II 

112TH CONGRESS 

2D SESSION S. 2257 

To increase access to community behavioral health services for all Americans 

and to improve Medicaid reimbursement for community behavioral health 

services. 

IN THE SENATE OF THE UNITED STATES 

MARCH 29, 2012 

Ms. STABENOW (for herself and Mr. REED) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To increase access to community behavioral health services 

for all Americans and to improve Medicaid reimbursement for community behavioral health services. 

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 ‘‘Excellence in Mental 

5 Health Act’’. 

6 SEC. 2. ESTABLISHING COMMUNITY BEHAVIORAL HEALTH 

7 CENTERS. 

8 Section 1913 of the Public Health Service Act (42 

9 U.S.C. 300x–2) is amended— 


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1 (1) in subsection (a)(2)(A), by striking ‘‘com2 munity mental health services’’ and inserting ‘‘be3 havioral health services (of the type offered by feder4 ally qualified community behavioral health centers 

5 consistent with subsection (c)(3))’’; 

6 (2) in subsection (b)— 

7 (A) by striking paragraph (1) and insert8 ing the following: 

9 ‘‘(1) services under the plan will be provided 

10 only through appropriate, qualified community pro11 grams (which may include federally qualified com12 munity behavioral health centers, child mental 

13 health programs, psychosocial rehabilitation pro14 grams, mental health peer-support programs, out15 patient addiction treatment programs, acute detoxi16 fication services, and mental health primary con17 sumer-directed programs); and’’; and 

18 (B) in paragraph (2), by striking ‘‘commu19 nity mental health centers’’ and inserting ‘‘fed20 erally qualified community behavioral health 

21 centers’’; and 

22 (3) by striking subsection (c) and inserting the 

23 following: 

24 ‘‘(c) CRITERIA FOR FEDERALLY QUALIFIED COMMU25 NITY BEHAVIORAL HEALTH CENTERS.— 


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1 ‘‘(1) IN GENERAL.—The Administrator shall 

2 certify, and recertify at least every 5 years, federally 

3 qualified community behavioral health centers as 

4 meeting the criteria specified in this subsection. 

5 ‘‘(2) REGULATIONS.—Not later than 18 months 

6 after the date of the enactment of the Excellence in 

7 Mental Health Act, the Administrator, in consulta8 tion with State Mental Health and Substance Abuse 

9 Authorities, shall issue final regulations for certi10 fying non-profit or local government centers as cen11 ters under paragraph (1). 

12 ‘‘(3) CRITERIA.—The criteria referred to in 

13 subsection (b)(2) are that the center performs each 

14 of the following: 

15 ‘‘(A) Provide services in locations that en16 sure services will be available and accessible 

17 promptly and in a manner which preserves 

18 human dignity and assures continuity of care. 

19 ‘‘(B) Provide services in a mode of service 

20 delivery appropriate for the target population. 

21 ‘‘(C) Provide individuals with a choice of 

22 service options where there is more than one ef23 ficacious treatment. 


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1 ‘‘(D) Employ a core staff of clinical staff 

2 that is multidisciplinary and culturally and lin3 guistically competent. 

4 ‘‘(E) Provide services, within the limits of 

5 the capacities of the center, to any individual 

6 residing or employed in the service area of the 

7 center, regardless of the ability of the individual 

8 to pay. 

9 ‘‘(F) Provide, directly or through contract, 

10 to the extent covered for adults in the State 

11 Medicaid plan under title XIX of the Social Se12 curity Act and for children in accordance with 

13 section 1905(r) of such Act regarding early and 

14 periodic screening, diagnosis, and treatment, 

15 each of the following services: 

16 ‘‘(i) Screening, assessment, and diag17 nosis, including risk assessment. 

18 ‘‘(ii) Person-centered treatment plan19 ning or similar processes, including risk as20 sessment and crisis planning. 

21 ‘‘(iii) Outpatient mental health and 

22 substance use services, including screening, 

23 assessment, diagnosis, psychotherapy, 

24 medication management, and integrated 

25 treatment for mental illness and substance 


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1 abuse which shall be evidence-based (in2 cluding cognitive behavioral therapy and 

3 other such therapies which are evidence4 based). 

