[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2646 Received in Senate (RDS)]
<DOC>
114th CONGRESS
2d Session
H. R. 2646
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 7, 2016
Received
_______________________________________________________________________
AN ACT
To make available needed psychiatric, psychological, and supportive
services for individuals with mental illness and families in mental
health crisis, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Helping Families
in Mental Health Crisis Act of 2016''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
Sec. 101. Assistant Secretary for Mental Health and Substance Use.
Sec. 102. Improving oversight of mental health and substance use
programs.
Sec. 103. National Mental Health and Substance Use Policy Laboratory.
Sec. 104. Peer-support specialist programs.
Sec. 105. Prohibition against lobbying using Federal funds by systems
accepting Federal funds to protect and
advocate the rights of individuals with
mental illness.
Sec. 106. Reporting for protection and advocacy organizations.
Sec. 107. Grievance procedure.
Sec. 108. Center for Behavioral Health Statistics and Quality.
Sec. 109. Strategic plan.
Sec. 110. Authorities of centers for mental health services and
substance abuse treatment.
Sec. 111. Advisory councils.
Sec. 112. Peer review.
TITLE II--MEDICAID MENTAL HEALTH COVERAGE
Sec. 201. Rule of construction related to Medicaid coverage of mental
health services and primary care services
furnished on the same day.
Sec. 202. Optional limited coverage of inpatient services furnished in
institutions for mental diseases.
Sec. 203. Study and report related to Medicaid managed care regulation.
Sec. 204. Guidance on opportunities for innovation.
Sec. 205. Study and report on Medicaid emergency psychiatric
demonstration project.
Sec. 206. Providing EPSDT services to children in IMDs.
Sec. 207. Electronic visit verification system required for personal
care services and home health care services
under Medicaid.
TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE
Sec. 301. Interdepartmental Serious Mental Illness Coordinating
Committee.
TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA
Sec. 401. Sense of Congress.
Sec. 402. Confidentiality of records.
Sec. 403. Clarification of circumstances under which disclosure of
protected health information is permitted.
Sec. 404. Development and dissemination of model training programs.
TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS
Sec. 501. Assertive community treatment grant program for individuals
with serious mental illness.
Sec. 502. Strengthening community crisis response systems.
Sec. 503. Increased and extended funding for assisted outpatient grant
program for individuals with serious mental
illness.
Sec. 504. Liability protections for health professional volunteers at
community health centers.
TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS
Subtitle A--Encouraging the Advancement, Incorporation, and Development
of Evidence-Based Practices
Sec. 601. Encouraging innovation and evidence-based programs.
Sec. 602. Promoting access to information on evidence-based programs
and practices.
Sec. 603. Sense of Congress.
Subtitle B--Supporting the State Response to Mental Health Needs
Sec. 611. Community Mental Health Services Block Grant.
Subtitle C--Strengthening Mental Health Care for Children and
Adolescents
Sec. 621. Tele-mental health care access grants.
Sec. 622. Infant and early childhood mental health promotion,
intervention, and treatment.
Sec. 623. National Child Traumatic Stress Initiative.
TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATION
Subtitle A--Garrett Lee Smith Memorial Act Reauthorization
Sec. 701. Youth interagency research, training, and technical
assistance centers.
Sec. 702. Youth suicide early intervention and prevention strategies.
Sec. 703. Mental health and substance use disorder services on campus.
Subtitle B--Other Provisions
Sec. 711. National Suicide Prevention Lifeline Program.
Sec. 712. Workforce development studies and reports.
Sec. 713. Minority Fellowship Program.
Sec. 714. Center and program repeals.
Sec. 715. National violent death reporting system.
Sec. 716. Sense of Congress on prioritizing Native American youth and
suicide prevention programs.
Sec. 717. Peer professional workforce development grant program.
Sec. 718. National Health Service Corps.
Sec. 719. Adult suicide prevention.
Sec. 720. Crisis intervention grants for police officers and first
responders.
Sec. 721. Demonstration grant program to train health service
psychologists in community-based mental
health.
Sec. 722. Investment in tomorrow's pediatric health care workforce.
Sec. 723. CUTGO compliance.
TITLE VIII--MENTAL HEALTH PARITY
Sec. 801. Enhanced compliance with mental health and substance use
disorder coverage requirements.
Sec. 802. Action plan for enhanced enforcement of mental health and
substance use disorder coverage.
Sec. 803. Report on investigations regarding parity in mental health
and substance use disorder benefits.
Sec. 804. GAO study on parity in mental health and substance use
disorder benefits.
Sec. 805. Information and awareness on eating disorders.
Sec. 806. Education and training on eating disorders.
Sec. 807. GAO study on preventing discriminatory coverage limitations
for individuals with serious mental illness
and substance use disorders.
Sec. 808. Clarification of existing parity rules.
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
SEC. 101. ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE.
(a) Assistant Secretary.--Section 501(c) of the Public Health
Service Act (42 U.S.C. 290aa) is amended to read as follows:
``(c) Assistant Secretary and Deputy Assistant Secretary.--
``(1) Assistant secretary.--
``(A) Appointment.--The Administration shall be
headed by an official to be known as the Assistant
Secretary for Mental Health and Substance Use
(hereinafter in this title referred to as the
`Assistant Secretary') who shall be appointed by the
President, by and with the advice and consent of the
Senate.
``(B) Qualifications.--In selecting the Assistant
Secretary, the President shall give preference to
individuals who have--
``(i) a doctoral degree in medicine,
osteopathic medicine, or psychology;
``(ii) clinical and research experience
regarding mental health and substance use
disorders; and
``(iii) an understanding of biological,
psychosocial, and pharmaceutical treatments of
mental illness and substance use disorders.
``(2) Deputy assistant secretary.--The Assistant Secretary,
with the approval of the Secretary, may appoint a Deputy
Assistant Secretary and may employ and prescribe the functions
of such officers and employees, including attorneys, as are
necessary to administer the activities to be carried out
through the Administration.''.
(b) Transfer of Authorities.--The Secretary of Health and Human
Services shall delegate to the Assistant Secretary for Mental Health
and Substance Use all duties and authorities that--
(1) as of the day before the date of enactment of this Act,
were vested in the Administrator of the Substance Abuse and
Mental Health Services Administration; and
(2) are not terminated by this Act.
(c) Evaluation.--Section 501(d) of the Public Health Service Act
(42 U.S.C. 290aa(d)) is amended--
(1) in paragraph (17), by striking ``and'' at the end;
(2) in paragraph (18), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following:
``(19) evaluate, in consultation with the Assistant
Secretary for Financial Resources, the information used for
oversight of grants under programs related to mental illness
and substance use disorders, including co-occurring illness or
disorders, administered by the Center for Mental Health
Services;
``(20) periodically review Federal programs and activities
relating to the diagnosis or prevention of, or treatment or
rehabilitation for, mental illness and substance use disorders
to identify any such programs or activities that have proven to
be effective or efficient in improving outcomes or increasing
access to evidence-based programs;
``(21) establish standards for the appointment of peer-
review panels to evaluate grant applications and recommend
standards for mental health grant programs; and''.
(d) Standards for Grant Programs.--Section 501(d) of the Public
Health Service Act (42 U.S.C. 290aa(d)), as amended by subsection (c),
is further amended by adding at the end the following:
``(22) in consultation with the National Mental Health and
Substance Use Policy Laboratory, and after providing an
opportunity for public input, set standards for grant programs
under this title for mental health and substance use services,
which may address--
``(A) the capacity of the grantee to implement the
award;
``(B) requirements for the description of the
program implementation approach;
``(C) the extent to which the grant plan submitted
by the grantee as part of its application must explain
how the grantee will reach the population of focus and
provide a statement of need, including to what extent
the grantee will increase the number of clients served
and the estimated percentage of clients receiving
services who report positive functioning after 6 months
or no past-month substance use, as applicable;
``(D) the extent to which the grantee must collect
and report on required performance measures; and
``(E) the extent to which the grantee is proposing
evidence-based practices and the extent to which--
``(i) those evidence-based practices must
be used with respect to a population similar to
the population for which the evidence-based
practices were shown to be effective; or
``(ii) if no evidence-based practice exists
for a population of focus, the way in which the
grantee will implement adaptations of evidence-
based practices, promising practices, or
cultural practices.''.
(e) Emergency Response.--Section 501(m) of the Public Health
Service Act (42 U.S.C. 290aa(m)) is amended by adding at the end the
following:
``(4) Availability of funds through following fiscal
year.--Amounts made available for carrying out this subsection
shall remain available through the end of the fiscal year
following the fiscal year for which such amounts are
appropriated.''.
(f) Member of Council on Graduate Medical Education.--Section 762
of the Public Health Service Act (42 U.S.C. 290o) is amended--
(1) in subsection (b)--
(A) by redesignating paragraphs (4), (5), and (6)
as paragraphs (5), (6), and (7), respectively; and
(B) by inserting after paragraph (3) the following:
``(4) the Assistant Secretary for Mental Health and
Substance Use;''; and
(2) in subsection (c), by striking ``(4), (5), and (6)''
each place it appears and inserting ``(5), (6), and (7)''.
(g) Conforming Amendments.--Title V of the Public Health Service
Act (42 U.S.C. 290aa et seq.), as amended by the previous provisions of
this section, is further amended--
(1) by striking ``Administrator of the Substance Abuse and
Mental Health Services Administration'' each place it appears
and inserting ``Assistant Secretary for Mental Health and
Substance Use''; and
(2) by striking ``Administrator'' each place it appears
(including in any headings) and inserting ``Assistant
Secretary'', except where the term ``Administrator'' appears--
(A) in each of subsections (e) and (f) of section
501 of such Act (42 U.S.C. 290aa), including the
headings of such subsections, within the term
``Associate Administrator'';
(B) in section 507(b)(6) of such Act (42 U.S.C.
290bb(b)(6)), within the term ``Administrator of the
Health Resources and Services Administration'';
(C) in section 507(b)(6) of such Act (42 U.S.C.
290bb(b)(6)), within the term ``Administrator of the
Centers for Medicare & Medicaid Services'';
(D) in section 519B(c)(1)(B) of such Act (42 U.S.C.
290bb-25b(c)(1)(B)), within the term ``Administrator of
the National Highway Traffic Safety Administration'';
or
(E) in each of sections 519B(c)(1)(B), 520C(a), and
520D(a) of such Act (42 U.S.C. 290bb-25b(c)(1)(B),
290bb-34(a), 290bb-35(a)), within the term
``Administrator of the Office of Juvenile Justice and
Delinquency Prevention''.
(h) References.--After executing subsections (a), (b), and (f), any
reference in statute, regulation, or guidance to the Administrator of
the Substance Abuse and Mental Health Services Administration shall be
construed to be a reference to the Assistant Secretary for Mental
Health and Substance Use.
SEC. 102. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE USE
PROGRAMS.
Title V of the Public Health Service Act is amended by inserting
after section 501 of such Act (42 U.S.C. 290aa) the following:
``SEC. 501A. IMPROVING OVERSIGHT OF MENTAL HEALTH AND SUBSTANCE USE
PROGRAMS.
``(a) Activities.--For the purpose of ensuring efficient and
effective planning and evaluation of mental illness and substance use
disorder programs and related activities, the Assistant Secretary for
Planning and Evaluation, in consultation with the Assistant Secretary
for Mental Health and Substance Use, shall--
``(1) collect and organize relevant data on homelessness,
involvement with the criminal justice system, hospitalizations,
mortality outcomes, and other measures the Secretary deems
appropriate from across Federal departments and agencies;
``(2) evaluate programs related to mental illness and
substance use disorders, including co-occurring illness or
disorders, across Federal departments and agencies, as
appropriate, including programs related to--
``(A) prevention, intervention, treatment, and
recovery support services, including such services for
individuals with a serious mental illness or serious
emotional disturbance;
``(B) the reduction of homelessness and involvement
with the criminal justice system among individuals with
a mental illness or substance use disorder; and
``(C) public health and health services; and
``(3) consult, as appropriate, with the Assistant
Secretary, the Behavioral Health Coordinating Council of the
Department of Health and Human Services, other agencies within
the Department of Health and Human Services, and other relevant
Federal departments.
``(b) Recommendations.--The Assistant Secretary for Planning and
Evaluation shall develop an evaluation strategy that identifies
priority programs to be evaluated by the Assistant Secretary and
priority programs to be evaluated by other relevant agencies within the
Department of Health and Human Services. The Assistant Secretary for
Planning and Evaluation shall provide recommendations on improving
programs and activities based on the evaluation described in subsection
(a)(2) as needing improvement.''.
SEC. 103. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY LABORATORY.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended by inserting after section 501A, as added by section 102 of
this Act, the following:
``SEC. 501B. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY
LABORATORY.
``(a) In General.--There shall be established within the
Administration a National Mental Health and Substance Use Policy
Laboratory (referred to in this section as the `Laboratory').
``(b) Responsibilities.--The Laboratory shall--
``(1) continue to carry out the authorities and activities
that were in effect for the Office of Policy, Planning, and
Innovation as such Office existed prior to the date of
enactment of the Helping Families in Mental Health Crisis Act
of 2016;
``(2) identify, coordinate, and facilitate the
implementation of policy changes likely to have a significant
effect on mental health, mental illness, and the prevention and
treatment of substance use disorder services;
``(3) collect, as appropriate, information from grantees
under programs operated by the Administration in order to
evaluate and disseminate information on evidence-based
practices, including culturally and linguistically appropriate
services, as appropriate, and service delivery models;
``(4) provide leadership in identifying and coordinating
policies and programs, including evidence-based programs,
related to mental illness and substance use disorders;
``(5) recommend ways in which payers may implement program
and policy findings of the Administration and the Laboratory to
improve outcomes and reduce per capita program costs;
``(6) in consultation with the Assistant Secretary for
Planning and Evaluation, as appropriate, periodically review
Federal programs and activities relating to the diagnosis or
prevention of, or treatment or rehabilitation for, mental
illness and substance use disorders, including by--
``(A) identifying any such programs or activities
that are duplicative;
``(B) identifying any such programs or activities
that are not evidence-based, effective, or efficient;
and
``(C) formulating recommendations for coordinating,
eliminating, or improving programs or activities
identified under subparagraph (A) or (B) and merging
such programs or activities into other successful
programs or activities; and
``(7) carry out other activities as deemed necessary to
continue to encourage innovation and disseminate evidence-based
programs and practices, including programs and practices with
scientific merit.
