---
kind: "range"
citation: "42 U.S.C. §§ 300x–300x–66"
title: "42"
from: "300x"
to: "300x–66"
count: 42
release: "119-102"
url: "https://uscodex.org/usc/42/300x..300x-66"
---

# §300x. Formula grants to States

- (a) **In general—** For the purpose described in [subsection (b)](#b), the [Secretary](/usc/42/201.md?p=c), acting through the [Director](/usc/42/5061.md?p=1) of the Center for Mental Health [Services](/usc/42/201.md?p=a), shall make an allotment each fiscal year for each [State](/usc/42/300gg–91.md?p=d-14) in an amount determined in accordance with [section 300x–7 of this title](/usc/42/300x–7.md). The [Secretary](/usc/42/201.md?p=c) shall make a grant to the [State](/usc/42/300gg–91.md?p=d-14) of the allotment made for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year if the [State](/usc/42/300gg–91.md?p=d-14) submits to the [Secretary](/usc/42/201.md?p=c) an application in accordance with [section 300x–6 of this title](/usc/42/300x–6.md).
- (b) **Purpose of grants—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [subsection (a)](#a) is that, subject to [section 300x–5 of this title](/usc/42/300x–5.md), the [State](/usc/42/300gg–91.md?p=d-14) involved will expend the grant only for the purpose of—
  - (1) providing community mental health [services](/usc/42/201.md?p=a) for [adults with a serious mental illness](/usc/42/300x–1.md?p=c-1) and [children with a serious emotional disturbance](/usc/42/300x–1.md?p=c-1) as defined in accordance with [section 300x–1(c) of this title](/usc/42/300x–1.md?p=c);
  - (2) carrying out the plan submitted under [section 300x–1(a) of this title](/usc/42/300x–1.md?p=a) by the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year involved;
  - (3) evaluating [programs](/usc/42/274l–1.md?p=4) and [services](/usc/42/201.md?p=a) carried out under the plan; and
  - (4) planning, administration, and educational activities related to providing [services](/usc/42/201.md?p=a) under the plan.

# §300x–1. State plan for comprehensive community mental health services for certain individuals

- (a) **In general—** The [Secretary](/usc/42/201.md?p=c) may make a grant under [section 300x of this title](/usc/42/300x.md) only if—
  - (1) the [State](/usc/42/300gg–91.md?p=d-14) involved submits to the [Secretary](/usc/42/201.md?p=c) a plan for providing comprehensive community mental health [services](/usc/42/201.md?p=a) to [adults with a serious mental illness](#c-1) and to [children with a serious emotional disturbance](#c-1);
  - (2) the plan meets the criteria specified in [subsection (b)](#b); and
  - (3) the plan is approved by the [Secretary](/usc/42/201.md?p=c).
- (b) **Criteria for plan—** In accordance with [subsection (a)](#a), a [State](/usc/42/300gg–91.md?p=d-14) shall submit to the [Secretary](/usc/42/201.md?p=c) a plan every two years that, at a minimum, includes each of the following:
  - (1) **System of care—** A description of the [State](/usc/42/300gg–91.md?p=d-14)’s system of care that contains the following:
    - (A) **Comprehensive community-based health systems—** The plan shall—
      - (i) identify the [single](/usc/42/2304.md?p=m) [State agency](/usc/42/1396r–8.md?p=k-9) to be responsible for the administration of the [program](/usc/42/274l–1.md?p=4) under the grant, including any third party who administers mental health [services](/usc/42/201.md?p=a) 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](/usc/42/201.md?p=a) and resources in a comprehensive system of care, including [services](/usc/42/201.md?p=a) for individuals with co-occurring disorders;
      - (iii) include a description of the manner in which the [State](/usc/42/300gg–91.md?p=d-14) and local entities will coordinate [services](/usc/42/201.md?p=a) to maximize the efficiency, effectiveness, quality, and cost-effectiveness of [services](/usc/42/201.md?p=a) and [programs](/usc/42/274l–1.md?p=4) to produce the best possible outcomes (including health [services](/usc/42/201.md?p=a), rehabilitation [services](/usc/42/201.md?p=a), employment [services](/usc/42/201.md?p=a), [housing](/usc/42/1490p–2.md?p=r-3) [services](/usc/42/201.md?p=a), educational [services](/usc/42/201.md?p=a), [substance use disorder services](/usc/42/290cc–34.md?p=4), legal [services](/usc/42/201.md?p=a), law enforcement [services](/usc/42/201.md?p=a), social [services](/usc/42/201.md?p=a), [child](/usc/42/416.md?p=e) welfare [services](/usc/42/201.md?p=a), medical and dental care [services](/usc/42/201.md?p=a), and other support [services](/usc/42/201.md?p=a) to be provided with Federal, [State](/usc/42/300gg–91.md?p=d-14), and local public and private resources) with other agencies to enable individuals receiving [services](/usc/42/201.md?p=a) to function outside of inpatient or residential institutions, to the maximum extent of their capabilities, including [services](/usc/42/201.md?p=a) to be provided by local [school](/usc/42/6372.md?p=1) systems under the Individuals with Disabilities Education Act [[20 U.S.C. 1400](/usc/20/1400.md) et seq.];
      - (iv) include a description of how the [State](/usc/42/300gg–91.md?p=d-14) promotes evidence-based [practices](/usc/42/17061.md?p=19), including those evidence-based [programs](/usc/42/274l–1.md?p=4) that address the needs of individuals with early serious mental illness regardless of the age of the individual at onset, provide comprehensive individualized [treatment](/usc/42/11851.md?p=11), or integrate mental and physical health [services](/usc/42/201.md?p=a);
      - (v) include a description of case management [services](/usc/42/201.md?p=a);
      - (vi) include a description of activities that seek to engage [adults with a serious mental illness](#c-1) or [children with a serious emotional disturbance](#c-1) and their caregivers where appropriate in making health care decisions, including activities that enhance communication among individuals, [families](/usc/42/12704.md?p=11), caregivers, and [treatment](/usc/42/11851.md?p=11) providers; and
      - (vii) as appropriate to, and reflective of, the uses the [State](/usc/42/300gg–91.md?p=d-14) proposes for the block [grant funds](/usc/42/5106a.md?p=f-1-B), include—
        - (I) a description of the activities intended to reduce hospitalizations and [hospital](/usc/42/1395dd.md?p=e-5) stays using the block [grant funds](/usc/42/5106a.md?p=f-1-B);
        - (II) a description of the activities intended to reduce incidents of suicide using the block [grant funds](/usc/42/5106a.md?p=f-1-B);
        - (III) a description of how the [State](/usc/42/300gg–91.md?p=d-14) integrates mental health and primary care using the block [grant funds](/usc/42/5106a.md?p=f-1-B), which may include providing, in the case of individuals with co-occurring mental and substance use disorders, both mental and substance use disorders [services](/usc/42/201.md?p=a) in primary care settings or arrangements to provide primary and specialty care [services](/usc/42/201.md?p=a) in community-based mental and substance use disorders settings; and
        - (IV) a description of recovery and recovery support [services](/usc/42/201.md?p=a) for [adults with a serious mental illness](#c-1) and [children with a serious emotional disturbance](#c-1).
    - (B) **Mental health system data and epidemiology—** The plan shall contain an estimate of the incidence and prevalence in the [State](/usc/42/300gg–91.md?p=d-14) of serious mental illness among adults and serious emotional disturbance among [children](/usc/42/256e.md?p=g-2) and present quantitative targets and outcome measures for [programs](/usc/42/274l–1.md?p=4) and [services](/usc/42/201.md?p=a) provided under this subpart.
    - (C) **Children’s services—** In the case of [children with a serious emotional disturbance](#c-1) (as defined pursuant to [subsection (c)](#c)), the plan shall provide for a system of integrated social [services](/usc/42/201.md?p=a), educational [services](/usc/42/201.md?p=a), [child](/usc/42/416.md?p=e) welfare [services](/usc/42/201.md?p=a), juvenile justice [services](/usc/42/201.md?p=a), law enforcement [services](/usc/42/201.md?p=a), and [substance use disorder services](/usc/42/290cc–34.md?p=4) that, together with health and mental health [services](/usc/42/201.md?p=a), will be provided in order for such [children](/usc/42/256e.md?p=g-2) to receive care appropriate for their multiple needs (such system to include [services](/usc/42/201.md?p=a) provided under the Individuals with Disabilities Education Act).
    - (D) **Targeted services to rural and homeless populations—** The plan shall describe the [State](/usc/42/300gg–91.md?p=d-14)’s outreach to and [services](/usc/42/201.md?p=a) for individuals who are homeless and how community-based [services](/usc/42/201.md?p=a) will be provided to individuals residing in rural areas.
    - (E) **Management services—** The plan shall 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, and shall provide for the [training](/usc/42/285e–2.md?p=b-2) of providers of emergency health [services](/usc/42/201.md?p=a) regarding mental health. The plan shall further describe the manner in which the [State](/usc/42/300gg–91.md?p=d-14) intends to expend the grant under [section 300x of this title](/usc/42/300x.md) for the fiscal year involved, and the manner in which the [State](/usc/42/300gg–91.md?p=d-14) intends to comply with each of the [funding agreements](/usc/42/290ff–4.md?p=d-3) in this subpart and subpart III.
  - (2) **Goals and objectives—** The establishment of 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](/usc/42/201.md?p=c) shall establish definitions for the terms “adults with a serious mental illness” and “children with a serious emotional disturbance”. The [Secretary](/usc/42/201.md?p=c) shall disseminate the definitions to the [States](/usc/42/300gg–91.md?p=d-14).
  - (2) **Standardized methods—** The [Secretary](/usc/42/201.md?p=c) shall establish standardized methods for making the estimates required in subsection (b)(11)[^1] with respect to a [State](/usc/42/300gg–91.md?p=d-14). A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x of this title](/usc/42/300x.md) for the [State](/usc/42/300gg–91.md?p=d-14) is that the [State](/usc/42/300gg–91.md?p=d-14) will utilize such methods in making the estimates.
  - (3) **Date certain for compliance by Secretary—** Not later than 90 days after July 10, 1992, the [Secretary](/usc/42/201.md?p=c) shall establish the definitions described in [paragraph (1)](#c-1), shall begin dissemination of the definitions to the [States](/usc/42/300gg–91.md?p=d-14), and shall establish the standardized methods described in [paragraph (2)](#c-2).
- (d) **Requirement of implementation of plan—**
  - (1) **Complete implementation—** Except as provided in [paragraph (2)](#d-2), in making a grant under [section 300x of this title](/usc/42/300x.md) to a [State](/usc/42/300gg–91.md?p=d-14) for a fiscal year, the [Secretary](/usc/42/201.md?p=c) shall make a determination of the extent to which the [State](/usc/42/300gg–91.md?p=d-14) has implemented the plan required in [subsection (a)](#a). If the [Secretary](/usc/42/201.md?p=c) determines that a [State](/usc/42/300gg–91.md?p=d-14) has not completely implemented the plan, the [Secretary](/usc/42/201.md?p=c) shall reduce the amount of the allotment under [section 300x of this title](/usc/42/300x.md) for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year involved by an amount equal to 10 percent of the amount determined under [section 300x–7 of this title](/usc/42/300x–7.md) for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year.
  - (2) **Substantial implementation and good faith effort regarding fiscal year 1993—**
    - (A) In making a grant under [section 300x of this title](/usc/42/300x.md) to a [State](/usc/42/300gg–91.md?p=d-14) for fiscal year 1993, the [Secretary](/usc/42/201.md?p=c) shall make a determination of the extent to which the [State](/usc/42/300gg–91.md?p=d-14) has implemented the plan required in [subsection (a)](#a). If the [Secretary](/usc/42/201.md?p=c) determines that the [State](/usc/42/300gg–91.md?p=d-14) has not substantially implemented the plan, the [Secretary](/usc/42/201.md?p=c) shall, subject to [subparagraph (B)](#d-2-B), reduce the amount of the allotment under [section 300x of this title](/usc/42/300x.md) for the [State](/usc/42/300gg–91.md?p=d-14) for such fiscal year by an amount equal to 10 percent of the amount determined under [section 300x–7 of this title](/usc/42/300x–7.md) for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year.
    - (B) In carrying out [subparagraph (A)](#d-2-A), if the [Secretary](/usc/42/201.md?p=c) determines that the [State](/usc/42/300gg–91.md?p=d-14) is making a good faith effort to implement the plan required in [subsection (a)](#a), the [Secretary](/usc/42/201.md?p=c) 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 300x–7 of this title](/usc/42/300x–7.md) for the [State](/usc/42/300gg–91.md?p=d-14) for fiscal year 1993.

# §300x–2. Certain agreements

- (a) **Allocation for systems of integrated services for children—**
  - (1) **In general—** With respect to [children with a serious emotional disturbance](/usc/42/300x–1.md?p=c-1), a [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x of this title](/usc/42/300x.md) is that—
    - (A) in the case of a grant for fiscal year 1993, the [State](/usc/42/300gg–91.md?p=d-14) involved will expend not less than 10 percent of the grant to increase (relative to fiscal year 1992) funding for the system of integrated [services](/usc/42/201.md?p=a) described in [section 300x–1(b)(9)](/usc/42/300x–1.md)[^1] of this title;
    - (B) in the case of a grant for fiscal year 1994, the [State](/usc/42/300gg–91.md?p=d-14) will expend not less than 10 percent of the grant to increase (relative to fiscal year 1993) funding for such system; and
    - (C) in the case of a grant for any subsequent fiscal year, the [State](/usc/42/300gg–91.md?p=d-14) will expend for such system not less than an amount equal to the amount expended by the [State](/usc/42/300gg–91.md?p=d-14) for fiscal year 1994.
  - (2) **Waiver—**
    - (A) Upon the request of a [State](/usc/42/300gg–91.md?p=d-14), the [Secretary](/usc/42/201.md?p=c) may provide to the [State](/usc/42/300gg–91.md?p=d-14) a waiver of all or part of the requirement established in [paragraph (1)](#a-1) if the [Secretary](/usc/42/201.md?p=c) determines that the [State](/usc/42/300gg–91.md?p=d-14) is providing an adequate level of comprehensive community mental health [services](/usc/42/201.md?p=a) for [children](/usc/42/256e.md?p=g-2) with a serious emotional distrubance,[^2] as indicated by a comparison of the number of such [children](/usc/42/256e.md?p=g-2) for which such [services](/usc/42/201.md?p=a) are sought with the availability in the [State](/usc/42/300gg–91.md?p=d-14) of the [services](/usc/42/201.md?p=a).
    - (B) The [Secretary](/usc/42/201.md?p=c) shall approve or deny a request for a waiver under [subparagraph (A)](#a-2-A) not later than 120 days after the date on which the request is made.
    - (C) Any waiver provided by the [Secretary](/usc/42/201.md?p=c) under [subparagraph (A)](#a-2-A) shall be applicable only to the fiscal year involved.
- (b) **Providers of services—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x of this title](/usc/42/300x.md) for a [State](/usc/42/300gg–91.md?p=d-14) is that, with respect to the plan submitted under [section 300x–1(a) of this title](/usc/42/300x–1.md?p=a) for the fiscal year involved—
  - (1) [services](/usc/42/201.md?p=a) under the plan will be provided only through appropriate, qualified community [programs](/usc/42/274l–1.md?p=4) (which may include community mental health centers, [child](/usc/42/416.md?p=e) mental-health [programs](/usc/42/274l–1.md?p=4), psychosocial rehabilitation [programs](/usc/42/274l–1.md?p=4), mental health peer-support [programs](/usc/42/274l–1.md?p=4), and mental-health primary consumer-directed [programs](/usc/42/274l–1.md?p=4)); and
  - (2) [services](/usc/42/201.md?p=a) under the plan will be provided through community mental health centers only if the centers meet the criteria specified in [subsection (c)](#c).
- (c) **Criteria for mental health centers—** The criteria referred to in [subsection (b)(2)](#b-2) regarding community mental health centers are as follows:
  - (1) With respect to mental health [services](/usc/42/201.md?p=a), the centers provide [services](/usc/42/201.md?p=a) as follows:
    - (A) [Services](/usc/42/201.md?p=a) principally to individuals residing in a defined [geographic area](/usc/42/11360.md?p=9) (hereafter in this subsection referred to as a “[service](/usc/42/201.md?p=a) area”).
    - (B) Outpatient [services](/usc/42/201.md?p=a), including specialized outpatient [services](/usc/42/201.md?p=a) for [children](/usc/42/256e.md?p=g-2), the elderly, individuals with a serious mental illness, and residents of the [service](/usc/42/201.md?p=a) areas of the centers who have been discharged from inpatient [treatment](/usc/42/11851.md?p=11) at a mental health [facility](/usc/42/11049.md?p=4).
    - (C) 24-hour-a-day emergency care [services](/usc/42/201.md?p=a).
    - (D) Day [treatment](/usc/42/11851.md?p=11) or other partial hospitalization [services](/usc/42/201.md?p=a), or psychosocial rehabilitation [services](/usc/42/201.md?p=a).
    - (E) Screening for patients being considered for admission to [State](/usc/42/300gg–91.md?p=d-14) mental health [facilities](/usc/42/11049.md?p=4) to determine the appropriateness of such admission.
  - (2) The mental health [services](/usc/42/201.md?p=a) of the centers are provided, within the limits of the capacities of the centers, to any individual residing or employed in the [service](/usc/42/201.md?p=a) area of the center regardless of ability to pay for such [services](/usc/42/201.md?p=a).
  - (3) The mental health [services](/usc/42/201.md?p=a) of the centers are available and accessible promptly, as appropriate and in a manner which preserves human dignity and assures continuity and high quality care.

