[Congressional Record Volume 162, Number 108 (Wednesday, July 6, 2016)]
[House]
[Pages H4301-H4325]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT OF 2016
Mr. MURPHY of Pennsylvania. Mr. Speaker, I move to suspend the rules
and pass the bill (H.R. 2646) to make available needed psychiatric,
psychological, and supportive services for individuals with mental
illness and families in mental health crisis, and for other purposes,
as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 2646
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Helping
Families in Mental Health Crisis Act of 2016''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
Sec. 101. Assistant Secretary for Mental Health and Substance Use.
Sec. 102. Improving oversight of mental health and substance use
programs.
Sec. 103. National Mental Health and Substance Use Policy Laboratory.
Sec. 104. Peer-support specialist programs.
Sec. 105. Prohibition against lobbying using Federal funds by systems
accepting Federal funds to protect and advocate the
rights of individuals with mental illness.
Sec. 106. Reporting for protection and advocacy organizations.
Sec. 107. Grievance procedure.
Sec. 108. Center for Behavioral Health Statistics and Quality.
Sec. 109. Strategic plan.
Sec. 110. Authorities of centers for mental health services and
substance abuse treatment.
Sec. 111. Advisory councils.
Sec. 112. Peer review.
TITLE II--MEDICAID MENTAL HEALTH COVERAGE
Sec. 201. Rule of construction related to Medicaid coverage of mental
health services and primary care services furnished on
the same day.
Sec. 202. Optional limited coverage of inpatient services furnished in
institutions for mental diseases.
Sec. 203. Study and report related to Medicaid managed care regulation.
Sec. 204. Guidance on opportunities for innovation.
Sec. 205. Study and report on Medicaid emergency psychiatric
demonstration project.
Sec. 206. Providing EPSDT services to children in IMDs.
Sec. 207. Electronic visit verification system required for personal
care services and home health care services under
Medicaid.
[[Page H4302]]
TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE
Sec. 301. Interdepartmental Serious Mental Illness Coordinating
Committee.
TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA
Sec. 401. Sense of Congress.
Sec. 402. Confidentiality of records.
Sec. 403. Clarification of circumstances under which disclosure of
protected health information is permitted.
Sec. 404. Development and dissemination of model training programs.
TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS
Sec. 501. Assertive community treatment grant program for individuals
with serious mental illness.
Sec. 502. Strengthening community crisis response systems.
Sec. 503. Increased and extended funding for assisted outpatient grant
program for individuals with serious mental illness.
Sec. 504. Liability protections for health professional volunteers at
community health centers.
TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS
Subtitle A--Encouraging the Advancement, Incorporation, and Development
of Evidence-Based Practices
Sec. 601. Encouraging innovation and evidence-based programs.
Sec. 602. Promoting access to information on evidence-based programs
and practices.
Sec. 603. Sense of Congress.
Subtitle B--Supporting the State Response to Mental Health Needs
Sec. 611. Community Mental Health Services Block Grant.
Subtitle C--Strengthening Mental Health Care for Children and
Adolescents
Sec. 621. Tele-mental health care access grants.
Sec. 622. Infant and early childhood mental health promotion,
intervention, and treatment.
Sec. 623. National Child Traumatic Stress Initiative.
TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATION
Subtitle A--Garrett Lee Smith Memorial Act Reauthorization
Sec. 701. Youth interagency research, training, and technical
assistance centers.
Sec. 702. Youth suicide early intervention and prevention strategies.
Sec. 703. Mental health and substance use disorder services on campus.
Subtitle B--Other Provisions
Sec. 711. National Suicide Prevention Lifeline Program.
Sec. 712. Workforce development studies and reports.
Sec. 713. Minority Fellowship Program.
Sec. 714. Center and program repeals.
Sec. 715. National violent death reporting system.
Sec. 716. Sense of Congress on prioritizing Native American youth and
suicide prevention programs.
Sec. 717. Peer professional workforce development grant program.
Sec. 718. National Health Service Corps.
Sec. 719. Adult suicide prevention.
Sec. 720. Crisis intervention grants for police officers and first
responders.
Sec. 721. Demonstration grant program to train health service
psychologists in community-based mental health.
Sec. 722. Investment in tomorrow's pediatric health care workforce.
Sec. 723. CUTGO compliance.
TITLE VIII--MENTAL HEALTH PARITY
Sec. 801. Enhanced compliance with mental health and substance use
disorder coverage requirements.
Sec. 802. Action plan for enhanced enforcement of mental health and
substance use disorder coverage.
Sec. 803. Report on investigations regarding parity in mental health
and substance use disorder benefits.
Sec. 804. GAO study on parity in mental health and substance use
disorder benefits.
Sec. 805. Information and awareness on eating disorders.
Sec. 806. Education and training on eating disorders.
Sec. 807. GAO study on preventing discriminatory coverage limitations
for individuals with serious mental illness and substance
use disorders.
Sec. 808. Clarification of existing parity rules.
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
SEC. 101. ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE
USE.
(a) Assistant Secretary.--Section 501(c) of the Public
Health Service Act (42 U.S.C. 290aa) is amended to read as
follows:
``(c) Assistant Secretary and Deputy Assistant Secretary.--
``(1) Assistant secretary.--
``(A) Appointment.--The Administration shall be headed by
an official to be known as the Assistant Secretary for Mental
Health and Substance Use (hereinafter in this title referred
to as the `Assistant Secretary') who shall be appointed by
the President, by and with the advice and consent of the
Senate.
``(B) Qualifications.--In selecting the Assistant
Secretary, the President shall give preference to individuals
who have--
``(i) a doctoral degree in medicine, osteopathic medicine,
or psychology;
``(ii) clinical and research experience regarding mental
health and substance use disorders; and
``(iii) an understanding of biological, psychosocial, and
pharmaceutical treatments of mental illness and substance use
disorders.
``(2) Deputy assistant secretary.--The Assistant Secretary,
with the approval of the Secretary, may appoint a Deputy
Assistant Secretary and may employ and prescribe the
functions of such officers and employees, including
attorneys, as are necessary to administer the activities to
be carried out through the Administration.''.
(b) Transfer of Authorities.--The Secretary of Health and
Human Services shall delegate to the Assistant Secretary for
Mental Health and Substance Use all duties and authorities
that--
(1) as of the day before the date of enactment of this Act,
were vested in the Administrator of the Substance Abuse and
Mental Health Services Administration; and
(2) are not terminated by this Act.
(c) Evaluation.--Section 501(d) of the Public Health
Service Act (42 U.S.C. 290aa(d)) is amended--
(1) in paragraph (17), by striking ``and'' at the end;
(2) in paragraph (18), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following:
``(19) evaluate, in consultation with the Assistant
Secretary for Financial Resources, the information used for
oversight of grants under programs related to mental illness
and substance use disorders, including co-occurring illness
or disorders, administered by the Center for Mental Health
Services;
``(20) periodically review Federal programs and activities
relating to the diagnosis or prevention of, or treatment or
rehabilitation for, mental illness and substance use
disorders to identify any such programs or activities that
have proven to be effective or efficient in improving
outcomes or increasing access to evidence-based programs;
``(21) establish standards for the appointment of peer-
review panels to evaluate grant applications and recommend
standards for mental health grant programs; and''.
(d) Standards for Grant Programs.--Section 501(d) of the
Public Health Service Act (42 U.S.C. 290aa(d)), as amended by
subsection (c), is further amended by adding at the end the
following:
``(22) in consultation with the National Mental Health and
Substance Use Policy Laboratory, and after providing an
opportunity for public input, set standards for grant
programs under this title for mental health and substance use
services, which may address--
``(A) the capacity of the grantee to implement the award;
``(B) requirements for the description of the program
implementation approach;
``(C) the extent to which the grant plan submitted by the
grantee as part of its application must explain how the
grantee will reach the population of focus and provide a
statement of need, including to what extent the grantee will
increase the number of clients served and the estimated
percentage of clients receiving services who report positive
functioning after 6 months or no past-month substance use, as
applicable;
``(D) the extent to which the grantee must collect and
report on required performance measures; and
``(E) the extent to which the grantee is proposing
evidence-based practices and the extent to which--
``(i) those evidence-based practices must be used with
respect to a population similar to the population for which
the evidence-based practices were shown to be effective; or
``(ii) if no evidence-based practice exists for a
population of focus, the way in which the grantee will
implement adaptations of evidence-based practices, promising
practices, or cultural practices.''.
(e) Emergency Response.--Section 501(m) of the Public
Health Service Act (42 U.S.C. 290aa(m)) is amended by adding
at the end the following:
``(4) Availability of funds through following fiscal
year.--Amounts made available for carrying out this
subsection shall remain available through the end of the
fiscal year following the fiscal year for which such amounts
are appropriated.''.
(f) Member of Council on Graduate Medical Education.--
Section 762 of the Public Health Service Act (42 U.S.C. 290o)
is amended--
(1) in subsection (b)--
(A) by redesignating paragraphs (4), (5), and (6) as
paragraphs (5), (6), and (7), respectively; and
(B) by inserting after paragraph (3) the following:
``(4) the Assistant Secretary for Mental Health and
Substance Use;''; and
(2) in subsection (c), by striking ``(4), (5), and (6)''
each place it appears and inserting ``(5), (6), and (7)''.
(g) Conforming Amendments.--Title V of the Public Health
Service Act (42 U.S.C. 290aa et seq.), as amended by the
previous provisions of this section, is further amended--
[[Page H4303]]
(1) by striking ``Administrator of the Substance Abuse and
Mental Health Services Administration'' each place it appears
and inserting ``Assistant Secretary for Mental Health and
Substance Use''; and
(2) by striking ``Administrator'' each place it appears
(including in any headings) and inserting ``Assistant
Secretary'', except where the term ``Administrator''
appears--
(A) in each of subsections (e) and (f) of section 501 of
such Act (42 U.S.C. 290aa), including the headings of such
subsections, within the term ``Associate Administrator'';
(B) in section 507(b)(6) of such Act (42 U.S.C.
290bb(b)(6)), within the term ``Administrator of the Health
Resources and Services Administration'';
(C) in section 507(b)(6) of such Act (42 U.S.C.
290bb(b)(6)), within the term ``Administrator of the Centers
for Medicare & Medicaid Services'';
(D) in section 519B(c)(1)(B) of such Act (42 U.S.C. 290bb-
25b(c)(1)(B)), within the term ``Administrator of the
National Highway Traffic Safety Administration''; or
(E) in each of sections 519B(c)(1)(B), 520C(a), and 520D(a)
of such Act (42 U.S.C. 290bb-25b(c)(1)(B), 290bb-34(a),
290bb-35(a)), within the term ``Administrator of the Office
of Juvenile Justice and Delinquency Prevention''.
(h) References.--After executing subsections (a), (b), and
(f), any reference in statute, regulation, or guidance to the
Administrator of the Substance Abuse and Mental Health
Services Administration shall be construed to be a reference
to the Assistant Secretary for Mental Health and Substance
Use.
SEC. 102. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE
USE PROGRAMS.
Title V of the Public Health Service Act is amended by
inserting after section 501 of such Act (42 U.S.C. 290aa) the
following:
``SEC. 501A. IMPROVING OVERSIGHT OF MENTAL HEALTH AND
SUBSTANCE USE PROGRAMS.
``(a) Activities.--For the purpose of ensuring efficient
and effective planning and evaluation of mental illness and
substance use disorder programs and related activities, the
Assistant Secretary for Planning and Evaluation, in
consultation with the Assistant Secretary for Mental Health
and Substance Use, shall--
``(1) collect and organize relevant data on homelessness,
involvement with the criminal justice system,
hospitalizations, mortality outcomes, and other measures the
Secretary deems appropriate from across Federal departments
and agencies;
``(2) evaluate programs related to mental illness and
substance use disorders, including co-occurring illness or
disorders, across Federal departments and agencies, as
appropriate, including programs related to--
``(A) prevention, intervention, treatment, and recovery
support services, including such services for individuals
with a serious mental illness or serious emotional
disturbance;
``(B) the reduction of homelessness and involvement with
the criminal justice system among individuals with a mental
illness or substance use disorder; and
``(C) public health and health services; and
``(3) consult, as appropriate, with the Assistant
Secretary, the Behavioral Health Coordinating Council of the
Department of Health and Human Services, other agencies
within the Department of Health and Human Services, and other
relevant Federal departments.
``(b) Recommendations.--The Assistant Secretary for
Planning and Evaluation shall develop an evaluation strategy
that identifies priority programs to be evaluated by the
Assistant Secretary and priority programs to be evaluated by
other relevant agencies within the Department of Health and
Human Services. The Assistant Secretary for Planning and
Evaluation shall provide recommendations on improving
programs and activities based on the evaluation described in
subsection (a)(2) as needing improvement.''.
SEC. 103. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY
LABORATORY.
Title V of the Public Health Service Act (42 U.S.C. 290aa
et seq.) is amended by inserting after section 501A, as added
by section 102 of this Act, the following:
``SEC. 501B. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY
LABORATORY.
``(a) In General.--There shall be established within the
Administration a National Mental Health and Substance Use
Policy Laboratory (referred to in this section as the
`Laboratory').
``(b) Responsibilities.--The Laboratory shall--
``(1) continue to carry out the authorities and activities
that were in effect for the Office of Policy, Planning, and
Innovation as such Office existed prior to the date of
enactment of the Helping Families in Mental Health Crisis Act
of 2016;
``(2) identify, coordinate, and facilitate the
implementation of policy changes likely to have a significant
effect on mental health, mental illness, and the prevention
and treatment of substance use disorder services;
``(3) collect, as appropriate, information from grantees
under programs operated by the Administration in order to
evaluate and disseminate information on evidence-based
practices, including culturally and linguistically
appropriate services, as appropriate, and service delivery
models;
``(4) provide leadership in identifying and coordinating
policies and programs, including evidence-based programs,
related to mental illness and substance use disorders;
``(5) recommend ways in which payers may implement program
and policy findings of the Administration and the Laboratory
to improve outcomes and reduce per capita program costs;
``(6) in consultation with the Assistant Secretary for
Planning and Evaluation, as appropriate, periodically review
Federal programs and activities relating to the diagnosis or
prevention of, or treatment or rehabilitation for, mental
illness and substance use disorders, including by--
``(A) identifying any such programs or activities that are
duplicative;
``(B) identifying any such programs or activities that are
not evidence-based, effective, or efficient; and
``(C) formulating recommendations for coordinating,
eliminating, or improving programs or activities identified
under subparagraph (A) or (B) and merging such programs or
activities into other successful programs or activities; and
``(7) carry out other activities as deemed necessary to
continue to encourage innovation and disseminate evidence-
based programs and practices, including programs and
practices with scientific merit.
``(c) Evidence-Based Practices and Service Delivery
Models.--
``(1) In general.--In selecting evidence-based best
practices and service delivery models for evaluation and
dissemination, the Laboratory--
``(A) shall give preference to models that improve--
``(i) the coordination between mental health and physical
health providers;
``(ii) the coordination among such providers and the
justice and corrections system; and
``(iii) the cost effectiveness, quality, effectiveness, and
efficiency of health care services furnished to individuals
with serious mental illness or serious emotional disturbance,
in mental health crisis, or at risk to themselves, their
families, and the general public; and
``(B) may include clinical protocols and practices used in
the Recovery After Initial Schizophrenia Episode (RAISE)
project and the North American Prodrome Longitudinal Study
(NAPLS) of the National Institute of Mental Health.
``(2) Deadline for beginning implementation.--The
Laboratory shall begin implementation of the duties described
in this section not later than January 1, 2018.
``(3) Consultation.--In carrying out the duties under this
section, the Laboratory shall consult with--
``(A) representatives of the National Institute of Mental
Health, the National Institute on Drug Abuse, and the
National Institute on Alcohol Abuse and Alcoholism, on an
ongoing basis;
``(B) other appropriate Federal agencies;
``(C) clinical and analytical experts with expertise in
psychiatric medical care and clinical psychological care,
health care management, education, corrections health care,
and mental health court systems, as appropriate; and
``(D) other individuals and agencies as determined
appropriate by the Assistant Secretary.''.
SEC. 104. PEER-SUPPORT SPECIALIST PROGRAMS.
(a) In General.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General of the United
States shall conduct a study on peer-support specialist
programs in up to 10 States (to be selected by the
Comptroller General) that receive funding from the Substance
Abuse and Mental Health Services Administration and submit to
the Committee on Health, Education, Labor, and Pensions of
the Senate and the Committee on Energy and Commerce of the
House of Representatives a report containing the results of
such study.
(b) Contents of Study.--In conducting the study under
subsection (a), the Comptroller General of the United States
shall examine and identify best practices in the selected
States related to training and credential requirements for
peer-support specialist programs, such as--
(1) hours of formal work or volunteer experience related to
mental illness and substance use disorders conducted through
such programs;
(2) types of peer-support specialist exams required for
such programs in the States;
(3) codes of ethics used by such programs in the States;
(4) required or recommended skill sets of such programs in
the State; and
(5) requirements for continuing education.
SEC. 105. PROHIBITION AGAINST LOBBYING USING FEDERAL FUNDS BY
SYSTEMS ACCEPTING FEDERAL FUNDS TO PROTECT AND
ADVOCATE THE RIGHTS OF INDIVIDUALS WITH MENTAL
ILLNESS.
Section 105(a) of the Protection and Advocacy for
Individuals with Mental Illness Act (42 U.S.C. 10805(a)) is
amended--
(1) in paragraph (9), by striking ``and'' at the end;
(2) in paragraph (10), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(11) agree to refrain, during any period for which
funding is provided to the system under this part, from using
Federal funds to pay the salary or expenses of any grant or
contract recipient, or agent acting for such recipient,
related to any activity designed to
[[Page H4304]]
influence the enactment of legislation, appropriations,
regulation, administrative action, or Executive order
proposed or pending before the Congress or any State or local
government, including any legislative body, other than for
normal and recognized executive-legislative relationships or
participation by an agency or officer of a State, local, or
tribal government in policymaking and administrative
processes within the executive branch of that government.''.
SEC. 106. REPORTING FOR PROTECTION AND ADVOCACY
ORGANIZATIONS.
(a) Public Availability of Reports.--Section 105(a)(7) of
the Protection and Advocacy for Individuals with Mental
Illness Act (42 U.S.C. 10805(a)(7)) is amended by striking
``is located a report'' and inserting ``is located, and make
publicly available, a report''.
(b) Detailed Accounting.--Section 114(a) of the Protection
and Advocacy for Individuals with Mental Illness Act (42
U.S.C. 10824(a)) is amended--
(1) in paragraph (3), by striking ``and'' at the end;
(2) in paragraph (4), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(5) using data from the existing required annual program
progress reports submitted by each system funded under this
title, a detailed accounting for each such system of how
funds are spent, disaggregated according to whether the funds
were received from the Federal Government, the State
government, a local government, or a private entity.''.
SEC. 107. GRIEVANCE PROCEDURE.
Section 105 of the Protection and Advocacy for Individuals
with Mental Illness Act (42 U.S.C. 10805), as amended, is
further amended by adding at the end the following:
``(d) Grievance Procedure.--The Secretary shall establish
an independent grievance procedure for persons described in
subsection (a)(9).''.
SEC. 108. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND
QUALITY.
Title V of the Public Health Service Act (42 U.S.C. 290aa
et seq.) is amended--
(1) in section 501(b) (42 U.S.C. 290aa(b)), by adding at
the end the following:
``(4) The Center for Behavioral Health Statistics and
Quality.'';
(2) in section 502(a)(1) (42 U.S.C. 290aa-1(a)(1))--
(A) in subparagraph (C), by striking ``and'' at the end;
(B) in subparagraph (D), by striking the period at the end
and inserting ``; and''; and
(C) by inserting after subparagraph (D) the following:
``(E) the Center for Behavioral Health Statistics and
Quality.''; and
(3) in part B (42 U.S.C. 290bb et seq.) by adding at the
end the following new subpart:
``Subpart 4--Center for Behavioral Health Statistics and Quality
``SEC. 520L. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND
QUALITY.
``(a) Establishment.--There is established in the
Administration a Center for Behavioral Health Statistics and
Quality (in this section referred to as the `Center'). The
Center shall be headed by a Director (in this section
referred to as the `Director') appointed by the Secretary
from among individuals with extensive experience and academic
qualifications in research and analysis in behavioral health
care or related fields.
``(b) Duties.--The Director of the Center shall--
``(1) coordinate the Administration's integrated data
strategy by coordinating--
``(A) surveillance and data collection (including that
authorized by section 505);
``(B) evaluation;
``(C) statistical and analytic support;
``(D) service systems research; and
``(E) performance and quality information systems;
``(2) recommend a core set of measurement standards for
grant programs administered by the Administration; and
``(3) coordinate evaluation efforts for the grant programs,
contracts, and collaborative agreements of the
Administration.
``(c) Biannual Report to Congress.--Not later than 2 years
after the date of enactment of this section, and every 2
years thereafter, the Director of the Center shall submit to
Congress a report on the quality of services furnished
through grant programs of the Administration, including
applicable measures of outcomes for individuals and public
outcomes such as--
``(1) the number of patients screened positive for
unhealthy alcohol use who receive brief counseling as
appropriate; the number of patients screened positive for
tobacco use and receiving smoking cessation interventions;
the number of patients with a new diagnosis of major
depressive episode who are assessed for suicide risk; the
number of patients screened positive for clinical depression
with a documented followup plan; and the number of patients
with a documented pain assessment that have a followup
treatment plan when pain is present; and satisfaction with
care;
``(2) the incidence and prevalence of mental illness and
substance use disorders; the number of suicide attempts and
suicide completions; overdoses seen in emergency rooms
resulting from alcohol and drug use; emergency room boarding;
overdose deaths; emergency psychiatric hospitalizations; new
criminal justice involvement while in treatment; stable
housing; and rates of involvement in employment, education,
and training; and
``(3) such other measures for outcomes of services as the
Director may determine.
``(d) Staffing Composition.--The staff of the Center may
include individuals with advanced degrees and field expertise
as well as clinical and research experience in mental illness
and substance use disorders such as--
``(1) professionals with clinical and research expertise in
the prevention and treatment of, and recovery from, mental
illness and substance use disorders;
``(2) professionals with training and expertise in
statistics or research and survey design and methodologies;
and
``(3) other related fields in the social and behavioral
sciences, as specified by relevant position descriptions.
``(e) Grants and Contracts.--In carrying out the duties
established in subsection (b), the Director may make grants
to, and enter into contracts and cooperative agreements with,
public and nonprofit private entities.
``(f) Definition.--In this section, the term `emergency
room boarding' means the practice of admitting patients to an
emergency department and holding such patients in the
department until inpatient psychiatric beds become
available.''.
SEC. 109. STRATEGIC PLAN.
Section 501 of the Public Health Service Act (42 U.S.C.
