Mental Health Draft Bill

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[DISCUSSION DRAFT]
113TH CONGRESS 2D SESSION
H. R. ll
Review: To improve mental healthFor messaging, how would you express the long title?.
IN THE HOUSE OF REPRESENTATIVES

Mr. BARBER introduced the following bill; which was referred to the Committee on llllllllllllll
A BILL
Review: To improve mental healthFor messaging, how would you express the long title?. 1 Be it enacted by the Senate and House of Representa-
2 tives of the United States of America in Congress assembled, 3 4

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.This Act may be cited as the
5 Strengthening Mental Health in Our Communities Act 6 of 2014. 7 (b) TABLE

OF
CONTENTS.The table of contents for
8 this Act is as follows:

Sec. 1. Short title; table of contents. Sec. 2. White House Office of Mental Health Policy.
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Sec. Sec. Sec. Sec. 3. 4. 5. 6. Appointment and duties of the Director. National strategy for mental health. Coordination with Federal departments and agencies. National mental health advisory board.
TITLE ISTRENGTHENING AND INVESTING IN SAMHSA PROGRAMS Sec. 101. Community mental health services block grant reauthorization. Sec. 102. Reporting requirements for block grants regarding mental health and substance use disorders. Sec. 103. Garrett Lee Smith Memorial Act Reauthorization. Sec. 104. Programs of regional and national significance reauthorization. Sec. 105. Grants for jail diversion programs reauthorization. Sec. 106. Comprehensive community mental health services for children with serious emotional disturbances. Sec. 107. Grants to address the problems of individuals who experience trauma and violence related stress. Sec. 108. Protection and advocacy for individuals with mental illness reauthorization. Sec. 109. Mental health awareness training grants. Sec. 110. National media campaign to reduce the stigma associated with mental illness. Sec. 111. SAMHSA and HRSA integration of mental health services into primary care settings. Sec. 112. Evidence-based practices for older Americans. TITLE IIIMPROVING MEDICAID AND MEDICARE MENTAL HEALTH SERVICES Sec. 201. Access to mental health prescription drugs under Medicare and Medicaid. Sec. 202. Medicaid Coverage of Mental Health Services and Primary Care Services Furnished on the Same Day. Sec. 203. Elimination of 190-day lifetime limit on inpatient psychiatric hospital services. Sec. 204. Discharge planning in psychiatric facilities. Sec. 205. Coverage of intensive outpatient services. Sec. 206. Expanding the Medicaid home and community-based services waiver to include youth in need of services provided in a psychiatric residential treatment facility. Sec. 207. Application of Rosas Law for Individuals with Intellectual Disabilities. Sec. 208. Complete application of mental health parity rules under Medicaid and CHIP. TITLE IIIDEVELOPING THE BEHAVIORAL HEALTH WORKFORCE Sec. 301. National health service corps scholarship and loan repayment funding for behavioral and mental health professionals. Sec. 302. Reauthorization of HRSAs mental and behavioral health education and training program. Sec. 303. SAMHSA grant program for development and implementation of curricula for continuing education on serious mental illness.

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Sec. 304. Demonstration grant program to recruit, train, deploy, and professionally support psychiatric physicians in Indian health programs. Sec. 305. Including occupational therapists as behavioral and mental health professionals for purposes of the National Health Service Corps. Sec. 306. Coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program. Sec. 307. Extension of certain health care workforce loan repayment programs through fiscal year 2018. TITLE IVIMPROVING MENTAL HEALTH RESEARCH AND COORDINATION Sec. 401. National institute of mental health research program on serious mental illness. Sec. 402. Suicide prevention and brain research. Sec. 403. Youth mental health research network. Sec. 404. National violent death reporting system. TITLE VEDUCATION AND YOUTH Sec. 501. School-Based Mental Health Programs. Sec. 502. Improving mental health and behavioral health outcomes on college campuses. Sec. 503. Examining mental health care for children. TITLE VIJUSTICE AND MENTAL HEALTH COLLABORATION Sec. Sec. Sec. Sec. Sec. Sec. Sec. 601. 602. 603. 604. 605. 606. 607. Assisting veterans. Correctional facilities. High utilizers. Academy training. Evidence based practices. Safe communities. Reauthorization of appropriations.
TITLE VIIBEHAVIORAL HEALTH INFORMATION TECHNOLOGY Sec. 701. Extension of health information technology assistance for behavioral and mental health and substance abuse. Sec. 702. Extension of eligibility for medicare and Medicaid health information technology implementation assistance. TITLE VIIISERVICE MEMBERS AND VETERANS MENTAL HEALTH Sec. 801. Preliminary mental health assessments. Sec. 802. Extension of eligibility for domiciliary care for certain veterans who served in a theater of combat operations. Sec. 803. Review of characterization or terms of discharge from the Armed Forces of individuals with mental health disorders alleged to affect terms of discharge. Sec. 804. Improvement of mental health care provided by Department of Veterans Affairs and Department of Defense. Sec. 805. Collaboration between Department of Veterans Affairs and Department of Defense on health care matters.
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Sec. 806. Pilot program for repayment of educational loans for certain psychiatrists of Veterans Health Administration. Sec. 807. Comptroller General study on pay disparities of psychiatrists of Veterans Health Administration. TITLE IXMAKING PARITY WORK Sec. 901. Clarification of HIPAA training requirements regarding disclosure of protected health information concerning individuals with mental health disorders. Sec. 902. GAO study on mental health parity enforcement efforts. Sec. 903. Report to Congress on Federal assistance to State insurance regulators regarding mental health parity enforcement.
1 2
SEC. 2. WHITE HOUSE OFFICE OF MENTAL HEALTH POLICY.
(a) ESTABLISHMENT
OF
OFFICE.There is estab-
3 lished in the Executive Office of the President the White 4 House Office of Mental Health Policy (hereafter referred 5 to as the Office), which shall 6 7 8 9 10 11 12 13 14 15 16 17 18 (1) monitor Federal activities with respect to mental health and serious mental illness; (2) make recommendations to the Secretary of Health and Human Services regarding any appropriate changes to such activities, including recommendations to the Director of the National Institutes of Health with respect to the national strategy developed under paragraph (3); (3) develop and annually update a National Strategy for Mental Health to improve outcomes for individuals with mental illness and maximize the efficiency and effectiveness of community-based mental health programs and services;

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5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (4) make recommendations to the Secretary of Health and Human Services regarding public participation in decisions relating to serious mental illness; (5) review and make recommendations with respect to the budgets for Federal mental health services to ensure the adequacy of those budgets; (6) submit to the Congress the national strategy and any updates to such strategy; (7) coordinate the mental health services provided by Federal departments and agencies and coordinate Federal interagency mental health services; (8) 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, with respect to improving mental health services; and (9) develop and annually update a summary of advances in serious mental illness research related to causes, prevention, treatment, early screening, diagnosis or rule out, intervention, and access to services and supports for individuals with serious mental illness.

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6 1 (b) DIRECTOR.There shall be a Director who shall
2 head the Office (hereafter referred to as the Director) 3 and who shall hold the same rank and status as the head 4 of an executive department listed in section 101 of title 5 5, United States Code. 6 (c) ACCESS
BY
CONGRESS.The location of the Of-
7 fice in the Executive Office of the President shall not be 8 construed as affecting access by Congress, or any com9 mittee of the House of Representatives or the Senate, to 10 any 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) information, document, or study in the possession of, or conducted by or at the direction of, the Director; or (2) personnel of the Office.
SEC. 3. APPOINTMENT AND DUTIES OF THE DIRECTOR.
(a) APPOINTMENT. (1) IN

GENERAL.The
President shall appoint
the Director, by and with the advice and consent of the Senate. The Director shall serve at the pleasure of the President. (2) PROHIBITIONS. (A) OTHER
POSITIONS.No
person shall
serve as Director while serving in any other position in the Federal Government or while em-

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7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ployed in a full-time position outside of the Federal Government. (B) POLITICAL

CAMPAIGNING.The
Direc-
tor may not participate in election campaign activities, except that the Director is not prohibited by this subparagraph from making contributions to individual candidates. (b) RESPONSIBILITIES.The Director shall (1) assist the President to establish policies, goals, objectives, and priorities with respect to mental health, particularly serious mental illness, and to improve outcomes for individuals with mental illness and maximize the efficiency and effectiveness of community-based mental health programs and services; (2) work with Federal departments and agencies providing mental health services to strengthen the coordination of mental health services in order to maximize the access of individuals with a mental illness, particularly individuals with a serious mental illness, to community-based services, strengthen the impact of services, and meet the comprehensive needs of individuals with a mental illness;

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8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (3) coordinate and oversee the development, coordination, implementation, and evaluation of the National Strategy for Mental Health; (4) promulgate National Strategy for Mental Health, ensuring its wide availability to government officials and the public; (5) make such recommendations to the President as the Director determines are appropriate with respect to the organization, management, and budgets of Federal departments and agencies providing mental health services, including changes in the allocation of personnel to and within those departments and agencies to implement the policies, goals, objectives, and priorities established under paragraph (1) and the National Strategy for Mental Health; (6) 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, with respect to improving mental health services; (7) appear before duly constituted committees and subcommittees of the House of Representatives and of the Senate to represent the policies of the President related to mental health and serve as the

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9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 spokesperson of the President, if the President determines it appropriate, on issues related to mental health , and the National Strategy for Mental Health; (8) submit an annual report to Congress detailing how the Director has consulted and coordinated with the National Mental Health Council described in section 806, the National Mental Health Advisory Board, State, local, and tribal governments, nongovernmental entities, and individuals with a mental illness, particularly individuals with a serious mental illness; and (9) ensure the Office meets each of its responsibilities under this title. (c) BUDGET REVIEW AND RECOMMENDATIONS. (1) REVIEW
OF BUDGET REQUESTS.Each
de-
partment or agency of the Federal Government providing mental health services shall transmit each year to the Director a copy of the proposed budget request of that department or agency with respect to mental health services at a time not later than that department or agencys submitting of such budget request to the Office of Management and Budget for preparation of the budget of the President submitted to Congress under section 1105(a) of title 31,

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10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 United States Code. The proposed budget request shall be transmitted to the Director in such form as the Director, in consultation with the Office of Management and Budget, determines appropriate. (2) RECOMMENDATIONS
BUDGET REQUESTS.After WITH RESPECT TO
the receipt of proposed
budget requests pursuant to paragraph (1), the Director shall provide budget recommendations with respect to Federal mental health services to the Director of the Office of Management and Budget and to the President at a time that allows such recommendations to be incorporated into the budget of the President submitted to Congress under section 1105(a) of title 31, United States Code. The recommendations shall address funding priorities developed in the National Strategy for Mental Health and shall address future fiscal projections as determined by the Director. (d) POWERS
OF THE
DIRECTOR.In carrying out
20 this title, the Director may 21 22 23 24 (1) select, appoint, employ, and fix the compensation of such officers and employees of the Office as may be necessary to carry out the functions of the Office under this title;

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11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (2) request the head of a department or agency of the Federal Government to place department or agency personnel who are engaged in activities with respect to mental health, on temporary detail to another department or agency in order to implement the National Strategy for Mental Health, and the head of such department or agency shall comply with such request; (3) use for administrative purposes, on a reimbursable basis, the available services, equipment, personnel, and facilities of Federal, State, local, and tribal departments and agencies; (4) procure the services of experts and consultants in accordance with section 3109 of title 5, United States Code, relating to appointments in the Federal Service, at rates of compensation for individuals not to exceed the daily equivalent of the rate of pay payable under level IV of the Executive Schedule under section 5311 of title 5, United States Code; (5) use the mails in the same manner as any other department or agency of the executive branch; and (6) monitor implementation of the National Strategy for Mental Health, including

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12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (A) conducting program and performance audits and evaluations; and (B) requesting assistance from the Inspector General of the relevant department or agency in such audits and evaluations. (e) PERSONNEL DETAILED TO THE OFFICE. (1) EVALUATIONS.Notwithstanding any provision of chapter 43 of title 5, United States Code, the Director shall perform the evaluation of the performance of any employee detailed to the Office for the purposes of the applicable performance appraisal system established under such chapter for any rating period, or part thereof, that such employee is detailed to the Office. (2) COMPENSATION. (A) BONUS
PAYMENTS.Notwithstanding
any other provision of law, the Director may provide periodic bonus payments to any employee detailed to the Office. (B) RESTRICTIONS.An amount paid
under this paragraph to an employee for any period (i) shall not be greater than 20 percent of the basic pay paid or payable to such employee for such period; and

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13 1 2 3 4 5 6 7 8 9 10 11 (3) (ii) shall be in addition to the basic pay of such employee. AGGREGATE
AMOUNT.The
aggregate
amount paid during any fiscal year to an employee detailed to the Office as basic pay, awards, bonuses, and other compensation shall not exceed the annual rate payable at the end of such fiscal year for positions at level III of the Executive Schedule under section 5311 of title 5, United States Code.
SEC. 4. NATIONAL STRATEGY FOR MENTAL HEALTH.
(a) IN GENERAL.Not later than February 1 of each
12 year, the Director shall submit to the President and Con13 gress and make available to the public a National Strategy 14 for Mental Health (hereinafter referred to in this title as 15 the Strategy) that shall set forth a comprehensive plan 16 for that year to improve outcomes for individuals with 17 mental illness and maximize the efficiency and effective18 ness of community-based mental health programs and 19 services. 20 (b) PROCESS.In preparing the Strategy, the Direc-
21 tor shall actively consult and work in coordination with 22 the following: 23 24 25 (1) The heads of all Federal departments and agencies that provide mental health services. (2) The National Mental Health Council.

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14 1 2 3 4 5 6 7 8 9 10 (3) The National Mental Health Advisory Board. (4) Existing Federal interagency efforts related to mental health services, such as the Military and Veterans Mental Health Interagency Task Force. (5) State, local, and tribal governments. (6) Nongovernmental entities. (7) Individuals with mental illness, particularly individuals with a serious mental illness. (c) CONTENTS.The Director shall ensure the Strat-
11 egy meets the following requirements: 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) GOALS

AND PERFORMANCE MEASURES.
The Strategy shall contain comprehensive, researchbased goals and quantifiable performance measures that shall serve as targets for the year with respect to which the Strategy applies for (A) improving the outcomes of and accessibility to evidence-based mental programs and services; (B) promoting community integration of individuals with mental illness; (C) increasing access to prevention and early intervention services related to mental health;

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15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (D) promoting mental health awareness and reducing stigma; and (E) advancing mental health research. (2) ACCOUNTABILITY
MEASURES.The FOR PAST PERFORMANCE
Strategy shall contain a report on
Federal effectiveness with respect to meeting those performance measures set by the Strategy for the preceding year, including an evaluation of whether or not such performance measures were met and the reasons therefore, including (A) the extent of coordination between Federal departments and agencies providing mental health services; (B) the extent to which the objectives and budgets of Federal departments and agencies providing mental health services were consistent with the recommendations of the Strategy for the preceding year; and (C) the efficiency and adequacy of Federal programs and policies with respect to mental health services. (3) REPORTING
ON AND IDENTIFYING GAPS IN
MENTAL HEALTH SERVICES.The
Strategy shall
contain a report on

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16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (A) the mental health diagnoses,
disaggregated by age, race, gender, geographic distribution, population density, socioeconomic status, and other target populations determined necessary for inclusion by the Director; (B) the quality and quantity of mental health services for individuals with mental illness, disaggregated by age, race, gender, geographic distribution, population density, socioeconomic status, and other target populations determined necessary for inclusion by the Director; and (C) the size and allocation of Federal resources devoted to supporting individuals with mental illness, particularly serious mental illness, disaggregated by age, race, gender, geographic distribution, population density, socioeconomic status, and other target populations determined necessary for inclusion by the Director. (4) COORDINATION
EFFORTS.The
Strategy
shall contain a report on Federal efforts to consult, coordinate with, facilitate joint efforts among, and support State, local, and tribal governments, nongovernmental entities, and individuals with mental

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17 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 illness, particularly serious mental illness, including an evaluation of the effectiveness of those efforts. (5) GUIDANCE.The Strategy shall contain research-based guidance for assessing and improving the quality of mental health services that is responsive to gaps identified in mental health services, particularly for individuals with a serious mental illness. (6) MENTAL
SPECTIVES.The HEALTH ADVOCATES AND PER-
Strategy shall contain the views
and perspectives of individuals with mental illness, particularly individuals with serious mental illness, with respect to mental health services as prepared by the National Mental Health Advisory Board. (7) STRATEGIC
PLAN.The
Strategy shall con-
tain a plan to achieve the goals and performance measures set for the year with respect to which the Strategy applies, including the following: (A) Program and budget priorities necessary to achieve the performance measures. (B) Recommendations for improved Federal interagency coordination, such as shared grant application processes, grantee reporting requirements, training and technical assistance efforts, definitions, recipient eligibility requirements, research, evaluation efforts, and data

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18 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 collection, and recommendations for legislative changes necessary to achieve such interagency coordination and to facilitate the delivery of a comprehensive array of mental health services. (C) Recommendations for improved coordination between the Federal Government and State, local, and tribal governments, nongovernmental entities, and individuals with mental illness, particularly individuals with serious mental illness. (D) A strategic research, innovation, and demonstration agenda to guide the use of Federal research spending with respect to mental illness, particularly serious mental illness. (E) Recommendations to promote community integration of individuals with mental illness, consistent with the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and the Supreme Courts decision in Olmstead v. L.C. (8) ADDITIONAL
REPORTS.The
Strategy shall
contain additional reports the Director determines necessary, such as reports on the unmet needs of individuals with mental illness, international comparisons of mental health services and outcomes, or the

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19 1 2 3 4 5 6 status of implementation and enforcement of mental health parity.

SEC. 5. COORDINATION WITH FEDERAL DEPARTMENTS AND AGENCIES.
(a) FEDERAL DEPARTMENT

TION.Each
AND
AGENCY COOPERA-
department or agency of the Federal Gov-
7 ernment providing mental health services shall 8 9 10 11 12 13 14 15 16 17 18 19 (1) cooperate with the efforts of the Director under this title; (2) provide such assistance, statistics, studies, reports, information, and advice as the Director may request, to the extent permitted by law; (3) adjust department or agency staff job descriptions and performance measures to support collaboration and implementation of the Strategy; and (4) assign department or agency liaisons to the Office to oversee and implement interagency coordination. (b) INTERAGENCY ALIGNMENT.The Director, in
20 collaboration with the heads of Federal departments and 21 agencies providing mental health services, shall strengthen 22 the coordination of Federal mental health services in order 23 to maximize the access of individuals with mental illness, 24 particularly individuals with serious mental illness, to com25 munity-based mental health services, strengthen the im-

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20 1 pact of mental health services, and meet the comprehen2 sive needs of individuals with mental illness, particularly 3 individuals with serious mental illness, by, where appro4 priate 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 (1) facilitating the development of shared grant application processes; (2) offering joint training and technical assistance efforts; (3) improving opportunities for individuals with mental illness to maintain services as they transition from systems of care; (4) aligning (A) grantee reporting requirements; (B) definitions; (C) eligibility requirements; (D) research; (E) evaluation efforts; and (F) data collection; (5) making recommendations with respect to the legislative changes necessary to achieve the interagency alignment and coordination necessary to facilitate the delivery of a comprehensive array of mental health services; and

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21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (6) taking other steps necessary to improve collaboration between Federal departments and agencies providing mental health services. (c) JOINT FUNDING AND COORDINATION. (1) IN
GENERAL.The
Director, in consulta-
tion with the heads of Federal departments and agencies, may oversee the development and administration of initiatives involving multiple Federal departments and agencies, including initiatives that involve the integration of funding from different Federal departments and agencies to the extent permitted by law. (2) ADMINISTRATION
OF FUNDS.With
respect
to an initiative that involves the integration of funding from different Federal departments and agencies, the Federal department or agency principally involved in such an initiative, as determined by the Director, may be designated by the Director to act for all involved departments or agencies in administering funds for the initiative. (3) NONGOVERNMENTAL
ENTITIES.Initiatives
developed under this subsection may involve nongovernmental entities. (d) NATIONAL MENTAL HEALTH COUNCIL.

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22 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) ESTABLISHMENT.There is established within the Office the National Mental Health Council (hereinafter referred to in this title as the Council). (2) MEMBERS
AND TERMS.The
members of
the Council shall include (A) the President; (B) the Director; (C) the Secretary of Health and Human Services; (D) the Director of the National Institute of Mental Health; (E) the Attorney General of the United States; (F) the Secretary of Veterans Affairs; (G) the Assistant Secretary Indian Affairs of the Department of the Interior; (H) the Director of the Centers for Disease Control and Prevention; (I) the Director of the National Institutes of Health; (J) the directors of such national research institutes of the National Institutes of Health as the Director determines appropriate;

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23 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (K) representatives, appointed by the Director, of Federal agencies that are outside of the Department of Health and Human Services and serve individuals with serious mental illness, such as the Department of Education; (L) the Administrator of Substance Abuse and Mental Health Services Administration; (M) the Secretary of Defense; and (N) other Federal officials as directed by the President. (3) CHAIRPERSON.The Chairperson of the Council shall be the President. (4) DESIGNEES.Members of the Council may select a designee to perform duties under this subsection, but it is the sense of Congress that such members should refrain from doing so whenever possible. (5) MEETINGS. (A) IN
GENERAL.The
full membership of
the Council shall meet at the call of the Chairperson, but at least once each year. The Chairperson may call additional meetings composed of less than the full membership of the Council as needed.

