[House Report 116-544]
[From the U.S. Government Publishing Office]


116th Congress   }                                         {    Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                         {   116-544

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



 
  IMPROVING MENTAL HEALTH ACCESS FROM THE EMERGENCY DEPARTMENT ACT OF 
                                  2020

                                _______
                                

 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. 2519]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2519) to authorize the Secretary of Health and 
Human Services, acting through the Director of the Center for 
Mental Health Services of the Substance Abuse and Mental Health 
Services Administration, to award grants to implement 
innovative approaches to securing prompt access to appropriate 
follow-on care for individuals who experience an acute mental 
health episode and present for care in an emergency department, 
and for other purposes, having considered the same, reports 
favorably thereon with an amendment and recommends that the 
bill as amended do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................3
 II. Background and Need for the Legislation..........................3
III. Committee Hearings...............................................4
 IV. Committee Consideration..........................................5
  V. Committee Votes..................................................5
 VI. Oversight Findings...............................................5
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures5
VIII.Federal Mandates Statement.......................................6

 IX. Statement of General Performance Goals and Objectives............6
  X. Duplication of Federal Programs..................................6
 XI. Committee Cost Estimate..........................................6
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......6
XIII.Advisory Committee Statement.....................................6

XIV. Applicability to Legislative Branch..............................6
 XV. Section-by-Section Analysis of the Legislation...................6
XVI. Changes in Existing Law Made by the Bill, as Reported............7

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Improving Mental Health Access from 
the Emergency Department Act of 2020''.

SEC. 2. SECURING APPROPRIATE FOLLOW-ON CARE FOR ACUTE MENTAL HEALTH 
                    ILLNESS AFTER AN EMERGENCY DEPARTMENT ENCOUNTER.

  The Public Health Service Act is amended by inserting after section 
520J of such Act (42 U.S.C. 290bb-31) the following new section:

``SEC. 520J-1. SECURING APPROPRIATE FOLLOW-ON CARE FOR ACUTE MENTAL 
                    HEALTH ILLNESS AFTER AN EMERGENCY DEPARTMENT 
                    ENCOUNTER.

  ``(a) In General.--The Secretary may award grants on a competitive 
basis to qualifying health providers to implement innovative approaches 
to securing prompt access to appropriate follow-on care for individuals 
who experience an acute mental health episode and present for care in 
an emergency department.
  ``(b) Eligible Grant Recipients.--In this section, the term 
`qualifying health provider' means a health care facility licensed 
under applicable law that--
          ``(1) has an emergency department;
          ``(2) is staffed by medical personnel (such as emergency 
        physicians, psychiatrists, psychiatric registered nurses, 
        mental health technicians, clinical social workers, 
        psychologists, and therapists) capable of providing treatment 
        focused on stabilizing acute mental health conditions and 
        assisting patients to access resources to continue treatment in 
        the least restrictive appropriate setting; and
          ``(3) has arrangements in place with other providers of care 
        that can provide a full range of medically appropriate, 
        evidence-based services for the treatment of acute mental 
        health episodes.
  ``(c) Use of Funds.--A qualifying health provider receiving funds 
under this section shall use such funds to create, support, or expand 
programs or projects intended to assist individuals who are treated at 
the provider's emergency department for acute mental health episodes 
and to expeditiously transition such individuals to an appropriate 
facility or setting for follow-on care. Such use of funds may support 
the following:
          ``(1) Expediting placement in appropriate facilities through 
        activities such as expanded coordination with regional service 
        providers, assessment, peer navigators, bed availability 
        tracking and management, transfer protocol development, 
        networking infrastructure development, and transportation 
        services.
          ``(2) Increasing the supply of inpatient psychiatric beds and 
        alternative care settings such as regional emergency 
        psychiatric facilities.
          ``(3) Use of alternative approaches to providing psychiatric 
        care in the emergency department setting, including through 
        tele-psychiatric support and other remote psychiatric 
        consultation, implementation of peak period crisis clinics, or 
        creation of psychiatric emergency service units.
          ``(4) Use of approaches that include proactive followup such 
        as telephone check-ins, telemedicine, or other technology-based 
        outreach to individuals during the period of transition.
          ``(5) Such other activities as are determined by the 
        Secretary to be appropriate, consistent with subsection (a).
  ``(d) Application.--A qualifying health provider desiring a grant 
under this section shall prepare and submit an application to the 
Secretary at such time and in such manner as the Secretary may require. 
At a minimum, the application shall include the following:
          ``(1) A description of identified need for acute mental 
        health services in the provider's service area.
          ``(2) A description of the existing efforts of the provider 
        to meet the need for acute mental health services in the 
        service area, and identified gaps in the provision of such 
        services.
          ``(3) A description of the proposed use of funds to meet the 
        need and gaps identified pursuant to paragraph (2).
          ``(4) A description of how the provider will coordinate 
        efforts with Federal, State, local, and private entities within 
        the service area.
          ``(5) A description of program objectives, how the objectives 
        are proposed to be met, and how the provider will evaluate 
        outcomes relative to objectives.
  ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2021 through 2025.''.

