[Congressional Record Volume 155, Number 70 (Thursday, May 7, 2009)]
[Senate]
[Pages S5284-S5287]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Ms. Collins, and Ms. Stabenow):
  S. 999. A bill to increase the number of well-trained mental health 
service professionals (including those based in schools) providing 
clinical mental health care to children and adolescents, and for other 
purposes; to the Committee on Health, Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, I am introducing legislation today with 
Ms. Collins and Ms. Stabenow entitled Child Health Care Crisis Relief 
Act of 2009.
  This important legislation will address the national shortage of 
children's mental health professionals, including school-based 
professionals, by encouraging more individuals to enter these critical 
fields. The landmark 1999 Surgeon General's report on mental health 
brought a hidden mental health crisis to the attention of the U.S. 
public. According to that report, 13.7 million children in our 
country--about one in five--suffer from a diagnosable emotional or 
behavioral disorder. Such disorders as Anxiety Disorders, Attention-
Deficit/Hyperactivity Disorder, and Depression are among the most 
common in this age group. Yet more than \2/3\ of these children do not 
receive any treatment. Long waiting lists for children seeking 
services, including those in crisis, are not uncommon. The primary 
reason is that severe shortages exist in qualified mental health 
professionals, including child and adolescent psychiatrists, 
psychologists, social workers, and counselors. The President's New 
Freedom Commission on Mental Health also found that ``the supply of 
well-trained mental health professionals is inadequate in most areas of 
the country . . . particular shortages exist for mental health 
providers who serve children, adolescents, and older Americans.'' The 
situation is no better in our public schools, where children's mental 
health needs are often first identified. According to the National 
Center for Education Statistics within the Department of Education, 
there are approximately 479 students for each school counselor in U.S. 
schools, nearly twice the recommended ratio of 250 students for each 
counselor.
  The situation in my home State of New Mexico is a case in point. 
Estimates suggest that 56,000 children and adolescents in New Mexico 
have an emotional or behavioral disorder. Of these, roughly 20,000 have 
serious disturbances that impair their ability to fulfill the demands 
of everyday life. In 2009, there were a total of 55 child and 
adolescent psychiatrists in the entire State of New Mexico. The impact 
of this shortage on the affected children and their communities is 
disconcerting. Research shows that children with untreated emotional 
and behavioral disorders are at higher risk for school failure and 
dropping out of school, violence, drug abuse, suicide, and criminal 
activity. For New Mexico youth, the suicide rate is twice the national 
average, the fourth highest in the nation, and the third leading cause 
of death. By one estimate, roughly 1 in 7 youth in New Mexico detention 
centers are in need of mental health treatment that is just not 
available.
  New Mexico is not alone in its struggle to address the needs of these 
children. Nationwide, over 1,600 urban, suburban, and rural communities 
have been designated Mental Health Professional Shortage Areas by the 
Federal Government due to their severe lack of psychiatrists, 
psychologists, social workers, and other professionals to serve 
children and adults. Rural areas are especially hard hit. For example, 
in New Mexico there is one psychiatrist per 20,000 residents in rural 
areas, whereas in urban areas there is one per 3,000 residents. In 
rural and frontier counties, it is not unusual for the parents of a 
child in need of services to travel 60 to 90 miles to reach the nearest 
psychiatrist, psychologist, or other mental health provider.
  Finally, graduate programs providing the vital pipeline for the child 
mental health workforce have not sufficiently increased their funding, 
class sizes, and training programs to meet the ever growing need for 
these specialists. In the U.S., only 300 new child and adolescent 
psychiatrists are trained each year, despite projections by the Bureau 
of Health Professions that the shortage of child and adolescent 
psychiatrist will grow to 4,000 by the year 2020. Federal grant funding 
for graduate psychology education has also been significantly reduced 
in the past 2 years, which could reduce the numbers of child and 
adolescent psychologists entering the profession.
  Clearly something needs to be done to address this serious shortage 
in mental health professionals to meet the growing needs of our 
Nation's youth. It is for this reason that I rise today to offer the 
Child Health Care Crisis Relief Act of 2009. This bill creates 
incentives to help recruit and retain mental health professionals 
providing direct clinical care, and to help create, expand, and improve 
programs to train child mental health professionals. It provides loan 
repayments and scholarships for child mental health and school-based 
service professionals as well as internships and field placements in 
child mental health services and training for paraprofessionals who 
work in children's mental health clinical settings. The bill also 
provides grants to graduate schools to help develop and expand child 
and adolescent mental health programs. It restores the Medicare 
Graduate Medical Education Program funding for child and adolescent 
psychiatrists and extends the board eligibility period for residents 
and fellows from 4 years to 6 years. Across all mental health 
professions, priority for loan repayments, scholarships, and grants is 
given to individuals and programs serving children and adolescents in 
high-need areas.
  Finally, the Child Health Care Crisis Relief Act of 2009 requires the 
Secretary to prepare a report on the distribution and need for child 
mental health and school-based professionals, including disparities in 
the availability of services, on a State-by-State basis. This report 
will help Congress more clearly ascertain the mental health workforce 
needs that are facing our Nation.
  This important legislation has been endorsed by the following 
organizations: Alliance for Children and Families, American Academy of 
Child and Adolescent Psychiatry, American Academy of Pediatrics, 
American Association for Geriatric Psychiatry, American Association for 
Marriage and Family Therapy, American Counseling Association, American 
Group Psychotherapy Association, American Mental Health Counselors 
Association, American Orthopsychiatric Association,

