I 

118TH CONGRESS 

1ST SESSION H. R. 5804 

To authorize the Secretary of Health and Human Services to make loans 

and loan guarantees for planning, constructing, or renovating pediatric 

or adult mental health treatment facilities and pediatric or adult substance use disorder treatment facilities, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 28, 2023 

Mr. KILMER (for himself and Mr. BACON) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To authorize the Secretary of Health and Human Services 

to make loans and loan guarantees for planning, constructing, or renovating pediatric or adult mental health 

treatment facilities and pediatric or adult substance use 

disorder treatment facilities, and for other purposes. 

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 ‘‘Mental Health Infra5 structure Improvement Act of 2023’’. 


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1 SEC. 2. LOANS AND LOAN GUARANTEES. 

2 Part P of title III of the Public Health Service Act 

3 is amended by inserting after section 399V–7 of such Act 

4 (42 U.S.C. 280g–17) the following: 

5 ‘‘SEC. 399V–8. LOANS AND LOAN GUARANTEES FOR PLAN6 NING, CONSTRUCTING, OR RENOVATING ELI7 GIBLE FACILITIES FOR PEDIATRIC OR ADULT 

8 MENTAL HEALTH AND SUBSTANCE USE DIS9 ORDER SERVICES. 

10 ‘‘(a) IN GENERAL.—The Secretary may— 

11 ‘‘(1) make loans and loan guarantees to eligible 

12 entities for the purpose of— 

13 ‘‘(A) constructing or renovating, including 

14 planning the construction or renovation of, a 

15 pediatric or adult mental health treatment facil16 ity or a pediatric or adult substance use dis17 order treatment facility; 

18 ‘‘(B) improving digital infrastructure, tele19 health capabilities, or other patient care infra20 structure at such a facility; or 

21 ‘‘(C) adding, or converting beds to, adult 

22 or pediatric psychiatric and substance use inpa23 tient beds at such a facility; and 

24 ‘‘(2) subject to subsection (e), make loans and 

25 loan guarantees for refinancing loans that were 

26 made for such purpose to an eligible entity. 


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1 ‘‘(b) PREFERENCE.—In making loans and loan guar2 antees under this section, the Secretary shall give pref3 erence to eligible entities proposing to construct or ren4 ovate a pediatric or adult mental health treatment facility, 

5 or a pediatric or adult substance use disorder treatment 

6 facility, that will— 

7 ‘‘(1) increase the number of pediatric or adult 

8 psychiatric beds or pediatric or adult substance use 

9 disorder beds in a county that has insufficient psy10 chiatric or substance use disorder treatment bed ca11 pacity; 

12 ‘‘(2) provide mental health or substance use 

13 disorder services in a high-need rural or 

14 underresourced community; 

15 ‘‘(3) provide multiple services across the con16 tinuum of mental health or substance use disorder 

17 care; or 

18 ‘‘(4) have the capacity to provide integrated or 

19 specialized mental health and substance use disorder 

20 care for complex cases or patients with medical co21 morbidities. 

22 ‘‘(c) SET-ASIDE.—The Secretary shall allocate at 

23 least 25 percent of the funds under this section for any 

24 fiscal year for awards to construct or renovate facilities 

25 serving primarily pediatric populations. 


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1 ‘‘(d) TERMS AND CONDITIONS.—Loans and loan 

2 guarantees under this section shall be made on such terms 

3 and conditions as the Secretary may prescribe, subject to 

4 the provisions of this section including the following: 

5 ‘‘(1) The Secretary may allow credit to a pro6 spective borrower only where— 

7 ‘‘(A) it is necessary to increase the number 

8 of psychiatric or substance use disorder treat9 ment facilities to enhance the public’s access to 

10 a comprehensive continuum of mental health 

11 and substance use disorder services; and 

12 ‘‘(B) a credit subsidy is the most efficient 

13 way to achieve such increase (on a borrower-by14 borrower basis). 

15 ‘‘(2) The final maturity of loans made or guar16 anteed under this section shall not exceed a period 

17 of 20 years, or the period of 50 percent of the useful 

18 life of any physical asset to be financed by the loan, 

19 whichever is less as determined by the Secretary. 