``(c) Evidence-Based Practices and Service Delivery Models.--
``(1) In general.--In selecting evidence-based best
practices and service delivery models for evaluation and
dissemination, the Laboratory--
``(A) shall give preference to models that
improve--
``(i) the coordination between mental
health and physical health providers;
``(ii) the coordination among such
providers and the justice and corrections
system; and
``(iii) the cost effectiveness, quality,
effectiveness, and efficiency of health care
services furnished to individuals with serious
mental illness or serious emotional
disturbance, in mental health crisis, or at
risk to themselves, their families, and the
general public; and
``(B) may include clinical protocols and practices
used in the Recovery After Initial Schizophrenia
Episode (RAISE) project and the North American Prodrome
Longitudinal Study (NAPLS) of the National Institute of
Mental Health.
``(2) Deadline for beginning implementation.--The
Laboratory shall begin implementation of the duties described
in this section not later than January 1, 2018.
``(3) Consultation.--In carrying out the duties under this
section, the Laboratory shall consult with--
``(A) representatives of the National Institute of
Mental Health, the National Institute on Drug Abuse,
and the National Institute on Alcohol Abuse and
Alcoholism, on an ongoing basis;
``(B) other appropriate Federal agencies;
``(C) clinical and analytical experts with
expertise in psychiatric medical care and clinical
psychological care, health care management, education,
corrections health care, and mental health court
systems, as appropriate; and
``(D) other individuals and agencies as determined
appropriate by the Assistant Secretary.''.
SEC. 104. PEER-SUPPORT SPECIALIST PROGRAMS.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, the Comptroller General of the United States shall conduct
a study on peer-support specialist programs in up to 10 States (to be
selected by the Comptroller General) that receive funding from the
Substance Abuse and Mental Health Services Administration and submit to
the Committee on Health, Education, Labor, and Pensions of the Senate
and the Committee on Energy and Commerce of the House of
Representatives a report containing the results of such study.
(b) Contents of Study.--In conducting the study under subsection
(a), the Comptroller General of the United States shall examine and
identify best practices in the selected States related to training and
credential requirements for peer-support specialist programs, such as--
(1) hours of formal work or volunteer experience related to
mental illness and substance use disorders conducted through
such programs;
(2) types of peer-support specialist exams required for
such programs in the States;
(3) codes of ethics used by such programs in the States;
(4) required or recommended skill sets of such programs in
the State; and
(5) requirements for continuing education.
SEC. 105. PROHIBITION AGAINST LOBBYING USING FEDERAL FUNDS BY SYSTEMS
ACCEPTING FEDERAL FUNDS TO PROTECT AND ADVOCATE THE
RIGHTS OF INDIVIDUALS WITH MENTAL ILLNESS.
Section 105(a) of the Protection and Advocacy for Individuals with
Mental Illness Act (42 U.S.C. 10805(a)) is amended--
(1) in paragraph (9), by striking ``and'' at the end;
(2) in paragraph (10), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(11) agree to refrain, during any period for which
funding is provided to the system under this part, from using
Federal funds to pay the salary or expenses of any grant or
contract recipient, or agent acting for such recipient, related
to any activity designed to influence the enactment of
legislation, appropriations, regulation, administrative action,
or Executive order proposed or pending before the Congress or
any State or local government, including any legislative body,
other than for normal and recognized executive-legislative
relationships or participation by an agency or officer of a
State, local, or tribal government in policymaking and
administrative processes within the executive branch of that
government.''.
SEC. 106. REPORTING FOR PROTECTION AND ADVOCACY ORGANIZATIONS.
(a) Public Availability of Reports.--Section 105(a)(7) of the
Protection and Advocacy for Individuals with Mental Illness Act (42
U.S.C. 10805(a)(7)) is amended by striking ``is located a report'' and
inserting ``is located, and make publicly available, a report''.
(b) Detailed Accounting.--Section 114(a) of the Protection and
Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10824(a))
is amended--
(1) in paragraph (3), by striking ``and'' at the end;
(2) in paragraph (4), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(5) using data from the existing required annual program
progress reports submitted by each system funded under this
title, a detailed accounting for each such system of how funds
are spent, disaggregated according to whether the funds were
received from the Federal Government, the State government, a
local government, or a private entity.''.
SEC. 107. GRIEVANCE PROCEDURE.
Section 105 of the Protection and Advocacy for Individuals with
Mental Illness Act (42 U.S.C. 10805), as amended, is further amended by
adding at the end the following:
``(d) Grievance Procedure.--The Secretary shall establish an
independent grievance procedure for persons described in subsection
(a)(9).''.
SEC. 108. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended--
(1) in section 501(b) (42 U.S.C. 290aa(b)), by adding at
the end the following:
``(4) The Center for Behavioral Health Statistics and
Quality.'';
(2) in section 502(a)(1) (42 U.S.C. 290aa-1(a)(1))--
(A) in subparagraph (C), by striking ``and'' at the
end;
(B) in subparagraph (D), by striking the period at
the end and inserting ``; and''; and
(C) by inserting after subparagraph (D) the
following:
``(E) the Center for Behavioral Health Statistics
and Quality.''; and
(3) in part B (42 U.S.C. 290bb et seq.) by adding at the
end the following new subpart:
``Subpart 4--Center for Behavioral Health Statistics and Quality
``SEC. 520L. CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.
``(a) Establishment.--There is established in the Administration a
Center for Behavioral Health Statistics and Quality (in this section
referred to as the `Center'). The Center shall be headed by a Director
(in this section referred to as the `Director') appointed by the
Secretary from among individuals with extensive experience and academic
qualifications in research and analysis in behavioral health care or
related fields.
``(b) Duties.--The Director of the Center shall--
``(1) coordinate the Administration's integrated data
strategy by coordinating--
``(A) surveillance and data collection (including
that authorized by section 505);
``(B) evaluation;
``(C) statistical and analytic support;
``(D) service systems research; and
``(E) performance and quality information systems;
``(2) recommend a core set of measurement standards for
grant programs administered by the Administration; and
``(3) coordinate evaluation efforts for the grant programs,
contracts, and collaborative agreements of the Administration.
``(c) Biannual Report to Congress.--Not later than 2 years after
the date of enactment of this section, and every 2 years thereafter,
the Director of the Center shall submit to Congress a report on the
quality of services furnished through grant programs of the
Administration, including applicable measures of outcomes for
individuals and public outcomes such as--
``(1) the number of patients screened positive for
unhealthy alcohol use who receive brief counseling as
appropriate; the number of patients screened positive for
tobacco use and receiving smoking cessation interventions; the
number of patients with a new diagnosis of major depressive
episode who are assessed for suicide risk; the number of
patients screened positive for clinical depression with a
documented followup plan; and the number of patients with a
documented pain assessment that have a followup treatment plan
when pain is present; and satisfaction with care;
``(2) the incidence and prevalence of mental illness and
substance use disorders; the number of suicide attempts and
suicide completions; overdoses seen in emergency rooms
resulting from alcohol and drug use; emergency room boarding;
overdose deaths; emergency psychiatric hospitalizations; new
criminal justice involvement while in treatment; stable
housing; and rates of involvement in employment, education, and
training; and
``(3) such other measures for outcomes of services as the
Director may determine.
``(d) Staffing Composition.--The staff of the Center may include
individuals with advanced degrees and field expertise as well as
clinical and research experience in mental illness and substance use
disorders such as--
``(1) professionals with clinical and research expertise in
the prevention and treatment of, and recovery from, mental
illness and substance use disorders;
``(2) professionals with training and expertise in
statistics or research and survey design and methodologies; and
``(3) other related fields in the social and behavioral
sciences, as specified by relevant position descriptions.
``(e) Grants and Contracts.--In carrying out the duties established
in subsection (b), the Director may make grants to, and enter into
contracts and cooperative agreements with, public and nonprofit private
entities.
``(f) Definition.--In this section, the term `emergency room
boarding' means the practice of admitting patients to an emergency
department and holding such patients in the department until inpatient
psychiatric beds become available.''.
SEC. 109. STRATEGIC PLAN.
Section 501 of the Public Health Service Act (42 U.S.C. 290aa) is
further amended--
(1) by redesignating subsections (l) through (o) as
subsections (m) through (p), respectively; and
(2) by inserting after subsection (k) the following:
``(l) Strategic Plan.--
``(1) In general.--Not later than December 1, 2017, and
every 5 years thereafter, the Assistant Secretary shall develop
and carry out a strategic plan in accordance with this
subsection for the planning and operation of evidence-based
programs and grants carried out by the Administration.
``(2) Coordination.--In developing and carrying out the
strategic plan under this section, the Assistant Secretary
shall take into consideration the report of the
Interdepartmental Serious Mental Illness Coordinating Committee
under section 301 of the Helping Families in Mental Health
Crisis Act of 2016.
``(3) Publication of plan.--Not later than December 1,
2017, and every 5 years thereafter, the Assistant Secretary
shall--
``(A) submit the strategic plan developed under
paragraph (1) to the appropriate committees of
Congress; and
``(B) post such plan on the Internet website of the
Administration.
``(4) Contents.--The strategic plan developed under
paragraph (1) shall--
``(A) identify strategic priorities, goals, and
measurable objectives for mental illness and substance
use disorder activities and programs operated and
supported by the Administration, including priorities
to prevent or eliminate the burden of mental illness
and substance use disorders;
``(B) identify ways to improve services for
individuals with a mental illness or substance use
disorder, including services related to the prevention
of, diagnosis of, intervention in, treatment of, and
recovery from, mental illness or substance use
disorders, including serious mental illness or serious
emotional disturbance, and access to services and
supports for individuals with a serious mental illness
or serious emotional disturbance;
``(C) ensure that programs provide, as appropriate,
access to effective and evidence-based prevention,
diagnosis, intervention, treatment, and recovery
services, including culturally and linguistically
appropriate services, as appropriate, for individuals
with a mental illness or substance use disorder;
``(D) identify opportunities to collaborate with
the Health Resources and Services Administration to
develop or improve--
``(i) initiatives to encourage individuals
to pursue careers (especially in rural and
underserved areas and populations) as
psychiatrists, psychologists, psychiatric nurse
practitioners, physician assistants,
occupational therapists, clinical social
workers, certified peer-support specialists,
licensed professional counselors, or other
licensed or certified mental health
professionals, including such professionals
specializing in the diagnosis, evaluation, or
treatment of individuals with a serious mental
illness or serious emotional disturbance; and
``(ii) a strategy to improve the
recruitment, training, and retention of a
workforce for the treatment of individuals with
mental illness or substance use disorders, or
co-occurring illness or disorders;
``(E) identify opportunities to improve
collaboration with States, local governments,
communities, and Indian tribes and tribal organizations
(as such terms are defined in section 4 of the Indian
Self-Determination and Education Assistance Act (25
U.S.C. 450b)); and
``(F) specify a strategy to disseminate evidenced-
based and promising best practices related to
prevention, diagnosis, early intervention, treatment,
and recovery services related to mental illness,
particularly for individuals with a serious mental
illness and children and adolescents with a serious
emotional disturbance, and substance use disorders.''.
SEC. 110. AUTHORITIES OF CENTERS FOR MENTAL HEALTH SERVICES AND
SUBSTANCE ABUSE TREATMENT.
(a) Center for Mental Health Services.--Section 520(b) of the
Public Health Service Act (42 U.S.C. 290bb-31(b)) is amended--
(1) by redesignating paragraphs (3) through (15) as
paragraphs (4) through (16), respectively;
(2) by inserting after paragraph (2) the following:
``(3) collaborate with the Director of the National
Institute of Mental Health to ensure that, as appropriate,
programs related to the prevention and treatment of mental
illness and the promotion of mental health are carried out in a
manner that reflects the best available science and evidence-
based practices, including culturally and linguistically
appropriate services;'';
(3) in paragraph (5), as so redesignated, by inserting
``through policies and programs that reduce risk and promote
resiliency'' before the semicolon;
(4) in paragraph (6), as so redesignated, by inserting ``in
collaboration with the Director of the National Institute of
Mental Health,'' before ``develop'';
(5) in paragraph (8), as so redesignated, by inserting ``,
increase meaningful participation of individuals with mental
illness in programs and activities of the Administration,''
before ``and protect the legal'';
(6) in paragraph (10), as so redesignated, by striking
``professional and paraprofessional personnel pursuant to
section 303'' and inserting ``paraprofessional personnel and
health professionals'';
(7) in paragraph (11), as so redesignated, by inserting
``and telemental health,'' after ``rural mental health,'';
(8) in paragraph (12), as so redesignated, by striking
``establish a clearinghouse for mental health information to
assure the widespread dissemination of such information'' and
inserting ``disseminate mental health information, including
evidenced-based practices,'';
(9) in paragraph (15), as so redesignated, by striking
``and'' at the end;
(10) in paragraph (16), as so redesignated, by striking the
period and inserting ``; and''; and
(11) by adding at the end the following:
``(17) consult with other agencies and offices of the
Department of Health and Human Services to ensure, with respect
to each grant awarded by the Center for Mental Health Services,
the consistent documentation of the application of criteria
when awarding grants and the ongoing oversight of grantees
after such grants are awarded.''.
(b) Director of the Center for Substance Abuse Treatment.--Section
507 of the Public Health Service Act (42 U.S.C. 290bb) is amended--
(1) in subsection (a)--
(A) by striking ``treatment of substance abuse''
and inserting ``treatment of substance use disorders'';
and
(B) by striking ``abuse treatment systems'' and
inserting ``use disorder treatment systems''; and
(2) in subsection (b)--
(A) in paragraph (3), by striking ``abuse'' and
inserting ``use disorder'';
(B) in paragraph (4), by striking ``individuals who
abuse drugs'' and inserting ``individuals who use
drugs'';
(C) in paragraph (9), by striking ``carried out by
the Director'';
(D) by striking paragraph (10);
(E) by redesignating paragraphs (11) through (14)
as paragraphs (10) through (13), respectively;
(F) in paragraph (12), as so redesignated, by
striking ``; and'' and inserting a semicolon; and
(G) by striking paragraph (13), as so redesignated,
and inserting the following:
``(13) ensure the consistent documentation of the
application of criteria when awarding grants and the ongoing
oversight of grantees after such grants are awarded; and
``(14) work with States, providers, and individuals in
recovery, and their families, to promote the expansion of
recovery support services and systems of care oriented towards
recovery.''.
