[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4204 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 4204

   To establish national centers of excellence for the treatment of 
                   depressive and bipolar disorders.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 3, 2009

Mr. Kennedy (for himself, Mr. Tim Murphy of Pennsylvania, Mr. Yarmuth, 
 and Mr. Maffei) introduced the following bill; which was referred to 
                  the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To establish national centers of excellence for the treatment of 
                   depressive and bipolar disorders.

    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 ``Establishing a Network of Health-
Advancing National Centers of Excellence for Depression Act of 2009'' 
or the ``ENHANCED Act of 2009''.

SEC. 2. PURPOSES; GOAL.

    (a) Purpose.--It is the purpose of this Act to--
            (1) establish a national network of centers of excellence 
        for depressive disorders;
            (2) provide Federal financial assistance to establish and 
        support a National network of depression centers that provide 
        for university- and community-based delivery of evidence-based 
        interventions, innovative practices, and services to 
        individuals with depressive disorders; and
            (3) improve the standard of care and delivery of evidence-
        based interventions, innovative practices, and services to 
        individuals with depressive disorders.
    (b) Goal.--It is the goal of this Act to--
            (1) increase the number of individuals with depressive 
        disorders who receive appropriate and evidence-based treatment, 
        through the implementation of multidisciplinary research and 
        clinical programs that use a recovery framework, standardize 
        diagnoses, treat individuals early and more effectively, and 
        prevent recurrences of depressive disorders; and
            (2) to establish a national resource to develop and 
        disseminate evidence-based interventions for depressive 
        disorders, provide public and professional education about 
        depressive disorders, and eradicate the stigma associated with 
        depressive disorders.

SEC. 3. CENTERS OF EXCELLENCE FOR DEPRESSION.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb et seq.) is amended by inserting after section 520A the 
following:

``SEC. 520B. NATIONAL CENTERS OF EXCELLENCE FOR DEPRESSION.

