[House Report 116-543]
[From the U.S. Government Publishing Office]


116th Congress  }                                              {   Report
                         HOUSE OF REPRESENTATIVES
 2d Session     }                                              {  116-543

======================================================================



 
EFFECTIVE SUICIDE SCREENING AND ASSESSMENT IN THE EMERGENCY DEPARTMENT 
                              ACT OF 2019

                                _______
                                

 September 29, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 4861]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4861) to amend the Public Health Service Act to 
establish a program to improve the identification, assessment, 
and treatment of patients in the emergency department who are 
at risk of suicide, and for other purposes, having considered 
the same, reports favorably thereon without amendment and 
recommends that the bill do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................1
 II. Background and Need for the Legislation..........................2
III. Committee Hearings...............................................2
 IV. Committee Consideration..........................................3
  V. Committee Votes..................................................3
 VI. Oversight Findings...............................................3
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures3
VIII.Federal Mandates Statement.......................................4

 IX. Statement of General Performance Goals and Objectives............4
  X. Duplication of Federal Programs..................................4
 XI. Committee Cost Estimate..........................................4
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......4
XIII.Advisory Committee Statement.....................................4

XIV. Applicability to Legislative Branch..............................4
 XV. Section-by-Section Analysis of the Legislation...................5
XVI. Changes in Existing Law Made by the Bill, as Reported............5

                         I. Purpose and Summary

    H.R. 4861, the ``Effective Suicide Screening and Assessment 
in the Emergency Department Act of 2019'', introduced on 
October 28, 2019, by Representatives Gus M. Bilirakis (R-FL) 
and Eliot L. Engel (D-NY), would create a grant program to 
improve the identification, assessment, and treatment of 
patients in emergency departments who are at risk for suicide 
by developing policies and procedures for identifying and 
assessing individuals who are at risk of suicide and enhancing 
the coordination of care for such individuals after discharge.

              II. Background and Need for the Legislation

    Data from 2018 show that 47.6 million American adults had a 
mental illness in the past year, while 11.4 million adults had 
a serious mental illness (SMI).\1\ Research also showed that an 
estimated 7.7 million children have a mental disorder.\2\
---------------------------------------------------------------------------
    \1\Id.
    \2\Whitney DG, Peterson MD. US National and State-Level Prevalence 
of Mental Health Disorders and Disparities of Mental Health Care Use in 
Children. JAMA Pediatr. (2019) (pubmed.ncbi.nlm.nih.gov/30742204/).
---------------------------------------------------------------------------
    Currently, substantial barriers to treatment exist for 
people with mental health conditions. Of those with mental 
health conditions, only slightly more than 43 percent say they 
have received treatment.\3\ For adults with SMI, 64.1 percent 
said they had received care.\4\ Overall, 11.2 million adults 
with mental conditions and 5.1 million adults with SMI said 
they had an unmet mental health treatment need in 2018.\5\
---------------------------------------------------------------------------
    \3\U.S. Department of Health and Human Services, Mental Health 
Myths and Fact (www.mentalhealth.gov) (accessed June 6, 2020).
    \4\Id.
    \5\Id.
---------------------------------------------------------------------------
    Past research found that one in every eight emergency 
department visits in the United States is related to a mental 
health or substance use disorder.\6\ A recent study by the 
University of Southern California Schaeffer Center found that 
emergency room visits for mental-health concerns have 
substantially increased since 2009, most of which were driven 
by adolescents and young adults.\7\
---------------------------------------------------------------------------
    \6\Moore BJ (IBM Watson Health), Stocks C (AHRQ), Owens PL (AHRQ). 
Trends in Emergency Department Visits, 2006-2014. HCUP Statistical 
Brief #227. (September 2017).
    \7\Genevieve Santillanes et al., National trends in mental health-
related emergency department visits by children and adults, 2009-2015, 
American Journal of Emergency Medicine. (December 20, 2019).
---------------------------------------------------------------------------
    H.R. 4861 would improve the identification, assessment, and 
treatment of patients in emergency departments who are at risk 
for suicide. Under the bill, the Secretary of Health and Human 
Services (the Secretary) is authorized to award grants aimed at 
supporting personnel and policies to improve suicide screening 
services and care in emergency rooms.

