[Congressional Record Volume 155, Number 83 (Thursday, June 4, 2009)]
[Senate]
[Pages S6201-S6204]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. REED (for himself, Ms. Murkowski, and Mr. Whitehouse):
  S. 1188. A bill to amend the Public Health Service Act with respect 
to mental health services; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. REED. Mr. President, today I introduce, along with Senators 
Murkowski and Whitehouse, the Community Mental Health Services 
Improvement Act. For decades, we have known that people suffering from 
mental illness die sooner--on average 25 years sooner--and have higher 
rates of disability than the general population. People with mental 
illness are at greater risk of preventable health conditions such as 
heart disease and diabetes. With this legislation, we are taking steps 
to address these disturbing trends.
  We know that mental health and physical health are inter-related. Yet 
historically mental health and physical health have been treated 
separately. This legislation would integrate care in one setting.
  In a recent survey, 91 percent of community mental health centers 
said that improving the quality of health care is a priority. However, 
only one-third have the capacity to provide health care on site, and 
only one-fifth provide medical referrals off site. The centers 
identified a lack of financial resources as the biggest barrier to 
integrating treatment.
  Accordingly, this legislation provides grants to integrate treatment 
for mental health, substance abuse, and primary and specialty care. 
Grantees can use the funds for screenings, basic health care services 
on site, referrals, or information technology.
  This legislation also comprehensively responds to the well identified 
mental health workforce crisis by providing grants for a wide range of 
innovative recruitment and retention efforts, including loan 
forgiveness and repayment programs, to placement and support for new 
mental health professionals, and expanded mental health education and 
training programs.
  Finally, this legislation provides grants for tele-mental health in 
medically-underserved areas, and invests in health IT for mental health 
providers. These proposals address the twin goals of improving the 
quality of mental

[[Page S6202]]

health treatment while expanding access to that treatment in rural and 
underserved areas.
  This bipartisan legislation has the overwhelming support of the 
mental health community. It has been endorsed by the National Council 
for Community Behavioral Healthcare, the National Alliance on Mental 
Illness, Mental Health America, the Campaign for Mental Health Reform, 
and the American Psychological Association. I am especially grateful 
for the support of the Rhode Island Council of Community Mental Health 
Organizations, whose members treat close to 15,000 Rhode Islanders of 
all ages.
  As a member of the Senate Committee on Health, Education, Labor, and 
Pensions, I look forward to our upcoming work on reforming our nation's 
health care system--and including important improvements to prevent and 
treat mental and physical illnesses and conditions. It is my hope that 
this year we can truly begin to address the challenge of 
comprehensively improving and expanding access to mental health 
services.
  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. 1188

       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 ``Community Mental Health 
     Services Improvement Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) almost 60,000,000 Americans, or one in four adults and 
     one in five children, have a mental illness that can be 
     diagnosed and treated in a given year;
       (2) mental illness costs our economy more than 
     $80,000,000,000 annually, accounting for 15 percent of the 
     total economic burden of disease;
       (3) alcohol and drug abuse contributes to the death of more 
     than 100,000 people and costs society upwards of half a 
     trillion dollars a year;
       (4) individuals with serious mental illness die on average 
     25 years sooner than individuals in the general population; 
     and
       (5) community mental and behavioral health organizations 
     provide cost-efficient and evidence-based treatment and care 
     for millions of Americans with mental illness and addiction 
     disorders.

     SEC. 3. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-
                   BASED MENTAL HEALTH 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 by adding at the 
     end the following:

     ``SEC. 520K. GRANTS FOR CO-LOCATING PRIMARY AND SPECIALTY 
                   CARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS.

