[Congressional Record Volume 150, Number 89 (Thursday, June 24, 2004)]
[Senate]
[Pages S7437-S7441]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. CLINTON (for herself, Ms. Collins, and Mr. Breaux):
  S. 2572. A bill to amend the Older Americans Act of 1965 to provide 
for mental health screening and treatment services, to amend the Public 
Health Service Act to provide for integration of mental health services 
and mental health treatment outreach teams, and for other purposes; to 
the Committee on Health, Education, Labor, and Pensions.
  Mrs. CLINTON. Mr. President, today, I rise to introduce the Positive 
Aging Act of 2004 to improve the accessibility and quality of mental 
health services for our rapidly growing population of older Americans 
with my colleagues Senators Breaux and Collins. Representatives Patrick 
Kennedy and Ileana Ros-Lehtinen are also introducing a companion bill 
in the House this afternoon.
  My colleagues John Breaux and Patrick Kennedy introduced this bill 
initially to focus on mental health programs, and with constituent 
input we decided to broaden it to involve the aging community as well. 
I want to acknowledge our partners from both the mental health and 
aging organizations who have collaborated with us and been working hard 
on these issues for a long time.
  Our significant success in extending the life span of older adults 
has created a set of challenges related to the quality of life for 
American's senior citizens. It is critically important now to focus on 
making the extra years of life as productive and healthy as possible. 
This legislation is designed to do just that. It puts mental health 
services on a par with other primary care services in community 
settings that are easily accessible to the elderly. I firmly believe we 
must integrate mental health services with other essential primary 
care.
  The Surgeon General's report on mental health in 1999 told us that 
disability due to mental illness in the elderly population is fast 
becoming a major public health problem. Depression, dementia, anxiety, 
and substance abuse are growing problems among older Americans that 
result in functional dependence, long-term institutional care and 
reduced quality of life.
  Nearly 20 percent of those over age 55 experience mental illnesses 
that are not a part of ``normal'' aging, and are all too frequently 
undetected and untreated. The real tragedy is that we can effectively 
treat many of these conditions, but in far too many instances we are 
not making such treatments available. Unrecognized and untreated mental 
illness among elderly adults can be traced to gaps in training of 
health professionals, and in our failure to fully integrate mental 
health screening and treatment with other health services. Far too 
often physicians and other health professionals fail to recognize the 
signs and symptoms of mental illness. More troubling, knowledge about 
effective interventions is simply not accessible to many primary care 
practitioners.
  Research has shown that treatment of mental illnesses can reduce the 
need for other health services and can improve health outcomes for 
those with other chronic diseases. These missed opportunities to 
diagnose and treat mental diseases are taking a huge toll on the 
elderly and increasing the burden on their families and our health care 
system.
  I know there are a number of reasons for our failure to meet the 
mental health needs of our seniors. Regrettably, acknowledging and 
seeking mental health care can be impeded by the stigma associated with 
mental illness. In addition, Medicare benefit discrimination related to 
coverage of mental health services continues to be a barrier to 
appropriate care for the elderly.
  Finally, the lack of coverage for prescription drugs in Medicare has 
until now imposed significant financial burdens on many older 
Americans. Notwithstanding the addition of a limited Medicare drug 
benefit, there remains the potential that drugs needed for 
the treatment of mental illness will be treated unfairly through 
formulary restrictions, prior authorization, and higher out-of-pocket 
expenses. We must be especially vigilant in our oversight of this 
benefit to prevent such discrimination on behalf of the millions of 
older Americans with mental illnesses.

