Section by Section Summary of Murphy Bill (H.R. 3717) “Helping Families in MH Crisis Act of 2013” and Democratic Discussion Bill entitled “Strengthening Mental Health in Our Communities Act”

Helping Families in Mental Health Crisis Act (Murphy Bill) Strengthening Mental Health in Our Communities ActTitle I: Assistant Secretary for Mental Health Title I

Sec. 101. Would create an Assistant Secretary for Mental Health & Substance Use Disorders, who must have an understanding of biological, psychosocial and pharmaceutical treatments of mental illness and either a doctoral degree in psychology with clinical and research experience or a doctoral degree in medicine or osteopathic medicine with clinical and research experience in psychiatry. The Assistant Secretary would be charged with:

1. coordinating the work of departments, agencies and organizations dealing with the problems of individuals suffering from substance abuse and mental illness; 2. overseeing SAMHSA; 3. within HHS, overseeing and coordinating all programs and activities relating to the prevention and treatment of and rehabilitation for mental health or substance abuse services; 4. reviewing programs and activities across the Federal government, identifying duplicative programs and activities, and formulating recommendations for coordination; 5. supervising data collection for and disseminating best practices by a newly created National Mental Health Policy Laboratory (NHPL);6. prioritizing the integration of mental health or substance abuse services with primary care services;7. prioritizing early diagnosis and intervention services; and8. overseeing the NMHPL in its work of identifying and implementing policy changes and trends likely to have the most significant impact on mental health services and evaluating and collecting and disseminating grantee data, evidence-based practices, and service delivery models.

NMHPL, in selecting evidence-based practices and services delivery models, would be required to give preference to models that improve coordination,

Sec. 101. White House Office of Mental Health PolicyCreates White House Office on Mental Health Policy in the Executive Office. The Office, led by a Director who would be appointed by the President with the advice and consent of the Senate, would be charged with:

1. monitoring Federal activities with regard to mental health, serious mental illness(SMI), and serious emotional disturbances;

2. making recommendations to the HHS Secretary on changes to those activities, including recommendations on national strategy;

3. developing and annually updating a National Strategy for Mental Health to maximize access to community-based services, strengthen the impact of services, and meet the comprehensive needs of individuals with mental illness;

4. making recommendations to the HHS Secretary on public participation in decision-making on mental health, SMI, and serious emotional disturbances;

5. reviewing and making recommendations on budgets for the Federal mental health services agencies to ensure adequacy of those budgets;

6. submitting the National Strategy and any updates to Congress;7. coordinating mental health services provided by Federal agencies and

coordinating Federal interagency mental health services;8. consulting, coordinating with, and facilitating joint efforts on improving

community-based and other mental health services with state, local, and tribal governments, NGEs, and individuals with a mental illness, particularly individuals with an SMI;

9. developing and annually updating a summary of advances in mental illness and serious emotional disturbances research related to causes, prevention, treatment, early screening, diagnosis or rule out, intervention, and access to services and supports.

quality and efficiency of health care services furnished to individuals with a serious mental illness (SMI). It could include clinical protocols and practices used in the Recovery After Initial Schizophrenia Episode (RAISE) project and the North America Prodrome Longitudinal Study (NAPLS) for NIMH.

The NMHPL director would be required to evaluate grant programs, including analyses of the quality of care furnished, patient-level outcomes, and public health outcomes, as well as changes in spending. The director, taking into account the results of the evaluations, would be authorized to expand the use of specific delivery models funded under the Block Grants for Community Mental Health Services, as long as quality can be improved without increasing spending or spending can be reduced without reducing quality.

The NMHPL director would begin implementation January 1, 2016.

Sec. 102. Appointment and Duties of the DirectorWould require the Director, in addition to helming the above duties of the Office, to:

1. assist the President in establishing policies, goals, objectives, and priorities with respect to mental health, particularly SMI, to improve outcomes, and to maximize the efficiencies and effectiveness of the community-based mental health programs and services;

2. work with Federal departments and agencies providing mental health services to strengthen coordination of services in order to maximize access, particularly for individuals with an SMI, to community-based services, strengthen the impact of services, and meet the comprehensive needs of individuals with a mental illness;

3. coordinate and oversee the development, coordination, implementation, evaluation, and promotion of the National Strategy;

4. make recommendations to the President regarding the organization, management, and budgets of Federal departments and agencies providing mental health services, including changes in personnel;

5. appear before Congressional committees to represent the policies of the President on mental health and the National Strategy; and

6. submit an annual report to Congress detailing how the Director has consulted and coordinated with the National Mental Health Council, the National Mental Health Advisory Board created under Section 6 (below), State, local, and tribal governments, NGEs, and individuals with a mental illness, particularly individuals with an SMIL, and children and adolescents with serious emotional disturbances.

The Director would also have the responsibility of monitoring implementation of the National Strategy, and conducting program and performance evaluations with the assistance of the OIG. Each Federal agency and department providing mental health services would be required to transmit to the Director annually a copy of its proposed budget for the Director’s budget recommendations to OMB and the President.

Title V – Improving Mental Health Research and CoordinationSec. 102. Would create an Interagency SMI Coordinating Committee to assist the Assistant Secretary in monitoring Federal activities with respect to SMI and develop and annually update a summary of advances in SMI research. The Interagency Committee would also evaluate the impact on public health of projects addressing priority mental health needs of regional and national significance, including whether each project has reduced mortality rates, prevalence and emergency room visits and the effect of those visits on public health resources, while also identifying duplicative programs. Not more than 5 percent of community mental health block grant monies for FY 2014 through FY 2019 would be set aside to fund the Coordinating Committee’s Activities.

Committee membership would include the administrator of SAMHSA and the new Assistant Secretary, as well as the directors of CDC and NIH. At least one member would be required to be from each of the following categories: an individual with a diagnosis of SMI; a parent or legal guardian of an individual with SMI; a representative of leading research, advocacy and service organizations for individuals with SMI; a psychiatrist; a clinical psychologist; a judge with experience in applying assisted outpatient treatment; a law enforcement office; and a corrections officer.

Sec. 501. National Institute of Mental Health Research Program on SMI.Would require the Director of NIMH to conduct or support research on SMI, including the causes, prevention, and treatment of SMI and interventions to improve early identification of individuals with SMI and referral of those individuals to mental health professionals for treatment.

The bill would authorize $40 million in each of FYs 2015 through 2019 for this purpose.

Sec. 103. Would create a 4-year Assisted Outpatient Treatment (AOT) Grant pilot program. This section would require the Assistant Secretary, in consultation with the NIMH director and the US Attorney General to award not more than 50 grants each year to counties, cities, mental health systems, mental health courts and other entities that have not previously implemented AOT programs to implement, monitor and oversee such programs. Grants would be used to seek out and evaluate eligible individuals who could benefit from AOT, prepare and execute treatment plans, file petitions in appropriate courts, provide case management services under a court order, carry out referrals and medical evaluations, and to pay legal counsel. The Assistant Secretary would be required to submit an annual report to Congress on cost savings and public health outcomes, rates of incarceration of patients, rates of employment of patients and rates of homelessness.

The law would define AOT as either (A) medically prescribed treatment that an eligible patient must undergo while living in a community under the terms of a law authorizing a state or local court to order such treatment, or (B) a court ordered treatment plan that requires the patient to obtain treatment while living in the community that is designed to improve access and adherence to intensive behavioral health services to avert relapse, repeated hospitalizations, arrest, incarceration, suicide, property destruction, or violent behavior and provide the patient with an opportunity to live in a less restrictive setting that incarceration or involuntary hospitalization.

An “eligible patient” would be defined as an adult, mentally ill person who: 1. is determined by the court to have a history of violence,

incarceration, or medically unnecessary hospitalizations; 2. without supervision and treatment may be a danger to self or

others in the community; 3. is substantially unlikely to voluntarily participate in treatment;4. may be unable, for reasons other than indigence, to provide for any

of his or her basic needs;5. has a history of mental illness or a condition likely to substantially

deteriorate if the patient is not provided with timely treatment; and

6. due to mental illness, lacks capacity to fully understand or lacks judgment to make informed decisions regarding the need for treatment, care, or supervision.

Sec. 104. Would create a 3-Year Tele-Psychiatry & Primary Care Physician Training Grant Program to provide grants of not more than $1M over 3 years to 10 eligible states, utilizing a total of $9 million in grant moneys, to train primary care physicians in the use of approved behavioral health screening tools and for services furnished, using innovative payment models that can be replicated in other states. Grants also could be used by states to pay for consultations by a psychiatrist or psychologist to a primary care physician through the use of qualified telehealth technology for the identification, diagnosis, mitigation, or treatment of a mental health disorder that is provided one-day following a primary care office visit.

“Qualified telehealth technology” would be defined to mean the use of interactive audio, video, or other telecommunications technology by a health care provider to deliver services within the scope of the provider’s practice at a site other than the site where the patient is located. It would not include the use of audio-only telephone conversations, electronic mail messages, or faxes.

Qualifying states would have to agree to match 20% of the federal moneys provided under a grant. The Assistant Secretary would be required to ensure a geographic balance in the distribution of grants and reported annually to Congress.

Sec. 103. National Strategy for Mental HealthThe Director would be required to submit to the President and Congress annually, no later than February 1, a National Strategy for Mental Health. [Compare to Sec. 2, which specifies a National Strategy with updates, a better approach.] In preparing the Strategy, the Director would be required to actively consult and work in coordination with: Federal departments and agencies that provide mental health services; the National Mental Health Council; the National Mental Health Advisory Board; existing Federal interagency efforts; NGEs; state, local, and tribal governments; and individuals with mental illness, particularly those with an SMI, and children and adolescents with serious emotional disturbances.

The strategy would be required to contain comprehensive, research-based goals and quantifiable performance measures for:

1. improving outcomes of and accessibility to evidence-based programs and services;

2. promoting community integration;3. increasing access to prevention and early intervention services;4. promoting mental health awareness and reducing stigma; and 5. advancing mental health research.

