[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1223 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1223

     To increase the number of well-trained mental health service 
  professionals (including those based in schools) providing clinical 
mental health care to children and adolescents, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 10, 2003

  Mr. Bingaman (for himself, Ms. Collins, Mr. Jeffords, and Mr. Dodd) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
     To increase the number of well-trained mental health service 
  professionals (including those based in schools) providing clinical 
mental health care to children and adolescents, 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 ``Child Health Care Crisis Relief 
Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Center for Mental Health Services estimates that 20 
        percent or 13,700,000 of the Nation's children and adolescents 
        have a diagnosable mental health disorder, and about \2/3\ of 
        these children and adolescents do not receive mental health 
        care.
            (2) According to ``Mental Health: A Report of the Surgeon 
        General'' in 1999, there are approximately 6,000,000 to 
        9,000,000 children and adolescents in the United States 
        (accounting for 9 to 13 percent of all children and adolescents 
        in the United States) who meet the definition for having a 
        serious emotional disturbance.
            (3) According to the Center for Mental Health Services, 
        approximately 5 to 9 percent of children and adolescents in the 
        United States meet the definition for extreme functional 
        impairment.
            (4) According to the Surgeon General's Report, there are 
        particularly acute shortages in the numbers of mental health 
        service professionals serving children and adolescents with 
        serious emotional disorders.
            (5) According to the National Center for Education 
        Statistics in the Department of Education, there are 
        approximately 513 students for each school counselor in United 
        States schools, which ratio is more than double the recommended 
        ratio of 250 students for each school counselor.
            (6) According to a year 2000 estimate of the Bureau of 
        Health Professions, the demand for the services of child and 
        adolescent psychiatry is projected to increase by 100 percent 
        by 2020.
            (7) The development and application of knowledge about the 
        impact of disasters on children, adolescents, and their 
        families has been impeded by critical shortages of qualified 
        researchers and practitioners specializing in this work.
            (8) According to the Bureau of the Census, the population 
        of children and adolescents in the United States under the age 
        of 18 is projected to grow by more than 40 percent, from 
        70,000,000 to more than 100,000,000 by 2050.

SEC. 3. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS TO IMPROVE CHILD AND 
              ADOLESCENT MENTAL HEALTH CARE.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.) is amended by adding at the end the following:

``SEC. 742. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS TO IMPROVE CHILD 
              AND ADOLESCENT MENTAL HEALTH CARE.

