H. Rept. 114-667 - HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT OF 2016114th Congress (2015-2016)
Committee Report
| Report Type: | House Report |
|---|---|
| Accompanies: | H.R.2646 |
| Committees: |
H. Rept. 114-667 - 114th Congress (2015-2016)
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House Report 114-667 - HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT OF 2016
[House Report 114-667]
[From the U.S. Government Publishing Office]
114th Congress } { Rept. 114-667
HOUSE OF REPRESENTATIVES
2d Session } { Part 1
======================================================================
HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT OF 2016
_______
July 6, 2016.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 2646]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 2646) to make available needed psychiatric,
psychological, and supportive services for individuals with
mental illness and families in mental health crisis, and for
other purposes, having considered the same, report favorably
thereon with an amendment and recommend that the bill as
amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 39
Background and Need for Legislation.............................. 40
Hearings......................................................... 40
Committee Consideration.......................................... 40
Committee Votes.................................................. 41
Committee Oversight Findings..................................... 44
Statement of General Performance Goals and Objectives............ 44
New Budget Authority, Entitlement Authority, and Tax Expenditures 44
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 44
Committee Cost Estimate.......................................... 44
Congressional Budget Office Estimate............................. 44
Federal Mandates Statement....................................... 47
Duplication of Federal Programs.................................. 47
Disclosure of Directed Rule Makings.............................. 47
Advisory Committee Statement..................................... 47
Applicability to Legislative Branch.............................. 47
Section-by-Section Analysis of the Legislation................... 47
Changes in Existing Law Made by the Bill, as Reported............ 56
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Helping Families in
Mental Health Crisis Act of 2016''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
Sec. 101. Assistant Secretary for Mental Health and Substance Use.
Sec. 102. Improving oversight of mental health and substance use
programs.
Sec. 103. National Mental Health and Substance Use Policy Laboratory.
Sec. 104. Peer-support specialist programs.
Sec. 105. Prohibition against lobbying using Federal funds by systems
accepting Federal funds to protect and advocate the rights of
individuals with mental illness.
Sec. 106. Reporting for protection and advocacy organizations.
Sec. 107. Grievance procedure.
Sec. 108. Center for Behavioral Health Statistics and Quality.
Sec. 109. Strategic plan.
Sec. 110. Authorities of centers for mental health services and
substance abuse treatment.
Sec. 111. Advisory councils.
Sec. 112. Peer review.
TITLE II--MEDICAID MENTAL HEALTH COVERAGE
Sec. 201. Rule of construction related to Medicaid coverage of mental
health services and primary care services furnished on the same day.
Sec. 202. Optional limited coverage of inpatient services furnished in
institutions for mental diseases.
Sec. 203. Study and report related to Medicaid managed care regulation.
Sec. 204. Guidance on opportunities for innovation.
Sec. 205. Study and report on Medicaid emergency psychiatric
demonstration project.
Sec. 206. Providing full-range of EPSDT services to children in IMDs.
Sec. 207. Electronic visit verification system required for personal
care services and home health care services under Medicaid.
TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE
Sec. 301. Interdepartmental Serious Mental Illness Coordinating
Committee.
TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA
Sec. 401. Sense of Congress.
Sec. 402. Confidentiality of records.
Sec. 403. Clarification of circumstances under which disclosure of
protected health information is permitted.
Sec. 404. Development and dissemination of model training programs.
TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS
Sec. 501. Assertive community treatment grant program for individuals
with serious mental illness.
Sec. 502. Strengthening community crisis response systems.
Sec. 503. Increased and extended funding for assisted outpatient grant
program for individuals with serious mental illness.
Sec. 504. Liability protections for health professional volunteers at
community health centers.
TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS
Subtitle A--Encouraging the Advancement, Incorporation, and Development
of Evidence-Based Practices
Sec. 601. Encouraging innovation and evidence-based programs.
Sec. 602. Promoting access to information on evidence-based programs
and practices.
Sec. 603. Sense of Congress.
Subtitle B--Supporting the State Response to Mental Health Needs
Sec. 611. Community Mental Health Services Block Grant.
Subtitle C--Strengthening Mental Health Care for Children and
Adolescents
Sec. 621. Telehealth child psychiatry access grants.
Sec. 622. Infant and early childhood mental health promotion,
intervention, and treatment.
Sec. 623. National Child Traumatic Stress Initiative.
TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATION
Subtitle A--Garrett Lee Smith Memorial Act Reauthorization
Sec. 701. Youth interagency research, training, and technical
assistance centers.
Sec. 702. Youth suicide early intervention and prevention strategies.
Sec. 703. Mental health and substance use disorder services on campus.
Subtitle B--Other Provisions
Sec. 711. National Suicide Prevention Lifeline Program.
Sec. 712. Workforce development studies and reports.
Sec. 713. Minority Fellowship Program.
Sec. 714. Center and program repeals.
Sec. 715. National violent death reporting system.
Sec. 716. Sense of Congress on prioritizing Native American youth and
suicide prevention programs.
Sec. 717. Peer professional workforce development grant program.
Sec. 718. National Health Service Corps.
Sec. 719. Adult suicide prevention.
Sec. 720. Crisis intervention grants for police officers and first
responders.
Sec. 721. Demonstration grant program to train health service
psychologists in community-based mental health.
Sec. 722. Investment in tomorrow's pediatric health care workforce.
Sec. 723. CUTGO compliance.
TITLE VIII--MENTAL HEALTH PARITY
Sec. 801. Enhanced compliance with mental health and substance use
disorder coverage requirements.
Sec. 802. Action plan for enhanced enforcement of mental health and
substance use disorder coverage.
Sec. 803. Report on investigations regarding parity in mental health
and substance use disorder benefits.
Sec. 804. GAO study on parity in mental health and substance use
disorder benefits.
Sec. 805. Information and awareness on eating disorders.
Sec. 806. Education and training on eating disorders.
Sec. 807. GAO study on preventing discriminatory coverage limitations
for individuals with serious mental illness and substance use
disorders.
Sec. 808. Clarification of existing parity rules.
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
SEC. 101. ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE.
(a) Assistant Secretary.--Section 501(c) of the Public Health Service
Act (42 U.S.C. 290aa) is amended to read as follows:
``(c) Assistant Secretary and Deputy Assistant Secretary.--
``(1) Assistant secretary.--
``(A) Appointment.--The Administration shall be
headed by an official to be known as the Assistant
Secretary for Mental Health and Substance Use
(hereinafter in this title referred to as the
`Assistant Secretary') who shall be appointed by the
President, by and with the advice and consent of the
Senate.
``(B) Qualifications.--In selecting the Assistant
Secretary, the President shall give preference to
individuals who have--
``(i) a doctoral degree in medicine,
osteopathic medicine, or psychology;
``(ii) clinical and research experience
regarding mental health and substance use
disorders; and
``(iii) an understanding of biological,
psychosocial, and pharmaceutical treatments of
mental illness and substance use disorders.
``(2) Deputy assistant secretary.--The Assistant Secretary,
with the approval of the Secretary, may appoint a Deputy
Assistant Secretary and may employ and prescribe the functions
of such officers and employees, including attorneys, as are
necessary to administer the activities to be carried out
through the Administration.''.
(b) Transfer of Authorities.--The Secretary of Health and Human
Services shall delegate to the Assistant Secretary for Mental Health
and Substance Use all duties and authorities that--
(1) as of the day before the date of enactment of this Act,
were vested in the Administrator of the Substance Abuse and
Mental Health Services Administration; and
(2) are not terminated by this Act.
(c) Evaluation.--Section 501(d) of the Public Health Service Act (42
U.S.C. 290aa(d)) is amended--
(1) in paragraph (17), by striking ``and'' at the end;
(2) in paragraph (18), by striking the period at the end and
inserting a semicolon; and
(3) by adding at the end the following:
``(19) evaluate, in consultation with the Assistant Secretary
for Financial Resources, the information used for oversight of
grants under programs related to mental and substance use
disorders, including co-occurring disorders, administered by
the Center for Mental Health Services;
``(20) periodically review Federal programs and activities
relating to the diagnosis or prevention of, or treatment or
rehabilitation for, mental illness and substance use disorders
to identify any such programs or activities that have proven to
be effective or efficient in improving outcomes or increasing
access to evidence-based programs;
``(21) establish standards for the appointment of peer-review
panels to evaluate grant applications and recommend standards
for mental health grant programs; and''.
(d) Standards for Grant Programs.--Section 501(d) of the Public
Health Service Act (42 U.S.C. 290aa(d)), as amended by subsection (c),
is further amended by adding at the end the following:
``(22) in consultation with the National Mental Health and
Substance Use Policy Laboratory, and after providing an
opportunity for public input, set standards for grant programs
under this title for mental health and substance use services,
which may address--
``(A) the capacity of the grantee to implement the
award;
``(B) requirements for the description of the program
implementation approach;
``(C) the extent to which the grant plan submitted by
the grantee as part of its application must explain how
the grantee will reach the population of focus and
provide a statement of need, including to what extent
the grantee will increase the number of clients served
and the estimated percentage of clients receiving
services who report positive functioning after 6 months
or no past-month substance use, as applicable;
``(D) the extent to which the grantee must collect
and report on required performance measures; and
``(E) the extent to which the grantee is proposing
evidence-based practices and the extent to which--
``(i) those evidence-based practices must be
used with respect to a population similar to
the population for which the evidence-based
practices were shown to be effective; or
``(ii) if no evidence-based practice exists
for a population of focus, the way in which the
grantee will implement adaptations of evidence-
based practices, promising practices, or
cultural practices.''.
(e) Member of Council on Graduate Medical Education.--Section 762 of
the Public Health Service Act (42 U.S.C. 290o) is amended--
(1) in subsection (b)--
(A) by redesignating paragraphs (4), (5), and (6) as
paragraphs (5), (6), and (7), respectively; and
(B) by inserting after paragraph (3) the following:
``(4) the Assistant Secretary for Mental Health and Substance
Use;''; and
(2) in subsection (c), by striking ``(4), (5), and (6)'' each
place it appears and inserting ``(5), (6), and (7)''.
(f) Conforming Amendments.--Title V of the Public Health Service Act
(42 U.S.C. 290aa et seq.), as amended by the previous provisions of
this section, is further amended--
(1) by striking ``Administrator of the Substance Abuse and
Mental Health Services Administration'' each place it appears
and inserting ``Assistant Secretary for Mental Health and
Substance Use''; and
(2) by striking ``Administrator'' each place it appears
(including in any headings) and inserting ``Assistant
Secretary'', except where the term ``Administrator'' appears--
(A) in each of subsections (e) and (f) of section 501
of such Act (42 U.S.C. 290aa), including the headings
of such subsections, within the term ``Associate
Administrator'';
(B) in section 507(b)(6) of such Act (42 U.S.C.
290bb(b)(6)), within the term ``Administrator of the
Health Resources and Services Administration'';
(C) in section 507(b)(6) of such Act (42 U.S.C.
290bb(b)(6)), within the term ``Administrator of the
Centers for Medicare & Medicaid Services'';
(D) in section 519B(c)(1)(B) of such Act (42 U.S.C.
290bb-25b(c)(1)(B)), within the term ``Administrator of
the National Highway Traffic Safety Administration'';
or
(E) in each of sections 519B(c)(1)(B), 520C(a), and
520D(a) of such Act (42 U.S.C. 290bb-25b(c)(1)(B),
290bb-34(a), 290bb-35(a)), within the term
``Administrator of the Office of Juvenile Justice and
Delinquency Prevention''.
(g) References.--After executing subsections (a), (b), and (f), any
reference in statute, regulation, or guidance to the Administrator of
the Substance Abuse and Mental Health Services Administration shall be
construed to be a reference to the Assistant Secretary for Mental
Health and Substance Use.
SEC. 102. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE USE
PROGRAMS.
Title V of the Public Health Service Act is amended by inserting
after section 501 of such Act (42 U.S.C. 290aa) the following:
``SEC. 501A. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE USE
PROGRAMS.
``(a) Activities.--For the purpose of ensuring efficient and
effective planning and evaluation of mental and substance use disorder
programs and related activities, the Assistant Secretary for Planning
and Evaluation, in consultation with the Assistant Secretary for Mental
Health and Substance Use, shall--
``(1) collect and organize relevant data on homelessness,
involvement with the criminal justice system, hospitalizations,
mortality outcomes, and other measures the Secretary deems
appropriate from across Federal departments and agencies;
``(2) evaluate programs related to mental and substance use
disorders, including co-occurring disorders, across Federal
departments and agencies, as appropriate, including programs
related to--
``(A) prevention, intervention, treatment, and
recovery support services, including such services for
individuals with a serious mental illness or serious
emotional disturbance;
``(B) the reduction of homelessness and involvement
with the criminal justice system among individuals with
a mental or substance use disorder; and
``(C) public health and health services; and
``(3) consult, as appropriate, with the Assistant Secretary,
the Behavioral Health Coordinating Council of the Department of
Health and Human Services, other agencies within the Department
of Health and Human Services, and other relevant Federal
departments.
``(b) Recommendations.--The Assistant Secretary for Planning and
Evaluation shall develop an evaluation strategy that identifies
priority programs to be evaluated by the Assistant Secretary and
priority programs to be evaluated by other relevant agencies within the
Department of Health and Human Services. The Assistant Secretary for
Planning and Evaluation shall provide recommendations on improving
programs and activities based on the evaluation described in subsection
(a)(2) as needing improvement.''.
SEC. 103. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY LABORATORY.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is
amended by inserting after section 501A, as added by section 102 of
this Act, the following:
``SEC. 501B. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY
LABORATORY.
``(a) In General.--There shall be established within the
Administration a National Mental Health and Substance Use Policy
Laboratory (referred to in this section as the `Laboratory').
``(b) Responsibilities.--The Laboratory shall--
``(1) continue to carry out the authorities and activities
that were in effect for the Office of Policy, Planning, and
Innovation as such Office existed prior to the date of
enactment of the Helping Families in Mental Health Crisis Act
of 2016;
``(2) identify, coordinate, and facilitate the implementation
of policy changes likely to have a significant effect on mental
health, mental illness, and the prevention and treatment of
substance use disorder services;
``(3) collect, as appropriate, information from grantees
under programs operated by the Administration in order to
evaluate and disseminate information on evidence-based
practices, including culturally and linguistically appropriate
services, as appropriate, and service delivery models;
``(4) provide leadership in identifying and coordinating
policies and programs, including evidence-based programs,
related to mental and substance use disorders;
``(5) recommend ways in which payers may implement program
and policy findings of the Administration and the Laboratory to
improve outcomes and reduce per capita program costs;
``(6) in consultation with the Assistant Secretary for
Planning and Evaluation, as appropriate, periodically review
Federal programs and activities relating to the diagnosis or
prevention of, or treatment or rehabilitation for, mental
illness and substance use disorders, including by--
``(A) identifying any such programs or activities
that are duplicative;
``(B) identifying any such programs or activities
that are not evidence-based, effective, or efficient;
and
``(C) formulating recommendations for coordinating,
eliminating, or improving programs or activities
identified under subparagraph (A) or (B) and merging
such programs or activities into other successful
programs or activities; and
``(7) carry out other activities as deemed necessary to
continue to encourage innovation and disseminate evidence-based
programs and practices, including programs and practices with
scientific merit.
``(c) Evidence-Based Practices and Service Delivery Models.--
``(1) In general.--In selecting evidence-based best practices
and service delivery models for evaluation and dissemination,
the Laboratory--
``(A) shall give preference to models that improve--
``(i) the coordination between mental health
and physical health providers;
``(ii) the coordination among such providers
and the justice and corrections system; and
``(iii) the cost effectiveness, quality,
effectiveness, and efficiency of health care
services furnished to individuals with serious
mental illness or serious emotional
disturbance, in mental health crisis, or at
risk to themselves, their families, and the
general public; and
``(B) may include clinical protocols and practices
used in the Recovery After Initial Schizophrenia
Episode (RAISE) project and the North American Prodrome
Longitudinal Study (NAPLS) of the National Institute of
Mental Health.
``(2) Deadline for beginning implementation.--The Laboratory
shall begin implementation of the duties described in this
subsection not later than January 1, 2018.
``(3) Consultation.--In carrying out the duties under this
subsection, the Laboratory shall consult with--
``(A) representatives of the National Institute of
Mental Health, the National Institute on Drug Abuse,
and the National Institute on Alcohol Abuse and
Alcoholism, on an ongoing basis;
``(B) other appropriate Federal agencies;
``(C) clinical and analytical experts with expertise
in psychiatric medical care and clinical psychological
care, health care management, education, corrections
health care, and mental health court systems, as
appropriate; and
``(D) other individuals and agencies as determined
appropriate by the Assistant Secretary.''.
SEC. 104. PEER-SUPPORT SPECIALIST PROGRAMS.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, the Comptroller General of the United States shall conduct
a study on peer-support specialist programs in up to 10 States (to be
selected by the Comptroller General) that receive funding from the
Substance Abuse and Mental Health Services Administration and submit to
the Committee on Health, Education, Labor, and Pensions of the Senate
and the Committee on Energy and Commerce of the House of
Representatives a report containing the results of such study.
(b) Contents of Study.--In conducting the study under subsection (a),
the Comptroller General of the United States shall examine and identify
best practices in the selected States related to training and
credential requirements for peer-specialist programs, such as--
(1) hours of formal work or volunteer experience related to
mental and substance use disorders conducted through such
programs;
(2) types of peer support specialist exams required for such
programs in the States;
(3) codes of ethics used by such programs in the States;
(4) required or recommended skill sets of such programs in
the State; and
(5) requirements for continuing education.
SEC. 105. PROHIBITION AGAINST LOBBYING USING FEDERAL FUNDS BY SYSTEMS
ACCEPTING FEDERAL FUNDS TO PROTECT AND ADVOCATE THE
RIGHTS OF INDIVIDUALS WITH MENTAL ILLNESS.
Section 105(a) of the Protection and Advocacy for Individuals with
Mental Illness Act (42 U.S.C. 10805(a)) is amended--
(1) in paragraph (9), by striking ``and'' at the end;
(2) in paragraph (10), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(11) agree to refrain, during any period for which funding
is provided to the system under this part, from using Federal
funds to pay the salary or expenses of any grant or contract
recipient, or agent acting for such recipient, related to any
activity designed to influence the enactment of legislation,
appropriations, regulation, administrative action, or Executive
order proposed or pending before the Congress or any State
government, State legislature or local legislature or
legislative body, other than for normal and recognized
executive-legislative relationships or participation by an
agency or officer of a State, local, or tribal government in
policymaking and administrative processes within the executive
branch of that government.''.
SEC. 106. REPORTING FOR PROTECTION AND ADVOCACY ORGANIZATIONS.
(a) Public Availability of Reports.--Section 105(a)(7) of the
Protection and Advocacy for Individuals with Mental Illness Act (42
U.S.C. 10805(a)(7)) is amended by striking ``is located a report'' and
inserting ``is located, and make publicly available, a report''.
(b) Detailed Accounting.--Section 114(a) of the Protection and
Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10824(a))
is amended--
(1) in paragraph (3), by striking ``and'' at the end;
(2) in paragraph (4), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(5) using data from the existing required annual program
progress reports submitted by each system funded under this
title, a detailed accounting for each such system of how funds
are spent, disaggregated according to whether the funds were
received from the Federal Government, the State government, a
local government, or a private entity.''.
SEC. 107. GRIEVANCE PROCEDURE.
Section 105 of the Protection and Advocacy for Individuals with
Mental Illness Act (42 U.S.C. 10805), as amended, is further amended by
adding at the end the following:
``(d) Grievance Procedure.--The Secretary shall establish an
independent grievance procedure for persons described in subsection
(a)(9).''.
SEC. 108. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is
amended--
(1) in section 501(b) (42 U.S.C. 290aa(b)), by adding at the
end the following:
``(4) The Center for Behavioral Health Statistics and
Quality.'';
(2) in section 502(a)(1) (42 U.S.C. 290aa-1(a)(1))--
(A) in subparagraph (C), by striking ``and'' at the
end;
(B) in subparagraph (D), by striking the period at
the end and inserting ``; and''; and
(C) by inserting after subparagraph (D) the
following:
``(E) the Center for Behavioral Health Statistics and
Quality.''; and
(3) in part B (42 U.S.C. 290bb et seq.) by adding at the end
the following new subpart:
``Subpart 4--Center for Behavioral Health Statistics and Quality
``SEC. 520L. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.
``(a) Establishment.--There is established in the Administration a
Center for Behavioral Health Statistics and Quality (in this section
referred to as the `Center'). The Center shall be headed by a Director
(in this section referred to as the `Director') appointed by the
Secretary from among individuals with extensive experience and academic
qualifications in research and analysis in behavioral health care or
related fields.
``(b) Duties.--The Director of the Center shall--
``(1) coordinate the Administration's integrated data
strategy by coordinating--
``(A) surveillance and data collection (including
that authorized by section 505);
``(B) evaluation;
``(C) statistical and analytic support;
``(D) service systems research; and
``(E) performance and quality information systems;
``(2) recommend a core set of measurement standards for grant
programs administered by the Administration; and
``(3) coordinate evaluation efforts for the grant programs,
contracts, and collaborative agreements of the Administration.
``(c) Biannual Report to Congress.--Not later than 2 years after the
date of enactment of this section, and every 2 years thereafter, the
Director of the Center shall submit to Congress a report on the quality
of services furnished through grant programs of the Administration,
including applicable measures of outcomes for individuals and public
outcomes such as--
``(1) the number of patients screened positive for unhealthy
alcohol use who receive brief counseling as appropriate; the
number of patients screened positive for tobacco use and
receiving smoking cessation interventions; the number of
patients with a new diagnosis of major depressive episode who
are assessed for suicide risk; the number of patients screened
positive for clinical depression with a documented followup
plan; and the number of patients with a documented pain
assessment that have a followup treatment plan when pain is
present; and satisfaction with care;
``(2) the incidence and prevalence of substance use and
mental disorders; the number of suicide attempts and suicide
completions; overdoses seen in emergency rooms resulting from
alcohol and drug use; emergency room boarding; overdose deaths;
emergency psychiatric hospitalizations; new criminal justice
involvement while in treatment; stable housing; and rates of
involvement in employment, education, and training; and
``(3) such other measures for outcomes of services as the
Director may determine.
``(d) Staffing Composition.--The staff of the Center may include
individuals with advanced degrees and field expertise as well as
clinical and research experience in mental and substance use disorders
such as--
``(1) professionals with clinical and research expertise in
the prevention and treatment of, and recovery from, substance
use and mental disorders;
``(2) professionals with training and expertise in statistics
or research and survey design and methodologies; and
``(3) other related fields in the social and behavioral
sciences, as specified by relevant position descriptions.
``(e) Grants and Contracts.--In carrying out the duties established
in subsection (b), the Director may make grants to and enter into
contracts and cooperative agreements with public and nonprofit private
entities.
``(f) Definition.--In this section, the term `emergency room
boarding' means the practice of admitting patients to an emergency
department and holding such patients in the department until inpatient
psychiatric beds become available.''.
SEC. 109. STRATEGIC PLAN.
Section 501 of the Public Health Service Act (42 U.S.C. 290aa) is
amended--
(1) by redesignating subsections (l) through (o) as
subsections (m) through (p), respectively; and
(2) by inserting after subsection (k) the following:
``(l) Strategic Plan.--
``(1) In general.--Not later than December 1, 2017, and every
5 years thereafter, the Assistant Secretary shall develop and
carry out a strategic plan in accordance with this subsection
for the planning and operation of evidence-based programs and
grants carried out by the Administration.
``(2) Coordination.--In developing and carrying out the
strategic plan under this section, the Assistant Secretary
shall take into consideration the report of the
Interdepartmental Serious Mental Illness Coordinating Committee
under section 301 of the Helping Families in Mental Health
Crisis Act of 2016.
``(3) Publication of plan.--Not later than December 1, 2017,
and every 5 years thereafter, the Assistant Secretary shall--
``(A) submit the strategic plan developed under
paragraph (1) to the appropriate committees of
Congress; and
``(B) post such plan on the Internet website of the
Administration.
``(4) Contents.--The strategic plan developed under paragraph
(1) shall--
``(A) identify strategic priorities, goals, and
measurable objectives for mental and substance use
disorder activities and programs operated and supported
by the Administration, including priorities to prevent
or eliminate the burden of mental illness and substance
use disorders;
``(B) identify ways to improve services for
individuals with a mental or substance use disorder,
including services related to the prevention of,
diagnosis of, intervention in, treatment of, and
recovery from, mental or substance use disorders,
including serious mental illness or serious emotional
disturbance, and access to services and supports for
individuals with a serious mental illness or serious
emotional disturbance;
``(C) ensure that programs provide, as appropriate,
access to effective and evidence-based prevention,
diagnosis, intervention, treatment, and recovery
services, including culturally and linguistically
appropriate services, as appropriate, for individuals
with a mental or substance use disorder;
``(D) identify opportunities to collaborate with the
Health Resources and Services Administration to develop
or improve--
``(i) initiatives to encourage individuals to
pursue careers (especially in rural and
underserved areas and populations) as
psychiatrists, psychologists, psychiatric nurse
practitioners, physician assistants,
occupational therapists, clinical social
workers, certified peer support specialists,
licensed professional counselors, or other
licensed or certified mental health
professionals, including such professionals
specializing in the diagnosis, evaluation, or
treatment of individuals with a serious mental
illness or serious emotional disturbance; and
``(ii) a strategy to improve the recruitment,
training, and retention of a workforce for the
treatment of individuals with mental or
substance use disorders, or co-occurring
disorders;
``(E) identify opportunities to improve collaboration
with States, local governments, communities, and Indian
tribes and tribal organizations (as such terms are
defined in section 4 of the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450b)); and
``(F) specify a strategy to disseminate evidenced-
based and promising best practices related to
prevention, diagnosis, early intervention, treatment,
and recovery services related to mental illness,
particularly for individuals with a serious mental
illness and children and adolescents with a serious
emotional disturbance, and substance use disorders.''.
SEC. 110. AUTHORITIES OF CENTERS FOR MENTAL HEALTH SERVICES AND
SUBSTANCE ABUSE TREATMENT.
(a) Center for Mental Health Services.--Section 520(b) of the Public
Health Service Act (42 U.S.C. 290bb-31(b)) is amended--
(1) by redesignating paragraphs (3) through (15) as
paragraphs (4) through (16), respectively;
(2) by inserting after paragraph (2) the following:
``(3) collaborate with the Director of the National Institute
of Mental Health to ensure that, as appropriate, programs
related to the prevention and treatment of mental illness and
the promotion of mental health are carried out in a manner that
reflects the best available science and evidence-based
practices, including culturally and linguistically appropriate
services;'';
(3) in paragraph (5), as so redesignated, by inserting
``through policies and programs that reduce risk and promote
resiliency'' before the semicolon;
(4) in paragraph (6), as so redesignated, by inserting ``in
collaboration with the Director of the National Institute of
Mental Health,'' before ``develop'';
(5) in paragraph (8), as so redesignated, by inserting ``,
increase meaningful participation of individuals with mental
illness in programs and activities of the Administration,''
before ``and protect the legal'';
(6) in paragraph (10), as so redesignated, by striking
``professional and paraprofessional personnel pursuant to
section 303'' and inserting ``paraprofessional personnel and
health professionals'';
(7) in paragraph (11), as so redesignated, by inserting ``and
telemental health,'' after ``rural mental health,'';
(8) in paragraph (12), as so redesignated, by striking
``establish a clearinghouse for mental health information to
assure the widespread dissemination of such information'' and
inserting ``disseminate mental health information, including
evidenced-based practices,'';
(9) in paragraph (15), as so redesignated, by striking
``and'' at the end;
(10) in paragraph (16), as so redesignated, by striking the
period and inserting ``; and''; and
(11) by adding at the end the following:
``(17) consult with other agencies and offices of the
Department of Health and Human Services to ensure, with respect
to each grant awarded by the Center for Mental Health Services,
the consistent documentation of the application of criteria
when awarding grants and the ongoing oversight of grantees
after such grants are awarded.''.
(b) Director of the Center for Substance Abuse Treatment.--Section
507 of the Public Health Service Act (42 U.S.C. 290bb) is amended--
(1) in subsection (a)--
(A) by striking ``treatment of substance abuse'' and
inserting ``treatment of substance use disorders''; and
(B) by striking ``abuse treatment systems'' and
inserting ``use disorder treatment systems''; and
(2) in subsection (b)--
(A) in paragraph (3), by striking ``abuse'' and
inserting ``use disorder'';
(B) in paragraph (4), by striking ``individuals who
abuse drugs'' and inserting ``individuals who use
drugs'';
(C) in paragraph (9), by striking ``carried out by
the Director'';
(D) by striking paragraph (10);
(E) by redesignating paragraphs (11) through (14) as
paragraphs (10) through (13), respectively;
(F) in paragraph (12), as so redesignated, by
striking ``; and'' and inserting a semicolon; and
(G) by striking paragraph (13), as so redesignated,
and inserting the following:
``(13) ensure the consistent documentation of the application
of criteria when awarding grants and the ongoing oversight of
grantees after such grants are awarded; and
``(14) work with States, providers, and individuals in
recovery, and their families, to promote the expansion of
recovery support services and systems of care oriented towards
recovery.''.
SEC. 111. ADVISORY COUNCILS.
Section 502(b) of the Public Health Service Act (42 U.S.C. 290aa-
1(b)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (E), by striking ``and'' after
the semicolon;
(B) by redesignating subparagraph (F) as subparagraph
(I); and
(C) by inserting after subparagraph (E), the
following:
``(F) for the advisory councils appointed under
subsections (a)(1)(A) and (a)(1)(D), the Director of
the National Institute of Mental Health;
``(G) for the advisory councils appointed under
subsections (a)(1)(A), (a)(1)(B), and (a)(1)(C), the
Director of the National Institute on Drug Abuse;
``(H) for the advisory councils appointed under
subsections (a)(1)(A), (a)(1)(B), and (a)(1)(C), the
Director of the National Institute on Alcohol Abuse and
Alcoholism; and''; and
(2) in paragraph (3), by adding at the end the following:
``(C) Not less than half of the members of the
advisory council appointed under subsection (a)(1)(D)--
``(i) shall have--
``(I) a medical degree;
``(II) a doctoral degree in
psychology; or
``(III) an advanced degree in nursing
or social work from an accredited
graduate school or be a certified
physician assistant; and
``(ii) shall specialize in the mental health
field.''.
SEC. 112. PEER REVIEW.
Section 504(b) of the Public Health Service Act (42 U.S.C. 290aa-
3(b)) is amended by adding at the end the following: ``In the case of
any such peer review group that is reviewing a grant, cooperative
agreement, or contract related to mental illness treatment, not less
than half of the members of such peer review group shall be licensed
and experienced professionals in the prevention, diagnosis, or
treatment of, or recovery from, mental or substance use disorders and
have a medical degree, a doctoral degree in psychology, or an advanced
degree in nursing or social work from an accredited program.''.
TITLE II--MEDICAID MENTAL HEALTH COVERAGE
SEC. 201. RULE OF CONSTRUCTION RELATED TO MEDICAID COVERAGE OF MENTAL
HEALTH SERVICES AND PRIMARY CARE SERVICES FURNISHED
ON THE SAME DAY.
Nothing in title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) shall be construed as prohibiting separate payment under the
State plan under such title (or under a waiver of the plan) for the
provision of a mental health service or primary care service under such
plan, with respect to an individual, because such service is--
(1) a primary care service furnished to the individual by a
provider at a facility on the same day a mental health service
is furnished to such individual by such provider (or another
provider) at the facility; or
(2) a mental health service furnished to the individual by a
provider at a facility on the same day a primary care service
is furnished to such individual by such provider (or another
provider) at the facility.
SEC. 202. OPTIONAL LIMITED COVERAGE OF INPATIENT SERVICES FURNISHED IN
INSTITUTIONS FOR MENTAL DISEASES.
(a) In General.--Section 1903(m)(2) of the Social Security Act (42
U.S.C. 1396b(m)(2)) is amended by adding at the end the following new
subparagraph:
``(I)(i) Notwithstanding the limitation specified in the subdivision
(B) following paragraph (29) of section 1905(a) and subject to clause
(ii), a State may, under a risk contract entered into by the State
under this title (or under section 1115) with a medicaid managed care
organization or a prepaid inpatient health plan (as defined in section
438.2 of title 42, Code of Federal Regulations (or any successor
regulation)), make a monthly capitation payment to such organization or
plan for enrollees with the organization or plan who are over 21 years
of age and under 65 years of age and are receiving inpatient treatment
in an institution for mental diseases (as defined in section 1905(i)),
so long as each of the following conditions is met:
``(I) The institution is a hospital providing inpatient
psychiatric or substance use disorder services or a sub-acute
facility providing psychiatric or substance use disorder crisis
residential services.
``(II) The length of stay in such an institution for such
treatment is for a short-term stay of no more than 15 days
during the period of the monthly capitation payment.
``(III) The provision of such treatment meets the following
criteria for consideration as services or settings that are in
lieu of services or settings covered under the State plan:
``(aa) The State determines that the alternative
service or setting is a medically appropriate and cost-
effective substitute for the covered service or setting
under the State plan.
``(bb) The enrollee is not required by the managed
care organization or prepaid inpatient health plan to
use the alternative service or setting.
``(cc) Such treatment is authorized and identified in
such contract, and will be offered to such enrollees at
the option of the managed care organization or prepaid
inpatient health plan.
``(ii) For purposes of setting the amount of such a monthly
capitation payment, a State may use the utilization of services
provided to an individual under this subparagraph when developing the
inpatient psychiatric or substance use disorder component of such
payment, but the amount of such payment for such services may not
exceed the cost of the same services furnished through providers
included under the State plan.''.
(b) Effective Date.--The amendment made by subsection (a) shall apply
beginning on July 5, 2016, or the date of the enactment of this Act,
whichever is later.
SEC. 203. STUDY AND REPORT RELATED TO MEDICAID MANAGED CARE REGULATION.
(a) Study.--The Secretary of Health and Human Services, acting
through the Administrator of the Centers for Medicare & Medicaid
Services, shall conduct a study on coverage under the Medicaid program
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) of
services provided through a medicaid managed care organization (as
defined in section 1903(m) of such Act (42 U.S.C. 1396b(m)) or a
prepaid inpatient health plan (as defined in section 438.2 of title 42,
Code of Federal Regulations (or any successor regulation)) with respect
to individuals over the age of 21 and under the age of 65 for the
treatment of a mental health disorder in institutions for mental
diseases (as defined in section 1905(i) of such Act (42 U.S.C.
1396d(i))). Such study shall include information on the following:
(1) The extent to which States, including the District of
Columbia and each territory or possession of the United States,
are providing capitated payments to such organizations or plans
for enrollees who are receiving services in institutions for
mental diseases.
(2) The number of individuals receiving medical assistance
under a State plan under such title XIX, or a waiver of such
plan, who receive services in institutions for mental diseases
through such organizations and plans.
(3) The range of and average number of months, and the length
of stay during such months, that such individuals are receiving
such services in such institutions.
(4) How such organizations or plans determine when to provide
for the furnishing of such services through an institution for
mental diseases in lieu of other benefits (including the full
range of community-based services) under their contract with
the State agency administering the State plan under such title
XIX, or a waiver of such plan, to address psychiatric or
substance use disorder treatment.
(5) The extent to which the provision of services within such
institutions has affected the capitated payments for such
organizations or plans.
(b) Report.--Not later than three years after the date of the
enactment of this Act, the Secretary shall submit to Congress a report
on the study conducted under subsection (a).
SEC. 204. GUIDANCE ON OPPORTUNITIES FOR INNOVATION.
Not later than one year after the date of the enactment of this Act,
the Administrator of the Centers for Medicare & Medicaid Services shall
issue a State Medicaid Director letter regarding opportunities to
design innovative service delivery systems, including systems for
providing community-based services, for individuals with serious mental
illness or serious emotional disturbance who are receiving medical
assistance under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.). The letter shall include opportunities for demonstration
projects under section 1115 of such Act (42 U.S.C. 1315), to improve
care for such individuals.
SEC. 205. STUDY AND REPORT ON MEDICAID EMERGENCY PSYCHIATRIC
DEMONSTRATION PROJECT.
(a) Collection of Information.--The Secretary of Health and Human
Services, acting through the Administrator of the Centers for Medicare
& Medicaid Services, shall, with respect to each State that has
participated in the demonstration project established under section
2707 of the Patient Protection and Affordable Care Act (42 U.S.C. 1396a
note), collect from each such State information on the following:
(1) The number of institutions for mental diseases (as
defined in section 1905(i) of the Social Security Act (42
U.S.C. 1396d(i))) and beds in such institutions that received
payment for the provision of services to individuals who
receive medical assistance under a State plan under the
Medicaid program under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) (or under a waiver of such plan) through
the demonstration project in each such State as compared to the
total number of institutions for mental diseases and beds in
the State.
(2) The extent to which there is a reduction in expenditures
under the Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) or other spending on the
full continuum of physical or mental health care for
individuals who receive treatment in an institution for mental
diseases under the demonstration project, including outpatient,
inpatient, emergency, and ambulatory care, that is attributable
to such individuals receiving treatment in institutions for
mental diseases under the demonstration project.
(3) The number of forensic psychiatric hospitals, the number
of beds in such hospitals, and the number of forensic
psychiatric beds in other hospitals in such State, based on the
most recent data available, to the extent practical, as
determined by such Administrator.
(4) The amount of any disproportionate share hospital
payments under section 1923 of the Social Security Act (42
U.S.C. 1396r-4) that institutions for mental diseases in the
State received during the period beginning on July 1, 2012, and
ending on June 30, 2015, and the extent to which the
demonstration project reduced the amount of such payments.
(5) The most recent data regarding all facilities or sites in
the State in which any individuals with serious mental illness
who are receiving medical assistance under a State plan under
the Medicaid program under title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) (or under a waiver of such plan) are
treated during the period referred to in paragraph (4), to the
extent practical, as determined by the Administrator,
including--
(A) the types of such facilities or sites (such as an
institution for mental diseases, a hospital emergency
department, or other inpatient hospital);
(B) the average length of stay in such a facility or
site by such an individual, disaggregated by facility
type; and
(C) the payment rate under the State plan (or a
waivers of such plan) for services furnished to such an
individual for that treatment, disaggregated by
facility type, during the period in which the
demonstration project is in operation.
(6) The extent to which the utilization of hospital emergency
departments during the period in which the demonstration
project was is in operation differed, with respect to
individuals who are receiving medical assistance under a State
plan under the Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) (or under a waiver of
such plan), between--
(A) those individuals who received treatment in an
institution for mental diseases under the demonstration
project;
(B) those individuals who met the eligibility
requirements for the demonstration project but who did
not receive treatment in an institution for mental
diseases under the demonstration project; and
(C) those individuals with serious mental illness who
did not meet such eligibility requirements and did not
receive treatment for such illness in an institution
for mental diseases.
(b) Report.--Not later than two years after the date of the enactment
of this Act, the Secretary of Health and Human Services shall submit to
Congress a report that summarizes and analyzes the information
collected under subsection (a). Such report may be submitted as part of
the report required under section 2707(f) of the Patient Protection and
Affordable Care Act (42 U.S.C. 1396a note) or separately.
SEC. 206. PROVIDING FULL-RANGE OF EPSDT SERVICES TO CHILDREN IN IMDS.
Section 1905(a)(16) of the Social Security Act (42 U.S.C.
1396d(a)(16)) is amended by inserting before the semicolon at the end
the following: ``, and, effective January 1, 2019, the full-range of
early and periodic screening, diagnostic, and treatment services (as
defined in subsection (r)) for such individuals whether or not such
screening, diagnostic, and treatment services are furnished by the
provider of inpatient psychiatric hospital services for individuals
under age 21''.
SEC. 207. ELECTRONIC VISIT VERIFICATION SYSTEM REQUIRED FOR PERSONAL
CARE SERVICES AND HOME HEALTH CARE SERVICES UNDER
MEDICAID.
(a) In General.--Section 1903 of the Social Security Act (42 U.S.C.
1396b) is amended by inserting after subsection (k) the following new
subsection:
``(l)(1) Subject to paragraphs (3) and (4), with respect to any
amount expended for personal care services or home health care services
requiring an in-home visit by a provider that are provided under a
State plan under this title (or under a waiver of the plan) and
furnished in a calendar quarter beginning on or after January 1, 2019
(or, in the case of home health care services, on or after January 1,
2023), unless a State requires the use of an electronic visit
verification system for such services furnished in such quarter under
the plan or such waiver, the Federal medical assistance percentage
shall be reduced--
``(A) in the case of personal care services--
``(i) for calendar quarters in 2019 and 2020, by .25
percentage points;
``(ii) for calendar quarters in 2021, by .5
percentage points;
``(iii) for calendar quarters in 2022, by .75
percentage points; and
``(iv) for calendar quarters in 2023 and each year
thereafter, by 1 percentage point; and
``(B) in the case of home health care services--
``(i) for calendar quarters in 2023 and 2024, by .25
percentage points;
``(ii) for calendar quarters in 2025, by .5
percentage points;
``(iii) for calendar quarters in 2026, by .75
percentage points; and
``(iv) for calendar quarters in 2027 and each year
thereafter, by 1 percentage point.
``(2) Subject to paragraphs (3) and (4), in implementing the
requirement for the use of an electronic visit verification system
under paragraph (1), a State shall--
``(A) consult with agencies and entities that provide
personal care services, home health care services, or both
under the State plan (or under a waiver of the plan) to ensure
that such system--
``(i) is minimally burdensome;
``(ii) takes into account existing best practices and
electronic visit verification systems in use in the
State; and
``(iii) is conducted in accordance with the
requirements of HIPAA privacy and security law (as
defined in section 3009 of the Public Health Service
Act);
``(B) take into account a stakeholder process that includes
input from beneficiaries, family caregivers, personal care or
home health care services workers, and other stakeholders, as
determined by the State in accordance with guidance from the
Secretary; and
``(C) ensure that individuals who furnish personal care
services, home health care services, or both under the State
plan (or under a waiver of the plan) are provided the
opportunity for training on the use of such system.
``(3) Paragraphs (1) and (2) shall not apply in the case of a State
that, as of the date of the enactment of this subsection, requires the
use of any system for the electronic verification of visits conducted
as part of both personal care services and home health care services.
``(4)(A) In the case of a State described in subparagraph (B), the
reduction under paragraph (1) shall not apply--
``(i) in the case of personal care services, for calendar
quarters in 2019; and
``(ii) in the case of home health care services, for calendar
quarters in 2023.
``(B) For purposes of subparagraph (A), a State described in this
subparagraph is a State that demonstrates to the Secretary that the
State--
``(i) has made a good faith effort to comply with the
requirements of paragraphs (1) and (2) (including by taking
steps to adopt the technology used for an electronic visit
verification system); or
``(ii) in implementing such a system, has encountered
unavoidable system delays.
``(5) In this subsection:
``(A) The term `electronic visit verification system' means,
with respect to personal care services or home health care
services, a system under which visits conducted as part of such
services are electronically verified with respect to--
``(i) the type of service performed;
``(ii) the individual receiving the service;
``(iii) the date of the service;
``(iv) the location of service delivery;
``(v) the individual providing the service; and
``(vi) the time the service begins and ends.
``(B) The term `home health care services' means services
described in section 1905(a)(7) provided under a State plan
under this title (or under a waiver of the plan).
``(C) The term `personal care services' means personal care
services provided under a State plan under this title (or under
a waiver of the plan), including services provided under
section 1905(a)(24), 1915(c), 1915(i), 1915(j), or 1915(k) or
under a wavier under section 1115.
``(6)(A) In the case in which a State requires personal care service
and home health care service providers to utilize an electronic visit
verification system operated by the State or a contractor on behalf of
the State, the Secretary shall pay to the State, for each quarter, an
amount equal to 90 per centum of so much of the sums expended during
such quarter as are attributable to the design, development, or
installation of such system, and 75 per centum of so much of the sums
for the operation and maintenance of such system.
``(B) Subparagraph (A) shall not apply in the case in which a State
requires personal care service and home health care service providers
to utilize an electronic visit verification system that is not operated
by the State or a contractor on behalf of the State.''.
(b) Collection and Dissemination of Best Practices.--Not later than
January 1, 2018, the Secretary of Health and Human Services shall, with
respect to electronic visit verification systems (as defined in
subsection (l)(5) of section 1903 of the Social Security Act (42 U.S.C.
1396b), as inserted by subsection (a)), collect and disseminate best
practices to State Medicaid Directors with respect to--
(1) training individuals who furnish personal care services,
home health care services, or both under the State plan under
title XIX of such Act (or under a waiver of the plan) on such
systems and the operation of such systems and the prevention of
fraud with respect to the provision of personal care services
or home health care services (as defined in such subsection
(l)(5)); and
(2) the provision of notice and educational materials to
family caregivers and beneficiaries with respect to the use of
such electronic visit verification systems and other means to
prevent such fraud.
(c) Rules of Construction.--
(1) No employer-employee relationship established.--Nothing
in the amendment made by this section may be construed as
establishing an employer-employee relationship between the
agency or entity that provides for personal care services or
home health care services and the individuals who, under a
contract with such an agency or entity, furnish such services
for purposes of part 552 of title 29, Code of Federal
Regulations (or any successor regulations).
(2) No particular or uniform electronic visit verification
system required.--Nothing in the amendment made by this section
shall be construed to require the use of a particular or
uniform electronic visit verification system (as defined in
subsection (l)(5) of section 1903 of the Social Security Act
(42 U.S.C. 1396b), as inserted by subsection (a)) by all
agencies or entities that provide personal care services or
home health care under a State plan under title XIX of the
Social Security Act (or under a waiver of the plan) (42 U.S.C.
1396 et seq.).
(3) No limits on provision of care.--Nothing in the amendment
made by this section may be construed to limit, with respect to
personal care services or home health care services provided
under a State plan under title XIX of the Social Security Act
(or under a waiver of the plan) (42 U.S.C. 1396 et seq.),
provider selection, constrain beneficiaries' selection of a
caregiver, or impede the manner in which care is delivered.
(4) No prohibition on state quality measures requirements.--
Nothing in the amendment made by this section shall be
construed as prohibiting a State, in implementing an electronic
visit verification system (as defined in subsection (l)(5) of
section 1903 of the Social Security Act (42 U.S.C. 1396b), as
inserted by subsection (a)), from establishing requirements
related to quality measures for such system.
TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE
SEC. 301. INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE.
(a) Establishment.--
(1) In general.--Not later than 3 months after the date of
enactment of this Act, the Secretary of Health and Human
Services, or the designee of the Secretary, shall establish a
committee to be known as the ``Interdepartmental Serious Mental
Illness Coordinating Committee'' (in this section referred to
as the ``Committee'').
(2) Federal advisory committee act.--Except as provided in
this section, the provisions of the Federal Advisory Committee
Act (5 U.S.C. App.) shall apply to the Committee.
(b) Meetings.--The Committee shall meet not fewer than 2 times each
year.
(c) Responsibilities.--Not later than 1 year after the date of
enactment of this Act, and 5 years after such date of enactment, the
Committee shall submit to Congress a report including--
(1) a summary of advances in serious mental illness and
serious emotional disturbance research related to the
prevention of, diagnosis of, intervention in, and treatment and
recovery of, serious mental illnesses, serious emotional
disturbances, and advances in access to services and support
for individuals with a serious mental illness or serious
emotional disturbance;
(2) an evaluation of the effect on public health of Federal
programs related to serious mental illness or serious emotional
disturbance, including measurements of public health outcomes
such as--
(A) rates of suicide, suicide attempts, prevalence of
serious mental illness, serious emotional disturbances,
and substance use disorders, overdose, overdose deaths,
emergency hospitalizations, emergency room boarding,
preventable emergency room visits, involvement with the
criminal justice system, crime, homelessness, and
unemployment;
(B) increased rates of employment and enrollment in
educational and vocational programs;
(C) quality of mental and substance use disorder
treatment services; and
(D) any other criteria as may be determined by the
Secretary;
(3) a plan to improve outcomes for individuals with serious
mental illness or serious emotional disturbances, including
reducing incarceration for such individuals, reducing
homelessness, and increasing employment; and
(4) specific recommendations for actions that agencies can
take to better coordinate the administration of mental health
services for people with serious mental illness or serious
emotional disturbances.
(d) Committee Extension.--Upon the submission of the second report
under subsection (c), the Secretary shall submit a recommendation to
Congress on whether to extend the operation of the Committee.
(e) Membership.--
(1) Federal members.--The Committee shall be composed of the
following Federal representatives, or their designees:
(A) The Secretary of Health and Human Services, who
shall serve as the Chair of the Committee.
(B) The Director of the National Institutes of
Health.
(C) The Assistant Secretary for Health of the
Department of Health and Human Services.
(D) The Assistant Secretary for Mental Health and
Substance Use.
(E) The Attorney General of the United States.
(F) The Secretary of Veterans Affairs.
(G) The Secretary of Defense.
(H) The Secretary of Housing and Urban Development.
(I) The Secretary of Education.
(J) The Secretary of Labor.
(K) The Commissioner of Social Security.
(L) The Administrator of the Centers for Medicare &
Medicaid Services.
(2) Non-federal members.--The Committee shall also include
not less than 14 non-Federal public members appointed by the
Secretary of Health and Human Services, of which--
(A) at least 2 members shall be individuals with
lived experience with serious mental illness or serious
emotional disturbance;
(B) at least 1 member shall be a parent or legal
guardian of an individual with a history of a serious
mental illness or serious emotional disturbance;
(C) at least 1 member shall be a representative of a
leading research, advocacy, or service organization for
individuals with serious mental illness or serious
emotional disturbance;
(D) at least 2 members shall be--
(i) a licensed psychiatrist with experience
treating serious mental illnesses or serious
emotional disturbances;
(ii) a licensed psychologist with experience
treating serious mental illnesses or serious
emotional disturbances;
(iii) a licensed clinical social worker with
experience treating serious mental illness or
serious emotional disturbances; or
(iv) a licensed psychiatric nurse, nurse
practitioner, or physician assistant with
experience treating serious mental illnesses or
serious emotional disturbances;
(E) at least 1 member shall be a licensed mental
health professional with a specialty in treating
children and adolescents with serious emotional
disturbances;
(F) at least 1 member shall be a mental health
professional who has research or clinical mental health
experience working with minorities;
(G) at least 1 member shall be a mental health
professional who has research or clinical mental health
experience working with medically underserved
populations;
(H) at least 1 member shall be a State certified
mental health peer specialist;
(I) at least 1 member shall be a judge with
experience adjudicating cases within a mental health
court;
(J) at least 1 member shall be a law enforcement
officer or corrections officer with extensive
experience in interfacing with individuals with a
serious mental illness or serious emotional
disturbance, or in a mental health crisis; and
(K) at least 1 member shall be a homeless services
provider with experience working with individuals with
serious mental illness, with serious emotional
disturbance, or having mental health crisis.
(3) Terms.--A member of the Committee appointed under
paragraph (2) shall serve for a term of 3 years, and may be
reappointed for one or more additional 3-year terms. Any member
appointed to fill a vacancy for an unexpired term shall be
appointed for the remainder of such term. A member may serve
after the expiration of the member's term until a successor has
been appointed.
(f) Working Groups.--In carrying out its functions, the Committee may
establish working groups. Such working groups shall be composed of
Committee members, or their designees, and may hold such meetings as
are necessary.
(g) Sunset.--The Committee shall terminate on the date that is 6
years after the date on which the Committee is established under
subsection (a)(1).
TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA
SEC. 401. SENSE OF CONGRESS.
(a) Findings.--Congress finds the following:
(1) The vast majority of individuals with mental illness are
capable of understanding their illness and caring for
themselves.
(2) Persons with serious mental illness (in this section
referred to as ``SMI''), including schizophrenia spectrum,
bipolar disorders, and major depressive disorder, may be
significantly impaired in their ability to understand or make
sound decisions for their care and needs. By nature of their
illness, cognitive impairments in reasoning and judgment, as
well as the presence of hallucinations, delusions, and severe
emotional distortions, they may lack the awareness they even
have a mental illness (a condition known as anosognosia), and
thus may be unable to make sound decisions regarding their
care, nor follow through consistently and effectively on their
care needs.
(3) Persons with mental illness or SMI may require and
benefit from mental health treatment in order to recover to the
fullest extent of their ability; these beneficial interventions
may include psychiatric care, psychological care, medication,
peer support, educational support, employment support, and
housing support.
(4) Persons with SMI who are provided with professional and
supportive services may still experience times when their
symptoms may greatly impair their abilities to make sound
decisions for their personal care or may discontinue their care
as a result of this impaired decisionmaking resulting in a
further deterioration of their condition. They may experience a
temporary or prolonged impairment as a result of their
diminished capacity to care for themselves.
(5) Episodes of psychiatric crises among those with SMI can
result in neurological harm to the individual's brain.
(6) Persons with SMI--
(A) are at high risk for other chronic physical
illnesses, with approximately 50 percent having two or
more co-occurring chronic physical illnesses such as
cardiac, pulmonary, cancer, and endocrine disorders;
and
(B) have three times the odds of having chronic
bronchitis, five times the odds of having emphysema,
and four times the odds of having COPD, are more than
four times as likely to have fluid and electrolyte
disorders, and are nearly three times as likely to be
nicotine dependent.
(7) Some psychotropic medications, such as second generation
antipsychotics, significantly increase risk for chronic
illnesses such as diabetes and cardiovascular disease.
(8) When the individual fails to seek or maintain treatment
for these physical conditions over a long term, it can result
in the individual becoming gravely disabled, or developing
life-threatening illnesses. Early and consistent treatment can
ameliorate or reduce symptoms or cure the disease.
(9) Persons with SMI die 7 to 24 years earlier than their age
cohorts primarily because of complications from their chronic
physical illness and failure to seek or maintain treatment
resulting from emotional and cognitive impairments from their
SMI.
(10) It is beneficial to the person with SMI and chronic
illness to seek and maintain continuity of medical care and
treatment for their mental illness to prevent further
deterioration and harm to their own safety.
(11) When the individual with SMI is significantly diminished
in their capacity to care for themselves long term or acutely,
other supportive interventions to assist their care may be
necessary to protect their health and safety.
(12) Prognosis for the physical and psychiatric health of
those with SMI may improve when responsible caregivers
facilitate and participate in care.
(13) When an individual with SMI is chronically incapacitated
in their ability to care for themselves, caregivers can pursue
legal guardianship to facilitate care in appropriate areas
while being mindful to allow the individual to make decisions
for themselves in areas where they are capable.
(14) Individuals with SMI who have prolonged periods of being
significantly functional can, during such periods, design and
sign an advanced directive to predefine and choose medications,
providers, treatment plans, and hospitals, and provide
caregivers with guardianship the ability to help in those times
when a patient's psychiatric symptoms worsen to the point of
making them incapacitated or leaving them with a severely
diminished capacity to make informed decisions about their care
which may result in harm to their physical and mental health.
(15) All professional and support efforts should be made to
help the individual with SMI and acute or chronic physical
illnesses to understand and follow through on treatment.
(16) When individuals with SMI, even after efforts to help
them understand, have failed to care for themselves, there
exists confusion in the health care community around what is
currently permissible under HIPAA rules. This confusion may
hinder communication with responsible caregivers who may be
able to facilitate care for the patient with SMI in instances
when the individual does not give permission for disclosure.
(b) Sense of Congress.--It is the sense of the Congress that, for the
sake of the health and safety of persons with serious mental illness,
more clarity is needed surrounding the existing HIPAA privacy rule
promulgated pursuant to section 264(c) of the Health Insurance
Portability and Accountability Act (42 U.S.C. 1320d-2 note) to permit
health care professionals to communicate, when necessary, with
responsible known caregivers of such persons, the limited, appropriate
protected health information of such persons in order to facilitate
treatment, but not including psychotherapy notes.
SEC. 402. CONFIDENTIALITY OF RECORDS.
Not later than one year after the date on which the Secretary of
Health and Human Services first finalizes regulations updating part 2
of title 42, Code of Federal Regulations (relating to confidentiality
of alcohol and drug abuse patient records) after the date of enactment
of this Act, the Secretary shall convene relevant stakeholders to
determine the effect of such regulations on patient care, health
outcomes, and patient privacy. The Secretary shall submit to the
Committee on Energy and Commerce of the House of Representatives and
the Committee on Health, Education, Labor, and Pensions of the Senate,
and make publicly available, a report on the findings of such
stakeholders.
SEC. 403. CLARIFICATION OF CIRCUMSTANCES UNDER WHICH DISCLOSURE OF
PROTECTED HEALTH INFORMATION IS PERMITTED.
(a) In General.--Not later than one year after the date of enactment
of this section, the Secretary of Health and Human Services shall
promulgate final regulations clarifying the circumstances under which,
consistent with the provisions of subpart C of title XI of the Social
Security Act (42 U.S.C. 1320d et seq.) and regulations promulgated
pursuant to section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2 note), a health care
provider or covered entity may disclose the protected health
information of a patient with a mental illness, including for purposes
of--
(1) communicating (including with respect to treatment, side
effects, risk factors, and the availability of community
resources) with a family member of such patient, caregiver of
such patient, or other individual to the extent that such
family member, caregiver, or individual is involved in the care
of the patient;
(2) communicating with a family member of the patient,
caregiver of such patient, or other individual involved in the
care of the patient in the case that the patient is an adult;
(3) communicating with the parent or caregiver of a patient
in the case that the patient is a minor;
(4) considering the patient's capacity to agree or object to
the sharing of the protected health information of the patient;
(5) communicating and sharing information with the family or
caregivers of the patient when--
(A) the patient consents;
(B) the patient does not consent, but the patient
lacks the capacity to agree or object and the
communication or sharing of information is in the
patient's best interest;
(C) the patient does not consent and the patient is
not incapacitated or in an emergency circumstance, but
the ability of the patient to make rational health care
decisions is significantly diminished by reason of the
physical or mental health condition of the patient; and
(D) the patient does not consent, but such
communication and sharing of information is necessary
to prevent impending and serious deterioration of the
patient's mental or physical health;
(6) involving a patient's family members, caregivers, or
others involved in the patient's care or care plan, including
facilitating treatment and medication adherence, in dealing
with patient failures to adhere to medication or other therapy;
(7) listening to or receiving information with respect to the
patient from the family or caregiver of such patient receiving
mental illness treatment;
(8) communicating with family members of the patient,
caregivers of the patient, law enforcement, or others when the
patient presents a serious and imminent threat of harm to self
or others; and
(9) communicating to law enforcement and family members of
the patient or caregivers of the patient about the admission of
the patient to receive care at a facility or the release of a
patient who was admitted to a facility for an emergency
psychiatric hold or involuntary treatment.
(b) Coordination.--The Secretary of Health and Human Services shall
carry out this section in coordination with the Director of the Office
for Civil Rights within the Department of Health and Human Services.
(c) Consistency With Guidance.--The Secretary of Health and Human
Services shall ensure that the regulations under this section are
consistent with the guidance entitled ``HIPAA Privacy Rule and Sharing
Information Related to Mental Health'', issued by the Department of
Health and Human Services on February 20, 2014.
SEC. 404. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING PROGRAMS.
(a) Initial Programs and Materials.--Not later than one year after
the date of the enactment of this Act, the Secretary of Health and
Human Services (in this section referred to as the ``Secretary'') shall
develop and disseminate--
(1) a model program and materials for training health care
providers (including physicians, emergency medical personnel,
psychologists, counselors, therapists, behavioral health
facilities and clinics, care managers, and hospitals) regarding
the circumstances under which, consistent with the standards
governing the privacy and security of individually identifiable
health information promulgated by the Secretary under subpart C
of title XI of the Social Security Act (42 U.S.C. 1320d et
seq.) and regulations promulgated pursuant to section 264(c) of
the Health Insurance Portability and Accountability Act of 1996
(42 U.S.C. 1320d-2 note), the protected health information of
patients with a mental illness may be disclosed with and
without patient consent;
(2) a model program and materials for training lawyers and
others in the legal profession on such circumstances; and
(3) a model program and materials for training patients and
their families regarding their rights to protect and obtain
information under the standards specified in paragraph (1).
(b) Periodic Updates.--The Secretary shall--
(1) periodically review and update the model programs and
materials developed under subsection (a); and
(2) disseminate the updated model programs and materials.
(c) Contents.--The programs and materials developed under subsection
(a) shall address the guidance entitled ``HIPAA Privacy Rule and
Sharing Information Related to Mental Health'', issued by the
Department of Health and Human Services on February 20, 2014.
(d) Coordination.--The Secretary shall carry out this section in
coordination with the Director of the Office for Civil Rights within
the Department of Health and Human Services, the Assistant Secretary
for Mental Health and Substance Use, the Administrator of the Health
Resources and Services Administration, and the heads of other relevant
agencies within the Department of Health and Human Services.
(e) Input of Certain Entities.--In developing the model programs and
materials required by subsections (a) and (b), the Secretary shall
solicit the input of relevant national, State, and local associations,
medical societies, and licensing boards.
(f) Funding.--There are authorized to be appropriated to carry out
this section $4,000,000 for fiscal year 2018, $2,000,000 for each of
fiscal years 2019 and 2020, and $1,000,000 for each of fiscal years
2021 and 2022.
TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS
SEC. 501. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR INDIVIDUALS
WITH SERIOUS MENTAL ILLNESS.
Part B of title V of the Public Health Service Act (42 U.S.C. 290bb
et seq.) is amended by inserting after section 520L the following:
``SEC. 520M. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR
INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.
``(a) In General.--The Assistant Secretary shall award grants to
eligible entities--
``(1) to establish assertive community treatment programs for
individuals with serious mental illness; or
``(2) to maintain or expand such programs.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall be a State, county, city, tribe, tribal
organization, mental health system, health care facility, or any other
entity the Assistant Secretary deems appropriate.
``(c) Special Consideration.--In selecting among applicants for a
grant under this section, the Assistant Secretary may give special
consideration to the potential of the applicant's program to reduce
hospitalization, homelessness, and involvement with the criminal
justice system while improving the health and social outcomes of the
patient.
``(d) Additional Activities.--The Assistant Secretary shall--
``(1) not later than the end of fiscal year 2021, submit a
report to the appropriate congressional committees on the grant
program under this section, including an evaluation of--
``(A) cost savings and public health outcomes such as
mortality, suicide, substance abuse, hospitalization,
and use of services;
``(B) rates of involvement with the criminal justice
system of patients;
``(C) rates of homelessness among patients; and
``(D) patient and family satisfaction with program
participation; and
``(2) provide appropriate information, training, and
technical assistance to grant recipients under this section to
help such recipients to establish, maintain, or expand their
assertive community treatment programs.
``(e) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there is
authorized to be appropriated $5,000,000 for the period of
fiscal years 2018 through 2022.
``(2) Use of certain funds.--Of the funds appropriated to
carry out this section in any fiscal year, no more than 5
percent shall be available to the Assistant Secretary for
carrying out subsection (d).''.
SEC. 502. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.
Section 520F of the Public Health Service Act (42 U.S.C. 290bb-37) is
amended to read as follows:
``SEC. 520F. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.
``(a) In General.--The Secretary shall award competitive grants--
``(1) to State and local governments and Indian tribes and
tribal organizations to enhance community-based crisis response
systems; or
``(2) to States to develop, maintain, or enhance a database
of beds at inpatient psychiatric facilities, crisis
stabilization units, and residential community mental health
and residential substance use disorder treatment facilities,
for individuals with serious mental illness, serious emotional
disturbance, or substance use disorders.
``(b) Application.--
``(1) In general.--To receive a grant or cooperative
agreement under subsection (a), an entity shall submit to the
Secretary an application, at such time, in such manner, and
containing such information as the Secretary may require.
``(2) Community-based crisis response plan.--An application
for a grant under subsection (a)(1) shall include a plan for--
``(A) promoting integration and coordination between
local public and private entities engaged in crisis
response, including first responders, emergency health
care providers, primary care providers, law
enforcement, court systems, health care payers, social
service providers, and behavioral health providers;
``(B) developing a plan for entering into memoranda
of understanding with public and private entities to
implement crisis response services;
``(C) expanding the continuum of community-based
services to address crisis intervention and prevention;
and
``(D) developing models for minimizing hospital
readmissions, including through appropriate discharge
planning.
``(3) Beds database plan.--An application for a grant under
subsection (a)(2) shall include a plan for developing,
maintaining, or enhancing a real-time Internet-based bed
database to collect, aggregate, and display information about
beds in inpatient psychiatric facilities and crisis
stabilization units, and residential community mental health
and residential substance use disorder treatment facilities, to
facilitate the identification and designation of facilities for
the temporary treatment of individuals in mental or substance
use disorder crisis.
``(c) Database Requirements.--A bed database described in this
section is a database that--
``(1) includes information on inpatient psychiatric
facilities, crisis stabilization units, and residential
community mental health and residential substance use disorder
facilities in the State involved, including contact information
for the facility or unit;
``(2) provides real-time information about the number of beds
available at each facility or unit and, for each available bed,
the type of patient that may be admitted, the level of security
provided, and any other information that may be necessary to
allow for the proper identification of appropriate facilities
for treatment of individuals in mental or substance use
disorder crisis; and
``(3) enables searches of the database to identify available
beds that are appropriate for the treatment of individuals in
mental or substance use disorder crisis.
``(d) Evaluation.--An entity receiving a grant under subsection
(a)(1) shall submit to the Secretary, at such time, in such manner, and
containing such information as the Secretary may reasonably require, a
report, including an evaluation of the effect of such grant on--
``(1) local crisis response services and measures of
individuals receiving crisis planning and early intervention
supports;
``(2) individuals reporting improved functional outcomes; and
``(3) individuals receiving regular followup care following a
crisis.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $5,000,000 for the period of
fiscal years 2018 through 2022.''.
SEC. 503. INCREASED AND EXTENDED FUNDING FOR ASSISTED OUTPATIENT GRANT
PROGRAM FOR INDIVIDUALS WITH SERIOUS MENTAL
ILLNESS.
Section 224(g) of the Protecting Access to Medicare Act of 2014 (42
U.S.C. 290aa note) is amended--
(1) in paragraph (1), by striking ``2018'' and inserting
``2022''; and
(2) in paragraph (2), by striking ``is authorized to be
appropriated to carry out this section $15,000,000 for each of
fiscal years 2015 through 2018'' and inserting ``are authorized
to be appropriated to carry out this section $15,000,000 for
each of fiscal years 2015 through 2017, $20,000,000 for fiscal
year 2018, $19,000,000 for each of fiscal years 2019 and 2020,
and $18,000,000 for each of fiscal years 2021 and 2022''.
SEC. 504. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL VOLUNTEERS AT
COMMUNITY HEALTH CENTERS.
Section 224 of the Public Health Service Act (42 U.S.C. 233) is
amended by adding at the end the following:
``(q)(1) For purposes of this section, a health professional
volunteer at an entity described in subsection (g)(4) shall, in
providing a health professional service eligible for funding under
section 330 to an individual, be deemed to be an employee of the Public
Health Service for a calendar year that begins during a fiscal year for
which a transfer was made under paragraph (4)(C). The preceding
sentence is subject to the provisions of this subsection.
``(2) In providing a health service to an individual, a health care
practitioner shall for purposes of this subsection be considered to be
a health professional volunteer at an entity described in subsection
(g)(4) if the following conditions are met:
``(A) The service is provided to the individual at the
facilities of an entity described in subsection (g)(4), or
through offsite programs or events carried out by the entity.
``(B) The entity is sponsoring the health care practitioner
pursuant to paragraph (3)(B).
``(C) The health care practitioner does not receive any
compensation for the service from the individual or from any
third-party payer (including reimbursement under any insurance
policy or health plan, or under any Federal or State health
benefits program), except that the health care practitioner may
receive repayment from the entity described in subsection
(g)(4) for reasonable expenses incurred by the health care
practitioner in the provision of the service to the individual.
``(D) Before the service is provided, the health care
practitioner or the entity described in subsection (g)(4) posts
a clear and conspicuous notice at the site where the service is
provided of the extent to which the legal liability of the
health care practitioner is limited pursuant to this
subsection.
``(E) At the time the service is provided, the health care
practitioner is licensed or certified in accordance with
applicable law regarding the provision of the service.
``(3) Subsection (g) (other than paragraphs (3) and (5)) and
subsections (h), (i), and (l) apply to a health care practitioner for
purposes of this subsection to the same extent and in the same manner
as such subsections apply to an officer, governing board member,
employee, or contractor of an entity described in subsection (g)(4),
subject to paragraph (4) and subject to the following:
``(A) The first sentence of paragraph (1) applies in lieu of
the first sentence of subsection (g)(1)(A).
``(B) With respect to an entity described in subsection
(g)(4), a health care practitioner is not a health professional
volunteer at such entity unless the entity sponsors the health
care practitioner. For purposes of this subsection, the entity
shall be considered to be sponsoring the health care
practitioner if--
``(i) with respect to the health care practitioner,
the entity submits to the Secretary an application
meeting the requirements of subsection (g)(1)(D); and
``(ii) the Secretary, pursuant to subsection
(g)(1)(E), determines that the health care practitioner
is deemed to be an employee of the Public Health
Service.
``(C) In the case of a health care practitioner who is
determined by the Secretary pursuant to subsection (g)(1)(E) to
be a health professional volunteer at such entity, this
subsection applies to the health care practitioner (with
respect to services performed on behalf of the entity
sponsoring the health care practitioner pursuant to
subparagraph (B)) for any cause of action arising from an act
or omission of the health care practitioner occurring on or
after the date on which the Secretary makes such determination.
``(D) Subsection (g)(1)(F) applies to a health care
practitioner for purposes of this subsection only to the extent
that, in providing health services to an individual, each of
the conditions specified in paragraph (2) is met.
``(4)(A) Amounts in the fund established under subsection (k)(2)
shall be available for transfer under subparagraph (C) for purposes of
carrying out this subsection.
``(B) Not later May 1 of each fiscal year, the Attorney General, in
consultation with the Secretary, shall submit to the Congress a report
providing an estimate of the amount of claims (together with related
fees and expenses of witnesses) that, by reason of the acts or
omissions of health professional volunteers, will be paid pursuant to
this section during the calendar year that begins in the following
fiscal year. Subsection (k)(1)(B) applies to the estimate under the
preceding sentence regarding health professional volunteers to the same
extent and in the same manner as such subsection applies to the
estimate under such subsection regarding officers, governing board
members, employees, and contractors of entities described in subsection
(g)(4).
``(C) Not later than December 31 of each fiscal year, the Secretary
shall transfer from the fund under subsection (k)(2) to the appropriate
accounts in the Treasury an amount equal to the estimate made under
subparagraph (B) for the calendar year beginning in such fiscal year,
subject to the extent of amounts in the fund.
``(5)(A) This subsection takes effect on October 1, 2017, except as
provided in subparagraph (B).
``(B) Effective on the date of the enactment of this subsection--
``(i) the Secretary may issue regulations for carrying out
this subsection, and the Secretary may accept and consider
applications submitted pursuant to paragraph (3)(B); and
``(ii) reports under paragraph (4)(B) may be submitted to the
Congress.''.
TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS
Subtitle A--Encouraging the Advancement, Incorporation, and Development
of Evidence-Based Practices
SEC. 601. ENCOURAGING INNOVATION AND EVIDENCE-BASED PROGRAMS.
Section 501B of the Public Health Service Act, as inserted by section
103, is further amended, by inserting after subsection (c) the
following new subsection:
``(d) Promoting Innovation.--
``(1) In general.--The Assistant Secretary, in coordination
with the Laboratory, may award grants to States, local
governments, Indian tribes or tribal organizations (as such
terms are defined in section 4 of the Indian Self-Determination
and Education Assistance Act), educational institutions, and
nonprofit organizations to develop evidence-based
interventions, including culturally and linguistically
appropriate services, as appropriate, for--
``(A) evaluating a model that has been scientifically
demonstrated to show promise, but would benefit from
further applied development, for--
``(i) enhancing the prevention, diagnosis,
intervention, treatment, and recovery of mental
illness, serious emotional disturbance,
substance use disorders, and co-occurring
disorders; or
``(ii) integrating or coordinating physical
health services and mental and substance use
disorder services; and
``(B) expanding, replicating, or scaling evidence-
based programs across a wider area to enhance effective
screening, early diagnosis, intervention, and treatment
with respect to mental illness, serious mental illness,
and serious emotional disturbance, primarily by--
``(i) applying delivery of care, including
training staff in effective evidence-based
treatment; or
``(ii) integrating models of care across
specialties and jurisdictions.
``(2) Consultation.--In awarding grants under this paragraph,
the Assistant Secretary shall, as appropriate, consult with the
advisory councils described in section 502, the National
Institute of Mental Health, the National Institute on Drug
Abuse, and the National Institute on Alcohol Abuse and
Alcoholism, as appropriate.
``(3) Authorization of appropriations.--There are authorized
to be appropriated--
``(A) to carry out paragraph (1)(A), $7,000,000 for
the period of fiscal years 2018 through 2020; and
``(B) to carry out paragraph (1)(B), $7,000,000 for
the period of fiscal years 2018 through 2020.''.
SEC. 602. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED PROGRAMS
AND PRACTICES.
Part D of title V of the Public Health Service Act is amended by
inserting after section 543 of such Act (42 U.S.C. 290dd-2 ) the
following:
``SEC. 544. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED PROGRAMS
AND PRACTICES.
``(a) In General.--The Assistant Secretary shall improve access to
reliable and valid information on evidence-based programs and
practices, including information on the strength of evidence associated
with such programs and practices, related to mental and substance use
disorders for States, local communities, nonprofit entities, and other
stakeholders by posting on the website of the National Registry of
Evidence-Based Programs and Practices evidence-based programs and
practices that have been reviewed by the Assistant Secretary pursuant
to the requirements of this section.
