II 

113TH CONGRESS 

1ST SESSION S. 264 

To expand access to community mental health centers and improve the quality 

of mental health care for all Americans. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 7, 2013 

Ms. STABENOW (for herself, Mr. REED, Mr. BLUNT, Mr. RUBIO, Ms. COLLINS, Mrs. BOXER, Mr. ROCKEFELLER, Mr. TESTER, Mr. BEGICH, and 

Mr. LEAHY) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To expand access to community mental health centers and 

improve the quality of mental health care for all Americans. 

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 Section 1913 of the Public Health Service Act (42 

9 U.S.C. 300x–2) is amended— 


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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 feder4 ally qualified community behavioral health centers 

5 consistent with subsection (c)(3))’’; 

6 (2) in subsection (b)— 

7 (A) by striking paragraph (1) and insert8 ing the following: 

9 ‘‘(1) services under the plan will be provided 

10 only through appropriate, qualified community pro11 grams (which may include federally qualified com12 munity behavioral health centers, child mental 

13 health programs, psychosocial rehabilitation pro14 grams, mental health peer-support programs, out15 patient addiction treatment programs, acute detoxi16 fication services, and mental health primary con17 sumer-directed programs); and’’; and 

18 (B) in paragraph (2), by striking ‘‘commu19 nity mental health centers’’ and inserting ‘‘fed20 erally qualified community behavioral health 

21 centers’’; and 

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

23 following: 

24 ‘‘(c) CRITERIA FOR FEDERALLY QUALIFIED COMMU25 NITY BEHAVIORAL HEALTH CENTERS.— 


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1 ‘‘(1) IN GENERAL.—The Administrator shall 

2 certify, and recertify at least every 5 years, federally 

3 qualified community behavioral health centers as 

4 meeting the criteria specified in this subsection. 

5 ‘‘(2) REGULATIONS.—Not later than 18 months 

6 after the date of the enactment of the Excellence in 

7 Mental Health Act, the Administrator, in consulta8 tion with State Mental Health and Substance Abuse 

9 Authorities, shall issue final regulations for certi10 fying non-profit or local government centers as cen11 ters under paragraph (1). 

12 ‘‘(3) CRITERIA.—The criteria referred to in 

13 subsection (b)(2) are that the center performs each 

14 of the following: 

15 ‘‘(A) Provide services in locations that en16 sure services will be available and accessible 

17 promptly and in a manner which preserves 

18 human dignity and assures continuity of care. 

19 ‘‘(B) Provide services in a mode of service 

20 delivery appropriate for the target population. 

21 ‘‘(C) Provide individuals with a choice of 

22 service options where there is more than one ef23 ficacious treatment. 


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1 ‘‘(D) Employ a core staff of clinical staff 

2 that is multidisciplinary and culturally and lin3 guistically competent. 

4 ‘‘(E) Provide services, within the limits of 

5 the capacities of the center, to any individual 

6 residing or employed in the service area of the 

7 center, regardless of the ability of the individual 

8 to pay. 

9 ‘‘(F) Provide, directly or through contract, 

10 to the extent covered for adults in the State 

11 Medicaid plan under title XIX of the Social Se12 curity Act and for children in accordance with 

13 section 1905(r) of such Act regarding early and 

14 periodic screening, diagnosis, and treatment, 

15 each of the following services: 

16 ‘‘(i) Screening, assessment, and diag17 nosis, including risk assessment. 

18 ‘‘(ii) Person-centered treatment plan19 ning or similar processes, including risk as20 sessment and crisis planning. 

21 ‘‘(iii) Outpatient mental health and 

22 substance use services, including screening, 

23 assessment, diagnosis, psychotherapy, med24 ication management, and integrated treat25 ment for mental illness and substance 


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1 abuse which shall be evidence-based (in2 cluding cognitive behavioral therapy and 

3 other such therapies which are evidence4 based). 

5 ‘‘(iv) Outpatient clinic primary care 

6 screening and monitoring of key health in7 dicators and health risk (including screen8 ing for diabetes, hypertension, and cardio9 vascular disease and monitoring of weight, 

10 height, body mass index (BMI), blood pres11 sure, blood glucose or HbA1C, and lipid 

12 profile). 

13 ‘‘(v) Crisis mental health services, in14 cluding 24-hour mobile crisis teams, emer15 gency crisis intervention services, and cri16 sis stabilization. 

17 ‘‘(vi) Targeted case management 

18 (services to assist individuals gaining ac19 cess to needed medical, social, educational, 

20 and other services and applying for income 

21 security and other benefits to which they 

22 may be entitled). 

