Short title

This Act may be cited as the

Community Mental Health Services Improvement Act

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.

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:

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.

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).

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:

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:

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

Assurances

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

Report

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.

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:

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

Assurances

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

Report

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.

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:

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.

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.

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.