II 

109TH CONGRESS 

1ST SESSION S. 709 

To amend the Public Health Service Act to establish a grant program to 

provide supportive services in permanent supportive housing for chronically homeless individuals, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 5, 2005 

Mr. DEWINE (for himself, Mr. REED, Mr. BURR, and Mr. DODD) 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 grant 

program to provide supportive services in permanent supportive housing for chronically homeless individuals, and 

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Services for Ending 

5 Long-Term Homelessness Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 
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1 (1) Nationally, there are approximately 200,000 

2 to 250,000 people who experience chronic homeless3 ness, including some families with children. Chron4 ically homeless people often live in shelters or on the 

5 streets for years at a time, experience repeated epi6 sodes of homelessness without achieving housing sta7 bility, or cycle between homelessness, jails, mental 

8 health facilities, and hospitals. 

9 (2) The President’s New Freedom Commission 

10 on Mental Health recommended the development 

11 and implementation of a comprehensive plan de12 signed to facilitate access to 150,000 units of per13 manent supportive housing for consumers and fami14 lies who are chronically homeless. The Commission 

15 found that affordable housing alone is insufficient 

16 for many people with severe mental illness, and that 

17 flexible, mobile, individualized support services are 

18 also necessary to support and sustain consumers in 

19 their housing. 

20 (3) Congress and the President have set a goal 

21 of ending chronic homelessness in 10 years. 

22 (4) Permanent supportive housing is a proven 

23 and cost effective solution to chronic homelessness. 

24 A recent study by the University of Pennsylvania 

25 found that each unit of supportive housing for home-
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1 less people with mental illness in New York City re2 sulted in public savings of $16,281 per year in sys3 tems of care such as mental health, human services, 

4 health care, veterans’ affairs, and corrections. 

5 (5) Current programs for funding services in 

6 permanent supportive housing, other than those ad7 ministered by the Department of Housing and 

8 Urban Development, were not designed to be closely 

9 coordinated with housing resources, nor were they 

10 designed to meet the multiple needs of people who 

11 are chronically homeless. 

12 SEC. 3. DUTIES OF ADMINISTRATOR OF SUBSTANCE ABUSE 

13 AND MENTAL HEALTH SERVICES ADMINIS14 TRATION. 

15 Section 501(d) of the Public Health Service Act (42 

16 U.S.C. 290aa(d)) is amended— 

17 (1) in paragraph (17), by striking ‘‘and’’ at the 

18 end; 

19 (2) in paragraph (18), by striking the period 

20 and inserting ‘‘; and’’; and 

21 (3) by adding at the end the following: 

22 ‘‘(19) collaborate with Federal departments and 

23 programs that are part of the President’s Inter24 agency Council on Homelessness, particularly the 

25 Department of Housing and Urban Development, 
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1 the Department of Labor, and the Department of 

2 Veterans Affairs, and with other agencies within the 

3 Department of Health and Human Services, particu4 larly the Health Resources and Services Administra5 tion, the Administration on Children and Families, 

6 and the Centers for Medicare and Medicaid Services, 

7 to design national strategies for providing services in 

8 supportive housing that will assist in ending chronic 

9 homelessness and to implement programs that ad10 dress chronic homelessness.’’. 

11 SEC. 4. GRANTS FOR SERVICES FOR CHRONICALLY HOME12 LESS INDIVIDUALS IN SUPPORTIVE HOUSING. 

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

14 290aa et seq.) is amended by adding at the end the fol15 lowing: 

16 ‘‘PART J—GRANTS FOR SERVICES TO END 

17 CHRONIC HOMELESSNESS 

18 ‘‘SEC. 596. GRANTS FOR SERVICES TO END CHRONIC HOME19 LESSNESS. 

20 ‘‘(a) IN GENERAL.— 

21 ‘‘(1) GRANTS.—The Secretary shall make 

22 grants to entities described in paragraph (2) for the 

23 purpose of carrying out projects to provide the serv24 ices described in subsection (d) to chronically home25 less individuals in permanent supportive housing. 
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1 ‘‘(2) ELIGIBLE ENTITIES.—For purposes of 

2 paragraph (1), an entity described in this paragraph 

3 is— 

4 ‘‘(A) a State or political subdivision of a 

5 State, an Indian tribe or tribal organization, or 

6 a public or nonprofit private entity, including a 

7 community-based provider of homelessness serv8 ices, health care, housing, or other services im9 portant to individuals experiencing chronic 

10 homelessness; or 

11 ‘‘(B) a consortium composed of entities de12 scribed in subparagraph (A), which consortium 

13 includes a public or nonprofit private entity 

14 that serves as the lead applicant and has re15 sponsibility for coordinating the activities of the 

16 consortium. 

