Disability Rights Network; and
           Harvey Rosenthal, Executive Director, New 
        York Association of Psychiatric Rehabilitation 
        Services.

                        Committee Consideration

    On November 3 and 4, 2015, the Subcommittee on Health met 
in open markup session and forwarded H.R. 2646, as amended, to 
the full Committee by a record vote of 18 yeas and 12 nays. On 
June 14 and 15, 2016, the full Committee on Energy and Commerce 
met in open markup session and ordered H.R. 2646, as amended, 
favorably reported to the House by a record vote of 53 yeas and 
0 nays.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. The 
following reflects the record votes taken during the Committee 
consideration:


                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held a hearing and made 
findings that are reflected in this report.

         Statement of General Performance Goals and Objectives

    The legislation aims to improve and increase access to 
evidence based treatment and services for individuals with 
mentally illness and SMI and provide greater oversight of the 
Federal mental health system, specifically focusing on the 
Substance Abuse and Mental Health Services Administration.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
2646 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures or revenues.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI 
of the Rules of the House of Representatives, the Committee 
finds that H.R. 2646 contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, July 5, 2016.
Re Helping Families in Mental Health Crisis Act of 2015

Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
estimated the direct spending effects of H.R. 2646, the Helping 
Families in Mental Health Crisis Act of 2016, as reported by 
the House Committee on Energy and Commerce on June 15, 2016.
    CBO estimates that enacting H.R. 2646 would reduce net 
direct spending in the Medicaid program by $5 million over the 
2017-2026 period (see enclosed table). Pay-as-you-go procedures 
apply because enacting the legislation would affect direct 
spending. H.R. 2646 would not affect revenues.
    Implementing the legislation also would affect spending 
subject to appropriation mostly because it would reauthorize 
and make changes to several grant programs administered by the 
Substance Abuse and Mental Health Services Administration. 
However, CBO has not yet completed an estimate of the effects 
the bill would have on discretionary spending.
    CBO estimates that enacting the legislation would not 
increase net direct spending or on-budget deficits in any of 
the four consecutive 10-year periods beginning in 2027.

    PROVIDING SERVICES TO CHILDREN IN INSTITUTIONS OF MENTAL DISEASE

    Section 206 of the bill would allow federal reimbursement 
for certain medical services (such as screening, diagnostic, 
and treatment services) for children and young adults receiving 
inpatient care in institutions of mental disease (IMDs), 
beginning in 2019. Under current law, federal reimbursement is 
limited to inpatient psychiatric services for these 
individuals. Based on an analysis of administrative data from 
the Department of Health and Human Services, CBO estimates that 
enacting this provision would increase federal spending on 
average each year by about $250 per child or young adult in an 
IMD. As a result, CBO estimates that section 206 would cost 
$285 million over the 2017-2026 period.

                 ELECTRONIC VISIT VERIFICATION SYSTEMS

    Section 207 of the bill would require state Medicaid 
programs to implement an electronic visit verification system 
(EVV) for verifying the arrival and departure time of 
attendants who provide personal care or home health care 
services in a beneficiary's home. Federal payments to a state 
for personal care services would be reduced if a state fails to 
implement an EVV for those services by January 1, 2019. 
Similarly, federal payments for home health care services would 
be reduced if a state fails to implement an EVV for those 
services by January 1, 2023.
    Based on information from states and other stakeholders, 
CBO estimates that EVV programs would reduce spending for 
personal care services and home health services by less than 1 
percent, on average, over the 2017-2026 period. Because of the 
flexibility that H.R. 2646 would provide to states to establish 
such programs, CBO expects that some states would generate 
significantly higher savings than the average and others would 
generate little to no savings. CBO does not expect that any 
states would have their federal payments reduced as a result of 
the provision.
    Under current law, about two thirds of spending for 
personal care services and less than a third of spending for 
home health services are estimated to be subject to EVV over 
the next ten years because of programs initiated voluntarily by 
some states. After adjusting for EVV programs that will be in 
place under current law, CBO estimates that enacting section 
207 would reduce direct spending by $290 million over the 2017-
2026 period.

                            OTHER PROVISIONS

    Section 201 of H.R. 2646 would allow states to continue to 
provide separate Medicaid payments for mental health services 
and primary care services that are furnished on the same day. 
Section 202 of the bill would allow states to receive Medicaid 
reimbursement for payments made to managed care organizations 
for treatment in IMDs for adult beneficiaries in certain 
limited circumstances. That section codifies a provision in a 
final rule published in the Federal Register on May 6, 2016. 
Because sections 201 and 202 would codify current policies, CBO 
estimates that they would have no effect on the federal budget.

                      LONG-TERM BUDGETARY EFFECTS

    CBO estimates that enacting the legislation would not 
increase net direct spending or on-budget deficits in any of 
the four consecutive 10-year periods beginning in 2027.

             INTERGOVERNMENTAL AND PRIVATE-SECTOR MANDATES

    H.R. 2646 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act. CBO 
estimates that provisions in the bill that would decrease 
federal spending in Medicaid would similarly result in a 
reduction in state spending for Medicaid over the 2017-2026 
period.
    If you wish further details on this estimate, we would be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

     CBO ESTIMATE OF THE DIRECT SPENDING EFFECTS FOR H.R. 2646, THE HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT OF 2016, AS ORDERED REPORTED BY THE
                                                    COMMITTEE ON ENERGY AND COMMERCE ON JUNE 15, 2016
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                     Millions of dollars, by fiscal year--
                                                     ---------------------------------------------------------------------------------------------------
                                                       2017   2018   2019    2020    2021    2022    2023    2024    2025    2026   2017-2021  2017-2026
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               CHANGES IN DIRECT SPENDING
 
Providing Services to Children in Institutions of
 Mental Disease:
    Estimated Budget Authority......................      0      0      23      33      34      35      37      39      41      43        90        285
    Estimated Outlays...............................      0      0      23      33      34      35      37      39      41      43        90        285
Electronic Visit Verification Systems:
    Estimated Budget Authority......................      0      0     -11     -21     -30     -39     -43     -46     -48     -52       -61       -290
    Estimated Outlays...............................      0      0     -11     -21     -30     -39     -43     -46     -48     -52       -61       -290
    Total:
        Estimated Budget Authority..................      0      0      13      12       4      -4      -6      -7      -7      -9        29         -5
        Estimated Outlays...........................      0      0      13      12       4      -4      -6      -7      -7      -9        29         -5
--------------------------------------------------------------------------------------------------------------------------------------------------------
Source: Congressional Budget Office.
Notes: Components may not add to totals because of rounding.
Other provisions of H.R. 2464 would affect spending subject to appropriation. Those provisions would authorize grant programs administered by the
  Substance Abuse and Mental Health Services Administration and would direct the Administrator of the Centers for Medicare and Medicaid Services to
  conduct studies, issue guidance, and issue reports. However, CBO has not yet completed an estimate of the discretionary costs of implementing the
  bill.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                    Duplication of Federal Programs

    No provision of H.R. 2646 establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                  Disclosure of Directed Rule Makings

    The Committee estimates that enacting H.R. 2646 
specifically directs to be completed 1 rule making within the 
meaning of 5 U.S.C. 551.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


    TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE


Section 101. Assistant Secretary for Mental Health and Substance Use

    This section would create an Assistant Secretary for Mental 
Health and Substance Use (ASMHSU). The Assistant Secretary 
would replace the Administrator of SAMSHA. The Assistant 
Secretary would be appointed by the President and confirmed by 
the Senate, like the current SAMSHA Administrator. Preference 
for hiring an Assistant Secretary will be given to individuals 
with a doctoral degree in medicine, osteopathic medicine, or 
psychology with clinical and research experience.
    The Assistant Secretary will be responsible for improving 
the standards used to evaluate grants, grantees, and the 
programs being administered by SAMSHA in consultation the 
National Mental Health and Substance Use Policy Lab (NMHSUPL). 
The Assistant Secretary will have a Deputy Assistant Secretary 
that will replace the Deputy Administrator of SAMSHA. The 
ASMHSU will serve as a voting member on the Council on Graduate 
Medical Education.

Section 102. Improving Oversight of Mental Health and Substance Use 
        Programs

    This section directs the Assistant Secretary for Planning 
and Evaluation (ASPE) to improve oversight of mental health and 
substance use programs. The ASPE will collect and organize 
relevant data, evaluate programs across Federal departments and 
agencies, and consult with other relevant agencies. The ASPE 
shall make recommendations on the evaluation of relevant 
programs across the department.

Section 103. National Mental Health and Substance Use Policy Laboratory

    This section creates National Mental Health and Substance 
Use Policy Laboratory within SAMSHA. It will be responsible for 
identifying, coordinating, and facilitating the implementation 
of policy changes likely to have a significant effect on mental 
health, mental illness, and substance use disorder services 
while promoting evidence based practices. The NMHSUPL will 
build off of the existing Office of Policy Planning and 
Innovation within SAMSHA.

Section 104. Peer Support Specialists Programs

    This section directs the Comptroller General of the United 
States to conduct a study on best practices for peer-support 
specialist programs in a selection of ten states.

Section 105. Prohibition against Using Federal Funds by Systems 
        Accepting Federal Funds to Protect and Advocate the Rights of 
        Individuals with Mental Illness

    This section reiterates current appropriations law and 
restates the prohibition on Protection and Advocacy 
organizations against using Federal funds for lobbying.

Section 106. Increased Reporting for Protection and Advocacy 
        Organizations

    This section leverages existing reporting that the state-
based Protection and Advocacy organizations currently submit to 
SAMSHA. This section requires Protection and Advocacy 
organizations to make their yearly Program Performance Request 
publicly available. In releasing these reports, Protection and 
Advocacy organizations should ensure the protection of 
personally identifiable information from public disclosure. 
This section also requires Protection and Advocacy 
organizations to provide a more detailed and disaggregated 
accounting for how each system spends funds and what the source 
of those funds are. The Committee intends this to build upon 
the existing data and reporting requirements of current law and 
not require new data collection or additional reporting.

Section 107. Grievance Procedures

    This section directs the Secretary of HHS to establish a 
grievance procedure within SAMSHA for the state based 
Protection and Advocacy organizations. The Committee believes 
that the use of this grievance procedure should come after the 
exhaustion of the internal grievance procedure established by 
existing law. The Committee intends the Secretary to ensure 
compliance with the requirements of the Protection and Advocacy 
for Individuals with Mental Illness (PAIMI) Act through this 
grievance procedure.

Section 108. Center for Behavioral Health Statistics and Quality

    This section authorizes the already existing Center for 
Behavioral Health Statistics and Quality.

Section 109. Strategic Plan

    This section directs the ASMHSU to develop and carry out a 
strategic plan that is to be updated every five years. The plan 
should among other initiatives include and help identify 
strategic priorities, goals and measurable objectives for 
SAMSHA activities, identify ways to improve services for 
individuals with SMI and serious emotional disturbance (SED), 
and ensure programs provide access to evidence based care.

Section 11. Authorities of Centers for Mental Health Services and 
        Substance Abuse Treatment

    This section ensures that the Center for Mental Health 
Services within SAMSHA collaborates with the Director of the 
National Institute on Mental Health. This section will also 
increase the oversight of grants administered by SAMSHA.

Section 111. Advisory Councils

    This section adds the Director of the National Institute of 
Mental Health, the Director of the National Institute on 
Alcohol Abuse and Alcoholism and the Director of the National 
Institute on Drug Abuse onto relevant advisory committees 
within SAMSHA.

Section 112. Peer Review

    This section requires not less than half of all members of 
peer review groups related to mental health treatment at SAMSHA 
to be licensed and experienced professionals with relevant 
medical, doctoral or advanced degrees in the prevention, 
diagnosis, or treatment of, or recovery from mental and 
substance use disorders.

             TITLE II--MEDICAID AND MENTAL HEALTH COVERAGE


Section 201. Rule of Construction Related to Medicaid Coverage of 
        Mental Health Services and Primary Care Services Furnished on 
        the Same Day

    This section clarifies that nothing in the Medicaid statute 
should be construed as prohibiting separate payment for the 
provision of mental health and primary care services provided 
to an individual on the same day.

Section 202. Optional Limited Coverage of Inpatient Services Furnished 
        in Institutions for Mental Diseases

    This section codifies the provision in the recently-
finalized Medicaid managed care regulation allowing for 
capitation payments to be made under certain circumstances for 
adults receiving treatment in an IMD. Payment can only be made 
for adults staying no more than 15 days in any given month in 
an IMD to receive services that, at beneficiary election, are 
in lieu of other services covered by the state plan.

Section 203. Study and Report Related to Medicaid Managed Care 
        Regulation

    This section directs the Secretary acting through the 
Administrator of the Centers for Medicare & Medicaid Services 
to conduct a study on the provision of care to adults who were 
enrolled in Medicaid managed care and received treatment in an 
IMD. Among other things, the study, due within three years 
after enactment, is to include information on the number of 
individuals receiving treatment in IMDs, their length of stay, 
and how managed care plans determine when to provide services 
in an IMD in lieu of other benefits, such as community-based 
mental health services.

Section 204. Guidance on Opportunities for Innovation

    This section directs the Administrator of the Centers for 
Medicare & Medicaid Services to issue a State Medicaid Director 
letter, within one year of enactment, on opportunities to 
design innovative service delivery systems to improve care for 
individuals with serious mental illness or serious emotional 
disturbance.

Section 205. Study and Report on Medicaid Emergency Psychiatric 
        Demonstration Project

    This section directs the Secretary, acting through the 
Administrator of the Centers for Medicare & Medicaid Services, 
to collect, analyze, and report on additional data from states 
that participated in the Medicaid Emergency Psychiatric 
Demonstration Project under section 2707 of the Patient 
Protection and Affordable Care Act. The report is due no later 
than two years after enactment.

Section 206. Providing Full-Range of EPSDT Services to Children in IMDS

    While Medicaid coverage is available for children and young 
adults under age 21 receiving inpatient psychiatric services, 
under current law, these individuals are statutorily excluded 
from coverage of early and periodic screening, diagnostic and 
treatment services (EPSDT). The EPSDT benefit provides 
comprehensive and preventive health care services for children 
under age 21 who are enrolled in Medicaid. This benefit ensures 
that all children in Medicaid receive appropriate preventive, 
dental, mental health, and developmental, and specialty 
services. This section specifies that, effective January 1, 
2019, children receiving Medicaid-covered inpatient psychiatric 
hospital services are also entitled to early and periodic 
screening, diagnostic, and treatment services, from their 
choice of provider.

Section 207. Electronic Visit Verification System Required for Personal 
        Care Services and Home Health Care Services Under Medicaid

    The Office of the Inspector General at HHS has found that 
personal care services provided in Medicaid are often at risk 
for fraud, waste, and abuse. To ensure needed services are 
provided to vulnerable and frail Medicaid beneficiaries, this 
section directs States to require the use of an electronic 
visit verification system for Medicaid-provided personal care 
services and home health services (but this policy does not 
require States to adopt a single system for providers within 
their State.) This policy provides enhanced federal matching 
for state efforts to implement this policy. The enhanced 
federal matching percentage outlined in the provision is 
current law. States that do not require a system for personal 
care services by January 1, 2019 and home health services by 
January 1, 2023 will face a modest, incremental reduction in 
their federal matching percentage for that service. The 
reduction in the federal matching percentage can be delayed up 
to one year if the State demonstrates a good faith effort to 
comply with the requirement. Based on conversations with the 
Congressional Budget Office, this policy offsets the cost of 
section 206.

   TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING 
                               COMMITTEE


Section 301. Interdepartmental Serious Mental Illness Coordinating 
        Committee

    This section establishes a committee known as the 
Interdepartmental Serious Mental Illness Coordinating Committee 
(SMICC). The committee shall report on a summary of advances in 
serious mental illness SMI and serious emotional disturbance 
(SED) research, evaluate Federal programs related to SMI and 
SED, a plan to improve outcomes for those with SMI and SED, and 
specific recommendations on action relevant agencies can take. 
The SMICC shall terminate six years after the date it is 
established.

             TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA


Section 401. Sense of Congress

    This section states that it is the Sense of Congress that 
more clarity is needed surrounding existing HIPAA privacy rules 
to reduce confusion that may hinder communication with 
responsible caregivers for a patient with SMI.

Section 402. Confidentiality of Records

    This section directs the Secretary to convene stakeholders 
one year after the regulations updating part 2 of title 42, 
Code of Federal Regulations are finalized. Stakeholders will 
determine the effect of the regulation on patient care, health 
outcomes, and patient privacy.

Section 403. Clarification of Circumstances Under Which Disclosure of 
        Protected Health Information is Permitted

    This section directs the Secretary to promulgate rulemaking 
to clarify circumstances under which disclosure of protected 
health information is permitted for a patient with mental 
illness. The Secretary already has the authority to undertake a 
rule making here, so this does not represent any sort of 
expansion of Secretary's authority.

Section 404. Development and Dissemination of Model Training Programs

    This section would require the Secretary to develop and 
disseminate model program and materials for training health 
care providers, lawyers, patients and their families regarding 
the circumstances under which patient with mental illness' 
protected health information can be disclosed without patient 
consent.

   TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS


Section 501. Assertive Community Treatment Grant Program for 
        Individuals with Serious Mental Illness

    This section directs the ASMHSU to award grants to 
establish assertive community treatment programs for 
individuals with SMI. This section has an authorization of $5 
million total for the period of FY18-FY22.

Section 502. Strengthening Community Crisis Response Systems

    This section directs the Secretary of Health and Human 
Services to award grants to states to enhance community-based 
crisis response systems or to develop, maintain or enhance 
databases of psychiatric, crisis stabilization units, and 
residential substance use disorder and community mental health 
treatment facility beds for individuals with SMI, SED, or 
substance use disorder. This section has an authorization of $5 
million total for the period of FY18-FY22.

Section 503. Increased and Extended Funding for Assisted Outpatient 
        Grant Program Individuals with Serious Mental Illness

    This section extends the authorization of the existing 
assisted outpatient treatment grant program to 2020. The 
authorization would be increased to $20 million for 2018, $19 
million for 2019 and 2020, and $18 million for 2021 and 2022.

Section 504. Liability for Health Professional Volunteers at Community 
        Health Centers

    This section extends liability protections for health 
professional volunteers at community health centers. This 
section has no authorization of appropriations.

      TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS


SUBTITLE A--ENCOURAGING THE ADVANCEMENT, INCORPORATION AND DEVELOPMENT 
                      OF EVIDENCE-BASED PRACTICES

Section 601. Encouraging Innovation and Evidence Based Programs

    This section promotes innovation in awarding grants in the 
mental health space with a focus on advancing evidence-based 
models. The grants will go towards evaluating models that show 
promise, integrating care, and expanding and scaling up 
successful programs.

Section 602. Promoting Access to Information on Evidence-Based Programs 
        and Practices

    This section directs the Assistant Secretary to improve 
access to reliable and valid information on evidence-based 
programs and practices through the National Registry of 
Evidence-Based Programs and Practices.

Section 603. Sense of Congress

    This sense of Congress states that the National Institute 
of Mental Health should conduct or support research on the 
determinants of self-directed and other violence and the 
connection to mental illness.

    SUBTITLE B--SUPPORTING THE STATE RESPONSE TO MENTAL HEALTH NEEDS

Section 611. Community Mental Health Services Block Grant

    This section directs states receiving the mental health 
block grant to submit a plan to SAMSHA on a variety of measures 
and activities. States will outline their goals and objectives 
for the period of the plan and identify targets and milestones 
to be met.
    Additional provisions include empowering SAMSHA to hold 
states that are found materially incompliant on their 
maintenance of effort within their block grant program 
accountable.

     SUBTITLE C--STRENGTHENING MENTAL HEALTH CARE FOR CHILDREN AND 
                              ADOLESCENTS

Section 621. Telehealth Child Psychiatry Access Grants

    This section awards grants to support the development of 
statewide child psychiatry access programs and the improvement 
of already existing statewide programs. This section has an 
authorization of $9 million total for the period of FY18-FY20.

Section 622. Infant and Early Childhood Mental Health Promotion, 
        Intervention and Treatment

    This section provides grants to programs for infants and 
children at significant risk of developing, exhibiting early 
signs of, or having been diagnosed with mental disorders 
including SED. This section has an authorization of $20 million 
total for the period of FY18-FY22.

Section 623. National Child Traumatic Stress Network

    This section reauthorizes the National Child Traumatic 
Stress Network at its last appropriated level of $46,887,000 
for each of FY17-FY21.

         TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATIONS


       SUBTITLE A--GARRETT LEE SMITH MEMORIAL ACT REAUTHORIZATION

Section 701, 702, and 703. Garrett Lee Smith Memorial Act 
        Reauthorization

    This section reauthorizes the Garrett Lee Smith Memorial 
Act at its last appropriated levels of $5,988,000 for the 
Suicide Prevention Technical Assistance Center, $35,427,000 for 
Youth Suicide Early Intervention and Prevention Strategies, and 
$6,488,000 for Mental Health and Substance Use Disorder 
Services on Campus. Each section is reauthorized at the levels 
in the last sentence for each of FY17-FY21.

                      SUBTITLE B--OTHER PROVISIONS

Section 711. National Suicide Prevention Lifeline Program

    This section authorizes the National Suicide Prevention 
Lifeline at its last appropriated level of $7,198,000 for each 
of FY17-FY21.

Section 712. Workforce Development Studies and Reports

    This section directs the ASMHSU to report on national and 
state level workforce projections, the workforce capacity and 
other relevant information.

Section 713. Minority Fellowship Program

    This section authorizes the Minority Fellowship Program at 
$12,669,000 a year for FY17-19 and $13,669,000 a year for FY20-
21.

Section 714. Center and Program Repeals

    The repeals in this section are for programs that have 
expired authorizations and have never been appropriated.

Section 715. National Violent Death Reporting System

    This section encourages the Centers for Disease Control and 
Prevention to improve the National Violent Death Reporting 
System.

Section 716. Sense of Congress on Prioritizing Native American Youth 
        Suicide Prevention Programs

    This Sense of Congress urges the Secretary to prioritize 
programs and activities for individuals who have a high risk or 
disproportional burden of suicide, such as Native Americans.

Section 717. Peer Professional Workforce Development Grant Program

    This section authorizes the Secretary to award grants to 
develop and sustain behavioral health paraprofessional training 
and education programs at $10 million for the period of FY18-
FY22.

Section 718. National Health Service Corps

    This section clarifies that child and adolescent 
psychiatrists can participate in the National Health Service 
Corps.

Section 719. Adult Suicide Prevention

    This section authorizes grants for adult suicide prevention 
at $30 million total for the period of FY18-FY22.

Section 720. Crisis Intervention Grants for Police and First Responders

    This section authorizes crisis intervention training grants 
for police officers and first responders at $9 million total 
for the period of FY18-FY20.

Section 721. Demonstration Grant Program to Train Health Service 
        Psychologists in Community-Based Mental Health

    This section authorizes a grant program to increase the 
psychologist work force at $12 million total for the period of 
FY18-FY22.

Section 722. Investment in Tomorrow's Pediatric Health Care Workforce

    This section reauthorizes Section 774(f) of the Public 
Health Service Act which provides for a pediatric specialty 
loan repayment program. The authorization is for $12 million 
total for the period of FY18-FY22.

Section 723. Cut-Go Compliance

    This section brings this bill into cut-go compliance.

                    TITLE VIII--MENTAL HEALTH PARITY


Section 801. Enhanced Compliance with Mental Health and Substance Use 
        Disorder Coverage Requirements

    This section aims to improve mental health payment parity 
through better compliance guidance and disclosure support. 
Among other items, the section develops inter-agency agreements 
for information sharing and creates new standards for updating 
program compliance documents. Agency officials must hold 
stakeholder meetings with plan issuers to improve public-
private coordination and take into consideration public 
feedback.

Section 802. Action Plan for Enhanced Enforcement of Mental Health and 
        Substance Use Disorder Coverage

    Under this section, federal agency officials must hold a 
public stakeholders meeting with state governments and 
nationwide stakeholders, including third-party groups and 
patient advocates, to produce an action plan for improving 
mental health parity and addiction equity requirements.

Section 803. Report on Investigations Regarding Parity in Mental Health 
        and Substance Use Disorder Benefits

    One year following enactment, and annually for five years, 
an inter-agency analysis on any serious violations of mental 
health parity compliance standards would be published, 
summarizing the results of all closed federal investigations 
finalized in the 12 months preceding the report.

Section 804. GAO Study on Parity in Mental Health and Substance Use 
        Disorder Benefits

    Within three years, the Comptroller General of the United 
States, through consultation with inter-agency leaders, must 
provide an independent report on treatment limitations, among 
other items, concerning plan issuers--including state- and 
federally-funded programs--that treat patients for medical and 
surgical benefits as well as and mental health or substance use 
disorder services.

Section 805. Information and Awareness on Eating Disorders

    In an effort to improve education and awareness of eating 
disorders, this section updates and modernizes public outreach 
efforts through the Office of Women's Health. Among other 
items, the public awareness should include revised findings on 
the comorbidities and physician and mental health consequences 
of serious eating disorders.

Section 806. Education and Training on Eating Disorders

    Similar to the provision on eating disorder awareness, this 
section provides support to educate and train health 
professionals and school personnel in effective strategies to 
identify individuals with eating disorders and facilitate early 
intervention programs. Further, this section helps with early 
intervention and prevention efforts for avoiding eating 
disorders.

Section 807. GAO Study on Preventing Discriminatory Coverage 
        Limitations for Individuals with Serious Mental Illness and 
        Substance Use Disorders

    Two years after the bill takes effect, the Comptroller 
General of the United States must submit a public report to 
Congress detailing the effectiveness of compliance guidelines 
and the shortfalls of meeting enforcement, education, and 
coordination of parity requirements.

Section 808. Clarification of Existing Parity Rules

    This section clarifies that plan issuers offering coverage 
for eating disorder benefits must do so in alignment with 
current mental health parity standards.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *


         TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS

Part A--Administration

           *       *       *       *       *       *       *


          defense of certain malpractice and negligence suits

  Sec. 224. (a) The remedy against the United States provided 
by sections 1346(b) and 2672 of title 28, or by alternative 
benefits provided by the United States where the availability 
of such benefits precludes a remedy under section 1346(b) of 
title 28, for damage for personal injury, including death, 
resulting from the performance of medical, surgical, dental, or 
related functions, including the conduct of clinical studies or 
investigation, by any commissioned officer or employee of the 
Public Health Service while acting within the scope of his 
office or employment, shall be exclusive of any other civil 
action or proceeding by reason of the same subject-matter 
against the officer or employee (or his estate) whose act or 
omission gave rise to the claim.
  (b) The Attorney General shall defend any civil action or 
proceeding brought in any court against any person referred to 
in subsection (a) of this section (or his estate) for any such 
damage or injury. Any such person against whom such civil 
action or proceeding is brought shall deliver within such time 
after date of service or knowledge of service as determined by 
the Attorney General, all process served upon him or an 
attested true copy thereof to his immediate superior or to 
whomever was designated by the Secretary to receive such papers 
and such persons shall promptly furnish copies of the pleading 
and process therein to the United States attorney for the 
district embracing the place wherein the proceeding is brought, 
to the Attorney General, and to the Secretary.
  (c) Upon a certification by the Attorney General that the 
defendant was acting in the scope of his employment at the time 
of the incident out of which the suit arose, any such civil 
action or proceeding commenced in a State court shall be 
removed without bond at any time before trial by the Attorney 
General to the district court of the United States of the 
district and division embracing the place wherein it is pending 
and the proceeding deemed a tort action brought against the 
United States under the provisions of title 28 and all 
references thereto. Should a United States district court 
determine on a hearing on a motion to remand held before a 
trial on the merit that the case so removed is one in which a 
remedy by suit within the meaning of subsection (a) of this 
section is not available against the United States, the case 
shall be remanded to the State Court: Provided, That where such 
a remedy is precluded because of the availability of a remedy 
through proceedings for compensation or other benefits from the 
United States as provided by any other law, the case shall be 
dismissed, but in the event the running of any limitation of 
time for commencing, or filing an application or claim in, such 
proceedings for compensation or other benefits shall be deemed 
to have been suspended during the pendency of the civil action 
or proceeding under this section.
  (d) The Attorney General may compromise or settle any claim 
asserted in such civil action or proceeding in the manner 
provided in section 2677 of title 28 and with the same effect.
  (e) For purposes of this section, the provisions of section 
2680(h) of title 28 shall not apply to assault or battery 
arising out of negligence in the performance of medical, 
surgical, dental, or related functions, including the conduct 
of clinical studies or investigations.
  (f) The Secretary or his designee may, to the extent that he 
deems appropriate, hold harmless or provide liability insurance 
for any officer or employee of the Public Health Service for 
damage for personal injury, including death, negligently caused 
by such officer or employee while acting within the scope of 
his office or employment and as a result of the performance of 
medical, surgical, dental, or related functions, including the 
conduct of clinical studies or investigations, if such employee 
is assigned to a foreign country or detailed to a State or 
political subdivision thereof or to a non-profit institution, 
and if the circumstances are such as are likely to preclude the 
remedies of third persons against the United States described 
in section 2679(b) of title 28, for such damage or injury.
  (g)(1)(A) For purposes of this section and subject to the 
approval by the Secretary of an application under subparagraph 
(D), an entity described in paragraph (4), and any officer, 
governing board member, or employee of such an entity, and any 
contractor of such an entity who is a physician or other 
licensed or certified health care practitioner (subject to 
paragraph (5)), shall be deemed to be an employee of the Public 
Health Service for a calendar year that begins during a fiscal 
year for which a transfer was made under subsection (k)(3) 
(subject to paragraph (3)). The remedy against the United 
States for an entity described in paragraph (4) and any 
officer, governing board member, employee, or contractor 
(subject to paragraph (5)) of such an entity who is deemed to 
be an employee of the Public Health Service pursuant to this 
paragraph shall be exclusive of any other civil action or 
proceeding to the same extent as the remedy against the United 
States is exclusive pursuant to subsection (a).
  (B) The deeming of any entity or officer, governing board 
member, employee, or contractor of the entity to be an employee 
of the Public Health Service for purposes of this section shall 
apply with respect to services provided--
          (i) to all patients of the entity, and
          (ii) subject to subparagraph (C), to individuals who 
        are not patients of the entity.
  (C) Subparagraph (B)(ii) applies to services provided to 
individuals who are not patients of an entity if the Secretary 
determines, after reviewing an application submitted under 
subparagraph (D), that the provision of the services to such 
individuals--
          (i) benefits patients of the entity and general 
        populations that could be served by the entity through 
        community-wide intervention efforts within the 
        communities served by such entity;
          (ii) facilitates the provision of services to 
        patients of the entity; or
          (iii) are otherwise required under an employment 
        contract (or similar arrangement) between the entity 
        and an officer, governing board member, employee, or 
        contractor of the entity.
  (D) The Secretary may not under subparagraph (A) deem an 
entity or an officer, governing board member, employee, or 
contractor of the entity to be an employee of the Public Health 
Service for purposes of this section, and may not apply such 
deeming to services described in subparagraph (B)(ii), unless 
the entity has submitted an application for such deeming to the 
Secretary in such form and such manner as the Secretary shall 
prescribe. The application shall contain detailed information, 
along with supporting documentation, to verify that the entity, 
and the officer, governing board member, employee, or 
contractor of the entity, as the case may be, meets the 
requirements of subparagraphs (B) and (C) of this paragraph and 
that the entity meets the requirements of paragraphs (1) 
through (4) of subsection (h).
  (E) The Secretary shall make a determination of whether an 
entity or an officer, governing board member, employee, or 
contractor of the entity is deemed to be an employee of the 
Public Health Service for purposes of this section within 30 
days after the receipt of an application under subparagraph 
(D). The determination of the Secretary that an entity or an 
officer, governing board member, employee, or contractor of the 
entity is deemed to be an employee of the Public Health Service 
for purposes of this section shall apply for the period 
specified by the Secretary under subparagraph (A).
  (F) Once the Secretary makes a determination that an entity 
or an officer, governing board member, employee, or contractor 
of an entity is deemed to be an employee of the Public Health 
Service for purposes of this section, the determination shall 
be final and binding upon the Secretary and the Attorney 
General and other parties to any civil action or proceeding. 
Except as provided in subsection (i), the Secretary and the 
Attorney General may not determine that the provision of 
services which are the subject of such a determination are not 
covered under this section.
  (G) In the case of an entity described in paragraph (4) that 
has not submitted an application under subparagraph (D):
          (i) The Secretary may not consider the entity in 
        making estimates under subsection (k)(1).
          (ii) This section does not affect any authority of 
        the entity to purchase medical malpractice liability 
        insurance coverage with Federal funds provided to the 
        entity under section 329, 330, or 340A.
  (H) In the case of an entity described in paragraph (4) for 
which an application under subparagraph (D) is in effect, the 
entity may, through notifying the Secretary in writing, elect 
to terminate the applicability of this subsection to the 
entity. With respect to such election by the entity:
          (i) The election is effective upon the expiration of 
        the 30-day period beginning on the date on which the 
        entity submits such notification.
          (ii) Upon taking effect, the election terminates the 
        applicability of this subsection to the entity and each 
        officer, governing board member, employee, and 
        contractor of the entity.
          (iii) Upon the effective date for the election, 
        clauses (i) and (ii) of subparagraph (G) apply to the 
        entity to the same extent and in the same manner as 
        such clauses apply to an entity that has not submitted 
        an application under subparagraph (D).
          (iv) If after making the election the entity submits 
        an application under subparagraph (D), the election 
        does not preclude the Secretary from approving the 
        application (and thereby restoring the applicability of 
        this subsection to the entity and each officer, 
        governing board member, employee, and contractor of the 
        entity, subject to the provisions of this subsection 
        and the subsequent provisions of this section.
  (2) If, with respect to an entity or person deemed to be an 
employee for purposes of paragraph (1), a cause of action is 
instituted against the United States pursuant to this section, 
any claim of the entity or person for benefits under an 
insurance policy with respect to medical malpractice relating 
to such cause of action shall be subrogated to the United 
States.
  (3) This subsection shall apply with respect to a cause of 
action arising from an act or omission which occurs on or after 
January 1, 1993.
  (4) An entity described in this paragraph is a public or non-
profit private entity receiving Federal funds under section 
330.
  (5) For purposes of paragraph (1), an individual may be 
considered a contractor of an entity described in paragraph (4) 
only if--
          (A) the individual normally performs on average at 
        least 32\1/2\ hours of service per week for the entity 
        for the period of the contract; or
          (B) in the case of an individual who normally 
        performs an average of less than 32\1/2\ hours of 
        services per week for the entity for the period of the 
        contract, the individual is a licensed or certified 
        provider of services in the fields of family practice, 
        general internal medicine, general pediatrics, or 
        obstetrics and gynecology.
  (h) The Secretary may not approve an application under 
subsection (g)(1)(D) unless the Secretary determines that the 
entity--
          (1) has implemented appropriate policies and 
        procedures to reduce the risk of malpractice and the 
        risk of lawsuits arising out of any health or health-
        related functions performed by the entity;
          (2) has reviewed and verified the professional 
        credentials, references, claims history, fitness, 
        professional review organization findings, and license 
        status of its physicians and other licensed or 
        certified health care practitioners, and, where 
        necessary, has obtained the permission from these 
        individuals to gain access to this information;
          (3) has no history of claims having been filed 
        against the United States as a result of the 
        application of this section to the entity or its 
        officers, employees, or contractors as provided for 
        under this section, or, if such a history exists, has 
        fully cooperated with the Attorney General in defending 
        against any such claims and either has taken, or will 
        take, any necessary corrective steps to assure against 
        such claims in the future; and
          (4) will fully cooperate with the Attorney General in 
        providing information relating to an estimate described 
        under subsection (k).
  (i)(1) Notwithstanding subsection (g)(1), the Attorney 
General, in consultation with the Secretary, may on the record 
determine, after notice and opportunity for a full and fair 
hearing, that an individual physician or other licensed or 
certified health care practitioner who is an officer, employee, 
or contractor of an entity described in subsection (g)(4) shall 
not be deemed to be an employee of the Public Health Service 
for purposes of this section, if treating such individual as 
such an employee would expose the Government to an unreasonably 
high degree of risk of loss because such individual--
          (A) does not comply with the policies and procedures 
        that the entity has implemented pursuant to subsection 
        (h)(1);
          (B) has a history of claims filed against him or her 
        as provided for under this section that is outside the 
        norm for licensed or certified health care 
        practitioners within the same specialty;
          (C) refused to reasonably cooperate with the Attorney 
        General in defending against any such claim;
          (D) provided false information relevant to the 
        individual's performance of his or her duties to the 
        Secretary, the Attorney General, or an applicant for or 
        recipient of funds under this Act; or
          (E) was the subject of disciplinary action taken by a 
        State medical licensing authority or a State or 
        national professional society.
  (2) A final determination by the Attorney General under this 
subsection that an individual physician or other licensed or 
certified health care professional shall not be deemed to be an 
employee of the Public Health Service shall be effective upon 
receipt by the entity employing such individual of notice of 
such determination, and shall apply only to acts or omissions 
occurring after the date such notice is received.
  (j) In the case of a health care provider who is an officer, 
employee, or contractor of an entity described in subsection 
(g)(4), section 335(e) shall apply with respect to the provider 
to the same extent and in the same manner as such section 
applies to any member of the National Health Service Corps.
  (k)(1)(A) For each fiscal year, the Attorney General, in 
consultation with the Secretary, shall estimate by the 
beginning of the year the amount of all claims which are 
expected to arise under this section (together with related 
fees and expenses of witnesses) for which payment is expected 
to be made in accordance with section 1346 and chapter 171 of 
title 28, United States Code, from the acts or omissions, 
during the calendar year that begins during that fiscal year, 
of entities described in subsection (g)(4) and of officers, 
employees, or contractors (subject to subsection (g)(5)) of 
such entities.
  (B) The estimate under subparagraph (A) shall take into 
account--
          (i) the value and frequency of all claims for damage 
        for personal injury, including death, resulting from 
        the performance of medical, surgical, dental, or 
        related functions by entities described in subsection 
        (g)(4) or by officers, employees, or contractors 
        (subject to subsection (g)(5)) of such entities who are 
        deemed to be employees of the Public Health Service 
        under subsection (g)(1) that, during the preceding 5-
        year period, are filed under this section or, with 
        respect to years occurring before this subsection takes 
        effect, are filed against persons other than the United 
        States,
          (ii) the amounts paid during that 5-year period on 
        all claims described in clause (i), regardless of when 
        such claims were filed, adjusted to reflect payments 
        which would not be permitted under section 1346 and 
        chapter 171 of title 28, United States Code, and
          (iii) amounts in the fund established under paragraph 
        (2) but unspent from prior fiscal years.
  (2) Subject to appropriations, for each fiscal year, the 
Secretary shall establish a fund of an amount equal to the 
amount estimated under paragraph (1) that is attributable to 
entities receiving funds under each of the grant programs 
described in paragraph (4) of subsection (g), but not to exceed 
a total of $10,000,000 for each such fiscal year. 
Appropriations for purposes of this paragraph shall be made 
separate from appropriations made for purposes of sections 329, 
330 and 340A.
  (3) In order for payments to be made for judgments against 
the United States (together with related fees and expenses of 
witnesses) pursuant to this section arising from the acts or 
omissions of entities described in subsection (g)(4) and of 
officers, employees, or contractors (subject to subsection 
(g)(5)) of such entities, the total amount contained within the 
fund established by the Secretary under paragraph (2) for a 
fiscal year shall be transferred not later than the December 31 
that occurs during the fiscal year to the appropriate accounts 
in the Treasury.
  (l)(1) If a civil action or proceeding is filed in a State 
court against any entity described in subsection (g)(4) or any 
officer, governing board member, employee, or any contractor of 
such an entity for damages described in subsection (a), the 
Attorney General, within 15 days after being notified of such 
filing, shall make an appearance in such court and advise such 
court as to whether the Secretary has determined under 
subsections (g) and (h), that such entity, officer, governing 
board member, employee, or contractor of the entity is deemed 
to be an employee of the Public Health Service for purposes of 
this section with respect to the actions or omissions that are 
the subject of such civil action or proceeding. Such advice 
shall be deemed to satisfy the provisions of subsection (c) 
that the Attorney General certify that an entity, officer, 
governing board member, employee, or contractor of the entity 
was acting within the scope of their employment or 
responsibility.
  (2) If the Attorney General fails to appear in State court 
within the time period prescribed under paragraph (1), upon 
petition of any entity or officer, governing board member, 
employee, or contractor of the entity named, the civil action 
or proceeding shall be removed to the appropriate United States 
district court. The civil action or proceeding shall be stayed 
in such court until such court conducts a hearing, and makes a 
determination, as to the appropriate forum or procedure for the 
assertion of the claim for damages described in subsection (a) 
and issues an order consistent with such determination.
  (m)(1) An entity or officer, governing board member, 
employee, or contractor of an entity described in subsection 
(g)(1) shall, for purposes of this section, be deemed to be an 
employee of the Public Health Service with respect to services 
provided to individuals who are enrollees of a managed care 
plan if the entity contracts with such managed care plan for 
the provision of services.
  (2) Each managed care plan which enters into a contract with 
an entity described in subsection (g)(4) shall deem the entity 
and any officer, governing board member, employee, or 
contractor of the entity as meeting whatever malpractice 
coverage requirements such plan may require of contracting 
providers for a calendar year if such entity or officer, 
governing board member, employee, or contractor of the entity 
has been deemed to be an employee of the Public Health Service 
for purposes of this section for such calendar year. Any plan 
which is found by the Secretary on the record, after notice and 
an opportunity for a full and fair hearing, to have violated 
this subsection shall upon such finding cease, for a period to 
be determined by the Secretary, to receive and to be eligible 
to receive any Federal funds under titles XVIII or XIX of the 
Social Security Act.
  (3) For purposes of this subsection, the term ``managed care 
plan'' shall mean health maintenance organizations and similar 
entities that contract at-risk with payors for the provision of 
health services or plan enrollees and which contract with 
providers (such as entities described in subsection (g)(4)) for 
the delivery of such services to plan enrollees.
  (n)(1) Not later than one year after the date of the 
enactment of the Federally Supported Health Centers Assistance 
Act of 1995, the Comptroller General of the United States shall 
submit to the Congress a report on the following:
          (A) The medical malpractice liability claims 
        experience of entities that have been deemed to be 
        employees for purposes of this section.
          (B) The risk exposure of such entities.
          (C) The value of private sector risk-management 
        services, and the value of risk-management services and 
        procedures required as a condition of receiving a grant 
        under section 329, 330, or 340A.
          (D) A comparison of the costs and the benefits to 
        taxpayers of maintaining medical malpractice liability 
        coverage for such entities pursuant to this section, 
        taking into account--
                  (i) a comparison of the costs of premiums 
                paid by such entities for private medical 
                malpractice liability insurance with the cost 
                of coverage pursuant to this section; and
                  (ii) an analysis of whether the cost of 
                premiums for private medical malpractice 
                liability insurance coverage is consistent with 
                the liability claims experience of such 
                entities.
  (2) The report under paragraph (1) shall include the 
following:
          (A) A comparison of--
                  (i) an estimate of the aggregate amounts that 
                such entities (together with the officers, 
                governing board members, employees, and 
                contractors of such entities who have been 
                deemed to be employees for purposes of this 
                section) would have directly or indirectly paid 
                in premiums to obtain medical malpractice 
                liability insurance coverage if this section 
                were not in effect; with
                  (ii) the aggregate amounts by which the 
                grants received by such entities under this Act 
                were reduced pursuant to subsection (k)(2).
          (B) A comparison of--
                  (i) an estimate of the amount of privately 
                offered such insurance that such entities 
                (together with the officers, governing board 
                members, employees, and contractors of such 
                entities who have been deemed to be employees 
                for purposes of this section) purchased during 
                the three-year period beginning on January 1, 
                1993; with
                  (ii) an estimate of the amount of such 
                insurance that such entities (together with the 
                officers, governing board members, employees, 
                and contractors of such entities who have been 
                deemed to be employees for purposes of this 
                section) will purchase after the date of the 
                enactment of the Federally Supported Health 
                Centers Assistance Act of 1995.
          (C) An estimate of the medical malpractice liability 
        loss history of such entities for the 10-year period 
        preceding October 1, 1996, including but not limited to 
        the following:
                  (i) Claims that have been paid and that are 
                estimated to be paid, and legal expenses to 
                handle such claims that have been paid and that 
                are estimated to be paid, by the Federal 
                Government pursuant to deeming entities as 
                employees for purposes of this section.
                  (ii) Claims that have been paid and that are 
                estimated to be paid, and legal expenses to 
                handle such claims that have been paid and that 
                are estimated to be paid, by private medical 
                malpractice liability insurance.
          (D) An analysis of whether the cost of premiums for 
        private medical malpractice liability insurance 
        coverage is consistent with the liability claims 
        experience of entities that have been deemed as 
        employees for purposes of this section.
  (3) In preparing the report under paragraph (1), the 
Comptroller General of the United States shall consult with 
public and private entities with expertise on the matters with 
which the report is concerned.
  (o)(1) For purposes of this section, a free clinic health 
professional shall in providing a qualifying health service to 
an individual, or an officer, governing board member, employee, 
or contractor of a free clinic shall in providing services for 
the free clinic, be deemed to be an employee of the Public 
Health Service for a calendar year that begins during a fiscal 
year for which a transfer was made under paragraph (6)(D). The 
preceding sentence is subject to the provisions of this 
subsection.
  (2) In providing a health service to an individual, a health 
care practitioner shall for purposes of this subsection be 
considered to be a free clinic health professional if the 
following conditions are met:
          (A) The service is provided to the individual at a 
        free clinic, or through offsite programs or events 
        carried out by the free clinic.
          (B) The free clinic is sponsoring the health care 
        practitioner pursuant to paragraph (5)(C).
          (C) The service is a qualifying health service (as 
        defined in paragraph (4)).
          (D) Neither the health care practitioner nor the free 
        clinic receives any compensation for the service from 
        the individual or from any third-party payor (including 
        reimbursement under any insurance policy or health 
        plan, or under any Federal or State health benefits 
        program). With respect to compliance with such 
        condition:
                  (i) The health care practitioner may receive 
                repayment from the free clinic for reasonable 
                expenses incurred by the health care 
                practitioner in the provision of the service to 
                the individual.
                  (ii) The free clinic may accept voluntary 
                donations for the provision of the service by 
                the health care practitioner to the individual.
          (E) Before the service is provided, the health care 
        practitioner or the free clinic provides written notice 
        to the individual of the extent to which the legal 
        liability of the health care practitioner is limited 
        pursuant to this subsection (or in the case of an 
        emergency, the written notice is provided to the 
        individual as soon after the emergency as is 
        practicable). If the individual is a minor or is 
        otherwise legally incompetent, the condition under this 
        subparagraph is that the written notice be provided to 
        a legal guardian or other person with legal 
        responsibility for the care of the individual.
          (F) At the time the service is provided, the health 
        care practitioner is licensed or certified in 
        accordance with applicable law regarding the provision 
        of the service.
  (3)(A) For purposes of this subsection, the term ``free 
clinic'' means a health care facility operated by a nonprofit 
private entity meeting the following requirements:
          (i) The entity does not, in providing health services 
        through the facility, accept reimbursement from any 
        third-party payor (including reimbursement under any 
        insurance policy or health plan, or under any Federal 
        or State health benefits program).
          (ii) The entity, in providing health services through 
        the facility, either does not impose charges on the 
        individuals to whom the services are provided, or 
        imposes a charge according to the ability of the 
        individual involved to pay the charge.
          (iii) The entity is licensed or certified in 
        accordance with applicable law regarding the provision 
        of health services.
  (B) With respect to compliance with the conditions under 
subparagraph (A), the entity involved may accept voluntary 
donations for the provision of services.
  (4) For purposes of this subsection, the term ``qualifying 
health service'' means any medical assistance required or 
authorized to be provided in the program under title XIX of the 
Social Security Act, without regard to whether the medical 
assistance is included in the plan submitted under such program 
by the State in which the health care practitioner involved 
provides the medical assistance. References in the preceding 
sentence to such program shall as applicable be considered to 
be references to any successor to such program.
  (5) Subsection (g) (other than paragraphs (3) through (5)) 
and subsections (h), (i), and (l) apply to a health care 
practitioner for purposes of this subsection to the same extent 
and in the same manner as such subsections apply to an officer, 
governing board member, employee, or contractor of an entity 
described in subsection (g)(4), subject to paragraph (6) and 
subject to the following:
          (A) The first sentence of paragraph (1) applies in 
        lieu of the first sentence of subsection (g)(1)(A).
          (B) This subsection may not be construed as deeming 
        any free clinic to be an employee of the Public Health 
        Service for purposes of this section.
          (C) With respect to a free clinic, a health care 
        practitioner is not a free clinic health professional 
        unless the free clinic sponsors the health care 
        practitioner. For purposes of this subsection, the free 
        clinic shall be considered to be sponsoring the health 
        care practitioner if--
                  (i) with respect to the health care 
                practitioner, the free clinic submits to the 
                Secretary an application meeting the 
                requirements of subsection (g)(1)(D); and
                  (ii) the Secretary, pursuant to subsection 
                (g)(1)(E), determines that the health care 
                practitioner is deemed to be an employee of the 
                Public Health Service.
          (D) In the case of a health care practitioner who is 
        determined by the Secretary pursuant to subsection 
        (g)(1)(E) to be a free clinic health professional, this 
        subsection applies to the health care practitioner 
        (with respect to the free clinic sponsoring the health 
        care practitioner pursuant to subparagraph (C)) for any 
        cause of action arising from an act or omission of the 
        health care practitioner occurring on or after the date 
        on which the Secretary makes such determination.
          (E) Subsection (g)(1)(F) applies to a health care 
        practitioner for purposes of this subsection only to 
        the extent that, in providing health services to an 
        individual, each of the conditions specified in 
        paragraph (2) is met.
  (6)(A) For purposes of making payments for judgments against 
the United States (together with related fees and expenses of 
witnesses) pursuant to this section arising from the acts or 
omissions of free clinic health professionals, there is 
authorized to be appropriated $10,000,000 for each fiscal year.
  (B) The Secretary shall establish a fund for purposes of this 
subsection. Each fiscal year amounts appropriated under 
subparagraph (A) shall be deposited in such fund.
  (C) Not later than May 1 of each fiscal year, the Attorney 
General, in consultation with the Secretary, shall submit to 
the Congress a report providing an estimate of the amount of 
claims (together with related fees and expenses of witnesses) 
that, by reason of the acts or omissions of free clinic health 
professionals, will be paid pursuant to this section during the 
calendar year that begins in the following fiscal year. 
Subsection (k)(1)(B) applies to the estimate under the 
preceding sentence regarding free clinic health professionals 
to the same extent and in the same manner as such subsection 
applies to the estimate under such subsection regarding 
officers, governing board members, employees, and contractors 
of entities described in subsection (g)(4).
  (D) Not later than December 31 of each fiscal year, the 
Secretary shall transfer from the fund under subparagraph (B) 
to the appropriate accounts in the Treasury an amount equal to 
the estimate made under subparagraph (C) for the calendar year 
beginning in such fiscal year, subject to the extent of amounts 
in the fund.
  (7)(A) This subsection takes effect on the date of the 
enactment of the first appropriations Act that makes an 
appropriation under paragraph (6)(A), except as provided in 
subparagraph (B)(i).
  (B)(i) Effective on the date of the enactment of the Health 
Insurance Portability and Accountability Act of 1996--
          (I) the Secretary may issue regulations for carrying 
        out this subsection, and the Secretary may accept and 
        consider applications submitted pursuant to paragraph 
        (5)(C); and
          (II) reports under paragraph (6)(C) may be submitted 
        to the Congress.
  (ii) For the first fiscal year for which an appropriation is 
made under subparagraph (A) of paragraph (6), if an estimate 
under subparagraph (C) of such paragraph has not been made for 
the calendar year beginning in such fiscal year, the transfer 
under subparagraph (D) of such paragraph shall be made 
notwithstanding the lack of the estimate, and the transfer 
shall be made in an amount equal to the amount of such 
appropriation.
  (p) Administration of Smallpox Countermeasures by Health 
Professionals.--
          (1) In general.--For purposes of this section, and 
        subject to other provisions of this subsection, a 
        covered person shall be deemed to be an employee of the 
        Public Health Service with respect to liability arising 
        out of administration of a covered countermeasure 
        against smallpox to an individual during the effective 
        period of a declaration by the Secretary under 
        paragraph (2)(A).
          (2) Declaration by secretary concerning 
        countermeasure against smallpox.--
                  (A) Authority to issue declaration.--
                          (i) In general.--The Secretary may 
                        issue a declaration, pursuant to this 
                        paragraph, concluding that an actual or 
                        potential bioterrorist incident or 
                        other actual or potential public health 
                        emergency makes advisable the 
                        administration of a covered 
                        countermeasure to a category or 
                        categories of individuals.
                          (ii) Covered countermeasure.--The 
                        Secretary shall specify in such 
                        declaration the substance or substances 
                        that shall be considered covered 
                        countermeasures (as defined in 
                        paragraph (7)(A)) for purposes of 
                        administration to individuals during 
                        the effective period of the 
                        declaration.
                          (iii) Effective period.--The 
                        Secretary shall specify in such 
                        declaration the beginning and ending 
                        dates of the effective period of the 
                        declaration, and may subsequently amend 
                        such declaration to shorten or extend 
                        such effective period, provided that 
                        the new closing date is after the date 
                        when the declaration is amended.
                          (iv) Publication.--The Secretary 
                        shall promptly publish each such 
                        declaration and amendment in the 
                        Federal Register.
                  (B) Liability of united states only for 
                administrations within scope of declaration.--
                Except as provided in paragraph (5)(B)(ii), the 
                United States shall be liable under this 
                subsection with respect to a claim arising out 
                of the administration of a covered 
                countermeasure to an individual only if--
                          (i) the countermeasure was 
                        administered by a qualified person, for 
                        a purpose stated in paragraph 
                        (7)(A)(i), and during the effective 
                        period of a declaration by the 
                        Secretary under subparagraph (A) with 
                        respect to such countermeasure; and
                          (ii)(I) the individual was within a 
                        category of individuals covered by the 
                        declaration; or
                          (II) the qualified person 
                        administering the countermeasure had 
                        reasonable grounds to believe that such 
                        individual was within such category.
                  (C) Presumption of administration within 
                scope of declaration in case of accidental 
                vaccinia inoculation.--
                          (i) In general.--If vaccinia vaccine 
                        is a covered countermeasure specified 
                        in a declaration under subparagraph 
                        (A), and an individual to whom the 
                        vaccinia vaccine is not administered 
                        contracts vaccinia, then, under the 
                        circumstances specified in clause (ii), 
                        the individual--
                                  (I) shall be rebuttably 
                                presumed to have contracted 
                                vaccinia from an individual to 
                                whom such vaccine was 
                                administered as provided by 
                                clauses (i) and (ii) of 
                                subparagraph (B); and
                                  (II) shall (unless such 
                                presumption is rebutted) be 
                                deemed for purposes of this 
                                subsection to be an individual 
                                to whom a covered 
                                countermeasure was administered 
                                by a qualified person in 
                                accordance with the terms of 
                                such declaration and as 
                                described by subparagraph (B).
                          (ii) Circumstances in which 
                        presumption applies.--The presumption 
                        and deeming stated in clause (i) shall 
                        apply if--
                                  (I) the individual contracts 
                                vaccinia during the effective 
                                period of a declaration under 
                                subparagraph (A) or by the date 
                                30 days after the close of such 
                                period; or
                                  (II) the individual has 
                                resided with, or has had 
                                contact with, an individual to 
                                whom such vaccine was 
                                administered as provided by 
                                clauses (i) and (ii) of 
                                subparagraph (B) and contracts 
                                vaccinia after such date.
                  (D) Acts and omissions deemed to be within 
                scope of employment.--
                          (i) In general.--In the case of a 
                        claim arising out of alleged 
                        transmission of vaccinia from an 
                        individual described in clause (ii), 
                        acts or omissions by such individual 
                        shall be deemed to have been taken 
                        within the scope of such individual's 
                        office or employment for purposes of--
                                  (I) subsection (a); and
                                  (II) section 1346(b) and 
                                chapter 171 of title 28, United 
                                States Code.
                          (ii) Individuals to whom deeming 
                        applies.--An individual is described by 
                        this clause if--
                                  (I) vaccinia vaccine was 
                                administered to such individual 
                                as provided by subparagraph 
                                (B); and
                                  (II) such individual was 
                                within a category of 
                                individuals covered by a 
                                declaration under subparagraph 
                                (A)(i).
          (3) Exhaustion; exclusivity; offset.--
                  (A) Exhaustion.--
                          (i) In general.--A person may not 
                        bring a claim under this subsection 
                        unless such person has exhausted such 
                        remedies as are available under part C 
                        of this title, except that if the 
                        Secretary fails to make a final 
                        determination on a request for benefits 
                        or compensation filed in accordance 
                        with the requirements of such part 
                        within 240 days after such request was 
                        filed, the individual may seek any 
                        remedy that may be available under this 
                        section.
                          (ii) Tolling of statute of 
                        limitations.--The time limit for filing 
                        a claim under this subsection, or for 
                        filing an action based on such claim, 
                        shall be tolled during the pendency of 
                        a request for benefits or compensation 
                        under part C of this title.
                          (iii) Construction.--This subsection 
                        shall not be construed as superseding 
                        or otherwise affecting the application 
                        of a requirement, under chapter 171 of 
                        title 28, United States Code, to 
                        exhaust administrative remedies.
                  (B) Exclusivity.--The remedy provided by 
                subsection (a) shall be exclusive of any other 
                civil action or proceeding for any claim or 
                suit this subsection encompasses, except for a 
                proceeding under part C of this title.
                  (C) Offset.--The value of all compensation 
                and benefits provided under part C of this 
                title for an incident or series of incidents 
                shall be offset against the amount of an award, 
                compromise, or settlement of money damages in a 
                claim or suit under this subsection based on 
                the same incident or series of incidents.
          (4) Certification of action by attorney general.--
        Subsection (c) applies to actions under this 
        subsection, subject to the following provisions:
                  (A) Nature of certification.--The 
                certification by the Attorney General that is 
                the basis for deeming an action or proceeding 
                to be against the United States, and for 
                removing an action or proceeding from a State 
                court, is a certification that the action or 
                proceeding is against a covered person and is 
                based upon a claim alleging personal injury or 
                death arising out of the administration of a 
                covered countermeasure.
                  (B) Certification of attorney general 
                conclusive.--The certification of the Attorney 
                General of the facts specified in subparagraph 
                (A) shall conclusively establish such facts for 
                purposes of jurisdiction pursuant to this 
                subsection.
          (5) Covered person to cooperate with united states.--
                  (A) In general.--A covered person shall 
                cooperate with the United States in the 
                processing and defense of a claim or action 
                under this subsection based upon alleged acts 
                or omissions of such person.
                  (B) Consequences of failure to cooperate.--
                Upon the motion of the United States or any 
                other party and upon finding that such person 
                has failed to so cooperate--
                          (i) the court shall substitute such 
                        person as the party defendant in place 
                        of the United States and, upon motion, 
                        shall remand any such suit to the court 
                        in which it was instituted if it 
                        appears that the court lacks subject 
                        matter jurisdiction;
                          (ii) the United States shall not be 
                        liable based on the acts or omissions 
                        of such person; and
                          (iii) the Attorney General shall not 
                        be obligated to defend such action.
          (6) Recourse against covered person in case of gross 
        misconduct or contract violation.--
                  (A) In general.--Should payment be made by 
                the United States to any claimant bringing a 
                claim under this subsection, either by way of 
                administrative determination, settlement, or 
                court judgment, the United States shall have, 
                notwithstanding any provision of State law, the 
                right to recover for that portion of the 
                damages so awarded or paid, as well as interest 
                and any costs of litigation, resulting from the 
                failure of any covered person to carry out any 
                obligation or responsibility assumed by such 
                person under a contract with the United States 
                or from any grossly negligent, reckless, or 
                illegal conduct or willful misconduct on the 
                part of such person.
                  (B) Venue.--The United States may maintain an 
                action under this paragraph against such person 
                in the district court of the United States in 
                which such person resides or has its principal 
                place of business.
          (7) Definitions.--As used in this subsection, terms 
        have the following meanings:
                  (A) Covered countermeasure.--The term 
                ``covered countermeasure'' or ``covered 
                countermeasure against smallpox'', means a 
                substance that is--
                          (i)(I) used to prevent or treat 
                        smallpox (including the vaccinia or 
                        another vaccine); or
                                  (II) used to control or treat 
                                the adverse effects of vaccinia 
                                inoculation or of 
                                administration of another 
                                covered countermeasure; and
                          (ii) specified in a declaration under 
                        paragraph (2).
                  (B) Covered person.--The term ``covered 
                person'', when used with respect to the 
                administration of a covered countermeasure, 
                means a person who is--
                          (i) a manufacturer or distributor of 
                        such countermeasure;
                          (ii) a health care entity under whose 
                        auspices--
                                  (I) such countermeasure was 
                                administered;
                                  (II) a determination was made 
                                as to whether, or under what 
                                circumstances, an individual 
                                should receive a covered 
                                countermeasure;
                                  (III) the immediate site of 
                                administration on the body of a 
                                covered countermeasure was 
                                monitored, managed, or cared 
                                for; or
                                  (IV) an evaluation was made 
                                of whether the administration 
                                of a countermeasure was 
                                effective;
                          (iii) a qualified person who 
                        administered such countermeasure;
                          (iv) a State, a political subdivision 
                        of a State, or an agency or official of 
                        a State or of such a political 
                        subdivision, if such State, 
                        subdivision, agency, or official has 
                        established requirements, provided 
                        policy guidance, supplied technical or 
                        scientific advice or assistance, or 
                        otherwise supervised or administered a 
                        program with respect to administration 
                        of such countermeasures;
                          (v) in the case of a claim arising 
                        out of alleged transmission of vaccinia 
                        from an individual--
                                  (I) the individual who 
                                allegedly transmitted the 
                                vaccinia, if vaccinia vaccine 
                                was administered to such 
                                individual as provided by 
                                paragraph (2)(B) and such 
                                individual was within a 
                                category of individuals covered 
                                by a declaration under 
                                paragraph (2)(A)(i); or
                                  (II) an entity that employs 
                                an individual described by 
                                clause (I) or where such 
                                individual has privileges or is 
                                otherwise authorized to provide 
                                health care;
                          (vi) an official, agent, or employee 
                        of a person described in clause (i), 
                        (ii), (iii), or (iv);
                          (vii) a contractor of, or a volunteer 
                        working for, a person described in 
                        clause (i), (ii), or (iv), if the 
                        contractor or volunteer performs a 
                        function for which a person described 
                        in clause (i), (ii), or (iv) is a 
                        covered person; or
                          (viii) an individual who has 
                        privileges or is otherwise authorized 
                        to provide health care under the 
                        auspices of an entity described in 
                        clause (ii) or (v)(II).
                  (C) Qualified person.--The term ``qualified 
                person'', when used with respect to the 
                administration of a covered countermeasure, 
                means a licensed health professional or other 
                individual who--
                          (i) is authorized to administer such 
                        countermeasure under the law of the 
                        State in which the countermeasure was 
                        administered; or
                          (ii) is otherwise authorized by the 
                        Secretary to administer such 
                        countermeasure.
                  (D) Arising out of administration of a 
                covered countermeasure.--The term ``arising out 
                of administration of a covered 
                countermeasure'', when used with respect to a 
                claim or liability, includes a claim or 
                liability arising out of--
                          (i) determining whether, or under 
                        what conditions, an individual should 
                        receive a covered countermeasure;
                          (ii) obtaining informed consent of an 
                        individual to the administration of a 
                        covered countermeasure;
                          (iii) monitoring, management, or care 
                        of an immediate site of administration 
                        on the body of a covered 
                        countermeasure, or evaluation of 
                        whether the administration of the 
                        countermeasure has been effective; or
                          (iv) transmission of vaccinia virus 
                        by an individual to whom vaccinia 
                        vaccine was administered as provided by 
                        paragraph (2)(B).
  (q)(1) For purposes of this section, a health professional 
volunteer at an entity described in subsection (g)(4) shall, in 
providing a health professional service eligible for funding 
under section 330 to an individual, be deemed to be an employee 
of the Public Health Service for a calendar year that begins 
during a fiscal year for which a transfer was made under 
paragraph (4)(C). The preceding sentence is subject to the 
provisions of this subsection.
  (2) In providing a health service to an individual, a health 
care practitioner shall for purposes of this subsection be 
considered to be a health professional volunteer at an entity 
described in subsection (g)(4) if the following conditions are 
met:
          (A) The service is provided to the individual at the 
        facilities of an entity described in subsection (g)(4), 
        or through offsite programs or events carried out by 
        the entity.
          (B) The entity is sponsoring the health care 
        practitioner pursuant to paragraph (3)(B).
          (C) The health care practitioner does not receive any 
        compensation for the service from the individual or 
        from any third-party payer (including reimbursement 
        under any insurance policy or health plan, or under any 
        Federal or State health benefits program), except that 
        the health care practitioner may receive repayment from 
        the entity described in subsection (g)(4) for 
        reasonable expenses incurred by the health care 
        practitioner in the provision of the service to the 
        individual.
          (D) Before the service is provided, the health care 
        practitioner or the entity described in subsection 
        (g)(4) posts a clear and conspicuous notice at the site 
        where the service is provided of the extent to which 
        the legal liability of the health care practitioner is 
        limited pursuant to this subsection.
          (E) At the time the service is provided, the health 
        care practitioner is licensed or certified in 
        accordance with applicable law regarding the provision 
        of the service.
  (3) Subsection (g) (other than paragraphs (3) and (5)) and 
subsections (h), (i), and (l) apply to a health care 
practitioner for purposes of this subsection to the same extent 
and in the same manner as such subsections apply to an officer, 
governing board member, employee, or contractor of an entity 
described in subsection (g)(4), subject to paragraph (4) and 
subject to the following:
          (A) The first sentence of paragraph (1) applies in 
        lieu of the first sentence of subsection (g)(1)(A).
          (B) With respect to an entity described in subsection 
        (g)(4), a health care practitioner is not a health 
        professional volunteer at such entity unless the entity 
        sponsors the health care practitioner. For purposes of 
        this subsection, the entity shall be considered to be 
        sponsoring the health care practitioner if--
                  (i) with respect to the health care 
                practitioner, the entity submits to the 
                Secretary an application meeting the 
                requirements of subsection (g)(1)(D); and
                  (ii) the Secretary, pursuant to subsection 
                (g)(1)(E), determines that the health care 
                practitioner is deemed to be an employee of the 
                Public Health Service.
          (C) In the case of a health care practitioner who is 
        determined by the Secretary pursuant to subsection 
        (g)(1)(E) to be a health professional volunteer at such 
        entity, this subsection applies to the health care 
        practitioner (with respect to services performed on 
        behalf of the entity sponsoring the health care 
        practitioner pursuant to subparagraph (B)) for any 
        cause of action arising from an act or omission of the 
        health care practitioner occurring on or after the date 
        on which the Secretary makes such determination.
          (D) Subsection (g)(1)(F) applies to a health care 
        practitioner for purposes of this subsection only to 
        the extent that, in providing health services to an 
        individual, each of the conditions specified in 
        paragraph (2) is met.
  (4)(A) Amounts in the fund established under subsection 
(k)(2) shall be available for transfer under subparagraph (C) 
for purposes of carrying out this subsection.
  (B) Not later May 1 of each fiscal year, the Attorney 
General, in consultation with the Secretary, shall submit to 
the Congress a report providing an estimate of the amount of 
claims (together with related fees and expenses of witnesses) 
that, by reason of the acts or omissions of health professional 
volunteers, will be paid pursuant to this section during the 
calendar year that begins in the following fiscal year. 
Subsection (k)(1)(B) applies to the estimate under the 
preceding sentence regarding health professional volunteers to 
the same extent and in the same manner as such subsection 
applies to the estimate under such subsection regarding 
officers, governing board members, employees, and contractors 
of entities described in subsection (g)(4).
  (C) Not later than December 31 of each fiscal year, the 
Secretary shall transfer from the fund under subsection (k)(2) 
to the appropriate accounts in the Treasury an amount equal to 
the estimate made under subparagraph (B) for the calendar year 
beginning in such fiscal year, subject to the extent of amounts 
in the fund.
  (5)(A) This subsection takes effect on October 1, 2017, 
except as provided in subparagraph (B).
  (B) Effective on the date of the enactment of this 
subsection--
          (i) the Secretary may issue regulations for carrying 
        out this subsection, and the Secretary may accept and 
        consider applications submitted pursuant to paragraph 
        (3)(B); and
          (ii) reports under paragraph (4)(B) may be submitted 
        to the Congress.