    ``(a) Loan Repayments for Child and Adolescent Mental Health 
Service Professionals.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may establish a program of entering into 
        contracts on a competitive basis with eligible individuals (as 
        defined in paragraph (2)) under which--
                    ``(A) the eligible individual agrees to be employed 
                full-time for a specified period of at least 2 years in 
                providing mental health services to children and 
                adolescents; and
                    ``(B) the Secretary agrees to make, during the 
                period of employment described in subparagraph (A), 
                partial or total payments on behalf of the individual 
                on the principal and interest due on the undergraduate 
                and graduate educational loans of the eligible 
                individual.
            ``(2) Eligible individual.--For purposes of this section, 
        the term `eligible individual' means an individual who--
                    ``(A) is receiving specialized training or clinical 
                experience in child and adolescent mental health in 
                psychiatry, psychology, school psychology, psychiatric 
                nursing, social work, school social work, marriage and 
                family therapy, school counseling, or professional 
                counseling and has less than 1 year remaining before 
                completion of such training or clinical experience; or
                    ``(B)(i) has a license in a State to practice 
                allopathic medicine, osteopathic medicine, psychology, 
                school psychology, psychiatric nursing, social work, 
                school social work, marriage and family therapy, school 
                counseling, or professional counseling; and
                    ``(ii)(I) is a mental health service professional 
                who completed (but not before the end of the calendar 
                year in which this section is enacted) specialized 
                training or clinical experience in child and adolescent 
                mental health services described in subparagraph (A); 
                or
                    ``(II) is a physician who graduated from (but not 
                before the end of the calendar year in which this 
                section is enacted) an accredited child and adolescent 
                psychiatry residency or fellowship program in the 
                United States.
            ``(3) Additional eligibility requirements.--The Secretary 
        may not enter into a contract under this subsection with an 
        eligible individual unless the individual--
                    ``(A) is a United States citizen or a permanent 
                legal United States resident; and
                    ``(B) if enrolled in a graduate program (including 
                a medical residency or fellowship), has an acceptable 
                level of academic standing as determined by the 
                Secretary.
            ``(4) Priority.--In entering into contracts under this 
        subsection, the Secretary shall give priority to applicants 
        who--
                    ``(A) are or will be working with high priority 
                populations;
                    ``(B) have familiarity with evidence-based methods 
                in child and adolescent mental health services;
                    ``(C) demonstrate financial need; and
                    ``(D) are or will be--
                            ``(i) working in the publicly funded 
                        sector;
                            ``(ii) working in organizations that serve 
                        underserved populations; or
                            ``(iii) willing to provide patient 
                        services--
                                    ``(I) regardless of the ability of 
                                a patient to pay for such services; or
                                    ``(II) on a sliding payment scale 
                                if a patient is unable to pay the total 
                                cost of such services.
            ``(5) Meaningful loan repayment.--If the Secretary 
        determines that funds appropriated for a fiscal year to carry 
        out this subsection are not sufficient to allow a meaningful 
        loan repayment to all expected applicants, the Secretary shall 
        limit the number of contracts entered into under paragraph (1) 
        to ensure that each such contract provides for a meaningful 
        loan repayment.
            ``(6) Amount.--
                    ``(A) Maximum.--For each year of the employment 
                period described in paragraph (1)(A), the Secretary 
                shall not, under a contract described in paragraph (1), 
                pay more than $35,000 on behalf of an individual.
                    ``(B) Consideration.--In determining the amount of 
                payments to be made on behalf of an eligible individual 
                under a contract described in paragraph (1), the 
                Secretary shall consider the income and debt load of 
                the eligible individual.
            ``(7) Applicability of certain provisions.--The provisions 
        of sections 338E and 338F shall apply to the program 
        established under paragraph (1) to the same extent and in the 
        same manner as such provisions apply to the National Health 
        Service Corps Loan Repayment Program established in subpart III 
        of part D of title III.
            ``(8) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        each of fiscal years 2004 through 2008.
    ``(b) Scholarships for Students Studying To Become Child and 
Adolescent Mental Health Service Professionals.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may establish a program to award scholarships 
        on a competitive basis to eligible students who agree to enter 
        into full-time employment (as described in paragraph (4)(C)) as 
        a child and adolescent mental health service professional after 
        graduation or completion of a residency or fellowship.
            ``(2) Eligible student.--For purposes of this subsection, 
        the term `eligible student' means a United States citizen or a 
        permanent legal United States resident who--
                    ``(A) is enrolled or accepted to be enrolled in a 
                graduate program that includes specialized training or 
                clinical experience in child and adolescent mental 
                health in psychology, school psychology, psychiatric 
                nursing, social work, school social work, marriage and 
                family therapy, school counseling, or professional 
                counseling; or
                    ``(B) is enrolled or accepted to be enrolled in an 
                accredited graduate training program of allopathic or 
                osteopathic medicine in the United States and intends 
                to complete an accredited residency or fellowship in 
                child and adolescent psychiatry.
            ``(3) Priority.--In awarding scholarships under this 
        subsection, the Secretary shall give--
                    ``(A) highest priority to applicants who previously 
                received a scholarship under this subsection and 
                satisfy the criteria described in subparagraph (B); and
                    ``(B) second highest priority to applicants who--
                            ``(i) demonstrate a commitment to working 
                        with high priority populations;
                            ``(ii) have familiarity with evidence-based 
                        methods in child and adolescent mental health 
                        services;
                            ``(iii) demonstrate financial need; and
                            ``(iv) are or will be--
                                    ``(I) working in the publicly 
                                funded sector;
                                    ``(II) working in organizations 
                                that serve underserved populations; or
                                    ``(III) willing to provide patient 
                                services--
                                            ``(aa) regardless of the 
                                        ability of a patient to pay for 
                                        such services; or
                                            ``(bb) on a sliding payment 
                                        scale if a patient is unable to 
                                        pay the total cost of such 
                                        services.
            ``(4) Requirements.--The Secretary may award a scholarship 
        to an eligible student under this subsection only if the 
        eligible student agrees--
                    ``(A) to complete any graduate training program, 
                internship, residency, or fellowship applicable to that 
                eligible student under paragraph (2);
                    ``(B) to maintain an acceptable level of academic 
                standing (as determined by the Secretary) during the 
                completion of such graduate training program, 
                internship, residency, or fellowship; and
                    ``(C) to be employed full-time after graduation or 
                completion of a residency or fellowship, for at least 
                the number of years for which a scholarship is received 
                by the eligible student under this subsection, in 
                providing mental health services to children and 
                adolescents.
            ``(5) Use of scholarship funds.--A scholarship awarded to 
        an eligible student for a school year under this subsection may 
        be used to pay for only tuition expenses of the school year, 
        other reasonable educational expenses (including fees, books, 
        and laboratory expenses incurred by the eligible student in the 
        school year), and reasonable living expenses, as such tuition 
        expenses, reasonable educational expenses, and reasonable 
        living expenses are determined by the Secretary.
            ``(6) Amount.--The amount of a scholarship under this 
        subsection shall not exceed the total amount of the tuition 
