I
107TH CONGRESS
2D SESSION
H. R. 5077
To amend the Public Health Service Act with respect to mental health
services for elderly individuals.
IN THE HOUSE OF REPRESENTATIVES
JULY 9, 2002
Mr. KENNEDY of Rhode Island introduced the following bill; which was
referred to the Committee on Energy and Commerce
A BILL
To amend the Public Health Service Act with respect to
mental health services for elderly individuals.
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 ‘‘Positive Aging Act of
2002’’.
SEC. 2. FINDINGS; STATEMENT OF PURPOSE.
(a) FINDINGS.—The Congress finds that—
(1) although, on average, 1⁄4 of all patients seen
in primary care settings have a mental illness, pri-
mary care practitioners identify such illness in only
about half of these cases;
(2) four mental disorders are among the 10
leading causes of disability in the United States;
(3) among the elderly, 10 percent have demen-
tia and as many as one quarter have significant clin-
ical depression;
(4) access to mental health services by the el-
derly is compromised by health benefits coverage
limits, gaps in the mental health services delivery
system, and shortages of geriatric mental health
practitioners;
(5) the integration of medical and mental
health treatment provides an effective means of co-
ordinating care, improving mental health outcomes,
and saving health care dollars; and
(6) the treatment of mental illness in elderly
patients, particularly those with other chronic dis-
eases, can improve health outcomes and the quality
of life for these patients.
(b) STATEMENT OF PURPOSE.—In order to address
the emerging crisis in the identification and treatment of
mental illness among the elderly, it is the purpose of this
Act to—
(1) promote models of care that integrate men-
tal health services and medical care within primary
care settings; and
(2) improve access by geriatric patients to men-
tal health services in community-based settings.
TITLE 
I—ENHANCING 
ACCESS
TO MENTAL HEALTH SERV-
ICES FOR THE ELDERLY
SEC. 101. SERVICES IMPLEMENTATION PROJECTS TO SUP-
PORT 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 section 520(b)—
(A) in paragraph (14), by striking ‘‘and’’
at the end;
(B) in paragraph (15), by striking the pe-
riod at the end and inserting ‘‘; and’’; and
(C) by adding at the end the following
paragraph:
‘‘(16) conduct the demonstration projects speci-
fied in section 520K.’’; and
(2) by adding at the end the following section:
‘‘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 make grants to public and private nonprofit entities
for evidence-based projects to demonstrate ways of inte-
grating mental health services for geriatric 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 qualify for a
grant under this section, a project shall—
‘‘(1) provide for collaborative care within a pri-
mary care setting, including screening services by a
mental health professional with at least a masters
degree in an appropriate field of training, supported
by psychiatrists with appropriate training and expe-
rience in the treatment of geriatric patients;
‘‘(2) make available to such patients referrals
for necessary follow-up care, consultations, and care
planning oversight; and
‘‘(3) adopt and implement evidence-based proto-
cols, to the extent available, for prevalent mental
health disorders, including depression, anxiety, be-
havioral and psychological symptoms of dementia,
psychosis, and misuse of, or dependence on, alcohol
or medication.
‘‘(c) CONSIDERATIONS IN AWARDING GRANTS.—To
the extent feasible, the Secretary shall assure that—
‘‘(1) grants under this section are awarded to
projects in a variety of geographic areas, including
urban and rural areas; and
‘‘(2) that the needs of ethnically diverse at-risk
populations are addressed.
‘‘(d) DURATION.—A project may receive funding pur-
suant to a grant under this section for a period of up to
3 years, with an extension period of two additional years
at the discretion of the Secretary.
‘‘(e) APPLICATION.—In order 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, at such
time as the Secretary may specify); and
‘‘(2) agree to report to the Secretary standard-
ized clinical and behavioral data necessary to evalu-
ate patient outcomes and to facilitate evaluations
across participating projects.
‘‘(f) EVALUATION.—Not later than 6 months after
the close of a calendar year, the Secretary shall submit
to the Congress a report evaluating the projects receiving
awards under this section for such year.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated for fiscal year 2003 and
each fiscal year thereafter such sums as may be necessary
to carry out this section.’’.
SEC. 
102. 
GRANTS 
FOR 
COMMUNITY-BASED 
MENTAL
HEALTH TREATMENT OUTREACH TEAMS.
Subpart 3 of part B of title V of the Public Health
Service Act, as amended by section 101 of this Act, is fur-
ther amended by adding at the end the following section:
‘‘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 make grants to public or private nonprofit entities
that are community-based providers of geriatric mental
health services, to support the establishment and mainte-
nance by such entities of multi-disciplinary geriatric men-
tal health outreach teams in community settings where el-
derly persons reside or receive social services. Entities eli-
gible for such grants include (but are not limited to)—
‘‘(1) mental health service providers of a State
or local government;
‘‘(2) outpatient programs of private, nonprofit
hospitals; and
‘‘(3) community mental health centers meeting
the criteria specified in section 1913(c).
