[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2691 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2691

  To provide assistance to adolescents and young adults with serious 
        mental health disorders as they transition to adulthood.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 3, 2009

 Mr. Stark (for himself, Mr. Camp, and Mrs. Bono Mack) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
  To provide assistance to adolescents and young adults with serious 
        mental health disorders as they transition to adulthood.

    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 ``Healthy Transition Act of 2009''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) According to a June 2008 Government Accountability 
        Office (GAO) report to Congress there were at least 2,400,000 
        young adults aged 18 to 26 with a serious mental illness (SMI) 
        in 2006, and an additional 9.3 million who experienced mild or 
        moderate mental illness. GAO also found that in 2006--
                    (A) 46 percent to 63 percent of homeless young 
                adults experienced mental health problems;
                    (B) 63 percent to 71 percent of incarcerated young 
                adults experienced mental health problems; and
                    (C) close to 32 percent of young adults with SMI 
                had a co-occurring diagnosis of alcohol or drug abuse 
                or dependence along with at least one other mental 
                disorder.
            (2) A July 2008 American Psychological Association (APA) 
        report found that more than 60 percent of transition youth with 
        SMI do not complete high school, leaving many of these young 
        adults unemployed, unable to benefit from continuing education 
        (32 percent rate of postsecondary continuation versus 51 
        percent for youth without mental illness), and without the 
        skills needed to live independently.
            (3) The 2003 President's New Freedom Commission on Mental 
        Health found that only 1 in 3 persons with a disability 
        resulting from mental illness is employed--
                    (A) about 186,000 young adults with SMI received 
                disability benefits in 2006 because their illness was 
                severe enough to prevent sustainable employment; and
                    (B) youth centers often lack the expertise to find 
                employment for young adults because they do not 
                generally have the capacity to suit individual mental 
                health needs.
            (4) The Substance Abuse and Mental Health Services 
        Administration (SAMHSA) recommends supportive housing--which 
        would include job training and mental health services--to young 
        adults with SMI. State officials, however, cite a lack of 
        availability of such housing and the Department of Housing and 
        Urban Development (HUD) reports that the median age of HUD 
        supportive housing recipients is 47 years old.
            (5) During the transition to adulthood, youth with SMI are 
        also at risk of losing free or low-cost services they received 
        as children, but may not qualify for as adults. The difference 
        in eligibility criteria between child and adult benefits from 
        the Social Security Administration (SSA) can result in a loss 
        of benefits during the redetermination stage at age 18. For 
        example, Medicaid income requirements are more stringent for an 
        adult, even though an applicant may have received benefits as a 
        child.
            (6) GAO found critical gaps in mental health and housing 
        services for foster youth--
                    (A) the report found that States were serving less 
                than half of their eligible foster care population 
                through existing programs such as Chafee Foster Care 
                Independence and Medicaid; and
                    (B) a separate national survey from 2006 found that 
                foster youth were 4 times more likely to have attempted 
                suicide in the preceding year when compared to those 
                never placed in foster care.
            (7) Public service provision for young adults with SMI is 
        fragmented and these individuals can struggle to locate 
        services that aid in their transition to adulthood--
                    (A) GAO found that there are currently no Federal 
                programs to specifically target this population;
                    (B) directors of programs providing services to 
                youth aged 14 to 21 have difficulty finding adequate 
                age-appropriate mental health services for their 
                clients partly due to lack of proper training; and
                    (C) group therapy in mental health services is 
                often not age appropriate and as a result, SAMHSA 
                reported in 2007 that young adults with SMI have the 
                lowest ``help-seeking behavior'' of any age group.

SEC. 3. HEALTHY TRANSITIONING FOR YOUTH.

    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. HEALTHY TRANSITIONING FOR YOUTH.