20 ‘‘(3) The Secretary may not make a loan guar21 antee under this section, with respect to any bor22 rower, in excess of 80 percent of any potential loss 

23 on the loan. 


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1 ‘‘(4) The Secretary may not make any loan or 

2 loan guarantee under this section if the loan will be 

3 subordinated— 

4 ‘‘(A) to another debt contracted by the 

5 borrower; or 

6 ‘‘(B) to any other claims against the bor7 rower in the case of default. 

8 ‘‘(5) The Secretary may not make any loan 

9 guarantee under this section unless the Secretary 

10 determines that— 

11 ‘‘(A) the lender is responsible; and 

12 ‘‘(B) adequate provision is made for serv13 icing the loan on reasonable terms and pro14 tecting the financial interest of the United 

15 States. 

16 ‘‘(6) The Secretary may not make any loan 

17 guarantee under this section if the income from the 

18 loan will be excluded from gross income for purposes 

19 of chapter 1 of the Internal Revenue Code of 1986. 

20 ‘‘(7) The Secretary may not make any loan or 

21 loan guarantee under this section unless— 

22 ‘‘(A) the loan and interest supplements on 

23 any loan guarantee will be at an interest rate 

24 that is set by reference to a benchmark interest 

25 rate on marketable Treasury securities with a 


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1 similar maturity to the loan being made or 

2 guaranteed; and 

3 ‘‘(B) the minimum interest rate on the 

4 loan— 

5 ‘‘(i) will be no less than the estimated 

6 cost to the Government of making the loan 

7 plus 1 percent, with the goal of keeping 

8 the interest rate below the interest rate of 

9 a comparable and competitive private sec10 tor benchmark financial instrument; and 

11 ‘‘(ii) will be adjusted, as determined 

12 by the Secretary, every quarter to take ac13 count of changes in the interest rate of the 

14 benchmark financial instrument. 

15 ‘‘(8) The Secretary may not make any loan or 

16 loan guarantee under this section unless— 

17 ‘‘(A) fees or premiums on the loan or loan 

18 guarantee and corresponding insurance cov19 erage will be set at levels that minimize the cost 

20 to the Government (as defined in section 502(5) 

21 of the Federal Credit Reform Act of 1990) of 

22 insuring such loan or loan guarantee, while sup23 porting achievement of enhancing the public’s 

24 access to a comprehensive continuum of mental 

25 health and substance use disorder services, inVerDate Sep 11 2014 04:17 Oct 01, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5804.IH H5804

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1 cluding increasing the number of inpatient psy2 chiatric and substance use disorder bed counts 

3 in areas with insufficient bed capacity; 

4 ‘‘(B) the minimum guarantee fee or insur5 ance premium imposed by the Government will 

6 be no less than the level sufficient to cover all 

7 of the estimated costs to the Government of the 

8 expected default claims, plus one percent; and 

9 ‘‘(C) loan guarantee fees imposed by the 

10 Government will be reviewed every six months 

11 to ensure that the fees imposed on new loan 

12 guarantees are at a level sufficient to satisfy 

13 subparagraph (B) based on the most recent es14 timates of such costs. 

15 ‘‘(9) The provisions of any loan guarantee 

16 under this section shall state that the guarantee is 

17 conclusive evidence that— 

18 ‘‘(A) the guarantee has been properly ob19 tained; 

20 ‘‘(B) the underlying loan qualified for the 

21 guarantee; and 

22 ‘‘(C) except in the case of fraud or mate23 rial misrepresentation by the holder of the loan, 

24 the guarantee will be presumed to be valid, 

25 legal, and enforceable. 


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1 ‘‘(10) The Secretary may not make any loan or 

2 loan guarantee under this section unless— 

3 ‘‘(A) the borrower finances at least 25 per4 cent of the funded project from other sources; 

5 and 

6 ‘‘(B) the borrower uses funds that were 

7 not derived from Federal loans or loan guaran8 tees to pay the fees or premiums on the loan or 

9 loan guarantee under this section. 

