II 113th CONGRESS 1st Session S. 1119 IN THE SENATE OF THE UNITED STATES June 7, 2013 Ms. Collins (for herself and Ms. Mikulski ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL 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.

1. Short title This Act may be cited as the Positive Aging Act of 2013 . 2. Demonstration projects to support 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 after the semicolon; (B) in paragraph (15), by striking the period at the end and inserting ; and ; and (C) by adding at the end the following: (16) conduct the demonstration projects specified in section 520L. ; and (2) by adding at the end the following: 520L. 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 adults into primary 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 be eligible for a grant under this section, the project to be carried out by the entity shall provide for collaborative care within a primary care setting, provided by licensed mental health professionals with appropriate 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 professional with at least a masters degree in an appropriate field of training; (2) referrals for necessary prevention, intervention, follow-up care, consultations, and care planning oversight for mental health and other service needs, as indicated; and (3) adoption and implementation of evidence-based intervention and treatment protocols (to the extent such protocols are available) for mental disorders prevalent in older adults including, but not limited to, mood and anxiety disorders, dementias of all kinds (including the behavioral and psychological symptoms of dementia), psychotic disorders, and substance-related disorders. (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 geographic 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 pursuant 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 standardized clinical and behavioral data and other performance data necessary to evaluate patient outcomes and to facilitate evaluations across participating projects. (f) Evaluation Not later than July 31 of the second calendar year after the date of enactment of this section, and July 31 of every year thereafter, the Secretary shall submit to Congress a report evaluating the projects receiving awards under this section for the year involved. (g) Supplement, not supplant Funds made available under this section shall supplement, and not supplant, other Federal, State, or local funds available to an entity to carry out activities described in this section. (h) Authorization of appropriations There are authorized to be appropriated such sums as may be necessary to carry out this section for fiscal year 2014 and each fiscal year thereafter. . 3. 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 2, is further amended by adding at the end the following: 520M. 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 maintenance by such entities of interdisciplinary geriatric mental health outreach teams in community settings where older adults reside or receive social services. Entities eligible 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 protocols are available) for mental disorders prevalent in older adults including, but not limited to, mood and anxiety disorders, dementias of all kinds (including the behavioral and psychological symptoms of dementia), psychotic disorders, and substance-related disorders, relying to the greatest extent feasible on protocols that have been developed— (A) by or under the auspices of the Secretary; or (B) by academicians; (2) provide screening for mental disorders, diagnostic services, referrals for treatment, and case management and coordination through such teams; and (3) coordinate and integrate the services provided by such team with the services of social service, 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 older adults 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 administrative 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 geographic 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 standardized clinical and behavioral data and other performance data necessary to evaluate patient outcomes and to facilitate evaluations across participating projects. (f) Coordination The Secretary shall provide for appropriate coordination of programs and activities receiving funds pursuant to a grant under this section with programs and activities receiving funds pursuant to grants under section 520L and sections 381, 422, and 423 of the Older Americans Act of 1965 . (g) Evaluation Not later than July 31 of the second calendar year after the date of enactment of this section, and July 31 of every year thereafter, the Secretary shall submit to Congress a report evaluating the projects receiving awards under this section for such year. (h) Supplement, not supplant Funds made available under this section shall supplement, and not supplant, other Federal, State, or local funds available to an entity to carry out activities described in this section. (i) Authorization of appropriations There are authorized to be appropriated such sums as may be necessary to carry out this section for fiscal year 2014 and each fiscal year thereafter. . 4. Designation of Deputy Director for Older Adult Mental Health Services in Center 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 subsection (d); and (2) by inserting after subsection (b) the following: (c) Deputy Director for Older Adult Mental 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 responsible 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 older adult population; (2) innovative demonstration projects for the delivery of community-based mental health services for older adults; (3) support for the development and dissemination of evidence-based practice models, including models to address substance-related disorders in older adults; and (4) development of model training programs for mental health professionals and caregivers serving older adults. . 5. 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 adults or their families, and professionals with an expertise in geriatric mental health. . 6. Projects of national significance targeting 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 substance-related disorders . 7. 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–2(b)(4)) is amended to read as follows: (4) Targeted services to older individuals, individuals who are homeless, and individuals living in rural areas The plan describes the State’s outreach to and services for older individuals, individuals who are homeless, and individuals 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.