[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 999 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 999

     To increase the number of well-trained mental health service 
  professionals (including those based in schools) providing clinical 
mental health care to children and adolescents, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 7, 2009

 Mr. Bingaman (for himself, Ms. Collins, and Ms. Stabenow) introduced 
the following bill; which was read twice and referred to the Committee 
               on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
     To increase the number of well-trained mental health service 
  professionals (including those based in schools) providing clinical 
mental health care to children and adolescents, and for other purposes.

    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 ``Child Health Care Crisis Relief Act 
of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Center for Mental Health Services estimates that 20 
        percent or 13,700,000 of the Nation's children and adolescents 
        have a diagnosable mental disorder, and about \2/3\ of these 
        children and adolescents do not receive mental health care.
            (2) According to ``Mental Health: A Report of the Surgeon 
        General'' in 1999, there are approximately 6,000,000 to 
        9,000,000 children and adolescents in the United States 
        (accounting for 9 to 13 percent of all children and adolescents 
        in the United States) who meet the definition for having a 
        serious emotional disturbance.
            (3) According to the Center for Mental Health Services, 
        approximately 5 to 9 percent of United States children and 
        adolescents meet the definition for extreme functional 
        impairment.
            (4) According to the Surgeon General's Report, there are 
        particularly acute shortages in the numbers of mental health 
        service professionals serving children and adolescents with 
        serious emotional disorders.
            (5) According to the National Center for Education 
        Statistics in the Department of Education, there are 
        approximately 479 students for each school counselor in United 
        States schools, which ratio is almost double the recommended 
        ratio of 250 students for each school counselor.
            (6) According to the Bureau of Health Professions in 2000, 
        the demand for the services of child and adolescent psychiatry 
        is projected to increase by 100 percent by 2020.
            (7) The development and application of knowledge about the 
        impact of disasters on children, adolescents, and their 
        families has been impeded by critical shortages of qualified 
        researchers and practitioners specializing in this work.
            (8) According to the Bureau of the Census, the population 
        of children and adolescents in the United States under the age 
        of 18 is projected to grow by more than 40 percent in the next 
        50 years from 70,000,000 to more than 100,000,000 by 2050.
            (9) There are approximately 7,000 child and adolescent 
        psychiatrists in the United States. Only 300 child and 
        adolescent psychiatrists complete training each year.
            (10) According to the Department of Health and Human 
        Services, racial and ethnic minority representation is lacking 
        in the mental health workforce. Although 12 percent of the 
        United States population is African-American, only 2 percent of 
        psychologists, 2 percent of psychiatrists, and 4 percent of 
        social workers are African-American providers. Moreover, there 
        are only 29 Hispanic mental health professionals for every 
        100,000 Hispanics in the United States, compared with 173 non-
        Hispanic White providers per 100,000.
            (11) According to a 2006 study in the Journal of the 
        American Academy of Child and Adolescent Psychiatry, the 
        national shortage of child and adolescent psychiatrists affects 
        poor children and adolescents living in rural areas the 
        hardest.
            (12) According to the Department of Health and Human 
        Services, the ``U.S. mental health system is not well equipped 
        to meet the needs of racial and ethnic minority populations.''. 
        This is quite evident in access to care issues involving racial 
        and ethnic minority children. Studies have shown that there are 
        striking racial and ethnic differences in the utilization of 
        mental health services among children and youth. Overall, 
        mental health services meet the needs of 31 percent of non-
        minority children, but only 13 percent of minority children.
            (13) According to the National Center for Mental Health and 
        Juvenile Justice, 70 percent of youth involved in State and 
        local juvenile justice systems throughout the country suffer 
        from mental disorders, with at least 20 percent experiencing 
        symptoms so severe that their ability to function is 
        significantly impaired.
            (14) The Institute of Medicine, in Improving the Quality of 
        Health Care for Mental and Substance-Use Disorders, Quality 
        Chasm Series (2006) recommended that clinicians and patients 
        communicate effectively and share information to ensure quality 
        care, which is enhanced with education programs that allow 
        families and consumers to share information with mental health 
        providers about the lived experience of mental illness.

SEC. 3. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS TO IMPROVE CHILD AND 
              ADOLESCENT MENTAL HEALTH CARE.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 
294n et seq.) is amended by adding at the end the following:

          ``Subpart 3--Child and Adolescent Mental Health Care

``SEC. 775. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS TO IMPROVE CHILD 
              AND ADOLESCENT MENTAL HEALTH CARE.

