IB 

Union Calendar No. 517 

114TH CONGRESS 

2D SESSION H. R. 2646 

[Report No. 114–667, Part I] 

To make available needed psychiatric, psychological, and supportive services 

for individuals with mental illness and families in mental health crisis, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 4, 2015 

Mr. MURPHY of Pennsylvania (for himself, Ms. EDDIE BERNICE JOHNSON of 

Texas, Mr. BUCHANAN, Mr. DIAZ-BALART, Mr. BILIRAKIS, Mr. DOLD, 

Mr. GUINTA, Mrs. MIMI WALTERS of California, Mr. BRENDAN F. 

BOYLE of Pennsylvania, Mrs. ELLMERS of North Carolina, Mr. DENHAM, 

Mr. VARGAS, Mrs. MILLER of Michigan, Mr. HASTINGS, Mr. CALVERT, 

Mr. NUNES, Mr. HUNTER, Mr. BLUMENAUER, and Ms. SINEMA) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committees on Ways and Means 

and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

JULY 6, 2016 

Additional sponsors: Mr. HUDSON, Mr. CONNOLLY, Mr. KATKO, Mr. MCKINLEY, Mr. HINOJOSA, Mr. CRAMER, Mr. FORTENBERRY, Mr. GUTHRIE, 

Mr. DUNCAN of Tennessee, Mr. LANCE, Mr. RANGEL, Mr. WENSTRUP, 

Mr. WHITFIELD, Mr. BARR, Mr. TROTT, Mr. WEBSTER of Florida, Mr. 

CARTER of Georgia, Mr. HANNA, Mrs. BLACKBURN, Mr. AMODEI, Mr. 

CRAWFORD, Mr. WILSON of South Carolina, Ms. MCSALLY, Mr. 

JEFFRIES, Ms. BASS, Mr. RUSH, Mr. ROE of Tennessee, Mr. PETERSON, 

Mr. BARLETTA, Mr. WALZ, Mr. THOMPSON of Mississippi, Ms. BROWN

of Florida, Mr. JOYCE, Mr. LOWENTHAL, Mr. MULLIN, Mr. BERA, Mr. 

LAMALFA, Mr. COLLINS of New York, Mrs. BLACK, Mr. FLEISCHMANN, 

Mr. MICHAEL F. DOYLE of Pennsylvania, Ms. KAPTUR, Mr. OLSON, Mr. 

CARTER of Texas, Mr. CUELLAR, Mr. ROSKAM, Mr. BUCSHON, Mrs. 

BROOKS of Indiana, Mr. DUFFY, Mr. SENSENBRENNER, Mr. THOMPSON

of Pennsylvania, Mr. JOHNSON of Ohio, Mr. FRANKS of Arizona, Ms. 


sradovich on DSK3GDR082PROD with BILLS
2 

•HR 2646 RH

JUDY CHU of California, Mrs. LAWRENCE, Mr. GIBSON, Ms. PLASKETT, 

Mr. NOLAN, Mr. SALMON, Mr. COFFMAN, Mr. PAULSEN, Mr. KELLY of 

Pennsylvania, Mr. SHUSTER, Mr. COSTELLO of Pennsylvania, Mr. 

FITZPATRICK, Mr. DENT, Mr. BENISHEK, Ms. TITUS, Mrs. ROBY, Mr. 

MESSER, Mr. TURNER, Mr. BOUSTANY, Mrs. NOEM, Mrs. LUMMIS, Mrs. 

HARTZLER, Mr. MICA, Mr. COLE, Mr. LUCAS, Mr. KINZINGER of Illinois, 

Mr. HARRIS, Mr. STIVERS, Mr. SMITH of New Jersey, Mr. ROTHFUS, 

Mrs. WALORSKI, Mr. HECK of Washington, Mr. TED LIEU of California, 

Mr. PETERS, Mr. BISHOP of Michigan, Mr. BYRNE, Mr. O’ROURKE, Mr. 

RODNEY DAVIS of Illinois, Mr. QUIGLEY, Ms. ESHOO, Mr. REED, Mr. 

HUIZENGA of Michigan, Mr. SWALWELL of California, Ms. LEE, Mrs. 

COMSTOCK, Mr. LONG, Mr. DESAULNIER, Ms. NORTON, Ms. BONAMICI, 

Ms. HERRERA BEUTLER, Mr. CURBELO of Florida, Mr. REICHERT, Mr. 

MCHENRY, Mr. PIERLUISI, Mr. SESSIONS, Mr. SCALISE, Mr. ISRAEL, 

Mr. TOM PRICE of Georgia, Mr. FINCHER, Ms. STEFANIK, Mr. CRENSHAW, Mr. CHABOT, Mr. SCHWEIKERT, Mr. KING of New York, Mr. 

ROUZER, Mr. ASHFORD, Mr. SIMPSON, Mr. STEWART, Mr. ROYCE, Mr. 

DEFAZIO, Mr. HILL, Mr. ZINKE, Mr. FATTAH, Mr. POMPEO, Mr. WALDEN, Mr. HARPER, Mr. MEEKS, Mr. GRAVES of Missouri, Ms. ROSLEHTINEN, Mr. YOUNG of Iowa, Mr. MEEHAN, Mr. JOLLY, Mr. SHIMKUS, Mr. DEUTCH, Mr. LUETKEMEYER, Mr. COHEN, Mr. GOODLATTE, 

Mr. ABRAHAM, Mr. EMMER of Minnesota, Mr. ROONEY of Florida, Ms. 

SPEIER, Mr. AUSTIN SCOTT of Georgia, Mr. LOBIONDO, Mr. PALAZZO, 

Mr. HURT of Virginia, Mr. BRADY of Pennsylvania, Mr. LAHOOD, Mr. 

ROSS, Mr. RIBBLE, Mr. FRELINGHUYSEN, Ms. MCCOLLUM, Mr. YOUNG

of Indiana, Mr. TIPTON, Mr. PERRY, Mr. PITTENGER, Mr. RIGELL, Mr. 

MCDERMOTT, Mr. COOK, Mr. MARINO, Mr. POLIQUIN, Mr. ZELDIN, Mr. 

COOPER, Mr. RICE of South Carolina, Mr. DONOVAN, Mr. CARTWRIGHT, 

Mr. BOST, Mr. YOUNG of Alaska, Ms. VELA ́ZQUEZ, Mr. KNIGHT, Mr. 

FARR, Mr. MOOLENAAR, Ms. GRANGER, Mr. VALADAO, Mr. THOMPSON

of California, Mr. BISHOP of Georgia, Mr. GRAYSON, Mr. KLINE, Ms. 

HAHN, Mr. GRAVES of Louisiana, Mr. CHAFFETZ, Ms. JENKINS of Kansas, Ms. KUSTER, Mr. WILLIAMS, Mr. RICHMOND, Mr. HARDY, and Mr. 

NORCROSS

JULY 6, 2016 

Deleted sponsors: Mr. DESANTIS (added July 21, 2015; deleted July 22, 

2015), Mrs. BEATTY (added July 21, 2015; deleted July 22, 2015), Ms. 

LOFGREN (added July 21, 2015; deleted July 22, 2015), and Mr. YODER

(added October 7, 2015; deleted November 30, 2015). 


sradovich on DSK3GDR082PROD with BILLS
3 

•HR 2646 RH

JULY 6, 2016 

Reported from the Committee on Energy and Commerce with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

JULY 6, 2016 

The Committees on Ways and Means and Education and the Workforce discharged; committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on June 4, 2016] 


sradovich on DSK3GDR082PROD with BILLS
4 

•HR 2646 RH

A BILL 

To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and 

families in mental health crisis, and for other purposes. 


sradovich on DSK3GDR082PROD with BILLS
5 

•HR 2646 RH

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. 

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

5 ‘‘Helping Families in Mental Health Crisis Act of 2016’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—ASSISTANT SECRETARY FOR MENTAL HEALTH AND 

SUBSTANCE USE 

Sec. 101. Assistant Secretary for Mental Health and Substance Use. 

Sec. 102. Improving oversight of mental health and substance use programs. 

Sec. 103. National Mental Health and Substance Use Policy Laboratory. 

Sec. 104. Peer-support specialist programs. 

Sec. 105. Prohibition against lobbying using Federal funds by systems accepting 

Federal funds to protect and advocate the rights of individuals 

with mental illness. 

Sec. 106. Reporting for protection and advocacy organizations. 

Sec. 107. Grievance procedure. 

Sec. 108. Center for Behavioral Health Statistics and Quality. 

Sec. 109. Strategic plan. 

Sec. 110. Authorities of centers for mental health services and substance abuse 

treatment. 

Sec. 111. Advisory councils. 

Sec. 112. Peer review. 

TITLE II—MEDICAID MENTAL HEALTH COVERAGE 

Sec. 201. Rule of construction related to Medicaid coverage of mental health services and primary care services furnished on the same day. 

Sec. 202. Optional limited coverage of inpatient services furnished in institutions 

for mental diseases. 

Sec. 203. Study and report related to Medicaid managed care regulation. 

Sec. 204. Guidance on opportunities for innovation. 

Sec. 205. Study and report on Medicaid emergency psychiatric demonstration 

project. 

Sec. 206. Providing full-range of EPSDT services to children in IMDs. 

Sec. 207. Electronic visit verification system required for personal care services 

and home health care services under Medicaid. 

TITLE III—INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS 

COORDINATING COMMITTEE 

Sec. 301. Interdepartmental Serious Mental Illness Coordinating Committee. 


sradovich on DSK3GDR082PROD with BILLS
6 

•HR 2646 RH

TITLE IV—COMPASSIONATE COMMUNICATION ON HIPAA 

Sec. 401. Sense of Congress. 

Sec. 402. Confidentiality of records. 

Sec. 403. Clarification of circumstances under which disclosure of protected health 

information is permitted. 

Sec. 404. Development and dissemination of model training programs. 

TITLE V—INCREASING ACCESS TO TREATMENT FOR SERIOUS 

MENTAL ILLNESS 

Sec. 501. Assertive community treatment grant program for individuals with serious mental illness. 

Sec. 502. Strengthening community crisis response systems. 

Sec. 503. Increased and extended funding for assisted outpatient grant program 

for individuals with serious mental illness. 

Sec. 504. Liability protections for health professional volunteers at community 

health centers. 

TITLE VI—SUPPORTING INNOVATIVE AND EVIDENCE-BASED 

PROGRAMS 

Subtitle A—Encouraging the Advancement, Incorporation, and Development of 

Evidence-Based Practices 

Sec. 601. Encouraging innovation and evidence-based programs. 

Sec. 602. Promoting access to information on evidence-based programs and practices. 

Sec. 603. Sense of Congress. 

Subtitle B—Supporting the State Response to Mental Health Needs 

Sec. 611. Community Mental Health Services Block Grant. 

Subtitle C—Strengthening Mental Health Care for Children and Adolescents 

Sec. 621. Telehealth child psychiatry access grants. 

Sec. 622. Infant and early childhood mental health promotion, intervention, and 

treatment. 

Sec. 623. National Child Traumatic Stress Initiative. 

TITLE VII—GRANT PROGRAMS AND PROGRAM REAUTHORIZATION 

Subtitle A—Garrett Lee Smith Memorial Act Reauthorization 

Sec. 701. Youth interagency research, training, and technical assistance centers. 

Sec. 702. Youth suicide early intervention and prevention strategies. 

Sec. 703. Mental health and substance use disorder services on campus. 

Subtitle B—Other Provisions 

Sec. 711. National Suicide Prevention Lifeline Program. 

Sec. 712. Workforce development studies and reports. 

Sec. 713. Minority Fellowship Program. 

Sec. 714. Center and program repeals. 

Sec. 715. National violent death reporting system. 

Sec. 716. Sense of Congress on prioritizing Native American youth and suicide 

prevention programs. 

Sec. 717. Peer professional workforce development grant program. 


sradovich on DSK3GDR082PROD with BILLS
7 

•HR 2646 RH

Sec. 718. National Health Service Corps. 

Sec. 719. Adult suicide prevention. 

Sec. 720. Crisis intervention grants for police officers and first responders. 

Sec. 721. Demonstration grant program to train health service psychologists in 

community-based mental health. 

Sec. 722. Investment in tomorrow’s pediatric health care workforce. 

Sec. 723. CUTGO compliance. 

TITLE VIII—MENTAL HEALTH PARITY 

Sec. 801. Enhanced compliance with mental health and substance use disorder 

coverage requirements. 

Sec. 802. Action plan for enhanced enforcement of mental health and substance 

use disorder coverage. 

Sec. 803. Report on investigations regarding parity in mental health and substance use disorder benefits. 

Sec. 804. GAO study on parity in mental health and substance use disorder benefits. 

Sec. 805. Information and awareness on eating disorders. 

Sec. 806. Education and training on eating disorders. 

Sec. 807. GAO study on preventing discriminatory coverage limitations for individuals with serious mental illness and substance use disorders. 

Sec. 808. Clarification of existing parity rules. 

1 TITLE I—ASSISTANT SECRETARY 

2 FOR MENTAL HEALTH AND 

3 SUBSTANCE USE 

4 SEC. 101. ASSISTANT SECRETARY FOR MENTAL HEALTH 

5 AND SUBSTANCE USE. 

6 (a) ASSISTANT SECRETARY.—Section 501(c) of the 

7 Public Health Service Act (42 U.S.C. 290aa) is amended 

8 to read as follows: 

9 ‘‘(c) ASSISTANT SECRETARY AND DEPUTY ASSISTANT

10 SECRETARY.— 

11 ‘‘(1) ASSISTANT SECRETARY.— 

12 ‘‘(A) APPOINTMENT.—The Administration 

13 shall be headed by an official to be known as the 

14 Assistant Secretary for Mental Health and Sub15 stance Use (hereinafter in this title referred to as 


sradovich on DSK3GDR082PROD with BILLS
8 

•HR 2646 RH

1 the ‘Assistant Secretary’) who shall be appointed 

2 by the President, by and with the advice and 

3 consent of the Senate. 

4 ‘‘(B) QUALIFICATIONS.—In selecting the As5 sistant Secretary, the President shall give pref6 erence to individuals who have— 

7 ‘‘(i) a doctoral degree in medicine, os8 teopathic medicine, or psychology; 

9 ‘‘(ii) clinical and research experience 

10 regarding mental health and substance use 

11 disorders; and 

12 ‘‘(iii) an understanding of biological, 

13 psychosocial, and pharmaceutical treat14 ments of mental illness and substance use 

15 disorders. 

16 ‘‘(2) DEPUTY ASSISTANT SECRETARY.—The As17 sistant Secretary, with the approval of the Secretary, 

18 may appoint a Deputy Assistant Secretary and may 

19 employ and prescribe the functions of such officers 

20 and employees, including attorneys, as are necessary 

21 to administer the activities to be carried out through 

22 the Administration.’’. 

23 (b) TRANSFER OF AUTHORITIES.—The Secretary of 

24 Health and Human Services shall delegate to the Assistant 


sradovich on DSK3GDR082PROD with BILLS
9 

•HR 2646 RH

1 Secretary for Mental Health and Substance Use all duties 

2 and authorities that— 

3 (1) as of the day before the date of enactment of 

4 this Act, were vested in the Administrator of the Sub5 stance Abuse and Mental Health Services Administra6 tion; and 

7 (2) are not terminated by this Act. 

8 (c) EVALUATION.—Section 501(d) of the Public Health 

9 Service Act (42 U.S.C. 290aa(d)) is amended— 

10 (1) in paragraph (17), by striking ‘‘and’’ at the 

11 end; 

12 (2) in paragraph (18), by striking the period at 

13 the end and inserting a semicolon; and 

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

15 ‘‘(19) evaluate, in consultation with the Assist16 ant Secretary for Financial Resources, the informa17 tion used for oversight of grants under programs re18 lated to mental and substance use disorders, including 

19 co-occurring disorders, administered by the Center for 

20 Mental Health Services; 

21 ‘‘(20) periodically review Federal programs and 

22 activities relating to the diagnosis or prevention of, or 

23 treatment or rehabilitation for, mental illness and 

24 substance use disorders to identify any such programs 

25 or activities that have proven to be effective or effiVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
10 

•HR 2646 RH

1 cient in improving outcomes or increasing access to 

2 evidence-based programs; 

3 ‘‘(21) establish standards for the appointment of 

4 peer-review panels to evaluate grant applications and 

5 recommend standards for mental health grant pro6 grams; and’’. 

7 (d) STANDARDS FOR GRANT PROGRAMS.—Section 

8 501(d) of the Public Health Service Act (42 U.S.C. 

9 290aa(d)), as amended by subsection (c), is further amend10 ed by adding at the end the following: 

11 ‘‘(22) in consultation with the National Mental 

12 Health and Substance Use Policy Laboratory, and 

13 after providing an opportunity for public input, set 

14 standards for grant programs under this title for 

15 mental health and substance use services, which may 

16 address— 

17 ‘‘(A) the capacity of the grantee to imple18 ment the award; 

19 ‘‘(B) requirements for the description of the 

20 program implementation approach; 

21 ‘‘(C) the extent to which the grant plan sub22 mitted by the grantee as part of its application 

23 must explain how the grantee will reach the pop24 ulation of focus and provide a statement of need, 

25 including to what extent the grantee will inVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
11 

•HR 2646 RH

1 crease the number of clients served and the esti2 mated percentage of clients receiving services 

3 who report positive functioning after 6 months 

4 or no past-month substance use, as applicable; 

5 ‘‘(D) the extent to which the grantee must 

6 collect and report on required performance meas7 ures; and 

8 ‘‘(E) the extent to which the grantee is pro9 posing evidence-based practices and the extent to 

10 which— 

11 ‘‘(i) those evidence-based practices 

12 must be used with respect to a population 

13 similar to the population for which the evi14 dence-based practices were shown to be effec15 tive; or 

16 ‘‘(ii) if no evidence-based practice ex17 ists for a population of focus, the way in 

18 which the grantee will implement adapta19 tions of evidence-based practices, promising 

20 practices, or cultural practices.’’. 

21 (e) MEMBER OF COUNCIL ON GRADUATE MEDICAL

22 EDUCATION.—Section 762 of the Public Health Service Act 

23 (42 U.S.C. 290o) is amended— 

24 (1) in subsection (b)— 


sradovich on DSK3GDR082PROD with BILLS
12 

•HR 2646 RH

1 (A) by redesignating paragraphs (4), (5), 

2 and (6) as paragraphs (5), (6), and (7), respec3 tively; and 

4 (B) by inserting after paragraph (3) the fol5 lowing: 

6 ‘‘(4) the Assistant Secretary for Mental Health 

7 and Substance Use;’’; and 

8 (2) in subsection (c), by striking ‘‘(4), (5), and 

9 (6)’’ each place it appears and inserting ‘‘(5), (6), 

10 and (7)’’. 

11 (f) CONFORMING AMENDMENTS.—Title V of the Public 

12 Health Service Act (42 U.S.C. 290aa et seq.), as amended 

13 by the previous provisions of this section, is further amend14 ed— 

15 (1) by striking ‘‘Administrator of the Substance 

16 Abuse and Mental Health Services Administration’’ 

17 each place it appears and inserting ‘‘Assistant Sec18 retary for Mental Health and Substance Use’’; and 

19 (2) by striking ‘‘Administrator’’ each place it 

20 appears (including in any headings) and inserting 

21 ‘‘Assistant Secretary’’, except where the term ‘‘Admin22 istrator’’ appears— 

23 (A) in each of subsections (e) and (f) of sec24 tion 501 of such Act (42 U.S.C. 290aa), includVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
13 

•HR 2646 RH

1 ing the headings of such subsections, within the 

2 term ‘‘Associate Administrator’’; 

3 (B) in section 507(b)(6) of such Act (42 

4 U.S.C. 290bb(b)(6)), within the term ‘‘Adminis5 trator of the Health Resources and Services Ad6 ministration’’; 

7 (C) in section 507(b)(6) of such Act (42 

8 U.S.C. 290bb(b)(6)), within the term ‘‘Adminis9 trator of the Centers for Medicare & Medicaid 

10 Services’’; 

11 (D) in section 519B(c)(1)(B) of such Act 

12 (42 U.S.C. 290bb-25b(c)(1)(B)), within the term 

13 ‘‘Administrator of the National Highway Traffic 

14 Safety Administration’’; or 

15 (E) in each of sections 519B(c)(1)(B), 

16 520C(a), and 520D(a) of such Act (42 U.S.C. 

17 290bb-25b(c)(1)(B), 290bb-34(a), 290bb-35(a)), 

18 within the term ‘‘Administrator of the Office of 

19 Juvenile Justice and Delinquency Prevention’’. 

20 (g) REFERENCES.—After executing subsections (a), 

21 (b), and (f), any reference in statute, regulation, or guid22 ance to the Administrator of the Substance Abuse and Men23 tal Health Services Administration shall be construed to be 

24 a reference to the Assistant Secretary for Mental Health and 

25 Substance Use. 


sradovich on DSK3GDR082PROD with BILLS
14 

•HR 2646 RH

1 SEC. 102. IMPROVING OVERSIGHT OF MENTAL HEALTH AND 

2 SUBSTANCE USE PROGRAMS. 

3 Title V of the Public Health Service Act is amended 

4 by inserting after section 501 of such Act (42 U.S.C. 290aa) 

5 the following: 

6 ‘‘SEC. 501A. IMPROVING OVERSIGHT OF MENTAL HEALTH 

7 AND SUBSTANCE USE PROGRAMS. 

8 ‘‘(a) ACTIVITIES.—For the purpose of ensuring effi9 cient and effective planning and evaluation of mental and 

10 substance use disorder programs and related activities, the 

11 Assistant Secretary for Planning and Evaluation, in con12 sultation with the Assistant Secretary for Mental Health 

13 and Substance Use, shall— 

14 ‘‘(1) collect and organize relevant data on home15 lessness, involvement with the criminal justice system, 

16 hospitalizations, mortality outcomes, and other meas17 ures the Secretary deems appropriate from across 

18 Federal departments and agencies; 

19 ‘‘(2) evaluate programs related to mental and 

20 substance use disorders, including co-occurring dis21 orders, across Federal departments and agencies, as 

22 appropriate, including programs related to— 

23 ‘‘(A) prevention, intervention, treatment, 

24 and recovery support services, including such 

25 services for individuals with a serious mental ill26 ness or serious emotional disturbance; 


sradovich on DSK3GDR082PROD with BILLS
15 

•HR 2646 RH

1 ‘‘(B) the reduction of homelessness and in2 volvement with the criminal justice system 

3 among individuals with a mental or substance 

4 use disorder; and 

5 ‘‘(C) public health and health services; and 

6 ‘‘(3) consult, as appropriate, with the Assistant 

7 Secretary, the Behavioral Health Coordinating Coun8 cil of the Department of Health and Human Services, 

9 other agencies within the Department of Health and 

10 Human Services, and other relevant Federal depart11 ments. 

12 ‘‘(b) RECOMMENDATIONS.—The Assistant Secretary 

13 for Planning and Evaluation shall develop an evaluation 

14 strategy that identifies priority programs to be evaluated 

15 by the Assistant Secretary and priority programs to be 

16 evaluated by other relevant agencies within the Department 

17 of Health and Human Services. The Assistant Secretary for 

18 Planning and Evaluation shall provide recommendations 

19 on improving programs and activities based on the evalua20 tion described in subsection (a)(2) as needing improve21 ment.’’. 


sradovich on DSK3GDR082PROD with BILLS
16 

•HR 2646 RH

1 SEC. 103. NATIONAL MENTAL HEALTH AND SUBSTANCE USE 

2 POLICY LABORATORY. 

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

4 290aa et seq.) is amended by inserting after section 501A, 

5 as added by section 102 of this Act, the following: 

6 ‘‘SEC. 501B. NATIONAL MENTAL HEALTH AND SUBSTANCE 

7 USE POLICY LABORATORY. 

8 ‘‘(a) IN GENERAL.—There shall be established within 

9 the Administration a National Mental Health and Sub10 stance Use Policy Laboratory (referred to in this section 

11 as the ‘Laboratory’). 

