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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4694 Introduced in House (IH)]

108th CONGRESS
  2d Session
                                H. R. 4694

 To amend the Older Americans Act of 1965 to provide for mental health 
 screening and treatment services, to amend the Public Health Service 
  Act to provide for integration of mental health services and mental 
        health treatment outreach teams, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 24, 2004

    Mr. Kennedy of Rhode Island (for himself and Ms. Ros-Lehtinen) 
 introduced the following bill; which was referred to the Committee on 
Education and the Workforce, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
 To amend the Older Americans Act of 1965 to provide for mental health 
 screening and treatment services, to amend the Public Health Service 
  Act to provide for integration of mental health services and mental 
        health treatment outreach teams, and for other purposes.

    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 ``Positive Aging Act of 2004''.

         TITLE I--AMENDMENTS TO THE OLDER AMERICANS ACT OF 1965

SEC. 101. DEFINITIONS.

    Section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002) is 
amended by adding at the end the following:
            ``(44) Mental health screening and treatment services.--The 
        term `mental health screening and treatment services' means 
        patient screening, diagnostic services, care planning and 
        oversight, therapeutic interventions, and referrals that are--
                    ``(A) provided pursuant to evidence-based 
                intervention and treatment protocols (to the extent 
                such protocols are available) for mental disorders 
                prevalent in older individuals (including, but not 
                limited to, mood and anxiety disorders, dementias of 
                all kinds, psychotic disorders, and substances and 
                alcohol abuse), relying to the greatest extent feasible 
                on protocols that have been developed--
                            ``(i) by or under the auspices of the 
                        Secretary; or
                            ``(ii) by academicians with expertise in 
                        mental health and aging; and
                    ``(B) coordinated and integrated with the services 
                of social service, mental health, and health care 
                providers in an area in order to--
                            ``(i) improve patient outcomes; and
                            ``(ii) assure, to the maximum extent 
                        feasible, the continuing independence of older 
                        individuals who are residing in the area.''.

SEC. 102. OFFICE OF OLDER ADULT MENTAL HEALTH SERVICES.

    Section 301(b) of the Older Americans Act of 1965 (42 U.S.C. 
3021(b)) is amended by adding at the end the following:
    ``(3) The Assistant Secretary shall establish within the 
Administration an Office of Older Adult Mental Health Services, which 
shall be responsible for the development and implementation of 
initiatives to address the mental health needs of older individuals.''.

SEC. 103. GRANTS TO STATES FOR THE DEVELOPMENT AND OPERATION OF SYSTEMS 
              FOR PROVIDING MENTAL HEALTH SCREENING AND TREATMENT 
              SERVICES TO OLDER INDIVIDUALS LACKING ACCESS TO SUCH 
              SERVICES.

    Title III of the Older Americans Act of 1965 (42 U.S.C. 3021 et 
seq.) is amended--
            (1) in section 303 (42 U.S.C. 3023), by adding at the end 
        the following:
    ``(f) There are authorized to be appropriated to carry out part F 
(relating to grants for programs providing mental health screening and 
treatment services) such sums as may be necessary for fiscal year 2005 
and each of the 5 succeeding fiscal years.'';
            (2) in section 304(a)(1) (42 U.S.C. 3024(a)(1)), by 
        inserting ``and subsection (f)'' after ``through (d)''; and
            (3) by adding at the end the following:

  ``PART F--MENTAL HEALTH SCREENING AND TREATMENT SERVICES FOR OLDER 
                              INDIVIDUALS

``SEC. 381. GRANTS TO STATES FOR PROGRAMS PROVIDING MENTAL HEALTH 
              SCREENING AND TREATMENT SERVICES FOR OLDER INDIVIDUALS.

