I 

111TH CONGRESS 

1ST SESSION H. R. 2369 

To improve mental and substance use health care. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 12, 2009 

Mr. KENNEDY (for himself and Mrs. BONO MACK) introduced the following 

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

A BILL 

To improve mental and substance use health care. 

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; TABLE OF CONTENTS; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Improving the Quality of Mental and Substance Use 

6 Health Care Act of 2009’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents; findings. 

Sec. 2. Evidence-based mental and substance use health care. 

Sec. 3. Improved coordination of care. 

Sec. 4. Information technology for mental health and substance use health care 

providers. 

Sec. 5. Council on the Mental Health and Substance Use Health Care Workforce. 

Sec. 6. Funding of research through national centers of excellence. 


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Sec. 7. Patient-centered care. 

Sec. 8. Uniform methodologies for reimbursing behavioral health claims. 

Sec. 9. Study on use of public mental health and addiction services by individuals with private health coverage. 

Sec. 10. High-quality mental health and substance use health care Medicaid 

demonstration project. 

Sec. 11. Medicaid requirement for State repeal of laws denying health benefits 

coverage based on intoxication. 

1 (c) FINDINGS.—The Congress finds the following: 

2 (1) In its study, ‘‘Improving the Quality of 

3 Health Care for Mental and Substance-Use Condi4 tions’’, the Institute of Medicine found that each 

5 year, more than 33,000,000 Americans use health 

6 care services for their mental problems and illnesses, 

7 and for conditions resulting from their use of alco8 hol, inappropriate use of prescription medications, 

9 or, less often, illegal drugs. In the United States, 

10 mental and substance use illnesses (which often 

11 occur together) are the leading cause of death and 

12 disability for women, the highest for men ages 15 to 

13 44, and the second highest for all men. 

14 (2) Effective treatments for these medical ill15 nesses exist, but multiple barriers prevent many 

16 from receiving them. The consequences of these bar17 riers are serious for these individuals and their fami18 lies, for their employers and the workforce, for the 

19 Nation’s economy, and for the Nation’s education, 

20 welfare, and justice systems. The Institute of Medi21 cine further found that a comprehensive approach is 


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1 needed to remedy this issue that addresses the dis2 tinguishing characteristics of mental and substance 

3 use health care in the United States. 

4 (3) The Institute of Medicine recommended a 

5 multifaceted and comprehensive strategy to improve 

6 the quality of mental and substance use health care 

7 in the United States and thereby ensure that— 

8 (A) individual patient preferences, needs, 

9 and values prevail in the face of residual stig10 ma, discrimination, and coercion into treatment; 

11 (B) the necessary infrastructure exists to 

12 produce scientific evidence more quickly and 

13 promote its application in patient care; 

14 (C) multiple providers’ care of the same 

15 patient is coordinated; 

16 (D) emerging information technology re17 lated to health care benefits people with mental 

18 or substance use problems and illnesses; 

19 (E) the health care workforce has the edu20 cation, training, and capacity to deliver high21 quality care for mental and substance use con22 ditions; and 

23 (F) government programs, employers, and 

24 other group purchasers of health care for men25 tal and substance use conditions use their dolVerDate Nov 24 2008 05:02 May 14, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2369.IH H2369

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1 lars in ways that support the delivery of high2 quality care. 

3 (4) To implement this strategy, the Institute of 

4 Medicine noted that action is needed from many 

5 health care leaders, including the Congress. 

6 SEC. 2. EVIDENCE-BASED MENTAL AND SUBSTANCE USE 

7 HEALTH CARE. 

8 (a) COMMISSION FOR EVIDENCE-BASED MENTAL

9 AND SUBSTANCE USE HEALTH CARE.— 

10 (1) ESTABLISHMENT.—The Secretary of Health 

11 and Human Services (in this Act referred to as the 

12 ‘‘Secretary’’) shall establish a Commission for Evi13 dence-Based Mental and Substance Use Health Care 

14 (in this section referred to as the ‘‘Commission’’) to 

15 strengthen, coordinate, and consolidate the synthesis 

16 and dissemination of evidence on effective mental 

17 and substance use treatments and services. 