290aa) is further amended--
(1) by redesignating subsections (l) through (o) as
subsections (m) through (p), respectively; and
(2) by inserting after subsection (k) the following:
``(l) Strategic Plan.--
``(1) In general.--Not later than December 1, 2017, and
every 5 years thereafter, the Assistant Secretary shall
develop and carry out a strategic plan in accordance with
this subsection for the planning and operation of evidence-
based programs and grants carried out by the Administration.
``(2) Coordination.--In developing and carrying out the
strategic plan under this section, the Assistant Secretary
shall take into consideration the report of the
Interdepartmental Serious Mental Illness Coordinating
Committee under section 301 of the Helping Families in Mental
Health Crisis Act of 2016.
``(3) Publication of plan.--Not later than December 1,
2017, and every 5 years thereafter, the Assistant Secretary
shall--
``(A) submit the strategic plan developed under paragraph
(1) to the appropriate committees of Congress; and
``(B) post such plan on the Internet website of the
Administration.
``(4) Contents.--The strategic plan developed under
paragraph (1) shall--
``(A) identify strategic priorities, goals, and measurable
objectives for mental illness and substance use disorder
activities and programs operated and supported by the
Administration, including priorities to prevent or eliminate
the burden of mental illness and substance use disorders;
``(B) identify ways to improve services for individuals
with a mental illness or substance use disorder, including
services related to the prevention of, diagnosis of,
intervention in, treatment of, and recovery from, mental
illness or substance use disorders, including serious mental
illness or serious emotional disturbance, and access to
services and supports for individuals with a serious mental
illness or serious emotional disturbance;
``(C) ensure that programs provide, as appropriate, access
to effective and evidence-based prevention, diagnosis,
intervention, treatment, and recovery services, including
culturally and linguistically appropriate services, as
appropriate, for individuals with a mental illness or
substance use disorder;
``(D) identify opportunities to collaborate with the Health
Resources and Services Administration to develop or improve--
``(i) initiatives to encourage individuals to pursue
careers (especially in rural and underserved areas and
populations) as psychiatrists, psychologists, psychiatric
nurse practitioners, physician assistants, occupational
therapists, clinical social workers, certified peer-support
specialists, licensed professional counselors, or other
licensed or certified mental health professionals, including
such professionals specializing in the diagnosis, evaluation,
or treatment of individuals with a serious mental illness or
serious emotional disturbance; and
``(ii) a strategy to improve the recruitment, training, and
retention of a workforce for the treatment of individuals
with mental illness or substance use disorders, or co-
occurring illness or disorders;
``(E) identify opportunities to improve collaboration with
States, local governments, communities, and Indian tribes and
tribal organizations (as such terms are defined in section 4
of the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450b)); and
``(F) specify a strategy to disseminate evidenced-based and
promising best practices related to prevention, diagnosis,
early intervention, treatment, and recovery services related
to mental illness, particularly for individuals with a
serious mental illness and children and adolescents with a
serious emotional disturbance, and substance use
disorders.''.
SEC. 110. AUTHORITIES OF CENTERS FOR MENTAL HEALTH SERVICES
AND SUBSTANCE ABUSE TREATMENT.
(a) Center for Mental Health Services.--Section 520(b) of
the Public Health Service Act (42 U.S.C. 290bb-31(b)) is
amended--
[[Page H4305]]
(1) by redesignating paragraphs (3) through (15) as
paragraphs (4) through (16), respectively;
(2) by inserting after paragraph (2) the following:
``(3) collaborate with the Director of the National
Institute of Mental Health to ensure that, as appropriate,
programs related to the prevention and treatment of mental
illness and the promotion of mental health are carried out in
a manner that reflects the best available science and
evidence-based practices, including culturally and
linguistically appropriate services;'';
(3) in paragraph (5), as so redesignated, by inserting
``through policies and programs that reduce risk and promote
resiliency'' before the semicolon;
(4) in paragraph (6), as so redesignated, by inserting ``in
collaboration with the Director of the National Institute of
Mental Health,'' before ``develop'';
(5) in paragraph (8), as so redesignated, by inserting ``,
increase meaningful participation of individuals with mental
illness in programs and activities of the Administration,''
before ``and protect the legal'';
(6) in paragraph (10), as so redesignated, by striking
``professional and paraprofessional personnel pursuant to
section 303'' and inserting ``paraprofessional personnel and
health professionals'';
(7) in paragraph (11), as so redesignated, by inserting
``and telemental health,'' after ``rural mental health,'';
(8) in paragraph (12), as so redesignated, by striking
``establish a clearinghouse for mental health information to
assure the widespread dissemination of such information'' and
inserting ``disseminate mental health information, including
evidenced-based practices,'';
(9) in paragraph (15), as so redesignated, by striking
``and'' at the end;
(10) in paragraph (16), as so redesignated, by striking the
period and inserting ``; and''; and
(11) by adding at the end the following:
``(17) consult with other agencies and offices of the
Department of Health and Human Services to ensure, with
respect to each grant awarded by the Center for Mental Health
Services, the consistent documentation of the application of
criteria when awarding grants and the ongoing oversight of
grantees after such grants are awarded.''.
(b) Director of the Center for Substance Abuse Treatment.--
Section 507 of the Public Health Service Act (42 U.S.C.
290bb) is amended--
(1) in subsection (a)--
(A) by striking ``treatment of substance abuse'' and
inserting ``treatment of substance use disorders''; and
(B) by striking ``abuse treatment systems'' and inserting
``use disorder treatment systems''; and
(2) in subsection (b)--
(A) in paragraph (3), by striking ``abuse'' and inserting
``use disorder'';
(B) in paragraph (4), by striking ``individuals who abuse
drugs'' and inserting ``individuals who use drugs'';
(C) in paragraph (9), by striking ``carried out by the
Director'';
(D) by striking paragraph (10);
(E) by redesignating paragraphs (11) through (14) as
paragraphs (10) through (13), respectively;
(F) in paragraph (12), as so redesignated, by striking ``;
and'' and inserting a semicolon; and
(G) by striking paragraph (13), as so redesignated, and
inserting the following:
``(13) ensure the consistent documentation of the
application of criteria when awarding grants and the ongoing
oversight of grantees after such grants are awarded; and
``(14) work with States, providers, and individuals in
recovery, and their families, to promote the expansion of
recovery support services and systems of care oriented
towards recovery.''.
SEC. 111. ADVISORY COUNCILS.
Section 502(b) of the Public Health Service Act (42 U.S.C.
290aa-1(b)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (E), by striking ``and'' after the
semicolon;
(B) by redesignating subparagraph (F) as subparagraph (I);
and
(C) by inserting after subparagraph (E), the following:
``(F) for the advisory councils appointed under subsections
(a)(1)(A) and (a)(1)(D), the Director of the National
Institute of Mental Health;
``(G) for the advisory councils appointed under subsections
(a)(1)(A), (a)(1)(B), and (a)(1)(C), the Director of the
National Institute on Drug Abuse;
``(H) for the advisory councils appointed under subsections
(a)(1)(A), (a)(1)(B), and (a)(1)(C), the Director of the
National Institute on Alcohol Abuse and Alcoholism; and'';
and
(2) in paragraph (3), by adding at the end the following:
``(C) Not less than half of the members of the advisory
council appointed under subsection (a)(1)(D)--
``(i) shall have--
``(I) a medical degree;
``(II) a doctoral degree in psychology; or
``(III) an advanced degree in nursing or social work from
an accredited graduate school or be a certified physician
assistant; and
``(ii) shall specialize in the mental health field.''.
SEC. 112. PEER REVIEW.
Section 504(b) of the Public Health Service Act (42 U.S.C.
290aa-3(b)) is amended by adding at the end the following:
``In the case of any such peer review group that is reviewing
a grant, cooperative agreement, or contract related to mental
illness treatment, not less than half of the members of such
peer review group shall be licensed and experienced
professionals in the prevention, diagnosis, or treatment of,
or recovery from, mental illness or substance use disorders
and have a medical degree, a doctoral degree in psychology,
or an advanced degree in nursing or social work from an
accredited program.''.
TITLE II--MEDICAID MENTAL HEALTH COVERAGE
SEC. 201. RULE OF CONSTRUCTION RELATED TO MEDICAID COVERAGE
OF MENTAL HEALTH SERVICES AND PRIMARY CARE
SERVICES FURNISHED ON THE SAME DAY.
Nothing in title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) shall be construed as prohibiting separate
payment under the State plan under such title (or under a
waiver of the plan) for the provision of a mental health
service or primary care service under such plan, with respect
to an individual, because such service is--
(1) a primary care service furnished to the individual by a
provider at a facility on the same day a mental health
service is furnished to such individual by such provider (or
another provider) at the facility; or
(2) a mental health service furnished to the individual by
a provider at a facility on the same day a primary care
service is furnished to such individual by such provider (or
another provider) at the facility.
SEC. 202. OPTIONAL LIMITED COVERAGE OF INPATIENT SERVICES
FURNISHED IN INSTITUTIONS FOR MENTAL DISEASES.
(a) In General.--Section 1903(m)(2) of the Social Security
Act (42 U.S.C. 1396b(m)(2)) is amended by adding at the end
the following new subparagraph:
``(I)(i) Notwithstanding the limitation specified in the
subdivision (B) following paragraph (29) of section 1905(a)
and subject to clause (ii), a State may, under a risk
contract entered into by the State under this title (or under
section 1115) with a medicaid managed care organization or a
prepaid inpatient health plan (as defined in section 438.2 of
title 42, Code of Federal Regulations (or any successor
regulation)), make a monthly capitation payment to such
organization or plan for enrollees with the organization or
plan who are over 21 years of age and under 65 years of age
and are receiving inpatient treatment in an institution for
mental diseases (as defined in section 1905(i)), so long as
each of the following conditions is met:
``(I) The institution is a hospital providing inpatient
psychiatric or substance use disorder services or a sub-acute
facility providing psychiatric or substance use disorder
crisis residential services.
``(II) The length of stay in such an institution for such
treatment is for a short-term stay of no more than 15 days
during the period of the monthly capitation payment.
``(III) The provision of such treatment meets the following
criteria for consideration as services or settings that are
provided in lieu of services or settings covered under the
State plan:
``(aa) The State determines that the alternative service or
setting is a medically appropriate and cost-effective
substitute for the service or setting covered under the State
plan.
``(bb) The enrollee is not required by the managed care
organization or prepaid inpatient health plan to use the
alternative service or setting.
``(cc) Such treatment is authorized and identified in such
contract, and will be offered to such enrollees at the option
of the managed care organization or prepaid inpatient health
plan.
``(ii) For purposes of setting the amount of such a monthly
capitation payment, a State may use the utilization of
services provided to an individual under this subparagraph
when developing the inpatient psychiatric or substance use
disorder component of such payment, but the amount of such
payment for such services may not exceed the cost of the same
services furnished through providers included under the State
plan.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply beginning on July 5, 2016, or the date of the
enactment of this Act, whichever is later.
SEC. 203. STUDY AND REPORT RELATED TO MEDICAID MANAGED CARE
REGULATION.
(a) Study.--The Secretary of Health and Human Services,
acting through the Administrator of the Centers for Medicare
& Medicaid Services, shall conduct a study on coverage under
the Medicaid program under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.) of services provided through a
medicaid managed care organization (as defined in section
1903(m) of such Act (42 U.S.C. 1396b(m)) or a prepaid
inpatient health plan (as defined in section 438.2 of title
42, Code of Federal Regulations (or any successor
regulation)) with respect to individuals over the age of 21
and under the age of 65 for the treatment of a mental health
disorder in institutions for mental diseases (as defined in
section 1905(i) of such Act (42 U.S.C. 1396d(i))). Such study
shall include information on the following:
(1) The extent to which States, including the District of
Columbia and each territory or possession of the United
States, are providing capitated payments to such
organizations or plans for enrollees who are receiving
services in institutions for mental diseases.
[[Page H4306]]
(2) The number of individuals receiving medical assistance
under a State plan under such title XIX, or a waiver of such
plan, who receive services in institutions for mental
diseases through such organizations and plans.
(3) The range of and average number of months, and the
length of stay during such months, that such individuals are
receiving such services in such institutions.
(4) How such organizations or plans determine when to
provide for the furnishing of such services through an
institution for mental diseases in lieu of other benefits
(including the full range of community-based services) under
their contract with the State agency administering the State
plan under such title XIX, or a waiver of such plan, to
address psychiatric or substance use disorder treatment.
(5) The extent to which the provision of services within
such institutions has affected the capitated payments for
such organizations or plans.
(b) Report.--Not later than three years after the date of
the enactment of this Act, the Secretary shall submit to
Congress a report on the study conducted under subsection
(a).
SEC. 204. GUIDANCE ON OPPORTUNITIES FOR INNOVATION.
Not later than one year after the date of the enactment of
this Act, the Administrator of the Centers for Medicare &
Medicaid Services shall issue a State Medicaid Director
letter regarding opportunities to design innovative service
delivery systems, including systems for providing community-
based services, for individuals with serious mental illness
or serious emotional disturbance who are receiving medical
assistance under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.). The letter shall include opportunities
for demonstration projects under section 1115 of such Act (42
U.S.C. 1315), to improve care for such individuals.
SEC. 205. STUDY AND REPORT ON MEDICAID EMERGENCY PSYCHIATRIC
DEMONSTRATION PROJECT.
(a) Collection of Information.--The Secretary of Health and
Human Services, acting through the Administrator of the
Centers for Medicare & Medicaid Services, shall, with respect
to each State that has participated in the demonstration
project established under section 2707 of the Patient
Protection and Affordable Care Act (42 U.S.C. 1396a note),
collect from each such State information on the following:
(1) The number of institutions for mental diseases (as
defined in section 1905(i) of the Social Security Act (42
U.S.C. 1396d(i))) and beds in such institutions that received
payment for the provision of services to individuals who
receive medical assistance under a State plan under the
Medicaid program under title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) (or under a waiver of such plan)
through the demonstration project in each such State as
compared to the total number of institutions for mental
diseases and beds in the State.
(2) The extent to which there is a reduction in
expenditures under the Medicaid program under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) or other
spending on the full continuum of physical or mental health
care for individuals who receive treatment in an institution
for mental diseases under the demonstration project,
including outpatient, inpatient, emergency, and ambulatory
care, that is attributable to such individuals receiving
treatment in institutions for mental diseases under the
demonstration project.
(3) The number of forensic psychiatric hospitals, the
number of beds in such hospitals, and the number of forensic
psychiatric beds in other hospitals in such State, based on
the most recent data available, to the extent practical, as
determined by such Administrator.
(4) The amount of any disproportionate share hospital
payments under section 1923 of the Social Security Act (42
U.S.C. 1396r-4) that institutions for mental diseases in the
State received during the period beginning on July 1, 2012,
and ending on June 30, 2015, and the extent to which the
demonstration project reduced the amount of such payments.
(5) The most recent data regarding all facilities or sites
in the State in which any individuals with serious mental
illness who are receiving medical assistance under a State
plan under the Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) (or under a waiver of
such plan) are treated during the period referred to in
paragraph (4), to the extent practical, as determined by the
Administrator, including--
(A) the types of such facilities or sites (such as an
institution for mental diseases, a hospital emergency
department, or other inpatient hospital);
(B) the average length of stay in such a facility or site
by such an individual, disaggregated by facility type; and
(C) the payment rate under the State plan (or a waivers of
such plan) for services furnished to such an individual for
that treatment, disaggregated by facility type, during the
period in which the demonstration project is in operation.
(6) The extent to which the utilization of hospital
emergency departments during the period in which the
demonstration project was is in operation differed, with
respect to individuals who are receiving medical assistance
under a State plan under the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.) (or under
a waiver of such plan), between--
(A) those individuals who received treatment in an
institution for mental diseases under the demonstration
project;
(B) those individuals who met the eligibility requirements
for the demonstration project but who did not receive
treatment in an institution for mental diseases under the
demonstration project; and
(C) those individuals with serious mental illness who did
not meet such eligibility requirements and did not receive
treatment for such illness in an institution for mental
diseases.
(b) Report.--Not later than two years after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report that summarizes
and analyzes the information collected under subsection (a).
Such report may be submitted as part of the report required
under section 2707(f) of the Patient Protection and
Affordable Care Act (42 U.S.C. 1396a note) or separately.
SEC. 206. PROVIDING EPSDT SERVICES TO CHILDREN IN IMDS.
(a) In General.--Section 1905(a)(16) of the Social Security
Act (42 U.S.C. 1396d(a)(16)) is amended--
(1) by striking ``effective January 1, 1973'' and inserting
``(A) effective January 1, 1973''; and
(2) by inserting before the semicolon at the end the
following: ``, and, (B) for individuals receiving services
described in subparagraph (A), early and periodic screening,
diagnostic, and treatment services (as defined in subsection
(r)), whether or not such screening, diagnostic, and
treatment services are furnished by the provider of the
services described in such subparagraph''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply with respect to items and services furnished in
calendar quarters beginning on or after January 1, 2019.
SEC. 207. ELECTRONIC VISIT VERIFICATION SYSTEM REQUIRED FOR
PERSONAL CARE SERVICES AND HOME HEALTH CARE
SERVICES UNDER MEDICAID.
(a) In General.--Section 1903 of the Social Security Act
(42 U.S.C. 1396b) is amended by inserting after subsection
(k) the following new subsection:
``(l)(1) Subject to paragraphs (3) and (4), with respect to
any amount expended for personal care services or home health
care services requiring an in-home visit by a provider that
are provided under a State plan under this title (or under a
waiver of the plan) and furnished in a calendar quarter
beginning on or after January 1, 2019 (or, in the case of
home health care services, on or after January 1, 2023),
unless a State requires the use of an electronic visit
verification system for such services furnished in such
quarter under the plan or such waiver, the Federal medical
assistance percentage shall be reduced--
``(A) in the case of personal care services--
``(i) for calendar quarters in 2019 and 2020, by .25
percentage points;
``(ii) for calendar quarters in 2021, by .5 percentage
points;
``(iii) for calendar quarters in 2022, by .75 percentage
points; and
``(iv) for calendar quarters in 2023 and each year
thereafter, by 1 percentage point; and
``(B) in the case of home health care services--
``(i) for calendar quarters in 2023 and 2024, by .25
percentage points;
``(ii) for calendar quarters in 2025, by .5 percentage
points;
``(iii) for calendar quarters in 2026, by .75 percentage
points; and
``(iv) for calendar quarters in 2027 and each year
thereafter, by 1 percentage point.
``(2) Subject to paragraphs (3) and (4), in implementing
the requirement for the use of an electronic visit
verification system under paragraph (1), a State shall--
``(A) consult with agencies and entities that provide
personal care services, home health care services, or both
under the State plan (or under a waiver of the plan) to
ensure that such system--
``(i) is minimally burdensome;
``(ii) takes into account existing best practices and
electronic visit verification systems in use in the State;
and
``(iii) is conducted in accordance with the requirements of
HIPAA privacy and security law (as defined in section 3009 of
the Public Health Service Act);
``(B) take into account a stakeholder process that includes
input from beneficiaries, family caregivers, individuals who
furnish personal care services or home health care services,
and other stakeholders, as determined by the State in
accordance with guidance from the Secretary; and
``(C) ensure that individuals who furnish personal care
services, home health care services, or both under the State
plan (or under a waiver of the plan) are provided the
opportunity for training on the use of such system.
``(3) Paragraphs (1) and (2) shall not apply in the case of
a State that, as of the date of the enactment of this
subsection, requires the use of any system for the electronic
verification of visits conducted as part of both personal
care services and home health care services, so long as the
State continues to require the use of such system with
respect to the electronic verification of such visits.
``(4)(A) In the case of a State described in subparagraph
(B), the reduction under paragraph (1) shall not apply--
[[Page H4307]]
``(i) in the case of personal care services, for calendar
quarters in 2019; and
``(ii) in the case of home health care services, for
calendar quarters in 2023.
``(B) For purposes of subparagraph (A), a State described
in this subparagraph is a State that demonstrates to the
Secretary that the State--
``(i) has made a good faith effort to comply with the
requirements of paragraphs (1) and (2) (including by taking
steps to adopt the technology used for an electronic visit
verification system); or
``(ii) in implementing such a system, has encountered
unavoidable system delays.
``(5) In this subsection:
``(A) The term `electronic visit verification system'
means, with respect to personal care services or home health
care services, a system under which visits conducted as part
of such services are electronically verified with respect
to--
``(i) the type of service performed;
``(ii) the individual receiving the service;
``(iii) the date of the service;
``(iv) the location of service delivery;
``(v) the individual providing the service; and
``(vi) the time the service begins and ends.
``(B) The term `home health care services' means services
described in section 1905(a)(7) provided under a State plan
under this title (or under a waiver of the plan).
``(C) The term `personal care services' means personal care
services provided under a State plan under this title (or
under a waiver of the plan), including services provided
under section 1905(a)(24), 1915(c), 1915(i), 1915(j), or
1915(k) or under a wavier under section 1115.
``(6)(A) In the case in which a State requires personal
care service and home health care service providers to
utilize an electronic visit verification system operated by
the State or a contractor on behalf of the State, the
Secretary shall pay to the State, for each quarter, an amount
equal to 90 per centum of so much of the sums expended during
such quarter as are attributable to the design, development,
or installation of such system, and 75 per centum of so much
of the sums for the operation and maintenance of such system.
``(B) Subparagraph (A) shall not apply in the case in which
a State requires personal care service and home health care
service providers to utilize an electronic visit verification
system that is not operated by the State or a contractor on
behalf of the State.''.
(b) Collection and Dissemination of Best Practices.--Not
later than January 1, 2018, the Secretary of Health and Human
Services shall, with respect to electronic visit verification
systems (as defined in subsection (l)(5) of section 1903 of
the Social Security Act (42 U.S.C. 1396b), as inserted by
subsection (a)), collect and disseminate best practices to
State Medicaid Directors with respect to--
(1) training individuals who furnish personal care
services, home health care services, or both under the State
plan under title XIX of such Act (or under a waiver of the
plan) on such systems and the operation of such systems and
the prevention of fraud with respect to the provision of
personal care services or home health care services (as
defined in such subsection (l)(5)); and
(2) the provision of notice and educational materials to
family caregivers and beneficiaries with respect to the use
of such electronic visit verification systems and other means
to prevent such fraud.
(c) Rules of Construction.--
(1) No employer-employee relationship established.--Nothing
in the amendment made by this section may be construed as
establishing an employer-employee relationship between the
agency or entity that provides for personal care services or
home health care services and the individuals who, under a
contract with such an agency or entity, furnish such services
for purposes of part 552 of title 29, Code of Federal
Regulations (or any successor regulations).
(2) No particular or uniform electronic visit verification
system required.--Nothing in the amendment made by this
section shall be construed to require the use of a particular
or uniform electronic visit verification system (as defined
in subsection (l)(5) of section 1903 of the Social Security
Act (42 U.S.C. 1396b), as inserted by subsection (a)) by all
agencies or entities that provide personal care services or
home health care under a State plan under title XIX of the
Social Security Act (or under a waiver of the plan) (42
U.S.C. 1396 et seq.).
