To amend the Public Health Service Act with respect to mental health services for elderly individuals.

July 25 (legislative day, July 21), 2003

Mr. BREAUX introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

To amend the Public Health Service Act with respect to mental health services for elderly individuals.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Positive Aging Act of 2003'.

SEC. 2. FINDINGS; STATEMENT OF PURPOSE.

(a) FINDINGS- The Congress finds that--

(1) although, on average, 1/4 of all patients seen in primary care settings have a mental disorder, primary care practitioners identify such illness in only about half of these cases;

(2) four mental disorders are among the 10 leading causes of disability in the United States;

(3) among the elderly, 10 percent have dementia and as many as one quarter have significant clinical depression;

(4) access to mental health services by the elderly is compromised by health benefits coverage limits, gaps in the mental health services delivery system, and shortages of geriatric mental health practitioners;

(5) the integration of medical and mental health treatment provides an effective means of coordinating care, improving mental health outcomes, and saving health care dollars; and

(6) the treatment of mental disorders in older patients, particularly those with other chronic diseases, can improve health outcomes and the quality of life for these patients.

(b) STATEMENT OF PURPOSE- In order to address the emerging crisis in the identification and treatment of mental disorders among the elderly, it is the purpose of this Act to--

(1) promote models of care that integrate mental health services and medical care within primary care settings; and

(2) improve access by older adults to mental health services in community-based settings.

TITLE I--ENHANCING ACCESS TO MENTAL HEALTH SERVICES FOR THE ELDERLY

SEC. 101. SERVICES IMPLEMENTATION PROJECTS TO SUPPORT INTEGRATION OF MENTAL HEALTH SERVICES IN PRIMARY CARE SETTINGS.

Subpart 3 of part B of title V of the Public Health Service Act (42 U.S.C. 290bb-31 et seq.) is amended--

(1) in section 520(b)--

(A) in paragraph (14), by striking `and' at the end;

(B) in paragraph (15), by striking the period at the end and inserting `; and'; and

(C) by adding at the end the following paragraph:

`(16) conduct the demonstration projects specified in section 520K.'; and

(2) by adding at the end the following section:

`SEC. 520K. PROJECTS TO DEMONSTRATE INTEGRATION OF MENTAL HEALTH SERVICES IN PRIMARY CARE SETTINGS.

`(a) IN GENERAL- The Secretary, acting through the Director of the Center for Mental Health Services, shall make grants to public and private nonprofit entities for evidence-based projects to demonstrate ways of integrating mental health services for older patients into primary care settings, such as health centers receiving a grant under section 330 (or determined by the Secretary to meet the requirements for receiving such a grant), other Federally qualified health centers, primary care clinics, and private practice sites.

`(b) REQUIREMENTS- In order to qualify for a grant under this section, a project shall provide for collaborative care within a primary care setting, involving psychiatrists, psychologists, and other licensed mental health professionals with appropriate training and experience in the treatment of older adults, in which screening, assessment, and intervention services are combined into an integrated service delivery model, including--

`(1) screening services by a mental health professional with at least a masters degree in an appropriate field of training, supported by psychiatrists and psychologists with appropriate training and experience in the treatment of older adults to ensure adequate consideration of biomedical and psychosocial conditions, respectively;

`(2) referrals for necessary prevention, intervention, follow-up care, consultations, and care planning oversight for mental health and other service needs, as indicated; and

`(3) adoption and implementation of evidence-based protocols, to the extent available, for prevalent mental health disorders, including depression, anxiety, behavioral and psychological symptoms of dementia, psychosis, and misuse of, or dependence on, alcohol or medication.

`(c) CONSIDERATIONS IN AWARDING GRANTS- To the extent feasible, the Secretary shall ensure that--

`(1) grants under this section are awarded to projects in a variety of geographic areas, including urban and rural areas; and

`(2) the needs of ethnically diverse at-risk populations are addressed.

`(d) DURATION- A project may receive funding pursuant to a grant under this section for a period of up to 3 years, with an extension period of 2 additional years at the discretion of the Secretary.

`(e) APPLICATION- In order to receive a grant under this section, a public or private nonprofit entity shall--

`(1) submit an application to the Secretary (in such form, containing such information, and at such time as the Secretary may specify); and

`(2) agree to report to the Secretary standardized clinical and behavioral data necessary to evaluate patient outcomes and to facilitate evaluations across participating projects.

`(f) EVALUATION- Not later than 6 months after the close of a calendar year, the Secretary shall submit to the Congress a report evaluating the projects receiving awards under this section for such year.

`(g) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated for fiscal year 2004 and each fiscal year thereafter such sums as may be necessary to carry out this section.'.

SEC. 102. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH TREATMENT OUTREACH TEAMS.

Subpart 3 of part B of title V of the Public Health Service Act (42 U.S.C. 290bb-31 et seq.), as amended by section 101 of this Act, is further amended by adding at the end the following section:

`SEC. 520L. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH TREATMENT OUTREACH TEAMS.

`(a) IN GENERAL- The Secretary, acting through the Director of the Center for Mental Health Services, shall make grants to public or private nonprofit entities that are community-based providers of geriatric mental health services, to support the establishment and maintenance by such entities of multi-disciplinary geriatric mental health outreach teams in community settings where older adults reside or receive social services. Entities eligible for such grants include--

`(1) mental health service providers of a State or local government;

`(2) outpatient programs of private, nonprofit hospitals;

`(3) community mental health centers meeting the criteria specified in section 1913(c); and

`(4) other community-based providers of mental health services.