    ``(a) Program Authorized.--The Assistant Secretary shall carry out 
a program for making grants to States under State plans approved under 
section 307 for the development and operation of--
            ``(1) systems for the delivery of mental health screening 
        and treatment services for older individuals who lack access to 
        such services; and
            ``(2) programs to--
                    ``(A) increase public awareness regarding the 
                benefits of prevention and treatment of mental 
                disorders; and
                    ``(B) reduce the stigma associated with mental 
                disorders and other barriers to the diagnosis and 
                treatment of the disorders.
    ``(b) State Allocation and Priorities.--A State agency that 
receives funds through a grant made under this section shall allocate 
the funds to area agencies on aging to carry out this part in planning 
and service areas in the State. In allocating the funds, the State 
agency shall give priority to planning and service areas in the State--
            ``(1) that are medically underserved; and
            ``(2) in which there are a large number of older 
        individuals.
    ``(c) Area Coordination of Services With Other Providers.--In 
carrying out this part, to more efficiently and effectively deliver 
services to older individuals, each area agency on aging shall--
            ``(1) coordinate services described in subsection (a) with 
        other community agencies, and voluntary organizations, 
        providing similar or related services; and
            ``(2) to the greatest extent practicable, integrate 
        outreach and educational activities with existing (as of the 
        date of the integration) health care and social service 
        providers serving older individuals in the planning and service 
        area involved.
    ``(d) Relationship to Other Funding Sources.--Funds made available 
under this part shall supplement, and not supplant, any Federal, State, 
and local funds expended by a State or unit of general purpose local 
government (including an area agency on aging) to provide the services 
described in subsection (a).''.

SEC. 104. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH SCREENING AND 
              TREATMENT SERVICES TO OLDER INDIVIDUALS LIVING IN RURAL 
              AREAS.

    The Older Americans Act of 1965 (42 U.S.C. 3001 et seq.) is 
amended--
            (1) by inserting before section 401 (42 U.S.C. 3031) the 
        following:

      ``TITLE IV--GRANTS FOR EDUCATION, TRAINING, AND RESEARCH'';

        and
            (2) in part A of title IV (42 U.S.C. 3032 et seq.), by 
        adding at the end the following:

``SEC. 422. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH SCREENING 
              AND TREATMENT SERVICES TO OLDER INDIVIDUALS LIVING IN 
              RURAL AREAS.

    ``(a) Definition.--In this section, the term `rural area' means--
            ``(1) any area that is outside a metropolitan statistical 
        area (as defined by the Director of the Office of Management 
        and Budget); or
            ``(2) such similar area as the Secretary specifies in a 
        regulation issued under section 1886(d)(2)(D) of the Social 
        Security Act (42 U.S.C. 1395ww(d)(2)(D)).
    ``(b) Authority.--The Assistant Secretary shall make grants to 
eligible public agencies and nonprofit private organizations to pay 
part or all of the cost of developing or operating model health care 
service projects involving the provision of mental health screening and 
treatment services to older individuals residing in rural areas.
    ``(c) Duration.--Grants made under this section shall be made for 
3-year periods.
    ``(d) Application.--To be eligible to receive a grant under this 
section, a public agency or nonprofit private organization shall submit 
to the Assistant Secretary an application containing such information 
and assurances as the Secretary may require, including--
            ``(1) information describing--
                    ``(A) the geographic area and target population 
                (including the racial and ethnic composition of the 
                target population) to be served by the project; and
                    ``(B) the nature and extent of the applicant's 
                experience in providing mental health screening and 
                treatment services of the type to be provided in the 
                project;
            ``(2) assurances that the applicant will carry out the 
        project--
                    ``(A) through a multidisciplinary team of licensed 
                mental health professionals;
                    ``(B) using evidence-based intervention and 
                treatment protocols to the extent such protocols are 
                available;
                    ``(C) using telecommunications technologies as 
                appropriate and available; and
                    ``(D) in coordination with other providers of 
                health care and social services (such as senior centers 
                and adult day care providers) serving the area; and
            ``(3) assurances that the applicant will conduct and submit 
        to the Assistant Secretary such evaluations and reports as the 
Assistant Secretary may require.
    ``(e) Reports.--The Assistant Secretary shall prepare and submit to 
the appropriate committees of Congress a report that includes summaries 
of the evaluations and reports required under subsection (d)(3).
    ``(f) Coordination.--The Assistant Secretary shall provide for 
appropriate coordination of programs and activities receiving funds 
pursuant to a grant under this section with programs and activities 
receiving funds pursuant to grants under sections 381 and 423, and 
sections 520K and 520L of the Public Health Service Act.''.

SEC. 105. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH SCREENING AND 
              TREATMENT SERVICES TO OLDER INDIVIDUALS LIVING IN 
              NATURALLY OCCURRING RETIREMENT COMMUNITIES IN URBAN 
              AREAS.

