S 2182
110th CONGRESS
1st Session
S. 2182
To amend the Public Health Service Act with respect to mental
health services.
IN THE SENATE OF THE UNITED STATES
October 17, 2007
Mr. REED (for himself and Mr. SMITH) introduced the following bill;
which was read twice and referred to the Committee on Health, Education,
Labor, and Pensions
A BILL
To amend the Public Health Service Act with respect to mental
health services.
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 `Community Mental Health Services Improvement
Act'.
SEC. 2. FINDINGS.
(1) almost 60,000,000 Americans, or one in four adults and one in
five children, have a mental illness that can be diagnosed and treated
in a given year;
(2) mental illness costs our economy more than $80,000,000,000 annually,
accounting for 15 percent of the total economic burden of disease;
(3) alcohol and drug abuse contributes to the death of more than 100,000
people and costs society upwards of half a trillion dollars a year;
(4) individuals with serious mental illness die on average 25 years
sooner than individuals in the general population; and
(5) community mental and behavioral health organizations provide cost-efficient
and evidence-based treatment and care for millions of Americans with
mental illness and addiction disorders.
SEC. 3. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED
MENTAL HEALTH 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 by adding at the end the following:
`SEC. 520K. GRANTS FOR CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED
MENTAL HEALTH SETTINGS.
`(a) Definitions- In this section:
`(1) ELIGIBLE ENTITY- The term `eligible entity' means a qualified
community mental health program defined under section 1913(b)(1).
`(2) SPECIAL POPULATIONS- The term `special populations' refers to
the following 3 groups:
`(A) Children and adolescents with mental and emotional disturbances
who have co-occurring primary care conditions and chronic diseases.
`(B) Adults with mental illnesses who have co-occurring primary
care conditions and chronic diseases.
`(C) Older adults with mental illnesses who have co-occurring primary
care conditions and chronic diseases.
`(b) Program Authorized- The Secretary, acting through the Administrator
of the Substance Abuse and Mental Health Services Administration and
in coordination with the Director of the Health Resources and Services
Administration, shall award grants to eligible entities to establish
demonstration projects for the provision of coordinated and integrated
services to special populations through the co-location of primary and
specialty care services in community-based mental and behavioral health
settings.
`(c) Application- To be eligible to receive a grant under this section,
an eligible entity shall submit an application to the Administrator
at such time, in such manner, and accompanied by such information as
the Administrator may require. Each such application shall include--
`(1) an assessment of the primary care needs of the patients served
by the eligible entity and a description of how the eligible entity
will address such needs; and
`(2) a description of partnerships, cooperative agreements, or other
arrangements with local primary care providers, including community
health centers, to provide services to special populations.
`(1) IN GENERAL- For the benefit of special populations, an eligible
entity shall use funds awarded under this section for--
`(A) the provision, by qualified primary care professionals on a
reasonable cost basis, of--
`(i) primary care services on site at the eligible entity;
`(ii) diagnostic and laboratory services; or
`(iii) adult and pediatric eye, ear, and dental screenings;
`(B) reasonable costs associated with medically necessary referrals
to qualified specialty care professionals as well as to other coordinators
of care or, if permitted by the terms of the grant, for the provision,
by qualified specialty care professionals on a reasonable cost basis
on site at the eligible entity, of--
`(i) endocrinology services;
`(iii) pulmonary/respiratory services; or
`(iv) cardiovascular services;
`(C) information technology required to accommodate the clinical
needs of primary and specialty care professionals; or
`(D) facility improvements or modifications needed to bring primary
and specialty care professionals on site at the eligible entity.
`(2) LIMITATION- Not to exceed 15 percent of grant funds may be used
for activities described in subparagraphs (C) and (D) of paragraph
(1).
`(e) Geographic Distribution- The Secretary shall ensure that grants
awarded under this section are equitably distributed among the geographical
regions of the United States and between urban and rural populations.
`(f) Evaluation- Not later than 3 months after a grant or cooperative
agreement awarded under this section expires, an eligible entity shall
submit to the Secretary the results of an evaluation to be conducted
by the entity concerning the effectiveness of the activities carried
out under the grant or agreement.
`(g) Report- Not later than 5 years after the date of enactment of this
section, the Secretary shall prepare and submit to the appropriate committees
of Congress a report that shall evaluate the activities funded under
this section. The report shall include an evaluation of the impact of
co-locating primary and specialty care in community mental and behavioral
health settings on overall patient health status and recommendations
on whether or not the demonstration program under this section should
be made permanent.
`(h) Authorization of Appropriations- There are authorized to be appropriated
to carry out this section, $50,000,0000 for fiscal year 2009 and such
sums as may be necessary for each of fiscal years 2010 through 2013.'.