12 ‘‘(b) RESPONSIBILITIES.—The Laboratory shall— 

13 ‘‘(1) continue to carry out the authorities and 

14 activities that were in effect for the Office of Policy, 

15 Planning, and Innovation as such Office existed prior 

16 to the date of enactment of the Helping Families in 

17 Mental Health Crisis Act of 2016; 

18 ‘‘(2) identify, coordinate, and facilitate the im19 plementation of policy changes likely to have a sig20 nificant effect on mental health, mental illness, and 

21 the prevention and treatment of substance use dis22 order services; 

23 ‘‘(3) collect, as appropriate, information from 

24 grantees under programs operated by the Administra25 tion in order to evaluate and disseminate information 

26 on evidence-based practices, including culturally and 


sradovich on DSK3GDR082PROD with BILLS
17 

•HR 2646 RH

1 linguistically appropriate services, as appropriate, 

2 and service delivery models; 

3 ‘‘(4) provide leadership in identifying and co4 ordinating policies and programs, including evidence5 based programs, related to mental and substance use 

6 disorders; 

7 ‘‘(5) recommend ways in which payers may im8 plement program and policy findings of the Adminis9 tration and the Laboratory to improve outcomes and 

10 reduce per capita program costs; 

11 ‘‘(6) in consultation with the Assistant Secretary 

12 for Planning and Evaluation, as appropriate, peri13 odically review Federal programs and activities relat14 ing to the diagnosis or prevention of, or treatment or 

15 rehabilitation for, mental illness and substance use 

16 disorders, including by— 

17 ‘‘(A) identifying any such programs or ac18 tivities that are duplicative; 

19 ‘‘(B) identifying any such programs or ac20 tivities that are not evidence-based, effective, or 

21 efficient; and 

22 ‘‘(C) formulating recommendations for co23 ordinating, eliminating, or improving programs 

24 or activities identified under subparagraph (A) 


sradovich on DSK3GDR082PROD with BILLS
18 

•HR 2646 RH

1 or (B) and merging such programs or activities 

2 into other successful programs or activities; and 

3 ‘‘(7) carry out other activities as deemed nec4 essary to continue to encourage innovation and dis5 seminate evidence-based programs and practices, in6 cluding programs and practices with scientific merit. 

7 ‘‘(c) EVIDENCE-BASED PRACTICES AND SERVICE DE8 LIVERY MODELS.— 

9 ‘‘(1) IN GENERAL.—In selecting evidence-based 

10 best practices and service delivery models for evalua11 tion and dissemination, the Laboratory— 

12 ‘‘(A) shall give preference to models that im13 prove— 

14 ‘‘(i) the coordination between mental 

15 health and physical health providers; 

16 ‘‘(ii) the coordination among such pro17 viders and the justice and corrections sys18 tem; and 

19 ‘‘(iii) the cost effectiveness, quality, ef20 fectiveness, and efficiency of health care 

21 services furnished to individuals with seri22 ous mental illness or serious emotional dis23 turbance, in mental health crisis, or at risk 

24 to themselves, their families, and the general 

25 public; and 


sradovich on DSK3GDR082PROD with BILLS
19 

•HR 2646 RH

1 ‘‘(B) may include clinical protocols and 

2 practices used in the Recovery After Initial 

3 Schizophrenia Episode (RAISE) project and the 

4 North American Prodrome Longitudinal Study 

5 (NAPLS) of the National Institute of Mental 

6 Health. 

7 ‘‘(2) DEADLINE FOR BEGINNING IMPLEMENTA8 TION.—The Laboratory shall begin implementation of 

9 the duties described in this subsection not later than 

10 January 1, 2018. 

11 ‘‘(3) CONSULTATION.—In carrying out the duties 

12 under this subsection, the Laboratory shall consult 

13 with— 

14 ‘‘(A) representatives of the National Insti15 tute of Mental Health, the National Institute on 

16 Drug Abuse, and the National Institute on Alco17 hol Abuse and Alcoholism, on an ongoing basis; 

18 ‘‘(B) other appropriate Federal agencies; 

19 ‘‘(C) clinical and analytical experts with 

20 expertise in psychiatric medical care and clin21 ical psychological care, health care management, 

22 education, corrections health care, and mental 

23 health court systems, as appropriate; and 


sradovich on DSK3GDR082PROD with BILLS
20 

•HR 2646 RH

1 ‘‘(D) other individuals and agencies as de2 termined appropriate by the Assistant Sec3 retary.’’. 

4 SEC. 104. PEER-SUPPORT SPECIALIST PROGRAMS. 

5 (a) IN GENERAL.—Not later than 2 years after the 

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

7 the United States shall conduct a study on peer-support spe8 cialist programs in up to 10 States (to be selected by the 

9 Comptroller General) that receive funding from the Sub10 stance Abuse and Mental Health Services Administration 

11 and submit to the Committee on Health, Education, Labor, 

12 and Pensions of the Senate and the Committee on Energy 

13 and Commerce of the House of Representatives a report con14 taining the results of such study. 

15 (b) CONTENTS OF STUDY.—In conducting the study 

16 under subsection (a), the Comptroller General of the United 

17 States shall examine and identify best practices in the se18 lected States related to training and credential require19 ments for peer-specialist programs, such as— 

20 (1) hours of formal work or volunteer experience 

21 related to mental and substance use disorders con22 ducted through such programs; 

23 (2) types of peer support specialist exams re24 quired for such programs in the States; 


sradovich on DSK3GDR082PROD with BILLS
21 

•HR 2646 RH

1 (3) codes of ethics used by such programs in the 

2 States; 

3 (4) required or recommended skill sets of such 

4 programs in the State; and 

5 (5) requirements for continuing education. 

6 SEC. 105. PROHIBITION AGAINST LOBBYING USING FED7 ERAL FUNDS BY SYSTEMS ACCEPTING FED8 ERAL FUNDS TO PROTECT AND ADVOCATE 

9 THE RIGHTS OF INDIVIDUALS WITH MENTAL 

10 ILLNESS. 

11 Section 105(a) of the Protection and Advocacy for In12 dividuals with Mental Illness Act (42 U.S.C. 10805(a)) is 

13 amended— 

14 (1) in paragraph (9), by striking ‘‘and’’ at the 

15 end; 

16 (2) in paragraph (10), by striking the period at 

17 the end and inserting ‘‘; and’’; and 

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

19 ‘‘(11) agree to refrain, during any period for 

20 which funding is provided to the system under this 

21 part, from using Federal funds to pay the salary or 

22 expenses of any grant or contract recipient, or agent 

23 acting for such recipient, related to any activity de24 signed to influence the enactment of legislation, ap25 propriations, regulation, administrative action, or 


sradovich on DSK3GDR082PROD with BILLS
22 

•HR 2646 RH

1 Executive order proposed or pending before the Con2 gress or any State government, State legislature or 

3 local legislature or legislative body, other than for 

4 normal and recognized executive-legislative relation5 ships or participation by an agency or officer of a 

6 State, local, or tribal government in policymaking 

7 and administrative processes within the executive 

8 branch of that government.’’. 

9 SEC. 106. REPORTING FOR PROTECTION AND ADVOCACY 

10 ORGANIZATIONS. 

11 (a) PUBLIC AVAILABILITY OF REPORTS.—Section 

12 105(a)(7) of the Protection and Advocacy for Individuals 

13 with Mental Illness Act (42 U.S.C. 10805(a)(7)) is amended 

14 by striking ‘‘is located a report’’ and inserting ‘‘is located, 

15 and make publicly available, a report’’. 

16 (b) DETAILED ACCOUNTING.—Section 114(a) of the 

17 Protection and Advocacy for Individuals with Mental Ill18 ness Act (42 U.S.C. 10824(a)) is amended— 

19 (1) in paragraph (3), by striking ‘‘and’’ at the 

20 end; 

21 (2) in paragraph (4), by striking the period at 

22 the end and inserting ‘‘; and’’; and 

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

24 ‘‘(5) using data from the existing required an25 nual program progress reports submitted by each sysVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
23 

•HR 2646 RH

1 tem funded under this title, a detailed accounting for 

2 each such system of how funds are spent, 

3 disaggregated according to whether the funds were re4 ceived from the Federal Government, the State govern5 ment, a local government, or a private entity.’’. 

6 SEC. 107. GRIEVANCE PROCEDURE. 

7 Section 105 of the Protection and Advocacy for Indi8 viduals with Mental Illness Act (42 U.S.C. 10805), as 

9 amended, is further amended by adding at the end the fol10 lowing: 

11 ‘‘(d) GRIEVANCE PROCEDURE.—The Secretary shall 

12 establish an independent grievance procedure for persons 

13 described in subsection (a)(9).’’. 

14 SEC. 108. CENTER FOR BEHAVIORAL HEALTH STATISTICS 

15 AND QUALITY. 

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

17 290aa et seq.) is amended— 

18 (1) in section 501(b) (42 U.S.C. 290aa(b)), by 

19 adding at the end the following: 

20 ‘‘(4) The Center for Behavioral Health Statistics 

21 and Quality.’’; 

22 (2) in section 502(a)(1) (42 U.S.C. 290aa– 

23 1(a)(1))— 

24 (A) in subparagraph (C), by striking ‘‘and’’ 

25 at the end; 


sradovich on DSK3GDR082PROD with BILLS
24 

•HR 2646 RH

1 (B) in subparagraph (D), by striking the 

2 period at the end and inserting ‘‘; and’’; and 

3 (C) by inserting after subparagraph (D) the 

4 following: 

5 ‘‘(E) the Center for Behavioral Health Sta6 tistics and Quality.’’; and 

7 (3) in part B (42 U.S.C. 290bb et seq.) by add8 ing at the end the following new subpart: 

9 ‘‘Subpart 4—Center for Behavioral Health Statistics 

10 and Quality 

11 ‘‘SEC. 520L. CENTER FOR BEHAVIORAL HEALTH STATISTICS 

12 AND QUALITY. 

13 ‘‘(a) ESTABLISHMENT.—There is established in the Ad14 ministration a Center for Behavioral Health Statistics and 

15 Quality (in this section referred to as the ‘Center’). The 

16 Center shall be headed by a Director (in this section referred 

17 to as the ‘Director’) appointed by the Secretary from among 

18 individuals with extensive experience and academic quali19 fications in research and analysis in behavioral health care 

20 or related fields. 

21 ‘‘(b) DUTIES.—The Director of the Center shall— 

22 ‘‘(1) coordinate the Administration’s integrated 

23 data strategy by coordinating— 

24 ‘‘(A) surveillance and data collection (in25 cluding that authorized by section 505); 


sradovich on DSK3GDR082PROD with BILLS
25 

•HR 2646 RH

1 ‘‘(B) evaluation; 

2 ‘‘(C) statistical and analytic support; 

3 ‘‘(D) service systems research; and 

4 ‘‘(E) performance and quality information 

5 systems; 

6 ‘‘(2) recommend a core set of measurement 

7 standards for grant programs administered by the 

8 Administration; and 

9 ‘‘(3) coordinate evaluation efforts for the grant 

10 programs, contracts, and collaborative agreements of 

11 the Administration. 

12 ‘‘(c) BIANNUAL REPORT TO CONGRESS.—Not later 

13 than 2 years after the date of enactment of this section, and 

14 every 2 years thereafter, the Director of the Center shall sub15 mit to Congress a report on the quality of services furnished 

16 through grant programs of the Administration, including 

17 applicable measures of outcomes for individuals and public 

18 outcomes such as— 

19 ‘‘(1) the number of patients screened positive for 

20 unhealthy alcohol use who receive brief counseling as 

21 appropriate; the number of patients screened positive 

22 for tobacco use and receiving smoking cessation inter23 ventions; the number of patients with a new diagnosis 

24 of major depressive episode who are assessed for sui25 cide risk; the number of patients screened positive for 


sradovich on DSK3GDR082PROD with BILLS
26 

•HR 2646 RH

1 clinical depression with a documented followup plan; 

2 and the number of patients with a documented pain 

3 assessment that have a followup treatment plan when 

4 pain is present; and satisfaction with care; 

5 ‘‘(2) the incidence and prevalence of substance 

6 use and mental disorders; the number of suicide at7 tempts and suicide completions; overdoses seen in 

8 emergency rooms resulting from alcohol and drug use; 

9 emergency room boarding; overdose deaths; emergency 

10 psychiatric hospitalizations; new criminal justice in11 volvement while in treatment; stable housing; and 

12 rates of involvement in employment, education, and 

13 training; and 

14 ‘‘(3) such other measures for outcomes of services 

15 as the Director may determine. 

16 ‘‘(d) STAFFING COMPOSITION.—The staff of the Center 

17 may include individuals with advanced degrees and field 

18 expertise as well as clinical and research experience in men19 tal and substance use disorders such as— 

20 ‘‘(1) professionals with clinical and research ex21 pertise in the prevention and treatment of, and recov22 ery from, substance use and mental disorders; 

23 ‘‘(2) professionals with training and expertise in 

24 statistics or research and survey design and meth25 odologies; and 


sradovich on DSK3GDR082PROD with BILLS
27 

•HR 2646 RH

1 ‘‘(3) other related fields in the social and behav2 ioral sciences, as specified by relevant position de3 scriptions. 

4 ‘‘(e) GRANTS AND CONTRACTS.—In carrying out the 

5 duties established in subsection (b), the Director may make 

6 grants to and enter into contracts and cooperative agree7 ments with public and nonprofit private entities. 

8 ‘‘(f) DEFINITION.—In this section, the term ‘emergency 

9 room boarding’ means the practice of admitting patients 

10 to an emergency department and holding such patients in 

11 the department until inpatient psychiatric beds become 

12 available.’’. 

13 SEC. 109. STRATEGIC PLAN. 

14 Section 501 of the Public Health Service Act (42 

15 U.S.C. 290aa) is amended— 

16 (1) by redesignating subsections (l) through (o) 

17 as subsections (m) through (p), respectively; and 

18 (2) by inserting after subsection (k) the fol19 lowing: 

20 ‘‘(l) STRATEGIC PLAN.— 

21 ‘‘(1) IN GENERAL.—Not later than December 1, 

22 2017, and every 5 years thereafter, the Assistant Sec23 retary shall develop and carry out a strategic plan in 

24 accordance with this subsection for the planning and 


sradovich on DSK3GDR082PROD with BILLS
28 

•HR 2646 RH

1 operation of evidence-based programs and grants car2 ried out by the Administration. 

3 ‘‘(2) COORDINATION.—In developing and car4 rying out the strategic plan under this section, the 

5 Assistant Secretary shall take into consideration the 

6 report of the Interdepartmental Serious Mental Illness 

7 Coordinating Committee under section 301 of the 

8 Helping Families in Mental Health Crisis Act of 

9 2016. 

10 ‘‘(3) PUBLICATION OF PLAN.—Not later than De11 cember 1, 2017, and every 5 years thereafter, the As12 sistant Secretary shall— 

13 ‘‘(A) submit the strategic plan developed 

14 under paragraph (1) to the appropriate commit15 tees of Congress; and 

16 ‘‘(B) post such plan on the Internet website 

17 of the Administration. 

18 ‘‘(4) CONTENTS.—The strategic plan developed 

19 under paragraph (1) shall— 

20 ‘‘(A) identify strategic priorities, goals, and 

21 measurable objectives for mental and substance 

22 use disorder activities and programs operated 

23 and supported by the Administration, including 

24 priorities to prevent or eliminate the burden of 

25 mental illness and substance use disorders; 


sradovich on DSK3GDR082PROD with BILLS
29 

•HR 2646 RH

1 ‘‘(B) identify ways to improve services for 

2 individuals with a mental or substance use dis3 order, including services related to the prevention 

4 of, diagnosis of, intervention in, treatment of, 

5 and recovery from, mental or substance use dis6 orders, including serious mental illness or seri7 ous emotional disturbance, and access to services 

8 and supports for individuals with a serious men9 tal illness or serious emotional disturbance; 

10 ‘‘(C) ensure that programs provide, as ap11 propriate, access to effective and evidence-based 

12 prevention, diagnosis, intervention, treatment, 

13 and recovery services, including culturally and 

14 linguistically appropriate services, as appro15 priate, for individuals with a mental or sub16 stance use disorder; 

17 ‘‘(D) identify opportunities to collaborate 

18 with the Health Resources and Services Adminis19 tration to develop or improve— 

20 ‘‘(i) initiatives to encourage individ21 uals to pursue careers (especially in rural 

22 and underserved areas and populations) as 

23 psychiatrists, psychologists, psychiatric 

24 nurse practitioners, physician assistants, 

25 occupational therapists, clinical social 


sradovich on DSK3GDR082PROD with BILLS
30 

•HR 2646 RH

1 workers, certified peer support specialists, 

2 licensed professional counselors, or other li3 censed or certified mental health profes4 sionals, including such professionals special5 izing in the diagnosis, evaluation, or treat6 ment of individuals with a serious mental 

7 illness or serious emotional disturbance; 

8 and 

9 ‘‘(ii) a strategy to improve the recruit10 ment, training, and retention of a workforce 

11 for the treatment of individuals with mental 

12 or substance use disorders, or co-occurring 

13 disorders; 

14 ‘‘(E) identify opportunities to improve col15 laboration with States, local governments, com16 munities, and Indian tribes and tribal organiza17 tions (as such terms are defined in section 4 of 

18 the Indian Self-Determination and Education 

19 Assistance Act (25 U.S.C. 450b)); and 

20 ‘‘(F) specify a strategy to disseminate evi21 denced-based and promising best practices re22 lated to prevention, diagnosis, early intervention, 

23 treatment, and recovery services related to men24 tal illness, particularly for individuals with a se25 rious mental illness and children and adolescents 


sradovich on DSK3GDR082PROD with BILLS
31 

•HR 2646 RH

1 with a serious emotional disturbance, and sub2 stance use disorders.’’. 

3 SEC. 110. AUTHORITIES OF CENTERS FOR MENTAL HEALTH 

4 SERVICES AND SUBSTANCE ABUSE TREAT5 MENT. 

6 (a) CENTER FOR MENTAL HEALTH SERVICES.—Sec7 tion 520(b) of the Public Health Service Act (42 U.S.C. 

8 290bb–31(b)) is amended— 

9 (1) by redesignating paragraphs (3) through (15) 

10 as paragraphs (4) through (16), respectively; 

11 (2) by inserting after paragraph (2) the fol12 lowing: 

13 ‘‘(3) collaborate with the Director of the National 

14 Institute of Mental Health to ensure that, as appro15 priate, programs related to the prevention and treat16 ment of mental illness and the promotion of mental 

17 health are carried out in a manner that reflects the 

18 best available science and evidence-based practices, in19 cluding culturally and linguistically appropriate 

20 services;’’; 

21 (3) in paragraph (5), as so redesignated, by in22 serting ‘‘through policies and programs that reduce 

23 risk and promote resiliency’’ before the semicolon; 


sradovich on DSK3GDR082PROD with BILLS
32 

•HR 2646 RH

1 (4) in paragraph (6), as so redesignated, by in2 serting ‘‘in collaboration with the Director of the Na3 tional Institute of Mental Health,’’ before ‘‘develop’’; 

4 (5) in paragraph (8), as so redesignated, by in5 serting ‘‘, increase meaningful participation of indi6 viduals with mental illness in programs and activi7 ties of the Administration,’’ before ‘‘and protect the 

8 legal’’; 

9 (6) in paragraph (10), as so redesignated, by 

10 striking ‘‘professional and paraprofessional personnel 

11 pursuant to section 303’’ and inserting ‘‘paraprofes12 sional personnel and health professionals’’; 

13 (7) in paragraph (11), as so redesignated, by in14 serting ‘‘and telemental health,’’ after ‘‘rural mental 

15 health,’’; 

16 (8) in paragraph (12), as so redesignated, by 

17 striking ‘‘establish a clearinghouse for mental health 

18 information to assure the widespread dissemination of 

19 such information’’ and inserting ‘‘disseminate mental 

20 health information, including evidenced-based prac21 tices,’’; 

22 (9) in paragraph (15), as so redesignated, by 

23 striking ‘‘and’’ at the end; 

24 (10) in paragraph (16), as so redesignated, by 

25 striking the period and inserting ‘‘; and’’; and 


sradovich on DSK3GDR082PROD with BILLS
33 

•HR 2646 RH

1 (11) by adding at the end the following: 

2 ‘‘(17) consult with other agencies and offices of 

3 the Department of Health and Human Services to en4 sure, with respect to each grant awarded by the Cen5 ter for Mental Health Services, the consistent docu6 mentation of the application of criteria when award7 ing grants and the ongoing oversight of grantees after 

8 such grants are awarded.’’. 

9 (b) DIRECTOR OF THE CENTER FOR SUBSTANCE

10 ABUSE TREATMENT.—Section 507 of the Public Health 

11 Service Act (42 U.S.C. 290bb) is amended— 

12 (1) in subsection (a)— 

13 (A) by striking ‘‘treatment of substance 

14 abuse’’ and inserting ‘‘treatment of substance use 

15 disorders’’; and 

16 (B) by striking ‘‘abuse treatment systems’’ 

17 and inserting ‘‘use disorder treatment systems’’; 

18 and 

19 (2) in subsection (b)— 

20 (A) in paragraph (3), by striking ‘‘abuse’’ 

21 and inserting ‘‘use disorder’’; 

22 (B) in paragraph (4), by striking ‘‘individ23 uals who abuse drugs’’ and inserting ‘‘individ24 uals who use drugs’’; 


sradovich on DSK3GDR082PROD with BILLS
34 

•HR 2646 RH

1 (C) in paragraph (9), by striking ‘‘carried 

2 out by the Director’’; 

3 (D) by striking paragraph (10); 

4 (E) by redesignating paragraphs (11) 

5 through (14) as paragraphs (10) through (13), 

6 respectively; 

7 (F) in paragraph (12), as so redesignated, 

8 by striking ‘‘; and’’ and inserting a semicolon; 

9 and 

10 (G) by striking paragraph (13), as so redes11 ignated, and inserting the following: 

12 ‘‘(13) ensure the consistent documentation of the 

13 application of criteria when awarding grants and the 

14 ongoing oversight of grantees after such grants are 

15 awarded; and 

16 ‘‘(14) work with States, providers, and individ17 uals in recovery, and their families, to promote the 

18 expansion of recovery support services and systems of 

19 care oriented towards recovery.’’. 

