Pub. L. 94-63, tit. III, sec. 303

Sec. 303. The Community Mental Health Centers Act is amended to read as follows: “TITLE II—COMMUNITY MENTAL HEALTH CENTERS “Part A—Planning and Operations Assistance “requirements for community mental health centers “Sec. 201. (a) For purposes of this title (other than part B thereof), the term ‘community mental health center’ means a legal entity (1) through which comprehensive mental health services are provided— “(A) principally to individuals residing in a defined geographic area (referred loin this title as a ‘catchment area’), “(B) within the limits of its capacity, to any individual residing or employed in such area regardless of his ability to pay for such services, his current or past health condition, or any other factor, and “(C) in the manner prescribed by subsection (b), and (2) which is organized in the manner prescribed by subsections (c) and (d). “(b) (1) The comprehensive mental health services which shall be provided through a community mental health center shall include— “(A) inpatient services, outpatient services, day care and other partial hospitalization services, and emergency services; “(B) a program of specialized services for the mental health of children, including a full range of diagnostic, treatment, liaison, and follow up services (as prescribed by the Secretary); “(C) a program of specialized services for the mental health of the elderly, including a full range of diagnostic, treatment, liaison, and follow up services (as prescribed by the Secretary); “(D) consultation and education services which— “(i) are for a wide range of individuals and entities involved with mental health services, including health professionals, schools, courts, State and local law enforcement and correctional agencies, members of the clergy, public welfare agencies, health services delivery agencies, and other appropriate entities; and “(ii) include a wide range of activities (other than the provision of direct clinical services) designed to (I) develop effective mental health programs in the center’s catchment area, (II) promote the coordination of the provision of mental health services among various entities serving the center’s catchment area, (III) increase the awareness of the residents of the center’s catchment area of the nature of mental health problems and the types of mental health services available, and (IV) promote the prevention and control of rape and the proper treatment of the victims of rape; 89 STAT. 310 “(E) assistance to courts and other public agencies in screening residents of the center’s catchment area who are being considered for referral to a State mental health facility for inpatient treatment to determine if they should be so referred and provision, where appropriate, of treatment for such persons through the center as an alternative to inpatient treatment at such a facility; “(F) provision of follow up care for residents of its catchment area who have been discharged from a mental health facility; “(G) A program of transitional half-way house services for mentally ill individuals who are residents of its catchment area and who have been discharged from a mental health facility or would without such services require inpatient care in such a facility; and “(H) provision of each of the following service programs (other than a service program for which there is not sufficient need (as determined by the Secretary) in the center’s catchment area, or the need for which in the center’s catchment area the Secretary determines is currently being met): “(i) A program for the prevention and treatment of alcoholism and alcohol abuse and for the rehabilitation of alcohol abusers and alcoholics. “(ii) A program for the prevention and treatment of drug addiction and abuse and for the rehabilitation of drug addicts, drug abusers, and other persons with drug depend-ency problems. “(2) The provision of comprehensive mental health services through a center shall be coordinated with the provision of services by other health and social service agencies (including State mental health facilities) in or serving residents of the center’s catchment area to insure that persons receiving services through the center have access to all such health and social services as they may require. The center’s services (A) may be provided at the center or satellite centers through the staff of the Center or through appropriate arrangements with health professionals and others in the center’s catchment area, (B) shall be available and accessible to the residents of the area promptly, as appropriate, and in a manner which preserves human dignity and assures continuity and high quality care and which over-comes geographic, cultural, linguistic, and economic barriers to the receipt of services, and (C) when medically necessary, shall be available and accessible twenty-four hours a day and seven days a week. “(c) (1) (A) The governing body of a community mental health center (other than a center described in subparagraph (B)) shall (i) be composed, where practicable, of individuals who reside in the center’s catchment area and who, as a group, represent the residents of that area taking into consideration their employment, age, sex, and place of residence, and other demographic characteristics of the area, and (ii) meet at least once a month, establish general policies for the center (including a schedule of hours during which services will be provided), approve the center’s annual budget, and approve the selection of a director for the center. At least one-half of the members of such body shall be individuals who are not providers of health care. “(B) In the case of a community mental health center which before the date of enactment of the Community Mental Health Centers Amendments of 1975 was operated by a governmental agency and received a grant under section 220 (as in effect before such date), the requirements of subparagraph (A) shall not apply with respect to 89 STAT. 311such center, but the govern mental agency operating the center shall appoint a committee to advise it with respect to the operations of the center, which committee shall be composed of individuals who reside in the center’s catchment area, who are representative of the residents of the area as to employment, age, sex, place of residence, and other demographic characteristics, and at least one-half of whom are not providers of health care. “(2) For purposes of subparagraphs (A) and (B) of paragraph (1), the term ‘provider of health care’ means an individual— “(A) who is a direct provider of health care (including a physician, dentist, nurse, podiatrist, or physician assistant) in that (i) the individual’s primary current activity is the provision of health care to individuals or the administration of facilities or institutions (including hospitals, long-term care facilities, out-patient facilities, and health maintenance organizations) in which such care is provided, and (ii) when required by State law, the individual has received professional training in the provision of such care or in such administration and is licensed or certified for such provision or administration; or “(B) who is an indirect provider of health care in that the individual— “(i) holds a fiduciary position with, or has a fiduciary interest in, any entity described in subclause (II) or (IV) of clause (ii); “(ii) receives (either directly-or through his spouse) more than one-tenth of his gross annual income from any one or combination of the following: “(I) Fees or other compensation for research into or instruction in the provision of health care. “(II) Entities engaged in the Division of health care or in such research or instruction. “(III) Producing or supplying drugs or other articles for individuals or entities tor use in the provision of, in research into, or instruction in the provision of, health care. “(IV) Entities engaged in producing drugs or such other articles. “(iii) is a member of the immediate family of an individual described in subparagraph (A) or in clause (i), (ii),or (iv) of subparagraph (B);or “(iv) is engaged in issuing any policy or contract of individual or group health insurance or hospital or medical service benefits. “(d) A center shall have established, in accordance with regulations prescribed by the Secretary, (1) an ongoing quality assurance program (including utilization and peer review systems) respecting the center’s services, (2) an integrated medical records system (including a drug use profile) which, in accordance with applicable Federal and State, laws respecting confidentiality, is designed to provide access to all past and current information regarding the health status of each patient and to maintain safeguards to preserve confidentiality and to protect the rights of the patient. (3) a professional advisory board, which is composed of members of the center’s professional staff, to advise the governing board in establishing policies governing medical and other services provided by such staff on behalf of the center, and (4) an identifiable administrative unit which shall be responsible for providing the consultation and education services described in sub-89 STAT. 312section (b) (1) (A) The Secretary may waive the requirements of clause (4) with respect to any center if he determines that because of the size of such center or because of other relevant factors the establishment of the administrative unit described in such clause is not warranted. “grants for planning community mental health center programs “Sec. 202. (a) The Secretary may make grants to public and non-profit private entities to carry out projects to plan community mental health center programs. In