  The bill we are introducing today provides new authorities and 
resources to the Administration on Aging (AOA) and the Substance Abuse 
and Mental Health Services Administration (SAMHSA) in the Department of 
Health and Human Services. For over 35 years, the AOA has provided home 
and community-based services to millions of older persons through the 
programs funded under the Older Americans Act. SAMHSA provides block 
grants to the States and other financial support to develop and apply 
best practices in the identification and treatment of mental diseases 
at the community level. Working together these agencies have the 
potential for strengthening and extending the delivery of mental health 
services to older Americans.
  This legislation focuses on getting mental health services to 
community sites where primary care and other social services are 
provided. It will promote the integration of mental health services and 
the use of evidence-based practice protocols. This approach has the 
advantage of building on existing structures and programs, and 
``mainstreaming'' mental health care for these vulnerable populations.
  The bill authorizes AOA to make formula grants to the states for the 
development and operation of systems for providing mental health 
screening and treatment services to older Americans. These funds may 
also be used for outreach programs to increase public awareness of the 
availability and effectiveness of mental health assessments and 
treatment. Priority will be given to areas that are medically under-
served and include significant numbers of older adults. States will be 
required to coordinate projects with existing community agencies and 
voluntary organizations offering services to the targeted populations.
  This legislation also establishes new grant authorities at AOA to 
support development and operation of projects for screening and 
treating mental illness among seniors in rural and urban areas.

[[Page S7438]]

  Multidisciplinary teams of mental health professionals relying on 
evidence-based intervention and treatment protocols are required to 
deliver these services. To the maximum extent possible, the grants will 
be coordinated with activities in senior centers, adult day care 
programs, and naturally occurring retirement centers (NORCs).
  This legislation also authorizes two new grant programs at SAMHSA to 
provide new resources to support mental health screening and treatment 
services in clinical settings. Primary care sites serving a geriatric 
patient population such as public or private nonprofit community health 
centers or private practices would be eligible for one of these new 
grant programs.
  The other program will provide support for geriatric mental health 
outreach teams to foster collaboration between clinical sites and 
senior centers, assisted living facilities, and other social or 
residential service centers.
  Since the projects supported by these new grant programs are based in 
clinical settings, these funds will help to inform primary care 
practitioners and increase their capabilities in screening and 
treatment for mental illness. These projects build on existing health 
care delivery systems and extend their reach to low-income seniors in 
the community.
  I expect these demonstrations will be a catalyst for breaking down 
the barriers that have limited access to mental health services and 
retarded the dissemination of evidence-based protocols in the primary 
care setting. I have specifically set a priority for projects to serve 
a variety of populations, including racial and ethnic minorities and 
low-income populations, in both rural and urban areas.
  Finally, we have included in this bill several administrative 
provisions to raise the profile of mental health services for older 
adults at AOA and SAMHSA. A new Office of Older Adult Mental Health 
Services is established at AOA to provide a senior level focus for 
initiatives to improve the access of seniors to appropriate mental 
health screening and treatment services. At SAMHSA, the bill creates a 
new deputy director for geriatric mental health services within the 
Center for Mental Health Services to develop and implement targeted 
programs for older adults.
  There are practical and immediate opportunities to improve mental 
health care for older Americans. This legislation can help to target 
our resources on identifying and treating a population at high risk for 
disability and dependence.
  We have an obligation to take what is known about effective 
treatments and improve the quality of life and overall health of 
millions of seniors. It's not only the right thing to do; it's also an 
investment that will return enormous dividends in terms of more 
economical use of health resources, improved patient outcomes, and a 
better quality of life for older Americans. I ask unanimous consent 
that the text of the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2572

       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 ``Positive Aging Act of 
     2004''.

         TITLE I--AMENDMENTS TO THE OLDER AMERICANS ACT OF 1965

     SEC. 101. DEFINITIONS.

       Section 102 of the Older Americans Act of 1965 (42 U.S.C. 
     3002) is amended by adding at the end the following:
       ``(44) Mental health screening and treatment services.--The 
     term `mental health screening and treatment services' means 
     patient screening, diagnostic services, care planning and 
     oversight, therapeutic interventions, and referrals that 
     are--
       ``(A) provided pursuant to evidence-based intervention and 
     treatment protocols (to the extent such protocols are 
     available) for mental disorders prevalent in older 
     individuals (including, but not limited to, mood and anxiety 
     disorders, dementias of all kinds, psychotic disorders, and 
     substances and alcohol abuse), relying to the greatest extent 
     feasible on protocols that have been developed--
       ``(i) by or under the auspices of the Secretary; or
       ``(ii) by academicians with expertise in mental health and 
     aging; and
       ``(B) coordinated and integrated with the services of 
     social service, mental health, and health care providers in 
     an area in order to--
       ``(i) improve patient outcomes; and
       ``(ii) assure, to the maximum extent feasible, the 
     continuing independence of older individuals who are residing 
     in the area.''.