    Part A of title IV of the Older Americans Act of 1965 (42 U.S.C. 
3032 et seq.), as amended by section 104, is further amended by adding 
at the end the following:

``SEC. 423. DEMONSTRATION PROJECTS PROVIDING MENTAL HEALTH SCREENING 
              AND TREATMENT SERVICES TO OLDER INDIVIDUALS LIVING IN 
              NATURALLY OCCURRING RETIREMENT COMMUNITIES IN URBAN 
              AREAS.

    ``(a) Definitions.--In this section:
            ``(1) Naturally occurring retirement community.--The term 
        `naturally occurring retirement community' means a residential 
        area (such as an apartment building, housing complex or 
        development, or neighborhood) not originally built for older 
        individuals but in which a substantial number of individuals 
        have aged in place (and become older individuals) while 
        residing in such area.
            ``(2) Urban area.--The term `urban area' means--
                    ``(A) a metropolitan statistical area (as defined 
                by the Director of the Office of Management and 
                Budget); or
                    ``(B) such similar area as the Secretary specifies 
                in a regulation issued under section 1886(d)(2)(D) of 
                the Social Security Act (42 U.S.C. 1395ww(d)(2)(D)).
    ``(b) Authority.--The Assistant Secretary shall make grants to 
eligible public agencies and nonprofit private organizations to pay 
part or all of the cost of developing or operating model health care 
service projects involving the provision of mental health screening and 
treatment services to older individuals residing in naturally occurring 
retirement communities located in urban areas.
    ``(c) Duration.--Grants made under this section shall be made for 
3-year periods.
    ``(d) Application.--To be eligible to receive a grant under this 
section, a public agency or nonprofit private organization shall submit 
to the Assistant Secretary an application containing such information 
and assurances as the Secretary may require, including--
            ``(1) information describing--
                    ``(A) the naturally occurring retirement community 
                and target population (including the racial and ethnic 
                composition of the target population) to be served by 
                the project; and
                    ``(B) the nature and extent of the applicant's 
                experience in providing mental health screening and 
                treatment services of the type to be provided in the 
                project;
            ``(2) assurances that the applicant will carry out the 
        project--
                    ``(A) through a multidisciplinary team of licensed 
                mental health professionals;
                    ``(B) using evidence-based intervention and 
                treatment protocols to the extent such protocols are 
                available; and
                    ``(C) in coordination with other providers of 
                health care and social services serving the retirement 
                community; and
            ``(3) assurances that the applicant will conduct and submit 
        to the Assistant Secretary such evaluations and reports as the 
        Assistant Secretary may require.
    ``(e) Reports.--The Assistant Secretary shall prepare and submit to 
the appropriate committees of Congress a report that includes summaries 
of the evaluations and reports required under subsection (d)(3).
    ``(f) Coordination.--The Assistant Secretary shall provide for 
appropriate coordination of programs and activities receiving funds 
pursuant to grants made under this section with programs and activities 
receiving funds pursuant to grants made under sections 381 and 422, and 
sections 520K and 520L of the Public Health Service Act.''.

             TITLE II--PUBLIC HEALTH SERVICE ACT AMENDMENTS

SEC. 201. DEMONSTRATION PROJECTS TO SUPPORT INTEGRATION OF MENTAL 
              HEALTH SERVICES IN PRIMARY CARE SETTINGS.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31 et seq.) is amended--
            (1) in subsection (b) of section 520(b) (42 U.S.C. 290bb-
        31(b))--
                    (A) by striking ``and'' at the end of paragraph 
                (14);
                    (B) by striking the period at the end of paragraph 
                (15) and inserting in lieu thereof ``; and''; and
                    (C) by adding at the end the following:
            ``(16) conduct the demonstration projects specified in 
        section 520K.''.; and
            (2) by adding at the end the following:

