I 
108TH CONGRESS 
2D SESSION 
H. R. 4694 
To amend the Older Americans Act of 1965 to provide for mental health 
screening and treatment services, to amend the Public Health Service 
Act to provide for integration of mental health services and mental 
health treatment outreach teams, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 24, 2004 
Mr. KENNEDY of Rhode Island (for himself and Ms. ROS-LEHTINEN) intro-
duced the following bill; which was referred to the Committee on Edu-
cation and the Workforce, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend the Older Americans Act of 1965 to provide 
for mental health screening and treatment services, to 
amend the Public Health Service Act to provide for 
integration of mental health services and mental health 
treatment outreach teams, 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 ‘‘Positive Aging Act of 
2004’’.
TITLE I—AMENDMENTS TO THE 
OLDER AMERICANS ACT OF 1965 
SEC. 101. DEFINITIONS. 
Section 102 of the Older Americans Act of 1965 (42 
U.S.C. 3002) is amended by adding at the end the fol-
lowing: 
‘‘(44) 
MENTAL
HEALTH
SCREENING
AND 
TREATMENT
SERVICES.—The term ‘mental health 
screening and treatment services’ means patient 
screening, diagnostic services, care planning and 
oversight, therapeutic interventions, and referrals 
that are— 
‘‘(A) provided pursuant to evidence-based 
intervention and treatment protocols (to the ex-
tent such protocols are available) for mental 
disorders prevalent in older individuals (includ-
ing, but not limited to, mood and anxiety dis-
orders, dementias of all kinds, psychotic dis-
orders, and substances and alcohol abuse), rely-
ing to the greatest extent feasible on protocols 
that have been developed— 
‘‘(i) by or under the auspices of the 
Secretary; or 
‘‘(ii) by academicians with expertise in 
mental health and aging; and
‘‘(B) coordinated and integrated with the 
services of social service, mental health, and 
health care providers in an area in order to— 
‘‘(i) improve patient outcomes; and 
‘‘(ii) assure, to the maximum extent 
feasible, the continuing independence of 
older individuals who are residing in the 
area.’’. 
SEC. 102. OFFICE OF OLDER ADULT MENTAL HEALTH SERV-
ICES. 
Section 301(b) of the Older Americans Act of 1965 
(42 U.S.C. 3021(b)) is amended by adding at the end the 
following: 
‘‘(3) The Assistant Secretary shall establish within 
the Administration an Office of Older Adult Mental 
Health Services, which shall be responsible for the devel-
opment and implementation of initiatives to address the 
mental health needs of older individuals.’’. 
SEC. 103. GRANTS TO STATES FOR THE DEVELOPMENT AND 
OPERATION OF SYSTEMS FOR PROVIDING 
MENTAL HEALTH SCREENING AND TREAT-
MENT SERVICES TO OLDER INDIVIDUALS 
LACKING ACCESS TO SUCH SERVICES. 
Title III of the Older Americans Act of 1965 (42 
U.S.C. 3021 et seq.) is amended—
(1) in section 303 (42 U.S.C. 3023), by adding 
at the end the following: 
‘‘(f) There are authorized to be appropriated to carry 
out part F (relating to grants for programs providing 
mental health screening and treatment services) such 
sums as may be necessary for fiscal year 2005 and each 
of the 5 succeeding fiscal years.’’; 
(2) 
in 
section 
304(a)(1) 
(42 
U.S.C. 
3024(a)(1)), by inserting ‘‘and subsection (f)’’ after 
‘‘through (d)’’; and 
(3) by adding at the end the following: 
‘‘PART F—MENTAL HEALTH SCREENING AND 
TREATMENT SERVICES FOR OLDER INDIVIDUALS 
‘‘SEC. 381. GRANTS TO STATES FOR PROGRAMS PROVIDING 
MENTAL HEALTH SCREENING AND TREAT-
MENT SERVICES FOR OLDER INDIVIDUALS. 
‘‘(a) PROGRAM AUTHORIZED.—The Assistant Sec-
retary shall carry out a program for making grants to 
States under State plans approved under section 307 for 
the development and operation of— 
‘‘(1) systems for the delivery of mental health 
screening and treatment services for older individ-
uals who lack access to such services; and 
‘‘(2) programs to—
‘‘(A) increase public awareness regarding 
the benefits of prevention and treatment of 
mental disorders; and 
‘‘(B) reduce the stigma associated with 
mental disorders and other barriers to the diag-
nosis and treatment of the disorders. 
