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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1704 Introduced in Senate (IS)]

108th CONGRESS
  1st Session
                                S. 1704

  To amend the Public Health Service Act to establish a State family 
   support grant program to end the practice of parents giving legal 
  custody of their seriously emotionally disturbed children to State 
agencies for the purpose of obtaining mental health services for those 
                               children.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                            October 2, 2003

  Ms. Collins (for herself, Mr. Pryor, Mr. Coleman, and Mr. Bingaman) 
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 to establish a State family 
   support grant program to end the practice of parents giving legal 
  custody of their seriously emotionally disturbed children to State 
agencies for the purpose of obtaining mental health services for those 
                               children.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Keeping Families Together Act''.

SEC. 2. PURPOSE.

    It is the purpose of this Act to assist States in eliminating the 
practice of parents giving custody of their seriously emotionally 
disturbed children to State agencies for the purpose of securing mental 
health care for those children.

SEC. 3. FAMILY SUPPORT GRANTS.

    Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) 
is amended--
            (1) by redesignating the second part G (relating to 
        services provided through religious organizations) as part J;
            (2) by redesignating sections 581 through 584 of part J (as 
        so redesignated) as sections 596 through 596C, respectively; 
        and
            (3) by adding at the end the following:

                        ``Part K--Family Support

``SEC. 597. FAMILY SUPPORT GRANTS.