17 ‘‘(b) PRIORITIES.—In making grants under sub18 section (a), the Secretary shall give priority to applicants 

19 demonstrating that the applicants— 

20 ‘‘(1) target funds to individuals or families 

21 who— 

22 ‘‘(A) have been homeless for longer periods 

23 of time or have experienced more episodes of 

24 homelessness than are required to meet the def-
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1 inition of chronic homelessness under this sec2 tion; 

3 ‘‘(B) have high rates of utilization of emer4 gency public systems of care; or 

5 ‘‘(C) have a history of interactions with 

6 law enforcement and the criminal justice sys7 tem; 

8 ‘‘(2) have greater funding commitments from 

9 State or local government agencies responsible for 

10 overseeing mental health treatment, substance abuse 

11 treatment, medical care, and employment (including 

12 commitments to provide Federal funds in accordance 

13 with subsection (e)(2)(B)(ii)); 

14 ‘‘(3) will provide for an increase in the number 

15 of units of permanent supportive housing that would 

16 serve chronically homeless individuals in the commu17 nity as a result of an award of a grant under sub18 section (a); and 

19 ‘‘(4) have demonstrated experience providing 

20 services to address the mental health and substance 

21 abuse problems of chronically homeless individuals 

22 living in permanent supportive housing settings. 

23 ‘‘(c) GEOGRAPHIC DISTRIBUTION.—The Secretary 

24 shall ensure that consideration is given to geographic dis-
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1 tribution (such as urban and rural areas) in the awarding 

2 of grants under subsection (a). 

3 ‘‘(d) SERVICES.—The services referred to in sub4 section (a) are the following: 

5 ‘‘(1) Services provided by the grantee or by 

6 qualified subcontractors that promote recovery and 

7 self-sufficiency and address barriers to housing sta8 bility, including but not limited to the following: 

9 ‘‘(A) Mental health services, including 

10 treatment and recovery support services. 

11 ‘‘(B) Substance abuse treatment and re12 covery support services, including counseling, 

13 treatment planning, recovery coaching, and re14 lapse prevention. 

15 ‘‘(C) Integrated, coordinated treatment 

16 and recovery support services for co-occurring 

17 disorders. 

18 ‘‘(D) Health education, including referrals 

19 for medical and dental care. 

20 ‘‘(E) Services designed to help individuals 

21 make progress toward self-sufficiency and re22 covery, including benefits advocacy, money 

23 management, life-skills training, self-help pro24 grams, and engagement and motivational inter25 ventions. 
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1 ‘‘(F) Parental skills and family support. 

2 ‘‘(G) Case management. 

3 ‘‘(H) Other supportive services that pro4 mote an end to chronic homelessness. 

5 ‘‘(I) Coordination or partnership with 

6 other agencies, programs, or mainstream bene7 fits to maximize the availability of services and 

8 resources to meet the needs of chronically 

9 homeless persons living in supportive housing 

10 using cost-effective approaches that avoid dupli11 cation. 

12 ‘‘(J) Data collection and measuring per13 formance outcomes as specified in subsection 

14 (k). 

15 ‘‘(2) Services, as described in paragraph (1), 

16 that are delivered to individuals and families who 

17 are chronically homeless and who are scheduled to 

18 become residents of permanent supportive housing 

19 within 90 days pending the location or development 

20 of an appropriate unit of housing. 

21 ‘‘(3) For individuals and families who are oth22 erwise eligible, and who have voluntarily chosen to 

23 seek other housing opportunities after a period of 

24 tenancy in supportive housing, services, as described 

25 in paragraph (1), that are delivered, for a period of 
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1 90 days after exiting permanent supportive housing 

2 or until the individuals have transitioned to com3 prehensive services adequate to meet their current 

4 needs, provided that the purpose of the services is to 

5 support the individuals in their choice to transition 

6 into housing that is responsive to their individual 

7 needs and preferences. 