# §300x–3. State mental health planning council

- (a) **In general—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x of this title](/usc/42/300x.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will establish and maintain a [State](/usc/42/300gg–91.md?p=d-14) mental health planning [council](#d) in accordance with the conditions described in this section.
- (b) **Duties—** A condition under [subsection (a)](#a) for a [Council](#d) is that the duties of the [Council](#d) are—
  - (1) to review plans provided to the [Council](#d) pursuant to [section 300x–4(a) of this title](/usc/42/300x–4.md?p=a) by the [State](/usc/42/300gg–91.md?p=d-14) involved and to submit to the [State](/usc/42/300gg–91.md?p=d-14) any recommendations of the [Council](#d) for [modifications](/usc/42/7501.md?p=4) to the plans;
  - (2) to serve as an advocate for [adults with a serious mental illness](/usc/42/300x–1.md?p=c-1), [children](/usc/42/256e.md?p=g-2) with a severe emotional disturbance, and other individuals with mental illnesses or emotional problems; and
  - (3) to monitor, review, and evaluate, not less than once each year, the [allocation](/usc/42/2021b.md?p=2) and adequacy of mental health [services](/usc/42/201.md?p=a) within the [State](/usc/42/300gg–91.md?p=d-14).
- (c) **Membership—**
  - (1) **In general—** A condition under [subsection (a)](#a) for a [Council](#d) is that the [Council](#d) be composed of residents of the [State](/usc/42/300gg–91.md?p=d-14), including [representatives](/usc/42/3058f.md?p=5) of—
    - (A) the principal [State agencies](/usc/42/1396r–8.md?p=k-9) with respect to—
      - (i) mental health, education, vocational rehabilitation, criminal justice, [housing](/usc/42/1490p–2.md?p=r-3), and social [services](/usc/42/201.md?p=a); and
      - (ii) the development of the plan submitted pursuant to title XIX of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.];
    - (B) public and [private entities](/usc/42/12181.md?p=6) concerned with the need, planning, operation, funding, and use of mental health [services](/usc/42/201.md?p=a) and related support [services](/usc/42/201.md?p=a);
    - (C) adults with serious mental illnesses who are receiving (or have received) mental health [services](/usc/42/201.md?p=a); and
    - (D) the [families](/usc/42/12704.md?p=11) of such adults or [families](/usc/42/12704.md?p=11) of [children](/usc/42/256e.md?p=g-2) with emotional disturbance.
  - (2) **Certain requirements—** A condition under [subsection (a)](#a) for a [Council](#d) is that—
    - (A) with respect to the membership of the [Council](#d), the ratio of [parents](/usc/42/1396a.md?p=k-3) of [children with a serious emotional disturbance](/usc/42/300x–1.md?p=c-1) to other members of the [Council](#d) is sufficient to provide adequate representation of such [children](/usc/42/256e.md?p=g-2) in the deliberations of the [Council](#d); and
    - (B) not less than 50 percent of the members of the [Council](#d) are individuals who are not [State](/usc/42/300gg–91.md?p=d-14) [employees](/usc/42/300gg–91.md?p=d-5) or providers of mental health [services](/usc/42/201.md?p=a).
- (d) **“Council” defined—** For purposes of this section, the term “Council” means a [State](/usc/42/300gg–91.md?p=d-14) mental health planning council.

# §300x–4. Additional provisions

- (a) **Review of State plan by mental health planning council—** The [Secretary](/usc/42/201.md?p=c) may make a grant under [section 300x of this title](/usc/42/300x.md) to a [State](/usc/42/300gg–91.md?p=d-14) only if—
  - (1) the plan submitted under [section 300x–1(a) of this title](/usc/42/300x–1.md?p=a) with respect to the grant and the report of the [State](/usc/42/300gg–91.md?p=d-14) under [section 300x–52(a) of this title](/usc/42/300x–52.md?p=a) concerning the preceding fiscal year has been reviewed by the [State](/usc/42/300gg–91.md?p=d-14) mental health planning [council](/usc/42/300f.md?p=9) under [section 300x–3 of this title](/usc/42/300x–3.md); and
  - (2) the [State](/usc/42/300gg–91.md?p=d-14) submits to the [Secretary](/usc/42/201.md?p=c) any recommendations received by the [State](/usc/42/300gg–91.md?p=d-14) from such [council](/usc/42/300f.md?p=9) for [modifications](/usc/42/7501.md?p=4) to the plan (without regard to whether the [State](/usc/42/300gg–91.md?p=d-14) has made the recommended [modifications](/usc/42/7501.md?p=4)) and any comments concerning the annual report.
- (b) **Maintenance of effort regarding State expenditures for mental health—**
  - (1) **In general—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x of this title](/usc/42/300x.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will maintain [State](/usc/42/300gg–91.md?p=d-14) expenditures for community mental health [services](/usc/42/201.md?p=a) at a level that is not less than the average level of such expenditures maintained by the [State](/usc/42/300gg–91.md?p=d-14) for the 2-year period preceding the fiscal year for which the [State](/usc/42/300gg–91.md?p=d-14) is applying for the grant.
  - (2) **Exclusion of certain funds—** The [Secretary](/usc/42/201.md?p=c) may exclude from the aggregate [State](/usc/42/300gg–91.md?p=d-14) expenditures under [subsection (a)](#a), [funds](/usc/42/12854.md?p=3) appropriated to the principle agency for [authorized activities](/usc/42/300x–34.md?p=1) which are of a non-recurring nature and for a specific purpose.
  - (3) **Waiver—**
    - (A) **In general—** The [Secretary](/usc/42/201.md?p=c) may, upon the request of a [State](/usc/42/300gg–91.md?p=d-14), waive the requirement established in [paragraph (1)](#b-1) in whole or in part if the [Secretary](/usc/42/201.md?p=c) determines that extraordinary economic conditions in the [State](/usc/42/300gg–91.md?p=d-14) in the fiscal year involved or in the previous fiscal year justify the waiver[^1]
    - (B) **Date certain for action upon request—** The [Secretary](/usc/42/201.md?p=c) 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](/usc/42/201.md?p=c) under this paragraph shall be applicable only to the fiscal year involved.
  - (4) **Noncompliance by State—**
    - (A) **In general—**
      - (i) **Determination—** In making a grant under [section 300x of this title](/usc/42/300x.md) to a [State](/usc/42/300gg–91.md?p=d-14) for a fiscal year, the [Secretary](/usc/42/201.md?p=c) shall make a determination of whether, for the previous fiscal year, the [State](/usc/42/300gg–91.md?p=d-14) maintained material compliance with the [agreement](/usc/42/1320b–8.md?p=a-3-A) made under [paragraph (1)](#b-1). If the [Secretary](/usc/42/201.md?p=c) determines that a [State](/usc/42/300gg–91.md?p=d-14) has failed to maintain such compliance, the [Secretary](/usc/42/201.md?p=c) shall reduce the amount of the allotment under [section 300x of this title](/usc/42/300x.md) for the [State](/usc/42/300gg–91.md?p=d-14) 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.
      - (ii) **Alternative—** A [State](/usc/42/300gg–91.md?p=d-14) that has failed to comply with [paragraph (1)](#b-1) and would otherwise be subject to a reduction in the [State](/usc/42/300gg–91.md?p=d-14)’s allotment under [section 300x of this title](/usc/42/300x.md) may, upon request by the [State](/usc/42/300gg–91.md?p=d-14), in lieu of having the amount of the allotment under [section 300x of this title](/usc/42/300x.md) for the [State](/usc/42/300gg–91.md?p=d-14) reduced for the fiscal year of the grant, agree to comply with a negotiated [agreement](/usc/42/1320b–8.md?p=a-3-A) that is approved by the [Secretary](/usc/42/201.md?p=c) and carried out in accordance with guidelines issued by the [Secretary](/usc/42/201.md?p=c). If a [State](/usc/42/300gg–91.md?p=d-14) fails to enter into or comply with a negotiated [agreement](/usc/42/1320b–8.md?p=a-3-A), the [Secretary](/usc/42/201.md?p=c) may take action under this paragraph or the terms of the negotiated [agreement](/usc/42/1320b–8.md?p=a-3-A).
    - (B) **Submission of information to the secretary—** The [Secretary](/usc/42/201.md?p=c) may make a grant under [section 300x of this title](/usc/42/300x.md) for a fiscal year only if the [State](/usc/42/300gg–91.md?p=d-14) involved submits to the [Secretary](/usc/42/201.md?p=c) information sufficient for the [Secretary](/usc/42/201.md?p=c) to make the determination required in [subparagraph (A)(i)](#b-4-A-i).

# §300x–5. Restrictions on use of payments

- (a) **In general—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x of this title](/usc/42/300x.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will not expend the grant—
  - (1) to provide inpatient [services](/usc/42/201.md?p=a);
  - (2) to make cash payments to intended [recipients](/usc/42/2996a.md?p=6) of health [services](/usc/42/201.md?p=a);
  - (3) to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any [building](/usc/42/6881.md?p=i-3) or other [facility](/usc/42/11049.md?p=4), or purchase major medical equipment;
  - (4) to satisfy any requirement for the expenditure of non-Federal [funds](/usc/42/12854.md?p=3) as a condition for the receipt of Federal [funds](/usc/42/12854.md?p=3); or
  - (5) to provide financial assistance to any entity other than a public or nonprofit [private entity](/usc/42/12181.md?p=6).
- (b) **Limitation on administrative expenses—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x of this title](/usc/42/300x.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will not expend more than 5 percent of the grant for administrative expenses with respect to the grant.

# §300x–6. Application for grant

- (a) **In general—** For purposes of [section 300x of this title](/usc/42/300x.md), an application for a grant under such section for a fiscal year in accordance with this section if, subject to [subsection (b)](#b)—
  - (1) the plan is received by the [Secretary](/usc/42/201.md?p=c) not later than September 1 of the fiscal year prior to the fiscal year for which a [State](/usc/42/300gg–91.md?p=d-14) is seeking [funds](/usc/42/12854.md?p=3), and the report from the previous fiscal year as required under [section 300x–52(a) of this title](/usc/42/300x–52.md?p=a) is received by December 1 of the fiscal year of the grant;
  - (2) the application contains each [funding agreement](/usc/42/290ff–4.md?p=d-3) that is described in this subpart or subpart III for such a grant (other than any such [agreement](/usc/42/1320b–8.md?p=a-3-A) that is not applicable to the [State](/usc/42/300gg–91.md?p=d-14));
  - (3) the [agreements](/usc/42/1320b–8.md?p=a-3-A) are made through certification from the [chief executive officer](/usc/42/12511.md?p=9) of the [State](/usc/42/300gg–91.md?p=d-14);
  - (4) with respect to such [agreements](/usc/42/1320b–8.md?p=a-3-A), the application provides assurances of compliance satisfactory to the [Secretary](/usc/42/201.md?p=c);
  - (5) the application contains the plan required in [section 300x–1(a) of this title](/usc/42/300x–1.md?p=a), the information required in [section 300x–4(b) of this title](/usc/42/300x–4.md?p=b), and the report required in [section 300x–52(a) of this title](/usc/42/300x–52.md?p=a);
  - (6) the application contains recommendations in compliance with [section 300x–4(a) of this title](/usc/42/300x–4.md?p=a), or if no such recommendations are received by the [State](/usc/42/300gg–91.md?p=d-14), the application otherwise demonstrates compliance with such section; and
  - (7) the application (including the plan under [section 300x–1(a) of this title](/usc/42/300x–1.md?p=a)) is otherwise in such form, is made in such manner, and contains such [agreements](/usc/42/1320b–8.md?p=a-3-A), assurances, and information as the [Secretary](/usc/42/201.md?p=c) determines to be necessary to carry out this subpart.
- (b) **Waivers regarding certain territories—** In the case of any territory of the [United States](/usc/42/403.md?p=k) except Puerto Rico, the [Secretary](/usc/42/201.md?p=c) may waive such provisions of this subpart and subpart III as the [Secretary](/usc/42/201.md?p=c) determines to be appropriate, other than the provisions of [section 300x–5 of this title](/usc/42/300x–5.md).

# §300x–7. Determination of amount of allotment

- (a) **States—**
  - (1) **Determination under formula—** Subject to [subsection (b)](#b), the [Secretary](/usc/42/201.md?p=c) shall determine the amount of the allotment required in [section 300x of this title](/usc/42/300x.md) for a [State](#c-5) for a fiscal year in accordance with the following formula:

    |  | A | A | X |  |  |
    | --- | --- | --- | --- | --- | --- |
    | U |  |  |  |  |  |
    |  |  |  |  |  |  |

  - (2) **Determination of term “A”—** For purposes of [paragraph (1)](#a-1), the term “A” means the difference between—
    - (A) the amount appropriated under [section 300x–9(a) of this title](/usc/42/300x–9.md?p=a) for allotments under [section 300x of this title](/usc/42/300x.md) for the fiscal year involved; and
    - (B) an amount equal to 1.5 percent of the amount referred to in [subparagraph (A)](#a-2-A).
  - (3) **Determination of term “U”—** For purposes of [paragraph (1)](#a-1), the term “U” means the sum of the respective terms “X” determined for the [States](#c-5) under [paragraph (4)](#a-4).
  - (4) **Determination of term “X”—** For purposes of [paragraph (1)](#a-1), the term “X” means the product of—
    - (A) an amount equal to the product of—
      - (i) the term “P”, as determined for the [State](#c-5) involved under [paragraph (5)](#a-5); and
      - (ii) the factor determined under [paragraph (8)](#a-8) for the [State](#c-5); and
    - (B) the greater of—
      - (i) 0.4; and
      - (ii) an amount equal to an amount determined for the [State](#c-5) in accordance with the following formula:

        |  | 1−.35 | A | [R%](#a-6-A) |  |  |
        | --- | --- | --- | --- | --- | --- |
        | [P%](#a-7) |  |  |  |  |  |
        |  |  |  |  |  |  |

  - (5) **Determination of term “P”—**
    - (A) For purposes of [paragraph (4)](#a-4), the term “P” means the sum of—
      - (i) an amount equal to the product of 0.107 and the number of individuals in the [State](#c-5) who are between 18 and 24 years of age (inclusive);
      - (ii) an amount equal to the product of 0.166 and the number of individuals in the [State](#c-5) who are between 25 and 44 years of age (inclusive);
      - (iii) an amount equal to the product of 0.099 and the number of individuals in the [State](#c-5) who are between 45 and 64 years of age (inclusive); and
      - (iv) an amount equal to the product of 0.082 and the number of individuals in the [State](#c-5) who are 65 years of age or older.
    - (B) With respect to data on population that is necessary for purposes of making a determination under [subparagraph (A)](#a-5-A), the [Secretary](/usc/42/201.md?p=c) shall use the most recent data that is available from the [Secretary](/usc/42/201.md?p=c) of [Commerce](/usc/42/6311.md?p=7) pursuant to the decennial census and pursuant to reasonable estimates by such [Secretary](/usc/42/201.md?p=c) of changes occurring in the data in the ensuing period.
  - (6) **Determination of term “R%”—**
    - (A) For purposes of [paragraph (4)](#a-4), the term “R%”, except as provided in [subparagraph (D)](#a-6-D), means the percentage constituted by the ratio of the amount determined under [subparagraph (B)](#a-6-B) for the [State](#c-5) involved to the amount determined under [subparagraph (C)](#a-6-C).
    - (B) The amount determined under this subparagraph for the [State](#c-5) involved is the quotient of—
      - (i) the most recent 3-year arithmetic mean of the total taxable resources of the [State](#c-5), as determined by the [Secretary](/usc/42/201.md?p=c) of the Treasury; divided by
      - (ii) the factor determined under [paragraph (8)](#a-8) for the [State](#c-5).
    - (C) The amount determined under this subparagraph is the sum of the respective amounts determined for the [States](#c-5) under [subparagraph (B)](#a-6-B) (including the District of Columbia).
    - (D)
      - (i) In the case of the District of Columbia, for purposes of [paragraph (4)](#a-4), the term “[R%](#a-6-A)” means the percentage constituted by the ratio of the amount determined under [clause (ii)](#a-6-D-ii) for such District to the amount determined under [clause (iii)](#a-6-D-iii).
      - (ii) The amount determined under this clause for the District of Columbia is the quotient of—
        - (I) the most recent 3-year arithmetic mean of total personal [income](/usc/42/292s.md?p=c-4) in such District, as determined by the [Secretary](/usc/42/201.md?p=c) of [Commerce](/usc/42/6311.md?p=7); divided by
        - (II) the factor determined under [paragraph (8)](#a-8) for the District.
      - (iii) The amount determined under this clause is the sum of the respective amounts determined for the [States](#c-5) (including the District of Columbia) by making, for each [State](#c-5), the same determination as is described in [clause (ii)](#a-6-D-ii) for the District of Columbia.
  - (7) **Determination of term “P%”—** For purposes of [paragraph (4)](#a-4), the term “P%” means the percentage constituted by the ratio of the term “P” determined under [paragraph (5)](#a-5) for the [State](#c-5) involved to the sum of the respective terms “P” determined for the [States](#c-5).
  - (8) **Determination of certain factor—**
    - (A) The factor determined under this paragraph for the [State](#c-5) involved is a factor whose purpose is to adjust the amount determined under [clause (i)](#a-4-A-i) of paragraph (4)(A), and the amounts determined under each of subparagraphs [(B)(i)](#a-6-B-i) and [(D)(ii)(I)](#a-6-D-ii-I) of paragraph (6), to reflect the differences that exist between the [State](#c-5) and other [States](#c-5) in the costs of providing comprehensive community mental health [services](/usc/42/201.md?p=a) to [adults with a serious mental illness](/usc/42/300x–1.md?p=c-1) and to [children with a serious emotional disturbance](/usc/42/300x–1.md?p=c-1).
    - (B) Subject to [subparagraph (C)](#a-8-C), the factor determined under this paragraph and in effect for the fiscal year involved shall be determined according to the methodology described in the report entitled “Adjusting the Alcohol, [Drug](/usc/42/282.md?p=j-1-A-vii) Abuse and Mental Health [Services](/usc/42/201.md?p=a) Block Grant [Allocations](/usc/42/2021b.md?p=2) for Poverty Populations and Cost of [Service](/usc/42/201.md?p=a)”, dated March 30, 1990, and prepared by Health Economics Research, a [corporation](/usc/42/2296b–7.md?p=1), pursuant to a contract with the National Institute on [Drug](/usc/42/282.md?p=j-1-A-vii) Abuse.
    - (C) The factor determined under this paragraph for the [State](#c-5) involved may not for any fiscal year be greater than 1.1 or less than 0.9.
    - (D)
      - (i) Not later than October 1, 1992, the [Secretary](/usc/42/201.md?p=c), after consultation with the [Comptroller General](/usc/42/300x–64.md?p=b-1), shall in accordance with this section make a determination for each [State](#c-5) of the factor that is to be in effect for the [State](#c-5) under this paragraph. The factor so determined shall remain in effect through fiscal year 1994, and shall be recalculated every third fiscal year thereafter.
      - (ii) After consultation with the [Comptroller General](/usc/42/300x–64.md?p=b-1), the [Secretary](/usc/42/201.md?p=c) shall, through publication in the Federal Register, periodically make such refinements in the methodology referred to in [subparagraph (B)](#a-8-B) as are consistent with the purpose described in [subparagraph (A)](#a-8-A).
- (b) **Minimum allotments for States—** With respect to fiscal year 2000, and subsequent fiscal years, the amount of the allotment of a [State](/usc/42/300gg–91.md?p=d-14) under [section 300x of this title](/usc/42/300x.md) shall not be less than the amount the [State](/usc/42/300gg–91.md?p=d-14) received under such section for fiscal year 1998.
- (c) **Territories—**
  - (1) **Determination under formula—** Subject to paragraphs [(2)](#c-2) and [(4)](#c-4), the amount of an allotment under [section 300x of this title](/usc/42/300x.md) for a territory of the [United States](/usc/42/403.md?p=k) for a fiscal year shall be the product of—
    - (A) an amount equal to the amounts reserved under [paragraph (3)](#c-3) for the fiscal year; and
    - (B) a percentage equal to the quotient of—
      - (i) the civilian population of the territory, as indicated by the most recently available data; divided by
      - (ii) the aggregate civilian population of the [territories of the United States](/usc/42/300x–64.md?p=b-3), as indicated by such data.
  - (2) **Minimum allotment for territories—** The amount of an allotment under [section 300x of this title](/usc/42/300x.md) for a territory of the [United States](/usc/42/403.md?p=k) for a fiscal year shall be the greater of—
    - (A) the amount determined under [paragraph (1)](#c-1) for the territory for the fiscal year;
    - (B) $50,000; and
    - (C) with respect to fiscal years 1993 and 1994, an amount equal to 20.6 percent of the amount received by the territory from allotments made pursuant to this part for fiscal year 1992.
  - (3) **Reservation of amounts—** The [Secretary](/usc/42/201.md?p=c) shall each fiscal year reserve for the [territories of the United States](/usc/42/300x–64.md?p=b-3) 1.5 percent of the amounts appropriated under [section 300x–9(a) of this title](/usc/42/300x–9.md?p=a) for allotments under [section 300x of this title](/usc/42/300x.md) for the fiscal year.
  - (4) **Availability of data on population—** With respect to data on the civilian population of the [territories of the United States](/usc/42/300x–64.md?p=b-3), if the [Secretary](/usc/42/201.md?p=c) determines for a fiscal year that recent such data for purposes of [paragraph (1)(B)](#c-1-B) do not exist regarding a territory, the [Secretary](/usc/42/201.md?p=c) shall for such purposes estimate the civilian population of the territory by modifying the data on the territory to reflect the average extent of change occurring during the ensuing period in the population of all territories with respect to which recent such data do exist.
  - (5) **Applicability of certain provisions—** For purposes of [subsection (a)](#a), the term “[State](/usc/42/300gg–91.md?p=d-14)” does not include the [territories of the United States](/usc/42/300x–64.md?p=b-3).