SEC. 111. ADVISORY COUNCILS.
Section 502(b) of the Public Health Service Act (42 U.S.C. 290aa-
1(b)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (E), by striking ``and'' after
the semicolon;
(B) by redesignating subparagraph (F) as
subparagraph (I); and
(C) by inserting after subparagraph (E), the
following:
``(F) for the advisory councils appointed under
subsections (a)(1)(A) and (a)(1)(D), the Director of
the National Institute of Mental Health;
``(G) for the advisory councils appointed under
subsections (a)(1)(A), (a)(1)(B), and (a)(1)(C), the
Director of the National Institute on Drug Abuse;
``(H) for the advisory councils appointed under
subsections (a)(1)(A), (a)(1)(B), and (a)(1)(C), the
Director of the National Institute on Alcohol Abuse and
Alcoholism; and''; and
(2) in paragraph (3), by adding at the end the following:
``(C) Not less than half of the members of the
advisory council appointed under subsection (a)(1)(D)--
``(i) shall have--
``(I) a medical degree;
``(II) a doctoral degree in
psychology; or
``(III) an advanced degree in
nursing or social work from an
accredited graduate school or be a
certified physician assistant; and
``(ii) shall specialize in the mental
health field.''.
SEC. 112. PEER REVIEW.
Section 504(b) of the Public Health Service Act (42 U.S.C. 290aa-
3(b)) is amended by adding at the end the following: ``In the case of
any such peer review group that is reviewing a grant, cooperative
agreement, or contract related to mental illness treatment, not less
than half of the members of such peer review group shall be licensed
and experienced professionals in the prevention, diagnosis, or
treatment of, or recovery from, mental illness or substance use
disorders and have a medical degree, a doctoral degree in psychology,
or an advanced degree in nursing or social work from an accredited
program.''.
TITLE II--MEDICAID MENTAL HEALTH COVERAGE
SEC. 201. RULE OF CONSTRUCTION RELATED TO MEDICAID COVERAGE OF MENTAL
HEALTH SERVICES AND PRIMARY CARE SERVICES FURNISHED ON
THE SAME DAY.
Nothing in title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) shall be construed as prohibiting separate payment under the
State plan under such title (or under a waiver of the plan) for the
provision of a mental health service or primary care service under such
plan, with respect to an individual, because such service is--
(1) a primary care service furnished to the 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; or
(2) a mental health service furnished to the 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.
SEC. 202. OPTIONAL LIMITED COVERAGE OF INPATIENT SERVICES FURNISHED IN
INSTITUTIONS FOR MENTAL DISEASES.
(a) In General.--Section 1903(m)(2) of the Social Security Act (42
U.S.C. 1396b(m)(2)) is amended by adding at the end the following new
subparagraph:
``(I)(i) Notwithstanding the limitation specified in the
subdivision (B) following paragraph (29) of section 1905(a) and subject
to clause (ii), a State may, under a risk contract entered into by the
State under this title (or under section 1115) with a medicaid managed
care organization or a prepaid inpatient health plan (as defined in
section 438.2 of title 42, Code of Federal Regulations (or any
successor regulation)), make a monthly capitation payment to such
organization or plan for enrollees with the organization or plan who
are over 21 years of age and under 65 years of age and are receiving
inpatient treatment in an institution for mental diseases (as defined
in section 1905(i)), so long as each of the following conditions is
met:
``(I) The institution is a hospital providing inpatient
psychiatric or substance use disorder services or a sub-acute
facility providing psychiatric or substance use disorder crisis
residential services.
``(II) The length of stay in such an institution for such
treatment is for a short-term stay of no more than 15 days
during the period of the monthly capitation payment.
``(III) The provision of such treatment meets the following
criteria for consideration as services or settings that are
provided in lieu of services or settings covered under the
State plan:
``(aa) The State determines that the alternative
service or setting is a medically appropriate and cost-
effective substitute for the service or setting covered
under the State plan.
``(bb) The enrollee is not required by the managed
care organization or prepaid inpatient health plan to
use the alternative service or setting.
``(cc) Such treatment is authorized and identified
in such contract, and will be offered to such enrollees
at the option of the managed care organization or
prepaid inpatient health plan.
``(ii) For purposes of setting the amount of such a monthly
capitation payment, a State may use the utilization of services
provided to an individual under this subparagraph when developing the
inpatient psychiatric or substance use disorder component of such
payment, but the amount of such payment for such services may not
exceed the cost of the same services furnished through providers
included under the State plan.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply beginning on July 5, 2016, or the date of the enactment of this
Act, whichever is later.
SEC. 203. STUDY AND REPORT RELATED TO MEDICAID MANAGED CARE REGULATION.
(a) Study.--The Secretary of Health and Human Services, acting
through the Administrator of the Centers for Medicare & Medicaid
Services, shall conduct a study on coverage under the Medicaid program
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) of
services provided through a medicaid managed care organization (as
defined in section 1903(m) of such Act (42 U.S.C. 1396b(m)) or a
prepaid inpatient health plan (as defined in section 438.2 of title 42,
Code of Federal Regulations (or any successor regulation)) with respect
to individuals over the age of 21 and under the age of 65 for the
treatment of a mental health disorder in institutions for mental
diseases (as defined in section 1905(i) of such Act (42 U.S.C.
1396d(i))). Such study shall include information on the following:
(1) The extent to which States, including the District of
Columbia and each territory or possession of the United States,
are providing capitated payments to such organizations or plans
for enrollees who are receiving services in institutions for
mental diseases.
(2) The number of individuals receiving medical assistance
under a State plan under such title XIX, or a waiver of such
plan, who receive services in institutions for mental diseases
through such organizations and plans.
(3) The range of and average number of months, and the
length of stay during such months, that such individuals are
receiving such services in such institutions.
(4) How such organizations or plans determine when to
provide for the furnishing of such services through an
institution for mental diseases in lieu of other benefits
(including the full range of community-based services) under
their contract with the State agency administering the State
plan under such title XIX, or a waiver of such plan, to address
psychiatric or substance use disorder treatment.
(5) The extent to which the provision of services within
such institutions has affected the capitated payments for such
organizations or plans.
(b) Report.--Not later than 3 years after the date of the enactment
of this Act, the Secretary shall submit to Congress a report on the
study conducted under subsection (a).
SEC. 204. GUIDANCE ON OPPORTUNITIES FOR INNOVATION.
Not later than 1 year after the date of the enactment of this Act,
the Administrator of the Centers for Medicare & Medicaid Services shall
issue a State Medicaid Director letter regarding opportunities to
design innovative service delivery systems, including systems for
providing community-based services, for individuals with serious mental
illness or serious emotional disturbance who are receiving medical
assistance under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.). The letter shall include opportunities for demonstration
projects under section 1115 of such Act (42 U.S.C. 1315), to improve
care for such individuals.
SEC. 205. STUDY AND REPORT ON MEDICAID EMERGENCY PSYCHIATRIC
DEMONSTRATION PROJECT.
(a) Collection of Information.--The Secretary of Health and Human
Services, acting through the Administrator of the Centers for Medicare
& Medicaid Services, shall, with respect to each State that has
participated in the demonstration project established under section
2707 of the Patient Protection and Affordable Care Act (42 U.S.C. 1396a
note), collect from each such State information on the following:
(1) The number of institutions for mental diseases (as
defined in section 1905(i) of the Social Security Act (42
U.S.C. 1396d(i))) and beds in such institutions that received
payment for the provision of services to individuals who
receive medical assistance under a State plan under the
Medicaid program under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) (or under a waiver of such plan) through
the demonstration project in each such State as compared to the
total number of institutions for mental diseases and beds in
the State.
(2) The extent to which there is a reduction in
expenditures under the Medicaid program under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) or other spending
on the full continuum of physical or mental health care for
individuals who receive treatment in an institution for mental
diseases under the demonstration project, including outpatient,
inpatient, emergency, and ambulatory care, that is attributable
to such individuals receiving treatment in institutions for
mental diseases under the demonstration project.
(3) The number of forensic psychiatric hospitals, the
number of beds in such hospitals, and the number of forensic
psychiatric beds in other hospitals in such State, based on the
most recent data available, to the extent practical, as
determined by such Administrator.
(4) The amount of any disproportionate share hospital
payments under section 1923 of the Social Security Act (42
U.S.C. 1396r-4) that institutions for mental diseases in the
State received during the period beginning on July 1, 2012, and
ending on June 30, 2015, and the extent to which the
demonstration project reduced the amount of such payments.
(5) The most recent data regarding all facilities or sites
in the State in which any individuals with serious mental
illness who are receiving medical assistance under a State plan
under the Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) (or under a waiver of
such plan) are treated during the period referred to in
paragraph (4), to the extent practical, as determined by the
Administrator, including--
(A) the types of such facilities or sites (such as
an institution for mental diseases, a hospital
emergency department, or other inpatient hospital);
(B) the average length of stay in such a facility
or site by such an individual, disaggregated by
facility type; and
(C) the payment rate under the State plan (or a
waivers of such plan) for services furnished to such an
individual for that treatment, disaggregated by
facility type, during the period in which the
demonstration project is in operation.
(6) The extent to which the utilization of hospital
emergency departments during the period in which the
demonstration project was is in operation differed, with
respect to individuals who are receiving medical assistance
under a State plan under the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.) (or under a
waiver of such plan), between--
(A) those individuals who received treatment in an
institution for mental diseases under the demonstration
project;
(B) those individuals who met the eligibility
requirements for the demonstration project but who did
not receive treatment in an institution for mental
diseases under the demonstration project; and
(C) those individuals with serious mental illness
who did not meet such eligibility requirements and did
not receive treatment for such illness in an
institution for mental diseases.
(b) Report.--Not later than 2 years after the date of the enactment
of this Act, the Secretary of Health and Human Services shall submit to
Congress a report that summarizes and analyzes the information
collected under subsection (a). Such report may be submitted as part of
the report required under section 2707(f) of the Patient Protection and
Affordable Care Act (42 U.S.C. 1396a note) or separately.
SEC. 206. PROVIDING EPSDT SERVICES TO CHILDREN IN IMDS.
(a) In General.--Section 1905(a)(16) of the Social Security Act (42
U.S.C. 1396d(a)(16)) is amended--
(1) by striking ``effective January 1, 1973'' and inserting
``(A) effective January 1, 1973''; and
(2) by inserting before the semicolon at the end the
following: ``, and, (B) for individuals receiving services
described in subparagraph (A), early and periodic screening,
diagnostic, and treatment services (as defined in subsection
(r)), whether or not such screening, diagnostic, and treatment
services are furnished by the provider of the services
described in such subparagraph''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to items and services furnished in calendar quarters
beginning on or after January 1, 2019.
SEC. 207. ELECTRONIC VISIT VERIFICATION SYSTEM REQUIRED FOR PERSONAL
CARE SERVICES AND HOME HEALTH CARE SERVICES UNDER
MEDICAID.
(a) In General.--Section 1903 of the Social Security Act (42 U.S.C.
1396b) is amended by inserting after subsection (k) the following new
subsection:
``(l)(1) Subject to paragraphs (3) and (4), with respect to any
amount expended for personal care services or home health care services
requiring an in-home visit by a provider that are provided under a
State plan under this title (or under a waiver of the plan) and
furnished in a calendar quarter beginning on or after January 1, 2019
(or, in the case of home health care services, on or after January 1,
2023), unless a State requires the use of an electronic visit
verification system for such services furnished in such quarter under
the plan or such waiver, the Federal medical assistance percentage
shall be reduced--
``(A) in the case of personal care services--
``(i) for calendar quarters in 2019 and 2020, by
.25 percentage points;
``(ii) for calendar quarters in 2021, by .5
percentage points;
``(iii) for calendar quarters in 2022, by .75
percentage points; and
``(iv) for calendar quarters in 2023 and each year
thereafter, by 1 percentage point; and
``(B) in the case of home health care services--
``(i) for calendar quarters in 2023 and 2024, by
.25 percentage points;
``(ii) for calendar quarters in 2025, by .5
percentage points;
``(iii) for calendar quarters in 2026, by .75
percentage points; and
``(iv) for calendar quarters in 2027 and each year
thereafter, by 1 percentage point.
``(2) Subject to paragraphs (3) and (4), in implementing the
requirement for the use of an electronic visit verification system
under paragraph (1), a State shall--
``(A) consult with agencies and entities that provide
personal care services, home health care services, or both
under the State plan (or under a waiver of the plan) to ensure
that such system--
``(i) is minimally burdensome;
``(ii) takes into account existing best practices
and electronic visit verification systems in use in the
State; and
``(iii) is conducted in accordance with the
requirements of HIPAA privacy and security law (as
defined in section 3009 of the Public Health Service
Act);
``(B) take into account a stakeholder process that includes
input from beneficiaries, family caregivers, individuals who
furnish personal care services or home health care services,
and other stakeholders, as determined by the State in
accordance with guidance from the Secretary; and
``(C) ensure that individuals who furnish personal care
services, home health care services, or both under the State
plan (or under a waiver of the plan) are provided the
opportunity for training on the use of such system.
``(3) Paragraphs (1) and (2) shall not apply in the case of a State
that, as of the date of the enactment of this subsection, requires the
use of any system for the electronic verification of visits conducted
as part of both personal care services and home health care services,
so long as the State continues to require the use of such system with
respect to the electronic verification of such visits.
``(4)(A) In the case of a State described in subparagraph (B), the
reduction under paragraph (1) shall not apply--
``(i) in the case of personal care services, for calendar
quarters in 2019; and
``(ii) in the case of home health care services, for
calendar quarters in 2023.
``(B) For purposes of subparagraph (A), a State described in this
subparagraph is a State that demonstrates to the Secretary that the
State--
``(i) has made a good faith effort to comply with the
requirements of paragraphs (1) and (2) (including by taking
steps to adopt the technology used for an electronic visit
verification system); or
``(ii) in implementing such a system, has encountered
unavoidable system delays.