``(b) Notice.--
``(1) Periods.--In carrying out subsection (a), the Assistant
Secretary may establish an initial period for the submission of
applications for evidence-based programs and practices to be
posted publicly in accordance with subsection (a) (and may
establish subsequent such periods). The Assistant Secretary
shall publish notice of such application periods in the Federal
Register.
``(2) Addressing gaps.--Such notice may solicit applications
for evidence-based practices and programs to address gaps in
information identified by the Assistant Secretary, the
Assistant Secretary for Planning and Evaluation, the Assistant
Secretary for Financial Resources, or the National Mental
Health and Substance Use Policy Laboratory, including pursuant
to priorities identified in the strategic plan established
under section 501(l).
``(c) Requirements.--The Assistant Secretary shall establish minimum
requirements for applications referred to in this section, including
applications related to the submission of research and evaluation.
``(d) Review and Rating.--The Assistant Secretary shall review
applications prior to public posting, and may prioritize the review of
applications for evidence-based practices and programs that are related
to topics included in the notice established under subsection (b). The
Assistant Secretary shall utilize a rating and review system, which
shall include information on the strength of evidence associated with
such programs and practices and a rating of the methodological rigor of
the research supporting the application. The Assistant Secretary shall
make the metrics used to evaluate applications and the resulting
ratings publicly available.''.
SEC. 603. SENSE OF CONGRESS.
It is the sense of the Congress that the National Institute of Mental
Health should conduct or support research on the determinants of self-
directed and other violence connected to mental illness.
Subtitle B--Supporting the State Response to Mental Health Needs
SEC. 611. COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT.
(a) Formula Grants.--Section 1911(b) of the Public Health Service Act
(42 U.S.C. 300x(b)) is amended--
(1) by redesignating paragraphs (1) through (3) as paragraphs
(2) through (4), respectively; and
(2) by inserting before paragraph (2) (as so redesignated),
the following:
``(1) providing community mental health services for adults
with a serious mental illness and children with a serious
emotional disturbance as defined in accordance with section
1912(c);''.
(b) State Plan.--Subsection (b) of section 1912 of the Public Health
Service Act (42 U.S.C. 300x-1) is amended to read as follows:
``(b) Criteria for Plan.--In accordance with subsection (a), a State
shall submit to the Secretary a plan that, at a minimum, satisfies the
following criteria:
``(1) System of care.--The plan provides a description of the
system of care of the State, including as follows:
``(A) Comprehensive community-based health systems.--
The plan shall--
``(i) identify the single State agency to be
responsible for the administration of the
program under the grant, including any third
party who administers mental health services
and is responsible for complying with the
requirements of this part with respect to the
grant;
``(ii) provide for an organized community-
based system of care for individuals with
mental illness, and describe available services
and resources in a comprehensive system of
care, including services for individuals with
mental health and behavioral health co-
occurring disorders;
``(iii) include a description of the manner
in which the State and local entities will
coordinate services to maximize the efficiency,
effectiveness, quality, and cost effectiveness
of services and programs to produce the best
possible outcomes (including health services,
rehabilitation services, employment services,
housing services, educational services,
substance use disorder services, legal
services, law enforcement services, social
services, child welfare services, medical and
dental care services, and other support
services to be provided with Federal, State,
and local public and private resources) with
other agencies to enable individuals receiving
services to function outside of inpatient or
residential institutions, to the maximum extent
of their capabilities, including services to be
provided by local school systems under the
Individuals with Disabilities Education Act;
``(iv) include a description of how the
State--
``(I) promotes evidence-based
practices, including those evidence-
based programs that address the needs
of individuals with early serious
mental illness regardless of the age of
the individual at onset;
``(II) provides comprehensive
individualized treatment; or
``(III) integrates mental and
physical health services;
``(v) include a description of case
management services;
``(vi) include a description of activities
that seek to engage individuals with serious
mental illness or serious emotional disturbance
and their caregivers where appropriate in
making health care decisions, including
activities that enhance communication between
individuals, families, caregivers, and
treatment providers; and
``(vii) as appropriate to and reflective of
the uses the State proposes for the block grant
monies--
``(I) a description of the activities
intended to reduce hospitalizations and
hospital stays using the block grant
monies;
``(II) a description of the
activities intended to reduce incidents
of suicide using the block grant
monies; and
``(III) a description of how the
State integrates mental health and
primary care using the block grant
monies.
``(B) Mental health system data and epidemiology.--
The plan shall contain an estimate of the incidence and
prevalence in the State of serious mental illness among
adults and serious emotional disturbance among children
and presents quantitative targets and outcome measures
for programs and services provided under this subpart.
``(C) Children's services.--In the case of children
with serious emotional disturbance (as defined in
accordance with subsection (c)), the plan shall provide
for a system of integrated social services, educational
services, child welfare services, juvenile justice
services, law enforcement services, and substance use
disorder services that, together with health and mental
health services, will be provided in order for such
children to receive care appropriate for their multiple
needs (such system to include services provided under
the Individuals with Disabilities Education Act).
``(D) Targeted services to rural and homeless
populations.--The plan shall describe the State's
outreach to and services for individuals who are
homeless and how community-based services will be
provided to individuals residing in rural areas.
``(E) Management services.--The plan shall--
``(i) describe the financial resources
available, the existing mental health
workforce, and the workforce trained in
treating individuals with co-occurring mental
and substance use disorders;
``(ii) provide for the training of providers
of emergency health services regarding mental
health;
``(iii) describe the manner in which the
State intends to expend the grant under section
1911 for the fiscal year involved; and
``(iv) describe the manner in which the State
intends to comply with each of the funding
agreements in this subpart and subpart III.
``(2) Goals and objectives.--The plan establishes goals and
objectives for the period of the plan, including targets and
milestones that are intended to be met, and the activities that
will be undertaken to achieve those targets.''.
(c) Best Practices in Clinical Care Models.--Section 1920 of the
Public Health Service Act (42 U.S.C. 300x-9) is amended by adding at
the end the following:
``(c) Best Practices in Clinical Care Models.--A State shall expend
not less than 10 percent of the amount the State receives for carrying
out this subpart in each fiscal year to support evidence-based programs
that address the needs of individuals with early serious mental
illness, including psychotic disorders, regardless of the age of the
individual at onset.''.
(d) Additional Provisions.--Section 1915(b) of the Public Health
Service Act (42 U.S.C. 300x-4(b)) is amended--
(1) by amending paragraph (1) to read as follows:
``(1) In general.--A funding agreement for a grant under
section 1911 is that the State involved will maintain State
expenditures for community mental health services at a level
that is not less than the average of the amounts prescribed by
this paragraph (prior to any waiver under paragraph (3)) for
such expenditures by such State for each of the two fiscal
years immediately preceding the fiscal year for which the State
is applying for the grant.'';
(2) in paragraph (2)--
(A) by striking ``subsection (a)'' and inserting
``paragraph (1)''; and
(B) by striking ``principle'' and inserting
``principal'';
(3) by amending paragraph (3) to read as follows:
``(3) Waiver.--
``(A) In general.--The Secretary may, upon the
request of a State, waive the requirement established
in paragraph (1) in whole or in part, if the Secretary
determines that extraordinary economic conditions in
the State in the fiscal year involved or in the
previous fiscal year justify the waiver.
``(B) Date certain for action upon request.--The
Secretary shall approve or deny a request for a waiver
under this paragraph not later than 120 days after the
date on which the request is made.
``(C) Applicability of waiver.--A waiver provided by
the Secretary under this paragraph shall be applicable
only to the fiscal year involved.''; and
(4) in paragraph (4)--
(A) by amending subparagraph (A) to read as follows:
``(A) In general.--
``(i) Determination and reduction.--The
Secretary shall determine, in the case of each
State, and for each fiscal year, whether the
State maintained material compliance with the
agreement made under paragraph (1). If the
Secretary determines that a State has failed to
maintain such compliance for a fiscal year, the
Secretary shall reduce the amount of the
allotment under section 1911 for the State, for
the first fiscal year beginning after such
determination is final, by an amount equal to
the amount constituting such failure for the
previous fiscal year about which the
determination was made.
``(ii) Alternative sanction.--The Secretary
may by regulation provide for an alternative
method of imposing a sanction for a failure by
a State to maintain material compliance with
the agreement under paragraph (1) if the
Secretary determines that such alternative
method would be more equitable and would be a
more effective incentive for States to maintain
such material compliance.''; and
(B) in subparagraph (B)--
(i) by inserting after the subparagraph
designation the following: ``Submission of
information to the secretary.--''; and
(ii) by striking ``subparagraph (A)'' and
inserting ``subparagraph (A)(i)''.
(e) Application for Grant.--Section 1917(a) of the Public Health
Service Act (42 U.S.C. 300x-6(a)) is amended--
(1) in paragraph (1), by striking ``1941'' and inserting
``1942(a)''; and
(2) in paragraph (5), by striking ``1915(b)(3)(B)'' and
inserting ``1915(b)''.
Subtitle C--Strengthening Mental Health Care for Children and
Adolescents
SEC. 621. TELEHEALTH CHILD PSYCHIATRY ACCESS GRANTS.
Title III of the Public Health Service Act is amended by inserting
after section 330L of such Act (42 U.S.C. 254c-18) the following new
section:
``SEC. 330M. TELEHEALTH CHILD PSYCHIATRY ACCESS GRANTS.
``(a) In General.--The Secretary, acting through the Administrator of
the Health Resources and Services Administration and in coordination
with other relevant Federal agencies, shall award grants to States,
political subdivisions of States, Indian tribes, and tribal
organizations (for purposes of this section, as such terms are defined
in section 4 of the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450b)) to promote behavioral health integration in
pediatric primary care by--
``(1) supporting the development of statewide child
psychiatry access programs; and
``(2) supporting the improvement of existing statewide child
psychiatry access programs.
``(b) Program Requirements.--
``(1) In general.--A child psychiatry access program referred
to in subsection (a), with respect to which a grant under such
subsection may be used, shall--
``(A) be a statewide network of pediatric mental
health teams that provide support to pediatric primary
care sites as an integrated team;
``(B) support and further develop organized State
networks of child and adolescent psychiatrists to
provide consultative support to pediatric primary care
sites;
``(C) conduct an assessment of critical behavioral
consultation needs among pediatric providers and such
providers' preferred mechanisms for receiving
consultation and training and technical assistance;
``(D) develop an online database and communication
mechanisms, including telehealth, to facilitate
consultation support to pediatric practices;
``(E) provide rapid statewide clinical telephone or
telehealth consultations when requested between the
pediatric mental health teams and pediatric primary
care providers;
``(F) conduct training and provide technical
assistance to pediatric primary care providers to
support the early identification, diagnosis, treatment,
and referral of children with behavioral health
conditions or co-occurring intellectual and other
developmental disabilities;
``(G) inform and assist pediatric providers in
accessing child psychiatry consultations and in
scheduling and conducting technical assistance;
``(H) assist with referrals to specialty care and
community or behavioral health resources; and
``(I) establish mechanisms for measuring and
monitoring increased access to child and adolescent
psychiatric services by pediatric primary care
providers and expanded capacity of pediatric primary
care providers to identify, treat, and refer children
with mental health problems.
``(2) Pediatric mental health teams.--In this subsection, the
term `pediatric mental health team' means a team of case
coordinators, child and adolescent psychiatrists, and licensed
clinical mental health professionals, such as a psychologist,
social worker, or mental health counselor.
``(c) Application.--A State, political subdivision of a State, Indian
tribe, or tribal organization seeking a grant under this section shall
submit an application to the Secretary at such time, in such manner,
and containing such information as the Secretary may require, including
a plan for the rigorous evaluation of activities that are carried out
with funds received under such grant.
``(d) Evaluation.--A State, political subdivision of a State, Indian
tribe, or tribal organization that receives a grant under this section
shall prepare and submit an evaluation of activities carried out with
funds received under such grant to the Secretary at such time, in such
manner, and containing such information as the Secretary may reasonably
require, including a process and outcome evaluation.
``(e) Matching Requirement.--The Secretary may not award a grant
under this section unless the State, political subdivision of a State,
Indian tribe, or tribal organization involved agrees, with respect to
the costs to be incurred by the State, political subdivision of a
State, Indian tribe, or tribal organization in carrying out the purpose
described in this section, to make available non-Federal contributions
(in cash or in kind) toward such costs in an amount that is not less
than 20 percent of Federal funds provided in the grant.
``(f) Authorization of Appropriations.--To carry this section, there
are authorized to be appropriated $9,000,000 for the period of fiscal
years 2018 through 2020.''.
SEC. 622. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION,
INTERVENTION, AND TREATMENT.
Part Q of title III of the Public Health Service Act (42 U.S.C. 290h
et seq.) is amended by adding at the end the following:
``SEC. 399Z-2. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION,
INTERVENTION, AND TREATMENT.
``(a) Grants.--The Secretary shall--
``(1) award grants to eligible entities, including human
services agencies, to develop, maintain, or enhance infant and
early childhood mental health promotion, intervention, and
treatment programs, including--
``(A) programs for infants and children at
significant risk of developing, showing early signs of,
or having been diagnosed with mental disorders
including serious emotional disturbance; and
``(B) multigenerational therapy and other services
that support the caregiving relationship; and
``(2) ensure that programs funded through grants under this
section are evidence-informed or evidence-based models,
practices, and methods that are, as appropriate, culturally and
linguistically appropriate, and can be replicated in other
appropriate settings.
``(b) Eligible Children and Entities.--In this section:
``(1) Eligible child.--The term `eligible child' means a
child from birth to not more than 5 years of age who--
``(A) is at risk for, shows early signs of, or has
been diagnosed with a mental disorder, including
serious emotional disturbance; and
``(B) may benefit from infant and early childhood
intervention or treatment programs or specialized
preschool or elementary school programs that are
evidence-based or that have been scientifically
demonstrated to show promise but would benefit from
further applied development.
``(2) Eligible entity.--The term `eligible entity' means a
nonprofit institution that--
``(A) is accredited or approved by a State mental
health or education agency, as applicable, to provide
for children from infancy to 5 years of age mental
health promotion, intervention, or treatment services
that are evidence-based or that have been
scientifically demonstrated to show promise but would
benefit from further applied development; and
``(B) provides programs described in subsection (a)
that are evidence-based or that have been
scientifically demonstrated to show promise but would
benefit from further applied development.
``(c) Application.--An eligible entity seeking a grant under
subsection (a) shall submit to the Secretary an application at such
time, in such manner, and containing such information as the Secretary
may require.
``(d) Use of Funds for Early Intervention and Treatment Programs.--An
eligible entity may use amounts awarded under a grant under subsection
(a)(1) to carry out the following:
``(1) Provide age-appropriate mental health promotion and
early intervention services or mental disorder treatment
services, which may include specialized programs, for eligible
children at significant risk of developing, showing early signs
of, or having been diagnosed with a mental disorder, including
serious emotional disturbance. Such services may include social
and behavioral services as well as multigenerational therapy
and other services ?that support the caregiving relationship.
``(2) Provide training for health care professionals with
expertise in infant and early childhood mental health care with
respect to appropriate and relevant integration with other
disciplines such as primary care clinicians, early intervention
specialists, child welfare staff, home visitors, early care and
education providers, and others who work with young children
and families.
``(3) Provide mental health consultation to personnel of
early care and education programs (including licensed or
regulated center-based and home-based child care, home
visiting, preschool special education, and early intervention
programs) who work with children and families.
``(4) Provide training for mental health clinicians in infant
and early childhood promising and evidence-based practices and
models for mental health treatment and early intervention,
including with regard to practices for identifying and treating
mental and behavioral disorders of infants and children
resulting from exposure or repeated exposure to adverse
childhood experiences or childhood trauma.
``(5) Provide age-appropriate assessment, diagnostic, and
intervention services for eligible children, including early
mental health promotion, intervention, and treatment services.
``(e) Matching Funds.--The Secretary may not award a grant under this
section to an eligible entity unless the eligible entity agrees, with
respect to the costs to be incurred by the eligible entity in carrying
out the activities described in subsection (d), to make available non-
Federal contributions (in cash or in kind) toward such costs in an
amount that is not less than 10 percent of the total amount of Federal
funds provided in the grant.
``(f) Authorization of Appropriations.--To carry this section, there
are authorized to be appropriated $20,000,000 for the period of fiscal
years 2018 through 2022.''.
SEC. 623. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.
Section 582 of the Public Health Service Act (42 U.S.C. 290hh-1;
relating to grants to address the problems of persons who experience
violence related stress) is amended--
(1) in subsection (a), by striking ``developing programs''
and all that follows and inserting the following: ``developing
and maintaining programs that provide for--
``(1) the continued operation of the National Child Traumatic
Stress Initiative (referred to in this section as the `NCTSI'),
which includes a coordinating center that focuses on the
mental, behavioral, and biological aspects of psychological
trauma response; and
``(2) the development of knowledge with regard to evidence-
based practices for identifying and treating mental disorders,
behavioral disorders, and physical health conditions of
children and youth resulting from witnessing or experiencing a
traumatic event.'';
(2) in subsection (b)--
(A) by striking ``subsection (a) related'' and
inserting ``subsection (a)(2) (related'';
(B) by striking ``treating disorders associated with
psychological trauma'' and inserting ``treating mental,
behavioral, and biological disorders associated with
psychological trauma)''; and
(C) by striking ``mental health agencies and programs
that have established clinical and basic research'' and
inserting ``universities, hospitals, mental health
agencies, and other programs that have established
clinical expertise and research'';
(3) by redesignating subsections (c) through (g) as
subsections (g) through (k), respectively;
(4) by inserting after subsection (b), the following:
``(c) Child Outcome Data.--The NCTSI coordinating center shall
collect, analyze, report, and make publicly available NCTSI-wide child
treatment process and outcome data regarding the early identification
and delivery of evidence-based treatment and services for children and
families served by the NCTSI grantees.
``(d) Training.--The NCTSI coordinating center shall facilitate the
coordination of training initiatives in evidence-based and trauma-
informed treatments, interventions, and practices offered to NCTSI
grantees, providers, and partners.
``(e) Dissemination.--The NCTSI coordinating center shall, as
appropriate, collaborate with the Secretary in the dissemination of
evidence-based and trauma-informed interventions, treatments, products,
and other resources to appropriate stakeholders.
``(f) Review.--The Secretary shall, consistent with the peer-review
process, ensure that NCTSI applications are reviewed by appropriate
experts in the field as part of a consensus review process. The
Secretary shall include review criteria related to expertise and
experience in child trauma and evidence-based practices.'';
(5) in subsection (g) (as so redesignated), by striking
``with respect to centers of excellence are distributed
equitably among the regions of the country'' and inserting
``are distributed equitably among the regions of the United
States'';
(6) in subsection (i) (as so redesignated), by striking
``recipient may not exceed 5 years'' and inserting ``recipient
shall not be less than 4 years, but shall not exceed 5 years'';
and
(7) in subsection (j) (as so redesignated), by striking
``$50,000,000'' and all that follows through ``2006'' and
inserting ``$46,887,000 for each of fiscal years 2017 through
2021''.
TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATION
Subtitle A--Garrett Lee Smith Memorial Act Reauthorization
SEC. 701. YOUTH INTERAGENCY RESEARCH, TRAINING, AND TECHNICAL
ASSISTANCE CENTERS.
Section 520C of the Public Health Service Act (42 U.S.C. 290bb-34) is
amended--
(1) by striking the section heading and inserting ``suicide
prevention technical assistance center.'';
(2) in subsection (a), by striking ``and in consultation
with'' and all that follows through the period at the end of
paragraph (2) and inserting ``shall establish a research,
training, and technical assistance resource center to provide
appropriate information, training, and technical assistance to
States, political subdivisions of States, federally recognized
Indian tribes, tribal organizations, institutions of higher
education, public organizations, or private nonprofit
organizations regarding the prevention of suicide among all
ages, particularly among groups that are at high risk for
suicide.'';
(3) by striking subsections (b) and (c);
(4) by redesignating subsection (d) as subsection (b);
(5) in subsection (b), as so redesignated--
(A) by striking the subsection heading and inserting
``Responsibilities of the Center.--'';
(B) in the matter preceding paragraph (1), by
striking ``The additional research'' and all that
follows through ``nonprofit organizations for'' and
inserting ``The center established under subsection (a)
shall conduct activities for the purpose of'';
(C) by striking ``youth suicide'' each place such
term appears and inserting ``suicide'';
(D) in paragraph (1)--
(i) by striking ``the development or
continuation of'' and inserting ``developing
and continuing''; and
(ii) by inserting ``for all ages,
particularly among groups that are at high risk
for suicide'' before the semicolon at the end;
(E) in paragraph (2), by inserting ``for all ages,
particularly among groups that are at high risk for
suicide'' before the semicolon at the end;
(F) in paragraph (3), by inserting ``and tribal''
after ``statewide'';
(G) in paragraph (5), by inserting ``and prevention''
after ``intervention'';
(H) in paragraph (8), by striking ``in youth'';
(I) in paragraph (9), by striking ``and behavioral
health'' and inserting ``health and substance use
disorder''; and
(J) in paragraph (10), by inserting ``conducting''
before ``other''; and
(6) by striking subsection (e) and inserting the following:
``(c) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $5,988,000
for each of fiscal years 2017 through 2021.
``(d) Report.--Not later than 2 years after the date of enactment of
the Helping Families in Mental Health Crisis Act of 2016, the Secretary
shall submit to Congress a report on the activities carried out by the
center established under subsection (a) during the year involved,
including the potential effects of such activities, and the States,
organizations, and institutions that have worked with the center.''.
SEC. 702. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.
Section 520E of the Public Health Service Act (42 U.S.C. 290bb-36) is
amended--
(1) in paragraph (1) of subsection (a) and in subsection (c),
by striking ``substance abuse'' each place such term appears
and inserting ``substance use disorder'';
(2) in subsection (b)(2)--
(A) by striking ``each State is awarded only 1 grant
or cooperative agreement under this section'' and
inserting ``a State does not receive more than 1 grant
or cooperative agreement under this section at any 1
time''; and
(B) by striking ``been awarded'' and inserting
``received''; and
(3) by striking subsection (m) and inserting the following:
``(m) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $35,427,000
for each of fiscal years 2017 through 2021.''.
SEC. 703. MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES ON CAMPUS.
Section 520E-2 of the Public Health Service Act (42 U.S.C. 290bb-36b)
is amended--
(1) in the section heading, by striking ``and behavioral
health'' and inserting ``health and substance use disorder'';
(2) in subsection (a)--
(A) by striking ``Services,'' and inserting
``Services and'';
(B) by striking ``and behavioral health problems''
and inserting ``health or substance use disorders'';
and
(C) by striking ``substance abuse'' and inserting
``substance use disorders'';
(3) in subsection (b)--
(A) in the matter preceding paragraph (1), by
striking ``for--'' and inserting ``for one or more of
the following:''; and
(B) by striking paragraphs (1) through (6) and
inserting the following:
``(1) Educating students, families, faculty, and staff to
increase awareness of mental health and substance use
disorders.
``(2) The operation of hotlines.
``(3) Preparing informational material.
``(4) Providing outreach services to notify students about
available mental health and substance use disorder services.
``(5) Administering voluntary mental health and substance use
disorder screenings and assessments.
``(6) Supporting the training of students, faculty, and staff
to respond effectively to students with mental health and
substance use disorders.
``(7) Creating a network infrastructure to link colleges and
universities with health care providers who treat mental health
and substance use disorders.'';
(4) in subsection (c)(5), by striking ``substance abuse'' and
inserting ``substance use disorder'';
(5) in subsection (d)--
(A) in the matter preceding paragraph (1), by
striking ``An institution of higher education desiring
a grant under this section'' and inserting ``To be
eligible to receive a grant under this section, an
institution of higher education'';
(B) in paragraph (1)--
(i) by striking ``and behavioral health'' and
inserting ``health and substance use
disorder''; and
(ii) by inserting ``, including veterans
whenever possible and appropriate,'' after
``students''; and
(C) in paragraph (2), by inserting ``, which may
include, as appropriate and in accordance with
subsection (b)(7), a plan to seek input from relevant
stakeholders in the community, including appropriate
public and private entities, in order to carry out the
program under the grant'' before the period at the end;
(6) in subsection (e)(1), by striking ``and behavioral health
problems'' and inserting ``health and substance use
disorders'';
(7) in subsection (f)(2)--
(A) by striking ``and behavioral health'' and
inserting ``health and substance use disorder''; and
(B) by striking ``suicide and substance abuse'' and
inserting ``suicide and substance use disorders''; and
(8) in subsection (h), by striking ``$5,000,000 for fiscal
year 2005'' and all that follows through the period at the end
and inserting ``$6,488,000 for each of fiscal years 2017
through 2021.''.
Subtitle B--Other Provisions
SEC. 711. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb-31 et seq.) is amended by inserting after section 520E-2
(42 U.S.C. 290bb-36b) the following:
``SEC. 520E-3. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
``(a) In General.--The Secretary, acting through the Assistant
Secretary, shall maintain the National Suicide Prevention Lifeline
Program (referred to in this section as the `Program'), authorized
under section 520A and in effect prior to the date of enactment of the
Helping Families in Mental Health Crisis Act of 2016.
``(b) Activities.--In maintaining the Program, the activities of the
Secretary shall include--
``(1) coordinating a network of crisis centers across the
United States for providing suicide prevention and crisis
intervention services to individuals seeking help at any time,
day or night;
``(2) maintaining a suicide prevention hotline to link
callers to local emergency, mental health, and social services
resources; and
``(3) consulting with the Secretary of Veterans Affairs to
ensure that veterans calling the suicide prevention hotline
have access to a specialized veterans' suicide prevention
hotline.
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $7,198,000 for each of fiscal
years 2017 through 2021.''.
SEC. 712. WORKFORCE DEVELOPMENT STUDIES AND REPORTS.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, the Assistant Secretary for Mental Health and Substance
Use, in consultation with the Administrator of the Health Resources and
Services Administration, shall conduct a study, and publicly post on
the appropriate Internet website of the Department of Health and Human
Services a report, on the mental health and substance use disorder
workforce in order to inform Federal, State, and local efforts related
to workforce enhancement.
(b) Contents.--The report under this section shall contain--
(1) national and State-level projections of the supply and
demand of mental health and substance use disorder health
workers, including the number of individuals practicing in
fields deemed relevant by the Secretary;
(2) an assessment of the mental health and substance use
disorder workforce capacity, strengths, and weaknesses as of
the date of the report, including the capacity of primary care
to prevent, screen, treat, or refer for mental health and
substance use disorders;
(3) information on trends within the mental health and
substance use disorder provider workforce, including the number
of individuals entering the mental health workforce over the
next five years;
(4) information on the gaps in workforce development for
mental health providers and professionals, including those who
serve pediatric, adult, and geriatric patients; and
(5) any additional information determined by the Assistant
Secretary for Mental Health and Substance Use, in consultation
with the Administrator of the Health Resources and Services
Administration, to be relevant to the mental health and
substance use disorder provider workforce.
SEC. 713. MINORITY FELLOWSHIP PROGRAM.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is
amended by adding at the end the following:
``PART K--MINORITY FELLOWSHIP PROGRAM
``SEC. 597. FELLOWSHIPS.
``(a) In General.--The Secretary shall maintain a program, to be
known as the Minority Fellowship Program, under which the Secretary
awards fellowships, which may include stipends, for the purposes of--
``(1) increasing behavioral health practitioners' knowledge
of issues related to prevention, treatment, and recovery
support for mental and substance use disorders among racial and
ethnic minority populations;
``(2) improving the quality of mental and substance use
disorder prevention and treatment delivered to racial and
ethnic minorities; and
``(3) increasing the number of culturally competent
behavioral health professionals and school personnel who teach,
administer, conduct services research, and provide direct
mental health or substance use services to racial and ethnic
minority populations.
``(b) Training Covered.--The fellowships under subsection (a) shall
be for postbaccalaureate training (including for master's and doctoral
degrees) for mental health professionals, including in the fields of
psychiatry, nursing, social work, psychology, marriage and family
therapy, mental health counseling, and substance use and addiction
counseling.
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $12,669,000 for each of fiscal
years 2017, 2018, and 2019 and $13,669,000 for each of fiscal years
2020 and 2021.''.
SEC. 714. CENTER AND PROGRAM REPEALS.
Part B of title V of the Public Health Service Act (42 U.S.C. 290bb
et seq.) is amended by striking the second section 514 (42 U.S.C.
290bb-9), relating to methamphetamine and amphetamine treatment
initiatives, and sections 514A, 517, 519A, 519C, 519E, 520D, and 520H
(42 U.S.C. 290bb-8, 290bb-23, 290bb-25a, 290bb-25c, 290bb-25e, 290bb-
35, and 290bb-39).
SEC. 715. NATIONAL VIOLENT DEATH REPORTING SYSTEM.
The Secretary of Health and Human Services, acting through the
Director of the Centers for Disease Control and Prevention, is
encouraged to improve, particularly through the inclusion of additional
States, the National Violent Death Reporting System as authorized by
title III of the Public Health Service Act (42 U.S.C. 241 et seq.).
Participation in the system by the States shall be voluntary.
SEC. 716. SENSE OF CONGRESS ON PRIORITIZING NATIVE AMERICAN YOUTH AND
SUICIDE PREVENTION PROGRAMS.
(a) Findings.--The Congress finds as follows:
(1) Suicide is the eighth leading cause of death among
American Indians and Alaska Natives across all ages.
(2) Among American Indians and Alaska Natives who are 10 to
34 years of age, suicide is the second leading cause of death.
(3) The suicide rate among American Indian and Alaska Native
adolescents and young adults ages 15 to 34 (19.5 per 100,000)
is 1.5 times higher than the national average for that age
group (12.9 per 100,000).
(b) Sense of Congress.--It is the sense of Congress that the
Secretary of Health and Human Services, in carrying out programs for
Native American youth and suicide prevention programs for youth suicide
intervention, should prioritize programs and activities for individuals
who have a high risk or disproportional burden of suicide, such as
Native Americans.
SEC. 717. PEER PROFESSIONAL WORKFORCE DEVELOPMENT GRANT PROGRAM.
(a) In General.--For the purposes described in subsection (b), the
Secretary of Health and Human Services shall award grants to develop
and sustain behavioral health paraprofessional training and education
programs, including through tuition support.
(b) Purposes.--The purposes of grants under this section are--
(1) to increase the number of behavioral health
paraprofessionals, including trained peers, recovery coaches,
mental health and addiction specialists, prevention
specialists, and pre-masters-level addiction counselors; and
(2) to help communities develop the infrastructure to train
and certify peers as behavioral health paraprofessionals.
(c) Eligible Entities.--To be eligible to receive a grant under this
section, an entity shall be a community college or other entity the
Secretary deems appropriate.
(d) Geographic Distribution.--In awarding grants under this section,
the Secretary shall seek to achieve an appropriate national balance in
the geographic distribution of such awards.
(e) Special Consideration.--In awarding grants under this section,
the Secretary may give special consideration to proposed and existing
programs targeting peer professionals serving youth ages 16 to 25.
(f) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $10,000,000 for the period of
fiscal years 2018 through 2022.
SEC. 718. NATIONAL HEALTH SERVICE CORPS.
(a) Definitions.--
(1) Primary health services.--Section 331(a)(3)(D) of the
Public Health Service Act (42 U.S.C. 254d(a)(3)) is amended by
inserting ``(including pediatric mental health subspecialty
services)'' after ``pediatrics''.
(2) Behavioral and mental health professionals.--Clause (i)
of section 331(a)(3)(E) of the Public Health Service Act (42
U.S.C. 254d(a)(3)(E)) is amended by inserting ``(and pediatric
subspecialists thereof)'' before the period at the end.
(b) Eligibility To Participate in Loan Repayment Program.--Section
338B(b)(1)(B) of the Public Health Service Act (42 U.S.C. 254l-
1(b)(1)(B)) is amended by inserting ``, including any physician child
and adolescent psychiatry residency or fellowship training program''
after ``be enrolled in an approved graduate training program in
medicine, osteopathic medicine, dentistry, behavioral and mental
health, or other health profession''.
SEC. 719. ADULT SUICIDE PREVENTION.
(a) Grants.--
(1) Authority.--The Assistant Secretary for Mental Health and
Substance Use (referred to in this section as the ``Assistant
Secretary'') may award grants to eligible entities in order to
implement suicide prevention efforts amongst adults 25 and
older.
(2) Purpose.--The grant program under this section shall be
designed to raise suicide awareness, establish referral
processes, and improve clinical care practice standards for
treating suicide ideation, plans, and attempts among adults.
(3) Recipients.--To be eligible to receive a grant under this
section, an entity shall be a community-based primary care or
behavioral health care setting, an emergency department, a
State mental health agency, an Indian tribe, a tribal
organization, or any other entity the Assistant Secretary deems
appropriate.
(4) Nature of activities.--The grants awarded under paragraph
(1) shall be used to implement programs that--
(A) screen for suicide risk in adults and provide
intervention and referral to treatment;
(B) implement evidence-based practices to treat
individuals who are at suicide risk, including
appropriate followup services; and
(C) raise awareness, reduce stigma, and foster open
dialogue about suicide prevention.
(b) Additional Activities.--The Assistant Secretary shall--
(1) evaluate the activities supported by grants awarded under
subsection (a) in order to further the Nation's understanding
of effective interventions to prevent suicide in adults;
(2) disseminate the findings from the evaluation as the
Assistant Secretary considers appropriate; and
(3) provide appropriate information, training, and technical
assistance to eligible entities that receive a grant under this
section, in order to help such entities to meet the
requirements of this section, including assistance with--
(A) selection and implementation of evidence-based
interventions and frameworks to prevent suicide, such
as the Zero Suicide framework; and
(B) other activities as the Assistant Secretary
determines appropriate.
(c) Duration.--A grant under this section shall be for a period of
not more than 5 years.
(d) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated to
carry out this section $30,000,000 for the period of fiscal
years 2018 through 2022.
(2) Use of certain funds.--Of the funds appropriated to carry
out this section in any fiscal year, the lesser of 5 percent of
such funds or $500,000 shall be available to the Assistant
Secretary for purposes of carrying out subsection (b).
SEC. 720. CRISIS INTERVENTION GRANTS FOR POLICE OFFICERS AND FIRST
RESPONDERS.
(a) In General.--The Assistant Secretary for Mental Health and
Substance Use may award grants to entities such as law enforcement
agencies and first responders--
(1) to provide specialized training to law enforcement
officers, corrections officers, paramedics, emergency medical
services workers, and other first responders (including village
public safety officers (as defined in section 247 of the Indian
Arts and Crafts Amendments Act of 2010 (42 U.S.C. 3796dd
note)))--
(A) to recognize individuals who have mental illness
and how to properly intervene with individuals with
mental illness; and
(B) to establish programs that enhance the ability of
law enforcement agencies to address the mental health,
behavioral, and substance use problems of individuals
encountered in the line of duty; and
(2) to establish collaborative law enforcement and mental
health programs, including behavioral health response teams and
mental health crisis intervention teams comprised of mental
health professionals, law enforcement officers, and other first
responders, as appropriate, to provide on-site, face-to-face,
mental and behavioral health care services during a mental
health crisis, and to connect the individual in crisis to
appropriate community-based treatment services in lieu of
unnecessary hospitalization or further involvement with the
criminal justice system.
(b) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $9,000,000 for the period of
fiscal years 2018 through 2020.
SEC. 721. DEMONSTRATION GRANT PROGRAM TO TRAIN HEALTH SERVICE
PSYCHOLOGISTS IN COMMUNITY-BASED MENTAL HEALTH.
(a) Establishment.--The Secretary of Health and Human Services shall
establish a grant program under which the Assistant Secretary of Mental
Health and Substance Use Disorders may award grants to eligible
institutions to support the recruitment, education, and clinical
training experiences of health services psychology students, interns,
and postdoctoral residents for education and clinical experience in
community mental health settings.
(b) Eligible Institutions.--For purposes of this section, the term
``eligible institutions'' includes American Psychological Association-
accredited doctoral, internship, and postdoctoral residency schools or
programs in health service psychology that--
(1) are focused on the development and implementation of
interdisciplinary training of psychology graduate students and
postdoctoral fellows in providing mental and behavioral health
services to address substance use disorders, serious emotional
disturbance, and serious illness, as well as developing faculty
and implementing curriculum to prepare psychologists to work
with underserved populations; and
(2) demonstrate an ability to train health service
psychologists in psychiatric hospitals, forensic hospitals,
community mental health centers, community health centers,
federally qualified health centers, or adult and juvenile
correctional facilities.
(c) Priorities.--In selecting grant recipients under this section,
the Secretary shall give priority to eligible institutions in which
training focuses on the needs of individuals with serious mental
illness, serious emotional disturbance, justice-involved youth, and
individuals with or at high risk for substance use disorders.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $12,000,000 for the period of
fiscal years 2018 through 2022.
SEC. 722. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.
Section 775(e) of the Public Health Service Act (42 U.S.C 295f(e)) is
amended to read as follows:
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $12,000,000 for the period of
fiscal years 2018 through 2022.''.
SEC. 723. CUTGO COMPLIANCE.
Section 319D(f) of the Public Health Service Act (42 U.S.C. 247d-
4(f)) is amended by striking ``$138,300,000 for each of fiscal years
2014 through 2018'' and inserting ``$138,300,000 for each of fiscal
years 2014 through 2016 and $58,000,000 for each of fiscal years 2017
and 2018''.
TITLE VIII--MENTAL HEALTH PARITY
SEC. 801. ENHANCED COMPLIANCE WITH MENTAL HEALTH AND SUBSTANCE USE
DISORDER COVERAGE REQUIREMENTS.
(a) Compliance Program Guidance Document.--Section 2726(a) of the
Public Health Service Act (42 U.S.C. 300gg-26(a)) is amended by adding
at the end the following:
``(6) Compliance program guidance document.--
``(A) In general.--Not later than 6 months after the
date of enactment of the Helping Families in Mental
Health Crisis Act of 2016, the Inspector General of the
Department of Health and Human Services, in
coordination with the Secretary, the Secretary of
Labor, or the Secretary of the Treasury, shall issue a
compliance program guidance document to help improve
compliance with this section.
``(B) Examples illustrating compliance and
noncompliance.--
``(i) In general.--The compliance program
guidance document required under this paragraph
shall provide illustrative, de-identified
examples (that do not disclose any protected
health information or individually identifiable
information) of previous findings of compliance
and noncompliance with this section, section
712 of the Employee Retirement Income Security
Act of 1974, or section 9812 of the Internal
Revenue Code of 1986 based on investigations of
violations of such sections, including--
``(I) examples illustrating
requirements for information
disclosures and nonquantitative
treatment limitations; and
``(II) descriptions of the violations
uncovered during the course of such
investigations.
``(ii) Nonquantitative treatment
limitations.--To the extent that any example
described in clause (i) involves a finding of
compliance or noncompliance with regard to any
requirement for nonquantitative treatment
limitations, the example shall provide
sufficient detail to fully explain such
finding, including a full description of the
criteria involved for medical and surgical
benefits and the criteria involved for mental
health and substance use disorder benefits.
``(iii) Access to additional information
regarding compliance.--In developing and
issuing the compliance program guidance
document required under this paragraph, the
Inspector General of the Department of Health
and Human Services may--
``(I) enter into interagency
agreements with the Inspector General
of the Department of Labor and the
Inspector General of the Department of
the Treasury to share findings of
compliance and noncompliance with this
section, section 712 of the Employee
Retirement Income Security Act of 1974,
or section 9812 of the Internal Revenue
Code of 1986; and
``(II) enter into an agreement with a
State to share information on findings
of compliance and noncompliance with
this section, section 712 of the
Employee Retirement Income Security Act
of 1974, or section 9812 of the
Internal Revenue Code of 1986.
``(C) Recommendations.--The compliance program
guidance document shall include recommendations to
avoid violations of this section and encourage the
development and use of internal controls to monitor
adherence to applicable statutes, regulations, and
program requirements. Such internal controls may
include a compliance checklist with illustrative
examples of nonquantitative treatment limitations on
mental health and substance use disorder benefits,
which may fail to comply with this section in relation
to nonquantitative treatment limitations on medical and
surgical benefits.
``(D) Updating the compliance program guidance
document.--The compliance program guidance document
shall be updated every 2 years to include illustrative,
de-identified examples (that do not disclose any
protected health information or individually
identifiable information) of previous findings of
compliance and noncompliance with this section, section
712 of the Employee Retirement Income Security Act of
1974, or section 9812 of the Internal Revenue Code of
1986.''.
(b) Additional Guidance.--Section 2726(a) of the Public Health
Service Act (42 U.S.C. 300gg-26(a)) is amended by adding at the end the
following:
``(7) Additional guidance.--
``(A) In general.--Not later than 6 months after the
date of enactment of the Helping Families in Mental
Health Crisis Act of 2016, the Secretary, in
coordination with the Secretary of Labor and the
Secretary of the Treasury, shall issue guidance to
group health plans and health insurance issuers
offering group or individual health insurance coverage
to assist such plans and issuers in satisfying the
requirements of this section.
``(B) Disclosure.--
``(i) Guidance for plans and issuers.--The
guidance issued under this paragraph shall
include clarifying information and illustrative
examples of methods that group health plans and
health insurance issuers offering group or
individual health insurance coverage may use
for disclosing information to ensure compliance
with the requirements under this section (and
any regulations promulgated pursuant to this
section).
``(ii) Documents for participants,
beneficiaries, contracting providers, or
authorized representatives.--The guidance
issued under this paragraph may include
clarifying information and illustrative
examples of methods that group health plans and
health insurance issuers offering group or
individual health insurance coverage may use to
provide any participant, beneficiary,
contracting provider, or authorized
representative, as applicable, with documents
containing information that the health plans or
issuers are required to disclose to
participants, beneficiaries, contracting
providers, or authorized representatives to
ensure compliance with this section, any
regulation issued pursuant to this section, or
any other applicable law or regulation,
including information that is comparative in
nature with respect to--
``(I) nonquantitative treatment
limitations for both medical and
surgical benefits and mental health and
substance use disorder benefits;
``(II) the processes, strategies,
evidentiary standards, and other
factors used to apply the limitations
described in subclause (I); and
``(III) the application of the
limitations described in subclause (I)
to ensure that such limitations are
applied in parity with respect to both
medical and surgical benefits and
mental health and substance use
disorder benefits.
``(C) Nonquantitative treatment limitations.--The
guidance issued under this paragraph shall include
clarifying information and illustrative examples of
methods, processes, strategies, evidentiary standards,
and other factors that group health plans and health
insurance issuers offering group or individual health
insurance coverage may use regarding the development
and application of nonquantitative treatment
limitations to ensure compliance with this section (and
any regulations promulgated pursuant to this section),
including--
``(i) examples of methods of determining
appropriate types of nonquantitative treatment
limitations with respect to both medical and
surgical benefits and mental health and
substance use disorder benefits, including
nonquantitative treatment limitations
pertaining to--
``(I) medical management standards
based on medical necessity or
appropriateness, or whether a treatment
is experimental or investigative;
``(II) limitations with respect to
prescription drug formulary design; and
``(III) use of fail-first or step
therapy protocols;
``(ii) examples of methods of determining--
``(I) network admission standards
(such as credentialing); and
``(II) factors used in provider
reimbursement methodologies (such as
service type, geographic market, demand
for services, and provider supply,
practice size, training, experience,
and licensure) as such factors apply to
network adequacy;
``(iii) examples of sources of information
that may serve as evidentiary standards for the
purposes of making determinations regarding the
development and application of nonquantitative
treatment limitations;
``(iv) examples of specific factors, and the
evidentiary standards used to evaluate such
factors, used by such plans or issuers in
performing a nonquantitative treatment
limitation analysis;
``(v) examples of how specific evidentiary
standards may be used to determine whether
treatments are considered experimental or
investigative;
``(vi) examples of how specific evidentiary
standards may be applied to each service
category or classification of benefits;
``(vii) examples of methods of reaching
appropriate coverage determinations for new
mental health or substance use disorder
treatments, such as evidence-based early
intervention programs for individuals with a
serious mental illness and types of medical
management techniques;
``(viii) examples of methods of reaching
appropriate coverage determinations for which
there is an indirect relationship between the
covered mental health or substance use disorder
benefit and a traditional covered medical and
surgical benefit, such as residential treatment
or hospitalizations involving voluntary or
involuntary commitment; and
``(ix) additional illustrative examples of
methods, processes, strategies, evidentiary
standards, and other factors for which the
Secretary determines that additional guidance
is necessary to improve compliance with this
section.
``(D) Public comment.--Prior to issuing any final
guidance under this paragraph, the Secretary shall
provide a public comment period of not less than 60
days during which any member of the public may provide
comments on a draft of the guidance.''.
(c) Improving Compliance.--
(1) In general.--In the case that the Secretary of Health and
Human Services, the Secretary of Labor, or the Secretary of the
Treasury determines that a group health plan or health
insurance issuer offering group or individual health insurance
coverage has violated, at least 5 times, section 2726 of the
Public Health Service Act (42 U.S.C. 300gg-26), section 712 of
the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185a), or section 9812 of the Internal Revenue Code, the
appropriate Secretary shall audit plan documents for such
health plan or issuer in the plan year following the
Secretary's determination in order to help improve compliance
with such section.
(2) Rule of construction.--Nothing in this subsection shall
be construed to limit the authority, as in effect on the day
before the date of enactment of this Act, of the Secretary of
Health and Human Services, the Secretary of Labor, or the
Secretary of the Treasury to audit documents of health plans or
health insurance issuers.
SEC. 802. ACTION PLAN FOR ENHANCED ENFORCEMENT OF MENTAL HEALTH AND
SUBSTANCE USE DISORDER COVERAGE.
(a) Public Meeting.--
(1) In general.--Not later than 6 months after the date of
enactment of this Act, the Secretary of Health and Human
Services shall convene a public meeting of stakeholders
described in paragraph (2) to produce an action plan for
improved Federal and State coordination related to the
enforcement of mental health parity and addiction equity
requirements.
(2) Stakeholders.--The stakeholders described in this
paragraph shall include each of the following:
(A) The Federal Government, including representatives
from--
(i) the Department of Health and Human
Services;
(ii) the Department of the Treasury;
(iii) the Department of Labor; and
(iv) the Department of Justice.
(B) State governments, including--
(i) State health insurance commissioners;
(ii) appropriate State agencies, including
agencies on public health or mental health; and
(iii) State attorneys general or other
representatives of State entities involved in
the enforcement of mental health parity laws.
(C) Representatives from key stakeholder groups,
including--
(i) the National Association of Insurance
Commissioners;
(ii) health insurance providers;
(iii) providers of mental health and
substance use disorder treatment;
(iv) employers; and
(v) patients or their advocates.
(b) Action Plan.--Not later than 6 months after the public meeting
under subsection (a), the Secretary of Health and Human Services shall
finalize the action plan described in such subsection and make it
plainly available on the Internet website of the Department of Health
and Human Services.
(c) Content.--The action plan under this section shall--
(1) reflect the input of the stakeholders invited to the
public meeting under subsection (a);
(2) identify specific strategic objectives regarding how the
various Federal and State agencies charged with enforcement of
mental health parity and addiction equity requirements will
collaborate to improve enforcement of such requirements;
(3) provide a timeline for implementing the action plan; and
(4) provide specific examples of how such objectives may be
met, which may include--
(A) providing common educational information and
documents to patients about their rights under Federal
or State mental health parity and addiction equity
requirements;
(B) facilitating the centralized collection of,
monitoring of, and response to patient complaints or
inquiries relating to Federal or State mental health
parity and addiction equity requirements, which may be
through the development and administration of a single,
toll-free telephone number and an Internet website
portal;
(C) Federal and State law enforcement agencies
entering into memoranda of understanding to better
coordinate enforcement responsibilities and information
sharing, including whether such agencies should make
the results of enforcement actions related to mental
health parity and addiction equity requirements
publicly available; and
(D) recommendations to the Secretary and Congress
regarding the need for additional legal authority to
improve enforcement of mental health parity and
addiction equity requirements, including the need for
additional legal authority to ensure that
nonquantitative treatment limitations are applied, and
the extent and frequency of the applications of such
limitations, both to medical and surgical benefits and
to mental health and substance use disorder benefits in
a comparable manner.
SEC. 803. REPORT ON INVESTIGATIONS REGARDING PARITY IN MENTAL HEALTH
AND SUBSTANCE USE DISORDER BENEFITS.
(a) In General.--Not later than 1 year after the date of enactment of
this Act, and annually thereafter for the subsequent 5 years, the
Administrator of the Centers for Medicare & Medicaid Services, in
collaboration with the Assistant Secretary of Labor of the Employee
Benefits Security Administration and the Secretary of the Treasury,
shall submit to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor, and
Pensions of the Senate a report summarizing the results of all closed
Federal investigations completed during the preceding 12-month period
with findings of any serious violation regarding compliance with mental
health and substance use disorder coverage requirements under section
2726 of the Public Health Service Act (42 U.S.C. 300gg-26), section 712
of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185a), and section 9812 of the Internal Revenue Code of 1986.
(b) Contents.--Subject to subsection (c), a report under subsection
(a) shall, with respect to investigations described in such subsection,
include each of the following:
(1) The number of open or closed Federal investigations
conducted during the covered reporting period.
(2) Each benefit classification examined by any such
investigation conducted during the covered reporting period.
(3) Each subject matter, including compliance with
requirements for quantitative and nonquantitative treatment
limitations, of any such investigation conducted during the
covered reporting period.
(4) A summary of the basis of the final decision rendered for
each closed investigation conducted during the covered
reporting period that resulted in a finding of a serious
violation.
(c) Limitation.--Any individually identifiable information shall be
excluded from reports under subsection (a) consistent with protections
under the health privacy and security rules promulgated under section
264(c) of the Health Insurance Portability and Accountability Act of
1996 (42 U.S.C. 1320d-2 note).
SEC. 804. GAO STUDY ON PARITY IN MENTAL HEALTH AND SUBSTANCE USE
DISORDER BENEFITS.
Not later than 3 years after the date of enactment of this Act, the
Comptroller General of the United States, in consultation with the
Secretary of Health and Human Services, the Secretary of Labor, and the
Secretary of the Treasury, shall submit to the Committee on Energy and
Commerce of the House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate a report detailing the
extent to which group health plans or health insurance issuers offering
group or individual health insurance coverage that provides both
medical and surgical benefits and mental health or substance use
disorder benefits, medicaid managed care organizations with a contract
under section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)),
and health plans provided under the State Children's Health Insurance
Program under title XXI of the Social Security Act (42 U.S.C. 1397aa et
seq.) comply with section 2726 of the Public Health Service Act (42
U.S.C. 300gg-26), section 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a), and section 9812 of the
Internal Revenue Code of 1986, including--
(1) how nonquantitative treatment limitations, including
medical necessity criteria, of such plans or issuers comply
with such sections;
(2) how the responsible Federal departments and agencies
ensure that such plans or issuers comply with such sections,
including an assessment of how the Secretary of Health and
Human Services has used its authority to conduct audits of such
plans to ensure compliance;
(3) a review of how the various Federal and State agencies
responsible for enforcing mental health parity requirements
have improved enforcement of such requirements in accordance
with the objectives and timeline described in the action plan
under section 802; and
(4) recommendations for how additional enforcement,
education, and coordination activities by responsible Federal
and State departments and agencies could better ensure
compliance with such sections, including recommendations
regarding the need for additional legal authority.
SEC. 805. INFORMATION AND AWARENESS ON EATING DISORDERS.
(a) Information.--The Secretary of Health and Human Services (in this
section referred to as the ``Secretary'') may--
(1) update information, related fact sheets, and resource
lists related to eating disorders that are available on the
public Internet website of the National Women's Health
Information Center sponsored by the Office on Women's Health,
to include--
(A) updated findings and current research related to
eating disorders, as appropriate; and
(B) information about eating disorders, including
information related to males and females;
(2) incorporate, as appropriate, and in coordination with the
Secretary of Education, information from publicly available
resources into appropriate obesity prevention programs
developed by the Office on Women's Health; and
(3) make publicly available (through a public Internet
website or other method) information, related fact sheets and
resource lists, as updated under paragraph (1), and the
information incorporated into appropriate obesity prevention
programs, as updated under paragraph (2).
(b) Awareness.--The Secretary may advance public awareness on--
(1) the types of eating disorders;
(2) the seriousness of eating disorders, including
prevalence, comorbidities, and physical and mental health
consequences;
(3) methods to identify, intervene, refer for treatment, and
prevent behaviors that may lead to the development of eating
disorders;
(4) discrimination and bullying based on body size;
(5) the effects of media on self-esteem and body image; and
(6) the signs and symptoms of eating disorders.
SEC. 806. EDUCATION AND TRAINING ON EATING DISORDERS.
The Secretary of Health and Human Services may facilitate the
identification of programs to educate and train health professionals
and school personnel in effective strategies to--
(1) identify individuals with eating disorders;
(2) provide early intervention services for individuals with
eating disorders;
(3) refer patients with eating disorders for appropriate
treatment;
(4) prevent the development of eating disorders; or
(5) provide appropriate treatment services for individuals
with eating disorders.
SEC. 807. GAO STUDY ON PREVENTING DISCRIMINATORY COVERAGE LIMITATIONS
FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS AND
SUBSTANCE USE DISORDERS.
Not later than 2 years after the date of the enactment of this Act,
the Comptroller General of the United States shall submit to Congress
and make publicly available a report detailing Federal oversight of
group health plans and health insurance coverage offered in connection
with such plans (as such terms are defined in section 2791 of the
Public Health Service Act (42 U.S.C. 300gg-91), including Medicaid
managed care plans under section 1903 of the Social Security Act (42
U.S.C. 1396b), to ensure compliance of such plans and coverage with
sections 2726 of the Public Health Service Act (42 U.S.C. 300gg-26),
712 of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185a), and 9812 of the Internal Revenue Code of 1986 (in this section
collectively referred to as the ``parity law''), including--
(1) a description of how Federal regulations and guidance
consider nonquantitative treatment limitations, including
medical necessity criteria and application of such criteria to
medical, surgical, and primary care, of such plans and coverage
in ensuring compliance by such plans and coverage with the
parity law;
(2) a description of actions that Federal departments and
agencies are taking to ensure that such plans and coverage
comply with the parity law; and
(3) the identification of enforcement, education, and
coordination activities within Federal departments and
agencies, including educational activities directed to State
insurance commissioners, and a description of how such proper
activities can be used to ensure full compliance with the
parity law.
SEC. 808. CLARIFICATION OF EXISTING PARITY RULES.
If a group health plan or a health insurance issuer offering group
or individual health insurance coverage provides coverage for eating
disorder benefits, including residential treatment, such group health
plan or health insurance issuer shall provide such benefits consistent
with the requirements of section 2726 of the Public Health Service Act
(42 U.S.C. 300gg-26), section 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a), and section 9812 of the
Internal Revenue Code of 1986.
Purpose and Summary
H.R. 2646, the ``Helping Families in Mental Health Crisis
Act of 2016,'' was introduced on June 4, 2015, by Rep. Tim
Murphy (R-PA) and Rep. Eddie Bernice Johnson (D-TX). H.R. 2646
seeks to direct the Substance Abuse and Mental Health Services
Administration to utilize evidence-based approaches when
awarding grants. The bill also codifies a provision from a
recently finalized Medicaid managed care regulation related to
payments for short term stays for adults in institutions for
mental diseases (IMD) and extends the availability of the full
range of early and periodic screening, diagnostic, and
treatment (EPSDT) services to Medicaid children receiving
services in an IMD. The cost of the EPSDT policy is offset by
requiring the use of electronic visit verification systems for
Medicaid-provided personal care services and home health
services. H.R. 2646 also directs the Secretary of Health and
Human Services (HHS) to undertake rulemaking to clarify when
disclosure to families and loved ones is allowed under HIPAA.
This legislation provides for targeted, fully CUTGO compliant
mental health reauthorizations and authorizations of select new
grant programs. Finally, the proposal provides improvements for
mental health payment parity through better compliance guidance
and disclosure support. Inter-agency officials must meet with
public stakeholders--including patient advocates and third-
party groups--to build a strategy for improving mental health
parity and addiction equity requirements.
Background and Need for Legislation
The Energy and Commerce Committee, through the Oversight
and Investigation Subcommittee led by Congressman Tim Murphy,
undertook a yearlong investigation that spanned the 113th and
114th Congress that examined the state of our mental health
care system. In particular, the focus was on untreated serious
mental illness (SMI). The Committee inquiry focused
specifically on three areas of critical public policy interest:
the scope of society's problem that is untreated serious mental
illness, how privacy laws may interfere with patient care and
public safety, including in the mental health context, and how
certain federal resources appropriated for services and
treatment of mental illness are currently being spent. This
investigation included numerous hearings, bipartisan forums,
GAO reports, and culminated in a comprehensive committee
report. The main finding was that the patients with serious
mental illness, such as schizophrenia, bipolar disorder, or
major depression, are often the least likely to be engaged in
medical care.
In response to this finding in the second session of the
113th Congress, Rep. Murphy introduced H.R. 3717, the ``Helping
Families in Mental Health Crisis Act.'' In the first session of
the 114th Congress, Rep. Murphy reintroduced the ``Helping
Families in Mental Health Crisis Act'' as H.R. 2646.
Hearings
The Subcommittee on Health held a hearing on H.R. 2646 on
June 16, 2015. The hearing was entitled, ``Examining H.R. 2646,
the Helping Families in Mental Health Crisis Act of 2015'' and
witnesses included the following:
Creigh Deeds, Senator, Senate of Virginia;
Patrick J. Kennedy, Former U.S.
Representative (RI), Founder, Kennedy Forum;
Jeffrey A. Lieberman, M.D., Chairman,
Department of Psychiatry, Columbia University College
of Physicians and Surgeons;
Paul Gionfriddo, President and CEO; Mental
Health America;
Steve Coe, Chief Executive Officer,
Community Access;
Mary Jean Billingsley, Parent, National
Disability Rights Network; and
Harvey Rosenthal, Executive Director, New
York Association of Psychiatric Rehabilitation
Services.
Committee Consideration
On November 3 and 4, 2015, the Subcommittee on Health met
in open markup session and forwarded H.R. 2646, as amended, to
the full Committee by a record vote of 18 yeas and 12 nays. On
June 14 and 15, 2016, the full Committee on Energy and Commerce
met in open markup session and ordered H.R. 2646, as amended,
favorably reported to the House by a record vote of 53 yeas and
0 nays.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto. The
following reflects the record votes taken during the Committee
consideration:
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee held a hearing and made
findings that are reflected in this report.
Statement of General Performance Goals and Objectives
The legislation aims to improve and increase access to
evidence based treatment and services for individuals with
mentally illness and SMI and provide greater oversight of the
Federal mental health system, specifically focusing on the
Substance Abuse and Mental Health Services Administration.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
2646 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI
of the Rules of the House of Representatives, the Committee
finds that H.R. 2646 contains no earmarks, limited tax
benefits, or limited tariff benefits.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 5, 2016.
Re Helping Families in Mental Health Crisis Act of 2015
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
estimated the direct spending effects of H.R. 2646, the Helping
Families in Mental Health Crisis Act of 2016, as reported by
the House Committee on Energy and Commerce on June 15, 2016.
CBO estimates that enacting H.R. 2646 would reduce net
direct spending in the Medicaid program by $5 million over the
2017-2026 period (see enclosed table). Pay-as-you-go procedures
apply because enacting the legislation would affect direct
spending. H.R. 2646 would not affect revenues.
Implementing the legislation also would affect spending
subject to appropriation mostly because it would reauthorize
and make changes to several grant programs administered by the
Substance Abuse and Mental Health Services Administration.
However, CBO has not yet completed an estimate of the effects
the bill would have on discretionary spending.
CBO estimates that enacting the legislation would not
increase net direct spending or on-budget deficits in any of
the four consecutive 10-year periods beginning in 2027.
PROVIDING SERVICES TO CHILDREN IN INSTITUTIONS OF MENTAL DISEASE
Section 206 of the bill would allow federal reimbursement
for certain medical services (such as screening, diagnostic,
and treatment services) for children and young adults receiving
inpatient care in institutions of mental disease (IMDs),
beginning in 2019. Under current law, federal reimbursement is
limited to inpatient psychiatric services for these
individuals. Based on an analysis of administrative data from
the Department of Health and Human Services, CBO estimates that
enacting this provision would increase federal spending on
average each year by about $250 per child or young adult in an
IMD. As a result, CBO estimates that section 206 would cost
$285 million over the 2017-2026 period.
ELECTRONIC VISIT VERIFICATION SYSTEMS
Section 207 of the bill would require state Medicaid
programs to implement an electronic visit verification system
(EVV) for verifying the arrival and departure time of
attendants who provide personal care or home health care
services in a beneficiary's home. Federal payments to a state
for personal care services would be reduced if a state fails to
implement an EVV for those services by January 1, 2019.
Similarly, federal payments for home health care services would
be reduced if a state fails to implement an EVV for those
services by January 1, 2023.
Based on information from states and other stakeholders,
CBO estimates that EVV programs would reduce spending for
personal care services and home health services by less than 1
percent, on average, over the 2017-2026 period. Because of the
flexibility that H.R. 2646 would provide to states to establish
such programs, CBO expects that some states would generate
significantly higher savings than the average and others would
generate little to no savings. CBO does not expect that any
states would have their federal payments reduced as a result of
the provision.
Under current law, about two thirds of spending for
personal care services and less than a third of spending for
home health services are estimated to be subject to EVV over
the next ten years because of programs initiated voluntarily by
some states. After adjusting for EVV programs that will be in
place under current law, CBO estimates that enacting section
207 would reduce direct spending by $290 million over the 2017-
2026 period.
OTHER PROVISIONS
Section 201 of H.R. 2646 would allow states to continue to
provide separate Medicaid payments for mental health services
and primary care services that are furnished on the same day.
Section 202 of the bill would allow states to receive Medicaid
reimbursement for payments made to managed care organizations
for treatment in IMDs for adult beneficiaries in certain
limited circumstances. That section codifies a provision in a
final rule published in the Federal Register on May 6, 2016.
Because sections 201 and 202 would codify current policies, CBO
estimates that they would have no effect on the federal budget.
LONG-TERM BUDGETARY EFFECTS
CBO estimates that enacting the legislation would not
increase net direct spending or on-budget deficits in any of
the four consecutive 10-year periods beginning in 2027.
INTERGOVERNMENTAL AND PRIVATE-SECTOR MANDATES
H.R. 2646 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act. CBO
estimates that provisions in the bill that would decrease
federal spending in Medicaid would similarly result in a
reduction in state spending for Medicaid over the 2017-2026
period.
If you wish further details on this estimate, we would be
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
Sincerely,
Keith Hall,
Director.
Enclosure.
CBO ESTIMATE OF THE DIRECT SPENDING EFFECTS FOR H.R. 2646, THE HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT OF 2016, AS ORDERED REPORTED BY THE
COMMITTEE ON ENERGY AND COMMERCE ON JUNE 15, 2016
--------------------------------------------------------------------------------------------------------------------------------------------------------
Millions of dollars, by fiscal year--
---------------------------------------------------------------------------------------------------
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2017-2021 2017-2026
--------------------------------------------------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING
Providing Services to Children in Institutions of
Mental Disease:
Estimated Budget Authority...................... 0 0 23 33 34 35 37 39 41 43 90 285
Estimated Outlays............................... 0 0 23 33 34 35 37 39 41 43 90 285
Electronic Visit Verification Systems:
Estimated Budget Authority...................... 0 0 -11 -21 -30 -39 -43 -46 -48 -52 -61 -290
Estimated Outlays............................... 0 0 -11 -21 -30 -39 -43 -46 -48 -52 -61 -290
Total:
Estimated Budget Authority.................. 0 0 13 12 4 -4 -6 -7 -7 -9 29 -5
Estimated Outlays........................... 0 0 13 12 4 -4 -6 -7 -7 -9 29 -5
--------------------------------------------------------------------------------------------------------------------------------------------------------
Source: Congressional Budget Office.
Notes: Components may not add to totals because of rounding.
Other provisions of H.R. 2464 would affect spending subject to appropriation. Those provisions would authorize grant programs administered by the
Substance Abuse and Mental Health Services Administration and would direct the Administrator of the Centers for Medicare and Medicaid Services to
conduct studies, issue guidance, and issue reports. However, CBO has not yet completed an estimate of the discretionary costs of implementing the
bill.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Duplication of Federal Programs
No provision of H.R. 2646 establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Disclosure of Directed Rule Makings
The Committee estimates that enacting H.R. 2646
specifically directs to be completed 1 rule making within the
meaning of 5 U.S.C. 551.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
Section 101. Assistant Secretary for Mental Health and Substance Use
This section would create an Assistant Secretary for Mental
Health and Substance Use (ASMHSU). The Assistant Secretary
would replace the Administrator of SAMSHA. The Assistant
Secretary would be appointed by the President and confirmed by
the Senate, like the current SAMSHA Administrator. Preference
for hiring an Assistant Secretary will be given to individuals
with a doctoral degree in medicine, osteopathic medicine, or
psychology with clinical and research experience.
The Assistant Secretary will be responsible for improving
the standards used to evaluate grants, grantees, and the
programs being administered by SAMSHA in consultation the
National Mental Health and Substance Use Policy Lab (NMHSUPL).
The Assistant Secretary will have a Deputy Assistant Secretary
that will replace the Deputy Administrator of SAMSHA. The
ASMHSU will serve as a voting member on the Council on Graduate
Medical Education.
Section 102. Improving Oversight of Mental Health and Substance Use
Programs
This section directs the Assistant Secretary for Planning
and Evaluation (ASPE) to improve oversight of mental health and
substance use programs. The ASPE will collect and organize
relevant data, evaluate programs across Federal departments and
agencies, and consult with other relevant agencies. The ASPE
shall make recommendations on the evaluation of relevant
programs across the department.
Section 103. National Mental Health and Substance Use Policy Laboratory
This section creates National Mental Health and Substance
Use Policy Laboratory within SAMSHA. It will be responsible for
identifying, coordinating, and facilitating the implementation
of policy changes likely to have a significant effect on mental
health, mental illness, and substance use disorder services
while promoting evidence based practices. The NMHSUPL will
build off of the existing Office of Policy Planning and
Innovation within SAMSHA.
Section 104. Peer Support Specialists Programs
This section directs the Comptroller General of the United
States to conduct a study on best practices for peer-support
specialist programs in a selection of ten states.
Section 105. Prohibition against Using Federal Funds by Systems
Accepting Federal Funds to Protect and Advocate the Rights of
Individuals with Mental Illness
This section reiterates current appropriations law and
restates the prohibition on Protection and Advocacy
organizations against using Federal funds for lobbying.
Section 106. Increased Reporting for Protection and Advocacy
Organizations
This section leverages existing reporting that the state-
based Protection and Advocacy organizations currently submit to
SAMSHA. This section requires Protection and Advocacy
organizations to make their yearly Program Performance Request
publicly available. In releasing these reports, Protection and
Advocacy organizations should ensure the protection of
personally identifiable information from public disclosure.
This section also requires Protection and Advocacy
organizations to provide a more detailed and disaggregated
accounting for how each system spends funds and what the source
of those funds are. The Committee intends this to build upon
the existing data and reporting requirements of current law and
not require new data collection or additional reporting.
Section 107. Grievance Procedures
This section directs the Secretary of HHS to establish a
grievance procedure within SAMSHA for the state based
Protection and Advocacy organizations. The Committee believes
that the use of this grievance procedure should come after the
exhaustion of the internal grievance procedure established by
existing law. The Committee intends the Secretary to ensure
compliance with the requirements of the Protection and Advocacy
for Individuals with Mental Illness (PAIMI) Act through this
grievance procedure.
Section 108. Center for Behavioral Health Statistics and Quality
This section authorizes the already existing Center for
Behavioral Health Statistics and Quality.
Section 109. Strategic Plan
This section directs the ASMHSU to develop and carry out a
strategic plan that is to be updated every five years. The plan
should among other initiatives include and help identify
strategic priorities, goals and measurable objectives for
SAMSHA activities, identify ways to improve services for
individuals with SMI and serious emotional disturbance (SED),
and ensure programs provide access to evidence based care.
Section 11. Authorities of Centers for Mental Health Services and
Substance Abuse Treatment
This section ensures that the Center for Mental Health
Services within SAMSHA collaborates with the Director of the
National Institute on Mental Health. This section will also
increase the oversight of grants administered by SAMSHA.
Section 111. Advisory Councils
This section adds the Director of the National Institute of
Mental Health, the Director of the National Institute on
Alcohol Abuse and Alcoholism and the Director of the National
Institute on Drug Abuse onto relevant advisory committees
within SAMSHA.
Section 112. Peer Review
This section requires not less than half of all members of
peer review groups related to mental health treatment at SAMSHA
to be licensed and experienced professionals with relevant
medical, doctoral or advanced degrees in the prevention,
diagnosis, or treatment of, or recovery from mental and
substance use disorders.
TITLE II--MEDICAID AND MENTAL HEALTH COVERAGE
Section 201. Rule of Construction Related to Medicaid Coverage of
Mental Health Services and Primary Care Services Furnished on
the Same Day
This section clarifies that nothing in the Medicaid statute
should be construed as prohibiting separate payment for the
provision of mental health and primary care services provided
to an individual on the same day.
Section 202. Optional Limited Coverage of Inpatient Services Furnished
in Institutions for Mental Diseases
This section codifies the provision in the recently-
finalized Medicaid managed care regulation allowing for
capitation payments to be made under certain circumstances for
adults receiving treatment in an IMD. Payment can only be made
for adults staying no more than 15 days in any given month in
an IMD to receive services that, at beneficiary election, are
in lieu of other services covered by the state plan.
Section 203. Study and Report Related to Medicaid Managed Care
Regulation
This section directs the Secretary acting through the
Administrator of the Centers for Medicare & Medicaid Services
to conduct a study on the provision of care to adults who were
enrolled in Medicaid managed care and received treatment in an
IMD. Among other things, the study, due within three years
after enactment, is to include information on the number of
individuals receiving treatment in IMDs, their length of stay,
and how managed care plans determine when to provide services
in an IMD in lieu of other benefits, such as community-based
mental health services.
Section 204. Guidance on Opportunities for Innovation
This section directs the Administrator of the Centers for
Medicare & Medicaid Services to issue a State Medicaid Director
letter, within one year of enactment, on opportunities to
design innovative service delivery systems to improve care for
individuals with serious mental illness or serious emotional
disturbance.
Section 205. Study and Report on Medicaid Emergency Psychiatric
Demonstration Project
This section directs the Secretary, acting through the
Administrator of the Centers for Medicare & Medicaid Services,
to collect, analyze, and report on additional data from states
that participated in the Medicaid Emergency Psychiatric
Demonstration Project under section 2707 of the Patient
Protection and Affordable Care Act. The report is due no later
than two years after enactment.
Section 206. Providing Full-Range of EPSDT Services to Children in IMDS
While Medicaid coverage is available for children and young
adults under age 21 receiving inpatient psychiatric services,
under current law, these individuals are statutorily excluded
from coverage of early and periodic screening, diagnostic and
treatment services (EPSDT). The EPSDT benefit provides
comprehensive and preventive health care services for children
under age 21 who are enrolled in Medicaid. This benefit ensures
that all children in Medicaid receive appropriate preventive,
dental, mental health, and developmental, and specialty
services. This section specifies that, effective January 1,
2019, children receiving Medicaid-covered inpatient psychiatric
hospital services are also entitled to early and periodic
screening, diagnostic, and treatment services, from their
choice of provider.
Section 207. Electronic Visit Verification System Required for Personal
Care Services and Home Health Care Services Under Medicaid
The Office of the Inspector General at HHS has found that
personal care services provided in Medicaid are often at risk
for fraud, waste, and abuse. To ensure needed services are
provided to vulnerable and frail Medicaid beneficiaries, this
section directs States to require the use of an electronic
visit verification system for Medicaid-provided personal care
services and home health services (but this policy does not
require States to adopt a single system for providers within
their State.) This policy provides enhanced federal matching
for state efforts to implement this policy. The enhanced
federal matching percentage outlined in the provision is
current law. States that do not require a system for personal
care services by January 1, 2019 and home health services by
January 1, 2023 will face a modest, incremental reduction in
their federal matching percentage for that service. The
reduction in the federal matching percentage can be delayed up
to one year if the State demonstrates a good faith effort to
comply with the requirement. Based on conversations with the
Congressional Budget Office, this policy offsets the cost of
section 206.
TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE
Section 301. Interdepartmental Serious Mental Illness Coordinating
Committee
This section establishes a committee known as the
Interdepartmental Serious Mental Illness Coordinating Committee
(SMICC). The committee shall report on a summary of advances in
serious mental illness SMI and serious emotional disturbance
(SED) research, evaluate Federal programs related to SMI and
SED, a plan to improve outcomes for those with SMI and SED, and
specific recommendations on action relevant agencies can take.
The SMICC shall terminate six years after the date it is
established.
TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA
Section 401. Sense of Congress
This section states that it is the Sense of Congress that
more clarity is needed surrounding existing HIPAA privacy rules
to reduce confusion that may hinder communication with
responsible caregivers for a patient with SMI.
Section 402. Confidentiality of Records
This section directs the Secretary to convene stakeholders
one year after the regulations updating part 2 of title 42,
Code of Federal Regulations are finalized. Stakeholders will
determine the effect of the regulation on patient care, health
outcomes, and patient privacy.
