[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 2257 Introduced in Senate (IS)]

112th CONGRESS
  2d Session
                                S. 2257

  To increase access to community behavioral health services for all 
     Americans and to improve Medicaid reimbursement for community 
                      behavioral health services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 29, 2012

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

_______________________________________________________________________

                                 A BILL


 
  To increase access to community behavioral health services for all 
     Americans and to improve Medicaid reimbursement for community 
                      behavioral health services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Excellence in Mental Health Act''.

SEC. 2. ESTABLISHING COMMUNITY BEHAVIORAL HEALTH CENTERS.

    Section 1913 of the Public Health Service Act (42 U.S.C. 300x-2) is 
amended--
            (1) in subsection (a)(2)(A), by striking ``community mental 
        health services'' and inserting ``behavioral health services 
        (of the type offered by federally qualified community 
        behavioral health centers consistent with subsection (c)(3))'';
            (2) in subsection (b)--
                    (A) by striking paragraph (1) and inserting the 
                following:
            ``(1) services under the plan will be provided only through 
        appropriate, qualified community programs (which may include 
        federally qualified community behavioral health centers, child 
        mental health programs, psychosocial rehabilitation programs, 
        mental health peer-support programs, outpatient addiction 
        treatment programs, acute detoxification services, and mental 
        health primary consumer-directed programs); and''; and
                    (B) in paragraph (2), by striking ``community 
                mental health centers'' and inserting ``federally 
                qualified community behavioral health centers''; and
            (3) by striking subsection (c) and inserting the following:
    ``(c) Criteria for Federally Qualified Community Behavioral Health 
Centers.--
            ``(1) In general.--The Administrator shall certify, and 
        recertify at least every 5 years, federally qualified community 
        behavioral health centers as meeting the criteria specified in 
        this subsection.
            ``(2) Regulations.--Not later than 18 months after the date 
        of the enactment of the Excellence in Mental Health Act, the 
        Administrator, in consultation with State Mental Health and 
        Substance Abuse Authorities, shall issue final regulations for 
        certifying non-profit or local government centers as centers 
        under paragraph (1).
            ``(3) Criteria.--The criteria referred to in subsection 
        (b)(2) are that the center performs each of the following:
                    ``(A) Provide services in locations that ensure 
                services will be available and accessible promptly and 
                in a manner which preserves human dignity and assures 
                continuity of care.
                    ``(B) Provide services in a mode of service 
                delivery appropriate for the target population.
                    ``(C) Provide individuals with a choice of service 
                options where there is more than one efficacious 
                treatment.
                    ``(D) Employ a core staff of clinical staff that is 
                multidisciplinary and culturally and linguistically 
                competent.
                    ``(E) Provide services, within the limits of the 
                capacities of the center, to any individual residing or 
                employed in the service area of the center, regardless 
                of the ability of the individual to pay.
                    ``(F) Provide, directly or through contract, to the 
                extent covered for adults in the State Medicaid plan 
                under title XIX of the Social Security Act and for 
                children in accordance with section 1905(r) of such Act 
                regarding early and periodic screening, diagnosis, and 
                treatment, each of the following services:
                            ``(i) Screening, assessment, and diagnosis, 
                        including risk assessment.
                            ``(ii) Person-centered treatment planning 
                        or similar processes, including risk assessment 
                        and crisis planning.
                            ``(iii) Outpatient mental health and 
                        substance use services, including screening, 
                        assessment, diagnosis, psychotherapy, 
                        medication management, and integrated treatment 
                        for mental illness and substance abuse which 
                        shall be evidence-based (including cognitive 
                        behavioral therapy and other such therapies 
                        which are evidence-based).
                            ``(iv) Outpatient clinic primary care 
                        screening and monitoring of key health 
                        indicators and health risk (including screening 
                        for diabetes, hypertension, and cardiovascular 
                        disease and monitoring of weight, height, body 
                        mass index (BMI), blood pressure, blood glucose 
                        or HbA1C, and lipid profile).
                            ``(v) Crisis mental health services, 
                        including 24-hour mobile crisis teams, 
                        emergency crisis intervention services, and 
                        crisis stabilization.
                            ``(vi) Targeted case management (services 
                        to assist individuals gaining access to needed 
                        medical, social, educational, and other 
                        services and applying for income security and 
                        other benefits to which they may be entitled).
                            ``(vii) Psychiatric rehabilitation services 
                        including skills training, assertive community 
                        treatment, family psychoeducation, disability 
                        self-management, supported employment, 
                        supported housing services, therapeutic foster 
                        care services, and such other evidence-based 
                        practices as the Secretary may require.
                            ``(viii) Peer support and counselor 
                        services and family supports.
                    ``(G) Maintain linkages, and where possible enter 
                into formal contracts with the following:
                            ``(i) Federally qualified health centers.
                            ``(ii) Inpatient psychiatric facilities and 
                        substance use detoxification, post-
                        detoxification step-down services, and 
                        residential programs.
                            ``(iii) Adult and youth peer support and 
                        counselor services.
                            ``(iv) Family support services for families 
                        of children with serious mental or substance 
                        use disorders.
                            ``(v) Other community or regional services, 
                        supports, and providers, including schools, 
                        child welfare agencies, juvenile and criminal 
                        justice agencies and facilities, housing 
                        agencies and programs, employers, and other 
                        social services.
                            ``(vi) Onsite or offsite access to primary 
                        care services.
                            ``(vii) Enabling services, including 
                        outreach, transportation, and translation.
                            ``(viii) Health and wellness services, 
                        including services for tobacco cessation.
            ``(4) Rule of construction.--Nothing in paragraph (1) shall 
        be construed as prohibiting States receiving funds appropriated 
        through the Community Mental Health Services Block Grant under 
        subpart I of part B of this title from financing qualified 
        community programs (whether such programs meet the definition 
        of eligible programs prior to or after the date of enactment of 
        this subsection).
            ``(5) Limitation.--With respect to federally qualified 
        behavioral health centers authorized under this subsection, 20 
        percent of the total number of such centers shall become newly 
        eligible to receive reimbursement under this section in each of 
        the first 5 years after the initial year of eligibility through 
        fiscal year 2022. In implementing this paragraph, the Secretary 
        shall ensure geographic diversity of such sites, take into 
        account the ability of such sites to provide required services, 
        and the ability of such sites to report required data.''.

