[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2223 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 2223
To authorize the Secretary of Health and Human Services to make loans,
loan guarantees, and grants for purchasing, planning, constructing, or
renovating pediatric or adult mental health treatment facilities and
pediatric or adult substance use disorder treatment facilities, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 18, 2025
Ms. Salinas (for herself and Ms. Balint) introduced the following bill;
which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To authorize the Secretary of Health and Human Services to make loans,
loan guarantees, and grants for purchasing, planning, constructing, or
renovating pediatric or adult mental health treatment facilities and
pediatric or adult substance use disorder treatment facilities, 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.
This Act may be cited as the ``Building Capacity for Care Act''.
SEC. 2. LOANS AND LOAN GUARANTEES.
Part P of title III of the Public Health Service Act is amended by
inserting after section 399V-7 of such Act (42 U.S.C. 280g-17) the
following:
``SEC. 399V-8. LOANS, LOAN GUARANTEES, AND GRANTS FOR PURCHASING,
PLANNING, CONSTRUCTING, OR RENOVATING ELIGIBLE FACILITIES
FOR PEDIATRIC OR ADULT MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES.
``(a) In General.--The Secretary may--
``(1) make loans, loan guarantees, or grants to eligible
entities for the purpose of--
``(A) purchasing, constructing, or renovating,
including planning the purchase, construction, or
renovation of, a pediatric or adult mental health
treatment facility or a pediatric or adult substance
use disorder treatment facility;
``(B) improving digital infrastructure, telehealth
capabilities, or other patient care infrastructure at
such a facility; or
``(C) adding, or converting beds to, adult,
adolescent, or pediatric psychiatric and substance use
inpatient beds at such a facility; and
``(2) subject to subsection (f), make loans and loan
guarantees for refinancing loans that were made for such
purpose to an eligible entity.
``(b) Eligible Entities.--An entity shall be eligible to receive a
loan, loan guarantee, or grant under this section if--
``(1) such entity is a public, private for-profit, and
private not-for-profit--
``(A) hospital, including a general acute hospital,
psychiatric hospital, critical access hospital, rural
emergency hospital, sole community hospital, children's
hospital, or other hospital as specified by the
Secretary;
``(B) substance use disorder treatment facility;
``(C) mental health treatment facility;
``(D) facility that employs licensed mental health
and substance use disorder professionals, such as child
and adult psychiatrists, child and adult psychologists,
advanced practice nurses, social workers, licensed
professional counselors, or other licensed
professionals that provide mental health or substance
use disorder services to pediatric or adult patients;
``(E) alliance of hospitals or facilities listed in
any of subparagraphs (A), (B), (C), or (D); and
``(F) health care facility, as determined by the
Secretary; and
``(2) such entity proposes to purchase, construct, or
renovate a pediatric or adult mental health treatment facility,
or a pediatric or adult substance use disorder treatment
facility, that will--
``(A) increase the number of pediatric, adolescent,
or adult psychiatric beds or pediatric, adolescent, or
adult substance use disorder beds in a county that has
insufficient psychiatric or substance use disorder
treatment bed capacity;
``(B) provide mental health or substance use
disorder services in a high-need rural or
underresourced community;
``(C) provide multiple services across the
continuum of mental health or substance use disorder
care; or
``(D) have the capacity to provide integrated or
specialized mental health and substance use disorder
care for complex cases or patients with medical co-
morbidities.
``(c) Application.--An eligible entity seeking a loan, loan
guarantee, or grant under this section shall submit to the Secretary an
application at such time and in such manner as the Secretary may
specify. Such application shall contain the proposal of the entity to
purchase, construct, or renovate a pediatric or adult mental health
treatment facility, or a pediatric or adult substance use disorder
treatment facility (as described in subsection (b)(2)) and such other
information as the Secretary may specify.
``(d) Geographic Preference for Grants.--In making grants under
this section, the Secretary shall give preference to eligible entities
located in--
``(1) a mental health professional shortage area, as
designated under section 332;
``(2) a county (or a municipality, if not contained within
any county) where the mean drug overdose death rate per 100,000
people over the past 3 years for which official data is
available from the State, is higher than the most recent
available national average overdose death rate per 100,000
people, as reported by the Centers for Disease Control and
Prevention; or
``(3) a county (or a municipality, if not contained within
any county) where the mean suicide rate per 100,000 people over
the past 3 years for which official data is available from the
State, is higher than the most recent available national
average suicide rate per 100,000 people, as reported by the
Centers for Disease Control and Prevention.
