I 

110TH CONGRESS 

2D SESSION H. R. 5176 

To amend the Public Health Service Act with respect to mental health 

services. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 29, 2008 

Mr. GENE GREEN of Texas (for himself and Mr. TIM MURPHY of Pennsylvania) introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL 

To amend the Public Health Service Act with respect to 

mental 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 ‘‘Community Mental 

5 Health Services Improvement Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds that— 

8 (1) almost 60,000,000 Americans, or one in 

9 four adults and one in five children, have a mental 


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1 illness that can be diagnosed and treated in a given 

2 year; 

3 (2) mental illness costs our economy more than 

4 $80,000,000,000 annually, accounting for 15 per5 cent of the total economic burden of disease; 

6 (3) alcohol and drug abuse contributes to the 

7 death of more than 100,000 people and costs society 

8 upwards of half a trillion dollars a year; 

9 (4) individuals with serious mental illness die 

10 on average 25 years sooner than individuals in the 

11 general population; and 

12 (5) community mental and behavioral health or13 ganizations provide cost-efficient and evidence-based 

14 treatment and care for millions of Americans with 

15 mental illness and addiction disorders. 

16 SEC. 3. CO-LOCATING PRIMARY AND SPECIALTY CARE IN 

17 COMMUNITY-BASED MENTAL HEALTH SET18 TINGS. 

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

20 Service Act (42 U.S.C. 290bb–31 et seq.) is amended by 

21 adding at the end the following: 

22 ‘‘SEC. 520K. GRANTS FOR CO-LOCATING PRIMARY AND SPE23 CIALTY CARE IN COMMUNITY-BASED MENTAL 

24 HEALTH SETTINGS. 

25 ‘‘(a) DEFINITIONS.—In this section: 


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1 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en2 tity’ means a qualified community mental health 

3 program defined under section 1913(b)(1). 

4 ‘‘(2) SPECIAL POPULATIONS.—The term ‘spe5 cial populations’ refers to the following 3 groups: 

6 ‘‘(A) Children and adolescents with mental 

7 and emotional disturbances who have co-occur8 ring primary care conditions and chronic dis9 eases. 

10 ‘‘(B) Adults with mental illnesses who have 

11 co-occurring primary care conditions and chron12 ic diseases. 

13 ‘‘(C) Older adults with mental illnesses 

14 who have co-occurring primary care conditions 

15 and chronic diseases. 

16 ‘‘(b) PROGRAM AUTHORIZED.—The Secretary, acting 

17 through the Administrator of the Substance Abuse and 

18 Mental Health Services Administration and in coordina19 tion with the Director of the Health Resources and Serv20 ices Administration, shall award grants to eligible entities 

21 to establish demonstration projects for the provision of co22 ordinated and integrated services to special populations 

23 through the co-location of primary and specialty care serv24 ices in community-based mental and behavioral health set25 tings. 


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1 ‘‘(c) APPLICATION.—To be eligible to receive a grant 

2 under this section, an eligible entity shall submit an appli3 cation to the Administrator at such time, in such manner, 

4 and accompanied by such information as the Adminis5 trator may require. Each such application shall include— 

6 ‘‘(1) an assessment of the primary care needs 

7 of the patients served by the eligible entity and a de8 scription of how the eligible entity will address such 

9 needs; and 

10 ‘‘(2) a description of partnerships, cooperative 

11 agreements, or other arrangements with local pri12 mary care providers, including community health 

13 centers, to provide services to special populations. 