        expenses, reasonable educational expenses, and reasonable 
        living expenses described in paragraph (5).
            ``(7) Applicability of certain provisions.--The provisions 
        of sections 338E and 338F shall apply to the program 
        established under paragraph (1) to the same extent and in the 
        same manner as such provisions apply to the National Health 
        Service Corps Scholarship Program established in subpart III of 
        part D of title III.
            ``(8) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $5,000,000 for 
        each of fiscal years 2004 through 2008.
    ``(c) Clinical Training Grants for Professionals.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, and in cooperation with the Administrator of 
        the Substance Abuse and Mental Health Services Administration, 
        may establish a program to award grants on a competitive basis 
        to accredited institutions of higher education to establish or 
        expand internships or other field placement programs for 
        students receiving specialized training or clinical experience 
        in child and adolescent mental health in the fields of 
        psychiatry, psychology, school psychology, psychiatric nursing, 
        social work, school social work, marriage and family therapy, 
        school counseling, or professional counseling.
            ``(2) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to applicants that--
                    ``(A) have demonstrated the ability to collect data 
                on the number of students trained in child and 
                adolescent mental health and the populations served by 
                such students after graduation;
                    ``(B) have demonstrated familiarity with evidence-
                based methods in child and adolescent mental health 
                services; and
                    ``(C) have programs designed to increase the number 
                of professionals serving high priority populations.
            ``(3) Requirements.--The Secretary may award a grant to an 
        applicant under this subsection only if the applicant agrees 
        that--
                    ``(A) any internship or other field placement 
                program assisted under the grant will prioritize 
                cultural competency;
                    ``(B) students benefiting from any assistance under 
                this subsection will be United States citizens or 
                permanent legal United States residents;
                    ``(C) the institution will provide to the Secretary 
                such data, assurances, and information as the Secretary 
                may require; and
                    ``(D) with respect to any violation of the 
                agreement between the Secretary and the institution, 
                the institution will pay such liquidated damages as 
                prescribed by the Secretary by regulation.
            ``(4) Application.--Each institution of higher education 
        desiring a grant under this section shall submit to the 
        Secretary an application at such time, in such manner, and 
        containing such information as the Secretary may require 
        including a description of the experience of such institution 
        in working with child and adolescent mental health issues.
            ``(5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        each of fiscal years 2004 through 2008.
    ``(d) Progressive Education Grants for Paraprofessionals.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, and in cooperation with the Administrator of 
        the Substance Abuse and Mental Health Services Administration, 
        may establish a program to award grants on a competitive basis 
        to State-licensed mental health nonprofit and for-profit 
        organizations, including accredited institutions of higher 
        education, (in this subsection referred to as `organizations') 
        to enable such organizations to pay for programs for preservice 
        or in-service training of paraprofessional child and adolescent 
        mental health workers.
            ``(2) Definition.--For purposes of this subsection, the 
        term `paraprofessional child and adolescent mental health 
        worker' means an individual who is not a mental health service 
        professional, but who works at the first stage of contact with 
        children and families who are seeking mental health services.
            ``(3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to organizations that--
                    ``(A) have demonstrated the ability to collect data 
                on the number of paraprofessional child and adolescent 
                mental health workers trained by the applicant and the 
populations served by these workers after the completion of the 
training;
                    ``(B) have familiarity with evidence-based methods 
                in child and adolescent mental health services; and
                    ``(C) have programs designed to increase the number 
                of paraprofessional child and adolescent mental health 
                workers serving high priority populations.
            ``(4) Requirements.--The Secretary may award a grant to an 
        organization under this subsection only if the organization 
        agrees that--
                    ``(A) any training program assisted under the grant 
                will prioritize cultural competency;
                    ``(B) the organization will provide to the 
                Secretary such data, assurances, and information as the 
                Secretary may require; and
                    ``(C) with respect to any violation of the 
                agreement between the Secretary and the organization, 
                the organization will pay such liquidated damages as 
                prescribed by the Secretary by regulation.
            ``(5) Application.--Each organization desiring a grant 
        under this subsection shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require including a 
        description of the experience of the organization in working 
        with paraprofessional child and adolescent mental health 
        workers.
            ``(6) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $5,000,000 for 
        each of fiscal years 2004 through 2008.
    ``(e) Child and Adolescent Mental Health Program Development 
Grants.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may establish a program to increase the number 
        of well-trained child and adolescent mental health service 
        professionals in the United States by awarding grants on a 
        competitive basis to accredited institutions of higher 
        education to enable such institutions to establish or expand 
        accredited graduate child and adolescent mental health 
        programs.
            ``(2) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to applicants that--
                    ``(A) demonstrate familiarity with the use of 
                evidence-based methods in child and adolescent mental 
                health services;
                    ``(B) provide experience in and collaboration with 
                community-based child and adolescent mental health 
                services;
                    ``(C) have included normal child development 
                education in their curricula; and
                    ``(D) demonstrate commitment to working with high 
                priority populations.
            ``(3) Use of funds.--Funds awarded under this subsection 
        may be used to establish or expand any accredited graduate 
        child and adolescent mental health program in any manner deemed 
        appropriate by the Secretary, including improving the 
        coursework, related field placements, or faculty of such 
        program.
            ``(4) Requirements.--The Secretary may award a grant to an 
        accredited institution of higher education under this 
        subsection only if the institution agrees that--
                    ``(A) any child and adolescent mental health 
                program assisted under the grant will prioritize 
                cultural competency;
                    ``(B) the institution will provide to the Secretary 
                such data, assurances, and information as the Secretary 
                may require; and
                    ``(C) with respect to any violation of the 
                agreement between the Secretary and the institution, 
                the institution will pay such liquidated damages as 
                prescribed by the Secretary by regulation.
            ``(5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $15,000,000 for 
        each of fiscal years 2004 through 2008.
    ``(f) Definitions.--In this section:
            ``(1) High priority population.--The term `high priority 
        population' means a population that has a high incidence of 
        children and adolescents who have serious emotional 
        disturbances, are racial and ethnic minorities, or live in 
        underserved urban or rural areas.
            ``(2) Mental health service professional.--The term `mental 
        health service professional' means an individual with a 
        graduate or postgraduate degree from an accredited institution 
        of higher education in psychiatry, psychology, school 
        psychology, psychiatric nursing, social work, school social 
        work, marriage and family counseling, school counseling, or 
        professional counseling.
            ``(3) Specialized training or clinical experience in child 
        and adolescent mental health.--The term `specialized training 
        or clinical experience in child and adolescent mental health' 
        means training and clinical experience that--
                    ``(A) is part of or occurs after completion of an 
                accredited graduate program in the United States for 
                training mental health service professionals;
                    ``(B) consists of at least 500 hours of training or 
                clinical experience in treating children and 
                adolescents; and
                    ``(C) is comprehensive, coordinated, 
                developmentally appropriate, and of high quality to 
                address the unique ethnic and cultural diversity of the 
                United States population.''.

