II 118th CONGRESS 2d Session S. 4312 IN THE SENATE OF THE UNITED STATES May 9, 2024 Mr. Fetterman (for himself and Ms. Smith ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To establish a United States Senate Commission on Mental Health for the purpose of providing to Congress and the President independent, expert policy recommendations to improve access to and affordability of mental health care services.

1. Short title This Act may be cited as the United States Senate Commission on Mental Health Act of 2024 . 2. Purposes The purposes of this section are as follows: (1) To establish the United States Senate Commission on Mental Health to review available data, research, policies, and other pertinent information regarding mental health care services and delivery. (2) To facilitate discussion among relevant stakeholders, including Federal agencies, to understand what policies have successfully improved mental health care services and delivery and to develop recommendations for congressional and executive action to improve access to, and affordability of, mental health care services. 3. Establishment of United States Senate Commission on Mental Health (a) Establishment There is established a United States Senate Commission on Mental Health (referred to in this Act as the Commission ). (b) Purposes The purpose of the Commission is to provide Congress and the President independent, expert policy recommendations to improve mental health care services, including improving equitable access and affordability. (c) Membership (1) In general The Commission shall be composed of 8 members, as follows: (A) Six shall be Members of the Senate appointed by the President of the Senate, of which— (i) 3 shall be selected, after consultation with the majority leader of the Senate, from the majority party; and (ii) 3 shall be selected, after consultation with the minority leader of the Senate, from the minority party. (B) Two shall be experts with a demonstrated academic and professional background in mental health care, selected by the majority leader of the Senate, after consultation with the minority leader of the Senate. (2) Period of appointment Each member of the Commission shall be appointed for a term of 2 years. (3) Chair and vice chair On the commencement of each 2-year period of appointment of the members of the Commission, the members of the Commission shall select a Chair from among the members appointed under paragraph (1)(A)(i), and a Vice Chair from among the members appointed under paragraph (1)(A)(ii). (4) No compensation The members of the Commission shall serve without compensation for their work on the Commission. (5) Travel expenses A member of the Commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Commission. (d) Retention of support The Commission shall retain and make use of such staff, materials, and infrastructure of the Senate as is necessary to carry out the duties of the Commission. (e) Meetings The Commission shall conduct meetings, not less frequently than every 90 days, with relevant stakeholders across the United States, including mental health care providers (such as physicians, psychiatrists, psychologists, counselors, and therapists), patients, and individuals representing advocacy groups, academic and research institutions, nonprofit organizations, industry, and other relevant stakeholders, as determined by the Commission. (f) Vacancies A vacancy in the Commission— (1) shall not affect the powers of the Commission; and (2) shall be filled in the same manner as the original appointment. 4. Duties of the Commission (a) In general The Commission shall study relevant issues regarding mental health care services and delivery and issue reports, as required under subsection (b). (b) Topics studied (1) In general Each calendar year, the Commission shall study specific topics relating to improving mental health care services and delivery, including improving equitable access and affordability with respect to such services, in accordance with paragraphs (2) and (3), including by convening meetings described in section 3(e). (2) Initial topics In the first year following the establishment of the Commission, the Commission shall consider the following topics: (A) Mental health care services coverage, including mental health parity requirements, under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ), the Medicaid program under title XIX of such Act ( 42 U.S.C. 1396 et seq. ), the State Children's Health Insurance Program under title XXI of such Act ( 42 U.S.C. 1397aa et seq. ), and, as the Commission determines appropriate, other health programs administered by the Federal Government, including— (i) the extent to which mental health care services are covered under such programs; and (ii) the extent to which mental health parity requirements applicable to such programs are effective in meeting the mental health care needs of patients. (B) Reimbursement rates for mental health care services with respect to mental health care providers, including— (i) the extent to which reimbursement rates under the programs described in subparagraph (A)(i), impact the affordability, accessibility, and availability of mental health care services; (ii) how reimbursement rates for all mental health care services differ from reimbursement rates for physical health care services under such programs; and (iii) the probable impact of increasing the rates of mental health reimbursement rates under such programs, including the cost to the Federal Government and the number of providers and patients who would be impacted. (C) Workforce challenges with respect to mental health care providers, including— (i) challenges and barriers that prevent individuals, including students, from entering mental health care professions; (ii) challenges and barriers that students enrolled in mental health care professional training programs face while pursuing their degrees; (iii) the challenges and barriers professors and staff in such training programs face; (iv) challenges and barriers mental health care providers face; and (v) factors that contribute to mental health care providers leaving the field. (3) Topics in subsequent years After the submission of the first report under subsection (c) that addresses the topics described in paragraph (2), the Commission shall consider such topics each year as the Commission determines appropriate. (4) Definition In this subsection, the term mental health parity means— (A) with respect to the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ), and other applicable plans administered by the Federal Government, efforts to ensure that reimbursement rates for mental health care services are equivalent to reimbursement rates for physical health care services under such program or such plans; and (B) with respect to the Medicaid program under title XIX of such Act ( 42 U.S.C. 1396 et seq. ) and the State Children's Health Insurance Program under title XXI of such Act ( 42 U.S.C. 1397aa et seq. ), the requirements set forth in the rule titled Medicaid and Children's Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children's Health Insurance Program (CHIP), and Alternative Benefit Plans (81 Fed. Reg. 18390). (c) Annual report (1) In general Not later than January 1 each year, beginning with the first year that begins at least 2 years after the date of enactment of this Act, the Commission shall submit to Congress, the Secretary of Health and Human Services, and, as appropriate, the heads of other relevant Federal agencies a report, based on the studies carried out under subsection (b), regarding the state of mental health care services and delivery, including a needs and gap assessment across the continuum of mental health care. Each report shall include— (A) an analysis of the current barriers to accessing affordable and equitable mental health care services, challenges facing the mental health care workforce, and successful efforts by State, local, or Tribal entities to improve mental health care services and delivery; and (B) policy recommendations for legislative and administrative actions to address issues identified through the report. (2) Contents of report Each report submitted under paragraph (1) shall include a discussion of the topics considered under subsection (b) for the applicable year and the following: (A) The most current and comprehensive data and research on the state of mental health care in the United States, including barriers to accessing mental health care. (B) A comprehensive needs and gap assessment across the continuum of mental health care services, using disaggregated data, for— (i) different age groups, such as for children, adolescents, adults, and older adults; (ii) student status, for each of the primary, secondary, and postsecondary levels; (iii) people with disabilities; (iv) individuals with co-morbidities, including substance use; (v) racial and ethnic minorities; (vi) LGBTQ+ individuals; (vii) individuals residing in rural communities; and (viii) members of Tribal communities. (C) Prioritizing health equity through building and maintaining a culturally competent and diverse mental health care workforce across the continuum of care. 5. Termination of Commission The Commission shall terminate 10 years after the date of enactment of this Act. 6. Authorization of Appropriations To carry out this Act, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2025 through 2034.