The Director would also be required to report on Federal effectiveness in coordinating mental health services, meeting objectives for the preceding year, and the efficiency and adequacy of Federal programs. The Strategy would be required to contain figures on mental health diagnoses, the quality and quantity of mental health services, and the allocation of Federal resources, all aggregated by age, race, gender, geographic location, population density, socioeconomic status, and other appropriate target populations.

In addition, the Strategy would be required to report coordination activities, provide guidance on assessing and improving the quality of mental health services, contain the views and perspectives of individuals with mental illness, including SMI, and children and adolescents with a serious emotional disturbance. In addition, it would have to include specific recommendations for the coming year, including recommendations on program and budget priorities necessary to achieve performance measures, recommendations for improved Federal interagency coordination and intergovernmental coordination, and a strategic research, innovation, and demonstration agenda.

The Strategy would also be required to include recommendations designed to promote community integration, as well as recommendations to enhance prevention and early intervention services for children and adolescents. It would have to recommend ways to promote expansion of Medicaid-financed intensive community-based services, such as supported housing, ACT, mobile crisis, supported employment, peer-support services, including through enhanced Federal reimbursement rates, as well as ways to promote the expansion of intensive outpatient services under the Medicare Program, such as through ACT,

intensive case management, and psychiatric rehabilitation.Sec. 104. Coordination with Federal Departments and AgenciesWould require the Director in collaboration with Federal departmental and agency heads, to strengthen the coordination of Federal mental health services through alignment, including where appropriate, through (1) shared grant application and aligned reporting processes; (2) joint training and technical assistance; (2) improving opportunities to maintain services during transitions; (3) recommendations for legislative changes, definitions, and eligibility requirements; and (4) research, evaluation, and data collection.

Would also authorize the Director, in consultation with the heads of Federal departments and agencies, to oversee the development and administration of initiatives involving multiple Federal departments and agencies, including initiatives to integrate funding to extent permitted by law.

The section would also create an Office of the National Mental Health Council that is chaired by the President, and includes the Director, HHS Secretary, Director of NIMH, Attorney General, the VA Secretary, Assistant Secretary of Indian Affairs, Director of the Centers for Disease Control and Prevention (CDC), Director of NIH, directors of national research institutes, SAMHSA Administrator, the Defense Secretary, and other Federal agency officials from agencies other than HHS. The Council would be required to meet at least once annually.

The Council would be charged with: (1) assisting the Director in coordination of departments, agencies, and mental health services; and (2) assisting the Director in soliciting and documenting input and recommendations from public and private stakeholders and individuals with mental illness, particularly individuals with an SMI, and adolescents and children with a serious emotional disturbance.Sec. 105. National Mental Health Advisory BoardWould create an Advisory Board appointed by the Director, with at least 12 members or one-half of the total membership (whichever is greater) being individuals with a diagnosis of SMI, at least one member being a parent or legal guardian of an individual with SMI, at least one member being a representative of a leading research organization, at least one member being a representative of a leading advocacy organization, at least one member being a representative of

leading community service organization, at least one member who having served a senior position in a state mental health system, at least one member who served a senior position in a local mental health system, at least one member who is a parent or guardian of a child or adolescent with a serious emotional disturbance, at least one member who is a primary care provider and at least one psychiatrist, one clinical psychiatrist, one law enforcement officer, and one child or adolescent psychiatrist.

Members would serve 2-year terms, with no member serving more than 3 terms. Members would be required to meet in person not fewer than 4 times annually.

The Board would be mandated to:1. advise the President, the heads of Federal departments and agencies

providing mental health services, and other senior Federal Government officials on proposed and pending legislation, budget expenditures, and other mental illness policy matters;

2. work in partnership with local organizations to solicit the views and perspectives on mental health services from individuals with mental illness, particularly individuals with serious mental illness, and parents or legal guardians of individuals with mental illness;

3. prepare a section of the National Strategy outlining the views and perspectives of individuals with mental illness on mental health services; and

4. evaluate staff support and training and technical assistance.Title II - FQCBHCs

Sec. 201. Would create a 5-Year, $50 million Demonstration Program to enable not more than 10 states to improve behavioral health services provided by federally qualified community behavioral health clinics (FQCBHCs). To qualify, a state would have to certify that not more than 75 percent of the total number of behavioral health providers providing assistance are participating Medicaid providers and demonstrate the actuarial soundness of the proposed program. The Secretary of HHS would be authorized to waive the Medicaid statewidedness requirement to ensure that FQCBHCs are located in rural or other mental health professional shortage areas. As a condition of receiving a grant, a state would be

required to pay FQCBHCs under a prospective payment system. No payment could be used for in-patient care, residential treatment, room and board expenses, or any other non-ambulatory services, and no payment could be made to satellite facilities of newly created clinics.

The bill would require a long list of specific conditions that a participating clinic would have to meet:

(1) include primary health services; (2) provide services in locations that ensure services will be available

and accessible promptly, in a manner that preserves human dignity and assures continuity of care;

(3) provide services in a mode of service delivery appropriate for the target population; (4) provide a choice of services options where there is more than one evidence-based treatment;

(4) employ a core staff trained in child and adolescent psychiatry or psychology and child and adolescent psychiatry, as well as dual diagnosis issues, crisis management, and stabilization, with interventions with patients at high risk for violence;

(5) provide services to any individual residing or employed in the service area, regardless of the ability to pay, within the limits of the center’s capacities;

(6) use and share electronic health records; (7) be available to provide assisted outpatient treatment ordered by a

state court; (8) be available to participate in NIMH research projects; (9) provide outreach and engagement; and (10)provide, directly or through contract—to the extent covered by

Medicaid for adults and to the extent covered for children under EPSDT services—screening, assessment and diagnosis, person-centered treatment planning, outpatient mental health and substance use services, integrated treatment for mental illness and substance abuse which is evidence-based, outpatient clinic primary care screening and monitoring of key health indicators and health risk, crisis mental health services, targeted case management, psychiatric rehabilitation, peer support and counselor services and supports, supported education and supported employment for

individuals with SMI after an initial psychotic episode, and case management services for individuals with SMI after an initial psychotic episode.

Participating clinics would also be required to maintain linkages or, if possible, formal contracts with federally qualified health centers (FQHCs), inpatient psychiatric facilities, substance use detoxification and post-detoxification services and residential programs, adult and youth peer support and counseling services, family support services, and other community or regional services, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities, housing agencies and programs and other social services. In addition, they would be expected to integrate care with primary services through, to the extent feasible, a common delivery site, provide enabling services such as transportation and translation services, provide health and wellness services, including services for tobacco cessation, and adopt models of first-episode psychosis training, supervision, and coordination.

Participating states would receive the enhanced federal match available under CHIP of the number of percentage points equal to 30 percent of the number of percentage points by which the Federal medical assistance percentage for the state is less than 100 percent, not to exceed an enhanced FMAP of 85 percent.

The Secretary would be required to make an annual report to Congress assessing the impact of the demonstration programs on the costs of the full range of mental health services and a peer-reviewed assessment of the public health impact. Not later than December 31, 2019, the Secretary would be required to recommend whether to continue the demonstration programs and make them national.

Title III-HIPAA and FERPASec. 301. Would require that a caregiver of an adult individual with an SMI who doesn’t provide consent be treated as a personal representative, with access to the individual’s protected health information, if the provider furnishing the services reasonably believes it is necessary for that information to be made available to the caregiver to protect the health, safety, or welfare of the individual or the safety of one or more other

individuals. A “caregiver” would be defined to include (1) an immediate family member, (2) an individual who assumes primary responsibility for providing a basic need, or (3) a personal representative as determined by the law of the state in which the individual resides. An adult individual with an SMI to whom this would apply would be one who, in the year immediately prior to the disclosure, has been evaluated, diagnosed, or treated for a mental, behavioral or emotional disorder that is of sufficient duration to meet DSM diagnostic criteria and that results in functional impairment that substantially interferes with or limits one or more major life activities.Sec. 302. Would give caregivers access to educational records maintained by educational agencies or institutions under the same circumstances as health records are to be made available under Sec. 301.

Title IV-DOJ Reforms Title VII-Justice and Mental Health CollaborationSec. 401. Would authorize the use of grant funds under Title I of the Omnibus Crime Control and Safe Streets Act of 1968 to:

(i) make grants to States and units of local government for them to provide additional personnel, equipment, supplies, contractual support, training, technical assistance, and information systems for criminal justice to mental health programs and operation;

(ii) provide specialized training to law enforcement officers in recognizing individuals who have a mental illness and how to properly intervene with those individuals;

(iii) establish programs that enhance the ability of law enforcement agencies to address the mental health, behavioral, and substance abuse problems of individuals encountered in the line of duty; and

(iv) provide specialized training to enhance the ability of corrections officers to address the mental health of individuals under the care and custody of jails and prisons.

This section also would authorize the use of Staffing for Adequate Fire and Emergency Response Grants to provide specialized training to paramedics, emergency medical services workers, and other first responders in recognizing individuals with mental illness and how to properly intervene with those individuals.

Sec. 701. Assisting Veterans.Would authorize the Attorney General, in consultation with the VA Secretary, to award grants to establish or expand veterans’ treatment court programs and peer to per services or programs for qualified veterans, as well as practices that identify and provide treatment, rehabilitation, legal, transitional, and other appropriate services to qualified veterans who have been incarcerated. The AG and VA Secretary would also be authorized to establish training programs to teach criminal justice, law enforcement, corrections, mental health, and substance abuse personnel how to identify and appropriately respond to incidents involving qualified veterans. Veterans dishonorably discharged would not qualify to participate.

The peer to peer services or programs would use other veterans for the purposes of providing support and mentorship to assist veterans in obtaining treatment, recovery, stabilization, or rehabilitation.

The veterans’ treatment court programs would involve collaboration with criminal justice, veterans, mental health and substance abuse agencies to provide: (1) intensive judicial supervision and case management, which could include random and frequent drug testing; (2) a full continuum of treatment services, including mental health services, substance abuse services, medical services, and

services to address trauma; (3) alternatives to incarceration; and (4) other appropriate services, including housing, transportation, mentoring, employment, job training, education, and assistance in applying for and obtaining benefits.

