```

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1109 Introduced in House (IH)]

<DOC>

116th CONGRESS
  1st Session
                                H. R. 1109

 To amend the Public Health Service Act to revise and extend projects 
      relating to children and to provide access to school-based 
                 comprehensive mental health programs.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            February 8, 2019

 Mrs. Napolitano (for herself, Mr. Katko, Mr. Lowenthal, Ms. DelBene, 
   Mr. Tonko, Mr. Cicilline, Mr. Payne, Mr. Lujan, Mr. Doggett, Ms. 
 McCollum, Mr. Moulton, Mr. Schiff, Mr. Welch, Mr. Heck, Mr. Grijalva, 
  Ms. Hill of California, Ms. Judy Chu of California, Mr. Kilmer, Ms. 
 Wilson of Florida, Ms. Kelly of Illinois, Miss Rice of New York, Mr. 
Ryan, Mr. Khanna, Mr. Reed, Mr. Larsen of Washington, Ms. Jackson Lee, 
Ms. Moore, Mr. DeSaulnier, Ms. Pingree, Mrs. Lawrence, Ms. Speier, Mr. 
    Panetta, Mr. Soto, Ms. Roybal-Allard, Mrs. Watson Coleman, Mr. 
 Ruppersberger, Mr. Cardenas, Mr. Aguilar, Mr. Gomez, Mr. DeFazio, Mr. 
   McGovern, Mr. Blumenauer, Ms. Omar, Mrs. Murphy, Mr. Sablan, Mr. 
Gallego, Mr. Suozzi, Mr. Cohen, Mr. Cisneros, Ms. Matsui, Ms. Sanchez, 
 Ms. Kuster of New Hampshire, Mrs. Carolyn B. Maloney of New York, Ms. 
Johnson of Texas, Mr. Raskin, Mr. Carbajal, Ms. Castor of Florida, and 
Mr. McNerney) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
 To amend the Public Health Service Act to revise and extend projects 
      relating to children and to provide access to school-based 
                 comprehensive mental health programs.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Mental Health Services for Students 
Act of 2019''.

SEC. 2. PURPOSES.

    The purposes of this Act are to--
            (1) revise, increase funding for, and expand the scope of 
        the Project AWARE State Educational Agency Grant Program 
        carried out by the Secretary of Health and Human Services, in 
        order to provide access to more comprehensive school-based 
        mental health services and supports;
            (2) provide for comprehensive staff development for school 
        and community service personnel working in the school;
            (3) provide for comprehensive training to improve health 
        and academic outcomes for children with, or at risk for, mental 
        health disorders, for parents or guardians, siblings, and other 
        family members of such children, and for concerned members of 
        the community;
            (4) provide for comprehensive, universal, evidence-based 
        screening to identify children and adolescents with potential 
        mental health disorders or unmet emotional health needs;
            (5) recognize best practices for the delivery of mental 
        health care in school-based settings, including school-based 
        health centers;
            (6) provide for comprehensive training for parents or 
        guardians, siblings, other family members, and concerned 
        members of the community on behalf of children and adolescents 
        experiencing mental health trauma, disorder, or disability; and
            (7) establish formal working relationships between health, 
        human service, and educational entities that support the mental 
        and emotional health of children and adolescents in the school 
        setting.

SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    (a) Technical Amendments.--The second part G (relating to services 
provided through religious organizations) of title V of the Public 
Health Service Act (42 U.S.C. 290kk et seq.) is amended--
            (1) by redesignating such part as part J; and
            (2) by redesignating sections 581 through 584 as sections 
        596 through 596C, respectively.
    (b) School-Based Mental Health and Children.--Section 581 of the 
Public Health Service Act (42 U.S.C. 290hh) (relating to children and 
violence) is amended to read as follows:

``SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN AND ADOLESCENTS.