# §300x–8. Definitions


For purposes of this subpart:

- (1) The terms “[adults with a serious mental illness](/usc/42/300x–1.md?p=c-1)” and “[children with a serious emotional disturbance](/usc/42/300x–1.md?p=c-1)” have the meanings given such terms under [section 300x–1(c)(1) of this title](/usc/42/300x–1.md?p=c-1).
- (2) The term “[funding agreement](/usc/42/290ff–4.md?p=d-3)”, with respect to a grant under [section 300x of this title](/usc/42/300x.md) to a [State](/usc/42/300gg–91.md?p=d-14), means that the [Secretary](/usc/42/201.md?p=c) may make such a grant only if the [State](/usc/42/300gg–91.md?p=d-14) makes the [agreement](/usc/42/1320b–8.md?p=a-3-A) involved.

# §300x–9. Funding

- (a) **Authorization of appropriations—** For the purpose of carrying out this subpart, and subpart III and [section 290aa–4(c) of this title](/usc/42/290aa–4.md?p=c) with respect to mental health, there are authorized to be appropriated $857,571,000 for each of fiscal years 2023 through 2027.
- (b) **Allocations for technical assistance, data collection, and program evaluation—**
  - (1) **In general—** For the purpose of carrying out [section 300x–58(a) of this title](/usc/42/300x–58.md?p=a) with respect to mental health and the purposes specified in paragraphs [(2)](#b-2) and [(3)](#b-3), the [Secretary](/usc/42/201.md?p=c) shall obligate 5 percent of the amounts appropriated under [subsection (a)](#a) for a fiscal year.
  - (2) **Data collection—** The purpose specified in this paragraph is carrying out sections [290aa–4(c)](/usc/42/290aa–4.md?p=c) and [300y](/usc/42/300y.md) of this title with respect to mental health.
  - (3) **Program evaluation—** The purpose specified in this paragraph is the conduct of evaluations of prevention and [treatment](/usc/42/11851.md?p=11) [programs](/usc/42/274l–1.md?p=4) and [services](/usc/42/201.md?p=a) with respect to mental health to determine methods for improving the availability and quality of such [programs](/usc/42/274l–1.md?p=4) and [services](/usc/42/201.md?p=a).
- (c) **Early serious mental illness—**
  - (1) **In general—** Except as provided in [paragraph (2)](#c-2), a [State](/usc/42/300gg–91.md?p=d-14) shall expend not less than 10 percent of the amount the [State](/usc/42/300gg–91.md?p=d-14) receives for carrying out this section for each fiscal year to support evidence-based [programs](/usc/42/274l–1.md?p=4) that address the needs of individuals with early serious mental illness, including psychotic disorders, regardless of the age of the individual at onset.
  - (2) **State flexibility—** In lieu of expending 10 percent of the amount the [State](/usc/42/300gg–91.md?p=d-14) receives under this section for a fiscal year as required under [paragraph (1)](#c-1), a [State](/usc/42/300gg–91.md?p=d-14) may elect to expend not less than 20 percent of such amount by the end of such succeeding fiscal year.
- (d) **Crisis care—**
  - (1) **In general—** Except as provided in [paragraph (3)](#d-3), a [State](/usc/42/300gg–91.md?p=d-14) shall expend at least 5 percent of the amount the [State](/usc/42/300gg–91.md?p=d-14) receives pursuant to [section 300x of this title](/usc/42/300x.md) for each fiscal year to support evidenced-based [programs](/usc/42/274l–1.md?p=4) that address the crisis care needs of individuals with serious mental illnesses and [children](/usc/42/256e.md?p=g-2) with serious emotional disturbances, which may include individuals (including [children](/usc/42/256e.md?p=g-2) and adolescents) experiencing mental health crises demonstrating serious mental illness or serious emotional disturbance, as applicable.
  - (2) **Core elements—** At the discretion of the [single](/usc/42/2304.md?p=m) [State agency](/usc/42/1396r–8.md?p=k-9) responsible for the administration of the [program](/usc/42/274l–1.md?p=4) of the [State](/usc/42/300gg–91.md?p=d-14) under a grant under [section 300x of this title](/usc/42/300x.md), [funds](/usc/42/12854.md?p=3) expended pursuant to [paragraph (1)](#d-1) may be used to [fund](/usc/42/12854.md?p=3) some or all of the core crisis care [service](/usc/42/201.md?p=a) components, as applicable and appropriate, including the following:
    - (A) Crisis call centers.
    - (B) 24/7 mobile crisis [services](/usc/42/201.md?p=a).
    - (C) Crisis stabilization [programs](/usc/42/274l–1.md?p=4) offering acute care or subacute care in a [hospital](/usc/42/1395dd.md?p=e-5) or appropriately licensed [facility](/usc/42/11049.md?p=4), as determined by such [State](/usc/42/300gg–91.md?p=d-14), with referrals to inpatient or outpatient care.
  - (3) **State flexibility—** In lieu of expending 5 percent of the amount the [State](/usc/42/300gg–91.md?p=d-14) receives pursuant to [section 300x of this title](/usc/42/300x.md) for a fiscal year to support evidence-based [programs](/usc/42/274l–1.md?p=4) as required by [paragraph (1)](#d-1), a [State](/usc/42/300gg–91.md?p=d-14) may elect to expend not less than 10 percent of such amount to support such [programs](/usc/42/274l–1.md?p=4) by the end of two consecutive fiscal years.
  - (4) **Rule of construction—** [Section 300x–1(b)(1)(A)(vi)](/usc/42/300x–1.md?p=b-1-A-vi) shall not be construed as limiting the provision of crisis care [services](/usc/42/201.md?p=a) pursuant to [paragraph (1)](#d-1).

# §300x–21. Formula grants to States

- (a) **In general—** For the purpose described in [subsection (b)](#b), the [Secretary](/usc/42/201.md?p=c), acting through the Center for Substance Abuse [Treatment](/usc/42/11851.md?p=11), shall make an allotment each fiscal year for each [State](/usc/42/300gg–91.md?p=d-14) in an amount determined in accordance with [section 300x–33 of this title](/usc/42/300x–33.md). The [Secretary](/usc/42/201.md?p=c) shall make a grant to the [State](/usc/42/300gg–91.md?p=d-14) of the allotment made for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year if the [State](/usc/42/300gg–91.md?p=d-14) submits to the [Secretary](/usc/42/201.md?p=c) an application in accordance with [section 300x–32 of this title](/usc/42/300x–32.md).
- (b) **Authorized activities—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [subsection (a)](#a) is that, subject to [section 300x–31 of this title](/usc/42/300x–31.md), the [State](/usc/42/300gg–91.md?p=d-14) involved will expend the grant only for the purpose of carrying out the plan developed in accordance with [section 300x–32(b) of this title](/usc/42/300x–32.md?p=b) and for planning, carrying out, and evaluating activities to prevent, treat, and provide recovery support [services](/usc/42/201.md?p=a) for [substance use disorders](/usc/42/300x–34.md?p=4) and for related activities authorized in [section 300x–24 of this title](/usc/42/300x–24.md).

# §300x–22. Certain allocations

- (a) **Allocation regarding primary prevention programs—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that, in expending the grant, the [State](/usc/42/300gg–91.md?p=d-14) involved—
  - (1) will expend not less than 20 percent for [programs](/usc/42/274l–1.md?p=4) for individuals who do not require [treatment](/usc/42/11851.md?p=11) for [substance use disorders](/usc/42/300x–34.md?p=4), which [programs](/usc/42/274l–1.md?p=4)—
    - (A) educate and counsel the individuals on such disorders; and
    - (B) provide for activities to reduce the risk of such disorders by the individuals;
  - (2) will, in carrying out [paragraph (1)](#a-1)—
    - (A) give priority to [programs](/usc/42/274l–1.md?p=4) for populations that are at risk of developing a pattern of such disorders; and
    - (B) ensure that [programs](/usc/42/274l–1.md?p=4) receiving priority under [subparagraph (A)](#a-2-A) develop community-based strategies for the prevention of such disorders, including strategies to discourage the use of alcoholic beverages and tobacco products by individuals to whom it is unlawful to sell or distribute such beverages or products.
- (b) **Allocations regarding women—**
  - (1) **In general—** Subject to [paragraph (2)](#b-2), a [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for a fiscal year is that—
    - (A) in the case of a grant for fiscal year 1993, the [State](/usc/42/300gg–91.md?p=d-14) involved will expend not less than 5 percent of the grant to increase (relative to fiscal year 1992) the availability of [treatment services](/usc/42/300x–34.md?p=7) designed for pregnant women and women with dependent [children](/usc/42/256e.md?p=g-2) (either by establishing new [programs](/usc/42/274l–1.md?p=4) or expanding the capacity of existing [programs](/usc/42/274l–1.md?p=4));
    - (B) in the case of a grant for fiscal year 1994, the [State](/usc/42/300gg–91.md?p=d-14) will expend not less than 5 percent of the grant to so increase (relative to fiscal year 1993) the availability of such [services](/usc/42/201.md?p=a) for such women; and
    - (C) in the case of a grant for any subsequent fiscal year, the [State](/usc/42/300gg–91.md?p=d-14) will expend for such [services](/usc/42/201.md?p=a) for such women not less than an amount equal to the amount expended by the [State](/usc/42/300gg–91.md?p=d-14) for fiscal year 1994.
  - (2) **Waiver—**
    - (A) Upon the request of a [State](/usc/42/300gg–91.md?p=d-14), the [Secretary](/usc/42/201.md?p=c) may provide to the [State](/usc/42/300gg–91.md?p=d-14) a waiver of all or part of the requirement established in [paragraph (1)](#b-1) if the [Secretary](/usc/42/201.md?p=c) determines that the [State](/usc/42/300gg–91.md?p=d-14) is providing an adequate level of [treatments](/usc/42/11851.md?p=11) [services](/usc/42/201.md?p=a) for women described in such paragraph, as indicated by a comparison of the number of such women seeking the [services](/usc/42/201.md?p=a) with the availability in the [State](/usc/42/300gg–91.md?p=d-14) of the [services](/usc/42/201.md?p=a).
    - (B) The [Secretary](/usc/42/201.md?p=c) shall approve or deny a request for a waiver under [subparagraph (A)](#b-2-A) not later than 120 days after the date on which the request is made.
    - (C) Any waiver provided by the [Secretary](/usc/42/201.md?p=c) under [subparagraph (A)](#b-2-A) shall be applicable only to the fiscal year involved.
  - (3) **Childcare and prenatal care—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for a [State](/usc/42/300gg–91.md?p=d-14) is that each entity providing [treatment services](/usc/42/300x–34.md?p=7) with amounts reserved under [paragraph (1)](#b-1) by the [State](/usc/42/300gg–91.md?p=d-14) will, directly or through arrangements with other public or nonprofit [private entities](/usc/42/12181.md?p=6), make available prenatal care to women receiving such [services](/usc/42/201.md?p=a) and, while the women are receiving the [services](/usc/42/201.md?p=a), childcare.

# §300x–23. Intravenous substance use

- (a) **Capacity of treatment programs—**
  - (1) **Notification of reaching capacity—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will, in the case of [programs](/usc/42/274l–1.md?p=4) of [treatment](/usc/42/11851.md?p=11) for intravenous [substance use disorders](/usc/42/300x–34.md?p=4), require that any such [program](/usc/42/274l–1.md?p=4) receiving amounts from the grant, upon reaching 90 percent of its capacity to admit individuals to the [program](/usc/42/274l–1.md?p=4), provide to the [State](/usc/42/300gg–91.md?p=d-14) a notification of such fact.
  - (2) **Provision of treatment—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will, with respect to notifications under [paragraph (1)](#a-1), ensure that each individual who requests and is in need of [treatment](/usc/42/11851.md?p=11) for intravenous [substance use disorders](/usc/42/300x–34.md?p=4) is admitted to a [program](/usc/42/274l–1.md?p=4) of such [treatment](/usc/42/11851.md?p=11) not later than—
    - (A) 14 days after making the request for admission to such a [program](/usc/42/274l–1.md?p=4); or
    - (B) 120 days after the date of such request, if no such [program](/usc/42/274l–1.md?p=4) has the capacity to admit the individual on the date of such request and if [interim services](/usc/42/300x–64.md?p=b-4) are made available to the individual not later than 48 hours after such request.
- (b) **Outreach to persons who inject drugs—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved, in providing amounts from the grant to any entity for [treatment services](/usc/42/300x–34.md?p=7) for [persons](/usc/42/1320a–7k.md?p=d-4-C-i) who inject [drugs](/usc/42/282.md?p=j-1-A-vii), will require the entity to carry out activities to encourage individuals in need of such [treatment](/usc/42/11851.md?p=11) to undergo [treatment](/usc/42/11851.md?p=11).

# §300x–24. Requirements regarding tuberculosis and human immunodeficiency virus

- (a) **Tuberculosis—**
  - (1) **In general—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will require that any entity receiving amounts from the grant for operating a [program](/usc/42/274l–1.md?p=4) of [treatment](/usc/42/11851.md?p=11) for [substance use disorders](/usc/42/300x–34.md?p=4)—
    - (A) will, directly or through arrangements with other public or nonprofit [private entities](/usc/42/12181.md?p=6), routinely make available [tuberculosis services](#a-2) to each individual receiving [treatment](/usc/42/11851.md?p=11) for such disorders; and
    - (B) in the case of an individual in need of such [treatment](/usc/42/11851.md?p=11) who is denied admission to the [program](/usc/42/274l–1.md?p=4) on the basis of the lack of the capacity of the [program](/usc/42/274l–1.md?p=4) to admit the individual, will refer the individual to another provider of [tuberculosis services](#a-2).
  - (2) **Tuberculosis services—** For purposes of [paragraph (1)](#a-1), the term “tuberculosis services”, with respect to an individual, means—
    - (A) counseling the individual with respect to tuberculosis;
    - (B) testing to determine whether the individual has contracted such disease and testing to determine the form of [treatment](/usc/42/11851.md?p=11) for the disease that is appropriate for the individual; and
    - (C) providing such [treatment](/usc/42/11851.md?p=11) to the individual.
- (b) **Human immunodeficiency virus—**
  - (1) **Requirement for certain States—** In the case of a [State](/usc/42/300gg–91.md?p=d-14) described in [paragraph (2)](#b-2), a [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that—
    - (A) with respect to individuals undergoing [treatment](/usc/42/11851.md?p=11) for [substance use disorders](/usc/42/300x–34.md?p=4), the [State](/usc/42/300gg–91.md?p=d-14) will, subject to [paragraph (3)](#b-3), carry out 1 or more [projects](/usc/42/11360.md?p=20) to make available to the individuals [early intervention services](#b-7-B) for [HIV disease](#b-7-C) at the sites at which the individuals are undergoing such [treatment](/usc/42/11851.md?p=11);
    - (B) for the purpose of providing such [early intervention services](#b-7-B) through such [projects](/usc/42/11360.md?p=20), the [State](/usc/42/300gg–91.md?p=d-14) will make available from the grant the percentage that is applicable for the [State](/usc/42/300gg–91.md?p=d-14) under [paragraph (4)](#b-4); and
    - (C) the [State](/usc/42/300gg–91.md?p=d-14) will, subject to [paragraph (5)](#b-5), carry out such [projects](/usc/42/11360.md?p=20) only in [geographic areas](/usc/42/11360.md?p=9) of the [State](/usc/42/300gg–91.md?p=d-14) that have the greatest need for the [projects](/usc/42/11360.md?p=20).
  - (2) **Designated States—** For purposes of this subsection, a [State](/usc/42/300gg–91.md?p=d-14) described in this paragraph is any [State](/usc/42/300gg–91.md?p=d-14) whose rate of cases of acquired immune deficiency syndrome is 10 or more such cases per 100,000 individuals (as indicated by the number of such cases reported to and confirmed by the [Director](/usc/42/5061.md?p=1) of the Centers for Disease Control and Prevention for the most recent calendar year for which such data are available).
  - (3) **Use of existing programs regarding substance use disorders—** With respect to [programs](/usc/42/274l–1.md?p=4) that provide [treatment services](/usc/42/300x–34.md?p=7) for [substance use disorders](/usc/42/300x–34.md?p=4), a [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for a [designated State](#b-7-A) is that each such [program](/usc/42/274l–1.md?p=4) participating in a [project](/usc/42/11360.md?p=20) under [paragraph (1)](#b-1) will be a [program](/usc/42/274l–1.md?p=4) that began operation prior to the fiscal year for which the [State](/usc/42/300gg–91.md?p=d-14) is applying to receive the grant. A [program](/usc/42/274l–1.md?p=4) that so began operation may participate in a [project](/usc/42/11360.md?p=20) under [paragraph (1)](#b-1) without regard to whether the [program](/usc/42/274l–1.md?p=4) has been providing [early intervention services](#b-7-B) for [HIV disease](#b-7-C).
  - (4) **Applicable percentage regarding expenditures for services—**
    - (A)
      - (i) For purposes of [paragraph (1)(B)](#b-1-B), the percentage that is applicable under this paragraph for a [designated State](#b-7-A) is, subject to [subparagraph (B)](#b-4-B), the percentage by which the amount of the grant under [section 300x–21 of this title](/usc/42/300x–21.md) for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year involved is an increase over the amount specified in [clause (ii)](#b-4-A-ii).
      - (ii) The amount specified in this clause is the amount that was reserved by the [designated State](#b-7-A) involved from the allotment of the [State](/usc/42/300gg–91.md?p=d-14) under section 300x–1a[^1] of this title for fiscal year 1991 in compliance with [section 300x–4(c)(6)(A)(ii)](/usc/42/300x–4.md)[^1] of this title (as such sections were in effect for such fiscal year).
    - (B) If the percentage determined under [subparagraph (A)](#b-4-A) for a [designated State](#b-7-A) for a fiscal year is less than 2 percent (including a negative percentage, in the case of a [State](/usc/42/300gg–91.md?p=d-14) for which there is no increase for purposes of such subparagraph), the percentage applicable under this paragraph for the [State](/usc/42/300gg–91.md?p=d-14) is 2 percent. If the percentage so determined is 2 percent or more, the percentage applicable under this paragraph for the [State](/usc/42/300gg–91.md?p=d-14) is the percentage determined under [subparagraph (A)](#b-4-A), subject to not exceeding 5 percent.
  - (5) **Requirement regarding rural areas—**
    - (A) A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for a [designated State](#b-7-A) is that, if the [State](/usc/42/300gg–91.md?p=d-14) will carry out 2 or more [projects](/usc/42/11360.md?p=20) under [paragraph (1)](#b-1), the [State](/usc/42/300gg–91.md?p=d-14) will carry out 1 such [project](/usc/42/11360.md?p=20) in a rural area of the [State](/usc/42/300gg–91.md?p=d-14), subject to [subparagraph (B)](#b-5-B).
    - (B) The [Secretary](/usc/42/201.md?p=c) shall waive the requirement established in [subparagraph (A)](#b-5-A) if the [State](/usc/42/300gg–91.md?p=d-14) involved certifies to the [Secretary](/usc/42/201.md?p=c) that—
      - (i) there is insufficient demand in the [State](/usc/42/300gg–91.md?p=d-14) to carry out a [project](/usc/42/11360.md?p=20) under [paragraph (1)](#b-1) in any rural area of the [State](/usc/42/300gg–91.md?p=d-14); or
      - (ii) there are no rural areas in the [State](/usc/42/300gg–91.md?p=d-14).
  - (6) **Manner of providing services—** With respect to the provision of [early intervention services](#b-7-B) for [HIV disease](#b-7-C) to an individual, a [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for a [designated State](#b-7-A) is that—
    - (A) such [services](/usc/42/201.md?p=a) will be undertaken voluntarily by, and with the informed consent of, the individual; and
    - (B) undergoing such [services](/usc/42/201.md?p=a) will not be required as a condition of receiving [treatment services](/usc/42/300x–34.md?p=7) for [substance use disorders](/usc/42/300x–34.md?p=4) or any other [services](/usc/42/201.md?p=a).
  - (7) **Definitions—** For purposes of this subsection:
    - (A) The term “designated State” means a [State](/usc/42/300gg–91.md?p=d-14) described in [paragraph (2)](#b-2).
    - (B) The term “early intervention services”, with respect to [HIV disease](#b-7-C), means—
      - (i) appropriate pretest counseling;
      - (ii) testing individuals with respect to such disease, including tests to confirm the presence of the disease, tests to diagnose the extent of the deficiency in the immune system, and tests to provide information on appropriate therapeutic measures for preventing and treating the deterioration of the immune system and for preventing and treating conditions arising from the disease;
      - (iii) appropriate post-test counseling; and
      - (iv) providing the therapeutic measures described in [clause (ii)](#b-7-B-ii).
    - (C) The term “HIV disease” means infection with the etiologic agent for acquired immune deficiency syndrome.
- (c) **Expenditure of grant for compliance with agreements—**
  - (1) **In general—** A grant under [section 300x–21 of this title](/usc/42/300x–21.md) may be expended for purposes of compliance with the [agreements](/usc/42/1320b–8.md?p=a-3-A) required in this section, subject to [paragraph (2)](#c-2).
  - (2) **Limitation—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for a [State](/usc/42/300gg–91.md?p=d-14) is that the grant will not be expended to make payment for any [service](/usc/42/201.md?p=a) provided for purposes of compliance with this section to the extent that payment has been made, or can reasonably be expected to be made, with respect to such [service](/usc/42/201.md?p=a)—
    - (A) under any [State](/usc/42/300gg–91.md?p=d-14) compensation [program](/usc/42/274l–1.md?p=4), under any insurance policy, or under any Federal or [State](/usc/42/300gg–91.md?p=d-14) health benefits [program](/usc/42/274l–1.md?p=4) (including the [program](/usc/42/274l–1.md?p=4) established in title XVIII of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq.] and the [program](/usc/42/274l–1.md?p=4) established in title XIX of such Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.]); or
    - (B) by an entity that provides health [services](/usc/42/201.md?p=a) on a prepaid basis.
- (d) **Applicability of certain provision—** [Section 300x–31 of this title](/usc/42/300x–31.md) applies to this section (and to each other provision of this subpart).