20 SEC. 111. ADVISORY COUNCILS. 

21 Section 502(b) of the Public Health Service Act (42 

22 U.S.C. 290aa–1(b)) is amended— 

23 (1) in paragraph (2)— 

24 (A) in subparagraph (E), by striking ‘‘and’’ 

25 after the semicolon; 


sradovich on DSK3GDR082PROD with BILLS
35 

•HR 2646 RH

1 (B) by redesignating subparagraph (F) as 

2 subparagraph (I); and 

3 (C) by inserting after subparagraph (E), 

4 the following: 

5 ‘‘(F) for the advisory councils appointed 

6 under subsections (a)(1)(A) and (a)(1)(D), the 

7 Director of the National Institute of Mental 

8 Health; 

9 ‘‘(G) for the advisory councils appointed 

10 under subsections (a)(1)(A), (a)(1)(B), and 

11 (a)(1)(C), the Director of the National Institute 

12 on Drug Abuse; 

13 ‘‘(H) for the advisory councils appointed 

14 under subsections (a)(1)(A), (a)(1)(B), and 

15 (a)(1)(C), the Director of the National Institute 

16 on Alcohol Abuse and Alcoholism; and’’; and 

17 (2) in paragraph (3), by adding at the end the 

18 following: 

19 ‘‘(C) Not less than half of the members of 

20 the advisory council appointed under subsection 

21 (a)(1)(D)— 

22 ‘‘(i) shall have— 

23 ‘‘(I) a medical degree; 

24 ‘‘(II) a doctoral degree in psy25 chology; or 


sradovich on DSK3GDR082PROD with BILLS
36 

•HR 2646 RH

1 ‘‘(III) an advanced degree in 

2 nursing or social work from an accred3 ited graduate school or be a certified 

4 physician assistant; and 

5 ‘‘(ii) shall specialize in the mental 

6 health field.’’. 

7 SEC. 112. PEER REVIEW. 

8 Section 504(b) of the Public Health Service Act (42 

9 U.S.C. 290aa–3(b)) is amended by adding at the end the 

10 following: ‘‘In the case of any such peer review group that 

11 is reviewing a grant, cooperative agreement, or contract re12 lated to mental illness treatment, not less than half of the 

13 members of such peer review group shall be licensed and 

14 experienced professionals in the prevention, diagnosis, or 

15 treatment of, or recovery from, mental or substance use dis16 orders and have a medical degree, a doctoral degree in psy17 chology, or an advanced degree in nursing or social work 

18 from an accredited program.’’. 


sradovich on DSK3GDR082PROD with BILLS
37 

•HR 2646 RH

1 TITLE II—MEDICAID MENTAL 

2 HEALTH COVERAGE 

3 SEC. 201. RULE OF CONSTRUCTION RELATED TO MEDICAID 

4 COVERAGE OF MENTAL HEALTH SERVICES 

5 AND PRIMARY CARE SERVICES FURNISHED 

6 ON THE SAME DAY. 

7 Nothing in title XIX of the Social Security Act (42 

8 U.S.C. 1396 et seq.) shall be construed as prohibiting sepa9 rate payment under the State plan under such title (or 

10 under a waiver of the plan) for the provision of a mental 

11 health service or primary care service under such plan, with 

12 respect to an individual, because such service is— 

13 (1) a primary care service furnished to the indi14 vidual by a provider at a facility on the same day 

15 a mental health service is furnished to such indi16 vidual by such provider (or another provider) at the 

17 facility; or 

18 (2) a mental health service furnished to the indi19 vidual by a provider at a facility on the same day 

20 a primary care service is furnished to such individual 

21 by such provider (or another provider) at the facility. 


sradovich on DSK3GDR082PROD with BILLS
38 

•HR 2646 RH

1 SEC. 202. OPTIONAL LIMITED COVERAGE OF INPATIENT 

2 SERVICES FURNISHED IN INSTITUTIONS FOR 

3 MENTAL DISEASES. 

4 (a) IN GENERAL.—Section 1903(m)(2) of the Social 

5 Security Act (42 U.S.C. 1396b(m)(2)) is amended by add6 ing at the end the following new subparagraph: 

7 ‘‘(I)(i) Notwithstanding the limitation specified in the 

8 subdivision (B) following paragraph (29) of section 1905(a) 

9 and subject to clause (ii), a State may, under a risk con10 tract entered into by the State under this title (or under 

11 section 1115) with a medicaid managed care organization 

12 or a prepaid inpatient health plan (as defined in section 

13 438.2 of title 42, Code of Federal Regulations (or any suc14 cessor regulation)), make a monthly capitation payment to 

15 such organization or plan for enrollees with the organiza16 tion or plan who are over 21 years of age and under 65 

17 years of age and are receiving inpatient treatment in an 

18 institution for mental diseases (as defined in section 

19 1905(i)), so long as each of the following conditions is met: 

20 ‘‘(I) The institution is a hospital providing in21 patient psychiatric or substance use disorder services 

22 or a sub-acute facility providing psychiatric or sub23 stance use disorder crisis residential services. 

24 ‘‘(II) The length of stay in such an institution 

25 for such treatment is for a short-term stay of no more 


sradovich on DSK3GDR082PROD with BILLS
39 

•HR 2646 RH

1 than 15 days during the period of the monthly capi2 tation payment. 

3 ‘‘(III) The provision of such treatment meets the 

4 following criteria for consideration as services or set5 tings that are in lieu of services or settings covered 

6 under the State plan: 

7 ‘‘(aa) The State determines that the alter8 native service or setting is a medically appro9 priate and cost-effective substitute for the covered 

10 service or setting under the State plan. 

11 ‘‘(bb) The enrollee is not required by the 

12 managed care organization or prepaid inpatient 

13 health plan to use the alternative service or set14 ting. 

15 ‘‘(cc) Such treatment is authorized and 

16 identified in such contract, and will be offered to 

17 such enrollees at the option of the managed care 

18 organization or prepaid inpatient health plan. 

19 ‘‘(ii) For purposes of setting the amount of such a 

20 monthly capitation payment, a State may use the utiliza21 tion of services provided to an individual under this sub22 paragraph when developing the inpatient psychiatric or 

23 substance use disorder component of such payment, but the 

24 amount of such payment for such services may not exceed 


sradovich on DSK3GDR082PROD with BILLS
40 

•HR 2646 RH

1 the cost of the same services furnished through providers in2 cluded under the State plan.’’. 

3 (b) EFFECTIVE DATE.—The amendment made by sub4 section (a) shall apply beginning on July 5, 2016, or the 

5 date of the enactment of this Act, whichever is later. 

6 SEC. 203. STUDY AND REPORT RELATED TO MEDICAID MAN7 AGED CARE REGULATION. 

8 (a) STUDY.—The Secretary of Health and Human 

9 Services, acting through the Administrator of the Centers 

10 for Medicare & Medicaid Services, shall conduct a study 

11 on coverage under the Medicaid program under title XIX 

12 of the Social Security Act (42 U.S.C. 1396 et seq.) of serv13 ices provided through a medicaid managed care organiza14 tion (as defined in section 1903(m) of such Act (42 U.S.C. 

15 1396b(m)) or a prepaid inpatient health plan (as defined 

16 in section 438.2 of title 42, Code of Federal Regulations 

17 (or any successor regulation)) with respect to individuals 

18 over the age of 21 and under the age of 65 for the treatment 

19 of a mental health disorder in institutions for mental dis20 eases (as defined in section 1905(i) of such Act (42 U.S.C. 

21 1396d(i))). Such study shall include information on the fol22 lowing: 

23 (1) The extent to which States, including the 

24 District of Columbia and each territory or possession 

25 of the United States, are providing capitated payVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
41 

•HR 2646 RH

1 ments to such organizations or plans for enrollees who 

2 are receiving services in institutions for mental dis3 eases. 

4 (2) The number of individuals receiving medical 

5 assistance under a State plan under such title XIX, 

6 or a waiver of such plan, who receive services in in7 stitutions for mental diseases through such organiza8 tions and plans. 

9 (3) The range of and average number of months, 

10 and the length of stay during such months, that such 

11 individuals are receiving such services in such insti12 tutions. 

13 (4) How such organizations or plans determine 

14 when to provide for the furnishing of such services 

15 through an institution for mental diseases in lieu of 

16 other benefits (including the full range of community17 based services) under their contract with the State 

18 agency administering the State plan under such title 

19 XIX, or a waiver of such plan, to address psychiatric 

20 or substance use disorder treatment. 

21 (5) The extent to which the provision of services 

22 within such institutions has affected the capitated 

23 payments for such organizations or plans. 

24 (b) REPORT.—Not later than three years after the date 

25 of the enactment of this Act, the Secretary shall submit to 


sradovich on DSK3GDR082PROD with BILLS
42 

•HR 2646 RH

1 Congress a report on the study conducted under subsection 

2 (a). 

3 SEC. 204. GUIDANCE ON OPPORTUNITIES FOR INNOVATION. 

4 Not later than one year after the date of the enactment 

5 of this Act, the Administrator of the Centers for Medicare 

6 & Medicaid Services shall issue a State Medicaid Director 

7 letter regarding opportunities to design innovative service 

8 delivery systems, including systems for providing commu9 nity-based services, for individuals with serious mental ill10 ness or serious emotional disturbance who are receiving 

11 medical assistance under title XIX of the Social Security 

12 Act (42 U.S.C. 1396 et seq.). The letter shall include oppor13 tunities for demonstration projects under section 1115 of 

14 such Act (42 U.S.C. 1315), to improve care for such individ15 uals. 

16 SEC. 205. STUDY AND REPORT ON MEDICAID EMERGENCY 

17 PSYCHIATRIC DEMONSTRATION PROJECT. 

18 (a) COLLECTION OF INFORMATION.—The Secretary of 

19 Health and Human Services, acting through the Adminis20 trator of the Centers for Medicare & Medicaid Services, 

21 shall, with respect to each State that has participated in 

22 the demonstration project established under section 2707 of 

23 the Patient Protection and Affordable Care Act (42 U.S.C. 

24 1396a note), collect from each such State information on 

25 the following: 


sradovich on DSK3GDR082PROD with BILLS
43 

•HR 2646 RH

1 (1) The number of institutions for mental dis2 eases (as defined in section 1905(i) of the Social Secu3 rity Act (42 U.S.C. 1396d(i))) and beds in such insti4 tutions that received payment for the provision of 

5 services to individuals who receive medical assistance 

6 under a State plan under the Medicaid program 

7 under title XIX of the Social Security Act (42 U.S.C. 

8 1396 et seq.) (or under a waiver of such plan) 

9 through the demonstration project in each such State 

10 as compared to the total number of institutions for 

11 mental diseases and beds in the State. 

12 (2) The extent to which there is a reduction in 

13 expenditures under the Medicaid program under title 

14 XIX of the Social Security Act (42 U.S.C. 1396 et 

15 seq.) or other spending on the full continuum of phys16 ical or mental health care for individuals who receive 

17 treatment in an institution for mental diseases under 

18 the demonstration project, including outpatient, inpa19 tient, emergency, and ambulatory care, that is attrib20 utable to such individuals receiving treatment in in21 stitutions for mental diseases under the demonstration 

22 project. 

23 (3) The number of forensic psychiatric hospitals, 

24 the number of beds in such hospitals, and the number 

25 of forensic psychiatric beds in other hospitals in such 


sradovich on DSK3GDR082PROD with BILLS
44 

•HR 2646 RH

1 State, based on the most recent data available, to the 

2 extent practical, as determined by such Adminis3 trator. 

4 (4) The amount of any disproportionate share 

5 hospital payments under section 1923 of the Social 

6 Security Act (42 U.S.C. 1396r–4) that institutions 

7 for mental diseases in the State received during the 

8 period beginning on July 1, 2012, and ending on 

9 June 30, 2015, and the extent to which the dem10 onstration project reduced the amount of such pay11 ments. 

12 (5) The most recent data regarding all facilities 

13 or sites in the State in which any individuals with 

14 serious mental illness who are receiving medical as15 sistance under a State plan under the Medicaid pro16 gram under title XIX of the Social Security Act (42 

17 U.S.C. 1396 et seq.) (or under a waiver of such plan) 

18 are treated during the period referred to in paragraph 

19 (4), to the extent practical, as determined by the Ad20 ministrator, including— 

21 (A) the types of such facilities or sites (such 

22 as an institution for mental diseases, a hospital 

23 emergency department, or other inpatient hos24 pital); 


sradovich on DSK3GDR082PROD with BILLS
45 

•HR 2646 RH

1 (B) the average length of stay in such a fa2 cility or site by such an individual, 

3 disaggregated by facility type; and 

4 (C) the payment rate under the State plan 

5 (or a waivers of such plan) for services furnished 

6 to such an individual for that treatment, 

7 disaggregated by facility type, during the period 

8 in which the demonstration project is in oper9 ation. 

10 (6) The extent to which the utilization of hos11 pital emergency departments during the period in 

12 which the demonstration project was is in operation 

13 differed, with respect to individuals who are receiving 

14 medical assistance under a State plan under the Med15 icaid program under title XIX of the Social Security 

16 Act (42 U.S.C. 1396 et seq.) (or under a waiver of 

17 such plan), between— 

18 (A) those individuals who received treat19 ment in an institution for mental diseases under 

20 the demonstration project; 

21 (B) those individuals who met the eligibility 

22 requirements for the demonstration project but 

23 who did not receive treatment in an institution 

24 for mental diseases under the demonstration 

25 project; and 


sradovich on DSK3GDR082PROD with BILLS
46 

•HR 2646 RH

1 (C) those individuals with serious mental 

2 illness who did not meet such eligibility require3 ments and did not receive treatment for such ill4 ness in an institution for mental diseases. 

5 (b) REPORT.—Not later than two years after the date 

6 of the enactment of this Act, the Secretary of Health and 

7 Human Services shall submit to Congress a report that 

8 summarizes and analyzes the information collected under 

9 subsection (a). Such report may be submitted as part of 

10 the report required under section 2707(f) of the Patient Pro11 tection and Affordable Care Act (42 U.S.C. 1396a note) or 

12 separately. 

13 SEC. 206. PROVIDING FULL-RANGE OF EPSDT SERVICES TO 

14 CHILDREN IN IMDS. 

15 Section 1905(a)(16) of the Social Security Act (42 

16 U.S.C. 1396d(a)(16)) is amended by inserting before the 

17 semicolon at the end the following: ‘‘, and, effective January 

18 1, 2019, the full-range of early and periodic screening, diag19 nostic, and treatment services (as defined in subsection (r)) 

20 for such individuals whether or not such screening, diag21 nostic, and treatment services are furnished by the provider 

22 of inpatient psychiatric hospital services for individuals 

23 under age 21’’. 


sradovich on DSK3GDR082PROD with BILLS
47 

•HR 2646 RH

1 SEC. 207. ELECTRONIC VISIT VERIFICATION SYSTEM RE2 QUIRED FOR PERSONAL CARE SERVICES AND 

3 HOME HEALTH CARE SERVICES UNDER MED4 ICAID. 

5 (a) IN GENERAL.—Section 1903 of the Social Security 

6 Act (42 U.S.C. 1396b) is amended by inserting after sub7 section (k) the following new subsection: 

8 ‘‘(l)(1) Subject to paragraphs (3) and (4), with respect 

9 to any amount expended for personal care services or home 

10 health care services requiring an in-home visit by a pro11 vider that are provided under a State plan under this title 

12 (or under a waiver of the plan) and furnished in a calendar 

13 quarter beginning on or after January 1, 2019 (or, in the 

14 case of home health care services, on or after January 1, 

15 2023), unless a State requires the use of an electronic visit 

16 verification system for such services furnished in such quar17 ter under the plan or such waiver, the Federal medical as18 sistance percentage shall be reduced— 

19 ‘‘(A) in the case of personal care services— 

20 ‘‘(i) for calendar quarters in 2019 and 

21 2020, by .25 percentage points; 

22 ‘‘(ii) for calendar quarters in 2021, by .5 

23 percentage points; 

24 ‘‘(iii) for calendar quarters in 2022, by .75 

25 percentage points; and 


sradovich on DSK3GDR082PROD with BILLS
48 

•HR 2646 RH

1 ‘‘(iv) for calendar quarters in 2023 and 

2 each year thereafter, by 1 percentage point; and 

3 ‘‘(B) in the case of home health care services— 

4 ‘‘(i) for calendar quarters in 2023 and 

5 2024, by .25 percentage points; 

6 ‘‘(ii) for calendar quarters in 2025, by .5 

7 percentage points; 

8 ‘‘(iii) for calendar quarters in 2026, by .75 

9 percentage points; and 

10 ‘‘(iv) for calendar quarters in 2027 and 

11 each year thereafter, by 1 percentage point. 

12 ‘‘(2) Subject to paragraphs (3) and (4), in imple13 menting the requirement for the use of an electronic visit 

14 verification system under paragraph (1), a State shall— 

15 ‘‘(A) consult with agencies and entities that pro16 vide personal care services, home health care services, 

17 or both under the State plan (or under a waiver of 

18 the plan) to ensure that such system— 

19 ‘‘(i) is minimally burdensome; 

20 ‘‘(ii) takes into account existing best prac21 tices and electronic visit verification systems in 

22 use in the State; and 

23 ‘‘(iii) is conducted in accordance with the 

24 requirements of HIPAA privacy and security 


sradovich on DSK3GDR082PROD with BILLS
49 

•HR 2646 RH

1 law (as defined in section 3009 of the Public 

2 Health Service Act); 

3 ‘‘(B) take into account a stakeholder process that 

4 includes input from beneficiaries, family caregivers, 

5 personal care or home health care services workers, 

6 and other stakeholders, as determined by the State in 

7 accordance with guidance from the Secretary; and 

8 ‘‘(C) ensure that individuals who furnish per9 sonal care services, home health care services, or both 

10 under the State plan (or under a waiver of the plan) 

11 are provided the opportunity for training on the use 

12 of such system. 

13 ‘‘(3) Paragraphs (1) and (2) shall not apply in the 

14 case of a State that, as of the date of the enactment of this 

15 subsection, requires the use of any system for the electronic 

16 verification of visits conducted as part of both personal care 

17 services and home health care services. 

18 ‘‘(4)(A) In the case of a State described in subpara19 graph (B), the reduction under paragraph (1) shall not 

20 apply— 

21 ‘‘(i) in the case of personal care services, for cal22 endar quarters in 2019; and 

23 ‘‘(ii) in the case of home health care services, for 

24 calendar quarters in 2023. 


sradovich on DSK3GDR082PROD with BILLS
50 

•HR 2646 RH

1 ‘‘(B) For purposes of subparagraph (A), a State de2 scribed in this subparagraph is a State that demonstrates 

3 to the Secretary that the State— 

4 ‘‘(i) has made a good faith effort to comply with 

5 the requirements of paragraphs (1) and (2) (includ6 ing by taking steps to adopt the technology used for 

7 an electronic visit verification system); or 

8 ‘‘(ii) in implementing such a system, has en9 countered unavoidable system delays. 

10 ‘‘(5) In this subsection: 

11 ‘‘(A) The term ‘electronic visit verification sys12 tem’ means, with respect to personal care services or 

13 home health care services, a system under which visits 

14 conducted as part of such services are electronically 

15 verified with respect to— 

16 ‘‘(i) the type of service performed; 

17 ‘‘(ii) the individual receiving the service; 

18 ‘‘(iii) the date of the service; 

19 ‘‘(iv) the location of service delivery; 

20 ‘‘(v) the individual providing the service; 

21 and 

22 ‘‘(vi) the time the service begins and ends. 

23 ‘‘(B) The term ‘home health care services’ means 

24 services described in section 1905(a)(7) provided 


sradovich on DSK3GDR082PROD with BILLS
51 

•HR 2646 RH

1 under a State plan under this title (or under a waiv2 er of the plan). 

3 ‘‘(C) The term ‘personal care services’ means 

4 personal care services provided under a State plan 

5 under this title (or under a waiver of the plan), in6 cluding services provided under section 1905(a)(24), 

7 1915(c), 1915(i), 1915(j), or 1915(k) or under a 

8 wavier under section 1115. 

9 ‘‘(6)(A) In the case in which a State requires personal 

10 care service and home health care service providers to utilize 

11 an electronic visit verification system operated by the State 

12 or a contractor on behalf of the State, the Secretary shall 

13 pay to the State, for each quarter, an amount equal to 90 

14 per centum of so much of the sums expended during such 

15 quarter as are attributable to the design, development, or 

16 installation of such system, and 75 per centum of so much 

17 of the sums for the operation and maintenance of such sys18 tem. 

19 ‘‘(B) Subparagraph (A) shall not apply in the case 

20 in which a State requires personal care service and home 

21 health care service providers to utilize an electronic visit 

22 verification system that is not operated by the State or a 

23 contractor on behalf of the State.’’. 

24 (b) COLLECTION AND DISSEMINATION OF BEST PRAC25 TICES.—Not later than January 1, 2018, the Secretary of 


sradovich on DSK3GDR082PROD with BILLS
52 

•HR 2646 RH

1 Health and Human Services shall, with respect to electronic 

2 visit verification systems (as defined in subsection (l)(5) of 

3 section 1903 of the Social Security Act (42 U.S.C. 1396b), 

4 as inserted by subsection (a)), collect and disseminate best 

5 practices to State Medicaid Directors with respect to— 

6 (1) training individuals who furnish personal 

7 care services, home health care services, or both under 

8 the State plan under title XIX of such Act (or under 

9 a waiver of the plan) on such systems and the oper10 ation of such systems and the prevention of fraud 

11 with respect to the provision of personal care services 

12 or home health care services (as defined in such sub13 section (l)(5)); and 

14 (2) the provision of notice and educational mate15 rials to family caregivers and beneficiaries with re16 spect to the use of such electronic visit verification 

17 systems and other means to prevent such fraud. 

18 (c) RULES OF CONSTRUCTION.— 

19 (1) NO EMPLOYER-EMPLOYEE RELATIONSHIP ES20 TABLISHED.—Nothing in the amendment made by 

21 this section may be construed as establishing an em22 ployer-employee relationship between the agency or 

23 entity that provides for personal care services or home 

24 health care services and the individuals who, under a 

25 contract with such an agency or entity, furnish such 


sradovich on DSK3GDR082PROD with BILLS
53 

•HR 2646 RH

1 services for purposes of part 552 of title 29, Code of 

2 Federal Regulations (or any successor regulations). 

3 (2) NO PARTICULAR OR UNIFORM ELECTRONIC

4 VISIT VERIFICATION SYSTEM REQUIRED.—Nothing in 

5 the amendment made by this section shall be con6 strued to require the use of a particular or uniform 

7 electronic visit verification system (as defined in sub8 section (l)(5) of section 1903 of the Social Security 

9 Act (42 U.S.C. 1396b), as inserted by subsection (a)) 

10 by all agencies or entities that provide personal care 

11 services or home health care under a State plan under 

12 title XIX of the Social Security Act (or under a waiv13 er of the plan) (42 U.S.C. 1396 et seq.). 

14 (3) NO LIMITS ON PROVISION OF CARE.—Nothing 

15 in the amendment made by this section may be con16 strued to limit, with respect to personal care services 

17 or home health care services provided under a State 

18 plan under title XIX of the Social Security Act (or 

19 under a waiver of the plan) (42 U.S.C. 1396 et seq.), 

20 provider selection, constrain beneficiaries’ selection of 

21 a caregiver, or impede the manner in which care is 

22 delivered. 

23 (4) NO PROHIBITION ON STATE QUALITY MEAS24 URES REQUIREMENTS.—Nothing in the amendment 

25 made by this section shall be construed as prohibiting 


sradovich on DSK3GDR082PROD with BILLS
54 

•HR 2646 RH

1 a State, in implementing an electronic visit 

2 verification system (as defined in subsection (l)(5) of 

3 section 1903 of the Social Security Act (42 U.S.C. 

4 1396b), as inserted by subsection (a)), from estab5 lishing requirements related to quality measures for 

6 such system. 