In awarding grants, the AG would be required to give priority to applicants that demonstrate collaboration and joint investments by criminal justice, mental health, substance abuse and veterans’ service agencies, promote effective strategies to identify and reduce the risk of harm, and propose interventions with empirical support for improving outcomes among veterans.

Sec. 402. Would reauthorize the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA, adding authorization to use validated assessment tools to target for treatment adult or juvenile ”preliminarily qualified offenders” with a moderate or high risk of recidivism and a need for treatment and services. Such offenders would be those diagnosed by a qualified mental health professional as having a mental illness or substance abuse disorder, manifesting obvious signs of having a mental illness or substance abuse disorder during arrest or confinement or before any court, and unanimously approved for participation in a MIOTCRA-funded program by the prosecuting attorney, defense attorney, probations or corrections official, judge, and a representative from the relevant mental health agency. In determining whether to designate a defendant as a “preliminarily qualified offender,” those making the determination would be required to consider the individual’s criminal history and the nature and severity of the offense with which he or she is charged, whether participation in the treatment program would pose a substantial risk of violence to the community, the views of victims, cost savings to the community, and the extent to which the defendant would benefit from participation. The individual’s offense could not have, as an element, the use, attempted use, or threatened use of physical force against person or property of another, or be a felony that, but its nature, involves a substantial risk that physical force may be used in the course of committing the offense.

The bill also would authorize the U.S. Attorney General to award grants using no more than 20 percent of the funds available under Title I of the Omnibus Crime Control and Safe Streets Act to establish or expand:

Sec. 702. Correctional Facilities.Would authorize the AG to award grants to enhance the capabilities of correctional facilities to identify and screen held, detained, or incarcerated inmates who manifest obvious signs of a mental illness or who have been diagnosed by a qualified mental health professional as having a mental illness.

A grantee would be required to plan and provide initial and periodic assessments of the clinical, medical, and social needs of inmates, and appropriate treatment and services. Grantees would also be required to develop, implement, and enhance post-release, comprehensive treatment plans that coordinate health, housing, medical, employment, and other appropriate services and public benefits, the availability of mental health and substance abuse treatment services, and alternatives to solitary confinement and segregated housing, with mental health screening and treatment for inmates of solitary confinement and segregated housing.

Grantees would also be required to train each correctional facility employee to identify and appropriately respond to incidents involving inmates with mental health or co-occurring mental health and substance abuse disorders.

(1) veterans’ treatment court programs, (2) peer-to-peer services or programs designed to connect veterans to

other veterans for support and mentorship in obtaining treatment, recovery stabilization, or rehabilitation;

(3) practices that identify and provide treatment, rehabilitation, legal, transitional, and other appropriate services to previously incarcerated veterans, and

(4) programs to train criminal justice, law enforcement, corrections, mental health and substance abuse personnel how to identify and appropriately respond to incidents involving veterans.

The Attorney General would be required to prioritize grant applications that demonstrate collaboration, promote effective strategies to identify and reduce the risk of harm to the veteran and public safety, and propose interventions with empirical support to improve outcomes.

The Attorney General also would be authorized to award grants to enhance the capabilities of a correctional facility to identify, screen, and treat inmates with a mental illness or substance abuse issue, as well as develop and implement post-release transition plans that coordinate health, housing, medical, employment, and other appropriate services and public benefits. These grants would be expected to fund alternatives to solitary confinement and segregated housing.

Sec. 403. Would authorize the Attorney General to make grants to states, state courts, local courts, units of local government, and Indian tribal governments, acting directly or through agreements with other public or nonprofit entities, for programs that involve the coordinated delivery of court-ordered AOT when the court determines AOT to be necessary.

Sec. 703. High Utilizers.Would authorize the AG to make 6 grants per year for the purpose of reducing use of public services by “high utilizers” who manifest obvious signs of mental illness or have been diagnosed by a qualified mental health professional as having a mental illness and consume a significantly disproportionate quantity of public resources, including emergency, housing, judicial, corrections, and law enforcement services.

Grantees would be expected to develop or support multi-disciplinary teams that coordinate, implement, and administer community-based crisis responses and long-term plans for high utilizers, or provide training for public service personnel on appropriate responses to the unique issues of high utilizers. Grantees could also develop or support alternatives to hospital and jail admissions for high utilizers that provide treatment, stabilization, and other appropriate supports in the least restrictive, appropriate environment, or develop protocols and systems among law enforcement, mental health, substance abuse, housing, corrections, and EMS operations to provide coordinated assistance to high utilizers.

Grant recipients would be required to submit to the AG a report that measures the performance of the grantee in reducing the use of public services by high utilizers and provides a model set of practices, systems, or procedures that other jurisdictions can adopt to reduce the use of public services by high utilizers.

Sec. 404. Would require any data prepared by or submitted to the Attorney General or the Director of the Federal Bureau of Investigation (FBI) with respect to homicides, law enforcement officers killed and assaulted, or individuals killed by law enforcement officers to include data about the involvement of any mental illness in such incidents.Sec. 405. Would direct the General Accountability Office (GAO) to detail the cost of federal, state, or local imprisonment for persons who have an SMI, including the number and type of crimes committed by individuals with an SMI each year, and detailed strategies for preventing crimes by individuals with an SMI from occurring.

Sec. 704. Academy Training.Would authorize the AG to make Adult and Juvenile Justice Collaboration grants under the Omnibus Crime Control and Safe Streets Act to States, units of local government, Indian tribes, and tribal organizations to provide support for academy

curricula, law enforcement officer orientation programs, continuing education training and other programs on how to identify and respond to incidents involving individuals with mental illness or co-occurring mental illness and substance abuse disorders. Priority in awarding grants would be given to programs that demonstrate a “cooperative” approach between law enforcement personnel and members of the mental health and substance abuse professions in development and administration.Sec. 705. Evidence-Based Practices. Would require that the AG, in awarding Adult and Juvenile Justice Collaboration grants under the Omnibus Crime Control and Safe Streets Act, give priority to applications that propose interventions that have been shown by empirical evidence to reduce recidivism and, when appropriate, use validated assessment tools to target preliminarily qualified offenders with a moderate or high risk of recidivism and a need for treatment and services.Sec. 706. Safe Communities.Would amend the Adult and Juvenile Justice Collaboration grants under the Omnibus Crime Control and Safe Streets Act to redefine “non-violent offense” for purposes of determining whether an offender can participate in a grantee’s program. The offender could not have been involved in an offense that involves the use, attempted use, or threatened use of physical force against the person or property of another or that is a felony that by its nature involves a substantial risk that physical force against person or property could be used in the course of committing the offense.

Offenders would have to be unanimously approved for participation in a grant-funded program by, when appropriate, the relevant prosecuting and defense attorney, probation or corrections, official, judge, and a representative from the relevant mental health agency. A determination of participation would be based on whether the individual poses a substantial risk of violence to the community, the criminal history of the individual and the nature and severity of the offense with which he or she was charged, the extent to which the individual would benefit from participation, the extent to which the community would realize cost savings from the individual’s participation, and whether the individual otherwise satisfies eligibility criteria for program participation established by the relevant prosecuting and defense attorney, probation or corrections, official, judge, and representative

from the relevant mental health agency. Veterans qualifying under §701 of the bill would have to be diagnosed with, or manifest, obvious signs of mental illness or a substance abuse disorder or co-occurring mental illness and substance abuse disorder to qualify.Sec. 707. Reauthorization of Appropriations.Would reauthorize spending under the Adult and Juvenile Justice Collaboration grants under the Omnibus Crime Control and Safe Streets Act of $40 million for each of FYs 2015 through 2019. No more than 20 percent of the funds authorized could be used for the veterans’ court program.

Title V-Medicare & Medicaid Reforms Title III – Improving Medicaid and Medicare Mental Health ServicesSec. 501. Would amend the Medicaid law to prohibit a state Medicaid plan from prohibiting payment for a same-day qualifying mental health service or primary care service furnished to an individual at an FQCBHC or an FQHC on the same day as the other kind of service. (Language identical to the Strengthening Mental Health in Our Communities Act.)

This section also would also permit states to provide medical assistance for inpatient psychiatric hospital services and psychiatric residential treatment facility services for individuals age 21-65 in state-operated psychiatric hospitals with a facility-wide average length of stay (calculated on an annual basis) of less than 30 days. This partial elimination of the IMD exclusion would be permitted beginning the first day of the first calendar year after the date of enactment of the bill, or the first day after the close of the next regular session of the state’s legislature in which conforming authorizing legislation must be enacted.

Sec. 302. Medicaid Coverage of Mental Health Services and Primary Care Services Furnished on the Same Day. Would amend the Medicaid law to prohibit a state Medicaid plan from prohibiting payment for a same-day qualifying mental health service or primary care service furnished to an individual at an FQCBHC or an FQHC on the same day as the other kind of service. (Language identical to H.R. 3717.)

NO IMD provisions in the Strengthening Mental Health in Our Communities Act. But see Sec. 305, below.

Sec. 502. Would prohibit the Medicare and Medicaid programs from excluding coverage or restricting access to covered outpatient drugs used for the treatment of a mental health disorder. A state Medicaid program could still utilize a prior authorization program to manage those prescriptions.

Sec. 301. Access to Mental Health Prescription Drugs Under MedicareWould require coverage of all antidepressants and anti-psychotics under Medicare Part D.

Sec. 303. Elimination of 190-Day Lifetime Limit on Inpatient Psychiatric Hospital Services.Would eliminate the 190-day limit on coverage of inpatient psychiatric hospital services under the Medicare program, effective January 1, 2015.