                        III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 4861:
    The Subcommittee on Health held a virtual legislative 
hearing on June 30, 2020, entitled ``High Anxiety and Stress: 
Legislation to Improve Mental Health During Crisis,'' to 
consider H.R. 4861, the ``Effective Suicide Screening and 
Assessment in the Emergency Department Act of 2019'', and 21 
other bills. The Subcommittee received testimony from the 
following witnesses:
           The Honorable Patrick J. Kennedy, Founder of 
        the Kennedy Forum and former Member of Congress
           Arthur C. Evans, Jr., Ph.D., Chief Executive 
        Officer, American Psychological Association
           Jeffrey L. Geller, M.D., M.P.H., President, 
        American Psychiatric Association, Professor of 
        Psychiatry and Director of Public Sector Psychiatry at 
        the University of Massachusetts Medical School 
        Worcester Recovery Center and Hospital
           Arriana Gross, National Youth Advisory Board 
        Member, Sandy Hook Promise Students Against Violence 
        Everywhere (SAVE) Promise Club

                      IV. Committee Consideration

    Representatives Bilirakis (R-FL) and Engel (D-NY) 
introduced H.R. 4861, the ``Effective Suicide Screening and 
Assessment in the Emergency Department Act of 2019'', on 
October 28, 2019, and the bill was referred to the Committee on 
Energy and Commerce. H.R. 4861 was then referred to the 
Subcommittee on Health on October 29, 2019. A virtual 
legislative hearing was held on the bill on July 30, 2020.
    On September 9, 2020, H.R. 4861 was discharged from further 
consideration by the Subcommittee on Health as it was called up 
for markup by the full Committee on Energy and Commerce. The 
full Committee met in virtual open markup session on September 
9, 2020, pursuant to notice, to consider H.R. 4861. There were 
no amendments offered to H.R. 4861. Upon conclusion of 
consideration of the bill, the full Committee agreed to a 
motion on final passage by Mr. Pallone, Chairman of the 
Committee, to order H.R. 4861 reported favorably to the House, 
without amendment, by a voice vote, a quorum being present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
4861, including the motion for final passage of the bill.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
establish a grant program at the U.S. Department of Health and 
Human Services to improve the identification, assessment, and 
treatment of patients in the emergency department who are at 
risk of suicide, and for other purposes.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 4861 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111--139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 4861 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``Effective Suicide Screening and Assessment in the 
Emergency Department Act of 2019''.

Sec. 2. Program to improve the care provided to patients in the 
        emergency department who are at risk of suicide

    Section 2 amends the Public Health Service Act to authorize 
the Secretary to establish a program to improve the 
identification, assessment, and treatment of patients in 
emergency departments who are at risk for suicide.
    Activities in this program include developing policies and 
procedures for identifying and assessing individuals who are at 
risk of suicide and enhancing the coordination of care for 
those individuals after discharge. Grants are limited to not 
more than 40 eligible health care sites, which are defined as 
hospitals with an emergency department that deploys onsite 
health care or social services professionals to connect at risk 
patients with mental health services.
    In awarding grants, the Secretary may give preference to 
critical access hospitals, sole community hospitals, entities 
operated by the Indian Health Service or an Indian Tribe or 
Tribal organization, or entities located in geographic areas 
with suicide rates higher than the national average. Grants in 
this program are awarded for at least two years.
    Health care sites receiving a grant must use the grant to 
train emergency department health care professionals to 
identify, assess, and treat patients at risk of suicide; 
establish and implement suicide-related identification, 
assessment, and treatment policies; and establish and implement 
evidence-based care coordination policies and procedures for 
discharging at-risk patients. Additional uses of the grant may 
include hiring emergency department mental health staff; 
developing and implementing of best practices for follow-up 
care and long-term treatment for individuals who are at risk of 
suicide; increasing evidence-based treatment; and providing 
consultation and referral to other support services.
    Grantees are required to submit an annual report to the 
Secretary that must include the number of individuals: 
screened, identified as being at-risk of suicide, and referred 
to other treatment facilities. The report must also include the 
effectiveness of programs at preventing suicides and suicide 
attempts, in addition to any other relevant information. The 
Secretary must submit a report to Congress by the end of fiscal 
year 2025 on the program's effectiveness, overall patient 
outcomes, and the policies, procedures, and best practices 
developed by grantees.
    The program is authorized at $20 million for fiscal years 
2020 through 2024.

       XVI. Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italics and existing law in which no change is 
proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT




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TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

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PART P--ADDITIONAL PROGRAMS

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SEC. 399V-7. PROGRAM TO IMPROVE THE CARE PROVIDED TO PATIENTS IN THE 
                    EMERGENCY DEPARTMENT WHO ARE AT RISK OF SUICIDE.

