To amend the Older Americans Act of 1965 to provide for mental health screening and treatment services, to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes.

June 24, 2004

Mrs. CLINTON (for herself, Ms. COLLINS, and Mr. BREAUX) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

To amend the Older Americans Act of 1965 to provide for mental health screening and treatment services, to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes.

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 2004'.

TITLE I--AMENDMENTS TO THE OLDER AMERICANS ACT OF 1965

SEC. 101. DEFINITIONS.

Section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002) is amended by adding at the end the following:

`(44) MENTAL HEALTH SCREENING AND TREATMENT SERVICES- The term `mental health screening and treatment services' means patient screening, diagnostic services, care planning and oversight, therapeutic interventions, and referrals that are--

`(A) provided pursuant to evidence-based intervention and treatment protocols (to the extent such protocols are available) for mental disorders prevalent in older individuals (including, but not limited to, mood and anxiety disorders, dementias of all kinds, psychotic disorders, and substances and alcohol abuse), relying to the greatest extent feasible on protocols that have been developed--

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

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

`(B) coordinated and integrated with the services of social service, mental health, and health care providers in an area in order to--

`(i) improve patient outcomes; and

`(ii) assure, to the maximum extent feasible, the continuing independence of older individuals who are residing in the area.'.

SEC. 102. OFFICE OF OLDER ADULT MENTAL HEALTH SERVICES.

Section 301(b) of the Older Americans Act of 1965 (42 U.S.C. 3021(b)) is amended by adding at the end the following:

`(3) The Assistant Secretary shall establish within the Administration an Office of Older Adult Mental Health Services, which shall be responsible for the development and implementation of initiatives to address the mental health needs of older individuals.'.

SEC. 103. GRANTS TO STATES FOR THE DEVELOPMENT AND OPERATION OF SYSTEMS FOR PROVIDING MENTAL HEALTH SCREENING AND TREATMENT SERVICES TO OLDER INDIVIDUALS LACKING ACCESS TO SUCH SERVICES.

Title III of the Older Americans Act of 1965 (42 U.S.C. 3021 et seq.) is amended--

(1) in section 303 (42 U.S.C. 3023), by adding at the end the following:

`(f) There are authorized to be appropriated to carry out part F (relating to grants for programs providing mental health screening and treatment services) such sums as may be necessary for fiscal year 2005 and each of the 5 succeeding fiscal years.';

(2) in section 304(a)(1) (42 U.S.C. 3024(a)(1)), by inserting `and subsection (f)' after `through (d)'; and

(3) by adding at the end the following:

`PART F--MENTAL HEALTH SCREENING AND TREATMENT SERVICES FOR OLDER INDIVIDUALS

`SEC. 381. GRANTS TO STATES FOR PROGRAMS PROVIDING MENTAL HEALTH SCREENING AND TREATMENT SERVICES FOR OLDER INDIVIDUALS.

`(a) PROGRAM AUTHORIZED- The Assistant Secretary shall carry out a program for making grants to States under State plans approved under section 307 for the development and operation of--

`(1) systems for the delivery of mental health screening and treatment services for older individuals who lack access to such services; and

`(2) programs to--

`(A) increase public awareness regarding the benefits of prevention and treatment of mental disorders; and

`(B) reduce the stigma associated with mental disorders and other barriers to the diagnosis and treatment of the disorders.

`(b) STATE ALLOCATION AND PRIORITIES- A State agency that receives funds through a grant made under this section shall allocate the funds to area agencies on aging to carry out this part in planning and service areas in the State. In allocating the funds, the State agency shall give priority to planning and service areas in the State--

`(1) that are medically underserved; and

`(2) in which there are a large number of older individuals.

`(c) AREA COORDINATION OF SERVICES WITH OTHER PROVIDERS- In carrying out this part, to more efficiently and effectively deliver services to older individuals, each area agency on aging shall--

`(1) coordinate services described in subsection (a) with other community agencies, and voluntary organizations, providing similar or related services; and

`(2) to the greatest extent practicable, integrate outreach and educational activities with existing (as of the date of the integration) health care and social service providers serving older individuals in the planning and service area involved.

`(d) RELATIONSHIP TO OTHER FUNDING SOURCES- Funds made available under this part shall supplement, and not supplant, any Federal, State, and local funds expended by a State or unit of general purpose local government (including an area agency on aging) to provide the services described in subsection (a).'.