``SEC. 520K. PROJECTS TO DEMONSTRATE INTEGRATION OF MENTAL HEALTH 
              SERVICES IN PRIMARY CARE SETTINGS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Center for Mental Health Services, shall award grants to public and 
private nonprofit entities for projects to demonstrate ways of 
integrating mental health services for older patients into primary care 
settings, such as health centers receiving a grant under section 330 
(or determined by the Secretary to meet the requirements for receiving 
such a grant), other Federally qualified health centers, primary care 
clinics, and private practice sites.
    ``(b) Requirements.--In order to be eligible for a grant under this 
section, the project to be carried out by the entity shall provide for 
collaborative care within a primary care setting, involving 
psychiatrists, psychologists, and other licensed mental health 
professionals (such as social workers and advanced practice nurses) 
with appropriate training and experience in the treatment of older 
adults, in which screening, assessment, and intervention services are 
combined into an integrated service delivery model, including--
            ``(1) screening services by a mental health professional 
        with at least a masters degree in an appropriate field of 
        training;
            ``(2) referrals for necessary prevention, intervention, 
        follow-up care, consultations, and care planning oversight for 
        mental health and other service needs, as indicated; and
            ``(3) adoption and implementation of evidence-based 
        protocols, to the extent available, for prevalent mental health 
        disorders, including depression, anxiety, behavioral and 
        psychological symptoms of dementia, psychosis, and misuse of, 
        or dependence on, alcohol or medication.
    ``(c) Considerations in Awarding Grants.--In awarding grants under 
this section the Secretary, to the extent feasible, shall ensure that--
            ``(1) projects are funded in a variety of geographic areas, 
        including urban and rural areas; and
            ``(2) a variety of populations, including racial and ethnic 
        minorities and low-income populations, are served by projects 
        funded under this section.
    ``(d) Duration.--A project may receive funding pursuant to a grant 
under this section for a period of up to 3 years, with an extension 
period of 2 additional years at the discretion of the Secretary.
    ``(e) Application.--To be eligible to receive a grant under this 
section, a public or private nonprofit entity shall--
            ``(1) submit an application to the Secretary (in such form, 
        containing such information, and at such time as the Secretary 
        may specify); and
            ``(2) agree to report to the Secretary standardized 
        clinical and behavioral data necessary to evaluate patient 
        outcomes and to facilitate evaluations across participating 
        projects.
    ``(f) Evaluation.--Not later than July 31 of each calendar year, 
the Secretary shall submit to Congress a report evaluating the projects 
receiving awards under this section for such year.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section 
for fiscal year 2005 and each fiscal year thereafter.''.

SEC. 202. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH TREATMENT OUTREACH 
              TEAMS.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31 et seq.), as amended by section 201, is further amended 
by adding at the end the following:

``SEC. 520L. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH TREATMENT 
              OUTREACH TEAMS.

    ``(a) In general.--The Secretary, acting through the Director of 
the Center for Mental Health Services, shall award grants to public or 
private nonprofit entities that are community-based providers of 
geriatric mental health services, to support the establishment and 
maintenance by such entities of multi-disciplinary geriatric mental 
health outreach teams in community settings where older adults reside 
or receive social services. Entities eligible for such grants include--
            ``(1) mental health service providers of a State or local 
        government;
            ``(2) outpatient programs of private, nonprofit hospitals;
            ``(3) community mental health centers meeting the criteria 
        specified in section 1913(c); and
            ``(4) other community-based providers of mental health 
        services.
    ``(b) Requirements.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) adopt and implement, for use by its mental health 
        outreach team, evidence-based intervention and treatment 
        protocols (to the extent such protocols are available) for 
        mental disorders prevalent in older individuals (including, but 
        not limited to, mood and anxiety disorders, dementias of all 
        kinds, psychotic disorders, and substance and alcohol abuse), 
        relying to the greatest extent feasible on protocols that have 
        been developed--
                    ``(A) by or under the auspices of the Secretary; or
                    ``(B) by academicians with expertise in mental 
                health and aging;
            ``(2) provide screening for mental disorders, diagnostic 
        services, referrals for treatment, and case management and 
        coordination through such teams; and
            ``(3) coordinate and integrate the services provided by 
        such team with the services of social service, mental health, 
        and medical providers at the site or sites where the team is 
        based in order to--
                    ``(A) improve patient outcomes; and
                    ``(B) to assure, to the maximum extent feasible, 
                the continuing independence of older adults who are 
                residing in the community.
    ``(c) Cooperative Arrangements With Sites Serving as Bases for 
Outreach.--An entity receiving a grant under this section may enter 
into an agreement with a person operating a site at which a geriatric 
mental health outreach team of the entity is based, including--
            ``(1) senior centers;
            ``(2) adult day care programs;
            ``(3) assisted living facilities; and
            ``(4) recipients of grants to provide services to senior 
        citizens under the Older Americans Act of 1965,
under which such person provides (and is reimbursed by the entity, out 
of funds received under the grant, for) any supportive services, such 
as transportation and administrative support, that such person provides 
to an outreach team of such entity.
    ``(d) Considerations in Awarding Grants.--In awarding grants under 
this section the Secretary, to the extent feasible, shall ensure that--
            ``(1) projects are funded in a variety of geographic areas, 
        including urban and rural areas; and
            ``(2) a variety of populations, including racial and ethnic 
        minorities and low-income populations, are served by projects 
        funded under this section.
    ``(e) Application.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) submit an application to the Secretary (in such form, 
        containing such information, at such time as the Secretary may 
        specify); and
            ``(2) agree to report to the Secretary standardized 
        clinical and behavioral data necessary to evaluate patient 
        outcomes and to facilitate evaluations across participating 
        projects.
    ``(f) Coordination.--The Secretary shall provide for appropriate 
coordination of programs and activities receiving funds pursuant to a 
grant under this section with programs and activities receiving funds 
pursuant to grants under section 520K and sections 381, 422, and 423 of 
the Older Americans Act of 1965.
    ``(g) Evaluation.--Not later than July 31 of each calendar year, 
the Secretary shall submit to Congress a report evaluating the projects 
receiving awards under this section for such year.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section 
for fiscal year 2005 and each fiscal year thereafter.''.

