I 
111TH CONGRESS 
1ST SESSION H. R. 4204 
To establish national centers of excellence for the treatment of depressive 
and bipolar disorders. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 3, 2009 
Mr. KENNEDY
(for himself, Mr. TIM
MURPHY
of Pennsylvania, Mr. 
YARMUTH, and Mr. MAFFEI) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce 
A BILL 
To establish national centers of excellence for the treatment 
of depressive and bipolar disorders. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Establishing a Net-
work of Health-Advancing National Centers of Excellence 
for Depression Act of 2009’’ or the ‘‘ENHANCED Act 
of 2009’’. 
SEC. 2. PURPOSES; GOAL. 
(a) PURPOSE.—It is the purpose of this Act to— 
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(1) establish a national network of centers of 
excellence for depressive disorders; 
(2) provide Federal financial assistance to es-
tablish and support a National network of depres-
sion centers that provide for university- and commu-
nity-based delivery of evidence-based interventions, 
innovative practices, and services to individuals with 
depressive disorders; and 
(3) improve the standard of care and delivery of 
evidence-based interventions, innovative practices, 
and services to individuals with depressive disorders. 
(b) GOAL.—It is the goal of this Act to— 
(1) increase the number of individuals with de-
pressive disorders who receive appropriate and evi-
dence-based treatment, through the implementation 
of multidisciplinary research and clinical programs 
that use a recovery framework, standardize diag-
noses, treat individuals early and more effectively, 
and prevent recurrences of depressive disorders; and 
(2) to establish a national resource to develop 
and disseminate evidence-based interventions for de-
pressive disorders, provide public and professional 
education about depressive disorders, and eradicate 
the stigma associated with depressive disorders. 
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SEC. 3. CENTERS OF EXCELLENCE FOR DEPRESSION. 
Subpart 3 of part B of title V of the Public Health 
Service Act (42 U.S.C. 290bb et seq.) is amended by in-
serting after section 520A the following: 
‘‘SEC. 520B. NATIONAL CENTERS OF EXCELLENCE FOR DE-
PRESSION. 
‘‘(a) DEPRESSIVE DISORDER DEFINED.—In this sec-
tion, the term ‘depressive disorder’ means a mental or 
brain disorder relating to depression, including major de-
pression, bipolar disorder, and related mood disorders. 
‘‘(b) GRANT PROGRAM.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator, shall award grants on a 
competitive basis to eligible entities to establish na-
tional centers of excellence for depression (referred 
to in this section as ‘centers of excellence’), which 
shall engage in activities related to the treatment of 
depressive disorders. 
‘‘(2) ALLOCATION OF AWARDS.—If the funds 
authorized under subsection (f) are appropriated in 
the amounts provided for under such subsection, the 
Secretary shall allocate such amounts so that— 
‘‘(A) not later than 1 year after the date 
of enactment of the ENHANCED Act of 2009, 
not more than 20 centers of excellence may be 
established; and 
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‘‘(B) not later than September 30, 2016, 
not more than 30 centers of excellence may be 
established. 
‘‘(3) GRANT PERIOD.— 
‘‘(A) IN
GENERAL.—A grant awarded 
under this section shall be for a period of 5 
years. 
‘‘(B) RENEWAL.—A grant awarded under 
subparagraph (A) may be renewed, on a com-
petitive basis, for 1 additional 5-year period, at 
the discretion of the Secretary. In determining 
whether to renew a grant, the Secretary shall 
consider the report cards issued under sub-
section (e)(2). 
‘‘(4) USE
OF
FUNDS.—Grant funds awarded 
under this subsection shall be used for the establish-
ment and ongoing activities of the recipient of such 
funds. 
‘‘(5) ELIGIBLE ENTITIES.— 
‘‘(A) REQUIREMENTS.—To be eligible to 
receive a grant under this section, an entity 
shall— 
‘‘(i) be an institution of higher edu-
cation or a public or private nonprofit re-
search institution; and 
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‘‘(ii) submit an application to the Sec-
retary at such time and in such manner as 
the Secretary may require, as described in 
subparagraph (B). 