Section 403. Clarification of Circumstances Under Which Disclosure of
Protected Health Information is Permitted
This section directs the Secretary to promulgate rulemaking
to clarify circumstances under which disclosure of protected
health information is permitted for a patient with mental
illness. The Secretary already has the authority to undertake a
rule making here, so this does not represent any sort of
expansion of Secretary's authority.
Section 404. Development and Dissemination of Model Training Programs
This section would require the Secretary to develop and
disseminate model program and materials for training health
care providers, lawyers, patients and their families regarding
the circumstances under which patient with mental illness'
protected health information can be disclosed without patient
consent.
TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS
Section 501. Assertive Community Treatment Grant Program for
Individuals with Serious Mental Illness
This section directs the ASMHSU to award grants to
establish assertive community treatment programs for
individuals with SMI. This section has an authorization of $5
million total for the period of FY18-FY22.
Section 502. Strengthening Community Crisis Response Systems
This section directs the Secretary of Health and Human
Services to award grants to states to enhance community-based
crisis response systems or to develop, maintain or enhance
databases of psychiatric, crisis stabilization units, and
residential substance use disorder and community mental health
treatment facility beds for individuals with SMI, SED, or
substance use disorder. This section has an authorization of $5
million total for the period of FY18-FY22.
Section 503. Increased and Extended Funding for Assisted Outpatient
Grant Program Individuals with Serious Mental Illness
This section extends the authorization of the existing
assisted outpatient treatment grant program to 2020. The
authorization would be increased to $20 million for 2018, $19
million for 2019 and 2020, and $18 million for 2021 and 2022.
Section 504. Liability for Health Professional Volunteers at Community
Health Centers
This section extends liability protections for health
professional volunteers at community health centers. This
section has no authorization of appropriations.
TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS
SUBTITLE A--ENCOURAGING THE ADVANCEMENT, INCORPORATION AND DEVELOPMENT
OF EVIDENCE-BASED PRACTICES
Section 601. Encouraging Innovation and Evidence Based Programs
This section promotes innovation in awarding grants in the
mental health space with a focus on advancing evidence-based
models. The grants will go towards evaluating models that show
promise, integrating care, and expanding and scaling up
successful programs.
Section 602. Promoting Access to Information on Evidence-Based Programs
and Practices
This section directs the Assistant Secretary to improve
access to reliable and valid information on evidence-based
programs and practices through the National Registry of
Evidence-Based Programs and Practices.
Section 603. Sense of Congress
This sense of Congress states that the National Institute
of Mental Health should conduct or support research on the
determinants of self-directed and other violence and the
connection to mental illness.
SUBTITLE B--SUPPORTING THE STATE RESPONSE TO MENTAL HEALTH NEEDS
Section 611. Community Mental Health Services Block Grant
This section directs states receiving the mental health
block grant to submit a plan to SAMSHA on a variety of measures
and activities. States will outline their goals and objectives
for the period of the plan and identify targets and milestones
to be met.
Additional provisions include empowering SAMSHA to hold
states that are found materially incompliant on their
maintenance of effort within their block grant program
accountable.
SUBTITLE C--STRENGTHENING MENTAL HEALTH CARE FOR CHILDREN AND
ADOLESCENTS
Section 621. Telehealth Child Psychiatry Access Grants
This section awards grants to support the development of
statewide child psychiatry access programs and the improvement
of already existing statewide programs. This section has an
authorization of $9 million total for the period of FY18-FY20.
Section 622. Infant and Early Childhood Mental Health Promotion,
Intervention and Treatment
This section provides grants to programs for infants and
children at significant risk of developing, exhibiting early
signs of, or having been diagnosed with mental disorders
including SED. This section has an authorization of $20 million
total for the period of FY18-FY22.
Section 623. National Child Traumatic Stress Network
This section reauthorizes the National Child Traumatic
Stress Network at its last appropriated level of $46,887,000
for each of FY17-FY21.
TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATIONS
SUBTITLE A--GARRETT LEE SMITH MEMORIAL ACT REAUTHORIZATION
Section 701, 702, and 703. Garrett Lee Smith Memorial Act
Reauthorization
This section reauthorizes the Garrett Lee Smith Memorial
Act at its last appropriated levels of $5,988,000 for the
Suicide Prevention Technical Assistance Center, $35,427,000 for
Youth Suicide Early Intervention and Prevention Strategies, and
$6,488,000 for Mental Health and Substance Use Disorder
Services on Campus. Each section is reauthorized at the levels
in the last sentence for each of FY17-FY21.
SUBTITLE B--OTHER PROVISIONS
Section 711. National Suicide Prevention Lifeline Program
This section authorizes the National Suicide Prevention
Lifeline at its last appropriated level of $7,198,000 for each
of FY17-FY21.
Section 712. Workforce Development Studies and Reports
This section directs the ASMHSU to report on national and
state level workforce projections, the workforce capacity and
other relevant information.
Section 713. Minority Fellowship Program
This section authorizes the Minority Fellowship Program at
$12,669,000 a year for FY17-19 and $13,669,000 a year for FY20-
21.
Section 714. Center and Program Repeals
The repeals in this section are for programs that have
expired authorizations and have never been appropriated.
Section 715. National Violent Death Reporting System
This section encourages the Centers for Disease Control and
Prevention to improve the National Violent Death Reporting
System.
Section 716. Sense of Congress on Prioritizing Native American Youth
Suicide Prevention Programs
This Sense of Congress urges the Secretary to prioritize
programs and activities for individuals who have a high risk or
disproportional burden of suicide, such as Native Americans.
Section 717. Peer Professional Workforce Development Grant Program
This section authorizes the Secretary to award grants to
develop and sustain behavioral health paraprofessional training
and education programs at $10 million for the period of FY18-
FY22.
Section 718. National Health Service Corps
This section clarifies that child and adolescent
psychiatrists can participate in the National Health Service
Corps.
Section 719. Adult Suicide Prevention
This section authorizes grants for adult suicide prevention
at $30 million total for the period of FY18-FY22.
Section 720. Crisis Intervention Grants for Police and First Responders
This section authorizes crisis intervention training grants
for police officers and first responders at $9 million total
for the period of FY18-FY20.
Section 721. Demonstration Grant Program to Train Health Service
Psychologists in Community-Based Mental Health
This section authorizes a grant program to increase the
psychologist work force at $12 million total for the period of
FY18-FY22.
Section 722. Investment in Tomorrow's Pediatric Health Care Workforce
This section reauthorizes Section 774(f) of the Public
Health Service Act which provides for a pediatric specialty
loan repayment program. The authorization is for $12 million
total for the period of FY18-FY22.
Section 723. Cut-Go Compliance
This section brings this bill into cut-go compliance.
TITLE VIII--MENTAL HEALTH PARITY
Section 801. Enhanced Compliance with Mental Health and Substance Use
Disorder Coverage Requirements
This section aims to improve mental health payment parity
through better compliance guidance and disclosure support.
Among other items, the section develops inter-agency agreements
for information sharing and creates new standards for updating
program compliance documents. Agency officials must hold
stakeholder meetings with plan issuers to improve public-
private coordination and take into consideration public
feedback.
Section 802. Action Plan for Enhanced Enforcement of Mental Health and
Substance Use Disorder Coverage
Under this section, federal agency officials must hold a
public stakeholders meeting with state governments and
nationwide stakeholders, including third-party groups and
patient advocates, to produce an action plan for improving
mental health parity and addiction equity requirements.
Section 803. Report on Investigations Regarding Parity in Mental Health
and Substance Use Disorder Benefits
One year following enactment, and annually for five years,
an inter-agency analysis on any serious violations of mental
health parity compliance standards would be published,
summarizing the results of all closed federal investigations
finalized in the 12 months preceding the report.
Section 804. GAO Study on Parity in Mental Health and Substance Use
Disorder Benefits
Within three years, the Comptroller General of the United
States, through consultation with inter-agency leaders, must
provide an independent report on treatment limitations, among
other items, concerning plan issuers--including state- and
federally-funded programs--that treat patients for medical and
surgical benefits as well as and mental health or substance use
disorder services.
Section 805. Information and Awareness on Eating Disorders
In an effort to improve education and awareness of eating
disorders, this section updates and modernizes public outreach
efforts through the Office of Women's Health. Among other
items, the public awareness should include revised findings on
the comorbidities and physician and mental health consequences
of serious eating disorders.
Section 806. Education and Training on Eating Disorders
Similar to the provision on eating disorder awareness, this
section provides support to educate and train health
professionals and school personnel in effective strategies to
identify individuals with eating disorders and facilitate early
intervention programs. Further, this section helps with early
intervention and prevention efforts for avoiding eating
disorders.
Section 807. GAO Study on Preventing Discriminatory Coverage
Limitations for Individuals with Serious Mental Illness and
Substance Use Disorders
Two years after the bill takes effect, the Comptroller
General of the United States must submit a public report to
Congress detailing the effectiveness of compliance guidelines
and the shortfalls of meeting enforcement, education, and
coordination of parity requirements.
Section 808. Clarification of Existing Parity Rules
This section clarifies that plan issuers offering coverage
for eating disorder benefits must do so in alignment with
current mental health parity standards.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS
Part A--Administration
* * * * * * *
defense of certain malpractice and negligence suits
Sec. 224. (a) The remedy against the United States provided
by sections 1346(b) and 2672 of title 28, or by alternative
benefits provided by the United States where the availability
of such benefits precludes a remedy under section 1346(b) of
title 28, for damage for personal injury, including death,
resulting from the performance of medical, surgical, dental, or
related functions, including the conduct of clinical studies or
investigation, by any commissioned officer or employee of the
Public Health Service while acting within the scope of his
office or employment, shall be exclusive of any other civil
action or proceeding by reason of the same subject-matter
against the officer or employee (or his estate) whose act or
omission gave rise to the claim.
(b) The Attorney General shall defend any civil action or
proceeding brought in any court against any person referred to
in subsection (a) of this section (or his estate) for any such
damage or injury. Any such person against whom such civil
action or proceeding is brought shall deliver within such time
after date of service or knowledge of service as determined by
the Attorney General, all process served upon him or an
attested true copy thereof to his immediate superior or to
whomever was designated by the Secretary to receive such papers
and such persons shall promptly furnish copies of the pleading
and process therein to the United States attorney for the
district embracing the place wherein the proceeding is brought,
to the Attorney General, and to the Secretary.
(c) Upon a certification by the Attorney General that the
defendant was acting in the scope of his employment at the time
of the incident out of which the suit arose, any such civil
action or proceeding commenced in a State court shall be
removed without bond at any time before trial by the Attorney
General to the district court of the United States of the
district and division embracing the place wherein it is pending
and the proceeding deemed a tort action brought against the
United States under the provisions of title 28 and all
references thereto. Should a United States district court
determine on a hearing on a motion to remand held before a
trial on the merit that the case so removed is one in which a
remedy by suit within the meaning of subsection (a) of this
section is not available against the United States, the case
shall be remanded to the State Court: Provided, That where such
a remedy is precluded because of the availability of a remedy
through proceedings for compensation or other benefits from the
United States as provided by any other law, the case shall be
dismissed, but in the event the running of any limitation of
time for commencing, or filing an application or claim in, such
proceedings for compensation or other benefits shall be deemed
to have been suspended during the pendency of the civil action
or proceeding under this section.
(d) The Attorney General may compromise or settle any claim
asserted in such civil action or proceeding in the manner
provided in section 2677 of title 28 and with the same effect.
(e) For purposes of this section, the provisions of section
2680(h) of title 28 shall not apply to assault or battery
arising out of negligence in the performance of medical,
surgical, dental, or related functions, including the conduct
of clinical studies or investigations.
(f) The Secretary or his designee may, to the extent that he
deems appropriate, hold harmless or provide liability insurance
for any officer or employee of the Public Health Service for
damage for personal injury, including death, negligently caused
by such officer or employee while acting within the scope of
his office or employment and as a result of the performance of
medical, surgical, dental, or related functions, including the
conduct of clinical studies or investigations, if such employee
is assigned to a foreign country or detailed to a State or
political subdivision thereof or to a non-profit institution,
and if the circumstances are such as are likely to preclude the
remedies of third persons against the United States described
in section 2679(b) of title 28, for such damage or injury.
(g)(1)(A) For purposes of this section and subject to the
approval by the Secretary of an application under subparagraph
(D), an entity described in paragraph (4), and any officer,
governing board member, or employee of such an entity, and any
contractor of such an entity who is a physician or other
licensed or certified health care practitioner (subject to
paragraph (5)), shall be deemed to be an employee of the Public
Health Service for a calendar year that begins during a fiscal
year for which a transfer was made under subsection (k)(3)
(subject to paragraph (3)). The remedy against the United
States for an entity described in paragraph (4) and any
officer, governing board member, employee, or contractor
(subject to paragraph (5)) of such an entity who is deemed to
be an employee of the Public Health Service pursuant to this
paragraph shall be exclusive of any other civil action or
proceeding to the same extent as the remedy against the United
States is exclusive pursuant to subsection (a).
(B) The deeming of any entity or officer, governing board
member, employee, or contractor of the entity to be an employee
of the Public Health Service for purposes of this section shall
apply with respect to services provided--
(i) to all patients of the entity, and
(ii) subject to subparagraph (C), to individuals who
are not patients of the entity.
(C) Subparagraph (B)(ii) applies to services provided to
individuals who are not patients of an entity if the Secretary
determines, after reviewing an application submitted under
subparagraph (D), that the provision of the services to such
individuals--
(i) benefits patients of the entity and general
populations that could be served by the entity through
community-wide intervention efforts within the
communities served by such entity;
(ii) facilitates the provision of services to
patients of the entity; or
(iii) are otherwise required under an employment
contract (or similar arrangement) between the entity
and an officer, governing board member, employee, or
contractor of the entity.
(D) The Secretary may not under subparagraph (A) deem an
entity or an officer, governing board member, employee, or
contractor of the entity to be an employee of the Public Health
Service for purposes of this section, and may not apply such
deeming to services described in subparagraph (B)(ii), unless
the entity has submitted an application for such deeming to the
Secretary in such form and such manner as the Secretary shall
prescribe. The application shall contain detailed information,
along with supporting documentation, to verify that the entity,
and the officer, governing board member, employee, or
contractor of the entity, as the case may be, meets the
requirements of subparagraphs (B) and (C) of this paragraph and
that the entity meets the requirements of paragraphs (1)
through (4) of subsection (h).
(E) The Secretary shall make a determination of whether an
entity or an officer, governing board member, employee, or
contractor of the entity is deemed to be an employee of the
Public Health Service for purposes of this section within 30
days after the receipt of an application under subparagraph
(D). The determination of the Secretary that an entity or an
officer, governing board member, employee, or contractor of the
entity is deemed to be an employee of the Public Health Service
for purposes of this section shall apply for the period
specified by the Secretary under subparagraph (A).
(F) Once the Secretary makes a determination that an entity
or an officer, governing board member, employee, or contractor
of an entity is deemed to be an employee of the Public Health
Service for purposes of this section, the determination shall
be final and binding upon the Secretary and the Attorney
General and other parties to any civil action or proceeding.
Except as provided in subsection (i), the Secretary and the
Attorney General may not determine that the provision of
services which are the subject of such a determination are not
covered under this section.
(G) In the case of an entity described in paragraph (4) that
has not submitted an application under subparagraph (D):
(i) The Secretary may not consider the entity in
making estimates under subsection (k)(1).
(ii) This section does not affect any authority of
the entity to purchase medical malpractice liability
insurance coverage with Federal funds provided to the
entity under section 329, 330, or 340A.
(H) In the case of an entity described in paragraph (4) for
which an application under subparagraph (D) is in effect, the
entity may, through notifying the Secretary in writing, elect
to terminate the applicability of this subsection to the
entity. With respect to such election by the entity:
(i) The election is effective upon the expiration of
the 30-day period beginning on the date on which the
entity submits such notification.
(ii) Upon taking effect, the election terminates the
applicability of this subsection to the entity and each
officer, governing board member, employee, and
contractor of the entity.
(iii) Upon the effective date for the election,
clauses (i) and (ii) of subparagraph (G) apply to the
entity to the same extent and in the same manner as
such clauses apply to an entity that has not submitted
an application under subparagraph (D).
(iv) If after making the election the entity submits
an application under subparagraph (D), the election
does not preclude the Secretary from approving the
application (and thereby restoring the applicability of
this subsection to the entity and each officer,
governing board member, employee, and contractor of the
entity, subject to the provisions of this subsection
and the subsequent provisions of this section.
(2) If, with respect to an entity or person deemed to be an
employee for purposes of paragraph (1), a cause of action is
instituted against the United States pursuant to this section,
any claim of the entity or person for benefits under an
insurance policy with respect to medical malpractice relating
to such cause of action shall be subrogated to the United
States.
(3) This subsection shall apply with respect to a cause of
action arising from an act or omission which occurs on or after
January 1, 1993.
(4) An entity described in this paragraph is a public or non-
profit private entity receiving Federal funds under section
330.
(5) For purposes of paragraph (1), an individual may be
considered a contractor of an entity described in paragraph (4)
only if--
(A) the individual normally performs on average at
least 32\1/2\ hours of service per week for the entity
for the period of the contract; or
(B) in the case of an individual who normally
performs an average of less than 32\1/2\ hours of
services per week for the entity for the period of the
contract, the individual is a licensed or certified
provider of services in the fields of family practice,
general internal medicine, general pediatrics, or
obstetrics and gynecology.
(h) The Secretary may not approve an application under
subsection (g)(1)(D) unless the Secretary determines that the
entity--
(1) has implemented appropriate policies and
procedures to reduce the risk of malpractice and the
risk of lawsuits arising out of any health or health-
related functions performed by the entity;
(2) has reviewed and verified the professional
credentials, references, claims history, fitness,
professional review organization findings, and license
status of its physicians and other licensed or
certified health care practitioners, and, where
necessary, has obtained the permission from these
individuals to gain access to this information;
(3) has no history of claims having been filed
against the United States as a result of the
application of this section to the entity or its
officers, employees, or contractors as provided for
under this section, or, if such a history exists, has
fully cooperated with the Attorney General in defending
against any such claims and either has taken, or will
take, any necessary corrective steps to assure against
such claims in the future; and
(4) will fully cooperate with the Attorney General in
providing information relating to an estimate described
under subsection (k).
(i)(1) Notwithstanding subsection (g)(1), the Attorney
General, in consultation with the Secretary, may on the record
determine, after notice and opportunity for a full and fair
hearing, that an individual physician or other licensed or
certified health care practitioner who is an officer, employee,
or contractor of an entity described in subsection (g)(4) shall
not be deemed to be an employee of the Public Health Service
for purposes of this section, if treating such individual as
such an employee would expose the Government to an unreasonably
high degree of risk of loss because such individual--
(A) does not comply with the policies and procedures
that the entity has implemented pursuant to subsection
(h)(1);
(B) has a history of claims filed against him or her
as provided for under this section that is outside the
norm for licensed or certified health care
practitioners within the same specialty;
(C) refused to reasonably cooperate with the Attorney
General in defending against any such claim;
(D) provided false information relevant to the
individual's performance of his or her duties to the
Secretary, the Attorney General, or an applicant for or
recipient of funds under this Act; or
(E) was the subject of disciplinary action taken by a
State medical licensing authority or a State or
national professional society.
(2) A final determination by the Attorney General under this
subsection that an individual physician or other licensed or
certified health care professional shall not be deemed to be an
employee of the Public Health Service shall be effective upon
receipt by the entity employing such individual of notice of
such determination, and shall apply only to acts or omissions
occurring after the date such notice is received.
(j) In the case of a health care provider who is an officer,
employee, or contractor of an entity described in subsection
(g)(4), section 335(e) shall apply with respect to the provider
to the same extent and in the same manner as such section
applies to any member of the National Health Service Corps.
(k)(1)(A) For each fiscal year, the Attorney General, in
consultation with the Secretary, shall estimate by the
beginning of the year the amount of all claims which are
expected to arise under this section (together with related
fees and expenses of witnesses) for which payment is expected
to be made in accordance with section 1346 and chapter 171 of
title 28, United States Code, from the acts or omissions,
during the calendar year that begins during that fiscal year,
of entities described in subsection (g)(4) and of officers,
employees, or contractors (subject to subsection (g)(5)) of
such entities.
(B) The estimate under subparagraph (A) shall take into
account--
(i) the value and frequency of all claims for damage
for personal injury, including death, resulting from
the performance of medical, surgical, dental, or
related functions by entities described in subsection
(g)(4) or by officers, employees, or contractors
(subject to subsection (g)(5)) of such entities who are
deemed to be employees of the Public Health Service
under subsection (g)(1) that, during the preceding 5-
year period, are filed under this section or, with
respect to years occurring before this subsection takes
effect, are filed against persons other than the United
States,
(ii) the amounts paid during that 5-year period on
all claims described in clause (i), regardless of when
such claims were filed, adjusted to reflect payments
which would not be permitted under section 1346 and
chapter 171 of title 28, United States Code, and
(iii) amounts in the fund established under paragraph
(2) but unspent from prior fiscal years.
(2) Subject to appropriations, for each fiscal year, the
Secretary shall establish a fund of an amount equal to the
amount estimated under paragraph (1) that is attributable to
entities receiving funds under each of the grant programs
described in paragraph (4) of subsection (g), but not to exceed
a total of $10,000,000 for each such fiscal year.
Appropriations for purposes of this paragraph shall be made
separate from appropriations made for purposes of sections 329,
330 and 340A.
(3) In order for payments to be made for judgments against
the United States (together with related fees and expenses of
witnesses) pursuant to this section arising from the acts or
omissions of entities described in subsection (g)(4) and of
officers, employees, or contractors (subject to subsection
(g)(5)) of such entities, the total amount contained within the
fund established by the Secretary under paragraph (2) for a
fiscal year shall be transferred not later than the December 31
that occurs during the fiscal year to the appropriate accounts
in the Treasury.
(l)(1) If a civil action or proceeding is filed in a State
court against any entity described in subsection (g)(4) or any
officer, governing board member, employee, or any contractor of
such an entity for damages described in subsection (a), the
Attorney General, within 15 days after being notified of such
filing, shall make an appearance in such court and advise such
court as to whether the Secretary has determined under
subsections (g) and (h), that such entity, officer, governing
board member, employee, or contractor of the entity is deemed
to be an employee of the Public Health Service for purposes of
this section with respect to the actions or omissions that are
the subject of such civil action or proceeding. Such advice
shall be deemed to satisfy the provisions of subsection (c)
that the Attorney General certify that an entity, officer,
governing board member, employee, or contractor of the entity
was acting within the scope of their employment or
responsibility.
(2) If the Attorney General fails to appear in State court
within the time period prescribed under paragraph (1), upon
petition of any entity or officer, governing board member,
employee, or contractor of the entity named, the civil action
or proceeding shall be removed to the appropriate United States
district court. The civil action or proceeding shall be stayed
in such court until such court conducts a hearing, and makes a
determination, as to the appropriate forum or procedure for the
assertion of the claim for damages described in subsection (a)
and issues an order consistent with such determination.
(m)(1) An entity or officer, governing board member,
employee, or contractor of an entity described in subsection
(g)(1) shall, for purposes of this section, be deemed to be an
employee of the Public Health Service with respect to services
provided to individuals who are enrollees of a managed care
plan if the entity contracts with such managed care plan for
the provision of services.
(2) Each managed care plan which enters into a contract with
an entity described in subsection (g)(4) shall deem the entity
and any officer, governing board member, employee, or
contractor of the entity as meeting whatever malpractice
coverage requirements such plan may require of contracting
providers for a calendar year if such entity or officer,
governing board member, employee, or contractor of the entity
has been deemed to be an employee of the Public Health Service
for purposes of this section for such calendar year. Any plan
which is found by the Secretary on the record, after notice and
an opportunity for a full and fair hearing, to have violated
this subsection shall upon such finding cease, for a period to
be determined by the Secretary, to receive and to be eligible
to receive any Federal funds under titles XVIII or XIX of the
Social Security Act.
(3) For purposes of this subsection, the term ``managed care
plan'' shall mean health maintenance organizations and similar
entities that contract at-risk with payors for the provision of
health services or plan enrollees and which contract with
providers (such as entities described in subsection (g)(4)) for
the delivery of such services to plan enrollees.
(n)(1) Not later than one year after the date of the
enactment of the Federally Supported Health Centers Assistance
Act of 1995, the Comptroller General of the United States shall
submit to the Congress a report on the following:
(A) The medical malpractice liability claims
experience of entities that have been deemed to be
employees for purposes of this section.
(B) The risk exposure of such entities.
(C) The value of private sector risk-management
services, and the value of risk-management services and
procedures required as a condition of receiving a grant
under section 329, 330, or 340A.
(D) A comparison of the costs and the benefits to
taxpayers of maintaining medical malpractice liability
coverage for such entities pursuant to this section,
taking into account--
(i) a comparison of the costs of premiums
paid by such entities for private medical
malpractice liability insurance with the cost
of coverage pursuant to this section; and
(ii) an analysis of whether the cost of
premiums for private medical malpractice
liability insurance coverage is consistent with
the liability claims experience of such
entities.
(2) The report under paragraph (1) shall include the
following:
(A) A comparison of--
(i) an estimate of the aggregate amounts that
such entities (together with the officers,
governing board members, employees, and
contractors of such entities who have been
deemed to be employees for purposes of this
section) would have directly or indirectly paid
in premiums to obtain medical malpractice
liability insurance coverage if this section
were not in effect; with
(ii) the aggregate amounts by which the
grants received by such entities under this Act
were reduced pursuant to subsection (k)(2).
(B) A comparison of--
(i) an estimate of the amount of privately
offered such insurance that such entities
(together with the officers, governing board
members, employees, and contractors of such
entities who have been deemed to be employees
for purposes of this section) purchased during
the three-year period beginning on January 1,
1993; with
(ii) an estimate of the amount of such
insurance that such entities (together with the
officers, governing board members, employees,
and contractors of such entities who have been
deemed to be employees for purposes of this
section) will purchase after the date of the
enactment of the Federally Supported Health
Centers Assistance Act of 1995.
(C) An estimate of the medical malpractice liability
loss history of such entities for the 10-year period
preceding October 1, 1996, including but not limited to
the following:
(i) Claims that have been paid and that are
estimated to be paid, and legal expenses to
handle such claims that have been paid and that
are estimated to be paid, by the Federal
Government pursuant to deeming entities as
employees for purposes of this section.
(ii) Claims that have been paid and that are
estimated to be paid, and legal expenses to
handle such claims that have been paid and that
are estimated to be paid, by private medical
malpractice liability insurance.
(D) An analysis of whether the cost of premiums for
private medical malpractice liability insurance
coverage is consistent with the liability claims
experience of entities that have been deemed as
employees for purposes of this section.
(3) In preparing the report under paragraph (1), the
Comptroller General of the United States shall consult with
public and private entities with expertise on the matters with
which the report is concerned.
(o)(1) For purposes of this section, a free clinic health
professional shall in providing a qualifying health service to
an individual, or an officer, governing board member, employee,
or contractor of a free clinic shall in providing services for
the free clinic, be deemed to be an employee of the Public
Health Service for a calendar year that begins during a fiscal
year for which a transfer was made under paragraph (6)(D). The
preceding sentence is subject to the provisions of this
subsection.
(2) In providing a health service to an individual, a health
care practitioner shall for purposes of this subsection be
considered to be a free clinic health professional if the
following conditions are met:
(A) The service is provided to the individual at a
free clinic, or through offsite programs or events
carried out by the free clinic.
(B) The free clinic is sponsoring the health care
practitioner pursuant to paragraph (5)(C).
(C) The service is a qualifying health service (as
defined in paragraph (4)).
(D) Neither the health care practitioner nor the free
clinic receives any compensation for the service from
the individual or from any third-party payor (including
reimbursement under any insurance policy or health
plan, or under any Federal or State health benefits
program). With respect to compliance with such
condition:
(i) The health care practitioner may receive
repayment from the free clinic for reasonable
expenses incurred by the health care
practitioner in the provision of the service to
the individual.
(ii) The free clinic may accept voluntary
donations for the provision of the service by
the health care practitioner to the individual.
(E) Before the service is provided, the health care
practitioner or the free clinic provides written notice
to the individual of the extent to which the legal
liability of the health care practitioner is limited
pursuant to this subsection (or in the case of an
emergency, the written notice is provided to the
individual as soon after the emergency as is
practicable). If the individual is a minor or is
otherwise legally incompetent, the condition under this
subparagraph is that the written notice be provided to
a legal guardian or other person with legal
responsibility for the care of the individual.
(F) At the time the service is provided, the health
care practitioner is licensed or certified in
accordance with applicable law regarding the provision
of the service.
(3)(A) For purposes of this subsection, the term ``free
clinic'' means a health care facility operated by a nonprofit
private entity meeting the following requirements:
(i) The entity does not, in providing health services
through the facility, accept reimbursement from any
third-party payor (including reimbursement under any
insurance policy or health plan, or under any Federal
or State health benefits program).
(ii) The entity, in providing health services through
the facility, either does not impose charges on the
individuals to whom the services are provided, or
imposes a charge according to the ability of the
individual involved to pay the charge.
(iii) The entity is licensed or certified in
accordance with applicable law regarding the provision
of health services.
(B) With respect to compliance with the conditions under
subparagraph (A), the entity involved may accept voluntary
donations for the provision of services.
(4) For purposes of this subsection, the term ``qualifying
health service'' means any medical assistance required or
authorized to be provided in the program under title XIX of the
Social Security Act, without regard to whether the medical
assistance is included in the plan submitted under such program
by the State in which the health care practitioner involved
provides the medical assistance. References in the preceding
sentence to such program shall as applicable be considered to
be references to any successor to such program.
(5) Subsection (g) (other than paragraphs (3) through (5))
and subsections (h), (i), and (l) apply to a health care
practitioner for purposes of this subsection to the same extent
and in the same manner as such subsections apply to an officer,
governing board member, employee, or contractor of an entity
described in subsection (g)(4), subject to paragraph (6) and
subject to the following:
(A) The first sentence of paragraph (1) applies in
lieu of the first sentence of subsection (g)(1)(A).
(B) This subsection may not be construed as deeming
any free clinic to be an employee of the Public Health
Service for purposes of this section.
(C) With respect to a free clinic, a health care
practitioner is not a free clinic health professional
unless the free clinic sponsors the health care
practitioner. For purposes of this subsection, the free
clinic shall be considered to be sponsoring the health
care practitioner if--
(i) with respect to the health care
practitioner, the free clinic submits to the
Secretary an application meeting the
requirements of subsection (g)(1)(D); and
(ii) the Secretary, pursuant to subsection
(g)(1)(E), determines that the health care
practitioner is deemed to be an employee of the
Public Health Service.
(D) In the case of a health care practitioner who is
determined by the Secretary pursuant to subsection
(g)(1)(E) to be a free clinic health professional, this
subsection applies to the health care practitioner
(with respect to the free clinic sponsoring the health
care practitioner pursuant to subparagraph (C)) for any
cause of action arising from an act or omission of the
health care practitioner occurring on or after the date
on which the Secretary makes such determination.
(E) Subsection (g)(1)(F) applies to a health care
practitioner for purposes of this subsection only to
the extent that, in providing health services to an
individual, each of the conditions specified in
paragraph (2) is met.
(6)(A) For purposes of making payments for judgments against
the United States (together with related fees and expenses of
witnesses) pursuant to this section arising from the acts or
omissions of free clinic health professionals, there is
authorized to be appropriated $10,000,000 for each fiscal year.
(B) The Secretary shall establish a fund for purposes of this
subsection. Each fiscal year amounts appropriated under
subparagraph (A) shall be deposited in such fund.
(C) Not later than May 1 of each fiscal year, the Attorney
General, in consultation with the Secretary, shall submit to
the Congress a report providing an estimate of the amount of
claims (together with related fees and expenses of witnesses)
that, by reason of the acts or omissions of free clinic health
professionals, will be paid pursuant to this section during the
calendar year that begins in the following fiscal year.
Subsection (k)(1)(B) applies to the estimate under the
preceding sentence regarding free clinic health professionals
to the same extent and in the same manner as such subsection
applies to the estimate under such subsection regarding
officers, governing board members, employees, and contractors
of entities described in subsection (g)(4).
(D) Not later than December 31 of each fiscal year, the
Secretary shall transfer from the fund under subparagraph (B)
to the appropriate accounts in the Treasury an amount equal to
the estimate made under subparagraph (C) for the calendar year
beginning in such fiscal year, subject to the extent of amounts
in the fund.
(7)(A) This subsection takes effect on the date of the
enactment of the first appropriations Act that makes an
appropriation under paragraph (6)(A), except as provided in
subparagraph (B)(i).
(B)(i) Effective on the date of the enactment of the Health
Insurance Portability and Accountability Act of 1996--
(I) the Secretary may issue regulations for carrying
out this subsection, and the Secretary may accept and
consider applications submitted pursuant to paragraph
(5)(C); and
(II) reports under paragraph (6)(C) may be submitted
to the Congress.
(ii) For the first fiscal year for which an appropriation is
made under subparagraph (A) of paragraph (6), if an estimate
under subparagraph (C) of such paragraph has not been made for
the calendar year beginning in such fiscal year, the transfer
under subparagraph (D) of such paragraph shall be made
notwithstanding the lack of the estimate, and the transfer
shall be made in an amount equal to the amount of such
appropriation.
(p) Administration of Smallpox Countermeasures by Health
Professionals.--
(1) In general.--For purposes of this section, and
subject to other provisions of this subsection, a
covered person shall be deemed to be an employee of the
Public Health Service with respect to liability arising
out of administration of a covered countermeasure
against smallpox to an individual during the effective
period of a declaration by the Secretary under
paragraph (2)(A).
(2) Declaration by secretary concerning
countermeasure against smallpox.--
(A) Authority to issue declaration.--
(i) In general.--The Secretary may
issue a declaration, pursuant to this
paragraph, concluding that an actual or
potential bioterrorist incident or
other actual or potential public health
emergency makes advisable the
administration of a covered
countermeasure to a category or
categories of individuals.
(ii) Covered countermeasure.--The
Secretary shall specify in such
declaration the substance or substances
that shall be considered covered
countermeasures (as defined in
paragraph (7)(A)) for purposes of
administration to individuals during
the effective period of the
declaration.
(iii) Effective period.--The
Secretary shall specify in such
declaration the beginning and ending
dates of the effective period of the
declaration, and may subsequently amend
such declaration to shorten or extend
such effective period, provided that
the new closing date is after the date
when the declaration is amended.
(iv) Publication.--The Secretary
shall promptly publish each such
declaration and amendment in the
Federal Register.
(B) Liability of united states only for
administrations within scope of declaration.--
Except as provided in paragraph (5)(B)(ii), the
United States shall be liable under this
subsection with respect to a claim arising out
of the administration of a covered
countermeasure to an individual only if--
(i) the countermeasure was
administered by a qualified person, for
a purpose stated in paragraph
(7)(A)(i), and during the effective
period of a declaration by the
Secretary under subparagraph (A) with
respect to such countermeasure; and
(ii)(I) the individual was within a
category of individuals covered by the
declaration; or
(II) the qualified person
administering the countermeasure had
reasonable grounds to believe that such
individual was within such category.
(C) Presumption of administration within
scope of declaration in case of accidental
vaccinia inoculation.--
(i) In general.--If vaccinia vaccine
is a covered countermeasure specified
in a declaration under subparagraph
(A), and an individual to whom the
vaccinia vaccine is not administered
contracts vaccinia, then, under the
circumstances specified in clause (ii),
the individual--
(I) shall be rebuttably
presumed to have contracted
vaccinia from an individual to
whom such vaccine was
administered as provided by
clauses (i) and (ii) of
subparagraph (B); and
(II) shall (unless such
presumption is rebutted) be
deemed for purposes of this
subsection to be an individual
to whom a covered
countermeasure was administered
by a qualified person in
accordance with the terms of
such declaration and as
described by subparagraph (B).
(ii) Circumstances in which
presumption applies.--The presumption
and deeming stated in clause (i) shall
apply if--
(I) the individual contracts
vaccinia during the effective
period of a declaration under
subparagraph (A) or by the date
30 days after the close of such
period; or
(II) the individual has
resided with, or has had
contact with, an individual to
whom such vaccine was
administered as provided by
clauses (i) and (ii) of
subparagraph (B) and contracts
vaccinia after such date.
(D) Acts and omissions deemed to be within
scope of employment.--
(i) In general.--In the case of a
claim arising out of alleged
transmission of vaccinia from an
individual described in clause (ii),
acts or omissions by such individual
shall be deemed to have been taken
within the scope of such individual's
office or employment for purposes of--
(I) subsection (a); and
(II) section 1346(b) and
chapter 171 of title 28, United
States Code.
(ii) Individuals to whom deeming
applies.--An individual is described by
this clause if--
(I) vaccinia vaccine was
administered to such individual
as provided by subparagraph
(B); and
(II) such individual was
within a category of
individuals covered by a
declaration under subparagraph
(A)(i).
(3) Exhaustion; exclusivity; offset.--
(A) Exhaustion.--
(i) In general.--A person may not
bring a claim under this subsection
unless such person has exhausted such
remedies as are available under part C
of this title, except that if the
Secretary fails to make a final
determination on a request for benefits
or compensation filed in accordance
with the requirements of such part
within 240 days after such request was
filed, the individual may seek any
remedy that may be available under this
section.
(ii) Tolling of statute of
limitations.--The time limit for filing
a claim under this subsection, or for
filing an action based on such claim,
shall be tolled during the pendency of
a request for benefits or compensation
under part C of this title.
(iii) Construction.--This subsection
shall not be construed as superseding
or otherwise affecting the application
of a requirement, under chapter 171 of
title 28, United States Code, to
exhaust administrative remedies.
(B) Exclusivity.--The remedy provided by
subsection (a) shall be exclusive of any other
civil action or proceeding for any claim or
suit this subsection encompasses, except for a
proceeding under part C of this title.
(C) Offset.--The value of all compensation
and benefits provided under part C of this
title for an incident or series of incidents
shall be offset against the amount of an award,
compromise, or settlement of money damages in a
claim or suit under this subsection based on
the same incident or series of incidents.
(4) Certification of action by attorney general.--
Subsection (c) applies to actions under this
subsection, subject to the following provisions:
(A) Nature of certification.--The
certification by the Attorney General that is
the basis for deeming an action or proceeding
to be against the United States, and for
removing an action or proceeding from a State
court, is a certification that the action or
proceeding is against a covered person and is
based upon a claim alleging personal injury or
death arising out of the administration of a
covered countermeasure.
(B) Certification of attorney general
conclusive.--The certification of the Attorney
General of the facts specified in subparagraph
(A) shall conclusively establish such facts for
purposes of jurisdiction pursuant to this
subsection.
(5) Covered person to cooperate with united states.--
(A) In general.--A covered person shall
cooperate with the United States in the
processing and defense of a claim or action
under this subsection based upon alleged acts
or omissions of such person.
(B) Consequences of failure to cooperate.--
Upon the motion of the United States or any
other party and upon finding that such person
has failed to so cooperate--
(i) the court shall substitute such
person as the party defendant in place
of the United States and, upon motion,
shall remand any such suit to the court
in which it was instituted if it
appears that the court lacks subject
matter jurisdiction;
(ii) the United States shall not be
liable based on the acts or omissions
of such person; and
(iii) the Attorney General shall not
be obligated to defend such action.
(6) Recourse against covered person in case of gross
misconduct or contract violation.--
(A) In general.--Should payment be made by
the United States to any claimant bringing a
claim under this subsection, either by way of
administrative determination, settlement, or
court judgment, the United States shall have,
notwithstanding any provision of State law, the
right to recover for that portion of the
damages so awarded or paid, as well as interest
and any costs of litigation, resulting from the
failure of any covered person to carry out any
obligation or responsibility assumed by such
person under a contract with the United States
or from any grossly negligent, reckless, or
illegal conduct or willful misconduct on the
part of such person.
(B) Venue.--The United States may maintain an
action under this paragraph against such person
in the district court of the United States in
which such person resides or has its principal
place of business.
(7) Definitions.--As used in this subsection, terms
have the following meanings:
(A) Covered countermeasure.--The term
``covered countermeasure'' or ``covered
countermeasure against smallpox'', means a
substance that is--
(i)(I) used to prevent or treat
smallpox (including the vaccinia or
another vaccine); or
(II) used to control or treat
the adverse effects of vaccinia
inoculation or of
administration of another
covered countermeasure; and
(ii) specified in a declaration under
paragraph (2).
(B) Covered person.--The term ``covered
person'', when used with respect to the
administration of a covered countermeasure,
means a person who is--
(i) a manufacturer or distributor of
such countermeasure;
(ii) a health care entity under whose
auspices--
(I) such countermeasure was
administered;
(II) a determination was made
as to whether, or under what
circumstances, an individual
should receive a covered
countermeasure;
(III) the immediate site of
administration on the body of a
covered countermeasure was
monitored, managed, or cared
for; or
(IV) an evaluation was made
of whether the administration
of a countermeasure was
effective;
(iii) a qualified person who
administered such countermeasure;
(iv) a State, a political subdivision
of a State, or an agency or official of
a State or of such a political
subdivision, if such State,
subdivision, agency, or official has
established requirements, provided
policy guidance, supplied technical or
scientific advice or assistance, or
otherwise supervised or administered a
program with respect to administration
of such countermeasures;
(v) in the case of a claim arising
out of alleged transmission of vaccinia
from an individual--
(I) the individual who
allegedly transmitted the
vaccinia, if vaccinia vaccine
was administered to such
individual as provided by
paragraph (2)(B) and such
individual was within a
category of individuals covered
by a declaration under
paragraph (2)(A)(i); or
(II) an entity that employs
an individual described by
clause (I) or where such
individual has privileges or is
otherwise authorized to provide
health care;
(vi) an official, agent, or employee
of a person described in clause (i),
(ii), (iii), or (iv);
(vii) a contractor of, or a volunteer
working for, a person described in
clause (i), (ii), or (iv), if the
contractor or volunteer performs a
function for which a person described
in clause (i), (ii), or (iv) is a
covered person; or
(viii) an individual who has
privileges or is otherwise authorized
to provide health care under the
auspices of an entity described in
clause (ii) or (v)(II).
(C) Qualified person.--The term ``qualified
person'', when used with respect to the
administration of a covered countermeasure,
means a licensed health professional or other
individual who--
(i) is authorized to administer such
countermeasure under the law of the
State in which the countermeasure was
administered; or
(ii) is otherwise authorized by the
Secretary to administer such
countermeasure.
(D) Arising out of administration of a
covered countermeasure.--The term ``arising out
of administration of a covered
countermeasure'', when used with respect to a
claim or liability, includes a claim or
liability arising out of--
(i) determining whether, or under
what conditions, an individual should
receive a covered countermeasure;
(ii) obtaining informed consent of an
individual to the administration of a
covered countermeasure;
(iii) monitoring, management, or care
of an immediate site of administration
on the body of a covered
countermeasure, or evaluation of
whether the administration of the
countermeasure has been effective; or
(iv) transmission of vaccinia virus
by an individual to whom vaccinia
vaccine was administered as provided by
paragraph (2)(B).
(q)(1) For purposes of this section, a health professional
volunteer at an entity described in subsection (g)(4) shall, in
providing a health professional service eligible for funding
under section 330 to an individual, be deemed to be an employee
of the Public Health Service for a calendar year that begins
during a fiscal year for which a transfer was made under
paragraph (4)(C). The preceding sentence is subject to the
provisions of this subsection.
(2) In providing a health service to an individual, a health
care practitioner shall for purposes of this subsection be
considered to be a health professional volunteer at an entity
described in subsection (g)(4) if the following conditions are
met:
(A) The service is provided to the individual at the
facilities of an entity described in subsection (g)(4),
or through offsite programs or events carried out by
the entity.
(B) The entity is sponsoring the health care
practitioner pursuant to paragraph (3)(B).
(C) The health care practitioner does not receive any
compensation for the service from the individual or
from any third-party payer (including reimbursement
under any insurance policy or health plan, or under any
Federal or State health benefits program), except that
the health care practitioner may receive repayment from
the entity described in subsection (g)(4) for
reasonable expenses incurred by the health care
practitioner in the provision of the service to the
individual.
(D) Before the service is provided, the health care
practitioner or the entity described in subsection
(g)(4) posts a clear and conspicuous notice at the site
where the service is provided of the extent to which
the legal liability of the health care practitioner is
limited pursuant to this subsection.
(E) At the time the service is provided, the health
care practitioner is licensed or certified in
accordance with applicable law regarding the provision
of the service.
(3) Subsection (g) (other than paragraphs (3) and (5)) and
subsections (h), (i), and (l) apply to a health care
practitioner for purposes of this subsection to the same extent
and in the same manner as such subsections apply to an officer,
governing board member, employee, or contractor of an entity
described in subsection (g)(4), subject to paragraph (4) and
subject to the following:
(A) The first sentence of paragraph (1) applies in
lieu of the first sentence of subsection (g)(1)(A).
(B) With respect to an entity described in subsection
(g)(4), a health care practitioner is not a health
professional volunteer at such entity unless the entity
sponsors the health care practitioner. For purposes of
this subsection, the entity shall be considered to be
sponsoring the health care practitioner if--
(i) with respect to the health care
practitioner, the entity submits to the
Secretary an application meeting the
requirements of subsection (g)(1)(D); and
(ii) the Secretary, pursuant to subsection
(g)(1)(E), determines that the health care
practitioner is deemed to be an employee of the
Public Health Service.
(C) In the case of a health care practitioner who is
determined by the Secretary pursuant to subsection
(g)(1)(E) to be a health professional volunteer at such
entity, this subsection applies to the health care
practitioner (with respect to services performed on
behalf of the entity sponsoring the health care
practitioner pursuant to subparagraph (B)) for any
cause of action arising from an act or omission of the
health care practitioner occurring on or after the date
on which the Secretary makes such determination.
(D) Subsection (g)(1)(F) applies to a health care
practitioner for purposes of this subsection only to
the extent that, in providing health services to an
individual, each of the conditions specified in
paragraph (2) is met.
(4)(A) Amounts in the fund established under subsection
(k)(2) shall be available for transfer under subparagraph (C)
for purposes of carrying out this subsection.
(B) Not later May 1 of each fiscal year, the Attorney
General, in consultation with the Secretary, shall submit to
the Congress a report providing an estimate of the amount of
claims (together with related fees and expenses of witnesses)
that, by reason of the acts or omissions of health professional
volunteers, will be paid pursuant to this section during the
calendar year that begins in the following fiscal year.
Subsection (k)(1)(B) applies to the estimate under the
preceding sentence regarding health professional volunteers to
the same extent and in the same manner as such subsection
applies to the estimate under such subsection regarding
officers, governing board members, employees, and contractors
of entities described in subsection (g)(4).
(C) Not later than December 31 of each fiscal year, the
Secretary shall transfer from the fund under subsection (k)(2)
to the appropriate accounts in the Treasury an amount equal to
the estimate made under subparagraph (B) for the calendar year
beginning in such fiscal year, subject to the extent of amounts
in the fund.
(5)(A) This subsection takes effect on October 1, 2017,
except as provided in subparagraph (B).
(B) Effective on the date of the enactment of this
subsection--
(i) the Secretary may issue regulations for carrying
out this subsection, and the Secretary may accept and
consider applications submitted pursuant to paragraph
(3)(B); and
(ii) reports under paragraph (4)(B) may be submitted
to the Congress.
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part B--Federal-State Cooperation
* * * * * * *
SEC. 319D. REVITALIZING THE CENTERS FOR DISEASE CONTROL AND PREVENTION.
(a) Facilities; Capacities.--
(1) Findings.--Congress finds that the Centers for
Disease Control and Prevention has an essential role in
defending against and combatting public health threats
domestically and abroad and requires secure and modern
facilities, and expanded and improved capabilities
related to bioterrorism and other public health
emergencies, sufficient to enable such Centers to
conduct this important mission.
(2) Facilities.--
(A) In general.--The Director of the Centers
for Disease Control and Prevention may design,
construct, and equip new facilities, renovate
existing facilities (including laboratories,
laboratory support buildings, scientific
communication facilities, transshipment
complexes, secured and isolated parking
structures, office buildings, and other
facilities and infrastructure), and upgrade
security of such facilities, in order to better
conduct the capacities described in section
319A, and for supporting public health
activities.
(B) Multiyear contracting authority.--For any
project of designing, constructing, equipping,
or renovating any facility under subparagraph
(A), the Director of the Centers for Disease
Control and Prevention may enter into a single
contract or related contracts that collectively
include the full scope of the project, and the
solicitation and contract shall contain the
clause ``availability of funds'' found at
section 52.232-18 of title 48, Code of Federal
Regulations.
(3) Improving the capacities of the centers for
disease control and prevention.--The Secretary shall
expand, enhance, and improve the capabilities of the
Centers for Disease Control and Prevention relating to
preparedness for and responding effectively to
bioterrorism and other public health emergencies.
Activities that may be carried out under the preceding
sentence include--
(A) expanding or enhancing the training of
personnel;
(B) improving communications facilities and
networks, including delivery of necessary
information to rural areas;
(C) improving capabilities for public health
surveillance and reporting activities, taking
into account the integrated system or systems
of public health alert communications and
surveillance networks under subsection (b); and
(D) improving laboratory facilities related
to bioterrorism and other public health
emergencies, including increasing the security
of such facilities.
(b) National Communications and Surveillance Networks.--
(1) In general.--The Secretary, directly or through
awards of grants, contracts, or cooperative agreements,
shall provide for the establishment of an integrated
system or systems of public health alert communications
and surveillance networks between and among--
(A) Federal, State, and local public health
officials;
(B) public and private health-related
laboratories, hospitals, poison control
centers, and other health care facilities; and
(C) any other entities determined appropriate
by the Secretary.
(2) Requirements.--The Secretary shall ensure that
networks under paragraph (1) allow for the timely
sharing and discussion, in a secure manner, of
essential information concerning bioterrorism or
another public health emergency, or recommended methods
for responding to such an attack or emergency, allowing
for coordination to maximize all-hazards medical and
public health preparedness and response and to minimize
duplication of effort.
(3) Standards.--Not later than one year after the
date of the enactment of the Public Health Security and
Bioterrorism Preparedness and Response Act of 2002, the
Secretary, in cooperation with health care providers
and State and local public health officials, shall
establish any additional technical and reporting
standards (including standards for interoperability)
for networks under paragraph (1) and update such
standards as necessary.
(c) Modernizing Public Health Situational Awareness and
Biosurveillance.--
(1) In general.--Not later than 2 years after the
date of enactment of the Pandemic and All-Hazards
Preparedness Reauthorization Act of 2013, the
Secretary, in collaboration with State, local, and
tribal public health officials, shall establish a near
real-time electronic nationwide public health
situational awareness capability through an
interoperable network of systems to share data and
information to enhance early detection of rapid
response to, and management of, potentially
catastrophic infectious disease outbreaks, novel
emerging threats, and other public health emergencies
that originate domestically or abroad. Such network
shall be built on existing State situational awareness
systems or enhanced systems that enable such
connectivity.
(2) Strategy and implementation plan.--Not later than
180 days after the date of enactment of the Pandemic
and All-Hazards Preparedness Reauthorization Act of
2013, the Secretary shall submit to the appropriate
committees of Congress a coordinated strategy and an
accompanying implementation plan that identifies and
demonstrates the measurable steps the Secretary will
carry out to--
(A) develop, implement, and evaluate the
network described in paragraph (1), utilizing
the elements described in paragraph (3);
(B) modernize and enhance biosurveillance
activities; and
(C) improve information sharing,
coordination, and communication among disparate
biosurveillance systems supported by the
Department of Health and Human Services.
(3) Elements.--The network described in paragraph (1)
shall include data and information transmitted in a
standardized format from--
(A) State, local, and tribal public health
entities, including public health laboratories;
(B) Federal health agencies;
(C) zoonotic disease monitoring systems;
(D) public and private sector health care
entities, hospitals, pharmacies, poison control
centers or professional organizations in the
field of poison control, community health
centers, health centers and clinical
laboratories, to the extent practicable and
provided that such data are voluntarily
provided simultaneously to the Secretary and
appropriate State, local, and tribal public
health agencies; and
(E) such other sources as the Secretary may
deem appropriate.
(4) Rule of construction.--Paragraph (3) shall not be
construed as requiring separate reporting of data and
information from each source listed.
(5) Required activities.--In establishing and
operating the network described in paragraph (1), the
Secretary shall--
(A) utilize applicable interoperability
standards as determined by the Secretary, and
in consultation with the Office of the National
Coordinator for Health Information Technology,
through a joint public and private sector
process;
(B) define minimal data elements for such
network;
(C) in collaboration with State, local, and
tribal public health officials, integrate and
build upon existing State, local, and tribal
capabilities, ensuring simultaneous sharing of
data, information, and analyses from the
network described in paragraph (1) with State,
local, and tribal public health agencies; and
(D) in collaboration with State, local, and
tribal public health officials, develop
procedures and standards for the collection,
analysis, and interpretation of data that
States, regions, or other entities collect and
report to the network described in paragraph
(1).
(6) Consultation with the national biodefense science
board.--In carrying out this section and consistent
with section 319M, the National Biodefense Science
Board shall provide expert advice and guidance,
including recommendations, regarding the measurable
steps the Secretary should take to modernize and
enhance biosurveillance activities pursuant to the
efforts of the Department of Health and Human Services
to ensure comprehensive, real-time, all-hazards
biosurveillance capabilities. In complying with the
preceding sentence, the National Biodefense Science
Board shall--
(A) identify the steps necessary to achieve a
national biosurveillance system for human
health, with international connectivity, where
appropriate, that is predicated on State,
regional, and community level capabilities and
creates a networked system to allow for two-way
information flow between and among Federal,
State, and local government public health
authorities and clinical health care providers;
(B) identify any duplicative surveillance
programs under the authority of the Secretary,
or changes that are necessary to existing
programs, in order to enhance and modernize
such activities, minimize duplication,
strengthen and streamline such activities under
the authority of the Secretary, and achieve
real-time and appropriate data that relate to
disease activity, both human and zoonotic; and
(C) coordinate with applicable existing
advisory committees of the Director of the
Centers for Disease Control and Prevention,
including such advisory committees consisting
of representatives from State, local, and
tribal public health authorities and
appropriate public and private sector health
care entities and academic institutions, in
order to provide guidance on public health
surveillance activities.
(d) State and Regional Systems To Enhance Situational
Awareness in Public Health Emergencies.--
(1) In general.--To implement the network described
in subsection (c), the Secretary may award grants to
States or consortia of States to enhance the ability of
such States or consortia of States to establish or
operate a coordinated public health situational
awareness system for regional or Statewide early
detection of, rapid response to, and management of
potentially catastrophic infectious disease outbreaks
and public health emergencies, in collaboration with
appropriate public health agencies, sentinel hospitals,
clinical laboratories, pharmacies, poison control
centers, other health care organizations, and animal
health organizations within such States.
(2) Eligibility.--To be eligible to receive a grant
under paragraph (1), the State or consortium of States
shall submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require, including an assurance
that the State or consortium of States will submit to
the Secretary--
(A) reports of such data, information, and
metrics as the Secretary may require;
(B) a report on the effectiveness of the
systems funded under the grant; and
(C) a description of the manner in which
grant funds will be used to enhance the
timelines and comprehensiveness of efforts to
detect, respond to, and manage potentially
catastrophic infectious disease outbreaks and
public health emergencies.
(3) Use of funds.--A State or consortium of States
that receives an award under this subsection--
(A) shall establish, enhance, or operate a
coordinated public health situational awareness
system for regional or Statewide early
detection of, rapid response to, and management
of potentially catastrophic infectious disease
outbreaks and public health emergencies;
(B) may award grants or contracts to entities
described in paragraph (1) within or serving
such State to assist such entities in improving
the operation of information technology
systems, facilitating the secure exchange of
data and information, and training personnel to
enhance the operation of the system described
in subparagraph (A); and
(C) may conduct a pilot program for the
development of multi-State telehealth network
test beds that build on, enhance, and securely
link existing State and local telehealth
programs to prepare for, monitor, respond to,
and manage the events of public health
emergencies, facilitate coordination and
communication among medical, public health, and
emergency response agencies, and provide
medical services through telehealth initiatives
within the States that are involved in such a
multi-State telehealth network test bed.
(4) Limitation.--Information technology systems
acquired or implemented using grants awarded under this
section must be compliant with--
(A) interoperability and other technological
standards, as determined by the Secretary; and
(B) data collection and reporting
requirements for the network described in
subsection (c).
(5) Independent evaluation.--Not later than 3 years
after the date of enactment of the Pandemic and All-
Hazards Preparedness Reauthorization Act of 2013, the
Government Accountability Office shall conduct an
independent evaluation, and submit to the Secretary and
the appropriate committees of Congress a report
concerning the activities conducted under this
subsection and subsection (c).
(e) Telehealth Enhancements for Emergency Response.--
(1) Evaluation.--The Secretary, in consultation with
the Federal Communications Commission and other
relevant Federal agencies, shall--
(A) conduct an inventory of telehealth
initiatives in existence on the date of
enactment of the Pandemic and All-Hazards
Preparedness Act, including--
(i) the specific location of network
components;
(ii) the medical, technological, and
communications capabilities of such
components;
(iii) the functionality of such
components; and
(iv) the capacity and ability of such
components to handle increased volume
during the response to a public health
emergency;
(B) identify methods to expand and
interconnect the regional health information
networks funded by the Secretary, the State and
regional broadband networks funded through the
rural health care support mechanism pilot
program funded by the Federal Communications
Commission, and other telehealth networks;
(C) evaluate ways to prepare for, monitor,
respond rapidly to, or manage the events of, a
public health emergency through the enhanced
use of telehealth technologies, including
mechanisms for payment or reimbursement for use
of such technologies and personnel during
public health emergencies;
(D) identify methods for reducing legal
barriers that deter health care professionals
from providing telemedicine services, such as
by utilizing State emergency health care
professional credentialing verification
systems, encouraging States to establish and
implement mechanisms to improve interstate
medical licensure cooperation, facilitating the
exchange of information among States regarding
investigations and adverse actions, and
encouraging States to waive the application of
licensing requirements during a public health
emergency;
(E) evaluate ways to integrate the practice
of telemedicine within the National Disaster
Medical System; and
(F) promote greater coordination among
existing Federal interagency telemedicine and
health information technology initiatives.
(2) Report.--Not later than 12 months after the date
of enactment of the Pandemic and All-Hazards
Preparedness Act, the Secretary shall prepare and
submit a report to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on
Energy and Commerce of the House of Representatives
regarding the findings and recommendations pursuant to
subparagraphs (A) through (F) of paragraph (1).
(f) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section, [$138,300,000 for
each of fiscal years 2014 through 2018] $138,300,000 for each
of fiscal years 2014 through 2016 and $58,000,000 for each of
fiscal years 2017 and 2018.
(g) Definition.--For purposes of this section the term
``biosurveillance'' means the process of gathering near real-
time biological data that relates to human and zoonotic disease
activity and threats to human or animal health, in order to
achieve early warning and identification of such health
threats, early detection and prompt ongoing tracking of health
events, and overall situational awareness of disease activity.
* * * * * * *
Part D--Primary Health Care
Subpart I--Health Centers
* * * * * * *
SEC. 330M. TELEHEALTH CHILD PSYCHIATRY ACCESS GRANTS.
(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in coordination with other relevant Federal
agencies, shall award grants to States, political subdivisions
of States, Indian tribes, and tribal organizations (for
purposes of this section, as such terms are defined in section
4 of the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450b)) to promote behavioral health integration in
pediatric primary care by--
(1) supporting the development of statewide child
psychiatry access programs; and
(2) supporting the improvement of existing statewide
child psychiatry access programs.
(b) Program Requirements.--
(1) In general.--A child psychiatry access program
referred to in subsection (a), with respect to which a
grant under such subsection may be used, shall--
(A) be a statewide network of pediatric
mental health teams that provide support to
pediatric primary care sites as an integrated
team;
(B) support and further develop organized
State networks of child and adolescent
psychiatrists to provide consultative support
to pediatric primary care sites;
(C) conduct an assessment of critical
behavioral consultation needs among pediatric
providers and such providers' preferred
mechanisms for receiving consultation and
training and technical assistance;
(D) develop an online database and
communication mechanisms, including telehealth,
to facilitate consultation support to pediatric
practices;
(E) provide rapid statewide clinical
telephone or telehealth consultations when
requested between the pediatric mental health
teams and pediatric primary care providers;
(F) conduct training and provide technical
assistance to pediatric primary care providers
to support the early identification, diagnosis,
treatment, and referral of children with
behavioral health conditions or co-occurring
intellectual and other developmental
disabilities;
(G) inform and assist pediatric providers in
accessing child psychiatry consultations and in
scheduling and conducting technical assistance;
(H) assist with referrals to specialty care
and community or behavioral health resources;
and
(I) establish mechanisms for measuring and
monitoring increased access to child and
adolescent psychiatric services by pediatric
primary care providers and expanded capacity of
pediatric primary care providers to identify,
treat, and refer children with mental health
problems.
(2) Pediatric mental health teams.--In this
subsection, the term ``pediatric mental health team''
means a team of case coordinators, child and adolescent
psychiatrists, and licensed clinical mental health
professionals, such as a psychologist, social worker,
or mental health counselor.
(c) Application.--A State, political subdivision of a State,
Indian tribe, or tribal organization seeking a grant under this
section shall submit an application to the Secretary at such
time, in such manner, and containing such information as the
Secretary may require, including a plan for the rigorous
evaluation of activities that are carried out with funds
received under such grant.
(d) Evaluation.--A State, political subdivision of a State,
Indian tribe, or tribal organization that receives a grant
under this section shall prepare and submit an evaluation of
activities carried out with funds received under such grant to
the Secretary at such time, in such manner, and containing such
information as the Secretary may reasonably require, including
a process and outcome evaluation.
(e) Matching Requirement.--The Secretary may not award a
grant under this section unless the State, political
subdivision of a State, Indian tribe, or tribal organization
involved agrees, with respect to the costs to be incurred by
the State, political subdivision of a State, Indian tribe, or
tribal organization in carrying out the purpose described in
this section, to make available non-Federal contributions (in
cash or in kind) toward such costs in an amount that is not
less than 20 percent of Federal funds provided in the grant.
(f) Authorization of Appropriations.--To carry this section,
there are authorized to be appropriated $9,000,000 for the
period of fiscal years 2018 through 2020.
Subpart II--National Health Service Corps Program
national health service corps
Sec. 331. (a)(1) For the purpose of eliminating health
manpower shortages in health professional shortage areas, there
is established, within the Service, the National Health Service
Corps, which shall consist of--
(A) such officers of the Regular and Reserve Corps of
the Service as the Secretary may designate,
(B) such civilian employees of the United States as
the Secretary may appoint, and
(C) such other individuals who are not employees of
the United States.
(2) The Corps shall be utilized by the Secretary to provide
primary health services in health professional shortage areas.
(3) For purposes of this subpart and subpart III:
(A) The term ``Corps'' means the National Health
Service Corps.
(B) The term ``Corps member'' means each of the
officers, employees, and individuals of which the Corps
consists pursuant to paragraph (1).
(C) The term ``health professional shortage area''
has the meaning given such term in section 332(a).
(D) The term ``primary health services'' means health
services regarding family medicine, internal medicine,
pediatrics (including pediatric mental health
subspecialty services), obstetrics and gynecology,
dentistry, or mental health, that are provided by
physicians or other health professionals.
(E)(i) The term ``behavioral and mental health
professionals'' means health service psychologists,
licensed clinical social workers, licensed professional
counselors, marriage and family therapists, psychiatric
nurse specialists, and psychiatrists (and pediatric
subspecialists thereof).
(ii) The term ``graduate program of behavioral and
mental health'' means a program that trains behavioral
and mental health professionals.
(b)(1) The Secretary may conduct at schools of medicine,
osteopathic medicine, dentistry, and, as appropriate, nursing
and other schools of the health professions, including schools
at which graduate programs of behavioral and mental health are
offered, and at entities which train allied health personnel,
recruiting programs for the Corps, the Scholarship Program, and
the Loan Repayment Program. Such recruiting programs shall
include efforts to recruit individuals who will serve in the
Corps other than pursuant to obligated service under the
Scholarship or Loan Repayment Program.
(2) In the case of physicians, dentists, behavioral and
mental health professionals, certified nurse midwives,
certified nurse practitioners, and physician assistants who
have an interest and a commitment to providing primary health
care, the Secretary may establish fellowship programs to enable
such health professionals to gain exposure to and expertise in
the delivery of primary health services in health professional
shortage areas. To the maximum extent practicable, the
Secretary shall ensure that any such programs are established
in conjunction with accredited residency programs, and other
training programs, regarding such health professions.
(c)(1) The Secretary may reimburse an applicant for a
position in the Corps (including an individual considering
entering into a written agreement pursuant to section 338D) for
the actual and reasonable expenses incurred in traveling to and
from the applicant's place of residence to an eligible site to
which the applicant may be assigned under section 333 for the
purpose of evaluating such site with regard to being assigned
at such site. The Secretary may establish a maximum total
amount that may be paid to an individual as reimbursement for
such expenses.
(2) The Secretary may also reimburse the applicant for the
actual and reasonable expenses incurred for the travel of 1
family member to accompany the applicant to such site. The
Secretary may establish a maximum total amount that may be paid
to an individual as reimbursement for such expenses.
(3) In the case of an individual who has entered into a
contract for obligated service under the Scholarship Program or
under the Loan Repayment Program, the Secretary may reimburse
such individual for all or part of the actual and reasonable
expenses incurred in transporting the individual, the
individual's family, and the family's possessions to the site
of the individual's assignment under section 333. The Secretary
may establish a maximum total amount that may be paid to an
individual as reimbursement for such expenses.
(d)(1) The Secretary may, under regulations promulgated by
the Secretary, adjust the monthly pay of each member of the
Corps (other than a member described in subsection (a)(1)(C))
who is directly engaged in the delivery of health services in a
health professional shortage area as follows:
(A) During the first 36 months in which such a member
is so engaged in the delivery of health services, his
monthly pay may be increased by an amount which when
added to the member's monthly pay and allowances will
provide a monthly income competitive with the average
monthly income from a practice of an individual who is
a member of the profession of the Corps member, who has
equivalent training, and who has been in practice for a
period equivalent to the period during which the Corps
member has been in practice.
(B) During the period beginning upon the expiration
of the 36 months referred to in subparagraph (A) and
ending with the month in which the member's monthly pay
and allowances are equal to or exceed the monthly
income he received for the last of such 36 months, the
member may receive in addition to his monthly pay and
allowances an amount which when added to such monthly
pay and allowances equals the monthly income he
received for such last month.
(C) For each month in which a member is directly
engaged in the delivery of health services in a health
professional shortage area in accordance with an
agreement with the Secretary entered into under section
741(f)(1)(C), under which the Secretary is obligated to
make payments in accordance with section 741(f)(2), the
amount of any monthly increase under subparagraph (A)
or (B) with respect to such member shall be decreased
by an amount equal to one-twelfth of the amount which
the Secretary is obligated to pay upon the completion
of the year of practice in which such month occurs.
For purposes of subparagraphs (A) and (B), the term ``monthly
pay'' includes special pay received under chapter 5 of title 37
of the United States Code.
(2) In the case of a member of the Corps who is directly
engaged in the delivery of health services in a health
professional shortage area in accordance with a service
obligation incurred under the Scholarship Program or the Loan
Repayment Program, the adjustment in pay authorized by
paragraph (1) may be made for such a member only upon
satisfactory completion of such service obligation, and the
first 36 months of such member's being so engaged in the
delivery of health services shall, for purposes of paragraph
(1)(A), be deemed to begin upon such satisfactory completion.
(3) A member of the Corps described in subparagraph (C) of
subsection (a)(1) shall when assigned to an entity under
section 333 be subject to the personnel system of such entity,
except that such member shall receive during the period of
assignment the income that the member would receive if the
member was a member of the Corps described in subparagraph (B)
of such subsection.
(e) Corps members assigned under section 333 to provide
health services in health professional shortage areas shall not
be counted against any employment ceiling affecting the
Department.
(f) Sections 214 and 216 shall not apply to members of the
National Health Service Corps during their period of obligated
service under the Scholarship Program or the Loan Repayment
Program, except when such members are Commissioned Corps
officers who entered into a contract with Secretary under
section 338A or 338B after December 31, 2006 and when the
Secretary determines that exercising the authority provided
under section 214 or 216 with respect to any such officer to
would not cause unreasonable disruption to health care services
provided in the community in which such officer is providing
health care services.
(g)(1) The Secretary shall, by rule, prescribe conversion
provisions applicable to any individual who, within a year
after completion of service as a member of the Corps described
in subsection (a)(1)(C), becomes a commissioned officer in the
Regular or Reserve Corps of the Service.
(2) The rules prescribed under paragraph (1) shall provide
that in applying the appropriate provisions of this Act which
relate to retirement, any individual who becomes such an
officer shall be entitled to have credit for any period of
service as a member of the Corps described in subsection
(a)(1)(C).
(h) The Secretary shall ensure that adequate staff is
provided to the Service with respect to effectively
administering the program for the Corps.
(i)(1) In carrying out subpart III, the Secretary may, in
accordance with this subsection, issue waivers to individuals
who have entered into a contract for obligated service under
the Scholarship Program or the Loan Repayment Program under
which the individuals are authorized to satisfy the requirement
of obligated service through providing clinical practice that
is half time.
(2) A waiver described in paragraph (1) may be provided by
the Secretary only if--
(A) the entity for which the service is to be
performed--
(i) has been approved under section 333A for
assignment of a Corps member; and
(ii) has requested in writing assignment of a
health professional who would serve half time;
(B) the Secretary has determined that assignment of a
health professional who would serve half time would be
appropriate for the area where the entity is located;
(C) a Corps member who is required to perform
obligated service has agreed in writing to be assigned
for half-time service to an entity described in
subparagraph (A);
(D) the entity and the Corps member agree in writing
that the Corps member will perform half-time clinical
practice;
(E) the Corps member agrees in writing to fulfill all
of the service obligations under section 338C through
half-time clinical practice and either--
(i) double the period of obligated service
that would otherwise be required; or
(ii) in the case of contracts entered into
under section 338B, accept a minimum service
obligation of 2 years with an award amount
equal to 50 percent of the amount that would
otherwise be payable for full-time service; and
(F) the Corps member agrees in writing that if the
Corps member begins providing half-time service but
fails to begin or complete the period of obligated
service, the method stated in 338E(c) for determining
the damages for breach of the individual's written
contract will be used after converting periods of
obligated service or of service performed into their
full-time equivalents.
(3) In evaluating waivers issued under paragraph (1), the
Secretary shall examine the effect of multidisciplinary teams.
(j) For the purposes of this subpart and subpart III:
(1) The term ``Department'' means the Department of
Health and Human Services.
(2) The term ``Loan Repayment Program'' means the
National Health Service Corps Loan Repayment Program
established under section 338B.
(3) The term ``Scholarship Program'' means the
National Health Service Corps Scholarship Program
established under section 338A.
(4) The term ``State'' includes, in addition to the
several States, only the District of Columbia, the
Commonwealth of Puerto Rico, the Commonwealth of the
Northern Mariana Islands, the Virgin Islands, Guam,
American Samoa, and the Trust Territory of the Pacific
Islands.
(5) The terms ``full time'' and ``full-time'' mean a
minimum of 40 hours per week in a clinical practice,
for a minimum of 45 weeks per year.
(6) The terms ``half time'' and ``half-time'' mean a
minimum of 20 hours per week (not to exceed 39 hours
per week) in a clinical practice, for a minimum of 45
weeks per year.
* * * * * * *
Subpart III--Scholarship Program and Loan Repayment Program
* * * * * * *
SEC. 338B. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAM.
(a) Establishment.--The Secretary shall establish a program
to be known as the National Health Service Corps Loan Repayment
Program to assure, with respect to the provision of primary
health services pursuant to section 331(a)(2)--
(1) an adequate supply of physicians, dentists,
behavioral and mental health professionals, certified
nurse midwives, certified nurse practitioners, and
physician assistants; and
(2) if needed by the Corps, an adequate supply of
other health professionals.
(b) Eligibility.--To be eligible to participate in the Loan
Repayment Program, an individual must--
(1)(A) have a degree in medicine, osteopathic
medicine, dentistry, or another health profession, or
an appropriate degree from a graduate program of
behavioral and mental health, or be certified as a
nurse midwife, nurse practitioner, or physician
assistant;
(B) be enrolled in an approved graduate training
program in medicine, osteopathic medicine, dentistry,
behavioral and mental health, or other health
profession, including any physician child and
adolescent psychiatry residency or fellowship training
program; or
(C) be enrolled as a full-time student--
(i) in an accredited (as determined by the
Secretary) educational institution in a State;
and
(ii) in the final year of a course of a study
or program, offered by such institution and
approved by the Secretary, leading to a degree
in medicine, osteopathic medicine, dentistry,
or other health profession;
(2) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of
the Service or be eligible for selection for civilian
service in the Corps; and
(3) submit to the Secretary an application for a
contract described in subsection (f) (relating to the
payment by the Secretary of the educational loans of
the individual in consideration of the individual
serving for a period of obligated service).
(c) Application, Contract, and Information Requirements.--
(1) Summary and information.--In disseminating
application forms and contract forms to individuals
desiring to participate in the Loan Repayment Program,
the Secretary shall include with such forms--
(A) a fair summary of the rights and
liabilities of an individual whose application
is approved (and whose contract is accepted) by
the Secretary, including in the summary a clear
explanation of the damages to which the United
States is entitled under section 338E in the
case of the individual's breach of the
contract; and
(B) information respecting meeting a service
obligation through private practice under an
agreement under section 338D and such other
information as may be necessary for the
individual to understand the individual's
prospective participation in the Loan Repayment
Program and service in the Corps.