    ``(a) In General.--The Secretary, in collaboration with the 
Secretary of Education, shall, directly or through grants, contracts, 
or cooperative agreements awarded to eligible entities described in 
subsection (c), assist local communities and schools (including schools 
funded by the Bureau of Indian Education) in applying a public health 
approach to mental health services both in schools and in the 
community. Such approach shall provide comprehensive developmentally 
appropriate services and supports that are linguistically and 
culturally appropriate and trauma-informed, and incorporate 
developmentally appropriate strategies of positive behavioral 
interventions and supports. A comprehensive school-based mental health 
program funded under this section shall assist children in dealing with 
traumatic experiences, grief, bereavement, risk of suicide, and 
violence.
    ``(b) Activities.--Under the program under subsection (a), the 
Secretary may--
            ``(1) provide financial support to enable local communities 
        to implement a comprehensive culturally and linguistically 
        appropriate, trauma-informed, and developmentally appropriate, 
        school-based mental health program that--
                    ``(A) builds awareness of individual trauma and the 
                intergenerational, continuum of impacts of trauma on 
                populations;
                    ``(B) trains appropriate staff to identify, and 
                screen for, signs of trauma exposure, mental health 
                disorders, or risk of suicide; and
                    ``(C) incorporates positive behavioral 
                interventions, family engagement, student treatment, 
                and multigenerational supports to foster the health and 
                development of children, prevent mental health 
                disorders, and ameliorate the impact of trauma;
            ``(2) provide technical assistance to local communities 
        with respect to the development of programs described in 
        paragraph (1);
            ``(3) provide assistance to local communities in the 
        development of policies to address child and adolescent trauma 
        and mental health issues and violence when and if it occurs;
            ``(4) facilitate community partnerships among families, 
        students, law enforcement agencies, education agencies, mental 
        health and substance use disorder service systems, family-based 
        mental health service systems, child welfare agencies, health 
        care providers (including primary care physicians, mental 
        health professionals, and other professionals who specialize in 
        children's mental health such as child and adolescent 
        psychiatrists), institutions of higher education, faith-based 
        programs, trauma networks, and other community-based systems; 
        and
            ``(5) establish mechanisms for children and adolescents to 
        report incidents of violence or plans by other children, 
        adolescents, or adults to commit violence.
    ``(c) Requirements.--
            ``(1) In general.--To be eligible for a grant, contract, or 
        cooperative agreement under subsection (a), an entity shall--
                    ``(A) be a partnership that includes--
                            ``(i) a State educational agency, as 
                        defined in section 8101 of the Elementary and 
                        Secondary Education Act of 1965, in 
                        coordination with one or more local educational 
                        agencies, as defined in section 8101 of the 
                        Elementary and Secondary Education Act of 1965, 
                        or a consortium of any entities described in 
                        subparagraph (B), (C), (D), or (E) of section 
                        8101(30) of such Act; and
                            ``(ii) in accordance with paragraph 
                        (2)(A)(i), appropriate public or private 
                        entities that employ interventions that are 
                        evidence-based, as defined in section 8101 of 
                        the Elementary and Secondary Education Act of 
                        1965; and
                    ``(B) submit an application, that is endorsed by 
                all members of the partnership, that--
                            ``(i) specifies which member will serve as 
                        the lead partner; and
                            ``(ii) contains the assurances described in 
                        paragraph (2).
            ``(2) Required assurances.--An application under paragraph 
        (1) shall contain assurances as follows:
                    ``(A) The eligible entity will ensure that, in 
                carrying out activities under this section, the 
                eligible entity will enter into a memorandum of 
                understanding--
                            ``(i) with at least 1 community-based 
                        mental health provider, including a public or 
                        private mental health entity, health care 
                        entity, family-based mental health entity, 
                        trauma network, or other community-based 
                        entity, as determined by the Secretary (and 
                        which may include additional entities such as a 
                        human services agency, law enforcement or 
                        juvenile justice entity, child welfare agency, 
                        agency, an institution of higher education, or 
                        another entity, as determined by the 
                        Secretary); and
                            ``(ii) that clearly states--
                                    ``(I) the responsibilities of each 
                                partner with respect to the activities 
                                to be carried out, including how family 
                                engagement will be incorporated in the 
                                activities;
                                    ``(II) how school-employed and 
                                school-based or community-based mental 
                                health professionals will be utilized 
                                for carrying out such responsibilities;
                                    ``(III) how each such partner will 
                                be accountable for carrying out such 
                                responsibilities; and
                                    ``(IV) the amount of non-Federal 
                                funding or in-kind contributions that 
                                each such partner will contribute in 
                                order to sustain the program.
