I 

108TH CONGRESS 

1ST SESSION H. R. 2241

To amend the Public Health Service Act with respect to mental health 

services for elderly individuals. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 22, 2003

Mr. KENNEDY of Rhode Island (for himself, Mr. HOYER, Mr. SERRANO, Ms. 

JACKSON-LEE of Texas, Mr. KILDEE, Mr. WYNN, Mrs. NAPOLITANO, Mr. 

FROST, Mr. MCNULTY, Mr. ACEVEDO-VILA ́, Mr. LIPINSKI, Ms. LEE, Mr. 

MENENDEZ, and Mr. WAXMAN) introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

A BILL

To amend the Public Health Service Act with respect to 

mental health services for elderly individuals.

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 ‘‘Positive Aging Act of 

5 2003’’. 

6 SEC. 2. FINDINGS; STATEMENT OF PURPOSE. 

7 (a) FINDINGS.—The Congress finds that—

(1) although, on average, 1 8 ⁄4 of all patients seen 

9 in primary care settings have a mental disorder, pri-
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1 mary care practitioners identify such illness in only 

2 about half of these cases; 

3 (2) four mental disorders are among the 10 

4 leading causes of disability in the United States; 

5 (3) among the elderly, 10 percent have demen6 tia and as many as one quarter have significant clin7 ical depression; 

8 (4) access to mental health services by the el9 derly is compromised by health benefits coverage 

10 limits, gaps in the mental health services delivery 

11 system, and shortages of geriatric mental health 

12 practitioners; 

13 (5) the integration of medical and mental 

14 health treatment provides an effective means of co15 ordinating care, improving mental health outcomes, 

16 and saving health care dollars; and 

17 (6) the treatment of mental disorders in older 

18 patients, particularly those with other chronic dis19 eases, can improve health outcomes and the quality 

20 of life for these patients. 

21 (b) STATEMENT OF PURPOSE.—In order to address 

22 the emerging crisis in the identification and treatment of 

23 mental disorders among the elderly, it is the purpose of 

24 this Act to—
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1 (1) promote models of care that integrate men2 tal health services and medical care within primary 

3 care settings; and 

4 (2) improve access by older adults to mental 

5 health services in community-based settings. 

6 TITLE I—ENHANCING ACCESS 

7 TO MENTAL HEALTH SERV8 ICES FOR THE ELDERLY 

9 SEC. 101. SERVICES IMPLEMENTATION PROJECTS TO SUP10 PORT INTEGRATION OF MENTAL HEALTH 

11 SERVICES IN PRIMARY CARE SETTINGS. 

12 Subpart 3 of part B of title V of the Public Health 

13 Service Act (42 U.S.C. 290bb–31 et seq.) is amended—

14 (1) in section 520(b)—

15 (A) in paragraph (14), by striking ‘‘and’’ 

16 at the end; 

17 (B) in paragraph (15), by striking the pe18 riod at the end and inserting ‘‘; and’’; and 

19 (C) by adding at the end the following 

20 paragraph: 

21 ‘‘(16) conduct the demonstration projects speci22 fied in section 520K.’’; and 

23 (2) by adding at the end the following section: 
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1 ‘‘SEC. 520K. PROJECTS TO DEMONSTRATE INTEGRATION OF 

2 MENTAL HEALTH SERVICES IN PRIMARY 

3 CARE SETTINGS. 

4 ‘‘(a) IN GENERAL.—The Secretary, acting through 

5 the Director of the Center for Mental Health Services, 

6 shall make grants to public and private nonprofit entities 

7 for evidence-based projects to demonstrate ways of inte8 grating mental health services for older patients into pri9 mary care settings, such as health centers receiving a 

10 grant under section 330 (or determined by the Secretary 

11 to meet the requirements for receiving such a grant), other 

12 Federally qualified health centers, primary care clinics, 

13 and private practice sites. 

14 ‘‘(b) REQUIREMENTS.—In order to qualify for a 

15 grant under this section, a project shall provide for col16 laborative care within a primary care setting, involving 

17 psychiatrists, psychologists, and other licensed mental 

18 health professionals with appropriate training and experi19 ence in the treatment of older adults, in which screening, 

20 assessment, and intervention services are combined into 

21 an integrated service delivery model, including—

22 ‘‘(1) screening services by a mental health pro23 fessional with at least a masters degree in an appro24 priate field of training, supported by psychiatrists 

25 and psychologists with appropriate training and ex26 perience in the treatment of older adults to ensure 
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1 adequate consideration of biomedical and psycho2 social conditions, respectively; 

3 ‘‘(2) referrals for necessary prevention, inter4 vention, follow-up care, consultations, and care plan5 ning oversight for mental health and other service 

6 needs, as indicated; and 

7 ‘‘(3) adoption and implementation of evidence8 based protocols, to the extent available, for prevalent 

9 mental health disorders, including depression, anx10 iety, behavioral and psychological symptoms of de11 mentia, psychosis, and misuse of, or dependence on, 

12 alcohol or medication. 