8 ‘‘(e) MATCHING FUNDS.— 

9 ‘‘(1) IN GENERAL.—A condition for the receipt 

10 of a grant under subsection (a) is that, with respect 

11 to the cost of the project to be carried out by an ap12 plicant pursuant to such subsection, the applicant 

13 agree as follows: 

14 ‘‘(A) In the case of the initial grant pursu15 ant to subsection (j)(1)(A), the applicant will, 

16 in accordance with paragraphs (2) and (3), 

17 make available contributions toward such costs 

18 in an amount that is not less than $1 for each 

19 $3 of Federal funds provided in the grant. 

20 ‘‘(B) In the case of a renewal grant pursu21 ant to subsection (j)(1)(B), the applicant will, 

22 in accordance with paragraphs (2) and (3), 

23 make available contributions toward such costs 

24 in an amount that is not less than $1 for each 

25 $1 of Federal funds provided in the grant. 
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1 ‘‘(2) SOURCE OF CONTRIBUTION.—For pur2 poses of paragraph (1), contributions made by an 

3 applicant are in accordance with this paragraph if 

4 made as follows: 

5 ‘‘(A) The contribution is made from funds 

6 of the applicant or from donations from public 

7 or private entities. 

8 ‘‘(B) Of the contribution— 

9 ‘‘(i) not less than 80 percent is from 

10 non-Federal funds; and 

11 ‘‘(ii) not more than 20 percent is from 

12 Federal funds provided under programs 

13 that— 

14 ‘‘(I) are not expressly directed at 

15 services for homeless individuals, but 

16 whose purposes are broad enough to 

17 include the provision of a service or 

18 services described in subsection (d) as 

19 authorized expenditures under such 

20 program; and 

21 ‘‘(II) do not prohibit Federal 

22 funds under the program from being 

23 used to provide a contribution that is 

24 required as a condition for obtaining 

25 Federal funds. 
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1 ‘‘(3) DETERMINATION OF AMOUNT CONTRIB2 UTED.—Contributions required in paragraph (1) 

3 may be in cash or in kind, fairly evaluated, including 

4 plant, equipment, or services. Amounts provided by 

5 the Federal Government, or services assisted or sub6 sidized to any significant extent by the Federal Gov7 ernment, may not be included in determining the 

8 amount of non-Federal contributions required in 

9 paragraph (2)(B)(i). 

10 ‘‘(f) ADMINISTRATIVE EXPENSES.—A condition for 

11 the receipt of a grant under subsection (a) is that the ap12 plicant involved agree that not more than 10 percent of 

13 the grant will be expended for administrative expenses 

14 with respect to the grant. Expenses for data collection and 

15 measuring performance outcomes as specified in sub16 section (k) shall not be considered as administrative ex17 penses subject to the limitation in this subsection. 

18 ‘‘(g) CERTAIN USES OF FUNDS.—Notwithstanding 

19 other provisions of this section, a grantee under subsection 

20 (a) may expend not more than 20 percent of the grant 

21 to provide the services described in subsection (d) to home22 less individuals who are not chronically homeless. 

23 ‘‘(h) APPLICATION FOR GRANT.—A grant may be 

24 made under subsection (a) only if an application for the 

25 grant is submitted to the Secretary and the application 
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1 is in such form, is made in such manner, and contains 

2 such agreements, assurances, and information as the Sec3 retary determines to be necessary to carry out this section. 

4 ‘‘(i) CERTAIN REQUIREMENTS.—A condition for the 

5 receipt of a grant under subsection (a) is that the appli6 cant involved demonstrate the following: 

7 ‘‘(1) The applicant and all direct providers of 

8 services have the experience, infrastructure, and ex9 pertise needed to ensure the quality and effective10 ness of services, which may be demonstrated by any 

11 of the following: 

12 ‘‘(A) Compliance with all local, city, coun13 ty, or State requirements for licensing, accredi14 tation, or certification (if any) which are appli15 cable to the proposed project. 

16 ‘‘(B) A minimum of two years experience 

17 providing comparable services that do not re18 quire licensing, accreditation, or certification. 

19 ‘‘(C) Certification as a Medicaid service 

20 provider, including health care for the homeless 

21 programs and community health centers. 

22 ‘‘(D) An executed agreement with a rel23 evant State or local government agency that 

24 will provide oversight over the mental health, 
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1 substance abuse, or other services that will be 

2 delivered by the project. 