(2) Understandability.--The application form,
contract form, and all other information furnished by
the Secretary under this subpart shall be written in a
manner calculated to be understood by the average
individual applying to participate in the Loan
Repayment Program.
(3) Availability.--The Secretary shall make such
application forms, contract forms, and other
information available to individuals desiring to
participate in the Loan Repayment Program on a date
sufficiently early to ensure that such individuals have
adequate time to carefully review and evaluate such
forms and information.
(4) Recruitment and retention.--
(A) The Secretary shall distribute to health
professions schools materials providing
information on the Loan Repayment Program and
shall encourage the schools to disseminate the
materials to the students of the schools.
(B)(i) In the case of any health professional
whose period of obligated service under the
Loan Repayment Program is nearing completion,
the Secretary shall encourage the individual to
remain in a health professional shortage area
and to continue providing primary health
services.
(ii) During the period in which a health
professional is planning and making the
transition to private practice from obligated
service under the Loan Repayment Program, the
Secretary may provide assistance to the
professional regarding such transition if the
professional is remaining in a health
professional shortage area and is
continuing to provide primary health services.
(C) In the case of entities to which
participants in the Loan Repayment Program are
assigned under section 333, the Secretary shall
encourage the entities to provide options with
respect to assisting the participants in
remaining in the health professional shortage
areas involved, and in continuing to provide
primary health services, after the period of
obligated service under the Loan Repayment
Program is completed. The options with respect
to which the Secretary provides such
encouragement may include options regarding the
sharing of a single employment position in the
health professions by 2 or more health
professionals, and options regarding the
recruitment of couples where both of the
individuals are health professionals.
(d)(1) Subject to section 333A, in providing contracts under
the Loan Repayment Program--
(A) the Secretary shall consider the extent of the
demonstrated interest of the applicants for the
contracts in providing primary health services; and
(B) may consider such other factors regarding the
applicants as the Secretary determines to be relevant
to selecting qualified individuals to participate in
such Program.
(2) In providing contracts under the Loan Repayment Program,
the Secretary shall give priority--
(A) to any application for such a contract submitted
by an individual whose training is in a health
profession or specialty determined by the Secretary to
be needed by the Corps;
(B) to any application for such a contract submitted
by an individual who has (and whose spouse, if any,
has) characteristics that increase the probability that
the individual will continue to serve in a health
professional shortage area after the period of
obligated service pursuant to subsection (f) is
completed; and
(C) subject to subparagraph (B), to any application
for such a contract submitted by an individual who is
from a disadvantaged background.
(e) Approval Required for Participation.--An individual
becomes a participant in the Loan Repayment Program only upon
the Secretary and the individual entering into a written
contract described in subsection (f).
(f) Contents of Contracts.--The written contract (referred to
in this subpart) between the Secretary and an individual shall
contain--
(1) an agreement that--
(A) subject to paragraph (3), the Secretary
agrees--
(i) to pay on behalf of the
individual loans in accordance with
subsection (g); and
(ii) to accept (subject to the
availability of appropriated funds for
carrying out sections 331 through 335
and section 337) the individual into
the Corps (or for equivalent service as
otherwise provided in this subpart);
and
(B) subject to paragraph (3), the individual
agrees--
(i) to accept loan payments on behalf
of the individual;
(ii) in the case of an individual
described in subsection (b)(1)(C), to
maintain enrollment in a course of
study or training described in such
subsection until the individual
completes the course of study or
training;
(iii) in the case of an individual
described in subsection (b)(1)(C),
while enrolled in such course of study
or training, to maintain an acceptable
level of academic standing (as
determined under regulations of the
Secretary by the educational
institution offering such course of
study or training); and
(iv) to serve for a time period
(hereinafter in this subpart referred
to as the ``period of obligated
service'') equal to 2 years or such
longer period as the individual may
agree to, as a provider of primary
health services in a health
professional shortage area (designated
under section 332) to which such
individual is assigned by the Secretary
as a member of the Corps or released
under section 338D;
(2) a provision permitting the Secretary to extend
for such longer additional periods, as the individual
may agree to, the period of obligated service agreed to
by the individual under paragraph (1)(B)(iv), including
extensions resulting in an aggregate period of
obligated service in excess of 4 years;
(3) a provision that any financial obligation of the
United States arising out of a contract entered into
under this subpart and any obligation of the individual
that is conditioned thereon, is contingent on funds
being appropriated for loan repayments under this
subpart and to carry out the purposes of sections 331
through 335 and sections 337 and 338;
(4) a statement of the damages to which the United
States is entitled, under section 338E for the
individual's breach of the contract; and
(5) such other statements of the rights and
liabilities of the Secretary and of the individual, not
inconsistent with this subpart.
(g) Payments.--
(1) In general.--A loan repayment provided for an
individual under a written contract under the Loan
Repayment Program shall consist of payment, in
accordance with paragraph (2), on behalf of the
individual of the principal, interest, and related
expenses on government and commercial loans received by
the individual regarding the undergraduate or graduate
education of the individual (or both), which loans were
made for--
(A) tuition expenses;
(B) all other reasonable educational
expenses, including fees, books, and laboratory
expenses, incurred by the individual; or
(C) reasonable living expenses as determined
by the Secretary.
(2) Payments for years served.--
(A) In general.--For each year of obligated
service that an individual contracts to serve
under subsection (f) the Secretary may pay up
to $50,000, plus, beginning with fiscal year
2012, an amount determined by the Secretary on
an annual basis to reflect inflation, on behalf
of the individual for loans described in
paragraph (1). In making a determination of the
amount to pay for a year of such service by an
individual, the Secretary shall consider the
extent to which each such determination--
(i) affects the ability of the
Secretary to maximize the number of
contracts that can be provided under
the Loan Repayment Program from the
amounts appropriated for such
contracts;
(ii) provides an incentive to serve
in health professional shortage areas
with the greatest such shortages; and
(iii) provides an incentive with
respect to the health professional
involved remaining in a health
professional shortage area, and
continuing to provide primary health
services, after the completion of the
period of obligated service under the
Loan Repayment Program.
(B) Repayment schedule.--Any arrangement made
by the Secretary for the making of loan
repayments in accordance with this subsection
shall provide that any repayments for a year of
obligated service shall be made no later than
the end of the fiscal year in which the
individual completes such year of service.
(3) Tax liability.--For the purpose of providing
reimbursements for tax liability resulting from
payments under paragraph (2) on behalf of an
individual--
(A) the Secretary shall, in addition to such
payments, make payments to the individual in an
amount equal to 39 percent of the total amount
of loan repayments made for the taxable year
involved; and
(B) may make such additional payments as the
Secretary determines to be appropriate with
respect to such purpose.
(4) Payment schedule.--The Secretary may enter into
an agreement with the holder of any loan for which
payments are made under the Loan Repayment Program to
establish a schedule for the making of such payments.
(h) Employment Ceiling.--Notwithstanding any other provision
of law, individuals who have entered into written contracts
with the Secretary under this section, while undergoing
academic or other training, shall not be counted against any
employment ceiling affecting the Department.
* * * * * * *
PART Q--PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN
* * * * * * *
SEC. 399Z-2. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION,
INTERVENTION, AND TREATMENT.
(a) Grants.--The Secretary shall--
(1) award grants to eligible entities, including
human services agencies, to develop, maintain, or
enhance infant and early childhood mental health
promotion, intervention, and treatment programs,
including--
(A) programs for infants and children at
significant risk of developing, showing early
signs of, or having been diagnosed with mental
disorders including serious emotional
disturbance; and
(B) multigenerational therapy and other
services that support the caregiving
relationship; and
(2) ensure that programs funded through grants under
this section are evidence-informed or evidence-based
models, practices, and methods that are, as
appropriate, culturally and linguistically appropriate,
and can be replicated in other appropriate settings.
(b) Eligible Children and Entities.--In this section:
(1) Eligible child.--The term ``eligible child''
means a child from birth to not more than 5 years of
age who--
(A) is at risk for, shows early signs of, or
has been diagnosed with a mental disorder,
including serious emotional disturbance; and
(B) may benefit from infant and early
childhood intervention or treatment programs or
specialized preschool or elementary school
programs that are evidence-based or that have
been scientifically demonstrated to show
promise but would benefit from further applied
development.
(2) Eligible entity.--The term ``eligible entity''
means a nonprofit institution that--
(A) is accredited or approved by a State
mental health or education agency, as
applicable, to provide for children from
infancy to 5 years of age mental health
promotion, intervention, or treatment services
that are evidence-based or that have been
scientifically demonstrated to show promise but
would benefit from further applied development;
and
(B) provides programs described in subsection
(a) that are evidence-based or that have been
scientifically demonstrated to show promise but
would benefit from further applied development.
(c) Application.--An eligible entity seeking a grant under
subsection (a) shall submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
(d) Use of Funds for Early Intervention and Treatment
Programs.--An eligible entity may use amounts awarded under a
grant under subsection (a)(1) to carry out the following:
(1) Provide age-appropriate mental health promotion
and early intervention services or mental disorder
treatment services, which may include specialized
programs, for eligible children at significant risk of
developing, showing early signs of, or having been
diagnosed with a mental disorder, including serious
emotional disturbance. Such services may include social
and behavioral services as well as multigenerational
therapy and other services ?that support the caregiving
relationship.
(2) Provide training for health care professionals
with expertise in infant and early childhood mental
health care with respect to appropriate and relevant
integration with other disciplines such as primary care
clinicians, early intervention specialists, child
welfare staff, home visitors, early care and education
providers, and others who work with young children and
families.
(3) Provide mental health consultation to personnel
of early care and education programs (including
licensed or regulated center-based and home-based child
care, home visiting, preschool special education, and
early intervention programs) who work with children and
families.
(4) Provide training for mental health clinicians in
infant and early childhood promising and evidence-based
practices and models for mental health treatment and
early intervention, including with regard to practices
for identifying and treating mental and behavioral
disorders of infants and children resulting from
exposure or repeated exposure to adverse childhood
experiences or childhood trauma.
(5) Provide age-appropriate assessment, diagnostic,
and intervention services for eligible children,
including early mental health promotion, intervention,
and treatment services.
(e) Matching Funds.--The Secretary may not award a grant
under this section to an eligible entity unless the eligible
entity agrees, with respect to the costs to be incurred by the
eligible entity in carrying out the activities described in
subsection (d), to make available non-Federal contributions (in
cash or in kind) toward such costs in an amount that is not
less than 10 percent of the total amount of Federal funds
provided in the grant.
(f) Authorization of Appropriations.--To carry this section,
there are authorized to be appropriated $20,000,000 for the
period of fiscal years 2018 through 2022.
* * * * * * *
TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
Part A--Organization and General Authorities
SEC. 501. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION.
(a) Establishment.--The Substance Abuse and Mental Health
Services Administration (hereafter referred to in this title as
the ``Administration'') is an agency of the Service.
(b) Agencies.--The following entities are agencies of the
Administration:
(1) The Center for Substance Abuse Treatment.
(2) The Center for Substance Abuse Prevention.
(3) The Center for Mental Health Services.
(4) The Center for Behavioral Health Statistics and
Quality.
[(c) Administrator and Deputy Administrator.--
[(1) Administrator.--The Administration shall be
headed by an Administrator (hereinafter in this title
referred to as the ``Administrator'') who shall be
appointed by the President, by and with the advice and
consent of the Senate.
[(2) Deputy Administrator.--The Administrator, with
the approval of the Secretary, may appoint a Deputy
Administrator and may employ and prescribe the
functions of such officers and employees, including
attorneys, as are necessary to administer the
activities to be carried out through the
Administration.]
(c) Assistant Secretary and Deputy Assistant Secretary.--
(1) Assistant secretary.--
(A) Appointment.--The Administration shall be
headed by an official to be known as the
Assistant Secretary for Mental Health and
Substance Use (hereinafter in this title
referred to as the ``Assistant Secretary'') who
shall be appointed by the President, by and
with the advice and consent of the Senate.
(B) Qualifications.--In selecting the
Assistant Secretary, the President shall give
preference to individuals who have--
(i) a doctoral degree in medicine,
osteopathic medicine, or psychology;
(ii) clinical and research experience
regarding mental health and substance
use disorders; and
(iii) an understanding of biological,
psychosocial, and pharmaceutical
treatments of mental illness and
substance use disorders.
(2) Deputy assistant secretary.--The Assistant
Secretary, with the approval of the Secretary, may
appoint a Deputy Assistant Secretary and may employ and
prescribe the functions of such officers and employees,
including attorneys, as are necessary to administer the
activities to be carried out through the
Administration.
(d) Authorities.--The Secretary, acting through the
[Administrator] Assistant Secretary, shall--
(1) supervise the functions of the agencies of the
Administration in order to assure that the programs
carried out through each such agency receive
appropriate and equitable support and that there is
cooperation among the agencies in the implementation of
such programs;
(2) establish and implement, through the respective
agencies, a comprehensive program to improve the
provision of treatment and related services to
individuals with respect to substance abuse and mental
illness and to improve prevention services, promote
mental health and protect the legal rights of
individuals with mental illnesses and individuals who
are substance abusers;
(3) carry out the administrative and financial
management, policy development and planning,
evaluation, knowledge dissemination, and public
information functions that are required for the
implementation of this title;
(4) assure that the Administration conduct and
coordinate demonstration projects, evaluations, and
service system assessments and other activities
necessary to improve the availability and quality of
treatment, prevention and related services;
(5) support activities that will improve the
provision of treatment, prevention and related
services, including the development of national mental
health and substance abuse goals and model programs;
(6) in cooperation with the National Institutes of
Health, the Centers for Disease Control and the Health
Resources and Services Administration develop
educational materials and intervention strategies to
reduce the risks of HIV or tuberculosis among substance
abusers and individuals with mental illness and to
develop appropriate mental health services for
individuals with such illnesses;
(7) coordinate Federal policy with respect to the
provision of treatment services for substance abuse
utilizing anti-addiction medications, including
methadone;
(8) conduct programs, and assure the coordination of
such programs with activities of the National
Institutes of Health and the Agency for Health Care
Policy Research, as appropriate, to evaluate the
process, outcomes and community impact of treatment and
prevention services and systems of care in order to
identify the manner in which such services can most
effectively be provided;
(9) collaborate with the Director of the National
Institutes of Health in the development of a system by
which the relevant research findings of the National
Institute on Drug Abuse, the National Institute on
Alcohol Abuse and Alcoholism, the National Institute of
Mental Health, and, as appropriate, the Agency for
Health Care Policy Research are disseminated to service
providers in a manner designed to improve the delivery
and effectiveness of treatment and prevention services;
(10) encourage public and private entities that
provide health insurance to provide benefits for
substance abuse and mental health services;
(11) promote the integration of substance abuse and
mental health services into the mainstream of the
health care delivery system of the United States;
(12) monitor compliance by hospitals and other
facilities with the requirements of sections 542 and
543;
(13) with respect to grant programs authorized under
this title, assure that--
(A) all grants that are awarded for the
provision of services are subject to
performance and outcome evaluations; and
(B) all grants that are awarded to entities
other than States are awarded only after the
State in which the entity intends to provide
services--
(i) is notified of the pendency of
the grant application; and
(ii) is afforded an opportunity to
comment on the merits of the
application;
(14) assure that services provided with amounts
appropriated under this title are provided bilingually,
if appropriate;
(15) improve coordination among prevention programs,
treatment facilities and nonhealth care systems such as
employers, labor unions, and schools, and encourage the
adoption of employee assistance programs and student
assistance programs;
(16) maintain a clearinghouse for substance abuse and
mental health information to assure the widespread
dissemination of such information to States, political
subdivisions, educational agencies and institutions,
treatment providers, and the general public;
(17) in collaboration with the National Institute on
Aging, and in consultation with the National Institute
on Drug Abuse, the National Institute on Alcohol Abuse
and Alcoholism and the National Institute of Mental
Health, as appropriate, promote and evaluate substance
abuse services for older Americans in need of such
services, and mental health services for older
Americans who are seriously mentally ill; [and]
(18) promote the coordination of service programs
conducted by other departments, agencies, organizations
and individuals that are or may be related to the
problems of individuals suffering from mental illness
or substance abuse, including liaisons with the Social
Security Administration, Centers for Medicare &
Medicaid Services, and other programs of the
Department, as well as liaisons with the Department of
Education, Department of Justice, and other Federal
Departments and offices, as appropriate[.];
(19) evaluate, in consultation with the Assistant
Secretary for Financial Resources, the information used
for oversight of grants under programs related to
mental and substance use disorders, including co-
occurring disorders, administered by the Center for
Mental Health Services;
(20) periodically review Federal programs and
activities relating to the diagnosis or prevention of,
or treatment or rehabilitation for, mental illness and
substance use disorders to identify any such programs
or activities that have proven to be effective or
efficient in improving outcomes or increasing access to
evidence-based programs;
(21) establish standards for the appointment of peer-
review panels to evaluate grant applications and
recommend standards for mental health grant programs;
and
(22) in consultation with the National Mental Health
and Substance Use Policy Laboratory, and after
providing an opportunity for public input, set
standards for grant programs under this title for
mental health and substance use services, which may
address--
(A) the capacity of the grantee to implement
the award;
(B) requirements for the description of the
program implementation approach;
(C) the extent to which the grant plan
submitted by the grantee as part of its
application must explain how the grantee will
reach the population of focus and provide a
statement of need, including to what extent the
grantee will increase the number of clients
served and the estimated percentage of clients
receiving services who report positive
functioning after 6 months or no past-month
substance use, as applicable;
(D) the extent to which the grantee must
collect and report on required performance
measures; and
(E) the extent to which the grantee is
proposing evidence-based practices and the
extent to which--
(i) those evidence-based practices
must be used with respect to a
population similar to the population
for which the evidence-based practices
were shown to be effective; or
(ii) if no evidence-based practice
exists for a population of focus, the
way in which the grantee will implement
adaptations of evidence-based
practices, promising practices, or
cultural practices.
(e) Associate Administrator for Alcohol Prevention and
Treatment Policy.--
(1) In general.--There may be in the Administration
an Associate Administrator for Alcohol Prevention and
Treatment Policy to whom the [Administrator] Assistant
Secretary may delegate the functions of promoting,
monitoring, and evaluating service programs for the
prevention and treatment of alcoholism and alcohol
abuse within the Center for Substance Abuse Prevention,
the Center for Substance Abuse Treatment and the Center
for Mental Health Services, and coordinating such
programs among the Centers, and among the Centers and
other public and private entities. The Associate
Administrator also may ensure that alcohol prevention,
education, and policy strategies are integrated into
all programs of the Centers that address substance
abuse prevention, education, and policy, and that the
Center for Substance Abuse Prevention addresses the
Healthy People 2010 goals and the National Dietary
Guidelines of the Department of Health and Human
Services and the Department of Agriculture related to
alcohol consumption.
(2) Plan.--
(A) The [Administrator] Assistant Secretary,
acting through the Associate Administrator for
Alcohol Prevention and Treatment Policy, shall
develop, and periodically review and as
appropriate revise, a plan for programs and
policies to treat and prevent alcoholism and
alcohol abuse. The plan shall be developed (and
reviewed and revised) in collaboration with the
Directors of the Centers of the Administration
and in consultation with members of other
Federal agencies and public and private
entities.
(B) Not later than 1 year after the date of
the enactment of the ADAMHA Reorganization Act,
the [Administrator] Assistant Secretary shall
submit to the Congress the first plan developed
under subparagraph (A).
(3) Report.--
(A) Not less than once during each 2 years,
the [Administrator] Assistant Secretary, acting
through the Associate Administrator for Alcohol
Prevention and Treatment Policy, shall prepare
a report describing the alcoholism and alcohol
abuse prevention and treatment programs
undertaken by the Administration and its
agencies, and the report shall include a
detailed statement of the expenditures made for
the activities reported on and the personnel
used in connection with such activities.
(B) Each report under subparagraph (A) shall
include a description of any revisions in the
plan under paragraph (2) made during the
preceding 2 years.
(C) Each report under subparagraph (A) shall
be submitted to the [Administrator] Assistant
Secretary for inclusion in the biennial report
under subsection (k).
(f) Associate Administrator for Women's Services.--
(1) Appointment.--The [Administrator] Assistant
Secretary, with the approval of the Secretary, shall
appoint an Associate Administrator for Women's Services
who shall report directly to the [Administrator]
Assistant Secretary.
(2) Duties.--The Associate Administrator appointed
under paragraph (1) shall--
(A) establish a committee to be known as the
Coordinating Committee for Women's Services
(hereafter in this subparagraph referred to as
the ``Coordinating Committee''), which shall be
composed of the Directors of the agencies of
the Administration (or the designees of the
Directors);
(B) acting through the Coordinating
Committee, with respect to women's substance
abuse and mental health services--
(i) identify the need for such
services, and make an estimate each
fiscal year of the funds needed to
adequately support the services;
(ii) identify needs regarding the
coordination of services;
(iii) encourage the agencies of the
Administration to support such
services; and
(iv) assure that the unique needs of
minority women, including Native
American, Hispanic, African-American
and Asian women, are recognized and
addressed within the activities of the
Administration; and
(C) establish an advisory committee to be
known as the Advisory Committee for Women's
Services, which shall be composed of not more
than 10 individuals, a majority of whom shall
be women, who are not officers or employees of
the Federal Government, to be appointed by the
[Administrator] Assistant Secretary from among
physicians, practitioners, treatment providers,
and other health professionals, whose clinical
practice, specialization, or professional
expertise includes a significant focus on
women's substance abuse and mental health
conditions, that shall--
(i) advise the Associate
Administrator on appropriate activities
to be undertaken by the agencies of the
Administration with respect to women's
substance abuse and mental health
services, including services which
require a multidisciplinary approach;
(ii) collect and review data,
including information provided by the
Secretary (including the material
referred to in paragraph (3)), and
report biannually to the
[Administrator] Assistant Secretary
regarding the extent to which women are
represented among senior personnel, and
make recommendations regarding
improvement in the participation of
women in the workforce of the
Administration; and
(iii) prepare, for inclusion in the
biennial report required pursuant to
subsection (k), a description of
activities of the Committee, including
findings made by the Committee
regarding--
(I) the extent of
expenditures made for women's
substance abuse and mental
health services by the agencies
of the Administration; and
(II) the estimated level of
funding needed for substance
abuse and mental health
services to meet the needs of
women;
(D) improve the collection of data on women's
health by--
(i) reviewing the current data at the
Administration to determine its
uniformity and applicability;
(ii) developing standards for all
programs funded by the Administration
so that data are, to the extent
practicable, collected and reported
using common reporting formats,
linkages and definitions; and
(iii) reporting to the
[Administrator] Assistant Secretary a
plan for incorporating the standards
developed under clause (ii) in all
Administration programs and a plan to
assure that the data so collected are
accessible to health professionals,
providers, researchers, and members of
the public; and
(E) shall establish, maintain, and operate a
program to provide information on women's
substance abuse and mental health services.
(3) Study.--
(A) The Secretary, acting through the
Assistant Secretary for Personnel, shall
conduct a study to evaluate the extent to which
women are represented among senior personnel at
the Administration.
(B) Not later than 90 days after the date of
the enactment of the ADAMHA Reorganization Act,
the Assistant Secretary for Personnel shall
provide the Advisory Committee for Women's
Services with a study plan, including the
methodology of the study and any sampling
frames. Not later than 180 days after such date
of enactment, the Assistant Secretary shall
prepare and submit directly to the Advisory
Committee a report concerning the results of
the study conducted under subparagraph (A).
(C) The Secretary shall prepare and provide
to the Advisory Committee for Women's Services
any additional data as requested.
(4) Office.--Nothing in this subsection shall be
construed to preclude the Secretary from establishing
within the Substance Abuse and Mental Health
Administration an Office of Women's Health.
(5) Definition.--For purposes of this subsection, the
term ``women's substance abuse and mental health
conditions'', with respect to women of all age, ethnic,
and racial groups, means all aspects of substance abuse
and mental illness--
(A) unique to or more prevalent among women;
or
(B) with respect to which there have been
insufficient services involving women or
insufficient data.
(g) Services of Experts.--
(1) In general.--The [Administrator] Assistant
Secretary may obtain (in accordance with section 3109
of title 5, United States Code, but without regard to
the limitation in such section on the number of days or
the period of service) the services of not more than 20
experts or consultants who have professional
qualifications. Such experts and consultants shall be
obtained for the Administration and for each of its
agencies.
(2) Compensation and expenses.--
(A) Experts and consultants whose services
are obtained under paragraph (1) shall be paid
or reimbursed for their expenses associated
with traveling to and from their assignment
location in accordance with sections 5724,
5724a(a), 5724a(c), and 5726(c) of title 5,
United States Code.
(B) Expenses specified in subparagraph (A)
may not be allowed in connection with the
assignment of an expert or consultant whose
services are obtained under paragraph (1),
unless and until the expert or consultant
agrees in writing to complete the entire period
of assignment or one year, whichever is
shorter, unless separated or reassigned for
reasons beyond the control of the expert or
consultant that are acceptable to the
Secretary. If the expert or consultant violates
the agreement, the money spent by the United
States for the expenses specified in
subparagraph (A) is recoverable from the expert
or consultant as a debt of the United States.
The Secretary may waive in whole or in part a
right of recovery under this subparagraph.
(h) Peer Review Groups.--The [Administrator] Assistant
Secretary shall, without regard to the provisions of title 5,
United States Code, governing appointments in the competitive
service, and without regard to the provisions of chapter 51 and
subchapter III of chapter 53 of such title, relating to
classification and General Schedule pay rates, establish such
peer review groups and program advisory committees as are
needed to carry out the requirements of this title and appoint
and pay members of such groups, except that officers and
employees of the United States shall not receive additional
compensation for services as members of such groups. The
Federal Advisory Committee Act shall not apply to the duration
of a peer review group appointed under this subsection.
(i) Voluntary Services.--The [Administrator] Assistant
Secretary may accept voluntary and uncompensated services.
(j) Administration.--The [Administrator] Assistant Secretary
shall ensure that programs and activities assigned under this
title to the Administration are fully administered by the
respective Centers to which such programs and activities are
assigned.
(k) Report Concerning Activities and Progress.--Not later
than February 10, 1994, and once every 2 years thereafter, the
[Administrator] Assistant Secretary shall prepare and submit to
the Committee on Energy and Commerce of the House of
Representatives, and to the Committee on Labor and Human
Resources of the Senate, the report containing--
(1) a description of the activities carried out by
the Administration;
(2) a description of any measurable progress made in
improving the availability and quality of substance
abuse and mental health services;
(3) a description of the mechanisms by which relevant
research findings of the National Institute on Drug
Abuse, the National Institute on Alcohol Abuse and
Alcoholism, and the National Institute of Mental Health
have been disseminated to service providers or
otherwise utilized by the Administration to further the
purposes of this title; and
(4) any report required in this title to be submitted
to the Adminstrator for inclusion in the report under
this subsection.
(l) Strategic Plan.--
(1) In general.--Not later than December 1, 2017, and
every 5 years thereafter, the Assistant Secretary shall
develop and carry out a strategic plan in accordance
with this subsection for the planning and operation of
evidence-based programs and grants carried out by the
Administration.
(2) Coordination.--In developing and carrying out the
strategic plan under this section, the Assistant
Secretary shall take into consideration the report of
the Interdepartmental Serious Mental Illness
Coordinating Committee under section 301 of the Helping
Families in Mental Health Crisis Act of 2016.
(3) Publication of plan.--Not later than December 1,
2017, and every 5 years thereafter, the Assistant
Secretary shall--
(A) submit the strategic plan developed under
paragraph (1) to the appropriate committees of
Congress; and
(B) post such plan on the Internet website of
the Administration.
(4) Contents.--The strategic plan developed under
paragraph (1) shall--
(A) identify strategic priorities, goals, and
measurable objectives for mental and substance
use disorder activities and programs operated
and supported by the Administration, including
priorities to prevent or eliminate the burden
of mental illness and substance use disorders;
(B) identify ways to improve services for
individuals with a mental or substance use
disorder, including services related to the
prevention of, diagnosis of, intervention in,
treatment of, and recovery from, mental or
substance use disorders, including serious
mental illness or serious emotional
disturbance, and access to services and
supports for individuals with a serious mental
illness or serious emotional disturbance;
(C) ensure that programs provide, as
appropriate, access to effective and evidence-
based prevention, diagnosis, intervention,
treatment, and recovery services, including
culturally and linguistically appropriate
services, as appropriate, for individuals with
a mental or substance use disorder;
(D) identify opportunities to collaborate
with the Health Resources and Services
Administration to develop or improve--
(i) initiatives to encourage
individuals to pursue careers
(especially in rural and underserved
areas and populations) as
psychiatrists, psychologists,
psychiatric nurse practitioners,
physician assistants, occupational
therapists, clinical social workers,
certified peer support specialists,
licensed professional counselors, or
other licensed or certified mental
health professionals, including such
professionals specializing in the
diagnosis, evaluation, or treatment of
individuals with a serious mental
illness or serious emotional
disturbance; and
(ii) a strategy to improve the
recruitment, training, and retention of
a workforce for the treatment of
individuals with mental or substance
use disorders, or co-occurring
disorders;
(E) identify opportunities to improve
collaboration with States, local governments,
communities, and Indian tribes and tribal
organizations (as such terms are defined in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b)); and
(F) specify a strategy to disseminate
evidenced-based and promising best practices
related to prevention, diagnosis, early
intervention, treatment, and recovery services
related to mental illness, particularly for
individuals with a serious mental illness and
children and adolescents with a serious
emotional disturbance, and substance use
disorders.
[(l)] (m) Applications for Grants and Contracts.--With
respect to awards of grants, cooperative agreements, and
contracts under this title, the [Administrator] Assistant
Secretary, or the Director of the Center involved, as the case
may be, may not make such an award unless--
(1) an application for the award is submitted to the
official involved;
(2) with respect to carrying out the purpose for
which the award is to be provided, the application
provides assurances of compliance satisfactory to such
official; and
(3) the application is otherwise in such form, is
made in such manner, and contains such agreements,
assurances, and information as the official determines
to be necessary to carry out the purpose for which the
award is to be provided.
[(m)] (n) Emergency Response.--
(1) In general.--Notwithstanding section 504 and
except as provided in paragraph (2), the Secretary may
use not to exceed 2.5 percent of all amounts
appropriated under this title for a fiscal year to make
noncompetitive grants, contracts or cooperative
agreements to public entities to enable such entities
to address emergency substance abuse or mental health
needs in local communities.
(2) Exceptions.--Amounts appropriated under part C
shall not be subject to paragraph (1).
(3) Emergencies.--The Secretary shall establish
criteria for determining that a substance abuse or
mental health emergency exists and publish such
criteria in the Federal Register prior to providing
funds under this subsection.
[(n)] (o) Limitation on the Use of Certain Information.--No
information, if an establishment or person supplying the
information or described in it is identifiable, obtained in the
course of activities undertaken or supported under section 505
may be used for any purpose other than the purpose for which it
was supplied unless such establishment or person has consented
(as determined under regulations of the Secretary) to its use
for such other purpose. Such information may not be published
or released in other form if the person who supplied the
information or who is described in it is identifiable unless
such person has consented (as determined under regulations of
the Secretary) to its publication or release in other form.
[(o)] (p) Authorization of Appropriations.--For the purpose
of providing grants, cooperative agreements, and contracts
under this section, there are authorized to be appropriated
$25,000,000 for fiscal year 2001, and such sums as may be
necessary for each of the fiscal years 2002 and 2003.
SEC. 501A. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE USE
PROGRAMS.
(a) Activities.--For the purpose of ensuring efficient and
effective planning and evaluation of mental and substance use
disorder programs and related activities, the Assistant
Secretary for Planning and Evaluation, in consultation with the
Assistant Secretary for Mental Health and Substance Use,
shall--
(1) collect and organize relevant data on
homelessness, involvement with the criminal justice
system, hospitalizations, mortality outcomes, and other
measures the Secretary deems appropriate from across
Federal departments and agencies;
(2) evaluate programs related to mental and substance
use disorders, including co-occurring disorders, across
Federal departments and agencies, as appropriate,
including programs related to--
(A) prevention, intervention, treatment, and
recovery support services, including such
services for individuals with a serious mental
illness or serious emotional disturbance;
(B) the reduction of homelessness and
involvement with the criminal justice system
among individuals with a mental or substance
use disorder; and
(C) public health and health services; and
(3) consult, as appropriate, with the Assistant
Secretary, the Behavioral Health Coordinating Council
of the Department of Health and Human Services, other
agencies within the Department of Health and Human
Services, and other relevant Federal departments.
(b) Recommendations.--The Assistant Secretary for Planning
and Evaluation shall develop an evaluation strategy that
identifies priority programs to be evaluated by the Assistant
Secretary and priority programs to be evaluated by other
relevant agencies within the Department of Health and Human
Services. The Assistant Secretary for Planning and Evaluation
shall provide recommendations on improving programs and
activities based on the evaluation described in subsection
(a)(2) as needing improvement.
SEC. 501B. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY LABORATORY.
(a) In General.--There shall be established within the
Administration a National Mental Health and Substance Use
Policy Laboratory (referred to in this section as the
``Laboratory'').
(b) Responsibilities.--The Laboratory shall--
(1) continue to carry out the authorities and
activities that were in effect for the Office of
Policy, Planning, and Innovation as such Office existed
prior to the date of enactment of the Helping Families
in Mental Health Crisis Act of 2016;
(2) identify, coordinate, and facilitate the
implementation of policy changes likely to have a
significant effect on mental health, mental illness,
and the prevention and treatment of substance use
disorder services;
(3) collect, as appropriate, information from
grantees under programs operated by the Administration
in order to evaluate and disseminate information on
evidence-based practices, including culturally and
linguistically appropriate services, as appropriate,
and service delivery models;
(4) provide leadership in identifying and
coordinating policies and programs, including evidence-
based programs, related to mental and substance use
disorders;
(5) recommend ways in which payers may implement
program and policy findings of the Administration and
the Laboratory to improve outcomes and reduce per
capita program costs;
(6) in consultation with the Assistant Secretary for
Planning and Evaluation, as appropriate, periodically
review Federal programs and activities relating to the
diagnosis or prevention of, or treatment or
rehabilitation for, mental illness and substance use
disorders, including by--
(A) identifying any such programs or
activities that are duplicative;
(B) identifying any such programs or
activities that are not evidence-based,
effective, or efficient; and
(C) formulating recommendations for
coordinating, eliminating, or improving
programs or activities identified under
subparagraph (A) or (B) and merging such
programs or activities into other successful
programs or activities; and
(7) carry out other activities as deemed necessary to
continue to encourage innovation and disseminate
evidence-based programs and practices, including
programs and practices with scientific merit.
(c) Evidence-Based Practices and Service Delivery Models.--
(1) In general.--In selecting evidence-based best
practices and service delivery models for evaluation
and dissemination, the Laboratory--
(A) shall give preference to models that
improve--
(i) the coordination between mental
health and physical health providers;
(ii) the coordination among such
providers and the justice and
corrections system; and
(iii) the cost effectiveness,
quality, effectiveness, and efficiency
of health care services furnished to
individuals with serious mental illness
or serious emotional disturbance, in
mental health crisis, or at risk to
themselves, their families, and the
general public; and
(B) may include clinical protocols and
practices used in the Recovery After Initial
Schizophrenia Episode (RAISE) project and the
North American Prodrome Longitudinal Study
(NAPLS) of the National Institute of Mental
Health.
(2) Deadline for beginning implementation.--The
Laboratory shall begin implementation of the duties
described in this subsection not later than January 1,
2018.
(3) Consultation.--In carrying out the duties under
this subsection, the Laboratory shall consult with--
(A) representatives of the National Institute
of Mental Health, the National Institute on
Drug Abuse, and the National Institute on
Alcohol Abuse and Alcoholism, on an ongoing
basis;
(B) other appropriate Federal agencies;
(C) clinical and analytical experts with
expertise in psychiatric medical care and
clinical psychological care, health care
management, education, corrections health care,
and mental health court systems, as
appropriate; and
(D) other individuals and agencies as
determined appropriate by the Assistant
Secretary.
(d) Promoting Innovation.--
(1) In general.--The Assistant Secretary, in
coordination with the Laboratory, may award grants to
States, local governments, Indian tribes or tribal
organizations (as such terms are defined in section 4
of the Indian Self-Determination and Education
Assistance Act), educational institutions, and
nonprofit organizations to develop evidence-based
interventions, including culturally and linguistically
appropriate services, as appropriate, for--
(A) evaluating a model that has been
scientifically demonstrated to show promise,
but would benefit from further applied
development, for--
(i) enhancing the prevention,
diagnosis, intervention, treatment, and
recovery of mental illness, serious
emotional disturbance, substance use
disorders, and co-occurring disorders;
or
(ii) integrating or coordinating
physical health services and mental and
substance use disorder services; and
(B) expanding, replicating, or scaling
evidence-based programs across a wider area to
enhance effective screening, early diagnosis,
intervention, and treatment with respect to
mental illness, serious mental illness, and
serious emotional disturbance, primarily by--
(i) applying delivery of care,
including training staff in effective
evidence-based treatment; or
(ii) integrating models of care
across specialties and jurisdictions.
(2) Consultation.--In awarding grants under this
paragraph, the Assistant Secretary shall, as
appropriate, consult with the advisory councils
described in section 502, the National Institute of
Mental Health, the National Institute on Drug Abuse,
and the National Institute on Alcohol Abuse and
Alcoholism, as appropriate.
(3) Authorization of appropriations.--There are
authorized to be appropriated--
(A) to carry out paragraph (1)(A), $7,000,000
for the period of fiscal years 2018 through
2020; and
(B) to carry out paragraph (1)(B), $7,000,000
for the period of fiscal years 2018 through
2020.
advisory councils
Sec. 502. (a) Appointment.--
(1) In general.--The Secretary shall appoint an
advisory council for--
(A) the Substance Abuse and Mental Health
Services Administration;
(B) the Center for Substance Abuse Treatment;
(C) the Center for Substance Abuse
Prevention; [and]
(D) the Center for Mental Health Services[.];
and
(E) the Center for Behavioral Health
Statistics and Quality.
Each such advisory council shall advise, consult with,
and make recommendations to the Secretary and the
[Administrator] Assistant Secretary or Director of the
Administration or Center for which the advisory council
is established concerning matters relating to the
activities carried out by and through the
Administration or Center and the policies respecting
such activities.
(2) Function and activities.--An advisory council--
(A)(i) may on the basis of the materials
provided by the organization respecting
activities conducted at the organization, make
recommendations to the [Administrator]
Assistant Secretary or Director of the
Administration or Center for which it was
established respecting such activities;
(ii) shall review applications submitted for
grants and cooperative agreements for
activities for which advisory council approval
is required under section 504(d)(2) and
recommend for approval applications for
projects that show promise of making valuable
contributions to the Administration's mission;
and
(iii) may review any grant, contract, or
cooperative agreement proposed to be made or
entered into by the organization;
(B)may collect, by correspondence or by
personal investigation, information as to
studies and services that are being carried on
in the United States or any other country as to
the diseases, disorders, or other aspects of
human health with respect to which the
organization was established and with the
approval of the [Administrator] Assistant
Secretary or Director, whichever is
appropriate, make such information available
through appropriate publications for the
benefit of public and private health entities
and health professions personnel and for the
information of the general public; and
(C) may appoint subcommittees and convene
workshops and conferences.
(b) Membership.--
(1) In general.--Each advisory council shall consist
of nonvoting ex officio members and not more than 12
members to be appointed by the Secretary under
paragraph (3).
(2) Ex officio members.--The ex officio members of an
advisory council shall consist of--
(A) the Secretary;
(B) the [Administrator] Assistant Secretary;
(C) the Director of the Center for which the
council is established;
(D) the Under Secretary for Health of the
Department of Veterans Affairs;
(E) the Assistant Secretary for Defense for
Health Affairs (or the designates of such
officers); [and]
(F) for the advisory councils appointed under
subsections (a)(1)(A) and (a)(1)(D), the
Director of the National Institute of Mental
Health;
(G) for the advisory councils appointed under
subsections (a)(1)(A), (a)(1)(B), and
(a)(1)(C), the Director of the National
Institute on Drug Abuse;
(H) for the advisory councils appointed under
subsections (a)(1)(A), (a)(1)(B), and
(a)(1)(C), the Director of the National
Institute on Alcohol Abuse and Alcoholism; and
[(F)] (I) such additional officers or
employees of the United States as the Secretary
determines necessary for the advisory council
to effectively carry out its functions.
(3) Appointed members.--Individuals shall be
appointed to an advisory council under paragraph (1) as
follows:
(A) Nine of the members shall be appointed by
the Secretary from among the leading
representatives of the health disciplines
(including public health and behavioral and
social sciences) relevant to the activities of
the Administration or Center for which the
advisory council is established.
(B) Three of the members shall be appointed
by the Secretary from the general public and
shall include leaders in fields of public
policy, public relations, law, health policy
economics, or management.
(C) Not less than half of the members of the
advisory council appointed under subsection
(a)(1)(D)--
(i) shall have--
(I) a medical degree;
(II) a doctoral degree in
psychology; or
(III) an advanced degree in
nursing or social work from an
accredited graduate school or
be a certified physician
assistant; and
(ii) shall specialize in the mental
health field.
(4) Compensation.--Members of an advisory council who
are officers or employees of the United States shall
not receive any compensation for service on the
advisory council. The remaining members of an advisory
council shall receive, for each day (including travel
time) they are engaged in the performance of the
functions of the advisory council, compensation at
rates not to exceed the daily equivalent to the annual
rate in effect for grade GS-18 of the General Schedule.
(c) Terms of Office.--
(1) In general.--The term of office of a member of an
advisory council appointed under subsection (b) shall
be 4 years, except that any member appointed to fill a
vacancy for an unexpired term shall serve for the
remainder of such term. The Secretary shall make
appointments to an advisory council in such a manner as
to ensure that the terms of the members not all expire
in the same year. A member of an advisory council may
serve after the expiration of such member's term until
a successor has been appointed and taken office.
(2) Reappointments.--A member who has been appointed
to an advisory council for a term of 4 years may not be
reappointed to an advisory council during the 2-year
period beginning on the date on which such 4-year term
expired.
(3) Time for appointment.--If a vacancy occurs in an
advisory council among the members under subsection
(b), the Secretary shall make an appointment to fill
such vacancy within 90 days from the date the vacancy
occurs.
(d) Chair.--The Secretary shall select a member of an
advisory council to serve as the chair of the council. The
Secretary may so select an individual from among the appointed
members, or may select the [Administrator] Assistant Secretary
or the Director of the Center involved. The term of office of
the chair shall be 2 years.
(e) Meetings.--An advisory council shall meet at the call of
the chairperson or upon the request of the [Administrator]
Assistant Secretary or Director of the Administration or Center
for which the advisory council is established, but in no event
less than 2 times during each fiscal year. The location of the
meetings of each advisory council shall be subject to the
approval of the [Administrator] Assistant Secretary or Director
of Administration or Center for which the council was
established.
(f) Executive Secretary and Staff.--The [Administrator]
Assistant Secretary or Director of the Administration or Center
for which the advisory council is established shall designate a
member of the staff of the Administration or Center for which
the advisory council is established to serve as the Executive
Secretary of the advisory council. The [Administrator]
Assistant Secretary or Director shall make available to the
advisory council such staff, information, and other assistance
as it may require to carry out its functions. The
[Administrator] Assistant Secretary or Director shall provide
orientation and training for new members of the advisory
council to provide for their effective participation in the
functions of the advisory council.
* * * * * * *
SEC. 504. PEER REVIEW.
(a) In General.--The Secretary, after consultation with the
[Administrator] Assistant Secretary, shall require appropriate
peer review of grants, cooperative agreements, and contracts to
be administered through the agency which exceed the simple
acquisition threshold as defined in section 4(11) of the Office
of Federal Procurement Policy Act.
(b) Members.--The members of any peer review group
established under subsection (a) shall be individuals who by
virtue of their training or experience are eminently qualified
to perform the review functions of the group. Not more than
one-fourth of the members of any such peer review group shall
be officers or employees of the United States. In the case of
any such peer review group that is reviewing a grant,
cooperative agreement, or contract related to mental illness
treatment, not less than half of the members of such peer
review group shall be licensed and experienced professionals in
the prevention, diagnosis, or treatment of, or recovery from,
mental or substance use disorders and have a medical degree, a
doctoral degree in psychology, or an advanced degree in nursing
or social work from an accredited program.
(c) Advisory Council Review.--If the direct cost of a grant
or cooperative agreement (described in subsection (a)) exceeds
the simple acquisition threshold as defined by section 4(11) of
the Office of Federal Procurement Policy Act, the Secretary may
make such a grant or cooperative agreement only if such grant
or cooperative agreement is recommended--
(1) after peer review required under subsection (a);
and
(2) by the appropriate advisory council.
(d) Conditions.--The Secretary may establish limited
exceptions to the limitations contained in this section
regarding participation of Federal employees and advisory
council approval. The circumstances under which the Secretary
may make such an exception shall be made public.
data collection
Sec. 505. (a) The Secretary, acting through the
[Administrator] Assistant Secretary, shall collect data each
year on--
(1) the national incidence and prevalence of the
various forms of mental illness and substance abuse;
and
(2) the incidence and prevalence of such various
forms in major metropolitan areas selected by the
[Administrator] Assistant Secretary.
(b) With respect to the activities of the [Administrator]
Assistant Secretary under subsection (a) relating to mental
health, the [Administrator] Assistant Secretary shall ensure
that such activities include, at a minimum, the collection of
data on--
(1) the number and variety of public and nonprofit
private treatment programs;
(2) the number and demographic characteristics of
individuals receiving treatment through such programs;
(3) the type of care received by such individuals;
and
(4) such other data as may be appropriate.
(c)(1) With respect to the activities of the [Administrator]
Assistant Secretary under subsection (a) relating to substance
abuse, the [Administrator] Assistant Secretary shall ensure
that such activities include, at a minimum, the collection of
data on--
(A) the number of individuals admitted to the
emergency rooms of hospitals as a result of the abuse
of alcohol or other drugs;
(B) the number of deaths occurring as a result of
substance abuse, as indicated in reports by coroners;
(C) the number and variety of public and private
nonprofit treatment programs, including the number and
type of patient slots available;
(D) the number of individuals seeking treatment
through such programs, the number and demographic
characteristics of individuals receiving such
treatment, the percentage of individuals who complete
such programs, and, with respect to individuals
receiving such treatment, the length of time between an
individual's request for treatment and the commencement
of treatment;
(E) the number of such individuals who return for
treatment after the completion of a prior treatment in
such programs and the method of treatment utilized
during the prior treatment;
(F) the number of individuals receiving public
assistance for such treatment programs;
(G) the costs of the different types of treatment
modalities for drug and alcohol abuse and the aggregate
relative costs of each such treatment modality provided
within a State in each fiscal year;
(H) to the extent of available information, the
number of individuals receiving treatment for alcohol
or drug abuse who have private insurance coverage for
the costs of such treatment;
(I) the extent of alcohol and drug abuse among high
school students and among the general population; and
(J) the number of alcohol and drug abuse counselors
and other substance abuse treatment personnel employed
in public and private treatment facilities.
(2) Annual surveys shall be carried out in the collection of
data under this subsection. Summaries and analyses of the data
collected shall be made available to the public.
(d) After consultation with the States and with appropriate
national organizations, the [Administrator] Assistant Secretary
shall develop uniform criteria for the collection of data,
using the best available technology, pursuant to this section.
* * * * * * *
SEC. 506B. GRANTS FOR ECSTASY AND OTHER CLUB DRUGS ABUSE PREVENTION.
(a) Authority.--The [Administrator] Assistant Secretary may
make grants to, and enter into contracts and cooperative
agreements with, public and nonprofit private entities to
enable such entities--
(1) to carry out school-based programs concerning the
dangers of the abuse of and addiction to 3,4-
methylenedioxy methamphetamine, related drugs, and
other drugs commonly referred to as ``club drugs''
using methods that are effective and science-based,
including initiatives that give students the
responsibility to create their own anti-drug abuse
education programs for their schools; and
(2) to carry out community-based abuse and addiction
prevention programs relating to 3,4-methylenedioxy
methamphetamine, related drugs, and other club drugs
that are effective and science-based.
(b) Use of Funds.--Amounts made available under a grant,
contract or cooperative agreement under subsection (a) shall be
used for planning, establishing, or administering prevention
programs relating to 3,4-methylenedioxy methamphetamine,
related drugs, and other club drugs.
(c) Use of Funds.--
(1) Discretionary functions.--Amounts provided to an
entity under this section may be used--
(A) to carry out school-based programs that
are focused on those districts with high or
increasing rates of abuse and addiction to 3,4-
methylenedioxy methamphetamine, related drugs,
and other club drugs and targeted at
populations that are most at risk to start
abusing these drugs;
(B) to carry out community-based prevention
programs that are focused on those populations
within the community that are most at-risk for
abuse of and addiction to 3,4-methylenedioxy
methamphetamine, related drugs, and other club
drugs;
(C) to assist local government entities to
conduct appropriate prevention activities
relating to 3,4-methylenedioxy methamphetamine,
related drugs, and other club drugs;
(D) to train and educate State and local law
enforcement officials, prevention and education
officials, health professionals, members of
community anti-drug coalitions and parents on
the signs of abuse of and addiction to 3,4-
methylenedioxy methamphetamine, related drugs,
and other club drugs and the options for
treatment and prevention;
(E) for planning, administration, and
educational activities related to the
prevention of abuse of and addiction to 3,4-
methylenedioxy methamphetamine, related drugs,
and other club drugs;
(F) for the monitoring and evaluation of
prevention activities relating to 3,4-
methylenedioxy methamphetamine, related drugs,
and other club drugs and reporting and
disseminating resulting information to the
public; and
(G) for targeted pilot programs with
evaluation components to encourage innovation
and experimentation with new methodologies.
(2) Priority.--The [Administrator] Assistant
Secretary shall give priority in awarding grants under
this section to rural and urban areas that are
experiencing a high rate or rapid increases in abuse
and addiction to 3,4-methylenedioxy methamphetamine,
related drugs, and other club drugs.
(d) Allocation and Report.--
(1) Prevention program allocation.--Not less than
$500,000 of the amount appropriated in each fiscal year
to carry out this section shall be made available to
the [Administrator] Assistant Secretary, acting in
consultation with other Federal agencies, to support
and conduct periodic analyses and evaluations of
effective prevention programs for abuse of and
addiction to 3,4-methylenedioxy methamphetamine,
related drugs, and other club drugs and the development
of appropriate strategies for disseminating information
about and implementing such programs.
(2) Report.--The [Administrator] Assistant Secretary
shall annually prepare and submit to the Committee on
Health, Education, Labor, and Pensions, the Committee
on the Judiciary, and the Committee on Appropriations
of the Senate, and the Committee on Commerce, the
Committee on the Judiciary, and the Committee on
Appropriations of the House of Representatives, a
report containing the results of the analyses and
evaluations conducted under paragraph (1).
(e) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section--
(1) $10,000,000 for fiscal year 2001; and
(2) such sums as may be necessary for each succeeding
fiscal year.
Part B--Centers and Programs
Subpart 1--Center for Substance Abuse Treatment
center for substance abuse treatment
Sec. 507. (a) Establishment.--There is established in the
Administration a Center for Substance Abuse Treatment
(hereafter in this section referred to as the ``Center''). The
Center shall be headed by a Director (hereafter in this section
referred to as the ``Director'') appointed by the Secretary
from among individuals with extensive experience or academic
qualifications in the [treatment of substance abuse] treatment
of substance use disorders or in the evaluation of substance
[abuse treatment systems] use disorder treatment systems.
(b) Duties.--The Director of the Center shall--
(1) administer the substance abuse treatment block
grant program authorized in section 1921;
(2) ensure that emphasis is placed on children and
adolescents in the development of treatment programs;
(3) collaborate with the Attorney General to develop
programs to provide substance [abuse] use disorder
treatment services to individuals who have had contact
with the Justice system, especially adolescents;
(4) collaborate with the Director of the Center for
Substance Abuse Prevention in order to provide outreach
services to identify individuals in need of treatment
services, with emphasis on the provision of such
services to pregnant and postpartum women and their
infants and to [individuals who abuse drugs]
individuals who use drugs intravenously;
(5) collaborate with the Director of the National
Institute on Drug Abuse, with the Director of the
National Institute on Alcohol Abuse and Alcoholism, and
with the States to promote the study, dissemination,
and implementation of research findings that will
improve the delivery and effectiveness of treatment
services;
(6) collaborate with the Administrator of the Health
Resources and Services Administration and the
Administrator of the Centers for Medicare & Medicaid
Services to promote the increased integration into the
mainstream of the health care system of the United
States of programs for providing treatment services;
(7) evaluate plans submitted by the States pursuant
to section 1932(a)(6) in order to determine whether the
plans adequately provide for the availability,
allocation, and effectiveness of treatment services;
(8) sponsor regional workshops on improving the
quality and availability of treatment services;
(9) provide technical assistance to public and
nonprofit private entities that provide treatment
services, including technical assistance with respect
to the process of submitting to the Director
applications for any program of grants or contracts
[carried out by the Director];
[(10) encourage the States to expand the availability
(relative to fiscal year 1992) of programs providing
treatment services through self-run, self-supported
recovery based on the programs of housing operated
pursuant to section 1925;]
[(11)] (10) carry out activities to educate
individuals on the need for establishing treatment
facilities within their communities;
[(12)] (11) encourage public and private entities
that provide health insurance to provide benefits for
outpatient treatment services and other nonhospital-
based treatment services;
[(13)] (12) evaluate treatment programs to determine
the quality and appropriateness of various forms of
treatment, which shall be carried out through grants,
contracts, or cooperative agreements provided to public
or nonprofit private entities[; and];
[(14) in carrying out paragraph (13), assess the
quality, appropriateness, and costs of various
treatment forms for specific patient groups.]
(13) ensure the consistent documentation of the
application of criteria when awarding grants and the
ongoing oversight of grantees after such grants are
awarded; and
(14) work with States, providers, and individuals in
recovery, and their families, to promote the expansion
of recovery support services and systems of care
oriented towards recovery.
(c) Grants and Contracts.--In carrying out the duties
established in subsection (b), the Director may make grants to
and enter into contracts and cooperative agreements with public
and nonprofit private entities.
residential treatment programs for pregnant and postpartum women
Sec. 508. (a) In General.--The Director of the Center for
Substance Abuse Treatment shall provide awards of grants,
cooperative agreement, or contracts to public and nonprofit
private entities for the purpose of providing to pregnant and
postpartum women treatment for substance abuse through programs
in which, during the course of receiving treatment--
(1) the women reside in facilities provided by the
programs;
(2) the minor children of the women reside with the
women in such facilities, if the women so request; and
(3) the services described in subsection (d) are
available to or on behalf of the women.
(b) Availability of Services for Each Participant.--A funding
agreement for an award under subsection (a) for an applicant is
that, in the program operated pursuant to such subsection--
(1) treatment services and each supplemental service
will be available through the applicant, either
directly or through agreements with other public or
nonprofit private entities; and
(2) the services will be made available to each woman
admitted to the program.
(c) Individualized Plan of Services.--A funding agreement for
an award under subsection (a) for an applicant is that--
(1) in providing authorized services for an eligible
woman pursuant to such subsection, the applicant will,
in consultation with the women, prepare an
individualized plan for the provision to the woman of
the services; and
(2) treatment services under the plan will include--
(A) individual, group, and family counseling,
as appropriate, regarding substance abuse; and
(B) follow-up services to assist the woman in
preventing a relapse into such abuse.
(d) Required Supplemental Services.--In the case of an
eligible woman, the services referred to in subsection (a)(3)
are as follows:
(1) Prenatal and postpartum health care.
(2) Referrals for necessary hospital services.
(3) For the infants and children of the woman--
(A) pediatric health care, including
treatment for any perinatal effects of maternal
substance abuse and including screenings
regarding the physical and mental development
of the infants and children;
(B) counseling and other mental health
services, in the case of children; and
(C) comprehensive social services.
(4) Providing supervision of children during periods
in which the woman is engaged in therapy or in other
necessary health or rehabilitative activities.
(5) Training in parenting.
(6) Counseling on the human immunodeficiency virus
and on acquired immune deficiency syndrome.
(7) Counseling on domestic violence and sexual abuse.
(8) Counseling on obtaining employment, including the
importance of graduating from a secondary school.
(9) Reasonable efforts to preserve and support the
family units of the women, including promoting the
appropriate involvement of parents and others, and
counseling the children of the women.
(10) Planning for and counseling to assist reentry
into society, both before and after discharge,
including referrals to any public or nonprofit private
entities in the community involved that provide
services appropriate for the women and the children of
the women.
(11) Case management services, including--
(A) assessing the extent to which authorized
services are appropriate for the women and
their children;
(B) in the case of the services that are
appropriate, ensuring that the services are
provided in a coordinated manner; and
(C) assistance in establishing eligibility
for assistance under Federal, State, and local
programs providing health services, mental
health services, housing services, employment
services, educational services, or social
services.
(e) Minimum Qualifications For Receipt of Award.--
(1) Certification by relevant state agency.--With
respect to the principal agency of the State involved
that administers programs relating to substance abuse,
the Director may make an award under subsection (a) to
an applicant only if the agency has certified to the
Director that--
(A) the applicant has the capacity to carry
out a program described in subsection (a);
(B) the plans of the applicant for such a
program are consistent with the policies of
such agency regarding the treatment of
substance abuse; and
(C) the applicant, or any entity through
which the applicant will provide authorized
services, meets all applicable State licensure
or certification requirements regarding the
provision of the services involved.
(2) Status as medicaid provider.--
(A) Subject to subparagraphs (B) and (C), the
Director may make an award under subsection (a)
only if, in the case of any authorized service
that is available pursuant to the State plan
approved under title XIX of the Social Security
Act for the State involved--
(i) the applicant for the award will
provide the service directly, and the
applicant has entered into a
participation agreement under the State
plan and is qualified to receive
payments under such plan; or
(ii) the applicant will enter into an
agreement with a public or nonprofit
private entity under which the entity
will provide the service, and the
entity has entered into such a
participation agreement plan and is
qualified to receive such payments.
(B)(i) In the case of an entity making an
agreement pursuant to subparagraph (A)(ii)
regarding the provision of services, the
requirement established in such subparagraph
regarding a participation agreement shall be
waived by the Director if the entity does not,
in providing health care services, impose a
charge or accept reimbursement available from
any third-party payor, including reimbursement
under any insurance policy or under any Federal
or State health benefits plan.
(ii) A determination by the Director of
whether an entity referred to in clause (i)
meets the criteria for a waiver under such
clause shall be made without regard to whether
the entity accepts voluntary donations
regarding the provision of services to the
public.
(C) With respect to any authorized service
that is available pursuant to the State plan
described in subparagraph (A), the requirements
established in such subparagraph shall not
apply to the provision of any such service by
an institution for mental diseases to an
individual who has attained 21 years of age and
who has not attained 65 years of age. For
purposes of the preceding sentence, the term
``institution for mental diseases'' has the
meaning given such term in section 1905(i) of
the Social Security Act.
(f) Requirement of Matching Funds.--
(1) In general.--With respect to the costs of the
program to be carried out by an applicant pursuant to
subsection (a), a funding agreement for an award under
such subsection is that the applicant will make
available (directly or through donations from public or
private entities) non-Federal contributions toward such
costs in an amount that--
(A) for the first fiscal year for which the
applicant receives payments under an award
under such subsection, is not less than $1 for
each $9 of Federal funds provided in the award;
(B) for any second such fiscal year, is not
less than $1 for each $9 of Federal funds
provided in the award; and
(C) for any subsequent such fiscal year, is
not less than $1 for each $3 of Federal funds
provided in the award.
(2) Determination of amount contributed.--Non-Federal
contributions required in paragraph (1) may be in cash
or in kind, fairly evaluated, including plant,
equipment, or services. Amounts provided by the Federal
Government, or services assisted or subsidized to any
significant extent by the Federal Government, may not
be included in determining the amount of such non-
Federal contributions.
(g) Outreach.--A funding agreement for an award under
subsection (a) for an applicant is that the applicant will
provide outreach services in the community involved to identify
women who are engaging in substance abuse and to encourage the
women to undergo treatment for such abuse.
(h) Accessibility of Program; Cultural Context of Services.--
A funding agreement for an award under subsection (a) for an
applicant is that--
(1) the program operated pursuant to such subsection
will be operated at a location that is accessible to
low-income pregnant and postpartum women; and
(2) authorized services will be provided in the
language and the cultural context that is most
appropriate.
(i) Continuing Education.--A funding agreement for an award
under subsection (a) is that the applicant involved will
provide for continuing education in treatment services for the
individuals who will provide treatment in the program to be
operated by the applicant pursuant to such subsection.
(j) Imposition of Charges.--A funding agreement for an award
under subsection (a) for an applicant is that, if a charge is
imposed for the provision of authorized services to on behalf
of an eligible woman, such charge--
(1) will be made according to a schedule of charges
that is made available to the public;
(2) will be adjusted to reflect the income of the
woman involved; and
(3) will not be imposed on any such woman with an
income of less than 185 percent of the official poverty
line, as established by the Director of the Office for
Management and Budget and revised by the Secretary in
accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981.
(k) Reports to Director.--A funding agreement for an award
under subsection (a) is that the applicant involved will submit
to the Director a report--
(1) describing the utilization and costs of services
provided under the award;
(2) specifying the number of women served, the number
of infants served, and the type and costs of services
provided; and
(3) providing such other information as the Director
determines to be appropriate.
(l) Requirement of Application.--The Director may make an
award under subsection (a) only if an application for the award
is submitted to the Director containing such agreements, and
the application is in such form, is made in such manner, and
contains such other agreements and such assurances and
information as the Director determines to be necessary to carry
out this section.
(m) Equitable Allocation of Awards.--In making awards under
subsection (a), the Director shall ensure that the awards are
equitably allocated among the principal geographic regions of
the United States, subject to the availability of qualified
applicants for the awards.
(n) Duration of Award.--The period during which payments are
made to an entity from an award under subsection (a) may not
exceed 5 years. The provision of such payments shall be subject
to annual approval by the Director of the payments and subject
to the availability of appropriations for the fiscal year
involved to make the payments. This subsection may not be
construed to establish a limitation on the number of awards
under such subsection that may be made to an entity.
(o) Evaluations; Dissemination of Findings.--The Director
shall, directly or through contract, provide for the conduct of
evaluations of programs carried out pursuant to subsection (a).
The Director shall disseminate to the States the findings made
as a result of the evaluations.
(p) Reports to Congress.--Not later than October 1, 1994, the
Director shall submit to the Committee on Energy and Commerce
of the House of Representatives, and to the Committee on Labor
and Human Resources of the Senate, a report describing programs
carried out pursuant to this section. Every 2 years thereafter,
the Director shall prepare a report describing such programs
carried out during the preceding 2 years, and shall submit the
report to the [Administrator] Assistant Secretary for inclusion
in the biennial report under section 501(k). Each report under
this subsection shall include a summary of any evaluations
conducted under subsection (m) during the period with respect
to which the report is prepared.
(q) Definitions.--For purposes of this section:
(1) The term ``authorized services'' means treatment
services and supplemental services.
(2) The term ``eligible woman'' means a woman who has
been admitted to a program operated pursuant to
subsection (a).
(3) The term ``funding agreement under subsection
(a)'', with respect to an award under subsection (a),
means that the Director may make the award only if the
applicant makes the agreement involved.
(4) The term ``treatment services'' means treatment
for substance abuse, including the counseling and
services described in subsection (c)(2).
(5) The term ``supplemental services'' means the
services described in subsection (d).
(r) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary to fiscal years 2001
through 2003.
* * * * * * *
[methamphetamine and amphetamine treatment initiative
[Sec. 514. (a) Grants.--
[(1) Authority to make grants.--The Director of the
Center for Substance Abuse Treatment may make grants to
States and Indian tribes recognized by the United
States that have a high rate, or have had a rapid
increase, in methamphetamine or amphetamine abuse or
addiction in order to permit such States and Indian
tribes to expand activities in connection with the
treatment of methamphetamine or amphetamine abuser or
addiction in the specific geographical areas of such
States or Indian tribes, as the case may be, where
there is such a rate or has been such an increase.
[(2) Recipients.--Any grants under paragraph (1)
shall be directed to the substance abuse directors of
the States, and of the appropriate tribal government
authorities of the Indian tribes, selected by the
Director to receive such grants.
[(3) Nature of activities.--Any activities under a
grant under paragraph (1) shall be based on reliable
scientific evidence of their efficacy in the treatment
of methamphetamine or amphetamine abuse or addiction.
[(b) Geographic Distribution.--The Director shall ensure that
grants under subsection (a) are distributed equitably among the
various regions of the country and among rural, urban, and
suburban areas that are affected by methamphetamine or
amphetamine abuse or addiction.
[(c) Additional Activities.--The Director shall--
[(1) evaluate the activities supported by grants
under subsection (a);
[(2) disseminate widely such significant information
derived from the evaluation as the Director considers
appropriate to assist States, Indian tribes, and
private providers of treatment services for
methamphetamine or amphetamine abuser or addiction in
the treatment of methamphetamine or amphetamine abuse
or addiction; and
[(3) provide States, Indian tribes, and such
providers with technical assistance in connection with
the provision of such treatment.
[(d) Authorization of Appropriations.--
[(1) In general.--There are authorized to be
appropriated to carry out this section $10,000,000 for
fiscal year 2000 and such sums as may be necessary for
each of fiscal years 2001 and 2002.
[(2) Use of certain funds.--Of the funds appropriated
to carry out this section in any fiscal year, the
lesser of 5 percent of such funds or $1,000,000 shall
be available to the Director for purposes of carrying
out subsection (c).
[SEC. 514A. EARLY INTERVENTION SERVICES FOR CHILDREN AND ADOLESCENTS.
[(a) In General.--The Secretary shall award grants,
contracts, or cooperative agreements to public and private
nonprofit entities, including local educational agencies (as
defined in section 14101 of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 8801)), for the purpose of
providing early intervention substance abuse services for
children and adolescents.
[(b) Priority.--In awarding grants, contracts, or cooperative
agreements under subsection (a), the Secretary shall give
priority to applicants who demonstrate an ability to--
[(1) screen for and assess substance use and abuse by
children and adolescents;
[(2) make appropriate referrals for children and
adolescents who are in need of treatment for substance
abuse;
[(3) provide early intervention services, including
counseling and ancillary services, that are designed to
meet the developmental needs of children and
adolescents who are at risk for substance abuse; and
[(4) develop networks with the educational, juvenile
justice, social services, and other agencies and
organizations in the State or local community involved
that will work to identify children and adolescents who
are in need of substance abuse treatment services.
[(c) Condition.--In awarding grants, contracts, or
cooperative agreements under subsection (a), the Secretary
shall ensure that such grants, contracts, or cooperative
agreements are allocated, subject to the availability of
qualified applicants, among the principal geographic regions of
the United States, to Indian tribes and tribal organizations,
and to urban and rural areas.
[(d) Duration of Grants.--The Secretary shall award grants,
contracts, or cooperative agreements under subsection (a) for
periods not to exceed 5 fiscal years.
[(e) Application.--An entity desiring a grant, contract, or
cooperative agreement under subsection (a) shall submit an
application to the Secretary at such time, in such manner, and
accompanied by such information as the Secretary may reasonably
require.
[(f) Evaluation.--An entity that receives a grant, contract,
or cooperative agreement under subsection (a) shall submit, in
the application for such grant, contract, or cooperative
agreement, a plan for the evaluation of any project undertaken
with funds provided under this section. Such entity shall
provide the Secretary with periodic evaluations of the progress
of such project and such evaluation at the completion of such
project as the Secretary determines to be appropriate.
[(g) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section, $20,000,000 for
fiscal year 2001, and such sums as may be necessary for fiscal
years 2002 and 2003.]
* * * * * * *
Subpart 2--Center for Substance Abuse Prevention
* * * * * * *
[prevention, treatment, and rehabilitation model projects for high risk
youth
[Sec. 517. (a) The Secretary, through the Director of the
Prevention Center, shall make grants to public and nonprofit
private entities for projects to demonstrate effective models
for the prevention, treatment, and rehabilitation of drug abuse
and alcohol abuse among high risk youth.
[(b)(1) In making grants for drug abuse and alcohol abuse
prevention projects under this section, the Secretary shall
give priority to applications for projects directed at children
of substance abusers, latchkey children, children at risk of
abuse or neglect, preschool children eligible for services
under the Head Start Act, children at risk of dropping out of
school, children at risk of becoming adolescent parents, and
children who do not attend school and who are at risk of being
unemployed.
[(2) In making grants for drug abuse and alcohol abuse
treatment and rehabilitation projects under this section, the
Secretary shall give priority to projects which address the
relationship between drug abuse or alcohol abuse and physical
child abuse, sexual child abuse, emotional child abuse,
dropping out of school, unemployment, delinquency, pregnancy,
violence, suicide, or mental health problems.
[(3) In making grants under this section, the Secretary shall
give priority to applications from community based
organizations for projects to develop innovative models with
multiple, coordinated services for the prevention or for the
treatment and rehabilitation of drug abuse or alcohol abuse by
high risk youth.
[(4) In making grants under this section, the Secretary shall
give priority to applications for projects to demonstrate
effective models with multiple, coordinated services which may
be replicated and which are for the prevention or for the
treatment and rehabilitation of drug abuse or alcohol abuse by
high risk youth.
[(5) In making grants under this section, the Secretary shall
give priority to applications that employ research designs
adequate for evaluating the effectiveness of the program.
[(c) The Secretary shall ensure that projects under
subsection (a) include strategies for reducing the use of
alcoholic beverages and tobacco products by individuals to whom
it is unlawful to sell or distribute such beverages or
products.
[(d) To the extent feasible, the Secretary shall make grants
under this section in all regions of the United States, and
shall ensure the distribution of grants under this section
among urban and rural areas.
[(e) In order to receive a grant for a project under this
section for a fiscal year, a public or nonprofit private entity
shall submit an application to the Secretary, acting through
the Office. The Secretary may provide to the Governor of the
State the opportunity to review and comment on such
application. Such application shall be in such form, shall
contain such information, and shall be submitted at such time
as the Secretary may by regulation prescribe.
[(f) The Director of the Office shall evaluate projects
conducted with grants under this section.
[(g) For purposes of this section, the term ``high risk
youth'' means an individual who has not attained the age of 21
years, who is at high risk of becoming, or who has become, a
drug abuser or an alcohol abuser, and who--
[(1) is identified as a child of a substance abuser;
[(2) is a victim of physical, sexual, or
psychological abuse;
[(3) has dropped out of school;
[(4) has become pregnant;
[(5) is economically disadvantaged;
[(6) has committed a violent or delinquent act;
[(7) has experienced mental health problems;
[(8) has attempted suicide;
[(9) has experienced long-term physical pain due to
injury; or
[(10) has experienced chronic failure in school.
[(h) For the purpose of carrying out this section, there are
authorized to be appropriated such sums as may be necessary for
each of the fiscal years 2001 through 2003.]
* * * * * * *
[SEC. 519A. GRANTS FOR STRENGTHENING FAMILIES.
[(a) Program Authorized.--The Secretary, acting through the
Director of the Prevention Center, may make grants to public
and nonprofit private entities to develop and implement model
substance abuse prevention programs to provide early
intervention and substance abuse prevention services for
individuals of high-risk families and the communities in which
such individuals reside.
[(b) Priority.--In awarding grants under subsection (a), the
Secretary shall give priority to applicants that--
[(1) have proven experience in preventing substance
abuse by individuals of high-risk families and reducing
substance abuse in communities of such individuals;
[(2) have demonstrated the capacity to implement
community-based partnership initiatives that are
sensitive to the diverse backgrounds of individuals of
high-risk families and the communities of such
individuals;
[(3) have experience in providing technical
assistance to support substance abuse prevention
programs that are community-based;
[(4) have demonstrated the capacity to implement
research-based substance abuse prevention strategies;
and
[(5) have implemented programs that involve families,
residents, community agencies, and institutions in the
implementation and design of such programs.
[(c) Duration of Grants.--The Secretary shall award grants
under subsection (a) for a period not to exceed 5 years.
[(d) Use of Funds.--An applicant that is awarded a grant
under subsection (a) shall--
[(1) in the first fiscal year that such funds are
received under the grant, use such funds to develop a
model substance abuse prevention program; and
[(2) in the fiscal year following the first fiscal
year that such funds are received, use such funds to
implement the program developed under paragraph (1) to
provide early intervention and substance abuse
prevention services to--
[(A) strengthen the environment of children
of high risk families by targeting
interventions at the families of such children
and the communities in which such children
reside;
[(B) strengthen protective factors, such as--
[(i) positive adult role models;
[(ii) messages that oppose substance
abuse;
[(iii) community actions designed to
reduce accessibility to and use of
illegal substances; and
[(iv) willingness of individuals of
families in which substance abuse
occurs to seek treatment for substance
abuse;
[(C) reduce family and community risks, such
as family violence, alcohol or drug abuse,
crime, and other behaviors that may effect
healthy child development and increase the
likelihood of substance abuse; and
[(D) build collaborative and formal
partnerships between community agencies,
institutions, and businesses to ensure that
comprehensive high quality services are
provided, such as early childhood education,
health care, family support programs, parent
education programs, and home visits for
infants.
