Mental health draft bill

[Discussion Draft]

[DISCUSSION DRAFT] 113TH CONGRESS

2D SESSION H. R. ll øReview: To improve mental health¿øFor messaging, how would you express

the long title?¿.

IN THE HOUSE OF REPRESENTATIVES

Mr. BARBER introduced the following bill; which was referred to the

Committee on llllllllllllll

A BILL øReview: To improve mental health¿øFor messaging, how

would you express the long title?¿.

Be it enacted by the Senate and House of Representa-1

tives of the United States of America in Congress assembled, 2

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3

(a) SHORT TITLE.—This Act may be cited as the 4

‘‘Strengthening Mental Health in Our Communities Act 5

of 2014’’. 6

(b) TABLE OF CONTENTS.—The table of contents for 7

this Act is as follows:8

Sec. 1. Short title; table of contents.

Sec. 2. White House Office of Mental Health Policy.

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Sec. 3. Appointment and duties of the Director.

Sec. 4. National strategy for mental health.

Sec. 5. Coordination with Federal departments and agencies.

Sec. 6. National mental health advisory board.

TITLE I—STRENGTHENING AND INVESTING IN SAMHSA

PROGRAMS

Sec. 101. Community mental health services block grant reauthorization.

Sec. 102. Reporting requirements for block grants regarding mental health and

substance use disorders.

Sec. 103. Garrett Lee Smith Memorial Act Reauthorization.

Sec. 104. Programs of regional and national significance reauthorization.

Sec. 105. Grants for jail diversion programs reauthorization.

Sec. 106. Comprehensive community mental health services for children with

serious emotional disturbances.

Sec. 107. Grants to address the problems of individuals who experience trauma

and violence related stress.

Sec. 108. Protection and advocacy for individuals with mental illness reauthor-

ization.

Sec. 109. Mental health awareness training grants.

Sec. 110. National media campaign to reduce the stigma associated with men-

tal illness.

Sec. 111. SAMHSA and HRSA integration of mental health services into pri-

mary care settings.

Sec. 112. Evidence-based practices for older Americans.

TITLE II—IMPROVING MEDICAID AND MEDICARE MENTAL

HEALTH SERVICES

Sec. 201. Access to mental health prescription drugs under Medicare and Med-

icaid.

Sec. 202. Medicaid Coverage of Mental Health Services and Primary Care

Services Furnished on the Same Day.

Sec. 203. Elimination of 190-day lifetime limit on inpatient psychiatric hospital

services.

Sec. 204. Discharge planning in psychiatric facilities.

Sec. 205. Coverage of intensive outpatient services.

Sec. 206. Expanding the Medicaid home and community-based services waiver

to include youth in need of services provided in a psychiatric

residential treatment facility.

Sec. 207. Application of Rosa’s Law for Individuals with Intellectual Disabil-

ities.

Sec. 208. Complete application of mental health parity rules under Medicaid

and CHIP.

TITLE III—DEVELOPING THE BEHAVIORAL HEALTH WORKFORCE

Sec. 301. National health service corps scholarship and loan repayment funding

for behavioral and mental health professionals.

Sec. 302. Reauthorization of HRSA’s mental and behavioral health education

and training program.

Sec. 303. SAMHSA grant program for development and implementation of cur-

ricula for continuing education on serious mental illness.



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Sec. 304. Demonstration grant program to recruit, train, deploy, and profes-

sionally support psychiatric physicians in Indian health pro-

grams.

Sec. 305. Including occupational therapists as behavioral and mental health

professionals for purposes of the National Health Service

Corps.

Sec. 306. Coverage of marriage and family therapist services and mental health

counselor services under part B of the Medicare program.

Sec. 307. Extension of certain health care workforce loan repayment programs

through fiscal year 2018.

TITLE IV—IMPROVING MENTAL HEALTH RESEARCH AND

COORDINATION

Sec. 401. National institute of mental health research program on serious men-

tal illness.

Sec. 402. Suicide prevention and brain research.

Sec. 403. Youth mental health research network.

Sec. 404. National violent death reporting system.

TITLE V—EDUCATION AND YOUTH

Sec. 501. School-Based Mental Health Programs.

Sec. 502. Improving mental health and behavioral health outcomes on college

campuses.

Sec. 503. Examining mental health care for children.

TITLE VI—JUSTICE AND MENTAL HEALTH COLLABORATION

Sec. 601. Assisting veterans.

Sec. 602. Correctional facilities.

Sec. 603. High utilizers.

Sec. 604. Academy training.

Sec. 605. Evidence based practices.

Sec. 606. Safe communities.

Sec. 607. Reauthorization of appropriations.

TITLE VII—BEHAVIORAL HEALTH INFORMATION TECHNOLOGY

Sec. 701. Extension of health information technology assistance for behavioral

and mental health and substance abuse.

Sec. 702. Extension of eligibility for medicare and Medicaid health information

technology implementation assistance.

TITLE VIII—SERVICE MEMBERS AND VETERANS MENTAL

HEALTH

Sec. 801. Preliminary mental health assessments.

Sec. 802. Extension of eligibility for domiciliary care for certain veterans who

served in a theater of combat operations.

Sec. 803. Review of characterization or terms of discharge from the Armed

Forces of individuals with mental health disorders alleged to

affect terms of discharge.

Sec. 804. Improvement of mental health care provided by Department of Vet-

erans Affairs and Department of Defense.

Sec. 805. Collaboration between Department of Veterans Affairs and Depart-

ment of Defense on health care matters.



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Sec. 806. Pilot program for repayment of educational loans for certain psychia-

trists of Veterans Health Administration.

Sec. 807. Comptroller General study on pay disparities of psychiatrists of Vet-

erans Health Administration.

TITLE IX—MAKING PARITY WORK

Sec. 901. Clarification of HIPAA training requirements regarding disclosure of

protected health information concerning individuals with men-

tal health disorders.

Sec. 902. GAO study on mental health parity enforcement efforts.

Sec. 903. Report to Congress on Federal assistance to State insurance regu-

lators regarding mental health parity enforcement.

SEC. 2. WHITE HOUSE OFFICE OF MENTAL HEALTH POLICY. 1

(a) ESTABLISHMENT OF OFFICE.—There is estab-2

lished in the Executive Office of the President the White 3

House Office of Mental Health Policy (hereafter referred 4

to as the ‘‘Office’’), which shall—5

(1) monitor Federal activities with respect to 6

mental health and serious mental illness; 7

(2) make recommendations to the Secretary of 8

Health and Human Services regarding any appro-9

priate changes to such activities, including rec-10

ommendations to the Director of the National Insti-11

tutes of Health with respect to the national strategy 12

developed under paragraph (3); 13

(3) develop and annually update a National 14

Strategy for Mental Health to improve outcomes for 15

individuals with mental illness and maximize the ef-16

ficiency and effectiveness of community-based men-17

tal health programs and services; 18



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(4) make recommendations to the Secretary of 1

Health and Human Services regarding public par-2

ticipation in decisions relating to serious mental ill-3

ness; 4

(5) review and make recommendations with re-5

spect to the budgets for Federal mental health serv-6

ices to ensure the adequacy of those budgets; 7

(6) submit to the Congress the national strat-8

egy and any updates to such strategy; 9

(7) coordinate the mental health services pro-10

vided by Federal departments and agencies and co-11

ordinate Federal interagency mental health services; 12

(8) consult, coordinate with, facilitate joint ef-13

forts among, and support State, local, and tribal 14

governments, nongovernmental entities, and individ-15

uals with a mental illness, particularly individuals 16

with a serious mental illness, with respect to improv-17

ing mental health services; and 18

(9) develop and annually update a summary of 19

advances in serious mental illness research related to 20

causes, prevention, treatment, early screening, diag-21

nosis or rule out, intervention, and access to services 22

and supports for individuals with serious mental ill-23

ness. 24



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(b) DIRECTOR.—There shall be a Director who shall 1

head the Office (hereafter referred to as the ‘‘Director’’) 2

and who shall hold the same rank and status as the head 3

of an executive department listed in section 101 of title 4

5, United States Code. 5

(c) ACCESS BY CONGRESS.—The location of the Of-6

fice in the Executive Office of the President shall not be 7

construed as affecting access by Congress, or any com-8

mittee of the House of Representatives or the Senate, to 9

any—10

(1) information, document, or study in the pos-11

session of, or conducted by or at the direction of, the 12

Director; or 13

(2) personnel of the Office. 14

SEC. 3. APPOINTMENT AND DUTIES OF THE DIRECTOR. 15

(a) APPOINTMENT.—16

(1) IN GENERAL.—The President shall appoint 17

the Director, by and with the advice and consent of 18

the Senate. The Director shall serve at the pleasure 19

of the President. 20

(2) PROHIBITIONS.—21

(A) OTHER POSITIONS.—No person shall 22

serve as Director while serving in any other po-23

sition in the Federal Government or while em-24



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ployed in a full-time position outside of the 1

Federal Government. 2

(B) POLITICAL CAMPAIGNING.—The Direc-3

tor may not participate in election campaign ac-4

tivities, except that the Director is not prohib-5

ited by this subparagraph from making con-6

tributions to individual candidates. 7

(b) RESPONSIBILITIES.—The Director shall—8

(1) assist the President to establish policies, 9

goals, objectives, and priorities with respect to men-10

tal health, particularly serious mental illness, and to 11

improve outcomes for individuals with mental illness 12

and maximize the efficiency and effectiveness of 13

community-based mental health programs and serv-14

ices; 15

(2) work with Federal departments and agen-16

cies providing mental health services to strengthen 17

the coordination of mental health services in order to 18

maximize the access of individuals with a mental ill-19

ness, particularly individuals with a serious mental 20

illness, to community-based services, strengthen the 21

impact of services, and meet the comprehensive 22

needs of individuals with a mental illness; 23



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(3) coordinate and oversee the development, co-1

ordination, implementation, and evaluation of the 2

National Strategy for Mental Health; 3

(4) promulgate National Strategy for Mental 4

Health, ensuring its wide availability to government 5

officials and the public; 6

(5) make such recommendations to the Presi-7

dent as the Director determines are appropriate with 8

respect to the organization, management, and budg-9

ets of Federal departments and agencies providing 10

mental health services, including changes in the allo-11

cation of personnel to and within those departments 12

and agencies to implement the policies, goals, objec-13

tives, and priorities established under paragraph (1) 14

and the National Strategy for Mental Health; 15

(6) consult, coordinate with, facilitate joint ef-16

forts among, and support State, local, and tribal 17

governments, nongovernmental entities, and individ-18

uals with a mental illness, particularly individuals 19

with a serious mental illness, with respect to improv-20

ing mental health services; 21

(7) appear before duly constituted committees 22

and subcommittees of the House of Representatives 23

and of the Senate to represent the policies of the 24

President related to mental health and serve as the 25



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spokesperson of the President, if the President de-1

termines it appropriate, on issues related to mental 2

health , and the National Strategy for Mental 3

Health; 4

(8) submit an annual report to Congress detail-5

ing how the Director has consulted and coordinated 6

with the National Mental Health Council described 7

in section 806, the National Mental Health Advisory 8

Board, State, local, and tribal governments, non-9

governmental entities, and individuals with a mental 10

illness, particularly individuals with a serious mental 11

illness; and 12

(9) ensure the Office meets each of its respon-13

sibilities under this title. 14

(c) BUDGET REVIEW AND RECOMMENDATIONS.—15

(1) REVIEW OF BUDGET REQUESTS.—Each de-16

partment or agency of the Federal Government pro-17

viding mental health services shall transmit each 18

year to the Director a copy of the proposed budget 19

request of that department or agency with respect to 20

mental health services at a time not later than that 21

department or agency’s submitting of such budget 22

request to the Office of Management and Budget for 23

preparation of the budget of the President submitted 24

to Congress under section 1105(a) of title 31, 25



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United States Code. The proposed budget request 1

shall be transmitted to the Director in such form as 2

the Director, in consultation with the Office of Man-3

agement and Budget, determines appropriate. 4

(2) RECOMMENDATIONS WITH RESPECT TO 5

BUDGET REQUESTS.—After the receipt of proposed 6

budget requests pursuant to paragraph (1), the Di-7

rector shall provide budget recommendations with 8

respect to Federal mental health services to the Di-9

rector of the Office of Management and Budget and 10

to the President at a time that allows such rec-11

ommendations to be incorporated into the budget of 12

the President submitted to Congress under section 13

1105(a) of title 31, United States Code. The rec-14

ommendations shall address funding priorities devel-15

oped in the National Strategy for Mental Health and 16

shall address future fiscal projections as determined 17

by the Director. 18

(d) POWERS OF THE DIRECTOR.—In carrying out 19

this title, the Director may—20

(1) select, appoint, employ, and fix the com-21

pensation of such officers and employees of the Of-22

fice as may be necessary to carry out the functions 23

of the Office under this title; 24



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(2) request the head of a department or agency 1

of the Federal Government to place department or 2

agency personnel who are engaged in activities with 3

respect to mental health, on temporary detail to an-4

other department or agency in order to implement 5

the National Strategy for Mental Health, and the 6

head of such department or agency shall comply 7

with such request; 8

(3) use for administrative purposes, on a reim-9

bursable basis, the available services, equipment, 10

personnel, and facilities of Federal, State, local, and 11

tribal departments and agencies; 12

(4) procure the services of experts and consult-13

ants in accordance with section 3109 of title 5, 14

United States Code, relating to appointments in the 15

Federal Service, at rates of compensation for indi-16

viduals not to exceed the daily equivalent of the rate 17

of pay payable under level IV of the Executive 18

Schedule under section 5311 of title 5, United 19

States Code; 20

(5) use the mails in the same manner as any 21

other department or agency of the executive branch; 22

and 23

(6) monitor implementation of the National 24

Strategy for Mental Health, including—25



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(A) conducting program and performance 1

audits and evaluations; and 2

(B) requesting assistance from the Inspec-3

tor General of the relevant department or agen-4

cy in such audits and evaluations. 5

(e) PERSONNEL DETAILED TO THE OFFICE.—6

(1) EVALUATIONS.—Notwithstanding any provi-7

sion of chapter 43 of title 5, United States Code, the 8

Director shall perform the evaluation of the perform-9

ance of any employee detailed to the Office for the 10

purposes of the applicable performance appraisal 11

system established under such chapter for any rating 12

period, or part thereof, that such employee is de-13

tailed to the Office. 14

(2) COMPENSATION.—15

(A) BONUS PAYMENTS.—Notwithstanding 16

any other provision of law, the Director may 17

provide periodic bonus payments to any em-18

ployee detailed to the Office. 19

(B) RESTRICTIONS.—An amount paid 20

under this paragraph to an employee for any 21

period—22

(i) shall not be greater than 20 per-23

cent of the basic pay paid or payable to 24

such employee for such period; and 25



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(ii) shall be in addition to the basic 1

pay of such employee. 2

(3) AGGREGATE AMOUNT.—The aggregate 3

amount paid during any fiscal year to an employee 4

detailed to the Office as basic pay, awards, bonuses, 5

and other compensation shall not exceed the annual 6

rate payable at the end of such fiscal year for posi-7

tions at level III of the Executive Schedule under 8

section 5311 of title 5, United States Code. 9

SEC. 4. NATIONAL STRATEGY FOR MENTAL HEALTH. 10

(a) IN GENERAL.—Not later than February 1 of each 11

year, the Director shall submit to the President and Con-12

gress and make available to the public a National Strategy 13

for Mental Health (hereinafter referred to in this title as 14

the ‘‘Strategy’’) that shall set forth a comprehensive plan 15

for that year to improve outcomes for individuals with 16

mental illness and maximize the efficiency and effective-17

ness of community-based mental health programs and 18

services. 19

(b) PROCESS.—In preparing the Strategy, the Direc-20

tor shall actively consult and work in coordination with 21

the following: 22

(1) The heads of all Federal departments and 23

agencies that provide mental health services. 24

(2) The National Mental Health Council. 25



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(3) The National Mental Health Advisory 1

Board. 2

(4) Existing Federal interagency efforts related 3

to mental health services, such as the Military and 4

Veterans Mental Health Interagency Task Force. 5

(5) State, local, and tribal governments. 6

(6) Nongovernmental entities. 7

(7) Individuals with mental illness, particularly 8

individuals with a serious mental illness. 9

(c) CONTENTS.—The Director shall ensure the Strat-10

egy meets the following requirements: 11

(1) GOALS AND PERFORMANCE MEASURES.—12

The Strategy shall contain comprehensive, research-13

based goals and quantifiable performance measures 14

that shall serve as targets for the year with respect 15

to which the Strategy applies for—16

(A) improving the outcomes of and accessi-17

bility to evidence-based mental programs and 18

services; 19

(B) promoting community integration of 20

individuals with mental illness; 21

(C) increasing access to prevention and 22

early intervention services related to mental 23

health; 24



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(D) promoting mental health awareness 1

and reducing stigma; and 2

(E) advancing mental health research. 3

(2) ACCOUNTABILITY FOR PAST PERFORMANCE 4

MEASURES.—The Strategy shall contain a report on 5

Federal effectiveness with respect to meeting those 6

performance measures set by the Strategy for the 7

preceding year, including an evaluation of whether 8

or not such performance measures were met and the 9

reasons therefore, including—10

(A) the extent of coordination between 11

Federal departments and agencies providing 12

mental health services; 13

(B) the extent to which the objectives and 14

budgets of Federal departments and agencies 15

providing mental health services were consistent 16

with the recommendations of the Strategy for 17

the preceding year; and 18

(C) the efficiency and adequacy of Federal 19

programs and policies with respect to mental 20

health services. 21

(3) REPORTING ON AND IDENTIFYING GAPS IN 22

MENTAL HEALTH SERVICES.—The Strategy shall 23

contain a report on—24



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(A) the mental health diagnoses, 1

disaggregated by age, race, gender, geographic 2

distribution, population density, socioeconomic 3

status, and other target populations determined 4

necessary for inclusion by the Director; 5

(B) the quality and quantity of mental 6

health services for individuals with mental ill-7

ness, disaggregated by age, race, gender, geo-8

graphic distribution, population density, socio-9

economic status, and other target populations 10

determined necessary for inclusion by the Di-11

rector; and 12

(C) the size and allocation of Federal re-13

sources devoted to supporting individuals with 14

mental illness, particularly serious mental ill-15

ness, disaggregated by age, race, gender, geo-16

graphic distribution, population density, socio-17

economic status, and other target populations 18

determined necessary for inclusion by the Di-19

rector. 20

(4) COORDINATION EFFORTS.—The Strategy 21

shall contain a report on Federal efforts to consult, 22

coordinate with, facilitate joint efforts among, and 23

support State, local, and tribal governments, non-24

governmental entities, and individuals with mental 25



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illness, particularly serious mental illness, including 1

an evaluation of the effectiveness of those efforts. 2

(5) GUIDANCE.—The Strategy shall contain re-3

search-based guidance for assessing and improving 4

the quality of mental health services that is respon-5

sive to gaps identified in mental health services, par-6

ticularly for individuals with a serious mental illness. 7

(6) MENTAL HEALTH ADVOCATES AND PER-8

SPECTIVES.—The Strategy shall contain the views 9

and perspectives of individuals with mental illness, 10

particularly individuals with serious mental illness, 11

with respect to mental health services as prepared by 12

the National Mental Health Advisory Board. 13

(7) STRATEGIC PLAN.—The Strategy shall con-14

tain a plan to achieve the goals and performance 15

measures set for the year with respect to which the 16

Strategy applies, including the following: 17

(A) Program and budget priorities nec-18

essary to achieve the performance measures. 19

(B) Recommendations for improved Fed-20

eral interagency coordination, such as shared 21

grant application processes, grantee reporting 22

requirements, training and technical assistance 23

efforts, definitions, recipient eligibility require-24

ments, research, evaluation efforts, and data 25



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collection, and recommendations for legislative 1

changes necessary to achieve such interagency 2

coordination and to facilitate the delivery of a 3

comprehensive array of mental health services. 4

(C) Recommendations for improved coordi-5

nation between the Federal Government and 6

State, local, and tribal governments, nongovern-7

mental entities, and individuals with mental ill-8

ness, particularly individuals with serious men-9

tal illness. 10

(D) A strategic research, innovation, and 11

demonstration agenda to guide the use of Fed-12

eral research spending with respect to mental 13

illness, particularly serious mental illness. 14

(E) Recommendations to promote commu-15

nity integration of individuals with mental ill-16

ness, consistent with the Americans with Dis-17

abilities Act, Section 504 of the Rehabilitation 18

Act, and the Supreme Court’s decision in 19

Olmstead v. L.C. 20

(8) ADDITIONAL REPORTS.—The Strategy shall 21

contain additional reports the Director determines 22

necessary, such as reports on the unmet needs of in-23

dividuals with mental illness, international compari-24

sons of mental health services and outcomes, or the 25



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status of implementation and enforcement of mental 1

health parity. 2

SEC. 5. COORDINATION WITH FEDERAL DEPARTMENTS 3

AND AGENCIES. 4

(a) FEDERAL DEPARTMENT AND AGENCY COOPERA-5

TION.—Each department or agency of the Federal Gov-6

ernment providing mental health services shall—7

(1) cooperate with the efforts of the Director 8

under this title; 9

(2) provide such assistance, statistics, studies, 10

reports, information, and advice as the Director may 11

request, to the extent permitted by law; 12

(3) adjust department or agency staff job de-13

scriptions and performance measures to support col-14

laboration and implementation of the Strategy; and 15

(4) assign department or agency liaisons to the 16

Office to oversee and implement interagency coordi-17

nation. 18

(b) INTERAGENCY ALIGNMENT.—The Director, in 19

collaboration with the heads of Federal departments and 20

agencies providing mental health services, shall strengthen 21

the coordination of Federal mental health services in order 22

to maximize the access of individuals with mental illness, 23

particularly individuals with serious mental illness, to com-24

munity-based mental health services, strengthen the im-25



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pact of mental health services, and meet the comprehen-1

sive needs of individuals with mental illness, particularly 2

individuals with serious mental illness, by, where appro-3

priate—4

(1) facilitating the development of shared grant 5

application processes; 6

(2) offering joint training and technical assist-7

ance efforts; 8

(3) improving opportunities for individuals with 9

mental illness to maintain services as they transition 10

from systems of care; 11

(4) aligning—12

(A) grantee reporting requirements; 13

(B) definitions; 14

(C) eligibility requirements; 15

(D) research; 16

(E) evaluation efforts; and 17

(F) data collection; 18

(5) making recommendations with respect to 19

the legislative changes necessary to achieve the 20

interagency alignment and coordination necessary to 21

facilitate the delivery of a comprehensive array of 22

mental health services; and 23



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(6) taking other steps necessary to improve col-1

laboration between Federal departments and agen-2

cies providing mental health services. 3

(c) JOINT FUNDING AND COORDINATION.—4

(1) IN GENERAL.—The Director, in consulta-5

tion with the heads of Federal departments and 6

agencies, may oversee the development and adminis-7

tration of initiatives involving multiple Federal de-8

partments and agencies, including initiatives that in-9

volve the integration of funding from different Fed-10

eral departments and agencies to the extent per-11

mitted by law. 12

(2) ADMINISTRATION OF FUNDS.—With respect 13

to an initiative that involves the integration of fund-14

ing from different Federal departments and agen-15

cies, the Federal department or agency principally 16

involved in such an initiative, as determined by the 17

Director, may be designated by the Director to act 18

for all involved departments or agencies in admin-19

istering funds for the initiative. 20

(3) NONGOVERNMENTAL ENTITIES.—Initiatives 21

developed under this subsection may involve non-22

governmental entities. 23

(d) NATIONAL MENTAL HEALTH COUNCIL.—24



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(1) ESTABLISHMENT.—There is established 1

within the Office the National Mental Health Coun-2

cil (hereinafter referred to in this title as the ‘‘Coun-3

cil’’). 4

(2) MEMBERS AND TERMS.—The members of 5

the Council shall include—6

(A) the President; 7

(B) the Director; 8

(C) the Secretary of Health and Human 9

Services; 10

(D) the Director of the National Institute 11

of Mental Health; 12

(E) the Attorney General of the United 13

States; 14

(F) the Secretary of Veterans Affairs; 15

(G) the Assistant Secretary – Indian Af-16

fairs of the Department of the Interior; 17

(H) the Director of the Centers for Dis-18

ease Control and Prevention; 19

(I) the Director of the National Institutes 20

of Health; 21

(J) the directors of such national research 22

institutes of the National Institutes of Health 23

as the Director determines appropriate; 24



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(K) representatives, appointed by the Di-1

rector, of Federal agencies that are outside of 2

the Department of Health and Human Services 3

and serve individuals with serious mental ill-4

ness, such as the Department of Education; 5

(L) the Administrator of Substance Abuse 6

and Mental Health Services Administration; 7

(M) the Secretary of Defense; and 8

(N) other Federal officials as directed by 9

the President. 10

(3) CHAIRPERSON.—The Chairperson of the 11

Council shall be the President. 12

(4) DESIGNEES.—Members of the Council may 13

select a designee to perform duties under this sub-14

section, but it is the sense of Congress that such 15

members should refrain from doing so whenever pos-16

sible. 17

(5) MEETINGS.—18

(A) IN GENERAL.—The full membership of 19

the Council shall meet at the call of the Chair-20

person, but at least once each year. The Chair-21

person may call additional meetings composed 22

of less than the full membership of the Council 23

as needed. 24



f:\VHLC\042514\042514.229.xml (571949|22)

24

[Discussion Draft]

(B) FIRST MEETING.—The first meeting of 1

the Council shall be not more than four months 2

after the date of the enactment of this title. 3

(C) INCLUSION OF THE NATIONAL MENTAL 4

HEALTH ADVISORY BOARD.—At least one meet-5

ing of the Council each year shall be opened to 6

the participation of members of the National 7

Mental Health Advisory Board. 8

(6) RESPONSIBILITIES.—The Council shall—9

(A) assist the Director to coordinate the 10

mental health services provided by Federal de-11

partments and agencies and to coordinate Fed-12

eral interagency mental health services; 13

(B) assist the Director in the development, 14

coordination, implementation, evaluation, and 15

promulgation of the Strategy; 16

(C) assist the Director in soliciting and 17

documenting ongoing input and recommenda-18

tions with respect to mental health services and 19

mental health outcomes, particularly for indi-20

viduals with serious mental illness, from State, 21

local, and tribal governments, nongovernmental 22

entities, and individuals with mental illness, 23

particularly individuals with serious mental ill-24

ness; and 25



f:\VHLC\042514\042514.229.xml (571949|22)

25

[Discussion Draft]

(D) ensure that members of the Council 1

oversee the implementation of those sections of 2

the Strategy for which each such member’s de-3

partment or agency is responsible, as deter-4

mined by the Director, and to report to the Di-5

rector on such implementation and the results 6

thereof. 7

(7) COMPENSATION AND TRAVEL AND TRANS-8

PORTATION EXPENSES.—9

(A) NO COMPENSATION FOR SERVICE ON 10

COUNCIL.—Each member of the Council who is 11

not an officer or employee of the United States 12

shall not receive pay by reason of the member’s 13

service on the Council, and shall not be consid-14

ered an officer or employee of the United States 15

by reason of such service. Each member of the 16

Council who is an officer or employee of the 17

United States shall serve without compensation 18

in addition to that received for the member’s 19

service as an officer or employee of the United 20

States. 21

(B) TRAVEL AND TRANSPORTATION EX-22

PENSES.—Each member of the Council may be 23

allowed travel or transportation expenses in ac-24

cordance with section 5703 of title 5, United 25



f:\VHLC\042514\042514.229.xml (571949|22)

