II 

111TH CONGRESS 

1ST SESSION S. 1188 

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

services. 

IN THE SENATE OF THE UNITED STATES 

JUNE 4, 2009 

Mr. REED (for himself, Ms. MURKOWSKI, and Mr. WHITEHOUSE) introduced 

the following bill; which was read twice and referred to the Committee 

on Health, Education, Labor, and Pensions 

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; 

10 ‘‘(C) information technology required to 

11 accommodate the clinical needs of primary and 

12 specialty care professionals; or 

13 ‘‘(D) facility improvements or modifica14 tions needed to bring primary and specialty 

15 care professionals on site at the eligible entity. 

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

17 grant funds may be used for activities described in 

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

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

20 shall ensure that grants awarded under this section are 

21 equitably distributed among the geographical regions of 

22 the United States and between urban and rural popu23 lations. 

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

25 grant or cooperative agreement awarded under this section 


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

2 results of an evaluation to be conducted by the entity con3 cerning the effectiveness of the activities carried out under 

4 the grant or agreement. 

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

6 of enactment of this section, the Secretary shall prepare 

7 and submit to the appropriate committees of Congress a 

8 report that shall evaluate the activities funded under this 

9 section. The report shall include an evaluation of the im10 pact of co-locating primary and specialty care in commu11 nity mental and behavioral health settings on overall pa12 tient health status and recommendations on whether or 

13 not the demonstration program under this section should 

14 be made permanent. 

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

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

17 $50,000,0000 for fiscal year 2010 and such sums as may 

18 be necessary for each of fiscal years 2011 through 2014.’’. 

19 SEC. 4. INTEGRATING TREATMENT FOR MENTAL HEALTH 

20 AND SUBSTANCE ABUSE CO-OCCURRING DIS21 ORDERS. 

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

23 U.S.C. 290bb–40) is amended— 

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

25 following: 


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

2 to carry out this section, $14,000,000 for fiscal year 2010, 

3 $20,000,000 for fiscal year 2011, and such sums as may 

4 be necessary for each of fiscal years 2012 through 2014. 

5 Such sums shall be made available in equal amount from 

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

7 and 

8 (2) by inserting before subsection (j), the fol9 lowing: 

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

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

12 nonprofit organization’ includes a qualified community 

13 mental health program as defined under section 

14 1913(b)(1).’’. 

15 SEC. 5. IMPROVING THE MENTAL HEALTH WORKFORCE. 

16 (a) NATIONAL HEALTH SERVICE CORPS.—Para17 graph (1) of section 332(a) of the Public Health Service 

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

19 community mental health centers meeting the criteria 

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

21 (42 U.S.C. 1395x(aa)),’’. 

22 (b) RECRUITMENT AND RETENTION OF MENTAL

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

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

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


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

2 OF MENTAL HEALTH PROFESSIONALS. 

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

4 through the Administrator of the Health Resources and 

5 Services Administration, shall award grants to States, ter6 ritories, and Indian tribes or tribal organizations for inno7 vative programs to address the behavioral and mental 

8 health workforce needs of designated mental health profes9 sional shortage areas. 

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

11 grant funds awarded under this section for— 

12 ‘‘(1) loan forgiveness and repayment programs 

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

14 repayment programs carried out under subpart III 

15 of part D) for behavioral and mental health profes16 sionals who— 

17 ‘‘(A) agree to practice in designated men18 tal health professional shortage areas; 

19 ‘‘(B) are graduates of programs in behav20 ioral or mental health; 

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

22 nonprofit entities, or as public mental health 

23 professionals for the Federal, State or local gov24 ernment; and 

25 ‘‘(D) agree to— 


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1 ‘‘(i) provide services to patients re2 gardless of such patients’ ability to pay; 

3 and 

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

5 patients who are unable to pay the total 

6 cost of services; 

7 ‘‘(2) behavioral and mental health professional 

8 recruitment and retention efforts, with a particular 

9 emphasis on candidates from racial and ethnic mi10 nority and medically underserved communities; 

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

12 for behavioral and mental health professionals who 

13 participate in the Medicaid program under title XIX 

14 of the Social Security Act to establish or expand 

15 practices in designated mental health professional 

16 shortage areas, or to serve in qualified community 

17 mental health programs as defined in section 

18 1913(b)(1); 

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

20 mental health students, residents, trainees, and fel21 lows or interns; or 

22 ‘‘(5) continuing behavioral and mental health 

23 education, including distance-based education. 