SEC. 3. MEDICAID COVERAGE AND PAYMENT FOR COMMUNITY BEHAVIORAL HEALTH 
              CENTER SERVICES.

    (a) Payment for Services Provided by Federally Qualified Community 
Behavioral Health Centers.--Section 1902(bb) of the Social Security Act 
(42 U.S.C. 1396a(bb)) is amended--
            (1) in the heading, by striking ``and Rural Health 
        Clinics'' and inserting ``, Federally Qualified Community 
        Behavioral Health Centers, and Rural Health Clinics'';
            (2) in paragraph (1), by inserting ``(and beginning with 
        fiscal year 2013 with respect to services furnished on or after 
        January 1, 2013, and each succeeding fiscal year, for services 
        described in section 1905(a)(2)(D) furnished by a federally 
        qualified community behavioral health center)'' after ``by a 
        rural health clinic'';
            (3) in paragraph (2)--
                    (A) by striking the heading and inserting ``Initial 
                fiscal year'';
                    (B) by inserting ``(or, in the case of services 
                described in section 1905(a)(2)(D) furnished by a 
                federally qualified community behavioral health center, 
                for services furnished on and after January 1, 2013, 
                during fiscal year 2013)'' after ``January 1, 2001, 
                during fiscal year 2001'';
                    (C) by inserting ``(or, in the case of services 
                described in section 1905(a)(2)(D) furnished by a 
                federally qualified community behavioral health center, 
                during fiscal years 2010 and 2011)'' after ``1999 and 
                2000''; and
                    (D) by inserting ``(or, in the case of services 
                described in section 1905(a)(2)(D) furnished by a 
                federally qualified community behavioral health center, 
                during fiscal year 2013)'' before the period;
            (4) in paragraph (3)--
                    (A) in the heading, by striking ``Fiscal year 2002 
                and succeeding'' and inserting ``Succeeding''; and
                    (B) by inserting ``(or, in the case of services 
                described in section 1905(a)(2)(D) furnished by a 
                federally qualified community behavioral health center, 
                for services furnished during fiscal year 2013 or a 
                succeeding fiscal year)'' after ``2002 or a succeeding 
                fiscal year'';
            (5) in paragraph (4)--
                    (A) by inserting ``(or as a federally qualified 
                community behavioral health center after fiscal year 
                2011)'' after ``or rural health clinic after fiscal 
                year 2000'';
                    (B) by striking ``furnished by the center or'' and 
                inserting ``furnished by the federally qualified health 
                center, services described in section 1905(a)(2)(D) 
                furnished by the federally qualified community 
                behavioral health center, or''; and
                    (C) in the second sentence, by striking ``or rural 
                health clinic'' and inserting ``, federally qualified 
                community behavioral health center, or rural health 
                clinic'';
            (6) in paragraph (5), in each of subparagraphs (A) and (B), 
        by striking ``or rural health clinic'' and inserting ``, 
        federally qualified community behavioral health center, or 
        rural health clinic''; and
            (7) in paragraph (6), by striking ``or to a rural health 
        clinic'' and inserting ``, to a federally qualified community 
        behavioral health center for services described in section 
        1905(a)(2)(D), or to a rural health clinic''.
    (b) Inclusion of Community Behavioral Health Center Services in the 
Term Medical Assistance.--Section 1905(a)(2) of the Social Security Act 
(42 U.S.C. 1396d(a)(2)) is amended--
            (1) by striking ``and'' before ``(C)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (D) federally qualified community behavioral 
        health center services (as defined in subsection (l)(4))''.
    (c) Definition of Federally Qualified Community Behavioral Health 
Center Services.--Section 1905(l) of the Social Security Act (42 U.S.C. 
1396d(l)) is amended by adding at the end the following paragraph:
            ``(4)(A) The term `community behavioral health center 
        services' means services furnished to an individual at a 
        federally qualified community behavioral health center (as 
        defined by subparagraph (B)).
            ``(B) The term `federally qualified community behavioral 
        health center' means an entity that is certified under section 
        1913(c) of the Public Health Service Act as meeting the 
        criteria described in paragraph (3) of such section.''.

