[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1945 Introduced in Senate (IS)]
114th CONGRESS
1st Session
S. 1945
To make available needed psychiatric, psychological, and supportive
services for individuals with mental illness and families in mental
health crisis, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
August 5, 2015
Mr. Cassidy (for himself, Mr. Murphy, and Ms. Collins) introduced the
following bill; which was read twice and referred to the Committee on
Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To make available needed psychiatric, psychological, and supportive
services for individuals with mental illness and families in mental
health crisis, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Mental Health
Reform Act of 2015''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
DISORDERS
Sec. 101. Assistant Secretary for mental health and substance use
disorders.
Sec. 102. Reports.
Sec. 103. Advisory Council on graduate medical education.
TITLE II--GRANTS
Sec. 201. National Mental Health Policy Laboratory.
Sec. 202. Innovation grants.
Sec. 203. Demonstration grants.
Sec. 204. Early childhood intervention and treatment.
Sec. 205. Extension of assisted outpatient treatment grant program for
individuals with serious mental illness.
Sec. 206. Block grants.
Sec. 207. Telehealth child psychiatry access grants.
Sec. 208. Liability protections for health care professional volunteers
at community health centers and community
mental health centers.
Sec. 209. Minority fellowship program.
Sec. 210. National health service corps.
Sec. 211. Reauthorization of mental and behavioral health education
training grant.
Sec. 212. National suicide prevention lifeline program.
TITLE III--INTEGRATION
Sec. 301. Primary and behavioral health care integration grant
programs.
TITLE IV--INTERAGENCY SERIOUS MENTAL ILLNESS COORDINATING COMMITTEE
Sec. 401. Interagency Serious Mental Illness Coordinating Committee.
TITLE V--HIPAA CLARIFICATION
Sec. 501. Findings.
Sec. 502. Modifications to HIPAA.
Sec. 503. Development and dissemination of model training programs.
Sec. 504. Confidentiality of records.
TITLE VI--MEDICARE AND MEDICAID REFORMS
Sec. 601. Enhanced Medicaid coverage relating to certain mental health
services.
Sec. 602. Modifications to Medicare discharge planning requirements.
TITLE VII--RESEARCH BY NATIONAL INSTITUTE OF MENTAL HEALTH
Sec. 701. Increase in funding for certain research.
TITLE VIII--SAMHSA REAUTHORIZATION AND REFORMS
Subtitle A--Organization and General Authorities
Sec. 801. Peer review.
Sec. 802. Advisory councils.
Sec. 803. Grants for jail diversion programs reauthorization.
Sec. 804. Projects for assistance in transition from homelessness.
Sec. 805. Comprehensive community mental health services for children
with serious emotional disturbances.
Sec. 806. Reauthorization of priority mental health needs of regional
and national significance.
TITLE IX--MENTAL HEALTH PARITY
Sec. 901. GAO study on preventing discriminatory coverage limitations
for individuals with serious mental illness
and substance use disorders.
Sec. 902. Report on investigations regarding parity in mental health
and substance use disorder benefits.
Sec. 903. Strengthening parity in mental health and substance use
disorder benefits.
SEC. 2. DEFINITIONS.
In this Act:
(1) Assistant secretary.--Except as otherwise specified,
the term ``Assistant Secretary'' means the Assistant Secretary
for Mental Health and Substance Use Disorders.
(2) Evidence-based.--The term ``evidence-based'' means the
conscientious, systematic, explicit, and judicious appraisal
and use of external, current, reliable, and valid research
findings as the basis for making decisions about the
effectiveness and efficacy of a program, intervention, or
treatment.
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
DISORDERS
SEC. 101. ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
DISORDERS.
(a) In General.--There shall be in the Department of Health and
Human Services an official to be known as the Assistant Secretary for
Mental Health and Substance Use Disorders, who shall--
(1) report directly to the Secretary;
(2) be appointed by the President, by and with the advice
and consent of the Senate; and
(3) be selected from among individuals who--
(A)(i) have a doctoral degree in medicine or
osteopathic medicine;
(ii) have clinical, research, and policy experience
in psychiatry;
(iii) graduated from an Accreditation Council for
Graduate Medical Education-accredited psychiatric
residency program; and
(iv) have an understanding of biological,
psychosocial, and pharmaceutical treatments of mental
illness and substance use disorders;
(B) have a doctoral degree in psychology and--
(i) clinical, research, and policy
experience regarding mental illness and
substance use disorders;
(ii) have completed an internship with an
organization that is a member of the
Association of Psychology Post-doctoral and
Internship Centers as part of doctoral degree
completion; and
(iii) an understanding of biological,
psychosocial, and pharmaceutical treatments of
mental illness and substance use disorders; or
(C) have a doctoral degree in social work and--
(i) clinical, research, and policy
experience regarding mental illness and
substance use disorders; and
(ii) an understanding of biological,
psychosocial, and pharmaceutical treatments of
mental illness and substance use disorders.
(b) SAMHSA Administrator.--Section 501(c)(1) of the Public Health
Service Act (42 U.S.C. 290aa(c)(1)) is amended by striking ``the
President, by and with the advice and consent of the Senate'' and
inserting ``, and serve under, the Assistant Secretary for Mental
Health and Substance Use Disorders''.
(c) Duties.--The Assistant Secretary shall--
(1) promote, evaluate, organize, integrate, and coordinate
research, treatment, and services across departments, agencies,
organizations, and individuals with respect to the problems of
individuals suffering from substance use disorders or mental
illness;
(2) carry out any functions within the Department of Health
and Human Services--
(A) to improve services for individuals with
substance use disorders or mental illness, including
services related to the prevention of, diagnosis of,
intervention in, and treatment and rehabilitation of,
substance use disorders or mental illness;
(B) to ensure access to effective, evidence-based
diagnosis, prevention, intervention, treatment and
rehabilitation for individuals with mental illnesses
and individuals with a substance use disorder;
(C) to ensure that all grants with respect to
serious mental illness or substance use disorders, are
consistent with the grant management standards set
forth by the Department, and that such grants are
evidence-based, have scientific merit and avoid
duplication;
(D) to develop and implement initiatives to
encourage individuals to pursue careers (especially in
underserved areas and populations) as psychiatrists,
psychologists, psychiatric nurse practitioners,
clinical social workers, and other licensed mental
health professionals specializing in the diagnosis,
evaluation, and treatment of individuals with severe
mental illness;
(E) to consult, coordinate with, facilitate joint
efforts among, and support State, local, and tribal
governments, nongovernmental entities, and individuals
with a mental illness, particularly individuals with a
serious mental illness and children and adolescents
with a serious emotional disturbance, with respect to
improving community-based and other mental health
services;
(F) to disseminate evidenced-based and promising
best practices developed by the National Mental Health
Policy Lab established under section 201 and other
qualified research organizations that are culturally
and linguistically indicated treatment and prevention
services related to a mental illness, particularly
individuals with a serious mental illness and children
and adolescents with a serious emotional disturbance;
and
(G) to develop criteria for the application of best
practices within the mental health and substance use
disorder service delivery system;
(3) within the Department of Health and Human Services,
oversee and coordinate all programs and activities relating
to--
(A) diagnosis, prevention, intervention, treatment,
rehabilitation with respect to mental health or
substance use disorders;
(B) parity in health insurance benefits and
conditions relating to mental health and substance use
disorders; or
(C) the reduction of homelessness and incarceration
among individuals with mental health and substance use
disorders;
(4) make recommendations to the Secretary of Health and
Human Services regarding public participation in decisions
relating to mental health, including serious mental illness,
and serious emotional disturbances across the lifespan;
(5) review and make recommendations with respect to the
Department of Health and Human Services budget to ensure the
adequacy of such budget;
(6) across the Federal Government, in conjunction with the
Interagency Serious Mental Illness Coordinating Committee under
section 501A of the Public Health Service Act (as added by
section 401)--
(A) review all programs and activities relating to
the diagnosis or prevention of, or treatment or
rehabilitation for, mental illness or substance use
disorders;
(B) identify any such programs and activities that
are duplicative;
(C) identify any such programs and activities that
are not evidence-based, effective, or efficient; and
(D) formulate recommendations for expanding,
coordinating, eliminating, and improving programs and
activities identified pursuant to subparagraphs (B) and
(C) and merging such programs and activities into
other, successful programs and activities;
(7) identify evidence-based and promising best practices
across the Federal Government for treatment and services for
individuals with mental health and substance use disorders by
reviewing practices for efficiency, effectiveness, quality,
coordination, and cost effectiveness; and
(8) not later than 18 months after the date of enactment of
this Act and every 2 years thereafter, submit to Congress a
report containing a nationwide strategy to recruit, train, and
increase the mental health workforce for the treatment of
individuals with mental illness, serious mental illness,
substance use disorders, and co-occurring disorders.
(d) Nationwide Strategy.--The Assistant Secretary shall ensure that
the nationwide strategy in the report under subsection (c)(8) is
designed--
(1) to encourage and incentivize students enrolled in an
accredited medical or osteopathic school, or nursing,
psychology, or social work graduate program, to specialize in
the mental health field;
(2) to promote greater research-oriented psychiatric,
psychological, nursing, and social work training on evidence-
based service delivery models for individuals with mental
illness or substance use disorders, including models with
family participation;
(3) to promote appropriate Federal administrative and
fiscal mechanisms that support--
(A) evidence-based collaborative care models; and
(B) the necessary mental health workforce capacity
for the models under subparagraph (A), including
psychiatrists, child and adolescent psychiatrists,
psychologists, psychiatric nurse practitioners,
clinical social workers, and mental health, peer-
support specialists;
(4) to increase access to child and adolescent psychiatric
services in order to promote early intervention for prevention
and mitigation of mental illness;
(5) to identify populations and locations that are the most
underserved by mental health professionals, including
psychiatrists, child and adolescent psychiatrists,
psychologists, psychiatric nurse practitioners, clinical social
workers, other licensed mental health professionals, and peer-
support specialists; and
(6) to identify means of alleviating the strain on the
budgets of the criminal justice and correctional systems and
the capacity of such systems with respect to mental health and
substance use disorders.
(e) Prioritization of Integration of Services, Early Diagnosis,
Intervention, and Workforce Development.--In carrying out the duties
described in subsection (c), the Assistant Secretary--
(1) shall prioritize--
(A) the integration of mental health, substance
use, and physical health services for the purpose of
diagnosing, preventing, treating, and providing
rehabilitation for mental illness or substance use
disorders, including any such services provided through
the justice system (including departments of
correction) or entities other than the Department of
Health and Human Services;
(B) the early diagnosis and intervention services
for the prevention of, or crisis intervention for, and
treatment or rehabilitation for, serious mental health
disorders or substance use disorders, in selecting
evidence-based practices and service delivery models
for evaluation and dissemination under section
201(a)(2)(C); and
(C) workforce development for--
(i) appropriate treatment of serious mental
illness or substance use disorders;
(ii) research activities that advance
scientific and clinical understandings of
serious mental illness or substance use
disorders; and
(iii) increasing the number of mental
health professionals, including psychiatrists,
child and adolescent psychiatrists,
psychologists, psychiatric nurse practitioners,
clinical social workers, and mental health peer
support specialists;
(2) shall give preference to models that improve the
coordination, quality, and efficiency of health care services
furnished to individuals with serious mental illness; and
(3) may include clinical protocols and practices used in
the Recovery After an Initial Schizophrenia Episode project of
the National Institute of Mental Health or similar models, such
as the Specialized Treatment Early in Psychosis program.
SEC. 102. REPORTS.