24 ‘‘(c) APPLICATION.— 


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1 ‘‘(1) IN GENERAL.—Each eligible entity desir2 ing a grant under this section shall submit an appli3 cation to the Secretary at such time, in such man4 ner, and containing such information as the Sec5 retary may reasonably require. 

6 ‘‘(2) ASSURANCES.—The application shall in7 clude assurances that the applicant will meet the re8 quirements of this subsection and that the applicant 

9 possesses sufficient infrastructure to manage the ac10 tivities to be funded through the grant and to evalu11 ate and report on the outcomes resulting from such 

12 activities. 

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

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

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

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

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

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

19 than 35 percent of Federal funds provided under the 

20 grant. The entity may provide the contributions in cash 

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

22 and services, and may provide the contributions from 

23 State, local, or private sources. 

24 ‘‘(e) SUPPLEMENT NOT SUPPLANT.—A grant award25 ed under this section shall be expended to supplement, and 


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1 not supplant, the expenditures of the eligible entity and 

2 the value of in-kind contributions for carrying out the ac3 tivities for which the grant was awarded. 

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

5 shall ensure that grants awarded under this section are 

6 equitably distributed among the geographical regions of 

7 the United States and between urban and rural popu8 lations. 

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

10 a grant awarded under this section expires, an eligible en11 tity shall submit to the Secretary the results of an evalua12 tion to be conducted by the entity concerning the effective13 ness of the activities carried out under the grant. 

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

15 of enactment of this section, the Secretary shall prepare 

16 and submit to the appropriate committees of Congress a 

17 report containing data relating to whether grants provided 

18 under this section have increased access to behavioral and 

19 mental health services in designated mental health profes20 sional shortage areas. 

21 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 

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

23 $10,000,000 for fiscal year 2010, and such sums as may 

24 be necessary for each of fiscal years 2011 through 2014.’’. 


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1 (c) BEHAVIORAL AND MENTAL HEALTH EDUCATION

2 AND TRAINING PROGRAMS.—Part A of title V of the Pub3 lic Health Service Act (42 U.S.C. 290aa et seq.) is amend4 ed by adding at the end the following: 

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

6 HEALTH EDUCATION AND TRAINING PRO7 GRAMS. 

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

9 the term ‘related mental health personnel’ means an indi10 vidual who— 

11 ‘‘(1) facilitates access to a medical, social, edu12 cational, or other service; and 

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

14 who is the first point of contact with persons who 

15 are seeking mental health services. 

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

17 through the Administrator of the Substance Abuse and 

18 Mental Health Services Administration, shall establish a 

19 program to increase the number of trained behavioral and 

20 mental health professionals and related mental health per21 sonnel by awarding grants on a competitive basis to men22 tal and behavioral health nonprofit organizations or ac23 credited institutions of higher education to enable such en24 tities to establish or expand accredited mental and behav25 ioral health education programs. 


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1 ‘‘(c) APPLICATION.— 

2 ‘‘(1) IN GENERAL.—Each eligible entity desir3 ing a grant under this section shall submit an appli4 cation to the Secretary at such time, in such man5 ner, and containing such information as the Sec6 retary may reasonably require. 

7 ‘‘(2) ASSURANCES.—The application shall in8 clude assurances that the applicant will meet the re9 quirements of this subsection and that the applicant 

10 possesses sufficient infrastructure to manage the ac11 tivities to be funded through the grant and to evalu12 ate and report on the outcomes resulting from such 

13 activities. 

14 ‘‘(d) PRIORITY.—In awarding grants under this sec15 tion, the Secretary shall give priority to applicants that— 

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

17 evidence-based methods in behavioral and mental 

18 health services; 

19 ‘‘(2) provide interdisciplinary training experi20 ences; and 

21 ‘‘(3) demonstrate a commitment to training 

22 methods and practices that emphasize the integrated 

23 treatment of mental health and substance abuse dis24 orders. 


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

2 section shall be used to— 

3 ‘‘(1) establish or expand accredited behavioral 

4 and mental health education programs, including im5 proving the coursework, related field placements, or 

6 faculty of such programs; or 

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

8 behavioral health training programs for related men9 tal health personnel. 

