I 

114TH CONGRESS 

2D SESSION H. R. 4388 

To amend the Public Health Service Act to authorize a primary and 

behavioral health care integration grant program. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 13, 2016 

Mr. LOEBSACK (for himself, Mr. TONKO, Mr. KENNEDY, and Ms. MATSUI) 

introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to authorize a 

primary and behavioral health care integration grant program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Behavioral Health 

5 Care Integration Act of 2016’’. 

6 SEC. 2. PRIMARY AND BEHAVIORAL HEALTH CARE INTE7 GRATION GRANT PROGRAMS. 

8 Section 520K of the Public Health Service Act (42 

9 U.S.C. 290bb–42) is amended to read as follows: 


smartinez on DSK4TPTVN1PROD with BILLS
2 

•HR 4388 IH

1 ‘‘SEC. 520K. INTEGRATION INCENTIVE GRANTS. 

2 ‘‘(a) IN GENERAL.—The Secretary shall establish a 

3 primary and behavioral health care integration grant pro4 gram. The Secretary may award grants and cooperative 

5 agreements to eligible entities to expend funds for im6 provements in integrated settings with integrated prac7 tices. 

8 ‘‘(b) DEFINITIONS.—In this section: 

9 ‘‘(1) INTEGRATED CARE.—The term ‘integrated 

10 care’ means full collaboration in merged or trans11 formed practices offering behavioral and physical 

12 health services within the same shared practice 

13 space in the same facility, where the entity— 

14 ‘‘(A) provides services in a shared space 

15 that ensures services will be available and ac16 cessible promptly and in a manner which pre17 serves human dignity and assures continuity of 

18 care; 

19 ‘‘(B) ensures communication among the in20 tegrated care team that is consistent and team21 based; 

22 ‘‘(C) ensures shared decisionmaking be23 tween behavioral health and primary care pro24 viders; 


smartinez on DSK4TPTVN1PROD with BILLS
3 

•HR 4388 IH

1 ‘‘(D) provides evidence-based services in a 

2 mode of service delivery appropriate for the tar3 get population; 

4 ‘‘(E) employs staff who are multidisci5 plinary and culturally and linguistically com6 petent; 

7 ‘‘(F) provides integrated services related to 

8 screening, diagnosis, and treatment of mental 

9 illness and substance use disorder and co-occur10 ring primary care conditions and chronic dis11 eases; and 

12 ‘‘(G) provides targeted case management, 

13 including services to assist individuals gaining 

14 access to needed medical, social, educational, 

15 and other services and applying for income se16 curity, housing, employment, and other benefits 

17 to which they may be entitled. 

18 ‘‘(2) INTEGRATED CARE TEAM.—The term ‘in19 tegrated care team’ means a team that includes— 

20 ‘‘(A) allopathic or osteopathic medical doc21 tors, such as a primary care physician and a 

22 psychiatrist; 

23 ‘‘(B) licensed clinical behavioral health 

24 professionals, such as psychologists or social 

25 workers; 


smartinez on DSK4TPTVN1PROD with BILLS
4 

•HR 4388 IH

1 ‘‘(C) a case manager; and 

2 ‘‘(D) other members, such as psychiatric 

3 advanced practice nurses, physician assistants, 

4 peer-support specialists or other allied health 

5 professionals, such as mental health counselors. 

6 ‘‘(3) SPECIAL POPULATION.—The term ‘special 

7 population’ means— 

8 ‘‘(A) adults with mental illnesses who have 

9 co-occurring primary care conditions with 

10 chronic diseases; 

11 ‘‘(B) adults with serious mental illnesses 

12 who have co-occurring primary care conditions 

13 with chronic diseases; 

14 ‘‘(C) children and adolescents with serious 

15 emotional disorders with co-occurring primary 

16 care conditions and chronic diseases; 

17 ‘‘(D) older adults with mental illness who 

18 have co-occurring primary care conditions with 

19 chronic conditions; 

20 ‘‘(E) individuals with substance use dis21 order; or 

22 ‘‘(F) individuals from populations for 

23 which there is a significant disparity in the 

24 quality, outcomes, cost, or use of mental health 

25 or substance use disorder services or a signifiVerDate Sep 11 2014 02:24 Jan 14, 2016 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4388.IH H4388

smartinez on DSK4TPTVN1PROD with BILLS
5 

•HR 4388 IH

1 cant disparity in access to such services, as 

2 compared to the general population, such as ra3 cial and ethnic minorities and rural populations. 

4 ‘‘(c) PURPOSE.—The grant program under this sec5 tion shall be designed to lead to full collaboration between 

6 primary and behavioral health in an integrated practice 

7 model to ensure that— 

8 ‘‘(1) the overall wellness and physical health 

9 status of individuals with serious mental illness and 

10 co-occurring substance use disorders is supported 

11 through integration of primary care into community 

12 mental health centers meeting the criteria specified 

13 in section 1913(c) of the Social Security Act or cer14 tified community behavioral health clinics described 

15 in section 223 of the Protecting Access to Medicare 

16 Act of 2014; or 

17 ‘‘(2) the mental health status of individuals 

18 with significant co-occurring psychiatric and physical 

19 conditions will be supported through integration of 

20 behavioral health into primary care settings. 