5 ‘‘(iv) Outpatient clinic primary care 

6 screening and monitoring of key health in7 dicators and health risk (including screen8 ing for diabetes, hypertension, and cardio9 vascular disease and monitoring of weight, 

10 height, body mass index (BMI), blood pres11 sure, blood glucose or HbA1C, and lipid 

12 profile). 

13 ‘‘(v) Crisis mental health services, in14 cluding 24-hour mobile crisis teams, emer15 gency crisis intervention services, and cri16 sis stabilization. 

17 ‘‘(vi) Targeted case management 

18 (services to assist individuals gaining ac19 cess to needed medical, social, educational, 

20 and other services and applying for income 

21 security and other benefits to which they 

22 may be entitled). 

23 ‘‘(vii) Psychiatric rehabilitation serv24 ices including skills training, assertive com25 munity treatment, family psychoeducation, 


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1 disability self-management, supported em2 ployment, supported housing services, 

3 therapeutic foster care services, and such 

4 other evidence-based practices as the Sec5 retary may require. 

6 ‘‘(viii) Peer support and counselor 

7 services and family supports. 

8 ‘‘(G) Maintain linkages, and where possible 

9 enter into formal contracts with the following: 

10 ‘‘(i) Federally qualified health centers. 

11 ‘‘(ii) Inpatient psychiatric facilities 

12 and substance use detoxification, post-de13 toxification step-down services, and resi14 dential programs. 

15 ‘‘(iii) Adult and youth peer support 

16 and counselor services. 

17 ‘‘(iv) Family support services for fam18 ilies of children with serious mental or sub19 stance use disorders. 

20 ‘‘(v) Other community or regional 

21 services, supports, and providers, including 

22 schools, child welfare agencies, juvenile and 

23 criminal justice agencies and facilities, 

24 housing agencies and programs, employers, 

25 and other social services. 


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1 ‘‘(vi) Onsite or offsite access to pri2 mary care services. 

3 ‘‘(vii) Enabling services, including 

4 outreach, transportation, and translation. 

5 ‘‘(viii) Health and wellness services, 

6 including services for tobacco cessation. 

7 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 

8 paragraph (1) shall be construed as prohibiting 

9 States receiving funds appropriated through the 

10 Community Mental Health Services Block Grant 

11 under subpart I of part B of this title from financ12 ing qualified community programs (whether such 

13 programs meet the definition of eligible programs 

14 prior to or after the date of enactment of this sub15 section). 

16 ‘‘(5) LIMITATION.—With respect to federally 

17 qualified behavioral health centers authorized under 

18 this subsection, 20 percent of the total number of 

19 such centers shall become newly eligible to receive 

20 reimbursement under this section in each of the first 

21 5 years after the initial year of eligibility through 

22 fiscal year 2022. In implementing this paragraph, 

23 the Secretary shall ensure geographic diversity of 

24 such sites, take into account the ability of such sites 


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1 to provide required services, and the ability of such 

2 sites to report required data.’’. 

3 SEC. 3. MEDICAID COVERAGE AND PAYMENT FOR COMMU4 NITY BEHAVIORAL HEALTH CENTER SERV5 ICES. 

6 (a) PAYMENT FOR SERVICES PROVIDED BY FEDER7 ALLY QUALIFIED COMMUNITY BEHAVIORAL HEALTH

8 CENTERS.—Section 1902(bb) of the Social Security Act 

9 (42 U.S.C. 1396a(bb)) is amended— 

10 (1) in the heading, by striking ‘‘AND RURAL

11 HEALTH CLINICS’’ and inserting ‘‘, FEDERALLY

12 QUALIFIED COMMUNITY BEHAVIORAL HEALTH

13 CENTERS, AND RURAL HEALTH CLINICS’’; 

14 (2) in paragraph (1), by inserting ‘‘(and begin15 ning with fiscal year 2013 with respect to services 

16 furnished on or after January 1, 2013, and each 

17 succeeding fiscal year, for services described in sec18 tion 1905(a)(2)(D) furnished by a federally qualified 

19 community behavioral health center)’’ after ‘‘by a 

20 rural health clinic’’; 

21 (3) in paragraph (2)— 

22 (A) by striking the heading and inserting 

23 ‘‘INITIAL FISCAL YEAR’’; 

24 (B) by inserting ‘‘(or, in the case of serv25 ices described in section 1905(a)(2)(D) furVerDate Mar 15 2010 03:08 Mar 31, 2012 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2257.IS S2257