SEC. 4. INTEGRATING TREATMENT FOR MENTAL HEALTH AND SUBSTANCE ABUSE
CO-OCCURRING DISORDERS.
Section 520I of the Public Health Service Act (42 U.S.C. 290bb-40) is
amended--
(1) by striking subsection (i) and inserting the following:
`(j) Funding- The Secretary shall make available to carry out this section,
$14,000,000 for fiscal year 2009, $20,000,000 for fiscal year 2010,
and such sums as may be necessary for each of fiscal years 2011 through
2013. Such sums shall be made available in equal amount from amounts
appropriated under sections 509 and 520A.'; and
(2) by inserting before subsection (j), the following:
`(i) Community Mental Health Program- For purposes of eligibility under
this section, the term `private nonprofit organization' includes a qualified
community mental health program as defined under section 1913(b)(1).'.
SEC. 5. IMPROVING THE MENTAL HEALTH WORKFORCE.
(a) National Health Service Corps- Section 332(a) of the Public Health
Service Act (42 U.S.C. 254e(a)) is amended--
(1) in paragraph (1), by inserting after `that meet the requirements
of section 334' the following: `and qualified community mental health
programs as defined in section 1913(b)(1),'; and
(2) in paragraph (2)(A), by striking `community mental health center,'.
(b) Recruitment and Retention of Mental Health Professionals- Subpart
X of part D of title III of the Public Health Service Act (42 U.S.C.
256f et seq.) is amended by adding at the end the following:
`SEC. 340H. GRANTS FOR RECRUITMENT AND RETENTION OF MENTAL HEALTH
PROFESSIONALS.
`(a) Establishment- The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall award grants
to States, territories, and Indian tribes or tribal organizations for
innovative programs to address the behavioral and mental health workforce
needs of designated mental health professional shortage areas.
`(b) Use of Funds- An eligible entity shall use grant funds awarded
under this section for--
`(1) loan forgiveness and repayment programs (to be carried out in
a manner similar to the loan repayment programs carried out under
subpart III of part D) for behavioral and mental health professionals
who--
`(A) agree to practice in designated mental health professional
shortage areas;
`(B) are graduates of programs in behavioral or mental health;
`(C) agree to serve in community-based non-profit entities, or as
public mental health professionals for the Federal, State or local
government; and
`(i) provide services to patients regardless of such patients'
ability to pay; and
`(ii) use a sliding payment scale for patients who are unable
to pay the total cost of services;
`(2) behavioral and mental health professional recruitment and retention
efforts, with a particular emphasis on candidates from racial and
ethnic minority and medically-underserved communities;
`(3) grants or low-interest or no-interest loans for behavioral and
mental health professionals who participate in the Medicaid program
under title XIX of the Social Security Act to establish or expand
practices in designated mental health professional shortage areas,
or to serve in qualified community mental health programs as defined
in section 1913(b)(1);
`(4) placement and support for behavioral and mental health students,
residents, trainees, and fellows or interns; or
`(5) continuing behavioral and mental health education, including
distance-based education.
`(1) IN GENERAL- Each eligible entity desiring a grant under this
section shall submit an application to the Secretary at such time,
in such manner, and containing such information as the Secretary may
reasonably require.
`(2) ASSURANCES- The application shall include assurances that the
applicant will meet the requirements of this subsection and that the
applicant possesses sufficient infrastructure to manage the activities
to be funded through the grant and to evaluate and report on the outcomes
resulting from such activities.
`(d) Matching Requirement- The Secretary may not make a grant to an
eligible entity under this section unless that entity agrees that, with
respect to the costs to be incurred by the entity in carrying out the
activities for which the grant was awarded, the entity will provide
non-Federal contributions in an amount equal to not less than 35 percent
of Federal funds provided under the grant. The entity may provide the
contributions in cash or in kind, fairly evaluated, including plant,
equipment, and services, and may provide the contributions from State,
local, or private sources.
`(e) Supplement Not Supplant- A grant awarded under this section shall
be expended to supplement, and not supplant, the expenditures of the
eligible entity and the value of in-kind contributions for carrying
out the activities for which the grant was awarded.
`(f) Geographic Distribution- The Secretary shall ensure that grants
awarded under this section are equitably distributed among the geographical
regions of the United States and between urban and rural populations.
`(g) Evaluation- Not later than 3 months after a grant awarded under
this section expires, an eligible entity shall submit to the Secretary
the results of an evaluation to be conducted by the entity concerning
the effectiveness of the activities carried out under the grant.