23 ‘‘(vii) Psychiatric rehabilitation serv24 ices including skills training, assertive com25 munity treatment, family psychoeducation, 


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1 disability self-management, supported em2 ployment, supported housing services, 

3 therapeutic foster care services, and such 

4 other evidence-based practices as the Sec5 retary may require. 

6 ‘‘(viii) Peer support and counselor 

7 services and family supports. 

8 ‘‘(G) Maintain linkages, and where possible 

9 enter into formal contracts with the following: 

10 ‘‘(i) Federally qualified health centers. 

11 ‘‘(ii) Inpatient psychiatric facilities 

12 and substance use detoxification, post-de13 toxification step-down services, and resi14 dential programs. 

15 ‘‘(iii) Adult and youth peer support 

16 and counselor services. 

17 ‘‘(iv) Family support services for fam18 ilies of children with serious mental or sub19 stance use disorders. 

20 ‘‘(v) Other community or regional 

21 services, supports, and providers, including 

22 schools, child welfare agencies, juvenile and 

23 criminal justice agencies and facilities, 

24 housing agencies and programs, employers, 

25 and other social services. 


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1 ‘‘(vi) Onsite or offsite access to pri2 mary care services. 

3 ‘‘(vii) Enabling services, including 

4 outreach, transportation, and translation. 

5 ‘‘(viii) Health and wellness services, 

6 including services for tobacco cessation. 

7 ‘‘(H) Where feasible, provide outreach and 

8 engagement to encourage individuals who could 

9 benefit from mental health care to freely par10 ticipate in receiving the services described in 

11 this subsection. 

12 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 

13 paragraph (1) shall be construed as prohibiting 

14 States receiving funds appropriated through the 

15 Community Mental Health Services Block Grant 

16 under subpart I of part B of this title from financ17 ing qualified community programs (whether such 

18 programs meet the definition of eligible programs 

19 prior to or after the date of enactment of this sub20 section). 

21 ‘‘(5) LIMITATION.—With respect to federally 

22 qualified behavioral health centers authorized under 

23 this subsection, 20 percent of the total number of 

24 such centers shall become newly eligible to receive 

25 reimbursement under this section in each of the first 


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1 5 years after the initial year of eligibility through 

2 fiscal year 2023. In implementing this paragraph, 

3 the Secretary shall ensure geographic diversity of 

4 such sites, take into account the ability of such sites 

5 to provide required services, and the ability of such 

6 sites to report required data.’’. 

7 SEC. 3. MEDICAID COVERAGE AND PAYMENT FOR COMMU8 NITY BEHAVIORAL HEALTH CENTER SERV9 ICES. 

10 (a) PAYMENT FOR SERVICES PROVIDED BY FEDER11 ALLY QUALIFIED COMMUNITY BEHAVIORAL HEALTH

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

13 (42 U.S.C. 1396a(bb)) is amended— 

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

15 HEALTH CLINICS’’ and inserting ‘‘, FEDERALLY

16 QUALIFIED COMMUNITY BEHAVIORAL HEALTH

17 CENTERS, AND RURAL HEALTH CLINICS’’; 

18 (2) in paragraph (1), by inserting ‘‘(and begin19 ning with fiscal year 2016 with respect to services 

20 furnished on or after January 1, 2016, and each 

21 succeeding fiscal year, for services described in sec22 tion 1905(a)(2)(D) furnished by a federally qualified 

23 community behavioral health center)’’ after ‘‘by a 

24 rural health clinic’’; 

25 (3) in paragraph (2)— 


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1 (A) by striking the heading and inserting 

2 ‘‘INITIAL FISCAL YEAR’’; 

3 (B) by inserting ‘‘(or, in the case of serv4 ices described in section 1905(a)(2)(D) fur5 nished by a federally qualified community be6 havioral health center, for services furnished on 

7 and after January 1, 2016, during fiscal year 

8 2016)’’ after ‘‘January 1, 2001, during fiscal 

9 year 2001’’; 

10 (C) by inserting ‘‘(or, in the case of serv11 ices described in section 1905(a)(2)(D) fur12 nished by a federally qualified community be13 havioral health center, during fiscal years 2014 

14 and 2015)’’ after ‘‘1999 and 2000’’; and 

15 (D) by inserting ‘‘(or, in the case of serv16 ices described in section 1905(a)(2)(D) fur17 nished by a federally qualified community be18 havioral health center, during fiscal year 

19 2016)’’ before the period; 