‘‘(b) STATE ALLOCATION AND PRIORITIES.—A State 
agency that receives funds through a grant made under 
this section shall allocate the funds to area agencies on 
aging to carry out this part in planning and service areas 
in the State. In allocating the funds, the State agency 
shall give priority to planning and service areas in the 
State— 
‘‘(1) that are medically underserved; and 
‘‘(2) in which there are a large number of older 
individuals. 
‘‘(c) AREA
COORDINATION
OF
SERVICES
WITH 
OTHER PROVIDERS.—In carrying out this part, to more 
efficiently and effectively deliver services to older individ-
uals, each area agency on aging shall— 
‘‘(1) coordinate services described in subsection 
(a) with other community agencies, and voluntary 
organizations, providing similar or related services; 
and
‘‘(2) to the greatest extent practicable, integrate 
outreach and educational activities with existing (as 
of the date of the integration) health care and social 
service providers serving older individuals in the 
planning and service area involved. 
‘‘(d) 
RELATIONSHIP
TO
OTHER
FUNDING 
SOURCES.—Funds made available under this part shall 
supplement, and not supplant, any Federal, State, and 
local funds expended by a State or unit of general purpose 
local government (including an area agency on aging) to 
provide the services described in subsection (a).’’. 
SEC. 104. DEMONSTRATION PROJECTS PROVIDING MENTAL 
HEALTH SCREENING AND TREATMENT SERV-
ICES TO OLDER INDIVIDUALS LIVING IN 
RURAL AREAS. 
The Older Americans Act of 1965 (42 U.S.C. 3001 
et seq.) is amended— 
(1) by inserting before section 401 (42 U.S.C. 
3031) the following: 
‘‘TITLE IV—GRANTS FOR EDU-
CATION, TRAINING, AND RE-
SEARCH’’; 
and 
(2) in part A of title IV (42 U.S.C. 3032 et 
seq.), by adding at the end the following:
‘‘SEC. 422. DEMONSTRATION PROJECTS PROVIDING MEN-
TAL HEALTH SCREENING AND TREATMENT 
SERVICES TO OLDER INDIVIDUALS LIVING IN 
RURAL AREAS. 
‘‘(a) DEFINITION.—In this section, the term ‘rural 
area’ means— 
‘‘(1) any area that is outside a metropolitan 
statistical area (as defined by the Director of the Of-
fice of Management and Budget); or 
‘‘(2) such similar area as the Secretary specifies 
in a regulation issued under section 1886(d)(2)(D) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(2)(D)). 
‘‘(b) AUTHORITY.—The Assistant Secretary shall 
make grants to eligible public agencies and nonprofit pri-
vate organizations to pay part or all of the cost of devel-
oping or operating model health care service projects in-
volving the provision of mental health screening and treat-
ment services to older individuals residing in rural areas. 
‘‘(c) DURATION.—Grants made under this section 
shall be made for 3-year periods. 
‘‘(d) APPLICATION.—To be eligible to receive a grant 
under this section, a public agency or nonprofit private 
organization shall submit to the Assistant Secretary an 
application containing such information and assurances as 
the Secretary may require, including—
‘‘(1) information describing— 
‘‘(A) the geographic area and target popu-
lation (including the racial and ethnic composi-
tion of the target population) to be served by 
the project; and 
‘‘(B) the nature and extent of the appli-
cant’s experience in providing mental health 
screening and treatment services of the type to 
be provided in the project; 
‘‘(2) assurances that the applicant will carry 
out the project— 
‘‘(A) through a multidisciplinary team of 
licensed mental health professionals; 
‘‘(B) using evidence-based intervention and 
treatment protocols to the extent such protocols 
are available; 
‘‘(C) 
using 
telecommunications 
tech-
nologies as appropriate and available; and 
‘‘(D) in coordination with other providers 
of health care and social services (such as sen-
ior centers and adult day care providers) serv-
ing the area; and 
‘‘(3) assurances that the applicant will conduct 
and submit to the Assistant Secretary such evalua-
tions and reports as the Assistant Secretary may re-
quire. 
‘‘(e) REPORTS.—The Assistant Secretary shall pre-
pare and submit to the appropriate committees of Con-
gress a report that includes summaries of the evaluations 
and reports required under subsection (d)(3). 
‘‘(f) COORDINATION.—The Assistant Secretary shall 
provide for appropriate coordination of programs and ac-
tivities receiving funds pursuant to a grant under this sec-
tion with programs and activities receiving funds pursuant 
to grants under sections 381 and 423, and sections 520K 
and 520L of the Public Health Service Act.’’. 