(3) No limits on provision of care.--Nothing in the
amendment made by this section may be construed to limit,
with respect to personal care services or home health care
services provided under a State plan under title XIX of the
Social Security Act (or under a waiver of the plan) (42
U.S.C. 1396 et seq.), provider selection, constrain
beneficiaries' selection of a caregiver, or impede the manner
in which care is delivered.
(4) No prohibition on state quality measures
requirements.--Nothing in the amendment made by this section
shall be construed as prohibiting a State, in implementing an
electronic visit verification system (as defined in
subsection (l)(5) of section 1903 of the Social Security Act
(42 U.S.C. 1396b), as inserted by subsection (a)), from
establishing requirements related to quality measures for
such system.
TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE
SEC. 301. INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS
COORDINATING COMMITTEE.
(a) Establishment.--
(1) In general.--Not later than 3 months after the date of
enactment of this Act, the Secretary of Health and Human
Services, or the designee of the Secretary, shall establish a
committee to be known as the ``Interdepartmental Serious
Mental Illness Coordinating Committee'' (in this section
referred to as the ``Committee'').
(2) Federal advisory committee act.--Except as provided in
this section, the provisions of the Federal Advisory
Committee Act (5 U.S.C. App.) shall apply to the Committee.
(b) Meetings.--The Committee shall meet not fewer than 2
times each year.
(c) Responsibilities.--Not later than 1 year after the date
of enactment of this Act, and 5 years after such date of
enactment, the Committee shall submit to Congress a report
including--
(1) a summary of advances in serious mental illness and
serious emotional disturbance research related to the
prevention of, diagnosis of, intervention in, and treatment
and recovery of, serious mental illnesses, serious emotional
disturbances, and advances in access to services and support
for individuals with a serious mental illness or serious
emotional disturbance;
(2) an evaluation of the effect on public health of Federal
programs related to serious mental illness or serious
emotional disturbance, including measurements of public
health outcomes such as--
(A) rates of suicide, suicide attempts, prevalence of
serious mental illness, serious emotional disturbances, and
substance use disorders, overdose, overdose deaths, emergency
hospitalizations, emergency room boarding, preventable
emergency room visits, involvement with the criminal justice
system, crime, homelessness, and unemployment;
(B) increased rates of employment and enrollment in
educational and vocational programs;
(C) quality of mental illness and substance use disorder
treatment services; and
(D) any other criteria as may be determined by the
Secretary;
(3) a plan to improve outcomes for individuals with serious
mental illness or serious emotional disturbances, including
reducing incarceration for such individuals, reducing
homelessness, and increasing employment; and
(4) specific recommendations for actions that agencies can
take to better coordinate the administration of mental health
services for people with serious mental illness or serious
emotional disturbances.
(d) Committee Extension.--Upon the submission of the second
report under subsection (c), the Secretary shall submit a
recommendation to Congress on whether to extend the operation
of the Committee.
(e) Membership.--
(1) Federal members.--The Committee shall be composed of
the following Federal representatives, or their designees:
(A) The Secretary of Health and Human Services, who shall
serve as the Chair of the Committee.
(B) The Director of the National Institutes of Health.
(C) The Assistant Secretary for Health of the Department of
Health and Human Services.
(D) The Assistant Secretary for Mental Health and Substance
Use.
(E) The Attorney General of the United States.
(F) The Secretary of Veterans Affairs.
(G) The Secretary of Defense.
(H) The Secretary of Housing and Urban Development.
(I) The Secretary of Education.
(J) The Secretary of Labor.
(K) The Commissioner of Social Security.
(L) The Administrator of the Centers for Medicare &
Medicaid Services.
(2) Non-federal members.--The Committee shall also include
not less than 14 non-Federal public members appointed by the
Secretary of Health and Human Services, of which--
(A) at least 2 members shall be individuals with lived
experience with serious mental illness or serious emotional
disturbance;
(B) at least 1 member shall be a parent or legal guardian
of an individual with a history of a serious mental illness
or serious emotional disturbance;
(C) at least 1 member shall be a representative of a
leading research, advocacy, or service organization for
individuals with serious mental illness or serious emotional
disturbance;
(D) at least 2 members shall be--
(i) a licensed psychiatrist with experience treating
serious mental illnesses or serious emotional disturbances;
(ii) a licensed psychologist with experience treating
serious mental illnesses or serious emotional disturbances;
(iii) a licensed clinical social worker with experience
treating serious mental illness or serious emotional
disturbances; or
(iv) a licensed psychiatric nurse, nurse practitioner, or
physician assistant with experience treating serious mental
illnesses or serious emotional disturbances;
(E) at least 1 member shall be a licensed mental health
professional with a specialty in treating children and
adolescents with serious emotional disturbances;
[[Page H4308]]
(F) at least 1 member shall be a mental health professional
who has research or clinical mental health experience working
with minorities;
(G) at least 1 member shall be a mental health professional
who has research or clinical mental health experience working
with medically underserved populations;
(H) at least 1 member shall be a State certified mental
health peer-support specialist;
(I) at least 1 member shall be a judge with experience
adjudicating cases within a mental health court;
(J) at least 1 member shall be a law enforcement officer or
corrections officer with extensive experience in interfacing
with individuals with a serious mental illness or serious
emotional disturbance, or in a mental health crisis; and
(K) at least 1 member shall be a homeless services provider
with experience working with individuals with serious mental
illness, with serious emotional disturbance, or having mental
health crisis.
(3) Terms.--A member of the Committee appointed under
paragraph (2) shall serve for a term of 3 years, and may be
reappointed for one or more additional 3-year terms. Any
member appointed to fill a vacancy for an unexpired term
shall be appointed for the remainder of such term. A member
may serve after the expiration of the member's term until a
successor has been appointed.
(f) Working Groups.--In carrying out its functions, the
Committee may establish working groups. Such working groups
shall be composed of Committee members, or their designees,
and may hold such meetings as are necessary.
(g) Sunset.--The Committee shall terminate on the date that
is 6 years after the date on which the Committee is
established under subsection (a)(1).
TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA
SEC. 401. SENSE OF CONGRESS.
(a) Findings.--Congress finds the following:
(1) The vast majority of individuals with mental illness
are capable of understanding their illness and caring for
themselves.
(2) Persons with serious mental illness (in this section
referred to as ``SMI''), including schizophrenia spectrum,
bipolar disorders, and major depressive disorder, may be
significantly impaired in their ability to understand or make
sound decisions for their care and needs. By nature of their
illness, cognitive impairments in reasoning and judgment, as
well as the presence of hallucinations, delusions, and severe
emotional distortions, they may lack the awareness they even
have a mental illness (a condition known as anosognosia), and
thus may be unable to make sound decisions regarding their
care, nor follow through consistently and effectively on
their care needs.
(3) Persons with mental illness or SMI may require and
benefit from mental health treatment in order to recover to
the fullest extent of their ability; these beneficial
interventions may include psychiatric care, psychological
care, medication, peer support, educational support,
employment support, and housing support.
(4) Persons with SMI who are provided with professional and
supportive services may still experience times when their
symptoms may greatly impair their abilities to make sound
decisions for their personal care or may discontinue their
care as a result of this impaired decisionmaking resulting in
a further deterioration of their condition. They may
experience a temporary or prolonged impairment as a result of
their diminished capacity to care for themselves.
(5) Episodes of psychiatric crises among those with SMI can
result in neurological harm to the individual's brain.
(6) Persons with SMI--
(A) are at high risk for other chronic physical illnesses,
with approximately 50 percent having two or more co-occurring
chronic physical illnesses such as cardiac, pulmonary,
cancer, and endocrine disorders; and
(B) have three times the odds of having chronic bronchitis,
five times the odds of having emphysema, and four times the
odds of having COPD, are more than four times as likely to
have fluid and electrolyte disorders, and are nearly three
times as likely to be nicotine dependent.
(7) Some psychotropic medications, such as second
generation antipsychotics, significantly increase risk for
chronic illnesses such as diabetes and cardiovascular
disease.
(8) When the individual fails to seek or maintain treatment
for these physical conditions over a long term, it can result
in the individual becoming gravely disabled, or developing
life-threatening illnesses. Early and consistent treatment
can ameliorate or reduce symptoms or cure the disease.
(9) Persons with SMI die 7 to 24 years earlier than their
age cohorts primarily because of complications from their
chronic physical illness and failure to seek or maintain
treatment resulting from emotional and cognitive impairments
from their SMI.
(10) It is beneficial to the person with SMI and chronic
illness to seek and maintain continuity of medical care and
treatment for their mental illness to prevent further
deterioration and harm to their own safety.
(11) When the individual with SMI is significantly
diminished in their capacity to care for themselves long term
or acutely, other supportive interventions to assist their
care may be necessary to protect their health and safety.
(12) Prognosis for the physical and psychiatric health of
those with SMI may improve when responsible caregivers
facilitate and participate in care.
(13) When an individual with SMI is chronically
incapacitated in their ability to care for themselves,
caregivers can pursue legal guardianship to facilitate care
in appropriate areas while being mindful to allow the
individual to make decisions for themselves in areas where
they are capable.
(14) Individuals with SMI who have prolonged periods of
being significantly functional can, during such periods,
design and sign an advanced directive to predefine and choose
medications, providers, treatment plans, and hospitals, and
provide caregivers with guardianship the ability to help in
those times when a patient's psychiatric symptoms worsen to
the point of making them incapacitated or leaving them with a
severely diminished capacity to make informed decisions about
their care which may result in harm to their physical and
mental health.
(15) All professional and support efforts should be made to
help the individual with SMI and acute or chronic physical
illnesses to understand and follow through on treatment.
(16) When individuals with SMI, even after efforts to help
them understand, have failed to care for themselves, there
exists confusion in the health care community around what is
currently permissible under HIPAA rules. This confusion may
hinder communication with responsible caregivers who may be
able to facilitate care for the patient with SMI in instances
when the individual does not give permission for disclosure.
(b) Sense of Congress.--It is the sense of the Congress
that, for the sake of the health and safety of persons with
serious mental illness, more clarity is needed surrounding
the existing HIPAA privacy rule promulgated pursuant to
section 264(c) of the Health Insurance Portability and
Accountability Act (42 U.S.C. 1320d-2 note) to permit health
care professionals to communicate, when necessary, with
responsible known caregivers of such persons, the limited,
appropriate protected health information of such persons in
order to facilitate treatment, but not including
psychotherapy notes.
SEC. 402. CONFIDENTIALITY OF RECORDS.
Not later than one year after the date on which the
Secretary of Health and Human Services first finalizes
regulations updating part 2 of title 42, Code of Federal
Regulations (relating to confidentiality of alcohol and drug
abuse patient records) after the date of enactment of this
Act, the Secretary shall convene relevant stakeholders to
determine the effect of such regulations on patient care,
health outcomes, and patient privacy. The Secretary shall
submit to the Committee on Energy and Commerce of the House
of Representatives and the Committee on Health, Education,
Labor, and Pensions of the Senate, and make publicly
available, a report on the findings of such stakeholders.
SEC. 403. CLARIFICATION OF CIRCUMSTANCES UNDER WHICH
DISCLOSURE OF PROTECTED HEALTH INFORMATION IS
PERMITTED.
(a) In General.--Not later than one year after the date of
enactment of this section, the Secretary of Health and Human
Services shall promulgate final regulations clarifying the
circumstances under which, consistent with the provisions of
subpart C of title XI of the Social Security Act (42 U.S.C.
1320d et seq.) and regulations promulgated pursuant to
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2 note), a health
care provider or covered entity may disclose the protected
health information of a patient with a mental illness,
including for purposes of--
(1) communicating (including with respect to treatment,
side effects, risk factors, and the availability of community
resources) with a family member of such patient, caregiver of
such patient, or other individual to the extent that such
family member, caregiver, or individual is involved in the
care of the patient;
(2) communicating with a family member of the patient,
caregiver of such patient, or other individual involved in
the care of the patient in the case that the patient is an
adult;
(3) communicating with the parent or caregiver of a patient
in the case that the patient is a minor;
(4) considering the patient's capacity to agree or object
to the sharing of the protected health information of the
patient;
(5) communicating and sharing information with the family
or caregivers of the patient when--
(A) the patient consents;
(B) the patient does not consent, but the patient lacks the
capacity to agree or object and the communication or sharing
of information is in the patient's best interest;
(C) the patient does not consent and the patient is not
incapacitated or in an emergency circumstance, but the
ability of the patient to make rational health care decisions
is significantly diminished by reason of the physical or
mental health condition of the patient; and
(D) the patient does not consent, but such communication
and sharing of information is necessary to prevent impending
and serious deterioration of the patient's mental or physical
health;
(6) involving a patient's family members, caregivers, or
others involved in the patient's care or care plan, including
facilitating treatment and medication adherence,
[[Page H4309]]
in dealing with patient failures to adhere to medication or
other therapy;
(7) listening to or receiving information with respect to
the patient from the family or caregiver of such patient
receiving mental illness treatment;
(8) communicating with family members of the patient,
caregivers of the patient, law enforcement, or others when
the patient presents a serious and imminent threat of harm to
self or others; and
(9) communicating to law enforcement and family members of
the patient or caregivers of the patient about the admission
of the patient to receive care at a facility or the release
of a patient who was admitted to a facility for an emergency
psychiatric hold or involuntary treatment.
(b) Coordination.--The Secretary of Health and Human
Services shall carry out this section in coordination with
the Director of the Office for Civil Rights within the
Department of Health and Human Services.
(c) Consistency With Guidance.--The Secretary of Health and
Human Services shall ensure that the regulations under this
section are consistent with the guidance entitled ``HIPAA
Privacy Rule and Sharing Information Related to Mental
Health'', issued by the Department of Health and Human
Services on February 20, 2014.
SEC. 404. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING
PROGRAMS.
(a) Initial Programs and Materials.--Not later than one
year after the date of the enactment of this Act, the
Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall develop and
disseminate--
(1) a model program and materials for training health care
providers (including physicians, emergency medical personnel,
psychologists, counselors, therapists, behavioral health
facilities and clinics, care managers, and hospitals)
regarding the circumstances under which, consistent with the
standards governing the privacy and security of individually
identifiable health information promulgated by the Secretary
under subpart C of title XI of the Social Security Act (42
U.S.C. 1320d et seq.) and regulations promulgated pursuant to
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2 note), the
protected health information of patients with a mental
illness may be disclosed with and without patient consent;
(2) a model program and materials for training lawyers and
others in the legal profession on such circumstances; and
(3) a model program and materials for training patients and
their families regarding their rights to protect and obtain
information under the standards specified in paragraph (1).
(b) Periodic Updates.--The Secretary shall--
(1) periodically review and update the model programs and
materials developed under subsection (a); and
(2) disseminate the updated model programs and materials.
(c) Contents.--The programs and materials developed under
subsection (a) shall address the guidance entitled ``HIPAA
Privacy Rule and Sharing Information Related to Mental
Health'', issued by the Department of Health and Human
Services on February 20, 2014.
(d) Coordination.--The Secretary shall carry out this
section in coordination with the Director of the Office for
Civil Rights within the Department of Health and Human
Services, the Assistant Secretary for Mental Health and
Substance Use, the Administrator of the Health Resources and
Services Administration, and the heads of other relevant
agencies within the Department of Health and Human Services.
(e) Input of Certain Entities.--In developing the model
programs and materials required by subsections (a) and (b),
the Secretary shall solicit the input of relevant national,
State, and local associations, medical societies, and
licensing boards.
(f) Funding.--There are authorized to be appropriated to
carry out this section $4,000,000 for fiscal year 2018,
$2,000,000 for each of fiscal years 2019 and 2020, and
$1,000,000 for each of fiscal years 2021 and 2022.
TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS
SEC. 501. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR
INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.
Part B of title V of the Public Health Service Act (42
U.S.C. 290bb et seq.) is amended by inserting after section
520L the following:
``SEC. 520M. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR
INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.
``(a) In General.--The Assistant Secretary shall award
grants to eligible entities--
``(1) to establish assertive community treatment programs
for individuals with serious mental illness; or
``(2) to maintain or expand such programs.
``(b) Eligible Entities.--To be eligible to receive a grant
under this section, an entity shall be a State, county, city,
tribe, tribal organization, mental health system, health care
facility, or any other entity the Assistant Secretary deems
appropriate.
``(c) Special Consideration.--In selecting among applicants
for a grant under this section, the Assistant Secretary may
give special consideration to the potential of the
applicant's program to reduce hospitalization, homelessness,
and involvement with the criminal justice system while
improving the health and social outcomes of the patient.
``(d) Additional Activities.--The Assistant Secretary
shall--
``(1) not later than the end of fiscal year 2021, submit a
report to the appropriate congressional committees on the
grant program under this section, including an evaluation
of--
``(A) cost savings and public health outcomes such as
mortality, suicide, substance abuse, hospitalization, and use
of services;
``(B) rates of involvement with the criminal justice system
of patients;
``(C) rates of homelessness among patients; and
``(D) patient and family satisfaction with program
participation; and
``(2) provide appropriate information, training, and
technical assistance to grant recipients under this section
to help such recipients to establish, maintain, or expand
their assertive community treatment programs.
``(e) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there is
authorized to be appropriated $5,000,000 for the period of
fiscal years 2018 through 2022.
``(2) Use of certain funds.--Of the funds appropriated to
carry out this section in any fiscal year, no more than 5
percent shall be available to the Assistant Secretary for
carrying out subsection (d).''.
SEC. 502. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.
Section 520F of the Public Health Service Act (42 U.S.C.
290bb-37) is amended to read as follows:
``SEC. 520F. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.
``(a) In General.--The Secretary shall award competitive
grants--
``(1) to State and local governments and Indian tribes and
tribal organizations to enhance community-based crisis
response systems; or
``(2) to States to develop, maintain, or enhance a database
of beds at inpatient psychiatric facilities, crisis
stabilization units, and residential community mental health
and residential substance use disorder treatment facilities,
for individuals with serious mental illness, serious
emotional disturbance, or substance use disorders.
``(b) Application.--
``(1) In general.--To receive a grant or cooperative
agreement under subsection (a), an entity shall submit to the
Secretary an application, at such time, in such manner, and
containing such information as the Secretary may require.
``(2) Community-based crisis response plan.--An application
for a grant under subsection (a)(1) shall include a plan
for--
``(A) promoting integration and coordination between local
public and private entities engaged in crisis response,
including first responders, emergency health care providers,
primary care providers, law enforcement, court systems,
health care payers, social service providers, and behavioral
health providers;
``(B) developing a plan for entering into memoranda of
understanding with public and private entities to implement
crisis response services;
``(C) expanding the continuum of community-based services
to address crisis intervention and prevention; and
``(D) developing models for minimizing hospital
readmissions, including through appropriate discharge
planning.
``(3) Beds database plan.--An application for a grant under
subsection (a)(2) shall include a plan for developing,
maintaining, or enhancing a real-time Internet-based bed
database to collect, aggregate, and display information about
beds in inpatient psychiatric facilities and crisis
stabilization units, and residential community mental health
and residential substance use disorder treatment facilities,
to facilitate the identification and designation of
facilities for the temporary treatment of individuals in
mental or substance use disorder crisis.
``(c) Database Requirements.--A bed database described in
this section is a database that--
``(1) includes information on inpatient psychiatric
facilities, crisis stabilization units, and residential
community mental health and residential substance use
disorder facilities in the State involved, including contact
information for the facility or unit;
``(2) provides real-time information about the number of
beds available at each facility or unit and, for each
available bed, the type of patient that may be admitted, the
level of security provided, and any other information that
may be necessary to allow for the proper identification of
appropriate facilities for treatment of individuals in mental
or substance use disorder crisis; and
``(3) enables searches of the database to identify
available beds that are appropriate for the treatment of
individuals in mental or substance use disorder crisis.
``(d) Evaluation.--An entity receiving a grant under
subsection (a)(1) shall submit to the Secretary, at such
time, in such manner, and containing such information as the
Secretary may reasonably require, a report, including an
evaluation of the effect of such grant on--
``(1) local crisis response services and measures of
individuals receiving crisis planning and early intervention
supports;
``(2) individuals reporting improved functional outcomes;
and
``(3) individuals receiving regular followup care following
a crisis.
``(e) Authorization of Appropriations.--There is authorized
to be appropriated to
[[Page H4310]]
carry out this section, $5,000,000 for the period of fiscal
years 2018 through 2022.''.
SEC. 503. INCREASED AND EXTENDED FUNDING FOR ASSISTED
OUTPATIENT GRANT PROGRAM FOR INDIVIDUALS WITH
SERIOUS MENTAL ILLNESS.
Section 224(g) of the Protecting Access to Medicare Act of
2014 (42 U.S.C. 290aa note) is amended--
(1) in paragraph (1), by striking ``2018'' and inserting
``2022''; and
(2) in paragraph (2), by striking ``is authorized to be
appropriated to carry out this section $15,000,000 for each
of fiscal years 2015 through 2018'' and inserting ``are
authorized to be appropriated to carry out this section
$15,000,000 for each of fiscal years 2015 through 2017,
$20,000,000 for fiscal year 2018, $19,000,000 for each of
fiscal years 2019 and 2020, and $18,000,000 for each of
fiscal years 2021 and 2022''.
SEC. 504. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL
VOLUNTEERS AT COMMUNITY HEALTH CENTERS.
Section 224 of the Public Health Service Act (42 U.S.C.
233) is amended by adding at the end the following:
``(q)(1) For purposes of this section, a health
professional volunteer at an entity described in subsection
(g)(4) shall, in providing a health professional service
eligible for funding under section 330 to an individual, be
deemed to be an employee of the Public Health Service for a
calendar year that begins during a fiscal year for which a
transfer was made under paragraph (4)(C). The preceding
sentence is subject to the provisions of this subsection.
``(2) In providing a health service to an individual, a
health care practitioner shall for purposes of this
subsection be considered to be a health professional
volunteer at an entity described in subsection (g)(4) if the
following conditions are met:
``(A) The service is provided to the individual at the
facilities of an entity described in subsection (g)(4), or
through offsite programs or events carried out by the entity.
``(B) The entity is sponsoring the health care practitioner
pursuant to paragraph (3)(B).
``(C) The health care practitioner does not receive any
compensation for the service from the individual or from any
third-party payer (including reimbursement under any
insurance policy or health plan, or under any Federal or
State health benefits program), except that the health care
practitioner may receive repayment from the entity described
in subsection (g)(4) for reasonable expenses incurred by the
health care practitioner in the provision of the service to
the individual.
``(D) Before the service is provided, the health care
practitioner or the entity described in subsection (g)(4)
posts a clear and conspicuous notice at the site where the
service is provided of the extent to which the legal
liability of the health care practitioner is limited pursuant
to this subsection.
``(E) At the time the service is provided, the health care
practitioner is licensed or certified in accordance with
applicable law regarding the provision of the service.