       ``(a) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means a 
     qualified community mental health program defined under 
     section 1913(b)(1).
       ``(2) Special populations.--The term `special populations' 
     refers to the following 3 groups:
       ``(A) Children and adolescents with mental and emotional 
     disturbances who have co-occurring primary care conditions 
     and chronic diseases.
       ``(B) Adults with mental illnesses who have co-occurring 
     primary care conditions and chronic diseases.
       ``(C) Older adults with mental illnesses who have co-
     occurring primary care conditions and chronic diseases.
       ``(b) Program Authorized.--The Secretary, acting through 
     the Administrator of the Substance Abuse and Mental Health 
     Services Administration and in coordination with the Director 
     of the Health Resources and Services Administration, shall 
     award grants to eligible entities to establish demonstration 
     projects for the provision of coordinated and integrated 
     services to special populations through the co-location of 
     primary and specialty care services in community-based mental 
     and behavioral health settings.
       ``(c) Application.--To be eligible to receive a grant under 
     this section, an eligible entity shall submit an application 
     to the Administrator at such time, in such manner, and 
     accompanied by such information as the Administrator may 
     require. Each such application shall include--
       ``(1) an assessment of the primary care needs of the 
     patients served by the eligible entity and a description of 
     how the eligible entity will address such needs; and
       ``(2) a description of partnerships, cooperative 
     agreements, or other arrangements with local primary care 
     providers, including community health centers, to provide 
     services to special populations.
       ``(d) Use of Funds.--
       ``(1) In general.--For the benefit of special populations, 
     an eligible entity shall use funds awarded under this section 
     for--
       ``(A) the provision, by qualified primary care 
     professionals on a reasonable cost basis, of--
       ``(i) primary care services on site at the eligible entity;
       ``(ii) diagnostic and laboratory services; or
       ``(iii) adult and pediatric eye, ear, and dental 
     screenings;
       ``(B) reasonable costs associated with medically necessary 
     referrals to qualified specialty care professionals as well 
     as to other coordinators of care or, if permitted by the 
     terms of the grant, for the provision, by qualified specialty 
     care professionals on a reasonable cost basis on site at the 
     eligible entity;
       ``(C) information technology required to accommodate the 
     clinical needs of primary and specialty care professionals; 
     or
       ``(D) facility improvements or modifications needed to 
     bring primary and specialty care professionals on site at the 
     eligible entity.
       ``(2) Limitation.--Not to exceed 15 percent of grant funds 
     may be used for activities described in subparagraphs (C) and 
     (D) of paragraph (1).
       ``(e) Geographic Distribution.--The Secretary shall ensure 
     that grants awarded under this section are equitably 
     distributed among the geographical regions of the United 
     States and between urban and rural populations.
       ``(f) Evaluation.--Not later than 3 months after a grant or 
     cooperative agreement awarded under this section expires, an 
     eligible entity shall submit to the Secretary the results of 
     an evaluation to be conducted by the entity concerning the 
     effectiveness of the activities carried out under the grant 
     or agreement.
       ``(g) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     that shall evaluate the activities funded under this section. 
     The report shall include an evaluation of the impact of co-
     locating primary and specialty care in community mental and 
     behavioral health settings on overall patient health status 
     and recommendations on whether or not the demonstration 
     program under this section should be made permanent.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $50,000,0000 for fiscal year 2010 and such sums as may be 
     necessary for each of fiscal years 2011 through 2014.''.

     SEC. 4. INTEGRATING TREATMENT FOR MENTAL HEALTH AND SUBSTANCE 
                   ABUSE CO-OCCURRING DISORDERS.

       Section 520I of the Public Health Service Act (42 U.S.C. 
     290bb-40) is amended--
       (1) by striking subsection (i) and inserting the following:
       ``(j) Funding.--The Secretary shall make available to carry 
     out this section, $14,000,000 for fiscal year 2010, 
     $20,000,000 for fiscal year 2011, and such sums as may be 
     necessary for each of fiscal years 2012 through 2014. Such 
     sums shall be made available in equal amount from amounts 
     appropriated under sections 509 and 520A.''; and
       (2) by inserting before subsection (j), the following:
       ``(i) Community Mental Health Program.--For purposes of 
     eligibility under this section, the term `private nonprofit 
     organization' includes a qualified community mental health 
     program as defined under section 1913(b)(1).''.

     SEC. 5. IMPROVING THE MENTAL HEALTH WORKFORCE.

       (a) National Health Service Corps.--Paragraph (1) of 
     section 332(a) of the Public Health Service Act (42 U.S.C. 
     254e(a)) is amended by inserting ``and community mental 
     health centers meeting the criteria specified in section 
     1913(c)'' after ``Social Security Act (42 U.S.C. 
     1395x(aa)),''.
       (b) Recruitment and Retention of Mental Health 
     Professionals.--Subpart X of part D of title III of the 
     Public Health Service Act (42 U.S.C. 256f et seq.) is amended 
     by adding at the end the following:

     ``SEC. 340H. GRANTS FOR RECRUITMENT AND RETENTION OF MENTAL 
                   HEALTH PROFESSIONALS.