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1 nished by a federally qualified community be2 havioral health center, for services furnished on 

3 and after January 1, 2013, during fiscal year 

4 2013)’’ after ‘‘January 1, 2001, during fiscal 

5 year 2001’’; 

6 (C) by inserting ‘‘(or, in the case of serv7 ices described in section 1905(a)(2)(D) fur8 nished by a federally qualified community be9 havioral health center, during fiscal years 2010 

10 and 2011)’’ after ‘‘1999 and 2000’’; and 

11 (D) by inserting ‘‘(or, in the case of serv12 ices described in section 1905(a)(2)(D) fur13 nished by a federally qualified community be14 havioral health center, during fiscal year 

15 2013)’’ before the period; 

16 (4) in paragraph (3)— 

17 (A) in the heading, by striking ‘‘FISCAL

18 YEAR 2002 AND SUCCEEDING’’ and inserting 

19 ‘‘SUCCEEDING’’; and 

20 (B) by inserting ‘‘(or, in the case of serv21 ices described in section 1905(a)(2)(D) fur22 nished by a federally qualified community be23 havioral health center, for services furnished 

24 during fiscal year 2013 or a succeeding fiscal 

25 year)’’ after ‘‘2002 or a succeeding fiscal year’’; 


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1 (5) in paragraph (4)— 

2 (A) by inserting ‘‘(or as a federally quali3 fied community behavioral health center after 

4 fiscal year 2011)’’ after ‘‘or rural health clinic 

5 after fiscal year 2000’’; 

6 (B) by striking ‘‘furnished by the center 

7 or’’ and inserting ‘‘furnished by the federally 

8 qualified health center, services described in 

9 section 1905(a)(2)(D) furnished by the feder10 ally qualified community behavioral health cen11 ter, or’’; and 

12 (C) in the second sentence, by striking ‘‘or 

13 rural health clinic’’ and inserting ‘‘, federally 

14 qualified community behavioral health center, 

15 or rural health clinic’’; 

16 (6) in paragraph (5), in each of subparagraphs 

17 (A) and (B), by striking ‘‘or rural health clinic’’ and 

18 inserting ‘‘, federally qualified community behavioral 

19 health center, or rural health clinic’’; and 

20 (7) in paragraph (6), by striking ‘‘or to a rural 

21 health clinic’’ and inserting ‘‘, to a federally quali22 fied community behavioral health center for services 

23 described in section 1905(a)(2)(D), or to a rural 

24 health clinic’’. 


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1 (b) INCLUSION OF COMMUNITY BEHAVIORAL

2 HEALTH CENTER SERVICES IN THE TERM MEDICAL AS3 SISTANCE.—Section 1905(a)(2) of the Social Security Act 

4 (42 U.S.C. 1396d(a)(2)) is amended— 

5 (1) by striking ‘‘and’’ before ‘‘(C)’’; and 

6 (2) by inserting before the semicolon at the end 

7 the following: ‘‘, and (D) federally qualified commu8 nity behavioral health center services (as defined in 

9 subsection (l)(4))’’. 

10 (c) DEFINITION OF FEDERALLY QUALIFIED COMMU11 NITY BEHAVIORAL HEALTH CENTER SERVICES.—Section 

12 1905(l) of the Social Security Act (42 U.S.C. 1396d(l)) 

13 is amended by adding at the end the following paragraph: 

14 ‘‘(4)(A) The term ‘community behavioral health 

15 center services’ means services furnished to an indi16 vidual at a federally qualified community behavioral 

17 health center (as defined by subparagraph (B)). 

18 ‘‘(B) The term ‘federally qualified community 

19 behavioral health center’ means an entity that is cer20 tified under section 1913(c) of the Public Health 

21 Service Act as meeting the criteria described in 

22 paragraph (3) of such section.’’. 


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1 SEC. 4. COMMUNITY-BASED MENTAL HEALTH INFRASTRUC2 TURE IMPROVEMENT. 

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

4 280g et seq.) is amended by adding at the end the fol5 lowing: 

6 ‘‘PART H—COMMUNITY-BASED MENTAL HEALTH 

7 INFRASTRUCTURE IMPROVEMENTS 

8 ‘‘SEC. 560. GRANTS FOR COMMUNITY-BASED MENTAL 

9 HEALTH INFRASTRUCTURE IMPROVEMENTS. 

10 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

11 award grants to eligible entities to expend funds for the 

12 construction or modernization of facilities used to provide 

13 mental health and substance abuse services to individuals. 