18 (2) DUTIES.—For the purposes described in 

19 paragraph (1), the Commission shall, on an ongoing 

20 basis— 

21 (A) identify, describe, and categorize the 

22 available evidence-based preventive, diagnostic, 

23 and therapeutic interventions (including screen24 ing, diagnostic, and symptom-monitoring tools), 


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1 including interventions for various age and eth2 nic groups; 

3 (B) recommend procedure and payment 

4 codes and definitions for such evidence-based 

5 interventions and tools for their use in adminis6 trative datasets under part C of title XI of the 

7 Social Security Act and recommend standards 

8 for health data collection relating to such inter9 ventions; 

10 (C) identify on an annual basis priority 

11 areas for research on— 

12 (i) the development of new evidence13 based preventive, diagnostic, and thera14 peutic interventions; 

15 (ii) comparative effectiveness and cost 

16 effectiveness of existing interventions and 

17 new evidence-based interventions; and 

18 (iii) how best to translate new evi19 dence-based findings into practice in com20 munity-based clinical settings; 

21 (D) recommend to the Director of the Na22 tional Institute of Mental Health, the Director 

23 of the National Institute on Drug Abuse, the 

24 Director of the National Institute on Alcohol 

25 Abuse and Alcoholism, and other Federal offiVerDate Nov 24 2008 23:12 May 14, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2369.IH H2369

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1 cials methods to coordinate the conduct or sup2 port of research described in subparagraph (C); 

3 (E) collect, synthesize, and disseminate in4 formation on research concerning evidence5 based strategies for promoting the use of evi6 dence-based preventive, diagnostic, and thera7 peutic interventions; 

8 (F) provide guidance on effective mental 

9 and substance use interventions to Federal 

10 agencies that provide or support such interven11 tions, including the Centers for Medicare & 

12 Medicaid Services, the Substance Abuse and 

13 Mental Health Services Administration, the 

14 Agency for Healthcare Research and Quality, 

15 the Centers for Disease Control and Prevention, 

16 the Health Resources and Services Administra17 tion, the Department of Defense, the Depart18 ment of Veterans Affairs, the Indian Health 

19 Service, and the Bureau of Prisons; and 

20 (G) periodically assess the progress of 

21 agencies described in subparagraph (F) in im22 plementing such interventions. 

23 (3) CONSULTATION.—In carrying out this sec24 tion, the Commission shall— 


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1 (A) seek consultation from leading public 

2 and private State and national authorities, and 

3 consolidate evidence, opinions, and findings of 

4 these authorities as they see fit; and 

5 (B) ensure that interested parties have op6 portunities to provide input before the Commis7 sion makes recommendations or decisions. 

8 (4) MEMBERSHIP.—The Commission shall be 

9 composed of not fewer than 15 and not more than 

10 20 members, who shall be appointed by the Presi11 dent from among experts in evidence-based mental 

12 and substance use health care. Such members shall 

13 include— 

14 (A) researchers; 

15 (B) practitioners from various specialties, 

16 professions, and practice settings; 

17 (C) mental health and substance abuse 

18 health care consumers; and 

19 (D) health care payers. 

20 (5) TERMS.— 

21 (A) IN GENERAL.—Each member of the 

22 Commission shall be appointed for a term of 4 

23 years, except as provided in subparagraphs (B) 

24 and (C). 


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1 (B) TERMS OF INITIAL APPOINTEES.—As 

2 designated by the President at the time of ap3 pointment, of the members of the Commission 

first appointed, 1 4 ⁄4 shall each be appointed for 

5 terms of 1, 2, and 3 years and the remainder 

6 shall be appointed for a term of 4 years. 

7 (C) VACANCIES.—Any member appointed 

8 to fill a vacancy occurring before the expiration 

9 of the term for which the member’s predecessor 

10 was appointed shall be appointed only for the 

11 remainder of that term. A member may serve 

12 after the expiration of that member’s term until 

13 a successor has taken office. 

14 (b) CMS ANNUAL REPORT.—The Administrator of 

15 the Centers for Medicare & Medicaid Services shall report 

16 annually to the Congress on the extent to which the Med17 icaid program under title XIX of the Social Security Act 

18 provides coverage of evidence-based interventions identi19 fied by the Commission, including— 

20 (1) a list of those interventions not so covered 

21 and the reasons why they are not covered; 

22 (2) a justification for each evidence-based inter23 vention that is not so covered; and 

24 (3) a list of evidence-based interventions that 

25 can be covered only with statutory change. 


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1 (c) CONSTRUCTION REGARDING APPLICATION.— 

2 Nothing in this section shall be construed as requiring, 

3 as a condition of payment under the Medicaid program 

4 under title XIX of the Social Security Act, that an inter5 vention must be an evidence-based practice. 