connection with a project to plan a community mental health center program for an area the grant recipient shall (1) assess the needs of the area for mental health services, (2) design a community mental health center program for the area based on such assessment, (3) obtain within the area financial and professional assistance and support for the program, and (4) initiate and encourage continuing community involvement in the development and operation of the program. The amount of any grant under this subsection may not exceed $75,000. “(b) A grant under subsection (a) for a project, shall be made for its costs for the one-year period beginning on the first day of the month in which the grant is made; and, if a grant is made under such subsection for a project., no other grant may be made for such project under such subsection. “(c) The Secretary shall give special consideration to applications submitted for grants under subsection (a) for projects for community mental health centers programs for areas designated by the Secretary as urban or rural poverty areas. No applications for a grant under subsection (a) may be approved unless the application is recommended for approval by the National Advisory Mental Health Council. “(d) There are authorized to be appropriated for payments under grants under subsection (a) $3,780,000 for the fiscal year 1976, and $3,750,000 for the fiscal year 1977. “grants for initial operation Sec. 203. (a) (1) The Secretary may make grants to— “(A) public and nonprofit private community mental health centers, and “(B) any public or nonprofit private entity which— “(i) is providing mental health services, “(ii) meets the requirements of section 201 except that it is not providing all of the comprehensive mental health services described in subsection (b)(1) of such section, and “(iii) has a plan satisfactory to the Secretary for the provision of all such services within two years after the date of the receipt of the first grant under this subsection, to assist them in meeting their costs of operation (other than costs related to construction). “(2) Grants under subsection (a) may only be made for a grantee’s costs of operation during the first eight years after its establishment. In the ease of a community mental health center or other entity which received a grant under section 220 (as in effect before the date of enactment of the Community Mental Health Centers Amendments of 1975), such center or other entity shall, for purposes of grants under subsection (a), be considered as having been in operation for a number of years equal to the sum of the number of grants in the first series 89 STAT. 313of grants it received under such section and the number of grants it has received under this subsection. “(b) (1) Each grant under subsection (a) to a community mental health center or other entity shall be made for the costs of its operation for the one-year period beginning on the first day of the month in which such grant is made. “(2) No community mental health center may receive more than eight grants under subsection (a). No entity described in subsection (a)(1)(B) may receive more than two grants under subsection (a). In determining the number of grants that a community mental health center has received under subsection (a), there shall be included any grants which the center received under such subsection as an entity described in paragraph (1)(B) of such subsection. “(c) The amount of a grant for any year made under subsection (a) shall be the lesser of the amounts computed under paragraph (1) or (2) as follows: “(1) An amount equal to the amount by which the grantee’s projected costs of operation for that year exceed the total of State, local, and other funds and of the fees, premiums, and third-party reimbursements which the grantee may reasonably be expected to collect in that year. “(2) (A) Except as provided in subparagraph (B), an amount equal to the following percentages of the grantee’s projected costs of operation: 80 per centum of such costs for the first year of its operation, 65 per centum of such costs for the second year of its operation, 50 per centum of such costs for the third year of its operation, 35 per centum of such costs for the fourth year of its operation, 30 per centum of such costs for the fifth and sixth years of its operation, and 25 per centum of such costs for the seventh and eighth years of its operation. “(B) In the case of a grantee providing services for persons in an area designated by the Secretary as an urban or rural poverty area, an amount equal to the following percentages of the grantee’s projected costs of operation: 90 per centum of such costs for the first two years of its operation, 80 per centum of such costs for the third year of its operation, 70 per centum of such costs for the fourth year of its operation, 60 per centum of such costs for the fifth year of its operation, 50 per centum of such costs for the sixth year of its operation, 40 per centum of such costs for the seventh year of its operation, and 30 per centum of such costs for the eighth year of its operation. In any year in which a grantee receives a grant under section 204 for consultation and education services, the costs of the grantee’s operation for that year attributable to the provision of such services and its collections in that year for such services shall be disregarded in making a computation under paragraph (1) or (2) respecting a grant under subsection (a) for that year. “(d) (1) There are authorized to be appropriated for payments under initial grants under subsection (a) $50,000,000 for fiscal year 1976, and $55,000,000 for, fiscal year 1977. “(2) For fiscal year 1977, and for each of the succeeding seven fiscal years, there are authorized to be appropriated such sums as may be necessary to make payments under continuation grants under subsection (a) to community mental health centers and other entities which first received an initial grant under this section for fiscal year 1976, or the next fiscal year and which are eligible for a grant under this section 89 STAT. 314in a fiscal year for which sums are authorized to be appropriated under this paragraph. “(e) (1) Any entity which has not received a grant under subsection (a), which received a grant under section 220, 242, 243, 251, 256, 264, or 271 of this title (as in effect before the date of enactment of the Community Mental Health Centers Amendments of 1975) from appropriations under this title for a fiscal year ending before July 1, 1975, and which would be eligible for another grant under such section from an appropriation for a succeeding fiscal year if such section were not repealed by the Community Mental Health Centers Amendments of 1975 may, in lieu of receiving a grant under subsection (a) of this section, continue to receive a grant under each such repealed section under which it would be so eligible for another grant— “(A) for the number of years and in the amount prescribed for the grant under each such repealed section, except that— “(i) the entity may not receive under this subsection more than two grants under any such repealed section unless it meets the requirements of section 201, and “(ii) the total amount received for any year (as determined under regulation of the Secretary) under the total of the grants made to the entity under this subsection may not exceed the amount by which the entity’s projected costs of operation for that year exceed the total collections of State, local, and other funds and of the fees, premiums, and third-party reimbursements which the entity may reasonably be expected to make in that year; and “(B) in accordance with any other terms and conditions applicable to such grant. In any year in which a grantee under this subsection receives a grant under section SIM for consultation and education services, the staffing costs of the grantee for that year which are attributable to the provision of such services and the grantee’s collections in that year for such services shall be disregarded in applying subparagraph (A) and the provisions of the repealed section applicable to determining the amount of the grant the grantee may receive under this subsection for that year. “(2) An entity which receives a grant the authority for which is provided by this subsection may not receive any grant under subsection (a). “(3) There are authorized to be appropriated for fiscal year 1976, and for each of the next six fiscal years such sums as may be necessary to make grants in accordance with paragraph (1). “(f) Unless otherwise specifically provided, a reference in this title to a grant under section 203 includes a grant under subsection (a) of this section and a grant the authority for which is provided by subsection (e) of this section. “okants for consultation and education services “Sec. 204. (a) (1) The Secretary may make annual grants to any community mental health center for the costs of providing the consultation and education services described in section 201(b)(1)(D) if the center— “(A) received from appropriations for a fiscal year ending before July 1, 1975, a staffing grant under section 220 of this title (as in effect before the date of enactment of the Community Mental Health Centers Amendments of 1975) and may not because 89 STAT. 315of limitations respecting the period for which grants under that section may be made receive under section 203 (e) an additional grant under such section 220; or “(B) has received or is receiving a grant under section 203 and the number of years in which the center has been in operation (as determined in accordance with section 203(a) (2)) is not less than four (or is not less than two if