14 ‘‘(b) ELIGIBLE ENTITY.—In this section, the term 

15 ‘eligible entity’ means— 

16 ‘‘(1) a State that is the recipient of a Commu17 nity Mental Health Services Block Grant under sub18 part I of part B of title XIX and a Substance Abuse 

19 Prevention and Treatment Block Grant under sub20 part II of such part; or 

21 ‘‘(2) an Indian tribe or a tribal organization (as 

22 such terms are defined in sections 4(b) and 4(c) of 

23 the Indian Self-Determination and Education Assist24 ance Act). 


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1 ‘‘(c) APPLICATION.—A eligible entity desiring a grant 

2 under this section shall submit to the Secretary an appli3 cation at such time, in such manner, and containing— 

4 ‘‘(1) a plan for the construction or moderniza5 tion of facilities used to provide mental health and 

6 substance abuse services to individuals that— 

7 ‘‘(A) designates a single State or tribal 

8 agency as the sole agency for the supervision 

9 and administration of the grant; 

10 ‘‘(B) contains satisfactory evidence that 

11 such agency so designated will have the author12 ity to carry out the plan; 

13 ‘‘(C) provides for the designation of an ad14 visory council, which shall include representa15 tives of nongovernmental organizations or 

16 groups, and of the relevant State or tribal agen17 cies, that aided in the development of the plan 

18 and that will implement and monitor any grant 

19 awarded to the eligible entity under this section; 

20 ‘‘(D) in the case of an eligible entity that 

21 is a State, includes a copy of the State plan 

22 under section 1912(b) and section 1932(b); 

23 ‘‘(E)(i) includes a listing of the projects to 

24 be funded by the grant; and 


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1 ‘‘(ii) in the case of an eligible entity that 

2 is a State, explains how each listed project 

3 helps the State in accomplishing its goals and 

4 objectives under the Community Mental Health 

5 Services Block Grant under subpart I of part B 

6 of title XIX and the Substance Abuse Preven7 tion and Treatment Block Grant under subpart 

8 II of such part; 

9 ‘‘(F) includes assurances that the facilities 

10 will be used for a period of not less than 10 

11 years for the provision of community-based 

12 mental health or substance abuse services for 

13 those who cannot pay for such services, subject 

14 to subsection (e); and 

15 ‘‘(G) in the case of a facility that is not a 

16 public facility, includes the name and executive 

17 director of the entity who will provide services 

18 in the facility; and 

19 ‘‘(2) with respect to each construction or mod20 ernization project described in the application— 

21 ‘‘(A) a description of the site for the 

22 project; 

23 ‘‘(B) plans and specifications for the 

24 project and State or tribal approval for the 

25 plans and specifications; 


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1 ‘‘(C) assurance that the title for the site is 

2 or will be vested with either the public entity or 

3 private nonprofit entity who will provide the 

4 services in the facility; 

5 ‘‘(D) assurance that adequate financial re6 sources will be available for the construction or 

7 major rehabilitation of the project and for the 

8 maintenance and operation of the facility; 

9 ‘‘(E) estimates of the cost of the project; 

10 and 

11 ‘‘(F) the estimated length of time for com12 pletion of the project. 

13 ‘‘(d) SUBGRANTS BY STATES.— 

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

15 grant under this section may award a subgrant to 

16 a qualified community program (as such term is 

17 used in section 1913(b)(1)). 

18 ‘‘(2) USE OF FUNDS.—Subgrants awarded pur19 suant to paragraph (1) may be used for activities 

20 such as— 

21 ‘‘(A) the construction, expansion, and mod22 ernization of facilities used to provide mental 

23 health and substance abuse services to individ24 uals; 


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1 ‘‘(B) acquiring and leasing facilities and 

2 equipment (including paying the costs of amor3 tizing the principal of, and paying the interest 

4 on, loans for such facilities and equipment) to 

5 support or further the operation of the sub6 grantee; 

7 ‘‘(C) the construction and structural modi8 fication (including equipment acquisition) of fa9 cilities to permit the integrated delivery of be10 havioral health and primary care of specialty 

11 medical services to individuals with co-occurring 

12 mental illnesses and chronic medical or surgical 

13 diseases at a single service site; and 

14 ‘‘(D) acquiring information technology re15 quired to accommodate the clinical needs of pri16 mary and specialty care professionals. 