[[Page S5285]]

American Psychiatric Association, American Psychiatric Nurses 
Association, American Psychological Association, Anxiety Disorders 
Association of America, Association for the Advancement of Psychology, 
Association for Ambulatory Behavioral Healthcare, Association for 
Behavioral Health and Wellness, Bazelon Center for Mental Health Law, 
Children and Adults with Attention-Deficit/Attention Disorder, Child & 
Adolescent Bipolar Foundation, Child Welfare League of America, 
Children and Adults with Attention-Deficit/Hyperactivity Disorder, 
Children's Healthcare Is a Legal Duty, Depression and Bipolar Support 
Alliance, Eating Disorders Coalition for Research Policy & Action, 
Mental Health America, National Alliance to Advance Adolescent Health, 
National Alliance on Mental Illness, National Association for 
Children's Behavioral Health, National Association of Pediatric Nurse 
Practitioners, National Association of Psychiatric Health Systems, 
National Association of School Psychologists, National Association of 
Social Workers, National Council for Community Behavioral Healthcare, 
National Federation of Families for Children's Mental Health, National 
Mental Health Awareness Campaign, Suicide Prevention Action Network 
USA, Therapeutic Communities of America, U.S. Psychiatric 
Rehabilitation Association, Witness Justice.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 999

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Child Health Care Crisis 
     Relief Act of 2009''.

     SEC. 2. FINDINGS.

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

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

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

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

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

       ``(a) Loan Repayments for Child and Adolescent Mental 
     Health Service Professionals.--
       ``(1) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may establish a program of entering into 
     contracts on a competitive basis with eligible individuals 
     under which--
       ``(A) the eligible individual agrees to be employed full-
     time for a specified period (which shall be not less than 2 
     years) in providing mental health services to children and 
     adolescents; and
       ``(B) the Secretary agrees to make, during not more than 3 
     years of the period of employment described in subparagraph 
     (A), partial or total payments on behalf of the individual on 
     the principal and interest due on the undergraduate and 
     graduate educational loans of the eligible individual.
       ``(2) Eligible individual.--For purposes of this section, 
     the term `eligible individual' means an individual who--
       ``(A) is receiving specialized training or clinical 
     experience in child and adolescent mental health in 
     psychiatry, psychology, school psychology, behavioral 
     pediatrics, psychiatric nursing, social work, school social 
     work, marriage and family therapy, school counseling, or 
     professional counseling and has less than 1 year remaining 
     before completion of such training or clinical experience; or
       ``(B)(i) has a license or certification in a State to 
     practice allopathic medicine, osteopathic medicine, 
     psychology, school psychology, psychiatric nursing, social 
     work, school social work, marriage and family therapy, school 
     counseling, or professional counseling; and
       ``(ii)(I) is a mental health service professional who 
     completed (but not before the end of the calendar year in 
     which this section is enacted) specialized training or 
     clinical experience in child and adolescent mental health 
     described in subparagraph (A); or
       ``(II) is a physician who graduated from (but not before 
     the end of the calendar year in which this section is 
     enacted) an accredited child and adolescent psychiatry 
     residency or fellowship program in the United States.
       ``(3) Additional eligibility requirements.--The Secretary 
     may not enter into a contract under this subsection with an 
     eligible individual unless--
       ``(A) the individual is a United States citizen or a 
     permanent legal United States resident; and
       ``(B) if the individual is enrolled in a graduate program 
     (including a medical residency or fellowship), the program is 
     accredited, and the individual has an acceptable level of 
     academic standing (as determined by the Secretary).
       ``(4) Priority.--In entering into contracts under this 
     subsection, the Secretary shall give priority to applicants 
     who--
       ``(A) are or will be working with high-priority populations 
     for mental health in a Health Professional Shortage Area 
     (HPSA), Medically Underserved Area (MUA), or Medically 
     Underserved Population (MUP);
       ``(B) have familiarity with evidence-based methods and 
     cultural and linguistic competence in child and adolescent 
     mental health services;
       ``(C) demonstrate financial need; and
       ``(D) are or will be working in the publicly funded sector, 
     particularly in community mental health programs described in 
     section 1913(b)(1).
       ``(5) Meaningful loan repayment.--If the Secretary 
     determines that funds appropriated for a fiscal year to carry 
     out this subsection are not sufficient to allow a meaningful 
     loan repayment to all expected applicants, the Secretary 
     shall limit the