                    ``(B) The comprehensive school-based mental health 
                program carried out under this section supports the 
                flexible use of funds to address--
                            ``(i) universal prevention, through the 
                        promotion of the social, emotional, mental, and 
                        behavioral health of all students in an 
                        environment that is conducive to learning;
                            ``(ii) selective prevention, through the 
                        reduction in the likelihood of at risk students 
                        developing social, emotional, mental, 
                        behavioral health problems, suicide, or 
                        substance use disorders;
                            ``(iii) the screening for, and early 
                        identification of, social, emotional, mental, 
                        behavioral problems, suicide risk, or substance 
                        use disorders and the provision of early 
                        intervention services;
                            ``(iv) the treatment or referral for 
                        treatment of students with existing social, 
                        emotional, mental, behavioral health problems, 
                        or substance use disorders;
                            ``(v) the development and implementation of 
                        evidence-based programs to assist children who 
                        are experiencing or have been exposed to trauma 
                        and violence, including program curricula, 
                        school supports, and after-school programs; and
                            ``(vi) the development and implementation 
                        of evidence-based programs to assist children 
                        who are grieving, which may include training 
                        for school personnel on the impact of trauma 
                        and bereavement on children, and services to 
                        provide support to grieving children.
                    ``(C) The comprehensive school-based mental health 
                program carried out under this section will provide for 
                in-service training of all school personnel, including 
                ancillary staff and volunteers, in--
                            ``(i) the techniques and supports needed to 
                        promote early identification of children with 
                        trauma histories, children who are grieving, 
                        and children with a mental health disorder or 
                        at risk of developing a mental health disorder, 
                        or who are at risk of suicide;
                            ``(ii) the use of referral mechanisms that 
                        effectively link such children to appropriate 
                        prevention, treatment, and intervention 
                        services in the school and in the community and 
                        to follow-up when services are not available;
                            ``(iii) strategies that promote a school-
                        wide positive environment, including strategies 
                        to prevent bullying, which includes cyber-
                        bullying;
                            ``(iv) strategies for promoting the social, 
                        emotional, mental, and behavioral health of all 
                        students; and
                            ``(v) strategies to increase the knowledge 
                        and skills of school and community leaders 
                        about the impact of trauma and violence and on 
                        the application of a public health approach to 
                        comprehensive school-based mental health 
                        programs.
                    ``(D) The comprehensive school-based mental health 
                program carried out under this section will include 
                comprehensive training for parents or guardians, 
                siblings, and other family members of children with 
                mental health disorders, and for concerned members of 
                the community in--
                            ``(i) the techniques and supports needed to 
                        promote early identification of children with 
                        trauma histories, children who are grieving, 
                        children with a mental health disorder or at 
                        risk of developing a mental health disorder, 
                        and children who are at risk of suicide;
                            ``(ii) the use of referral mechanisms that 
                        effectively link such children to appropriate 
                        prevention, treatment, and intervention 
                        services in the school and in the community and 
                        follow-up when such services are not available; 
                        and
                            ``(iii) strategies that promote a school-
                        wide positive environment, including strategies 
                        to prevent bullying, including cyber-bullying.
                    ``(E) The comprehensive school-based mental health 
                program carried out under this section will demonstrate 
                the measures to be taken to sustain the program (which 
                may include seeking funding for the program under a 
                State Medicaid plan under title XIX of the Social 
                Security Act or a waiver of such a plan, or under a 
                State plan under subpart 1 of part B or part E of title 
                IV of the Social Security Act).
                    ``(F) The eligible entity is supported by the State 
                agency with primary responsibility for behavioral 
                health to ensure that the comprehensive school-based 
                mental health program carried out under this section 
                will be sustainable after funding under this section 
                terminates.
                    ``(G) The comprehensive school-based mental health 
                program carried out under this section will be 
                coordinated with early intervening activities carried 
                out under the Individuals with Disabilities Education 
                Act or activities funded under part A of title IV of 
                the Elementary and Secondary Education Act of 1965.