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24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (B) FIRST
MEETING.The
first meeting of
the Council shall be not more than four months after the date of the enactment of this title. (C) INCLUSION
OF THE NATIONAL MENTAL
HEALTH ADVISORY BOARD.At
least one meet-
ing of the Council each year shall be opened to the participation of members of the National Mental Health Advisory Board. (6) RESPONSIBILITIES.The Council shall (A) assist the Director to coordinate the mental health services provided by Federal departments and agencies and to coordinate Federal interagency mental health services; (B) assist the Director in the development, coordination, implementation, evaluation, and promulgation of the Strategy; (C) assist the Director in soliciting and documenting ongoing input and recommendations with respect to mental health services and mental health outcomes, particularly for individuals with serious mental illness, from State, local, and tribal governments, nongovernmental entities, and individuals with mental illness, particularly individuals with serious mental illness; and

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25 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (D) ensure that members of the Council oversee the implementation of those sections of the Strategy for which each such members department or agency is responsible, as determined by the Director, and to report to the Director on such implementation and the results thereof. (7) COMPENSATION
PORTATION EXPENSES. AND TRAVEL AND TRANS-
(A) NO
COMPENSATION FOR SERVICE ON
COUNCIL.Each
member of the Council who is
not an officer or employee of the United States shall not receive pay by reason of the members service on the Council, and shall not be considered an officer or employee of the United States by reason of such service. Each member of the Council who is an officer or employee of the United States shall serve without compensation in addition to that received for the members service as an officer or employee of the United States. (B) TRAVEL
PENSES.Each AND TRANSPORTATION EX-
member of the Council may be
allowed travel or transportation expenses in accordance with section 5703 of title 5, United

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26 1 2 3 4 5 States Code, while away from the members home or regular place of business in performance of services for the Council.
SEC. 6. NATIONAL MENTAL HEALTH ADVISORY BOARD.
(a) ESTABLISHMENT.There is established within
6 the Office the National Mental Health Advisory Board 7 (hereinafter referred to in this title as the Board). 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (b) MEMBERS AND TERMS. (1) IN
GENERAL.Except
as provided in para-
graph (3), each member shall serve a two-year term. No member shall serve more than three terms. The Board shall be composed of non-Federal public members to be appointed by the Director, or which (A) at least 10 members, or 1/2 of total membership, whichever is greater, shall be individuals with a diagnosis of serious mental illness; (B) at least one such member shall be a parent or legal guardian of an individual with a serious mental illness; (C) at least one such member shall be a representative of leading research organization for individuals with serious mental illness;

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27 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (D) at least one such member shall be a representative of leading advocacy organization for individuals with serious mental illness; (E) at least one such member shall be a representative of leading research organization for individuals with serious mental illness; (F) at least one such member shall be a representative of leading community service organization for individuals with serious mental illness; (G) at least one member shall have served in a senior position in a state mental health system; (H) at least one member shall have served in a senior position in a local mental health system; (I) at least one member shall be a psychiatrist; (J) at least one member shall be a clinical psychologist; and (K) at least one member shall be a law enforcement officer. (2) SELECTION
PROCESS FOR THE INITIAL
MEMBERSHIP OF THE BOARD.The
Director shall
design an application and selection process to fill the

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28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
THE
initial membership of the Board. Political affiliation or views may not be taken into account in such application and selection process and relatives of elected officials shall not be eligible for membership. (3) SELECTION
BOARD PROCESS FOR MEMBERSHIP OF THE INITIAL MEMBER-
FOLLOWING
SHIP.The
initial membership of the Board shall
design an application and selection process to fill the membership of the Board for those terms following the term of the initial membership. Such application and selection process shall ensure that Board members select the membership that will follow that Board memberships term and, notwithstanding the two-year term requirement in paragraph (1), such application process shall ensure that not more than half of the terms of Board members expire in a given year. (4) CHAIRPERSON.The initial membership of the Board shall elect two members as co-chairs of the Board. Co-chairs shall serve a term of one year and the Board shall elect new co-chairs as vacancies arise. (c) MEETINGS.The Board shall meet in person not
24 fewer than four times each year. The Director shall re25 quest senior Federal Government officials to attend each

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29 1 of the four meetings, including requesting that the Council 2 attend one of the four meetings. The co-chairs of the 3 Board may call additional meetings online and by tele4 phone as determined necessary by the co-chairs. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (d) DUTIES.The Board shall (1) advise the President, the heads of Federal departments and agencies providing mental health services, and other senior Federal Government officials on proposed and pending legislation, budget expenditures, and other policy matters with respect to mental illness, particularly serious mental illness; (2) work in partnership with local organizations to solicit the views and perspectives of individuals with mental illness, particularly individuals with serious mental illness, and parents or legal guardians of individuals with mental illness, with respect to mental health services; (3) prepare a section of the Strategy outlining the views and perspectives of individuals with mental illness, particularly individuals with serious mental illness, with respect to mental health services; and (4) provide the Director evaluations of the staff support and training and technical assistance the Board has received.

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30 1 (e) PROCEDURES.The membership of the Board
2 shall, in consultation with the Director, determine the pro3 cedures of the Board. 4 (f) STAFF SUPPORT
AND
TRAINING
AND
TECHNICAL
5 ASSISTANCE. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 (1) IN
GENERAL.The
Director shall make
available, directly or through the funding of eligible organizations, the staff support and training and technical assistance necessary for the Board to fulfill the duties of the Board under this title. (2) ELIGIBLE
ORGANIZATION DESCRIBED.An
eligible organization under this subsection is a nonprofit organization that has demonstrated, as determined by the Director, special expertise and broad national experience in mental health policy.
TITLE ISTRENGTHENING AND INVESTING IN SAMHSA PROGRAMS

SEC. 101. COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT REAUTHORIZATION.
Section 1920(a) of the Public Health Service Act (42
22 U.S.C. 300x9(a)) is amended by striking $450,000,000 23 for fiscal year 2001, and such sums as may be necessary 24 for each of the fiscal years 2002 and 2003 and inserting

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31 1 $llll for each of fiscal years 2015 through 2019 2 The blank is to be filled in with the FY 2014 level.. 3 4 5 6
SEC. 102. REPORTING REQUIREMENTS FOR BLOCK GRANTS REGARDING MENTAL HEALTH AND SUB-
STANCE USE DISORDERS.
Section 1942 of the Public Health Service Act (42
7 U.S.C. 300x52) is amended to read as follows: 8 9 10

SEC. 1942. REQUIREMENT OF REPORTS AND AUDITS BY STATES.
(a) BLOCK GRANTS
FOR
COMMUNITY MENTAL
11 HEALTH SERVICES. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) ANNUAL

REPORT.A
funding agreement
for a grant under section 1911 is that (A) the State involved will prepare and submit to the Secretary an annual report on the activities funded through the grant; and (B) each such report shall be prepared by, or in consultation with, the State agency responsible for community mental health programs and activities. (2) STANDARDIZED
FORM; CONTENTS.In
order to properly evaluate and to compare the performance of different States assisted under section 1911, reports under this section shall be in such standardized form and contain such information as

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32 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 the Secretary determines (after consultation with the States) to be necessary (A) to secure an accurate description of the activities funded through the grant under section 1911; (B) to determine the extent to which funds were expended consistent with the States application transmitted under section 1917(a); and (C) to describe the extent to which the State has met the goals and objectives it set forth in its State plan under section 1912(b). (3) MINIMUM
CONTENTS.Each
report under
this section shall, at a minimum, include the following information: (A)(i) The number of individuals served by the State under subpart I (by class of individuals). (ii) The proportion of each class of such individuals which has health coverage. (iii) The types of services (as defined by the Secretary) provided under subpart I to individuals within each such class.

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33 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (iv) The amounts spent under subpart I on each type of service (by class of individuals served). (B) Information on the status of mental health in the State, including information (by county and by racial and ethnic group) on each of the following: (i) The proportion of adolescents with serious mental illness (including major depression). (ii) The proportion of adults with serious mental illness (including major depression). (iii) The proportion of individuals with co-occurring mental health and substance use disorders. (iv) The proportion of children and adolescents with mental health disorders who seek and receive treatment. (v) The proportion of adults with mental health disorders who seek and receive treatment. (vi) The proportion of individuals with co-occurring mental health and sub-

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[Discussion Draft]
34 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 stance use disorders who seek and receive treatment. (vii) The proportion of homeless adults with mental health disorders who receive treatment. (viii) The number of primary care facilities that provide mental health screening and treatment services onsite or by paid referral. (ix) The number of primary care physician office visits that include mental health screening services. (x) The number of juvenile residential facilities that screen admissions for mental health disorders. (xi) The number of deaths attributable to suicide. (C) Information on the number and type of health care practitioners licensed in the State and providing mental health-related services. (4) AVAILABILITY
OF REPORTS.The
Sec-
retary shall, upon request, provide a copy of any report under this section to any interested public agency.

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35 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (b) BLOCK GRANTS

MENT OF FOR
PREVENTION
AND
TREAT-
SUBSTANCE USE DISORDERS. (1) ANNUAL

REPORT.A
funding agreement
for a grant under section 1921 is that (A) the State involved will prepare and submit to the Secretary an annual report on the activities funded through the grant; and (B) each such report shall be prepared by, or in consultation with, the State agency responsible for substance use disorder programs and activities. (2) STANDARDIZED
FORM; CONTENTS.In
order to properly evaluate and to compare the performance of different States assisted under section 1921, reports under this section shall be in such standardized form and contain such information as the Secretary determines (after consultation with the States) to be necessary (A) to secure an accurate description of the activities funded through the grant under section 1921; (B) to determine the extent to which funds were expended consistent with the States application transmitted under section 1932(a); and

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36 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (C) to describe the extent to which the State has met the goals and objectives it set forth in its State plan under section 1932(b). (3) MINIMUM
CONTENTS.Each
report under
this section shall, at a minimum, include the following information: (A)(i) The number of individuals served by the State under subpart II (by class of individuals). (ii) The proportion of each class of such individuals which has health coverage. (iii) The types of services (as defined by the Secretary) provided under subpart II to individuals within each such class. (iv) The amounts spent under subpart II on each type of service (by class of individuals served). (B) Information on the status of substance use disorders in the State, including information (by county and by racial and ethnic group) on each of the following: (i) The proportion of adolescents using alcohol or other addictive drugs (including nicotine).

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37 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (ii) The proportion of adults (including pregnant women) using alcohol or other addictive drugs (including nicotine). (iii) The proportion of adolescents using prescription drugs for nonmedical purposes. (iv) The proportion of adults using prescription drugs for nonmedical purposes. (v) The number of individuals (including pregnant women) admitted to substance use disorder treatment programs (including group home arrangements). (vi) The number of deaths attributable to alcohol. (vii) The number of deaths attributable to illicit drugs. (viii) The number of deaths attributable to prescription drugs. (C) Information on the number and type of health care practitioners licensed in the State and providing substance use disorder-related services. (4) AVAILABILITY
OF REPORTS.The
Sec-
retary shall, upon request, provide a copy of any re-

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38 1 2 3 4 5 port under this section to any interested public agency..

SEC. 103. GARRETT LEE SMITH MEMORIAL ACT REAUTHORIZATION.
(a) SHORT TITLE.This section may be cited as the
6 Garrett Lee Smith Memorial Act Reauthorization of 7 2014. 8 (b) SUICIDE PREVENTION TECHNICAL ASSISTANCE
9 CENTER.Section 520C of the Public Health Service Act 10 (42 U.S.C. 290bb34) is amended to read as follows: 11 12 13
SEC. 520C. SUICIDE PREVENTION TECHNICAL ASSISTANCE CENTER.
(a) PROGRAM AUTHORIZED.The Secretary, acting
14 through the Administrator of the Substance Abuse and 15 Mental Health Services Administration, shall award a 16 grant for the operation and maintenance of a research, 17 training, and technical assistance resource center to pro18 vide appropriate information, training, and technical as19 sistance to States, political subdivisions of States, feder20 ally recognized Indian tribes, tribal organizations, institu21 tions of higher education, public organizations, or private 22 nonprofit organizations concerning the prevention of sui23 cide among all ages, particularly among groups that are 24 at high risk for suicide.

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39 1 (b) RESPONSIBILITIES
OF THE
CENTER.The cen-
2 ter operated and maintained under subsection (a) shall 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) assist in the development or continuation of statewide and tribal suicide early intervention and prevention strategies for all ages, particularly among groups that are at high risk for suicide; (2) ensure the surveillance of suicide early intervention and prevention strategies for all ages, particularly among groups that are at high risk for suicide; (3) study the costs and effectiveness of statewide and tribal suicide early intervention and prevention strategies in order to provide information concerning relevant issues of importance to State, tribal, and national policymakers; (4) further identify and understand causes and associated risk factors for suicide for all ages, particularly among groups that are at high risk for suicide; (5) analyze the efficacy of new and existing suicide early intervention and prevention techniques and technology for all ages, particularly among groups that are at high risk for suicide; (6) ensure the surveillance of suicidal behaviors and nonfatal suicidal attempts;

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40 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 (7) study the effectiveness of State-sponsored statewide and tribal suicide early intervention and prevention strategies for all ages particularly among groups that are at high risk for suicide on the overall wellness and health promotion strategies related to suicide attempts; (8) promote the sharing of data regarding suicide with Federal agencies involved with suicide early intervention and prevention, and State-sponsored statewide and tribal suicide early intervention and prevention strategies for the purpose of identifying previously unknown mental health causes and associated risk factors for suicide among all ages particularly among groups that are at high risk for suicide; (9) evaluate and disseminate outcomes and best practices of mental health and substance use disorder services at institutions of higher education; and (10) conduct other activities determined appropriate by the Secretary. (c) AUTHORIZATION
OF
APPROPRIATIONS.For the
23 purpose of carrying out this section, there are authorized 24 to be appropriated $4,957,000 for each of the fiscal years 25 2015 through 2019..

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41 1 2
TION
(c) YOUTH SUICIDE INTERVENTION
AND
PREVEN-
STRATEGIES.Section 520E of the Public Health
3 Service Act (42 U.S.C. 290bb36) is amended to read as 4 follows: 5 6 7

SEC. 520E. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.
(a) IN GENERAL.The Secretary, acting through
8 the Administrator of the Substance Abuse and Mental 9 Health Services Administration, shall award grants or co10 operative agreements to eligible entities to 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) develop and implement State-sponsored statewide or tribal youth suicide early intervention and prevention strategies in schools, educational institutions, juvenile justice systems, substance use disorder programs, mental health programs, foster care systems, and other child and youth support organizations; (2) support public organizations and private nonprofit organizations actively involved in Statesponsored statewide or tribal youth suicide early intervention and prevention strategies and in the development and continuation of State-sponsored statewide youth suicide early intervention and prevention strategies;

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42 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (3) provide grants to institutions of higher education to coordinate the implementation of Statesponsored statewide or tribal youth suicide early intervention and prevention strategies; (4) collect and analyze data on State-sponsored statewide or tribal youth suicide early intervention and prevention services that can be used to monitor the effectiveness of such services and for research, technical assistance, and policy development; and (5) assist eligible entities, through State-sponsored statewide or tribal youth suicide early intervention and prevention strategies, in achieving targets for youth suicide reductions under title V of the Social Security Act. (b) ELIGIBLE ENTITY. (1) DEFINITION.In this section, the term eligible entity means (A) a State; (B) a public organization or private nonprofit organization designated by a State to develop or direct the State-sponsored statewide youth suicide early intervention and prevention strategy; or

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43 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 (C) a federally recognized Indian tribe or tribal organization (as defined in the Indian Self-Determination and Education Assistance Act) or an urban Indian organization (as defined in the Indian Health Care Improvement Act) that is actively involved in the development and continuation of a tribal youth suicide early intervention and prevention strategy. (2) LIMITATION.In carrying out this section, the Secretary shall ensure that a State does not receive more than one grant or cooperative agreement under this section at any one time. For purposes of the preceding sentence, a State shall be considered to have received a grant or cooperative agreement if the eligible entity involved is the State or an entity designated by the State under paragraph (1)(B). Nothing in this paragraph shall be constructed to apply to entities described in paragraph (1)(C). (c) PREFERENCE.In providing assistance under a
20 grant or cooperative agreement under this section, an eli21 gible entity shall give preference to public organizations, 22 private nonprofit organizations, political subdivisions, in23 stitutions of higher education, and tribal organizations ac24 tively involved with the State-sponsored statewide or tribal

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44 1 youth suicide early intervention and prevention strategy 2 that 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) provide early intervention and assessment services, including screening programs, to youth who are at risk for mental or emotional disorders that may lead to a suicide attempt, and that are integrated with school systems, educational institutions, juvenile justice systems, substance use disorder programs, mental health programs, foster care systems, and other child and youth support organizations; (2) demonstrate collaboration among early intervention and prevention services or certify that entities will engage in future collaboration; (3) employ or include in their applications a commitment to evaluate youth suicide early intervention and prevention practices and strategies adapted to the local community; (4) provide timely referrals for appropriate community-based mental health care and treatment of youth who are at risk for suicide in child-serving settings and agencies; (5) provide immediate support and information resources to families of youth who are at risk for suicide;

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45 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (6) offer access to services and care to youth with diverse linguistic and cultural backgrounds; (7) offer appropriate postsuicide intervention services, care, and information to families, friends, schools, educational institutions, juvenile justice systems, substance use disorder programs, mental health programs, foster care systems, and other child and youth support organizations of youth who recently completed suicide; (8) offer continuous and up-to-date information and awareness campaigns that target parents, family members, child care professionals, community care providers, and the general public and highlight the risk factors associated with youth suicide and the life-saving help and care available from early intervention and prevention services; (9) ensure that information and awareness campaigns on youth suicide risk factors, and early intervention and prevention services, use effective communication mechanisms that are targeted to and reach youth, families, schools, educational institutions, and youth organizations; (10) provide a timely response system to ensure that child-serving professionals and providers are properly trained in youth suicide early interven-

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[Discussion Draft]
46 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 tion and prevention strategies and that child-serving professionals and providers involved in early intervention and prevention services are properly trained in effectively identifying youth who are at risk for suicide; (11) provide continuous training activities for child care professionals and community care providers on the latest youth suicide early intervention and prevention services practices and strategies; (12) conduct annual self-evaluations of outcomes and activities, including consulting with interested families and advocacy organizations; (13) provide services in areas or regions with rates of youth suicide that exceed the national average as determined by the Centers for Disease Control and Prevention; and (14) obtain informed written consent from a parent or legal guardian of an at-risk child before involving the child in a youth suicide early intervention and prevention program. (d) REQUIREMENT
FOR
DIRECT SERVICES.Not
22 less than 85 percent of grant funds received under this 23 section shall be used to provide direct services, of which 24 not less than 5 percent shall be used for activities author25 ized under subsection (a)(3).

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47 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (e) CONSULTATION (1) IN

AND
POLICY DEVELOPMENT. carrying out this sec-
GENERAL.In
tion, the Secretary shall collaborate with relevant Federal agencies and suicide working groups responsible for early intervention and prevention services relating to youth suicide. (2) CONSULTATION.In carrying out this section, the Secretary shall consult with (A) State and local agencies, including agencies responsible for early intervention and prevention services under title XIX of the Social Security Act, the State Childrens Health Insurance Program under title XXI of the Social Security Act, and programs funded by grants under title V of the Social Security Act; (B) local and national organizations that serve youth at risk for suicide and their families; (C) relevant national medical and other health and education specialty organizations; (D) youth who are at risk for suicide, who have survived suicide attempts, or who are currently receiving care from early intervention services;

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48 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (E) families and friends of youth who are at risk for suicide, who have survived suicide attempts, who are currently receiving care from early intervention and prevention services, or who have completed suicide; (F) qualified professionals who possess the specialized knowledge, skills, experience, and relevant attributes needed to serve youth at risk for suicide and their families; and (G) third-party payers, managed care organizations, and related commercial industries. (3) POLICY
DEVELOPMENT.In
carrying out
this section, the Secretary shall (A) coordinate and collaborate on policy development at the Federal level with the relevant Department of Health and Human Services agencies and suicide working groups; and (B) consult on policy development at the Federal level with the private sector, including consumer, medical, suicide prevention advocacy groups, and other health and education professional-based organizations, with respect to State-sponsored statewide or tribal youth suicide early intervention and prevention strategies.

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49 1 (f) RULE
OF
CONSTRUCTION; RELIGIOUS
AND
2 MORAL ACCOMMODATION.Nothing in this section shall 3 be construed to require suicide assessment, early interven4 tion, or treatment services for youth whose parents or 5 legal guardians object based on the parents or legal 6 guardians religious beliefs or moral objections. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (g) EVALUATIONS AND REPORT. (1) EVALUATIONS
BY ELIGIBLE ENTITIES.
Not later than 18 months after receiving a grant or cooperative agreement under this section, an eligible entity shall submit to the Secretary the results of an evaluation to be conducted by the entity concerning the effectiveness of the activities carried out under the grant or agreement. (2) REPORT.Not later than 2 years after the date of enactment of this section, the Secretary shall submit to the appropriate committees of Congress a report concerning the results of (A) the evaluations conducted under paragraph (1); and (B) an evaluation conducted by the Secretary to analyze the effectiveness and efficacy of the activities conducted with grants, collaborations, and consultations under this section.

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50 1 2 (h) RULE
TION.Nothing OF
CONSTRUCTION; STUDENT MEDICA-
in this section shall be construed to allow
3 school personnel to require that a student obtain any 4 medication as a condition of attending school or receiving 5 services. 6 (i) PROHIBITION.Funds appropriated to carry out
7 this section, section 527, or section 529 shall not be used 8 to pay for or refer for abortion. 9 (j) PARENTAL CONSENT.States and entities re-
10 ceiving funding under this section shall obtain prior writ11 ten, informed consent from the childs parent or legal 12 guardian for assessment services, school-sponsored pro13 grams, and treatment involving medication related to 14 youth suicide conducted in elementary and secondary 15 schools. The requirement of the preceding sentence does 16 not apply in the following cases: 17 18 19 20 21 22 23 (1) In an emergency, where it is necessary to protect the immediate health and safety of the student or other students. (2) Other instances, as defined by the State, where parental consent cannot reasonably be obtained. (k) RELATION
TO
EDUCATION PROVISIONS.Noth-
24 ing in this section shall be construed to supersede section 25 444 of the General Education Provisions Act, including

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51 1 the requirement of prior parental consent for the disclo2 sure of any education records. Nothing in this section shall 3 be construed to modify or affect parental notification re4 quirements for programs authorized under the Elementary 5 and Secondary Education Act of 1965 (as amended by the 6 No Child Left Behind Act of 2001; Public Law 107110). 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (l) DEFINITIONS.In this section: (1) EARLY
INTERVENTION.The
term early
intervention means a strategy or approach that is intended to prevent an outcome or to alter the course of an existing condition. (2) EDUCATIONAL
INSTITUTION; INSTITUTION
OF HIGHER EDUCATION; SCHOOL.The
term
(A) educational institution means a school or institution of higher education; (B) institution of higher education has the meaning given such term in section 101 of the Higher Education Act of 1965; and (C) school means an elementary or secondary school (as such terms are defined in section 9101 of the Elementary and Secondary Education Act of 1965). (3) PREVENTION.The term prevention
means a strategy or approach that reduces the likelihood or risk of onset, or delays the onset, of adverse

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52 1 2 3 4 5 health problems that have been known to lead to suicide. (4) YOUTH.The term youth means individuals who are between 10 and 24 years of age. (m) AUTHORIZATION
OF
APPROPRIATIONS.For
6 the purpose of carrying out this section, there are author7 ized to be appropriated $29,738,000 for each of the fiscal 8 years 2015 through 2019.. 9 10 (d) MENTAL HEALTH
ORDERS AND
SUBSTANCE USE DISON
SERVICES
AND
OUTREACH
CAMPUS.Section
11 520E2 of the Public Health Service Act (42 U.S.C. 12 290bb36b) is amended to read as follows: 13 14 15
SEC. 520E2. MENTAL HEALTH AND SUBSTANCE USE DISORDERS SERVICES ON CAMPUS.
(a) IN GENERAL.The Secretary, acting through
16 the Director of the Center for Mental Health Services and 17 in consultation with the Secretary of Education, shall 18 award grants on a competitive basis to institutions of 19 higher education to enhance services for students with 20 mental health or substance use disorders and to develop 21 best practices for the delivery of such services. 22 (b) USES
OF
FUNDS.Amounts received under a
23 grant under this section shall be used for 1 or more of 24 the following activities:

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53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) The provision of mental health and substance use disorder services to students, including prevention, promotion of mental health, voluntary screening, early intervention, voluntary assessment, treatment, and management of mental health and substance abuse disorder issues. (2) The provision of outreach services to notify students about the existence of mental health and substance use disorder services. (3) Educating students, families, faculty, staff, and communities to increase awareness of mental health and substance use disorders. (4) The employment of appropriately trained staff, including administrative staff. (5) The provision of training to students, faculty, and staff to respond effectively to students with mental health and substance use disorders. (6) The creation of a networking infrastructure to link colleges and universities with providers who can treat mental health and substance use disorders. (7) Developing, supporting, evaluating, and disseminating evidence-based and emerging best practices.