                         I. Purpose and Summary

    H.R. 2519, the ``Improving Mental Health Access from the 
Emergency Department Act of 2020'', introduced by 
Representative Raul Ruiz (D-CA) on May 3, 2019, would authorize 
the Secretary of Health and Human Services (the Secretary) to 
award grants to qualifying emergency departments for the 
purpose of supporting mental health services. Grant recipients 
must use funds to support the provision of follow-up services 
for individuals who present for care of acute mental health 
episodes, such as placement in appropriate facilities.

              II. Background and Need for the Legislation

    Mental health is an essential part of overall health and 
includes an individual's emotional, psychological, and social 
well-being.\1\ Depression, anxiety, and post-traumatic stress 
disorder (PTSD) are among the most common mental health 
conditions in the United States. Nearly one third of adults 
report feeling worried, nervous, or anxious on a daily, weekly, 
or monthly basis.\2\ In 2018, 17 million adults and three 
million adolescents experienced a major depressive episode.\3\ 
Data from 2018 show that 47.6 million American adults had a 
mental illness in the past year, while 11.4 million adults had 
serious mental illness (SMI).\4\ Research also shows that an 
estimated 7.7 million children have a mental disorder.\5\
---------------------------------------------------------------------------
    \1\U.S. Department of Health and Human Services, What is Mental 
health? (www.mentalhealth.gov/basics/what-is-mental-health) (accessed 
June 5, 2020).
    \2\National Center for Health Statistics, National Health Interview 
Survey, 2015-2018 (www.cdc.gov/nchs/nhis/index.htm) (accessed June 5, 
2020).
    \3\Substance Abuse and Mental Health Services Administration. Key 
substance use and mental health indicators in the United States: 
Results from the 2018 National Survey on Drug Use and Health (2019) 
(www.samhsa.gov/data/sites/default/files/cbhsq-reports/
NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf).
    \4\ Id.
    \5\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/).
---------------------------------------------------------------------------
    The coronavirus disease of 2019 (COVID-19) public health 
emergency has triggered distress for many Americans, such as 
experiencing the loss of family or community members, loss of 
employment, insurance, and other supports.\6\ The Disaster 
Distress Helpline, supported by the Substance Abuse and Mental 
Health Services Administration (SAMHSA), saw an 891 percent 
increase in call volume in March 2020, compared to its call 
volume in March 2019.\7\ Research suggests that adverse 
emotional effects of the pandemic on people with mental health 
conditions may be exacerbated by physical distancing, self-
isolation, and fear.\8\ Some children and adolescents are 
experiencing additional emotional distress because of a 
disrupted school schedule, family stress, or abuse at home.\9\
---------------------------------------------------------------------------
    \6\Kaiser Family Foundation, The Implications of COVID-19 for 
Mental Health and Substance Use (Aug. 21, 2020) (www.kff.org/
coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-
mental-health-and-substance-use/).
    \7\Calls to US helpline jump 891%, as White House is warned of 
mental health crisis, ABC News (Apr. 7, 2020) (abcnews.go.com/Politics/
calls-us-helpline-jump-891-white-house-warned/story?id=70010113).
    \8\Kaiser Family Foundation, The Implications of COVID-19 for 
Mental Health and Substance Use (Apr. 21, 2020) (www.kff.org/
coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-
mental-health-and-substance-use/).
    \9\United Nations, Policy Brief: COVID-19 and the Need for Action 
on Mental Health, (May 13, 2020) (www.un.org/sites/un2.un.org/files/
un_policy_brief-covid_and_mental_health_final.pdf).
---------------------------------------------------------------------------
    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.\10\ For adults with SMI, 64.1 percent 
said they have received care.\11\ 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.\12\ 
Studies show that the most common reason individuals do not 
seek care is the inability to pay for services.\13\ Other 
barriers include fear of discrimination in housing or 
employment.\14\ Workforce shortages have also contributed to 
the lack of available treatment.\15\
---------------------------------------------------------------------------
    \10\U.S. Department of Health and Human Services, Mental Health 
Myths and Fact (www.mentalhealth.gov) (accessed June 6, 2020).
    \11\Id.
    \12\Id.
    \13\Novak P. et al., Behavioral health treatment utilization among 
individuals with co-occurring opioid use disorder and mental illness: 
Evidence from a national survey. Journal of Substance Abuse Treatment 
(2019).
    \14\Mojtabai R. et al., Comparing barriers to mental health 
treatment and substance use disorder treatment among individuals with 
comorbid major depression and substance use disorders. Journal of 
Substance Abuse Treatment (2014) (pubmed.ncbi.nlm.nih.gov/30665603/).
    \15\Health Resources & Services Administration, Health Professional 
Shortage Areas (data.hrsa.gov/topics/health-workforce/shortage-areas) 
(accessed June 5, 2020).
---------------------------------------------------------------------------
    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.\16\ 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.\17\
---------------------------------------------------------------------------
    \16\Moore B.J. (IBM Watson Health), Stocks C (AHRQ), Owens PL 
(AHRQ). Trends in Emergency Department Visits, 2006-2014. HCUP 
Statistical Brief #227. (September 2017).
    \17\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. 2519 would help to increase access to care for 
individuals who report to the emergency department for acute 
mental health episode. Under the bill, the Secretary is 
authorized to award grants to health care providers to support 
innovative approaches for providing follow-up care for 
individuals treated in the emergency department for acute 
mental health episodes.

