[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5804 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 5804

 To authorize the Secretary of Health and Human Services to make loans 
and loan guarantees for planning, constructing, or renovating pediatric 
  or adult mental health treatment facilities and pediatric or adult 
  substance use disorder treatment facilities, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 2023

 Mr. Kilmer (for himself and Mr. Bacon) introduced the following bill; 
       which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To authorize the Secretary of Health and Human Services to make loans 
and loan guarantees for planning, constructing, or renovating pediatric 
  or adult mental health treatment facilities and pediatric or adult 
  substance use disorder treatment facilities, 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 ``Mental Health Infrastructure 
Improvement Act of 2023''.

SEC. 2. LOANS AND LOAN GUARANTEES.

    Part P of title III of the Public Health Service Act is amended by 
inserting after section 399V-7 of such Act (42 U.S.C. 280g-17) the 
following:

``SEC. 399V-8. LOANS AND LOAN GUARANTEES FOR PLANNING, CONSTRUCTING, OR 
              RENOVATING ELIGIBLE FACILITIES FOR PEDIATRIC OR ADULT 
              MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES.

    ``(a) In General.--The Secretary may--
            ``(1) make loans and loan guarantees to eligible entities 
        for the purpose of--
                    ``(A) constructing or renovating, including 
                planning the construction or renovation of, a pediatric 
                or adult mental health treatment facility or a 
                pediatric or adult substance use disorder treatment 
                facility;
                    ``(B) improving digital infrastructure, telehealth 
                capabilities, or other patient care infrastructure at 
                such a facility; or
                    ``(C) adding, or converting beds to, adult or 
                pediatric psychiatric and substance use inpatient beds 
                at such a facility; and
            ``(2) subject to subsection (e), make loans and loan 
        guarantees for refinancing loans that were made for such 
        purpose to an eligible entity.
    ``(b) Preference.--In making loans and loan guarantees under this 
section, the Secretary shall give preference to eligible entities 
proposing to construct or renovate a pediatric or adult mental health 
treatment facility, or a pediatric or adult substance use disorder 
treatment facility, that will--
            ``(1) increase the number of pediatric or adult psychiatric 
        beds or pediatric or adult substance use disorder beds in a 
        county that has insufficient psychiatric or substance use 
        disorder treatment bed capacity;
            ``(2) provide mental health or substance use disorder 
        services in a high-need rural or underresourced community;
            ``(3) provide multiple services across the continuum of 
        mental health or substance use disorder care; or
            ``(4) have the capacity to provide integrated or 
        specialized mental health and substance use disorder care for 
        complex cases or patients with medical co-morbidities.
    ``(c) Set-Aside.--The Secretary shall allocate at least 25 percent 
of the funds under this section for any fiscal year for awards to 
construct or renovate facilities serving primarily pediatric 
populations.
    ``(d) Terms and Conditions.--Loans and loan guarantees under this 
section shall be made on such terms and conditions as the Secretary may 
prescribe, subject to the provisions of this section including the 
following:
            ``(1) The Secretary may allow credit to a prospective 
        borrower only where--
                    ``(A) it is necessary to increase the number of 
                psychiatric or substance use disorder treatment 
                facilities to enhance the public's access to a 
                comprehensive continuum of mental health and substance 
                use disorder services; and
                    ``(B) a credit subsidy is the most efficient way to 
                achieve such increase (on a borrower-by-borrower 
                basis).
            ``(2) The final maturity of loans made or guaranteed under 
        this section shall not exceed a period of 20 years, or the 
        period of 50 percent of the useful life of any physical asset 
        to be financed by the loan, whichever is less as determined by 
        the Secretary.
            ``(3) The Secretary may not make a loan guarantee under 
        this section, with respect to any borrower, in excess of 80 
        percent of any potential loss on the loan.
            ``(4) The Secretary may not make any loan or loan guarantee 
        under this section if the loan will be subordinated--
                    ``(A) to another debt contracted by the borrower; 
                or
                    ``(B) to any other claims against the borrower in 
                the case of default.
            ``(5) The Secretary may not make any loan guarantee under 
        this section unless the Secretary determines that--
                    ``(A) the lender is responsible; and
                    ``(B) adequate provision is made for servicing the 
                loan on reasonable terms and protecting the financial 
                interest of the United States.
            ``(6) The Secretary may not make any loan guarantee under 
        this section if the income from the loan will be excluded from 
        gross income for purposes of chapter 1 of the Internal Revenue 
        Code of 1986.
            ``(7) The Secretary may not make any loan or loan guarantee 
        under this section unless--
                    ``(A) the loan and interest supplements on any loan 
                guarantee will be at an interest rate that is set by 
                reference to a benchmark interest rate on marketable 
                Treasury securities with a similar maturity to the loan 
                being made or guaranteed; and
                    ``(B) the minimum interest rate on the loan--