    ``(a) In General.--The Secretary, acting through the Administrator 
and in consultation with the task force established under section 597A, 
is authorized to award competitive grants to States to enable such 
States to establish systems of care to treat and provide services to 
all eligible children and youth. The Secretary shall ensure that the 
amount awarded to each grantee is sufficient to enable the grantee to 
accomplish the purposes of the grant.
    ``(b) Eligibility.--To be eligible for a grant under subsection (a) 
a State shall--
            ``(1) have laws or policies in effect to ensure that 
        children receive appropriate mental health services so that 
        parents do not have to relinquish legal custody of such 
        children;
            ``(2) submit to the Secretary an application from the 
        Governor in accordance with subsection (c);
            ``(3) provide assurances that the State will provide 
        matching funds in accordance with subsection (e); and
            ``(4) meet such other requirements as the Secretary 
        determines appropriate.
    ``(c) Application.--
            ``(1) In general.--An application submitted for a grant 
        under this section shall include--
                    ``(A) a brief description of the system of care 
                that the State intends to establish with amounts 
                received under the grant to ensure that eligible 
                children and youth and their families receive the 
                appropriate individualized mental health treatment and 
                family support services necessary to keep such families 
                together;
                    ``(B) a description of the process by which the 
                State will formulate a State plan that meets the 
                requirements of paragraph (2), including participants, 
                timelines, and any previous or ongoing efforts related 
                to the establishment of a statewide system;
                    ``(C) an estimate of the number of eligible 
                children and youth in the State, and the number of 
                eligible children and youth who will be served under 
                the grant;
                    ``(D) a description of existing systems of care in 
                the State (including systems funded under section 561) 
                and existing interagency collaboration that 
                demonstrates a foundation on which the State can build 
                a system of care under a grant under this section;
                    ``(E) a brief description of the manner in which 
                services for all eligible children and youth are 
                expected to be funded under the system established by 
                the State under the grant;
                    ``(F) a description of children's mental health 
                services capacity in the State and the steps that will 
                be taken, if necessary, to ensure that adequate 
                capacity exists to implement the proposed system of 
                care;
                    ``(G) a description of the source of the State 
                matching funds; and
                    ``(H) other information as required by the 
                Secretary.
            ``(2) State plan.--Prior to receiving funds under the grant 
        for the second grant year, a State shall submit to the 
        Secretary and the Secretary shall approve, a State plan that--
                    ``(A) is developed through a collaborative process 
                that includes the required State partners as 
                represented by senior officials with policymaking 
                authority, the required private partners, and other 
                entities that the governor of the State determines 
                appropriate;
                    ``(B) contains a description and assessment of the 
                effectiveness of the laws or policies that the State 
                has in effect to ensure that children receive 
                appropriate mental health services and that parents do 
                not have to relinquish legal custody of such children 
                in order to obtain such services;
                    ``(C) contains a description of the services to be 
                provided to eligible children and youth and the sources 
                of such services, including the extent to which the 
                State will build upon existing systems of care within 
                the State;
                    ``(D) contains a description of the procedures to 
                be implemented for the early identification, 
                assessment, and referral, by health care providers, 
                mental health agencies, other child-serving entities, 
                child welfare, corrections, and juvenile justice 
                systems, of all eligible children and youth for 
                appropriate care and for coordinating services among 
                child welfare, juvenile justice, and child mental 
                health agencies, including co-location of services as 
                appropriate;
                    ``(E) describes any legislative changes that are 
                required to implement the State plan;
                    ``(F) describes how the State screens children and 
                youth entering the juvenile justice and child welfare 
                systems for mental health problems, including the 
                State's mental health screening procedures as part of 
                the early and periodic screening, diagnostic, and 
                treatment services described in section 1905(r) of the 
                Social Security Act that are provided under the 
                medicaid programs;
                    ``(G) contains a description of the plan of the 
                State for ensuring that there will be adequate capacity 
                to serve all eligible children;
                    ``(H) contains a description of the plan of the 
                State for financing the system of care developed under 
                the grant, including--
                            ``(i) the manner in which the State will 
                        use--
                                    ``(I) contributions from State 
                                agencies;
                                    ``(II) State eligibility options or 
                                waivers authorized with respect to the 
                                State medicaid program such as those 
                                authorized under sections 1902(e)(3) 
                                and 1915(c) of the Social Security Act;
                                    ``(III) the State Children's Health 
                                Insurance Program under title XXI of 
                                the Social Security Act (including an 
                                assurance that grant funds will not be 
                                used as a State match under the 
                                medicaid or SCHIP programs); and
                                    ``(IV) other public health 
                                insurance mechanisms; and
                            ``(ii) how Federal grant dollars will be 
                        used to enable the State to achieve a 
                        sustainable system of care to serve all 
                        eligible children and youth;
                    ``(I) contains a description of how the State will 
                provide outreach services to families, provide for 
                public educational activities, and involve families; 
                and
                    ``(J) establishes a method for tracking and 
                reporting the number of children and youth entering 
                child welfare and juvenile justice systems with 
                significant mental health problems.
            ``(3) Priority.--In awarding grants under this section, the 
        Secretary shall give priority to States--
                    ``(A) that have a history of developing and 
                supporting local or statewide systems care and of 
                successful interagency collaboration;
                    ``(B) that have taken steps to broaden access to 
                community-based services for children with serious 
                emotional disturbances;
                    ``(C) that have provided reasonable estimates of 
                the numbers of eligible children and youth;
                    ``(D) that have sufficient mental health service 
                capacity or specific plans for sufficiently increasing 
                mental health services capacity to successfully 
                implement the proposed system of care;
                    ``(E) in which the governor's office will play a 
                leading role in the formulation of the State plan 
                required under paragraph (2); and
                    ``(F) that will involve State juvenile and family 
                court judges in the planning and oversight of the 
                system of care.
    ``(d) Use of Funds.--A State shall use amounts received under a 