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54 1 (c) IMPLEMENTATION OF ACTIVITIES USING GRANT
2 FUNDS.An institution of higher education that receives 3 a grant under this section may carry out activities under 4 the grant through 5 6 7 8 9 10 11 12 13 14 15 16 (1) college counseling centers; (2) college and university psychological service centers; (3) mental health centers; (4) psychology training clinics; (5) institution of higher education supported, evidence-based, mental health and substance use disorder programs; or (6) any other entity that provides mental health and substance use disorder services at an institution of higher education. (d) APPLICATION.To be eligible to receive a grant
17 under this section, an institution of higher education shall 18 prepare and submit to the Secretary an application at 19 such time and in such manner as the Secretary may re20 quire. At a minimum, such application shall include the 21 following: 22 23 24 (1) A description of identified mental health and substance use disorder needs of students at the institution of higher education.

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55 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (2) A description of Federal, State, local, private, and institutional resources currently available to address the needs described in paragraph (1) at the institution of higher education. (3) A description of the outreach strategies of the institution of higher education for promoting access to services, including a proposed plan for reaching those students most in need of mental health services. (4) A plan, when applicable, to meet the specific mental health and substance use disorder needs of veterans attending institutions of higher education. (5) A plan to seek input from community mental health providers, when available, community groups and other public and private entities in carrying out the program under the grant. (6) A plan to evaluate program outcomes, including a description of the proposed use of funds, the program objectives, and how the objectives will be met. (7) An assurance that the institution will submit a report to the Secretary each fiscal year concerning the activities carried out with the grant and the results achieved through those activities.

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56 1 (e) SPECIAL CONSIDERATIONS.In awarding
2 grants under this section, the Secretary shall give special 3 consideration to applications that describe programs to be 4 carried out under the grant that 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) demonstrate the greatest need for new or additional mental and substance use disorder services, in part by providing information on current ratios of students to mental health and substance use disorder health professionals; and (2) demonstrate the greatest potential for replication. (f) REQUIREMENT OF MATCHING FUNDS. (1) IN
GENERAL.The
Secretary may make a
grant under this section to an institution of higher education only if the institution agrees to make available (directly or through donations from public or private entities) non-Federal contributions in an amount that is not less than $1 for each $1 of Federal funds provided under the grant, toward the costs of activities carried out with the grant (as described in subsection (b)) and other activities by the institution to reduce student mental health and substance use disorders. (2) DETERMINATION
UTED.Non-Federal OF AMOUNT CONTRIB-
contributions required under

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57 1 2 3 4 5 6 7 8 9 10 11 12 paragraph (1) may be in cash or in kind. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions. (3) WAIVER.The Secretary may waive the application of paragraph (1) with respect to an institution of higher education if the Secretary determines that extraordinary need at the institution justifies the waiver. (g) REPORTS.For each fiscal year that grants are
13 awarded under this section, the Secretary shall conduct 14 a study on the results of the grants and submit to the 15 Congress a report on such results that includes the fol16 lowing: 17 18 19 20 21 22 23 24 25 (1) An evaluation of the grant program outcomes, including a summary of activities carried out with the grant and the results achieved through those activities. (2) Recommendations on how to improve access to mental health and substance use disorder services at institutions of higher education, including efforts to reduce the incidence of suicide and substance use disorders.

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58 1 (h) DEFINITIONS.In this section, the term insti-
2 tution of higher education has the meaning given such 3 term in section 101 of the Higher Education Act of 1965. 4 (i) AUTHORIZATION
OF
APPROPRIATIONS.For the
5 purpose of carrying out this section, there are authorized 6 to be appropriated $4,975,000 for each of the fiscal years 7 2015 through 2019.. 8 9 10
SEC. 104. PROGRAMS OF REGIONAL AND NATIONAL SIGNIFICANCE REAUTHORIZATION.
(a) MENTAL HEALTH PROGRAMS
OF
REGIONAL
AND
11 NATIONAL SIGNIFICANCE. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) GENERAL

SAMHSA AUTHORITIES.Section
501(o) of the Public Health Service Act (42 U.S.C. 290aa(o)) is amended by striking $25,000,000 for fiscal year 2001, and such sums as may be necessary for each of the fiscal years 2002 and 2003 and inserting $lll for each of fiscal years 2015 through 2019 The blank is to be filled in with the FY 2014 level.. (2) GRANTS
FOR THE BENEFIT OF HOMELESS
INDIVIDUALS.Section
506(e) of the Public Health
Service Act (42 U.S.C. 290aa5(e)) is amended by striking $50,000,000 for fiscal year 2001, and such sums as may be necessary for each of the fiscal years 2002 and 2003 and inserting $lll for

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59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 each of fiscal years 2015 through 2019 The blank is to be filled in with the FY 2014 level.. (3) PRIORITY
GIONAL AND MENTAL HEALTH NEEDS OF RESIGNIFICANCE.Section
NATIONAL
520A(f)(1) of the Public Health Service Act (42 U.S.C. 290bb32(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 $lll for each of fiscal years 2015 through 2019. The blank is to be filled in with the FY 2014 level. (4) YOUTH
INTERAGENCY RESEARCH, TRAIN-
ING, AND TECHNICAL ASSISTANCE CENTERS.For
reauthorization of section 520C of the Public Health Service Act (42 U.S.C. 290bb34), see section 103(b) of this Act.Compare with policy of reauthorizing 520C at FY 2014 levels (5) YOUTH
PREVENTION SUICIDE EARLY INTERVENTION AND
STRATEGIES.For
provisions reau-
thorizing section 520E of the Public Health Service Act (42 U.S.C. 290bb36), see section 103(c) of this Act. Compare with policy of reauthorizing 520E at FY 2014 levels. (6) MENTAL
AND BEHAVIORAL HEALTH SERV-
ICES ON CAMPUS.For
provisions reauthorizing sec-

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60 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 tion 520E2 of the Public Health Service Act (42 U.S.C. 290bb36b), see section 103(d) of this Act. Compare with policy of reauthorizing 520E2 at FY 2014 levels (7) AWARDS
SPECIALTY CARE FOR CO-LOCATING PRIMARY AND IN COMMUNITY-BASED MENTAL
HEALTH SETTINGS.Section
520K(f) of the Public
Health Service Act (42 U.S.C. 290bb42(f)) is amended by striking $50,000,000 for fiscal year 2010 and such sums as may be necessary for each of fiscal years 2011 through 2014 and inserting $lll for each of fiscal years 2015 through 2019. The blank is to be filled in with the FY 2014 level.. (8) PRIORITY
NEEDS OF SUBSTANCE ABUSE PREVENTION AND NATIONAL SIGNIFI-
REGIONAL
CANCE.You
asked to reauthorize section 516 of the
PHSA both here and in subsection (b) below. Subsection (b) seems to be the more appropriate placement. (9) CHILDREN
AND VIOLENCE.For
provisions
reauthorizing section 581 of the Public Health Service Act (42 U.S.C. 290hh), see section 501 of this Act. Compare with policy of reauthorizing 581 at FY 2014 levels.

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61 1 2 3 4 5 6 7 (10) GRANTS
PERSONS WHO TO ADDRESS THE PROBLEMS OF VIOLENCE RELATED
EXPERIENCE
STRESS.For
provisions reauthorizing section 582
of the Public Health Service Act (42 U.S.C. 290hh 1), see section 107 of this Act. Compare with policy of reauthorizing 582 at FY 2014 levels. (b) SUBSTANCE ABUSE PREVENTION PROGRAMS
OF
8 REGIONAL AND NATIONAL SIGNIFICANCE. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) PRIORITY

NEEDS OF SUBSTANCE ABUSE PREVENTION AND NATIONAL SIGNIFI-
REGIONAL
CANCE.Section
516(f) of the Public Health Service
Act (42 U.S.C. 290bb22(f)) 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 $lll for each of fiscal years 2015 through 2019. The blank is to be filled in with the FY 2014 level. (2) PROGRAMS
ING.Section TO REDUCE UNDERAGE DRINK-
519B of the Public Health Service
Act (42 U.S.C. 290bb25b) is amended The blanks need to be filled in with the FY 2014 levels (A) in subsection (c)(3), by striking $1,000,000 for fiscal year 2007, and
$1,000,000 for each of the fiscal years 2008

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62 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 through 2010 and inserting $lll for each of fiscal years 2015 through 2019; (B) in subsection (d)(4), by striking $1,000,000 for fiscal year 2007 and
$1,000,000 for each of the fiscal years 2008 through 2010 and inserting $ll for each of fiscal years 2015 through 2019; (C) in subsection (e)(1)(I), by striking $5,000,000 for fiscal year 2007, and
$5,000,000 for each of the fiscal years 2008 through 2010 and inserting $ll for each of fiscal years 2015 through 2019; and (D) in subsection (e)(2)(H), by striking $5,000,000 for fiscal year 2007, and
$5,000,000 for each of the fiscal years 2008 through 2010 and inserting $ll for each of fiscal years 2015 through 2019. (3) CENTERS
OF EXCELLENCE ON SERVICES
FOR INDIVIDUALS WITH FETAL ALCOHOL SYNDROME AND ALCOHOL-RELATED BIRTH DEFECTS AND
TREATMENT FOR INDIVIDUALS WITH SUCH CONDITIONS AND THEIR FAMILIES.Section
519D(f) of
the Public Health Service Act (42 U.S.C. 290bb 25d(f)) is amended by striking $5,000,000 for fiscal year 2001, and such sums as may be necessary

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[Discussion Draft]
63 1 2 3 4 5 for each of the fiscal years 2002 and 2003 and inserting $lll for each of fiscal years 2015 through 2019. The blank is to be filled in with the FY 2014 level. (c) SUBSTANCE ABUSE TREATMENT PROGRAMS
OF
6 REGIONAL AND NATIONAL SIGNIFICANCE. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) GRANTS

FOR THE BENEFIT OF HOMELESS
INDIVIDUALS.Section
506(e) of the Public Health
Service Act (42 U.S.C. 290aa5(e)) is amended by striking $50,000,000 for fiscal year 2001, and such sums as may be necessary for each of the fiscal years 2002 and 2003 and inserting $lll for each of fiscal years 2015 through 2019. The blank is to be filled in with the FY 2014 level. (2) RESIDENTIAL
PREGNANT AND TREATMENT PROGRAMS FOR WOMEN.Section
POSTPARTUM
508(r) of the Public Health Service Act (42 U.S.C. 290bb1(r)) is amended by striking such sums as may be necessary to fiscal years 2001 through 2003 and inserting $lll for each of fiscal years 2015 through 2019. The blank is to be filled in with the FY 2014 level. (3) PRIORITY
NEEDS OF SUBSTANCE ABUSE TREATMENT AND NATIONAL SIGNIFI-
REGIONAL
CANCE.Section
509(f) of the Public Health Service

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64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Act (42 U.S.C. 290bb2(f)) 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 $lll for each of fiscal years 2015 through 2019. The blank is to be filled in with the FY 2014 level. (4) METHAMPHETAMINE
TREATMENT INITIATIVE.The AND AMPHETAMINE
second section 514 of
the Public Health Service Act (42 U.S.C. 290bb9) is amended (A) by redesignating such section as section 514B; and (B) in subsection (d)(1), by striking $10,000,000 for fiscal year 2000 and such sums as may be necessary for each of fiscal years 2001 and 2002 and inserting $lll for each of fiscal years 2015 through 2019. The blank is to be filled in with the FY 2014 level.
SEC. 105. GRANTS FOR JAIL DIVERSION PROGRAMS REAUTHORIZATION.
Section 520G(i) of the Public Health Service Act (42
23 U.S.C. 290bb38(i)) is amended by striking $10,000,000 24 for fiscal year 2001, and such sums as may be necessary 25 for fiscal years 2002 through 2003 and inserting

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[Discussion Draft]
65 1 $lll for each of fiscal years 2015 through 2019. 2 The blank is to be filled in with the FY 2014 level. 3 4 5 6 7 (42
SEC. 106. COMPREHENSIVE COMMUNITY MENTAL HEALTH SERVICES FOR CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCES.
Section 565(f)(1) of the Public Health Service Act U.S.C. 290ff4) is amended by striking
8 $100,000,000 for fiscal year 2001, and such sums as 9 may be necessary for each of the fiscal years 2002 and 10 2003 and inserting $lll for each of fiscal years 11 2015 through 2019. The blank is to be filled in with 12 the FY 2014 level. 13 14 15 16
SEC. 107. GRANTS TO ADDRESS THE PROBLEMS OF INDIVIDUALS WHO EXPERIENCE TRAUMA AND VIOLENCE RELATED STRESS.
Section 582 of the Public Health Service Act (42
17 U.S.C. 290hh-1) is amended to read as follows: 18 19 20 21

SEC. 582. GRANTS TO ADDRESS THE PROBLEMS OF INDIVIDUALS WHO EXPERIENCE TRAUMA AND VIOLENCE RELATED STRESS.
(a) IN GENERAL.The Secretary shall award
22 grants, contracts or cooperative agreements to public and 23 nonprofit private entities, as well as to Indian tribes and 24 tribal organizations, for the purpose of developing and 25 maintaining programs that provide for

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66 1 2 3 4 5 6 7 8 9 10 11 (1) the continued operation of the National Child Traumatic Stress Initiative (referred to in this section as the NCTSI) that focus on the mental, behavioral, and biological aspects of psychological trauma response; and (2) the development of knowledge with regard to evidence-based practices for identifying and treating mental, behavioral, and biological disorders of children and youth resulting from witnessing or experiencing a traumatic event. (b) PRIORITIES.In awarding grants, contracts or
12 cooperative agreements under subsection (a)(2) (related to 13 the development of knowledge on evidence-based practices 14 for treating mental, behavioral, and biological disorders 15 associated with psychological trauma), the Secretary shall 16 give priority to universities, hospitals, mental health agen17 cies, and other community-based child-serving programs 18 that have established clinical and research experience in 19 the field of trauma-related mental disorders. 20 (c) CHILD OUTCOME DATA.The NCTSI coordi-
21 nating center shall collect, analyze, and report NCTSI22 wide child outcome and process data for the purpose of 23 establishing the effectiveness, implementation, and clinical 24 utility of early identification and delivery of evidence-based

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[Discussion Draft]
67 1 treatment and services delivered to children and families 2 served by the NCTSI grantees. 3 (d) TRAINING.The NCTSI coordinating center
4 shall oversee the continuum of interprofessional training 5 initiatives in evidence-based and trauma-informed treat6 ments, interventions, and practices offered to NCTSI 7 grantees and providers in all child-serving systems. 8 (e) DISSEMINATION.The NCTSI coordinating
9 center shall collaborate with the Secretary in the dissemi10 nation of evidence-based and trauma-informed interven11 tions, treatments, products, and other resources to all 12 child-serving systems and policymakers. 13 (f) REVIEW.The Secretary shall establish con-
14 sensus-driven, in-person or teleconference review of 15 NCTSI applications by child trauma experts and review 16 criteria related to expertise and experience related to child 17 trauma and evidence-based practices. 18 (g) GEOGRAPHICAL DISTRIBUTION.The Secretary
19 shall ensure that grants, contracts or cooperative agree20 ments under subsection (a) are distributed equitably 21 among the regions of the United States and among urban 22 and rural areas. Notwithstanding the previous sentence, 23 expertise and experience in the field of trauma-related dis24 orders shall be prioritized in the awarding of such grants 25 are required under subsection (b).

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[Discussion Draft]
68 1 (h) EVALUATION.The Secretary, as part of the
2 application process, shall require that each applicant for 3 a grant, contract or cooperative agreement under sub4 section (a) submit a plan for the rigorous evaluation of 5 the activities funded under the grant, contract or agree6 ment, including both process and outcome evaluation, and 7 the submission of an evaluation at the end of the project 8 period. 9 (i) DURATION
OF
AWARDS.With respect to a
10 grant, contract or cooperative agreement under subsection 11 (a), the period during which payments under such an 12 award will be made to the recipient shall be 6 years. Such 13 grants, contracts or agreements may be renewed. Exper14 tise and experience in the field of trauma-related disorders 15 shall be a priority for new and continuing awards. 16 (j) AUTHORIZATION
OF
APPROPRIATIONS.There
17 is authorized to be appropriated to carry out this section, 18 $50,000,000 for fiscal year 2015, and such sums as may 19 be necessary for each of fiscal years 2016 through 2019.. 20 21 22
SEC. 108. PROTECTION AND ADVOCACY FOR INDIVIDUALS WITH MENTAL ILLNESS REAUTHORIZATION.
Section 117 of the Protection and Advocacy for Indi-
23 viduals with Mental Illness Act (42 U.S.C. 10827) is 24 amended by striking $19,500,000 for fiscal year 1992, 25 and such sums as may be necessary for each of the fiscal

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[Discussion Draft]
69 1 years 1993 through 2003 and inserting $lll for 2 each of fiscal years 2015 through 2019. The blank is 3 to be filled in with the FY 2014 level. 4 5
SEC. 109. MENTAL HEALTH AWARENESS TRAINING GRANTS.
Section 520J of the Public Health Service Act (42
6 U.S.C. 290bb41) is amended 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) in the section heading, by inserting MENTAL HEALTH AWARENESS
before TRAINING;
and (2) in subsection (b) (A) in the subsection heading, by striking ILLNESS and inserting HEALTH; (B) in paragraph (1), by inserting and other categories of individuals, as determined by the Secretary, after emergency services personnel; (C) in paragraph (5) (i) in the matter preceding subparagraph (A), by striking to and inserting for evidence-based programs for the purpose of; and (ii) by striking subparagraphs (A) through (C) and inserting the following: (A) recognizing the signs and symptoms of mental illness; and

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[Discussion Draft]
70 1 2 3 4 5 6 7 8 9 10 11 12 13 14 (B)(i) providing education to personnel regarding resources available in the community for individuals with a mental illness and other relevant resources; or (ii) the safe de-escalation of crisis situations involving individuals with a mental illness.; and (D) in paragraph (7), by striking , $25,000,000 and all that follows through the period at the end and inserting $20,000,000 for each of fiscal years 2014 through 2018.
SEC. 110. NATIONAL MEDIA CAMPAIGN TO REDUCE THE STIGMA ASSOCIATED WITH MENTAL ILLNESS.
Subpart 3 of part B of title V of the Public Health
15 Service Act (42 U.S.C. 290bb31 et seq.) is amended by 16 adding at the end the following new section: 17 18 19
SEC. 520L. NATIONAL MEDIA CAMPAIGN TO REDUCE THE STIGMA ASSOCIATED WITH MENTAL ILLNESS.
(a) SCOPE
OF THE
CAMPAIGN.The Secretary, act-
20 ing through the Administrator of the Substance Abuse 21 and Mental Health Services Administration, shall provide 22 for the production, broadcasting, and evaluation of a na23 tional media public service campaign to reduce the stigma 24 associated with mental illness. Such campaign shall seek 25 to reach as wide and diverse an audience as possible and

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[Discussion Draft]
71 1 shall particularly target the population between the ages 2 of 16 and 24 years of age. 3 (b) REPORT.The Secretary shall provide a report
4 to the Congress annually detailing 5 6 7 8 9 10 11 (1) the production, broadcasting, and evaluation of the campaign under subsection (a); and (2) the effectiveness of the campaign in reducing the stigma associated with mental illness, as measured using such methods as public attitude surveys and mental health services utilization statistics. (c) CONSULTATION REQUIREMENT.In carrying
12 out this section, the Secretary shall ensure that mental 13 health professionals and patient advocates are consulted 14 in carrying out the media campaign under this section. 15 The progress of this consultative process is to be covered 16 in the report under subsection (b). 17 (d) AUTHORIZATION
OF
18 are authorized to be appropriated to carry out this section, 19 $10,000,000 for each of the fiscal years 2015 through 20 2019..