[(e) Application.--To be eligible to receive a grant under
subsection (a), an applicant shall prepare and submit to the
Secretary an application that--
[(1) describes a model substance abuse prevention
program that such applicant will establish;
[(2) describes the manner in which the services
described in subsection (d)(2) will be provided; and
[(3) describe in as much detail as possible the
results that the entity expects to achieve in
implementing such a program.
[(f) Matching Funding.--The Secretary may not make a grant to
a entity under subsection (a) unless that entity agrees that,
with respect to the costs to be incurred by the entity in
carrying out the program for which the grant was awarded, the
entity will make available non-Federal contributions in an
amount that is not less than 40 percent of the amount provided
under the grant.
[(g) Report to Secretary.--An applicant that is awarded a
grant under subsection (a) shall prepare and submit to the
Secretary a report in such form and containing such information
as the Secretary may require, including an assessment of the
efficacy of the model substance abuse prevention program
implemented by the applicant and the short, intermediate, and
long term results of such program.
[(h) Evaluations.--The Secretary shall conduct evaluations,
based in part on the reports submitted under subsection (g), to
determine the effectiveness of the programs funded under
subsection (a) in reducing substance use in high-risk families
and in making communities in which such families reside in
stronger. The Secretary shall submit such evaluations to the
appropriate committees of Congress.
[(i) High-Risk Families.--In this section, the term ``high-
risk family'' means a family in which the individuals of such
family are at a significant risk of using or abusing alcohol or
any illegal substance.
[(j) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section, $3,000,000 for
fiscal year 2001, and such sums as may be necessary for each of
the fiscal years 2002 and 2003.]
SEC. 519B. PROGRAMS TO REDUCE UNDERAGE DRINKING.
(a) Definitions.--For purposes of this section:
(1) The term ``alcohol beverage industry'' means the
brewers, vintners, distillers, importers, distributors,
and retail or online outlets that sell or serve beer,
wine, and distilled spirits.
(2) The term ``school-based prevention'' means
programs, which are institutionalized, and run by staff
members or school-designated persons or organizations
in any grade of school, kindergarten through 12th
grade.
(3) The term ``youth'' means persons under the age of
21.
(4) The term ``IOM report'' means the report released
in September 2003 by the National Research Council,
Institute of Medicine, and entitled ``Reducing Underage
Drinking: A Collective Responsibility''.
(b) Sense of Congress.--It is the sense of the Congress that:
(1) A multi-faceted effort is needed to more
successfully address the problem of underage drinking
in the United States. A coordinated approach to
prevention, intervention, treatment, enforcement, and
research is key to making progress. This Act recognizes
the need for a focused national effort, and addresses
particulars of the Federal portion of that effort, as
well as Federal support for State activities.
(2) The Secretary of Health and Human Services shall
continue to conduct research and collect data on the
short and long-range impact of alcohol use and abuse
upon adolescent brain development and other organ
systems.
(3) States and communities, including colleges and
universities, are encouraged to adopt comprehensive
prevention approaches, including--
(A) evidence-based screening, programs and
curricula;
(B) brief intervention strategies;
(C) consistent policy enforcement; and
(D) environmental changes that limit underage
access to alcohol.
(4) Public health groups, consumer groups, and the
alcohol beverage industry should continue and expand
evidence-based efforts to prevent and reduce underage
drinking.
(5) The entertainment industries have a powerful
impact on youth, and they should use rating systems and
marketing codes to reduce the likelihood that underage
audiences will be exposed to movies, recordings, or
television programs with unsuitable alcohol content.
(6) The National Collegiate Athletic Association, its
member colleges and universities, and athletic
conferences should affirm a commitment to a policy of
discouraging alcohol use among underage students and
other young fans.
(7) Alcohol is a unique product and should be
regulated differently than other products by the States
and Federal Government. States have primary authority
to regulate alcohol distribution and sale, and the
Federal Government should support and supplement these
State efforts. States also have a responsibility to
fight youth access to alcohol and reduce underage
drinking. Continued State regulation and licensing of
the manufacture, importation, sale, distribution,
transportation and storage of alcoholic beverages are
clearly in the public interest and are critical to
promoting responsible consumption, preventing illegal
access to alcohol by persons under 21 years of age from
commercial and non-commercial sources, maintaining
industry integrity and an orderly marketplace, and
furthering effective State tax collection.
(c) Interagency Coordinating Committee; Annual Report on
State Underage Drinking Prevention and Enforcement
Activities.--
(1) Interagency coordinating committee on the
prevention of underage drinking.--
(A) In general.--The Secretary, in
collaboration with the Federal officials
specified in subparagraph (B), shall formally
establish and enhance the efforts of the
interagency coordinating committee, that began
operating in 2004, focusing on underage
drinking (referred to in this subsection as the
``Committee'').
(B) Other agencies.--The officials referred
to in paragraph (1) are the Secretary of
Education, the Attorney General, the Secretary
of Transportation, the Secretary of the
Treasury, the Secretary of Defense, the Surgeon
General, the Director of the Centers for
Disease Control and Prevention, the Director of
the National Institute on Alcohol Abuse and
Alcoholism, the [Administrator of the Substance
Abuse and Mental Health Services
Administration] Assistant Secretary for Mental
Health and Substance Use, the Director of the
National Institute on Drug Abuse, the Assistant
Secretary for Children and Families, the
Director of the Office of National Drug Control
Policy, the Administrator of the National
Highway Traffic Safety Administration, the
Administrator of the Office of Juvenile Justice
and Delinquency Prevention, the Chairman of the
Federal Trade Commission, and such other
Federal officials as the Secretary of Health
and Human Services determines to be
appropriate.
(C) Chair.--The Secretary of Health and Human
Services shall serve as the chair of the
Committee.
(D) Duties.--The Committee shall guide policy
and program development across the Federal
Government with respect to underage drinking,
provided, however, that nothing in this section
shall be construed as transferring regulatory
or program authority from an Agency to the
Coordinating Committee.
(E) Consultations.--The Committee shall
actively seek the input of and shall consult
with all appropriate and interested parties,
including States, public health research and
interest groups, foundations, and alcohol
beverage industry trade associations and
companies.
(F) Annual report.--
(i) In general.--The Secretary, on
behalf of the Committee, shall annually
submit to the Congress a report that
summarizes--
(I) all programs and policies
of Federal agencies designed to
prevent and reduce underage
drinking;
(II) the extent of progress
in preventing and reducing
underage drinking nationally;
(III) data that the Secretary
shall collect with respect to
the information specified in
clause (ii); and
(IV) such other information
regarding underage drinking as
the Secretary determines to be
appropriate.
(ii) Certain information.--The report
under clause (i) shall include
information on the following:
(I) Patterns and consequences
of underage drinking as
reported in research and
surveys such as, but not
limited to Monitoring the
Future, Youth Risk Behavior
Surveillance System, the
National Survey on Drug Use and
Health, and the Fatality
Analysis Reporting System.
(II) Measures of the
availability of alcohol from
commercial and non-commercial
sources to underage
populations.
(III) Measures of the
exposure of underage
populations to messages
regarding alcohol in
advertising and the
entertainment media as reported
by the Federal Trade
Commission.
(IV) Surveillance data,
including information on the
onset and prevalence of
underage drinking, consumption
patterns and the means of
underage access. The Secretary
shall develop a plan to improve
the collection, measurement and
consistency of reporting
Federal underage alcohol data.
(V) Any additional findings
resulting from research
conducted or supported under
subsection (f).
(VI) Evidence-based best
practices to prevent and reduce
underage drinking and provide
treatment services to those
youth who need them.
(2) Annual report on state underage drinking
prevention and enforcement activities.--
(A) In general.--The Secretary shall, with
input and collaboration from other appropriate
Federal agencies, States, Indian tribes,
territories, and public health, consumer, and
alcohol beverage industry groups, annually
issue a report on each State's performance in
enacting, enforcing, and creating laws,
regulations, and programs to prevent or reduce
underage drinking.
(B) State performance measures.--
(i) In general.--The Secretary shall
develop, in consultation with the
Committee, a set of measures to be used
in preparing the report on best
practices.
(ii) Categories.--In developing these
measures, the Secretary shall consider
categories including, but not limited
to:
(I) Whether or not the State
has comprehensive anti-underage
drinking laws such as for the
illegal sale, purchase, attempt
to purchase, consumption, or
possession of alcohol; illegal
use of fraudulent ID; illegal
furnishing or obtaining of
alcohol for an individual under
21 years; the degree of
strictness of the penalties for
such offenses; and the
prevalence of the enforcement
of each of these infractions.
(II) Whether or not the State
has comprehensive liability
statutes pertaining to underage
access to alcohol such as dram
shop, social host, and house
party laws, and the prevalence
of enforcement of each of these
laws.
(III) Whether or not the
State encourages and conducts
comprehensive enforcement
efforts to prevent underage
access to alcohol at retail
outlets, such as random
compliance checks and shoulder
tap programs, and the number of
compliance checks within
alcohol retail outlets measured
against the number of total
alcohol retail outlets in each
State, and the result of such
checks.
(IV) Whether or not the State
encourages training on the
proper selling and serving of
alcohol for all sellers and
servers of alcohol as a
condition of employment.
(V) Whether or not the State
has policies and regulations
with regard to direct sales to
consumers and home delivery of
alcoholic beverages.
(VI) Whether or not the State
has programs or laws to deter
adults from purchasing alcohol
for minors; and the number of
adults targeted by these
programs.
(VII) Whether or not the
State has programs targeted to
youths, parents, and caregivers
to deter underage drinking; and
the number of individuals
served by these programs.
(VIII) Whether or not the
State has enacted graduated
drivers licenses and the extent
of those provisions.
(IX) The amount that the
State invests, per youth
capita, on the prevention of
underage drinking, further
broken down by the amount spent
on--
(aa) compliance check
programs in retail
outlets, including
providing technology to
prevent and detect the
use of false
identification by
minors to make alcohol
purchases;
(bb) checkpoints and
saturation patrols that
include the goal of
reducing and deterring
underage drinking;
(cc) community-based,
school-based, and
higher-education-based
programs to prevent
underage drinking;
(dd) underage
drinking prevention
programs that target
youth within the
juvenile justice and
child welfare systems;
and
(ee) other State
efforts or programs as
deemed appropriate.
(3) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection $1,000,000 for fiscal year 2007, and
$1,000,000 for each of the fiscal years 2008 through
2010.
(d) National Media Campaign To Prevent Underage Drinking.--
(1) Scope of the campaign.--The Secretary shall
continue to fund and oversee the production,
broadcasting, and evaluation of the national adult-
oriented media public service campaign if the Secretary
determines that such campaign is effective in achieving
the media campaign's measurable objectives.
(2) Report.--The Secretary shall provide a report to
the Congress annually detailing the production,
broadcasting, and evaluation of the campaign referred
to in paragraph (1), and to detail in the report the
effectiveness of the campaign in reducing underage
drinking, the need for and likely effectiveness of an
expanded adult-oriented media campaign, and the
feasibility and the likely effectiveness of a national
youth-focused media campaign to combat underage
drinking.
(3) Consultation requirement.--In carrying out the
media campaign, the Secretary shall direct the entity
carrying out the national adult-oriented media public
service campaign to consult with interested parties
including both the alcohol beverage industry and public
health and consumer groups. The progress of this
consultative process is to be covered in the report
under paragraph (2).
(4) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection, $1,000,000 for fiscal year 2007 and
$1,000,000 for each of the fiscal years 2008 through
2010.
(e) Interventions.--
(1) Community-based coalition enhancement grants to
prevent underage drinking.--
(A) Authorization of program.--The
[Administrator of the Substance Abuse and
Mental Health Services Administration]
Assistant Secretary for Mental Health and
Substance Use, in consultation with the
Director of the Office of National Drug Control
Policy, shall award, if the [Administrator]
Assistant Secretary determines that the
Department of Health and Human Services is not
currently conducting activities that duplicate
activities of the type described in this
subsection, ``enhancement grants'' to eligible
entities to design, test, evaluate and
disseminate effective strategies to maximize
the effectiveness of community-wide approaches
to preventing and reducing underage drinking.
This subsection is subject to the availability
of appropriations.
(B) Purposes.--The purposes of this paragraph
are to--
(i) prevent and reduce alcohol use
among youth in communities throughout
the United States;
(ii) strengthen collaboration among
communities, the Federal Government,
and State, local, and tribal
governments;
(iii) enhance intergovernmental
cooperation and coordination on the
issue of alcohol use among youth;
(iv) serve as a catalyst for
increased citizen participation and
greater collaboration among all sectors
and organizations of a community that
first demonstrates a long-term
commitment to reducing alcohol use
among youth;
(v) disseminate to communities timely
information regarding state-of-the-art
practices and initiatives that have
proven to be effective in preventing
and reducing alcohol use among youth;
and
(vi) enhance, not supplant, effective
local community initiatives for
preventing and reducing alcohol use
among youth.
(C) Application.--An eligible entity desiring
an enhancement grant under this paragraph shall
submit an application to the [Administrator]
Assistant Secretary at such time, and in such
manner, and accompanied by such information as
the [Administrator] Assistant Secretary may
require. Each application shall include--
(i) a complete description of the
entity's current underage alcohol use
prevention initiatives and how the
grant will appropriately enhance the
focus on underage drinking issues; or
(ii) a complete description of the
entity's current initiatives, and how
it will use this grant to enhance those
initiatives by adding a focus on
underage drinking prevention.
(D) Uses of funds.--Each eligible entity that
receives a grant under this paragraph shall use
the grant funds to carry out the activities
described in such entity's application
submitted pursuant to subparagraph (C). Grants
under this paragraph shall not exceed $50,000
per year and may not exceed four years.
(E) Supplement not supplant.--Grant funds
provided under this paragraph shall be used to
supplement, not supplant, Federal and non-
Federal funds available for carrying out the
activities described in this paragraph.
(F) Evaluation.--Grants under this paragraph
shall be subject to the same evaluation
requirements and procedures as the evaluation
requirements and procedures imposed on
recipients of drug free community grants.
(G) Definitions.--For purposes of this
paragraph, the term ``eligible entity'' means
an organization that is currently receiving or
has received grant funds under the Drug-Free
Communities Act of 1997 (21 U.S.C. 1521 et
seq.).
(H) Administrative expenses.--Not more than 6
percent of a grant under this paragraph may be
expended for administrative expenses.
(I) Authorization of appropriations.--There
are authorized to be appropriated to carry out
this paragraph $5,000,000 for fiscal year 2007,
and $5,000,000 for each of the fiscal years
2008 through 2010.
(2) Grants directed at preventing and reducing
alcohol abuse at institutions of higher education.--
(A) Authorization of program.--The Secretary
shall award grants to eligible entities to
enable the entities to prevent and reduce the
rate of underage alcohol consumption including
binge drinking among students at institutions
of higher education.
(B) Applications.--An eligible entity that
desires to receive a grant under this paragraph
shall submit an application to the Secretary at
such time, in such manner, and accompanied by
such information as the Secretary may require.
Each application shall include--
(i) a description of how the eligible
entity will work to enhance an
existing, or where none exists to build
a, statewide coalition;
(ii) a description of how the
eligible entity will target underage
students in the State;
(iii) a description of how the
eligible entity intends to ensure that
the statewide coalition is actually
implementing the purpose of this
section and moving toward indicators
described in subparagraph (D);
(iv) a list of the members of the
statewide coalition or interested
parties involved in the work of the
eligible entity;
(v) a description of how the eligible
entity intends to work with State
agencies on substance abuse prevention
and education;
(vi) the anticipated impact of funds
provided under this paragraph in
preventing and reducing the rates of
underage alcohol use;
(vii) outreach strategies, including
ways in which the eligible entity
proposes to--
(I) reach out to students and
community stakeholders;
(II) promote the purpose of
this paragraph;
(III) address the range of
needs of the students and the
surrounding communities; and
(IV) address community norms
for underage students regarding
alcohol use; and
(viii) such additional information as
required by the Secretary.
(C) Uses of funds.--Each eligible entity that
receives a grant under this paragraph shall use
the grant funds to carry out the activities
described in such entity's application
submitted pursuant to subparagraph (B).
(D) Accountability.--On the date on which the
Secretary first publishes a notice in the
Federal Register soliciting applications for
grants under this paragraph, the Secretary
shall include in the notice achievement
indicators for the program authorized under
this paragraph. The achievement indicators
shall be designed--
(i) to measure the impact that the
statewide coalitions assisted under
this paragraph are having on the
institutions of higher education and
the surrounding communities, including
changes in the number of incidents of
any kind in which students have abused
alcohol or consumed alcohol while under
the age of 21 (including violations,
physical assaults, sexual assaults,
reports of intimidation, disruptions of
school functions, disruptions of
student studies, mental health
referrals, illnesses, or deaths);
(ii) to measure the quality and
accessibility of the programs or
information offered by the eligible
entity; and
(iii) to provide such other measures
of program impact as the Secretary
determines appropriate.
(E) Supplement not supplant.--Grant funds
provided under this paragraph shall be used to
supplement, and not supplant, Federal and non-
Federal funds available for carrying out the
activities described in this paragraph.
(F) Definitions.--For purposes of this
paragraph:
(i) Eligible entity.--The term
``eligible entity'' means a State,
institution of higher education, or
nonprofit entity.
(ii) Institution of higher
education.--The term ``institution of
higher education'' has the meaning
given the term in section 101(a) of the
Higher Education Act of 1965 (20 U.S.C.
1001(a)).
(iii) Secretary.--The term
``Secretary'' means the Secretary of
Education.
(iv) State.--The term ``State'' means
each of the 50 States, the District of
Columbia, and the Commonwealth of
Puerto Rico.
(v) Statewide coalition.--The term
``statewide coalition'' means a
coalition that--
(I) includes, but is not
limited to--
(aa) institutions of
higher education within
a State; and
(bb) a nonprofit
group, a community
underage drinking
prevention coalition,
or another substance
abuse prevention group
within a State; and
(II) works toward lowering
the alcohol abuse rate by
targeting underage students at
institutions of higher
education throughout the State
and in the surrounding
communities.
(vi) Surrounding community.--The term
``surrounding community'' means the
community--
(I) that surrounds an
institution of higher education
participating in a statewide
coalition;
(II) where the students from
the institution of higher
education take part in the
community; and
(III) where students from the
institution of higher education
live in off-campus housing.
(G) Administrative expenses.--Not more than 5
percent of a grant under this paragraph may be
expended for administrative expenses.
(H) Authorization of appropriations.--There
are authorized to be appropriated to carry out
this paragraph $5,000,000 for fiscal year 2007,
and $5,000,000 for each of the fiscal years
2008 through 2010.
(f) Additional Research.--
(1) Additional research on underage drinking.--
(A) In general.--The Secretary shall, subject
to the availability of appropriations, collect
data, and conduct or support research that is
not duplicative of research currently being
conducted or supported by the Department of
Health and Human Services, on underage
drinking, with respect to the following:
(i) Comprehensive community-based
programs or strategies and statewide
systems to prevent and reduce underage
drinking, across the underage years
from early childhood to age 21,
including programs funded and
implemented by government entities,
public health interest groups and
foundations, and alcohol beverage
companies and trade associations.
(ii) Annually obtain and report more
precise information than is currently
collected on the scope of the underage
drinking problem and patterns of
underage alcohol consumption, including
improved knowledge about the problem
and progress in preventing, reducing
and treating underage drinking; as well
as information on the rate of exposure
of youth to advertising and other media
messages encouraging and discouraging
alcohol consumption.
(iii) Compiling information on the
involvement of alcohol in unnatural
deaths of persons ages 12 to 20 in the
United States, including suicides,
homicides, and unintentional injuries
such as falls, drownings, burns,
poisonings, and motor vehicle crash
deaths.
(B) Certain matters.--The Secretary shall
carry out activities toward the following
objectives with respect to underage drinking:
(i) Obtaining new epidemiological
data within the national or targeted
surveys that identify alcohol use and
attitudes about alcohol use during pre-
and early adolescence, including harm
caused to self or others as a result of
adolescent alcohol use such as
violence, date rape, risky sexual
behavior, and prenatal alcohol
exposure.
(ii) Developing or identifying
successful clinical treatments for
youth with alcohol problems.
(C) Peer review.--Research under subparagraph
(A) shall meet current Federal standards for
scientific peer review.
(2) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection $6,000,000 for fiscal year 2007, and
$6,000,000 for each of the fiscal years 2008 through
2010.
[SEC. 519C. SERVICES FOR INDIVIDUALS WITH FETAL ALCOHOL SYNDROME.
[(a) In General.--The Secretary shall make awards of grants,
cooperative agreements, or contracts to public and nonprofit
private entities, including Indian tribes and tribal
organizations, to provide services to individuals diagnosed
with fetal alcohol syndrome or alcohol-related birth defects.
[(b) Use of Funds.--An award under subsection (a) may,
subject to subsection (d), be used to--
[(1) screen and test individuals to determine the
type and level of services needed;
[(2) develop a comprehensive plan for providing
services to the individual;
[(3) provide mental health counseling;
[(4) provide substance abuse prevention services and
treatment, if needed;
[(5) coordinate services with other social programs
including social services, justice system, educational
services, health services, mental health and substance
abuse services, financial assistance programs,
vocational services and housing assistance programs;
[(6) provide vocational services;
[(7) provide health counseling;
[(8) provide housing assistance;
[(9) parenting skills training;
[(10) overall case management;
[(11) supportive services for families of individuals
with Fetal Alcohol Syndrome; and
[(12) provide other services and programs, to the
extent authorized by the Secretary after consideration
of recommendations made by the National Task Force on
Fetal Alcohol Syndrome.
[(c) Requirements.--To be eligible to receive an award under
subsection (a), an applicant shall--
[(1) demonstrate that the program will be part of a
coordinated, comprehensive system of care for such
individuals;
[(2) demonstrate an established communication with
other social programs in the community including social
services, justice system, financial assistance
programs, health services, educational services, mental
health and substance abuse services, vocational
services and housing assistance services;
[(3) show a history of working with individuals with
fetal alcohol syndrome or alcohol-related birth
defects;
[(4) provide assurance that the services will be
provided in a culturally and linguistically appropriate
manner; and
[(5) provide assurance that at the end of the 5-year
award period, other mechanisms will be identified to
meet the needs of the individuals and families served
under such award.
[(d) Relationship to Payments Under Other Programs.--An award
may be made under subsection (a) only if the applicant involved
agrees that the award will not be expended to pay the expenses
of providing any service under this section to an individual to
the extent that payment has been made, or can reasonably be
expected to be made, with respect to such expenses--
[(1) under any State compensation program, under an
insurance policy, or under any Federal or State health
benefits program; or
[(2) by an entity that provides health services on a
prepaid basis.
[(e) Duration of Awards.--With respect to an award under
subsection (a), the period during which payments under such
award are made to the recipient may not exceed 5 years.
[(f) Evaluation.--The Secretary shall evaluate each project
carried out under subsection (a) and shall disseminate the
findings with respect to each such evaluation to appropriate
public and private entities.
[(g) Funding.--
[(1) Authorization of appropriations.--For the
purpose of carrying out this section, there are
authorized to be appropriated $25,000,000 for fiscal
year 2001, and such sums as may be necessary for each
of the fiscal years 2002 and 2003.
[(2) Allocation.--Of the amounts appropriated under
paragraph (1) for a fiscal year, not less than $300,000
shall, for purposes relating to fetal alcohol syndrome
and alcohol-related birth defects, be made available
for collaborative, coordinated interagency efforts with
the National Institute on Alcohol Abuse and Alcoholism,
the Eunice Kennedy Shriver National Institute of Child
Health and Human Development, the Health Resources and
Services Administration, the Agency for Healthcare
Research and Quality, the Centers for Disease Control
and Prevention, the Department of Education, and the
Department of Justice.]
* * * * * * *
[SEC. 519E. PREVENTION OF METHAMPHETAMINE AND INHALANT ABUSE AND
ADDICTION.
[(a) Grants.--The Director of the Center for Substance Abuse
Prevention (referred to in this section as the ``Director'')
may make grants to and enter into contracts and cooperative
agreements with public and nonprofit private entities to enable
such entities--
[(1) to carry out school-based programs concerning
the dangers of methamphetamine or inhalant abuse and
addiction, using methods that are effective and
evidence-based, including initiatives that give
students the responsibility to create their own anti-
drug abuse education programs for their schools; and
[(2) to carry out community-based methamphetamine or
inhalant abuse and addiction prevention programs that
are effective and evidence-based.
[(b) Use of Funds.--Amounts made available under a grant,
contract or cooperative agreement under subsection (a) shall be
used for planning, establishing, or administering
methamphetamine or inhalant prevention programs in accordance
with subsection (c).
[(c) Prevention Programs and Activities.--
[(1) In general.--Amounts provided under this section
may be used--
[(A) to carry out school-based programs that
are focused on those districts with high or
increasing rates of methamphetamine or inhalant
abuse and addiction and targeted at populations
which are most at risk to start methamphetamine
or inhalant abuse;
[(B) to carry out community-based prevention
programs that are focused on those populations
within the community that are most at-risk for
methamphetamine or inhalant abuse and
addiction;
[(C) to assist local government entities to
conduct appropriate methamphetamine or inhalant
prevention activities;
[(D) to train and educate State and local law
enforcement officials, prevention and education
officials, members of community anti-drug
coalitions and parents on the signs of
methamphetamine or inhalant abuse and addiction
and the options for treatment and prevention;
[(E) for planning, administration, and
educational activities related to the
prevention of methamphetamine or inhalant abuse
and addiction;
[(F) for the monitoring and evaluation of
methamphetamine or inhalant prevention
activities, and reporting and disseminating
resulting information to the public; and
[(G) for targeted pilot programs with
evaluation components to encourage innovation
and experimentation with new methodologies.
[(2) Priority.--The Director shall give priority in
making grants under this section to rural and urban
areas that are experiencing a high rate or rapid
increases in methamphetamine or inhalant abuse and
addiction.
[(d) Analyses and Evaluation.--
[(1) In general.--Up to $500,000 of the amount
available in each fiscal year to carry out this section
shall be made available to the Director, acting in
consultation with other Federal agencies, to support
and conduct periodic analyses and evaluations of
effective prevention programs for methamphetamine or
inhalant abuse and addiction and the development of
appropriate strategies for disseminating information
about and implementing these programs.
[(2) Annual reports.--The Director shall submit to
the Committee on Health, Education, Labor, and Pensions
and the Committee on Appropriations of the Senate and
the Committee on Commerce and Committee on
Appropriations of the House of Representatives, an
annual report with the results of the analyses and
evaluation under paragraph (1).
[(e) Authorization of Appropriations.--There is authorized to
be appropriated to carry out subsection (a), $10,000,000 for
fiscal year 2001, and such sums as may be necessary for each of
fiscal years 2002 and 2003.]
Subpart 3--Center for Mental Health Services
center for mental health services
Sec. 520. (a) Establishment.--There is established in the
Administration a Center for Mental Health Services (hereafter
in this section referred to as the ``Center''). The Center
shall be headed by a Director (hereafter in this section
referred to as the ``Director'') appointed by the Secretary
from among individuals with extensive experience or academic
qualifications in the provision of mental health services or in
the evaluation of mental health service systems.
(b) Duties.--The Director of the Center shall--
(1) design national goals and establish national
priorities for--
(A) the prevention of mental illness; and
(B) the promotion of mental health;
(2) encourage and assist local entities and State
agencies to achieve the goals and priorities described
in paragraph (1);
(3) collaborate with the Director of the National
Institute of Mental Health to ensure that, as
appropriate, programs related to the prevention and
treatment of mental illness and the promotion of mental
health are carried out in a manner that reflects the
best available science and evidence-based practices,
including culturally and linguistically appropriate
services;
[(3)] (4) collaborate with the Department of
Education and the Department of Justice to develop
programs to assist local communities in addressing
violence among children and adolescents;
[(4)] (5) develop and coordinate Federal prevention
policies and programs and to assure increased focus on
the prevention of mental illness and the promotion of
mental health through policies and programs that reduce
risk and promote resiliency;
[(5)] (6) in collaboration with the Director of the
National Institute of Mental Health, develop improved
methods of treating individuals with mental health
problems and improved methods of assisting the families
of such individuals;
[(6)] (7) administer the mental health services block
grant program authorized in section 1911;
[(7)] (8) promote policies and programs at Federal,
State, and local levels and in the private sector that
foster independence, increase meaningful participation
of individuals with mental illness in programs and
activities of the Administration, and protect the legal
rights of persons with mental illness, including
carrying out the provisions of the Protection and
Advocacy of Mentally Ill Individuals Act;
[(8)] (9) carry out the programs under part C;
[(9)] (10) carry out responsibilities for the Human
Resource Development program, and programs of clinical
training for [professional and paraprofessional
personnel pursuant to section 303] paraprofessional
personnel and health professionals;
[(10)] (11) conduct services-related assessments,
including evaluations of the organization and financing
of care, self-help and consumer-run programs, mental
health economics, mental health service systems, rural
mental health, and telemental health, and improve the
capacity of State to conduct evaluations of publicly
funded mental health programs;
[(11) establish a clearinghouse for mental health
information to assure the widespread dissemination of
such information] (12) disseminate mental health
information, including evidenced-based practices, to
States, political subdivisions, educational agencies
and institutions, treatment and prevention service
providers, and the general public, including
information concerning the practical application of
research supported by the National Institute of Mental
Health that is applicable to improving the delivery of
services;
[(12)] (13) provide technical assistance to public
and private entities that are providers of mental
health services;
[(13)] (14) monitor and enforce obligations incurred
by community mental health centers pursuant to the
Community Mental Health Centers Act (as in effect prior
to the repeal of such Act on August 13, 1981, by
section 902(e)(2)(B) of Public Law 97-35 (95 Stat.
560));
[(14)] (15) conduct surveys with respect to mental
health, such as the National Reporting Program; [and]
[(15)] (16) assist States in improving their mental
health data collection[.]; and
(17) consult with other agencies and offices of the
Department of Health and Human Services to ensure, with
respect to each grant awarded by the Center for Mental
Health Services, the consistent documentation of the
application of criteria when awarding grants and the
ongoing oversight of grantees after such grants are
awarded.
(c) Grants and Contracts.--In carrying out the duties
established in subsection (b), the Director may make grants to
and enter into contracts and cooperative agreements with public
and nonprofit private entities.
* * * * * * *
SEC. 520B. NATIONAL CENTERS OF EXCELLENCE FOR DEPRESSION.
(a) Depressive Disorder Defined.--In this section, the term
``depressive disorder'' means a mental or brain disorder
relating to depression, including major depression, bipolar
disorder, and related mood disorders.
(b) Grant Program.--
(1) In general.--The Secretary, acting through the
[Administrator] Assistant Secretary, shall award grants
on a competitive basis to eligible entities to
establish national centers of excellence for depression
(referred to in this section as ``Centers''), which
shall engage in activities related to the treatment of
depressive disorders.
(2) Allocation of awards.--If the funds authorized
under subsection (f) are appropriated in the amounts
provided for under such subsection, the Secretary shall
allocate such amounts so that--
(A) not later than 1 year after the date of
enactment of the ENHANCED Act of 2009, not more
than 20 Centers may be established; and
(B) not later than September 30, 2016, not
more than 30 Centers may be established.
(3) Grant period.--
(A) In general.--A grant awarded under this
section shall be for a period of 5 years.
(B) Renewal.--A grant awarded under
subparagraph (A) may be renewed, on a
competitive basis, for 1 additional 5-year
period, at the discretion of the Secretary. In
determining whether to renew a grant, the
Secretary shall consider the report cards
issued under subsection (e)(2).
(4) Use of funds.--Grant funds awarded under this
subsection shall be used for the establishment and
ongoing activities of the recipient of such funds.
(5) Eligible entities.--
(A) Requirements.--To be eligible to receive
a grant under this section, an entity shall--
(i) be an institution of higher
education or a public or private
nonprofit research institution; and
(ii) submit an application to the
Secretary at such time and in such
manner as the Secretary may require, as
described in subparagraph (B).
(B) Application.--An application described in
subparagraph (A)(ii) shall include--
(i) evidence that such entity--
(I) provides, or is capable
of coordinating with other
entities to provide,
comprehensive health services
with a focus on mental health
services and subspecialty
expertise for depressive
disorders;
(II) collaborates with other
mental health providers, as
necessary, to address co-
occurring mental illnesses;
(III) is capable of training
health professionals about
mental health; and
(ii) such other information, as the
Secretary may require.
(C) Priorities.--In awarding grants under
this section, the Secretary shall give priority
to eligible entities that meet 1 or more of the
following criteria:
(i) Demonstrated capacity and
expertise to serve the targeted
population.
(ii) Existing infrastructure or
expertise to provide appropriate,
evidence-based and culturally and
linguistically competent services.
(iii) A location in a geographic area
with disproportionate numbers of
underserved and at-risk populations in
medically underserved areas and health
professional shortage areas.
(iv) Proposed innovative approaches
for outreach to initiate or expand
services.
(v) Use of the most up-to-date
science, practices, and interventions
available.
(vi) Demonstrated capacity to
establish cooperative and collaborative
agreements with community mental health
centers and other community entities to
provide mental health, social, and
human services to individuals with
depressive disorders.
(6) National coordinating center.--
(A) In general.--The Secretary, acting
through the [Administrator] Assistant
Secretary, shall designate 1 recipient of a
grant under this section to be the coordinating
center of excellence for depression (referred
to in this section as the ``coordinating
center''). The Secretary shall select such
coordinating center on a competitive basis,
based upon the demonstrated capacity of such
center to perform the duties described in
subparagraph (C).
(B) Application.--A Center that has been
awarded a grant under paragraph (1) may apply
for designation as the coordinating center by
submitting an application to the Secretary at
such time, in such manner, and containing such
information as the Secretary may require.
(C) Duties.--The coordinating center shall--
(i) develop, administer, and
coordinate the network of Centers under
this section;
(ii) oversee and coordinate the
national database described in
subsection (d);
(iii) lead a strategy to disseminate
the findings and activities of the
Centers through such database; and
(iv) serve as a liaison with the
Administration, the National Registry
of Evidence-based Programs and
Practices of the Administration, and
any Federal interagency or interagency
forum on mental health.
(7) Matching funds.--The Secretary may not award a
grant or contract under this section to an entity
unless the entity agrees that it will make available
(directly or through contributions from other public or
private entities) non-Federal contributions toward the
activities to be carried out under the grant or
contract in an amount equal to $1 for each $5 of
Federal funds provided under the grant or contract.
Such non-Federal matching funds may be provided
directly or through donations from public or private
entities and may be in cash or in-kind, fairly
evaluated, including plant, equipment, or services.
(c) Activities of the Centers.--Each Center shall carry out
the following activities:
(1) General activities.--Each Center shall--
(A) integrate basic, clinical, or health
services interdisciplinary research and
practice in the development, implementation,
and dissemination of evidence-based
interventions;
(B) involve a broad cross-section of
stakeholders, such as researchers, clinicians,
consumers, families of consumers, and voluntary
health organizations, to develop a research
agenda and disseminate findings, and to provide
support in the implementation of evidence-based
practices;
(C) provide training and technical assistance
to mental health professionals, and engage in
and disseminate translational research with a
focus on meeting the needs of individuals with
depressive disorders; and
(D) educate policy makers, employers,
community leaders, and the public about
depressive disorders to reduce stigma and raise
awareness of treatments.
(2) Improved treatment standards, clinical
guidelines, diagnostic protocols, and care coordination
practice.--Each Center shall collaborate with other
Centers in the network to--
(A) develop and implement treatment
standards, clinical guidelines, and protocols
that emphasize primary prevention, early
intervention, treatment for, and recovery from,
depressive disorders;
(B) foster communication with other providers
attending to co-occurring physical health
conditions such as cardiovascular, diabetes,
cancer, and substance abuse disorders;
(C) leverage available community resources,
develop and implement improved self-management
programs, and, when appropriate, involve family
and other providers of social support in the
development and implementation of care plans;
and
(D) use electronic health records and
telehealth technology to better coordinate and
manage, and improve access to, care, as
determined by the coordinating center.
(3) Translational research through collaboration of
centers and community-based organizations.--Each Center
shall--
(A) demonstrate effective use of a public-
private partnership to foster collaborations
among members of the network and community-
based organizations such as community mental
health centers and other social and human
services providers;
(B) expand interdisciplinary, translational,
and patient-oriented research and treatment;
and
(C) coordinate with accredited academic
programs to provide ongoing opportunities for
the professional and continuing education of
mental health providers.
(d) National Database.--
(1) In general.--The coordinating center shall
establish and maintain a national, publicly available
database to improve prevention programs, evidence-based
interventions, and disease management programs for
depressive disorders, using data collected from the
Centers, as described in paragraph (2).
(2) Data collection.--Each Center shall submit data
gathered at such center, as appropriate, to the
coordinating center regarding--
(A) the prevalence and incidence of
depressive disorders;
(B) the health and social outcomes of
individuals with depressive disorders;
(C) the effectiveness of interventions
designed, tested, and evaluated;
(D) other information, as the Secretary may
require.
(3) Submission of data to the [administrator]
assistant secretary.--The coordinating center shall
submit to the [Administrator] Assistant Secretary the
data and financial information gathered under paragraph
(2).
(4) Publication using data from the database.--A
Center, or an individual affiliated with a Center, may
publish findings using the data described in paragraph
(2) only if such center submits such data to the
coordinating center, as required under such paragraph.
(e) Establishment of Standards; Report Cards and
Recommendations; Third Party Review.--
(1) Establishment of standards.--The Secretary,
acting through the [Administrator] Assistant Secretary,
shall establish performance standards for--
(A) each Center; and
(B) the network of Centers as a whole.
(2) Report cards.--The Secretary, acting through the
[Administrator] Assistant Secretary, shall--
(A) for each Center, not later than 3 years
after the date on which such center of
excellence is established and annually
thereafter, issue a report card to the
coordinating center to rate the performance of
such Center; and
(B) not later than 3 years after the date on
which the first grant is awarded under
subsection (b)(1) and annually thereafter,
issue a report card to Congress to rate the
performance of the network of centers of
excellence as a whole.
(3) Recommendations.--Based upon the report cards
described in paragraph (2), the Secretary shall, not
later than September 30, 2015--
(A) make recommendations to the Centers
regarding improvements such centers shall make;
and
(B) make recommendations to Congress for
expanding the Centers to serve individuals with
other types of mental disorders.
(4) Third party review.--Not later than 3 years after
the date on which the first grant is awarded under
subsection (b)(1) and annually thereafter, the
Secretary shall arrange for an independent third party
to conduct an evaluation of the network of Centers to
ensure that such centers are meeting the goals of this
section.
(f) Authorization of Appropriations.--
(1) In general.--To carry out this section, there are
authorized to be appropriated--
(A) $100,000,000 for each of the fiscal years
2011 through 2015; and
(B) $150,000,000 for each of the fiscal years
2016 through 2020.
(2) Allocation of funds authorized.--Of the amount
appropriated under paragraph (1) for a fiscal year, the
Secretary shall determine the allocation of each Center
receiving a grant under this section, but in no case
may the allocation be more than $5,000,000, except that
the Secretary may allocate not more than $10,000,000 to
the coordinating center.
SEC. 520C. [YOUTH INTERAGENCY RESEARCH, TRAINING, AND TECHNICAL
ASSISTANCE CENTERS.] SUICIDE PREVENTION TECHNICAL
ASSISTANCE CENTER.
(a) Program Authorized.--The Secretary, acting through the
[Administrator of the Substance Abuse and Mental Health
Services Administration] Assistant Secretary for Mental Health
and Substance Use, [and in consultation with the Administrator
of the Office of Juvenile Justice and Delinquency Prevention,
the Director of the Bureau of Justice Assistance and the
Director of the National Institutes of Health--]
[(1) shall award grants or contracts to public or
nonprofit private entities to establish not more than
four research, training, and technical assistance
centers to carry out the activities described in
subsection (c); and
[(2) shall award a competitive grant to 1 additional
research, training, and technical assistance center to
carry out the activities described in subsection (d).]
shall establish a research, training, and technical
assistance resource center to provide appropriate
information, training, and technical assistance to
States, political subdivisions of States, federally
recognized Indian tribes, tribal organizations,
institutions of higher education, public organizations,
or private nonprofit organizations regarding the
prevention of suicide among all ages, particularly
among groups that are at high risk for suicide.
[(b) Application.--A public or private nonprofit entity
desiring a grant or contract under subsection (a) shall prepare
and submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary
may require.
[(c) Authorized Activities.--A center established under a
grant or contract under subsection (a)(1) shall--
[(1) provide training with respect to state-of-the-
art mental health and justice-related services and
successful mental health and substance abuse-justice
collaborations that focus on children and adolescents,
to public policymakers, law enforcement administrators,
public defenders, police, probation officers, judges,
parole officials, jail administrators and mental health
and substance abuse providers and administrators;
[(2) engage in research and evaluations concerning
State and local justice and mental health systems,
including system redesign initiatives, and disseminate
information concerning the results of such evaluations;
[(3) provide direct technical assistance, including
assistance provided through toll-free telephone
numbers, concerning issues such as how to accommodate
individuals who are being processed through the courts
under the Americans with Disabilities Act of 1990 (42
U.S.C. 12101 et seq.), what types of mental health or
substance abuse service approaches are effective within
the judicial system, and how community-based mental
health or substance abuse services can be more
effective, including relevant regional, ethnic, and
gender-related considerations; and
[(4) provide information, training, and technical
assistance to State and local governmental officials to
enhance the capacity of such officials to provide
appropriate services relating to mental health or
substance abuse.
[(d) Additional Center.--] (b) Responsibilities of the
Center.--[The additional research, training, and technical
assistance center established under subsection (a)(2) shall
provide appropriate information, training, and technical
assistance to States, political subdivisions of a State,
Federally recognized Indian tribes, tribal organizations,
institutions of higher education, public organizations, or
private nonprofit organizations for] The center established
under subsection (a) shall conduct activities for the purpose
of--
(1) [the development or continuation of] developing
and continuing statewide or tribal [youth suicide]
suicide early intervention and prevention strategies
for all ages, particularly among groups that are at
high risk for suicide;
(2) ensuring the surveillance of [youth suicide]
suicide early intervention and prevention strategies
for all ages, particularly among groups that are at
high risk for suicide;
(3) studying the costs and effectiveness of statewide
and tribal [youth suicide] suicide early intervention
and prevention strategies in order to provide
information concerning relevant issues of importance to
State, tribal, and national policymakers;
(4) further identifying and understanding causes and
associated risk factors for [youth suicide] suicide;
(5) analyzing the efficacy of new and existing [youth
suicide] suicide early intervention and prevention
techniques and technology;
(6) ensuring the surveillance of suicidal behaviors
and nonfatal suicidal attempts;
(7) studying the effectiveness of State-sponsored
statewide and tribal [youth suicide] suicide early
intervention and prevention strategies on the overall
wellness and health promotion strategies related to
suicide attempts;
(8) promoting the sharing of data regarding [youth
suicide] suicide with Federal agencies involved with
[youth suicide] suicide early intervention and
prevention, and State-sponsored statewide or tribal
[youth suicide] suicide early intervention and
prevention strategies for the purpose of identifying
previously unknown mental health causes and associated
risk factors for suicide [in youth];
(9) evaluating and disseminating outcomes and best
practices of mental [and behavioral health] health and
substance use disorder services at institutions of
higher education; and
(10) conducting other activities determined
appropriate by the Secretary.
[(e) Authorization of Appropriations.--
[(1) For the purpose of awarding grants or contracts
under subsection (a)(1), there is authorized to be
appropriated $4,000,000 for fiscal year 2001, and such
sums as may be necessary for fiscal years 2002 and
2003.
[(2) For the purpose of awarding a grant under
subsection (a)(2), there are authorized to be
appropriated $3,000,000 for fiscal year 2005,
$4,000,000 for fiscal year 2006, and $5,000,000 for
fiscal year 2007.]
(c) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $5,988,000 for each of fiscal years 2017 through
2021.
(d) Report.--Not later than 2 years after the date of
enactment of the Helping Families in Mental Health Crisis Act
of 2016, the Secretary shall submit to Congress a report on the
activities carried out by the center established under
subsection (a) during the year involved, including the
potential effects of such activities, and the States,
organizations, and institutions that have worked with the
center.
[SEC. 520D. SERVICES FOR YOUTH OFFENDERS.
[(a) In General.--The Secretary, acting through the Director
of the Center for Mental Health Services, and in consultation
with the Director of the Center for Substance Abuse Treatment,
the Administrator of the Office of Juvenile Justice and
Delinquency Prevention, and the Director of the Special
Education Programs, shall award grants on a competitive basis
to State or local juvenile justice agencies to enable such
agencies to provide aftercare services for youth offenders who
have been discharged from facilities in the juvenile or
criminal justice system and have serious emotional disturbances
or are at risk of developing such disturbances.
[(b) Use of Funds.--A State or local juvenile justice agency
receiving a grant under subsection (a) shall use the amounts
provided under the grant--
[(1) to develop a plan describing the manner in which
the agency will provide services for each youth
offender who has a serious emotional disturbance and
has been detained or incarcerated in facilities within
the juvenile or criminal justice system;
[(2) to provide a network of core or aftercare
services or access to such services for each youth
offender, including diagnostic and evaluation services,
substance abuse treatment services, outpatient mental
health care services, medication management services,
intensive home-based therapy, intensive day treatment
services, respite care, and therapeutic foster care;
[(3) to establish a program that coordinates with
other State and local agencies providing recreational,
social, educational, vocational, or operational
services for youth, to enable the agency receiving a
grant under this section to provide community-based
system of care services for each youth offender that
addresses the special needs of the youth and helps the
youth access all of the aforementioned services; and
[(4) using not more than 20 percent of funds
received, to provide planning and transition services
as described in paragraph (3) for youth offenders while
such youth are incarcerated or detained.
[(c) Application.--A State or local juvenile justice agency
that desires a grant under subsection (a) shall submit an
application to the Secretary at such time, in such manner, and
accompanied by such information as the Secretary may reasonably
require.
[(d) Report.--Not later than 3 years after the date of the
enactment of this section and annually thereafter, the
Secretary shall prepare and submit, to the Committee on Health,
Education, Labor, and Pensions of the Senate and the Committee
on Commerce of the House of Representatives, a report that
describes the services provided pursuant to this section.
[(e) Definitions.--In this section:
[(1) Serious emotional disturbance.--The term
``serious emotional disturbance'' with respect to a
youth offender means an offender who currently, or at
any time within the 1-year period ending on the day on
which services are sought under this section, has a
diagnosable mental, behavioral, or emotional disorder
that functionally impairs the offender's life by
substantially limiting the offender's role in family,
school, or community activities, and interfering with
the offender's ability to achieve or maintain one or
more developmentally-appropriate social, behavior,
cognitive, communicative, or adaptive skills.
[(2) Community-based system of care.--The term
``community-based system of care'' means the provision
of services for the youth offender by various State or
local agencies that in an interagency fashion or
operating as a network addresses the recreational,
social, educational, vocational, mental health,
substance abuse, and operational needs of the youth
offender.
[(3) Youth offender.--The term ``youth offender''
means an individual who is 21 years of age or younger
who has been discharged from a State or local juvenile
or criminal justice system, except that if the
individual is between the ages of 18 and 21 years, such
individual has had contact with the State or local
juvenile or criminal justice system prior to attaining
18 years of age and is under the jurisdiction of such a
system at the time services are sought.
[(f) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section $40,000,000 for
fiscal year 2001, and such sums as may be necessary for each of
fiscal years 2002 and 2003.]
SEC. 520E. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.
(a) In General.--The Secretary, acting through the
[Administrator of the Substance Abuse and Mental Health
Services Administration] Assistant Secretary for Mental Health
and Substance Use, shall award grants or cooperative agreements
to eligible entities to--
(1) develop and implement State-sponsored statewide
or tribal youth suicide early intervention and
prevention strategies in schools, educational
institutions, juvenile justice systems, [substance
abuse] substance use disorder programs, mental health
programs, foster care systems, and other child and
youth support organizations;
(2) support public organizations and private
nonprofit organizations actively involved in State-
sponsored statewide or tribal youth suicide early
intervention and prevention strategies and in the
development and continuation of State-sponsored
statewide youth suicide early intervention and
prevention strategies;
(3) provide grants to institutions of higher
education to coordinate the implementation of State-
sponsored statewide or tribal youth suicide early
intervention and prevention strategies;
(4) collect and analyze data on State-sponsored
statewide or tribal youth suicide early intervention
and prevention services that can be used to monitor the
effectiveness of such services and for research,
technical assistance, and policy development; and
(5) assist eligible entities, through State-sponsored
statewide or tribal youth suicide early intervention
and prevention strategies, in achieving targets for
youth suicide reductions under title V of the Social
Security Act.
(b) Eligible Entity.--
(1) Definition.--In this section, the term ``eligible
entity'' means--
(A) a State;
(B) a public organization or private
nonprofit organization designated by a State to
develop or direct the State-sponsored statewide
youth suicide early intervention and prevention
strategy; or
(C) a Federally recognized Indian tribe or
tribal organization (as defined in the Indian
Self-Determination and Education Assistance
Act) or an urban Indian organization (as
defined in the Indian Health Care Improvement
Act) that is actively involved in the
development and continuation of a tribal youth
suicide early intervention and prevention
strategy.
(2) Limitation.--In carrying out this section, the
Secretary shall ensure that [each State is awarded only
1 grant or cooperative agreement under this section] a
State does not receive more than 1 grant or cooperative
agreement under this section at any 1 time. For
purposes of the preceding sentence, a State shall be
considered to have [been awarded] received a grant or
cooperative agreement if the eligible entity involved
is the State or an entity designated by the State under
paragraph (1)(B). Nothing in this paragraph shall be
construed to apply to entities described in paragraph
(1)(C).
(c) Preference.--In providing assistance under a grant or
cooperative agreement under this section, an eligible entity
shall give preference to public organizations, private
nonprofit organizations, political subdivisions, institutions
of higher education, and tribal organizations actively involved
with the State-sponsored statewide or tribal youth suicide
early intervention and prevention strategy that--
(1) provide early intervention and assessment
services, including screening programs, to youth who
are at risk for mental or emotional disorders that may
lead to a suicide attempt, and that are integrated with
school systems, educational institutions, juvenile
justice systems, [substance abuse] substance use
disorder programs, mental health programs, foster care
systems, and other child and youth support
organizations;
(2) demonstrate collaboration among early
intervention and prevention services or certify that
entities will engage in future collaboration;
(3) employ or include in their applications a
commitment to evaluate youth suicide early intervention
and prevention practices and strategies adapted to the
local community;
(4) provide timely referrals for appropriate
community-based mental health care and treatment of
youth who are at risk for suicide in child-serving
settings and agencies;
(5) provide immediate support and information
resources to families of youth who are at risk for
suicide;
(6) offer access to services and care to youth with
diverse linguistic and cultural backgrounds;
(7) offer appropriate postsuicide intervention
services, care, and information to families, friends,
schools, educational institutions, juvenile justice
systems, substance abuse programs, mental health
programs, foster care systems, and other child and
youth support organizations of youth who recently
completed suicide;
(8) offer continuous and up-to-date information and
awareness campaigns that target parents, family
members, child care professionals, community care
providers, and the general public and highlight the
risk factors associated with youth suicide and the
life-saving help and care available from early
intervention and prevention services;
(9) ensure that information and awareness campaigns
on youth suicide risk factors, and early intervention
and prevention services, use effective communication
mechanisms that are targeted to and reach youth,
families, schools, educational institutions, and youth
organizations;
(10) provide a timely response system to ensure that
child-serving professionals and providers are properly
trained in youth suicide early intervention and
prevention strategies and that child-serving
professionals and providers involved in early
intervention and prevention services are properly
trained in effectively identifying youth who are at
risk for suicide;
(11) provide continuous training activities for child
care professionals and community care providers on the
latest youth suicide early intervention and prevention
services practices and strategies;
(12) conduct annual self-evaluations of outcomes and
activities, including consulting with interested
families and advocacy organizations;
(13) provide services in areas or regions with rates
of youth suicide that exceed the national average as
determined by the Centers for Disease Control and
Prevention; and
(14) obtain informed written consent from a parent or
legal guardian of an at-risk child before involving the
child in a youth suicide early intervention and
prevention program.
(d) Requirement for Direct Services.--Not less than 85
percent of grant funds received under this section shall be
used to provide direct services, of which not less than 5
percent shall be used for activities authorized under
subsection (a)(3).
(e) Coordination and Collaboration.--
(1) In general.--In carrying out this section, the
Secretary shall collaborate with relevant Federal
agencies and suicide working groups responsible for
early intervention and prevention services relating to
youth suicide.
(2) Consultation.--In carrying out this section, the
Secretary shall consult with--
(A) State and local agencies, including
agencies responsible for early intervention and
prevention services under title XIX of the
Social Security Act, the State Children's
Health Insurance Program under title XXI of the
Social Security Act, and programs funded by
grants under title V of the Social Security
Act;
(B) local and national organizations that
serve youth at risk for suicide and their
families;
(C) relevant national medical and other
health and education specialty organizations;
(D) youth who are at risk for suicide, who
have survived suicide attempts, or who are
currently receiving care from early
intervention services;
(E) families and friends of youth who are at
risk for suicide, who have survived suicide
attempts, who are currently receiving care from
early intervention and prevention services, or
who have completed suicide;
(F) qualified professionals who possess the
specialized knowledge, skills, experience, and
relevant attributes needed to serve youth at
risk for suicide and their families; and
(G) third-party payers, managed care
organizations, and related commercial
industries.
(3) Policy development.--In carrying out this
section, the Secretary shall--
(A) coordinate and collaborate on policy
development at the Federal level with the
relevant Department of Health and Human
Services agencies and suicide working groups;
and
(B) consult on policy development at the
Federal level with the private sector,
including consumer, medical, suicide prevention
advocacy groups, and other health and education
professional-based organizations, with respect
to State-sponsored statewide or tribal youth
suicide early intervention and prevention
strategies.
(f) Rule of Construction; Religious and Moral
Accommodation.--Nothing in this section shall be construed to
require suicide assessment, early intervention, or treatment
services for youth whose parents or legal guardians object
based on the parents' or legal guardians' religious beliefs or
moral objections.
(g) Evaluations and Report.--
(1) Evaluations by eligible entities.--Not later than
18 months after receiving a grant or cooperative
agreement under this section, an eligible entity shall
submit to the Secretary the results of an evaluation to
be conducted by the entity concerning the effectiveness
of the activities carried out under the grant or
agreement.
(2) Report.--Not later than 2 years after the date of
enactment of this section, the Secretary shall submit
to the appropriate committees of Congress a report
concerning the results of--
(A) the evaluations conducted under paragraph
(1); and
(B) an evaluation conducted by the Secretary
to analyze the effectiveness and efficacy of
the activities conducted with grants,
collaborations, and consultations under this
section.
(h) Rule of Construction; Student Medication.--Nothing in
this section or section 520E-1 shall be construed to allow
school personnel to require that a student obtain any
medication as a condition of attending school or receiving
services.
(i) Prohibition.--Funds appropriated to carry out this
section, section 520C, section 520E-1, or section 520E-2 shall
not be used to pay for or refer for abortion.
(j) Parental consent.--States and entities receiving funding
under this section and section 520E-1 shall obtain prior
written, informed consent from the child's parent or legal
guardian for assessment services, school-sponsored programs,
and treatment involving medication related to youth suicide
conducted in elementary and secondary schools. The requirement
of the preceding sentence does not apply in the following
cases:
(1) In an emergency, where it is necessary to protect
the immediate health and safety of the student or other
students.
(2) Other instances, as defined by the State, where
parental consent cannot reasonably be obtained.
(k) Relation to Education Provisions.--Nothing in this
section or section 520E-1 shall be construed to supersede
section 444 of the General Education Provisions Act, including
the requirement of prior parental consent for the disclosure of
any education records. Nothing in this section or section 520E-
1 shall be construed to modify or affect parental notification
requirements for programs authorized under the Elementary and
Secondary Education Act of 1965 (as amended by the No Child
Left Behind Act of 2001; Public Law 107-110).
(l) Definitions.--In this section:
(1) Early intervention.--The term ``early
intervention'' means a strategy or approach that is
intended to prevent an outcome or to alter the course
of an existing condition.
(2) Educational institution; institution of higher
education; school.--The term--
(A) ``educational institution'' means a
school or institution of higher education;
(B) ``institution of higher education'' has
the meaning given such term in section 101 of
the Higher Education Act of 1965; and
(C) ``school'' means an elementary school or
secondary school (as such terms are defined in
section 8101 of the Elementary and Secondary
Education Act of 1965).
(3) Prevention.--The term ``prevention'' means a
strategy or approach that reduces the likelihood or
risk of onset, or delays the onset, of adverse health
problems that have been known to lead to suicide.
(4) Youth.--The term ``youth'' means individuals who
are between 10 and 24 years of age.
[(m) Authorization of Appropriations.--
[(1) In general.--For the purpose of carrying out
this section, there are authorized to be appropriated
$7,000,000 for fiscal year 2005, $18,000,000 for fiscal
year 2006, and $30,000,000 for fiscal year 2007.
[(2) Preference.--If less than $3,500,000 is
appropriated for any fiscal year to carry out this
section, in awarding grants and cooperative agreements
under this section during the fiscal year, the
Secretary shall give preference to States that have
rates of suicide that significantly exceed the national
average as determined by the Centers for Disease
Control and Prevention.]
(m) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $35,427,000 for each of fiscal years 2017 through
2021.
* * * * * * *
SEC. 520E-2. MENTAL [AND BEHAVIORAL HEALTH] HEALTH AND SUBSTANCE USE
DISORDER SERVICES ON CAMPUS.
(a) In General.--The Secretary, acting through the Director
of the Center for Mental Health [Services,] Services and in
consultation with the Secretary of Education, may award grants
on a competitive basis to institutions of higher education to
enhance services for students with mental [and behavioral
health problems] health or substance use disorders that can
lead to school failure, such as depression, [substance abuse]
substance use disorders, and suicide attempts, so that students
will successfully complete their studies.
(b) Use of Funds.--The Secretary may not make a grant to an
institution of higher education under this section unless the
institution agrees to use the grant only [for--] for one or
more of the following:
[(1) educational seminars;
[(2) the operation of hot lines;
[(3) preparation of informational material;
[(4) preparation of educational materials for
families of students to increase awareness of potential
mental and behavioral health issues of students
enrolled at the institution of higher education;
[(5) training programs for students and campus
personnel to respond effectively to students with
mental and behavioral health problems that can lead to
school failure, such as depression, substance abuse,
and suicide attempts; or
[(6) the creation of a networking infrastructure to
link colleges and universities that do not have mental
health services with health care providers who can
treat mental and behavioral health problems.]
(1) Educating students, families, faculty, and staff
to increase awareness of mental health and substance
use disorders.
(2) The operation of hotlines.
(3) Preparing informational material.
(4) Providing outreach services to notify students
about available mental health and substance use
disorder services.
(5) Administering voluntary mental health and
substance use disorder screenings and assessments.
(6) Supporting the training of students, faculty, and
staff to respond effectively to students with mental
health and substance use disorders.
(7) Creating a network infrastructure to link
colleges and universities with health care providers
who treat mental health and substance use disorders.
(c) Eligible grant recipients.--Any institution of higher
education receiving a grant under this section may carry out
activities under the grant through--
(1) college counseling centers;
(2) college and university psychological service
centers;
(3) mental health centers;
(4) psychology training clinics; or
(5) institution of higher education supported,
evidence-based, mental health and [substance abuse]
substance use disorder programs.
(d) Application.--[An institution of higher education
desiring a grant under this section] To be eligible to receive
a grant under this section, an institution of higher education
shall prepare and submit an application to the Secretary at
such time and in such manner as the Secretary may require. At a
minimum, the application shall include the following:
(1) A description of identified mental [and
behavioral health] health and substance use disorder
needs of students, including veterans whenever possible
and appropriate, at the institution of higher
education.
(2) A description of Federal, State, local, private,
and institutional resources currently available to
address the needs described in paragraph (1) at the
institution of higher education, which may include, as
appropriate and in accordance with subsection (b)(7), a
plan to seek input from relevant stakeholders in the
community, including appropriate public and private
entities, in order to carry out the program under the
grant.
(3) A description of the outreach strategies of the
institution of higher education for promoting access to
services, including a proposed plan for reaching those
students most in need of mental health services.
(4) A plan to evaluate program outcomes, including a
description of the proposed use of funds, the program
objectives, and how the objectives will be met.
(5) An assurance that the institution will submit a
report to the Secretary each fiscal year on the
activities carried out with the grant and the results
achieved through those activities.
(e) Requirement of Matching Funds.--
(1) In general.--The Secretary may make a grant under
this section to an institution of higher education only
if the institution agrees to make available (directly
or through donations from public or private entities)
non-Federal contributions in an amount that is not less
than $1 for each $1 of Federal funds provided in the
grant, toward the costs of activities carried out with
the grant (as described in subsection (b)) and other
activities by the institution to reduce student mental
[and behavioral health problems] health and substance
use disorders.
(2) Determination of amount contributed.--Non-Federal
contributions required under paragraph (1) may be in
cash or in kind. Amounts provided by the Federal
Government, or services assisted or subsidized to any
significant extent by the Federal Government, may not
be included in determining the amount of such non-
Federal contributions.
(3) Waiver.--The Secretary may waive the requirement
established in paragraph (1) with respect to an
institution of higher education if the Secretary
determines that extraordinary need at the institution
justifies the waiver.
(f) Reports.--For each fiscal year that grants are awarded
under this section, the Secretary shall conduct a study on the
results of the grants and submit to the Congress a report on
such results that includes the following:
(1) An evaluation of the grant program outcomes,
including a summary of activities carried out with the
grant and the results achieved through those
activities.
(2) Recommendations on how to improve access to
mental [and behavioral health] health and substance use
disorder services at institutions of higher education,
including efforts to reduce the incidence of [suicide
and substance abuse] suicide and substance use
disorders.
(g) Definition.--In this section, the term ``institution of
higher education'' has the meaning given such term in section
101 of the Higher Education Act of 1965.
(h) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated [$5,000,000 for fiscal year 2005, $5,000,000 for
fiscal year 2006, and $5,000,000 for fiscal year 2007.]
$6,488,000 for each of fiscal years 2017 through 2021.
SEC. 520E-3. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
(a) In General.--The Secretary, acting through the Assistant
Secretary, shall maintain the National Suicide Prevention
Lifeline Program (referred to in this section as the
``Program''), authorized under section 520A and in effect prior
to the date of enactment of the Helping Families in Mental
Health Crisis Act of 2016.
(b) Activities.--In maintaining the Program, the activities
of the Secretary shall include--
(1) coordinating a network of crisis centers across
the United States for providing suicide prevention and
crisis intervention services to individuals seeking
help at any time, day or night;
(2) maintaining a suicide prevention hotline to link
callers to local emergency, mental health, and social
services resources; and
(3) consulting with the Secretary of Veterans Affairs
to ensure that veterans calling the suicide prevention
hotline have access to a specialized veterans' suicide
prevention hotline.
(c) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated $7,198,000 for
each of fiscal years 2017 through 2021.
[SEC. 520F. GRANTS FOR EMERGENCY MENTAL HEALTH CENTERS.
[(a) Program Authorized.--The Secretary shall award grants to
States, political subdivisions of States, Indian tribes, and
tribal organizations to support the designation of hospitals
and health centers as Emergency Mental Health Centers.
[(b) Health Center.--In this section, the term ``health
center'' has the meaning given such term in section 330, and
includes community health centers and community mental health
centers.
[(c) Distribution of Awards.--The Secretary shall ensure that
such grants awarded under subsection (a) are equitably
distributed among the geographical regions of the United
States, between urban and rural populations, and between
different settings of care including health centers, mental
health centers, hospitals, and other psychiatric units or
facilities.
[(d) Application.--A State, political subdivision of a State,
Indian tribe, or tribal organization that desires a grant under
subsection (a) shall submit an application to the Secretary at
such time, in such manner, and containing such information as
the Secretary may require, including a plan for the rigorous
evaluation of activities carried out with funds received under
this section.
[(e) Use of Funds.--
[(1) In general.--A State, political subdivision of a
State, Indian tribe, or tribal organization receiving a
grant under subsection (a) shall use funds from such
grant to establish or designate hospitals and health
centers as Emergency Mental Health Centers.
[(2) Emergency mental health centers.--Such Emergency
Mental Health Centers described in paragraph (1)--
[(A) shall--
[(i) serve as a central receiving
point in the community for individuals
who may be in need of emergency mental
health services;
[(ii) purchase, if needed, any
equipment necessary to evaluate,
diagnose and stabilize an individual
with a mental illness;
[(iii) provide training, if needed,
to the medical personnel staffing the
Emergency Mental Health Center to
evaluate, diagnose, stabilize, and
treat an individual with a mental
illness; and
[(iv) provide any treatment that is
necessary for an individual with a
mental illness or a referral for such
individual to another facility where
such treatment may be received; and
[(B) may establish and train a mobile crisis
intervention team to respond to mental health
emergencies within the community.
[(f) Evaluation.--A State, political subdivision of a State,
Indian tribe, or tribal organization that receives a grant
under subsection (a) shall prepare and submit an evaluation to
the Secretary at such time, in such manner, and containing such
information as the Secretary may reasonably require, including
an evaluation of activities carried out with funds received
under this section and a process and outcomes evaluation.
[(g) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section, $25,000,000 for
fiscal year 2001 and such sums as may be necessary for each of
the fiscal years 2002 through 2003.]
SEC. 520F. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.
(a) In General.--The Secretary shall award competitive
grants--
(1) to State and local governments and Indian tribes
and tribal organizations to enhance community-based
crisis response systems; or
(2) to States to develop, maintain, or enhance a
database of beds at inpatient psychiatric facilities,
crisis stabilization units, and residential community
mental health and residential substance use disorder
treatment facilities, for individuals with serious
mental illness, serious emotional disturbance, or
substance use disorders.
(b) Application.--
(1) In general.--To receive a grant or cooperative
agreement under subsection (a), an entity shall submit
to the Secretary an application, at such time, in such
manner, and containing such information as the
Secretary may require.
(2) Community-based crisis response plan.--An
application for a grant under subsection (a)(1) shall
include a plan for--
(A) promoting integration and coordination
between local public and private entities
engaged in crisis response, including first
responders, emergency health care providers,
primary care providers, law enforcement, court
systems, health care payers, social service
providers, and behavioral health providers;
(B) developing a plan for entering into
memoranda of understanding with public and
private entities to implement crisis response
services;
(C) expanding the continuum of community-
based services to address crisis intervention
and prevention; and
(D) developing models for minimizing hospital
readmissions, including through appropriate
discharge planning.
(3) Beds database plan.--An application for a grant
under subsection (a)(2) shall include a plan for
developing, maintaining, or enhancing a real-time
Internet-based bed database to collect, aggregate, and
display information about beds in inpatient psychiatric
facilities and crisis stabilization units, and
residential community mental health and residential
substance use disorder treatment facilities, to
facilitate the identification and designation of
facilities for the temporary treatment of individuals
in mental or substance use disorder crisis.
(c) Database Requirements.--A bed database described in this
section is a database that--
(1) includes information on inpatient psychiatric
facilities, crisis stabilization units, and residential
community mental health and residential substance use
disorder facilities in the State involved, including
contact information for the facility or unit;
(2) provides real-time information about the number
of beds available at each facility or unit and, for
each available bed, the type of patient that may be
admitted, the level of security provided, and any other
information that may be necessary to allow for the
proper identification of appropriate facilities for
treatment of individuals in mental or substance use
disorder crisis; and
(3) enables searches of the database to identify
available beds that are appropriate for the treatment
of individuals in mental or substance use disorder
crisis.
(d) Evaluation.--An entity receiving a grant under subsection
(a)(1) shall submit to the Secretary, at such time, in such
manner, and containing such information as the Secretary may
reasonably require, a report, including an evaluation of the
effect of such grant on--
(1) local crisis response services and measures of
individuals receiving crisis planning and early
intervention supports;
(2) individuals reporting improved functional
outcomes; and
(3) individuals receiving regular followup care
following a crisis.
(e) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section, $5,000,000 for the
period of fiscal years 2018 through 2022.
* * * * * * *
[SEC. 520H. IMPROVING OUTCOMES FOR CHILDREN AND ADOLESCENTS THROUGH
SERVICES INTEGRATION BETWEEN CHILD WELFARE AND
MENTAL HEALTH SERVICES.
[(a) In General.--The Secretary shall award grants, contracts
or cooperative agreements to States, political subdivisions of
States, Indian tribes, and tribal organizations to provide
integrated child welfare and mental health services for
children and adolescents under 19 years of age in the child
welfare system or at risk for becoming part of the system, and
parents or caregivers with a mental illness or a mental illness
and a co-occurring substance abuse disorder.
[(b) Duration.--With respect to a grant, contract or
cooperative agreement awarded under this section, the period
during which payments under such award are made to the
recipient may not exceed 5 years.
[(c) Application.--
[(1) In general.--To be eligible to receive an award
under subsection (a), a State, political subdivision of
a State, Indian tribe, or tribal organization shall
submit an application to the Secretary at such time, in
such manner, and accompanied by such information as the
Secretary may reasonably require.
[(2) Content.--An application submitted under
paragraph (1) shall--
[(A) describe the program to be funded under
the grant, contract or cooperative agreement;
[(B) explain how such program reflects best
practices in the provision of child welfare and
mental health services; and
[(C) provide assurances that--
[(i) persons providing services under
the grant, contract or cooperative
agreement are adequately trained to
provide such services; and
[(ii) the services will be provided
in accordance with subsection (d).
[(d) Use of Funds.--A State, political subdivision of a
State, Indian tribe, or tribal organization that receives a
grant, contract, or cooperative agreement under subsection (a)
shall use amounts made available through such grant, contract
or cooperative agreement to--
[(1) provide family-centered, comprehensive, and
coordinated child welfare and mental health services,
including prevention, early intervention and treatment
services for children and adolescents, and for their
parents or caregivers;
[(2) ensure a single point of access for such
coordinated services;
[(3) provide integrated mental health and substance
abuse treatment for children, adolescents, and parents
or caregivers with a mental illness and a co-occurring
substance abuse disorder;
[(4) provide training for the child welfare, mental
health and substance abuse professionals who will
participate in the program carried out under this
section;
[(5) provide technical assistance to child welfare
and mental health agencies;
[(6) develop cooperative efforts with other service
entities in the community, including education, social
services, juvenile justice, and primary health care
agencies;
[(7) coordinate services with services provided under
the Medicaid program and the State Children's Health
Insurance Program under titles XIX and XXI of the
Social Security Act;
[(8) provide linguistically appropriate and
culturally competent services; and
[(9) evaluate the effectiveness and cost-efficiency
of the integrated services that measure the level of
coordination, outcome measures for parents or
caregivers with a mental illness or a mental illness
and a co-occurring substance abuse disorder, and
outcome measures for children.
[(e) Distribution of Awards.--The Secretary shall ensure that
grants, contracts, and cooperative agreements awarded under
subsection (a) are equitably distributed among the geographical
regions of the United States and between urban and rural
populations.
[(f) Evaluation.--The Secretary shall evaluate each program
carried out by a State, political subdivision of a State,
Indian tribe, or tribal organization under subsection (a) and
shall disseminate the findings with respect to each such
evaluation to appropriate public and private entities.
[(g) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section, $10,000,000 for
fiscal year 2001, and such sums as may be necessary for each of
fiscal years 2002 and 2003.]
* * * * * * *
SEC. 520K. AWARDS FOR CO-LOCATING PRIMARY AND SPECIALTY CARE IN
COMMUNITY-BASED MENTAL HEALTH SETTINGS.
(a) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity''
means a qualified community mental health program
defined under section 1913(b)(1).
(2) Special populations.--The term ``special
populations'' means adults with mental illnesses who
have co-occurring primary care conditions and chronic
diseases.
(b) Program Authorized.--The Secretary, acting through the
[Administrator] Assistant Secretary shall award grants and
cooperative agreements to eligible entities to establish
demonstration projects for the provision of coordinated and
integrated services to special populations through the co-
location of primary and specialty care services in community-
based mental and behavioral health settings.
(c) Application.--To be eligible to receive a grant or
cooperative agreement under this section, an eligible entity
shall submit an application to the [Administrator] Assistant
Secretary at such time, in such manner, and accompanied by such
information as the [Administrator] Assistant Secretary may
require, including a description of partnerships, or other
arrangements with local primary care providers, including
community health centers, to provide services to special
populations.
(d) Use of Funds.--
(1) In general.--For the benefit of special
populations, an eligible entity shall use funds awarded
under this section for--
(A) the provision, by qualified primary care
professionals, of on site primary care
services;
(B) reasonable costs associated with
medically necessary referrals to qualified
specialty care professionals, other
coordinators of care or, if permitted by the
terms of the grant or cooperative agreement, by
qualified specialty care professionals on a
reasonable cost basis on site at the eligible
entity;
(C) information technology required to
accommodate the clinical needs of primary and
specialty care professionals; or
(D) facility modifications needed to bring
primary and specialty care professionals on
site at the eligible entity.
(2) Limitation.--Not to exceed 15 percent of grant or
cooperative agreement funds may be used for activities
described in subparagraphs (C) and (D) of paragraph
(1).
(e) Evaluation.--Not later than 90 days after a grant or
cooperative agreement awarded under this section expires, an
eligible entity shall submit to the Secretary the results of an
evaluation to be conducted by the entity concerning the
effectiveness of the activities carried out under the grant or
agreement.
