I 
115TH CONGRESS 
1ST SESSION H. R. 1253 
To authorize the Secretary of Health and Human Services to make loans 
and loan guarantees for constructing or renovating, or planning construc-
tion or renovation of, qualified psychiatric and substance abuse treatment 
facilities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 28, 2017 
Mr. KILMER (for himself, Ms. HERRERA BEUTLER, Mr. MURPHY of Pennsyl-
vania, and Ms. EDDIE BERNICE JOHNSON of Texas) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To authorize the Secretary of Health and Human Services 
to make loans and loan guarantees for constructing or 
renovating, or planning construction or renovation of, 
qualified psychiatric and substance abuse treatment fa-
cilities, and for other purposes. 
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 ‘‘Mental Health and 
Substance Abuse Treatment Accessibility Act of 2017’’. 
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SEC. 2. LOANS AND LOAN GUARANTEES. 
Part P of title III of the Public Health Service Act 
is amended by inserting after section 399V–6 of such Act 
(42 U.S.C. 280g–17) the following: 
‘‘SEC. 399V–7. LOANS AND LOAN GUARANTEES FOR CON-
STRUCTING OR RENOVATING, OR PLANNING 
CONSTRUCTION OR RENOVATION OF, CER-
TAIN QUALIFIED PSYCHIATRIC AND SUB-
STANCE ABUSE TREATMENT FACILITIES. 
‘‘(a) IN GENERAL.—The Secretary may— 
‘‘(1) make loans and loan guarantees for the 
purpose of constructing or renovating, including 
planning the construction or renovation of, a quali-
fied psychiatric treatment facility or a qualified sub-
stance abuse treatment facility to public, private for- 
profit, or private not-for-profit— 
‘‘(A) psychiatric treatment facilities; 
‘‘(B) substance abuse treatment facilities; 
‘‘(C) psychiatric hospitals; and 
‘‘(D) alliances of such facilities or hos-
pitals; and 
‘‘(2) subject to subsection (d), make loans and 
loan guarantees for refinancing loans that were 
made for such purpose to an entity listed in para-
graph (1). 
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‘‘(b) PREFERENCE.—In making loans and loan guar-
antees under this section, the Secretary shall give pref-
erence to psychiatric treatment facilities and substance 
abuse treatment facilities that propose to construct or ren-
ovate a qualified psychiatric treatment facility or qualified 
substance abuse treatment facility in a county that has 
insufficient inpatient psychiatric or substance abuse treat-
ment capacity. 
‘‘(c) TERMS
AND CONDITIONS.—Loans and loan 
guarantees under this section shall be made on such terms 
and conditions as the Secretary may prescribe, subject to 
the provisions of this section including the following: 
‘‘(1) The Secretary may allow credit to a pro-
spective borrower only where— 
‘‘(A) it is necessary to increase the number 
of psychiatric or substance use disorder treat-
ment beds to enhance the public’s access to 
acute inpatient mental health and substance 
abuse services; and 
‘‘(B) a credit subsidy is the most efficient 
way to achieve such increase (on a borrower-by- 
borrower basis). 
‘‘(2) The final maturity of loans made or guar-
anteed under this section shall not exceed a period 
of 20 years, or the period of 50 percent of the useful 
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life of any physical asset to be financed by the loan, 
whichever is less as determined by the Secretary. 
‘‘(3) The Secretary may not make a loan guar-
antee under this section, with respect to any bor-
rower, in excess of 80 percent of any potential loss 
on the loan. 
‘‘(4) The Secretary may not make any loan or 
loan guarantee under this section if the loan will be 
subordinated— 
‘‘(A) to another debt contracted by the 
borrower; or 
‘‘(B) to any other claims against the bor-
rower in the case of default. 
‘‘(5) The Secretary may not make any loan 
guarantee under this section unless the Secretary 
determines that— 
‘‘(A) the lender is responsible; and 
‘‘(B) adequate provision is made for serv-
icing the loan on reasonable terms and pro-
tecting the financial interest of the United 
States. 
‘‘(6) The Secretary may not make any loan 
guarantee under this section if the income from the 
loan will be excluded from gross income for purposes 
of chapter 1 of the Internal Revenue Code of 1986. 
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‘‘(B) the underlying loan qualified for the 
guarantee; and 
‘‘(C) except in the case of fraud or mate-
rial misrepresentation by the holder of the loan, 
the guarantee will be presumed to be valid, 
legal, and enforceable. 
‘‘(10) The Secretary may not make any loan or 
loan guarantee under this section unless— 
‘‘(A) the borrower finances at least 25 per-
cent of the funded project from other sources; 
and 
‘‘(B) the borrower uses funds that were 
not derived from Federal loans or loan guaran-
tees to pay the fees or premiums on the loan or 
loan guarantee under this section. 
‘‘(11) The Secretary— 
‘‘(A) shall prescribe explicit standards for 
use in periodically assessing the credit risk of 
new and existing direct loans and guaranteed 
loans; and 
‘‘(B) shall not make a loan or loan guar-
antee under this section unless the Secretary 
finds that there is a reasonable assurance of re-
payment. 