‘‘(B) APPLICATION.—An application de-
scribed in subparagraph (A)(ii) shall include— 
‘‘(i) evidence that such entity— 
‘‘(I) provides, or is capable of co-
ordinating with other entities to pro-
vide, comprehensive medical services 
with a focus on mental health services 
and subspecialty expertise for depres-
sive disorders; 
‘‘(II) collaborates with— 
‘‘(aa) other medical sub-
specialists to address co-occur-
ring mental illnesses; 
‘‘(bb) community organiza-
tions; and 
‘‘(cc) other members of the 
network; and 
‘‘(III) is capable of training 
health professionals about mental 
health; and 
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‘‘(ii) such other information, as the 
Secretary may require. 
‘‘(C) PRIORITIES.—In awarding grants 
under this section, the Secretary shall give pri-
ority to eligible entities that meet 1 or more of 
the following criteria: 
‘‘(i) Demonstrated capacity and exper-
tise to serve the targeted population. 
‘‘(ii) Existing infrastructure or exper-
tise to provide appropriate, evidence-based 
and culturally competent services. 
‘‘(iii) A location in a geographic area 
with disproportionate numbers of under-
served and at-risk populations in medically 
underserved areas and health professional 
shortage areas. 
‘‘(iv) A history of serving the popu-
lation described in clause (iii). 
‘‘(v) Proposed innovative approaches 
for outreach to initiate or expand services. 
‘‘(vi) Use of the most up-to-date 
science, practices, and interventions avail-
able. 
‘‘(vii) Demonstrated coordination and 
collaboration, or having a viable plan to co-
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ordinate, with a community mental health 
center or other community mental health 
resources. 
‘‘(viii) Capacity to establish coopera-
tive agreements with other community en-
tities to provide social and human services 
to individuals with depressive disorders. 
‘‘(ix) Demonstrated potential for rep-
lication and dissemination of evidence- 
based research and practices. 
‘‘(6) SPECIALTY CENTERS.—Of the centers of 
excellence receiving a grant under this section, the 
Secretary may select 1 or more such centers to spe-
cialize in— 
‘‘(A) subspecialties such as prepartum and 
postpartum depression, traumatic stress dis-
order, suicidal tendency, bipolar disorder, and 
depression; and 
‘‘(B) providing mental health services to 
communities with problems of access, such as 
rural communities and economically depressed 
communities. 
‘‘(7) NATIONAL COORDINATING CENTER.— 
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Administrator, shall designate 1 re-
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cipient of a grant under this section to be the 
coordinating center of excellence for depression 
(referred to in this section as the ‘coordinating 
center’). The Secretary shall select such coordi-
nating center on a competitive basis, based 
upon the demonstrated capacity of such center 
to perform the duties described in subpara-
graph (C). 
‘‘(B) APPLICATION.—A center of excel-
lence that has been awarded a grant under 
paragraph (1) may apply for designation as the 
coordinating center by submitting an applica-
tion to the Secretary at such time, in such man-
ner, and containing such information as the 
Secretary may require. 
‘‘(C) DUTIES.—The coordinating center 
shall— 
‘‘(i) develop, administer, and coordi-
nate the network of centers of excellence 
under this section; 
‘‘(ii) oversee and coordinate the na-
tional database described in subsection (d); 
‘‘(iii) lead a strategy to disseminate 
the findings and activities of the centers of 
excellence through such database; 
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‘‘(iv) serve as a liaison with the Ad-
ministration, the National Registry of Evi-
dence-based Programs and Practices of the 
Administration, and any Federal inter-
agency or interagency forum on mental 
health; and 
‘‘(v) establish a common network in-
frastructure to advance services provided 
by the centers of excellence and dem-
onstrate effectiveness in fostering a col-
laborative community among such centers 
for sharing knowledge and skills. 