14 ‘‘(d) USE OF FUNDS.— 

15 ‘‘(1) IN GENERAL.—For the benefit of special 

16 populations, an eligible entity shall use funds award17 ed under this section for— 

18 ‘‘(A) the provision, by qualified primary 

19 care professionals on a reasonable cost basis, 

20 of— 

21 ‘‘(i) primary care services on site at 

22 the eligible entity; 

23 ‘‘(ii) diagnostic and laboratory serv24 ices; or 


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1 ‘‘(iii) adult and pediatric eye, ear, and 

2 dental screenings; 

3 ‘‘(B) reasonable costs associated with 

4 medically necessary referrals to qualified spe5 cialty care professionals as well as to other co6 ordinators of care or, if permitted by the terms 

7 of the grant, for the provision, by qualified spe8 cialty care professionals on a reasonable cost 

9 basis on site at the eligible entity, of— 

10 ‘‘(i) endocrinology services; 

11 ‘‘(ii) oncology services; 

12 ‘‘(iii) pulmonary/respiratory services; 

13 or 

14 ‘‘(iv) cardiovascular services; 

15 ‘‘(C) information technology required to 

16 accommodate the clinical needs of primary and 

17 specialty care professionals; or 

18 ‘‘(D) facility improvements or modifica19 tions needed to bring primary and specialty 

20 care professionals on site at the eligible entity. 

21 ‘‘(2) LIMITATION.—Not to exceed 15 percent of 

22 grant funds may be used for activities described in 

23 subparagraphs (C) and (D) of paragraph (1). 

24 ‘‘(e) GEOGRAPHIC DISTRIBUTION.—The Secretary 

25 shall ensure that grants awarded under this section are 


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1 equitably distributed among the geographical regions of 

2 the United States and between urban and rural popu3 lations. 

4 ‘‘(f) EVALUATION.—Not later than 3 months after a 

5 grant or cooperative agreement awarded under this section 

6 expires, an eligible entity shall submit to the Secretary the 

7 results of an evaluation to be conducted by the entity con8 cerning the effectiveness of the activities carried out under 

9 the grant or agreement. 

10 ‘‘(g) REPORT.—Not later than 5 years after the date 

11 of enactment of this section, the Secretary shall prepare 

12 and submit to the appropriate committees of Congress a 

13 report that shall evaluate the activities funded under this 

14 section. The report shall include an evaluation of the im15 pact of co-locating primary and specialty care in commu16 nity mental and behavioral health settings on overall pa17 tient health status and recommendations on whether or 

18 not the demonstration program under this section should 

19 be made permanent. 

20 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated to carry out this section, 

22 $50,000,0000 for fiscal year 2009 and such sums as may 

23 be necessary for each of fiscal years 2010 through 2013.’’. 


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1 SEC. 4. INTEGRATING TREATMENT FOR MENTAL HEALTH 

2 AND SUBSTANCE ABUSE CO-OCCURRING DIS3 ORDERS. 

4 Section 520I of the Public Health Service Act (42 

5 U.S.C. 290bb–40) is amended— 

6 (1) by striking subsection (i) and inserting the 

7 following: 

8 ‘‘(j) FUNDING.—The Secretary shall make available 

9 to carry out this section, $14,000,000 for fiscal year 2009, 

10 $20,000,000 for fiscal year 2010, and such sums as may 

11 be necessary for each of fiscal years 2011 through 2013. 

12 Such sums shall be made available in equal amount from 

13 amounts appropriated under sections 509 and 520A.’’; 

14 and 

15 (2) by inserting before subsection (j), the fol16 lowing: 

17 ‘‘(i) COMMUNITY MENTAL HEALTH PROGRAM.—For 

18 purposes of eligibility under this section, the term ‘private 

19 nonprofit organization’ includes a qualified community 

20 mental health program as defined under section 

21 1913(b)(1).’’. 

22 SEC. 5. IMPROVING THE MENTAL HEALTH WORKFORCE. 

23 (a) NATIONAL HEALTH SERVICE CORPS.—Para24 graph (1) of section 332(a) of the Public Health Service 

25 Act (42 U.S.C. 254e(a)) is amended by inserting ‘‘and 

26 community mental health centers meeting the criteria 


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1 specified in section 1913(c)’’ after ‘‘Social Security Act 

2 (42 U.S.C. 1395x(aa)),’’. 