    ``(a) Planning Grants.--
            ``(1) In general.--The Secretary, in consultation with the 
        agencies described in subsection (c)(3), shall award grants or 
        cooperative agreements to States to develop plans for the 
        statewide coordination of services to assist adolescents and 
        young adults with a serious mental health disorder in acquiring 
        the skills, knowledge, and resources necessary to ensure their 
        healthy transition to successful adult roles and 
        responsibilities.
            ``(2) Application.--To be eligible for a grant or 
        cooperative agreement under this subsection, a State shall 
        submit to the Secretary an application, at such time, in such 
        manner, and containing such information as the Secretary may 
        require.
            ``(3) Plan.--Not later than 18 months after the receipt of 
        a grant or cooperative agreement under this subsection, a State 
        shall submit to the Secretary a State plan that shall include--
                    ``(A) reliable estimates on the number of 
                adolescents and young adults with serious mental health 
                disorders in the State;
                    ``(B) information on the youth targeted under this 
                Act, including--
                            ``(i) the number of adolescents and young 
                        adults with serious mental health disorders in 
                        the State and the number of such individuals 
                        who are currently being served in the State;
                            ``(ii) the number of such individuals who 
                        are receiving mental health services provided 
                        by State agencies other than the agency 
                        responsible for mental health services in the 
                        State;
                            ``(iii) the number of youth with serious 
                        mental health disorders who are involved in the 
                        juvenile justice system in the State;
                            ``(iv) the number of youth with serious 
                        mental health disorders who are involved in the 
                        child protection system in the State;
                            ``(v) the number of youth with serious 
                        mental health disorders who have plans in 
                        effect under the Individuals with Disabilities 
                        Education Act in the State;
                            ``(vi) the number of youth with serious 
                        mental health disorders who are involved in 
                        vocational rehabilitation in the State;
                            ``(vii) the range of ages served by the 
                        programs described in clauses (i) through (vi); 
                        and
                            ``(viii) a description of the overall 
                        transition coordination that is currently 
                        provided by the State or local authorities and 
                        programs in the State;
                    ``(C) an identification of the skills, knowledge, 
                and resources that adolescents and young adults with 
                serious mental health disorders in the State will need 
                to ensure their successful and healthy transition into 
                adult roles and responsibilities;
                    ``(D) an identification of the obstacles that 
                adolescents and young adults with serious mental health 
                disorders in the State encounter while transitioning 
                into adult roles and responsibilities, including breaks 
                in service or programs caused by eligibility and 
                program criteria differences between the child and 
                adult mental health systems, the lack of culturally and 
                linguistically appropriate mental and behavioral health 
                and transition services, and the lack of local access 
                to mental health and transition services;
                    ``(E) an identification of the current level, type, 
                quality, effectiveness, and availability of services, 
                including evidence-based practices, available in the 
                State that are uniquely designed for adolescents and 
                young adults with a serious mental health disorder to 
                ensure a healthy transition to successful adult roles 
                and responsibilities;
                    ``(F) an identification of adolescents and young 
                adults with a serious emotional disorder who have a low 
                likelihood of a healthy and successful transition due 
                to the severity of their illness, and an identification 
                of how the State will provide treatment and other 
                support services to this population;
                    ``(G) an analyses of the strengths, weaknesses, and 
                gaps of the current system in the State, including the 
                availability of lack of mental and behavioral health 
                professionals trained to treat adolescents and young 
                adults with a serious mental health disorder, as well 
                as barriers, to address the needs of adolescents and 
                young adults with a serious mental health disorder with 
                an appropriate array of effective services and 
                supports;
                    ``(H) a description of how the State will improve 
                the system of care to ensure successful and healthy 
                transitions;
                    ``(I) a description of how the State will ensure 
                that services and systems of care are culturally and 
                linguistically competent;
                    ``(J) a description of how the State will 
