I 

108TH CONGRESS 

1ST SESSION H. R. 3243

To amend the Public Health Service Act to establish a State family support 

grant program to end the practice of parents giving legal custody of 

their seriously emotionally disturbed children to State agencies for the 

purpose of obtaining mental health services for those children. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 2, 2003

Mr. RAMSTAD (for himself, Mr. NORWOOD, Mr. BACHUS, Mr. KENNEDY of 

Rhode Island, Mr. STARK, Mr. PICKERING, Mr. CASTLE, and Mrs. JOHNSON of Connecticut) introduced the following bill; which was referred to 

the Committee on Energy and Commerce 

A BILL

To amend the Public Health Service Act to establish a State 

family support grant program to end the practice of 

parents giving legal custody of their seriously emotionally 

disturbed children to State agencies for the purpose of 

obtaining mental health services for those children.

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 ‘‘Keeping Families To5 gether Act’’. 
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1 SEC. 2. PURPOSE. 

2 It is the purpose of this Act to assist States in elimi3 nating the practice of parents giving custody of their seri4 ously emotionally disturbed children to State agencies for 

5 the purpose of securing mental health care for those chil6 dren. 

7 SEC. 3. FAMILY SUPPORT GRANTS. 

8 Title V of the Public Health Service Act (42 U.S.C. 

9 290aa et seq.) is amended—

10 (1) by redesignating the second part G (relating 

11 to services provided through religious organizations) 

12 as part J; 

13 (2) by redesignating sections 581 through 584 

14 of part J (as so redesignated) as sections 596 

15 through 596C, respectively; and 

16 (3) by adding at the end the following: 

17 ‘‘PART K—FAMILY SUPPORT

18 ‘‘SEC. 597. FAMILY SUPPORT GRANTS. 

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

20 the Administrator and in consultation with the task force 

21 established under section 597A, is authorized to award 

22 competitive grants to States to enable such States to es23 tablish systems of care to treat and provide services to 

24 all eligible children and youth. The Secretary shall ensure 

25 that the amount awarded to each grantee is sufficient to 
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1 enable the grantee to accomplish the purposes of the 

2 grant. 

3 ‘‘(b) ELIGIBILITY.—To be eligible for a grant under 

4 subsection (a) a State shall—

5 ‘‘(1) have laws or policies in effect to ensure 

6 that children receive appropriate mental health serv7 ices so that parents do not have to relinquish legal 

8 custody of such children; 

9 ‘‘(2) submit to the Secretary an application 

10 from the Governor in accordance with subsection (c); 

11 ‘‘(3) provide assurances that the State will pro12 vide matching funds in accordance with subsection 

13 (e); and 

14 ‘‘(4) meet such other requirements as the Sec15 retary determines appropriate. 

16 ‘‘(c) APPLICATION.—

17 ‘‘(1) IN GENERAL.—An application submitted 

18 for a grant under this section shall include—

19 ‘‘(A) a brief description of the system of 

20 care that the State intends to establish with 

21 amounts received under the grant to ensure 

22 that eligible children and youth and their fami23 lies receive the appropriate individualized men24 tal health treatment and family support services 

25 necessary to keep such families together; 
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1 ‘‘(B) a description of the process by which 

2 the State will formulate a State plan that meets 

3 the requirements of paragraph (2), including 

4 participants, timelines, and any previous or on5 going efforts related to the establishment of a 

6 statewide system. 

7 ‘‘(C) an estimate of the number of eligible 

8 children and youth in the State, and the num9 ber of eligible children and youth who will be 

10 served under the grant; 

11 ‘‘(D) a description of existing systems of 

12 care in the State (including systems funded 

13 under section 561) and existing interagency col14 laboration that demonstrates a foundation on 

15 which the State can build a system of care 

16 under a grant under this section; 

17 ‘‘(E) a brief description of the manner in 

18 which services for all eligible children and youth 

19 are expected to be funded under the system es20 tablished by the State under the grant; 

21 ‘‘(F) a description of children’s mental 

22 health services capacity in the State and the 

23 steps that will be taken, if necessary, to ensure 

24 that adequate capacity exists to implement the 

25 proposed system of care; 
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1 ‘‘(G) a description of the source of the 