``(5) In this subsection:
``(A) The term `electronic visit verification system'
means, with respect to personal care services or home health
care services, a system under which visits conducted as part of
such services are electronically verified with respect to--
``(i) the type of service performed;
``(ii) the individual receiving the service;
``(iii) the date of the service;
``(iv) the location of service delivery;
``(v) the individual providing the service; and
``(vi) the time the service begins and ends.
``(B) The term `home health care services' means services
described in section 1905(a)(7) provided under a State plan
under this title (or under a waiver of the plan).
``(C) The term `personal care services' means personal care
services provided under a State plan under this title (or under
a waiver of the plan), including services provided under
section 1905(a)(24), 1915(c), 1915(i), 1915(j), or 1915(k) or
under a wavier under section 1115.
``(6)(A) In the case in which a State requires personal care
service and home health care service providers to utilize an electronic
visit verification system operated by the State or a contractor on
behalf of the State, the Secretary shall pay to the State, for each
quarter, an amount equal to 90 per centum of so much of the sums
expended during such quarter as are attributable to the design,
development, or installation of such system, and 75 per centum of so
much of the sums for the operation and maintenance of such system.
``(B) Subparagraph (A) shall not apply in the case in which a State
requires personal care service and home health care service providers
to utilize an electronic visit verification system that is not operated
by the State or a contractor on behalf of the State.''.
(b) Collection and Dissemination of Best Practices.--Not later than
January 1, 2018, the Secretary of Health and Human Services shall, with
respect to electronic visit verification systems (as defined in
subsection (l)(5) of section 1903 of the Social Security Act (42 U.S.C.
1396b), as inserted by subsection (a)), collect and disseminate best
practices to State Medicaid Directors with respect to--
(1) training individuals who furnish personal care
services, home health care services, or both under the State
plan under title XIX of such Act (or under a waiver of the
plan) on such systems and the operation of such systems and the
prevention of fraud with respect to the provision of personal
care services or home health care services (as defined in such
subsection (l)(5)); and
(2) the provision of notice and educational materials to
family caregivers and beneficiaries with respect to the use of
such electronic visit verification systems and other means to
prevent such fraud.
(c) Rules of Construction.--
(1) No employer-employee relationship established.--Nothing
in the amendment made by this section may be construed as
establishing an employer-employee relationship between the
agency or entity that provides for personal care services or
home health care services and the individuals who, under a
contract with such an agency or entity, furnish such services
for purposes of part 552 of title 29, Code of Federal
Regulations (or any successor regulations).
(2) No particular or uniform electronic visit verification
system required.--Nothing in the amendment made by this section
shall be construed to require the use of a particular or
uniform electronic visit verification system (as defined in
subsection (l)(5) of section 1903 of the Social Security Act
(42 U.S.C. 1396b), as inserted by subsection (a)) by all
agencies or entities that provide personal care services or
home health care under a State plan under title XIX of the
Social Security Act (or under a waiver of the plan) (42 U.S.C.
1396 et seq.).
(3) No limits on provision of care.--Nothing in the
amendment made by this section may be construed to limit, with
respect to personal care services or home health care services
provided under a State plan under title XIX of the Social
Security Act (or under a waiver of the plan) (42 U.S.C. 1396 et
seq.), provider selection, constrain beneficiaries' selection
of a caregiver, or impede the manner in which care is
delivered.
(4) No prohibition on state quality measures
requirements.--Nothing in the amendment made by this section
shall be construed as prohibiting a State, in implementing an
electronic visit verification system (as defined in subsection
(l)(5) of section 1903 of the Social Security Act (42 U.S.C.
1396b), as inserted by subsection (a)), from establishing
requirements related to quality measures for such system.
TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE
SEC. 301. INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
COMMITTEE.
(a) Establishment.--
(1) In general.--Not later than 3 months after the date of
enactment of this Act, the Secretary of Health and Human
Services, or the designee of the Secretary, shall establish a
committee to be known as the ``Interdepartmental Serious Mental
Illness Coordinating Committee'' (in this section referred to
as the ``Committee'').
(2) Federal advisory committee act.--Except as provided in
this section, the provisions of the Federal Advisory Committee
Act (5 U.S.C. App.) shall apply to the Committee.
(b) Meetings.--The Committee shall meet not fewer than two times
each year.
(c) Responsibilities.--Not later than 1 year after the date of
enactment of this Act, and 5 years after such date of enactment, the
Committee shall submit to Congress a report including--
(1) a summary of advances in serious mental illness and
serious emotional disturbance research related to the
prevention of, diagnosis of, intervention in, and treatment and
recovery of, serious mental illnesses, serious emotional
disturbances, and advances in access to services and support
for individuals with a serious mental illness or serious
emotional disturbance;
(2) an evaluation of the effect on public health of Federal
programs related to serious mental illness or serious emotional
disturbance, including measurements of public health outcomes
such as--
(A) rates of suicide, suicide attempts, prevalence
of serious mental illness, serious emotional
disturbances, and substance use disorders, overdose,
overdose deaths, emergency hospitalizations, emergency
room boarding, preventable emergency room visits,
involvement with the criminal justice system, crime,
homelessness, and unemployment;
(B) increased rates of employment and enrollment in
educational and vocational programs;
(C) quality of mental illness and substance use
disorder treatment services; and
(D) any other criteria as may be determined by the
Secretary;
(3) a plan to improve outcomes for individuals with serious
mental illness or serious emotional disturbances, including
reducing incarceration for such individuals, reducing
homelessness, and increasing employment; and
(4) specific recommendations for actions that agencies can
take to better coordinate the administration of mental health
services for people with serious mental illness or serious
emotional disturbances.
(d) Committee Extension.--Upon the submission of the second report
under subsection (c), the Secretary shall submit a recommendation to
Congress on whether to extend the operation of the Committee.
(e) Membership.--
(1) Federal members.--The Committee shall be composed of
the following Federal representatives, or their designees:
(A) The Secretary of Health and Human Services, who
shall serve as the Chair of the Committee.
(B) The Director of the National Institutes of
Health.
(C) The Assistant Secretary for Health of the
Department of Health and Human Services.
(D) The Assistant Secretary for Mental Health and
Substance Use.
(E) The Attorney General of the United States.
(F) The Secretary of Veterans Affairs.
(G) The Secretary of Defense.
(H) The Secretary of Housing and Urban Development.
(I) The Secretary of Education.
(J) The Secretary of Labor.
(K) The Commissioner of Social Security.
(L) The Administrator of the Centers for Medicare &
Medicaid Services.
(2) Non-federal members.--The Committee shall also include
not less than 14 non-Federal public members appointed by the
Secretary of Health and Human Services, of which--
(A) at least two members shall be individuals with
lived experience with serious mental illness or serious
emotional disturbance;
(B) at least one member shall be a parent or legal
guardian of an individual with a history of a serious
mental illness or serious emotional disturbance;
(C) at least one member shall be a representative
of a leading research, advocacy, or service
organization for individuals with serious mental
illness or serious emotional disturbance;
(D) at least two members shall be--
(i) a licensed psychiatrist with experience
treating serious mental illnesses or serious
emotional disturbances;
(ii) a licensed psychologist with
experience treating serious mental illnesses or
serious emotional disturbances;
(iii) a licensed clinical social worker
with experience treating serious mental illness
or serious emotional disturbances; or
(iv) a licensed psychiatric nurse, nurse
practitioner, or physician assistant with
experience treating serious mental illnesses or
serious emotional disturbances;
(E) at least one member shall be a licensed mental
health professional with a specialty in treating
children and adolescents with serious emotional
disturbances;
(F) at least one member shall be a mental health
professional who has research or clinical mental health
experience working with minorities;
(G) at least one member shall be a mental health
professional who has research or clinical mental health
experience working with medically underserved
populations;
(H) at least one member shall be a State certified
mental health peer-support specialist;
(I) at least one member shall be a judge with
experience adjudicating cases within a mental health
court;
(J) at least one member shall be a law enforcement
officer or corrections officer with extensive
experience in interfacing with individuals with a
serious mental illness or serious emotional
disturbance, or in a mental health crisis; and
(K) at least one member shall be a homeless
services provider with experience working with
individuals with serious mental illness, with serious
emotional disturbance, or having mental health crisis.
(3) Terms.--A member of the Committee appointed under
paragraph (2) shall serve for a term of 3 years, and may be
reappointed for one or more additional 3-year terms. Any member
appointed to fill a vacancy for an unexpired term shall be
appointed for the remainder of such term. A member may serve
after the expiration of the member's term until a successor has
been appointed.
(f) Working Groups.--In carrying out its functions, the Committee
may establish working groups. Such working groups shall be composed of
Committee members, or their designees, and may hold such meetings as
are necessary.
(g) Sunset.--The Committee shall terminate on the date that is 6
years after the date on which the Committee is established under
subsection (a)(1).
TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA
SEC. 401. SENSE OF CONGRESS.
(a) Findings.--Congress finds the following:
(1) The vast majority of individuals with mental illness
are capable of understanding their illness and caring for
themselves.
(2) Persons with serious mental illness (in this section
referred to as ``SMI''), including schizophrenia spectrum,
bipolar disorders, and major depressive disorder, may be
significantly impaired in their ability to understand or make
sound decisions for their care and needs. By nature of their
illness, cognitive impairments in reasoning and judgment, as
well as the presence of hallucinations, delusions, and severe
emotional distortions, they may lack the awareness they even
have a mental illness (a condition known as anosognosia), and
thus may be unable to make sound decisions regarding their
care, nor follow through consistently and effectively on their
care needs.
(3) Persons with mental illness or SMI may require and
benefit from mental health treatment in order to recover to the
fullest extent of their ability; these beneficial interventions
may include psychiatric care, psychological care, medication,
peer support, educational support, employment support, and
housing support.
(4) Persons with SMI who are provided with professional and
supportive services may still experience times when their
symptoms may greatly impair their abilities to make sound
decisions for their personal care or may discontinue their care
as a result of this impaired decisionmaking resulting in a
further deterioration of their condition. They may experience a
temporary or prolonged impairment as a result of their
diminished capacity to care for themselves.
(5) Episodes of psychiatric crises among those with SMI can
result in neurological harm to the individual's brain.
(6) Persons with SMI--
(A) are at high risk for other chronic physical
illnesses, with approximately 50 percent having two or
more co-occurring chronic physical illnesses such as
cardiac, pulmonary, cancer, and endocrine disorders;
and
(B) have three times the odds of having chronic
bronchitis, five times the odds of having emphysema,
and four times the odds of having COPD, are more than
four times as likely to have fluid and electrolyte
disorders, and are nearly three times as likely to be
nicotine dependent.
(7) Some psychotropic medications, such as second
generation antipsychotics, significantly increase risk for
chronic illnesses such as diabetes and cardiovascular disease.
(8) When the individual fails to seek or maintain treatment
for these physical conditions over a long term, it can result
in the individual becoming gravely disabled, or developing
life-threatening illnesses. Early and consistent treatment can
ameliorate or reduce symptoms or cure the disease.
(9) Persons with SMI die 7 to 24 years earlier than their
age cohorts primarily because of complications from their
chronic physical illness and failure to seek or maintain
treatment resulting from emotional and cognitive impairments
from their SMI.
(10) It is beneficial to the person with SMI and chronic
illness to seek and maintain continuity of medical care and
treatment for their mental illness to prevent further
deterioration and harm to their own safety.
(11) When the individual with SMI is significantly
diminished in their capacity to care for themselves long term
or acutely, other supportive interventions to assist their care
may be necessary to protect their health and safety.
(12) Prognosis for the physical and psychiatric health of
those with SMI may improve when responsible caregivers
facilitate and participate in care.
(13) When an individual with SMI is chronically
incapacitated in their ability to care for themselves,
caregivers can pursue legal guardianship to facilitate care in
appropriate areas while being mindful to allow the individual
to make decisions for themselves in areas where they are
capable.
(14) Individuals with SMI who have prolonged periods of
being significantly functional can, during such periods, design
and sign an advanced directive to predefine and choose
medications, providers, treatment plans, and hospitals, and
provide caregivers with guardianship the ability to help in
those times when a patient's psychiatric symptoms worsen to the
point of making them incapacitated or leaving them with a
severely diminished capacity to make informed decisions about
their care which may result in harm to their physical and
mental health.
(15) All professional and support efforts should be made to
help the individual with SMI and acute or chronic physical
illnesses to understand and follow through on treatment.
(16) When individuals with SMI, even after efforts to help
them understand, have failed to care for themselves, there
exists confusion in the health care community around what is
currently permissible under HIPAA rules. This confusion may
hinder communication with responsible caregivers who may be
able to facilitate care for the patient with SMI in instances
when the individual does not give permission for disclosure.
(b) Sense of Congress.--It is the sense of the Congress that, for
the sake of the health and safety of persons with serious mental
illness, more clarity is needed surrounding the existing HIPAA privacy
rule promulgated pursuant to section 264(c) of the Health Insurance
Portability and Accountability Act (42 U.S.C. 1320d-2 note) to permit
health care professionals to communicate, when necessary, with
responsible known caregivers of such persons, the limited, appropriate
protected health information of such persons in order to facilitate
treatment, but not including psychotherapy notes.
SEC. 402. CONFIDENTIALITY OF RECORDS.
Not later than 1 year after the date on which the Secretary of
Health and Human Services first finalizes regulations updating part 2
of title 42, Code of Federal Regulations (relating to confidentiality
of alcohol and drug abuse patient records) after the date of enactment
of this Act, the Secretary shall convene relevant stakeholders to
determine the effect of such regulations on patient care, health
outcomes, and patient privacy. The Secretary shall submit to the
Committee on Energy and Commerce of the House of Representatives and
the Committee on Health, Education, Labor, and Pensions of the Senate,
and make publicly available, a report on the findings of such
stakeholders.
SEC. 403. CLARIFICATION OF CIRCUMSTANCES UNDER WHICH DISCLOSURE OF
PROTECTED HEALTH INFORMATION IS PERMITTED.