7 TITLE III—INTERDEPART8 MENTAL SERIOUS MENTAL 

9 ILLNESS COORDINATING 

10 COMMITTEE 

11 SEC. 301. INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS 

12 COORDINATING COMMITTEE. 

13 (a) ESTABLISHMENT.— 

14 (1) IN GENERAL.—Not later than 3 months after 

15 the date of enactment of this Act, the Secretary of 

16 Health and Human Services, or the designee of the 

17 Secretary, shall establish a committee to be known as 

18 the ‘‘Interdepartmental Serious Mental Illness Coordi19 nating Committee’’ (in this section referred to as the 

20 ‘‘Committee’’). 

21 (2) FEDERAL ADVISORY COMMITTEE ACT.—Ex22 cept as provided in this section, the provisions of the 

23 Federal Advisory Committee Act (5 U.S.C. App.) 

24 shall apply to the Committee. 


sradovich on DSK3GDR082PROD with BILLS
55 

•HR 2646 RH

1 (b) MEETINGS.—The Committee shall meet not fewer 

2 than 2 times each year. 

3 (c) RESPONSIBILITIES.—Not later than 1 year after 

4 the date of enactment of this Act, and 5 years after such 

5 date of enactment, the Committee shall submit to Congress 

6 a report including— 

7 (1) a summary of advances in serious mental ill8 ness and serious emotional disturbance research re9 lated to the prevention of, diagnosis of, intervention 

10 in, and treatment and recovery of, serious mental ill11 nesses, serious emotional disturbances, and advances 

12 in access to services and support for individuals with 

13 a serious mental illness or serious emotional disturb14 ance; 

15 (2) an evaluation of the effect on public health 

16 of Federal programs related to serious mental illness 

17 or serious emotional disturbance, including measure18 ments of public health outcomes such as— 

19 (A) rates of suicide, suicide attempts, preva20 lence of serious mental illness, serious emotional 

21 disturbances, and substance use disorders, over22 dose, overdose deaths, emergency hospitalizations, 

23 emergency room boarding, preventable emergency 

24 room visits, involvement with the criminal jusVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
56 

•HR 2646 RH

1 tice system, crime, homelessness, and unemploy2 ment; 

3 (B) increased rates of employment and en4 rollment in educational and vocational pro5 grams; 

6 (C) quality of mental and substance use dis7 order treatment services; and 

8 (D) any other criteria as may be deter9 mined by the Secretary; 

10 (3) a plan to improve outcomes for individuals 

11 with serious mental illness or serious emotional dis12 turbances, including reducing incarceration for such 

13 individuals, reducing homelessness, and increasing 

14 employment; and 

15 (4) specific recommendations for actions that 

16 agencies can take to better coordinate the administra17 tion of mental health services for people with serious 

18 mental illness or serious emotional disturbances. 

19 (d) COMMITTEE EXTENSION.—Upon the submission of 

20 the second report under subsection (c), the Secretary shall 

21 submit a recommendation to Congress on whether to extend 

22 the operation of the Committee. 

23 (e) MEMBERSHIP.— 


sradovich on DSK3GDR082PROD with BILLS
57 

•HR 2646 RH

1 (1) FEDERAL MEMBERS.—The Committee shall 

2 be composed of the following Federal representatives, 

3 or their designees: 

4 (A) The Secretary of Health and Human 

5 Services, who shall serve as the Chair of the 

6 Committee. 

7 (B) The Director of the National Institutes 

8 of Health. 

9 (C) The Assistant Secretary for Health of 

10 the Department of Health and Human Services. 

11 (D) The Assistant Secretary for Mental 

12 Health and Substance Use. 

13 (E) The Attorney General of the United 

14 States. 

15 (F) The Secretary of Veterans Affairs. 

16 (G) The Secretary of Defense. 

17 (H) The Secretary of Housing and Urban 

18 Development. 

19 (I) The Secretary of Education. 

20 (J) The Secretary of Labor. 

21 (K) The Commissioner of Social Security. 

22 (L) The Administrator of the Centers for 

23 Medicare & Medicaid Services. 

24 (2) NON-FEDERAL MEMBERS.—The Committee 

25 shall also include not less than 14 non-Federal public 


sradovich on DSK3GDR082PROD with BILLS
58 

•HR 2646 RH

1 members appointed by the Secretary of Health and 

2 Human Services, of which— 

3 (A) at least 2 members shall be individuals 

4 with lived experience with serious mental illness 

5 or serious emotional disturbance; 

6 (B) at least 1 member shall be a parent or 

7 legal guardian of an individual with a history 

8 of a serious mental illness or serious emotional 

9 disturbance; 

10 (C) at least 1 member shall be a representa11 tive of a leading research, advocacy, or service 

12 organization for individuals with serious mental 

13 illness or serious emotional disturbance; 

14 (D) at least 2 members shall be— 

15 (i) a licensed psychiatrist with experi16 ence treating serious mental illnesses or se17 rious emotional disturbances; 

18 (ii) a licensed psychologist with experi19 ence treating serious mental illnesses or se20 rious emotional disturbances; 

21 (iii) a licensed clinical social worker 

22 with experience treating serious mental ill23 ness or serious emotional disturbances; or 

24 (iv) a licensed psychiatric nurse, nurse 

25 practitioner, or physician assistant with exVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
59 

•HR 2646 RH

1 perience treating serious mental illnesses or 

2 serious emotional disturbances; 

3 (E) at least 1 member shall be a licensed 

4 mental health professional with a specialty in 

5 treating children and adolescents with serious 

6 emotional disturbances; 

7 (F) at least 1 member shall be a mental 

8 health professional who has research or clinical 

9 mental health experience working with minori10 ties; 

11 (G) at least 1 member shall be a mental 

12 health professional who has research or clinical 

13 mental health experience working with medically 

14 underserved populations; 

15 (H) at least 1 member shall be a State cer16 tified mental health peer specialist; 

17 (I) at least 1 member shall be a judge with 

18 experience adjudicating cases within a mental 

19 health court; 

20 (J) at least 1 member shall be a law en21 forcement officer or corrections officer with exten22 sive experience in interfacing with individuals 

23 with a serious mental illness or serious emo24 tional disturbance, or in a mental health crisis; 

25 and 


sradovich on DSK3GDR082PROD with BILLS
60 

•HR 2646 RH

1 (K) at least 1 member shall be a homeless 

2 services provider with experience working with 

3 individuals with serious mental illness, with se4 rious emotional disturbance, or having mental 

5 health crisis. 

6 (3) TERMS.—A member of the Committee ap7 pointed under paragraph (2) shall serve for a term of 

8 3 years, and may be reappointed for one or more ad9 ditional 3-year terms. Any member appointed to fill 

10 a vacancy for an unexpired term shall be appointed 

11 for the remainder of such term. A member may serve 

12 after the expiration of the member’s term until a suc13 cessor has been appointed. 

14 (f) WORKING GROUPS.—In carrying out its functions, 

15 the Committee may establish working groups. Such working 

16 groups shall be composed of Committee members, or their 

17 designees, and may hold such meetings as are necessary. 

18 (g) SUNSET.—The Committee shall terminate on the 

19 date that is 6 years after the date on which the Committee 

20 is established under subsection (a)(1). 

21 TITLE IV—COMPASSIONATE 

22 COMMUNICATION ON HIPAA 

23 SEC. 401. SENSE OF CONGRESS. 

24 (a) FINDINGS.—Congress finds the following: 


sradovich on DSK3GDR082PROD with BILLS
61 

•HR 2646 RH

1 (1) The vast majority of individuals with mental 

2 illness are capable of understanding their illness and 

3 caring for themselves. 

4 (2) Persons with serious mental illness (in this 

5 section referred to as ‘‘SMI’’), including schizophrenia 

6 spectrum, bipolar disorders, and major depressive dis7 order, may be significantly impaired in their ability 

8 to understand or make sound decisions for their care 

9 and needs. By nature of their illness, cognitive im10 pairments in reasoning and judgment, as well as the 

11 presence of hallucinations, delusions, and severe emo12 tional distortions, they may lack the awareness they 

13 even have a mental illness (a condition known as 

14 anosognosia), and thus may be unable to make sound 

15 decisions regarding their care, nor follow through con16 sistently and effectively on their care needs. 

17 (3) Persons with mental illness or SMI may re18 quire and benefit from mental health treatment in 

19 order to recover to the fullest extent of their ability; 

20 these beneficial interventions may include psychiatric 

21 care, psychological care, medication, peer support, 

22 educational support, employment support, and hous23 ing support. 

24 (4) Persons with SMI who are provided with 

25 professional and supportive services may still experiVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
62 

•HR 2646 RH

1 ence times when their symptoms may greatly impair 

2 their abilities to make sound decisions for their per3 sonal care or may discontinue their care as a result 

4 of this impaired decisionmaking resulting in a fur5 ther deterioration of their condition. They may expe6 rience a temporary or prolonged impairment as a re7 sult of their diminished capacity to care for them8 selves. 

9 (5) Episodes of psychiatric crises among those 

10 with SMI can result in neurological harm to the indi11 vidual’s brain. 

12 (6) Persons with SMI— 

13 (A) are at high risk for other chronic phys14 ical illnesses, with approximately 50 percent 

15 having two or more co-occurring chronic phys16 ical illnesses such as cardiac, pulmonary, cancer, 

17 and endocrine disorders; and 

18 (B) have three times the odds of having 

19 chronic bronchitis, five times the odds of having 

20 emphysema, and four times the odds of having 

21 COPD, are more than four times as likely to 

22 have fluid and electrolyte disorders, and are 

23 nearly three times as likely to be nicotine de24 pendent. 


sradovich on DSK3GDR082PROD with BILLS
63 

•HR 2646 RH

1 (7) Some psychotropic medications, such as sec2 ond generation antipsychotics, significantly increase 

3 risk for chronic illnesses such as diabetes and cardio4 vascular disease. 

5 (8) When the individual fails to seek or main6 tain treatment for these physical conditions over a 

7 long term, it can result in the individual becoming 

8 gravely disabled, or developing life-threatening ill9 nesses. Early and consistent treatment can ameliorate 

10 or reduce symptoms or cure the disease. 

11 (9) Persons with SMI die 7 to 24 years earlier 

12 than their age cohorts primarily because of complica13 tions from their chronic physical illness and failure 

14 to seek or maintain treatment resulting from emo15 tional and cognitive impairments from their SMI. 

16 (10) It is beneficial to the person with SMI and 

17 chronic illness to seek and maintain continuity of 

18 medical care and treatment for their mental illness to 

19 prevent further deterioration and harm to their own 

20 safety. 

21 (11) When the individual with SMI is signifi22 cantly diminished in their capacity to care for them23 selves long term or acutely, other supportive interven24 tions to assist their care may be necessary to protect 

25 their health and safety. 


sradovich on DSK3GDR082PROD with BILLS
64 

•HR 2646 RH

1 (12) Prognosis for the physical and psychiatric 

2 health of those with SMI may improve when respon3 sible caregivers facilitate and participate in care. 

4 (13) When an individual with SMI is chron5 ically incapacitated in their ability to care for them6 selves, caregivers can pursue legal guardianship to fa7 cilitate care in appropriate areas while being mindful 

8 to allow the individual to make decisions for them9 selves in areas where they are capable. 

10 (14) Individuals with SMI who have prolonged 

11 periods of being significantly functional can, during 

12 such periods, design and sign an advanced directive 

13 to predefine and choose medications, providers, treat14 ment plans, and hospitals, and provide caregivers 

15 with guardianship the ability to help in those times 

16 when a patient’s psychiatric symptoms worsen to the 

17 point of making them incapacitated or leaving them 

18 with a severely diminished capacity to make informed 

19 decisions about their care which may result in harm 

20 to their physical and mental health. 

21 (15) All professional and support efforts should 

22 be made to help the individual with SMI and acute 

23 or chronic physical illnesses to understand and follow 

24 through on treatment. 


sradovich on DSK3GDR082PROD with BILLS
65 

•HR 2646 RH

1 (16) When individuals with SMI, even after ef2 forts to help them understand, have failed to care for 

3 themselves, there exists confusion in the health care 

4 community around what is currently permissible 

5 under HIPAA rules. This confusion may hinder com6 munication with responsible caregivers who may be 

7 able to facilitate care for the patient with SMI in in8 stances when the individual does not give permission 

9 for disclosure. 

10 (b) SENSE OF CONGRESS.—It is the sense of the Con11 gress that, for the sake of the health and safety of persons 

12 with serious mental illness, more clarity is needed sur13 rounding the existing HIPAA privacy rule promulgated 

14 pursuant to section 264(c) of the Health Insurance Port15 ability and Accountability Act (42 U.S.C. 1320d–2 note) 

16 to permit health care professionals to communicate, when 

17 necessary, with responsible known caregivers of such per18 sons, the limited, appropriate protected health information 

19 of such persons in order to facilitate treatment, but not in20 cluding psychotherapy notes. 

21 SEC. 402. CONFIDENTIALITY OF RECORDS. 

22 Not later than one year after the date on which the 

23 Secretary of Health and Human Services first finalizes reg24 ulations updating part 2 of title 42, Code of Federal Regu25 lations (relating to confidentiality of alcohol and drug 


sradovich on DSK3GDR082PROD with BILLS
66 

•HR 2646 RH

1 abuse patient records) after the date of enactment of this 

2 Act, the Secretary shall convene relevant stakeholders to de3 termine the effect of such regulations on patient care, health 

4 outcomes, and patient privacy. The Secretary shall submit 

5 to the Committee on Energy and Commerce of the House 

6 of Representatives and the Committee on Health, Edu7 cation, Labor, and Pensions of the Senate, and make pub8 licly available, a report on the findings of such stakeholders. 

9 SEC. 403. CLARIFICATION OF CIRCUMSTANCES UNDER 

10 WHICH DISCLOSURE OF PROTECTED HEALTH 

11 INFORMATION IS PERMITTED. 

12 (a) IN GENERAL.—Not later than one year after the 

13 date of enactment of this section, the Secretary of Health 

14 and Human Services shall promulgate final regulations 

15 clarifying the circumstances under which, consistent with 

16 the provisions of subpart C of title XI of the Social Security 

17 Act (42 U.S.C. 1320d et seq.) and regulations promulgated 

18 pursuant to section 264(c) of the Health Insurance Port19 ability and Accountability Act of 1996 (42 U.S.C. 1320d– 

20 2 note), a health care provider or covered entity may dis21 close the protected health information of a patient with a 

22 mental illness, including for purposes of— 

23 (1) communicating (including with respect to 

24 treatment, side effects, risk factors, and the avail25 ability of community resources) with a family memVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
67 

•HR 2646 RH

1 ber of such patient, caregiver of such patient, or other 

2 individual to the extent that such family member, 

3 caregiver, or individual is involved in the care of the 

4 patient; 

5 (2) communicating with a family member of the 

6 patient, caregiver of such patient, or other individual 

7 involved in the care of the patient in the case that the 

8 patient is an adult; 

9 (3) communicating with the parent or caregiver 

10 of a patient in the case that the patient is a minor; 

11 (4) considering the patient’s capacity to agree or 

12 object to the sharing of the protected health informa13 tion of the patient; 

14 (5) communicating and sharing information 

15 with the family or caregivers of the patient when— 

16 (A) the patient consents; 

17 (B) the patient does not consent, but the pa18 tient lacks the capacity to agree or object and the 

19 communication or sharing of information is in 

20 the patient’s best interest; 

21 (C) the patient does not consent and the pa22 tient is not incapacitated or in an emergency 

23 circumstance, but the ability of the patient to 

24 make rational health care decisions is signifiVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
68 

•HR 2646 RH

1 cantly diminished by reason of the physical or 

2 mental health condition of the patient; and 

3 (D) the patient does not consent, but such 

4 communication and sharing of information is 

5 necessary to prevent impending and serious dete6 rioration of the patient’s mental or physical 

7 health; 

8 (6) involving a patient’s family members, care9 givers, or others involved in the patient’s care or care 

10 plan, including facilitating treatment and medication 

11 adherence, in dealing with patient failures to adhere 

12 to medication or other therapy; 

13 (7) listening to or receiving information with re14 spect to the patient from the family or caregiver of 

15 such patient receiving mental illness treatment; 

16 (8) communicating with family members of the 

17 patient, caregivers of the patient, law enforcement, or 

18 others when the patient presents a serious and immi19 nent threat of harm to self or others; and 

20 (9) communicating to law enforcement and fam21 ily members of the patient or caregivers of the patient 

22 about the admission of the patient to receive care at 

23 a facility or the release of a patient who was admit24 ted to a facility for an emergency psychiatric hold or 

25 involuntary treatment. 


sradovich on DSK3GDR082PROD with BILLS
69 

•HR 2646 RH

1 (b) COORDINATION.—The Secretary of Health and 

2 Human Services shall carry out this section in coordination 

3 with the Director of the Office for Civil Rights within the 

4 Department of Health and Human Services. 

5 (c) CONSISTENCY WITH GUIDANCE.—The Secretary of 

6 Health and Human Services shall ensure that the regula7 tions under this section are consistent with the guidance 

8 entitled ‘‘HIPAA Privacy Rule and Sharing Information 

9 Related to Mental Health’’, issued by the Department of 

10 Health and Human Services on February 20, 2014. 

11 SEC. 404. DEVELOPMENT AND DISSEMINATION OF MODEL 

12 TRAINING PROGRAMS. 

13 (a) INITIAL PROGRAMS AND MATERIALS.—Not later 

14 than one year after the date of the enactment of this Act, 

15 the Secretary of Health and Human Services (in this sec16 tion referred to as the ‘‘Secretary’’) shall develop and dis17 seminate— 

18 (1) a model program and materials for training 

19 health care providers (including physicians, emer20 gency medical personnel, psychologists, counselors, 

21 therapists, behavioral health facilities and clinics, 

22 care managers, and hospitals) regarding the cir23 cumstances under which, consistent with the stand24 ards governing the privacy and security of individ25 ually identifiable health information promulgated by 


sradovich on DSK3GDR082PROD with BILLS
70 

•HR 2646 RH

1 the Secretary under subpart C of title XI of the Social 

2 Security Act (42 U.S.C. 1320d et seq.) and regula3 tions promulgated pursuant to section 264(c) of the 

4 Health Insurance Portability and Accountability Act 

5 of 1996 (42 U.S.C. 1320d–2 note), the protected 

6 health information of patients with a mental illness 

7 may be disclosed with and without patient consent; 

8 (2) a model program and materials for training 

9 lawyers and others in the legal profession on such cir10 cumstances; and 

11 (3) a model program and materials for training 

12 patients and their families regarding their rights to 

13 protect and obtain information under the standards 

14 specified in paragraph (1). 

15 (b) PERIODIC UPDATES.—The Secretary shall— 

16 (1) periodically review and update the model 

17 programs and materials developed under subsection 

18 (a); and 

19 (2) disseminate the updated model programs and 

20 materials. 

21 (c) CONTENTS.—The programs and materials devel22 oped under subsection (a) shall address the guidance enti23 tled ‘‘HIPAA Privacy Rule and Sharing Information Re24 lated to Mental Health’’, issued by the Department of 

25 Health and Human Services on February 20, 2014. 


sradovich on DSK3GDR082PROD with BILLS
71 

•HR 2646 RH

1 (d) COORDINATION.—The Secretary shall carry out 

2 this section in coordination with the Director of the Office 

3 for Civil Rights within the Department of Health and 

4 Human Services, the Assistant Secretary for Mental Health 

5 and Substance Use, the Administrator of the Health Re6 sources and Services Administration, and the heads of other 

7 relevant agencies within the Department of Health and 

8 Human Services. 

9 (e) INPUT OF CERTAIN ENTITIES.—In developing the 

10 model programs and materials required by subsections (a) 

11 and (b), the Secretary shall solicit the input of relevant na12 tional, State, and local associations, medical societies, and 

13 licensing boards. 

14 (f) FUNDING.—There are authorized to be appro15 priated to carry out this section $4,000,000 for fiscal year 

16 2018, $2,000,000 for each of fiscal years 2019 and 2020, 

17 and $1,000,000 for each of fiscal years 2021 and 2022. 


sradovich on DSK3GDR082PROD with BILLS
72 

•HR 2646 RH

1 TITLE V—INCREASING ACCESS 

2 TO TREATMENT FOR SERIOUS 

3 MENTAL ILLNESS 

4 SEC. 501. ASSERTIVE COMMUNITY TREATMENT GRANT PRO5 GRAM FOR INDIVIDUALS WITH SERIOUS MEN6 TAL ILLNESS. 

7 Part B of title V of the Public Health Service Act (42 

8 U.S.C. 290bb et seq.) is amended by inserting after section 

9 520L the following: 

10 ‘‘SEC. 520M. ASSERTIVE COMMUNITY TREATMENT GRANT 

11 PROGRAM FOR INDIVIDUALS WITH SERIOUS 

12 MENTAL ILLNESS. 

13 ‘‘(a) IN GENERAL.—The Assistant Secretary shall 

14 award grants to eligible entities— 

15 ‘‘(1) to establish assertive community treatment 

16 programs for individuals with serious mental illness; 

17 or 

18 ‘‘(2) to maintain or expand such programs. 

19 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive a 

20 grant under this section, an entity shall be a State, county, 

21 city, tribe, tribal organization, mental health system, health 

22 care facility, or any other entity the Assistant Secretary 

23 deems appropriate. 

24 ‘‘(c) SPECIAL CONSIDERATION.—In selecting among 

25 applicants for a grant under this section, the Assistant SecVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
73 

•HR 2646 RH

1 retary may give special consideration to the potential of 

2 the applicant’s program to reduce hospitalization, homeless3 ness, and involvement with the criminal justice system 

4 while improving the health and social outcomes of the pa5 tient. 

6 ‘‘(d) ADDITIONAL ACTIVITIES.—The Assistant Sec7 retary shall— 

8 ‘‘(1) not later than the end of fiscal year 2021, 

9 submit a report to the appropriate congressional com10 mittees on the grant program under this section, in11 cluding an evaluation of— 

12 ‘‘(A) cost savings and public health out13 comes such as mortality, suicide, substance 

14 abuse, hospitalization, and use of services; 

15 ‘‘(B) rates of involvement with the criminal 

16 justice system of patients; 

17 ‘‘(C) rates of homelessness among patients; 

18 and 

19 ‘‘(D) patient and family satisfaction with 

20 program participation; and 

21 ‘‘(2) provide appropriate information, training, 

22 and technical assistance to grant recipients under this 

23 section to help such recipients to establish, maintain, 

24 or expand their assertive community treatment pro25 grams. 


sradovich on DSK3GDR082PROD with BILLS
74 

•HR 2646 RH

1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

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

3 there is authorized to be appropriated $5,000,000 for 

4 the period of fiscal years 2018 through 2022. 

5 ‘‘(2) USE OF CERTAIN FUNDS.—Of the funds ap6 propriated to carry out this section in any fiscal 

7 year, no more than 5 percent shall be available to the 

8 Assistant Secretary for carrying out subsection (d).’’. 

9 SEC. 502. STRENGTHENING COMMUNITY CRISIS RESPONSE 

10 SYSTEMS. 

11 Section 520F of the Public Health Service Act (42 

12 U.S.C. 290bb–37) is amended to read as follows: 

13 ‘‘SEC. 520F. STRENGTHENING COMMUNITY CRISIS RE14 SPONSE SYSTEMS. 