13 ‘‘(c) CONSIDERATIONS IN AWARDING GRANTS.—To 

14 the extent feasible, the Secretary shall ensure that—

15 ‘‘(1) grants under this section are awarded to 

16 projects in a variety of geographic areas, including 

17 urban and rural areas; and

18 ‘‘(2) the needs of ethnically diverse at-risk pop19 ulations are addressed. 

20 ‘‘(d) DURATION.—A project may receive funding pur21 suant to a grant under this section for a period of up to 

22 3 years, with an extension period of 2 additional years 

23 at the discretion of the Secretary. 
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1 ‘‘(e) APPLICATION.—In order to receive a grant 

2 under this section, a public or private nonprofit entity 

3 shall—

4 ‘‘(1) submit an application to the Secretary (in 

5 such form, containing such information, and at such 

6 time as the Secretary may specify); and 

7 ‘‘(2) agree to report to the Secretary standard8 ized clinical and behavioral data necessary to evalu9 ate patient outcomes and to facilitate evaluations 

10 across participating projects. 

11 ‘‘(f) EVALUATION.—Not later than 6 months after 

12 the close of a calendar year, the Secretary shall submit 

13 to the Congress a report evaluating the projects receiving 

14 awards under this section for such year. 

15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated for fiscal year 2004 and 

17 each fiscal year thereafter such sums as may be necessary 

18 to carry out this section.’’. 

19 SEC. 102. GRANTS FOR COMMUNITY-BASED MENTAL 

20 HEALTH TREATMENT OUTREACH TEAMS. 

21 Subpart 3 of part B of title V of the Public Health 

22 Service Act (42 U.S.C. 290bb–31 et seq.), as amended by 

23 section 101 of this Act, is further amended by adding at 

24 the end the following section: 
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1 ‘‘SEC. 520L. GRANTS FOR COMMUNITY-BASED MENTAL 

2 HEALTH TREATMENT OUTREACH TEAMS. 

3 ‘‘(a) IN GENERAL.—The Secretary, acting through 

4 the Director of the Center for Mental Health Services, 

5 shall make grants to public or private nonprofit entities 

6 that are community-based providers of geriatric mental 

7 health services, to support the establishment and mainte8 nance by such entities of multi-disciplinary geriatric men9 tal health outreach teams in community settings where 

10 older adults reside or receive social services. Entities eligi11 ble for such grants include—

12 ‘‘(1) mental health service providers of a State 

13 or local government; 

14 ‘‘(2) outpatient programs of private, nonprofit 

15 hospitals; 

16 ‘‘(3) community mental health centers meeting 

17 the criteria specified in section 1913(c); and 

18 ‘‘(4) other community-based providers of mental 

19 health services. 

20 ‘‘(b) REQUIREMENTS.—In order to qualify for a 

21 grant under this section, an entity shall—

22 ‘‘(1) adopt and implement, for use by its mental 

23 health outreach team, evidence-based intervention 

24 and treatment protocols (to the extent such proto25 cols are available) for mental disorders prevalent in 
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1 older adults, relying to the greatest extent feasible 

2 on protocols that have been developed—

3 ‘‘(A) by or under the auspices of the Sec4 retary; or 

5 ‘‘(B) by academicians with expertise in 

6 mental health and aging; 

7 ‘‘(2) provide screening for mental disorders, di8 agnostic services, referrals for treatment, and case 

9 management and coordination through such teams; 

10 and 

11 ‘‘(3) coordinate and integrate the services pro12 vided by such team with the services of social serv13 ice, mental health, medical, and other health care 

14 providers at the site or sites where the team is based 

15 in order to—

16 ‘‘(A) improve patient outcomes; and 

17 ‘‘(B) to ensure, to the maximum extent 

18 feasible, the continuing independence of older 

19 adults who are residing in the community. 

20 ‘‘(c) COOPERATIVE ARRANGEMENTS WITH SITES

21 SERVING AS BASES FOR OUTREACH TEAMS.—An entity 

22 receiving a grant under this section may enter into an 

23 agreement with a person operating a site at which a geri24 atric mental health outreach team of the entity is based, 

25 including—
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1 ‘‘(1) senior centers; 

2 ‘‘(2) adult day care programs; 

3 ‘‘(3) assisted living facilities; and 

4 ‘‘(4) recipients of grants to provide services to 

5 senior citizens under the Older Americans Act, 

6 under which such person provides (and is reim7 bursed by the entity, out of funds received under the 

8 grant, for) any supportive services, such as transpor9 tation and administrative support, that such person 

10 provides to an outreach team of such entity. 

11 ‘‘(d) CONSIDERATIONS IN AWARDING GRANTS.—To 

12 the extent feasible, the Secretary shall ensure that—

13 ‘‘(1) grants under this section are awarded to 

14 projects in a variety of geographic areas, including 

15 urban and rural areas; and 

16 ‘‘(2) the needs of ethnically diverse at-risk pop17 ulations are addressed. 