[[Page S5286]]

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

[[Page S5287]]

       ``(C) with respect to any violation of the agreement 
     between the Secretary and the organization, the organization 
     will pay such liquidated damages as prescribed by the 
     Secretary by regulation.
       ``(5) Application.--The Secretary shall require that any 
     application for a grant under this subsection include a 
     description of the applicant's experience working with 
     paraprofessional child and adolescent mental health workers.
       ``(6) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $5,000,000 
     for each of fiscal years 2010 through 2014.
       ``(e) Child and Adolescent Mental Health Program 
     Development Grants.--
       ``(1) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may establish a program to increase the 
     number of well-trained child and adolescent mental health 
     service professionals in the United States by awarding grants 
     on a competitive basis to accredited institutions of higher 
     education to enable the institutions to establish or expand 
     accredited graduate child and adolescent mental health 
     programs.
       ``(2) Priority.--In awarding grants under this subsection, 
     the Secretary shall give priority to applicants that--
       ``(A) demonstrate familiarity with the use of evidence-
     based methods in child and adolescent mental health services;
       ``(B) provide experience in and collaboration with 
     community-based child and adolescent mental health services;
       ``(C) have included normal child development curricula; and
       ``(D) demonstrate commitment to working with high-priority 
     populations.
       ``(3) Use of funds.--Funds received as a grant under this 
     subsection may be used to establish or expand any accredited 
     graduate child and adolescent mental health program in any 
     manner deemed appropriate by the Secretary, including by 
     improving the course work, related field placements, or 
     faculty of such program.
       ``(4) Requirements.--The Secretary may award a grant to an 
     accredited institution of higher education under this 
     subsection only if the institution agrees that--
       ``(A) any child and adolescent mental health program 
     assisted under the grant will prioritize cultural and 
     linguistic competency;
       ``(B) the institution will provide to the Secretary such 
     data, assurances, and information as the Secretary may 
     require; and
       ``(C) with respect to any violation of the agreement 
     between the Secretary and the institution, the institution 
     will pay such liquidated damages as prescribed by the 
     Secretary by regulation.
       ``(5) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $15,000,000 
     for each of fiscal years 2010 through 2014.
       ``(f) Definitions.--In this section:
       ``(1) Specialized training or clinical experience in child 
     and adolescent mental health.--The term `specialized training 
     or clinical experience in child and adolescent mental health' 
     means training and clinical experience that--
       ``(A) is part of or occurs after completion of an 
     accredited graduate program in the United States for training 
     mental health service professionals;
       ``(B) consists of not less than 500 hours of training or 
     clinical experience in treating children and adolescents; and
       ``(C) is comprehensive, coordinated, developmentally 
     appropriate, and of high quality to address the unique ethnic 
     and cultural diversity of the United States population.
       ``(2) High-priority population.--The term `high-priority 
     population' means--
       ``(A) a population in which there is a significantly 
     greater incidence than the national average of--
       ``(i) children who have serious emotional disturbances; or
       ``(ii) children who are racial, ethnic, or linguistic 
     minorities; or
       ``(B) a population consisting of individuals living in a 
     high-poverty urban or rural area.
       ``(3) Mental health service professional.--The term `mental 
     health service professional' means an individual with a 
     graduate or postgraduate degree from an accredited 
     institution of higher education in psychiatry, psychology, 
     school psychology, behavioral pediatrics, psychiatric 
     nursing, social work, school social work, marriage and family 
     counseling, school counseling, or professional counseling.''.

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

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

     SEC. 5. CHILD MENTAL HEALTH PROFESSIONAL REPORT.

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

     SEC. 6. REPORTS.

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