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TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *


Part B--Federal-State Cooperation

           *       *       *       *       *       *       *


SEC. 319D. REVITALIZING THE CENTERS FOR DISEASE CONTROL AND PREVENTION.

  (a) Facilities; Capacities.--
          (1) Findings.--Congress finds that the Centers for 
        Disease Control and Prevention has an essential role in 
        defending against and combatting public health threats 
        domestically and abroad and requires secure and modern 
        facilities, and expanded and improved capabilities 
        related to bioterrorism and other public health 
        emergencies, sufficient to enable such Centers to 
        conduct this important mission.
          (2) Facilities.--
                  (A) In general.--The Director of the Centers 
                for Disease Control and Prevention may design, 
                construct, and equip new facilities, renovate 
                existing facilities (including laboratories, 
                laboratory support buildings, scientific 
                communication facilities, transshipment 
                complexes, secured and isolated parking 
                structures, office buildings, and other 
                facilities and infrastructure), and upgrade 
                security of such facilities, in order to better 
                conduct the capacities described in section 
                319A, and for supporting public health 
                activities.
                  (B) Multiyear contracting authority.--For any 
                project of designing, constructing, equipping, 
                or renovating any facility under subparagraph 
                (A), the Director of the Centers for Disease 
                Control and Prevention may enter into a single 
                contract or related contracts that collectively 
                include the full scope of the project, and the 
                solicitation and contract shall contain the 
                clause ``availability of funds'' found at 
                section 52.232-18 of title 48, Code of Federal 
                Regulations.
          (3) Improving the capacities of the centers for 
        disease control and prevention.--The Secretary shall 
        expand, enhance, and improve the capabilities of the 
        Centers for Disease Control and Prevention relating to 
        preparedness for and responding effectively to 
        bioterrorism and other public health emergencies. 
        Activities that may be carried out under the preceding 
        sentence include--
                  (A) expanding or enhancing the training of 
                personnel;
                  (B) improving communications facilities and 
                networks, including delivery of necessary 
                information to rural areas;
                  (C) improving capabilities for public health 
                surveillance and reporting activities, taking 
                into account the integrated system or systems 
                of public health alert communications and 
                surveillance networks under subsection (b); and
                  (D) improving laboratory facilities related 
                to bioterrorism and other public health 
                emergencies, including increasing the security 
                of such facilities.
  (b) National Communications and Surveillance Networks.--
          (1) In general.--The Secretary, directly or through 
        awards of grants, contracts, or cooperative agreements, 
        shall provide for the establishment of an integrated 
        system or systems of public health alert communications 
        and surveillance networks between and among--
                  (A) Federal, State, and local public health 
                officials;
                  (B) public and private health-related 
                laboratories, hospitals, poison control 
                centers, and other health care facilities; and
                  (C) any other entities determined appropriate 
                by the Secretary.
          (2) Requirements.--The Secretary shall ensure that 
        networks under paragraph (1) allow for the timely 
        sharing and discussion, in a secure manner, of 
        essential information concerning bioterrorism or 
        another public health emergency, or recommended methods 
        for responding to such an attack or emergency, allowing 
        for coordination to maximize all-hazards medical and 
        public health preparedness and response and to minimize 
        duplication of effort.
          (3) Standards.--Not later than one year after the 
        date of the enactment of the Public Health Security and 
        Bioterrorism Preparedness and Response Act of 2002, the 
        Secretary, in cooperation with health care providers 
        and State and local public health officials, shall 
        establish any additional technical and reporting 
        standards (including standards for interoperability) 
        for networks under paragraph (1) and update such 
        standards as necessary.
  (c) Modernizing Public Health Situational Awareness and 
Biosurveillance.--
          (1) In general.--Not later than 2 years after the 
        date of enactment of the Pandemic and All-Hazards 
        Preparedness Reauthorization Act of 2013, the 
        Secretary, in collaboration with State, local, and 
        tribal public health officials, shall establish a near 
        real-time electronic nationwide public health 
        situational awareness capability through an 
        interoperable network of systems to share data and 
        information to enhance early detection of rapid 
        response to, and management of, potentially 
        catastrophic infectious disease outbreaks, novel 
        emerging threats, and other public health emergencies 
        that originate domestically or abroad. Such network 
        shall be built on existing State situational awareness 
        systems or enhanced systems that enable such 
        connectivity.
          (2) Strategy and implementation plan.--Not later than 
        180 days after the date of enactment of the Pandemic 
        and All-Hazards Preparedness Reauthorization Act of 
        2013, the Secretary shall submit to the appropriate 
        committees of Congress a coordinated strategy and an 
        accompanying implementation plan that identifies and 
        demonstrates the measurable steps the Secretary will 
        carry out to--
                  (A) develop, implement, and evaluate the 
                network described in paragraph (1), utilizing 
                the elements described in paragraph (3);
                  (B) modernize and enhance biosurveillance 
                activities; and
                  (C) improve information sharing, 
                coordination, and communication among disparate 
                biosurveillance systems supported by the 
                Department of Health and Human Services.
          (3) Elements.--The network described in paragraph (1) 
        shall include data and information transmitted in a 
        standardized format from--
                  (A) State, local, and tribal public health 
                entities, including public health laboratories;
                  (B) Federal health agencies;
                  (C) zoonotic disease monitoring systems;
                  (D) public and private sector health care 
                entities, hospitals, pharmacies, poison control 
                centers or professional organizations in the 
                field of poison control, community health 
                centers, health centers and clinical 
                laboratories, to the extent practicable and 
                provided that such data are voluntarily 
                provided simultaneously to the Secretary and 
                appropriate State, local, and tribal public 
                health agencies; and
                  (E) such other sources as the Secretary may 
                deem appropriate.
          (4) Rule of construction.--Paragraph (3) shall not be 
        construed as requiring separate reporting of data and 
        information from each source listed.
          (5) Required activities.--In establishing and 
        operating the network described in paragraph (1), the 
        Secretary shall--
                  (A) utilize applicable interoperability 
                standards as determined by the Secretary, and 
                in consultation with the Office of the National 
                Coordinator for Health Information Technology, 
                through a joint public and private sector 
                process;
                  (B) define minimal data elements for such 
                network;
                  (C) in collaboration with State, local, and 
                tribal public health officials, integrate and 
                build upon existing State, local, and tribal 
                capabilities, ensuring simultaneous sharing of 
                data, information, and analyses from the 
                network described in paragraph (1) with State, 
                local, and tribal public health agencies; and
                  (D) in collaboration with State, local, and 
                tribal public health officials, develop 
                procedures and standards for the collection, 
                analysis, and interpretation of data that 
                States, regions, or other entities collect and 
                report to the network described in paragraph 
                (1).
          (6) Consultation with the national biodefense science 
        board.--In carrying out this section and consistent 
        with section 319M, the National Biodefense Science 
        Board shall provide expert advice and guidance, 
        including recommendations, regarding the measurable 
        steps the Secretary should take to modernize and 
        enhance biosurveillance activities pursuant to the 
        efforts of the Department of Health and Human Services 
        to ensure comprehensive, real-time, all-hazards 
        biosurveillance capabilities. In complying with the 
        preceding sentence, the National Biodefense Science 
        Board shall--
                  (A) identify the steps necessary to achieve a 
                national biosurveillance system for human 
                health, with international connectivity, where 
                appropriate, that is predicated on State, 
                regional, and community level capabilities and 
                creates a networked system to allow for two-way 
                information flow between and among Federal, 
                State, and local government public health 
                authorities and clinical health care providers;
                  (B) identify any duplicative surveillance 
                programs under the authority of the Secretary, 
                or changes that are necessary to existing 
                programs, in order to enhance and modernize 
                such activities, minimize duplication, 
                strengthen and streamline such activities under 
                the authority of the Secretary, and achieve 
                real-time and appropriate data that relate to 
                disease activity, both human and zoonotic; and
                  (C) coordinate with applicable existing 
                advisory committees of the Director of the 
                Centers for Disease Control and Prevention, 
                including such advisory committees consisting 
                of representatives from State, local, and 
                tribal public health authorities and 
                appropriate public and private sector health 
                care entities and academic institutions, in 
                order to provide guidance on public health 
                surveillance activities.
  (d) State and Regional Systems To Enhance Situational 
Awareness in Public Health Emergencies.--
          (1) In general.--To implement the network described 
        in subsection (c), the Secretary may award grants to 
        States or consortia of States to enhance the ability of 
        such States or consortia of States to establish or 
        operate a coordinated public health situational 
        awareness system for regional or Statewide early 
        detection of, rapid response to, and management of 
        potentially catastrophic infectious disease outbreaks 
        and public health emergencies, in collaboration with 
        appropriate public health agencies, sentinel hospitals, 
        clinical laboratories, pharmacies, poison control 
        centers, other health care organizations, and animal 
        health organizations within such States.
          (2) Eligibility.--To be eligible to receive a grant 
        under paragraph (1), the State or consortium of States 
        shall submit to the Secretary an application at such 
        time, in such manner, and containing such information 
        as the Secretary may require, including an assurance 
        that the State or consortium of States will submit to 
        the Secretary--
                  (A) reports of such data, information, and 
                metrics as the Secretary may require;
                  (B) a report on the effectiveness of the 
                systems funded under the grant; and
                  (C) a description of the manner in which 
                grant funds will be used to enhance the 
                timelines and comprehensiveness of efforts to 
                detect, respond to, and manage potentially 
                catastrophic infectious disease outbreaks and 
                public health emergencies.
          (3) Use of funds.--A State or consortium of States 
        that receives an award under this subsection--
                  (A) shall establish, enhance, or operate a 
                coordinated public health situational awareness 
                system for regional or Statewide early 
                detection of, rapid response to, and management 
                of potentially catastrophic infectious disease 
                outbreaks and public health emergencies;
                  (B) may award grants or contracts to entities 
                described in paragraph (1) within or serving 
                such State to assist such entities in improving 
                the operation of information technology 
                systems, facilitating the secure exchange of 
                data and information, and training personnel to 
                enhance the operation of the system described 
                in subparagraph (A); and
                  (C) may conduct a pilot program for the 
                development of multi-State telehealth network 
                test beds that build on, enhance, and securely 
                link existing State and local telehealth 
                programs to prepare for, monitor, respond to, 
                and manage the events of public health 
                emergencies, facilitate coordination and 
                communication among medical, public health, and 
                emergency response agencies, and provide 
                medical services through telehealth initiatives 
                within the States that are involved in such a 
                multi-State telehealth network test bed.
          (4) Limitation.--Information technology systems 
        acquired or implemented using grants awarded under this 
        section must be compliant with--
                  (A) interoperability and other technological 
                standards, as determined by the Secretary; and
                  (B) data collection and reporting 
                requirements for the network described in 
                subsection (c).
          (5) Independent evaluation.--Not later than 3 years 
        after the date of enactment of the Pandemic and All-
        Hazards Preparedness Reauthorization Act of 2013, the 
        Government Accountability Office shall conduct an 
        independent evaluation, and submit to the Secretary and 
        the appropriate committees of Congress a report 
        concerning the activities conducted under this 
        subsection and subsection (c).
  (e) Telehealth Enhancements for Emergency Response.--
          (1) Evaluation.--The Secretary, in consultation with 
        the Federal Communications Commission and other 
        relevant Federal agencies, shall--
                  (A) conduct an inventory of telehealth 
                initiatives in existence on the date of 
                enactment of the Pandemic and All-Hazards 
                Preparedness Act, including--
                          (i) the specific location of network 
                        components;
                          (ii) the medical, technological, and 
                        communications capabilities of such 
                        components;
                          (iii) the functionality of such 
                        components; and
                          (iv) the capacity and ability of such 
                        components to handle increased volume 
                        during the response to a public health 
                        emergency;
                  (B) identify methods to expand and 
                interconnect the regional health information 
                networks funded by the Secretary, the State and 
                regional broadband networks funded through the 
                rural health care support mechanism pilot 
                program funded by the Federal Communications 
                Commission, and other telehealth networks;
                  (C) evaluate ways to prepare for, monitor, 
                respond rapidly to, or manage the events of, a 
                public health emergency through the enhanced 
                use of telehealth technologies, including 
                mechanisms for payment or reimbursement for use 
                of such technologies and personnel during 
                public health emergencies;
                  (D) identify methods for reducing legal 
                barriers that deter health care professionals 
                from providing telemedicine services, such as 
                by utilizing State emergency health care 
                professional credentialing verification 
                systems, encouraging States to establish and 
                implement mechanisms to improve interstate 
                medical licensure cooperation, facilitating the 
                exchange of information among States regarding 
                investigations and adverse actions, and 
                encouraging States to waive the application of 
                licensing requirements during a public health 
                emergency;
                  (E) evaluate ways to integrate the practice 
                of telemedicine within the National Disaster 
                Medical System; and
                  (F) promote greater coordination among 
                existing Federal interagency telemedicine and 
                health information technology initiatives.
          (2) Report.--Not later than 12 months after the date 
        of enactment of the Pandemic and All-Hazards 
        Preparedness Act, the Secretary shall prepare and 
        submit a report to the Committee on Health, Education, 
        Labor, and Pensions of the Senate and the Committee on 
        Energy and Commerce of the House of Representatives 
        regarding the findings and recommendations pursuant to 
        subparagraphs (A) through (F) of paragraph (1).
  (f) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section, [$138,300,000 for 
each of fiscal years 2014 through 2018] $138,300,000 for each 
of fiscal years 2014 through 2016 and $58,000,000 for each of 
fiscal years 2017 and 2018.
  (g) Definition.--For purposes of this section the term 
``biosurveillance'' means the process of gathering near real-
time biological data that relates to human and zoonotic disease 
activity and threats to human or animal health, in order to 
achieve early warning and identification of such health 
threats, early detection and prompt ongoing tracking of health 
events, and overall situational awareness of disease activity.

           *       *       *       *       *       *       *


                      Part D--Primary Health Care

Subpart I--Health Centers

           *       *       *       *       *       *       *


SEC. 330M. TELEHEALTH CHILD PSYCHIATRY ACCESS GRANTS.

  (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration and in coordination with other relevant Federal 
agencies, shall award grants to States, political subdivisions 
of States, Indian tribes, and tribal organizations (for 
purposes of this section, as such terms are defined in section 
4 of the Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 450b)) to promote behavioral health integration in 
pediatric primary care by--
          (1) supporting the development of statewide child 
        psychiatry access programs; and
          (2) supporting the improvement of existing statewide 
        child psychiatry access programs.
  (b) Program Requirements.--
          (1) In general.--A child psychiatry access program 
        referred to in subsection (a), with respect to which a 
        grant under such subsection may be used, shall--
                  (A) be a statewide network of pediatric 
                mental health teams that provide support to 
                pediatric primary care sites as an integrated 
                team;
                  (B) support and further develop organized 
                State networks of child and adolescent 
                psychiatrists to provide consultative support 
                to pediatric primary care sites;
                  (C) conduct an assessment of critical 
                behavioral consultation needs among pediatric 
                providers and such providers' preferred 
                mechanisms for receiving consultation and 
                training and technical assistance;
                  (D) develop an online database and 
                communication mechanisms, including telehealth, 
                to facilitate consultation support to pediatric 
                practices;
                  (E) provide rapid statewide clinical 
                telephone or telehealth consultations when 
                requested between the pediatric mental health 
                teams and pediatric primary care providers;
                  (F) conduct training and provide technical 
                assistance to pediatric primary care providers 
                to support the early identification, diagnosis, 
                treatment, and referral of children with 
                behavioral health conditions or co-occurring 
                intellectual and other developmental 
                disabilities;
                  (G) inform and assist pediatric providers in 
                accessing child psychiatry consultations and in 
                scheduling and conducting technical assistance;
                  (H) assist with referrals to specialty care 
                and community or behavioral health resources; 
                and
                  (I) establish mechanisms for measuring and 
                monitoring increased access to child and 
                adolescent psychiatric services by pediatric 
                primary care providers and expanded capacity of 
                pediatric primary care providers to identify, 
                treat, and refer children with mental health 
                problems.
          (2) Pediatric mental health teams.--In this 
        subsection, the term ``pediatric mental health team'' 
        means a team of case coordinators, child and adolescent 
        psychiatrists, and licensed clinical mental health 
        professionals, such as a psychologist, social worker, 
        or mental health counselor.
  (c) Application.--A State, political subdivision of a State, 
Indian tribe, or tribal organization seeking a grant under this 
section shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the 
Secretary may require, including a plan for the rigorous 
evaluation of activities that are carried out with funds 
received under such grant.
  (d) Evaluation.--A State, political subdivision of a State, 
Indian tribe, or tribal organization that receives a grant 
under this section shall prepare and submit an evaluation of 
activities carried out with funds received under such grant to 
the Secretary at such time, in such manner, and containing such 
information as the Secretary may reasonably require, including 
a process and outcome evaluation.
  (e) Matching Requirement.--The Secretary may not award a 
grant under this section unless the State, political 
subdivision of a State, Indian tribe, or tribal organization 
involved agrees, with respect to the costs to be incurred by 
the State, political subdivision of a State, Indian tribe, or 
tribal organization in carrying out the purpose described in 
this section, to make available non-Federal contributions (in 
cash or in kind) toward such costs in an amount that is not 
less than 20 percent of Federal funds provided in the grant.
  (f) Authorization of Appropriations.--To carry this section, 
there are authorized to be appropriated $9,000,000 for the 
period of fiscal years 2018 through 2020.

           Subpart II--National Health Service Corps Program

                     national health service corps

  Sec. 331. (a)(1) For the purpose of eliminating health 
manpower shortages in health professional shortage areas, there 
is established, within the Service, the National Health Service 
Corps, which shall consist of--
          (A) such officers of the Regular and Reserve Corps of 
        the Service as the Secretary may designate,
          (B) such civilian employees of the United States as 
        the Secretary may appoint, and
          (C) such other individuals who are not employees of 
        the United States.
  (2) The Corps shall be utilized by the Secretary to provide 
primary health services in health professional shortage areas.
  (3) For purposes of this subpart and subpart III:
          (A) The term ``Corps'' means the National Health 
        Service Corps.
          (B) The term ``Corps member'' means each of the 
        officers, employees, and individuals of which the Corps 
        consists pursuant to paragraph (1).
          (C) The term ``health professional shortage area'' 
        has the meaning given such term in section 332(a).
          (D) The term ``primary health services'' means health 
        services regarding family medicine, internal medicine, 
        pediatrics (including pediatric mental health 
        subspecialty services), obstetrics and gynecology, 
        dentistry, or mental health, that are provided by 
        physicians or other health professionals.
          (E)(i) The term ``behavioral and mental health 
        professionals'' means health service psychologists, 
        licensed clinical social workers, licensed professional 
        counselors, marriage and family therapists, psychiatric 
        nurse specialists, and psychiatrists (and pediatric 
        subspecialists thereof).
          (ii) The term ``graduate program of behavioral and 
        mental health'' means a program that trains behavioral 
        and mental health professionals.
  (b)(1) The Secretary may conduct at schools of medicine, 
osteopathic medicine, dentistry, and, as appropriate, nursing 
and other schools of the health professions, including schools 
at which graduate programs of behavioral and mental health are 
offered, and at entities which train allied health personnel, 
recruiting programs for the Corps, the Scholarship Program, and 
the Loan Repayment Program. Such recruiting programs shall 
include efforts to recruit individuals who will serve in the 
Corps other than pursuant to obligated service under the 
Scholarship or Loan Repayment Program.
  (2) In the case of physicians, dentists, behavioral and 
mental health professionals, certified nurse midwives, 
certified nurse practitioners, and physician assistants who 
have an interest and a commitment to providing primary health 
care, the Secretary may establish fellowship programs to enable 
such health professionals to gain exposure to and expertise in 
the delivery of primary health services in health professional 
shortage areas. To the maximum extent practicable, the 
Secretary shall ensure that any such programs are established 
in conjunction with accredited residency programs, and other 
training programs, regarding such health professions.
  (c)(1) The Secretary may reimburse an applicant for a 
position in the Corps (including an individual considering 
entering into a written agreement pursuant to section 338D) for 
the actual and reasonable expenses incurred in traveling to and 
from the applicant's place of residence to an eligible site to 
which the applicant may be assigned under section 333 for the 
purpose of evaluating such site with regard to being assigned 
at such site. The Secretary may establish a maximum total 
amount that may be paid to an individual as reimbursement for 
such expenses.
  (2) The Secretary may also reimburse the applicant for the 
actual and reasonable expenses incurred for the travel of 1 
family member to accompany the applicant to such site. The 
Secretary may establish a maximum total amount that may be paid 
to an individual as reimbursement for such expenses.
  (3) In the case of an individual who has entered into a 
contract for obligated service under the Scholarship Program or 
under the Loan Repayment Program, the Secretary may reimburse 
such individual for all or part of the actual and reasonable 
expenses incurred in transporting the individual, the 
individual's family, and the family's possessions to the site 
of the individual's assignment under section 333. The Secretary 
may establish a maximum total amount that may be paid to an 
individual as reimbursement for such expenses.
  (d)(1) The Secretary may, under regulations promulgated by 
the Secretary, adjust the monthly pay of each member of the 
Corps (other than a member described in subsection (a)(1)(C)) 
who is directly engaged in the delivery of health services in a 
health professional shortage area as follows:
          (A) During the first 36 months in which such a member 
        is so engaged in the delivery of health services, his 
        monthly pay may be increased by an amount which when 
        added to the member's monthly pay and allowances will 
        provide a monthly income competitive with the average 
        monthly income from a practice of an individual who is 
        a member of the profession of the Corps member, who has 
        equivalent training, and who has been in practice for a 
        period equivalent to the period during which the Corps 
        member has been in practice.
          (B) During the period beginning upon the expiration 
        of the 36 months referred to in subparagraph (A) and 
        ending with the month in which the member's monthly pay 
        and allowances are equal to or exceed the monthly 
        income he received for the last of such 36 months, the 
        member may receive in addition to his monthly pay and 
        allowances an amount which when added to such monthly 
        pay and allowances equals the monthly income he 
        received for such last month.
          (C) For each month in which a member is directly 
        engaged in the delivery of health services in a health 
        professional shortage area in accordance with an 
        agreement with the Secretary entered into under section 
        741(f)(1)(C), under which the Secretary is obligated to 
        make payments in accordance with section 741(f)(2), the 
        amount of any monthly increase under subparagraph (A) 
        or (B) with respect to such member shall be decreased 
        by an amount equal to one-twelfth of the amount which 
        the Secretary is obligated to pay upon the completion 
        of the year of practice in which such month occurs.
For purposes of subparagraphs (A) and (B), the term ``monthly 
pay'' includes special pay received under chapter 5 of title 37 
of the United States Code.
  (2) In the case of a member of the Corps who is directly 
engaged in the delivery of health services in a health 
professional shortage area in accordance with a service 
obligation incurred under the Scholarship Program or the Loan 
Repayment Program, the adjustment in pay authorized by 
paragraph (1) may be made for such a member only upon 
satisfactory completion of such service obligation, and the 
first 36 months of such member's being so engaged in the 
delivery of health services shall, for purposes of paragraph 
(1)(A), be deemed to begin upon such satisfactory completion.
  (3) A member of the Corps described in subparagraph (C) of 
subsection (a)(1) shall when assigned to an entity under 
section 333 be subject to the personnel system of such entity, 
except that such member shall receive during the period of 
assignment the income that the member would receive if the 
member was a member of the Corps described in subparagraph (B) 
of such subsection.
  (e) Corps members assigned under section 333 to provide 
health services in health professional shortage areas shall not 
be counted against any employment ceiling affecting the 
Department.
  (f) Sections 214 and 216 shall not apply to members of the 
National Health Service Corps during their period of obligated 
service under the Scholarship Program or the Loan Repayment 
Program, except when such members are Commissioned Corps 
officers who entered into a contract with Secretary under 
section 338A or 338B after December 31, 2006 and when the 
Secretary determines that exercising the authority provided 
under section 214 or 216 with respect to any such officer to 
would not cause unreasonable disruption to health care services 
provided in the community in which such officer is providing 
health care services.
  (g)(1) The Secretary shall, by rule, prescribe conversion 
provisions applicable to any individual who, within a year 
after completion of service as a member of the Corps described 
in subsection (a)(1)(C), becomes a commissioned officer in the 
Regular or Reserve Corps of the Service.
  (2) The rules prescribed under paragraph (1) shall provide 
that in applying the appropriate provisions of this Act which 
relate to retirement, any individual who becomes such an 
officer shall be entitled to have credit for any period of 
service as a member of the Corps described in subsection 
(a)(1)(C).
  (h) The Secretary shall ensure that adequate staff is 
provided to the Service with respect to effectively 
administering the program for the Corps.
  (i)(1) In carrying out subpart III, the Secretary may, in 
accordance with this subsection, issue waivers to individuals 
who have entered into a contract for obligated service under 
the Scholarship Program or the Loan Repayment Program under 
which the individuals are authorized to satisfy the requirement 
of obligated service through providing clinical practice that 
is half time.
  (2) A waiver described in paragraph (1) may be provided by 
the Secretary only if--
          (A) the entity for which the service is to be 
        performed--
                  (i) has been approved under section 333A for 
                assignment of a Corps member; and
                  (ii) has requested in writing assignment of a 
                health professional who would serve half time;
          (B) the Secretary has determined that assignment of a 
        health professional who would serve half time would be 
        appropriate for the area where the entity is located;
          (C) a Corps member who is required to perform 
        obligated service has agreed in writing to be assigned 
        for half-time service to an entity described in 
        subparagraph (A);
          (D) the entity and the Corps member agree in writing 
        that the Corps member will perform half-time clinical 
        practice;
          (E) the Corps member agrees in writing to fulfill all 
        of the service obligations under section 338C through 
        half-time clinical practice and either--
                  (i) double the period of obligated service 
                that would otherwise be required; or
                  (ii) in the case of contracts entered into 
                under section 338B, accept a minimum service 
                obligation of 2 years with an award amount 
                equal to 50 percent of the amount that would 
                otherwise be payable for full-time service; and
          (F) the Corps member agrees in writing that if the 
        Corps member begins providing half-time service but 
        fails to begin or complete the period of obligated 
        service, the method stated in 338E(c) for determining 
        the damages for breach of the individual's written 
        contract will be used after converting periods of 
        obligated service or of service performed into their 
        full-time equivalents.
  (3) In evaluating waivers issued under paragraph (1), the 
Secretary shall examine the effect of multidisciplinary teams.
  (j) For the purposes of this subpart and subpart III:
          (1) The term ``Department'' means the Department of 
        Health and Human Services.
          (2) The term ``Loan Repayment Program'' means the 
        National Health Service Corps Loan Repayment Program 
        established under section 338B.
          (3) The term ``Scholarship Program'' means the 
        National Health Service Corps Scholarship Program 
        established under section 338A.
          (4) The term ``State'' includes, in addition to the 
        several States, only the District of Columbia, the 
        Commonwealth of Puerto Rico, the Commonwealth of the 
        Northern Mariana Islands, the Virgin Islands, Guam, 
        American Samoa, and the Trust Territory of the Pacific 
        Islands.
          (5) The terms ``full time'' and ``full-time'' mean a 
        minimum of 40 hours per week in a clinical practice, 
        for a minimum of 45 weeks per year.
          (6) The terms ``half time'' and ``half-time'' mean a 
        minimum of 20 hours per week (not to exceed 39 hours 
        per week) in a clinical practice, for a minimum of 45 
        weeks per year.

           *       *       *       *       *       *       *


Subpart III--Scholarship Program and Loan Repayment Program

           *       *       *       *       *       *       *


SEC. 338B. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAM.

  (a) Establishment.--The Secretary shall establish a program 
to be known as the National Health Service Corps Loan Repayment 
Program to assure, with respect to the provision of primary 
health services pursuant to section 331(a)(2)--
          (1) an adequate supply of physicians, dentists, 
        behavioral and mental health professionals, certified 
        nurse midwives, certified nurse practitioners, and 
        physician assistants; and
          (2) if needed by the Corps, an adequate supply of 
        other health professionals.
  (b) Eligibility.--To be eligible to participate in the Loan 
Repayment Program, an individual must--
          (1)(A) have a degree in medicine, osteopathic 
        medicine, dentistry, or another health profession, or 
        an appropriate degree from a graduate program of 
        behavioral and mental health, or be certified as a 
        nurse midwife, nurse practitioner, or physician 
        assistant;
          (B) be enrolled in an approved graduate training 
        program in medicine, osteopathic medicine, dentistry, 
        behavioral and mental health, or other health 
        profession, including any physician child and 
        adolescent psychiatry residency or fellowship training 
        program; or
          (C) be enrolled as a full-time student--
                  (i) in an accredited (as determined by the 
                Secretary) educational institution in a State; 
                and
                  (ii) in the final year of a course of a study 
                or program, offered by such institution and 
                approved by the Secretary, leading to a degree 
                in medicine, osteopathic medicine, dentistry, 
                or other health profession;
          (2) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of 
        the Service or be eligible for selection for civilian 
        service in the Corps; and
          (3) submit to the Secretary an application for a 
        contract described in subsection (f) (relating to the 
        payment by the Secretary of the educational loans of 
        the individual in consideration of the individual 
        serving for a period of obligated service).
  (c) Application, Contract, and Information Requirements.--
          (1) Summary and information.--In disseminating 
        application forms and contract forms to individuals 
        desiring to participate in the Loan Repayment Program, 
        the Secretary shall include with such forms--
                  (A) a fair summary of the rights and 
                liabilities of an individual whose application 
                is approved (and whose contract is accepted) by 
                the Secretary, including in the summary a clear 
                explanation of the damages to which the United 
                States is entitled under section 338E in the 
                case of the individual's breach of the 
                contract; and
                  (B) information respecting meeting a service 
                obligation through private practice under an 
                agreement under section 338D and such other 
                information as may be necessary for the 
                individual to understand the individual's 
                prospective participation in the Loan Repayment 
                Program and service in the Corps.
          (2) Understandability.--The application form, 
        contract form, and all other information furnished by 
        the Secretary under this subpart shall be written in a 
        manner calculated to be understood by the average 
        individual applying to participate in the Loan 
        Repayment Program.
          (3) Availability.--The Secretary shall make such 
        application forms, contract forms, and other 
        information available to individuals desiring to 
        participate in the Loan Repayment Program on a date 
        sufficiently early to ensure that such individuals have 
        adequate time to carefully review and evaluate such 
        forms and information.
          (4) Recruitment and retention.--
                  (A) The Secretary shall distribute to health 
                professions schools materials providing 
                information on the Loan Repayment Program and 
                shall encourage the schools to disseminate the 
                materials to the students of the schools.
                  (B)(i) In the case of any health professional 
                whose period of obligated service under the 
                Loan Repayment Program is nearing completion, 
                the Secretary shall encourage the individual to 
                remain in a health professional shortage area 
                and to continue providing primary health 
                services.
                  (ii) During the period in which a health 
                professional is planning and making the 
                transition to private practice from obligated 
                service under the Loan Repayment Program, the 
                Secretary may provide assistance to the 
                professional regarding such transition if the 
                professional is remaining in a health 
                professional shortage area and is
                continuing to provide primary health services.
                  (C) In the case of entities to which 
                participants in the Loan Repayment Program are 
                assigned under section 333, the Secretary shall 
                encourage the entities to provide options with 
                respect to assisting the participants in 
                remaining in the health professional shortage 
                areas involved, and in continuing to provide 
                primary health services, after the period of 
                obligated service under the Loan Repayment 
                Program is completed. The options with respect 
                to which the Secretary provides such 
                encouragement may include options regarding the 
                sharing of a single employment position in the 
                health professions by 2 or more health 
                professionals, and options regarding the 
                recruitment of couples where both of the 
                individuals are health professionals.
  (d)(1) Subject to section 333A, in providing contracts under 
the Loan Repayment Program--
          (A) the Secretary shall consider the extent of the 
        demonstrated interest of the applicants for the 
        contracts in providing primary health services; and
          (B) may consider such other factors regarding the 
        applicants as the Secretary determines to be relevant 
        to selecting qualified individuals to participate in 
        such Program.
  (2) In providing contracts under the Loan Repayment Program, 
the Secretary shall give priority--
          (A) to any application for such a contract submitted 
        by an individual whose training is in a health 
        profession or specialty determined by the Secretary to 
        be needed by the Corps;
          (B) to any application for such a contract submitted 
        by an individual who has (and whose spouse, if any, 
        has) characteristics that increase the probability that 
        the individual will continue to serve in a health 
        professional shortage area after the period of 
        obligated service pursuant to subsection (f) is 
        completed; and
          (C) subject to subparagraph (B), to any application 
        for such a contract submitted by an individual who is 
        from a disadvantaged background.
  (e) Approval Required for Participation.--An individual 
becomes a participant in the Loan Repayment Program only upon 
the Secretary and the individual entering into a written 
contract described in subsection (f).
  (f) Contents of Contracts.--The written contract (referred to 
in this subpart) between the Secretary and an individual shall 
contain--
          (1) an agreement that--
                  (A) subject to paragraph (3), the Secretary 
                agrees--
                          (i) to pay on behalf of the 
                        individual loans in accordance with 
                        subsection (g); and
                          (ii) to accept (subject to the 
                        availability of appropriated funds for 
                        carrying out sections 331 through 335 
                        and section 337) the individual into 
                        the Corps (or for equivalent service as 
                        otherwise provided in this subpart); 
                        and
                  (B) subject to paragraph (3), the individual 
                agrees--
                          (i) to accept loan payments on behalf 
                        of the individual;
                          (ii) in the case of an individual 
                        described in subsection (b)(1)(C), to 
                        maintain enrollment in a course of 
                        study or training described in such 
                        subsection until the individual 
                        completes the course of study or 
                        training;
                          (iii) in the case of an individual 
                        described in subsection (b)(1)(C), 
                        while enrolled in such course of study 
                        or training, to maintain an acceptable 
                        level of academic standing (as 
                        determined under regulations of the 
                        Secretary by the educational 
                        institution offering such course of 
                        study or training); and
                          (iv) to serve for a time period 
                        (hereinafter in this subpart referred 
                        to as the ``period of obligated 
                        service'') equal to 2 years or such 
                        longer period as the individual may 
                        agree to, as a provider of primary 
                        health services in a health 
                        professional shortage area (designated 
                        under section 332) to which such 
                        individual is assigned by the Secretary 
                        as a member of the Corps or released 
                        under section 338D;
          (2) a provision permitting the Secretary to extend 
        for such longer additional periods, as the individual 
        may agree to, the period of obligated service agreed to 
        by the individual under paragraph (1)(B)(iv), including 
        extensions resulting in an aggregate period of 
        obligated service in excess of 4 years;
          (3) a provision that any financial obligation of the 
        United States arising out of a contract entered into 
        under this subpart and any obligation of the individual 
        that is conditioned thereon, is contingent on funds 
        being appropriated for loan repayments under this 
        subpart and to carry out the purposes of sections 331 
        through 335 and sections 337 and 338;
          (4) a statement of the damages to which the United 
        States is entitled, under section 338E for the 
        individual's breach of the contract; and
          (5) such other statements of the rights and 
        liabilities of the Secretary and of the individual, not 
        inconsistent with this subpart.
  (g) Payments.--
          (1) In general.--A loan repayment provided for an 
        individual under a written contract under the Loan 
        Repayment Program shall consist of payment, in 
        accordance with paragraph (2), on behalf of the 
        individual of the principal, interest, and related 
        expenses on government and commercial loans received by 
        the individual regarding the undergraduate or graduate 
        education of the individual (or both), which loans were 
        made for--
                  (A) tuition expenses;
                  (B) all other reasonable educational 
                expenses, including fees, books, and laboratory 
                expenses, incurred by the individual; or
                  (C) reasonable living expenses as determined 
                by the Secretary.
          (2) Payments for years served.--
                  (A) In general.--For each year of obligated 
                service that an individual contracts to serve 
                under subsection (f) the Secretary may pay up 
                to $50,000, plus, beginning with fiscal year 
                2012, an amount determined by the Secretary on 
                an annual basis to reflect inflation, on behalf 
                of the individual for loans described in 
                paragraph (1). In making a determination of the 
                amount to pay for a year of such service by an 
                individual, the Secretary shall consider the 
                extent to which each such determination--
                          (i) affects the ability of the 
                        Secretary to maximize the number of 
                        contracts that can be provided under 
                        the Loan Repayment Program from the 
                        amounts appropriated for such 
                        contracts;
                          (ii) provides an incentive to serve 
                        in health professional shortage areas 
                        with the greatest such shortages; and
                          (iii) provides an incentive with 
                        respect to the health professional 
                        involved remaining in a health 
                        professional shortage area, and 
                        continuing to provide primary health 
                        services, after the completion of the 
                        period of obligated service under the 
                        Loan Repayment Program.
                  (B) Repayment schedule.--Any arrangement made 
                by the Secretary for the making of loan 
                repayments in accordance with this subsection 
                shall provide that any repayments for a year of 
                obligated service shall be made no later than 
                the end of the fiscal year in which the 
                individual completes such year of service.
          (3) Tax liability.--For the purpose of providing 
        reimbursements for tax liability resulting from 
        payments under paragraph (2) on behalf of an 
        individual--
                  (A) the Secretary shall, in addition to such 
                payments, make payments to the individual in an 
                amount equal to 39 percent of the total amount 
                of loan repayments made for the taxable year 
                involved; and
                  (B) may make such additional payments as the 
                Secretary determines to be appropriate with 
                respect to such purpose.
          (4) Payment schedule.--The Secretary may enter into 
        an agreement with the holder of any loan for which 
        payments are made under the Loan Repayment Program to 
        establish a schedule for the making of such payments.
  (h) Employment Ceiling.--Notwithstanding any other provision 
of law, individuals who have entered into written contracts 
with the Secretary under this section, while undergoing 
academic or other training, shall not be counted against any 
employment ceiling affecting the Department.

           *       *       *       *       *       *       *


PART Q--PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN

           *       *       *       *       *       *       *


SEC. 399Z-2. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION, 
                    INTERVENTION, AND TREATMENT.

  (a) Grants.--The Secretary shall--
          (1) award grants to eligible entities, including 
        human services agencies, to develop, maintain, or 
        enhance infant and early childhood mental health 
        promotion, intervention, and treatment programs, 
        including--
                  (A) programs for infants and children at 
                significant risk of developing, showing early 
                signs of, or having been diagnosed with mental 
                disorders including serious emotional 
                disturbance; and
                  (B) multigenerational therapy and other 
                services that support the caregiving 
                relationship; and
          (2) ensure that programs funded through grants under 
        this section are evidence-informed or evidence-based 
        models, practices, and methods that are, as 
        appropriate, culturally and linguistically appropriate, 
        and can be replicated in other appropriate settings.
  (b) Eligible Children and Entities.--In this section:
          (1) Eligible child.--The term ``eligible child'' 
        means a child from birth to not more than 5 years of 
        age who--
                  (A) is at risk for, shows early signs of, or 
                has been diagnosed with a mental disorder, 
                including serious emotional disturbance; and
                  (B) may benefit from infant and early 
                childhood intervention or treatment programs or 
                specialized preschool or elementary school 
                programs that are evidence-based or that have 
                been scientifically demonstrated to show 
                promise but would benefit from further applied 
                development.
          (2) Eligible entity.--The term ``eligible entity'' 
        means a nonprofit institution that--
                  (A) is accredited or approved by a State 
                mental health or education agency, as 
                applicable, to provide for children from 
                infancy to 5 years of age mental health 
                promotion, intervention, or treatment services 
                that are evidence-based or that have been 
                scientifically demonstrated to show promise but 
                would benefit from further applied development; 
                and
                  (B) provides programs described in subsection 
                (a) that are evidence-based or that have been 
                scientifically demonstrated to show promise but 
                would benefit from further applied development.
  (c) Application.--An eligible entity seeking a grant under 
subsection (a) shall submit to the Secretary an application at 
such time, in such manner, and containing such information as 
the Secretary may require.
  (d) Use of Funds for Early Intervention and Treatment 
Programs.--An eligible entity may use amounts awarded under a 
grant under subsection (a)(1) to carry out the following:
          (1) Provide age-appropriate mental health promotion 
        and early intervention services or mental disorder 
        treatment services, which may include specialized 
        programs, for eligible children at significant risk of 
        developing, showing early signs of, or having been 
        diagnosed with a mental disorder, including serious 
        emotional disturbance. Such services may include social 
        and behavioral services as well as multigenerational 
        therapy and other services ?that support the caregiving 
        relationship.
          (2) Provide training for health care professionals 
        with expertise in infant and early childhood mental 
        health care with respect to appropriate and relevant 
        integration with other disciplines such as primary care 
        clinicians, early intervention specialists, child 
        welfare staff, home visitors, early care and education 
        providers, and others who work with young children and 
        families.
          (3) Provide mental health consultation to personnel 
        of early care and education programs (including 
        licensed or regulated center-based and home-based child 
        care, home visiting, preschool special education, and 
        early intervention programs) who work with children and 
        families.
          (4) Provide training for mental health clinicians in 
        infant and early childhood promising and evidence-based 
        practices and models for mental health treatment and 
        early intervention, including with regard to practices 
        for identifying and treating mental and behavioral 
        disorders of infants and children resulting from 
        exposure or repeated exposure to adverse childhood 
        experiences or childhood trauma.
          (5) Provide age-appropriate assessment, diagnostic, 
        and intervention services for eligible children, 
        including early mental health promotion, intervention, 
        and treatment services.
  (e) Matching Funds.--The Secretary may not award a grant 
under this section to an eligible entity unless the eligible 
entity agrees, with respect to the costs to be incurred by the 
eligible entity in carrying out the activities described in 
subsection (d), to make available non-Federal contributions (in 
cash or in kind) toward such costs in an amount that is not 
less than 10 percent of the total amount of Federal funds 
provided in the grant.
  (f) Authorization of Appropriations.--To carry this section, 
there are authorized to be appropriated $20,000,000 for the 
period of fiscal years 2018 through 2022.

           *       *       *       *       *       *       *


   TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

              Part A--Organization and General Authorities

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

  (a) Establishment.--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.
          (4) The Center for Behavioral Health Statistics and 
        Quality.
  [(c) Administrator and Deputy Administrator.--
          [(1) Administrator.--The Administration shall be 
        headed by an 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 and employees, including 
        attorneys, as are necessary to administer the 
        activities to be carried out through the 
        Administration.]
  (c) Assistant Secretary and Deputy Assistant Secretary.--
          (1) Assistant secretary.--
                  (A) Appointment.--The Administration shall be 
                headed by an official to be known as the 
                Assistant Secretary for Mental Health and 
                Substance Use (hereinafter in this title 
                referred to as the ``Assistant Secretary'') who 
                shall be appointed by the President, by and 
                with the advice and consent of the Senate.
                  (B) Qualifications.--In selecting the 
                Assistant Secretary, the President shall give 
                preference to individuals who have--
                          (i) a doctoral degree in medicine, 
                        osteopathic medicine, or psychology;
                          (ii) clinical and research experience 
                        regarding mental health and substance 
                        use disorders; and
                          (iii) an understanding of biological, 
                        psychosocial, and pharmaceutical 
                        treatments of mental illness and 
                        substance use disorders.
          (2) Deputy assistant secretary.--The Assistant 
        Secretary, with the approval of the Secretary, may 
        appoint a Deputy Assistant Secretary and may employ and 
        prescribe the functions of such officers and employees, 
        including attorneys, as are necessary to administer the 
        activities to be carried out through the 
        Administration.
  (d) Authorities.--The Secretary, acting through the 
[Administrator] Assistant Secretary, shall--
          (1) supervise the functions of the agencies of the 
        Administration in order to assure that the programs 
        carried 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) establish 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 
        individuals with mental illnesses and individuals who 
        are substance abusers;
          (3) carry out the administrative and financial 
        management, policy development and planning, 
        evaluation, knowledge dissemination, 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 assessments 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 treatment, prevention and related 
        services, including the development 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 tuberculosis 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-addiction medications, including 
        methadone;
          (8) conduct programs, and assure the coordination of 
        such programs with activities of the National 
        Institutes of Health and the Agency for Health Care 
        Policy 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 manner in which such services can most 
        effectively be provided;
          (9) collaborate with the Director of the National 
        Institutes of Health in the development of a system by 
        which the relevant 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 manner 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 evaluations; 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 application; and
                          (ii) is afforded an opportunity to 
                        comment on the merits of the 
                        application;
          (14) assure that services provided with amounts 
        appropriated under this title are provided bilingually, 
        if appropriate;
          (15) improve coordination among prevention programs, 
        treatment facilities and nonhealth care systems such as 
        employers, labor unions, and schools, and encourage the 
        adoption of employee assistance programs and student 
        assistance programs;
          (16) maintain a clearinghouse for substance abuse and 
        mental 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 Alcoholism and the National Institute of Mental 
        Health, as appropriate, promote 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 suffering from mental illness 
        or substance abuse, including liaisons with the Social 
        Security Administration, Centers for Medicare & 
        Medicaid Services, and other programs of the 
        Department, as well as liaisons with the Department of 
        Education, Department of Justice, and other Federal 
        Departments and offices, as appropriate[.];
          (19) evaluate, in consultation with the Assistant 
        Secretary for Financial Resources, the information used 
        for oversight of grants under programs related to 
        mental and substance use disorders, including co-
        occurring disorders, administered by the Center for 
        Mental Health Services;
          (20) periodically review Federal programs and 
        activities relating to the diagnosis or prevention of, 
        or treatment or rehabilitation for, mental illness and 
        substance use disorders to identify any such programs 
        or activities that have proven to be effective or 
        efficient in improving outcomes or increasing access to 
        evidence-based programs;
          (21) establish standards for the appointment of peer-
        review panels to evaluate grant applications and 
        recommend standards for mental health grant programs; 
        and
          (22) in consultation with the National Mental Health 
        and Substance Use Policy Laboratory, and after 
        providing an opportunity for public input, set 
        standards for grant programs under this title for 
        mental health and substance use services, which may 
        address--
                  (A) the capacity of the grantee to implement 
                the award;
                  (B) requirements for the description of the 
                program implementation approach;
                  (C) the extent to which the grant plan 
                submitted by the grantee as part of its 
                application must explain how the grantee will 
                reach the population of focus and provide a 
                statement of need, including to what extent the 
                grantee will increase the number of clients 
                served and the estimated percentage of clients 
                receiving services who report positive 
                functioning after 6 months or no past-month 
                substance use, as applicable;
                  (D) the extent to which the grantee must 
                collect and report on required performance 
                measures; and
                  (E) the extent to which the grantee is 
                proposing evidence-based practices and the 
                extent to which--
                          (i) those evidence-based practices 
                        must be used with respect to a 
                        population similar to the population 
                        for which the evidence-based practices 
                        were shown to be effective; or
                          (ii) if no evidence-based practice 
                        exists for a population of focus, the 
                        way in which the grantee will implement 
                        adaptations of evidence-based 
                        practices, promising practices, or 
                        cultural practices.
  (e) Associate Administrator for Alcohol Prevention and 
Treatment Policy.--
          (1) In general.--There may be in the Administration 
        an Associate Administrator for Alcohol Prevention and 
        Treatment Policy to whom the [Administrator] Assistant 
        Secretary may delegate the functions of promoting, 
        monitoring, and evaluating service programs for the 
        prevention and treatment of alcoholism and alcohol 
        abuse within the Center for Substance Abuse Prevention, 
        the Center for Substance Abuse Treatment and the Center 
        for Mental Health Services, and coordinating such 
        programs among the Centers, and among the Centers and 
        other public and private entities. The Associate 
        Administrator also may ensure that alcohol prevention, 
        education, and policy strategies are integrated into 
        all programs of the Centers that address substance 
        abuse prevention, education, and policy, and that the 
        Center for Substance Abuse Prevention addresses the 
        Healthy People 2010 goals and the National Dietary 
        Guidelines of the Department of Health and Human 
        Services and the Department of Agriculture related to 
        alcohol consumption.
          (2) Plan.--
                  (A) The [Administrator] Assistant Secretary, 
                acting through the Associate Administrator for 
                Alcohol Prevention and 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 
                Directors of the Centers of the Administration 
                and in consultation with members of other 
                Federal agencies and public and private 
                entities.
                  (B) Not later than 1 year after the date of 
                the enactment of the ADAMHA Reorganization Act, 
                the [Administrator] Assistant Secretary shall 
                submit to the Congress the first plan developed 
                under subparagraph (A).
          (3) Report.--
                  (A) Not less than once during each 2 years, 
                the [Administrator] Assistant Secretary, acting 
                through the Associate Administrator for Alcohol 
                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 statement of the expenditures made for 
                the activities reported on and the personnel 
                used in connection with such activities.
                  (B) Each report under subparagraph (A) shall 
                include a description of any revisions in the 
                plan under paragraph (2) made during the 
                preceding 2 years.
                  (C) Each report under subparagraph (A) shall 
                be submitted to the [Administrator] Assistant 
                Secretary for inclusion in the biennial report 
                under subsection (k).
  (f) Associate Administrator for Women's Services.--
          (1) Appointment.--The [Administrator] Assistant 
        Secretary, with the approval of the Secretary, shall 
        appoint an Associate Administrator for Women's Services 
        who shall report directly to the [Administrator] 
        Assistant Secretary.
          (2) Duties.--The Associate Administrator appointed 
        under paragraph (1) shall--
                  (A) establish a committee to be known as the 
                Coordinating Committee for Women's Services 
                (hereafter in this subparagraph 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 services;
                          (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, African-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 
                [Administrator] Assistant Secretary from among 
                physicians, practitioners, treatment providers, 
                and other health professionals, whose clinical 
                practice, specialization, or professional 
                expertise includes a significant focus on 
                women's substance abuse and mental health 
                conditions, that shall--
                          (i) advise the Associate 
                        Administrator on appropriate 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] Assistant Secretary 
                        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 
                        Administration; 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
                                  (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 by--
                          (i) reviewing the current data at the 
                        Administration to determine its 
                        uniformity and applicability;
                          (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] Assistant Secretary a 
                        plan for incorporating the standards 
                        developed under clause (ii) in all 
                        Administration programs and a plan to 
                        assure that the data so collected are 
                        accessible to health professionals, 
                        providers, researchers, and members of 
                        the public; and
                  (E) shall establish, 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 Secretary 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 enactment of the ADAMHA Reorganization Act, 
                the Assistant Secretary for Personnel shall 
                provide the Advisory Committee 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, the Assistant Secretary shall 
                prepare and submit directly to the Advisory 
                Committee a report concerning the results of 
                the study conducted under subparagraph (A).
                  (C) The Secretary shall prepare and provide 
                to the Advisory Committee for Women's Services 
                any additional data as requested.
          (4) Office.--Nothing in this subsection shall be 
        construed to preclude the Secretary from establishing 
        within the Substance Abuse and Mental Health 
        Administration an Office of Women's Health.
          (5) Definition.--For purposes of this subsection, the 
        term ``women'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 
                insufficient data.
  (g) Services of Experts.--
          (1) In general.--The [Administrator] Assistant 
        Secretary may obtain (in accordance with section 3109 
        of title 5, United States Code, but without regard to 
        the limitation in such section on the number of days 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 Administration 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 from their assignment 
                location in accordance with sections 5724, 
                5724a(a), 5724a(c), 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 from the expert 
                or consultant as a debt of the United States. 
                The Secretary may waive in whole or in part a 
                right of recovery under this subparagraph.
  (h) Peer Review Groups.--The [Administrator] Assistant 
Secretary 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 additional 
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] Assistant 
Secretary may accept voluntary and uncompensated services.
  (j) Administration.--The [Administrator] Assistant Secretary 
shall ensure that programs 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] Assistant Secretary shall prepare and submit to 
the Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human 
Resources of the Senate, the report containing--
          (1) a description of the activities carried out by 
        the Administration;
          (2) a description of any measurable progress made in 
        improving 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 subsection.
  (l) Strategic Plan.--
          (1) In general.--Not later than December 1, 2017, and 
        every 5 years thereafter, the Assistant Secretary shall 
        develop and carry out a strategic plan in accordance 
        with this subsection for the planning and operation of 
        evidence-based programs and grants carried out by the 
        Administration.
          (2) Coordination.--In developing and carrying out the 
        strategic plan under this section, the Assistant 
        Secretary shall take into consideration the report of 
        the Interdepartmental Serious Mental Illness 
        Coordinating Committee under section 301 of the Helping 
        Families in Mental Health Crisis Act of 2016.
          (3) Publication of plan.--Not later than December 1, 
        2017, and every 5 years thereafter, the Assistant 
        Secretary shall--
                  (A) submit the strategic plan developed under 
                paragraph (1) to the appropriate committees of 
                Congress; and
                  (B) post such plan on the Internet website of 
                the Administration.
          (4) Contents.--The strategic plan developed under 
        paragraph (1) shall--
                  (A) identify strategic priorities, goals, and 
                measurable objectives for mental and substance 
                use disorder activities and programs operated 
                and supported by the Administration, including 
                priorities to prevent or eliminate the burden 
                of mental illness and substance use disorders;
                  (B) identify ways to improve services for 
                individuals with a mental or substance use 
                disorder, including services related to the 
                prevention of, diagnosis of, intervention in, 
                treatment of, and recovery from, mental or 
                substance use disorders, including serious 
                mental illness or serious emotional 
                disturbance, and access to services and 
                supports for individuals with a serious mental 
                illness or serious emotional disturbance;
                  (C) ensure that programs provide, as 
                appropriate, access to effective and evidence-
                based prevention, diagnosis, intervention, 
                treatment, and recovery services, including 
                culturally and linguistically appropriate 
                services, as appropriate, for individuals with 
                a mental or substance use disorder;
                  (D) identify opportunities to collaborate 
                with the Health Resources and Services 
                Administration to develop or improve--
                          (i) initiatives to encourage 
                        individuals to pursue careers 
                        (especially in rural and underserved 
                        areas and populations) as 
                        psychiatrists, psychologists, 
                        psychiatric nurse practitioners, 
                        physician assistants, occupational 
                        therapists, clinical social workers, 
                        certified peer support specialists, 
                        licensed professional counselors, or 
                        other licensed or certified mental 
                        health professionals, including such 
                        professionals specializing in the 
                        diagnosis, evaluation, or treatment of 
                        individuals with a serious mental 
                        illness or serious emotional 
                        disturbance; and
                          (ii) a strategy to improve the 
                        recruitment, training, and retention of 
                        a workforce for the treatment of 
                        individuals with mental or substance 
                        use disorders, or co-occurring 
                        disorders;
                  (E) identify opportunities to improve 
                collaboration with States, local governments, 
                communities, and Indian tribes and tribal 
                organizations (as such terms are defined in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 450b)); and
                  (F) specify a strategy to disseminate 
                evidenced-based and promising best practices 
                related to prevention, diagnosis, early 
                intervention, treatment, and recovery services 
                related to mental illness, particularly for 
                individuals with a serious mental illness and 
                children and adolescents with a serious 
                emotional disturbance, and substance use 
                disorders.
  [(l)] (m) Applications for Grants and Contracts.--With 
respect to awards of grants, cooperative agreements, and 
contracts under this title, the [Administrator] Assistant 
Secretary, or the Director of the Center involved, as the case 
may be, may not make such an award unless--
          (1) an application for the award is submitted to the 
        official involved;
          (2) with respect to carrying 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, and information as the official determines 
        to be necessary to carry out the purpose for which the 
        award is to be provided.
  [(m)] (n) Emergency Response.--
          (1) In general.--Notwithstanding section 504 and 
        except as provided in paragraph (2), the Secretary may 
        use not to exceed 2.5 percent of all amounts 
        appropriated under this title for a fiscal year to make 
        noncompetitive grants, contracts or cooperative 
        agreements to public entities to enable such entities 
        to address emergency substance abuse or mental health 
        needs in local communities.
          (2) Exceptions.--Amounts appropriated under part C 
        shall not be subject to paragraph (1).
          (3) Emergencies.--The Secretary shall establish 
        criteria for determining that a substance abuse or 
        mental health emergency exists and publish such 
        criteria in the Federal Register prior to providing 
        funds under this subsection.
  [(n)] (o) Limitation on the Use of Certain Information.--No 
information, if an establishment or person supplying the 
information or described in it is identifiable, obtained in the 
course of activities undertaken or supported under section 505 
may be used for any purpose other than the purpose for which it 
was supplied unless such establishment or person has consented 
(as determined under regulations of the Secretary) to its use 
for such other purpose. Such information may not be published 
or released in other form if the person who supplied the 
information or who is described in it is identifiable unless 
such person has consented (as determined under regulations of 
the Secretary) to its publication or release in other form.
  [(o)] (p) Authorization of Appropriations.--For the purpose 
of providing grants, cooperative agreements, and contracts 
under this section, there are authorized to be appropriated 
$25,000,000 for fiscal year 2001, and such sums as may be 
necessary for each of the fiscal years 2002 and 2003.