3 (b) RECRUITMENT AND RETENTION OF MENTAL

4 HEALTH PROFESSIONALS.—Subpart X of part D of title 

5 III of the Public Health Service Act (42 U.S.C. 256f et 

6 seq.) is amended by adding at the end the following: 

7 ‘‘SEC. 340H. GRANTS FOR RECRUITMENT AND RETENTION 

8 OF MENTAL HEALTH PROFESSIONALS. 

9 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

10 through the Administrator of the Health Resources and 

11 Services Administration, shall award grants to States, ter12 ritories, and Indian tribes or tribal organizations for inno13 vative programs to address the behavioral and mental 

14 health workforce needs of designated mental health profes15 sional shortage areas. 

16 ‘‘(b) USE OF FUNDS.—An eligible entity shall use 

17 grant funds awarded under this section for— 

18 ‘‘(1) loan forgiveness and repayment programs 

19 (to be carried out in a manner similar to the loan 

20 repayment programs carried out under subpart III 

21 of part D) for behavioral and mental health profes22 sionals who— 

23 ‘‘(A) agree to practice in designated men24 tal health professional shortage areas; 


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1 ‘‘(B) are graduates of programs in behav2 ioral or mental health; 

3 ‘‘(C) agree to serve in community-based 

4 non-profit entities, or as public mental health 

5 professionals for the Federal, State or local gov6 ernment; and 

7 ‘‘(D) agree to— 

8 ‘‘(i) provide services to patients re9 gardless of such patients’ ability to pay; 

10 and 

11 ‘‘(ii) use a sliding payment scale for 

12 patients who are unable to pay the total 

13 cost of services; 

14 ‘‘(2) behavioral and mental health professional 

15 recruitment and retention efforts, with a particular 

16 emphasis on candidates from racial and ethnic mi17 nority and medically-underserved communities; 

18 ‘‘(3) grants or low-interest or no-interest loans 

19 for behavioral and mental health professionals who 

20 participate in the Medicaid program under title XIX 

21 of the Social Security Act to establish or expand 

22 practices in designated mental health professional 

23 shortage areas, or to serve in qualified community 

24 mental health programs as defined in section 

25 1913(b)(1); 


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1 ‘‘(4) placement and support for behavioral and 

2 mental health students, residents, trainees, and fel3 lows or interns; or 

4 ‘‘(5) continuing behavioral and mental health 

5 education, including distance-based education. 

6 ‘‘(c) APPLICATION.— 

7 ‘‘(1) IN GENERAL.—Each eligible entity desir8 ing a grant under this section shall submit an appli9 cation to the Secretary at such time, in such man10 ner, and containing such information as the Sec11 retary may reasonably require. 

12 ‘‘(2) ASSURANCES.—The application shall in13 clude assurances that the applicant will meet the re14 quirements of this subsection and that the applicant 

15 possesses sufficient infrastructure to manage the ac16 tivities to be funded through the grant and to evalu17 ate and report on the outcomes resulting from such 

18 activities. 

19 ‘‘(d) MATCHING REQUIREMENT.—The Secretary may 

20 not make a grant to an eligible entity under this section 

21 unless that entity agrees that, with respect to the costs 

22 to be incurred by the entity in carrying out the activities 

23 for which the grant was awarded, the entity will provide 

24 non-Federal contributions in an amount equal to not less 

25 than 35 percent of Federal funds provided under the 


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1 grant. The entity may provide the contributions in cash 

2 or in kind, fairly evaluated, including plant, equipment, 

3 and services, and may provide the contributions from 

4 State, local, or private sources. 

5 ‘‘(e) SUPPLEMENT NOT SUPPLANT.—A grant award6 ed under this section shall be expended to supplement, and 

7 not supplant, the expenditures of the eligible entity and 

8 the value of in-kind contributions for carrying out the ac9 tivities for which the grant was awarded. 

10 ‘‘(f) GEOGRAPHIC DISTRIBUTION.—The Secretary 

11 shall ensure that grants awarded under this section are 

12 equitably distributed among the geographical regions of 

13 the United States and between urban and rural popu14 lations. 