     SEC. 102. OFFICE OF OLDER ADULT MENTAL HEALTH SERVICES.

       Section 301(b) of the Older Americans Act of 1965 (42 
     U.S.C. 3021(b)) is amended by adding at the end the 
     following:
       ``(3) The Assistant Secretary shall establish within the 
     Administration an Office of Older Adult Mental Health 
     Services, which shall be responsible for the development and 
     implementation of initiatives to address the mental health 
     needs of older individuals.''.

     SEC. 103. GRANTS TO STATES FOR THE DEVELOPMENT AND OPERATION 
                   OF SYSTEMS FOR PROVIDING MENTAL HEALTH 
                   SCREENING AND TREATMENT SERVICES TO OLDER 
                   INDIVIDUALS LACKING ACCESS TO SUCH SERVICES.

       Title III of the Older Americans Act of 1965 (42 U.S.C. 
     3021 et seq.) is amended--
       (1) in section 303 (42 U.S.C. 3023), by adding at the end 
     the following:
       ``(f) There are authorized to be appropriated to carry out 
     part F (relating to grants for programs providing mental 
     health screening and treatment services) such sums as may be 
     necessary for fiscal year 2005 and each of the 5 succeeding 
     fiscal years.'';
       (2) in section 304(a)(1) (42 U.S.C. 3024(a)(1)), by 
     inserting ``and subsection (f)'' after ``through (d)''; and
       (3) by adding at the end the following:

  ``PART F--MENTAL HEALTH SCREENING AND TREATMENT SERVICES FOR OLDER 
                              INDIVIDUALS

     ``SEC. 381. GRANTS TO STATES FOR PROGRAMS PROVIDING MENTAL 
                   HEALTH SCREENING AND TREATMENT SERVICES FOR 
                   OLDER INDIVIDUALS.

       ``(a) Program Authorized.--The Assistant Secretary shall 
     carry out a program for making grants to States under State 
     plans approved under section 307 for the development and 
     operation of--
       ``(1) systems for the delivery of mental health screening 
     and treatment services for older individuals who lack access 
     to such services; and
       ``(2) programs to--
       ``(A) increase public awareness regarding the benefits of 
     prevention and treatment of mental disorders; and
       ``(B) reduce the stigma associated with mental disorders 
     and other barriers to the diagnosis and treatment of the 
     disorders.
       ``(b) State Allocation and Priorities.--A State agency that 
     receives funds through a grant made under this section shall 
     allocate the funds to area agencies on aging to carry out 
     this part in planning and service areas in the State. In 
     allocating the funds, the State agency shall give priority to 
     planning and service areas in the State--
       ``(1) that are medically underserved; and
       ``(2) in which there are a large number of older 
     individuals.
       ``(c) Area Coordination of Services With Other Providers.--
     In carrying out this part, to more efficiently and 
     effectively deliver services to older individuals, each area 
     agency on aging shall--
       ``(1) coordinate services described in subsection (a) with 
     other community agencies, and voluntary organizations, 
     providing similar or related services; and
       ``(2) to the greatest extent practicable, integrate 
     outreach and educational activities with existing (as of the 
     date of the integration) health care and social service 
     providers serving older individuals in the planning and 
     service area involved.
       ``(d) Relationship to Other Funding Sources.--Funds made 
     available under this part shall supplement, and not supplant, 
     any Federal, State, and local funds expended by a State or 
     unit of general purpose local government (including an area 
     agency on aging) to provide the services described in 
     subsection (a).''.

     SEC. 104. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH 
                   SCREENING AND TREATMENT SERVICES TO OLDER 
                   INDIVIDUALS LIVING IN RURAL AREAS.

       The Older Americans Act of 1965 (42 U.S.C. 3001 et seq.) is 
     amended--
       (1) by inserting before section 401 (42 U.S.C. 3031) the 
     following:

      ``TITLE IV--GRANTS FOR EDUCATION, TRAINING, AND RESEARCH'';

     and
       (2) in part A of title IV (42 U.S.C. 3032 et seq.), by 
     adding at the end the following:

     ``SEC. 422. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH 
                   SCREENING AND TREATMENT SERVICES TO OLDER 
                   INDIVIDUALS LIVING IN RURAL AREAS.

