Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments Act of 1988

(Reported to House from the Committee on Energy and Commerce with amendment, H. Rept. 100-927)

Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments Act of 1988 - Amends title XIX (Block Grants) of the Public Health Service Act to revise and reorganize provisions relating to mental health and substance abuse programs, replacing the current part B (Alcohol and Drug Abuse and Mental Health Services Block Grant) and part C (Primary Care Block Grants) with a new part B (Acquired Immune Deficiency Syndrome and Intravenous Drug Abuse), part C (Alcohol and Drug Abuse Prevention, Treatment, and Rehabilitation Services), part D (Community Mental Health Services), and part E (General Provisions).

Directs the Secretary, in the new part B, for each of the FY 1989 through 1991, to make an allotment for each State for prevention of the transmission of the etiologic agent for acquired immune deficiency syndrome (AIDS) by eradicating intravenous drug abuse. Requires non-Federal matching funds in FY 1990 and subsequent years; prohibits the Secretary from requiring them in FY 1989. Allows funds to be used for drug abuse treatment, training counselors, outreach, testing for infection with the etiologic agent, and renovation or construction of drug abuse treatment facilities. Sets forth program requirements, including a requirement that public bathhouses being used for sexual relations and for intravenous substance abuse be closed. Sets forth application procedures and requirements, and a formula for determination of the amount of allotments. Directs the Secretary, directly or through contracts, to provide for evaluations of programs, collection of data regarding AIDS and intravenous drug abuse, and dissemination of information on the evaluations and data. Authorizes appropriations for FY 1989 through 1991.

Declares that all individuals receiving counseling under this part are to be counseled about the harmful effects of promiscuous sexual activity and intravenous substance abuse, and the benefits of abstaining from such activities.

Prohibits funds appropriated to carry out this part from being used to provide counseling that promotes or encourages, directly, homosexual or unsafe heterosexual sexual activity or intravenous substance abuse. Declares that this prohibition does not prohibit a counselor who has counseled an individual about the harmful effects of promiscuous sexual activity and intravenous substance abuse from providing that individual the most current scientific knowledge available, provided that any informational materials used are not obscene.

Directs, in the new part C, the Secretary, acting through the Administrator of the Alcohol, Drug Abuse, and Mental Health Administration, to make allotments and payments each fiscal year to States for establishing and carrying out programs of prevention, treatment, and rehabilitation with respect to substance abuse and related activities.

Specifies application procedures and requirements, including a requirement that a State must agree to use not less than specified portions of the payments for programs and activities related to: (1) alcoholism and alcohol abuse; (2) drug abuse; (3) prevention and early intervention regarding the abuse of alcohol and drugs; and (4) such programs and services designed for women.

Sets forth a formula for determining the amount of allotments, including special provisions for direct payment to an Indian tribe or tribal organization. Provides transition rules for territories for FY 1989 and 1990.

Directs the Secretary, acting through the Director of the National Institute on Alcohol Abuse and Alcoholism and the Director of the National Institute on Drug Abuse, to develop and evaluate alcohol and drug abuse treatment programs. Authorizes the use of grants, contracts, and cooperative agreements for such programs.

Authorizes appropriations for FY 1989 through 1991 for: (1) alcohol and drug abuse programs; (2) general provisions under part E; and (3) data collection, as provided in this Act, regarding substance abuse.

Directs, in the new part D, the Secretary of Health and Human Services, acting through the Administrator of the Alcohol, Drug Abuse, and Mental Health Administration, to make allotments and payments each fiscal year to each State for planning, developing, and providing community mental health services and related support services.

Sets forth allotment requirements, including a requirement that a State, in order to receive payments, agrees to establish and maintain a State mental health planning council with specified duties. Specifies application procedures and requirements.

Sets forth a formula for determining the amount of allotments, including special provisions for direct payment to an Indian tribe or tribal organization. Provides transition rules for States for FY 1989 and 1990. Specifies application procedures and requirements.

Directs the Secretary, acting through the Director of the National Institute of Mental Health, to develop and evaluate community mental health programs and services. Authorizes the use of grants, contracts, and cooperative agreements for such programs. Authorizes the Director of the National Institute of Mental Health to establish research centers to carry out the evaluations. Directs the Secretary, acting through the Director of the National Institute of Mental Health, to develop and make available a model plan for a community-based system for the care of chronically mentally ill individuals.