                coordinate the services of State and non-State agencies 
                that serve adolescents and young adults with a serious 
                mental health disorder;
                    ``(K) a description of how the State will provide a 
                system of coordinated service delivery under the grant 
                or cooperative agreement that will address the 
                effective services, supports, and unique needs of 
                adolescents and young adults with a serious mental 
                disorder, including those who have been placed in out 
                of home settings such as the juvenile justice system or 
                those who are or were involved in the child protection 
                systems;
                    ``(L) a description of how the State will 
                coordinate efforts under the grant or cooperative 
                agreement with existing services and systems in the 
                State that focus on life skills necessary for a healthy 
                transition including health, employment and pre-
                employment training, transportation, housing, 
                recreation, mental health services, substance use, 
                vocational rehabilitation services for persons with 
                disabilities, and training for adolescents, young 
                adults and adults, consumers and their families;
                    ``(M) a description of how the State will work to 
                build workforce capacity to serve the population 
                described in subparagraph (J);
                    ``(N) a description of how the State will reach out 
                to the target population pre-transition, during 
                transition, and post-transition;
                    ``(O) a description of how the State is currently 
                utilizing and leveraging (and how the State will use 
                and leverage) Federal funding streams to care for the 
                target population, including funding through Medicaid, 
                the Department of Housing and Urban Development, the 
                Department of Labor though supported employment, the 
                Early and Periodic Screening, Diagnosis, and Treatment 
                Program, and other programs, and including an outline 
                of the barriers the State faces in making Federal 
                funding flow to the targeted population in a 
                coordinated manner;
                    ``(P) a description of how the State will involve 
                adolescents and young adults with serious mental health 
                disorders and their families and guardians in the 
                service design, planning, and implementation of the 
                plan under the grant or cooperative agreement;
                    ``(Q) an implementation subplan that shall be 
                designed to recognize the challenges of implementing a 
                program between communities at a statewide level and 
                how the State will overcome those challenges;
                    ``(R) a description of how the State plans to 
                evaluate outcomes under the program funded under the 
                grant or cooperative agreement;
                    ``(S) a designation of the State office that will 
                be the lead agency responsible for administering the 
                program under the grant or cooperative agreement;
                    ``(T) a description of how the State will ensure 
                that the activities planned under the grant or 
                cooperative agreement will remain sustainable at the 
                end of the cycle of Federal funding under this section; 
                and
                    ``(U) any other information determined appropriate 
                by the Secretary.
            ``(4) Duration of support.--The duration of a grant or 
        cooperative agreement under this subsection shall be at least 1 
        fiscal year, but shall not exceed 2 fiscal years.
            ``(5) Technical assistance.--The Secretary shall provide 
        technical assistance and training in the development of the 
        plan under paragraph (3), including convening a meeting of 
        potential applicants for grants or cooperative agreement under 
        this subsection.
            ``(6) Authorization of appropriations.--
                    ``(A) In general.--There is authorized to be 
                appropriated to carry out this subsection, $4,500,000 
                for fiscal year 2011, and such sums as may be necessary 
                for each of fiscal years 2012 through 2015.
                    ``(B) Technical assistance.--The Secretary shall 
                make available up to 15 percent of the amount 
                appropriated under subparagraph (A), or $1,000,000, 
                whichever is greater, in each fiscal year for technical 
                assistance under paragraph (5).
    ``(b) Implementation Grants.--
            ``(1) In general.--The Secretary shall award grants or 
        cooperative agreement to eligible States for the coordination 
        of services to assist adolescents and young adults with serious 
        mental health disorders in acquiring the services, skills, and 
        knowledge necessary to ensure their healthy transition to 
        successful adult roles and responsibilities.
            ``(2) Eligibility.--To be eligible for a grant or 
        cooperative agreement under paragraph (1), a State shall--
                    ``(A) be a State that has received a grant or 
                cooperative agreement under subsection (a) and 
                submitted a plan that meets the requirements of 
                paragraph (3) of such subsection; or
                    ``(B) be a State that has not received such a grant 
                or cooperative agreement but that has a plan that is 
                equivalent to the plan required under subsection 
                (a)(3).