    ``(a) Loan Repayments for Child and Adolescent Mental Health 
Service Professionals.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may establish a program of entering into 
        contracts on a competitive basis with eligible individuals 
        under which--
                    ``(A) the eligible individual agrees to be employed 
                full-time for a specified period (which shall be not 
                less than 2 years) in providing mental health services 
                to children and adolescents; and
                    ``(B) the Secretary agrees to make, during not more 
                than 3 years of the period of employment described in 
                subparagraph (A), partial or total payments on behalf 
                of the individual on the principal and interest due on 
                the undergraduate and graduate educational loans of the 
                eligible individual.
            ``(2) Eligible individual.--For purposes of this section, 
        the term `eligible individual' means an individual who--
                    ``(A) is receiving specialized training or clinical 
                experience in child and adolescent mental health in 
                psychiatry, psychology, school psychology, behavioral 
                pediatrics, psychiatric nursing, social work, school 
                social work, marriage and family therapy, school 
                counseling, or professional counseling and has less 
                than 1 year remaining before completion of such 
                training or clinical experience; or
                    ``(B)(i) has a license or certification in a State 
                to practice allopathic medicine, osteopathic medicine, 
                psychology, school psychology, psychiatric nursing, 
                social work, school social work, marriage and family 
                therapy, school counseling, or professional counseling; 
                and
                    ``(ii)(I) is a mental health service professional 
                who completed (but not before the end of the calendar 
                year in which this section is enacted) specialized 
                training or clinical experience in child and adolescent 
                mental health described in subparagraph (A); or
                    ``(II) is a physician who graduated from (but not 
                before the end of the calendar year in which this 
                section is enacted) an accredited child and adolescent 
                psychiatry residency or fellowship program in the 
                United States.
            ``(3) Additional eligibility requirements.--The Secretary 
        may not enter into a contract under this subsection with an 
        eligible individual unless--
                    ``(A) the individual is a United States citizen or 
                a permanent legal United States resident; and
                    ``(B) if the individual is enrolled in a graduate 
                program (including a medical residency or fellowship), 
                the program is accredited, and the individual has an 
                acceptable level of academic standing (as determined by 
                the Secretary).
            ``(4) Priority.--In entering into contracts under this 
        subsection, the Secretary shall give priority to applicants 
        who--
                    ``(A) are or will be working with high-priority 
                populations for mental health in a Health Professional 
                Shortage Area (HPSA), Medically Underserved Area (MUA), 
                or Medically Underserved Population (MUP);
                    ``(B) have familiarity with evidence-based methods 
                and cultural and linguistic competence in child and 
                adolescent mental health services;
                    ``(C) demonstrate financial need; and
                    ``(D) are or will be working in the publicly funded 
                sector, particularly in community mental health 
                programs described in section 1913(b)(1).
            ``(5) Meaningful loan repayment.--If the Secretary 
        determines that funds appropriated for a fiscal year to carry 
        out this subsection are not sufficient to allow a meaningful 
        loan repayment to all expected applicants, the Secretary shall 
        limit the number of contracts entered into under paragraph (1) 
        to ensure that each such contract provides for a meaningful 
        loan repayment.
            ``(6) Amount.--
                    ``(A) Maximum.--For each year that the Secretary 
                agrees to make payments on behalf of an individual 
                under a contract entered into under paragraph (1), the 
                Secretary may agree to pay not more than $35,000 on 
                behalf of the individual.
                    ``(B) Consideration.--In determining the amount of 
                payments to be made on behalf of an eligible individual 
                under a contract to be entered into under paragraph 
                (1), the Secretary shall consider the eligible 
                individual's income and debt load.
            ``(7) Applicability of certain provisions.--The provisions 
        of sections 338E and 338F shall apply to the program 
        established under paragraph (1) to the same extent and in the 
        same manner as such provisions apply to the National Health 
        Service Corps Loan Repayment Program established in subpart III 
        of part D of title III.
            ``(8) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        each of fiscal years 2010 through 2014.
    ``(b) Scholarships for Students Studying To Become Child and 
Adolescent Mental Health Service Professionals.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may establish a program to award scholarships 
        on a competitive basis to eligible students who agree to enter 
        into full-time employment (as described in paragraph (4)(C)) as 
        a child and adolescent mental health service professional after 
        graduation or completion of a residency or fellowship.
            ``(2) Eligible student.--For purposes of this subsection, 
        the term `eligible student' means a United States citizen or a 
        permanent legal United States resident who--
                    ``(A) is enrolled or accepted to be enrolled in an 
                accredited graduate program that includes specialized 
                training or clinical experience in child and adolescent 
                mental health in psychology, school psychology, 
                psychiatric nursing, behavioral pediatrics, social 
                work, school social work, marriage and family therapy, 
                school counseling, or professional counseling and, if 
                enrolled, has an acceptable level of academic standing 
                (as determined by the Secretary); or
                    ``(B)(i) is enrolled or accepted to be enrolled in 
                an accredited graduate training program of allopathic 
                or osteopathic medicine in the United States and, if 
                enrolled, has an acceptable level of academic standing 
                (as determined by the Secretary); and
                    ``(ii) intends to complete an accredited residency 
                or fellowship in child and adolescent psychiatry or 
                behavioral pediatrics.
            ``(3) Priority.--In awarding scholarships under this 
        subsection, the Secretary shall give--
                    ``(A) highest priority to applicants who previously 
                received a scholarship under this subsection and 
                satisfy the criteria described in subparagraph (B); and
                    ``(B) second highest priority to applicants who--
                            ``(i) demonstrate a commitment to working 
                        with high-priority populations for mental 
                        health in a Health Professional Shortage Area 
                        (HPSA), Medically Underserved Area (MUA), or 
                        Medically Underserved Population (MUP) and to 
                        students from high-priority populations;
                            ``(ii) have familiarity with evidence-based 
                        methods in child and adolescent mental health 
                        services;
                            ``(iii) demonstrate financial need; and
                            ``(iv) are or will be working in the 
                        publicly funded sector, particularly in 
                        community mental health programs described in 
                        section 1913(b)(1).
            ``(4) Requirements.--The Secretary may award a scholarship 
        to an eligible student under this subsection only if the 
        eligible student agrees--
                    ``(A) to complete any graduate training program, 
                internship, residency, or fellowship applicable to that 
                eligible student under paragraph (2);
                    ``(B) to maintain an acceptable level of academic 
                standing (as determined by the Secretary) during the 
                completion of such graduate training program, 
                internship, residency, or fellowship; and
                    ``(C) to be employed full-time after graduation or 
                completion of a residency or fellowship, for not less 
                than the number of years for which a scholarship is 
                received by the eligible student under this subsection, 
                in providing mental health services to children and 
                adolescents.
            ``(5) Use of scholarship funds.--A scholarship awarded to 
        an eligible student for a school year under this subsection may 
        be used only to pay for tuition expenses of the school year, 
        other reasonable educational expenses (including fees, books, 
        and laboratory expenses incurred by the eligible student in the 
        school year), and reasonable living expenses, as such tuition 
        expenses, reasonable educational expenses, and reasonable 
        living expenses are determined by the Secretary.
            ``(6) Amount.--The amount of a scholarship under this 
        subsection shall not exceed the total amount of the tuition 
        expenses, reasonable educational expenses, and reasonable 
        living expenses described in paragraph (5).
            ``(7) Applicability of certain provisions.--The provisions 
        of sections 338E and 338F shall apply to the program 
        established under paragraph (1) to the same extent and in the 
        same manner as such provisions apply to the National Health 
        Service Corps Scholarship Program established in subpart III of 