                        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. 2519:
    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. 2519, the ``Improving Mental Health Access from 
the Emergency Department Act'', 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

    Representative Ruiz (D-CA) introduced H.R. 2519, the 
``Improving Mental Health Access from the Emergency Department 
Act of 2020'', on May 3, 2019, and the bill was referred to the 
Committee on Energy and Commerce. H.R. 2519 was then referred 
to the Subcommittee on Health on May 6, 2019. A legislative 
hearing was held on the bill on July 30, 2020.
    On September 9, 2020, H.R. 2519 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. 2519. During 
consideration of the bill, a Manager's amendment, offered by 
Mr. Ruiz, was agreed to by a voice vote. 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. 2519 reported favorably to the House, 
amended, 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. 
2519, 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 
authorize the Secretary, acting through the Director of the 
Center for Mental Health Services of SAMHSA, to award grants to 
implement innovative approaches to securing prompt access to 
appropriate follow-up care for individuals who experience an 
acute mental health episode and present for care in an 
emergency department, and for other purposes.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 2519 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. 2519 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 ``Improving Mental Health Access from the Emergency 
Department Act of 2020''.

Sec. 2. Securing appropriate follow up care for acute mental health 
        illness after an emergency department encounter

    Section 2 amends the Public Health Service Act to authorize 
the Secretary to award grants on a competitive basis to 
qualifying health providers to implement innovative approaches 
for securing prompt access to appropriate follow-up care for 
individuals who experience an acute mental health episode and 
present for care in an emergency department. A ``qualifying 
health provider'' is defined as a licensed facility that: has 
an emergency department; is staffed by medical personnel 
capable of providing treatment focused on stabilizing acute 
mental health conditions and assisting patients to access 
resources to continue treatment in the least restrictive 
emergency setting; and has arrangements in place with other 
providers of care that can provide a full range of medically 
appropriate, evidence-based services for the treatment of acute 
mental health episodes.
    Qualifying health providers that receive funding shall use 
the funds for the purposes of creating, supporting, or 
expanding programs or projects intended to assist individuals 
who are treated at the provider's emergency department for 
acute mental health episodes, and to expeditiously transition 
such individuals to an appropriate facility or setting for 
follow-up care. Those criteria include: expediting placement in 
appropriate facility; increasing the supply of inpatient 
psychiatric beds and alternative care settings; use of 
alternative approaches to providing psychiatric care in 
emergency department settings (such as tele-psychiatric support 
and other remote psychiatric consultation, or implementation of 
peak period crisis clinics); use of approaches that include 
proactive follow-up (such as telephone check-ins or 
telemedicine); and such other relevant activities determined by 
the Secretary.
    At a minimum, qualifying health care providers who apply 
must provide the Secretary with descriptions of: identified 
needs for acute mental health services in the provider's 
service area; existing efforts to meet the need for acute 
mental health services in the service area and identified gaps 
in those efforts; proposed uses of the grant funds; and how the 
provider will coordinate efforts with Federal, State, local, 
and private entities within the services area. In addition, 
qualifying providers must also provide the Secretary with their 
program objectives, how those objectives are proposed to be 
met, and how the provider will evaluate outcomes relative to 
those objectives.
    Section 2 authorizes $15 million for each of the fiscal 
years 2021 through 2025.