    ``(a) Depressive Disorder Defined.--In this section, the term 
`depressive disorder' means a mental or brain disorder relating to 
depression, including major depression, bipolar disorder, and related 
mood disorders.
    ``(b) Grant Program.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator, shall award grants on a competitive basis to 
        eligible entities to establish national centers of excellence 
        for depression (referred to in this section as `centers of 
        excellence'), which shall engage in activities related to the 
        treatment of depressive disorders.
            ``(2) Allocation of awards.--If the funds authorized under 
        subsection (f) are appropriated in the amounts provided for 
        under such subsection, the Secretary shall allocate such 
        amounts so that--
                    ``(A) not later than 1 year after the date of 
                enactment of the ENHANCED Act of 2009, not more than 20 
                centers of excellence may be established; and
                    ``(B) not later than September 30, 2016, not more 
                than 30 centers of excellence may be established.
            ``(3) Grant period.--
                    ``(A) In general.--A grant awarded under this 
                section shall be for a period of 5 years.
                    ``(B) Renewal.--A grant awarded under subparagraph 
                (A) may be renewed, on a competitive basis, for 1 
                additional 5-year period, at the discretion of the 
                Secretary. In determining whether to renew a grant, the 
                Secretary shall consider the report cards issued under 
                subsection (e)(2).
            ``(4) Use of funds.--Grant funds awarded under this 
        subsection shall be used for the establishment and ongoing 
        activities of the recipient of such funds.
            ``(5) Eligible entities.--
                    ``(A) Requirements.--To be eligible to receive a 
                grant under this section, an entity shall--
                            ``(i) be an institution of higher education 
                        or a public or private nonprofit research 
                        institution; and
                            ``(ii) submit an application to the 
                        Secretary at such time and in such manner as 
                        the Secretary may require, as described in 
                        subparagraph (B).
                    ``(B) Application.--An application described in 
                subparagraph (A)(ii) shall include--
                            ``(i) evidence that such entity--
                                    ``(I) provides, or is capable of 
                                coordinating with other entities to 
                                provide, comprehensive medical services 
                                with a focus on mental health services 
                                and subspecialty expertise for 
                                depressive disorders;
                                    ``(II) collaborates with--
                                            ``(aa) other medical 
                                        subspecialists to address co-
                                        occurring mental illnesses;
                                            ``(bb) community 
                                        organizations; and
                                            ``(cc) other members of the 
                                        network; and
                                    ``(III) is capable of training 
                                health professionals about mental 
                                health; and
                            ``(ii) such other information, as the 
                        Secretary may require.
                    ``(C) Priorities.--In awarding grants under this 
                section, the Secretary shall give priority to eligible 
                entities that meet 1 or more of the following criteria:
                            ``(i) Demonstrated capacity and expertise 
                        to serve the targeted population.
                            ``(ii) Existing infrastructure or expertise 
                        to provide appropriate, evidence-based and 
                        culturally competent services.
                            ``(iii) A location in a geographic area 
                        with disproportionate numbers of underserved 
                        and at-risk populations in medically 
                        underserved areas and health professional 
                        shortage areas.
                            ``(iv) A history of serving the population 
                        described in clause (iii).
                            ``(v) Proposed innovative approaches for 
                        outreach to initiate or expand services.
                            ``(vi) Use of the most up-to-date science, 
                        practices, and interventions available.
                            ``(vii) Demonstrated coordination and 
                        collaboration, or having a viable plan to 
                        coordinate, with a community mental health 
                        center or other community mental health 
                        resources.
                            ``(viii) Capacity to establish cooperative 
                        agreements with other community entities to 
                        provide social and human services to 
                        individuals with depressive disorders.
                            ``(ix) Demonstrated potential for 
                        replication and dissemination of evidence-based 
                        research and practices.
            ``(6) Specialty centers.--Of the centers of excellence 
        receiving a grant under this section, the Secretary may select 
        1 or more such centers to specialize in--
                    ``(A) subspecialties such as prepartum and 
                postpartum depression, traumatic stress disorder, 
                suicidal tendency, bipolar disorder, and depression; 
                and
                    ``(B) providing mental health services to 
                communities with problems of access, such as rural 
                communities and economically depressed communities.
            ``(7) National coordinating center.--
                    ``(A) In general.--The Secretary, acting through 
                the Administrator, shall designate 1 recipient of a 
                grant under this section to be the coordinating center 
                of excellence for depression (referred to in this 
                section as the `coordinating center'). The Secretary 
                shall select such coordinating center on a competitive 
                basis, based upon the demonstrated capacity of such 
                center to perform the duties described in subparagraph 
                (C).
                    ``(B) Application.--A center of excellence that has 
                been awarded a grant under paragraph (1) may apply for 
                designation as the coordinating center by submitting an 
                application to the Secretary at such time, in such 
                manner, and containing such information as the 
                Secretary may require.
                    ``(C) Duties.--The coordinating center shall--
                            ``(i) develop, administer, and coordinate 
                        the network of centers of excellence under this 
                        section;
                            ``(ii) oversee and coordinate the national 
                        database described in subsection (d);
                            ``(iii) lead a strategy to disseminate the 
                        findings and activities of the centers of 
                        excellence through such database;
                            ``(iv) serve as a liaison with the 
                        Administration, the National Registry of 
                        Evidence-based Programs and Practices of the 
                        Administration, and any Federal interagency or 
                        interagency forum on mental health; and
                            ``(v) establish a common network 
                        infrastructure to advance services provided by 
                        the centers of excellence and demonstrate 
                        effectiveness in fostering a collaborative 
                        community among such centers for sharing 
                        knowledge and skills.
            ``(8) Matching funds.--The Secretary may not award a grant 
        or contract under this section to an entity unless the entity 
        agrees that it will make available (directly or through 
        contributions from other public or private entities) non-
        Federal contributions toward the activities to be carried out 
        under the grant or contract in an amount equal to $1 for each 
        $5 of Federal funds provided under the grant or contract. Such 
        non-Federal matching funds may be provided directly or through 
        donations from public or private entities and may be in cash or 
        in-kind, fairly evaluated, including plant, equipment, or 
        services.
    ``(c) Activities of the Centers of Excellence.--Each center of 
excellence shall carry out the following activities:
            ``(1) General activities.--Each center of excellence 
        shall--
                    ``(A) integrate basic, clinical, or health services 
                interdisciplinary research and practice in the 