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72 1 2 3 4
SEC. 111. SAMHSA AND HRSA INTEGRATION OF MENTAL HEALTH SERVICES INTO PRIMARY CARE SETTINGS.
Title V of the Public Health Service Act is amended
5 by inserting after section 520K (42 U.S.C. 290bb42) the 6 following: 7 8 9

SEC. 520K1. AWARDS FOR CO-LOCATING MENTAL HEALTH SERVICES IN PRIMARY CARE SETTINGS.
(a) PROGRAM AUTHORIZED.The Secretary, acting
10 through the Administrators of the Substance Abuse and 11 Mental Health Services Administration and the Health 12 Resources and Services Administration, shall award 13 grants, contracts, and cooperative agreements to eligible 14 entities for the provision of coordinated and integrated 15 mental health services and primary health care. 16 (b) ELIGIBLE ENTITIES.To be eligible to seek a
17 grant, contract, or cooperative agreement this section, an 18 entity shall be a public or nonprofit entity. 19 (c) USE
OF
FUNDS.An eligible entity receiving an
20 award under this section shall use the award for the provi21 sion of coordinated and integrated mental health services 22 and primary health care through 23 24 (1) the co-location of mental health services in primary care settings;

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73 1 2 3 4 5 6 7 8 9 10 11 12 13 14 (2) the use of care management services to facilitate coordination between mental health and primary care providers; (3) the use of information technology (such as telemedicine) (A) to facilitate coordination between mental health and primary care providers; or (B) to expand the availability of mental health services; or (4) the provision of training and technical assistance to improve the delivery, effectiveness, and integration of mental health services into primary care settings. (d) AUTHORIZATION
OF
APPROPRIATIONS.To
15 carry out this section, there are authorized to be appro16 priated such sums as may be necessary for fiscal years 17 2015 through 2019.. 18 19 20 21
SEC. 112. EVIDENCE-BASED PRACTICES FOR OLDER AMERICANS.
(a) GERIATRIC SUBSTANCE USE DISORDERS TREATMENT.Section
509(e) of the Public Health Service Act
22 (42 U.S.C. 290bb2(e)) is amended 23 24 (1) by striking The Secretary shall establish and inserting:

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[Discussion Draft]
74 1 2 3 4 5 6 7 8 9 10 11 12 13 (1) IN lish; and (2) by adding at the end the following: (2) GERIATRIC
TREATMENT.The SUBSTANCE USE DISORDERS GENERAL.The
Secretary shall estab-
Secretary shall, as appropriate,
provide technical assistance to grantees regarding evidence-based practices for the treatment of geriatric substance use disorders, as well as disseminate information about such evidence-based practices to States and nongrantees throughout the United States.. (b) GERIATRIC SUBSTANCE USE DISORDERS PREVENTION.Section
516(e) of the Public Health Service
14 Act (42 U.S.C. 290bb22(e)) is amended 15 16 17 18 19 20 21 22 23 24 25 (1) by striking The Secretary shall establish and inserting: (1) IN lish; and (2) by adding at the end the following: (2) GERIATRIC
PREVENTION.The SUBSTANCE USE DISORDERS GENERAL.The
Secretary shall estab-
Secretary shall, as appropriate,
provide technical assistance to grantees regarding evidence-based practices for the prevention of geriatric substance use disorders, as well as disseminate information about such evidence-based practices to

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75 1 2 3 States and nongrantees throughout the United States.. (c) GERIATRIC MENTAL HEALTH DISORDERS.Sec-
4 tion 520A(e) of the Public Health Service Act (42 U.S.C. 5 290bb32(e)) is amended by adding at the end the fol6 lowing: 7 8 9 10 11 12 13 14 15 16 17 18 19 20 (3) GERIATRIC
MENTAL HEALTH DIS-
ORDERS.The
Secretary shall, as appropriate, pro-
vide technical assistance to grantees regarding evidence-based practices for the prevention and treatment of geriatric mental health disorders, as well as disseminate information about such evidence-based practices to States and nongrantees throughout the United States..
TITLE IIIMPROVING MEDICAID AND MEDICARE MENTAL HEALTH SERVICES

SEC. 201. ACCESS TO MENTAL HEALTH PRESCRIPTION DRUGS UNDER MEDICARE AND MEDICAID.
(a) COVERAGE
OF
PRESCRIPTION DRUGS USED
TO
21 TREAT MENTAL HEALTH DISORDERS UNDER MEDI22

CARE.Section
1860D4(b)(3)(G)(i)(II) of the Social Se-
23 curity Act (42 U.S.C. 1395w104(b)(3)(G)(i)(II)) is 24 amended by inserting , for categories and classes of 25 drugs other than the categories and classes of drugs speci-

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[Discussion Draft]
76 1 fied in subclauses (II) and (IV) of clause (iv), before ex2 ceptions. 3 (b) COVERAGE
OF
PRESCRIPTION DRUGS USED
TO
4 TREAT MENTAL HEALTH DISORDERS UNDER MED5

ICAID.Section
1927(d) of the Social Security Act (42
6 U.S.C. 1396r8(d)) is amended by adding at the end the 7 following new paragraph: 8 9 10 11 12 13 14 15 16 17 18 19 20 21 (8) ACCESS
TO MENTAL HEALTH DRUGS.
With respect to covered outpatient drugs used for the treatment of a mental health disorder, including major depression, bipolar (manic-depressive) disorder, panic disorder, obsessive-compulsive disorder, schizophrenia, and schizoaffective disorder, a State shall not exclude from coverage or otherwise restrict access to such drugs other than pursuant to a prior authorization program that is consistent with paragraph (5)..
SEC. 202. MEDICAID COVERAGE OF MENTAL HEALTH SERVICES AND PRIMARY CARE SERVICES FURNISHED ON THE SAME DAY.
(a) IN GENERAL.Section 1902(a) of the Social Se-
22 curity Act (42 U.S.C. 1396a(a)) is amended by inserting 23 after paragraph (77) the following new paragraph: 24 25 (78) not prohibit payment under the plan for a mental health service or primary care service fur-

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[Discussion Draft]
77 1 2 3 4 5 6 7 8 9 nished to an individual at a federally qualified community behavioral health center (as defined in section 1905(l)(4)) or a federally qualified health center (as defined in section 1861(aa)(3)) 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));. (b) SAME-DAY QUALIFYING SERVICE DEFINED.
10 Section 1902 of the Social Security Act (42 U.S.C. 1396a) 11 is amended by adding at the end the following new sub12 section: 13 (ll) SAME-DAY QUALIFYING SERVICE DEFINED.
14 For purposes of subsection (a)(78), the term same-day 15 qualifying service means 16 17 18 19 20 21 22 23 24 25 (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..

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78 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 (c) EFFECTIVE DATE. (1) IN

GENERAL.Subject
to paragraph (2),
the amendments made 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) 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.

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79 1 2 3
SEC. 203. ELIMINATION OF 190-DAY LIFETIME LIMIT ON INPATIENT PSYCHIATRIC HOSPITAL SERVICES.
(a) IN GENERAL.Section 1812 of the Social Secu-
4 rity Act (42 U.S.C. 1395d) is amended 5 6 7 8 9 10 11 12 13 14 (1) in subsection (b) (A) in paragraph (1), by adding or at the end; (B) in paragraph (2), by striking ; or at the end and inserting a period; and (C) by striking paragraph (3); and (2) in subsection (c), by striking (but shall not be included and all that follows before the period at the end. (b) EFFECTIVE DATE.The amendments made by
15 subsection (a) shall apply to items and services furnished 16 on or after January 1, 2015. 17 18 19
SEC. 204. DISCHARGE PLANNING IN PSYCHIATRIC FACILITIES.
Section 1861(ee) of the Social Security Act (42
20 U.S.C. 1395x(ee)) is amended by adding at the end the 21 following new paragraph: 22 23 24 25 26
VerDate 0ct 09 2002 17:34 Apr 25, 2014
(4)(A) Beginning 1 year after the date of the enactment of this paragraph, a psychiatric hospital or a psychiatric unit (as described in the matter following clause (v) of section 1886(d)(1)(B)) that is determined by the Secretary not to have in place a
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[Discussion Draft]
80 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 discharge planning process that meets the requirements of this subsection is subject to a civil money penalty of not more than $10,000. A civil money penalty under this subparagraph shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A are imposed and collected under that section. (B) Beginning 1 year after the date of the enactment of this paragraph, the Secretary may require a psychiatric hospital or such a psychiatric unit that the Secretary has determined on multiple occasions does not have in place a discharge planning process that meets the requirements of this subsection to enter into an agreement with the Secretary, similar to a system improvement agreement applied pursuant to section 1866(b), to (i) obtain from a third party that is selected by the Secretary an independent review of policies and procedures of the hospital or unit for purposes of providing recommendations for establishing a sufficient discharge planning process under this subsection; (ii) retain an independent compliance officer for a period specified in the agreement to monitor and assist the hospital or unit in estab-

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81 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 lishing a sufficient discharge planning process under this subsection; (iii) submit periodic reports to the Secretary detailing improvements made to the policies and procedures of the hospital or unit to have in place a sufficient discharge planning process under this subsection; and (iv) undertake such other actions as the Secretary determines necessary in order to ensure that the hospital or unit will continue to have a sufficient discharge planning process under this subsection on an ongoing basis. (C) In the case that a psychiatric hospital or such a psychiatric unit has entered into an agreement under subparagraph (B) and does not have in place a sufficient discharge planning process by the date that is 45 days after entering into such agreement, the Secretary may, in consultation with the State, appoint temporary management to oversee the operation of the hospital or unit, assure the health and safety of the hospital or units inpatients, and ensure compliance with requirements of such discharge planning process by the hospital or unit. The temporary management under this subparagraph shall be terminated when the Secretary has deter-

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[Discussion Draft]
82 1 2 3 4 5 6 mined that the hospital or unit has the management capability to ensure continued compliance with all such requirements..
SEC. 205. COVERAGE OF INTENSIVE OUTPATIENT SERVICES.
(a) COVERAGE.Section 1832(a)(2) of the Social Se-
7 curity Act (42 U.S.C. 1395k(a)(2)) is amended 8 9 10 11 12 13 14 15 16 (1) in subparagraph (I), by striking and at the end; (2) in subparagraph (J), by striking the period at the end and inserting ; and; and (3) by adding at the end the following new subparagraph: (K) intensive outpatient services (as described in section 1861(iii)).. (b) SERVICES DESCRIBED.Section 1861 of the So-
17 cial Security Act (42 U.S.C. 1395x), as amended by sec18 tion 201(b), is amended by adding at the end the following 19 new subsection: 20 (iii) INTENSIVE OUTPATIENT SERVICES.(1) The
21 term intensive outpatient services means the items and 22 services described in paragraph (2) prescribed by a physi23 cian and provided within the context described in para24 graph (3) under the supervision of a physician (or, to the 25 extent permitted under the law of the State in which the

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[Discussion Draft]
83 1 services are furnished, a non-physician mental health pro2 fessional) pursuant to an individualized, written plan of 3 treatment that is established by a physician and periodi4 cally reviewed by a physician or, to the extent permitted 5 under the laws of the State in which the services are fur6 nished, a non-physician mental health professional (in con7 sultation with appropriate staff participating in such serv8 ices), which plan sets forth the patients diagnosis, the 9 type, amount, frequency, and duration of the items and 10 services provided under the plan, and the goals for treat11 ment under the plan. 12 (2)(A) The items and services described in this
13 paragraph are the items and services described in sub14 paragraph (B) that are reasonable and necessary for the 15 diagnosis or treatment of the individuals condition, rea16 sonably expected to improve or maintain the individuals 17 condition and functional level and to prevent relapse or 18 hospitalization, and furnished pursuant to such guidelines 19 relating to frequency and duration of services as the Sec20 retary shall by regulation establish (taking into account 21 accepted norms of clinical practice). 22 (B) For purposes of subparagraph (A), the items
23 and services described in this paragraph are as follows: 24 25 (i) Psychiatric rehabilitation. (ii) Assertive community treatment.

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[Discussion Draft]
84 1 2 3 4 5 6 7 8 (iii) Intensive case management. (iv) Day treatment for individuals under 21 years of age. (v) Ambulatory detoxification. (vi) Such other items and services as the Secretary may provide (but in no event to include meals and transportation). (3) The context described in this paragraph for the
9 provision of intensive outpatient services is as follows: 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (A) Such services are furnished in a facility, home, or community setting. (B) Such services are furnished (i) to assist the individual to compensate for, or eliminate, functional deficits and interpersonal and environmental barriers created by the disability; and (ii) to restore skills to the individual for independent living, socialization, and effective life management. (C) Such services are furnished by an individual or entity that (i) is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) or

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[Discussion Draft]
85 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 meets such certification requirements that the Secretary may impose; and (ii) meets such other requirements as the Secretary may impose to assure the quality of the intensive outpatient services provided.. (c) PAYMENT. (1) IN
GENERAL.With
respect to intensive
outpatient services (as defined in section 1861(iii)(1) of the Social Security Act (as added by subsection (b)) furnished under the medicare program, the amount of payment under such Act for such services shall be 80 percent of (A) during 2015 and 2016, the reasonable costs of furnishing such services; and (B) on or after January 1, 2017, the amount of payment established for such services under the prospective payment system established by the Secretary under paragraph (2) for such services. (2) ESTABLISHMENT (A) IN
OF PPS.
GENERAL.With
respect to inten-
sive outpatient services (as defined in section 1861(iii)(1)) of the Social Security Act (as added by subsection (b)) furnished under the medicare program on or after January 1,

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[Discussion Draft]
86 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 2017, the Secretary of Health and Human Services (in this paragraph referred to as the Secretary) shall establish a prospective payment system for payment for such services. Such system shall include an adequate patient classification system that reflects the differences in patient resource use and costs and shall provide for an annual update to the rates of payment established under the system. (B) ADJUSTMENTS.In establishing the system under subparagraph (A), the Secretary shall provide for adjustments in the prospective payment amount for variations in wage and wage-related costs, case mix, and such other factors as the Secretary determines appropriate. (C) COLLECTION
TION.In OF DATA AND EVALUA-
developing the system described in
subparagraph (A), the Secretary may require providers of services under the medicare program to submit such information to the Secretary as the Secretary may require to develop the system, including the most recently available data. (D) REPORTS
TO CONGRESS.Not
later
than October 1 of each of 2015 and 2016,

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[Discussion Draft]
87 1 2 3 4 5 (d) the Secretary shall submit to Congress a report on the progress of the Secretary in establishing the prospective payment system under this paragraph. CONFORMING AMENDMENTS.(1) Section
6 1835(a)(2) of the Social Security Act (42 U.S.C. 7 1395n(a)(2)) is amended 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (A) in subparagraph (E), by striking and at the end; (B) in subparagraph (F), by striking the period at the end and inserting ; and; and (C) by inserting after subparagraph (F) the following new subparagraph: (G) in the case of intensive outpatient services, (i) such services are reasonably expected to improve or maintain the individuals condition and functional level and to prevent relapse or hospitalization, (ii) an individualized, written plan for furnishing such services has been established by a physician and is reviewed periodically by a physician or, to the extent permitted under the laws of the State in which the services are furnished, a non-physician mental health professional, and (iii) such services are or were furnished while the individual is or was

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[Discussion Draft]
88 1 2 3 4 5 under the care of a physician or, to the extent permitted under the law of the State in which the services are furnished, a non-physician mental health professional.. (2) Section 1861(s)(2)(B) of the Social Security Act
6 (42 U.S.C. 1395x(s)(2)(B)) is amended by inserting and 7 intensive outpatient services after partial hospitalization 8 services. 9 (3) Section 1861(ff)(1) of the Social Security Act (42
10 U.S.C. 1395x(ff)(1)) is amended 11 12 13 14 15 16 17 18 (A) by inserting or, to the extent permitted under the law of the State in which the services are furnished, a non-physician mental health professional, after under the supervision of a physician and after periodically reviewed by a physician; and (B) by striking physicians and inserting patients. (4) Section 1861(cc) of the Social Security Act (42
19 U.S.C. 1395x(cc)) is amended 20 21 22 23 24 25 (A) in paragraph (1), in the matter preceding subparagraph (A), by striking physician and inserting physician or, to the extent permitted under the law of the State in which the services are furnished, a non-physician mental health professional ; and

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89 1 2 3 4 5 6 7 8 9 (B) in paragraph (2)(E), by inserting before the semicolon at the end the following: , except that a patient receiving social and psychological services under paragraph (1)(D) may be under the care of a non-physician mental health professional with respect to such services to the extent permitted under the law of the State in which the services are furnished. (e) EFFECTIVE DATE.Review: There are already
10 effective dates built into subsections (a) through (c). Does 11 this only apply with respect to subsection (d)? The 12 amendments made by this section shall apply to items and 13 services furnished on or after January 1, 2016. 14 15 16 17 18 19
SEC. 206. EXPANDING THE MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER TO INCLUDE YOUTH IN NEED OF SERVICES PROVIDED IN A PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY.
(a) IN GENERAL.Section 1915(c) of the Social Se-
20 curity Act (42 U.S.C. 1396n(c)) is amended 21 22 23 24 25 (1) in paragraph (1) (A) by striking a hospital or a nursing facility or intermediate care facility for the mentally retarded and inserting a hospital, a nursing facility, an intermediate care facility for

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90 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 the intellectually disabled, or a psychiatric residential treatment facility,; and (B) by striking a hospital, nursing facility, or intermediate care facility for the mentally retarded and inserting a hospital, nursing facility, intermediate care facility for the intellectually disabled, or psychiatric residential treatment facility; (2) in paragraph (2)(B), by striking or services in an intermediate care facility for the mentally retarded each place it appears and inserting services in an intermediate care facility for the intellectually disabled, or services in a psychiatric residential treatment facility; (3) in paragraph (2)(C) (A) by striking or intermediate care facility for the mentally retarded and inserting intermediate care facility for the intellectually disabled, or psychiatric residential treatment facility; and (B) by striking or services in an intermediate care facility for the mentally retarded and inserting services in an intermediate care facility for the intellectually disabled, or services in a psychiatric residential treatment facility;

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[Discussion Draft]
91 1 2 3 4 5 6 7 8 (4) in paragraph (7)(A), by striking or intermediate care facilities for the mentally retarded, and inserting intermediate care facilities for the intellectually disabled, or psychiatric residential treatment facilities,; and (5) by adding at the end the following new paragraph: (11) For purposes of this subsection, the term psy-
9 chiatric residential treatment facility means a facility 10 other than a hospital that is certified as meeting the re11 quirements specified in regulations promulgated for such 12 facilities under section 1905(h)(1) and that provides psy13 chiatric services in an inpatient setting to individuals 14 under age 21 for which medical assistance is available 15 under a State plan under this title.. 16 (b) WAIVER LIMITATION.Section 1915(c) of such
17 Act, as amended by subsection (a), is further amended 18 19 20 21 22 23 24 25 (1) in paragraph (2) (A) in subparagraph (D), by striking ; and and inserting a semicolon; (B) in subparagraph (E), by striking the period at the end and inserting a semicolon; and (C) by adding at the end the following new subparagraphs:

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[Discussion Draft]
92 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 (F) under the waiver, the total number of Medicaid inpatient bed days at psychiatric residential treatment facilities during each fiscal year within the waiver period will not exceed the total number of Medicaid inpatient bed days at such facilities for the previous fiscal year as increased by the estimated percentage increase (if any) in the population of individuals under age 21 residing in the State over the preceding 12-month period; and (G) the State will provide to the Secretary annually, subject to such requirements as the Secretary determines appropriate, relevant information and evidence as to the manner in which the State will satisfy the requirements described in subparagraph (F).; and (2) by adding at the end the following new paragraph: (12) For purposes of paragraph (2)(F), an indi-
19 vidual who is under age 21 and is an inpatient in a bed 20 in a psychiatric residential treatment facility for a single 21 day shall be counted as one inpatient bed day.. 22 23 24
SEC. 207. APPLICATION OF ROSAS LAW FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES.
(a) REFERENCES
IN THE
SOCIAL SECURITY ACT.

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93 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) IN
GENERAL.With
the exception of sec-
tion 1930(b) of the Social Security Act (42 U.S.C. 1396u(b)), such Act, as amended by section 2, is further amended (A) by striking, wherever it appears, State mental retardation or developmental disability authority and inserting State intellectual disability or developmental disability authority; (B) by striking, wherever it appears, mental retardation and inserting intellectual disabilities; and (C) by striking, wherever it appears, mentally retarded and inserting intellectually disabled. (2) CONFORMING (A) IN
AMENDMENT.
GENERAL.Section
1902(e)(14)(F)
of such Act, as added by section 2002(a) of Public Law 111148, is amended by striking mentally retarded and inserting intellectually disabled. (B) EFFECTIVE
DATE.The
amendment
made under subparagraph (A) shall take effect on January 2, 2015. (b) REFERENCES.