SEC. 4. COMMUNITY-BASED MENTAL HEALTH INFRASTRUCTURE IMPROVEMENT.

    Title V of the Public Health Service Act (42 U.S.C. 280g et seq.) 
is amended by adding at the end the following:

  ``PART H--COMMUNITY-BASED MENTAL HEALTH INFRASTRUCTURE IMPROVEMENTS

``SEC. 560. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH INFRASTRUCTURE 
              IMPROVEMENTS.

    ``(a) Grants Authorized.--The Secretary may award grants to 
eligible entities to expend funds for the construction or modernization 
of facilities used to provide mental health and substance abuse 
services to individuals.
    ``(b) Eligible Entity.--In this section, the term `eligible entity' 
means--
            ``(1) a State that is the recipient of a Community Mental 
        Health Services Block Grant under subpart I of part B of title 
        XIX and a Substance Abuse Prevention and Treatment Block Grant 
        under subpart II of such part; or
            ``(2) an Indian tribe or a tribal organization (as such 
        terms are defined in sections 4(b) and 4(c) of the Indian Self-
        Determination and Education Assistance Act).
    ``(c) Application.--A eligible entity desiring a grant under this 
section shall submit to the Secretary an application at such time, in 
such manner, and containing--
            ``(1) a plan for the construction or modernization of 
        facilities used to provide mental health and substance abuse 
        services to individuals that--
                    ``(A) designates a single State or tribal agency as 
                the sole agency for the supervision and administration 
                of the grant;
                    ``(B) contains satisfactory evidence that such 
                agency so designated will have the authority to carry 
                out the plan;
                    ``(C) provides for the designation of an advisory 
                council, which shall include representatives of 
                nongovernmental organizations or groups, and of the 
                relevant State or tribal agencies, that aided in the 
                development of the plan and that will implement and 
                monitor any grant awarded to the eligible entity under 
                this section;
                    ``(D) in the case of an eligible entity that is a 
                State, includes a copy of the State plan under section 
                1912(b) and section 1932(b);
                    ``(E)(i) includes a listing of the projects to be 
                funded by the grant; and
                    ``(ii) in the case of an eligible entity that is a 
                State, explains how each listed project helps the State 
                in accomplishing its goals and objectives under the 
                Community Mental Health Services Block Grant under 
                subpart I of part B of title XIX and the Substance 
                Abuse Prevention and Treatment Block Grant under 
                subpart II of such part;
                    ``(F) includes assurances that the facilities will 
                be used for a period of not less than 10 years for the 
                provision of community-based mental health or substance 
                abuse services for those who cannot pay for such 
                services, subject to subsection (e); and
                    ``(G) in the case of a facility that is not a 
                public facility, includes the name and executive 
                director of the entity who will provide services in the 
                facility; and
            ``(2) with respect to each construction or modernization 
        project described in the application--
                    ``(A) a description of the site for the project;
                    ``(B) plans and specifications for the project and 
                State or tribal approval for the plans and 
                specifications;
                    ``(C) assurance that the title for the site is or 
                will be vested with either the public entity or private 
                nonprofit entity who will provide the services in the 
                facility;
                    ``(D) assurance that adequate financial resources 
                will be available for the construction or major 
                rehabilitation of the project and for the maintenance 
                and operation of the facility;
                    ``(E) estimates of the cost of the project; and
                    ``(F) the estimated length of time for completion 
                of the project.
    ``(d) Subgrants by States.--
            ``(1) In general.--A State that receives a grant under this 
        section may award a subgrant to a qualified community program 
        (as such term is used in section 1913(b)(1)).
            ``(2) Use of funds.--Subgrants awarded pursuant to 
        paragraph (1) may be used for activities such as--
                    ``(A) the construction, expansion, and 
                modernization of facilities used to provide mental 
                health and substance abuse services to individuals;
                    ``(B) acquiring and leasing facilities and 