(f) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section, $50,000,000 for
fiscal year 2010 and such sums as may be necessary for each of
fiscal years 2011 through 2014.
Subpart 4--Center for Behavioral Health Statistics and Quality
SEC. 520L. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.
(a) Establishment.--There is established in the
Administration a Center for Behavioral Health Statistics and
Quality (in this section referred to as the ``Center''). The
Center shall be headed by a Director (in this section referred
to as the ``Director'') appointed by the Secretary from among
individuals with extensive experience and academic
qualifications in research and analysis in behavioral health
care or related fields.
(b) Duties.--The Director of the Center shall--
(1) coordinate the Administration's integrated data
strategy by coordinating--
(A) surveillance and data collection
(including that authorized by section 505);
(B) evaluation;
(C) statistical and analytic support;
(D) service systems research; and
(E) performance and quality information
systems;
(2) recommend a core set of measurement standards for
grant programs administered by the Administration; and
(3) coordinate evaluation efforts for the grant
programs, contracts, and collaborative agreements of
the Administration.
(c) Biannual Report to Congress.--Not later than 2 years
after the date of enactment of this section, and every 2 years
thereafter, the Director of the Center shall submit to Congress
a report on the quality of services furnished through grant
programs of the Administration, including applicable measures
of outcomes for individuals and public outcomes such as--
(1) the number of patients screened positive for
unhealthy alcohol use who receive brief counseling as
appropriate; the number of patients screened positive
for tobacco use and receiving smoking cessation
interventions; the number of patients with a new
diagnosis of major depressive episode who are assessed
for suicide risk; the number of patients screened
positive for clinical depression with a documented
followup plan; and the number of patients with a
documented pain assessment that have a followup
treatment plan when pain is present; and satisfaction
with care;
(2) the incidence and prevalence of substance use and
mental disorders; the number of suicide attempts and
suicide completions; overdoses seen in emergency rooms
resulting from alcohol and drug use; emergency room
boarding; overdose deaths; emergency psychiatric
hospitalizations; new criminal justice involvement
while in treatment; stable housing; and rates of
involvement in employment, education, and training; and
(3) such other measures for outcomes of services as
the Director may determine.
(d) Staffing Composition.--The staff of the Center may
include individuals with advanced degrees and field expertise
as well as clinical and research experience in mental and
substance use disorders such as--
(1) professionals with clinical and research
expertise in the prevention and treatment of, and
recovery from, substance use and mental disorders;
(2) professionals with training and expertise in
statistics or research and survey design and
methodologies; and
(3) other related fields in the social and behavioral
sciences, as specified by relevant position
descriptions.
(e) Grants and Contracts.--In carrying out the duties
established in subsection (b), the Director may make grants to
and enter into contracts and cooperative agreements with public
and nonprofit private entities.
(f) Definition.--In this section, the term ``emergency room
boarding'' means the practice of admitting patients to an
emergency department and holding such patients in the
department until inpatient psychiatric beds become available.
SEC. 520M. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR INDIVIDUALS
WITH SERIOUS MENTAL ILLNESS.
(a) In General.--The Assistant Secretary shall award grants
to eligible entities--
(1) to establish assertive community treatment
programs for individuals with serious mental illness;
or
(2) to maintain or expand such programs.
(b) Eligible Entities.--To be eligible to receive a grant
under this section, an entity shall be a State, county, city,
tribe, tribal organization, mental health system, health care
facility, or any other entity the Assistant Secretary deems
appropriate.
(c) Special Consideration.--In selecting among applicants for
a grant under this section, the Assistant Secretary may give
special consideration to the potential of the applicant's
program to reduce hospitalization, homelessness, and
involvement with the criminal justice system while improving
the health and social outcomes of the patient.
(d) Additional Activities.--The Assistant Secretary shall--
(1) not later than the end of fiscal year 2021,
submit a report to the appropriate congressional
committees on the grant program under this section,
including an evaluation of--
(A) cost savings and public health outcomes
such as mortality, suicide, substance abuse,
hospitalization, and use of services;
(B) rates of involvement with the criminal
justice system of patients;
(C) rates of homelessness among patients; and
(D) patient and family satisfaction with
program participation; and
(2) provide appropriate information, training, and
technical assistance to grant recipients under this
section to help such recipients to establish, maintain,
or expand their assertive community treatment programs.
(e) Authorization of Appropriations.--
(1) In general.--To carry out this section, there is
authorized to be appropriated $5,000,000 for the period
of fiscal years 2018 through 2022.
(2) Use of certain funds.--Of the funds appropriated
to carry out this section in any fiscal year, no more
than 5 percent shall be available to the Assistant
Secretary for carrying out subsection (d).
Part C--Projects for Assistance in Transition From Homelessness
* * * * * * *
SEC. 528. REQUIREMENT OF REPORTS BY STATES.
(a) In General.--The Secretary may not make payments under
section 521 unless the State involved agrees that, by not later
than January 31 of each fiscal year, the State will prepare and
submit to the Secretary a report in such form and containing
such information as the Secretary determines (after
consultation with the [Administrator of the Substance Abuse and
Mental Health Services Administration] Assistant Secretary for
Mental Health and Substance Use) to be necessary for--
(1) securing a record and a description of the
purposes for which amounts received under section 521
were expended during the preceding fiscal year and of
the recipients of such amounts; and
(2) determining whether such amounts were expended in
accordance with the provisions of this part.
(b) Availability to Public of Reports.--The Secretary may not
make payments under section 521 unless the State involved
agrees to make copies of the reports described in subsection
(a) available for public inspection.
(c) Evaluations by Comptroller General.--The [Administrator
of the Substance Abuse and Mental Health Services
Administration] Assistant Secretary for Mental Health and
Substance Use shall evaluate at least once every 3 years the
expenditures of grants under this part by eligible entities in
order to ensure that expenditures are consistent with the
provisions of this part, and shall include in such evaluation
recommendations regarding changes needed in program design or
operations.
* * * * * * *
Part D--Miscellaneous Provisions Relating to Substance Abuse and Mental
Health
SEC. 541. SUBSTANCE ABUSE AMONG GOVERNMENT AND OTHER EMPLOYEES.
(a) Programs and Services.--
(1) Development.--The Secretary, acting through the
[Administrator of the Substance Abuse and Mental Health
Services Administration] Assistant Secretary for Mental
Health and Substance Use, shall be responsible for
fostering substance abuse prevention and treatment
programs and services in State and local governments
and in private industry.
(2) Model programs.--
(A) In general.--Consistent with the
responsibilities described in paragraph (1),
the Secretary, acting through the
[Administrator of the Substance Abuse and
Mental Health Services Administration]
Assistant Secretary for Mental Health and
Substance Use, shall develop a variety of model
programs suitable for replication on a cost-
effective basis in different types of business
concerns and State and local governmental
entities.
(B) Dissemination of information.--The
Secretary, acting through the [Administrator of
the Substance Abuse and Mental Health Services
Administration] Assistant Secretary for Mental
Health and Substance Use, shall disseminate
information and materials relative to such
model programs to the State agencies
responsible for the administration of substance
abuse prevention, treatment, and rehabilitation
activities and shall, to the extent feasible
provide technical assistance to such agencies
as requested.
(b) Deprivation of Employment.--
(1) Prohibition.--No person may be denied or deprived
of Federal civilian employment or a Federal
professional or other license or right solely on the
grounds of prior substance abuse.
(2) Application.--This subsection shall not apply to
employment in--
(A) the Central Intelligence Agency;
(B) the Federal Bureau of Investigation;
(C) the National Security Agency;
(D) any other department or agency of the
Federal Government designated for purposes of
national security by the President; or
(E) in any position in any department or
agency of the Federal Government, not referred
to in subparagraphs (A) through (D), which
position is determined pursuant to regulations
prescribed by the head of such agency or
department to be a sensitive position.
(3) Rehabilitation Act.--The inapplicability of the
prohibition described in paragraph (1) to the
employment described in paragraph (2) shall not be
construed to reflect on the applicability of the
Rehabilitation Act of 1973 or other anti-discrimination
laws to such employment.
(c) Construction.--This section shall not be construed to
prohibit the dismissal from employment of a Federal civilian
employee who cannot properly function in his employment.
* * * * * * *
SEC. 544. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED PROGRAMS
AND PRACTICES.
(a) In General.--The Assistant Secretary shall improve access
to reliable and valid information on evidence-based programs
and practices, including information on the strength of
evidence associated with such programs and practices, related
to mental and substance use disorders for States, local
communities, nonprofit entities, and other stakeholders by
posting on the website of the National Registry of Evidence-
Based Programs and Practices evidence-based programs and
practices that have been reviewed by the Assistant Secretary
pursuant to the requirements of this section.
(b) Notice.--
(1) Periods.--In carrying out subsection (a), the
Assistant Secretary may establish an initial period for
the submission of applications for evidence-based
programs and practices to be posted publicly in
accordance with subsection (a) (and may establish
subsequent such periods). The Assistant Secretary shall
publish notice of such application periods in the
Federal Register.
(2) Addressing gaps.--Such notice may solicit
applications for evidence-based practices and programs
to address gaps in information identified by the
Assistant Secretary, the Assistant Secretary for
Planning and Evaluation, the Assistant Secretary for
Financial Resources, or the National Mental Health and
Substance Use Policy Laboratory, including pursuant to
priorities identified in the strategic plan established
under section 501(l).
(c) Requirements.--The Assistant Secretary shall establish
minimum requirements for applications referred to in this
section, including applications related to the submission of
research and evaluation.
(d) Review and Rating.--The Assistant Secretary shall review
applications prior to public posting, and may prioritize the
review of applications for evidence-based practices and
programs that are related to topics included in the notice
established under subsection (b). The Assistant Secretary shall
utilize a rating and review system, which shall include
information on the strength of evidence associated with such
programs and practices and a rating of the methodological rigor
of the research supporting the application. The Assistant
Secretary shall make the metrics used to evaluate applications
and the resulting ratings publicly available.
* * * * * * *
Part G--Projects for Children and Violence
* * * * * * *
SEC. 582. GRANTS TO ADDRESS THE PROBLEMS OF PERSONS WHO EXPERIENCE
VIOLENCE RELATED STRESS.
(a) In General.--The Secretary shall award grants, contracts
or cooperative agreements to public and nonprofit private
entities, as well as to Indian tribes and tribal organizations,
for the purpose of [developing programs focusing on the
behavioral and biological aspects of psychological trauma
response and for developing knowledge with regard to evidence-
based practices for treating psychiatric disorders of children
and youth resulting from witnessing or experiencing a traumatic
event.] developing and maintaining programs that provide for--
(1) the continued operation of the National Child
Traumatic Stress Initiative (referred to in this
section as the ``NCTSI''), which includes a
coordinating center that focuses on the mental,
behavioral, and biological aspects of psychological
trauma response; and
(2) the development of knowledge with regard to
evidence-based practices for identifying and treating
mental disorders, behavioral disorders, and physical
health conditions of children and youth resulting from
witnessing or experiencing a traumatic event.
(b) Priorities.--In awarding grants, contracts or cooperative
agreements under [subsection (a) related] subsection (a)(2)
(related to the development of knowledge on evidence-based
practices for [treating disorders associated with psychological
trauma] treating mental, behavioral, and biological disorders
associated with psychological trauma), the Secretary shall give
priority to [mental health agencies and programs that have
established clinical and basic research] universities,
hospitals, mental health agencies, and other programs that have
established clinical expertise and research experience in the
field of trauma-related mental disorders.
(c) Child Outcome Data.--The NCTSI coordinating center shall
collect, analyze, report, and make publicly available NCTSI-
wide child treatment process and outcome data regarding the
early identification and delivery of evidence-based treatment
and services for children and families served by the NCTSI
grantees.
(d) Training.--The NCTSI coordinating center shall facilitate
the coordination of training initiatives in evidence-based and
trauma-informed treatments, interventions, and practices
offered to NCTSI grantees, providers, and partners.
(e) Dissemination.--The NCTSI coordinating center shall, as
appropriate, collaborate with the Secretary in the
dissemination of evidence-based and trauma-informed
interventions, treatments, products, and other resources to
appropriate stakeholders.
(f) Review.--The Secretary shall, consistent with the peer-
review process, ensure that NCTSI applications are reviewed by
appropriate experts in the field as part of a consensus review
process. The Secretary shall include review criteria related to
expertise and experience in child trauma and evidence-based
practices.
[(c)] (g) Geographical Distribution.--The Secretary shall
ensure that grants, contracts or cooperative agreements under
subsection (a) [with respect to centers of excellence are
distributed equitably among the regions of the country] are
distributed equitably among the regions of the United States
and among urban and rural areas.
[(d)] (h) Evaluation.--The Secretary, as part of the
application process, shall require that each applicant for a
grant, contract or cooperative agreement under subsection (a)
submit a plan for the rigorous evaluation of the activities
funded under the grant, contract or agreement, including both
process and outcomes evaluation, and the submission of an
evaluation at the end of the project period.
[(e)] (i) Duration of Awards.--With respect to a grant,
contract or cooperative agreement under subsection (a), the
period during which payments under such an award will be made
to the [recipient may not exceed 5 years] recipient shall not
be less than 4 years, but shall not exceed 5 years. Such
grants, contracts or agreements may be renewed.
[(f)] (j) Authorization of Appropriations.--There is
authorized to be appropriated to carry out this section,
[$50,000,000 for fiscal year 2001, and such sums as may be
necessary for each of fiscal years 2003 through 2006]
$46,887,000 for each of fiscal years 2017 through 2021.
[(g)] (k) Short Title.--This section may be cited as the
``Donald J. Cohen National Child Traumatic Stress Initiative''.
* * * * * * *
PART K--MINORITY FELLOWSHIP PROGRAM
SEC. 597. FELLOWSHIPS.
(a) In General.--The Secretary shall maintain a program, to
be known as the Minority Fellowship Program, under which the
Secretary awards fellowships, which may include stipends, for
the purposes of--
(1) increasing behavioral health practitioners'
knowledge of issues related to prevention, treatment,
and recovery support for mental and substance use
disorders among racial and ethnic minority populations;
(2) improving the quality of mental and substance use
disorder prevention and treatment delivered to racial
and ethnic minorities; and
(3) increasing the number of culturally competent
behavioral health professionals and school personnel
who teach, administer, conduct services research, and
provide direct mental health or substance use services
to racial and ethnic minority populations.
(b) Training Covered.--The fellowships under subsection (a)
shall be for postbaccalaureate training (including for master's
and doctoral degrees) for mental health professionals,
including in the fields of psychiatry, nursing, social work,
psychology, marriage and family therapy, mental health
counseling, and substance use and addiction counseling.
(c) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated $12,669,000
for each of fiscal years 2017, 2018, and 2019 and $13,669,000
for each of fiscal years 2020 and 2021.
* * * * * * *
TITLE VII--HEALTH PROFESSIONS EDUCATION
* * * * * * *
PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE
Subpart 1--Health Professions Workforce Information and Analysis
* * * * * * *
SEC. 762. ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION.
(a) Establishment; Duties.--There is established the Council
on Graduate Medical Education (in this section referred to as
the ``Council''). The Council shall--
(1) make recommendations to the Secretary of Health
and Human Services (in this section referred to as the
``Secretary''), and to the Committee on Labor and Human
Resources of the Senate, and the Committee on Energy
and Commerce of the House of Representatives, with
respect to--
(A) the supply and distribution of physicians
in the United States;
(B) current and future shortages or excesses
of physicians in medical and surgical
specialties and subspecialties;
(C) issues relating to foreign medical school
graduates;
(D) appropriate Federal policies with respect
to the matters specified in subparagraphs (A),
(B), and (C), including policies concerning
changes in the financing of undergraduate and
graduate medical education programs and changes
in the types of medical education training in
graduate medical education programs;
(E) appropriate efforts to be carried out by
hospitals, schools of medicine, schools of
osteopathic medicine, and accrediting bodies
with respect to the matters specified in
subparagraphs (A), (B), and (C), including
efforts for changes in undergraduate and
graduate medical education programs; and
(F) deficiencies in, and needs for
improvements in, existing data bases concerning
the supply and distribution of, and
postgraduate training programs for, physicians
in the United States and steps that should be
taken to eliminate those deficiencies;
(2) encourage entities providing graduate medical
education to conduct activities to voluntarily achieve
the recommendations of the Council under paragraph
(1)(E);
(3) develop, publish, and implement performance
measures for programs under this title, except for
programs under part C or D;
(4) develop and publish guidelines for longitudinal
evaluations (as described in section 761(d)(2)) for
programs under this title, except for programs under
part C or D; and
(5) recommend appropriation levels for programs under
this title, except for programs under part C or D.
(b) Composition.--The Council shall be composed of--
(1) the Assistant Secretary for Health or the
designee of the Assistant Secretary;
(2) the Administrator of the Health Care Financing
Administration;
(3) the Chief Medical Director of the Department of
Veterans Affairs;
(4) the Assistant Secretary for Mental Health and
Substance Use;
[(4)] (5) 6 members appointed by the Secretary to
include representatives of practicing primary care
physicians, national and specialty physician
organizations, foreign medical graduates, and medical
student and house staff associations;
[(5)] (6) 4 members appointed by the Secretary to
include representatives of schools of medicine and
osteopathic medicine and public and private teaching
hospitals; and
[(6)] (7) 4 members appointed by the Secretary to
include representatives of health insurers, business,
and labor.
(c) Terms of Appointed Members.--
(1) In general; staggered rotation.--Members of the
Council appointed under paragraphs [(4), (5), and (6)]
(5), (6), and (7) of subsection (b) shall be appointed
for a term of 4 years, except that the term of office
of the members first appointed shall expire, as
designated by the Secretary at the time of appointment,
4 at the end of 1 year, 4 at the end of 2 years, 3 at
the end of 3 years, and 3 at the end of 4 years.
(2) Date certain for appointment.--The Secretary
shall appoint the first members to the Council under
paragraphs [(4), (5), and (6)] (5), (6), and (7) of
subsection (b) within 60 days after the date of
enactment of this section.
(d) Chair.--The Council shall elect one of its members as
Chairman of the Council.
(e) Quorum.--Nine members of the Council shall constitute a
quorum, but a lesser number may hold hearings.
(f) Vacancies.--Any vacancy in the Council shall not affect
its power to function.
(g) Compensation.--Each member of the Council who is not
otherwise employed by the United States Government shall
receive compensation at a rate equal to the daily rate
prescribed for GS-18 under the General Schedule under section
5332 of title 5, United States Code, for each day, including
traveltime, such member is engaged in the actual performance of
duties as a member of the Council. A member of the Council who
is an officer or employee of the United States Government shall
serve without additional compensation. All members of the
Council shall be reimbursed for travel, subsistence, and other
necessary expenses incurred by them in the performance of their
duties.
(h) Certain Authorities and Duties.--
(1) Authorities.--In order to carry out the
provisions of this section, the Council is authorized
to--
(A) collect such information, hold such
hearings, and sit and act at such times and
places, either as a whole or by subcommittee,
and request the attendance and testimony of
such witnesses and the production of such
books, records, correspondence, memoranda,
papers, and documents as the Council or such
subcommittee may consider available; and
(B) request the cooperation and assistance of
Federal departments, agencies, and
instrumentalities, and such departments,
agencies, and instrumentalities are authorized
to provide such cooperation and assistance.
(2) Coordination of activities.--The Council shall
coordinate its activities with the activities of the
Secretary under section 792 of the Public Health
Service Act. The Secretary shall, in cooperation with
the Council and pursuant to the recommendations of the
Council, take such steps as are practicable to
eliminate deficiencies in the data base established
under such section 792 and shall make available in its
reports such comprehensive data sets as are developed
pursuant to this section.
(i) Requirement Regarding Reports.--In the reports required
under subsection (a), the Council shall specify its activities
during the period for which the report is made.
(j) Final Report.--Not later than April 1, 2002, the Council
shall submit a final report under subsection (a).
(k) Termination.--The Council shall terminate September 30,
2003.
(l) Funding.--Amounts otherwise appropriated under this title
may be utilized by the Secretary to support the activities of
the Council.
* * * * * * *
Subpart 3--Recruitment and Retention Programs
SEC. 775. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.
(a) Establishment.--The Secretary shall establish and carry
out a pediatric specialty loan repayment program under which
the eligible individual agrees to be employed full-time for a
specified period (which shall not be less than 2 years) in
providing pediatric medical subspecialty, pediatric surgical
specialty, or child and adolescent mental and behavioral health
care, including substance abuse prevention and treatment
services.
(b) Program Administration.--Through the program established
under this section, the Secretary shall enter into contracts
with qualified health professionals under which--
(1) such qualified health professionals will agree to
provide pediatric medical subspecialty, pediatric
surgical specialty, or child and adolescent mental and
behavioral health care in an area with a shortage of
the specified pediatric subspecialty that has a
sufficient pediatric population to support such
pediatric subspecialty, as determined by the Secretary;
and
(2) the Secretary agrees to make payments on the
principal and interest of undergraduate, graduate, or
graduate medical education loans of professionals
described in paragraph (1) of not more than $35,000 a
year for each year of agreed upon service under such
paragraph for a period of not more than 3 years during
the qualified health professional's--
(A) participation in an accredited pediatric
medical subspecialty, pediatric surgical
specialty, or child and adolescent mental
health subspecialty residency or fellowship; or
(B) employment as a pediatric medical
subspecialist, pediatric surgical specialist,
or child and adolescent mental health
professional serving an area or population
described in such paragraph.
(c) In General.--
(1) Eligible individuals.--
(A) Pediatric medical specialists and
pediatric surgical specialists.--For purposes
of contracts with respect to pediatric medical
specialists and pediatric surgical specialists,
the term ``qualified health professional''
means a licensed physician who--
(i) is entering or receiving training
in an accredited pediatric medical
subspecialty or pediatric surgical
specialty residency or fellowship; or
(ii) has completed (but not prior to
the end of the calendar year in which
this section is enacted) the training
described in subparagraph (B).
(B) Child and adolescent mental and
behavioral health.--For purposes of contracts
with respect to child and adolescent mental and
behavioral health care, the term ``qualified
health professional'' means a health care
professional who--
(i) has received specialized training
or clinical experience in child and
adolescent mental health in psychiatry,
psychology, school psychology,
behavioral pediatrics, psychiatric
nursing, social work, school social
work, substance abuse disorder
prevention and treatment, marriage and
family therapy, school counseling, or
professional counseling;
(ii) has a license or certification
in a State to practice allopathic
medicine, osteopathic medicine,
psychology, school psychology,
psychiatric nursing, social work,
school social work, marriage and family
therapy, school counseling, or
professional counseling; or
(iii) is a mental health service
professional who completed (but not
before the end of the calendar year in
which this section is enacted)
specialized training or clinical
experience in child and adolescent
mental health described in clause (i).
(2) Additional eligibility requirements.--The
Secretary may not enter into a contract under this
subsection with an eligible individual unless--
(A) the individual agrees to work in, or for
a provider serving, a health professional
shortage area or medically underserved area, or
to serve a medically underserved population;
(B) the individual is a United States citizen
or a permanent legal United States resident;
and
(C) if the individual is enrolled in a
graduate program, the program is accredited,
and the individual has an acceptable level of
academic standing (as determined by the
Secretary).
(d) Priority.--In entering into contracts under this
subsection, the Secretary shall give priority to applicants
who--
(1) are or will be working in a school or other pre-
kindergarten, elementary, or secondary education
setting;
(2) have familiarity with evidence-based methods and
cultural and linguistic competence health care
services; and
(3) demonstrate financial need.
[(e) Authorization of Appropriations.--There is authorized to
be appropriated $30,000,000 for each of fiscal years 2010
through 2014 to carry out subsection (c)(1)(A) and $20,000,000
for each of fiscal years 2010 through 2013 to carry out
subsection (c)(1)(B).]
(e) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $12,000,000 for
the period of fiscal years 2018 through 2022.
* * * * * * *
TITLE XIX--BLOCK GRANTS
* * * * * * *
Part B--Block Grants Regarding Mental Health and Substance Abuse
Subpart I--Block Grants for Community Mental Health Services
SEC. 1911. FORMULA GRANTS TO STATES.
(a) In General.--For the purpose described in subsection (b),
the Secretary, acting through the Director of the Center for
Mental Health Services, shall make an allotment each fiscal
year for each State in an amount determined in accordance with
section 1918. The Secretary shall make a grant to the State of
the allotment made for the State for the fiscal year if the
State submits to the Secretary an application in accordance
with section 1917.
(b) Purpose of Grants.--A funding agreement for a grant under
subsection (a) is that, subject to section 1916, the State
involved will expend the grant only for the purpose of--
(1) providing community mental health services for
adults with a serious mental illness and children with
a serious emotional disturbance as defined in
accordance with section 1912(c);
[(1)] (2) carrying out the plan submitted under
section 1912(a) by the State for the fiscal year
involved;
[(2)] (3) evaluating programs and services carried
out under the plan; and
[(3)] (4) planning, administration, and educational
activities related to providing services under the
plan.
SEC. 1912. STATE PLAN FOR COMPREHENSIVE COMMUNITY MENTAL HEALTH
SERVICES FOR CERTAIN INDIVIDUALS.
(a) In General.--The Secretary may make a grant under section
1911 only if--
(1) the State involved submits to the Secretary a
plan for providing comprehensive community mental
health services to adults with a serious mental illness
and to children with a serious emotional disturbance;
(2) the plan meets the criteria specified in
subsection (b); and
(3) the plan is approved by the Secretary.
[(b) Criteria for Plan.--With respect to the provision of
comprehensive community mental health services to individuals
who are either adults with a serious mental illness or children
with a serious emotional disturbance, the criteria referred to
in subsection (a) regarding a plan are as follows:
[(1) Comprehensive community-based mental health
systems.--The plan provides for an organized community-
based system of care for individuals with mental
illness and describes available services and resources
in a comprehensive system of care, including services
for dually diagnosed individuals. The description of
the system of care shall include health and mental
health services, rehabilitation services, employment
services, housing services, educational services,
substance abuse services, medical and dental care, and
other support services to be provided to individuals
with Federal, State and local public and private
resources to enable such individuals to function
outside of inpatient or residential institutions to the
maximum extent of their capabilities, including
services to be provided by local school systems under
the Individuals with Disabilities Education Act. The
plan shall include a separate description of case
management services and provide for activities leading
to reduction of hospitalization.
[(2) Mental health system data and epidemiology.--The
plan contains an estimate of the incidence and
prevalence in the State of serious mental illness among
adults and serious emotional disturbance among children
and presents quantitative targets to be achieved in the
implementation of the system described in paragraph
(1).
[(3) Children's services.--In the case of children
with serious emotional disturbance, the plan--
[(A) subject to subparagraph (B), provides
for a system of integrated social services,
educational services, juvenile services, and
substance abuse services that, together with
health and mental health services, will be
provided in order for such children to receive
care appropriate for their multiple needs (such
system to include services provided under the
Individuals with Disabilities Education Act);
[(B) provides that the grant under section
1911 for the fiscal year involved will not be
expended to provide any service under such
system other than comprehensive community
mental health services; and
[(C) provides for the establishment of a
defined geographic area for the provision of
the services of such system.
[(4) Targeted services to rural and homeless
populations.--The plan describes the State's outreach
to and services for individuals who are homeless and
how community-based services will be provided to
individuals residing in rural areas.
[(5) Management systems.--The plan describes the
financial resources, staffing and training for mental
health providers that is necessary to implement the
plan, and provides for the training of providers of
emergency health services regarding mental health. The
plan further describes the manner in which the State
intends to expend the grant under section 1911 for the
fiscal year involved.
Except as provided for in paragraph (3), the State plan shall
contain the information required under this subsection with
respect to both adults with serious mental illness and children
with serious emotional disturbance.]
(b) Criteria for Plan.--In accordance with subsection (a), a
State shall submit to the Secretary a plan that, at a minimum,
satisfies the following criteria:
(1) System of care.--The plan provides a description
of the system of care of the State, including as
follows:
(A) Comprehensive community-based health
systems.--The plan shall--
(i) identify the single State agency
to be responsible for the
administration of the program under the
grant, including any third party who
administers mental health services and
is responsible for complying with the
requirements of this part with respect
to the grant;
(ii) provide for an organized
community-based system of care for
individuals with mental illness, and
describe available services and
resources in a comprehensive system of
care, including services for
individuals with mental health and
behavioral health co-occurring
disorders;
(iii) include a description of the
manner in which the State and local
entities will coordinate services to
maximize the efficiency, effectiveness,
quality, and cost effectiveness of
services and programs to produce the
best possible outcomes (including
health services, rehabilitation
services, employment services, housing
services, educational services,
substance use disorder services, legal
services, law enforcement services,
social services, child welfare
services, medical and dental care
services, and other support services to
be provided with Federal, State, and
local public and private resources)
with other agencies to enable
individuals receiving services to
function outside of inpatient or
residential institutions, to the
maximum extent of their capabilities,
including services to be provided by
local school systems under the
Individuals with Disabilities Education
Act;
(iv) include a description of how the
State--
(I) promotes evidence-based
practices, including those
evidence-based programs that
address the needs of
individuals with early serious
mental illness regardless of
the age of the individual at
onset;
(II) provides comprehensive
individualized treatment; or
(III) integrates mental and
physical health services;
(v) include a description of case
management services;
(vi) include a description of
activities that seek to engage
individuals with serious mental illness
or serious emotional disturbance and
their caregivers where appropriate in
making health care decisions, including
activities that enhance communication
between individuals, families,
caregivers, and treatment providers;
and
(vii) as appropriate to and
reflective of the uses the State
proposes for the block grant monies--
(I) a description of the
activities intended to reduce
hospitalizations and hospital
stays using the block grant
monies;
(II) a description of the
activities intended to reduce
incidents of suicide using the
block grant monies; and
(III) a description of how
the State integrates mental
health and primary care using
the block grant monies.
(B) Mental health system data and
epidemiology.--The plan shall contain an
estimate of the incidence and prevalence in the
State of serious mental illness among adults
and serious emotional disturbance among
children and presents quantitative targets and
outcome measures for programs and services
provided under this subpart.
(C) Children's services.--In the case of
children with serious emotional disturbance (as
defined in accordance with subsection (c)), the
plan shall provide for a system of integrated
social services, educational services, child
welfare services, juvenile justice services,
law enforcement services, and substance use
disorder services that, together with health
and mental health services, will be provided in
order for such children to receive care
appropriate for their multiple needs (such
system to include services provided under the
Individuals with Disabilities Education Act).
(D) Targeted services to rural and homeless
populations.--The plan shall describe the
State's outreach to and services for
individuals who are homeless and how community-
based services will be provided to individuals
residing in rural areas.
(E) Management services.--The plan shall--
(i) describe the financial resources
available, the existing mental health
workforce, and the workforce trained in
treating individuals with co-occurring
mental and substance use disorders;
(ii) provide for the training of
providers of emergency health services
regarding mental health;
(iii) describe the manner in which
the State intends to expend the grant
under section 1911 for the fiscal year
involved; and
(iv) describe the manner in which the
State intends to comply with each of
the funding agreements in this subpart
and subpart III.
(2) Goals and objectives.--The plan establishes goals
and objectives for the period of the plan, including
targets and milestones that are intended to be met, and
the activities that will be undertaken to achieve those
targets.
(c) Definitions Regarding Mental Illness and Emotional
Disturbance; Methods for Estimate of Incidence and
Prevalence.--
(1) Establishment by secretary of definitions;
dissemination.--For purposes of this subpart, the
Secretary shall establish definitions for the terms
``adults with a serious mental illness'' and ``children
with a serious emotional disturbance''. The Secretary
shall disseminate the definitions to the States.
(2) Standardized methods.--The Secretary shall
establish standardized methods for making the estimates
required in subsection (b)(11) with respect to a State.
A funding agreement for a grant under section 1911 for
the State is that the State will utilize such methods
in making the estimates.
(3) Date certain for compliance by secretary.--Not
later than 90 days after the date of the enactment of
the ADAMHA Reorganization Act, the Secretary shall
establish the definitions described in paragraph (1),
shall begin dissemination of the definitions to the
States, and shall establish the standardized methods
described in paragraph (2).
(d) Requirement of Implementation of Plan.--
(1) Complete implementation.--Except as provided in
paragraph (2), in making a grant under section 1911 to
a State for a fiscal year, the Secretary shall make a
determination of the extent to which the State has
implemented the plan required in subsection (a). If the
Secretary determines that a State has not completely
implemented the plan, the Secretary shall reduce the
amount of the allotment under section 1911 for the
State for the fiscal year involved by an amount equal
to 10 percent of the amount determined under section
1918 for the State for the fiscal year.
(2) Substantial implementation and good faith effort
regarding fiscal year 1993.--
(A) In making a grant under section 1911 to a
State for fiscal year 1993, the Secretary shall
make a determination of the extent to which the
State has implemented the plan required in
subsection (a). If the Secretary determines
that the State has not substantially
implemented the plan, the Secretary shall,
subject to subparagraph (B), reduce the amount
of the allotment under section 1911 for the
State for such fiscal year by an amount equal
to 10 percent of the amount determined under
section 1918 for the State for the fiscal year.
(B) In carrying out subparagraph (A), if the
Secretary determines that the State is making a
good faith effort to implement the plan
required in subsection (a), the Secretary may
make a reduction under such subparagraph in an
amount that is less than the amount specified
in such subparagraph, except that the reduction
may not be made in an amount that is less than
5 percent of the amount determined under
section 1918 for the State for fiscal year
1993.
* * * * * * *
SEC. 1915. ADDITIONAL PROVISIONS.
(a) Review of State Plan by Mental Health Planning Council.--
The Secretary may make a grant under section 1911 to a State
only if--
(1) the plan submitted under section 1912(a) with
respect to the grant and the report of the State under
section 1942(a) concerning the preceding fiscal year
has been reviewed by the State mental health planning
council under section 1914; and
(2) the State submits to the Secretary any
recommendations received by the State from such council
for modifications to the plan (without regard to
whether the State has made the recommended
modifications) and any comments concerning the annual
report.
(b) Maintenance of Effort Regarding State Expenditures for
Mental Health.--
[(1) In general.--A funding agreement for a grant
under section 1911 is that the State involved will
maintain State expenditures for community mental health
services at a level that is not less than the average
level of such expenditures maintained by the State for
the 2-year period preceding the fiscal year for which
the State is applying for the grant.]
(1) In general.--A funding agreement for a grant
under section 1911 is that the State involved will
maintain State expenditures for community mental health
services at a level that is not less than the average
of the amounts prescribed by this paragraph (prior to
any waiver under paragraph (3)) for such expenditures
by such State for each of the two fiscal years
immediately preceding the fiscal year for which the
State is applying for the grant.
(2) Exclusion of certain funds.--The Secretary may
exclude from the aggregate State expenditures under
[subsection (a)] paragraph (1), funds appropriated to
the [principle] principal agency for authorized
activities which are of a non-recurring nature and for
a specific purpose.
[(3) Waiver.--The Secretary may, upon the request of
a State, waive the requirement established in paragraph
(1) if the Secretary determines that extraordinary
economic conditions in the State justify the waiver.]
(3) Waiver.--
(A) In general.--The Secretary may, upon the
request of a State, waive the requirement
established in paragraph (1) in whole or in
part, if the Secretary determines that
extraordinary economic conditions in the State
in the fiscal year involved or in the previous
fiscal year justify the waiver.
(B) Date certain for action upon request.--
The Secretary shall approve or deny a request
for a waiver under this paragraph not later
than 120 days after the date on which the
request is made.
(C) Applicability of waiver.--A waiver
provided by the Secretary under this paragraph
shall be applicable only to the fiscal year
involved.
(4) Noncompliance by State.--
[(A) In making a grant under section 1911 to
a State for a fiscal year, the Secretary shall
make a determination of whether, for the
previous fiscal year, the State maintained
material compliance with the agreement made
under paragraph (1). If the Secretary
determines that a State has failed to maintain
such compliance, the Secretary shall reduce the
amount of the allotment under section 1911 for
the State for the fiscal year for which the
grant is being made by an amount equal to the
amount constituting such failure for the
previous fiscal year.]
(A) In general.--
(i) Determination and reduction.--The
Secretary shall determine, in the case
of each State, and for each fiscal
year, whether the State maintained
material compliance with the agreement
made under paragraph (1). If the
Secretary determines that a State has
failed to maintain such compliance for
a fiscal year, the Secretary shall
reduce the amount of the allotment
under section 1911 for the State, for
the first fiscal year beginning after
such determination is final, by an
amount equal to the amount constituting
such failure for the previous fiscal
year about which the determination was
made.
(ii) Alternative sanction.--The
Secretary may by regulation provide for
an alternative method of imposing a
sanction for a failure by a State to
maintain material compliance with the
agreement under paragraph (1) if the
Secretary determines that such
alternative method would be more
equitable and would be a more effective
incentive for States to maintain such
material compliance.
(B) Submission of information to the
secretary._ The Secretary may make a grant
under section 1911 for a fiscal year only if
the State involved submits to the Secretary
information sufficient for the Secretary to
make the determination required in
[subparagraph (A)] subparagraph (A)(i).
* * * * * * *
SEC. 1917. APPLICATION FOR GRANT.
(a) In General.--For purposes of section 1911, an application
for a grant under such section for a fiscal year in accordance
with this section if, subject to subsection (b)--
(1) the plan is received by the Secretary not later
than September 1 of the fiscal year prior to the fiscal
year for which a State is seeking funds, and the report
from the previous fiscal year as required under section
[1941] 1942(a) is received by December 1 of the fiscal
year of the grant;
(2) the application contains each funding agreement
that is described in this subpart or subpart III for
such a grant (other than any such agreement that is not
applicable to the State);
(3) the agreements are made through certification
from the chief executive officer of the State;
(4) with respect to such agreements, the application
provides assurances of compliance satisfactory to the
Secretary;
(5) the application contains the plan required in
section 1912(a), the information required in section
[1915(b)(3)(B)] 1915(b), and the report required in
section 1942(a);
(6) the application contains recommendations in
compliance with section 1915(a), or if no such
recommendations are received by the State, the
application otherwise demonstrates compliance with such
section; and
(7) the application (including the plan under section
1912(a)) is otherwise in such form, is made in such
manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary
to carry out this subpart.
(b) Waivers Regarding Certain Territories.--In the case of
any territory of the United States except Puerto Rico, the
Secretary may waive such provisions of this subpart and subpart
III as the Secretary determines to be appropriate, other than
the provisions of section 1916.
* * * * * * *
SEC. 1920. FUNDING.
(a) Authorization of Appropriations.--For the purpose of
carrying out this subpart, and subpart III and section 505 with
respect to mental health, there are authorized to be
appropriated $450,000,000 for fiscal year 2001, and such sums
as may be necessary for each of the fiscal years 2002 and 2003.
(b) Allocations for Technical Assistance, Data Collection,
and Program Evaluation.--
(1) In general.--For the purpose of carrying out
section 1948(a) with respect to mental health and the
purposes specified in paragraphs (2) and (3), the
Secretary shall obligate 5 percent of the amounts
appropriated under subsection (a) for a fiscal year.
(2) Data collection.--The purpose specified in this
paragraph is carrying out sections 505 and 1971 with
respect to mental health.
(3) Program evaluation.--The purpose specified in
this paragraph is the conduct of evaluations of
prevention and treatment programs and services with
respect to mental health to determine methods for
improving the availability and quality of such programs
and services.
(c) Best Practices in Clinical Care Models.--A State shall
expend not less than 10 percent of the amount the State
receives for carrying out this subpart in each fiscal year to
support evidence-based programs that address the needs of
individuals with early serious mental illness, including
psychotic disorders, regardless of the age of the individual at
onset.
* * * * * * *
TITLE XXVII--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
PART A--INDIVIDUAL AND GROUP MARKET REFORMS
* * * * * * *
Subpart II--Improving Coverage
* * * * * * *
SEC. 2726. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS.
(a) In General.--
(1) Aggregate lifetime limits.--In the case of a
group health plan or a health insurance issuer offering
group or individual health insurance coverage that
provides both medical and surgical benefits and mental
health or substance use disorder benefits--
(A) No lifetime limit.--If the plan or
coverage does not include an aggregate lifetime
limit on substantially all medical and surgical
benefits, the plan or coverage may not impose
any aggregate lifetime limit on mental health
or substance use disorder benefits.
(B) Lifetime limit.--If the plan or coverage
includes an aggregate lifetime limit on
substantially all medical and surgical benefits
(in this paragraph referred to as the
``applicable lifetime limit''), the plan or
coverage shall either--
(i) apply the applicable lifetime
limit both to the medical and surgical
benefits to which it otherwise would
apply and to mental health and
substance use disorder benefits and not
distinguish in the application of such
limit between such medical and surgical
benefits and mental health and
substance use disorder benefits; or
(ii) not include any aggregate
lifetime limit on mental health or
substance use disorder benefits that is
less than the applicable lifetime
limit.
(C) Rule in case of different limits.--In the
case of a plan or coverage that is not
described in subparagraph (A) or (B) and that
includes no or different aggregate lifetime
limits on different categories of medical and
surgical benefits, the Secretary shall
establish rules under which subparagraph (B) is
applied to such plan or coverage with respect
to mental health and substance use disorder
benefits by substituting for the applicable
lifetime limit an average aggregate lifetime
limit that is computed taking into account the
weighted average of the aggregate lifetime
limits applicable to such categories.
(2) Annual limits.--In the case of a group health
plan or a health insurance issuer offering group or
individual health insurance coverage that provides both
medical and surgical benefits and mental health or
substance use disorder benefits--
(A) No annual limit.--If the plan or coverage
does not include an annual limit on
substantially all medical and surgical
benefits, the plan or coverage may not impose
any annual limit on mental health or substance
use disorder benefits.
(B) Annual limit.--If the plan or coverage
includes an annual limit on substantially all
medical and surgical benefits (in this
paragraph referred to as the ``applicable
annual limit''), the plan or coverage shall
either--
(i) apply the applicable annual limit
both to medical and surgical benefits
to which it otherwise would apply and
to mental health and substance use
disorder benefits and not distinguish
in the application of such limit
between such medical and surgical
benefits and mental health and
substance use disorder benefits; or
(ii) not include any annual limit on
mental health or substance use disorder
benefits that is less than the
applicable annual limit.
(C) Rule in case of different limits.--In the
case of a plan or coverage that is not
described in subparagraph (A) or (B) and that
includes no or different annual limits on
different categories of medical and surgical
benefits, the Secretary shall establish rules
under which subparagraph (B) is applied to such
plan or coverage with respect to mental health
and substance use disorder benefits by
substituting for the applicable annual limit an
average annual limit that is computed taking
into account the weighted average of the annual
limits applicable to such categories.
(3) Financial requirements and treatment
limitations.--
(A) In general.--In the case of a group
health plan or a health insurance issuer
offering group or individual health insurance
coverage that provides both medical and
surgical benefits and mental health or
substance use disorder benefits, such plan or
coverage shall ensure that--
(i) the financial requirements
applicable to such mental health or
substance use disorder benefits are no
more restrictive than the predominant
financial requirements applied to
substantially all medical and surgical
benefits covered by the plan (or
coverage), and there are no separate
cost sharing requirements that are
applicable only with respect to mental
health or substance use disorder
benefits; and
(ii) the treatment limitations
applicable to such mental health or
substance use disorder benefits are no
more restrictive than the predominant
treatment limitations applied to
substantially all medical and surgical
benefits covered by the plan (or
coverage) and there are no separate
treatment limitations that are
applicable only with respect to mental
health or substance use disorder
benefits.
(B) Definitions.--In this paragraph:
(i) Financial requirement.--The term
``financial requirement'' includes
deductibles, copayments, coinsurance,
and out-of-pocket expenses, but
excludes an aggregate lifetime limit
and an annual limit subject to
paragraphs (1) and (2).
(ii) Predominant.--A financial
requirement or treatment limit is
considered to be predominant if it is
the most common or frequent of such
type of limit or requirement.
(iii) Treatment limitation.--The term
``treatment limitation'' includes
limits on the frequency of treatment,
number of visits, days of coverage, or
other similar limits on the scope or
duration of treatment.
(4) Availability of plan information.--The criteria
for medical necessity determinations made under the
plan with respect to mental health or substance use
disorder benefits (or the health insurance coverage
offered in connection with the plan with respect to
such benefits) shall be made available by the plan
administrator (or the health insurance issuer offering
such coverage) in accordance with regulations to any
current or potential participant, beneficiary, or
contracting provider upon request. The reason for any
denial under the plan (or coverage) of reimbursement or
payment for services with respect to mental health or
substance use disorder benefits in the case of any
participant or beneficiary shall, on request or as
otherwise required, be made available by the plan
administrator (or the health insurance issuer offering
such coverage) to the participant or beneficiary in
accordance with regulations.
(5) Out-of-network providers.--In the case of a plan
or coverage that provides both medical and surgical
benefits and mental health or substance use disorder
benefits, if the plan or coverage provides coverage for
medical or surgical benefits provided by out-of-network
providers, the plan or coverage shall provide coverage
for mental health or substance use disorder benefits
provided by out-of-network providers in a manner that
is consistent with the requirements of this section.
(6) Compliance program guidance document.--
(A) In general.--Not later than 6 months
after the date of enactment of the Helping
Families in Mental Health Crisis Act of 2016,
the Inspector General of the Department of
Health and Human Services, in coordination with
the Secretary, the Secretary of Labor, or the
Secretary of the Treasury, shall issue a
compliance program guidance document to help
improve compliance with this section.
(B) Examples illustrating compliance and
noncompliance.--
(i) In general.--The compliance
program guidance document required
under this paragraph shall provide
illustrative, de-identified examples
(that do not disclose any protected
health information or individually
identifiable information) of previous
findings of compliance and
noncompliance with this section,
section 712 of the Employee Retirement
Income Security Act of 1974, or section
9812 of the Internal Revenue Code of
1986 based on investigations of
violations of such sections,
including--
(I) examples illustrating
requirements for information
disclosures and nonquantitative
treatment limitations; and
(II) descriptions of the
violations uncovered during the
course of such investigations.
(ii) Nonquantitative treatment
limitations.--To the extent that any
example described in clause (i)
involves a finding of compliance or
noncompliance with regard to any
requirement for nonquantitative
treatment limitations, the example
shall provide sufficient detail to
fully explain such finding, including a
full description of the criteria
involved for medical and surgical
benefits and the criteria involved for
mental health and substance use
disorder benefits.
(iii) Access to additional
information regarding compliance.--In
developing and issuing the compliance
program guidance document required
under this paragraph, the Inspector
General of the Department of Health and
Human Services may--
(I) enter into interagency
agreements with the Inspector
General of the Department of
Labor and the Inspector General
of the Department of the
Treasury to share findings of
compliance and noncompliance
with this section, section 712
of the Employee Retirement
Income Security Act of 1974, or
section 9812 of the Internal
Revenue Code of 1986; and
(II) enter into an agreement
with a State to share
information on findings of
compliance and noncompliance
with this section, section 712
of the Employee Retirement
Income Security Act of 1974, or
section 9812 of the Internal
Revenue Code of 1986.
(C) Recommendations.--The compliance program
guidance document shall include recommendations
to avoid violations of this section and
encourage the development and use of internal
controls to monitor adherence to applicable
statutes, regulations, and program
requirements. Such internal controls may
include a compliance checklist with
illustrative examples of nonquantitative
treatment limitations on mental health and
substance use disorder benefits, which may fail
to comply with this section in relation to
nonquantitative treatment limitations on
medical and surgical benefits.
(D) Updating the compliance program guidance
document.--The compliance program guidance
document shall be updated every 2 years to
include illustrative, de-identified examples
(that do not disclose any protected health
information or individually identifiable
information) of previous findings of compliance
and noncompliance with this section, section
712 of the Employee Retirement Income Security
Act of 1974, or section 9812 of the Internal
Revenue Code of 1986.
(7) Additional guidance.--
(A) In general.--Not later than 6 months
after the date of enactment of the Helping
Families in Mental Health Crisis Act of 2016,
the Secretary, in coordination with the
Secretary of Labor and the Secretary of the
Treasury, shall issue guidance to group health
plans and health insurance issuers offering
group or individual health insurance coverage
to assist such plans and issuers in satisfying
the requirements of this section.
(B) Disclosure.--
(i) Guidance for plans and issuers.--
The guidance issued under this
paragraph shall include clarifying
information and illustrative examples
of methods that group health plans and
health insurance issuers offering group
or individual health insurance coverage
may use for disclosing information to
ensure compliance with the requirements
under this section (and any regulations
promulgated pursuant to this section).
(ii) Documents for participants,
beneficiaries, contracting providers,
or authorized representatives.--The
guidance issued under this paragraph
may include clarifying information and
illustrative examples of methods that
group health plans and health insurance
issuers offering group or individual
health insurance coverage may use to
provide any participant, beneficiary,
contracting provider, or authorized
representative, as applicable, with
documents containing information that
the health plans or issuers are
required to disclose to participants,
beneficiaries, contracting providers,
or authorized representatives to ensure
compliance with this section, any
regulation issued pursuant to this
section, or any other applicable law or
regulation, including information that
is comparative in nature with respect
to--
(I) nonquantitative treatment
limitations for both medical
and surgical benefits and
mental health and substance use
disorder benefits;
(II) the processes,
strategies, evidentiary
standards, and other factors
used to apply the limitations
described in subclause (I); and
(III) the application of the
limitations described in
subclause (I) to ensure that
such limitations are applied in
parity with respect to both
medical and surgical benefits
and mental health and substance
use disorder benefits.
(C) Nonquantitative treatment limitations.--
The guidance issued under this paragraph shall
include clarifying information and illustrative
examples of methods, processes, strategies,
evidentiary standards, and other factors that
group health plans and health insurance issuers
offering group or individual health insurance
coverage may use regarding the development and
application of nonquantitative treatment
limitations to ensure compliance with this
section (and any regulations promulgated
pursuant to this section), including--
(i) examples of methods of
determining appropriate types of
nonquantitative treatment limitations
with respect to both medical and
surgical benefits and mental health and
substance use disorder benefits,
including nonquantitative treatment
limitations pertaining to--
(I) medical management
standards based on medical
necessity or appropriateness,
or whether a treatment is
experimental or investigative;
(II) limitations with respect
to prescription drug formulary
design; and
(III) use of fail-first or
step therapy protocols;
(ii) examples of methods of
determining--
(I) network admission
standards (such as
credentialing); and
(II) factors used in provider
reimbursement methodologies
(such as service type,
geographic market, demand for
services, and provider supply,
practice size, training,
experience, and licensure) as
such factors apply to network
adequacy;
(iii) examples of sources of
information that may serve as
evidentiary standards for the purposes
of making determinations regarding the
development and application of
nonquantitative treatment limitations;
(iv) examples of specific factors,
and the evidentiary standards used to
evaluate such factors, used by such
plans or issuers in performing a
nonquantitative treatment limitation
analysis;
(v) examples of how specific
evidentiary standards may be used to
determine whether treatments are
considered experimental or
investigative;
(vi) examples of how specific
evidentiary standards may be applied to
each service category or classification
of benefits;
(vii) examples of methods of reaching
appropriate coverage determinations for
new mental health or substance use
disorder treatments, such as evidence-
based early intervention programs for
individuals with a serious mental
illness and types of medical management
techniques;
(viii) examples of methods of
reaching appropriate coverage
determinations for which there is an
indirect relationship between the
covered mental health or substance use
disorder benefit and a traditional
covered medical and surgical benefit,
such as residential treatment or
hospitalizations involving voluntary or
involuntary commitment; and
(ix) additional illustrative examples
of methods, processes, strategies,
evidentiary standards, and other
factors for which the Secretary
determines that additional guidance is
necessary to improve compliance with
this section.
(D) Public comment.--Prior to issuing any
final guidance under this paragraph, the
Secretary shall provide a public comment period
of not less than 60 days during which any
member of the public may provide comments on a
draft of the guidance.
(b) Construction.--Nothing in this section shall be
construed--
(1) as requiring a group health plan or a health
insurance issuer offering group or individual health
insurance coverage to provide any mental health or
substance use disorder benefits; or
(2) in the case of a group health plan or a health
insurance issuer offering group or individual health
insurance coverage that provides mental health or
substance use disorder benefits, as affecting the terms
and conditions of the plan or coverage relating to such
benefits under the plan or coverage, except as provided
in subsection (a).
(c) Exemptions.--
(1) Small employer exemption.--This section shall not
apply to any group health plan and a health insurance
issuer offering group or individual health insurance
coverage for any plan year of a small employer (as
defined in section 2791(e)(4), except that for purposes
of this paragraph such term shall include employers
with 1 employee in the case of an employer residing in
a State that permits small groups to include a single
individual).
(2) Cost exemption.--
(A) In general.--With respect to a group
health plan or a health insurance issuer
offering group or individual health insurance
coverage, if the application of this section to
such plan (or coverage) results in an increase
for the plan year involved of the actual total
costs of coverage with respect to medical and
surgical benefits and mental health and
substance use disorder benefits under the plan
(as determined and certified under subparagraph
(C)) by an amount that exceeds the applicable
percentage described in subparagraph (B) of the
actual total plan costs, the provisions of this
section shall not apply to such plan (or
coverage) during the following plan year, and
such exemption shall apply to the plan (or
coverage) for 1 plan year. An employer may
elect to continue to apply mental health and
substance use disorder parity pursuant to this
section with respect to the group health plan
(or coverage) involved regardless of any
increase in total costs.
(B) Applicable percentage.--With respect to a
plan (or coverage), the applicable percentage
described in this subparagraph shall be--
(i) 2 percent in the case of the
first plan year in which this section
is applied; and
(ii) 1 percent in the case of each
subsequent plan year.
(C) Determinations by actuaries.--
Determinations as to increases in actual costs
under a plan (or coverage) for purposes of this
section shall be made and certified by a
qualified and licensed actuary who is a member
in good standing of the American Academy of
Actuaries. All such determinations shall be in
a written report prepared by the actuary. The
report, and all underlying documentation relied
upon by the actuary, shall be maintained by the
group health plan or health insurance issuer
for a period of 6 years following the
notification made under subparagraph (E).
(D) 6-month determinations.--If a group
health plan (or a health insurance issuer
offering coverage in connection with a group
health plan) seeks an exemption under this
paragraph, determinations under subparagraph
(A) shall be made after such plan (or coverage)
has complied with this section for the first 6
months of the plan year involved.
(E) Notification.--
(i) In general.--A group health plan
(or a health insurance issuer offering
coverage in connection with a group
health plan) that, based upon a
certification described under
subparagraph (C), qualifies for an
exemption under this paragraph, and
elects to implement the exemption,
shall promptly notify the Secretary,
the appropriate State agencies, and
participants and beneficiaries in the
plan of such election.
(ii) Requirement.--A notification to
the Secretary under clause (i) shall
include--
(I) a description of the
number of covered lives under
the plan (or coverage) involved
at the time of the
notification, and as
applicable, at the time of any
prior election of the cost-
exemption under this paragraph
by such plan (or coverage);
(II) for both the plan year
upon which a cost exemption is
sought and the year prior, a
description of the actual total
costs of coverage with respect
to medical and surgical
benefits and mental health and
substance use disorder benefits
under the plan; and
(III) for both the plan year
upon which a cost exemption is
sought and the year prior, the
actual total costs of coverage
with respect to mental health
and substance use disorder
benefits under the plan.
(iii) Confidentiality.--A
notification to the Secretary under
clause (i) shall be confidential. The
Secretary shall make available, upon
request and on not more than an annual
basis, an anonymous itemization of such
notifications, that includes--
(I) a breakdown of States by
the size and type of employers
submitting such notification;
and
(II) a summary of the data
received under clause (ii).
(F) Audits by appropriate agencies.--To
determine compliance with this paragraph, the
Secretary may audit the books and records of a
group health plan or health insurance issuer
relating to an exemption, including any
actuarial reports prepared pursuant to
subparagraph (C), during the 6 year period
following the notification of such exemption
under subparagraph (E). A State agency
receiving a notification under subparagraph (E)
may also conduct such an audit with respect to
an exemption covered by such notification.
(d) Separate Application to Each Option Offered.--In the case
of a group health plan that offers a participant or beneficiary
two or more benefit package options under the plan, the
requirements of this section shall be applied separately with
respect to each such option.
(e) Definitions.--For purposes of this section--
(1) Aggregate lifetime limit.--The term ``aggregate
lifetime limit'' means, with respect to benefits under
a group health plan or health insurance coverage, a
dollar limitation on the total amount that may be paid
with respect to such benefits under the plan or health
insurance coverage with respect to an individual or
other coverage unit.
(2) Annual limit.--The term ``annual limit'' means,
with respect to benefits under a group health plan or
health
insurance coverage, a dollar limitation on the total
amount of benefits that may be paid with respect to
such benefits in a 12-month period under the plan or
health insurance coverage with respect to an individual
or other coverage unit.
(3) Medical or surgical benefits.--The term ``medical
or surgical benefits'' means benefits with respect to
medical or surgical services, as defined under the
terms of the plan or coverage (as the case may be), but
does not include mental health or substance use
disorder benefits.
(4) Mental health benefits.--The term ``mental health
benefits'' means benefits with respect to services for
mental health conditions, as defined under the terms of
the plan and in accordance with applicable Federal and
State law.
(5) Substance use disorder benefits.--The term
``substance use disorder benefits'' means benefits with
respect to services for substance use disorders, as
defined under the terms of the plan and in accordance
with applicable Federal and State law.
* * * * * * *
----------
PROTECTION AND ADVOCACY FOR INDIVIDUALS WITH MENTAL ILLNESS ACT
* * * * * * *
TITLE I--PROTECTION AND ADVOCACY SYSTEMS
Part A--Establishment of Systems
* * * * * * *
system requirements
Sec. 105. (a) A system established in a State under section
103 to protect and advocate the rights of individuals with
mental illness shall--
(1) have the authority to--
(A) investigate incidents of abuse and
neglect of individuals with mental illness if
the incidents are reported to the system or if
there is probable cause to believe that the
incidents occurred;
(B) pursue administrative, legal, and other
appropriate remedies to ensure the protection
of individuals with mental illness who are
receiving care or treatment in the State; and
(C) pursue administrative, legal, and other
remedies on behalf of an individual who--
(i) was a individual with mental
illness; and
(ii) is a resident of the State,
but only with respect to matters which occur
within 90 days after the date of the discharge
of such individual from a facility providing
care or treatment;
(2) be independent of any agency in the State which
provides treatment or services (other than advocacy
services) to individuals with mental illness;
(3) have access to facilities in the State providing
care or treatment;
(4) in accordance with section 106, have access to
all records of--
(A) any individual who is a client of the
system if such individual, or the legal
guardian, conservator, or other legal
representative of such individual, has
authorized the system to have such access;
(B) any individual (including an individual
who has died or whose whereabouts are
unknown)--
(i) who by reason of the mental or
physical condition of such individual
is unable to authorize the system to
have such access;
(ii) who does not have a legal
guardian, conservator, or other legal
representative, or for whom the legal
guardian is the State; and
(iii) with respect to whom a
complaint has been received by the
system or with respect to whom as a
result of monitoring or other
activities (either of which result from
a complaint or other evidence) there is
probable cause to believe that such
individual has been subject to abuse or
neglect; and
(C) any individual with a mental illness, who
has a legal guardian, conservator, or other
legal representative, with respect to whom a
complaint has been received by the system or
with respect to whom there is probable cause to
believe the health or safety of the individual
is in serious and immediate jeopardy,
whenever--
(i) such representative has been
contacted by such system upon receipt
of the name and address of such
representative;
(ii) such system has offered
assistance to such representative to
resolve the situation; and
(iii) such representative has failed
or refused to act on behalf of the
individual;
(5) have an arrangement with the Secretary and the
agency of the State which administers the State plan
under title XIX of the Social Security Act for the
furnishing of the information required by subsection
(b);
(6) establish an advisory council--
(A) which will advise the system on policies
and priorities to be carried out in protecting
and advocating the rights of individuals with
mental illness;
(B) which shall include attorneys, mental
health professionals, individuals from the
public who are knowledgeable about mental
illness, a provider of mental health services,
individuals who have received or are receiving
mental health services, and family members of
such individuals, and at least 60 percent the
membership of which shall be comprised of
individuals who have received or are receiving
mental health services or who are family
members of such individuals; and
(C) which shall be chaired by an individual
who has received or is receiving mental health
services or who is a family member of such an
individual;
(7) on January 1, 1987, and January 1 of each
succeeding year, prepare and transmit to the Secretary
and the head of the State mental health agency of the
State in which the system [is located a report] is
located, and make publicly available, a report
describing the activities, accomplishments, and
expenditures of the system during the most recently
completed fiscal year, including a section prepared by
the advisory council that describes the activities of
the council and its assessment of the operations of the
system;
(8) on an annual basis, provide the public with an
opportunity to comment on the priorities established
by, and the activities of, the system;
(9) establish a grievance procedure for clients or
prospective clients of the system to assure that
individuals with mental illness have full access to the
services of the system and for individuals who have
received or are receiving mental health services,
family members of such individuals with mental illness,
or representatives of such individuals or family
members to assure that the eligible system is operating
in compliance with the provisions of this title and
title III; [and]
(10) not use allotments provided to a system in a
manner inconsistent with section 5 of the Assisted
Suicide Funding Restriction Act of 1997[.]; and
(11) agree to refrain, during any period for which
funding is provided to the system under this part, from
using Federal funds to pay the salary or expenses of
any grant or contract recipient, or agent acting for
such recipient, related to any activity designed to
influence the enactment of legislation, appropriations,
regulation, administrative action, or Executive order
proposed or pending before the Congress or any State
government, State legislature or local legislature or
legislative body, other than for normal and recognized
executive-legislative relationships or participation by
an agency or officer of a State, local, or tribal
government in policymaking and administrative processes
within the executive branch of that government.
(b) The Secretary and the agency of a State which administers
its State plan under title XIX of the Social Security Act shall
provide the eligible system of the State with a copy of each
annual survey report and plan of corrections for cited
deficiencies made pursuant to titles XVIII and XIX of the
Social Security Act with respect to any facility rendering care
or treatment to individuals with mental illness in the State in
which such system is located. A report or plan shall be made
available within 30 days after the completion of the report or
plan.
(c)(1)(A) Each system established in a State, through
allotments received under section 103, to protect and advocate
the rights of individuals with mental illness shall have a
governing authority.
(B) In States in which the governing authority is organized
as a private non-profit entity with a multi-member governing
board, or a public system with a multi-member governing board,
such governing board shall be selected according to the
policies and procedures of the system. The governing board
shall be composed of--
(i) members (to be selected no later than October 1,
1990) who broadly represent or are knowledgeable about
the needs of the clients served by the system; and
(ii) in the case of a governing authority organized
as a private non-profit entity, members who broadly
represent or are knowledgeable about the needs of the
clients served by the system including the chairperson
of the advisory council of such system. As used in this
subparagraph, the term ``members who broadly represent
or are knowledgeable about the needs of the clients
served by the system'' shall be construed to include
individuals who have received or are receiving mental
health services and family members of such individuals.
(2) The governing authority established under paragraph (1)
shall--
(A) be responsible for the planning, design,
implementation, and functioning of the system; and
(B) consistent with subparagraph (A), jointly develop
the annual priorities of the system with the advisory
council.
(d) Grievance Procedure.--The Secretary shall establish an
independent grievance procedure for persons described in
subsection (a)(9).
* * * * * * *
Part B--Administrative Provisions
* * * * * * *
REPORTS BY THE SECRETARY
Sec. 114. (a) The Secretary shall include in each report
required under section 105 of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000 a separate statement
which contains--
(1) a description of the activities, accomplishments,
and expenditures of systems to protect and advocate the
rights of individuals with mental illness supported
with payments from allotments under this title,
including--
(A) a specification of the total number of
individuals with mental illness served by such
systems;
(B) a description of the types of activities
undertaken by such systems;
(C) a description of the types of facilities
providing care or treatment with respect to
which such activities are undertaken;
(D) a description of the manner in which such
activities are initiated; and
(E) a description of the accomplishments
resulting from such activities;
(2) a description of--
(A) systems to protect and advocate the
rights of individuals with mental illness
supported with payments from allotments under
this title;
(B) activities conducted by States to protect
and advocate such rights;
(C) mechanisms established by residential
facilities for individuals with mental illness
to protect and advocate such rights; and
(D) the coordination among such systems,
activities, and mechanisms;
(3) a specification of the number of systems
established with allotments under this title and of
whether each such system was established by a public or
nonprofit private entity; [and]
(4) recommendations for activities and services to
improve the protection and advocacy of the rights of
individuals with mental illness and a description of
needs for such activities and services which have not
been met by systems established under this title[.];
and
(5) using data from the existing required annual
program progress reports submitted by each system
funded under this title, a detailed accounting for each
such system of how funds are spent, disaggregated
according to whether the funds were received from the
Federal Government, the State government, a local
government, or a private entity.
(b) In preparing each statement required by subsection (a),
the Secretary shall use and include information submitted to
the Secretary in the reports required under section 105(a)(7).
* * * * * * *
----------
SOCIAL SECURITY ACT
* * * * * * *
TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
* * * * * * *
PAYMENT TO STATES
Sec. 1903. (a) From the sums appropriated therefor, the
Secretary (except as otherwise provided in this section) shall
pay to each State which has a plan approved under this title,
for each quarter, beginning with the quarter commencing January
1, 1966--
(1) an amount equal to the Federal medical assistance
percentage (as defined in section 1905(b), subject to
subsections (g) and (j) of this section and subsection
1923(f)) of the total amount expended during such
quarter as medical assistance under the State plan;
plus
(2)(A) an amount equal to 75 per centum of so much of
the sums expended during such quarter (as found
necessary by the Secretary for the proper and efficient
administration of the State plan) as are attributable
to compensation or training of skilled professional
medical personnel, and staff directly supporting such
personnel, of the State agency or any other public
agency; plus
(B) notwithstanding paragraph (1) or subparagraph
(A), with respect to amounts expended for nursing aide
training and competency evaluation programs, and
competency evaluation programs, described in section
1919(e)(1) (including the costs for nurse aides to
complete such competency evaluation programs),
regardless of whether the programs are provided in or
outside nursing facilities or of the skill of the
personnel involved in such programs, an amount equal to
50 percent (or, for calendar quarters beginning on or
after July 1, 1988, and before October 1, 1990, the
lesser of 90 percent or the Federal medical assistance
percentage plus 25 percentage points) of so much of the
sums expended during such quarter (as found necessary
by the Secretary for the proper and efficient
administration of the State plan) as are attributable
to such programs; plus
(C) an amount equal to 75 percent of so much of the
sums expended during such quarter (as found necessary
by the Secretary for the proper and efficient
administration of the State plan) as are attributable
to preadmission screening and resident review
activities conducted by the State under section
1919(e)(7); plus
(D) for each calendar quarter during--
(i) fiscal year 1991, an amount equal to 90
percent,
(ii) fiscal year 1992, an amount equal to 85
percent,
(iii) fiscal year 1993, an amount equal to 80
percent, and
(iv) fiscal year 1994 and thereafter, an
amount equal to 75 percent,
of so much of the sums expended during such quarter (as
found necessary by the Secretary for the proper and
efficient administration of the State plan) as are
attributable to State activities under section 1919(g);
plus
(E) an amount equal to 75 percent of so much of the
sums expended during such quarter (as found necessary
by the Secretary for the proper and efficient
administration of the State plan) as are attributable
to translation or interpretation services in connection
with the enrollment of, retention of, and use of
services under this title by, children of families for
whom English is not the primary language; plus
(3) an amount equal to--
(A)(i) 90 per centum of so much of the sums
expended during such quarter as are
attributable to the design, development, or
installation of such mechanized claims
processing and information retrieval systems as
the Secretary determines are likely to provide
more efficient, economical, and effective
administration of the plan and to be compatible
with the claims processing and information
retrieval systems utilized in the
administration of title XVIII, including the
State's share of the cost of installing such a
system to be used jointly in the administration
of such State's plan and the plan of any other
State approved under this title,
(ii) 90 per centum of so much of the sums
expended during any such quarter in the fiscal
year ending June 30, 1972, or the fiscal year
ending June 30, 1973, as are attributable to
the design, development, or installation of
cost determination systems for State-owned
general hospitals (except that the total amount
paid to all States under this clause for either
such fiscal year shall not exceed $150,000),
and
(iii) an amount equal to the Federal medical
assistance percentage (as defined in section
1905(b)) of so much of the sums expended during
such quarter (as found necessary by the
Secretary for the proper and efficient
administration of the State plan) as are
attributable to such developments or
modifications of systems of the type described
in clause (i) as are necessary for the
efficient collection and reporting on child
health measures; and
(B) 75 per centum of so much of the sums
expended during such quarter as are
attributable to the operation of systems
(whether such systems are operated directly by
the State or by another person under a contract
with the State) of the type described in
subparagraph (A)(i) (whether or not designed,
developed, or installed with assistance under
such subparagraph) which are approved by the
Secretary and which include provision for
prompt written notice to each individual who is
furnished services covered by the plan, or to
each individual in a sample group of
individuals who are furnished such services, of
the specific services (other than confidential
services) so covered, the name of the person or
persons furnishing the services, the date or
dates on which the services were furnished, and
the amount of the payment or payments made
under the plan on account of the services; and
(C)(i) 75 per centum of the sums expended
with respect to costs incurred during such
quarter (as found necessary by the Secretary
for the proper and efficient administration of
the State plan) as are attributable to the
performance of medical and utilization review
by a utilization and quality control peer
review organization or by an entity which meets
the requirements of section 1152, as determined
by the Secretary, under a contract entered into
under section 1902(d); and
(ii) 75 percent of the sums expended with
respect to costs incurred during such quarter
(as found necessary by the Secretary for the
proper and efficient administration of the
State plan) as are attributable to the
performance of independent external reviews
conducted under section 1932(c)(2); and
(D) 75 percent of so much of the sums
expended by the State plan during a quarter in
1991, 1992, or 1993, as the Secretary
determines is attributable to the statewide
adoption of a drug use review program which
conforms to the requirements of section
1927(g);
(E) 50 percent of the sums expended with
respect to costs incurred during such quarter
as are attributable to providing--
(i) services to identify and educate
individuals who are likely to be
eligible for medical assistance under
this title and who have Sickle Cell
Disease or who are carriers of the
sickle cell gene, including education
regarding how to identify such
individuals; or
(ii) education regarding the risks of
stroke and other complications, as well
as the prevention of stroke and other
complications, in individuals who are
likely to be eligible for medical
assistance under this title and who
have Sickle Cell Disease; and
(F)(i) 100 percent of so much of the sums
expended during such quarter as are
attributable to payments to Medicaid providers
described in subsection (t)(1) to encourage the
adoption and use of certified EHR technology;
and
(ii) 90 percent of so much of the sums
expended during such quarter as are
attributable to payments for reasonable
administrative expenses related to the
administration of payments described in clause
(i) if the State meets the condition described
in subsection (t)(9); plus
(H)(i) 90 percent of the sums expended during
the quarter as are attributable to the design,
development, or installation of such mechanized
verification and information retrieval systems
as the Secretary determines are necessary to
implement section 1902(ee) (including a system
described in paragraph (2)(B) thereof), and
(ii) 75 percent of the sums expended during
the quarter as are attributable to the
operation of systems to which clause (i)
applies, plus
(4) an amount equal to 100 percent of the sums
expended during the quarter which are attributable to
the costs of the implementation and operation of the
immigration status verification system described in
section 1137(d); plus
(5) an amount equal to 90 per centum of the sums
expended during such quarter which are attributable to
the offering, arranging, and furnishing (directly or on
a contract basis) of family planning services and
supplies;
(6) subject to subsection (b)(3), an amount equal
to--
(A) 90 per centum of the sums expended during
such a quarter within the twelve-quarter period
beginning with the first quarter in which a
payment is made to the State pursuant to this
paragraph, and
(B) 75 per centum of the sums expended during
each succeeding calendar quarter,
with respect to costs incurred during such quarter (as
found necessary by the Secretary for the elimination of
fraud in the provision and administration of medical
assistance provided under the State plan) which are
attributable to the establishment and operation of
(including the training of personnel employed by) a
State medicaid fraud control unit (described in
subsection (q)); plus
(7) subject to section 1919(g)(3)(B), an amount equal
to 50 per centum of the remainder of the amounts
expended during such quarter as found necessary by the
Secretary for the proper and efficient administration
of the State plan.
(b)(1) Notwithstanding the preceding provisions of this
section, the amount determined under subsection (a)(1) for any
State for any quarter beginning after December 31, 1969, shall
not take into account any amounts expended as medical
assistance with respect to individuals aged 65 or over and
disabled individuals entitled to hospital insurance benefits
under title XVIII which would not have been so expended if the
individuals involved had been enrolled in the insurance program
established by part B of title XVIII, other than amounts
expended under provisions of the plan of such State required by
section 1902(a)(34).
(2) For limitation on Federal participation for capital
expenditures which are out of conformity with a comprehensive
plan of a State or areawide planning agency, see section 1122.
(3) The amount of funds which the Secretary is otherwise
obligated to pay a State during a quarter under subsection
(a)(6) may not exceed the higher of--
(A) $125,000, or
(B) one-quarter of 1 per centum of the sums expended
by the Federal, State, and local governments during the
previous quarter in carrying out the State's plan under
this title.
(4) Amounts expended by a State for the use of an enrollment
broker in marketing medicaid managed care organizations and
other managed care entities to eligible individuals under this
title shall be considered, for purposes of subsection (a)(7),
to be necessary for the proper and efficient administration of
the State plan but only if the following conditions are met
with respect to the broker:
(A) The broker is independent of any such entity and
of any health care providers (whether or not any such
provider participates in the State plan under this
title) that provide coverage of services in the same
State in which the broker is conducting enrollment
activities.