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[Discussion Draft]
94 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) IN
GENERAL.For
purposes of each provi-
sion amended by this section, issuing or amending regulations to carry out a provision amended by this section, or issuing any publication or other official communication in regards to any provision of the Social Security Act (A) a reference to an intellectual disability shall mean a condition previously referred to as mental retardation, or a variation of such term, and shall have the same meaning with respect to programs, or qualifications for such programs, for individuals with such a condition; (B) a reference to an individual who is intellectually disabled shall mean an individual who was previously referred to as an individual who is mentally retarded, an individual with mental retardation, or variations of such terms; (C) a reference to an intermediate care facility for the intellectually disabled shall mean a facility that was previously referred to as an intermediate care facility for the mentally retarded; and (D) a reference to a State intellectual disability or developmental disability authority shall mean an entity that was previously re-

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[Discussion Draft]
95 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ferred to as a State mental retardation or developmental disability authority. (2) REGULATIONS.For purposes of amending regulations to carry out this section, a Federal agency shall ensure that the regulations clearly state (A) that an intellectual disability was formerly termed mental retardation; (B) that individuals with intellectual disabilities were formerly termed individuals who are mentally retarded; (C) that an intermediate care facility for the intellectually disabled was formerly termed an intermediate care facility for the mentally retarded; and (D) that a State intellectual disability or developmental disability authority was formerly termed a State mental retardation or developmental disability authority. (c) RULE
OF
CONSTRUCTION.This section shall be
20 construed to make amendments to provisions of Federal 21 law to substitute the term intellectual disability for 22 mental retardation or any variation of such term with23 out any intent to

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[Discussion Draft]
96 1 2 3 4 5 6 7 8 9 (1) change the coverage, eligibility, rights, responsibilities, or definitions referred to in the amended provisions; or (2) compel States to change terminology in State laws for individuals covered by a provision amended by this section.
SEC. 208. COMPLETE APPLICATION OF MENTAL HEALTH PARITY RULES UNDER MEDICAID AND CHIP.
Not later than January 1, 2015, the Secretary of
10 Health and Human Services shall issue final regulations 11 to carry out the following provisions of law: 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) Section 1932(b)(8) of the Social Security Act (42 U.S.C. 1396u2(b)(8)) (relating to requiring medicaid managed care organizations to comply with the mental health requirements under certain provisions of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.)). (2) Section 1937(b)(6) of such Act (42 U.S.C. 1396u7(b)(6)) (relating to requiring benchmark benefit packages or benchmark equivalent coverage to comply with the mental health parity requirements under section 2705(a) of the Public Health Service Act (42 U.S.C. 300gg4)). (3) Section 2103(c)(6) of the Social Security Act (42 U.S.C. 1937cc(c)6)) (relating to requiring

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97 1 2 3 4 5 6 7 8 9 10 11 State child health plans to comply with mental health parity requirements under section 2705(a) of the Public Health Service Act (42 U.S.C. 300gg4)).
TITLE IIIDEVELOPING THE BEHAVIORAL HEALTH WORKFORCE

SEC. 301. NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT FUNDING FOR BEHAVIORAL AND MENTAL HEALTH PROFESSIONALS.
Section 338H of the Public Health Service Act (42
12 U.S.C. 254q) is amended 13 14 15 16 17 (1) by redesignating subsections (b) and (c) as subsections (c) and (d), respectively; and (2) by inserting after subsection (a) the following: (b) ADDITIONAL FUNDING
FOR
BEHAVIORAL
AND
18 MENTAL HEALTH PROFESSIONALS.In addition to the 19 amounts authorized to be appropriated under subsection 20 (a), and in addition to the amounts appropriated under 21 section 10503 of Public Law 111148, there are author22 ized to be appropriated such sums as may be necessary 23 for fiscal years 2015 through 2019 for scholarships and 24 loan repayments under this subpart for ensuring, as de-

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98 1 scribed in sections 338A(a) and 338B(a), an adequate 2 supply of behavioral and mental health professionals.. 3 4 5 6
SEC. 302. REAUTHORIZATION OF HRSAS MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING PROGRAM.
Subsection (e) of section 756 of the Public Health
7 Service Act (42 U.S.C. 294e-1) is amended to read as fol8 lows: 9 (e) AUTHORIZATION
OF
APPROPRIATIONS.To
10 carry out this section, there are authorized to be appro11 priated such sums as may be necessary for fiscal years 12 2015 through 2019.. 13 14 15 16 17
SEC. 303. SAMHSA GRANT PROGRAM FOR DEVELOPMENT AND IMPLEMENTATION OF CURRICULA FOR CONTINUING EDUCATION ON SERIOUS MENTAL ILLNESS.
Title V of the Public Health Service Act is amended
18 by inserting after section 520I (42 U.S.C. 290bb-40) the 19 following: 20 21 22

SEC. 520I-1. CURRICULA FOR CONTINUING EDUCATION ON SERIOUS MENTAL ILLNESS.
(a) GRANTS.The Secretary may award grants to
23 eligible entities for the development and implementation 24 of curricula for providing continuing education and train-

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99 1 ing to health care professionals on identifying, referring, 2 and treating individuals with serious mental illness. 3 (b) ELIGIBLE ENTITIES.To be eligible to seek a
4 grant under this section, an entity shall be a public or 5 nonprofit entity that 6 7 8 9 10 11 (1) provides continuing education or training to health care professionals; or (2) applies for the grant in partnership with another entity that provides such education and training. (c) PREFERENCE.In awarding grants under this
12 section, the Secretary shall give preference to eligible enti13 ties proposing to develop and implement curricula for pro14 viding continuing education and training to 15 16 17 18 19 20 21 (1) health care professionals in primary care specialities; or (2) health care professionals who are required, as a condition of State licensure, to participate in continuing education or training specific to mental health. (d) AUTHORIZATION
OF
APPROPRIATIONS.To
22 carry out this section, there are authorized to be appro23 priated such sums as may be necessary for fiscal years 24 2015 through 2019..

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100 1 2 3 4 5
SEC. 304. DEMONSTRATION GRANT PROGRAM TO RECRUIT, TRAIN, DEPLOY, AND PROFESSIONALLY SUPPORT PSYCHIATRIC PHYSICIANS IN INDIAN HEALTH PROGRAMS.
(a) SHORT TITLE.This section may be cited as the
6 Native American Psychiatric and Mental Health Care 7 Improvement Act. 8 (b) DEMONSTRATION GRANT PROGRAM
AND TO
RECRUIT,
9 TRAIN, DEPLOY, 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
PROFESSIONALLY SUPPORT PSYIN
CHIATRIC
PHYSICIANS
INDIAN HEALTH PROGRAMS.
(1) ESTABLISHMENT.The Secretary of Health and Human Services (in this subsection referred to as the Secretary), in consultation with the Director of the Indian Health Service and demonstration programs established under section 123 of the Indian Health Care Improvement Act (25 U.S.C. 1616p), shall award one 5-year grant to one eligible entity to carry out a demonstration program (in this Act referred to as the Program) under which the eligible entity shall carry out the activities described in paragraph (2). (2) ACTIVITIES
TO BE CARRIED OUT BY RECIPI-
ENT OF GRANT UNDER PROGRAM.Under
the Pro-
gram, the grant recipient shall (A) create a nationally-replicable workforce model that identifies and incorporates best
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101 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 practices for recruiting, training, deploying, and professionally supporting Native American and non-Native American psychiatric physicians to be fully integrated into medical, mental, and behavioral health systems in Indian health programs; (B) recruit to participate in the Program Native American and non-Native American psychiatric physicians who demonstrate interest in providing specialty health care services (as defined in section 313(a)(3) of the Indian Health Care Improvement Act (25 U.S.C.
1638g(a)(3))) and primary care services to American Indians and Alaska Natives; (C) provide such psychiatric physicians participating in the Program with not more than 1 year of supplemental clinical and cultural competency training to enable such physicians to provide such specialty health care services and primary care services in Indian health programs; (D) with respect to such psychiatric physicians who are participating in the Program and trained under subparagraph (C), deploy such physicians to practice specialty care or primary

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[Discussion Draft]
102 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 care in Indian health programs for a period of not less than 2 years and professionally support such physicians for such period with respect to practicing such care in such programs; and (E) not later than 1 year after the last day of the 5-year period for which the grant is awarded under paragraph (1), submit to the Secretary and to the appropriate committees of Congress a report that shall include (i) the workforce model created under subparagraph (A); (ii) strategies for disseminating the workforce model to other entities with the capability of adopting it; and (iii) recommendations for the Secretary and Congress with respect to supporting an effective and stable psychiatric and mental health workforce that serves American Indians and Alaska Natives. (3) ELIGIBLE
ENTITIES.
(A) REQUIREMENTS.To be eligible to receive the grant under this section, an entity shall (i) submit to the Secretary an application at such time, in such manner, and

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103 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 containing such information as the Secretary may require; (ii) be a department of psychiatry within a medical school in the United States that is accredited by the Liaison Committee on Medical Education or a public or private non-profit entity affiliated with a medical school in the United States that is accredited by the Liaison Committee on Medical Education; and (iii) have in existence, as of the time of submission of the application under subparagraph (A), a relationship with Indian health programs in at least two States with a demonstrated need for psychiatric physicians and provide assurances that the grant will be used to serve rural and nonrural American Indian and Alaska Native populations in at least two States. (B) PRIORITY
CIPIENT.In IN SELECTING GRANT RE-
awarding the grant under this
section, the Secretary shall give priority to an eligible entity that satisfies each of the following:

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[Discussion Draft]
104 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (i) Demonstrates sufficient infrastructure in size, scope, and capacity to undertake the supplemental clinical and cultural competency training of a minimum of 5 psychiatric physicians, and to provide ongoing professional support to psychiatric physicians during the deployment period to an Indian health program. (ii) Demonstrates a record in successfully recruiting, training, and deploying physicians who are American Indians and Alaska Natives. (iii) Demonstrates the ability to establish a program advisory board, which may be primarily composed of representatives of federally-recognized tribes, Alaska Natives, and Indian health programs to be served by the Program. (4) ELIGIBILITY
OF PSYCHIATRIC PHYSICIANS
TO PARTICIPATE IN THE PROGRAM.
(A) IN
GENERAL.To
be eligible to par-
ticipate in the Program, as described in paragraph (2), a psychiatric physician shall (i) be licensed or eligible for licensure to practice in the State to which the physi-

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[Discussion Draft]
105 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 cian is to be deployed under paragraph (2)(D); and (ii) demonstrate a commitment beyond the one year of training described in paragraph (2)(C) and two years of deployment described in paragraph (2)(D) to a career as a specialty care physician or primary care physician providing mental health services in Indian health programs. (B) PREFERENCE.In selecting physicians to participate under the Program, as described in paragraph (2)(B), the grant recipient shall give preference to physicians who are American Indians and Alaska Natives. (5) LOAN
FORGIVENESS.Under
the Program,
any psychiatric physician accepted to participate in the Program shall, notwithstanding the provisions of subsection (b) of section 108 of the Indian Health Care Improvement Act (25 U.S.C. 1616a) and upon acceptance into the Program, be deemed eligible and enrolled to participate in the Indian Health Service Loan Repayment Program under such section 108. Under such Loan Repayment Program, the Secretary shall pay on behalf of the physician for each year of deployment under the Program under this

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106 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 section up to $35,000 for loans described in subsection (g)(1) of such section 108. (6) DEFERRAL
OF CERTAIN SERVICE.The
starting date of required service of individuals in the National Health Service Corps Service Program under title II of the Public Health Service Act (42 U.S.C. 202 et seq.) who are psychiatric physicians participating under the Program under this section shall be deferred until the date that is 30 days after the date of completion of the participation of such a physician in the Program under this section. (7) DEFINITIONS.For purposes of this Act: (A) AMERICAN
TIVES.The INDIANS AND ALASKA NA-
term American Indians and Alas-
ka Natives has the meaning given the term Indian in section 447.50(b)(1) of title 42, Code of Federal Regulations, as in existence as of the date of the enactment of this Act. (B) INDIAN
HEALTH PROGRAM.The
term
Indian health program has the meaning given such term in section 104(12) of the Indian Health Care Improvement Act (25 U.S.C. 1603(12)). (C) PROFESSIONALLY
SUPPORT.The
term professionally support means, with re-

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[Discussion Draft]
107 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 spect to psychiatric physicians participating in the Program and deployed to practice specialty care or primary care in Indian health programs, the provision of compensation to such physicians for the provision of such care during such deployment and may include the provision, dissemination, or sharing of best practices, field training, and other activities deemed appropriate by the recipient of the grant under this section. (D) PSYCHIATRIC
PHYSICIAN.The
term
psychiatric physician means a medical doctor or doctor of osteopathy in good standing who has successfully completed four-year psychiatric residency training or who is enrolled in fouryear psychiatric residency training in a residency program accredited by the Accreditation Council for Graduate Medical Education. (8) AUTHORIZATION
OF APPROPRIATIONS.
There is authorized to be appropriated to carry out this section $1,000,000 for each of the fiscal years 2015 through 2019.

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108 1 2 3 4 5
SEC. 305. INCLUDING OCCUPATIONAL THERAPISTS AS BEHAVIORAL AND MENTAL HEALTH PROFESSIONALS FOR PURPOSES OF THE NATIONAL HEALTH SERVICE CORPS.
Section 331(a)(3)(E)(i) of the Public Health Service
6 Act (42 U.S.C. 254d(a)(3)(E)(i)) is amended by inserting 7 occupational therapists, after psychiatric nurse spe8 cialists,. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
VerDate 0ct 09 2002 17:34 Apr 25, 2014
SEC. 306. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES UNDER PART B OF THE MEDICARE PROGRAM.
(a) COVERAGE OF SERVICES. (1) IN

GENERAL.Section
1861(s)(2) of the
Social Security Act (42 U.S.C. 1395x(s)(2)) is amended (A) in subparagraph (EE), by striking and after the semicolon at the end; (B) in subparagraph (FF), by inserting and after the semicolon at the end; and (C) by adding at the end the following new subparagraph: (GG) marriage and family therapist services (as defined in subsection (iii)(1)) and mental health counselor (iii)(3));.
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PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 C:\USERS\WPBURKE\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BARBER~1.X Jkt 000000
services
(as
defined
in
subsection
[Discussion Draft]
109 1 2 3 (2) DEFINITIONS.Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:
4 Marriage and Family Therapist Services; Marriage and 5 6 7 Family Therapist; Mental Health Counselor Services; Mental Health Counselor (iii)(1) The term marriage and family therapist
8 services means services performed by a marriage and 9 family therapist (as defined in paragraph (2)) for the diag10 nosis and treatment of mental illnesses, which the mar11 riage and family therapist is legally authorized to perform 12 under State law (or the State regulatory mechanism pro13 vided by State law) of the State in which such services 14 are performed, as would otherwise be covered if furnished 15 by a physician or as an incident to a physicians profes16 sional service, but only if no facility or other provider 17 charges or is paid any amounts with respect to the fur18 nishing of such services. 19 (2) The term marriage and family therapist means
20 an individual who 21 22 23 24 (A) possesses a masters or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law;

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110 1 2 3 4 5 6 7 8 9 (B) after obtaining such degree has performed at least 2 years of clinical supervised experience in marriage and family therapy; and (C) in the case of an individual performing services in a State that provides for licensure or certification of marriage and family therapists, is licensed or certified as a marriage and family therapist in such State. (3) The term mental health counselor services
10 means services performed by a mental health counselor (as 11 defined in paragraph (4)) for the diagnosis and treatment 12 of mental illnesses which the mental health counselor is 13 legally authorized to perform under State law (or the 14 State regulatory mechanism provided by the State law) of 15 the State in which such services are performed, as would 16 otherwise be covered if furnished by a physician or as inci17 dent to a physicians professional service, but only if no 18 facility or other provider charges or is paid any amounts 19 with respect to the furnishing of such services. 20 (4) The term mental health counselor means an
21 individual who 22 23 (A) possesses a masters or doctors degree in mental health counseling or a related field;

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111 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (B) after obtaining such a degree has performed at least 2 years of supervised mental health counselor practice; and (C) in the case of an individual performing services in a State that provides for licensure or certification of mental health counselors or professional counselors, is licensed or certified as a mental health counselor or professional counselor in such State.. (3) PROVISION
B.Section FOR PAYMENT UNDER PART
1832(a)(2)(B) of the Social Security
Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the following new clause: (v) marriage and family therapist services (as defined in section 1861(iii)(1)) and mental health counselor services (as defined in section 1861(iii)(3));. (4) AMOUNT
OF PAYMENT.Section
1833(a)(1)
of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended (A) by striking and (Z) and inserting (Z); and (B) by inserting before the semicolon at the end the following: , and (AA) with respect to marriage and family therapist services and mental health counselor services under section

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112 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 1861(s)(2)(GG), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist under subparagraph (L). (5) EXCLUSION
OF MARRIAGE AND FAMILY
THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES FROM SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM.Section
1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting marriage and family therapist services (as defined in section 1861(iii)(1)), mental health counselor services (as defined in section 1861(iii)(3)), after qualified psychologist services,. (6) INCLUSION
OF MARRIAGE AND FAMILY
THERAPISTS AND MENTAL HEALTH COUNSELORS AS PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.Sec-
tion 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clauses: (vii) A marriage and family therapist (as defined in section 1861(iii)(2)). (viii) A mental health counselor (as defined in section 1861(iii)(4))..

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[Discussion Draft]
113 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
ICES
(b) COVERAGE
OF
CERTAIN MENTAL HEALTH SERV-
PROVIDED IN CERTAIN SETTINGS. (1) RURAL

QUALIFIED HEALTH CLINICS AND FEDERALLY HEALTH CENTERS.Section
1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking or by a clinical social worker (as defined in subsection (hh)(1)) and inserting , by a clinical social worker (as defined in subsection (hh)(1)), by a marriage and family therapist (as defined in subsection (iii)(2)), or by a mental health counselor (as defined in subsection (iii)(4)). (2) HOSPICE
PROGRAMS.Section
1861(dd)(2)(B)(i)(III) of the Social Security Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by inserting , marriage and family therapist, or mental health counselor after social worker. (c) AUTHORIZATION
AND OF
MARRIAGE
AND
FAMILY
19 THERAPISTS
MENTAL HEALTH COUNSELORS TO

FOR
20 DEVELOP DISCHARGE PLANS 21

ICES.Section
POST-HOSPITAL SERV-
1861(ee)(2)(G) of the Social Security Act
22 (42 U.S.C. 1395x(ee)(2)(G)) is amended by inserting , 23 including a marriage and family therapist and a mental 24 health counselor who meets qualification standards estab25 lished by the Secretary before the period at the end.

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114 1 (d) EFFECTIVE DATE.The amendments made by
2 this section shall apply with respect to services furnished 3 on or after January 1, 2015. 4 5 6 7
SEC. 307. EXTENSION OF CERTAIN HEALTH CARE WORKFORCE LOAN REPAYMENT PROGRAMS
THROUGH FISCAL YEAR 2018.
Section 775(e) of the Public Health Service Act (42
8 U.S.C. 295f(e)) is amended 9 10 11 12 13 14 15 16 17 18 and (2) by striking 2013 and inserting 2018. (1) by striking 2014 and inserting 2018;
TITLE IVIMPROVING MENTAL HEALTH RESEARCH AND COORDINATION

SEC. 401. NATIONAL INSTITUTE OF MENTAL HEALTH RESEARCH PROGRAM ON SERIOUS MENTAL ILLNESS.
(a) PURPOSE
OF
INSTITUTE.Section 464R(a) of
19 the Public Health Service Act (42 U.S.C. 285p(a)) is 20 amended by inserting serious mental illness research, 21 after biomedical and behavioral research,. 22 (b) RESEARCH PROGRAM.Section 464R(b) of the
23 Public Health Service Act (42 U.S.C. 285p(b)) is amend24 ed

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115 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 (1) by striking The research program and inserting the following: (1) IN
GENERAL.The
research program;
(2) by striking to further the treatment and prevention of mental illness and inserting to further the treatment and prevention of mental illness (including serious mental illness); and (3) by adding at the end the following: (2) RESEARCH
MENTAL ILLNESS.As WITH RESPECT TO SERIOUS
part of the research program
established under this subpart, the Director of the Institute shall conduct or support research on serious mental illness, including with respect to (A) the causes, prevention, and treatment of serious mental illness; and (B) interventions to improve early identification of individuals with serious mental illness and referral of such individuals to mental health professionals for treatment.. (c) BIENNIAL REPORT.Section 403(a)(5) of the
21 Public Health Service Act (42 U.S.C. 283(a)(5)) is 22 amended 23 24 (1) by redesignating subparagraph (L) as subparagraph (M); and

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116 1 2 3 4 (2) by inserting after subparagraph (K) the following: (L) Serious mental illness.. (d) AUTHORIZATION OF APPROPRIATIONS.In ad-
5 dition to amounts otherwise made available to the Na6 tional Institute of Mental Health, there are authorized to 7 be appropriated to such Institute $40,000,000 for each 8 of fiscal years 2015 through 2019 to carry out this sec9 tion.. 10 11
SEC. 402. SUICIDE PREVENTION AND BRAIN RESEARCH.
Subpart 16 of part C of title IV of the Public Health
12 Service Act (42 U.S.C. 285p et seq.) is amended by adding 13 at the end the following: 14 15 16
SEC. 464U-1. SUICIDE PREVENTION AND BRAIN RE-
SEARCH.
(a) IN GENERAL.The Director of the National
17 Institute of Mental Health shall use the funds made avail18 able to such Institute pursuant to subsection (b) exclu19 sively for the purpose of conducting and supporting 20 21 22 23 24 25 (1) research on the determinants of self-directed and other violence associated with mental illness, including studies designed to reduce the risk of self-harm, suicide, and interpersonal violence, especially in rural communities with a shortage of mental health services; and

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117 1 2 3 4 (2) brain research through the Brain Research Through Advancing Innovative
Neurotechnologies (BRAIN) Initiative. (b) AUTHORIZATION OF APPROPRIATIONS.In ad-
5 dition to amounts otherwise made available to the Na6 tional Institute of Mental Health, including amounts ap7 propriated pursuant to section 402A(a), there are author8 ized to be appropriated to such Institute $40,000,000 for 9 each of fiscal years 2015 through 2019 to carry out this 10 section.. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
SEC. 403. YOUTH MENTAL HEALTH RESEARCH NETWORK.
(a) YOUTH MENTAL HEALTH RESEARCH NETWORK.
(1) NETWORK.The Director of the National Institutes of Health may provide for the establishment of a Youth Mental Health Research Network for the conduct or support of (A) youth mental health research; and (B) youth mental health intervention services. (2) COLLABORATION
CENTERS.The BY INSTITUTES AND
Director of NIH shall carry out this
Act acting (A) through the Director of the National Institute of Mental Health; and

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118 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (B) in collaboration with other appropriate national research institutes and national centers that carry out activities involving youth mental health research. (3) MENTAL (A) IN
HEALTH RESEARCH. GENERAL.In
carrying out para-
graph (1), the Director of NIH may award cooperative agreements, grants, and contracts to State, local, and tribal governments and private nonprofit entities for (i) conducting, or entering into consortia with other entities to conduct (I) basic, clinical, behavioral, or translational research to meet unmet needs for youth mental health research; or (II) training for researchers in youth mental health research techniques; (ii) providing, or partnering with non-research institutions or communitybased groups with existing connections to youth to provide, youth mental health intervention services; and

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119 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (iii) collaborating with the National Institute of Mental Health to make use of, and build on, the scientific findings and clinical techniques of the Institutes earlier programs, projects. (B) RESEARCH.The Director of NIH shall ensure that (i) each recipient of an award under subparagraph (A)(i) conducts or supports at least one category of research described in subparagraph (A)(i)(I) and collectively such recipients conduct or support all such categories of research; and (ii) one or more such recipients provide training described in subparagraph (A)(i)(II). (C) NUMBER
OF AWARD RECIPIENTS.
studies,
and
demonstration
The Director of NIH may make awards under this paragraph for not more than 70 entities. (D) SUPPLEMENT,
NOT SUPPLANT.Any
support received by an entity under subparagraph (A) shall be used to supplement, and not supplant, other public or private support for ac-

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120 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
ON,
tivities authorized to be supported under this paragraph. (E) DURATION

OF SUPPORT.Support
of
an entity under subparagraph (A) may be for a period of not to exceed 5 years. Such period may be extended by the Director of NIH for additional periods of not more than 5 years. (4) COORDINATION.The Director of NIH shall (A) as appropriate, provide for the coordination of activities (including the exchange of information and regular communication) among the recipients of awards under this subsection; and (B) require the periodic preparation and submission to the Director of reports on the activities of each such recipient. (b) INTERVENTION SERVICES SEVERE MENTAL ILLNESS. (1) IN
GENERAL.In FOR, AND
RESEARCH
making awards under
subsection (a)(3), the Director of NIH shall ensure that an appropriate number of such awards are awarded to entities that agree to

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121 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (A) focus primarily on the early detection and intervention of severe mental illness in young people; (B) conduct or coordinate one or more multisite clinical trials of therapies for, or approaches to, the prevention, diagnosis, or treatment of early severe mental illness in a community setting; (C) rapidly and efficiently disseminate scientific findings resulting from such trials; and (D) adhere to the guidelines, protocols, and practices used in the North American Prodrome Longitudinal Study (NAPLS) and the Recovery After an Initial Schizophrenia Episode (RAISE) initiative. (2) DATA (A)
COORDINATING CENTER.
ESTABLISHMENT.In
connection
with awards to entities described in paragraph (1), the Director of NIH shall establish a data coordinating center for the following purposes: (i) To distribute the scientific findings referred to in paragraph (1)(C). (ii) To provide assistance in the design and conduct of collaborative research

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122 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 projects and the management, analysis, and storage of data associated with such projects. (iii) To organize and conduct
multisite monitoring activities. (iv) To provide assistance to the Centers for Disease Control and Prevention in the establishment of patient registries. (B) REPORTING.The Director of NIH shall (i) require the data coordinating center established under subparagraph (A) to provide regular reports to the Director of NIH on research conducted by entities described in paragraph (1), including information on enrollment in clinical trials and the allocation of resources with respect to such research; and (ii) as appropriate, incorporate information reported under clause (i) into the Directors biennial reports under section 403 of the Public Health Service Act (42 U.S.C. 283).