`(h) Report- Not later than 5 years after the date of enactment of this
section, the Secretary shall prepare and submit to the appropriate committees
of Congress a report containing data relating to whether grants provided
under this section have increased access to behavioral and mental health
services in designated mental health professional shortage areas.
`(i) Authorization of Appropriations- There is authorized to be appropriated
to carry out this section, $10,000,000 for fiscal year 2009, and such
sums as may be necessary for each of fiscal years 2010 through 2013.'.
(c) Behavioral and Mental Health Education and Training Programs- Part
A of title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended by adding at the end the following:
`SEC. 506C. GRANTS FOR BEHAVIORAL AND MENTAL HEALTH EDUCATION AND
TRAINING PROGRAMS.
`(a) Definition- For the purposes of this section, the term `related
mental health personnel' means an individual who--
`(1) facilitates access to a medical, social, educational, or other
service; and
`(2) is not a mental health professional, but who is the first point
of contact with persons who are seeking mental health services.
`(b) Establishment- The Secretary, acting through the Administrator
of the Substance Abuse and Mental Health Services Administration, shall
establish a program to increase the number of trained behavioral and
mental health professionals and related mental health personnel by awarding
grants on a competitive basis to mental and behavioral health nonprofit
organizations or accredited institutions of higher education to enable
such entities to establish or expand accredited mental and behavioral
health education programs.
`(1) IN GENERAL- Each eligible entity desiring a grant under this
section shall submit an application to the Secretary at such time,
in such manner, and containing such information as the Secretary may
reasonably require.
`(2) ASSURANCES- The application shall include assurances that the
applicant will meet the requirements of this subsection and that the
applicant possesses sufficient infrastructure to manage the activities
to be funded through the grant and to evaluate and report on the outcomes
resulting from such activities.
`(d) Priority- In awarding grants under this section, the Secretary
shall give priority to applicants that--
`(1) demonstrate a familiarity with the use of evidenced-based methods
in behavioral and mental health services;
`(2) provide interdisciplinary training experiences; and
`(3) demonstrate a commitment to training methods and practices that
emphasize the integrated treatment of mental health and substance
abuse disorders.
`(e) Use of Funds- Funds awarded under this section shall be used to--
`(1) establish or expand accredited behavioral and mental health education
programs, including improving the coursework, related field placements,
or faculty of such programs; or
`(2) establish or expand accredited mental and behavioral health training
programs for related mental health personnel.
`(f) Requirements- The Secretary may award a grant to an eligible entity
only if such entity agrees that--
`(1) any behavioral or mental health program assisted under the grant
will prioritize cultural competency and the recruitment of trainees
from racial and ethnic minority and medically-underserved communities;
and
`(2) with respect to any violation of the agreement between the Secretary
and the entity, the entity will pay such liquidated damages as prescribed
by the Secretary.
`(g) Geographic Distribution- The Secretary shall ensure that grants
awarded under this section are equitably distributed among the geographical
regions of the United States and between urban and rural populations.
`(h) Evaluation- Not later than 3 months after a grant awarded under
this section expires, an eligible entity shall submit to the Secretary
the results of an evaluation to be conducted by the entity concerning
the effectiveness of the activities carried out under the grant.
`(i) Report- Not later than 5 years after the date of enactment of this
section, the Secretary shall prepare and submit to the appropriate committees
of Congress a report containing data relating to whether grants provided
under this section have increased access to behavioral and mental health
services in designated mental health professional shortage areas.
`(j) Authorization of Appropriations- There is authorized to be appropriated
to carry out this section $4,000,0000 for fiscal year 2009, and such
sums as may be necessary for each of fiscal years 2010 through 2013.'.
SEC. 6. IMPROVING ACCESS TO MENTAL HEALTH SERVICES IN MEDICALLY-UNDERSERVED
AREAS.
Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb-31 et seq.) is amended by inserting after section 520A
the following:
`SEC. 520B. GRANTS FOR TELE-MENTAL HEALTH IN MEDICALLY-UNDERSERVED
AREAS.
`(a) Program Authorized- The Secretary, acting through the Administrator
of the Substance Abuse and Mental Health Services Administration, shall
award grants to eligible entities to provide tele-mental health in medically-underserved
areas.
`(b) Eligible Entity- To be eligible for assistance under the program
under subsection (a), an entity shall be a qualified community mental
health program (as defined in section 1913(b)(1)).
`(1) IN GENERAL- Each eligible entity desiring a grant under this
section shall submit an application to the Secretary at such time,
in such manner, and containing such information as the Secretary may
reasonably require.