10 ‘‘(11) The Secretary— 

11 ‘‘(A) shall prescribe explicit standards for 

12 use in periodically assessing the credit risk of 

13 new and existing direct loans and guaranteed 

14 loans; and 

15 ‘‘(B) shall not make a loan or loan guar16 antee under this section unless the Secretary 

17 finds that there is a reasonable assurance of re18 payment. 

19 ‘‘(e) LIMITATION ON REFINANCING.—The authority 

20 vested by subsection (a)(2)— 

21 ‘‘(1) authorizes making loans and loan guaran22 tees only for refinancing loans that are entered into 

23 on or before the date that is 24 months before the 

24 date of enactment of the Mental Health Infrastruc25 ture Improvement Act of 2023; and 


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1 ‘‘(2) terminates on the date that is 24 months 

2 after such date of enactment. 

3 ‘‘(f) PAYMENT OF LOSSES.— 

4 ‘‘(1) DEFAULT ON GUARANTEED LOANS.—If, as 

5 a result of a default by a borrower under a loan 

6 guaranteed under this section, after the holder 

7 thereof has made such further collection efforts and 

8 instituted such enforcement proceedings as the Sec9 retary may require, the Secretary determines that 

10 the holder has suffered a loss— 

11 ‘‘(A) the Secretary shall pay to such holder 

12 75 percent of such loss, as specified in the 

13 guarantee contract; 

14 ‘‘(B) upon making any such payment, the 

15 Secretary shall be subrogated to all the rights 

16 of the recipient of the payment; and 

17 ‘‘(C) the Secretary shall be entitled to re18 cover from the borrower the amount of any pay19 ments made pursuant to the guarantee con20 tract. 

21 ‘‘(2) REQUIRED ENFORCE OF FEDERAL

22 RIGHTS.—The Attorney General of the United 

23 States shall take such action as may be appropriate 

24 to enforce any right accruing to the United States 


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1 as a result of the issuance of any guarantee under 

2 this section. 

3 ‘‘(3) FORBEARANCE.—Nothing in this section 

4 precludes any forbearance for the benefit of the bor5 rower of a loan that is made or guaranteed under 

6 this section which is agreed upon by the parties to 

7 the loan and approved by the Secretary, provided 

8 that budget authority for any resulting cost to the 

9 Government (as defined in section 502(5) of the 

10 Federal Credit Reform Act of 1990) is available. 

11 ‘‘(g) DEFINITIONS.—In this section: 

12 ‘‘(1) The term ‘children’s hospital’ means a 

13 hospital that predominantly serves patients under 

14 the age of 18. 

15 ‘‘(2) The term ‘critical access hospital’ has the 

16 meaning given to such term in section 1861(mm) of 

17 the Social Security Act. 

18 ‘‘(3) The term ‘eligible entity’ includes public, 

19 private for-profit, and private not-for-profit— 

20 ‘‘(A) hospitals including general acute hos21 pitals, psychiatric hospitals, critical access hos22 pitals, rural emergency hospitals, sole commu23 nity hospitals, children’s hospitals, and other 

24 hospitals as specified by the Secretary; 


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1 ‘‘(B) substance use disorder treatment fa2 cilities; 

3 ‘‘(C) mental health treatment facilities; 

4 ‘‘(D) facilities that employ licensed mental 

5 health and substance use disorder professionals, 

6 such as child and adult psychiatrists, child and 

7 adult psychologists, advanced practice nurses, 

8 social workers, licensed professional counselors, 

9 or other licensed professionals that provide 

10 mental health or substance use disorder services 

11 to pediatric or adult patients; 

12 ‘‘(E) alliances of hospitals or facilities list13 ed in any of clauses (i), (ii), (iii), (iv), and (vi); 

14 and 

15 ‘‘(F) other facilities as determined by the 

16 Secretary. 

17 ‘‘(4) The term ‘mental health treatment facil18 ity’— 

19 ‘‘(A) includes— 

20 ‘‘(i) a child or adult outpatient facility 

21 that provides— 

22 ‘‘(I) intensive outpatient services; 