(a) Report on Best Practices for Peer-Support Specialist Programs,
Training, and Certification.--
(1) In general.--Not later than 18 months after the date of
enactment of this Act, and biannually thereafter, the Assistant
Secretary shall submit to Congress and make publicly available
a report on best practices and professional standards in States
for--
(A) establishing and operating health care programs
using peer-support specialists; and
(B) training and certifying peer-support
specialists.
(2) Peer-support specialist defined.--In this subsection,
the term ``peer-support specialist'' means an individual who--
(A) is credentialed by the State in which the
individual practices;
(B) uses his or her lived experience of recovery
from mental illness or substance abuse, plus skills
learned in formal training, to facilitate support
groups, and to work on a one-on-one basis, with
individuals with a serious mental illness or a
substance use disorder, in consultation with, and under
the supervision of, a licensed mental health or
substance use treatment professional;
(C) has been an active participant in mental health
or substance use treatment for at least the preceding
year;
(D) provides non-medical services; and
(E) performs services only within his or her area
of training, expertise, competence, or scope of
practice.
(3) Contents.--Each report under this subsection shall
include information on best practices and standards with regard
to the following:
(A) Hours of formal work or volunteer experience
related to mental health and substance use issues.
(B) Types of peer specialist exams required.
(C) Code of ethics.
(D) Additional training required prior to
certification, including in areas such as--
(i) ethics;
(ii) scope of practice;
(iii) crisis intervention;
(iv) State confidentiality laws;
(v) Federal privacy protections, including
under the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-
191); and
(vi) other areas, as determined by the
Assistant Secretary.
(E) Requirements to explain what, where, when, and
how to accurately complete all required documentation
activities.
(F) Required or recommended skill sets, including
knowledge of--
(i) risk indicators and responding
appropriately to individual stressors,
triggers, and indicators of pre-crisis
symptoms;
(ii) basic crisis avoidance techniques;
(iii) basic suicide prevention concepts and
techniques;
(iv) indicators that an individual may be
experiencing abuse or neglect;
(v) stages of change or recovery;
(vi) the typical process that should be
followed to access or participate in community
mental health and related services; and
(vii) circumstances when it is appropriate
to request assistance from other professionals
to help meet the individual's recovery goals.
(G) Annual requirements for continuing education
credits.
(b) Report on Mental Health and Substance Use Treatment in the
States.--
(1) In general.--Not later than 18 months after the date of
enactment of this Act, and not less than every 18 months
thereafter, the Assistant Secretary for Mental Health and
Substance Use Disorders, in collaboration with the Director of
the Agency for Healthcare Research and Quality and Director of
the National Institutes of Health, shall submit to Congress and
make available to the public a report on mental health and
substance use treatment in the States, including the following:
(A) A detailed report on how Federal mental health
and substance use treatment funds are used in each
State, including:
(i) The numbers of individuals with mental
illness, serious mental illness, substance use
disorders, or co-occurring disorders who are
served with Federal funds.
(ii) The types of programs made available
to individuals with mental illness, serious
mental illness, substance use disorders, or co-
occurring disorders.
(B) A summary of best practice models in the States
highlighting programs that are cost effective, provide
evidence-based care, increase access to care, integrate
physical, psychiatric, psychological, and behavioral
medicine, and improve outcomes for individuals with
serious mental illness or substance use disorders.
(C) A statistical report of outcome measures in
each State for individuals with mental illness, serious
mental illness, substance use disorders, or co-
occurring disorders, including rates of suicide,
suicide attempts, substance abuse, overdose, overdose
deaths, health outcomes, emergency psychiatric
hospitalizations and emergency room boarding, arrests,
incarcerations, homelessness, joblessness, employment,
and enrollment in educational or vocational programs.
(D) A comparative effectiveness research study
analyzing outcomes for different models of outpatient
treatment programs for the seriously mentally ill that
include outpatient mental health services that are
court ordered or voluntary, including--
(i) rates of keeping treatment appointments
and compliance with prescribed medications;
(ii) participants' perceived effectiveness
of the program;
(iii) rates of the programs helping
individuals with serious mental illness gain
control over their lives;
(iv) alcohol and drug abuse rates;
(v) incarceration and arrest rates;
(vi) violence against persons or property;
(vii) homelessness;
(viii) total treatment costs for compliance
with program; and
(ix) health outcomes.
(2) Definition.--In this subsection, the term ``emergency
room boarding'' means the practice of admitting patients to an
emergency department and holding such patients in the
department until inpatient psychiatric beds become available.
(c) Reporting Compliance Study.--
(1) In general.--The Assistant Secretary for Mental Health
and Substance Use Disorders shall enter into an arrangement
with the National Academy of Medicine (or, if the National
Academy of Medicine declines, another appropriate entity) under
which, not later than 18 months after the date of enactment of
this Act, the National Academy of Medicine will submit to the
appropriate committees of Congress a report that evaluates the
combined paperwork burden of--
(A) community mental health centers meeting the
criteria specified in section 1913(c) of the Public
Health Service Act (42 U.S.C. 300x-2(c)), including
such centers meeting such criteria as in effect on the
day before the date of enactment of this Act; and
(B) community mental health centers, as defined in
section 1861(ff)(3)(B) of the Social Security Act.
(2) Scope.--In preparing the report under subsection (a),
the National Academy of Medicine (or, if applicable, other
appropriate entity) shall examine licensing, certification,
service definitions, claims payment, billing codes, and
financial auditing requirements used by the Office of
Management and Budget, the Centers for Medicare & Medicaid
Services, the Health Resources and Services Administration, the
Substance Abuse and Mental Health Services Administration, the
Office of the Inspector General of the Department of Health and
Human Services, State Medicaid agencies, State departments of
health, State departments of education, and State and local
juvenile justice and social service agencies to make
administrative and statutory recommendations to Congress (which
recommendations may include a uniform methodology) to reduce
the paperwork burden experienced by centers and clinics
described in paragraph (1).
SEC. 103. ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION.
(a) In General.--Section 762(b) of the Public Health Service Act
(42 U.S.C. 294o(b)) is amended--
(1) by redesignating paragraphs (4) through (6) as
paragraphs (5) through (7), respectively; and
(2) by inserting after paragraph (3) the following:
``(4) the Assistant Secretary for Mental Health and
Substance Use Disorders;''.
(b) Conforming Amendment.--Section 762(c) of the Public Health
Service Act (42 U.S.C. 294o(c)) is amended by striking ``paragraphs
(4), (5), and (6)'' each place it appears and inserting ``paragraphs
(5), (6), and (7)''.
TITLE II--GRANTS
SEC. 201. NATIONAL MENTAL HEALTH POLICY LABORATORY.
(a) In General.--
(1) Establishment.--The Assistant Secretary for Mental
Health and Substance Use Disorders shall establish, within the
Office of the Assistant Secretary, the National Mental Health
Policy Laboratory (in this section referred to as the
``NMHPL''), to be headed by a Director.
(2) Duties.--The Director of the NMHPL shall--
(A) identify, coordinate, and implement policy
changes and other trends likely to have the most
significant impact on mental health services and
monitor their impact;
(B) collect information from grantees under
programs established or amended by this Act and under
other mental health programs under the Public Health
Service Act, including grantees that are States
receiving funds under a block grant under part B of
title XIX of the Public Health Service Act (42 U.S.C.
300x et seq.);
(C) evaluate and disseminate to such grantees
evidence-based practices and service delivery models
using the best available science shown to be cost-
effective while enhancing the quality of care furnished
to individuals; and
(D) establish standards for the appointment of
scientific peer-review panels to evaluate grant
applications.
(3) Evidence-based practices and service delivery models.--
In selecting evidence-based best practices and service delivery
models for evaluation and dissemination under paragraph (2)(C),
the Director of the NMHPL--
(A) shall give preference to models that--
(i) improve the coordination between mental
health and physical health providers;
(ii) improve the coordination among such
providers and the justice and corrections
system;
(iii) improve the cost effectiveness,
quality, effectiveness, and efficiency of
health care services furnished to individuals
with serious mental illness, in mental health
crisis, or at risk to themselves, their
families, and the general public; and
(iv) recognize the importance of family
participation in recovery; and
(B) may include clinical protocols and practices
used in the Recovery After Initial Schizophrenia
Episode project of the National Institute of Mental
Health and the Specialized Treatment Early in Psychosis
program.
(4) Deadline for beginning implementation.--The Director of
the NMHPL shall begin implementation of the duties described in
this subsection not later than January 1, 2018.
(5) Consultation.--In carrying out the duties under this
subsection, the Director of the NMHPL may consult with--
(A) representatives of the National Institute of
Mental Health on organizational and operational issues;
(B) other appropriate Federal agencies;
(C) clinical and analytical experts with expertise
in medicine, psychiatric and clinical psychological
care, health care management, education, corrections
health care, social services, and mental health court
systems; and
(D) other individuals and agencies as the Assistant
Secretary determines appropriate.
(b) Staffing.--
(1) Composition.--In selecting the staff of the NMHPL, the
Director of the NMHPL, in consultation with the Director of the
National Institute of Mental Health, shall include individuals
with advanced degrees and clinical and research experience, and
who have an understanding of biological, psychosocial, and
pharmaceutical treatments of mental illness and substance use
disorders, including--
(A) individuals with a medical degree or doctoral
degree from an accredited program in--
(i) allopathic or osteopathic medicine, and
who have specialized training in psychiatry;
(ii) psychology; or
(iii) social work;
(B) professionals or academics with clinical or
research expertise in substance use disorders and
treatment; and
(C) professionals or academics with expertise in
research design and methodologies.
(c) Report on Quality of Care.--Not later than 2 years after the
date of enactment of this Act, and every 2 years thereafter, the
Director of the NMHPL shall submit to Congress a report on the quality
of care furnished through grant programs administered by the Assistant
Secretary under the respective services delivery models, including
measurement of patient-level outcomes and public health outcomes, such
as--
(1) reduced rates of suicide, suicide attempts, substance
abuse, overdose, overdose deaths, emergency psychiatric
hospitalizations, emergency room boarding, incarceration,
crime, arrest, homelessness, and joblessness;
(2) rates of employment and enrollment in educational and
vocational programs; and
(3) such other criteria as the Director may determine.
(d) Definition.--In this section, the term ``emergency room
boarding'' means the practice of admitting patients to an emergency
department and holding such patients in the department until inpatient
psychiatric beds become available.
SEC. 202. INNOVATION GRANTS.
(a) In General.--The Assistant Secretary shall award grants to
State and local governments, educational institutions, and nonprofit
organizations for expanding a model that has been scientifically
demonstrated to show promise, but would benefit from further applied
research, for--
(1) enhancing the prevention, diagnosis, intervention,
treatment, and rehabilitation of mental illness, serious
emotional disorder, substance use disorder, and co-occurring
disorders; or
(2) integrating or coordinating physical health, mental
health, and substance use services.
(b) Duration.--A grant under this section shall be for a period of
not more than 3 years.
(c) Limitations.--Of the amounts made available for carrying out
this section for a fiscal year--
(1) not more than one-third shall be awarded for use for
prevention; and
(2) not less than one-third shall be awarded for screening,
diagnosis, treatment, or services, as described in subsection
(a), for individuals (or subpopulations of individuals) who are
below the age of 18 when activities funded through the grant
award are initiated.
(d) Guidelines.--As a condition on receipt of an award under this
section, an applicant shall agree to adhere to guidelines issued by the
National Mental Health Policy Laboratory on research designs and data
collection.
(e) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $10,000,000 for each of fiscal
years 2017 through 2021.
SEC. 203. DEMONSTRATION GRANTS.
