[Congressional Record Volume 151, Number 71 (Wednesday, May 25, 2005)]
[Senate]
[Pages S5923-S5926]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mrs. CLINTON (for herself and Ms. Collins):
S. 1116. 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, Senator Collins and I, and in the
House of Representatives, Congressman Kennedy and Congressman Ros-
Lehtinen, are reintroducing the Positive Aging Act, in an effort to
improve the accessibility and quality of mental health services for our
rapidly growing population of older Americans.
We are pleased to be reintroducing this important legislation during
Mental Health and Aging Week.
I want to acknowledge and thank our partners from the mental health
and aging community who have collaborated with us and have been working
diligently on these issues for many years, including the American
Association for Geriatric Psychiatry, the American Psychological
Association, the National Association of Social Workers, the American
Nurses Association.
Today, advances in medical science are helping us to live longer than
ever before. In New York State alone, there are 2\1/2\ million citizens
aged 65 or older. And this population will only continue to grow as the
firs wave of Baby Boomers turns 65 in less than 10 years.
As we look forward to this increased longevity, we must also
acknowledge the challenges that we face related to the quality of life
as we age. Chief among these are mental and behavioral health concerns.
Although most older adults enjoy good mental health it is estimated
that nearly 20 percent of Americans age 55 or older experience a mental
disorder. It is anticipated that the number of seniors with mental and
behavioral health problems will almost quadruple, from 4 million in
1970 to 15 million in 2030.
In New York State alone, there are an estimated 500,000 older adults
with mental health disorders. As the baby boomers age we expect to see
the number of seniors in need of mental health services in the State of
New York grow to over 750,000.
Among the most prevalent mental health concerns older adults
encounter are anxiety, depression, cognitive impairment, and substance
abuse. These disorders, if left untreated, can have severe physical and
psychological implications. In fact, older adults have the highest
rates of suicide in our country and depression is the foremost risk
factor.
The physical consequences of mental health disorders can be both
expensive and debilitating. Depression has a powerful negative impact
on ability to function, resulting in high rates of disability. The
World Health Organization projects that by the year 2020, depression
will remain a leading cause of disability, second only to
cardiovascular disease. Even mild depression lowers immunity and may
compromise a person's ability to fight infections and cancers. Research
indicates that 50-70 percent of all primary care medical visits are
related to psychological factors such as anxiety, depression, and
stress.
Mental disorders do not have to be a part of the aging process
because we have effective treatments for these conditions. But in far
too many instances our seniors go undiagnosed and untreated because of
the current divide in our country between health care and mental health
care.
Too often physicians and other health professionals fail to recognize
the signs and symptoms of mental health problems. Even more troubling,
knowledge about treatment is simply not accessible to many primary care
practitioners. As a whole, we have
[[Page S5924]]
failed to fully integrate mental health screening and treatment into
our health service systems.
These missed opportunities to diagnose and treat mental health
disorders are taking a tremendous toll on seniors and increasing the
burden on their families and our health care system.
That is why I am reintroducing the Positive Aging Act with my co-
sponsors Senator Collins and Representatives Kennedy and Ros-Lehtinen.
This legislation would amend the Older Americans Act and the Public
Health Service Act to strengthen the delivery of mental health services
to older Americans.
Specifically, the Positive Aging Act would fund grants to states to
provide screening and treatment for mental health disorders in seniors.
It would also fund demonstration projects to provide these screening
and treatment services to older adults residing in rural areas and in
naturally occurring retirement communities, NORC's.
This legislation would also authorize demonstration projects to reach
out to seniors and make much needed collaborative mental health
services available in community settings where older adults reside and
already receive services such as primary care clinics, senior centers,
adult day care programs, and assisted living facilities.
Today, we are fortunate to have a variety of effective treatments to
address the mental health needs of American seniors. I believe that we
owe it to older adults in this country to do all that we can to ensure
that high quality mental health care is both available and accessible.
This legislation takes an important step in that direction and I look
forward to working with you all to enact the Positive Aging Act during
the upcoming Older Americans Act and SAMHSA reauthorizations.
I ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
S. 1116
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
2005''.
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, 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 2006 and each of the 5 succeeding
fiscal years.'';
(2) in section 304(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 in older
individuals;
``(B) reduce the stigma associated with mental disorders in
older individuals and other barriers to the diagnosis and
treatment of the disorders; and
``(C) reduce age-related prejudice and discrimination
regarding mental disorders in older individuals.
``(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 the following:
``TITLE IV--GRANTS FOR EDUCATION, TRAINING, AND RESEARCH'';
and
(2) in part A of title IV, 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 agency or nonprofit private
organization shall submit to the Assistant Secretary an
application containing such information and assurances as the
Assistant 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
[[Page S5925]]
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
Assistant 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 section 520(b)--
(A) in paragraph (14), by striking ``and'' after the
semicolon;
(B) in paragraph (15), by striking the period at the end
and inserting ``; 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) Supplement, Not Supplant.--Funds made available under
this section shall supplement, and not supplant, other
Federal, State, or local funds available to an entity to
carry out activities described in this section.
``(h) Authorization of Appropriations.--There are
authorized to be appropriated such sums as may be necessary
to carry out this section for fiscal year 2006 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
``(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
[[Page S5926]]
``(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) Supplement, Not Supplant.--Funds made available under
this section shall supplement, and not supplant, other
Federal, State, or local funds available to an entity to
carry out activities described in this section.
``(i) Authorization of Appropriations.--There are
authorized to be appropriated such sums as may be necessary
to carry out this section for fiscal year 2006 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. 290aa-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-2(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.
______