I 
114TH CONGRESS 
2D SESSION 
H. R. 4388 
To amend the Public Health Service Act to authorize a primary and 
behavioral health care integration grant program. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 13, 2016 
Mr. LOEBSACK (for himself, Mr. TONKO, Mr. KENNEDY, and Ms. MATSUI) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend the Public Health Service Act to authorize a 
primary and behavioral health care integration grant pro-
gram. 
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 ‘‘Behavioral Health 
Care Integration Act of 2016’’. 
SEC. 2. PRIMARY AND BEHAVIORAL HEALTH CARE INTE-
GRATION GRANT PROGRAMS. 
Section 520K of the Public Health Service Act (42 
U.S.C. 290bb–42) is amended to read as follows: 
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‘‘SEC. 520K. INTEGRATION INCENTIVE GRANTS. 
‘‘(a) IN GENERAL.—The Secretary shall establish a 
primary and behavioral health care integration grant pro-
gram. The Secretary may award grants and cooperative 
agreements to eligible entities to expend funds for im-
provements in integrated settings with integrated prac-
tices. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) INTEGRATED CARE.—The term ‘integrated 
care’ means full collaboration in merged or trans-
formed practices offering behavioral and physical 
health services within the same shared practice 
space in the same facility, where the entity— 
‘‘(A) provides services in a shared space 
that ensures services will be available and ac-
cessible promptly and in a manner which pre-
serves human dignity and assures continuity of 
care; 
‘‘(B) ensures communication among the in-
tegrated care team that is consistent and team- 
based; 
‘‘(C) ensures shared decisionmaking be-
tween behavioral health and primary care pro-
viders; 
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‘‘(D) provides evidence-based services in a 
mode of service delivery appropriate for the tar-
get population; 
‘‘(E) employs staff who are multidisci-
plinary and culturally and linguistically com-
petent; 
‘‘(F) provides integrated services related to 
screening, diagnosis, and treatment of mental 
illness and substance use disorder and co-occur-
ring primary care conditions and chronic dis-
eases; and 
‘‘(G) provides targeted case management, 
including services to assist individuals gaining 
access to needed medical, social, educational, 
and other services and applying for income se-
curity, housing, employment, and other benefits 
to which they may be entitled. 
‘‘(2) INTEGRATED CARE TEAM.—The term ‘in-
tegrated care team’ means a team that includes— 
‘‘(A) allopathic or osteopathic medical doc-
tors, such as a primary care physician and a 
psychiatrist; 
‘‘(B) licensed clinical behavioral health 
professionals, such as psychologists or social 
workers; 
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‘‘(C) a case manager; and 
‘‘(D) other members, such as psychiatric 
advanced practice nurses, physician assistants, 
peer-support specialists or other allied health 
professionals, such as mental health counselors. 
‘‘(3) SPECIAL POPULATION.—The term ‘special 
population’ means— 
‘‘(A) adults with mental illnesses who have 
co-occurring primary care conditions with 
chronic diseases; 
‘‘(B) adults with serious mental illnesses 
who have co-occurring primary care conditions 
with chronic diseases; 
‘‘(C) children and adolescents with serious 
emotional disorders with co-occurring primary 
care conditions and chronic diseases; 
‘‘(D) older adults with mental illness who 
have co-occurring primary care conditions with 
chronic conditions; 
‘‘(E) individuals with substance use dis-
order; or 
‘‘(F) individuals from populations for 
which there is a significant disparity in the 
quality, outcomes, cost, or use of mental health 
or substance use disorder services or a signifi-
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cant disparity in access to such services, as 
compared to the general population, such as ra-
cial and ethnic minorities and rural populations. 
‘‘(c) PURPOSE.—The grant program under this sec-
tion shall be designed to lead to full collaboration between 
primary and behavioral health in an integrated practice 
model to ensure that— 
‘‘(1) the overall wellness and physical health 
status of individuals with serious mental illness and 
co-occurring substance use disorders is supported 
through integration of primary care into community 
mental health centers meeting the criteria specified 
in section 1913(c) of the Social Security Act or cer-
tified community behavioral health clinics described 
in section 223 of the Protecting Access to Medicare 
Act of 2014; or 
‘‘(2) the mental health status of individuals 
with significant co-occurring psychiatric and physical 
conditions will be supported through integration of 
behavioral health into primary care settings. 
‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 
a grant or cooperative agreement under this section, an 
entity shall be a State department of health, State mental 
health or addiction agency, State Medicaid agency, or li-
censed health care provider or institution. The Adminis-
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trator may give preference to States that have existing in-
tegrated care models, such as those authorized by section 
1945 of the Social Security Act. 
‘‘(e) APPLICATION.—An eligible entity desiring a 
grant or cooperative agreement under this section shall 
submit an application to the Administrator at such time, 
in such manner, and accompanied by such information as 
the Administrator may require, including a description of 
a plan to achieve fully collaborative agreements to provide 
services to special populations and— 
‘‘(1) a document that summarizes the State- 
specific policies that inhibit the provision of inte-
grated care, and the specific steps that will be taken 
to address such barriers, such as through licensing 
and billing procedures; and 
‘‘(2) a plan to develop and share a de-identified 
patient registry to track treatment implementation 
and clinical outcomes to inform clinical interven-
tions, patient education, and engagement with 
merged or transformed integrated practices in com-
pliance with applicable national and State health in-
formation privacy laws. 
‘‘(f) GRANT AMOUNTS.—The maximum annual grant 
amount under this section shall be $2,000,000, of which 
not more than 10 percent may be allocated to State ad-
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ministrative functions, and the remaining amounts shall 
be allocated to health facilities that provide integrated 
care. 
‘‘(g) DURATION.—A grant under this section shall be 
for a period of 5 years. 
‘‘(h) REPORT ON PROGRAM OUTCOMES.—An entity 
receiving a grant or cooperative agreement under this sec-
tion shall submit an annual report to the Administrator 
that includes— 
‘‘(1) the progress to reduce barriers to inte-
grated care, including regulatory and billing bar-
riers, as described in the entity’s application under 
subsection (d); and 
‘‘(2) a description of functional outcomes of 
special populations, such as— 
‘‘(A) with respect to individuals with seri-
ous mental illness, participation in supportive 
housing or independent living programs, en-
gagement in social or education activities, par-
ticipation in job training or employment oppor-
tunities, attendance at scheduled medical and 
mental health appointments, and compliance 
with treatment plans; 
‘‘(B) with respect to individuals with co-oc-
curring mental illness and primary care condi-
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tions and chronic diseases, attendance at sched-
uled medical and mental health appointments, 
compliance with treatment plans, and participa-
tion in learning opportunities related to im-
proved health and lifestyle practice; and 
‘‘(C) with respect to children and adoles-
cents with serious emotional disorders who have 
co-occurring primary care conditions and chron-
ic diseases, attendance at scheduled medical 
and mental health appointments, compliance 
with treatment plans, and participation in 
learning opportunities at school and extra-
curricular activities. 
‘‘(i) TECHNICAL ASSISTANCE CENTER FOR PRIMARY- 
BEHAVIORAL HEALTH CARE INTEGRATION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a program through which such Secretary shall 
provide appropriate information, training, and tech-
nical assistance to eligible entities that receive a 
grant or cooperative agreement under this section, in 
order to help such entities to meet the requirements 
of this section, including assistance with— 
‘‘(A) development and selection of inte-
grated care models; 
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‘‘(B) dissemination of evidence-based inter-
ventions in integrated care; 
‘‘(C) establishment of organizational prac-
tices to support operational and administrative 
success; and 
‘‘(D) other activities, as the Secretary de-
termines appropriate. 
‘‘(2) ADDITIONAL
DISSEMINATION
OF
TECH-
NICAL
INFORMATION.—The information and re-
sources provided by the technical assistance program 
established under paragraph (1) shall be made avail-
able to States, political subdivisions of a State, In-
dian tribes or tribal organizations (as defined in sec-
tion 4 of the Indian Self-Determination and Edu-
cation Assistance Act), outpatient mental health and 
addiction treatment centers, community mental 
health centers that meet the criteria under section 
1913(c), certified community behavioral health clin-
ics described in section 223 of the Protecting Access 
to Medicare Act of 2014, primary care organizations 
such as Federally qualified health centers or rural 
health centers, other community-based organiza-
tions, or other entities engaging in integrated care 
activities, as the Secretary determines appropriate. 
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‘‘(j) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated $50,000,000 for each of fiscal years 2017 through 
2021, of which $2,000,000 shall be available to the tech-
nical assistance program under subsection (i).’’. 
Æ 
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