(a) Grants.--The Assistant Secretary shall award grants to States,
counties, local governments, educational institutions, and private
nonprofit organizations for the expansion, replication, or scaling of
evidence-based programs across a wider area to enhance effective
screening, early diagnosis, intervention, and treatment with respect to
mental illness and serious mental illness, primarily by--
(1) applied delivery of care, including training staff in
effective evidence-based treatment; and
(2) integrating models of care across specialties and
jurisdictions.
(b) Duration.--A grant under this section shall be for a period of
not less than 2 years and not more than 5 years.
(c) Limitations.--Of the amounts made available for carrying out
this section for a fiscal year--
(1) not less than half shall be awarded for screening,
diagnosis, intervention, and treatment, as described in
subsection (a), for individuals (or subpopulations of
individuals) who are below the age of 26 when activities funded
through the grant award are initiated;
(2) no amounts shall be made available for any program or
project that is not evidence-based;
(3) no amounts shall be made available for primary
prevention; and
(4) no amounts shall be made available solely for the
purpose of expanding facilities or increasing staff at an
existing program.
(d) Guidelines.--As a condition on receipt of an award under this
section, an applicant shall agree to adhere to guidelines issued by the
National Mental Health Policy Laboratory (established under section
201) on research designs and data collection.
(e) Reporting.--As a condition on receipt of an award under this
section, an applicant shall agree--
(1) to report to the National Mental Health Policy
Laboratory and the Assistant Secretary the results of programs
and activities funded through the award; and
(2) to include in such reporting any relevant data
requested by the National Mental Health Policy Laboratory and
the Assistant Secretary.
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $10,000,000 for each of fiscal
years 2017 through 2021.
SEC. 204. EARLY CHILDHOOD INTERVENTION AND TREATMENT.
(a) Grants.--The Director of the National Mental Health Policy
Laboratory (in this section referred to as the ``NMHPL'') shall--
(1) award grants to eligible entities to initiate and
undertake early childhood intervention and treatment programs,
and specialized programs for preschool- and elementary school-
aged children at significant risk or who show early signs of
social or emotional disability (in addition to any learning
disability); and
(2) ensure that programs funded through grants under this
section are based on promising or evidence-based models and
methods that are culturally and linguistically relevant and can
be replicated in other settings.
(b) Eligible Entities and Children.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means a
nonprofit institution that--
(A) is accredited by a State mental health or
education agency, as applicable, for the intervention,
treatment, or education of children from 3 to 12 years
of age; and
(B) provides services that include early
intervention and treatment or specialized programs for
preschool- and elementary school-aged children whose
primary need is a social or emotional disability (in
addition to any learning disability).
(2) Eligible child.--The term ``eligible child'' means a
child who is at least 3 years old and not more than 12 years
old--
(A) whose primary need is a social or emotional
disability (in addition to any learning disability);
and
(B) who could benefit from early childhood
intervention and specialized preschool or elementary
school programs with the goal of intervening or
treating social or emotional disabilities.
(c) Application.--An eligible entity seeking a grant under
subsection (a) shall submit to the Secretary an application at such
time, in such manner, and containing such information as the Secretary
may require.
(d) Use of Funds for Early Intervention and Treatment Programs.--An
eligible entity shall use amounts awarded under a grant under
subsection (a)(1) to carry out the following activities:
(1) Deliver for eligible children mental health education
and treatment, early childhood education and intervention, and
specialized programs for preschool- and elementary school-aged
children at significant risk or who show early signs of social
or emotional disability (in addition to any learning
disability), including the provision of day treatment and
social-emotional and behavioral services.
(2) Treat and educate eligible children, including by
providing funding for--
(A) program and curricula development;
(B) staff;
(C) assessment, intervention, and treatment
services;
(D) administrative costs, including operating
costs, capital needs, and equipment;
(E) enrollment costs;
(F) collaboration with primary care physicians,
psychiatrists, and clinical services of psychologists
of other related mental health specialists;
(G) services to meet emergency needs of children;
and
(H) communication with families and physical and
mental health professionals concerning the children.
(3) Develop and implement other strategies to address
identified intervention, treatment, and educational needs of
eligible children that incorporate reliable and valid
evaluation modalities into the program to ensure outcomes based
on sound scientific metrics as determined by the NMHPL.
(e) Amount of Awards.--The amount of an award to an eligible entity
under subsection (a)(1) shall be not more than $600,000 per fiscal
year.
(f) Project Terms.--The period of a grant for awards under
subsection (a)(1), shall be not less than 3 fiscal years and not more
than 10 fiscal years.
(g) Matching Funds.--The Director of the NMHPL may not award a
grant under this section to an eligible entity unless the eligible
entity agrees, with respect to the costs to be incurred by the eligible
entity in carrying out the activities described in subsection (d), to
make available non-Federal contributions (in cash or in kind) toward
such costs in an amount that is not less than 10 percent of Federal
funds provided in the grant.
(h) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $10,000,000 for each of fiscal
years 2017 through 2021.
SEC. 205. EXTENSION OF ASSISTED OUTPATIENT TREATMENT GRANT PROGRAM FOR
INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.
Section 224 of the Protecting Access to Medicare Act of 2014 (42
U.S.C. 290aa note) is amended--
(1) in subsection (a), by striking ``4-year'' and inserting
``6-year'';
(2) in subsection (e), by striking ``and 2018'' and
inserting ``2018, 2019, and 2020''; and
(3) in subsection (g)--
(A) in paragraph (1), by striking ``2018'' and
inserting ``2020'';
(B) in paragraph (2) by striking ``2018'' and
inserting ``2020''; and
(C) by striking ``$15,000,000'' and inserting
``$20,000,000''.
SEC. 206. BLOCK GRANTS.
(a) Reauthorization of Block Grant.--Section 1920(a) of the Public
Health Service Act (42 U.S.C. 300x-9(a)) is amended by striking
``$450,000,000 for fiscal year 2001, and such sums as may be necessary
for each of the fiscal years 2002 and 2003'' and inserting
``$483,000,000 for fiscal year 2017 and such sums as may be necessary
for each of fiscal years 2018 through 2019''.
(b) Best Practices in Clinical Care Models.--Section 1920 of the
Public Health Service Act (42 U.S.C. 300x-9) is amended by adding at
the end the following:
``(c) Best Practices in Clinical Care Models.--The Assistant
Secretary, acting through the Administrator of the Substance Abuse and
Mental Health Services and in collaboration with the Director of the
National Institute of Mental Health, shall obligate 5 percent of the
amounts appropriated for a fiscal year under subsection (a) for
translating evidence-based (as defined in section 2 of the Mental
Health Reform Act of 2015) interventions and best available science
into systems of care, such as through models including the Recovery
After an Initial Schizophrenia Episode research project of the National
Institute of Mental Health.''.
(c) Additional Program Requirements.--
(1) Integrated services.--Subsection (b)(1) of section 1912
of the Public Health Service Act (42 U.S.C. 300x-1(b)(1)) is
amended--
(A) by striking ``The plan provides'' and inserting
the following:
``(A) In general.--The plan provides'';
(B) in the second sentence, by striking ``health
and mental health services'' and inserting ``integrated
physical and mental health services'';
(C) by striking ``The plan shall include'' and all
that follows through the period at the end and
inserting ``The plan shall integrate and coordinate
services to maximize the efficiency, effectiveness,
quality, coordination, and cost effectiveness of those
services and programs to produce the best possible
outcomes for individuals with serious mental
illness.''; and
(D) by adding at the end the following new
subparagraph:
``(B) Additional requirements.--The plan shall
include a separate description of case management
services and provide for activities leading to
reduction of rates of suicides, suicide attempts,
substance abuse, overdose deaths, emergency
hospitalizations, incarceration, crimes, arrest,
homelessness, joblessness, medication nonadherence, and
education and vocational programs drop outs. The plan
shall include a detailed list of services available for
eligible patients in each county or county
equivalent.''.
(2) Data collection system.--
(A) Subsection (b)(1)(A) (as so designated by
paragraph (1)) of section 1912 of the Public Health
Service Act (42 U.S.C. 300x-1(b)(1)(A)) is amended by
inserting ``legal services, and'' before ``other
support services''.
(B) Subsection (b)(2) of section 1912 of the Public
Health Service Act (42 U.S.C. 300x-1(b)(2)) is amended
by inserting ``and outcome measures for services and
resources'' before the period.
(3) Implementation of plan.--Subsection (d) of section 1912
of the Public Health Service Act (42 U.S.C. 300x-1(d)) is
amended--
(A) in paragraph (1)--
(i) by striking ``Except as provided'' and
inserting the following:
``(A) In general.--Except as provided''; and
(ii) by adding at the end the following new
subparagraph:
``(B) De-identified reports.--For eligible patients
receiving treatment through funds awarded under a grant
under section 1911, a State shall include in the State
plan for the first year beginning after the date of the
enactment of the Mental Health Reform Act of 2015 and
each subsequent year, a de-identified report,
containing information that is open source and de-
identified, on the outcomes measures collected in
subsection (b)(2) of section 1912 of the Public Health
Service Act and the overall cost of such treatment
provided.''.
(4) Incentives for state-based outcome measures.--Section
1920 of the Public Health Service Act (42 U.S.C. 300x-9) is
amended by adding at the end the following:
``(c) Incentives for State-Based Outcome Measures.--
``(1) In general.--In addition to the amounts made
available under subsection (a) for fiscal year 2019, the
Secretary shall provide to each State that meets the conditions
under paragraph (2) for fiscal year 2019, an amount equal to 2
percent of the formula grant amount described in section 1911
and section 1921.
``(2) Conditions.--The Secretary shall define the
conditions under which a State is eligible to receive the
additional amount under paragraph (1), based on the report on
mental health and substance use treatment in the States under
section 102(b) of the Mental Health Reform Act of 2015.
``(3) Clarification.--Any amounts made available under
paragraph (1) shall be in addition to the State's block grant
allocation and shall be made to a State for a fiscal year, as a
single payment, not later than the last day of the first
calendar quarter of fiscal year 2020.''.
(5) Evidence-based services delivery models.--Section 1912
of the Public Health Service Act (42 U.S.C. 300x-1) is amended
by adding at the end the following new subsection:
``(e) Expansion of Models.--
``(1) In general.--Taking into account the results of
evaluations under section 201(a)(2)(C) of the Mental Health
Reform Act of 2015, the Assistant Secretary may, by rule, as
part of the program of block grants under this subpart, provide
for expanded use across the Nation of evidence-based service
delivery models by providers funded under such block grants, so
long as--
``(A) the Assistant Secretary for Mental Health and
Substance Use Disorders (in this subsection referred to
as the `Assistant Secretary') determines that such
expansion will--
``(i) result in more effective use of funds
under such block grants without reducing the
quality of care; or
``(ii) improve the quality of patient care
without significantly increasing spending;
``(B) the Director of the National Institute of
Mental Health determines that such expansion would
improve the quality of patient care; and
``(C) the Assistant Secretary determines that the
change will--
``(i) significantly reduce severity and
duration of symptoms of mental illness;
``(ii) reduce rates of suicide, suicide
attempts, substance abuse, overdose, emergency
hospitalizations, emergency room boarding,
incarceration, crime, arrest, homelessness, or
joblessness; or
``(iii) significantly improve the quality
of patient care and mental health crisis
outcomes without significantly increasing
spending.
``(2) Definition.--In this subsection, the term `emergency
room boarding' means the practice of admitting patients to an
emergency department and holding such patients in the
department until inpatient psychiatric beds become
available.''.