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123 1 (c) DEFINITIONS.In this Act, the terms Director
2 of NIH, national center, and national research insti3 tute have the meanings given to such terms in section 4 401 of the Public Health Service Act (42 U.S.C. 281). 5 (d) AUTHORIZATION
OF
APPROPRIATIONS.To
6 carry out this Act, there is authorized to be appropriated 7 $25,000,000 for each of fiscal years 2015 through 2019. 8 9
SEC. 404. NATIONAL VIOLENT DEATH REPORTING SYSTEM.
The Secretary of Health and Human Services, acting
10 through the Director of the Centers for Disease Control 11 and Prevention, shall improve, particularly through the in12 clusion of additional States, the National Violent Death 13 Reporting System, as authorized by title III of the Public 14 Health Service Act (42 U.S.C. 241 et seq.). Participation 15 in the system by the States shall be voluntary. 16 17 18 19
TITLE VEDUCATION AND YOUTH

SEC. 501. SCHOOL-BASED MENTAL HEALTH PROGRAMS.
(a) PURPOSES.It is the purpose of this section
20 to 21 22 23 24 25 (1) revise, increase funding for, and expand the scope of the Safe Schools-Healthy Students program in order to provide access to more comprehensive school-based mental health services and supports;

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124 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
ICE
(2) provide for comprehensive staff development for school and community service personnel working in the school; and (3) provide for comprehensive training for children with mental health disorders, for parents, siblings, and other family members of such children, and for concerned members of the community. (b) AMENDMENTS ACT. (1) TECHNICAL
AMENDMENTS.The TO THE
PUBLIC HEALTH SERV-
second
part G (relating to services provided through religious organizations) of title V of the Public Health Service Act (42 U.S.C. 290kk et seq.) is amended (A) by redesignating such part as part J; and (B) by redesignating sections 581
through 584 as sections 596 through 596C, respectively. (2) SCHOOL-BASED

MENTAL HEALTH AND
CHILDREN AND VIOLENCE.Section
581 of the Pub-
lic Health Service Act (42 U.S.C. 290hh) is amended to read as follows:

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125 1 2 3
SEC. 581. SCHOOL-BASED MENTAL HEALTH AND CHILDREN AND VIOLENCE.
(a) IN GENERAL.The Secretary, in collaboration
4 with the Secretary of Education and in consultation with 5 the Attorney General, shall, directly or through grants, 6 contracts, or cooperative agreements awarded to public en7 tities and local education agencies, assist local commu8 nities and schools in applying a public health approach 9 to mental health services both in schools and in the com10 munity. Such approach should provide comprehensive age 11 appropriate services and supports, be linguistically and 12 culturally appropriate, be trauma-informed, and incor13 porate age appropriate strategies of positive behavioral 14 interventions and supports. A comprehensive school men15 tal health program funded under this section shall assist 16 children in dealing with trauma and violence. 17 (b) ACTIVITIES.Under the program under sub-
18 section (a), the Secretary may 19 20 21 22 23 24 25 (1) provide financial support to enable local communities to implement a comprehensive culturally and linguistically appropriate, trauma-informed, and age-appropriate, school mental health program that incorporates positive behavioral interventions, client treatment, and supports to foster the health and development of children;

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126 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (2) provide technical assistance to local communities with respect to the development of programs described in paragraph (1); (3) provide assistance to local communities in the development of policies to address child and adolescent trauma and mental health issues and violence when and if it occurs; (4) facilitate community partnerships among families, students, law enforcement agencies, education systems, mental health and substance use disorder service systems, family-based mental health service systems, welfare agencies, health care service systems (including physicians), faith-based programs, trauma networks, and other communitybased systems; and (5) establish mechanisms for children and adolescents to report incidents of violence or plans by other children, adolescents, or adults to commit violence. (c) REQUIREMENTS. (1) IN
GENERAL.To
be eligible for a grant,
contract, or cooperative agreement under subsection (a), an entity shall (A) be a partnership between a local education agency and at least one community

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127 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 program or agency that is involved in mental health; and (B) submit an application, that is endorsed by all members of the partnership, that contains the assurances described in paragraph (2). (2) REQUIRED
ASSURANCES.An
application
under paragraph (1) shall contain assurances as follows: (A) That the applicant will ensure that, in carrying out activities under this section, the local educational agency involved will enter into a memorandum of understanding (i) with, at least one, public or private mental health entity, health care entity, law enforcement or juvenile justice entity, child welfare agency, family-based mental health entity, family or family organization, trauma network, or other communitybased entity; and (ii) that clearly states (I) the responsibilities of each partner with respect to the activities to be carried out;

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128 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (II) how each such partner will be accountable for carrying out such responsibilities; and (III) the amount of non-Federal funding or in-kind contributions that each such partner will contribute in order to sustain the program. (B) That the comprehensive schoolbased mental health program carried out under this section supports the flexible use of funds to address (i) the promotion of the social, emotional, and behavioral health of all students in an environment that is conducive to learning; (ii) the reduction in the likelihood of at risk students developing social, emotional, behavioral health problems, or substance use disorders; (iii) the early identification of social, emotional, behavioral problems, or substance use disorders and the provision of early intervention services; (iv) the treatment or referral for treatment of students with existing social,

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129 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 emotional, behavioral health problems, or substance use disorders; and (v) the development and implementation of programs to assist children in dealing with trauma and violence. (C) That the comprehensive schoolbased mental health program carried out under this section will provide for in-service training of all school personnel, including ancillary staff and volunteers, in (i) the techniques and supports needed to identify early children with trauma histories and children with, or at risk of, mental illness; (ii) the use of referral mechanisms that effectively link such children to appropriate treatment and intervention services in the school and in the community and to follow-up when services are not available; (iii) strategies that promote a school-wide positive environment; (iv) strategies for promoting the social, emotional, mental, and behavioral health of all students; and

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130 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (v) strategies to increase the knowledge and skills of school and community leaders about the impact of trauma and violence and on the application of a public health approach to comprehensive schoolbased mental health programs. (D) That the comprehensive schoolbased mental health program carried out under this section will include comprehensive training for parents, siblings, and other family members of children with mental health disorders, and for concerned members of the community in (i) the techniques and supports needed to identify early children with trauma histories, and children with, or at risk of, mental illness; (ii) the use of referral mechanisms that effectively link such children to appropriate treatment and intervention services in the school and in the community and follow-up when such services are not available; and (iii) strategies that promote a school-wide positive environment.

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131 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (E) That the comprehensive schoolbased mental health program carried out under this section will demonstrate the measures to be taken to sustain the program after funding under this section terminates. (F) That the local education agency partnership involved is supported by the State educational and mental health system to ensure that the sustainability of the programs is established after funding under this section terminates. (G) That the comprehensive schoolbased mental health program carried out under this section will be based on trauma-informed and evidence-based practices. (H) That the comprehensive schoolbased mental health program carried out under this section will be coordinated with early intervening activities carried out under the Individuals with Disabilities Education Act. (I) That the comprehensive school-based mental health program carried out under this section will be trauma-informed and culturally and linguistically appropriate.

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132 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (J) That the comprehensive school-based mental health program carried out under this section will include a broad needs assessment of youth who drop out of school due to policies of zero tolerance with respect to drugs, alcohol, or weapons and an inability to obtain appropriate services. (K) That the mental health services provided through the comprehensive school-based mental health program carried out under this section will be provided by qualified mental and behavioral health professionals who are certified or licensed by the State involved and practicing within their area of expertise. (3) COORDINATOR.Any entity that is a member of a partnership described in paragraph (1)(A) may serve as the coordinator of funding and activities under the grant if all members of the partnership agree. (4) COMPLIANCE
WITH HIPAA.A
grantee
under this section shall be deemed to be a covered entity for purposes of compliance with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act

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133 1 2 3 of 1996 with respect to any patient records developed through activities under the grant. (d) GEOGRAPHICAL DISTRIBUTION.The Sec-
4 retary shall ensure that grants, contracts, or cooperative 5 agreements under subsection (a) will be distributed equi6 tably among the regions of the country and among urban 7 and rural areas. 8 (e) DURATION
OF
AWARDS.With respect to a
9 grant, contract, or cooperative agreement under sub10 section (a), the period during which payments under such 11 an award will be made to the recipient shall be 6 years. 12 An entity may receive only one award under this section, 13 except that an entity that is providing services and sup14 ports on a regional basis may receive additional funding 15 after the expiration of the preceding grant period. 16 17 18 19 20 21 22 23 24 (f)
COMES.
EVALUATION
AND
MEASURES
OF
OUT-
(1) DEVELOPMENT
OF PROCESS.The
Ad-
ministrator shall develop a fiscally appropriate process for evaluating activities carried out under this section. Such process shall include (A) the development of guidelines for the submission of program data by grant, contract, or cooperative agreement recipients;

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134 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (B) the development of measures of outcomes (in accordance with paragraph (2)) to be applied by such recipients in evaluating programs carried out under this section; and (C) the submission of annual reports by such recipients concerning the effectiveness of programs carried out under this section. (2) MEASURES (A) IN
OF OUTCOMES.
GENERAL.The
Administrator
shall develop measures of outcomes to be applied by recipients of assistance under this section, and the Administrator, in evaluating the effectiveness of programs carried out under this section. Such measures shall include student and family measures as provided for in subparagraph (B) and local educational measures as provided for under subparagraph (C). (B) STUDENT
OF OUTCOMES.The AND FAMILY MEASURES
measures of outcomes de-
veloped under paragraph (1)(B) relating to students and families shall, with respect to activities carried out under a program under this section, at a minimum include provisions to evaluate whether the program is effective in

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135 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 (i) increasing social and emotional competency; (ii) increasing academic competency (as defined by Secretary); (iii) reducing disruptive and aggressive behaviors; (iv) improving child functioning; (v) reducing substance use disorders; (vi) reducing suspensions, truancy, expulsions and violence; (vii) increasing graduation rates (as defined in section 1111(b)(2)(C)(vi) of the Elementary and Secondary Education Act of 1965); and (viii) improving access to care for mental health disorders. (C) LOCAL
EDUCATIONAL OUTCOMES.
The outcome measures developed under paragraph (1)(B) relating to local educational systems shall, with respect to activities carried out under a program under this section, at a minimum include provisions to evaluate

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136 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (i) the effectiveness of comprehensive school mental health programs established under this section; (ii) the effectiveness of formal partnership linkages among child and family serving institutions, community support systems, and the educational system; (iii) the progress made in sustaining the program once funding under the grant has expired; (iv) the effectiveness of training and professional development programs for all school personnel that incorporate indicators that measure cultural and linguistic competencies under the program in a manner that incorporates appropriate cultural and linguistic training; (v) the improvement in perception of a safe and supportive learning environment among school staff, students, and parents; (vi) the improvement in case-finding of students in need of more intensive services and referral of identified students to early intervention and clinical services;

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137 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (vii) the improvement in the immediate availability of clinical assessment and treatment services within the context of the local community to students posing a danger to themselves or others; (viii) the increased successful matriculation to postsecondary school; and (ix) reduced referrals to juvenile justice. (3) SUBMISSION
OF ANNUAL DATA.An
en-
tity that receives a grant, contract, or cooperative agreement under this section shall annually submit to the Administrator a report that includes data to evaluate the success of the program carried out by the entity based on whether such program is achieving the purposes of the program. Such reports shall utilize the measures of outcomes under paragraph (2) in a reasonable manner to demonstrate the progress of the program in achieving such purposes. (4) EVALUATION
BY ADMINISTRATOR.
Based on the data submitted under paragraph (3), the Administrator shall annually submit to Congress a report concerning the results and effectiveness of

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138 1 2 3 4 5 6 7 the programs carried out with assistance received under this section. (5) LIMITATION.A grantee shall use not to exceed 10 percent of amounts received under a grant under this section to carry out evaluation activities under this subsection. (g) INFORMATION
AND
EDUCATION.The Sec-
8 retary shall establish comprehensive information and edu9 cation programs to disseminate the findings of the knowl10 edge development and application under this section to the 11 general public and to health care professionals. 12 (h) AMOUNT
OF
GRANTS
AND
AUTHORIZATION
OF
13 APPROPRIATIONS. 14 15 16 17 18 19 20 21 22 23 24 (1) AMOUNT

OF GRANTS.A
grant under
this section shall be in an amount that is not more than $1,000,000 for each of grant years 2015 through 2019. The Secretary shall determine the amount of each such grant based on the population of children up to age 21 of the area to be served under the grant. (2) AUTHORIZATION
OF APPROPRIATIONS.
There is authorized to be appropriated to carry out this section, $200,000,000 for each of fiscal years 2015 through 2019..

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139 1 2 3 4 5 6 7 8 9 (3) CONFORMING

AMENDMENT.Part
G of
title V of the Public Health Service Act (42 U.S.C. 290hh et seq.), as amended by this section, is further amended by striking the part heading and inserting the following:
PART GSCHOOL-BASED MENTAL HEALTH.
SEC. 502. IMPROVING MENTAL HEALTH AND BEHAVIORAL HEALTH OUTCOMES ON COLLEGE CAMPUSES.
(a) SHORT TITLE.This section may be cited as
10 the Mental Health on Campus Improvement Act. 11 (b) FINDINGS.Congress makes the following find-
12 ings: 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) The 2011 Association of University and College Counseling Center Directors Survey found that the average ratio of counselors to students on campus is nearly 1 to 1,879 and is often far higher on large campuses. The International Association of Counseling Services accreditation standards recommends 1 counselor per 1,000 to 1,500 students. (2) College Counselors report that 10.8 percent of enrolled students sought counseling in the past year, totaling an estimated 2,000,000 students. (3) Over 90 percent of counseling directors believe there is an increase in the number of students

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140 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 coming to campus with severe psychological problems; today, 44 percent of the students who visit campus counseling centers are dealing with severe mental illness, up from 16 percent in 2000, and 24 percent are on psychiatric medication, up from 17 percent in 2000. (4) The majority of campus counseling directors report that the demand for services and the severity of student needs are growing without an increase in resources. (5) Many students who need help never receive it. Only 15 percent of college students who commit suicide received campus counseling. Of students who seriously consider suicide each year, only 52 percent of them seek any professional help at all. (6) A 2012 American College Health Association (ACHA) survey of more than 98,000 college and university students revealed that, within the last 12 months, 51 percent of students report having felt overwhelming anxiety, 31 percent felt so depressed it was difficult to function, and 46 percent felt hopeless. The ACHA survey found that 7.5 percent of students have seriously considered suicide in the past 12 months.

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141 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (7) The National Research Consortium of Counseling Centers in Higher Education found that 6 percent of students have seriously considered suicide in the past 12 months. The Research Consortium found that of those who have seriously considered suicide in the past 12 months, 52 percent sought no preferred help and only 54 percent told anyone that they were considering suicide. (8) Research conducted between 1997 and 2009, and presented at the 118th annual convention of the American Psychological Association found that more students are grappling with depression and anxiety disorders than did a decade ago. The study found that of students who sought college counseling, 41 percent had moderate to severe depression in 2009, that number was 34 percent in 1997. (9) A survey conducted by the University of Idaho Student Counseling Center in 2000 found that 77 percent of students who responded reported that they were more likely to stay in school because of counseling and that their school performance would have declined without counseling. (10) Students with psychological issues often struggle academically and are at risk for dropping

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142 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
ON
out of school. Counseling has been shown to address these issues while having a positive impact on students remaining in school. A 6-year longitudinal study found college students receiving counseling to have an 11.4 percent higher retention rate than the general university population (Turner & Berry, 2000). (11) A national survey of college students living with mental health conditions, conducted by the National Alliance on Mental Health, found that 64 percent of students who experience mental health problems in college and withdraw from school do so because of their mental health issues. The survey also found that 50 percent of that group never accessed mental health services and supports. (c) IMPROVING MENTAL AND BEHAVIORAL HEALTH COLLEGE CAMPUSES.Title V of the Public Health
18 Service Act is amended by inserting after section 520E 19 2 (42 U.S.C. 290bb36b) the following: 20 21 22
SEC. 520E3. GRANTS TO IMPROVE MENTAL AND BEHAVIORAL HEALTH ON COLLEGE CAMPUSES.
(a) PURPOSE.It is the purpose of this section,
23 with respect to college and university settings, to 24 25 (1) increase access to mental and behavioral health services;

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143 1 2 3 4 5 6 7 8 9 10 11 12 13 (2) foster and improve the prevention of mental and behavioral health disorders, and the promotion of mental health; (3) improve the identification and treatment for students at risk; (4) improve collaboration and the development of appropriate levels of mental and behavioral health care; (5) reduce the stigma for students with mental health disorders and enhance their access to mental health services; and (6) improve the efficacy of outreach efforts. (b) GRANTS.The Secretary, acting through the
14 Administrator and in consultation with the Secretary of 15 Education, shall award competitive grants to eligible enti16 ties to improve mental and behavioral health services and 17 outreach on college and university campuses. 18 (c) ELIGIBILITY.To be eligible to receive a grant
19 under subsection (b), an entity shall 20 21 22 23 24 (1) be an institution of higher education (as defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001)); and (2) submit to the Secretary an application at such time, in such manner, and containing such in-

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144 1 2 3 formation as the Secretary may require, including the information required under subsection (d). (d) APPLICATION.An application for a grant
4 under this section shall include 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) a description of the population to be targeted by the program carried out under the grant, the particular mental and behavioral health needs of the students involved; (2) a description of the Federal, State, local, private, and institutional resources available for meeting the needs of such students at the time the application is submitted; (3) an outline of the objectives of the program carried out under the grant; (4) a description of activities, services, and training to be provided under the program, including planned outreach strategies to reach students not currently seeking services; (5) a plan to seek input from community mental health providers, when available, community groups, and other public and private entities in carrying out the program; (6) a plan, when applicable, to meet the specific mental and behavioral health needs of veterans attending institutions of higher education;

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145 1 2 3 4 5 6 7 8 (7) a description of the methods to be used to evaluate the outcomes and effectiveness of the program; and (8) an assurance that grant funds will be used to supplement, and not supplant, any other Federal, State, or local funds available to carry out activities of the type carried out under the grant. (e) SPECIAL CONSIDERATIONS.In awarding
9 grants under this section, the Secretary shall give special 10 consideration to applications that describe programs to be 11 carried out under the grant that 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) demonstrate the greatest need for new or additional mental and behavioral health services, in part by providing information on current ratios of students to mental and behavioral health professionals; (2) propose effective approaches for initiating or expanding campus services and supports using evidence-based practices; (3) target traditionally underserved populations and populations most at risk; (4) where possible, demonstrate an awareness of, and a willingness to, coordinate with a community mental health center or other mental health re-

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146 1 2 3 4 5 6 7 8 9 source in the community, to support screening and referral of students requiring intensive services; (5) identify how the college or university will address psychiatric emergencies, including how information will be communicated with families or other appropriate parties; and (6) demonstrate the greatest potential for replication and dissemination. (f) USE
OF
FUNDS.Amounts received under a
10 grant under this section may be used to 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) provide mental and behavioral health services to students, including prevention, promotion of mental health, voluntary screening, early intervention, voluntary assessment, treatment, management, and education services relating to the mental and behavioral health of students; (2) provide outreach services to notify students about the existence of mental and behavioral health services; (3) educate students, families, faculty, staff, and communities to increase awareness of mental health issues; (4) support student groups on campus that engage in activities to educate students, including activities to reduce stigma surrounding mental and

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147 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 behavioral disorders, and promote mental health wellness; (5) employ appropriately trained staff; (6) provide training to students, faculty, and staff to respond effectively to students with mental and behavioral health issues; (7) expand mental health training through internship, post-doctorate, and residency programs; (8) develop and support evidence-based and emerging best practices, including a focus on culturally and linguistically appropriate best practices; and (9) evaluate and disseminate best practices to other colleges and universities. (g) DURATION
OF
GRANTS.A grant under this
16 section shall be awarded for a period not to exceed 3 17 years. 18 19 20 21 22 23 24 25 (h) EVALUATION AND REPORTING. (1) EVALUATION.Not later than 18 months after the date on which a grant is received under this section, the eligible entity involved shall submit to the Secretary the results of an evaluation to be conducted by the entity concerning the effectiveness of the activities carried out under the grant and plans for the sustainability of such efforts.

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148 1 2 3 4 5 6 7 8 9 10 11 (2) REPORT.Not later than 2 years after the date of enactment of this section, the Secretary shall submit to the appropriate committees of Congress a report concerning the results of (A) the evaluations conducted under paragraph (1); and (B) an evaluation conducted by the Secretary to analyze the effectiveness and efficacy of the activities conducted with grants under this section. (i) TECHNICAL ASSISTANCE.The Secretary may
12 provide technical assistance to grantees in carrying out 13 this section. 14 (j) AUTHORIZATION
OF
15 are authorized to be appropriated such sums as may be 16 necessary to carry out this section. 17 18 19 20
SEC. 520E4. MENTAL AND BEHAVIORAL HEALTH OUTREACH AND EDUCATION ON COLLEGE CAMPUSES.
(a) PURPOSE.It is the purpose of this section to
21 increase access to, and reduce the stigma associated with, 22 mental health services so as to ensure that college students 23 have the support necessary to successfully complete their 24 studies.

