I 
108TH CONGRESS 
1ST SESSION H. R. 3243
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 HOUSE OF REPRESENTATIVES 
OCTOBER 2, 2003
Mr. RAMSTAD (for himself, Mr. NORWOOD, Mr. BACHUS, Mr. KENNEDY of 
Rhode Island, Mr. STARK, Mr. PICKERING, Mr. CASTLE, and Mrs. JOHN-
SON of Connecticut) introduced the following bill; which was referred to 
the Committee on Energy and Commerce 
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 Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Keeping Families To-
gether Act’’.
SEC. 2. PURPOSE. 
It is the purpose of this Act to assist States in elimi-
nating the practice of parents giving custody of their seri-
ously emotionally disturbed children to State agencies for 
the purpose of securing mental health care for those chil-
dren. 
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 es-
tablish 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 serv-
ices 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 pro-
vide matching funds in accordance with subsection 
(e); and 
‘‘(4) meet such other requirements as the Sec-
retary 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 fami-
lies receive the appropriate individualized men-
tal 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 on-
going 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 num-
ber 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 col-
laboration 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 es-
tablished 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 part-
ners as represented by senior officials with pol-
icymaking authority, the required private part-
ners, and other entities that the governor of the 
State determines appropriate; 
‘‘(B) contains a description and assess-
ment of the effectiveness of the laws or policies 
that the State has in effect to ensure that chil-
dren 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 exist-
ing systems of care within the State; 
‘‘(D) contains a description of the proce-
dures to be implemented for the early identi-
fication, assessment, and referral, by health 
care providers, mental health agencies, other 
child-serving entities, child welfare, corrections, 
and juvenile justice systems, of all eligible chil-
dren and youth for appropriate care and for co-
ordinating services among child welfare, juve-
nile 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 chil-
dren and youth entering the juvenile justice and 
child welfare systems for mental health prob-
lems, 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 So-
cial Security Act that are provided under the 
medicaid programs;
‘‘(ii) how Federal grant dollars will be 
used to enable the State to achieve a sus-
tainable 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 in-
volve families; and 
‘‘(J) establishes a method for tracking and 
reporting the number of children and youth en-
tering 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 ac-
cess to community-based services for children 
with serious emotional disturbances; 
‘‘(C) that have provided reasonable esti-
mates 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 over-
sight of the system of care. 
‘‘(d) USE OF FUNDS.—A State shall use amounts re-
ceived under a grant under this section to—
‘‘(1) establish State- and local-level infrastruc-
ture 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 struc-
tures and eliminate inter-agency fragmentation 
of services; and 
‘‘(C) increase the capacity of agencies to 
share public resources and improve parental ac-
cess to services for children with mental health
needs to eliminate the need to relinquish cus-
tody 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 sup-
port services to eligible children and youth and their 
families as part of a transition to a sustainable sys-
tem of care for such children and youth; 
‘‘(4) provide outreach and public education con-
cerning programs and activities funded under this 
section; 
‘‘(5) provide training and professional develop-
ment for personnel who work with eligible children 
and youth as required to successfully implement the 
State plan; and 
‘‘(6) carry out other administrative activities re-
lated 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 pro-
vided in the grant; and 
‘‘(C) for the fifth and sixth such fiscal 
years, is not less than $2 for each $1 of Fed-
eral funds provided in the grant. 
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions required in para-
graph (1) may be in cash or in kind, fairly evalu-
ated, including plant, equipment, or services. 
Amounts provided by the Federal Government, or 
services assisted or subsidized to any significant ex-
tent by the Federal Government, may not be in-
cluded in determining the amount of such non-Fed-
eral contributions. 
‘‘(3) ACCOUNTING REQUIRED.—With respect to 
a State that complies with the requirement of para-
graph (2) through the provision of in-kind contribu-
tions, 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, in-
clude—
‘‘(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 eligi-
ble children and youth in school; 
‘‘(D) measures of the contacts of eligible 
children and youth with juvenile justice sys-
tems; 
‘‘(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 in-
formation 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 recommenda-
tions to strengthen the program under this sec-
tion. 
‘‘(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 car-
rying 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 sub-
section 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 serv-
ices 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 in-
surers; and 
‘‘(D) representatives of hospitals and resi-
dential care facilities.
‘‘(4) REQUIRED STATE PARTNERS.—The term 
‘required State partners’ with respect to a State in-
cludes—
‘‘(A) the State agency responsible for chil-
dren’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 ad-
dition to the several States, the District of Colum-
bia, the Commonwealth of Puerto Rico, the Com-
monwealth 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 each of fiscal years 
2006 through 2009.
‘‘SEC. 597A. TASK FORCE. 
‘‘(a) ESTABLISHMENT.—The Administrator, in con-
junction with the Director of the Office of Juvenile Justice 
and Delinquency Prevention, the Administrator of the Ad-
ministration 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 agen-
cies in promoting access by children and youth to mental 
health services. 
‘‘(b) DUTIES.—The task force established under sub-
section (a) shall—
‘‘(1) work with mental health and child advo-
cates, representatives of families of eligible children 
and youth, and representatives of State systems of 
care to make recommendations to Congress con-
cerning strategies to improve the delivery of mental 
health services, including prevention services, to chil-
dren 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 wel-
fare and juvenile justice systems;
‘‘(2) work with mental health and child advo-
cates, 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 appro-
priate stakeholders, create standard definitions for 
the categories of data to be collected on such chil-
dren and youth; 
‘‘(4) foster interagency cooperation to eliminate 
the practice of custody relinquishment; 
‘‘(5) provide advice to the Administrator in im-
plementation of the family support grant programs 
under section 597; 
‘‘(6) coordinate and deliver technical assistance 
to States and State agencies to help implement pro-
grams under such grant program; 
‘‘(7) make recommendations to break down bar-
riers 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 relin-
quishing 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 avail-
able 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 HOS-
PITAL SERVICES FOR INDIVIDUALS UNDER 
AGE 21 IN HOME OR COMMUNITY-BASED 
SERVICES WAIVERS. 
(a) IN GENERAL.—Section 1915(c) of the Social Se-
curity 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 re-
tarded’’; 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 serv-
ices in an intermediate care facility for the mentally 
retarded’’ each place it appears and inserting ‘‘serv-
ices 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 hos-
pital services for individuals under age 21,’’ 
after ‘‘, or intermediate care facility for the 
mentally retarded’’; and 
(B) by striking ‘‘or services in an inter-
mediate 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 inpa-
tient psychiatric hospital services for individuals 
under age 21,’’ after ‘‘intermediate care facility 
for the mentally retarded,’’; and 
(B) by inserting ‘‘or who would require in-
patient psychiatric hospital services for individ-
uals 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.
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