(B) No person who is an owner, employee, consultant,
or has a contract with the broker either has any direct
or indirect financial interest with such an entity or
health care provider or has been excluded from
participation in the program under this title or title
XVIII or debarred by any Federal agency, or subject to
a civil money penalty under this Act.
(5) Notwithstanding the preceding provisions of this section,
the amount determined under subsection (a)(1) for any State
shall be decreased in a quarter by the amount of any health
care related taxes (described in section 1902(w)(3)(A)) that
are imposed on a hospital described in subsection (w)(3)(F) in
that quarter.
(c) Nothing in this title shall be construed as prohibiting
or restricting, or authorizing the Secretary to prohibit or
restrict, payment under subsection (a) for medical assistance
for covered services furnished to a child with a disability
because such services are included in the child's
individualized education program established pursuant to part B
of the Individuals with Disabilities Education Act or furnished
to an infant or toddler with a disability because such services
are included in the child's individualized family service plan
adopted pursuant to part C of such Act.
(d)(1) Prior to the beginning of each quarter, the Secretary
shall estimate the amount to which a State will be entitled
under subsections (a) and (b) for such quarter, such estimates
to be based on (A) a report filed by the State containing its
estimate of the total sum to be expended in such quarter in
accordance with the provisions of such subsections, and stating
the amount appropriated or made available by the State and its
political subdivisions for such expenditures in such quarter,
and if such amount is less than the State's proportionate share
of the total sum of such estimated expenditures, the source or
sources from which the difference is expected to be derived,
and (B) such other investigation as the Secretary may find
necessary.
(2)(A) The Secretary shall then pay to the State, in such
installments as he may determine, the amount so estimated,
reduced or increased to the extent of any overpayment or
underpayment which the Secretary determines was made under this
section to such State for any prior quarter and with respect to
which adjustment has not already been made under this
subsection.
(B) Expenditures for which payments were made to the State
under subsection (a) shall be treated as an overpayment to the
extent that the State or local agency administering such plan
has been reimbursed for such expenditures by a third party
pursuant to the provisions of its plan in compliance with
section 1902(a)(25).
(C) For purposes of this subsection, when an overpayment is
discovered, which was made by a State to a person or other
entity, the State shall have a period of 1 year in which to
recover or attempt to recover such overpayment before
adjustment is made in the Federal payment to such State on
account of such overpayment. Except as otherwise provided in
subparagraph (D), the adjustment in the Federal payment shall
be made at the end of the 1-year period, whether or not
recovery was made.
(D)(i) In any case where the State is unable to recover a
debt which represents an overpayment (or any portion thereof)
made to a person or other entity on account of such debt having
been discharged in bankruptcy or otherwise being uncollectable,
no adjustment shall be made in the Federal payment to such
State on account of such overpayment (or portion thereof).
(ii) In any case where the State is unable to recover a debt
which represents an overpayment (or any portion thereof) made
to a person or other entity due to fraud within 1 year of
discovery because there is not a final determination of the
amount of the overpayment under an administrative or judicial
process (as applicable), including as a result of a judgment
being under appeal, no adjustment shall be made in the Federal
payment to such State on account of such overpayment (or
portion thereof) before the date that is 30 days after the date
on which a final judgment (including, if applicable, a final
determination on an appeal) is made.
(3)(A) The pro rata share to which the United States is
equitably entitled, as determined by the Secretary, of the net
amount recovered during any quarter by the State or any
political subdivision thereof with respect to medical
assistance furnished under the State plan shall be considered
an overpayment to be adjusted under this subsection.
(B)(i) Subparagraph (A) and paragraph (2)(B) shall not apply
to any amount recovered or paid to a State as part of the
comprehensive settlement of November 1998 between manufacturers
of tobacco products, as defined in section 5702(d) of the
Internal Revenue Code of 1986, and State Attorneys General, or
as part of any individual State settlement or judgment reached
in litigation initiated or pursued by a State against one or
more such manufacturers.
(ii) Except as provided in subsection (i)(19), a State may
use amounts recovered or paid to the State as part of a
comprehensive or individual settlement, or a judgment,
described in clause (i) for any expenditures determined
appropriate by the State.
(4) Upon the making of any estimate by the Secretary under
this subsection, any appropriations available for payments
under this section shall be deemed obligated.
(5) In any case in which the Secretary estimates that there
has been an overpayment under this section to a State on the
basis of a claim by such State that has been disallowed by the
Secretary under section 1116(d), and such State disputes such
disallowance, the amount of the Federal payment in controversy
shall, at the option of the State, be retained by such State or
recovered by the Secretary pending a final determination with
respect to such payment amount. If such final determination is
to the effect that any amount was properly disallowed, and the
State chose to retain payment of the amount in controversy, the
Secretary shall offset, from any subsequent payments made to
such State under this title, an amount equal to the proper
amount of the disallowance plus interest on such amount
disallowed for the period beginning on the date such amount was
disallowed and ending on the date of such final determination
at a rate (determined by the Secretary) based on the average of
the bond equivalent of the weekly 90-day treasury bill auction
rates during such period.
(6)(A) Each State (as defined in subsection (w)(7)(D)) shall
include, in the first report submitted under paragraph (1)
after the end of each fiscal year, information related to--
(i) provider-related donations made to the State or
units of local government during such fiscal year, and
(ii) health care related taxes collected by the State
or such units during such fiscal year.
(B) Each State shall include, in the first report submitted
under paragraph (1) after the end of each fiscal year,
information related to the total amount of payment adjustments
made, and the amount of payment adjustments made to individual
providers (by provider), under section 1923(c) during such
fiscal year.
(e) A State plan approved under this title may include, as a
cost with respect to hospital services under the plan under
this title, periodic expenditures made to reflect transitional
allowances established with respect to a hospital closure or
conversion under section 1884.
(f)(1)(A) Except as provided in paragraph (4), payment under
the preceding provisions of this section shall not be made with
respect to any amount expended as medical assistance in a
calendar quarter, in any State, for any member of a family the
annual income of which exceeds the applicable income limitation
determined under this paragraph.
(B)(i) Except as provided in clause (ii) of this
subparagraph, the applicable income limitation with respect to
any family is the amount determined, in accordance with
standards prescribed by the Secretary, to be equivalent to
133\1/3\ percent of the highest amount which would ordinarily
be paid to a family of the same size without any income or
resources, in the form of money payments, under the plan of the
State approved under part A of title IV of this Act.
(ii) If the Secretary finds that the operation of a uniform
maximum limits payments to families of more than one size, he
may adjust the amount otherwise determined under clause (i) to
take account of families of different sizes.
(C) The total amount of any applicable income limitation
determined under subparagraph (B) shall, if it is not a
multiple of $100 or such other amount as the Secretary may
prescribe, be rounded to the next higher multiple of $100 or
such other amount, as the case may be.
(2)(A) In computing a family's income for purposes of
paragraph (1), there shall be excluded any costs (whether in
the form of insurance premiums or otherwise and regardless of
whether such costs are reimbursed under another public program
of the State or political subdivision thereof) incurred by such
family for medical care or for any other type of remedial care
recognized under State law or, (B) notwithstanding section 1916
at State option, an amount paid by such family, at the family's
option, to the State, provided that the amount, when combined
with costs incurred in prior months, is sufficient when
excluded from the family's income to reduce such family's
income below the applicable income limitation described in
paragraph (1). The amount of State expenditures for which
medical assistance is available under subsection (a)(1) will be
reduced by amounts paid to the State pursuant to this
subparagraph.
(3) For purposes of paragraph (1)(B), in the case of a family
consisting of only one individual, the ``highest amount which
would ordinarily be paid'' to such family under the State's
plan approved under part A of title IV of this Act shall be the
amount determined by the State agency (on the basis of
reasonable relationship to the amounts payable under such plan
to families consisting of two or more persons) to be the amount
of the aid which would ordinarily be payable under such plan to
a family (without any income or resources) consisting of one
person if such plan provided for aid to such a family.
(4) The limitations on payment imposed by the preceding
provisions of this subsection shall not apply with respect to
any amount expended by a State as medical assistance for any
individual described in section 1902(a)(10)(A)(i)(III),
1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(V),
1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII),
1902(a)(10)(A)(i)(VIII),1902(a)(10)(A)(i)(IX),
1902(a)(10)(A)(ii)(IX), 1902(a)(10)(A)(ii)(X),
1902(a)(10)(A)(ii)(XIII), 1902(a)(10)(A)(ii)(XIV), or
1902(a)(10)(A)(ii)(XV), 1902(a)(10)(A)(ii)(XVI),
1902(a)(10)(A)(ii)(XVII), 1902(a)(10)(A)(ii)(XVIII),
1902(a)(10)(A)(ii)(XIX), 1902(a)(10)(A)(ii)(XX),
1902(a)(10)(A)(ii)(XXI), 1902(a)(10)(A)(ii)(XXII), 1905(p)(1)
or for any individual--
(A) who is receiving aid or assistance under any plan
of the State approved under title I, X, XIV or XVI, or
part A of title IV, or with respect to whom
supplemental security income benefits are being paid
under title XVI, or
(B) who is not receiving such aid or assistance, and
with respect to whom such benefits are not being paid,
but (i) is eligible to receive such aid or assistance,
or to have such benefits paid with respect to him, or
(ii) would be eligible to receive such aid or
assistance, or to have such benefits paid with respect
to him if he were not in a medical institution, or
(C) with respect to whom there is being paid, or who
is eligible, or would be eligible if he were not in a
medical institution, to have paid with respect to him,
a State supplementary payment and is eligible for
medical assistance equal in amount, duration, and scope
to the medical assistance made available to individuals
described in section 1902(a)(10)(A), or who is a PACE
program eligible individual enrolled in a PACE program
under section 1934, but only if the income of such
individual (as determined under section 1612, but
without regard to subsection (b) thereof) does not
exceed 300 percent of the supplemental security income
benefit rate established by section 1611(b)(1),
at the time of the provision of the medical assistance giving
rise to such expenditure.
(g)(1) Subject to paragraph (3), with respect to amounts paid
for the following services furnished under the State plan after
June 30, 1973 (other than services furnished pursuant to a
contract with a health maintenance organization as defined in
section 1876 or which is a qualified health maintenance
organization (as defined in section 1310(d) of the Public
Health Service Act)), the Federal medical assistance percentage
shall be decreased as follows: After an individual has received
inpatient hospital services or services in an intermediate care
facility for the mentally retarded for 60 days or inpatient
mental hospital services for 90 days (whether or not such days
are consecutive), during any fiscal year, the Federal medical
assistance percentage with respect to amounts paid for any such
care furnished thereafter to such individual shall be decreased
by a per centum thereof (determined under paragraph (5)) unless
the State agency responsible for the administration of the plan
makes a showing satisfactory to the Secretary that, with
respect to each calendar quarter for which the State submits a
request for payment at the full Federal medical assistance
percentage for amounts paid for inpatient hospital services or
services in an intermediate care facility for the mentally
retarded furnished beyond 60 days (or inpatient mental hospital
services furnished beyond 90 days), such State has an effective
program of medical review of the care of patients in mental
hospitals and intermediate care facilities for the mentally
retarded pursuant to paragraphs (26) and (31) of section
1902(a) whereby the professional management of each case is
reviewed and evaluated at least annually by independent
professional review teams. In determining the number of days on
which an individual has received services described in this
subsection, there shall not be counted any days with respect to
which such individual is entitled to have payments made (in
whole or in part) on his behalf under section 1812.
(2) The Secretary shall, as part of his validation procedures
under this subsection, conduct timely sample onsite surveys of
private and public institutions in which recipients of medical
assistance may receive care and services under a State plan
approved under this title, and his findings with respect to
such surveys (as well as the showings of the State agency
required under this subsection) shall be made available for
public inspection.
(3)(A) No reduction in the Federal medical assistance
percentage of a State otherwise required to be imposed under
this subsection shall take effect--
(i) if such reduction is due to the State's
unsatisfactory or invalid showing made with respect to
a calendar quarter beginning before January 1, 1977;
(ii) before January 1, 1978;
(iii) unless a notice of such reduction has been
provided to the State at least 30 days before the date
such reduction takes effect; or
(iv) due to the State's unsatisfactory or invalid
showing made with respect to a calendar quarter
beginning after September 30, 1977, unless notice of
such reduction has been provided to the State no later
than the first day of the fourth calendar quarter
following the calendar quarter with respect to which
such showing was made.
(B) The Secretary shall waive application of any reduction in
the Federal medical assistance percentage of a State otherwise
required to be imposed under paragraph (1) because a showing by
the State, made under such paragraph with respect to a calendar
quarter ending after January 1, 1977, and before January 1,
1978, is determined to be either unsatisfactory under such
paragraph or invalid under paragraph (2), if the Secretary
determines that the State's showing made under paragraph (1)
with respect to any calendar quarter ending on or before
December 31, 1978, is satisfactory under such paragraph and is
valid under paragraph (2).
(4)(A) The Secretary may not find the showing of a State,
with respect to a calendar quarter under paragraph (1), to be
satisfactory if the showing is submitted to the Secretary later
than the 30th day after the last day of the calendar quarter,
unless the State demonstrates to the satisfaction of the
Secretary good cause for not meeting such deadline.
(B) The Secretary shall find a showing of a State, with
respect to a calendar quarter under paragraph (1), to be
satisfactory under such paragraph with respect to the
requirement that the State conduct annual onsite inspections in
mental hospitals and intermediate care facilities for the
mentally retarded under paragraphs (26) and (31) of section
1902(a), if the showing demonstrates that the State has
conducted such an onsite inspection during the 12-month period
ending on the last date of the calendar quarter--
(i) in each of not less than 98 per centum of the
number of such hospitals and facilities requiring such
inspection, and
(ii) in every such hospital or facility which has 200
or more beds,
and that, with respect to such hospitals and facilities not
inspected within such period, the State has exercised good
faith and due diligence in attempting to conduct such
inspection, or if the State demonstrates to the satisfaction of
the Secretary that it would have made such a showing but for
failings of a technical nature only.
(5) In the case of a State's unsatisfactory or invalid
showing made with respect to a type of facility or
institutional services in a calendar quarter, the per centum
amount of the reduction of the State's Federal medical
assistance percentage for that type of services under paragraph
(1) is equal to 33\1/3\ per centum multiplied by a fraction,
the denominator of which is equal to the total number of
patients receiving that type of services in that quarter under
the State plan in facilities or institutions for which a
showing was required to be made under this subsection, and the
numerator of which is equal to the number of such patients
receiving such type of services in that quarter in those
facilities or institutions for which a satisfactory and valid
showing was not made for that calendar quarter.
(6)(A) Recertifications required under section 1902(a)(44)
shall be conducted at least every 60 days in the case of
inpatient hospital services.
(B) Such recertifications in the case of services in an
intermediate care facility for the mentally retarded shall be
conducted at least--
(i) 60 days after the date of the initial
certification,
(ii) 180 days after the date of the initial
certification,
(iii) 12 months after the date of the initial
certification,
(iv) 18 months after the date of the initial
certification,
(v) 24 months after the date of the initial
certification, and
(vi) every 12 months thereafter.
(C) For purposes of determining compliance with the schedule
established by this paragraph, a recertification shall be
considered to have been done on a timely basis if it was
performed not later than 10 days after the date the
recertification was otherwise required and the State
establishes good cause why the physician or other person making
such recertification did not meet such schedule.
(i) Payment under the preceding provisions of this section
shall not be made--
(1) for organ transplant procedures unless the State
plan provides for written standards respecting the
coverage of such procedures and unless such standards
provide that--
(A) similarly situated individuals are
treated alike; and
(B) any restriction, on the facilities or
practitioners which may provide such
procedures, is consistent with the
accessibility of high quality care to
individuals eligible for the procedures under
the State plan; or
(2) with respect to any amount expended for an item
or service (other than an emergency item or service,
not including items or services furnished in an
emergency room of a hospital) furnished--
(A) under the plan by any individual or
entity during any period when the individual or
entity is excluded from participation under
title V, XVIII, or XX or under this title
pursuant to section 1128, 1128A, 1156, or
1842(j)(2),
(B) at the medical direction or on the
prescription of a physician, during the period
when such physician is excluded from
participation under title V, XVIII, or XX or
under this title pursuant to section 1128,
1128A, 1156, or 1842(j)(2) and when the person
furnishing such item or service knew or had
reason to know of the exclusion (after a
reasonable time period after reasonable notice
has been furnished to the person); or
(C) by any individual or entity to whom the
State has failed to suspend payments under the
plan during any period when there is pending an
investigation of a credible allegation of fraud
against the individual or entity, as determined
by the State in accordance with regulations
promulgated by the Secretary for purposes of
section 1862(o) and this subparagraph, unless
the State determines in accordance with such
regulations there is good cause not to suspend
such payments; or
(3) with respect to any amount expended for inpatient
hospital services furnished under the plan (other than
amounts attributable to the special situation of a
hospital which serves a disproportionate number of low
income patients with special needs) to the extent that
such amount exceeds the hospital's customary charges
with respect to such services or (if such services are
furnished under the plan by a public institution free
of charge or at nominal charges to the public) exceeds
an amount determined on the basis of those items
(specified in regulations prescribed by the Secretary)
included in the determination of such payment which the
Secretary finds will provide fair compensation to such
institution for such services; or
(4) with respect to any amount expended for care or
services furnished under the plan by a hospital unless
such hospital has in effect a utilization review plan
which meets the requirements imposed by section 1861(k)
for purposes of title XVIII; and if such hospital has
in effect such a utilization review plan for purposes
of title XVIII, such plan shall serve as the plan
required by this subsection (with the same standards
and procedures and the same review committee or group)
as a condition of payment under this title; the
Secretary is authorized to waive the requirements of
this paragraph if the State agency demonstrates to his
satisfaction that it has in operation utilization
review procedures which are superior in their
effectiveness to the procedures required under section
1861(k); or
(5) with respect to any amount expended for any drug
product for which payment may not be made under part B
of title XVIII because of section 1862(c); or
(6) with respect to any amount expended for inpatient
hospital tests (other than in emergency situations) not
specifically ordered by the attending physician or
other responsible practitioner; or
(7) with respect to any amount expended for clinical
diagnostic laboratory tests performed by a physician,
independent laboratory, or hospital, to the extent such
amount exceeds the amount that would be recognized
under section 1833(h) for such tests performed for an
individual enrolled under part B of title XVIII; or
(8) with respect to any amount expended for medical
assistance (A) for nursing facility services to
reimburse (or otherwise compensate) a nursing facility
for payment of a civil money penalty imposed under
section 1919(h) or (B) for home and community care to
reimburse (or otherwise compensate) a provider of such
care for payment of a civil money penalty imposed under
this title or title XI or for legal expenses in defense
of an exclusion or civil money penalty under this title
or title XI if there is no reasonable legal ground for
the provider's case; or
(10)(A) with respect to covered outpatient drugs
unless there is a rebate agreement in effect under
section 1927 with respect to such drugs or unless
section 1927(a)(3) applies,
(B) with respect to any amount expended for an
innovator multiple source drug (as defined in section
1927(k)) dispensed on or after July 1, 1991, if, under
applicable State law, a less expensive multiple source
drug could have been dispensed, but only to the extent
that such amount exceeds the upper payment limit for
such multiple source drug;
(C) with respect to covered outpatient drugs
described in section 1927(a)(7), unless
information respecting utilization data and
coding on such drugs that is required to be
submitted under such section is submitted in
accordance with such section, and
(D) with respect to any amount expended for
reimbursement to a pharmacy under this title for the
ingredient cost of a covered outpatient drug for which
the pharmacy has already received payment under this
title (other than with respect to a reasonable
restocking fee for such drug); or
(11) with respect to any amount expended for
physicians' services furnished on or after the first
day of the first quarter beginning more than 60 days
after the date of establishment of the physician
identifier system under section 1902(x), unless the
claim for the services includes the unique physician
identifier provided under such system; or
(13) with respect to any amount expended to reimburse
(or otherwise compensate) a nursing facility for
payment of legal expenses associated with any action
initiated by the facility that is dismissed on the
basis that no reasonable legal ground existed for the
institution of such action; or
(14) with respect to any amount expended on
administrative costs to carry out the program under
section 1928; or
(15) with respect to any amount expended for a
single-antigen vaccine and its administration in any
case in which the administration of a combined-antigen
vaccine was medically appropriate (as determined by the
Secretary); or
(16) with respect to any amount expended for which
funds may not be used under the Assisted Suicide
Funding Restriction Act of 1997; or
(17) with respect to any amount expended for roads,
bridges, stadiums, or any other item or service not
covered under a State plan under this title; or
(18) with respect to any amount expended for home
health care services provided by an agency or
organization unless the agency or organization provides
the State agency on a continuing basis a surety bond in
a form specified by the Secretary under paragraph (7)
of section 1861(o) and in an amount that is not less
than $50,000 or such comparable surety bond as the
Secretary may permit under the last sentence of such
section; or
(19) with respect to any amount expended on
administrative costs to initiate or pursue litigation
described in subsection (d)(3)(B);
(20) with respect to amounts expended for medical
assistance provided to an individual described in
subclause (XV) or (XVI) of section 1902(a)(10)(A)(ii)
for a fiscal year unless the State demonstrates to the
satisfaction of the Secretary that the level of State
funds expended for such fiscal year for programs to
enable working individuals with disabilities to work
(other than for such medical assistance) is not less
than the level expended for such programs during the
most recent State fiscal year ending before the date of
the enactment of this paragraph;
(21) with respect to amounts expended for covered
outpatient drugs described in section 1927(d)(2)(K)
(relating to drugs when used for treatment of sexual or
erectile dysfunction);
(22) with respect to amounts expended for medical
assistance for an individual who declares under section
1137(d)(1)(A) to be a citizen or national of the United
States for purposes of establishing eligibility for
benefits under this title, unless the requirement of
section 1902(a)(46)(B) is met;
(23) with respect to amounts expended for medical
assistance for covered outpatient drugs (as defined in
section 1927(k)(2)) for which the prescription was
executed in written (and non-electronic) form unless
the prescription was executed on a tamper-resistant
pad;
(24) if a State is required to implement an asset
verification program under section 1940 and fails to
implement such program in accordance with such section,
with respect to amounts expended by such State for
medical assistance for individuals subject to asset
verification under such section, unless--
(A) the State demonstrates to the Secretary's
satisfaction that the State made a good faith
effort to comply;
(B) not later than 60 days after the date of
a finding that the State is in noncompliance,
the State submits to the Secretary (and the
Secretary approves) a corrective action plan to
remedy such noncompliance; and
(C) not later than 12 months after the date
of such submission (and approval), the State
fulfills the terms of such corrective action
plan;
(25) with respect to any amounts expended for medical
assistance for individuals for whom the State does not
report enrollee encounter data (as defined by the
Secretary) to the Medicaid Statistical Information
System (MSIS) in a timely manner (as determined by the
Secretary);
(26) with respect to any amounts expended for medical
assistance for individuals described in subclause
(VIII) of subsection (a)(10)(A)(i) other than medical
assistance provided through benchmark coverage
described in section 1937(b)(1) or benchmark equivalent
coverage described in section 1937(b)(2); or
(27) with respect to any amounts expended by the
State on the basis of a fee schedule for items
described in section 1861(n) and furnished on or after
January 1, 2019, as determined in the aggregate with
respect to each class of such items as defined by the
Secretary, in excess of the aggregate amount, if any,
that would be paid for such items within such class on
a fee-for-service basis under the program under part B
of title XVIII, including, as applicable, under a
competitive acquisition program under section 1847 in
an area of the State.
Nothing in paragraph (1) shall be construed as permitting a
State to provide services under its plan under this title that
are not reasonable in amount, duration, and scope to achieve
their purpose. Paragraphs (1), (2), (16), (17), and (18) shall
apply with respect to items or services furnished and amounts
expended by or through a managed care entity (as defined in
section 1932(a)(1)(B)) in the same manner as such paragraphs
apply to items or services furnished and amounts expended
directly by the State.
(j) Notwithstanding the preceding provisions of this section,
the amount determined under subsection (a)(1) for any State for
any quarter shall be adjusted in accordance with section 1914.
(k) The Secretary is authorized to provide at the request of
any State (and without cost to such State) such technical and
actuarial assistance as may be necessary to assist such State
to contract with any medicaid managed care organization which
meets the requirements of subsection (m) of this section for
the purpose of providing medical care and services to
individuals who are entitled to medical assistance under this
title.
(l)(1) Subject to paragraphs (3) and (4), with respect to any
amount expended for personal care services or home health care
services requiring an in-home visit by a provider that are
provided under a State plan under this title (or under a waiver
of the plan) and furnished in a calendar quarter beginning on
or after January 1, 2019 (or, in the case of home health care
services, on or after January 1, 2023), unless a State requires
the use of an electronic visit verification system for such
services furnished in such quarter under the plan or such
waiver, the Federal medical assistance percentage shall be
reduced--
(A) in the case of personal care services--
(i) for calendar quarters in 2019 and 2020,
by .25 percentage points;
(ii) for calendar quarters in 2021, by .5
percentage points;
(iii) for calendar quarters in 2022, by .75
percentage points; and
(iv) for calendar quarters in 2023 and each
year thereafter, by 1 percentage point; and
(B) in the case of home health care services--
(i) for calendar quarters in 2023 and 2024,
by .25 percentage points;
(ii) for calendar quarters in 2025, by .5
percentage points;
(iii) for calendar quarters in 2026, by .75
percentage points; and
(iv) for calendar quarters in 2027 and each
year thereafter, by 1 percentage point.
(2) Subject to paragraphs (3) and (4), in implementing the
requirement for the use of an electronic visit verification
system under paragraph (1), a State shall--
(A) consult with agencies and entities that provide
personal care services, home health care services, or
both under the State plan (or under a waiver of the
plan) to ensure that such system--
(i) is minimally burdensome;
(ii) takes into account existing best
practices and electronic visit verification
systems in use in the State; and
(iii) is conducted in accordance with the
requirements of HIPAA privacy and security law
(as defined in section 3009 of the Public
Health Service Act);
(B) take into account a stakeholder process that
includes input from beneficiaries, family caregivers,
personal care or home health care services workers, and
other stakeholders, as determined by the State in
accordance with guidance from the Secretary; and
(C) ensure that individuals who furnish personal care
services, home health care services, or both under the
State plan (or under a waiver of the plan) are provided
the opportunity for training on the use of such system.
(3) Paragraphs (1) and (2) shall not apply in the case of a
State that, as of the date of the enactment of this subsection,
requires the use of any system for the electronic verification
of visits conducted as part of both personal care services and
home health care services.
(4)(A) In the case of a State described in subparagraph (B),
the reduction under paragraph (1) shall not apply--
(i) in the case of personal care services, for
calendar quarters in 2019; and
(ii) in the case of home health care services, for
calendar quarters in 2023.
(B) For purposes of subparagraph (A), a State described in
this subparagraph is a State that demonstrates to the Secretary
that the State--
(i) has made a good faith effort to comply with the
requirements of paragraphs (1) and (2) (including by
taking steps to adopt the technology used for an
electronic visit verification system); or
(ii) in implementing such a system, has encountered
unavoidable system delays.
(5) In this subsection:
(A) The term ``electronic visit verification system''
means, with respect to personal care services or home
health care services, a system under which visits
conducted as part of such services are electronically
verified with respect to--
(i) the type of service performed;
(ii) the individual receiving the service;
(iii) the date of the service;
(iv) the location of service delivery;
(v) the individual providing the service; and
(vi) the time the service begins and ends.
(B) The term ``home health care services'' means
services described in section 1905(a)(7) provided under
a State plan under this title (or under a waiver of the
plan).
(C) The term ``personal care services'' means
personal care services provided under a State plan
under this title (or under a waiver of the plan),
including services provided under section 1905(a)(24),
1915(c), 1915(i), 1915(j), or 1915(k) or under a wavier
under section 1115.
(6)(A) In the case in which a State requires personal care
service and home health care service providers to utilize an
electronic visit verification system operated by the State or a
contractor on behalf of the State, the Secretary shall pay to
the State, for each quarter, an amount equal to 90 per centum
of so much of the sums expended during such quarter as are
attributable to the design, development, or installation of
such system, and 75 per centum of so much of the sums for the
operation and maintenance of such system.
(B) Subparagraph (A) shall not apply in the case in which a
State requires personal care service and home health care
service providers to utilize an electronic visit verification
system that is not operated by the State or a contractor on
behalf of the State.
(m)(1)(A) The term ``medicaid managed care organization''
means a health maintenance organization, an eligible
organization with a contract under section 1876 or a
Medicare+Choice organization with a contract under part C of
title XVIII, a provider sponsored organization, or any other
public or private organization, which meets the requirement of
section 1902(w) and--
(i) makes services it provides to individuals
eligible for benefits under this title accessible to
such individuals, within the area served by the
organization, to the same extent as such services are
made accessible to individuals (eligible for medical
assistance under the State plan) not enrolled with the
organization, and
(ii) has made adequate provision against the risk of
insolvency, which provision is satisfactory to the
State, meets the requirements of subparagraph (C)(i)
(if applicable), and which assures that individuals
eligible for benefits under this title are in no case
held liable for debts of the organization in case of
the organization's insolvency.
An organization that is a qualified health maintenance
organization (as defined in section 1310(d) of the Public
Health Service Act) is deemed to meet the requirements of
clauses (i) and (ii).
(B) The duties and functions of the Secretary, insofar as
they involve making determinations as to whether an
organization is a medicaid managed care organization within the
meaning of subparagraph (A), shall be integrated with the
administration of section 1312 (a) and (b) of the Public Health
Service Act.
(C)(i) Subject to clause (ii), a provision meets the
requirements of this subparagraph for an organization if the
organization meets solvency standards established by the State
for private health maintenance organizations or is licensed or
certified by the State as a risk-bearing entity.
(ii) Clause (i) shall not apply to an organization if--
(I) the organization is not responsible for the
provision (directly or through arrangements with
providers of services) of inpatient hospital services
and physicians' services;
(II) the organization is a public entity;
(III) the solvency of the organization is guaranteed
by the State; or
(IV) the organization is (or is controlled by) one or
more Federally-qualified health centers and meets
solvency standards established by the State for such an
organization.
For purposes of subclause (IV), the term ``control'' means the
possession, whether direct or indirect, of the power to direct
or cause the direction of the management and policies of the
organization through membership, board representation, or an
ownership interest equal to or greater than 50.1 percent.
(2)(A) Except as provided in subparagraphs (B), (C), and (G),
no payment shall be made under this title to a State with
respect to expenditures incurred by it for payment (determined
under a prepaid capitation basis or under any other risk basis)
for services provided by any entity (including a health
insuring organization) which is responsible for the provision
(directly or through arrangements with providers of services)
of inpatient hospital services and any other service described
in paragraph (2), (3), (4), (5), or (7) of section 1905(a) or
for the provision of any three or more of the services
described in such paragraphs unless--
(i) the Secretary has determined that the entity is a
medicaid managed care organization organization as
defined in paragraph (1);
(iii) such services are provided for the benefit of
individuals eligible for benefits under this title in
accordance with a contract between the State and the
entity under which prepaid payments to the entity are
made on an actuarially sound basis and under which the
Secretary must provide prior approval for contracts
providing for expenditures in excess of $1,000,000 for
1998 and, for a subsequent year, the amount established
under this clause for the previous year increased by
the percentage increase in the consumer price index for
all urban consumers over the previous year;
(iv) such contract provides that the Secretary and
the State (or any person or organization designated by
either) shall have the right to audit and inspect any
books and records of the entity (and of any
subcontractor) that pertain (I) to the ability of the
entity to bear the risk of potential financial losses,
or (II) to services performed or determinations of
amounts payable under the contract;
(v) such contract provides that in the entity's
enrollment, reenrollment, or disenrollment of
individuals who are eligible for benefits under this
title and eligible to enroll, reenroll, or disenroll
with the entity pursuant to the contract, the entity
will not discriminate among such individuals on the
basis of their health status or requirements for health
care services;
(vi) such contract (I) permits individuals who have
elected under the plan to enroll with the entity for
provision of such benefits to terminate such enrollment
in accordance with section 1932(a)(4), and (II)
provides for notification in accordance with such
section of each such individual, at the time of the
individual's enrollment, of such right to terminate
such enrollment;
(vii) such contract provides that, in the case of
medically necessary services which were provided (I) to
an individual enrolled with the entity under the
contract and entitled to benefits with respect to such
services under the State's plan and (II) other than
through the organization because the services were
immediately required due to an unforeseen illness,
injury, or condition, either the entity or the State
provides for reimbursement with respect to those
services,
(viii) such contract provides for disclosure of
information in accordance with section 1124 and
paragraph (4) of this subsection;
(ix) such contract provides, in the case of an entity
that has entered into a contract for the provision of
services with a Federally-qualified health center or a
rural health clinic, that the entity shall provide
payment that is not less than the level and amount of
payment which the entity would make for the services if
the services were furnished by a provider which is not
a Federally-qualified health center or a rural health
clinic;
(x) any physician incentive plan that it operates
meets the requirements described in section 1876(i)(8);
(xi) such contract provides for maintenance of
sufficient patient encounter data to identify the
physician who delivers services to patients and for the
provision of such data to the State at a frequency and
level of detail to be specified by the Secretary;
(xii) such contract, and the entity complies with the
applicable requirements of section 1932; and
(xiii) such contract provides that (I)
covered outpatient drugs dispensed to
individuals eligible for medical assistance who
are enrolled with the entity shall be subject
to the same rebate required by the agreement
entered into under section 1927 as the State is
subject to and that the State shall collect
such rebates from manufacturers, (II)
capitation rates paid to the entity shall be
based on actual cost experience related to
rebates and subject to the Federal regulations
requiring actuarially sound rates, and (III)
the entity shall report to the State, on such
timely and periodic basis as specified by the
Secretary in order to include in the
information submitted by the State to a
manufacturer and the Secretary under section
1927(b)(2)(A), information on the total number
of units of each dosage form and strength and
package size by National Drug Code of each
covered outpatient drug dispensed to
individuals eligible for medical assistance who
are enrolled with the entity and for which the
entity is responsible for coverage of such drug
under this subsection (other than covered
outpatient drugs that under subsection (j)(1)
of section 1927 are not subject to the
requirements of that section) and such other
data as the Secretary determines necessary to
carry out this subsection.
(B) Subparagraph (A) except with respect to clause (ix) of
subparagraph (A), does not apply with respect to payments under
this title to a State with respect to expenditures incurred by
it for payment for services provided by an entity which--
(i)(I) received a grant of at least $100,000 in the
fiscal year ending June 30, 1976, under section
329(d)(1)(A) or 330(d)(1) of the Public Health Service
Act, and for the period beginning July 1, 1976, and
ending on the expiration of the period for which
payments are to be made under this title has been the
recipient of a grant under either such section; and
(II) provides to its enrollees, on a prepaid
capitation risk basis or on any other risk basis, all
of the services and benefits described in paragraphs
(1), (2), (3), (4)(C), and (5) of section 1905(a) and,
to the extent required by section 1902(a)(10)(D) to be
provided under a State plan for medical assistance, the
services and benefits described in paragraph (7) of
section 1905(a); or
(ii) is a nonprofit primary health care entity
located in a rural area (as defined by the Appalachian
Regional Commission)--
(I) which received in the fiscal year ending
June 30, 1976, at least $100,000 (by grant,
subgrant, or subcontract) under the Appalachian
Regional Development Act of 1965, and
(II) for the period beginning July 1, 1976,
and ending on the expiration of the period for
which payments are to be made under this title
either has been the recipient of a grant,
subgrant, or subcontract under such Act or has
provided services under a contract (initially
entered into during a year in which the entity
was the recipient of such a grant, subgrant, or
subcontract) with a State agency under this
title on a prepaid capitation risk basis or on
any other risk basis; or
(iii) which has contracted with the single State
agency for the provision of services (but not including
inpatient hospital services) to persons eligible under
this title on a prepaid risk basis prior to 1970.
(G) In the case of an entity which is receiving (and has
received during the previous two years) a grant of at least
$100,000 under section 329(d)(1)(A) or 330(d)(1) of the Public
Health Service Act or is receiving (and has received during the
previous two years) at least $100,000 (by grant, subgrant, or
subcontract) under the Appalachian Regional Development Act of
1965, clause (i) of subparagraph (A) shall not apply.
(H) In the case of an individual who--
(i) in a month is eligible for benefits under this
title and enrolled with a medicaid managed care
organization with a contract under this paragraph or
with a primary care case manager with a contract
described in section 1905(t)(3),
(ii) in the next month (or in the next 2 months) is
not eligible for such benefits, but
(iii) in the succeeding month is again eligible for
such benefits,
the State plan, subject to subparagraph (A)(vi), may enroll the
individual for that succeeding month with the organization
described in clause (i) if the organization continues to have a
contract under this paragraph with the State or with the
manager described in such clause if the manager continues to
have a contract described in section 1905(t)(3) with the State.
(I)(i) Notwithstanding the limitation specified in the
subdivision (B) following paragraph (29) of section 1905(a) and
subject to clause (ii), a State may, under a risk contract
entered into by the State under this title (or under section
1115) with a medicaid managed care organization or a prepaid
inpatient health plan (as defined in section 438.2 of title 42,
Code of Federal Regulations (or any successor regulation)),
make a monthly capitation payment to such organization or plan
for enrollees with the organization or plan who are over 21
years of age and under 65 years of age and are receiving
inpatient treatment in an institution for mental diseases (as
defined in section 1905(i)), so long as each of the following
conditions is met:
(I) The institution is a hospital providing inpatient
psychiatric or substance use disorder services or a
sub-acute facility providing psychiatric or substance
use disorder crisis residential services.
(II) The length of stay in such an institution for
such treatment is for a short-term stay of no more than
15 days during the period of the monthly capitation
payment.
(III) The provision of such treatment meets the
following criteria for consideration as services or
settings that are in lieu of services or settings
covered under the State plan:
(aa) The State determines that the
alternative service or setting is a medically
appropriate and cost-effective substitute for
the covered service or setting under the State
plan.
(bb) The enrollee is not required by the
managed care organization or prepaid inpatient
health plan to use the alternative service or
setting.
(cc) Such treatment is authorized and
identified in such contract, and will be
offered to such enrollees at the option of the
managed care organization or prepaid inpatient
health plan.
(ii) For purposes of setting the amount of such a monthly
capitation payment, a State may use the utilization of services
provided to an individual under this subparagraph when
developing the inpatient psychiatric or substance use disorder
component of such payment, but the amount of such payment for
such services may not exceed the cost of the same services
furnished through providers included under the State plan.
(4)(A) Each medicaid managed care organization which is not a
qualified health maintenance organization (as defined in
section 1310(d) of the Public Health Service Act) must report
to the State and, upon request, to the Secretary, the Inspector
General of the Department of Health and Human Services, and the
Comptroller General a description of transactions between the
organization and a party in interest (as defined in section
1318(b) of such Act), including the following transactions:
(i) Any sale or exchange, or leasing of any property
between the organization and such a party.
(ii) Any furnishing for consideration of goods,
services (including management services), or facilities
between the organization and such a party, but not
including salaries paid to employees for services
provided in the normal course of their employment.
(iii) Any lending of money or other extension of
credit between the organization and such a party.
The State or Secretary may require that information reported
respecting an organization which controls, or is controlled by,
or is under common control with, another entity be in the form
of a consolidated financial statement for the organization and
such entity.
(B) Each organization shall make the information reported
pursuant to subparagraph (A) available to its enrollees upon
reasonable request.
(5)(A) If the Secretary determines that an entity with a
contract under this subsection--
(i) fails substantially to provide medically
necessary items and services that are required (under
law or under the contract) to be provided to an
individual covered under the contract, if the failure
has adversely affected (or has substantial likelihood
of adversely affecting) the individual;
(ii) imposes premiums on individuals enrolled under
this subsection in excess of the premiums permitted
under this title;
(iii) acts to discriminate among individuals in
violation of the provision of paragraph (2)(A)(v),
including expulsion or refusal to re-enroll an
individual or engaging in any practice that would
reasonably be expected to have the effect of denying or
discouraging enrollment (except as permitted by this
subsection) by eligible individuals with the
organization whose medical condition or history
indicates a need for substantial future medical
services;
(iv) misrepresents or falsifies information that is
furnished--
(I) to the Secretary or the State under this
subsection, or
(II) to an individual or to any other entity
under this subsection, or
(v) fails to comply with the requirements of section
1876(i)(8),
the Secretary may provide, in addition to any other remedies
available under law, for any of the remedies described in
subparagraph (B).
(B) The remedies described in this subparagraph are--
(i) civil money penalties of not more than $25,000
for each determination under subparagraph (A), or, with
respect to a determination under clause (iii) or
(iv)(I) of such subparagraph, of not more than $100,000
for each such determination, plus, with respect to a
determination under subparagraph (A)(ii), double the
excess amount charged in violation of such subparagraph
(and the excess amount charged shall be deducted from
the penalty and returned to the individual concerned),
and plus, with respect to a determination under
subparagraph (A)(iii), $15,000 for each individual not
enrolled as a result of a practice described in such
subparagraph, or
(ii) denial of payment to the State for medical
assistance furnished under the contract under this
subsection for individuals enrolled after the date the
Secretary notifies the organization of a determination
under subparagraph (A) and until the Secretary is
satisfied that the basis for such determination has
been corrected and is not likely to recur.
The provisions of section 1128A (other than subsections (a) and
(b)) shall apply to a civil money penalty under clause (i) in
the same manner as such provisions apply to a penalty or
proceeding under section 1128A(a).
(6)(A) For purposes of this subsection and section
1902(e)(2)(A), in the case of the State of New Jersey, the term
``contract'' shall be deemed to include an undertaking by the
State agency, in the State plan under this title, to operate a
program meeting all requirements of this subsection.
(B) The undertaking described in subparagraph (A) must
provide--
(i) for the establishment of a separate entity
responsible for the operation of a program meeting the
requirements of this subsection, which entity may be a
subdivision of the State agency administering the State
plan under this title;
(ii) for separate accounting for the funds used to
operate such program; and
(iii) for setting the capitation rates and any other
payment rates for services provided in accordance with
this subsection using a methodology satisfactory to the
Secretary designed to ensure that total Federal
matching payments under this title for such services
will be lower than the matching payments that would be
made for the same services, if provided under the State
plan on a fee for service basis to an actuarially
equivalent population.
(C) The undertaking described in subparagraph (A) shall be
subject to approval (and annual re-approval) by the Secretary
in the same manner as a contract under this subsection.
(D) The undertaking described in subparagraph (A) shall not
be eligible for a waiver under section 1915(b).
(o) Notwithstanding the preceding provisions of this section,
no payment shall be made to a State under the preceding
provisions of this section for expenditures for medical
assistance provided for an individual under its State plan
approved under this title to the extent that a private insurer
(as defined by the Secretary by regulation and including a
group health plan (as defined in section 607(1) of the Employee
Retirement Income Security Act of 1974), a service benefit
plan, and a health maintenance organization) would have been
obligated to provide such assistance but for a provision of its
insurance contract which has the effect of limiting or
excluding such obligation because the individual is eligible
for or is provided medical assistance under the plan.
(p)(1) When a political subdivision of a State makes, for the
State of which it is a political subdivision, or one State
makes, for another State, the enforcement and collection of
rights of support or payment assigned under section 1912,
pursuant to a cooperative arrangement under such section
(either within or outside of such State), there shall be paid
to such political subdivision or such other State from amounts
which would otherwise represent the Federal share of payments
for medical assistance provided to the eligible individuals on
whose behalf such enforcement and collection was made, an
amount equal to 15 percent of any amount collected which is
attributable to such rights of support or payment.
(2) Where more than one jurisdiction is involved in such
enforcement or collection, the amount of the incentive payment
determined under paragraph (1) shall be allocated among the
jurisdictions in a manner to be prescribed by the Secretary.
(q) For the purposes of this section, the term ``State
medicaid fraud control unit'' means a single identifiable
entity of the State government which the Secretary certifies
(and annually recertifies) as meeting the following
requirements:
(1) The entity (A) is a unit of the office of the
State Attorney General or of another department of
State government which possesses statewide authority to
prosecute individuals for criminal violations, (B) is
in a State the constitution of which does not provide
for the criminal prosecution of individuals by a
statewide authority and has formal procedures, approved
by the Secretary, that (i) assure its referral of
suspected criminal violations relating to the program
under this title to the appropriate authority or
authorities in the State for prosecution and (ii)
assure its assistance of, and coordination with, such
authority or authorities in such prosecutions, or (C)
has a formal working relationship with the office of
the State Attorney General and has formal procedures
(including procedures for its referral of suspected
criminal violations to such office) which are approved
by the Secretary and which provide effective
coordination of activities between the entity and such
office with respect to the detection, investigation,
and prosecution of suspected criminal violations
relating to the program under this title.
(2) The entity is separate and distinct from the
single State agency that administers or supervises the
administration of the State plan under this title.
(3) The entity's function is conducting a statewide
program for the investigation and prosecution of
violations of all applicable State laws regarding any
and all aspects of fraud in connection with (A) any
aspect of the provision of medical assistance and the
activities of providers of such assistance under the
State plan under this title; and (B) upon the approval
of the Inspector General of the relevant Federal
agency, any aspect of the provision of health care
services and activities of providers of such services
under any Federal health care program (as defined in
section 1128B(f)(1)), if the suspected fraud or
violation of law in such case or investigation is
primarily related to the State plan under this title.
(4)(A) The entity has--
(i) procedures for reviewing complaints of
abuse or neglect of patients in health care
facilities which receive payments under the
State plan under this title;
(ii) at the option of the entity, procedures
for reviewing complaints of abuse or neglect of
patients residing in board and care facilities;
and
(iii) procedures for acting upon such
complaints under the criminal laws of the State
or for referring such complaints to other State
agencies for action.
(B) For purposes of this paragraph, the term ``board
and care facility'' means a residential setting which
receives payment (regardless of whether such payment is
made under the State plan under this title) from or on
behalf of two or more unrelated adults who reside in
such facility, and for whom one or both of the
following is provided:
(i) Nursing care services provided by, or
under the supervision of, a registered nurse,
licensed practical nurse, or licensed nursing
assistant.
(ii) A substantial amount of personal care
services that assist residents with the
activities of daily living, including personal
hygiene, dressing, bathing, eating, toileting,
ambulation, transfer, positioning, self-
medication, body care, travel to medical
services, essential shopping, meal preparation,
laundry, and housework.
(5) The entity provides for the collection, or
referral for collection to a single State agency, of
overpayments that are made under the State plan or
under any Federal health care program (as so defined)
to health care facilities and that are discovered by
the entity in carrying out its activities. All funds
collected in accordance with this paragraph shall be
credited exclusively to, and available for expenditure
under, the Federal health care program (including the
State plan under this title) that was subject to the
activity that was the basis for the collection.
(6) The entity employs such auditors, attorneys,
investigators, and other necessary personnel and is
organized in such a manner as is necessary to promote
the effective and efficient conduct of the entity's
activities.
(7) The entity submits to the Secretary an
application and annual reports containing such
information as the Secretary determines, by regulation,
to be necessary to determine whether the entity meets
the other requirements of this subsection.
(r)(1) In order to receive payments under subsection (a) for
use of automated data systems in administration of the State
plan under this title, a State must, in addition to meeting the
requirements of paragraph (3), have in operation mechanized
claims processing and information retrieval systems that meet
the requirements of this subsection and that the Secretary has
found--
(A) are adequate to provide efficient, economical,
and effective administration of such State plan;
(B) are compatible with the claims processing and
information retrieval systems used in the
administration of title XVIII, and for this purpose--
(i) have a uniform identification coding
system for providers, other payees, and
beneficiaries under this title or title XVIII;
(ii) provide liaison between States and
carriers and intermediaries with agreements
under title XVIII to facilitate timely exchange
of appropriate data;
(iii) provide for exchange of data between
the States and the Secretary with respect to
persons sanctioned under this title or title
XVIII; and
(iv) effective for claims filed on or after
October 1, 2010, incorporate compatible
methodologies of the National Correct Coding
Initiative administered by the Secretary (or
any successor initiative to promote correct
coding and to control improper coding leading
to inappropriate payment) and such other
methodologies of that Initiative (or such other
national correct coding methodologies) as the
Secretary identifies in accordance with
paragraph (4);
(C) are capable of providing accurate and timely
data;
(D) are complying with the applicable provisions of
part C of title XI;
(E) are designed to receive provider claims in
standard formats to the extent specified by the
Secretary; and
(F) effective for claims filed on or after January 1,
1999, provide for electronic transmission of claims
data in the format specified by the Secretary and
consistent with the Medicaid Statistical Information
System (MSIS) (including detailed individual enrollee
encounter data and other information that the Secretary
may find necessary and including, for data submitted to
the Secretary on or after January 1, 2010, data
elements from the automated data system that the
Secretary determines to be necessary for program
integrity, program oversight, and administration, at
such frequency as the Secretary shall determine).
(2) In order to meet the requirements of this paragraph,
mechanized claims processing and information retrieval systems
must meet the following requirements:
(A) The systems must be capable of developing
provider, physician, and patient profiles which are
sufficient to provide specific information as to the
use of covered types of services and items, including
prescribed drugs.
(B) The State must provide that information on
probable fraud or abuse which is obtained from, or
developed by, the systems, is made available to the
State's medicaid fraud control unit (if any) certified
under subsection (q) of this section.
(C) The systems must meet all performance standards
and other requirements for initial approval developed
by the Secretary.
(3) In order to meet the requirements of this paragraph, a
State must have in operation an eligibility determination
system which provides for data matching through the Public
Assistance Reporting Information System (PARIS) facilitated by
the Secretary (or any successor system), including matching
with medical assistance programs operated by other States.
(4) For purposes of paragraph (1)(B)(iv), the Secretary shall
do the following:
(A) Not later than September 1, 2010:
(i) Identify those methodologies of the
National Correct Coding Initiative administered
by the Secretary (or any successor initiative
to promote correct coding and to control
improper coding leading to inappropriate
payment) which are compatible to claims filed
under this title.
(ii) Identify those methodologies of such
Initiative (or such other national correct
coding methodologies) that should be
incorporated into claims filed under this title
with respect to items or services for which
States provide medical assistance under this
title and no national correct coding
methodologies have been established under such
Initiative with respect to title XVIII.
(iii) Notify States of--
(I) the methodologies identified
under subparagraphs (A) and (B) (and of
any other national correct coding
methodologies identified under
subparagraph (B)); and
(II) how States are to incorporate
such methodologies into claims filed
under this title.
(B) Not later than March 1, 2011, submit a report to
Congress that includes the notice to States under
clause (iii) of subparagraph (A) and an analysis
supporting the identification of the methodologies made
under clauses (i) and (ii) of subparagraph (A).
(s) Notwithstanding the preceding provisions of this section,
no payment shall be made to a State under this section for
expenditures for medical assistance under the State plan
consisting of a designated health service (as defined in
subsection (h)(6) of section 1877) furnished to an individual
on the basis of a referral that would result in the denial of
payment for the service under title XVIII if such title
provided for coverage of such service to the same extent and
under the same terms and conditions as under the State plan,
and subsections (f) and (g)(5) of such section shall apply to a
provider of such a designated health service for which payment
may be made under this title in the same manner as such
subsections apply to a provider of such a service for which
payment may be made under such title.
(t)(1) For purposes of subsection (a)(3)(F), the payments
described in this paragraph to encourage the adoption and use
of certified EHR technology are payments made by the State in
accordance with this subsection --
(A) to Medicaid providers described in paragraph
(2)(A) not in excess of 85 percent of net average
allowable costs (as defined in paragraph (3)(E)) for
certified EHR technology (and support services
including maintenance and training that is for, or is
necessary for the adoption and operation of, such
technology) with respect to such providers; and
(B) to Medicaid providers described in paragraph
(2)(B) not in excess of the maximum amount permitted
under paragraph (5) for the provider involved.
(2) In this subsection and subsection (a)(3)(F), the term
``Medicaid provider'' means--
(A) an eligible professional (as defined in paragraph
(3)(B))--
(i) who is not hospital-based and has at
least 30 percent of the professional's patient
volume (as estimated in accordance with a
methodology established by the Secretary)
attributable to individuals who are receiving
medical assistance under this title;
(ii) who is not described in clause (i), who
is a pediatrician, who is not hospital-based,
and who has at least 20 percent of the
professional's patient volume (as estimated in
accordance with a methodology established by
the Secretary) attributable to individuals who
are receiving medical assistance under this
title; and
(iii) who practices predominantly in a
Federally qualified health center or rural
health clinic and has at least 30 percent of
the professional's patient volume (as estimated
in accordance with a methodology established by
the Secretary) attributable to needy
individuals (as defined in paragraph (3)(F));
and
(B)(i) a children's hospital, or
(ii) an acute-care hospital that is not described in
clause (i) and that has at least 10 percent of the
hospital's patient volume (as estimated in accordance
with a methodology established by the Secretary)
attributable to individuals who are receiving medical
assistance under this title.
An eligible professional shall not qualify as a Medicaid
provider under this subsection unless any right to payment
under sections 1848(o) and 1853(l) with respect to the eligible
professional has been waived in a manner specified by the
Secretary. For purposes of calculating patient volume under
subparagraph (A)(iii), insofar as it is related to
uncompensated care, the Secretary may require the adjustment of
such uncompensated care data so that it would be an appropriate
proxy for charity care, including a downward adjustment to
eliminate bad debt data from uncompensated care. In applying
subparagraphs (A) and (B)(ii), the methodology established by
the Secretary for patient volume shall include individuals
enrolled in a Medicaid managed care plan (under section 1903(m)
or section 1932).
(3) In this subsection and subsection (a)(3)(F):
(A) The term ``certified EHR technology'' means a
qualified electronic health record (as defined in
3000(13) of the Public Health Service Act) that is
certified pursuant to section 3001(c)(5) of such Act as
meeting standards adopted under section 3004 of such
Act that are applicable to the type of record involved
(as determined by the Secretary, such as an ambulatory
electronic health record for office-based physicians or
an inpatient hospital electronic health record for
hospitals).
(B) The term ``eligible professional'' means a--
(i) physician;
(ii) dentist;
(iii) certified nurse mid-wife;
(iv) nurse practitioner; and
(v) physician assistant insofar as the
assistant is practicing in a rural health
clinic that is led by a physician assistant or
is practicing in a Federally qualified health
center that is so led.
(C) The term ``average allowable costs'' means, with
respect to certified EHR technology of Medicaid
providers described in paragraph (2)(A) for--
(i) the first year of payment with respect to
such a provider, the average costs for the
purchase and initial implementation or upgrade
of such technology (and support services
including training that is for, or is necessary
for the adoption and initial operation of, such
technology) for such providers, as determined
by the Secretary based upon studies conducted
under paragraph (4)(C); and
(ii) a subsequent year of payment with
respect to such a provider, the average costs
not described in clause (i) relating to the
operation, maintenance, and use of such
technology for such providers, as determined by
the Secretary based upon studies conducted
under paragraph (4)(C).
(D) The term ``hospital-based'' means, with respect
to an eligible professional, a professional (such as a
pathologist, anesthesiologist, or emergency physician)
who furnishes substantially all of the individual's
professional services in a hospital inpatient or
emergency room setting and through the use of the
facilities and equipment, including qualified
electronic health records, of the hospital. The
determination of whether an eligible professional is a
hospital-based eligible professional shall be made on
the basis of the site of service (as defined by the
Secretary) and without regard to any employment or
billing arrangement between the eligible professional
and any other provider.
(E) The term ``net average allowable costs'' means,
with respect to a Medicaid provider described in
paragraph (2)(A), average allowable costs reduced by
the average payment the Secretary estimates will be
made to such Medicaid providers (determined on a
percentage or other basis for such classes or types of
providers as the Secretary may specify) from other
sources (other than under this subsection, or by the
Federal government or a State or local government) that
is directly attributable to payment for certified EHR
technology or support services described in
subparagraph (C).
(F) The term ``needy individual'' means, with respect
to a Medicaid provider, an individual--
(i) who is receiving assistance under this
title;
(ii) who is receiving assistance under title
XXI;
(iii) who is furnished uncompensated care by
the provider; or
(iv) for whom charges are reduced by the
provider on a sliding scale basis based on an
individual's ability to pay.
(4)(A) With respect to a Medicaid provider described in
paragraph (2)(A), subject to subparagraph (B), in no case
shall--
(i) the net average allowable costs under
this subsection for the first year of payment
(which may not be later than 2016), which is
intended to cover the costs described in
paragraph (3)(C)(i), exceed $25,000 (or such
lesser amount as the Secretary determines based
on studies conducted under subparagraph (C));
(ii) the net average allowable costs under
this subsection for a subsequent year of
payment, which is intended to cover costs
described in paragraph (3)(C)(ii), exceed
$10,000; and
(iii) payments be made for costs described in
clause (ii) after 2021 or over a period of
longer than 5 years.
(B) In the case of Medicaid provider described in paragraph
(2)(A)(ii), the dollar amounts specified in subparagraph (A)
shall be \2/3\ of the dollar amounts otherwise specified.
(C) For the purposes of determining average allowable costs
under this subsection, the Secretary shall study the average
costs to Medicaid providers described in paragraph (2)(A) of
purchase and initial implementation and upgrade of certified
EHR technology described in paragraph (3)(C)(i) and the average
costs to such providers of operations, maintenance, and use of
such technology described in paragraph (3)(C)(ii). In
determining such costs for such providers, the Secretary may
utilize studies of such amounts submitted by States.
(5)(A) In no case shall the payments described in paragraph
(1)(B) with respect to a Medicaid provider described in
paragraph (2)(B) exceed--
(i) in the aggregate the product of--
(I) the overall hospital EHR amount
for the provider computed under
subparagraph (B); and
(II) the Medicaid share for such
provider computed under subparagraph
(C);
(ii) in any year 50 percent of the product described
in clause (i); and
(iii) in any 2-year period 90 percent of such
product.
(B) For purposes of this paragraph, the overall hospital EHR
amount, with respect to a Medicaid provider, is the sum of the
applicable amounts specified in section 1886(n)(2)(A) for such
provider for the first 4 payment years (as estimated by the
Secretary) determined as if the Medicare share specified in
clause (ii) of such section were 1. The Secretary shall
establish, in consultation with the State, the overall hospital
EHR amount for each such Medicaid provider eligible for
payments under paragraph (1)(B). For purposes of this
subparagraph in computing the amounts under section
1886(n)(2)(C) for payment years after the first payment year,
the Secretary shall assume that in subsequent payment years
discharges increase at the average annual rate of growth of the
most recent 3 years for which discharge data are available per
year.
(C) The Medicaid share computed under this subparagraph, for
a Medicaid provider for a period specified by the Secretary,
shall be calculated in the same manner as the Medicare share
under section 1886(n)(2)(D) for such a hospital and period,
except that there shall be substituted for the numerator under
clause (i) of such section the amount that is equal to the
number of inpatient-bed-days (as established by the Secretary)
which are attributable to individuals who are receiving medical
assistance under this title and who are not described in
section 1886(n)(2)(D)(i). In computing inpatient-bed-days under
the previous sentence, the Secretary shall take into account
inpatient-bed-days attributable to inpatient-bed-days that are
paid for individuals enrolled in a Medicaid managed care plan
(under section 1903(m) or section 1932).
(D) In no case may the payments described in paragraph (1)(B)
with respect to a Medicaid provider described in paragraph
(2)(B) be paid--
(i) for any year beginning after 2016 unless the
provider has been provided payment under paragraph
(1)(B) for the previous year; and
(ii) over a period of more than 6 years of payment.
(6) Payments described in paragraph (1) are not in accordance
with this subsection unless the following requirements are met:
(A)(i) The State provides assurances satisfactory to
the Secretary that amounts received under subsection
(a)(3)(F) with respect to payments to a Medicaid
provider are paid, subject to clause (ii), directly to
such provider (or to an employer or facility to which
such provider has assigned payments) without any
deduction or rebate.
(ii) Amounts described in clause (i) may also be paid
to an entity promoting the adoption of certified EHR
technology, as designated by the State, if
participation in such a payment arrangement is
voluntary for the eligible professional involved and if
such entity does not retain more than 5 percent of such
payments for costs not related to certified EHR
technology (and support services including maintenance
and training) that is for, or is necessary for the
operation of, such technology.
(B) A Medicaid provider described in paragraph (2)(A)
is responsible for payment of the remaining 15 percent
of the net average allowable cost and shall be
determined to have met such responsibility to the
extent that the payment to the Medicaid provider is not
in excess of 85 percent of the net average allowable
cost.
(C)(i) Subject to clause (ii), with respect to
payments to a Medicaid provider--
(I) for the first year of payment to the
Medicaid provider under this subsection, the
Medicaid provider demonstrates that it is
engaged in efforts to adopt, implement, or
upgrade certified EHR technology; and
(II) for a year of payment, other than the
first year of payment to the Medicaid provider
under this subsection, the Medicaid provider
demonstrates meaningful use of certified EHR
technology through a means that is approved by
the State and acceptable to the Secretary, and
that may be based upon the methodologies
applied under section 1848(o) or 1886(n).
(ii) In the case of a Medicaid provider who has
completed adopting, implementing, or upgrading such
technology prior to the first year of payment to the
Medicaid provider under this subsection, clause (i)(I)
shall not apply and clause (i)(II) shall apply to each
year of payment to the Medicaid provider under this
subsection, including the first year of payment.
(D) To the extent specified by the Secretary, the
certified EHR technology is compatible with State or
Federal administrative management systems.
For purposes of subparagraph (B), a Medicaid provider described
in paragraph (2)(A) may accept payments for the costs described
in such subparagraph from a State or local government. For
purposes of subparagraph (C), in establishing the means
described in such subparagraph, which may include clinical
quality reporting to the State, the State shall ensure that
populations with unique needs, such as children, are
appropriately addressed.
(7) With respect to Medicaid providers described in paragraph
(2)(A), the Secretary shall ensure coordination of payment with
respect to such providers under sections 1848(o) and 1853(l)
and under this subsection to assure no duplication of funding.
Such coordination shall include, to the extent practicable, a
data matching process between State Medicaid agencies and the
Centers for Medicare & Medicaid Services using national
provider identifiers. For such purposes, the Secretary may
require the submission of such data relating to payments to
such Medicaid providers as the Secretary may specify.
(8) In carrying out paragraph (6)(C), the State and Secretary
shall seek, to the maximum extent practicable, to avoid
duplicative requirements from Federal and State governments to
demonstrate meaningful use of certified EHR technology under
this title and title XVIII. In doing so, the Secretary may deem
satisfaction of requirements for such meaningful use for a
payment year under title XVIII to be sufficient to qualify as
meaningful use under this subsection. The Secretary may also
specify the reporting periods under this subsection in order to
carry out this paragraph.
(9) In order to be provided Federal financial participation
under subsection (a)(3)(F)(ii), a State must demonstrate to the
satisfaction of the Secretary, that the State--
(A) is using the funds provided for the purposes of
administering payments under this subsection, including
tracking of meaningful use by Medicaid providers;
(B) is conducting adequate oversight of the program
under this subsection, including routine tracking of
meaningful use attestations and reporting mechanisms;
and
(C) is pursuing initiatives to encourage the adoption
of certified EHR technology to promote health care
quality and the exchange of health care information
under this title, subject to applicable laws and
regulations governing such exchange.
(10) The Secretary shall periodically submit reports to the
Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate on
status, progress, and oversight of payments described in
paragraph (1), including steps taken to carry out paragraph
(7). Such reports shall also describe the extent of adoption of
certified EHR technology among Medicaid providers resulting
from the provisions of this subsection and any improvements in
health outcomes, clinical quality, or efficiency resulting from
such adoption.
(u)(1)(A) Notwithstanding subsection (a)(1), if the ratio of
a State's erroneous excess payments for medical assistance (as
defined in subparagraph (D)) to its total expenditures for
medical assistance under the State plan approved under this
title exceeds 0.03, for the period consisting of the third and
fourth quarters of fiscal year 1983, or for any full fiscal
year thereafter, then the Secretary shall make no payment for
such period or fiscal year with respect to so much of such
erroneous excess payments as exceeds such allowable error rate
of 0.03.
(B) The Secretary may waive, in certain limited cases, all or
part of the reduction required under subparagraph (A) with
respect to any State if such State is unable to reach the
allowable error rate for a period or fiscal year despite a good
faith effort by such State.
(C) In estimating the amount to be paid to a State under
subsection (d), the Secretary shall take into consideration the
limitation on Federal financial participation imposed by
subparagraph (A) and shall reduce the estimate he makes under
subsection (d)(1), for purposes of payment to the State under
subsection (d)(3), in light of any expected erroneous excess
payments for medical assistance (estimated in accordance with
such criteria, including sampling procedures, as he may
prescribe and subject to subsequent adjustment, if necessary,
under subsection (d)(2)).
(D)(i) For purposes of this subsection, the term ``erroneous
excess payments for medical assistance'' means the total of--
(I) payments under the State plan with respect to
ineligible individuals and families, and
(II) overpayments on behalf of eligible individuals
and families by reason of error in determining the
amount of expenditures for medical care required of an
individual or family as a condition of eligibility.
(ii) In determining the amount of erroneous excess payments
for medical assistance to an ineligible individual or family
under clause (i)(I), if such ineligibility is the result of an
error in determining the amount of the resources of such
individual or family, the amount of the erroneous excess
payment shall be the smaller of (I) the amount of the payment
with respect to such individual or family, or (II) the
difference between the actual amount of such resources and the
allowable resource level established under the State plan.
(iii) In determining the amount of erroneous excess payments
for medical assistance to an individual or family under clause
(i)(II), the amount of the erroneous excess payment shall be
the smaller of (I) the amount of the payment on behalf of the
individual or family, or (II) the difference between the actual
amount incurred for medical care by the individual or family
and the amount which should have been incurred in order to
establish eligibility for medical assistance.
(iv) In determining the amount of erroneous excess payments,
there shall not be included any error resulting from a failure
of an individual to cooperate or give correct information with
respect to third-party liability as required under section
1912(a)(1)(C) or 402(a)(26)(C) or with respect to payments made
in violation of section 1906.
(v) In determining the amount of erroneous excess payments,
there shall not be included any erroneous payments made for
ambulatory prenatal care provided during a presumptive
eligibility period (as defined in section 1920(b)(1)), for
items and services described in subsection (a) of section 1920A
provided to a child during a presumptive eligibility period
under such section, for medical assistance provided to an
individual described in subsection (a) of section 1920B during
a presumptive eligibility period under such section, or for
medical assistance provided to an individual during a
presumptive eligibility period resulting from a determination
of presumptive eligibility made by a hospital that elects under
section 1902(a)(47)(B) to be a qualified entity for such
purpose.
(E) For purposes of subparagraph (D), there shall be
excluded, in determining both erroneous excess payments for
medical assistance and total expenditures for medical
assistance--
(i) payments with respect to any individual whose
eligibility therefor was determined exclusively by the
Secretary under an agreement pursuant to section 1634
and such other classes of individuals as the Secretary
may by regulation prescribe whose eligibility was
determined in part under such an agreement; and
(ii) payments made as the result of a technical
error.
(2) The State agency administering the plan approved under
this title shall, at such times and in such form as the
Secretary may specify, provide information on the rates of
erroneous excess payments made (or expected, with respect to
future periods specified by the Secretary) in connection with
its administration of such plan, together with any other data
he requests that are reasonably necessary for him to carry out
the provisions of this subsection.
(3)(A) If a State fails to cooperate with the Secretary in
providing information necessary to carry out this subsection,
the Secretary, directly or through contractual or such other
arrangements as he may find appropriate, shall establish the
error rates for that State on the basis of the best data
reasonably available to him and in accordance with such
techniques for sampling and estimating as he finds appropriate.
(B) In any case in which it is necessary for the Secretary to
exercise his authority under subparagraph (A) to determine a
State's error rates for a fiscal year, the amount that would
otherwise be payable to such State under this title for
quarters in such year shall be reduced by the costs incurred by
the Secretary in making (directly or otherwise) such
determination.
(4) This subsection shall not apply with respect to Puerto
Rico, Guam, the Virgin Islands, the Northern Mariana Islands,
or American Samoa.
(v)(1) Notwithstanding the preceding provisions of this
section, except as provided in paragraphs (2) and (4), no
payment may be made to a State under this section for medical
assistance furnished to an alien who is not lawfully admitted
for permanent residence or otherwise permanently residing in
the United States under color of law.
(2) Payment shall be made under this section for care and
services that are furnished to an alien described in paragraph
(1) only if--
(A) such care and services are necessary for the
treatment of an emergency medical condition of the
alien,
(B) such alien otherwise meets the eligibility
requirements for medical assistance under the State
plan approved under this title (other than the
requirement of the receipt of aid or assistance under
title IV, supplemental security income benefits under
title XVI, or a State supplementary payment), and
(C) such care and services are not related to an
organ transplant procedure.
(3) For purposes of this subsection, the term ``emergency
medical condition'' means a medical condition (including
emergency labor and delivery) manifesting itself by acute
symptoms of sufficient severity (including severe pain) such
that the absence of immediate medical attention could
reasonably be expected to result in--
(A) placing the patient's health in serious jeopardy,
(B) serious impairment to bodily functions, or
(C) serious dysfunction of any bodily organ or part.
(4)(A) A State may elect (in a plan amendment under this
title) to provide medical assistance under this title,
notwithstanding sections 401(a), 402(b), 403, and 421 of the
Personal Responsibility and Work Opportunity Reconciliation Act
of 1996, to children and pregnant women who are lawfully
residing in the United States (including battered individuals
described in section 431(c) of such Act) and who are otherwise
eligible for such assistance, within either or both of the
following eligibility categories:
(i) Pregnant women.--Women during pregnancy (and
during the 60-day period beginning on the last day of
the pregnancy).
(ii) Children.--Individuals under 21 years of age,
including optional targeted low-income children
described in section 1905(u)(2)(B).
(B) In the case of a State that has elected to provide
medical assistance to a category of aliens under subparagraph
(A), no debt shall accrue under an affidavit of support against
any sponsor of such an alien on the basis of provision of
assistance to such category and the cost of such assistance
shall not be considered as an unreimbursed cost.
(C) As part of the State's ongoing eligibility
redetermination requirements and procedures for an individual
provided medical assistance as a result of an election by the
State under subparagraph (A), a State shall verify that the
individual continues to lawfully reside in the United States
using the documentation presented to the State by the
individual on initial enrollment. If the State cannot
successfully verify that the individual is lawfully residing in
the United States in this manner, it shall require that the
individual provide the State with further documentation or
other evidence to verify that the individual is lawfully
residing in the United States.
(w)(1)(A) Notwithstanding the previous provisions of this
section, for purposes of determining the amount to be paid to a
State (as defined in paragraph (7)(D)) under subsection (a)(1)
for quarters in any fiscal year, the total amount expended
during such fiscal year as medical assistance under the State
plan (as determined without regard to this subsection) shall be
reduced by the sum of any revenues received by the State (or by
a unit of local government in the State) during the fiscal
year--
(i) from provider-related donations (as defined in
paragraph (2)(A)), other than--
(I) bona fide provider-related donations (as
defined in paragraph (2)(B)), and
(II) donations described in paragraph (2)(C);
(ii) from health care related taxes (as defined in
paragraph (3)(A)), other than broad-based health care
related taxes (as defined in paragraph (3)(B));
(iii) from a broad-based health care related tax, if
there is in effect a hold harmless provision (described
in paragraph (4)) with respect to the tax; or
(iv) only with respect to State fiscal years (or
portions thereof) occurring on or after January 1,
1992, and before October 1, 1995, from broad-based
health care related taxes to the extent the amount of
such taxes collected exceeds the limit established
under paragraph (5).
(B) Notwithstanding the previous provisions of this section,
for purposes of determining the amount to be paid to a State
under subsection (a)(7) for all quarters in a Federal fiscal
year (beginning with fiscal year 1993), the total amount
expended during the fiscal year for administrative expenditures
under the State plan (as determined without regard to this
subsection) shall be reduced by the sum of any revenues
received by the State (or by a unit of local government in the
State) during such quarters from donations described in
paragraph (2)(C), to the extent the amount of such donations
exceeds 10 percent of the amounts expended under the State plan
under this title during the fiscal year for purposes described
in paragraphs (2), (3), (4), (6), and (7) of subsection (a).
(C)(i) Except as otherwise provided in clause (ii),
subparagraph (A)(i) shall apply to donations received on or
after January 1, 1992.
(ii) Subject to the limits described in clause (iii) and
subparagraph (E), subparagraph (A)(i) shall not apply to
donations received before the effective date specified in
subparagraph (F) if such donations are received under programs
in effect or as described in State plan amendments or related
documents submitted to the Secretary by September 30, 1991, and
applicable to State fiscal year 1992, as demonstrated by State
plan amendments, written agreements, State budget
documentation, or other documentary evidence in existence on
that date.
(iii) In applying clause (ii) in the case of donations
received in State fiscal year 1993, the maximum amount of such
donations to which such clause may be applied may not exceed
the total amount of such donations received in the
corresponding period in State fiscal year 1992 (or not later
than 5 days after the last day of the corresponding period).
(D)(i) Except as otherwise provided in clause (ii),
subparagraphs (A)(ii) and (A)(iii) shall apply to taxes
received on or after January 1, 1992.
(ii) Subparagraphs (A)(ii) and (A)(iii) shall not apply to
impermissible taxes (as defined in clause (iii)) received
before the effective date specified in subparagraph (F) to the
extent the taxes (including the tax rate or base) were in
effect, or the legislation or regulations imposing such taxes
were enacted or adopted, as of November 22, 1991.
