To amend the Public Health Service Act to establish a State family support grant program to end the practice of parents giving legal custody of their seriously emotionally disturbed children to State agencies for the purpose of obtaining mental health services for those children.

February 15, 2005

Mr. RAMSTAD (for himself, Mr. STARK, Mrs. JOHNSON of Connecticut, Mr. KENNEDY of Rhode Island, and Mr. CASTLE) introduced the following bill; which was referred to the Committee on Energy and Commerce

To amend the Public Health Service Act to establish a State family support grant program to end the practice of parents giving legal custody of their seriously emotionally disturbed children to State agencies for the purpose of obtaining mental health services for those children.

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 `Keeping Families Together Act'.

SEC. 2. PURPOSE.

It is the purpose of this Act to assist States in eliminating the practice of parents giving custody of their seriously emotionally disturbed children to State agencies for the purpose of securing mental health care for those children.

SEC. 3. FAMILY SUPPORT GRANTS.

Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is amended--

(1) by redesignating the second part G (relating to services provided through religious organizations) as part J;

(2) by redesignating sections 581 through 584 of part J (as so redesignated) as sections 596 through 596C, respectively; and

(3) by adding at the end the following:

`PART K--FAMILY SUPPORT

`SEC. 597. FAMILY SUPPORT GRANTS.

`(a) In General- The Secretary, acting through the Administrator and in consultation with the task force established under section 597A, is authorized to award competitive grants to States to enable such States to establish systems of care to treat and provide services to all eligible children and youth. The Secretary shall ensure that the amount awarded to each grantee is sufficient to enable the grantee to accomplish the purposes of the grant.

`(b) Eligibility- To be eligible for a grant under subsection (a) a State shall--

`(1) have laws or policies in effect to ensure that children receive appropriate mental health services so that parents do not have to relinquish legal custody of such children;

`(2) submit to the Secretary an application from the Governor in accordance with subsection (c);

`(3) provide assurances that the State will provide matching funds in accordance with subsection (e); and

`(4) meet such other requirements as the Secretary determines appropriate.

`(c) Application-

`(1) IN GENERAL- An application submitted for a grant under this section shall include--

`(A) a brief description of the system of care that the State intends to establish with amounts received under the grant to ensure that eligible children and youth and their families receive the appropriate individualized mental health treatment and family support services necessary to keep such families together;

`(B) a description of the process by which the State will formulate a State plan that meets the requirements of paragraph (2), including participants, timelines, and any previous or ongoing efforts related to the establishment of a statewide system;

`(C) an estimate of the number of eligible children and youth in the State, and the number of eligible children and youth who will be served under the grant;

`(D) a description of existing systems of care in the State (including systems funded under section 561) and existing interagency collaboration that demonstrates a foundation on which the State can build a system of care under a grant under this section;

`(E) a brief description of the manner in which services for all eligible children and youth are expected to be funded under the system established by the State under the grant;

`(F) a description of children's mental health services capacity in the State and the steps that will be taken, if necessary, to ensure that adequate capacity exists to implement the proposed system of care;

`(G) a description of the source of the State matching funds; and

`(H) other information as required by the Secretary.

`(2) STATE PLAN- Prior to receiving funds under the grant for the second grant year, a State shall submit to the Secretary and the Secretary shall approve, a State plan that--

`(A) is developed through a collaborative process that includes the required State partners as represented by senior officials with policymaking authority, the required private partners, and other entities that the governor of the State determines appropriate;

`(B) contains a description and assessment of the effectiveness of the laws or policies that the State has in effect to ensure that children receive appropriate mental health services and that parents do not have to relinquish legal custody of such children in order to obtain such services;

`(C) contains a description of the services to be provided to eligible children and youth and the sources of such services, including the extent to which the State will build upon existing systems of care within the State;