(a) In General.--Not later than 1 year after the date of enactment
of this section, the Secretary of Health and Human Services shall
promulgate final regulations clarifying the circumstances under which,
consistent with the provisions of subpart C of title XI of the Social
Security Act (42 U.S.C. 1320d et seq.) and regulations promulgated
pursuant to section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2 note), a health care
provider or covered entity may disclose the protected health
information of a patient with a mental illness, including for purposes
of--
(1) communicating (including with respect to treatment,
side effects, risk factors, and the availability of community
resources) with a family member of such patient, caregiver of
such patient, or other individual to the extent that such
family member, caregiver, or individual is involved in the care
of the patient;
(2) communicating with a family member of the patient,
caregiver of such patient, or other individual involved in the
care of the patient in the case that the patient is an adult;
(3) communicating with the parent or caregiver of a patient
in the case that the patient is a minor;
(4) considering the patient's capacity to agree or object
to the sharing of the protected health information of the
patient;
(5) communicating and sharing information with the family
or caregivers of the patient when--
(A) the patient consents;
(B) the patient does not consent, but the patient
lacks the capacity to agree or object and the
communication or sharing of information is in the
patient's best interest;
(C) the patient does not consent and the patient is
not incapacitated or in an emergency circumstance, but
the ability of the patient to make rational health care
decisions is significantly diminished by reason of the
physical or mental health condition of the patient; and
(D) the patient does not consent, but such
communication and sharing of information is necessary
to prevent impending and serious deterioration of the
patient's mental or physical health;
(6) involving a patient's family members, caregivers, or
others involved in the patient's care or care plan, including
facilitating treatment and medication adherence, in dealing
with patient failures to adhere to medication or other therapy;
(7) listening to or receiving information with respect to
the patient from the family or caregiver of such patient
receiving mental illness treatment;
(8) communicating with family members of the patient,
caregivers of the patient, law enforcement, or others when the
patient presents a serious and imminent threat of harm to self
or others; and
(9) communicating to law enforcement and family members of
the patient or caregivers of the patient about the admission of
the patient to receive care at a facility or the release of a
patient who was admitted to a facility for an emergency
psychiatric hold or involuntary treatment.
(b) Coordination.--The Secretary of Health and Human Services shall
carry out this section in coordination with the Director of the Office
for Civil Rights within the Department of Health and Human Services.
(c) Consistency With Guidance.--The Secretary of Health and Human
Services shall ensure that the regulations under this section are
consistent with the guidance entitled ``HIPAA Privacy Rule and Sharing
Information Related to Mental Health'', issued by the Department of
Health and Human Services on February 20, 2014.
SEC. 404. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING PROGRAMS.
(a) Initial Programs and Materials.--Not later than 1 year after
the date of the enactment of this Act, the Secretary of Health and
Human Services (in this section referred to as the ``Secretary'') shall
develop and disseminate--
(1) a model program and materials for training health care
providers (including physicians, emergency medical personnel,
psychologists, counselors, therapists, behavioral health
facilities and clinics, care managers, and hospitals) regarding
the circumstances under which, consistent with the standards
governing the privacy and security of individually identifiable
health information promulgated by the Secretary under subpart C
of title XI of the Social Security Act (42 U.S.C. 1320d et
seq.) and regulations promulgated pursuant to section 264(c) of
the Health Insurance Portability and Accountability Act of 1996
(42 U.S.C. 1320d-2 note), the protected health information of
patients with a mental illness may be disclosed with and
without patient consent;
(2) a model program and materials for training lawyers and
others in the legal profession on such circumstances; and
(3) a model program and materials for training patients and
their families regarding their rights to protect and obtain
information under the standards specified in paragraph (1).
(b) Periodic Updates.--The Secretary shall--
(1) periodically review and update the model programs and
materials developed under subsection (a); and
(2) disseminate the updated model programs and materials.
(c) Contents.--The programs and materials developed under
subsection (a) shall address the guidance entitled ``HIPAA Privacy Rule
and Sharing Information Related to Mental Health'', issued by the
Department of Health and Human Services on February 20, 2014.
(d) Coordination.--The Secretary shall carry out this section in
coordination with the Director of the Office for Civil Rights within
the Department of Health and Human Services, the Assistant Secretary
for Mental Health and Substance Use, the Administrator of the Health
Resources and Services Administration, and the heads of other relevant
agencies within the Department of Health and Human Services.
(e) Input of Certain Entities.--In developing the model programs
and materials required by subsections (a) and (b), the Secretary shall
solicit the input of relevant national, State, and local associations,
medical societies, and licensing boards.
(f) Funding.--There are authorized to be appropriated to carry out
this section $4,000,000 for fiscal year 2018, $2,000,000 for each of
fiscal years 2019 and 2020, and $1,000,000 for each of fiscal years
2021 and 2022.
TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS
SEC. 501. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR INDIVIDUALS
WITH SERIOUS MENTAL ILLNESS.
Part B of title V of the Public Health Service Act (42 U.S.C. 290bb
et seq.) is amended by inserting after section 520L the following:
``SEC. 520M. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM FOR
INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.
``(a) In General.--The Assistant Secretary shall award grants to
eligible entities--
``(1) to establish assertive community treatment programs
for individuals with serious mental illness; or
``(2) to maintain or expand such programs.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall be a State, county, city, tribe, tribal
organization, mental health system, health care facility, or any other
entity the Assistant Secretary deems appropriate.
``(c) Special Consideration.--In selecting among applicants for a
grant under this section, the Assistant Secretary may give special
consideration to the potential of the applicant's program to reduce
hospitalization, homelessness, and involvement with the criminal
justice system while improving the health and social outcomes of the
patient.
``(d) Additional Activities.--The Assistant Secretary shall--
``(1) not later than the end of fiscal year 2021, submit a
report to the appropriate congressional committees on the grant
program under this section, including an evaluation of--
``(A) cost savings and public health outcomes such
as mortality, suicide, substance abuse,
hospitalization, and use of services;
``(B) rates of involvement with the criminal
justice system of patients;
``(C) rates of homelessness among patients; and
``(D) patient and family satisfaction with program
participation; and
``(2) provide appropriate information, training, and
technical assistance to grant recipients under this section to
help such recipients to establish, maintain, or expand their
assertive community treatment programs.
``(e) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there is
authorized to be appropriated $5,000,000 for the period of
fiscal years 2018 through 2022.
``(2) Use of certain funds.--Of the funds appropriated to
carry out this section in any fiscal year, no more than 5
percent shall be available to the Assistant Secretary for
carrying out subsection (d).''.
SEC. 502. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.
Section 520F of the Public Health Service Act (42 U.S.C. 290bb-37)
is amended to read as follows:
``SEC. 520F. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.
``(a) In General.--The Secretary shall award competitive grants--
``(1) to State and local governments and Indian tribes and
tribal organizations to enhance community-based crisis response
systems; or
``(2) to States to develop, maintain, or enhance a database
of beds at inpatient psychiatric facilities, crisis
stabilization units, and residential community mental health
and residential substance use disorder treatment facilities,
for individuals with serious mental illness, serious emotional
disturbance, or substance use disorders.
``(b) Application.--
``(1) In general.--To receive a grant or cooperative
agreement under subsection (a), an entity shall submit to the
Secretary an application, at such time, in such manner, and
containing such information as the Secretary may require.
``(2) Community-based crisis response plan.--An application
for a grant under subsection (a)(1) shall include a plan for--
``(A) promoting integration and coordination
between local public and private entities engaged in
crisis response, including first responders, emergency
health care providers, primary care providers, law
enforcement, court systems, health care payers, social
service providers, and behavioral health providers;
``(B) developing a plan for entering into memoranda
of understanding with public and private entities to
implement crisis response services;
``(C) expanding the continuum of community-based
services to address crisis intervention and prevention;
and
``(D) developing models for minimizing hospital
readmissions, including through appropriate discharge
planning.
``(3) Beds database plan.--An application for a grant under
subsection (a)(2) shall include a plan for developing,
maintaining, or enhancing a real-time Internet-based bed
database to collect, aggregate, and display information about
beds in inpatient psychiatric facilities and crisis
stabilization units, and residential community mental health
and residential substance use disorder treatment facilities, to
facilitate the identification and designation of facilities for
the temporary treatment of individuals in mental or substance
use disorder crisis.
``(c) Database Requirements.--A bed database described in this
section is a database that--
``(1) includes information on inpatient psychiatric
facilities, crisis stabilization units, and residential
community mental health and residential substance use disorder
facilities in the State involved, including contact information
for the facility or unit;
``(2) provides real-time information about the number of
beds available at each facility or unit and, for each available
bed, the type of patient that may be admitted, the level of
security provided, and any other information that may be
necessary to allow for the proper identification of appropriate
facilities for treatment of individuals in mental or substance
use disorder crisis; and
``(3) enables searches of the database to identify
available beds that are appropriate for the treatment of
individuals in mental or substance use disorder crisis.
``(d) Evaluation.--An entity receiving a grant under subsection
(a)(1) shall submit to the Secretary, at such time, in such manner, and
containing such information as the Secretary may reasonably require, a
report, including an evaluation of the effect of such grant on--
``(1) local crisis response services and measures of
individuals receiving crisis planning and early intervention
supports;
``(2) individuals reporting improved functional outcomes;
and
``(3) individuals receiving regular followup care following
a crisis.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $5,000,000 for the period of
fiscal years 2018 through 2022.''.
SEC. 503. INCREASED AND EXTENDED FUNDING FOR ASSISTED OUTPATIENT GRANT
PROGRAM FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.
Section 224(g) of the Protecting Access to Medicare Act of 2014 (42
U.S.C. 290aa note) is amended--
(1) in paragraph (1), by striking ``2018'' and inserting
``2022''; and
(2) in paragraph (2), by striking ``is authorized to be
appropriated to carry out this section $15,000,000 for each of
fiscal years 2015 through 2018'' and inserting ``are authorized
to be appropriated to carry out this section $15,000,000 for
each of fiscal years 2015 through 2017, $20,000,000 for fiscal
year 2018, $19,000,000 for each of fiscal years 2019 and 2020,
and $18,000,000 for each of fiscal years 2021 and 2022''.
SEC. 504. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL VOLUNTEERS AT
COMMUNITY HEALTH CENTERS.
Section 224 of the Public Health Service Act (42 U.S.C. 233) is
amended by adding at the end the following:
``(q)(1) For purposes of this section, a health professional
volunteer at an entity described in subsection (g)(4) shall, in
providing a health professional service eligible for funding under
section 330 to an individual, be deemed to be an employee of the Public
Health Service for a calendar year that begins during a fiscal year for
which a transfer was made under paragraph (4)(C). The preceding
sentence is subject to the provisions of this subsection.
``(2) In providing a health service to an individual, a health care
practitioner shall for purposes of this subsection be considered to be
a health professional volunteer at an entity described in subsection
(g)(4) if the following conditions are met:
``(A) The service is provided to the individual at the
facilities of an entity described in subsection (g)(4), or
through offsite programs or events carried out by the entity.
``(B) The entity is sponsoring the health care practitioner
pursuant to paragraph (3)(B).
``(C) The health care practitioner does not receive any
compensation for the service from the individual or from any
third-party payer (including reimbursement under any insurance
policy or health plan, or under any Federal or State health
benefits program), except that the health care practitioner may
receive repayment from the entity described in subsection
(g)(4) for reasonable expenses incurred by the health care
practitioner in the provision of the service to the individual.
``(D) Before the service is provided, the health care
practitioner or the entity described in subsection (g)(4) posts
a clear and conspicuous notice at the site where the service is
provided of the extent to which the legal liability of the
health care practitioner is limited pursuant to this
subsection.
``(E) At the time the service is provided, the health care
practitioner is licensed or certified in accordance with
applicable law regarding the provision of the service.
``(3) Subsection (g) (other than paragraphs (3) and (5)) and
subsections (h), (i), and (l) apply to a health care practitioner for
purposes of this subsection to the same extent and in the same manner
as such subsections apply to an officer, governing board member,
employee, or contractor of an entity described in subsection (g)(4),
subject to paragraph (4) and subject to the following:
``(A) The first sentence of paragraph (1) applies in lieu
of the first sentence of subsection (g)(1)(A).
``(B) With respect to an entity described in subsection
(g)(4), a health care practitioner is not a health professional
volunteer at such entity unless the entity sponsors the health
care practitioner. For purposes of this subsection, the entity
shall be considered to be sponsoring the health care
practitioner if--
``(i) with respect to the health care practitioner,
the entity submits to the Secretary an application
meeting the requirements of subsection (g)(1)(D); and
``(ii) the Secretary, pursuant to subsection
(g)(1)(E), determines that the health care practitioner
is deemed to be an employee of the Public Health
Service.
``(C) In the case of a health care practitioner who is
determined by the Secretary pursuant to subsection (g)(1)(E) to
be a health professional volunteer at such entity, this
subsection applies to the health care practitioner (with
respect to services performed on behalf of the entity
sponsoring the health care practitioner pursuant to
subparagraph (B)) for any cause of action arising from an act
or omission of the health care practitioner occurring on or
after the date on which the Secretary makes such determination.
``(D) Subsection (g)(1)(F) applies to a health care
practitioner for purposes of this subsection only to the extent
that, in providing health services to an individual, each of
the conditions specified in paragraph (2) is met.
``(4)(A) Amounts in the fund established under subsection (k)(2)
shall be available for transfer under subparagraph (C) for purposes of
carrying out this subsection.
``(B) Not later May 1 of each fiscal year, the Attorney General, in
consultation with the Secretary, shall submit to the Congress a report
providing an estimate of the amount of claims (together with related
fees and expenses of witnesses) that, by reason of the acts or
omissions of health professional volunteers, will be paid pursuant to
this section during the calendar year that begins in the following
fiscal year. Subsection (k)(1)(B) applies to the estimate under the
preceding sentence regarding health professional volunteers to the same
extent and in the same manner as such subsection applies to the
estimate under such subsection regarding officers, governing board
members, employees, and contractors of entities described in subsection
(g)(4).
``(C) Not later than December 31 of each fiscal year, the Secretary
shall transfer from the fund under subsection (k)(2) to the appropriate
accounts in the Treasury an amount equal to the estimate made under
subparagraph (B) for the calendar year beginning in such fiscal year,
subject to the extent of amounts in the fund.
``(5)(A) This subsection takes effect on October 1, 2017, except as
provided in subparagraph (B).