SEC. 501A. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE USE 
                    PROGRAMS.

  (a) Activities.--For the purpose of ensuring efficient and 
effective planning and evaluation of mental and substance use 
disorder programs and related activities, the Assistant 
Secretary for Planning and Evaluation, in consultation with the 
Assistant Secretary for Mental Health and Substance Use, 
shall--
          (1) collect and organize relevant data on 
        homelessness, involvement with the criminal justice 
        system, hospitalizations, mortality outcomes, and other 
        measures the Secretary deems appropriate from across 
        Federal departments and agencies;
          (2) evaluate programs related to mental and substance 
        use disorders, including co-occurring disorders, across 
        Federal departments and agencies, as appropriate, 
        including programs related to--
                  (A) prevention, intervention, treatment, and 
                recovery support services, including such 
                services for individuals with a serious mental 
                illness or serious emotional disturbance;
                  (B) the reduction of homelessness and 
                involvement with the criminal justice system 
                among individuals with a mental or substance 
                use disorder; and
                  (C) public health and health services; and
          (3) consult, as appropriate, with the Assistant 
        Secretary, the Behavioral Health Coordinating Council 
        of the Department of Health and Human Services, other 
        agencies within the Department of Health and Human 
        Services, and other relevant Federal departments.
  (b) Recommendations.--The Assistant Secretary for Planning 
and Evaluation shall develop an evaluation strategy that 
identifies priority programs to be evaluated by the Assistant 
Secretary and priority programs to be evaluated by other 
relevant agencies within the Department of Health and Human 
Services. The Assistant Secretary for Planning and Evaluation 
shall provide recommendations on improving programs and 
activities based on the evaluation described in subsection 
(a)(2) as needing improvement.

SEC. 501B. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY LABORATORY.

  (a) In General.--There shall be established within the 
Administration a National Mental Health and Substance Use 
Policy Laboratory (referred to in this section as the 
``Laboratory'').
  (b) Responsibilities.--The Laboratory shall--
          (1) continue to carry out the authorities and 
        activities that were in effect for the Office of 
        Policy, Planning, and Innovation as such Office existed 
        prior to the date of enactment of the Helping Families 
        in Mental Health Crisis Act of 2016;
          (2) identify, coordinate, and facilitate the 
        implementation of policy changes likely to have a 
        significant effect on mental health, mental illness, 
        and the prevention and treatment of substance use 
        disorder services;
          (3) collect, as appropriate, information from 
        grantees under programs operated by the Administration 
        in order to evaluate and disseminate information on 
        evidence-based practices, including culturally and 
        linguistically appropriate services, as appropriate, 
        and service delivery models;
          (4) provide leadership in identifying and 
        coordinating policies and programs, including evidence-
        based programs, related to mental and substance use 
        disorders;
          (5) recommend ways in which payers may implement 
        program and policy findings of the Administration and 
        the Laboratory to improve outcomes and reduce per 
        capita program costs;
          (6) in consultation with the Assistant Secretary for 
        Planning and Evaluation, as appropriate, periodically 
        review Federal programs and activities relating to the 
        diagnosis or prevention of, or treatment or 
        rehabilitation for, mental illness and substance use 
        disorders, including by--
                  (A) identifying any such programs or 
                activities that are duplicative;
                  (B) identifying any such programs or 
                activities that are not evidence-based, 
                effective, or efficient; and
                  (C) formulating recommendations for 
                coordinating, eliminating, or improving 
                programs or activities identified under 
                subparagraph (A) or (B) and merging such 
                programs or activities into other successful 
                programs or activities; and
          (7) carry out other activities as deemed necessary to 
        continue to encourage innovation and disseminate 
        evidence-based programs and practices, including 
        programs and practices with scientific merit.
  (c) Evidence-Based Practices and Service Delivery Models.--
          (1) In general.--In selecting evidence-based best 
        practices and service delivery models for evaluation 
        and dissemination, the Laboratory--
                  (A) shall give preference to models that 
                improve--
                          (i) the coordination between mental 
                        health and physical health providers;
                          (ii) the coordination among such 
                        providers and the justice and 
                        corrections system; and
                          (iii) the cost effectiveness, 
                        quality, effectiveness, and efficiency 
                        of health care services furnished to 
                        individuals with serious mental illness 
                        or serious emotional disturbance, in 
                        mental health crisis, or at risk to 
                        themselves, their families, and the 
                        general public; and
                  (B) may include clinical protocols and 
                practices used in the Recovery After Initial 
                Schizophrenia Episode (RAISE) project and the 
                North American Prodrome Longitudinal Study 
                (NAPLS) of the National Institute of Mental 
                Health.
          (2) Deadline for beginning implementation.--The 
        Laboratory shall begin implementation of the duties 
        described in this subsection not later than January 1, 
        2018.
          (3) Consultation.--In carrying out the duties under 
        this subsection, the Laboratory shall consult with--
                  (A) representatives of the National Institute 
                of Mental Health, the National Institute on 
                Drug Abuse, and the National Institute on 
                Alcohol Abuse and Alcoholism, on an ongoing 
                basis;
                  (B) other appropriate Federal agencies;
                  (C) clinical and analytical experts with 
                expertise in psychiatric medical care and 
                clinical psychological care, health care 
                management, education, corrections health care, 
                and mental health court systems, as 
                appropriate; and
                  (D) other individuals and agencies as 
                determined appropriate by the Assistant 
                Secretary.
   (d) Promoting Innovation.--
          (1) In general.--The Assistant Secretary, in 
        coordination with the Laboratory, may award grants to 
        States, local governments, Indian tribes or tribal 
        organizations (as such terms are defined in section 4 
        of the Indian Self-Determination and Education 
        Assistance Act), educational institutions, and 
        nonprofit organizations to develop evidence-based 
        interventions, including culturally and linguistically 
        appropriate services, as appropriate, for--
                  (A) evaluating a model that has been 
                scientifically demonstrated to show promise, 
                but would benefit from further applied 
                development, for--
                          (i) enhancing the prevention, 
                        diagnosis, intervention, treatment, and 
                        recovery of mental illness, serious 
                        emotional disturbance, substance use 
                        disorders, and co-occurring disorders; 
                        or
                          (ii) integrating or coordinating 
                        physical health services and mental and 
                        substance use disorder services; and
                  (B) expanding, replicating, or scaling 
                evidence-based programs across a wider area to 
                enhance effective screening, early diagnosis, 
                intervention, and treatment with respect to 
                mental illness, serious mental illness, and 
                serious emotional disturbance, primarily by--
                          (i) applying delivery of care, 
                        including training staff in effective 
                        evidence-based treatment; or
                          (ii) integrating models of care 
                        across specialties and jurisdictions.
          (2) Consultation.--In awarding grants under this 
        paragraph, the Assistant Secretary shall, as 
        appropriate, consult with the advisory councils 
        described in section 502, the National Institute of 
        Mental Health, the National Institute on Drug Abuse, 
        and the National Institute on Alcohol Abuse and 
        Alcoholism, as appropriate.
          (3) Authorization of appropriations.--There are 
        authorized to be appropriated--
                  (A) to carry out paragraph (1)(A), $7,000,000 
                for the period of fiscal years 2018 through 
                2020; and
                  (B) to carry out paragraph (1)(B), $7,000,000 
                for the period of fiscal years 2018 through 
                2020.

                           advisory councils

  Sec. 502. (a) Appointment.--
          (1) In general.--The Secretary shall appoint an 
        advisory council for--
                  (A) the Substance Abuse and Mental Health 
                Services Administration;
                  (B) the Center for Substance Abuse Treatment;
                  (C) the Center for Substance Abuse 
                Prevention; [and]
                  (D) the Center for Mental Health Services[.]; 
                and
                  (E) the Center for Behavioral Health 
                Statistics and Quality.
        Each such advisory council shall advise, consult with, 
        and make recommendations to the Secretary and the 
        [Administrator] Assistant Secretary 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] 
                Assistant Secretary or Director of the 
                Administration or Center for which it was 
                established respecting such activities;
                  (ii) shall review applications submitted for 
                grants and cooperative agreements for 
                activities for which advisory council approval 
                is required under section 504(d)(2) and 
                recommend for approval applications for 
                projects that show promise of making valuable 
                contributions to the Administration's mission; 
                and
                  (iii) may review any grant, contract, or 
                cooperative agreement proposed to be made or 
                entered into by the organization;
                  (B)may collect, by correspondence or by 
                personal investigation, information as to 
                studies and services that are being carried on 
                in the United States or any other country as to 
                the diseases, disorders, or other aspects of 
                human health with respect to which the 
                organization was established and with the 
                approval of the [Administrator] Assistant 
                Secretary or Director, whichever is 
                appropriate, make such information available 
                through appropriate publications for the 
                benefit of public and private health entities 
                and health professions personnel and for the 
                information of the general public; and
                  (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] Assistant Secretary;
                  (C) the Director of the Center for which the 
                council is established;
                  (D) the Under Secretary for Health of the 
                Department of Veterans Affairs;
                  (E) the Assistant Secretary for Defense for 
                Health Affairs (or the designates of such 
                officers); [and]
                  (F) for the advisory councils appointed under 
                subsections (a)(1)(A) and (a)(1)(D), the 
                Director of the National Institute of Mental 
                Health;
                  (G) for the advisory councils appointed under 
                subsections (a)(1)(A), (a)(1)(B), and 
                (a)(1)(C), the Director of the National 
                Institute on Drug Abuse;
                  (H) for the advisory councils appointed under 
                subsections (a)(1)(A), (a)(1)(B), and 
                (a)(1)(C), the Director of the National 
                Institute on Alcohol Abuse and Alcoholism; and
                  [(F)] (I) 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 
                social 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 policy 
                economics, or management.
                  (C) Not less than half of the members of the 
                advisory council appointed under subsection 
                (a)(1)(D)--
                          (i) shall have--
                                  (I) a medical degree;
                                  (II) a doctoral degree in 
                                psychology; or
                                  (III) an advanced degree in 
                                nursing or social work from an 
                                accredited graduate school or 
                                be a certified physician 
                                assistant; and
                          (ii) shall specialize in the mental 
                        health field.
          (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. The remaining members of an advisory 
        council shall receive, for each day (including travel 
        time) they are engaged in the performance of the 
        functions of the advisory council, compensation at 
        rates not to exceed the daily equivalent to the annual 
        rate in effect for grade GS-18 of the General 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 unexpired 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 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 taken 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 council 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] Assistant Secretary 
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] 
Assistant Secretary or Director of the Administration or Center 
for which the advisory council is established, but in no event 
less than 2 times during each fiscal year. The location of the 
meetings of each advisory council shall be subject to the 
approval of the [Administrator] Assistant Secretary or Director 
of Administration or Center for which the council was 
established.
  (f) Executive Secretary and Staff.--The [Administrator] 
Assistant Secretary 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 council is established to serve as the Executive 
Secretary of the advisory council. The [Administrator] 
Assistant Secretary 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] Assistant Secretary 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 council.

           *       *       *       *       *       *       *


SEC. 504. PEER REVIEW.

  (a) In General.--The Secretary, after consultation with the 
[Administrator] Assistant Secretary, shall require appropriate 
peer review of grants, cooperative agreements, and contracts to 
be administered through the agency which exceed the simple 
acquisition threshold as defined in section 4(11) of the Office 
of Federal Procurement Policy Act.
  (b) Members.--The members of any peer review group 
established under subsection (a) shall be individuals who by 
virtue of their training or experience are eminently qualified 
to perform the review functions of the group. Not more than 
one-fourth of the members of any such peer review group shall 
be officers or employees of the United States. In the case of 
any such peer review group that is reviewing a grant, 
cooperative agreement, or contract related to mental illness 
treatment, not less than half of the members of such peer 
review group shall be licensed and experienced professionals in 
the prevention, diagnosis, or treatment of, or recovery from, 
mental or substance use disorders and have a medical degree, a 
doctoral degree in psychology, or an advanced degree in nursing 
or social work from an accredited program.
  (c) Advisory Council Review.--If the direct cost of a grant 
or cooperative agreement (described in subsection (a)) exceeds 
the simple acquisition threshold as defined by section 4(11) of 
the Office of Federal Procurement Policy Act, the Secretary may 
make such a grant or cooperative agreement only if such grant 
or cooperative agreement is recommended--
          (1) after peer review required under subsection (a); 
        and
          (2) by the appropriate advisory council.
  (d) Conditions.--The Secretary may establish limited 
exceptions to the limitations contained in this section 
regarding participation of Federal employees and advisory 
council approval. The circumstances under which the Secretary 
may make such an exception shall be made public.

                            data collection

  Sec. 505. (a) The Secretary, acting through the 
[Administrator] Assistant Secretary, shall collect data each 
year on--
          (1) the national incidence and prevalence of the 
        various forms of mental illness and substance abuse; 
        and
          (2) the incidence and prevalence of such various 
        forms in major metropolitan areas selected by the 
        [Administrator] Assistant Secretary.
  (b) With respect to the activities of the [Administrator] 
Assistant Secretary under subsection (a) relating to mental 
health, the [Administrator] Assistant Secretary shall ensure 
that such activities include, at a minimum, the collection of 
data on--
          (1) the number and variety of public and nonprofit 
        private treatment programs;
          (2) the number and demographic characteristics of 
        individuals receiving treatment through such programs;
          (3) the type of care received by such individuals; 
        and
          (4) such other data as may be appropriate.
  (c)(1) With respect to the activities of the [Administrator] 
Assistant Secretary under subsection (a) relating to substance 
abuse, the [Administrator] Assistant Secretary shall ensure 
that such activities include, at a minimum, the collection of 
data on--
          (A) the number of individuals admitted to the 
        emergency rooms of hospitals as a result of the abuse 
        of alcohol or other drugs;
          (B) the number of deaths occurring as a result of 
        substance abuse, as indicated in reports by coroners;
          (C) the number and variety of public and private 
        nonprofit treatment programs, including the number and 
        type of patient slots available;
          (D) the number of individuals seeking treatment 
        through such programs, the number and demographic 
        characteristics of individuals receiving such 
        treatment, the percentage of individuals who complete 
        such programs, and, with respect to individuals 
        receiving such treatment, the length of time between an 
        individual's request for treatment and the commencement 
        of treatment;
          (E) the number of such individuals who return for 
        treatment after the completion of a prior treatment in 
        such programs and the method of treatment utilized 
        during the prior treatment;
          (F) the number of individuals receiving public 
        assistance for such treatment programs;
          (G) the costs of the different types of treatment 
        modalities for drug and alcohol abuse and the aggregate 
        relative costs of each such treatment modality provided 
        within a State in each fiscal year;
          (H) to the extent of available information, the 
        number of individuals receiving treatment for alcohol 
        or drug abuse who have private insurance coverage for 
        the costs of such treatment;
          (I) the extent of alcohol and drug abuse among high 
        school students and among the general population; and
          (J) the number of alcohol and drug abuse counselors 
        and other substance abuse treatment personnel employed 
        in public and private treatment facilities.
  (2) Annual surveys shall be carried out in the collection of 
data under this subsection. Summaries and analyses of the data 
collected shall be made available to the public.
  (d) After consultation with the States and with appropriate 
national organizations, the [Administrator] Assistant Secretary 
shall develop uniform criteria for the collection of data, 
using the best available technology, pursuant to this section.

           *       *       *       *       *       *       *


SEC. 506B. GRANTS FOR ECSTASY AND OTHER CLUB DRUGS ABUSE PREVENTION.

  (a) Authority.--The [Administrator] Assistant Secretary may 
make grants to, and enter into contracts and cooperative 
agreements with, public and nonprofit private entities to 
enable such entities--
          (1) to carry out school-based programs concerning the 
        dangers of the abuse of and addiction to 3,4-
        methylenedioxy methamphetamine, related drugs, and 
        other drugs commonly referred to as ``club drugs'' 
        using methods that are effective and science-based, 
        including initiatives that give students the 
        responsibility to create their own anti-drug abuse 
        education programs for their schools; and
          (2) to carry out community-based abuse and addiction 
        prevention programs relating to 3,4-methylenedioxy 
        methamphetamine, related drugs, and other club drugs 
        that are effective and science-based.
  (b) Use of Funds.--Amounts made available under a grant, 
contract or cooperative agreement under subsection (a) shall be 
used for planning, establishing, or administering prevention 
programs relating to 3,4-methylenedioxy methamphetamine, 
related drugs, and other club drugs.
  (c) Use of Funds.--
          (1) Discretionary functions.--Amounts provided to an 
        entity under this section may be used--
                  (A) to carry out school-based programs that 
                are focused on those districts with high or 
                increasing rates of abuse and addiction to 3,4-
                methylenedioxy methamphetamine, related drugs, 
                and other club drugs and targeted at 
                populations that are most at risk to start 
                abusing these drugs;
                  (B) to carry out community-based prevention 
                programs that are focused on those populations 
                within the community that are most at-risk for 
                abuse of and addiction to 3,4-methylenedioxy 
                methamphetamine, related drugs, and other club 
                drugs;
                  (C) to assist local government entities to 
                conduct appropriate prevention activities 
                relating to 3,4-methylenedioxy methamphetamine, 
                related drugs, and other club drugs;
                  (D) to train and educate State and local law 
                enforcement officials, prevention and education 
                officials, health professionals, members of 
                community anti-drug coalitions and parents on 
                the signs of abuse of and addiction to 3,4-
                methylenedioxy methamphetamine, related drugs, 
                and other club drugs and the options for 
                treatment and prevention;
                  (E) for planning, administration, and 
                educational activities related to the 
                prevention of abuse of and addiction to 3,4-
                methylenedioxy methamphetamine, related drugs, 
                and other club drugs;
                  (F) for the monitoring and evaluation of 
                prevention activities relating to 3,4-
                methylenedioxy methamphetamine, related drugs, 
                and other club drugs and reporting and 
                disseminating resulting information to the 
                public; and
                  (G) for targeted pilot programs with 
                evaluation components to encourage innovation 
                and experimentation with new methodologies.
          (2) Priority.--The [Administrator] Assistant 
        Secretary shall give priority in awarding grants under 
        this section to rural and urban areas that are 
        experiencing a high rate or rapid increases in abuse 
        and addiction to 3,4-methylenedioxy methamphetamine, 
        related drugs, and other club drugs.
  (d) Allocation and Report.--
          (1) Prevention program allocation.--Not less than 
        $500,000 of the amount appropriated in each fiscal year 
        to carry out this section shall be made available to 
        the [Administrator] Assistant Secretary, acting in 
        consultation with other Federal agencies, to support 
        and conduct periodic analyses and evaluations of 
        effective prevention programs for abuse of and 
        addiction to 3,4-methylenedioxy methamphetamine, 
        related drugs, and other club drugs and the development 
        of appropriate strategies for disseminating information 
        about and implementing such programs.
          (2) Report.--The [Administrator] Assistant Secretary 
        shall annually prepare and submit to the Committee on 
        Health, Education, Labor, and Pensions, the Committee 
        on the Judiciary, and the Committee on Appropriations 
        of the Senate, and the Committee on Commerce, the 
        Committee on the Judiciary, and the Committee on 
        Appropriations of the House of Representatives, a 
        report containing the results of the analyses and 
        evaluations conducted under paragraph (1).
  (e) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section--
          (1) $10,000,000 for fiscal year 2001; and
          (2) such sums as may be necessary for each succeeding 
        fiscal year.

                      Part B--Centers and Programs

            Subpart 1--Center for Substance Abuse Treatment

                  center for substance abuse treatment

  Sec. 507. (a) Establishment.--There is established in the 
Administration a Center for Substance 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 
from among individuals with extensive experience or academic 
qualifications in the [treatment of substance abuse] treatment 
of substance use disorders or in the evaluation of substance 
[abuse treatment systems] use disorder treatment systems.
  (b) Duties.--The Director of the Center shall--
          (1) administer the substance abuse treatment block 
        grant program authorized in section 1921;
          (2) ensure that emphasis is placed on children and 
        adolescents in the development of treatment programs;
          (3) collaborate with the Attorney General to develop 
        programs to provide substance [abuse] use disorder 
        treatment services to individuals who have had contact 
        with the Justice system, especially adolescents;
          (4) collaborate with the Director of the Center for 
        Substance Abuse Prevention in order to provide outreach 
        services to identify individuals in need of treatment 
        services, with emphasis on the provision of such 
        services to pregnant and postpartum women and their 
        infants and to [individuals who abuse drugs] 
        individuals who use drugs intravenously;
          (5) collaborate with the Director of the National 
        Institute on Drug Abuse, with the Director of the 
        National Institute on Alcohol Abuse and Alcoholism, and 
        with the States to promote the study, dissemination, 
        and implementation of research findings that will 
        improve the delivery and effectiveness of treatment 
        services;
          (6) collaborate with the Administrator of the Health 
        Resources and Services Administration and the 
        Administrator of the Centers for Medicare & Medicaid 
        Services to promote the increased integration into the 
        mainstream of the health care system of the United 
        States of programs for providing treatment services;
          (7) evaluate plans submitted by the States pursuant 
        to section 1932(a)(6) in order to determine whether the 
        plans adequately provide for the availability, 
        allocation, and effectiveness of treatment services;
          (8) sponsor regional workshops on improving the 
        quality and availability of treatment services;
          (9) provide technical assistance to public and 
        nonprofit private entities that provide treatment 
        services, including technical assistance with respect 
        to the process of submitting to the Director 
        applications for any program of grants or contracts 
        [carried out by the Director];
          [(10) encourage the States to expand the availability 
        (relative to fiscal year 1992) of programs providing 
        treatment services through self-run, self-supported 
        recovery based on the programs of housing operated 
        pursuant to section 1925;]
          [(11)] (10) carry out activities to educate 
        individuals on the need for establishing treatment 
        facilities within their communities;
          [(12)] (11) encourage public and private entities 
        that provide health insurance to provide benefits for 
        outpatient treatment services and other nonhospital-
        based treatment services;
          [(13)] (12) evaluate treatment programs to determine 
        the quality and appropriateness of various forms of 
        treatment, which shall be carried out through grants, 
        contracts, or cooperative agreements provided to public 
        or nonprofit private entities[; and];
          [(14) in carrying out paragraph (13), assess the 
        quality, appropriateness, and costs of various 
        treatment forms for specific patient groups.]
          (13) ensure the consistent documentation of the 
        application of criteria when awarding grants and the 
        ongoing oversight of grantees after such grants are 
        awarded; and
          (14) work with States, providers, and individuals in 
        recovery, and their families, to promote the expansion 
        of recovery support services and systems of care 
        oriented towards recovery.
  (c) Grants and Contracts.--In carrying out the duties 
established in subsection (b), the Director may make grants to 
and enter into contracts and cooperative agreements with public 
and nonprofit private entities.

    residential treatment programs for pregnant and postpartum women

  Sec. 508. (a) In General.--The Director of the Center for 
Substance Abuse Treatment shall provide awards of grants, 
cooperative agreement, or contracts to public and nonprofit 
private entities for the purpose of providing to pregnant and 
postpartum women treatment for substance abuse through programs 
in which, during the course of receiving treatment--
          (1) the women reside in facilities provided by the 
        programs;
          (2) the minor children of the women reside with the 
        women in such facilities, if the women so request; and
          (3) the services described in subsection (d) are 
        available to or on behalf of the women.
  (b) Availability of Services for Each Participant.--A funding 
agreement for an award under subsection (a) for an applicant is 
that, in the program operated pursuant to such subsection--
          (1) treatment services and each supplemental service 
        will be available through the applicant, either 
        directly or through agreements with other public or 
        nonprofit private entities; and
          (2) the services will be made available to each woman 
        admitted to the program.
  (c) Individualized Plan of 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 applicant will, 
        in consultation with the women, prepare an 
        individualized plan for the provision to the woman of 
        the services; and
          (2) treatment services under the plan will include--
                  (A) individual, group, and family counseling, 
                as appropriate, regarding substance abuse; and
                  (B) follow-up services to assist the woman in 
                preventing a relapse into such abuse.
  (d) Required Supplemental Services.--In the case of an 
eligible woman, the services referred to in subsection (a)(3) 
are as follows:
          (1) Prenatal and postpartum health care.
          (2) Referrals for necessary hospital services.
          (3) For the infants and children of the woman--
                  (A) pediatric health care, including 
                treatment for any perinatal effects of maternal 
                substance abuse and including screenings 
                regarding the physical and mental development 
                of the infants and children;
                  (B) counseling and other mental health 
                services, in the case of children; and
                  (C) comprehensive social services.
          (4) Providing supervision of children during periods 
        in which the woman is engaged in therapy or in other 
        necessary health or rehabilitative activities.
          (5) Training in parenting.
          (6) Counseling on the human immunodeficiency virus 
        and on acquired immune deficiency syndrome.
          (7) Counseling on domestic violence and sexual abuse.
          (8) Counseling on obtaining employment, including the 
        importance of graduating from a secondary school.
          (9) Reasonable efforts to preserve and support the 
        family units of the women, including promoting the 
        appropriate involvement of parents and others, and 
        counseling the children of the women.
          (10) Planning for and counseling to assist reentry 
        into society, both before and after discharge, 
        including referrals to any public or nonprofit private 
        entities in the community involved that provide 
        services appropriate for the women and the children of 
        the women.
          (11) Case management services, including--
                  (A) assessing the extent to which authorized 
                services are appropriate for the women and 
                their children;
                  (B) in the case of the services that are 
                appropriate, ensuring that the services are 
                provided in a coordinated manner; and
                  (C) assistance in establishing eligibility 
                for assistance under Federal, State, and local 
                programs providing health services, mental 
                health services, housing services, employment 
                services, educational services, or social 
                services.
  (e) Minimum Qualifications For Receipt of Award.--
          (1) Certification by relevant state agency.--With 
        respect to the principal agency of the State involved 
        that administers programs relating to substance abuse, 
        the Director may make an award under subsection (a) to 
        an applicant only if the agency has certified to the 
        Director that--
                  (A) the applicant has the capacity to carry 
                out a program described in subsection (a);
                  (B) the plans of the applicant for such a 
                program are consistent with the policies of 
                such agency regarding the treatment of 
                substance abuse; and
                  (C) the applicant, or any entity through 
                which the applicant will provide authorized 
                services, meets all applicable State licensure 
                or certification requirements regarding the 
                provision of the services involved.
          (2) Status as medicaid provider.--
                  (A) Subject to subparagraphs (B) and (C), the 
                Director may make an award under subsection (a) 
                only if, in the case of any authorized service 
                that is available pursuant to the State plan 
                approved under title XIX of the Social Security 
                Act for the State involved--
                          (i) the applicant for the award will 
                        provide the service directly, and the 
                        applicant has entered into a 
                        participation agreement under the State 
                        plan and is qualified to receive 
                        payments under such plan; or
                          (ii) the applicant will enter into an 
                        agreement with a public or nonprofit 
                        private entity under which the entity 
                        will provide the service, and the 
                        entity has entered into such a 
                        participation agreement plan and is 
                        qualified to receive such payments.
                  (B)(i) In the case of an entity making an 
                agreement pursuant to subparagraph (A)(ii) 
                regarding the provision of services, the 
                requirement established in such subparagraph 
                regarding a participation agreement shall be 
                waived by the Director if the entity does not, 
                in providing health care services, impose a 
                charge or accept reimbursement available from 
                any third-party payor, including reimbursement 
                under any insurance policy or under any Federal 
                or State health benefits plan.
                  (ii) A determination by the Director of 
                whether an entity referred to in clause (i) 
                meets the criteria for a waiver under such 
                clause shall be made without regard to whether 
                the entity accepts voluntary donations 
                regarding the provision of services to the 
                public.
                  (C) With respect to any authorized service 
                that is available pursuant to the State plan 
                described in subparagraph (A), the requirements 
                established in such subparagraph shall not 
                apply to the provision of any such service by 
                an institution for mental diseases to an 
                individual who has attained 21 years of age and 
                who has not attained 65 years of age. For 
                purposes of the preceding sentence, the term 
                ``institution for mental diseases'' has the 
                meaning given such term in section 1905(i) of 
                the Social Security Act.
  (f) Requirement of Matching Funds.--
          (1) In general.--With respect to the costs of the 
        program to be carried out by an applicant pursuant to 
        subsection (a), a funding agreement for an award under 
        such subsection is that the applicant will make 
        available (directly or through donations from public or 
        private entities) non-Federal contributions toward such 
        costs in an amount that--
                  (A) for the first fiscal year for which the 
                applicant receives payments under an award 
                under such subsection, is not less than $1 for 
                each $9 of Federal funds provided in the award;
                  (B) for any second such fiscal year, is not 
                less than $1 for each $9 of Federal funds 
                provided in the award; and
                  (C) for any subsequent such fiscal year, is 
                not less than $1 for each $3 of Federal funds 
                provided in the award.
          (2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash 
        or in kind, fairly evaluated, including plant, 
        equipment, or services. Amounts provided by the Federal 
        Government, or services assisted or subsidized to any 
        significant extent by the Federal Government, may not 
        be included in determining the amount of such non-
        Federal contributions.
  (g) Outreach.--A funding agreement for an award under 
subsection (a) for an applicant is that the applicant will 
provide outreach services in the community involved to identify 
women who are engaging in substance abuse and to encourage the 
women to undergo treatment for such abuse.
  (h) Accessibility of Program; Cultural Context of Services.--
A funding agreement for an award under subsection (a) for an 
applicant is that--
          (1) the program operated pursuant to such subsection 
        will be operated at a location that is accessible to 
        low-income pregnant and postpartum women; and
          (2) authorized services will be provided in the 
        language and the cultural context that is most 
        appropriate.
  (i) Continuing Education.--A funding agreement for an award 
under subsection (a) is that the applicant involved will 
provide for continuing education in treatment services for the 
individuals who will provide treatment in the program to be 
operated by the applicant pursuant to such subsection.
  (j) Imposition of Charges.--A funding agreement for an award 
under subsection (a) for an applicant is that, if a charge is 
imposed for the provision of authorized services to on behalf 
of an eligible woman, such charge--
          (1) will be made according to a schedule of charges 
        that is made available to the public;
          (2) will be adjusted to reflect the income of the 
        woman involved; and
          (3) will not be imposed on any such woman with an 
        income of less than 185 percent of the official poverty 
        line, as established by the Director of the Office for 
        Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981.
  (k) Reports to Director.--A funding agreement for an award 
under subsection (a) is that the applicant involved will submit 
to the Director a report--
          (1) describing the utilization and costs of services 
        provided under the award;
          (2) specifying the number of women served, the number 
        of infants served, and the type and costs of services 
        provided; and
          (3) providing such other information as the Director 
        determines to be appropriate.
  (l) Requirement of Application.--The Director may make an 
award under subsection (a) only if an application for the award 
is submitted to the Director containing such agreements, and 
the application is in such form, is made in such manner, and 
contains such other agreements and such assurances and 
information as the Director determines to be necessary to carry 
out this section.
  (m) Equitable Allocation of Awards.--In making awards under 
subsection (a), the Director shall ensure that the awards are 
equitably allocated among the principal geographic regions of 
the United States, subject to the availability of qualified 
applicants for the awards.
  (n) Duration of Award.--The period during which payments are 
made to an entity from an award under subsection (a) may not 
exceed 5 years. The provision of such payments shall be subject 
to annual approval by the Director of the payments and subject 
to the availability of appropriations for the fiscal year 
involved to make the payments. This subsection may not be 
construed to establish a limitation on the number of awards 
under such subsection that may be made to an entity.
  (o) Evaluations; Dissemination of Findings.--The Director 
shall, directly or through contract, provide for the conduct of 
evaluations of programs carried out pursuant to subsection (a). 
The Director shall disseminate to the States the findings made 
as a result of the evaluations.
  (p) Reports to Congress.--Not later than October 1, 1994, the 
Director shall submit to the Committee on Energy and Commerce 
of the House of Representatives, and to the Committee on Labor 
and Human Resources of the Senate, a report describing programs 
carried out pursuant to this section. Every 2 years thereafter, 
the Director shall prepare a report describing such programs 
carried out during the preceding 2 years, and shall submit the 
report to the [Administrator] Assistant Secretary for inclusion 
in the biennial report under section 501(k). Each report under 
this subsection shall include a summary of any evaluations 
conducted under subsection (m) during the period with respect 
to which the report is prepared.
  (q) Definitions.--For purposes of this section:
          (1) The term ``authorized services'' means treatment 
        services and supplemental services.
          (2) The term ``eligible woman'' means a woman who has 
        been admitted to a program operated pursuant to 
        subsection (a).
          (3) The term ``funding agreement under subsection 
        (a)'', with respect to an award under subsection (a), 
        means that the Director may make the award only if the 
        applicant makes the agreement involved.
          (4) The term ``treatment services'' means treatment 
        for substance abuse, including the counseling and 
        services described in subsection (c)(2).
          (5) The term ``supplemental services'' means the 
        services described in subsection (d).
  (r) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary to fiscal years 2001 
through 2003.

           *       *       *       *       *       *       *


         [methamphetamine and amphetamine treatment initiative

  [Sec. 514. (a) Grants.--
          [(1) Authority to make grants.--The Director of the 
        Center for Substance Abuse Treatment may make grants to 
        States and Indian tribes recognized by the United 
        States that have a high rate, or have had a rapid 
        increase, in methamphetamine or amphetamine abuse or 
        addiction in order to permit such States and Indian 
        tribes to expand activities in connection with the 
        treatment of methamphetamine or amphetamine abuser or 
        addiction in the specific geographical areas of such 
        States or Indian tribes, as the case may be, where 
        there is such a rate or has been such an increase.
          [(2) Recipients.--Any grants under paragraph (1) 
        shall be directed to the substance abuse directors of 
        the States, and of the appropriate tribal government 
        authorities of the Indian tribes, selected by the 
        Director to receive such grants.
          [(3) Nature of activities.--Any activities under a 
        grant under paragraph (1) shall be based on reliable 
        scientific evidence of their efficacy in the treatment 
        of methamphetamine or amphetamine abuse or addiction.
  [(b) Geographic Distribution.--The Director shall ensure that 
grants under subsection (a) are distributed equitably among the 
various regions of the country and among rural, urban, and 
suburban areas that are affected by methamphetamine or 
amphetamine abuse or addiction.
  [(c) Additional Activities.--The Director shall--
          [(1) evaluate the activities supported by grants 
        under subsection (a);
          [(2) disseminate widely such significant information 
        derived from the evaluation as the Director considers 
        appropriate to assist States, Indian tribes, and 
        private providers of treatment services for 
        methamphetamine or amphetamine abuser or addiction in 
        the treatment of methamphetamine or amphetamine abuse 
        or addiction; and
          [(3) provide States, Indian tribes, and such 
        providers with technical assistance in connection with 
        the provision of such treatment.
  [(d) Authorization of Appropriations.--
          [(1) In general.--There are authorized to be 
        appropriated to carry out this section $10,000,000 for 
        fiscal year 2000 and such sums as may be necessary for 
        each of fiscal years 2001 and 2002.
          [(2) Use of certain funds.--Of the funds appropriated 
        to carry out this section in any fiscal year, the 
        lesser of 5 percent of such funds or $1,000,000 shall 
        be available to the Director for purposes of carrying 
        out subsection (c).

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

  [(a) In General.--The Secretary shall award grants, 
contracts, or cooperative agreements to public and private 
nonprofit entities, including local educational agencies (as 
defined in section 14101 of the Elementary and Secondary 
Education Act of 1965 (20 U.S.C. 8801)), for the purpose of 
providing early intervention substance abuse services for 
children and adolescents.
  [(b) Priority.--In awarding grants, contracts, or cooperative 
agreements under subsection (a), the Secretary shall give 
priority to applicants who demonstrate an ability to--
          [(1) screen for and assess substance use and abuse by 
        children and adolescents;
          [(2) make appropriate referrals for children and 
        adolescents who are in need of treatment for substance 
        abuse;
          [(3) provide early intervention services, including 
        counseling and ancillary services, that are designed to 
        meet the developmental needs of children and 
        adolescents who are at risk for substance abuse; and
          [(4) develop networks with the educational, juvenile 
        justice, social services, and other agencies and 
        organizations in the State or local community involved 
        that will work to identify children and adolescents who 
        are in need of substance abuse treatment services.
  [(c) Condition.--In awarding grants, contracts, or 
cooperative agreements under subsection (a), the Secretary 
shall ensure that such grants, contracts, or cooperative 
agreements are allocated, subject to the availability of 
qualified applicants, among the principal geographic regions of 
the United States, to Indian tribes and tribal organizations, 
and to urban and rural areas.
  [(d) Duration of Grants.--The Secretary shall award grants, 
contracts, or cooperative agreements under subsection (a) for 
periods not to exceed 5 fiscal years.
  [(e) Application.--An entity desiring a grant, contract, or 
cooperative agreement under subsection (a) shall submit an 
application to the Secretary at such time, in such manner, and 
accompanied by such information as the Secretary may reasonably 
require.
  [(f) Evaluation.--An entity that receives a grant, contract, 
or cooperative agreement under subsection (a) shall submit, in 
the application for such grant, contract, or cooperative 
agreement, a plan for the evaluation of any project undertaken 
with funds provided under this section. Such entity shall 
provide the Secretary with periodic evaluations of the progress 
of such project and such evaluation at the completion of such 
project as the Secretary determines to be appropriate.
  [(g) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section, $20,000,000 for 
fiscal year 2001, and such sums as may be necessary for fiscal 
years 2002 and 2003.]

           *       *       *       *       *       *       *


Subpart 2--Center for Substance Abuse Prevention

           *       *       *       *       *       *       *


[prevention, treatment, and rehabilitation model projects for high risk 
                                 youth

  [Sec. 517. (a) The Secretary, through the Director of the 
Prevention Center, shall make grants to public and nonprofit 
private entities for projects to demonstrate effective models 
for the prevention, treatment, and rehabilitation of drug abuse 
and alcohol abuse among high risk youth.
  [(b)(1) In making grants for drug abuse and alcohol abuse 
prevention projects under this section, the Secretary shall 
give priority to applications for projects directed at children 
of substance abusers, latchkey children, children at risk of 
abuse or neglect, preschool children eligible for services 
under the Head Start Act, children at risk of dropping out of 
school, children at risk of becoming adolescent parents, and 
children who do not attend school and who are at risk of being 
unemployed.
  [(2) In making grants for drug abuse and alcohol abuse 
treatment and rehabilitation projects under this section, the 
Secretary shall give priority to projects which address the 
relationship between drug abuse or alcohol abuse and physical 
child abuse, sexual child abuse, emotional child abuse, 
dropping out of school, unemployment, delinquency, pregnancy, 
violence, suicide, or mental health problems.
  [(3) In making grants under this section, the Secretary shall 
give priority to applications from community based 
organizations for projects to develop innovative models with 
multiple, coordinated services for the prevention or for the 
treatment and rehabilitation of drug abuse or alcohol abuse by 
high risk youth.
  [(4) In making grants under this section, the Secretary shall 
give priority to applications for projects to demonstrate 
effective models with multiple, coordinated services which may 
be replicated and which are for the prevention or for the 
treatment and rehabilitation of drug abuse or alcohol abuse by 
high risk youth.
  [(5) In making grants under this section, the Secretary shall 
give priority to applications that employ research designs 
adequate for evaluating the effectiveness of the program.
  [(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.
  [(d) To the extent feasible, the Secretary shall make grants 
under this section in all regions of the United States, and 
shall ensure the distribution of grants under this section 
among urban and rural areas.
  [(e) In order to receive a grant for a project under this 
section for a fiscal year, a public or nonprofit private entity 
shall submit an application to the Secretary, acting through 
the Office. The Secretary may provide to the Governor of the 
State the opportunity to review and comment on such 
application. Such application shall be in such form, shall 
contain such information, and shall be submitted at such time 
as the Secretary may by regulation prescribe.
  [(f) The Director of the Office shall evaluate projects 
conducted with grants under this section.
  [(g) For purposes of this section, the term ``high risk 
youth'' means an individual who has not attained the age of 21 
years, who is at high risk of becoming, or who has become, a 
drug abuser or an alcohol abuser, and who--
          [(1) is identified as a child of a substance abuser;
          [(2) is a victim of physical, sexual, or 
        psychological abuse;
          [(3) has dropped out of school;
          [(4) has become pregnant;
          [(5) is economically disadvantaged;
          [(6) has committed a violent or delinquent act;
          [(7) has experienced mental health problems;
          [(8) has attempted suicide;
          [(9) has experienced long-term physical pain due to 
        injury; or
          [(10) has experienced chronic failure in school.
  [(h) For the purpose of carrying out this section, there are 
authorized to be appropriated such sums as may be necessary for 
each of the fiscal years 2001 through 2003.]

           *       *       *       *       *       *       *


[SEC. 519A. GRANTS FOR STRENGTHENING FAMILIES.

  [(a) Program Authorized.--The Secretary, acting through the 
Director of the Prevention Center, may make grants to public 
and nonprofit private entities to develop and implement model 
substance abuse prevention programs to provide early 
intervention and substance abuse prevention services for 
individuals of high-risk families and the communities in which 
such individuals reside.
  [(b) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to applicants that--
          [(1) have proven experience in preventing substance 
        abuse by individuals of high-risk families and reducing 
        substance abuse in communities of such individuals;
          [(2) have demonstrated the capacity to implement 
        community-based partnership initiatives that are 
        sensitive to the diverse backgrounds of individuals of 
        high-risk families and the communities of such 
        individuals;
          [(3) have experience in providing technical 
        assistance to support substance abuse prevention 
        programs that are community-based;
          [(4) have demonstrated the capacity to implement 
        research-based substance abuse prevention strategies; 
        and
          [(5) have implemented programs that involve families, 
        residents, community agencies, and institutions in the 
        implementation and design of such programs.
  [(c) Duration of Grants.--The Secretary shall award grants 
under subsection (a) for a period not to exceed 5 years.
  [(d) Use of Funds.--An applicant that is awarded a grant 
under subsection (a) shall--
          [(1) in the first fiscal year that such funds are 
        received under the grant, use such funds to develop a 
        model substance abuse prevention program; and
          [(2) in the fiscal year following the first fiscal 
        year that such funds are received, use such funds to 
        implement the program developed under paragraph (1) to 
        provide early intervention and substance abuse 
        prevention services to--
                  [(A) strengthen the environment of children 
                of high risk families by targeting 
                interventions at the families of such children 
                and the communities in which such children 
                reside;
                  [(B) strengthen protective factors, such as--
                          [(i) positive adult role models;
                          [(ii) messages that oppose substance 
                        abuse;
                          [(iii) community actions designed to 
                        reduce accessibility to and use of 
                        illegal substances; and
                          [(iv) willingness of individuals of 
                        families in which substance abuse 
                        occurs to seek treatment for substance 
                        abuse;
                  [(C) reduce family and community risks, such 
                as family violence, alcohol or drug abuse, 
                crime, and other behaviors that may effect 
                healthy child development and increase the 
                likelihood of substance abuse; and
                  [(D) build collaborative and formal 
                partnerships between community agencies, 
                institutions, and businesses to ensure that 
                comprehensive high quality services are 
                provided, such as early childhood education, 
                health care, family support programs, parent 
                education programs, and home visits for 
                infants.
  [(e) Application.--To be eligible to receive a grant under 
subsection (a), an applicant shall prepare and submit to the 
Secretary an application that--
          [(1) describes a model substance abuse prevention 
        program that such applicant will establish;
          [(2) describes the manner in which the services 
        described in subsection (d)(2) will be provided; and
          [(3) describe in as much detail as possible the 
        results that the entity expects to achieve in 
        implementing such a program.
  [(f) Matching Funding.--The Secretary may not make a grant to 
a entity under subsection (a) unless that entity agrees that, 
with respect to the costs to be incurred by the entity in 
carrying out the program for which the grant was awarded, the 
entity will make available non-Federal contributions in an 
amount that is not less than 40 percent of the amount provided 
under the grant.
  [(g) Report to Secretary.--An applicant that is awarded a 
grant under subsection (a) shall prepare and submit to the 
Secretary a report in such form and containing such information 
as the Secretary may require, including an assessment of the 
efficacy of the model substance abuse prevention program 
implemented by the applicant and the short, intermediate, and 
long term results of such program.
  [(h) Evaluations.--The Secretary shall conduct evaluations, 
based in part on the reports submitted under subsection (g), to 
determine the effectiveness of the programs funded under 
subsection (a) in reducing substance use in high-risk families 
and in making communities in which such families reside in 
stronger. The Secretary shall submit such evaluations to the 
appropriate committees of Congress.
  [(i) High-Risk Families.--In this section, the term ``high-
risk family'' means a family in which the individuals of such 
family are at a significant risk of using or abusing alcohol or 
any illegal substance.
  [(j) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $3,000,000 for 
fiscal year 2001, and such sums as may be necessary for each of 
the fiscal years 2002 and 2003.]

SEC. 519B. PROGRAMS TO REDUCE UNDERAGE DRINKING.

  (a) Definitions.--For purposes of this section:
          (1) The term ``alcohol beverage industry'' means the 
        brewers, vintners, distillers, importers, distributors, 
        and retail or online outlets that sell or serve beer, 
        wine, and distilled spirits.
          (2) The term ``school-based prevention'' means 
        programs, which are institutionalized, and run by staff 
        members or school-designated persons or organizations 
        in any grade of school, kindergarten through 12th 
        grade.
          (3) The term ``youth'' means persons under the age of 
        21.
          (4) The term ``IOM report'' means the report released 
        in September 2003 by the National Research Council, 
        Institute of Medicine, and entitled ``Reducing Underage 
        Drinking: A Collective Responsibility''.
  (b) Sense of Congress.--It is the sense of the Congress that:
          (1) A multi-faceted effort is needed to more 
        successfully address the problem of underage drinking 
        in the United States. A coordinated approach to 
        prevention, intervention, treatment, enforcement, and 
        research is key to making progress. This Act recognizes 
        the need for a focused national effort, and addresses 
        particulars of the Federal portion of that effort, as 
        well as Federal support for State activities.
          (2) The Secretary of Health and Human Services shall 
        continue to conduct research and collect data on the 
        short and long-range impact of alcohol use and abuse 
        upon adolescent brain development and other organ 
        systems.
          (3) States and communities, including colleges and 
        universities, are encouraged to adopt comprehensive 
        prevention approaches, including--
                  (A) evidence-based screening, programs and 
                curricula;
                  (B) brief intervention strategies;
                  (C) consistent policy enforcement; and
                  (D) environmental changes that limit underage 
                access to alcohol.
          (4) Public health groups, consumer groups, and the 
        alcohol beverage industry should continue and expand 
        evidence-based efforts to prevent and reduce underage 
        drinking.
          (5) The entertainment industries have a powerful 
        impact on youth, and they should use rating systems and 
        marketing codes to reduce the likelihood that underage 
        audiences will be exposed to movies, recordings, or 
        television programs with unsuitable alcohol content.
          (6) The National Collegiate Athletic Association, its 
        member colleges and universities, and athletic 
        conferences should affirm a commitment to a policy of 
        discouraging alcohol use among underage students and 
        other young fans.
          (7) Alcohol is a unique product and should be 
        regulated differently than other products by the States 
        and Federal Government. States have primary authority 
        to regulate alcohol distribution and sale, and the 
        Federal Government should support and supplement these 
        State efforts. States also have a responsibility to 
        fight youth access to alcohol and reduce underage 
        drinking. Continued State regulation and licensing of 
        the manufacture, importation, sale, distribution, 
        transportation and storage of alcoholic beverages are 
        clearly in the public interest and are critical to 
        promoting responsible consumption, preventing illegal 
        access to alcohol by persons under 21 years of age from 
        commercial and non-commercial sources, maintaining 
        industry integrity and an orderly marketplace, and 
        furthering effective State tax collection.
  (c) Interagency Coordinating Committee; Annual Report on 
State Underage Drinking Prevention and Enforcement 
Activities.--
          (1) Interagency coordinating committee on the 
        prevention of underage drinking.--
                  (A) In general.--The Secretary, in 
                collaboration with the Federal officials 
                specified in subparagraph (B), shall formally 
                establish and enhance the efforts of the 
                interagency coordinating committee, that began 
                operating in 2004, focusing on underage 
                drinking (referred to in this subsection as the 
                ``Committee'').
                  (B) Other agencies.--The officials referred 
                to in paragraph (1) are the Secretary of 
                Education, the Attorney General, the Secretary 
                of Transportation, the Secretary of the 
                Treasury, the Secretary of Defense, the Surgeon 
                General, the Director of the Centers for 
                Disease Control and Prevention, the Director of 
                the National Institute on Alcohol Abuse and 
                Alcoholism, the [Administrator of the Substance 
                Abuse and Mental Health Services 
                Administration] Assistant Secretary for Mental 
                Health and Substance Use, the Director of the 
                National Institute on Drug Abuse, the Assistant 
                Secretary for Children and Families, the 
                Director of the Office of National Drug Control 
                Policy, the Administrator of the National 
                Highway Traffic Safety Administration, the 
                Administrator of the Office of Juvenile Justice 
                and Delinquency Prevention, the Chairman of the 
                Federal Trade Commission, and such other 
                Federal officials as the Secretary of Health 
                and Human Services determines to be 
                appropriate.
                  (C) Chair.--The Secretary of Health and Human 
                Services shall serve as the chair of the 
                Committee.
                  (D) Duties.--The Committee shall guide policy 
                and program development across the Federal 
                Government with respect to underage drinking, 
                provided, however, that nothing in this section 
                shall be construed as transferring regulatory 
                or program authority from an Agency to the 
                Coordinating Committee.
                  (E) Consultations.--The Committee shall 
                actively seek the input of and shall consult 
                with all appropriate and interested parties, 
                including States, public health research and 
                interest groups, foundations, and alcohol 
                beverage industry trade associations and 
                companies.
                  (F) Annual report.--
                          (i) In general.--The Secretary, on 
                        behalf of the Committee, shall annually 
                        submit to the Congress a report that 
                        summarizes--
                                  (I) all programs and policies 
                                of Federal agencies designed to 
                                prevent and reduce underage 
                                drinking;
                                  (II) the extent of progress 
                                in preventing and reducing 
                                underage drinking nationally;
                                  (III) data that the Secretary 
                                shall collect with respect to 
                                the information specified in 
                                clause (ii); and
                                  (IV) such other information 
                                regarding underage drinking as 
                                the Secretary determines to be 
                                appropriate.
                          (ii) Certain information.--The report 
                        under clause (i) shall include 
                        information on the following:
                                  (I) Patterns and consequences 
                                of underage drinking as 
                                reported in research and 
                                surveys such as, but not 
                                limited to Monitoring the 
                                Future, Youth Risk Behavior 
                                Surveillance System, the 
                                National Survey on Drug Use and 
                                Health, and the Fatality 
                                Analysis Reporting System.
                                  (II) Measures of the 
                                availability of alcohol from 
                                commercial and non-commercial 
                                sources to underage 
                                populations.
                                  (III) Measures of the 
                                exposure of underage 
                                populations to messages 
                                regarding alcohol in 
                                advertising and the 
                                entertainment media as reported 
                                by the Federal Trade 
                                Commission.
                                  (IV) Surveillance data, 
                                including information on the 
                                onset and prevalence of 
                                underage drinking, consumption 
                                patterns and the means of 
                                underage access. The Secretary 
                                shall develop a plan to improve 
                                the collection, measurement and 
                                consistency of reporting 
                                Federal underage alcohol data.
                                  (V) Any additional findings 
                                resulting from research 
                                conducted or supported under 
                                subsection (f).
                                  (VI) Evidence-based best 
                                practices to prevent and reduce 
                                underage drinking and provide 
                                treatment services to those 
                                youth who need them.
          (2) Annual report on state underage drinking 
        prevention and enforcement activities.--
                  (A) In general.--The Secretary shall, with 
                input and collaboration from other appropriate 
                Federal agencies, States, Indian tribes, 
                territories, and public health, consumer, and 
                alcohol beverage industry groups, annually 
                issue a report on each State's performance in 
                enacting, enforcing, and creating laws, 
                regulations, and programs to prevent or reduce 
                underage drinking.
                  (B) State performance measures.--
                          (i) In general.--The Secretary shall 
                        develop, in consultation with the 
                        Committee, a set of measures to be used 
                        in preparing the report on best 
                        practices.
                          (ii) Categories.--In developing these 
                        measures, the Secretary shall consider 
                        categories including, but not limited 
                        to:
                                  (I) Whether or not the State 
                                has comprehensive anti-underage 
                                drinking laws such as for the 
                                illegal sale, purchase, attempt 
                                to purchase, consumption, or 
                                possession of alcohol; illegal 
                                use of fraudulent ID; illegal 
                                furnishing or obtaining of 
                                alcohol for an individual under 
                                21 years; the degree of 
                                strictness of the penalties for 
                                such offenses; and the 
                                prevalence of the enforcement 
                                of each of these infractions.
                                  (II) Whether or not the State 
                                has comprehensive liability 
                                statutes pertaining to underage 
                                access to alcohol such as dram 
                                shop, social host, and house 
                                party laws, and the prevalence 
                                of enforcement of each of these 
                                laws.
                                  (III) Whether or not the 
                                State encourages and conducts 
                                comprehensive enforcement 
                                efforts to prevent underage 
                                access to alcohol at retail 
                                outlets, such as random 
                                compliance checks and shoulder 
                                tap programs, and the number of 
                                compliance checks within 
                                alcohol retail outlets measured 
                                against the number of total 
                                alcohol retail outlets in each 
                                State, and the result of such 
                                checks.
                                  (IV) Whether or not the State 
                                encourages training on the 
                                proper selling and serving of 
                                alcohol for all sellers and 
                                servers of alcohol as a 
                                condition of employment.
                                  (V) Whether or not the State 
                                has policies and regulations 
                                with regard to direct sales to 
                                consumers and home delivery of 
                                alcoholic beverages.
                                  (VI) Whether or not the State 
                                has programs or laws to deter 
                                adults from purchasing alcohol 
                                for minors; and the number of 
                                adults targeted by these 
                                programs.
                                  (VII) Whether or not the 
                                State has programs targeted to 
                                youths, parents, and caregivers 
                                to deter underage drinking; and 
                                the number of individuals 
                                served by these programs.
                                  (VIII) Whether or not the 
                                State has enacted graduated 
                                drivers licenses and the extent 
                                of those provisions.
                                  (IX) The amount that the 
                                State invests, per youth 
                                capita, on the prevention of 
                                underage drinking, further 
                                broken down by the amount spent 
                                on--
                                          (aa) compliance check 
                                        programs in retail 
                                        outlets, including 
                                        providing technology to 
                                        prevent and detect the 
                                        use of false 
                                        identification by 
                                        minors to make alcohol 
                                        purchases;
                                          (bb) checkpoints and 
                                        saturation patrols that 
                                        include the goal of 
                                        reducing and deterring 
                                        underage drinking;
                                          (cc) community-based, 
                                        school-based, and 
                                        higher-education-based 
                                        programs to prevent 
                                        underage drinking;
                                          (dd) underage 
                                        drinking prevention 
                                        programs that target 
                                        youth within the 
                                        juvenile justice and 
                                        child welfare systems; 
                                        and
                                          (ee) other State 
                                        efforts or programs as 
                                        deemed appropriate.
          (3) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection $1,000,000 for fiscal year 2007, and 
        $1,000,000 for each of the fiscal years 2008 through 
        2010.
  (d) National Media Campaign To Prevent Underage Drinking.--
          (1) Scope of the campaign.--The Secretary shall 
        continue to fund and oversee the production, 
        broadcasting, and evaluation of the national adult-
        oriented media public service campaign if the Secretary 
        determines that such campaign is effective in achieving 
        the media campaign's measurable objectives.
          (2) Report.--The Secretary shall provide a report to 
        the Congress annually detailing the production, 
        broadcasting, and evaluation of the campaign referred 
        to in paragraph (1), and to detail in the report the 
        effectiveness of the campaign in reducing underage 
        drinking, the need for and likely effectiveness of an 
        expanded adult-oriented media campaign, and the 
        feasibility and the likely effectiveness of a national 
        youth-focused media campaign to combat underage 
        drinking.
          (3) Consultation requirement.--In carrying out the 
        media campaign, the Secretary shall direct the entity 
        carrying out the national adult-oriented media public 
        service campaign to consult with interested parties 
        including both the alcohol beverage industry and public 
        health and consumer groups. The progress of this 
        consultative process is to be covered in the report 
        under paragraph (2).
          (4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection, $1,000,000 for fiscal year 2007 and 
        $1,000,000 for each of the fiscal years 2008 through 
        2010.
  (e) Interventions.--
          (1) Community-based coalition enhancement grants to 
        prevent underage drinking.--
                  (A) Authorization of program.--The 
                [Administrator of the Substance Abuse and 
                Mental Health Services Administration] 
                Assistant Secretary for Mental Health and 
                Substance Use, in consultation with the 
                Director of the Office of National Drug Control 
                Policy, shall award, if the [Administrator] 
                Assistant Secretary determines that the 
                Department of Health and Human Services is not 
                currently conducting activities that duplicate 
                activities of the type described in this 
                subsection, ``enhancement grants'' to eligible 
                entities to design, test, evaluate and 
                disseminate effective strategies to maximize 
                the effectiveness of community-wide approaches 
                to preventing and reducing underage drinking. 
                This subsection is subject to the availability 
                of appropriations.
                  (B) Purposes.--The purposes of this paragraph 
                are to--
                          (i) prevent and reduce alcohol use 
                        among youth in communities throughout 
                        the United States;
                          (ii) strengthen collaboration among 
                        communities, the Federal Government, 
                        and State, local, and tribal 
                        governments;
                          (iii) enhance intergovernmental 
                        cooperation and coordination on the 
                        issue of alcohol use among youth;
                          (iv) serve as a catalyst for 
                        increased citizen participation and 
                        greater collaboration among all sectors 
                        and organizations of a community that 
                        first demonstrates a long-term 
                        commitment to reducing alcohol use 
                        among youth;
                          (v) disseminate to communities timely 
                        information regarding state-of-the-art 
                        practices and initiatives that have 
                        proven to be effective in preventing 
                        and reducing alcohol use among youth; 
                        and
                          (vi) enhance, not supplant, effective 
                        local community initiatives for 
                        preventing and reducing alcohol use 
                        among youth.
                  (C) Application.--An eligible entity desiring 
                an enhancement grant under this paragraph shall 
                submit an application to the [Administrator] 
                Assistant Secretary at such time, and in such 
                manner, and accompanied by such information as 
                the [Administrator] Assistant Secretary may 
                require. Each application shall include--
                          (i) a complete description of the 
                        entity's current underage alcohol use 
                        prevention initiatives and how the 
                        grant will appropriately enhance the 
                        focus on underage drinking issues; or
                          (ii) a complete description of the 
                        entity's current initiatives, and how 
                        it will use this grant to enhance those 
                        initiatives by adding a focus on 
                        underage drinking prevention.
                  (D) Uses of funds.--Each eligible entity that 
                receives a grant under this paragraph shall use 
                the grant funds to carry out the activities 
                described in such entity's application 
                submitted pursuant to subparagraph (C). Grants 
                under this paragraph shall not exceed $50,000 
                per year and may not exceed four years.
                  (E) Supplement not supplant.--Grant funds 
                provided under this paragraph shall be used to 
                supplement, not supplant, Federal and non-
                Federal funds available for carrying out the 
                activities described in this paragraph.
                  (F) Evaluation.--Grants under this paragraph 
                shall be subject to the same evaluation 
                requirements and procedures as the evaluation 
                requirements and procedures imposed on 
                recipients of drug free community grants.
                  (G) Definitions.--For purposes of this 
                paragraph, the term ``eligible entity'' means 
                an organization that is currently receiving or 
                has received grant funds under the Drug-Free 
                Communities Act of 1997 (21 U.S.C. 1521 et 
                seq.).
                  (H) Administrative expenses.--Not more than 6 
                percent of a grant under this paragraph may be 
                expended for administrative expenses.
                  (I) Authorization of appropriations.--There 
                are authorized to be appropriated to carry out 
                this paragraph $5,000,000 for fiscal year 2007, 
                and $5,000,000 for each of the fiscal years 
                2008 through 2010.
          (2) Grants directed at preventing and reducing 
        alcohol abuse at institutions of higher education.--
                  (A) Authorization of program.--The Secretary 
                shall award grants to eligible entities to 
                enable the entities to prevent and reduce the 
                rate of underage alcohol consumption including 
                binge drinking among students at institutions 
                of higher education.
                  (B) Applications.--An eligible entity that 
                desires to receive a grant under this paragraph 
                shall submit an application to the Secretary at 
                such time, in such manner, and accompanied by 
                such information as the Secretary may require. 
                Each application shall include--
                          (i) a description of how the eligible 
                        entity will work to enhance an 
                        existing, or where none exists to build 
                        a, statewide coalition;
                          (ii) a description of how the 
                        eligible entity will target underage 
                        students in the State;
                          (iii) a description of how the 
                        eligible entity intends to ensure that 
                        the statewide coalition is actually 
                        implementing the purpose of this 
                        section and moving toward indicators 
                        described in subparagraph (D);
                          (iv) a list of the members of the 
                        statewide coalition or interested 
                        parties involved in the work of the 
                        eligible entity;
                          (v) a description of how the eligible 
                        entity intends to work with State 
                        agencies on substance abuse prevention 
                        and education;
                          (vi) the anticipated impact of funds 
                        provided under this paragraph in 
                        preventing and reducing the rates of 
                        underage alcohol use;
                          (vii) outreach strategies, including 
                        ways in which the eligible entity 
                        proposes to--
                                  (I) reach out to students and 
                                community stakeholders;
                                  (II) promote the purpose of 
                                this paragraph;
                                  (III) address the range of 
                                needs of the students and the 
                                surrounding communities; and
                                  (IV) address community norms 
                                for underage students regarding 
                                alcohol use; and
                          (viii) such additional information as 
                        required by the Secretary.
                  (C) Uses of funds.--Each eligible entity that 
                receives a grant under this paragraph shall use 
                the grant funds to carry out the activities 
                described in such entity's application 
                submitted pursuant to subparagraph (B).
                  (D) Accountability.--On the date on which the 
                Secretary first publishes a notice in the 
                Federal Register soliciting applications for 
                grants under this paragraph, the Secretary 
                shall include in the notice achievement 
                indicators for the program authorized under 
                this paragraph. The achievement indicators 
                shall be designed--
                          (i) to measure the impact that the 
                        statewide coalitions assisted under 
                        this paragraph are having on the 
                        institutions of higher education and 
                        the surrounding communities, including 
                        changes in the number of incidents of 
                        any kind in which students have abused 
                        alcohol or consumed alcohol while under 
                        the age of 21 (including violations, 
                        physical assaults, sexual assaults, 
                        reports of intimidation, disruptions of 
                        school functions, disruptions of 
                        student studies, mental health 
                        referrals, illnesses, or deaths);
                          (ii) to measure the quality and 
                        accessibility of the programs or 
                        information offered by the eligible 
                        entity; and
                          (iii) to provide such other measures 
                        of program impact as the Secretary 
                        determines appropriate.
                  (E) Supplement not supplant.--Grant funds 
                provided under this paragraph shall be used to 
                supplement, and not supplant, Federal and non-
                Federal funds available for carrying out the 
                activities described in this paragraph.
                  (F) Definitions.--For purposes of this 
                paragraph:
                          (i) Eligible entity.--The term 
                        ``eligible entity'' means a State, 
                        institution of higher education, or 
                        nonprofit entity.
                          (ii) Institution of higher 
                        education.--The term ``institution of 
                        higher education'' has the meaning 
                        given the term in section 101(a) of the 
                        Higher Education Act of 1965 (20 U.S.C. 
                        1001(a)).
                          (iii) Secretary.--The term 
                        ``Secretary'' means the Secretary of 
                        Education.
                          (iv) State.--The term ``State'' means 
                        each of the 50 States, the District of 
                        Columbia, and the Commonwealth of 
                        Puerto Rico.
                          (v) Statewide coalition.--The term 
                        ``statewide coalition'' means a 
                        coalition that--
                                  (I) includes, but is not 
                                limited to--
                                          (aa) institutions of 
                                        higher education within 
                                        a State; and
                                          (bb) a nonprofit 
                                        group, a community 
                                        underage drinking 
                                        prevention coalition, 
                                        or another substance 
                                        abuse prevention group 
                                        within a State; and
                                  (II) works toward lowering 
                                the alcohol abuse rate by 
                                targeting underage students at 
                                institutions of higher 
                                education throughout the State 
                                and in the surrounding 
                                communities.
                          (vi) Surrounding community.--The term 
                        ``surrounding community'' means the 
                        community--
                                  (I) that surrounds an 
                                institution of higher education 
                                participating in a statewide 
                                coalition;
                                  (II) where the students from 
                                the institution of higher 
                                education take part in the 
                                community; and
                                  (III) where students from the 
                                institution of higher education 
                                live in off-campus housing.
                  (G) Administrative expenses.--Not more than 5 
                percent of a grant under this paragraph may be 
                expended for administrative expenses.
                  (H) Authorization of appropriations.--There 
                are authorized to be appropriated to carry out 
                this paragraph $5,000,000 for fiscal year 2007, 
                and $5,000,000 for each of the fiscal years 
                2008 through 2010.
  (f) Additional Research.--
          (1) Additional research on underage drinking.--
                  (A) In general.--The Secretary shall, subject 
                to the availability of appropriations, collect 
                data, and conduct or support research that is 
                not duplicative of research currently being 
                conducted or supported by the Department of 
                Health and Human Services, on underage 
                drinking, with respect to the following:
                          (i) Comprehensive community-based 
                        programs or strategies and statewide 
                        systems to prevent and reduce underage 
                        drinking, across the underage years 
                        from early childhood to age 21, 
                        including programs funded and 
                        implemented by government entities, 
                        public health interest groups and 
                        foundations, and alcohol beverage 
                        companies and trade associations.
                          (ii) Annually obtain and report more 
                        precise information than is currently 
                        collected on the scope of the underage 
                        drinking problem and patterns of 
                        underage alcohol consumption, including 
                        improved knowledge about the problem 
                        and progress in preventing, reducing 
                        and treating underage drinking; as well 
                        as information on the rate of exposure 
                        of youth to advertising and other media 
                        messages encouraging and discouraging 
                        alcohol consumption.
                          (iii) Compiling information on the 
                        involvement of alcohol in unnatural 
                        deaths of persons ages 12 to 20 in the 
                        United States, including suicides, 
                        homicides, and unintentional injuries 
                        such as falls, drownings, burns, 
                        poisonings, and motor vehicle crash 
                        deaths.
                  (B) Certain matters.--The Secretary shall 
                carry out activities toward the following 
                objectives with respect to underage drinking:
                          (i) Obtaining new epidemiological 
                        data within the national or targeted 
                        surveys that identify alcohol use and 
                        attitudes about alcohol use during pre- 
                        and early adolescence, including harm 
                        caused to self or others as a result of 
                        adolescent alcohol use such as 
                        violence, date rape, risky sexual 
                        behavior, and prenatal alcohol 
                        exposure.
                          (ii) Developing or identifying 
                        successful clinical treatments for 
                        youth with alcohol problems.
                  (C) Peer review.--Research under subparagraph 
                (A) shall meet current Federal standards for 
                scientific peer review.
          (2) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection $6,000,000 for fiscal year 2007, and 
        $6,000,000 for each of the fiscal years 2008 through 
        2010.