Sec. 304. Discharge Planning in Psychiatric Facilities.Would, beginning one year after date of enactment of the legislation, subject any psychiatric hospital or psychiatric unit that does not have a discharge planning process to a civil monetary penalty of not more than $10,000. The Secretary would have authority to require a psychiatric hospital or unit determined on multiple occasions not to have a discharge planning process to enter into an agreement under which the hospital or unit would be required to undergo an independent review of policies and procedures for purposes of establishing a discharge planning process, retain an independent compliance officer, submit periodic improvement reports to the HHS Secretary, and undertake other actions the Secretary deems necessary. A hospital or unit that enters into such an agreement and does not have a discharge planning process in place within 45 days could be subjected to temporary management by an appointee of the Secretary to oversee the hospital or unit, assure the health and safety of inpatients, and ensure compliance. The temporary management would be terminated when the Secretary determines the hospital or unit has the management capability to ensure continued compliance.Sec. 305. Expanding the Medicaid HCBS Waiver to Include Youth In Need of Services Provided in a Psychiatric Residential Treatment Facility.Would expand the HCBS waiver to permit HCBS services to any individual under the age of 21 needing the level of care provided on an inpatient basis in a psychiatric residential treatment facility under the State Plan. Under such a waiver, the total number of Medicaid inpatient bed days at psychiatric residential treatment facilities during each fiscal year could not exceed the total number of Medicaid inpatient bed days for the previous fiscal year plus the estimated percentage increase of individuals under age 21 residing in the state over the preceding 12-month period.Sec. 308. Coverage of Marriage and Family Therapist Services and Mental Health Counselor Services Under Medicare Part B.Would require coverage, beginning January 1, 2015, of Marriage and Family Therapist Services and Mental Health Counselor Services under Medicare Part B. The bill would define ‘marriage and family therapist services’ as services performed by a licensed or certified marriage and family therapist for the diagnosis and treatment of mental illnesses, which the marriage and family therapist is legally authorized to perform under the State law or regulation of the State in

which the services are performed and the therapist is licensed or certified, as would otherwise be covered if furnished by a physician or incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of the services. A marriage and family therapist would have to possess a qualifying masters or doctorate degree and have at least two years of clinical supervised experience in marriage and family therapy.

The section would define mental health counselor services similarly to the definition of marriage and family therapy services, and would define mental health counselor similarly to the definition of marriage and family therapist, in each case leaving the definition to state law or regulation.

Marriage and family therapists and mental health counselors would be paid at 80 percent of the lesser of the actual charge for services or 75 percent of a psychologist’s payment rate. They would be excluded from the skilled nursing facility prospective payment system. They would be permitted to provide services in a rural health clinic and FQHC, as well as in hospice. They would also be authorized to develop discharge plans for post hospital services if they meet qualification standards established by the HHS Secretary.

Title VI-Research by NIMHSec. 601. Would provide $40 million annually for FY 2015 through 2019 for research on either (1) the determinants of self- and other-directed violence in mental illness, including studies on reducing the risk of self-harm, suicide, and interpersonal violence, or (2) brain research.

Title VII- CMHS Block Grant Reform Title II – Strengthening and Investing in SAMHSA ProgramsSec. 701. Would transfer responsibility for the Community Mental Health Block Grants from the Director of the Center for Mental Health Services to the newly created Acting Secretary for Mental Health and Substance Use Disorders.

Sec. 201. Community Mental Health Services Block Grant ReauthorizationWould reauthorize funding for the MHBG for FY 2015 at $483.744 million and such sums as may be necessary for FYs 2016 through 2019.

Sec. 702. Would revise requirements for the funding agreement under a Community Mental Health Block Grant to require the reporting of specified data.

Sec. 202. Reporting Requirements for Block Grants Regarding Mental Health and Substance Use DisordersWould require that each MHBG funding agreement require that the state receiving a community mental health block grant prepare and submit to the Secretary an annual report on activities funded by the grant, the extent to which expenditures were consistent with the state’s application, and the extent to which the state

meets goals and objectives set out in the state plan. The report would have to be in a standardized form that includes: the number of individuals served; the proportion of each class of individuals who have health coverage; the types of services provided within each class; the amounts spent for each type of service by class of individuals; information on the status of mental health in the state, including a breakdown by racial and ethnic group of the proportion of adolescents with serious emotional disturbances and adults with SMI, including major depression; the proportion with co-occurring mental health and substance use disorders and what proportion of those seek and receive treatment; the proportion of children and adolescents and the proportion of adults who seek and receive treatment; the proportion of homeless adults who receive treatment; the number of primary care facilities that provide mental health screening and treatment on-site or by paid referral; the number of primary care provider office visits that include mental health screening; the number of juvenile residential facilities that screen admissions for mental health disorders; and the number of deaths attributable to suicide. Grantees would also be required to report the number and type of providers licensed in the state who provide mental health-related services.

Funding agreements for block grants for prevention and treatment of substance use disorders would also require annual reports from states in a standardized form that includes: an accurate description of activities funded and the extent to which those activities were consistent with the state’s application; the number of individuals served; the proportion of each class of individuals who have health coverage; the types of services provided within each class; the amounts spent; the proportion of adolescents and adults by racial and ethnic group using alcohol or addictive drugs, including nicotine, and prescription drugs for non-medical purposes; the number of individuals, including specifically pregnant women, admitted to treatment programs, including group homes; and the numbers of deaths attributed to alcohol, illicit drugs, and prescription drugs. Grantees would also be required to report the number and type of providers licensed in the state who provide substance use disorder-related services.

Sec. 703. Would permit the use of Community Mental Health Block Grant moneys for provider services without fiscal year limitation on when the moneys must be used.

Sec. 203. Garrett Lee Smith Memorial Act Reauthorization. See below.

Sec. 704. Would require that a Community Mental Health Block Grant funding agreement require that the state have a law in effect requiring a court to order a mentally ill individual to undergo inpatient or outpatient treatment if the court finds by clear and convincing evidence that the individual is a danger to self, is a danger to others, persistently or acutely disabled or gravely disabled and in need of treatment and is either unwilling or unable to accept voluntary treatment. The section would define “persistently or acutely disabled” as having an SMI that:

1. if not treated, has a substantial probability of causing the individual to suffer severe and abnormal mental, emotional, or physical harm that significantly impairs judgment, reason, behavior, or the capacity to recognize reality;

2. substantially impairs the individuals capacity to make an informed decision regarding treatment and this impairment causes the individual to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment or the alternatives to a particular treatment after those advantages, disadvantages, and alternatives are explained; and

3. has a reasonable prospect of being treatable by outpatient, inpatient or combined inpatient-outpatient treatment.

Sec. 705. Would tie Community Mental Health Block Grant funding to the Assistant Secretary certifying that the state has in effect an AOT law under which a state court could order outpatient mental health treatment for an adult, mentally ill “eligible patient” while the patient lives in the community. An “eligible patient” would be one found by the court to meet the definition under § 103 of the bill.

The AOT would have to be designed to improve the individual’s access and adherence to intensive behavioral health services for the purposes specified in § 103 of the bill.Sec. 706. Would create a 5 percent CMHBG set-aside for the NMHPL to ensure that evidence-based medicine and best practices in clinical care models are being implemented. The section specifically references the Recovery After an Initial Schizophrenia Episode (RAISE) and the North American Prodome Longitudinal Study as best practices.

Section 503 (continued from below). Youth Mental Health Research Network.Would require that, in making awards under the Youth Mental Health Research Network, the NIH Director ensure than an appropriate number of awards are awarded to entities that:

1. focus primarily on the early detection of and interventions for serious emotional disturbances in children and adolescents;

2. conduct or coordinate one or more multisite clinical trials of therapies for, or approaches to, the prevention, diagnosis, or treatment of early serious emotional disturbance in a community setting;

3. rapidly and efficiently disseminate scientific findings resulting from such trials; and

4. adhere to the guidelines, protocols, and practices used in the North American Prodrome Longitudinal Study (NAPLS) and the Recovery After an Initial Schizophrenia Episode (RAISE) initiative.

The Director would be required to establish a data coordinating center to distribute scientific findings, provide assistance in the design and conduct of collaborative research projects and the management, analysis and storage of data, organize and conduct multi-site monitoring, and provide assistance to the CDC in establishing patient registries.

Sec. 707. Would require the Assistant Secretary to evaluate the combined paperwork burden of community mental health centers and FQCMHCs and make administrative and statutory recommendations to Congress on reducing paperwork burden.

Title VIII-Behavioral Health Awareness ProgramSec. 801. Would direct the Secretary of Education, along with the Assistant Secretary, to organize a national awareness campaign to assist secondary school students and postsecondary students in:

(1) reducing the stigma associated with SMI; (2) understanding how to assist an individual demonstrating signs of an

SMI; and (3) understanding the importance of seeking treatment from a

physician, clinical psychologist, or licensed mental health professional when a student believes the student may be suffering from an SMI or behavioral health disorder.

Sec. 211. National Media Campaign to Reduce the Stigma Associated with Mental Illness.Would authorize $10 million for each of FYs 2015 through 2019 for the SAMHSA Administrator to provide for the production, broadcasting, and evaluation of a national media public service campaign to reduce the stigma associated with mental illness, designed to reach as wide and diverse an audience as possible, particularly targeting the population between the ages of 16 and 24. Mental health professionals and patient advocates would have to be consulted in carrying out the media campaign.

Sec. 601. School-Based Mental Health Programs.Would revise, increase funding for, and expand the scope of the Safe Schools-Healthy students program to provide access to more comprehensive school-based mental health services and supports, increase access to school-employed mental health professionals, provide for comprehensive staff development for school and community service personnel working in the school, and provide for

comprehensive training for children with mental health disorders, their parents, siblings, and other family members, and concerned members of the community.

The section would authorize $200 million in each of FYs 2015 through 2019 for mandated programs under which the HHS Secretary, in collaboration with the Education Secretary and in consultation with the AG, would be required to, directly or through 6-year grants, contracts, or cooperative agreements awarded to public entities and local education agencies, assist local communities and schools in applying a public health approach to mental health services in schools and the community. The approach would have to provide comprehensive, age-appropriate services and supports, be linguistically and culturally appropriate and trauma-informed, and use age-appropriate strategies of positive behavioral interventions and supports.