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149 1 (b) NATIONAL PUBLIC EDUCATION CAMPAIGN.
2 The Secretary, acting through the Administrator and in 3 collaboration with the Director of the Centers for Disease 4 Control and Prevention, shall convene an interagency, 5 public-private sector working group to plan, establish, and 6 begin coordinating and evaluating a targeted public edu7 cation campaign that is designed to focus on mental and 8 behavioral health on college campuses. Such campaign 9 shall be designed to 10 11 12 13 14 15 16 17 18 19 20 21 (1) improve the general understanding of mental health and mental health disorders; (2) encourage help-seeking behaviors relating to the promotion of mental health, prevention of mental health disorders, and treatment of such disorders; (3) make the connection between mental and behavioral health and academic success; and (4) assist the general public in identifying the early warning signs and reducing the stigma of mental illness. (c) COMPOSITION.The working group under sub-
22 section (b) shall include 23 24 (1) mental health consumers, including students and family members;

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150 1 2 3 4 5 6 7 8 9 10 11 12 13 (2) representatives of colleges and universities; (3) representatives of national mental and behavioral health and college associations; (4) representatives of college health promotion and prevention organizations; (5) representatives of mental health providers, including community mental health centers; and (6) representatives of private- and public-sector groups with experience in the development of effective public health education campaigns. (d) PLAN.The working group under subsection
14 (b) shall develop a plan that shall 15 16 17 18 19 20 21 22 23 24 (1) target promotional and educational efforts to the college age population and individuals who are employed in college and university settings, including the use of roundtables; (2) develop and propose the implementation of research-based public health messages and activities; (3) provide support for local efforts to reduce stigma by using the National Mental Health Information Center as a primary point of contact for in-

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151 1 2 3 4 5 6 7 formation, publications, and service program referrals; and (4) develop and propose the implementation of a social marketing campaign that is targeted at the college population and individuals who are employed in college and university settings. (e) AUTHORIZATION
OF
8 are authorized to be appropriated such sums as may be 9 necessary to carry out this section.. 10 (d) INTERAGENCY WORKING GROUP
ON
COLLEGE
11 MENTAL HEALTH. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) PURPOSE.It is the purpose of this section, pursuant to Executive Order 13263 (and the recommendations issued under section 6(b) of such Order), to provide for the establishment of a College Campus Task Force under the Federal Executive Steering Committee on Mental Health, to discuss mental and behavioral health concerns on college and university campuses. (2) ESTABLISHMENT.The Secretary of
Health and Human Services (referred to in this section as the Secretary) shall establish a College Campus Task Force (referred to in this section as the Task Force), under the Federal Executive Steering Committee on Mental Health, to discuss

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152 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 mental and behavioral health concerns on college and university campuses. (3) MEMBERSHIP.The Task Force shall be composed of a representative from each Federal agency (as appointed by the head of the agency) that has jurisdiction over, or is affected by, mental health and education policies and projects, including (A) the Department of Education; (B) the Department of Health and Human Services; (C) the Department of Veterans Affairs; and (D) such other Federal agencies as the Administrator of the Substance Abuse and Mental Health Services Administration and the Secretary jointly determine to be appropriate. (4) DUTIES.The Task Force shall (A) serve as a centralized mechanism to coordinate a national effort (i) to discuss and evaluate evidence and knowledge on mental and behavioral health services available to, and the prevalence of mental health illness among, the

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153 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 college age population of the United States; (ii) to determine the range of effective, feasible, and comprehensive actions to improve mental and behavioral health on college and university campuses; (iii) to examine and better address the needs of the college age population dealing with mental illness; (iv) to survey Federal agencies to determine which policies are effective in encouraging, and how best to facilitate outreach without duplicating, efforts relating to mental and behavioral health promotion; (v) to establish specific goals within and across Federal agencies for mental health promotion, including determinations of accountability for reaching those goals; (vi) to develop a strategy for allocating responsibilities and ensuring participation in mental and behavioral health promotions, particularly in the case of competing agency priorities;

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154 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (vii) to coordinate plans to communicate research results relating to mental and behavioral health amongst the college age population to enable reporting and outreach activities to produce more useful and timely information; (viii) to provide a description of evidence-based best practices, model programs, effective guidelines, and other strategies for promoting mental and behavioral health on college and university campuses; (ix) to make recommendations to improve Federal efforts relating to mental and behavioral health promotion on college campuses and to ensure Federal efforts are consistent with available standards and evidence and other programs in existence as of the date of enactment of this Act; and (x) to monitor Federal progress in meeting specific mental and behavioral health promotion goals as they relate to college and university settings;

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155 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 (B) consult with national organizations with expertise in mental and behavioral health, especially those organizations working with the college age population; and (C) consult with and seek input from mental health professionals working on college and university campuses as appropriate. (5) MEETINGS. (A) IN
GENERAL.The
Task Force shall
meet at least 3 times each year. (B) ANNUAL

CONFERENCE.The
Sec-
retary shall sponsor an annual conference on mental and behavioral health in college and university settings to enhance coordination, build partnerships, and share best practices in mental and behavioral health promotion, data collection, analysis, and services. (6) AUTHORIZATION
OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be necessary to carry out this section.
SEC. 503. EXAMINING MENTAL HEALTH CARE FOR CHILDREN.
(a) IN GENERAL.Not later than 1 year after the
24 date of enactment of this Act, the Comptroller General 25 of the United States shall conduct an independent evalua-

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156 1 tion, and submit to the Committee on Health, Education, 2 Labor, and Pensions of the Senate and the Committee on 3 Energy and Commerce of the House of Representatives, 4 a report concerning the utilization of mental health serv5 ices for children, including the usage of psychotropic medi6 cations. 7 (b) CONTENT.The report submitted under sub-
8 section (a) shall review and assess 9 10 11 12 13 14 15 16 17 18 19 20 21 (1) the ways in which children access mental health care, including information on whether children are treated by primary care or specialty providers, what types of referrals for additional care are recommended, and any barriers to accessing this care; (2) the extent to which children are prescribed psychotropic medications in the United States including the frequency of concurrent medication usage; and (3) the tools, assessments, and medications that are available and used to diagnose and treat children with mental health disorders.

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157 1 2 3 4
TITLE VIJUSTICE AND MENTAL HEALTH COLLABORATION

SEC. 601. ASSISTING VETERANS.
(a) REDESIGNATION.Section 2991 of the Omnibus
5 Crime Control and Safe Streets Act of 1968 (42 U.S.C. 6 3797aa) is amended by redesignating subsection (i) as 7 subsection (l). 8 (b) ASSISTING VETERANS.Section 2991 of the Om-
9 nibus Crime Control and Safe Streets Act of 1968 (42 10 U.S.C. 3797aa) is amended by inserting after subsection 11 (h) the following: 12 13 14 15 16 17 18 19 20 21 22 23 24 (i) ASSISTING VETERANS. (1) DEFINITIONS.In this subsection: (A) PEER
GRAMS.The TO PEER SERVICES OR PRO-
term peer to peer services or
programs means services or programs that connect qualified veterans with other veterans for the purpose of providing support and
mentorship to assist qualified veterans in obtaining treatment, recovery, stabilization, or rehabilitation. (B) QUALIFIED
VETERAN.The
term
qualified veteran means a preliminarily qualified offender who

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158 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 and (iv) other appropriate services, including housing, transportation, mentoring, (i) has served on active duty in any branch of the Armed Forces, including the National Guard and reserve components; and (ii) was discharged or released from such service under conditions other than dishonorable. (C) VETERANS
GRAM.The TREATMENT COURT PRO-
term veterans treatment court
program means a court program involving collaboration among criminal justice, veterans, and mental health and substance abuse agencies that provides qualified veterans with (i) intensive judicial supervision and case management, which may include random and frequent drug testing where appropriate; (ii) a full continuum of treatment services, including mental health services, substance abuse services, medical services, and services to address trauma; (iii) alternatives to incarceration;

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[Discussion Draft]
159 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 employment, job training, education, and assistance in applying for and obtaining available benefits. (2) VETERANS (A) IN
ASSISTANCE PROGRAM.
GENERAL.The
Attorney General,
in consultation with the Secretary of Veterans Affairs, may award grants under this subsection to applicants to establish or expand (i) veterans treatment court programs; (ii) peer to peer services or programs for qualified veterans; (iii) practices that identify and provide treatment, rehabilitation, legal, transitional, and other appropriate services to qualified veterans who have been incarcerated; and (iv) training programs to teach criminal justice, law enforcement, corrections, mental health, and substance abuse personnel how to identify and appropriately respond to incidents involving qualified veterans.

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160 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 (B) PRIORITY.In awarding grants
under this subsection, the Attorney General shall give priority to applications that (i) demonstrate collaboration between and joint investments by criminal justice, mental health, substance abuse, and veterans service agencies; (ii) promote effective strategies to identify and reduce the risk of harm to qualified veterans and public safety; and (iii) propose interventions with empirical support to improve outcomes for qualified veterans..
SEC. 602. CORRECTIONAL FACILITIES.
Section 2991 of the Omnibus Crime Control and Safe
16 Streets Act of 1968 (42 U.S.C. 3797aa) is amended by 17 inserting after subsection (i), as so added by section 601, 18 the following: 19 20 21 22 23 24 25 (j) CORRECTIONAL FACILITIES. (1) DEFINITIONS. (A) CORRECTIONAL
FACILITY.The
term
correctional facility means a jail, prison, or other detention facility used to house people who have been arrested, detained, held, or convicted by a criminal justice agency or a court.

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161 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (B) ELIGIBLE

INMATE.The
term eligi-
ble inmate means an individual who (i) is being held, detained, or incarcerated in a correctional facility; and (ii) manifests obvious signs of a mental illness or has been diagnosed by a qualified mental health professional as having a mental illness. (2) CORRECTIONAL
FACILITY GRANTS.The
Attorney General may award grants to applicants to enhance the capabilities of a correctional facility (A) to identify and screen for eligible inmates; (B) to plan and provide (i) initial and periodic assessments of the clinical, medical, and social needs of inmates; and (ii) appropriate treatment and services that address the mental health and substance abuse needs of inmates; (C) to develop, implement, and enhance (i) post-release transition plans for eligible inmates that, in a comprehensive manner, coordinate health, housing, med-

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[Discussion Draft]
162 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 ical, employment, and other appropriate services and public benefits; (ii) the availability of mental health care services and substance abuse treatment services; and (iii) alternatives to solitary confinement and segregated housing and mental health screening and treatment for inmates placed in solitary confinement or segregated housing; and (D) to train each employee of the correctional facility to identify and appropriately respond to incidents involving inmates with mental health or co-occurring mental health and substance abuse disorders..
SEC. 603. HIGH UTILIZERS.
Section 2991 of the Omnibus Crime Control and Safe
18 Streets Act of 1968 (42 U.S.C. 3797aa) is amended by 19 inserting after subsection (j), as added by section 602, the 20 following: 21 (k) DEMONSTRATION GRANTS RESPONDING
TO
22 HIGH UTILIZERS. 23 24 (1) DEFINITION.In this subsection, the term high utilizer means an individual who

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163 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (A) manifests obvious signs of mental illness or has been diagnosed by a qualified mental health professional as having a mental illness; and (B) consumes a significantly disproportionate quantity of public resources, such as emergency, housing, judicial, corrections, and law enforcement services. (2) DEMONSTRATION
HIGH UTILIZERS. GRANTS RESPONDING TO
(A) IN
GENERAL.The
Attorney General
may award not more than 6 grants per year under this subsection to applicants for the purpose of reducing the use of public services by high utilizers. (B) USE
OF GRANTS.A
recipient of a
grant awarded under this subsection may use the grant (i) to develop or support multidisciplinary teams that coordinate, implement, and administer community-based crisis responses and long-term plans for high utilizers; (ii) to provide training on how to respond appropriately to the unique issues

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164 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 involving high utilizers for public service personnel, including criminal justice, mental health, substance abuse, emergency room, healthcare, law enforcement, corrections, and housing personnel; (iii) to develop or support alternatives to hospital and jail admissions for high utilizers that provide treatment, stabilization, and other appropriate supports in the least restrictive, yet appropriate, environment; or (iv) to develop protocols and systems among law enforcement, mental health, substance abuse, housing, corrections, and emergency medical service operations to provide coordinated assistance to high utilizers. (C) REPORT.Not later than the last day of the first year following the fiscal year in which a grant is awarded under this subsection, the recipient of the grant shall submit to the Attorney General a report that (i) measures the performance of the grant recipient in reducing the use of public services by high utilizers; and

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[Discussion Draft]
165 1 2 3 4 5 6 (ii) provides a model set of practices, systems, or procedures that other jurisdictions can adopt to reduce the use of public services by high utilizers..
SEC. 604. ACADEMY TRAINING.
Section 2991(h) of the Omnibus Crime Control and
7 Safe Streets Act of 1968 (42 U.S.C. 3797aa(h)) is amend8 ed 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) in paragraph (1), by adding at the end the following: (F) ACADEMY
TRAINING.To
provide
support for academy curricula, law enforcement officer orientation programs, continuing education training, and other programs that teach law enforcement personnel how to identify and respond to incidents involving individuals with mental illness or co-occurring mental illness and substance abuse disorders.; and (2) by adding at the end the following: (4) PRIORITY
CONSIDERATION.The
Attorney
General, in awarding grants under this subsection, shall give priority to programs that law enforcement personnel and members of the mental health and substance abuse professions develop and administer cooperatively..

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166 1 2
SEC. 605. EVIDENCE BASED PRACTICES.
Section 2991(c) of the Omnibus Crime Control and
3 Safe Streets Act of 1968 (42 U.S.C. 3797aa(c)) is amend4 ed 5 6 7 8 9 10 11 12 13 14 15 16 17 18 end; (2) by redesignating paragraph (4) as paragraph (6); and (3) by inserting after paragraph (3), the following: (4) propose interventions that have been shown by empirical evidence to reduce recidivism; (5) when appropriate, use validated assessment tools to target preliminarily qualified offenders with a moderate or high risk of recidivism and a need for treatment and services; or.
SEC. 606. SAFE COMMUNITIES.
(1) in paragraph (3), by striking or at the
(a) IN GENERAL.Section 2991(a) of the Omnibus
19 Crime Control and Safe Streets Act of 1968 (42 U.S.C. 20 3797aa(a)) is amended by striking paragraph (9) and in21 serting the following: 22 23 24 25 (9) PRELIMINARILY (A) IN
QUALIFIED OFFENDER.
GENERAL.The
term prelimi-
narily qualified offender means an adult or juvenile accused of an offense who

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167 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (i)(I) previously or currently has been diagnosed by a qualified mental health professional as having a mental illness or co-occurring mental illness and substance abuse disorders; (II) manifests obvious signs of mental illness or co-occurring mental illness and substance abuse disorders during arrest or confinement or before any court; or (III) in the case of a veterans treatment court provided under subsection (i), has been diagnosed with, or manifests obvious signs of, mental illness or a substance abuse disorder or co-occurring mental illness and substance abuse disorder; and (ii) has been unanimously approved for participation in a program funded under this section by, when appropriate, the relevant (I) prosecuting attorney; (II) defense attorney; (III) probation or corrections official; (IV) judge; and

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168 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (V) a representative from the relevant mental health agency described in subsection (b)(5)(B)(i). (B) DETERMINATION.In determining whether to designate an individual as a preliminarily qualified offender, the relevant prosecuting attorney, defense attorney, probation or corrections official, judge, and mental health or substance abuse agency representative shall take into account (i) whether the participation of the individual in the program would pose a substantial risk of violence to the community; (ii) the criminal history of the individual and the nature and severity of the offense for which the individual is charged; (iii) the views of any relevant victims to the offense; (iv) the extent to which the individual would benefit from participation in the program; (v) the extent to which the community would realize cost savings because of

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169 1 2 3 4 5 6 7 8 9 10 the indiviudals participation in the program; and (vi) whether the individual satisfies the eligibility criteria for program participation unanimously established by the relevant prosecuting attorney, defense attorney, probation or corrections official, judge and mental health or substance abuse agency representative.. (b) TECHNICAL
AND
CONFORMING AMENDMENT.
11 Section 2927(2) of the Omnibus Crime Control and Safe 12 Streets Act of 1968 (42 U.S.C. 3797s6(2)) is amended 13 by striking has the meaning given that term in section 14 2991(a). and inserting means an offense that 15 16 17 18 19 20 21 22 23 (A) does not have as an element the use, attempted use, or threatened use of physical force against the person or property of another; or (B) is not a felony that by its nature involves a substantial risk that physical force against the person or property of another may be used in the course of committing the offense..

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170 1 2
SEC. 607. REAUTHORIZATION OF APPROPRIATIONS.
Subsection (l) of section 2991 of the Omnibus Crime
3 Control and Safe Streets Act of 1968 (42 U.S.C. 3797aa), 4 as redesignated in section 601(a), is amended 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) in paragraph (1) (A) in subparagraph (B), by striking and at the end; (B) in subparagraph (C), by striking the period and inserting ; and; and (C) by adding at the end the following: (D) $40,000,000 for each of fiscal years 2015 through 2019.; and (2) by adding at the end the following: (3) LIMITATION.Not more than 20 percent of the funds authorized to be appropriated under this section may be used for purposes described in subsection (i) (relating to veterans)..
TITLE VIIBEHAVIORAL HEALTH INFORMATION TECHNOLOGY

SEC. 701. EXTENSION OF HEALTH INFORMATION TECHNOLOGY ASSISTANCE FOR BEHAVIORAL AND MENTAL HEALTH AND SUBSTANCE ABUSE.
Section 3000(3) of the Public Health Service Act (42
25 U.S.C. 300jj(3)) is amended by inserting before and any 26 other category the following: behavioral and mental
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171 1 health professionals (as defined in section
2 331(a)(3)(E)(i)), a substance abuse professional, a psy3 chiatric hospital (as defined in section 1861(f) of the So4 cial Security Act), a community mental health center 5 meeting the criteria specified in section 1913(c), a residen6 tial or outpatient mental health or substance abuse treat7 ment facility,. 8 9 10 11 12
SEC. 702. EXTENSION OF ELIGIBILITY FOR MEDICARE AND MEDICAID HEALTH INFORMATION TECH-
NOLOGY IMPLEMENTATION ASSISTANCE.
(a) PAYMENT INCENTIVES

SIONALS
FOR
ELIGIBLE PROFES-
UNDER MEDICARE.Section 1848 of the Social
13 Security Act (42 U.S.C. 1395w4) is amended 14 15 16 17 18 19 20 21 22 23 24 25

BLE
(1) in subsection (a)(7) (A) in subparagraph (E), by adding at the end the following new clause: (iv) ADDITIONAL
SIONAL.The ELIGIBLE PROFES-
term additional eligible pro-
fessional means a clinical psychologist providing qualified psychologist services (as defined in section 1861(ii)).; and (B) by adding at the end the following new subparagraph: (F) APPLICATION
TO ADDITIONAL ELIGI-
PROFESSIONALS.The
Secretary
shall

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172 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 apply the provisions of this paragraph with respect to an additional eligible professional in the same manner as such provisions apply to an eligible professional, except in applying subparagraph (A) (i) in clause (i), the reference to 2015 shall be deemed a reference to 2019; (ii) in clause (ii), the references to 2015, 2016, and 2017 shall be deemed references to 2019, 2020, and 2021, respectively; and (iii) in clause (iii), the reference to 2018 shall be deemed a reference to 2022.; and (2) in subsection (o) (A) in paragraph (5), by adding at the end the following new subparagraph: (D) ADDITIONAL
ELIGIBLE PROFES-
SIONAL.The
term additional eligible profes-
sional means a clinical psychologist providing qualified psychologist services (as defined in section 1861(ii)).; and (B) by adding at the end the following new paragraph:

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173 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 (6) APPLICATION

PROFESSIONALS.The TO ADDITIONAL ELIGIBLE
Secretary shall apply the
provisions of this subsection with respect to an additional eligible professional in the same manner as such provisions apply to an eligible professional, except in applying (A) paragraph (1)(A)(ii), the reference to 2016 shall be deemed a reference to 2020; (B) paragraph (1)(B)(ii), the references to 2011 and 2012 shall be deemed references to 2015 and 2016, respectively; (C) paragraph (1)(B)(iii), the references to 2013 shall be deemed references to 2017; (D) paragraph (1)(B)(v), the references to 2014 shall be deemed references to 2018; and (E) paragraph (1)(E), the reference to 2011 shall be deemed a reference to 2015.. (b) ELIGIBLE HOSPITALS.Section 1886 of the So-
20 cial Security Act (42 U.S.C. 1395ww) is amended 21 22 23 24 25 (1) in subsection (b)(3)(B)(ix), by adding at the end the following new subclause: (V) The Secretary shall apply the provisions of this subsection with respect to an additional eligible hos-

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174 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 pital (as defined in subsection
(n)(6)(C)) in the same manner as such provisions apply to an eligible hospital, except in applying (aa) subclause (I), the references to 2015, 2016, and 2017 shall be deemed references to 2019, 2020, and 2021, respectively; and (bb) subclause (III), the reference to 2015 shall be
deemed a reference to 2019.; and (2) in subsection (n) (A) in paragraph (6), by adding at the end the following new subparagraph: (C) ADDITIONAL
ELIGIBLE HOSPITAL.
The term additional eligible hospital means an inpatient hospital that is a psychiatric hospital (as defined in section 1861(f)).; and (B) by adding at the end the following new paragraph: (7) APPLICATION
HOSPITALS.The TO ADDITIONAL ELIGIBLE
Secretary shall apply the provi-
sions of this subsection with respect to an additional

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175 1 2 3 4 5 6 7 8 9 eligible hospital in the same manner as such provisions apply to an eligible hospital, except in applying (A) paragraph (2)(E)(ii), the references to 2013 and 2015 shall be deemed references to 2017 and 2019, respectively; and (B) paragraph (2)(G)(i), the reference to 2011 shall be deemed a reference to 2015.. (c) MEDICAID PROVIDERS.Section 1903(t) of the
10 Social Security Act (42 U.S.C. 1396b(t)) is amended 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) in paragraph (2)(B) (A) in clause (i), by striking , or and inserting a semicolon; (B) in clause (ii), by striking the period and inserting a semicolon; and (C) by adding after clause (ii) the following new clauses: (iii) a public hospital that is principally a psychiatric hospital (as defined in section 1861(f)); (iv) a private hospital that is principally a psychiatric hospital (as defined in section 1861(f)) and that has at least 10 percent of its patient volume (as estimated in accordance with a methodology estab-

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[Discussion Draft]
176 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 lished by the Secretary) attributable to individuals receiving medical assistance
under this title; (v) a community mental health center meeting the criteria specified in section 1913(c) of the Public Health Service Act; or (vi) a residential or outpatient mental health or substance abuse treatment facility that (I) is accredited by the Joint Commission on Accreditation of
Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation, or any other national accrediting agency recognized by the Secretary; and (II) has at least 10 percent of its patient volume (as estimated in accordance with a methodology established by the Secretary) attributable to individuals receiving medical assistance under this title.; and (2) in paragraph (3)(B)