the Secretary determines that the center will be unable to adequately provide the consultation and education services described in section 201(b) (1) (D) during the third or fourth years of its operation without a grant under this subsection). “(2) The Secretary may also make annual grants to a public or non-profit private entity— “(A) which has not received any grant under this title (other than a grant under this section as amended by the Community Mental Health Centers Amendments of 1975), “(B) which meets the requirements of section 201 except, in the case of an entity which has not received a grant under this section, the requirement for the provision of consultation and education services described in section 201(b) (1) (D), and “(C) the catchment area of which is not within (in whole or in part) the catchment area of a community mental health center, for the costs of providing such consultation and education services. “(b) The amount of any grant made under subsection (a) shall be determined by the Secretary, but no such grant to a center may exceed the lesser of 100 per centum of such center’s costs of providing such consultation and education services during the year for which the grant is made or— “(1) in the case of each of the first two years for which a center receives such grant, the sum of (A) an amount equal to the product of $0.50 and the population of the center’s catchment area, and (B) the lesser of (i) one-half the amount determined under clause (A), or (ii) one-half of the amount received by the center in such year from charges for the provision of such services; “(2) in the ease, of the third year for which a center receives such a grant, the sum of (A) an amount equal to the product of $0.50 and the population of the center’s catchment area, and (B) the lesser of (i) one-half the amount determined under clause (A), or (ii) one-fourth of the amount received by the center in such year from charges for the provision of such services; and “(3) (A) except as provided in subparagraph (B), in the case of the fourth year and each subsequent year thereafter for which a center receives such a grant, the lesser of (i) the sum of (I) an amount equal to the product of $0,125 and the population of the centers catchment area, and (II) one-eighth of the amount received by the center in such year from charges for the provision of such services, or (ii) $50,000; or “(B) in the case of the fourth year and each subsequent year for which a center receives such a grant, the sum of (i) an amount equal to the product of $0.25 and the population of the center’s catchment area, and (ii) the lesser of (I) the amount determined under clause (i) of this subparagraph, or (II) one-fourth of the amount received by the center in such year from charges for the provision for such services if the amount of the last grant received by the center under section 220 of this title (as in effect before the date of the enactment of the Community Mental Health Centers Amendments of 1975) or section 203 of this title, as the case 89 STAT. 316may be, was determined on the basis of the center providing services to persons in an area designated by the Secretary as an urban or rural poverty area. For purposes of this subsection, the term ‘center’ includes an entity which receives a grant under subsection (a) (3). “(c) There arc authorized to be appropriated for payments under grants under this section $10,000,000 for fiscal year 1976, and ,000,000 for fiscal year 1977. “conversion grants “Sec. 205. (a) The Secretary may make not more than two grants to any public or nonprofit entity which— “(1) has an approved application for a grant under section 203 or 211, and “(2) can reasonably be expected to have an operating deficit, for the period for which a grant is or will be made under such application, which is greater than the amount of the grant the entity is receiving or will receive under such application, for the entity’s reasonable costs in providing mental health services which are described in section 201(b) (1) but which the entity did not provide before the date of the enactment of the Community Mental Health Centers Amendments of 1975. “(b) (1) Each grant under subsection (a) to an entity shall be made for the same period as the period for which the grant under section 203 or 211 for which the entity had an approved application is or will be made. “(2) The amount of any grant under subsection (a) to any entity shall be determined by the Secretary, but no such grant may exceed that part of the, entity’s projected operating deficit for the year for which the grant is made which is reasonably attributable to its costs of providing in such year the services with respect to which the grant is made. For purposes of this paragraph, the term ‘projected operating deficit’ means the excess of an entity’s projected costs of operation (including the costs of operation related to the provision of services for which a grant may be made under subsection (a)) for a particular period over the total of the amount of State, local, and other funds (including funds under a grant under section 203, 204, or 211) received by the entity in that period and the fees, premiums, and third-party reimbursements which the entity may reasonably be expected to collect during that period. “(c) There are authorized to be appropriated for payments under grants under subsection (a) $20,000,000 for fiscal year 1976, and $20,000,000 for fiscal year 1977. “general provisions respecting grants uniter this part “Sec. 206. (a) (1) No grant may be made under this part to any entity or community mental health center in any State unless a State plan for the provision of comprehensive mental health services with-in such State has been submitted to, and approved by, the Secretary under section 237. “(b) No grant may be made under this part unless an application (meeting the requirements of subsection (c)) for such grant has been submitted to, and approved by the Secretary. “(c) (1) An application for a grant under this part shall be Submitted m such form and manner as the Secretary shall prescribe, and shall 89 STAT. 317contain such information as the Secretary may require. Except us provided in paragraph (3), an application for a grant under section 203, 204, or 205 shall contain or be supported by assurances satisfactory to the Secretary that— “(A) the community mental health center for which the application is submitted will provide, in accordance with regulations of the Secretary (i) an overall plan and budget that meets the requirements of section 1861(z) of the Social Security Act, and (ii) an effective procedure for developing, compiling, evaluating, and reporting to the Secretary statistics and other information (which the Secretary shall publish and disseminate on a periodic basis and which the center shall disclose at least annually to the general public) relating to (1) the cost of the center s operation, (II) t he patterns of use of its services, (III) the avail-ability, accessibility, and acceptability of its services, (IV) the impact of its services upon the mental health of the residents of its catchment area, and (V) such other matters as the Secretary may require; “(B) such community mental health center will, in consultation with the residents of its catchment area, review its program of services and the statistics and other information referred to in subparagraph (A) to assure that its services are responsive to the needs of the residents of the catchment area.; “(C) to the extent practicable, such community mental health center will enter into cooperative arrangements with health maintenance organizations serving residents of the center’s catchment area for the provision through the center of mental health services for the members of such organizations under which arrangements the charges to the health maintenance organizations for such services shall be not less than the actual costs to the center of providing such services; “(D) in the case of a community mental health center serving a population including a substantial proportion of individuals of limited English-speaking ability, the center has (i) developed a plan and made arrangements responsive to the needs of such population for providing services to the extent practicable in the language and cultural context most appropriate to such individuals, and (ii) identified an individual on its staff who is fluent in both that language and English and whose responsibilities shall include providing guidance to such individuals and to appropriate staff members with respect to cultural sensitivities and bridging linguistic and cultural differences; “(E) such community mental health center has (i) established a requirement that the health care of every patient must be under the supervision of a member of the professional staff, and (ii) provided for having a member of the professional staff available to furnish necessary mental health care, in case of an emergency’; “(F) such community mental health center has provided appropriate methods and procedures for the dispensing and administering of drugs and biologicals; “(G) in the case of an application for a grant under section 203 for a community mental health center which will provide services to persons in an area designated by the Secretary as an urban or rural poverty area, the applicant will use the additional grant funds it receives, because it will provide services to persons in such an area, to provide services to persons in such area who are unable to pay therefor; 89 STAT. 318 “(H) such community mental health center will develop a plan for adequate financial support, to be available, and will use its best efforts