        part D of title III.
            ``(8) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $5,000,000 for 
        each of fiscal years 2010 through 2014.
    ``(c) Clinical Training Grants for Professionals.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, in cooperation with the Administrator of the 
        Substance Abuse and Mental Health Services Administration, may 
        establish a program to award grants on a competitive basis to 
        accredited institutions of higher education or accredited 
        professional training programs to establish or expand 
        internships or other field placement programs for students 
        receiving specialized training or clinical experience in child 
        and adolescent mental health in psychiatry, psychology, school 
        psychology, behavioral pediatrics, psychiatric nursing, social 
        work, school social work, marriage and family therapy, school 
        counseling, or professional counseling.
            ``(2) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to applicants that--
                    ``(A) have demonstrated the ability to collect data 
                on the number of students trained in child and 
                adolescent mental health and the populations served by 
                such students after graduation;
                    ``(B) have demonstrated familiarity with evidence-
                based methods in child and adolescent mental health 
                services;
                    ``(C) have programs designed to increase the number 
                of professionals serving high-priority populations and 
                to applicants who come from high-priority communities 
                and plan to serve in Health Professional Shortage Areas 
                (HPSA), Medically Underserved Areas (MUA), or Medically 
                Underserved Populations (MUP); and
                    ``(D) offer curriculum taught collaboratively with 
                a family on the consumer and family lived experience or 
                the importance of family-professional partnership.
            ``(3) Requirements.--The Secretary may award a grant to an 
        applicant under this subsection only if the applicant agrees 
        that--
                    ``(A) any internship or other field placement 
                program assisted under the grant will prioritize 
                cultural and linguistic competency;
                    ``(B) students benefitting from any assistance 
                under this subsection will be United States citizens or 
                permanent legal United States residents;
                    ``(C) the institution will provide to the Secretary 
                such data, assurances, and information as the Secretary 
                may require; and
                    ``(D) with respect to any violation of the 
                agreement between the Secretary and the institution, 
                the institution will pay such liquidated damages as 
                prescribed by the Secretary by regulation.
            ``(4) Application.--The Secretary shall require that any 
        application for a grant under this subsection include a 
        description of the applicant's experience working with child 
        and adolescent mental health issues.
            ``(5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        each of fiscal years 2010 through 2014.
    ``(d) Progressive Education Grants for Paraprofessionals.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, in cooperation with the Administrator of the 
        Substance Abuse and Mental Health Services Administration, may 
        establish a program to award grants on a competitive basis to 
        State-licensed mental health nonprofit and for-profit 
        organizations (including accredited institutions of higher 
        education) to enable such organizations to pay for programs for 
        preservice or in-service training of paraprofessional child and 
        adolescent mental health workers.
            ``(2) Definition.--For purposes of this subsection, the 
        term `paraprofessional child and adolescent mental health 
        worker' means an individual who is not a mental health service 
        professional, but who works at the first stage of contact with 
        children and families who are seeking mental health services.
            ``(3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to applicants that--
                    ``(A) have demonstrated the ability to collect data 
                on the number of paraprofessional child and adolescent 
                mental health workers trained by the applicant and the 
                populations served by these workers after the 
                completion of the training;
                    ``(B) have familiarity with evidence-based methods 
                in child and adolescent mental health services;
                    ``(C) have programs designed to increase the number 
                of paraprofessional child and adolescent mental health 
                workers serving high-priority populations; and
                    ``(D) provide services through a community mental 
                health program described in section 1913(b)(1).
            ``(4) Requirements.--The Secretary may award a grant to an 
        organization under this subsection only if the organization 
        agrees that--
                    ``(A) any training program assisted under the grant 
                will prioritize cultural and linguistic competency;
                    ``(B) the organization will provide to the 
                Secretary such data, assurances, and information as the 
                Secretary may require; and
                    ``(C) with respect to any violation of the 
                agreement between the Secretary and the organization, 
                the organization will pay such liquidated damages as 
                prescribed by the Secretary by regulation.
            ``(5) Application.--The Secretary shall require that any 
        application for a grant under this subsection include a 
        description of the applicant's experience working with 
        paraprofessional child and adolescent mental health workers.
            ``(6) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $5,000,000 for 
        each of fiscal years 2010 through 2014.
    ``(e) Child and Adolescent Mental Health Program Development 
Grants.--
            ``(1) Establishment.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may establish a program to increase the number 
        of well-trained child and adolescent mental health service 
        professionals in the United States by awarding grants on a 
        competitive basis to accredited institutions of higher 
        education to enable the institutions to establish or expand 
        accredited graduate child and adolescent mental health 
        programs.
            ``(2) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to applicants that--
                    ``(A) demonstrate familiarity with the use of 
                evidence-based methods in child and adolescent mental 
                health services;
                    ``(B) provide experience in and collaboration with 
                community-based child and adolescent mental health 
                services;
                    ``(C) have included normal child development 
                curricula; and
                    ``(D) demonstrate commitment to working with high-
                priority populations.
            ``(3) Use of funds.--Funds received as a grant under this 
        subsection may be used to establish or expand any accredited 
        graduate child and adolescent mental health program in any 
        manner deemed appropriate by the Secretary, including by 
        improving the course work, related field placements, or faculty 
        of such program.
            ``(4) Requirements.--The Secretary may award a grant to an 
        accredited institution of higher education under this 
        subsection only if the institution agrees that--
                    ``(A) any child and adolescent mental health 
                program assisted under the grant will prioritize 
                cultural and linguistic competency;
                    ``(B) the institution will provide to the Secretary 
                such data, assurances, and information as the Secretary 
                may require; and
                    ``(C) with respect to any violation of the 
                agreement between the Secretary and the institution, 
                the institution will pay such liquidated damages as 
                prescribed by the Secretary by regulation.
            ``(5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $15,000,000 for 
        each of fiscal years 2010 through 2014.
    ``(f) Definitions.--In this section:
            ``(1) Specialized training or clinical experience in child 
        and adolescent mental health.--The term `specialized training 
        or clinical experience in child and adolescent mental health' 
        means training and clinical experience that--
                    ``(A) is part of or occurs after completion of an 
                accredited graduate program in the United States for 
                training mental health service professionals;
                    ``(B) consists of not less than 500 hours of 
                training or clinical experience in treating children 
                and adolescents; and
                    ``(C) is comprehensive, coordinated, 
                developmentally appropriate, and of high quality to 
                address the unique ethnic and cultural diversity of the 
                United States population.
            ``(2) High-priority population.--The term `high-priority 
        population' means--
                    ``(A) a population in which there is a 
                significantly greater incidence than the national 
                average of--
                            ``(i) children who have serious emotional 
                        disturbances; or
                            ``(ii) children who are racial, ethnic, or 
                        linguistic minorities; or
                    ``(B) a population consisting of individuals living 
                in a high-poverty urban or rural area.
            ``(3) Mental health service professional.--The term `mental 
        health service professional' means an individual with a 
        graduate or postgraduate degree from an accredited institution 
        of higher education in psychiatry, psychology, school 
        psychology, behavioral pediatrics, psychiatric nursing, social 
        work, school social work, marriage and family counseling, 
        school counseling, or professional counseling.''.