# §300x–25. Group homes for persons in recovery from substance use disorders

- (a) **State revolving funds for establishment of homes—** A [State](/usc/42/300gg–91.md?p=d-14), using [funds](/usc/42/12854.md?p=3) available under [section 300x–21 of this title](/usc/42/300x–21.md), may establish and maintain the ongoing operation of a revolving [fund](/usc/42/12854.md?p=3) in accordance with this section to support [group homes](/usc/42/1437a.md?p=c-5) for [persons](/usc/42/1320a–7k.md?p=d-4-C-i) in recovery from [substance use disorders](/usc/42/300x–34.md?p=4) as follows:
  - (1) The purpose of the [fund](/usc/42/12854.md?p=3) is to make loans for the costs of establishing [programs](/usc/42/274l–1.md?p=4) for the provision of [housing](/usc/42/1490p–2.md?p=r-3) in which individuals recovering from alcohol or other [substance use disorders](/usc/42/300x–34.md?p=4) may reside in groups of not less than 6 individuals. The [fund](/usc/42/12854.md?p=3) is established directly by the [State](/usc/42/300gg–91.md?p=d-14) or through the provision of a grant or contract to a nonprofit [private entity](/usc/42/12181.md?p=6).
  - (2) The [programs](/usc/42/274l–1.md?p=4) are carried out in accordance with guidelines issued under [subsection (b)](#b).
  - (3) Not less than $100,000 is available for the [fund](/usc/42/12854.md?p=3).
  - (4) Loans made from the revolving [fund](/usc/42/12854.md?p=3) do not exceed $4,000 and each such loan is repaid to the revolving [fund](/usc/42/12854.md?p=3) by the residents of the [housing](/usc/42/1490p–2.md?p=r-3) involved not later than 2 years after the date on which the loan is made.
  - (5) Each such loan is repaid by such residents through monthly installments, and a reasonable penalty is assessed for each failure to pay such periodic installments by the date specified in the loan [agreement](/usc/42/1320b–8.md?p=a-3-A) involved.
  - (6) Such loans are made only to nonprofit [private entities](/usc/42/12181.md?p=6) agreeing that, in the operation of the [program](/usc/42/274l–1.md?p=4) established pursuant to the loan—
    - (A) the use of alcohol or any illegal [drug](/usc/42/282.md?p=j-1-A-vii) in the [housing](/usc/42/1490p–2.md?p=r-3) provided by the [program](/usc/42/274l–1.md?p=4) will be prohibited;
    - (B) any resident of the [housing](/usc/42/1490p–2.md?p=r-3) who violates such prohibition will be expelled from the [housing](/usc/42/1490p–2.md?p=r-3);
    - (C) the costs of the [housing](/usc/42/1490p–2.md?p=r-3), including fees for rent and utilities, will be paid by the residents of the [housing](/usc/42/1490p–2.md?p=r-3); and
    - (D) the residents of the [housing](/usc/42/1490p–2.md?p=r-3) will, through a majority vote of the residents, otherwise establish policies governing residence in the [housing](/usc/42/1490p–2.md?p=r-3), including the manner in which applications for residence in the [housing](/usc/42/1490p–2.md?p=r-3) are approved.
- (b) **Issuance by Secretary of guidelines—** The [Secretary](/usc/42/201.md?p=c) shall ensure that there are in effect guidelines under this subpart for the operation of [programs](/usc/42/274l–1.md?p=4) described in [subsection (a)](#a).
- (c) **Applicability to territories—** The requirements established in [subsection (a)](#a) shall not apply to any territory of the [United States](/usc/42/403.md?p=k) other than the Commonwealth of Puerto Rico.

# §300x–26. Sale of tobacco products to individuals under age of 21

- (a) **In general—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will—
  - (1) annually conduct random, unannounced [inspections](/usc/42/4851b.md?p=12) to ensure that retailers do not sell tobacco products to individuals under the age of 21; and
  - (2) annually submit to the [Secretary](/usc/42/201.md?p=c) a report describing—
    - (A) the activities carried out by the [State](/usc/42/300gg–91.md?p=d-14) to ensure that retailers do not sell tobacco products to individuals under the age of 21;
    - (B) the extent of success the [State](/usc/42/300gg–91.md?p=d-14) has achieved in ensuring that retailers do not sell tobacco products to individuals under the age of 21; and
    - (C) the strategies to be utilized by the [State](/usc/42/300gg–91.md?p=d-14) to ensure that retailers do not sell tobacco products to individuals under the age of 21 during the fiscal year for which the grant is sought.
- (b) **Noncompliance of State—**
  - (1) **In general—** Before making a grant under [section 300x–21 of this title](/usc/42/300x–21.md) to a [State](/usc/42/300gg–91.md?p=d-14), the [Secretary](/usc/42/201.md?p=c) shall make a determination of whether the [State](/usc/42/300gg–91.md?p=d-14) has maintained compliance with [subsection (a)](#a). If, after notice to the [State](/usc/42/300gg–91.md?p=d-14) and an opportunity for a hearing, the [Secretary](/usc/42/201.md?p=c) determines that the [State](/usc/42/300gg–91.md?p=d-14) is not in compliance with such subsections, the [Secretary](/usc/42/201.md?p=c) shall reduce the amount of the allotment under such section for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year involved by an amount up to 10 percent of the amount determined under [section 300x–33 of this title](/usc/42/300x–33.md) for the [State](/usc/42/300gg–91.md?p=d-14) for the applicable fiscal year.
  - (2) **Limitation—**
    - (A) **In general—** A [State](/usc/42/300gg–91.md?p=d-14) shall not have [funds](/usc/42/12854.md?p=3) withheld pursuant to [paragraph (1)](#b-1) if such [State](/usc/42/300gg–91.md?p=d-14) for which the [Secretary](/usc/42/201.md?p=c) has made a determination of noncompliance under such paragraph—
      - (i) certifies to the [Secretary](/usc/42/201.md?p=c) by May 1 of the fiscal year for which the [funds](/usc/42/12854.md?p=3) are appropriated, consistent with [subparagraph (B)](#b-2-B), that the [State](/usc/42/300gg–91.md?p=d-14) will commit additional [State](/usc/42/300gg–91.md?p=d-14) [funds](/usc/42/12854.md?p=3), in accordance with [paragraph (1)](#b-1), to ensure that retailers do not sell tobacco products to individuals under 21 years of age;
      - (ii) agrees to comply with a negotiated [agreement](/usc/42/1320b–8.md?p=a-3-A) for a corrective action plan that is approved by the [Secretary](/usc/42/201.md?p=c) and carried out in accordance with guidelines issued by the [Secretary](/usc/42/201.md?p=c); or
      - (iii) is a territory that receives less than $1,000,000 for a fiscal year under [section 300x–21 of this title](/usc/42/300x–21.md).
    - (B) **Certification—**
      - (i) **In general—** The amount of [funds](/usc/42/12854.md?p=3) to be committed by a [State](/usc/42/300gg–91.md?p=d-14) pursuant to [subparagraph (A)(i)](#b-2-A-i) shall be equal to 1 percent of such [State](/usc/42/300gg–91.md?p=d-14)’s [allocation](/usc/42/2021b.md?p=2) determined under [section 300x–33 of this title](/usc/42/300x–33.md) for each percentage point by which the [State](/usc/42/300gg–91.md?p=d-14) misses the retailer compliance rate goal established by the [Secretary](/usc/42/201.md?p=c).
      - (ii) **State expenditures—** For a fiscal year in which a [State](/usc/42/300gg–91.md?p=d-14) commits [funds](/usc/42/12854.md?p=3) as described in [clause (i)](#b-2-B-i), such [State](/usc/42/300gg–91.md?p=d-14) shall maintain [State](/usc/42/300gg–91.md?p=d-14) expenditures for tobacco prevention [programs](/usc/42/274l–1.md?p=4) and for compliance activities at a level that is not less than the level of such expenditures maintained by the [State](/usc/42/300gg–91.md?p=d-14) for the preceding fiscal year, plus the additional [funds](/usc/42/12854.md?p=3) for tobacco compliance activities required under [clause (i)](#b-2-B-i). The [State](/usc/42/300gg–91.md?p=d-14) shall submit a report to the [Secretary](/usc/42/201.md?p=c) on all [State](/usc/42/300gg–91.md?p=d-14) obligations of [funds](/usc/42/12854.md?p=3) for such fiscal year and all [State](/usc/42/300gg–91.md?p=d-14) expenditures for the preceding fiscal year for tobacco prevention and compliance activities by [program](/usc/42/274l–1.md?p=4) activity by July 31 of such fiscal year.
      - (iii) **Discretion—** The [Secretary](/usc/42/201.md?p=c) shall exercise discretion in enforcing the timing of the [State](/usc/42/300gg–91.md?p=d-14) obligation of the additional [funds](/usc/42/12854.md?p=3) required by the certification described in [subparagraph (A)(i)](#b-2-A-i) as late as July 31 of such fiscal year.
    - (C) **Failure to certify—** If a [State](/usc/42/300gg–91.md?p=d-14) described in [subparagraph (A)](#b-2-A) fails to certify to the [Secretary](/usc/42/201.md?p=c) pursuant to [subparagraph (A)(i)](#b-2-A-i) or enter into, or comply with, a negotiated [agreement](/usc/42/1320b–8.md?p=a-3-A) under [subparagraph (A)(ii)](#b-2-A-ii), the [Secretary](/usc/42/201.md?p=c) may take action pursuant to [paragraph (1)](#b-1).
- (c) **Implementation of reporting requirements—**
  - (1) **Transition period—** The [Secretary](/usc/42/201.md?p=c) shall—
    - (A) not withhold amounts under [subsection (b)](#b) for the 3-year period immediately following December 20, 2019; and
    - (B) use discretion in exercising its authority under [subsection (b)](#b) during the 2-year period immediately following the 3-year period described in [subparagraph (A)](#c-1-A), to allow for a transition period for implementation of the reporting requirements under [subsection (a)(2)](#a-2).
  - (2) **Regulations or guidance—** Not later than 180 days after December 20, 2019, the [Secretary](/usc/42/201.md?p=c) shall update [regulations](/usc/42/201.md?p=d) under [part 96 of title 45, Code of Federal Regulations](/cfr/45/part96.md)[^1] or guidance on the retailer compliance rate goal under [subsection (b)](#b), the use of [funds](/usc/42/12854.md?p=3) provided under [section 300x–21 of this title](/usc/42/300x–21.md) for purposes of meeting the requirements of this section, and reporting requirements under [subsection (a)(2)](#a-2).
  - (3) **Coordination—** The [Secretary](/usc/42/201.md?p=c) shall ensure the Assistant [Secretary](/usc/42/201.md?p=c) for Mental Health and Substance Use coordinates, as appropriate, with the [Commissioner](/usc/42/12302.md?p=1) of Food and [Drugs](/usc/42/282.md?p=j-1-A-vii) to ensure that the technical assistance provided to [States](/usc/42/300gg–91.md?p=d-14) under [subsection (e)](#e) is consistent with applicable [regulations](/usc/42/201.md?p=d) for retailers issued under [part 1140 of title 21, Code of Federal Regulations](/cfr/21/part1140.md).
- (d) **Transitional grants—**
  - (1) **In general—** The [Secretary](/usc/42/201.md?p=c) shall award grants under this subsection to each [State](/usc/42/300gg–91.md?p=d-14) that receives funding under [section 300x–21 of this title](/usc/42/300x–21.md) to ensure compliance of each such [State](/usc/42/300gg–91.md?p=d-14) with this section.
  - (2) **Use of funds—** A [State](/usc/42/300gg–91.md?p=d-14) receiving a grant under this subsection—
    - (A) shall use amounts received under such grant for activities to plan for or ensure compliance in the [State](/usc/42/300gg–91.md?p=d-14) with [subsection (a)](#a); and
    - (B) in the case of a [State](/usc/42/300gg–91.md?p=d-14) for which the [Secretary](/usc/42/201.md?p=c) has made a determination under [subsection (b)](#b) that the [State](/usc/42/300gg–91.md?p=d-14) is prepared to meet, or has met, the requirements of [subsection (a)](#a), may use such [funds](/usc/42/12854.md?p=3) for tobacco cessation activities, strategies to prevent the use of tobacco products by individuals under the age of 21, or allowable uses under [section 300x–21 of this title](/usc/42/300x–21.md).
  - (3) **Supplement not supplant—** Grants under this subsection shall be used to supplement and not supplant other Federal, [State](/usc/42/300gg–91.md?p=d-14), and local public [funds](/usc/42/12854.md?p=3) provided for activities under [paragraph (2)](#d-2).
  - (4) **Authorization of appropriations—** To carry out this subsection, there are authorized to be appropriated $18,580,790 for each of fiscal years 2020 through 2024.
  - (5) **Sunset—** This subsection shall have no force or effect after September 30, 2024.
- (e) **Technical assistance—** The [Secretary](/usc/42/201.md?p=c) shall provide technical assistance to [States](/usc/42/300gg–91.md?p=d-14) related to the activities required under this section.

# [§300x–26a. Repealed. Pub. L. 116–94, div. N, title I, § 604(c), Dec. 20, 2019, 133 Stat. 3127 — repealed]



# §300x–27. Treatment services for pregnant women

- (a) **In general—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved—
  - (1) will ensure that each pregnant woman in the [State](/usc/42/300gg–91.md?p=d-14) who seeks or is referred for and would benefit from such [services](/usc/42/201.md?p=a) is given preference in admissions to [treatment facilities](/usc/42/300x–34.md?p=6) receiving [funds](/usc/42/12854.md?p=3) pursuant to the grant; and
  - (2) will, in carrying out [paragraph (1)](#a-1), publicize the availability to such women of [services](/usc/42/201.md?p=a) from the [facilities](/usc/42/11049.md?p=4) and the fact that the women receive such preference.
- (b) **Referrals regarding States—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that, in carrying out [subsection (a)(1)](#a-1)—
  - (1) the [State](/usc/42/300gg–91.md?p=d-14) involved will require that, in the event that a [treatment facility](/usc/42/300x–34.md?p=6) has insufficient capacity to provide [treatment services](/usc/42/300x–34.md?p=7) to any woman described in such subsection who seeks the [services](/usc/42/201.md?p=a) from the [facility](/usc/42/11049.md?p=4), the [facility](/usc/42/11049.md?p=4) refer the woman to the [State](/usc/42/300gg–91.md?p=d-14); and
  - (2) the [State](/usc/42/300gg–91.md?p=d-14), in the case of each woman for whom a referral under [paragraph (1)](#b-1) is made to the [State](/usc/42/300gg–91.md?p=d-14)—
    - (A) will refer the woman to a [treatment facility](/usc/42/300x–34.md?p=6) that has the capacity to provide [treatment services](/usc/42/300x–34.md?p=7) to the woman; or
    - (B) will, if no [treatment facility](/usc/42/300x–34.md?p=6) has the capacity to admit the woman, make [interim services](/usc/42/300x–64.md?p=b-4) available to the woman not later than 48 hours after the women[^1] seeks the [treatment services](/usc/42/300x–34.md?p=7).