``(3) Subsection (g) (other than paragraphs (3) and (5))
and subsections (h), (i), and (l) apply to a health care
practitioner for purposes of this subsection to the same
extent and in the same manner as such subsections apply to an
officer, governing board member, employee, or contractor of
an entity described in subsection (g)(4), subject to
paragraph (4) and subject to the following:
``(A) The first sentence of paragraph (1) applies in lieu
of the first sentence of subsection (g)(1)(A).
``(B) With respect to an entity described in subsection
(g)(4), a health care practitioner is not a health
professional volunteer at such entity unless the entity
sponsors the health care practitioner. For purposes of this
subsection, the entity shall be considered to be sponsoring
the health care practitioner if--
``(i) with respect to the health care practitioner, the
entity submits to the Secretary an application meeting the
requirements of subsection (g)(1)(D); and
``(ii) the Secretary, pursuant to subsection (g)(1)(E),
determines that the health care practitioner is deemed to be
an employee of the Public Health Service.
``(C) In the case of a health care practitioner who is
determined by the Secretary pursuant to subsection (g)(1)(E)
to be a health professional volunteer at such entity, this
subsection applies to the health care practitioner (with
respect to services performed on behalf of the entity
sponsoring the health care practitioner pursuant to
subparagraph (B)) for any cause of action arising from an act
or omission of the health care practitioner occurring on or
after the date on which the Secretary makes such
determination.
``(D) Subsection (g)(1)(F) applies to a health care
practitioner for purposes of this subsection only to the
extent that, in providing health services to an individual,
each of the conditions specified in paragraph (2) is met.
``(4)(A) Amounts in the fund established under subsection
(k)(2) shall be available for transfer under subparagraph (C)
for purposes of carrying out this subsection.
``(B) Not later May 1 of each fiscal year, the Attorney
General, in consultation with the Secretary, shall submit to
the Congress a report providing an estimate of the amount of
claims (together with related fees and expenses of witnesses)
that, by reason of the acts or omissions of health
professional volunteers, will be paid pursuant to this
section during the calendar year that begins in the following
fiscal year. Subsection (k)(1)(B) applies to the estimate
under the preceding sentence regarding health professional
volunteers to the same extent and in the same manner as such
subsection applies to the estimate under such subsection
regarding officers, governing board members, employees, and
contractors of entities described in subsection (g)(4).
``(C) Not later than December 31 of each fiscal year, the
Secretary shall transfer from the fund under subsection
(k)(2) to the appropriate accounts in the Treasury an amount
equal to the estimate made under subparagraph (B) for the
calendar year beginning in such fiscal year, subject to the
extent of amounts in the fund.
``(5)(A) This subsection takes effect on October 1, 2017,
except as provided in subparagraph (B).
``(B) Effective on the date of the enactment of this
subsection--
``(i) the Secretary may issue regulations for carrying out
this subsection, and the Secretary may accept and consider
applications submitted pursuant to paragraph (3)(B); and
``(ii) reports under paragraph (4)(B) may be submitted to
the Congress.''.
TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS
Subtitle A--Encouraging the Advancement, Incorporation, and Development
of Evidence-Based Practices
SEC. 601. ENCOURAGING INNOVATION AND EVIDENCE-BASED PROGRAMS.
Section 501B of the Public Health Service Act, as inserted
by section 103, is further amended, by inserting after
subsection (c) the following new subsection:
``(d) Promoting Innovation.--
``(1) In general.--The Assistant Secretary, in coordination
with the Laboratory, may award grants to States, local
governments, Indian tribes or tribal organizations (as such
terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act), educational
institutions, and nonprofit organizations to develop
evidence-based interventions, including culturally and
linguistically appropriate services, as appropriate, for--
``(A) evaluating a model that has been scientifically
demonstrated to show promise, but would benefit from further
applied development, for--
``(i) enhancing the prevention, diagnosis, intervention,
treatment, and recovery of mental illness, serious emotional
disturbance, substance use disorders, and co-occurring
illness or disorders; or
``(ii) integrating or coordinating physical health services
and mental illness and substance use disorder services; and
``(B) expanding, replicating, or scaling evidence-based
programs across a wider area to enhance effective screening,
early diagnosis, intervention, and treatment with respect to
mental illness, serious mental illness, and serious emotional
disturbance, primarily by--
``(i) applying delivery of care, including training staff
in effective evidence-based treatment; or
``(ii) integrating models of care across specialties and
jurisdictions.
``(2) Consultation.--In awarding grants under this
paragraph, the Assistant Secretary shall, as appropriate,
consult with the advisory councils described in section 502,
the National Institute of Mental Health, the National
Institute on Drug Abuse, and the National Institute on
Alcohol Abuse and Alcoholism, as appropriate.
``(3) Authorization of appropriations.--There are
authorized to be appropriated--
``(A) to carry out paragraph (1)(A), $7,000,000 for the
period of fiscal years 2018 through 2020; and
``(B) to carry out paragraph (1)(B), $7,000,000 for the
period of fiscal years 2018 through 2020.''.
SEC. 602. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED
PROGRAMS AND PRACTICES.
Part D of title V of the Public Health Service Act is
amended by inserting after section 543 of such Act (42 U.S.C.
290dd-2 ) the following:
``SEC. 544. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED
PROGRAMS AND PRACTICES.
``(a) In General.--The Assistant Secretary shall improve
access to reliable and valid information on evidence-based
programs and practices, including information on the strength
of evidence associated with such programs and practices,
related to mental illness and substance use disorders for
States, local communities, nonprofit entities, and other
stakeholders by posting on the website of the National
Registry of Evidence-Based Programs and Practices evidence-
based programs and practices that have been reviewed by the
Assistant Secretary pursuant to the requirements of this
section.
``(b) Notice.--
``(1) Periods.--In carrying out subsection (a), the
Assistant Secretary may establish an initial period for the
submission of applications for evidence-based programs and
practices to be posted publicly in accordance with subsection
(a) (and may establish subsequent such periods). The
Assistant Secretary shall publish notice of such application
periods in the Federal Register.
``(2) Addressing gaps.--Such notice may solicit
applications for evidence-based practices and programs to
address gaps in information identified by the Assistant
Secretary, the Assistant Secretary for Planning
[[Page H4311]]
and Evaluation, the Assistant Secretary for Financial
Resources, or the National Mental Health and Substance Use
Policy Laboratory, including pursuant to priorities
identified in the strategic plan established under section
501(l).
``(c) Requirements.--The Assistant Secretary shall
establish minimum requirements for applications referred to
in this section, including applications related to the
submission of research and evaluation.
``(d) Review and Rating.--The Assistant Secretary shall
review applications prior to public posting, and may
prioritize the review of applications for evidence-based
practices and programs that are related to topics included in
the notice established under subsection (b). The Assistant
Secretary shall utilize a rating and review system, which
shall include information on the strength of evidence
associated with such programs and practices and a rating of
the methodological rigor of the research supporting the
application. The Assistant Secretary shall make the metrics
used to evaluate applications and the resulting ratings
publicly available.''.
SEC. 603. SENSE OF CONGRESS.
It is the sense of the Congress that the National Institute
of Mental Health should conduct or support research on the
determinants of self-directed and other violence connected to
mental illness.
Subtitle B--Supporting the State Response to Mental Health Needs
SEC. 611. COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT.
(a) Formula Grants.--Section 1911(b) of the Public Health
Service Act (42 U.S.C. 300x(b)) is amended--
(1) by redesignating paragraphs (1) through (3) as
paragraphs (2) through (4), respectively; and
(2) by inserting before paragraph (2) (as so redesignated),
the following:
``(1) providing community mental health services for adults
with a serious mental illness and children with a serious
emotional disturbance as defined in accordance with section
1912(c);''.
(b) State Plan.--Subsection (b) of section 1912 of the
Public Health Service Act (42 U.S.C. 300x-1) is amended to
read as follows:
``(b) Criteria for Plan.--The criteria specified in this
subsection are as follows:
``(1) System of care.--The plan provides a description of
the system of care of the State, including as follows:
``(A) Comprehensive community-based health systems.--The
plan shall--
``(i) identify the single State agency to be responsible
for the administration of the program under the grant and any
third party with whom the agency will contract (subject to
such third party complying with the requirements of this
part) for administering mental health services through such
program;
``(ii) provide for an organized community-based system of
care for individuals with mental illness, and describe
available services and resources in a comprehensive system of
care, including services for individuals with mental health
and behavioral health co-occurring illness or disorders;
``(iii) include a description of the manner in which the
State and local entities will coordinate services to maximize
the efficiency, effectiveness, quality, and cost
effectiveness of services and programs to produce the best
possible outcomes (including health services, rehabilitation
services, employment services, housing services, educational
services, substance use disorder services, legal services,
law enforcement services, social services, child welfare
services, medical and dental care services, and other support
services to be provided with Federal, State, and local public
and private resources) with other agencies to enable
individuals receiving services to function outside of
inpatient or residential institutions, to the maximum extent
of their capabilities, including services to be provided by
local school systems under the Individuals with Disabilities
Education Act;
``(iv) include a description of how the State--
``(I) promotes evidence-based practices, including those
evidence-based programs that address the needs of individuals
with early serious mental illness regardless of the age of
the individual at onset;
``(II) provides comprehensive individualized treatment; or
``(III) integrates mental and physical health services;
``(v) include a description of case management services in
the State;
``(vi) include a description of activities that seek to
engage individuals with serious mental illness or serious
emotional disturbance and their caregivers where appropriate
in making health care decisions, including activities that
enhance communication between individuals, families,
caregivers, and treatment providers; and
``(vii) as appropriate to and reflective of the uses the
State proposes for the block grant monies--
``(I) a description of the activities intended to reduce
hospitalizations and hospital stays using the block grant
monies;
``(II) a description of the activities intended to reduce
incidents of suicide using the block grant monies; and
``(III) a description of how the State integrates mental
health and primary care using the block grant monies.
``(B) Mental health system data and epidemiology.--The plan
shall contain an estimate of the incidence and prevalence in
the State of serious mental illness among adults and serious
emotional disturbance among children and presents
quantitative targets and outcome measures for programs and
services provided under this subpart.
``(C) Children's services.--In the case of children with
serious emotional disturbance (as defined in accordance with
subsection (c)), the plan shall provide for a system of
integrated social services, educational services, child
welfare services, juvenile justice services, law enforcement
services, and substance use disorder services that, together
with health and mental health services, will be provided in
order for such children to receive care appropriate for their
multiple needs (such system to include services provided
under the Individuals with Disabilities Education Act).
``(D) Targeted services to rural and homeless
populations.--The plan shall describe the State's outreach to
and services for individuals who are homeless and how
community-based services will be provided to individuals
residing in rural areas.
``(E) Management services.--The plan shall--
``(i) describe the financial resources available, the
existing mental health workforce, and the workforce trained
in treating individuals with co-occurring mental illness and
substance use disorders;
``(ii) provide for the training of providers of emergency
health services regarding mental health;
``(iii) describe the manner in which the State intends to
expend the grant under section 1911 for the fiscal year
involved; and
``(iv) describe the manner in which the State intends to
comply with each of the funding agreements in this subpart
and subpart III.
``(2) Goals and objectives.--The plan establishes goals and
objectives for the period of the plan, including targets and
milestones that are intended to be met, and the activities
that will be undertaken to achieve those goals and
objectives.''.
(c) Best Practices in Clinical Care Models.--Section 1920
of the Public Health Service Act (42 U.S.C. 300x-9) is
amended by adding at the end the following:
``(c) Best Practices in Clinical Care Models.--A State
shall expend not less than 10 percent of the amount the State
receives for carrying out this subpart in each fiscal year to
support evidence-based programs that address the needs of
individuals with early serious mental illness, including
psychotic disorders, regardless of the age of the individual
at the onset of such illness.''.
(d) Additional Provisions.--Section 1915(b) of the Public
Health Service Act (42 U.S.C. 300x-4(b)) is amended--
(1) by amending paragraph (1) to read as follows:
``(1) In general.--A funding agreement for a grant under
section 1911 is that the State involved will maintain State
expenditures for community mental health services at a level
that is not less than the average of the amounts prescribed
by this paragraph (prior to any waiver under paragraph (3))
for such expenditures by such State for each of the two
fiscal years immediately preceding the fiscal year for which
the State is applying for the grant.'';
(2) in paragraph (2)--
(A) by striking ``under subsection (a)'' and inserting
``specified in paragraph (1)''; and
(B) by striking ``principle'' and inserting ``principal'';
(3) by amending paragraph (3) to read as follows:
``(3) Waiver.--
``(A) In general.--The Secretary may, upon the request of a
State, waive the requirement established in paragraph (1) in
whole or in part, if the Secretary determines that
extraordinary economic conditions in the State in the fiscal
year involved or in the previous fiscal year justify the
waiver.
``(B) Date certain for action upon request.--The Secretary
shall approve or deny a request for a waiver under this
paragraph not later than 120 days after the date on which the
request is made.
``(C) Applicability of waiver.--A waiver provided by the
Secretary under this paragraph shall be applicable only to
the fiscal year involved.''; and
(4) in paragraph (4)--
(A) by amending subparagraph (A) to read as follows:
``(A) In general.--
``(i) Determination and reduction.--The Secretary shall
determine, in the case of each State, and for each fiscal
year, whether the State maintained material compliance with
the agreement made under paragraph (1). If the Secretary
determines that a State has failed to maintain such
compliance for a fiscal year, the Secretary shall reduce the
amount of the allotment under section 1911 for the State, for
the first fiscal year beginning after such determination is
final, by an amount equal to the amount constituting such
failure for the previous fiscal year about which the
determination was made.
``(ii) Alternative sanction.--The Secretary may by
regulation provide for an alternative method of imposing a
sanction for a failure by a State to maintain material
compliance with the agreement under paragraph (1) if the
Secretary determines that such alternative method would be
more equitable and would be a more effective incentive for
States to maintain such material compliance.''; and
(B) in subparagraph (B)--
(i) by inserting after the subparagraph designation the
following: ``Submission of information to the secretary.--'';
and
[[Page H4312]]
(ii) by striking ``subparagraph (A)'' and inserting
``subparagraph (A)(i)''.
(e) Application for Grant.--Section 1917(a) of the Public
Health Service Act (42 U.S.C. 300x-6(a)) is amended--
(1) in paragraph (1), by striking ``1941'' and inserting
``1942(a)''; and
(2) in paragraph (5), by striking ``1915(b)(3)(B)'' and
inserting ``1915(b)''.
Subtitle C--Strengthening Mental Health Care for Children and
Adolescents
SEC. 621. TELE-MENTAL HEALTH CARE ACCESS GRANTS.
Title III of the Public Health Service Act is amended by
inserting after section 330L of such Act (42 U.S.C. 254c-18)
the following new section:
``SEC. 330M. TELE-MENTAL HEALTH CARE ACCESS GRANTS.
``(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in coordination with other relevant
Federal agencies, shall award grants to States, political
subdivisions of States, Indian tribes, and tribal
organizations (for purposes of this section, as such terms
are defined in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b)) to promote
behavioral health integration in pediatric primary care by--
``(1) supporting the development of statewide child mental
health care access programs; and
``(2) supporting the improvement of existing statewide
child mental health care access programs.
``(b) Program Requirements.--
``(1) In general.--A child mental health care access
program referred to in subsection (a), with respect to which
a grant under such subsection may be used, shall--
``(A) be a statewide network of pediatric mental health
teams that provide support to pediatric primary care sites as
an integrated team;
``(B) support and further develop organized State networks
of child and adolescent psychiatrists and psychologists to
provide consultative support to pediatric primary care sites;
``(C) conduct an assessment of critical behavioral
consultation needs among pediatric providers and such
providers' preferred mechanisms for receiving consultation
and training and technical assistance;
``(D) develop an online database and communication
mechanisms, including telehealth, to facilitate consultation
support to pediatric practices;
``(E) provide rapid statewide clinical telephone or
telehealth consultations when requested between the pediatric
mental health teams and pediatric primary care providers;
``(F) conduct training and provide technical assistance to
pediatric primary care providers to support the early
identification, diagnosis, treatment, and referral of
children with behavioral health conditions or co-occurring
intellectual and other developmental disabilities;
``(G) provide information to pediatric providers about, and
assist pediatric providers in accessing, child psychiatry and
psychology consultations and in scheduling and conducting
technical assistance;
``(H) assist with referrals to specialty care and community
or behavioral health resources; and
``(I) establish mechanisms for measuring and monitoring
increased access to child and adolescent psychiatric and
psychology services by pediatric primary care providers and
expanded capacity of pediatric primary care providers to
identify, treat, and refer children with mental health
problems.
``(2) Pediatric mental health teams.--In this subsection,
the term `pediatric mental health team' means a team of case
coordinators, child and adolescent psychiatrists, and
licensed clinical mental health professionals, such as a
psychologist, social worker, or mental health counselor.
``(c) Application.--A State, political subdivision of a
State, Indian tribe, or tribal organization seeking 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 require, including a plan
for the rigorous evaluation of activities that are carried
out with funds received under such grant.
``(d) Evaluation.--A State, political subdivision of a
State, Indian tribe, or tribal organization that receives a
grant under this section shall prepare and submit an
evaluation of activities carried out with funds received
under such grant to the Secretary at such time, in such
manner, and containing such information as the Secretary may
reasonably require, including a process and outcome
evaluation.
``(e) Matching Requirement.--The Secretary may not award a
grant under this section unless the State, political
subdivision of a State, Indian tribe, or tribal organization
involved agrees, with respect to the costs to be incurred by
the State, political subdivision of a State, Indian tribe, or
tribal organization in carrying out the purpose described in
this section, to make available non-Federal contributions (in
cash or in kind) toward such costs in an amount that is not
less than 20 percent of Federal funds provided in the grant.
``(f) Authorization of Appropriations.--To carry this
section, there are authorized to be appropriated $9,000,000
for the period of fiscal years 2018 through 2020.''.
SEC. 622. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION,
INTERVENTION, AND TREATMENT.
Part Q of title III of the Public Health Service Act (42
U.S.C. 290h et seq.) is amended by adding at the end the
following:
``SEC. 399Z-2. INFANT AND EARLY CHILDHOOD MENTAL HEALTH
PROMOTION, INTERVENTION, AND TREATMENT.
``(a) Grants.--The Secretary shall--
``(1) award grants to eligible entities, including human
services agencies, to develop, maintain, or enhance infant
and early childhood mental health promotion, intervention,
and treatment programs, including--
``(A) programs for infants and children at significant risk
of developing, showing early signs of, or having been
diagnosed with mental illness including serious emotional
disturbance; and
``(B) multigenerational therapy and other services that
support the caregiving relationship; and
``(2) ensure that programs funded through grants under this
section are evidence-informed or evidence-based models,
practices, and methods that are, as appropriate, culturally
and linguistically appropriate, and can be replicated in
other appropriate settings.
``(b) Eligible Children and Entities.--In this section:
``(1) Eligible child.--The term `eligible child' means a
child from birth to not more than 5 years of age who--
``(A) is at risk for, shows early signs of, or has been
diagnosed with a mental illness, including serious emotional
disturbance; and
``(B) may benefit from infant and early childhood
intervention or treatment programs or specialized preschool
or elementary school programs that are evidence-based or that
have been scientifically demonstrated to show promise but
would benefit from further applied development.
``(2) Eligible entity.--The term `eligible entity' means a
nonprofit institution that--
``(A) is accredited or approved by a State mental health or
education agency, as applicable, to provide for children from
infancy to 5 years of age mental health promotion,
intervention, or treatment services that are evidence-based
or that have been scientifically demonstrated to show promise
but would benefit from further applied development; and
``(B) provides programs described in subsection (a) that
are evidence-based or that have been scientifically
demonstrated to show promise but would benefit from further
applied development.
``(c) Application.--An eligible entity seeking a grant
under subsection (a) shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
``(d) Use of Funds for Early Intervention and Treatment
Programs.--An eligible entity may use amounts awarded under a
grant under subsection (a)(1) to carry out the following:
``(1) Provide age-appropriate mental health promotion and
early intervention services or mental illness treatment
services, which may include specialized programs, for
eligible children at significant risk of developing, showing
early signs of, or having been diagnosed with a mental
illness, including serious emotional disturbance. Such
services may include social and behavioral services as well
as multigenerational therapy and other services ?that support
the caregiving relationship.
``(2) Provide training for health care professionals with
expertise in infant and early childhood mental health care
with respect to appropriate and relevant integration with
other disciplines such as primary care clinicians, early
intervention specialists, child welfare staff, home visitors,
early care and education providers, and others who work with
young children and families.
``(3) Provide mental health consultation to personnel of
early care and education programs (including licensed or
regulated center-based and home-based child care, home
visiting, preschool special education, and early intervention
programs) who work with children and families.
``(4) Provide training for mental health clinicians in
infant and early childhood in promising and evidence-based
practices and models for infant and early childhood mental
health treatment and early intervention, including with
regard to practices for identifying and treating mental
illness and behavioral disorders of infants and children
resulting from exposure or repeated exposure to adverse
childhood experiences or childhood trauma.
``(5) Provide age-appropriate assessment, diagnostic, and
intervention services for eligible children, including early
mental health promotion, intervention, and treatment
services.
``(e) Matching Funds.--The Secretary may not award a grant
under this section to an eligible entity unless the eligible
entity agrees, with respect to the costs to be incurred by
the eligible entity in carrying out the activities described
in subsection (d), to make available non-Federal
contributions (in cash or in kind) toward such costs in an
amount that is not less than 10 percent of the total amount
of Federal funds provided in the grant.
``(f) Authorization of Appropriations.--To carry this
section, there are authorized to be appropriated $20,000,000
for the period of fiscal years 2018 through 2022.''.
SEC. 623. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.
Section 582 of the Public Health Service Act (42 U.S.C.
290hh-1; relating to grants to address the problems of
persons who experience violence related stress) is amended--
[[Page H4313]]
(1) in subsection (a), by striking ``developing programs''
and all that follows and inserting the following:
``developing and maintaining programs that provide for--
``(1) the continued operation of the National Child
Traumatic Stress Initiative (referred to in this section as
the `NCTSI'), which includes a coordinating center that
focuses on the mental, behavioral, and biological aspects of
psychological trauma response; and
``(2) the development of knowledge with regard to evidence-
based practices for identifying and treating mental illness,
behavioral disorders, and physical health conditions of
children and youth resulting from witnessing or experiencing
a traumatic event.'';
(2) in subsection (b)--
(A) by striking ``subsection (a) related'' and inserting
``subsection (a)(2) (related'';
(B) by striking ``treating disorders associated with
psychological trauma'' and inserting ``treating mental
illness and behavioral and biological disorders associated
with psychological trauma)''; and
(C) by striking ``mental health agencies and programs that
have established clinical and basic research'' and inserting
``universities, hospitals, mental health agencies, and other
programs that have established clinical expertise and
research'';
(3) by redesignating subsections (c) through (g) as
subsections (g) through (k), respectively;
(4) by inserting after subsection (b), the following:
``(c) Child Outcome Data.--The NCTSI coordinating center
shall collect, analyze, report, and make publicly available
NCTSI-wide child treatment process and outcome data regarding
the early identification and delivery of evidence-based
treatment and services for children and families served by
the NCTSI grantees.