26

[Discussion Draft]

States Code, while away from the member’s 1

home or regular place of business in perform-2

ance of services for the Council. 3

SEC. 6. NATIONAL MENTAL HEALTH ADVISORY BOARD. 4

(a) ESTABLISHMENT.—There is established within 5

the Office the National Mental Health Advisory Board 6

(hereinafter referred to in this title as the ‘‘Board’’). 7

(b) MEMBERS AND TERMS.—8

(1) IN GENERAL.—Except as provided in para-9

graph (3), each member shall serve a two-year term. 10

No member shall serve more than three terms. The 11

Board shall be composed of non-Federal public 12

members to be appointed by the Director, or 13

which—14

(A) at least 10 members, or 1/2 of total 15

membership, whichever is greater, shall be indi-16

viduals with a diagnosis of serious mental ill-17

ness; 18

(B) at least one such member shall be a 19

parent or legal guardian of an individual with 20

a serious mental illness; 21

(C) at least one such member shall be a 22

representative of leading research organization 23

for individuals with serious mental illness; 24



f:\VHLC\042514\042514.229.xml (571949|22)

27

[Discussion Draft]

(D) at least one such member shall be a 1

representative of leading advocacy organization 2


(E) at least one such member shall be a 4

representative of leading research organization 5


(F) at least one such member shall be a 7

representative of leading community service or-8

ganization for individuals with serious mental 9

illness; 10

(G) at least one member shall have served 11

in a senior position in a state mental health 12

system; 13

(H) at least one member shall have served 14

in a senior position in a local mental health sys-15

tem; 16

(I) at least one member shall be a psychia-17

trist; 18

(J) at least one member shall be a clinical 19

psychologist; and 20

(K) at least one member shall be a law en-21

forcement officer. 22

(2) SELECTION PROCESS FOR THE INITIAL 23

MEMBERSHIP OF THE BOARD.—The Director shall 24

design an application and selection process to fill the 25



f:\VHLC\042514\042514.229.xml (571949|22)

28

[Discussion Draft]

initial membership of the Board. Political affiliation 1

or views may not be taken into account in such ap-2

plication and selection process and relatives of elect-3

ed officials shall not be eligible for membership. 4

(3) SELECTION PROCESS FOR MEMBERSHIP OF 5

THE BOARD FOLLOWING THE INITIAL MEMBER-6

SHIP.—The initial membership of the Board shall 7

design an application and selection process to fill the 8

membership of the Board for those terms following 9

the term of the initial membership. Such application 10

and selection process shall ensure that Board mem-11

bers select the membership that will follow that 12

Board membership’s term and, notwithstanding the 13

two-year term requirement in paragraph (1), such 14

application process shall ensure that not more than 15

half of the terms of Board members expire in a 16

given year. 17

(4) CHAIRPERSON.—The initial membership of 18

the Board shall elect two members as co-chairs of 19

the Board. Co-chairs shall serve a term of one year 20

and the Board shall elect new co-chairs as vacancies 21

arise. 22

(c) MEETINGS.—The Board shall meet in person not 23

fewer than four times each year. The Director shall re-24

quest senior Federal Government officials to attend each 25



f:\VHLC\042514\042514.229.xml (571949|22)

29

[Discussion Draft]

of the four meetings, including requesting that the Council 1

attend one of the four meetings. The co-chairs of the 2

Board may call additional meetings online and by tele-3

phone as determined necessary by the co-chairs. 4

(d) DUTIES.—The Board shall—5

(1) advise the President, the heads of Federal 6

departments and agencies providing mental health 7

services, and other senior Federal Government offi-8

cials on proposed and pending legislation, budget ex-9

penditures, and other policy matters with respect to 10

mental illness, particularly serious mental illness; 11

(2) work in partnership with local organizations 12

to solicit the views and perspectives of individuals 13

with mental illness, particularly individuals with se-14

rious mental illness, and parents or legal guardians 15

of individuals with mental illness, with respect to 16

mental health services; 17

(3) prepare a section of the Strategy outlining 18

the views and perspectives of individuals with mental 19

illness, particularly individuals with serious mental 20

illness, with respect to mental health services; and 21

(4) provide the Director evaluations of the staff 22

support and training and technical assistance the 23

Board has received. 24



f:\VHLC\042514\042514.229.xml (571949|22)

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[Discussion Draft]

(e) PROCEDURES.—The membership of the Board 1

shall, in consultation with the Director, determine the pro-2

cedures of the Board. 3

(f) STAFF SUPPORT AND TRAINING AND TECHNICAL 4

ASSISTANCE.—5

(1) IN GENERAL.—The Director shall make 6

available, directly or through the funding of eligible 7

organizations, the staff support and training and 8

technical assistance necessary for the Board to fulfill 9

the duties of the Board under this title. 10

(2) ELIGIBLE ORGANIZATION DESCRIBED.—An 11

eligible organization under this subsection is a non-12

profit organization that has demonstrated, as deter-13

mined by the Director, special expertise and broad 14

national experience in mental health policy. 15

TITLE I—STRENGTHENING AND 16

INVESTING IN SAMHSA PRO-17

GRAMS 18

SEC. 101. COMMUNITY MENTAL HEALTH SERVICES BLOCK 19

GRANT REAUTHORIZATION. 20

Section 1920(a) of the Public Health Service Act (42 21

U.S.C. 300x–9(a)) is amended by striking ‘‘$450,000,000 22

for fiscal year 2001, and such sums as may be necessary 23

for each of the fiscal years 2002 and 2003’’ and inserting 24



f:\VHLC\042514\042514.229.xml (571949|22)

31

[Discussion Draft]

‘‘$llll for each of fiscal years 2015 through 2019’’ 1

øThe blank is to be filled in with the FY 2014 level.¿. 2

SEC. 102. REPORTING REQUIREMENTS FOR BLOCK GRANTS 3

REGARDING MENTAL HEALTH AND SUB-4

STANCE USE DISORDERS. 5

Section 1942 of the Public Health Service Act (42 6

U.S.C. 300x–52) is amended to read as follows: 7

‘‘SEC. 1942. REQUIREMENT OF REPORTS AND AUDITS BY 8

STATES. 9

‘‘(a) BLOCK GRANTS FOR COMMUNITY MENTAL 10

HEALTH SERVICES.—11

‘‘(1) ANNUAL REPORT.—A funding agreement 12

for a grant under section 1911 is that—13

‘‘(A) the State involved will prepare and 14

submit to the Secretary an annual report on the 15

activities funded through the grant; and 16

‘‘(B) each such report shall be prepared 17

by, or in consultation with, the State agency re-18

sponsible for community mental health pro-19

grams and activities. 20

‘‘(2) STANDARDIZED FORM; CONTENTS.—In 21

order to properly evaluate and to compare the per-22

formance of different States assisted under section 23

1911, reports under this section shall be in such 24

standardized form and contain such information as 25



f:\VHLC\042514\042514.229.xml (571949|22)

32

[Discussion Draft]

the Secretary determines (after consultation with the 1

States) to be necessary—2

‘‘(A) to secure an accurate description of 3

the activities funded through the grant under 4

section 1911; 5

‘‘(B) to determine the extent to which 6

funds were expended consistent with the State’s 7

application transmitted under section 1917(a); 8

and 9

‘‘(C) to describe the extent to which the 10

State has met the goals and objectives it set 11

forth in its State plan under section 1912(b). 12

‘‘(3) MINIMUM CONTENTS.—Each report under 13

this section shall, at a minimum, include the fol-14

lowing information: 15

‘‘(A)(i) The number of individuals served 16

by the State under subpart I (by class of indi-17

viduals). 18

‘‘(ii) The proportion of each class of such 19

individuals which has health coverage. 20

‘‘(iii) The types of services (as defined by 21

the Secretary) provided under subpart I to indi-22

viduals within each such class. 23



f:\VHLC\042514\042514.229.xml (571949|22)

33

[Discussion Draft]

‘‘(iv) The amounts spent under subpart I 1

on each type of service (by class of individuals 2

served). 3

‘‘(B) Information on the status of mental 4

health in the State, including information (by 5

county and by racial and ethnic group) on each 6

of the following: 7

‘‘(i) The proportion of adolescents 8

with serious mental illness (including 9

major depression). 10

‘‘(ii) The proportion of adults with se-11

rious mental illness (including major de-12

pression). 13

‘‘(iii) The proportion of individuals 14

with co-occurring mental health and sub-15

stance use disorders. 16

‘‘(iv) The proportion of children and 17

adolescents with mental health disorders 18

who seek and receive treatment. 19

‘‘(v) The proportion of adults with 20

mental health disorders who seek and re-21

ceive treatment. 22

‘‘(vi) The proportion of individuals 23

with co-occurring mental health and sub-24



f:\VHLC\042514\042514.229.xml (571949|22)

34

[Discussion Draft]

stance use disorders who seek and receive 1

treatment. 2

‘‘(vii) The proportion of homeless 3

adults with mental health disorders who 4

receive treatment. 5

‘‘(viii) The number of primary care 6

facilities that provide mental health screen-7

ing and treatment services onsite or by 8

paid referral. 9

‘‘(ix) The number of primary care 10

physician office visits that include mental 11

health screening services. 12

‘‘(x) The number of juvenile residen-13

tial facilities that screen admissions for 14

mental health disorders. 15

‘‘(xi) The number of deaths attrib-16

utable to suicide. 17

‘‘(C) Information on the number and type 18

of health care practitioners licensed in the State 19

and providing mental health-related services. 20

‘‘(4) AVAILABILITY OF REPORTS.—The Sec-21

retary shall, upon request, provide a copy of any re-22

port under this section to any interested public 23

agency. 24



f:\VHLC\042514\042514.229.xml (571949|22)

35

[Discussion Draft]

‘‘(b) BLOCK GRANTS FOR PREVENTION AND TREAT-1

MENT OF SUBSTANCE USE DISORDERS.—2

‘‘(1) ANNUAL REPORT.—A funding agreement 3

for a grant under section 1921 is that—4

‘‘(A) the State involved will prepare and 5

submit to the Secretary an annual report on the 6

activities funded through the grant; and 7

‘‘(B) each such report shall be prepared 8

by, or in consultation with, the State agency re-9

sponsible for substance use disorder programs 10

and activities. 11

‘‘(2) STANDARDIZED FORM; CONTENTS.—In 12

order to properly evaluate and to compare the per-13

formance of different States assisted under section 14

1921, reports under this section shall be in such 15

standardized form and contain such information as 16

the Secretary determines (after consultation with the 17

States) to be necessary—18

‘‘(A) to secure an accurate description of 19

the activities funded through the grant under 20

section 1921; 21

‘‘(B) to determine the extent to which 22

funds were expended consistent with the State’s 23

application transmitted under section 1932(a); 24

and 25



f:\VHLC\042514\042514.229.xml (571949|22)

36

[Discussion Draft]

‘‘(C) to describe the extent to which the 1

State has met the goals and objectives it set 2

forth in its State plan under section 1932(b). 3

‘‘(3) MINIMUM CONTENTS.—Each report under 4

this section shall, at a minimum, include the fol-5

lowing information: 6

‘‘(A)(i) The number of individuals served 7

by the State under subpart II (by class of indi-8

viduals). 9

‘‘(ii) The proportion of each class of such 10

individuals which has health coverage. 11

‘‘(iii) The types of services (as defined by 12

the Secretary) provided under subpart II to in-13

dividuals within each such class. 14

‘‘(iv) The amounts spent under subpart II 15

on each type of service (by class of individuals 16

served). 17

‘‘(B) Information on the status of sub-18

stance use disorders in the State, including in-19

formation (by county and by racial and ethnic 20

group) on each of the following: 21

‘‘(i) The proportion of adolescents 22

using alcohol or other addictive drugs (in-23

cluding nicotine). 24



f:\VHLC\042514\042514.229.xml (571949|22)

37

[Discussion Draft]

‘‘(ii) The proportion of adults (includ-1

ing pregnant women) using alcohol or 2

other addictive drugs (including nicotine). 3

‘‘(iii) The proportion of adolescents 4

using prescription drugs for nonmedical 5

purposes. 6

‘‘(iv) The proportion of adults using 7

prescription drugs for nonmedical pur-8

poses. 9

‘‘(v) The number of individuals (in-10

cluding pregnant women) admitted to sub-11

stance use disorder treatment programs 12

(including group home arrangements). 13

‘‘(vi) The number of deaths attrib-14

utable to alcohol. 15

‘‘(vii) The number of deaths attrib-16

utable to illicit drugs. 17

‘‘(viii) The number of deaths attrib-18

utable to prescription drugs. 19

‘‘(C) Information on the number and type 20

of health care practitioners licensed in the State 21

and providing substance use disorder-related 22

services. 23

‘‘(4) AVAILABILITY OF REPORTS.—The Sec-24

retary shall, upon request, provide a copy of any re-25



f:\VHLC\042514\042514.229.xml (571949|22)

38

[Discussion Draft]

port under this section to any interested public 1

agency.’’. 2

SEC. 103. GARRETT LEE SMITH MEMORIAL ACT REAUTHOR-3

IZATION. 4

(a) SHORT TITLE.—This section may be cited as the 5

‘‘Garrett Lee Smith Memorial Act Reauthorization of 6

2014’’. 7

(b) SUICIDE PREVENTION TECHNICAL ASSISTANCE 8

CENTER.—Section 520C of the Public Health Service Act 9

(42 U.S.C. 290bb–34) is amended to read as follows: 10

‘‘SEC. 520C. SUICIDE PREVENTION TECHNICAL ASSISTANCE 11

CENTER. 12

‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 13

through the Administrator of the Substance Abuse and 14

Mental Health Services Administration, shall award a 15

grant for the operation and maintenance of a research, 16

training, and technical assistance resource center to pro-17

vide appropriate information, training, and technical as-18

sistance to States, political subdivisions of States, feder-19

ally recognized Indian tribes, tribal organizations, institu-20

tions of higher education, public organizations, or private 21

nonprofit organizations concerning the prevention of sui-22

cide among all ages, particularly among groups that are 23

at high risk for suicide. 24



f:\VHLC\042514\042514.229.xml (571949|22)

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[Discussion Draft]

‘‘(b) RESPONSIBILITIES OF THE CENTER.—The cen-1

ter operated and maintained under subsection (a) shall—2

‘‘(1) assist in the development or continuation 3

of statewide and tribal suicide early intervention and 4

prevention strategies for all ages, particularly among 5

groups that are at high risk for suicide; 6

‘‘(2) ensure the surveillance of suicide early 7

intervention and prevention strategies for all ages, 8

particularly among groups that are at high risk for 9

suicide; 10

‘‘(3) study the costs and effectiveness of state-11

wide and tribal suicide early intervention and pre-12

vention strategies in order to provide information 13

concerning relevant issues of importance to State, 14

tribal, and national policymakers; 15

‘‘(4) further identify and understand causes 16

and associated risk factors for suicide for all ages, 17


suicide; 19

‘‘(5) analyze the efficacy of new and existing 20

suicide early intervention and prevention techniques 21

and technology for all ages, particularly among 22

groups that are at high risk for suicide; 23

‘‘(6) ensure the surveillance of suicidal behav-24

iors and nonfatal suicidal attempts; 25



f:\VHLC\042514\042514.229.xml (571949|22)

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[Discussion Draft]

‘‘(7) study the effectiveness of State-sponsored 1

statewide and tribal suicide early intervention and 2

prevention strategies for all ages particularly among 3

groups that are at high risk for suicide on the over-4

all wellness and health promotion strategies related 5

to suicide attempts; 6

‘‘(8) promote the sharing of data regarding sui-7

cide with Federal agencies involved with suicide 8

early intervention and prevention, and State-spon-9

sored statewide and tribal suicide early intervention 10

and prevention strategies for the purpose of identi-11

fying previously unknown mental health causes and 12

associated risk factors for suicide among all ages 13


suicide; 15

‘‘(9) evaluate and disseminate outcomes and 16

best practices of mental health and substance use 17

disorder services at institutions of higher education; 18

and 19

‘‘(10) conduct other activities determined ap-20

propriate by the Secretary. 21

‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 22

purpose of carrying out this section, there are authorized 23

to be appropriated $4,957,000 for each of the fiscal years 24

2015 through 2019.’’. 25



f:\VHLC\042514\042514.229.xml (571949|22)

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[Discussion Draft]

(c) YOUTH SUICIDE INTERVENTION AND PREVEN-1

TION STRATEGIES.—Section 520E of the Public Health 2

Service Act (42 U.S.C. 290bb–36) is amended to read as 3

follows: 4

‘‘SEC. 520E. YOUTH SUICIDE EARLY INTERVENTION AND 5

PREVENTION STRATEGIES. 6

‘‘(a) IN GENERAL.—The Secretary, acting through 7

the Administrator of the Substance Abuse and Mental 8

Health Services Administration, shall award grants or co-9

operative agreements to eligible entities to—10

‘‘(1) develop and implement State-sponsored 11

statewide or tribal youth suicide early intervention 12

and prevention strategies in schools, educational in-13

stitutions, juvenile justice systems, substance use 14

disorder programs, mental health programs, foster 15

care systems, and other child and youth support or-16

ganizations; 17

‘‘(2) support public organizations and private 18

nonprofit organizations actively involved in State-19

sponsored statewide or tribal youth suicide early 20

intervention and prevention strategies and in the de-21

velopment and continuation of State-sponsored 22

statewide youth suicide early intervention and pre-23

vention strategies; 24



f:\VHLC\042514\042514.229.xml (571949|22)

42

[Discussion Draft]

‘‘(3) provide grants to institutions of higher 1

education to coordinate the implementation of State-2

sponsored statewide or tribal youth suicide early 3

intervention and prevention strategies; 4

‘‘(4) collect and analyze data on State-spon-5

sored statewide or tribal youth suicide early inter-6

vention and prevention services that can be used to 7

monitor the effectiveness of such services and for re-8

search, technical assistance, and policy development; 9

and 10

‘‘(5) assist eligible entities, through State-spon-11

sored statewide or tribal youth suicide early inter-12

vention and prevention strategies, in achieving tar-13

gets for youth suicide reductions under title V of the 14

Social Security Act. 15

‘‘(b) ELIGIBLE ENTITY.—16

‘‘(1) DEFINITION.—In this section, the term 17

‘eligible entity’ means—18

‘‘(A) a State; 19

‘‘(B) a public organization or private non-20

profit organization designated by a State to de-21

velop or direct the State-sponsored statewide 22

youth suicide early intervention and prevention 23

strategy; or 24



f:\VHLC\042514\042514.229.xml (571949|22)

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[Discussion Draft]

‘‘(C) a federally recognized Indian tribe or 1

tribal organization (as defined in the Indian 2

Self-Determination and Education Assistance 3

Act) or an urban Indian organization (as de-4

fined in the Indian Health Care Improvement 5

Act) that is actively involved in the development 6

and continuation of a tribal youth suicide early 7

intervention and prevention strategy. 8

‘‘(2) LIMITATION.—In carrying out this section, 9

the Secretary shall ensure that a State does not re-10

ceive more than one grant or cooperative agreement 11

under this section at any one time. For purposes of 12

the preceding sentence, a State shall be considered 13

to have received a grant or cooperative agreement if 14

the eligible entity involved is the State or an entity 15

designated by the State under paragraph (1)(B). 16

Nothing in this paragraph shall be constructed to 17

apply to entities described in paragraph (1)(C). 18

‘‘(c) PREFERENCE.—In providing assistance under a 19

grant or cooperative agreement under this section, an eli-20

gible entity shall give preference to public organizations, 21

private nonprofit organizations, political subdivisions, in-22

stitutions of higher education, and tribal organizations ac-23

tively involved with the State-sponsored statewide or tribal 24



f:\VHLC\042514\042514.229.xml (571949|22)

44

[Discussion Draft]

youth suicide early intervention and prevention strategy 1

that—2

‘‘(1) provide early intervention and assessment 3

services, including screening programs, to youth who 4

are at risk for mental or emotional disorders that 5

may lead to a suicide attempt, and that are inte-6

grated with school systems, educational institutions, 7

juvenile justice systems, substance use disorder pro-8

grams, mental health programs, foster care systems, 9

and other child and youth support organizations; 10

‘‘(2) demonstrate collaboration among early 11

intervention and prevention services or certify that 12

entities will engage in future collaboration; 13

‘‘(3) employ or include in their applications a 14

commitment to evaluate youth suicide early interven-15

tion and prevention practices and strategies adapted 16

to the local community; 17

‘‘(4) provide timely referrals for appropriate 18

community-based mental health care and treatment 19

of youth who are at risk for suicide in child-serving 20

settings and agencies; 21

‘‘(5) provide immediate support and informa-22

tion resources to families of youth who are at risk 23

for suicide; 24



f:\VHLC\042514\042514.229.xml (571949|22)

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[Discussion Draft]

‘‘(6) offer access to services and care to youth 1

with diverse linguistic and cultural backgrounds; 2

‘‘(7) offer appropriate postsuicide intervention 3

services, care, and information to families, friends, 4

schools, educational institutions, juvenile justice sys-5

tems, substance use disorder programs, mental 6

health programs, foster care systems, and other 7

child and youth support organizations of youth who 8

recently completed suicide; 9

‘‘(8) offer continuous and up-to-date informa-10

tion and awareness campaigns that target parents, 11

family members, child care professionals, community 12

care providers, and the general public and highlight 13

the risk factors associated with youth suicide and 14

the life-saving help and care available from early 15

intervention and prevention services; 16

‘‘(9) ensure that information and awareness 17

campaigns on youth suicide risk factors, and early 18

intervention and prevention services, use effective 19

communication mechanisms that are targeted to and 20

reach youth, families, schools, educational institu-21

tions, and youth organizations; 22

‘‘(10) provide a timely response system to en-23

sure that child-serving professionals and providers 24

are properly trained in youth suicide early interven-25



f:\VHLC\042514\042514.229.xml (571949|22)

46

[Discussion Draft]

tion and prevention strategies and that child-serving 1

professionals and providers involved in early inter-2

vention and prevention services are properly trained 3

in effectively identifying youth who are at risk for 4

suicide; 5

‘‘(11) provide continuous training activities for 6

child care professionals and community care pro-7

viders on the latest youth suicide early intervention 8

and prevention services practices and strategies; 9

‘‘(12) conduct annual self-evaluations of out-10

comes and activities, including consulting with inter-11

ested families and advocacy organizations; 12

‘‘(13) provide services in areas or regions with 13

rates of youth suicide that exceed the national aver-14

age as determined by the Centers for Disease Con-15

trol and Prevention; and 16

‘‘(14) obtain informed written consent from a 17

parent or legal guardian of an at-risk child before 18

involving the child in a youth suicide early interven-19

tion and prevention program. 20

‘‘(d) REQUIREMENT FOR DIRECT SERVICES.—Not 21

less than 85 percent of grant funds received under this 22

section shall be used to provide direct services, of which 23

not less than 5 percent shall be used for activities author-24

ized under subsection (a)(3). 25



f:\VHLC\042514\042514.229.xml (571949|22)

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[Discussion Draft]

‘‘(e) CONSULTATION AND POLICY DEVELOPMENT.—1

‘‘(1) IN GENERAL.—In carrying out this sec-2

tion, the Secretary shall collaborate with relevant 3

Federal agencies and suicide working groups respon-4

sible for early intervention and prevention services 5

relating to youth suicide. 6

‘‘(2) CONSULTATION.—In carrying out this sec-7

tion, the Secretary shall consult with—8

‘‘(A) State and local agencies, including 9

agencies responsible for early intervention and 10

prevention services under title XIX of the So-11

cial Security Act, the State Children’s Health 12

Insurance Program under title XXI of the So-13

cial Security Act, and programs funded by 14

grants under title V of the Social Security Act; 15

‘‘(B) local and national organizations that 16

serve youth at risk for suicide and their fami-17

lies; 18

‘‘(C) relevant national medical and other 19

health and education specialty organizations; 20

‘‘(D) youth who are at risk for suicide, 21

who have survived suicide attempts, or who are 22

currently receiving care from early intervention 23

services; 24



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[Discussion Draft]

‘‘(E) families and friends of youth who are 1

at risk for suicide, who have survived suicide at-2

tempts, who are currently receiving care from 3

early intervention and prevention services, or 4

who have completed suicide; 5

‘‘(F) qualified professionals who possess 6

the specialized knowledge, skills, experience, 7

and relevant attributes needed to serve youth at 8

risk for suicide and their families; and 9

‘‘(G) third-party payers, managed care or-10

ganizations, and related commercial industries. 11

‘‘(3) POLICY DEVELOPMENT.—In carrying out 12

this section, the Secretary shall—13

‘‘(A) coordinate and collaborate on policy 14

development at the Federal level with the rel-15

evant Department of Health and Human Serv-16

ices agencies and suicide working groups; and 17

‘‘(B) consult on policy development at the 18

Federal level with the private sector, including 19

consumer, medical, suicide prevention advocacy 20

groups, and other health and education profes-21

sional-based organizations, with respect to 22

State-sponsored statewide or tribal youth sui-23

cide early intervention and prevention strate-24

gies. 25



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[Discussion Draft]

‘‘(f) RULE OF CONSTRUCTION; RELIGIOUS AND 1

MORAL ACCOMMODATION.—Nothing in this section shall 2

be construed to require suicide assessment, early interven-3

tion, or treatment services for youth whose parents or 4

legal guardians object based on the parents’ or legal 5

guardians’ religious beliefs or moral objections. 6

‘‘(g) EVALUATIONS AND REPORT.—7

‘‘(1) EVALUATIONS BY ELIGIBLE ENTITIES.—8

Not later than 18 months after receiving a grant or 9

cooperative agreement under this section, an eligible 10

entity shall submit to the Secretary the results of an 11

evaluation to be conducted by the entity concerning 12

the effectiveness of the activities carried out under 13

the grant or agreement. 14

‘‘(2) REPORT.—Not later than 2 years after the 15

date of enactment of this section, the Secretary shall 16

submit to the appropriate committees of Congress a 17

report concerning the results of—18

‘‘(A) the evaluations conducted under 19

paragraph (1); and 20

‘‘(B) an evaluation conducted by the Sec-21

retary to analyze the effectiveness and efficacy 22

of the activities conducted with grants, collabo-23

rations, and consultations under this section. 24



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[Discussion Draft]