15 ‘‘(a) IN GENERAL.—The Secretary shall award com16 petitive grants— 

17 ‘‘(1) to State and local governments and Indian 

18 tribes and tribal organizations to enhance commu19 nity-based crisis response systems; or 

20 ‘‘(2) to States to develop, maintain, or enhance 

21 a database of beds at inpatient psychiatric facilities, 

22 crisis stabilization units, and residential community 

23 mental health and residential substance use disorder 

24 treatment facilities, for individuals with serious menVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
75 

•HR 2646 RH

1 tal illness, serious emotional disturbance, or substance 

2 use disorders. 

3 ‘‘(b) APPLICATION.— 

4 ‘‘(1) IN GENERAL.—To receive a grant or cooper5 ative agreement under subsection (a), an entity shall 

6 submit to the Secretary an application, at such time, 

7 in such manner, and containing such information as 

8 the Secretary may require. 

9 ‘‘(2) COMMUNITY-BASED CRISIS RESPONSE

10 PLAN.—An application for a grant under subsection 

11 (a)(1) shall include a plan for— 

12 ‘‘(A) promoting integration and coordina13 tion between local public and private entities en14 gaged in crisis response, including first respond15 ers, emergency health care providers, primary 

16 care providers, law enforcement, court systems, 

17 health care payers, social service providers, and 

18 behavioral health providers; 

19 ‘‘(B) developing a plan for entering into 

20 memoranda of understanding with public and 

21 private entities to implement crisis response 

22 services; 

23 ‘‘(C) expanding the continuum of commu24 nity-based services to address crisis intervention 

25 and prevention; and 


sradovich on DSK3GDR082PROD with BILLS
76 

•HR 2646 RH

1 ‘‘(D) developing models for minimizing hos2 pital readmissions, including through appro3 priate discharge planning. 

4 ‘‘(3) BEDS DATABASE PLAN.—An application for 

5 a grant under subsection (a)(2) shall include a plan 

6 for developing, maintaining, or enhancing a real-time 

7 Internet-based bed database to collect, aggregate, and 

8 display information about beds in inpatient psy9 chiatric facilities and crisis stabilization units, and 

10 residential community mental health and residential 

11 substance use disorder treatment facilities, to facili12 tate the identification and designation of facilities for 

13 the temporary treatment of individuals in mental or 

14 substance use disorder crisis. 

15 ‘‘(c) DATABASE REQUIREMENTS.—A bed database de16 scribed in this section is a database that— 

17 ‘‘(1) includes information on inpatient psy18 chiatric facilities, crisis stabilization units, and resi19 dential community mental health and residential sub20 stance use disorder facilities in the State involved, in21 cluding contact information for the facility or unit; 

22 ‘‘(2) provides real-time information about the 

23 number of beds available at each facility or unit and, 

24 for each available bed, the type of patient that may 

25 be admitted, the level of security provided, and any 


sradovich on DSK3GDR082PROD with BILLS
77 

•HR 2646 RH

1 other information that may be necessary to allow for 

2 the proper identification of appropriate facilities for 

3 treatment of individuals in mental or substance use 

4 disorder crisis; and 

5 ‘‘(3) enables searches of the database to identify 

6 available beds that are appropriate for the treatment 

7 of individuals in mental or substance use disorder 

8 crisis. 

9 ‘‘(d) EVALUATION.—An entity receiving a grant under 

10 subsection (a)(1) shall submit to the Secretary, at such time, 

11 in such manner, and containing such information as the 

12 Secretary may reasonably require, a report, including an 

13 evaluation of the effect of such grant on— 

14 ‘‘(1) local crisis response services and measures 

15 of individuals receiving crisis planning and early 

16 intervention supports; 

17 ‘‘(2) individuals reporting improved functional 

18 outcomes; and 

19 ‘‘(3) individuals receiving regular followup care 

20 following a crisis. 

21 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There is 

22 authorized to be appropriated to carry out this section, 

23 $5,000,000 for the period of fiscal years 2018 through 

24 2022.’’. 


sradovich on DSK3GDR082PROD with BILLS
78 

•HR 2646 RH

1 SEC. 503. INCREASED AND EXTENDED FUNDING FOR AS2 SISTED OUTPATIENT GRANT PROGRAM FOR 

3 INDIVIDUALS WITH SERIOUS MENTAL ILL4 NESS. 

5 Section 224(g) of the Protecting Access to Medicare Act 

6 of 2014 (42 U.S.C. 290aa note) is amended— 

7 (1) in paragraph (1), by striking ‘‘2018’’ and in8 serting ‘‘2022’’; and 

9 (2) in paragraph (2), by striking ‘‘is authorized 

10 to be appropriated to carry out this section 

11 $15,000,000 for each of fiscal years 2015 through 

12 2018’’ and inserting ‘‘are authorized to be appro13 priated to carry out this section $15,000,000 for each 

14 of fiscal years 2015 through 2017, $20,000,000 for fis15 cal year 2018, $19,000,000 for each of fiscal years 

16 2019 and 2020, and $18,000,000 for each of fiscal 

17 years 2021 and 2022’’. 

18 SEC. 504. LIABILITY PROTECTIONS FOR HEALTH PROFES19 SIONAL VOLUNTEERS AT COMMUNITY 

20 HEALTH CENTERS. 

21 Section 224 of the Public Health Service Act (42 

22 U.S.C. 233) is amended by adding at the end the following: 

23 ‘‘(q)(1) For purposes of this section, a health profes24 sional volunteer at an entity described in subsection (g)(4) 

25 shall, in providing a health professional service eligible for 

26 funding under section 330 to an individual, be deemed to 


sradovich on DSK3GDR082PROD with BILLS
79 

•HR 2646 RH

1 be an employee of the Public Health Service for a calendar 

2 year that begins during a fiscal year for which a transfer 

3 was made under paragraph (4)(C). The preceding sentence 

4 is subject to the provisions of this subsection. 

5 ‘‘(2) In providing a health service to an individual, 

6 a health care practitioner shall for purposes of this sub7 section be considered to be a health professional volunteer 

8 at an entity described in subsection (g)(4) if the following 

9 conditions are met: 

10 ‘‘(A) The service is provided to the individual at 

11 the facilities of an entity described in subsection 

12 (g)(4), or through offsite programs or events carried 

13 out by the entity. 

14 ‘‘(B) The entity is sponsoring the health care 

15 practitioner pursuant to paragraph (3)(B). 

16 ‘‘(C) The health care practitioner does not receive 

17 any compensation for the service from the individual 

18 or from any third-party payer (including reimburse19 ment under any insurance policy or health plan, or 

20 under any Federal or State health benefits program), 

21 except that the health care practitioner may receive 

22 repayment from the entity described in subsection 

23 (g)(4) for reasonable expenses incurred by the health 

24 care practitioner in the provision of the service to the 

25 individual. 


sradovich on DSK3GDR082PROD with BILLS
80 

•HR 2646 RH

1 ‘‘(D) Before the service is provided, the health 

2 care practitioner or the entity described in subsection 

3 (g)(4) posts a clear and conspicuous notice at the site 

4 where the service is provided of the extent to which the 

5 legal liability of the health care practitioner is lim6 ited pursuant to this subsection. 

7 ‘‘(E) At the time the service is provided, the 

8 health care practitioner is licensed or certified in ac9 cordance with applicable law regarding the provision 

10 of the service. 

11 ‘‘(3) Subsection (g) (other than paragraphs (3) and 

12 (5)) and subsections (h), (i), and (l) apply to a health care 

13 practitioner for purposes of this subsection to the same ex14 tent and in the same manner as such subsections apply to 

15 an officer, governing board member, employee, or contractor 

16 of an entity described in subsection (g)(4), subject to para17 graph (4) and subject to the following: 

18 ‘‘(A) The first sentence of paragraph (1) applies 

19 in lieu of the first sentence of subsection (g)(1)(A). 

20 ‘‘(B) With respect to an entity described in sub21 section (g)(4), a health care practitioner is not a 

22 health professional volunteer at such entity unless the 

23 entity sponsors the health care practitioner. For pur24 poses of this subsection, the entity shall be considered 

25 to be sponsoring the health care practitioner if— 


sradovich on DSK3GDR082PROD with BILLS
81 

•HR 2646 RH

1 ‘‘(i) with respect to the health care practi2 tioner, the entity submits to the Secretary an ap3 plication meeting the requirements of subsection 

4 (g)(1)(D); and 

5 ‘‘(ii) the Secretary, pursuant to subsection 

6 (g)(1)(E), determines that the health care practi7 tioner is deemed to be an employee of the Public 

8 Health Service. 

9 ‘‘(C) In the case of a health care practitioner 

10 who is determined by the Secretary pursuant to sub11 section (g)(1)(E) to be a health professional volunteer 

12 at such entity, this subsection applies to the health 

13 care practitioner (with respect to services performed 

14 on behalf of the entity sponsoring the health care 

15 practitioner pursuant to subparagraph (B)) for any 

16 cause of action arising from an act or omission of the 

17 health care practitioner occurring on or after the date 

18 on which the Secretary makes such determination. 

19 ‘‘(D) Subsection (g)(1)(F) applies to a health 

20 care practitioner for purposes of this subsection only 

21 to the extent that, in providing health services to an 

22 individual, each of the conditions specified in para23 graph (2) is met. 


sradovich on DSK3GDR082PROD with BILLS
82 

•HR 2646 RH

1 ‘‘(4)(A) Amounts in the fund established under sub2 section (k)(2) shall be available for transfer under subpara3 graph (C) for purposes of carrying out this subsection. 

4 ‘‘(B) Not later May 1 of each fiscal year, the Attorney 

5 General, in consultation with the Secretary, shall submit 

6 to the Congress a report providing an estimate of the 

7 amount of claims (together with related fees and expenses 

8 of witnesses) that, by reason of the acts or omissions of 

9 health professional volunteers, will be paid pursuant to this 

10 section during the calendar year that begins in the following 

11 fiscal year. Subsection (k)(1)(B) applies to the estimate 

12 under the preceding sentence regarding health professional 

13 volunteers to the same extent and in the same manner as 

14 such subsection applies to the estimate under such sub15 section regarding officers, governing board members, em16 ployees, and contractors of entities described in subsection 

17 (g)(4). 

18 ‘‘(C) Not later than December 31 of each fiscal year, 

19 the Secretary shall transfer from the fund under subsection 

20 (k)(2) to the appropriate accounts in the Treasury an 

21 amount equal to the estimate made under subparagraph (B) 

22 for the calendar year beginning in such fiscal year, subject 

23 to the extent of amounts in the fund. 

24 ‘‘(5)(A) This subsection takes effect on October 1, 2017, 

25 except as provided in subparagraph (B). 


sradovich on DSK3GDR082PROD with BILLS
83 

•HR 2646 RH

1 ‘‘(B) Effective on the date of the enactment of this sub2 section— 

3 ‘‘(i) the Secretary may issue regulations for car4 rying out this subsection, and the Secretary may ac5 cept and consider applications submitted pursuant to 

6 paragraph (3)(B); and 

7 ‘‘(ii) reports under paragraph (4)(B) may be 

8 submitted to the Congress.’’. 

9 TITLE VI—SUPPORTING INNOVA10 TIVE AND EVIDENCE-BASED 

11 PROGRAMS 

12 Subtitle A—Encouraging the Ad13 vancement, Incorporation, and 

14 Development of Evidence-Based 

15 Practices 

16 SEC. 601. ENCOURAGING INNOVATION AND EVIDENCE17 BASED PROGRAMS. 

18 Section 501B of the Public Health Service Act, as in19 serted by section 103, is further amended, by inserting after 

20 subsection (c) the following new subsection: 

21 ‘‘(d) PROMOTING INNOVATION.— 

22 ‘‘(1) IN GENERAL.—The Assistant Secretary, in 

23 coordination with the Laboratory, may award grants 

24 to States, local governments, Indian tribes or tribal 

25 organizations (as such terms are defined in section 4 


sradovich on DSK3GDR082PROD with BILLS
84 

•HR 2646 RH

1 of the Indian Self-Determination and Education As2 sistance Act), educational institutions, and nonprofit 

3 organizations to develop evidence-based interventions, 

4 including culturally and linguistically appropriate 

5 services, as appropriate, for— 

6 ‘‘(A) evaluating a model that has been sci7 entifically demonstrated to show promise, but 

8 would benefit from further applied development, 

9 for— 

10 ‘‘(i) enhancing the prevention, diag11 nosis, intervention, treatment, and recovery 

12 of mental illness, serious emotional disturb13 ance, substance use disorders, and co-occur14 ring disorders; or 

15 ‘‘(ii) integrating or coordinating phys16 ical health services and mental and sub17 stance use disorder services; and 

18 ‘‘(B) expanding, replicating, or scaling evi19 dence-based programs across a wider area to en20 hance effective screening, early diagnosis, inter21 vention, and treatment with respect to mental 

22 illness, serious mental illness, and serious emo23 tional disturbance, primarily by— 


sradovich on DSK3GDR082PROD with BILLS
85 

•HR 2646 RH

1 ‘‘(i) applying delivery of care, includ2 ing training staff in effective evidence-based 

3 treatment; or 

4 ‘‘(ii) integrating models of care across 

5 specialties and jurisdictions. 

6 ‘‘(2) CONSULTATION.—In awarding grants under 

7 this paragraph, the Assistant Secretary shall, as ap8 propriate, consult with the advisory councils described 

9 in section 502, the National Institute of Mental 

10 Health, the National Institute on Drug Abuse, and 

11 the National Institute on Alcohol Abuse and Alco12 holism, as appropriate. 

13 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

14 There are authorized to be appropriated— 

15 ‘‘(A) to carry out paragraph (1)(A), 

16 $7,000,000 for the period of fiscal years 2018 

17 through 2020; and 

18 ‘‘(B) to carry out paragraph (1)(B), 

19 $7,000,000 for the period of fiscal years 2018 

20 through 2020.’’. 

21 SEC. 602. PROMOTING ACCESS TO INFORMATION ON EVI22 DENCE-BASED PROGRAMS AND PRACTICES. 

23 Part D of title V of the Public Health Service Act is 

24 amended by inserting after section 543 of such Act (42 

25 U.S.C. 290dd–2 ) the following: 


sradovich on DSK3GDR082PROD with BILLS
86 

•HR 2646 RH

1 ‘‘SEC. 544. PROMOTING ACCESS TO INFORMATION ON EVI2 DENCE-BASED PROGRAMS AND PRACTICES. 

3 ‘‘(a) IN GENERAL.—The Assistant Secretary shall im4 prove access to reliable and valid information on evidence5 based programs and practices, including information on the 

6 strength of evidence associated with such programs and 

7 practices, related to mental and substance use disorders for 

8 States, local communities, nonprofit entities, and other 

9 stakeholders by posting on the website of the National Reg10 istry of Evidence-Based Programs and Practices evidence11 based programs and practices that have been reviewed by 

12 the Assistant Secretary pursuant to the requirements of this 

13 section. 

14 ‘‘(b) NOTICE.— 

15 ‘‘(1) PERIODS.—In carrying out subsection (a), 

16 the Assistant Secretary may establish an initial pe17 riod for the submission of applications for evidence18 based programs and practices to be posted publicly in 

19 accordance with subsection (a) (and may establish 

20 subsequent such periods). The Assistant Secretary 

21 shall publish notice of such application periods in the 

22 Federal Register. 

23 ‘‘(2) ADDRESSING GAPS.—Such notice may so24 licit applications for evidence-based practices and 

25 programs to address gaps in information identified 

26 by the Assistant Secretary, the Assistant Secretary for 


sradovich on DSK3GDR082PROD with BILLS
87 

•HR 2646 RH

1 Planning and Evaluation, the Assistant Secretary for 

2 Financial Resources, or the National Mental Health 

3 and Substance Use Policy Laboratory, including pur4 suant to priorities identified in the strategic plan es5 tablished under section 501(l). 

6 ‘‘(c) REQUIREMENTS.—The Assistant Secretary shall 

7 establish minimum requirements for applications referred 

8 to in this section, including applications related to the sub9 mission of research and evaluation. 

10 ‘‘(d) REVIEW AND RATING.—The Assistant Secretary 

11 shall review applications prior to public posting, and may 

12 prioritize the review of applications for evidence-based 

13 practices and programs that are related to topics included 

14 in the notice established under subsection (b). The Assistant 

15 Secretary shall utilize a rating and review system, which 

16 shall include information on the strength of evidence associ17 ated with such programs and practices and a rating of the 

18 methodological rigor of the research supporting the applica19 tion. The Assistant Secretary shall make the metrics used 

20 to evaluate applications and the resulting ratings publicly 

21 available.’’. 

22 SEC. 603. SENSE OF CONGRESS. 

23 It is the sense of the Congress that the National Insti24 tute of Mental Health should conduct or support research 


sradovich on DSK3GDR082PROD with BILLS
88 

•HR 2646 RH

1 on the determinants of self-directed and other violence con2 nected to mental illness. 

3 Subtitle B—Supporting the State 

4 Response to Mental Health Needs 

5 SEC. 611. COMMUNITY MENTAL HEALTH SERVICES BLOCK 

6 GRANT. 

7 (a) FORMULA GRANTS.—Section 1911(b) of the Public 

8 Health Service Act (42 U.S.C. 300x(b)) is amended— 

9 (1) by redesignating paragraphs (1) through (3) 

10 as paragraphs (2) through (4), respectively; and 

11 (2) by inserting before paragraph (2) (as so re12 designated), the following: 

13 ‘‘(1) providing community mental health services 

14 for adults with a serious mental illness and children 

15 with a serious emotional disturbance as defined in ac16 cordance with section 1912(c);’’. 

17 (b) STATE PLAN.—Subsection (b) of section 1912 of 

18 the Public Health Service Act (42 U.S.C. 300x–1) is amend19 ed to read as follows: 

20 ‘‘(b) CRITERIA FOR PLAN.—In accordance with sub21 section (a), a State shall submit to the Secretary a plan 

22 that, at a minimum, satisfies the following criteria: 

23 ‘‘(1) SYSTEM OF CARE.—The plan provides a de24 scription of the system of care of the State, including 

25 as follows: 


sradovich on DSK3GDR082PROD with BILLS
89 

•HR 2646 RH

1 ‘‘(A) COMPREHENSIVE COMMUNITY-BASED

2 HEALTH SYSTEMS.—The plan shall— 

3 ‘‘(i) identify the single State agency to 

4 be responsible for the administration of the 

5 program under the grant, including any 

6 third party who administers mental health 

7 services and is responsible for complying 

8 with the requirements of this part with re9 spect to the grant; 

10 ‘‘(ii) provide for an organized commu11 nity-based system of care for individuals 

12 with mental illness, and describe available 

13 services and resources in a comprehensive 

14 system of care, including services for indi15 viduals with mental health and behavioral 

16 health co-occurring disorders; 

17 ‘‘(iii) include a description of the man18 ner in which the State and local entities 

19 will coordinate services to maximize the ef20 ficiency, effectiveness, quality, and cost ef21 fectiveness of services and programs to 

22 produce the best possible outcomes (includ23 ing health services, rehabilitation services, 

24 employment services, housing services, edu25 cational services, substance use disorder 


sradovich on DSK3GDR082PROD with BILLS
90 

•HR 2646 RH

1 services, legal services, law enforcement serv2 ices, social services, child welfare services, 

3 medical and dental care services, and other 

4 support services to be provided with Fed5 eral, State, and local public and private re6 sources) with other agencies to enable indi7 viduals receiving services to function outside 

8 of inpatient or residential institutions, to 

9 the maximum extent of their capabilities, 

10 including services to be provided by local 

11 school systems under the Individuals with 

12 Disabilities Education Act; 

13 ‘‘(iv) include a description of how the 

14 State— 

15 ‘‘(I) promotes evidence-based prac16 tices, including those evidence-based 

17 programs that address the needs of in18 dividuals with early serious mental ill19 ness regardless of the age of the indi20 vidual at onset; 

21 ‘‘(II) provides comprehensive in22 dividualized treatment; or 

23 ‘‘(III) integrates mental and 

24 physical health services; 


sradovich on DSK3GDR082PROD with BILLS
91 

•HR 2646 RH

1 ‘‘(v) include a description of case man2 agement services; 

3 ‘‘(vi) include a description of activities 

4 that seek to engage individuals with serious 

5 mental illness or serious emotional disturb6 ance and their caregivers where appropriate 

7 in making health care decisions, including 

8 activities that enhance communication be9 tween individuals, families, caregivers, and 

10 treatment providers; and 

11 ‘‘(vii) as appropriate to and reflective 

12 of the uses the State proposes for the block 

13 grant monies— 

14 ‘‘(I) a description of the activities 

15 intended to reduce hospitalizations and 

16 hospital stays using the block grant 

17 monies; 

18 ‘‘(II) a description of the activi19 ties intended to reduce incidents of sui20 cide using the block grant monies; and 

21 ‘‘(III) a description of how the 

22 State integrates mental health and pri23 mary care using the block grant mon24 ies. 


sradovich on DSK3GDR082PROD with BILLS
92 

•HR 2646 RH

1 ‘‘(B) MENTAL HEALTH SYSTEM DATA AND

2 EPIDEMIOLOGY.—The plan shall contain an esti3 mate of the incidence and prevalence in the State 

4 of serious mental illness among adults and seri5 ous emotional disturbance among children and 

6 presents quantitative targets and outcome meas7 ures for programs and services provided under 

8 this subpart. 

9 ‘‘(C) CHILDREN’S SERVICES.—In the case of 

10 children with serious emotional disturbance (as 

11 defined in accordance with subsection (c)), the 

12 plan shall provide for a system of integrated so13 cial services, educational services, child welfare 

14 services, juvenile justice services, law enforcement 

15 services, and substance use disorder services that, 

16 together with health and mental health services, 

17 will be provided in order for such children to re18 ceive care appropriate for their multiple needs 

19 (such system to include services provided under 

20 the Individuals with Disabilities Education Act). 

21 ‘‘(D) TARGETED SERVICES TO RURAL AND

22 HOMELESS POPULATIONS.—The plan shall de23 scribe the State’s outreach to and services for in24 dividuals who are homeless and how communityVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
93 

•HR 2646 RH

1 based services will be provided to individuals re2 siding in rural areas. 

3 ‘‘(E) MANAGEMENT SERVICES.—The plan 

4 shall— 

5 ‘‘(i) describe the financial resources 

6 available, the existing mental health work7 force, and the workforce trained in treating 

8 individuals with co-occurring mental and 

9 substance use disorders; 

10 ‘‘(ii) provide for the training of pro11 viders of emergency health services regard12 ing mental health; 

13 ‘‘(iii) describe the manner in which the 

14 State intends to expend the grant under sec15 tion 1911 for the fiscal year involved; and 

16 ‘‘(iv) describe the manner in which the 

17 State intends to comply with each of the 

18 funding agreements in this subpart and 

19 subpart III. 

20 ‘‘(2) GOALS AND OBJECTIVES.—The plan estab21 lishes goals and objectives for the period of the plan, 

22 including targets and milestones that are intended to 

23 be met, and the activities that will be undertaken to 

24 achieve those targets.’’. 


sradovich on DSK3GDR082PROD with BILLS
94 

•HR 2646 RH

1 (c) BEST PRACTICES IN CLINICAL CARE MODELS.— 

2 Section 1920 of the Public Health Service Act (42 U.S.C. 

3 300x–9) is amended by adding at the end the following: 

4 ‘‘(c) BEST PRACTICES IN CLINICAL CARE MODELS.— 

5 A State shall expend not less than 10 percent of the amount 

6 the State receives for carrying out this subpart in each fis7 cal year to support evidence-based programs that address 

8 the needs of individuals with early serious mental illness, 

9 including psychotic disorders, regardless of the age of the 

10 individual at onset.’’. 

