II 

111TH CONGRESS 

1ST SESSION S. 1857 

To establish national centers of excellence for the treatment of depressive 

and bipolar disorders. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 22, 2009 

Ms. STABENOW (for herself, Mr. VOINOVICH, Mrs. HUTCHISON, Mr. BROWN, 

and Mr. KERRY) introduced the following bill; which was read twice and 

referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To establish national centers of excellence for the treatment 

of depressive and bipolar disorders. 

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 ‘‘Establishing a Net5 work of Health-Advancing National Centers of Excellence 

6 for Depression Act of 2009’’ or the ‘‘ENHANCED Act 

7 of 2009’’. 

8 SEC. 2. PURPOSES; GOAL. 

9 (a) PURPOSE.—It is the purpose of this Act to— 


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1 (1) establish a national network of centers of 

2 excellence for depressive disorders; 

3 (2) provide Federal financial assistance to es4 tablish and support a National network of depres5 sion centers that provide for university- and commu6 nity-based delivery of evidence-based interventions, 

7 innovative practices, and services to individuals with 

8 depressive disorders; and 

9 (3) improve the standard of care and delivery of 

10 evidence-based interventions, innovative practices, 

11 and services to individuals with depressive disorders. 

12 (b) GOAL.—It is the goal of this Act to— 

13 (1) increase the number of individuals with de14 pressive disorders who receive appropriate and evi15 dence-based treatment, through the implementation 

16 of multidisciplinary research and clinical programs 

17 that use a recovery framework, standardize diag18 noses, treat individuals early and more effectively, 

19 and prevent recurrences of depressive disorders; and 

20 (2) to establish a national resource to develop 

21 and disseminate evidence-based interventions for de22 pressive disorders, provide public and professional 

23 education about depressive disorders, and eradicate 

24 the stigma associated with depressive disorders. 


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1 SEC. 3. CENTERS OF EXCELLENCE FOR DEPRESSION. 

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

3 Service Act (42 U.S.C. 290bb et seq.) is amended by in4 serting after section 520A the following: 

5 ‘‘SEC. 520B. NATIONAL CENTERS OF EXCELLENCE FOR DE6 PRESSION. 

7 ‘‘(a) DEPRESSIVE DISORDER DEFINED.—In this sec8 tion, the term ‘depressive disorder’ means a mental or 

9 brain disorder relating to depression, including major de10 pression, bipolar disorder, and related mood disorders. 

11 ‘‘(b) GRANT PROGRAM.— 

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

13 through the Administrator, shall award grants on a 

14 competitive basis to eligible entities to establish na15 tional centers of excellence for depression (referred 

16 to in this section as ‘centers of excellence’), which 

17 shall engage in activities related to the treatment of 

18 depressive disorders. 

19 ‘‘(2) ALLOCATION OF AWARDS.—If the funds 

20 authorized under subsection (f) are appropriated in 

21 the amounts provided for under such subsection, the 

22 Secretary shall allocate such amounts so that— 

23 ‘‘(A) not later than 1 year after the date 

24 of enactment of the ENHANCED Act of 2009, 

25 not more than 20 centers of excellence may be 

26 established; and 


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1 ‘‘(B) not later than September 30, 2016, 

2 not more than 30 centers of excellence may be 

3 established. 

4 ‘‘(3) GRANT PERIOD.— 

5 ‘‘(A) IN GENERAL.—A grant awarded 

6 under this section shall be for a period of 5 

7 years. 

8 ‘‘(B) RENEWAL.—A grant awarded under 

9 subparagraph (A) may be renewed, on a com10 petitive basis, for 1 additional 5-year period, at 

11 the discretion of the Secretary. In determining 

12 whether to renew a grant, the Secretary shall 

13 consider the report cards issued under sub14 section (e)(2). 

15 ‘‘(4) USE OF FUNDS.—Grant funds awarded 

16 under this subsection shall be used for the establish17 ment and ongoing activities of the recipient of such 

18 funds. 

19 ‘‘(5) ELIGIBLE ENTITIES.— 

20 ‘‘(A) REQUIREMENTS.—To be eligible to 

21 receive a grant under this section, an entity 

22 shall— 

23 ‘‘(i) be an institution of higher edu24 cation or a public or private nonprofit re25 search institution; and 


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1 ‘‘(ii) submit an application to the Sec2 retary at such time and in such manner as 

3 the Secretary may require, as described in 

4 subparagraph (B). 

