I 

113TH CONGRESS 

1ST SESSION H. R. 1263 

To increase access to community behavioral health services for all Americans 

and to improve Medicaid reimbursement for community behavioral health 

services. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 19, 2013 

Ms. MATSUI (for herself, Mr. LANCE, Mr. WAXMAN, Mr. ENGEL, Ms. 

DEGETTE, and Ms. JENKINS) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To increase access to community behavioral health services 

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

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Excellence in Mental 

5 Health Act’’. 

6 SEC. 2. ESTABLISHING COMMUNITY BEHAVIORAL HEALTH 

7 CENTERS. 

8 (a) IN GENERAL.—Section 1913 of the Public Health 

9 Service Act (42 U.S.C. 300x–2) is amended— 


srobinson on DSK4SPTVN1PROD with BILLS
2 

•HR 1263 IH

1 (1) in subsection (a)(2)(A), by striking ‘‘com2 munity mental health services’’ and inserting ‘‘be3 havioral health services (of the type offered by a cer4 tified federally qualified community behavioral 

5 health center)’’; 

6 (2) in subsection (b)— 

7 (A) in paragraph (1), by striking ‘‘commu8 nity mental health centers’’ and inserting ‘‘cer9 tified federally qualified community behavioral 

10 health centers’’; and 

11 (B) in paragraph (2), by striking ‘‘commu12 nity mental health centers’’ and inserting ‘‘cer13 tified federally qualified community behavioral 

14 health centers’’; and 

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

16 following: 

17 ‘‘(c) CERTIFIED FEDERALLY QUALIFIED COMMU18 NITY BEHAVIORAL HEALTH CENTERS.— 

19 ‘‘(1) DEFINITION.—For purposes of subsection 

20 (a)(2) and subsection (b), the term ‘certified feder21 ally qualified community behavioral health center’ 

22 means a nonprofit or local government center that is 

23 certified by the Secretary as performing each of the 

24 following actions: 


srobinson on DSK4SPTVN1PROD with BILLS
3 

•HR 1263 IH

1 ‘‘(A) Providing services in locations that 

2 ensure services will be available and accessible 

3 promptly and in a manner which preserves 

4 human dignity and assures continuity of care. 

5 ‘‘(B) Providing services in a mode of serv6 ice delivery appropriate for the target popu7 lation. 

8 ‘‘(C) Providing individuals with a choice of 

9 service options where there is more than one ef10 ficacious treatment. 

11 ‘‘(D) Employing a core staff of clinical 

12 staff that is multidisciplinary and culturally and 

13 linguistically competent. 

14 ‘‘(E) Providing services, within the limits 

15 of the capacities of the center, to any individual 

16 residing or employed in the service area of the 

17 center, regardless of the ability of the individual 

18 to pay. 

19 ‘‘(F) Providing, directly or through con20 tract, to the extent covered for adults in the 

21 State Medicaid plan under title XIX of the So22 cial Security Act and for children in accordance 

23 with section 1905(r) of such Act regarding 

24 early and periodic screening, diagnosis, and 

25 treatment, each of the following services: 


srobinson on DSK4SPTVN1PROD with BILLS
4 

•HR 1263 IH

1 ‘‘(i) Screening, assessment, and diag2 nosis, including risk assessment. 

3 ‘‘(ii) Person-centered treatment plan4 ning or similar processes, including risk as5 sessment and crisis planning. 

6 ‘‘(iii) Outpatient mental health and 

7 substance use services, including screening, 

8 assessment, diagnosis, psychotherapy, 

9 medication management, and integrated 

10 treatment for mental illness and substance 

11 abuse which shall be evidence-based (in12 cluding cognitive behavioral therapy and 

13 other such therapies which are evidence14 based). 

15 ‘‘(iv) Outpatient clinic primary care 

16 screening and monitoring of key health in17 dicators and health risk (including screen18 ing for diabetes, hypertension, and cardio19 vascular disease and monitoring of weight, 

20 height, body mass index (BMI), blood pres21 sure, blood glucose or HbA1C, and lipid 

22 profile). 

23 ‘‘(v) Crisis mental health services, in24 cluding 24-hour mobile crisis teams, emerVerDate Mar 15 2010 23:22 Mar 25, 2013 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1263.IH H1263

srobinson on DSK4SPTVN1PROD with BILLS
5 

•HR 1263 IH

1 gency crisis intervention services, and cri2 sis stabilization. 