SEC. 105. DEMONSTRATION PROJECTS PROVIDING MENTAL 
HEALTH SCREENING AND TREATMENT SERV-
ICES TO OLDER INDIVIDUALS LIVING IN NAT-
URALLY OCCURRING RETIREMENT COMMU-
NITIES IN URBAN AREAS. 
Part A of title IV of the Older Americans Act of 1965 
(42 U.S.C. 3032 et seq.), as amended by section 104, is 
further amended by adding at the end the following:
‘‘SEC. 423. DEMONSTRATION PROJECTS PROVIDING MEN-
TAL HEALTH SCREENING AND TREATMENT 
SERVICES TO OLDER INDIVIDUALS LIVING IN 
NATURALLY OCCURRING RETIREMENT COM-
MUNITIES IN URBAN AREAS. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) NATURALLY
OCCURRING
RETIREMENT 
COMMUNITY.—The term ‘naturally occurring retire-
ment community’ means a residential area (such as 
an apartment building, housing complex or develop-
ment, or neighborhood) not originally built for older 
individuals but in which a substantial number of in-
dividuals have aged in place (and become older indi-
viduals) while residing in such area. 
‘‘(2) URBAN
AREA.—The term ‘urban area’ 
means— 
‘‘(A) a metropolitan statistical area (as de-
fined by the Director of the Office of Manage-
ment and Budget); or 
‘‘(B) such similar area as the Secretary 
specifies in a regulation issued under section 
1886(d)(2)(D) of the Social Security Act (42 
U.S.C. 1395ww(d)(2)(D)). 
‘‘(b) AUTHORITY.—The Assistant Secretary shall 
make grants to eligible public agencies and nonprofit pri-
vate organizations to pay part or all of the cost of devel-
oping or operating model health care service projects in-
volving the provision of mental health screening and treat-
ment services to older individuals residing in naturally oc-
curring retirement communities located in urban areas. 
‘‘(c) DURATION.—Grants made under this section 
shall be made for 3-year periods. 
‘‘(d) APPLICATION.—To be eligible to receive a grant 
under this section, a public agency or nonprofit private 
organization shall submit to the Assistant Secretary an 
application containing such information and assurances as 
the Secretary may require, including— 
‘‘(1) information describing— 
‘‘(A) the naturally occurring retirement 
community and target population (including the 
racial and ethnic composition of the target pop-
ulation) to be served by the project; and 
‘‘(B) the nature and extent of the appli-
cant’s experience in providing mental health 
screening and treatment services of the type to 
be provided in the project; 
‘‘(2) assurances that the applicant will carry 
out the project— 
‘‘(A) through a multidisciplinary team of 
licensed mental health professionals;
‘‘(B) using evidence-based intervention and 
treatment protocols to the extent such protocols 
are available; and 
‘‘(C) in coordination with other providers 
of health care and social services serving the re-
tirement community; and 
‘‘(3) assurances that the applicant will conduct 
and submit to the Assistant Secretary such evalua-
tions and reports as the Assistant Secretary may re-
quire. 
‘‘(e) REPORTS.—The Assistant Secretary shall pre-
pare and submit to the appropriate committees of Con-
gress a report that includes summaries of the evaluations 
and reports required under subsection (d)(3). 
‘‘(f) COORDINATION.—The Assistant Secretary shall 
provide for appropriate coordination of programs and ac-
tivities receiving funds pursuant to grants made under this 
section with programs and activities receiving funds pur-
suant to grants made under sections 381 and 422, and 
sections 520K and 520L of the Public Health Service 
Act.’’.
TITLE II—PUBLIC HEALTH 
SERVICE ACT AMENDMENTS 
SEC. 201. DEMONSTRATION PROJECTS TO SUPPORT INTE-
GRATION 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 subsection (b) of section 520(b) (42 
U.S.C. 290bb–31(b))— 
(A) by striking ‘‘and’’ at the end of para-
graph (14); 
(B) by striking the period at the end of 
paragraph (15) and inserting in lieu thereof ‘‘; 
and’’; and 
(C) by adding at the end the following: 
‘‘(16) conduct the demonstration projects speci-
fied in section 520K.’’.; and 
(2) by adding at the end the following: 
‘‘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 award grants to public and private nonprofit entities 
for projects to demonstrate ways of integrating mental
health services for older patients into primary care set-
tings, such as health centers receiving a grant under sec-
tion 330 (or determined by the Secretary to meet the re-
quirements for receiving such a grant), other Federally 
qualified health centers, primary care clinics, and private 
practice sites. 