``(d) Training.--The NCTSI coordinating center shall
facilitate the coordination of training initiatives in
evidence-based and trauma-informed treatments, interventions,
and practices offered to NCTSI grantees, providers, and
partners.
``(e) Dissemination.--The NCTSI coordinating center shall,
as appropriate, collaborate with the Secretary in the
dissemination of evidence-based and trauma-informed
interventions, treatments, products, and other resources to
appropriate stakeholders.
``(f) Review.--The Secretary shall, consistent with the
peer-review process, ensure that NCTSI applications are
reviewed by appropriate experts in the field as part of a
consensus review process. The Secretary shall include review
criteria related to expertise and experience in child trauma
and evidence-based practices.'';
(5) in subsection (g) (as so redesignated), by striking
``with respect to centers of excellence are distributed
equitably among the regions of the country'' and inserting
``are distributed equitably among the regions of the United
States'';
(6) in subsection (i) (as so redesignated), by striking
``recipient may not exceed 5 years'' and inserting
``recipient shall not be less than 4 years, but shall not
exceed 5 years''; and
(7) in subsection (j) (as so redesignated), by striking
``$50,000,000'' and all that follows through ``2006'' and
inserting ``$46,887,000 for each of fiscal years 2017 through
2021''.
TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATION
Subtitle A--Garrett Lee Smith Memorial Act Reauthorization
SEC. 701. YOUTH INTERAGENCY RESEARCH, TRAINING, AND TECHNICAL
ASSISTANCE CENTERS.
Section 520C of the Public Health Service Act (42 U.S.C.
290bb-34) is amended--
(1) by striking the section heading and inserting ``suicide
prevention technical assistance center.'';
(2) in subsection (a), by striking ``and in consultation
with'' and all that follows through the period at the end of
paragraph (2) and inserting ``shall establish a research,
training, and technical assistance resource center to provide
appropriate information, training, and technical assistance
to States, political subdivisions of States, federally
recognized Indian tribes, tribal organizations, institutions
of higher education, public organizations, or private
nonprofit organizations regarding the prevention of suicide
among all ages, particularly among groups that are at high
risk for suicide.'';
(3) by striking subsections (b) and (c);
(4) by redesignating subsection (d) as subsection (b);
(5) in subsection (b), as so redesignated--
(A) by striking the subsection heading and inserting
``Responsibilities of the Center.--'';
(B) in the matter preceding paragraph (1), by striking
``The additional research'' and all that follows through
``nonprofit organizations for'' and inserting ``The center
established under subsection (a) shall conduct activities for
the purpose of'';
(C) by striking ``youth suicide'' each place such term
appears and inserting ``suicide'';
(D) in paragraph (1)--
(i) by striking ``the development or continuation of'' and
inserting ``developing and continuing''; and
(ii) by inserting ``for all ages, particularly among groups
that are at high risk for suicide'' before the semicolon at
the end;
(E) in paragraph (2), by inserting ``for all ages,
particularly among groups that are at high risk for suicide''
before the semicolon at the end;
(F) in paragraph (3), by inserting ``and tribal'' after
``statewide'';
(G) in paragraph (5), by inserting ``and prevention'' after
``intervention'';
(H) in paragraph (8), by striking ``in youth'';
(I) in paragraph (9), by striking ``and behavioral health''
and inserting ``health and substance use disorder''; and
(J) in paragraph (10), by inserting ``conducting'' before
``other''; and
(6) by striking subsection (e) and inserting the following:
``(c) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $5,988,000 for each of fiscal years 2017 through
2021.
``(d) Report.--Not later than 2 years after the date of
enactment of the Helping Families in Mental Health Crisis Act
of 2016, the Secretary shall submit to Congress a report on
the activities carried out by the center established under
subsection (a) during the year involved, including the
potential effects of such activities, and the States,
organizations, and institutions that have worked with the
center.''.
SEC. 702. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION
STRATEGIES.
Section 520E of the Public Health Service Act (42 U.S.C.
290bb-36) is amended--
(1) in paragraph (1) of subsection (a) and in subsection
(c), by striking ``substance abuse'' each place such term
appears and inserting ``substance use disorder'';
(2) in subsection (b)(2)--
(A) by striking ``each State is awarded only 1 grant or
cooperative agreement under this section'' and inserting ``a
State does not receive more than 1 grant or cooperative
agreement under this section at any 1 time''; and
(B) by striking ``been awarded'' and inserting
``received''; and
(3) by striking subsection (m) and inserting the following:
``(m) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $35,427,000 for each of fiscal years 2017
through 2021.''.
SEC. 703. MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES
ON CAMPUS.
Section 520E-2 of the Public Health Service Act (42 U.S.C.
290bb-36b) is amended--
(1) in the section heading, by striking ``and behavioral
health'' and inserting ``health and substance use disorder'';
(2) in subsection (a)--
(A) by striking ``Services,'' and inserting ``Services
and'';
(B) by striking ``and behavioral health problems'' and
inserting ``health or substance use disorders''; and
(C) by striking ``substance abuse'' and inserting
``substance use disorders'';
(3) in subsection (b)--
(A) in the matter preceding paragraph (1), by striking
``for--'' and inserting ``for one or more of the
following:''; and
(B) by striking paragraphs (1) through (6) and inserting
the following:
``(1) Educating students, families, faculty, and staff to
increase awareness of mental health and substance use
disorders.
``(2) The operation of hotlines.
``(3) Preparing informational material.
``(4) Providing outreach services to notify students about
available mental health and substance use disorder services.
``(5) Administering voluntary mental health and substance
use disorder screenings and assessments.
``(6) Supporting the training of students, faculty, and
staff to respond effectively to students with mental health
and substance use disorders.
``(7) Creating a network infrastructure to link colleges
and universities with health care providers who treat mental
health and substance use disorders.'';
(4) in subsection (c)(5), by striking ``substance abuse''
and inserting ``substance use disorder'';
(5) in subsection (d)--
(A) in the matter preceding paragraph (1), by striking ``An
institution of higher education desiring a grant under this
section'' and inserting ``To be eligible to receive a grant
under this section, an institution of higher education'';
(B) in paragraph (1)--
(i) by striking ``and behavioral health'' and inserting
``health and substance use disorder''; and
(ii) by inserting ``, including veterans whenever possible
and appropriate,'' after ``students''; and
(C) in paragraph (2), by inserting ``, which may include,
as appropriate and in accordance with subsection (b)(7), a
plan to seek input from relevant stakeholders in the
community, including appropriate public and private entities,
in order to carry out the program under the grant'' before
the period at the end;
(6) in subsection (e)(1), by striking ``and behavioral
health problems'' and inserting ``health and substance use
disorders'';
(7) in subsection (f)(2)--
(A) by striking ``and behavioral health'' and inserting
``health and substance use disorder''; and
(B) by striking ``suicide and substance abuse'' and
inserting ``suicide and substance use disorders''; and
(8) in subsection (h), by striking ``$5,000,000 for fiscal
year 2005'' and all that follows through the period at the
end and inserting ``$6,488,000 for each of fiscal years 2017
through 2021.''.
[[Page H4314]]
Subtitle B--Other Provisions
SEC. 711. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
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 inserting
after section 520E-2 (42 U.S.C. 290bb-36b) the following:
``SEC. 520E-3. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
``(a) In General.--The Secretary, acting through the
Assistant Secretary, shall maintain the National Suicide
Prevention Lifeline Program (referred to in this section as
the `Program'), authorized under section 520A and in effect
prior to the date of enactment of the Helping Families in
Mental Health Crisis Act of 2016.
``(b) Activities.--In maintaining the Program, the
activities of the Secretary shall include--
``(1) coordinating a network of crisis centers across the
United States for providing suicide prevention and crisis
intervention services to individuals seeking help at any
time, day or night;
``(2) maintaining a suicide prevention hotline to link
callers to local emergency, mental health, and social
services resources; and
``(3) consulting with the Secretary of Veterans Affairs to
ensure that veterans calling the suicide prevention hotline
have access to a specialized veterans' suicide prevention
hotline.
``(c) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated $7,198,000
for each of fiscal years 2017 through 2021.''.
SEC. 712. WORKFORCE DEVELOPMENT STUDIES AND REPORTS.
(a) In General.--Not later than 2 years after the date of
enactment of this Act, the Assistant Secretary for Mental
Health and Substance Use, in consultation with the
Administrator of the Health Resources and Services
Administration, shall conduct a study, and publicly post on
the appropriate Internet website of the Department of Health
and Human Services a report, on the mental health and
substance use disorder workforce in order to inform Federal,
State, and local efforts related to workforce enhancement.
(b) Contents.--The report under this section shall
contain--
(1) national and State-level projections of the supply and
demand of mental health and substance use disorder health
workers, including the number of individuals practicing in
fields deemed relevant by the Secretary;
(2) an assessment of the mental health and substance use
disorder workforce capacity, strengths, and weaknesses as of
the date of the report, including the capacity of primary
care to prevent, screen, treat, or refer for mental health
and substance use disorders;
(3) information on trends within the mental health and
substance use disorder provider workforce, including the
number of individuals entering the mental health workforce
over the next five years;
(4) information on the gaps in workforce development for
mental health providers and professionals, including those
who serve pediatric, adult, and geriatric patients; and
(5) any additional information determined by the Assistant
Secretary for Mental Health and Substance Use, in
consultation with the Administrator of the Health Resources
and Services Administration, to be relevant to the mental
health and substance use disorder provider workforce.
SEC. 713. MINORITY FELLOWSHIP PROGRAM.
Title V of the Public Health Service Act (42 U.S.C. 290aa
et seq.) is amended by adding at the end the following:
``PART K--MINORITY FELLOWSHIP PROGRAM
``SEC. 597. FELLOWSHIPS.
``(a) In General.--The Secretary shall maintain a program,
to be known as the Minority Fellowship Program, under which
the Secretary awards fellowships, which may include stipends,
for the purposes of--
``(1) increasing behavioral health practitioners' knowledge
of issues related to prevention, treatment, and recovery
support for mental illness and substance use disorders among
racial and ethnic minority populations;
``(2) improving the quality of mental illness and substance
use disorder prevention and treatment delivered to racial and
ethnic minorities; and
``(3) increasing the number of culturally competent
behavioral health professionals and school personnel who
teach, administer, conduct services research, and provide
direct mental health or substance use services to racial and
ethnic minority populations.
``(b) Training Covered.--The fellowships under subsection
(a) shall be for postbaccalaureate training (including for
master's and doctoral degrees) for mental health
professionals, including in the fields of psychiatry,
nursing, social work, psychology, marriage and family
therapy, mental health counseling, and substance use and
addiction counseling.
``(c) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated $12,669,000
for each of fiscal years 2017, 2018, and 2019 and $13,669,000
for each of fiscal years 2020 and 2021.''.
SEC. 714. CENTER AND PROGRAM REPEALS.
Part B of title V of the Public Health Service Act (42
U.S.C. 290bb et seq.) is amended by striking the second
section 514 (42 U.S.C. 290bb-9), relating to methamphetamine
and amphetamine treatment initiatives, and sections 514A,
517, 519A, 519C, 519E, 520D, and 520H (42 U.S.C. 290bb-8,
290bb-23, 290bb-25a, 290bb-25c, 290bb-25e, 290bb-35, and
290bb-39).
SEC. 715. NATIONAL VIOLENT DEATH REPORTING SYSTEM.
The Secretary of Health and Human Services, acting through
the Director of the Centers for Disease Control and
Prevention, is encouraged to improve, particularly through
the inclusion of additional States, the National Violent
Death Reporting System as authorized by title III of the
Public Health Service Act (42 U.S.C. 241 et seq.).
Participation in the system by the States shall be voluntary.
SEC. 716. SENSE OF CONGRESS ON PRIORITIZING NATIVE AMERICAN
YOUTH AND SUICIDE PREVENTION PROGRAMS.
(a) Findings.--The Congress finds as follows:
(1) Suicide is the eighth leading cause of death among
American Indians and Alaska Natives across all ages.
(2) Among American Indians and Alaska Natives who are 10 to
34 years of age, suicide is the second leading cause of
death.
(3) The suicide rate among American Indian and Alaska
Native adolescents and young adults ages 15 to 34 (19.5 per
100,000) is 1.5 times higher than the national average for
that age group (12.9 per 100,000).
(b) Sense of Congress.--It is the sense of Congress that
the Secretary of Health and Human Services, in carrying out
programs for Native American youth and suicide prevention
programs for youth suicide intervention, should prioritize
programs and activities for individuals who have a high risk
or disproportional burden of suicide, such as Native
Americans.
SEC. 717. PEER PROFESSIONAL WORKFORCE DEVELOPMENT GRANT
PROGRAM.
(a) In General.--For the purposes described in subsection
(b), the Secretary of Health and Human Services shall award
grants to develop and sustain behavioral health
paraprofessional training and education programs, including
through tuition support.
(b) Purposes.--The purposes of grants under this section
are--
(1) to increase the number of behavioral health
paraprofessionals, including trained peers, recovery coaches,
mental health and addiction specialists, prevention
specialists, and pre-masters-level addiction counselors; and
(2) to help communities develop the infrastructure to train
and certify peers as behavioral health paraprofessionals.
(c) Eligible Entities.--To be eligible to receive a grant
under this section, an entity shall be a community college or
other entity the Secretary deems appropriate.
(d) Geographic Distribution.--In awarding grants under this
section, the Secretary shall seek to achieve an appropriate
national balance in the geographic distribution of such
awards.
(e) Special Consideration.--In awarding grants under this
section, the Secretary may give special consideration to
proposed and existing programs targeting peer professionals
serving youth ages 16 to 25.
(f) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $10,000,000
for the period of fiscal years 2018 through 2022.
SEC. 718. NATIONAL HEALTH SERVICE CORPS.
(a) Definitions.--
(1) Primary health services.--Section 331(a)(3)(D) of the
Public Health Service Act (42 U.S.C. 254d(a)(3)) is amended
by inserting ``(including pediatric mental health
subspecialty services)'' after ``pediatrics''.
(2) Behavioral and mental health professionals.--Clause (i)
of section 331(a)(3)(E) of the Public Health Service Act (42
U.S.C. 254d(a)(3)(E)) is amended by inserting ``(and
pediatric subspecialists thereof)'' before the period at the
end.
(b) Eligibility To Participate in Loan Repayment Program.--
Section 338B(b)(1)(B) of the Public Health Service Act (42
U.S.C. 254l-1(b)(1)(B)) is amended by inserting ``, including
any physician child and adolescent psychiatry residency or
fellowship training program'' after ``be enrolled in an
approved graduate training program in medicine, osteopathic
medicine, dentistry, behavioral and mental health, or other
health profession''.
SEC. 719. ADULT SUICIDE PREVENTION.
(a) Grants.--
(1) Authority.--The Assistant Secretary for Mental Health
and Substance Use (referred to in this section as the
``Assistant Secretary'') may award grants to eligible
entities in order to implement suicide prevention efforts
amongst adults 25 and older.
(2) Purpose.--The grant program under this section shall be
designed to raise suicide awareness, establish referral
processes, and improve clinical care practice standards for
treating suicide ideation, plans, and attempts among adults.
(3) Recipients.--To be eligible to receive a grant under
this section, an entity shall be a community-based primary
care or behavioral health care setting, an emergency
department, a State mental health agency, an Indian tribe, a
tribal organization, or any other entity the Assistant
Secretary deems appropriate.
(4) Nature of activities.--The grants awarded under
paragraph (1) shall be used to implement programs that--
(A) screen for suicide risk in adults and provide
intervention and referral to treatment;
(B) implement evidence-based practices to treat individuals
who are at suicide risk, including appropriate followup
services; and
[[Page H4315]]
(C) raise awareness, reduce stigma, and foster open
dialogue about suicide prevention.
(b) Additional Activities.--The Assistant Secretary shall--
(1) evaluate the activities supported by grants awarded
under subsection (a) in order to further the Nation's
understanding of effective interventions to prevent suicide
in adults;
(2) disseminate the findings from the evaluation as the
Assistant Secretary considers appropriate; and
(3) provide appropriate information, training, and
technical assistance to eligible entities that receive a
grant under this section, in order to help such entities to
meet the requirements of this section, including assistance
with--
(A) selection and implementation of evidence-based
interventions and frameworks to prevent suicide, such as the
Zero Suicide framework; and
(B) other activities as the Assistant Secretary determines
appropriate.
(c) Duration.--A grant under this section shall be for a
period of not more than 5 years.
(d) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated to
carry out this section $30,000,000 for the period of fiscal
years 2018 through 2022.
(2) Use of certain funds.--Of the funds appropriated to
carry out this section in any fiscal year, the lesser of 5
percent of such funds or $500,000 shall be available to the
Assistant Secretary for purposes of carrying out subsection
(b).
SEC. 720. CRISIS INTERVENTION GRANTS FOR POLICE OFFICERS AND
FIRST RESPONDERS.
(a) In General.--The Assistant Secretary for Mental Health
and Substance Use may award grants to entities such as law
enforcement agencies and first responders--
(1) to provide specialized training to law enforcement
officers, corrections officers, paramedics, emergency medical
services workers, and other first responders (including
village public safety officers (as defined in section 247 of
the Indian Arts and Crafts Amendments Act of 2010 (42 U.S.C.
3796dd note)))--
(A) to recognize individuals who have mental illness and
how to properly intervene with individuals with mental
illness; and
(B) to establish programs that enhance the ability of law
enforcement agencies to address the mental health,
behavioral, and substance use problems of individuals
encountered in the line of duty; and
(2) to establish collaborative law enforcement and mental
health programs, including behavioral health response teams
and mental health crisis intervention teams comprised of
mental health professionals, law enforcement officers, and
other first responders, as appropriate, to provide on-site,
face-to-face, mental and behavioral health care services
during a mental health crisis, and to connect the individual
in crisis to appropriate community-based treatment services
in lieu of unnecessary hospitalization or further involvement
with the criminal justice system.
(b) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section $9,000,000 for
the period of fiscal years 2018 through 2020.
SEC. 721. DEMONSTRATION GRANT PROGRAM TO TRAIN HEALTH SERVICE
PSYCHOLOGISTS IN COMMUNITY-BASED MENTAL HEALTH.
(a) Establishment.--The Secretary of Health and Human
Services shall establish a grant program under which the
Assistant Secretary of Mental Health and Substance Use
Disorders may award grants to eligible institutions to
support the recruitment, education, and clinical training
experiences of health services psychology students, interns,
and postdoctoral residents for education and clinical
experience in community mental health settings.
(b) Eligible Institutions.--For purposes of this section,
the term ``eligible institutions'' includes American
Psychological Association-accredited doctoral, internship,
and postdoctoral residency schools or programs in health
service psychology that--
(1) are focused on the development and implementation of
interdisciplinary training of psychology graduate students
and postdoctoral fellows in providing mental and behavioral
health services to address substance use disorders, serious
emotional disturbance, and serious illness, as well as
developing faculty and implementing curriculum to prepare
psychologists to work with underserved populations; and
(2) demonstrate an ability to train health service
psychologists in psychiatric hospitals, forensic hospitals,
community mental health centers, community health centers,
federally qualified health centers, or adult and juvenile
correctional facilities.
(c) Priorities.--In selecting grant recipients under this
section, the Secretary shall give priority to eligible
institutions in which training focuses on the needs of
individuals with serious mental illness, serious emotional
disturbance, justice-involved youth, and individuals with or
at high risk for substance use disorders.
(d) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $12,000,000 for
the period of fiscal years 2018 through 2022.
SEC. 722. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE
WORKFORCE.
Section 775(e) of the Public Health Service Act (42 U.S.C.
295f(e)) is amended to read as follows:
``(e) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $12,000,000
for the period of fiscal years 2018 through 2022.''.
SEC. 723. CUTGO COMPLIANCE.
Section 319D(f) of the Public Health Service Act (42 U.S.C.
247d-4(f)) is amended by striking ``$138,300,000 for each of
fiscal years 2014 through 2018'' and inserting ``$138,300,000
for each of fiscal years 2014 through 2016 and $58,000,000
for each of fiscal years 2017 and 2018''.
TITLE VIII--MENTAL HEALTH PARITY
SEC. 801. ENHANCED COMPLIANCE WITH MENTAL HEALTH AND
SUBSTANCE USE DISORDER COVERAGE REQUIREMENTS.
(a) Compliance Program Guidance Document.--Section 2726(a)
of the Public Health Service Act (42 U.S.C. 300gg-26(a)) is
amended by adding at the end the following:
``(6) Compliance program guidance document.--
``(A) In general.--Not later than 12 months after the date
of enactment of the Helping Families in Mental Health Crisis
Act of 2016, the Secretary, the Secretary of Labor, and the
Secretary of the Treasury, in consultation with the Inspector
General of the Department of Health and Human Services, shall
issue a compliance program guidance document to help improve
compliance with this section, section 712 of the Employee
Retirement Income Security Act of 1974, and section 9812 of
the Internal Revenue Code of 1986, as applicable.
``(B) Examples illustrating compliance and noncompliance.--
``(i) In general.--The compliance program guidance document
required under this paragraph shall provide illustrative, de-
identified examples (that do not disclose any protected
health information or individually identifiable information)
of previous findings of compliance and noncompliance with
this section, section 712 of the Employee Retirement Income
Security Act of 1974, or section 9812 of the Internal Revenue
Code of 1986, as applicable, based on investigations of
violations of such sections, including--
``(I) examples illustrating requirements for information
disclosures and nonquantitative treatment limitations; and
``(II) descriptions of the violations uncovered during the
course of such investigations.
``(ii) Nonquantitative treatment limitations.--To the
extent that any example described in clause (i) involves a
finding of compliance or noncompliance with regard to any
requirement for nonquantitative treatment limitations, the
example shall provide sufficient detail to fully explain such
finding, including a full description of the criteria
involved for medical and surgical benefits and the criteria
involved for mental health and substance use disorder
benefits.
``(iii) Access to additional information regarding
compliance.--In developing and issuing the compliance program
guidance document required under this paragraph, the
Secretaries specified in subparagraph (A)--
``(I) shall enter into interagency agreements with the
Inspector General of the Department of Health and Human
Services, the Inspector General of the Department of Labor,
and the Inspector General of the Department of the Treasury
to share findings of compliance and noncompliance with this
section, section 712 of the Employee Retirement Income
Security Act of 1974, or section 9812 of the Internal Revenue
Code of 1986, as applicable; and
``(II) shall seek to enter into an agreement with a State
to share information on findings of compliance and
noncompliance with this section, section 712 of the Employee
Retirement Income Security Act of 1974, or section 9812 of
the Internal Revenue Code of 1986, as applicable.
``(C) Recommendations.--The compliance program guidance
document shall include recommendations to comply with this
section, section 712 of the Employee Retirement Income
Security Act of 1974, or section 9812 of the Internal Revenue
Code of 1986, as applicable, and encourage the development
and use of internal controls to monitor adherence to
applicable statutes, regulations, and program requirements.