``(e) Terms and Conditions.--Loans and loan guarantees under this
section shall be made on such terms and conditions as the Secretary may
prescribe, subject to the provisions of this section including the
following:
``(1) The Secretary may allow credit to a prospective
borrower only where--
``(A) it is necessary to increase the number of
psychiatric or substance use disorder treatment
facilities to enhance the public's access to a
comprehensive continuum of mental health and substance
use disorder services; and
``(B) a credit subsidy is the most efficient way to
achieve such increase (on a borrower-by-borrower
basis).
``(2) The final maturity of loans made or guaranteed under
this section shall not exceed a period of 20 years, or the
period of 50 percent of the useful life of any physical asset
to be financed by the loan, whichever is less, as determined by
the Secretary.
``(3) The Secretary may not make a loan guarantee under
this section, with respect to any borrower, in excess of 80
percent of any potential loss on the loan.
``(4) The Secretary may not make any loan or loan guarantee
under this section if the loan will be subordinated--
``(A) to another debt contracted by the borrower;
or
``(B) to any other claims against the borrower in
the case of default.
``(5) The Secretary may not make any loan guarantee under
this section unless the Secretary determines that--
``(A) the lender is responsible; and
``(B) adequate provision is made for servicing the
loan on reasonable terms and protecting the financial
interest of the United States.
``(6) The Secretary may not make any loan guarantee under
this section if the income from the loan will be excluded from
gross income for purposes of chapter 1 of the Internal Revenue
Code of 1986.
``(7) The Secretary may not make any loan or loan guarantee
under this section unless--
``(A) the loan and interest supplements on any loan
guarantee will be at an interest rate that is set by
reference to a benchmark interest rate on marketable
Treasury securities with a similar maturity to the loan
being made or guaranteed; and
``(B) the minimum interest rate on the loan--
``(i) will be no less than the estimated
cost to the Government of making the loan plus
1 percent, with the goal of keeping the
interest rate below the interest rate of a
comparable and competitive private sector
benchmark financial instrument; and
``(ii) will be adjusted, as determined by
the Secretary, every quarter to take account of
changes in the interest rate of the benchmark
financial instrument.
``(8) The Secretary may not make any loan or loan guarantee
under this section unless--
``(A) fees or premiums on the loan or loan
guarantee and corresponding insurance coverage will be
set at levels that minimize the cost to the Government
(as defined in section 502(5) of the Federal Credit
Reform Act of 1990) of insuring such loan or loan
guarantee, while supporting achievement of enhancing
the public's access to a comprehensive continuum of
mental health and substance use disorder services,
including increasing the number of inpatient
psychiatric and substance use disorder bed counts in
areas with insufficient bed capacity;
``(B) the minimum guarantee fee or insurance
premium imposed by the Government will be no less than
the level sufficient to cover all of the estimated
costs to the Government of the expected default claims,
plus one percent; and
``(C) loan guarantee fees imposed by the Government
will be reviewed every six months to ensure that the
fees imposed on new loan guarantees are at a level
sufficient to satisfy subparagraph (B) based on the
most recent estimates of such costs.
``(9) The provisions of any loan guarantee under this
section shall state that the guarantee is conclusive evidence
that--
``(A) the guarantee has been properly obtained;
``(B) the underlying loan qualified for the
guarantee; and
``(C) except in the case of fraud or material
misrepresentation by the holder of the loan, the
guarantee will be presumed to be valid, legal, and
enforceable.
``(10) The Secretary may not make any loan or loan
guarantee under this section unless--
``(A) the borrower finances at least 25 percent of
the funded project from other sources; and
``(B) the borrower uses funds that were not derived
from Federal loans or loan guarantees to pay the fees
or premiums on the loan or loan guarantee under this
section.
``(11) The Secretary--
``(A) shall prescribe explicit standards for use in
periodically assessing the credit risk of new and
existing direct loans and guaranteed loans; and
``(B) shall not make a loan or loan guarantee under
this section unless the Secretary finds that there is a
reasonable assurance of repayment.
``(f) Limitation on Refinancing.--The authority vested by
subsection (a)(2)--
``(1) authorizes making loans and loan guarantees only for
refinancing loans that are entered into on or before the date
that is 24 months before the date of enactment of the Mental,
Behavioral, and Substance Use Disorder Treatment Infrastructure
and Capacity Act; and
``(2) terminates on the date that is 24 months after such
date of enactment.