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‘‘(d) LIMITATION ON REFINANCING.—The authority 
vested by subsection (a)(2)— 
‘‘(1) authorizes making loans and loan guaran-
tees only for refinancing loans that were entered into 
on or before the date that is 24 months before the 
date of enactment of the Mental Health and Sub-
stance Abuse Treatment Accessibility Act of 2017; 
and 
‘‘(2) terminates on the date that is 24 months 
after such date of enactment. 
‘‘(e) PAYMENT OF LOSSES.— 
‘‘(1) DEFAULT ON GUARANTEED LOANS.—If, as 
a result of a default by a borrower under a loan 
guaranteed under this section, after the holder 
thereof has made such further collection efforts and 
instituted such enforcement proceedings as the Sec-
retary may require, the Secretary determines that 
the holder has suffered a loss— 
‘‘(A) the Secretary shall pay to such holder 
75 percent of such loss, as specified in the 
guarantee contract; 
‘‘(B) upon making any such payment, the 
Secretary shall be subrogated to all the rights 
of the recipient of the payment; and 
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‘‘(C) the Secretary shall be entitled to re-
cover from the borrower the amount of any pay-
ments made pursuant to the guarantee con-
tract. 
‘‘(2) 
REQUIRED
ENFORCE
OF
FEDERAL 
RIGHTS.—The Attorney General of the United 
States shall take such action as may be appropriate 
to enforce any right accruing to the United States 
as a result of the issuance of any guarantee under 
this section. 
‘‘(3) FORBEARANCE.—Nothing in this section 
precludes any forbearance for the benefit of the bor-
rower of a loan that is made or guaranteed under 
this section which is agreed upon by the parties to 
the loan and approved by the Secretary, provided 
that budget authority for any resulting cost to the 
Government (as defined in section 502(5) of the 
Federal Credit Reform Act of 1990) is available. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) The term ‘qualified psychiatric treatment 
facility’— 
‘‘(A) means a psychiatric hospital (or other 
qualified treatment facility, as determined ap-
propriate by the Secretary) that is able to serve 
patients ages 21 and older that— 
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‘‘(i) will provide acute, short-term in-
patient psychiatric treatment services for 
such patients; 
‘‘(ii) will provide outpatient services; 
and 
‘‘(iii) may include a military services 
program to meet the needs of active and 
retired military servicemembers; and 
‘‘(B) excludes a facility that— 
‘‘(i) provides long-term inpatient care; 
‘‘(ii) is a health center (as defined in 
section 330); and 
‘‘(iii) is part of or affiliated with a 
prison (as defined in section 2246 of title 
18, United States Code). 
‘‘(2) The term ‘qualified substance abuse treat-
ment facility’— 
‘‘(A) means a psychiatric hospital (or other 
qualified treatment facility, as determined ap-
propriate by the Secretary) that is able to serve 
patients ages 21 and older that— 
‘‘(i) will provide acute, short-term in-
patient substance abuse treatment services 
for such patients; 
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‘‘(ii) will provide outpatient services; 
and 
‘‘(iii) may include a military services 
program to meet the needs of active and 
retired military servicemembers; and 
‘‘(B) excludes any facility described in 
paragraph (1)(B). 
‘‘(3) The term ‘psychiatric hospital’ means— 
‘‘(A) an institution that— 
‘‘(i) is primarily engaged in providing, 
by or under the supervision of one or more 
physicians, psychiatric services for the di-
agnosis and treatment of mentally ill per-
sons or those suffering from substance 
abuse disorders; 
‘‘(ii) satisfies the requirements of 
paragraphs (3) through (9) of subsection 
(e) of section 1861 of the Social Security 
Act; 
‘‘(iii) maintains clinical records on all 
patients and maintains such records as the 
Secretary finds to be necessary to deter-
mine the degree and intensity of the treat-
ment provided to individuals entitled to 
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hospital insurance benefits under part A of 
title XVIII of the Social Security Act; and 
‘‘(iv) meets such staffing requirements 
as the Secretary finds necessary for the in-
stitution to carry out an active program of 
treatment for individuals who are fur-
nished services in the institution; or 
‘‘(B) a distinct part of an institution that 
satisfies clauses (i) and (ii) of subparagraph 
(A) if such distinct part satisfies clauses (iii) 
and (iv) of subparagraph (A). 
‘‘(g) FUNDING LIMITATIONS.—The Secretary may 
provide loans and loan guarantees under this section— 
‘‘(1) only to the extent or in the amounts pro-
vided in advance in appropriation Acts; and 
‘‘(2) totaling not more than $200,000,000 in 
each of fiscal years 2018 through 2022.’’. 
SEC. 3. MENTAL HEALTH AND SUBSTANCE USE TREAT-
MENT TRUST FUND. 
(a) ESTABLISHMENT.—There is established in the 
Treasury of the United States a trust fund to be known 
as the Mental Health and Substance Use Treatment Trust 
Fund (in this section referred to as the ‘‘Trust Fund’’). 
(b) DEPOSITS.—There are hereby authorized to be 
appropriated to the Trust Fund, to remain available until 
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