‘‘(8) MATCHING
FUNDS.—The Secretary may 
not award a grant or contract under this section to 
an entity unless the entity agrees that it will make 
available (directly or through contributions from 
other public or private entities) non-Federal con-
tributions toward the activities to be carried out 
under the grant or contract in an amount equal to 
$1 for each $5 of Federal funds provided under the 
grant or contract. Such non-Federal matching funds 
may be provided directly or through donations from 
public or private entities and may be in cash or in- 
kind, fairly evaluated, including plant, equipment, or 
services. 
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‘‘(c) ACTIVITIES
OF
THE CENTERS
OF EXCEL-
LENCE.—Each center of excellence shall carry out the fol-
lowing activities: 
‘‘(1) GENERAL ACTIVITIES.—Each center of ex-
cellence shall— 
‘‘(A) integrate basic, clinical, or health 
services interdisciplinary research and practice 
in the development of evidence-based interven-
tions; 
‘‘(B) involve a broad cross-section of stake-
holders, such as researchers, clinicians, con-
sumers, and families of consumers, to develop 
innovative approaches to incorporate research 
and practice and advance evidence-based prac-
tices; 
‘‘(C) provide training and technical assist-
ance to mental health professionals, and engage 
in and disseminate translational research with a 
focus on meeting the needs of individuals with 
depressive disorders; 
‘‘(D) facilitate the dissemination and com-
munication of research findings and depressive 
disorder-related information from the institu-
tions of higher education to the public; and 
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‘‘(E) educate policy makers, employers, 
community leaders, and the general public 
about depressive disorders to reduce stigma and 
raise awareness of available treatments for such 
disorders. 
‘‘(2) IMPROVED TREATMENT STANDARDS, CLIN-
ICAL GUIDELINES, AND DIAGNOSTIC PROTOCOLS.— 
Each center of excellence shall collaborate with other 
centers of excellence in the network to— 
‘‘(A) develop and implement treatment 
standards, clinical guidelines, and protocols to 
improve the accuracy and timeliness of diag-
nosis of depressive disorders; and 
‘‘(B) develop and implement treatment 
standards that emphasize early intervention and 
treatment for, primary prevention and the pre-
vention of recurrences of, and recovery from, 
depressive disorders. 
‘‘(3) COORDINATION
AND
INTEGRATION
OF 
PHYSICAL, MENTAL, AND SOCIAL CARE.—Each cen-
ter of excellence shall— 
‘‘(A) incorporate principles of chronic care 
coordination and integration of services that ad-
dress physical, mental, and social conditions in 
the treatment of depressive disorders; 
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‘‘(B) foster communication with other pro-
viders attending to co-occurring physical health 
conditions such as cardiovascular, diabetes, can-
cer, and substance abuse disorders; 
‘‘(C) identify how treatment for depression 
interacts with such co-occurring illnesses to im-
prove overall health outcomes; 
‘‘(D) leverage available community re-
sources, develop and implement improved self- 
management programs, and, when appropriate, 
involve family and other providers of social sup-
port in the development and implementation of 
care plans; and 
‘‘(E) use electronic health records and tele-
health technology to better coordinate and man-
age, and improve access to, care, as determined 
by the coordinating center. 
‘‘(4) TRANSLATIONAL
RESEARCH
THROUGH 
COLLABORATION OF CENTERS OF EXCELLENCE AND 
COMMUNITY-BASED
ORGANIZATIONS.—Each center 
of excellence shall— 
‘‘(A) demonstrate effective use of a public- 
private partnership to foster collaborations 
among members of the network and commu-
nity-based organizations such as community 
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mental health centers and other social and 
human services providers; 
‘‘(B) 
expand 
multidisciplinary, 
translational, and patient-oriented research and 
treatment by fostering such collaborations; and 
‘‘(C) coordinate with accredited academic 
programs to provide ongoing opportunities, in 
academic and in community settings, for the 
professional and continuing education of mental 
health providers. 
‘‘(d) NATIONAL DATABASE.— 
‘‘(1) IN
GENERAL.—The coordinating center 
shall establish and maintain a national, publicly- 
available database to improve prevention programs, 
evidence-based interventions, and disease manage-
ment programs for depressive disorders, using data 
collected from the centers of excellence, as described 
in paragraph (2). 