(d) Period for Expenditure of Grant Funds.--Section 1913 of the
Public Health Service Act (42 U.S.C. 300x-2) is amended by adding at
the end the following:
``(d) Period for Expenditure of Grant Funds.--In implementing a
plan submitted under section 1912(a), a State receiving a grant under
section 1911 may make such funds available to providers of services
described in subsection (b) for the provision of services without
fiscal year limitation.''.
(e) Active Outreach and Engagement.--Section 1915 of the Public
Health Service Act (42 U.S.C. 300x-4) is amended by adding at the end
of the following:
``(c) Active Outreach and Engagement to Persons With Serious Mental
Illness.--
``(1) In general.--A funding agreement for a grant under
section 1911 is that the State involved has in effect active
programs that seek to engage individuals with serious mental
illness in comprehensive services in order to avert relapse,
repeated hospitalizations, arrest, incarceration, suicide, and
to provide the patient with the opportunity to live in the
least restrictive setting, through a comprehensive program of
evidence-based and culturally relevant assertive outreach and
engagement services focusing on individuals who are homeless,
have co-occurring disorders, are at risk for incarceration or
re-incarceration, or have a history of treatment failure,
including repeated hospitalizations or emergency room usage.
``(2) Evidence-based assertive outreach and engagement
services.--
``(A) SAMHSA.--The Administrator of the Substance
Abuse and Mental Health Services Administration, in
cooperation with the Director of the National Institute
of Mental Health, shall develop--
``(i) a list of evidence-based culturally
and linguistically relevant assertive outreach
and engagement services; and
``(ii) criteria to be used to assess the
scope and effectiveness of the approaches taken
by such services, such as the ability to
provide same-day appointments for emergent
situations.
``(B) Types of assertive outreach and engagement
services.--For purposes of paragraph (1), appropriate
programs of evidence-based assertive outreach and
engagement services may include peer support programs;
the Wellness Recovery Action Plan, Assertive Community
Treatment, and Forensic Assertive Community Treatment
of the Substance Abuse and Mental Health Services
Administration; assisted outpatient treatment,
appropriate supportive housing programs incorporating a
Housing First model; and intensive, evidence-based
approaches to early intervention in psychosis, such as
the Recovery After an Initial Schizophrenia Episode
model of the National Institute of Mental Health and
the Specialized Treatment Early in Psychosis program.
``(d) Psychiatric Advanced Directives.--A funding agreement for a
grant under section 1911 is that the State involved has in effect
active programs that seek to engage individuals with serious mental
illness in proactively making their own health care decisions and
enhancing communication between themselves, their families, and their
treatment providers by allowing for early intervention and reducing
legal proceedings related to involuntary treatment by developing
psychiatric advanced directives through a comprehensive program--
``(1) of assertive outreach and engagement services
focusing on individuals diagnosed with serious mental illness
or self-identifying as in recovery from serious mental illness
to obtain a psychiatric advanced directive; or
``(2) to support States in providing accessible legal
counsel to individuals diagnosed with serious mental
illness.''.
SEC. 207. TELEHEALTH CHILD PSYCHIATRY ACCESS GRANTS.
(a) In General.--The Secretary, acting through the Administrator of
the Health Resources and Services Administration, shall award grants to
States and Indian tribes or tribal organizations (as defined in section
4 of the Indian Self-Determination and Education Assistance Act) to
promote behavioral health integration in pediatric primary care by--
(1) supporting the creation of statewide child psychiatry
access programs; and
(2) supporting the expansion of existing statewide or
regional child psychiatry access programs.
(b) Program Requirements.--
(1) In general.--To be eligible for funding under
subsection (a), a child psychiatry access program shall--
(A) be a statewide network of pediatric mental
health teams that provide support to pediatric primary
care sites as an integrated team;
(B) support and further develop organized State
networks of child and adolescent psychiatrists to
provide consultative support to pediatric primary care
sites;
(C) conduct an assessment of critical behavioral
consultation needs among pediatric providers and such
providers' preferred mechanisms for receiving
consultation and training and technical assistance;
(D) develop an online database and communication
mechanisms, including telehealth, to facilitate
consultation support to pediatric practices;
(E) provide rapid (within 30 minutes) statewide
clinical telephone consultations when requested between
the pediatric mental health teams and pediatric primary
care providers;
(F) conduct training and provide technical
assistance to pediatric primary care providers to
support the early identification, diagnosis, treatment,
and referral of children with behavioral health
conditions;
(G) inform and assist pediatric providers in
accessing child psychiatry consultations and in
scheduling and conducting technical assistance;
(H) assist with referrals to specialty care and
community and behavioral health resources; and
(I) establish mechanisms for measuring and
monitoring increased access to child and adolescent
psychiatric services by pediatric primary care
providers and expanded capacity of pediatric primary
care providers to identify, treat, and refer children
with mental health problems.
(2) Pediatric mental health teams.--For purposes of this
subsection, the term ``pediatric mental health team'' means a
team of case coordinators, child and adolescent psychiatrists,
and a licensed clinical mental health professional, such as a
psychologist, social worker, or mental health counselor. Such a
team may be regionally based, provided there is access to a
pediatric mental health team across the State.
(c) Application.--A State, political subdivision of a State, Indian
tribe, or tribal organization that desires a grant under this section
shall submit an application to the Secretary at such time, in such
manner, and containing such information as the Secretary may require,
including a plan for the rigorous evaluation of activities that are
carried out with funds received under such grant.
(d) Evaluation.--A State, political subdivision of a State, Indian
tribe, or tribal organization that receives a grant under this section
shall prepare and submit an evaluation to the Secretary at such time,
in such manner, and containing such information as the Secretary may
reasonably require, including an evaluation of activities carried out
with funds received under such grant and a process and outcome
evaluation.
(e) Matching Requirement.--The Secretary may not award a grant
under the grant program unless the State involved agrees, with respect
to the costs to be incurred by the State in carrying out the purpose
described in this section, to make available non-Federal contributions
(in cash or in kind) toward such costs in an amount that is not less
than 20 percent of Federal funds provided in the grant.
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $25,000,000 for fiscal year
2017 and such sums as may be necessary for each of fiscal years 2018
through 2021.
SEC. 208. LIABILITY PROTECTIONS FOR HEALTH CARE PROFESSIONAL VOLUNTEERS
AT COMMUNITY HEALTH CENTERS AND COMMUNITY MENTAL HEALTH
CENTERS.
Section 224 of the Public Health Service Act (42 U.S.C. 233) is
amended by adding at the end the following:
``(q)(1) In this subsection, the term `community mental health
center' means--
``(A) a community mental health center, as defined in
section 1861(ff) of the Social Security Act; or
``(B) a community mental health center meeting the criteria
specified in section 1913(c).
``(2) For purposes of this section, a health care professional
volunteer at an entity described in subsection (g)(4) or a community
mental health center shall, in providing health care services eligible
for funding under section 330 or subpart I of part B of title XIX to an
individual, be deemed to be an employee of the Public Health Service
for a calendar year that begins during a fiscal year for which a
transfer was made under paragraph (5)(C). The preceding sentence is
subject to the provisions of this subsection.
``(3) In providing a health care service to an individual, a health
care professional shall, for purposes of this subsection be considered
to be a health professional volunteer at an entity described in
subsection (g)(4) or at a community mental health center if the
following conditions are met:
``(A) The service is provided to the individual at the
facilities of an entity described in subsection (g)(4), at a
federally qualified community behavioral health clinic, or
through offsite programs or events carried out by the center.
``(B) The center or entity is sponsoring the health care
professional volunteer pursuant to paragraph (4)(B).
``(C) The health care professional does not receive any
compensation for the service from the individual or from any
third-party payer (including reimbursement under any insurance
policy or health plan, or under any Federal or State health
benefits program), except that the health care professional may
receive repayment from the entity described in subsection
(g)(4) or the center for reasonable expenses incurred by the
health care professional in the provision of the service to the
individual.
``(D) Before the service is provided, the health care
professional or the center or entity described in subsection
(g)(4) posts a clear and conspicuous notice at the site where
the service is provided of the extent to which the legal
liability of the health care professional is limited pursuant
to this subsection.
``(E) At the time the service is provided, the health care
professional is licensed or certified in accordance with
applicable law regarding the provision of the service.
``(4) Subsection (g) (other than paragraphs (3) and (5)) and
subsections (h), (i), and (l) apply to a health care professional for
purposes of this subsection to the same extent and in the same manner
as such subsections apply to an officer, governing board member,
employee, or contractor of an entity described in subsection (g)(4),
subject to paragraph (5) and subject to the following:
``(A) The first sentence of paragraph (2) applies in lieu
of the first sentence of subsection (g)(1)(A).
``(B) With respect to an entity described in subsection
(g)(4) or a federally qualified community behavioral health
clinic, a health care professional is not a health professional
volunteer at such center unless the center sponsors the health
care professional. For purposes of this subsection, the center
shall be considered to be sponsoring the health care
professional if--
``(i) with respect to the health care professional,
the center submits to the Secretary an application
meeting the requirements of subsection (g)(1)(D); and
``(ii) the Secretary, pursuant to subsection
(g)(1)(E), determines that the health care professional
is deemed to be an employee of the Public Health
Service.
``(C) In the case of a health care professional who is
determined by the Secretary pursuant to subsection (g)(1)(E) to
be a health professional volunteer at such center, this
subsection applies to the health care professional (with
respect to services described in paragraph (2)) for any cause
of action arising from an act or omission of the health care
professional occurring on or after the date on which the
Secretary makes such determination.
``(D) Subsection (g)(1)(F) applies to a health professional
volunteer for purposes of this subsection only to the extent
that, in providing health services to an individual, each of
the conditions specified in paragraph (3) is met.
``(5)(A) Amounts in the fund established under subsection (k)(2)
shall be available for transfer under subparagraph (C) for purposes of
carrying out this subsection for health professional volunteers at
entities described in subsection (g)(4).
``(B) Not later than May 1 of each fiscal year, the Attorney
General, in consultation with the Secretary, shall submit to Congress a
report providing an estimate of the amount of claims (together with
related fees and expenses of witnesses) that, by reason of the acts or
omissions of health care professional volunteers, will be paid pursuant
to this subsection during the calendar year that begins in the
following fiscal year. Subsection (k)(1)(B) applies to the estimate
under the preceding sentence regarding health care professional
volunteers to the same extent and in the same manner as such subsection
applies to the estimate under such subsection regarding officers,
governing board members, employees, and contractors of entities
described in subsection (g)(4).
``(C) Not later than December 31 of each fiscal year, the Secretary
shall transfer from the fund under subsection (k)(2) to the appropriate
accounts in the Treasury an amount equal to the estimate made under
subparagraph (B) for the calendar year beginning in such fiscal year,
subject to the extent of amounts in the fund.
``(6)(A) This subsection takes effect on October 1, 2017, except as
provided in subparagraph (B).
``(B) Effective on the date of the enactment of this subsection--
``(i) the Secretary may issue regulations for carrying out
this subsection, and the Secretary may accept and consider
applications submitted pursuant to paragraph (4)(B); and
``(ii) reports under paragraph (5)(B) may be submitted to
Congress.''.
SEC. 209. MINORITY FELLOWSHIP PROGRAM.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended--
(1) by redesignating part G (42 U.S.C. 290kk et seq.),
relating to services provided through religious organizations
and added by section 144 of the Community Renewal Tax Relief
Act of 2000, as enacted into law by section 1(a)(7) of Public
Law 106-554, as part J;
(2) by redesignating sections 581 through 584 of part J, as
so redesignated, as sections 596 through 596C, respectively;
and
(3) by adding at the end the following:
``PART K--MINORITY FELLOWSHIP PROGRAM
``SEC. 597. FELLOWSHIPS.