       ``(a) Definition.--In this section, the term `rural area' 
     means--
       ``(1) any area that is outside a metropolitan statistical 
     area (as defined by the Director of the Office of Management 
     and Budget); or
       ``(2) such similar area as the Secretary specifies in a 
     regulation issued under section 1886(d)(2)(D) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(2)(D)).
       ``(b) Authority.--The Assistant Secretary shall make grants 
     to eligible public agencies and nonprofit private 
     organizations to pay part or all of the cost of developing or 
     operating model health care service projects involving the 
     provision of mental health screening and treatment services 
     to older individuals residing in rural areas.
       ``(c) Duration.--Grants made under this section shall be 
     made for 3-year periods.
       ``(d) Application.--To be eligible to receive a grant under 
     this section, a public

[[Page S7439]]

     agency or nonprofit private organization shall submit to the 
     Assistant Secretary an application containing such 
     information and assurances as the Secretary may require, 
     including--
       ``(1) information describing--
       ``(A) the geographic area and target population (including 
     the racial and ethnic composition of the target population) 
     to be served by the project; and
       ``(B) the nature and extent of the applicant's experience 
     in providing mental health screening and treatment services 
     of the type to be provided in the project;
       ``(2) assurances that the applicant will carry out the 
     project--
       ``(A) through a multidisciplinary team of licensed mental 
     health professionals;
       ``(B) using evidence-based intervention and treatment 
     protocols to the extent such protocols are available;
       ``(C) using telecommunications technologies as appropriate 
     and available; and
       ``(D) in coordination with other providers of health care 
     and social services (such as senior centers and adult day 
     care providers) serving the area; and
       ``(3) assurances that the applicant will conduct and submit 
     to the Assistant Secretary such evaluations and reports as 
     the Assistant Secretary may require.
       ``(e) Reports.--The Assistant Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     that includes summaries of the evaluations and reports 
     required under subsection (d)(3).
       ``(f) Coordination.--The Assistant Secretary shall provide 
     for appropriate coordination of programs and activities 
     receiving funds pursuant to a grant under this section with 
     programs and activities receiving funds pursuant to grants 
     under sections 381 and 423, and sections 520K and 520L of the 
     Public Health Service Act.''.

     SEC. 105. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH 
                   SCREENING AND TREATMENT SERVICES TO OLDER 
                   INDIVIDUALS LIVING IN NATURALLY OCCURRING 
                   RETIREMENT COMMUNITIES IN URBAN AREAS.

       Part A of title IV of the Older Americans Act of 1965 (42 
     U.S.C. 3032 et seq.), as amended by section 104, is further 
     amended by adding at the end the following:

     ``SEC. 423. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH 
                   SCREENING AND TREATMENT SERVICES TO OLDER 
                   INDIVIDUALS LIVING IN NATURALLY OCCURRING 
                   RETIREMENT COMMUNITIES IN URBAN AREAS.

