[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2182 Introduced in Senate (IS)]







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.

    Congress finds that--
            (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.
    ``(d) Use of Funds.--
            ``(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;
                            ``(ii) oncology 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
                    ``(D) agree to--
                            ``(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.
    ``(c) Application.--
            ``(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.
    ``(c) Application.--
            ``(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)).
    ``(c) Application.--
            ``(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.
                                 <all>