‘‘(h) RULE OF CONSTRUCTION; STUDENT MEDICA-1

TION.—Nothing in this section shall be construed to allow 2

school personnel to require that a student obtain any 3

medication as a condition of attending school or receiving 4

services. 5

‘‘(i) PROHIBITION.—Funds appropriated to carry out 6

this section, section 527, or section 529 shall not be used 7

to pay for or refer for abortion. 8

‘‘(j) PARENTAL CONSENT.—States and entities re-9

ceiving funding under this section shall obtain prior writ-10

ten, informed consent from the child’s parent or legal 11

guardian for assessment services, school-sponsored pro-12

grams, and treatment involving medication related to 13

youth suicide conducted in elementary and secondary 14

schools. The requirement of the preceding sentence does 15

not apply in the following cases: 16

‘‘(1) In an emergency, where it is necessary to 17

protect the immediate health and safety of the stu-18

dent or other students. 19

‘‘(2) Other instances, as defined by the State, 20

where parental consent cannot reasonably be ob-21

tained. 22

‘‘(k) RELATION TO EDUCATION PROVISIONS.—Noth-23

ing in this section shall be construed to supersede section 24

444 of the General Education Provisions Act, including 25



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[Discussion Draft]

the requirement of prior parental consent for the disclo-1

sure of any education records. Nothing in this section shall 2

be construed to modify or affect parental notification re-3

quirements for programs authorized under the Elementary 4

and Secondary Education Act of 1965 (as amended by the 5

No Child Left Behind Act of 2001; Public Law 107–110). 6

‘‘(l) DEFINITIONS.—In this section: 7

‘‘(1) EARLY INTERVENTION.—The term ‘early 8

intervention’ means a strategy or approach that is 9

intended to prevent an outcome or to alter the 10

course of an existing condition. 11

‘‘(2) EDUCATIONAL INSTITUTION; INSTITUTION 12

OF HIGHER EDUCATION; SCHOOL.—The term—13

‘‘(A) ‘educational institution’ means a 14

school or institution of higher education; 15

‘‘(B) ‘institution of higher education’ has 16

the meaning given such term in section 101 of 17

the Higher Education Act of 1965; and 18

‘‘(C) ‘school’ means an elementary or sec-19

ondary school (as such terms are defined in sec-20

tion 9101 of the Elementary and Secondary 21

Education Act of 1965). 22

‘‘(3) PREVENTION.—The term ‘prevention’ 23

means a strategy or approach that reduces the likeli-24

hood or risk of onset, or delays the onset, of adverse 25



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[Discussion Draft]

health problems that have been known to lead to sui-1

cide. 2

‘‘(4) YOUTH.—The term ‘youth’ means individ-3

uals who are between 10 and 24 years of age. 4

‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—For 5

the purpose of carrying out this section, there are author-6

ized to be appropriated $29,738,000 for each of the fiscal 7

years 2015 through 2019.’’. 8

(d) MENTAL HEALTH AND SUBSTANCE USE DIS-9

ORDERS SERVICES AND OUTREACH ON CAMPUS.—Section 10

520E–2 of the Public Health Service Act (42 U.S.C. 11

290bb–36b) is amended to read as follows: 12

‘‘SEC. 520E–2. MENTAL HEALTH AND SUBSTANCE USE DIS-13

ORDERS SERVICES ON CAMPUS. 14

‘‘(a) IN GENERAL.—The Secretary, acting through 15

the Director of the Center for Mental Health Services and 16

in consultation with the Secretary of Education, shall 17

award grants on a competitive basis to institutions of 18

higher education to enhance services for students with 19

mental health or substance use disorders and to develop 20

best practices for the delivery of such services. 21

‘‘(b) USES OF FUNDS.—Amounts received under a 22

grant under this section shall be used for 1 or more of 23

the following activities: 24



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[Discussion Draft]

‘‘(1) The provision of mental health and sub-1

stance use disorder services to students, including 2

prevention, promotion of mental health, voluntary 3

screening, early intervention, voluntary assessment, 4

treatment, and management of mental health and 5

substance abuse disorder issues. 6

‘‘(2) The provision of outreach services to notify 7

students about the existence of mental health and 8

substance use disorder services. 9

‘‘(3) Educating students, families, faculty, staff, 10

and communities to increase awareness of mental 11

health and substance use disorders. 12

‘‘(4) The employment of appropriately trained 13

staff, including administrative staff. 14

‘‘(5) The provision of training to students, fac-15

ulty, and staff to respond effectively to students with 16

mental health and substance use disorders. 17

‘‘(6) The creation of a networking infrastruc-18

ture to link colleges and universities with providers 19

who can treat mental health and substance use dis-20

orders. 21

‘‘(7) Developing, supporting, evaluating, and 22

disseminating evidence-based and emerging best 23

practices. 24



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[Discussion Draft]

‘‘(c) IMPLEMENTATION OF ACTIVITIES USING GRANT 1

FUNDS.—An institution of higher education that receives 2

a grant under this section may carry out activities under 3

the grant through—4

‘‘(1) college counseling centers; 5

‘‘(2) college and university psychological service 6

centers; 7

‘‘(3) mental health centers; 8

‘‘(4) psychology training clinics; 9

‘‘(5) institution of higher education supported, 10

evidence-based, mental health and substance use dis-11

order programs; or 12

‘‘(6) any other entity that provides mental 13

health and substance use disorder services at an in-14

stitution of higher education. 15

‘‘(d) APPLICATION.—To be eligible to receive a grant 16

under this section, an institution of higher education shall 17

prepare and submit to the Secretary an application at 18

such time and in such manner as the Secretary may re-19

quire. At a minimum, such application shall include the 20

following: 21

‘‘(1) A description of identified mental health 22

and substance use disorder needs of students at the 23

institution of higher education. 24



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[Discussion Draft]

‘‘(2) A description of Federal, State, local, pri-1

vate, and institutional resources currently available 2

to address the needs described in paragraph (1) at 3

the institution of higher education. 4

‘‘(3) A description of the outreach strategies of 5

the institution of higher education for promoting ac-6

cess to services, including a proposed plan for reach-7

ing those students most in need of mental health 8

services. 9

‘‘(4) A plan, when applicable, to meet the spe-10

cific mental health and substance use disorder needs 11

of veterans attending institutions of higher edu-12

cation. 13

‘‘(5) A plan to seek input from community 14

mental health providers, when available, community 15

groups and other public and private entities in car-16

rying out the program under the grant. 17

‘‘(6) A plan to evaluate program outcomes, in-18

cluding a description of the proposed use of funds, 19

the program objectives, and how the objectives will 20

be met. 21

‘‘(7) An assurance that the institution will sub-22

mit a report to the Secretary each fiscal year con-23

cerning the activities carried out with the grant and 24

the results achieved through those activities. 25



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[Discussion Draft]

‘‘(e) SPECIAL CONSIDERATIONS.—In awarding 1

grants under this section, the Secretary shall give special 2

consideration to applications that describe programs to be 3

carried out under the grant that—4

‘‘(1) demonstrate the greatest need for new or 5

additional mental and substance use disorder serv-6

ices, in part by providing information on current ra-7

tios of students to mental health and substance use 8

disorder health professionals; and 9

‘‘(2) demonstrate the greatest potential for rep-10

lication. 11

‘‘(f) REQUIREMENT OF MATCHING FUNDS.—12

‘‘(1) IN GENERAL.—The Secretary may make a 13

grant under this section to an institution of higher 14

education only if the institution agrees to make 15

available (directly or through donations from public 16

or private entities) non-Federal contributions in an 17

amount that is not less than $1 for each $1 of Fed-18

eral funds provided under the grant, toward the 19

costs of activities carried out with the grant (as de-20

scribed in subsection (b)) and other activities by the 21

institution to reduce student mental health and sub-22


‘‘(2) DETERMINATION OF AMOUNT CONTRIB-24

UTED.—Non-Federal contributions required under 25



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[Discussion Draft]

paragraph (1) may be in cash or in kind. Amounts 1

provided by the Federal Government, or services as-2

sisted or subsidized to any significant extent by the 3

Federal Government, may not be included in deter-4

mining the amount of such non-Federal contribu-5

tions. 6

‘‘(3) WAIVER.—The Secretary may waive the 7

application of paragraph (1) with respect to an insti-8

tution of higher education if the Secretary deter-9

mines that extraordinary need at the institution jus-10

tifies the waiver. 11

‘‘(g) REPORTS.—For each fiscal year that grants are 12

awarded under this section, the Secretary shall conduct 13

a study on the results of the grants and submit to the 14

Congress a report on such results that includes the fol-15

lowing: 16

‘‘(1) An evaluation of the grant program out-17

comes, including a summary of activities carried out 18

with the grant and the results achieved through 19

those activities. 20

‘‘(2) Recommendations on how to improve ac-21

cess to mental health and substance use disorder 22

services at institutions of higher education, including 23

efforts to reduce the incidence of suicide and sub-24




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[Discussion Draft]

‘‘(h) DEFINITIONS.—In this section, the term ‘insti-1

tution of higher education’ has the meaning given such 2

term in section 101 of the Higher Education Act of 1965. 3

‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the 4

purpose of carrying out this section, there are authorized 5

to be appropriated $4,975,000 for each of the fiscal years 6

2015 through 2019.’’. 7

SEC. 104. PROGRAMS OF REGIONAL AND NATIONAL SIG-8

NIFICANCE REAUTHORIZATION. 9

(a) MENTAL HEALTH PROGRAMS OF REGIONAL AND 10

NATIONAL SIGNIFICANCE.—11

(1) GENERAL SAMHSA AUTHORITIES.—Section 12

501(o) of the Public Health Service Act (42 U.S.C. 13

290aa(o)) is amended by striking ‘‘$25,000,000 for 14

fiscal year 2001, and such sums as may be nec-15

essary for each of the fiscal years 2002 and 2003’’ 16

and inserting ‘‘$lll for each of fiscal years 2015 17

through 2019’’ øThe blank is to be filled in with the 18

FY 2014 level.¿. 19

(2) GRANTS FOR THE BENEFIT OF HOMELESS 20

INDIVIDUALS.—Section 506(e) of the Public Health 21

Service Act (42 U.S.C. 290aa–5(e)) is amended by 22

striking ‘‘$50,000,000 for fiscal year 2001, and such 23

sums as may be necessary for each of the fiscal 24

years 2002 and 2003’’ and inserting ‘‘$lll for 25



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[Discussion Draft]

each of fiscal years 2015 through 2019’’ øThe blank 1

is to be filled in with the FY 2014 level.¿. 2

(3) PRIORITY MENTAL HEALTH NEEDS OF RE-3

GIONAL AND NATIONAL SIGNIFICANCE.—Section 4

520A(f)(1) of the Public Health Service Act (42 5

U.S.C. 290bb–32(f)(1)) is amended by striking 6

‘‘$300,000,000 for fiscal year 2001, and such sums 7

as may be necessary for each of the fiscal years 8

2002 and 2003’’ and inserting ‘‘$lll for each of 9

fiscal years 2015 through 2019’’. øThe blank is to 10

be filled in with the FY 2014 level.¿11

(4) YOUTH INTERAGENCY RESEARCH, TRAIN-12

ING, AND TECHNICAL ASSISTANCE CENTERS.—For 13

reauthorization of section 520C of the Public Health 14

Service Act (42 U.S.C. 290bb–34), see section 15

103(b) of this Act.øCompare with policy of reauthor-16

izing 520C at FY 2014 levels¿17

(5) YOUTH SUICIDE EARLY INTERVENTION AND 18

PREVENTION STRATEGIES.—For provisions reau-19

thorizing section 520E of the Public Health Service 20

Act (42 U.S.C. 290bb–36), see section 103(c) of this 21

Act. øCompare with policy of reauthorizing 520E at 22

FY 2014 levels.¿23

(6) MENTAL AND BEHAVIORAL HEALTH SERV-24

ICES ON CAMPUS.—For provisions reauthorizing sec-25



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[Discussion Draft]

tion 520E–2 of the Public Health Service Act (42 1

U.S.C. 290bb–36b), see section 103(d) of this Act. 2

øCompare with policy of reauthorizing 520E–2 at FY 3

2014 levels¿4

(7) AWARDS FOR CO-LOCATING PRIMARY AND 5

SPECIALTY CARE IN COMMUNITY-BASED MENTAL 6

HEALTH SETTINGS.—Section 520K(f) of the Public 7

Health Service Act (42 U.S.C. 290bb–42(f)) is 8

amended by striking ‘‘$50,000,000 for fiscal year 9

2010 and such sums as may be necessary for each 10

of fiscal years 2011 through 2014’’ and inserting 11

‘‘$lll for each of fiscal years 2015 through 12

2019’’. øThe blank is to be filled in with the FY 2014 13

level.¿. 14

(8) PRIORITY SUBSTANCE ABUSE PREVENTION 15

NEEDS OF REGIONAL AND NATIONAL SIGNIFI-16

CANCE.—øYou asked to reauthorize section 516 of the 17

PHSA both here and in subsection (b) below. Sub-18

section (b) seems to be the more appropriate place-19

ment.¿20

(9) CHILDREN AND VIOLENCE.—For provisions 21

reauthorizing section 581 of the Public Health Serv-22

ice Act (42 U.S.C. 290hh), see section 501 of this 23

Act. øCompare with policy of reauthorizing 581 at 24

FY 2014 levels.¿25



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[Discussion Draft]

(10) GRANTS TO ADDRESS THE PROBLEMS OF 1

PERSONS WHO EXPERIENCE VIOLENCE RELATED 2

STRESS.—For provisions reauthorizing section 582 3

of the Public Health Service Act (42 U.S.C. 290hh–4

1), see section 107 of this Act. øCompare with pol-5

icy of reauthorizing 582 at FY 2014 levels.¿6

(b) SUBSTANCE ABUSE PREVENTION PROGRAMS OF 7

REGIONAL AND NATIONAL SIGNIFICANCE.—8

(1) PRIORITY SUBSTANCE ABUSE PREVENTION 9


CANCE.—Section 516(f) of the Public Health Service 11

Act (42 U.S.C. 290bb–22(f)) is amended by striking 12

‘‘$300,000,000 for fiscal year 2001, and such sums 13





(2) PROGRAMS TO REDUCE UNDERAGE DRINK-18

ING.—Section 519B of the Public Health Service 19

Act (42 U.S.C. 290bb–25b) is amended øThe blanks 20

need to be filled in with the FY 2014 levels¿—21

(A) in subsection (c)(3), by striking 22

‘‘$1,000,000 for fiscal year 2007, and 23

$1,000,000 for each of the fiscal years 2008 24



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[Discussion Draft]

through 2010’’ and inserting ‘‘$lll for each 1

of fiscal years 2015 through 2019’’; 2

(B) in subsection (d)(4), by striking 3

‘‘$1,000,000 for fiscal year 2007 and 4


through 2010’’ and inserting ‘‘$ll for each 6

of fiscal years 2015 through 2019’’; 7

(C) in subsection (e)(1)(I), by striking 8




of fiscal years 2015 through 2019’’; and 12

(D) in subsection (e)(2)(H), by striking 13




of fiscal years 2015 through 2019’’. 17

(3) CENTERS OF EXCELLENCE ON SERVICES 18

FOR INDIVIDUALS WITH FETAL ALCOHOL SYNDROME 19

AND ALCOHOL-RELATED BIRTH DEFECTS AND 20

TREATMENT FOR INDIVIDUALS WITH SUCH CONDI-21

TIONS AND THEIR FAMILIES.—Section 519D(f) of 22

the Public Health Service Act (42 U.S.C. 290bb–23

25d(f)) is amended by striking ‘‘$5,000,000 for fis-24

cal year 2001, and such sums as may be necessary 25



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[Discussion Draft]

for each of the fiscal years 2002 and 2003’’ and in-1

serting ‘‘$lll for each of fiscal years 2015 2

through 2019’’. øThe blank is to be filled in with the 3

FY 2014 level.¿4

(c) SUBSTANCE ABUSE TREATMENT PROGRAMS OF 5

REGIONAL AND NATIONAL SIGNIFICANCE.—6

(1) GRANTS FOR THE BENEFIT OF HOMELESS 7

INDIVIDUALS.—Section 506(e) of the Public Health 8

Service Act (42 U.S.C. 290aa–5(e)) is amended by 9

striking ‘‘$50,000,000 for fiscal year 2001, and such 10

sums as may be necessary for each of the fiscal 11

years 2002 and 2003’’ and inserting ‘‘$lll for 12

each of fiscal years 2015 through 2019’’. øThe blank 13

is to be filled in with the FY 2014 level.¿14

(2) RESIDENTIAL TREATMENT PROGRAMS FOR 15

PREGNANT AND POSTPARTUM WOMEN.—Section 16

508(r) of the Public Health Service Act (42 U.S.C. 17

290bb–1(r)) is amended by striking ‘‘such sums as 18

may be necessary to fiscal years 2001 through 19

2003’’ and inserting ‘‘$lll for each of fiscal 20

years 2015 through 2019’’. øThe blank is to be filled 21

in with the FY 2014 level.¿22

(3) PRIORITY SUBSTANCE ABUSE TREATMENT 23


CANCE.—Section 509(f) of the Public Health Service 25



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[Discussion Draft]

Act (42 U.S.C. 290bb–2(f)) is amended by striking 1

‘‘$300,000,000 for fiscal year 2001 and such sums 2





(4) METHAMPHETAMINE AND AMPHETAMINE 7

TREATMENT INITIATIVE.—The second section 514 of 8

the Public Health Service Act (42 U.S.C. 290bb–9) 9

is amended—10

(A) by redesignating such section as sec-11

tion 514B; and 12

(B) in subsection (d)(1), by striking 13

‘‘$10,000,000 for fiscal year 2000 and such 14

sums as may be necessary for each of fiscal 15

years 2001 and 2002’’ and inserting ‘‘$lll 16

for each of fiscal years 2015 through 2019’’. 17

øThe blank is to be filled in with the FY 2014 18

level.¿19

SEC. 105. GRANTS FOR JAIL DIVERSION PROGRAMS REAU-20

THORIZATION. 21

Section 520G(i) of the Public Health Service Act (42 22

U.S.C. 290bb–38(i)) is amended by striking ‘‘$10,000,000 23

for fiscal year 2001, and such sums as may be necessary 24

for fiscal years 2002 through 2003’’ and inserting 25



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[Discussion Draft]

‘‘$lll for each of fiscal years 2015 through 2019’’. 1

øThe blank is to be filled in with the FY 2014 level.¿2

SEC. 106. COMPREHENSIVE COMMUNITY MENTAL HEALTH 3

SERVICES FOR CHILDREN WITH SERIOUS 4

EMOTIONAL DISTURBANCES. 5

Section 565(f)(1) of the Public Health Service Act 6

(42 U.S.C. 290ff–4) is amended by striking 7

‘‘$100,000,000 for fiscal year 2001, and such sums as 8

may be necessary for each of the fiscal years 2002 and 9

2003’’ and inserting ‘‘$lll for each of fiscal years 10

2015 through 2019’’. øThe blank is to be filled in with 11

the FY 2014 level.¿12

SEC. 107. GRANTS TO ADDRESS THE PROBLEMS OF INDI-13

VIDUALS WHO EXPERIENCE TRAUMA AND VI-14

OLENCE RELATED STRESS. 15

Section 582 of the Public Health Service Act (42 16

U.S.C. 290hh-1) is amended to read as follows: 17

‘‘SEC. 582. GRANTS TO ADDRESS THE PROBLEMS OF INDI-18

VIDUALS WHO EXPERIENCE TRAUMA AND VI-19

OLENCE RELATED STRESS. 20

‘‘(a) IN GENERAL.—The Secretary shall award 21

grants, contracts or cooperative agreements to public and 22

nonprofit private entities, as well as to Indian tribes and 23

tribal organizations, for the purpose of developing and 24

maintaining programs that provide for—25



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‘‘(1) the continued operation of the National 1

Child Traumatic Stress Initiative (referred to in this 2

section as the ‘NCTSI’) that focus on the mental, 3

behavioral, and biological aspects of psychological 4

trauma response; and 5

‘‘(2) the development of knowledge with regard 6

to evidence-based practices for identifying and treat-7

ing mental, behavioral, and biological disorders of 8

children and youth resulting from witnessing or ex-9

periencing a traumatic event. 10

‘‘(b) PRIORITIES.—In awarding grants, contracts or 11

cooperative agreements under subsection (a)(2) (related to 12

the development of knowledge on evidence-based practices 13

for treating mental, behavioral, and biological disorders 14

associated with psychological trauma), the Secretary shall 15

give priority to universities, hospitals, mental health agen-16

cies, and other community-based child-serving programs 17

that have established clinical and research experience in 18

the field of trauma-related mental disorders. 19

‘‘(c) CHILD OUTCOME DATA.—The NCTSI coordi-20

nating center shall collect, analyze, and report NCTSI-21

wide child outcome and process data for the purpose of 22

establishing the effectiveness, implementation, and clinical 23

utility of early identification and delivery of evidence-based 24



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[Discussion Draft]

treatment and services delivered to children and families 1

served by the NCTSI grantees. 2

‘‘(d) TRAINING.—The NCTSI coordinating center 3

shall oversee the continuum of interprofessional training 4

initiatives in evidence-based and trauma-informed treat-5

ments, interventions, and practices offered to NCTSI 6

grantees and providers in all child-serving systems. 7

‘‘(e) DISSEMINATION.—The NCTSI coordinating 8

center shall collaborate with the Secretary in the dissemi-9

nation of evidence-based and trauma-informed interven-10

tions, treatments, products, and other resources to all 11

child-serving systems and policymakers. 12

‘‘(f) REVIEW.—The Secretary shall establish con-13

sensus-driven, in-person or teleconference review of 14

NCTSI applications by child trauma experts and review 15

criteria related to expertise and experience related to child 16

trauma and evidence-based practices. 17

‘‘(g) GEOGRAPHICAL DISTRIBUTION.—The Secretary 18

shall ensure that grants, contracts or cooperative agree-19

ments under subsection (a) are distributed equitably 20

among the regions of the United States and among urban 21

and rural areas. Notwithstanding the previous sentence, 22

expertise and experience in the field of trauma-related dis-23

orders shall be prioritized in the awarding of such grants 24

are required under subsection (b). 25



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[Discussion Draft]

‘‘(h) EVALUATION.—The Secretary, as part of the 1

application process, shall require that each applicant for 2

a grant, contract or cooperative agreement under sub-3

section (a) submit a plan for the rigorous evaluation of 4

the activities funded under the grant, contract or agree-5

ment, including both process and outcome evaluation, and 6

the submission of an evaluation at the end of the project 7

period. 8

‘‘(i) DURATION OF AWARDS.—With respect to a 9

grant, contract or cooperative agreement under subsection 10

(a), the period during which payments under such an 11

award will be made to the recipient shall be 6 years. Such 12

grants, contracts or agreements may be renewed. Exper-13

tise and experience in the field of trauma-related disorders 14

shall be a priority for new and continuing awards. 15

‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 16

is authorized to be appropriated to carry out this section, 17

$50,000,000 for fiscal year 2015, and such sums as may 18

be necessary for each of fiscal years 2016 through 2019.’’. 19

SEC. 108. PROTECTION AND ADVOCACY FOR INDIVIDUALS 20

WITH MENTAL ILLNESS REAUTHORIZATION. 21

Section 117 of the Protection and Advocacy for Indi-22

viduals with Mental Illness Act (42 U.S.C. 10827) is 23

amended by striking ‘‘$19,500,000 for fiscal year 1992, 24

and such sums as may be necessary for each of the fiscal 25



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[Discussion Draft]

years 1993 through 2003’’ and inserting ‘‘$lll for 1

each of fiscal years 2015 through 2019’’. øThe blank is 2

to be filled in with the FY 2014 level.¿3

SEC. 109. MENTAL HEALTH AWARENESS TRAINING GRANTS. 4

Section 520J of the Public Health Service Act (42 5

U.S.C. 290bb–41) is amended—6

(1) in the section heading, by inserting ‘‘MEN-7

TAL HEALTH AWARENESS’’ before ‘‘TRAINING’’; 8

and 9

(2) in subsection (b)—10

(A) in the subsection heading, by striking 11

‘‘ILLNESS’’ and inserting ‘‘HEALTH’’; 12

(B) in paragraph (1), by inserting ‘‘and 13

other categories of individuals, as determined 14

by the Secretary,’’ after ‘‘emergency services 15

personnel’’; 16

(C) in paragraph (5)—17

(i) in the matter preceding subpara-18

graph (A), by striking ‘‘to’’ and inserting 19

‘‘for evidence-based programs for the pur-20

pose of’’; and 21

(ii) by striking subparagraphs (A) 22

through (C) and inserting the following: 23

‘‘(A) recognizing the signs and symptoms 24

of mental illness; and 25



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[Discussion Draft]

‘‘(B)(i) providing education to personnel 1

regarding resources available in the community 2

for individuals with a mental illness and other 3

relevant resources; or 4

‘‘(ii) the safe de-escalation of crisis situa-5

tions involving individuals with a mental ill-6

ness.’’; and 7

(D) in paragraph (7), by striking ‘‘, 8

$25,000,000’’ and all that follows through the 9

period at the end and inserting ‘‘$20,000,000 10

for each of fiscal years 2014 through 2018’’. 11

SEC. 110. NATIONAL MEDIA CAMPAIGN TO REDUCE THE 12

STIGMA ASSOCIATED WITH MENTAL ILLNESS. 13

Subpart 3 of part B of title V of the Public Health 14

Service Act (42 U.S.C. 290bb–31 et seq.) is amended by 15

adding at the end the following new section: 16

‘‘SEC. 520L. NATIONAL MEDIA CAMPAIGN TO REDUCE THE 17

STIGMA ASSOCIATED WITH MENTAL ILLNESS. 18

‘‘(a) SCOPE OF THE CAMPAIGN.—The Secretary, act-19

ing through the Administrator of the Substance Abuse 20

and Mental Health Services Administration, shall provide 21

for the production, broadcasting, and evaluation of a na-22

tional media public service campaign to reduce the stigma 23

associated with mental illness. Such campaign shall seek 24

to reach as wide and diverse an audience as possible and 25



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[Discussion Draft]

shall particularly target the population between the ages 1

of 16 and 24 years of age. 2

‘‘(b) REPORT.—The Secretary shall provide a report 3

to the Congress annually detailing—4

‘‘(1) the production, broadcasting, and evalua-5

tion of the campaign under subsection (a); and 6

‘‘(2) the effectiveness of the campaign in reduc-7

ing the stigma associated with mental illness, as 8

measured using such methods as public attitude sur-9

veys and mental health services utilization statistics. 10

‘‘(c) CONSULTATION REQUIREMENT.—In carrying 11

out this section, the Secretary shall ensure that mental 12

health professionals and patient advocates are consulted 13

in carrying out the media campaign under this section. 14

The progress of this consultative process is to be covered 15

in the report under subsection (b). 16

‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 17

are authorized to be appropriated to carry out this section, 18

$10,000,000 for each of the fiscal years 2015 through 19

2019.’’. 20



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SEC. 111. SAMHSA AND HRSA INTEGRATION OF MENTAL 1