       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



           *       *       *       *       *       *       *
TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

           *       *       *       *       *       *       *


Part B--Centers and Programs

           *       *       *       *       *       *       *


Subpart 3--Center for Mental Health Services

           *       *       *       *       *       *       *


SEC. 520J-1. SECURING APPROPRIATE FOLLOW-ON CARE FOR ACUTE MENTAL 
                    HEALTH ILLNESS AFTER AN EMERGENCY DEPARTMENT 
                    ENCOUNTER.

  (a) In General.--The Secretary may award grants on a 
competitive basis to qualifying health providers to implement 
innovative approaches to securing prompt access to appropriate 
follow-on care for individuals who experience an acute mental 
health episode and present for care in an emergency department.
  (b) Eligible Grant Recipients.--In this section, the term 
``qualifying health provider'' means a health care facility 
licensed under applicable law that--
          (1) has an emergency department;
          (2) is staffed by medical personnel (such as 
        emergency physicians, psychiatrists, psychiatric 
        registered nurses, mental health technicians, clinical 
        social workers, psychologists, and therapists) capable 
        of providing treatment focused on stabilizing acute 
        mental health conditions and assisting patients to 
        access resources to continue treatment in the least 
        restrictive appropriate setting; and
          (3) has arrangements in place with other providers of 
        care that can provide a full range of medically 
        appropriate, evidence-based services for the treatment 
        of acute mental health episodes.
  (c) Use of Funds.--A qualifying health provider receiving 
funds under this section shall use such funds to create, 
support, or expand programs or projects intended to assist 
individuals who are treated at the provider's emergency 
department for acute mental health episodes and to 
expeditiously transition such individuals to an appropriate 
facility or setting for follow-on care. Such use of funds may 
support the following:
          (1) Expediting placement in appropriate facilities 
        through activities such as expanded coordination with 
        regional service providers, assessment, peer 
        navigators, bed availability tracking and management, 
        transfer protocol development, networking 
        infrastructure development, and transportation 
        services.
          (2) Increasing the supply of inpatient psychiatric 
        beds and alternative care settings such as regional 
        emergency psychiatric facilities.
          (3) Use of alternative approaches to providing 
        psychiatric care in the emergency department setting, 
        including through tele-psychiatric support and other 
        remote psychiatric consultation, implementation of peak 
        period crisis clinics, or creation of psychiatric 
        emergency service units.
          (4) Use of approaches that include proactive followup 
        such as telephone check-ins, telemedicine, or other 
        technology-based outreach to individuals during the 
        period of transition.
          (5) Such other activities as are determined by the 
        Secretary to be appropriate, consistent with subsection 
        (a).
  (d) Application.--A qualifying health provider desiring a 
grant under this section shall prepare and submit an 
application to the Secretary at such time and in such manner as 
the Secretary may require. At a minimum, the application shall 
include the following:
          (1) A description of identified need for acute mental 
        health services in the provider's service area.
          (2) A description of the existing efforts of the 
        provider to meet the need for acute mental health 
        services in the service area, and identified gaps in 
        the provision of such services.
          (3) A description of the proposed use of funds to 
        meet the need and gaps identified pursuant to paragraph 
        (2).
          (4) A description of how the provider will coordinate 
        efforts with Federal, State, local, and private 
        entities within the service area.
          (5) A description of program objectives, how the 
        objectives are proposed to be met, and how the provider 
        will evaluate outcomes relative to objectives.
  (e) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated $15,000,000 for 
each of fiscal years 2021 through 2025.

           *       *       *       *       *       *       *


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