       ``(a) Definitions.--In this section:
       ``(1) Naturally occurring retirement community.--The term 
     `naturally occurring retirement community' means a 
     residential area (such as an apartment building, housing 
     complex or development, or neighborhood) not originally built 
     for older individuals but in which a substantial number of 
     individuals have aged in place (and become older individuals) 
     while residing in such area.
       ``(2) Urban area.--The term `urban area' means--
       ``(A) a metropolitan statistical area (as defined by the 
     Director of the Office of Management and Budget); or
       ``(B) such similar area as the Secretary specifies in a 
     regulation issued under section 1886(d)(2)(D) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(2)(D)).
       ``(b) Authority.--The Assistant Secretary shall make grants 
     to eligible public agencies and nonprofit private 
     organizations to pay part or all of the cost of developing or 
     operating model health care service projects involving the 
     provision of mental health screening and treatment services 
     to older individuals residing in naturally occurring 
     retirement communities located in urban areas.
       ``(c) Duration.--Grants made under this section shall be 
     made for 3-year periods.
       ``(d) Application.--To be eligible to receive a grant under 
     this section, a public agency or nonprofit private 
     organization shall submit to the Assistant Secretary an 
     application containing such information and assurances as the 
     Secretary may require, including--
       ``(1) information describing--
       ``(A) the naturally occurring retirement community and 
     target population (including the racial and ethnic 
     composition of the target population) to be served by the 
     project; and
       ``(B) the nature and extent of the applicant's experience 
     in providing mental health screening and treatment services 
     of the type to be provided in the project;
       ``(2) assurances that the applicant will carry out the 
     project--
       ``(A) through a multidisciplinary team of licensed mental 
     health professionals;
       ``(B) using evidence-based intervention and treatment 
     protocols to the extent such protocols are available; and
       ``(C) in coordination with other providers of health care 
     and social services serving the retirement community; and
       ``(3) assurances that the applicant will conduct and submit 
     to the Assistant Secretary such evaluations and reports as 
     the Assistant Secretary may require.
       ``(e) Reports.--The Assistant Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     that includes summaries of the evaluations and reports 
     required under subsection (d)(3).
       ``(f) Coordination.--The Assistant Secretary shall provide 
     for appropriate coordination of programs and activities 
     receiving funds pursuant to grants made under this section 
     with programs and activities receiving funds pursuant to 
     grants made under sections 381 and 422, and sections 520K and 
     520L of the Public Health Service Act.''.

             TITLE II--PUBLIC HEALTH SERVICE ACT AMENDMENTS

     SEC. 201. DEMONSTRATION PROJECTS TO SUPPORT INTEGRATION OF 
                   MENTAL HEALTH SERVICES IN PRIMARY CARE 
                   SETTINGS.

       Subpart 3 of part B of title V of the Public Health Service 
     Act (42 U.S.C. 290bb-31 et seq.) is amended--
       (1) in subsection (b) of section 520(b) (42 U.S.C. 290bb-
     31(b))--
       (A) by striking ``and'' at the end of paragraph (14);
       (B) by striking the period at the end of paragraph (15) and 
     inserting in lieu thereof ``; and''; and
       (C) by adding at the end the following:
       ``(16) conduct the demonstration projects specified in 
     section 520K.''.; and
       (2) by adding at the end the following:

     ``SEC. 520K. PROJECTS TO DEMONSTRATE INTEGRATION OF MENTAL 
                   HEALTH SERVICES IN PRIMARY CARE SETTINGS.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Center for Mental Health Services, shall 
     award grants to public and private nonprofit entities for 
     projects to demonstrate ways of integrating mental health 
     services for older patients into primary care settings, such 
     as health centers receiving a grant under section 330 (or 
     determined by the Secretary to meet the requirements for 
     receiving such a grant), other Federally qualified health 
     centers, primary care clinics, and private practice sites.
       ``(b) Requirements.--In order to be eligible for a grant 
     under this section, the project to be carried out by the 
     entity shall provide for collaborative care within a primary 
     care setting, involving psychiatrists, psychologists, and 
     other licensed mental health professionals (such as social 
     workers and advanced practice nurses) with appropriate 
     training and experience in the treatment of older adults, in 
     which screening, assessment, and intervention services are 
     combined into an integrated service delivery model, 
     including--
       ``(1) screening services by a mental health professional 
     with at least a masters degree in an appropriate field of 
     training;
       ``(2) referrals for necessary prevention, intervention, 
     follow-up care, consultations, and care planning oversight 
     for mental health and other service needs, as indicated; and
       ``(3) adoption and implementation of evidence-based 
     protocols, to the extent available, for prevalent mental 
     health disorders, including depression, anxiety, behavioral 
     and psychological symptoms of dementia, psychosis, and misuse 
     of, or dependence on, alcohol or medication.
       ``(c) Considerations in Awarding Grants.--In awarding 
     grants under this section the Secretary, to the extent 
     feasible, shall ensure that--
       ``(1) projects are funded in a variety of geographic areas, 
     including urban and rural areas; and
       ``(2) a variety of populations, including racial and ethnic 
     minorities and low-income populations, are served by projects 
     funded under this section.
       ``(d) Duration.--A project may receive funding pursuant to 
     a grant under this section for a period of up to 3 years, 
     with an extension period of 2 additional years at the 
     discretion of the Secretary.
       ``(e) Application.--To be eligible to receive a grant under 
     this section, a public or private nonprofit entity shall--
       ``(1) submit an application to the Secretary (in such form, 
     containing such information, and at such time as the 
     Secretary may specify); and
       ``(2) agree to report to the Secretary standardized 
     clinical and behavioral data necessary to evaluate patient 
     outcomes and to facilitate evaluations across participating 
     projects.
       ``(f) Evaluation.--Not later than July 31 of each calendar 
     year, the Secretary shall submit to Congress a report 
     evaluating the projects receiving awards under this section 
     for such year.
       ``(g) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out this section for fiscal year 2005 and each 
     fiscal year thereafter.''.