`(D) contains a description of the procedures to be implemented for the early identification, assessment, and referral, by health care providers, mental health agencies, other child-serving entities, child welfare, corrections, and juvenile justice systems, of all eligible children and youth for appropriate care and for coordinating services among child welfare, juvenile justice, and child mental health agencies, including co-location of services as appropriate;

`(E) describes any legislative changes that are required to implement the State plan;

`(F) describes how the State screens children and youth entering the juvenile justice and child welfare systems for mental health problems, including the State's mental health screening procedures as part of the early and periodic screening, diagnostic, and treatment services described in section 1905(r) of the Social Security Act that are provided under the medicaid programs;

`(G) contains a description of the plan of the State for ensuring that there will be adequate capacity to serve all eligible children;

`(H) contains a description of the plan of the State for financing the system of care developed under the grant, including--

`(i) the manner in which the State will use--

`(I) contributions from State agencies;

`(II) State eligibility options or waivers authorized with respect to the State medicaid program such as those authorized under sections 1902(e)(3) and 1915(c) of the Social Security Act;

`(III) the State Children's Health Insurance Program under title XXI of the Social Security Act (including an assurance that grant funds will not be used as a State match under the medicaid or SCHIP programs); and

`(IV) other public health insurance mechanisms; and

`(ii) how Federal grant dollars will be used to enable the State to achieve a sustainable system of care to serve all eligible children and youth;

`(I) contains a description of how the State will provide outreach services to families, provide for public educational activities, and involve families; and

`(J) establishes a method for tracking and reporting the number of children and youth entering child welfare and juvenile justice systems with significant mental health problems.

`(3) PRIORITY- In awarding grants under this section, the Secretary shall give priority to States--

`(A) that have a history of developing and supporting local or statewide systems care and of successful interagency collaboration;

`(B) that have taken steps to broaden access to community-based services for children with serious emotional disturbances;

`(C) that have provided reasonable estimates of the numbers of eligible children and youth;

`(D) that have sufficient mental health service capacity or specific plans for sufficiently increasing mental health services capacity to successfully implement the proposed system of care;

`(E) in which the governor's office will play a leading role in the formulation of the State plan required under paragraph (2); and

`(F) that will involve State juvenile and family court judges in the planning and oversight of the system of care.

`(d) Use of Funds- A State shall use amounts received under a grant under this section to--

`(1) establish State- and local-level infrastructure to allow for interagency cooperation and cross system financing to--

`(A) support the purchase and delivery of a comprehensive array of community-based mental health and family support services to all eligible children and youth and their families;

`(B) decrease categorical funding structures and eliminate inter-agency fragmentation of services; and

`(C) increase the capacity of agencies to share public resources and improve parental access to services for children with mental health needs to eliminate the need to relinquish custody in order to receive treatment;

`(2) expand public health insurance programs to cover a comprehensive array of community-based mental health and family support services for eligible children and youth and their families that will be sustainable after the grant has expired;

`(3) deliver mental health care and family support services to eligible children and youth and their families as part of a transition to a sustainable system of care for such children and youth;

`(4) provide outreach and public education concerning programs and activities funded under this section;

`(5) provide training and professional development for personnel who work with eligible children and youth as required to successfully implement the State plan; and

`(6) carry out other administrative activities related to the programs and activities carried out under the grant, including the development and maintenance of data systems.

`(e) Matching Funds-

`(1) IN GENERAL- A State that receives a grant under this section shall, with respect to the costs to be incurred by the State in carrying out the purpose for which the grant is awarded, make available non-Federal contributions toward such costs in an amount that--

`(A) for the third fiscal year for which the entity receives payments from a grant under such subsection, is not less than $1 for each $2 of Federal funds provided in the grant;

`(B) for the fourth such fiscal year, is not less than $1 for each $1 of Federal funds provided in the grant; and

`(C) for the fifth and sixth such fiscal years, is not less than $2 for each $1 of Federal funds provided in the grant.

