II 

110TH CONGRESS 

1ST SESSION S. 633 

To provide assistance to rural schools, hospitals, and communities for the 

conduct of collaborative efforts to secure a progressive and innovative 

system to improve access to mental health care for youth, seniors, and 

families. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 15, 2007 

Mr. COLEMAN introduced the following bill; which was read twice and referred 

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

A BILL 

To provide assistance to rural schools, hospitals, and communities for the conduct of collaborative efforts to secure 

a progressive and innovative system to improve access 

to mental health care for youth, seniors, and families. 

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 ‘‘Working Together for 

5 Rural Access to Mental Health and Wellness for Children 

6 and Seniors Act’’. 


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1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) Providing adequate mental health care in 

5 rural communities is a national problem. Mental 

6 health is an integral part of a person’s general 

7 health and well-being. In rural areas, where special8 ized mental health services are scarce, accessing 

9 mental health professional services is difficult. Pri10 mary care is often the only system for delivering 

11 mental health services. 

12 (2) Rural primary care providers are seeing an 

13 increase in mental health issues in their clinics. 

14 (3) The need is overwhelming with the Surgeon 

15 General estimating 21 percent of children experience 

16 the signs or symptoms of a mental disorder. Left 

17 untreated, these problems lead to rampant school 

18 failure, drug abuse, and often incarceration. 

19 (4) The Department of Health and Human 

20 Services indicates that 1 in 5 children and adoles21 cents may have a diagnosable disorder, yet 70 per22 cent to 80 percent receive little or no help. 

23 (5) Few schools have the resources to imple24 ment a full range of school mental health interven25 tions. Identifying sustainable and flexible funding 

26 sources for these programs is extremely important. 


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1 (6) Health, and especially mental health, is a 

2 fundamental cornerstone for ensuring that all youth 

3 have an equal opportunity to succeed at school. 

4 (7) Promoting and expanding telemental health 

5 collaborations to strengthen delivery of mental 

6 health services in remote and underserved areas is 

7 needed. 

8 (8) Telemental health is an effective tool for di9 agnosing and treating some mental health condi10 tions. For rural and remote areas, telemental health 

11 offers patients access and care. 

12 (b) PURPOSE.—It is the purpose of this Act to— 

13 (1) provide assistance to rural schools, hos14 pitals, and communities for the conduct of collabo15 rative efforts to secure a progressive and innovative 

16 system to improve access to mental health care for 

17 youth, seniors and families; 

18 (2) increase access of elementary and secondary 

19 school students to mental health services in rural 

20 areas by operating a mobile health services van pro21 gram in such areas; or 

22 (3) increase access of individuals of all ages to 

23 mental health services in rural areas by providing 

24 telemental health services in such areas. 


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1 SEC. 3. RURAL ACCESS TO MENTAL HEALTH SERVICES 

2 GRANT PROGRAM. 

3 (a) STATE GRANTS.—The Secretary of Health and 

4 Human Services (referred to in this section as the ‘‘Sec5 retary’’) shall award grants to States to enable such 

6 States to award subgrants to carry out the purposes of 

7 this Act. 

8 (b) ELIGIBILITY AND AMOUNT.— 

9 (1) ELIGIBILITY.—To be eligible for a grant 

10 under subsection (a), a State shall submit to the 

11 Secretary an application at such time, in such man12 ner, and containing such information as the Sec13 retary may require, including an assurance that the 

14 State will designate a lead agency in accordance 

15 with subsection (c) and submit a State plan in ac16 cordance with subsection (d). 

17 (2) AMOUNT.—The Secretary shall award a 

18 grant to a State under this section in an amount 

19 that is based on the respective number of critical ac20 cess hospitals (as defined in section 1861 (mm)(1) 

21 of the Social Security Act (42 U.S.C. 

22 1395x(mm)(1)) in the State as such compares to the 

23 total number of critical access hospitals in all States 

24 that are awarded grants under this section. 

25 (c) STATE LEAD AGENCY.— 


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1 (1) IN GENERAL.—To be eligible to receive a 

2 grant under this section, the governor of a State 

3 shall select a lead agency within the State to admin4 ister the State programs under the grant. If the gov5 ernor of the State selects a lead agency other than 

6 the State Office of Rural Health, the governor shall 

7 ensure the involvement of the State Office of Rural 

8 Health in the development and administration of the 

9 State program under this section. 

10 (2) DUTIES.—The lead agency of a State 

11 shall— 

12 (A) administer, directly or through other 

13 governmental or nongovernmental agencies, 

14 amounts received under a grant under sub15 section (a); and 

16 (B) develop the State plan under sub17 section (d) and coordinate the expenditure of 

18 funds in consultation with appropriate rep19 resentatives of the State and local educational 

20 agencies and the rural mental health providers 

21 and State hospital associations. 