                    ``(H) The comprehensive school-based mental health 
                program carried out under this section will be trauma-
                informed, evidence-based, and developmentally, 
                culturally, and linguistically appropriate.
                    ``(I) The comprehensive school-based mental health 
                program carried out under this section will include a 
                broad needs assessment of youth who drop out of school 
                due to policies of `zero tolerance' with respect to 
                drugs, alcohol, or weapons and an inability to obtain 
                appropriate services.
                    ``(J) The mental health services provided through 
                the comprehensive school-based mental health program 
                carried out under this section will be provided by 
                qualified mental and behavioral health professionals 
                who are certified, credentialed, or licensed in 
                compliance with applicable Federal and State law and 
                regulations by the State involved and who are 
                practicing within their area of expertise.
                    ``(K) Students will be permitted to self-refer to 
                the mental health program for mental health care and 
                self-consent for mental health crisis care to the 
                extent permitted by State or other applicable law.
            ``(3) Coordinator.--Any entity that is a member of a 
        partnership described in paragraph (1)(A) may serve as the 
        coordinator of funding and activities under the grant if all 
        members of the partnership agree.
            ``(4) Compliance with hipaa.--A grantee under this section 
        shall be deemed to be a covered entity for purposes of 
        compliance with the regulations promulgated under section 
        264(c) of the Health Insurance Portability and Accountability 
        Act of 1996 with respect to any patient records developed 
        through activities under the grant.
            ``(5) Compliance with ferpa.--Section 444 of the General 
        Education Provisions Act (commonly known as the `Family 
        Educational Rights and Privacy Act of 1974') shall apply to any 
        entity that is a member of the partnership in the same manner 
        that such section applies to an educational agency or 
        institution (as that term is defined in such section).
    ``(d) Geographical Distribution.--The Secretary shall ensure that 
grants, contracts, or cooperative agreements under subsection (a) will 
be distributed equitably among the regions of the country and among 
urban and rural areas.
    ``(e) Duration of Awards.--With respect to a grant, contract, or 
cooperative agreement under subsection (a), the period during which 
payments under such an award will be made to the recipient shall be 5 
years, with options for renewal.
    ``(f) Evaluation and Measures of Outcomes.--
            ``(1) Development of process.--The Assistant Secretary 
        shall develop a fiscally appropriate process for evaluating 
        activities carried out under this section. Such process shall 
        include--
                    ``(A) the development of guidelines for the 
                submission of program data by grant, contract, or 
                cooperative agreement recipients;
                    ``(B) the development of measures of outcomes (in 
                accordance with paragraph (2)) to be applied by such 
                recipients in evaluating programs carried out under 
                this section; and
                    ``(C) the submission of annual reports by such 
                recipients concerning the effectiveness of programs 
                carried out under this section.
            ``(2) Measures of outcomes.--
                    ``(A) In general.--The Assistant Secretary shall 
                develop measures of outcomes to be applied by 
                recipients of assistance under this section, and the 
                Assistant Secretary, in evaluating the effectiveness of 
                programs carried out under this section. Such measures 
                shall include student and family measures as provided 
                for in subparagraph (B) and local educational measures 
                as provided for under subparagraph (C).
                    ``(B) Student and family measures of outcomes.--The 
                measures for outcomes developed under paragraph (1)(B) 
                relating to students and families shall, with respect 
                to activities carried out under a program under this 
                section, at a minimum include provisions to evaluate 
                whether the program is effective in--
                            ``(i) increasing social and emotional 
                        competency;
                            ``(ii) improving academic outcomes, 
                        including as measured by proficiency on the 
                        annual assessments under section 1111(b)(2) of 
                        the Elementary and Secondary Education Act of 
                        1965;
                            ``(iii) reducing disruptive and aggressive 
                        behaviors;
                            ``(iv) improving child functioning;
                            ``(v) reducing substance use disorders;
                            ``(vi) reducing rates of suicide;
                            ``(vii) reducing suspensions, truancy, 
                        expulsions, and violence;
                            ``(viii) increasing high school graduation 
                        rates, calculated using the four-year adjusted 
                        cohort graduation rate or the extended-year 
                        adjusted cohort graduation rate (as such terms 
                        are defined in section 8101 of the Elementary 
                        and Secondary Education Act of 1965);
                            ``(ix) improving attendance rates and rates 
                        of chronic absenteeism;
                            ``(x) improving access to care for mental 
                        health disorders, including access to mental 
                        health services that are trauma-informed, and 
                        developmentally, linguistically, and culturally 
                        appropriate;
                            ``(xi) improving health outcomes; and
                            ``(xii) decreasing disparities among 
                        vulnerable and protected populations in 
                        outcomes described in clauses (i) through 
                        (viii).