21 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 

22 a grant or cooperative agreement under this section, an 

23 entity shall be a State department of health, State mental 

24 health or addiction agency, State Medicaid agency, or li25 censed health care provider or institution. The AdminisVerDate Sep 11 2014 02:24 Jan 14, 2016 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4388.IH H4388

smartinez on DSK4TPTVN1PROD with BILLS
6 

•HR 4388 IH

1 trator may give preference to States that have existing in2 tegrated care models, such as those authorized by section 

3 1945 of the Social Security Act. 

4 ‘‘(e) APPLICATION.—An eligible entity desiring a 

5 grant or cooperative agreement under this section shall 

6 submit an application to the Administrator at such time, 

7 in such manner, and accompanied by such information as 

8 the Administrator may require, including a description of 

9 a plan to achieve fully collaborative agreements to provide 

10 services to special populations and— 

11 ‘‘(1) a document that summarizes the State12 specific policies that inhibit the provision of inte13 grated care, and the specific steps that will be taken 

14 to address such barriers, such as through licensing 

15 and billing procedures; and 

16 ‘‘(2) a plan to develop and share a de-identified 

17 patient registry to track treatment implementation 

18 and clinical outcomes to inform clinical interven19 tions, patient education, and engagement with 

20 merged or transformed integrated practices in com21 pliance with applicable national and State health in22 formation privacy laws. 

23 ‘‘(f) GRANT AMOUNTS.—The maximum annual grant 

24 amount under this section shall be $2,000,000, of which 

25 not more than 10 percent may be allocated to State adVerDate Sep 11 2014 02:24 Jan 14, 2016 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4388.IH H4388

smartinez on DSK4TPTVN1PROD with BILLS
7 

•HR 4388 IH

1 ministrative functions, and the remaining amounts shall 

2 be allocated to health facilities that provide integrated 

3 care. 

4 ‘‘(g) DURATION.—A grant under this section shall be 

5 for a period of 5 years. 

6 ‘‘(h) REPORT ON PROGRAM OUTCOMES.—An entity 

7 receiving a grant or cooperative agreement under this sec8 tion shall submit an annual report to the Administrator 

9 that includes— 

10 ‘‘(1) the progress to reduce barriers to inte11 grated care, including regulatory and billing bar12 riers, as described in the entity’s application under 

13 subsection (d); and 

14 ‘‘(2) a description of functional outcomes of 

15 special populations, such as— 

16 ‘‘(A) with respect to individuals with seri17 ous mental illness, participation in supportive 

18 housing or independent living programs, en19 gagement in social or education activities, par20 ticipation in job training or employment oppor21 tunities, attendance at scheduled medical and 

22 mental health appointments, and compliance 

23 with treatment plans; 

24 ‘‘(B) with respect to individuals with co-oc25 curring mental illness and primary care condiVerDate Sep 11 2014 02:24 Jan 14, 2016 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4388.IH H4388

smartinez on DSK4TPTVN1PROD with BILLS
8 

•HR 4388 IH

1 tions and chronic diseases, attendance at sched2 uled medical and mental health appointments, 

3 compliance with treatment plans, and participa4 tion in learning opportunities related to im5 proved health and lifestyle practice; and 

6 ‘‘(C) with respect to children and adoles7 cents with serious emotional disorders who have 

8 co-occurring primary care conditions and chron9 ic diseases, attendance at scheduled medical 

10 and mental health appointments, compliance 

11 with treatment plans, and participation in 

12 learning opportunities at school and extra13 curricular activities. 

14 ‘‘(i) TECHNICAL ASSISTANCE CENTER FOR PRIMARY15 BEHAVIORAL HEALTH CARE INTEGRATION.— 

16 ‘‘(1) IN GENERAL.—The Secretary shall estab17 lish a program through which such Secretary shall 

18 provide appropriate information, training, and tech19 nical assistance to eligible entities that receive a 

20 grant or cooperative agreement under this section, in 

21 order to help such entities to meet the requirements 

22 of this section, including assistance with— 

23 ‘‘(A) development and selection of inte24 grated care models; 


smartinez on DSK4TPTVN1PROD with BILLS
9 

•HR 4388 IH

1 ‘‘(B) dissemination of evidence-based inter2 ventions in integrated care; 

3 ‘‘(C) establishment of organizational prac4 tices to support operational and administrative 

5 success; and 

6 ‘‘(D) other activities, as the Secretary de7 termines appropriate. 

8 ‘‘(2) ADDITIONAL DISSEMINATION OF TECH9 NICAL INFORMATION.—The information and re10 sources provided by the technical assistance program 

11 established under paragraph (1) shall be made avail12 able to States, political subdivisions of a State, In13 dian tribes or tribal organizations (as defined in sec14 tion 4 of the Indian Self-Determination and Edu15 cation Assistance Act), outpatient mental health and 

16 addiction treatment centers, community mental 

17 health centers that meet the criteria under section 

18 1913(c), certified community behavioral health clin19 ics described in section 223 of the Protecting Access 

20 to Medicare Act of 2014, primary care organizations 

21 such as Federally qualified health centers or rural 

22 health centers, other community-based organiza23 tions, or other entities engaging in integrated care 

24 activities, as the Secretary determines appropriate. 


smartinez on DSK4TPTVN1PROD with BILLS
10 

•HR 4388 IH

1 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 

2 carry out this section, there are authorized to be appro3 priated $50,000,000 for each of fiscal years 2017 through 

4 2021, of which $2,000,000 shall be available to the tech5 nical assistance program under subsection (i).’’. 

Æ 


smartinez on DSK4TPTVN1PROD with BILLS