5 ‘‘(B) APPLICATION.—An application de6 scribed in subparagraph (A)(ii) shall include— 

7 ‘‘(i) evidence that such entity— 

8 ‘‘(I) provides, or is capable of co9 ordinating with other entities to pro10 vide, comprehensive medical services 

11 with a focus on mental health services 

12 and subspecialty expertise for depres13 sive disorders; 

14 ‘‘(II) collaborates with— 

15 ‘‘(aa) other medical sub16 specialists to address co-occur17 ring mental illnesses; 

18 ‘‘(bb) community organiza19 tions; and 

20 ‘‘(cc) other members of the 

21 network; 

22 ‘‘(III) is capable of training 

23 health professionals about mental 

24 health; and 


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1 ‘‘(ii) such other information, as the 

2 Secretary may require. 

3 ‘‘(C) PRIORITIES.—In awarding grants 

4 under this section, the Secretary shall give pri5 ority to eligible entities that meet 1 or more of 

6 the following criteria: 

7 ‘‘(i) Demonstrated capacity and exper8 tise to serve the targeted population. 

9 ‘‘(ii) Existing infrastructure or exper10 tise to provide appropriate, evidence-based 

11 and culturally competent services. 

12 ‘‘(iii) A location in a geographic area 

13 with disproportionate numbers of under14 served and at-risk populations in medically 

15 underserved areas and health professional 

16 shortage areas. 

17 ‘‘(iv) A history of serving the popu18 lation described in clause (iii). 

19 ‘‘(v) Proposed innovative approaches 

20 for outreach to initiate or expand services. 

21 ‘‘(vi) Use of the most up-to-date 

22 science, practices, and interventions avail23 able. 

24 ‘‘(vii) Demonstrated coordination and 

25 collaboration, or having a viable plan to coVerDate Nov 24 2008 00:24 Oct 23, 2009 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1857.IS S1857

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1 ordinate, with a community mental health 

2 center or other community mental health 

3 resources. 

4 ‘‘(viii) Capacity to establish coopera5 tive agreements with other community en6 tities to provide social and human services 

7 to individuals with depressive disorders. 

8 ‘‘(ix) Demonstrated potential for rep9 lication and dissemination of evidence10 based research and practices. 

11 ‘‘(6) SPECIALTY CENTERS.—Of the centers of 

12 excellence receiving a grant under this section, the 

13 Secretary may select 1 or more such centers to spe14 cialize in— 

15 ‘‘(A) subspecialties such as prepartum and 

16 postpartum depression, traumatic stress dis17 order, suicidal tendency, bipolar disorder, and 

18 depression; and 

19 ‘‘(B) providing mental health services to 

20 communities with problems of access, such as 

21 rural communities and economically depressed 

22 communities. 

23 ‘‘(7) NATIONAL COORDINATING CENTER.— 

24 ‘‘(A) IN GENERAL.—The Secretary, acting 

25 through the Administrator, shall designate 1 reVerDate Nov 24 2008 00:24 Oct 23, 2009 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1857.IS S1857

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1 cipient of a grant under this section to be the 

2 coordinating center of excellence for depression 

3 (referred to in this section as the ‘coordinating 

4 center’). The Secretary shall select such coordi5 nating center on a competitive basis, based 

6 upon the demonstrated capacity of such center 

7 to perform the duties described in subpara8 graph (C). 

9 ‘‘(B) APPLICATION.—A center of excel10 lence that has been awarded a grant under 

11 paragraph (1) may apply for designation as the 

12 coordinating center by submitting an applica13 tion to the Secretary at such time, in such man14 ner, and containing such information as the 

15 Secretary may require. 

16 ‘‘(C) DUTIES.—The coordinating center 

17 shall— 

18 ‘‘(i) develop, administer, and coordi19 nate the network of centers of excellence 

20 under this section; 

21 ‘‘(ii) oversee and coordinate the na22 tional database described in subsection (d); 

23 ‘‘(iii) lead a strategy to disseminate 

24 the findings and activities of the centers of 

25 excellence through such database; 


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1 ‘‘(iv) serve as a liaison with the Ad2 ministration, the National Registry of Evi3 dence-based Programs and Practices of the 

4 Administration, and any Federal inter5 agency or interagency forum on mental 

6 health; and 

7 ‘‘(v) establish a common network in8 frastructure to advance services provided 

9 by the centers of excellence and dem10 onstrate effectiveness in fostering a col11 laborative community among such centers 

12 for sharing knowledge and skills. 