``(a) In General.--The Secretary shall maintain a program, to be
known as the Minority Fellowship Program, under which the Secretary
awards fellowships, which may include stipends, for the purposes of--
``(1) increasing behavioral health practitioners' knowledge
of issues related to prevention, treatment, and recovery
support for mental and substance use disorders among racial and
ethnic minority populations;
``(2) improving the quality of mental and substance use
disorder prevention and treatment delivered to ethnic
minorities; and
``(3) increasing the number of culturally competent
behavioral health professionals who teach, administer, conduct
services research, and provide direct mental health or
substance use services to underserved minority populations.
``(b) Training Covered.--The fellowships under subsection (a) shall
be for postbaccalaureate training (including for master's and doctoral
degrees) for mental health professionals, including in the fields of
psychiatry, nursing, social work, psychology, marriage and family
therapy, and substance use and addiction counseling.
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $10,000,000 for each of fiscal
years 2017 through 2021.''.
SEC. 210. NATIONAL HEALTH SERVICE CORPS.
(a) Definitions.--
(1) Primary health services.--Section 331(a)(3)(D) of the
Public Health Service Act (42 U.S.C. 254d(a)(3)(D)) is amended
by inserting ``(including pediatric mental health subspecialty
services)'' after ``pediatrics''.
(2) Behavioral and mental health professionals.--Clause (i)
of section 331(a)(3)(E)(i) of the Public Health Service Act (42
U.S.C. 254d(a)(3)(E)(i)) is amended by inserting ``, including
such professionals who are pediatric subspecialists'' before
the period at the end.
(3) Health professional shortage area.--Section 332(a)(1)
of the Public Health Service Act (42 U.S.C. 254e(a)(1)) is
amended by inserting ``(which may be a group comprised of
children and adolescents)'' after ``population group''.
(4) Medical facility.--Section 332(a)(2)(A) of the Public
Health Service Act (42 U.S.C. 254e(a)(2)(A)) is amended by
inserting ``medical residency or fellowship training site for
training in child and adolescent psychiatry,'' before
``facility operated by a city or county health department,''.
(b) Eligibility To Participate in Loan Repayment Program.--Section
338B(b)(1)(B) of the Public Health Service Act (42 U.S.C. 254l-
1(b)(1)(B)) is amended by inserting ``, including any child and
adolescent psychiatry medical residency or fellowship training
program'' before the semicolon.
SEC. 211. REAUTHORIZATION OF MENTAL AND BEHAVIORAL HEALTH EDUCATION
TRAINING GRANT.
Section 756 of the Public Health Service Act (42 U.S.C. 294e-1) is
amended to read as follows:
``SEC. 756. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.
``(a) Grants Authorized.--The Secretary, acting through the
Administrators of the Substance Abuse and Mental Health Administration
and the Health Resources and Services Administration, may award grants
to eligible institutions to support the recruitment of students for,
and education and clinical experience of the students in--
``(1) accredited institutions of higher education or
accredited professional training programs that are establishing
or expanding internships or other field placement programs in
mental health in psychiatry, psychology, school psychology,
behavioral pediatrics, psychiatric nursing, social work, school
social work, substance abuse prevention and treatment, marriage
and family therapy, school counseling, or professional
counseling, with a preference for programs addressing child and
adolescent mental health, in particular transitional age youth
between 16 to 25 years old;
``(2) accredited doctoral, internship, and post-doctoral
residency programs of health service psychology (which includes
clinical psychology, counseling, and school psychology) for the
development and implementation of interdisciplinary training of
psychology graduate students for providing behavioral and
mental health services, including substance abuse prevention
and treatment services, as well as the development of faculty
in health service psychology;
``(3) accredited master's and doctoral degree programs of
social work for the development and implementation of
interdisciplinary training of social work graduate students for
providing behavioral and mental health services, including
substance abuse prevention and treatment services, and the
development of faculty in social work; or
``(4) paraprofessional certificate training programs
offered by accredited community and technical colleges granting
State licensure or certification in a behavioral health-related
paraprofessional field, such as community health worker,
outreach worker, social services aide, mental health worker,
substance abuse or addictions worker, youth worker, promotora,
or peer paraprofessional, with preference for pre-service or
in-service training of paraprofessional child and adolescent
mental health workers.
``(b) Eligibility Requirements.--To be eligible to receive a grant
under this section, an institution shall demonstrate--
``(1) an ability to recruit and place psychiatrists,
psychologists, social workers, or paraprofessionals in areas
with a high need and high demand population;
``(2) participation of individuals and groups from
different racial, ethnic, cultural, geographic, religious,
linguistic, and class backgrounds, and different genders and
orientations in the institution's programs;
``(3) knowledge and understanding of the concerns of the
individuals and groups described in paragraph (2), especially
individuals with mental health symptoms or diagnoses,
particularly children and adolescents, with a special emphasis
on transitional-aged persons 16 to 25 years old;
``(4) prioritization of cultural and linguistic competency
in training professionals and paraprofessionals in any academic
program, field placement, internship, or post-doctoral
position; and
``(5) the willingness to provide to the Secretary such
data, assurances, and information as the Secretary may require.
``(c) Priority.--In selecting grant recipients the Secretary shall
give priority to--
``(1) programs that have demonstrated the ability to train
psychology and social work professionals to work in integrated
care settings; and
``(2) programs for paraprofessionals that offer curriculum
with an emphasis on the role of the family and the lived
experience of the consumer and family-paraprofessional
partnerships.
``(d) Institutional Requirement.--Of the grants awarded under
paragraphs (2) and (3) of subsection (a), at least 4 of the grant
recipients shall be historically black colleges or other minority
serving institutions.
``(e) Report to Congress.--Not later than 2 years after the date of
enactment of the Mental Health Reform Act of 2015, and annually
thereafter, the Secretary, acting through the Administrators of the
Substance Abuse and Mental Health Services Administration and the
Health Resources Services Administration, shall submit to Congress a
report on the effectiveness of--
``(1) providing graduate students support for experiential
training (internship or field placement);
``(2) recruitment of students interested in behavioral
health practice;
``(3) development and implementation of interprofessional
training and integration within primary care;
``(4) development and implementation of accredited field
placements and internships; and
``(5) data collected on the number of students trained in
mental health and the number of available accredited
internships and field placements.
``(f) Authorization of Appropriations.--For each of fiscal years
2017 through 2021, there are authorized to be appropriated to carry out
this section $44,000,000, to be allocated as follows:
``(1) $15,000,000 shall be allocated to institutions to
expand mental health internships or other field placement
programs under subsection (a)(1).
``(2) $14,000,000 shall be allocated to training in
graduate psychology under subsection (a)(2).
``(3) $10,000,000 shall be allocated to training in
graduate social work under subsection (a)(3).
``(4) $5,000,000 shall be allocated to training
paraprofessionals under subsection (a)(4).''.
SEC. 212. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb-31 et seq.) is amended by inserting after section 520E-2
the following:
``SEC. 520E-3. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
``(a) In General.--The Secretary shall maintain the National
Suicide Prevention Lifeline program. The activities of the Secretary
under such program shall include--
``(1) coordinating a network of crisis centers across the
Nation for providing suicide prevention and crisis intervention
services to individuals seeking help at any time, day or night;
``(2) maintaining a suicide prevention hotline to link
callers to local emergency, mental health, and social services
resources; and
``(3) consulting with the Secretary of Veterans Affairs to
ensure that veterans calling the suicide prevention hotline
have access to a specialized veterans' suicide prevention
hotline.
``(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $5,000,000 for each of fiscal
years 2016 through 2020.''.
TITLE III--INTEGRATION
SEC. 301. PRIMARY AND BEHAVIORAL HEALTH CARE INTEGRATION GRANT
PROGRAMS.
Section 520K of the Public Health Service Act (42 U.S.C. 290bb-42)
is amended to read as follows:
``SEC. 520K. INTEGRATION INCENTIVE GRANTS.
``(a) In General.--There is established within the Substance Abuse
and Mental Health Services Administration a primary and behavioral
health care integration grant program. The Assistant Secretary for
Mental Health and Substance Use Disorders may award grants and
cooperative agreements to eligible entities to expend funds for
improvements in integrated settings with integrated practices.
``(b) Definitions.--In this section:
``(1) Integrated care.--The term `integrated care' means
full collaboration in merged or transformed practices offering
mental and physical health services within the same shared
practice space in the same facility, where the entity--
``(A) provides services in a shared space that
ensures services will be available and accessible
promptly and in a manner which preserves human dignity
and assures continuity of care;
``(B) ensures communication among the integrated
care team that is consistent and team-based;
``(C) ensures shared decisionmaking between mental
health and primary care providers;
``(D) provides evidence-based services in a mode of
service delivery appropriate for the target population;
``(E) employs staff who are multidisciplinary and
culturally and linguistically competent;
``(F) provides integrated services related to
screening, diagnosis, and treatment of mental illness
and co-occurring primary care conditions and chronic
diseases; and
``(G) provides targeted case management, including
services to assist individuals gaining access to needed
medical, social, educational, and other services and
applying for income security, housing, employment, and
other benefits to which they may be entitled.
``(2) Integrated care team.--The term `integrated care
team' means a team that includes--
``(A) allopathic or osteopathic medical doctors,
including a primary care physician and a board
certified psychiatrist;
``(B) licensed clinical mental health
professionals, such as psychologists or social workers;
``(C) a case manager; and
``(D) other members, which may include psychiatric
advanced practice nurses and other allied health
professionals, such as mental health counselors, or
others as appropriate.
``(3) Special population.--The term `special population'
means--
``(A) adults with mental illnesses who have co-
occurring primary care conditions with chronic
diseases;
``(B) adults with serious mental illnesses who have
co-occurring primary care conditions with chronic
diseases;
``(C) children and adolescents with serious
emotional disorders with co-occurring primary care
conditions and chronic diseases; or
``(D) individuals with substance use disorder.
``(c) Purpose.--The grant program under this section shall be
designed to lead to full collaboration between primary and behavioral
health in an integrated practice model at a statewide level, to ensure
that--
``(1) the overall wellness and physical health status of
individuals with serious mental illness and co-occurring
substance use disorders is supported through integration of
primary care into community mental health centers meeting the
criteria specified in section 1913(c) of the Social Security
Act or certified community behavioral health clinics described
in section 223 of the Protecting Access to Medicare Act of
2014; and
``(2) the mental health status of individuals with
significant co-occurring psychiatric and physical conditions
will be supported through integration of behavioral health into
primary care settings.
``(d) Eligible Entities.--To be eligible to receive a grant or
cooperative agreement under this section, an entity shall be a State
department of health, State mental health or addiction agency, or State
Medicaid agency. The Administrator shall give preference to States that
have existing integrated care models, such as those authorized by
section 1945 of the Social Security Act.
``(e) Application.--An eligible entity desiring a grant or
cooperative agreement under this section shall submit an application to
the Administrator at such time, in such manner, and accompanied by such
information as the Administrator may require, including a description
of a plan to achieve fully collaborative agreements to provide services
to special populations and--
``(1) a document that summarizes the State-specific
policies that inhibit the provision of integrated care, and the
specific steps that will be taken to address such barriers,
such as through licensing and billing procedures; and
``(2) a plan to develop and share a de-identified patient
registry to track treatment implementation and clinical
outcomes to inform clinical interventions, patient education,
and engagement with merged or transformed integrated practices
in compliance with applicable national and State health
information privacy laws.
``(f) Grant Amounts.--The maximum annual grant amount under this
section shall be $2,000,000, of which not more than 10 percent may be
allocated to State administrative functions, and the remaining amounts
shall be allocated to health facilities that provide integrated care.