3 ‘‘(vi) Targeted case management 

4 (services to assist individuals gaining ac5 cess to needed medical, social, educational, 

6 and other services and applying for income 

7 security and other benefits to which they 

8 may be entitled). 

9 ‘‘(vii) Psychiatric rehabilitation serv10 ices including skills training, assertive com11 munity treatment, family psychoeducation, 

12 disability self-management, supported em13 ployment, supported housing services, 

14 therapeutic foster care services, and such 

15 other evidence-based practices as the Sec16 retary may require. 

17 ‘‘(viii) Peer support and counselor 

18 services and family supports. 

19 ‘‘(G) Maintaining linkages, and where pos20 sible entering into formal contracts with the fol21 lowing: 

22 ‘‘(i) Federally qualified health centers. 

23 ‘‘(ii) Inpatient psychiatric facilities 

24 and substance use detoxification, post deVerDate Mar 15 2010 23:22 Mar 25, 2013 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1263.IH H1263

srobinson on DSK4SPTVN1PROD with BILLS
6 

•HR 1263 IH

1 toxification step-down services, and resi2 dential programs. 

3 ‘‘(iii) Adult and youth peer support 

4 and counselor services. 

5 ‘‘(iv) Family support services for fam6 ilies of children with serious mental or sub7 stance abuse disorders. 

8 ‘‘(v) Other community or regional 

9 services, supports, and providers, including 

10 schools, child welfare agencies, juvenile and 

11 criminal justice agencies and facilities, 

12 housing agencies and programs, employers, 

13 and other social services. 

14 ‘‘(vi) Onsite or offsite access to pri15 mary care services. 

16 ‘‘(vii) Enabling services, including 

17 outreach, transportation, and translation. 

18 ‘‘(viii) Health and wellness services, 

19 including services for tobacco cessation. 

20 ‘‘(2) FREQUENCY OF CERTIFICATION.—Certifi21 cation under paragraph (1) shall be for a 5-year pe22 riod. The Administrator shall provide an opportunity 

23 for recertification at the end of each certification pe24 riod. 


srobinson on DSK4SPTVN1PROD with BILLS
7 

•HR 1263 IH

1 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in 

2 paragraph (1) shall be construed as prohibiting any 

3 State receiving funds appropriated through the Com4 munity Mental Health Services Block Grant under 

5 this subpart from financing qualified community 

6 programs (whether such programs meet the defini7 tion of eligible programs prior to or after the date 

8 of enactment of the Excellence in Mental Health 

9 Act).’’. 

10 (b) REGULATIONS.—Not later than 18 months after 

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

12 Health and Human Services, in consultation with State 

13 mental health and substance abuse authorities, shall issue 

14 final regulations for certifying nonprofit or local govern15 ment centers under subsection (c) of section 1913 of the 

16 Public Health Service Act, as amended by this section. 

17 SEC. 3. MEDICAID COVERAGE AND PAYMENT FOR COMMU18 NITY BEHAVIORAL HEALTH CENTER SERV19 ICES. 

20 (a) PAYMENT FOR SERVICES PROVIDED BY FEDER21 ALLY QUALIFIED COMMUNITY BEHAVIORAL HEALTH

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

23 (42 U.S.C. 1396a(bb)) is amended— 


srobinson on DSK4SPTVN1PROD with BILLS
8 

•HR 1263 IH

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

2 HEALTH CLINICS’’ and inserting ‘‘, SELECTED CER3 TIFIED FQCBHCS, AND RURAL HEALTH CLINICS’’; 

4 (2) in paragraph (1), by inserting ‘‘(and begin5 ning with fiscal year 2014 with respect to services 

6 furnished on or after January 1, 2014, and each 

7 succeeding fiscal year, for services described in sec8 tion 1905(a)(2)(D) furnished by a selected certified 

9 FQCBHC)’’ after ‘‘by a rural health clinic’’; 

10 (3) in paragraph (2)— 

11 (A) by striking the heading and inserting 

12 ‘‘INITIAL FISCAL YEAR’’; 

13 (B) by inserting ‘‘(or, in the case of serv14 ices described in section 1905(a)(2)(D) fur15 nished by a selected certified FQCBHC, for 

16 services furnished on and after January 1, 

17 2014, during fiscal year 2014)’’ after ‘‘January 

18 1, 2001, during fiscal year 2001’’; 