[SEC. 519C. SERVICES FOR INDIVIDUALS WITH FETAL ALCOHOL SYNDROME.

  [(a) In General.--The Secretary shall make awards of grants, 
cooperative agreements, or contracts to public and nonprofit 
private entities, including Indian tribes and tribal 
organizations, to provide services to individuals diagnosed 
with fetal alcohol syndrome or alcohol-related birth defects.
  [(b) Use of Funds.--An award under subsection (a) may, 
subject to subsection (d), be used to--
          [(1) screen and test individuals to determine the 
        type and level of services needed;
          [(2) develop a comprehensive plan for providing 
        services to the individual;
          [(3) provide mental health counseling;
          [(4) provide substance abuse prevention services and 
        treatment, if needed;
          [(5) coordinate services with other social programs 
        including social services, justice system, educational 
        services, health services, mental health and substance 
        abuse services, financial assistance programs, 
        vocational services and housing assistance programs;
          [(6) provide vocational services;
          [(7) provide health counseling;
          [(8) provide housing assistance;
          [(9) parenting skills training;
          [(10) overall case management;
          [(11) supportive services for families of individuals 
        with Fetal Alcohol Syndrome; and
          [(12) provide other services and programs, to the 
        extent authorized by the Secretary after consideration 
        of recommendations made by the National Task Force on 
        Fetal Alcohol Syndrome.
  [(c) Requirements.--To be eligible to receive an award under 
subsection (a), an applicant shall--
          [(1) demonstrate that the program will be part of a 
        coordinated, comprehensive system of care for such 
        individuals;
          [(2) demonstrate an established communication with 
        other social programs in the community including social 
        services, justice system, financial assistance 
        programs, health services, educational services, mental 
        health and substance abuse services, vocational 
        services and housing assistance services;
          [(3) show a history of working with individuals with 
        fetal alcohol syndrome or alcohol-related birth 
        defects;
          [(4) provide assurance that the services will be 
        provided in a culturally and linguistically appropriate 
        manner; and
          [(5) provide assurance that at the end of the 5-year 
        award period, other mechanisms will be identified to 
        meet the needs of the individuals and families served 
        under such award.
  [(d) Relationship to Payments Under Other Programs.--An award 
may be made under subsection (a) only if the applicant involved 
agrees that the award will not be expended to pay the expenses 
of providing any service under this section to an individual to 
the extent that payment has been made, or can reasonably be 
expected to be made, with respect to such expenses--
          [(1) under any State compensation program, under an 
        insurance policy, or under any Federal or State health 
        benefits program; or
          [(2) by an entity that provides health services on a 
        prepaid basis.
  [(e) Duration of Awards.--With respect to an award under 
subsection (a), the period during which payments under such 
award are made to the recipient may not exceed 5 years.
  [(f) Evaluation.--The Secretary shall evaluate each project 
carried out under subsection (a) and shall disseminate the 
findings with respect to each such evaluation to appropriate 
public and private entities.
  [(g) Funding.--
          [(1) Authorization of appropriations.--For the 
        purpose of carrying out this section, there are 
        authorized to be appropriated $25,000,000 for fiscal 
        year 2001, and such sums as may be necessary for each 
        of the fiscal years 2002 and 2003.
          [(2) Allocation.--Of the amounts appropriated under 
        paragraph (1) for a fiscal year, not less than $300,000 
        shall, for purposes relating to fetal alcohol syndrome 
        and alcohol-related birth defects, be made available 
        for collaborative, coordinated interagency efforts with 
        the National Institute on Alcohol Abuse and Alcoholism, 
        the Eunice Kennedy Shriver National Institute of Child 
        Health and Human Development, the Health Resources and 
        Services Administration, the Agency for Healthcare 
        Research and Quality, the Centers for Disease Control 
        and Prevention, the Department of Education, and the 
        Department of Justice.]

           *       *       *       *       *       *       *


[SEC. 519E. PREVENTION OF METHAMPHETAMINE AND INHALANT ABUSE AND 
                    ADDICTION.

  [(a) Grants.--The Director of the Center for Substance Abuse 
Prevention (referred to in this section as the ``Director'') 
may make grants to and enter into contracts and cooperative 
agreements with public and nonprofit private entities to enable 
such entities--
          [(1) to carry out school-based programs concerning 
        the dangers of methamphetamine or inhalant abuse and 
        addiction, using methods that are effective and 
        evidence-based, including initiatives that give 
        students the responsibility to create their own anti-
        drug abuse education programs for their schools; and
          [(2) to carry out community-based methamphetamine or 
        inhalant abuse and addiction prevention programs that 
        are effective and evidence-based.
  [(b) Use of Funds.--Amounts made available under a grant, 
contract or cooperative agreement under subsection (a) shall be 
used for planning, establishing, or administering 
methamphetamine or inhalant prevention programs in accordance 
with subsection (c).
  [(c) Prevention Programs and Activities.--
          [(1) In general.--Amounts provided under this section 
        may be used--
                  [(A) to carry out school-based programs that 
                are focused on those districts with high or 
                increasing rates of methamphetamine or inhalant 
                abuse and addiction and targeted at populations 
                which are most at risk to start methamphetamine 
                or inhalant abuse;
                  [(B) to carry out community-based prevention 
                programs that are focused on those populations 
                within the community that are most at-risk for 
                methamphetamine or inhalant abuse and 
                addiction;
                  [(C) to assist local government entities to 
                conduct appropriate methamphetamine or inhalant 
                prevention activities;
                  [(D) to train and educate State and local law 
                enforcement officials, prevention and education 
                officials, members of community anti-drug 
                coalitions and parents on the signs of 
                methamphetamine or inhalant abuse and addiction 
                and the options for treatment and prevention;
                  [(E) for planning, administration, and 
                educational activities related to the 
                prevention of methamphetamine or inhalant abuse 
                and addiction;
                  [(F) for the monitoring and evaluation of 
                methamphetamine or inhalant prevention 
                activities, and reporting and disseminating 
                resulting information to the public; and
                  [(G) for targeted pilot programs with 
                evaluation components to encourage innovation 
                and experimentation with new methodologies.
          [(2) Priority.--The Director shall give priority in 
        making grants under this section to rural and urban 
        areas that are experiencing a high rate or rapid 
        increases in methamphetamine or inhalant abuse and 
        addiction.
  [(d) Analyses and Evaluation.--
          [(1) In general.--Up to $500,000 of the amount 
        available in each fiscal year to carry out this section 
        shall be made available to the Director, acting in 
        consultation with other Federal agencies, to support 
        and conduct periodic analyses and evaluations of 
        effective prevention programs for methamphetamine or 
        inhalant abuse and addiction and the development of 
        appropriate strategies for disseminating information 
        about and implementing these programs.
          [(2) Annual reports.--The Director shall submit to 
        the Committee on Health, Education, Labor, and Pensions 
        and the Committee on Appropriations of the Senate and 
        the Committee on Commerce and Committee on 
        Appropriations of the House of Representatives, an 
        annual report with the results of the analyses and 
        evaluation under paragraph (1).
  [(e) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out subsection (a), $10,000,000 for 
fiscal year 2001, and such sums as may be necessary for each of 
fiscal years 2002 and 2003.]

              Subpart 3--Center for Mental Health Services

                   center for mental health services

  Sec. 520. (a) Establishment.--There is established in the 
Administration a Center for Mental Health Services (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 
from among individuals with extensive experience or academic 
qualifications in the provision of mental health services or in 
the evaluation of mental health service systems.
  (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) collaborate with the Director of the National 
        Institute of Mental Health to ensure that, as 
        appropriate, programs related to the prevention and 
        treatment of mental illness and the promotion of mental 
        health are carried out in a manner that reflects the 
        best available science and evidence-based practices, 
        including culturally and linguistically appropriate 
        services;
          [(3)] (4) collaborate with the Department of 
        Education and the Department of Justice to develop 
        programs to assist local communities in addressing 
        violence among children and adolescents;
          [(4)] (5) 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 through policies and programs that reduce 
        risk and promote resiliency;
          [(5)] (6) in collaboration with the Director of the 
        National Institute of Mental Health, develop improved 
        methods of treating individuals with mental health 
        problems and improved methods of assisting the families 
        of such individuals;
          [(6)] (7) administer the mental health services block 
        grant program authorized in section 1911;
          [(7)] (8) promote policies and programs at Federal, 
        State, and local levels and in the private sector that 
        foster independence, increase meaningful participation 
        of individuals with mental illness in programs and 
        activities of the Administration, and protect the legal 
        rights of persons with mental illness, including 
        carrying out the provisions of the Protection and 
        Advocacy of Mentally Ill Individuals Act;
          [(8)] (9) carry out the programs under part C;
          [(9)] (10) carry out responsibilities for the Human 
        Resource Development program, and programs of clinical 
        training for [professional and paraprofessional 
        personnel pursuant to section 303] paraprofessional 
        personnel and health professionals;
          [(10)] (11) conduct services-related assessments, 
        including evaluations of the organization and financing 
        of care, self-help and consumer-run programs, mental 
        health economics, mental health service systems, rural 
        mental health, and telemental health, and improve the 
        capacity of State to conduct evaluations of publicly 
        funded mental health programs;
          [(11) establish a clearinghouse for mental health 
        information to assure the widespread dissemination of 
        such information] (12) disseminate mental health 
        information, including evidenced-based practices, to 
        States, political subdivisions, educational agencies 
        and institutions, treatment and prevention service 
        providers, and the general public, including 
        information concerning the practical application of 
        research supported by the National Institute of Mental 
        Health that is applicable to improving the delivery of 
        services;
          [(12)] (13) provide technical assistance to public 
        and private entities that are providers of mental 
        health services;
          [(13)] (14) monitor and enforce obligations incurred 
        by community mental health centers pursuant to the 
        Community Mental Health Centers Act (as in effect prior 
        to the repeal of such Act on August 13, 1981, by 
        section 902(e)(2)(B) of Public Law 97-35 (95 Stat. 
        560));
          [(14)] (15) conduct surveys with respect to mental 
        health, such as the National Reporting Program; [and]
          [(15)] (16) assist States in improving their mental 
        health data collection[.]; and
          (17) consult with other agencies and offices of the 
        Department of Health and Human Services to ensure, with 
        respect to each grant awarded by the Center for Mental 
        Health Services, the consistent documentation of the 
        application of criteria when awarding grants and the 
        ongoing oversight of grantees after such grants are 
        awarded.
  (c) Grants and Contracts.--In carrying out the duties 
established in subsection (b), the Director may make grants to 
and enter into contracts and cooperative agreements with public 
and nonprofit private entities.

           *       *       *       *       *       *       *


SEC. 520B. NATIONAL CENTERS OF EXCELLENCE FOR DEPRESSION.

  (a) Depressive Disorder Defined.--In this section, the term 
``depressive disorder'' means a mental or brain disorder 
relating to depression, including major depression, bipolar 
disorder, and related mood disorders.
  (b) Grant Program.--
          (1) In general.--The Secretary, acting through the 
        [Administrator] Assistant Secretary, shall award grants 
        on a competitive basis to eligible entities to 
        establish national centers of excellence for depression 
        (referred to in this section as ``Centers''), which 
        shall engage in activities related to the treatment of 
        depressive disorders.
          (2) Allocation of awards.--If the funds authorized 
        under subsection (f) are appropriated in the amounts 
        provided for under such subsection, the Secretary shall 
        allocate such amounts so that--
                  (A) not later than 1 year after the date of 
                enactment of the ENHANCED Act of 2009, not more 
                than 20 Centers may be established; and
                  (B) not later than September 30, 2016, not 
                more than 30 Centers may be established.
          (3) Grant period.--
                  (A) In general.--A grant awarded under this 
                section shall be for a period of 5 years.
                  (B) Renewal.--A grant awarded under 
                subparagraph (A) may be renewed, on a 
                competitive basis, for 1 additional 5-year 
                period, at the discretion of the Secretary. In 
                determining whether to renew a grant, the 
                Secretary shall consider the report cards 
                issued under subsection (e)(2).
          (4) Use of funds.--Grant funds awarded under this 
        subsection shall be used for the establishment and 
        ongoing activities of the recipient of such funds.
          (5) Eligible entities.--
                  (A) Requirements.--To be eligible to receive 
                a grant under this section, an entity shall--
                          (i) be an institution of higher 
                        education or a public or private 
                        nonprofit research institution; and
                          (ii) submit an application to the 
                        Secretary at such time and in such 
                        manner as the Secretary may require, as 
                        described in subparagraph (B).
                  (B) Application.--An application described in 
                subparagraph (A)(ii) shall include--
                          (i) evidence that such entity--
                                  (I) provides, or is capable 
                                of coordinating with other 
                                entities to provide, 
                                comprehensive health services 
                                with a focus on mental health 
                                services and subspecialty 
                                expertise for depressive 
                                disorders;
                                  (II) collaborates with other 
                                mental health providers, as 
                                necessary, to address co-
                                occurring mental illnesses;
                                  (III) is capable of training 
                                health professionals about 
                                mental health; and
                          (ii) such other information, as the 
                        Secretary may require.
                  (C) Priorities.--In awarding grants under 
                this section, the Secretary shall give priority 
                to eligible entities that meet 1 or more of the 
                following criteria:
                          (i) Demonstrated capacity and 
                        expertise to serve the targeted 
                        population.
                          (ii) Existing infrastructure or 
                        expertise to provide appropriate, 
                        evidence-based and culturally and 
                        linguistically competent services.
                          (iii) A location in a geographic area 
                        with disproportionate numbers of 
                        underserved and at-risk populations in 
                        medically underserved areas and health 
                        professional shortage areas.
                          (iv) Proposed innovative approaches 
                        for outreach to initiate or expand 
                        services.
                          (v) Use of the most up-to-date 
                        science, practices, and interventions 
                        available.
                          (vi) Demonstrated capacity to 
                        establish cooperative and collaborative 
                        agreements with community mental health 
                        centers and other community entities to 
                        provide mental health, social, and 
                        human services to individuals with 
                        depressive disorders.
          (6) National coordinating center.--
                  (A) In general.--The Secretary, acting 
                through the [Administrator] Assistant 
                Secretary, shall designate 1 recipient of a 
                grant under this section to be the coordinating 
                center of excellence for depression (referred 
                to in this section as the ``coordinating 
                center''). The Secretary shall select such 
                coordinating center on a competitive basis, 
                based upon the demonstrated capacity of such 
                center to perform the duties described in 
                subparagraph (C).
                  (B) Application.--A Center that has been 
                awarded a grant under paragraph (1) may apply 
                for designation as the coordinating center by 
                submitting an application to the Secretary at 
                such time, in such manner, and containing such 
                information as the Secretary may require.
                  (C) Duties.--The coordinating center shall--
                          (i) develop, administer, and 
                        coordinate the network of Centers under 
                        this section;
                          (ii) oversee and coordinate the 
                        national database described in 
                        subsection (d);
                          (iii) lead a strategy to disseminate 
                        the findings and activities of the 
                        Centers through such database; and
                          (iv) serve as a liaison with the 
                        Administration, the National Registry 
                        of Evidence-based Programs and 
                        Practices of the Administration, and 
                        any Federal interagency or interagency 
                        forum on mental health.
          (7) Matching funds.--The Secretary may not award a 
        grant or contract under this section to an entity 
        unless the entity agrees that it will make available 
        (directly or through contributions from other public or 
        private entities) non-Federal contributions toward the 
        activities to be carried out under the grant or 
        contract in an amount equal to $1 for each $5 of 
        Federal funds provided under the grant or contract. 
        Such non-Federal matching funds may be provided 
        directly or through donations from public or private 
        entities and may be in cash or in-kind, fairly 
        evaluated, including plant, equipment, or services.
  (c) Activities of the Centers.--Each Center shall carry out 
the following activities:
          (1) General activities.--Each Center shall--
                  (A) integrate basic, clinical, or health 
                services interdisciplinary research and 
                practice in the development, implementation, 
                and dissemination of evidence-based 
                interventions;
                  (B) involve a broad cross-section of 
                stakeholders, such as researchers, clinicians, 
                consumers, families of consumers, and voluntary 
                health organizations, to develop a research 
                agenda and disseminate findings, and to provide 
                support in the implementation of evidence-based 
                practices;
                  (C) provide training and technical assistance 
                to mental health professionals, and engage in 
                and disseminate translational research with a 
                focus on meeting the needs of individuals with 
                depressive disorders; and
                  (D) educate policy makers, employers, 
                community leaders, and the public about 
                depressive disorders to reduce stigma and raise 
                awareness of treatments.
          (2) Improved treatment standards, clinical 
        guidelines, diagnostic protocols, and care coordination 
        practice.--Each Center shall collaborate with other 
        Centers in the network to--
                  (A) develop and implement treatment 
                standards, clinical guidelines, and protocols 
                that emphasize primary prevention, early 
                intervention, treatment for, and recovery from, 
                depressive disorders;
                  (B) foster communication with other providers 
                attending to co-occurring physical health 
                conditions such as cardiovascular, diabetes, 
                cancer, and substance abuse disorders;
                  (C) leverage available community resources, 
                develop and implement improved self-management 
                programs, and, when appropriate, involve family 
                and other providers of social support in the 
                development and implementation of care plans; 
                and
                  (D) use electronic health records and 
                telehealth technology to better coordinate and 
                manage, and improve access to, care, as 
                determined by the coordinating center.
          (3) Translational research through collaboration of 
        centers and community-based organizations.--Each Center 
        shall--
                  (A) demonstrate effective use of a public-
                private partnership to foster collaborations 
                among members of the network and community-
                based organizations such as community mental 
                health centers and other social and human 
                services providers;
                  (B) expand interdisciplinary, translational, 
                and patient-oriented research and treatment; 
                and
                  (C) coordinate with accredited academic 
                programs to provide ongoing opportunities for 
                the professional and continuing education of 
                mental health providers.
  (d) National Database.--
          (1) In general.--The coordinating center shall 
        establish and maintain a national, publicly available 
        database to improve prevention programs, evidence-based 
        interventions, and disease management programs for 
        depressive disorders, using data collected from the 
        Centers, as described in paragraph (2).
          (2) Data collection.--Each Center shall submit data 
        gathered at such center, as appropriate, to the 
        coordinating center regarding--
                  (A) the prevalence and incidence of 
                depressive disorders;
                  (B) the health and social outcomes of 
                individuals with depressive disorders;
                  (C) the effectiveness of interventions 
                designed, tested, and evaluated;
                  (D) other information, as the Secretary may 
                require.
          (3) Submission of data to the [administrator]  
        assistant secretary.--The coordinating center shall 
        submit to the [Administrator] Assistant Secretary the 
        data and financial information gathered under paragraph 
        (2).
          (4) Publication using data from the database.--A 
        Center, or an individual affiliated with a Center, may 
        publish findings using the data described in paragraph 
        (2) only if such center submits such data to the 
        coordinating center, as required under such paragraph.
  (e) Establishment of Standards; Report Cards and 
Recommendations; Third Party Review.--
          (1) Establishment of standards.--The Secretary, 
        acting through the [Administrator] Assistant Secretary, 
        shall establish performance standards for--
                  (A) each Center; and
                  (B) the network of Centers as a whole.
          (2) Report cards.--The Secretary, acting through the 
        [Administrator] Assistant Secretary, shall--
                  (A) for each Center, not later than 3 years 
                after the date on which such center of 
                excellence is established and annually 
                thereafter, issue a report card to the 
                coordinating center to rate the performance of 
                such Center; and
                  (B) not later than 3 years after the date on 
                which the first grant is awarded under 
                subsection (b)(1) and annually thereafter, 
                issue a report card to Congress to rate the 
                performance of the network of centers of 
                excellence as a whole.
          (3) Recommendations.--Based upon the report cards 
        described in paragraph (2), the Secretary shall, not 
        later than September 30, 2015--
                  (A) make recommendations to the Centers 
                regarding improvements such centers shall make; 
                and
                  (B) make recommendations to Congress for 
                expanding the Centers to serve individuals with 
                other types of mental disorders.
          (4) Third party review.--Not later than 3 years after 
        the date on which the first grant is awarded under 
        subsection (b)(1) and annually thereafter, the 
        Secretary shall arrange for an independent third party 
        to conduct an evaluation of the network of Centers to 
        ensure that such centers are meeting the goals of this 
        section.
  (f) Authorization of Appropriations.--
          (1) In general.--To carry out this section, there are 
        authorized to be appropriated--
                  (A) $100,000,000 for each of the fiscal years 
                2011 through 2015; and
                  (B) $150,000,000 for each of the fiscal years 
                2016 through 2020.
          (2) Allocation of funds authorized.--Of the amount 
        appropriated under paragraph (1) for a fiscal year, the 
        Secretary shall determine the allocation of each Center 
        receiving a grant under this section, but in no case 
        may the allocation be more than $5,000,000, except that 
        the Secretary may allocate not more than $10,000,000 to 
        the coordinating center.

SEC. 520C. [YOUTH INTERAGENCY RESEARCH, TRAINING, AND TECHNICAL 
                    ASSISTANCE CENTERS.]  SUICIDE PREVENTION TECHNICAL 
                    ASSISTANCE CENTER.

  (a) Program Authorized.--The Secretary, acting through the 
[Administrator of the Substance Abuse and Mental Health 
Services Administration] Assistant Secretary for Mental Health 
and Substance Use, [and in consultation with the Administrator 
of the Office of Juvenile Justice and Delinquency Prevention, 
the Director of the Bureau of Justice Assistance and the 
Director of the National Institutes of Health--]
          [(1) shall award grants or contracts to public or 
        nonprofit private entities to establish not more than 
        four research, training, and technical assistance 
        centers to carry out the activities described in 
        subsection (c); and
          [(2) shall award a competitive grant to 1 additional 
        research, training, and technical assistance center to 
        carry out the activities described in subsection (d).] 
        shall establish a research, training, and technical 
        assistance resource center to provide appropriate 
        information, training, and technical assistance to 
        States, political subdivisions of States, federally 
        recognized Indian tribes, tribal organizations, 
        institutions of higher education, public organizations, 
        or private nonprofit organizations regarding the 
        prevention of suicide among all ages, particularly 
        among groups that are at high risk for suicide.
  [(b) Application.--A public or private nonprofit entity 
desiring a grant or contract under subsection (a) shall prepare 
and submit an application to the Secretary at such time, in 
such manner, and containing such information as the Secretary 
may require.
  [(c) Authorized Activities.--A center established under a 
grant or contract under subsection (a)(1) shall--
          [(1) provide training with respect to state-of-the-
        art mental health and justice-related services and 
        successful mental health and substance abuse-justice 
        collaborations that focus on children and adolescents, 
        to public policymakers, law enforcement administrators, 
        public defenders, police, probation officers, judges, 
        parole officials, jail administrators and mental health 
        and substance abuse providers and administrators;
          [(2) engage in research and evaluations concerning 
        State and local justice and mental health systems, 
        including system redesign initiatives, and disseminate 
        information concerning the results of such evaluations;
          [(3) provide direct technical assistance, including 
        assistance provided through toll-free telephone 
        numbers, concerning issues such as how to accommodate 
        individuals who are being processed through the courts 
        under the Americans with Disabilities Act of 1990 (42 
        U.S.C. 12101 et seq.), what types of mental health or 
        substance abuse service approaches are effective within 
        the judicial system, and how community-based mental 
        health or substance abuse services can be more 
        effective, including relevant regional, ethnic, and 
        gender-related considerations; and
          [(4) provide information, training, and technical 
        assistance to State and local governmental officials to 
        enhance the capacity of such officials to provide 
        appropriate services relating to mental health or 
        substance abuse.
  [(d) Additional Center.--] (b) Responsibilities of the 
Center.--[The additional research, training, and technical 
assistance center established under subsection (a)(2) shall 
provide appropriate information, training, and technical 
assistance to States, political subdivisions of a State, 
Federally recognized Indian tribes, tribal organizations, 
institutions of higher education, public organizations, or 
private nonprofit organizations for] The center established 
under subsection (a) shall conduct activities for the purpose 
of--
          (1) [the development or continuation of] developing 
        and continuing statewide or tribal [youth suicide] 
        suicide early intervention and prevention strategies 
        for all ages, particularly among groups that are at 
        high risk for suicide;
          (2) ensuring the surveillance of [youth suicide] 
        suicide early intervention and prevention strategies 
        for all ages, particularly among groups that are at 
        high risk for suicide;
          (3) studying the costs and effectiveness of statewide 
        and tribal [youth suicide] suicide early intervention 
        and prevention strategies in order to provide 
        information concerning relevant issues of importance to 
        State, tribal, and national policymakers;
          (4) further identifying and understanding causes and 
        associated risk factors for [youth suicide] suicide;
          (5) analyzing the efficacy of new and existing [youth 
        suicide] suicide early intervention and prevention 
        techniques and technology;
          (6) ensuring the surveillance of suicidal behaviors 
        and nonfatal suicidal attempts;
          (7) studying the effectiveness of State-sponsored 
        statewide and tribal [youth suicide] suicide early 
        intervention and prevention strategies on the overall 
        wellness and health promotion strategies related to 
        suicide attempts;
          (8) promoting the sharing of data regarding [youth 
        suicide] suicide with Federal agencies involved with 
        [youth suicide] suicide early intervention and 
        prevention, and State-sponsored statewide or tribal 
        [youth suicide] suicide early intervention and 
        prevention strategies for the purpose of identifying 
        previously unknown mental health causes and associated 
        risk factors for suicide [in youth];
          (9) evaluating and disseminating outcomes and best 
        practices of mental [and behavioral health] health and 
        substance use disorder services at institutions of 
        higher education; and
          (10) conducting other activities determined 
        appropriate by the Secretary.
  [(e) Authorization of Appropriations.--
          [(1) For the purpose of awarding grants or contracts 
        under subsection (a)(1), there is authorized to be 
        appropriated $4,000,000 for fiscal year 2001, and such 
        sums as may be necessary for fiscal years 2002 and 
        2003.
          [(2) For the purpose of awarding a grant under 
        subsection (a)(2), there are authorized to be 
        appropriated $3,000,000 for fiscal year 2005, 
        $4,000,000 for fiscal year 2006, and $5,000,000 for 
        fiscal year 2007.]
  (c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $5,988,000 for each of fiscal years 2017 through 
2021.
  (d) Report.--Not later than 2 years after the date of 
enactment of the Helping Families in Mental Health Crisis Act 
of 2016, the Secretary shall submit to Congress a report on the 
activities carried out by the center established under 
subsection (a) during the year involved, including the 
potential effects of such activities, and the States, 
organizations, and institutions that have worked with the 
center.

[SEC. 520D. SERVICES FOR YOUTH OFFENDERS.

  [(a) In General.--The Secretary, acting through the Director 
of the Center for Mental Health Services, and in consultation 
with the Director of the Center for Substance Abuse Treatment, 
the Administrator of the Office of Juvenile Justice and 
Delinquency Prevention, and the Director of the Special 
Education Programs, shall award grants on a competitive basis 
to State or local juvenile justice agencies to enable such 
agencies to provide aftercare services for youth offenders who 
have been discharged from facilities in the juvenile or 
criminal justice system and have serious emotional disturbances 
or are at risk of developing such disturbances.
  [(b) Use of Funds.--A State or local juvenile justice agency 
receiving a grant under subsection (a) shall use the amounts 
provided under the grant--
          [(1) to develop a plan describing the manner in which 
        the agency will provide services for each youth 
        offender who has a serious emotional disturbance and 
        has been detained or incarcerated in facilities within 
        the juvenile or criminal justice system;
          [(2) to provide a network of core or aftercare 
        services or access to such services for each youth 
        offender, including diagnostic and evaluation services, 
        substance abuse treatment services, outpatient mental 
        health care services, medication management services, 
        intensive home-based therapy, intensive day treatment 
        services, respite care, and therapeutic foster care;
          [(3) to establish a program that coordinates with 
        other State and local agencies providing recreational, 
        social, educational, vocational, or operational 
        services for youth, to enable the agency receiving a 
        grant under this section to provide community-based 
        system of care services for each youth offender that 
        addresses the special needs of the youth and helps the 
        youth access all of the aforementioned services; and
          [(4) using not more than 20 percent of funds 
        received, to provide planning and transition services 
        as described in paragraph (3) for youth offenders while 
        such youth are incarcerated or detained.
  [(c) Application.--A State or local juvenile justice agency 
that desires a grant under subsection (a) shall submit an 
application to the Secretary at such time, in such manner, and 
accompanied by such information as the Secretary may reasonably 
require.
  [(d) Report.--Not later than 3 years after the date of the 
enactment of this section and annually thereafter, the 
Secretary shall prepare and submit, to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Committee 
on Commerce of the House of Representatives, a report that 
describes the services provided pursuant to this section.
  [(e) Definitions.--In this section:
          [(1) Serious emotional disturbance.--The term 
        ``serious emotional disturbance'' with respect to a 
        youth offender means an offender who currently, or at 
        any time within the 1-year period ending on the day on 
        which services are sought under this section, has a 
        diagnosable mental, behavioral, or emotional disorder 
        that functionally impairs the offender's life by 
        substantially limiting the offender's role in family, 
        school, or community activities, and interfering with 
        the offender's ability to achieve or maintain one or 
        more developmentally-appropriate social, behavior, 
        cognitive, communicative, or adaptive skills.
          [(2) Community-based system of care.--The term 
        ``community-based system of care'' means the provision 
        of services for the youth offender by various State or 
        local agencies that in an interagency fashion or 
        operating as a network addresses the recreational, 
        social, educational, vocational, mental health, 
        substance abuse, and operational needs of the youth 
        offender.
          [(3) Youth offender.--The term ``youth offender'' 
        means an individual who is 21 years of age or younger 
        who has been discharged from a State or local juvenile 
        or criminal justice system, except that if the 
        individual is between the ages of 18 and 21 years, such 
        individual has had contact with the State or local 
        juvenile or criminal justice system prior to attaining 
        18 years of age and is under the jurisdiction of such a 
        system at the time services are sought.
  [(f) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section $40,000,000 for 
fiscal year 2001, and such sums as may be necessary for each of 
fiscal years 2002 and 2003.]

SEC. 520E. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.

  (a) In General.--The Secretary, acting through the 
[Administrator of the Substance Abuse and Mental Health 
Services Administration] Assistant Secretary for Mental Health 
and Substance Use, shall award grants or cooperative agreements 
to eligible entities to--
          (1) develop and implement State-sponsored statewide 
        or tribal youth suicide early intervention and 
        prevention strategies in schools, educational 
        institutions, juvenile justice systems, [substance 
        abuse] substance use disorder programs, mental health 
        programs, foster care systems, and other child and 
        youth support organizations;
          (2) support public organizations and private 
        nonprofit organizations actively involved in State-
        sponsored statewide or tribal youth suicide early 
        intervention and prevention strategies and in the 
        development and continuation of State-sponsored 
        statewide youth suicide early intervention and 
        prevention strategies;
          (3) provide grants to institutions of higher 
        education to coordinate the implementation of State-
        sponsored statewide or tribal youth suicide early 
        intervention and prevention strategies;
          (4) collect and analyze data on State-sponsored 
        statewide or tribal youth suicide early intervention 
        and prevention services that can be used to monitor the 
        effectiveness of such services and for research, 
        technical assistance, and policy development; and
          (5) assist eligible entities, through State-sponsored 
        statewide or tribal youth suicide early intervention 
        and prevention strategies, in achieving targets for 
        youth suicide reductions under title V of the Social 
        Security Act.
  (b) Eligible Entity.--
          (1) Definition.--In this section, the term ``eligible 
        entity'' means--
                  (A) a State;
                  (B) a public organization or private 
                nonprofit organization designated by a State to 
                develop or direct the State-sponsored statewide 
                youth suicide early intervention and prevention 
                strategy; or
                  (C) a Federally recognized Indian tribe or 
                tribal organization (as defined in the Indian 
                Self-Determination and Education Assistance 
                Act) or an urban Indian organization (as 
                defined in the Indian Health Care Improvement 
                Act) that is actively involved in the 
                development and continuation of a tribal youth 
                suicide early intervention and prevention 
                strategy.
          (2) Limitation.--In carrying out this section, the 
        Secretary shall ensure that [each State is awarded only 
        1 grant or cooperative agreement under this section] a 
        State does not receive more than 1 grant or cooperative 
        agreement under this section at any 1 time. For 
        purposes of the preceding sentence, a State shall be 
        considered to have [been awarded] received a grant or 
        cooperative agreement if the eligible entity involved 
        is the State or an entity designated by the State under 
        paragraph (1)(B). Nothing in this paragraph shall be 
        construed to apply to entities described in paragraph 
        (1)(C).
  (c) Preference.--In providing assistance under a grant or 
cooperative agreement under this section, an eligible entity 
shall give preference to public organizations, private 
nonprofit organizations, political subdivisions, institutions 
of higher education, and tribal organizations actively involved 
with the State-sponsored statewide or tribal youth suicide 
early intervention and prevention strategy that--
          (1) provide early intervention and assessment 
        services, including screening programs, to youth who 
        are at risk for mental or emotional disorders that may 
        lead to a suicide attempt, and that are integrated with 
        school systems, educational institutions, juvenile 
        justice systems, [substance abuse] substance use 
        disorder programs, mental health programs, foster care 
        systems, and other child and youth support 
        organizations;
          (2) demonstrate collaboration among early 
        intervention and prevention services or certify that 
        entities will engage in future collaboration;
          (3) employ or include in their applications a 
        commitment to evaluate youth suicide early intervention 
        and prevention practices and strategies adapted to the 
        local community;
          (4) provide timely referrals for appropriate 
        community-based mental health care and treatment of 
        youth who are at risk for suicide in child-serving 
        settings and agencies;
          (5) provide immediate support and information 
        resources to families of youth who are at risk for 
        suicide;
          (6) offer access to services and care to youth with 
        diverse linguistic and cultural backgrounds;
          (7) offer appropriate postsuicide intervention 
        services, care, and information to families, friends, 
        schools, educational institutions, juvenile justice 
        systems, substance abuse programs, mental health 
        programs, foster care systems, and other child and 
        youth support organizations of youth who recently 
        completed suicide;
          (8) offer continuous and up-to-date information and 
        awareness campaigns that target parents, family 
        members, child care professionals, community care 
        providers, and the general public and highlight the 
        risk factors associated with youth suicide and the 
        life-saving help and care available from early 
        intervention and prevention services;
          (9) ensure that information and awareness campaigns 
        on youth suicide risk factors, and early intervention 
        and prevention services, use effective communication 
        mechanisms that are targeted to and reach youth, 
        families, schools, educational institutions, and youth 
        organizations;
          (10) provide a timely response system to ensure that 
        child-serving professionals and providers are properly 
        trained in youth suicide early intervention and 
        prevention strategies and that child-serving 
        professionals and providers involved in early 
        intervention and prevention services are properly 
        trained in effectively identifying youth who are at 
        risk for suicide;
          (11) provide continuous training activities for child 
        care professionals and community care providers on the 
        latest youth suicide early intervention and prevention 
        services practices and strategies;
          (12) conduct annual self-evaluations of outcomes and 
        activities, including consulting with interested 
        families and advocacy organizations;
          (13) provide services in areas or regions with rates 
        of youth suicide that exceed the national average as 
        determined by the Centers for Disease Control and 
        Prevention; and
          (14) obtain informed written consent from a parent or 
        legal guardian of an at-risk child before involving the 
        child in a youth suicide early intervention and 
        prevention program.
  (d) Requirement for Direct Services.--Not less than 85 
percent of grant funds received under this section shall be 
used to provide direct services, of which not less than 5 
percent shall be used for activities authorized under 
subsection (a)(3).
  (e) Coordination and Collaboration.--
          (1) In general.--In carrying out this section, the 
        Secretary shall collaborate with relevant Federal 
        agencies and suicide working groups responsible for 
        early intervention and prevention services relating to 
        youth suicide.
          (2) Consultation.--In carrying out this section, the 
        Secretary shall consult with--
                  (A) State and local agencies, including 
                agencies responsible for early intervention and 
                prevention services under title XIX of the 
                Social Security Act, the State Children's 
                Health Insurance Program under title XXI of the 
                Social Security Act, and programs funded by 
                grants under title V of the Social Security 
                Act;
                  (B) local and national organizations that 
                serve youth at risk for suicide and their 
                families;
                  (C) relevant national medical and other 
                health and education specialty organizations;
                  (D) youth who are at risk for suicide, who 
                have survived suicide attempts, or who are 
                currently receiving care from early 
                intervention services;
                  (E) families and friends of youth who are at 
                risk for suicide, who have survived suicide 
                attempts, who are currently receiving care from 
                early intervention and prevention services, or 
                who have completed suicide;
                  (F) qualified professionals who possess the 
                specialized knowledge, skills, experience, and 
                relevant attributes needed to serve youth at 
                risk for suicide and their families; and
                  (G) third-party payers, managed care 
                organizations, and related commercial 
                industries.
          (3) Policy development.--In carrying out this 
        section, the Secretary shall--
                  (A) coordinate and collaborate on policy 
                development at the Federal level with the 
                relevant Department of Health and Human 
                Services agencies and suicide working groups; 
                and
                  (B) consult on policy development at the 
                Federal level with the private sector, 
                including consumer, medical, suicide prevention 
                advocacy groups, and other health and education 
                professional-based organizations, with respect 
                to State-sponsored statewide or tribal youth 
                suicide early intervention and prevention 
                strategies.
  (f) Rule of Construction; Religious and Moral 
Accommodation.--Nothing in this section shall be construed to 
require suicide assessment, early intervention, or treatment 
services for youth whose parents or legal guardians object 
based on the parents' or legal guardians' religious beliefs or 
moral objections.
  (g) Evaluations and Report.--
          (1) Evaluations by eligible entities.--Not later than 
        18 months after receiving a grant or cooperative 
        agreement under this section, an eligible entity shall 
        submit to the Secretary the results of an evaluation to 
        be conducted by the entity concerning the effectiveness 
        of the activities carried out under the grant or 
        agreement.
          (2) Report.--Not later than 2 years after the date of 
        enactment of this section, the Secretary shall submit 
        to the appropriate committees of Congress a report 
        concerning the results of--
                  (A) the evaluations conducted under paragraph 
                (1); and
                  (B) an evaluation conducted by the Secretary 
                to analyze the effectiveness and efficacy of 
                the activities conducted with grants, 
                collaborations, and consultations under this 
                section.
  (h) Rule of Construction; Student Medication.--Nothing in 
this section or section 520E-1 shall be construed to allow 
school personnel to require that a student obtain any 
medication as a condition of attending school or receiving 
services.
  (i) Prohibition.--Funds appropriated to carry out this 
section, section 520C, section 520E-1, or section 520E-2 shall 
not be used to pay for or refer for abortion.
  (j) Parental consent.--States and entities receiving funding 
under this section and section 520E-1 shall obtain prior 
written, informed consent from the child's parent or legal 
guardian for assessment services, school-sponsored programs, 
and treatment involving medication related to youth suicide 
conducted in elementary and secondary schools. The requirement 
of the preceding sentence does not apply in the following 
cases:
          (1) In an emergency, where it is necessary to protect 
        the immediate health and safety of the student or other 
        students.
          (2) Other instances, as defined by the State, where 
        parental consent cannot reasonably be obtained.
  (k) Relation to Education Provisions.--Nothing in this 
section or section 520E-1 shall be construed to supersede 
section 444 of the General Education Provisions Act, including 
the requirement of prior parental consent for the disclosure of 
any education records. Nothing in this section or section 520E-
1 shall be construed to modify or affect parental notification 
requirements for programs authorized under the Elementary and 
Secondary Education Act of 1965 (as amended by the No Child 
Left Behind Act of 2001; Public Law 107-110).
  (l) Definitions.--In this section:
          (1) Early intervention.--The term ``early 
        intervention'' means a strategy or approach that is 
        intended to prevent an outcome or to alter the course 
        of an existing condition.
          (2) Educational institution; institution of higher 
        education; school.--The term--
                  (A) ``educational institution'' means a 
                school or institution of higher education;
                  (B) ``institution of higher education'' has 
                the meaning given such term in section 101 of 
                the Higher Education Act of 1965; and
                  (C) ``school'' means an elementary school or 
                secondary school (as such terms are defined in 
                section 8101 of the Elementary and Secondary 
                Education Act of 1965).
          (3) Prevention.--The term ``prevention'' means a 
        strategy or approach that reduces the likelihood or 
        risk of onset, or delays the onset, of adverse health 
        problems that have been known to lead to suicide.
          (4) Youth.--The term ``youth'' means individuals who 
        are between 10 and 24 years of age.
  [(m) Authorization of Appropriations.--
          [(1) In general.--For the purpose of carrying out 
        this section, there are authorized to be appropriated 
        $7,000,000 for fiscal year 2005, $18,000,000 for fiscal 
        year 2006, and $30,000,000 for fiscal year 2007.
          [(2) Preference.--If less than $3,500,000 is 
        appropriated for any fiscal year to carry out this 
        section, in awarding grants and cooperative agreements 
        under this section during the fiscal year, the 
        Secretary shall give preference to States that have 
        rates of suicide that significantly exceed the national 
        average as determined by the Centers for Disease 
        Control and Prevention.]
  (m) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $35,427,000 for each of fiscal years 2017 through 
2021.

           *       *       *       *       *       *       *


SEC. 520E-2. MENTAL [AND BEHAVIORAL HEALTH]  HEALTH AND SUBSTANCE USE 
                    DISORDER SERVICES ON CAMPUS.

  (a) In General.--The Secretary, acting through the Director 
of the Center for Mental Health [Services,] Services and in 
consultation with the Secretary of Education, may award grants 
on a competitive basis to institutions of higher education to 
enhance services for students with mental [and behavioral 
health problems] health or substance use disorders that can 
lead to school failure, such as depression, [substance abuse] 
substance use disorders, and suicide attempts, so that students 
will successfully complete their studies.
  (b) Use of Funds.--The Secretary may not make a grant to an 
institution of higher education under this section unless the 
institution agrees to use the grant only [for--] for one or 
more of the following:
          [(1) educational seminars;
          [(2) the operation of hot lines;
          [(3) preparation of informational material;
          [(4) preparation of educational materials for 
        families of students to increase awareness of potential 
        mental and behavioral health issues of students 
        enrolled at the institution of higher education;
          [(5) training programs for students and campus 
        personnel to respond effectively to students with 
        mental and behavioral health problems that can lead to 
        school failure, such as depression, substance abuse, 
        and suicide attempts; or
          [(6) the creation of a networking infrastructure to 
        link colleges and universities that do not have mental 
        health services with health care providers who can 
        treat mental and behavioral health problems.]
          (1) Educating students, families, faculty, and staff 
        to increase awareness of mental health and substance 
        use disorders.
          (2) The operation of hotlines.
          (3) Preparing informational material.
          (4) Providing outreach services to notify students 
        about available mental health and substance use 
        disorder services.
          (5) Administering voluntary mental health and 
        substance use disorder screenings and assessments.
          (6) Supporting the training of students, faculty, and 
        staff to respond effectively to students with mental 
        health and substance use disorders.
          (7) Creating a network infrastructure to link 
        colleges and universities with health care providers 
        who treat mental health and substance use disorders.
  (c) Eligible grant recipients.--Any institution of higher 
education receiving a grant under this section may carry out 
activities under the grant through--
          (1) college counseling centers;
          (2) college and university psychological service 
        centers;
          (3) mental health centers;
          (4) psychology training clinics; or
          (5) institution of higher education supported, 
        evidence-based, mental health and [substance abuse] 
        substance use disorder programs.
  (d) Application.--[An institution of higher education 
desiring a grant under this section] To be eligible to receive 
a grant under this section, an institution of higher education 
shall prepare and submit an application to the Secretary at 
such time and in such manner as the Secretary may require. At a 
minimum, the application shall include the following:
          (1) A description of identified mental [and 
        behavioral health] health and substance use disorder 
        needs of students, including veterans whenever possible 
        and appropriate, at the institution of higher 
        education.
          (2) A description of Federal, State, local, private, 
        and institutional resources currently available to 
        address the needs described in paragraph (1) at the 
        institution of higher education, which may include, as 
        appropriate and in accordance with subsection (b)(7), a 
        plan to seek input from relevant stakeholders in the 
        community, including appropriate public and private 
        entities, in order to carry out the program under the 
        grant.
          (3) A description of the outreach strategies of the 
        institution of higher education for promoting access to 
        services, including a proposed plan for reaching those 
        students most in need of mental health services.
          (4) A plan to evaluate program outcomes, including a 
        description of the proposed use of funds, the program 
        objectives, and how the objectives will be met.
          (5) An assurance that the institution will submit a 
        report to the Secretary each fiscal year on the 
        activities carried out with the grant and the results 
        achieved through those activities.
  (e) Requirement of Matching Funds.--
          (1) In general.--The Secretary may make a grant under 
        this section to an institution of higher education only 
        if the institution agrees to make available (directly 
        or through donations from public or private entities) 
        non-Federal contributions in an amount that is not less 
        than $1 for each $1 of Federal funds provided in the 
        grant, toward the costs of activities carried out with 
        the grant (as described in subsection (b)) and other 
        activities by the institution to reduce student mental 
        [and behavioral health problems] health and substance 
        use disorders.
          (2) Determination of amount contributed.--Non-Federal 
        contributions required under paragraph (1) may be in 
        cash or in kind. Amounts provided by the Federal 
        Government, or services assisted or subsidized to any 
        significant extent by the Federal Government, may not 
        be included in determining the amount of such non-
        Federal contributions.
          (3) Waiver.--The Secretary may waive the requirement 
        established in paragraph (1) with respect to an 
        institution of higher education if the Secretary 
        determines that extraordinary need at the institution 
        justifies the waiver.
  (f) Reports.--For each fiscal year that grants are awarded 
under this section, the Secretary shall conduct a study on the 
results of the grants and submit to the Congress a report on 
such results that includes the following:
          (1) An evaluation of the grant program outcomes, 
        including a summary of activities carried out with the 
        grant and the results achieved through those 
        activities.
          (2) Recommendations on how to improve access to 
        mental [and behavioral health] health and substance use 
        disorder services at institutions of higher education, 
        including efforts to reduce the incidence of [suicide 
        and substance abuse] suicide and substance use 
        disorders.
  (g) Definition.--In this section, the term ``institution of 
higher education'' has the meaning given such term in section 
101 of the Higher Education Act of 1965.
  (h) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated [$5,000,000 for fiscal year 2005, $5,000,000 for 
fiscal year 2006, and $5,000,000 for fiscal year 2007.] 
$6,488,000 for each of fiscal years 2017 through 2021.

SEC. 520E-3. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.

  (a) In General.--The Secretary, acting through the Assistant 
Secretary, shall maintain the National Suicide Prevention 
Lifeline Program (referred to in this section as the 
``Program''), authorized under section 520A and in effect prior 
to the date of enactment of the Helping Families in Mental 
Health Crisis Act of 2016.
  (b) Activities.--In maintaining the Program, the activities 
of the Secretary shall include--
          (1) coordinating a network of crisis centers across 
        the United States for providing suicide prevention and 
        crisis intervention services to individuals seeking 
        help at any time, day or night;
          (2) maintaining a suicide prevention hotline to link 
        callers to local emergency, mental health, and social 
        services resources; and
          (3) consulting with the Secretary of Veterans Affairs 
        to ensure that veterans calling the suicide prevention 
        hotline have access to a specialized veterans' suicide 
        prevention hotline.
  (c) Authorization of Appropriations.--To carry out this 
section, there are authorized to be appropriated $7,198,000 for 
each of fiscal years 2017 through 2021.

[SEC. 520F. GRANTS FOR EMERGENCY MENTAL HEALTH CENTERS.

  [(a) Program Authorized.--The Secretary shall award grants to 
States, political subdivisions of States, Indian tribes, and 
tribal organizations to support the designation of hospitals 
and health centers as Emergency Mental Health Centers.
  [(b) Health Center.--In this section, the term ``health 
center'' has the meaning given such term in section 330, and 
includes community health centers and community mental health 
centers.
  [(c) Distribution of Awards.--The Secretary shall ensure that 
such grants awarded under subsection (a) are equitably 
distributed among the geographical regions of the United 
States, between urban and rural populations, and between 
different settings of care including health centers, mental 
health centers, hospitals, and other psychiatric units or 
facilities.
  [(d) Application.--A State, political subdivision of a State, 
Indian tribe, or tribal organization that desires a grant under 
subsection (a) shall submit an application to the Secretary at 
such time, in such manner, and containing such information as 
the Secretary may require, including a plan for the rigorous 
evaluation of activities carried out with funds received under 
this section.
  [(e) Use of Funds.--
          [(1) In general.--A State, political subdivision of a 
        State, Indian tribe, or tribal organization receiving a 
        grant under subsection (a) shall use funds from such 
        grant to establish or designate hospitals and health 
        centers as Emergency Mental Health Centers.
          [(2) Emergency mental health centers.--Such Emergency 
        Mental Health Centers described in paragraph (1)--
                  [(A) shall--
                          [(i) serve as a central receiving 
                        point in the community for individuals 
                        who may be in need of emergency mental 
                        health services;
                          [(ii) purchase, if needed, any 
                        equipment necessary to evaluate, 
                        diagnose and stabilize an individual 
                        with a mental illness;
                          [(iii) provide training, if needed, 
                        to the medical personnel staffing the 
                        Emergency Mental Health Center to 
                        evaluate, diagnose, stabilize, and 
                        treat an individual with a mental 
                        illness; and
                          [(iv) provide any treatment that is 
                        necessary for an individual with a 
                        mental illness or a referral for such 
                        individual to another facility where 
                        such treatment may be received; and
                  [(B) may establish and train a mobile crisis 
                intervention team to respond to mental health 
                emergencies within the community.
  [(f) Evaluation.--A State, political subdivision of a State, 
Indian tribe, or tribal organization that receives a grant 
under subsection (a) shall prepare and submit an evaluation to 
the Secretary at such time, in such manner, and containing such 
information as the Secretary may reasonably require, including 
an evaluation of activities carried out with funds received 
under this section and a process and outcomes evaluation.
  [(g) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $25,000,000 for 
fiscal year 2001 and such sums as may be necessary for each of 
the fiscal years 2002 through 2003.]

SEC. 520F. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.

  (a) In General.--The Secretary shall award competitive 
grants--
          (1) to State and local governments and Indian tribes 
        and tribal organizations to enhance community-based 
        crisis response systems; or
          (2) to States to develop, maintain, or enhance a 
        database of beds at inpatient psychiatric facilities, 
        crisis stabilization units, and residential community 
        mental health and residential substance use disorder 
        treatment facilities, for individuals with serious 
        mental illness, serious emotional disturbance, or 
        substance use disorders.
  (b) Application.--
          (1) In general.--To receive a grant or cooperative 
        agreement under subsection (a), an entity shall submit 
        to the Secretary an application, at such time, in such 
        manner, and containing such information as the 
        Secretary may require.
          (2) Community-based crisis response plan.--An 
        application for a grant under subsection (a)(1) shall 
        include a plan for--
                  (A) promoting integration and coordination 
                between local public and private entities 
                engaged in crisis response, including first 
                responders, emergency health care providers, 
                primary care providers, law enforcement, court 
                systems, health care payers, social service 
                providers, and behavioral health providers;
                  (B) developing a plan for entering into 
                memoranda of understanding with public and 
                private entities to implement crisis response 
                services;
                  (C) expanding the continuum of community-
                based services to address crisis intervention 
                and prevention; and
                  (D) developing models for minimizing hospital 
                readmissions, including through appropriate 
                discharge planning.
          (3) Beds database plan.--An application for a grant 
        under subsection (a)(2) shall include a plan for 
        developing, maintaining, or enhancing a real-time 
        Internet-based bed database to collect, aggregate, and 
        display information about beds in inpatient psychiatric 
        facilities and crisis stabilization units, and 
        residential community mental health and residential 
        substance use disorder treatment facilities, to 
        facilitate the identification and designation of 
        facilities for the temporary treatment of individuals 
        in mental or substance use disorder crisis.
  (c) Database Requirements.--A bed database described in this 
section is a database that--
          (1) includes information on inpatient psychiatric 
        facilities, crisis stabilization units, and residential 
        community mental health and residential substance use 
        disorder facilities in the State involved, including 
        contact information for the facility or unit;
          (2) provides real-time information about the number 
        of beds available at each facility or unit and, for 
        each available bed, the type of patient that may be 
        admitted, the level of security provided, and any other 
        information that may be necessary to allow for the 
        proper identification of appropriate facilities for 
        treatment of individuals in mental or substance use 
        disorder crisis; and
          (3) enables searches of the database to identify 
        available beds that are appropriate for the treatment 
        of individuals in mental or substance use disorder 
        crisis.
  (d) Evaluation.--An entity receiving a grant under subsection 
(a)(1) shall submit to the Secretary, at such time, in such 
manner, and containing such information as the Secretary may 
reasonably require, a report, including an evaluation of the 
effect of such grant on--
          (1) local crisis response services and measures of 
        individuals receiving crisis planning and early 
        intervention supports;
          (2) individuals reporting improved functional 
        outcomes; and
          (3) individuals receiving regular followup care 
        following a crisis.
  (e) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $5,000,000 for the 
period of fiscal years 2018 through 2022.

           *       *       *       *       *       *       *


[SEC. 520H. IMPROVING OUTCOMES FOR CHILDREN AND ADOLESCENTS THROUGH 
                    SERVICES INTEGRATION BETWEEN CHILD WELFARE AND 
                    MENTAL HEALTH SERVICES.