``(g) Duration.--A grant under this section shall be for a period
of 5 years.
``(h) Report on Program Outcomes.--An entity receiving a grant or
cooperative agreement under this section shall submit an annual report
to the Administrator that includes--
``(1) the progress to reduce barriers to integrated care,
including regulatory and billing barriers, as described in the
entity's application under subsection (d); and
``(2) a description of functional outcomes of special
populations, including--
``(A) with respect to individuals with serious
mental illness, participation in supportive housing or
independent living programs, attendance in social and
rehabilitative programs, participation in job training
opportunities, satisfactory performance in work
settings, attendance at scheduled medical and mental
health appointments, and compliance with prescribed
medication regimes;
``(B) with respect to individuals with co-occurring
mental illness and primary care conditions and chronic
diseases, attendance at scheduled medical and mental
health appointments, compliance with prescribed
medication regimes, and participation in learning
opportunities related to improved health and lifestyle
practice; and
``(C) with respect to children and adolescents with
serious emotional disorders who have co-occurring
primary care conditions and chronic diseases,
attendance at scheduled medical and mental health
appointments, compliance with prescribed medication
regimes, and participation in learning opportunities at
school and extracurricular activities.
``(i) Technical Assistance Center for Primary-Behavioral Health
Care Integration.--
``(1) In general.--The Assistant Secretary for Mental
Health and Substance Use Disorders shall establish a program
through which such Assistant Secretary shall provide
appropriate information, training, and technical assistance to
eligible entities that receive a grant or cooperative agreement
under this section, in order to help such entities to meet the
requirements of this section, including assistance with--
``(A) development and selection of integrated care
models;
``(B) dissemination of evidence-based interventions
in integrated care;
``(C) establishment of organizational practices to
support operational and administrative success; and
``(D) other activities, as the Assistant Secretary
for Mental Health and Substance Use Disorders
determines appropriate.
``(2) Additional dissemination of technical information.--
The information and resources provided by the technical
assistance program established under paragraph (1) shall be
made available to States, political subdivisions of a State,
Indian tribes or tribal organizations (as defined in section 4
of the Indian Self-Determination and Education Assistance Act),
outpatient mental health and addiction treatment centers,
community mental health centers that meet the criteria under
section 1913(c), certified community behavioral health clinics
described in section 223 of the Protecting Access to Medicare
Act of 2014, primary care organizations such as Federally
qualified health centers or rural health centers, other
community-based organizations, or other entities engaging in
integrated care activities, as the Assistant Secretary for
Mental Health and Substance Use Disorders determines
appropriate.
``(j) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $50,000,000 for each of fiscal
years 2017 through 2021, of which $2,000,000 shall be available to the
technical assistance program under subsection (i).''.
TITLE IV--INTERAGENCY SERIOUS MENTAL ILLNESS COORDINATING COMMITTEE
SEC. 401. INTERAGENCY SERIOUS MENTAL ILLNESS COORDINATING COMMITTEE.
Title V of the Public Health Service Act is amended by inserting
after section 501 the following:
``SEC. 501A. INTERAGENCY SERIOUS MENTAL ILLNESS COORDINATING COMMITTEE.
``(a) Establishment.--The Assistant Secretary for Mental Health and
Substance Use Disorders (in this section referred to as the `Assistant
Secretary') shall establish a committee, to be known as the Interagency
Serious Mental Illness Coordinating Committee (in this section referred
to as the `Committee'), to assist the Assistant Secretary in carrying
out the Assistant Secretary's duties.
``(b) Responsibilities.--The Committee shall--
``(1) develop and annually update a summary of advances in
serious mental illness research related to prevention of,
diagnosis of, intervention in, and treatment and rehabilitation
of, serious mental illness, and access to services and supports
for individuals with serious mental illness;
``(2) monitor Federal programs and activities with respect
to serious mental illness;
``(3) make recommendations to the Assistant Secretary
regarding any appropriate changes to such activities, including
recommendations to the Director of NIH with respect to the
strategic plan developed under paragraph (5);
``(4) make recommendations to the Assistant Secretary
regarding public participation in decisions relating to serious
mental illness;
``(5) develop and update every 3 years a strategic plan for
the conduct and support of programs and services to assist
individuals with serious mental illness, including--
``(A) a summary of the advances in serious mental
illness research developed in under paragraph (1);
``(B) a list of the Federal programs and activities
identified in paragraph (2);
``(C) an analysis of the efficiency, effectiveness,
quality, coordination, and cost-effectiveness of
Federal programs and activities relating to the
prevention, diagnosis, treatment, or rehabilitation of
serious mental illness, including an accounting of the
costs of such programs and activities with
administrative costs disaggregated from the costs of
services and care; and
``(D) a plan with recommendations--
``(i) for the coordination and improvement
of Federal programs and activities related to
serious mental illness, including budgetary
requirements;
``(ii) for improving outcomes for
individuals with a serious mental illness
including appropriate benchmarks to measure
progress on achieving improvements;
``(iii) for the mental health workforce;
``(iv) to disseminate relevant information
developed by the coordinating committee to the
public, health care providers, social service
providers, public health officials, courts, law
enforcement, and other relevant groups;
``(v) to identify research needs, including
longitudinal studies of pediatric populations;
and
``(vi) for vulnerable and underserved
populations, including pediatric and geriatric
populations; and
``(6) submit to Congress such strategic plan and any
updates to such plan.
``(c) Membership.--
``(1) In general.--The Committee shall be composed of not
more than 9 Federal representatives including--
``(A) the Assistant Secretary for Mental Health and
Substance Use Disorders (or the Assistant Secretary's
designee), who shall serve as the Chair of the
Committee;
``(B) the Director of the National Institute of
Mental Health (or the Director's designee);
``(C) the Attorney General of the United States (or
the Attorney General's designee);
``(D) the Director of the Centers for Disease
Control and Prevention (or the Director's designee);
``(E) the Director of the National Institutes of
Health (or the Director's designee);
``(F) a member of the United States Interagency
Council on Homelessness;
``(G) representatives, appointed by the Assistant
Secretary, of Federal agencies that serve individuals
with serious mental illness, including representatives
of the Centers for Medicare & Medicaid Services, the
Administration on Community Living, the Agency for
Healthcare Research and Quality, the Bureau of Indian
Affairs, the Department of Defense, the Department of
Education, the Department of Housing and Urban
Development, the Department of Labor, the Department of
Veterans Affairs, and the Social Security
Administration; and
``(H) the additional members appointed under
paragraph (2).
``(2) Additional members.--At least 14 members of the
Committee shall be non-Federal public members appointed by the
Assistant Secretary, of which--
``(A) at least 1 member shall be an individual in
recovery from a diagnosis of serious mental illness who
has benefitted from and is receiving medical treatment
under the care of a licensed mental health
professional;
``(B) at least 1 member shall be a parent or legal
guardian of an individual with a history of serious
mental illness who has either attempted suicide or is
incarcerated for violence committed while experiencing
a serious mental illness;
``(C) at least 1 member shall be a representative
of a leading research, advocacy, and service
organization for individuals with serious mental
illness;
``(D) at least 2 members shall be--
``(i) a licensed psychiatrist with
experience treating serious mental illness;
``(ii) a licensed psychologist with
experience treating serious mental illness;
``(iii) a licensed clinical social worker;
or
``(iv) a licensed psychiatric nurse or
nurse practitioner;
``(E) at least 1 member shall be a mental health
professional with a significant focus in his or her
practice on working with children and adolescents;
``(F) at least 1 member shall be a mental health
professional who has demonstrated cultural competencies
and has research or clinical mental health experience
working with minorities;
``(G) at least 1 member shall be a State certified
mental health peer specialist;
``(H) at least 1 member shall be a judge with
experience adjudicating cases related to criminal
justice and serious mental illness;
``(I) at least 1 member shall be a law enforcement
officer or corrections officer with extensive
experience in interfacing with psychiatric and
psychological disorders or individuals in mental health
crisis; and
``(J) 4 members, of which--
``(i) 1 shall be appointed by the majority
leader of the Senate;
``(ii) 1 shall be appointed by the minority
leader of the Senate;
``(iii) 1 shall be appointed by the Speaker
of the House of Representatives; and
``(iv) 1 shall be appointed by the minority
leader of the House of Representatives.
``(d) Reports to Congress.--Not later than 1 year after the date of
release of the first strategic plan under subsection (b)(5) and
annually thereafter, the Committee shall submit a report to Congress--
``(1) evaluating the impact on public health of projects
addressing priority mental health needs of regional and
national significance under sections 501, 509, 516, and 520A,
including measurement of public health outcomes such as--
``(A) reduced rates of suicide, suicide attempts,
substance abuse, overdose, overdose deaths, emergency
hospitalizations, emergency room boarding (as defined
in section 1912(e)), incarceration, crime, arrest,
homelessness, and joblessness;
``(B) increased rates of employment and enrollment
in educational and vocational programs; and
``(C) such other criteria as may be determined by
the Assistant Secretary;
``(2) formulating recommendations for the coordination and
improvement of Federal programs and activities described in
paragraph (2);
``(3) identifying any such programs and activities that are
duplicative; and
``(4) summarizing all recommendations made, activities
carried out, and results achieved pursuant to the workforce
development strategy under section 101(c)(8) of the Mental
Health Reform Act of 2015.
``(e) Administrative Support; Terms of Service; Other Provisions.--
The following provisions shall apply with respect to the Committee:
``(1) The Assistant Secretary shall provide such
administrative support to the Committee as may be necessary for
the Committee to carry out its responsibilities.
``(2) Members of the Committee appointed under subsection
(c)(2) shall serve for a term of 4 years, and may be
reappointed for one or more additional 4-year terms. Any member
appointed to fill a vacancy for an unexpired term shall be
appointed for the remainder of such term. A member may serve
after the expiration of the member's term until a successor has
taken office.
``(3) The Committee shall meet at the call of the chair or
upon the request of the Assistant Secretary. The Committee
shall meet not fewer than 2 times each year.
``(4) All meetings of the Committee shall be public and
shall include appropriate time periods for questions and
presentations by the public.
``(f) Subcommittees; Establishment and Membership.--In carrying out
its functions, the Committee may establish subcommittees and convene
workshops and conferences. Such subcommittees shall be composed of
Committee members and may hold such meetings as are necessary to enable
the subcommittees to carry out their duties.''.
TITLE V--HIPAA CLARIFICATION
SEC. 501. FINDINGS.
The Senate makes the following findings:
(1) The privacy regulations promulgated under section
264(c) of the Health Insurance Portability and Accountability
Act (42 U.S.C. 1320d-2 note) recognize the value of family
members in the health and well-being of individuals
experiencing temporary psychosis. However, a lack of
understanding by health professionals has been a barrier to
many family members assisting in the treatment of an individual
with serious mental illness.
(2) The privacy rule under section 164.510(b)(2) of title
45, Code of Federal Regulations allows for the disclosure of
protected health information in the event that a covered entity
receives the individual's agreement provides an opportunity for
an individual to object, and the individual does not express an
objection or the covered entity reasonably infers that the
individual does not object.
(3) The privacy rule under section 164.510(b)(3) of title
45, Code of Federal Regulations allows for the disclosure of
protected health information if an individual is not present or
is otherwise incapacitated if the medical provider determines
that the disclosure is in the best interests of the individual.
(4) Engagement by family members has been shown to help
individuals with serious mental illness adhere to a treatment
plan and improved outcomes.
(5) Whenever possible, an individual who is the subject of
protected health information shall be given advanced notice of
the desire to share information with family members or other
caregivers. This notice should include an explanation of what
information is to be shared and why it is clinically desirable
to share such information.