‘‘(b) REQUIREMENTS.—In order to be eligible for a 
grant under this section, the project to be carried out by 
the entity shall provide for collaborative care within a pri-
mary care setting, involving psychiatrists, psychologists, 
and other licensed mental health professionals (such as so-
cial workers and advanced practice nurses) with appro-
priate training and experience 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; 
‘‘(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.—In 
awarding grants under this section the Secretary, to the 
extent feasible, shall ensure that— 
‘‘(1) projects are funded in a variety of geo-
graphic areas, including urban and rural areas; and 
‘‘(2) a variety of populations, including racial 
and ethnic minorities and low-income populations, 
are served by projects funded under this section. 
‘‘(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.—To be eligible 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 July 31 of each 
calendar year, the Secretary shall submit to Congress a 
report evaluating the projects receiving awards under this 
section for such year. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section for fiscal year 2005 
and each fiscal year thereafter.’’. 
SEC. 
202. 
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 201, is further amended by adding at the end the 
following: 
‘‘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 award 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.—To be eligible to receive 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 individuals (including, but not limited to, mood 
and anxiety disorders, dementias of all kinds, psy-
chotic disorders, and substance and alcohol abuse), 
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, 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 older 
adults who are residing in the community. 
‘‘(c) COOPERATIVE ARRANGEMENTS WITH SITES 
SERVING AS BASES FOR OUTREACH.—An entity receiving 
a grant under this section may enter into an agreement 
with a person operating a site at which a geriatric 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 of 
1965, 
under which such person provides (and is reimbursed by 
the entity, out of funds received under the grant, for) any
supportive services, such as transportation and adminis-
trative support, that such person provides to an outreach 
team of such entity. 
‘‘(d) CONSIDERATIONS IN AWARDING GRANTS.—In 
awarding grants under this section the Secretary, to the 
extent feasible, shall ensure that— 
‘‘(1) projects are funded in a variety of geo-
graphic areas, including urban and rural areas; and 
‘‘(2) a variety of populations, including racial 
and ethnic minorities and low-income populations, 
are served by projects funded under this section. 
‘‘(e) APPLICATION.—To be eligible 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) COORDINATION.—The Secretary shall provide 
for appropriate coordination of programs and activities re-
ceiving funds pursuant to a grant under this section with 
programs and activities receiving funds pursuant to grants
under section 520K and sections 381, 422, and 423 of 
the Older Americans Act of 1965. 
‘‘(g) EVALUATION.—Not later than July 31 of each 
calendar year, the Secretary shall submit to Congress a 
report evaluating the projects receiving awards under this 
section for such year. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section for fiscal year 2005 
and each fiscal year thereafter.’’. 
SEC. 203. DESIGNATION OF DEPUTY DIRECTOR FOR OLDER 
ADULT 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— 
(1) by redesignating subsection (c) as sub-
section (d); and 
(2) by inserting after subsection (b) the fol-
lowing: 
‘‘(c) DEPUTY DIRECTOR FOR OLDER ADULT MEN-
TAL
HEALTH
SERVICES
IN
CENTER
FOR
MENTAL 
HEALTH SERVICES.—The Director, after consultation 
with the Administrator, shall designate a Deputy Director 
for Older Adult Mental Health Services, who shall be re-
sponsible for the development and implementation of ini-
tiatives 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 care givers serv-
ing older adults.’’. 
SEC. 204. 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.’’.
SEC. 205. 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. 206 CRITERIA FOR STATE PLANS UNDER COMMUNITY 
MENTAL HEALTH SERVICES BLOCK GRANTS. 
(a) IN GENERAL.—Section 1912(b)(4) of the Public 
Health Service Act (42 U.S.C. 300x–1(b)(4)) is amended 
to read as follows: 
‘‘(4) TARGETED SERVICES TO OLDER INDIVID-
UALS, INDIVIDUALS WHO ARE HOMELESS, AND INDI-
VIDUALS LIVING IN RURAL AREAS.—The plan de-
scribes the State’s outreach to and services for older 
individuals, individuals who are homeless, and indi-
viduals living in rural areas, and how community- 
based services will be provided to these individuals.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to State plans submitted on or 
after the date that is 180 days after the date of enactment 
of this Act. 
Æ