15 ‘‘(g) EVALUATION.—Not later than 3 months after 

16 a grant awarded under this section expires, an eligible en17 tity shall submit to the Secretary the results of an evalua18 tion to be conducted by the entity concerning the effective19 ness of the activities carried out under the grant. 

20 ‘‘(h) REPORT.—Not later than 5 years after the date 

21 of enactment of this section, the Secretary shall prepare 

22 and submit to the appropriate committees of Congress a 

23 report containing data relating to whether grants provided 

24 under this section have increased access to behavioral and 


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1 mental health services in designated mental health profes2 sional shortage areas. 

3 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section, 

5 $10,000,000 for fiscal year 2009, and such sums as may 

6 be necessary for each of fiscal years 2010 through 2013.’’. 

7 (c) BEHAVIORAL AND MENTAL HEALTH EDUCATION

8 AND TRAINING PROGRAMS.—Part A of title V of the Pub9 lic Health Service Act (42 U.S.C. 290aa et seq.) is amend10 ed by adding at the end the following: 

11 ‘‘SEC. 506C. GRANTS FOR BEHAVIORAL AND MENTAL 

12 HEALTH EDUCATION AND TRAINING PRO13 GRAMS. 

14 ‘‘(a) DEFINITION.—For the purposes of this section, 

15 the term ‘related mental health personnel’ means an indi16 vidual who— 

17 ‘‘(1) facilitates access to a medical, social, edu18 cational, or other service; and 

19 ‘‘(2) is not a mental health professional, but 

20 who is the first point of contact with persons who 

21 are seeking mental health services. 

22 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

23 through the Administrator of the Substance Abuse and 

24 Mental Health Services Administration, shall establish a 

25 program to increase the number of trained behavioral and 


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1 mental health professionals and related mental health per2 sonnel by awarding grants on a competitive basis to men3 tal and behavioral health nonprofit organizations or ac4 credited institutions of higher education to enable such en5 tities to establish or expand accredited mental and behav6 ioral health education programs. 

7 ‘‘(c) APPLICATION.— 

8 ‘‘(1) IN GENERAL.—Each eligible entity desir9 ing a grant under this section shall submit an appli10 cation to the Secretary at such time, in such man11 ner, and containing such information as the Sec12 retary may reasonably require. 

13 ‘‘(2) ASSURANCES.—The application shall in14 clude assurances that the applicant will meet the re15 quirements of this subsection and that the applicant 

16 possesses sufficient infrastructure to manage the ac17 tivities to be funded through the grant and to evalu18 ate and report on the outcomes resulting from such 

19 activities. 

20 ‘‘(d) PRIORITY.—In awarding grants under this sec21 tion, the Secretary shall give priority to applicants that— 

22 ‘‘(1) demonstrate a familiarity with the use of 

23 evidenced-based methods in behavioral and mental 

24 health services; 


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1 ‘‘(2) provide interdisciplinary training experi2 ences; and 

3 ‘‘(3) demonstrate a commitment to training 

4 methods and practices that emphasize the integrated 

5 treatment of mental health and substance abuse dis6 orders. 

7 ‘‘(e) USE OF FUNDS.—Funds awarded under this 

8 section shall be used to— 

9 ‘‘(1) establish or expand accredited behavioral 

10 and mental health education programs, including im11 proving the coursework, related field placements, or 

12 faculty of such programs; or 

13 ‘‘(2) establish or expand accredited mental and 

14 behavioral health training programs for related men15 tal health personnel. 

16 ‘‘(f) REQUIREMENTS.—The Secretary may award a 

17 grant to an eligible entity only if such entity agrees that— 

18 ‘‘(1) any behavioral or mental health program 

19 assisted under the grant will prioritize cultural com20 petency and the recruitment of trainees from racial 

21 and ethnic minority and medically-underserved com22 munities; and 

23 ‘‘(2) with respect to any violation of the agree24 ment between the Secretary and the entity, the entiVerDate Aug 31 2005 01:59 Jan 31, 2008 Jkt 069200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H5176.IH H5176

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1 ty will pay such liquidated damages as prescribed by 

2 the Secretary. 