                equipment (including paying the costs of amortizing the 
                principal of, and paying the interest on, loans for 
                such facilities and equipment) to support or further 
                the operation of the subgrantee;
                    ``(C) the construction and structural modification 
                (including equipment acquisition) of facilities to 
                permit the integrated delivery of behavioral health and 
                primary care of specialty medical services to 
                individuals with co-occurring mental illnesses and 
                chronic medical or surgical diseases at a single 
                service site; and
                    ``(D) acquiring information technology required to 
                accommodate the clinical needs of primary and specialty 
                care professionals.
            ``(3) Limitation.--Not to exceed 15 percent of grant funds 
        may be used for activities described in paragraph (2)(D).
    ``(e) Request To Transfer Obligation.--An eligible entity that 
receives a grant under this section may submit a request to the 
Secretary for permission to transfer the 10-year obligation of facility 
use, as described in subsection (c)(1)(F), to another facility.
    ``(f) Agreement to Federal Share.--As a condition of receipt of a 
grant under this section, an eligible entity shall agree, with respect 
to the costs to be incurred by the entity in carrying out the 
activities for which such grant is awarded, that the entity will make 
available non-Federal contributions (which may include State or local 
funds, or funds from the qualified community program) in an amount 
equal to not less than $1 for every $1 of Federal funds provided under 
the grant.
    ``(g) Reporting.--
            ``(1) Reporting by states.--During the 10-year period 
        referred to in subsection (c)(1)(F), the Secretary shall 
        require that a State that receives a grant under this section 
        submit, as part of the report of the State required under the 
        Community Mental Health Services Block Grant under subpart I of 
        part B of title XIX and the Substance Abuse Prevention and 
        Treatment Block Grant under subpart II of such part, a 
        description of the progress on--
                    ``(A) the projects carried out pursuant to the 
                grant under this section; and
                    ``(B) the assurances that the facilities involved 
                continue to be used for the purpose for which they were 
                funded under such grant during such 10-year period.
            ``(2) Reporting by indian tribes and tribal 
        organizations.--The Secretary shall establish reporting 
        requirements for Indian tribes and tribal organizations that 
        receive a grant under this section. Such reporting requirements 
        shall include that such Indian tribe or tribal organization 
        provide a description of the progress on--
                    ``(A) the projects carried out pursuant to the 
                grant under this section; and
                    ``(B) the assurances that the facilities involved 
                continue to be used for the purpose for which they were 
                funded under such grant during the 10-year period 
                referred to in subsection (c)(1)(F).
    ``(h) Failure To Meet Obligations.--
            ``(1) In general.--If an eligible entity that receives a 
        grant under this section fails to meet any of the obligations 
        of the entity required under this section, the Secretary shall 
        take appropriate steps, which may include--
                    ``(A) requiring that the entity return the unused 
                portion of the funds awarded under this section for the 
                projects that are incomplete; and
                    ``(B) extending the length of time that the entity 
                must ensure that the facility involved is used for the 
                purposes for which it is intended, as described in 
                subsection (c)(1)(F).
            ``(2) Hearing.--Prior to requesting the return of the funds 
        under paragraph (1)(B), the Secretary shall provide the entity 
        notice and opportunity for a hearing.
    ``(i) Collaboration.--The Secretary may establish intergovernmental 
and interdepartmental memorandums of agreement as necessary to carry 
out this section.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2013 through 2017.''.

SEC. 5. EXPANDED PARTICIPATION IN 340B PROGRAM.

    Section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 
256b(a)(4)) is amended by adding at the end the following:
                    ``(P) An entity receiving funds under subpart I of 
                part B of title XIX of this Act for the provision of 
                community mental health services.
                    ``(Q) An entity receiving funds under subpart II of 
                part B of title XIX of this Act for the provision of 
                treatment services for substance abuse.''.
                                 <all>