11 (d) ADDITIONAL PROVISIONS.—Section 1915(b) of the 

12 Public Health Service Act (42 U.S.C. 300x–4(b)) is amend13 ed— 

14 (1) by amending paragraph (1) to read as fol15 lows: 

16 ‘‘(1) IN GENERAL.—A funding agreement for a 

17 grant under section 1911 is that the State involved 

18 will maintain State expenditures for community 

19 mental health services at a level that is not less than 

20 the average of the amounts prescribed by this para21 graph (prior to any waiver under paragraph (3)) for 

22 such expenditures by such State for each of the two 

23 fiscal years immediately preceding the fiscal year for 

24 which the State is applying for the grant.’’; 

25 (2) in paragraph (2)— 


sradovich on DSK3GDR082PROD with BILLS
95 

•HR 2646 RH

1 (A) by striking ‘‘subsection (a)’’ and insert2 ing ‘‘paragraph (1)’’; and 

3 (B) by striking ‘‘principle’’ and inserting 

4 ‘‘principal’’; 

5 (3) by amending paragraph (3) to read as fol6 lows: 

7 ‘‘(3) WAIVER.— 

8 ‘‘(A) IN GENERAL.—The Secretary may, 

9 upon the request of a State, waive the require10 ment established in paragraph (1) in whole or in 

11 part, if the Secretary determines that extraor12 dinary economic conditions in the State in the 

13 fiscal year involved or in the previous fiscal year 

14 justify the waiver. 

15 ‘‘(B) DATE CERTAIN FOR ACTION UPON RE16 QUEST.—The Secretary shall approve or deny a 

17 request for a waiver under this paragraph not 

18 later than 120 days after the date on which the 

19 request is made. 

20 ‘‘(C) APPLICABILITY OF WAIVER.—A waiver 

21 provided by the Secretary under this paragraph 

22 shall be applicable only to the fiscal year in23 volved.’’; and 

24 (4) in paragraph (4)— 


sradovich on DSK3GDR082PROD with BILLS
96 

•HR 2646 RH

1 (A) by amending subparagraph (A) to read 

2 as follows: 

3 ‘‘(A) IN GENERAL.— 

4 ‘‘(i) DETERMINATION AND REDUC5 TION.—The Secretary shall determine, in 

6 the case of each State, and for each fiscal 

7 year, whether the State maintained mate8 rial compliance with the agreement made 

9 under paragraph (1). If the Secretary deter10 mines that a State has failed to maintain 

11 such compliance for a fiscal year, the Sec12 retary shall reduce the amount of the allot13 ment under section 1911 for the State, for 

14 the first fiscal year beginning after such de15 termination is final, by an amount equal to 

16 the amount constituting such failure for the 

17 previous fiscal year about which the deter18 mination was made. 

19 ‘‘(ii) ALTERNATIVE SANCTION.—The 

20 Secretary may by regulation provide for an 

21 alternative method of imposing a sanction 

22 for a failure by a State to maintain mate23 rial compliance with the agreement under 

24 paragraph (1) if the Secretary determines 

25 that such alternative method would be more 


sradovich on DSK3GDR082PROD with BILLS
97 

•HR 2646 RH

1 equitable and would be a more effective in2 centive for States to maintain such material 

3 compliance.’’; and 

4 (B) in subparagraph (B)— 

5 (i) by inserting after the subparagraph 

6 designation the following: ‘‘SUBMISSION OF

7 INFORMATION TO THE SECRETARY.—’’; and 

8 (ii) by striking ‘‘subparagraph (A)’’ 

9 and inserting ‘‘subparagraph (A)(i)’’. 

10 (e) APPLICATION FOR GRANT.—Section 1917(a) of the 

11 Public Health Service Act (42 U.S.C. 300x–6(a)) is amend12 ed— 

13 (1) in paragraph (1), by striking ‘‘1941’’ and in14 serting ‘‘1942(a)’’; and 

15 (2) in paragraph (5), by striking 

16 ‘‘1915(b)(3)(B)’’ and inserting ‘‘1915(b)’’. 

17 Subtitle C—Strengthening Mental 

18 Health Care for Children and 

19 Adolescents 

20 SEC. 621. TELEHEALTH CHILD PSYCHIATRY ACCESS 

21 GRANTS. 

22 Title III of the Public Health Service Act is amended 

23 by inserting after section 330L of such Act (42 U.S.C. 254c– 

24 18) the following new section: 


sradovich on DSK3GDR082PROD with BILLS
98 

•HR 2646 RH

1 ‘‘SEC. 330M. TELEHEALTH CHILD PSYCHIATRY ACCESS 

2 GRANTS. 

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

4 Administrator of the Health Resources and Services Admin5 istration and in coordination with other relevant Federal 

6 agencies, shall award grants to States, political subdivi7 sions of States, Indian tribes, and tribal organizations (for 

8 purposes of this section, as such terms are defined in section 

9 4 of the Indian Self-Determination and Education Assist10 ance Act (25 U.S.C. 450b)) to promote behavioral health 

11 integration in pediatric primary care by— 

12 ‘‘(1) supporting the development of statewide 

13 child psychiatry access programs; and 

14 ‘‘(2) supporting the improvement of existing 

15 statewide child psychiatry access programs. 

16 ‘‘(b) PROGRAM REQUIREMENTS.— 

17 ‘‘(1) IN GENERAL.—A child psychiatry access 

18 program referred to in subsection (a), with respect to 

19 which a grant under such subsection may be used, 

20 shall— 

21 ‘‘(A) be a statewide network of pediatric 

22 mental health teams that provide support to pe23 diatric primary care sites as an integrated team; 

24 ‘‘(B) support and further develop organized 

25 State networks of child and adolescent psychiaVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
99 

•HR 2646 RH

1 trists to provide consultative support to pediatric 

2 primary care sites; 

3 ‘‘(C) conduct an assessment of critical be4 havioral consultation needs among pediatric pro5 viders and such providers’ preferred mechanisms 

6 for receiving consultation and training and tech7 nical assistance; 

8 ‘‘(D) develop an online database and com9 munication mechanisms, including telehealth, to 

10 facilitate consultation support to pediatric prac11 tices; 

12 ‘‘(E) provide rapid statewide clinical tele13 phone or telehealth consultations when requested 

14 between the pediatric mental health teams and 

15 pediatric primary care providers; 

16 ‘‘(F) conduct training and provide technical 

17 assistance to pediatric primary care providers to 

18 support the early identification, diagnosis, treat19 ment, and referral of children with behavioral 

20 health conditions or co-occurring intellectual and 

21 other developmental disabilities; 

22 ‘‘(G) inform and assist pediatric providers 

23 in accessing child psychiatry consultations and 

24 in scheduling and conducting technical assist25 ance; 


sradovich on DSK3GDR082PROD with BILLS
100 

•HR 2646 RH

1 ‘‘(H) assist with referrals to specialty care 

2 and community or behavioral health resources; 

3 and 

4 ‘‘(I) establish mechanisms for measuring 

5 and monitoring increased access to child and ad6 olescent psychiatric services by pediatric pri7 mary care providers and expanded capacity of 

8 pediatric primary care providers to identify, 

9 treat, and refer children with mental health 

10 problems. 

11 ‘‘(2) PEDIATRIC MENTAL HEALTH TEAMS.—In 

12 this subsection, the term ‘pediatric mental health 

13 team’ means a team of case coordinators, child and 

14 adolescent psychiatrists, and licensed clinical mental 

15 health professionals, such as a psychologist, social 

16 worker, or mental health counselor. 

17 ‘‘(c) APPLICATION.—A State, political subdivision of 

18 a State, Indian tribe, or tribal organization seeking a grant 

19 under this section shall submit an application to the Sec20 retary at such time, in such manner, and containing such 

21 information as the Secretary may require, including a plan 

22 for the rigorous evaluation of activities that are carried out 

23 with funds received under such grant. 

24 ‘‘(d) EVALUATION.—A State, political subdivision of 

25 a State, Indian tribe, or tribal organization that receives 


sradovich on DSK3GDR082PROD with BILLS
101 

•HR 2646 RH

1 a grant under this section shall prepare and submit an 

2 evaluation of activities carried out with funds received 

3 under such grant to the Secretary at such time, in such 

4 manner, and containing such information as the Secretary 

5 may reasonably require, including a process and outcome 

6 evaluation. 

7 ‘‘(e) MATCHING REQUIREMENT.—The Secretary may 

8 not award a grant under this section unless the State, polit9 ical subdivision of a State, Indian tribe, or tribal organiza10 tion involved agrees, with respect to the costs to be incurred 

11 by the State, political subdivision of a State, Indian tribe, 

12 or tribal organization in carrying out the purpose described 

13 in this section, to make available non-Federal contributions 

14 (in cash or in kind) toward such costs in an amount that 

15 is not less than 20 percent of Federal funds provided in 

16 the grant. 

17 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

18 this section, there are authorized to be appropriated 

19 $9,000,000 for the period of fiscal years 2018 through 

20 2020.’’. 


sradovich on DSK3GDR082PROD with BILLS
102 

•HR 2646 RH

1 SEC. 622. INFANT AND EARLY CHILDHOOD MENTAL HEALTH 

2 PROMOTION, INTERVENTION, AND TREAT3 MENT. 

4 Part Q of title III of the Public Health Service Act 

5 (42 U.S.C. 290h et seq.) is amended by adding at the end 

6 the following: 

7 ‘‘SEC. 399Z–2. INFANT AND EARLY CHILDHOOD MENTAL 

8 HEALTH PROMOTION, INTERVENTION, AND 

9 TREATMENT. 

10 ‘‘(a) GRANTS.—The Secretary shall— 

11 ‘‘(1) award grants to eligible entities, including 

12 human services agencies, to develop, maintain, or en13 hance infant and early childhood mental health pro14 motion, intervention, and treatment programs, in15 cluding— 

16 ‘‘(A) programs for infants and children at 

17 significant risk of developing, showing early 

18 signs of, or having been diagnosed with mental 

19 disorders including serious emotional disturb20 ance; and 

21 ‘‘(B) multigenerational therapy and other 

22 services that support the caregiving relationship; 

23 and 

24 ‘‘(2) ensure that programs funded through grants 

25 under this section are evidence-informed or evidence26 based models, practices, and methods that are, as apVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
103 

•HR 2646 RH

1 propriate, culturally and linguistically appropriate, 

2 and can be replicated in other appropriate settings. 

3 ‘‘(b) ELIGIBLE CHILDREN AND ENTITIES.—In this sec4 tion: 

5 ‘‘(1) ELIGIBLE CHILD.—The term ‘eligible child’ 

6 means a child from birth to not more than 5 years 

7 of age who— 

8 ‘‘(A) is at risk for, shows early signs of, or 

9 has been diagnosed with a mental disorder, in10 cluding serious emotional disturbance; and 

11 ‘‘(B) may benefit from infant and early 

12 childhood intervention or treatment programs or 

13 specialized preschool or elementary school pro14 grams that are evidence-based or that have been 

15 scientifically demonstrated to show promise but 

16 would benefit from further applied development. 

17 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible enti18 ty’ means a nonprofit institution that— 

19 ‘‘(A) is accredited or approved by a State 

20 mental health or education agency, as applicable, 

21 to provide for children from infancy to 5 years 

22 of age mental health promotion, intervention, or 

23 treatment services that are evidence-based or that 

24 have been scientifically demonstrated to show 


sradovich on DSK3GDR082PROD with BILLS
104 

•HR 2646 RH

1 promise but would benefit from further applied 

2 development; and 

3 ‘‘(B) provides programs described in sub4 section (a) that are evidence-based or that have 

5 been scientifically demonstrated to show promise 

6 but would benefit from further applied develop7 ment. 

8 ‘‘(c) APPLICATION.—An eligible entity seeking a grant 

9 under subsection (a) shall submit to the Secretary an appli10 cation at such time, in such manner, and containing such 

11 information as the Secretary may require. 

12 ‘‘(d) USE OF FUNDS FOR EARLY INTERVENTION AND

13 TREATMENT PROGRAMS.—An eligible entity may use 

14 amounts awarded under a grant under subsection (a)(1) to 

15 carry out the following: 

16 ‘‘(1) Provide age-appropriate mental health pro17 motion and early intervention services or mental dis18 order treatment services, which may include special19 ized programs, for eligible children at significant risk 

20 of developing, showing early signs of, or having been 

21 diagnosed with a mental disorder, including serious 

22 emotional disturbance. Such services may include so23 cial and behavioral services as well as 

24 multigenerational therapy and other services ?that 

25 support the caregiving relationship. 


sradovich on DSK3GDR082PROD with BILLS
105 

•HR 2646 RH

1 ‘‘(2) Provide training for health care profes2 sionals with expertise in infant and early childhood 

3 mental health care with respect to appropriate and 

4 relevant integration with other disciplines such as 

5 primary care clinicians, early intervention special6 ists, child welfare staff, home visitors, early care and 

7 education providers, and others who work with young 

8 children and families. 

9 ‘‘(3) Provide mental health consultation to per10 sonnel of early care and education programs (includ11 ing licensed or regulated center-based and home-based 

12 child care, home visiting, preschool special education, 

13 and early intervention programs) who work with chil14 dren and families. 

15 ‘‘(4) Provide training for mental health clini16 cians in infant and early childhood promising and 

17 evidence-based practices and models for mental health 

18 treatment and early intervention, including with re19 gard to practices for identifying and treating mental 

20 and behavioral disorders of infants and children re21 sulting from exposure or repeated exposure to adverse 

22 childhood experiences or childhood trauma. 

23 ‘‘(5) Provide age-appropriate assessment, diag24 nostic, and intervention services for eligible children, 


sradovich on DSK3GDR082PROD with BILLS
106 

•HR 2646 RH

1 including early mental health promotion, interven2 tion, and treatment services. 

3 ‘‘(e) MATCHING FUNDS.—The Secretary may not 

4 award a grant under this section to an eligible entity unless 

5 the eligible entity agrees, with respect to the costs to be in6 curred by the eligible entity in carrying out the activities 

7 described in subsection (d), to make available non-Federal 

8 contributions (in cash or in kind) toward such costs in an 

9 amount that is not less than 10 percent of the total amount 

10 of Federal funds provided in the grant. 

11 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

12 this section, there are authorized to be appropriated 

13 $20,000,000 for the period of fiscal years 2018 through 

14 2022.’’. 

15 SEC. 623. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE. 

16 Section 582 of the Public Health Service Act (42 

17 U.S.C. 290hh–1; relating to grants to address the problems 

18 of persons who experience violence related stress) is amend19 ed— 

20 (1) in subsection (a), by striking ‘‘developing 

21 programs’’ and all that follows and inserting the fol22 lowing: ‘‘developing and maintaining programs that 

23 provide for— 

24 ‘‘(1) the continued operation of the National 

25 Child Traumatic Stress Initiative (referred to in this 


sradovich on DSK3GDR082PROD with BILLS
107 

•HR 2646 RH

1 section as the ‘NCTSI’), which includes a coordi2 nating center that focuses on the mental, behavioral, 

3 and biological aspects of psychological trauma re4 sponse; and 

5 ‘‘(2) the development of knowledge with regard to 

6 evidence-based practices for identifying and treating 

7 mental disorders, behavioral disorders, and physical 

8 health conditions of children and youth resulting from 

9 witnessing or experiencing a traumatic event.’’; 

10 (2) in subsection (b)— 

11 (A) by striking ‘‘subsection (a) related’’ and 

12 inserting ‘‘subsection (a)(2) (related’’; 

13 (B) by striking ‘‘treating disorders associ14 ated with psychological trauma’’ and inserting 

15 ‘‘treating mental, behavioral, and biological dis16 orders associated with psychological trauma)’’; 

17 and 

18 (C) by striking ‘‘mental health agencies and 

19 programs that have established clinical and basic 

20 research’’ and inserting ‘‘universities, hospitals, 

21 mental health agencies, and other programs that 

22 have established clinical expertise and research’’; 

23 (3) by redesignating subsections (c) through (g) 

24 as subsections (g) through (k), respectively; 


sradovich on DSK3GDR082PROD with BILLS
108 

•HR 2646 RH

1 (4) by inserting after subsection (b), the fol2 lowing: 

3 ‘‘(c) CHILD OUTCOME DATA.—The NCTSI coordi4 nating center shall collect, analyze, report, and make pub5 licly available NCTSI-wide child treatment process and 

6 outcome data regarding the early identification and deliv7 ery of evidence-based treatment and services for children 

8 and families served by the NCTSI grantees. 

9 ‘‘(d) TRAINING.—The NCTSI coordinating center shall 

10 facilitate the coordination of training initiatives in evi11 dence-based and trauma-informed treatments, interven12 tions, and practices offered to NCTSI grantees, providers, 

13 and partners. 

14 ‘‘(e) DISSEMINATION.—The NCTSI coordinating cen15 ter shall, as appropriate, collaborate with the Secretary in 

16 the dissemination of evidence-based and trauma-informed 

17 interventions, treatments, products, and other resources to 

18 appropriate stakeholders. 

19 ‘‘(f) REVIEW.—The Secretary shall, consistent with the 

20 peer-review process, ensure that NCTSI applications are re21 viewed by appropriate experts in the field as part of a con22 sensus review process. The Secretary shall include review 

23 criteria related to expertise and experience in child trauma 

24 and evidence-based practices.’’; 


sradovich on DSK3GDR082PROD with BILLS
109 

•HR 2646 RH

1 (5) in subsection (g) (as so redesignated), by 

2 striking ‘‘with respect to centers of excellence are dis3 tributed equitably among the regions of the country’’ 

4 and inserting ‘‘are distributed equitably among the 

5 regions of the United States’’; 

6 (6) in subsection (i) (as so redesignated), by 

7 striking ‘‘recipient may not exceed 5 years’’ and in8 serting ‘‘recipient shall not be less than 4 years, but 

9 shall not exceed 5 years’’; and 

10 (7) in subsection (j) (as so redesignated), by 

11 striking ‘‘$50,000,000’’ and all that follows through 

12 ‘‘2006’’ and inserting ‘‘$46,887,000 for each of fiscal 

13 years 2017 through 2021’’. 

14 TITLE VII—GRANT PROGRAMS 

15 AND PROGRAM REAUTHOR16 IZATION 

17 Subtitle A—Garrett Lee Smith 

18 Memorial Act Reauthorization 

19 SEC. 701. YOUTH INTERAGENCY RESEARCH, TRAINING, AND 

20 TECHNICAL ASSISTANCE CENTERS. 

21 Section 520C of the Public Health Service Act (42 

22 U.S.C. 290bb–34) is amended— 

23 (1) by striking the section heading and inserting 

24 ‘‘SUICIDE PREVENTION TECHNICAL ASSIST25 ANCE CENTER.’’; 


sradovich on DSK3GDR082PROD with BILLS
110 

•HR 2646 RH

1 (2) in subsection (a), by striking ‘‘and in con2 sultation with’’ and all that follows through the pe3 riod at the end of paragraph (2) and inserting ‘‘shall 

4 establish a research, training, and technical assist5 ance resource center to provide appropriate informa6 tion, training, and technical assistance to States, po7 litical subdivisions of States, federally recognized In8 dian tribes, tribal organizations, institutions of high9 er education, public organizations, or private non10 profit organizations regarding the prevention of sui11 cide among all ages, particularly among groups that 

12 are at high risk for suicide.’’; 

13 (3) by striking subsections (b) and (c); 

14 (4) by redesignating subsection (d) as subsection 

15 (b); 

16 (5) in subsection (b), as so redesignated— 

17 (A) by striking the subsection heading and 

18 inserting ‘‘RESPONSIBILITIES OF THE CEN19 TER.—’’; 

20 (B) in the matter preceding paragraph (1), 

21 by striking ‘‘The additional research’’ and all 

22 that follows through ‘‘nonprofit organizations 

23 for’’ and inserting ‘‘The center established under 

24 subsection (a) shall conduct activities for the 

25 purpose of’’; 


sradovich on DSK3GDR082PROD with BILLS
111 

•HR 2646 RH

1 (C) by striking ‘‘youth suicide’’ each place 

2 such term appears and inserting ‘‘suicide’’; 

3 (D) in paragraph (1)— 

4 (i) by striking ‘‘the development or 

5 continuation of’’ and inserting ‘‘developing 

6 and continuing’’; and 

7 (ii) by inserting ‘‘for all ages, particu8 larly among groups that are at high risk for 

9 suicide’’ before the semicolon at the end; 

10 (E) in paragraph (2), by inserting ‘‘for all 

11 ages, particularly among groups that are at high 

12 risk for suicide’’ before the semicolon at the end; 

13 (F) in paragraph (3), by inserting ‘‘and 

14 tribal’’ after ‘‘statewide’’; 

15 (G) in paragraph (5), by inserting ‘‘and 

16 prevention’’ after ‘‘intervention’’; 

17 (H) in paragraph (8), by striking ‘‘in 

18 youth’’; 

19 (I) in paragraph (9), by striking ‘‘and be20 havioral health’’ and inserting ‘‘health and sub21 stance use disorder’’; and 

22 (J) in paragraph (10), by inserting ‘‘con23 ducting’’ before ‘‘other’’; and 

24 (6) by striking subsection (e) and inserting the 

25 following: 


sradovich on DSK3GDR082PROD with BILLS
112 

•HR 2646 RH

1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 

2 purpose of carrying out this section, there are authorized 

3 to be appropriated $5,988,000 for each of fiscal years 2017 

4 through 2021. 

5 ‘‘(d) REPORT.—Not later than 2 years after the date 

6 of enactment of the Helping Families in Mental Health Cri7 sis Act of 2016, the Secretary shall submit to Congress a 

8 report on the activities carried out by the center established 

9 under subsection (a) during the year involved, including 

10 the potential effects of such activities, and the States, orga11 nizations, and institutions that have worked with the cen12 ter.’’. 

13 SEC. 702. YOUTH SUICIDE EARLY INTERVENTION AND PRE14 VENTION STRATEGIES. 

15 Section 520E of the Public Health Service Act (42 

16 U.S.C. 290bb–36) is amended— 

17 (1) in paragraph (1) of subsection (a) and in 

18 subsection (c), by striking ‘‘substance abuse’’ each 

19 place such term appears and inserting ‘‘substance use 

20 disorder’’; 

21 (2) in subsection (b)(2)— 

22 (A) by striking ‘‘each State is awarded only 

23 1 grant or cooperative agreement under this sec24 tion’’ and inserting ‘‘a State does not receive 


sradovich on DSK3GDR082PROD with BILLS
113 

•HR 2646 RH

1 more than 1 grant or cooperative agreement 

2 under this section at any 1 time’’; and 

3 (B) by striking ‘‘been awarded’’ and insert4 ing ‘‘received’’; and 

5 (3) by striking subsection (m) and inserting the 

6 following: 

7 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—For the 

8 purpose of carrying out this section, there are authorized 

9 to be appropriated $35,427,000 for each of fiscal years 2017 

10 through 2021.’’. 