grant under this section to--
            ``(1) establish State- and local-level infrastructure to 
        allow for interagency cooperation and cross system financing 
        to--
                    ``(A) support the purchase and delivery of a 
                comprehensive array of community-based mental health 
                and family support services to all eligible children 
                and youth and their families;
                    ``(B) decrease categorical funding structures and 
                eliminate inter-agency fragmentation of services; and
                    ``(C) increase the capacity of agencies to share 
                public resources and improve parental access to 
                services for children with mental health needs to 
                eliminate the need to relinquish custody in order to 
                receive treatment;
            ``(2) expand public health insurance programs to cover a 
        comprehensive array of community-based mental health and family 
        support services for eligible children and youth and their 
        families that will be sustainable after the grant has expired;
            ``(3) deliver mental health care and family support 
        services to eligible children and youth and their families as 
        part of a transition to a sustainable system of care for such 
        children and youth;
            ``(4) provide outreach and public education concerning 
        programs and activities funded under this section;
            ``(5) provide training and professional development for 
        personnel who work with eligible children and youth as required 
        to successfully implement the State plan; and
            ``(6) carry out other administrative activities related to 
        the programs and activities carried out under the grant, 
        including the development and maintenance of data systems.
    ``(e) Matching Funds.--
            ``(1) In general.--A State that receives a grant under this 
        section shall, with respect to the costs to be incurred by the 
        State in carrying out the purpose for which the grant is 
        awarded, make available non-Federal contributions toward such 
        costs in an amount that--
                    ``(A) for the third fiscal year for which the 
                entity receives payments from a grant under such 
                subsection, is not less than $1 for each $2 of Federal 
                funds provided in the grant;
                    ``(B) for the fourth such fiscal year, is not less 
                than $1 for each $1 of Federal funds provided in the 
                grant; and
                    ``(C) for the fifth and sixth such fiscal years, is 
                not less than $2 for each $1 of Federal funds provided 
                in the grant.
            ``(2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services. Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.
            ``(3) Accounting required.--With respect to a State that 
        complies with the requirement of paragraph (2) through the 
        provision of in-kind contributions, such State shall provide 
        the Secretary with an accounting that describes the value of 
        such in-kind contributions.
    ``(f) Limitation on Use for Administrative Costs.--Not more than 5 
percent of the amount that a State receives under a grant under this 
section shall be used for administrative costs.
    ``(g) Payments.--Grants under this section shall be payable over a 
6-year period.
    ``(h) Reporting Requirements.--
            ``(1) In general.--Secretary, acting through the 
        Administrator and in consultation with the task force 
        established under section 597A, shall require States to report 
        information that is appropriate to permit an assessment to be 
        made of the success of States in the implementation of programs 
        under this section. Such information shall, at a minimum, 
        include--
                    ``(A) the number of eligible children and youth in 
                foster care;
                    ``(B) the number of eligible children and youth in 
                residential treatment centers;
                    ``(C) appropriate information concerning the 
                participation and academic progress of eligible 
                children and youth in school;
                    ``(D) measures of the contacts of eligible children 
                and youth with juvenile justice systems;
                    ``(E) measures of the clinical improvement of 
                eligible children and youth; and
                    ``(F) information concerning the level of 
                satisfaction of eligible children and youth and their 
                families with services received.
            ``(2) Annual report by states.--Beginning with the second 
        fiscal year in which a State receives funding under a grant 
        under this section, the State shall annually report to the 
        Secretary on the success of the programs and activities carried 
        out by the State under the grant. Such reports shall include 
        the information specified in paragraph (1) and other 
        information required by the Secretary.
            ``(3) Reports by the secretary.--
                    ``(A) In general.--Not later than 3 years after the 
                date of enactment of this part, the Secretary shall 
                submit to Congress a report on the success of States in 
                using grants under this section to eliminate children 
                and youth custody relinquishment solely to obtain 
                mental health care. Such report shall include 
                recommendations to strengthen the program under this 
                section.
                    ``(B) Final report.--Not later than 6 years after 
                the date of enactment of this part, the Secretary shall 
                submit to Congress a final report on the success of 
                States in using grants under this section to eliminate 
                children and youth custody relinquishment solely to 
                obtain mental health care.
    ``(i) Technical Assistance.--The Secretary, in consultation with 
the task force established under section 597A, may provide technical 
assistance to States in carrying out programs and activities under this 
section. The Secretary shall use not more than 20 percent of the amount 
appropriate for each fiscal year, not to exceed $5,000,000 in any such 
fiscal year, to carry out this subsection and shall coordinate 
technical assistance under this section with other technical assistance 
programs as appropriate.
    ``(j) Definitions.--In this section:
            ``(1) Eligible children and youth.--The term `eligible 
        children and youth' means children and youth under the age of 
        21 years who are in the custody of the State for the purpose of 
receiving mental health services or at-risk of entering into the 
custody of the State for the purpose of receiving mental health 
services.
            ``(2) Family support services.--The term `family support 
        services' means individualized services that are designed with 
        input from the family and provided to eligible children and 
        youth and their families to promote the mental health of an 
        eligible child or youth, to strengthen the ability of family 
        members to care for an eligible child or youth, or to enable an 
        eligible child or youth to take advantage of other treatment 
        and family support services.
            ``(3) Required private partners.--The term `required 
        private partners' includes--
                    ``(A) representatives of families of seriously 
                emotionally disturbed children;
                    ``(B) representatives of mental health care 
                providers;
                    ``(C) representatives of private health insurers; 
                and
                    ``(D) representatives of hospitals and residential 
                care facilities.
            ``(4) Required state partners.--The term `required State 
        partners' with respect to a State includes--
                    ``(A) the State agency responsible for children's 
                mental health;
                    ``(B) the State child welfare agency;
                    ``(C) the State juvenile justice agency;
                    ``(D) the State Medicaid agency;
                    ``(E) the State education agency;
                    ``(F) the State substance abuse agency;
                    ``(G) the State bureau of insurance; and
                    ``(H) the office of the Governor of the State.
            ``(5) State.--The term `State' includes, in addition to the 
        several States, the District of Columbia, the Commonwealth of 
        Puerto Rico, the Commonwealth of the Northern Mariana Islands, 
        the Virgin Islands, Guam, American Samoa, the Trust Territory 
        of the Pacific Islands, and Indian tribes.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $4,500,000 for fiscal year 
2004, $6,500,000 for fiscal year 2005, and $11,000,000 for each of 
fiscal years 2006 through 2009.