  [(a) In General.--The Secretary shall award grants, contracts 
or cooperative agreements to States, political subdivisions of 
States, Indian tribes, and tribal organizations to provide 
integrated child welfare and mental health services for 
children and adolescents under 19 years of age in the child 
welfare system or at risk for becoming part of the system, and 
parents or caregivers with a mental illness or a mental illness 
and a co-occurring substance abuse disorder.
  [(b) Duration.--With respect to a grant, contract or 
cooperative agreement awarded under this section, the period 
during which payments under such award are made to the 
recipient may not exceed 5 years.
  [(c) Application.--
          [(1) In general.--To be eligible to receive an award 
        under subsection (a), a State, political subdivision of 
        a State, Indian tribe, or tribal organization shall 
        submit an application to the Secretary at such time, in 
        such manner, and accompanied by such information as the 
        Secretary may reasonably require.
          [(2) Content.--An application submitted under 
        paragraph (1) shall--
                  [(A) describe the program to be funded under 
                the grant, contract or cooperative agreement;
                  [(B) explain how such program reflects best 
                practices in the provision of child welfare and 
                mental health services; and
                  [(C) provide assurances that--
                          [(i) persons providing services under 
                        the grant, contract or cooperative 
                        agreement are adequately trained to 
                        provide such services; and
                          [(ii) the services will be provided 
                        in accordance with subsection (d).
  [(d) Use of Funds.--A State, political subdivision of a 
State, Indian tribe, or tribal organization that receives a 
grant, contract, or cooperative agreement under subsection (a) 
shall use amounts made available through such grant, contract 
or cooperative agreement to--
          [(1) provide family-centered, comprehensive, and 
        coordinated child welfare and mental health services, 
        including prevention, early intervention and treatment 
        services for children and adolescents, and for their 
        parents or caregivers;
          [(2) ensure a single point of access for such 
        coordinated services;
          [(3) provide integrated mental health and substance 
        abuse treatment for children, adolescents, and parents 
        or caregivers with a mental illness and a co-occurring 
        substance abuse disorder;
          [(4) provide training for the child welfare, mental 
        health and substance abuse professionals who will 
        participate in the program carried out under this 
        section;
          [(5) provide technical assistance to child welfare 
        and mental health agencies;
          [(6) develop cooperative efforts with other service 
        entities in the community, including education, social 
        services, juvenile justice, and primary health care 
        agencies;
          [(7) coordinate services with services provided under 
        the Medicaid program and the State Children's Health 
        Insurance Program under titles XIX and XXI of the 
        Social Security Act;
          [(8) provide linguistically appropriate and 
        culturally competent services; and
          [(9) evaluate the effectiveness and cost-efficiency 
        of the integrated services that measure the level of 
        coordination, outcome measures for parents or 
        caregivers with a mental illness or a mental illness 
        and a co-occurring substance abuse disorder, and 
        outcome measures for children.
  [(e) Distribution of Awards.--The Secretary shall ensure that 
grants, contracts, and cooperative agreements awarded under 
subsection (a) are equitably distributed among the geographical 
regions of the United States and between urban and rural 
populations.
  [(f) Evaluation.--The Secretary shall evaluate each program 
carried out by a State, political subdivision of a State, 
Indian tribe, or tribal organization under subsection (a) and 
shall disseminate the findings with respect to each such 
evaluation to appropriate public and private entities.
  [(g) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $10,000,000 for 
fiscal year 2001, and such sums as may be necessary for each of 
fiscal years 2002 and 2003.]

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SEC. 520K. AWARDS FOR CO-LOCATING PRIMARY AND SPECIALTY CARE IN 
                    COMMUNITY-BASED MENTAL HEALTH SETTINGS.

  (a) Definitions.--In this section:
          (1) Eligible entity.--The term ``eligible entity'' 
        means a qualified community mental health program 
        defined under section 1913(b)(1).
          (2) Special populations.--The term ``special 
        populations'' means adults with mental illnesses who 
        have co-occurring primary care conditions and chronic 
        diseases.
  (b) Program Authorized.--The Secretary, acting through the 
[Administrator] Assistant Secretary shall award grants and 
cooperative agreements to eligible entities to establish 
demonstration projects for the provision of coordinated and 
integrated services to special populations through the co-
location of primary and specialty care services in community-
based mental and behavioral health settings.
  (c) Application.--To be eligible to receive a grant or 
cooperative agreement under this section, an eligible entity 
shall submit an application to the [Administrator] Assistant 
Secretary at such time, in such manner, and accompanied by such 
information as the [Administrator] Assistant Secretary may 
require, including a description of partnerships, or other 
arrangements with local primary care providers, including 
community health centers, to provide services to special 
populations.
  (d) Use of Funds.--
          (1) In general.--For the benefit of special 
        populations, an eligible entity shall use funds awarded 
        under this section for--
                  (A) the provision, by qualified primary care 
                professionals, of on site primary care 
                services;
                  (B) reasonable costs associated with 
                medically necessary referrals to qualified 
                specialty care professionals, other 
                coordinators of care or, if permitted by the 
                terms of the grant or cooperative agreement, by 
                qualified specialty care professionals on a 
                reasonable cost basis on site at the eligible 
                entity;
                  (C) information technology required to 
                accommodate the clinical needs of primary and 
                specialty care professionals; or
                  (D) facility modifications needed to bring 
                primary and specialty care professionals on 
                site at the eligible entity.
          (2) Limitation.--Not to exceed 15 percent of grant or 
        cooperative agreement funds may be used for activities 
        described in subparagraphs (C) and (D) of paragraph 
        (1).
  (e) Evaluation.--Not later than 90 days after a grant or 
cooperative agreement awarded under this section expires, an 
eligible entity shall submit to the Secretary the results of an 
evaluation to be conducted by the entity concerning the 
effectiveness of the activities carried out under the grant or 
agreement.
  (f) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section, $50,000,000 for 
fiscal year 2010 and such sums as may be necessary for each of 
fiscal years 2011 through 2014.

     Subpart 4--Center for Behavioral Health Statistics and Quality

SEC. 520L. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.

  (a) Establishment.--There is established in the 
Administration a Center for Behavioral Health Statistics and 
Quality (in this section referred to as the ``Center''). The 
Center shall be headed by a Director (in this section referred 
to as the ``Director'') appointed by the Secretary from among 
individuals with extensive experience and academic 
qualifications in research and analysis in behavioral health 
care or related fields.
  (b) Duties.--The Director of the Center shall--
          (1) coordinate the Administration's integrated data 
        strategy by coordinating--
                  (A) surveillance and data collection 
                (including that authorized by section 505);
                  (B) evaluation;
                  (C) statistical and analytic support;
                  (D) service systems research; and
                  (E) performance and quality information 
                systems;
          (2) recommend a core set of measurement standards for 
        grant programs administered by the Administration; and
          (3) coordinate evaluation efforts for the grant 
        programs, contracts, and collaborative agreements of 
        the Administration.
  (c) Biannual Report to Congress.--Not later than 2 years 
after the date of enactment of this section, and every 2 years 
thereafter, the Director of the Center shall submit to Congress 
a report on the quality of services furnished through grant 
programs of the Administration, including applicable measures 
of outcomes for individuals and public outcomes such as--
          (1) the number of patients screened positive for 
        unhealthy alcohol use who receive brief counseling as 
        appropriate; the number of patients screened positive 
        for tobacco use and receiving smoking cessation 
        interventions; the number of patients with a new 
        diagnosis of major depressive episode who are assessed 
        for suicide risk; the number of patients screened 
        positive for clinical depression with a documented 
        followup plan; and the number of patients with a 
        documented pain assessment that have a followup 
        treatment plan when pain is present; and satisfaction 
        with care;
          (2) the incidence and prevalence of substance use and 
        mental disorders; the number of suicide attempts and 
        suicide completions; overdoses seen in emergency rooms 
        resulting from alcohol and drug use; emergency room 
        boarding; overdose deaths; emergency psychiatric 
        hospitalizations; new criminal justice involvement 
        while in treatment; stable housing; and rates of 
        involvement in employment, education, and training; and
          (3) such other measures for outcomes of services as 
        the Director may determine.
  (d) Staffing Composition.--The staff of the Center may 
include individuals with advanced degrees and field expertise 
as well as clinical and research experience in mental and 
substance use disorders such as--
          (1) professionals with clinical and research 
        expertise in the prevention and treatment of, and 
        recovery from, substance use and mental disorders;
          (2) professionals with training and expertise in 
        statistics or research and survey design and 
        methodologies; and
          (3) other related fields in the social and behavioral 
        sciences, as specified by relevant position 
        descriptions.
  (e) Grants and Contracts.--In carrying out the duties 
established in subsection (b), the Director may make grants to 
and enter into contracts and cooperative agreements with public 
and nonprofit private entities.
  (f) Definition.--In this section, the term ``emergency room 
boarding'' means the practice of admitting patients to an 
emergency department and holding such patients in the 
department until inpatient psychiatric beds become available.

SEC. 520M. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR INDIVIDUALS 
                    WITH SERIOUS MENTAL ILLNESS.

  (a) In General.--The Assistant Secretary shall award grants 
to eligible entities--
          (1) to establish assertive community treatment 
        programs for individuals with serious mental illness; 
        or
          (2) to maintain or expand such programs.
  (b) Eligible Entities.--To be eligible to receive a grant 
under this section, an entity shall be a State, county, city, 
tribe, tribal organization, mental health system, health care 
facility, or any other entity the Assistant Secretary deems 
appropriate.
  (c) Special Consideration.--In selecting among applicants for 
a grant under this section, the Assistant Secretary may give 
special consideration to the potential of the applicant's 
program to reduce hospitalization, homelessness, and 
involvement with the criminal justice system while improving 
the health and social outcomes of the patient.
  (d) Additional Activities.--The Assistant Secretary shall--
          (1) not later than the end of fiscal year 2021, 
        submit a report to the appropriate congressional 
        committees on the grant program under this section, 
        including an evaluation of--
                  (A) cost savings and public health outcomes 
                such as mortality, suicide, substance abuse, 
                hospitalization, and use of services;
                  (B) rates of involvement with the criminal 
                justice system of patients;
                  (C) rates of homelessness among patients; and
                  (D) patient and family satisfaction with 
                program participation; and
          (2) provide appropriate information, training, and 
        technical assistance to grant recipients under this 
        section to help such recipients to establish, maintain, 
        or expand their assertive community treatment programs.
  (e) Authorization of Appropriations.--
          (1) In general.--To carry out this section, there is 
        authorized to be appropriated $5,000,000 for the period 
        of fiscal years 2018 through 2022.
          (2) Use of certain funds.--Of the funds appropriated 
        to carry out this section in any fiscal year, no more 
        than 5 percent shall be available to the Assistant 
        Secretary for carrying out subsection (d).

Part C--Projects for Assistance in Transition From Homelessness

           *       *       *       *       *       *       *


SEC. 528. REQUIREMENT OF REPORTS BY STATES.

  (a) In General.--The Secretary may not make payments under 
section 521 unless the State involved agrees that, by not later 
than January 31 of each fiscal year, the State will prepare and 
submit to the Secretary a report in such form and containing 
such information as the Secretary determines (after 
consultation with the [Administrator of the Substance Abuse and 
Mental Health Services Administration] Assistant Secretary for 
Mental Health and Substance Use) to be necessary for--
          (1) securing a record and a description of the 
        purposes for which amounts received under section 521 
        were expended during the preceding fiscal year and of 
        the recipients of such amounts; and
          (2) determining whether such amounts were expended in 
        accordance with the provisions of this part.
  (b) Availability to Public of Reports.--The Secretary may not 
make payments under section 521 unless the State involved 
agrees to make copies of the reports described in subsection 
(a) available for public inspection.
  (c) Evaluations by Comptroller General.--The [Administrator 
of the Substance Abuse and Mental Health Services 
Administration] Assistant Secretary for Mental Health and 
Substance Use shall evaluate at least once every 3 years the 
expenditures of grants under this part by eligible entities in 
order to ensure that expenditures are consistent with the 
provisions of this part, and shall include in such evaluation 
recommendations regarding changes needed in program design or 
operations.

           *       *       *       *       *       *       *


Part D--Miscellaneous Provisions Relating to Substance Abuse and Mental 
                                 Health

SEC. 541. 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 
        Services Administration] Assistant Secretary for Mental 
        Health and Substance Use, 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 and 
                Mental Health Services Administration] 
                Assistant Secretary for Mental Health and 
                Substance Use, shall develop a variety of model 
                programs suitable for replication on a cost-
                effective basis in different types of business 
                concerns and State and local governmental 
                entities.
                  (B) Dissemination of information.--The 
                Secretary, acting through the [Administrator of 
                the Substance Abuse and Mental Health Services 
                Administration] Assistant Secretary for Mental 
                Health and Substance Use, shall disseminate 
                information and materials relative to such 
                model programs to the State agencies 
                responsible for the administration 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 
        employment 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 Government 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 agency or 
                department to be a sensitive position.
          (3) Rehabilitation Act.--The inapplicability of the 
        prohibition described in paragraph (1) to the 
        employment 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 employment.
  (c) Construction.--This section shall not be construed to 
prohibit the dismissal from employment of a Federal civilian 
employee who cannot properly function in his employment.

           *       *       *       *       *       *       *


SEC. 544. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED PROGRAMS 
                    AND PRACTICES.

  (a) In General.--The Assistant Secretary shall improve access 
to reliable and valid information on evidence-based programs 
and practices, including information on the strength of 
evidence associated with such programs and practices, related 
to mental and substance use disorders for States, local 
communities, nonprofit entities, and other stakeholders by 
posting on the website of the National Registry of Evidence-
Based Programs and Practices evidence-based programs and 
practices that have been reviewed by the Assistant Secretary 
pursuant to the requirements of this section.
  (b) Notice.--
          (1) Periods.--In carrying out subsection (a), the 
        Assistant Secretary may establish an initial period for 
        the submission of applications for evidence-based 
        programs and practices to be posted publicly in 
        accordance with subsection (a) (and may establish 
        subsequent such periods). The Assistant Secretary shall 
        publish notice of such application periods in the 
        Federal Register.
          (2) Addressing gaps.--Such notice may solicit 
        applications for evidence-based practices and programs 
        to address gaps in information identified by the 
        Assistant Secretary, the Assistant Secretary for 
        Planning and Evaluation, the Assistant Secretary for 
        Financial Resources, or the National Mental Health and 
        Substance Use Policy Laboratory, including pursuant to 
        priorities identified in the strategic plan established 
        under section 501(l).
  (c) Requirements.--The Assistant Secretary shall establish 
minimum requirements for applications referred to in this 
section, including applications related to the submission of 
research and evaluation.
  (d) Review and Rating.--The Assistant Secretary shall review 
applications prior to public posting, and may prioritize the 
review of applications for evidence-based practices and 
programs that are related to topics included in the notice 
established under subsection (b). The Assistant Secretary shall 
utilize a rating and review system, which shall include 
information on the strength of evidence associated with such 
programs and practices and a rating of the methodological rigor 
of the research supporting the application. The Assistant 
Secretary shall make the metrics used to evaluate applications 
and the resulting ratings publicly available.

           *       *       *       *       *       *       *


Part G--Projects for Children and Violence

           *       *       *       *       *       *       *


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

  (a) In General.--The Secretary shall award grants, contracts 
or cooperative agreements to public and nonprofit private 
entities, as well as to Indian tribes and tribal organizations, 
for the purpose of [developing programs focusing on the 
behavioral and biological aspects of psychological trauma 
response and for developing knowledge with regard to evidence-
based practices for treating psychiatric disorders of children 
and youth resulting from witnessing or experiencing a traumatic 
event.] developing and maintaining programs that provide for--
          (1) the continued operation of the National Child 
        Traumatic Stress Initiative (referred to in this 
        section as the ``NCTSI''), which includes a 
        coordinating center that focuses on the mental, 
        behavioral, and biological aspects of psychological 
        trauma response; and
          (2) the development of knowledge with regard to 
        evidence-based practices for identifying and treating 
        mental disorders, behavioral disorders, and physical 
        health conditions of children and youth resulting from 
        witnessing or experiencing a traumatic event.
  (b) Priorities.--In awarding grants, contracts or cooperative 
agreements under [subsection (a) related] subsection (a)(2) 
(related to the development of knowledge on evidence-based 
practices for [treating disorders associated with psychological 
trauma] treating mental, behavioral, and biological disorders 
associated with psychological trauma), the Secretary shall give 
priority to [mental health agencies and programs that have 
established clinical and basic research] universities, 
hospitals, mental health agencies, and other programs that have 
established clinical expertise and research experience in the 
field of trauma-related mental disorders.
  (c) Child Outcome Data.--The NCTSI coordinating center shall 
collect, analyze, report, and make publicly available NCTSI-
wide child treatment process and outcome data regarding the 
early identification and delivery of evidence-based treatment 
and services for children and families served by the NCTSI 
grantees.
  (d) Training.--The NCTSI coordinating center shall facilitate 
the coordination of training initiatives in evidence-based and 
trauma-informed treatments, interventions, and practices 
offered to NCTSI grantees, providers, and partners.
  (e) Dissemination.--The NCTSI coordinating center shall, as 
appropriate, collaborate with the Secretary in the 
dissemination of evidence-based and trauma-informed 
interventions, treatments, products, and other resources to 
appropriate stakeholders.
  (f) Review.--The Secretary shall, consistent with the peer-
review process, ensure that NCTSI applications are reviewed by 
appropriate experts in the field as part of a consensus review 
process. The Secretary shall include review criteria related to 
expertise and experience in child trauma and evidence-based 
practices.
  [(c)] (g) Geographical Distribution.--The Secretary shall 
ensure that grants, contracts or cooperative agreements under 
subsection (a) [with respect to centers of excellence are 
distributed equitably among the regions of the country] are 
distributed equitably among the regions of the United States 
and among urban and rural areas.
  [(d)] (h) Evaluation.--The Secretary, as part of the 
application process, shall require that each applicant for a 
grant, contract or cooperative agreement under subsection (a) 
submit a plan for the rigorous evaluation of the activities 
funded under the grant, contract or agreement, including both 
process and outcomes evaluation, and the submission of an 
evaluation at the end of the project period.
  [(e)] (i) Duration of Awards.--With respect to a grant, 
contract or cooperative agreement under subsection (a), the 
period during which payments under such an award will be made 
to the [recipient may not exceed 5 years] recipient shall not 
be less than 4 years, but shall not exceed 5 years. Such 
grants, contracts or agreements may be renewed.
  [(f)] (j) Authorization of Appropriations.--There is 
authorized to be appropriated to carry out this section, 
[$50,000,000 for fiscal year 2001, and such sums as may be 
necessary for each of fiscal years 2003 through 2006] 
$46,887,000 for each of fiscal years 2017 through 2021.
  [(g)] (k) Short Title.--This section may be cited as the 
``Donald J. Cohen National Child Traumatic Stress Initiative''.

           *       *       *       *       *       *       *


                  PART K--MINORITY FELLOWSHIP PROGRAM

SEC. 597. FELLOWSHIPS.

  (a) In General.--The Secretary shall maintain a program, to 
be known as the Minority Fellowship Program, under which the 
Secretary awards fellowships, which may include stipends, for 
the purposes of--
          (1) increasing behavioral health practitioners' 
        knowledge of issues related to prevention, treatment, 
        and recovery support for mental and substance use 
        disorders among racial and ethnic minority populations;
          (2) improving the quality of mental and substance use 
        disorder prevention and treatment delivered to racial 
        and ethnic minorities; and
          (3) increasing the number of culturally competent 
        behavioral health professionals and school personnel 
        who teach, administer, conduct services research, and 
        provide direct mental health or substance use services 
        to racial and ethnic minority populations.
  (b) Training Covered.--The fellowships under subsection (a) 
shall be for postbaccalaureate training (including for master's 
and doctoral degrees) for mental health professionals, 
including in the fields of psychiatry, nursing, social work, 
psychology, marriage and family therapy, mental health 
counseling, and substance use and addiction counseling.
  (c) Authorization of Appropriations.--To carry out this 
section, there are authorized to be appropriated $12,669,000 
for each of fiscal years 2017, 2018, and 2019 and $13,669,000 
for each of fiscal years 2020 and 2021.

           *       *       *       *       *       *       *


TITLE VII--HEALTH PROFESSIONS EDUCATION

           *       *       *       *       *       *       *


         PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE

Subpart 1--Health Professions Workforce Information and Analysis

           *       *       *       *       *       *       *


SEC. 762. ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION.

  (a) Establishment; Duties.--There is established the Council 
on Graduate Medical Education (in this section referred to as 
the ``Council''). The Council shall--
          (1) make recommendations to the Secretary of Health 
        and Human Services (in this section referred to as the 
        ``Secretary''), and to the Committee on Labor and Human 
        Resources of the Senate, and the Committee on Energy 
        and Commerce of the House of Representatives, with 
        respect to--
                  (A) the supply and distribution of physicians 
                in the United States;
                  (B) current and future shortages or excesses 
                of physicians in medical and surgical 
                specialties and subspecialties;
                  (C) issues relating to foreign medical school 
                graduates;
                  (D) appropriate Federal policies with respect 
                to the matters specified in subparagraphs (A), 
                (B), and (C), including policies concerning 
                changes in the financing of undergraduate and 
                graduate medical education programs and changes 
                in the types of medical education training in 
                graduate medical education programs;
                  (E) appropriate efforts to be carried out by 
                hospitals, schools of medicine, schools of 
                osteopathic medicine, and accrediting bodies 
                with respect to the matters specified in 
                subparagraphs (A), (B), and (C), including 
                efforts for changes in undergraduate and 
                graduate medical education programs; and
                  (F) deficiencies in, and needs for 
                improvements in, existing data bases concerning 
                the supply and distribution of, and 
                postgraduate training programs for, physicians 
                in the United States and steps that should be 
                taken to eliminate those deficiencies;
          (2) encourage entities providing graduate medical 
        education to conduct activities to voluntarily achieve 
        the recommendations of the Council under paragraph 
        (1)(E);
          (3) develop, publish, and implement performance 
        measures for programs under this title, except for 
        programs under part C or D;
          (4) develop and publish guidelines for longitudinal 
        evaluations (as described in section 761(d)(2)) for 
        programs under this title, except for programs under 
        part C or D; and
          (5) recommend appropriation levels for programs under 
        this title, except for programs under part C or D.
  (b) Composition.--The Council shall be composed of--
          (1) the Assistant Secretary for Health or the 
        designee of the Assistant Secretary;
          (2) the Administrator of the Health Care Financing 
        Administration;
          (3) the Chief Medical Director of the Department of 
        Veterans Affairs;
          (4) the Assistant Secretary for Mental Health and 
        Substance Use;
          [(4)] (5) 6 members appointed by the Secretary to 
        include representatives of practicing primary care 
        physicians, national and specialty physician 
        organizations, foreign medical graduates, and medical 
        student and house staff associations;
          [(5)] (6) 4 members appointed by the Secretary to 
        include representatives of schools of medicine and 
        osteopathic medicine and public and private teaching 
        hospitals; and
          [(6)] (7) 4 members appointed by the Secretary to 
        include representatives of health insurers, business, 
        and labor.
  (c) Terms of Appointed Members.--
          (1) In general; staggered rotation.--Members of the 
        Council appointed under paragraphs [(4), (5), and (6)] 
        (5), (6), and (7) of subsection (b) shall be appointed 
        for a term of 4 years, except that the term of office 
        of the members first appointed shall expire, as 
        designated by the Secretary at the time of appointment, 
        4 at the end of 1 year, 4 at the end of 2 years, 3 at 
        the end of 3 years, and 3 at the end of 4 years.
          (2) Date certain for appointment.--The Secretary 
        shall appoint the first members to the Council under 
        paragraphs [(4), (5), and (6)] (5), (6), and (7) of 
        subsection (b) within 60 days after the date of 
        enactment of this section.
  (d) Chair.--The Council shall elect one of its members as 
Chairman of the Council.
  (e) Quorum.--Nine members of the Council shall constitute a 
quorum, but a lesser number may hold hearings.
  (f) Vacancies.--Any vacancy in the Council shall not affect 
its power to function.
  (g) Compensation.--Each member of the Council who is not 
otherwise employed by the United States Government shall 
receive compensation at a rate equal to the daily rate 
prescribed for GS-18 under the General Schedule under section 
5332 of title 5, United States Code, for each day, including 
traveltime, such member is engaged in the actual performance of 
duties as a member of the Council. A member of the Council who 
is an officer or employee of the United States Government shall 
serve without additional compensation. All members of the 
Council shall be reimbursed for travel, subsistence, and other 
necessary expenses incurred by them in the performance of their 
duties.
  (h) Certain Authorities and Duties.--
          (1) Authorities.--In order to carry out the 
        provisions of this section, the Council is authorized 
        to--
                  (A) collect such information, hold such 
                hearings, and sit and act at such times and 
                places, either as a whole or by subcommittee, 
                and request the attendance and testimony of 
                such witnesses and the production of such 
                books, records, correspondence, memoranda, 
                papers, and documents as the Council or such 
                subcommittee may consider available; and
                  (B) request the cooperation and assistance of 
                Federal departments, agencies, and 
                instrumentalities, and such departments, 
                agencies, and instrumentalities are authorized 
                to provide such cooperation and assistance.
          (2) Coordination of activities.--The Council shall 
        coordinate its activities with the activities of the 
        Secretary under section 792 of the Public Health 
        Service Act. The Secretary shall, in cooperation with 
        the Council and pursuant to the recommendations of the 
        Council, take such steps as are practicable to 
        eliminate deficiencies in the data base established 
        under such section 792 and shall make available in its 
        reports such comprehensive data sets as are developed 
        pursuant to this section.
  (i) Requirement Regarding Reports.--In the reports required 
under subsection (a), the Council shall specify its activities 
during the period for which the report is made.
  (j) Final Report.--Not later than April 1, 2002, the Council 
shall submit a final report under subsection (a).
  (k) Termination.--The Council shall terminate September 30, 
2003.
  (l) Funding.--Amounts otherwise appropriated under this title 
may be utilized by the Secretary to support the activities of 
the Council.

           *       *       *       *       *       *       *


             Subpart 3--Recruitment and Retention Programs

SEC. 775. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.

  (a) Establishment.--The Secretary shall establish and carry 
out a pediatric specialty loan repayment program under which 
the eligible individual agrees to be employed full-time for a 
specified period (which shall not be less than 2 years) in 
providing pediatric medical subspecialty, pediatric surgical 
specialty, or child and adolescent mental and behavioral health 
care, including substance abuse prevention and treatment 
services.
  (b) Program Administration.--Through the program established 
under this section, the Secretary shall enter into contracts 
with qualified health professionals under which--
          (1) such qualified health professionals will agree to 
        provide pediatric medical subspecialty, pediatric 
        surgical specialty, or child and adolescent mental and 
        behavioral health care in an area with a shortage of 
        the specified pediatric subspecialty that has a 
        sufficient pediatric population to support such 
        pediatric subspecialty, as determined by the Secretary; 
        and
          (2) the Secretary agrees to make payments on the 
        principal and interest of undergraduate, graduate, or 
        graduate medical education loans of professionals 
        described in paragraph (1) of not more than $35,000 a 
        year for each year of agreed upon service under such 
        paragraph for a period of not more than 3 years during 
        the qualified health professional's--
                  (A) participation in an accredited pediatric 
                medical subspecialty, pediatric surgical 
                specialty, or child and adolescent mental 
                health subspecialty residency or fellowship; or
                  (B) employment as a pediatric medical 
                subspecialist, pediatric surgical specialist, 
                or child and adolescent mental health 
                professional serving an area or population 
                described in such paragraph.
  (c) In General.--
          (1) Eligible individuals.--
                  (A) Pediatric medical specialists and 
                pediatric surgical specialists.--For purposes 
                of contracts with respect to pediatric medical 
                specialists and pediatric surgical specialists, 
                the term ``qualified health professional'' 
                means a licensed physician who--
                          (i) is entering or receiving training 
                        in an accredited pediatric medical 
                        subspecialty or pediatric surgical 
                        specialty residency or fellowship; or
                          (ii) has completed (but not prior to 
                        the end of the calendar year in which 
                        this section is enacted) the training 
                        described in subparagraph (B).
                  (B) Child and adolescent mental and 
                behavioral health.--For purposes of contracts 
                with respect to child and adolescent mental and 
                behavioral health care, the term ``qualified 
                health professional'' means a health care 
                professional who--
                          (i) has received specialized training 
                        or clinical experience in child and 
                        adolescent mental health in psychiatry, 
                        psychology, school psychology, 
                        behavioral pediatrics, psychiatric 
                        nursing, social work, school social 
                        work, substance abuse disorder 
                        prevention and treatment, marriage and 
                        family therapy, school counseling, or 
                        professional counseling;
                          (ii) has a license or certification 
                        in a State to practice allopathic 
                        medicine, osteopathic medicine, 
                        psychology, school psychology, 
                        psychiatric nursing, social work, 
                        school social work, marriage and family 
                        therapy, school counseling, or 
                        professional counseling; or
                          (iii) is a mental health service 
                        professional who completed (but not 
                        before the end of the calendar year in 
                        which this section is enacted) 
                        specialized training or clinical 
                        experience in child and adolescent 
                        mental health described in clause (i).
          (2) Additional eligibility requirements.--The 
        Secretary may not enter into a contract under this 
        subsection with an eligible individual unless--
                  (A) the individual agrees to work in, or for 
                a provider serving, a health professional 
                shortage area or medically underserved area, or 
                to serve a medically underserved population;
                  (B) the individual is a United States citizen 
                or a permanent legal United States resident; 
                and
                  (C) if the individual is enrolled in a 
                graduate program, the program is accredited, 
                and the individual has an acceptable level of 
                academic standing (as determined by the 
                Secretary).
  (d) Priority.--In entering into contracts under this 
subsection, the Secretary shall give priority to applicants 
who--
          (1) are or will be working in a school or other pre-
        kindergarten, elementary, or secondary education 
        setting;
          (2) have familiarity with evidence-based methods and 
        cultural and linguistic competence health care 
        services; and
          (3) demonstrate financial need.
  [(e) Authorization of Appropriations.--There is authorized to 
be appropriated $30,000,000 for each of fiscal years 2010 
through 2014 to carry out subsection (c)(1)(A) and $20,000,000 
for each of fiscal years 2010 through 2013 to carry out 
subsection (c)(1)(B).]
  (e) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated $12,000,000 for 
the period of fiscal years 2018 through 2022.

           *       *       *       *       *       *       *


TITLE XIX--BLOCK GRANTS

           *       *       *       *       *       *       *


    Part B--Block Grants Regarding Mental Health and Substance Abuse

      Subpart I--Block Grants for Community Mental Health Services

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, subject to section 1916, the State 
involved will expend the grant only for the purpose of--
          (1) providing community mental health services for 
        adults with a serious mental illness and children with 
        a serious emotional disturbance as defined in 
        accordance with section 1912(c);
          [(1)] (2) carrying out the plan submitted under 
        section 1912(a) by the State for the fiscal year 
        involved;
          [(2)] (3) evaluating programs and services carried 
        out under the plan; and
          [(3)] (4) planning, administration, and educational 
        activities related to providing services under the 
        plan.

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

  (a) In General.--The Secretary may make a grant under section 
1911 only if--
          (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.--With respect to the provision of 
comprehensive community mental health services to individuals 
who are either adults with a serious mental illness or children 
with a serious emotional disturbance, the criteria referred to 
in subsection (a) regarding a plan are as follows:
          [(1) Comprehensive community-based mental health 
        systems.--The plan provides for an organized community-
        based system of care for individuals with mental 
        illness and describes available services and resources 
        in a comprehensive system of care, including services 
        for dually diagnosed individuals. The description of 
        the system of care shall include health and mental 
        health services, rehabilitation services, employment 
        services, housing services, educational services, 
        substance abuse services, medical and dental care, and 
        other support services to be provided to individuals 
        with Federal, State and local public and private 
        resources to enable such individuals to function 
        outside of inpatient or residential institutions to the 
        maximum extent of their capabilities, including 
        services to be provided by local school systems under 
        the Individuals with Disabilities Education Act. The 
        plan shall include a separate description of case 
        management services and provide for activities leading 
        to reduction of hospitalization.
          [(2) Mental health system data and epidemiology.--The 
        plan contains an estimate of the incidence and 
        prevalence in the State of serious mental illness among 
        adults and serious emotional disturbance among children 
        and presents quantitative targets to be achieved in the 
        implementation of the system described in paragraph 
        (1).
          [(3) Children's services.--In the case of children 
        with serious emotional disturbance, the plan--
                  [(A) subject to 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 (such 
                system to include services provided under the 
                Individuals with Disabilities Education Act);
                  [(B) provides that the grant under section 
                1911 for the fiscal year involved will not be 
                expended to provide any service under such 
                system other than comprehensive community 
                mental health services; and
                  [(C) provides for the establishment of a 
                defined geographic area for the provision of 
                the services of such system.
          [(4) Targeted services to rural and homeless 
        populations.--The plan describes the State's outreach 
        to and services for individuals who are homeless and 
        how community-based services will be provided to 
        individuals residing in rural areas.
          [(5) Management systems.--The plan describes the 
        financial resources, staffing and training for mental 
        health providers that is necessary to implement the 
        plan, and provides for the training of providers of 
        emergency health services regarding mental health. The 
        plan further describes the manner in which the State 
        intends to expend the grant under section 1911 for the 
        fiscal year involved.
Except as provided for in paragraph (3), the State plan shall 
contain the information required under this subsection with 
respect to both adults with serious mental illness and children 
with serious emotional disturbance.]
  (b) Criteria for Plan.--In accordance with subsection (a), a 
State shall submit to the Secretary a plan that, at a minimum, 
satisfies the following criteria:
          (1) System of care.--The plan provides a description 
        of the system of care of the State, including as 
        follows:
                  (A) Comprehensive community-based health 
                systems.--The plan shall--
                          (i) identify the single State agency 
                        to be responsible for the 
                        administration of the program under the 
                        grant, including any third party who 
                        administers mental health services and 
                        is responsible for complying with the 
                        requirements of this part with respect 
                        to the grant;
                          (ii) provide for an organized 
                        community-based system of care for 
                        individuals with mental illness, and 
                        describe available services and 
                        resources in a comprehensive system of 
                        care, including services for 
                        individuals with mental health and 
                        behavioral health co-occurring 
                        disorders;
                          (iii) include a description of the 
                        manner in which the State and local 
                        entities will coordinate services to 
                        maximize the efficiency, effectiveness, 
                        quality, and cost effectiveness of 
                        services and programs to produce the 
                        best possible outcomes (including 
                        health services, rehabilitation 
                        services, employment services, housing 
                        services, educational services, 
                        substance use disorder services, legal 
                        services, law enforcement services, 
                        social services, child welfare 
                        services, medical and dental care 
                        services, and other support services to 
                        be provided with Federal, State, and 
                        local public and private resources) 
                        with other agencies to enable 
                        individuals receiving services to 
                        function outside of inpatient or 
                        residential institutions, to the 
                        maximum extent of their capabilities, 
                        including services to be provided by 
                        local school systems under the 
                        Individuals with Disabilities Education 
                        Act;
                          (iv) include a description of how the 
                        State--
                                  (I) promotes evidence-based 
                                practices, including those 
                                evidence-based programs that 
                                address the needs of 
                                individuals with early serious 
                                mental illness regardless of 
                                the age of the individual at 
                                onset;
                                  (II) provides comprehensive 
                                individualized treatment; or
                                  (III) integrates mental and 
                                physical health services;
                          (v) include a description of case 
                        management services;
                          (vi) include a description of 
                        activities that seek to engage 
                        individuals with serious mental illness 
                        or serious emotional disturbance and 
                        their caregivers where appropriate in 
                        making health care decisions, including 
                        activities that enhance communication 
                        between individuals, families, 
                        caregivers, and treatment providers; 
                        and
                          (vii) as appropriate to and 
                        reflective of the uses the State 
                        proposes for the block grant monies--
                                  (I) a description of the 
                                activities intended to reduce 
                                hospitalizations and hospital 
                                stays using the block grant 
                                monies;
                                  (II) a description of the 
                                activities intended to reduce 
                                incidents of suicide using the 
                                block grant monies; and
                                  (III) a description of how 
                                the State integrates mental 
                                health and primary care using 
                                the block grant monies.
                  (B) Mental health system data and 
                epidemiology.--The plan shall contain an 
                estimate of the incidence and prevalence in the 
                State of serious mental illness among adults 
                and serious emotional disturbance among 
                children and presents quantitative targets and 
                outcome measures for programs and services 
                provided under this subpart.
                  (C) Children's services.--In the case of 
                children with serious emotional disturbance (as 
                defined in accordance with subsection (c)), the 
                plan shall provide for a system of integrated 
                social services, educational services, child 
                welfare services, juvenile justice services, 
                law enforcement services, and substance use 
                disorder services that, together with health 
                and mental health services, will be provided in 
                order for such children to receive care 
                appropriate for their multiple needs (such 
                system to include services provided under the 
                Individuals with Disabilities Education Act).
                  (D) Targeted services to rural and homeless 
                populations.--The plan shall describe the 
                State's outreach to and services for 
                individuals who are homeless and how community-
                based services will be provided to individuals 
                residing in rural areas.
                  (E) Management services.--The plan shall--
                          (i) describe the financial resources 
                        available, the existing mental health 
                        workforce, and the workforce trained in 
                        treating individuals with co-occurring 
                        mental and substance use disorders;
                          (ii) provide for the training of 
                        providers of emergency health services 
                        regarding mental health;
                          (iii) describe the manner in which 
                        the State intends to expend the grant 
                        under section 1911 for the fiscal year 
                        involved; and
                          (iv) describe the manner in which the 
                        State intends to comply with each of 
                        the funding agreements in this subpart 
                        and subpart III.
          (2) Goals and objectives.--The plan establishes goals 
        and objectives for the period of the plan, including 
        targets and milestones that are intended to be met, and 
        the activities that will be undertaken to achieve those 
        targets.
  (c) Definitions Regarding Mental Illness and Emotional 
Disturbance; Methods for Estimate of Incidence and 
Prevalence.--
          (1) Establishment by secretary of definitions; 
        dissemination.--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 
        establish standardized methods for making the estimates 
        required in subsection (b)(11) 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) Substantial 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 determination of the extent to which the 
                State has implemented the plan required in 
                subsection (a). If the Secretary determines 
                that the State has not substantially 
                implemented the plan, the Secretary 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 Secretary 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. 1915. ADDITIONAL PROVISIONS.

  (a) Review of State Plan by Mental Health Planning Council.--
The Secretary may make a grant under section 1911 to a State 
only if--
          (1) the plan submitted under section 1912(a) with 
        respect to the grant and the report of the State under 
        section 1942(a) concerning the preceding fiscal year 
        has been reviewed by the State mental health planning 
        council under section 1914; and
          (2) the State submits to the Secretary any 
        recommendations received by the State from such council 
        for modifications to the plan (without regard to 
        whether the State has made the recommended 
        modifications) and any comments concerning the annual 
        report.
  (b) Maintenance of Effort Regarding State Expenditures for 
Mental Health.--
          [(1) In general.--A funding agreement for a grant 
        under section 1911 is that the State involved will 
        maintain State expenditures for community mental health 
        services at a level that is not less than the average 
        level of such expenditures maintained by the State for 
        the 2-year period preceding the fiscal year for which 
        the State is applying for the grant.]
          (1) In general.--A funding agreement for a grant 
        under section 1911 is that the State involved will 
        maintain State expenditures for community mental health 
        services at a level that is not less than the average 
        of the amounts prescribed by this paragraph (prior to 
        any waiver under paragraph (3)) for such expenditures 
        by such State for each of the two fiscal years 
        immediately preceding the fiscal year for which the 
        State is applying for the grant.
          (2) Exclusion of certain funds.--The Secretary may 
        exclude from the aggregate State expenditures under 
        [subsection (a)] paragraph (1), funds appropriated to 
        the [principle] principal agency for authorized 
        activities which are of a non-recurring nature and for 
        a specific purpose.
          [(3) Waiver.--The Secretary may, upon the request of 
        a State, waive the requirement established in paragraph 
        (1) if the Secretary determines that extraordinary 
        economic conditions in the State justify the waiver.]
          (3) Waiver.--
                  (A) In general.--The Secretary may, upon the 
                request of a State, waive the requirement 
                established in paragraph (1) in whole or in 
                part, if the Secretary determines that 
                extraordinary economic conditions in the State 
                in the fiscal year involved or in the previous 
                fiscal year justify the waiver.
                  (B) Date certain for action upon request.--
                The Secretary shall approve or deny a request 
                for a waiver under this paragraph not later 
                than 120 days after the date on which the 
                request is made.
                  (C) Applicability of waiver.--A waiver 
                provided by the Secretary under this paragraph 
                shall be applicable only to the fiscal year 
                involved.
          (4) Noncompliance by State.--
                  [(A) In making a grant under section 1911 to 
                a State for a fiscal year, the Secretary shall 
                make a determination of whether, for the 
                previous fiscal year, the State maintained 
                material compliance with the agreement made 
                under paragraph (1). If the Secretary 
                determines that a State has failed to maintain 
                such compliance, the Secretary shall reduce the 
                amount of the allotment under section 1911 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.]
                  (A) In general.--
                          (i) Determination and reduction.--The 
                        Secretary shall determine, in the case 
                        of each State, and for each fiscal 
                        year, whether the State maintained 
                        material compliance with the agreement 
                        made under paragraph (1). If the 
                        Secretary determines that a State has 
                        failed to maintain such compliance for 
                        a fiscal year, the Secretary shall 
                        reduce the amount of the allotment 
                        under section 1911 for the State, for 
                        the first fiscal year beginning after 
                        such determination is final, by an 
                        amount equal to the amount constituting 
                        such failure for the previous fiscal 
                        year about which the determination was 
                        made.
                          (ii) Alternative sanction.--The 
                        Secretary may by regulation provide for 
                        an alternative method of imposing a 
                        sanction for a failure by a State to 
                        maintain material compliance with the 
                        agreement under paragraph (1) if the 
                        Secretary determines that such 
                        alternative method would be more 
                        equitable and would be a more effective 
                        incentive for States to maintain such 
                        material compliance.
                  (B)  Submission of information to the 
                secretary._  The Secretary may make a grant 
                under section 1911 for a fiscal year only if 
                the State involved submits to the Secretary 
                information sufficient for the Secretary to 
                make the determination required in 
                [subparagraph (A)] subparagraph (A)(i).

           *       *       *       *       *       *       *


SEC. 1917. APPLICATION FOR GRANT.

  (a) In General.--For purposes of section 1911, an application 
for a grant under such section for a fiscal year in accordance 
with this section if, subject to subsection (b)--
          (1) the plan is received by the Secretary not later 
        than September 1 of the fiscal year prior to the fiscal 
        year for which a State is seeking funds, and the report 
        from the previous fiscal year as required under section 
        [1941] 1942(a) is received by December 1 of the fiscal 
        year of the grant;
          (2) the application contains each funding agreement 
        that is described in this subpart or 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 
        from 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)(3)(B)] 1915(b), and the report required in 
        section 1942(a);
          (6) the application contains recommendations in 
        compliance with section 1915(a), or if no such 
        recommendations are received by the State, the 
        application otherwise demonstrates compliance with such 
        section; and
          (7) the application (including the plan under 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 except Puerto Rico, the 
Secretary may waive such provisions of this subpart and subpart 
III as the Secretary determines to be appropriate, other than 
the provisions of section 1916.

           *       *       *       *       *       *       *


SEC. 1920. FUNDING.

  (a) Authorization of Appropriations.--For the purpose of 
carrying out this subpart, and subpart III and section 505 with 
respect to mental health, there are authorized to be 
appropriated $450,000,000 for fiscal year 2001, and such sums 
as may be necessary for each of the fiscal years 2002 and 2003.
  (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 specified in paragraphs (2) and (3), the 
        Secretary shall obligate 5 percent of the amounts 
        appropriated under subsection (a) for a fiscal year.
          (2) Data collection.--The purpose specified in this 
        paragraph is carrying out sections 505 and 1971 with 
        respect to mental health.
          (3) Program evaluation.--The purpose specified in 
        this paragraph is the conduct of evaluations of 
        prevention and treatment programs and services with 
        respect to mental health to determine methods for 
        improving the availability and quality of such programs 
        and services.
  (c) Best Practices in Clinical Care Models.--A State shall 
expend not less than 10 percent of the amount the State 
receives for carrying out this subpart in each fiscal year to 
support evidence-based programs that address the needs of 
individuals with early serious mental illness, including 
psychotic disorders, regardless of the age of the individual at 
onset.

           *       *       *       *       *       *       *


    TITLE XXVII--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE

PART A--INDIVIDUAL AND GROUP MARKET REFORMS

           *       *       *       *       *       *       *


Subpart II--Improving Coverage

           *       *       *       *       *       *       *


SEC. 2726. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS.

  (a) In General.--
          (1) Aggregate lifetime limits.--In the case of a 
        group health plan or a health insurance issuer offering 
        group or individual health insurance coverage that 
        provides both medical and surgical benefits and mental 
        health or substance use disorder benefits--
                  (A) No lifetime limit.--If the plan or 
                coverage does not include an aggregate lifetime 
                limit on substantially all medical and surgical 
                benefits, the plan or coverage may not impose 
                any aggregate lifetime limit on mental health 
                or substance use disorder benefits.
                  (B) Lifetime limit.--If the plan or coverage 
                includes an aggregate lifetime limit on 
                substantially all medical and surgical benefits 
                (in this paragraph referred to as the 
                ``applicable lifetime limit''), the plan or 
                coverage shall either--
                          (i) apply the applicable lifetime 
                        limit both to the medical and surgical 
                        benefits to which it otherwise would 
                        apply and to mental health and 
                        substance use disorder benefits and not 
                        distinguish in the application of such 
                        limit between such medical and surgical 
                        benefits and mental health and 
                        substance use disorder benefits; or
                          (ii) not include any aggregate 
                        lifetime limit on mental health or 
                        substance use disorder benefits that is 
                        less than the applicable lifetime 
                        limit.
                  (C) Rule in case of different limits.--In the 
                case of a plan or coverage that is not 
                described in subparagraph (A) or (B) and that 
                includes no or different aggregate lifetime 
                limits on different categories of medical and 
                surgical benefits, the Secretary shall 
                establish rules under which subparagraph (B) is 
                applied to such plan or coverage with respect 
                to mental health and substance use disorder 
                benefits by substituting for the applicable 
                lifetime limit an average aggregate lifetime 
                limit that is computed taking into account the 
                weighted average of the aggregate lifetime 
                limits applicable to such categories.
          (2) Annual limits.--In the case of a group health 
        plan or a health insurance issuer offering group or 
        individual health insurance coverage that provides both 
        medical and surgical benefits and mental health or 
        substance use disorder benefits--
                  (A) No annual limit.--If the plan or coverage 
                does not include an annual limit on 
                substantially all medical and surgical 
                benefits, the plan or coverage may not impose 
                any annual limit on mental health or substance 
                use disorder benefits.
                  (B) Annual limit.--If the plan or coverage 
                includes an annual limit on substantially all 
                medical and surgical benefits (in this 
                paragraph referred to as the ``applicable 
                annual limit''), the plan or coverage shall 
                either--
                          (i) apply the applicable annual limit 
                        both to medical and surgical benefits 
                        to which it otherwise would apply and 
                        to mental health and substance use 
                        disorder benefits and not distinguish 
                        in the application of such limit 
                        between such medical and surgical 
                        benefits and mental health and 
                        substance use disorder benefits; or
                          (ii) not include any annual limit on 
                        mental health or substance use disorder 
                        benefits that is less than the 
                        applicable annual limit.
                  (C) Rule in case of different limits.--In the 
                case of a plan or coverage that is not 
                described in subparagraph (A) or (B) and that 
                includes no or different annual limits on 
                different categories of medical and surgical 
                benefits, the Secretary shall establish rules 
                under which subparagraph (B) is applied to such 
                plan or coverage with respect to mental health 
                and substance use disorder benefits by 
                substituting for the applicable annual limit an 
                average annual limit that is computed taking 
                into account the weighted average of the annual 
                limits applicable to such categories.
          (3) Financial requirements and treatment 
        limitations.--
                  (A) In general.--In the case of a group 
                health plan or a health insurance issuer 
                offering group or individual health insurance 
                coverage that provides both medical and 
                surgical benefits and mental health or 
                substance use disorder benefits, such plan or 
                coverage shall ensure that--
                          (i) the financial requirements 
                        applicable to such mental health or 
                        substance use disorder benefits are no 
                        more restrictive than the predominant 
                        financial requirements applied to 
                        substantially all medical and surgical 
                        benefits covered by the plan (or 
                        coverage), and there are no separate 
                        cost sharing requirements that are 
                        applicable only with respect to mental 
                        health or substance use disorder 
                        benefits; and
                          (ii) the treatment limitations 
                        applicable to such mental health or 
                        substance use disorder benefits are no 
                        more restrictive than the predominant 
                        treatment limitations applied to 
                        substantially all medical and surgical 
                        benefits covered by the plan (or 
                        coverage) and there are no separate 
                        treatment limitations that are 
                        applicable only with respect to mental 
                        health or substance use disorder 
                        benefits.
                  (B) Definitions.--In this paragraph:
                          (i) Financial requirement.--The term 
                        ``financial requirement'' includes 
                        deductibles, copayments, coinsurance, 
                        and out-of-pocket expenses, but 
                        excludes an aggregate lifetime limit 
                        and an annual limit subject to 
                        paragraphs (1) and (2).
                          (ii) Predominant.--A financial 
                        requirement or treatment limit is 
                        considered to be predominant if it is 
                        the most common or frequent of such 
                        type of limit or requirement.
                          (iii) Treatment limitation.--The term 
                        ``treatment limitation'' includes 
                        limits on the frequency of treatment, 
                        number of visits, days of coverage, or 
                        other similar limits on the scope or 
                        duration of treatment.
          (4) Availability of plan information.--The criteria 
        for medical necessity determinations made under the 
        plan with respect to mental health or substance use 
        disorder benefits (or the health insurance coverage 
        offered in connection with the plan with respect to 
        such benefits) shall be made available by the plan 
        administrator (or the health insurance issuer offering 
        such coverage) in accordance with regulations to any 
        current or potential participant, beneficiary, or 
        contracting provider upon request. The reason for any 
        denial under the plan (or coverage) of reimbursement or 
        payment for services with respect to mental health or 
        substance use disorder benefits in the case of any 
        participant or beneficiary shall, on request or as 
        otherwise required, be made available by the plan 
        administrator (or the health insurance issuer offering 
        such coverage) to the participant or beneficiary in 
        accordance with regulations.
          (5) Out-of-network providers.--In the case of a plan 
        or coverage that provides both medical and surgical 
        benefits and mental health or substance use disorder 
        benefits, if the plan or coverage provides coverage for 
        medical or surgical benefits provided by out-of-network 
        providers, the plan or coverage shall provide coverage 
        for mental health or substance use disorder benefits 
        provided by out-of-network providers in a manner that 
        is consistent with the requirements of this section.
          (6) Compliance program guidance document.--
                  (A) In general.--Not later than 6 months 
                after the date of enactment of the Helping 
                Families in Mental Health Crisis Act of 2016, 
                the Inspector General of the Department of 
                Health and Human Services, in coordination with 
                the Secretary, the Secretary of Labor, or the 
                Secretary of the Treasury, shall issue a 
                compliance program guidance document to help 
                improve compliance with this section.
                  (B) Examples illustrating compliance and 
                noncompliance.--
                          (i) In general.--The compliance 
                        program guidance document required 
                        under this paragraph shall provide 
                        illustrative, de-identified examples 
                        (that do not disclose any protected 
                        health information or individually 
                        identifiable information) of previous 
                        findings of compliance and 
                        noncompliance with this section, 
                        section 712 of the Employee Retirement 
                        Income Security Act of 1974, or section 
                        9812 of the Internal Revenue Code of 
                        1986 based on investigations of 
                        violations of such sections, 
                        including--
                                  (I) examples illustrating 
                                requirements for information 
                                disclosures and nonquantitative 
                                treatment limitations; and
                                  (II) descriptions of the 
                                violations uncovered during the 
                                course of such investigations.
                          (ii) Nonquantitative treatment 
                        limitations.--To the extent that any 
                        example described in clause (i) 
                        involves a finding of compliance or 
                        noncompliance with regard to any 
                        requirement for nonquantitative 
                        treatment limitations, the example 
                        shall provide sufficient detail to 
                        fully explain such finding, including a 
                        full description of the criteria 
                        involved for medical and surgical 
                        benefits and the criteria involved for 
                        mental health and substance use 
                        disorder benefits.
                          (iii) Access to additional 
                        information regarding compliance.--In 
                        developing and issuing the compliance 
                        program guidance document required 
                        under this paragraph, the Inspector 
                        General of the Department of Health and 
                        Human Services may--
                                  (I) enter into interagency 
                                agreements with the Inspector 
                                General of the Department of 
                                Labor and the Inspector General 
                                of the Department of the 
                                Treasury to share findings of 
                                compliance and noncompliance 
                                with this section, section 712 
                                of the Employee Retirement 
                                Income Security Act of 1974, or 
                                section 9812 of the Internal 
                                Revenue Code of 1986; and
                                  (II) enter into an agreement 
                                with a State to share 
                                information on findings of 
                                compliance and noncompliance 
                                with this section, section 712 
                                of the Employee Retirement 
                                Income Security Act of 1974, or 
                                section 9812 of the Internal 
                                Revenue Code of 1986.
                  (C) Recommendations.--The compliance program 
                guidance document shall include recommendations 
                to avoid violations of this section and 
                encourage the development and use of internal 
                controls to monitor adherence to applicable 
                statutes, regulations, and program 
                requirements. Such internal controls may 
                include a compliance checklist with 
                illustrative examples of nonquantitative 
                treatment limitations on mental health and 
                substance use disorder benefits, which may fail 
                to comply with this section in relation to 
                nonquantitative treatment limitations on 
                medical and surgical benefits.
                  (D) Updating the compliance program guidance 
                document.--The compliance program guidance 
                document shall be updated every 2 years to 
                include illustrative, de-identified examples 
                (that do not disclose any protected health 
                information or individually identifiable 
                information) of previous findings of compliance 
                and noncompliance with this section, section 
                712 of the Employee Retirement Income Security 
                Act of 1974, or section 9812 of the Internal 
                Revenue Code of 1986.
          (7) Additional guidance.--
                  (A) In general.--Not later than 6 months 
                after the date of enactment of the Helping 
                Families in Mental Health Crisis Act of 2016, 
                the Secretary, in coordination with the 
                Secretary of Labor and the Secretary of the 
                Treasury, shall issue guidance to group health 
                plans and health insurance issuers offering 
                group or individual health insurance coverage 
                to assist such plans and issuers in satisfying 
                the requirements of this section.
                  (B) Disclosure.--
                          (i) Guidance for plans and issuers.--
                        The guidance issued under this 
                        paragraph shall include clarifying 
                        information and illustrative examples 
                        of methods that group health plans and 
                        health insurance issuers offering group 
                        or individual health insurance coverage 
                        may use for disclosing information to 
                        ensure compliance with the requirements 
                        under this section (and any regulations 
                        promulgated pursuant to this section).
                          (ii) Documents for participants, 
                        beneficiaries, contracting providers, 
                        or authorized representatives.--The 
                        guidance issued under this paragraph 
                        may include clarifying information and 
                        illustrative examples of methods that 
                        group health plans and health insurance 
                        issuers offering group or individual 
                        health insurance coverage may use to 
                        provide any participant, beneficiary, 
                        contracting provider, or authorized 
                        representative, as applicable, with 
                        documents containing information that 
                        the health plans or issuers are 
                        required to disclose to participants, 
                        beneficiaries, contracting providers, 
                        or authorized representatives to ensure 
                        compliance with this section, any 
                        regulation issued pursuant to this 
                        section, or any other applicable law or 
                        regulation, including information that 
                        is comparative in nature with respect 
                        to--
                                  (I) nonquantitative treatment 
                                limitations for both medical 
                                and surgical benefits and 
                                mental health and substance use 
                                disorder benefits;
                                  (II) the processes, 
                                strategies, evidentiary 
                                standards, and other factors 
                                used to apply the limitations 
                                described in subclause (I); and
                                  (III) the application of the 
                                limitations described in 
                                subclause (I) to ensure that 
                                such limitations are applied in 
                                parity with respect to both 
                                medical and surgical benefits 
                                and mental health and substance 
                                use disorder benefits.
                  (C) Nonquantitative treatment limitations.--
                The guidance issued under this paragraph shall 
                include clarifying information and illustrative 
                examples of methods, processes, strategies, 
                evidentiary standards, and other factors that 
                group health plans and health insurance issuers 
                offering group or individual health insurance 
                coverage may use regarding the development and 
                application of nonquantitative treatment 
                limitations to ensure compliance with this 
                section (and any regulations promulgated 
                pursuant to this section), including--
                          (i) examples of methods of 
                        determining appropriate types of 
                        nonquantitative treatment limitations 
                        with respect to both medical and 
                        surgical benefits and mental health and 
                        substance use disorder benefits, 
                        including nonquantitative treatment 
                        limitations pertaining to--
                                  (I) medical management 
                                standards based on medical 
                                necessity or appropriateness, 
                                or whether a treatment is 
                                experimental or investigative;
                                  (II) limitations with respect 
                                to prescription drug formulary 
                                design; and
                                  (III) use of fail-first or 
                                step therapy protocols;
                          (ii) examples of methods of 
                        determining--
                                  (I) network admission 
                                standards (such as 
                                credentialing); and
                                  (II) factors used in provider 
                                reimbursement methodologies 
                                (such as service type, 
                                geographic market, demand for 
                                services, and provider supply, 
                                practice size, training, 
                                experience, and licensure) as 
                                such factors apply to network 
                                adequacy;
                          (iii) examples of sources of 
                        information that may serve as 
                        evidentiary standards for the purposes 
                        of making determinations regarding the 
                        development and application of 
                        nonquantitative treatment limitations;
                          (iv) examples of specific factors, 
                        and the evidentiary standards used to 
                        evaluate such factors, used by such 
                        plans or issuers in performing a 
                        nonquantitative treatment limitation 
                        analysis;
                          (v) examples of how specific 
                        evidentiary standards may be used to 
                        determine whether treatments are 
                        considered experimental or 
                        investigative;
                          (vi) examples of how specific 
                        evidentiary standards may be applied to 
                        each service category or classification 
                        of benefits;
                          (vii) examples of methods of reaching 
                        appropriate coverage determinations for 
                        new mental health or substance use 
                        disorder treatments, such as evidence-
                        based early intervention programs for 
                        individuals with a serious mental 
                        illness and types of medical management 
                        techniques;
                          (viii) examples of methods of 
                        reaching appropriate coverage 
                        determinations for which there is an 
                        indirect relationship between the 
                        covered mental health or substance use 
                        disorder benefit and a traditional 
                        covered medical and surgical benefit, 
                        such as residential treatment or 
                        hospitalizations involving voluntary or 
                        involuntary commitment; and
                          (ix) additional illustrative examples 
                        of methods, processes, strategies, 
                        evidentiary standards, and other 
                        factors for which the Secretary 
                        determines that additional guidance is 
                        necessary to improve compliance with 
                        this section.
                  (D) Public comment.--Prior to issuing any 
                final guidance under this paragraph, the 
                Secretary shall provide a public comment period 
                of not less than 60 days during which any 
                member of the public may provide comments on a 
                draft of the guidance.
  (b) Construction.--Nothing in this section shall be 
construed--
          (1) as requiring a group health plan or a health 
        insurance issuer offering group or individual health 
        insurance coverage to provide any mental health or 
        substance use disorder benefits; or
          (2) in the case of a group health plan or a health 
        insurance issuer offering group or individual health 
        insurance coverage that provides mental health or 
        substance use disorder benefits, as affecting the terms 
        and conditions of the plan or coverage relating to such 
        benefits under the plan or coverage, except as provided 
        in subsection (a).
  (c) Exemptions.--
          (1) Small employer exemption.--This section shall not 
        apply to any group health plan and a health insurance 
        issuer offering group or individual health insurance 
        coverage for any plan year of a small employer (as 
        defined in section 2791(e)(4), except that for purposes 
        of this paragraph such term shall include employers 
        with 1 employee in the case of an employer residing in 
        a State that permits small groups to include a single 
        individual).
          (2) Cost exemption.--
                  (A) In general.--With respect to a group 
                health plan or a health insurance issuer 
                offering group or individual health insurance 
                coverage, if the application of this section to 
                such plan (or coverage) results in an increase 
                for the plan year involved of the actual total 
                costs of coverage with respect to medical and 
                surgical benefits and mental health and 
                substance use disorder benefits under the plan 
                (as determined and certified under subparagraph 
                (C)) by an amount that exceeds the applicable 
                percentage described in subparagraph (B) of the 
                actual total plan costs, the provisions of this 
                section shall not apply to such plan (or 
                coverage) during the following plan year, and 
                such exemption shall apply to the plan (or 
                coverage) for 1 plan year. An employer may 
                elect to continue to apply mental health and 
                substance use disorder parity pursuant to this 
                section with respect to the group health plan 
                (or coverage) involved regardless of any 
                increase in total costs.
                  (B) Applicable percentage.--With respect to a 
                plan (or coverage), the applicable percentage 
                described in this subparagraph shall be--
                          (i) 2 percent in the case of the 
                        first plan year in which this section 
                        is applied; and
                          (ii) 1 percent in the case of each 
                        subsequent plan year.
                  (C) Determinations by actuaries.--
                Determinations as to increases in actual costs 
                under a plan (or coverage) for purposes of this 
                section shall be made and certified by a 
                qualified and licensed actuary who is a member 
                in good standing of the American Academy of 
                Actuaries. All such determinations shall be in 
                a written report prepared by the actuary. The 
                report, and all underlying documentation relied 
                upon by the actuary, shall be maintained by the 
                group health plan or health insurance issuer 
                for a period of 6 years following the 
                notification made under subparagraph (E).
                  (D) 6-month determinations.--If a group 
                health plan (or a health insurance issuer 
                offering coverage in connection with a group 
                health plan) seeks an exemption under this 
                paragraph, determinations under subparagraph 
                (A) shall be made after such plan (or coverage) 
                has complied with this section for the first 6 
                months of the plan year involved.
                  (E) Notification.--
                          (i) In general.--A group health plan 
                        (or a health insurance issuer offering 
                        coverage in connection with a group 
                        health plan) that, based upon a 
                        certification described under 
                        subparagraph (C), qualifies for an 
                        exemption under this paragraph, and 
                        elects to implement the exemption, 
                        shall promptly notify the Secretary, 
                        the appropriate State agencies, and 
                        participants and beneficiaries in the 
                        plan of such election.
                          (ii) Requirement.--A notification to 
                        the Secretary under clause (i) shall 
                        include--
                                  (I) a description of the 
                                number of covered lives under 
                                the plan (or coverage) involved 
                                at the time of the 
                                notification, and as 
                                applicable, at the time of any 
                                prior election of the cost-
                                exemption under this paragraph 
                                by such plan (or coverage);
                                  (II) for both the plan year 
                                upon which a cost exemption is 
                                sought and the year prior, a 
                                description of the actual total 
                                costs of coverage with respect 
                                to medical and surgical 
                                benefits and mental health and 
                                substance use disorder benefits 
                                under the plan; and
                                  (III) for both the plan year 
                                upon which a cost exemption is 
                                sought and the year prior, the 
                                actual total costs of coverage 
                                with respect to mental health 
                                and substance use disorder 
                                benefits under the plan.
                          (iii) Confidentiality.--A 
                        notification to the Secretary under 
                        clause (i) shall be confidential. The 
                        Secretary shall make available, upon 
                        request and on not more than an annual 
                        basis, an anonymous itemization of such 
                        notifications, that includes--
                                  (I) a breakdown of States by 
                                the size and type of employers 
                                submitting such notification; 
                                and
                                  (II) a summary of the data 
                                received under clause (ii).
                  (F) Audits by appropriate agencies.--To 
                determine compliance with this paragraph, the 
                Secretary may audit the books and records of a 
                group health plan or health insurance issuer 
                relating to an exemption, including any 
                actuarial reports prepared pursuant to 
                subparagraph (C), during the 6 year period 
                following the notification of such exemption 
                under subparagraph (E). A State agency 
                receiving a notification under subparagraph (E) 
                may also conduct such an audit with respect to 
                an exemption covered by such notification.
  (d) Separate Application to Each Option Offered.--In the case 
of a group health plan that offers a participant or beneficiary 
two or more benefit package options under the plan, the 
requirements of this section shall be applied separately with 
respect to each such option.
  (e) Definitions.--For purposes of this section--
          (1) Aggregate lifetime limit.--The term ``aggregate 
        lifetime limit'' means, with respect to benefits under 
        a group health plan or health insurance coverage, a 
        dollar limitation on the total amount that may be paid 
        with respect to such benefits under the plan or health 
        insurance coverage with respect to an individual or 
        other coverage unit.
          (2) Annual limit.--The term ``annual limit'' means, 
        with respect to benefits under a group health plan or 
        health 
        insurance coverage, a dollar limitation on the total 
        amount of benefits that may be paid with respect to 
        such benefits in a 12-month period under the plan or 
        health insurance coverage with respect to an individual 
        or other coverage unit.
          (3) Medical or surgical benefits.--The term ``medical 
        or surgical benefits'' means benefits with respect to 
        medical or surgical services, as defined under the 
        terms of the plan or coverage (as the case may be), but 
        does not include mental health or substance use 
        disorder benefits.
          (4) Mental health benefits.--The term ``mental health 
        benefits'' means benefits with respect to services for 
        mental health conditions, as defined under the terms of 
        the plan and in accordance with applicable Federal and 
        State law.
          (5) Substance use disorder benefits.--The term 
        ``substance use disorder benefits'' means benefits with 
        respect to services for substance use disorders, as 
        defined under the terms of the plan and in accordance 
        with applicable Federal and State law.