‘‘(2) DATA COLLECTION.— 
‘‘(A) DATA.—Each center of excellence 
shall submit data gathered at such center, as 
appropriate, to the coordinating center regard-
ing— 
‘‘(i) the prevalence and incidence of 
depressive disorders; 
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‘‘(ii) the health and social outcomes of 
individuals with depressive disorders; 
‘‘(iii) the effectiveness of interventions 
designed, tested, and evaluated; 
‘‘(iv) the progress in the prevention 
of, and recovery from, depressive disorders; 
and 
‘‘(v) the economic impact of the activi-
ties of such center. 
‘‘(B) 
FINANCIAL
INFORMATION.—Each 
center of excellence shall provide to the coordi-
nating center appropriately summarized finan-
cial information to enable the coordinating cen-
ter to assess the efficiency and financial sus-
tainability of such center. 
‘‘(3) SUBMISSION OF DATA TO THE ADMINIS-
TRATOR.—The coordinating center shall submit to 
the Administrator the data and financial information 
gathered under paragraph (2). 
‘‘(4) PUBLICATION
USING
DATA
FROM
THE 
DATABASE.—A center of excellence, or an individual 
affiliated with a center of excellence, may publish 
findings using the data described in paragraph 
(2)(A) only if such center submits such data to the 
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coordinating center, as required under such para-
graph. 
‘‘(e) ESTABLISHMENT
OF
STANDARDS; REPORT 
CARDS
AND RECOMMENDATIONS; THIRD PARTY RE-
VIEW.— 
‘‘(1) ESTABLISHMENT
OF
STANDARDS.—The 
Secretary, acting through the Administrator, shall 
establish performance standards for— 
‘‘(A) each center of excellence; and 
‘‘(B) the network of centers of excellence 
as a whole. 
‘‘(2) REPORT
CARDS.—The Secretary, acting 
through the Administrator, shall— 
‘‘(A) for each center of excellence, not later 
than 3 years after the date on which such cen-
ter of excellence is established and annually 
thereafter, issue a report card to the coordi-
nating center to rate the performance of such 
center of excellence; and 
‘‘(B) not later than 3 years after the date 
on which the first grant is awarded under sub-
section (b)(1) and annually thereafter, issue a 
report card to Congress to rate the performance 
of the network of centers of excellence as a 
whole. 
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‘‘(3) RECOMMENDATIONS.—Based upon the re-
port cards described in paragraph (1), the Secretary 
shall, not later than September 30, 2015— 
‘‘(A) make recommendations to the centers 
of excellence regarding improvements such cen-
ters shall make; and 
‘‘(B) make recommendations to Congress 
for expanding the centers of excellence to serve 
individuals with other types of mental disorders. 
‘‘(4) THIRD PARTY REVIEW.—Not later than 3 
years after the date on which the first grant is 
awarded under subsection (b)(1) and annually there-
after, the Secretary shall arrange for an independent 
third party to conduct an evaluation of the network 
of centers of excellence to ensure that such centers 
are meeting the goals of this section. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—To carry out this section, 
there are authorized to be appropriated— 
‘‘(A) $100,000,000 for each of the fiscal 
years 2011 through 2015; and 
‘‘(B) $150,000,000 for each of the fiscal 
years 2016 through 2020. 
‘‘(2) ALLOCATION OF FUNDS AUTHORIZED.—Of 
the amount appropriated under paragraph (1) for a 
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fiscal year, the Secretary shall determine the alloca-
tion of each center of excellence receiving a grant 
under this section, but in no case may the allocation 
be more than $5,000,000, except that the Secretary 
may allocate not more than $10,000,000 to the co-
ordinating center.’’. 
SEC. 4. SENSE OF THE SENATE. 
It is the sense of the Senate that the knowledge and 
research developed by the centers of excellence for depres-
sion established under section 520B of the Public Health 
Service Act should be disseminated broadly within the 
medical community and the Federal Government, particu-
larly to agencies with an interest in mental health, includ-
ing other agencies within the Department of Health and 
Human Services and the Departments of Justice, Defense, 
Labor, and Veterans Affairs. 
Æ 
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