Authorizes appropriations for FY 1989 through 1991 for: (1) mental health programs and services; (2) general provisions under part E; and (3) data collection, as provided in this Act, regarding mental health and substance abuse.

Sets forth, in the new part E, general provisions, including: (1) a requirement that, in order for the Secretary to make payments under specified provisions of this Act, a State must submit a description of the purposes for which the State intends to expend such payments; (2) the content such statement must have for specified provisions of this Act; (3) a requirement of public notice and opportunity for comment; (4) restrictions on the use of payments, including restrictions on the portion used for administrative expenses; (5) agreements a State must make in order for the Secretary to make payments; (6) annual reports a State is required, for payments under specified provisions, to prepare and submit to the Secretary; (7) availability of the reports to the public; (8) evaluations, by the Comptroller General of the United States, of expenditures by States under specified provisions; (9) repayment of payments for failure to comply with agreements; (10) a prohibition against certain false statements; and (11) a prohibition of discrimination.

Directs the Secretary to provide technical assistance to a State receiving payments under specified provisions of this Act, or entities designated by the State, without charge. Authorizes the Secretary to provide supplies and services in lieu of grant funds. Requires the Secretary, no later than October 1, 1989, to report to the Congress on the activities of the States carried out under specified provisions of this Act.

Amends the Public Health Service Act to create a new title on counseling and testing with respect to acquired immune deficiency syndrome (AIDS), starting with a part on grant procedures for counseling and testing.

Prohibits the Secretary of Health and Human Services from providing financial assistance unless the applicant agrees to ensure, in accordance with Federal law and with State and local law not superseded by Federal law, the confidentiality of information and records with respect to individuals counseled or tested.

Requires a written, signed statement of informed consent by the individual to be tested, with special provisions relating to testing through the use of a pseudonym and anonymous testing.

Requires recipients of Federal financial assistance to provide counseling which includes coverage of specified points before testing, after a negative test result, and after a positive test result. Requires recipients to provide, where appropriate, opportunities for women, children, and hemophiliacs to undergo counseling under conditions appropriate to their needs. Allows grantees to use the grant to provide counseling without testing.

Prohibits the Secretary from providing Federal financial assistance to a State unless the State requires that: (1) any entity carrying out testing confidentially report to the State public health officer information sufficient to perform statistical and epidemiological analyses of the incidence and demographic characteristics of cases of infection; and (2) the State public health officer, to the extent appropriate in the determination of the officer, carry out a program of contact tracing.

Prohibits the Secretary from providing Federal financial assistance to a State unless the State requires testing of each individual who is convicted of prostitution, a crime relating to sexual assault, or a crime relating to intravenous drug abuse. Requires the State to notify the individual before the test is performed. Requires, on request of a victim of a crime relating to sexual assault, that the victim be notified of the results of the testing. Allows the Secretary to provide Federal financial assistance to a State for each of the FY 1989 and 1990 if the State provides assurances that it will establish the requirements not later than October 1, 1990.

Requires State recipients of financial assistance to establish a civil cause of action and a criminal penalty for knowing actions by an infected individual which exposes another individual to the etiologic agent through: (1) donation of blood, semen, breast milk, or an organ; (2) sexual activity; and (3) any behavior with intent to expose another individual. Provides for an exception where the person exposed gives prior consent to being exposed. Allows the Secretary to provide financial assistance to a State for each of the FY 1989 and 1990 if the State provides assurances that it will establish the civil and criminal actions not later than October 1, 1990. Allows the State chief executive officer to certify, in lieu of enactment of any statute or issuance of any regulation, that the law of the State is in substantial compliance.

Requires States, to the extent permitted under State law, to offer substantial opportunities for an individual to undergo counseling and testing anonymously and through the use of a pseudonym.

Prohibits requiring testing as a condition of receiving other health services, unless the testing is medically indicated in the health services being sought.

Prohibits recipients from expending the funds to distribute sterile needles for the hypodermic injuection of any illegal drug or to distribute bleach for the purpose of cleansing needles for such injection.

Creates another new part in the new subtitle established by this Act concerning confidentiality with respect to counseling and testing. Prohibits a described person, without regard to whether the described person receives Federal financial assistance, from disclosing identifying information with respect to a protected individual or a contact of such individual. Includes among the described persons anyone who obtains identifying information: (1) directly or indirectly in connection with counseling or testing with regard to AIDS, providing health care to the protected individual, or carrying out a disclosure authorized by this Act or ordered by a court under this Act; or (2) by directly perceiving any record developed in such counseling, testing, health care, or disclosure.