19 (C) by inserting ‘‘(or, in the case of serv20 ices described in section 1905(a)(2)(D) fur21 nished by a selected certified FQCBHC, during 

22 fiscal years 2012 and 2013)’’ after ‘‘1999 and 

23 2000’’; and 

24 (D) by inserting ‘‘(or, in the case of serv25 ices described in section 1905(a)(2)(D) furVerDate Mar 15 2010 23:22 Mar 25, 2013 Jkt 029200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1263.IH H1263

srobinson on DSK4SPTVN1PROD with BILLS
9 

•HR 1263 IH

1 nished by a selected certified FQCBHC, during 

2 fiscal year 2014)’’ before the period; 

3 (4) in paragraph (3)— 

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

5 YEAR 2002 AND SUCCEEDING’’ and inserting 

6 ‘‘SUCCEEDING’’; and 

7 (B) by inserting ‘‘(or, in the case of serv8 ices described in section 1905(a)(2)(D) fur9 nished by a selected certified FQCBHC, for 

10 services furnished during fiscal year 2015 or a 

11 succeeding fiscal year)’’ after ‘‘2002 or a suc12 ceeding fiscal year’’; 

13 (5) in paragraph (4)— 

14 (A) by inserting ‘‘(or as a selected certified 

15 FQCBHC after fiscal year 2013)’’ after ‘‘or 

16 rural health clinic after fiscal year 2000’’; 

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

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

19 qualified health center, services described in 

20 section 1905(a)(2)(D) furnished by the selected 

21 certified FQCBHC, or’’; and 

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

23 rural health clinic’’ and inserting ‘‘, selected 

24 certified FQCBHC, or rural health clinic’’; 


srobinson on DSK4SPTVN1PROD with BILLS
10 

•HR 1263 IH

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

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

3 inserting ‘‘, selected certified FQCBHC, or rural 

4 health clinic’’; 

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

6 health clinic’’ and inserting ‘‘, to a selected certified 

7 FQCBHC for services described in section 

8 1905(a)(2)(D), or to a rural health clinic’’; and 

9 (8) by adding at the end the following: 

10 ‘‘(7) SELECTED CERTIFIED FQCBHC.—For pur11 poses of this subsection, the term ‘selected certified 

12 FQCBHC’ shall have the meaning given such term 

13 in section 1905(l)(4)(B).’’. 

14 (b) INCLUSION OF COMMUNITY BEHAVIORAL

15 HEALTH CENTER SERVICES IN THE TERM MEDICAL AS16 SISTANCE.—Section 1905(a)(2) of the Social Security Act 

17 (42 U.S.C. 1396d(a)(2)) is amended— 

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

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

20 the following: ‘‘, and (D) federally qualified commu21 nity behavioral health center services (as defined in 

22 subsection (l)(4))’’. 

23 (c) DEFINITION OF FEDERALLY QUALIFIED COMMU24 NITY BEHAVIORAL HEALTH CENTER SERVICES.—Section 


srobinson on DSK4SPTVN1PROD with BILLS
11 

•HR 1263 IH

1 1905(l) of the Social Security Act (42 U.S.C. 1396d(l)) 

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

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

4 center services’ means services furnished to an indi5 vidual at a selected certified FQCBHC (as defined 

6 by subparagraph (B)). 

7 ‘‘(B) The term ‘selected certified FQCBHC’ 

8 means, with respect to a fiscal year, a certified fed9 erally qualified community behavioral health center 

10 that is selected by the Secretary under subparagraph 

11 (D) for such fiscal year. 

12 ‘‘(C) With respect to a fiscal year, for purposes 

13 of this paragraph, an entity is a certified federally 

14 qualified community behavioral health center for 

15 such fiscal year if the entity is a certified federally 

16 qualified community behavioral health center under 

17 section 1913(c) of the Public Health Service Act for 

18 such fiscal year. 

19 ‘‘(D)(i) For purposes of this section and section 

20 1902(bb)— 

21 ‘‘(I) for fiscal years 2014 through 2018, 

22 the Secretary shall select 20 percent of the total 

23 number of certified federally qualified commu24 nity behavioral health centers; 


srobinson on DSK4SPTVN1PROD with BILLS
12 

•HR 1263 IH

1 ‘‘(II) for fiscal years 2019 through 2023, 

2 the Secretary shall select the certified federally 

3 qualified community behavioral health centers 

4 selected under subclause (II) and an additional 

5 20 percent of the total number of certified fed6 erally qualified community behavioral health 

7 centers; and 

8 ‘‘(III) for fiscal year 2024 and subsequent 

9 fiscal years, the Secretary shall select all cer10 tified federally qualified community behavioral 

11 health centers. 