     SEC. 202. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH TREATMENT 
                   OUTREACH TEAMS.

       Subpart 3 of part B of title V of the Public Health Service 
     Act (42 U.S.C. 290bb-31 et seq.), as amended by section 201, 
     is further amended by adding at the end the following:

     ``SEC. 520L. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH 
                   TREATMENT OUTREACH TEAMS.

       ``(a) In general.--The Secretary, acting through the 
     Director of the Center for Mental Health Services, shall 
     award grants to public or private nonprofit entities that are 
     community-based providers of geriatric mental health 
     services, to support the establishment and maintenance by 
     such entities of multi-disciplinary geriatric mental health 
     outreach teams in community settings where older adults 
     reside or receive social services. Entities eligible for such 
     grants include--
       ``(1) mental health service providers of a State or local 
     government;
       ``(2) outpatient programs of private, nonprofit hospitals;
       ``(3) community mental health centers meeting the criteria 
     specified in section 1913(c); and

[[Page S7440]]

       ``(4) other community-based providers of mental health 
     services.
       ``(b) Requirements.--To be eligible to receive a grant 
     under this section, an entity shall--
       ``(1) adopt and implement, for use by its mental health 
     outreach team, evidence-based intervention and treatment 
     protocols (to the extent such protocols are available) for 
     mental disorders prevalent in older individuals (including, 
     but not limited to, mood and anxiety disorders, dementias of 
     all kinds, psychotic disorders, and substance and alcohol 
     abuse), relying to the greatest extent feasible on protocols 
     that have been developed--
       ``(A) by or under the auspices of the Secretary; or
       ``(B) by academicians with expertise in mental health and 
     aging;
       ``(2) provide screening for mental disorders, diagnostic 
     services, referrals for treatment, and case management and 
     coordination through such teams; and
       ``(3) coordinate and integrate the services provided by 
     such team with the services of social service, mental health, 
     and medical providers at the site or sites where the team is 
     based in order to--
       ``(A) improve patient outcomes; and
       ``(B) to assure, to the maximum extent feasible, the 
     continuing independence of older adults who are residing in 
     the community.
       ``(c) Cooperative Arrangements With Sites Serving as Bases 
     for Outreach.--An entity receiving a grant under this section 
     may enter into an agreement with a person operating a site at 
     which a geriatric mental health outreach team of the entity 
     is based, including--
       ``(1) senior centers;
       ``(2) adult day care programs;
       ``(3) assisted living facilities; and
       ``(4) recipients of grants to provide services to senior 
     citizens under the Older Americans Act of 1965,

     under which such person provides (and is reimbursed by the 
     entity, out of funds received under the grant, for) any 
     supportive services, such as transportation and 
     administrative support, that such person provides to an 
     outreach team of such entity.
       ``(d) Considerations in Awarding Grants.--In awarding 
     grants under this section the Secretary, to the extent 
     feasible, shall ensure that--
       ``(1) projects are funded in a variety of geographic areas, 
     including urban and rural areas; and
       ``(2) a variety of populations, including racial and ethnic 
     minorities and low-income populations, are served by projects 
     funded under this section.
       ``(e) Application.--To be eligible to receive a grant under 
     this section, an entity shall--
       ``(1) submit an application to the Secretary (in such form, 
     containing such information, at such time as the Secretary 
     may specify); and
       ``(2) agree to report to the Secretary standardized 
     clinical and behavioral data necessary to evaluate patient 
     outcomes and to facilitate evaluations across participating 
     projects.
       ``(f) Coordination.--The Secretary shall provide for 
     appropriate coordination of programs and activities receiving 
     funds pursuant to a grant under this section with programs 
     and activities receiving funds pursuant to grants under 
     section 520K and sections 381, 422, and 423 of the Older 
     Americans Act of 1965.
       ``(g) Evaluation.--Not later than July 31 of each calendar 
     year, the Secretary shall submit to Congress a report 
     evaluating the projects receiving awards under this section 
     for such year.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out this section for fiscal year 2005 and each 
     fiscal year thereafter.''.