           *       *       *       *       *       *       *

                              ----------                              


PROTECTION AND ADVOCACY FOR INDIVIDUALS WITH MENTAL ILLNESS ACT

           *       *       *       *       *       *       *


                TITLE I--PROTECTION AND ADVOCACY SYSTEMS

Part A--Establishment of Systems

           *       *       *       *       *       *       *


                          system requirements

  Sec. 105. (a) A system established in a State under section 
103 to protect and advocate the rights of individuals with 
mental illness shall--
          (1) have the authority to--
                  (A) investigate incidents of abuse and 
                neglect of individuals with mental illness if 
                the incidents are reported to the system or if 
                there is probable cause to believe that the 
                incidents occurred;
                  (B) pursue administrative, legal, and other 
                appropriate remedies to ensure the protection 
                of individuals with mental illness who are 
                receiving care or treatment in the State; and
                  (C) pursue administrative, legal, and other 
                remedies on behalf of an individual who--
                          (i) was a individual with mental 
                        illness; and
                          (ii) is a resident of the State,
                but only with respect to matters which occur 
                within 90 days after the date of the discharge 
                of such individual from a facility providing 
                care or treatment;
          (2) be independent of any agency in the State which 
        provides treatment or services (other than advocacy 
        services) to individuals with mental illness;
          (3) have access to facilities in the State providing 
        care or treatment;
          (4) in accordance with section 106, have access to 
        all records of--
                  (A) any individual who is a client of the 
                system if such individual, or the legal 
                guardian, conservator, or other legal 
                representative of such individual, has 
                authorized the system to have such access;
                  (B) any individual (including an individual 
                who has died or whose whereabouts are 
                unknown)--
                          (i) who by reason of the mental or 
                        physical condition of such individual 
                        is unable to authorize the system to 
                        have such access;
                          (ii) who does not have a legal 
                        guardian, conservator, or other legal 
                        representative, or for whom the legal 
                        guardian is the State; and
                          (iii) with respect to whom a 
                        complaint has been received by the 
                        system or with respect to whom as a 
                        result of monitoring or other 
                        activities (either of which result from 
                        a complaint or other evidence) there is 
                        probable cause to believe that such 
                        individual has been subject to abuse or 
                        neglect; and
                  (C) any individual with a mental illness, who 
                has a legal guardian, conservator, or other 
                legal representative, with respect to whom a 
                complaint has been received by the system or 
                with respect to whom there is probable cause to 
                believe the health or safety of the individual 
                is in serious and immediate jeopardy, 
                whenever--
                          (i) such representative has been 
                        contacted by such system upon receipt 
                        of the name and address of such 
                        representative;
                          (ii) such system has offered 
                        assistance to such representative to 
                        resolve the situation; and
                          (iii) such representative has failed 
                        or refused to act on behalf of the 
                        individual;
          (5) have an arrangement with the Secretary and the 
        agency of the State which administers the State plan 
        under title XIX of the Social Security Act for the 
        furnishing of the information required by subsection 
        (b);
          (6) establish an advisory council--
                  (A) which will advise the system on policies 
                and priorities to be carried out in protecting 
                and advocating the rights of individuals with 
                mental illness;
                  (B) which shall include attorneys, mental 
                health professionals, individuals from the 
                public who are knowledgeable about mental 
                illness, a provider of mental health services, 
                individuals who have received or are receiving 
                mental health services, and family members of 
                such individuals, and at least 60 percent the 
                membership of which shall be comprised of 
                individuals who have received or are receiving 
                mental health services or who are family 
                members of such individuals; and
                  (C) which shall be chaired by an individual 
                who has received or is receiving mental health 
                services or who is a family member of such an 
                individual;
          (7) on January 1, 1987, and January 1 of each 
        succeeding year, prepare and transmit to the Secretary 
        and the head of the State mental health agency of the 
        State in which the system [is located a report] is 
        located, and make publicly available, a report 
        describing the activities, accomplishments, and 
        expenditures of the system during the most recently 
        completed fiscal year, including a section prepared by 
        the advisory council that describes the activities of 
        the council and its assessment of the operations of the 
        system;
          (8) on an annual basis, provide the public with an 
        opportunity to comment on the priorities established 
        by, and the activities of, the system;
          (9) establish a grievance procedure for clients or 
        prospective clients of the system to assure that 
        individuals with mental illness have full access to the 
        services of the system and for individuals who have 
        received or are receiving mental health services, 
        family members of such individuals with mental illness, 
        or representatives of such individuals or family 
        members to assure that the eligible system is operating 
        in compliance with the provisions of this title and 
        title III; [and]
          (10) not use allotments provided to a system in a 
        manner inconsistent with section 5 of the Assisted 
        Suicide Funding Restriction Act of 1997[.]; and
          (11) agree to refrain, during any period for which 
        funding is provided to the system under this part, from 
        using Federal funds to pay the salary or expenses of 
        any grant or contract recipient, or agent acting for 
        such recipient, related to any activity designed to 
        influence the enactment of legislation, appropriations, 
        regulation, administrative action, or Executive order 
        proposed or pending before the Congress or any State 
        government, State legislature or local legislature or 
        legislative body, other than for normal and recognized 
        executive-legislative relationships or participation by 
        an agency or officer of a State, local, or tribal 
        government in policymaking and administrative processes 
        within the executive branch of that government.
  (b) The Secretary and the agency of a State which administers 
its State plan under title XIX of the Social Security Act shall 
provide the eligible system of the State with a copy of each 
annual survey report and plan of corrections for cited 
deficiencies made pursuant to titles XVIII and XIX of the 
Social Security Act with respect to any facility rendering care 
or treatment to individuals with mental illness in the State in 
which such system is located. A report or plan shall be made 
available within 30 days after the completion of the report or 
plan.
  (c)(1)(A) Each system established in a State, through 
allotments received under section 103, to protect and advocate 
the rights of individuals with mental illness shall have a 
governing authority.
  (B) In States in which the governing authority is organized 
as a private non-profit entity with a multi-member governing 
board, or a public system with a multi-member governing board, 
such governing board shall be selected according to the 
policies and procedures of the system. The governing board 
shall be composed of--
          (i) members (to be selected no later than October 1, 
        1990) who broadly represent or are knowledgeable about 
        the needs of the clients served by the system; and
          (ii) in the case of a governing authority organized 
        as a private non-profit entity, members who broadly 
        represent or are knowledgeable about the needs of the 
        clients served by the system including the chairperson 
        of the advisory council of such system. As used in this 
        subparagraph, the term ``members who broadly represent 
        or are knowledgeable about the needs of the clients 
        served by the system'' shall be construed to include 
        individuals who have received or are receiving mental 
        health services and family members of such individuals.
  (2) The governing authority established under paragraph (1) 
shall--
          (A) be responsible for the planning, design, 
        implementation, and functioning of the system; and
          (B) consistent with subparagraph (A), jointly develop 
        the annual priorities of the system with the advisory 
        council.
  (d) Grievance Procedure.--The Secretary shall establish an 
independent grievance procedure for persons described in 
subsection (a)(9).

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Part B--Administrative Provisions

           *       *       *       *       *       *       *


                        REPORTS BY THE SECRETARY

  Sec. 114. (a) The Secretary shall include in each report 
required under section 105 of the Developmental Disabilities 
Assistance and Bill of Rights Act of 2000 a separate statement 
which contains--
          (1) a description of the activities, accomplishments, 
        and expenditures of systems to protect and advocate the 
        rights of individuals with mental illness supported 
        with payments from allotments under this title, 
        including--
                  (A) a specification of the total number of 
                individuals with mental illness served by such 
                systems;
                  (B) a description of the types of activities 
                undertaken by such systems;
                  (C) a description of the types of facilities 
                providing care or treatment with respect to 
                which such activities are undertaken;
                  (D) a description of the manner in which such 
                activities are initiated; and
                  (E) a description of the accomplishments 
                resulting from such activities;
          (2) a description of--
                  (A) systems to protect and advocate the 
                rights of individuals with mental illness 
                supported with payments from allotments under 
                this title;
                  (B) activities conducted by States to protect 
                and advocate such rights;
                  (C) mechanisms established by residential 
                facilities for individuals with mental illness 
                to protect and advocate such rights; and
                  (D) the coordination among such systems, 
                activities, and mechanisms;
          (3) a specification of the number of systems 
        established with allotments under this title and of 
        whether each such system was established by a public or 
        nonprofit private entity; [and]
          (4) recommendations for activities and services to 
        improve the protection and advocacy of the rights of 
        individuals with mental illness and a description of 
        needs for such activities and services which have not 
        been met by systems established under this title[.]; 
        and
          (5) using data from the existing required annual 
        program progress reports submitted by each system 
        funded under this title, a detailed accounting for each 
        such system of how funds are spent, disaggregated 
        according to whether the funds were received from the 
        Federal Government, the State government, a local 
        government, or a private entity.
  (b) In preparing each statement required by subsection (a), 
the Secretary shall use and include information submitted to 
the Secretary in the reports required under section 105(a)(7).