                            ``(i) will be no less than the estimated 
                        cost to the Government of making the loan plus 
                        1 percent, with the goal of keeping the 
                        interest rate below the interest rate of a 
                        comparable and competitive private sector 
                        benchmark financial instrument; and
                            ``(ii) will be adjusted, as determined by 
                        the Secretary, every quarter to take account of 
                        changes in the interest rate of the benchmark 
                        financial instrument.
            ``(8) The Secretary may not make any loan or loan guarantee 
        under this section unless--
                    ``(A) fees or premiums on the loan or loan 
                guarantee and corresponding insurance coverage will be 
                set at levels that minimize the cost to the Government 
                (as defined in section 502(5) of the Federal Credit 
                Reform Act of 1990) of insuring such loan or loan 
                guarantee, while supporting achievement of enhancing 
                the public's access to a comprehensive continuum of 
                mental health and substance use disorder services, 
                including increasing the number of inpatient 
                psychiatric and substance use disorder bed counts in 
                areas with insufficient bed capacity;
                    ``(B) the minimum guarantee fee or insurance 
                premium imposed by the Government will be no less than 
                the level sufficient to cover all of the estimated 
                costs to the Government of the expected default claims, 
                plus one percent; and
                    ``(C) loan guarantee fees imposed by the Government 
                will be reviewed every six months to ensure that the 
                fees imposed on new loan guarantees are at a level 
                sufficient to satisfy subparagraph (B) based on the 
                most recent estimates of such costs.
            ``(9) The provisions of any loan guarantee under this 
        section shall state that the guarantee is conclusive evidence 
        that--
                    ``(A) the guarantee has been properly obtained;
                    ``(B) the underlying loan qualified for the 
                guarantee; and
                    ``(C) except in the case of fraud or material 
                misrepresentation by the holder of the loan, the 
                guarantee will be presumed to be valid, legal, and 
                enforceable.
            ``(10) The Secretary may not make any loan or loan 
        guarantee under this section unless--
                    ``(A) the borrower finances at least 25 percent of 
                the funded project from other sources; and
                    ``(B) the borrower uses funds that were not derived 
                from Federal loans or loan guarantees to pay the fees 
                or premiums on the loan or loan guarantee under this 
                section.
            ``(11) The Secretary--
                    ``(A) shall prescribe explicit standards for use in 
                periodically assessing the credit risk of new and 
                existing direct loans and guaranteed loans; and
                    ``(B) shall not make a loan or loan guarantee under 
                this section unless the Secretary finds that there is a 
                reasonable assurance of repayment.
    ``(e) Limitation on Refinancing.--The authority vested by 
subsection (a)(2)--
            ``(1) authorizes making loans and loan guarantees only for 
        refinancing loans that are entered into on or before the date 
        that is 24 months before the date of enactment of the Mental 
        Health Infrastructure Improvement Act of 2023; and
            ``(2) terminates on the date that is 24 months after such 
        date of enactment.
    ``(f) Payment of Losses.--
            ``(1) Default on guaranteed loans.--If, as a result of a 
        default by a borrower under a loan guaranteed under this 
        section, after the holder thereof has made such further 
        collection efforts and instituted such enforcement proceedings 
        as the Secretary may require, the Secretary determines that the 
        holder has suffered a loss--
                    ``(A) the Secretary shall pay to such holder 75 
                percent of such loss, as specified in the guarantee 
                contract;
                    ``(B) upon making any such payment, the Secretary 
                shall be subrogated to all the rights of the recipient 
                of the payment; and
                    ``(C) the Secretary shall be entitled to recover 
                from the borrower the amount of any payments made 
                pursuant to the guarantee contract.
            ``(2) Required enforce of federal rights.--The Attorney 
        General of the United States shall take such action as may be 
        appropriate to enforce any right accruing to the United States 
        as a result of the issuance of any guarantee under this 
        section.
            ``(3) Forbearance.--Nothing in this section precludes any 
        forbearance for the benefit of the borrower of a loan that is 
        made or guaranteed under this section which is agreed upon by 
        the parties to the loan and approved by the Secretary, provided 
        that budget authority for any resulting cost to the Government 
        (as defined in section 502(5) of the Federal Credit Reform Act 
        of 1990) is available.
    ``(g) Definitions.--In this section:
            ``(1) The term `children's hospital' means a hospital that 
        predominantly serves patients under the age of 18.
            ``(2) The term `critical access hospital' has the meaning 
        given to such term in section 1861(mm) of the Social Security 
        Act.
            ``(3) The term `eligible entity' includes public, private 
        for-profit, and private not-for-profit--
                    ``(A) hospitals including general acute hospitals, 