18 ‘‘(e) APPLICATION.—In order to receive a grant 

19 under this section, an entity shall—

20 ‘‘(1) submit an application to the Secretary (in 

21 such form, containing such information, and at such 

22 time as the Secretary may specify); and 

23 ‘‘(2) agree to report to the Secretary standard24 ized clinical and behavioral data necessary to evalu-
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1 ate patient outcomes and to facilitate evaluations 

2 across participating projects. 

3 ‘‘(f) EVALUATION.—Not later than 6 months after 

4 the close of a calendar year, the Secretary shall submit 

5 to the Congress a report evaluating the programs receiving 

6 a grant under this section for such year. 

7 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated for fiscal year 2004 and 

9 each fiscal year thereafter such sums as may be necessary 

10 to carry out this section.’’. 

11 TITLE II—ADMINISTRATIVE 

12 CHANGES TO STRENGTHEN 

13 PROGRAMS FOR GERIATRIC 

14 MENTAL HEALTH SERVICES 

15 SEC. 201. DESIGNATION OF DEPUTY DIRECTOR FOR GERI16 ATRIC MENTAL HEALTH SERVICES IN CEN17 TER FOR MENTAL HEALTH SERVICES. 

18 Section 520 of the Public Health Service Act (42 

19 U.S.C. 290bb–31) is amended by redesignating subsection

20 (c) as subsection (d) and inserting after subsection (b) the 

21 following: 

22 ‘‘(c) DEPUTY DIRECTOR FOR GERIATRIC MENTAL

23 HEALTH SERVICES.—The Director, after consultation 

24 with the Administrator, shall designate a Deputy Director 

25 for Geriatric Mental Health Services, who shall be respon-
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1 sible for the development and implementation of initiatives 

2 of the Center to address the mental health needs of older 

3 adults. Such initiatives shall include—

4 ‘‘(1) research on prevention and identification 

5 of mental disorders in the geriatric population; 

6 ‘‘(2) innovative demonstration projects for the 

7 delivery of community-based mental health services 

8 for older Americans; 

9 ‘‘(3) support for the development and dissemi10 nation of evidence-based practice models, including 

11 models to address dependence on, and misuse of, al12 cohol and medication in older adults; and 

13 ‘‘(4) development of model training programs 

14 for mental health professionals and caregivers serv15 ing older adults.’’. 

16 SEC. 202. MEMBERSHIP OF ADVISORY COUNCIL FOR THE 

17 CENTER FOR MENTAL HEALTH SERVICES. 

18 Section 502(b)(3) of the Public Health Service Act 

19 (42 U.S.C. 290aa–1(b)(3)) is amended by adding at the 

20 end the following: 

21 ‘‘(C) In the case of the advisory council for 

22 the Center for Mental Health Services, the 

23 members appointed pursuant to subparagraphs 

24 (A) and (B) shall include representatives of 

25 older Americans, their families, and geriatric 
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1 mental health specialists, including at least 1 

2 physician with board certification in geriatric 

3 psychiatry and at least 1 psychologist with ap4 propriate training and experience in the treat5 ment of older adults.’’. 

6 SEC. 203. PROJECTS OF NATIONAL SIGNIFICANCE TAR7 GETING SUBSTANCE ABUSE IN OLDER 

8 ADULTS. 

9 Section 509(b)(2) of the Public Health Service Act 

10 (42 U.S.C. 290bb–2(b)(2)) is amended by inserting before 

11 the period the following: ‘‘, and to providing treatment for 

12 older adults with alcohol or substance abuse or addiction, 

13 including medication misuse or dependence’’. 

14 SEC. 204. CRITERIA FOR STATE PLANS UNDER COMMUNITY 

15 MENTAL HEALTH SERVICES BLOCK GRANTS. 

16 (a) IN GENERAL.—Section 1912(b) of the Public 

17 Health Service Act (42 U.S.C. 300x–2(b)) is amended by 

18 inserting after paragraph (5) the following: 

19 ‘‘(6) GOALS AND INITIATIVES FOR IMPROVING

20 ACCESS TO SERVICES FOR OLDER ADULTS.—The 

21 plan—

22 ‘‘(A) specifies goals for improving access 

23 by older Americans to community-based mental 

24 health services; 
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1 ‘‘(B) includes a plan identifying and ad2 dressing the unmet needs of such individuals 

3 for mental health services; and 

4 ‘‘(C) includes an inventory of the services, 

5 personnel, and treatment sites available to im6 prove the delivery of mental health services to 

7 such individuals.’’. 

8 (b) EFFECTIVE DATE.—The amendment made by 

9 subsection (a) shall apply to State plans submitted under 

10 section 1912 of the Public Health Service Act on or after 

11 the date that is 180 days after the date of the enactment 

12 of this Act.

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