3 ‘‘(g) GEOGRAPHIC DISTRIBUTION.—The Secretary 

4 shall ensure that grants awarded under this section are 

5 equitably distributed among the geographical regions of 

6 the United States and between urban and rural popu7 lations. 

8 ‘‘(h) EVALUATION.—Not later than 3 months after 

9 a grant awarded under this section expires, an eligible en10 tity shall submit to the Secretary the results of an evalua11 tion to be conducted by the entity concerning the effective12 ness of the activities carried out under the grant. 

13 ‘‘(i) REPORT.—Not later than 5 years after the date 

14 of enactment of this section, the Secretary shall prepare 

15 and submit to the appropriate committees of Congress a 

16 report containing data relating to whether grants provided 

17 under this section have increased access to behavioral and 

18 mental health services in designated mental health profes19 sional shortage areas. 

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

21 is authorized to be appropriated to carry out this section 

22 $4,000,0000 for fiscal year 2009, and such sums as may 

23 be necessary for each of fiscal years 2010 through 2013.’’. 


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1 SEC. 6. IMPROVING ACCESS TO MENTAL HEALTH SERVICES 

2 IN MEDICALLY-UNDERSERVED AREAS. 

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

4 Service Act (42 U.S.C. 290bb–31 et seq.) is amended by 

5 inserting after section 520A the following: 

6 ‘‘SEC. 520B. GRANTS FOR TELE-MENTAL HEALTH IN MEDI7 CALLY-UNDERSERVED AREAS. 

8 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

9 through the Administrator of the Substance Abuse and 

10 Mental Health Services Administration, shall award 

11 grants to eligible entities to provide tele-mental health in 

12 medically-underserved areas. 

13 ‘‘(b) ELIGIBLE ENTITY.—To be eligible for assist14 ance under the program under subsection (a), an entity 

15 shall be a qualified community mental health program (as 

16 defined in section 1913(b)(1)). 

17 ‘‘(c) APPLICATION.— 

18 ‘‘(1) IN GENERAL.—Each eligible entity desir19 ing a grant under this section shall submit an appli20 cation to the Secretary at such time, in such man21 ner, and containing such information as the Sec22 retary may reasonably require. 

23 ‘‘(2) ASSURANCES.—The application shall in24 clude assurances that the applicant will meet the re25 quirements of this subsection and that the applicant 

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1 tivities to be funded through the grant and to evalu2 ate and report on the outcomes resulting from such 

3 activities. 

4 ‘‘(d) USE OF FUNDS.—An eligible entity shall use 

5 funds received under a grant under this section for— 

6 ‘‘(1) the provision of tele-mental health services; 

7 or 

8 ‘‘(2) infrastructure improvements for the provi9 sion of tele-mental health services. 

10 ‘‘(e) GEOGRAPHIC DISTRIBUTION.—The Secretary 

11 shall ensure that grants awarded under this section are 

12 equitably distributed among the geographical regions of 

13 the United States and between urban and rural popu14 lations. 

15 ‘‘(f) EVALUATION.—Not later than 3 months after a 

16 grant awarded under this section expires, an eligible entity 

17 shall submit to the Secretary the results of an evaluation 

18 to be conducted by the entity concerning the effectiveness 

19 of the activities carried out under the grant. 

20 ‘‘(g) REPORT.—Not later than 5 years after the date 

21 of enactment of this section, the Secretary shall prepare 

22 and submit to the appropriate committees of Congress a 

23 report that shall evaluate the activities funded under this 

24 section. 


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1 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $20,000,000 for fiscal year 2009, and such sums as may 

4 be necessary for each of fiscal years 2010 through 2013.’’. 

