I 
108TH CONGRESS 
1ST SESSION H. R. 2241
To amend the Public Health Service Act with respect to mental health 
services for elderly individuals. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 22, 2003
Mr. KENNEDY of Rhode Island (for himself, Mr. HOYER, Mr. SERRANO, Ms. 
JACKSON-LEE of Texas, Mr. KILDEE, Mr. WYNN, Mrs. NAPOLITANO, Mr. 
FROST, Mr. MCNULTY, Mr. ACEVEDO-VILA´, Mr. LIPINSKI, Ms. LEE, Mr. 
MENENDEZ, and Mr. WAXMAN) 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 
2003’’. 
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 disorder, 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 disorders in older 
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 disorders 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 older adults to mental 
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 older patients into pri-
mary 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 provide for col-
laborative care within a primary care setting, involving 
psychiatrists, psychologists, and other licensed mental 
health professionals with appropriate training and experi-
ence 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 pro-
fessional with at least a masters degree in an appro-
priate field of training, supported by psychiatrists 
and psychologists with appropriate training and ex-
perience in the treatment of older adults to ensure
adequate consideration of biomedical and psycho-
social conditions, respectively; 
‘‘(2) referrals for necessary prevention, inter-
vention, follow-up care, consultations, and care plan-
ning 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, anx-
iety, behavioral and psychological symptoms of de-
mentia, psychosis, and misuse of, or dependence on, 
alcohol or medication. 
‘‘(c) CONSIDERATIONS IN AWARDING GRANTS.—To 
the extent feasible, the Secretary shall ensure that—
‘‘(1) grants under this section are awarded to 
projects in a variety of geographic areas, including 
urban and rural areas; and
‘‘(2) the needs of ethnically diverse at-risk pop-
ulations 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 2 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, and 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 2004 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 (42 U.S.C. 290bb–31 et seq.), as amended by 
section 101 of this Act, is further 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 
older adults reside or receive social services. Entities eligi-
ble 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.—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
older adults, relying to the greatest extent feasible 
on protocols that have been developed—
‘‘(A) by or under the auspices of the Sec-
retary; or 
‘‘(B) by academicians with expertise in 
mental health and aging; 
‘‘(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 serv-
ice, mental health, medical, and other health care 
providers at the site or sites where the team is based 
in order to—
‘‘(A) improve patient outcomes; and 
‘‘(B) to ensure, 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 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—
‘‘(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 ensure that—
‘‘(1) grants under this section are awarded to 
projects in a variety of geographic areas, including 
urban and rural areas; and 
‘‘(2) the needs of ethnically diverse at-risk pop-
ulations 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, and 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 2004 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—
‘‘(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 older adults; and 
‘‘(4) development of model training programs 
for mental health professionals and caregivers serv-
ing older adults.’’. 
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. 290aa–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 1 
physician with board certification in geriatric 
psychiatry and at least 1 psychologist with ap-
propriate training and experience in the treat-
ment of older adults.’’. 
SEC. 203. PROJECTS OF NATIONAL SIGNIFICANCE TAR-
GETING 
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. 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
OLDER
ADULTS.—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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