HEALTH SERVICES INTO PRIMARY CARE SET-2

TINGS. 3

Title V of the Public Health Service Act is amended 4

by inserting after section 520K (42 U.S.C. 290bb–42) the 5

following: 6

‘‘SEC. 520K–1. AWARDS FOR CO-LOCATING MENTAL HEALTH 7

SERVICES IN PRIMARY CARE SETTINGS. 8

‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 9

through the Administrators of the Substance Abuse and 10

Mental Health Services Administration and the Health 11

Resources and Services Administration, shall award 12

grants, contracts, and cooperative agreements to eligible 13

entities for the provision of coordinated and integrated 14

mental health services and primary health care. 15

‘‘(b) ELIGIBLE ENTITIES.—To be eligible to seek a 16

grant, contract, or cooperative agreement this section, an 17

entity shall be a public or nonprofit entity. 18

‘‘(c) USE OF FUNDS.—An eligible entity receiving an 19

award under this section shall use the award for the provi-20

sion of coordinated and integrated mental health services 21

and primary health care through—22

‘‘(1) the co-location of mental health services in 23

primary care settings; 24



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‘‘(2) the use of care management services to fa-1

cilitate coordination between mental health and pri-2

mary care providers; 3

‘‘(3) the use of information technology (such as 4

telemedicine)—5

‘‘(A) to facilitate coordination between 6

mental health and primary care providers; or 7

‘‘(B) to expand the availability of mental 8

health services; or 9

‘‘(4) the provision of training and technical as-10

sistance to improve the delivery, effectiveness, and 11

integration of mental health services into primary 12

care settings. 13

‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 14

carry out this section, there are authorized to be appro-15

priated such sums as may be necessary for fiscal years 16

2015 through 2019.’’. 17

SEC. 112. EVIDENCE-BASED PRACTICES FOR OLDER AMERI-18

CANS. 19

(a) GERIATRIC SUBSTANCE USE DISORDERS TREAT-20

MENT.—Section 509(e) of the Public Health Service Act 21

(42 U.S.C. 290bb–2(e)) is amended—22

(1) by striking ‘‘The Secretary shall establish’’ 23

and inserting: 24



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‘‘(1) IN GENERAL.—The Secretary shall estab-1

lish’’; and 2

(2) by adding at the end the following: 3

‘‘(2) GERIATRIC SUBSTANCE USE DISORDERS 4

TREATMENT.—The Secretary shall, as appropriate, 5

provide technical assistance to grantees regarding 6

evidence-based practices for the treatment of geri-7

atric substance use disorders, as well as disseminate 8

information about such evidence-based practices to 9

States and nongrantees throughout the United 10

States.’’. 11

(b) GERIATRIC SUBSTANCE USE DISORDERS PRE-12

VENTION.—Section 516(e) of the Public Health Service 13

Act (42 U.S.C. 290bb–22(e)) is amended—14

(1) by striking ‘‘The Secretary shall establish’’ 15

and inserting: 16

‘‘(1) IN GENERAL.—The Secretary shall estab-17

lish’’; and 18


‘‘(2) GERIATRIC SUBSTANCE USE DISORDERS 20

PREVENTION.—The Secretary shall, as appropriate, 21

provide technical assistance to grantees regarding 22

evidence-based practices for the prevention of geri-23

atric substance use disorders, as well as disseminate 24

information about such evidence-based practices to 25



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[Discussion Draft]

States and nongrantees throughout the United 1

States.’’. 2

(c) GERIATRIC MENTAL HEALTH DISORDERS.—Sec-3

tion 520A(e) of the Public Health Service Act (42 U.S.C. 4

290bb–32(e)) is amended by adding at the end the fol-5

lowing: 6

‘‘(3) GERIATRIC MENTAL HEALTH DIS-7

ORDERS.—The Secretary shall, as appropriate, pro-8

vide technical assistance to grantees regarding evi-9

dence-based practices for the prevention and treat-10

ment of geriatric mental health disorders, as well as 11

disseminate information about such evidence-based 12

practices to States and nongrantees throughout the 13

United States.’’. 14

TITLE II—IMPROVING MEDICAID 15

AND MEDICARE MENTAL 16

HEALTH SERVICES 17

SEC. 201. ACCESS TO MENTAL HEALTH PRESCRIPTION 18

DRUGS UNDER MEDICARE AND MEDICAID. 19

(a) COVERAGE OF PRESCRIPTION DRUGS USED TO 20

TREAT MENTAL HEALTH DISORDERS UNDER MEDI-21

CARE.—Section 1860D–4(b)(3)(G)(i)(II) of the Social Se-22

curity Act (42 U.S.C. 1395w–104(b)(3)(G)(i)(II)) is 23

amended by inserting ‘‘, for categories and classes of 24

drugs other than the categories and classes of drugs speci-25



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[Discussion Draft]

fied in subclauses (II) and (IV) of clause (iv),’’ before ‘‘ex-1

ceptions’’. 2

(b) COVERAGE OF PRESCRIPTION DRUGS USED TO 3

TREAT MENTAL HEALTH DISORDERS UNDER MED-4

ICAID.—Section 1927(d) of the Social Security Act (42 5

U.S.C. 1396r–8(d)) is amended by adding at the end the 6

following new paragraph: 7

‘‘(8) ACCESS TO MENTAL HEALTH DRUGS.—8

With respect to covered outpatient drugs used for 9

the treatment of a mental health disorder, including 10

major depression, bipolar (manic-depressive) dis-11

order, panic disorder, obsessive-compulsive disorder, 12

schizophrenia, and schizoaffective disorder, a State 13

shall not exclude from coverage or otherwise restrict 14

access to such drugs other than pursuant to a prior 15

authorization program that is consistent with para-16

graph (5).’’. 17

SEC. 202. MEDICAID COVERAGE OF MENTAL HEALTH SERV-18

ICES AND PRIMARY CARE SERVICES FUR-19

NISHED ON THE SAME DAY. 20

(a) IN GENERAL.—Section 1902(a) of the Social Se-21

curity Act (42 U.S.C. 1396a(a)) is amended by inserting 22

after paragraph (77) the following new paragraph: 23

‘‘(78) not prohibit payment under the plan for 24

a mental health service or primary care service fur-25



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[Discussion Draft]

nished to an individual at a federally qualified com-1

munity behavioral health center (as defined in sec-2

tion 1905(l)(4)) or a federally qualified health center 3

(as defined in section 1861(aa)(3)) for which pay-4

ment would otherwise be payable under the plan, 5

with respect to such individual, if such service were 6

not a same-day qualifying service (as defined in sub-7

section (ll));’’. 8

(b) SAME-DAY QUALIFYING SERVICE DEFINED.—9

Section 1902 of the Social Security Act (42 U.S.C. 1396a) 10

is amended by adding at the end the following new sub-11

section: 12

‘‘(ll) SAME-DAY QUALIFYING SERVICE DEFINED.—13

For purposes of subsection (a)(78), the term ‘same-day 14

qualifying service’ means—15

‘‘(1) a primary care service furnished to an in-16

dividual by a provider at a facility on the same day 17

a mental health service is furnished to such indi-18

vidual by such provider (or another provider) at the 19

facility; and 20

‘‘(2) a mental health service furnished to an in-21

dividual by a provider at a facility on the same day 22

a primary care service is furnished to such individual 23

by such provider (or another provider) at the facil-24

ity.’’. 25



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(c) EFFECTIVE DATE.—1

(1) IN GENERAL.—Subject to paragraph (2), 2

the amendments made this section shall apply to 3

items and services furnished after the first day of 4

the first calendar year that begins after the date of 5

the enactment of this section. 6

(2) EXCEPTION FOR STATE LEGISLATION.—In 7

the case of a State plan under title XIX of the So-8

cial Security Act, which the Secretary of Health and 9

Human Services determines requires State legisla-10

tion in order for the respective plan to meet any re-11

quirement imposed by amendments made by this 12

section, the respective plan shall not be regarded as 13

failing to comply with the requirements of such title 14

solely on the basis of its failure to meet such an ad-15

ditional requirement before the first day of the first 16

calendar quarter beginning after the close of the 17

first regular session of the State legislature that be-18

gins after the date of enactment of this section. For 19

purposes of the previous sentence, in the case of a 20

State that has a 2-year legislative session, each year 21

of the session shall be considered to be a separate 22

regular session of the State legislature. 23



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SEC. 203. ELIMINATION OF 190-DAY LIFETIME LIMIT ON IN-1

PATIENT PSYCHIATRIC HOSPITAL SERVICES. 2

(a) IN GENERAL.—Section 1812 of the Social Secu-3

rity Act (42 U.S.C. 1395d) is amended—4

(1) in subsection (b)—5

(A) in paragraph (1), by adding ‘‘or’’ at 6

the end; 7

(B) in paragraph (2), by striking ‘‘; or’’ at 8

the end and inserting a period; and 9

(C) by striking paragraph (3); and 10

(2) in subsection (c), by striking ‘‘(but shall not 11

be included’’ and all that follows before the period 12

at the end. 13

(b) EFFECTIVE DATE.—The amendments made by 14

subsection (a) shall apply to items and services furnished 15

on or after January 1, 2015. 16

SEC. 204. DISCHARGE PLANNING IN PSYCHIATRIC FACILI-17

TIES. 18

Section 1861(ee) of the Social Security Act (42 19

U.S.C. 1395x(ee)) is amended by adding at the end the 20

following new paragraph: 21

‘‘(4)(A) Beginning 1 year after the date of the 22

enactment of this paragraph, a psychiatric hospital 23

or a psychiatric unit (as described in the matter fol-24

lowing clause (v) of section 1886(d)(1)(B)) that is 25

determined by the Secretary not to have in place a 26



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[Discussion Draft]

discharge planning process that meets the require-1

ments of this subsection is subject to a civil money 2

penalty of not more than $10,000. A civil money 3

penalty under this subparagraph shall be imposed 4

and collected in the same manner as civil money 5

penalties under subsection (a) of section 1128A are 6

imposed and collected under that section. 7

‘‘(B) Beginning 1 year after the date of the en-8

actment of this paragraph, the Secretary may re-9

quire a psychiatric hospital or such a psychiatric 10

unit that the Secretary has determined on multiple 11

occasions does not have in place a discharge plan-12

ning process that meets the requirements of this 13

subsection to enter into an agreement with the Sec-14

retary, similar to a system improvement agreement 15

applied pursuant to section 1866(b), to—16

‘‘(i) obtain from a third party that is se-17

lected by the Secretary an independent review 18

of policies and procedures of the hospital or 19

unit for purposes of providing recommendations 20

for establishing a sufficient discharge planning 21

process under this subsection; 22

‘‘(ii) retain an independent compliance offi-23

cer for a period specified in the agreement to 24

monitor and assist the hospital or unit in estab-25



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[Discussion Draft]

lishing a sufficient discharge planning process 1

under this subsection; 2

‘‘(iii) submit periodic reports to the Sec-3

retary detailing improvements made to the poli-4

cies and procedures of the hospital or unit to 5

have in place a sufficient discharge planning 6

process under this subsection; and 7

‘‘(iv) undertake such other actions as the 8

Secretary determines necessary in order to en-9

sure that the hospital or unit will continue to 10

have a sufficient discharge planning process 11

under this subsection on an ongoing basis. 12

‘‘(C) In the case that a psychiatric hospital or 13

such a psychiatric unit has entered into an agree-14

ment under subparagraph (B) and does not have in 15

place a sufficient discharge planning process by the 16

date that is 45 days after entering into such agree-17

ment, the Secretary may, in consultation with the 18

State, appoint temporary management to oversee the 19

operation of the hospital or unit, assure the health 20

and safety of the hospital or unit’s inpatients, and 21

ensure compliance with requirements of such dis-22

charge planning process by the hospital or unit. The 23

temporary management under this subparagraph 24

shall be terminated when the Secretary has deter-25



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[Discussion Draft]

mined that the hospital or unit has the management 1

capability to ensure continued compliance with all 2

such requirements.’’. 3

SEC. 205. COVERAGE OF INTENSIVE OUTPATIENT SERV-4

ICES. 5

(a) COVERAGE.—Section 1832(a)(2) of the Social Se-6

curity Act (42 U.S.C. 1395k(a)(2)) is amended—7

(1) in subparagraph (I), by striking ‘‘and’’ at 8

the end; 9

(2) in subparagraph (J), by striking the period 10

at the end and inserting ‘‘; and’’; and 11

(3) by adding at the end the following new sub-12

paragraph: 13

‘‘(K) intensive outpatient services (as de-14

scribed in section 1861(iii)).’’. 15

(b) SERVICES DESCRIBED.—Section 1861 of the So-16

cial Security Act (42 U.S.C. 1395x), as amended by sec-17

tion 201(b), is amended by adding at the end the following 18

new subsection: 19

‘‘(iii) INTENSIVE OUTPATIENT SERVICES.—(1) The 20

term ‘intensive outpatient services’ means the items and 21

services described in paragraph (2) prescribed by a physi-22

cian and provided within the context described in para-23

graph (3) under the supervision of a physician (or, to the 24

extent permitted under the law of the State in which the 25



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services are furnished, a non-physician mental health pro-1

fessional) pursuant to an individualized, written plan of 2

treatment that is established by a physician and periodi-3

cally reviewed by a physician or, to the extent permitted 4

under the laws of the State in which the services are fur-5

nished, a non-physician mental health professional (in con-6

sultation with appropriate staff participating in such serv-7

ices), which plan sets forth the patient’s diagnosis, the 8

type, amount, frequency, and duration of the items and 9

services provided under the plan, and the goals for treat-10

ment under the plan. 11

‘‘(2)(A) The items and services described in this 12

paragraph are the items and services described in sub-13

paragraph (B) that are reasonable and necessary for the 14

diagnosis or treatment of the individual’s condition, rea-15

sonably expected to improve or maintain the individual’s 16

condition and functional level and to prevent relapse or 17

hospitalization, and furnished pursuant to such guidelines 18

relating to frequency and duration of services as the Sec-19

retary shall by regulation establish (taking into account 20

accepted norms of clinical practice). 21

‘‘(B) For purposes of subparagraph (A), the items 22

and services described in this paragraph are as follows: 23

‘‘(i) Psychiatric rehabilitation. 24

‘‘(ii) Assertive community treatment. 25



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‘‘(iii) Intensive case management. 1

‘‘(iv) Day treatment for individuals under 21 2

years of age. 3

‘‘(v) Ambulatory detoxification. 4

‘‘(vi) Such other items and services as the Sec-5

retary may provide (but in no event to include meals 6

and transportation). 7

‘‘(3) The context described in this paragraph for the 8

provision of intensive outpatient services is as follows: 9

‘‘(A) Such services are furnished in a facility, 10

home, or community setting. 11

‘‘(B) Such services are furnished—12

‘‘(i) to assist the individual to compensate 13

for, or eliminate, functional deficits and inter-14

personal and environmental barriers created by 15

the disability; and 16

‘‘(ii) to restore skills to the individual for 17

independent living, socialization, and effective 18

life management. 19

‘‘(C) Such services are furnished by an indi-20

vidual or entity that—21

‘‘(i) is legally authorized to furnish such 22

services under State law (or the State regu-23

latory mechanism provided by State law) or 24



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[Discussion Draft]

meets such certification requirements that the 1

Secretary may impose; and 2

‘‘(ii) meets such other requirements as the 3

Secretary may impose to assure the quality of 4

the intensive outpatient services provided.’’. 5

(c) PAYMENT.—6

(1) IN GENERAL.—With respect to intensive 7

outpatient services (as defined in section 1861(iii)(1) 8

of the Social Security Act (as added by subsection 9

(b)) furnished under the medicare program, the 10

amount of payment under such Act for such services 11

shall be 80 percent of—12

(A) during ø2015 and 2016¿, the reason-13

able costs of furnishing such services; and 14

(B) on or after January 1, ø2017¿, the 15

amount of payment established for such serv-16

ices under the prospective payment system es-17

tablished by the Secretary under paragraph (2) 18

for such services. 19

(2) ESTABLISHMENT OF PPS.—20

(A) IN GENERAL.—With respect to inten-21

sive outpatient services (as defined in section 22

1861(iii)(1)) of the Social Security Act (as 23

added by subsection (b)) furnished under the 24

medicare program on or after January 1, 25



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ø2017¿, the Secretary of Health and Human 1

Services (in this paragraph referred to as the 2

‘‘Secretary’’) shall establish a prospective pay-3

ment system for payment for such services. 4

Such system shall include an adequate patient 5

classification system that reflects the dif-6

ferences in patient resource use and costs and 7

shall provide for an annual update to the rates 8

of payment established under the system. 9

(B) ADJUSTMENTS.—In establishing the 10

system under subparagraph (A), the Secretary 11

shall provide for adjustments in the prospective 12

payment amount for variations in wage and 13

wage-related costs, case mix, and such other 14

factors as the Secretary determines appropriate. 15

(C) COLLECTION OF DATA AND EVALUA-16

TION.—In developing the system described in 17

subparagraph (A), the Secretary may require 18

providers of services under the medicare pro-19

gram to submit such information to the Sec-20

retary as the Secretary may require to develop 21

the system, including the most recently avail-22

able data. 23

(D) REPORTS TO CONGRESS.—Not later 24

than October 1 of each of ø2015 and 2016¿, 25



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[Discussion Draft]

the Secretary shall submit to Congress a report 1

on the progress of the Secretary in establishing 2

the prospective payment system under this 3

paragraph. 4

(d) CONFORMING AMENDMENTS.—(1) Section 5

1835(a)(2) of the Social Security Act (42 U.S.C. 6

1395n(a)(2)) is amended—7

(A) in subparagraph (E), by striking ‘‘and’’ at 8

the end; 9

(B) in subparagraph (F), by striking the period 10

at the end and inserting ‘‘; and’’; and 11

(C) by inserting after subparagraph (F) the fol-12

lowing new subparagraph: 13

‘‘(G) in the case of intensive outpatient 14

services, (i) such services are reasonably ex-15

pected to improve or maintain the individual’s 16

condition and functional level and to prevent re-17

lapse or hospitalization, (ii) an individualized, 18

written plan for furnishing such services has 19

been established by a physician and is reviewed 20

periodically by a physician or, to the extent per-21

mitted under the laws of the State in which the 22

services are furnished, a non-physician mental 23

health professional, and (iii) such services are 24

or were furnished while the individual is or was 25



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[Discussion Draft]

under the care of a physician or, to the extent 1

permitted under the law of the State in which 2

the services are furnished, a non-physician men-3

tal health professional.’’. 4

(2) Section 1861(s)(2)(B) of the Social Security Act 5

(42 U.S.C. 1395x(s)(2)(B)) is amended by inserting ‘‘and 6

intensive outpatient services’’ after ‘‘partial hospitalization 7

services’’. 8

(3) Section 1861(ff)(1) of the Social Security Act (42 9

U.S.C. 1395x(ff)(1)) is amended—10

(A) by inserting ‘‘or, to the extent permitted 11

under the law of the State in which the services are 12

furnished, a non-physician mental health profes-13

sional,’’ after ‘‘under the supervision of a physician’’ 14

and after ‘‘periodically reviewed by a physician’’; and 15

(B) by striking ‘‘physician’s’’ and inserting ‘‘pa-16

tient’s’’. 17

(4) Section 1861(cc) of the Social Security Act (42 18

U.S.C. 1395x(cc)) is amended—19

(A) in paragraph (1), in the matter preceding 20

subparagraph (A), by striking ‘‘physician—’’ and in-21

serting ‘‘physician or, to the extent permitted under 22

the law of the State in which the services are fur-23

nished, a non-physician mental health professional—24

’’; and 25



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(B) in paragraph (2)(E), by inserting before 1

the semicolon at the end the following: ‘‘, except that 2

a patient receiving social and psychological services 3

under paragraph (1)(D) may be under the care of 4

a non-physician mental health professional with re-5

spect to such services to the extent permitted under 6

the law of the State in which the services are fur-7

nished’’. 8

(e) EFFECTIVE DATE.—øReview: There are already 9

effective dates built into subsections (a) through (c). Does 10

this only apply with respect to subsection (d)?¿ The 11

amendments made by this section shall apply to items and 12

services furnished on or after January 1, 2016. 13

SEC. 206. EXPANDING THE MEDICAID HOME AND COMMU-14

NITY-BASED SERVICES WAIVER TO INCLUDE 15

YOUTH IN NEED OF SERVICES PROVIDED IN 16

A PSYCHIATRIC RESIDENTIAL TREATMENT 17

FACILITY. 18

(a) IN GENERAL.—Section 1915(c) of the Social Se-19

curity Act (42 U.S.C. 1396n(c)) is amended—20

(1) in paragraph (1)—21

(A) by striking ‘‘a hospital or a nursing fa-22

cility or intermediate care facility for the men-23

tally retarded’’ and inserting ‘‘a hospital, a 24

nursing facility, an intermediate care facility for 25



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[Discussion Draft]

the intellectually disabled, or a psychiatric resi-1

dential treatment facility,’’; and 2

(B) by striking ‘‘a hospital, nursing facil-3

ity, or intermediate care facility for the men-4

tally retarded’’ and inserting ‘‘a hospital, nurs-5

ing facility, intermediate care facility for the in-6

tellectually disabled, or psychiatric residential 7

treatment facility’’; 8

(2) in paragraph (2)(B), by striking ‘‘or serv-9

ices in an intermediate care facility for the mentally 10

retarded’’ each place it appears and inserting ‘‘serv-11

ices in an intermediate care facility for the intellec-12

tually disabled, or services in a psychiatric residen-13

tial treatment facility’’; 14

(3) in paragraph (2)(C)—15

(A) by striking ‘‘or intermediate care facil-16

ity for the mentally retarded’’ and inserting 17

‘‘intermediate care facility for the intellectually 18

disabled, or psychiatric residential treatment fa-19

cility’’; and 20

(B) by striking ‘‘or services in an inter-21

mediate care facility for the mentally retarded’’ 22

and inserting ‘‘services in an intermediate care 23

facility for the intellectually disabled, or services 24

in a psychiatric residential treatment facility’’; 25



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(4) in paragraph (7)(A), by striking ‘‘or inter-1

mediate care facilities for the mentally retarded,’’ 2

and inserting ‘‘intermediate care facilities for the in-3

tellectually disabled, or psychiatric residential treat-4

ment facilities,’’; and 5

(5) by adding at the end the following new 6

paragraph: 7

‘‘(11) For purposes of this subsection, the term ‘psy-8

chiatric residential treatment facility’ means a facility 9

other than a hospital that is certified as meeting the re-10

quirements specified in regulations promulgated for such 11

facilities under section 1905(h)(1) and that provides psy-12

chiatric services in an inpatient setting to individuals 13

under age 21 for which medical assistance is available 14

under a State plan under this title.’’. 15

(b) WAIVER LIMITATION.—Section 1915(c) of such 16

Act, as amended by subsection (a), is further amended—17


(A) in subparagraph (D), by striking ‘‘; 19

and’’ and inserting a semicolon; 20

(B) in subparagraph (E), by striking the 21

period at the end and inserting a semicolon; 22

and 23

(C) by adding at the end the following new 24

subparagraphs: 25



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[Discussion Draft]

‘‘(F) under the waiver, the total number of 1

Medicaid inpatient bed days at psychiatric residen-2

tial treatment facilities during each fiscal year with-3

in the waiver period will not exceed the total number 4

of Medicaid inpatient bed days at such facilities for 5

the previous fiscal year as increased by the esti-6

mated percentage increase (if any) in the population 7

of individuals under age 21 residing in the State 8

over the preceding 12-month period; and 9

‘‘(G) the State will provide to the Secretary an-10

nually, subject to such requirements as the Sec-11

retary determines appropriate, relevant information 12

and evidence as to the manner in which the State 13

will satisfy the requirements described in subpara-14

graph (F).’’; and 15

(2) by adding at the end the following new 16

paragraph: 17

‘‘(12) For purposes of paragraph (2)(F), an indi-18

vidual who is under age 21 and is an inpatient in a bed 19

in a psychiatric residential treatment facility for a single 20

day shall be counted as one inpatient bed day.’’. 21

SEC. 207. APPLICATION OF ROSA’S LAW FOR INDIVIDUALS 22

WITH INTELLECTUAL DISABILITIES. 23

(a) REFERENCES IN THE SOCIAL SECURITY ACT.—24



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[Discussion Draft]

(1) IN GENERAL.—With the exception of sec-1

tion 1930(b) of the Social Security Act (42 U.S.C. 2

1396u(b)), such Act, as amended by section 2, is 3

further amended—4

(A) by striking, wherever it appears, 5

‘‘State mental retardation or developmental dis-6

ability authority’’ and inserting ‘‘State intellec-7

tual disability or developmental disability au-8

thority’’; 9

(B) by striking, wherever it appears, 10

‘‘mental retardation’’ and inserting ‘‘intellectual 11

disabilities’’; and 12

(C) by striking, wherever it appears, ‘‘men-13

tally retarded’’ and inserting ‘‘intellectually dis-14

abled’’. 15

(2) CONFORMING AMENDMENT.—16

(A) IN GENERAL.—Section 1902(e)(14)(F) 17

of such Act, as added by section 2002(a) of 18

Public Law 111–148, is amended by striking 19

‘‘mentally retarded’’ and inserting ‘‘intellectu-20

ally disabled’’. 21

(B) EFFECTIVE DATE.—The amendment 22

made under subparagraph (A) shall take effect 23

on January 2, 2015. 24

(b) REFERENCES.—25



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[Discussion Draft]

(1) IN GENERAL.—For purposes of each provi-1

sion amended by this section, issuing or amending 2

regulations to carry out a provision amended by this 3

section, or issuing any publication or other official 4

communication in regards to any provision of the 5

Social Security Act—6

(A) a reference to an intellectual disability 7

shall mean a condition previously referred to as 8

mental retardation, or a variation of such term, 9

and shall have the same meaning with respect 10

to programs, or qualifications for such pro-11

grams, for individuals with such a condition; 12

(B) a reference to an individual who is in-13

tellectually disabled shall mean an individual 14

who was previously referred to as an individual 15

who is mentally retarded, an individual with 16

mental retardation, or variations of such terms; 17

(C) a reference to an intermediate care fa-18

cility for the intellectually disabled shall mean 19

a facility that was previously referred to as an 20

intermediate care facility for the mentally re-21

tarded; and 22

(D) a reference to a State intellectual dis-23

ability or developmental disability authority 24

shall mean an entity that was previously re-25



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[Discussion Draft]

ferred to as a State mental retardation or de-1

velopmental disability authority. 2

(2) REGULATIONS.—For purposes of amending 3

regulations to carry out this section, a Federal agen-4

cy shall ensure that the regulations clearly state—5

(A) that an intellectual disability was for-6

merly termed mental retardation; 7

(B) that individuals with intellectual dis-8

abilities were formerly termed individuals who 9

are mentally retarded; 10

(C) that an intermediate care facility for 11

the intellectually disabled was formerly termed 12

an intermediate care facility for the mentally 13

retarded; and 14

(D) that a State intellectual disability or 15

developmental disability authority was formerly 16

termed a State mental retardation or develop-17

mental disability authority. 18

(c) RULE OF CONSTRUCTION.—This section shall be 19

construed to make amendments to provisions of Federal 20

law to substitute the term ‘‘intellectual disability’’ for 21

‘‘mental retardation’’ or any variation of such term with-22

out any intent to—23



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[Discussion Draft]

(1) change the coverage, eligibility, rights, re-1

sponsibilities, or definitions referred to in the 2

amended provisions; or 3

(2) compel States to change terminology in 4

State laws for individuals covered by a provision 5

amended by this section. 6

SEC. 208. COMPLETE APPLICATION OF MENTAL HEALTH 7

PARITY RULES UNDER MEDICAID AND CHIP. 8

Not later than January 1, 2015, the Secretary of 9

Health and Human Services shall issue final regulations 10

to carry out the following provisions of law: 11

(1) Section 1932(b)(8) of the Social Security 12

Act (42 U.S.C. 1396u–2(b)(8)) (relating to requir-13

ing medicaid managed care organizations to comply 14

with the mental health requirements under certain 15

provisions of part A of title XXVII of the Public 16

Health Service Act (42 U.S.C. 300gg et seq.)). 17

(2) Section 1937(b)(6) of such Act (42 U.S.C. 18

1396u–7(b)(6)) (relating to requiring benchmark 19

benefit packages or benchmark equivalent coverage 20

to comply with the mental health parity require-21

ments under section 2705(a) of the Public Health 22

Service Act (42 U.S.C. 300gg–4)). 23

(3) Section 2103(c)(6) of the Social Security 24

Act (42 U.S.C. 1937cc(c)6)) (relating to requiring 25



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[Discussion Draft]