``(g) Payment of Losses.--
``(1) Default on guaranteed loans.--If, as a result of a
default by a borrower under a loan guaranteed under this
section, after the holder thereof has made such further
collection efforts and instituted such enforcement proceedings
as the Secretary may require, the Secretary determines that the
holder has suffered a loss--
``(A) the Secretary shall pay to such holder 75
percent of such loss, as specified in the guarantee
contract;
``(B) upon making any such payment, the Secretary
shall be subrogated to all the rights of the recipient
of the payment; and
``(C) the Secretary shall be entitled to recover
from the borrower the amount of any payments made
pursuant to the guarantee contract.
``(2) Required enforce of federal rights.--The Attorney
General of the United States shall take such action as may be
appropriate to enforce any right accruing to the United States
as a result of the issuance of any guarantee under this
section.
``(3) Forbearance.--Nothing in this section precludes any
forbearance for the benefit of the borrower of a loan that is
made or guaranteed under this section which is agreed upon by
the parties to the loan and approved by the Secretary, provided
that budget authority for any resulting cost to the Government
(as defined in section 502(5) of the Federal Credit Reform Act
of 1990) is available.
``(h) Definitions.--In this section:
``(1) The term `children's hospital' means a hospital that
predominantly serves patients under the age of 18.
``(2) The term `critical access hospital' has the meaning
given to such term in section 1861(mm) of the Social Security
Act.
``(3) The term `mental health treatment facility'--
``(A) includes--
``(i) a child or adult outpatient facility
that provides--
``(I) intensive outpatient
services;
``(II) partial hospitalization
services;
``(III) crisis intervention and
stabilization; or
``(IV) other mental, behavioral, or
emotional health services deemed
appropriate by the Secretary;
``(ii) a hospital (including a general
acute hospital, a psychiatric hospital, a
critical access hospital, a rural emergency
hospital, a sole community hospital, a
children's hospital, or other type of hospital
as specified by the Secretary) that--
``(I) provides acute, short-term
inpatient psychiatric treatment
services or outpatient services; and
``(II) may include a military
services program to meet the needs of
active and retired military
servicemembers; and
``(iii) a facility within or near an
emergency department for providing discharge
planning and instructions to emergency
department patients in need of mental health or
substance use disorder treatment and transfer
to an appropriate mental health or substance
use disorder treatment care setting; and
``(B) excludes a facility that provide long-term
inpatient care.
``(4) The term `substance use disorder treatment
facility'--
``(A) includes--
``(i) a child or adult outpatient facility
that provides outpatient substance use disorder
services; and
``(ii) a hospital (including a general
acute hospital, a psychiatric hospital, a
critical access hospital, a rural emergency
hospital, a sole community hospital, a
children's hospital, or other type of hospital
as specified by the Secretary) that--
``(I) provides acute, short-term
inpatient substance use disorder
treatment services or outpatient
services; and
``(II) may include a military
services program to meet the needs of
active and retired military
servicemembers; and
``(B) excludes any facility described in paragraph
(1)(B).
``(5) The term `psychiatric hospital' has the meaning given
to such term in section 1861(f) of the Social Security Act.
``(6) The term `rural emergency hospital' has the meaning
given to such term in section 1861(kkk) of the Social Security
Act.
``(7) The term `sole community hospital' has the meaning
given to such term in section 1886(d)(5)(D)(iii) of the Social
Security Act.
``(i) Funding.--
``(1) Limitations for loans and loan guarantees.--The
Secretary may provide loans and loan guarantees under this
section--
``(A) only to the extent or in the amounts provided
in advance in appropriation Acts; and
``(B) totaling not more than $200,000,000 for each
of fiscal years 2025 through 2029.
``(2) Authorization of appropriations for grants.--There is
authorized to be appropriated to the Secretary to make grants
under this section $200,000,000 for each of fiscal years 2025
through 2029.''.
SEC. 3. MENTAL HEALTH AND SUBSTANCE USE TREATMENT TRUST FUND.
(a) Establishment.--There is established in the Treasury of the
United States a trust fund to be known as the Mental Health and
Substance Use Treatment Trust Fund (in this section referred to as the
``Trust Fund'').
(b) Deposits.--There are hereby authorized to be appropriated to
the Trust Fund, to remain available until expended, amounts equivalent
to any revenues from the program of loans and loan guarantees under
section 399V-8 of the Public Health Service Act, as added by section 2,
that exceed the costs of carrying out such program.
(c) Use of Fund.--Amounts in the Trust Fund shall be available, as
provided by appropriation Acts, for block grants for community mental
health services under subpart I of part B of title XIX of the Public
Health Service Act (42 U.S.C. 300x et seq.).
<all>