to insure that adequate financial support will be available, to it from Federal sources (other than this part) and non-Federal sources (including, to the maximum extent feasible, reimbursement from the recipients of consultation and education services and screening services provided in accordance with sections 201(b) (1) (D) and 201(b)(1) (E)) so that the center will be able to continue to provide comprehensive mental health services when financial assistance provided under this part, is reduced or terminated, as the case may be; “(I) such community mental health center (i) has or will have a contractual or other arrangement with the agency of the State, in which it provides services, which administers or supervises the administration of a State plan approved under title XIX of the Social Security Act for the payment of all or a part of the center’s costs in providing health services to persons who are eligible for medical assistance under such a State plan, or (ii) has made or will make every reasonable effort to enter into such an arrangement; “(J) such community mental health center has made or will make and will continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to persons who are entitled to insurance benefits under title XVIII of the Social Security Act, to medical assistance under a State plan approved under title XIX of such Act, or to assistance for medical expenses under any other public assistance program or private health insurance program; “(K) such community mental health center (i) has prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts to be applied to the payment of such fees or payments which discounts arc adjusted on the basis of the patient’s ability to pay; (ii) has made and will continue to make every reasonable effort (I) to secure from patients payment for services in accordance with such approved schedules, and (II) to collect reimbursement for health services to persons described in subparagraph (J) on the basis of the full amount of fees and payments for such services without application of any discount, and (iii) has submitted to the Secretary such reports as he may require to determine compliance with this subparagraph; and “(L) such community mental health center will adopt and enforce a policy (i) under which fees for the .provision of mental health services through the center will be paid to the center, and (ii) which prohibits health professionals who provide such services to patients through the center from providing such services to such patients except through the center. An application for a grant under section 203 shall also contain a long-range plan for the expansion of the program of the community mental health center for which the application is submitted for the purpose of meeting anticipated increases in demand by residents of the center’s catchment area for the comprehensive mental health services described in section 201 (b)(1). Such a plan shall include a description of planned growth in the programs of the center, estimates of increased costs arising from such growth, estimates of the portion of such increased costs to lie paid from Federal funds, and anticipated 89 STAT. 319sources of non-Federal funds to pay the portion of such increased costs not to be paid from Federal funds. “(2) The Secretary may approve an application for a grant under section 203, 204, or 205 only if the application is recommended for approval by the National Advisory Mental Health Council, the application meets the requirements of paragraph (1), and, except as provided in paragraph (3), the Secretary— “(A) determines that the facilities and equipment of the applicant under the application meet such requirements as the Secretary may prescribe; “(B) determines that— “(i) the application contains or is supported by satisfactory assurances that the comprehensive mental health services (in the ease of an application for a grant under section 203 or 205) or the consultation and education services (in the case of an application for a grant under section 204) to be provided by the applicant will constitute an addition to, or a significant improvement in quality (as determined in accordance with criteria of the Secretary) of, services that would other-wise be provided in the catchment area of the applicant; “(ii) the application contains or is supported by satisfactory assurances that Federal funds made available under section 203, 204, or 205, as the case may be, will (I) be used to supplement and, to the extent practical, increase the level of State, local, and other non-Federal funds, including third-party health insurance payments, that would in the absence of such Federal funds be made available for the applicant’s comprehensive mental health services, and (II) in no event supplant such State, local, and other non-Federal funds; “(iii) in the case of an applicant which received a grant from appropriations for the preceding fiscal year, during the year for which the grant was made the applicant met, in accordance with the section under which such grant was made, the requirements of section 201 and complied with the assurances which were contained in or supported the applicant’s application for such grant; and “(iv) in the case of an application for a grant the amount of which is or may be determined under section 203(c) (2) (B) or 204(b) (3) (B) or under a provision of a repealed section of this title referred to in section 203(e) which authorizes an increase in the ceiling on the amount of a grant to support services to persons in areas designated by the Secretary as urban or rural poverty areas, the application contains or is supported by assurances satisfactory to the Secretary that the services of the applicant will, to the extent feasible, lie used by a significant number of persons residing in an area designated by the Secretary as an urban or rural poverty area and requiring such services. “(3) In the case of an application— “(A) for the first grant under section 203(a) for an entity described in section 203(a)(1)(B), or “(B) for the first grant the authority for which is provided by section 203(e), the Secretary may approve such application without regard to the assurances required by the second sentence of paragraph (1) of this subsection and without regard to the determinations required of the Secretary under paragraph (2) of this subsection if the application 89 STAT. 320contains or is supported by assurances satisfactory to the Secretary that the applicant will undertake, during the period for which such first grant is to be made, such actions as may be necessary to enable the applicant, upon the expiration of such period, to make each of the assurances required by paragraph (1) and to enable the Secretary, upon the expiration of such period, to make each of the determinations required by paragraph (2). “(4) In each fiscal year for which a community mental health center receives a grant under section 203,204, or 205, such center shall obligate for a program of continuing evaluation of the effectiveness of its pro-grams in serving the needs of the residents of its catchment area and for a review of the quality of the services provided by the center not less than an amount equal to 2 per centum of the amount obligated by the center in the preceding fiscal year for its operating expenses. “(5) The costs for which grants may be made under section 203(a), 204, or 205 shall be determined in the manner prescribed in regulations of the Secretary issued after consultation with the National Advisory Mental Health Council. “(6) If the Secretary determines under section 203, 204, or 205 that an applicant for a grant under such section— “(A) has not made reasonable efforts to secure payments or reimbursements in accordance with assurances provided under Subparagraph (I), (J), or (K) of subsection (c)(1), or “(B) is capable of increasing the amount, of payments or reimbursements described in any such subparagraph, the Secretary shall, in the case of a determination described in subparagraph (A), inform the applicant of the respects in which the applicant has not made such reasonable efforts and the manner in which the applicant’s performance can be improved and, in the case of a determination described in subparagraph (B), inform the applicant of the manner in which the applicant can increase the amount of such payments. The Secretary shall give to an applicant a reasonable opportunity to respond, before the amount of the grant the applicant is applying for is determined, to a determination described in the preceding sentence. A determination of the Secretary referred to in the first sentence shall he referred to the National Advisory Mental Health Council for its review and recommendations. “(d) An application for a grant under this part which is submitted to the Secretary shall at the same time be submitted to the State mental health authority for the State in which the project or community mental health center for which the application is submitted is located. A State mental health authority which receives such an application under this subsection may review it and submit its comments to the Secretary within the forty-five-day period beginning on the date the application was received by it. The Secretary shall take action to require an applicant to revise his application or to approve or dis-approve an application within the period beginning on the date the State mental health authority submits its comments or on the expiration of such forty-five-day period, whichever occurs first, and ending on the ninetieth day following the date the application was submitted to him. “(e) Not more than 2 per centum of the total amount appropriated under