6 (d) PROMPT DEVELOPMENT AND IMPLEMENTATION

7 OF CLAIMS PROCESSING AND DATA CODES.—The Sec8 retary, acting through the Administrator of the Centers 

9 for Medicare & Medicaid Services, shall establish, or enter 

10 into an agreement with, one or more entities for the pur11 pose of developing, as soon as practicable after the date 

12 of the enactment of this Act, codes that should be applied 

13 to claims processing and health data collection activities 

14 as recommended by the Commission pursuant to sub15 section (a)(2)(B). 

16 (e) DEFINITION.—In this section, the term ‘‘interven17 tion’’ means a preventive, diagnostic, or therapeutic action 

18 with respect to a mental health or substance use disease 

19 process. 

20 SEC. 3. IMPROVED COORDINATION OF CARE. 

21 (a) INTERAGENCY COLLABORATIVE GROUP.— 

22 (1) ESTABLISHMENT.—The Secretary shall con23 vene an interagency collaborative group (in this sec24 tion referred to as the ‘‘interagency collaborative 

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1 ical and programmatic level of mental health and 

2 substance use services and primary care services, 

3 funded in whole or in part through the Department 

4 of Health and Human Services, the Department of 

5 Justice, the Department of Veterans Affairs, the De6 partment of Defense, and the Department of Edu7 cation, using one or more evidence-based coordina8 tion models, such as the following: 

9 (A) Formal agreements between mental 

10 health, substance use, and primary care pro11 viders. 

12 (B) Case management of mental health, 

13 substance use, and primary care. 

14 (C) Co-location of mental health, substance 

15 use, and primary care providers. 

16 (D) Delivery of mental health, substance 

17 use, and primary care in integrated practices. 

18 (2) DUTIES.—The interagency collaborative 

19 group shall— 

20 (A) develop a plan for government agencies 

21 to implement the recommendations made by the 

22 Commission for Evidence-Based Mental and 

23 Substance Use Health Care; 


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1 (B) coordinate with States and appropriate 

2 public stakeholders to foster interagency col3 laboration at the State and local level; 

4 (C) make recommendations to the Presi5 dent and the Congress to break down barriers 

6 to coordination of existing Federal programs 

7 funding mental health and substance use serv8 ices and to allow for more effective integration 

9 of such programs across agencies and pro10 grams; 

11 (D) assess progress toward such coordina12 tion through development and monitoring of 

13 performance measures of coordination; and 

14 (E) report to the Congress biannually on 

15 the status of such coordination. 

16 (3) COMPOSITION.—The interagency collabo17 rative group shall include the following members: 

18 (A) The Secretary of Health and Human 

19 Services (or the Secretary’s designee). 

20 (B) The Attorney General (or the Attorney 

21 General’s designee). 

22 (C) The Secretary of Veterans Affairs (or 

23 such Secretary’s designee). 

24 (D) The Secretary of Defense (or such 

25 Secretary’s designee). 


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1 (E) The Secretary of Education (or such 

2 Secretary’s designee). 

3 (4) MEETINGS.—The interagency collaborative 

4 group shall meet not less than quarterly. 

5 (5) STAFF AND SUPPORT.—The Secretary shall 

6 provide, without the requirement for reimbursement, 

7 staff and other administrative support necessary for 

8 the operation of the interagency collaborative group. 

9 (b) COORDINATED DELIVERY OF CARE.—The Fed10 eral agencies participating in the interagency collaborative 

11 group shall modify internal policies and practices, to the 

12 extent practicable and consistent with legal authority, in 

13 order to implement one or more of the evidence-based co14 ordination models referred to in subsection (a)(1). 

15 (c) NO EFFECT ON HIPAA PRIVACY RULES.—Noth16 ing in this section shall be construed to alter the applica17 tion of rules promulgated under section 264(c) of the 

18 Health Insurance Portability and Accountability Act of 

19 1996. 

20 (d) GAO REPORT.—Not later than 2 years after the 

21 date of the enactment of this Act, the Comptroller General 

22 of the United States shall conduct a study and submit a 

23 report to the Congress on the implementation of this sec24 tion. 


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1 (e) CLARIFICATION OF MEDICAID REIMBURSEMENT

2 OPTIONS.—The Secretary shall provide, by regulation, for 

3 a change in the rules under title XIX of the Social Secu4 rity Act relating to reimbursement for primary care serv5 ices and mental health and substance use services to the 

6 same patient on the same day so as to permit payment 

7 for the legitimate provisions of both types of services on 

8 the same day to a patient. 