# §300x–28. Additional agreements

- (a) **Improvement of process for appropriate referrals for treatment—** With respect to individuals seeking [treatment services](/usc/42/300x–34.md?p=7), a [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will improve the process in the [State](/usc/42/300gg–91.md?p=d-14) for referring the individuals to [treatment facilities](/usc/42/300x–34.md?p=6) that can provide to the individuals the [treatment](/usc/42/11851.md?p=11) modality that is most appropriate for the individuals.
- (b) **Professional development—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will ensure that prevention, [treatment](/usc/42/11851.md?p=11), and recovery personnel operating in the [State](/usc/42/300gg–91.md?p=d-14)’s [substance use disorder](/usc/42/300x–34.md?p=4) prevention, [treatment](/usc/42/11851.md?p=11), and recovery systems have an opportunity to receive [training](/usc/42/285e–2.md?p=b-2), on an ongoing basis, concerning—
  - (1) recent trends in [substance use disorders](/usc/42/300x–34.md?p=4) in the [State](/usc/42/300gg–91.md?p=d-14);
  - (2) improved methods and evidence-based [practices](/usc/42/17061.md?p=19) for providing [substance use disorder](/usc/42/300x–34.md?p=4) prevention and [treatment services](/usc/42/300x–34.md?p=7);
  - (3) performance-based accountability;
  - (4) data collection and reporting requirements; and
  - (5) any other matters that would serve to further improve the delivery of [substance use disorder](/usc/42/300x–34.md?p=4) prevention and [treatment services](/usc/42/300x–34.md?p=7) within the [State](/usc/42/300gg–91.md?p=d-14).
- (c) **Coordination of various activities and services—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will coordinate prevention and [treatment activities](/usc/42/300x–34.md?p=5) with the provision of other appropriate [services](/usc/42/201.md?p=a) (including health, social, correctional and criminal justice, educational, vocational rehabilitation, and employment [services](/usc/42/201.md?p=a)).
- (d) **Waiver of requirement—**
  - (1) **In general—** Upon the request of a [State](/usc/42/300gg–91.md?p=d-14), the [Secretary](/usc/42/201.md?p=c) may provide to a [State](/usc/42/300gg–91.md?p=d-14) a waiver of any or all of the requirements established in this section if the [Secretary](/usc/42/201.md?p=c) determines that, with respect to [services](/usc/42/201.md?p=a) for the prevention and [treatment](/usc/42/11851.md?p=11) of [substance use disorders](/usc/42/300x–34.md?p=4), the requirement involved is unnecessary for maintaining quality in the provision of such [services](/usc/42/201.md?p=a) in the [State](/usc/42/300gg–91.md?p=d-14).
  - (2) **Date certain for acting upon request—** The [Secretary](/usc/42/201.md?p=c) shall approve or deny a request for a waiver under [paragraph (1)](#d-1) not later than 120 days after the date on which the request is made.
  - (3) **Applicability of waiver—** Any waiver provided by the [Secretary](/usc/42/201.md?p=c) under [paragraph (1)](#d-1) shall be applicable only to the fiscal year involved.

# [§300x–29. Repealed. Pub. L. 114–255, div. B, title VIII, § 8002(f), Dec. 13, 2016, 130 Stat. 1230 — repealed]



# §300x–30. Maintenance of effort regarding State expenditures

- (a) **In general—** With respect to the principal agency of a [State](/usc/42/300gg–91.md?p=d-14) for carrying out [authorized activities](/usc/42/300x–34.md?p=1), a [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for the [State](/usc/42/300gg–91.md?p=d-14) for a fiscal year is that such agency will for such year maintain aggregate [State](/usc/42/300gg–91.md?p=d-14) expenditures for [authorized activities](/usc/42/300x–34.md?p=1) at a level that is not less than the average level of such expenditures maintained by the [State](/usc/42/300gg–91.md?p=d-14) for the 2-year period preceding the fiscal year for which the [State](/usc/42/300gg–91.md?p=d-14) is applying for the grant.
- (b) **Exclusion of certain funds—** The [Secretary](/usc/42/201.md?p=c) may exclude from the aggregate [State](/usc/42/300gg–91.md?p=d-14) expenditures under [subsection (a)](#a), [funds](/usc/42/12854.md?p=3) appropriated to the principle agency for [authorized activities](/usc/42/300x–34.md?p=1) which are of a non-recurring nature and for a specific purpose.
- (c) **Waiver—**
  - (1) **In general—** Upon the request of a [State](/usc/42/300gg–91.md?p=d-14), the [Secretary](/usc/42/201.md?p=c) may waive all or part of the requirement established in [subsection (a)](#a) if the [Secretary](/usc/42/201.md?p=c) determines that extraordinary economic conditions exist in the [State](/usc/42/300gg–91.md?p=d-14), or any part of the [State](/usc/42/300gg–91.md?p=d-14), to justify the waiver.
  - (2) **Date certain for acting upon request—** The [Secretary](/usc/42/201.md?p=c) shall approve or deny a request for a waiver under [paragraph (1)](#c-1) not later than 120 days after the date on which the request is made.
  - (3) **Applicability of waiver—** Any waiver provided by the [Secretary](/usc/42/201.md?p=c) under [paragraph (1)](#c-1) shall be applicable only to the fiscal year involved.
- (d) **Noncompliance by State—**
  - (1) **In general—** In making a grant under [section 300x–21 of this title](/usc/42/300x–21.md) to a [State](/usc/42/300gg–91.md?p=d-14) for a fiscal year, the [Secretary](/usc/42/201.md?p=c) shall make a determination of whether, for the previous fiscal year, the [State](/usc/42/300gg–91.md?p=d-14) maintained material compliance with any [agreement](/usc/42/1320b–8.md?p=a-3-A) made under [subsection (a)](#a). If the [Secretary](/usc/42/201.md?p=c) determines that a [State](/usc/42/300gg–91.md?p=d-14) has failed to maintain such compliance, the [Secretary](/usc/42/201.md?p=c) shall reduce the amount of the allotment under [section 300x–21 of this title](/usc/42/300x–21.md) for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year for which the grant is being made by an amount equal to the amount constituting such failure for the previous fiscal year.
  - (2) **Submission of information to Secretary—** The [Secretary](/usc/42/201.md?p=c) may make a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for a fiscal year only if the [State](/usc/42/300gg–91.md?p=d-14) involved submits to the [Secretary](/usc/42/201.md?p=c) information sufficient for the [Secretary](/usc/42/201.md?p=c) to make the determination required in [paragraph (1)](#d-1).
  - (3) **Alternative—** A [State](/usc/42/300gg–91.md?p=d-14) that has failed to comply with this section and would otherwise be subject to a reduction in the [State](/usc/42/300gg–91.md?p=d-14)’s allotment under [section 300x–21 of this title](/usc/42/300x–21.md), may, upon request by the [State](/usc/42/300gg–91.md?p=d-14), in lieu of having the [State](/usc/42/300gg–91.md?p=d-14)’s allotment under [section 300x–21 of this title](/usc/42/300x–21.md) reduced, agree to comply with a negotiated [agreement](/usc/42/1320b–8.md?p=a-3-A) that is approved by the [Secretary](/usc/42/201.md?p=c) and carried out in accordance with guidelines issued by the [Secretary](/usc/42/201.md?p=c). If a [State](/usc/42/300gg–91.md?p=d-14) fails to enter into or comply with a negotiated [agreement](/usc/42/1320b–8.md?p=a-3-A), the [Secretary](/usc/42/201.md?p=c) may take action under this paragraph or the terms of the negotiated [agreement](/usc/42/1320b–8.md?p=a-3-A).

# §300x–31. Restrictions on expenditure of grant

- (a) **In general—**
  - (1) **Certain restrictions—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will not expend the grant—
    - (A) to provide inpatient [hospital](/usc/42/1395dd.md?p=e-5) [services](/usc/42/201.md?p=a), except as provided in [subsection (b)](#b);
    - (B) to make cash payments to intended [recipients](/usc/42/2996a.md?p=6) of health [services](/usc/42/201.md?p=a);
    - (C) to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any [building](/usc/42/6881.md?p=i-3) or other [facility](/usc/42/11049.md?p=4), or purchase major medical equipment;
    - (D) to satisfy any requirement for the expenditure of non-Federal [funds](/usc/42/12854.md?p=3) as a condition for the receipt of Federal [funds](/usc/42/12854.md?p=3);
    - (E) to provide financial assistance to any entity other than a public or nonprofit [private entity](/usc/42/12181.md?p=6); or
    - (F) to carry out any [program](/usc/42/274l–1.md?p=4) prohibited by [section 300ee–5 of this title](/usc/42/300ee–5.md).
  - (2) **Limitation on administrative expenses—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that the [State](/usc/42/300gg–91.md?p=d-14) involved will not expend more than 5 percent of the grant to pay the costs of administering the grant.
  - (3) **Limitation regarding penal and correctional institutions—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a [State](/usc/42/300gg–91.md?p=d-14) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is that, in expending the grant for the purpose of providing [treatment services](/usc/42/300x–34.md?p=7) in penal or correctional institutions of the [State](/usc/42/300gg–91.md?p=d-14), the [State](/usc/42/300gg–91.md?p=d-14) will not expend more than an amount equal to the amount expended for such purpose by the [State](/usc/42/300gg–91.md?p=d-14) from the grant made under section 300x–1a[^1] of this title to the [State](/usc/42/300gg–91.md?p=d-14) for fiscal year 1991 (as section 300x–1a[^1] of this title was in effect for such fiscal year).
- (b) **Exception regarding inpatient hospital services—**
  - (1) **Medical necessity as precondition—** With respect to compliance with the [agreement](/usc/42/1320b–8.md?p=a-3-A) made under [subsection (a)](#a), a [State](/usc/42/300gg–91.md?p=d-14) may expend a grant under [section 300x–21 of this title](/usc/42/300x–21.md) to provide inpatient [hospital](/usc/42/1395dd.md?p=e-5) [services](/usc/42/201.md?p=a) as [treatment](/usc/42/11851.md?p=11) for [substance use disorders](/usc/42/300x–34.md?p=4) only if it has been determined, in accordance with guidelines issued by the [Secretary](/usc/42/201.md?p=c), that such [treatment](/usc/42/11851.md?p=11) is a medical necessity for the individual involved, and that the individual cannot be effectively treated in a community-based, nonhospital, residential [program](/usc/42/274l–1.md?p=4) of [treatment](/usc/42/11851.md?p=11).
  - (2) **Rate of payment—** In the case of an individual for whom a grant under [section 300x–21 of this title](/usc/42/300x–21.md) is expended to provide inpatient [hospital](/usc/42/1395dd.md?p=e-5) [services](/usc/42/201.md?p=a) described in [paragraph (1)](#b-1), a [funding agreement](/usc/42/290ff–4.md?p=d-3) for the grant for the [State](/usc/42/300gg–91.md?p=d-14) involved is that the daily rate of payment provided to the [hospital](/usc/42/1395dd.md?p=e-5) for providing the [services](/usc/42/201.md?p=a) to the individual will not exceed the comparable daily rate provided for community-based, nonhospital, residential [programs](/usc/42/274l–1.md?p=4) of [treatment](/usc/42/11851.md?p=11) for [substance use disorders](/usc/42/300x–34.md?p=4).
- (c) **Waiver regarding construction of facilities—**
  - (1) **In general—** The [Secretary](/usc/42/201.md?p=c) may provide to any [State](/usc/42/300gg–91.md?p=d-14) a waiver of the restriction established in [subsection (a)(1)(C)](#a-1-C) for the purpose of authorizing the [State](/usc/42/300gg–91.md?p=d-14) to expend a grant under [section 300x–21 of this title](/usc/42/300x–21.md) for the [construction](/usc/42/7479.md?p=2-C) of a new [facility](/usc/42/11049.md?p=4) or rehabilitation of an existing [facility](/usc/42/11049.md?p=4), but not for land acquisition.
  - (2) **Standard regarding need for waiver—** The [Secretary](/usc/42/201.md?p=c) may approve a waiver under [paragraph (1)](#c-1) only if the [State](/usc/42/300gg–91.md?p=d-14) demonstrates to the [Secretary](/usc/42/201.md?p=c) that adequate [treatment](/usc/42/11851.md?p=11) cannot be provided through the use of existing [facilities](/usc/42/11049.md?p=4) and that alternative [facilities](/usc/42/11049.md?p=4) in existing suitable [buildings](/usc/42/6881.md?p=i-3) are not available.
  - (3) **Amount—** In granting a waiver under [paragraph (1)](#c-1), the [Secretary](/usc/42/201.md?p=c) shall allow the use of a specified amount of [funds](/usc/42/12854.md?p=3) to construct or rehabilitate a specified number of beds for residential [treatment](/usc/42/11851.md?p=11) and a specified number of slots for outpatient [treatment](/usc/42/11851.md?p=11), based on reasonable estimates by the [State](/usc/42/300gg–91.md?p=d-14) of the costs of [construction](/usc/42/7479.md?p=2-C) or rehabilitation. In considering waiver applications, the [Secretary](/usc/42/201.md?p=c) shall ensure that the [State](/usc/42/300gg–91.md?p=d-14) has carefully designed a [program](/usc/42/274l–1.md?p=4) that will minimize the costs of additional beds.
  - (4) **Matching funds—** The [Secretary](/usc/42/201.md?p=c) may grant a waiver under [paragraph (1)](#c-1) only if the [State](/usc/42/300gg–91.md?p=d-14) agrees, with respect to the costs to be incurred by the [State](/usc/42/300gg–91.md?p=d-14) in carrying out the purpose of the waiver, to make available non-Federal contributions in cash toward such costs in an amount equal to not less than $1 for each $1 of Federal [funds](/usc/42/12854.md?p=3) provided under [section 300x–21 of this title](/usc/42/300x–21.md).
  - (5) **Date certain for acting upon request—** The [Secretary](/usc/42/201.md?p=c) shall act upon a request for a waiver under [paragraph (1)](#c-1) not later than 120 days after the date on which the request is made.