Authorizes consensual disclosure of identifying information through a specified procedure, including consent by a guardian of a legally incompetent person and consent, after the death of the protected individual, by the claimant of life insurance proceeds, for disclosure to the insurance company.

Provides for nonconsensual disclosure: (1) to a health care provider in connection with counseling or testing, to the protected individual, or to the guardian of an incompetent individual; (2) to a health care provider who is likely to be occupationally exposed to the etiologic agent; (3) to a State public health officer if required by State law; (4) in connection with donation of blood, semen, breast milk, or an organ; (5) to a person preparing the body of a protected individual for burial; (6) intraorganizationally as necessary; (7) from a person receiving disclosure to any person authorized in these provisions for authorized purposes; and (8) in connection with certain sales, transfers, mergers, or consolidations of organizations.

Authorizes a court of competent jurisdiction, with respect to the protected individual or contact involved, to: (1) order disclosure of identifying information to a State health officer in order to prevent a clear and imminent danger of transmission, by the individual or contact, of the etiologic agent; and (2) authorize the officer to disclose identifying information to the extent reasonably necessary to prevent such danger. Sets forth procedures, including in camera hearings, use of pseudonyms, and sealing of records.

Authorizes physicians and counselors to make nonconsensual disclosures: (1) to spouses, sexual contacts, and people with whom the protected individual has shared a hypodermic needle, in certain circumstances; and (2) if the protected individual is convicted of a crime relating to sexual assualt and the disclosure is made to victim of the crime at the request of the victim.

Requires, subject to exception, that: (1) disclosures be accompanied by a written declaration that redisclosure may be prohibited by law; and (2) in certain circumstances, the protected individual be notified in writing of the disclosure.

Provides for civil money penalties and civil causes of action for intentional or negligent violation of disclosure provisions of this part. Authorizes injunctive relief initiated by the Secretary and a civil cause of action by any aggrieved individual. Provides for in camera proceedings, use of pseudonyms, and sealing of records.

Provides for criminal penalties for intentional violation of disclosure provisions.

Provides for termination of grants from and contracts with any Federal agency and suspension or debarment of any Federal grantee or contractor for violation of certain disclosure provisions of this part.

Declares that the imposition of a penalty or the receipt of relief under specified provisions of this part does not preclude other penalties or relief under Federal law.

Declares that this part supersedes any State law that provides penalties or causes of action for failure to make disclosures not authorized by this part or for making disclosures authorized by this part.

Directs the Secretary, acting through the Director of the Centers for Disease Control, to collect data each year on the number of individuals who are both infected with the etiologic agent for AIDS and admitted to the emrgency rooms of hospitals as a result of intravenous drug abuse. Prohibits this provision from being construed to require, authorize, or preclude testing for such infection.

Directs the Secretary, acting through the Director of the National Institute of Mental Health, to collect data each year on the number of cases of mental illness arising as a result of cases of asymptomatic infection with the etiologic agent and arising as a result of cases of AIDS. Prohibits this provision from being construed to require, authorize, or preclude testing for such infection.

Allows a State, if the amount of its allotments under the new part C (relating to substance abuse services) or part D (relating to mental health services) of title XIX (Block Grants) of the Public Health Service Act (as added by this Act) are less than under previous provisions, to transfer not more than 25 percent of its allotment for either part to the other part.

Authorizes appropriations for FY 1989 through 1991 for the Office of Substance Abuse Prevention.

Amends the Public Health Service Act to direct the Secretary, acting through the Administrator of the Alcohol, Drug Abuse, and Mental Health Administration, to collect data on the incidence, nationally and in selected major metropolitan areas, of the various forms of mental illness and substance abuse. Specifies the types of data to be included.

Directs the Secretary, acting through the Director of the Office of Substance Abuse Prevention, to make grants for prevention, education, and treatment regarding drug and alcohol abuse relating to pregnant and postpartum women and their infants, giving priority to projects: (1) for low-income women; and (2) to develop innovative approaches regarding the use of the drugs about which there exists insufficient information, including cocaine and crack. Requires that grants be distributed among projects that provide inpatient, outpatient, and residential treatment. Requires the Director to evaluate the projects.

Authorizes the Secretary to make grants to expand programs of treatment for drug abuse, limiting eligibility to applicants whose treatment programs have a waiting period of one month or more. Authorizes appropriations.