     SEC. 203. DESIGNATION OF DEPUTY DIRECTOR FOR OLDER ADULT 
                   MENTAL HEALTH SERVICES IN CENTER FOR MENTAL 
                   HEALTH SERVICES.

       Section 520 of the Public Health Service Act (42 U.S.C. 
     290bb-31) is amended--
       (1) by redesignating subsection (c) as subsection (d); and
       (2) by inserting after subsection (b) the following:
       ``(c) Deputy Director for Older Adult Mental Health 
     Services in Center for Mental Health Services.--The Director, 
     after consultation with the Administrator, shall designate a 
     Deputy Director for Older Adult Mental Health Services, who 
     shall be responsible for the development and implementation 
     of initiatives of the Center to address the mental health 
     needs of older adults. Such initiatives shall include--
       ``(1) research on prevention and identification of mental 
     disorders in the geriatric population;
       ``(2) innovative demonstration projects for the delivery of 
     community-based mental health services for older Americans;
       ``(3) support for the development and dissemination of 
     evidence-based practice models, including models to address 
     dependence on, and misuse of, alcohol and medication in older 
     adults; and
       ``(4) development of model training programs for mental 
     health professionals and care givers serving older adults.''.

     SEC. 204. MEMBERSHIP OF ADVISORY COUNCIL FOR THE CENTER FOR 
                   MENTAL HEALTH SERVICES.

       Section 502(b)(3) of the Public Health service Act (42 
     U.S.C. 269aa-1(b)(3)) is amended by adding at the end the 
     following:
       ``(C) In the case of the advisory council for the Center 
     for Mental Health Services, the members appointed pursuant to 
     subparagraphs (A) and (B) shall include representatives of 
     older Americans, their families, and geriatric mental health 
     specialists.''.

     SEC. 205. PROJECTS OF NATIONAL SIGNIFICANCE TARGETING 
                   SUBSTANCE ABUSE IN OLDER ADULTS.

       Section 509(b)(2) of the Public Health Service Act (42 
     U.S.C. 290bb-2(b)(2)) is amended by inserting before the 
     period the following: ``, and to providing treatment for 
     older adults with alcohol or substance abuse or addiction, 
     including medication misuse or dependence''.

     SEC. 206 CRITERIA FOR STATE PLANS UNDER COMMUNITY MENTAL 
                   HEALTH SERVICES BLOCK GRANTS.

       (a) In General.--Section 1912(b)(4) of the Public Health 
     Service Act (42 U.S.C. 300x-1(b)(4)) is amended to read as 
     follows:
       ``(4) Targeted services to older individuals, individuals 
     who are homeless, and individuals living in rural areas.--The 
     plan describes the State's outreach to and services for older 
     individuals, individuals who are homeless, and individuals 
     living in rural areas, and how community-based services will 
     be provided to these individuals.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to State plans submitted on or after the date 
     that is 180 days after the date of enactment of this Act.