                    ``(C) Local educational outcomes.--The outcome 
                measures developed under paragraph (1)(B) relating to 
                local educational systems shall, with respect to 
                activities carried out under a program under this 
                section, at a minimum include provisions to evaluate--
                            ``(i) the effectiveness of comprehensive 
                        school mental health programs established under 
                        this section;
                            ``(ii) the effectiveness of formal 
                        partnership linkages among child and family 
                        serving institutions, community support 
                        systems, and the educational system;
                            ``(iii) the progress made in sustaining the 
                        program once funding under the grant has 
                        expired;
                            ``(iv) the effectiveness of training and 
                        professional development programs for all 
                        school personnel that incorporate indicators 
                        that measure cultural and linguistic 
                        competencies under the program in a manner that 
                        incorporates appropriate cultural and 
                        linguistic training;
                            ``(v) the improvement in perception of a 
                        safe and supportive learning environment among 
                        school staff, students, and parents;
                            ``(vi) the improvement in case-finding of 
                        students in need of more intensive services and 
                        referral of identified students to prevention, 
                        early intervention, and clinical services;
                            ``(vii) the improvement in the immediate 
                        availability of clinical assessment and 
                        treatment services within the context of the 
                        local community to students posing a danger to 
                        themselves or others;
                            ``(viii) the increased successful 
                        matriculation to postsecondary school;
                            ``(ix) reduced suicide rates;
                            ``(x) reduced referrals to juvenile 
                        justice; and
                            ``(xi) increased educational equity.
            ``(3) Submission of annual data.--An eligible entity 
        described in subsection (c) that receives a grant, contract, or 
        cooperative agreement under this section shall annually submit 
        to the Assistant Secretary a report that includes data to 
        evaluate the success of the program carried out by the entity 
        based on whether such program is achieving the purposes of the 
        program. Such reports shall utilize the measures of outcomes 
        under paragraph (2) in a reasonable manner to demonstrate the 
        progress of the program in achieving such purposes.
            ``(4) Evaluation by assistant secretary.--Based on the data 
        submitted under paragraph (3), the Assistant Secretary shall 
        annually submit to Congress a report concerning the results and 
        effectiveness of the programs carried out with assistance 
        received under this section.
            ``(5) Limitation.--An eligible entity shall use not more 
        than 20 percent of amounts received under a grant under this 
        section to carry out evaluation activities under this 
        subsection.
    ``(g) Information and Education.--The Secretary shall establish 
comprehensive information and education programs to disseminate the 
findings of the knowledge development and application under this 
section to the general public and to health care professionals.
    ``(h) Amount of Grants and Authorization of Appropriations.--
            ``(1) Amount of grants.--A grant under this section shall 
        be in an amount that is not more than $2,000,000 for each of 
        the first 5 fiscal years following the date of enactment of the 
        Mental Health Services for Students Act of 2019. The Secretary 
        shall determine the amount of each such grant based on the 
        population of children up to age 21 of the area to be served 
        under the grant.
            ``(2) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this section, $200,000,000 for 
        each of the first 5 fiscal years following the date of 
        enactment of the Mental Health Services for Students Act of 
        2019.''.
    (c) Conforming Amendment.--Part G of title V of the Public Health 
Service Act (42 U.S.C. 290hh et seq.), as amended by subsection (b), is 
further amended by striking the part designation and heading and 
inserting the following:

                ``PART G--SCHOOL-BASED MENTAL HEALTH''.

                                 <all>
```