# §300x–32. Application for grant; approval of State plan

- (a) **In general—** For purposes of [section 300x–21 of this title](/usc/42/300x–21.md), an application for a grant under such section for a fiscal year is in accordance with this section if, subject to [subsection (c)](#c)—
  - (1) the application is received by the [Secretary](/usc/42/201.md?p=c) not later than October 1 of the fiscal year for which the [State](/usc/42/300gg–91.md?p=d-14) is seeking [funds](/usc/42/12854.md?p=3);
  - (2) the application contains each [funding agreement](/usc/42/290ff–4.md?p=d-3) that is described in this subpart or subpart III for such a grant (other than any such [agreement](/usc/42/1320b–8.md?p=a-3-A) that is not applicable to the [State](/usc/42/300gg–91.md?p=d-14));
  - (3) the [agreements](/usc/42/1320b–8.md?p=a-3-A) are made through certification from the [chief executive officer](/usc/42/12511.md?p=9) of the [State](/usc/42/300gg–91.md?p=d-14);
  - (4) with respect to such [agreements](/usc/42/1320b–8.md?p=a-3-A), the application provides assurances of compliance satisfactory to the [Secretary](/usc/42/201.md?p=c);
  - (5) the application contains the report required in [section 300x–52(a) of this title](/usc/42/300x–52.md?p=a);
  - (6)
    - (A) the application contains a plan in accordance with [subsection (b)](#b) and the plan is approved by the [Secretary](/usc/42/201.md?p=c); and
    - (B) the [State](/usc/42/300gg–91.md?p=d-14) provides assurances satisfactory to the [Secretary](/usc/42/201.md?p=c) that the [State](/usc/42/300gg–91.md?p=d-14) complied with the provisions of the plan under [subparagraph (A)](#a-6-A) that was approved by the [Secretary](/usc/42/201.md?p=c) for the most recent fiscal year for which the [State](/usc/42/300gg–91.md?p=d-14) received a grant under [section 300x–21 of this title](/usc/42/300x–21.md); and
  - (7) the application (including the plan under [paragraph (6)](#a-6)) is otherwise in such form, is made in such manner, and contains such [agreements](/usc/42/1320b–8.md?p=a-3-A), assurances, and information as the [Secretary](/usc/42/201.md?p=c) determines to be necessary to carry out this subpart.
- (b) **State plan—**
  - (1) **In general—** In order for a [State](/usc/42/300gg–91.md?p=d-14) to be in compliance with [subsection (a)(6)](#a-6), the [State](/usc/42/300gg–91.md?p=d-14) shall submit to the [Secretary](/usc/42/201.md?p=c) a plan that, at a minimum, includes the following:
    - (A) A description of the [State](/usc/42/300gg–91.md?p=d-14)’s system of care that—
      - (i) identifies the [single](/usc/42/2304.md?p=m) [State agency](/usc/42/1396r–8.md?p=k-9) responsible for the administration of the [program](/usc/42/274l–1.md?p=4), including any third party who administers [substance use disorder services](/usc/42/290cc–34.md?p=4) and is responsible for complying with the requirements of the grant;
      - (ii) provides information on the need for [substance use disorder](/usc/42/300x–34.md?p=4) prevention and [treatment services](/usc/42/300x–34.md?p=7) in the [State](/usc/42/300gg–91.md?p=d-14), including estimates on the number of individuals who need [treatment](/usc/42/11851.md?p=11), who are pregnant women, women with dependent [children](/usc/42/256e.md?p=g-2), individuals with a co-occurring mental health and [substance use disorder](/usc/42/300x–34.md?p=4), [persons](/usc/42/1320a–7k.md?p=d-4-C-i) who inject [drugs](/usc/42/282.md?p=j-1-A-vii), and [persons](/usc/42/1320a–7k.md?p=d-4-C-i) who are experiencing homelessness;
      - (iii) provides aggregate information on the number of individuals in [treatment](/usc/42/11851.md?p=11) within the [State](/usc/42/300gg–91.md?p=d-14), including the number of such individuals who are pregnant women, women with dependent [children](/usc/42/256e.md?p=g-2), individuals with a co-occurring mental health and [substance use disorder](/usc/42/300x–34.md?p=4), [persons](/usc/42/1320a–7k.md?p=d-4-C-i) who inject [drugs](/usc/42/282.md?p=j-1-A-vii), and [persons](/usc/42/1320a–7k.md?p=d-4-C-i) who are experiencing homelessness;
      - (iv) provides a description of the system that is available to provide [services](/usc/42/201.md?p=a) by modality, including the provision of recovery support [services](/usc/42/201.md?p=a);
      - (v) provides a description of the [State](/usc/42/300gg–91.md?p=d-14)’s comprehensive statewide prevention efforts, including the number of individuals being served in the system, target populations, and priority needs, and provides a description of the amount of [funds](/usc/42/12854.md?p=3) from the prevention set-aside expended on primary prevention;
      - (vi) provides a description of—
        - (I) the [State](/usc/42/300gg–91.md?p=d-14)’s comprehensive statewide recovery support [services](/usc/42/201.md?p=a) activities, including the number of individuals being served, target populations, workforce capacity (consistent with [clause (viii)](#b-1-A-viii)), and priority needs; and
        - (II) the amount of [funds](/usc/42/12854.md?p=3) received under this subpart expended on recovery support [services](/usc/42/201.md?p=a), disaggregated by the amount expended for type of [service](/usc/42/201.md?p=a) activity;
      - (vii) provides a description of the financial resources available;
      - (viii) describes the existing [substance use disorders](/usc/42/300x–34.md?p=4) workforce, including with respect to prevention, [treatment](/usc/42/11851.md?p=11), and recovery, and workforce trained in treating co-occurring substance use and mental disorders;
      - (ix) includes a description of how the [State](/usc/42/300gg–91.md?p=d-14) promotes evidence-based [practices](/usc/42/17061.md?p=19); and
      - (x) describes how the [State](/usc/42/300gg–91.md?p=d-14) integrates [substance use disorder services](/usc/42/290cc–34.md?p=4) and primary health care, which in the case of those individuals with co-occurring mental health and [substance use disorders](/usc/42/300x–34.md?p=4) may include providing both mental health and [substance use disorder services](/usc/42/290cc–34.md?p=4) in primary care settings or providing primary and specialty care [services](/usc/42/201.md?p=a) in community-based mental health and [substance use disorder](/usc/42/300x–34.md?p=4) [service](/usc/42/201.md?p=a) settings.
    - (B) The establishment of 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) A description of how the [State](/usc/42/300gg–91.md?p=d-14) will comply with each [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) that is applicable to the [State](/usc/42/300gg–91.md?p=d-14), including a description of the manner in which the [State](/usc/42/300gg–91.md?p=d-14) intends to expend [grant funds](/usc/42/5106a.md?p=f-1-B).
  - (2) **Modifications—**
    - (A) **Authority of Secretary—** As a condition;[^1] of making a grant under [section 300x–21 of this title](/usc/42/300x–21.md) to a [State](/usc/42/300gg–91.md?p=d-14) for a fiscal year, the [Secretary](/usc/42/201.md?p=c) may require that the [State](/usc/42/300gg–91.md?p=d-14) modify any provision of the plan submitted by the [State](/usc/42/300gg–91.md?p=d-14) under [subsection (a)(6)](#a-6) (including provisions on priorities in carrying out [authorized activities](/usc/42/300x–34.md?p=1)). If the [Secretary](/usc/42/201.md?p=c) approves the plan and makes the grant to the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year, the [Secretary](/usc/42/201.md?p=c) may not during such year require the [State](/usc/42/300gg–91.md?p=d-14) to modify the plan.
    - (B) **State request for modification—** If the [State](/usc/42/300gg–91.md?p=d-14) determines that a [modification](/usc/42/7501.md?p=4) to such plan is necessary, the [State](/usc/42/300gg–91.md?p=d-14) may request the [Secretary](/usc/42/201.md?p=c) to approve the [modification](/usc/42/7501.md?p=4). Any such [modification](/usc/42/7501.md?p=4) shall be in accordance with [paragraph (1)](#b-1) and [section 300x–51 of this title](/usc/42/300x–51.md).
  - (3) **Authority of Center for Substance Abuse Prevention—** With respect to plans submitted by the [States](/usc/42/300gg–91.md?p=d-14) under [subsection (a)(6)](#a-6), including any [modification](/usc/42/7501.md?p=4) under [paragraph (2)](#b-2), the [Secretary](/usc/42/201.md?p=c), acting through the [Director](/usc/42/5061.md?p=1) of the Center for Substance Abuse Prevention, shall review and approve or disapprove the provisions of the plans that relate to [prevention activities](/usc/42/300x–34.md?p=3).
- (c) **Waivers regarding certain territories—** In the case of any territory of the [United States](/usc/42/403.md?p=k) except Puerto Rico, the [Secretary](/usc/42/201.md?p=c) may waive such provisions of this subpart and subpart III as the [Secretary](/usc/42/201.md?p=c) determines to be appropriate, other than the provisions of [section 300x–31 of this title](/usc/42/300x–31.md).
- (d) **Issuance of regulations; precondition to making grants—**
  - (1) **Regulations—** Not later than August 25, 1992, the [Secretary](/usc/42/201.md?p=c), acting as appropriate through the [Director](/usc/42/5061.md?p=1) of the Center for [Treatment](/usc/42/11851.md?p=11) Improvement or the [Director](/usc/42/5061.md?p=1) of the Center for Substance Abuse Prevention, shall by regulation establish [standards](/usc/42/1320d.md?p=7) specifying the circumstances in which the [Secretary](/usc/42/201.md?p=c) will consider an application for a grant under [section 300x–21 of this title](/usc/42/300x–21.md) to be in accordance with this section.
  - (2) **Issuance as precondition to making grants—** The [Secretary](/usc/42/201.md?p=c) may not make payments under any grant under [section 300x–21 of this title](/usc/42/300x–21.md) for fiscal year 1993 on or after January 1, 1993, unless the [Secretary](/usc/42/201.md?p=c) has issued [standards](/usc/42/1320d.md?p=7) under [paragraph (1)](#d-1).
- (e) **Waiver authority for certain requirements—**
  - (1) **In general—** Upon the request of a [State](/usc/42/300gg–91.md?p=d-14), the [Secretary](/usc/42/201.md?p=c) may waive the requirements of all or part of the sections described in [paragraph (2)](#e-2) using objective criteria established by the [Secretary](/usc/42/201.md?p=c) by regulation after consultation with the [States](/usc/42/300gg–91.md?p=d-14) and other interested parties including consumers and providers.
  - (2) **Sections—** The sections described in [paragraph (1)](#e-1) are sections [300x–22(b)](/usc/42/300x–22.md?p=b), [300x–23](/usc/42/300x–23.md), [300x–24](/usc/42/300x–24.md) and [300x–28](/usc/42/300x–28.md) of this title.
  - (3) **Date certain for acting upon request—** The [Secretary](/usc/42/201.md?p=c) shall approve or deny a request for a waiver under [paragraph (1)](#e-1) and inform the [State](/usc/42/300gg–91.md?p=d-14) of that decision not later than 120 days after the date on which the request and all the information needed to support the request are submitted.
  - (4) **Annual reporting requirement—** The [Secretary](/usc/42/201.md?p=c) shall annually report to the general public on the [States](/usc/42/300gg–91.md?p=d-14) that receive a waiver under this subsection.

# §300x–33. Determination of amount of allotment

- (a) **States—**
  - (1) **In general—** Subject to [subsection (b)](#b), the [Secretary](/usc/42/201.md?p=c) shall determine the amount of the allotment required in [section 300x–21 of this title](/usc/42/300x–21.md) for a [State](#c-5) for a fiscal year as follows:
    - (A) The formula established in paragraph (1) of [section 300x–7(a) of this title](/usc/42/300x–7.md?p=a) shall apply to this subsection to the same extent and in the same manner as the formula applies for purposes of [section 300x–7(a) of this title](/usc/42/300x–7.md?p=a), except that, in the application of such formula for purposes of this subsection, the [modifications](/usc/42/7501.md?p=4) described in [subparagraph (B)](#a-1-B) shall apply.
    - (B) For purposes of [subparagraph (A)](#a-1-A), the [modifications](/usc/42/7501.md?p=4) described in this subparagraph are as follows:
      - (i) The amount specified in paragraph (2)(A) of [section 300x–7(a) of this title](/usc/42/300x–7.md?p=a) is deemed to be the amount appropriated under [section 300x–35(a) of this title](/usc/42/300x–35.md?p=a) for allotments under [section 300x–21 of this title](/usc/42/300x–21.md) for the fiscal year involved.
      - (ii) The term “P” is deemed to have the meaning given in paragraph (2) of this subsection. [Section 300x–7(a)(5)(B) of this title](/usc/42/300x–7.md?p=a-5-B) applies to the data used in determining such term for the [States](#c-5).
      - (iii) The factor determined under paragraph (8) of [section 300x–7(a) of this title](/usc/42/300x–7.md?p=a) is deemed to have the purpose of reflecting the differences that exist between the [State](#c-5) involved and other [States](#c-5) in the costs of providing authorized [services](/usc/42/201.md?p=a).
  - (2) **Determination of term “P”—** For purposes of this subsection, the term “P” means the percentage that is the arithmetic mean of the percentage determined under [subparagraph (A)](#a-2-A) and the percentage determined under [subparagraph (B)](#a-2-B), as follows:
    - (A) The percentage constituted by the ratio of—
      - (i) an amount equal to the sum of the total number of individuals who reside in the [State](#c-5) involved and are between 18 and 24 years of age (inclusive) and the number of individuals in the [State](#c-5) who reside in urbanized areas of the [State](#c-5) and are between such years of age; to
      - (ii) an amount equal to the total of the respective sums determined for the [States](#c-5) under [clause (i)](#a-2-A-i).
    - (B) The percentage constituted by the ratio of—
      - (i) the total number of individuals in the [State](#c-5) who are between 25 and 64 years of age (inclusive); to
      - (ii) an amount equal to the sum of the respective amounts determined for the [States](#c-5) under [clause (i)](#a-2-B-i).
- (b) **Minimum allotments for States—**
  - (1) **In general—** With respect to fiscal year 2000, and each subsequent fiscal year, the amount of the allotment of a [State](#c-5) under [section 300x–21 of this title](/usc/42/300x–21.md) shall not be less than the amount the [State](#c-5) received under such section for the previous fiscal year increased by an amount equal to 30.65 percent of the percentage by which the aggregate amount allotted to all [States](#c-5) for such fiscal year exceeds the aggregate amount allotted to all [States](#c-5) for the previous fiscal year.
  - (2) **Limitations—**
    - (A) **In general—** Except as provided in [subparagraph (B)](#b-2-B), a [State](#c-5) shall not receive an allotment under [section 300x–21 of this title](/usc/42/300x–21.md) for a fiscal year in an amount that is less than an amount equal to 0.375 percent of the amount appropriated under [section 300x–35(a) of this title](/usc/42/300x–35.md?p=a) for such fiscal year.
    - (B) **Exception—** In applying [subparagraph (A)](#b-2-A), the [Secretary](/usc/42/201.md?p=c) shall ensure that no [State](#c-5) receives an increase in its allotment under [section 300x–21 of this title](/usc/42/300x–21.md) for a fiscal year (as compared to the amount allotted to the [State](#c-5) in the prior fiscal year) that is in excess of an amount equal to 300 percent of the percentage by which the amount appropriated under [section 300x–35(a) of this title](/usc/42/300x–35.md?p=a) for such fiscal year exceeds the amount appropriated for the prior fiscal year.
  - (3) **Decrease in or equal appropriations—** If the amount appropriated under [section 300x–35(a) of this title](/usc/42/300x–35.md?p=a) for a fiscal year is equal to or less than the amount appropriated under such section for the prior fiscal year, the amount of the [State](#c-5) allotment under [section 300x–21 of this title](/usc/42/300x–21.md) shall be equal to the amount that the [State](#c-5) received under [section 300x–21 of this title](/usc/42/300x–21.md) in the prior fiscal year decreased by the percentage by which the amount appropriated for such fiscal year is less than the amount appropriated or[^1] such section for the prior fiscal year.
- (c) **Territories—**
  - (1) **Determination under formula—** Subject to paragraphs [(2)](#c-2) and [(4)](#c-4), the amount of an allotment under [section 300x–21 of this title](/usc/42/300x–21.md) for a territory of the [United States](/usc/42/403.md?p=k) for a fiscal year shall be the product of—
    - (A) an amount equal to the amounts reserved under [paragraph (3)](#c-3) for the fiscal year; and
    - (B) a percentage equal to the quotient of—
      - (i) the civilian population of the territory, as indicated by the most recently available data; divided by
      - (ii) the aggregate civilian population of the [territories of the United States](/usc/42/300x–64.md?p=b-3), as indicated by such data.
  - (2) **Minimum allotment for territories—** The amount of an allotment under [section 300x–21 of this title](/usc/42/300x–21.md) for a territory of the [United States](/usc/42/403.md?p=k) for a fiscal year shall be the greater of—
    - (A) the amount determined under [paragraph (1)](#c-1) for the territory for the fiscal year;
    - (B) $50,000; and
    - (C) with respect to fiscal years 1993 and 1994, an amount equal to 79.4 percent of the amount received by the territory from allotments made pursuant to this part for fiscal year 1992.
  - (3) **Reservation of amounts—** The [Secretary](/usc/42/201.md?p=c) shall each fiscal year reserve for the [territories of the United States](/usc/42/300x–64.md?p=b-3) 1.5 percent of the amounts appropriated under [section 300x–35(a) of this title](/usc/42/300x–35.md?p=a) for allotments under [section 300x–21 of this title](/usc/42/300x–21.md) for the fiscal year.
  - (4) **Availability of data on population—** With respect to data on the civilian population of the [territories of the United States](/usc/42/300x–64.md?p=b-3), if the [Secretary](/usc/42/201.md?p=c) determines for a fiscal year that recent such data for purposes of [paragraph (1)(B)](#c-1-B) do not exist regarding a territory, the [Secretary](/usc/42/201.md?p=c) shall for such purposes estimate the civilian population of the territory by modifying the data on the territory to reflect the average extent of change occurring during the ensuing period in the population of all territories with respect to which recent such data do exist.
  - (5) **Applicability of certain provisions—** For purposes of subsections [(a)](#a) and [(b)](#b), the term “[State](/usc/42/300gg–91.md?p=d-14)” does not include the [territories of the United States](/usc/42/300x–64.md?p=b-3).
- (d) **Indian Tribes and Tribal organizations—**
  - (1) **In general—** If the [Secretary](/usc/42/201.md?p=c)—
    - (A) receives a request from the governing body of an [Indian Tribe](/usc/42/300f.md?p=14) or [Tribal organization](/usc/42/629a.md?p=a-6) within any [State](/usc/42/300gg–91.md?p=d-14) that [funds](/usc/42/12854.md?p=3) under this subpart be provided directly by the [Secretary](/usc/42/201.md?p=c) to such Tribe or organization; and
    - (B) makes a determination that the members of such Tribe or [Tribal organization](/usc/42/629a.md?p=a-6) would be better served by means of grants made directly by the [Secretary](/usc/42/201.md?p=c) under this subpart;

    the [Secretary](/usc/42/201.md?p=c) shall reserve from the allotment under [section 300x–21 of this title](/usc/42/300x–21.md) for the [State](/usc/42/300gg–91.md?p=d-14) for the fiscal year involved an amount that bears the same ratio to the allotment as the amount provided under this subpart to the Tribe or [Tribal organization](/usc/42/629a.md?p=a-6) for fiscal year 1991 for activities relating to the prevention and [treatment](/usc/42/11851.md?p=11) of the use of substances bore to the amount of the portion of the allotment under this subpart for the [State](/usc/42/300gg–91.md?p=d-14) for such fiscal year that was expended for such activities.

  - (2) **Indian Tribe or Tribal organization as grantee—** The amount reserved by the [Secretary](/usc/42/201.md?p=c) on the basis of a determination under this subsection shall be granted to the [Indian Tribe](/usc/42/300f.md?p=14) or [Tribal organization](/usc/42/629a.md?p=a-6) serving the individuals for whom such a determination has been made.
  - (3) **Application—** In order for an [Indian Tribe](/usc/42/300f.md?p=14) or [Tribal organization](/usc/42/629a.md?p=a-6) to be eligible for a grant for a fiscal year under this paragraph,[^2] it shall submit to the [Secretary](/usc/42/201.md?p=c) a plan for such fiscal year that meets such criteria as the [Secretary](/usc/42/201.md?p=c) may prescribe.
  - (4) **Definitions—** The terms “[Indian Tribe](/usc/42/300f.md?p=14)” and “[Tribal organization](/usc/42/629a.md?p=a-6)” have the meanings given the terms “[Indian tribe](/usc/42/300f.md?p=14)” and “[tribal organization](/usc/42/629a.md?p=a-6)” in subsections [(b)](#b) and [(c)](#c)[^3] of [section 5304 of title 25](/usc/25/5304.md).

# §300x–34. Definitions


For purposes of this subpart:

- (1) The term “authorized activities”, subject to [section 300x–31 of this title](/usc/42/300x–31.md), means the activities described in [section 300x–21(b) of this title](/usc/42/300x–21.md?p=b).
- (2) The term “[funding agreement](/usc/42/290ff–4.md?p=d-3)”, with respect to a grant under [section 300x–21 of this title](/usc/42/300x–21.md) to a [State](/usc/42/300gg–91.md?p=d-14), means that the [Secretary](/usc/42/201.md?p=c) may make such a grant only if the [State](/usc/42/300gg–91.md?p=d-14) makes the [agreement](/usc/42/1320b–8.md?p=a-3-A) involved.
- (3) The term “prevention activities”, subject to [section 300x–31 of this title](/usc/42/300x–31.md), means activities to prevent [substance use disorders](#4).
- (4) The term “substance use disorder” means the recurrent use of alcohol or other [drugs](/usc/42/282.md?p=j-1-A-vii) that [causes](/usc/42/9908.md?p=c-2) clinically significant impairment.
- (5) The term “treatment activities” means [treatment services](#7) and, subject to [section 300x–31 of this title](/usc/42/300x–31.md), [authorized activities](#1) that are related to [treatment services](#7).
- (6) The term “treatment facility” means an entity that provides [treatment services](#7).
- (7) The term “treatment services”, subject to [section 300x–31 of this title](/usc/42/300x–31.md), means [treatment](/usc/42/11851.md?p=11) for [substance use disorders](#4).

# §300x–35. Funding

- (a) **Authorization of appropriations—** For the purpose of carrying out this subpart, subpart III and [section 290aa–4(d) of this title](/usc/42/290aa–4.md?p=d) with respect to [substance use disorders](/usc/42/300x–34.md?p=4), and [section 290bb–21(d) of this title](/usc/42/290bb–21.md?p=d), there are authorized to be appropriated $1,908,079,000 for each of fiscal years 2023 through 2027.
- (b) **Allocations for technical assistance, national data base, data collection, and program evaluations—**
  - (1) **In general—**
    - (A) For the purpose of carrying out [section 300x–58(a) of this title](/usc/42/300x–58.md?p=a) with respect to [substance use disorders](/usc/42/300x–34.md?p=4), [section 290bb–21(d) of this title](/usc/42/290bb–21.md?p=d), and the purposes specified in subparagraphs [(B)](#b-1-B) and [(C)](#b-1-C), the [Secretary](/usc/42/201.md?p=c) shall obligate 5 percent of the amounts appropriated under [subsection (a)](#a) each fiscal year.
    - (B) The purpose specified in this subparagraph is carrying out sections [290aa–4(d)](/usc/42/290aa–4.md?p=d) and [300y](/usc/42/300y.md) of this title with respect to [substance use disorders](/usc/42/300x–34.md?p=4).
    - (C) The purpose specified in this subparagraph is the conduct of evaluations of [authorized activities](/usc/42/300x–34.md?p=1) to determine methods for improving the availability and quality of such activities.
  - (2) **Activities of Center for Substance Abuse Prevention—** Of the amounts reserved under [paragraph (1)](#b-1) for a fiscal year, the [Secretary](/usc/42/201.md?p=c), acting through the [Director](/usc/42/5061.md?p=1) of the Center for Substance Abuse Prevention, shall obligate 20 percent for carrying out [paragraph (1)(C)](#b-1-C), [section 300x–58(a) of this title](/usc/42/300x–58.md?p=a) with respect to [prevention activities](/usc/42/300x–34.md?p=3), and [section 290bb–21(d) of this title](/usc/42/290bb–21.md?p=d).
  - (3) **Core data set—** A [State](/usc/42/300gg–91.md?p=d-14) that receives a new grant, contract, or cooperative [agreement](/usc/42/1320b–8.md?p=a-3-A) from amounts available to the [Secretary](/usc/42/201.md?p=c) under [paragraph (1)](#b-1), for the purposes of improving the data collection, analysis and reporting capabilities of the [State](/usc/42/300gg–91.md?p=d-14), shall be required, as a condition of receipt of [funds](/usc/42/12854.md?p=3), to collect, analyze, and report to the [Secretary](/usc/42/201.md?p=c) for each fiscal year subsequent to receiving such [funds](/usc/42/12854.md?p=3) a core data set to be determined by the [Secretary](/usc/42/201.md?p=c) in conjunction with the [States](/usc/42/300gg–91.md?p=d-14).