12 ‘‘(ii) In making the selections under subclauses 

13 (I) and (II) of clause (i), the Secretary shall— 

14 ‘‘(I) ensure geographic diversity of the se15 lected certified FQCBHCs; and 

16 ‘‘(II) take into account the ability of such 

17 centers to provide the services required by sec18 tion 1913 of the Public Health Service Act and 

19 to report data as required under this title.’’. 

20 SEC. 4. COMMUNITY-BASED MENTAL HEALTH INFRASTRUC21 TURE IMPROVEMENT. 

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

23 280g et seq.) is amended— 

24 (1) by redesignating the second part G, as 

25 added by section 144 of the Community Renewal 


srobinson on DSK4SPTVN1PROD with BILLS
13 

•HR 1263 IH

1 Tax Relief Act of 2000 (as enacted into law by sec2 tion 1(a)(7) of Public Law 106–554; 114 Stat. 

3 2763A–619), as part J; 

4 (2) by redesignating sections 581 through 584 

5 in such part (42 U.S.C. 290kk through 290kk–3) as 

6 sections 595C through 595F, respectively; and 

7 (3) by inserting after part J, as so redesig8 nated, the following: 

9 ‘‘PART K—COMMUNITY-BASED MENTAL HEALTH 

10 INFRASTRUCTURE IMPROVEMENTS 

11 ‘‘SEC. 595G. GRANTS FOR COMMUNITY-BASED MENTAL 

12 HEALTH INFRASTRUCTURE IMPROVEMENTS. 

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

14 award grants to eligible entities to expend funds for the 

15 construction or modernization of facilities used to provide 

16 mental health and substance abuse services to individuals. 

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

18 ‘eligible entity’ means— 

19 ‘‘(1) a State that is the recipient of a Commu20 nity Mental Health Services Block Grant under sub21 part I of part B of title XIX and a Substance Abuse 

22 Prevention and Treatment Block Grant under sub23 part II of such part; or 

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

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


srobinson on DSK4SPTVN1PROD with BILLS
14 

•HR 1263 IH

1 the Indian Self-Determination and Education Assist2 ance Act). 

3 ‘‘(c) APPLICATION.—An eligible entity desiring a 

4 grant under this section shall submit to the Secretary an 

5 application at such time, in such manner, and con6 taining— 

7 ‘‘(1) a plan for the construction or moderniza8 tion of facilities used to provide mental health and 

9 substance abuse services to individuals that— 

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

11 agency as the sole agency for the supervision 

12 and administration of the grant; 

13 ‘‘(B) contains satisfactory evidence that 

14 such agency so designated will have the author15 ity to carry out the plan; 

16 ‘‘(C) provides for the designation of an ad17 visory council, which shall include representa18 tives of nongovernmental organizations or 

19 groups, and of the relevant State or tribal agen20 cies, that aided in the development of the plan 

21 and that will implement and monitor any grant 

22 awarded to the eligible entity under this section; 

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

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

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


srobinson on DSK4SPTVN1PROD with BILLS
15 

•HR 1263 IH

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

2 be funded by the grant; and 

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

4 is a State, explains how each listed project 

5 helps the State in accomplishing its goals and 

6 objectives under the Community Mental Health 

7 Services Block Grant under subpart I of part B 

8 of title XIX and the Substance Abuse Preven9 tion and Treatment Block Grant under subpart 

10 II of such part; 

11 ‘‘(F) includes assurances that the facilities 

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

13 years for the provision of community-based 

14 mental health or substance abuse services for 

15 those who cannot pay for such services, subject 

16 to subsection (e); and 

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

18 public facility, includes the name and executive 

19 director of the entity who will provide services 

20 in the facility; and 

21 ‘‘(2) with respect to each construction or mod22 ernization project described in the application— 

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

24 project; 


srobinson on DSK4SPTVN1PROD with BILLS
16 

•HR 1263 IH

1 ‘‘(B) plans and specifications for the 

2 project and State or tribal approval for the 

3 plans and specifications; 

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

5 or will be vested with either the public entity or 

6 private nonprofit entity who will provide the 

7 services in the facility; 

8 ‘‘(D) assurance that adequate financial re9 sources will be available for the construction or 

10 major rehabilitation of the project and for the 

11 maintenance and operation of the facility; 

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

13 and 

14 ‘‘(F) the estimated length of time for com15 pletion of the project. 