sections 203, 204, and 205 for any fiscal year shall lie used by the Secretary to provide directly through the Department technical assistance for program management, and for training in program management to community mental health centers which received grants under such sections or to entities which received grants under section 220 of 89 STAT. 321this title in a fiscal year beginning before the date of the enactment of the Community Mental Health Center’s Amendments of 1975. “(f) For purposes of subsections (b), (c), (d), and (e) of this section, the term ‘community mental health center’ includes an entity which applies for or has received a grant under section 203 or 204 (a)(2). “Part B—Financial Distress Grants “grant authority “Sec. 211. The Secretary may make grants for the operation of any community mental health center which— “(1) (A) received a grant under section 220 of this title (as in effect lief ore the date of enactment of the Community Mental Health Centers Amendments of 1975) and, because of limitations in such section 220 respecting the period for which the center may receive grants under such section 220, is not eligible for further grants under that section for a fiscal year beginning after June 30, 1975; or “(B) received a grant or grants under section 203(a) of this title and, because of limitations respecting the period for which grants under such section may be made, is not eligible for further grants under that section; and “(2) demonstrates that without a grant under this section there will be a significant reduction in the types or quality of services provided or there will lie an inability to provide the services described in section 201 (b). “grant requirements “Sec. 212. (a) No grant may be made under section 211 to any community mental health center in any State unless a State plan for the provision of comprehensive mental health services within such State has been submitted to, and approved by, the Secretary under section 237. Any grant under section 211 may be made upon such terms and conditions as the Secretary determines to be reasonable and necessary, including requirements that the community mental health center agree (1) to disclose any financial information or data deemed by the Secretary to be necessary to determine the sources or causes of that center’s financial distress, (2) to conduct a comprehensive cost analysis study in cooperation with the Secretary, (3) to carry out appropriate operational and financial reforms on the basis of information obtained in the course of the comprehensive cost analysis study or on the basis of other relevant information, and (4) to use a grant received under section 211 to enable it to provide (within such period as the Secretary may prescribe) the comprehensive mental health services described in section 201(b) and to revise its organization to meet the requirements of sections 201(c) and 201 id). “(b) An application for a grant under section 211 must contain or be supported by the assurances prescribed by subparagraphs (A), (B), (C), (D), (E), (F). (G), (I), (,T), (K),and (L) of section 206(c) (1) and assurances satisfactory to the Secretary that the applicant will expend for its operation as a community mental health center, during the year for which such grant is sought, an amount of funds (other than funds for construction, as determined by the Secretary) from non-Federal sources which is at least as great as the average annual 89 STAT. 322amount of funds expended by such applicant for such purpose (excluding expenditures of a nonrecurring nature) in the three years immediately preceding the year for which such grant is sought. The Secretary may not approve such an application unless it has been recommended for approval by the National Advisory Mental Health Council. The requirements of section 206(d) respecting opportunity for review of applications by State mental health authorities and time limitations on actions by the Secretary on applications shall apply with respect to applications submitted for grants under section 211. “(c) Each grant under this section to a grantee shall be made for the projected costs of operation (except the costs of providing the consultation and education services described in section 201(b)(1) (D)) of such grantee for the one-year period beginning on the first day of the first month in which such grant is made. No community mental health center may receive more than three grants under section 211. “(d) The amount of a grant for a community mental health center under section 211 for any year shall be the lesser of the amounts computed under paragraph (1) or (2) as follows: “(1) An amount equal to the amount by which the center’s projected costs of operation for that year exceed the total of State, local, and other funds and of the fees, premiums, and third-party reimbursements which the center may reasonably be expected to collect in that year. “(2) An amount equal to the product of— “(A) 90 per centum of the percentage of costs— “(i) which was the ceiling on the grant last made to the center in the first series of grants it received under section 220 of this title (as in effect before the date of the enactment of the Community Mental Health Centers Amendments of 1975),or “(ii) prescribed by subsection (c) (2) of section 203 for computation of the last grant to the center under such section, whichever grant was made last, and “(B) the center’s projected costs of operation in the year for which the grant is to be made under section 211. “authorization or appropriations “Sec. 213. There are authorized to be appropriated $15,000,000 for fiscal year 1976, and $15,000,000 for fiscal year 1977 for payments under grants under section 211. “Part C—Facilities Assistance “assistance authority Sec. 221. (a) From allotments made under section 227 the Secretary shall pay, in accordance with this part, the Federal share of projects for (1) the acquisition or remodeling, or both, of facilities for community mental health centers, (2) the leasing (for not more than twenty-five years) of facilities for such centers, (3) the construction of new facilities or expansion of existing facilities for community mental health centers if not less than 25 per centum of the residents of the centers’ catchment areas are members of low-income groups (as determined under regulations prescribed by the Secretary), and (4) the initial equipment of a facility acquired, remodeled, leased, con-89 STAT. 323structed, or expanded with financial assistance provided under payments tinder this part. Payments shall not be made, for the construction of a new facility or the expansion of an existing one unless the Secretary determines that it is not feasible for the recipient to acquire or remodel an existing facility. “(b) (1) For purposes of this part, the term ‘Federal share’ with respect to any project described in subsection (a) means the portion of the cost of such project to be paid by the Federal Government under this part. “(2) The Federal share with respect to any project described in subsection (a) in a State shall be the amount determined by the State agency of the State, but, except as provided in paragraph (3), the Federal share for any such project may not exceed 66% per centum of the costs of such project or the State’s Federal percentage, which-ever is the lower. Prior to the approval of the first such project in a State during any fiscal year, the State agency shall give the Secretary written notification of (A) the maximum Federal share, established pursuant to this paragraph, for such projects in such State which the Secretary approves during such fiscal year, and (B) the method for determining the specific Federal share to be paid with respect to any such project; and such maximum Federal share and such method of Federal share determination for such projects in such State during such fiscal year shall not be changed after the approval of the first such project in the State during such fiscal year. “(3) In the case of any community mental health center which provides or will, upon completion of the project for which application has been made under this part, provide services for persons in an area designated by the Secretary as an urban or rural poverty area, the maximum Federal share determined under paragraph (2) may not exceed 90 per centum of the costs of the project. “(4) (A) For purposes of paragraph (2), the Federal percentage for (i) Puerto Rico, Guam, American Samoa, and the Virgin Islands shall be 66% per centum, and (ii) any other State shall be 100 per centum less that percentage which bears the same ratio to 50 per centum as the per capita income of such State bears to the average per capita income of all such other States. “(B) The Federal percentages under clause (ii) of subparagraph (A) shall be promulgated by the Secretary, between October 1 find December 31 of each even-numbered year, on the basis of the average of the per capita incomes of each of the States subject to such Federal percentages and of all the States subject to such percentages for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be conclusive for each of the two fiscal years in the period beginning July 1 next succeeding such promulgation. “approval of projects “Sec. 222. (a) For each project for a community mental health center facility pursuant, to a State plan approved under section 237, there shall be submitted to the Secretary, through the State agency of the State, an application by the State or a political subdivision thereof or by a public or other nonprofit agency. If two or more such agencies join in the project, the application may be filed by one or more of such agencies. Such application