`(2) DETERMINATION OF AMOUNT CONTRIBUTED- Non-Federal contributions required in paragraph (1) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions.

`(3) ACCOUNTING REQUIRED- With respect to a State that complies with the requirement of paragraph (2) through the provision of in-kind contributions, such State shall provide the Secretary with an accounting that describes the value of such in-kind contributions.

`(f) Limitation on Use for Administrative Costs- Not more than 5 percent of the amount that a State receives under a grant under this section shall be used for administrative costs.

`(g) Payments- Grants under this section shall be payable over a 6-year period.

`(h) Reporting Requirements-

`(1) IN GENERAL- The Secretary, acting through the Administrator and in consultation with the task force established under section 597A, shall require States to report information that is appropriate to permit an assessment to be made of the success of States in the implementation of programs under this section. Such information shall, at a minimum, include--

`(A) the number of eligible children and youth in foster care;

`(B) the number of eligible children and youth in residential treatment centers;

`(C) appropriate information concerning the participation and academic progress of eligible children and youth in school;

`(D) measures of the contacts of eligible children and youth with juvenile justice systems;

`(E) measures of the clinical improvement of eligible children and youth; and

`(F) information concerning the level of satisfaction of eligible children and youth and their families with services received.

`(2) ANNUAL REPORT BY STATES- Beginning with the second fiscal year in which a State receives funding under a grant under this section, the State shall annually report to the Secretary on the success of the programs and activities carried out by the State under the grant. Such reports shall include the information specified in paragraph (1) and other information required by the Secretary.

`(3) REPORTS BY THE SECRETARY-

`(A) IN GENERAL- Not later than 3 years after the date of enactment of this part, the Secretary shall submit to Congress a report on the success of States in using grants under this section to eliminate children and youth custody relinquishment solely to obtain mental health care. Such report shall include recommendations to strengthen the program under this section.

`(B) FINAL REPORT- Not later than 6 years after the date of enactment of this part, the Secretary shall submit to Congress a final report on the success of States in using grants under this section to eliminate children and youth custody relinquishment solely to obtain mental health care.

`(i) Technical Assistance- The Secretary, in consultation with the task force established under section 597A, may provide technical assistance to States in carrying out programs and activities under this section. The Secretary shall use not more than 20 percent of the amount appropriate for each fiscal year, not to exceed $5,000,000 in any such fiscal year, to carry out this subsection and shall coordinate technical assistance under this section with other technical assistance programs as appropriate.

`(j) Definitions- In this section:

`(1) ELIGIBLE CHILDREN AND YOUTH- The term `eligible children and youth' means children and youth under the age of 21 years who are in the custody of the State for the purpose of receiving mental health services or at-risk of entering into the custody of the State for the purpose of receiving mental health services.

`(2) FAMILY SUPPORT SERVICES- The term `family support services' means individualized services that are designed with input from the family and provided to eligible children and youth and their families to promote the mental health of an eligible child or youth, to strengthen the ability of family members to care for an eligible child or youth, or to enable an eligible child or youth to take advantage of other treatment and family support services.

`(3) REQUIRED PRIVATE PARTNERS- The term `required private partners' includes--

`(A) representatives of families of seriously emotionally disturbed children;

`(B) representatives of mental health care providers;

`(C) representatives of private health insurers; and

`(D) representatives of hospitals and residential care facilities.

`(4) REQUIRED STATE PARTNERS- The term `required State partners' with respect to a State includes--

`(A) the State agency responsible for children's mental health;

`(B) the State child welfare agency;

`(C) the State juvenile justice agency;

`(D) the State Medicaid agency;

`(E) the State education agency;

`(F) the State substance abuse agency;

`(G) the State bureau of insurance; and

`(H) the office of the Governor of the State.

`(5) STATE- The term `State' includes, in addition to the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the Trust Territory of the Pacific Islands, and Indian tribes.