Directs the Secretary, directly or by contract, to provide for an independent evaluation of Federally funded programs of: (1) treatment for drug abuse; and (2) research into methods of such treatment. Sets forth reporting requirements.

Authorizes appropriations for FY 1989 through 1991 to carry out specified provisions of the Public Health Service Act relating to: (1) alcohol abuse and alcoholism; and (2) research with respect to drug abuse.

Authorizes the Secretary, acting through the Director of the National Institute on Drug Abuse, to make grants for demonstration projects: (1) to determine the feasibility and efficacy of providing drug abuse treatment and vocational training in exchange for public service; (2) to conduct outreach to intravenous drug abusers with respect to AIDS; and (3) to provide drug abuse treatment services to pregnant and postpartum women and their infants. Directs the Secretary, directly or through contracts, to provide for evaluations of the projects and for dissemination of information developed.

Amends the Public Health Service Act to direct the Secretary, acting through the Director of the National Institute of Mental Health (Director), to develop and publish information regarding the causes of suicide and the means of preventing suicide, especially among individuals under 24 years of age.

Directs the Secretary, acting through the Director, to make grants and enter into cooperative agreements for research on mental illness.

Directs the Secretary, through the Director, to establish a National Mental Health Education Program to: (1) develop treatment and family assistance methods; (2) support research, training, and education; (3) collect and disseminate information; (4) provide technical assistance; and (5) establish a clearinghouse to collect and disseminate information.

Authorizes the Secretary, acting through the Director, to make grants for mental health services demonstration projects for the planning, coordination, and improvement of community services, including outreach and self-help services, for chronically mentally ill individuals, seriously emotionally disturbed children and youth, elderly individuals, and homeless chronically mentally ill individuals, and for the conduct of research concerning such services.

Authorizes the Secretary, acting through the Director, to make grants for prevention services demonstration projects for the provision of prevention services for individuals who are at risk of developing mental illness. Limits the duration of such a grant and the portion of the grant which may be used for administrative expenses. Authorizes appropriations for FY 1989 and 1990.

Amends the Public Health Service Act to state that the Office of Substance Abuse Prevention is an entity of the Alcohol, Drug Abuse, and Mental Health Administration (Administration). Changes from annual to not less than once each three years the requirement that the Administrator, acting through the Associate Administrator for Prevention, report to the Congress regarding prevention activities undertaken by the Administration.

Directs the Administrator to establish a process for responding to reports of scientific misconduct in connection with projects using funds under title V of the Public Health Service Act. (Current law requires such a process for scientific fraud.)

Repeals provisions dealing with the duties, composition, and operation of the Alcohol, Drug Abuse, and Mental Health Advisory Board.

Authorizes the Administrator to: (1) accept voluntary and uncompensated services; and (2) conduct and support certain research training.

Authorizes the Secretary, through the Administrator, to make grants for the acquisition of small instrumentation necessary to carry out the purpose, with respect to research, of title V (Administration and Coordination of the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcholoism, and the National Institute on Drug Abuse) of the Public Health Service Act. Requires that the instrumentation acquired with the grant be contemporaneously utilized by more than one research grantee. Makes the grants subject to peer review under existing provisions. Authorizes appropriations for FY 1989 through 1991.

Amends provisions relating to drug abuse research and to drug abuse demonstration projects to require special consideration regarding pregnant women and their children.

Amends provisions relating to mental health clinical traineeships to impose a service obligation on individuals receiving such a traineeship in marital and family therapy.

Amends the Anti-Drug Abuse Act of 1986 to require the Secretary to report to the Congress with respect to the results of a study regarding insurance coverage of drug abuse treatment, within 18 months after the execution of the contract for the study. (Current law requires such a report within one year of the enactment of that Act.)

Mandates that butyl nitrite be considered a banned hazardous product under provisions of the Consumer Product Safety Act, subject to exception.

Declares that any conviction of a person for certain violations of the Federal Food, Drug, and Cosmetic Act involving anabolic steriods or human growth hormone shall be considered a conviction for purposes of specified provisions of the Controlled Substances Act.

Directs the Administrator of the Environmental Protection Agency to: (1) develop guidelines and provide counseling for law enforcement agencies for dealing with illegal drug laboratories to protect the public health and environment; and (2) carry out demonstration projects to clean up substances associated with illegal drug laboratories. Amends the Controlled Substances Act to allow proceeds from the sale of forfeited property to be used to pay for demonstration projects for and expenses of cleanup of substances associated with illegal drug laboratories.