``(B) Effective on the date of the enactment of this subsection--
``(i) the Secretary may issue regulations for carrying out
this subsection, and the Secretary may accept and consider
applications submitted pursuant to paragraph (3)(B); and
``(ii) reports under paragraph (4)(B) may be submitted to
the Congress.''.
TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS
Subtitle A--Encouraging the Advancement, Incorporation, and Development
of Evidence-Based Practices
SEC. 601. ENCOURAGING INNOVATION AND EVIDENCE-BASED PROGRAMS.
Section 501B of the Public Health Service Act, as inserted by
section 103, is further amended, by inserting after subsection (c) the
following new subsection:
``(d) Promoting Innovation.--
``(1) In general.--The Assistant Secretary, in coordination
with the Laboratory, may award grants to States, local
governments, Indian tribes or tribal organizations (as such
terms are defined in section 4 of the Indian Self-Determination
and Education Assistance Act), educational institutions, and
nonprofit organizations to develop evidence-based
interventions, including culturally and linguistically
appropriate services, as appropriate, for--
``(A) evaluating a model that has been
scientifically demonstrated to show promise, but would
benefit from further applied development, for--
``(i) enhancing the prevention, diagnosis,
intervention, treatment, and recovery of mental
illness, serious emotional disturbance,
substance use disorders, and co-occurring
illness or disorders; or
``(ii) integrating or coordinating physical
health services and mental illness and
substance use disorder services; and
``(B) expanding, replicating, or scaling evidence-
based programs across a wider area to enhance effective
screening, early diagnosis, intervention, and treatment
with respect to mental illness, serious mental illness,
and serious emotional disturbance, primarily by--
``(i) applying delivery of care, including
training staff in effective evidence-based
treatment; or
``(ii) integrating models of care across
specialties and jurisdictions.
``(2) Consultation.--In awarding grants under this
paragraph, the Assistant Secretary shall, as appropriate,
consult with the advisory councils described in section 502,
the National Institute of Mental Health, the National Institute
on Drug Abuse, and the National Institute on Alcohol Abuse and
Alcoholism, as appropriate.
``(3) Authorization of appropriations.--There are
authorized to be appropriated--
``(A) to carry out paragraph (1)(A), $7,000,000 for
the period of fiscal years 2018 through 2020; and
``(B) to carry out paragraph (1)(B), $7,000,000 for
the period of fiscal years 2018 through 2020.''.
SEC. 602. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED PROGRAMS
AND PRACTICES.
Part D of title V of the Public Health Service Act is amended by
inserting after section 543 of such Act (42 U.S.C. 290dd-2 ) the
following:
``SEC. 544. PROMOTING ACCESS TO INFORMATION ON EVIDENCE-BASED PROGRAMS
AND PRACTICES.
``(a) In General.--The Assistant Secretary shall improve access to
reliable and valid information on evidence-based programs and
practices, including information on the strength of evidence associated
with such programs and practices, related to mental illness and
substance use disorders for States, local communities, nonprofit
entities, and other stakeholders by posting on the website of the
National Registry of Evidence-Based Programs and Practices evidence-
based programs and practices that have been reviewed by the Assistant
Secretary pursuant to the requirements of this section.
``(b) Notice.--
``(1) Periods.--In carrying out subsection (a), the
Assistant Secretary may establish an initial period for the
submission of applications for evidence-based programs and
practices to be posted publicly in accordance with subsection
(a) (and may establish subsequent such periods). The Assistant
Secretary shall publish notice of such application periods in
the Federal Register.
``(2) Addressing gaps.--Such notice may solicit
applications for evidence-based practices and programs to
address gaps in information identified by the Assistant
Secretary, the Assistant Secretary for Planning and Evaluation,
the Assistant Secretary for Financial Resources, or the
National Mental Health and Substance Use Policy Laboratory,
including pursuant to priorities identified in the strategic
plan established under section 501(l).
``(c) Requirements.--The Assistant Secretary shall establish
minimum requirements for applications referred to in this section,
including applications related to the submission of research and
evaluation.
``(d) Review and Rating.--The Assistant Secretary shall review
applications prior to public posting, and may prioritize the review of
applications for evidence-based practices and programs that are related
to topics included in the notice established under subsection (b). The
Assistant Secretary shall utilize a rating and review system, which
shall include information on the strength of evidence associated with
such programs and practices and a rating of the methodological rigor of
the research supporting the application. The Assistant Secretary shall
make the metrics used to evaluate applications and the resulting
ratings publicly available.''.
SEC. 603. SENSE OF CONGRESS.
It is the sense of the Congress that the National Institute of
Mental Health should conduct or support research on the determinants of
self-directed and other violence connected to mental illness.
Subtitle B--Supporting the State Response to Mental Health Needs
SEC. 611. COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT.
(a) Formula Grants.--Section 1911(b) of the Public Health Service
Act (42 U.S.C. 300x(b)) is amended--
(1) by redesignating paragraphs (1) through (3) as
paragraphs (2) through (4), respectively; and
(2) by inserting before paragraph (2) (as so redesignated),
the following:
``(1) providing community mental health services for adults
with a serious mental illness and children with a serious
emotional disturbance as defined in accordance with section
1912(c);''.
(b) State Plan.--Subsection (b) of section 1912 of the Public
Health Service Act (42 U.S.C. 300x-1) is amended to read as follows:
``(b) Criteria for Plan.--The criteria specified in this subsection
are as follows:
``(1) System of care.--The plan provides a description of
the system of care of the State, including as follows:
``(A) Comprehensive community-based health
systems.--The plan shall--
``(i) identify the single State agency to
be responsible for the administration of the
program under the grant and any third party
with whom the agency will contract (subject to
such third party complying with the
requirements of this part) for administering
mental health services through such program;
``(ii) provide for an organized community-
based system of care for individuals with
mental illness, and describe available services
and resources in a comprehensive system of
care, including services for individuals with
mental health and behavioral health co-
occurring illness or disorders;
``(iii) include a description of the manner
in which the State and local entities will
coordinate services to maximize the efficiency,
effectiveness, quality, and cost effectiveness
of services and programs to produce the best
possible outcomes (including health services,
rehabilitation services, employment services,
housing services, educational services,
substance use disorder services, legal
services, law enforcement services, social
services, child welfare services, medical and
dental care services, and other support
services to be provided with Federal, State,
and local public and private resources) with
other agencies to enable individuals receiving
services to function outside of inpatient or
residential institutions, to the maximum extent
of their capabilities, including services to be
provided by local school systems under the
Individuals with Disabilities Education Act;
``(iv) include a description of how the
State--
``(I) promotes evidence-based
practices, including those evidence-
based programs that address the needs
of individuals with early serious
mental illness regardless of the age of
the individual at onset;
``(II) provides comprehensive
individualized treatment; or
``(III) integrates mental and
physical health services;
``(v) include a description of case
management services in the State;
``(vi) include a description of activities
that seek to engage individuals with serious
mental illness or serious emotional disturbance
and their caregivers where appropriate in
making health care decisions, including
activities that enhance communication between
individuals, families, caregivers, and
treatment providers; and
``(vii) as appropriate to and reflective of
the uses the State proposes for the block grant
monies--
``(I) a description of the
activities intended to reduce
hospitalizations and hospital stays
using the block grant monies;
``(II) a description of the
activities intended to reduce incidents
of suicide using the block grant
monies; and
``(III) a description of how the
State integrates mental health and
primary care using the block grant
monies.
``(B) Mental health system data and epidemiology.--
The plan shall contain an estimate of the incidence and
prevalence in the State of serious mental illness among
adults and serious emotional disturbance among children
and presents quantitative targets and outcome measures
for programs and services provided under this subpart.
``(C) Children's services.--In the case of children
with serious emotional disturbance (as defined in
accordance with subsection (c)), the plan shall provide
for a system of integrated social services, educational
services, child welfare services, juvenile justice
services, law enforcement services, and substance use
disorder services that, together with health and mental
health services, will be provided in order for such
children to receive care appropriate for their multiple
needs (such system to include services provided under
the Individuals with Disabilities Education Act).
``(D) Targeted services to rural and homeless
populations.--The plan shall describe the State's
outreach to and services for individuals who are
homeless and how community-based services will be
provided to individuals residing in rural areas.
``(E) Management services.--The plan shall--
``(i) describe the financial resources
available, the existing mental health
workforce, and the workforce trained in
treating individuals with co-occurring mental
illness and substance use disorders;
``(ii) provide for the training of
providers of emergency health services
regarding mental health;
``(iii) describe the manner in which the
State intends to expend the grant under section
1911 for the fiscal year involved; and
``(iv) describe the manner in which the
State intends to comply with each of the
funding agreements in this subpart and subpart
III.
``(2) Goals and objectives.--The plan establishes goals and
objectives for the period of the plan, including targets and
milestones that are intended to be met, and the activities that
will be undertaken to achieve those goals and objectives.''.
(c) Best Practices in Clinical Care Models.--Section 1920 of the
Public Health Service Act (42 U.S.C. 300x-9) is amended by adding at
the end the following:
``(c) Best Practices in Clinical Care Models.--A State shall expend
not less than 10 percent of the amount the State receives for carrying
out this subpart in each fiscal year to support evidence-based programs
that address the needs of individuals with early serious mental
illness, including psychotic disorders, regardless of the age of the
individual at the onset of such illness.''.
(d) Additional Provisions.--Section 1915(b) of the Public Health
Service Act (42 U.S.C. 300x-4(b)) is amended--
(1) by amending paragraph (1) to read as follows:
``(1) In general.--A funding agreement for a grant under
section 1911 is that the State involved will maintain State
expenditures for community mental health services at a level
that is not less than the average of the amounts prescribed by
this paragraph (prior to any waiver under paragraph (3)) for
such expenditures by such State for each of the 2 fiscal years
immediately preceding the fiscal year for which the State is
applying for the grant.'';
(2) in paragraph (2)--
(A) by striking ``under subsection (a)'' and
inserting ``specified in paragraph (1)''; and
(B) by striking ``principle'' and inserting
``principal'';
(3) by amending paragraph (3) to read as follows:
``(3) Waiver.--
``(A) In general.--The Secretary may, upon the
request of a State, waive the requirement established
in paragraph (1) in whole or in part, if the Secretary
determines that extraordinary economic conditions in
the State in the fiscal year involved or in the
previous fiscal year justify the waiver.
``(B) Date certain for action upon request.--The
Secretary shall approve or deny a request for a waiver
under this paragraph not later than 120 days after the
date on which the request is made.
``(C) Applicability of waiver.--A waiver provided
by the Secretary under this paragraph shall be
applicable only to the fiscal year involved.''; and
(4) in paragraph (4)--
(A) by amending subparagraph (A) to read as
follows:
``(A) In general.--
``(i) Determination and reduction.--The
Secretary shall determine, in the case of each
State, and for each fiscal year, whether the
State maintained material compliance with the
agreement made under paragraph (1). If the
Secretary determines that a State has failed to
maintain such compliance for a fiscal year, the
Secretary shall reduce the amount of the
allotment under section 1911 for the State, for
the first fiscal year beginning after such
determination is final, by an amount equal to
the amount constituting such failure for the
previous fiscal year about which the
determination was made.
``(ii) Alternative sanction.--The Secretary
may by regulation provide for an alternative
method of imposing a sanction for a failure by
a State to maintain material compliance with
the agreement under paragraph (1) if the
Secretary determines that such alternative
method would be more equitable and would be a
more effective incentive for States to maintain
such material compliance.''; and
(B) in subparagraph (B)--
(i) by inserting after the subparagraph
designation the following: ``Submission of
information to the secretary.--''; and
(ii) by striking ``subparagraph (A)'' and
inserting ``subparagraph (A)(i)''.
(e) Application for Grant.--Section 1917(a) of the Public Health
Service Act (42 U.S.C. 300x-6(a)) is amended--
(1) in paragraph (1), by striking ``1941'' and inserting
``1942(a)''; and
(2) in paragraph (5), by striking ``1915(b)(3)(B)'' and
inserting ``1915(b)''.
Subtitle C--Strengthening Mental Health Care for Children and
Adolescents
SEC. 621. TELE-MENTAL HEALTH CARE ACCESS GRANTS.
Title III of the Public Health Service Act is amended by inserting
after section 330L of such Act (42 U.S.C. 254c-18) the following new
section:
``SEC. 330M. TELE-MENTAL HEALTH CARE ACCESS GRANTS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration and in coordination
with other relevant Federal agencies, shall award grants to States,
political subdivisions of States, Indian tribes, and tribal
organizations (for purposes of this section, as such terms are defined
in section 4 of the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450b)) to promote behavioral health integration in
pediatric primary care by--
``(1) supporting the development of statewide child mental
health care access programs; and
``(2) supporting the improvement of existing statewide
child mental health care access programs.
``(b) Program Requirements.--
``(1) In general.--A child mental health care access
program referred to in subsection (a), with respect to which a
grant under such subsection may be used, shall--
``(A) be a statewide network of pediatric mental
health teams that provide support to pediatric primary
care sites as an integrated team;
``(B) support and further develop organized State
networks of child and adolescent psychiatrists and
psychologists to provide consultative support to
pediatric primary care sites;
``(C) conduct an assessment of critical behavioral
consultation needs among pediatric providers and such
providers' preferred mechanisms for receiving
consultation and training and technical assistance;
``(D) develop an online database and communication
mechanisms, including telehealth, to facilitate
consultation support to pediatric practices;
``(E) provide rapid statewide clinical telephone or
telehealth consultations when requested between the
pediatric mental health teams and pediatric primary
care providers;
``(F) conduct training and provide technical
assistance to pediatric primary care providers to
support the early identification, diagnosis, treatment,
and referral of children with behavioral health
conditions or co-occurring intellectual and other
developmental disabilities;
``(G) provide information to pediatric providers
about, and assist pediatric providers in accessing,
child psychiatry and psychology consultations and in
scheduling and conducting technical assistance;
``(H) assist with referrals to specialty care and
community or behavioral health resources; and
``(I) establish mechanisms for measuring and
monitoring increased access to child and adolescent
psychiatric and psychology services by pediatric
primary care providers and expanded capacity of
pediatric primary care providers to identify, treat,
and refer children with mental health problems.