The Secretary would be required to ensure that grants, contracts, or cooperative agreements are distributed equitably among the regions of the country and among urban and rural areas. No entity could receive more than one award, although an entity providing services and supports on a regional basis could receive additional funding.

The Secretary would be authorized to: (1) provide financial support and/or technical assistance to local communities; (2) provide assistance to those communities in the development of policies to address child and adolescent trauma, mental health issues and violence; (3) facilitate community partnerships among families, students, law enforcement agencies, education systems, school-based health centers, mental health and substance use disorder service systems, family-based mental health service systems, welfare agencies, health care service systems (including physicians), faith-based programs, trauma networks, and other community-based systems; and (4) establish mechanisms for children and adolescents to report incidents of violence or plans by other children, adolescents, or adults to commit violence.

To be eligible for a grant, contract, or cooperative agreement, an applicant would have to be a partnership between an LEA and at least one community program or agency involved in mental health. The LEA would be required to enter into an

MOU with at least one public or private mental health entity, health care entity, law enforcement or juvenile justice entity, child welfare agency, family-based mental health entity, family or family organization, trauma network, or other community-based entity. The MOU would have to state how school-employed mental health professionals would be utilized, and the responsibilities and in-kind or non-Federal cash contributions of each partner to the effort.

Individual grants could not exceed $1 million for each of grant years FYs 2015 through 2019. A grantee could not use more than 10 percent of grant monies to carry out required evaluation activities.

School-based programs could address (1) the promotion of the social emotional and behavioral health of all students in an environment conductive to learning; (2) reduction in the likelihood of at-risk students developing social, emotional or behavioral health problems or substance use disorders; (3) early identification and early intervention; (4) treatment and referral; and (5) the development and implementation of programs to assist children in dealing with trauma and violence.

Programs would be required to provide for in-service training of all school personnel, including ancillary staff and volunteers, as well as parents, siblings, and family members of children with mental health disorders and concerned members of the community in:

1. the techniques and supports needed to identify early children with trauma histories and children with, or at risk of, mental illness;

2. the use of referral mechanisms that effectively link such children to appropriate treatment and intervention services in the school and in the community and to follow-up when services are not available; and

3. strategies that promote a school-wide positive environment.

Training for school personnel would also have to include strategies for promoting the social, emotional, mental, and behavioral health of all children, and strategies for increasing knowledge and skills of school and community leaders about the impact of trauma and violence and on the application of a public health approach to comprehensive school-based mental health programs.

The LEA would be required to ensure the sustainability of the program after Federal funding ends, and the program would have to be based on trauma-informed and evidence-based practices. The program would be required to include a broad needs assessment of youth who drop out of school due to zero tolerance policies and an inability to obtain appropriate services. Mental health services would have to be provided by qualified mental and behavioral health professionals, certified or licensed in the state involved and practicing within their area of expertise.Sec. 602. Improving Mental Health and Behavioral Health Outcomes on College Campuses.Would authorize sums in an undetermined amount, as necessary for FYs 2015 through 2019, to increase access to mental and behavioral health services on college and university settings, foster and improve the prevention of mental health and behavioral health disorders and the promotion of mental health, improve identification and treatment for at-risk students, improve collaboration and the development of appropriate levels of mental and behavioral health care, reduce the stigma for students with mental health disorders, and improve outreach efforts.

The SAMHSA Administrator, in collaboration with the Department of Education, would be required to award 3-year competitive grants to institutions of higher education to improve mental and behavioral health services and outreach on college and university campuses through the use of funding supplemental to that already in place. The Administrator would be required to give special consideration to programs that: (1) demonstrate the greatest need for new or additional mental and behavioral health services, based on the ratio of students to mental and behavioral health professionals; (2) target traditionally underserved populations and populations most at risk; (3) propose to expand services using evidence-based practices; (4) demonstrate an awareness of and willingness to coordinate with a community mental health center or other community mental health resource to support screening and referral of students requiring intensive services; identify how to address psychiatric emergencies, including how information is to be communicated to families; and (5) demonstrate the greatest potential for replication and dissemination.

Grants could be used to provide services, provide student outreach, educate and increase awareness of mental health issues, employ trained staff, train student and faculty on response techniques, expand mental health training, develop and support evidence-based and emerging best practices, evaluate and disseminate best practices to other colleges and universities, and support student groups on campus that educate, work to reduce stigma, and promote mental health wellness.

The SAMHSA Administrator would also be required under this section to collaborate with the CDC Director in convening an interagency, public-private sector working group to plan, establish, and coordinate a targeted public education campaign designed to focus on mental and behavioral health on college campuses. The campaign would be expected to improve the general understanding of mental health and mental health disorders, encourage help-seeking behaviors, promote prevention and treatment, make the connection between mental and behavioral health and academic success, and assist the general public in identifying early warning signs and reducing the stigma of mental illness.Sec. 603. Examining Mental Health Care for Children.Within 1 year of enactment of the bill, the GAO would be required to conduct an evaluation for submission to Congress on the utilization of mental health services for children, including the prescription and frequency of use of psychotropic drugs and whether the prescription of psychotropic drugs serves as a barrier to accessing non-pharmaceutical interventions. The report would be required to review and assess the ways in which children access mental health care, including whether they are screened and treated by primary care or specialty providers, what types of referrals are recommended, and any barriers to access. In addition, the report would be expected to review tools, assessments, and medications that are available and used to diagnose and treat children with mental health disorders.

Title IX – Behavioral Health Information Technology Title VIII- Behavioral Health Information Technology

Sec. 901. Would amend the Public Health Service Act (PHSA) to include in the definition of “health care provider” behavioral and mental health professionals, substance abuse professionals, psychiatric hospitals, certain community mental health centers (including those operated by a county behavioral health agency), FQCBHCs certified under Sec. 201 of the bill, and residential or outpatient mental health or substance abuse treatment facilities for purposes of affording those providers access to the electronic health records (EHR) meaningful use incentives.

Sec. 801. Extension of Health Information Technology Assistance for Behavioral and Mental Health and Substance Abuse.This section is identical to Sec. 901 of H.R. 3717, except that it does not reference the FQCBHCs that would be certified under H.R. 3717 and are included in the pilot authorized under the SGR fix legislation.

Sec. 902. Would amend the Medicare statute with respect to the EHR meaningful use incentives to include as additional eligible professionals clinical psychologists providing qualified psychologist services and clinical social workers. Inpatient psychiatric hospitals also would be eligible for incentives under Medicare.

The section also would subject certain additional eligible professionals, including those employed or contracted with a Medicare Advantage (MA) plan, to reductions or incentive payments for meaningful EHR use.

In addition, the section would make incentives available to Medicaid-enrolled public and private psychiatric hospitals, clinical psychologists, and community mental health centers, as well as accredited residential or outpatient mental health or substance abuse treatment facilities with a patient volume that is at least 10 percent Medicaid enrollees.

Sec. 802. Extension of Eligibility for Medicare and Medicaid Health Information Technology Implementation Assistance.This section is identical to Sec. 902 of H.R. 3717.

Title X – Expanding Access to Care Through Health Care ProfessionalVolunteerism

Sec. 1001. Would amend the PHSA to accord licensed or certified health care professional volunteers at community mental health centers and FQCBHCs the liability protections provided Public Health Service employees for tortious acts or omissions. The professional, center, or other entity would be required to post a clear and conspicuous notice at the site where service is provided of the extent to which legal liability is limited.

Title XI-SAMHSA Reauthorization and ReformsSubtitle A—Organization and General Authorities

Sec. 1101. Would put the Assistant Secretary for Mental Health and

Substance Use Disorders in charge of SAMHSA and eliminate SAMHSA’s responsibility for mental illness-related issues. The section also would require that SAMHSA give written notice to the House Energy and Commerce Committee and the Senate HELP Committee at least 30 days before awarding a grant, cooperative agreement, or contract. At least 50 percent of any peer review group reviewing a proposal or grant related to mental illness would have to be individuals with a medical degree or equivalent doctoral degree in psychology or clinical experience. In addition, the section would reduce, from 2.5 percent of all amounts appropriated for the fiscal year to 1.5 percent of all amounts appropriated for the fiscal year, moneys that could be used by the Secretary to make noncompetitive grants, contracts, or cooperative agreements to public entities to enable those entities to address emergency substance abuse or mental health needs in local communities.Sec. 1102. Would require that at least 50 percent of the members of any SAMHSA or Substance Abuse or Mental Health advisory council have a medical degree, equivalent doctoral degree in psychology, or serve as a licensed mental health professional. Sec. 1103. Would require that at least half the members of any peer review group reviewing grants, cooperative agreements, or contracts have a degree in medicine or an equivalent doctoral degree in psychology. Before making the award, the Secretary would be required to provide a list of peer review group members to the House Energy and Commerce and Senate HELP committees.Sec. 1104. Would require the Secretary to require the Assistant Secretary to transfer all functions and responsibilities of the Center for Behavioral Health Statistics and Quality to the newly created NMHPL and add to the requisite areas of data collection on mental health the number of individuals with an SMI, the number of individuals admitted to hospital emergency rooms with an SMI, the number of individuals receiving inpatient care and subsequently readmitted to the hospital as a result of their condition within two years, and other public health outcomes, including mortality rates for individuals with an SMI.

Subtitle B—Center for Mental Health ServicesSec. 1111. Would revise the responsibilities of the Center for Mental

Health Services (CMHS), removing the responsibility to administer the Block Grant program. The section would charge CMHS with assisting NIMH in deploying methods of treating individuals with mental health problems rather than having the current responsibility for developing treatment methods. In addition, it would no longer have responsibility for assessing consumer-run programs. The clearinghouse of mental health information it maintains would be required to contain evidence-based practices reviewed and approved by a panel of psychiatrists and clinical psychologists. Responsibility for surveys also would be transferred to the Assistant Secretary and the Centers for Disease Control and Prevention.Sec. 1112. Would reauthorize the Secretary to address priority mental health needs of regional and national significance, requiring that technical assistance programs be evidence-based and that the House Energy and Commerce and Senate HELP committees be provided prior notice of an award of a grant, cooperative agreement, or contract. Priority would have to be assigned to programs promoting primary and behavioral health care integration. $150 million would be authorized for appropriation for FY 2014 through 2018.