Such internal controls may include a compliance checklist
with illustrative examples of nonquantitative treatment
limitations on mental health and substance use disorder
benefits, which may fail to comply with this section, section
712 of the Employee Retirement Income Security Act of 1974,
or section 9812 of the Internal Revenue Code of 1986, as
applicable, in relation to nonquantitative treatment
limitations on medical and surgical benefits.
``(D) Updating the compliance program guidance document.--
The compliance program guidance document shall be updated
every 2 years to include illustrative, de-identified examples
(that do not disclose any protected health information or
individually identifiable information) of previous findings
of compliance and noncompliance with this section, section
712 of the Employee Retirement Income Security Act of 1974,
or section 9812 of the Internal Revenue Code of 1986, as
applicable.''.
(b) Additional Guidance.--Section 2726(a) of the Public
Health Service Act (42 U.S.C. 300gg-26(a)), as amended by
subsection (a), is further amended by adding at the end the
following:
``(7) Additional guidance.--
``(A) In general.--Not later than 1 year after the date of
enactment of the Helping Families in Mental Health Crisis Act
of 2016,
[[Page H4316]]
the Secretary, in coordination with the Secretary of Labor
and the Secretary of the Treasury, shall issue guidance to
group health plans and health insurance issuers offering
group or individual health insurance coverage to assist such
plans and issuers in satisfying the requirements of this
section, section 712 of the Employee Retirement Income
Security Act of 1974, or section 9812 of the Internal Revenue
Code of 1986, as applicable,.
``(B) Disclosure.--
``(i) Guidance for plans and issuers.--The guidance issued
under this paragraph shall include clarifying information and
illustrative examples of methods that group health plans and
health insurance issuers offering group or individual health
insurance coverage may use for disclosing information to
ensure compliance with the requirements under this section,
section 712 of the Employee Retirement Income Security Act of
1974, or section 9812 of the Internal Revenue Code of 1986,
as applicable, (and any regulations promulgated pursuant to
such sections, as applicable).
``(ii) Documents for participants, beneficiaries,
contracting providers, or authorized representatives.--The
guidance issued under this paragraph shall include clarifying
information and illustrative examples of methods that group
health plans and health insurance issuers offering group or
individual health insurance coverage may use to provide any
participant, beneficiary, contracting provider, or authorized
representative, as applicable, with documents containing
information that the health plans or issuers are required to
disclose to participants, beneficiaries, contracting
providers, or authorized representatives to ensure compliance
with this section, section 712 of the Employee Retirement
Income Security Act of 1974, or section 9812 of the Internal
Revenue Code of 1986, as applicable; any regulation issued
pursuant to such respective section, or any other applicable
law or regulation, including information that is comparative
in nature with respect to--
``(I) nonquantitative treatment limitations for both
medical and surgical benefits and mental health and substance
use disorder benefits;
``(II) the processes, strategies, evidentiary standards,
and other factors used to apply the limitations described in
subclause (I); and
``(III) the application of the limitations described in
subclause (I) to ensure that such limitations are applied in
parity with respect to both medical and surgical benefits and
mental health and substance use disorder benefits.
``(C) Nonquantitative treatment limitations.--The guidance
issued under this paragraph shall include clarifying
information and illustrative examples of methods, processes,
strategies, evidentiary standards, and other factors that
group health plans and health insurance issuers offering
group or individual health insurance coverage may use
regarding the development and application of nonquantitative
treatment limitations to ensure compliance with this section,
section 712 of the Employee Retirement Income Security Act of
1974, or section 9812 of the Internal Revenue Code of 1986,
as applicable, (and any regulations promulgated pursuant to
such respective section), including--
``(i) examples of methods of determining appropriate types
of nonquantitative treatment limitations with respect to both
medical and surgical benefits and mental health and substance
use disorder benefits, including nonquantitative treatment
limitations pertaining to--
``(I) medical management standards based on medical
necessity or appropriateness, or whether a treatment is
experimental or investigative;
``(II) limitations with respect to prescription drug
formulary design; and
``(III) use of fail-first or step therapy protocols;
``(ii) examples of methods of determining--
``(I) network admission standards (such as credentialing);
and
``(II) factors used in provider reimbursement methodologies
(such as service type, geographic market, demand for
services, and provider supply, practice size, training,
experience, and licensure) as such factors apply to network
adequacy;
``(iii) examples of sources of information that may serve
as evidentiary standards for the purposes of making
determinations regarding the development and application of
nonquantitative treatment limitations;
``(iv) examples of specific factors, and the evidentiary
standards used to evaluate such factors, used by such plans
or issuers in performing a nonquantitative treatment
limitation analysis;
``(v) examples of how specific evidentiary standards may be
used to determine whether treatments are considered
experimental or investigative;
``(vi) examples of how specific evidentiary standards may
be applied to each service category or classification of
benefits;
``(vii) examples of methods of reaching appropriate
coverage determinations for new mental health or substance
use disorder treatments, such as evidence-based early
intervention programs for individuals with a serious mental
illness and types of medical management techniques;
``(viii) examples of methods of reaching appropriate
coverage determinations for which there is an indirect
relationship between the covered mental health or substance
use disorder benefit and a traditional covered medical and
surgical benefit, such as residential treatment or
hospitalizations involving voluntary or involuntary
commitment; and
``(ix) additional illustrative examples of methods,
processes, strategies, evidentiary standards, and other
factors for which the Secretary determines that additional
guidance is necessary to improve compliance with this
section, section 712 of the Employee Retirement Income
Security Act of 1974, or section 9812 of the Internal Revenue
Code of 1986, as applicable.
``(D) Public comment.--Prior to issuing any final guidance
under this paragraph, the Secretary shall provide a public
comment period of not less than 60 days during which any
member of the public may provide comments on a draft of the
guidance.''.
(c) Availability of Plan Information.--
(1) PHSA amendment.--Paragraph (4) of section 2726(a) of
the Public Health Service Act (42 U.S.C. 300gg-26(a)) is
amended to read as follows:
``(4) Availability of plan information.--The criteria for
medical necessity determinations made under the plan or
health insurance coverage with respect to mental health or
substance use disorder benefits or medical or surgical
benefits, the reason for denial of any such benefits, and any
other information appropriate to demonstrate compliance under
this section (including any such medical and surgical
information) shall be made available by the plan
administrator (or the health insurance issuer offering such
coverage) in accordance with applicable regulations to the
current or potential participant, beneficiary, or contracting
provider involved upon request. The Secretary may promulgate
any such regulations, including interim final regulations or
temporary regulations, as may be appropriate to carry out
this paragraph.''.
(2) ERISA amendment.--Paragraph (4) of section 712(a) of
the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185a(a)) is amended to read as follows:
``(4) Availability of plan information.--The criteria for
medical necessity determinations made under the plan with
respect to mental health or substance use disorder benefits
or medical or surgical benefits (or the health insurance
coverage offered in connection with the plan with respect to
such benefits), the reason for denial of any such benefits,
and any other information appropriate to demonstrate
compliance under this section (including any such medical and
surgical information) shall be made available by the plan
administrator (or the health insurance issuer offering such
coverage) in accordance with applicable regulations to the
current or potential participant, beneficiary, or contracting
provider involved upon request. The Secretary may promulgate
any such regulations, including interim final regulations or
temporary regulations, as may be appropriate to carry out
this paragraph.''.
(3) IRC amendment.--Paragraph (4) of section 9812(a) of the
Internal Revenue Code of 1986 is amended to read as follows:
``(4) Availability of plan information.--The criteria for
medical necessity determinations made under the plan with
respect to mental health or substance use disorder benefits
or medical or surgical benefits, the reason for denial of any
such benefits, and any other information appropriate to
demonstrate compliance under this section (including any such
medical and surgical information) shall be made available by
the plan administrator in accordance with applicable
regulations to the current or potential participant,
beneficiary, or contracting provider involved upon request.
The Secretary may promulgate any such regulations, including
interim final regulations or temporary regulations, as may be
appropriate to carry out this paragraph.''.
(d) Improving Compliance.--
(1) In general.--In the case that the Secretary of Health
and Human Services, the Secretary of Labor, or the Secretary
of the Treasury determines that a group health plan or health
insurance issuer offering group or individual health
insurance coverage has violated, at least 5 times, section
2726 of the Public Health Service Act (42 U.S.C. 300gg-26),
section 712 of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1185a), or section 9812 of the Internal
Revenue Code of 1986, respectively, the appropriate Secretary
shall audit plan documents for such health plan or issuer in
the plan year following the Secretary's determination in
order to help improve compliance with such section.
(2) Rule of construction.--Nothing in this subsection shall
be construed to limit the authority, as in effect on the day
before the date of enactment of this Act, of the Secretary of
Health and Human Services, the Secretary of Labor, or the
Secretary of the Treasury to audit documents of health plans
or health insurance issuers.
SEC. 802. ACTION PLAN FOR ENHANCED ENFORCEMENT OF MENTAL
HEALTH AND SUBSTANCE USE DISORDER COVERAGE.
(a) Public Meeting.--
(1) In general.--Not later than 6 months after the date of
enactment of this Act, the Secretary of Health and Human
Services shall convene a public meeting of stakeholders
described in paragraph (2) to produce an action plan for
improved Federal and State coordination related to the
enforcement of section 2726 of the Public Health Service Act
(42 U.S.C. 300gg-26), section 712 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1185a), and section
[[Page H4317]]
9812 of the Internal Revenue Code of 1986, and any comparable
provisions of State law (in this section collectively
referred to as ``mental health parity and addiction equity
requirements'').
(2) Stakeholders.--The stakeholders described in this
paragraph shall include each of the following:
(A) The Federal Government, including representatives
from--
(i) the Department of Health and Human Services;
(ii) the Department of the Treasury;
(iii) the Department of Labor; and
(iv) the Department of Justice.
(B) State governments, including--
(i) State health insurance commissioners;
(ii) appropriate State agencies, including agencies on
public health or mental health; and
(iii) State attorneys general or other representatives of
State entities involved in the enforcement of mental health
parity and addiction equity requirements.
(C) Representatives from key stakeholder groups,
including--
(i) the National Association of Insurance Commissioners;
(ii) health insurance providers;
(iii) providers of mental health and substance use disorder
treatment;
(iv) employers; and
(v) patients or their advocates.
(b) Action Plan.--Not later than 6 months after the
conclusion of the public meeting under subsection (a), the
Secretary of Health and Human Services shall finalize the
action plan described in such subsection and make it plainly
available on the Internet website of the Department of Health
and Human Services.
(c) Content.--The action plan under this section shall--
(1) reflect the input of the stakeholders participating in
the public meeting under subsection (a);
(2) identify specific strategic objectives regarding how
the various Federal and State agencies charged with
enforcement of mental health parity and addiction equity
requirements will collaborate to improve enforcement of such
requirements;
(3) provide a timeline for implementing the action plan;
and
(4) provide specific examples of how such objectives may be
met, which may include--
(A) providing common educational information and documents
to patients about their rights under mental health parity and
addiction equity requirements;
(B) facilitating the centralized collection of, monitoring
of, and response to patient complaints or inquiries relating
to mental health parity and addiction equity requirements,
which may be through the development and administration of a
single, toll-free telephone number and an Internet website
portal;
(C) Federal and State law enforcement agencies entering
into memoranda of understanding to better coordinate
enforcement responsibilities and information sharing,
including whether such agencies should make the results of
enforcement actions related to mental health parity and
addiction equity requirements publicly available; and
(D) recommendations to the Congress regarding the need for
additional legal authority to improve enforcement of mental
health parity and addiction equity requirements, including
the need for additional legal authority to ensure that
nonquantitative treatment limitations are applied, and the
extent and frequency of the applications of such limitations,
both to medical and surgical benefits and to mental health
and substance use disorder benefits in a comparable manner.
SEC. 803. REPORT ON INVESTIGATIONS REGARDING PARITY IN MENTAL
HEALTH AND SUBSTANCE USE DISORDER BENEFITS.
(a) In General.--Not later than 1 year after the date of
enactment of this Act, and annually thereafter for the
subsequent 5 years, the Administrator of the Centers for
Medicare & Medicaid Services, in collaboration with the
Assistant Secretary of Labor of the Employee Benefits
Security Administration and the Secretary of the Treasury,
shall submit to the Committee on Energy and Commerce of the
House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate a report
summarizing the results of all closed Federal investigations
completed during the preceding 12-month period with findings
of any serious violation regarding compliance with mental
health and substance use disorder coverage requirements under
section 2726 of the Public Health Service Act (42 U.S.C.
300gg-26), section 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a), and section 9812 of
the Internal Revenue Code of 1986.
(b) Contents.--Subject to subsection (c), a report under
subsection (a) shall, with respect to investigations
described in such subsection, include each of the following:
(1) The number of closed Federal investigations conducted
during the covered reporting period.
(2) Each benefit classification examined by any such
investigation conducted during the covered reporting period.
(3) Each subject matter, including compliance with
requirements for quantitative and nonquantitative treatment
limitations, of any such investigation conducted during the
covered reporting period.
(4) A summary of the basis of the final decision rendered
for each closed investigation conducted during the covered
reporting period that resulted in a finding of a serious
violation.
(c) Limitation.--Any individually identifiable information
shall be excluded from reports under subsection (a)
consistent with protections under the health privacy and
security rules promulgated under section 264(c) of the Health
Insurance Portability and Accountability Act of 1996 (42
U.S.C. 1320d-2 note).
SEC. 804. GAO STUDY ON PARITY IN MENTAL HEALTH AND SUBSTANCE
USE DISORDER BENEFITS.
Not later than 3 years after the date of enactment of this
Act, the Comptroller General of the United States, in
consultation with the Secretary of Health and Human Services,
the Secretary of Labor, and the Secretary of the Treasury,
shall submit to the Committee on Energy and Commerce of the
House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate a report
detailing the extent to which group health plans or health
insurance issuers offering group or individual health
insurance coverage that provides both medical and surgical
benefits and mental health or substance use disorder
benefits, medicaid managed care organizations with a contract
under section 1903(m) of the Social Security Act (42 U.S.C.
1396b(m)), and health plans provided under the State
Children's Health Insurance Program under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.) comply with
section 2726 of the Public Health Service Act (42 U.S.C.
300gg-26), section 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a), and section 9812 of
the Internal Revenue Code of 1986, including--
(1) how nonquantitative treatment limitations, including
medical necessity criteria, of such plans or issuers comply
with such sections;
(2) how the responsible Federal departments and agencies
ensure that such plans or issuers comply with such sections,
including an assessment of how the Secretary of Health and
Human Services has used its authority to conduct audits of
such plans to ensure compliance;
(3) a review of how the various Federal and State agencies
responsible for enforcing mental health parity requirements
have improved enforcement of such requirements in accordance
with the objectives and timeline described in the action plan
under section 802; and
(4) recommendations for how additional enforcement,
education, and coordination activities by responsible Federal
and State departments and agencies could better ensure
compliance with such sections, including recommendations
regarding the need for additional legal authority.
SEC. 805. INFORMATION AND AWARENESS ON EATING DISORDERS.
(a) Information.--The Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
may--
(1) update information, related fact sheets, and resource
lists related to eating disorders that are available on the
public Internet website of the National Women's Health
Information Center sponsored by the Office on Women's Health,
to include--
(A) updated findings and current research related to eating
disorders, as appropriate; and
(B) information about eating disorders, including
information related to males and females;
(2) incorporate, as appropriate, and in coordination with
the Secretary of Education, information from publicly
available resources into appropriate obesity prevention
programs developed by the Office on Women's Health; and
(3) make publicly available (through a public Internet
website or other method) information, related fact sheets and
resource lists, as updated under paragraph (1), and the
information incorporated into appropriate obesity prevention
programs, as updated under paragraph (2).
(b) Awareness.--The Secretary may advance public awareness
on--
(1) the types of eating disorders;
(2) the seriousness of eating disorders, including
prevalence, comorbidities, and physical and mental health
consequences;
(3) methods to identify, intervene, refer for treatment,
and prevent behaviors that may lead to the development of
eating disorders;
(4) discrimination and bullying based on body size;
(5) the effects of media on self-esteem and body image; and
(6) the signs and symptoms of eating disorders.
SEC. 806. EDUCATION AND TRAINING ON EATING DISORDERS.
The Secretary of Health and Human Services may facilitate
the identification of programs to educate and train health
professionals and school personnel in effective strategies
to--
(1) identify individuals with eating disorders;
(2) provide early intervention services for individuals
with eating disorders;
(3) refer patients with eating disorders for appropriate
treatment;
(4) prevent the development of eating disorders; or
(5) provide appropriate treatment services for individuals
with eating disorders.
[[Page H4318]]
SEC. 807. GAO STUDY ON PREVENTING DISCRIMINATORY COVERAGE
LIMITATIONS FOR INDIVIDUALS WITH SERIOUS MENTAL
ILLNESS AND SUBSTANCE USE DISORDERS.
Not later than 2 years after the date of the enactment of
this Act, the Comptroller General of the United States shall
submit to Congress and make publicly available a report
detailing Federal oversight of group health plans and health
insurance coverage offered in the individual or group market
(as such terms are defined in section 2791 of the Public
Health Service Act (42 U.S.C. 300gg-91)), including Medicaid
managed care plans under section 1903 of the Social Security
Act (42 U.S.C. 1396b), to ensure compliance of such plans and
coverage with sections 2726 of the Public Health Service Act
(42 U.S.C. 300gg-26), 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a), and 9812 of the
Internal Revenue Code of 1986 (in this section collectively
referred to as the ``parity law''), including--
(1) a description of how Federal regulations and guidance
consider nonquantitative treatment limitations, including
medical necessity criteria and application of such criteria
to medical, surgical, and primary care, of such plans and
coverage in ensuring compliance by such plans and coverage
with the parity law;
(2) a description of actions that Federal departments and
agencies are taking to ensure that such plans and coverage
comply with the parity law; and
(3) the identification of enforcement, education, and
coordination activities within Federal departments and
agencies, including educational activities directed to State
insurance commissioners, and a description of how such proper
activities can be used to ensure full compliance with the
parity law.
SEC. 808. CLARIFICATION OF EXISTING PARITY RULES.
If a group health plan or a health insurance issuer
offering group or individual health insurance coverage
provides coverage for eating disorder benefits, including
residential treatment, such group health plan or health
insurance issuer shall provide such benefits consistent with
the requirements of section 2726 of the Public Health Service
Act (42 U.S.C. 300gg-26), section 712 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1185a), and
section 9812 of the Internal Revenue Code of 1986.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Pennsylvania (Mr. Murphy) and the gentleman from New Jersey (Mr.
Pallone) each will control 20 minutes.
The Chair recognizes the gentleman from Pennsylvania.
General Leave
Mr. MURPHY of Pennsylvania. Mr. Speaker, I ask unanimous consent that
all Members have 5 legislative days in which to revise and extend their
remarks and insert extraneous materials in the Record on the bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Pennsylvania?
There was no objection.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield myself such time as
I may consume.
Mr. Speaker, our mental health system in this country is a failure.
This is one of those times where we are not gathered for a moment of
silence, but a time of action. We are here finally to speak up for the
last, the lost, the least, and the lonely, that is those who suffer
from mental illness which is untreated.
Mental illness affects one in five Americans. About 10 million
Americans have serious mental illness. About 4 million of those go
without any treatment. There are 100,000 new cases each year. Half of
psychosis cases emerge by age 14, 75 percent by age 24. We have a need
for 30,000 child psychiatrists. We only have 9,000. We have great
shortages of psychologists.
The time between the emergence of the first symptoms of serious
mental illness and the first appointment is about 80 weeks. We need
about 100,000 hospital beds in this country, but we only have 40,000
for psychiatric crises. A person is 10 times more likely, therefore, to
be in jail than in a hospital if they are mentally ill.
And these statistics, too: 43,000 suicides last year, 47,000 drug
overdose deaths, 1,000 homicides, 250 mentally ill violently killed in
a police encounter where they attacked a policeman. We have hundreds of
thousands of homeless and mentally ill who die the slow-motion death of
chronic illness, and that comes to more than the number who die of
breast cancer, perhaps 350,000 or more a year.
The Helping Families in Mental Health Crisis Act, a bipartisan bill
with over 205 cosponsors, which came out of the Committee on Energy and
Commerce with a unanimous vote, fixes this. It allows parents and
caregivers to help with care. It increases the number of crisis mental
health beds. It drives evidence-based care. It builds on existing
mental health and substance abuse parity laws. It brings accountability
to Federal grant programs, which two GAO reports say were disastrous.
It focuses on innovation and reaches underserved and rural populations,
expands the mental health workforce, advances early intervention and
prevention programs, develops alternatives to institutionalization,
focuses on suicide prevention, increases program coordination across
the 112 Federal programs and agencies, reforms protection and advocacy,
provides training grants to train police officers and first responders,
and saves the Federal Government money. It is wide ranging, it is
impactful, and it is something that we are going to have to pass today
if we really, truly want to make a difference.
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
I rise in support of H.R. 2646, the Helping Families in Mental Health
Crisis Act.
Today's mental health system can hardly be described as a system at
all. While some States are undertaking promising improvements, the
system is fragmented, overwhelmed, and underresourced. Far too many
people with mental illnesses can't get the treatment they need to live
long, healthy, and productive lives, so I am pleased that this bill
takes an important step toward improving mental health care in this
country.
The bill under consideration today, Mr. Speaker, is a significant
improvement over the original version introduced a year ago. It is no
secret that many of us had substantial concerns with some of the
provisions in the original text of the bill, and I am sure that my
fellow Members of the Committee on Energy and Commerce remember the
extensive debate we had on this bill during our subcommittee markup
last November.
Since that time, we have found common ground. We removed many
provisions that would have done more harm than good, in my opinion, and
replaced them with policies that strengthen the bill. I am proud that
H.R. 2646 now includes several policies championed by Democrats.
The bill requires that States provide the full range of early and
periodic screening, diagnostic, and treatment--EPSDT--services to
children in the Medicaid program who receive inpatient psychiatric care
at so-called institutions of mental disease. It creates a new assertive
community treatment grant program and a peer professional workforce
grant program. The legislation also creates new grant programs to
address adult suicide, expands access to community crisis response
services, and creates and disseminates model HIPAA training programs.
A great deal of work went into crafting this agreement, and I want to
thank my Republican colleagues for continuing to meet with us
throughout this process so that we could bring a bipartisan product to
the floor.
That said, the bill before us today is not transformative reform nor
is it a panacea to the many problems now facing our mental health
system. I encourage my colleagues to see this legislation as a
necessary step rather than a solution, and I want to be very clear on
this point. If we are truly serious about fixing our broken mental
health system, we have to expand access and make sustained investment,
and that means we must work to encourage all States to expand Medicaid
and provide more Federal resources to support the growth of community-
based prevention, treatment, and recovery services.