2 State matching funds; and 

3 ‘‘(H) other information as required by the 

4 Secretary. 

5 ‘‘(2) STATE PLAN.—Prior to receiving funds 

6 under the grant for the second grant year, a State 

7 shall submit to the Secretary and the Secretary shall 

8 approve, a State plan that—

9 ‘‘(A) is developed through a collaborative 

10 process that includes the required State part11 ners as represented by senior officials with pol12 icymaking authority, the required private part13 ners, and other entities that the governor of the 

14 State determines appropriate; 

15 ‘‘(B) contains a description and assess16 ment of the effectiveness of the laws or policies 

17 that the State has in effect to ensure that chil18 dren receive appropriate mental health services 

19 and that parents do not have to relinquish legal 

20 custody of such children in order to obtain such 

21 services; 

22 ‘‘(C) contains a description of the services 

23 to be provided to eligible children and youth

24 and the sources of such services, including the 
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1 extent to which the State will build upon exist2 ing systems of care within the State; 

3 ‘‘(D) contains a description of the proce4 dures to be implemented for the early identi5 fication, assessment, and referral, by health 

6 care providers, mental health agencies, other 

7 child-serving entities, child welfare, corrections, 

8 and juvenile justice systems, of all eligible chil9 dren and youth for appropriate care and for co10 ordinating services among child welfare, juve11 nile justice, and child mental health agencies, 

12 including co-location of services as appropriate; 

13 ‘‘(E) describes any legislative changes that 

14 are required to implement the State plan; 

15 ‘‘(F) describes how the State screens chil16 dren and youth entering the juvenile justice and 

17 child welfare systems for mental health prob18 lems, including the State’s mental health 

19 screening procedures as part of the early and 

20 periodic screening, diagnostic, and treatment 

21 services described in section 1905(r) of the So22 cial Security Act that are provided under the 

23 medicaid programs; 
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1 ‘‘(G) contains a description of the plan of 

2 the State for ensuring that there will be ade3 quate capacity to serve all eligible children; 

4 ‘‘(H) contains a description of the plan of 

5 the State for financing the system of care devel6 oped under the grant, including—

7 ‘‘(i) the manner in which the State 

8 will use—

9 ‘‘(I) contributions from State 

10 agencies; 

11 ‘‘(II) State eligibility options or 

12 waivers authorized with respect to the 

13 State medicaid program such as those 

14 authorized under sections 1902(e)(3) 

15 and 1915(c) of the Social Security 

16 Act; 

17 ‘‘(III) the State Children’s 

18 Health Insurance Program under title 

19 XXI of the Social Security Act (in20 cluding an assurance that grant funds 

21 will not be used as a State match 

22 under the medicaid or SCHIP pro23 grams); and 

24 ‘‘(IV) other public health insur25 ance mechanisms; and 
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1 ‘‘(ii) how Federal grant dollars will be 

2 used to enable the State to achieve a sus3 tainable system of care to serve all eligible 

4 children and youth; 

5 ‘‘(I) contains a description of how the 

6 State will provide outreach services to families, 

7 provide for public educational activities, and in8 volve families; and 

9 ‘‘(J) establishes a method for tracking and 

10 reporting the number of children and youth en11 tering child welfare and juvenile justice systems 

12 with significant mental health problems. 

13 ‘‘(3) PRIORITY.—In awarding grants under this 

14 section, the Secretary shall give priority to States—

15 ‘‘(A) that have a history of developing and 

16 supporting local or statewide systems care and 

17 of successful interagency collaboration; 

18 ‘‘(B) that have taken steps to broaden ac19 cess to community-based services for children 

20 with serious emotional disturbances; 

21 ‘‘(C) that have provided reasonable esti22 mates of the numbers of eligible children and 

23 youth; 

24 ‘‘(D) that have sufficient mental health 

25 service capacity or specific plans for sufficiently 
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1 increasing mental health services capacity to 

2 successfully implement the proposed system of 

3 care; 

4 ‘‘(E) in which the governor’s office will 

5 play a leading role in the formulation of the 

6 State plan required under paragraph (2); and 

7 ‘‘(F) that will involve State juvenile and 

8 family court judges in the planning and over9 sight of the system of care. 