13 ‘‘(8) MATCHING FUNDS.—The Secretary may 

14 not award a grant or contract under this section to 

15 an entity unless the entity agrees that it will make 

16 available (directly or through contributions from 

17 other public or private entities) non-Federal con18 tributions toward the activities to be carried out 

19 under the grant or contract in an amount equal to 

20 $1 for each $5 of Federal funds provided under the 

21 grant or contract. Such non-Federal matching funds 

22 may be provided directly or through donations from 

23 public or private entities and may be in cash or in24 kind, fairly evaluated, including plant, equipment, or 

25 services. 


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1 ‘‘(c) ACTIVITIES OF THE CENTERS OF EXCEL2 LENCE.—Each center of excellence shall carry out the fol3 lowing activities: 

4 ‘‘(1) GENERAL ACTIVITIES.—Each center of ex5 cellence shall— 

6 ‘‘(A) integrate basic, clinical, or health 

7 services interdisciplinary research and practice 

8 in the development of evidence-based interven9 tions; 

10 ‘‘(B) involve a broad cross-section of stake11 holders, such as researchers, clinicians, con12 sumers, and families of consumers, to develop 

13 innovative approaches to incorporate research 

14 and practice and advance evidence-based prac15 tices; 

16 ‘‘(C) provide training and technical assist17 ance to mental health professionals, and engage 

18 in and disseminate translational research with a 

19 focus on meeting the needs of individuals with 

20 depressive disorders; 

21 ‘‘(D) facilitate the dissemination and com22 munication of research findings and depressive 

23 disorder-related information from the institu24 tions of higher education to the public; and 


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1 ‘‘(E) educate policy makers, employers, 

2 community leaders, and the general public 

3 about depressive disorders to reduce stigma and 

4 raise awareness of available treatments for such 

5 disorders. 

6 ‘‘(2) IMPROVED TREATMENT STANDARDS, CLIN7 ICAL GUIDELINES, AND DIAGNOSTIC PROTOCOLS.— 

8 Each center of excellence shall collaborate with other 

9 centers of excellence in the network to— 

10 ‘‘(A) develop and implement treatment 

11 standards, clinical guidelines, and protocols to 

12 improve the accuracy and timeliness of diag13 nosis of depressive disorders; and 

14 ‘‘(B) develop and implement treatment 

15 standards that emphasize early intervention and 

16 treatment for, primary prevention and the pre17 vention of recurrences of, and recovery from, 

18 depressive disorders. 

19 ‘‘(3) COORDINATION AND INTEGRATION OF

20 PHYSICAL, MENTAL, AND SOCIAL CARE.—Each cen21 ter of excellence shall— 

22 ‘‘(A) incorporate principles of chronic care 

23 coordination and integration of services that ad24 dress physical, mental, and social conditions in 

25 the treatment of depressive disorders; 


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1 ‘‘(B) foster communication with other pro2 viders attending to co-occurring physical health 

3 conditions such as cardiovascular, diabetes, can4 cer, and substance abuse disorders; 

5 ‘‘(C) identify how treatment for depression 

6 interacts with such co-occurring illnesses to im7 prove overall health outcomes; 

8 ‘‘(D) leverage available community re9 sources, develop and implement improved self10 management programs, and, when appropriate, 

11 involve family and other providers of social sup12 port in the development and implementation of 

13 care plans; and 

14 ‘‘(E) use electronic health records and tele15 health technology to better coordinate and man16 age, and improve access to, care, as determined 

17 by the coordinating center. 

18 ‘‘(4) TRANSLATIONAL RESEARCH THROUGH

19 COLLABORATION OF CENTERS OF EXCELLENCE AND

20 COMMUNITY-BASED ORGANIZATIONS.—Each center 

21 of excellence shall— 

22 ‘‘(A) demonstrate effective use of a public23 private partnership to foster collaborations 

24 among members of the network and commu25 nity-based organizations such as community 


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1 mental health centers and other social and 

2 human services providers; 

3 ‘‘(B) expand multidisciplinary, 

4 translational, and patient-oriented research and 

5 treatment by fostering such collaborations; and 

6 ‘‘(C) coordinate with accredited academic 

7 programs to provide ongoing opportunities, in 

8 academic and in community settings, for the 

9 professional and continuing education of mental 

10 health providers. 

11 ‘‘(d) NATIONAL DATABASE.— 

12 ‘‘(1) IN GENERAL.—The coordinating center 

13 shall establish and maintain a national, publicly 

14 available database to improve prevention programs, 

15 evidence-based interventions, and disease manage16 ment programs for depressive disorders, using data 

17 collected from the centers of excellence, as described 

18 in paragraph (2). 