Sec. 204 Priority Mental Health Needs of Regional and National Significance Reauthorization.Sec. 205. Grants for Jail Diversion Programs Reauthorization.Sec. 206. Projects for Assistance in Transition from Homelessness.Would specifically reauthorize the Secretary to fund—at amounts to be determined, for the most part for each of fiscal years 2015 through 2019—the following programs:

1. Priority and Mental Health Needs of Regional and National Significance at amounts to be determined;

2. Grants for Jail Diversion, at $4.28 million in FY2015, and sums as necessary in FYs 2016 through 2019 (a reduction from the original 2001 authorization of $5.72 million);

3. Projects for Assistance in Transition from Homelessness, at $64.8 million in FY 2015 and as necessary in FYs 2016 through 2019 (a reduction from the original 2001 authorization of $10.2 million.

Sec. 1113. Would amend the PHSA to reauthorize and revise requirements for a youth interagency research, training, and technical assistance center to prevent suicides (the Suicide Prevention Technical Assistance Center). The section would expand the program's focus from youth suicides to suicides among all ages, particularly among groups that are at high risk for suicide. It would repeal authority for grants to establish research, training, and technical assistance centers related to mental health, substance abuse and the justice system.

In addition, it would reauthorize the grant/cooperative agreement program for the development of state or tribal youth suicide early intervention and

Sec. 203. Garret Lee Smith Memorial Act ReauthorizationWould authorize the HHS Secretary through the SAMHSA Administrator to award a grant for operation and maintenance of one Suicide Prevention research, training, and technical assistance Resource Center providing research, training, and technical assistance for states, political subdivisions, Indian tribes and tribal organizations, institutions of higher education, public organizations, and private nonprofits on the prevention of suicide among all ages, particularly among groups at high risk for suicide. The bill would authorize $4.948 million in each of FYs 2015 through 2019.

prevention strategies, but newly require collaboration with the Secretary of Education. It would authorize $29.738 million for appropriation in each of FY2014 through 2018.

This would replace the current authority to fund not more than five centers focused on youth.

This section also would reauthorize and revise a grant program to enhance services for students with mental health or substance use disorders at institutions of higher education. It would require the Secretary (who currently is merely authorized), acting through the CMHS Director, to award grants to enhance such services and to develop best practices for the delivery of such services. It would permit grant funds to be used for the provision of services to students and to employ appropriately trained staff. The Secretary would be required to give special consideration to applications for grants for programs that demonstrate the greatest need for new or additional mental and substance use disorder services and the greatest potential for replication. The recipient institution would be required to match the Federal funds granted on a 1:1 basis, in cash or in-kind; the Secretary could waive this requirement for extraordinary need. The section authorizes for appropriation $4.975 million per year for Fiscal Years 2014 through 2018.

This would replace the current statutory authority for funding not more than five centers focused on youth suicide prevention.

The Center would, for the most part, have the same responsibilities as previously required of the five centers, but for all ages and not just youth. It would be charged with:

1. assisting in the development or continuation of statewide and tribal suicide early intervention and prevention strategies for all ages, particularly among groups that are at high risk for suicide;2. ensuring surveillance of suicide early intervention and prevention strategies for all ages, particularly among high-risk groups;3. studying the costs and effectiveness of statewide and tribal suicide early intervention and prevention strategies in order to provide information concerning relevant issues of importance to State, tribal, and national policymakers;4. identifying and understanding causes and associated risk factors for youth suicide;5. analyzing the efficacy of new and existing youth suicide early intervention and prevention techniques and technology; 6. ensuring the surveillance of suicidal behaviors and nonfatal suicidal attempts;7. studying the effectiveness of State-sponsored statewide and tribal youth suicide early intervention and prevention strategies on the overall wellness and health promotion strategies related to suicide attempts;8. promoting the sharing of data regarding suicide with Federal agencies involved with suicide early intervention and prevention, and State-sponsored statewide and tribal suicide early intervention and prevention strategies for the purpose of identifying previously unknown mental health causes and associated risk factors for suicide; and9. evaluating and disseminating outcomes and best practices of mental and behavioral health services at institutions of higher education.

The bill would authorize $4.948 million in each of FYs 2015 through 2019 for this purpose.

Youth Suicide Early Intervention and Prevention StrategiesThe bill would also authorize $29.682 million for each of FYs 2015 through 2019 for the SAMHSA Administrator to award grants or cooperative agreements to states, public organizations or private nonprofits designated by a state, or Indian tribes or tribal organizations under an existing statutory program to:

1. develop and implement state-sponsored Youth Suicide Early Intervention and Prevention Strategies in schools, juvenile justice systems, substance use disorder programs, mental health programs, foster care systems, and other child and youth support organizations;2. support public organizations and private nonprofit organizations actively involved in State-sponsored statewide or tribal youth suicide early intervention and prevention strategies and in the development and continuation of State-sponsored statewide youth suicide early intervention and prevention strategies;3. provide grants to institutions of higher education to coordinate the implementation of state-sponsored statewide or tribal youth suicide early intervention or prevention strategies; 4. collect and analyze data on State-sponsored statewide or tribal youth suicide early intervention and prevention services that can be used to monitor the effectiveness of such services and for research, technical assistance, and policy development; and5. otherwise assist eligible entities, through State-sponsored statewide or tribal youth suicide early intervention and prevention strategies, in achieving targets for reduction in youth suicides. (more)

Sec. 502. Suicide Prevention and Brain Research.Would authorize $40 million in each of FYs 2015 through 2019 for the Director of NIMH to conduct and support: (1) research of the determinants of self-directed and other violence associated with mental illness, including studies designed to reduce the risk of self-harm, suicide, and interpersonal violence, with emphasis on rural communities with a shortage of mental health services; and (2) the BRAIN initiative.

Sec. 504. National Violent Death Reporting System.Would require the Director of the CDC to improve, particularly through the inclusion of additional states, the National Violent Death Reporting System. Participation by states would continue to be voluntary.

Subtitle C—Children with Serious Emotional DisturbancesSec. 1121. Would require that, before making a grant to a public entity under the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances program, the Assistant Secretary consult with the Director of NIH to ensure the grant recipient will use evidence-based practices.Sec. 1122. Would re-authorize for appropriation for the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances program $117 million for FY2015, $120 million for FY2016, $123 million for FY 2017, $126 million for FY2018, and $130 million for FY2019.

Sec. 207. Comprehensive Community Mental Health Services for Children with Serious Emotional DisturbancesWould re-authorize Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances, at $117.315 million in FY2015 and as necessary in FYs 2016 through 2019 (an increase in the original 2001 authorization of $17.315 million).Sec. 503. Youth Mental Health Research NetworkWould authorize $25 million in each of FYs 2015 through 2019 for the NIMH Director to establish a Youth Mental Health Research Network to conduct and support both relevant research and youth mental health intervention services.

The program would have to be collaborate with other appropriate national research institutes and national centers focusing on activities involving youth mental health research. The program could be carried out through cooperative agreements, grants, and contracts with state, local and tribal governments and private nonprofit entities using consortia to conduct basic, clinical, behavioral, or traditional research and training for researchers. NIMH would be expected to provide or partner with non-research institutions or community-based groups to provide youth mental health intervention services. Further, NIMH would be expected to make use of and build on scientific findings and clinical techniques from earlier programs, studies, and demonstrations.

The Director would have to ensure that each recipient of an award conducts or supports at least one category of research and that collectively all recipients conduct or support all categories, and that one or more recipient provides training.

There could not be more than 70 awardees, and support could not be for more than 5 years, with an extension of not more than 5 additional years. The support could not supplant any existing public or private support, but would have to supplement existing support.

Subtitle D—Projects for Children and ViolenceSec. 1131. Would repeal authority for the Secretary of Education and the Attorney General to make grants, contracts, or cooperative agreements with public entities to assist local communities in developing ways to assist children in dealing with violence.

Sec. 601. School-Based Mental Health Programs.Would revise, increase funding for, and expand the scope of the Safe Schools-Healthy students program to provide access to more comprehensive school-based mental health services and supports, increase access to school-employed mental health professionals, provide for comprehensive staff development for school and community service personnel working in the school, and provide for comprehensive training for children with mental health disorders, their parents, siblings, and other family members, and concerned members of the community.

The section authorize $200 million in each of FYs 2015 through 2019 for mandated programs under which the HHS Secretary, in collaboration with the Education Secretary and consultation with the Attorney General, would be required to, directly or through 6-year grants, contracts, or cooperative agreements awarded to public entities and local education agencies, assist local communities and schools in applying a public health approach to mental health services in schools and the community. The approach would have to provide comprehensive, age-appropriate services and supports, be linguistically and culturally appropriate, trauma-informed, and use age-appropriate strategies of positive behavioral interventions and supports.

The Secretary would be required to ensure that grants, contracts, or cooperative agreements are distributed equitably among the regions of the country and among urban and rural areas. No entity could receive more than one award, although an entity providing services and supports on a regional basis could receive additional funding.

The Secretary would be authorized to: (1) provide financial support and/or technical assistance to local communities; (2) assistance to those communities in the development of policies to address child and adolescent trauma, mental health issues and violence; (3) facilitate community partnerships among families,

students, law enforcement agencies, education systems, school-based health centers, mental health and substance use disorder service systems, family-based mental health service systems, welfare agencies, health care service systems (including physicians), faith-based programs, trauma networks, and other community-based systems; and (4) establish mechanisms for children and adolescents to report incidents of violence or plans by other children, adolescents, or adults to commit violence.

To be eligible for a grant, contract, or cooperative agreement, an applicant would have to be a partnership between an LEA and at least one community program or agency involved in mental health. The LEA would be required to enter into an MOU with at least one public or private mental health entity, health care entity, law enforcement or juvenile justice entity, child welfare agency, family-based mental health entity, family or family organization, trauma network, or other community-based entity. The MOU would have to state how school-employed mental health professionals would be utilized, and the responsibilities and in-kind or non-Federal cash contributions of each partner to the effort.