5 SEC. 7. IMPROVING HEALTH INFORMATION TECHNOLOGY 

6 FOR MENTAL HEALTH PROVIDERS. 

7 Part A of title V of the Public Health Service Act 

8 (42 U.S.C. 290aa et seq.), as amended by section 5(c), 

9 is further amended by adding at the end the following: 

10 ‘‘SEC. 506D. IMPROVING HEALTH INFORMATION TECH11 NOLOGY FOR MENTAL HEALTH PROVIDERS. 

12 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

13 with the Secretary of Veterans Affairs, shall collaborate 

14 with the Administrator of the Substance Abuse and Men15 tal Health Services Administration and the National Coor16 dinator for Health Information Technology to— 

17 ‘‘(1) develop and implement a plan for ensuring 

18 that various components of the National Health In19 formation Infrastructure, including data and privacy 

20 standards, electronic health records, and community 

21 and regional health networks, address the needs of 

22 mental health and substance abuse treatment pro23 viders; and 


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1 ‘‘(2) finance related infrastructure improve2 ments, technical support, personnel training, and on3 going quality improvements. 

4 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

6 $10,000,000 for fiscal year 2009, and such sums as may 

7 be necessary for each of fiscal years 2010 through 2013.’’. 

8 SEC. 8. PAPERWORK REDUCTION STUDY. 

9 (a) IN GENERAL.—Not later than 12 months after 

10 the date of enactment of this Act, the Institute of Medi11 cine shall submit to the appropriate committees of Con12 gress a report that evaluates the combined paperwork bur13 den of qualified community mental health programs as de14 fined in section 1913(b)(1) of the Public Health Service 

15 Act. 

16 (b) SCOPE.—In preparing the report under sub17 section (a), the Institute of Medicine shall examine licens18 ing, certification, service definitions, claims payment, bill19 ing codes, and financial auditing requirements utilized by 

20 the Office of Management and Budget, the Centers for 

21 Medicare & Medicaid Services, the Health Resources and 

22 Services Administration, the Substance Abuse and Mental 

23 Health Services Administration, the Office of the Inspec24 tor General, State Medicaid agencies, State departments 


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1 of health, State departments of education, and State and 

2 local juvenile justice and social service agencies to— 

3 (1) establish an estimate of the combined na4 tionwide cost of complying with the requirements de5 scribed in this paragraph, in terms of both adminis6 trative funding and staff time; 

7 (2) establish an estimate of the per capita cost 

8 to each qualified community mental health program 

9 defined in section 1913(b)(1) of the Public Health 

10 Service Act to comply with the requirements of this 

11 paragraph, in terms of both administrative funding 

12 and staff time; and 

13 (3) make administrative and statutory rec14 ommendations to Congress, which may include a 

15 uniform methodology, to reduce the paperwork bur16 den experienced by qualified community mental 

17 health programs defined in section 1913(b)(1) of the 

18 Public Health Service Act. 

19 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to carry out this section 

21 $550,000 for each of fiscal years 2009 and 2010. 

22 SEC. 9. WAGE STUDY. 

23 (a) IN GENERAL.—Not later than 12 months after 

24 the date of enactment of this Act, the Institute of Medi25 cine shall conduct a nationwide analysis, and submit a reVerDate Aug 31 2005 01:59 Jan 31, 2008 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H5176.IH H5176

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1 port to the appropriate committees of Congress, con2 cerning the compensation structure of professional and 

3 paraprofessional personnel employed by qualified commu4 nity mental health programs as defined under section 

5 1913(b)(1) of the Public Health Service Act, as compared 

6 with the compensation structure of comparable health 

7 safety net providers and relevant private sector health care 

8 employers. 

9 (b) SCOPE.—In preparing the report under sub10 section (a), the Institute of Medicine shall examine com11 pensation disparities, if such disparities are determined to 

12 exist, by type of personnel, type of provider or private sec13 tor employer, and geographic region. 

14 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section, 

16 $550,000 for each of fiscal years 2009 and 20l0. 

Æ 


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