10 ‘‘(d) USE OF FUNDS.—A State shall use amounts re11 ceived under a grant under this section to—

12 ‘‘(1) establish State- and local-level infrastruc13 ture to allow for interagency cooperation and cross 

14 system financing to—

15 ‘‘(A) support the purchase and delivery of 

16 a comprehensive array of community-based 

17 mental health and family support services to all 

18 eligible children and youth and their families; 

19 ‘‘(B) decrease categorical funding struc20 tures and eliminate inter-agency fragmentation 

21 of services; and 

22 ‘‘(C) increase the capacity of agencies to 

23 share public resources and improve parental ac24 cess to services for children with mental health 
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1 needs to eliminate the need to relinquish cus2 tody in order to receive treatment; 

3 ‘‘(2) expand public health insurance programs 

4 to cover a comprehensive array of community-based 

5 mental health and family support services for eligible 

6 children and youth and their families that will be 

7 sustainable after the grant has expired; 

8 ‘‘(3) deliver mental health care and family sup9 port services to eligible children and youth and their 

10 families as part of a transition to a sustainable sys11 tem of care for such children and youth; 

12 ‘‘(4) provide outreach and public education con13 cerning programs and activities funded under this 

14 section; 

15 ‘‘(5) provide training and professional develop16 ment for personnel who work with eligible children 

17 and youth as required to successfully implement the 

18 State plan; and 

19 ‘‘(6) carry out other administrative activities re20 lated to the programs and activities carried out 

21 under the grant, including the development and 

22 maintenance of data systems. 

23 ‘‘(e) MATCHING FUNDS.—

24 ‘‘(1) IN GENERAL.—A State that receives a 

25 grant under this section shall, with respect to the
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1 costs to be incurred by the State in carrying out 

2 the purpose for which the grant is awarded, make 

3 available non-Federal contributions toward such 

4 costs in an amount that—

5 ‘‘(A) for the third fiscal year for which the 

6 entity receives payments from a grant under 

7 such subsection, is not less than $1 for each $2 

8 of Federal funds provided in the grant; 

9 ‘‘(B) for the fourth such fiscal year, is not 

10 less than $1 for each $1 of Federal funds pro11 vided in the grant; and 

12 ‘‘(C) for the fifth and sixth such fiscal 

13 years, is not less than $2 for each $1 of Fed14 eral funds provided in the grant. 

15 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB16 UTED.—Non-Federal contributions required in para17 graph (1) may be in cash or in kind, fairly evalu18 ated, including plant, equipment, or services. 

19 Amounts provided by the Federal Government, or 

20 services assisted or subsidized to any significant ex21 tent by the Federal Government, may not be in22 cluded in determining the amount of such non-Fed23 eral contributions. 

24 ‘‘(3) ACCOUNTING REQUIRED.—With respect to 

25 a State that complies with the requirement of para-
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1 graph (2) through the provision of in-kind contribu2 tions, such State shall provide the Secretary with an 

3 accounting that describes the value of such in-kind 

4 contributions. 

5 ‘‘(f) LIMITATION ON USE FOR ADMINISTRATIVE

6 COSTS.—Not more than 5 percent of the amount that a 

7 State receives under a grant under this section shall be 

8 used for administrative costs. 

9 ‘‘(g) PAYMENTS.—Grants under this section shall be 

10 payable over a 6-year period. 

11 ‘‘(h) REPORTING REQUIREMENTS.—

12 ‘‘(1) IN GENERAL.—Secretary, acting through 

13 the Administrator and in consultation with the task 

14 force established under section 597A, shall require 

15 States to report information that is appropriate to 

16 permit an assessment to be made of the success of 

17 States in the implementation of programs under this 

18 section. Such information shall, at a minimum, in19 clude—

20 ‘‘(A) the number of eligible children and 

21 youth in foster care; 

22 ‘‘(B) the number of eligible children and 

23 youth in residential treatment centers; 
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1 ‘‘(C) appropriate information concerning 

2 the participation and academic progress of eligi3 ble children and youth in school; 

4 ‘‘(D) measures of the contacts of eligible 

5 children and youth with juvenile justice sys6 tems; 

7 ‘‘(E) measures of the clinical improvement 

8 of eligible children and youth; and 

9 ‘‘(F) information concerning the level of 

10 satisfaction of eligible children and youth and 

11 their families with services received. 

12 ‘‘(2) ANNUAL REPORT BY STATES.—Beginning 

13 with the second fiscal year in which a State receives 

14 funding under a grant under this section, the State 

15 shall annually report to the Secretary on the success 

16 of the programs and activities carried out by the 

17 State under the grant. Such reports shall include the 

18 information specified in paragraph (1) and other in19 formation required by the Secretary. 