3 ‘‘(2) There is a mechanism for determining 

4 whether residents are chronically homeless. Such a 

5 mechanism may rely on local data systems or 

6 records of shelter admission. If there are no sources 

7 of data regarding the duration or number of home8 less episodes, or if such data are unreliable for the 

9 purposes of this subsection, an applicant must dem10 onstrate that the project will implement appropriate 

11 procedures, taking into consideration the capacity of 

12 local homeless service providers to document epi13 sodes of homelessness and the challenges of engag14 ing persons who have been chronically homeless, to 

15 verify that an individual or family meets the defini16 tion for being chronically homeless under this sec17 tion. 

18 ‘‘(3) The applicant participates in a local, re19 gional, or statewide homeless management informa20 tion system. 

21 ‘‘(j) DURATION OF INITIAL AND RENEWAL GRANTS; 

22 ADDITIONAL PROVISIONS REGARDING RENEWAL

23 GRANTS.— 

24 ‘‘(1) IN GENERAL.—Subject to paragraphs (2) 

25 and (3), the period during which payments are made 
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1 to a grantee under subsection (a) shall be in accord2 ance with the following: 

3 ‘‘(A) In the case of the initial grant, the 

4 period of payments shall be not less than three 

5 years and not more than five years. 

6 ‘‘(B) In the case of a subsequent grant (re7 ferred to in this subsection as a ‘renewal 

8 grant’), the period of payments shall be not 

9 more than five years. 

10 ‘‘(2) ANNUAL APPROVAL; AVAILABILITY OF AP11 PROPRIATIONS; NUMBER OF GRANTS.—The provision 

12 of payments under an initial or renewal grant is sub13 ject to annual approval by the Secretary of the pay14 ments and to the availability of appropriations for 

15 the fiscal year involved to make the payments. This 

16 subsection may not be construed as establishing a 

17 limitation on the number of grants under subsection 

18 (a) that may be made to an entity. 

19 ‘‘(3) ADDITIONAL PROVISIONS REGARDING RE20 NEWAL GRANTS.— 

21 ‘‘(A) COMPLIANCE WITH MINIMUM STAND22 ARDS.—A renewal grant may be made by the 

23 Secretary only if the Secretary determines that 

24 the applicant involved has, in the project car25 ried out with the grant, maintained compliance 
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1 with minimum standards for quality and suc2 cessful outcomes for housing retention, as de3 termined by the Secretary. 

4 ‘‘(B) AMOUNT.—The maximum amount of 

5 a renewal grant under this subsection shall not 

6 exceed an amount equal to— 

7 ‘‘(i) 75 percent of the amount of Fed8 eral funds provided in the final year of the 

9 initial grant period; or 

10 ‘‘(ii) 50 percent of the total costs of 

11 sustaining the program funded under the 

12 grant at the level provided for in the year 

13 preceding the year for which the renewal 

14 grant is being awarded; 

15 as determined by the Secretary. 

16 ‘‘(k) STRATEGIC PERFORMANCE OUTCOMES AND RE17 PORTS.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall, as a 

19 condition of the receipt of grants under subsection 

20 (a), require grantees to provide data regarding the 

21 performance outcomes of the projects carried out 

22 under the grants. Consistent with the requirements 

23 and procedures established by the Secretary, each 

24 grantee shall measure and report specific perform25 ance outcomes related to the long-term goals of in-
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1 creasing stability within the community for people 

2 who have been chronically homeless, and decreasing 

3 the recurrence of periods of homelessness. 

4 ‘‘(2) PERFORMANCE OUTCOMES.—The perform5 ance outcomes described under paragraph (1) shall 

6 include, with respect to individuals who have been 

7 chronically homeless— 

8 ‘‘(A) improvements in housing stability; 

9 ‘‘(B) improvements in employment and 

10 education; 

11 ‘‘(C) reductions in problems related to sub12 stance abuse; 

13 ‘‘(D) reductions in problems related to 

14 mental health disorders; and 

15 ‘‘(E) other areas as the Secretary deter16 mines appropriate. 

