1.
This Act may be cited as the
Child Health Care Crisis Relief
Act
.
2.
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.
3.
Loan repayments, scholarships, and grants to improve child and
adolescent mental health care
Subpart 2 of part E of title
VII of the Public Health Service Act
(42 U.S.C.
295 et seq.) is amended by adding at the end the
following:
771.
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)
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)
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)
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)
(A)
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)
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
2006 through 2010.
(b)
Scholarships for students studying to become child and
adolescent mental health service professionals
(1)
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)
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)
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)
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)
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)
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
2006 through 2010.
(c)
Clinical training grants for professionals
(1)
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)
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)
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 benefitting 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)
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
2006 through 2010.
(d)
Progressive education grants for paraprofessionals
(1)
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)
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)
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)
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)
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
2006 through 2010.
(e)
Child and adolescent mental health program development
grants
(1)
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)
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)
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)
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
2006 through 2010.
(f)
In this section:
(1)
The term high
priority population means a population that has a significantly greater
incidence than the national average of children who have serious emotional
disturbances, children who are racial and ethnic minorities, or children who
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.
.
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)
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)
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)
The amendments made by
paragraph (1) shall apply to residency training years beginning on or after
July 1, 2006.
5.
Child mental health professional report
(a)
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)
The results of the study
required by subsection (a) shall be disaggregated by State.
(c)
Not later than 2 years 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).
6.
(a)
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)
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.