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177 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 (A) in clause (iv), by striking and after the semicolon; (B) in clause (v), by striking the period and inserting ; and; and (C) by adding at the end the following new clause: (vi) clinical psychologist providing qualified psychologist services (as defined in section 1861(ii)), if such clinical psychologist is practicing in an outpatient clinic that (I) is led by a clinical psychologist; and (II) is not otherwise receiving payment under paragraph (1) as a Medicaid provider described in paragraph (2)(B).. (d) MEDICARE ADVANTAGE ORGANIZATIONS.Sec-
19 tion 1853 of the Social Security Act (42 U.S.C. 1395w 20 23) is amended 21 22 23 24 25 (1) in subsection (l) (A) in paragraph (1) (i) by inserting or additional eligible professionals (as described in paragraph (9)) after paragraph (2); and

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[Discussion Draft]
178 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (ii) by inserting and additional eligible professionals before under such sections; (B) in paragraph (3)(B) (i) in clause (i) in the matter preceding subclause (I), by inserting or an additional eligible professional described in paragraph (9) after paragraph (2); and (ii) in clause (ii) (I) in the matter preceding subclause (I), by inserting or an additional eligible professional described in paragraph (2); and (II) in subclause (I), by inserting or an additional eligible professional, respectively, after eligible professional; (C) in paragraph (3)(C), by inserting and additional eligible professionals after all eligible professionals; (D) in paragraph (4)(D), by adding at the end the following new sentence: In the case that a qualifying MA organization attests that not all additional eligible professionals of the (9) after paragraph

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[Discussion Draft]
179 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 organization are meaningful EHR users with respect to an applicable year, the Secretary shall apply the payment adjustment under this paragraph based on the proportion of all such additional eligible professionals of the organization that are not meaningful EHR users for such year.; (E) in paragraph (6)(A), by inserting and, as applicable, each additional eligible professional described in paragraph (9) after paragraph (2); (F) in paragraph (6)(B), by inserting and, as applicable, each additional eligible hospital described in paragraph (9) after subsection (m)(1); (G) in paragraph (7)(A), by inserting and, as applicable, additional eligible professionals after eligible professionals; (H) in paragraph (7)(B), by inserting and, as applicable, additional eligible professionals after eligible professionals; (I) in paragraph (8)(B), by inserting and additional eligible professionals described in paragraph (9) after paragraph (2); and

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180 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (J) by adding at the end the following new paragraph: (9) ADDITIONAL
SCRIBED.With ELIGIBLE PROFESSIONAL DE-
respect to a qualifying MA organi-
zation, an additional eligible professional described in this paragraph is an additional eligible professional (as defined for purposes of section 1848(o)) who (A)(i) is employed by the organization; or (ii)(I) is employed by, or is a partner of, an entity that through contract with the organization furnishes at least 80 percent of the entitys Medicare patient care services to enrollees of such organization; and (II) furnishes at least 80 percent of the professional services of the additional eligible professional covered under this title to enrollees of the organization; and (B) furnishes, on average, at least 20 hours per week of patient care services.; and (2) in subsection (m) (A) in paragraph (1) (i) by inserting or additional eligible hospitals (as described in paragraph (7)) after paragraph (2); and

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181 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (ii) by inserting and additional eligible hospitals before under such sections; (B) in paragraph (3)(A)(i), by inserting or additional eligible hospital after eligible hospital; (C) in paragraph (3)(A)(ii), by inserting or an additional eligible hospital after eligible hospital in each place it occurs; (D) in paragraph (3)(B) (i) in clause (i), by inserting or an additional eligible hospital described in paragraph (7) after paragraph (2); and (ii) in clause (ii) (I) in the matter preceding subclause (I), by inserting or an additional eligible hospital described in paragraph (2); and (II) in subclause (I), by inserting or an additional eligible hospital, respectively, after eligible hospital; (E) in paragraph (4)(A), by inserting or one or more additional eligible hospitals (as de(7) after paragraph

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182 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 fined in section 1886(n)), as appropriate, after section 1886(n)(6)(A)); (F) in paragraph (4)(D), by adding at the end the following new sentence: In the case that a qualifying MA organization attests that not all additional eligible hospitals of the organization are meaningful EHR users with respect to an applicable period, the Secretary shall apply the payment adjustment under this paragraph based on the methodology specified by the Secretary, taking into account the proportion of such additional eligible hospitals, or discharges from such hospitals, that are not meaningful EHR users for such period.; (G) in paragraph (5)(A), by inserting and, as applicable, each additional eligible hospital described in paragraph (7) after paragraph (2); (H) in paragraph (5)(B), by inserting and additional eligible hospitals, as applicable, after eligible hospitals; (I) in paragraph (6)(B), by inserting and additional eligible hospitals described in paragraph (7) after paragraph (2); and

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183 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 (J) by adding at the end the following new paragraph: (7) ADDITIONAL
SCRIBED.With ELIGIBLE HOSPITAL DE-
respect to a qualifying MA organi-
zation, an additional eligible hospital described in this paragraph is an additional eligible hospital (as defined in section 1886(n)(6)(C)) that is under common corporate governance with such organization and serves individuals enrolled under an MA plan offered by such organization..
TITLE VIIISERVICE MEMBERS AND VETERANS MENTAL HEALTH

SEC. 801. PRELIMINARY MENTAL HEALTH ASSESSMENTS.
(a) IN GENERAL.Chapter 31 of title 10, United
16 States Code, is amended by adding at the end the fol17 lowing new section: 18 19 20
SEC. 520d. PRELIMINARY MENTAL HEALTH ASSESSMENTS.
(a) PROVISION
MENT.Before
OF
MENTAL HEALTH ASSESS-
any individual enlists in an armed force
21 or is commissioned as an officer in an armed force, the 22 Secretary concerned shall provide the individual with a 23 mental health assessment. The Secretary shall use such 24 results as a baseline for any subsequent mental health ex-

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184 1 aminations, including such examinations provided under 2 sections 1074f and 1074m of this title. 3 (b) USE
OF
ASSESSMENT.The Secretary may not
4 consider the results of a mental health assessment con5 ducted under subsection (a) in determining the assign6 ment or promotion of a member of the Armed Forces. 7 (c) APPLICATION
OF
PRIVACY LAWS.With respect
8 to applicable laws and regulations relating to the privacy 9 of information, the Secretary shall treat a mental health 10 assessment conducted under subsection (a) in the same 11 manner as the medical records of a member of the Armed 12 Forces.. 13 (b) CLERICAL AMENDMENT.The table of sections
14 at the beginning of such chapter is amended by adding 15 after the item relating to section 520c the following new 16 item:
520d. Preliminary mental health assessments.
17 18 19 20 21 22 23 24
(c) REPORT. (1) IN

GENERAL.Not
later than 180 days
after the date of the enactment of this Act, the National Institute of Mental Health of the National Institutes of Health shall submit to Congress and the Secretary of Defense a report on preliminary mental health assessments of members of the Armed Forces.

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185 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 (2) MATTERS

INCLUDED.The
report under
paragraph (1) shall include the following: (A) Recommendations with respect to establishing a preliminary mental health assessment of members of the Armed Forces to bring mental health screenings to parity with physical screenings of members. (B) Recommendations with respect to the composition of the mental health assessment, best practices, and how to track assessment changes relating to traumatic brain injuries, post-traumatic stress disorder, and other conditions. (3) COORDINATION.The National Institute of Mental Health shall carry out paragraph (1) in coordination with the Secretary of Veterans Affairs, the Director of the Centers for Disease Control and Prevention, the surgeons general of the military departments, and other relevant experts.
SEC. 802. EXTENSION OF ELIGIBILITY FOR DOMICILIARY CARE FOR CERTAIN VETERANS WHO SERVED IN A THEATER OF COMBAT OPERATIONS.
Section 1710(e)(3)(A) of title 38, United States
24 Code, is amended by striking period of five years and 25 inserting period of 15 years.

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186 1 2 3 4 5 6
SEC. 803. REVIEW OF CHARACTERIZATION OR TERMS OF DISCHARGE FROM THE ARMED FORCES OF INDIVIDUALS WITH MENTAL HEALTH DISORDERS ALLEGED TO AFFECT TERMS OF DISCHARGE.
(a) IN GENERAL.The Secretaries of the military
7 departments shall each provide for a process by which a 8 covered individual may challenge the terms or character9 ization of the individuals discharge or separation from the 10 Armed Forces. 11 (b) COVERED INDIVIDUALS.For purposes of this
12 section, a covered individual is any individual as follows: 13 14 15 16 17 18 19 20 21 22 23 24 (1) An individual who was discharged or separated from the Armed Forces for a personality disorder. (2) An individual who (A) was discharged or separated from the Armed Forces on a punitive basis, or under other than honorable conditions; and (B) who alleges that the basis for such discharge or separation was a mental health injury or disorder incurred or aggravated by the individual during service in the Armed Forces. (c) DISCHARGE
OF OF
PROCESS THROUGH BOARDS
OF
25 CORRECTIONS
RECORDS.The Secretary of a military
26 department shall carry out the process required by subf:\VHLC\042514\042514.229.xml April 25, 2014 (5:34 p.m.)
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[Discussion Draft]
187 1 section (a) through boards for the correction of military 2 records of the military department concerned. 3 4
OF
(d) CONSIDERATIONS DISCHARGE

OR
ON
MODIFICATION
OF
TERMS
SEPARATION.In deciding whether to
5 modify the terms or characterization of an individuals dis6 charge or separation pursuant to the process required by 7 subsection (a), the Secretary of the military department 8 concerned shall instruct boards to give due consideration 9 to any mental health injury or disorder determined to have 10 been incurred or aggravated by the individual during serv11 ice in the Armed Forces and to what bearing such injury 12 or disorder may have had on the circumstances sur13 rounding the individuals discharge or separation from the 14 Armed Forces. 15 16 17 18
SEC. 804. IMPROVEMENT OF MENTAL HEALTH CARE PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE.
(a) EVALUATIONS
OF
MENTAL HEALTH CARE
AND
19 SUICIDE PREVENTION PROGRAMS. 20 21 22 23 24 (1) IN

GENERAL.Not
less frequently than
once each year, the Secretary concerned shall provide for the conduct of an evaluation of the mental health care and suicide prevention programs carried out under the laws administered by such Secretary.

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[Discussion Draft]
188 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (2) ELEMENTS.Each evaluation conducted under paragraph (1) shall (A) use metrics that are common among and useful for practitioners in the field of mental health care and suicide prevention; (B) identify the most effective mental health care and suicide prevention programs conducted by the Secretary concerned; and (C) propose best practices for caring for individuals who suffer from mental health disorders or are at risk of suicide. (3) THIRD
PARTY.Each
evaluation conducted
under paragraph (1) shall be conducted by an independent third party unaffiliated with the Department of Veterans Affairs and the Department of Defense. (b) TRAINING OF PROVIDERS. (1) IN
GENERAL.The
Secretary concerned
shall train all providers of health care under the laws administered by such Secretary on the following: (A) Recognizing if an individual is at risk of suicide. (B) Treating or referring for treatment an individual who is at risk of suicide.

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[Discussion Draft]
189 1 2 3 4 5 6 7 8 9 (C) Recognizing the symptoms of
posttraumatic stress disorder. (2) DISSEMINATION

OF BEST PRACTICES.The
Secretary concerned shall ensure that best practices for identifying individuals at risk of suicide and providing quality mental health care are disseminated to providers of health care under the laws administered by such Secretary. (c) SECRETARY CONCERNED DEFINED.In this sec-
10 tion, the term Secretary concerned means 11 12 13 14 15 16 17 18 19 (1) the Secretary of Veterans Affairs with respect to matters concerning the Department of Veterans Affairs; and (2) the Secretary of Defense with respect to matters concerning the Department of Defense.
SEC. 805. COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE ON HEALTH CARE MATTERS.
(a) TIMELINE
FOR
IMPLEMENTING INTEROPERABLE
20 ELECTRONIC HEALTH RECORDS. 21 22 23 (1) IN

GENERAL.Section
1635 of the Wound-
ed Warrior Act (10 U.S.C. 1071 note) is amended by adding at the end the following new subsection:

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[Discussion Draft]
190 1 (k) TIMELINE.In carrying out this section, the
2 Secretary of Defense and the Secretary of Veterans Af3 fairs shall ensure that 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) the creation of a health data authoritative source by the Department of Defense and the Department of Veterans Affairs that can be accessed by multiple providers and standardizes the input of new medical information is achieved not later than 180 days after the date of the enactment of this subsection; (2) the ability of patients of both the Department of Defense and the Department of Veterans Affairs to download the medical records of the patient (commonly referred to as the Blue Button Initiative) is achieved not later than 180 days after the date of the enactment of this subsection; (3) the full interoperability of personal health care information between the Departments is achieved not later than one year after the date of the enactment of this subsection; (4) the acceleration of the exchange of realtime data between the Departments is achieved not later than one year after the date of the enactment of this subsection;

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[Discussion Draft]
191 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 (5) the upgrade of the graphical user interface to display a joint common graphical user interface is achieved not later than one year after the date of the enactment of this subsection; and (6) each current member of the Armed Forces and the dependent of such a member may elect to receive an electronic copy of the health care record of the individual beginning not later than June 30, 2015.. (2) CONFORMING
AMENDMENTS.Section
1635
of such Act is further amended (A) in subsection (a), by striking The Secretary and inserting In accordance with the timeline described in subsection (k), the Secretary; and (B) in the matter preceding paragraph (1) of subsection (e), by inserting in accordance with subsection (k) after under this section. (b) ESTABLISHMENT
OF
UNIFORM PRESCRIPTION
20 FORMULARY.The Secretary of Veterans Affairs and the 21 Secretary of Defense shall jointly establish a uniform pre22 scription formulary for use in prescribing medication 23 under the laws administered by the Secretary of Veterans 24 Affairs and the laws administered by the Secretary of De25 fense.

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[Discussion Draft]
192 1 2 3 4 5
SEC. 806. PILOT PROGRAM FOR REPAYMENT OF EDUCATIONAL LOANS FOR CERTAIN PSYCHIATRISTS OF VETERANS HEALTH ADMINISTRATION.
(a) ESTABLISHMENT.The Secretary of Veterans
6 Affairs shall carry out a pilot program to repay a loan 7 of an individual described in subsection (b) that 8 9 10 11 12 13 14 15 16 (1) was used by the individual to finance education regarding psychiatric medicine, including education leading to an undergraduate degree and education leading to the degree of doctor of medicine or of doctor of osteopathy; and (2) was obtained from a governmental entity, private financial institution, school, or other authorized entity, as determined by the Secretary. (b) ELIGIBLE INDIVIDUALS.To be eligible to obtain
17 a loan repayment under this section, an individual shall 18 19 20 21 22 23 24 25 (1) either (A) be licensed or eligible for licensure to practice psychiatric medicine in the Veterans Health Administration of the Department of Veterans Affairs; or (B) be enrolled in the final year of a residency program leading to a specialty qualification in psychiatric medicine that is approved by

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[Discussion Draft]
193 1 2 3 4 5 6 7 8 the Accreditation Council for Graduate Medical Education; and (2) as determined appropriate by the Secretary, demonstrate a commitment to a long-term career as a psychiatrist in the Veterans Health Administration, including by requiring a set number of years of obligated service. (c) SELECTION.The Secretary shall select not less
9 than 10 individuals described in subsection (b) to partici10 pate in the pilot program for each year in which the Sec11 retary carries out the pilot program. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (d) LOAN REPAYMENTS. (1) AMOUNTS.Subject to the limits established by paragraph (2), a loan repayment under this section may consist of payment of the principal, interest, and related expenses of a loan obtained by an individual described in subsection (b) for all educational expenses (including tuition, fees, books, and laboratory expenses) relating to a degree described in subsection (a)(1). (2) LIMIT.For each year of obligated service that an individual agrees to serve in an agreement described in subsection (b)(2), the Secretary may pay not more than $60,000 on behalf of the individual.

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194 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 (e) BREACH. (1) LIABILITY.An individual who participates in the pilot program under subsection (a) who fails to satisfy the commitment described in subsection (b)(2) shall be liable to the United States, in lieu of any service obligation arising from such participation, for the amount which has been paid or is payable to or on behalf of the individual under the program, reduced by the proportion that the number of days served for completion of the service obligation bears to the total number of days in the period of obligated service of the individual. (2) REPAYMENT
PERIOD.Any
amount of dam-
ages which the United States is entitled to recover under this subsection shall be paid to the United States within the one-year period beginning on the date of the breach of the agreement. (f) PROHIBITION
ON
SIMULTANEOUS ELIGIBILITY.
19 An individual who is participating in any other program 20 of the Federal Government that repays the educational 21 loans of the individual may not participate in the pilot pro22 gram under subsection (a). 23 (g) REPORT.Not later than 90 days after the date
24 on which the pilot program terminates under subsection 25 (g), the Secretary shall submit to the Committees on Vet-

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[Discussion Draft]
195 1 erans Affairs of the House of Representatives and the 2 Senate a report on the pilot program. The report shall 3 include the overall effect of the pilot program on the psy4 chiatric workforce shortage of the Veterans Health Ad5 ministration, the long-term stability of such workforce, 6 and overall workforce strategies of the Veterans Health 7 Administration that seek to promote the physical and 8 mental resiliency of all veterans. 9 (h) REGULATIONS.The Secretary shall prescribe
10 regulations to carry out this section, including standards 11 for qualified loans and authorized payees and other terms 12 and conditions for the making of loan repayments. 13 (i) TERMINATION.The authority to carry out the
14 pilot program shall expire on the date that is three years 15 after the date on which the Secretary commences the pilot 16 program. 17 18 19 20 21 22 23 24
SEC. 807. COMPTROLLER GENERAL STUDY ON PAY DISPARITIES OF PSYCHIATRISTS OF VETERANS HEALTH ADMINISTRATION.
(a) STUDY. (1) IN

GENERAL.Not
later than one year
after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study of pay disparities among psychiatrists

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[Discussion Draft]
196 1 2 3 4 5 6 7 8 9 10 11 of the Veterans Health Administration of the Department of Veterans Affairs. (2) ELEMENTS.The study required by paragraph (1) shall include the following: (A) An examination of laws, regulations, practices, and policies, including salary flexibilities, that contribute to such disparities. (B) Recommendations for legislative or regulatory action to improve equity in pay among such psychiatrists. (b) REPORT.Not later than one year after the date
12 on which the Comptroller General completes the study 13 under subsection (a), the Comptroller General shall sub14 mit to the Committee on Veterans Affairs of the Senate 15 and the Committee on Veterans Affairs of the House of 16 Representatives a report containing the results of the 17 study.

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197 1 2 3 4 5 6 7 8
TITLE IXMAKING PARITY WORK

SEC. 901. CLARIFICATION OF HIPAA TRAINING REQUIREMENTS REGARDING DISCLOSURE OF PROTECTED CERNING HEALTH INFORMATION WITH CON-
INDIVIDUALS
MENTAL
HEALTH DISORDERS.
Not later than 6 months after the date of enactment
9 of this Act, the Secretary of Health and Human Services 10 shall issue guidance regarding the requirements of section 11 164.530(b) of title 45, Code of Federal Regulations, so 12 as to ensure that training under such section includes a 13 clear explanation of the circumstances under which health 14 care professionals and other covered entities (as such term 15 is defined for purposes of regulations promulgated under 16 section 264(c) of the Health Insurance Portability and Ac17 countability Act of 1996) are permitted or required to dis18 close protected health information concerning individuals 19 with a mental health disorder. 20 21 22
SEC. 902. GAO STUDY ON MENTAL HEALTH PARITY ENFORCEMENT EFFORTS.
Not later than one year after the date of the enact-
23 ment of this Act, the Government Accountability Office, 24 in consultation with the Department of Health and 25 Human Services as well as the Department of Labor, shall
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198 1 submit to Congress a report detailing the enforcement ef2 forts that the responsible departments and agencies have 3 carried out in the implementation of the Paul Wellstone 4 and Pete Domenici Mental Health Parity and Addiction 5 Act (Public Law 110343), including the number of in6 vestigations that have been conducted into potential parity 7 violations and details on the guidance or enforcement ac8 tion that was carried out as a result of such investigations 9 that would not identify the subject of such enforcement 10 or investigation 11 12 13 14 15
SEC. 903. REPORT TO CONGRESS ON FEDERAL ASSISTANCE TO STATE INSURANCE REGULATORS REGARDING MENTAL HEALTH PARITY ENFORCEMENT.
Not later than one year after the date of the enact-
16 ment of this Act, the Secretary of the Department of 17 Health and Human Services shall submit to Congress a 18 report detailing the ways in which state governments and 19 state insurance regulators are either empowered or re20 quired to enforce the Paul Wellstone and Pete Domenici 21 Mental Health Parity and Addiction Equity Act of 2008 22 (Public Law 110343), their capability to carry out 23 these enforcement powers or requirements, and any tech24 nical assistance to state government and state insurance

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199 1 regulators that have been communicated by the Depart2 ment

(571949|22)

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F:\M13\BARBER\BARBER_051.

IN THE HOUSE OF REPRESENTATIVES

2 tives of the United States of America in Congress assembled, 3 4

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

5 Strengthening Mental Health in Our Communities Act 6 of 2014. 7 (b) TABLE

CONTENTS.The table of contents for

8 this Act is as follows:

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

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6 1 (b) DIRECTOR.There shall be a Director who shall

CONGRESS.The location of the Of-

(a) APPOINTMENT. (1) IN

President shall appoint

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7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ployed in a full-time position outside of the Federal Government. (B) POLITICAL

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the receipt of proposed

DIRECTOR.In carrying out

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

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11 egy meets the following requirements: 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) GOALS

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Strategy shall contain a report on

MENTAL HEALTH SERVICES.The

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16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (A) the mental health diagnoses,

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Strategy shall contain the views

Strategy shall con-

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19 1 2 3 4 5 6 status of implementation and enforcement of mental health parity.

(a) FEDERAL DEPARTMENT

department or agency of the Federal Gov-

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HEALTH ADVISORY BOARD.At

least one meet-

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COMPENSATION FOR SERVICE ON

member of the Council who is

member of the Council may be

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(a) ESTABLISHMENT.There is established within

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MEMBERSHIP OF THE BOARD.The

design an application and selection process to fill the

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initial membership of the Board shall

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30 1 (e) PROCEDURES.The membership of the Board

Director shall make