       ``(a) Establishment.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall award grants to States, territories, 
     and Indian tribes or tribal organizations for innovative 
     programs to address the behavioral and mental health 
     workforce needs of designated mental health professional 
     shortage areas.
       ``(b) Use of Funds.--An eligible entity shall use grant 
     funds awarded under this section for--
       ``(1) loan forgiveness and repayment programs (to be 
     carried out in a manner similar to the loan repayment 
     programs carried out under subpart III of part D) for 
     behavioral and mental health professionals who--
       ``(A) agree to practice in designated mental health 
     professional shortage areas;
       ``(B) are graduates of programs in behavioral or mental 
     health;
       ``(C) agree to serve in community-based non-profit 
     entities, or as public mental health professionals for the 
     Federal, State or local government; and
       ``(D) agree to--
       ``(i) provide services to patients regardless of such 
     patients' ability to pay; and
       ``(ii) use a sliding payment scale for patients who are 
     unable to pay the total cost of services;
       ``(2) behavioral and mental health professional recruitment 
     and retention efforts, with a particular emphasis on 
     candidates

[[Page S6203]]

     from racial and ethnic minority and medically-underserved 
     communities;
       ``(3) grants or low-interest or no-interest loans for 
     behavioral and mental health professionals who participate in 
     the Medicaid program under title XIX of the Social Security 
     Act to establish or expand practices in designated mental 
     health professional shortage areas, or to serve in qualified 
     community mental health programs as defined in section 
     1913(b)(1);
       ``(4) placement and support for behavioral and mental 
     health students, residents, trainees, and fellows or interns; 
     or
       ``(5) continuing behavioral and mental health education, 
     including distance-based education.
       ``(c) Application.--
       ``(1) In general.--Each eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(2) Assurances.--The application shall include assurances 
     that the applicant will meet the requirements of this 
     subsection and that the applicant possesses sufficient 
     infrastructure to manage the activities to be funded through 
     the grant and to evaluate and report on the outcomes 
     resulting from such activities.
       ``(d) Matching Requirement.--The Secretary may not make a 
     grant to an eligible entity under this section unless that 
     entity agrees that, with respect to the costs to be incurred 
     by the entity in carrying out the activities for which the 
     grant was awarded, the entity will provide non-Federal 
     contributions in an amount equal to not less than 35 percent 
     of Federal funds provided under the grant. The entity may 
     provide the contributions in cash or in kind, fairly 
     evaluated, including plant, equipment, and services, and may 
     provide the contributions from State, local, or private 
     sources.
       ``(e) Supplement Not Supplant.--A grant awarded under this 
     section shall be expended to supplement, and not supplant, 
     the expenditures of the eligible entity and the value of in-
     kind contributions for carrying out the activities for which 
     the grant was awarded.
       ``(f) Geographic Distribution.--The Secretary shall ensure 
     that grants awarded under this section are equitably 
     distributed among the geographical regions of the United 
     States and between urban and rural populations.
       ``(g) Evaluation.--Not later than 3 months after a grant 
     awarded under this section expires, an eligible entity shall 
     submit to the Secretary the results of an evaluation to be 
     conducted by the entity concerning the effectiveness of the 
     activities carried out under the grant.
       ``(h) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     containing data relating to whether grants provided under 
     this section have increased access to behavioral and mental 
     health services in designated mental health professional 
     shortage areas.
       ``(i) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $10,000,000 for fiscal year 2010, and such sums as may be 
     necessary for each of fiscal years 2011 through 2014.''.
       (c) Behavioral and Mental Health Education and Training 
     Programs.--Part A of title V of the Public Health Service Act 
     (42 U.S.C. 290aa et seq.) is amended by adding at the end the 
     following:

     ``SEC. 506C. GRANTS FOR BEHAVIORAL AND MENTAL HEALTH 
                   EDUCATION AND TRAINING PROGRAMS.

       ``(a) Definition.--For the purposes of this section, the 
     term `related mental health personnel' means an individual 
     who--
       ``(1) facilitates access to a medical, social, educational, 
     or other service; and
       ``(2) is not a mental health professional, but who is the 
     first point of contact with persons who are seeking mental 
     health services.
       ``(b) Establishment.--The Secretary, acting through the 
     Administrator of the Substance Abuse and Mental Health 
     Services Administration, shall establish a program to 
     increase the number of trained behavioral and mental health 
     professionals and related mental health personnel by awarding 
     grants on a competitive basis to mental and behavioral health 
     nonprofit organizations or accredited institutions of higher 
     education to enable such entities to establish or expand 
     accredited mental and behavioral health education programs.
       ``(c) Application.--
       ``(1) In general.--Each eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(2) Assurances.--The application shall include assurances 
     that the applicant will meet the requirements of this 
     subsection and that the applicant possesses sufficient 
     infrastructure to manage the activities to be funded through 
     the grant and to evaluate and report on the outcomes 
     resulting from such activities.
       ``(d) Priority.--In awarding grants under this section, the 
     Secretary shall give priority to applicants that--
       ``(1) demonstrate a familiarity with the use of evidenced-
     based methods in behavioral and mental health services;
       ``(2) provide interdisciplinary training experiences; and
       ``(3) demonstrate a commitment to training methods and 
     practices that emphasize the integrated treatment of mental 
     health and substance abuse disorders.
       ``(e) Use of Funds.--Funds awarded under this section shall 
     be used to--
       ``(1) establish or expand accredited behavioral and mental 
     health education programs, including improving the 
     coursework, related field placements, or faculty of such 
     programs; or
       ``(2) establish or expand accredited mental and behavioral 
     health training programs for related mental health personnel.
       ``(f) Requirements.--The Secretary may award a grant to an 
     eligible entity only if such entity agrees that--
       ``(1) any behavioral or mental health program assisted 
     under the grant will prioritize cultural competency and the 
     recruitment of trainees from racial and ethnic minority and 
     medically-underserved communities; and
       ``(2) with respect to any violation of the agreement 
     between the Secretary and the entity, the entity will pay 
     such liquidated damages as prescribed by the Secretary.
       ``(g) Geographic Distribution.--The Secretary shall ensure 
     that grants awarded under this section are equitably 
     distributed among the geographical regions of the United 
     States and between urban and rural populations.
       ``(h) Evaluation.--Not later than 3 months after a grant 
     awarded under this section expires, an eligible entity shall 
     submit to the Secretary the results of an evaluation to be 
     conducted by the entity concerning the effectiveness of the 
     activities carried out under the grant.
       ``(i) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     containing data relating to whether grants provided under 
     this section have increased access to behavioral and mental 
     health services in designated mental health professional 
     shortage areas.
       ``(j) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $4,000,0000 for fiscal year 2010, and such sums as may be 
     necessary for each of fiscal years 2011 through 2014.''.