(6) The use of psychiatric advance directives should be
encouraged for individuals with serious mental illness.
SEC. 502. MODIFICATIONS TO HIPAA.
In applying section 164.510(b)(3) of title 45, Code of Federal
Regulations, for the purposes of assisting health professionals to
determine the best interests of the individual, the Secretary of Health
and Human Services shall consider the following factors:
(1) Timely intervention for treatment of a serious mental
or general medical illness.
(2) Safe and stable housing for the individual.
(3) Increased daily living skills that are likely to allow
the individual to live within the community.
(4) An increased capacity of caregivers to support the
patient to live within the community.
SEC. 503. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING PROGRAMS.
(a) Initial Programs and Materials.--Not later than 1 year after
the date of enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary''), in
consultation with appropriate experts, shall develop and disseminate--
(1) a model program and materials for training health care
providers (including physicians, emergency medical personnel,
psychiatrists, psychologists, counselors, therapists,
behavioral health facilities and clinics, care managers, and
hospitals) regarding the circumstances under which, consistent
with the standards governing the privacy and security of
individually identifiable health information promulgated by the
Secretary under section 264 of the Health Insurance Portability
and Accountability Act of 1996 (42 U.S.C. 1320d-2 note) and
part C of title XI of the Social Security Act (42 U.S.C. 1320d
et seq.), the protected health information of patients with a
mental illness may be disclosed with and without patient
consent;
(2) a model program and materials for training lawyers and
others in the legal profession on such circumstances; and
(3) a model program and materials for training patients and
their families regarding their rights to protect and obtain
information under the standards specified in paragraph (1).
(b) Periodic Updates.--The Secretary shall--
(1) periodically review, evaluate, and update the model
programs and materials developed under subsection (a); and
(2) disseminate the updated model programs and materials.
(c) Contents.--The programs and materials developed under
subsection (a) shall address the guidance entitled ``HIPAA Privacy Rule
and Sharing Information Related to Mental Health'', issued by the
Department of Health and Human Services on February 20, 2014.
(d) Coordination.--The Secretary shall carry out this section in
coordination with the Director of the Office for Civil Rights within
the Department of Health and Human Services, the Administrator of the
Substance Abuse and Mental Health Services Administration, the
Administrator of the Health Resources and Services Administration, and
the heads of other relevant agencies within the Department of Health
and Human Services.
(e) Input of Certain Entities.--In developing the model programs
and materials required under subsections (a) and (b), the Secretary
shall solicit the input of relevant national, State, and local
associations, medical societies, and licensing boards.
(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $5,000,000 for each of fiscal
years 2017 through 2022.
SEC. 504. CONFIDENTIALITY OF RECORDS.
Section 543 of the Public Health Service Act (42 U.S.C. 290dd-2) is
amended by inserting after subsection (h) the following:
``(i) Streamlined Consent in Integrated Care Settings.--
``(1) In general.--For the sharing of records described in
subsection (a) involving the interchange of electronic health
records (as defined in section 13400 of division A of Public
Law 111-5) solely for the purposes of improving the provision
of health care and health care coordination solely within
accountable care organizations described in section 1899 of the
Social Security Act, health information exchanges (as defined
for purposes of section 3013), health homes (as defined in
section 1945(h)(3) of the Social Security Act), or other
integrated care arrangements (in existence before, on, or after
the date of the enactment of the Mental Health Reform Act of
2015), a patient's prior written or electronic consent for
disclosure and re-disclosure of records may be provided
annually in a generalized and revocable format to and for all
of the health care providers in the accountable care
organization, health information exchange, health home, or
other integrated care arrangement, who are involved in the
patient's care.
``(2) Disclosure required.--For all other disclosures or
re-disclosures of the records described in subsection (a),
except those expressly proscribed in paragraph 1, patient
consent is required to be obtained in accordance with the
procedures described in part 2 of title 42, Code of Federal
Regulations.
``(3) Prohibitions.--It shall be unlawful for any health
plan or health insurance program to use the records described
in subsection (a) or this subsection to deny or condition the
issuance of a plan, policy, or coverage on the basis of the
contents of such records, or for a health care provider to use
the records described in subsection (a) and this section to
discriminate in the provision of medically necessary health
care services to an individual who is the subject of such
records.''.
TITLE VI--MEDICARE AND MEDICAID REFORMS
SEC. 601. ENHANCED MEDICAID COVERAGE RELATING TO CERTAIN MENTAL HEALTH
SERVICES.
(a) Medicaid Coverage of Mental Health Services and Primary Care
Services Furnished on the Same Day.--
(1) In general.--Section 1902(a) of the Social Security Act
(42 U.S.C. 1396a(a)) is amended by inserting after paragraph
(77) the following new paragraph:
``(78) not prohibit payment under the plan for a mental
health service or primary care service furnished to an
individual at a community mental health center meeting the
criteria specified in section 1913(c) of the Public Health
Service Act or a Federally qualified health center (as defined
in section 1861(aa)(4)) for which payment would otherwise be
payable under the plan, with respect to such individual, if
such service were not a same-day qualifying service (as defined
in subsection (ll)).''.
(2) Same-day qualifying services defined.--Section 1902 of
the Social Security Act (42 U.S.C. 1396a) is amended by adding
at the end the following new subsection:
``(ll) Same-Day Qualifying Services Defined.--For purposes of
subsection (a)(78), the term `same-day qualifying service' means--
``(1) a primary care service furnished to an individual by
a provider at a facility on the same day a mental health
service is furnished to such individual by such provider (or
another provider) at the facility; and
``(2) a mental health service furnished to an individual by
a provider at a facility on the same day a primary care service
is furnished to such individual by such provider (or another
provider) at the facility.''.
(b) State Option To Provide Medical Assistance for Certain
Inpatient Psychiatric Services to Nonelderly Adults.--Section 1905 of
the Social Security Act (42 U.S.C. 1396d) is amended--
(1) in subsection (a)--
(A) in paragraph (16)--
(i) by striking ``effective'' and inserting
``(A) effective''; and
(ii) by inserting before the semicolon at
the end the following: ``, and (B) qualified
inpatient psychiatric hospital services (as
defined in subsection (h)(3)) for individuals
over 21 years of age and under 65 years of
age''; and
(B) in the subdivision (B) that follows paragraph
(29), by inserting ``(other than services described in
subparagraph (B) of paragraph (16) for individuals
described in such subparagraph)'' after ``patient in an
institution for mental diseases''; and
(2) in subsection (h), by adding at the end the following
new paragraph:
``(3) For purposes of subsection (a)(16)(B), the term
`qualified inpatient psychiatric hospital services'' means,
with respect to individuals described in such subsection,
services described in subparagraphs (A) and (B) of paragraph
(1) that are furnished in an acute care psychiatric unit in a
State-operated psychiatric hospital or a psychiatric hospital
(as defined section 1861(f)) if such unit or hospital, as
applicable, has a facility-wide average (determined on an
annual basis) length of stay of less than 20 days.''.
(c) Study and Report.--
(1) Study.--The Secretary shall conduct a study to
determine the impact of the amendments made by this section on
the Medicaid IMD exclusion.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall submit to Congress a
report containing the results of the study conducted under
paragraph (1). The report shall include the following
information:
(A) An assessment of the level of State
expenditures on short-term acute inpatient psychiatric
hospital care for which no Federal financial
participation is provided for the most recent State
fiscal year ending prior to the effective date of the
amendments made by this section and an analysis of the
impact of the changes to the Medicaid IMD exclusion
made by such amendments on State expenditures for such
care.
(B) An assessment of the extent to which States
used disproportionate share hospital payment
adjustments described in section 1923 of the Social
Security Act (42 U.S.C. 1396r-4) to fund short-term
acute inpatient psychiatric hospital care prior to the
effective date of the amendments made by this section
and an analysis of the impact of the changes to the
Medicaid IMD exclusion made by such amendments on the
use of such payment adjustments to fund such care.
(C) The total amount by which State expenditures
and the extent to which States use disproportionate
share hospital payment adjustments for short-term acute
inpatient psychiatric hospital care have been reduced
due to the changes to the Medicaid IMD exclusion made
by the amendments made by this section.
(D) Recommendations for strategies to encourage
States to reinvest savings in State expenditures and
disproportionate share hospital payment adjustments
that result from the changes to the Medicaid IMD
exclusion made by the amendments made by this section
in community-based mental health services.
(3) Definitions.--For purposes of this subsection:
(A) Medicaid imd exclusion.--The term ``Medicaid
IMD exclusion'' means the prohibition on Federal
matching payments under Medicaid for care or services
provided to patients who have attained age 22, but have
not attained age 65, in an institution for mental
diseases under subdivision (B) of the matter following
paragraph (29) of section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)).
(B) Secretary.--The term ``Secretary'' means the
Secretary of Health and Human Services.
(C) Short-term acute inpatient psychiatric hospital
care.--The term ``short-term acute inpatient
psychiatric hospital care'' means care provided in
either--
(i) an acute-care psychiatric unit with an
average annual length of stay of fewer than 20
days that is operated within a State-operated
psychiatric hospital; or
(ii) a psychiatric hospital with an average
length of stay of fewer than 20 days on an
annual basis.
(d) Effective Date.--
(1) In general.--Subject to paragraphs (2) and (3), the
amendments made by this section shall apply to items and
services furnished after the first day of the first calendar
year that begins after the date of the enactment of this
section.
(2) Certification of no increased spending.--The amendments
made by this section shall not be effective unless the Chief
Actuary of the Centers for Medicare & Medicaid Services
certifies that the inclusion of qualified inpatient psychiatric
hospital services (as defined by paragraph (3) of section
1905(h) of the Social Security Act (42 U.S.C. 1396d(h)), as
added by subsection (b)) furnished to nonelderly adults as
medical assistance under section 1905(a) of the Social Security
Act (42 U.S.C. 1396d(a)), as amended by subsection (b), would
not result in any increase in net program spending under title
XIX of such Act.
(3) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act, which
the Secretary of Health and Human Services determines requires
State legislation in order for the respective plan to meet any
requirement imposed by amendments made by this section, the
respective plan shall not be regarded as failing to comply with
the requirements of such title solely on the basis of its
failure to meet such an additional requirement before the first
day of the first calendar quarter beginning after the close of
the first regular session of the State legislature that begins
after the date of enactment of this section. For purposes of
the previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
SEC. 602. MODIFICATIONS TO MEDICARE DISCHARGE PLANNING REQUIREMENTS.
Section 1861(ee) of the Social Security Act (42 U.S.C. 1395x(ee))
is amended--
(1) in paragraph (1), by inserting ``and, in the case of a
psychiatric hospital or a psychiatric unit (as described in the
matter following clause (v) of section 1886(d)(1)(B)), if it
also meets the guidelines and standards established by the
Secretary under paragraph (4)'' before the period at the end;
and
(2) by adding at the end the following new paragraph:
``(4) The Secretary shall develop guidelines and standards,
in addition to those developed under paragraph (2), for the
discharge planning process of a psychiatric hospital or a
psychiatric unit (as described in the matter following clause
(v) of section 1886(d)(1)(B)) in order to ensure a timely and
smooth transition to the most appropriate type of, and setting
for, posthospital or rehabilitative care. The Secretary shall
issue final regulations implementing such guidelines and
standards not later than 24 months after the date of the
enactment of this paragraph. The guidelines and standards shall
include the following:
``(A) The hospital or unit must identify the types
of services needed upon discharge by a patient being
treated by the hospital or unit.