Individual grants could not exceed $1 million for each of grant years FYs 2015 through 2019. A grantee could not use more than 10 percent of grant monies to carry out required evaluation activities.

School-based programs could address (1) the promotion of the social emotional and behavioral health of all students in an environment conductive to learning; (2) the reduction in the likelihood of at-risk students developing social, emotional or behavioral health problems or substance use disorders; (3) early identification and early intervention; (4) treatment and referral; and (5) the development and implementation of programs to assist children in dealing with trauma and violence.

Programs would be required to provide for in-service training of all school personnel, including ancillary staff and volunteers, as well as parents, siblings, and family members of children with mental health disorders and concerned members of the community in:

1. the techniques and supports needed to identify early children with trauma histories and children with, or at risk of, mental illness;

2. the use of referral mechanisms that effectively link such children to appropriate treatment and intervention services in the school and in the community and to follow-up when services are not available; and3. strategies that promote a school-wide positive environment.

Training for school personnel would also have to include strategies for promoting the social, emotional, mental, and behavioral health of all children, and strategies for increasing knowledge and skills of school and community leaders about the impact of trauma and violence and on the application of a public health approach to comprehensive school-based mental health programs.

The LEA would be required to ensure the sustainability of the program after Federal funding ends, and the program would have to be based on trauma-informed and evidence-based practices. The program would be required to include a broad needs assessment of youth who drop out of school due to zero tolerance policies and an inability to obtain appropriate services. Mental health services would have to be provided by qualified mental and behavioral health professionals, certified or licensed in the state involved and practicing within their area of expertise.Sec. 602. Improving Mental Health and Behavioral Health Outcomes on College Campuses.Would authorize sums in an undetermined amount, as necessary for FYs 2015 through 2019, to increase access to mental and behavioral health services on colleges and universities, foster and improve the prevention of mental health and behavioral health disorders and the promotion of mental health, improve identification and treatment for at-risk students, improve collaboration and the development of appropriate levels of mental and behavioral health care, reduce the stigma for students with mental health disorders, and improve outreach.

The SAMHSA Administrator, in collaboration with the Education Secretary, would be required to award 3-year competitive grants to institutions of higher education to improve mental and behavioral health services and outreach on college and university campuses through the use of funding supplemental to that already in place. The Administrator would be required to give special consideration to programs that: (1) demonstrate the greatest need for new or additional mental and behavioral health services, based on the ratio of students to mental and

behavioral health professionals; (2) target traditionally underserved populations and populations most at risk; (3) propose to expand services using evidence-based practices; (4) demonstrate an awareness of and willingness to coordinate with a community mental health center or other community mental health resource to support screening and referral of students requiring intensive services; (5) identify how to address psychiatric emergencies, including how information is to be communicated to families; and (6) demonstrate the greatest potential for replication and dissemination.

Grants could be used to provide services, provide student outreach, educate and increase awareness of mental health issues, employ trained staff, train student and faculty on response techniques, expand mental health training, develop and support evidence-based and emerging best practices, and evaluate and disseminate best practices to other colleges and universities. They could also be used to support student groups on campus that educate, work to reduce stigma, and promote mental health wellness.

The SAMHSA Administrator would be required under this section to collaborate with the CDC Director in convening an interagency, public-private sector working group to plan, establish, and coordinate a targeted public education campaign designed to focus on mental and behavioral health on college campuses. The campaign would be expected to improve the general understanding of mental health and mental health disorders, encourage help-seeking behaviors, promote prevention and treatment, make the connection between mental and behavioral health and academic success, and assist the general public in identifying early warning signs and reducing the stigma of mental illness.

The bill would authorize such unidentified sums as necessary for each of FYs 2015 through 2019.Sec. 203 (cont’d) Mental Health and Substance Use Disorder ServicesWould amend the existing statutory authority for SAMHSA grants for mental and behavioral health services on campus, changing the name of the section of law to reflect mental health and substance use disorder services on campus and changing the purposes to which those grants can be put. In addition to the current authority for operating hotlines, preparing informational materials, and providing training

for students, faculty and staff to respond effectively to students with mental health and substance use disorders, grants could also be used for:

1. educating students, families, faculty, and staff to increase awareness of mental health and substance use disorders;

2. providing outreach services to notify students about available mental health and substance use disorder services;

3. administering voluntary mental health and substance use disorder screenings and assessments; and

4. creating a network infrastructure to link colleges and universities with health care providers who treat mental health and substance use.

The existing authority is also amended to require applicant institutions to identify where it might serve veterans whenever possible and appropriate. In identifying current resources available to address the needs of students, the institution may include a plan to seek input from relevant stakeholders in the community, including appropriate public and private entities. This latter language may be misplaced in the bill. It is more likely that the inclusion of stakeholders is intended to supplement existing language requiring the application to include a description of outreach strategies for promoting access to services.

The bill would include authorization for these services at $4.858 million for FYs 2015 through 2019, which is about $142,000 less annually than the original statute authorized.

Sec. 1132. Would reauthorize the National Child Traumatic Stress Network, authorizing $50 million annually in FY2014 through FY2017 for appropriation.

Subtitle E—Protection and Advocacy for Individuals with Mental IllnessSec. 1132 (cont’d). Would also reduce funding for the Protection and Advocacy for Individuals with Mental Illness to $5 million annually for each of those Fiscal Years.Sec. 1141. Would prohibit lobbying at the Federal, state or local level by systems accepting Federal funds to protect and advocate the rights of individuals with mental illness under the Protection and Advocacy for Individuals with Mental Illness Act. This section would also prohibit such systems from using funding to engage in systemic lawsuits, or to investigate and seek legal remedies other than in individual cases of abuse or neglect. Finally, the section would prohibit a system from counseling an individual with an SMI who lacks insight into his or her condition on refusing medical treatment or acting against the wishes of his or her caregiver.

Sec. 209. Protection and Advocacy for Individuals with Mental Illness Reauthorization.Would reauthorize Protection and Advocacy for Individuals with Mental Illness, at $36.238 million for FY 2015 and as necessary for FYs 2016 through 2019 (an increase in the original 1992 authorization of $16.738 million).

Subtitle F—Limitations on AuthoritySec. 1151. Would prohibit SAMHSA from hosting or sponsoring any conference not primarily administered by itself without at least 90 days’ prior notice to the House Energy and Commerce and Senate HELP committees. This section would also prohibit SAMHSA from providing financial assistance for any mental health or substance use diagnosis or treatment program that does not rely on evidence-based practices.Sec. 1152. Would prohibit SAMHSA from establishing and the Secretary from delegating to SAMHSA responsibility for any program or project not explicitly authorized or required by statute. By the end of FY2014, all programs and projects not statutorily authorized would have to be terminated, with a report to Congress due by July 31, 2014 identifying each program, project, or activity to be terminated. The report would be required to recommend any programs which should be retained based on public health data, such as reduced mortality rates and hospitalization within the community for individuals with an SMI, proving the program has had a demonstrable public health benefit and epidemiological impact.

Sec. 210. Mental Health Awareness Training Grants.Would expand who could receive training under the Mental Health Awareness Training Grants to include, in addition to emergency services personnel and other first responders:

1. Police officers and other law enforcement personnel;

2. Teachers and school administrators;3. Human resources professionals;4. Faith community leaders;5. Nurses and other primary care personnel;6. Students enrolled in elementary or secondary school or an institution of

higher education and their parents;7. Veterans; and8. Other individuals, audiences, or training populations.

The bill would require the training to be in evidence-based programs, Mental Health First Aid, and other mental health education and literacy programs. The bill would otherwise repurpose the program to require that the training include recognizing the signs and symptoms of mental illness and providing education to personnel regarding available community resources or the safe de-escalation of crisis situations.

The section would reauthorize the program at $20 million for each of FYs 2014 through 2018 ($5 million less than the original 2001 authorization). This is likely a drafting error; the Fiscal Years likely should be 2015 through 2019. Sec. 212. Awards for Co-Locating Mental Health Services in Primary Care SettingsWould require the SAMHSA Administrator and the Health Resources and Services Administration (HRSA) Administrator to award grants, contracts, and cooperative agreements to public or nonprofit entities for the provision of coordinated and integrated mental health services and primary care. Awards could be used for co-location, care management services to facilitate coordination of mental health and primary care providers, information technology to facilitate coordination between providers or expand the availability of mental health services, or training and technical assistance to improve delivery, effectiveness, and integration.

The bill would authorize “such sums as may be necessary” for FYs 2015 through 2019.

Similarly, Sec. 216 would re-authorize awards for co-locating primary and specialty care in community-based mental and behavioral health settings , at an undetermined amount in FY 2015 and as necessary in FYs 2016 through 2019.

Sec. 213. Geriatric Mental Health Disorders.Would authorize the HHS Secretary to provide technical assistance to grantees for evidence-based practices for prevention and treatment of geriatric mental health disorders, as well as disseminate information about such practices to states and non-grantees.

Sec. 214. Assessing Barriers to Behavioral Health Integration.Would mandate that the GAO submit a report to Congress on Federal requirements that impact access to treatment of mental health and substance use disorders in an integrated setting, including administrative and regulatory issues, quality measurement and accountability, and data-sharing.

The report would have to include an evaluation of the administrative or regulatory burden on behavioral health care providers, the identification of relevant outcome and quality measures and an evaluation of the data collection burden on providers, and alternative methods for evaluation. In addition, the report would be required to include an analysis of the degree to which electronic data standards, including interoperability and meaningful use standards, include behavioral health measures, and an analysis of strategies to address barriers to participation in the Health Information Exchange. Finally, the report would be required to evaluate the degree to which Federal regulations for behavioral and physical health care are aligned and to make recommendations for addressing identified barriers to alignment.Sec. 215. Acute Care Bed Registry Grants for States.Would authorize the SAMHSA Administrator to award grants to state mental health agencies for developing and administering a web-based acute psychiatric be registry for available acute beds in public and private inpatient psychiatric facilities and public and private residential crisis stabilization units, in order to facilitate the temporary treatment of individuals in psychiatric crisis. The real-time registry would have to permit employees and designees of community mental health service providers, employees of in-patient psychiatric facilities or public and private residential crisis stabilization units, and health care providers working in an emergency room of a hospital or clinic or other facility rendering emergency medical care to perform searches of the registry to identify available beds that are appropriate for the treatment of individuals in psychiatric crisis.