SEC. 4. AMENDMENTS TO SOCIAL SECURITY ACT TO IMPROVE CHILD AND 
              ADOLESCENT MENTAL HEALTH CARE.

    (a) Increasing Number of Child and Adolescent Psychiatry Residents 
Permitted To Be Paid Under the Medicare Graduate Medical Education 
Program.--Section 1886(h)(4)(F) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)(F)) is amended by adding at the end the following:
                            ``(iii) Increase allowed for training in 
                        child and adolescent psychiatry.--In applying 
                        clause (i), there shall not be taken into 
                        account such additional number of full-time 
                        equivalent residents in the field of allopathic 
                        or osteopathic medicine who are residents or 
                        fellows in child and adolescent psychiatry as 
                        the Secretary determines reasonable to meet the 
                        need for such physicians as demonstrated by the 
                        1999 report of the Department of Health and 
                        Human Services entitled `Mental Health: A 
                        Report of the Surgeon General'.''.
    (b) Extension of Medicare Board Eligibility Period for Residents 
and Fellows in Child and Adolescent Psychiatry.--
            (1) In general.--Section 1886(h)(5)(G) of the Social 
        Security Act (42 U.S.C. 1395ww(h)(5)(G)) is amended--
                    (A) in clause (i), by striking ``and (v)'' and 
                inserting ``(v), and (vi)''; and
                    (B) by adding at the end the following:
                            ``(vi) Child and adolescent psychiatry 
                        training programs.--In the case of an 
                        individual enrolled in a child and adolescent 
                        psychiatry residency or fellowship program 
                        approved by the Secretary, the period of board 
                        eligibility and the initial residency period 
                        shall be the period of board eligibility for 
                        the specialty of general psychiatry, plus 2 
                        years for the subspecialty of child and 
                        adolescent psychiatry.''.
            (2) Conforming amendment.--Section 1886(h)(5)(F) of the 
        Social Security Act (42 U.S.C. 1395ww(h)(5)(F)) is amended by 
        striking ``subparagraph (G)(v)'' and inserting ``clauses (v) 
        and (vi) of subparagraph (G)''.
            (3) Effective date.--The amendments made by paragraph (1) 
        shall apply to residency training years beginning on or after 
        July 1, 2003.