            ``(3) Application.--To be eligible for a grant or 
        cooperative agreement under this subsection, a State shall 
        submit to the Secretary an application, at such time, in such 
        manner, and containing such information as the Secretary 
        requires, including--
                    ``(A) a copy of the plan submitted under subsection 
                (a)(3), or in the case of a State described in 
                paragraph (2)(B), a plan that is equivalent to the plan 
                required under subsection (a)(3);
                    ``(B) a list of the State agencies that will 
                participate in the program to be funded under the grant 
                or cooperative agreement along with written 
                verification as to the commitment of such agencies to 
                the program;
                    ``(C) an assurance that the State will develop a 
                coordinating committee composed of representatives of 
                the participating State agencies, as well as consumers 
                and families of consumers;
                    ``(D) a description of the role of such 
                coordinating committee; and
                    ``(E) the names of at least two local communities 
                that will implement the program at the local level and 
                how those communities will implement the State plan.
            ``(4) Use of funds.--Funds provided under a grant or 
        cooperative agreement under this subsection shall be used to 
        implement the State plan, including--
                    ``(A) facilitating a youth ombudsman or other 
                advocacy program;
                    ``(B) facilitating peer support programs and 
                networks within the State;
                    ``(C) facilitating access to independent living and 
                life skills supports;
                    ``(D) developing infrastructure to support access 
                to necessary health, mental health, employment, 
                education, and housing supports; and
                    ``(E) facilitating the training of support 
                providers and workforce capacity to serve the target 
                population.
            ``(5) Duration of support.--The duration of a grant or 
        cooperative agreement under this subsection shall not exceed 5 
        fiscal years.
            ``(6) Matching requirement.--
                    ``(A) In general.--To be eligible for a grant or 
                cooperative agreement under this subsection, the State 
                shall agree that, with respect to the costs to be 
                incurred by the State in carrying out activities under 
                the grant or cooperative agreement, the State will make 
                available (directly or through donations from public or 
                private entities) non-Federal contributions toward such 
                costs in an amount that--
                            ``(i) for the first fiscal year for which 
                        the State receives payments under the grant or 
                        cooperative agreement, is not less than $1 for 
                        each $3 of Federal funds provided under the 
                        grant or cooperative agreement;
                            ``(ii) for any second or third such fiscal 
                        year, is not less than $1 for each $2 of 
                        Federal funds provided under the grant or 
                        cooperative agreement;
                            ``(iii) for any fourth such fiscal year, is 
                        not less than $1 for each $1 of Federal funds 
                        provided under the grant or cooperative 
                        agreement; and
                            ``(iv) for any fifth such fiscal year, is 
                        not less than $2 for each $1 of Federal funds 
                        provided under the grant or cooperative 
                        agreement.
                    ``(B) Determination of amount contributed.--
                            ``(i) In general.--Non-Federal 
                        contributions required under subparagraph (A) 
                        may be in cash or in kind, fairly evaluated, 
                        including plant, equipment, or services. 
                        Amounts provided by the Federal Government, or 
                        services assisted or subsidized to any 
                        significant extent by the Federal Government, 
                        may not be included in determining the amount 
                        of such non-Federal contributions.
                            ``(ii) Non-federal contributions.--In 
                        making a determination of the amount of non-
                        Federal contributions for purposes of clause 
                        (i), the Secretary may include only non-Federal 
                        contributions in excess of the average amount 
                        of non-Federal contributions made by the State 
                        involved toward the purpose of the grant or 
                        cooperative agreement under this subsection for 
                        the 2-year period preceding the first fiscal 
                        year for which the State receives a grant or 
                        cooperative agreement under such subsection.
            ``(7) Technical assistance.--The Secretary shall provide 
        technical assistance and training to recipients of grants or 
        cooperative agreements under this subsection, including 
        convening meetings each year to identify ways of improving 
        State programs. Such meetings shall include the members of the 
        Federal Partners Committee under subsection (c).