`(2) ASSURANCES- The application shall include assurances that the
applicant will meet the requirements of this subsection and that the
applicant possesses sufficient infrastructure to manage the activities
to be funded through the grant and to evaluate and report on the outcomes
resulting from such activities.
`(d) Use of Funds- An eligible entity shall use funds received under
a grant under this section for--
`(1) the provision of tele-mental health services; or
`(2) infrastructure improvements for the provision of tele-mental
health services.
`(e) Geographic Distribution- The Secretary shall ensure that grants
awarded under this section are equitably distributed among the geographical
regions of the United States and between urban and rural populations.
`(f) Evaluation- Not later than 3 months after a grant awarded under
this section expires, an eligible entity shall submit to the Secretary
the results of an evaluation to be conducted by the entity concerning
the effectiveness of the activities carried out under the grant.
`(g) Report- Not later than 5 years after the date of enactment of this
section, the Secretary shall prepare and submit to the appropriate committees
of Congress a report that shall evaluate the activities funded under
this section.
`(h) Authorization of Appropriations- There are authorized to be appropriated
to carry out this section $20,000,000 for fiscal year 2009, and such
sums as may be necessary for each of fiscal years 2010 through 2013.'.
SEC. 7. IMPROVING HEALTH INFORMATION TECHNOLOGY FOR MENTAL HEALTH
PROVIDERS.
Part A of title V of the Public Health Service Act (42 U.S.C. 290aa
et seq.), as amended by section 5(c), is further amended by adding at
the end the following:
`SEC. 506D. IMPROVING HEALTH INFORMATION TECHNOLOGY FOR MENTAL HEALTH
PROVIDERS.
`(a) In General- The Secretary, in consultation with the Secretary of
Veterans Affairs, shall collaborate with the Administrator of the Substance
Abuse and Mental Health Services Administration and the National Coordinator
for Health Information Technology to--
`(1) develop and implement a plan for ensuring that various components
of the National Health Information Infrastructure, including data
and privacy standards, electronic health records, and community and
regional health networks, address the needs of mental health and substance
abuse treatment providers; and
`(2) finance related infrastructure improvements, technical support,
personnel training, and ongoing quality improvements.
`(b) Authorization of Appropriations- There are authorized to be appropriated
to carry out this section $10,000,000 for fiscal year 2009, and such
sums as may be necessary for each of fiscal years 2010 through 2013.'.
SEC. 8. PAPERWORK REDUCTION STUDY.
(a) In General- Not later than 12 months after the date of enactment
of this Act, the Institute of Medicine shall submit to the appropriate
committees of Congress a report that evaluates the combined paperwork
burden of qualified community mental health programs as defined in section
1913(b)(1) of the Public Health Service Act.
(b) Scope- In preparing the report under subsection (a), the Institute
of Medicine shall examine licensing, certification, service definitions,
claims payment, billing codes, and financial auditing requirements utilized
by the Office of Management and Budget, the Centers for Medicare &
Medicaid Services, the Health Resources and Services Administration,
the Substance Abuse and Mental Health Services Administration, the Office
of the Inspector General, State Medicaid agencies, State departments
of health, State departments of education, and State and local juvenile
justice and social service agencies to--
(1) establish an estimate of the combined nationwide cost of complying
with the requirements described in this paragraph, in terms of both
administrative funding and staff time;
(2) establish an estimate of the per capita cost to each qualified
community mental health program defined in section 1913(b)(1) of the
Public Health Service Act to comply with the requirements of this
paragraph, in terms of both administrative funding and staff time;
and
(3) make administrative and statutory recommendations to Congress,
which may include a uniform methodology, to reduce the paperwork burden
experienced by qualified community mental health programs defined
in section 1913(b)(1) of the Public Health Service Act.
(c) Authorization of Appropriations- There are authorized to be appropriated
to carry out this section $550,000 for each of fiscal years 2009 and
2010.
SEC. 9. WAGE STUDY.
(a) In General- Not later than 12 months after the date of enactment
of this Act, the Institute of Medicine shall conduct a nationwide analysis,
and submit a report to the appropriate committees of Congress, concerning
the compensation structure of professional and paraprofessional personnel
employed by qualified community mental health programs as defined under
section 1913(b)(1) of the Public Health Service Act, as compared with
the compensation structure of comparable health safety net providers
and relevant private sector health care employers.
(b) Scope- In preparing the report under subsection (a), the Institute
of Medicine shall examine compensation disparities, if such disparities
are determined to exist, by type of personnel, type of provider or private
sector employer, and geographic region.
(c) Authorization of Appropriations- There are authorized to be appropriated
to carry out this section, $550,000 for each of fiscal years 2009 and
20l0.
END