State child health plans to comply with mental 1

health parity requirements under section 2705(a) of 2

the Public Health Service Act (42 U.S.C. 300gg–4)). 3

TITLE III—DEVELOPING THE BE-4

HAVIORAL HEALTH WORK-5

FORCE 6

SEC. 301. NATIONAL HEALTH SERVICE CORPS SCHOLAR-7

SHIP AND LOAN REPAYMENT FUNDING FOR 8

BEHAVIORAL AND MENTAL HEALTH PROFES-9

SIONALS. 10

Section 338H of the Public Health Service Act (42 11

U.S.C. 254q) is amended—12

(1) by redesignating subsections (b) and (c) as 13

subsections (c) and (d), respectively; and 14

(2) by inserting after subsection (a) the fol-15

lowing: 16

‘‘(b) ADDITIONAL FUNDING FOR BEHAVIORAL AND 17

MENTAL HEALTH PROFESSIONALS.—In addition to the 18

amounts authorized to be appropriated under subsection 19

(a), and in addition to the amounts appropriated under 20

section 10503 of Public Law 111–148, there are author-21

ized to be appropriated such sums as may be necessary 22

for fiscal years 2015 through 2019 for scholarships and 23

loan repayments under this subpart for ensuring, as de-24



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[Discussion Draft]

scribed in sections 338A(a) and 338B(a), an adequate 1

supply of behavioral and mental health professionals.’’. 2

SEC. 302. REAUTHORIZATION OF HRSA’S MENTAL AND BE-3

HAVIORAL HEALTH EDUCATION AND TRAIN-4

ING PROGRAM. 5

Subsection (e) of section 756 of the Public Health 6

Service Act (42 U.S.C. 294e-1) is amended to read as fol-7

lows: 8

‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 9



2015 through 2019.’’. 12

SEC. 303. SAMHSA GRANT PROGRAM FOR DEVELOPMENT 13

AND IMPLEMENTATION OF CURRICULA FOR 14

CONTINUING EDUCATION ON SERIOUS MEN-15

TAL ILLNESS. 16

Title V of the Public Health Service Act is amended 17

by inserting after section 520I (42 U.S.C. 290bb-40) the 18

following: 19

‘‘SEC. 520I-1. CURRICULA FOR CONTINUING EDUCATION ON 20

SERIOUS MENTAL ILLNESS. 21

‘‘(a) GRANTS.—The Secretary may award grants to 22

eligible entities for the development and implementation 23

of curricula for providing continuing education and train-24



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[Discussion Draft]

ing to health care professionals on identifying, referring, 1

and treating individuals with serious mental illness. 2

‘‘(b) ELIGIBLE ENTITIES.—To be eligible to seek a 3

grant under this section, an entity shall be a public or 4

nonprofit entity that—5

‘‘(1) provides continuing education or training 6

to health care professionals; or 7

‘‘(2) applies for the grant in partnership with 8

another entity that provides such education and 9

training. 10

‘‘(c) PREFERENCE.—In awarding grants under this 11

section, the Secretary shall give preference to eligible enti-12

ties proposing to develop and implement curricula for pro-13

viding continuing education and training to—14

‘‘(1) health care professionals in primary care 15

specialities; or 16

‘‘(2) health care professionals who are required, 17

as a condition of State licensure, to participate in 18

continuing education or training specific to mental 19

health. 20

‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 21



2015 through 2019.’’. 24



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[Discussion Draft]

SEC. 304. DEMONSTRATION GRANT PROGRAM TO RECRUIT, 1

TRAIN, DEPLOY, AND PROFESSIONALLY SUP-2

PORT PSYCHIATRIC PHYSICIANS IN INDIAN 3

HEALTH PROGRAMS. 4

(a) SHORT TITLE.—This section may be cited as the 5

‘‘Native American Psychiatric and Mental Health Care 6

Improvement Act’’. 7

(b) DEMONSTRATION GRANT PROGRAM TO RECRUIT, 8

TRAIN, DEPLOY, AND PROFESSIONALLY SUPPORT PSY-9

CHIATRIC PHYSICIANS IN INDIAN HEALTH PROGRAMS.—10

(1) ESTABLISHMENT.—The Secretary of Health 11

and Human Services (in this subsection referred to 12

as the ‘‘Secretary’’), in consultation with the Direc-13

tor of the Indian Health Service and demonstration 14

programs established under section 123 of the In-15

dian Health Care Improvement Act (25 U.S.C. 16

1616p), shall award one 5-year grant to one eligible 17

entity to carry out a demonstration program (in this 18

Act referred to as the ‘‘Program’’) under which the 19

eligible entity shall carry out the activities described 20

in paragraph (2). 21

(2) ACTIVITIES TO BE CARRIED OUT BY RECIPI-22

ENT OF GRANT UNDER PROGRAM.—Under the Pro-23

gram, the grant recipient shall—24

(A) create a nationally-replicable workforce 25

model that identifies and incorporates best 26



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[Discussion Draft]

practices for recruiting, training, deploying, and 1

professionally supporting Native American and 2

non-Native American psychiatric physicians to 3

be fully integrated into medical, mental, and be-4

havioral health systems in Indian health pro-5

grams; 6

(B) recruit to participate in the Program 7

Native American and non-Native American psy-8

chiatric physicians who demonstrate interest in 9

providing specialty health care services (as de-10

fined in section 313(a)(3) of the Indian Health 11

Care Improvement Act (25 U.S.C. 12

1638g(a)(3))) and primary care services to 13

American Indians and Alaska Natives; 14

(C) provide such psychiatric physicians 15

participating in the Program with not more 16

than 1 year of supplemental clinical and cul-17

tural competency training to enable such physi-18

cians to provide such specialty health care serv-19

ices and primary care services in Indian health 20

programs; 21

(D) with respect to such psychiatric physi-22

cians who are participating in the Program and 23

trained under subparagraph (C), deploy such 24

physicians to practice specialty care or primary 25



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[Discussion Draft]

care in Indian health programs for a period of 1

not less than 2 years and professionally support 2

such physicians for such period with respect to 3

practicing such care in such programs; and 4

(E) not later than 1 year after the last day 5

of the 5-year period for which the grant is 6

awarded under paragraph (1), submit to the 7

Secretary and to the appropriate committees of 8

Congress a report that shall include—9

(i) the workforce model created under 10

subparagraph (A); 11

(ii) strategies for disseminating the 12

workforce model to other entities with the 13

capability of adopting it; and 14

(iii) recommendations for the Sec-15

retary and Congress with respect to sup-16

porting an effective and stable psychiatric 17

and mental health workforce that serves 18

American Indians and Alaska Natives. 19

(3) ELIGIBLE ENTITIES.—20

(A) REQUIREMENTS.—To be eligible to re-21

ceive the grant under this section, an entity 22

shall—23

(i) submit to the Secretary an applica-24

tion at such time, in such manner, and 25



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[Discussion Draft]

containing such information as the Sec-1

retary may require; 2

(ii) be a department of psychiatry 3

within a medical school in the United 4

States that is accredited by the Liaison 5

Committee on Medical Education or a pub-6

lic or private non-profit entity affiliated 7

with a medical school in the United States 8

that is accredited by the Liaison Com-9

mittee on Medical Education; and 10

(iii) have in existence, as of the time 11

of submission of the application under sub-12

paragraph (A), a relationship with Indian 13

health programs in at least two States with 14

a demonstrated need for psychiatric physi-15

cians and provide assurances that the 16

grant will be used to serve rural and non-17

rural American Indian and Alaska Native 18

populations in at least two States. 19

(B) PRIORITY IN SELECTING GRANT RE-20

CIPIENT.—In awarding the grant under this 21

section, the Secretary shall give priority to an 22

eligible entity that satisfies each of the fol-23

lowing: 24



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(i) Demonstrates sufficient infrastruc-1

ture in size, scope, and capacity to under-2

take the supplemental clinical and cultural 3

competency training of a minimum of 5 4

psychiatric physicians, and to provide on-5

going professional support to psychiatric 6

physicians during the deployment period to 7

an Indian health program. 8

(ii) Demonstrates a record in success-9

fully recruiting, training, and deploying 10

physicians who are American Indians and 11

Alaska Natives. 12

(iii) Demonstrates the ability to estab-13

lish a program advisory board, which may 14

be primarily composed of representatives of 15

federally-recognized tribes, Alaska Natives, 16

and Indian health programs to be served 17

by the Program. 18

(4) ELIGIBILITY OF PSYCHIATRIC PHYSICIANS 19

TO PARTICIPATE IN THE PROGRAM.—20

(A) IN GENERAL.—To be eligible to par-21

ticipate in the Program, as described in para-22

graph (2), a psychiatric physician shall—23

(i) be licensed or eligible for licensure 24

to practice in the State to which the physi-25



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[Discussion Draft]

cian is to be deployed under paragraph 1

(2)(D); and 2

(ii) demonstrate a commitment be-3

yond the one year of training described in 4

paragraph (2)(C) and two years of deploy-5

ment described in paragraph (2)(D) to a 6

career as a specialty care physician or pri-7

mary care physician providing mental 8

health services in Indian health programs. 9

(B) PREFERENCE.—In selecting physicians 10

to participate under the Program, as described 11

in paragraph (2)(B), the grant recipient shall 12

give preference to physicians who are American 13

Indians and Alaska Natives. 14

(5) LOAN FORGIVENESS.—Under the Program, 15

any psychiatric physician accepted to participate in 16

the Program shall, notwithstanding the provisions of 17

subsection (b) of section 108 of the Indian Health 18

Care Improvement Act (25 U.S.C. 1616a) and upon 19

acceptance into the Program, be deemed eligible and 20

enrolled to participate in the Indian Health Service 21

Loan Repayment Program under such section 108. 22

Under such Loan Repayment Program, the Sec-23

retary shall pay on behalf of the physician for each 24

year of deployment under the Program under this 25



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[Discussion Draft]

section up to $35,000 for loans described in sub-1

section (g)(1) of such section 108. 2

(6) DEFERRAL OF CERTAIN SERVICE.—The 3

starting date of required service of individuals in the 4

National Health Service Corps Service Program 5

under title II of the Public Health Service Act (42 6

U.S.C. 202 et seq.) who are psychiatric physicians 7

participating under the Program under this section 8

shall be deferred until the date that is 30 days after 9

the date of completion of the participation of such 10

a physician in the Program under this section. 11

(7) DEFINITIONS.—For purposes of this Act: 12

(A) AMERICAN INDIANS AND ALASKA NA-13

TIVES.—The term ‘‘American Indians and Alas-14

ka Natives’’ has the meaning given the term 15

‘‘Indian’’ in section 447.50(b)(1) of title 42, 16

Code of Federal Regulations, as in existence as 17

of the date of the enactment of this Act. 18

(B) INDIAN HEALTH PROGRAM.—The term 19

‘‘Indian health program’’ has the meaning given 20

such term in section 104(12) of the Indian 21

Health Care Improvement Act (25 U.S.C. 22

1603(12)). 23

(C) PROFESSIONALLY SUPPORT.—The 24

term ‘‘professionally support’’ means, with re-25



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[Discussion Draft]

spect to psychiatric physicians participating in 1

the Program and deployed to practice specialty 2

care or primary care in Indian health programs, 3

the provision of compensation to such physi-4

cians for the provision of such care during such 5

deployment and may include the provision, dis-6

semination, or sharing of best practices, field 7

training, and other activities deemed appro-8

priate by the recipient of the grant under this 9

section. 10

(D) PSYCHIATRIC PHYSICIAN.—The term 11

‘‘psychiatric physician’’ means a medical doctor 12

or doctor of osteopathy in good standing who 13

has successfully completed four-year psychiatric 14

residency training or who is enrolled in four-15

year psychiatric residency training in a resi-16

dency program accredited by the Accreditation 17

Council for Graduate Medical Education. 18

(8) AUTHORIZATION OF APPROPRIATIONS.—19

There is authorized to be appropriated to carry out 20

this section $1,000,000 for each of the fiscal years 21

2015 through 2019. 22



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SEC. 305. INCLUDING OCCUPATIONAL THERAPISTS AS BE-1

HAVIORAL AND MENTAL HEALTH PROFES-2

SIONALS FOR PURPOSES OF THE NATIONAL 3

HEALTH SERVICE CORPS. 4

Section 331(a)(3)(E)(i) of the Public Health Service 5

Act (42 U.S.C. 254d(a)(3)(E)(i)) is amended by inserting 6

‘‘occupational therapists,’’ after ‘‘psychiatric nurse spe-7

cialists,’’. 8

SEC. 306. COVERAGE OF MARRIAGE AND FAMILY THERA-9

PIST SERVICES AND MENTAL HEALTH COUN-10

SELOR SERVICES UNDER PART B OF THE 11

MEDICARE PROGRAM. 12

(a) COVERAGE OF SERVICES.—13

(1) IN GENERAL.—Section 1861(s)(2) of the 14

Social Security Act (42 U.S.C. 1395x(s)(2)) is 15

amended—16

(A) in subparagraph (EE), by striking 17

‘‘and’’ after the semicolon at the end; 18

(B) in subparagraph (FF), by inserting 19

‘‘and’’ after the semicolon at the end; and 20


subparagraph: 22

‘‘(GG) marriage and family therapist services 23

(as defined in subsection (iii)(1)) and mental health 24

counselor services (as defined in subsection 25

(iii)(3));’’. 26



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(2) DEFINITIONS.—Section 1861 of the Social 1

Security Act (42 U.S.C. 1395x) is amended by add-2

ing at the end the following new subsection: 3

‘‘Marriage and Family Therapist Services; Marriage and 4

Family Therapist; Mental Health Counselor Serv-5

ices; Mental Health Counselor 6

‘‘(iii)(1) The term ‘marriage and family therapist 7

services’ means services performed by a marriage and 8

family therapist (as defined in paragraph (2)) for the diag-9

nosis and treatment of mental illnesses, which the mar-10

riage and family therapist is legally authorized to perform 11

under State law (or the State regulatory mechanism pro-12

vided by State law) of the State in which such services 13

are performed, as would otherwise be covered if furnished 14

by a physician or as an incident to a physician’s profes-15

sional service, but only if no facility or other provider 16

charges or is paid any amounts with respect to the fur-17

nishing of such services. 18

‘‘(2) The term ‘marriage and family therapist’ means 19

an individual who—20

‘‘(A) possesses a master’s or doctoral degree 21

which qualifies for licensure or certification as a 22

marriage and family therapist pursuant to State 23

law; 24



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‘‘(B) after obtaining such degree has performed 1

at least 2 years of clinical supervised experience in 2

marriage and family therapy; and 3

‘‘(C) in the case of an individual performing 4

services in a State that provides for licensure or cer-5

tification of marriage and family therapists, is li-6

censed or certified as a marriage and family thera-7

pist in such State. 8

‘‘(3) The term ‘mental health counselor services’ 9

means services performed by a mental health counselor (as 10

defined in paragraph (4)) for the diagnosis and treatment 11

of mental illnesses which the mental health counselor is 12

legally authorized to perform under State law (or the 13

State regulatory mechanism provided by the State law) of 14

the State in which such services are performed, as would 15

otherwise be covered if furnished by a physician or as inci-16

dent to a physician’s professional service, but only if no 17

facility or other provider charges or is paid any amounts 18

with respect to the furnishing of such services. 19

‘‘(4) The term ‘mental health counselor’ means an 20

individual who—21

‘‘(A) possesses a master’s or doctor’s degree in 22

mental health counseling or a related field; 23



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‘‘(B) after obtaining such a degree has per-1

formed at least 2 years of supervised mental health 2

counselor practice; and 3

‘‘(C) in the case of an individual performing 4

services in a State that provides for licensure or cer-5

tification of mental health counselors or professional 6

counselors, is licensed or certified as a mental health 7

counselor or professional counselor in such State.’’. 8

(3) PROVISION FOR PAYMENT UNDER PART 9

B.—Section 1832(a)(2)(B) of the Social Security 10

Act (42 U.S.C. 1395k(a)(2)(B)) is amended by add-11

ing at the end the following new clause: 12

‘‘(v) marriage and family therapist 13

services (as defined in section 1861(iii)(1)) 14

and mental health counselor services (as 15

defined in section 1861(iii)(3));’’. 16

(4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 17

of the Social Security Act (42 U.S.C. 1395l(a)(1)) 18

is amended—19

(A) by striking ‘‘and (Z)’’ and inserting 20

‘‘(Z)’’; and 21

(B) by inserting before the semicolon at 22

the end the following: ‘‘, and (AA) with respect 23

to marriage and family therapist services and 24

mental health counselor services under section 25



f:\VHLC\042514\042514.229.xml (571949|22)

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[Discussion Draft]

1861(s)(2)(GG), the amounts paid shall be 80 1

percent of the lesser of the actual charge for 2

the services or 75 percent of the amount deter-3

mined for payment of a psychologist under sub-4

paragraph (L)’’. 5

(5) EXCLUSION OF MARRIAGE AND FAMILY 6

THERAPIST SERVICES AND MENTAL HEALTH COUN-7

SELOR SERVICES FROM SKILLED NURSING FACILITY 8

PROSPECTIVE PAYMENT SYSTEM.—Section 9

1888(e)(2)(A)(ii) of the Social Security Act (42 10

U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 11

‘‘marriage and family therapist services (as defined 12

in section 1861(iii)(1)), mental health counselor 13

services (as defined in section 1861(iii)(3)),’’ after 14

‘‘qualified psychologist services,’’. 15

(6) INCLUSION OF MARRIAGE AND FAMILY 16

THERAPISTS AND MENTAL HEALTH COUNSELORS AS 17

PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec-18

tion 1842(b)(18)(C) of the Social Security Act (42 19

U.S.C. 1395u(b)(18)(C)) is amended by adding at 20

the end the following new clauses: 21

‘‘(vii) A marriage and family therapist (as de-22

fined in section 1861(iii)(2)). 23

‘‘(viii) A mental health counselor (as defined in 24

section 1861(iii)(4)).’’. 25



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(b) COVERAGE OF CERTAIN MENTAL HEALTH SERV-1

ICES PROVIDED IN CERTAIN SETTINGS.—2

(1) RURAL HEALTH CLINICS AND FEDERALLY 3

QUALIFIED HEALTH CENTERS.—Section 4

1861(aa)(1)(B) of the Social Security Act (42 5

U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 6

by a clinical social worker (as defined in subsection 7

(hh)(1))’’ and inserting ‘‘, by a clinical social worker 8

(as defined in subsection (hh)(1)), by a marriage 9

and family therapist (as defined in subsection 10

(iii)(2)), or by a mental health counselor (as defined 11

in subsection (iii)(4))’’. 12

(2) HOSPICE PROGRAMS.—Section 13

1861(dd)(2)(B)(i)(III) of the Social Security Act (42 14

U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in-15

serting ‘‘, marriage and family therapist, or mental 16

health counselor’’ after ‘‘social worker’’. 17

(c) AUTHORIZATION OF MARRIAGE AND FAMILY 18

THERAPISTS AND MENTAL HEALTH COUNSELORS TO 19

DEVELOP DISCHARGE PLANS FOR POST-HOSPITAL SERV-20

ICES.—Section 1861(ee)(2)(G) of the Social Security Act 21

(42 U.S.C. 1395x(ee)(2)(G)) is amended by inserting ‘‘, 22

including a marriage and family therapist and a mental 23

health counselor who meets qualification standards estab-24

lished by the Secretary’’ before the period at the end. 25



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(d) EFFECTIVE DATE.—The amendments made by 1

this section shall apply with respect to services furnished 2

on or after January 1, 2015. 3

SEC. 307. EXTENSION OF CERTAIN HEALTH CARE WORK-4

FORCE LOAN REPAYMENT PROGRAMS 5

THROUGH FISCAL YEAR 2018. 6

Section 775(e) of the Public Health Service Act (42 7

U.S.C. 295f(e)) is amended—8

(1) by striking ‘‘2014’’ and inserting ‘‘2018’’; 9

and 10

(2) by striking ‘‘2013’’ and inserting ‘‘2018’’. 11

øTITLE IV—IMPROVING MENTAL 12

HEALTH RESEARCH AND CO-13

ORDINATION¿14

øSEC. 401. NATIONAL INSTITUTE OF MENTAL HEALTH RE-15

SEARCH PROGRAM ON SERIOUS MENTAL ILL-16

NESS. 17

ø(a) PURPOSE OF INSTITUTE.—Section 464R(a) of 18

the Public Health Service Act (42 U.S.C. 285p(a)) is 19

amended by inserting ‘‘serious mental illness research,’’ 20

after ‘‘biomedical and behavioral research,’’.¿21

ø(b) RESEARCH PROGRAM.—Section 464R(b) of the 22

Public Health Service Act (42 U.S.C. 285p(b)) is amend-23

ed—¿24



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ø(1) by striking ‘‘The research program’’ and 1

inserting the following:¿2

ø‘‘(1) IN GENERAL.—The research program’’;¿3

ø(2) by striking ‘‘to further the treatment and 4

prevention of mental illness’’ and inserting ‘‘to fur-5

ther the treatment and prevention of mental illness 6

(including serious mental illness)’’; and¿7

ø(3) by adding at the end the following:¿8

ø‘‘(2) RESEARCH WITH RESPECT TO SERIOUS 9

MENTAL ILLNESS.—As part of the research program 10

established under this subpart, the Director of the 11

Institute shall conduct or support research on seri-12

ous mental illness, including with respect to—¿13

ø‘‘(A) the causes, prevention, and treat-14

ment of serious mental illness; and¿15

ø‘‘(B) interventions to improve early iden-16

tification of individuals with serious mental ill-17

ness and referral of such individuals to mental 18

health professionals for treatment.’’.¿19

ø(c) BIENNIAL REPORT.—Section 403(a)(5) of the 20

Public Health Service Act (42 U.S.C. 283(a)(5)) is 21

amended—¿22

ø(1) by redesignating subparagraph (L) as sub-23

paragraph (M); and¿24



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ø(2) by inserting after subparagraph (K) the 1

following:¿2

ø‘‘(L) Serious mental illness.″.¿3

ø‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—In ad-4

dition to amounts otherwise made available to the Na-5

tional Institute of Mental Health, there are authorized to 6

be appropriated to such Institute $40,000,000 for each 7

of fiscal years 2015 through 2019 to carry out this sec-8

tion.’’.¿9

øSEC. 402. SUICIDE PREVENTION AND BRAIN RESEARCH. 10

Subpart 16 of part C of title IV of the Public Health 11

Service Act (42 U.S.C. 285p et seq.) is amended by adding 12

at the end the following:¿13

ø‘‘SEC. 464U-1. SUICIDE PREVENTION AND BRAIN RE-14

SEARCH. 15

ø‘‘(a) IN GENERAL.—The Director of the National 16

Institute of Mental Health shall use the funds made avail-17

able to such Institute pursuant to subsection (b) exclu-18

sively for the purpose of conducting and supporting—¿19

ø‘‘(1) research on the determinants of self-di-20

rected and other violence associated with mental ill-21

ness, including studies designed to reduce the risk of 22

self-harm, suicide, and interpersonal violence, espe-23

cially in rural communities with a shortage of men-24

tal health services; and¿25



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ø‘‘(2) brain research through the Brain Re-1

search Through Advancing Innovative 2

Neurotechnologies (BRAIN) Initiative.¿3

ø‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—In ad-4

dition to amounts otherwise made available to the Na-5

tional Institute of Mental Health, including amounts ap-6

propriated pursuant to section 402A(a), there are author-7

ized to be appropriated to such Institute $40,000,000 for 8

each of fiscal years 2015 through 2019 to carry out this 9

section.’’.¿10

øSEC. 403. YOUTH MENTAL HEALTH RESEARCH NETWORK. 11

ø(a) YOUTH MENTAL HEALTH RESEARCH NET-12

WORK.—¿13

ø(1) NETWORK.—The Director of the National 14

Institutes of Health may provide for the establish-15

ment of a Youth Mental Health Research Network 16

for the conduct or support of—¿17

ø(A) youth mental health research; and¿18

ø(B) youth mental health intervention 19

services.¿20

ø(2) COLLABORATION BY INSTITUTES AND 21

CENTERS.—The Director of NIH shall carry out this 22

Act acting—¿23

ø(A) through the Director of the National 24

Institute of Mental Health; and¿25



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ø(B) in collaboration with other appro-1

priate national research institutes and national 2

centers that carry out activities involving youth 3

mental health research.¿4

ø(3) MENTAL HEALTH RESEARCH.—5

ø(A) IN GENERAL.—In carrying out para-6

graph (1), the Director of NIH may award co-7

operative agreements, grants, and contracts to 8

State, local, and tribal governments and private 9

nonprofit entities for—¿10

ø(i) conducting, or entering into con-11

sortia with other entities to conduct—¿12

ø(I) basic, clinical, behavioral, or 13

translational research to meet unmet 14

needs for youth mental health re-15

search; or¿16

ø(II) training for researchers in 17

youth mental health research tech-18

niques;¿19

ø(ii) providing, or partnering with 20

non-research institutions or community-21

based groups with existing connections to 22

youth to provide, youth mental health 23

intervention services; and¿24



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ø(iii) collaborating with the National 1