           *       *       *       *       *       *       *

                              ----------                              


SOCIAL SECURITY ACT

           *       *       *       *       *       *       *


TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS

           *       *       *       *       *       *       *


                           PAYMENT TO STATES

  Sec. 1903. (a) From the sums appropriated therefor, the 
Secretary (except as otherwise provided in this section) shall 
pay to each State which has a plan approved under this title, 
for each quarter, beginning with the quarter commencing January 
1, 1966--
          (1) an amount equal to the Federal medical assistance 
        percentage (as defined in section 1905(b), subject to 
        subsections (g) and (j) of this section and subsection 
        1923(f)) of the total amount expended during such 
        quarter as medical assistance under the State plan; 
        plus
          (2)(A) an amount equal to 75 per centum of so much of 
        the sums expended during such quarter (as found 
        necessary by the Secretary for the proper and efficient 
        administration of the State plan) as are attributable 
        to compensation or training of skilled professional 
        medical personnel, and staff directly supporting such 
        personnel, of the State agency or any other public 
        agency; plus
          (B) notwithstanding paragraph (1) or subparagraph 
        (A), with respect to amounts expended for nursing aide 
        training and competency evaluation programs, and 
        competency evaluation programs, described in section 
        1919(e)(1) (including the costs for nurse aides to 
        complete such competency evaluation programs), 
        regardless of whether the programs are provided in or 
        outside nursing facilities or of the skill of the 
        personnel involved in such programs, an amount equal to 
        50 percent (or, for calendar quarters beginning on or 
        after July 1, 1988, and before October 1, 1990, the 
        lesser of 90 percent or the Federal medical assistance 
        percentage plus 25 percentage points) of so much of the 
        sums expended during such quarter (as found necessary 
        by the Secretary for the proper and efficient 
        administration of the State plan) as are attributable 
        to such programs; plus
          (C) an amount equal to 75 percent of so much of the 
        sums expended during such quarter (as found necessary 
        by the Secretary for the proper and efficient 
        administration of the State plan) as are attributable 
        to preadmission screening and resident review 
        activities conducted by the State under section 
        1919(e)(7); plus
          (D) for each calendar quarter during--
                  (i) fiscal year 1991, an amount equal to 90 
                percent,
                  (ii) fiscal year 1992, an amount equal to 85 
                percent,
                  (iii) fiscal year 1993, an amount equal to 80 
                percent, and
                  (iv) fiscal year 1994 and thereafter, an 
                amount equal to 75 percent,
        of so much of the sums expended during such quarter (as 
        found necessary by the Secretary for the proper and 
        efficient administration of the State plan) as are 
        attributable to State activities under section 1919(g); 
        plus
          (E) an amount equal to 75 percent of so much of the 
        sums expended during such quarter (as found necessary 
        by the Secretary for the proper and efficient 
        administration of the State plan) as are attributable 
        to translation or interpretation services in connection 
        with the enrollment of, retention of, and use of 
        services under this title by, children of families for 
        whom English is not the primary language; plus
          (3) an amount equal to--
                  (A)(i) 90 per centum of so much of the sums 
                expended during such quarter as are 
                attributable to the design, development, or 
                installation of such mechanized claims 
                processing and information retrieval systems as 
                the Secretary determines are likely to provide 
                more efficient, economical, and effective 
                administration of the plan and to be compatible 
                with the claims processing and information 
                retrieval systems utilized in the 
                administration of title XVIII, including the 
                State's share of the cost of installing such a 
                system to be used jointly in the administration 
                of such State's plan and the plan of any other 
                State approved under this title,
                  (ii) 90 per centum of so much of the sums 
                expended during any such quarter in the fiscal 
                year ending June 30, 1972, or the fiscal year 
                ending June 30, 1973, as are attributable to 
                the design, development, or installation of 
                cost determination systems for State-owned 
                general hospitals (except that the total amount 
                paid to all States under this clause for either 
                such fiscal year shall not exceed $150,000), 
                and
                  (iii) an amount equal to the Federal medical 
                assistance percentage (as defined in section 
                1905(b)) of so much of the sums expended during 
                such quarter (as found necessary by the 
                Secretary for the proper and efficient 
                administration of the State plan) as are 
                attributable to such developments or 
                modifications of systems of the type described 
                in clause (i) as are necessary for the 
                efficient collection and reporting on child 
                health measures; and
                  (B) 75 per centum of so much of the sums 
                expended during such quarter as are 
                attributable to the operation of systems 
                (whether such systems are operated directly by 
                the State or by another person under a contract 
                with the State) of the type described in 
                subparagraph (A)(i) (whether or not designed, 
                developed, or installed with assistance under 
                such subparagraph) which are approved by the 
                Secretary and which include provision for 
                prompt written notice to each individual who is 
                furnished services covered by the plan, or to 
                each individual in a sample group of 
                individuals who are furnished such services, of 
                the specific services (other than confidential 
                services) so covered, the name of the person or 
                persons furnishing the services, the date or 
                dates on which the services were furnished, and 
                the amount of the payment or payments made 
                under the plan on account of the services; and
                  (C)(i) 75 per centum of the sums expended 
                with respect to costs incurred during such 
                quarter (as found necessary by the Secretary 
                for the proper and efficient administration of 
                the State plan) as are attributable to the 
                performance of medical and utilization review 
                by a utilization and quality control peer 
                review organization or by an entity which meets 
                the requirements of section 1152, as determined 
                by the Secretary, under a contract entered into 
                under section 1902(d); and
                  (ii) 75 percent of the sums expended with 
                respect to costs incurred during such quarter 
                (as found necessary by the Secretary for the 
                proper and efficient administration of the 
                State plan) as are attributable to the 
                performance of independent external reviews 
                conducted under section 1932(c)(2); and
                  (D) 75 percent of so much of the sums 
                expended by the State plan during a quarter in 
                1991, 1992, or 1993, as the Secretary 
                determines is attributable to the statewide 
                adoption of a drug use review program which 
                conforms to the requirements of section 
                1927(g);
                  (E) 50 percent of the sums expended with 
                respect to costs incurred during such quarter 
                as are attributable to providing--
                          (i) services to identify and educate 
                        individuals who are likely to be 
                        eligible for medical assistance under 
                        this title and who have Sickle Cell 
                        Disease or who are carriers of the 
                        sickle cell gene, including education 
                        regarding how to identify such 
                        individuals; or
                          (ii) education regarding the risks of 
                        stroke and other complications, as well 
                        as the prevention of stroke and other 
                        complications, in individuals who are 
                        likely to be eligible for medical 
                        assistance under this title and who 
                        have Sickle Cell Disease; and
                  (F)(i) 100 percent of so much of the sums 
                expended during such quarter as are 
                attributable to payments to Medicaid providers 
                described in subsection (t)(1) to encourage the 
                adoption and use of certified EHR technology; 
                and
                  (ii) 90 percent of so much of the sums 
                expended during such quarter as are 
                attributable to payments for reasonable 
                administrative expenses related to the 
                administration of payments described in clause 
                (i) if the State meets the condition described 
                in subsection (t)(9); plus
                  (H)(i) 90 percent of the sums expended during 
                the quarter as are attributable to the design, 
                development, or installation of such mechanized 
                verification and information retrieval systems 
                as the Secretary determines are necessary to 
                implement section 1902(ee) (including a system 
                described in paragraph (2)(B) thereof), and
                  (ii) 75 percent of the sums expended during 
                the quarter as are attributable to the 
                operation of systems to which clause (i) 
                applies, plus
          (4) an amount equal to 100 percent of the sums 
        expended during the quarter which are attributable to 
        the costs of the implementation and operation of the 
        immigration status verification system described in 
        section 1137(d); plus
          (5) an amount equal to 90 per centum of the sums 
        expended during such quarter which are attributable to 
        the offering, arranging, and furnishing (directly or on 
        a contract basis) of family planning services and 
        supplies;
          (6) subject to subsection (b)(3), an amount equal 
        to--
                  (A) 90 per centum of the sums expended during 
                such a quarter within the twelve-quarter period 
                beginning with the first quarter in which a 
                payment is made to the State pursuant to this 
                paragraph, and
                  (B) 75 per centum of the sums expended during 
                each succeeding calendar quarter,
        with respect to costs incurred during such quarter (as 
        found necessary by the Secretary for the elimination of 
        fraud in the provision and administration of medical 
        assistance provided under the State plan) which are 
        attributable to the establishment and operation of 
        (including the training of personnel employed by) a 
        State medicaid fraud control unit (described in 
        subsection (q)); plus
          (7) subject to section 1919(g)(3)(B), an amount equal 
        to 50 per centum of the remainder of the amounts 
        expended during such quarter as found necessary by the 
        Secretary for the proper and efficient administration 
        of the State plan.
  (b)(1) Notwithstanding the preceding provisions of this 
section, the amount determined under subsection (a)(1) for any 
State for any quarter beginning after December 31, 1969, shall 
not take into account any amounts expended as medical 
assistance with respect to individuals aged 65 or over and 
disabled individuals entitled to hospital insurance benefits 
under title XVIII which would not have been so expended if the 
individuals involved had been enrolled in the insurance program 
established by part B of title XVIII, other than amounts 
expended under provisions of the plan of such State required by 
section 1902(a)(34).
  (2) For limitation on Federal participation for capital 
expenditures which are out of conformity with a comprehensive 
plan of a State or areawide planning agency, see section 1122.
  (3) The amount of funds which the Secretary is otherwise 
obligated to pay a State during a quarter under subsection 
(a)(6) may not exceed the higher of--
          (A) $125,000, or
          (B) one-quarter of 1 per centum of the sums expended 
        by the Federal, State, and local governments during the 
        previous quarter in carrying out the State's plan under 
        this title.
  (4) Amounts expended by a State for the use of an enrollment 
broker in marketing medicaid managed care organizations and 
other managed care entities to eligible individuals under this 
title shall be considered, for purposes of subsection (a)(7), 
to be necessary for the proper and efficient administration of 
the State plan but only if the following conditions are met 
with respect to the broker:
          (A) The broker is independent of any such entity and 
        of any health care providers (whether or not any such 
        provider participates in the State plan under this 
        title) that provide coverage of services in the same 
        State in which the broker is conducting enrollment 
        activities.
          (B) No person who is an owner, employee, consultant, 
        or has a contract with the broker either has any direct 
        or indirect financial interest with such an entity or 
        health care provider or has been excluded from 
        participation in the program under this title or title 
        XVIII or debarred by any Federal agency, or subject to 
        a civil money penalty under this Act.
  (5) Notwithstanding the preceding provisions of this section, 
the amount determined under subsection (a)(1) for any State 
shall be decreased in a quarter by the amount of any health 
care related taxes (described in section 1902(w)(3)(A)) that 
are imposed on a hospital described in subsection (w)(3)(F) in 
that quarter.
  (c) Nothing in this title shall be construed as prohibiting 
or restricting, or authorizing the Secretary to prohibit or 
restrict, payment under subsection (a) for medical assistance 
for covered services furnished to a child with a disability 
because such services are included in the child's 
individualized education program established pursuant to part B 
of the Individuals with Disabilities Education Act or furnished 
to an infant or toddler with a disability because such services 
are included in the child's individualized family service plan 
adopted pursuant to part C of such Act.
  (d)(1) Prior to the beginning of each quarter, the Secretary 
shall estimate the amount to which a State will be entitled 
under subsections (a) and (b) for such quarter, such estimates 
to be based on (A) a report filed by the State containing its 
estimate of the total sum to be expended in such quarter in 
accordance with the provisions of such subsections, and stating 
the amount appropriated or made available by the State and its 
political subdivisions for such expenditures in such quarter, 
and if such amount is less than the State's proportionate share 
of the total sum of such estimated expenditures, the source or 
sources from which the difference is expected to be derived, 
and (B) such other investigation as the Secretary may find 
necessary.
  (2)(A) The Secretary shall then pay to the State, in such 
installments as he may determine, the amount so estimated, 
reduced or increased to the extent of any overpayment or 
underpayment which the Secretary determines was made under this 
section to such State for any prior quarter and with respect to 
which adjustment has not already been made under this 
subsection.
  (B) Expenditures for which payments were made to the State 
under subsection (a) shall be treated as an overpayment to the 
extent that the State or local agency administering such plan 
has been reimbursed for such expenditures by a third party 
pursuant to the provisions of its plan in compliance with 
section 1902(a)(25).
  (C) For purposes of this subsection, when an overpayment is 
discovered, which was made by a State to a person or other 
entity, the State shall have a period of 1 year in which to 
recover or attempt to recover such overpayment before 
adjustment is made in the Federal payment to such State on 
account of such overpayment. Except as otherwise provided in 
subparagraph (D), the adjustment in the Federal payment shall 
be made at the end of the 1-year period, whether or not 
recovery was made.
  (D)(i) In any case where the State is unable to recover a 
debt which represents an overpayment (or any portion thereof) 
made to a person or other entity on account of such debt having 
been discharged in bankruptcy or otherwise being uncollectable, 
no adjustment shall be made in the Federal payment to such 
State on account of such overpayment (or portion thereof).
  (ii) In any case where the State is unable to recover a debt 
which represents an overpayment (or any portion thereof) made 
to a person or other entity due to fraud within 1 year of 
discovery because there is not a final determination of the 
amount of the overpayment under an administrative or judicial 
process (as applicable), including as a result of a judgment 
being under appeal, no adjustment shall be made in the Federal 
payment to such State on account of such overpayment (or 
portion thereof) before the date that is 30 days after the date 
on which a final judgment (including, if applicable, a final 
determination on an appeal) is made.
  (3)(A) The pro rata share to which the United States is 
equitably entitled, as determined by the Secretary, of the net 
amount recovered during any quarter by the State or any 
political subdivision thereof with respect to medical 
assistance furnished under the State plan shall be considered 
an overpayment to be adjusted under this subsection.
  (B)(i) Subparagraph (A) and paragraph (2)(B) shall not apply 
to any amount recovered or paid to a State as part of the 
comprehensive settlement of November 1998 between manufacturers 
of tobacco products, as defined in section 5702(d) of the 
Internal Revenue Code of 1986, and State Attorneys General, or 
as part of any individual State settlement or judgment reached 
in litigation initiated or pursued by a State against one or 
more such manufacturers.
  (ii) Except as provided in subsection (i)(19), a State may 
use amounts recovered or paid to the State as part of a 
comprehensive or individual settlement, or a judgment, 
described in clause (i) for any expenditures determined 
appropriate by the State.
  (4) Upon the making of any estimate by the Secretary under 
this subsection, any appropriations available for payments 
under this section shall be deemed obligated.
  (5) In any case in which the Secretary estimates that there 
has been an overpayment under this section to a State on the 
basis of a claim by such State that has been disallowed by the 
Secretary under section 1116(d), and such State disputes such 
disallowance, the amount of the Federal payment in controversy 
shall, at the option of the State, be retained by such State or 
recovered by the Secretary pending a final determination with 
respect to such payment amount. If such final determination is 
to the effect that any amount was properly disallowed, and the 
State chose to retain payment of the amount in controversy, the 
Secretary shall offset, from any subsequent payments made to 
such State under this title, an amount equal to the proper 
amount of the disallowance plus interest on such amount 
disallowed for the period beginning on the date such amount was 
disallowed and ending on the date of such final determination 
at a rate (determined by the Secretary) based on the average of 
the bond equivalent of the weekly 90-day treasury bill auction 
rates during such period.
  (6)(A) Each State (as defined in subsection (w)(7)(D)) shall 
include, in the first report submitted under paragraph (1) 
after the end of each fiscal year, information related to--
          (i) provider-related donations made to the State or 
        units of local government during such fiscal year, and
          (ii) health care related taxes collected by the State 
        or such units during such fiscal year.
  (B) Each State shall include, in the first report submitted 
under paragraph (1) after the end of each fiscal year, 
information related to the total amount of payment adjustments 
made, and the amount of payment adjustments made to individual 
providers (by provider), under section 1923(c) during such 
fiscal year.
  (e) A State plan approved under this title may include, as a 
cost with respect to hospital services under the plan under 
this title, periodic expenditures made to reflect transitional 
allowances established with respect to a hospital closure or 
conversion under section 1884.
  (f)(1)(A) Except as provided in paragraph (4), payment under 
the preceding provisions of this section shall not be made with 
respect to any amount expended as medical assistance in a 
calendar quarter, in any State, for any member of a family the 
annual income of which exceeds the applicable income limitation 
determined under this paragraph.
  (B)(i) Except as provided in clause (ii) of this 
subparagraph, the applicable income limitation with respect to 
any family is the amount determined, in accordance with 
standards prescribed by the Secretary, to be equivalent to 
133\1/3\ percent of the highest amount which would ordinarily 
be paid to a family of the same size without any income or 
resources, in the form of money payments, under the plan of the 
State approved under part A of title IV of this Act.
  (ii) If the Secretary finds that the operation of a uniform 
maximum limits payments to families of more than one size, he 
may adjust the amount otherwise determined under clause (i) to 
take account of families of different sizes.
  (C) The total amount of any applicable income limitation 
determined under subparagraph (B) shall, if it is not a 
multiple of $100 or such other amount as the Secretary may 
prescribe, be rounded to the next higher multiple of $100 or 
such other amount, as the case may be.
  (2)(A) In computing a family's income for purposes of 
paragraph (1), there shall be excluded any costs (whether in 
the form of insurance premiums or otherwise and regardless of 
whether such costs are reimbursed under another public program 
of the State or political subdivision thereof) incurred by such 
family for medical care or for any other type of remedial care 
recognized under State law or, (B) notwithstanding section 1916 
at State option, an amount paid by such family, at the family's 
option, to the State, provided that the amount, when combined 
with costs incurred in prior months, is sufficient when 
excluded from the family's income to reduce such family's 
income below the applicable income limitation described in 
paragraph (1). The amount of State expenditures for which 
medical assistance is available under subsection (a)(1) will be 
reduced by amounts paid to the State pursuant to this 
subparagraph.
  (3) For purposes of paragraph (1)(B), in the case of a family 
consisting of only one individual, the ``highest amount which 
would ordinarily be paid'' to such family under the State's 
plan approved under part A of title IV of this Act shall be the 
amount determined by the State agency (on the basis of 
reasonable relationship to the amounts payable under such plan 
to families consisting of two or more persons) to be the amount 
of the aid which would ordinarily be payable under such plan to 
a family (without any income or resources) consisting of one 
person if such plan provided for aid to such a family.
  (4) The limitations on payment imposed by the preceding 
provisions of this subsection shall not apply with respect to 
any amount expended by a State as medical assistance for any 
individual described in section 1902(a)(10)(A)(i)(III), 
1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(V), 
1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII), 
1902(a)(10)(A)(i)(VIII),1902(a)(10)(A)(i)(IX), 
1902(a)(10)(A)(ii)(IX), 1902(a)(10)(A)(ii)(X), 
1902(a)(10)(A)(ii)(XIII), 1902(a)(10)(A)(ii)(XIV), or 
1902(a)(10)(A)(ii)(XV), 1902(a)(10)(A)(ii)(XVI), 
1902(a)(10)(A)(ii)(XVII), 1902(a)(10)(A)(ii)(XVIII), 
1902(a)(10)(A)(ii)(XIX), 1902(a)(10)(A)(ii)(XX), 
1902(a)(10)(A)(ii)(XXI), 1902(a)(10)(A)(ii)(XXII), 1905(p)(1) 
or for any individual--
          (A) who is receiving aid or assistance under any plan 
        of the State approved under title I, X, XIV or XVI, or 
        part A of title IV, or with respect to whom 
        supplemental security income benefits are being paid 
        under title XVI, or
          (B) who is not receiving such aid or assistance, and 
        with respect to whom such benefits are not being paid, 
        but (i) is eligible to receive such aid or assistance, 
        or to have such benefits paid with respect to him, or 
        (ii) would be eligible to receive such aid or 
        assistance, or to have such benefits paid with respect 
        to him if he were not in a medical institution, or
          (C) with respect to whom there is being paid, or who 
        is eligible, or would be eligible if he were not in a 
        medical institution, to have paid with respect to him, 
        a State supplementary payment and is eligible for 
        medical assistance equal in amount, duration, and scope 
        to the medical assistance made available to individuals 
        described in section 1902(a)(10)(A), or who is a PACE 
        program eligible individual enrolled in a PACE program 
        under section 1934, but only if the income of such 
        individual (as determined under section 1612, but 
        without regard to subsection (b) thereof) does not 
        exceed 300 percent of the supplemental security income 
        benefit rate established by section 1611(b)(1),
at the time of the provision of the medical assistance giving 
rise to such expenditure.
  (g)(1) Subject to paragraph (3), with respect to amounts paid 
for the following services furnished under the State plan after 
June 30, 1973 (other than services furnished pursuant to a 
contract with a health maintenance organization as defined in 
section 1876 or which is a qualified health maintenance 
organization (as defined in section 1310(d) of the Public 
Health Service Act)), the Federal medical assistance percentage 
shall be decreased as follows: After an individual has received 
inpatient hospital services or services in an intermediate care 
facility for the mentally retarded for 60 days or inpatient 
mental hospital services for 90 days (whether or not such days 
are consecutive), during any fiscal year, the Federal medical 
assistance percentage with respect to amounts paid for any such 
care furnished thereafter to such individual shall be decreased 
by a per centum thereof (determined under paragraph (5)) unless 
the State agency responsible for the administration of the plan 
makes a showing satisfactory to the Secretary that, with 
respect to each calendar quarter for which the State submits a 
request for payment at the full Federal medical assistance 
percentage for amounts paid for inpatient hospital services or 
services in an intermediate care facility for the mentally 
retarded furnished beyond 60 days (or inpatient mental hospital 
services furnished beyond 90 days), such State has an effective 
program of medical review of the care of patients in mental 
hospitals and intermediate care facilities for the mentally 
retarded pursuant to paragraphs (26) and (31) of section 
1902(a) whereby the professional management of each case is 
reviewed and evaluated at least annually by independent 
professional review teams. In determining the number of days on 
which an individual has received services described in this 
subsection, there shall not be counted any days with respect to 
which such individual is entitled to have payments made (in 
whole or in part) on his behalf under section 1812.
  (2) The Secretary shall, as part of his validation procedures 
under this subsection, conduct timely sample onsite surveys of 
private and public institutions in which recipients of medical 
assistance may receive care and services under a State plan 
approved under this title, and his findings with respect to 
such surveys (as well as the showings of the State agency 
required under this subsection) shall be made available for 
public inspection.
  (3)(A) No reduction in the Federal medical assistance 
percentage of a State otherwise required to be imposed under 
this subsection shall take effect--
          (i) if such reduction is due to the State's 
        unsatisfactory or invalid showing made with respect to 
        a calendar quarter beginning before January 1, 1977;
          (ii) before January 1, 1978;
          (iii) unless a notice of such reduction has been 
        provided to the State at least 30 days before the date 
        such reduction takes effect; or
          (iv) due to the State's unsatisfactory or invalid 
        showing made with respect to a calendar quarter 
        beginning after September 30, 1977, unless notice of 
        such reduction has been provided to the State no later 
        than the first day of the fourth calendar quarter 
        following the calendar quarter with respect to which 
        such showing was made.
  (B) The Secretary shall waive application of any reduction in 
the Federal medical assistance percentage of a State otherwise 
required to be imposed under paragraph (1) because a showing by 
the State, made under such paragraph with respect to a calendar 
quarter ending after January 1, 1977, and before January 1, 
1978, is determined to be either unsatisfactory under such 
paragraph or invalid under paragraph (2), if the Secretary 
determines that the State's showing made under paragraph (1) 
with respect to any calendar quarter ending on or before 
December 31, 1978, is satisfactory under such paragraph and is 
valid under paragraph (2).
  (4)(A) The Secretary may not find the showing of a State, 
with respect to a calendar quarter under paragraph (1), to be 
satisfactory if the showing is submitted to the Secretary later 
than the 30th day after the last day of the calendar quarter, 
unless the State demonstrates to the satisfaction of the 
Secretary good cause for not meeting such deadline.
  (B) The Secretary shall find a showing of a State, with 
respect to a calendar quarter under paragraph (1), to be 
satisfactory under such paragraph with respect to the 
requirement that the State conduct annual onsite inspections in 
mental hospitals and intermediate care facilities for the 
mentally retarded under paragraphs (26) and (31) of section 
1902(a), if the showing demonstrates that the State has 
conducted such an onsite inspection during the 12-month period 
ending on the last date of the calendar quarter--
          (i) in each of not less than 98 per centum of the 
        number of such hospitals and facilities requiring such 
        inspection, and
          (ii) in every such hospital or facility which has 200 
        or more beds,
and that, with respect to such hospitals and facilities not 
inspected within such period, the State has exercised good 
faith and due diligence in attempting to conduct such 
inspection, or if the State demonstrates to the satisfaction of 
the Secretary that it would have made such a showing but for 
failings of a technical nature only.
  (5) In the case of a State's unsatisfactory or invalid 
showing made with respect to a type of facility or 
institutional services in a calendar quarter, the per centum 
amount of the reduction of the State's Federal medical 
assistance percentage for that type of services under paragraph 
(1) is equal to 33\1/3\ per centum multiplied by a fraction, 
the denominator of which is equal to the total number of 
patients receiving that type of services in that quarter under 
the State plan in facilities or institutions for which a 
showing was required to be made under this subsection, and the 
numerator of which is equal to the number of such patients 
receiving such type of services in that quarter in those 
facilities or institutions for which a satisfactory and valid 
showing was not made for that calendar quarter.
  (6)(A) Recertifications required under section 1902(a)(44) 
shall be conducted at least every 60 days in the case of 
inpatient hospital services.
  (B) Such recertifications in the case of services in an 
intermediate care facility for the mentally retarded shall be 
conducted at least--
          (i) 60 days after the date of the initial 
        certification,
          (ii) 180 days after the date of the initial 
        certification,
          (iii) 12 months after the date of the initial 
        certification,
          (iv) 18 months after the date of the initial 
        certification,
          (v) 24 months after the date of the initial 
        certification, and
          (vi) every 12 months thereafter.
  (C) For purposes of determining compliance with the schedule 
established by this paragraph, a recertification shall be 
considered to have been done on a timely basis if it was 
performed not later than 10 days after the date the 
recertification was otherwise required and the State 
establishes good cause why the physician or other person making 
such recertification did not meet such schedule.
  (i) Payment under the preceding provisions of this section 
shall not be made--
          (1) for organ transplant procedures unless the State 
        plan provides for written standards respecting the 
        coverage of such procedures and unless such standards 
        provide that--
                  (A) similarly situated individuals are 
                treated alike; and
                  (B) any restriction, on the facilities or 
                practitioners which may provide such 
                procedures, is consistent with the 
                accessibility of high quality care to 
                individuals eligible for the procedures under 
                the State plan; or
          (2) with respect to any amount expended for an item 
        or service (other than an emergency item or service, 
        not including items or services furnished in an 
        emergency room of a hospital) furnished--
                  (A) under the plan by any individual or 
                entity during any period when the individual or 
                entity is excluded from participation under 
                title V, XVIII, or XX or under this title 
                pursuant to section 1128, 1128A, 1156, or 
                1842(j)(2),
                  (B) at the medical direction or on the 
                prescription of a physician, during the period 
                when such physician is excluded from 
                participation under title V, XVIII, or XX or 
                under this title pursuant to section 1128, 
                1128A, 1156, or 1842(j)(2) and when the person 
                furnishing such item or service knew or had 
                reason to know of the exclusion (after a 
                reasonable time period after reasonable notice 
                has been furnished to the person); or
                  (C) by any individual or entity to whom the 
                State has failed to suspend payments under the 
                plan during any period when there is pending an 
                investigation of a credible allegation of fraud 
                against the individual or entity, as determined 
                by the State in accordance with regulations 
                promulgated by the Secretary for purposes of 
                section 1862(o) and this subparagraph, unless 
                the State determines in accordance with such 
                regulations there is good cause not to suspend 
                such payments; or
          (3) with respect to any amount expended for inpatient 
        hospital services furnished under the plan (other than 
        amounts attributable to the special situation of a 
        hospital which serves a disproportionate number of low 
        income patients with special needs) to the extent that 
        such amount exceeds the hospital's customary charges 
        with respect to such services or (if such services are 
        furnished under the plan by a public institution free 
        of charge or at nominal charges to the public) exceeds 
        an amount determined on the basis of those items 
        (specified in regulations prescribed by the Secretary) 
        included in the determination of such payment which the 
        Secretary finds will provide fair compensation to such 
        institution for such services; or
          (4) with respect to any amount expended for care or 
        services furnished under the plan by a hospital unless 
        such hospital has in effect a utilization review plan 
        which meets the requirements imposed by section 1861(k) 
        for purposes of title XVIII; and if such hospital has 
        in effect such a utilization review plan for purposes 
        of title XVIII, such plan shall serve as the plan 
        required by this subsection (with the same standards 
        and procedures and the same review committee or group) 
        as a condition of payment under this title; the 
        Secretary is authorized to waive the requirements of 
        this paragraph if the State agency demonstrates to his 
        satisfaction that it has in operation utilization 
        review procedures which are superior in their 
        effectiveness to the procedures required under section 
        1861(k); or
          (5) with respect to any amount expended for any drug 
        product for which payment may not be made under part B 
        of title XVIII because of section 1862(c); or
          (6) with respect to any amount expended for inpatient 
        hospital tests (other than in emergency situations) not 
        specifically ordered by the attending physician or 
        other responsible practitioner; or
          (7) with respect to any amount expended for clinical 
        diagnostic laboratory tests performed by a physician, 
        independent laboratory, or hospital, to the extent such 
        amount exceeds the amount that would be recognized 
        under section 1833(h) for such tests performed for an 
        individual enrolled under part B of title XVIII; or
          (8) with respect to any amount expended for medical 
        assistance (A) for nursing facility services to 
        reimburse (or otherwise compensate) a nursing facility 
        for payment of a civil money penalty imposed under 
        section 1919(h) or (B) for home and community care to 
        reimburse (or otherwise compensate) a provider of such 
        care for payment of a civil money penalty imposed under 
        this title or title XI or for legal expenses in defense 
        of an exclusion or civil money penalty under this title 
        or title XI if there is no reasonable legal ground for 
        the provider's case; or
          (10)(A) with respect to covered outpatient drugs 
        unless there is a rebate agreement in effect under 
        section 1927 with respect to such drugs or unless 
        section 1927(a)(3) applies,
          (B) with respect to any amount expended for an 
        innovator multiple source drug (as defined in section 
        1927(k)) dispensed on or after July 1, 1991, if, under 
        applicable State law, a less expensive multiple source 
        drug could have been dispensed, but only to the extent 
        that such amount exceeds the upper payment limit for 
        such multiple source drug;
                  (C) with respect to covered outpatient drugs 
                described in section 1927(a)(7), unless 
                information respecting utilization data and 
                coding on such drugs that is required to be 
                submitted under such section is submitted in 
                accordance with such section, and
          (D) with respect to any amount expended for 
        reimbursement to a pharmacy under this title for the 
        ingredient cost of a covered outpatient drug for which 
        the pharmacy has already received payment under this 
        title (other than with respect to a reasonable 
        restocking fee for such drug); or
          (11) with respect to any amount expended for 
        physicians' services furnished on or after the first 
        day of the first quarter beginning more than 60 days 
        after the date of establishment of the physician 
        identifier system under section 1902(x), unless the 
        claim for the services includes the unique physician 
        identifier provided under such system; or
          (13) with respect to any amount expended to reimburse 
        (or otherwise compensate) a nursing facility for 
        payment of legal expenses associated with any action 
        initiated by the facility that is dismissed on the 
        basis that no reasonable legal ground existed for the 
        institution of such action; or
          (14) with respect to any amount expended on 
        administrative costs to carry out the program under 
        section 1928; or
          (15) with respect to any amount expended for a 
        single-antigen vaccine and its administration in any 
        case in which the administration of a combined-antigen 
        vaccine was medically appropriate (as determined by the 
        Secretary); or
          (16) with respect to any amount expended for which 
        funds may not be used under the Assisted Suicide 
        Funding Restriction Act of 1997; or
          (17) with respect to any amount expended for roads, 
        bridges, stadiums, or any other item or service not 
        covered under a State plan under this title; or
          (18) with respect to any amount expended for home 
        health care services provided by an agency or 
        organization unless the agency or organization provides 
        the State agency on a continuing basis a surety bond in 
        a form specified by the Secretary under paragraph (7) 
        of section 1861(o) and in an amount that is not less 
        than $50,000 or such comparable surety bond as the 
        Secretary may permit under the last sentence of such 
        section; or
          (19) with respect to any amount expended on 
        administrative costs to initiate or pursue litigation 
        described in subsection (d)(3)(B);
          (20) with respect to amounts expended for medical 
        assistance provided to an individual described in 
        subclause (XV) or (XVI) of section 1902(a)(10)(A)(ii) 
        for a fiscal year unless the State demonstrates to the 
        satisfaction of the Secretary that the level of State 
        funds expended for such fiscal year for programs to 
        enable working individuals with disabilities to work 
        (other than for such medical assistance) is not less 
        than the level expended for such programs during the 
        most recent State fiscal year ending before the date of 
        the enactment of this paragraph;
          (21) with respect to amounts expended for covered 
        outpatient drugs described in section 1927(d)(2)(K) 
        (relating to drugs when used for treatment of sexual or 
        erectile dysfunction);
          (22) with respect to amounts expended for medical 
        assistance for an individual who declares under section 
        1137(d)(1)(A) to be a citizen or national of the United 
        States for purposes of establishing eligibility for 
        benefits under this title, unless the requirement of 
        section 1902(a)(46)(B) is met;
          (23) with respect to amounts expended for medical 
        assistance for covered outpatient drugs (as defined in 
        section 1927(k)(2)) for which the prescription was 
        executed in written (and non-electronic) form unless 
        the prescription was executed on a tamper-resistant 
        pad;
          (24) if a State is required to implement an asset 
        verification program under section 1940 and fails to 
        implement such program in accordance with such section, 
        with respect to amounts expended by such State for 
        medical assistance for individuals subject to asset 
        verification under such section, unless--
                  (A) the State demonstrates to the Secretary's 
                satisfaction that the State made a good faith 
                effort to comply;
                  (B) not later than 60 days after the date of 
                a finding that the State is in noncompliance, 
                the State submits to the Secretary (and the 
                Secretary approves) a corrective action plan to 
                remedy such noncompliance; and
                  (C) not later than 12 months after the date 
                of such submission (and approval), the State 
                fulfills the terms of such corrective action 
                plan;
          (25) with respect to any amounts expended for medical 
        assistance for individuals for whom the State does not 
        report enrollee encounter data (as defined by the 
        Secretary) to the Medicaid Statistical Information 
        System (MSIS) in a timely manner (as determined by the 
        Secretary);
          (26) with respect to any amounts expended for medical 
        assistance for individuals described in subclause 
        (VIII) of subsection (a)(10)(A)(i) other than medical 
        assistance provided through benchmark coverage 
        described in section 1937(b)(1) or benchmark equivalent 
        coverage described in section 1937(b)(2); or
          (27) with respect to any amounts expended by the 
        State on the basis of a fee schedule for items 
        described in section 1861(n) and furnished on or after 
        January 1, 2019, as determined in the aggregate with 
        respect to each class of such items as defined by the 
        Secretary, in excess of the aggregate amount, if any, 
        that would be paid for such items within such class on 
        a fee-for-service basis under the program under part B 
        of title XVIII, including, as applicable, under a 
        competitive acquisition program under section 1847 in 
        an area of the State.
Nothing in paragraph (1) shall be construed as permitting a 
State to provide services under its plan under this title that 
are not reasonable in amount, duration, and scope to achieve 
their purpose. Paragraphs (1), (2), (16), (17), and (18) shall 
apply with respect to items or services furnished and amounts 
expended by or through a managed care entity (as defined in 
section 1932(a)(1)(B)) in the same manner as such paragraphs 
apply to items or services furnished and amounts expended 
directly by the State.
  (j) Notwithstanding the preceding provisions of this section, 
the amount determined under subsection (a)(1) for any State for 
any quarter shall be adjusted in accordance with section 1914.
  (k) The Secretary is authorized to provide at the request of 
any State (and without cost to such State) such technical and 
actuarial assistance as may be necessary to assist such State 
to contract with any medicaid managed care organization which 
meets the requirements of subsection (m) of this section for 
the purpose of providing medical care and services to 
individuals who are entitled to medical assistance under this 
title.
  (l)(1) Subject to paragraphs (3) and (4), with respect to any 
amount expended for personal care services or home health care 
services requiring an in-home visit by a provider that are 
provided under a State plan under this title (or under a waiver 
of the plan) and furnished in a calendar quarter beginning on 
or after January 1, 2019 (or, in the case of home health care 
services, on or after January 1, 2023), unless a State requires 
the use of an electronic visit verification system for such 
services furnished in such quarter under the plan or such 
waiver, the Federal medical assistance percentage shall be 
reduced--
          (A) in the case of personal care services--
                  (i) for calendar quarters in 2019 and 2020, 
                by .25 percentage points;
                  (ii) for calendar quarters in 2021, by .5 
                percentage points;
                  (iii) for calendar quarters in 2022, by .75 
                percentage points; and
                  (iv) for calendar quarters in 2023 and each 
                year thereafter, by 1 percentage point; and
          (B) in the case of home health care services--
                  (i) for calendar quarters in 2023 and 2024, 
                by .25 percentage points;
                  (ii) for calendar quarters in 2025, by .5 
                percentage points;
                  (iii) for calendar quarters in 2026, by .75 
                percentage points; and
                  (iv) for calendar quarters in 2027 and each 
                year thereafter, by 1 percentage point.
  (2) Subject to paragraphs (3) and (4), in implementing the 
requirement for the use of an electronic visit verification 
system under paragraph (1), a State shall--
          (A) consult with agencies and entities that provide 
        personal care services, home health care services, or 
        both under the State plan (or under a waiver of the 
        plan) to ensure that such system--
                  (i) is minimally burdensome;
                  (ii) takes into account existing best 
                practices and electronic visit verification 
                systems in use in the State; and
                  (iii) is conducted in accordance with the 
                requirements of HIPAA privacy and security law 
                (as defined in section 3009 of the Public 
                Health Service Act);
          (B) take into account a stakeholder process that 
        includes input from beneficiaries, family caregivers, 
        personal care or home health care services workers, and 
        other stakeholders, as determined by the State in 
        accordance with guidance from the Secretary; and
          (C) ensure that individuals who furnish personal care 
        services, home health care services, or both under the 
        State plan (or under a waiver of the plan) are provided 
        the opportunity for training on the use of such system.
  (3) Paragraphs (1) and (2) shall not apply in the case of a 
State that, as of the date of the enactment of this subsection, 
requires the use of any system for the electronic verification 
of visits conducted as part of both personal care services and 
home health care services.
  (4)(A) In the case of a State described in subparagraph (B), 
the reduction under paragraph (1) shall not apply--
          (i) in the case of personal care services, for 
        calendar quarters in 2019; and
          (ii) in the case of home health care services, for 
        calendar quarters in 2023.
  (B) For purposes of subparagraph (A), a State described in 
this subparagraph is a State that demonstrates to the Secretary 
that the State--
          (i) has made a good faith effort to comply with the 
        requirements of paragraphs (1) and (2) (including by 
        taking steps to adopt the technology used for an 
        electronic visit verification system); or
          (ii) in implementing such a system, has encountered 
        unavoidable system delays.
  (5) In this subsection:
          (A) The term ``electronic visit verification system'' 
        means, with respect to personal care services or home 
        health care services, a system under which visits 
        conducted as part of such services are electronically 
        verified with respect to--
                  (i) the type of service performed;
                  (ii) the individual receiving the service;
                  (iii) the date of the service;
                  (iv) the location of service delivery;
                  (v) the individual providing the service; and
                  (vi) the time the service begins and ends.
          (B) The term ``home health care services'' means 
        services described in section 1905(a)(7) provided under 
        a State plan under this title (or under a waiver of the 
        plan).
          (C) The term ``personal care services'' means 
        personal care services provided under a State plan 
        under this title (or under a waiver of the plan), 
        including services provided under section 1905(a)(24), 
        1915(c), 1915(i), 1915(j), or 1915(k) or under a wavier 
        under section 1115.
  (6)(A) In the case in which a State requires personal care 
service and home health care service providers to utilize an 
electronic visit verification system operated by the State or a 
contractor on behalf of the State, the Secretary shall pay to 
the State, for each quarter, an amount equal to 90 per centum 
of so much of the sums expended during such quarter as are 
attributable to the design, development, or installation of 
such system, and 75 per centum of so much of the sums for the 
operation and maintenance of such system.
  (B) Subparagraph (A) shall not apply in the case in which a 
State requires personal care service and home health care 
service providers to utilize an electronic visit verification 
system that is not operated by the State or a contractor on 
behalf of the State.
  (m)(1)(A) The term ``medicaid managed care organization'' 
means a health maintenance organization, an eligible 
organization with a contract under section 1876 or a 
Medicare+Choice organization with a contract under part C of 
title XVIII, a provider sponsored organization, or any other 
public or private organization, which meets the requirement of 
section 1902(w) and--
          (i) makes services it provides to individuals 
        eligible for benefits under this title accessible to 
        such individuals, within the area served by the 
        organization, to the same extent as such services are 
        made accessible to individuals (eligible for medical 
        assistance under the State plan) not enrolled with the 
        organization, and
          (ii) has made adequate provision against the risk of 
        insolvency, which provision is satisfactory to the 
        State, meets the requirements of subparagraph (C)(i) 
        (if applicable), and which assures that individuals 
        eligible for benefits under this title are in no case 
        held liable for debts of the organization in case of 
        the organization's insolvency.
An organization that is a qualified health maintenance 
organization (as defined in section 1310(d) of the Public 
Health Service Act) is deemed to meet the requirements of 
clauses (i) and (ii).
  (B) The duties and functions of the Secretary, insofar as 
they involve making determinations as to whether an 
organization is a medicaid managed care organization within the 
meaning of subparagraph (A), shall be integrated with the 
administration of section 1312 (a) and (b) of the Public Health 
Service Act.
  (C)(i) Subject to clause (ii), a provision meets the 
requirements of this subparagraph for an organization if the 
organization meets solvency standards established by the State 
for private health maintenance organizations or is licensed or 
certified by the State as a risk-bearing entity.
  (ii) Clause (i) shall not apply to an organization if--
          (I) the organization is not responsible for the 
        provision (directly or through arrangements with 
        providers of services) of inpatient hospital services 
        and physicians' services;
          (II) the organization is a public entity;
          (III) the solvency of the organization is guaranteed 
        by the State; or
          (IV) the organization is (or is controlled by) one or 
        more Federally-qualified health centers and meets 
        solvency standards established by the State for such an 
        organization.
For purposes of subclause (IV), the term ``control'' means the 
possession, whether direct or indirect, of the power to direct 
or cause the direction of the management and policies of the 
organization through membership, board representation, or an 
ownership interest equal to or greater than 50.1 percent.
  (2)(A) Except as provided in subparagraphs (B), (C), and (G), 
no payment shall be made under this title to a State with 
respect to expenditures incurred by it for payment (determined 
under a prepaid capitation basis or under any other risk basis) 
for services provided by any entity (including a health 
insuring organization) which is responsible for the provision 
(directly or through arrangements with providers of services) 
of inpatient hospital services and any other service described 
in paragraph (2), (3), (4), (5), or (7) of section 1905(a) or 
for the provision of any three or more of the services 
described in such paragraphs unless--
          (i) the Secretary has determined that the entity is a 
        medicaid managed care organization organization as 
        defined in paragraph (1);
          (iii) such services are provided for the benefit of 
        individuals eligible for benefits under this title in 
        accordance with a contract between the State and the 
        entity under which prepaid payments to the entity are 
        made on an actuarially sound basis and under which the 
        Secretary must provide prior approval for contracts 
        providing for expenditures in excess of $1,000,000 for 
        1998 and, for a subsequent year, the amount established 
        under this clause for the previous year increased by 
        the percentage increase in the consumer price index for 
        all urban consumers over the previous year;
          (iv) such contract provides that the Secretary and 
        the State (or any person or organization designated by 
        either) shall have the right to audit and inspect any 
        books and records of the entity (and of any 
        subcontractor) that pertain (I) to the ability of the 
        entity to bear the risk of potential financial losses, 
        or (II) to services performed or determinations of 
        amounts payable under the contract;
          (v) such contract provides that in the entity's 
        enrollment, reenrollment, or disenrollment of 
        individuals who are eligible for benefits under this 
        title and eligible to enroll, reenroll, or disenroll 
        with the entity pursuant to the contract, the entity 
        will not discriminate among such individuals on the 
        basis of their health status or requirements for health 
        care services;
          (vi) such contract (I) permits individuals who have 
        elected under the plan to enroll with the entity for 
        provision of such benefits to terminate such enrollment 
        in accordance with section 1932(a)(4), and (II) 
        provides for notification in accordance with such 
        section of each such individual, at the time of the 
        individual's enrollment, of such right to terminate 
        such enrollment;
          (vii) such contract provides that, in the case of 
        medically necessary services which were provided (I) to 
        an individual enrolled with the entity under the 
        contract and entitled to benefits with respect to such 
        services under the State's plan and (II) other than 
        through the organization because the services were 
        immediately required due to an unforeseen illness, 
        injury, or condition, either the entity or the State 
        provides for reimbursement with respect to those 
        services,
          (viii) such contract provides for disclosure of 
        information in accordance with section 1124 and 
        paragraph (4) of this subsection;
          (ix) such contract provides, in the case of an entity 
        that has entered into a contract for the provision of 
        services with a Federally-qualified health center or a 
        rural health clinic, that the entity shall provide 
        payment that is not less than the level and amount of 
        payment which the entity would make for the services if 
        the services were furnished by a provider which is not 
        a Federally-qualified health center or a rural health 
        clinic;
          (x) any physician incentive plan that it operates 
        meets the requirements described in section 1876(i)(8);
          (xi) such contract provides for maintenance of 
        sufficient patient encounter data to identify the 
        physician who delivers services to patients and for the 
        provision of such data to the State at a frequency and 
        level of detail to be specified by the Secretary;
          (xii) such contract, and the entity complies with the 
        applicable requirements of section 1932; and
                  (xiii) such contract provides that (I) 
                covered outpatient drugs dispensed to 
                individuals eligible for medical assistance who 
                are enrolled with the entity shall be subject 
                to the same rebate required by the agreement 
                entered into under section 1927 as the State is 
                subject to and that the State shall collect 
                such rebates from manufacturers, (II) 
                capitation rates paid to the entity shall be 
                based on actual cost experience related to 
                rebates and subject to the Federal regulations 
                requiring actuarially sound rates, and (III) 
                the entity shall report to the State, on such 
                timely and periodic basis as specified by the 
                Secretary in order to include in the 
                information submitted by the State to a 
                manufacturer and the Secretary under section 
                1927(b)(2)(A), information on the total number 
                of units of each dosage form and strength and 
                package size by National Drug Code of each 
                covered outpatient drug dispensed to 
                individuals eligible for medical assistance who 
                are enrolled with the entity and for which the 
                entity is responsible for coverage of such drug 
                under this subsection (other than covered 
                outpatient drugs that under subsection (j)(1) 
                of section 1927 are not subject to the 
                requirements of that section) and such other 
                data as the Secretary determines necessary to 
                carry out this subsection.
  (B) Subparagraph (A) except with respect to clause (ix) of 
subparagraph (A), does not apply with respect to payments under 
this title to a State with respect to expenditures incurred by 
it for payment for services provided by an entity which--
          (i)(I) received a grant of at least $100,000 in the 
        fiscal year ending June 30, 1976, under section 
        329(d)(1)(A) or 330(d)(1) of the Public Health Service 
        Act, and for the period beginning July 1, 1976, and 
        ending on the expiration of the period for which 
        payments are to be made under this title has been the 
        recipient of a grant under either such section; and
          (II) provides to its enrollees, on a prepaid 
        capitation risk basis or on any other risk basis, all 
        of the services and benefits described in paragraphs 
        (1), (2), (3), (4)(C), and (5) of section 1905(a) and, 
        to the extent required by section 1902(a)(10)(D) to be 
        provided under a State plan for medical assistance, the 
        services and benefits described in paragraph (7) of 
        section 1905(a); or
          (ii) is a nonprofit primary health care entity 
        located in a rural area (as defined by the Appalachian 
        Regional Commission)--
                  (I) which received in the fiscal year ending 
                June 30, 1976, at least $100,000 (by grant, 
                subgrant, or subcontract) under the Appalachian 
                Regional Development Act of 1965, and
                  (II) for the period beginning July 1, 1976, 
                and ending on the expiration of the period for 
                which payments are to be made under this title 
                either has been the recipient of a grant, 
                subgrant, or subcontract under such Act or has 
                provided services under a contract (initially 
                entered into during a year in which the entity 
                was the recipient of such a grant, subgrant, or 
                subcontract) with a State agency under this 
                title on a prepaid capitation risk basis or on 
                any other risk basis; or
          (iii) which has contracted with the single State 
        agency for the provision of services (but not including 
        inpatient hospital services) to persons eligible under 
        this title on a prepaid risk basis prior to 1970.
  (G) In the case of an entity which is receiving (and has 
received during the previous two years) a grant of at least 
$100,000 under section 329(d)(1)(A) or 330(d)(1) of the Public 
Health Service Act or is receiving (and has received during the 
previous two years) at least $100,000 (by grant, subgrant, or 
subcontract) under the Appalachian Regional Development Act of 
1965, clause (i) of subparagraph (A) shall not apply.
  (H) In the case of an individual who--
          (i) in a month is eligible for benefits under this 
        title and enrolled with a medicaid managed care 
        organization with a contract under this paragraph or 
        with a primary care case manager with a contract 
        described in section 1905(t)(3),
          (ii) in the next month (or in the next 2 months) is 
        not eligible for such benefits, but
          (iii) in the succeeding month is again eligible for 
        such benefits,
the State plan, subject to subparagraph (A)(vi), may enroll the 
individual for that succeeding month with the organization 
described in clause (i) if the organization continues to have a 
contract under this paragraph with the State or with the 
manager described in such clause if the manager continues to 
have a contract described in section 1905(t)(3) with the State.
  (I)(i) Notwithstanding the limitation specified in the 
subdivision (B) following paragraph (29) of section 1905(a) and 
subject to clause (ii), a State may, under a risk contract 
entered into by the State under this title (or under section 
1115) with a medicaid managed care organization or a prepaid 
inpatient health plan (as defined in section 438.2 of title 42, 
Code of Federal Regulations (or any successor regulation)), 
make a monthly capitation payment to such organization or plan 
for enrollees with the organization or plan who are over 21 
years of age and under 65 years of age and are receiving 
inpatient treatment in an institution for mental diseases (as 
defined in section 1905(i)), so long as each of the following 
conditions is met:
          (I) The institution is a hospital providing inpatient 
        psychiatric or substance use disorder services or a 
        sub-acute facility providing psychiatric or substance 
        use disorder crisis residential services.
          (II) The length of stay in such an institution for 
        such treatment is for a short-term stay of no more than 
        15 days during the period of the monthly capitation 
        payment.
          (III) The provision of such treatment meets the 
        following criteria for consideration as services or 
        settings that are in lieu of services or settings 
        covered under the State plan:
                  (aa) The State determines that the 
                alternative service or setting is a medically 
                appropriate and cost-effective substitute for 
                the covered service or setting under the State 
                plan.
                  (bb) The enrollee is not required by the 
                managed care organization or prepaid inpatient 
                health plan to use the alternative service or 
                setting.
                  (cc) Such treatment is authorized and 
                identified in such contract, and will be 
                offered to such enrollees at the option of the 
                managed care organization or prepaid inpatient 
                health plan.
  (ii) For purposes of setting the amount of such a monthly 
capitation payment, a State may use the utilization of services 
provided to an individual under this subparagraph when 
developing the inpatient psychiatric or substance use disorder 
component of such payment, but the amount of such payment for 
such services may not exceed the cost of the same services 
furnished through providers included under the State plan.
  (4)(A) Each medicaid managed care organization which is not a 
qualified health maintenance organization (as defined in 
section 1310(d) of the Public Health Service Act) must report 
to the State and, upon request, to the Secretary, the Inspector 
General of the Department of Health and Human Services, and the 
Comptroller General a description of transactions between the 
organization and a party in interest (as defined in section 
1318(b) of such Act), including the following transactions:
          (i) Any sale or exchange, or leasing of any property 
        between the organization and such a party.
          (ii) Any furnishing for consideration of goods, 
        services (including management services), or facilities 
        between the organization and such a party, but not 
        including salaries paid to employees for services 
        provided in the normal course of their employment.
          (iii) Any lending of money or other extension of 
        credit between the organization and such a party.
The State or Secretary may require that information reported 
respecting an organization which controls, or is controlled by, 
or is under common control with, another entity be in the form 
of a consolidated financial statement for the organization and 
such entity.
  (B) Each organization shall make the information reported 
pursuant to subparagraph (A) available to its enrollees upon 
reasonable request.
  (5)(A) If the Secretary determines that an entity with a 
contract under this subsection--
          (i) fails substantially to provide medically 
        necessary items and services that are required (under 
        law or under the contract) to be provided to an 
        individual covered under the contract, if the failure 
        has adversely affected (or has substantial likelihood 
        of adversely affecting) the individual;
          (ii) imposes premiums on individuals enrolled under 
        this subsection in excess of the premiums permitted 
        under this title;
          (iii) acts to discriminate among individuals in 
        violation of the provision of paragraph (2)(A)(v), 
        including expulsion or refusal to re-enroll an 
        individual or engaging in any practice that would 
        reasonably be expected to have the effect of denying or 
        discouraging enrollment (except as permitted by this 
        subsection) by eligible individuals with the 
        organization whose medical condition or history 
        indicates a need for substantial future medical 
        services;
          (iv) misrepresents or falsifies information that is 
        furnished--
                  (I) to the Secretary or the State under this 
                subsection, or
                  (II) to an individual or to any other entity 
                under this subsection, or
          (v) fails to comply with the requirements of section 
        1876(i)(8),
the Secretary may provide, in addition to any other remedies 
available under law, for any of the remedies described in 
subparagraph (B).
  (B) The remedies described in this subparagraph are--
          (i) civil money penalties of not more than $25,000 
        for each determination under subparagraph (A), or, with 
        respect to a determination under clause (iii) or 
        (iv)(I) of such subparagraph, of not more than $100,000 
        for each such determination, plus, with respect to a 
        determination under subparagraph (A)(ii), double the 
        excess amount charged in violation of such subparagraph 
        (and the excess amount charged shall be deducted from 
        the penalty and returned to the individual concerned), 
        and plus, with respect to a determination under 
        subparagraph (A)(iii), $15,000 for each individual not 
        enrolled as a result of a practice described in such 
        subparagraph, or
          (ii) denial of payment to the State for medical 
        assistance furnished under the contract under this 
        subsection for individuals enrolled after the date the 
        Secretary notifies the organization of a determination 
        under subparagraph (A) and until the Secretary is 
        satisfied that the basis for such determination has 
        been corrected and is not likely to recur.
The provisions of section 1128A (other than subsections (a) and 
(b)) shall apply to a civil money penalty under clause (i) in 
the same manner as such provisions apply to a penalty or 
proceeding under section 1128A(a).
  (6)(A) For purposes of this subsection and section 
1902(e)(2)(A), in the case of the State of New Jersey, the term 
``contract'' shall be deemed to include an undertaking by the 
State agency, in the State plan under this title, to operate a 
program meeting all requirements of this subsection.
  (B) The undertaking described in subparagraph (A) must 
provide--
          (i) for the establishment of a separate entity 
        responsible for the operation of a program meeting the 
        requirements of this subsection, which entity may be a 
        subdivision of the State agency administering the State 
        plan under this title;
          (ii) for separate accounting for the funds used to 
        operate such program; and
          (iii) for setting the capitation rates and any other 
        payment rates for services provided in accordance with 
        this subsection using a methodology satisfactory to the 
        Secretary designed to ensure that total Federal 
        matching payments under this title for such services 
        will be lower than the matching payments that would be 
        made for the same services, if provided under the State 
        plan on a fee for service basis to an actuarially 
        equivalent population.
  (C) The undertaking described in subparagraph (A) shall be 
subject to approval (and annual re-approval) by the Secretary 
in the same manner as a contract under this subsection.
  (D) The undertaking described in subparagraph (A) shall not 
be eligible for a waiver under section 1915(b).
  (o) Notwithstanding the preceding provisions of this section, 
no payment shall be made to a State under the preceding 
provisions of this section for expenditures for medical 
assistance provided for an individual under its State plan 
approved under this title to the extent that a private insurer 
(as defined by the Secretary by regulation and including a 
group health plan (as defined in section 607(1) of the Employee 
Retirement Income Security Act of 1974), a service benefit 
plan, and a health maintenance organization) would have been 
obligated to provide such assistance but for a provision of its 
insurance contract which has the effect of limiting or 
excluding such obligation because the individual is eligible 
for or is provided medical assistance under the plan.
  (p)(1) When a political subdivision of a State makes, for the 
State of which it is a political subdivision, or one State 
makes, for another State, the enforcement and collection of 
rights of support or payment assigned under section 1912, 
pursuant to a cooperative arrangement under such section 
(either within or outside of such State), there shall be paid 
to such political subdivision or such other State from amounts 
which would otherwise represent the Federal share of payments 
for medical assistance provided to the eligible individuals on 
whose behalf such enforcement and collection was made, an 
amount equal to 15 percent of any amount collected which is 
attributable to such rights of support or payment.
  (2) Where more than one jurisdiction is involved in such 
enforcement or collection, the amount of the incentive payment 
determined under paragraph (1) shall be allocated among the 
jurisdictions in a manner to be prescribed by the Secretary.
  (q) For the purposes of this section, the term ``State 
medicaid fraud control unit'' means a single identifiable 
entity of the State government which the Secretary certifies 
(and annually recertifies) as meeting the following 
requirements:
          (1) The entity (A) is a unit of the office of the 
        State Attorney General or of another department of 
        State government which possesses statewide authority to 
        prosecute individuals for criminal violations, (B) is 
        in a State the constitution of which does not provide 
        for the criminal prosecution of individuals by a 
        statewide authority and has formal procedures, approved 
        by the Secretary, that (i) assure its referral of 
        suspected criminal violations relating to the program 
        under this title to the appropriate authority or 
        authorities in the State for prosecution and (ii) 
        assure its assistance of, and coordination with, such 
        authority or authorities in such prosecutions, or (C) 
        has a formal working relationship with the office of 
        the State Attorney General and has formal procedures 
        (including procedures for its referral of suspected 
        criminal violations to such office) which are approved 
        by the Secretary and which provide effective 
        coordination of activities between the entity and such 
        office with respect to the detection, investigation, 
        and prosecution of suspected criminal violations 
        relating to the program under this title.
          (2) The entity is separate and distinct from the 
        single State agency that administers or supervises the 
        administration of the State plan under this title.
          (3) The entity's function is conducting a statewide 
        program for the investigation and prosecution of 
        violations of all applicable State laws regarding any 
        and all aspects of fraud in connection with (A) any 
        aspect of the provision of medical assistance and the 
        activities of providers of such assistance under the 
        State plan under this title; and (B) upon the approval 
        of the Inspector General of the relevant Federal 
        agency, any aspect of the provision of health care 
        services and activities of providers of such services 
        under any Federal health care program (as defined in 
        section 1128B(f)(1)), if the suspected fraud or 
        violation of law in such case or investigation is 
        primarily related to the State plan under this title.
          (4)(A) The entity has--
                  (i) procedures for reviewing complaints of 
                abuse or neglect of patients in health care 
                facilities which receive payments under the 
                State plan under this title;
                  (ii) at the option of the entity, procedures 
                for reviewing complaints of abuse or neglect of 
                patients residing in board and care facilities; 
                and
                  (iii) procedures for acting upon such 
                complaints under the criminal laws of the State 
                or for referring such complaints to other State 
                agencies for action.
          (B) For purposes of this paragraph, the term ``board 
        and care facility'' means a residential setting which 
        receives payment (regardless of whether such payment is 
        made under the State plan under this title) from or on 
        behalf of two or more unrelated adults who reside in 
        such facility, and for whom one or both of the 
        following is provided:
                  (i) Nursing care services provided by, or 
                under the supervision of, a registered nurse, 
                licensed practical nurse, or licensed nursing 
                assistant.
                  (ii) A substantial amount of personal care 
                services that assist residents with the 
                activities of daily living, including personal 
                hygiene, dressing, bathing, eating, toileting, 
                ambulation, transfer, positioning, self-
                medication, body care, travel to medical 
                services, essential shopping, meal preparation, 
                laundry, and housework.
          (5) The entity provides for the collection, or 
        referral for collection to a single State agency, of 
        overpayments that are made under the State plan or 
        under any Federal health care program (as so defined) 
        to health care facilities and that are discovered by 
        the entity in carrying out its activities. All funds 
        collected in accordance with this paragraph shall be 
        credited exclusively to, and available for expenditure 
        under, the Federal health care program (including the 
        State plan under this title) that was subject to the 
        activity that was the basis for the collection.
          (6) The entity employs such auditors, attorneys, 
        investigators, and other necessary personnel and is 
        organized in such a manner as is necessary to promote 
        the effective and efficient conduct of the entity's 
        activities.
          (7) The entity submits to the Secretary an 
        application and annual reports containing such 
        information as the Secretary determines, by regulation, 
        to be necessary to determine whether the entity meets 
        the other requirements of this subsection.
  (r)(1) In order to receive payments under subsection (a) for 
use of automated data systems in administration of the State 
plan under this title, a State must, in addition to meeting the 
requirements of paragraph (3), have in operation mechanized 
claims processing and information retrieval systems that meet 
the requirements of this subsection and that the Secretary has 
found--
          (A) are adequate to provide efficient, economical, 
        and effective administration of such State plan;
          (B) are compatible with the claims processing and 
        information retrieval systems used in the 
        administration of title XVIII, and for this purpose--
                  (i) have a uniform identification coding 
                system for providers, other payees, and 
                beneficiaries under this title or title XVIII;
                  (ii) provide liaison between States and 
                carriers and intermediaries with agreements 
                under title XVIII to facilitate timely exchange 
                of appropriate data;
                  (iii) provide for exchange of data between 
                the States and the Secretary with respect to 
                persons sanctioned under this title or title 
                XVIII; and
                  (iv) effective for claims filed on or after 
                October 1, 2010, incorporate compatible 
                methodologies of the National Correct Coding 
                Initiative administered by the Secretary (or 
                any successor initiative to promote correct 
                coding and to control improper coding leading 
                to inappropriate payment) and such other 
                methodologies of that Initiative (or such other 
                national correct coding methodologies) as the 
                Secretary identifies in accordance with 
                paragraph (4);
          (C) are capable of providing accurate and timely 
        data;
          (D) are complying with the applicable provisions of 
        part C of title XI;
          (E) are designed to receive provider claims in 
        standard formats to the extent specified by the 
        Secretary; and
          (F) effective for claims filed on or after January 1, 
        1999, provide for electronic transmission of claims 
        data in the format specified by the Secretary and 
        consistent with the Medicaid Statistical Information 
        System (MSIS) (including detailed individual enrollee 
        encounter data and other information that the Secretary 
        may find necessary and including, for data submitted to 
        the Secretary on or after January 1, 2010, data 
        elements from the automated data system that the 
        Secretary determines to be necessary for program 
        integrity, program oversight, and administration, at 
        such frequency as the Secretary shall determine).
  (2) In order to meet the requirements of this paragraph, 
mechanized claims processing and information retrieval systems 
must meet the following requirements:
          (A) The systems must be capable of developing 
        provider, physician, and patient profiles which are 
        sufficient to provide specific information as to the 
        use of covered types of services and items, including 
        prescribed drugs.
          (B) The State must provide that information on 
        probable fraud or abuse which is obtained from, or 
        developed by, the systems, is made available to the 
        State's medicaid fraud control unit (if any) certified 
        under subsection (q) of this section.
          (C) The systems must meet all performance standards 
        and other requirements for initial approval developed 
        by the Secretary.
  (3) In order to meet the requirements of this paragraph, a 
State must have in operation an eligibility determination 
system which provides for data matching through the Public 
Assistance Reporting Information System (PARIS) facilitated by 
the Secretary (or any successor system), including matching 
with medical assistance programs operated by other States.
  (4) For purposes of paragraph (1)(B)(iv), the Secretary shall 
do the following:
          (A) Not later than September 1, 2010:
                  (i) Identify those methodologies of the 
                National Correct Coding Initiative administered 
                by the Secretary (or any successor initiative 
                to promote correct coding and to control 
                improper coding leading to inappropriate 
                payment) which are compatible to claims filed 
                under this title.
                  (ii) Identify those methodologies of such 
                Initiative (or such other national correct 
                coding methodologies) that should be 
                incorporated into claims filed under this title 
                with respect to items or services for which 
                States provide medical assistance under this 
                title and no national correct coding 
                methodologies have been established under such 
                Initiative with respect to title XVIII.
                  (iii) Notify States of--
                          (I) the methodologies identified 
                        under subparagraphs (A) and (B) (and of 
                        any other national correct coding 
                        methodologies identified under 
                        subparagraph (B)); and
                          (II) how States are to incorporate 
                        such methodologies into claims filed 
                        under this title.
          (B) Not later than March 1, 2011, submit a report to 
        Congress that includes the notice to States under 
        clause (iii) of subparagraph (A) and an analysis 
        supporting the identification of the methodologies made 
        under clauses (i) and (ii) of subparagraph (A).
  (s) Notwithstanding the preceding provisions of this section, 
no payment shall be made to a State under this section for 
expenditures for medical assistance under the State plan 
consisting of a designated health service (as defined in 
subsection (h)(6) of section 1877) furnished to an individual 
on the basis of a referral that would result in the denial of 
payment for the service under title XVIII if such title 
provided for coverage of such service to the same extent and 
under the same terms and conditions as under the State plan, 
and subsections (f) and (g)(5) of such section shall apply to a 
provider of such a designated health service for which payment 
may be made under this title in the same manner as such 
subsections apply to a provider of such a service for which 
payment may be made under such title.
  (t)(1) For purposes of subsection (a)(3)(F), the payments 
described in this paragraph to encourage the adoption and use 
of certified EHR technology are payments made by the State in 
accordance with this subsection --
          (A) to Medicaid providers described in paragraph 
        (2)(A) not in excess of 85 percent of net average 
        allowable costs (as defined in paragraph (3)(E)) for 
        certified EHR technology (and support services 
        including maintenance and training that is for, or is 
        necessary for the adoption and operation of, such 
        technology) with respect to such providers; and
          (B) to Medicaid providers described in paragraph 
        (2)(B) not in excess of the maximum amount permitted 
        under paragraph (5) for the provider involved.
  (2) In this subsection and subsection (a)(3)(F), the term 
``Medicaid provider'' means--
          (A) an eligible professional (as defined in paragraph 
        (3)(B))--
                  (i) who is not hospital-based and has at 
                least 30 percent of the professional's patient 
                volume (as estimated in accordance with a 
                methodology established by the Secretary) 
                attributable to individuals who are receiving 
                medical assistance under this title;
                  (ii) who is not described in clause (i), who 
                is a pediatrician, who is not hospital-based, 
                and who has at least 20 percent of the 
                professional's patient volume (as estimated in 
                accordance with a methodology established by 
                the Secretary) attributable to individuals who 
                are receiving medical assistance under this 
                title; and
                  (iii) who practices predominantly in a 
                Federally qualified health center or rural 
                health clinic and has at least 30 percent of 
                the professional's patient volume (as estimated 
                in accordance with a methodology established by 
                the Secretary) attributable to needy 
                individuals (as defined in paragraph (3)(F)); 
                and
          (B)(i) a children's hospital, or
          (ii) an acute-care hospital that is not described in 
        clause (i) and that has at least 10 percent of the 
        hospital's patient volume (as estimated in accordance 
        with a methodology established by the Secretary) 
        attributable to individuals who are receiving medical 
        assistance under this title.
An eligible professional shall not qualify as a Medicaid 
provider under this subsection unless any right to payment 
under sections 1848(o) and 1853(l) with respect to the eligible 
professional has been waived in a manner specified by the 
Secretary. For purposes of calculating patient volume under 
subparagraph (A)(iii), insofar as it is related to 
uncompensated care, the Secretary may require the adjustment of 
such uncompensated care data so that it would be an appropriate 
proxy for charity care, including a downward adjustment to 
eliminate bad debt data from uncompensated care. In applying 
subparagraphs (A) and (B)(ii), the methodology established by 
the Secretary for patient volume shall include individuals 
enrolled in a Medicaid managed care plan (under section 1903(m) 
or section 1932).
  (3) In this subsection and subsection (a)(3)(F):
          (A) The term ``certified EHR technology'' means a 
        qualified electronic health record (as defined in 
        3000(13) of the Public Health Service Act) that is 
        certified pursuant to section 3001(c)(5) of such Act as 
        meeting standards adopted under section 3004 of such 
        Act that are applicable to the type of record involved 
        (as determined by the Secretary, such as an ambulatory 
        electronic health record for office-based physicians or 
        an inpatient hospital electronic health record for 
        hospitals).
          (B) The term ``eligible professional'' means a--
                  (i) physician;
                  (ii) dentist;
                  (iii) certified nurse mid-wife;
                  (iv) nurse practitioner; and
                  (v) physician assistant insofar as the 
                assistant is practicing in a rural health 
                clinic that is led by a physician assistant or 
                is practicing in a Federally qualified health 
                center that is so led.
          (C) The term ``average allowable costs'' means, with 
        respect to certified EHR technology of Medicaid 
        providers described in paragraph (2)(A) for--
                  (i) the first year of payment with respect to 
                such a provider, the average costs for the 
                purchase and initial implementation or upgrade 
                of such technology (and support services 
                including training that is for, or is necessary 
                for the adoption and initial operation of, such 
                technology) for such providers, as determined 
                by the Secretary based upon studies conducted 
                under paragraph (4)(C); and
                  (ii) a subsequent year of payment with 
                respect to such a provider, the average costs 
                not described in clause (i) relating to the 
                operation, maintenance, and use of such 
                technology for such providers, as determined by 
                the Secretary based upon studies conducted 
                under paragraph (4)(C).
          (D) The term ``hospital-based'' means, with respect 
        to an eligible professional, a professional (such as a 
        pathologist, anesthesiologist, or emergency physician) 
        who furnishes substantially all of the individual's 
        professional services in a hospital inpatient or 
        emergency room setting and through the use of the 
        facilities and equipment, including qualified 
        electronic health records, of the hospital. The 
        determination of whether an eligible professional is a 
        hospital-based eligible professional shall be made on 
        the basis of the site of service (as defined by the 
        Secretary) and without regard to any employment or 
        billing arrangement between the eligible professional 
        and any other provider.
          (E) The term ``net average allowable costs'' means, 
        with respect to a Medicaid provider described in 
        paragraph (2)(A), average allowable costs reduced by 
        the average payment the Secretary estimates will be 
        made to such Medicaid providers (determined on a 
        percentage or other basis for such classes or types of 
        providers as the Secretary may specify) from other 
        sources (other than under this subsection, or by the 
        Federal government or a State or local government) that 
        is directly attributable to payment for certified EHR 
        technology or support services described in 
        subparagraph (C).
          (F) The term ``needy individual'' means, with respect 
        to a Medicaid provider, an individual--
                  (i) who is receiving assistance under this 
                title;
                  (ii) who is receiving assistance under title 
                XXI;
                  (iii) who is furnished uncompensated care by 
                the provider; or
                  (iv) for whom charges are reduced by the 
                provider on a sliding scale basis based on an 
                individual's ability to pay.
  (4)(A) With respect to a Medicaid provider described in 
paragraph (2)(A), subject to subparagraph (B), in no case 
shall--
                  (i) the net average allowable costs under 
                this subsection for the first year of payment 
                (which may not be later than 2016), which is 
                intended to cover the costs described in 
                paragraph (3)(C)(i), exceed $25,000 (or such 
                lesser amount as the Secretary determines based 
                on studies conducted under subparagraph (C));
                  (ii) the net average allowable costs under 
                this subsection for a subsequent year of 
                payment, which is intended to cover costs 
                described in paragraph (3)(C)(ii), exceed 
                $10,000; and
                  (iii) payments be made for costs described in 
                clause (ii) after 2021 or over a period of 
                longer than 5 years.
  (B) In the case of Medicaid provider described in paragraph 
(2)(A)(ii), the dollar amounts specified in subparagraph (A) 
shall be \2/3\ of the dollar amounts otherwise specified.
  (C) For the purposes of determining average allowable costs 
under this subsection, the Secretary shall study the average 
costs to Medicaid providers described in paragraph (2)(A) of 
purchase and initial implementation and upgrade of certified 
EHR technology described in paragraph (3)(C)(i) and the average 
costs to such providers of operations, maintenance, and use of 
such technology described in paragraph (3)(C)(ii). In 
determining such costs for such providers, the Secretary may 
utilize studies of such amounts submitted by States.
  (5)(A) In no case shall the payments described in paragraph 
(1)(B) with respect to a Medicaid provider described in 
paragraph (2)(B) exceed--
          (i) in the aggregate the product of--
                          (I) the overall hospital EHR amount 
                        for the provider computed under 
                        subparagraph (B); and
                          (II) the Medicaid share for such 
                        provider computed under subparagraph 
                        (C);
          (ii) in any year 50 percent of the product described 
        in clause (i); and
          (iii) in any 2-year period 90 percent of such 
        product.
  (B) For purposes of this paragraph, the overall hospital EHR 
amount, with respect to a Medicaid provider, is the sum of the 
applicable amounts specified in section 1886(n)(2)(A) for such 
provider for the first 4 payment years (as estimated by the 
Secretary) determined as if the Medicare share specified in 
clause (ii) of such section were 1. The Secretary shall 
establish, in consultation with the State, the overall hospital 
EHR amount for each such Medicaid provider eligible for 
payments under paragraph (1)(B). For purposes of this 
subparagraph in computing the amounts under section 
1886(n)(2)(C) for payment years after the first payment year, 
the Secretary shall assume that in subsequent payment years 
discharges increase at the average annual rate of growth of the 
most recent 3 years for which discharge data are available per 
year.
  (C) The Medicaid share computed under this subparagraph, for 
a Medicaid provider for a period specified by the Secretary, 
shall be calculated in the same manner as the Medicare share 
under section 1886(n)(2)(D) for such a hospital and period, 
except that there shall be substituted for the numerator under 
clause (i) of such section the amount that is equal to the 
number of inpatient-bed-days (as established by the Secretary) 
which are attributable to individuals who are receiving medical 
assistance under this title and who are not described in 
section 1886(n)(2)(D)(i). In computing inpatient-bed-days under 
the previous sentence, the Secretary shall take into account 
inpatient-bed-days attributable to inpatient-bed-days that are 
paid for individuals enrolled in a Medicaid managed care plan 
(under section 1903(m) or section 1932).
  (D) In no case may the payments described in paragraph (1)(B) 
with respect to a Medicaid provider described in paragraph 
(2)(B) be paid--
          (i) for any year beginning after 2016 unless the 
        provider has been provided payment under paragraph 
        (1)(B) for the previous year; and
          (ii) over a period of more than 6 years of payment.
  (6) Payments described in paragraph (1) are not in accordance 
with this subsection unless the following requirements are met:
          (A)(i) The State provides assurances satisfactory to 
        the Secretary that amounts received under subsection 
        (a)(3)(F) with respect to payments to a Medicaid 
        provider are paid, subject to clause (ii), directly to 
        such provider (or to an employer or facility to which 
        such provider has assigned payments) without any 
        deduction or rebate.
          (ii) Amounts described in clause (i) may also be paid 
        to an entity promoting the adoption of certified EHR 
        technology, as designated by the State, if 
        participation in such a payment arrangement is 
        voluntary for the eligible professional involved and if 
        such entity does not retain more than 5 percent of such 
        payments for costs not related to certified EHR 
        technology (and support services including maintenance 
        and training) that is for, or is necessary for the 
        operation of, such technology.
          (B) A Medicaid provider described in paragraph (2)(A) 
        is responsible for payment of the remaining 15 percent 
        of the net average allowable cost and shall be 
        determined to have met such responsibility to the 
        extent that the payment to the Medicaid provider is not 
        in excess of 85 percent of the net average allowable 
        cost.
          (C)(i) Subject to clause (ii), with respect to 
        payments to a Medicaid provider--
                  (I) for the first year of payment to the 
                Medicaid provider under this subsection, the 
                Medicaid provider demonstrates that it is 
                engaged in efforts to adopt, implement, or 
                upgrade certified EHR technology; and
                  (II) for a year of payment, other than the 
                first year of payment to the Medicaid provider 
                under this subsection, the Medicaid provider 
                demonstrates meaningful use of certified EHR 
                technology through a means that is approved by 
                the State and acceptable to the Secretary, and 
                that may be based upon the methodologies 
                applied under section 1848(o) or 1886(n).
          (ii) In the case of a Medicaid provider who has 
        completed adopting, implementing, or upgrading such 
        technology prior to the first year of payment to the 
        Medicaid provider under this subsection, clause (i)(I) 
        shall not apply and clause (i)(II) shall apply to each 
        year of payment to the Medicaid provider under this 
        subsection, including the first year of payment.
          (D) To the extent specified by the Secretary, the 
        certified EHR technology is compatible with State or 
        Federal administrative management systems.
For purposes of subparagraph (B), a Medicaid provider described 
in paragraph (2)(A) may accept payments for the costs described 
in such subparagraph from a State or local government. For 
purposes of subparagraph (C), in establishing the means 
described in such subparagraph, which may include clinical 
quality reporting to the State, the State shall ensure that 
populations with unique needs, such as children, are 
appropriately addressed.
  (7) With respect to Medicaid providers described in paragraph 
(2)(A), the Secretary shall ensure coordination of payment with 
respect to such providers under sections 1848(o) and 1853(l) 
and under this subsection to assure no duplication of funding. 
Such coordination shall include, to the extent practicable, a 
data matching process between State Medicaid agencies and the 
Centers for Medicare & Medicaid Services using national 
provider identifiers. For such purposes, the Secretary may 
require the submission of such data relating to payments to 
such Medicaid providers as the Secretary may specify.
  (8) In carrying out paragraph (6)(C), the State and Secretary 
shall seek, to the maximum extent practicable, to avoid 
duplicative requirements from Federal and State governments to 
demonstrate meaningful use of certified EHR technology under 
this title and title XVIII. In doing so, the Secretary may deem 
satisfaction of requirements for such meaningful use for a 
payment year under title XVIII to be sufficient to qualify as 
meaningful use under this subsection. The Secretary may also 
specify the reporting periods under this subsection in order to 
carry out this paragraph.
  (9) In order to be provided Federal financial participation 
under subsection (a)(3)(F)(ii), a State must demonstrate to the 
satisfaction of the Secretary, that the State--
          (A) is using the funds provided for the purposes of 
        administering payments under this subsection, including 
        tracking of meaningful use by Medicaid providers;
          (B) is conducting adequate oversight of the program 
        under this subsection, including routine tracking of 
        meaningful use attestations and reporting mechanisms; 
        and
          (C) is pursuing initiatives to encourage the adoption 
        of certified EHR technology to promote health care 
        quality and the exchange of health care information 
        under this title, subject to applicable laws and 
        regulations governing such exchange.
  (10) The Secretary shall periodically submit reports to the 
Committee on Energy and Commerce of the House of 
Representatives and the Committee on Finance of the Senate on 
status, progress, and oversight of payments described in 
paragraph (1), including steps taken to carry out paragraph 
(7). Such reports shall also describe the extent of adoption of 
certified EHR technology among Medicaid providers resulting 
from the provisions of this subsection and any improvements in 
health outcomes, clinical quality, or efficiency resulting from 
such adoption.
  (u)(1)(A) Notwithstanding subsection (a)(1), if the ratio of 
a State's erroneous excess payments for medical assistance (as 
defined in subparagraph (D)) to its total expenditures for 
medical assistance under the State plan approved under this 
title exceeds 0.03, for the period consisting of the third and 
fourth quarters of fiscal year 1983, or for any full fiscal 
year thereafter, then the Secretary shall make no payment for 
such period or fiscal year with respect to so much of such 
erroneous excess payments as exceeds such allowable error rate 
of 0.03.
  (B) The Secretary may waive, in certain limited cases, all or 
part of the reduction required under subparagraph (A) with 
respect to any State if such State is unable to reach the 
allowable error rate for a period or fiscal year despite a good 
faith effort by such State.
  (C) In estimating the amount to be paid to a State under 
subsection (d), the Secretary shall take into consideration the 
limitation on Federal financial participation imposed by 
subparagraph (A) and shall reduce the estimate he makes under 
subsection (d)(1), for purposes of payment to the State under 
subsection (d)(3), in light of any expected erroneous excess 
payments for medical assistance (estimated in accordance with 
such criteria, including sampling procedures, as he may 
prescribe and subject to subsequent adjustment, if necessary, 
under subsection (d)(2)).
  (D)(i) For purposes of this subsection, the term ``erroneous 
excess payments for medical assistance'' means the total of--
          (I) payments under the State plan with respect to 
        ineligible individuals and families, and
          (II) overpayments on behalf of eligible individuals 
        and families by reason of error in determining the 
        amount of expenditures for medical care required of an 
        individual or family as a condition of eligibility.
  (ii) In determining the amount of erroneous excess payments 
for medical assistance to an ineligible individual or family 
under clause (i)(I), if such ineligibility is the result of an 
error in determining the amount of the resources of such 
individual or family, the amount of the erroneous excess 
payment shall be the smaller of (I) the amount of the payment 
with respect to such individual or family, or (II) the 
difference between the actual amount of such resources and the 
allowable resource level established under the State plan.
  (iii) In determining the amount of erroneous excess payments 
for medical assistance to an individual or family under clause 
(i)(II), the amount of the erroneous excess payment shall be 
the smaller of (I) the amount of the payment on behalf of the 
individual or family, or (II) the difference between the actual 
amount incurred for medical care by the individual or family 
and the amount which should have been incurred in order to 
establish eligibility for medical assistance.
  (iv) In determining the amount of erroneous excess payments, 
there shall not be included any error resulting from a failure 
of an individual to cooperate or give correct information with 
respect to third-party liability as required under section 
1912(a)(1)(C) or 402(a)(26)(C) or with respect to payments made 
in violation of section 1906.
  (v) In determining the amount of erroneous excess payments, 
there shall not be included any erroneous payments made for 
ambulatory prenatal care provided during a presumptive 
eligibility period (as defined in section 1920(b)(1)), for 
items and services described in subsection (a) of section 1920A 
provided to a child during a presumptive eligibility period 
under such section, for medical assistance provided to an 
individual described in subsection (a) of section 1920B during 
a presumptive eligibility period under such section, or for 
medical assistance provided to an individual during a 
presumptive eligibility period resulting from a determination 
of presumptive eligibility made by a hospital that elects under 
section 1902(a)(47)(B) to be a qualified entity for such 
purpose.
  (E) For purposes of subparagraph (D), there shall be 
excluded, in determining both erroneous excess payments for 
medical assistance and total expenditures for medical 
assistance--
          (i) payments with respect to any individual whose 
        eligibility therefor was determined exclusively by the 
        Secretary under an agreement pursuant to section 1634 
        and such other classes of individuals as the Secretary 
        may by regulation prescribe whose eligibility was 
        determined in part under such an agreement; and
          (ii) payments made as the result of a technical 
        error.
  (2) The State agency administering the plan approved under 
this title shall, at such times and in such form as the 
Secretary may specify, provide information on the rates of 
erroneous excess payments made (or expected, with respect to 
future periods specified by the Secretary) in connection with 
its administration of such plan, together with any other data 
he requests that are reasonably necessary for him to carry out 
the provisions of this subsection.
  (3)(A) If a State fails to cooperate with the Secretary in 
providing information necessary to carry out this subsection, 
the Secretary, directly or through contractual or such other 
arrangements as he may find appropriate, shall establish the 
error rates for that State on the basis of the best data 
reasonably available to him and in accordance with such 
techniques for sampling and estimating as he finds appropriate.
  (B) In any case in which it is necessary for the Secretary to 
exercise his authority under subparagraph (A) to determine a 
State's error rates for a fiscal year, the amount that would 
otherwise be payable to such State under this title for 
quarters in such year shall be reduced by the costs incurred by 
the Secretary in making (directly or otherwise) such 
determination.
  (4) This subsection shall not apply with respect to Puerto 
Rico, Guam, the Virgin Islands, the Northern Mariana Islands, 
or American Samoa.
  (v)(1) Notwithstanding the preceding provisions of this 
section, except as provided in paragraphs (2) and (4), no 
payment may be made to a State under this section for medical 
assistance furnished to an alien who is not lawfully admitted 
for permanent residence or otherwise permanently residing in 
the United States under color of law.
  (2) Payment shall be made under this section for care and 
services that are furnished to an alien described in paragraph 
(1) only if--
          (A) such care and services are necessary for the 
        treatment of an emergency medical condition of the 
        alien,
          (B) such alien otherwise meets the eligibility 
        requirements for medical assistance under the State 
        plan approved under this title (other than the 
        requirement of the receipt of aid or assistance under 
        title IV, supplemental security income benefits under 
        title XVI, or a State supplementary payment), and
          (C) such care and services are not related to an 
        organ transplant procedure.
  (3) For purposes of this subsection, the term ``emergency 
medical condition'' means a medical condition (including 
emergency labor and delivery) manifesting itself by acute 
symptoms of sufficient severity (including severe pain) such 
that the absence of immediate medical attention could 
reasonably be expected to result in--
          (A) placing the patient's health in serious jeopardy,
          (B) serious impairment to bodily functions, or
          (C) serious dysfunction of any bodily organ or part.
  (4)(A) A State may elect (in a plan amendment under this 
title) to provide medical assistance under this title, 
notwithstanding sections 401(a), 402(b), 403, and 421 of the 
Personal Responsibility and Work Opportunity Reconciliation Act 
of 1996, to children and pregnant women who are lawfully 
residing in the United States (including battered individuals 
described in section 431(c) of such Act) and who are otherwise 
eligible for such assistance, within either or both of the 
following eligibility categories:
          (i) Pregnant women.--Women during pregnancy (and 
        during the 60-day period beginning on the last day of 
        the pregnancy).
          (ii) Children.--Individuals under 21 years of age, 
        including optional targeted low-income children 
        described in section 1905(u)(2)(B).
  (B) In the case of a State that has elected to provide 
medical assistance to a category of aliens under subparagraph 
(A), no debt shall accrue under an affidavit of support against 
any sponsor of such an alien on the basis of provision of 
assistance to such category and the cost of such assistance 
shall not be considered as an unreimbursed cost.
  (C) As part of the State's ongoing eligibility 
redetermination requirements and procedures for an individual 
provided medical assistance as a result of an election by the 
State under subparagraph (A), a State shall verify that the 
individual continues to lawfully reside in the United States 
using the documentation presented to the State by the 
individual on initial enrollment. If the State cannot 
successfully verify that the individual is lawfully residing in 
the United States in this manner, it shall require that the 
individual provide the State with further documentation or 
other evidence to verify that the individual is lawfully 
residing in the United States.
  (w)(1)(A) Notwithstanding the previous provisions of this 
section, for purposes of determining the amount to be paid to a 
State (as defined in paragraph (7)(D)) under subsection (a)(1) 
for quarters in any fiscal year, the total amount expended 
during such fiscal year as medical assistance under the State 
plan (as determined without regard to this subsection) shall be 
reduced by the sum of any revenues received by the State (or by 
a unit of local government in the State) during the fiscal 
year--
          (i) from provider-related donations (as defined in 
        paragraph (2)(A)), other than--
                  (I) bona fide provider-related donations (as 
                defined in paragraph (2)(B)), and
                  (II) donations described in paragraph (2)(C);
          (ii) from health care related taxes (as defined in 
        paragraph (3)(A)), other than broad-based health care 
        related taxes (as defined in paragraph (3)(B));
          (iii) from a broad-based health care related tax, if 
        there is in effect a hold harmless provision (described 
        in paragraph (4)) with respect to the tax; or
          (iv) only with respect to State fiscal years (or 
        portions thereof) occurring on or after January 1, 
        1992, and before October 1, 1995, from broad-based 
        health care related taxes to the extent the amount of 
        such taxes collected exceeds the limit established 
        under paragraph (5).
  (B) Notwithstanding the previous provisions of this section, 
for purposes of determining the amount to be paid to a State 
under subsection (a)(7) for all quarters in a Federal fiscal 
year (beginning with fiscal year 1993), the total amount 
expended during the fiscal year for administrative expenditures 
under the State plan (as determined without regard to this 
subsection) shall be reduced by the sum of any revenues 
received by the State (or by a unit of local government in the 
State) during such quarters from donations described in 
paragraph (2)(C), to the extent the amount of such donations 
exceeds 10 percent of the amounts expended under the State plan 
under this title during the fiscal year for purposes described 
in paragraphs (2), (3), (4), (6), and (7) of subsection (a).
  (C)(i) Except as otherwise provided in clause (ii), 
subparagraph (A)(i) shall apply to donations received on or 
after January 1, 1992.
  (ii) Subject to the limits described in clause (iii) and 
subparagraph (E), subparagraph (A)(i) shall not apply to 
donations received before the effective date specified in 
subparagraph (F) if such donations are received under programs 
in effect or as described in State plan amendments or related 
documents submitted to the Secretary by September 30, 1991, and 
applicable to State fiscal year 1992, as demonstrated by State 
plan amendments, written agreements, State budget 
documentation, or other documentary evidence in existence on 
that date.
  (iii) In applying clause (ii) in the case of donations 
received in State fiscal year 1993, the maximum amount of such 
donations to which such clause may be applied may not exceed 
the total amount of such donations received in the 
corresponding period in State fiscal year 1992 (or not later 
than 5 days after the last day of the corresponding period).
  (D)(i) Except as otherwise provided in clause (ii), 
subparagraphs (A)(ii) and (A)(iii) shall apply to taxes 
received on or after January 1, 1992.
  (ii) Subparagraphs (A)(ii) and (A)(iii) shall not apply to 
impermissible taxes (as defined in clause (iii)) received 
before the effective date specified in subparagraph (F) to the 
extent the taxes (including the tax rate or base) were in 
effect, or the legislation or regulations imposing such taxes 
were enacted or adopted, as of November 22, 1991.
  (iii) In this subparagraph and subparagraph (E), the term 
``impermissible tax'' means a health care related tax for which 
a reduction may be made under clause (ii) or (iii) of 
subparagraph (A).
  (E)(i) In no case may the total amount of donations and taxes 
permitted under the exception provided in subparagraphs (C)(ii) 
and (D)(ii) for the portion of State fiscal year 1992 occurring 
during calendar year 1992 exceed the limit under paragraph (5) 
minus the total amount of broad-based health care related taxes 
received in the portion of that fiscal year.
  (ii) In no case may the total amount of donations and taxes 
permitted under the exception provided in subparagraphs (C)(ii) 
and (D)(ii) for State fiscal year 1993 exceed the limit under 
paragraph (5) minus the total amount of broad-based health care 
related taxes received in that fiscal year.
  (F) In this paragraph in the case of a State--
          (i) except as provided in clause (iii), with a State 
        fiscal year beginning on or before July 1, the 
        effective date is October 1, 1992,
          (ii) except as provided in clause (iii), with a State 
        fiscal year that begins after July 1, the effective 
        date is January 1, 1993, or
          (iii) with a State legislature which is not scheduled 
        to have a regular legislative session in 1992, with a 
        State legislature which is not scheduled to have a 
        regular legislative session in 1993, or with a 
        provider-specific tax enacted on November 4, 1991, the 
        effective date is July 1, 1993.
  (2)(A) In this subsection (except as provided in paragraph 
(6)), the term ``provider-related donation'' means any donation 
or other voluntary payment (whether in cash or in kind) made 
(directly or indirectly) to a State or unit of local government 
by--
          (i) a health care provider (as defined in paragraph 
        (7)(B)),
          (ii) an entity related to a health care provider (as 
        defined in paragraph (7)(C)), or
          (iii) an entity providing goods or services under the 
        State plan for which payment is made to the State under 
        paragraph (2), (3), (4), (6), or (7) of subsection (a).
  (B) For purposes of paragraph (1)(A)(i)(I), the term ``bona 
fide provider-related donation'' means a provider-related 
donation that has no direct or indirect relationship (as 
determined by the Secretary) to payments made under this title 
to that provider, to providers furnishing the same class of 
items and services as that provider, or to any related entity, 
as established by the State to the satisfaction of the 
Secretary. The Secretary may by regulation specify types of 
provider-related donations described in the previous sentence 
that will be considered to be bona fide provider-related 
donations.
  (C) For purposes of paragraph (1)(A)(i)(II), donations 
described in this subparagraph are funds expended by a 
hospital, clinic, or similar entity for the direct cost 
(including costs of training and of preparing and distributing 
outreach materials) of State or local agency personnel who are 
stationed at the hospital, clinic, or entity to determine the 
eligibility of individuals for medical assistance under this 
title and to provide outreach services to eligible or 
potentially eligible individuals.
  (3)(A) In this subsection (except as provided in paragraph 
(6)), the term ``health care related tax'' means a tax (as 
defined in paragraph (7)(F)) that--
          (i) is related to health care items or services, or 
        to the provision of, the authority to provide, or 
        payment for, such items or services, or
          (ii) is not limited to such items or services but 
        provides for treatment of individuals or entities that 
        are providing or paying for such items or services that 
        is different from the treatment provided to other 
        individuals or entities.
In applying clause (i), a tax is considered to relate to health 
care items or services if at least 85 percent of the burden of 
such tax falls on health care providers.
  (B) In this subsection, the term ``broad-based health care 
related tax'' means a health care related tax which is imposed 
with respect to a class of health care items or services (as 
described in paragraph (7)(A)) or with respect to providers of 
such items or services and which, except as provided in 
subparagraphs (D), (E), and (F)--
          (i) is imposed at least with respect to all items or 
        services in the class furnished by all non-Federal, 
        nonpublic providers in the State (or, in the case of a 
        tax imposed by a unit of local government, the area 
        over which the unit has jurisdiction) or is imposed 
        with respect to all non-Federal, nonpublic providers in 
        the class; and
          (ii) is imposed uniformly (in accordance with 
        subparagraph (C)).
  (C)(i) Subject to clause (ii), for purposes of subparagraph 
(B)(ii), a tax is considered to be imposed uniformly if--
          (I) in the case of a tax consisting of a licensing 
        fee or similar tax on a class of health care items or 
        services (or providers of such items or services), the 
        amount of the tax imposed is the same for every 
        provider providing items or services within the class;
          (II) in the case of a tax consisting of a licensing 
        fee or similar tax imposed on a class of health care 
        items or services (or providers of such services) on 
        the basis of the number of beds (licensed or otherwise) 
        of the provider, the amount of the tax is the same for 
        each bed of each provider of such items or services in 
        the class;
          (III) in the case of a tax based on revenues or 
        receipts with respect to a class of items or services 
        (or providers of items or services) the tax is imposed 
        at a uniform rate for all items and services (or 
        providers of such items of services) in the class on 
        all the gross revenues or receipts, or net operating 
        revenues, relating to the provision of all such items 
        or services (or all such providers) in the State (or, 
        in the case of a tax imposed by a unit of local 
        government within the State, in the area over which the 
        unit has jurisdiction); or
          (IV) in the case of any other tax, the State 
        establishes to the satisfaction of the Secretary that 
        the tax is imposed uniformly.
  (ii) Subject to subparagraphs (D) and (E), a tax imposed with 
respect to a class of health care items and services is not 
considered to be imposed uniformly if the tax provides for any 
credits, exclusions, or deductions which have as their purpose 
or effect the return to providers of all or a portion of the 
tax paid in a manner that is inconsistent with subclauses (I) 
and (II) of subparagraph (E)(ii) or provides for a hold 
harmless provision described in paragraph (4).
  (D) A tax imposed with respect to a class of health care 
items and services is considered to be imposed uniformly--
          (i) notwithstanding that the tax is not imposed with 
        respect to items or services (or the providers thereof) 
        for which payment is made under a State plan under this 
        title or title XVIII, or
          (ii) in the case of a tax described in subparagraph 
        (C)(i)(III), notwithstanding that the tax provides for 
        exclusion (in whole or in part) of revenues or receipts 
        from a State plan under this title or title XVIII.
  (E)(i) A State may submit an application to the Secretary 
requesting that the Secretary treat a tax as a broad-based 
health care related tax, notwithstanding that the tax does not 
apply to all health care items or services in class (or all 
providers of such items and services), provides for a credit, 
deduction, or exclusion, is not applied uniformly, or otherwise 
does not meet the requirements of subparagraph (B) or (C). 
Permissible waivers may include exemptions for rural or sole-
community providers.
  (ii) The Secretary shall approve such an application if the 
State establishes to the satisfaction of the Secretary that--
          (I) the net impact of the tax and associated 
        expenditures under this title as proposed by the State 
        is generally redistributive in nature, and
          (II) the amount of the tax is not directly correlated 
        to payments under this title for items or services with 
        respect to which the tax is imposed.
The Secretary shall by regulation specify types of credits, 
exclusions, and deductions that will be considered to meet the 
requirements of this subparagraph.
  (F) In no case shall a tax not qualify as a broad-based 
health care related tax under this paragraph because it does 
not apply to a hospital that is described in section 501(c)(3) 
of the Internal Revenue Code of 1986 and exempt from taxation 
under section 501(a) of such Code and that does not accept 
payment under the State plan under this title or under title 
XVIII.
  (4) For purposes of paragraph (1)(A)(iii), there is in effect 
a hold harmless provision with respect to a broad-based health 
care related tax imposed with respect to a class of items or 
services if the Secretary determines that any of the following 
applies:
          (A) The State or other unit of government imposing 
        the tax provides (directly or indirectly) for a payment 
        (other than under this title) to taxpayers and the 
        amount of such payment is positively correlated either 
        to the amount of such tax or to the difference between 
        the amount of the tax and the amount of payment under 
        the State plan.
          (B) All or any portion of the payment made under this 
        title to the taxpayer varies based only upon the amount 
        of the total tax paid.
          (C)(i) The State or other unit of government imposing 
        the tax provides (directly or indirectly) for any 
        payment, offset, or waiver that guarantees to hold 
        taxpayers harmless for any portion of the costs of the 
        tax.
          (ii) For purposes of clause (i), a determination of 
        the existence of an indirect guarantee shall be made 
        under paragraph (3)(i) of section 433.68(f) of title 
        42, Code of Federal Regulations, as in effect on 
        November 1, 2006, except that for portions of fiscal 
        years beginning on or after January 1, 2008, and before 
        October 1, 2011, ``5.5 percent'' shall be substituted 
        for ``6 percent'' each place it appears.
The provisions of this paragraph shall not prevent use of the 
tax to reimburse health care providers in a class for 
expenditures under this title nor preclude States from relying 
on such reimbursement to justify or explain the tax in the 
legislative process.
  (5)(A) For purposes of this subsection, the limit under this 
subparagraph with respect to a State is an amount equal to 25 
percent (or, if greater, the State base percentage, as defined 
in subparagraph (B)) of the non-Federal share of the total 
amount expended under the State plan during a State fiscal year 
(or portion thereof), as it would be determined pursuant to 
paragraph (1)(A) without regard to paragraph (1)(A)(iv).
  (B)(i) In subparagraph (A), the term ``State base 
percentage'' means, with respect to a State, an amount 
(expressed as a percentage) equal to--
          (I) the total of the amount of health care related 
        taxes (whether or not broad-based) and the amount of 
        provider-related donations (whether or not bona fide) 
        projected to be collected (in accordance with clause 
        (ii)) during State fiscal year 1992, divided by
          (II) the non-Federal share of the total amount 
        estimated to be expended under the State plan during 
        such State fiscal year.
  (ii) For purposes of clause (i)(I), in the case of a tax that 
is not in effect throughout State fiscal year 1992 or the rate 
(or base) of which is increased during such fiscal year, the 
Secretary shall project the amount to be collected during such 
fiscal year as if the tax (or increase) were in effect during 
the entire State fiscal year.
  (C)(i) The total amount of health care related taxes under 
subparagraph (B)(i)(I) shall be determined by the Secretary 
based on only those taxes (including the tax rate or base) 
which were in effect, or for which legislation or regulations 
imposing such taxes were enacted or adopted, as of November 22, 
1991.
  (ii) The amount of provider-related donations under 
subparagraph (B)(i)(I) shall be determined by the Secretary 
based on programs in effect on September 30, 1991, and 
applicable to State fiscal year 1992, as demonstrated by State 
plan amendments, written agreements, State budget 
documentation, or other documentary evidence in existence on 
that date.
  (iii) The amount of expenditures described in subparagraph 
(B)(i)(II) shall be determined by the Secretary based on the 
best data available as of the date of the enactment of this 
subsection.
  (6)(A) Notwithstanding the provisions of this subsection, the 
Secretary may not restrict States' use of funds where such 
funds are derived from State or local taxes (or funds 
appropriated to State university teaching hospitals) 
transferred from or certified by units of government within a 
State as the non-Federal share of expenditures under this 
title, regardless of whether the unit of government is also a 
health care provider, except as provided in section 1902(a)(2), 
unless the transferred funds are derived by the unit of 
government from donations or taxes that would not otherwise be 
recognized as the non-Federal share under this section.
  (B) For purposes of this subsection, funds the use of which 
the Secretary may not restrict under subparagraph (A) shall not 
be considered to be a provider-related donation or a health 
care related tax.
  (7) For purposes of this subsection:
          (A) Each of the following shall be considered a 
        separate class of health care items and services:
                  (i) Inpatient hospital services.
                  (ii) Outpatient hospital services.
                  (iii) Nursing facility services (other than 
                services of intermediate care facilities for 
                the mentally retarded).
                  (iv) Services of intermediate care facilities 
                for the mentally retarded.
                  (v) Physicians' services.
                  (vi) Home health care services.
                  (vii) Outpatient prescription drugs.
                  (viii) Services of managed care organizations 
                (including health maintenance organizations, 
                preferred provider organizations, and such 
                other similar organizations as the Secretary 
                may specify by regulation).
                  (ix) Such other classification of health care 
                items and services consistent with this 
                subparagraph as the Secretary may establish by 
                regulation.
          (B) The term ``health care provider'' means an 
        individual or person that receives payments for the 
        provision of health care items or services.
          (C) An entity is considered to be ``related'' to a 
        health care provider if the entity--
                  (i) is an organization, association, 
                corporation or partnership formed by or on 
                behalf of health care providers;
                  (ii) is a person with an ownership or control 
                interest (as defined in section 1124(a)(3)) in 
                the provider;
                  (iii) is the employee, spouse, parent, child, 
                or sibling of the provider (or of a person 
                described in clause (ii)); or
                  (iv) has a similar, close relationship (as 
                defined in regulations) to the provider.
          (D) The term ``State'' means only the 50 States and 
        the District of Columbia but does not include any State 
        whose entire program under this title is operated under 
        a waiver granted under section 1115.
          (E) The ``State fiscal year'' means, with respect to 
        a specified year, a State fiscal year ending in that 
        specified year.
          (F) The term ``tax'' includes any licensing fee, 
        assessment, or other mandatory payment, but does not 
        include payment of a criminal or civil fine or penalty 
        (other than a fine or penalty imposed in lieu of or 
        instead of a fee, assessment, or other mandatory 
        payment).
          (G) The term ``unit of local government'' means, with 
        respect to a State, a city, county, special purpose 
        district, or other governmental unit in the State.
  (x)(1) For purposes of section 1902(a)(46)(B)(i), the 
requirement of this subsection is, with respect to an 
individual declaring to be a citizen or national of the United 
States, that, subject to paragraph (2), there is presented 
satisfactory documentary evidence of citizenship or nationality 
(as defined in paragraph (3)) of the individual.
  (2) The requirement of paragraph (1) shall not apply to an 
individual declaring to be a citizen or national of the United 
States who is eligible for medical assistance under this 
title--
          (A) and is entitled to or enrolled for benefits under 
        any part of title XVIII;
          (B) and is receiving--
                  (i) disability insurance benefits under 
                section 223 or monthly insurance benefits under 
                section 202 based on such individual's 
                disability (as defined in section 223(d)); or
                  (ii) supplemental security income benefits 
                under title XVI;
          (C) and with respect to whom--
                  (i) child welfare services are made available 
                under part B of title IV on the basis of being 
                a child in foster care; or
                  (ii) adoption or foster care assistance is 
                made available under part E of title IV;
          (D) pursuant to the application of section 1902(e)(4) 
        (and, in the case of an individual who is eligible for 
        medical assistance on such basis, the individual shall 
        be deemed to have provided satisfactory documentary 
        evidence of citizenship or nationality and shall not be 
        required to provide further documentary evidence on any 
        date that occurs during or after the period in which 
        the individual is eligible for medical assistance on 
        such basis); or
          (E) on such basis as the Secretary may specify under 
        which satisfactory documentary evidence of citizenship 
        or nationality has been previously presented.
  (3)(A) For purposes of this subsection, the term 
``satisfactory documentary evidence of citizenship or 
nationality'' means--
          (i) any document described in subparagraph (B); or
          (ii) a document described in subparagraph (C) and a 
        document described in subparagraph (D).
  (B) The following are documents described in this 
subparagraph:
          (i) A United States passport.
          (ii) Form N-550 or N-570 (Certificate of 
        Naturalization).
          (iii) Form N-560 or N-561 (Certificate of United 
        States Citizenship).
          (iv) A valid State-issued driver's license or other 
        identity document described in section 274A(b)(1)(D) of 
        the Immigration and Nationality Act, but only if the 
        State issuing the license or such document requires 
        proof of United States citizenship before issuance of 
        such license or document or obtains a social security 
        number from the applicant and verifies before 
        certification that such number is valid and assigned to 
        the applicant who is a citizen.
          (v)(I) Except as provided in subclause (II), a 
        document issued by a federally recognized Indian tribe 
        evidencing membership or enrollment in, or affiliation 
        with, such tribe (such as a tribal enrollment card or 
        certificate of degree of Indian blood).
          (II) With respect to those federally recognized 
        Indian tribes located within States having an 
        international border whose membership includes 
        individuals who are not citizens of the United States, 
        the Secretary shall, after consulting with such tribes, 
        issue regulations authorizing the presentation of such 
        other forms of documentation (including tribal 
        documentation, if appropriate) that the Secretary 
        determines to be satisfactory documentary evidence of 
        citizenship or nationality for purposes of satisfying 
        the requirement of this subsection.
          (vi) Such other document as the Secretary may 
        specify, by regulation, that provides proof of United 
        States citizenship or nationality and that provides a 
        reliable means of documentation of personal identity.
  (C) The following are documents described in this 
subparagraph:
          (i) A certificate of birth in the United States.
          (ii) Form FS-545 or Form DS-1350 (Certification of 
        Birth Abroad).
          (iii) Form I-197 (United States Citizen 
        Identification Card).
          (iv) Form FS-240 (Report of Birth Abroad of a Citizen 
        of the United States).
          (v) Such other document (not described in 
        subparagraph (B)(iv)) as the Secretary may specify that 
        provides proof of United States citizenship or 
        nationality.
  (D) The following are documents described in this 
subparagraph:
          (i) Any identity document described in section 
        274A(b)(1)(D) of the Immigration and Nationality Act.
          (ii) Any other documentation of personal identity of 
        such other type as the Secretary finds, by regulation, 
        provides a reliable means of identification.
  (E) A reference in this paragraph to a form includes a 
reference to any successor form.
  (4) In the case of an individual declaring to be a citizen or 
national of the United States with respect to whom a State 
requires the presentation of satisfactory documentary evidence 
of citizenship or nationality under section 1902(a)(46)(B)(i), 
the individual shall be provided at least the reasonable 
opportunity to present satisfactory documentary evidence of 
citizenship or nationality under this subsection as is provided 
under clauses (i) and (ii) of section 1137(d)(4)(A) to an 
individual for the submittal to the State of evidence 
indicating a satisfactory immigration status.
  (5) Nothing in subparagraph (A) or (B) of section 
1902(a)(46), the preceding paragraphs of this subsection, or 
the Deficit Reduction Act of 2005, including section 6036 of 
such Act, shall be construed as changing the requirement of 
section 1902(e)(4) that a child born in the United States to an 
alien mother for whom medical assistance for the delivery of 
such child is available as treatment of an emergency medical 
condition pursuant to subsection (v) shall be deemed eligible 
for medical assistance during the first year of such child's 
life.
  (y) Payments for Establishment of Alternate Non-Emergency 
Services Providers.--
          (1) Payments.--In addition to the payments otherwise 
        provided under subsection (a), subject to paragraph 
        (2), the Secretary shall provide for payments to States 
        under such subsection for the establishment of 
        alternate non-emergency service providers (as defined 
        in section 1916A(e)(5)(B)), or networks of such 
        providers.
          (2) Limitation.--The total amount of payments under 
        this subsection shall not exceed $50,000,000 during the 
        4-year period beginning with 2006. This subsection 
        constitutes budget authority in advance of 
        appropriations Acts and represents the obligation of 
        the Secretary to provide for the payment of amounts 
        provided under this subsection.
          (3) Preference.--In providing for payments to States 
        under this subsection, the Secretary shall provide 
        preference to States that establish, or provide for, 
        alternate non-emergency services providers or networks 
        of such providers that--
                  (A) serve rural or underserved areas where 
                beneficiaries under this title may not have 
                regular access to providers of primary care 
                services; or
                  (B) are in partnership with local community 
                hospitals.
          (4) Form and manner of payment.--Payment to a State 
        under this subsection shall be made only upon the 
        filing of such application in such form and in such 
        manner as the Secretary shall specify. Payment to a 
        State under this subsection shall be made in the same 
        manner as other payments under section 1903(a).
  (z) Medicaid Transformation Payments.--
          (1) In general.--In addition to the payments provided 
        under subsection (a), subject to paragraph (4), the 
        Secretary shall provide for payments to States for the 
        adoption of innovative methods to improve the 
        effectiveness and efficiency in providing medical 
        assistance under this title.
          (2) Permissible uses of funds.--The following are 
        examples of innovative methods for which funds provided 
        under this subsection may be used:
                  (A) Methods for reducing patient error rates 
                through the implementation and use of 
                electronic health records, electronic clinical 
                decision support tools, or e-prescribing 
                programs.
                  (B) Methods for improving rates of collection 
                from estates of amounts owed under this title.
                  (C) Methods for reducing waste, fraud, and 
                abuse under the program under this title, such 
                as reducing improper payment rates as measured 
                by annual payment error rate measurement (PERM) 
                project rates.
                  (D) Implementation of a medication risk 
                management program as part of a drug use review 
                program under section 1927(g).
                  (E) Methods in reducing, in clinically 
                appropriate ways, expenditures under this title 
                for covered outpatient drugs, particularly in 
                the categories of greatest drug utilization, by 
                increasing the utilization of generic drugs 
                through the use of education programs and other 
                incentives to promote greater use of generic 
                drugs.
                  (F) Methods for improving access to primary 
                and specialty physician care for the uninsured 
                using integrated university-based hospital and 
                clinic systems.
          (3) Application; terms and conditions.--
                  (A) In general.--No payments shall be made to 
                a State under this subsection unless the State 
                applies to the Secretary for such payments in a 
                form, manner, and time specified by the 
                Secretary.
                  (B) Terms and conditions.--Such payments are 
                made under such terms and conditions consistent 
                with this subsection as the Secretary 
                prescribes.
                  (C) Annual report.--Payment to a State under 
                this subsection is conditioned on the State 
                submitting to the Secretary an annual report on 
                the programs supported by such payment. Such 
                report shall include information on--
                          (i) the specific uses of such 
                        payment;
                          (ii) an assessment of quality 
                        improvements and clinical outcomes 
                        under such programs; and
                          (iii) estimates of cost savings 
                        resulting from such programs.
          (4) Funding.--
                  (A) Limitation on funds.--The total amount of 
                payments under this subsection shall be equal 
                to, and shall not exceed--
                          (i) $75,000,000 for fiscal year 2007; 
                        and
                          (ii) $75,000,000 for fiscal year 
                        2008.
                This subsection constitutes budget authority in 
                advance of appropriations Acts and represents 
                the obligation of the Secretary to provide for 
                the payment of amounts provided under this 
                subsection.
                  (B) Allocation of funds.--The Secretary shall 
                specify a method for allocating the funds made 
                available under this subsection among States. 
                Such method shall provide preference for States 
                that design programs that target health 
                providers that treat significant numbers of 
                Medicaid beneficiaries. Such method shall 
                provide that not less than 25 percent of such 
                funds shall be allocated among States the 
                population of which (as determined according to 
                data collected by the United States Census 
                Bureau) as of July 1, 2004, was more than 105 
                percent of the population of the respective 
                State (as so determined) as of April 1, 2000.
                  (C) Form and manner of payment.--Payment to a 
                State under this subsection shall be made in 
                the same manner as other payments under section 
                1903(a). There is no requirement for State 
                matching funds to receive payments under this 
                subsection.
          (5) Medication risk management program.--
                  (A) In general.--For purposes of this 
                subsection, the term ``medication risk 
                management program'' means a program for 
                targeted beneficiaries that ensures that 
                covered outpatient drugs are appropriately used 
                to optimize therapeutic outcomes through 
                improved medication use and to reduce the risk 
                of adverse events.
                  (B) Elements.--Such program may include the 
                following elements:
                          (i) The use of established principles 
                        and standards for drug utilization 
                        review and best practices to analyze 
                        prescription drug claims of targeted 
                        beneficiaries and identify outlier 
                        physicians.
                          (ii) On an ongoing basis provide 
                        outlier physicians--
                                  (I) a comprehensive pharmacy 
                                claims history for each 
                                targeted beneficiary under 
                                their care;
                                  (II) information regarding 
                                the frequency and cost of 
                                relapses and hospitalizations 
                                of targeted beneficiaries under 
                                the physician's care; and
                                  (III) applicable best 
                                practice guidelines and 
                                empirical references.
                          (iii) Monitor outlier physician's 
                        prescribing, such as failure to refill, 
                        dosage strengths, and provide 
                        incentives and information to encourage 
                        the adoption of best clinical 
                        practices.
                  (C) Targeted beneficiaries.--For purposes of 
                this paragraph, the term ``targeted 
                beneficiaries'' means Medicaid eligible 
                beneficiaries who are identified as having high 
                prescription drug costs and medical costs, such 
                as individuals with behavioral disorders or 
                multiple chronic diseases who are taking 
                multiple medications.