This legislation is not comprehensive. It by no means contains enough
funding to make the mental health system whole. I hope that, in the
near future, we can work together again on additional legislation to
increase treatment options and further strengthen mental health parity
enforcement.
I once again want to thank my colleagues who stood with me throughout
this long process, fiercely voicing their concerns and advocating for
major improvements to the bill. I want to thank Chairman Upton for his
leadership, and the bill's sponsors, Representatives Tim Murphy and
Eddie Bernice Johnson, for championing this issue for so many years.
[[Page H4319]]
I urge my colleagues to support this important bipartisan bill, and I
look forward to the Senate's action on this issue.
Mr. Speaker, I reserve the balance of my time.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 1 minute to the
gentleman from New Jersey (Mr. Lance), a member of the Committee on
Energy and Commerce, who has been supporting this from the onset.
Mr. LANCE. Mr. Speaker, today marks a very important moment in the
long and tortuous road to reform a mental health system that is broken
and must be fixed.
I joined the gentleman from Pennsylvania (Mr. Murphy), a psychologist
and my friend and colleague, and our former colleague, now U.S. Senator
from Louisiana, Dr. Bill Cassidy, in a conference room in the basement
of the U.S. Capitol in December 2013, where the three of us stood
together and called on Congress to address a mental healthcare system
in crisis, a system where millions of Americans suffer every year and
are all too often pushed into the shadows by archaic regulations and an
outdated Federal bureaucracy. 2\1/2\ years later, I am proud that the
House stands poised today to pass the most significant reform to our
Nation's mental health programs in decades.
This bill includes provisions I have championed to help provide early
detection of eating disorders and improve access to treatment coverage.
This is an historic achievement, as it marks the first time Congress
has addressed eating disorders specifically through legislation.
I thank Subcommittee Chairman Murphy, Chairman Upton, and the entire
Committee on Energy and Commerce for working together to pass this
landmark mental healthcare reform bill and move us one step closer to
providing millions of Americans and their families a chance at
treatment before tragedy strikes.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman
from Texas (Mr. Gene Green), the ranking member of the Health
Subcommittee.
{time} 1400
Mr. GENE GREEN of Texas. Mr. Speaker, I rise in support of H.R. 2646,
legislation to improve our mental health system.
This bill is a positive step forward. I want to thank my colleagues
on both sides of the aisle for their work to improve access,
prevention, and treatment for those with mental and behavioral
conditions. We worked extensively and collaboratively to craft the
legislation.
I want to particularly thank Energy and Commerce Committee Chairman
Upton; Ranking Member Pallone; Representatives Kennedy, Matsui,
Loebsack, Tonko, and DeGette for their contributions; and Congressman
Tim Murphy for elevating the conversation about mental health.
H.R. 2646 includes new grant programs that expand access to critical
mental health services, such as community crisis response systems and
adult suicide prevention. It provides new tools to improve compliance
with mental health parity, HIPAA training programs for patients and
providers to better understand their protections and rights, and a peer
professional workforce development grant.
I am pleased that this legislation extends the Federal Tort Claims
Act to help professional volunteers at community health centers. It
also affords the full range of Early and Periodic Screening,
Diagnostic, and Treatment services to Medicaid children who receive
care in Institutes of Mental Diseases.
While not comprehensive and lacking key resources, today's vote marks
a significant step forward to strengthening our Nation's mental health
system.
Again, I want to thank my colleagues on the Energy and Commerce
Committee and their staffs, and I urge Members to vote in favor of this
legislation.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 1 minute to the
gentleman from Louisiana (Mr. Scalise) the majority whip.
Mr. SCALISE. Mr. Speaker, I thank my colleague from Pennsylvania for
yielding, but especially for taking the lead on this issue.
Mr. Speaker, it has been decades since Congress has reformed our
mental health laws. Unfortunately, we have seen so many negative
aspects since then. Suicide rates are through the roof. There are so
many other problems throughout our country. It has touched every
community in this Nation. We see a growing problem with mental health.
This bill really refocuses efforts, but it also puts a different
priority on Federal grants and Federal agencies to force them to do a
better job of addressing these problems. It also helps families to get
more involved in the mental health problems that their own children
face. Right now, some Federal laws make it harder for parents to help
their own children. These kinds of serious problems have been
complicated to work through.
Mr. Speaker, when you look at the fact that it has been decades,
there is a reason why. This is hard work. It is complicated work. This
bill has been at least 3 years in the making, and so it is very
important that we bring this bill to the floor today and pass it over
to the Senate. This is not only reform that can pass the House, but
reform that actually get signed by the President and make a real
difference and impact in improving people's lives.
Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from
California (Ms. Matsui).
Ms. MATSUI. Mr. Speaker, I thank the gentleman for yielding.
For far too long, those with mental illness have been left in the
shadows, and mental health prevention and treatment have been left out
of our health systems.
The mental health crisis in this country is very personal to me, and
I have been fighting for patients and their loved ones for many years.
I believe there is a lot we can do better to stop or slow down the hurt
and pain that patients and families feel when mental health is left
unaddressed.
The bill before us today is a good bill. It is a first step toward
mental health reform, offering policies that help move us in the
direction of better parity between mental and physical illness, a
stronger workforce trained to address mental illness, and promotion of
evidence-based services and supports.
Especially important to me are the provisions that will help clarify
when and how providers are able to share information with families and
caregivers in order to better serve the patients in times of need.
There is more left to be done, more to do, and our reform efforts
will not be complete or comprehensive until we make real investments in
our mental health system. I will continue working for the comprehensive
mental health reforms that our families need and deserve.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 1 minute to the
gentleman from Michigan (Mr. Upton), chairman of the full committee and
who we owe a great debt of gratitude for moving forward this bill.
Mr. UPTON. Mr. Speaker, today marks an important milestone in the
multiyear, multi-Congress effort to deliver meaningful reforms to the
Nation's mental health system.
Last month, the Energy and Commerce Committee passed this bill 53-0
in committee. It has been bipartisan. We know that this is an issue
that impacts every community and so many families in one way or
another. We continue to hear tales of great loss where intervention was
lacking or nonexistent. So we got to work. We spent hundreds and
hundreds of hours--I am not kidding--in staff work and work by Members.
For way too long, mental health was a subject that was left in the
shadows. Thankfully, that is no longer the case. Today we have
developed a thoughtful solution. Throughout the process, we have
achieved many important reforms. Today we build upon that momentum.
Our current system of siloed grants, prevention, and treatment simply
doesn't work the way it should. This bill changes that with real
reforms to provide SAMHSA new tools, under the leadership of a new
Assistant Secretary, and we have done it the way that we should.
This bipartisan bill will save lives, aid families, and provide
comfort and relief to those who are struggling.
Mr. Speaker, today marks an important milestone in the multi-year,
multi-Congress effort to deliver meaningful reforms to the nation's
mental health system. Last month, the
[[Page H4320]]
Energy and Commerce Committee unanimously approved H.R. 2646 by a vote
of 53 to zero to help families in mental health crisis.
This is an issue that impacts every community, and so many families,
in one way or another. We continue to hear tales of great loss where
intervention was lacking or nonexistent.
But you know what? Congressman Tim Murphy got to work. For way too
long, mental health was a subject left for the shadows. Thankfully,
that's no longer the case. Today, we have developed a thoughtful
legislative solution. Throughout this process, we have achieved
important reforms and today we build upon that momentum.
Our current system of siloed grants, prevention, and treatment simply
does not work as well as it should. The ``Helping Families in Mental
Health Crisis Act'' includes new reforms to make sure the federal
government is leveraging their dollars with investments in evidence-
based programs. The bill includes reforms to provide SAMHSA new tools,
under the leadership of an Assistant Secretary for Mental Health and
Substance Use, to do its job better.
Thoughtful legislating takes time and dedication. This Congress we
have seen multi-year landmark committee efforts finally make it across
the finish line in SGR reform, pipeline safety and chemical safety
reforms, which were both signed into law late last month. 21st Century
Cures has taken years, and we continue to make progress. And I am
hopeful these mental health reforms that we have long pursued are on
the same path to being signed into law, building upon our proud
bipartisan record of success.
This bipartisan bill will save lives, aid families, and provide
comfort and relief to those struggling. This strong bill is something
that both Republicans and Democrats can be proud of. I thank Dr.
Murphy, Health Subcommittee Chairman Pitts, full committee Ranking
Member Frank Pallone and the staff, who worked hundreds of hours to
bring us to where we are today.
This bill will truly make a real difference and deliver meaningful
reforms to families in mental health crisis all across America.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman
from New York (Mr. Tonko).
Mr. TONKO. Mr. Speaker, I thank the gentleman from New Jersey for
yielding.
Mr. Speaker, I rise today in support of H.R. 2646, the Helping
Families in Mental Health Crisis Act. While this bill is not perfect
and necessarily represents a compromise from all sides, it is a good
first step in making the improvement to our Nation's mental health
system. It has been a long road to get here, and the passionate debate
we have had has only served to strengthen the bill and produce
legislation that we can all support.
In particular, I would like to highlight section 502, which is based
on my Coordinating Crisis Care Act, which I sponsored. This provision
would authorize a new grant program at SAMHSA to fund the development
of real-time bed registry systems that will help get individuals in
crisis the appropriate care they need in a timely fashion. By ensuring
better coordination of crisis care systems, we can save lives and
support individuals and families in their time of need.
Looking forward, Congress needs to do more to heal a broken mental
health system. We should pass additional legislation that would ensure
vigorous enforcement of our mental health parity laws and to strengthen
mental health and substance use coverage for Medicaid and Medicare
beneficiaries. That is ultimately the key to quality performance here
for the mental health community.
Finally, we have to acknowledge that the current dysfunction in our
mental health systems stems, in part, from decades of broken promises
and a chronic underinvestment in community-based mental health services
that simply cannot be solved by one single bill like this.
We must do better, and I stand ready to help in that fight.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 1 minute to the
gentleman from Oregon (Mr. Walden).
Mr. WALDEN. Mr. Speaker, today I rise in support of Representative
Murphy's Helping Families in Mental Health Crisis Act.
Ten million Americans suffer from serious mental illness, Mr.
Speaker. If they get care, they are 16 times less likely to harm
themselves or others. Right now, too many patients fall through the
cracks.
At a recent roundtable in Medford, Oregon, and on a tele-townhall I
just completed, I heard from parents about their children who
experienced homelessness and violence due to their illness, from
caregivers about the difficulty of getting timely care, and from law
enforcement about how the default place for the mentally ill is often a
jail.
The consensus among all of them was that the healthcare system, the
government, and society are failing those who need help the most. They
overwhelmingly support the provisions in this legislation.
We can improve treatment, we can and do boost resources, and we will
get care to people in need, especially in our rural communities.
Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from
Massachusetts (Mr. Kennedy).
Mr. KENNEDY. Mr. Speaker, I want to thank Ranking Member Pallone,
Chairman Upton, and Congressman Murphy for, once again, the bipartisan
leadership that has guided this bill through our committee and onto the
floor.
Mr. Speaker, you cannot listen to the constant stories from patients
and families who have been denied access to mental health care and
believe that there are not tragic gaps in our mental health system.
This bill is a bipartisan, incremental step forward in our efforts to
address those gaps.
I am especially pleased by the inclusion of my bill to remove the
discriminatory barrier to care for children in certain inpatient
psychiatric facilities, yet we have to acknowledge that, unless this is
just the first step, we have failed to fix a broken system. Unless we
increase Medicaid reimbursements rates, providers will still be forced
to turn away our most vulnerable patient populations. Unless we inspire
and encourage a new generation to pursue careers as psychologists,
psychiatrists, and social workers, there will still be a shortage of
professionals to care for our patients. Unless we can guarantee parity,
insurance companies will continue to construct barriers to care,
leaving patients without access to the mental health system no matter
how strong that system may be.
And that is where our eyes should be focused tomorrow after this bill
is passed.
Whether in conference or in our future committee hearings, we cannot
accept this bill as a full, comprehensive fix to a fully broken system.
If we do, patients suffering from mental illness will continue to fall
through the same gaps that exist today.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 2 minutes to the
gentleman from Florida (Mr. Bilirakis), a member of the Energy and
Commerce Committee.
Mr. BILIRAKIS. Mr. Speaker, I rise today in support of H.R. 2646, the
Helping Families in Mental Health Crisis Act, of which I am a
cosponsor.
I want to thank Chairman Murphy for the extensive amount of time and
attention he has put into addressing mental health and substance abuse
disorders. He even joined me in my district to hear directly from my
constituents about this particular bill. I thank Chairman Murphy again
for that.
We discussed the struggles that individuals with mental illness face
and how Congress can best address the need of those we serve. With
their input, we worked to address every aspect of this overall problem.
This legislation will help countless individuals and families in my
district in Florida and in communities across our country. I urge my
colleagues to support this great piece of legislation.
Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Texas (Ms. Eddie Bernice Johnson), the Democratic sponsor of the bill.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today in
support of H.R. 2646, the Helping Families in Mental Health Crisis Act.
As the original Democratic cosponsor of this piece of legislation and
the one that preceded it, I am proud to see it come to the floor today.
H.R. 2646 is a demonstration of more than 3 years of collaboration
between not only myself and Congressman Tim Murphy, but the many other
Members and organizations that came to the table to offer feedback,
suggestions, and, at times, criticism. At no time did Congressman
Murphy turn anyone's input down.
[[Page H4321]]
The end result is a bill that remains focused on enabling the most
severely and mentally ill to access the treatment they desperately
deserve, while allowing their families and caregivers to help them
along the way.
This piece of legislation contains several necessary provisions,
including the establishment of an Assistant Secretary for Mental Health
and Substance Use Disorder, easing our Nation's chronic shortage of
psychiatric beds, requiring the Secretary of Health and Human Services
to clarify confusing HIPAA rules surrounding mental health patients,
and increasing grant programs with results proven to help individuals
with serious mental health illness gain access to treatment like
Assisted Outpatient Treatment and Assertive Community Treatment.
As two of the few mental health providers serving in Congress--
another over here to my left, Dr. McDermott, a psychiatrist--
Congressman Murphy and I have always been focused on the needs of the
severely mentally ill. Many that we read about daily in our many cities
across the Nation end up in jail or prison.
{time} 1415
While the homeless and prison population are particularly vulnerable
to mental illness, these are the individuals that get the least amount
of attention and access to mental health services. Through our work, we
have a deep understanding of patient need, and this need is not being
met.
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Mr. PALLONE. Mr. Speaker, I yield the gentlewoman an additional 1
minute.
Ms. EDDIE BERNICE JOHNSON of Texas. Unfortunately, we have found that
many of our fellow Members lack the understanding of patients in
crisis, making this process more difficult.
I am hopeful, however, that this bill will be a framework to help us
move the needle forward on mental health treatment in America.
I would like to thank Congressman Murphy for his steadfast commitment
to mental health. I would also like to thank the chairman, Fred Upton,
and our ranking member, Mr. Pallone, for their hard work on this
measure. While we still have a long ways to go, this is certainly a
step forward.
Mr. MURPHY of Pennsylvania. Mr. Speaker, how much time do I have
remaining?
The SPEAKER pro tempore (Mr. Loudermilk). The gentleman from
Pennsylvania has 12\1/2\ minutes remaining.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield such time as she may
consume to the gentlewoman from Indiana (Mrs. Brooks), who has been a
real champion of this bill.
Mrs. BROOKS of Indiana. Mr. Speaker, 1 in 4 adults, a total of 61.5
million Americans, will experience mental illness within a given year.
The numbers alone don't tell the stories behind the deeply personal
pain that this disease inflicts on our friends, neighbors, and, most
importantly, their families.
Today, I am proud to stand with the gentleman from Pennsylvania in
support of this strong bipartisan bill. He has truly championed the
first major mental health reform in this country in 50 years.
Right now, our healthcare system does not allow families of those
suffering from mental illness to become partners in their health care,
and this bill ensures that adult patients struggling with mental
illness will receive the healthcare treatment they need, while allowing
their families to become close partners in their care. It expands the
mental health workforce and increases the number of psychiatric
hospital beds for those experiencing an acute mental health crisis.
This legislation is a significant, important step toward
comprehensive, community-based care that will work better for people
and, most importantly, their families. I urge my colleagues to vote
``yes'' on this bill.
Mr. PALLONE. Mr. Speaker, how much time do I have remaining?
The SPEAKER pro tempore. The gentleman from New Jersey has 8\1/2\
minutes remaining.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman
from Ohio (Ms. Kaptur).
Ms. KAPTUR. Mr. Speaker, I rise today in support of the Helping
Families in Mental Health Crisis Act, H.R. 2646, and wish to thank
Chairman Upton, Ranking Member Pallone, and the two driving sponsors of
this measure, Congressman Tim Murphy and Congresswoman Eddie Bernice
Johnson, who have adeptly navigated this bill through very choppy
legislative waters.
The bill takes head-on one of the most compelling and unaddressed
health challenges of our society: the suffering, the anguish, the
travails, the plight of the seriously mentally ill. The bill will
empower parents and caregivers, drive innovation, advance early-
intervention and prevention programs, and offer alternatives to
institutionalization, and provide the first step in a long time to show
respect and real treatment alternatives to Americans living with mental
illness.
It is no secret our prisons have become the domiciles for the
mentally ill. This bill rings out: ``No more, no more.''
Sadly, psychiatric care has become the responsibility of our prison
system. Three of the largest mental health ``hospitals'' in our country
are incarceration facilities. Speak to any local sheriff. They will
tell you their jails are overcrowded with the mentally ill.
What too often happens is that the ill person in an adult
incarceration facility actually began their journey in a child
correction facility, and as they matured, essentially, graduated to the
adult facility without their underlying mental illness being properly
diagnosed, much less treated. What an indictment of our Nation, not
just our health and corrections system, this is, but our entire
country.
Today's bill calls for a complete overhaul of the current mental
health system. It has been needed since the de-institutionalization
that sent millions, some to their death when they were sent to the
streets.
I want to congratulate, as I conclude, Representatives Murphy and
Johnson for bringing this bill to the floor and addressing a crying
human need for too long ignored in our country. They are doing
something noble for the Nation. The severely mentally ill must be
humanely treated.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 1 minute to the
gentleman from Pennsylvania (Mr. Pitts), the chairman of the Health
Subcommittee of the Committee on Energy and Commerce.
Mr. PITTS. Mr. Speaker, I thank Mr. Murphy for his leadership and his
persistence in getting this historic legislation to the floor.
When a person struggles with mental illness, he or she may lose her
job, her friends, even her family, which can make the mental illness
worse. And help for this person may be available, but she may not be
able to navigate available resources alone or drive to her doctor's
appointments regularly without help.
Therefore, organizations providing mental health assistance must not
only provide resources, they must make sure they actually connect
people with people in need.
When the Federal Government distributes mental health funding, it
needs to go to programs that are doing this, and Congressman Murphy's
bill is a step in the right direction. His bill will increase
accountability so that we can better understand how Federal mental
health and substance abuse treatment funds are used in each State. It
would summarize best practice models in the States and do many other
things, and this way we can highlight mental health programs that are
most effective.
I urge my colleagues to support the bill.
Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from
Washington (Mr. McDermott), the chairman of the Ways and Means Health
Subcommittee.
Mr. McDERMOTT. Mr. Speaker, first of all, I want to say
congratulations to Congressman Murphy. His persistence brought this
bill to the floor, and it is important that this issue be discussed.
We are all going to vote for this bill. It will go out of here
unanimously. We are all going to vote for it. But it is a hollow
promise if there is not some money in it.
Now, I was in my training in Chicago, in 1964, when the first mental
health money came from the Federal Government to Chicago, and it went
all
[[Page H4322]]
over the country. And if the Federal Government doesn't put money into
this program that we are outlining in this very carefully constructed
bill, we will be sending out a blank check. There will be nothing. It
won't be worth anything. To think that State legislatures or somebody
is going to find the money somewhere is simply not real.
Now, this morning, Mr. Pallone and I sat on a conference committee on
opioids. We are doing the same thing there. We know there is addiction,
we know there are all kinds of problems all over the place, and we are
passing a wonderful bill out with some nice words in it, but no money.
And if you are not willing to put some money into a program like this,
you are simply consigning the mental health people to the jail.
I was the King County Jail psychiatrist in 1979 and I ran the second-
largest mental hospital in the State of Washington. I had more patients
every night in that jail than anybody except the guy running the State
mental hospital down in Tacoma. And that is where the mentally ill are
today.
If you want to get them out of that situation and get them into
treatment, you are going to have to put some money out into the
community in a variety of these programs. Good programs. I like what is
in them. But you have got to put some money where your mouth is.
I will support the bill, and I want to hear the appropriations
process next.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 1 minute to the
gentleman from Texas (Mr. Burgess).
Mr. BURGESS. I thank the gentleman for the recognition.
Mr. Speaker, passage of this bill represents a major milestone for
individuals affected by mental illness across the country, and, of
course, I want to congratulate Chairman and Congressman Tim Murphy and
Congresswoman Eddie Bernice Johnson on the progress they have made on
this front. Many of us have worked in committee for a long time to
achieve this day.
And while we are in the business of congratulating ourselves as a
routine matter, I also want to take a moment to acknowledge the
participation of staff, both in our personal offices, as well as the
professional committee staff that helped bring this bill to the point
we are today. In particular, an alumnus of my office, Adrianna
Simonelli, worked hard to get this bill to a place where both sides
could expect and accept the results that we are achieving today.
Thank you, Mr. Chairman, for the recognition. Thanks for bringing
this bill to the floor of the House.
Mr. PALLONE. Mr. Speaker, could I inquire again about the time
remaining on each side, and ask whether Mr. Murphy, how many additional
speakers he has?
The SPEAKER pro tempore. The gentleman from New Jersey has 5 minutes
remaining.
Mr. PALLONE. Does the gentleman have a number of additional speakers?
Mr. MURPHY of Pennsylvania. I have about 10 more speakers who would
like to speak.
Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Colorado (Ms. DeGette), who is the ranking member of the Oversight and
Investigations Subcommittee.
Ms. DeGETTE. Mr. Speaker, today's vote on this wonderful bill is the
result of longstanding efforts in the Energy and Commerce Committee to
come to a bipartisan compromise on mental health legislation. I
particularly want to thank my compadre, my chairman, Mr. Murphy, for
his hard work on this. I have spent many, many hours talking to him
about this bill over the last few years, and I am happy to have it come
together.
This bill really incorporates a number of our positive changes that
included key provisions from the Comprehensive Behavioral Health Reform
and Recovery Act, which I am an original cosponsor, and other bills.
But as Mr. McDermott and others on this side of the aisle have said,
we still have a lot more work to do. This bill is really just the first
step towards true reform. And if we want to make a difference, Congress
really does need to provide the resources needed.
We have heard people talking about overfilled jails. We have heard
people talking about parents who can't find beds for their tremendously
mentally ill children. We have heard about the lack of truly educated
professionals.
These things can only be achieved with resources and money. And so I
truly see this bill as the first step towards a very robust mental
health system in this country.