9 SEC. 4. INFORMATION TECHNOLOGY FOR MENTAL HEALTH 

10 AND SUBSTANCE USE HEALTH CARE PRO11 VIDERS. 

12 (a) DEVELOPMENT AND IMPLEMENTATION OF

13 PLAN.—The Secretary, acting through the National Coor14 dinator for Health Information Technology and the Ad15 ministrator of the Substance Abuse and Mental Health 

16 Services Administration, shall develop and implement a 

17 plan for ensuring that activities of the Department of 

18 Health and Human Services to promote the use of infor19 mation technology by health care providers include pro20 motion of information technology that is accessible and 

21 pertinent to mental health and substance use health care 

22 providers and consumers. 

23 (b) CONTENTS OF PLAN.—The plan developed under 

24 subsection (a) shall address— 


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1 (1) how the development of an electronic health 

2 information infrastructure, including the awarding 

3 of grants and contracts to promote the use of elec4 tronic health records (EHRs), personal health 

5 records (PHRs), regional health information organi6 zations (RHIOs), and other forms of health informa7 tion technology, and the establishment of data 

8 standards, will ensure that the needs of mental and 

9 substance use health care providers and consumers 

10 are met with particular emphasis on the privacy con11 cerns of consumers; 

12 (2) how financial incentives that are generally 

13 made available for the development of such infra14 structure for health care providers can be provided 

15 to individual mental health and substance use clini16 cians and organizations (and particularly publicly17 funded providers) for investments in information 

18 technology to enable them to participate on a full 

19 and equal basis in the emerging electronic health in20 frastructure; 

21 (3) how any continuing technical assistance and 

22 training for developing virtual networks may be 

23 made available to give individual and small group 

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1 lation data and health records, and billing and clin2 ical decision-support systems; and 

3 (4) how to create and support a continuing 

4 mechanism to engage mental health and substance 

5 use stakeholders in the public and private sectors in 

6 developing consensus-based recommendations for 

7 data elements, standards, and processes needed to 

8 address unique aspects of information management 

9 related to mental and substance use healthcare. 

10 (c) CONSIDERATION.—In awarding any grant or con11 tract for the development or implementation of any com12 ponent of a national electronic health infrastructure, the 

13 Secretary shall consider the application of such component 

14 to mental health and substance use health care and pro15 viders of such care. 

16 (d) CONTINUED PRIVACY PROTECTIONS.—In devel17 oping or promoting the national electronic health infra18 structure, the Secretary shall ensure that privacy and con19 fidentiality requirements traditionally applicable to mental 

20 health and substance use health care continue to be ap21 plied. 

22 (e) INCLUSION OF INFORMATION IN REPORTS.—In 

23 preparing any report to the Congress relating to the devel24 opment or implementation of a national electronic health 

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1 mation technology, the Secretary shall include information 

2 on such development, implementation, or promotion in the 

3 field of mental health and substance use treatment. 

4 SEC. 5. COUNCIL ON THE MENTAL HEALTH AND SUB5 STANCE USE HEALTH CARE WORKFORCE. 

6 (a) ESTABLISHMENT.—The Secretary shall establish 

7 a public-private advisory group called the Council on the 

8 Mental Health and Substance Use Health Care Workforce 

9 (in this section referred to as the ‘‘Council’’). 

10 (b) DUTIES.— 

11 (1) DEVELOPMENT OF COMPREHENSIVE

12 PLAN.—The Council shall develop and publish a 

13 comprehensive plan for purpose of strengthening the 

14 capacity of the workforce to deliver high-quality 

15 mental health and substance use health care. 

16 (2) PLAN CONTENTS.—The plan developed 

17 under this subsection shall— 

18 (A) identify the specific clinical com19 petencies that all mental health and substance 

20 use professionals should possess to be certified 

21 or licensed and the competencies, including a 

22 component of patient centered care, that should 

23 be maintained over time; 

24 (B) identify the specific mental health and 

25 substance use education that should be required 


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1 of health care professionals and integrated into 

2 the medical education and training of all health 

3 care professionals; 

4 (C) propose national standards for the 

5 credentialing and licensure of mental health and 

6 substance use health care providers based on 

7 core competencies that should be included in 

8 curricula and education programs across all the 

9 mental health and substance use disciplines and 

10 make recommendations regarding accreditation 

11 standards for mental health and substance use 

12 health care programs; 

13 (D) propose programs for funding from 

14 Federal, State, and local governments and the 

15 private sector to address and resolve long16 standing workforce issues such as diversity, cul17 tural relevance, faculty development, training 

18 effectiveness, continuing shortages of well19 trained clinicians needed to work with children 

20 and the elderly and in high-need areas, and pro21 grams for training competent clinical super22 visors and administrators; and 

23 (E) provide for continuing assessment of 

24 mental health and substance use workforce 

25 trends, issues, and financing policies. 