# §300x–51. Opportunity for public comment on State plans


A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title is that the [State](/usc/42/300gg–91.md?p=d-14) involved will make the plan required in [section 300x–1 of this title](/usc/42/300x–1.md), and the plan required in [section 300x–32 of this title](/usc/42/300x–32.md), respectively, public within the [State](/usc/42/300gg–91.md?p=d-14) in such manner as to facilitate comment from any [person](/usc/42/1320a–7k.md?p=d-4-C-i) (including any Federal or other [public agency](/usc/42/11851.md?p=8)) during the development of the plan (including any revisions) and after the submission of the plan to the [Secretary](/usc/42/201.md?p=c).


# §300x–52. Requirement of reports and audits by States

- (a) **Report—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title is that the [State](/usc/42/300gg–91.md?p=d-14) involved will submit to the [Secretary](/usc/42/201.md?p=c) a report in such form and containing such information as the [Secretary](/usc/42/201.md?p=c) determines (after consultation with the [States](/usc/42/300gg–91.md?p=d-14)) to be necessary for securing a record and a description of—
  - (1) the purposes for which the grant received by the [State](/usc/42/300gg–91.md?p=d-14) for the preceding fiscal year under the [program involved](/usc/42/300x–64.md?p=a-1) were expended and a description of the activities of the [State](/usc/42/300gg–91.md?p=d-14) under the [program](/usc/42/274l–1.md?p=4);
  - (2) the [recipients](/usc/42/2996a.md?p=6) of amounts provided in the grant; and
  - (3) the amount provided to each [recipient](/usc/42/2996a.md?p=6) in the previous fiscal year.
- (b) **Audits—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title is that the [State](/usc/42/300gg–91.md?p=d-14) will, with respect to the grant, comply with [chapter 75](/usc/31/chstV-ch75.md) of title 31.
- (c) **Availability to public—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title is that the [State](/usc/42/300gg–91.md?p=d-14) involved will—
  - (1) make copies of the reports and audits described in this section available for public [inspection](/usc/42/4851b.md?p=12) within the [State](/usc/42/300gg–91.md?p=d-14); and
  - (2) provide copies of the report under [subsection (a)](#a), upon request, to any interested [person](/usc/42/1320a–7k.md?p=d-4-C-i) (including any [public agency](/usc/42/11851.md?p=8)).

# §300x–53. Additional requirements

- (a) **In general—** A [funding agreement](/usc/42/290ff–4.md?p=d-3) for a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title is that the [State](/usc/42/300gg–91.md?p=d-14) involved will—
  - (1)
    - (A) for the fiscal year for which the grant involved is provided, provide for independent peer review to assess the quality, appropriateness, and efficacy of [treatment services](/usc/42/300x–34.md?p=7) provided in the [State](/usc/42/300gg–91.md?p=d-14) to individuals under the [program involved](/usc/42/300x–64.md?p=a-1); and
    - (B) ensure that, in the conduct of such peer review, not fewer than 5 percent of the entities providing [services](/usc/42/201.md?p=a) in the [State](/usc/42/300gg–91.md?p=d-14) under such [program](/usc/42/274l–1.md?p=4) are reviewed (which 5 percent is [representative](/usc/42/3058f.md?p=5) of the total population of such entities);
  - (2) permit and cooperate with Federal investigations undertaken in accordance with [section 300x–55 of this title](/usc/42/300x–55.md); and
  - (3) provide to the [Secretary](/usc/42/201.md?p=c) any data required by the [Secretary](/usc/42/201.md?p=c) pursuant to subsections (c) and (d) of [section 290aa–4 of this title](/usc/42/290aa–4.md) and will cooperate with the [Secretary](/usc/42/201.md?p=c) in the development of uniform criteria for the collection of data pursuant to such section.
- (b) **Patient records—** The [Secretary](/usc/42/201.md?p=c) may make a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title only if the [State](/usc/42/300gg–91.md?p=d-14) involved has in effect a system to protect from inappropriate disclosure patient records maintained by the [State](/usc/42/300gg–91.md?p=d-14) in connection with an activity funded under the [program involved](/usc/42/300x–64.md?p=a-1) or by any entity which is receiving amounts from the grant.

# §300x–54. Disposition of certain funds appropriated for allotments

- (a) **In general—** Amounts described in [subsection (b)](#b) and available for a fiscal year pursuant to section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title, as the case may be, shall be allotted by the [Secretary](/usc/42/201.md?p=c) and paid to the [States](/usc/42/300gg–91.md?p=d-14) receiving a grant under the [program involved](/usc/42/300x–64.md?p=a-1), other than any [State](/usc/42/300gg–91.md?p=d-14) referred to in [subsection (b)](#b) with respect to such [program](/usc/42/274l–1.md?p=4). Such amounts shall be allotted in a manner equivalent to the manner in which the allotment under the [program involved](/usc/42/300x–64.md?p=a-1) was determined.
- (b) **Specification of amounts—** The amounts referred to in [subsection (a)](#a) are any amounts that—
  - (1) are not paid to [States](/usc/42/300gg–91.md?p=d-14) under the [program involved](/usc/42/300x–64.md?p=a-1) as a result of—
    - (A) the failure of any [State](/usc/42/300gg–91.md?p=d-14) to submit an application in accordance with the [program](/usc/42/274l–1.md?p=4);
    - (B) the failure of any [State](/usc/42/300gg–91.md?p=d-14) to prepare such application in compliance with the [program](/usc/42/274l–1.md?p=4); or
    - (C) any [State](/usc/42/300gg–91.md?p=d-14) informing the [Secretary](/usc/42/201.md?p=c) that the [State](/usc/42/300gg–91.md?p=d-14) does not intend to expend the full amount of the allotment made to the [State](/usc/42/300gg–91.md?p=d-14) under the [program](/usc/42/274l–1.md?p=4);
  - (2) are terminated, repaid, or offset under [section 300x–55 of this title](/usc/42/300x–55.md);
  - (3) in the case of the [program](/usc/42/274l–1.md?p=4) established in [section 300x of this title](/usc/42/300x.md), are available as a result of reductions in allotments under such section pursuant to section [300x–1(d)](/usc/42/300x–1.md?p=d) or [300x–4(b)](/usc/42/300x–4.md?p=b) of this title; or
  - (4) in the case of the [program](/usc/42/274l–1.md?p=4) established in [section 300x–21 of this title](/usc/42/300x–21.md), are available as a result of reductions in allotments under such section pursuant to section [300x–26](/usc/42/300x–26.md) or [300x–30](/usc/42/300x–30.md) of this title.

# §300x–55. Failure to comply with agreements

- (a) **Suspension or termination of payments—** Subject to [subsection (e)](#e), if the [Secretary](/usc/42/201.md?p=c) determines that a [State](/usc/42/300gg–91.md?p=d-14) has materially failed to comply with the [agreements](/usc/42/1320b–8.md?p=a-3-A) or other conditions required for the receipt of a grant under the [program involved](/usc/42/300x–64.md?p=a-1), the [Secretary](/usc/42/201.md?p=c) may in whole or in part suspend payments under the grant, terminate the grant for [cause](/usc/42/9908.md?p=c-2), or employ such other remedies (including the remedies provided for in subsections [(b)](#b) and [(c)](#c)) as may be legally available and appropriate in the circumstances involved.
- (b) **Repayment of payments—**
  - (1) **In general—** Subject to [subsection (e)](#e), the [Secretary](/usc/42/201.md?p=c) may require a [State](/usc/42/300gg–91.md?p=d-14) to repay with interest any payments received by the [State](/usc/42/300gg–91.md?p=d-14) under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title that the [Secretary](/usc/42/201.md?p=c) determines were not expended by the [State](/usc/42/300gg–91.md?p=d-14) in accordance with the [agreements](/usc/42/1320b–8.md?p=a-3-A) required under the [program involved](/usc/42/300x–64.md?p=a-1).
  - (2) **Offset against payments—** If a [State](/usc/42/300gg–91.md?p=d-14) fails to make a repayment required in [paragraph (1)](#b-1), the [Secretary](/usc/42/201.md?p=c) may offset the amount of the repayment against the amount of any payment due to be paid to the [State](/usc/42/300gg–91.md?p=d-14) under the [program involved](/usc/42/300x–64.md?p=a-1).
- (c) **Withholding of payments—**
  - (1) **In general—** Subject to subsections [(e)](#e) and [(g)(3)](#g-3), the [Secretary](/usc/42/201.md?p=c) may withhold payments due under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title if the [Secretary](/usc/42/201.md?p=c) determines that the [State](/usc/42/300gg–91.md?p=d-14) involved is not expending amounts received under the [program involved](/usc/42/300x–64.md?p=a-1) in accordance with the [agreements](/usc/42/1320b–8.md?p=a-3-A) required under the [program](/usc/42/274l–1.md?p=4).
  - (2) **Termination of withholding—** The [Secretary](/usc/42/201.md?p=c) shall cease withholding payments from a [State](/usc/42/300gg–91.md?p=d-14) under [paragraph (1)](#c-1) if the [Secretary](/usc/42/201.md?p=c) determines that there are reasonable assurances that the [State](/usc/42/300gg–91.md?p=d-14) will expend amounts received under the [program involved](/usc/42/300x–64.md?p=a-1) in accordance with the [agreements](/usc/42/1320b–8.md?p=a-3-A) required under the [program](/usc/42/274l–1.md?p=4).
- (d) **Applicability of remedies to certain violations—**
  - (1) **In general—** With respect to [agreements](/usc/42/1320b–8.md?p=a-3-A) or other conditions for receiving a grant under the [program involved](/usc/42/300x–64.md?p=a-1), in the case of the failure of a [State](/usc/42/300gg–91.md?p=d-14) to maintain material compliance with a condition referred to in [paragraph (2)](#d-2), the provisions for noncompliance with the condition that are provided in the section establishing the condition shall apply in lieu of [subsections (a) through (c)](#a..c) of this section.
  - (2) **Relevant conditions—** For purposes of [paragraph (1)](#d-1):
    - (A) In the case of the [program](/usc/42/274l–1.md?p=4) established in [section 300x of this title](/usc/42/300x.md), a condition referred to in this paragraph is the condition established in [section 300x–1(d) of this title](/usc/42/300x–1.md?p=d) and the condition established in [section 300x–4(b) of this title](/usc/42/300x–4.md?p=b).
    - (B) In the case of the [program](/usc/42/274l–1.md?p=4) established in [section 300x–21 of this title](/usc/42/300x–21.md), a condition referred to in this paragraph is the condition established in [section 300x–26 of this title](/usc/42/300x–26.md) and the condition established in [section 300x–30 of this title](/usc/42/300x–30.md).
- (e) **Opportunity for hearing—** Before taking action against a [State](/usc/42/300gg–91.md?p=d-14) under any of [subsections (a) through (c)](#a..c) (or under a section referred to in [subsection (d)(2)](#d-2), as the case may be), the [Secretary](/usc/42/201.md?p=c) shall provide to the [State](/usc/42/300gg–91.md?p=d-14) involved adequate notice and an opportunity for a hearing.
- (f) **Requirement of hearing in certain circumstances—**
  - (1) **In general—** If the [Secretary](/usc/42/201.md?p=c) receives a complaint that a [State](/usc/42/300gg–91.md?p=d-14) has failed to maintain material compliance with the [agreements](/usc/42/1320b–8.md?p=a-3-A) or other conditions required for receiving a grant under the [program involved](/usc/42/300x–64.md?p=a-1) (including any condition referred to for purposes of [subsection (d)](#d)), and there appears to be reasonable evidence to support the complaint, the [Secretary](/usc/42/201.md?p=c) shall promptly conduct a hearing with respect to the complaint.
  - (2) **Finding of material noncompliance—** If in a hearing under [paragraph (1)](#f-1) the [Secretary](/usc/42/201.md?p=c) finds that the [State](/usc/42/300gg–91.md?p=d-14) involved has failed to maintain material compliance with the [agreement](/usc/42/1320b–8.md?p=a-3-A) or other condition involved, the [Secretary](/usc/42/201.md?p=c) shall take such action under this section as may be appropriate to ensure that material compliance is so maintained, or such action as may be required in a section referred to in [subsection (d)(2)](#d-2), as the case may be.
- (g) **Certain investigations—**
  - (1) **Requirement regarding Secretary—** The [Secretary](/usc/42/201.md?p=c) shall in fiscal year 1994 and each subsequent fiscal year conduct in not less than 10 [States](/usc/42/300gg–91.md?p=d-14) investigations of the expenditure of grants received by the [States](/usc/42/300gg–91.md?p=d-14) under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title in order to evaluate compliance with the [agreements](/usc/42/1320b–8.md?p=a-3-A) required under the [program involved](/usc/42/300x–64.md?p=a-1).
  - (2) **Provision of records, etc., upon request—** Each [State](/usc/42/300gg–91.md?p=d-14) receiving a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title, and each entity receiving [funds](/usc/42/12854.md?p=3) from the grant, shall make appropriate books, documents, papers, and records available to the [Secretary](/usc/42/201.md?p=c) or the [Comptroller General](/usc/42/300x–64.md?p=b-1), or any of their duly authorized [representatives](/usc/42/3058f.md?p=5), for examination, copying, or mechanical reproduction on or off the premises of the appropriate entity upon a reasonable request therefor.
  - (3) **Limitations on authority—** The [Secretary](/usc/42/201.md?p=c) may not institute proceedings under [subsection (c)](#c) unless the [Secretary](/usc/42/201.md?p=c) has conducted an investigation concerning whether the [State](/usc/42/300gg–91.md?p=d-14) has expended payments under the [program involved](/usc/42/300x–64.md?p=a-1) in accordance with the [agreements](/usc/42/1320b–8.md?p=a-3-A) required under the [program](/usc/42/274l–1.md?p=4). Any such investigation shall be conducted within the [State](/usc/42/300gg–91.md?p=d-14) by qualified investigators.

# §300x–56. Prohibitions regarding receipt of funds

- (a) **Establishment—**
  - (1) **Certain false statements and representations—** A [person](/usc/42/1320a–7k.md?p=d-4-C-i) shall not knowingly and willfully make or [cause](/usc/42/9908.md?p=c-2) to be made any false statement or representation of a material fact in connection with the furnishing of items or [services](/usc/42/201.md?p=a) for which payments may be made by a [State](/usc/42/300gg–91.md?p=d-14) from a grant made to the [State](/usc/42/300gg–91.md?p=d-14) under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title.
  - (2) **Concealing or failing to disclose certain events—** A [person](/usc/42/1320a–7k.md?p=d-4-C-i) with knowledge of the occurrence of any event affecting the initial or continued right of the [person](/usc/42/1320a–7k.md?p=d-4-C-i) to receive any payments from a grant made to a [State](/usc/42/300gg–91.md?p=d-14) under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title shall not conceal or fail to disclose any such event with an intent fraudulently to secure such payment either in a greater amount than is due or when no such amount is due.
- (b) **Criminal penalty for violation of prohibition—** Any [person](/usc/42/1320a–7k.md?p=d-4-C-i) who violates any prohibition established in [subsection (a)](#a) shall for each [violation](/usc/42/2000e–16a.md?p=c) be fined in accordance with [title 18](/usc/18.md) or imprisoned for not more than 5 years, or both.

# §300x–57. Nondiscrimination

- (a) **In general—**
  - (1) **Rule of construction regarding certain civil rights laws—** For the purpose of applying the prohibitions against discrimination on the basis of age under the Age Discrimination Act of 1975 [[42 U.S.C. 6101](/usc/42/6101.md) et seq.], on the basis of handicap under section 504 of the Rehabilitation Act of 1973 [[29 U.S.C. 794](/usc/29/794.md)], on the basis of sex under title IX of the Education Amendments of 1972 [[20 U.S.C. 1681](/usc/20/1681.md) et seq.], or on the basis of race, color, or national origin under title VI of the Civil Rights Act of 1964 [[42 U.S.C. 2000d](/usc/42/2000d.md) et seq.], [programs](/usc/42/274l–1.md?p=4) and activities funded in whole or in part with [funds](/usc/42/12854.md?p=3) made available under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title shall be considered to be [programs](/usc/42/274l–1.md?p=4) and activities receiving Federal financial assistance.
  - (2) **Prohibition—** No [person](/usc/42/1320a–7k.md?p=d-4-C-i) shall on the ground of sex (including, in the case of a woman, on the ground that the woman is pregnant), or on the ground of religion, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any [program or activity](/usc/42/2000cc–5.md?p=6) funded in whole or in part with [funds](/usc/42/12854.md?p=3) made available under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title.
- (b) **Enforcement—**
  - (1) **Referrals to Attorney General after notice—** Whenever the [Secretary](/usc/42/201.md?p=c) finds that a [State](/usc/42/300gg–91.md?p=d-14), or an entity that has received a payment pursuant to section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title, has failed to comply with a provision of law referred to in [subsection (a)(1)](#a-1), with [subsection (a)(2)](#a-2), or with an applicable regulation (including one prescribed to carry out [subsection (a)(2)](#a-2)), the [Secretary](/usc/42/201.md?p=c) shall notify the [chief executive officer](/usc/42/12511.md?p=9) of the [State](/usc/42/300gg–91.md?p=d-14) and shall request the [chief executive officer](/usc/42/12511.md?p=9) to secure compliance. If within a reasonable period of time, not to exceed 60 days, the [chief executive officer](/usc/42/12511.md?p=9) fails or refuses to secure compliance, the [Secretary](/usc/42/201.md?p=c) may—
    - (A) refer the matter to the [Attorney General](/usc/42/14902.md?p=6) with a recommendation that an appropriate civil action be instituted;
    - (B) exercise the powers and functions provided by the Age Discrimination Act of 1975 [[42 U.S.C. 6101](/usc/42/6101.md) et seq.], section 504 of the Rehabilitation Act of 1973 [[29 U.S.C. 794](/usc/29/794.md)], title IX of the Education Amendments of 1972 [[20 U.S.C. 1681](/usc/20/1681.md) et seq.], or title VI of the Civil Rights Act of 1964 [[42 U.S.C. 2000d](/usc/42/2000d.md) et seq.], as may be applicable; or
    - (C) take such other actions as may be authorized by law.
  - (2) **Authority of Attorney General—** When a matter is referred to the [Attorney General](/usc/42/14902.md?p=6) pursuant to [paragraph (1)(A)](#b-1-A), or whenever the [Attorney General](/usc/42/14902.md?p=6) has reason to believe that a [State](/usc/42/300gg–91.md?p=d-14) or an entity is engaged in a pattern or practice in [violation](/usc/42/2000e–16a.md?p=c) of a provision of law referred to in [subsection (a)(1)](#a-1) or in [violation](/usc/42/2000e–16a.md?p=c) of [subsection (a)(2)](#a-2), the [Attorney General](/usc/42/14902.md?p=6) may bring a civil action in any appropriate district court of the [United States](/usc/42/403.md?p=k) for such relief as may be appropriate, including injunctive relief.