20 (4) in paragraph (3)— 

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

22 YEAR 2002 AND SUCCEEDING’’ and inserting 

23 ‘‘SUCCEEDING’’; and 

24 (B) by inserting ‘‘(or, in the case of serv25 ices described in section 1905(a)(2)(D) furVerDate Mar 15 2010 22:31 Feb 19, 2013 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S264.IS S264

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1 nished by a federally qualified community be2 havioral health center, for services furnished 

3 during fiscal year 2017 or a succeeding fiscal 

4 year)’’ after ‘‘2002 or a succeeding fiscal year’’; 

5 (5) in paragraph (4)— 

6 (A) by inserting ‘‘(or as a federally quali7 fied community behavioral health center after 

8 fiscal year 2015)’’ after ‘‘or rural health clinic 

9 after fiscal year 2000’’; 

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

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

12 qualified health center, services described in 

13 section 1905(a)(2)(D) furnished by the feder14 ally qualified community behavioral health cen15 ter, or’’; and 

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

17 rural health clinic’’ and inserting ‘‘, federally 

18 qualified community behavioral health center, 

19 or rural health clinic’’; 

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

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

22 inserting ‘‘, federally qualified community behavioral 

23 health center, or rural health clinic’’; and 

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

25 health clinic’’ and inserting ‘‘, to a federally qualiVerDate Mar 15 2010 22:31 Feb 19, 2013 Jkt 029200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S264.IS S264

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1 fied community behavioral health center for services 

2 described in section 1905(a)(2)(D), or to a rural 

3 health clinic’’. 

4 (b) INCLUSION OF COMMUNITY BEHAVIORAL

5 HEALTH CENTER SERVICES IN THE TERM MEDICAL AS6 SISTANCE.—Section 1905(a)(2) of the Social Security Act 

7 (42 U.S.C. 1396d(a)(2)) is amended— 

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

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

10 the following: ‘‘, and (D) federally qualified commu11 nity behavioral health center services (as defined in 

12 subsection (l)(4))’’. 

13 (c) DEFINITION OF FEDERALLY QUALIFIED COMMU14 NITY BEHAVIORAL HEALTH CENTER SERVICES.—Section 

15 1905(l) of the Social Security Act (42 U.S.C. 1396d(l)) 

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

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

18 center services’ means services furnished to an indi19 vidual at a federally qualified community behavioral 

20 health center (as defined by subparagraph (B)). 

21 ‘‘(B) The term ‘federally qualified community 

22 behavioral health center’ means an entity that is cer23 tified under section 1913(c) of the Public Health 

24 Service Act as meeting the criteria described in 

25 paragraph (3) of such section.’’. 


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1 (d) EFFECTIVE DATE.—The amendments made by 

2 this section take effect on January 1, 2016. 

3 SEC. 4. COMMUNITY-BASED MENTAL HEALTH INFRASTRUC4 TURE IMPROVEMENT. 

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

6 280g et seq.) is amended by adding at the end the fol7 lowing: 

8 ‘‘PART H—COMMUNITY-BASED MENTAL HEALTH 

9 INFRASTRUCTURE IMPROVEMENTS 

10 ‘‘SEC. 560. GRANTS FOR COMMUNITY-BASED MENTAL 

11 HEALTH INFRASTRUCTURE IMPROVEMENTS. 

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

13 award grants to eligible entities to expend funds for the 

14 construction or modernization of facilities used to provide 

15 mental health and substance abuse services to individuals. 

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

17 ‘eligible entity’ means— 

18 ‘‘(1) a State that is the recipient of a Commu19 nity Mental Health Services Block Grant under sub20 part I of part B of title XIX and a Substance Abuse 

21 Prevention and Treatment Block Grant under sub22 part II of such part; or 

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

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


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

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

4 under this section shall submit to the Secretary an appli5 cation at such time, in such manner, and containing— 

6 ‘‘(1) a plan for the construction or moderniza7 tion of facilities used to provide mental health and 

8 substance abuse services to individuals that— 

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

10 agency as the sole agency for the supervision 

11 and administration of the grant; 

12 ‘‘(B) contains satisfactory evidence that 

13 such agency so designated will have the author14 ity to carry out the plan; 

15 ‘‘(C) provides for the designation of an ad16 visory council, which shall include representa17 tives of nongovernmental organizations or 

18 groups, and of the relevant State or tribal agen19 cies, that aided in the development of the plan 

20 and that will implement and monitor any grant 

21 awarded to the eligible entity under this section; 

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

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

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


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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; 


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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 


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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 22:31 Feb 19, 2013 Jkt 029200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S264.IS S264

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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 


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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— 


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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 memorandums 

14 of 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 


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