``SEC. 597A. TASK FORCE.

    ``(a) Establishment.--The Administrator, in conjunction with the 
Director of the Office of Juvenile Justice and Delinquency Prevention, 
the Administrator of the Administration for Children and Families, the 
Administrator of the Centers for Medicare & Medicaid Services, and the 
Assistant Secretary of Education for Special Education, shall establish 
and staff a task force to examine problems of mental health in the 
child welfare and juvenile justice systems and issues with respect to 
access by children and youth to mental health services, and the role of 
their agencies in promoting access by children and youth to mental 
health services.
    ``(b) Duties.--The task force established under subsection (a) 
shall--
            ``(1) work with mental health and child advocates, 
        representatives of families of eligible children and youth, and 
        representatives of State systems of care to make 
        recommendations to Congress concerning strategies to improve 
        the delivery of mental health services, including prevention 
        services, to children and youth with serious emotional 
        disturbances, including those who are at risk of dropping out 
        of school or at risk of coming in contact with child welfare 
        and juvenile justice systems;
            ``(2) work with mental health and child advocates, 
        representatives of families of eligible children and youth, and 
        representatives of State systems of care to develop improved 
        reporting requirements for States concerning the number of 
children and youth entering child welfare and juvenile justice systems 
solely to access mental health services;
            ``(3) in consultation with States and appropriate 
        stakeholders, create standard definitions for the categories of 
        data to be collected on such children and youth;
            ``(4) foster interagency cooperation to eliminate the 
        practice of custody relinquishment;
            ``(5) provide advice to the Administrator in implementation 
        of the family support grant programs under section 597;
            ``(6) coordinate and deliver technical assistance to States 
        and State agencies to help implement programs under such grant 
        program;
            ``(7) make recommendations to break down barriers to 
        coordination in existing Federal programs and to allow for more 
        effective integration across agencies and programs; and
            ``(8) provide a biannual report to Congress on its 
        recommendations and its progress in carrying out its duties, 
        ending the practice of parents relinquishing legal custody of 
        their children with serious emotional disturbances in order to 
        obtain mental health services, and improving the delivery of 
        mental health services to children with serious emotional 
        disturbances.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $1,000,000 for each of fiscal 
years 2004 through 2009. Of the amount appropriate for each fiscal year 
under this subsection, 60 percent of such amount shall be made 
available to the Secretary, 20 percent of such amount shall be made 
available to the Attorney General, and 20 percent of such amount shall 
be made available to the Secretary of Education.''.

SEC. 4. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR 
              INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED 
              SERVICES WAIVERS.

    (a) In General.--Section 1915(c) of the Social Security Act (42 
U.S.C. 1396n(c)) is amended--
            (1) in paragraph (1)--
                    (A) in the first sentence, by inserting ``, or 
                would require inpatient psychiatric hospital services 
                for individuals under age 21,'' after ``intermediate 
                care facility for the mentally retarded''; and
                    (B) in the second sentence, by inserting ``, or 
                would require inpatient psychiatric hospital services 
                for individuals under age 21'' before the period;
            (2) in paragraph (2)(B), by striking ``or services in an 
        intermediate care facility for the mentally retarded'' each 
        place it appears and inserting ``services in an intermediate 
        care facility for the mentally retarded, or inpatient 
        psychiatric hospital services for individuals under age 21'';
            (3) in paragraph (2)(C)--
                    (A) by inserting ``, or who are determined to be 
                likely to require inpatient psychiatric hospital 
                services for individuals under age 21,'' after ``, or 
                intermediate care facility for the mentally retarded''; 
                and
                    (B) by striking ``or services in an intermediate 
                care facility for the mentally retarded'' and inserting 
                ``services in an intermediate care facility for the 
                mentally retarded, or inpatient psychiatric hospital 
                services for individuals under age 21''; and
            (4) in paragraph (7)(A)--
                    (A) by inserting ``or would require inpatient 
                psychiatric hospital services for individuals under age 
                21,'' after ``intermediate care facility for the 
                mentally retarded,''; and
                    (B) by inserting ``or who would require inpatient 
                psychiatric hospital services for individuals under age 
                21'' before the period.
    (b) Effective Date.--The amendments made by subsection (a) apply 
with respect to medical assistance provided on or after January 1, 
2004.
                                 <all>
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