`(b) REQUIREMENTS- In order to qualify for a grant under this section, an entity shall--

`(1) adopt and implement, for use by its mental health outreach team, evidence-based intervention and treatment protocols (to the extent such protocols are available) for mental disorders prevalent in older adults, relying to the greatest extent feasible on protocols that have been developed--

`(A) by or under the auspices of the Secretary; or

`(B) by academicians with expertise in mental health and aging;

`(2) provide screening for mental disorders, diagnostic services, referrals for treatment, and case management and coordination through such teams; and

`(3) coordinate and integrate the services provided by such team with the services of social service, mental health, medical, and other health care providers at the site or sites where the team is based in order to--

`(A) improve patient outcomes; and

`(B) to ensure, to the maximum extent feasible, the continuing independence of older adults who are residing in the community.

`(c) COOPERATIVE ARRANGEMENTS WITH SITES SERVING AS BASES FOR OUTREACH TEAMS- An entity receiving a grant under this section may enter into an agreement with a person operating a site at which a geriatric mental health outreach team of the entity is based, including--

`(1) senior centers;

`(2) adult day care programs;

`(3) assisted living facilities; and

`(4) recipients of grants to provide services to senior citizens under the Older Americans Act, under which such person provides (and is reimbursed by the entity, out of funds received under the grant, for) any supportive services, such as transportation and administrative support, that such person provides to an outreach team of such entity.

`(d) CONSIDERATIONS IN AWARDING GRANTS- To the extent feasible, the Secretary shall ensure that--

`(1) grants under this section are awarded to projects in a variety of geographic areas, including urban and rural areas; and

`(2) the needs of ethnically diverse at-risk populations are addressed.

`(e) APPLICATION- In order to receive a grant under this section, an entity shall--

`(1) submit an application to the Secretary (in such form, containing such information, and at such time as the Secretary may specify); and

`(2) agree to report to the Secretary standardized clinical and behavioral data necessary to evaluate patient outcomes and to facilitate evaluations across participating projects.

`(f) EVALUATION- Not later than 6 months after the close of a calendar year, the Secretary shall submit to the Congress a report evaluating the programs receiving a grant under this section for such year.

`(g) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated for fiscal year 2004 and each fiscal year thereafter such sums as may be necessary to carry out this section.'.

TITLE II--ADMINISTRATIVE CHANGES TO STRENGTHEN PROGRAMS FOR GERIATRIC MENTAL HEALTH SERVICES

SEC. 201. DESIGNATION OF DEPUTY DIRECTOR FOR GERIATRIC MENTAL HEALTH SERVICES IN CENTER FOR MENTAL HEALTH SERVICES.

Section 520 of the Public Health Service Act (42 U.S.C. 290bb-31) is amended by redesignating subsection

(c) as subsection (d) and inserting after subsection (b) the following:

`(c) DEPUTY DIRECTOR FOR GERIATRIC MENTAL HEALTH SERVICES- The Director, after consultation with the Administrator, shall designate a Deputy Director for Geriatric Mental Health Services, who shall be responsible for the development and implementation of initiatives of the Center to address the mental health needs of older adults. Such initiatives shall include--

`(1) research on prevention and identification of mental disorders in the geriatric population;

`(2) innovative demonstration projects for the delivery of community-based mental health services for older Americans;

`(3) support for the development and dissemination of evidence-based practice models, including models to address dependence on, and misuse of, alcohol and medication in older adults; and

`(4) development of model training programs for mental health professionals and caregivers serving older adults.'.

SEC. 202. MEMBERSHIP OF ADVISORY COUNCIL FOR THE CENTER FOR MENTAL HEALTH SERVICES.

Section 502(b)(3) of the Public Health Service Act (42 U.S.C. 290aa-1(b)(3)) is amended by adding at the end the following:

`(C) In the case of the advisory council for the Center for Mental Health Services, the members appointed pursuant to subparagraphs (A) and (B) shall include representatives of older Americans, their families, and geriatric mental health specialists, including at least 1 physician with board certification in geriatric psychiatry and at least 1 psychologist with appropriate training and experience in the treatment of older adults.'.

SEC. 203. PROJECTS OF NATIONAL SIGNIFICANCE TARGETING SUBSTANCE ABUSE IN OLDER ADULTS.

Section 509(b)(2) of the Public Health Service Act (42 U.S.C. 290bb-2(b)(2)) is amended by inserting before the period the following: `, and to providing treatment for older adults with alcohol or substance abuse or addiction, including medication misuse or dependence'.

SEC. 204. CRITERIA FOR STATE PLANS UNDER COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANTS.

(a) IN GENERAL- Section 1912(b) of the Public Health Service Act (42 U.S.C. 300x-2(b)) is amended by inserting after paragraph (5) the following:

`(6) GOALS AND INITIATIVES FOR IMPROVING ACCESS TO SERVICES FOR OLDER ADULTS- The plan--

`(A) specifies goals for improving access by older Americans to community-based mental health services;

`(B) includes a plan identifying and addressing the unmet needs of such individuals for mental health services; and

`(C) includes an inventory of the services, personnel, and treatment sites available to improve the delivery of mental health services to such individuals.'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to State plans submitted under section 1912 of the Public Health Service Act on or after the date that is 180 days after the date of the enactment of this Act.

END