                development of evidence-based interventions;
                    ``(B) involve a broad cross-section of 
                stakeholders, such as researchers, clinicians, 
                consumers, and families of consumers, to develop 
                innovative approaches to incorporate research and 
                practice and advance evidence-based practices;
                    ``(C) provide training and technical assistance to 
                mental health professionals, and engage in and 
                disseminate translational research with a focus on 
                meeting the needs of individuals with depressive 
                disorders;
                    ``(D) facilitate the dissemination and 
                communication of research findings and depressive 
                disorder-related information from the institutions of 
                higher education to the public; and
                    ``(E) educate policy makers, employers, community 
                leaders, and the general public about depressive 
                disorders to reduce stigma and raise awareness of 
                available treatments for such disorders.
            ``(2) Improved treatment standards, clinical guidelines, 
        and diagnostic protocols.--Each center of excellence shall 
        collaborate with other centers of excellence in the network 
        to--
                    ``(A) develop and implement treatment standards, 
                clinical guidelines, and protocols to improve the 
                accuracy and timeliness of diagnosis of depressive 
                disorders; and
                    ``(B) develop and implement treatment standards 
                that emphasize early intervention and treatment for, 
                primary prevention and the prevention of recurrences 
                of, and recovery from, depressive disorders.
            ``(3) Coordination and integration of physical, mental, and 
        social care.--Each center of excellence shall--
                    ``(A) incorporate principles of chronic care 
                coordination and integration of services that address 
                physical, mental, and social conditions in the 
                treatment of depressive disorders;
                    ``(B) foster communication with other providers 
                attending to co-occurring physical health conditions 
                such as cardiovascular, diabetes, cancer, and substance 
                abuse disorders;
                    ``(C) identify how treatment for depression 
                interacts with such co-occurring illnesses to improve 
                overall health outcomes;
                    ``(D) leverage available community resources, 
                develop and implement improved self-management 
                programs, and, when appropriate, involve family and 
                other providers of social support in the development 
                and implementation of care plans; and
                    ``(E) use electronic health records and telehealth 
                technology to better coordinate and manage, and improve 
                access to, care, as determined by the coordinating 
                center.
            ``(4) Translational research through collaboration of 
        centers of excellence and community-based organizations.--Each 
        center of excellence shall--
                    ``(A) demonstrate effective use of a public-private 
                partnership to foster collaborations among members of 
                the network and community-based organizations such as 
                community mental health centers and other social and 
                human services providers;
                    ``(B) expand multidisciplinary, translational, and 
                patient-oriented research and treatment by fostering 
                such collaborations; and
                    ``(C) coordinate with accredited academic programs 
                to provide ongoing opportunities, in academic and in 
                community settings, for the professional and continuing 
                education of mental health providers.
    ``(d) National Database.--
            ``(1) In general.--The coordinating center shall establish 
        and maintain a national, publicly-available database to improve 
        prevention programs, evidence-based interventions, and disease 
        management programs for depressive disorders, using data 
        collected from the centers of excellence, as described in 
        paragraph (2).
            ``(2) Data collection.--
                    ``(A) Data.--Each center of excellence shall submit 
                data gathered at such center, as appropriate, to the 
                coordinating center regarding--
                            ``(i) the prevalence and incidence of 
                        depressive disorders;
                            ``(ii) the health and social outcomes of 
                        individuals with depressive disorders;
                            ``(iii) the effectiveness of interventions 
                        designed, tested, and evaluated;
                            ``(iv) the progress in the prevention of, 
                        and recovery from, depressive disorders; and
                            ``(v) the economic impact of the activities 
                        of such center.
                    ``(B) Financial information.--Each center of 
                excellence shall provide to the coordinating center 
                appropriately summarized financial information to 
                enable the coordinating center to assess the efficiency 
                and financial sustainability of such center.
            ``(3) Submission of data to the administrator.--The 
        coordinating center shall submit to the Administrator the data 
        and financial information gathered under paragraph (2).
            ``(4) Publication using data from the database.--A center 
        of excellence, or an individual affiliated with a center of 
        excellence, may publish findings using the data described in 
        paragraph (2)(A) only if such center submits such data to the 
        coordinating center, as required under such paragraph.
    ``(e) Establishment of Standards; Report Cards and Recommendations; 
Third Party Review.--
            ``(1) Establishment of standards.--The Secretary, acting 
        through the Administrator, shall establish performance 
        standards for--
                    ``(A) each center of excellence; and
                    ``(B) the network of centers of excellence as a 
                whole.
            ``(2) Report cards.--The Secretary, acting through the 
        Administrator, shall--
                    ``(A) for each center of excellence, not later than 
                3 years after the date on which such center of 
                excellence is established and annually thereafter, 
                issue a report card to the coordinating center to rate 
                the performance of such center of excellence; and
                    ``(B) not later than 3 years after the date on 
                which the first grant is awarded under subsection 
                (b)(1) and annually thereafter, issue a report card to 
                Congress to rate the performance of the network of 
                centers of excellence as a whole.
            ``(3) Recommendations.--Based upon the report cards 
        described in paragraph (1), the Secretary shall, not later than 
        September 30, 2015--
                    ``(A) make recommendations to the centers of 
                excellence regarding improvements such centers shall 
                make; and
                    ``(B) make recommendations to Congress for 
                expanding the centers of excellence to serve 
                individuals with other types of mental disorders.
            ``(4) Third party review.--Not later than 3 years after the 
        date on which the first grant is awarded under subsection 
        (b)(1) and annually thereafter, the Secretary shall arrange for 
        an independent third party to conduct an evaluation of the 
        network of centers of excellence to ensure that such centers 
        are meeting the goals of this section.
    ``(f) Authorization of Appropriations.--
            ``(1) In general.--To carry out this section, there are 
        authorized to be appropriated--
                    ``(A) $100,000,000 for each of the fiscal years 
                2011 through 2015; and
                    ``(B) $150,000,000 for each of the fiscal years 
                2016 through 2020.
            ``(2) Allocation of funds authorized.--Of the amount 
        appropriated under paragraph (1) for a fiscal year, the 
        Secretary shall determine the allocation of each center of 
        excellence receiving a grant under this section, but in no case 
        may the allocation be more than $5,000,000, except that the 
        Secretary may allocate not more than $10,000,000 to the 
        coordinating center.''.

SEC. 4. SENSE OF THE SENATE.

    It is the sense of the Senate that the knowledge and research 
developed by the centers of excellence for depression established under 
section 520B of the Public Health Service Act should be disseminated 
broadly within the medical community and the Federal Government, 
particularly to agencies with an interest in mental health, including 
other agencies within the Department of Health and Human Services and 
the Departments of Justice, Defense, Labor, and Veterans Affairs.
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