11 SEC. 703. MENTAL HEALTH AND SUBSTANCE USE DISORDER 

12 SERVICES ON CAMPUS. 

13 Section 520E–2 of the Public Health Service Act (42 

14 U.S.C. 290bb–36b) is amended— 

15 (1) in the section heading, by striking ‘‘AND BE16 HAVIORAL HEALTH’’ and inserting ‘‘HEALTH AND

17 SUBSTANCE USE DISORDER’’; 

18 (2) in subsection (a)— 

19 (A) by striking ‘‘Services,’’ and inserting 

20 ‘‘Services and’’; 

21 (B) by striking ‘‘and behavioral health 

22 problems’’ and inserting ‘‘health or substance use 

23 disorders’’; and 

24 (C) by striking ‘‘substance abuse’’ and in25 serting ‘‘substance use disorders’’; 


sradovich on DSK3GDR082PROD with BILLS
114 

•HR 2646 RH

1 (3) in subsection (b)— 

2 (A) in the matter preceding paragraph (1), 

3 by striking ‘‘for—’’ and inserting ‘‘for one or 

4 more of the following:’’; and 

5 (B) by striking paragraphs (1) through (6) 

6 and inserting the following: 

7 ‘‘(1) Educating students, families, faculty, and 

8 staff to increase awareness of mental health and sub9 stance use disorders. 

10 ‘‘(2) The operation of hotlines. 

11 ‘‘(3) Preparing informational material. 

12 ‘‘(4) Providing outreach services to notify stu13 dents about available mental health and substance use 

14 disorder services. 

15 ‘‘(5) Administering voluntary mental health and 

16 substance use disorder screenings and assessments. 

17 ‘‘(6) Supporting the training of students, faculty, 

18 and staff to respond effectively to students with men19 tal health and substance use disorders. 

20 ‘‘(7) Creating a network infrastructure to link 

21 colleges and universities with health care providers 

22 who treat mental health and substance use dis23 orders.’’; 

24 (4) in subsection (c)(5), by striking ‘‘substance 

25 abuse’’ and inserting ‘‘substance use disorder’’; 


sradovich on DSK3GDR082PROD with BILLS
115 

•HR 2646 RH

1 (5) in subsection (d)— 

2 (A) in the matter preceding paragraph (1), 

3 by striking ‘‘An institution of higher education 

4 desiring a grant under this section’’ and insert5 ing ‘‘To be eligible to receive a grant under this 

6 section, an institution of higher education’’; 

7 (B) in paragraph (1)— 

8 (i) by striking ‘‘and behavioral health’’ 

9 and inserting ‘‘health and substance use 

10 disorder’’; and 

11 (ii) by inserting ‘‘, including veterans 

12 whenever possible and appropriate,’’ after 

13 ‘‘students’’; and 

14 (C) in paragraph (2), by inserting ‘‘, which 

15 may include, as appropriate and in accordance 

16 with subsection (b)(7), a plan to seek input from 

17 relevant stakeholders in the community, includ18 ing appropriate public and private entities, in 

19 order to carry out the program under the grant’’ 

20 before the period at the end; 

21 (6) in subsection (e)(1), by striking ‘‘and behav22 ioral health problems’’ and inserting ‘‘health and sub23 stance use disorders’’; 

24 (7) in subsection (f)(2)— 


sradovich on DSK3GDR082PROD with BILLS
116 

•HR 2646 RH

1 (A) by striking ‘‘and behavioral health’’ and 

2 inserting ‘‘health and substance use disorder’’; 

3 and 

4 (B) by striking ‘‘suicide and substance 

5 abuse’’ and inserting ‘‘suicide and substance use 

6 disorders’’; and 

7 (8) in subsection (h), by striking ‘‘$5,000,000 for 

8 fiscal year 2005’’ and all that follows through the pe9 riod at the end and inserting ‘‘$6,488,000 for each of 

10 fiscal years 2017 through 2021.’’. 

11 Subtitle B—Other Provisions 

12 SEC. 711. NATIONAL SUICIDE PREVENTION LIFELINE PRO13 GRAM. 

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

15 Service Act (42 U.S.C. 290bb–31 et seq.) is amended by in16 serting after section 520E–2 (42 U.S.C. 290bb–36b) the fol17 lowing: 

18 ‘‘SEC. 520E–3. NATIONAL SUICIDE PREVENTION LIFELINE 

19 PROGRAM. 

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

21 Assistant Secretary, shall maintain the National Suicide 

22 Prevention Lifeline Program (referred to in this section as 

23 the ‘Program’), authorized under section 520A and in effect 

24 prior to the date of enactment of the Helping Families in 

25 Mental Health Crisis Act of 2016. 


sradovich on DSK3GDR082PROD with BILLS
117 

•HR 2646 RH

1 ‘‘(b) ACTIVITIES.—In maintaining the Program, the 

2 activities of the Secretary shall include— 

3 ‘‘(1) coordinating a network of crisis centers 

4 across the United States for providing suicide preven5 tion and crisis intervention services to individuals 

6 seeking help at any time, day or night; 

7 ‘‘(2) maintaining a suicide prevention hotline to 

8 link callers to local emergency, mental health, and so9 cial services resources; and 

10 ‘‘(3) consulting with the Secretary of Veterans 

11 Affairs to ensure that veterans calling the suicide pre12 vention hotline have access to a specialized veterans’ 

13 suicide prevention hotline. 

14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

15 out this section, there are authorized to be appropriated 

16 $7,198,000 for each of fiscal years 2017 through 2021.’’. 

17 SEC. 712. WORKFORCE DEVELOPMENT STUDIES AND RE18 PORTS. 

19 (a) IN GENERAL.—Not later than 2 years after the 

20 date of enactment of this Act, the Assistant Secretary for 

21 Mental Health and Substance Use, in consultation with the 

22 Administrator of the Health Resources and Services Admin23 istration, shall conduct a study, and publicly post on the 

24 appropriate Internet website of the Department of Health 

25 and Human Services a report, on the mental health and 


sradovich on DSK3GDR082PROD with BILLS
118 

•HR 2646 RH

1 substance use disorder workforce in order to inform Federal, 

2 State, and local efforts related to workforce enhancement. 

3 (b) CONTENTS.—The report under this section shall 

4 contain— 

5 (1) national and State-level projections of the 

6 supply and demand of mental health and substance 

7 use disorder health workers, including the number of 

8 individuals practicing in fields deemed relevant by 

9 the Secretary; 

10 (2) an assessment of the mental health and sub11 stance use disorder workforce capacity, strengths, and 

12 weaknesses as of the date of the report, including the 

13 capacity of primary care to prevent, screen, treat, or 

14 refer for mental health and substance use disorders; 

15 (3) information on trends within the mental 

16 health and substance use disorder provider workforce, 

17 including the number of individuals entering the 

18 mental health workforce over the next five years; 

19 (4) information on the gaps in workforce devel20 opment for mental health providers and professionals, 

21 including those who serve pediatric, adult, and geri22 atric patients; and 

23 (5) any additional information determined by 

24 the Assistant Secretary for Mental Health and Sub25 stance Use, in consultation with the Administrator of 


sradovich on DSK3GDR082PROD with BILLS
119 

•HR 2646 RH

1 the Health Resources and Services Administration, to 

2 be relevant to the mental health and substance use 

3 disorder provider workforce. 

4 SEC. 713. MINORITY FELLOWSHIP PROGRAM. 

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

6 290aa et seq.) is amended by adding at the end the fol7 lowing: 

8 ‘‘PART K—MINORITY FELLOWSHIP PROGRAM 

9 ‘‘SEC. 597. FELLOWSHIPS. 

10 ‘‘(a) IN GENERAL.—The Secretary shall maintain a 

11 program, to be known as the Minority Fellowship Program, 

12 under which the Secretary awards fellowships, which may 

13 include stipends, for the purposes of— 

14 ‘‘(1) increasing behavioral health practitioners’ 

15 knowledge of issues related to prevention, treatment, 

16 and recovery support for mental and substance use 

17 disorders among racial and ethnic minority popu18 lations; 

19 ‘‘(2) improving the quality of mental and sub20 stance use disorder prevention and treatment deliv21 ered to racial and ethnic minorities; and 

22 ‘‘(3) increasing the number of culturally com23 petent behavioral health professionals and school per24 sonnel who teach, administer, conduct services re25 search, and provide direct mental health or substance 


sradovich on DSK3GDR082PROD with BILLS
120 

•HR 2646 RH

1 use services to racial and ethnic minority popu2 lations. 

3 ‘‘(b) TRAINING COVERED.—The fellowships under sub4 section (a) shall be for postbaccalaureate training (includ5 ing for master’s and doctoral degrees) for mental health pro6 fessionals, including in the fields of psychiatry, nursing, so7 cial work, psychology, marriage and family therapy, men8 tal health counseling, and substance use and addiction 

9 counseling. 

10 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated 

12 $12,669,000 for each of fiscal years 2017, 2018, and 2019 

13 and $13,669,000 for each of fiscal years 2020 and 2021.’’. 

14 SEC. 714. CENTER AND PROGRAM REPEALS. 

15 Part B of title V of the Public Health Service Act (42 

16 U.S.C. 290bb et seq.) is amended by striking the second sec17 tion 514 (42 U.S.C. 290bb–9), relating to methamphet18 amine and amphetamine treatment initiatives, and sections 

19 514A, 517, 519A, 519C, 519E, 520D, and 520H (42 U.S.C. 

20 290bb–8, 290bb–23, 290bb–25a, 290bb–25c, 290bb–25e, 

21 290bb–35, and 290bb–39). 

22 SEC. 715. NATIONAL VIOLENT DEATH REPORTING SYSTEM. 

23 The Secretary of Health and Human Services, acting 

24 through the Director of the Centers for Disease Control and 

25 Prevention, is encouraged to improve, particularly through 


sradovich on DSK3GDR082PROD with BILLS
121 

•HR 2646 RH

1 the inclusion of additional States, the National Violent 

2 Death Reporting System as authorized by title III of the 

3 Public Health Service Act (42 U.S.C. 241 et seq.). Partici4 pation in the system by the States shall be voluntary. 

5 SEC. 716. SENSE OF CONGRESS ON PRIORITIZING NATIVE 

6 AMERICAN YOUTH AND SUICIDE PREVENTION 

7 PROGRAMS. 

8 (a) FINDINGS.—The Congress finds as follows: 

9 (1) Suicide is the eighth leading cause of death 

10 among American Indians and Alaska Natives across 

11 all ages. 

12 (2) Among American Indians and Alaska Na13 tives who are 10 to 34 years of age, suicide is the sec14 ond leading cause of death. 

15 (3) The suicide rate among American Indian 

16 and Alaska Native adolescents and young adults ages 

17 15 to 34 (19.5 per 100,000) is 1.5 times higher than 

18 the national average for that age group (12.9 per 

19 100,000). 

20 (b) SENSE OF CONGRESS.—It is the sense of Congress 

21 that the Secretary of Health and Human Services, in car22 rying out programs for Native American youth and suicide 

23 prevention programs for youth suicide intervention, should 

24 prioritize programs and activities for individuals who have 


sradovich on DSK3GDR082PROD with BILLS
122 

•HR 2646 RH

1 a high risk or disproportional burden of suicide, such as 

2 Native Americans. 

3 SEC. 717. PEER PROFESSIONAL WORKFORCE DEVELOP4 MENT GRANT PROGRAM. 

5 (a) IN GENERAL.—For the purposes described in sub6 section (b), the Secretary of Health and Human Services 

7 shall award grants to develop and sustain behavioral health 

8 paraprofessional training and education programs, includ9 ing through tuition support. 

10 (b) PURPOSES.—The purposes of grants under this sec11 tion are— 

12 (1) to increase the number of behavioral health 

13 paraprofessionals, including trained peers, recovery 

14 coaches, mental health and addiction specialists, pre15 vention specialists, and pre-masters-level addiction 

16 counselors; and 

17 (2) to help communities develop the infrastruc18 ture to train and certify peers as behavioral health 

19 paraprofessionals. 

20 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

21 grant under this section, an entity shall be a community 

22 college or other entity the Secretary deems appropriate. 

23 (d) GEOGRAPHIC DISTRIBUTION.—In awarding grants 

24 under this section, the Secretary shall seek to achieve an 


sradovich on DSK3GDR082PROD with BILLS
123 

•HR 2646 RH

1 appropriate national balance in the geographic distribution 

2 of such awards. 

3 (e) SPECIAL CONSIDERATION.—In awarding grants 

4 under this section, the Secretary may give special consider5 ation to proposed and existing programs targeting peer pro6 fessionals serving youth ages 16 to 25. 

7 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

8 out this section, there is authorized to be appropriated 

9 $10,000,000 for the period of fiscal years 2018 through 

10 2022. 

11 SEC. 718. NATIONAL HEALTH SERVICE CORPS. 

12 (a) DEFINITIONS.— 

13 (1) PRIMARY HEALTH SERVICES.—Section 

14 331(a)(3)(D) of the Public Health Service Act (42 

15 U.S.C. 254d(a)(3)) is amended by inserting ‘‘(includ16 ing pediatric mental health subspecialty services)’’ 

17 after ‘‘pediatrics’’. 

18 (2) BEHAVIORAL AND MENTAL HEALTH PROFES19 SIONALS.—Clause (i) of section 331(a)(3)(E) of the 

20 Public Health Service Act (42 U.S.C. 254d(a)(3)(E)) 

21 is amended by inserting ‘‘(and pediatric subspecial22 ists thereof)’’ before the period at the end. 

23 (b) ELIGIBILITY TO PARTICIPATE IN LOAN REPAY24 MENT PROGRAM.—Section 338B(b)(1)(B) of the Public 

25 Health Service Act (42 U.S.C. 254l–1(b)(1)(B)) is amended 


sradovich on DSK3GDR082PROD with BILLS
124 

•HR 2646 RH

1 by inserting ‘‘, including any physician child and adoles2 cent psychiatry residency or fellowship training program’’ 

3 after ‘‘be enrolled in an approved graduate training pro4 gram in medicine, osteopathic medicine, dentistry, behav5 ioral and mental health, or other health profession’’. 

6 SEC. 719. ADULT SUICIDE PREVENTION. 

7 (a) GRANTS.— 

8 (1) AUTHORITY.—The Assistant Secretary for 

9 Mental Health and Substance Use (referred to in this 

10 section as the ‘‘Assistant Secretary’’) may award 

11 grants to eligible entities in order to implement sui12 cide prevention efforts amongst adults 25 and older. 

13 (2) PURPOSE.—The grant program under this 

14 section shall be designed to raise suicide awareness, 

15 establish referral processes, and improve clinical care 

16 practice standards for treating suicide ideation, 

17 plans, and attempts among adults. 

18 (3) RECIPIENTS.—To be eligible to receive a 

19 grant under this section, an entity shall be a commu20 nity-based primary care or behavioral health care set21 ting, an emergency department, a State mental health 

22 agency, an Indian tribe, a tribal organization, or any 

23 other entity the Assistant Secretary deems appro24 priate. 


sradovich on DSK3GDR082PROD with BILLS
125 

•HR 2646 RH

1 (4) NATURE OF ACTIVITIES.—The grants award2 ed under paragraph (1) shall be used to implement 

3 programs that— 

4 (A) screen for suicide risk in adults and 

5 provide intervention and referral to treatment; 

6 (B) implement evidence-based practices to 

7 treat individuals who are at suicide risk, includ8 ing appropriate followup services; and 

9 (C) raise awareness, reduce stigma, and fos10 ter open dialogue about suicide prevention. 

11 (b) ADDITIONAL ACTIVITIES.—The Assistant Secretary 

12 shall— 

13 (1) evaluate the activities supported by grants 

14 awarded under subsection (a) in order to further the 

15 Nation’s understanding of effective interventions to 

16 prevent suicide in adults; 

17 (2) disseminate the findings from the evaluation 

18 as the Assistant Secretary considers appropriate; and 

19 (3) provide appropriate information, training, 

20 and technical assistance to eligible entities that re21 ceive a grant under this section, in order to help such 

22 entities to meet the requirements of this section, in23 cluding assistance with— 

24 (A) selection and implementation of evi25 dence-based interventions and frameworks to preVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
126 

•HR 2646 RH

1 vent suicide, such as the Zero Suicide frame2 work; and 

3 (B) other activities as the Assistant Sec4 retary determines appropriate. 

5 (c) DURATION.—A grant under this section shall be for 

6 a period of not more than 5 years. 

7 (d) AUTHORIZATION OF APPROPRIATIONS.— 

8 (1) IN GENERAL.—There is authorized to be ap9 propriated to carry out this section $30,000,000 for 

10 the period of fiscal years 2018 through 2022. 

11 (2) USE OF CERTAIN FUNDS.—Of the funds ap12 propriated to carry out this section in any fiscal 

13 year, the lesser of 5 percent of such funds or $500,000 

14 shall be available to the Assistant Secretary for pur15 poses of carrying out subsection (b). 

16 SEC. 720. CRISIS INTERVENTION GRANTS FOR POLICE OFFI17 CERS AND FIRST RESPONDERS. 

18 (a) IN GENERAL.—The Assistant Secretary for Mental 

19 Health and Substance Use may award grants to entities 

20 such as law enforcement agencies and first responders— 

21 (1) to provide specialized training to law en22 forcement officers, corrections officers, paramedics, 

23 emergency medical services workers, and other first 

24 responders (including village public safety officers (as 


sradovich on DSK3GDR082PROD with BILLS
127 

•HR 2646 RH

1 defined in section 247 of the Indian Arts and Crafts 

2 Amendments Act of 2010 (42 U.S.C. 3796dd note)))— 

3 (A) to recognize individuals who have men4 tal illness and how to properly intervene with 

5 individuals with mental illness; and 

6 (B) to establish programs that enhance the 

7 ability of law enforcement agencies to address the 

8 mental health, behavioral, and substance use 

9 problems of individuals encountered in the line 

10 of duty; and 

11 (2) to establish collaborative law enforcement 

12 and mental health programs, including behavioral 

13 health response teams and mental health crisis inter14 vention teams comprised of mental health profes15 sionals, law enforcement officers, and other first re16 sponders, as appropriate, to provide on-site, face-to17 face, mental and behavioral health care services dur18 ing a mental health crisis, and to connect the indi19 vidual in crisis to appropriate community-based 

20 treatment services in lieu of unnecessary hospitaliza21 tion or further involvement with the criminal justice 

22 system. 

23 (b) AUTHORIZATION OF APPROPRIATIONS.—There are 

24 authorized to be appropriated to carry out this section 

25 $9,000,000 for the period of fiscal years 2018 through 2020. 


sradovich on DSK3GDR082PROD with BILLS
128 

•HR 2646 RH

1 SEC. 721. DEMONSTRATION GRANT PROGRAM TO TRAIN 

2 HEALTH SERVICE PSYCHOLOGISTS IN COM3 MUNITY-BASED MENTAL HEALTH. 

4 (a) ESTABLISHMENT.—The Secretary of Health and 

5 Human Services shall establish a grant program under 

6 which the Assistant Secretary of Mental Health and Sub7 stance Use Disorders may award grants to eligible institu8 tions to support the recruitment, education, and clinical 

9 training experiences of health services psychology students, 

10 interns, and postdoctoral residents for education and clin11 ical experience in community mental health settings. 

12 (b) ELIGIBLE INSTITUTIONS.—For purposes of this 

13 section, the term ‘‘eligible institutions’’ includes American 

14 Psychological Association-accredited doctoral, internship, 

15 and postdoctoral residency schools or programs in health 

16 service psychology that— 

17 (1) are focused on the development and imple18 mentation of interdisciplinary training of psychology 

19 graduate students and postdoctoral fellows in pro20 viding mental and behavioral health services to ad21 dress substance use disorders, serious emotional dis22 turbance, and serious illness, as well as developing 

23 faculty and implementing curriculum to prepare psy24 chologists to work with underserved populations; and 

25 (2) demonstrate an ability to train health service 

26 psychologists in psychiatric hospitals, forensic hosVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
129 

•HR 2646 RH

1 pitals, community mental health centers, community 

2 health centers, federally qualified health centers, or 

3 adult and juvenile correctional facilities. 

4 (c) PRIORITIES.—In selecting grant recipients under 

5 this section, the Secretary shall give priority to eligible in6 stitutions in which training focuses on the needs of individ7 uals with serious mental illness, serious emotional disturb8 ance, justice-involved youth, and individuals with or at 

9 high risk for substance use disorders. 

10 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

11 authorized to be appropriated to carry out this section 

12 $12,000,000 for the period of fiscal years 2018 through 

13 2022. 

14 SEC. 722. INVESTMENT IN TOMORROW’S PEDIATRIC 

15 HEALTH CARE WORKFORCE. 

16 Section 775(e) of the Public Health Service Act (42 

17 U.S.C 295f(e)) is amended to read as follows: 

18 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there is authorized to be appropriated 

20 $12,000,000 for the period of fiscal years 2018 through 

21 2022.’’. 

22 SEC. 723. CUTGO COMPLIANCE. 

23 Section 319D(f) of the Public Health Service Act (42 

24 U.S.C. 247d–4(f)) is amended by striking ‘‘$138,300,000 for 

25 each of fiscal years 2014 through 2018’’ and inserting 


sradovich on DSK3GDR082PROD with BILLS
130 

•HR 2646 RH

1 ‘‘$138,300,000 for each of fiscal years 2014 through 2016 

2 and $58,000,000 for each of fiscal years 2017 and 2018’’. 

3 TITLE VIII—MENTAL HEALTH 

4 PARITY 

5 SEC. 801. ENHANCED COMPLIANCE WITH MENTAL HEALTH 

6 AND SUBSTANCE USE DISORDER COVERAGE 

7 REQUIREMENTS. 

8 (a) COMPLIANCE PROGRAM GUIDANCE DOCUMENT.— 

9 Section 2726(a) of the Public Health Service Act (42 U.S.C. 

10 300gg–26(a)) is amended by adding at the end the fol11 lowing: 

12 ‘‘(6) COMPLIANCE PROGRAM GUIDANCE DOCU13 MENT.— 

14 ‘‘(A) IN GENERAL.—Not later than 6 

15 months after the date of enactment of the Help16 ing Families in Mental Health Crisis Act of 

17 2016, the Inspector General of the Department of 

18 Health and Human Services, in coordination 

19 with the Secretary, the Secretary of Labor, or the 

20 Secretary of the Treasury, shall issue a compli21 ance program guidance document to help im22 prove compliance with this section. 

23 ‘‘(B) EXAMPLES ILLUSTRATING COMPLIANCE

24 AND NONCOMPLIANCE.— 


sradovich on DSK3GDR082PROD with BILLS
131 

•HR 2646 RH

1 ‘‘(i) IN GENERAL.—The compliance 

2 program guidance document required under 

3 this paragraph shall provide illustrative, 

4 de-identified examples (that do not disclose 

5 any protected health information or indi6 vidually identifiable information) of pre7 vious findings of compliance and non8 compliance with this section, section 712 of 

9 the Employee Retirement Income Security 

10 Act of 1974, or section 9812 of the Internal 

11 Revenue Code of 1986 based on investiga12 tions of violations of such sections, includ13 ing— 

14 ‘‘(I) examples illustrating require15 ments for information disclosures and 

16 nonquantitative treatment limitations; 

17 and 

18 ‘‘(II) descriptions of the violations 

19 uncovered during the course of such in20 vestigations. 

21 ‘‘(ii) NONQUANTITATIVE TREATMENT

22 LIMITATIONS.—To the extent that any ex23 ample described in clause (i) involves a 

24 finding of compliance or noncompliance 

25 with regard to any requirement for nonVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
132 

•HR 2646 RH

1 quantitative treatment limitations, the ex2 ample shall provide sufficient detail to fully 

3 explain such finding, including a full de4 scription of the criteria involved for medical 

5 and surgical benefits and the criteria in6 volved for mental health and substance use 

7 disorder benefits. 