SEC. 5. CHILD MENTAL HEALTH PROFESSIONAL REPORT.

    (a) Study.--The Administrator of the Health Resources and Services 
Administration (in this section referred to as the ``Administrator'') 
shall study and make findings and recommendations on the distribution 
and need for child mental health service professionals, including--
            (1) the need for specialty certifications;
            (2) the breadth of practice types;
            (3) the adequacy of locations;
            (4) the adequacy of education and training; and
            (5) an evaluation of best practice characteristics.
    (b) Disaggregation.--The results of the study required by 
subsection (a) shall be disaggregated by State.
    (c) Report.--Not later than 1 year after the date of enactment of 
this Act, the Administrator shall submit to the appropriate committees 
of Congress and make publicly available a report on the study, 
findings, and recommendations required by subsection (a).
    (d) Revision.--Each year the Administrator shall revise the report 
required under subsection (c).
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2004 through 2008.

SEC. 6. REPORTS.

    (a) Transmission.--The Secretary of Health and Human Services shall 
transmit a report described in subsection (b) to Congress--
            (1) not later than 3 years after the date of the enactment 
        of this Act; and
            (2) not later than 5 years after the date of the enactment 
        of this Act.
    (b) Contents.--The reports transmitted to Congress under subsection 
(a) shall address each of the following:
            (1) The effectiveness of the amendments made by, and the 
        programs carried out under, this Act in increasing the number 
        of child and adolescent mental health service professionals and 
        paraprofessional child and adolescent mental health workers.
            (2) The demographics of the individuals served by such 
        increased number of child and adolescent mental health service 
        professionals and paraprofessional child and adolescent mental 
        health workers.
                                 <all>