SEC. 104. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH SCREENING AND TREATMENT SERVICES TO OLDER INDIVIDUALS LIVING IN RURAL AREAS.

The Older Americans Act of 1965 (42 U.S.C. 3001 et seq.) is amended--

(1) by inserting before section 401 (42 U.S.C. 3031) the following:

`TITLE IV--GRANTS FOR EDUCATION, TRAINING, AND RESEARCH';

and

(2) in part A of title IV (42 U.S.C. 3032 et seq.), by adding at the end the following:

`SEC. 422. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH SCREENING AND TREATMENT SERVICES TO OLDER INDIVIDUALS LIVING IN RURAL AREAS.

`(a) DEFINITION- In this section, the term `rural area' means--

`(1) any area that is outside a metropolitan statistical area (as defined by the Director of the Office of Management and Budget); or

`(2) such similar area as the Secretary specifies in a regulation issued under section 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(2)(D)).

`(b) AUTHORITY- The Assistant Secretary shall make grants to eligible public agencies and nonprofit private organizations to pay part or all of the cost of developing or operating model health care service projects involving the provision of mental health screening and treatment services to older individuals residing in rural areas.

`(c) DURATION- Grants made under this section shall be made for 3-year periods.

`(d) APPLICATION- To be eligible to receive a grant under this section, a public agency or nonprofit private organization shall submit to the Assistant Secretary an application containing such information and assurances as the Secretary may require, including--

`(1) information describing--

`(A) the geographic area and target population (including the racial and ethnic composition of the target population) to be served by the project; and

`(B) the nature and extent of the applicant's experience in providing mental health screening and treatment services of the type to be provided in the project;

`(2) assurances that the applicant will carry out the project--

`(A) through a multidisciplinary team of licensed mental health professionals;

`(B) using evidence-based intervention and treatment protocols to the extent such protocols are available;

`(C) using telecommunications technologies as appropriate and available; and

`(D) in coordination with other providers of health care and social services (such as senior centers and adult day care providers) serving the area; and

`(3) assurances that the applicant will conduct and submit to the Assistant Secretary such evaluations and reports as the Assistant Secretary may require.

`(e) REPORTS- The Assistant Secretary shall prepare and submit to the appropriate committees of Congress a report that includes summaries of the evaluations and reports required under subsection (d)(3).

`(f) COORDINATION- The Assistant Secretary shall provide for appropriate coordination of programs and activities receiving funds pursuant to a grant under this section with programs and activities receiving funds pursuant to grants under sections 381 and 423, and sections 520K and 520L of the Public Health Service Act.'.

SEC. 105. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH SCREENING AND TREATMENT SERVICES TO OLDER INDIVIDUALS LIVING IN NATURALLY OCCURRING RETIREMENT COMMUNITIES IN URBAN AREAS.

Part A of title IV of the Older Americans Act of 1965 (42 U.S.C. 3032 et seq.), as amended by section 104, is further amended by adding at the end the following:

`SEC. 423. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH SCREENING AND TREATMENT SERVICES TO OLDER INDIVIDUALS LIVING IN NATURALLY OCCURRING RETIREMENT COMMUNITIES IN URBAN AREAS.

`(a) DEFINITIONS- In this section:

`(1) NATURALLY OCCURRING RETIREMENT COMMUNITY- The term `naturally occurring retirement community' means a residential area (such as an apartment building, housing complex or development, or neighborhood) not originally built for older individuals but in which a substantial number of individuals have aged in place (and become older individuals) while residing in such area.

`(2) URBAN AREA- The term `urban area' means--

`(A) a metropolitan statistical area (as defined by the Director of the Office of Management and Budget); or

`(B) such similar area as the Secretary specifies in a regulation issued under section 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(2)(D)).

`(b) AUTHORITY- The Assistant Secretary shall make grants to eligible public agencies and nonprofit private organizations to pay part or all of the cost of developing or operating model health care service projects involving the provision of mental health screening and treatment services to older individuals residing in naturally occurring retirement communities located in urban areas.

`(c) DURATION- Grants made under this section shall be made for 3-year periods.

`(d) APPLICATION- To be eligible to receive a grant under this section, a public agency or nonprofit private organization shall submit to the Assistant Secretary an application containing such information and assurances as the Secretary may require, including--

`(1) information describing--

`(A) the naturally occurring retirement community and target population (including the racial and ethnic composition of the target population) to be served by the project; and

`(B) the nature and extent of the applicant's experience in providing mental health screening and treatment services of the type to be provided in the project;

`(2) assurances that the applicant will carry out the project--

`(A) through a multidisciplinary team of licensed mental health professionals;

`(B) using evidence-based intervention and treatment protocols to the extent such protocols are available; and

`(C) in coordination with other providers of health care and social services serving the retirement community; and

`(3) assurances that the applicant will conduct and submit to the Assistant Secretary such evaluations and reports as the Assistant Secretary may require.