Sec. 217. Grants for the Benefit of Homeless Individuals.Would reauthorize the Grants for the Benefit of Homeless Individuals program at an undetermined amount in FY 2015 and as necessary in FYs 2016 through 2019. (The program was originally authorized in 2001 at $50 million.)

Title IV – Developing the Behavioral Health Workforce

Sec. 401 – National Health Service Corps Scholarship and Loan Repayment Funding for Behavioral and Mental Health Professionals.Would authorize amounts as necessary for FYs 2015 through 2019 for scholarships and loan payments for ensuring an adequate supply of behavioral and mental health professionals.Sec. 402. Reauthorization of HRSA’s Mental and Behavioral Health Education and Training Program.Would reauthorize amounts as necessary for FYs 2015 through 2019.

Sec. 403. SAMHSA Grant Program for Development and Implementation of Curricula for Continuing Education on Serious Mental Illness.Would authorize, in undetermined amounts as necessary for FYs 2015 through 2019, the HHS Secretary (presumably through SAMHSA) to award grants to public or nonprofit entities that provide continuing education or training to health care professionals or that partner with such entities to provide continuing education and training on identifying, referring, and treating individuals with SMI. The Secretary would be required to give preference in awarding grants to entities proposing to develop and implement curricula for health care professionals in primary care specialties or health care professionals required as a condition of state licensure to participate in education or training specific to mental health.Sec. 404. Demonstration Grant Program to Recruit, Train, Deploy, and Professionally Support Psychiatric Physicians in Indian Health Programs.Would authorize $1 million for each of FYs 2015 through 2019 for a 5-year grant, made by the HHS Secretary in consultation with the Director of HIS, to 1 entity to create a nationally replicable workforce model for recruiting, training, deploying, and professionally supporting Native American and non-Native American psychiatric physicians, who would be fully integrated into medical, mental, and behavioral health systems in the Indian health program. The grantee would also be expected to:

1. recruit to participate Native American and non-Native American

psychiatric physicians who demonstrate interest in providing specialty health care services and primary care services to American Indians and Alaska Natives;

2. provide those psychiatric physicians participating in the Program with not more than 1 year of supplemental clinical and cultural competency training;

3. deploy them to practice specialty care or primary care for Indian health programs for not less than 2 years and professionally support them for that period, with such support including the dissemination or sharing of best practices, field training, and other appropriate activities; and

4. not later than 1 year after the last day of the 5-year pilot submit to the Secretary and Congress a report on the model, strategies for disseminating the model, and other recommendations for supporting an effective and stable psychiatric and mental health workforce serving American Indians and Alaska Natives.

To be eligible for the grant, an entity would have to be an accredited department of psychiatry within a U.S. medical school or a public or private nonprofit entity affiliated with an accredited medical school that has a relationship with Indian health programs in at least two states with a demonstrated need for psychiatric physicians. Eligible entities would have to provide assurances that the grant would be used to serve rural and non-rural American Indian and Alaska Native populations in at least two states (one of which presumably would have to be Alaska).

The Secretary would be required to give priority to an entity that demonstrates sufficient infrastructure in size, scope, and capacity to undertake the clinical and cultural competency training of at least 5 psychiatric physicians, and to provide ongoing professional support to psychiatric physicians. The entity would also have to demonstrate a record in successfully recruiting, training, and deploying physicians who are American Indians and Alaska Natives, as well as the ability to establish a program advisory board primarily composed of representatives of federally recognized tribes, Alaska Natives, and Indian health programs.To be eligible to participate in the program, a psychiatric physician would have to be a medical doctor or doctor of osteopathy who is enrolled in or has completed

an accredited 4-year psychiatric residency training and is licensed or eligible for licensure to practice in the state in which he or she is to be deployed. He or she must demonstrate a commitment beyond the 1year of training and 2 years of deployment to a career as a specialty care physician or primary care physician providing mental health services in Indian health programs. The grant recipient would be required to give preference in selection to physicians who are American Indians and Alaska Natives.

Participating physicians would be deemed eligible to participate in the Indian Health Service Loan Repayment program, with the Secretary paying on behalf of the physician for each year of deployment up to $35,000 for loans. A physician’s required service in the National Health Service Corps Service Program would be postponed until 30 days after completion of his or her participation in the pilot.Sec. 405. Including Occupational Therapists as Behavioral and Mental Health Professionals for Purposes of the National Health Service Corps.As stated in the title.

Sec. 406. Extension of Certain Health Care Workforce Loan Repayment Programs Through Fiscal Year 2019.Would reauthorize the Workforce Loan Repayment Program for Pediatric Health Care through FY 2019.

Title IX – Service Members and Veterans Mental HealthSec. 901. Preliminary Mental Health Assessments.Would incorporate the provisions of the Medical Evaluation Parity for Service Members Act for 2014 (MEPS), for which NASMHPD has sent a letter of support. Would require that before any individual enlists or is commissioned as an office, he or she would have to undergo a mental health assessment, which would be used as a baseline for subsequent mental health examinations. The results of an assessment could not be used to determine assignment or promotion, and it would be treated with the same privacy protections as the medical records of a member of the Armed Forces. Not later than 190 days after enactment of the bill, the Defense Secretary would be required to submit to Congress a report with recommendations on how to bring the preliminary screenings into parity with physical screenings, as well as recommendations on the composition of the mental health assessment, best practices, and how to track assessment changes relating to TBI, PTSD, and other conditions.

Sec. 902. Unlimited eligibility for Health Care for Mental Illnesses for Veterans of Combat Service During Certain Periods of Hostilities and War.Would require that all veterans who served in active duty during any period of war or in combat against a hostile force during a period of hostilities be eligible for hospital care, medical services, and nursing home care for any mental illness, even if there is insufficient medical evidence to conclude the illness is attributable to the service.Sec. 903. Timeline for Implementing Integrated Electronic Health Records.Would require the Secretaries of Defense and Veterans Affairs to create a health data authoritative source not later than 180 days after enactment of the bill, and to ensure that patients of both departments are able to download medical records within 365 days of the bill’s enactment. They would also be required to ensure the seamless integration of personal health care information between the two departments and the standardization and exchange acceleration of health care data between the two departments within 365 days. The same 365-day deadline would apply to an upgrade of the graphical user interface to display the new standardized health care data of the departments. Each incoming member of the Armed Forces and his or her dependent would have to be able to receive an electronic copy of his or her health care records not later than October 1 of this year, and each current member and his or her dependent would have to be able to receive his or her health care record not later than October 1, 2015.

The two Secretaries would also be required to study the feasibility of a secure, remote, network-accessible cloud storage system for members, which would enable Armed Forces members and veterans to upload health care records and allow medical providers the ability to access those records when providing care.Sec. 904. Pilot Program for Repayment of Educational Loans for Certain VHA Psychiatrists.Would require the VA Secretary to implement a 3-year pilot program, for no fewer than 10 individuals, under which the VA would repay undergraduate school loans used by licensed or license-eligible VA or VHA psychiatrists to become doctors of medicine or osteopathy. An individual whose loan is to be repaid would have to be enrolled in the final year of a residency program for an accredited specialty qualification in psychiatric medicine and demonstrate a commitment to a long-term career as a VHA psychiatrist. The Secretary could require a set number of

years of obligated service. No individual participating in any other Federal school loan repayment program could participate in the pilot. An individual who fails to honor his or her commitment would be liable for a portion of the loan repayment, determined by the proportion of days served, due within one year.

VA Loan repayments could consist of the payment of principal, interest, or related expenses for any educational expense—including tuition, fees, books, and laboratory expenses—not exceeding $60,000 for each individual.

The VA Secretary would have to report to Congress within 90 days of the termination of the program on the overall effect of the pilot on the VHA psychiatric workforce shortage, the long-term stability of the workforce, and overall VHA workforce strategies designed to promote physical and mental resiliency of veterans.

The GAO would be required, within 1 year of enactment of the legislation, to conduct a study of pay disparities among VHA psychiatrists that includes an examination of laws, regulations, practices, and policies that contribute to disparities—including salary flexibilities—with recommendations for legislative or regulatory actions to improve equity. The GAO report would be due within 1 year after the date the study is completed.

Title X – Making Parity Work

Sec. 307. Complete Application of Mental Health Parity Rules Under Medicaid and CHIP.Would require the HHS Secretary to issue a final regulation not later than January 1, 2015 requiring Medicaid MCOs, benchmark benefit packages, benchmark equivalent coverage, and state CHIP plans to comply with mental health parity requirements.Sec. 1001. GAO Study on Mental Health and Substance Use Disorder Parity Enforcement Efforts.Would require, not later than 1 year after enactment of the legislation, the GAO, in consultation with the Secretaries of HHS and DOL, to report to Congress on parity enforcement efforts, including the number of investigations conducted and the de-identified details of investigations or enforcement actions.Sec. 1002. Report to Congress on Federal Assistance to State Insurance Regulators Regarding Mental Health Parity Enforcement.Would require, not later than 1 year after enactment, the HHS Secretary to submit a report to Congress detailing the ways in which state governments and state insurance regulators are empowered or required to enforce parity, their ability to carry out enforcement, and any technical assistance communicated by HHS to the states.Sec. 1003. Annual Report to Congress by Secretaries of Labor and HHS.Would require the Secretary of Labor, in coordination with the HHS Secretary, to report not later than 1 year after enactment and annually thereafter on the actions taken by the Federal government and the states to ensure compliance with parity, a collection and classification of inquiries and complaints, a report of all de-identified Federal and state enforcement actions, and a compliance guide that includes detailed answers to relevant questions raised during the previous year and specific guidelines providing clear interpretations of the parity law and regulations.