SEC. 4. AMENDMENTS TO SOCIAL SECURITY ACT TO IMPROVE CHILD AND 
              ADOLESCENT MENTAL HEALTH CARE.

    (a) Increasing Number of Child and Adolescent Psychiatry Residents 
Permitted To Be Paid Under the Medicare Graduate Medical Education 
Program.--Section 1886(h)(4)(F) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)(F)) is amended by adding at the end the following new 
clause:
                            ``(iii) Increase allowed for training in 
                        child and adolescent psychiatry.--In applying 
                        clause (i), there shall not be taken into 
                        account such additional number of full-time 
                        equivalent residents in the field of allopathic 
                        or osteopathic medicine who are residents or 
                        fellows in child and adolescent psychiatry as 
                        the Secretary determines reasonable to meet the 
                        need for such physicians as demonstrated by the 
                        1999 report of the Department of Health and 
                        Human Services entitled `Mental Health: A 
                        Report of the Surgeon General'.''.
    (b) Extension of Medicare Board Eligibility Period for Residents 
and Fellows in Child and Adolescent Psychiatry.--Section 1886(h)(5)(G) 
of the Social Security Act (42 U.S.C. 1395ww(h)(5)(G)) is amended--
            (1) in clause (i), by striking ``and (v)'' and inserting 
        ``(v), and (vi)''; and
            (2) by adding at the end the following new clause:
                            ``(vi) Child and adolescent psychiatry 
                        training programs.--In the case of an 
                        individual enrolled in a child and adolescent 
                        psychiatry residency or fellowship program 
                        approved by the Secretary, the period of board 
                        eligibility and the initial residency period 
                        shall be the period of board eligibility for 
                        the specialty of general psychiatry, plus 2 
                        years for the subspecialty of child and 
                        adolescent psychiatry.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to residency training years beginning on or after July 1, 2010.