22 (d) STATE PLAN.—To be eligible to receive a grant 

23 under subsection (a), a State shall submit to the Secretary 

24 a State plan that shall— 

25 (1) identify the lead agency of the State; 


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1 (2) contain assurances that the State shall use 

2 the amounts provided to the State under the grant 

3 to address— 

4 (A) in the case of mobile van services, the 

5 mental health needs of elementary school and 

6 secondary school students; or 

7 (B) in the case of telemental health serv8 ices, the mental health needs of individuals of 

9 all ages through telemental health services, and 

10 to pay administrative costs incurred in connec11 tion with providing the assistance to grant re12 cipients; 

13 (3) contain assurances that benefits and serv14 ices under the grant shall be available throughout 

15 the entire State; and 

16 (4) contain assurances that the lead agency 

17 shall consult with rural mental health providers and 

18 hospital associations that represent such providers in 

19 such State on the most appropriate ways to use the 

20 funds received under the grant. 

21 (e) AWARDING OF SUBGRANTS.— 

22 (1) IN GENERAL.—The lead agency of the State 

23 shall use amounts received under a grant under sub24 section (a) to award subgrants to eligible entities on 

25 a competitive basis. 


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1 (2) ELIGIBILITY.—To be eligible to receive a 

2 subgrant under paragraph (1), a grant applicant 

3 shall be located in or serving a rural area and be a 

4 government-owned or private nonprofit hospital (or, 

5 in the case of a mobile van services program, a gov6 ernmental, tribal, or private nonprofit school district 

7 or educational institution which provides elementary 

8 education or secondary education (kindergarten 

9 through grade 12) and that collaborates with such 

10 a hospital), a community mental health center, a pri11 mary care clinic, or other nonprofit agency providing 

12 mental health services. 

13 (3) SELECTION CRITERIA.—In establishing pro14 cedures for the awarding of subgrants under para15 graph (1), the lead agency of the State shall provide 

16 for the use of the following selection criteria: 

17 (A) The extent to which a grant applicant 

18 demonstrates a need to improve the access of 

19 mental health services within the community 

20 served by such applicant. 

21 (B) The extent to which a grant applicant 

22 will serve a rural community with a significant 

23 low-income or other population that is under24 served with respect to the provision of mental 

25 health services. 


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1 (4) APPLICATION AND APPROVAL.—To be eligi2 ble to receive a subgrant under paragraph (1), an 

3 entity shall submit an application to the lead agency 

4 of the State that includes— 

5 (A) a description of the manner in which 

6 the entity intends to use amounts provided 

7 under the subgrant; 

8 (B) such information as the lead agency 

9 may require to apply the selection criteria 

10 under paragraph (3); 

11 (C) measurable objectives for the use of 

12 funds provided under the subgrant; 

13 (D) a description of the manner in which 

14 the applicant will evaluate the effectiveness of 

15 the program carried out under the subgrant; 

16 (E) an agreement to maintain such 

17 records, make such reports, and cooperate with 

18 such reviews or audits as the lead agency and 

19 the Secretary may find necessary for purposes 

20 of oversight of program activities and expendi21 tures; 

22 (F) a plan for sustaining activities and 

23 services funded under the subgrant after Fed24 eral support for such activities and services has 

25 ended; and 


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1 (G) such other information and assurances 

2 as the Secretary may require. 

3 (5) USE OF FUNDS.—A recipient of a subgrant 

4 under paragraph (1) shall use amounts awarded 

5 under the grant to— 

6 (A) in the case of mobile van health serv7 ices, offset costs incurred after December 31, 

8 2007, that are related to operating a mobile 

9 van outreach program under which a hospital 

10 and one or more elementary or secondary 

11 schools provide mental health care services to 

12 students of such schools in the rural area, 

13 which may include the costs of— 

14 (i) purchasing or leasing a mobile van 

15 in which mental health services are pro16 vided to elementary school or secondary 

17 school students; 

18 (ii) repairs and maintenance for such 

19 a mobile van; 

20 (iii) purchasing or leasing communica21 tions capabilities reasonable and necessary 

22 to operate the mobile van; 

23 (iv) providing education and training 

24 to staff on operating the mobile van pro25 gram; and 


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1 (v) providing for additional mental 