16 ‘‘(d) SUBGRANTS BY STATES.— 

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

18 grant under this section may award a subgrant to 

19 a qualified community program (as such term is 

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

21 ‘‘(2) USE OF FUNDS.—Subgrants awarded pur22 suant to paragraph (1) may be used for activities 

23 such as— 

24 ‘‘(A) the construction, expansion, and mod25 ernization of facilities used to provide mental 


srobinson on DSK4SPTVN1PROD with BILLS
17 

•HR 1263 IH

1 health and substance abuse services to individ2 uals; 

3 ‘‘(B) acquiring and leasing facilities and 

4 equipment (including paying the costs of amor5 tizing the principal of, and paying the interest 

6 on, loans for such facilities and equipment) to 

7 support or further the operation of the sub8 grantee; 

9 ‘‘(C) the construction and structural modi10 fication (including equipment acquisition) of fa11 cilities to permit the integrated delivery of be12 havioral health and primary care of specialty 

13 medical services to individuals with co-occurring 

14 mental illnesses and chronic medical or surgical 

15 diseases at a single service site; and 

16 ‘‘(D) acquiring information technology re17 quired to accommodate the clinical needs of pri18 mary and specialty care professionals. 

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

20 grant funds may be used for activities described in 

21 paragraph (2)(D). 

22 ‘‘(e) REQUEST TO TRANSFER OBLIGATION.—An eli23 gible entity that receives a grant under this section may 

24 submit a request to the Secretary for permission to transVerDate Mar 15 2010 23:22 Mar 25, 2013 Jkt 029200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H1263.IH H1263

srobinson on DSK4SPTVN1PROD with BILLS
18 

•HR 1263 IH

1 fer the 10-year obligation of facility use, as described in 

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

3 ‘‘(f) AGREEMENT TO FEDERAL SHARE.—As a condi4 tion of receipt of a grant under this section, an eligible 

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

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

7 grant is awarded, that the entity will make available non8 Federal contributions (which may include State or local 

9 funds, or funds from the qualified community program) 

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

11 Federal funds provided under the grant. 

12 ‘‘(g) REPORTING.— 

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

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

15 Secretary shall require that a State that receives a 

16 grant under this section submit, as part of the re17 port of the State required under the Community 

18 Mental Health Services Block Grant under subpart 

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

20 Prevention and Treatment Block Grant under sub21 part II of such part, a description of the progress 

22 on— 

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

24 the grant under this section; and 


srobinson on DSK4SPTVN1PROD with BILLS
19 

•HR 1263 IH

1 ‘‘(B) the assurances that the facilities in2 volved continue to be used for the purpose for 

3 which they were funded under such grant dur4 ing such 10-year period. 

5 ‘‘(2) REPORTING BY INDIAN TRIBES AND TRIB6 AL ORGANIZATIONS.—The Secretary shall establish 

7 reporting requirements for Indian tribes and tribal 

8 organizations that receive a grant under this section. 

9 Such reporting requirements shall include that such 

10 Indian tribe or tribal organization provide a descrip11 tion of the progress on— 

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

13 the grant under this section; and 

14 ‘‘(B) the assurances that the facilities in15 volved continue to be used for the purpose for 

16 which they were funded under such grant dur17 ing the 10-year period referred to in subsection 

18 (c)(1)(F). 

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

20 ‘‘(1) IN GENERAL.—If an eligible entity that re21 ceives a grant under this section fails to meet any 

22 of the obligations of the entity required under this 

23 section, the Secretary shall take appropriate steps, 

24 which may include— 


srobinson on DSK4SPTVN1PROD with BILLS
20 

•HR 1263 IH

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

2 unused portion of the funds awarded under this 

3 section for the projects that are incomplete; and 

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

5 entity must ensure that the facility involved is 

6 used for the purposes for which it is intended, 

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

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

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

10 shall provide the entity notice and opportunity for a 

11 hearing. 

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

13 intergovernmental and interdepartmental memoranda of 

14 agreement as necessary to carry out this section. 

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

16 is authorized to be appropriated to carry out this section 

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

18 2014 through 2018.’’. 

Æ 


srobinson on DSK4SPTVN1PROD with BILLS