# §300x–58. Technical assistance and provision of supplies and services in lieu of grant funds

- (a) **Technical assistance—** The [Secretary](/usc/42/201.md?p=c) shall, without charge to a [State](/usc/42/300gg–91.md?p=d-14) receiving a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title, provide to the [State](/usc/42/300gg–91.md?p=d-14) (or to any public or nonprofit [private entity](/usc/42/12181.md?p=6) within the [State](/usc/42/300gg–91.md?p=d-14)) technical assistance with respect to the planning, development, and operation of any [program](/usc/42/274l–1.md?p=4) or [service](/usc/42/201.md?p=a) carried out pursuant to the [program involved](/usc/42/300x–64.md?p=a-1). The [Secretary](/usc/42/201.md?p=c) may provide such technical assistance directly, through contract, or through grants.
- (b) **Provision of supplies and services in lieu of grant funds—**
  - (1) **In general—** Upon the request of a [State](/usc/42/300gg–91.md?p=d-14) receiving a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title, the [Secretary](/usc/42/201.md?p=c) may, subject to [paragraph (2)](#b-2), provide supplies, equipment, and [services](/usc/42/201.md?p=a) for the purpose of aiding the [State](/usc/42/300gg–91.md?p=d-14) in carrying out the [program involved](/usc/42/300x–64.md?p=a-1) and, for such purpose, may detail to the [State](/usc/42/300gg–91.md?p=d-14) any officer or [employee](/usc/42/300gg–91.md?p=d-5) of the Department of Health and Human [Services](/usc/42/201.md?p=a).
  - (2) **Corresponding reduction in payments—** With respect to a request described in [paragraph (1)](#b-1), the [Secretary](/usc/42/201.md?p=c) shall reduce the amount of payments under the [program involved](/usc/42/300x–64.md?p=a-1) to the [State](/usc/42/300gg–91.md?p=d-14) by an amount equal to the costs of detailing personnel and the fair market value of any supplies, equipment, or [services](/usc/42/201.md?p=a) provided by the [Secretary](/usc/42/201.md?p=c). The [Secretary](/usc/42/201.md?p=c) shall, for the payment of expenses incurred in complying with such request, expend the amounts withheld.

# §300x–59. Plans for performance partnerships

- (a) **Development—** The [Secretary](/usc/42/201.md?p=c) in conjunction with [States](/usc/42/300gg–91.md?p=d-14) and other interested groups shall develop separate plans for the [programs](/usc/42/274l–1.md?p=4) authorized under subparts I and II for creating more flexibility for [States](/usc/42/300gg–91.md?p=d-14) and accountability based on outcome and other performance measures. The plans shall each include—
  - (1) a description of the flexibility that would be given to the [States](/usc/42/300gg–91.md?p=d-14) under the plan;
  - (2) the common set of performance measures that would be used for accountability, including measures that would be used for the [program](/usc/42/274l–1.md?p=4) under subpart II for pregnant [addicts](/usc/42/201.md?p=k), HIV transmission, tuberculosis, and those with a co-occurring substance use disorders and mental disorders, and for [programs](/usc/42/274l–1.md?p=4) under subpart I for [children](/usc/42/256e.md?p=g-2) with serious emotional disturbance and adults with serious mental illness and for individuals with co-occurring mental health and substance use disorders disorders;[^1]
  - (3) the definitions for the data elements to be used under the plan;
  - (4) the obstacles to implementation of the plan and the manner in which such obstacles would be resolved;
  - (5) the resources needed to implement the performance partnerships under the plan; and
  - (6) an implementation strategy complete with recommendations for any necessary legislation.
- (b) **Submission—** Not later than 2 years after October 17, 2000, the plans developed under [subsection (a)](#a) shall be submitted to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on [Commerce](/usc/42/6311.md?p=7) of the House of [Representatives](/usc/42/3058f.md?p=5).
- (c) **Information—** As the elements of the plans described in [subsection (a)](#a) are developed, [States](/usc/42/300gg–91.md?p=d-14) are encouraged to provide information to the [Secretary](/usc/42/201.md?p=c) on a voluntary basis.
- (d) **Participants—** The [Secretary](/usc/42/201.md?p=c) shall include among those interested groups that participate in the development of the plan consumers of mental health or substance use disorders [services](/usc/42/201.md?p=a), providers, [representatives](/usc/42/3058f.md?p=5) of political divisions of [States](/usc/42/300gg–91.md?p=d-14), and [representatives](/usc/42/3058f.md?p=5) of racial and ethnic groups including [Native Americans](/usc/42/254c–20.md?p=a-5).

# §300x–60. Rule of construction regarding delegation of authority to States


With respect to [States](/usc/42/300gg–91.md?p=d-14) receiving grants under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title, this part may not be construed to authorize the [Secretary](/usc/42/201.md?p=c) to delegate to the [States](/usc/42/300gg–91.md?p=d-14) the primary responsibility for interpreting the governing provisions of this part.


# §300x–61. Solicitation of views of certain entities


In carrying out this part, the [Secretary](/usc/42/201.md?p=c), as appropriate, shall solicit the views of the [States](/usc/42/300gg–91.md?p=d-14) and other appropriate entities.


# §300x–62. Availability to States of grant payments


Any amounts paid to a [State](/usc/42/300gg–91.md?p=d-14) for a fiscal year under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title shall be available for obligation and expenditure until the end of the fiscal year following the fiscal year for which the amounts were paid.


# §300x–63. Continuation of certain programs

- (a) **In general—** Of the amount allotted to the [State](/usc/42/300gg–91.md?p=d-14) of Hawaii under [section 300x of this title](/usc/42/300x.md), and the amount allotted to such [State](/usc/42/300gg–91.md?p=d-14) under [section 300x–21 of this title](/usc/42/300x–21.md), an amount equal to the proportion of Native Hawaiians residing in the [State](/usc/42/300gg–91.md?p=d-14) to the total population of the [State](/usc/42/300gg–91.md?p=d-14) shall be available, respectively, for carrying out the [program involved](/usc/42/300x–64.md?p=a-1) for Native Hawaiians.
- (b) **Expenditure of amounts—** The amount made available under [subsection (a)](#a) may be expended only through contracts entered into by the [State](/usc/42/300gg–91.md?p=d-14) of Hawaii with public and private nonprofit organizations to enable such organizations to plan, conduct, and administer comprehensive substance use disorder and [treatment](/usc/42/11851.md?p=11) [programs](/usc/42/274l–1.md?p=4) for the benefit of Native Hawaiians. In entering into contracts under this section, the [State](/usc/42/300gg–91.md?p=d-14) of Hawaii shall give preference to [Native Hawaiian organizations](/usc/42/280g–4c.md?p=a-6) and Native Hawaiian health centers.
- (c) **Definitions—** For the purposes of this subsection,[^1] the terms “Native Hawaiian”, “Native Hawaiian organization”, and “Native Hawaiian health center” have the meaning given such terms in [section 11707 of this title](/usc/42/11707.md).

# §300x–64. Definitions

- (a) **Definitions for this subpart—** For purposes of this subpart:
  - (1) The term “program involved” means the [program](/usc/42/274l–1.md?p=4) of grants established in section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title, or both, as indicated by whether the [State](/usc/42/300gg–91.md?p=d-14) involved is receiving or is applying to receive a grant under section [300x](/usc/42/300x.md) or [300x–21](/usc/42/300x–21.md) of this title, or both.
  - (2)
    - (A) The term “[funding agreement](/usc/42/290ff–4.md?p=d-3)”, with respect to a grant under [section 300x of this title](/usc/42/300x.md), has the meaning given such term in [section 300x–8 of this title](/usc/42/300x–8.md).
    - (B) The term “[funding agreement](/usc/42/290ff–4.md?p=d-3)”, with respect to a grant under [section 300x–21 of this title](/usc/42/300x–21.md), has the meaning given such term in [section 300x–34 of this title](/usc/42/300x–34.md).
- (b) **Definitions for this part—** For purposes of this part:
  - (1) The term “Comptroller General” means the Comptroller General of the [United States](/usc/42/403.md?p=k).
  - (2) The term “[State](/usc/42/300gg–91.md?p=d-14)”, except as provided in [sections 300x–7(c)(5)](/usc/42/300x–7.md?p=c-5) of this title and [300x–33(c)(5)](/usc/42/300x–33.md?p=c-5) of this title, means each of the several [States](/usc/42/300gg–91.md?p=d-14), the District of Columbia, and each of the [territories of the United States](#b-3).
  - (3) The term “territories of the United States” means each of the Commonwealth of Puerto Rico, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Palau, the Marshall Islands, and Micronesia.
  - (4) The term “interim services”, in the case of an individual in need of [treatment](/usc/42/11851.md?p=11) for substance use disorders who has been denied admission to a [program](/usc/42/274l–1.md?p=4) of such [treatment](/usc/42/11851.md?p=11) on the basis of the lack of the capacity of the [program](/usc/42/274l–1.md?p=4) to admit the individual, means [services](/usc/42/201.md?p=a) for reducing the adverse health effects of such disorders, for promoting the health of the individual, and for reducing the risk of transmission of disease, which [services](/usc/42/201.md?p=a) are provided until the individual is admitted to such a [program](/usc/42/274l–1.md?p=4).

# §300x–65. Services provided by nongovernmental organizations

- (a) **Purposes—** The purposes of this section are—
  - (1) to prohibit discrimination against nongovernmental organizations and certain individuals on the basis of religion in the distribution of government [funds](/usc/42/12854.md?p=3) to provide [substance abuse services](/usc/42/290cc–34.md?p=4) under this subchapter and subchapter III–A, and the receipt of [services](/usc/42/201.md?p=a) under such subchapters; and
  - (2) to allow the organizations to accept the [funds](/usc/42/12854.md?p=3) to provide the [services](/usc/42/201.md?p=a) to the individuals without impairing the religious character of the organizations or the religious freedom of the individuals.
- (b) **Religious organizations included as nongovernmental providers—**
  - (1) **In general—** A [State](/usc/42/300gg–91.md?p=d-14) may administer and provide [substance abuse services](/usc/42/290cc–34.md?p=4) under any [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A through grants, contracts, or cooperative [agreements](/usc/42/1320b–8.md?p=a-3-A) to provide assistance to [beneficiaries](/usc/42/300gg–91.md?p=d-2) under such subchapters with nongovernmental organizations.
  - (2) **Requirement—** A [State](/usc/42/300gg–91.md?p=d-14) that elects to utilize nongovernmental organizations as provided for under [paragraph (1)](#b-1) shall consider, on the same basis as other nongovernmental organizations, religious organizations to provide [services](/usc/42/201.md?p=a) under substance abuse [programs](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A, so long as the [programs](/usc/42/274l–1.md?p=4) under such subchapters are implemented in a manner consistent with the Establishment Clause of the first amendment to the Constitution. Neither the Federal Government nor a [State](/usc/42/300gg–91.md?p=d-14) or [local government](/usc/42/8401a.md) receiving [funds](/usc/42/12854.md?p=3) under such [programs](/usc/42/274l–1.md?p=4) shall discriminate against an organization that provides [services](/usc/42/201.md?p=a) under, or applies to provide [services](/usc/42/201.md?p=a) under, such [programs](/usc/42/274l–1.md?p=4), on the basis that the organization has a religious character.
- (c) **Religious character and independence—**
  - (1) **In general—** A religious organization that provides [services](/usc/42/201.md?p=a) under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A shall retain its [independence](/usc/42/242q–4.md?p=1-B) from Federal, [State](/usc/42/300gg–91.md?p=d-14), and [local governments](/usc/42/8401a.md), including such organization’s control over the definition, development, practice, and expression of its religious beliefs.
  - (2) **Additional safeguards—** Neither the Federal Government nor a [State](/usc/42/300gg–91.md?p=d-14) or [local government](/usc/42/8401a.md) shall require a religious organization—
    - (A) to alter its form of internal governance; or
    - (B) to [remove](/usc/42/9601.md?p=23) religious art, icons, scripture, or other symbols,

    in order to be eligible to provide [services](/usc/42/201.md?p=a) under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A.

- (d) **Employment practices—**
  - (1) **Substance abuse—** A religious organization that provides [services](/usc/42/201.md?p=a) under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A may require that its [employees](/usc/42/300gg–91.md?p=d-5) providing [services](/usc/42/201.md?p=a) under such [program](/usc/42/274l–1.md?p=4) adhere to rules forbidding the use of [drugs](/usc/42/282.md?p=j-1-A-vii) or alcohol.
  - (2) **Title VII exemption—** The exemption of a religious organization provided under section 702 or 703(e)(2) of the Civil Rights Act of 1964 ([42 U.S.C. 2000e–1](/usc/42/2000e–1.md), 2000e–2(e)(2)) regarding employment [practices](/usc/42/17061.md?p=19) shall not be affected by the religious organization’s provision of [services](/usc/42/201.md?p=a) under, or receipt of [funds](/usc/42/12854.md?p=3) from, any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A.
- (e) **Rights of beneficiaries of assistance—**
  - (1) **In general—** If an individual described in [paragraph (3)](#e-3) has an objection to the religious character of the organization from which the individual receives, or would receive, [services](/usc/42/201.md?p=a) funded under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A, the appropriate Federal, [State](/usc/42/300gg–91.md?p=d-14), or local governmental entity shall provide to such individual (if otherwise eligible for such [services](/usc/42/201.md?p=a)) within a reasonable period of time after the date of such objection, [services](/usc/42/201.md?p=a) that—
    - (A) are from an alternative provider that is accessible to the individual; and
    - (B) have a value that is not less than the value of the [services](/usc/42/201.md?p=a) that the individual would have received from such organization.
  - (2) **Notice—** The appropriate Federal, [State](/usc/42/300gg–91.md?p=d-14), or local governmental entity shall ensure that notice is provided to individuals described in [paragraph (3)](#e-3) of the rights of such individuals under this section.
  - (3) **Individual described—** An individual described in this paragraph is an individual who receives or applies for [services](/usc/42/201.md?p=a) under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A.
- (f) **Nondiscrimination against beneficiaries—** A religious organization providing [services](/usc/42/201.md?p=a) through a grant, contract, or cooperative [agreement](/usc/42/1320b–8.md?p=a-3-A) under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A shall not discriminate, in carrying out such [program](/usc/42/274l–1.md?p=4), against an individual described in [subsection (e)(3)](#e-3) on the basis of religion, a religious belief, a refusal to hold a religious belief, or a refusal to actively participate in a religious practice.
- (g) **Fiscal accountability—**
  - (1) **In general—** Except as provided in [paragraph (2)](#g-2), any religious organization providing [services](/usc/42/201.md?p=a) under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A shall be subject to the same [regulations](/usc/42/201.md?p=d) as other nongovernmental organizations to account in accord with generally accepted accounting principles for the use of such [funds](/usc/42/12854.md?p=3) provided under such [program](/usc/42/274l–1.md?p=4).
  - (2) **Limited audit—** Such organization shall segregate government [funds](/usc/42/12854.md?p=3) provided under such substance abuse [program](/usc/42/274l–1.md?p=4) into a separate account. Only the government [funds](/usc/42/12854.md?p=3) shall be subject to audit by the government.
- (h) **Compliance—** Any party that seeks to enforce such party’s rights under this section may assert a civil action for injunctive relief exclusively in an appropriate Federal or [State](/usc/42/300gg–91.md?p=d-14) court against the entity, agency or official that allegedly commits such [violation](/usc/42/2000e–16a.md?p=c).
- (i) **Limitations on use of funds for certain purposes—** No [funds](/usc/42/12854.md?p=3) provided through a grant or contract to a religious organization to provide [services](/usc/42/201.md?p=a) under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A shall be expended for sectarian worship, instruction, or proselytization.
- (j) **Effect on State and local funds—** If a [State](/usc/42/300gg–91.md?p=d-14) or [local government](/usc/42/8401a.md) contributes [State](/usc/42/300gg–91.md?p=d-14) or local [funds](/usc/42/12854.md?p=3) to carry out any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A, the [State](/usc/42/300gg–91.md?p=d-14) or [local government](/usc/42/8401a.md) may segregate the [State](/usc/42/300gg–91.md?p=d-14) or local [funds](/usc/42/12854.md?p=3) from the Federal [funds](/usc/42/12854.md?p=3) provided to carry out the [program](/usc/42/274l–1.md?p=4) or may commingle the [State](/usc/42/300gg–91.md?p=d-14) or local [funds](/usc/42/12854.md?p=3) with the Federal [funds](/usc/42/12854.md?p=3). If the [State](/usc/42/300gg–91.md?p=d-14) or [local government](/usc/42/8401a.md) commingles the [State](/usc/42/300gg–91.md?p=d-14) or local [funds](/usc/42/12854.md?p=3), the provisions of this section shall apply to the commingled [funds](/usc/42/12854.md?p=3) in the same manner, and to the same extent, as the provisions apply to the Federal [funds](/usc/42/12854.md?p=3).
- (k) **Treatment of intermediate contractors—** If a nongovernmental organization (referred to in this subsection as an “intermediate organization”), acting under a contract or other [agreement](/usc/42/1320b–8.md?p=a-3-A) with the Federal Government or a [State](/usc/42/300gg–91.md?p=d-14) or [local government](/usc/42/8401a.md), is given the authority under the contract or [agreement](/usc/42/1320b–8.md?p=a-3-A) to select nongovernmental organizations to provide [services](/usc/42/201.md?p=a) under any substance abuse [program](/usc/42/274l–1.md?p=4) under this subchapter or subchapter III–A, the intermediate organization shall have the same duties under this section as the government but shall retain all other rights of a nongovernmental organization under this section.

# §300x–66. Services for individuals with co-occurring disorders


[States](/usc/42/300gg–91.md?p=d-14) may use [funds](/usc/42/12854.md?p=3) available for [treatment](/usc/42/11851.md?p=11) under sections [300x](/usc/42/300x.md) and [300x–21](/usc/42/300x–21.md) of this title to treat [persons](/usc/42/1320a–7k.md?p=d-4-C-i) with co-occurring substance use disorders and mental disorders as long as [funds](/usc/42/12854.md?p=3) available under such sections are used for the purposes for which they were authorized by law and can be tracked for accounting purposes.