shall set forth— “(1) a description of the site for such project; 89 STAT. 324 “(2) plans and specifications therefor in accordance with the regulations prescribed by the Secretary under section 236; “(3) except in the case of a leasing project, reasonable assurance that title to such site is or will be vested in one or more of the agencies filing the application or in a public or nonprofit private agency which is to operate the community mental health center; “(4) reasonable assurance that adequate financial support will be available for the project and for its maintenance and operation when completed; “(5) reasonable assurance that all laborers and mechanics employed by contractor’s or subcontractors in the performance of work on a construction or remodeling project will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a–276a–5, known as the Davis-Bacon Act), and the Secretary of Labor shall have with respect to such labor standards the authority and functions set forth in Reorganization Plan Numbered 14 of 1960 (15 F.R. 3176; 5 U.S.C. Appendix) and section 2 of the Act of June 13, 1934 (40 U.S.C. 276c); “(6) a certification by the State agency of the Federal share for the project; and “(7) the assurances described in section 206(c)(2). Each applicant shall be afforded an opportunity for a hearing before the State agency respecting its application. For purposes of paragraph (3), the term ‘title’ means a fee simple or such other estate or interest (including a leasehold on which the rental does not exceed 4 per centum of the value of the hind) as the Secretary finds sufficient to assure for a period of not less than fifty years undisturbed use and possession for the purposes of acquisition, remodeling, construction, or expansion of a facility and its operation. “(b) The Secretary shall approve an application submitted in accordance with subsection (a) if— “(1) sufficient funds to pay the Federal share for the project for which the application was submitted are available from the allotment to the State; “(2) the Secretary finds that the application meets the applicable requirements of subsection (a) and the community mental health center for which the application was submitted will meet the requirements of the State plan (under section 237) of the State in which the project is located: and “(3) the Secretary finds that the application has been approved and recommended by the State agency and is entitled to priority over other projects within the State, as determined under the State plan. No application shall be disapproved by the Secretary until he has afforded the State agency an opportunity for a hearing. The Secretary may not approve an application under this part for a project for a facility for a community mental health center or other entity which received a grant under section 220, 242, 243, 251, 256, 264, or 271 of this title (as in effect before the date of the enactment of the Community Mental Health Centers Amendments of 1975) from appropriations for a fiscal year ending before July 1, 1975, unless the Secretary determines that the application is for a project for a center or entity which upon completion of such project will lie able to significantly expand its services and which demonstrates exceptional financial need 89 STAT. 325for assistance under this part for such project. Amendment of any approved application shall be subject to approval in the same manner as an original application. “payments “Sec. 223. (a) (1) Upon certification to the Secretary by the State agency, based upon inspection by it, that work has been performed upon a remodeling, construction, or expansion project, or purchases for such a project have been made, in accordance with the approved plans and specifications, and that payment of an installment is due to the applicant, such installment shall be paid to the State, from the applicable allotment of such State, except that (I) if the State is not authorized by law to make payments to the applicant, the payment shall be made directly to the applicant, (2) if the Secretary, after investigation or otherwise, has reason to believe that any act (or failure to act) has occurred requiring action pursuant to subsection (c) of this section payment may, after he has given the State agency notice of opportunity for hearing pursuant to such section, be withheld in whole or in part, pending corrective action or action based on such hearing, and (3) the total payments with respect to such project may not exceed an amount equal to the Federal share of the cost of such project. “(2) If an amendment to an approved application is approved or the estimated cost of a remodeling, construction, or expansion project is revised upward, any additional payment, with respect thereto may be made from the applicable allotment of the State for the fiscal year in which such amendment or revision is approved. “(b) Payments from a State allotment for acquisition and leasing projects shall be made, in accordance, with regulations which the Secretary shall promulgate. “(c) (1) If the Secretary finds that— “(A) a State agency is not substantially complying with the provisions required by section 237 to be in a State plan or with regulations issued under section 236; “(B) any assurance required to be in an application filed under section 222 is not being carried out; “(C) there is substantial failure to carry out plans and specifications approved by the Secretary under section 222; or “(D) adequate State fluids are not being provided annually for the direct administration of a State plan approved under section 237, the Secretary may take the action authorized under paragraph (2) of this subsection if the finding was made after reasonable notice and opportunity for hearing to the involved State agency. “(2) If the Secretary makes a finding described in paragraph (1), he may notify the involved State agency, which is the subject of the finding or which is connected with a project or State plan which is the subject of the finding, that— “(A) no further payments will be made to the State from allotments under section 227; or “(B) no further payments will be made from allotments under section 227 for any project or projects designated by the Secretary as being affected by the action or inaction referred to in subparagraph (A), (B), (C),or (D) of paragraph (1), as the Secretary may determine to be appropriate under the circumstances; and, except with regard to any project for which the application has already been approved and which is not directly affected, further’ payments from such allotments may be withheld, in whole or 89 STAT. 326in part, until there is no longer any failure to comply (or to carry out the assurance or plans and specifications or to provide adequate State funds, as the case may be) or, if such compliance (or other action) is impossible, until the State repays or arranges for the repayment of Federal moneys to which the recipient was not entitled. “judicial review “Sec. 224. If— “(1) the Secretary refuses to approve an application for a project submitted under section 222, the State agency through which such application was submitted, or “(2) any State is dissatisfied with the Secretary’s action under section 223(c) or 237 (c), such State, may appeal to the United States court of appeals for the circuit in which such State agency or State is located, by filing a petition with such court within sixty days after such action. A copy of the petition shall be forthwith transmitted by the clerk of the court to the Secretary, or any officer designated by him for that purpose. The Secretary thereupon shall file in the court the record of the proceedings on which he based his action, as provided in section 2112 of title 28, United States Code. Upon the filing of such petition, the court shall have jurisdiction to affirm the action of the Secretary or to set it aside, in whole or in part, temporarily or permanently, out, until the filing of the record, the Secretary may modify or set aside his order. The findings of the Secretary as to the facts, if supported by substantial evidence, shall be conclusive, but the court, for good cause shown, may remand the case to the Secretary to take further evidence, and the Secretary may there-upon make new or modified findings of facts and may modify nis previous action, and shall file in the court, the record of the further proceedings. Such new or modified findings of fact shall likewise be conclusive if supported by substantial evidence. The judgment of the court affirming or setting aside, in whole or in part, any action of the Secretary shall be final, subject to review by the Supreme Court, of the United States upon certiorari or certification as provided in section 1254 of title 28, United States Code. The commencement of proceedings under this section shall not, unless so specifically ordered by t he court, operate as a stay of the Secretary’s action. “recovery “Sec. 225. If any facility of a community mental health center acquired, remodeled, constructed, or expanded with funds provided under this part is, at any time within twenty years after the completion of such remodeling, construction, or expansion or after the date of its acquisition with such funds— “(1) sold or transferred to any person or entity (A) which is not qualified to file an application under section 222, or (B) which is not approved as a transferee by the State agency of the State in which such facility is located, or its successor; or “(2) not used by a community mental health center in the pro-vision of comprehensive mental health services, and the Secretary has not determined that there is good cause for termination of such use, the United