``(2) Pediatric mental health teams.--In this subsection,
the term `pediatric mental health team' means a team of case
coordinators, child and adolescent psychiatrists, and licensed
clinical mental health professionals, such as a psychologist,
social worker, or mental health counselor.
``(c) Application.--A State, political subdivision of a State,
Indian tribe, or tribal organization seeking a grant under this section
shall submit an application to the Secretary at such time, in such
manner, and containing such information as the Secretary may require,
including a plan for the rigorous evaluation of activities that are
carried out with funds received under such grant.
``(d) Evaluation.--A State, political subdivision of a State,
Indian tribe, or tribal organization that receives a grant under this
section shall prepare and submit an evaluation of activities carried
out with funds received under such grant to the Secretary at such time,
in such manner, and containing such information as the Secretary may
reasonably require, including a process and outcome evaluation.
``(e) Matching Requirement.--The Secretary may not award a grant
under this section unless the State, political subdivision of a State,
Indian tribe, or tribal organization involved agrees, with respect to
the costs to be incurred by the State, political subdivision of a
State, Indian tribe, or tribal organization in carrying out the purpose
described in this section, to make available non-Federal contributions
(in cash or in kind) toward such costs in an amount that is not less
than 20 percent of Federal funds provided in the grant.
``(f) Authorization of Appropriations.--To carry this section,
there are authorized to be appropriated $9,000,000 for the period of
fiscal years 2018 through 2020.''.
SEC. 622. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION,
INTERVENTION, AND TREATMENT.
Part Q of title III of the Public Health Service Act (42 U.S.C.
290h et seq.) is amended by adding at the end the following:
``SEC. 399Z-2. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION,
INTERVENTION, AND TREATMENT.
``(a) Grants.--The Secretary shall--
``(1) award grants to eligible entities, including human
services agencies, to develop, maintain, or enhance infant and
early childhood mental health promotion, intervention, and
treatment programs, including--
``(A) programs for infants and children at
significant risk of developing, showing early signs of,
or having been diagnosed with mental illness including
serious emotional disturbance; and
``(B) multigenerational therapy and other services
that support the caregiving relationship; and
``(2) ensure that programs funded through grants under this
section are evidence-informed or evidence-based models,
practices, and methods that are, as appropriate, culturally and
linguistically appropriate, and can be replicated in other
appropriate settings.
``(b) Eligible Children and Entities.--In this section:
``(1) Eligible child.--The term `eligible child' means a
child from birth to not more than 5 years of age who--
``(A) is at risk for, shows early signs of, or has
been diagnosed with a mental illness, including serious
emotional disturbance; and
``(B) may benefit from infant and early childhood
intervention or treatment programs or specialized
preschool or elementary school programs that are
evidence-based or that have been scientifically
demonstrated to show promise but would benefit from
further applied development.
``(2) Eligible entity.--The term `eligible entity' means a
nonprofit institution that--
``(A) is accredited or approved by a State mental
health or education agency, as applicable, to provide
for children from infancy to 5 years of age mental
health promotion, intervention, or treatment services
that are evidence-based or that have been
scientifically demonstrated to show promise but would
benefit from further applied development; and
``(B) provides programs described in subsection (a)
that are evidence-based or that have been
scientifically demonstrated to show promise but would
benefit from further applied development.
``(c) Application.--An eligible entity seeking a grant under
subsection (a) shall submit to the Secretary an application at such
time, in such manner, and containing such information as the Secretary
may require.
``(d) Use of Funds for Early Intervention and Treatment Programs.--
An eligible entity may use amounts awarded under a grant under
subsection (a)(1) to carry out the following:
``(1) Provide age-appropriate mental health promotion and
early intervention services or mental illness treatment
services, which may include specialized programs, for eligible
children at significant risk of developing, showing early signs
of, or having been diagnosed with a mental illness, including
serious emotional disturbance. Such services may include social
and behavioral services as well as multigenerational therapy
and other services ?that support the caregiving relationship.
``(2) Provide training for health care professionals with
expertise in infant and early childhood mental health care with
respect to appropriate and relevant integration with other
disciplines such as primary care clinicians, early intervention
specialists, child welfare staff, home visitors, early care and
education providers, and others who work with young children
and families.
``(3) Provide mental health consultation to personnel of
early care and education programs (including licensed or
regulated center-based and home-based child care, home
visiting, preschool special education, and early intervention
programs) who work with children and families.
``(4) Provide training for mental health clinicians in
infant and early childhood in promising and evidence-based
practices and models for infant and early childhood mental
health treatment and early intervention, including with regard
to practices for identifying and treating mental illness and
behavioral disorders of infants and children resulting from
exposure or repeated exposure to adverse childhood experiences
or childhood trauma.
``(5) Provide age-appropriate assessment, diagnostic, and
intervention services for eligible children, including early
mental health promotion, intervention, and treatment services.
``(e) Matching Funds.--The Secretary may not award a grant under
this section to an eligible entity unless the eligible entity agrees,
with respect to the costs to be incurred by the eligible entity in
carrying out the activities described in subsection (d), to make
available non-Federal contributions (in cash or in kind) toward such
costs in an amount that is not less than 10 percent of the total amount
of Federal funds provided in the grant.
``(f) Authorization of Appropriations.--To carry this section,
there are authorized to be appropriated $20,000,000 for the period of
fiscal years 2018 through 2022.''.
SEC. 623. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.
Section 582 of the Public Health Service Act (42 U.S.C. 290hh-1;
relating to grants to address the problems of persons who experience
violence related stress) is amended--
(1) in subsection (a), by striking ``developing programs''
and all that follows and inserting the following: ``developing
and maintaining programs that provide for--
``(1) the continued operation of the National Child
Traumatic Stress Initiative (referred to in this section as the
`NCTSI'), which includes a coordinating center that focuses 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 illness,
behavioral disorders, and physical health conditions of
children and youth resulting from witnessing or experiencing a
traumatic event.'';
(2) in subsection (b)--
(A) by striking ``subsection (a) related'' and
inserting ``subsection (a)(2) (related'';
(B) by striking ``treating disorders associated
with psychological trauma'' and inserting ``treating
mental illness and behavioral and biological disorders
associated with psychological trauma)''; and
(C) by striking ``mental health agencies and
programs that have established clinical and basic
research'' and inserting ``universities, hospitals,
mental health agencies, and other programs that have
established clinical expertise and research'';
(3) by redesignating subsections (c) through (g) as
subsections (g) through (k), respectively;
(4) by inserting after subsection (b), the following:
``(c) Child Outcome Data.--The NCTSI coordinating center shall
collect, analyze, report, and make publicly available NCTSI-wide child
treatment process and outcome data regarding the early identification
and delivery of evidence-based treatment and services for children and
families served by the NCTSI grantees.
``(d) Training.--The NCTSI coordinating center shall facilitate the
coordination of training initiatives in evidence-based and trauma-
informed treatments, interventions, and practices offered to NCTSI
grantees, providers, and partners.
``(e) Dissemination.--The NCTSI coordinating center shall, as
appropriate, collaborate with the Secretary in the dissemination of
evidence-based and trauma-informed interventions, treatments, products,
and other resources to appropriate stakeholders.
``(f) Review.--The Secretary shall, consistent with the peer-review
process, ensure that NCTSI applications are reviewed by appropriate
experts in the field as part of a consensus review process. The
Secretary shall include review criteria related to expertise and
experience in child trauma and evidence-based practices.'';
(5) in subsection (g) (as so redesignated), by striking
``with respect to centers of excellence are distributed
equitably among the regions of the country'' and inserting
``are distributed equitably among the regions of the United
States'';
(6) in subsection (i) (as so redesignated), by striking
``recipient may not exceed 5 years'' and inserting ``recipient
shall not be less than 4 years, but shall not exceed 5 years'';
and
(7) in subsection (j) (as so redesignated), by striking
``$50,000,000'' and all that follows through ``2006'' and
inserting ``$46,887,000 for each of fiscal years 2017 through
2021''.
TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATION
Subtitle A--Garrett Lee Smith Memorial Act Reauthorization
SEC. 701. YOUTH INTERAGENCY RESEARCH, TRAINING, AND TECHNICAL
ASSISTANCE CENTERS.
Section 520C of the Public Health Service Act (42 U.S.C. 290bb-34)
is amended--
(1) by striking the section heading and inserting ``suicide
prevention technical assistance center.'';
(2) in subsection (a), by striking ``and in consultation
with'' and all that follows through the period at the end of
paragraph (2) and inserting ``shall establish a research,
training, and technical assistance resource center to provide
appropriate information, training, and technical assistance to
States, political subdivisions of States, federally recognized
Indian tribes, tribal organizations, institutions of higher
education, public organizations, or private nonprofit
organizations regarding the prevention of suicide among all
ages, particularly among groups that are at high risk for
suicide.'';
(3) by striking subsections (b) and (c);
(4) by redesignating subsection (d) as subsection (b);
(5) in subsection (b), as so redesignated--
(A) by striking the subsection heading and
inserting ``Responsibilities of the Center.--'';
(B) in the matter preceding paragraph (1), by
striking ``The additional research'' and all that
follows through ``nonprofit organizations for'' and
inserting ``The center established under subsection (a)
shall conduct activities for the purpose of'';
(C) by striking ``youth suicide'' each place such
term appears and inserting ``suicide'';
(D) in paragraph (1)--
(i) by striking ``the development or
continuation of'' and inserting ``developing
and continuing''; and
(ii) by inserting ``for all ages,
particularly among groups that are at high risk
for suicide'' before the semicolon at the end;
(E) in paragraph (2), by inserting ``for all ages,
particularly among groups that are at high risk for
suicide'' before the semicolon at the end;
(F) in paragraph (3), by inserting ``and tribal''
after ``statewide'';
(G) in paragraph (5), by inserting ``and
prevention'' after ``intervention'';
(H) in paragraph (8), by striking ``in youth'';
(I) in paragraph (9), by striking ``and behavioral
health'' and inserting ``health and substance use
disorder''; and
(J) in paragraph (10), by inserting ``conducting''
before ``other''; and
(6) by striking subsection (e) and inserting the following:
``(c) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $5,988,000
for each of fiscal years 2017 through 2021.
``(d) Report.--Not later than 2 years after the date of enactment
of the Helping Families in Mental Health Crisis Act of 2016, the
Secretary shall submit to Congress a report on the activities carried
out by the center established under subsection (a) during the year
involved, including the potential effects of such activities, and the
States, organizations, and institutions that have worked with the
center.''.
SEC. 702. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.
Section 520E of the Public Health Service Act (42 U.S.C. 290bb-36)
is amended--
(1) in paragraph (1) of subsection (a) and in subsection
(c), by striking ``substance abuse'' each place such term
appears and inserting ``substance use disorder'';
(2) in subsection (b)(2)--
(A) by striking ``each State is awarded only 1
grant or cooperative agreement under this section'' and
inserting ``a State does not receive more than one
grant or cooperative agreement under this section at
any one time''; and
(B) by striking ``been awarded'' and inserting
``received''; and
(3) by striking subsection (m) and inserting the following:
``(m) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $35,427,000
for each of fiscal years 2017 through 2021.''.
SEC. 703. MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES ON CAMPUS.
Section 520E-2 of the Public Health Service Act (42 U.S.C. 290bb-
36b) is amended--
(1) in the section heading, by striking ``and behavioral
health'' and inserting ``health and substance use disorder'';
(2) in subsection (a)--
(A) by striking ``Services,'' and inserting
``Services and'';
(B) by striking ``and behavioral health problems''
and inserting ``health or substance use disorders'';
and
(C) by striking ``substance abuse'' and inserting
``substance use disorders'';
(3) in subsection (b)--
(A) in the matter preceding paragraph (1), by
striking ``for--'' and inserting ``for one or more of
the following:''; and
(B) by striking paragraphs (1) through (6) and
inserting the following:
``(1) Educating students, families, faculty, and staff to
increase awareness of mental health and substance use
disorders.
``(2) The operation of hotlines.
``(3) Preparing informational material.
``(4) Providing outreach services to notify students about
available mental health and substance use disorder services.
``(5) Administering voluntary mental health and substance
use disorder screenings and assessments.
``(6) Supporting the training of students, faculty, and
staff to respond effectively to students with mental health and
substance use disorders.
``(7) Creating a network infrastructure to link colleges
and universities with health care providers who treat mental
health and substance use disorders.'';
(4) in subsection (c)(5), by striking ``substance abuse''
and inserting ``substance use disorder'';
(5) in subsection (d)--
(A) in the matter preceding paragraph (1), by
striking ``An institution of higher education desiring
a grant under this section'' and inserting ``To be
eligible to receive a grant under this section, an
institution of higher education'';
(B) in paragraph (1)--
(i) by striking ``and behavioral health''
and inserting ``health and substance use
disorder''; and
(ii) by inserting ``, including veterans
whenever possible and appropriate,'' after
``students''; and
(C) in paragraph (2), by inserting ``, which may
include, as appropriate and in accordance with
subsection (b)(7), a plan to seek input from relevant
stakeholders in the community, including appropriate
public and private entities, in order to carry out the
program under the grant'' before the period at the end;
(6) in subsection (e)(1), by striking ``and behavioral
health problems'' and inserting ``health and substance use
disorders'';
(7) in subsection (f)(2)--
(A) by striking ``and behavioral health'' and
inserting ``health and substance use disorder''; and
(B) by striking ``suicide and substance abuse'' and
inserting ``suicide and substance use disorders''; and
(8) in subsection (h), by striking ``$5,000,000 for fiscal
year 2005'' and all that follows through the period at the end
and inserting ``$6,488,000 for each of fiscal years 2017
through 2021.''.
Subtitle B--Other Provisions
SEC. 711. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb-31 et seq.) is amended by inserting after section 520E-2
(42 U.S.C. 290bb-36b) the following:
``SEC. 520E-3. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
``(a) In General.--The Secretary, acting through the Assistant
Secretary, shall maintain the National Suicide Prevention Lifeline
Program (referred to in this section as the `Program'), authorized
under section 520A and in effect prior to the date of enactment of the
Helping Families in Mental Health Crisis Act of 2016.