SEC. 203. DESIGNATION OF DEPUTY DIRECTOR FOR OLDER ADULT MENTAL HEALTH 
              SERVICES IN CENTER FOR MENTAL HEALTH SERVICES.

    Section 520 of the Public Health Service Act (42 U.S.C. 290bb-31) 
is amended--
            (1) by redesignating subsection (c) as subsection (d); and
            (2) by inserting after subsection (b) the following:
    ``(c) Deputy Director for Older Adult Mental Health Services in 
Center for Mental Health Services.--The Director, after consultation 
with the Administrator, shall designate a Deputy Director for Older 
Adult Mental Health Services, who shall be responsible for the 
development and implementation of initiatives of the Center to address 
the mental health needs of older adults. Such initiatives shall 
include--
            ``(1) research on prevention and identification of mental 
        disorders in the geriatric population;
            ``(2) innovative demonstration projects for the delivery of 
        community-based mental health services for older Americans;
            ``(3) support for the development and dissemination of 
        evidence-based practice models, including models to address 
        dependence on, and misuse of, alcohol and medication in older 
        adults; and
            ``(4) development of model training programs for mental 
        health professionals and care givers serving older adults.''.

SEC. 204. MEMBERSHIP OF ADVISORY COUNCIL FOR THE CENTER FOR MENTAL 
              HEALTH SERVICES.

    Section 502(b)(3) of the Public Health service Act (42 U.S.C. 
269aa-1(b)(3)) is amended by adding at the end the following:
                    ``(C) In the case of the advisory council for the 
                Center for Mental Health Services, the members 
                appointed pursuant to subparagraphs (A) and (B) shall 
                include representatives of older Americans, their 
                families, and geriatric mental health specialists.''.

SEC. 205. PROJECTS OF NATIONAL SIGNIFICANCE TARGETING SUBSTANCE ABUSE 
              IN OLDER ADULTS.

    Section 509(b)(2) of the Public Health Service Act (42 U.S.C. 
290bb-2(b)(2)) is amended by inserting before the period the following: 
``, and to providing treatment for older adults with alcohol or 
substance abuse or addiction, including medication misuse or 
dependence''.

SEC. 206 CRITERIA FOR STATE PLANS UNDER COMMUNITY MENTAL HEALTH 
              SERVICES BLOCK GRANTS.

    (a) In General.--Section 1912(b)(4) of the Public Health Service 
Act (42 U.S.C. 300x-1(b)(4)) is amended to read as follows:
            ``(4) Targeted services to older individuals, individuals 
        who are homeless, and individuals living in rural areas.--The 
        plan describes the State's outreach to and services for older 
        individuals, individuals who are homeless, and individuals 
        living in rural areas, and how community-based services will be 
        provided to these individuals.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to State plans submitted on or after the date that is 180 days 
after the date of enactment of this Act.
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