SEC. 5. CHILD MENTAL HEALTH PROFESSIONAL REPORT.

    (a) Study.--The Administrator of the Health Resources and Services 
Administration (in this section referred to as the ``Administrator'') 
shall study and make findings and recommendations on--
            (1) the distribution and need for child mental health 
        service professionals, including with respect to specialty 
        certifications, practice characteristics, professional 
        licensure, racial and ethnic background, practice types, 
        locations, education, and training; and
            (2) a comparison of such distribution and need, including 
        identification of disparities, on a State-by-State basis.
    (b) Report.--Not later than 2 years after the date of enactment of 
this Act, the Administrator shall submit to the Congress and make 
publicly available a report on the results of the study required by 
subsection (a), including with respect to findings and recommendations 
on disparities among the States.

SEC. 6. REPORTS.

    (a) Transmission.--The Secretary of Health and Human Services shall 
transmit a report described in subsection (b) to Congress--
            (1) not later than 3 years after the date of enactment of 
        this Act; and
            (2) not later than 5 years after the date of enactment of 
        this Act.
    (b) Contents.--The reports transmitted to Congress under subsection 
(a) shall address each of the following:
            (1) The effectiveness of the amendments made by, and the 
        programs carried out under, this Act in increasing the number 
        of child and adolescent mental health service professionals and 
        paraprofessional child and adolescent mental health workers.
            (2) The demographics of the individuals served by such 
        increased number of child and adolescent mental health service 
        professionals and paraprofessional child and adolescent mental 
        health workers.
                                 <all>