23 ‘‘(II) partial hospitalization serv24 ices; 


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1 ‘‘(III) crisis intervention and sta2 bilization; or 

3 ‘‘(IV) other mental, behavioral, 

4 or emotional health services deemed 

5 appropriate by the Secretary; 

6 ‘‘(ii) a hospital (including a general 

7 acute hospital, a psychiatric hospital, a 

8 critical access hospital, a rural emergency 

9 hospital, a sole community hospital, a chil10 dren’s hospital, or other type of hospital as 

11 specified by the Secretary) that— 

12 ‘‘(I) provides acute, short-term 

13 inpatient psychiatric treatment serv14 ices or outpatient services; and 

15 ‘‘(II) may include a military serv16 ices program to meet the needs of ac17 tive and retired military 

18 servicemembers; and 

19 ‘‘(iii) a facility within or near an 

20 emergency department for providing dis21 charge planning and instructions to emer22 gency department patients in need of men23 tal health or substance use disorder treat24 ment and transfer to an appropriate menVerDate Sep 11 2014 04:17 Oct 01, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5804.IH H5804

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1 tal health or substance use disorder treat2 ment care setting; and 

3 ‘‘(B) excludes a facility that provide long4 term inpatient care. 

5 ‘‘(5) The term ‘substance use disorder treat6 ment facility’— 

7 ‘‘(A) includes— 

8 ‘‘(i) a child or adult outpatient facility 

9 that provides outpatient substance use dis10 order services; and 

11 ‘‘(ii) a hospital (including a general 

12 acute hospital, a psychiatric hospital, a 

13 critical access hospital, a rural emergency 

14 hospital, a sole community hospital, a chil15 dren’s hospital, or other type of hospital as 

16 specified by the Secretary) that— 

17 ‘‘(I) provides acute, short-term 

18 inpatient substance use disorder treat19 ment services or outpatient services; 

20 and 

21 ‘‘(II) may include a military serv22 ices program to meet the needs of ac23 tive and retired military 

24 servicemembers; and 


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1 ‘‘(B) excludes any facility described in 

2 paragraph (1)(B). 

3 ‘‘(6) The term ‘psychiatric hospital’ has the 

4 meaning given to such term in section 1861(f) of the 

5 Social Security Act. 

6 ‘‘(7) The term ‘rural emergency hospital’ has 

7 the meaning given to such term in section 

8 1861(kkk) of the Social Security Act. 

9 ‘‘(8) The term ‘sole community hospital’ has 

10 the meaning given to such term in section 

11 1886(d)(5)(D)(iii) of the Social Security Act. 

12 ‘‘(h) FUNDING LIMITATIONS.—The Secretary may 

13 provide loans and loan guarantees under this section— 

14 ‘‘(1) only to the extent or in the amounts pro15 vided in advance in appropriation Acts; and 

16 ‘‘(2) totaling not more than $200,000,000 for 

17 each of fiscal years 2024 through 2028.’’. 

18 SEC. 3. MENTAL HEALTH AND SUBSTANCE USE TREAT19 MENT TRUST FUND. 

20 (a) ESTABLISHMENT.—There is established in the 

21 Treasury of the United States a trust fund to be known 

22 as the Mental Health and Substance Use Treatment Trust 

23 Fund (in this section referred to as the ‘‘Trust Fund’’). 

24 (b) DEPOSITS.—There are hereby authorized to be 

25 appropriated to the Trust Fund, to remain available until 


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1 expended, amounts equivalent to any revenues from the 

2 program of loans and loan guarantees under section 

3 399V–7 of the Public Health Service Act, as added by sec4 tion 2, that exceed the costs of carrying out such program. 

5 (c) USE OF FUND.—Amounts in the Trust Fund 

6 shall be available, as provided by appropriation Acts, for 

7 block grants for community mental health services under 

8 subpart I of part B of title XIX of the Public Health Serv9 ice Act (42 U.S.C. 300x et seq.). 

Æ 


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