2 health services professional staff that are 

3 employed to provide mental health services 

4 as part of the mobile van program; and 

5 (B) in the case of telemental health serv6 ices, offset costs incurred after December 31, 

7 2007, that are related to providing telemental 

8 health services to persons of all ages in the 

9 rural area, which may include the cost of— 

10 (i) purchasing, leasing, repairing, 

11 maintaining, or upgrading telemental 

12 health services equipment; 

13 (ii) operating telemental health serv14 ices equipment, including telecommuni15 cations, utilities, and software costs; 

16 (iii) providing education and training 

17 to staff concerning the provision of tele18 mental health services; and 

19 (iv) employing additional mental 

20 health services professional staff to provide 

21 telemental health services. 

22 (6) LIMITS.—The amount awarded to an entity 

23 as a subgrant under paragraph (1) for any fiscal 

24 year shall not exceed $300,000. 


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1 (f) REPORTING, MONITORING, AND EVALUATION.— 

2 The lead agency of each State that receives a grant under 

3 subsection (a) shall submit a report to the Secretary that 

4 contains— 

5 (1) the amounts received under the grant; 

6 (2) the amounts allocated as subgrants under 

7 subsection (e); 

8 (3) the types of expenditures made by subgrant 

9 recipients with such funds; and 

10 (4) such other information as may be required 

11 by the Secretary to assist the Secretary in moni12 toring the effectiveness of this section. 

13 (g) REVIEW OF COMPLIANCE WITH STATE PLAN.— 

14 (1) IN GENERAL.—The Secretary shall review 

15 and monitor State compliance with the requirements 

16 of this section and the State plan submitted under 

17 subsection (d). 

18 (2) FAILURE TO COMPLY.—If the Secretary, 

19 after reasonable notice to a State and opportunity 

20 for a hearing, determines that there has been a fail21 ure by the State to comply substantially with any 

22 provision or requirement set forth in the State plan 

23 or a requirement of this section, the Secretary shall 

24 notify the lead agency of the State of such deter25 mination and that no further payments to the State 


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1 will be made with respect to the State grant until 

2 the Secretary is satisfied that there is no longer any 

3 failure to comply or that the noncompliance will be 

4 promptly corrected. 

5 (h) INTERACTION OF FEDERAL AND STATE LAW.— 

6 Federal and State procurement laws shall be preempted 

7 to the extent necessary to carry out this section. 

8 (i) DEFINITIONS.—In this section: 

9 (1) HOSPITAL.—The term ‘‘hospital’’ means a 

10 non-Federal short-term general acute care facility lo11 cated in or serving a rural area. 

12 (2) MOBILE VAN.—The term ‘‘mobile van’’ 

13 means a mobile wellness center the purpose of which 

14 is to improve access to, and focuses on, early inter15 vention of mental health, and that provides consulta16 tion, education, comprehensive interdisciplinary edu17 cation, and collaborative treatment planning serv18 ices. 

19 (3) RURAL AREA.—The term ‘‘rural area’’, with 

20 respect to the location of an eligible applicant, or 

21 with respect to the location of mental health serv22 ices, means that the entity or services— 

23 (A) is located in a rural census tract of a 

24 metropolitan statistical area, as determined 

25 under the most recent version of the Goldsmith 


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1 Modification, the Rural-Urban Commuting Area 

2 codes, as determined by the Office of Rural 

3 Health Policy of the Health Resources and 

4 Services Administration; or 

5 (B) is located in an area designated by any 

6 law or regulation of such State as a rural area 

7 (or, in the case of a hospital, is designated by 

8 such State as a rural hospital). 

9 (4) TELEMENTAL HEALTH SERVICES.—The 

10 term ‘‘telemental health services’’ means mental 

11 health services that are provided through the use of 

12 videoconferencing or similar means of electronic 

13 communications and information technology. 

14 (5) TELEMENTAL HEALTH SERVICES EQUIP15 MENT.—The term ‘‘telemental health services equip16 ment’’ includes telecommunications and peripheral 

17 equipment used to provide patient evaluations, case 

18 management, medication management, crisis re19 sponse, pre-admission and pre-discharge planning, 

20 treatment planning, individual and group therapy, 

21 family therapy, mental status evaluations, case con22 ferences, family visits, staff training, and adminis23 trative activities relating to the mental health serv24 ices. 


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1 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

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

3 $10,000,000 for each of fiscal years 2008 through 2010. 

Æ 


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