            ``(8) Evaluation.--The Secretary shall carry out a cross-
        site evaluation that--
                    ``(A) reports on current State efforts to 
                transition the population involved prior to the 
                implementation of the State plans under this section; 
                and
                    ``(B) evaluates the program carried out by the 
                State under this section to determine the effectiveness 
                of such program in meeting its goals and objectives as 
                compared with current approaches.
            ``(9) Authorization of appropriations.--
                    ``(A) In general.--There is authorized to be 
                appropriated to carry out this subsection, $6,000,000 
                for each of fiscal years 2011 and 2012, $15,000,000 for 
                fiscal year 2013, $20,000,000 for fiscal year 2014, and 
                $25,000,000 for fiscal year 2015.
                    ``(B) Technical assistance and evaluation.--The 
                Secretary shall make available up to 15 percent of the 
                amount appropriated under subparagraph (A), or 
                $2,000,000 whichever is greater, in each fiscal year 
                for technical assistance under paragraph (7) and the 
                evaluation under paragraph (8).
    ``(c) Federal Partners.--
            ``(1) In general.--The Secretary shall designate an 
        existing Federal entity, or establish a Committee of Federal 
        Partners, to coordinate service programs to assist adolescents 
        and young adults with serious mental health disorders in 
        acquiring the knowledge and skills necessary for them to 
        transition into adult roles and responsibilities.
            ``(2) Existing federal entity.--If the Secretary elects to 
        utilize an existing Federal entity under paragraph (1), the 
        Secretary shall ensure that--
                    ``(A) such entity is comprised of representatives 
                of at least the agencies described in paragraph (3); 
                and
                    ``(B) such entity shall give special attention to 
                the knowledge and skills needed by adolescents and 
                young adults with mental health disorders in 
                coordinating the programs funded under this section.
            ``(3) Membership.--A Federal entity utilized under this 
        subsection, or a committee established under paragraph (1), 
        shall include representatives of--
                    ``(A) the Department of Education (or any subagency 
                of the Department);
                    ``(B) the Department of Health and Human Services 
                (or any subagency of the Department);
                    ``(C) the Department of Labor (or any subagency of 
                the Department);
                    ``(D) the Department of Transportation (or any 
                subagency of the Department);
                    ``(E) the Department of Housing and Urban 
                Development (or any subagency of the Department);
                    ``(F) the Department of Interior (or any subagency 
                of the Department);
                    ``(G) the Department of Justice (or any subagency 
                of the Department);
                    ``(H) the Social Security Administration;
                    ``(I) an organization representing consumers and 
                families of consumers as designated by the Secretary; 
                and
                    ``(J) an organization representing mental health 
                and behavioral health professionals as designated by 
                the Secretary.
            ``(4) Role of entity or committee.--The Federal entity or 
        committee designated or established under paragraph (1) shall 
        review how Federal programs and efforts that address issues 
        related to the transition of adolescents and young adults with 
        serious mental health disorders may be coordinated to ensure 
        the maximum benefit for the individuals being served and to 
        provide technical assistance to the States who are planning or 
        implementing programs under this section.
            ``(5) Report.--Not later than 18 months after the date of 
        enactment of this Act, the Federal entity or committee 
        designated or established under paragraph (1) shall submit to 
        the appropriate committees of Congress, and make available to 
        the general public, a report concerning the participation of 
        Federal agencies and stakeholders in the planning and 
        operations of the entity or committee. Such report shall also 
        contain a description of the status of the efforts of such 
        entity or committee in coordinating Federal efforts on behalf 
        of the target population.
            ``(6) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection, 
        $1,000,000 for fiscal year 2011, and such sums as may be 
        necessary for each of fiscal years 2012 through 2015.
    ``(d) Definition.--In this section, the term `serious mental health 
disorder' has the meaning given the term `serious mental illness' by 
the Administrator for purposes of this title.''.
                                 <all>