The last thing I want to say is, action on mental health legislation
does not excuse inaction on gun violence prevention legislation. We
must do something as well as passing comprehensive mental health
legislation to respond to the gun violence epidemic.
Americans, my constituents, want us to take these steps. They have
made this abundantly clear in the last few weeks, and I am urging that
we have a vote separately on those issues.
But for today, let's all vote ``yes'' on this piece of legislation,
and then let's move forward for the important steps we need to take.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 45 seconds to the
gentleman from Michigan (Mr. Benishek).
Mr. BENISHEK. Mr. Speaker, we are here today to vote on long overdue
bipartisan mental health legislation. This bill will finally take
concrete steps toward improving the quality of care available to those
suffering from mental illness.
For too long, the most desperate among us have not had access to
proper mental health care. Patients, along with their families and
loved ones, have had nowhere to turn.
As a doctor taking care of patients in northern Michigan for 30
years, I am all too familiar with the lack of resources and attention
devoted to providing quality mental health care for our Nation. There
are many communities in my district there are no psychiatric beds
available. Local agencies don't have the staff or the resources to
provide answers for those seeking help, let alone treatment. This bill
represents a major step forward in turning all that around.
I hope all my colleagues will join me in supporting this commonsense
step to help deliver better mental health care.
Mr. PALLONE. Mr. Speaker, I reserve the balance of my time.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 45 seconds to the
gentleman from New York (Mr. Gibson).
Mr. GIBSON. Mr. Speaker, I want to congratulate Dr. Murphy and Ms.
Johnson for this landmark mental health legislation. I believe it
builds on earlier legislation we enacted in this Congress, like the
Clay Hunt suicide awareness and prevention bill, improving the mental
health for our veterans. And it fills a void that has existed for
decades now since we de-institutionalized in the 1970s, a decision I
support, but we never put Federal policy in behind it until today, Mr.
Speaker, resources for the local level for inpatient care for Americans
and families in mental health crisis.
{time} 1430
It improves coordination across the agencies to deliver better
suicide awareness and prevention in mental health.
I want to thank my wife, Mary Jo, a licensed clinical social worker,
for her advice and inspiration.
Mr. Speaker, I urge my colleagues to support this legislation.
Mr. PALLONE. I continue to reserve the balance of my time, Mr.
Speaker.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 45 seconds to the
gentleman from Pennsylvania (Mr. Rothfus), my friend and colleague.
Mr. ROTHFUS. Mr. Speaker, I want to thank my colleague and neighbor
from Pennsylvania, Congressman Murphy, for his unrelenting leadership
on this legislation and for calling attention to a problem that affects
millions of families across the country.
Nearly 10 million Americans have serious mental illness, including
schizophrenia, substance abuse disorder, and major depression. I think
today of the many families in my district who tell me about the
heartbreak they have had after losing loved ones to drug addiction or
suicide.
This legislation will improve the oversight of mental health and
substance abuse programs by ensuring we are using the most relevant
data and most effective, evidence-based programs to address our mental
health crisis.
I urge my colleagues to support this legislation, and I thank the
gentleman for his leadership.
[[Page H4323]]
Mr. PALLONE. Mr. Speaker, I will continue to reserve the balance of
my time until we get to closing remarks.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 45 seconds to the
gentleman from Georgia (Mr. Allen).
Mr. ALLEN. Mr. Speaker, I thank Chairman Murphy for this great piece
of legislation.
I rise today in support of H.R. 2646, the Helping Families in Mental
Health Crisis Act. Too many families across America have experienced a
loved one who is living with or has been diagnosed with a mental
illness. Sadly, one in five children ages 13 to 18 have or will battle
a mental illness.
As a proud member of the House Education and the Workforce Committee,
I had the privilege of visiting schools across Georgia's 12th
Congressional District and visiting with educators and staff members.
School leaders from elementary school to college all say that mental
health is one of their top concerns for the students.
These heartbreaking statistics are more than data and numbers on a
spreadsheet. They are mothers, fathers, sisters, brothers, students,
friends, and children.
Mr. Speaker, I urge my colleagues to vote in favor of H.R. 2646.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 45 seconds to the
gentlewoman from Virginia (Mrs. Comstock).
Mrs. COMSTOCK. Mr. Speaker, I thank the gentleman for yielding and
for his tireless work on this important bipartisan legislation which I
was proud to cosponsor.
I rise in support of H.R. 2646, the Helping Families in Mental Health
Crisis Act.
Every week we hear from constituents concerned about this issue, and,
of course, we all no doubt know somebody battling with this issue. I
appreciate the input from all stakeholders that has been taken into
account here--doctors, healthcare providers, academics, and law
enforcement--but, most importantly, the input from the families, the
caregivers, and those dealing with the mental health conditions that
are in so much need for more care.
So I urge my colleagues to support this bipartisan bill that will
allow for more efficient use of the resource allocation, improved
responsiveness, and reduced time and energy that is now lost spent
navigating a very difficult system that will be improved by this. So I
thank the gentleman.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I include in the Record this
list of over 50 professional organizations in support of this bill and
also a list of 65-plus editorials in support of this bill.
Helping Families in Mental Health Crisis Editorial Board Endorsements
(H.R. 2646)
2015-2016 Editorial Endorsements
1. The Florida Times Union, Congress begins to tackle
mental illness (April 21, 2015).
2. Observer-Reporter, Reforms to mental-health system
neede, (July 21, 2015).
3. The Sacramento Bee, Perhaps Congress will address mental
health care (August 1, 2015).
4. The National Review, Congress is Waking Up To Mental
health, (August 4, 2015).
5. Reading Record Searchlight, Perhaps Congress will
address mental health care (August 9, 2015).
6. U.S. News and World Report, America Wakes Up to Mental
Health (August 11, 2015).
7. The Florida Times-Union, Florida's inept system for
mental health leads to tragedies (August 20, 2015).
8. The Washington Times, Stopping the shooters (August 27,
2015).
9. KDKA-News, KDKA Urges Congress To Pass Murphy's Helping
Families in Mental Health Crisis Act (August 31, 2015).
10. The Connecticut Post, Congress can finally make a
difference for mental-health reform (September 17, 2015).
11. The Winona Daily News, Congress can finally make a
difference for mental-health reform (September 17, 2015).
12. Dubuque Telegraph Herald, Congress can finally make a
difference for mental-health reform (September 17, 2015).
13. Boulder Daily Camera, Congress can finally make a
difference for mental-health reform (September 17, 2015).
14. The Rome News-Tribune, Congress can finally make a
difference for mental-health reform (September 17, 2015).
15. Carlsbad Current Argus, Congress can finally make a
difference for mental-health reform (September 17, 2015).
16. Cecil Whig, Congress can finally make a difference for
mental-health reform (September 17, 2015).
17. The Seattle Times, Congress can finally make a
difference for mental-health reform (September 17, 2015).
18. Vero Beach Press Journal, Another View: Mental health
reform effort deserves support (September 22, 2015).
19. Alamogordo Daily News, Mental health reform effort
deserves support (September 25, 2015).
20. Grand Rapids Business Journal, Behavioral Health Care:
We Can Do Better Than This (October 2, 2015).
21. The Roanoke Times, Our view: Murphy's (would-be) law
(October 7, 2015).
22. The Dallas Morning News, Congress can rewrite mental
illness stories by doing this (October 21, 2015).
23. The San Francisco Chronicle, Crime, punishment and
mental health (October 22, 2015).
24. The National Review, Editorial: The Week (October 26,
2015).
25. North Dallas Gazette, Dealing with Mental Illness in a
Dysfunctional Society (October 28, 2015).
26. The Daily Courier, Seeking to help people before they
pull the trigger (October 29, 2015).
27. The Sacramento Bee, We've come to accept the
unacceptable (October 30, 2015).
28. The Washington Post, Movement on mental-health care
(November 1, 2015).
29. The National Review, Editorial: The Week (November 2,
2015).
30. Kane County Chronicle, Another view: Movement on Mental
Health Care (November 2, 2015).
31. Northwest Arkansas Democrat Gazette, Others say:
Movement on mental-health care (November 3, 2015).
32. Grand Forks Herald, OUR OPINION: Support US. House's
mental health care reform (November 4, 2015).
33. The Oklahoman, A review of state, federal mental health
laws is justified (November 9, 2015).
34. Sarasota Herald Tribune, Bill targets mental health
crisis (November 22, 2015).
35. The Wall Street Journal, The Next Mad Gunman (November
29, 2015).
36. The Tampa Bay Tribune, Confront Our Mental Health
Crisis (December 1, 2015).
37. PennLive, Full U.S. house should get a vote on Rep. Tim
Murphy's mental health bill (December 14, 2015).
38. The Scranton Times-Tribune, Retool mental health system
(December 16, 2015).
39. The Citizens Voice, Improve access to mental health
care (December 16, 2015).
40. New York Daily News, Sane law promises mental health
treatment for the dangerously insane (January 28, 2016).
41. Washington Post, A glimmer of hope for reforming mental
health care in America (June 25, 2016).
2013-2014 Editorial Endorsements
42. The Express-Times, Don't give up on background checks,
mental health reform (December 15, 2013).
43. Washington Observer-Reporter, Murphy's bill a step
toward mental health reform (December 21, 2013).
44. The Wall Street Journal, A Mental Health Overhaul
(December 25, 2013).
45. Houston Chronicle, Dealing with it (January 15, 2014).
46. The Wall Street Journal, The Definition of Insanity
(March 31, 2014).
47. Pittsburgh Post-Gazette, Worthy of Support: Murphy's
Mental Health Bill Faces the Critics (April 6, 2014).
48. The Toledo Blade, Worth of support (April 9, 2014).
49. Pittsburgh Post-Gazette, Better Care for the Mentally
Ill is Crucial for Our Society (April 13, 2014).
50. The Washington Post Mental health care in the U.S.
needs a check-up (April 16, 2014).
51. The Orange County Register, A Mental Health Fix That
Merits A Chance (April 21, 2014).
52. Mansfield News Journal, How Congress can solve our
mental-health crisis (May 19, 2014).
53. The Sacramento Bee, Efforts underway to prevent all-
too-often tragic results of untreated severe mental illness
(May 20, 2014).
54. The Fresno Bee, Orange County sets example with passage
of Laura's Law (May 21, 2014).
55. The Seattle Times, Mental-health reform to consider in
light of Santa Barbara shootings (May 28, 2014).
56. Cecil Whig, Rampage spurring new approaches (June 2,
2014).
57. The Arizona Republic, Reforms shouldn't protect `Big
Mental Health' (June 6, 2014).
58. National Review, Don't Go Wobbly on Mental Illness
(June 9, 2014).
59. The Sacramento Bee, San Francisco Casts Vote for
Compassion for People with Severe Mental Illness (July 9,
2014).
60. San Mateo Journal, A vote for compassion (July 10,
2014).
61. Ocala Star Banner, Mental health issue (August 18,
2014).
62. Bradenton Herald, Bill in Congress a solid overhaul of
America's broken mental health system (August 21, 2014).
63. Raleigh News & Observer, Pennsylvania Congressman has
Ideas to Address Mental Health Care (August 28, 2014).
64. The Fayetteville Observer, Mental health-care Overhaul
Bill Worth Attention (August 29, 2014).
65. The Tampa Tribune, Nation needs to treat mental illness
as a crisis (December 21, 2014).
Organizations
Adventist Health Care, American Academy of Child &
Adolescent Psychiatry, American Academy of Emergency
Medicine, American Academy of Forensic Sciences, American
Foundation For Suicide Prevention, American College of
Emergency Physicians,
[[Page H4324]]
American Occupational Therapy Association, Inc., American
Psychiatric Association, American Psychological Association,
Behavioral Health IT Coalition, California Psychiatric
Association, Center for Substance Abuse Research.
College of Psychiatric and Neurologic Pharmacists,
Developmental Disabilities Area Board 10 Los Angeles, Federal
Law Enforcement Association of America, International Bipolar
Foundation, Mental Health America, Mental Health Association
of Essex County, NJ.
Mental Illness FACTS, Mental Illness Policy Organization,
National Alliance on Mental Illness (NAMI), National
Association of Psychiatric Health Systems, NAMI Harlem, NAMI
Kentucky.
NAMI Los Angeles County, NAMI New York State, NAMI Ohio,
NAMI San Francisco, NAMI West Side Los Angeles, National
Association for the Advancement of Psychoanalysis, National
Association of Psychiatric Health Systems, National Council
for Behavioral Health, National Sheriffs' Association, No
Health Without Mental Health, Pennsylvania Medical Society,
Pine Rest Christian Mental Health Services.
Saint Paulus Lutheran Church (San Francisco), Schizophrenia
and Related Disorders Alliance of America, Sheppard Pratt
Hospital, Society of Hospital Medicine, Sunovian, Treatment
Advocacy Cater, Treatment Before Tragedy, University of
Pittsburgh, Department of Psychiatry, Washington Psychiatric
Society, New York State Association of Chiefs of Police.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 45 seconds to the
gentleman from Georgia (Mr. Carter).
Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for
yielding.
=========================== NOTE ===========================
July 6, 2016, on page H4324, the following appeared: Mr.
Speaker, I yield 45 seconds to the gentleman from Georgia (Mr.
Carter). . . . Mr. CARTER of Georgia. Mr. Speaker
The online version has been corrected to read: Mr. MURPHY of
Pennsylvania. Mr. Speaker, I yield 45 seconds to the gentleman
from Georgia (Mr. Carter). Mr. CARTER of Georgia. Mr. Speaker
========================= END NOTE =========================
Mr. Speaker, I rise today in support of H.R. 2646, the Helping
Families in Mental Health Crisis Act of 2015.
Mental health has become a crisis in our country. There is a
nationwide shortage of nearly 100,000 psychiatric beds. Three of the
largest mental health hospitals are, in fact, criminal incarceration
facilities. Only one child psychologist is available for every 2,000
children with a mental disorder.
Our Nation's mental health system is broken. Yet through the hard
work of my friend from Pennsylvania (Mr. Murphy), this bill fixes the
deficit that currently exists in our mental health system through
refocusing programs, reforming grants, and removing Federal barriers
for care. It provides for additional psychiatric hospital beds. It
advances telepsychiatry to allow for better coordination. It also
incentivizes States to provide community-based alternatives to
institutionalization.
This bill takes numerous steps to addressing the deficiencies that
our mental health community faces.
I commend Representative Tim Murphy for his work on this bill, and I
encourage my colleagues to support this bill.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 45 seconds to the
gentlewoman from California (Mrs. Mimi Walters).
Mrs. MIMI WALTERS of California. Mr. Speaker, I rise today in strong
support of the Helping Families in Mental Health Crisis Act.
Across this country, our mental health system is broken. Nearly 10
million Americans suffer from serious mental illness, and for far too
many of those individuals the Federal Government stands between them
and the care that they so desperately need.
The laws on the books are complicated and outdated, but with this
legislation, we have the opportunity to reform our national mental
health system. This bipartisan bill will refocus programs, reform
grants, and remove the Federal Government as a barrier to lifesaving
health care.
I urge my colleagues to support this critical legislation to improve
the quality and access to mental health care treatment.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 1 minute to the
gentleman from California (Mr. McCarthy), the majority leader of the
House of Representatives.
Mr. McCARTHY. Mr. Speaker, I thank the gentleman for yielding.
Mr. Speaker, it is a testament to Representative Tim Murphy's
expertise, persuasion, and sheer force of will that something so many
thought would be impossible is now inevitable.
The House will soon vote to pass Mr. Murphy's Helping Families in
Mental Health Crisis Act under suspension. Though this bill is the most
significant reform to our Nation's mental health program in decades, it
has such a breadth of bipartisan support that we know it will pass with
far more than a majority of votes in this House.
This is a work that Mr. Murphy of Pennsylvania has done not just for
1 month, not 2, not even 1 year, but I would say a lifetime of his
work. You see, each year, the Federal Government has responded with
money--$130 billion to be exact. But we cannot and should never
conflate the amount we spend with the effectiveness of the spending.
The Federal Government has 112 programs to address mental illness.
But coordination is limited and gaps are common. Children with mental
health disorders can't get psychiatrists. Criminal facilities are
commonly used to house mental health patients. Funding isn't going to
support evidence-based breakthroughs that improve people's lives.
We need simplification, coordination, and effectiveness. We need
reforms that help those who suffer from mental illness while also
making our Nation safer.
This bill is thorough and will deliver. From top to bottom it will
improve our fragmented mental health systems, giving new hope to those
too often forgotten and support to those truly in need.
It is an honor to be on this floor with Representative Tim Murphy. He
had the passion, but he had the servant's heart to never forget those
that he wanted to serve. Many of those did not have a voice, and many
of those felt left out, with no one there to speak for them.
Mr. Murphy of Pennsylvania has never given up, and he has shown that
the entire body of this House, and in essence willed it together, that
it came out of the Committee on Energy and Commerce unanimously, and I
hope on this floor we follow that direction.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield 45 seconds to the
gentleman from Illinois (Mr. LaHood.)
Mr. LaHOOD. Mr. Speaker, I rise in support of H.R. 2646 and commend
Dr. Murphy for introducing it.
Across the country, over 10 million Americans suffer from severe
mental illness. Unfortunately, many are not receiving their proper
treatment, including access to inpatient facilities or trained mental
health professionals.
In my prior life, I spent about 10 years as a State and Federal
prosecutor. In that role, I saw the negative effects of a broken mental
health system. It is a system in much need of reform in Illinois and
all across this country. I have litigated many cases in which mental
health played a significant role in the case, and I can assure you that
when it comes to mental illness, incarceration in prison is not the
solution.
This bill is a step in the right direction. It is comprehensive, and
it will help change the direction of our mental health system. I
strongly support it and urge my colleagues to support it.
Mr. PALLONE. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, this bill is an important and positive step towards
expanding and improving mental health care services in this country,
but it is only a first step. If we are serious about strengthening our
national mental health care system, we must expand access and dedicate
more resources.
Comprehensive legislation should include dedicating robust resources
to ensure access to community-based prevention, treatment, and recovery
services in every community across the country. It must provide
additional tools to strengthen mental health parity enforcement.
Democrats will stay focused on continuing to expand and improve the
continuum care for mental health care services.
That said, I do want my colleagues, and I urge my colleagues, to
support this bipartisan legislation, and let us also work together to
get the Senate to pass their bipartisan bill, and they need to go to
conference or somehow get a bill that would pass both Houses and get to
the President. I do pledge to my colleagues on the Republican side that
we need to do that between now and the end of year.
I wanted to take a moment to thank the Democratic committee staff who
worked so hard on this bill--most of them are on the floor--Tiffany
Guarascio, Waverly Gordon to my right, Rachel Pryor, Arielle Woronoff,
Una Lee, and, finally, our fellow, Kyle Fischer.
Again, I urge my colleagues to support this bill.
[[Page H4325]]
Mr. Speaker, I yield back the balance of my time.
Mr. MURPHY of Pennsylvania. Mr. Speaker, may I inquire how much time
I have remaining?
The SPEAKER pro tempore. The gentleman has 2\1/2\ minutes remaining.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield myself the balance
of my time.
I want to add my thanks also to the ranking member, Mr. Pallone, for
his steadfast work in this and to his staff. I have learned a lot from
them. We have had a lot of conversations and hopefully we have learned
from each other.
Particularly, I want to thank Eddie Bernice Johnson of Texas. Her
persistence and her role as a psychiatric nurse has been invaluable in
this whole process.
In addition, other Members on the other side of the aisle, Mr. Gene
Green of Texas and Ms. DeGette, Marcy Kaptur and Jim McDermott, who
have been incredible allies in this process, and, of course, the
chairman of the full committee, Mr. Upton.
The staff I want to thank are Gary Andres, Karen Christian, Sam
Spector, Paul Edattel, Adrianna Simonelli; my staff, Susan Mosychuk,
Scott Dziengelski; my former staff, Brad Grantz; and also Michelle
Rosenberg from the committee, for their help.
Publicly, I want to also thank those families who spoke up. Many
families came out of their pain--Senator Creigh Deeds, Cathy Costello
of Oklahoma, Anthony Hernandez of California and Jennifer Hoff of
California, Liza Long from up in Idaho, and Doris Fuller from nearby--
all talking about the suffering of their families.
Thousands of other families spoke up, but there are still millions
who suffer silently in the shadows trying to deal with mental illness
and a Federal Government that has failed them, States that have
underfunded it.
I appreciate the comments from my colleagues. Indeed, if we do not
fund some of these things we are authorizing here, it is a far cry from
what we need to do. But this bill comes a long way in reforming a
system.
I ask my colleagues also now, this is one of those moments to put
aside any political differences. In the 40 years that I have worked as
a psychologist, I have never once asked any of my patients what party
they belonged to. We were there to help them. This is our opportunity
to speak up for those who have no voice, as I said at the onset, the
last, the lost, the least, and the lonely. They depend on us.
I know that Members from both sides of the aisle have told me many
times of the stories that they have suffered themselves of their own
families and friends.
But now let me take a moment to set aside my title as Congressman or
as doctor but to talk as a family member.
I think I was in college at the time when I heard a soft voice call
in my house just saying ``help.'' It was my father. I went into the
bathroom where he was. He had cut the arteries in his arms and he was
bleeding out. I called an ambulance and asked them to come get help for
him. He eventually recovered and made peace. But it was that soft voice
calling for help that I responded to.
It is decades later and he is long gone. But it is that soft voice
that millions of Americans are also calling out for help.
We have a chance here with this bill to make a huge difference.
Unlike any other bills we may pass in Congress, this is one where I
think Members can really go back and say: Today I voted to save lives.
Let's have treatment before tragedy, because where there is help,
there is hope.
Mr. Speaker, I yield back the balance of my time.
Mr. LEVIN. Mr. Speaker, reforming our mental health system has been
an active priority of mine. That's why I supported legislation
increasing access to the mental health care, including the Mental
Health Parity Act of 1996, the Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008, the Excellence in
Mental Health Act, and the Affordable Care Act.
Among its provisions, the Affordable Care Act expanded mental health
parity protections by including mental health coverage as one of ten
Essential Health Benefit categories. The ACA also ended insurers'
ability to refuse to cover someone due to a pre-existing condition.
Prior to the ACA, insurers often declined to cover someone who had
diagnoses of mental health conditions such as bipolar disorder,
schizophrenia, and anorexia. This was no accident, and these important
mental health reforms were yet another reason I supported the ACA.
The amended version of H.R. 2646, the Helping Families in Mental
Health Crisis Act as reported out of Committee on the Energy and
Commerce, takes another meaningful step towards reforming our mental
health system by strengthening enforcement of mental health parity
requirements, increasing access to community-based treatment, and
growing the mental health workforce. I am pleased to support this
bipartisan legislation, and I look forward to working with my
colleagues in Congress to continue to improve the nation's mental
health system.
{time} 1445
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Pennsylvania (Mr. Murphy) that the House suspend the
rules and pass the bill, H.R. 2646, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. MURPHY of Pennsylvania. Mr. Speaker, on that I demand the yeas
and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this motion will be postponed.
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