States shall be entitled to recover from either the transferor or the transferee in the case of a sale or transfer or from the owner in the case of termination of use an amount bearing the same ratio to the 89 STAT. 327then value (as determined by the agreement of the parties or by action brought in the United States district court for the district in which the center is situated) of so much of such facility or center as constituted an approved project or projects, as the amount of the Federal participation bore to the acquisition, remodeling, construction, or expansion cost of such project or projects. Such right of recovery shall not constitute a lien upon such facility or center prior to judgment. “nonduplication “Sec. 226. No grant may be made under the Public Health Service Act for the remodeling, construction, or expansion of a facility for a community mental health center unless the Secretary determines that there are no funds available under this pa it for the remodeling, construction, or expansion of such facility. “allotments to states “Sec. 227. (a) In each fiscal year, the Secretary shall, in accordance with regulations, make allotments, from the sums appropriated under section 228, to the States (with State plans approved under section 237) on the basis of (1) the population, (2) the extent of the need for community mental health centers, and (3) the financial need, of the respective States; except that no such allotment to any State, other than the Virgin Islands, American Samoa, Guam, and the Trust Territory of the Pacific Islands, in any fiscal year may be less than $100,000. Sums so allotted to a State other than the Virgin Islands, American Samoa, Guam, and the Trust Territory of the Pacific Islands, in a fiscal year and remaining unobligated at the end of such year shall remain available to such State for such purpose in the next fiscal year (and in such year only), in addition to the sums allotted for such State in such next fiscal year. Sums so allotted to the Virgin Islands, American Samoa, Guam, or the Trust Territory of the Pacific Islands in a fiscal year and remaining unobligated at the end of such year shall remain available to such State for such purpose in the next two fiscal years (and in such years only), in addition to the sums allotted to such State for such purpose in each of such next two fiscal years. “(b) The amount of an allotment under subsection (a) to a State in a fiscal year which the Secretary determines will not be required by the State during the period for which it is available for the purpose for which allotted shall be available for reallotment by the Secretary from time to time, on such date or dates as lie may fix, to other States with respect to which such a determination has not been made, in pro-portion to the original allotments of such States for such fiscal year, but with such proportionate amount for any of such other States being reduced to the extent it exceeds the sum the Secretary estimates such State needs and will be able to use during such period; and the total of such reductions shall be similarly reallotted among the States whose proportionate amounts were not so reduced. Any amount so reallotted to a State in a fiscal year shall be deemed to be a part of its allotment under subsection (a) in such fiscal year. “authorization of appropriations “Sec. 228. There are authorized to be appropriated $5,000,000 for fiscal year 1976, and $5,000,000 for fiscal year 1977, for allotments under section 227. 89 STAT. 328 “Part D—Rape Prevention and Control “rape prevention and control “Sec. 231. (a) The Secretary shall establish within the National Institute of Mental Health an identifiable administrative unit to be known as the National Center for the Prevention and Control of Rape (hereinafter in this section referred to as the ‘Center’). “(b) (1) The Secretary, acting through the Center, may, directly or by grant, carry out the following: “(A) A continuing study of rape, including a study and investigation of— “(i) the effectiveness of existing Federal, State, and local laws dealing with rape; “(ii) the relationship, if any, between traditional legal and social attitudes toward sexual roles, the act of rape, and the formulation of laws dealing with rape; “(iii) the treatment of the victims of rape by law enforcement agencies, hospitals or other medical institutions, prosecutors, and the courts; “(iv) the causes of rape, identifying to the degree possible— “(I) social conditions which encourage sexual attacks, and “(II) the motives of offenders, and “(v) the impact of rape on the victim and the family of the victim; “(vi) sexual assaults in correctional institutions; “(vii) the actual incidence of forcible rape as compared to the reported incidence of forcible rape and the reasons for any difference in such incidences; and “(viii) the effectiveness of existing private and local and State government educational, counseling, and other pro-grams designed to prevent and control rape. “(B) The compilation, analysis, and publication of summaries of the continuing study conducted under subparagraph (A) and the research and demonstration projects conducted under subparagraph (E). The Secretary shall annually submit to the Congress a summary of such study and projects together with recommendations where appropriate. “(C) The development and maintenance of an information clearinghouse with regard to— “(i) the prevention and control o f rape; “(ii) the treatment and counseling of the victims of rape and their families; and “(iii) t he rehabilitation of offenders. “(D) The compilation and publication of training materials for personnel who are engaged or intend to engage in programs designed to prevent and control rape. “(E) Assistance to community mental health centers and other qualified public and nonprofit private entities in conducting research and demonstration projects concerning the prevention and control of rape, including projects (i) for the planning, developing, implementing, and evaluating of alternative methods used in the prevention and control of rape, the treatment and counseling of the victims of rape and their families, and the rehabilitation of offenders; (ii) for the application of such alternative 89 STAT. 329methods; and (iii) for the promotion of community awareness of the specific locations in which, and the specific social and other conditions under which, sexual attacks are most likely to occur. “(F) Assistance to community mental health centers in meeting the costs of providing consultation and education services respecting rape. “(2) For purposes of this subsection, the term ‘rape’ includes statutory and attempted rape and any other criminal sexual assault (whether homosexual or heterosexual) which involves force or the threat of force. “(c) The Secretary shall appoint an advisory committee to advise, consult with, and make recommendations to him on the implementation of subsection (b). The Secretary shall appoint to such committee persons who are particularly qualified to assist in carrying out the functions of the committee. A majority of the members of the committee shall be women. Members of the advisory committee shall receive compensation at rates, not to exceed the daily equivalent of the annual rate in effect for grade GS–18 of the General Schedule, for each day (including travel time) they are engaged in the performance of their duties as members of the advisory committee and, while so serving away from their homes or regular places of business, each member shall be allowed travel expenses, including per diem in lieu of subsistence, in the same manner as authorized by section 5703 of title 5, United States Code, for persons in Government service employed intermittently. “(d) For the purpose of carrying out subsection (b), there are authorized to be appropriated $7,000,000 for fiscal year 1976, And $10,000,000 for fiscal year 1977. “Part E—General Provisions “definitions “Sec. 235. For purposes of this title— “(1) The term ‘State’ includes the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands, the Trust Territory of the Pacific Islands, and the District of Columbia. “(2) The term ‘State agency’ means the State mental health authority for which grants are authorized under section 314(d) of the Public Health Service Act. “(3) The term ‘Secretary’ means the Secretary of Health, Education, and Welfare. “(4) The term ‘National Advisory Mental Health Council’ means the National Advisory Mental Health Council established under section 217 of the Public Health Service Act. “regulations “Sec. 236. Regulations issued by the Secretary for the administration of this title shall include provisions applicable uniformly to all the States which— “(1) prescribe the general manner in which the State agency of a State shall determine the priority of projects for community mental health centers on the basis of the relative need of the different areas of the State for such centers and their services and require special consideration for projects on the basis of the extent to which a center to be assisted or established upon completion of a 89 STAT. 330project (A) will, alone or in conjunction with other centers owned or operated by the applicant for the project, or affiliated or associated with such applicant, provide comprehensive mental health services for residents of a particular community or communities, or (B) will be part of or closely associated wit h a general hospital; “(2) prescribe general standards for facilities and equipment for centers of different classes and in different types of location; and “(3) require that the State plan of a State submitted under section 237 provide for adequate