19 ‘‘(2) DATA COLLECTION.— 

20 ‘‘(A) DATA.—Each center of excellence 

21 shall submit data gathered at such center, as 

22 appropriate, to the coordinating center regard23 ing— 

24 ‘‘(i) the prevalence and incidence of 

25 depressive disorders; 


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1 ‘‘(ii) the health and social outcomes of 

2 individuals with depressive disorders; 

3 ‘‘(iii) the effectiveness of interventions 

4 designed, tested, and evaluated; 

5 ‘‘(iv) the progress in the prevention 

6 of, and recovery from, depressive disorders; 

7 and 

8 ‘‘(v) the economic impact of the activi9 ties of such center. 

10 ‘‘(B) FINANCIAL INFORMATION.—Each 

11 center of excellence shall provide to the coordi12 nating center appropriately summarized finan13 cial information to enable the coordinating cen14 ter to assess the efficiency and financial sus15 tainability of such center. 

16 ‘‘(3) SUBMISSION OF DATA TO THE ADMINIS17 TRATOR.—The coordinating center shall submit to 

18 the Administrator the data and financial information 

19 gathered under paragraph (2). 

20 ‘‘(4) PUBLICATION USING DATA FROM THE

21 DATABASE.—A center of excellence, or an individual 

22 affiliated with a center of excellence, may publish 

23 findings using the data described in paragraph 

24 (2)(A) only if such center submits such data to the 


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1 coordinating center, as required under such para2 graph. 

3 ‘‘(e) ESTABLISHMENT OF STANDARDS; REPORT

4 CARDS AND RECOMMENDATIONS; THIRD PARTY RE5 VIEW.— 

6 ‘‘(1) ESTABLISHMENT OF STANDARDS.—The 

7 Secretary, acting through the Administrator, shall 

8 establish performance standards for— 

9 ‘‘(A) each center of excellence; and 

10 ‘‘(B) the network of centers of excellence 

11 as a whole. 

12 ‘‘(2) REPORT CARDS.—The Secretary, acting 

13 through the Administrator, shall— 

14 ‘‘(A) for each center of excellence, not later 

15 than 3 years after the date on which such cen16 ter of excellence is established and annually 

17 thereafter, issue a report card to the coordi18 nating center to rate the performance of such 

19 center of excellence; and 

20 ‘‘(B) not later than 3 years after the date 

21 on which the first grant is awarded under sub22 section (b)(1) and annually thereafter, issue a 

23 report card to Congress to rate the performance 

24 of the network of centers of excellence as a 

25 whole. 


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1 ‘‘(3) RECOMMENDATIONS.—Based upon the re2 port cards described in paragraph (1), the Secretary 

3 shall, not later than September 30, 2015— 

4 ‘‘(A) make recommendations to the centers 

5 of excellence regarding improvements such cen6 ters shall make; and 

7 ‘‘(B) make recommendations to Congress 

8 for expanding the centers of excellence to serve 

9 individuals with other types of mental disorders. 

10 ‘‘(4) THIRD PARTY REVIEW.—Not later than 3 

11 years after the date on which the first grant is 

12 awarded under subsection (b)(1) and annually there13 after, the Secretary shall arrange for an independent 

14 third party to conduct an evaluation of the network 

15 of centers of excellence to ensure that such centers 

16 are meeting the goals of this section. 

17 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 

18 ‘‘(1) IN GENERAL.—To carry out this section, 

19 there are authorized to be appropriated— 

20 ‘‘(A) $100,000,000 for each of the fiscal 

21 years 2011 through 2015; and 

22 ‘‘(B) $150,000,000 for each of the fiscal 

23 years 2016 through 2020. 

24 ‘‘(2) ALLOCATION OF FUNDS AUTHORIZED.—Of 

25 the amount appropriated under paragraph (1) for a 


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1 fiscal year, the Secretary shall determine the alloca2 tion of each center of excellence receiving a grant 

3 under this section, but in no case may the allocation 

4 be more than $5,000,000, except that the Secretary 

5 may allocate not more than $10,000,000 to the co6 ordinating center.’’. 

7 SEC. 4. SENSE OF THE SENATE. 

8 It is the sense of the Senate that the knowledge and 

9 research developed by the centers of excellence for depres10 sion established under section 520B of the Public Health 

11 Service Act should be disseminated broadly within the 

12 medical community and the Federal Government, particu13 larly to agencies with an interest in mental health, includ14 ing other agencies within the Department of Health and 

15 Human Services and the Departments of Justice, Defense, 

16 Labor, and Veterans Affairs. 

Æ 


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