     SEC. 6. IMPROVING ACCESS TO MENTAL HEALTH SERVICES IN 
                   MEDICALLY-UNDERSERVED AREAS.

       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 3, is 
     amended by inserting after section 520A the following:

     ``SEC. 520B. GRANTS FOR TELE-MENTAL HEALTH IN MEDICALLY-
                   UNDERSERVED AREAS.

       ``(a) Program Authorized.--The Secretary, acting through 
     the Administrator of the Substance Abuse and Mental Health 
     Services Administration, shall award grants to eligible 
     entities to provide tele-mental health in medically-
     underserved areas.
       ``(b) Eligible Entity.--To be eligible for assistance under 
     the program under subsection (a), an entity shall be a 
     qualified community mental health program (as defined in 
     section 1913(b)(1)).
       ``(c) Application.--
       ``(1) In general.--Each eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(2) Assurances.--The application shall include assurances 
     that the applicant will meet the requirements of this 
     subsection and that the applicant possesses sufficient 
     infrastructure to manage the activities to be funded through 
     the grant and to evaluate and report on the outcomes 
     resulting from such activities.
       ``(d) Use of Funds.--An eligible entity shall use funds 
     received under a grant under this section for--
       ``(1) the provision of tele-mental health services; or
       ``(2) infrastructure improvements for the provision of 
     tele-mental health services.
       ``(e) Geographic Distribution.--The Secretary shall ensure 
     that grants awarded under this section are equitably 
     distributed among the geographical regions of the United 
     States and between urban and rural populations.
       ``(f) Evaluation.--Not later than 3 months after a grant 
     awarded under this section expires, an eligible entity shall 
     submit to the Secretary the results of an evaluation to be 
     conducted by the entity concerning the effectiveness of the 
     activities carried out under the grant.
       ``(g) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report 
     that shall evaluate the activities funded under this section.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $20,000,000 for fiscal year 2010, and such sums as may be 
     necessary for each of fiscal years 2011 through 2014.''.

     SEC. 7. IMPROVING HEALTH INFORMATION TECHNOLOGY FOR MENTAL 
                   HEALTH PROVIDERS.

       Part A of title V of the Public Health Service Act (42 
     U.S.C. 290aa et seq.), as amended by section 5(c), is further 
     amended by adding at the end the following:

[[Page S6204]]

     ``SEC. 506D. IMPROVING HEALTH INFORMATION TECHNOLOGY FOR 
                   MENTAL HEALTH PROVIDERS.

       ``(a) In General.--The Secretary, in consultation with the 
     Secretary of Veterans Affairs, shall collaborate with the 
     Administrator of the Substance Abuse and Mental Health 
     Services Administration and the National Coordinator for 
     Health Information Technology to--
       ``(1) develop and implement a plan for ensuring that 
     various components of the National Health Information 
     Infrastructure, including data and privacy standards, 
     electronic health records, and community and regional health 
     networks, address the needs of mental health and substance 
     abuse treatment providers; and
       ``(2) finance related infrastructure improvements, 
     technical support, personnel training, and ongoing quality 
     improvements.
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $10,000,000 for fiscal year 2010, and such sums as may be 
     necessary for each of fiscal years 2011 through 2014.''.
                                 ______