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

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

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

13 assisted under the grant will prioritize cultural com14 petency and the recruitment of trainees from racial 

15 and ethnic minority and medically underserved com16 munities; and 

17 ‘‘(2) with respect to any violation of the agree18 ment between the Secretary and the entity, the enti19 ty will pay such liquidated damages as prescribed by 

20 the Secretary. 

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

22 shall ensure that grants awarded under this section are 

23 equitably distributed among the geographical regions of 

24 the United States and between urban and rural popu25 lations. 


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

2 a grant awarded under this section expires, an eligible en3 tity shall submit to the Secretary the results of an evalua4 tion to be conducted by the entity concerning the effective5 ness of the activities carried out under the grant. 

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

7 of enactment of this section, the Secretary shall prepare 

8 and submit to the appropriate committees of Congress a 

9 report containing data relating to whether grants provided 

10 under this section have increased access to behavioral and 

11 mental health services in designated mental health profes12 sional shortage areas. 

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

14 are authorized to be appropriated to carry out this section 

15 $4,000,0000 for fiscal year 2010, and such sums as may 

16 be necessary for each of fiscal years 2011 through 2014.’’. 

17 SEC. 6. IMPROVING ACCESS TO MENTAL HEALTH SERVICES 

18 IN MEDICALLY UNDERSERVED AREAS. 

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

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

21 section 3, is amended by inserting after section 520A the 

22 following: 


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1 ‘‘SEC. 520B. GRANTS FOR TELE-MENTAL HEALTH IN MEDI2 CALLY UNDERSERVED AREAS. 

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

4 through the Administrator of the Substance Abuse and 

5 Mental Health Services Administration, shall award 

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

7 medically underserved areas. 

8 ‘‘(b) ELIGIBLE ENTITY.—To be eligible for assist9 ance under the program under subsection (a), an entity 

10 shall be a qualified community mental health program (as 

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

12 ‘‘(c) APPLICATION.— 

13 ‘‘(1) IN GENERAL.—Each eligible entity desir14 ing a grant under this section shall submit an appli15 cation to the Secretary at such time, in such man16 ner, and containing such information as the Sec17 retary may reasonably require. 

18 ‘‘(2) ASSURANCES.—The application shall in19 clude assurances that the applicant will meet the re20 quirements of this subsection and that the applicant 

21 possesses sufficient infrastructure to manage the ac22 tivities to be funded through the grant and to evalu23 ate and report on the outcomes resulting from such 

24 activities. 

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

26 funds received under a grant under this section for— 


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

2 or 

3 ‘‘(2) infrastructure improvements for the provi4 sion of tele-mental health services. 

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

6 shall ensure that grants awarded under this section are 

7 equitably distributed among the geographical regions of 

8 the United States and between urban and rural popu9 lations. 

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

11 grant awarded under this section expires, an eligible entity 

12 shall submit to the Secretary the results of an evaluation 

13 to be conducted by the entity concerning the effectiveness 

14 of the activities carried out under the grant. 

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

16 of enactment of this section, the Secretary shall prepare 

17 and submit to the appropriate committees of Congress a 

18 report that shall evaluate the activities funded under this 

19 section. 

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

21 are authorized to be appropriated to carry out this section 

22 $20,000,000 for fiscal year 2010, and such sums as may 

23 be necessary for each of fiscal years 2011 through 2014.’’. 


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1 SEC. 7. IMPROVING HEALTH INFORMATION TECHNOLOGY 

2 FOR MENTAL HEALTH PROVIDERS. 

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

4 (42 U.S.C. 290aa et seq.), as amended by section 5(c), 

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

6 ‘‘SEC. 506D. IMPROVING HEALTH INFORMATION TECH7 NOLOGY FOR MENTAL HEALTH PROVIDERS. 

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

9 with the Secretary of Veterans Affairs, shall collaborate 

10 with the Administrator of the Substance Abuse and Men11 tal Health Services Administration and the National Coor12 dinator for Health Information Technology to— 

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

14 that various components of the National Health In15 formation Infrastructure, including data and privacy 

16 standards, electronic health records, and community 

17 and regional health networks, address the needs of 

18 mental health and substance abuse treatment pro19 viders; and 

20 ‘‘(2) finance related infrastructure improve21 ments, technical support, personnel training, and on22 going quality improvements. 

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

24 are authorized to be appropriated to carry out this section 


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1 $10,000,000 for fiscal year 2010, and such sums as may 

2 be necessary for each of fiscal years 2011 through 2014.’’. 

Æ 


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