Institute of Mental Health to make use of, 2

and build on, the scientific findings and 3

clinical techniques of the Institute’s earlier 4

programs, studies, and demonstration 5

projects.¿6

ø(B) RESEARCH.—The Director of NIH 7

shall ensure that—¿8

ø(i) each recipient of an award under 9

subparagraph (A)(i) conducts or supports 10

at least one category of research described 11

in subparagraph (A)(i)(I) and collectively 12

such recipients conduct or support all such 13

categories of research; and¿14

ø(ii) one or more such recipients pro-15

vide training described in subparagraph 16

(A)(i)(II).¿17

ø(C) NUMBER OF AWARD RECIPIENTS.—18

The Director of NIH may make awards under 19

this paragraph for not more than 70 entities.¿20

ø(D) SUPPLEMENT, NOT SUPPLANT.—Any 21

support received by an entity under subpara-22

graph (A) shall be used to supplement, and not 23

supplant, other public or private support for ac-24



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[Discussion Draft]

tivities authorized to be supported under this 1

paragraph.¿2

ø(E) DURATION OF SUPPORT.—Support of 3

an entity under subparagraph (A) may be for a 4

period of not to exceed 5 years. Such period 5

may be extended by the Director of NIH for 6

additional periods of not more than 5 years.¿7

ø(4) COORDINATION.—The Director of NIH 8

shall—¿9

ø(A) as appropriate, provide for the coordi-10

nation of activities (including the exchange of 11

information and regular communication) among 12

the recipients of awards under this subsection; 13

and¿14

ø(B) require the periodic preparation and 15

submission to the Director of reports on the ac-16

tivities of each such recipient.¿17

ø(b) INTERVENTION SERVICES FOR, AND RESEARCH 18

ON, SEVERE MENTAL ILLNESS.—¿19

ø(1) IN GENERAL.—In making awards under 20

subsection (a)(3), the Director of NIH shall ensure 21

that an appropriate number of such awards are 22

awarded to entities that agree to—¿23



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ø(A) focus primarily on the early detection 1

and intervention of severe mental illness in 2

young people;¿3

ø(B) conduct or coordinate one or more 4

multisite clinical trials of therapies for, or ap-5

proaches to, the prevention, diagnosis, or treat-6

ment of early severe mental illness in a commu-7

nity setting;¿8

ø(C) rapidly and efficiently disseminate 9

scientific findings resulting from such trials; 10

and¿11

ø(D) adhere to the guidelines, protocols, 12

and practices used in the North American Pro-13

drome Longitudinal Study (NAPLS) and the 14

Recovery After an Initial Schizophrenia Episode 15

(RAISE) initiative.¿16

ø(2) DATA COORDINATING CENTER.—17

ø(A) ESTABLISHMENT.—In connection 18

with awards to entities described in paragraph 19

(1), the Director of NIH shall establish a data 20

coordinating center for the following purposes:¿21

ø(i) To distribute the scientific find-22

ings referred to in paragraph (1)(C).¿23

ø(ii) To provide assistance in the de-24

sign and conduct of collaborative research 25



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projects and the management, analysis, 1

and storage of data associated with such 2

projects.¿3

ø(iii) To organize and conduct 4

multisite monitoring activities.¿5

ø(iv) To provide assistance to the 6

Centers for Disease Control and Preven-7

tion in the establishment of patient reg-8

istries.¿9

ø(B) REPORTING.—The Director of NIH 10

shall—¿11

ø(i) require the data coordinating cen-12

ter established under subparagraph (A) to 13

provide regular reports to the Director of 14

NIH on research conducted by entities de-15

scribed in paragraph (1), including infor-16

mation on enrollment in clinical trials and 17

the allocation of resources with respect to 18

such research; and¿19

ø(ii) as appropriate, incorporate infor-20

mation reported under clause (i) into the 21

Director’s biennial reports under section 22

403 of the Public Health Service Act (42 23

U.S.C. 283).¿24



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ø(c) DEFINITIONS.—In this Act, the terms ‘‘Director 1

of NIH’’, ‘‘national center’’, and ‘‘national research insti-2

tute’’ have the meanings given to such terms in section 3

401 of the Public Health Service Act (42 U.S.C. 281).¿4

ø(d) AUTHORIZATION OF APPROPRIATIONS.—To 5

carry out this Act, there is authorized to be appropriated 6

$25,000,000 for each of fiscal years 2015 through 2019.¿7

øSEC. 404. NATIONAL VIOLENT DEATH REPORTING SYSTEM. 8

The Secretary of Health and Human Services, acting 9

through the Director of the Centers for Disease Control 10

and Prevention, shall improve, particularly through the in-11

clusion of additional States, the National Violent Death 12

Reporting System, as authorized by title III of the Public 13

Health Service Act (42 U.S.C. 241 et seq.). Participation 14

in the system by the States shall be voluntary.¿15

øTITLE V—EDUCATION AND 16

YOUTH¿17

øSEC. 501. SCHOOL-BASED MENTAL HEALTH PROGRAMS. 18

ø(a) PURPOSES.—It is the purpose of this section 19

to—¿20

ø(1) revise, increase funding for, and expand 21

the scope of the Safe Schools-Healthy Students pro-22

gram in order to provide access to more comprehen-23

sive school-based mental health services and sup-24

ports;¿25



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ø(2) provide for comprehensive staff develop-1

ment for school and community service personnel 2

working in the school; and¿3

ø(3) provide for comprehensive training for 4

children with mental health disorders, for parents, 5

siblings, and other family members of such children, 6

and for concerned members of the community.¿7

ø(b) AMENDMENTS TO THE PUBLIC HEALTH SERV-8

ICE ACT.—¿9

ø(1) TECHNICAL AMENDMENTS.—The second 10

part G (relating to services provided through reli-11

gious organizations) of title V of the Public Health 12

Service Act (42 U.S.C. 290kk et seq.) is amended—13

¿14

ø(A) by redesignating such part as part J; 15

and¿16

ø(B) by redesignating sections 581 17

through 584 as sections 596 through 596C, re-18

spectively.¿19

ø(2) SCHOOL-BASED MENTAL HEALTH AND 20

CHILDREN AND VIOLENCE.—Section 581 of the Pub-21

lic Health Service Act (42 U.S.C. 290hh) is amend-22

ed to read as follows:¿23



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ø‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH AND CHIL-1

DREN AND VIOLENCE. 2

ø‘‘(a) IN GENERAL.—The Secretary, in collaboration 3

with the Secretary of Education and in consultation with 4

the Attorney General, shall, directly or through grants, 5

contracts, or cooperative agreements awarded to public en-6

tities and local education agencies, assist local commu-7

nities and schools in applying a public health approach 8

to mental health services both in schools and in the com-9

munity. Such approach should provide comprehensive age 10

appropriate services and supports, be linguistically and 11

culturally appropriate, be trauma-informed, and incor-12

porate age appropriate strategies of positive behavioral 13

interventions and supports. A comprehensive school men-14

tal health program funded under this section shall assist 15

children in dealing with trauma and violence.¿16

ø‘‘(b) ACTIVITIES.—Under the program under sub-17

section (a), the Secretary may—¿18

ø‘‘(1) provide financial support to enable local 19

communities to implement a comprehensive cul-20

turally and linguistically appropriate, trauma-in-21

formed, and age-appropriate, school mental health 22

program that incorporates positive behavioral inter-23

ventions, client treatment, and supports to foster the 24

health and development of children;¿25



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ø‘‘(2) provide technical assistance to local com-1

munities with respect to the development of pro-2

grams described in paragraph (1);¿3

ø‘‘(3) provide assistance to local communities in 4

the development of policies to address child and ado-5

lescent trauma and mental health issues and violence 6

when and if it occurs;¿7

ø‘‘(4) facilitate community partnerships among 8

families, students, law enforcement agencies, edu-9

cation systems, mental health and substance use dis-10

order service systems, family-based mental health 11

service systems, welfare agencies, health care service 12

systems (including physicians), faith-based pro-13

grams, trauma networks, and other community-14

based systems; and¿15

ø‘‘(5) establish mechanisms for children and 16

adolescents to report incidents of violence or plans 17

by other children, adolescents, or adults to commit 18

violence.¿19

ø‘‘(c) REQUIREMENTS.—¿20

ø‘‘(1) IN GENERAL.—To be eligible for a grant, 21

contract, or cooperative agreement under subsection 22

(a), an entity shall—¿23

ø‘‘(A) be a partnership between a local 24

education agency and at least one community 25



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[Discussion Draft]

program or agency that is involved in mental 1

health; and¿2

ø‘‘(B) submit an application, that is en-3

dorsed by all members of the partnership, that 4

contains the assurances described in paragraph 5

(2).¿6

ø‘‘(2) REQUIRED ASSURANCES.—An application 7

under paragraph (1) shall contain assurances as fol-8

lows:¿9

ø‘‘(A) That the applicant will ensure that, 10

in carrying out activities under this section, the 11

local educational agency involved will enter into 12

a memorandum of understanding—¿13

ø‘‘(i) with, at least one, public or pri-14

vate mental health entity, health care enti-15

ty, law enforcement or juvenile justice enti-16

ty, child welfare agency, family-based men-17

tal health entity, family or family organiza-18

tion, trauma network, or other community-19

based entity; and¿20

ø‘‘(ii) that clearly states—¿21

ø‘‘(I) the responsibilities of each 22

partner with respect to the activities 23

to be carried out;¿24



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ø‘‘(II) how each such partner will 1

be accountable for carrying out such 2

responsibilities; and¿3

ø‘‘(III) the amount of non-Fed-4

eral funding or in-kind contributions 5

that each such partner will contribute 6

in order to sustain the program.¿7

ø‘‘(B) That the comprehensive school-8

based mental health program carried out under 9

this section supports the flexible use of funds to 10

address—¿11

ø‘‘(i) the promotion of the social, 12

emotional, and behavioral health of all stu-13

dents in an environment that is conducive 14

to learning;¿15

ø‘‘(ii) the reduction in the likelihood 16

of at risk students developing social, emo-17

tional, behavioral health problems, or sub-18

stance use disorders;¿19

ø‘‘(iii) the early identification of so-20

cial, emotional, behavioral problems, or 21

substance use disorders and the provision 22

of early intervention services;¿23

ø‘‘(iv) the treatment or referral for 24

treatment of students with existing social, 25



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[Discussion Draft]

emotional, behavioral health problems, or 1

substance use disorders; and¿2

ø‘‘(v) the development and implemen-3

tation of programs to assist children in 4

dealing with trauma and violence.¿5

ø‘‘(C) That the comprehensive school-6


this section will provide for in-service training 8

of all school personnel, including ancillary staff 9

and volunteers, in—¿10

ø‘‘(i) the techniques and supports 11

needed to identify early children with trau-12

ma histories and children with, or at risk 13

of, mental illness;¿14

ø‘‘(ii) the use of referral mechanisms 15

that effectively link such children to appro-16

priate treatment and intervention services 17

in the school and in the community and to 18

follow-up when services are not available;¿19

ø‘‘(iii) strategies that promote a 20

school-wide positive environment;¿21

ø‘‘(iv) strategies for promoting the so-22

cial, emotional, mental, and behavioral 23

health of all students; and¿24



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ø‘‘(v) strategies to increase the knowl-1

edge and skills of school and community 2

leaders about the impact of trauma and vi-3

olence and on the application of a public 4

health approach to comprehensive school-5

based mental health programs.¿6

ø‘‘(D) That the comprehensive school-7


this section will include comprehensive training 9

for parents, siblings, and other family members 10

of children with mental health disorders, and 11

for concerned members of the community in—12

¿13

ø‘‘(i) the techniques and supports 14

needed to identify early children with trau-15

ma histories, and children with, or at risk 16

of, mental illness;¿17

ø‘‘(ii) the use of referral mechanisms 18

that effectively link such children to appro-19

priate treatment and intervention services 20

in the school and in the community and 21

follow-up when such services are not avail-22

able; and¿23

ø‘‘(iii) strategies that promote a 24

school-wide positive environment.¿25



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ø‘‘(E) That the comprehensive school-1


this section will demonstrate the measures to be 3

taken to sustain the program after funding 4

under this section terminates.¿5

ø‘‘(F) That the local education agency 6

partnership involved is supported by the State 7

educational and mental health system to ensure 8

that the sustainability of the programs is estab-9

lished after funding under this section termi-10

nates.¿11

ø‘‘(G) That the comprehensive school-12


this section will be based on trauma-informed 14

and evidence-based practices.¿15

ø‘‘(H) That the comprehensive school-16


this section will be coordinated with early inter-18

vening activities carried out under the Individ-19

uals with Disabilities Education Act.¿20

ø‘‘(I) That the comprehensive school-based 21

mental health program carried out under this 22

section will be trauma-informed and culturally 23

and linguistically appropriate.¿24



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ø‘‘(J) That the comprehensive school-based 1


section will include a broad needs assessment of 3

youth who drop out of school due to policies of 4

‘zero tolerance’ with respect to drugs, alcohol, 5

or weapons and an inability to obtain appro-6

priate services.¿7

ø‘‘(K) That the mental health services pro-8

vided through the comprehensive school-based 9


section will be provided by qualified mental and 11

behavioral health professionals who are certified 12

or licensed by the State involved and practicing 13

within their area of expertise.¿14

ø‘‘(3) COORDINATOR.—Any entity that is a 15

member of a partnership described in paragraph 16

(1)(A) may serve as the coordinator of funding and 17

activities under the grant if all members of the part-18

nership agree.¿19

ø‘‘(4) COMPLIANCE WITH HIPAA.—A grantee 20

under this section shall be deemed to be a covered 21

entity for purposes of compliance with the regula-22

tions promulgated under section 264(c) of the 23

Health Insurance Portability and Accountability Act 24



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[Discussion Draft]

of 1996 with respect to any patient records devel-1

oped through activities under the grant.¿2

ø‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Sec-3

retary shall ensure that grants, contracts, or cooperative 4

agreements under subsection (a) will be distributed equi-5

tably among the regions of the country and among urban 6

and rural areas.¿7

ø‘‘(e) DURATION OF AWARDS.—With respect to a 8

grant, contract, or cooperative agreement under sub-9

section (a), the period during which payments under such 10

an award will be made to the recipient shall be 6 years. 11

An entity may receive only one award under this section, 12

except that an entity that is providing services and sup-13

ports on a regional basis may receive additional funding 14

after the expiration of the preceding grant period.¿15

ø‘‘(f) EVALUATION AND MEASURES OF OUT-16

COMES.—¿17

ø‘‘(1) DEVELOPMENT OF PROCESS.—The Ad-18

ministrator shall develop a fiscally appropriate proc-19

ess for evaluating activities carried out under this 20

section. Such process shall include—¿21

ø‘‘(A) the development of guidelines for 22

the submission of program data by grant, con-23

tract, or cooperative agreement recipients;¿24



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ø‘‘(B) the development of measures of out-1

comes (in accordance with paragraph (2)) to be 2

applied by such recipients in evaluating pro-3

grams carried out under this section; and¿4

ø‘‘(C) the submission of annual reports by 5

such recipients concerning the effectiveness of 6

programs carried out under this section.¿7

ø‘‘(2) MEASURES OF OUTCOMES.—¿8

ø‘‘(A) IN GENERAL.—The Administrator 9

shall develop measures of outcomes to be ap-10

plied by recipients of assistance under this sec-11

tion, and the Administrator, in evaluating the 12

effectiveness of programs carried out under this 13

section. Such measures shall include student 14

and family measures as provided for in sub-15

paragraph (B) and local educational measures 16

as provided for under subparagraph (C).¿17

ø‘‘(B) STUDENT AND FAMILY MEASURES 18

OF OUTCOMES.—The measures of outcomes de-19

veloped under paragraph (1)(B) relating to stu-20

dents and families shall, with respect to activi-21

ties carried out under a program under this 22

section, at a minimum include provisions to 23

evaluate whether the program is effective in—24

¿25



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ø‘‘(i) increasing social and emotional 1

competency;¿2

ø‘‘(ii) increasing academic competency 3

(as defined by Secretary);¿4

ø‘‘(iii) reducing disruptive and aggres-5

sive behaviors;¿6

ø‘‘(iv) improving child functioning;¿7

ø‘‘(v) reducing substance use dis-8

orders;¿9

ø‘‘(vi) reducing suspensions, truancy, 10

expulsions and violence;¿11

ø‘‘(vii) increasing graduation rates (as 12

defined in section 1111(b)(2)(C)(vi) of the 13

Elementary and Secondary Education Act 14

of 1965); and¿15

ø‘‘(viii) improving access to care for 16

mental health disorders.¿17

ø‘‘(C) LOCAL EDUCATIONAL OUTCOMES.—18

The outcome measures developed under para-19

graph (1)(B) relating to local educational sys-20

tems shall, with respect to activities carried out 21

under a program under this section, at a min-22

imum include provisions to evaluate—¿23



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ø‘‘(i) the effectiveness of comprehen-1

sive school mental health programs estab-2

lished under this section;¿3

ø‘‘(ii) the effectiveness of formal part-4

nership linkages among child and family 5

serving institutions, community support 6

systems, and the educational system;¿7

ø‘‘(iii) the progress made in sus-8

taining the program once funding under 9

the grant has expired;¿10

ø‘‘(iv) the effectiveness of training 11

and professional development programs for 12

all school personnel that incorporate indi-13

cators that measure cultural and linguistic 14

competencies under the program in a man-15

ner that incorporates appropriate cultural 16

and linguistic training;¿17

ø‘‘(v) the improvement in perception 18

of a safe and supportive learning environ-19

ment among school staff, students, and 20

parents;¿21

ø‘‘(vi) the improvement in case-find-22

ing of students in need of more intensive 23

services and referral of identified students 24

to early intervention and clinical services;¿25



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ø‘‘(vii) the improvement in the imme-1

diate availability of clinical assessment and 2

treatment services within the context of 3

the local community to students posing a 4

danger to themselves or others;¿5

ø‘‘(viii) the increased successful ma-6

triculation to postsecondary school; and¿7

ø‘‘(ix) reduced referrals to juvenile 8

justice.¿9

ø‘‘(3) SUBMISSION OF ANNUAL DATA.—An en-10

tity that receives a grant, contract, or cooperative 11

agreement under this section shall annually submit 12

to the Administrator a report that includes data to 13

evaluate the success of the program carried out by 14

the entity based on whether such program is achiev-15

ing the purposes of the program. Such reports shall 16

utilize the measures of outcomes under paragraph 17

(2) in a reasonable manner to demonstrate the 18

progress of the program in achieving such pur-19

poses.¿20

ø‘‘(4) EVALUATION BY ADMINISTRATOR.—21

Based on the data submitted under paragraph (3), 22

the Administrator shall annually submit to Congress 23

a report concerning the results and effectiveness of 24



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[Discussion Draft]

the programs carried out with assistance received 1

under this section.¿2

ø‘‘(5) LIMITATION.—A grantee shall use not to 3

exceed 10 percent of amounts received under a grant 4

under this section to carry out evaluation activities 5

under this subsection.¿6

ø‘‘(g) INFORMATION AND EDUCATION.—The Sec-7

retary shall establish comprehensive information and edu-8

cation programs to disseminate the findings of the knowl-9

edge development and application under this section to the 10

general public and to health care professionals.¿11

ø‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF 12

APPROPRIATIONS.—¿13

ø‘‘(1) AMOUNT OF GRANTS.—A grant under 14

this section shall be in an amount that is not more 15

than $1,000,000 for each of grant years 2015 16

through 2019. The Secretary shall determine the 17

amount of each such grant based on the population 18

of children up to age 21 of the area to be served 19

under the grant.¿20

ø‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—21

There is authorized to be appropriated to carry out 22

this section, $200,000,000 for each of fiscal years 23

2015 through 2019.’’.¿24



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ø(3) CONFORMING AMENDMENT.—Part G of 1

title V of the Public Health Service Act (42 U.S.C. 2

290hh et seq.), as amended by this section, is fur-3

ther amended by striking the part heading and in-4

serting the following:¿5

ø‘‘PART G—SCHOOL-BASED MENTAL HEALTH¿’’.¿6

øSEC. 502. IMPROVING MENTAL HEALTH AND BEHAVIORAL 7

HEALTH OUTCOMES ON COLLEGE CAMPUSES. 8

ø(a) SHORT TITLE.—This section may be cited as 9

the ‘‘Mental Health on Campus Improvement Act’’.¿10

ø(b) FINDINGS.—Congress makes the following find-11

ings:¿12

ø(1) The 2011 Association of University and 13

College Counseling Center Directors Survey found 14

that the average ratio of counselors to students on 15

campus is nearly 1 to 1,879 and is often far higher 16

on large campuses. The International Association of 17

Counseling Services accreditation standards rec-18

ommends 1 counselor per 1,000 to 1,500 students.¿19

ø(2) College Counselors report that 10.8 per-20

cent of enrolled students sought counseling in the 21

past year, totaling an estimated 2,000,000 stu-22

dents.¿23

ø(3) Over 90 percent of counseling directors be-24

lieve there is an increase in the number of students 25



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coming to campus with severe psychological prob-1

lems; today, 44 percent of the students who visit 2

campus counseling centers are dealing with severe 3

mental illness, up from 16 percent in 2000, and 24 4

percent are on psychiatric medication, up from 17 5

percent in 2000.¿6

ø(4) The majority of campus counseling direc-7

tors report that the demand for services and the se-8

verity of student needs are growing without an in-9

crease in resources.¿10

ø(5) Many students who need help never receive 11

it. Only 15 percent of college students who commit 12

suicide received campus counseling. Of students who 13

seriously consider suicide each year, only 52 percent 14

of them seek any professional help at all.¿15

ø(6) A 2012 American College Health Associa-16

tion (ACHA) survey of more than 98,000 college 17

and university students revealed that, within the last 18

12 months, 51 percent of students report having felt 19

overwhelming anxiety, 31 percent felt so depressed it 20

was difficult to function, and 46 percent felt hope-21

less. The ACHA survey found that 7.5 percent of 22

students have seriously considered suicide in the 23

past 12 months.¿24



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ø(7) The National Research Consortium of 1

Counseling Centers in Higher Education found that 2

6 percent of students have seriously considered sui-3

cide in the past 12 months. The Research Consor-4

tium found that of those who have seriously consid-5

ered suicide in the past 12 months, 52 percent 6

sought no preferred help and only 54 percent told 7

anyone that they were considering suicide.¿8

ø(8) Research conducted between 1997 and 9

2009, and presented at the 118th annual convention 10

of the American Psychological Association found 11

that more students are grappling with depression 12

and anxiety disorders than did a decade ago. The 13

study found that of students who sought college 14

counseling, 41 percent had moderate to severe de-15

pression in 2009, that number was 34 percent in 16

1997.¿17

ø(9) A survey conducted by the University of 18

Idaho Student Counseling Center in 2000 found 19

that 77 percent of students who responded reported 20

that they were more likely to stay in school because 21

of counseling and that their school performance 22

would have declined without counseling.¿23

ø(10) Students with psychological issues often 24

struggle academically and are at risk for dropping 25



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out of school. Counseling has been shown to address 1

these issues while having a positive impact on stu-2

dents remaining in school. A 6-year longitudinal 3

study found college students receiving counseling to 4

have an 11.4 percent higher retention rate than the 5

general university population (Turner & Berry, 6

2000).¿7

ø(11) A national survey of college students liv-8

ing with mental health conditions, conducted by the 9

National Alliance on Mental Health, found that 64 10

percent of students who experience mental health 11

problems in college and withdraw from school do so 12

because of their mental health issues. The survey 13

also found that 50 percent of that group never 14

accessed mental health services and supports.¿15

ø(c) IMPROVING MENTAL AND BEHAVIORAL HEALTH 16

ON COLLEGE CAMPUSES.—Title V of the Public Health 17

Service Act is amended by inserting after section 520E–18

2 (42 U.S.C. 290bb–36b) the following:¿19

ø‘‘SEC. 520E–3. GRANTS TO IMPROVE MENTAL AND BEHAV-20

IORAL HEALTH ON COLLEGE CAMPUSES. 21

ø‘‘(a) PURPOSE.—It is the purpose of this section, 22

with respect to college and university settings, to—¿23

ø‘‘(1) increase access to mental and behavioral 24

health services;¿25



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ø‘‘(2) foster and improve the prevention of 1

mental and behavioral health disorders, and the pro-2

motion of mental health;¿3

ø‘‘(3) improve the identification and treatment 4

for students at risk;¿5

ø‘‘(4) improve collaboration and the develop-6

ment of appropriate levels of mental and behavioral 7

health care;¿8

ø‘‘(5) reduce the stigma for students with men-9

tal health disorders and enhance their access to 10

mental health services; and¿11

ø‘‘(6) improve the efficacy of outreach efforts.¿12

ø‘‘(b) GRANTS.—The Secretary, acting through the 13

Administrator and in consultation with the Secretary of 14

Education, shall award competitive grants to eligible enti-15

ties to improve mental and behavioral health services and 16

outreach on college and university campuses.¿17

ø‘‘(c) ELIGIBILITY.—To be eligible to receive a grant 18

under subsection (b), an entity shall—¿19

ø‘‘(1) be an institution of higher education (as 20

defined in section 101 of the Higher Education Act 21

of 1965 (20 U.S.C. 1001)); and¿22

ø‘‘(2) submit to the Secretary an application at 23

such time, in such manner, and containing such in-24



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formation as the Secretary may require, including 1

the information required under subsection (d).¿2

ø‘‘(d) APPLICATION.—An application for a grant 3

under this section shall include—¿4

ø‘‘(1) a description of the population to be tar-5

geted by the program carried out under the grant, 6

the particular mental and behavioral health needs of 7

the students involved;¿8

ø‘‘(2) a description of the Federal, State, local, 9

private, and institutional resources available for 10

meeting the needs of such students at the time the 11

application is submitted;¿12

ø‘‘(3) an outline of the objectives of the pro-13

gram carried out under the grant;¿14

ø‘‘(4) a description of activities, services, and 15

training to be provided under the program, including 16

planned outreach strategies to reach students not 17

currently seeking services;¿18

ø‘‘(5) a plan to seek input from community 19

mental health providers, when available, community 20

groups, and other public and private entities in car-21

rying out the program;¿22

ø‘‘(6) a plan, when applicable, to meet the spe-23

cific mental and behavioral health needs of veterans 24

attending institutions of higher education;¿25



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ø‘‘(7) a description of the methods to be used 1

to evaluate the outcomes and effectiveness of the 2

program; and¿3

ø‘‘(8) an assurance that grant funds will be 4

used to supplement, and not supplant, any other 5

Federal, State, or local funds available to carry out 6

activities of the type carried out under the grant.¿7

ø‘‘(e) SPECIAL CONSIDERATIONS.—In awarding 8

grants under this section, the Secretary shall give special 9

consideration to applications that describe programs to be 10

carried out under the grant that—¿11

ø‘‘(1) demonstrate the greatest need for new or 12

additional mental and behavioral health services, in 13

part by providing information on current ratios of 14

students to mental and behavioral health profes-15

sionals;¿16

ø‘‘(2) propose effective approaches for initiating 17

or expanding campus services and supports using 18

evidence-based practices;¿19

ø‘‘(3) target traditionally underserved popu-20

lations and populations most at risk;¿21

ø‘‘(4) where possible, demonstrate an awareness 22

of, and a willingness to, coordinate with a commu-23

nity mental health center or other mental health re-24



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source in the community, to support screening and 1

referral of students requiring intensive services;¿2

ø‘‘(5) identify how the college or university will 3

address psychiatric emergencies, including how in-4

formation will be communicated with families or 5

other appropriate parties; and¿6

ø‘‘(6) demonstrate the greatest potential for 7

replication and dissemination.¿8

ø‘‘(f) USE OF FUNDS.—Amounts received under a 9

grant under this section may be used to—¿10

ø‘‘(1) provide mental and behavioral health 11

services to students, including prevention, promotion 12

of mental health, voluntary screening, early interven-13

tion, voluntary assessment, treatment, management, 14

and education services relating to the mental and be-15

havioral health of students;¿16

ø‘‘(2) provide outreach services to notify stu-17

dents about the existence of mental and behavioral 18

health services;¿19

ø‘‘(3) educate students, families, faculty, staff, 20

and communities to increase awareness of mental 21

health issues;¿22

ø‘‘(4) support student groups on campus that 23

engage in activities to educate students, including 24

activities to reduce stigma surrounding mental and 25



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behavioral disorders, and promote mental health 1

wellness;¿2

ø‘‘(5) employ appropriately trained staff;¿3

ø‘‘(6) provide training to students, faculty, and 4

staff to respond effectively to students with mental 5

and behavioral health issues;¿6

ø‘‘(7) expand mental health training through 7

internship, post-doctorate, and residency programs;¿8

ø‘‘(8) develop and support evidence-based and 9

emerging best practices, including a focus on cul-10

turally and linguistically appropriate best practices; 11

and¿12

ø‘‘(9) evaluate and disseminate best practices 13

to other colleges and universities.¿14

ø‘‘(g) DURATION OF GRANTS.—A grant under this 15

section shall be awarded for a period not to exceed 3 16

years.¿17

ø‘‘(h) EVALUATION AND REPORTING.—¿18

ø‘‘(1) EVALUATION.—Not later than 18 months 19

after the date on which a grant is received under 20

this section, the eligible entity involved shall submit 21

to the Secretary the results of an evaluation to be 22

conducted by the entity concerning the effectiveness 23

of the activities carried out under the grant and 24

plans for the sustainability of such efforts.¿25



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ø‘‘(2) REPORT.—Not later than 2 years after 1

the date of enactment of this section, the Secretary 2

shall submit to the appropriate committees of Con-3

gress a report concerning the results of—¿4

ø‘‘(A) the evaluations conducted under 5

paragraph (1); and¿6

ø‘‘(B) an evaluation conducted by the Sec-7

retary to analyze the effectiveness and efficacy 8

of the activities conducted with grants under 9

this section.¿10

ø‘‘(i) TECHNICAL ASSISTANCE.—The Secretary may 11

provide technical assistance to grantees in carrying out 12

this section.¿13

ø‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 14

are authorized to be appropriated such sums as may be 15

necessary to carry out this section.¿16

ø‘‘SEC. 520E–4. MENTAL AND BEHAVIORAL HEALTH OUT-17

REACH AND EDUCATION ON COLLEGE CAM-18

PUSES. 19

ø‘‘(a) PURPOSE.—It is the purpose of this section to 20

increase access to, and reduce the stigma associated with, 21

mental health services so as to ensure that college students 22

have the support necessary to successfully complete their 23

studies.¿24



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ø‘‘(b) NATIONAL PUBLIC EDUCATION CAMPAIGN.—1