                psychiatric hospitals, critical access hospitals, rural 
                emergency hospitals, sole community hospitals, 
                children's hospitals, and other hospitals as specified 
                by the Secretary;
                    ``(B) substance use disorder treatment facilities;
                    ``(C) mental health treatment facilities;
                    ``(D) facilities that employ licensed mental health 
                and substance use disorder professionals, such as child 
                and adult psychiatrists, child and adult psychologists, 
                advanced practice nurses, social workers, licensed 
                professional counselors, or other licensed 
                professionals that provide mental health or substance 
                use disorder services to pediatric or adult patients;
                    ``(E) alliances of hospitals or facilities listed 
                in any of clauses (i), (ii), (iii), (iv), and (vi); and
                    ``(F) other facilities as determined by the 
                Secretary.
            ``(4) The term `mental health treatment facility'--
                    ``(A) includes--
                            ``(i) a child or adult outpatient facility 
                        that provides--
                                    ``(I) intensive outpatient 
                                services;
                                    ``(II) partial hospitalization 
                                services;
                                    ``(III) crisis intervention and 
                                stabilization; or
                                    ``(IV) other mental, behavioral, or 
                                emotional health services deemed 
                                appropriate by the Secretary;
                            ``(ii) a hospital (including a general 
                        acute hospital, a psychiatric hospital, a 
                        critical access hospital, a rural emergency 
                        hospital, a sole community hospital, a 
                        children's hospital, or other type of hospital 
                        as specified by the Secretary) that--
                                    ``(I) provides acute, short-term 
                                inpatient psychiatric treatment 
                                services or outpatient services; and
                                    ``(II) may include a military 
                                services program to meet the needs of 
                                active and retired military 
                                servicemembers; and
                            ``(iii) a facility within or near an 
                        emergency department for providing discharge 
                        planning and instructions to emergency 
                        department patients in need of mental health or 
                        substance use disorder treatment and transfer 
                        to an appropriate mental health or substance 
                        use disorder treatment care setting; and
                    ``(B) excludes a facility that provide long-term 
                inpatient care.
            ``(5) The term `substance use disorder treatment 
        facility'--
                    ``(A) includes--
                            ``(i) a child or adult outpatient facility 
                        that provides outpatient substance use disorder 
                        services; and
                            ``(ii) a hospital (including a general 
                        acute hospital, a psychiatric hospital, a 
                        critical access hospital, a rural emergency 
                        hospital, a sole community hospital, a 
                        children's hospital, or other type of hospital 
                        as specified by the Secretary) that--
                                    ``(I) provides acute, short-term 
                                inpatient substance use disorder 
                                treatment services or outpatient 
                                services; and
                                    ``(II) may include a military 
                                services program to meet the needs of 
                                active and retired military 
                                servicemembers; and
                    ``(B) excludes any facility described in paragraph 
                (1)(B).
            ``(6) The term `psychiatric hospital' has the meaning given 
        to such term in section 1861(f) of the Social Security Act.
            ``(7) The term `rural emergency hospital' has the meaning 
        given to such term in section 1861(kkk) of the Social Security 
        Act.
            ``(8) The term `sole community hospital' has the meaning 
        given to such term in section 1886(d)(5)(D)(iii) of the Social 
        Security Act.
    ``(h) Funding Limitations.--The Secretary may provide loans and 
loan guarantees under this section--
            ``(1) only to the extent or in the amounts provided in 
        advance in appropriation Acts; and
            ``(2) totaling not more than $200,000,000 for each of 
        fiscal years 2024 through 2028.''.

SEC. 3. MENTAL HEALTH AND SUBSTANCE USE TREATMENT TRUST FUND.

    (a) Establishment.--There is established in the Treasury of the 
United States a trust fund to be known as the Mental Health and 
Substance Use Treatment Trust Fund (in this section referred to as the 
``Trust Fund'').
    (b) Deposits.--There are hereby authorized to be appropriated to 
the Trust Fund, to remain available until expended, amounts equivalent 
to any revenues from the program of loans and loan guarantees under 
section 399V-7 of the Public Health Service Act, as added by section 2, 
that exceed the costs of carrying out such program.
    (c) Use of Fund.--Amounts in the Trust Fund shall be available, as 
provided by appropriation Acts, for block grants for community mental 
health services under subpart I of part B of title XIX of the Public 
Health Service Act (42 U.S.C. 300x et seq.).
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