(iii) In this subparagraph and subparagraph (E), the term
``impermissible tax'' means a health care related tax for which
a reduction may be made under clause (ii) or (iii) of
subparagraph (A).
(E)(i) In no case may the total amount of donations and taxes
permitted under the exception provided in subparagraphs (C)(ii)
and (D)(ii) for the portion of State fiscal year 1992 occurring
during calendar year 1992 exceed the limit under paragraph (5)
minus the total amount of broad-based health care related taxes
received in the portion of that fiscal year.
(ii) In no case may the total amount of donations and taxes
permitted under the exception provided in subparagraphs (C)(ii)
and (D)(ii) for State fiscal year 1993 exceed the limit under
paragraph (5) minus the total amount of broad-based health care
related taxes received in that fiscal year.
(F) In this paragraph in the case of a State--
(i) except as provided in clause (iii), with a State
fiscal year beginning on or before July 1, the
effective date is October 1, 1992,
(ii) except as provided in clause (iii), with a State
fiscal year that begins after July 1, the effective
date is January 1, 1993, or
(iii) with a State legislature which is not scheduled
to have a regular legislative session in 1992, with a
State legislature which is not scheduled to have a
regular legislative session in 1993, or with a
provider-specific tax enacted on November 4, 1991, the
effective date is July 1, 1993.
(2)(A) In this subsection (except as provided in paragraph
(6)), the term ``provider-related donation'' means any donation
or other voluntary payment (whether in cash or in kind) made
(directly or indirectly) to a State or unit of local government
by--
(i) a health care provider (as defined in paragraph
(7)(B)),
(ii) an entity related to a health care provider (as
defined in paragraph (7)(C)), or
(iii) an entity providing goods or services under the
State plan for which payment is made to the State under
paragraph (2), (3), (4), (6), or (7) of subsection (a).
(B) For purposes of paragraph (1)(A)(i)(I), the term ``bona
fide provider-related donation'' means a provider-related
donation that has no direct or indirect relationship (as
determined by the Secretary) to payments made under this title
to that provider, to providers furnishing the same class of
items and services as that provider, or to any related entity,
as established by the State to the satisfaction of the
Secretary. The Secretary may by regulation specify types of
provider-related donations described in the previous sentence
that will be considered to be bona fide provider-related
donations.
(C) For purposes of paragraph (1)(A)(i)(II), donations
described in this subparagraph are funds expended by a
hospital, clinic, or similar entity for the direct cost
(including costs of training and of preparing and distributing
outreach materials) of State or local agency personnel who are
stationed at the hospital, clinic, or entity to determine the
eligibility of individuals for medical assistance under this
title and to provide outreach services to eligible or
potentially eligible individuals.
(3)(A) In this subsection (except as provided in paragraph
(6)), the term ``health care related tax'' means a tax (as
defined in paragraph (7)(F)) that--
(i) is related to health care items or services, or
to the provision of, the authority to provide, or
payment for, such items or services, or
(ii) is not limited to such items or services but
provides for treatment of individuals or entities that
are providing or paying for such items or services that
is different from the treatment provided to other
individuals or entities.
In applying clause (i), a tax is considered to relate to health
care items or services if at least 85 percent of the burden of
such tax falls on health care providers.
(B) In this subsection, the term ``broad-based health care
related tax'' means a health care related tax which is imposed
with respect to a class of health care items or services (as
described in paragraph (7)(A)) or with respect to providers of
such items or services and which, except as provided in
subparagraphs (D), (E), and (F)--
(i) is imposed at least with respect to all items or
services in the class furnished by all non-Federal,
nonpublic providers in the State (or, in the case of a
tax imposed by a unit of local government, the area
over which the unit has jurisdiction) or is imposed
with respect to all non-Federal, nonpublic providers in
the class; and
(ii) is imposed uniformly (in accordance with
subparagraph (C)).
(C)(i) Subject to clause (ii), for purposes of subparagraph
(B)(ii), a tax is considered to be imposed uniformly if--
(I) in the case of a tax consisting of a licensing
fee or similar tax on a class of health care items or
services (or providers of such items or services), the
amount of the tax imposed is the same for every
provider providing items or services within the class;
(II) in the case of a tax consisting of a licensing
fee or similar tax imposed on a class of health care
items or services (or providers of such services) on
the basis of the number of beds (licensed or otherwise)
of the provider, the amount of the tax is the same for
each bed of each provider of such items or services in
the class;
(III) in the case of a tax based on revenues or
receipts with respect to a class of items or services
(or providers of items or services) the tax is imposed
at a uniform rate for all items and services (or
providers of such items of services) in the class on
all the gross revenues or receipts, or net operating
revenues, relating to the provision of all such items
or services (or all such providers) in the State (or,
in the case of a tax imposed by a unit of local
government within the State, in the area over which the
unit has jurisdiction); or
(IV) in the case of any other tax, the State
establishes to the satisfaction of the Secretary that
the tax is imposed uniformly.
(ii) Subject to subparagraphs (D) and (E), a tax imposed with
respect to a class of health care items and services is not
considered to be imposed uniformly if the tax provides for any
credits, exclusions, or deductions which have as their purpose
or effect the return to providers of all or a portion of the
tax paid in a manner that is inconsistent with subclauses (I)
and (II) of subparagraph (E)(ii) or provides for a hold
harmless provision described in paragraph (4).
(D) A tax imposed with respect to a class of health care
items and services is considered to be imposed uniformly--
(i) notwithstanding that the tax is not imposed with
respect to items or services (or the providers thereof)
for which payment is made under a State plan under this
title or title XVIII, or
(ii) in the case of a tax described in subparagraph
(C)(i)(III), notwithstanding that the tax provides for
exclusion (in whole or in part) of revenues or receipts
from a State plan under this title or title XVIII.
(E)(i) A State may submit an application to the Secretary
requesting that the Secretary treat a tax as a broad-based
health care related tax, notwithstanding that the tax does not
apply to all health care items or services in class (or all
providers of such items and services), provides for a credit,
deduction, or exclusion, is not applied uniformly, or otherwise
does not meet the requirements of subparagraph (B) or (C).
Permissible waivers may include exemptions for rural or sole-
community providers.
(ii) The Secretary shall approve such an application if the
State establishes to the satisfaction of the Secretary that--
(I) the net impact of the tax and associated
expenditures under this title as proposed by the State
is generally redistributive in nature, and
(II) the amount of the tax is not directly correlated
to payments under this title for items or services with
respect to which the tax is imposed.
The Secretary shall by regulation specify types of credits,
exclusions, and deductions that will be considered to meet the
requirements of this subparagraph.
(F) In no case shall a tax not qualify as a broad-based
health care related tax under this paragraph because it does
not apply to a hospital that is described in section 501(c)(3)
of the Internal Revenue Code of 1986 and exempt from taxation
under section 501(a) of such Code and that does not accept
payment under the State plan under this title or under title
XVIII.
(4) For purposes of paragraph (1)(A)(iii), there is in effect
a hold harmless provision with respect to a broad-based health
care related tax imposed with respect to a class of items or
services if the Secretary determines that any of the following
applies:
(A) The State or other unit of government imposing
the tax provides (directly or indirectly) for a payment
(other than under this title) to taxpayers and the
amount of such payment is positively correlated either
to the amount of such tax or to the difference between
the amount of the tax and the amount of payment under
the State plan.
(B) All or any portion of the payment made under this
title to the taxpayer varies based only upon the amount
of the total tax paid.
(C)(i) The State or other unit of government imposing
the tax provides (directly or indirectly) for any
payment, offset, or waiver that guarantees to hold
taxpayers harmless for any portion of the costs of the
tax.
(ii) For purposes of clause (i), a determination of
the existence of an indirect guarantee shall be made
under paragraph (3)(i) of section 433.68(f) of title
42, Code of Federal Regulations, as in effect on
November 1, 2006, except that for portions of fiscal
years beginning on or after January 1, 2008, and before
October 1, 2011, ``5.5 percent'' shall be substituted
for ``6 percent'' each place it appears.
The provisions of this paragraph shall not prevent use of the
tax to reimburse health care providers in a class for
expenditures under this title nor preclude States from relying
on such reimbursement to justify or explain the tax in the
legislative process.
(5)(A) For purposes of this subsection, the limit under this
subparagraph with respect to a State is an amount equal to 25
percent (or, if greater, the State base percentage, as defined
in subparagraph (B)) of the non-Federal share of the total
amount expended under the State plan during a State fiscal year
(or portion thereof), as it would be determined pursuant to
paragraph (1)(A) without regard to paragraph (1)(A)(iv).
(B)(i) In subparagraph (A), the term ``State base
percentage'' means, with respect to a State, an amount
(expressed as a percentage) equal to--
(I) the total of the amount of health care related
taxes (whether or not broad-based) and the amount of
provider-related donations (whether or not bona fide)
projected to be collected (in accordance with clause
(ii)) during State fiscal year 1992, divided by
(II) the non-Federal share of the total amount
estimated to be expended under the State plan during
such State fiscal year.
(ii) For purposes of clause (i)(I), in the case of a tax that
is not in effect throughout State fiscal year 1992 or the rate
(or base) of which is increased during such fiscal year, the
Secretary shall project the amount to be collected during such
fiscal year as if the tax (or increase) were in effect during
the entire State fiscal year.
(C)(i) The total amount of health care related taxes under
subparagraph (B)(i)(I) shall be determined by the Secretary
based on only those taxes (including the tax rate or base)
which were in effect, or for which legislation or regulations
imposing such taxes were enacted or adopted, as of November 22,
1991.
(ii) The amount of provider-related donations under
subparagraph (B)(i)(I) shall be determined by the Secretary
based on programs in effect on September 30, 1991, and
applicable to State fiscal year 1992, as demonstrated by State
plan amendments, written agreements, State budget
documentation, or other documentary evidence in existence on
that date.
(iii) The amount of expenditures described in subparagraph
(B)(i)(II) shall be determined by the Secretary based on the
best data available as of the date of the enactment of this
subsection.
(6)(A) Notwithstanding the provisions of this subsection, the
Secretary may not restrict States' use of funds where such
funds are derived from State or local taxes (or funds
appropriated to State university teaching hospitals)
transferred from or certified by units of government within a
State as the non-Federal share of expenditures under this
title, regardless of whether the unit of government is also a
health care provider, except as provided in section 1902(a)(2),
unless the transferred funds are derived by the unit of
government from donations or taxes that would not otherwise be
recognized as the non-Federal share under this section.
(B) For purposes of this subsection, funds the use of which
the Secretary may not restrict under subparagraph (A) shall not
be considered to be a provider-related donation or a health
care related tax.
(7) For purposes of this subsection:
(A) Each of the following shall be considered a
separate class of health care items and services:
(i) Inpatient hospital services.
(ii) Outpatient hospital services.
(iii) Nursing facility services (other than
services of intermediate care facilities for
the mentally retarded).
(iv) Services of intermediate care facilities
for the mentally retarded.
(v) Physicians' services.
(vi) Home health care services.
(vii) Outpatient prescription drugs.
(viii) Services of managed care organizations
(including health maintenance organizations,
preferred provider organizations, and such
other similar organizations as the Secretary
may specify by regulation).
(ix) Such other classification of health care
items and services consistent with this
subparagraph as the Secretary may establish by
regulation.
(B) The term ``health care provider'' means an
individual or person that receives payments for the
provision of health care items or services.
(C) An entity is considered to be ``related'' to a
health care provider if the entity--
(i) is an organization, association,
corporation or partnership formed by or on
behalf of health care providers;
(ii) is a person with an ownership or control
interest (as defined in section 1124(a)(3)) in
the provider;
(iii) is the employee, spouse, parent, child,
or sibling of the provider (or of a person
described in clause (ii)); or
(iv) has a similar, close relationship (as
defined in regulations) to the provider.
(D) The term ``State'' means only the 50 States and
the District of Columbia but does not include any State
whose entire program under this title is operated under
a waiver granted under section 1115.
(E) The ``State fiscal year'' means, with respect to
a specified year, a State fiscal year ending in that
specified year.
(F) The term ``tax'' includes any licensing fee,
assessment, or other mandatory payment, but does not
include payment of a criminal or civil fine or penalty
(other than a fine or penalty imposed in lieu of or
instead of a fee, assessment, or other mandatory
payment).
(G) The term ``unit of local government'' means, with
respect to a State, a city, county, special purpose
district, or other governmental unit in the State.
(x)(1) For purposes of section 1902(a)(46)(B)(i), the
requirement of this subsection is, with respect to an
individual declaring to be a citizen or national of the United
States, that, subject to paragraph (2), there is presented
satisfactory documentary evidence of citizenship or nationality
(as defined in paragraph (3)) of the individual.
(2) The requirement of paragraph (1) shall not apply to an
individual declaring to be a citizen or national of the United
States who is eligible for medical assistance under this
title--
(A) and is entitled to or enrolled for benefits under
any part of title XVIII;
(B) and is receiving--
(i) disability insurance benefits under
section 223 or monthly insurance benefits under
section 202 based on such individual's
disability (as defined in section 223(d)); or
(ii) supplemental security income benefits
under title XVI;
(C) and with respect to whom--
(i) child welfare services are made available
under part B of title IV on the basis of being
a child in foster care; or
(ii) adoption or foster care assistance is
made available under part E of title IV;
(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for
medical assistance on such basis, the individual shall
be deemed to have provided satisfactory documentary
evidence of citizenship or nationality and shall not be
required to provide further documentary evidence on any
date that occurs during or after the period in which
the individual is eligible for medical assistance on
such basis); or
(E) on such basis as the Secretary may specify under
which satisfactory documentary evidence of citizenship
or nationality has been previously presented.
(3)(A) For purposes of this subsection, the term
``satisfactory documentary evidence of citizenship or
nationality'' means--
(i) any document described in subparagraph (B); or
(ii) a document described in subparagraph (C) and a
document described in subparagraph (D).
(B) The following are documents described in this
subparagraph:
(i) A United States passport.
(ii) Form N-550 or N-570 (Certificate of
Naturalization).
(iii) Form N-560 or N-561 (Certificate of United
States Citizenship).
(iv) A valid State-issued driver's license or other
identity document described in section 274A(b)(1)(D) of
the Immigration and Nationality Act, but only if the
State issuing the license or such document requires
proof of United States citizenship before issuance of
such license or document or obtains a social security
number from the applicant and verifies before
certification that such number is valid and assigned to
the applicant who is a citizen.
(v)(I) Except as provided in subclause (II), a
document issued by a federally recognized Indian tribe
evidencing membership or enrollment in, or affiliation
with, such tribe (such as a tribal enrollment card or
certificate of degree of Indian blood).
(II) With respect to those federally recognized
Indian tribes located within States having an
international border whose membership includes
individuals who are not citizens of the United States,
the Secretary shall, after consulting with such tribes,
issue regulations authorizing the presentation of such
other forms of documentation (including tribal
documentation, if appropriate) that the Secretary
determines to be satisfactory documentary evidence of
citizenship or nationality for purposes of satisfying
the requirement of this subsection.
(vi) Such other document as the Secretary may
specify, by regulation, that provides proof of United
States citizenship or nationality and that provides a
reliable means of documentation of personal identity.
(C) The following are documents described in this
subparagraph:
(i) A certificate of birth in the United States.
(ii) Form FS-545 or Form DS-1350 (Certification of
Birth Abroad).
(iii) Form I-197 (United States Citizen
Identification Card).
(iv) Form FS-240 (Report of Birth Abroad of a Citizen
of the United States).
(v) Such other document (not described in
subparagraph (B)(iv)) as the Secretary may specify that
provides proof of United States citizenship or
nationality.
(D) The following are documents described in this
subparagraph:
(i) Any identity document described in section
274A(b)(1)(D) of the Immigration and Nationality Act.
(ii) Any other documentation of personal identity of
such other type as the Secretary finds, by regulation,
provides a reliable means of identification.
(E) A reference in this paragraph to a form includes a
reference to any successor form.
(4) In the case of an individual declaring to be a citizen or
national of the United States with respect to whom a State
requires the presentation of satisfactory documentary evidence
of citizenship or nationality under section 1902(a)(46)(B)(i),
the individual shall be provided at least the reasonable
opportunity to present satisfactory documentary evidence of
citizenship or nationality under this subsection as is provided
under clauses (i) and (ii) of section 1137(d)(4)(A) to an
individual for the submittal to the State of evidence
indicating a satisfactory immigration status.
(5) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection, or
the Deficit Reduction Act of 2005, including section 6036 of
such Act, shall be construed as changing the requirement of
section 1902(e)(4) that a child born in the United States to an
alien mother for whom medical assistance for the delivery of
such child is available as treatment of an emergency medical
condition pursuant to subsection (v) shall be deemed eligible
for medical assistance during the first year of such child's
life.
(y) Payments for Establishment of Alternate Non-Emergency
Services Providers.--
(1) Payments.--In addition to the payments otherwise
provided under subsection (a), subject to paragraph
(2), the Secretary shall provide for payments to States
under such subsection for the establishment of
alternate non-emergency service providers (as defined
in section 1916A(e)(5)(B)), or networks of such
providers.
(2) Limitation.--The total amount of payments under
this subsection shall not exceed $50,000,000 during the
4-year period beginning with 2006. This subsection
constitutes budget authority in advance of
appropriations Acts and represents the obligation of
the Secretary to provide for the payment of amounts
provided under this subsection.
(3) Preference.--In providing for payments to States
under this subsection, the Secretary shall provide
preference to States that establish, or provide for,
alternate non-emergency services providers or networks
of such providers that--
(A) serve rural or underserved areas where
beneficiaries under this title may not have
regular access to providers of primary care
services; or
(B) are in partnership with local community
hospitals.
(4) Form and manner of payment.--Payment to a State
under this subsection shall be made only upon the
filing of such application in such form and in such
manner as the Secretary shall specify. Payment to a
State under this subsection shall be made in the same
manner as other payments under section 1903(a).
(z) Medicaid Transformation Payments.--
(1) In general.--In addition to the payments provided
under subsection (a), subject to paragraph (4), the
Secretary shall provide for payments to States for the
adoption of innovative methods to improve the
effectiveness and efficiency in providing medical
assistance under this title.
(2) Permissible uses of funds.--The following are
examples of innovative methods for which funds provided
under this subsection may be used:
(A) Methods for reducing patient error rates
through the implementation and use of
electronic health records, electronic clinical
decision support tools, or e-prescribing
programs.
(B) Methods for improving rates of collection
from estates of amounts owed under this title.
(C) Methods for reducing waste, fraud, and
abuse under the program under this title, such
as reducing improper payment rates as measured
by annual payment error rate measurement (PERM)
project rates.
(D) Implementation of a medication risk
management program as part of a drug use review
program under section 1927(g).
(E) Methods in reducing, in clinically
appropriate ways, expenditures under this title
for covered outpatient drugs, particularly in
the categories of greatest drug utilization, by
increasing the utilization of generic drugs
through the use of education programs and other
incentives to promote greater use of generic
drugs.
(F) Methods for improving access to primary
and specialty physician care for the uninsured
using integrated university-based hospital and
clinic systems.
(3) Application; terms and conditions.--
(A) In general.--No payments shall be made to
a State under this subsection unless the State
applies to the Secretary for such payments in a
form, manner, and time specified by the
Secretary.
(B) Terms and conditions.--Such payments are
made under such terms and conditions consistent
with this subsection as the Secretary
prescribes.
(C) Annual report.--Payment to a State under
this subsection is conditioned on the State
submitting to the Secretary an annual report on
the programs supported by such payment. Such
report shall include information on--
(i) the specific uses of such
payment;
(ii) an assessment of quality
improvements and clinical outcomes
under such programs; and
(iii) estimates of cost savings
resulting from such programs.
(4) Funding.--
(A) Limitation on funds.--The total amount of
payments under this subsection shall be equal
to, and shall not exceed--
(i) $75,000,000 for fiscal year 2007;
and
(ii) $75,000,000 for fiscal year
2008.
This subsection constitutes budget authority in
advance of appropriations Acts and represents
the obligation of the Secretary to provide for
the payment of amounts provided under this
subsection.
(B) Allocation of funds.--The Secretary shall
specify a method for allocating the funds made
available under this subsection among States.
Such method shall provide preference for States
that design programs that target health
providers that treat significant numbers of
Medicaid beneficiaries. Such method shall
provide that not less than 25 percent of such
funds shall be allocated among States the
population of which (as determined according to
data collected by the United States Census
Bureau) as of July 1, 2004, was more than 105
percent of the population of the respective
State (as so determined) as of April 1, 2000.
(C) Form and manner of payment.--Payment to a
State under this subsection shall be made in
the same manner as other payments under section
1903(a). There is no requirement for State
matching funds to receive payments under this
subsection.
(5) Medication risk management program.--
(A) In general.--For purposes of this
subsection, the term ``medication risk
management program'' means a program for
targeted beneficiaries that ensures that
covered outpatient drugs are appropriately used
to optimize therapeutic outcomes through
improved medication use and to reduce the risk
of adverse events.
(B) Elements.--Such program may include the
following elements:
(i) The use of established principles
and standards for drug utilization
review and best practices to analyze
prescription drug claims of targeted
beneficiaries and identify outlier
physicians.
(ii) On an ongoing basis provide
outlier physicians--
(I) a comprehensive pharmacy
claims history for each
targeted beneficiary under
their care;
(II) information regarding
the frequency and cost of
relapses and hospitalizations
of targeted beneficiaries under
the physician's care; and
(III) applicable best
practice guidelines and
empirical references.
(iii) Monitor outlier physician's
prescribing, such as failure to refill,
dosage strengths, and provide
incentives and information to encourage
the adoption of best clinical
practices.
(C) Targeted beneficiaries.--For purposes of
this paragraph, the term ``targeted
beneficiaries'' means Medicaid eligible
beneficiaries who are identified as having high
prescription drug costs and medical costs, such
as individuals with behavioral disorders or
multiple chronic diseases who are taking
multiple medications.
* * * * * * *
DEFINITIONS
Sec. 1905. For purposes of this title--
(a) The term ``medical assistance'' means payment of part or
all of the cost of the following care and services or the care
and services themselves, or both (if provided in or after the
third month before the month in which the recipient makes
application for assistance or, in the case of medicare cost-
sharing with respect to a qualified medicare beneficiary
described in subsection (p)(1), if provided after the month in
which the individual becomes such a beneficiary) for
individuals, and, with respect to physicians' or dentists'
services, at the option of the State, to individuals (other
than individuals with respect to whom there is being paid, or
who are eligible, or would be eligible if they were not in a
medical institution, to have paid with respect to them a State
supplementary payment and are eligible for medical assistance
equal in amount, duration, and scope to the medical assistance
made available to individuals described in section
1902(a)(10)(A)) not receiving aid or assistance under any plan
of the State approved under title I, X, XIV, or XVI, or part A
of title IV, and with respect to whom supplemental security
income benefits are not being paid under title XVI, who are--
(i) under the age of 21, or, at the option of the
State, under the age of 20, 19, or 18 as the State may
choose,
(ii) relatives specified in section 406(b)(1) with
whom a child is living if such child is (or would, if
needy, be) a dependent child under part A of title IV,
(iii) 65 years of age or older,
(iv) blind, with respect to States eligible to
participate in the State plan program established under
title XVI,
(v) 18 years of age or older and permanently and
totally disabled, with respect to States eligible to
participate in the State plan program established under
title XVI,
(vi) persons essential (as described in the second
sentence of this subsection) to individuals receiving
aid or assistance under State plans approved under
title I, X, XIV, or XVI,
(vii) blind or disabled as defined in section 1614,
with respect to States not eligible to participate in
the State plan program established under title XVI,
(viii) pregnant women,
(ix) individuals provided extended benefits under
section 1925,
(x) individuals described in section 1902(u)(1),
(xi) individuals described in section 1902(z)(1),
(xii) employed individuals with a medically improved
disability (as defined in subsection (v)),
(xiii) individuals described in section 1902(aa),
(xiv) individuals described in section
1902(a)(10)(A)(i)(VIII) or 1902(a)(10)(A)(i)(IX),
(xv) individuals described in section
1902(a)(10)(A)(ii)(XX),
(xvi) individuals described in
section 1902(ii), or
(xvii) individuals who are eligible for home and
community-based services under needs-based criteria
established under paragraph (1)(A) of section 1915(i),
or who are eligible for home and community-based
services under paragraph (6) of such section, and who
will receive home and community-based services pursuant
to a State plan amendment under such subsection,
but whose income and resources are insufficient to meet all of
such cost--
(1) inpatient hospital services (other than services
in an institution for mental diseases);
(2)(A) outpatient hospital services, (B) consistent
with State law permitting such services, rural health
clinic services (as defined in subsection (l)(1)) and
any other ambulatory services which are offered by a
rural health clinic (as defined in subsection (l)(1))
and which are otherwise included in the plan, and (C)
Federally-qualified health center services (as defined
in subsection (l)(2)) and any other ambulatory services
offered by a Federally-qualified health center and
which are otherwise included in the plan;
(3) other laboratory and X-ray services;
(4)(A) nursing facility services (other than services
in an institution for mental diseases) for individuals
21 years of age or older; (B) early and periodic
screening, diagnostic, and treatment services (as
defined in subsection (r)) for individuals who are
eligible under the plan and are under the age of 21;
(C) family planning services and supplies furnished
(directly or under arrangements with others) to
individuals of child-bearing age (including minors who
can be considered to be sexually active) who are
eligible under the State plan and who desire such
services and supplies; and (D) counseling and
pharmacotherapy for cessation of tobacco use by
pregnant women (as defined in subsection (bb));
(5)(A) physicians' services furnished by a physician
(as defined in section 1861(r)(1)), whether furnished
in the office, the patient's home, a hospital, or a
nursing facility, or elsewhere, and (B) medical and
surgical services furnished by a dentist (described in
section 1861(r)(2)) to the extent such services may be
performed under State law either by a doctor of
medicine or by a doctor of dental surgery or dental
medicine and would be described in clause (A) if
furnished by a physician (as defined in section
1861(r)(1));
(6) medical care, or any other type of remedial care
recognized under State law, furnished by licensed
practitioners within the scope of their practice as
defined by State law;
(7) home health care services;
(8) private duty nursing services;
(9) clinic services furnished by or under the
direction of a physician, without regard to whether the
clinic itself is administered by a physician, including
such services furnished outside the clinic by clinic
personnel to an eligible individual who does not reside
in a permanent dwelling or does not have a fixed home
or mailing address;
(10) dental services;
(11) physical therapy and related services;
(12) prescribed drugs, dentures, and prosthetic
devices; and eyeglasses prescribed by a physician
skilled in diseases of the eye or by an optometrist,
whichever the individual may select;
(13) other diagnostic, screening, preventive, and
rehabilitative services, including--
(A) any clinical preventive services that are
assigned a grade of A or B by the United States
Preventive Services Task Force;
(B) with respect to an adult individual,
approved vaccines recommended by the Advisory
Committee on Immunization Practices (an
advisory committee established by the
Secretary, acting through the Director of the
Centers for Disease Control and Prevention) and
their administration; and
(C) any medical or remedial services
(provided in a facility, a home, or other
setting) recommended by a physician or other
licensed practitioner of the healing arts
within the scope of their practice under State
law, for the maximum reduction of physical or
mental disability and restoration of an
individual to the best possible functional
level;
(14) inpatient hospital services and nursing facility
services for individuals 65 years of age or over in an
institution for mental diseases;
(15) services in an intermediate care facility for
the mentally retarded (other than in an institution for
mental diseases) for individuals who are determined, in
accordance with section 1902(a)(31), to be in need of
such care;
(16) effective January 1, 1973, inpatient psychiatric
hospital services for individuals under age 21, as
defined in subsection (h), and, effective January 1,
2019, the full-range of early and periodic screening,
diagnostic, and treatment services (as defined in
subsection (r)) for such individuals whether or not
such screening, diagnostic, and treatment services are
furnished by the provider of inpatient psychiatric
hospital services for individuals under age 21;
(17) services furnished by a nurse-midwife (as
defined in section 1861(gg)) which the nurse-midwife is
legally authorized to perform under State law (or the
State regulatory mechanism provided by State law),
whether or not the nurse-midwife is under the
supervision of, or associated with, a physician or
other health care provider, and without regard to
whether or not the services are performed in the area
of management of the care of mothers and babies
throughout the maternity cycle;
(18) hospice care (as defined in subsection (o));
(19) case management services (as defined in section
1915(g)(2)) and TB-related services described in
section 1902(z)(2)(F);
(20) respiratory care services (as defined in section
1902(e)(9)(C));
(21) services furnished by a certified pediatric
nurse practitioner or certified family nurse
practitioner (as defined by the Secretary) which the
certified pediatric nurse practitioner or certified
family nurse practitioner is legally authorized to
perform under State law (or the State regulatory
mechanism provided by State law), whether or not the
certified pediatric nurse practitioner or certified
family nurse practitioner is under the supervision of,
or associated with, a physician or other health care
provider;
(22) home and community care (to the extent allowed
and as defined in section 1929) for functionally
disabled elderly individuals;
(23) community supported living arrangements services
(to the extent allowed and as defined in section 1930);
(24) personal care services furnished to an
individual who is not an inpatient or resident of a
hospital, nursing facility, intermediate care facility
for the mentally retarded, or institution for mental
disease that are (A) authorized for the individual by a
physician in accordance with a plan of treatment or (at
the option of the State) otherwise authorized for the
individual in accordance with a service plan approved
by the State, (B) provided by an individual who is
qualified to provide such services and who is not a
member of the individual's family, and (C) furnished in
a home or other location;
(25) primary care case management services (as
defined in subsection (t));
(26) services furnished under a PACE program under
section 1934 to PACE program eligible individuals
enrolled under the program under such section;
(27) subject to subsection (x), primary and secondary
medical strategies and treatment and services for
individuals who have Sickle Cell Disease;
(28) freestanding birth center services (as defined
in subsection (l)(3)(A)) and other ambulatory services
that are offered by a freestanding birth center (as
defined in subsection (l)(3)(B)) and that are otherwise
included in the plan; and
(29) any other medical care, and any other type of
remedial care recognized under State law, specified by
the Secretary,
except as otherwise provided in paragraph (16), such term does
not include--
(A) any such payments with respect to care or
services for any individual who is an inmate of a
public institution (except as a patient in a medical
institution); or
(B) any such payments with respect to care or
services for any individual who has not attained 65
years of age and who is a patient in an institution for
mental diseases.
For purposes of clause (vi) of the preceding sentence, a person
shall be considered essential to another individual if such
person is the spouse of and is living with such individual, the
needs of such person are taken into account in determining the
amount of aid or assistance furnished to such individual (under
a State plan approved under title I, X, XIV, or XVI), and such
person is determined, under such a State plan, to be essential
to the well-being of such individual. The payment described in
the first sentence may include expenditures for medicare cost-
sharing and for premiums under part B of title XVIII for
individuals who are eligible for medical assistance under the
plan and (A) are receiving aid or assistance under any plan of
the State approved under title I, X, XIV, or XVI, or part A of
title IV, or with respect to whom supplemental security income
benefits are being paid under title XVI, or (B) with respect to
whom there is being paid a State supplementary payment and are
eligible for medical assistance equal in amount, duration, and
scope to the medical assistance made available to individuals
described in section 1902(a)(10)(A), and, except in the case of
individuals 65 years of age or older and disabled individuals
entitled to health insurance benefits under title XVIII who are
not enrolled under part B of title XVIII, other insurance
premiums for medical or any other type of remedial care or the
cost thereof. No service (including counseling) shall be
excluded from the definition of ``medical assistance'' solely
because it is provided as a treatment service for alcoholism or
drug dependency.
(b) Subject to subsections (y), (z), and (aa) and section
1933(d), the term ``Federal medical assistance percentage'' for
any State shall be 100 per centum less the State percentage;
and the State percentage shall be that percentage which bears
the same ratio to 45 per centum as the square of the per capita
income of such State bears to the square of the per capita
income of the continental United States (including Alaska) and
Hawaii; except that (1) the Federal medical assistance
percentage shall in no case be less than 50 per centum or more
than 83 per centum, (2) the Federal medical assistance
percentage for Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, and American Samoa shall be 55
percent, (3) for purposes of this title and title XXI, the
Federal medical assistance percentage for the District of
Columbia shall be 70 percent, (4) the Federal medical
assistance percentage shall be equal to the enhanced FMAP
described in section 2105(b) with respect to medical assistance
provided to individuals who are eligible for such assistance
only on the basis of section 1902(a)(10)(A)(ii)(XVIII), and (5)
in the case of a State that provides medical assistance for
services and vaccines described in subparagraphs (A) and (B) of
subsection (a)(13), and prohibits cost-sharing for such
services and vaccines, the Federal medical assistance
percentage, as determined under this subsection and subsection
(y) (without regard to paragraph (1)(C) of such subsection),
shall be increased by 1 percentage point with respect to
medical assistance for such services and vaccines and for items
and services described in subsection (a)(4)(D). The Federal
medical assistance percentage for any State shall be determined
and promulgated in accordance with the provisions of section
1101(a)(8)(B). Notwithstanding the first sentence of this
section, the Federal medical assistance percentage shall be 100
per centum with respect to amounts expended as medical
assistance for services which are received through an Indian
Health Service facility whether operated by the Indian Health
Service or by an Indian tribe or tribal organization (as
defined in section 4 of the Indian Health Care Improvement
Act). Notwithstanding the first sentence of this subsection, in
the case of a State plan that meets the condition described in
subsection (u)(1), with respect to expenditures (other than
expenditures under section 1923) described in subsection
(u)(2)(A) or subsection (u)(3) for the State for a fiscal year,
and that do not exceed the amount of the State's available
allotment under section 2104, the Federal medical assistance
percentage is equal to the enhanced FMAP described in section
2105(b).
(c) For definition of the term ``nursing facility'', see
section 1919(a).
(d) The term ``intermediate care facility for the mentally
retarded'' means an institution (or distinct part thereof) for
the mentally retarded or persons with related conditions if--
(1) the primary purpose of such institution (or
distinct part thereof) is to provide health or
rehabilitative services for mentally retarded
individuals and the institution meets such standards as
may be prescribed by the Secretary;
(2) the mentally retarded individual with respect to
whom a request for payment is made under a plan
approved under this title is receiving active treatment
under such a program; and
(3) in the case of a public institution, the State or
political subdivision responsible for the operation of
such institution has agreed that the non-Federal
expenditures in any calendar quarter prior to January
1, 1975, with respect to services furnished to patients
in such institution (or distinct part thereof) in the
State will not, because of payments made under this
title, be reduced below the average amount expended for
such services in such institution in the four quarters
immediately preceding the quarter in which the State in
which such institution is located elected to make such
services available under its plan approved under this
title.
(e) In the case of any State the State plan of which (as
approved under this title)--
(1) does not provide for the payment of services
(other than services covered under section 1902(a)(12))
provided by an optometrist; but
(2) at a prior period did provide for the payment of
services referred to in paragraph (1);
the term ``physicians' services'' (as used in subsection
(a)(5)) shall include services of the type which an optometrist
is legally authorized to perform where the State plan
specifically provides that the term ``physicians' services'',
as employed in such plan, includes services of the type which
an optometrist is legally authorized to perform, and shall be
reimbursed whether furnished by a physician or an optometrist.
(f) For purposes of this title, the term ``nursing facility
services'' means services which are or were required to be
given an individual who needs or needed on a daily basis
nursing care (provided directly by or requiring the supervision
of nursing personnel) or other rehabilitation services which as
a practical matter can only be provided in a nursing facility
on an inpatient basis.
(g) If the State plan includes provision of chiropractors'
services, such services include only--
(1) services provided by a chiropractor (A) who is
licensed as such by the State and (B) who meets uniform
minimum standards promulgated by the Secretary under
section 1861(r)(5); and
(2) services which consist of treatment by means of
manual manipulation of the spine which the chiropractor
is legally authorized to perform by the State.
(h)(1) For purposes of paragraph (16) of subsection (a), the
term ``inpatient psychiatric hospital services for individuals
under age 21'' includes only--
(A) inpatient services which are provided in an
institution (or distinct part thereof) which is a
psychiatric hospital as defined in section 1861(f) or
in another inpatient setting that the Secretary has
specified in regulations;
(B) inpatient services which, in the case of any
individual (i) involve active treatment which meets
such standards as may be prescribed in regulations by
the Secretary, and (ii) a team, consisting of
physicians and other personnel qualified to make
determinations with respect to mental health conditions
and the treatment thereof, has determined are necessary
on an inpatient basis and can reasonably be expected to
improve the condition, by reason of which such services
are necessary, to the extent that eventually such
services will no longer be necessary; and
(C) inpatient services which, in the case of any
individual, are provided prior to (i) the date such
individual attains age 21, or (ii) in the case of an
individual who was receiving such services in the
period immediately preceding the date on which he
attained age 21, (I) the date such individual no longer
requires such services, or (II) if earlier, the date
such individual attains age 22;
(2) Such term does not include services provided during any
calendar quarter under the State plan of any State if the total
amount of the funds expended, during such quarter, by the State
(and the political subdivisions thereof) from non-Federal funds
for inpatient services included under paragraph (1), and for
active psychiatric care and treatment provided on an outpatient
basis for eligible mentally ill children, is less than the
average quarterly amount of the funds expended, during the 4-
quarter period ending December 31, 1971, by the State (and the
political subdivisions thereof) from non-Federal funds for such
services.
(i) The term ``institution for mental diseases'' means a
hospital, nursing facility, or other institution of more than
16 beds, that is primarily engaged in providing diagnosis,
treatment, or care of persons with mental diseases, including
medical attention, nursing care, and related services.
(j) The term ``State supplementary payment'' means any cash
payment made by a State on a regular basis to an individual who
is receiving supplemental security income benefits under title
XVI or who would but for his income be eligible to receive such
benefits, as assistance based on need in supplementation of
such benefits (as determined by the Commissioner of Social
Security), but only to the extent that such payments are made
with respect to an individual with respect to whom supplemental
security income benefits are payable under title XVI, or would
but for his income be payable under that title.
(k) Increased supplemental security income benefits payable
pursuant to section 211 of Public Law 93-66 shall not be
considered supplemental security income benefits payable under
title XVI.
(l)(1) The terms ``rural health clinic services'' and ``rural
health clinic'' have the meanings given such terms in section
1861(aa), except that (A) clause (ii) of section 1861(aa)(2)
shall not apply to such terms, and (B) the physician
arrangement required under section 1861(aa)(2)(B) shall only
apply with respect to rural health clinic services and, with
respect to other ambulatory care services, the physician
arrangement required shall be only such as may be required
under the State plan for those services.
(2)(A) The term ``Federally-qualified health center
services'' means services of the type described in
subparagraphs (A) through (C) of section 1861(aa)(1) when
furnished to an individual as an patient of a Federally-
qualified health center and, for this purpose, any reference to
a rural health clinic or a physician described in section
1861(aa)(2)(B) is deemed a reference to a Federally-qualified
health center or a physician at the center, respectively.
(B) The term ``Federally-qualified health center'' means an
entity which--
(i) is receiving a grant under section 330 of the
Public Health Service Act,
(ii)(I) is receiving funding from such a grant under
a contract with the recipient of such a grant, and
(II) meets the requirements to receive a grant under
section 330 of such Act,
(iii) based on the recommendation of the Health
Resources and Services Administration within the Public
Health Service, is determined by the Secretary to meet
the requirements for receiving such a grant, including
requirements of the Secretary that an entity may not be
owned, controlled, or operated by another entity, or
(iv) was treated by the Secretary, for purposes of
part B of title XVIII, as a comprehensive Federally
funded health center as of January 1, 1990;
and includes an outpatient health program or facility operated
by a tribe or tribal organization under the Indian Self-
Determination Act (Public Law 93-638) or by an urban Indian
organization receiving funds under title V of the Indian Health
Care Improvement Act for the provision of primary health
services. In applying clause (ii), the Secretary may waive any
requirement referred to in such clause for up to 2 years for
good cause shown.
(3)(A) The term ``freestanding birth center services'' means
services furnished to an individual at a freestanding birth
center (as defined in subparagraph (B)) at such center.
(B) The term ``freestanding birth center'' means a health
facility--
(i) that is not a hospital;
(ii) where childbirth is planned to occur away from
the pregnant woman's residence;
(iii) that is licensed or otherwise approved by the
State to provide prenatal labor and delivery or
postpartum care and other ambulatory services that are
included in the plan; and
(iv) that complies with such other requirements
relating to the health and safety of individuals
furnished services by the facility as the State shall
establish.
(C) A State shall provide separate payments to providers
administering prenatal labor and delivery or postpartum care in
a freestanding birth center (as defined in subparagraph (B)),
such as nurse midwives and other providers of services such as
birth attendants recognized under State law, as determined
appropriate by the Secretary. For purposes of the preceding
sentence, the term ``birth attendant'' means an individual who
is recognized or registered by the State involved to provide
health care at childbirth and who provides such care within the
scope of practice under which the individual is legally
authorized to perform such care under State law (or the State
regulatory mechanism provided by State law), regardless of
whether the individual is under the supervision of, or
associated with, a physician or other health care provider.
Nothing in this subparagraph shall be construed as changing
State law requirements applicable to a birth attendant.
(m)(1) Subject to paragraph (2), the term ``qualified family
member'' means an individual (other than a qualified pregnant
woman or child, as defined in subsection (n)) who is a member
of a family that would be receiving aid under the State plan
under part A of title IV pursuant to section 407 if the State
had not exercised the option under section 407(b)(2)(B)(i).
(2) No individual shall be a qualified family member for any
period after September 30, 1998.
(n) The term ``qualified pregnant woman or child'' means--
(1) a pregnant woman who--
(A) would be eligible for aid to families
with dependent children under part A of title
IV (or would be eligible for such aid if
coverage under the State plan under part A of
title IV included aid to families with
dependent children of unemployed parents
pursuant to section 407) if her child had been
born and was living with her in the month such
aid would be paid, and such pregnancy has been
medically verified;
(B) is a member of a family which would be
eligible for aid under the State plan under
part A of title IV pursuant to section 407 if
the plan required the payment of aid pursuant
to such section; or
(C) otherwise meets the income and resources
requirements of a State plan under part A of
title IV; and
(2) a child who has not attained the age of 19, who
was born after September 30, 1983 (or such earlier date
as the State may designate), and who meets the income
and resources requirements of the State plan under part
A of title IV.
(o)(1)(A) Subject to subparagraphs (B) and (C), the term
``hospice care'' means the care described in section
1861(dd)(1) furnished by a hospice program (as defined in
section 1861(dd)(2)) to a terminally ill individual who has
voluntarily elected (in accordance with paragraph (2)) to have
payment made for hospice care instead of having payment made
for certain benefits described in section 1812(d)(2)(A) and for
which payment may otherwise be made under title XVIII and
intermediate care facility services under the plan. For
purposes of such election, hospice care may be provided to an
individual while such individual is a resident of a skilled
nursing facility or intermediate care facility, but the only
payment made under the State plan shall be for the hospice
care.
(B) For purposes of this title, with respect to the
definition of hospice program under section 1861(dd)(2), the
Secretary may allow an agency or organization to make the
assurance under subparagraph (A)(iii) of such section without
taking into account any individual who is afflicted with
acquired immune deficiency syndrome (AIDS).
(C) A voluntary election to have payment made for hospice
care for a child (as defined by the State) shall not constitute
a waiver of any rights of the child to be provided with, or to
have payment made under this title for, services that are
related to the treatment of the child's condition for which a
diagnosis of terminal illness has been made.
(2) An individual's voluntary election under this subsection
--
(A) shall be made in accordance with procedures that
are established by the State and that are consistent
with the procedures established under section
1812(d)(2);
(B) shall be for such a period or periods (which need
not be the same periods described in section
1812(d)(1)) as the State may establish; and
(C) may be revoked at any time without a showing of
cause and may be modified so as to change the hospice
program with respect to which a previous election was
made.
(3) In the case of an individual--
(A) who is residing in a nursing facility or
intermediate care facility for the mentally retarded
and is receiving medical assistance for services in
such facility under the plan,
(B) who is entitled to benefits under part A of title
XVIII and has elected, under section 1812(d), to
receive hospice care under such part, and
(C) with respect to whom the hospice program under
such title and the nursing facility or intermediate
care facility for the mentally retarded have entered
into a written agreement under which the program takes
full responsibility for the professional management of
the individual's hospice care and the facility agrees
to provide room and board to the individual,
instead of any payment otherwise made under the plan with
respect to the facility's services, the State shall provide for
payment to the hospice program of an amount equal to the
additional amount determined in section 1902(a)(13)(B) and, if
the individual is an individual described in section
1902(a)(10)(A), shall provide for payment of any coinsurance
amounts imposed under section 1813(a)(4).
(p)(1) The term ``qualified medicare beneficiary'' means an
individual--
(A) who is entitled to hospital insurance benefits
under part A of title XVIII (including an individual
entitled to such benefits pursuant to an enrollment
under section 1818, but not including an individual
entitled to such benefits only pursuant to an
enrollment under section 1818A),
(B) whose income (as determined under section 1612
for purposes of the supplemental security income
program, except as provided in paragraph (2)(D)) does
not exceed an income level established by the State
consistent with paragraph (2), and
(C) whose resources (as determined under section 1613
for purposes of the supplemental security income
program) do not exceed twice the maximum amount of
resources that an individual may have and obtain
benefits under that program or, effective beginning
with January 1, 2010, whose resources (as so
determined) do not exceed the maximum resource level
applied for the year under subparagraph (D) of section
1860D-14(a)(3) (determined without regard to the life
insurance policy exclusion provided under subparagraph
(G) of such section) applicable to an individual or to
the individual and the individual's spouse (as the case
may be).
(2)(A) The income level established under paragraph (1)(B)
shall be at least the percent provided under subparagraph (B)
(but not more than 100 percent) of the official poverty line
(as defined by the Office of Management and Budget, and revised
annually in accordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981) applicable to a family of
the size involved.
(B) Except as provided in subparagraph (C), the percent
provided under this clause, with respect to eligibility for
medical assistance on or after--
(i) January 1, 1989, is 85 percent,
(ii) January 1, 1990, is 90 percent, and
(iii) January 1, 1991, is 100 percent.
(C) In the case of a State which has elected treatment under
section 1902(f) and which, as of January 1, 1987, used an
income standard for individuals age 65 or older which was more
restrictive than the income standard established under the
supplemental security income program under title XVI, the
percent provided under subparagraph (B), with respect to
eligibility for medical assistance on or after--
(i) January 1, 1989, is 80 percent,
(ii) January 1, 1990, is 85 percent,
(iii) January 1, 1991, is 95 percent, and
(iv) January 1, 1992, is 100 percent.
(D)(i) In determining under this subsection the income of an
individual who is entitled to monthly insurance benefits under
title II for a transition month (as defined in clause (ii)) in
a year, such income shall not include any amounts attributable
to an increase in the level of monthly insurance benefits
payable under such title which have occurred pursuant to
section 215(i) for benefits payable for months beginning with
December of the previous year.
(ii) For purposes of clause (i), the term ``transition
month'' means each month in a year through the month following
the month in which the annual revision of the official poverty
line, referred to in subparagraph (A), is published.
(3) The term ``medicare cost-sharing'' means (subject to
section 1902(n)(2)) the following costs incurred with respect
to a qualified medicare beneficiary, without regard to whether
the costs incurred were for items and services for which
medical assistance is otherwise available under the plan:
(A)(i) premiums under section 1818 or 1818A, and
(ii) premiums under section 1839,
(B) Coinsurance under title XVIII (including
coinsurance described in section 1813).
(C) Deductibles established under title XVIII
(including those described in section 1813 and section
1833(b)).
(D) The difference between the amount that is paid
under section 1833(a) and the amount that would be paid
under such section if any reference to ``80 percent''
therein were deemed a reference to ``100 percent''.
Such term also may include, at the option of a State, premiums
for enrollment of a qualified medicare beneficiary with an
eligible organization under section 1876.
(4) Notwithstanding any other provision of this title, in the
case of a State (other than the 50 States and the District of
Columbia)--
(A) the requirement stated in section 1902(a)(10)(E)
shall be optional, and
(B) for purposes of paragraph (2), the State may
substitute for the percent provided under subparagraph
(B) of such paragraph or 1902(a)(10)(E)(iii) any
percent.
In the case of any State which is providing medical assistance
to its residents under a waiver granted under section 1115, the
Secretary shall require the State to meet the requirement of
section 1902(a)(10)(E) in the same manner as the State would be
required to meet such requirement if the State had in effect a
plan approved under this title.
(5)(A) The Secretary shall develop and distribute to States a
simplified application form for use by individuals (including
both qualified medicare beneficiaries and specified low-income
medicare beneficiaries) in applying for medical assistance for
medicare cost-sharing under this title in the States which
elect to use such form. Such form shall be easily readable by
applicants and uniform nationally. The Secretary shall provide
for the translation of such application form into at least the
10 languages (other than English) that are most often used by
individuals applying for hospital insurance benefits under
section 226 or 226A and shall make the translated forms
available to the States and to the Commissioner of Social
Security.
(B) In developing such form, the Secretary shall consult with
beneficiary groups and the States.
(6) For provisions relating to outreach efforts to increase
awareness of the availability of medicare cost-sharing, see
section 1144.
(q) The term ``qualified severely impaired individual'' means
an individual under age 65--
(1) who for the month preceding the first month to
which this subsection applies to such individual--
(A) received (i) a payment of supplemental
security income benefits under section 1611(b)
on the basis of blindness or disability, (ii) a
supplementary payment under section 1616 of
this Act or under section 212 of Public Law 93-
66 on such basis, (iii) a payment of monthly
benefits under section 1619(a), or (iv) a
supplementary payment under section 1616(c)(3),
and
(B) was eligible for medical assistance under
the State plan approved under this title; and
(2) with respect to whom the Commissioner of Social
Security determines that--
(A) the individual continues to be blind or
continues to have the disabling physical or
mental impairment on the basis of which he was
found to be under a disability and, except for
his earnings, continues to meet all non-
disability-related requirements for eligibility
for benefits under title XVI,
(B) the income of such individual would not,
except for his earnings, be equal to or in
excess of the amount which would cause him to
be ineligible for payments under section
1611(b) (if he were otherwise eligible for such
payments),
(C) the lack of eligibility for benefits
under this title would seriously inhibit his
ability to continue or obtain employment, and
(D) the individual's earnings are not
sufficient to allow him to provide for himself
a reasonable equivalent of the benefits under
title XVI (including any federally administered
State supplementary payments), this title, and
publicly funded attendant care services
(including personal care assistance) that would
be available to him in the absence of such
earnings.
In the case of an individual who is eligible for
medical assistance pursuant to section 1619(b) in June,
1987, the individual shall be a qualified severely
impaired individual for so long as such individual
meets the requirements of paragraph (2).
(r) The term ``early and periodic screening, diagnostic, and
treatment services'' means the following items and services:
(1) Screening services--
(A) which are provided--
(i) at intervals which meet
reasonable standards of medical and
dental practice, as determined by the
State after consultation with
recognized medical and dental
organizations involved in child health
care and, with respect to immunizations
under subparagraph (B)(iii), in
accordance with the schedule referred
to in section 1928(c)(2)(B)(i) for
pediatric vaccines, and
(ii) at such other intervals,
indicated as medically necessary, to
determine the existence of certain
physical or mental illnesses or
conditions; and
(B) which shall at a minimum include--
(i) a comprehensive health and
developmental history (including
assessment of both physical and mental
health development),
(ii) a comprehensive unclothed
physical exam,
(iii) appropriate immunizations
(according to the schedule referred to
in section 1928(c)(2)(B)(i) for
pediatric vaccines) according to age
and health history,
(iv) laboratory tests (including lead
blood level assessment appropriate for
age and risk factors), and
(v) health education (including
anticipatory guidance).
(2) Vision services--
(A) which are provided--
(i) at intervals which meet
reasonable standards of medical
practice, as determined by the State
after consultation with recognized
medical organizations involved in child
health care, and
(ii) at such other intervals,
indicated as medically necessary, to
determine the existence of a suspected
illness or condition; and
(B) which shall at a minimum include
diagnosis and treatment for defects in vision,
including eyeglasses.
(3) Dental services--
(A) which are provided--
(i) at intervals which meet
reasonable standards of dental
practice, as determined by the State
after consultation with recognized
dental organizations involved in child
health care, and
(ii) at such other intervals,
indicated as medically necessary, to
determine the existence of a suspected
illness or condition; and
(B) which shall at a minimum include relief
of pain and infections, restoration of teeth,
and maintenance of dental health.
(4) Hearing services--
(A) which are provided--
(i) at intervals which meet
reasonable standards of medical
practice, as determined by the State
after consultation with recognized
medical organizations involved in child
health care, and
(ii) at such other intervals,
indicated as medically necessary, to
determine the existence of a suspected
illness or condition; and
(B) which shall at a minimum include
diagnosis and treatment for defects in hearing,
including hearing aids.
(5) Such other necessary health care, diagnostic
services, treatment, and other measures described in
section 1905(a) to correct or ameliorate defects and
physical and mental illnesses and conditions discovered
by the screening services, whether or not such services
are covered under the State plan.
Nothing in this title shall be construed as limiting providers
of early and periodic screening, diagnostic, and treatment
services to providers who are qualified to provide all of the
items and services described in the previous sentence or as
preventing a provider that is qualified under the plan to
furnish one or more (but not all) of such items or services
from being qualified to provide such items and services as part
of early and periodic screening, diagnostic, and treatment
services. The Secretary shall, not later than July 1, 1990, and
every 12 months thereafter, develop and set annual
participation goals for each State for participation of
individuals who are covered under the State plan under this
title in early and periodic screening, diagnostic, and
treatment services.
(s) The term ``qualified disabled and working individual''
means an individual--
(1) who is entitled to enroll for hospital insurance
benefits under part A of title XVIII under section
1818A (as added by 6012 of the Omnibus Budget
Reconciliation Act of 1989);
(2) whose income (as determined under section 1612
for purposes of the supplemental security income
program) does not exceed 200 percent of the official
poverty line (as defined by the Office of Management
and Budget and revised annually in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act
of 1981) applicable to a family of the size involved;
(3) whose resources (as determined under section 1613
for purposes of the supplemental security income
program) do not exceed twice the maximum amount of
resources that an individual or a couple (in the case
of an individual with a spouse) may have and obtain
benefits for supplemental security income benefits
under title XVI; and
(4) who is not otherwise eligible for medical
assistance under this title.
(t)(1) The term ``primary care case management services''
means case-management related services (including locating,
coordinating, and monitoring of health care services) provided
by a primary care case manager under a primary care case
management contract.
(2) The term ``primary care case manager'' means any of the
following that provides services of the type described in
paragraph (1) under a contract referred to in such paragraph:
(A) A physician, a physician group practice, or an
entity employing or having other arrangements with
physicians to provide such services.
(B) At State option--
(i) a nurse practitioner (as described in
section 1905(a)(21));
(ii) a certified nurse-midwife (as defined in
section 1861(gg)); or
(iii) a physician assistant (as defined in
section 1861(aa)(5)).
(3) The term ``primary care case management contract'' means
a contract between a primary care case manager and a State
under which the manager undertakes to locate, coordinate, and
monitor covered primary care (and such other covered services
as may be specified under the contract) to all individuals
enrolled with the manager, and which--
(A) provides for reasonable and adequate hours of
operation, including 24-hour availability of
information, referral, and treatment with respect to
medical emergencies;
(B) restricts enrollment to individuals residing
sufficiently near a service delivery site of the
manager to be able to reach that site within a
reasonable time using available and affordable modes of
transportation;
(C) provides for arrangements with, or referrals to,
sufficient numbers of physicians and other appropriate
health care professionals to ensure that services under
the contract can be furnished to enrollees promptly and
without compromise to quality of care;
(D) prohibits discrimination on the basis of health
status or requirements for health care services in
enrollment, disenrollment, or reenrollment of
individuals eligible for medical assistance under this
title;
(E) provides for a right for an enrollee to terminate
enrollment in accordance with section 1932(a)(4); and
(F) complies with the other applicable provisions of
section 1932.
(4) For purposes of this subsection, the term ``primary
care'' includes all health care services customarily provided
in accordance with State licensure and certification laws and
regulations, and all laboratory services customarily provided
by or through, a general practitioner, family medicine
physician, internal medicine physician, obstetrician/
gynecologist, or pediatrician.
(u)(1) The conditions described in this paragraph for a State
plan are as follows:
(A) The State is complying with the requirement of
section 2105(d)(1).
(B) The plan provides for such reporting of
information about expenditures and payments
attributable to the operation of this subsection as the
Secretary deems necessary in order to carry out the
fourth sentence of subsection (b).
(2)(A) For purposes of subsection (b), the expenditures
described in this subparagraph are expenditures for medical
assistance for optional targeted low-income children described
in subparagraph (B).
(B) For purposes of this paragraph, the term ``optional
targeted low-income child'' means a targeted low-income child
as defined in section 2110(b)(1) (determined without regard to
that portion of subparagraph (C) of such section concerning
eligibility for medical assistance under this title) who would
not qualify for medical assistance under the State plan under
this title as in effect on March 31, 1997 (but taking into
account the expansion of age of eligibility effected through
the operation of section 1902(l)(1)(D)). Such term excludes any
child eligible for medical assistance only by reason of section
1902(a)(10)(A)(ii)(XIX).
(3) For purposes of subsection (b), the expenditures
described in this paragraph are expenditures for medical
assistance for children who are born before October 1, 1983,
and who would be described in section 1902(l)(1)(D) if they had
been born on or after such date, and who are not eligible for
such assistance under the State plan under this title based on
such State plan as in effect as of March 31, 1997.
(4) The limitations on payment under subsections (f) and (g)
of section 1108 shall not apply to Federal payments made under
section 1903(a)(1) based on an enhanced FMAP described in
section 2105(b).
(v)(1) The term ``employed individual with a medically
improved disability'' means an individual who--
(A) is at least 16, but less than 65, years of age;
(B) is employed (as defined in paragraph (2));
(C) ceases to be eligible for medical assistance
under section 1902(a)(10)(A)(ii)(XV) because the
individual, by reason of medical improvement, is
determined at the time of a regularly scheduled
continuing disability review to no longer be eligible
for benefits under section 223(d) or 1614(a)(3); and
(D) continues to have a severe medically determinable
impairment, as determined under regulations of the
Secretary.
(2) For purposes of paragraph (1), an individual is
considered to be ``employed'' if the individual--
(A) is earning at least the applicable minimum wage
requirement under section 6 of the Fair Labor Standards
Act (29 U.S.C. 206) and working at least 40 hours per
month; or
(B) is engaged in a work effort that meets
substantial and reasonable threshold criteria for hours
of work, wages, or other measures, as defined by the
State and approved by the Secretary.'
(w)(1) For purposes of this title, the term ``independent
foster care adolescent'' means an individual--
(A) who is under 21 years of age;
(B) who, on the individual's 18th birthday, was in
foster care under the responsibility of a State; and
(C) whose assets, resources, and income do not exceed
such levels (if any) as the State may establish
consistent with paragraph (2).
(2) The levels established by a State under paragraph (1)(C)
may not be less than the corresponding levels applied by the
State under section 1931(b).
(3) A State may limit the eligibility of independent foster
care adolescents under section 1902(a)(10)(A)(ii)(XVII) to
those individuals with respect to whom foster care maintenance
payments or independent living services were furnished under a
program funded under part E of title IV before the date the
individuals attained 18 years of age.
(x) For purposes of subsection (a)(27), the strategies,
treatment, and services described in that subsection include
the following:
(1) Chronic blood transfusion (with deferoxamine
chelation) to prevent stroke in individuals with Sickle
Cell Disease who have been identified as being at high
risk for stroke.
(2) Genetic counseling and testing for individuals
with Sickle Cell Disease or the sickle cell trait to
allow health care professionals to treat such
individuals and to prevent symptoms of Sickle Cell
Disease.
(3) Other treatment and services to prevent
individuals who have Sickle Cell Disease and who have
had a stroke from having another stroke.
(y) Increased FMAP for Medical Assistance for Newly Eligible
Mandatory Individuals.--
(1) Amount of increase.--Notwithstanding subsection
(b), the Federal medical assistance percentage for a
State that is one of the 50 States or the District of
Columbia, with respect to amounts expended by such
State for medical assistance for newly eligible
individuals described in subclause (VIII) of section
1902(a)(10)(A)(i), shall be equal to--
(A) 100 percent for calendar quarters in
2014, 2015, and 2016;
(B) 95 percent for calendar quarters in 2017;
(C) 94 percent for calendar quarters in 2018;
(D) 93 percent for calendar quarters in 2019;
and
(E) 90 percent for calendar quarters in 2020
and each year thereafter.
(2) Definitions.--In this subsection:
(A) Newly eligible.--The term ``newly
eligible'' means, with respect to an individual
described in subclause (VIII) of section
1902(a)(10)(A)(i), an individual who is not
under 19 years of age (or such higher age as
the State may have elected) and who, as of
December 1, 2009, is not eligible under the
State plan or under a waiver of the plan for
full benefits or for benchmark coverage
described in subparagraph (A), (B), or (C) of
section 1937(b)(1) or benchmark equivalent
coverage described in section 1937(b)(2) that
has an aggregate actuarial value that is at
least actuarially equivalent to benchmark
coverage described in subparagraph (A), (B), or
(C) of section 1937(b)(1), or is eligible but
not enrolled (or is on a waiting list) for such
benefits or coverage through a waiver under the
plan that has a capped or limited enrollment
that is full.
(B) Full benefits.--The term ``full
benefits'' means, with respect to an
individual, medical assistance for all services
covered under the State plan under this title
that is not less in amount, duration, or scope,
or is determined by the Secretary to be
substantially equivalent, to the medical
assistance available for an individual
described in section 1902(a)(10)(A)(i).
(z) Equitable Support for Certain States.--
(1)(A) During the period that begins on January 1,
2014, and ends on December 31, 2015, notwithstanding
subsection (b), the Federal medical assistance
percentage otherwise determined under subsection (b)
with respect to a fiscal year occurring during that
period shall be increased by 2.2 percentage points for
any State described in subparagraph (B) for amounts
expended for medical assistance for individuals who are
not newly eligible (as defined in subsection (y)(2))
individuals described in subclause (VIII) of section
1902(a)(10)(A)(i).
(B) For purposes of subparagraph (A), a State
described in this subparagraph is a State that--
(i) is an expansion State described in
paragraph (3);
(ii) the Secretary determines will not
receive any payments under this title on the
basis of an increased Federal medical
assistance percentage under subsection (y) for
expenditures for medical assistance for newly
eligible individuals (as so defined); and
(iii) has not been approved by the Secretary
to divert a portion of the DSH allotment for a
State to the costs of providing medical
assistance or other health benefits coverage
under a waiver that is in effect on July 2009.
(2)(A) For calendar quarters in 2014 and each year
thereafter, the Federal medical assistance percentage
otherwise determined under subsection (b) for an
expansion State described in paragraph (3) with respect
to medical assistance for individuals described in
section 1902(a)(10)(A)(i)(VIII) who are nonpregnant
childless adults with respect to whom the State may
require enrollment in benchmark coverage under section
1937 shall be equal to the percent specified in
subparagraph (B)(i) for such year.
(B)(i) The percent specified in this subparagraph for
a State for a year is equal to the Federal medical
assistance percentage (as defined in the first sentence
of subsection (b)) for the State increased by a number
of percentage points equal to the transition percentage
(specified in clause (ii) for the year) of the number
of percentage points by which--
(I) such Federal medical assistance
percentage for the State, is less than
(II) the percent specified in subsection
(y)(1) for the year.
(ii) The transition percentage specified in this
clause for--
(I) 2014 is 50 percent;
(II) 2015 is 60 percent;
(III) 2016 is 70 percent;
(IV) 2017 is 80 percent;
(V) 2018 is 90 percent; and
(VI) 2019 and each subsequent year is 100
percent.
(3) A State is an expansion State if, on the date of
the enactment of the Patient Protection and Affordable
Care Act, the State offers health benefits coverage
statewide to parents and nonpregnant, childless adults
whose income is at least 100 percent of the poverty
line, that includes inpatient hospital services, is not
dependent on access to employer coverage, employer
contribution, or employment and is not limited to
premium assistance, hospital-only benefits, a high
deductible health plan, or alternative benefits under a
demonstration program authorized under section 1938. A
State that offers health benefits coverage to only
parents or only nonpregnant childless adults described
in the preceding sentence shall not be considered to be
an expansion State.
(aa)(1) Notwithstanding subsection (b), beginning January 1,
2011, the Federal medical assistance percentage for a fiscal
year for a disaster-recovery FMAP adjustment State shall be
equal to the following:
(A) In the case of the first fiscal year (or part of
a fiscal year) for which this subsection applies to the
State, the State's regular FMAP shall be increased by
50 percent of the number of percentage points by which
the State's regular FMAP for such fiscal year is less
than the Federal medical assistance percentage
determined for the State for the preceding fiscal year
after the application of only subsection (a) of section
5001 of Public Law 111-5 (if applicable to the
preceding fiscal year) and without regard to this
subsection, subsections (y) and (z), and subsections
(b) and (c) of section 5001 of Public Law 111-5.
(B) In the case of the second or any succeeding
fiscal year for which this subsection applies to the
State, the State's regular FMAP for such fiscal year
shall be increased by 25 percent (or 50 percent in the
case of fiscal year 2013) of the number of percentage
points by which the State's regular FMAP for such
fiscal year is less than the Federal medical assistance
percentage received by the State during the preceding
fiscal year.
(2) In this subsection, the term ``disaster-recovery FMAP
adjustment State'' means a State that is one of the 50 States
or the District of Columbia, for which, at any time during the
preceding 7 fiscal years, the President has declared a major
disaster under section 401 of the Robert T. Stafford Disaster
Relief and Emergency Assistance Act and determined as a result
of such disaster that every county or parish in the State
warrant individual and public assistance or public assistance
from the Federal Government under such Act and for which--
(A) in the case of the first fiscal year (or part of
a fiscal year) for which this subsection applies to the
State, the State's regular FMAP for the fiscal year is
less than the Federal medical assistance percentage
determined for the State for the preceding fiscal year
after the application of only subsection (a) of section
5001 of Public Law 111-5 (if applicable to the
preceding fiscal year) and without regard to this
subsection, subsections (y) and (z), and subsections
(b) and (c) of section 5001 of Public Law 111-5, by at
least 3 percentage points; and
(B) in the case of the second or any succeeding
fiscal year for which this subsection applies to the
State, the State's regular FMAP for the fiscal year is
less than the Federal medical assistance percentage
determined for the State for the preceding fiscal year
under this subsection by at least 3 percentage points.
(3) In this subsection, the term ``regular FMAP'' means, for
each fiscal year for which this subsection applies to a State,
the Federal medical assistance percentage that would otherwise
apply to the State for the fiscal year, as determined under
subsection (b) and without regard to this subsection,
subsections (y) and (z), and section 10202 of the Patient
Protection and Affordable Care Act.
(4) The Federal medical assistance percentage determined for
a disaster-recovery FMAP adjustment State under paragraph (1)
shall apply for purposes of this title (other than with respect
to disproportionate share hospital payments described in
section 1923 and payments under this title that are based on
the enhanced FMAP described in 2105(b)) and shall not apply
with respect to payments under title IV (other than under part
E of title IV) or payments under title XXI.
(bb)(1) For purposes of this title, the term ``counseling and
pharmacotherapy for cessation of tobacco use by pregnant
women'' means diagnostic, therapy, and counseling services and
pharmacotherapy (including the coverage of prescription and
nonprescription tobacco cessation agents approved by the Food
and Drug Administration) for cessation of tobacco use by
pregnant women who use tobacco products or who are being
treated for tobacco use that is furnished--
(A) by or under the supervision of a physician; or
(B) by any other health care professional who--
(i) is legally authorized to furnish such
services under State law (or the State
regulatory mechanism provided by State law) of
the State in which the services are furnished;
and
(ii) is authorized to receive payment for
other services under this title or is
designated by the Secretary for this purpose.
(2) Subject to paragraph (3), such term is limited to--
(A) services recommended with respect to pregnant
women in ``Treating Tobacco Use and Dependence: 2008
Update: A Clinical Practice Guideline'', published by
the Public Health Service in May 2008, or any
subsequent modification of such Guideline; and
(B) such other services that the Secretary recognizes
to be effective for cessation of tobacco use by
pregnant women.
(3) Such term shall not include coverage for drugs or
biologicals that are not otherwise covered under this title.
(cc) Requirement for Certain States.--Notwithstanding
subsections (y), (z), and (aa), in the case of a State that
requires political subdivisions within the State to contribute
toward the non-Federal share of expenditures required under the
State plan under section 1902(a)(2), the State shall not be
eligible for an increase in its Federal medical assistance
percentage under such subsections if it requires that political
subdivisions pay a greater percentage of the non-Federal share
of such expenditures, or a greater percentage of the non-
Federal share of payments under section 1923, than the
respective percentages that would have been required by the
State under the State plan under this title, State law, or
both, as in effect on December 31, 2009, and without regard to
any such increase. Voluntary contributions by a political
subdivision to the non-Federal share of expenditures under the
State plan under this title or to the non-Federal share of
payments under section 1923, shall not be considered to be
required contributions for purposes of this subsection. The
treatment of voluntary contributions, and the treatment of
contributions required by a State under the State plan under
this title, or State law, as provided by this subsection, shall
also apply to the increases in the Federal medical assistance
percentage under section 5001 of the American Recovery and
Reinvestment Act of 2009.
(dd) Increased FMAP for Additional Expenditures for Primary
Care Services.--Notwithstanding subsection (b), with respect to
the portion of the amounts expended for medical assistance for
services described in section 1902(a)(13)(C) furnished on or
after January 1, 2013, and before January 1, 2015, that is
attributable to the amount by which the minimum payment rate
required under such section (or, by application, section
1932(f)) exceeds the payment rate applicable to such services
under the State plan as of July 1, 2009, the Federal medical
assistance percentage for a State that is one of the 50 States
or the District of Columbia shall be equal to 100 percent. The
preceding sentence does not prohibit the payment of Federal
financial participation based on the Federal medical assistance
percentage for amounts in excess of those specified in such
sentence.
* * * * * * *
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PROTECTING ACCESS TO MEDICARE ACT OF 2014
* * * * * * *
TITLE II--OTHER HEALTH PROVISIONS
* * * * * * *
SEC. 224. ASSISTED OUTPATIENT TREATMENT GRANT PROGRAM FOR INDIVIDUALS
WITH SERIOUS MENTAL ILLNESS.
(a) In general.--The Secretary shall establish a 4-year pilot
program to award not more than 50 grants each year to eligible
entities for assisted outpatient treatment programs for
individuals with serious mental illness.
(b) Consultation.--The Secretary shall carry out this section
in consultation with the Director of the National Institute of
Mental Health, the Attorney General of the United States, the
Administrator of the Administration for Community Living, and
the Administrator of the Substance Abuse and Mental Health
Services Administration.
(c) Selecting Among Applicants.--The Secretary--
(1) may only award grants under this section to
applicants that have not previously implemented an
assisted outpatient treatment program; and
(2) shall evaluate applicants based on their
potential to reduce hospitalization, homelessness,
incarceration, and interaction with the criminal
justice system while improving the health and social
outcomes of the patient.
(d) Use of Grant.--An assisted outpatient treatment program
funded with a grant awarded under this section shall include--
(1) evaluating the medical and social needs of the
patients who are participating in the program;
(2) preparing and executing treatment plans for such
patients that--
(A) include criteria for completion of court-
ordered treatment; and
(B) provide for monitoring of the patient's
compliance with the treatment plan, including
compliance with medication and other treatment
regimens;
(3) providing for such patients case management
services that support the treatment plan;
(4) ensuring appropriate referrals to medical and
social service providers;
(5) evaluating the process for implementing the
program to ensure consistency with the patient's needs
and State law; and
(6) measuring treatment outcomes, including health
and social outcomes such as rates of incarceration,
health care utilization, and homelessness.
(e) Report.--Not later than the end of each of fiscal years
2016, 2017, and 2018, the Secretary shall submit a report to
the appropriate congressional committees on the grant program
under this section. Each such report shall include an
evaluation of the following:
(1) Cost savings and public health outcomes such as
mortality, suicide, substance abuse, hospitalization,
and use of services.
(2) Rates of incarceration by patients.
(3) Rates of homelessness among patients.
(4) Patient and family satisfaction with program
participation.
(f) Definitions.--In this section:
(1) The term ``assisted outpatient treatment'' means
medically prescribed mental health treatment that a
patient receives while living in a community under the
terms of a law authorizing a State or local court to
order such treatment.
(2) The term ``eligible entity'' means a county,
city, mental health system, mental health court, or any
other entity with authority under the law of the State
in which the grantee is located to implement, monitor,
and oversee assisted outpatient treatment programs.
(3) The term ``Secretary'' means the Secretary of
Health and Human Services.
(g) Funding.--
(1) Amount of grants.--A grant under this section
shall be in an amount that is not more than $1,000,000
for each of fiscal years 2015 through [2018] 2022.
Subject to the preceding sentence, the Secretary shall
determine the amount of each grant based on the
population of the area, including estimated patients,
to be served under the grant.
(2) Authorization of appropriations.--There [is
authorized to be appropriated to carry out this section
$15,000,000 for each of fiscal years 2015 through 2018]
are authorized to be appropriated to carry out this
section $15,000,000 for each of fiscal years 2015
through 2017, $20,000,000 for fiscal year 2018,
$19,000,000 for each of fiscal years 2019 and 2020, and
$18,000,000 for each of fiscal years 2021 and 2022.
* * * * * * *
[all]