`(e) REPORTS- The Assistant Secretary shall prepare and submit to the appropriate committees of Congress a report that includes summaries of the evaluations and reports required under subsection (d)(3).

`(f) COORDINATION- The Assistant Secretary shall provide for appropriate coordination of programs and activities receiving funds pursuant to grants made under this section with programs and activities receiving funds pursuant to grants made under sections 381 and 422, and sections 520K and 520L of the Public Health Service Act.'.

TITLE II--PUBLIC HEALTH SERVICE ACT AMENDMENTS

SEC. 201. DEMONSTRATION 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 subsection (b) of section 520(b) (42 U.S.C. 290bb-31(b))--

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

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

(C) by adding at the end the following:

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

(2) by adding at the end the following:

`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 award grants to public and private nonprofit entities for 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 be eligible for a grant under this section, the project to be carried out by the entity shall provide for collaborative care within a primary care setting, involving psychiatrists, psychologists, and other licensed mental health professionals (such as social workers and advanced practice nurses) 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;

`(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- In awarding grants under this section the Secretary, to the extent feasible, shall ensure that--

`(1) projects are funded in a variety of geographic areas, including urban and rural areas; and

`(2) a variety of populations, including racial and ethnic minorities and low-income populations, are served by projects funded under this section.

`(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- To be eligible 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 July 31 of each calendar year, the Secretary shall submit to Congress a report evaluating the projects receiving awards under this section for such year.

`(g) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated such sums as may be necessary to carry out this section for fiscal year 2005 and each fiscal year thereafter.'.

SEC. 202. 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 201, is further amended by adding at the end the following:

`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 award 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- To be eligible to receive 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 individuals (including, but not limited to, mood and anxiety disorders, dementias of all kinds, psychotic disorders, and substance and alcohol abuse), 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, and medical providers at the site or sites where the team is based in order to--

`(A) improve patient outcomes; and

`(B) to assure, 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- 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 of 1965,

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- In awarding grants under this section the Secretary, to the extent feasible, shall ensure that--

`(1) projects are funded in a variety of geographic areas, including urban and rural areas; and

`(2) a variety of populations, including racial and ethnic minorities and low-income populations, are served by projects funded under this section.

`(e) APPLICATION- To be eligible to receive a grant under this section, an entity shall--

`(1) submit an application to the Secretary (in such form, containing such information, 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) COORDINATION- The Secretary shall provide for appropriate coordination of programs and activities receiving funds pursuant to a grant under this section with programs and activities receiving funds pursuant to grants under section 520K and sections 381, 422, and 423 of the Older Americans Act of 1965.

`(g) EVALUATION- Not later than July 31 of each calendar year, the Secretary shall submit to Congress a report evaluating the projects receiving awards under this section for such year.

`(h) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated such sums as may be necessary to carry out this section for fiscal year 2005 and each fiscal year thereafter.'.

SEC. 203. DESIGNATION OF DEPUTY DIRECTOR FOR OLDER ADULT 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--

(1) by redesignating subsection (c) as subsection (d); and

(2) by inserting after subsection (b) the following:

`(c) DEPUTY DIRECTOR FOR OLDER ADULT MENTAL HEALTH SERVICES IN CENTER FOR MENTAL HEALTH SERVICES- The Director, after consultation with the Administrator, shall designate a Deputy Director for Older Adult 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 care givers serving older adults.'.

SEC. 204. 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. 269aa-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.'.

SEC. 205. 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. 206. CRITERIA FOR STATE PLANS UNDER COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANTS.

(a) IN GENERAL- Section 1912(b)(4) of the Public Health Service Act (42 U.S.C. 300x-1(b)(4)) is amended to read as follows:

`(4) TARGETED SERVICES TO OLDER INDIVIDUALS, INDIVIDUALS WHO ARE HOMELESS, AND INDIVIDUALS LIVING IN RURAL AREAS- The plan describes the State's outreach to and services for older individuals, individuals who are homeless, and individuals living in rural areas, and how community-based services will be provided to these individuals.'.

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

END