17 ‘‘(3) LIMITATION.—Not to exceed 15 percent of 

18 grant funds may be used for activities described in 

19 paragraph (2)(D). 

20 ‘‘(e) REQUEST TO TRANSFER OBLIGATION.—An eli21 gible entity that receives a grant under this section may 

22 submit a request to the Secretary for permission to trans23 fer the 10-year obligation of facility use, as described in 

24 subsection (c)(1)(F), to another facility. 


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1 ‘‘(f) AGREEMENT TO FEDERAL SHARE.—As a condi2 tion of receipt of a grant under this section, an eligible 

3 entity shall agree, with respect to the costs to be incurred 

4 by the entity in carrying out the activities for which such 

5 grant is awarded, that the entity will make available non6 Federal contributions (which may include State or local 

7 funds, or funds from the qualified community program) 

8 in an amount equal to not less than $1 for every $1 of 

9 Federal funds provided under the grant. 

10 ‘‘(g) REPORTING.— 

11 ‘‘(1) REPORTING BY STATES.—During the 10- 

12 year period referred to in subsection (c)(1)(F), the 

13 Secretary shall require that a State that receives a 

14 grant under this section submit, as part of the re15 port of the State required under the Community 

16 Mental Health Services Block Grant under subpart 

17 I of part B of title XIX and the Substance Abuse 

18 Prevention and Treatment Block Grant under sub19 part II of such part, a description of the progress 

20 on— 

21 ‘‘(A) the projects carried out pursuant to 

22 the grant under this section; and 

23 ‘‘(B) the assurances that the facilities in24 volved continue to be used for the purpose for 


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1 which they were funded under such grant dur2 ing such 10-year period. 

3 ‘‘(2) REPORTING BY INDIAN TRIBES AND TRIB4 AL ORGANIZATIONS.—The Secretary shall establish 

5 reporting requirements for Indian tribes and tribal 

6 organizations that receive a grant under this section. 

7 Such reporting requirements shall include that such 

8 Indian tribe or tribal organization provide a descrip9 tion of the progress on— 

10 ‘‘(A) the projects carried out pursuant to 

11 the grant under this section; and 

12 ‘‘(B) the assurances that the facilities in13 volved continue to be used for the purpose for 

14 which they were funded under such grant dur15 ing the 10-year period referred to in subsection 

16 (c)(1)(F). 

17 ‘‘(h) FAILURE TO MEET OBLIGATIONS.— 

18 ‘‘(1) IN GENERAL.—If an eligible entity that re19 ceives a grant under this section fails to meet any 

20 of the obligations of the entity required under this 

21 section, the Secretary shall take appropriate steps, 

22 which may include— 

23 ‘‘(A) requiring that the entity return the 

24 unused portion of the funds awarded under this 

25 section for the projects that are incomplete; and 


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1 ‘‘(B) extending the length of time that the 

2 entity must ensure that the facility involved is 

3 used for the purposes for which it is intended, 

4 as described in subsection (c)(1)(F). 

5 ‘‘(2) HEARING.—Prior to requesting the return 

6 of the funds under paragraph (1)(B), the Secretary 

7 shall provide the entity notice and opportunity for a 

8 hearing. 

9 ‘‘(i) COLLABORATION.—The Secretary may establish 

10 intergovernmental and interdepartmental memorandums 

11 of agreement as necessary to carry out this section. 

12 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

13 is authorized to be appropriated to carry out this section 

14 such sums as may be necessary for each of fiscal years 

15 2013 through 2017.’’. 

16 SEC. 5. EXPANDED PARTICIPATION IN 340B PROGRAM. 

17 Section 340B(a)(4) of the Public Health Service Act 

18 (42 U.S.C. 256b(a)(4)) is amended by adding at the end 

19 the following: 

20 ‘‘(P) An entity receiving funds under sub21 part I of part B of title XIX of this Act for the 

22 provision of community mental health services. 

23 ‘‘(Q) An entity receiving funds under sub24 part II of part B of title XIX of this Act for 


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1 the provision of treatment services for sub2 stance abuse.’’. 

Æ 


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