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1 (3) EVALUATION; REPORTING.—On a biannual 

2 basis, the Council shall— 

3 (A) conduct an evaluation of the extent to 

4 which the purpose specified in paragraph (1) 

5 has been met; and 

6 (B) submit a report to the Congress on the 

7 results of such evaluation, including a descrip8 tion of the status of the mental health and sub9 stance use health care workforce. 

10 (4) ASSISTANCE.—The Council shall collaborate 

11 with private sector coalitions to facilitate and imple12 ment its recommendations. 

13 (c) MEMBERSHIP.— 

14 (1) NUMBER; APPOINTMENT; CHAIR.—The 

15 Council shall be composed of not less than 21 and 

16 not more than 25 individuals appointed by the Sec17 retary. The Council shall elect a chair from among 

18 its members. 

19 (2) PUBLIC SECTOR MEMBERS.—The Council 

20 shall include the following officials (or their des21 ignees): 

22 (A) The Assistant Secretary for Health in 

23 the Department of Health and Human Services. 

24 (B) The Administrator of the Centers for 

25 Medicare & Medicaid Services. 


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1 (C) The Administrator of the Substance 

2 Abuse and Mental Health Services Administra3 tion. 

4 (D) The Secretary of Veterans Affairs. 

5 (3) PRIVATE SECTOR MEMBERS.—The Council 

6 shall include representatives from the substance use 

7 and mental health services and consumer commu8 nities who are not employees of the Federal Govern9 ment. Such representatives shall be appointed by the 

10 Secretary without regard to the Federal civil service 

11 laws and shall include the following: 

12 (A) One individual selected from full-time 

13 students enrolled in mental health training pro14 grams. 

15 (B) One individual selected from full-time 

16 students enrolled in substance use health care 

17 training programs. 

18 (C) One individual selected from mental 

19 health consumers. 

20 (D) One individual selected from substance 

21 use health care consumers. 

22 (E) One individual selected from faculty 

23 members at mental health training facilities. 


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1 (F) One individual selected from faculty 

2 members at substance use health care training 

3 facilities. 

4 (G) Five individuals selected from among 

5 leading professional associations in the various 

6 fields charged with carrying out mental health 

7 and substance use services, including psychi8 atry, addiction medicine, psychology, social 

9 work, psychiatric nursing, counseling, marriage 

10 and family therapy, pastoral counseling, psycho11 social rehabilitation, and substance use treat12 ment counselors. 

13 (H) Five individuals selected from among 

14 leading professional licensing and credentialing 

15 entities in the various fields charged with car16 rying out mental health and substance use serv17 ices including psychiatry, addiction medicine, 

18 psychology, social work, psychiatric nursing, 

19 counseling, marriage and family therapy, pas20 toral counseling, psychosocial rehabilitation, 

21 and substance use treatment counseling. 

22 (4) SELECTION.—In selecting the members of 

23 the Council under paragraph (3), the Secretary shall 

24 ensure— 


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1 (A) the inclusion of both urban and rural 

2 members; 

3 (B) a range of members from a variety of 

4 practice settings and including expertise in pre5 vention and treatment across the lifespan; 

6 (C) adequate representation of racial, eth7 nic, religious, and economic diversity in its 

8 membership; and 

9 (D) the members appointed under sub10 paragraphs (G) and (H) of paragraph (3) are 

11 equitably distributed between those specializing 

12 in mental health services and those specializing 

13 in substance use services. 

14 (5) TERMS.— 

15 (A) IN GENERAL.—Each member of the 

16 Council under paragraph (3) shall be appointed 

17 for a term of 4 years, except that except as pro18 vided in subparagraphs (B) and (C). 

19 (B) TERMS OF INITIAL APPOINTEES.—As 

20 designated by the Secretary at the time of ap21 pointment, of the members of the Council first 

appointed under paragraph (3), 1 22 ⁄4 shall each 

23 be appointed for terms of 1, 2, and 3 years and 

24 the remainder shall be appointed for a term of 

25 4 years. 


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1 (C) VACANCIES.—Any member appointed 

2 under paragraph (3) to fill a vacancy occurring 

3 before the expiration of the term for which the 

4 member’s predecessor was appointed shall be 

5 appointed only for the remainder of that term. 

6 A member may serve after the expiration of 

7 that member’s term until a successor has taken 

8 office. 

9 (d) MEETINGS.—The Council shall conduct at least 

10 3 meetings each year. 

11 (e) STAFF AND SUPPORT.—The Secretary shall pro12 vide, without the requirement for reimbursement, staff 

13 and other administrative support necessary for the oper14 ation of the Council. 