``(B) The hospital or unit must--
``(i) identify organizations that offer
community services to the community that is
served by the hospital or unit and the types of
services provided by the organizations; and
``(ii) make demonstrated efforts to
establish connections, relationships, and
partnerships with such organizations.
``(C) The hospital or unit must arrange (with the
participation of the patient and of any other
individuals selected by the patient for such purpose)
for the development and implementation of a discharge
plan for the patient as part of the patient's overall
treatment plan from admission to discharge. Such
discharge plan shall meet the requirements described in
subparagraphs (G) and (H) of paragraph (2).
``(D) The hospital or unit shall coordinate with
the patient (or assist the patient with) the referral
for posthospital or rehabilitative care and as part of
that referral the hospital or unit shall include
transmitting to the receiving organization, in a timely
manner, appropriate information about the care
furnished to the patient by the hospital or unit and
recommendations for posthospital or rehabilitative care
to be furnished to the patient by the organization.''.
TITLE VII--RESEARCH BY NATIONAL INSTITUTE OF MENTAL HEALTH
SEC. 701. INCREASE IN FUNDING FOR CERTAIN RESEARCH.
Section 402A(a) of the Public Health Service Act (42 U.S.C.
282a(a)) is amended by adding at the end the following:
``(3) Funding for the brain initiative at the national
institute of mental health.--
``(A) Funding.--In addition to amounts made
available pursuant to paragraphs (1) and (2), there are
authorized to be appropriated to the National Institute
of Mental Health for the purposes described in
subparagraph (B) $40,000,000 for each of fiscal years
2017 through 2021.
``(B) Purposes.--Amounts appropriated pursuant to
subparagraph (A) shall be used exclusively for the
purpose of conducting or supporting--
``(i) research on the determinants of self-
and other directed-violence in mental illness,
including studies directed at reducing the risk
of self harm, suicide, and interpersonal
violence; or
``(ii) brain research through the Brain
Research through Advancing Innovative
Neurotechnologies Initiative.''.
TITLE VIII--SAMHSA REAUTHORIZATION AND REFORMS
Subtitle A--Organization and General Authorities
SEC. 801. PEER REVIEW.
(a) Section 501(h) of the Public Health Service Act (42 U.S.C.
290aa(h)) is amended by inserting at the end the following: ``In the
case of any such peer-review group that is reviewing a proposal or
grant related to mental illness, no fewer than half of the members of
the group shall have a medical degree, a doctoral degree in psychology,
or advanced degree in nursing or social work from an accredited
graduate school, and shall specialize in the mental health field.''.
(b) Section 504 of the Public Health Service Act (42 U.S.C. 290aa-
3) is amended by adding at the end of subsection (b) the following:
``At least half of the members of any peer-review group established
under subsection (a) shall have a medical degree, a doctoral degree in
psychology, or advanced degree in nursing or social work from an
accredited graduate school, and shall specialize in the mental health
field.''.
SEC. 802. ADVISORY COUNCILS.
Paragraph (3) of section 502(b) of the Public Health Service Act
(42 U.S.C. 290aa-1(b)) is amended by adding at the end the following:
``(C) Not fewer than half of the members of the
group shall have a medical degree, a doctoral degree in
psychology, or advanced degree in nursing or social
work from an accredited graduate school and shall
specialize in the mental health field.
``(D) Each advisory committee shall include at
least one member of the National Institute of Mental
Health and 1 member from any Federal agency that has a
program serving a similar population.''.
SEC. 803. GRANTS FOR JAIL DIVERSION PROGRAMS REAUTHORIZATION.
Section 520G(i) of the Public Health Service Act (42 U.S.C. 290bb-
38(i)) is amended by striking ``$10,000,000 for fiscal year 2001, and
such sums as may be necessary for fiscal years 2002 through 2003'' and
inserting ``$5,000,000 for each of fiscal years 2017 through 2021''.
SEC. 804. PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS.
Section 535(a) of the Public Health Service Act (42 U.S.C. 290cc-
35(a)) is amended by striking ``$75,000,000 for each of the fiscal
years 2001 through 2003'' and inserting ``$65,000,000 for each of
fiscal years 2017 through 2021''.
SEC. 805. COMPREHENSIVE COMMUNITY MENTAL HEALTH SERVICES FOR CHILDREN
WITH SERIOUS EMOTIONAL DISTURBANCES.
Section 565 of the Public Health Service Act (42 U.S.C. 290ff-4) is
amended--
(1) in subsection (b)(1), by striking ``receiving a grant
under section 561(a)'' and inserting ``(irrespective of whether
the public entity is in receipt of a grant under section
561(a))'';
(2) in subsection (b)(1)(B), by striking ``pursuant to
section 562'' and inserting ``described in section 562''; and
(3) in subsection (f)(1), by striking ``$100,000,000 for
fiscal year 2001, and such sums as may be necessary for each of
the fiscal years 2002 and 2003'' and inserting ``$117,000,000
for each of fiscal years 2017 through 2021''.
SEC. 806. REAUTHORIZATION OF PRIORITY MENTAL HEALTH NEEDS OF REGIONAL
AND NATIONAL SIGNIFICANCE.
Section 520A(f)(1) of the Public Health Service Act (42 U.S.C.
290bb-32(f)(1)) is amended by striking ``$300,000,000 for fiscal year
2001, and such sums as may be necessary for each of the fiscal years
2002 and 2003'' and inserting ``$370,000,000 for each of fiscal years
2017 through 2021''.
TITLE IX--MENTAL HEALTH PARITY
SEC. 901. GAO STUDY ON PREVENTING DISCRIMINATORY COVERAGE LIMITATIONS
FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS AND SUBSTANCE
USE DISORDERS.
Not later than 1 year after the date of enactment of this Act, the
Comptroller General of the United States, in consultation with the
Assistant Secretary for Mental Health and Substance Use Disorders, the
Secretary of Health and Human Services, the Secretary of Labor, and the
Secretary of the Treasury, shall submit to Congress a report detailing
the extent to which covered group health plans (or health insurance
coverage offered in connection with such plans), including Medicaid
managed care plans under section 1903 of the Social Security Act (42
U.S.C. 1396b), comply with the Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008 (subtitle B of title V
of division C of Public Law 110-343) (in this section referred to as
the ``law''), including--
(1) how nonquantitative treatment limitations, including
medical necessity criteria, of covered group health plans
comply with the law;
(2) how the responsible Federal departments and agencies
ensure that plans comply with the law; and
(3) how proper enforcement, education, and coordination
activities within responsible Federal departments and agencies
can be used to ensure full compliance with the law, including
educational activities directed to State insurance
commissioners.
SEC. 902. REPORT ON INVESTIGATIONS REGARDING PARITY IN MENTAL HEALTH
AND SUBSTANCE USE DISORDER BENEFITS.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, and annually thereafter, the Administrator of the Centers
for Medicare & Medicaid Services, in collaboration with the Assistant
Secretary of Labor of the Employee Benefits Security Administration and
the Secretary of the Treasury, and in consultation with the Assistant
Secretary for Mental Health and Substance Use Disorders, shall submit
to Congress a report--
(1) identifying Federal investigations conducted or
completed during the preceding 12-month period regarding
compliance with parity in mental health and substance use
disorder benefits, including benefits provided to persons with
serious mental illness and substance use disorders, under the
Paul Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008 (subtitle B of title V of division
C of Public Law 110-343); and
(2) summarizing the results of such investigations.
(b) Contents.--Subject to subsection (c), each report under
subsection (a) shall include the following information:
(1) The number of investigations opened and closed during
the covered reporting period.
(2) The benefit classification or classifications examined
by each investigation.
(3) The subject matter or subject matters of each
investigation, including quantitative and nonquantitative
treatment limitations.
(4) A summary of the basis of the final decision rendered
for each investigation.
(c) Limitation.--Individually identifiable information shall be
excluded from reports under subsection (a) consistent with Federal
privacy protections.
SEC. 903. STRENGTHENING PARITY IN MENTAL HEALTH AND SUBSTANCE USE
DISORDER BENEFITS.
Section 2726(a) of the Public Health Service Act (42 U.S.C. 300gg-
26(a)) is amended by adding at the end the following new paragraph:
``(6) Disclosure and enforcement requirements.--
``(A) Disclosure requirements.--
``(i) Regulations.--Not later than March 1,
2016, the Secretary, in cooperation with the
Secretary of Labor and the Secretary of the
Treasury shall issue additional regulations or
sub-regulatory guidance for carrying out this
section, including an explanation of documents
that are required to be disclosed, and analyses
that are required to be conducted, including
how non-quantitative treatment limitations are
applied to mental health or substance use
disorder benefits and medical or surgical
benefits covered under the plan, by a group
health plan (or health insurance issuer)
offering health insurance coverage in the group
or individual market in order for such plan or
issuer to demonstrate compliance with the
provisions of this section. The disclosure
requirements shall include a report detailing
the specific analyses performed to develop a
compliance review of the requirements of the
Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008,
including the amendments made by such Act. With
respect to non-quantitative treatment
limitations, this report shall--
``(I) identify the specific factors
used by the plan in performing its non-
quantitative treatment limitations
analysis;
``(II) identify and define the
specific evidentiary standards relied
on to evaluate the factors;
``(III) describe how the
evidentiary standards were applied to
each service category;
``(IV) disclose the results of the
analyses of the specific evidentiary
standards in each service category; and
``(V) disclose the plan's specific
findings in each service category and
the conclusions reached with respect to
compliance with comparability and
stringency of application tests under
the non-quantitative treatment
limitations rule.
``(ii) Guidance.--The Secretary, in
cooperation with the Secretary of Labor and the
Secretary of the Treasury shall issue guidance
to group health plans and health insurance
issuers offering health insurance coverage in
the group or individual markets on how to
satisfy the requirements of this section with
respect to making information, including
certificate of coverage documents and
instruments under which the plan is
administered and operated that specify,
include, or refer to procedures, formulas, and
methodologies applied to determine a
participant or beneficiary's benefit under the
plan, regardless of whether such information is
contained in a document designated as the `plan
document' available to current and potential
participants and beneficiaries. This guidance
shall include plan disclosure of how the plan
has met the 2-part test under the non-
quantitative treatment limitations rule of
comparability and stringency in application.
``(B) Enforcement.--
``(i) Process for complaints.--The
Secretary, in cooperation with the Secretary of
Labor and the Secretary of the Treasury, as
appropriate, shall, with respect to group
health plans and health insurance issuers
offering health insurance coverage in the group
or individual market, issue guidance to clarify
the process and timeline for current and
potential participants and beneficiaries and
their authorized representatives and providers
with respect to such plans and coverage to file
formal complaints of such plans or issuers
being in violation of this section, including
guidance on the relevant individual State,
regional, and national offices with which such
claims should be filed by plan type.
``(ii) Authority for public enforcement.--
The Secretary shall make available to the
public de-identified information on audits and
investigations of group health plans and health
insurance issuers conducted under this section.
``(iii) Audits.--
``(I) Randomized audits.--The
Secretary is authorized to conduct
randomized audits of group health plans
and health insurance issuers offering
health insurance coverage in the group
or individual market to determine
compliance with this section. Such
audits shall be conducted on no fewer
than 12 plans and issuers per plan
year. The information shall be made
plainly available on the public
Internet websites of the Department of
Health and Human Services and the
Department of Labor.
``(II) Additional audits.--In the
case of a group health plan or health
insurance issuer offering health
insurance coverage in the group or
individual market with respect to which
at least 5 substantiated claims of the
same type of non-compliance with this
section have been filed during a plan
year, the Secretary shall audit plan
documents to determine compliance with
this section. Information detailing the
results of the audit shall be made
available on the public Internet
website of the Department of Health and
Human Services.''.
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