`(k) Authorization of Appropriations- There are authorized to be appropriated to carry out this section, $4,500,000 for fiscal year 2006, $6,500,000 for fiscal year 2007, and $11,000,000 for each of each of fiscal years 2008 through 2011.

`SEC. 597A. TASK FORCE.

`(a) Establishment- The Administrator, in conjunction with the Director of the Office of Juvenile Justice and Delinquency Prevention, the Administrator of the Administration for Children and Families, the Administrator of the Centers for Medicare & Medicaid Services, and the Assistant Secretary of Education for Special Education, shall establish and staff a task force to examine problems of mental health in the child welfare and juvenile justice systems and issues with respect to access by children and youth to mental health services, and the role of their agencies in promoting access by children and youth to mental health services.

`(b) Duties- The task force established under subsection (a) shall--

`(1) work with mental health and child advocates, representatives of families of eligible children and youth, and representatives of State systems of care to make recommendations to Congress concerning strategies to improve the delivery of mental health services, including prevention services, to children and youth with serious emotional disturbances, including those who are at risk of dropping out of school or at-risk of coming in contact with child welfare and juvenile justice systems;

`(2) work with mental health and child advocates, representatives of families of eligible children and youth, and representatives of State systems of care to develop improved reporting requirements for States concerning the number of children and youth entering child welfare and juvenile justice systems solely to access mental health services;

`(3) in consultation with States and appropriate stakeholders, create standard definitions for the categories of data to be collected on such children and youth;

`(4) foster interagency cooperation to eliminate the practice of custody relinquishment;

`(5) provide advice to the Administrator in implementation of the family support grant programs under section 597;

`(6) coordinate and deliver technical assistance to States and State agencies to help implement programs under such grant program;

`(7) make recommendations to break down barriers to coordination in existing Federal programs and to allow for more effective integration across agencies and programs; and

`(8) provide a biannual report to Congress on its recommendations and its progress in carrying out its duties, ending the practice of parents relinquishing legal custody of their children with serious emotional disturbances in order to obtain mental health services, and improving the delivery of mental health services to children with serious emotional disturbances.

`(c) Authorization of Appropriations- There are authorized to be appropriated to carry out this section, $1,000,000 for each of fiscal years 2006 through 2011. Of the amount appropriate for each fiscal year under this subsection, 60 percent of such amount shall be made available to the Secretary, 20 percent of such amount shall be made available to the Attorney General, and 20 percent of such amount shall be made available to the Secretary of Education.'.

SEC. 4. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED SERVICES WAIVERS.

(a) In General- Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is amended--

(1) in paragraph (1)--

(A) in the first sentence, by inserting `, or would require inpatient psychiatric hospital services for individuals under age 21,' after `intermediate care facility for the mentally retarded'; and

(B) in the second sentence, by inserting `, or would require inpatient psychiatric hospital services for individuals under age 21' before the period;

(2) in paragraph (2)(B), by striking `or services in an intermediate care facility for the mentally retarded' each place it appears and inserting `services in an intermediate care facility for the mentally retarded, or inpatient psychiatric hospital services for individuals under age 21';

(3) in paragraph (2)(C)--

(A) by inserting `, or who are determined to be likely to require inpatient psychiatric hospital services for individuals under age 21,' after `, or intermediate care facility for the mentally retarded'; and

(B) by striking `or services in an intermediate care facility for the mentally retarded' and inserting `services in an intermediate care facility for the mentally retarded, or inpatient psychiatric hospital services for individuals under age 21'; and

(4) in paragraph (7)(A)--

(A) by inserting `or would require inpatient psychiatric hospital services for individuals under age 21,' after `intermediate care facility for the mentally retarded,'; and

(B) by inserting `or who would require inpatient psychiatric hospital services for individuals under age 21' before the period.

(b) Effective Date- The amendments made by subsection (a) apply with respect to medical assistance provided on or after January 1, 2006.

END