15 SEC. 6. FUNDING OF RESEARCH THROUGH NATIONAL CEN16 TERS OF EXCELLENCE. 

17 (a) GRANTS.—The Director of the National Insti18 tutes of Health (in this section referred to as the ‘‘Direc19 tor of NIH’’), acting through the Directors of the National 

20 Institute of Mental Health, the National Institute of Drug 

21 Abuse, and the National Institute on Alcohol Abuse and 

22 Alcoholism, and in consultation with the Administrator of 

23 the Substance Abuse and Mental Health Services Admin24 istration, shall make grants to entities to fund a network 


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1 of national centers of excellence in mental health and sub2 stance use health care. 

3 (b) USE OF FUNDS.—As a condition on receipt of 

4 a grant under this section, an entity shall agree to use 

5 the grant to establish or support one or more centers of 

6 excellence in mental health and substance use health care. 

7 Each such center shall— 

8 (1) integrate basic, clinical, or health services 

9 research with interventions in a range of usual set10 tings of care delivery and involve a broad cross-sec11 tion of mental health and substance use health care 

12 stakeholders; and 

13 (2) develop innovative approaches to tie to14 gether research and practice in order to develop a 

15 research agenda relevant to providers of mental 

16 health and substance use health care services in a 

17 range of usual settings of care. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated 

20 $10,000,000 for fiscal year 2011, $15,000,000 for fiscal 

21 year 2012, $20,000,000 for fiscal year 2013, $25,000,000 

22 for fiscal year 2014, and such sums as may be necessary 

23 for each subsequent fiscal year. 


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1 SEC. 7. PATIENT-CENTERED CARE. 

2 (a) PROMOTION IN FEDERAL PROGRAMS.—With re3 spect to any program that provides for the Department 

4 of Health and Human Services, the Department of Jus5 tice, the Department of Veterans Affairs, Department of 

6 Defense, or the Department of Education to pay for or 

7 provide mental health and substance use care, each such 

8 Department shall provide for the following: 

9 (1) Within the authority of the Department 

10 with respect to such program— 

11 (A) include payment for, or provision of, 

12 peer support and illness self-management pro13 grams that meet evidence-based standards for 

14 individuals with chronic mental illnesses or sub15 stance use dependence; and 

16 (B) provide for appropriate payment and 

17 coverage reforms, such as the application of co18 payments, service exclusions, and benefit limits, 

19 so as to eliminate barriers to the effective, ap20 propriate, and evidence-based provision of such 

21 care. 

22 (2) Endeavor to make reliable comparative in23 formation on the quality of such care provided by 

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1 formation when making decisions about from whom 

2 to receive such care. 

3 (3) Insofar as the Department does not have 

4 authority described in paragraph (1), make rec5 ommendations to the Congress regarding changes in 

6 law to provide for such authority. 

7 (b) SENSE OF CONGRESS FOR ALL PROGRAMS.—It 

8 is the sense of the Congress that clinicians and organiza9 tions providing mental health and substance use treatment 

10 services should— 

11 (1) incorporate, consistent with applicable State 

12 laws, informed, patient-centered decisionmaking and 

13 (for children) informed family decisionmaking 

14 throughout their practices, including active patient 

15 participation in the design and revision of the pa16 tient treatment and recovery plans, psychiatric ad17 vance directives, and provision of information on the 

18 availability and effectiveness of mental health and 

19 substance use treatment options; 

20 (2) adopt recovery-oriented and illness self21 management practices that support patient pref22 erence for treatment (including medications), peer 

23 support, and other elements of the wellness recovery 

24 plan; and 


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1 (3) maintain effective, formal linkages with 

2 community resources to support patient illness self3 management and recovery. 

4 SEC. 8. UNIFORM METHODOLOGIES FOR REIMBURSING BE5 HAVIORAL HEALTH CLAIMS. 

6 (a) IN GENERAL.—The Secretary, through the work7 ing group convened under subsection (b), shall develop 

8 uniform methodologies across geographic areas and types 

9 of payers for the following with respect to medical assist10 ance, related services, and administrative costs furnished 

11 to individuals with mental illnesses and substance use dis12 orders in both community-based and residential settings: 

13 (1) Qualifications for eligibility for payment. 

14 (2) Financial auditing. 

15 (3) Claims payment (including billing codes). 

16 (b) CONVENING OF WORKING GROUP.—The Sec17 retary shall carry out subsection (a) by convening a work18 ing group is composed of the Directors and Administrators 

19 of all relevant agencies, including the Centers for Medicare 

20 & Medicaid Services, the Office of Management and Budg21 et, the Health Resources and Services Administration, the 

22 Substance Abuse and Mental Health Services Administra23 tion, the office of the Inspector General of the Department 

24 of Health and Human Services, acting jointly with State 


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1 Medicaid directors and other State, local, and private 

2 healthcare payers. 