17 ‘‘(3) COORDINATION AND CONSISTENCY WITH

18 OTHER HOMELESS ASSISTANCE PROGRAMS.— 

19 ‘‘(A) PROCEDURES.—In establishing stra20 tegic performance outcomes and reporting re21 quirements under paragraph (1), the Secretary 

22 shall develop and implement procedures that 

23 minimize the costs and burdens to grantees and 

24 program participants, and that are practical, 

25 streamlined, and designed for consistency with 
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1 the requirements of the homeless assistance 

2 programs administered by the Secretary of 

3 Housing and Urban Development. 

4 ‘‘(B) APPLICANT COORDINATION.—Appli5 cants under this section shall coordinate with 

6 community stakeholders, including participants 

7 in the local homeless management information 

8 system, concerning the development of systems 

9 to measure performance outcomes and with the 

10 Secretary for assistance with data collection 

11 and measurements activities. 

12 ‘‘(4) REPORT.—A grantee shall submit an an13 nual report to the Secretary that— 

14 ‘‘(A) identifies the grantee’s progress to15 wards achieving its strategic performance out16 comes; and 

17 ‘‘(B) describes other activities conducted 

18 by the grantee to increase the participation, 

19 housing stability, and other improvements in 

20 outcomes for individuals who have been chron21 ically homeless. 

22 ‘‘(l) TRAINING AND TECHNICAL ASSISTANCE.—The 

23 Secretary, directly or through awards of grants or con24 tracts to public or nonprofit private entities, shall provide 

25 training and technical assistance regarding the planning, 
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1 development, and provision of services in projects under 

2 subsection (a). 

3 ‘‘(m) BIENNIAL REPORTS TO CONGRESS.—Not later 

4 than two years after the date of the enactment of the Serv5 ices for Ending Long-Term Homelessness Act, and bienni6 ally thereafter, the Secretary shall submit to the Congress 

7 a report on projects under subsection (a) that includes a 

8 summary of information received by the Secretary under 

9 subsection (k), and that describes the impact of the pro10 gram under subsection (a) as part of a comprehensive 

11 strategy for ending long term homelessness and improving 

12 outcomes for individuals with mental illness and substance 

13 abuse problems. 

14 ‘‘(n) DEFINITIONS.—For purposes of this section: 

15 ‘‘(1) The term ‘chronically homeless’ means an 

16 individual or family who— 

17 ‘‘(A) is currently homeless; 

18 ‘‘(B) has been homeless continuously for at 

19 least one year or has been homeless on at least 

20 four separate occasions in the last three years; 

21 and 

22 ‘‘(C) has an adult head of household with 

23 a disabling condition, defined as a diagnosable 

24 substance use disorder, serious mental illness, 

25 developmental disability, or chronic physical ill-
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1 ness or disability, including the co-occurrence of 

2 two or more of these conditions. 

3 ‘‘(2) The term ‘disabling condition’ means a 

4 condition that limits an individual’s ability to work 

5 or perform one or more activities of daily living. 

6 ‘‘(3) The term ‘homeless’ means sleeping in a 

7 place not meant for human habitation or in an emer8 gency homeless shelter. 

9 ‘‘(4)(A) The term ‘permanent supportive hous10 ing’ means permanent, affordable housing with flexi11 ble support services that are available and designed 

12 to help the tenants stay housed and build the nec13 essary skills to live as independently as possible. 

14 Such term does not include housing that is time-lim15 ited. Supportive housing offers residents assistance 

16 in reaching their full potential, which may include 

17 opportunities to secure other housing that meets 

18 their needs and preferences, based on individual 

19 choice instead of the requirements of time-limited 

20 transitional programs. Under this section, perma21 nent affordable housing includes but is not limited 

22 to permanent housing funded or assisted through 

23 title IV of the McKinney-Vento Homeless Assistance 

24 Act and section (8) of the United States Housing 

25 Act of 1937. 
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1 ‘‘(B) For purposes of subparagraph (A), the 

2 term ‘affordable’ means within the financial means 

3 of individuals who are extremely low income, as de4 fined by the Secretary of Housing and Urban Devel5 opment. 

6 ‘‘(o) FUNDING.— 

7 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

8 For the purpose of carrying out this section, there 

9 are authorized to be appropriated such sums as may 

10 be necessary for each of the fiscal years 2006 

11 through 2010. 

12 ‘‘(2) ALLOCATION FOR TRAINING AND TECH13 NICAL ASSISTANCE.—Of the amount appropriated 

14 under paragraph (1) for a fiscal year, the Secretary 

15 may reserve not more than 3 percent for carrying 

16 out subsection (l).’’.

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