community mental health centers for people residing in the. State, and provide for adequate community mental health centers to furnish needed services for persons unable to pay therefor. The National Advisory Mental Health Council shall be consulted by the Secretary before the issuance of regulations under this section. “state plan “Sec. 237. (a) A State plan for the provision of comprehensive mental health services within a State shall be comprised of the following two parts: “(1) An administrative part containing provisions respecting the administration of the plan and related matters. Such part shall— “(A) provide for the designation of a State advisory council to consult with the State agency in administering such plan, which council shall include (i) representatives of non-government organizations or groups, and of State agencies, concerned with the planning, operation, or use of community mental health centers or other mental health facilities, and (ii) representatives of consumers and providers of the services of such centers and facilities who are familiar with the need for such services; “(B) provide that the State agency will make such reports in such, form and containing such information as the Secretary may from time to time reasonably require, and will keep such records and afford such access thereto as the Secretary may find necessary to assure the correctness and verification of such reports; “(C) provide that the State agency will from time to time, but not less often than annually, review the State plan and submit to the Secretary appropriate modifications thereof which it considers necessary; and “(D) include provisions, meeting such requirements as the Civil Service Commission may prescribe, relating to the establishment and maintenance of personnel standards on a merit basis. “(2) A services and facilities part, containing provisions respecting services to be offered within the State by community mental health centers and provisions respecting facilities for such centers. Such part shall— “(A) be consistent with the provisions of the State plan prepared in accordance with section 1524(c) (21 of the. Public Health Service Act or the State plan approved under section 314(a) of such Act, whichever is applicable, relating to the, provision of mental health services; “(B) set forth a program for community mental health centers within the State (i) which is based on a statewide inven-89 STAT. 331tory of existing facilities and a survey of need for the comprehensive mental health services described in section 201 (b); (ii) which conforms with regulations prescribed by the Secretary under section 236; and (iii) which shall provide for adequate community mental health centers to furnish needed services for persons unable to pay therefor; “(C) set forth the relative need, determined in accordance with the regulations prescribed under section 236, for the projects included in the program described in subparagraph (B), and, in the case of projects under part C, provide for the completion of such projects in the order of such relative need; “(D) emphasize the provision of outpatient services by community mental health centers as a preferable alternative to inpatient hospital services; and “(E) provide minimum standards (to be fixed in the discretion of the State) for the maintenance and operation of centers which receive Federal aid under this title and provide for enforcement of such standards with respect to projects approved by the Secretary under this title. “(b) The State agency shall administer or supervise the administration of the State plan. “(c) A State shall submit a State plan in such form and manner as the Secretary shall by regulation prescribe. The Secretary shall approve any State plan (and any modification thereof) which com-plies with the requirements of subsection (a). The Secretary shall not finally disapprove a State plan except after reasonable notice and opportunity for a hearing to the State. “(d) (1) At the request of any State, a portion of any allotment or allotments of such State under section 227 for any fiscal year shall be available to pay one-half (or such smaller share as the State may request ) of the expenditures found necessary by the Secretary for the proper and efficient administration of the provisions of the State plan approved under this section which relate to projects under part C for facilities for community mental health centers; except that not more than 5 per centum of the total of the allotments of such State for any fiscal year, or $50,000, whichever is less, shall be available for such purpose. Amounts made available to any State under this paragraph from its allotment or allotments under section 227 for any fiscal year shall be available only for such expenditures (referred to in the ’preceding sentence) during such fiscal year or the following fiscal year. Payments of amounts due under this paragraph may be made in advance or by way of reimbursement, and in such installments, ns the Secretary may determine. “(2) Any amount paid under paragraph (1) to any State for any fiscal year for administration of the provisions of an approved State plan shall be paid on condition that there shall be expended from State sources for each year for administration of such provisions not less than the total amount expended for such purposes from such sources during the fiscal year ending June 30, 1968. “catchment area review “Sec. 238. Each State health planning and development agency designated for a State under section 1521 of the Public Health Service Act shall, in consultation with that State’s mental health authority, periodically review the catchment areas of the community mental health centers located in that State to (1) insure that the sizes of 89 STAT. 332such, areas are such that the services to be provided through the centers (including their satellites) serving the areas are available and accessible to the residents of the areas promptly, as appropriate, (2) insure that the boundaries of such areas conform, to the extent practicable, with relevant boundaries of political subdivisions, school districts, and Federal and State health and social service programs, and (3) insure that the boundaries of such areas eliminate, to the extent possible, barriers to access to the services of the centers serving the areas, including barriers resulting from an area’s physical characteristics, its residential patterns, its economic and social groupings, and available transportation. “state control of operations “Sec. 239. Except as otherwise specifically provided, nothing in this title shall be construed as conferring on any Federal officer or employee the right to exercise any supervision or control over the administration, personnel, maintenance, or operation of any community mental health center with respect to which any funds have been or may be expended under this title. “recoups and audit “Sec. 240. (a) Each recipient of assistance under this title shall keep such records as the Secretary shall prescribe, including records which fully disclose the amount and disposition by such recipient of the proceeds of such assistance, the total cost of the project or undertaking in connection with which such assistance is given or used, and the amount of that portion of the cost of the project or undertaking supplied by other sources, and such other records as will facilitate an effective audit. “(b) The Secretary and the Comptroller General of the United States, or any of their duly authorized representatives, shall have access for the purpose of audit and examination to any books, documents, papers, and records of the recipients that are pertinent to the assistance received under this title. “nonduplication “Sec. 241. In determining the amount of any grant under part A, B, or C for the costs of any project there shall be excluded from such costs an amount equal to the sum of (1) the amount of any other Federal grant which the applicant for such grant has obtained, or is assured of obtaining, with respect to such project, and (2) the amount of any non-Federal funds required to be expended as a condition of such other Federal grant. “determination of poverty area “Sec. 242. For purposes of any determination by the Secretary under this title as to whether any urban or rural area is a poverty area, the Secretary may not determine that an area is an urban or rural poverty area unless— “(1) such area contains one or more subareas which are characterized as subareas of poverty; “(2) the population of such subarea or subareas constitutes a substantial portion of the population of such rural or urban area; and 89 STAT. 333 “(3) the project, facility, or activity, in connection with which such determination is made, does, or (when completed or put into operation) will, serve the needs of the residents of such subarea or subareas. “protection of personal rights “Sec. 243. In making grants under parts A and B, the Secretary shall take such steps as may be necessary to assure that no individual shall be made the subject of any research involving surgery which is carried out (in whole or in part ) with funds under such grants unless such individual explicitly agrees to become a subject of such research. “reimbursement “Sec. 244. The Secretary shall, to the extent permitted by law, work with States, private insurers, community mental health centers, and other appropriate entities to assure that community mental health centers shall be eligible for reimbursement for their mental health services to the same extent as general hospitals and other licensed providers. “short title “Sec. 245. This title may be cited as the ‘Community Mental Health Centers Act’.”.