3 (c) REQUIREMENTS.—The methodology developed 

4 under subsection (a)— 

5 (1) shall not result in new medical necessity cri6 teria, and shall not prohibit or restrict payment for 

7 medical assistance, related services, and administra8 tive activities under title XIX of the Social Security 

9 Act that are provided or conducted in accordance 

10 with options under such title regarding targeted case 

11 management, rehabilitative services, or clinical serv12 ices; and 

13 (2) with respect to administrative costs, shall be 

14 based on— 

15 (A) standards related to time studies and 

16 populations estimates; and 

17 (B) a national standard for determining 

18 payment of such costs. 

19 (d) RULE OF CONSTRUCTION.—Nothing in this sec20 tion shall be construed as requiring, as a condition of pay21 ment under the Medicaid program under title XIX of the 

22 Social Security Act, that an intervention must be an evi23 dence-based practice. 


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1 SEC. 9. STUDY ON USE OF PUBLIC MENTAL HEALTH AND 

2 ADDICTION SERVICES BY INDIVIDUALS WITH 

3 PRIVATE HEALTH COVERAGE. 

4 (a) IN GENERAL.—The Comptroller General of the 

5 United States shall conduct a study on the use of publicly 

6 supported mental health and addiction services by individ7 uals who have any level of private health insurance cov8 erage. 

9 (b) REPORT.—The Comptroller General shall submit 

10 to the Congress a report on the study under subsection 

11 (a). The report shall include a description of— 

12 (1) the number of individuals described in sub13 section (a); 

14 (2) the types of private health insurance cov15 erage involved; and 

16 (3) the public programs providing the mental 

17 health and addiction services involved and the cost 

18 of such services provided. 

19 SEC. 10. HIGH-QUALITY MENTAL HEALTH AND SUBSTANCE 

20 USE HEALTH CARE MEDICAID DEMONSTRA21 TION PROJECT. 

22 (a) IN GENERAL.—The Secretary shall establish a 5- 

23 year demonstration project (in this section referred to as 

24 the ‘‘project’’) designed to demonstrate the impact of cre25 ating delivery and financing structures that deliver high26 quality, integrated mental health and substance use health 


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1 care. Such project shall be based upon the report of the 

2 Institute of Medicine (of November 2005) relating to Im3 proving the Quality of Health Care for Mental and Sub4 stance-Use Conditions: Quality Chasm Series, and shall 

5 include demonstrating at least the following: 

6 (1) Coordinated delivery of mental health, sub7 stance use, and primary health care, utilizing a co8 location or integrated delivery model. 

9 (2) Use of evidence-based practices, to as great 

10 an extent as possible. 

11 (3) Provision of patient-centered care that em12 phasizes recovery-oriented practices and informed 

13 patients and, where appropriate, family decision14 making. 

15 (4) A commitment to utilizing health informa16 tion technology to improve the quality and efficiency 

17 of care. 

18 (b) REQUIRED REPORTING ON QUALITY.—The Sec19 retary shall provide that each health care provider partici20 pating in the project shall submit data on quality meas21 ures determined by the Secretary. 

22 (c) WAIVER OF REQUIREMENTS.— 

23 (1) IN GENERAL.—Subject to paragraph (2), 

24 the Secretary is authorized to waive such require25 ments of title XIX of the Social Security Act, such 


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1 as statewideness, a limitation on the scope of serv2 ices included in medical assistance, and the coverage 

3 of additional administrative expenses, as may be 

4 necessary for the implementation of the project. 

5 (2) LIMITATION ON FUNDING.—The Secretary 

6 shall design the project in such a manner so that the 

7 net additional Federal expenditures under title XIX 

8 of the Social Security Act resulting from the project 

9 does not exceed $50,000,000. 

10 (d) INDEPENDENT EVALUATION.—The Secretary 

11 shall provide for an independent evaluation of activities 

12 provided under the project, in comparison with a control 

13 group. Such evaluation shall include an assessment of 

14 health and social outcomes for beneficiary participants, 

15 such as employment status, receipt of welfare benefits, 

16 criminal justice contacts, and homelessness, as well as the 

17 resource utilization for medical services, mental and sub18 stance use health care, and social services. Such evaluation 

19 shall also include an assessment of the impact of activities 

20 provided under the project on workforce recruitment and 

21 retention. 