‘‘(b) REQUIREMENTS.—In order to qualify for 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 proto-
cols are available) for mental disorders prevalent in
geriatric patients, relying to the greatest extent fea-
sible on protocols that have been developed—
‘‘(A) by or under the auspices of the Sec-
retary; or
‘‘(B) by geriatric mental health programs
based at academic medical centers;
‘‘(2) provide screening for mental disorders, di-
agnostic services, referrals for treatment, and case
management and coordination through such teams;
and
‘‘(3) coordinate and integrate the services pro-
vided by such team with the services of social service
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 geri-
atric patients who are residing in the commu-
nity.
‘‘(c) COOPERATIVE ARRANGEMENTS WITH SITES
SERVING AS BASES FOR OUTREACH TEAMS.—An entity
receiving a grant under this section may enter into an
agreement with a person operating a site at which a geri-
atric mental health outreach team of the entity is based,
including (but not limited to)—
‘‘(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,
under which such person provides (and is reim-
bursed by the entity, out of funds received under the
grant, for) any supportive services, such as transpor-
tation and administrative support, that such person
provides to an outreach team of such entity.
‘‘(d) CONSIDERATIONS IN AWARDING GRANTS.—To
the extent feasible, the Secretary shall assure that—
‘‘(1) grants under this section are awarded to
projects in a variety of geographic areas, including
urban and rural areas; and
‘‘(2) that the needs of ethnically diverse at-risk
populations are addressed.
‘‘(e) APPLICATION.—In order 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 standard-
ized clinical and behavioral data necessary to evalu-
ate patient outcomes and to facilitate evaluations
across participating projects.
‘‘(f) EVALUATION.—Not later than 6 months after
the close of a calendar year, the Secretary shall submit
to the Congress a report evaluating the programs receiving
a grant under this section for such year.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated for fiscal year 2003 and
each fiscal year thereafter such sums as may be necessary
to carry out this section.’’.
TITLE 
II—ADMINISTRATIVE
CHANGES 
TO 
STRENGTHEN
PROGRAMS FOR GERIATRIC
MENTAL HEALTH SERVICES
SEC. 201. DESIGNATION OF DEPUTY DIRECTOR FOR GERI-
ATRIC MENTAL HEALTH SERVICES IN CEN-
TER FOR MENTAL HEALTH SERVICES.
Section 520 of the Public Health Service Act (42
U.S.C. 290bb–31) is amended by redesignating subsection
(c) as subsection (d) and inserting after subsection (b) the
following:
‘‘(c) DEPUTY DIRECTOR FOR GERIATRIC MENTAL
HEALTH SERVICES.—The Director, after consultation
with the Administrator, shall designate a Deputy Director
for Geriatric Mental Health Services, who shall be respon-
sible for the development and implementation of initiatives
of the Center to address the mental health needs of older
adults. Such initiatives shall include (but are not limited
to)—
‘‘(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 dissemi-
nation of evidence-based practice models, including
models to address dependence on, and misuse of, al-
cohol and medication in geriatric patients; and
‘‘(4) development of model training programs
for mental health professionals and care givers serv-
ing geriatric patients.’’.
SEC. 202. 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, including at least one
physician with board certification in geriatric
psychiatry.’’.
SEC. 203. PROJECTS OF NATIONAL SIGNIFICANCE TAR-
GETING SUBSTANCE ABUSE IN GERIATRIC
PATIENTS.
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
geriatric patients with alcohol or substance abuse or addic-
tion, including medication misuse or dependence’’.
SEC. 204. CRITERIA FOR STATE PLANS UNDER COMMUNITY
MENTAL HEALTH SERVICES BLOCK GRANTS.
(a) IN GENERAL.—Section 1912(b) of the Public
Health Service Act (42 U.S.C. 300x–2(b)) is amended by
inserting after paragraph (5) the following:
‘‘(6) GOALS AND INITIATIVES FOR IMPROVING
ACCESS TO SERVICES FOR GERIATRIC PATIENTS.—
The plan—
‘‘(A) specifies goals for improving access
by older Americans to community-based mental
health services;
‘‘(B) includes a plan identifying and ad-
dressing the unmet needs of such individuals
for mental health services; and
‘‘(C) includes an inventory of the services,
personnel, and treatment sites available to im-
prove the delivery of mental health services to
such individuals.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to State plans submitted under
section 1912 of the Public Health Service Act on or after
the date that is 180 days after the date of the enactment
of this Act.
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