20 ‘‘(3) REPORTS BY THE SECRETARY.—

21 ‘‘(A) IN GENERAL.—Not later than 3 years 

22 after the date of enactment of this part, the 

23 Secretary shall submit to Congress a report on 

24 the success of States in using grants under this 

25 section to eliminate children and youth custody 
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1 relinquishment solely to obtain mental health 

2 care. Such report shall include recommenda3 tions to strengthen the program under this sec4 tion. 

5 ‘‘(B) FINAL REPORT.—Not later than 6 

6 years after the date of enactment of this part, 

7 the Secretary shall submit to Congress a final 

8 report on the success of States in using grants 

9 under this section to eliminate children and 

10 youth custody relinquishment solely to obtain 

11 mental health care. 

12 ‘‘(i) TECHNICAL ASSISTANCE.—The Secretary, in 

13 consultation with the task force established under section 

14 597A, may provide technical assistance to States in car15 rying out programs and activities under this section. The 

16 Secretary shall use not more than 20 percent of the 

17 amount appropriate for each fiscal year, not to exceed 

18 $5,000,000 in any such fiscal year, to carry out this sub19 section and shall coordinate technical assistance under 

20 this section with other technical assistance programs as 

21 appropriate. 

22 ‘‘(j) DEFINITIONS.—In this section: 

23 ‘‘(1) ELIGIBLE CHILDREN AND YOUTH.—The 

24 term ‘eligible children and youth’ means children 

25 and youth under the age of 21 years who are in the 
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1 custody of the State for the purpose of receiving 

2 mental health services or at-risk of entering into the 

3 custody of the State for the purpose of receiving 

4 mental health services. 

5 ‘‘(2) FAMILY SUPPORT SERVICES.—The term 

6 ‘family support services’ means individualized serv7 ices that are designed with input from the family 

8 and provided to eligible children and youth and their 

9 families to promote the mental health of an eligible 

10 child or youth, to strengthen the ability of family 

11 members to care for an eligible child or youth, or to 

12 enable an eligible child or youth to take advantage 

13 of other treatment and family support services. 

14 ‘‘(3) REQUIRED PRIVATE PARTNERS.—The 

15 term ‘required private partners’ includes—

16 ‘‘(A) representatives of families of seriously 

17 emotionally disturbed children; 

18 ‘‘(B) representatives of mental health care 

19 providers; 

20 ‘‘(C) representatives of private health in21 surers; and 

22 ‘‘(D) representatives of hospitals and resi23 dential care facilities.
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1 ‘‘(4) REQUIRED STATE PARTNERS.—The term 

2 ‘required State partners’ with respect to a State in3 cludes—

4 ‘‘(A) the State agency responsible for chil5 dren’s mental health; 

6 ‘‘(B) the State child welfare agency; 

7 ‘‘(C) the State juvenile justice agency; 

8 ‘‘(D) the State Medicaid agency; 

9 ‘‘(E) the State education agency; 

10 ‘‘(F) the State substance abuse agency; 

11 ‘‘(G) the State bureau of insurance; and 

12 ‘‘(H) the office of the Governor of the 

13 State. 

14 ‘‘(5) STATE.—The term ‘State’ includes, in ad15 dition to the several States, the District of Colum16 bia, the Commonwealth of Puerto Rico, the Com17 monwealth of the Northern Mariana Islands, the 

18 Virgin Islands, Guam, American Samoa, the Trust 

19 Territory of the Pacific Islands, and Indian tribes. 

20 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated to carry out this section, 

22 $4,500,000 for fiscal year 2004, $6,500,000 for fiscal year 

23 2005, and $11,000,000 for each of each of fiscal years 

24 2006 through 2009. 
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1 ‘‘SEC. 597A. TASK FORCE. 

2 ‘‘(a) ESTABLISHMENT.—The Administrator, in con3 junction with the Director of the Office of Juvenile Justice 

4 and Delinquency Prevention, the Administrator of the Ad5 ministration for Children and Families, the Administrator 

6 of the Centers for Medicare & Medicaid Services, and the 

7 Assistant Secretary of Education for Special Education, 

8 shall establish and staff a task force to examine problems 

9 of mental health in the child welfare and juvenile justice 

10 systems and issues with respect to access by children and 

11 youth to mental health services, and the role of their agen12 cies in promoting access by children and youth to mental 

13 health services. 