The Secretary, acting through the Administrator and in 2

collaboration with the Director of the Centers for Disease 3

Control and Prevention, shall convene an interagency, 4

public-private sector working group to plan, establish, and 5

begin coordinating and evaluating a targeted public edu-6

cation campaign that is designed to focus on mental and 7

behavioral health on college campuses. Such campaign 8

shall be designed to—¿9

ø‘‘(1) improve the general understanding of 10

mental health and mental health disorders;¿11

ø‘‘(2) encourage help-seeking behaviors relating 12

to the promotion of mental health, prevention of 13

mental health disorders, and treatment of such dis-14

orders;¿15

ø‘‘(3) make the connection between mental and 16

behavioral health and academic success; and¿17

ø‘‘(4) assist the general public in identifying 18

the early warning signs and reducing the stigma of 19

mental illness.¿20

ø‘‘(c) COMPOSITION.—The working group under sub-21

section (b) shall include—¿22

ø‘‘(1) mental health consumers, including stu-23

dents and family members;¿24



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ø‘‘(2) representatives of colleges and univer-1

sities;¿2

ø‘‘(3) representatives of national mental and 3

behavioral health and college associations;¿4

ø‘‘(4) representatives of college health pro-5

motion and prevention organizations;¿6

ø‘‘(5) representatives of mental health pro-7

viders, including community mental health centers; 8

and¿9

ø‘‘(6) representatives of private- and public-sec-10

tor groups with experience in the development of ef-11

fective public health education campaigns.¿12

ø‘‘(d) PLAN.—The working group under subsection 13

(b) shall develop a plan that shall—¿14

ø‘‘(1) target promotional and educational ef-15

forts to the college age population and individuals 16

who are employed in college and university settings, 17

including the use of roundtables;¿18

ø‘‘(2) develop and propose the implementation 19

of research-based public health messages and activi-20

ties;¿21

ø‘‘(3) provide support for local efforts to reduce 22

stigma by using the National Mental Health Infor-23

mation Center as a primary point of contact for in-24



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formation, publications, and service program refer-1

rals; and¿2

ø‘‘(4) develop and propose the implementation 3

of a social marketing campaign that is targeted at 4

the college population and individuals who are em-5

ployed in college and university settings.¿6

ø‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 7

are authorized to be appropriated such sums as may be 8

necessary to carry out this section.’’.¿9

ø(d) INTERAGENCY WORKING GROUP ON COLLEGE 10

MENTAL HEALTH.—¿11

ø(1) PURPOSE.—It is the purpose of this sec-12

tion, pursuant to Executive Order 13263 (and the 13

recommendations issued under section 6(b) of such 14

Order), to provide for the establishment of a College 15

Campus Task Force under the Federal Executive 16

Steering Committee on Mental Health, to discuss 17

mental and behavioral health concerns on college 18

and university campuses.¿19

ø(2) ESTABLISHMENT.—The Secretary of 20

Health and Human Services (referred to in this sec-21

tion as the ‘‘Secretary’’) shall establish a College 22

Campus Task Force (referred to in this section as 23

the ‘‘Task Force’’), under the Federal Executive 24

Steering Committee on Mental Health, to discuss 25



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mental and behavioral health concerns on college 1

and university campuses.¿2

ø(3) MEMBERSHIP.—The Task Force shall be 3

composed of a representative from each Federal 4

agency (as appointed by the head of the agency) 5

that has jurisdiction over, or is affected by, mental 6

health and education policies and projects, includ-7

ing—¿8

ø(A) the Department of Education;¿9

ø(B) the Department of Health and 10

Human Services;¿11

ø(C) the Department of Veterans Affairs; 12

and¿13

ø(D) such other Federal agencies as the 14

Administrator of the Substance Abuse and 15

Mental Health Services Administration and the 16

Secretary jointly determine to be appropriate.¿17

ø(4) DUTIES.—The Task Force shall—¿18

ø(A) serve as a centralized mechanism to 19

coordinate a national effort—¿20

ø(i) to discuss and evaluate evidence 21

and knowledge on mental and behavioral 22

health services available to, and the preva-23

lence of mental health illness among, the 24



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college age population of the United 1

States;¿2

ø(ii) to determine the range of effec-3

tive, feasible, and comprehensive actions to 4

improve mental and behavioral health on 5

college and university campuses;¿6

ø(iii) to examine and better address 7

the needs of the college age population 8

dealing with mental illness;¿9

ø(iv) to survey Federal agencies to de-10

termine which policies are effective in en-11

couraging, and how best to facilitate out-12

reach without duplicating, efforts relating 13

to mental and behavioral health pro-14

motion;¿15

ø(v) to establish specific goals within 16

and across Federal agencies for mental 17

health promotion, including determinations 18

of accountability for reaching those goals;¿19

ø(vi) to develop a strategy for allo-20

cating responsibilities and ensuring partici-21

pation in mental and behavioral health 22

promotions, particularly in the case of 23

competing agency priorities;¿24



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ø(vii) to coordinate plans to commu-1

nicate research results relating to mental 2

and behavioral health amongst the college 3

age population to enable reporting and out-4

reach activities to produce more useful and 5

timely information;¿6

ø(viii) to provide a description of evi-7

dence-based best practices, model pro-8

grams, effective guidelines, and other 9

strategies for promoting mental and behav-10

ioral health on college and university cam-11

puses;¿12

ø(ix) to make recommendations to im-13

prove Federal efforts relating to mental 14

and behavioral health promotion on college 15

campuses and to ensure Federal efforts are 16

consistent with available standards and 17

evidence and other programs in existence 18

as of the date of enactment of this Act; 19

and¿20

ø(x) to monitor Federal progress in 21

meeting specific mental and behavioral 22

health promotion goals as they relate to 23

college and university settings;¿24



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ø(B) consult with national organizations 1

with expertise in mental and behavioral health, 2

especially those organizations working with the 3

college age population; and¿4

ø(C) consult with and seek input from 5

mental health professionals working on college 6

and university campuses as appropriate.¿7

ø(5) MEETINGS.—8

ø(A) IN GENERAL.—The Task Force shall 9

meet at least 3 times each year.¿10

ø(B) ANNUAL CONFERENCE.—The Sec-11

retary shall sponsor an annual conference on 12

mental and behavioral health in college and uni-13

versity settings to enhance coordination, build 14

partnerships, and share best practices in mental 15

and behavioral health promotion, data collec-16

tion, analysis, and services.¿17

ø(6) AUTHORIZATION OF APPROPRIATIONS.—18

There are authorized to be appropriated such sums 19

as may be necessary to carry out this section.¿20

øSEC. 503. EXAMINING MENTAL HEALTH CARE FOR CHIL-21

DREN. 22

ø(a) IN GENERAL.—Not later than 1 year after the 23

date of enactment of this Act, the Comptroller General 24

of the United States shall conduct an independent evalua-25



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tion, and submit to the Committee on Health, Education, 1

Labor, and Pensions of the Senate and the Committee on 2

Energy and Commerce of the House of Representatives, 3

a report concerning the utilization of mental health serv-4

ices for children, including the usage of psychotropic medi-5

cations.¿6

ø(b) CONTENT.—The report submitted under sub-7

section (a) shall review and assess—¿8

ø(1) the ways in which children access mental 9

health care, including information on whether chil-10

dren are treated by primary care or specialty pro-11

viders, what types of referrals for additional care are 12

recommended, and any barriers to accessing this 13

care;¿14

ø(2) the extent to which children are prescribed 15

psychotropic medications in the United States in-16

cluding the frequency of concurrent medication 17

usage; and¿18

ø(3) the tools, assessments, and medications 19

that are available and used to diagnose and treat 20

children with mental health disorders.¿21



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TITLE VI—JUSTICE AND MENTAL 1

HEALTH COLLABORATION 2

SEC. 601. ASSISTING VETERANS. 3

(a) REDESIGNATION.—Section 2991 of the Omnibus 4

Crime Control and Safe Streets Act of 1968 (42 U.S.C. 5

3797aa) is amended by redesignating subsection (i) as 6

subsection (l). 7

(b) ASSISTING VETERANS.—Section 2991 of the Om-8

nibus Crime Control and Safe Streets Act of 1968 (42 9

U.S.C. 3797aa) is amended by inserting after subsection 10

(h) the following: 11

‘‘(i) ASSISTING VETERANS.—12

‘‘(1) DEFINITIONS.—In this subsection: 13

‘‘(A) PEER TO PEER SERVICES OR PRO-14

GRAMS.—The term ‘peer to peer services or 15

programs’ means services or programs that con-16

nect qualified veterans with other veterans for 17

the purpose of providing support and 18

mentorship to assist qualified veterans in ob-19

taining treatment, recovery, stabilization, or re-20

habilitation. 21

‘‘(B) QUALIFIED VETERAN.—The term 22

‘qualified veteran’ means a preliminarily quali-23

fied offender who—24



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‘‘(i) has served on active duty in any 1

branch of the Armed Forces, including the 2

National Guard and reserve components; 3

and 4

‘‘(ii) was discharged or released from 5

such service under conditions other than 6

dishonorable. 7

‘‘(C) VETERANS TREATMENT COURT PRO-8

GRAM.—The term ‘veterans treatment court 9

program’ means a court program involving col-10

laboration among criminal justice, veterans, and 11

mental health and substance abuse agencies 12

that provides qualified veterans with—13

‘‘(i) intensive judicial supervision and 14

case management, which may include ran-15

dom and frequent drug testing where ap-16

propriate; 17

‘‘(ii) a full continuum of treatment 18

services, including mental health services, 19

substance abuse services, medical services, 20

and services to address trauma; 21

‘‘(iii) alternatives to incarceration; 22

and 23

‘‘(iv) other appropriate services, in-24

cluding housing, transportation, mentoring, 25



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employment, job training, education, and 1

assistance in applying for and obtaining 2

available benefits. 3

‘‘(2) VETERANS ASSISTANCE PROGRAM.—4

‘‘(A) IN GENERAL.—The Attorney General, 5

in consultation with the Secretary of Veterans 6

Affairs, may award grants under this sub-7

section to applicants to establish or expand—8

‘‘(i) veterans treatment court pro-9

grams; 10

‘‘(ii) peer to peer services or programs 11

for qualified veterans; 12

‘‘(iii) practices that identify and pro-13

vide treatment, rehabilitation, legal, transi-14

tional, and other appropriate services to 15

qualified veterans who have been incarcer-16

ated; and 17

‘‘(iv) training programs to teach 18

criminal justice, law enforcement, correc-19

tions, mental health, and substance abuse 20

personnel how to identify and appro-21

priately respond to incidents involving 22

qualified veterans. 23



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‘‘(B) PRIORITY.—In awarding grants 1

under this subsection, the Attorney General 2

shall give priority to applications that—3

‘‘(i) demonstrate collaboration be-4

tween and joint investments by criminal 5

justice, mental health, substance abuse, 6

and veterans service agencies; 7

‘‘(ii) promote effective strategies to 8

identify and reduce the risk of harm to 9

qualified veterans and public safety; and 10

‘‘(iii) propose interventions with em-11

pirical support to improve outcomes for 12

qualified veterans.’’. 13

SEC. 602. CORRECTIONAL FACILITIES. 14

Section 2991 of the Omnibus Crime Control and Safe 15

Streets Act of 1968 (42 U.S.C. 3797aa) is amended by 16

inserting after subsection (i), as so added by section 601, 17

the following: 18

‘‘(j) CORRECTIONAL FACILITIES.—19

‘‘(1) DEFINITIONS.—20

‘‘(A) CORRECTIONAL FACILITY.—The term 21

‘correctional facility’ means a jail, prison, or 22

other detention facility used to house people 23

who have been arrested, detained, held, or con-24

victed by a criminal justice agency or a court. 25



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‘‘(B) ELIGIBLE INMATE.—The term ‘eligi-1

ble inmate’ means an individual who—2

‘‘(i) is being held, detained, or incar-3

cerated in a correctional facility; and 4

‘‘(ii) manifests obvious signs of a 5

mental illness or has been diagnosed by a 6

qualified mental health professional as hav-7

ing a mental illness. 8

‘‘(2) CORRECTIONAL FACILITY GRANTS.—The 9

Attorney General may award grants to applicants to 10

enhance the capabilities of a correctional facility—11

‘‘(A) to identify and screen for eligible in-12

mates; 13

‘‘(B) to plan and provide—14

‘‘(i) initial and periodic assessments of 15

the clinical, medical, and social needs of in-16

mates; and 17

‘‘(ii) appropriate treatment and serv-18

ices that address the mental health and 19

substance abuse needs of inmates; 20

‘‘(C) to develop, implement, and enhance—21

‘‘(i) post-release transition plans for 22

eligible inmates that, in a comprehensive 23

manner, coordinate health, housing, med-24



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ical, employment, and other appropriate 1

services and public benefits; 2

‘‘(ii) the availability of mental health 3

care services and substance abuse treat-4

ment services; and 5

‘‘(iii) alternatives to solitary confine-6

ment and segregated housing and mental 7

health screening and treatment for inmates 8

placed in solitary confinement or seg-9

regated housing; and 10

‘‘(D) to train each employee of the correc-11

tional facility to identify and appropriately re-12

spond to incidents involving inmates with men-13

tal health or co-occurring mental health and 14

substance abuse disorders.’’. 15

SEC. 603. HIGH UTILIZERS. 16

Section 2991 of the Omnibus Crime Control and Safe 17

Streets Act of 1968 (42 U.S.C. 3797aa) is amended by 18

inserting after subsection (j), as added by section 602, the 19

following: 20

‘‘(k) DEMONSTRATION GRANTS RESPONDING TO 21

HIGH UTILIZERS.—22

‘‘(1) DEFINITION.—In this subsection, the term 23

‘high utilizer’ means an individual who—24



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[Discussion Draft]

‘‘(A) manifests obvious signs of mental ill-1

ness or has been diagnosed by a qualified men-2

tal health professional as having a mental ill-3

ness; and 4

‘‘(B) consumes a significantly dispropor-5

tionate quantity of public resources, such as 6

emergency, housing, judicial, corrections, and 7

law enforcement services. 8

‘‘(2) DEMONSTRATION GRANTS RESPONDING TO 9

HIGH UTILIZERS.—10

‘‘(A) IN GENERAL.—The Attorney General 11

may award not more than 6 grants per year 12

under this subsection to applicants for the pur-13

pose of reducing the use of public services by 14

high utilizers. 15

‘‘(B) USE OF GRANTS.—A recipient of a 16

grant awarded under this subsection may use 17

the grant—18

‘‘(i) to develop or support multidisci-19

plinary teams that coordinate, implement, 20

and administer community-based crisis re-21

sponses and long-term plans for high uti-22

lizers; 23

‘‘(ii) to provide training on how to re-24

spond appropriately to the unique issues 25



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[Discussion Draft]

involving high utilizers for public service 1

personnel, including criminal justice, men-2

tal health, substance abuse, emergency 3

room, healthcare, law enforcement, correc-4

tions, and housing personnel; 5

‘‘(iii) to develop or support alter-6

natives to hospital and jail admissions for 7

high utilizers that provide treatment, sta-8

bilization, and other appropriate supports 9

in the least restrictive, yet appropriate, en-10

vironment; or 11

‘‘(iv) to develop protocols and systems 12

among law enforcement, mental health, 13

substance abuse, housing, corrections, and 14

emergency medical service operations to 15

provide coordinated assistance to high uti-16

lizers. 17

‘‘(C) REPORT.—Not later than the last 18

day of the first year following the fiscal year in 19

which a grant is awarded under this subsection, 20

the recipient of the grant shall submit to the 21

Attorney General a report that—22

‘‘(i) measures the performance of the 23

grant recipient in reducing the use of pub-24

lic services by high utilizers; and 25



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[Discussion Draft]

‘‘(ii) provides a model set of practices, 1

systems, or procedures that other jurisdic-2

tions can adopt to reduce the use of public 3

services by high utilizers.’’. 4

SEC. 604. ACADEMY TRAINING. 5

Section 2991(h) of the Omnibus Crime Control and 6

Safe Streets Act of 1968 (42 U.S.C. 3797aa(h)) is amend-7

ed—8

(1) in paragraph (1), by adding at the end the 9

following: 10

‘‘(F) ACADEMY TRAINING.—To provide 11

support for academy curricula, law enforcement 12

officer orientation programs, continuing edu-13

cation training, and other programs that teach 14

law enforcement personnel how to identify and 15

respond to incidents involving individuals with 16

mental illness or co-occurring mental illness and 17

substance abuse disorders.’’; and 18


‘‘(4) PRIORITY CONSIDERATION.—The Attorney 20

General, in awarding grants under this subsection, 21

shall give priority to programs that law enforcement 22

personnel and members of the mental health and 23

substance abuse professions develop and administer 24

cooperatively.’’. 25



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[Discussion Draft]

SEC. 605. EVIDENCE BASED PRACTICES. 1

Section 2991(c) of the Omnibus Crime Control and 2

Safe Streets Act of 1968 (42 U.S.C. 3797aa(c)) is amend-3

ed—4

(1) in paragraph (3), by striking ‘‘or’’ at the 5

end; 6

(2) by redesignating paragraph (4) as para-7

graph (6); and 8

(3) by inserting after paragraph (3), the fol-9

lowing: 10

‘‘(4) propose interventions that have been 11

shown by empirical evidence to reduce recidivism; 12

‘‘(5) when appropriate, use validated assess-13

ment tools to target preliminarily qualified offenders 14

with a moderate or high risk of recidivism and a 15

need for treatment and services; or’’. 16

SEC. 606. SAFE COMMUNITIES. 17

(a) IN GENERAL.—Section 2991(a) of the Omnibus 18

Crime Control and Safe Streets Act of 1968 (42 U.S.C. 19

3797aa(a)) is amended by striking paragraph (9) and in-20

serting the following: 21

‘‘(9) PRELIMINARILY QUALIFIED OFFENDER.—22

‘‘(A) IN GENERAL.—The term ‘prelimi-23

narily qualified offender’ means an adult or ju-24

venile accused of an offense who—25



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[Discussion Draft]

‘‘(i)(I) previously or currently has 1

been diagnosed by a qualified mental 2

health professional as having a mental ill-3

ness or co-occurring mental illness and 4

substance abuse disorders; 5

‘‘(II) manifests obvious signs of men-6

tal illness or co-occurring mental illness 7

and substance abuse disorders during ar-8

rest or confinement or before any court; or 9

‘‘(III) in the case of a veterans treat-10

ment court provided under subsection (i), 11

has been diagnosed with, or manifests ob-12

vious signs of, mental illness or a sub-13

stance abuse disorder or co-occurring men-14

tal illness and substance abuse disorder; 15

and 16

‘‘(ii) has been unanimously approved 17

for participation in a program funded 18

under this section by, when appropriate, 19

the relevant—20

‘‘(I) prosecuting attorney; 21

‘‘(II) defense attorney; 22

‘‘(III) probation or corrections 23

official; 24

‘‘(IV) judge; and 25



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[Discussion Draft]

‘‘(V) a representative from the 1

relevant mental health agency de-2

scribed in subsection (b)(5)(B)(i). 3

‘‘(B) DETERMINATION.—In determining 4

whether to designate an individual as a prelimi-5

narily qualified offender, the relevant pros-6

ecuting attorney, defense attorney, probation or 7

corrections official, judge, and mental health or 8

substance abuse agency representative shall 9

take into account—10

‘‘(i) whether the participation of the 11

individual in the program would pose a 12

substantial risk of violence to the commu-13

nity; 14

‘‘(ii) the criminal history of the indi-15

vidual and the nature and severity of the 16

offense for which the individual is charged; 17

‘‘(iii) the views of any relevant victims 18

to the offense; 19

‘‘(iv) the extent to which the indi-20

vidual would benefit from participation in 21

the program; 22

‘‘(v) the extent to which the commu-23

nity would realize cost savings because of 24



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[Discussion Draft]

the indiviudal’s participation in the pro-1

gram; and 2

‘‘(vi) whether the individual satisfies 3

the eligibility criteria for program partici-4

pation unanimously established by the rel-5

evant prosecuting attorney, defense attor-6

ney, probation or corrections official, judge 7

and mental health or substance abuse 8

agency representative.’’. 9

(b) TECHNICAL AND CONFORMING AMENDMENT.—10

Section 2927(2) of the Omnibus Crime Control and Safe 11

Streets Act of 1968 (42 U.S.C. 3797s–6(2)) is amended 12

by striking ‘‘has the meaning given that term in section 13

2991(a).’’ and inserting ‘‘means an offense that—14

‘‘(A) does not have as an element the use, 15

attempted use, or threatened use of physical 16

force against the person or property of another; 17

or 18

‘‘(B) is not a felony that by its nature in-19

volves a substantial risk that physical force 20

against the person or property of another may 21

be used in the course of committing the of-22

fense.’’. 23



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[Discussion Draft]

SEC. 607. REAUTHORIZATION OF APPROPRIATIONS. 1

Subsection (l) of section 2991 of the Omnibus Crime 2

Control and Safe Streets Act of 1968 (42 U.S.C. 3797aa), 3

as redesignated in section 601(a), is amended—4


(A) in subparagraph (B), by striking 6

‘‘and’’ at the end; 7

(B) in subparagraph (C), by striking the 8

period and inserting ‘‘; and’’; and 9

(C) by adding at the end the following: 10

‘‘(D) $40,000,000 for each of fiscal years 11

2015 through 2019.’’; and 12


‘‘(3) LIMITATION.—Not more than 20 percent 14

of the funds authorized to be appropriated under 15

this section may be used for purposes described in 16

subsection (i) (relating to veterans).’’. 17

TITLE VII—BEHAVIORAL 18

HEALTH INFORMATION TECH-19

NOLOGY 20

øSEC. 701. EXTENSION OF HEALTH INFORMATION TECH-21

NOLOGY ASSISTANCE FOR BEHAVIORAL AND 22

MENTAL HEALTH AND SUBSTANCE ABUSE. 23

Section 3000(3) of the Public Health Service Act (42 24

U.S.C. 300jj(3)) is amended by inserting before ‘‘and any 25

other category’’ the following: ‘‘behavioral and mental 26



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[Discussion Draft]

health professionals (as defined in section 1

331(a)(3)(E)(i)), a substance abuse professional, a psy-2

chiatric hospital (as defined in section 1861(f) of the So-3

cial Security Act), a community mental health center 4

meeting the criteria specified in section 1913(c), a residen-5

tial or outpatient mental health or substance abuse treat-6

ment facility,’’.¿7

SEC. 702. EXTENSION OF ELIGIBILITY FOR MEDICARE AND 8

MEDICAID HEALTH INFORMATION TECH-9

NOLOGY IMPLEMENTATION ASSISTANCE. 10

(a) PAYMENT INCENTIVES FOR ELIGIBLE PROFES-11

SIONALS UNDER MEDICARE.—Section 1848 of the Social 12

Security Act (42 U.S.C. 1395w–4) is amended—13

(1) in subsection (a)(7)—14

(A) in subparagraph (E), by adding at the 15

end the following new clause: 16

‘‘(iv) ADDITIONAL ELIGIBLE PROFES-17

SIONAL.—The term ‘additional eligible pro-18

fessional’ means a clinical psychologist pro-19

viding qualified psychologist services (as 20

defined in section 1861(ii)).’’; and 21

(B) by adding at the end the following new 22

subparagraph: 23

‘‘(F) APPLICATION TO ADDITIONAL ELIGI-24

BLE PROFESSIONALS.—The Secretary shall 25



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[Discussion Draft]

apply the provisions of this paragraph with re-1

spect to an additional eligible professional in 2

the same manner as such provisions apply to an 3

eligible professional, except in applying sub-4

paragraph (A)—5

‘‘(i) in clause (i), the reference to 6

2015 shall be deemed a reference to 2019; 7

‘‘(ii) in clause (ii), the references to 8

2015, 2016, and 2017 shall be deemed ref-9

erences to 2019, 2020, and 2021, respec-10

tively; and 11

‘‘(iii) in clause (iii), the reference to 12

2018 shall be deemed a reference to 13

2022.’’; and 14

(2) in subsection (o)—15

(A) in paragraph (5), by adding at the end 16

the following new subparagraph: 17

‘‘(D) ADDITIONAL ELIGIBLE PROFES-18

SIONAL.—The term ‘additional eligible profes-19

sional’ means a clinical psychologist providing 20

qualified psychologist services (as defined in 21

section 1861(ii)).’’; and 22


paragraph: 24



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[Discussion Draft]