22 (e) REPORTS TO CONGRESS.— 

23 (1) INTERIM REPORT.—Not later than 2 years 

24 after the initiation of the project, the Secretary shall 

25 submit to the Congress an interim report on the 


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1 project. Such report shall include such recommenda2 tions as the Secretary determines appropriate. 

3 (2) FINAL REPORT.—Not later than 1 year 

4 after the completion of the project, the Secretary 

5 shall submit to the Congress a final report on the 

6 project. The report shall include the results of the 

7 independent evaluation provided under subsection 

8 (d) as well as recommendations regarding redesign 

9 of the mental health and substance use benefit 

10 under the Medicaid program to maximize the quality 

11 and efficiency of such benefits. 

12 SEC. 11. MEDICAID REQUIREMENT FOR STATE REPEAL OF 

13 LAWS DENYING HEALTH BENEFITS COV14 ERAGE BASED ON INTOXICATION. 

15 (a) IN GENERAL.—Section 1902 of the Social Secu16 rity Act (42 U.S.C. 1396a), as amended by section 5006 

17 of division B of Public Law 111–5, is amended— 

18 (1) in subsection (a)— 

19 (A) by striking ‘‘and’’ at the end of para20 graph (72); 

21 (B) by striking the period at the end of 

22 paragraph (73) and inserting ‘‘; and’’; and 

23 (C) by inserting after paragraph (73) the 

24 following new paragraph: 


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1 ‘‘(74) provide that the State has in effect a law 

2 that requires any insurance contract covering med3 ical care losses in the group and individual market 

4 that is to be offered in the State to meet the re5 quirements of subsection (gg)(1).’’; and 

6 (2) by adding at the end the following new sub7 section: 

8 ‘‘(gg) REQUIREMENTS FOR INSURANCE COVERING

9 MEDICAL LOSSES IN THE GROUP AND INDIVIDUAL MAR10 KET.— 

11 ‘‘(1) RESTRICTIONS ON EXCLUSIONS AND LIMI12 TATIONS RELATING TO INTOXICATION.—The re13 quirements of this paragraph with respect to insur14 ance contracts covering medical care losses in the 

15 group and individual market are as follows: 

16 ‘‘(A) A prohibition against the exclusion or 

17 denial of covered services and benefits, in con18 nection with the treatment of any patient whose 

19 medical condition, illness, or injury, involves 

20 confirmed or suspected intoxication as a result 

21 of alcohol or other substance. 

22 ‘‘(B) A prohibition against discrimination 

23 against health care providers in the rate or level 

24 of payment for covered services in cases in 


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1 which intoxication is either suspected or con2 firmed. 

3 ‘‘(C) An express obligation to provide and 

4 pay for covered services and treatments nec5 essary to the treatment of any condition, illness, 

6 or injury without regard to whether intoxication 

7 is either suspected or confirmed. 

8 ‘‘(D) An express obligation to cooperate 

9 with the state agency for medical assistance as 

10 provided under section 1902(a)(25). 

11 ‘‘(2) INCLUSION OF ALL FORMS OF COV12 ERAGE.—For purposes of subsection (a)(74) and 

13 paragraph (1), the term ‘insurance contract covering 

14 medical care losses in the group and individual mar15 ket’ includes any class or type of insurance relating 

16 to medical care in the group or individual market, 

17 including plans covering public employees as well as 

18 private employees, regardless of whether coverage 

19 under the contract is expressed in terms of defined 

20 benefits or defined cash contributions toward the 

21 cost of medical losses.’’. 

22 (b) EFFECTIVE DATE.— 

23 (1) Except as provided in paragraph (2), the 

24 amendments made by subsection (a) shall apply to 

25 calendar quarters beginning on or after January 1, 


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1 2010, without regard to whether or not final regula2 tions to carry out such amendments have been pro3 mulgated by such date. 

4 (2) In the case of a State plan for medical as5 sistance under title XIX of the Social Security Act 

6 which the Secretary determines requires State legis7 lation (other than legislation appropriating funds) in 

8 order for the plan to meet the additional require9 ments imposed by the amendments made by sub10 section (a), the State plan shall not be regarded as 

11 failing to comply with the requirements of such title 

12 solely on the basis of its failure to meet these addi13 tional requirements before the first day of the first 

14 calendar quarter beginning after the close of the 

15 first regular session of the State legislature that be16 gins after the date of the enactment of this Act. For 

17 purposes of the previous sentence, in the case of a 

18 State that has a 2-year legislative session, each year 

19 of such session shall be deemed to be a separate reg20 ular session of the State legislature. 

Æ 


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