  Ms. COLLINS. Mr. President, I am pleased to join with my colleague 
from New York in introducing the Positive Aging Act, which will help to 
increase older Americans' access to quality mental health screening and 
treatment services in community-based care settings.
  The legislation we are introducing today is particularly important 
for States, like Maine, that have a disproportionate number of elderly 
persons. Maine currently is our Nation's seventh ``oldest'' State. 
Moreover, our older population will continue to grow in the future and, 
by the year 2025, one in five Mainers will be over the age of 65.
  One of the most daunting public health challenges facing our Nation 
today is how to increase access to quality mental health services for 
the more than 44 million Americans with severe, disabling mental 
disorders that can devastate their lives and the lives of the people 
around them.
  What is often overlooked, however, is the prevalence of mental 
illness among our Nation's elderly. Studies have shown that more than 
one in five Americans aged 65 and older--including more than 32,000 
Mainers--experience mental illness, and that as many as 80 percent of 
elderly persons in nursing homes suffer from some kind of mental 
impairment.
  Particularly disturbing is that fact that the mental health needs of 
older Americans are often overlooked or not recognized because of the 
mistaken belief that they are a normal part of aging and therefore 
cannot be treated.
  While older Americans experience the full range of mental disorders, 
the most prevalent mental illness afflicting older people is 
depression. Ironically, while recent advances have made depression an 
eminently treatable disorder, only a minority of elderly depressed 
persons are receiving adequate treatment. Unfortunately, the vast 
majority of depressed elderly don't seek help. Many simply accept their 
feelings of profound sadness and do not realize that they are 
clinically depressed.
  Those who do seek help are often underdiagnosed or misdiagnosed, 
leading the National Institute of Mental Health to estimate that 60 
percent of older Americans with depression are not receiving the mental 
health care that they need. Failure to treat this kind of disorder 
leads to poorer health outcomes for other medical conditions, higher 
rates of institutionalization, and increased health care costs.
  Untreated depression can even lead to suicide. The sad fact is that 
Americans over 65 are more likely to commit suicide than any other age 
group. Among those over 85, the suicide rate is twice the national 
average. What is particularly disturbing about these statistics is that 
studies have shown that 40 percent of older people who commit suicide 
have had a visit with their primary care provider within one week of 
their death. Seventy percent of these elderly suicide victims had a 
primary care visit within 30 days of their death.
  Fortunately, important research is being done that is helping to 
develop innovative approaches to improve the delivery of mental health 
care for older

[[Page S7441]]

adults by integrating it into primary care settings. This research 
demonstrates that older adults are more likely to receive appropriate 
mental health care if there is a mental health professional on the 
primary care team, rather than simply referring them to a mental health 
specialist outside the primary care setting. Multiple appointments with 
multiple providers in multiple settings simply don't work for older 
patients who must also cope with concurrent chronic illnesses, mobility 
problems, and limited transportation options. The research also shows 
that there is less stigma associated with psychiatric services when 
they are integrated into general medical care.

  The Positive Aging Act builds upon this research and authorizes 
funding for a range of projects that integrate mental health screening 
and treatment services into community sites and primary health care 
settings, including community health centers, senior centers, and 
assisted living facilities. Moreover, the evidence-based services under 
this legislation will be provided by interdisciplinary teams of mental 
health professionals working in collaboration with other providers of 
health and social services.
  Among other provisions, our legislation authorizes the creation of an 
Office of Older Adult Mental Health Services in the Administration on 
Aging to develop and implement initiatives to address the mental health 
needs of older adults. In addition, the Administration on Aging would 
be authorized to provide grants to States for the development and 
testing of model mental health delivery systems for the diagnosis and 
treatment of mental illness and the elderly. It would also be 
authorized to award demonstration grants to projects targeted to 
providing screening and mental health services for seniors residing in 
rural areas, as well as grants to encourage the collaboration between 
mental health and other health and social services providers in 
providing screening and treatment services.
  The legislation also authorizes the Substance Abuse and Mental Health 
Services Administration (SAMHSA) to award demonstration grants which 
would support the integration of evidence-based mental health services 
by geriatric mental health specialists into primary care settings and 
support the establishment of community-based mental health treatment 
outreach teams in settings where older adults reside or receive social 
services.
  The Positive Aging Act will help to promote the mental health and 
well-being of our older citizens. It is an investment that will return 
tremendous dividends in terms of improved quality of life, better 
patient outcomes, and more efficient use of health care dollars. The 
legislation has been endorsed by the American Association for Geriatric 
Psychiatry, the National Council on Aging, the American Nurses 
Association, the American Psychological Association, the American 
Psychiatric Association and the National Association of Social Workers, 
and I urge all of our colleagues to join us as cosponsors.
                                 ______