8 ‘‘(iii) ACCESS TO ADDITIONAL INFOR9 MATION REGARDING COMPLIANCE.—In de10 veloping and issuing the compliance pro11 gram guidance document required under 

12 this paragraph, the Inspector General of the 

13 Department of Health and Human Services 

14 may— 

15 ‘‘(I) enter into interagency agree16 ments with the Inspector General of the 

17 Department of Labor and the Inspector 

18 General of the Department of the 

19 Treasury to share findings of compli20 ance and noncompliance with this sec21 tion, section 712 of the Employee Re22 tirement Income Security Act of 1974, 

23 or section 9812 of the Internal Revenue 

24 Code of 1986; and 


sradovich on DSK3GDR082PROD with BILLS
133 

•HR 2646 RH

1 ‘‘(II) enter into an agreement 

2 with a State to share information on 

3 findings of compliance and noncompli4 ance with this section, section 712 of 

5 the Employee Retirement Income Secu6 rity Act of 1974, or section 9812 of the 

7 Internal Revenue Code of 1986. 

8 ‘‘(C) RECOMMENDATIONS.—The compliance 

9 program guidance document shall include rec10 ommendations to avoid violations of this section 

11 and encourage the development and use of inter12 nal controls to monitor adherence to applicable 

13 statutes, regulations, and program requirements. 

14 Such internal controls may include a compliance 

15 checklist with illustrative examples of non16 quantitative treatment limitations on mental 

17 health and substance use disorder benefits, which 

18 may fail to comply with this section in relation 

19 to nonquantitative treatment limitations on 

20 medical and surgical benefits. 

21 ‘‘(D) UPDATING THE COMPLIANCE PROGRAM

22 GUIDANCE DOCUMENT.—The compliance pro23 gram guidance document shall be updated every 

24 2 years to include illustrative, de-identified ex25 amples (that do not disclose any protected health 


sradovich on DSK3GDR082PROD with BILLS
134 

•HR 2646 RH

1 information or individually identifiable infor2 mation) of previous findings of compliance and 

3 noncompliance with this section, section 712 of 

4 the Employee Retirement Income Security Act of 

5 1974, or section 9812 of the Internal Revenue 

6 Code of 1986.’’. 

7 (b) ADDITIONAL GUIDANCE.—Section 2726(a) of the 

8 Public Health Service Act (42 U.S.C. 300gg–26(a)) is 

9 amended by adding at the end the following: 

10 ‘‘(7) ADDITIONAL GUIDANCE.— 

11 ‘‘(A) IN GENERAL.—Not later than 6 

12 months after the date of enactment of the Help13 ing Families in Mental Health Crisis Act of 

14 2016, the Secretary, in coordination with the 

15 Secretary of Labor and the Secretary of the 

16 Treasury, shall issue guidance to group health 

17 plans and health insurance issuers offering 

18 group or individual health insurance coverage to 

19 assist such plans and issuers in satisfying the re20 quirements of this section. 

21 ‘‘(B) DISCLOSURE.— 

22 ‘‘(i) GUIDANCE FOR PLANS AND

23 ISSUERS.—The guidance issued under this 

24 paragraph shall include clarifying informa25 tion and illustrative examples of methods 


sradovich on DSK3GDR082PROD with BILLS
135 

•HR 2646 RH

1 that group health plans and health insur2 ance issuers offering group or individual 

3 health insurance coverage may use for dis4 closing information to ensure compliance 

5 with the requirements under this section 

6 (and any regulations promulgated pursuant 

7 to this section). 

8 ‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 

9 BENEFICIARIES, CONTRACTING PROVIDERS, 

10 OR AUTHORIZED REPRESENTATIVES.—The 

11 guidance issued under this paragraph may 

12 include clarifying information and illus13 trative examples of methods that group 

14 health plans and health insurance issuers 

15 offering group or individual health insur16 ance coverage may use to provide any par17 ticipant, beneficiary, contracting provider, 

18 or authorized representative, as applicable, 

19 with documents containing information 

20 that the health plans or issuers are required 

21 to disclose to participants, beneficiaries, 

22 contracting providers, or authorized rep23 resentatives to ensure compliance with this 

24 section, any regulation issued pursuant to 

25 this section, or any other applicable law or 


sradovich on DSK3GDR082PROD with BILLS
136 

•HR 2646 RH

1 regulation, including information that is 

2 comparative in nature with respect to— 

3 ‘‘(I) nonquantitative treatment 

4 limitations for both medical and sur5 gical benefits and mental health and 

6 substance use disorder benefits; 

7 ‘‘(II) the processes, strategies, evi8 dentiary standards, and other factors 

9 used to apply the limitations described 

10 in subclause (I); and 

11 ‘‘(III) the application of the limi12 tations described in subclause (I) to en13 sure that such limitations are applied 

14 in parity with respect to both medical 

15 and surgical benefits and mental 

16 health and substance use disorder bene17 fits. 

18 ‘‘(C) NONQUANTITATIVE TREATMENT LIMI19 TATIONS.—The guidance issued under this para20 graph shall include clarifying information and 

21 illustrative examples of methods, processes, strat22 egies, evidentiary standards, and other factors 

23 that group health plans and health insurance 

24 issuers offering group or individual health insur25 ance coverage may use regarding the developVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
137 

•HR 2646 RH

1 ment and application of nonquantitative treat2 ment limitations to ensure compliance with this 

3 section (and any regulations promulgated pursu4 ant to this section), including— 

5 ‘‘(i) examples of methods of deter6 mining appropriate types of nonquantita7 tive treatment limitations with respect to 

8 both medical and surgical benefits and men9 tal health and substance use disorder bene10 fits, including nonquantitative treatment 

11 limitations pertaining to— 

12 ‘‘(I) medical management stand13 ards based on medical necessity or ap14 propriateness, or whether a treatment 

15 is experimental or investigative; 

16 ‘‘(II) limitations with respect to 

17 prescription drug formulary design; 

18 and 

19 ‘‘(III) use of fail-first or step ther20 apy protocols; 

21 ‘‘(ii) examples of methods of deter22 mining— 

23 ‘‘(I) network admission standards 

24 (such as credentialing); and 


sradovich on DSK3GDR082PROD with BILLS
138 

•HR 2646 RH

1 ‘‘(II) factors used in provider re2 imbursement methodologies (such as 

3 service type, geographic market, de4 mand for services, and provider sup5 ply, practice size, training, experience, 

6 and licensure) as such factors apply to 

7 network adequacy; 

8 ‘‘(iii) examples of sources of informa9 tion that may serve as evidentiary stand10 ards for the purposes of making determina11 tions regarding the development and appli12 cation of nonquantitative treatment limita13 tions; 

14 ‘‘(iv) examples of specific factors, and 

15 the evidentiary standards used to evaluate 

16 such factors, used by such plans or issuers 

17 in performing a nonquantitative treatment 

18 limitation analysis; 

19 ‘‘(v) examples of how specific evi20 dentiary standards may be used to deter21 mine whether treatments are considered ex22 perimental or investigative; 

23 ‘‘(vi) examples of how specific evi24 dentiary standards may be applied to each 

25 service category or classification of benefits; 


sradovich on DSK3GDR082PROD with BILLS
139 

•HR 2646 RH

1 ‘‘(vii) examples of methods of reaching 

2 appropriate coverage determinations for 

3 new mental health or substance use disorder 

4 treatments, such as evidence-based early 

5 intervention programs for individuals with 

6 a serious mental illness and types of med7 ical management techniques; 

8 ‘‘(viii) examples of methods of reaching 

9 appropriate coverage determinations for 

10 which there is an indirect relationship be11 tween the covered mental health or sub12 stance use disorder benefit and a traditional 

13 covered medical and surgical benefit, such 

14 as residential treatment or hospitalizations 

15 involving voluntary or involuntary commit16 ment; and 

17 ‘‘(ix) additional illustrative examples 

18 of methods, processes, strategies, evidentiary 

19 standards, and other factors for which the 

20 Secretary determines that additional guid21 ance is necessary to improve compliance 

22 with this section. 

23 ‘‘(D) PUBLIC COMMENT.—Prior to issuing 

24 any final guidance under this paragraph, the 

25 Secretary shall provide a public comment period 


sradovich on DSK3GDR082PROD with BILLS
140 

•HR 2646 RH

1 of not less than 60 days during which any mem2 ber of the public may provide comments on a 

3 draft of the guidance.’’. 

4 (c) IMPROVING COMPLIANCE.— 

5 (1) IN GENERAL.—In the case that the Secretary 

6 of Health and Human Services, the Secretary of 

7 Labor, or the Secretary of the Treasury determines 

8 that a group health plan or health insurance issuer 

9 offering group or individual health insurance cov10 erage has violated, at least 5 times, section 2726 of 

11 the Public Health Service Act (42 U.S.C. 300gg–26), 

12 section 712 of the Employee Retirement Income Secu13 rity Act of 1974 (29 U.S.C. 1185a), or section 9812 

14 of the Internal Revenue Code, the appropriate Sec15 retary shall audit plan documents for such health 

16 plan or issuer in the plan year following the Sec17 retary’s determination in order to help improve com18 pliance with such section. 

19 (2) RULE OF CONSTRUCTION.—Nothing in this 

20 subsection shall be construed to limit the authority, as 

21 in effect on the day before the date of enactment of 

22 this Act, of the Secretary of Health and Human Serv23 ices, the Secretary of Labor, or the Secretary of the 

24 Treasury to audit documents of health plans or health 

25 insurance issuers. 


sradovich on DSK3GDR082PROD with BILLS
141 

•HR 2646 RH

1 SEC. 802. ACTION PLAN FOR ENHANCED ENFORCEMENT OF 

2 MENTAL HEALTH AND SUBSTANCE USE DIS3 ORDER COVERAGE. 

4 (a) PUBLIC MEETING.— 

5 (1) IN GENERAL.—Not later than 6 months after 

6 the date of enactment of this Act, the Secretary of 

7 Health and Human Services shall convene a public 

8 meeting of stakeholders described in paragraph (2) to 

9 produce an action plan for improved Federal and 

10 State coordination related to the enforcement of men11 tal health parity and addiction equity requirements. 

12 (2) STAKEHOLDERS.—The stakeholders described 

13 in this paragraph shall include each of the following: 

14 (A) The Federal Government, including rep15 resentatives from— 

16 (i) the Department of Health and 

17 Human Services; 

18 (ii) the Department of the Treasury; 

19 (iii) the Department of Labor; and 

20 (iv) the Department of Justice. 

21 (B) State governments, including— 

22 (i) State health insurance commis23 sioners; 

24 (ii) appropriate State agencies, includ25 ing agencies on public health or mental 

26 health; and 


sradovich on DSK3GDR082PROD with BILLS
142 

•HR 2646 RH

1 (iii) State attorneys general or other 

2 representatives of State entities involved in 

3 the enforcement of mental health parity 

4 laws. 

5 (C) Representatives from key stakeholder 

6 groups, including— 

7 (i) the National Association of Insur8 ance Commissioners; 

9 (ii) health insurance providers; 

10 (iii) providers of mental health and 

11 substance use disorder treatment; 

12 (iv) employers; and 

13 (v) patients or their advocates. 

14 (b) ACTION PLAN.—Not later than 6 months after the 

15 public meeting under subsection (a), the Secretary of Health 

16 and Human Services shall finalize the action plan described 

17 in such subsection and make it plainly available on the 

18 Internet website of the Department of Health and Human 

19 Services. 

20 (c) CONTENT.—The action plan under this section 

21 shall— 

22 (1) reflect the input of the stakeholders invited to 

23 the public meeting under subsection (a); 

24 (2) identify specific strategic objectives regarding 

25 how the various Federal and State agencies charged 


sradovich on DSK3GDR082PROD with BILLS
143 

•HR 2646 RH

1 with enforcement of mental health parity and addic2 tion equity requirements will collaborate to improve 

3 enforcement of such requirements; 

4 (3) provide a timeline for implementing the ac5 tion plan; and 

6 (4) provide specific examples of how such objec7 tives may be met, which may include— 

8 (A) providing common educational infor9 mation and documents to patients about their 

10 rights under Federal or State mental health par11 ity and addiction equity requirements; 

12 (B) facilitating the centralized collection of, 

13 monitoring of, and response to patient com14 plaints or inquiries relating to Federal or State 

15 mental health parity and addiction equity re16 quirements, which may be through the develop17 ment and administration of a single, toll-free 

18 telephone number and an Internet website portal; 

19 (C) Federal and State law enforcement 

20 agencies entering into memoranda of under21 standing to better coordinate enforcement respon22 sibilities and information sharing, including 

23 whether such agencies should make the results of 

24 enforcement actions related to mental health parVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
144 

•HR 2646 RH

1 ity and addiction equity requirements publicly 

2 available; and 

3 (D) recommendations to the Secretary and 

4 Congress regarding the need for additional legal 

5 authority to improve enforcement of mental 

6 health parity and addiction equity requirements, 

7 including the need for additional legal authority 

8 to ensure that nonquantitative treatment limita9 tions are applied, and the extent and frequency 

10 of the applications of such limitations, both to 

11 medical and surgical benefits and to mental 

12 health and substance use disorder benefits in a 

13 comparable manner. 

14 SEC. 803. REPORT ON INVESTIGATIONS REGARDING PARITY 

15 IN MENTAL HEALTH AND SUBSTANCE USE 

16 DISORDER BENEFITS. 

17 (a) IN GENERAL.—Not later than 1 year after the date 

18 of enactment of this Act, and annually thereafter for the 

19 subsequent 5 years, the Administrator of the Centers for 

20 Medicare & Medicaid Services, in collaboration with the As21 sistant Secretary of Labor of the Employee Benefits Secu22 rity Administration and the Secretary of the Treasury, 

23 shall submit to the Committee on Energy and Commerce 

24 of the House of Representatives and the Committee on 

25 Health, Education, Labor, and Pensions of the Senate a 


sradovich on DSK3GDR082PROD with BILLS
145 

•HR 2646 RH

1 report summarizing the results of all closed Federal inves2 tigations completed during the preceding 12-month period 

3 with findings of any serious violation regarding compliance 

4 with mental health and substance use disorder coverage re5 quirements under section 2726 of the Public Health Service 

6 Act (42 U.S.C. 300gg–26), section 712 of the Employee Re7 tirement Income Security Act of 1974 (29 U.S.C. 1185a), 

8 and section 9812 of the Internal Revenue Code of 1986. 

9 (b) CONTENTS.—Subject to subsection (c), a report 

10 under subsection (a) shall, with respect to investigations de11 scribed in such subsection, include each of the following: 

12 (1) The number of open or closed Federal inves13 tigations conducted during the covered reporting pe14 riod. 

15 (2) Each benefit classification examined by any 

16 such investigation conducted during the covered re17 porting period. 

18 (3) Each subject matter, including compliance 

19 with requirements for quantitative and nonquantita20 tive treatment limitations, of any such investigation 

21 conducted during the covered reporting period. 

22 (4) A summary of the basis of the final decision 

23 rendered for each closed investigation conducted dur24 ing the covered reporting period that resulted in a 

25 finding of a serious violation. 


sradovich on DSK3GDR082PROD with BILLS
146 

•HR 2646 RH

1 (c) LIMITATION.—Any individually identifiable infor2 mation shall be excluded from reports under subsection (a) 

3 consistent with protections under the health privacy and 

4 security rules promulgated under section 264(c) of the 

5 Health Insurance Portability and Accountability Act of 

6 1996 (42 U.S.C. 1320d–2 note). 

7 SEC. 804. GAO STUDY ON PARITY IN MENTAL HEALTH AND 

8 SUBSTANCE USE DISORDER BENEFITS. 

9 Not later than 3 years after the date of enactment of 

10 this Act, the Comptroller General of the United States, in 

11 consultation with the Secretary of Health and Human 

12 Services, the Secretary of Labor, and the Secretary of the 

13 Treasury, shall submit to the Committee on Energy and 

14 Commerce of the House of Representatives and the Com15 mittee on Health, Education, Labor, and Pensions of the 

16 Senate a report detailing the extent to which group health 

17 plans or health insurance issuers offering group or indi18 vidual health insurance coverage that provides both medical 

19 and surgical benefits and mental health or substance use 

20 disorder benefits, medicaid managed care organizations 

21 with a contract under section 1903(m) of the Social Secu22 rity Act (42 U.S.C. 1396b(m)), and health plans provided 

23 under the State Children’s Health Insurance Program 

24 under title XXI of the Social Security Act (42 U.S.C. 

25 1397aa et seq.) comply with section 2726 of the Public 


sradovich on DSK3GDR082PROD with BILLS
147 

•HR 2646 RH

1 Health Service Act (42 U.S.C. 300gg–26), section 712 of 

2 the Employee Retirement Income Security Act of 1974 (29 

3 U.S.C. 1185a), and section 9812 of the Internal Revenue 

4 Code of 1986, including— 

5 (1) how nonquantitative treatment limitations, 

6 including medical necessity criteria, of such plans or 

7 issuers comply with such sections; 

8 (2) how the responsible Federal departments and 

9 agencies ensure that such plans or issuers comply 

10 with such sections, including an assessment of how 

11 the Secretary of Health and Human Services has used 

12 its authority to conduct audits of such plans to ensure 

13 compliance; 

14 (3) a review of how the various Federal and 

15 State agencies responsible for enforcing mental health 

16 parity requirements have improved enforcement of 

17 such requirements in accordance with the objectives 

18 and timeline described in the action plan under sec19 tion 802; and 

20 (4) recommendations for how additional enforce21 ment, education, and coordination activities by re22 sponsible Federal and State departments and agencies 

23 could better ensure compliance with such sections, in24 cluding recommendations regarding the need for addi25 tional legal authority. 


sradovich on DSK3GDR082PROD with BILLS
148 

•HR 2646 RH

1 SEC. 805. INFORMATION AND AWARENESS ON EATING DIS2 ORDERS. 

3 (a) INFORMATION.—The Secretary of Health and 

4 Human Services (in this section referred to as the ‘‘Sec5 retary’’) may— 

6 (1) update information, related fact sheets, and 

7 resource lists related to eating disorders that are 

8 available on the public Internet website of the Na9 tional Women’s Health Information Center sponsored 

10 by the Office on Women’s Health, to include— 

11 (A) updated findings and current research 

12 related to eating disorders, as appropriate; and 

13 (B) information about eating disorders, in14 cluding information related to males and fe15 males; 

16 (2) incorporate, as appropriate, and in coordi17 nation with the Secretary of Education, information 

18 from publicly available resources into appropriate 

19 obesity prevention programs developed by the Office 

20 on Women’s Health; and 

21 (3) make publicly available (through a public 

22 Internet website or other method) information, related 

23 fact sheets and resource lists, as updated under para24 graph (1), and the information incorporated into ap25 propriate obesity prevention programs, as updated 

26 under paragraph (2). 


sradovich on DSK3GDR082PROD with BILLS
149 

•HR 2646 RH

1 (b) AWARENESS.—The Secretary may advance public 

2 awareness on— 

3 (1) the types of eating disorders; 

4 (2) the seriousness of eating disorders, including 

5 prevalence, comorbidities, and physical and mental 

6 health consequences; 

7 (3) methods to identify, intervene, refer for treat8 ment, and prevent behaviors that may lead to the de9 velopment of eating disorders; 

10 (4) discrimination and bullying based on body 

11 size; 

12 (5) the effects of media on self-esteem and body 

13 image; and 

14 (6) the signs and symptoms of eating disorders. 

15 SEC. 806. EDUCATION AND TRAINING ON EATING DIS16 ORDERS. 

17 The Secretary of Health and Human Services may fa18 cilitate the identification of programs to educate and train 

19 health professionals and school personnel in effective strate20 gies to— 

21 (1) identify individuals with eating disorders; 

22 (2) provide early intervention services for indi23 viduals with eating disorders; 

24 (3) refer patients with eating disorders for ap25 propriate treatment; 


sradovich on DSK3GDR082PROD with BILLS
150 

•HR 2646 RH

1 (4) prevent the development of eating disorders; 

2 or 

3 (5) provide appropriate treatment services for 

4 individuals with eating disorders. 

5 SEC. 807. GAO STUDY ON PREVENTING DISCRIMINATORY 

6 COVERAGE LIMITATIONS FOR INDIVIDUALS 

7 WITH SERIOUS MENTAL ILLNESS AND SUB8 STANCE USE DISORDERS. 

9 Not later than 2 years after the date of the enactment 

10 of this Act, the Comptroller General of the United States 

11 shall submit to Congress and make publicly available a re12 port detailing Federal oversight of group health plans and 

13 health insurance coverage offered in connection with such 

14 plans (as such terms are defined in section 2791 of the Pub15 lic Health Service Act (42 U.S.C. 300gg–91), including 

16 Medicaid managed care plans under section 1903 of the So17 cial Security Act (42 U.S.C. 1396b), to ensure compliance 

18 of such plans and coverage with sections 2726 of the Public 

19 Health Service Act (42 U.S.C. 300gg–26), 712 of the Em20 ployee Retirement Income Security Act of 1974 (29 U.S.C. 

21 1185a), and 9812 of the Internal Revenue Code of 1986 (in 

22 this section collectively referred to as the ‘‘parity law’’), in23 cluding— 

24 (1) a description of how Federal regulations and 

25 guidance consider nonquantitative treatment limitaVerDate Sep 11 2014 21:12 Jul 06, 2016 Jkt 059200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6203 E:\BILLS\H2646.RH H2646

sradovich on DSK3GDR082PROD with BILLS
151 

•HR 2646 RH

1 tions, including medical necessity criteria and appli2 cation of such criteria to medical, surgical, and pri3 mary care, of such plans and coverage in ensuring 

4 compliance by such plans and coverage with the par5 ity law; 

6 (2) a description of actions that Federal depart7 ments and agencies are taking to ensure that such 

8 plans and coverage comply with the parity law; and 

9 (3) the identification of enforcement, education, 

10 and coordination activities within Federal depart11 ments and agencies, including educational activities 

12 directed to State insurance commissioners, and a de13 scription of how such proper activities can be used to 

14 ensure full compliance with the parity law. 

15 SEC. 808. CLARIFICATION OF EXISTING PARITY RULES. 

16 If a group health plan or a health insurance issuer 

17 offering group or individual health insurance coverage pro18 vides coverage for eating disorder benefits, including resi19 dential treatment, such group health plan or health insur20 ance issuer shall provide such benefits consistent with the 

21 requirements of section 2726 of the Public Health Service 

22 Act (42 U.S.C. 300gg–26), section 712 of the Employee Re23 tirement Income Security Act of 1974 (29 U.S.C. 1185a), 

24 and section 9812 of the Internal Revenue Code of 1986. 


sradovich on DSK3GDR082PROD with BILLS
Union Calendar No. 517 

114TH CONGRESS 

2D SESSION H. R. 2646 

[Report No. 114–667, Part I] 

A BILL 

To make available needed psychiatric, psychological, 

and for other purposes. tal illness and families in mental health crisis, and supportive services for individuals with menJULY 6, 2016 

Reported from the Committee on Energy and Commerce 

with an amendment 

JULY 6, 2016 

The Committees on Ways and Means and Education and 

dered to be printed of the Whole House on the State of the Union and orthe Workforce discharged; committed to the Committee 


sradovich on DSK3GDR082PROD with BILLS