  (a) In General.--The Secretary shall establish a program (in 
this Act referred to as the ``Program'') to improve the 
identification, assessment, and treatment of patients in 
emergency departments who are at risk for suicide, including 
by--
          (1) developing policies and procedures for 
        identifying and assessing individuals who are at risk 
        of suicide; and
          (2) enhancing the coordination of care for such 
        individuals after discharge.
  (b) Grant Establishment and Participation.--
          (1) In general.--In carrying out the Program, the 
        Secretary shall award grants on a competitive basis to 
        not more than 40 eligible health care sites described 
        in paragraph (2).
          (2) Eligibility.--To be eligible for a grant under 
        this section, a health care site shall--
                  (A) submit an application to the Secretary at 
                such time, in such manner, and containing such 
                information as the Secretary may specify;
                  (B) be a hospital (as defined in section 
                1861(e) of the Social Security Act);
                  (C) have an emergency department; and
                  (D) deploy onsite health care or social 
                service professionals to help connect and 
                integrate patients who are at risk of suicide 
                with treatment and mental health support 
                services.
          (3) Preference.--In awarding grants under this 
        section, the Secretary may give preference to eligible 
        health care sites described in paragraph (2) that meet 
        at least one of the following criteria:
                  (A) The eligible health care site is a 
                critical access hospital (as defined in section 
                1861(mm)(1) of the Social Security Act).
                  (B) The eligible health care site is a sole 
                community hospital (as defined in section 
                1886(d)(5)(D)(iii) of the Social Security Act).
                  (C) The eligible health care site is operated 
                by the Indian Health Service, by an Indian 
                tribe or tribal organization (as such terms are 
                defined in section 4 of the Indian Self-
                Determination and Education Assistance Act), or 
                by an urban Indian organization (as defined in 
                section 4 of the Indian Health Care Improvement 
                Act).
                  (D) The eligible health care site is located 
                in a geographic area with a suicide rate that 
                is higher than the national rate, as determined 
                by the Secretary based on the most recent data 
                from the Centers for Disease Control and 
                Prevention.
  (c) Period of Grant.--A grant awarded to an eligible health 
care site under this section shall be for a period of at least 
2 years.
  (d) Grant Uses.--
          (1) Required uses.--A grant awarded under this 
        section to an eligible health care site shall be used 
        for the following purposes:
                  (A) To train emergency department health care 
                professionals to identify, assess, and treat 
                patients who are at risk of suicide.
                  (B) To establish and implement policies and 
                procedures for emergency departments to improve 
                the identification, assessment and treatment of 
                individuals who are at risk of suicide.
                  (C) To establish and implement policies and 
                procedures with respect to care coordination, 
                integrated care models, or referral to 
                evidence-based treatment to be used upon the 
                discharge from the emergency department of 
                patients who are at risk of suicide.
          (2) Additional permissible uses.--In addition to the 
        required uses listed in paragraph (1), a grant awarded 
        under this section to an eligible health care site may 
        be used for any of the following purposes:
                  (A) To hire emergency department 
                psychiatrists, psychologists, nurse 
                practitioners, counselors, therapists, or other 
                licensed health care and behavioral health 
                professionals specializing in the treatment of 
                individuals at risk of suicide.
                  (B) To develop and implement best practices 
                for the follow-up care and long-term treatment 
                of individuals who are at risk of suicide.
                  (C) To increase the availability of and 
                access to evidence-based treatment for 
                individuals who are at risk of suicide, 
                including through telehealth services and 
                strategies to reduce the boarding of these 
                patients in emergency departments.
                  (D) To offer consultation with and referral 
                to other supportive services that provide 
                evidence-based treatment and recovery for 
                individuals who are at risk of suicide.
  (e) Reporting Requirements.--
          (1) Reports by grantees.--Each eligible health care 
        site receiving a grant under this section shall submit 
        to the Secretary an annual report for each year for 
        which the grant is received on the progress of the 
        program funded through the grant. Each such report 
        shall include information on--
                  (A) the number of individuals screened in the 
                site's emergency department for being at risk 
                of suicide;
                  (B) the number of individuals identified in 
                the site's emergency department as being--
                          (i) survivors of an attempted 
                        suicide; or
                          (ii) are at risk of suicide;
                  (C) the number of individuals who are 
                identified in the site's emergency department 
                as being at risk of suicide by a health care or 
                behavioral health professional hired pursuant 
                to subsection (d)(2)(A);
                  (D) the number of individuals referred by the 
                site's emergency department to other treatment 
                facilities, the types of such other facilities, 
                and the number of such individuals admitted to 
                such other facilities pursuant to such 
                referrals;
                  (E) the effectiveness of programs and 
                activities funded through the grant in 
                preventing suicides and suicide attempts; and
                  (F) any other relevant additional data 
                regarding the programs and activities funded 
                through the grant.
          (2) Report by secretary.--Not less than one year 
        after the end of fiscal year 2024, the Secretary shall 
        submit to Congress a report that includes--
                  (A) findings on the Program;
                  (B) overall patient outcomes achieved through 
                the Program;
                  (C) an evaluation of the effectiveness of 
                having a trained health care or behavioral 
                health professional onsite to identify, assess, 
                and treat patients who are at risk of suicide; 
                and
                  (D) a compilation of policies, procedures, 
                and best practices established, developed, or 
                implemented by grantees under this section.
  (f) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section $20,000,000 for the 
period of fiscal years 2020 through 2024.

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