‘‘(6) APPLICATION TO ADDITIONAL ELIGIBLE 1

PROFESSIONALS.—The Secretary shall apply the 2

provisions of this subsection with respect to an addi-3

tional eligible professional in the same manner as 4

such provisions apply to an eligible professional, ex-5

cept in applying—6

‘‘(A) paragraph (1)(A)(ii), the reference to 7

2016 shall be deemed a reference to 2020; 8

‘‘(B) paragraph (1)(B)(ii), the references 9

to 2011 and 2012 shall be deemed references to 10

2015 and 2016, respectively; 11

‘‘(C) paragraph (1)(B)(iii), the references 12

to 2013 shall be deemed references to 2017; 13

‘‘(D) paragraph (1)(B)(v), the references 14

to 2014 shall be deemed references to 2018; 15

and 16

‘‘(E) paragraph (1)(E), the reference to 17

2011 shall be deemed a reference to 2015.’’. 18

(b) ELIGIBLE HOSPITALS.—Section 1886 of the So-19

cial Security Act (42 U.S.C. 1395ww) is amended—20

(1) in subsection (b)(3)(B)(ix), by adding at the 21

end the following new subclause: 22

‘‘(V) The Secretary shall apply 23

the provisions of this subsection with 24

respect to an additional eligible hos-25



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[Discussion Draft]

pital (as defined in subsection 1

(n)(6)(C)) in the same manner as 2

such provisions apply to an eligible 3

hospital, except in applying—4

‘‘(aa) subclause (I), the ref-5

erences to 2015, 2016, and 2017 6

shall be deemed references to 7

2019, 2020, and 2021, respec-8

tively; and 9

‘‘(bb) subclause (III), the 10

reference to 2015 shall be 11

deemed a reference to 2019.’’; 12

and 13

(2) in subsection (n)—14

(A) in paragraph (6), by adding at the end 15

the following new subparagraph: 16

‘‘(C) ADDITIONAL ELIGIBLE HOSPITAL.—17

The term ‘additional eligible hospital’ means an 18

inpatient hospital that is a psychiatric hospital 19

(as defined in section 1861(f)).’’; and 20


paragraph: 22

‘‘(7) APPLICATION TO ADDITIONAL ELIGIBLE 23

HOSPITALS.—The Secretary shall apply the provi-24

sions of this subsection with respect to an additional 25



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[Discussion Draft]

eligible hospital in the same manner as such provi-1

sions apply to an eligible hospital, except in apply-2

ing—3

‘‘(A) paragraph (2)(E)(ii), the references 4

to 2013 and 2015 shall be deemed references to 5

2017 and 2019, respectively; and 6

‘‘(B) paragraph (2)(G)(i), the reference to 7

2011 shall be deemed a reference to 2015.’’. 8

(c) MEDICAID PROVIDERS.—Section 1903(t) of the 9

Social Security Act (42 U.S.C. 1396b(t)) is amended—10

(1) in paragraph (2)(B)—11

(A) in clause (i), by striking ‘‘, or’’ and in-12

serting a semicolon; 13

(B) in clause (ii), by striking the period 14

and inserting a semicolon; and 15

(C) by adding after clause (ii) the following 16

new clauses: 17

‘‘(iii) a public hospital that is prin-18

cipally a psychiatric hospital (as defined in 19

section 1861(f)); 20

‘‘(iv) a private hospital that is prin-21

cipally a psychiatric hospital (as defined in 22

section 1861(f)) and that has at least 10 23

percent of its patient volume (as estimated 24

in accordance with a methodology estab-25



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[Discussion Draft]

lished by the Secretary) attributable to in-1

dividuals receiving medical assistance 2

under this title; 3

‘‘(v) a community mental health cen-4

ter meeting the criteria specified in section 5

1913(c) of the Public Health Service Act; 6

or 7

‘‘(vi) a residential or outpatient men-8

tal health or substance abuse treatment fa-9

cility that—10

‘‘(I) is accredited by the Joint 11

Commission on Accreditation of 12

Healthcare Organizations, the Com-13

mission on Accreditation of Rehabili-14

tation Facilities, the Council on Ac-15

creditation, or any other national ac-16

crediting agency recognized by the 17

Secretary; and 18

‘‘(II) has at least 10 percent of 19

its patient volume (as estimated in ac-20

cordance with a methodology estab-21

lished by the Secretary) attributable 22

to individuals receiving medical assist-23

ance under this title.’’; and 24

(2) in paragraph (3)(B)—25



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[Discussion Draft]

(A) in clause (iv), by striking ‘‘and’’ after 1

the semicolon; 2

(B) in clause (v), by striking the period 3

and inserting ‘‘; and’’; and 4


clause: 6

‘‘(vi) clinical psychologist providing 7

qualified psychologist services (as defined 8

in section 1861(ii)), if such clinical psy-9

chologist is practicing in an outpatient 10

clinic that—11

‘‘(I) is led by a clinical psycholo-12

gist; and 13

‘‘(II) is not otherwise receiving 14

payment under paragraph (1) as a 15

Medicaid provider described in para-16

graph (2)(B).’’. 17

(d) MEDICARE ADVANTAGE ORGANIZATIONS.—Sec-18

tion 1853 of the Social Security Act (42 U.S.C. 1395w–19

23) is amended—20

(1) in subsection (l)—21

(A) in paragraph (1)—22

(i) by inserting ‘‘or additional eligible 23

professionals (as described in paragraph 24

(9))’’ after ‘‘paragraph (2)’’; and 25



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[Discussion Draft]

(ii) by inserting ‘‘and additional eligi-1

ble professionals’’ before ‘‘under such sec-2

tions’’; 3

(B) in paragraph (3)(B)—4

(i) in clause (i) in the matter pre-5

ceding subclause (I), by inserting ‘‘or an 6

additional eligible professional described in 7

paragraph (9)’’ after ‘‘paragraph (2)’’; and 8

(ii) in clause (ii)—9

(I) in the matter preceding sub-10

clause (I), by inserting ‘‘or an addi-11

tional eligible professional described in 12

paragraph (9)’’ after ‘‘paragraph 13

(2)’’; and 14

(II) in subclause (I), by inserting 15

‘‘or an additional eligible professional, 16

respectively,’’ after ‘‘eligible profes-17

sional’’; 18

(C) in paragraph (3)(C), by inserting ‘‘and 19

additional eligible professionals’’ after ‘‘all eligi-20

ble professionals’’; 21

(D) in paragraph (4)(D), by adding at the 22

end the following new sentence: ‘‘In the case 23

that a qualifying MA organization attests that 24

not all additional eligible professionals of the 25



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[Discussion Draft]

organization are meaningful EHR users with 1

respect to an applicable year, the Secretary 2

shall apply the payment adjustment under this 3

paragraph based on the proportion of all such 4

additional eligible professionals of the organiza-5

tion that are not meaningful EHR users for 6

such year.’’; 7

(E) in paragraph (6)(A), by inserting 8

‘‘and, as applicable, each additional eligible pro-9

fessional described in paragraph (9)’’ after 10

‘‘paragraph (2)’’; 11

(F) in paragraph (6)(B), by inserting 12

‘‘and, as applicable, each additional eligible hos-13

pital described in paragraph (9)’’ after ‘‘sub-14

section (m)(1)’’; 15

(G) in paragraph (7)(A), by inserting 16

‘‘and, as applicable, additional eligible profes-17

sionals’’ after ‘‘eligible professionals’’; 18

(H) in paragraph (7)(B), by inserting 19

‘‘and, as applicable, additional eligible profes-20

sionals’’ after ‘‘eligible professionals’’; 21

(I) in paragraph (8)(B), by inserting ‘‘and 22

additional eligible professionals described in 23




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[Discussion Draft]

(J) by adding at the end the following new 1

paragraph: 2

‘‘(9) ADDITIONAL ELIGIBLE PROFESSIONAL DE-3

SCRIBED.—With respect to a qualifying MA organi-4

zation, an additional eligible professional described 5

in this paragraph is an additional eligible profes-6

sional (as defined for purposes of section 1848(o)) 7

who—8

‘‘(A)(i) is employed by the organization; or 9

‘‘(ii)(I) is employed by, or is a partner of, 10

an entity that through contract with the organi-11

zation furnishes at least 80 percent of the enti-12

ty’s Medicare patient care services to enrollees 13

of such organization; and 14

‘‘(II) furnishes at least 80 percent of the 15

professional services of the additional eligible 16

professional covered under this title to enrollees 17

of the organization; and 18

‘‘(B) furnishes, on average, at least 20 19

hours per week of patient care services.’’; and 20

(2) in subsection (m)—21

(A) in paragraph (1)—22

(i) by inserting ‘‘or additional eligible 23

hospitals (as described in paragraph (7))’’ 24

after ‘‘paragraph (2)’’; and 25



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[Discussion Draft]

(ii) by inserting ‘‘and additional eligi-1

ble hospitals’’ before ‘‘under such sec-2

tions’’; 3

(B) in paragraph (3)(A)(i), by inserting 4

‘‘or additional eligible hospital’’ after ‘‘eligible 5

hospital’’; 6

(C) in paragraph (3)(A)(ii), by inserting 7

‘‘or an additional eligible hospital’’ after ‘‘eligi-8

ble hospital’’ in each place it occurs; 9

(D) in paragraph (3)(B)—10

(i) in clause (i), by inserting ‘‘or an 11

additional eligible hospital described in 12


(ii) in clause (ii)—14

(I) in the matter preceding sub-15

clause (I), by inserting ‘‘or an addi-16

tional eligible hospital described in 17

paragraph (7)’’ after ‘‘paragraph 18

(2)’’; and 19

(II) in subclause (I), by inserting 20

‘‘or an additional eligible hospital, re-21

spectively,’’ after ‘‘eligible hospital’’; 22

(E) in paragraph (4)(A), by inserting ‘‘or 23

one or more additional eligible hospitals (as de-24



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[Discussion Draft]

fined in section 1886(n)), as appropriate,’’ after 1

‘‘section 1886(n)(6)(A))’’; 2

(F) in paragraph (4)(D), by adding at the 3

end the following new sentence: ‘‘In the case 4

that a qualifying MA organization attests that 5

not all additional eligible hospitals of the orga-6

nization are meaningful EHR users with re-7

spect to an applicable period, the Secretary 8

shall apply the payment adjustment under this 9

paragraph based on the methodology specified 10

by the Secretary, taking into account the pro-11

portion of such additional eligible hospitals, or 12

discharges from such hospitals, that are not 13

meaningful EHR users for such period.’’; 14

(G) in paragraph (5)(A), by inserting 15

‘‘and, as applicable, each additional eligible hos-16

pital described in paragraph (7)’’ after ‘‘para-17

graph (2)’’; 18

(H) in paragraph (5)(B), by inserting 19

‘‘and additional eligible hospitals, as applica-20

ble,’’ after ‘‘eligible hospitals’’; 21

(I) in paragraph (6)(B), by inserting ‘‘and 22

additional eligible hospitals described in para-23

graph (7)’’ after ‘‘paragraph (2)’’; and 24



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[Discussion Draft]

(J) by adding at the end the following new 1

paragraph: 2

‘‘(7) ADDITIONAL ELIGIBLE HOSPITAL DE-3

SCRIBED.—With respect to a qualifying MA organi-4

zation, an additional eligible hospital described in 5

this paragraph is an additional eligible hospital (as 6

defined in section 1886(n)(6)(C)) that is under com-7

mon corporate governance with such organization 8

and serves individuals enrolled under an MA plan of-9

fered by such organization.’’. 10

TITLE VIII—SERVICE MEMBERS 11

AND VETERANS MENTAL 12

HEALTH 13

SEC. 801. PRELIMINARY MENTAL HEALTH ASSESSMENTS. 14

(a) IN GENERAL.—Chapter 31 of title 10, United 15

States Code, is amended by adding at the end the fol-16

lowing new section: 17

‘‘SEC. 520d. PRELIMINARY MENTAL HEALTH ASSESSMENTS. 18

‘‘(a) PROVISION OF MENTAL HEALTH ASSESS-19

MENT.—Before any individual enlists in an armed force 20

or is commissioned as an officer in an armed force, the 21

Secretary concerned shall provide the individual with a 22

mental health assessment. The Secretary shall use such 23

results as a baseline for any subsequent mental health ex-24



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[Discussion Draft]

aminations, including such examinations provided under 1

sections 1074f and 1074m of this title. 2

‘‘(b) USE OF ASSESSMENT.—The Secretary may not 3

consider the results of a mental health assessment con-4

ducted under subsection (a) in determining the assign-5

ment or promotion of a member of the Armed Forces. 6

‘‘(c) APPLICATION OF PRIVACY LAWS.—With respect 7

to applicable laws and regulations relating to the privacy 8

of information, the Secretary shall treat a mental health 9

assessment conducted under subsection (a) in the same 10

manner as the medical records of a member of the Armed 11

Forces.’’. 12

(b) CLERICAL AMENDMENT.—The table of sections 13

at the beginning of such chapter is amended by adding 14

after the item relating to section 520c the following new 15

item:16

‘‘520d. Preliminary mental health assessments’’.

(c) REPORT.—17

(1) IN GENERAL.—Not later than 180 days 18

after the date of the enactment of this Act, the Na-19

tional Institute of Mental Health of the National In-20

stitutes of Health shall submit to Congress and the 21

Secretary of Defense a report on preliminary mental 22

health assessments of members of the Armed 23

Forces. 24



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[Discussion Draft]

(2) MATTERS INCLUDED.—The report under 1

paragraph (1) shall include the following: 2

(A) Recommendations with respect to es-3

tablishing a preliminary mental health assess-4

ment of members of the Armed Forces to bring 5

mental health screenings to parity with physical 6

screenings of members. 7

(B) Recommendations with respect to the 8

composition of the mental health assessment, 9

best practices, and how to track assessment 10

changes relating to traumatic brain injuries, 11

post-traumatic stress disorder, and other condi-12

tions. 13

(3) COORDINATION.—The National Institute of 14

Mental Health shall carry out paragraph (1) in co-15

ordination with the Secretary of Veterans Affairs, 16

the Director of the Centers for Disease Control and 17

Prevention, the surgeons general of the military de-18

partments, and other relevant experts. 19

SEC. 802. EXTENSION OF ELIGIBILITY FOR DOMICILIARY 20

CARE FOR CERTAIN VETERANS WHO SERVED 21

IN A THEATER OF COMBAT OPERATIONS. 22

Section 1710(e)(3)(A) of title 38, United States 23

Code, is amended by striking ‘‘period of five years’’ and 24

inserting ‘‘period of 15 years’’. 25



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SEC. 803. REVIEW OF CHARACTERIZATION OR TERMS OF 1

DISCHARGE FROM THE ARMED FORCES OF 2

INDIVIDUALS WITH MENTAL HEALTH DIS-3

ORDERS ALLEGED TO AFFECT TERMS OF DIS-4

CHARGE. 5

(a) IN GENERAL.—The Secretaries of the military 6

departments shall each provide for a process by which a 7

covered individual may challenge the terms or character-8

ization of the individual’s discharge or separation from the 9

Armed Forces. 10

(b) COVERED INDIVIDUALS.—For purposes of this 11

section, a covered individual is any individual as follows: 12

(1) An individual who was discharged or sepa-13

rated from the Armed Forces for a personality dis-14

order. 15

(2) An individual who—16

(A) was discharged or separated from the 17

Armed Forces on a punitive basis, or under 18

other than honorable conditions; and 19

(B) who alleges that the basis for such dis-20

charge or separation was a mental health injury 21

or disorder incurred or aggravated by the indi-22

vidual during service in the Armed Forces. 23

(c) DISCHARGE OF PROCESS THROUGH BOARDS OF 24

CORRECTIONS OF RECORDS.—The Secretary of a military 25

department shall carry out the process required by sub-26



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[Discussion Draft]

section (a) through boards for the correction of military 1

records of the military department concerned. 2

(d) CONSIDERATIONS ON MODIFICATION OF TERMS 3

OF DISCHARGE OR SEPARATION.—In deciding whether to 4

modify the terms or characterization of an individual’s dis-5

charge or separation pursuant to the process required by 6

subsection (a), the Secretary of the military department 7

concerned shall instruct boards to give due consideration 8

to any mental health injury or disorder determined to have 9

been incurred or aggravated by the individual during serv-10

ice in the Armed Forces and to what bearing such injury 11

or disorder may have had on the circumstances sur-12

rounding the individual’s discharge or separation from the 13

Armed Forces. 14

SEC. 804. IMPROVEMENT OF MENTAL HEALTH CARE PRO-15

VIDED BY DEPARTMENT OF VETERANS AF-16

FAIRS AND DEPARTMENT OF DEFENSE. 17

(a) EVALUATIONS OF MENTAL HEALTH CARE AND 18

SUICIDE PREVENTION PROGRAMS.—19

(1) IN GENERAL.—Not less frequently than 20

once each year, the Secretary concerned shall pro-21

vide for the conduct of an evaluation of the mental 22

health care and suicide prevention programs carried 23

out under the laws administered by such Secretary. 24



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[Discussion Draft]

(2) ELEMENTS.—Each evaluation conducted 1

under paragraph (1) shall—2

(A) use metrics that are common among 3

and useful for practitioners in the field of men-4

tal health care and suicide prevention; 5

(B) identify the most effective mental 6

health care and suicide prevention programs 7

conducted by the Secretary concerned; and 8

(C) propose best practices for caring for 9

individuals who suffer from mental health dis-10

orders or are at risk of suicide. 11

(3) THIRD PARTY.—Each evaluation conducted 12

under paragraph (1) shall be conducted by an inde-13

pendent third party unaffiliated with the Depart-14

ment of Veterans Affairs and the Department of De-15

fense. 16

(b) TRAINING OF PROVIDERS.—17

(1) IN GENERAL.—The Secretary concerned 18

shall train all providers of health care under the 19

laws administered by such Secretary on the fol-20

lowing: 21

(A) Recognizing if an individual is at risk 22

of suicide. 23

(B) Treating or referring for treatment an 24

individual who is at risk of suicide. 25



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[Discussion Draft]

(C) Recognizing the symptoms of 1

posttraumatic stress disorder. 2

(2) DISSEMINATION OF BEST PRACTICES.—The 3

Secretary concerned shall ensure that best practices 4

for identifying individuals at risk of suicide and pro-5

viding quality mental health care are disseminated to 6

providers of health care under the laws administered 7

by such Secretary. 8

(c) SECRETARY CONCERNED DEFINED.—In this sec-9

tion, the term ‘‘Secretary concerned’’ means—10

(1) the Secretary of Veterans Affairs with re-11

spect to matters concerning the Department of Vet-12

erans Affairs; and 13

(2) the Secretary of Defense with respect to 14

matters concerning the Department of Defense. 15

SEC. 805. COLLABORATION BETWEEN DEPARTMENT OF 16

VETERANS AFFAIRS AND DEPARTMENT OF 17

DEFENSE ON HEALTH CARE MATTERS. 18

(a) TIMELINE FOR IMPLEMENTING INTEROPERABLE 19

ELECTRONIC HEALTH RECORDS.—20

(1) IN GENERAL.—Section 1635 of the Wound-21

ed Warrior Act (10 U.S.C. 1071 note) is amended 22

by adding at the end the following new subsection: 23



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[Discussion Draft]

‘‘(k) TIMELINE.—In carrying out this section, the 1

Secretary of Defense and the Secretary of Veterans Af-2

fairs shall ensure that—3

‘‘(1) the creation of a health data authoritative 4

source by the Department of Defense and the De-5

partment of Veterans Affairs that can be accessed 6

by multiple providers and standardizes the input of 7

new medical information is achieved not later than 8

180 days after the date of the enactment of this 9

subsection; 10

‘‘(2) the ability of patients of both the Depart-11

ment of Defense and the Department of Veterans 12

Affairs to download the medical records of the pa-13

tient (commonly referred to as the ‘Blue Button Ini-14

tiative’) is achieved not later than 180 days after the 15

date of the enactment of this subsection; 16

‘‘(3) the full interoperability of personal health 17

care information between the Departments is 18

achieved not later than one year after the date of 19

the enactment of this subsection; 20

‘‘(4) the acceleration of the exchange of real-21

time data between the Departments is achieved not 22

later than one year after the date of the enactment 23

of this subsection; 24



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[Discussion Draft]

‘‘(5) the upgrade of the graphical user interface 1

to display a joint common graphical user interface is 2

achieved not later than one year after the date of 3

the enactment of this subsection; and 4

‘‘(6) each current member of the Armed Forces 5

and the dependent of such a member may elect to 6

receive an electronic copy of the health care record 7

of the individual beginning not later than June 30, 8

2015.’’. 9

(2) CONFORMING AMENDMENTS.—Section 1635 10

of such Act is further amended—11

(A) in subsection (a), by striking ‘‘The 12

Secretary’’ and inserting ‘‘In accordance with 13

the timeline described in subsection (k), the 14

Secretary’’; and 15

(B) in the matter preceding paragraph (1) 16

of subsection (e), by inserting ‘‘in accordance 17

with subsection (k)’’ after ‘‘under this section’’. 18

(b) ESTABLISHMENT OF UNIFORM PRESCRIPTION 19

FORMULARY.—The Secretary of Veterans Affairs and the 20

Secretary of Defense shall jointly establish a uniform pre-21

scription formulary for use in prescribing medication 22

under the laws administered by the Secretary of Veterans 23

Affairs and the laws administered by the Secretary of De-24

fense. 25



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[Discussion Draft]

SEC. 806. PILOT PROGRAM FOR REPAYMENT OF EDU-1

CATIONAL LOANS FOR CERTAIN PSYCHIA-2

TRISTS OF VETERANS HEALTH ADMINISTRA-3

TION. 4

(a) ESTABLISHMENT.—The Secretary of Veterans 5

Affairs shall carry out a pilot program to repay a loan 6

of an individual described in subsection (b) that—7

(1) was used by the individual to finance edu-8

cation regarding psychiatric medicine, including edu-9

cation leading to an undergraduate degree and edu-10

cation leading to the degree of doctor of medicine or 11

of doctor of osteopathy; and 12

(2) was obtained from a governmental entity, 13

private financial institution, school, or other author-14

ized entity, as determined by the Secretary. 15

(b) ELIGIBLE INDIVIDUALS.—To be eligible to obtain 16

a loan repayment under this section, an individual shall—17

(1) either—18

(A) be licensed or eligible for licensure to 19

practice psychiatric medicine in the Veterans 20

Health Administration of the Department of 21

Veterans Affairs; or 22

(B) be enrolled in the final year of a resi-23

dency program leading to a specialty qualifica-24

tion in psychiatric medicine that is approved by 25



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[Discussion Draft]

the Accreditation Council for Graduate Medical 1

Education; and 2

(2) as determined appropriate by the Secretary, 3

demonstrate a commitment to a long-term career as 4

a psychiatrist in the Veterans Health Administra-5

tion, including by requiring a set number of years of 6

obligated service. 7

(c) SELECTION.—The Secretary shall select not less 8

than 10 individuals described in subsection (b) to partici-9

pate in the pilot program for each year in which the Sec-10

retary carries out the pilot program. 11

(d) LOAN REPAYMENTS.—12

(1) AMOUNTS.—Subject to the limits estab-13

lished by paragraph (2), a loan repayment under 14

this section may consist of payment of the principal, 15

interest, and related expenses of a loan obtained by 16

an individual described in subsection (b) for all edu-17

cational expenses (including tuition, fees, books, and 18

laboratory expenses) relating to a degree described 19

in subsection (a)(1). 20

(2) LIMIT.—For each year of obligated service 21

that an individual agrees to serve in an agreement 22

described in subsection (b)(2), the Secretary may 23

pay not more than $60,000 on behalf of the indi-24

vidual. 25



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[Discussion Draft]

(e) BREACH.—1

(1) LIABILITY.—An individual who participates 2

in the pilot program under subsection (a) who fails 3

to satisfy the commitment described in subsection 4

(b)(2) shall be liable to the United States, in lieu of 5

any service obligation arising from such participa-6

tion, for the amount which has been paid or is pay-7

able to or on behalf of the individual under the pro-8

gram, reduced by the proportion that the number of 9

days served for completion of the service obligation 10

bears to the total number of days in the period of 11

obligated service of the individual. 12

(2) REPAYMENT PERIOD.—Any amount of dam-13

ages which the United States is entitled to recover 14

under this subsection shall be paid to the United 15

States within the one-year period beginning on the 16

date of the breach of the agreement. 17

(f) PROHIBITION ON SIMULTANEOUS ELIGIBILITY.—18

An individual who is participating in any other program 19

of the Federal Government that repays the educational 20

loans of the individual may not participate in the pilot pro-21

gram under subsection (a). 22

(g) REPORT.—Not later than 90 days after the date 23

on which the pilot program terminates under subsection 24

(g), the Secretary shall submit to the Committees on Vet-25



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[Discussion Draft]

erans’ Affairs of the House of Representatives and the 1

Senate a report on the pilot program. The report shall 2

include the overall effect of the pilot program on the psy-3

chiatric workforce shortage of the Veterans Health Ad-4

ministration, the long-term stability of such workforce, 5

and overall workforce strategies of the Veterans Health 6

Administration that seek to promote the physical and 7

mental resiliency of all veterans. 8

(h) REGULATIONS.—The Secretary shall prescribe 9

regulations to carry out this section, including standards 10

for qualified loans and authorized payees and other terms 11

and conditions for the making of loan repayments. 12

(i) TERMINATION.—The authority to carry out the 13

pilot program shall expire on the date that is three years 14

after the date on which the Secretary commences the pilot 15

program. 16

SEC. 807. COMPTROLLER GENERAL STUDY ON PAY DIS-17

PARITIES OF PSYCHIATRISTS OF VETERANS 18

HEALTH ADMINISTRATION. 19

(a) STUDY.—20

(1) IN GENERAL.—Not later than one year 21

after the date of the enactment of this Act, the 22

Comptroller General of the United States shall con-23

duct a study of pay disparities among psychiatrists 24



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[Discussion Draft]

of the Veterans Health Administration of the De-1

partment of Veterans Affairs. 2

(2) ELEMENTS.—The study required by para-3

graph (1) shall include the following: 4

(A) An examination of laws, regulations, 5

practices, and policies, including salary flexibili-6

ties, that contribute to such disparities. 7

(B) Recommendations for legislative or 8

regulatory action to improve equity in pay 9

among such psychiatrists. 10

(b) REPORT.—Not later than one year after the date 11

on which the Comptroller General completes the study 12

under subsection (a), the Comptroller General shall sub-13

mit to the Committee on Veterans’ Affairs of the Senate 14

and the Committee on Veterans’ Affairs of the House of 15

Representatives a report containing the results of the 16

study. 17



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[Discussion Draft]

øTITLE IX—MAKING PARITY 1

WORK¿2

øSEC. 901. CLARIFICATION OF HIPAA TRAINING REQUIRE-3

MENTS REGARDING DISCLOSURE OF PRO-4

TECTED HEALTH INFORMATION CON-5

CERNING INDIVIDUALS WITH MENTAL 6

HEALTH DISORDERS. 7

Not later than 6 months after the date of enactment 8

of this Act, the Secretary of Health and Human Services 9

shall issue guidance regarding the requirements of section 10

164.530(b) of title 45, Code of Federal Regulations, so 11

as to ensure that training under such section includes a 12

clear explanation of the circumstances under which health 13

care professionals and other covered entities (as such term 14

is defined for purposes of regulations promulgated under 15

section 264(c) of the Health Insurance Portability and Ac-16

countability Act of 1996) are permitted or required to dis-17

close protected health information concerning individuals 18

with a mental health disorder.¿19

øSEC. 902. GAO STUDY ON MENTAL HEALTH PARITY EN-20

FORCEMENT EFFORTS. 21

Not later than one year after the date of the enact-22

ment of this Act, the Government Accountability Office, 23

in consultation with the Department of Health and 24

Human Services as well as the Department of Labor, shall 25



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[Discussion Draft]

submit to Congress a report detailing the enforcement ef-1

forts that the responsible departments and agencies have 2

carried out in the implementation of the Paul Wellstone 3

and Pete Domenici Mental Health Parity and Addiction 4

Act ø(Public Law 110–343)¿, including the number of in-5

vestigations that have been conducted into potential parity 6

violations and details on the guidance or enforcement ac-7

tion that was carried out as a result of such investigations 8

that would not identify the subject of such enforcement 9

or investigation¿10

øSEC. 903. REPORT TO CONGRESS ON FEDERAL ASSIST-11

ANCE TO STATE INSURANCE REGULATORS 12

REGARDING MENTAL HEALTH PARITY EN-13

FORCEMENT. 14

Not later than one year after the date of the enact-15

ment of this Act, the Secretary of the Department of 16

Health and Human Services shall submit to Congress a 17

report detailing the ways in which state governments and 18

state insurance regulators are either empowered or re-19

quired to enforce the Paul Wellstone and Pete Domenici 20

Mental Health Parity and Addiction Equity Act of 2008 21

ø(Public Law 110–343)¿, their capability to carry out 22

these enforcement powers or requirements, and any tech-23

nical assistance to state government and state insurance 24



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199

[Discussion Draft]

regulators that have been communicated by the Depart-1

ment¿2



f:\VHLC\042514\042514.229.xml (571949|22)

Documents

Mental health draft bill