           *       *       *       *       *       *       *


                              DEFINITIONS

  Sec. 1905. For purposes of this title--
  (a) The term ``medical assistance'' means payment of part or 
all of the cost of the following care and services or the care 
and services themselves, or both (if provided in or after the 
third month before the month in which the recipient makes 
application for assistance or, in the case of medicare cost-
sharing with respect to a qualified medicare beneficiary 
described in subsection (p)(1), if provided after the month in 
which the individual becomes such a beneficiary) for 
individuals, and, with respect to physicians' or dentists' 
services, at the option of the State, to individuals (other 
than individuals with respect to whom there is being paid, or 
who are eligible, or would be eligible if they were not in a 
medical institution, to have paid with respect to them a State 
supplementary payment and are eligible for medical assistance 
equal in amount, duration, and scope to the medical assistance 
made available to individuals described in section 
1902(a)(10)(A)) not receiving aid or assistance under any plan 
of the State approved under title I, X, XIV, or XVI, or part A 
of title IV, and with respect to whom supplemental security 
income benefits are not being paid under title XVI, who are--
          (i) under the age of 21, or, at the option of the 
        State, under the age of 20, 19, or 18 as the State may 
        choose,
          (ii) relatives specified in section 406(b)(1) with 
        whom a child is living if such child is (or would, if 
        needy, be) a dependent child under part A of title IV,
          (iii) 65 years of age or older,
          (iv) blind, with respect to States eligible to 
        participate in the State plan program established under 
        title XVI,
          (v) 18 years of age or older and permanently and 
        totally disabled, with respect to States eligible to 
        participate in the State plan program established under 
        title XVI,
          (vi) persons essential (as described in the second 
        sentence of this subsection) to individuals receiving 
        aid or assistance under State plans approved under 
        title I, X, XIV, or XVI,
          (vii) blind or disabled as defined in section 1614, 
        with respect to States not eligible to participate in 
        the State plan program established under title XVI,
          (viii) pregnant women,
          (ix) individuals provided extended benefits under 
        section 1925,
          (x) individuals described in section 1902(u)(1),
          (xi) individuals described in section 1902(z)(1),
          (xii) employed individuals with a medically improved 
        disability (as defined in subsection (v)),
          (xiii) individuals described in section 1902(aa),
          (xiv) individuals described in section 
        1902(a)(10)(A)(i)(VIII) or 1902(a)(10)(A)(i)(IX),
          (xv) individuals described in section 
        1902(a)(10)(A)(ii)(XX),
                          (xvi) individuals described in 
                        section 1902(ii), or
          (xvii) individuals who are eligible for home and 
        community-based services under needs-based criteria 
        established under paragraph (1)(A) of section 1915(i), 
        or who are eligible for home and community-based 
        services under paragraph (6) of such section, and who 
        will receive home and community-based services pursuant 
        to a State plan amendment under such subsection,
but whose income and resources are insufficient to meet all of 
such cost--
          (1) inpatient hospital services (other than services 
        in an institution for mental diseases);
          (2)(A) outpatient hospital services, (B) consistent 
        with State law permitting such services, rural health 
        clinic services (as defined in subsection (l)(1)) and 
        any other ambulatory services which are offered by a 
        rural health clinic (as defined in subsection (l)(1)) 
        and which are otherwise included in the plan, and (C) 
        Federally-qualified health center services (as defined 
        in subsection (l)(2)) and any other ambulatory services 
        offered by a Federally-qualified health center and 
        which are otherwise included in the plan;
          (3) other laboratory and X-ray services;
          (4)(A) nursing facility services (other than services 
        in an institution for mental diseases) for individuals 
        21 years of age or older; (B) early and periodic 
        screening, diagnostic, and treatment services (as 
        defined in subsection (r)) for individuals who are 
        eligible under the plan and are under the age of 21; 
        (C) family planning services and supplies furnished 
        (directly or under arrangements with others) to 
        individuals of child-bearing age (including minors who 
        can be considered to be sexually active) who are 
        eligible under the State plan and who desire such 
        services and supplies; and (D) counseling and 
        pharmacotherapy for cessation of tobacco use by 
        pregnant women (as defined in subsection (bb));
          (5)(A) physicians' services furnished by a physician 
        (as defined in section 1861(r)(1)), whether furnished 
        in the office, the patient's home, a hospital, or a 
        nursing facility, or elsewhere, and (B) medical and 
        surgical services furnished by a dentist (described in 
        section 1861(r)(2)) to the extent such services may be 
        performed under State law either by a doctor of 
        medicine or by a doctor of dental surgery or dental 
        medicine and would be described in clause (A) if 
        furnished by a physician (as defined in section 
        1861(r)(1));
          (6) medical care, or any other type of remedial care 
        recognized under State law, furnished by licensed 
        practitioners within the scope of their practice as 
        defined by State law;
          (7) home health care services;
          (8) private duty nursing services;
          (9) clinic services furnished by or under the 
        direction of a physician, without regard to whether the 
        clinic itself is administered by a physician, including 
        such services furnished outside the clinic by clinic 
        personnel to an eligible individual who does not reside 
        in a permanent dwelling or does not have a fixed home 
        or mailing address;
          (10) dental services;
          (11) physical therapy and related services;
          (12) prescribed drugs, dentures, and prosthetic 
        devices; and eyeglasses prescribed by a physician 
        skilled in diseases of the eye or by an optometrist, 
        whichever the individual may select;
          (13) other diagnostic, screening, preventive, and 
        rehabilitative services, including--
                  (A) any clinical preventive services that are 
                assigned a grade of A or B by the United States 
                Preventive Services Task Force;
                  (B) with respect to an adult individual, 
                approved vaccines recommended by the Advisory 
                Committee on Immunization Practices (an 
                advisory committee established by the 
                Secretary, acting through the Director of the 
                Centers for Disease Control and Prevention) and 
                their administration; and
                  (C) any medical or remedial services 
                (provided in a facility, a home, or other 
                setting) recommended by a physician or other 
                licensed practitioner of the healing arts 
                within the scope of their practice under State 
                law, for the maximum reduction of physical or 
                mental disability and restoration of an 
                individual to the best possible functional 
                level;
          (14) inpatient hospital services and nursing facility 
        services for individuals 65 years of age or over in an 
        institution for mental diseases;
          (15) services in an intermediate care facility for 
        the mentally retarded (other than in an institution for 
        mental diseases) for individuals who are determined, in 
        accordance with section 1902(a)(31), to be in need of 
        such care;
          (16) effective January 1, 1973, inpatient psychiatric 
        hospital services for individuals under age 21, as 
        defined in subsection (h), and, effective January 1, 
        2019, the full-range of early and periodic screening, 
        diagnostic, and treatment services (as defined in 
        subsection (r)) for such individuals whether or not 
        such screening, diagnostic, and treatment services are 
        furnished by the provider of inpatient psychiatric 
        hospital services for individuals under age 21;
          (17) services furnished by a nurse-midwife (as 
        defined in section 1861(gg)) which the nurse-midwife is 
        legally authorized to perform under State law (or the 
        State regulatory mechanism provided by State law), 
        whether or not the nurse-midwife is under the 
        supervision of, or associated with, a physician or 
        other health care provider, and without regard to 
        whether or not the services are performed in the area 
        of management of the care of mothers and babies 
        throughout the maternity cycle;
          (18) hospice care (as defined in subsection (o));
          (19) case management services (as defined in section 
        1915(g)(2)) and TB-related services described in 
        section 1902(z)(2)(F);
          (20) respiratory care services (as defined in section 
        1902(e)(9)(C));
          (21) services furnished by a certified pediatric 
        nurse practitioner or certified family nurse 
        practitioner (as defined by the Secretary) which the 
        certified pediatric nurse practitioner or certified 
        family nurse practitioner is legally authorized to 
        perform under State law (or the State regulatory 
        mechanism provided by State law), whether or not the 
        certified pediatric nurse practitioner or certified 
        family nurse practitioner is under the supervision of, 
        or associated with, a physician or other health care 
        provider;
          (22) home and community care (to the extent allowed 
        and as defined in section 1929) for functionally 
        disabled elderly individuals;
          (23) community supported living arrangements services 
        (to the extent allowed and as defined in section 1930);
          (24) personal care services furnished to an 
        individual who is not an inpatient or resident of a 
        hospital, nursing facility, intermediate care facility 
        for the mentally retarded, or institution for mental 
        disease that are (A) authorized for the individual by a 
        physician in accordance with a plan of treatment or (at 
        the option of the State) otherwise authorized for the 
        individual in accordance with a service plan approved 
        by the State, (B) provided by an individual who is 
        qualified to provide such services and who is not a 
        member of the individual's family, and (C) furnished in 
        a home or other location;
          (25) primary care case management services (as 
        defined in subsection (t));
          (26) services furnished under a PACE program under 
        section 1934 to PACE program eligible individuals 
        enrolled under the program under such section;
          (27) subject to subsection (x), primary and secondary 
        medical strategies and treatment and services for 
        individuals who have Sickle Cell Disease;
          (28) freestanding birth center services (as defined 
        in subsection (l)(3)(A)) and other ambulatory services 
        that are offered by a freestanding birth center (as 
        defined in subsection (l)(3)(B)) and that are otherwise 
        included in the plan; and
          (29) any other medical care, and any other type of 
        remedial care recognized under State law, specified by 
        the Secretary,
except as otherwise provided in paragraph (16), such term does 
not include--
          (A) any such payments with respect to care or 
        services for any individual who is an inmate of a 
        public institution (except as a patient in a medical 
        institution); or
          (B) any such payments with respect to care or 
        services for any individual who has not attained 65 
        years of age and who is a patient in an institution for 
        mental diseases.
For purposes of clause (vi) of the preceding sentence, a person 
shall be considered essential to another individual if such 
person is the spouse of and is living with such individual, the 
needs of such person are taken into account in determining the 
amount of aid or assistance furnished to such individual (under 
a State plan approved under title I, X, XIV, or XVI), and such 
person is determined, under such a State plan, to be essential 
to the well-being of such individual. The payment described in 
the first sentence may include expenditures for medicare cost-
sharing and for premiums under part B of title XVIII for 
individuals who are eligible for medical assistance under the 
plan and (A) are receiving aid or assistance under any plan of 
the State approved under title I, X, XIV, or XVI, or part A of 
title IV, or with respect to whom supplemental security income 
benefits are being paid under title XVI, or (B) with respect to 
whom there is being paid a State supplementary payment and are 
eligible for medical assistance equal in amount, duration, and 
scope to the medical assistance made available to individuals 
described in section 1902(a)(10)(A), and, except in the case of 
individuals 65 years of age or older and disabled individuals 
entitled to health insurance benefits under title XVIII who are 
not enrolled under part B of title XVIII, other insurance 
premiums for medical or any other type of remedial care or the 
cost thereof. No service (including counseling) shall be 
excluded from the definition of ``medical assistance'' solely 
because it is provided as a treatment service for alcoholism or 
drug dependency.
  (b) Subject to subsections (y), (z), and (aa) and section 
1933(d), the term ``Federal medical assistance percentage'' for 
any State shall be 100 per centum less the State percentage; 
and the State percentage shall be that percentage which bears 
the same ratio to 45 per centum as the square of the per capita 
income of such State bears to the square of the per capita 
income of the continental United States (including Alaska) and 
Hawaii; except that (1) the Federal medical assistance 
percentage shall in no case be less than 50 per centum or more 
than 83 per centum, (2) the Federal medical assistance 
percentage for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa shall be 55 
percent, (3) for purposes of this title and title XXI, the 
Federal medical assistance percentage for the District of 
Columbia shall be 70 percent, (4) the Federal medical 
assistance percentage shall be equal to the enhanced FMAP 
described in section 2105(b) with respect to medical assistance 
provided to individuals who are eligible for such assistance 
only on the basis of section 1902(a)(10)(A)(ii)(XVIII), and (5) 
in the case of a State that provides medical assistance for 
services and vaccines described in subparagraphs (A) and (B) of 
subsection (a)(13), and prohibits cost-sharing for such 
services and vaccines, the Federal medical assistance 
percentage, as determined under this subsection and subsection 
(y) (without regard to paragraph (1)(C) of such subsection), 
shall be increased by 1 percentage point with respect to 
medical assistance for such services and vaccines and for items 
and services described in subsection (a)(4)(D). The Federal 
medical assistance percentage for any State shall be determined 
and promulgated in accordance with the provisions of section 
1101(a)(8)(B). Notwithstanding the first sentence of this 
section, the Federal medical assistance percentage shall be 100 
per centum with respect to amounts expended as medical 
assistance for services which are received through an Indian 
Health Service facility whether operated by the Indian Health 
Service or by an Indian tribe or tribal organization (as 
defined in section 4 of the Indian Health Care Improvement 
Act). Notwithstanding the first sentence of this subsection, in 
the case of a State plan that meets the condition described in 
subsection (u)(1), with respect to expenditures (other than 
expenditures under section 1923) described in subsection 
(u)(2)(A) or subsection (u)(3) for the State for a fiscal year, 
and that do not exceed the amount of the State's available 
allotment under section 2104, the Federal medical assistance 
percentage is equal to the enhanced FMAP described in section 
2105(b).
  (c) For definition of the term ``nursing facility'', see 
section 1919(a).
  (d) The term ``intermediate care facility for the mentally 
retarded'' means an institution (or distinct part thereof) for 
the mentally retarded or persons with related conditions if--
          (1) the primary purpose of such institution (or 
        distinct part thereof) is to provide health or 
        rehabilitative services for mentally retarded 
        individuals and the institution meets such standards as 
        may be prescribed by the Secretary;
          (2) the mentally retarded individual with respect to 
        whom a request for payment is made under a plan 
        approved under this title is receiving active treatment 
        under such a program; and
          (3) in the case of a public institution, the State or 
        political subdivision responsible for the operation of 
        such institution has agreed that the non-Federal 
        expenditures in any calendar quarter prior to January 
        1, 1975, with respect to services furnished to patients 
        in such institution (or distinct part thereof) in the 
        State will not, because of payments made under this 
        title, be reduced below the average amount expended for 
        such services in such institution in the four quarters 
        immediately preceding the quarter in which the State in 
        which such institution is located elected to make such 
        services available under its plan approved under this 
        title.
  (e) In the case of any State the State plan of which (as 
approved under this title)--
          (1) does not provide for the payment of services 
        (other than services covered under section 1902(a)(12)) 
        provided by an optometrist; but
          (2) at a prior period did provide for the payment of 
        services referred to in paragraph (1);
the term ``physicians' services'' (as used in subsection 
(a)(5)) shall include services of the type which an optometrist 
is legally authorized to perform where the State plan 
specifically provides that the term ``physicians' services'', 
as employed in such plan, includes services of the type which 
an optometrist is legally authorized to perform, and shall be 
reimbursed whether furnished by a physician or an optometrist.
  (f) For purposes of this title, the term ``nursing facility 
services'' means services which are or were required to be 
given an individual who needs or needed on a daily basis 
nursing care (provided directly by or requiring the supervision 
of nursing personnel) or other rehabilitation services which as 
a practical matter can only be provided in a nursing facility 
on an inpatient basis.
  (g) If the State plan includes provision of chiropractors' 
services, such services include only--
          (1) services provided by a chiropractor (A) who is 
        licensed as such by the State and (B) who meets uniform 
        minimum standards promulgated by the Secretary under 
        section 1861(r)(5); and
          (2) services which consist of treatment by means of 
        manual manipulation of the spine which the chiropractor 
        is legally authorized to perform by the State.
  (h)(1) For purposes of paragraph (16) of subsection (a), the 
term ``inpatient psychiatric hospital services for individuals 
under age 21'' includes only--
          (A) inpatient services which are provided in an 
        institution (or distinct part thereof) which is a 
        psychiatric hospital as defined in section 1861(f) or 
        in another inpatient setting that the Secretary has 
        specified in regulations;
          (B) inpatient services which, in the case of any 
        individual (i) involve active treatment which meets 
        such standards as may be prescribed in regulations by 
        the Secretary, and (ii) a team, consisting of 
        physicians and other personnel qualified to make 
        determinations with respect to mental health conditions 
        and the treatment thereof, has determined are necessary 
        on an inpatient basis and can reasonably be expected to 
        improve the condition, by reason of which such services 
        are necessary, to the extent that eventually such 
        services will no longer be necessary; and
          (C) inpatient services which, in the case of any 
        individual, are provided prior to (i) the date such 
        individual attains age 21, or (ii) in the case of an 
        individual who was receiving such services in the 
        period immediately preceding the date on which he 
        attained age 21, (I) the date such individual no longer 
        requires such services, or (II) if earlier, the date 
        such individual attains age 22;
  (2) Such term does not include services provided during any 
calendar quarter under the State plan of any State if the total 
amount of the funds expended, during such quarter, by the State 
(and the political subdivisions thereof) from non-Federal funds 
for inpatient services included under paragraph (1), and for 
active psychiatric care and treatment provided on an outpatient 
basis for eligible mentally ill children, is less than the 
average quarterly amount of the funds expended, during the 4-
quarter period ending December 31, 1971, by the State (and the 
political subdivisions thereof) from non-Federal funds for such 
services.
  (i) The term ``institution for mental diseases'' means a 
hospital, nursing facility, or other institution of more than 
16 beds, that is primarily engaged in providing diagnosis, 
treatment, or care of persons with mental diseases, including 
medical attention, nursing care, and related services.
  (j) The term ``State supplementary payment'' means any cash 
payment made by a State on a regular basis to an individual who 
is receiving supplemental security income benefits under title 
XVI or who would but for his income be eligible to receive such 
benefits, as assistance based on need in supplementation of 
such benefits (as determined by the Commissioner of Social 
Security), but only to the extent that such payments are made 
with respect to an individual with respect to whom supplemental 
security income benefits are payable under title XVI, or would 
but for his income be payable under that title.
  (k) Increased supplemental security income benefits payable 
pursuant to section 211 of Public Law 93-66 shall not be 
considered supplemental security income benefits payable under 
title XVI.
  (l)(1) The terms ``rural health clinic services'' and ``rural 
health clinic'' have the meanings given such terms in section 
1861(aa), except that (A) clause (ii) of section 1861(aa)(2) 
shall not apply to such terms, and (B) the physician 
arrangement required under section 1861(aa)(2)(B) shall only 
apply with respect to rural health clinic services and, with 
respect to other ambulatory care services, the physician 
arrangement required shall be only such as may be required 
under the State plan for those services.
  (2)(A) The term ``Federally-qualified health center 
services'' means services of the type described in 
subparagraphs (A) through (C) of section 1861(aa)(1) when 
furnished to an individual as an patient of a Federally-
qualified health center and, for this purpose, any reference to 
a rural health clinic or a physician described in section 
1861(aa)(2)(B) is deemed a reference to a Federally-qualified 
health center or a physician at the center, respectively.
  (B) The term ``Federally-qualified health center'' means an 
entity which--
          (i) is receiving a grant under section 330 of the 
        Public Health Service Act,
          (ii)(I) is receiving funding from such a grant under 
        a contract with the recipient of such a grant, and
          (II) meets the requirements to receive a grant under 
        section 330 of such Act,
          (iii) based on the recommendation of the Health 
        Resources and Services Administration within the Public 
        Health Service, is determined by the Secretary to meet 
        the requirements for receiving such a grant, including 
        requirements of the Secretary that an entity may not be 
        owned, controlled, or operated by another entity, or
          (iv) was treated by the Secretary, for purposes of 
        part B of title XVIII, as a comprehensive Federally 
        funded health center as of January 1, 1990;
and includes an outpatient health program or facility operated 
by a tribe or tribal organization under the Indian Self-
Determination Act (Public Law 93-638) or by an urban Indian 
organization receiving funds under title V of the Indian Health 
Care Improvement Act for the provision of primary health 
services. In applying clause (ii), the Secretary may waive any 
requirement referred to in such clause for up to 2 years for 
good cause shown.
  (3)(A) The term ``freestanding birth center services'' means 
services furnished to an individual at a freestanding birth 
center (as defined in subparagraph (B)) at such center.
  (B) The term ``freestanding birth center'' means a health 
facility--
          (i) that is not a hospital;
          (ii) where childbirth is planned to occur away from 
        the pregnant woman's residence;
          (iii) that is licensed or otherwise approved by the 
        State to provide prenatal labor and delivery or 
        postpartum care and other ambulatory services that are 
        included in the plan; and
          (iv) that complies with such other requirements 
        relating to the health and safety of individuals 
        furnished services by the facility as the State shall 
        establish.
  (C) A State shall provide separate payments to providers 
administering prenatal labor and delivery or postpartum care in 
a freestanding birth center (as defined in subparagraph (B)), 
such as nurse midwives and other providers of services such as 
birth attendants recognized under State law, as determined 
appropriate by the Secretary. For purposes of the preceding 
sentence, the term ``birth attendant'' means an individual who 
is recognized or registered by the State involved to provide 
health care at childbirth and who provides such care within the 
scope of practice under which the individual is legally 
authorized to perform such care under State law (or the State 
regulatory mechanism provided by State law), regardless of 
whether the individual is under the supervision of, or 
associated with, a physician or other health care provider. 
Nothing in this subparagraph shall be construed as changing 
State law requirements applicable to a birth attendant.
  (m)(1) Subject to paragraph (2), the term ``qualified family 
member'' means an individual (other than a qualified pregnant 
woman or child, as defined in subsection (n)) who is a member 
of a family that would be receiving aid under the State plan 
under part A of title IV pursuant to section 407 if the State 
had not exercised the option under section 407(b)(2)(B)(i).
  (2) No individual shall be a qualified family member for any 
period after September 30, 1998.
  (n) The term ``qualified pregnant woman or child'' means--
          (1) a pregnant woman who--
                  (A) would be eligible for aid to families 
                with dependent children under part A of title 
                IV (or would be eligible for such aid if 
                coverage under the State plan under part A of 
                title IV included aid to families with 
                dependent children of unemployed parents 
                pursuant to section 407) if her child had been 
                born and was living with her in the month such 
                aid would be paid, and such pregnancy has been 
                medically verified;
                  (B) is a member of a family which would be 
                eligible for aid under the State plan under 
                part A of title IV pursuant to section 407 if 
                the plan required the payment of aid pursuant 
                to such section; or
                  (C) otherwise meets the income and resources 
                requirements of a State plan under part A of 
                title IV; and
          (2) a child who has not attained the age of 19, who 
        was born after September 30, 1983 (or such earlier date 
        as the State may designate), and who meets the income 
        and resources requirements of the State plan under part 
        A of title IV.
  (o)(1)(A) Subject to subparagraphs (B) and (C), the term 
``hospice care'' means the care described in section 
1861(dd)(1) furnished by a hospice program (as defined in 
section 1861(dd)(2)) to a terminally ill individual who has 
voluntarily elected (in accordance with paragraph (2)) to have 
payment made for hospice care instead of having payment made 
for certain benefits described in section 1812(d)(2)(A) and for 
which payment may otherwise be made under title XVIII and 
intermediate care facility services under the plan. For 
purposes of such election, hospice care may be provided to an 
individual while such individual is a resident of a skilled 
nursing facility or intermediate care facility, but the only 
payment made under the State plan shall be for the hospice 
care.
  (B) For purposes of this title, with respect to the 
definition of hospice program under section 1861(dd)(2), the 
Secretary may allow an agency or organization to make the 
assurance under subparagraph (A)(iii) of such section without 
taking into account any individual who is afflicted with 
acquired immune deficiency syndrome (AIDS).
  (C) A voluntary election to have payment made for hospice 
care for a child (as defined by the State) shall not constitute 
a waiver of any rights of the child to be provided with, or to 
have payment made under this title for, services that are 
related to the treatment of the child's condition for which a 
diagnosis of terminal illness has been made.
  (2) An individual's voluntary election under this subsection 
--
          (A) shall be made in accordance with procedures that 
        are established by the State and that are consistent 
        with the procedures established under section 
        1812(d)(2);
          (B) shall be for such a period or periods (which need 
        not be the same periods described in section 
        1812(d)(1)) as the State may establish; and
          (C) may be revoked at any time without a showing of 
        cause and may be modified so as to change the hospice 
        program with respect to which a previous election was 
        made.
  (3) In the case of an individual--
          (A) who is residing in a nursing facility or 
        intermediate care facility for the mentally retarded 
        and is receiving medical assistance for services in 
        such facility under the plan,
          (B) who is entitled to benefits under part A of title 
        XVIII and has elected, under section 1812(d), to 
        receive hospice care under such part, and
          (C) with respect to whom the hospice program under 
        such title and the nursing facility or intermediate 
        care facility for the mentally retarded have entered 
        into a written agreement under which the program takes 
        full responsibility for the professional management of 
        the individual's hospice care and the facility agrees 
        to provide room and board to the individual,
instead of any payment otherwise made under the plan with 
respect to the facility's services, the State shall provide for 
payment to the hospice program of an amount equal to the 
additional amount determined in section 1902(a)(13)(B) and, if 
the individual is an individual described in section 
1902(a)(10)(A), shall provide for payment of any coinsurance 
amounts imposed under section 1813(a)(4).
  (p)(1) The term ``qualified medicare beneficiary'' means an 
individual--
          (A) who is entitled to hospital insurance benefits 
        under part A of title XVIII (including an individual 
        entitled to such benefits pursuant to an enrollment 
        under section 1818, but not including an individual 
        entitled to such benefits only pursuant to an 
        enrollment under section 1818A),
          (B) whose income (as determined under section 1612 
        for purposes of the supplemental security income 
        program, except as provided in paragraph (2)(D)) does 
        not exceed an income level established by the State 
        consistent with paragraph (2), and
          (C) whose resources (as determined under section 1613 
        for purposes of the supplemental security income 
        program) do not exceed twice the maximum amount of 
        resources that an individual may have and obtain 
        benefits under that program or, effective beginning 
        with January 1, 2010, whose resources (as so 
        determined) do not exceed the maximum resource level 
        applied for the year under subparagraph (D) of section 
        1860D-14(a)(3) (determined without regard to the life 
        insurance policy exclusion provided under subparagraph 
        (G) of such section) applicable to an individual or to 
        the individual and the individual's spouse (as the case 
        may be).
  (2)(A) The income level established under paragraph (1)(B) 
shall be at least the percent provided under subparagraph (B) 
(but not more than 100 percent) of the official poverty line 
(as defined by the Office of Management and Budget, and revised 
annually in accordance with section 673(2) of the Omnibus 
Budget Reconciliation Act of 1981) applicable to a family of 
the size involved.
  (B) Except as provided in subparagraph (C), the percent 
provided under this clause, with respect to eligibility for 
medical assistance on or after--
          (i) January 1, 1989, is 85 percent,
          (ii) January 1, 1990, is 90 percent, and
          (iii) January 1, 1991, is 100 percent.
  (C) In the case of a State which has elected treatment under 
section 1902(f) and which, as of January 1, 1987, used an 
income standard for individuals age 65 or older which was more 
restrictive than the income standard established under the 
supplemental security income program under title XVI, the 
percent provided under subparagraph (B), with respect to 
eligibility for medical assistance on or after--
          (i) January 1, 1989, is 80 percent,
          (ii) January 1, 1990, is 85 percent,
          (iii) January 1, 1991, is 95 percent, and
          (iv) January 1, 1992, is 100 percent.
  (D)(i) In determining under this subsection the income of an 
individual who is entitled to monthly insurance benefits under 
title II for a transition month (as defined in clause (ii)) in 
a year, such income shall not include any amounts attributable 
to an increase in the level of monthly insurance benefits 
payable under such title which have occurred pursuant to 
section 215(i) for benefits payable for months beginning with 
December of the previous year.
  (ii) For purposes of clause (i), the term ``transition 
month'' means each month in a year through the month following 
the month in which the annual revision of the official poverty 
line, referred to in subparagraph (A), is published.
  (3) The term ``medicare cost-sharing'' means (subject to 
section 1902(n)(2)) the following costs incurred with respect 
to a qualified medicare beneficiary, without regard to whether 
the costs incurred were for items and services for which 
medical assistance is otherwise available under the plan:
          (A)(i) premiums under section 1818 or 1818A, and
          (ii) premiums under section 1839,
          (B) Coinsurance under title XVIII (including 
        coinsurance described in section 1813).
          (C) Deductibles established under title XVIII 
        (including those described in section 1813 and section 
        1833(b)).
          (D) The difference between the amount that is paid 
        under section 1833(a) and the amount that would be paid 
        under such section if any reference to ``80 percent'' 
        therein were deemed a reference to ``100 percent''.
Such term also may include, at the option of a State, premiums 
for enrollment of a qualified medicare beneficiary with an 
eligible organization under section 1876.
  (4) Notwithstanding any other provision of this title, in the 
case of a State (other than the 50 States and the District of 
Columbia)--
          (A) the requirement stated in section 1902(a)(10)(E) 
        shall be optional, and
          (B) for purposes of paragraph (2), the State may 
        substitute for the percent provided under subparagraph 
        (B) of such paragraph or 1902(a)(10)(E)(iii) any 
        percent.
In the case of any State which is providing medical assistance 
to its residents under a waiver granted under section 1115, the 
Secretary shall require the State to meet the requirement of 
section 1902(a)(10)(E) in the same manner as the State would be 
required to meet such requirement if the State had in effect a 
plan approved under this title.
  (5)(A) The Secretary shall develop and distribute to States a 
simplified application form for use by individuals (including 
both qualified medicare beneficiaries and specified low-income 
medicare beneficiaries) in applying for medical assistance for 
medicare cost-sharing under this title in the States which 
elect to use such form. Such form shall be easily readable by 
applicants and uniform nationally. The Secretary shall provide 
for the translation of such application form into at least the 
10 languages (other than English) that are most often used by 
individuals applying for hospital insurance benefits under 
section 226 or 226A and shall make the translated forms 
available to the States and to the Commissioner of Social 
Security.
  (B) In developing such form, the Secretary shall consult with 
beneficiary groups and the States.
  (6) For provisions relating to outreach efforts to increase 
awareness of the availability of medicare cost-sharing, see 
section 1144.
  (q) The term ``qualified severely impaired individual'' means 
an individual under age 65--
          (1) who for the month preceding the first month to 
        which this subsection applies to such individual--
                  (A) received (i) a payment of supplemental 
                security income benefits under section 1611(b) 
                on the basis of blindness or disability, (ii) a 
                supplementary payment under section 1616 of 
                this Act or under section 212 of Public Law 93-
                66 on such basis, (iii) a payment of monthly 
                benefits under section 1619(a), or (iv) a 
                supplementary payment under section 1616(c)(3), 
                and
                  (B) was eligible for medical assistance under 
                the State plan approved under this title; and
          (2) with respect to whom the Commissioner of Social 
        Security determines that--
                  (A) the individual continues to be blind or 
                continues to have the disabling physical or 
                mental impairment on the basis of which he was 
                found to be under a disability and, except for 
                his earnings, continues to meet all non-
                disability-related requirements for eligibility 
                for benefits under title XVI,
                  (B) the income of such individual would not, 
                except for his earnings, be equal to or in 
                excess of the amount which would cause him to 
                be ineligible for payments under section 
                1611(b) (if he were otherwise eligible for such 
                payments),
                  (C) the lack of eligibility for benefits 
                under this title would seriously inhibit his 
                ability to continue or obtain employment, and
                  (D) the individual's earnings are not 
                sufficient to allow him to provide for himself 
                a reasonable equivalent of the benefits under 
                title XVI (including any federally administered 
                State supplementary payments), this title, and 
                publicly funded attendant care services 
                (including personal care assistance) that would 
                be available to him in the absence of such 
                earnings.
        In the case of an individual who is eligible for 
        medical assistance pursuant to section 1619(b) in June, 
        1987, the individual shall be a qualified severely 
        impaired individual for so long as such individual 
        meets the requirements of paragraph (2).
  (r) The term ``early and periodic screening, diagnostic, and 
treatment services'' means the following items and services:
          (1) Screening services--
                  (A) which are provided--
                          (i) at intervals which meet 
                        reasonable standards of medical and 
                        dental practice, as determined by the 
                        State after consultation with 
                        recognized medical and dental 
                        organizations involved in child health 
                        care and, with respect to immunizations 
                        under subparagraph (B)(iii), in 
                        accordance with the schedule referred 
                        to in section 1928(c)(2)(B)(i) for 
                        pediatric vaccines, and
                          (ii) at such other intervals, 
                        indicated as medically necessary, to 
                        determine the existence of certain 
                        physical or mental illnesses or 
                        conditions; and
                  (B) which shall at a minimum include--
                          (i) a comprehensive health and 
                        developmental history (including 
                        assessment of both physical and mental 
                        health development),
                          (ii) a comprehensive unclothed 
                        physical exam,
                          (iii) appropriate immunizations 
                        (according to the schedule referred to 
                        in section 1928(c)(2)(B)(i) for 
                        pediatric vaccines) according to age 
                        and health history,
                          (iv) laboratory tests (including lead 
                        blood level assessment appropriate for 
                        age and risk factors), and
                          (v) health education (including 
                        anticipatory guidance).
          (2) Vision services--
                  (A) which are provided--
                          (i) at intervals which meet 
                        reasonable standards of medical 
                        practice, as determined by the State 
                        after consultation with recognized 
                        medical organizations involved in child 
                        health care, and
                          (ii) at such other intervals, 
                        indicated as medically necessary, to 
                        determine the existence of a suspected 
                        illness or condition; and
                  (B) which shall at a minimum include 
                diagnosis and treatment for defects in vision, 
                including eyeglasses.
          (3) Dental services--
                  (A) which are provided--
                          (i) at intervals which meet 
                        reasonable standards of dental 
                        practice, as determined by the State 
                        after consultation with recognized 
                        dental organizations involved in child 
                        health care, and
                          (ii) at such other intervals, 
                        indicated as medically necessary, to 
                        determine the existence of a suspected 
                        illness or condition; and
                  (B) which shall at a minimum include relief 
                of pain and infections, restoration of teeth, 
                and maintenance of dental health.
          (4) Hearing services--
                  (A) which are provided--
                          (i) at intervals which meet 
                        reasonable standards of medical 
                        practice, as determined by the State 
                        after consultation with recognized 
                        medical organizations involved in child 
                        health care, and
                          (ii) at such other intervals, 
                        indicated as medically necessary, to 
                        determine the existence of a suspected 
                        illness or condition; and
                  (B) which shall at a minimum include 
                diagnosis and treatment for defects in hearing, 
                including hearing aids.
          (5) Such other necessary health care, diagnostic 
        services, treatment, and other measures described in 
        section 1905(a) to correct or ameliorate defects and 
        physical and mental illnesses and conditions discovered 
        by the screening services, whether or not such services 
        are covered under the State plan.
Nothing in this title shall be construed as limiting providers 
of early and periodic screening, diagnostic, and treatment 
services to providers who are qualified to provide all of the 
items and services described in the previous sentence or as 
preventing a provider that is qualified under the plan to 
furnish one or more (but not all) of such items or services 
from being qualified to provide such items and services as part 
of early and periodic screening, diagnostic, and treatment 
services. The Secretary shall, not later than July 1, 1990, and 
every 12 months thereafter, develop and set annual 
participation goals for each State for participation of 
individuals who are covered under the State plan under this 
title in early and periodic screening, diagnostic, and 
treatment services.
  (s) The term ``qualified disabled and working individual'' 
means an individual--
          (1) who is entitled to enroll for hospital insurance 
        benefits under part A of title XVIII under section 
        1818A (as added by 6012 of the Omnibus Budget 
        Reconciliation Act of 1989);
          (2) whose income (as determined under section 1612 
        for purposes of the supplemental security income 
        program) does not exceed 200 percent of the official 
        poverty line (as defined by the Office of Management 
        and Budget and revised annually in accordance with 
        section 673(2) of the Omnibus Budget Reconciliation Act 
        of 1981) applicable to a family of the size involved;
          (3) whose resources (as determined under section 1613 
        for purposes of the supplemental security income 
        program) do not exceed twice the maximum amount of 
        resources that an individual or a couple (in the case 
        of an individual with a spouse) may have and obtain 
        benefits for supplemental security income benefits 
        under title XVI; and
          (4) who is not otherwise eligible for medical 
        assistance under this title.
  (t)(1) The term ``primary care case management services'' 
means case-management related services (including locating, 
coordinating, and monitoring of health care services) provided 
by a primary care case manager under a primary care case 
management contract.
  (2) The term ``primary care case manager'' means any of the 
following that provides services of the type described in 
paragraph (1) under a contract referred to in such paragraph:
          (A) A physician, a physician group practice, or an 
        entity employing or having other arrangements with 
        physicians to provide such services.
          (B) At State option--
                  (i) a nurse practitioner (as described in 
                section 1905(a)(21));
                  (ii) a certified nurse-midwife (as defined in 
                section 1861(gg)); or
                  (iii) a physician assistant (as defined in 
                section 1861(aa)(5)).
  (3) The term ``primary care case management contract'' means 
a contract between a primary care case manager and a State 
under which the manager undertakes to locate, coordinate, and 
monitor covered primary care (and such other covered services 
as may be specified under the contract) to all individuals 
enrolled with the manager, and which--
          (A) provides for reasonable and adequate hours of 
        operation, including 24-hour availability of 
        information, referral, and treatment with respect to 
        medical emergencies;
          (B) restricts enrollment to individuals residing 
        sufficiently near a service delivery site of the 
        manager to be able to reach that site within a 
        reasonable time using available and affordable modes of 
        transportation;
          (C) provides for arrangements with, or referrals to, 
        sufficient numbers of physicians and other appropriate 
        health care professionals to ensure that services under 
        the contract can be furnished to enrollees promptly and 
        without compromise to quality of care;
          (D) prohibits discrimination on the basis of health 
        status or requirements for health care services in 
        enrollment, disenrollment, or reenrollment of 
        individuals eligible for medical assistance under this 
        title;
          (E) provides for a right for an enrollee to terminate 
        enrollment in accordance with section 1932(a)(4); and
          (F) complies with the other applicable provisions of 
        section 1932.
  (4) For purposes of this subsection, the term ``primary 
care'' includes all health care services customarily provided 
in accordance with State licensure and certification laws and 
regulations, and all laboratory services customarily provided 
by or through, a general practitioner, family medicine 
physician, internal medicine physician, obstetrician/
gynecologist, or pediatrician.
  (u)(1) The conditions described in this paragraph for a State 
plan are as follows:
          (A) The State is complying with the requirement of 
        section 2105(d)(1).
          (B) The plan provides for such reporting of 
        information about expenditures and payments 
        attributable to the operation of this subsection as the 
        Secretary deems necessary in order to carry out the 
        fourth sentence of subsection (b).
  (2)(A) For purposes of subsection (b), the expenditures 
described in this subparagraph are expenditures for medical 
assistance for optional targeted low-income children described 
in subparagraph (B).
  (B) For purposes of this paragraph, the term ``optional 
targeted low-income child'' means a targeted low-income child 
as defined in section 2110(b)(1) (determined without regard to 
that portion of subparagraph (C) of such section concerning 
eligibility for medical assistance under this title) who would 
not qualify for medical assistance under the State plan under 
this title as in effect on March 31, 1997 (but taking into 
account the expansion of age of eligibility effected through 
the operation of section 1902(l)(1)(D)). Such term excludes any 
child eligible for medical assistance only by reason of section 
1902(a)(10)(A)(ii)(XIX).
  (3) For purposes of subsection (b), the expenditures 
described in this paragraph are expenditures for medical 
assistance for children who are born before October 1, 1983, 
and who would be described in section 1902(l)(1)(D) if they had 
been born on or after such date, and who are not eligible for 
such assistance under the State plan under this title based on 
such State plan as in effect as of March 31, 1997.
  (4) The limitations on payment under subsections (f) and (g) 
of section 1108 shall not apply to Federal payments made under 
section 1903(a)(1) based on an enhanced FMAP described in 
section 2105(b).
  (v)(1) The term ``employed individual with a medically 
improved disability'' means an individual who--
          (A) is at least 16, but less than 65, years of age;
          (B) is employed (as defined in paragraph (2));
          (C) ceases to be eligible for medical assistance 
        under section 1902(a)(10)(A)(ii)(XV) because the 
        individual, by reason of medical improvement, is 
        determined at the time of a regularly scheduled 
        continuing disability review to no longer be eligible 
        for benefits under section 223(d) or 1614(a)(3); and
          (D) continues to have a severe medically determinable 
        impairment, as determined under regulations of the 
        Secretary.
  (2) For purposes of paragraph (1), an individual is 
considered to be ``employed'' if the individual--
          (A) is earning at least the applicable minimum wage 
        requirement under section 6 of the Fair Labor Standards 
        Act (29 U.S.C. 206) and working at least 40 hours per 
        month; or
          (B) is engaged in a work effort that meets 
        substantial and reasonable threshold criteria for hours 
        of work, wages, or other measures, as defined by the 
        State and approved by the Secretary.'
  (w)(1) For purposes of this title, the term ``independent 
foster care adolescent'' means an individual--
          (A) who is under 21 years of age;
          (B) who, on the individual's 18th birthday, was in 
        foster care under the responsibility of a State; and
          (C) whose assets, resources, and income do not exceed 
        such levels (if any) as the State may establish 
        consistent with paragraph (2).
  (2) The levels established by a State under paragraph (1)(C) 
may not be less than the corresponding levels applied by the 
State under section 1931(b).
  (3) A State may limit the eligibility of independent foster 
care adolescents under section 1902(a)(10)(A)(ii)(XVII) to 
those individuals with respect to whom foster care maintenance 
payments or independent living services were furnished under a 
program funded under part E of title IV before the date the 
individuals attained 18 years of age.
  (x) For purposes of subsection (a)(27), the strategies, 
treatment, and services described in that subsection include 
the following:
          (1) Chronic blood transfusion (with deferoxamine 
        chelation) to prevent stroke in individuals with Sickle 
        Cell Disease who have been identified as being at high 
        risk for stroke.
          (2) Genetic counseling and testing for individuals 
        with Sickle Cell Disease or the sickle cell trait to 
        allow health care professionals to treat such 
        individuals and to prevent symptoms of Sickle Cell 
        Disease.
          (3) Other treatment and services to prevent 
        individuals who have Sickle Cell Disease and who have 
        had a stroke from having another stroke.
  (y) Increased FMAP for Medical Assistance for Newly Eligible 
Mandatory Individuals.--
          (1) Amount of increase.--Notwithstanding subsection 
        (b), the Federal medical assistance percentage for a 
        State that is one of the 50 States or the District of 
        Columbia, with respect to amounts expended by such 
        State for medical assistance for newly eligible 
        individuals described in subclause (VIII) of section 
        1902(a)(10)(A)(i), shall be equal to--
                  (A) 100 percent for calendar quarters in 
                2014, 2015, and 2016;
                  (B) 95 percent for calendar quarters in 2017;
                  (C) 94 percent for calendar quarters in 2018;
                  (D) 93 percent for calendar quarters in 2019; 
                and
                  (E) 90 percent for calendar quarters in 2020 
                and each year thereafter.
          (2) Definitions.--In this subsection:
                  (A) Newly eligible.--The term ``newly 
                eligible'' means, with respect to an individual 
                described in subclause (VIII) of section 
                1902(a)(10)(A)(i), an individual who is not 
                under 19 years of age (or such higher age as 
                the State may have elected) and who, as of 
                December 1, 2009, is not eligible under the 
                State plan or under a waiver of the plan for 
                full benefits or for benchmark coverage 
                described in subparagraph (A), (B), or (C) of 
                section 1937(b)(1) or benchmark equivalent 
                coverage described in section 1937(b)(2) that 
                has an aggregate actuarial value that is at 
                least actuarially equivalent to benchmark 
                coverage described in subparagraph (A), (B), or 
                (C) of section 1937(b)(1), or is eligible but 
                not enrolled (or is on a waiting list) for such 
                benefits or coverage through a waiver under the 
                plan that has a capped or limited enrollment 
                that is full.
                  (B) Full benefits.--The term ``full 
                benefits'' means, with respect to an 
                individual, medical assistance for all services 
                covered under the State plan under this title 
                that is not less in amount, duration, or scope, 
                or is determined by the Secretary to be 
                substantially equivalent, to the medical 
                assistance available for an individual 
                described in section 1902(a)(10)(A)(i).
  (z) Equitable Support for Certain States.--
          (1)(A) During the period that begins on January 1, 
        2014, and ends on December 31, 2015, notwithstanding 
        subsection (b), the Federal medical assistance 
        percentage otherwise determined under subsection (b) 
        with respect to a fiscal year occurring during that 
        period shall be increased by 2.2 percentage points for 
        any State described in subparagraph (B) for amounts 
        expended for medical assistance for individuals who are 
        not newly eligible (as defined in subsection (y)(2)) 
        individuals described in subclause (VIII) of section 
        1902(a)(10)(A)(i).
          (B) For purposes of subparagraph (A), a State 
        described in this subparagraph is a State that--
                  (i) is an expansion State described in 
                paragraph (3);
                  (ii) the Secretary determines will not 
                receive any payments under this title on the 
                basis of an increased Federal medical 
                assistance percentage under subsection (y) for 
                expenditures for medical assistance for newly 
                eligible individuals (as so defined); and
                  (iii) has not been approved by the Secretary 
                to divert a portion of the DSH allotment for a 
                State to the costs of providing medical 
                assistance or other health benefits coverage 
                under a waiver that is in effect on July 2009.
          (2)(A) For calendar quarters in 2014 and each year 
        thereafter, the Federal medical assistance percentage 
        otherwise determined under subsection (b) for an 
        expansion State described in paragraph (3) with respect 
        to medical assistance for individuals described in 
        section 1902(a)(10)(A)(i)(VIII) who are nonpregnant 
        childless adults with respect to whom the State may 
        require enrollment in benchmark coverage under section 
        1937 shall be equal to the percent specified in 
        subparagraph (B)(i) for such year.
          (B)(i) The percent specified in this subparagraph for 
        a State for a year is equal to the Federal medical 
        assistance percentage (as defined in the first sentence 
        of subsection (b)) for the State increased by a number 
        of percentage points equal to the transition percentage 
        (specified in clause (ii) for the year) of the number 
        of percentage points by which--
                  (I) such Federal medical assistance 
                percentage for the State, is less than
                  (II) the percent specified in subsection 
                (y)(1) for the year.
          (ii) The transition percentage specified in this 
        clause for--
                  (I) 2014 is 50 percent;
                  (II) 2015 is 60 percent;
                  (III) 2016 is 70 percent;
                  (IV) 2017 is 80 percent;
                  (V) 2018 is 90 percent; and
                  (VI) 2019 and each subsequent year is 100 
                percent.
          (3) A State is an expansion State if, on the date of 
        the enactment of the Patient Protection and Affordable 
        Care Act, the State offers health benefits coverage 
        statewide to parents and nonpregnant, childless adults 
        whose income is at least 100 percent of the poverty 
        line, that includes inpatient hospital services, is not 
        dependent on access to employer coverage, employer 
        contribution, or employment and is not limited to 
        premium assistance, hospital-only benefits, a high 
        deductible health plan, or alternative benefits under a 
        demonstration program authorized under section 1938. A 
        State that offers health benefits coverage to only 
        parents or only nonpregnant childless adults described 
        in the preceding sentence shall not be considered to be 
        an expansion State.
  (aa)(1) Notwithstanding subsection (b), beginning January 1, 
2011, the Federal medical assistance percentage for a fiscal 
year for a disaster-recovery FMAP adjustment State shall be 
equal to the following:
          (A) In the case of the first fiscal year (or part of 
        a fiscal year) for which this subsection applies to the 
        State, the State's regular FMAP shall be increased by 
        50 percent of the number of percentage points by which 
        the State's regular FMAP for such fiscal year is less 
        than the Federal medical assistance percentage 
        determined for the State for the preceding fiscal year 
        after the application of only subsection (a) of section 
        5001 of Public Law 111-5 (if applicable to the 
        preceding fiscal year) and without regard to this 
        subsection, subsections (y) and (z), and subsections 
        (b) and (c) of section 5001 of Public Law 111-5.
          (B) In the case of the second or any succeeding 
        fiscal year for which this subsection applies to the 
        State, the State's regular FMAP for such fiscal year 
        shall be increased by 25 percent (or 50 percent in the 
        case of fiscal year 2013) of the number of percentage 
        points by which the State's regular FMAP for such 
        fiscal year is less than the Federal medical assistance 
        percentage received by the State during the preceding 
        fiscal year.
  (2) In this subsection, the term ``disaster-recovery FMAP 
adjustment State'' means a State that is one of the 50 States 
or the District of Columbia, for which, at any time during the 
preceding 7 fiscal years, the President has declared a major 
disaster under section 401 of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act and determined as a result 
of such disaster that every county or parish in the State 
warrant individual and public assistance or public assistance 
from the Federal Government under such Act and for which--
          (A) in the case of the first fiscal year (or part of 
        a fiscal year) for which this subsection applies to the 
        State, the State's regular FMAP for the fiscal year is 
        less than the Federal medical assistance percentage 
        determined for the State for the preceding fiscal year 
        after the application of only subsection (a) of section 
        5001 of Public Law 111-5 (if applicable to the 
        preceding fiscal year) and without regard to this 
        subsection, subsections (y) and (z), and subsections 
        (b) and (c) of section 5001 of Public Law 111-5, by at 
        least 3 percentage points; and
          (B) in the case of the second or any succeeding 
        fiscal year for which this subsection applies to the 
        State, the State's regular FMAP for the fiscal year is 
        less than the Federal medical assistance percentage 
        determined for the State for the preceding fiscal year 
        under this subsection by at least 3 percentage points.
  (3) In this subsection, the term ``regular FMAP'' means, for 
each fiscal year for which this subsection applies to a State, 
the Federal medical assistance percentage that would otherwise 
apply to the State for the fiscal year, as determined under 
subsection (b) and without regard to this subsection, 
subsections (y) and (z), and section 10202 of the Patient 
Protection and Affordable Care Act.
  (4) The Federal medical assistance percentage determined for 
a disaster-recovery FMAP adjustment State under paragraph (1) 
shall apply for purposes of this title (other than with respect 
to disproportionate share hospital payments described in 
section 1923 and payments under this title that are based on 
the enhanced FMAP described in 2105(b)) and shall not apply 
with respect to payments under title IV (other than under part 
E of title IV) or payments under title XXI.
  (bb)(1) For purposes of this title, the term ``counseling and 
pharmacotherapy for cessation of tobacco use by pregnant 
women'' means diagnostic, therapy, and counseling services and 
pharmacotherapy (including the coverage of prescription and 
nonprescription tobacco cessation agents approved by the Food 
and Drug Administration) for cessation of tobacco use by 
pregnant women who use tobacco products or who are being 
treated for tobacco use that is furnished--
          (A) by or under the supervision of a physician; or
          (B) by any other health care professional who--
                  (i) is legally authorized to furnish such 
                services under State law (or the State 
                regulatory mechanism provided by State law) of 
                the State in which the services are furnished; 
                and
                  (ii) is authorized to receive payment for 
                other services under this title or is 
                designated by the Secretary for this purpose.
  (2) Subject to paragraph (3), such term is limited to--
          (A) services recommended with respect to pregnant 
        women in ``Treating Tobacco Use and Dependence: 2008 
        Update: A Clinical Practice Guideline'', published by 
        the Public Health Service in May 2008, or any 
        subsequent modification of such Guideline; and
          (B) such other services that the Secretary recognizes 
        to be effective for cessation of tobacco use by 
        pregnant women.
  (3) Such term shall not include coverage for drugs or 
biologicals that are not otherwise covered under this title.
  (cc) Requirement for Certain States.--Notwithstanding 
subsections (y), (z), and (aa), in the case of a State that 
requires political subdivisions within the State to contribute 
toward the non-Federal share of expenditures required under the 
State plan under section 1902(a)(2), the State shall not be 
eligible for an increase in its Federal medical assistance 
percentage under such subsections if it requires that political 
subdivisions pay a greater percentage of the non-Federal share 
of such expenditures, or a greater percentage of the non-
Federal share of payments under section 1923, than the 
respective percentages that would have been required by the 
State under the State plan under this title, State law, or 
both, as in effect on December 31, 2009, and without regard to 
any such increase. Voluntary contributions by a political 
subdivision to the non-Federal share of expenditures under the 
State plan under this title or to the non-Federal share of 
payments under section 1923, shall not be considered to be 
required contributions for purposes of this subsection. The 
treatment of voluntary contributions, and the treatment of 
contributions required by a State under the State plan under 
this title, or State law, as provided by this subsection, shall 
also apply to the increases in the Federal medical assistance 
percentage under section 5001 of the American Recovery and 
Reinvestment Act of 2009.
  (dd) Increased FMAP for Additional Expenditures for Primary 
Care Services.--Notwithstanding subsection (b), with respect to 
the portion of the amounts expended for medical assistance for 
services described in section 1902(a)(13)(C) furnished on or 
after January 1, 2013, and before January 1, 2015, that is 
attributable to the amount by which the minimum payment rate 
required under such section (or, by application, section 
1932(f)) exceeds the payment rate applicable to such services 
under the State plan as of July 1, 2009, the Federal medical 
assistance percentage for a State that is one of the 50 States 
or the District of Columbia shall be equal to 100 percent. The 
preceding sentence does not prohibit the payment of Federal 
financial participation based on the Federal medical assistance 
percentage for amounts in excess of those specified in such 
sentence.

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PROTECTING ACCESS TO MEDICARE ACT OF 2014

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TITLE II--OTHER HEALTH PROVISIONS

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SEC. 224. ASSISTED OUTPATIENT TREATMENT GRANT PROGRAM FOR INDIVIDUALS 
                    WITH SERIOUS MENTAL ILLNESS.

  (a) In general.--The Secretary shall establish a 4-year pilot 
program to award not more than 50 grants each year to eligible 
entities for assisted outpatient treatment programs for 
individuals with serious mental illness.
  (b) Consultation.--The Secretary shall carry out this section 
in consultation with the Director of the National Institute of 
Mental Health, the Attorney General of the United States, the 
Administrator of the Administration for Community Living, and 
the Administrator of the Substance Abuse and Mental Health 
Services Administration.
  (c) Selecting Among Applicants.--The Secretary--
          (1) may only award grants under this section to 
        applicants that have not previously implemented an 
        assisted outpatient treatment program; and
          (2) shall evaluate applicants based on their 
        potential to reduce hospitalization, homelessness, 
        incarceration, and interaction with the criminal 
        justice system while improving the health and social 
        outcomes of the patient.
  (d) Use of Grant.--An assisted outpatient treatment program 
funded with a grant awarded under this section shall include--
          (1) evaluating the medical and social needs of the 
        patients who are participating in the program;
          (2) preparing and executing treatment plans for such 
        patients that--
                  (A) include criteria for completion of court-
                ordered treatment; and
                  (B) provide for monitoring of the patient's 
                compliance with the treatment plan, including 
                compliance with medication and other treatment 
                regimens;
          (3) providing for such patients case management 
        services that support the treatment plan;
          (4) ensuring appropriate referrals to medical and 
        social service providers;
          (5) evaluating the process for implementing the 
        program to ensure consistency with the patient's needs 
        and State law; and
          (6) measuring treatment outcomes, including health 
        and social outcomes such as rates of incarceration, 
        health care utilization, and homelessness.
  (e) Report.--Not later than the end of each of fiscal years 
2016, 2017, and 2018, the Secretary shall submit a report to 
the appropriate congressional committees on the grant program 
under this section. Each such report shall include an 
evaluation of the following:
          (1) Cost savings and public health outcomes such as 
        mortality, suicide, substance abuse, hospitalization, 
        and use of services.
          (2) Rates of incarceration by patients.
          (3) Rates of homelessness among patients.
          (4) Patient and family satisfaction with program 
        participation.
  (f) Definitions.--In this section:
          (1) The term ``assisted outpatient treatment'' means 
        medically prescribed mental health treatment that a 
        patient receives while living in a community under the 
        terms of a law authorizing a State or local court to 
        order such treatment.
          (2) The term ``eligible entity'' means a county, 
        city, mental health system, mental health court, or any 
        other entity with authority under the law of the State 
        in which the grantee is located to implement, monitor, 
        and oversee assisted outpatient treatment programs.
          (3) The term ``Secretary'' means the Secretary of 
        Health and Human Services.
  (g) Funding.--
          (1) Amount of grants.--A grant under this section 
        shall be in an amount that is not more than $1,000,000 
        for each of fiscal years 2015 through [2018] 2022. 
        Subject to the preceding sentence, the Secretary shall 
        determine the amount of each grant based on the 
        population of the area, including estimated patients, 
        to be served under the grant.
          (2) Authorization of appropriations.--There [is 
        authorized to be appropriated to carry out this section 
        $15,000,000 for each of fiscal years 2015 through 2018] 
        are authorized to be appropriated to carry out this 
        section $15,000,000 for each of fiscal years 2015 
        through 2017, $20,000,000 for fiscal year 2018, 
        $19,000,000 for each of fiscal years 2019 and 2020, and 
        $18,000,000 for each of fiscal years 2021 and 2022.

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