14 ‘‘(b) DUTIES.—The task force established under sub15 section (a) shall—

16 ‘‘(1) work with mental health and child advo17 cates, representatives of families of eligible children 

18 and youth, and representatives of State systems of 

19 care to make recommendations to Congress con20 cerning strategies to improve the delivery of mental 

21 health services, including prevention services, to chil22 dren and youth with serious emotional disturbances, 

23 including those who are at risk of dropping out of 

24 school or at-risk of coming in contact with child wel25 fare and juvenile justice systems; 
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1 ‘‘(2) work with mental health and child advo2 cates, representatives of families of eligible children 

3 and youth, and representatives of State systems of 

4 care to develop improved reporting requirements for 

5 States concerning the number of children and youth 

6 entering child welfare and juvenile justice systems 

7 solely to access mental health services; 

8 ‘‘(3) in consultation with States and appro9 priate stakeholders, create standard definitions for 

10 the categories of data to be collected on such chil11 dren and youth; 

12 ‘‘(4) foster interagency cooperation to eliminate 

13 the practice of custody relinquishment; 

14 ‘‘(5) provide advice to the Administrator in im15 plementation of the family support grant programs 

16 under section 597; 

17 ‘‘(6) coordinate and deliver technical assistance 

18 to States and State agencies to help implement pro19 grams under such grant program; 

20 ‘‘(7) make recommendations to break down bar21 riers to coordination in existing Federal programs 

22 and to allow for more effective integration across 

23 agencies and programs; and 

24 ‘‘(8) provide a biannual report to Congress on 

25 its recommendations and its progress in carrying out 
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1 its duties, ending the practice of parents relin2 quishing legal custody of their children with serious 

3 emotional disturbances in order to obtain mental 

4 health services, and improving the delivery of mental 

5 health services to children with serious emotional 

6 disturbances. 

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

8 are authorized to be appropriated to carry out this section, 

9 $1,000,000 for each of fiscal years 2004 through 2009. 

10 Of the amount appropriate for each fiscal year under this 

11 subsection, 60 percent of such amount shall be made avail12 able to the Secretary, 20 percent of such amount shall 

13 be made available to the Attorney General, and 20 percent 

14 of such amount shall be made available to the Secretary 

15 of Education.’’. 

16 SEC. 4. TREATMENT OF INPATIENT PSYCHIATRIC HOS17 PITAL SERVICES FOR INDIVIDUALS UNDER 

18 AGE 21 IN HOME OR COMMUNITY-BASED 

19 SERVICES WAIVERS. 

20 (a) IN GENERAL.—Section 1915(c) of the Social Se21 curity Act (42 U.S.C. 1396n(c)) is amended—

22 (1) in paragraph (1)—

23 (A) in the first sentence, by inserting ‘‘, or 

24 would require inpatient psychiatric hospital 

25 services for individuals under age 21,’’ after 
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1 ‘‘intermediate care facility for the mentally re2 tarded’’; and 

3 (B) in the second sentence, by inserting ‘‘, 

4 or would require inpatient psychiatric hospital 

5 services for individuals under age 21’’ before 

6 the period; 

7 (2) in paragraph (2)(B), by striking ‘‘or serv8 ices in an intermediate care facility for the mentally 

9 retarded’’ each place it appears and inserting ‘‘serv10 ices in an intermediate care facility for the mentally 

11 retarded, or inpatient psychiatric hospital services 

12 for individuals under age 21’’; 

13 (3) in paragraph (2)(C)—

14 (A) by inserting ‘‘, or who are determined 

15 to be likely to require inpatient psychiatric hos16 pital services for individuals under age 21,’’ 

17 after ‘‘, or intermediate care facility for the 

18 mentally retarded’’; and 

19 (B) by striking ‘‘or services in an inter20 mediate care facility for the mentally retarded’’ 

21 and inserting ‘‘services in an intermediate care 

22 facility for the mentally retarded, or inpatient 

23 psychiatric hospital services for individuals 

24 under age 21’’; and 

25 (4) in paragraph (7)(A)—
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1 (A) by inserting ‘‘or would require inpa2 tient psychiatric hospital services for individuals 

3 under age 21,’’ after ‘‘intermediate care facility 

4 for the mentally retarded,’’; and 

5 (B) by inserting ‘‘or who would require in6 patient psychiatric hospital services for individ7 uals under age 21’’ before the period. 

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

9 subsection (a) apply with respect to medical assistance 

10 provided on or after January 1, 2004.

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