``(b) Activities.--In maintaining the Program, the activities of
the Secretary shall include--
``(1) coordinating a network of crisis centers across the
United States for providing suicide prevention and crisis
intervention services to individuals seeking help at any time,
day or night;
``(2) maintaining a suicide prevention hotline to link
callers to local emergency, mental health, and social services
resources; and
``(3) consulting with the Secretary of Veterans Affairs to
ensure that veterans calling the suicide prevention hotline
have access to a specialized veterans' suicide prevention
hotline.
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $7,198,000 for each of fiscal
years 2017 through 2021.''.
SEC. 712. WORKFORCE DEVELOPMENT STUDIES AND REPORTS.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, the Assistant Secretary for Mental Health and Substance
Use, in consultation with the Administrator of the Health Resources and
Services Administration, shall conduct a study, and publicly post on
the appropriate Internet website of the Department of Health and Human
Services a report, on the mental health and substance use disorder
workforce in order to inform Federal, State, and local efforts related
to workforce enhancement.
(b) Contents.--The report under this section shall contain--
(1) national and State-level projections of the supply and
demand of mental health and substance use disorder health
workers, including the number of individuals practicing in
fields deemed relevant by the Secretary;
(2) an assessment of the mental health and substance use
disorder workforce capacity, strengths, and weaknesses as of
the date of the report, including the capacity of primary care
to prevent, screen, treat, or refer for mental health and
substance use disorders;
(3) information on trends within the mental health and
substance use disorder provider workforce, including the number
of individuals entering the mental health workforce over the
next 5 years;
(4) information on the gaps in workforce development for
mental health providers and professionals, including those who
serve pediatric, adult, and geriatric patients; and
(5) any additional information determined by the Assistant
Secretary for Mental Health and Substance Use, in consultation
with the Administrator of the Health Resources and Services
Administration, to be relevant to the mental health and
substance use disorder provider workforce.
SEC. 713. MINORITY FELLOWSHIP PROGRAM.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended by adding at the end the following:
``PART K--MINORITY FELLOWSHIP PROGRAM
``SEC. 597. FELLOWSHIPS.
``(a) In General.--The Secretary shall maintain a program, to be
known as the Minority Fellowship Program, under which the Secretary
awards fellowships, which may include stipends, for the purposes of--
``(1) increasing behavioral health practitioners' knowledge
of issues related to prevention, treatment, and recovery
support for mental illness and substance use disorders among
racial and ethnic minority populations;
``(2) improving the quality of mental illness and substance
use disorder prevention and treatment delivered to racial and
ethnic minorities; and
``(3) increasing the number of culturally competent
behavioral health professionals and school personnel who teach,
administer, conduct services research, and provide direct
mental health or substance use services to racial and ethnic
minority populations.
``(b) Training Covered.--The fellowships under subsection (a) shall
be for postbaccalaureate training (including for master's and doctoral
degrees) for mental health professionals, including in the fields of
psychiatry, nursing, social work, psychology, marriage and family
therapy, mental health counseling, and substance use and addiction
counseling.
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $12,669,000 for each of fiscal
years 2017, 2018, and 2019 and $13,669,000 for each of fiscal years
2020 and 2021.''.
SEC. 714. CENTER AND PROGRAM REPEALS.
Part B of title V of the Public Health Service Act (42 U.S.C. 290bb
et seq.) is amended by striking the second section 514 (42 U.S.C.
290bb-9), relating to methamphetamine and amphetamine treatment
initiatives, and sections 514A, 517, 519A, 519C, 519E, 520D, and 520H
(42 U.S.C. 290bb-8, 290bb-23, 290bb-25a, 290bb-25c, 290bb-25e, 290bb-
35, and 290bb-39).
SEC. 715. NATIONAL VIOLENT DEATH REPORTING SYSTEM.
The Secretary of Health and Human Services, acting through the
Director of the Centers for Disease Control and Prevention, is
encouraged to improve, particularly through the inclusion of additional
States, the National Violent Death Reporting System as authorized by
title III of the Public Health Service Act (42 U.S.C. 241 et seq.).
Participation in the system by the States shall be voluntary.
SEC. 716. SENSE OF CONGRESS ON PRIORITIZING NATIVE AMERICAN YOUTH AND
SUICIDE PREVENTION PROGRAMS.
(a) Findings.--The Congress finds as follows:
(1) Suicide is the eighth leading cause of death among
American Indians and Alaska Natives across all ages.
(2) Among American Indians and Alaska Natives who are 10 to
34 years of age, suicide is the second leading cause of death.
(3) The suicide rate among American Indian and Alaska
Native adolescents and young adults ages 15 to 34 (19.5 per
100,000) is 1.5 times higher than the national average for that
age group (12.9 per 100,000).
(b) Sense of Congress.--It is the sense of Congress that the
Secretary of Health and Human Services, in carrying out programs for
Native American youth and suicide prevention programs for youth suicide
intervention, should prioritize programs and activities for individuals
who have a high risk or disproportional burden of suicide, such as
Native Americans.
SEC. 717. PEER PROFESSIONAL WORKFORCE DEVELOPMENT GRANT PROGRAM.
(a) In General.--For the purposes described in subsection (b), the
Secretary of Health and Human Services shall award grants to develop
and sustain behavioral health paraprofessional training and education
programs, including through tuition support.
(b) Purposes.--The purposes of grants under this section are--
(1) to increase the number of behavioral health
paraprofessionals, including trained peers, recovery coaches,
mental health and addiction specialists, prevention
specialists, and pre-masters-level addiction counselors; and
(2) to help communities develop the infrastructure to train
and certify peers as behavioral health paraprofessionals.
(c) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall be a community college or other entity
the Secretary deems appropriate.
(d) Geographic Distribution.--In awarding grants under this
section, the Secretary shall seek to achieve an appropriate national
balance in the geographic distribution of such awards.
(e) Special Consideration.--In awarding grants under this section,
the Secretary may give special consideration to proposed and existing
programs targeting peer professionals serving youth ages 16 to 25.
(f) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $10,000,000 for the period of
fiscal years 2018 through 2022.
SEC. 718. NATIONAL HEALTH SERVICE CORPS.
(a) Definitions.--
(1) Primary health services.--Section 331(a)(3)(D) of the
Public Health Service Act (42 U.S.C. 254d(a)(3)) is amended by
inserting ``(including pediatric mental health subspecialty
services)'' after ``pediatrics''.
(2) Behavioral and mental health professionals.--Clause (i)
of section 331(a)(3)(E) of the Public Health Service Act (42
U.S.C. 254d(a)(3)(E)) is amended by inserting ``(and pediatric
subspecialists thereof)'' before the period at the end.
(b) Eligibility To Participate in Loan Repayment Program.--Section
338B(b)(1)(B) of the Public Health Service Act (42 U.S.C. 254l-
1(b)(1)(B)) is amended by inserting ``, including any physician child
and adolescent psychiatry residency or fellowship training program''
after ``be enrolled in an approved graduate training program in
medicine, osteopathic medicine, dentistry, behavioral and mental
health, or other health profession''.
SEC. 719. ADULT SUICIDE PREVENTION.
(a) Grants.--
(1) Authority.--The Assistant Secretary for Mental Health
and Substance Use (referred to in this section as the
``Assistant Secretary'') may award grants to eligible entities
in order to implement suicide prevention efforts amongst adults
25 and older.
(2) Purpose.--The grant program under this section shall be
designed to raise suicide awareness, establish referral
processes, and improve clinical care practice standards for
treating suicide ideation, plans, and attempts among adults.
(3) Recipients.--To be eligible to receive a grant under
this section, an entity shall be a community-based primary care
or behavioral health care setting, an emergency department, a
State mental health agency, an Indian tribe, a tribal
organization, or any other entity the Assistant Secretary deems
appropriate.
(4) Nature of activities.--The grants awarded under
paragraph (1) shall be used to implement programs that--
(A) screen for suicide risk in adults and provide
intervention and referral to treatment;
(B) implement evidence-based practices to treat
individuals who are at suicide risk, including
appropriate followup services; and
(C) raise awareness, reduce stigma, and foster open
dialogue about suicide prevention.
(b) Additional Activities.--The Assistant Secretary shall--
(1) evaluate the activities supported by grants awarded
under subsection (a) in order to further the Nation's
understanding of effective interventions to prevent suicide in
adults;
(2) disseminate the findings from the evaluation as the
Assistant Secretary considers appropriate; and
(3) provide appropriate information, training, and
technical assistance to eligible entities that receive a grant
under this section, in order to help such entities to meet the
requirements of this section, including assistance with--
(A) selection and implementation of evidence-based
interventions and frameworks to prevent suicide, such
as the Zero Suicide framework; and
(B) other activities as the Assistant Secretary
determines appropriate.
(c) Duration.--A grant under this section shall be for a period of
not more than 5 years.
(d) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated to
carry out this section $30,000,000 for the period of fiscal
years 2018 through 2022.
(2) Use of certain funds.--Of the funds appropriated to
carry out this section in any fiscal year, the lesser of 5
percent of such funds or $500,000 shall be available to the
Assistant Secretary for purposes of carrying out subsection
(b).
SEC. 720. CRISIS INTERVENTION GRANTS FOR POLICE OFFICERS AND FIRST
RESPONDERS.
(a) In General.--The Assistant Secretary for Mental Health and
Substance Use may award grants to entities such as law enforcement
agencies and first responders--
(1) to provide specialized training to law enforcement
officers, corrections officers, paramedics, emergency medical
services workers, and other first responders (including village
public safety officers (as defined in section 247 of the Indian
Arts and Crafts Amendments Act of 2010 (42 U.S.C. 3796dd
note)))--
(A) to recognize individuals who have mental
illness and how to properly intervene with individuals
with mental illness; and
(B) to establish programs that enhance the ability
of law enforcement agencies to address the mental
health, behavioral, and substance use problems of
individuals encountered in the line of duty; and
(2) to establish collaborative law enforcement and mental
health programs, including behavioral health response teams and
mental health crisis intervention teams comprised of mental
health professionals, law enforcement officers, and other first
responders, as appropriate, to provide on-site, face-to-face,
mental and behavioral health care services during a mental
health crisis, and to connect the individual in crisis to
appropriate community-based treatment services in lieu of
unnecessary hospitalization or further involvement with the
criminal justice system.
(b) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $9,000,000 for the period of
fiscal years 2018 through 2020.
SEC. 721. DEMONSTRATION GRANT PROGRAM TO TRAIN HEALTH SERVICE
PSYCHOLOGISTS IN COMMUNITY-BASED MENTAL HEALTH.
(a) Establishment.--The Secretary of Health and Human Services
shall establish a grant program under which the Assistant Secretary of
Mental Health and Substance Use Disorders may award grants to eligible
institutions to support the recruitment, education, and clinical
training experiences of health services psychology students, interns,
and postdoctoral residents for education and clinical experience in
community mental health settings.
(b) Eligible Institutions.--For purposes of this section, the term
``eligible institutions'' includes American Psychological Association-
accredited doctoral, internship, and postdoctoral residency schools or
programs in health service psychology that--
(1) are focused on the development and implementation of
interdisciplinary training of psychology graduate students and
postdoctoral fellows in providing mental and behavioral health
services to address substance use disorders, serious emotional
disturbance, and serious illness, as well as developing faculty
and implementing curriculum to prepare psychologists to work
with underserved populations; and
(2) demonstrate an ability to train health service
psychologists in psychiatric hospitals, forensic hospitals,
community mental health centers, community health centers,
federally qualified health centers, or adult and juvenile
correctional facilities.
(c) Priorities.--In selecting grant recipients under this section,
the Secretary shall give priority to eligible institutions in which
training focuses on the needs of individuals with serious mental
illness, serious emotional disturbance, justice-involved youth, and
individuals with or at high risk for substance use disorders.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $12,000,000 for the period of
fiscal years 2018 through 2022.
SEC. 722. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.
Section 775(e) of the Public Health Service Act (42 U.S.C. 295f(e))
is amended to read as follows:
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $12,000,000 for the period of
fiscal years 2018 through 2022.''.
SEC. 723. CUTGO COMPLIANCE.
Section 319D(f) of the Public Health Service Act (42 U.S.C. 247d-
4(f)) is amended by striking ``$138,300,000 for each of fiscal years
2014 through 2018'' and inserting ``$138,300,000 for each of fiscal
years 2014 through 2016 and $58,000,000 for each of fiscal years 2017
and 2018''.
TITLE VIII--MENTAL HEALTH PARITY
SEC. 801. ENHANCED COMPLIANCE WITH MENTAL HEALTH AND SUBSTANCE USE
DISORDER COVERAGE REQUIREMENTS.
(a) Compliance Program Guidance Document.--Section 2726(a) of the
Public Health Service Act (42 U.S.C. 300gg-26(a)) is amended by adding
at the end the following:
``(6) Compliance program guidance document.--
``(A) In general.--Not later than 12 months after
the date of enactment of the Helping Families in Mental
Health Crisis Act of 2016, the Secretary, the Secretary
of Labor, and the Secretary of the Treasury, in
consultation with the Inspector General of the
Department of Health and Human Services, shall issue a
compliance program guidance document to help improve
compliance with this section, section 712 of the
Employee Retirement Income Security Act of 1974, and
section 9812 of the Internal Revenue Code of 1986, as
applicable.
``(B) Examples illustrating compliance and
noncompliance.--
``(i) In general.--The compliance program
guidance document required under this paragraph
shall provide illustrative, de-identified
examples (that do not disclose any protected
health information or individually identifiable
information) of previous findings of compliance
and noncompliance with this section, section
712 of the Employee Retirement Income Security
Act of 1974, or section 9812 of the Internal
Revenue Code of 1986, as applicable, based on
investigations of violations of such sections,
including--
``(I) examples illustrating
requirements for information
disclosures and nonquantitative
treatment limitations; and
``(II) descriptions of the
violations uncovered during the course
of such investigations.
``(ii) Nonquantitative treatment
limitations.--To the extent that any example
described in clause (i) involves a finding of
compliance or noncompliance with regard to any
requirement for nonquantitative treatment
limitations, the example shall provide
sufficient detail to fully explain such
finding, including a full description of the
criteria involved for medical and surgical
benefits and the criteria involved for mental
health and substance use disorder benefits.
``(iii) Access to additional information
regarding compliance.--In developing and
issuing the compliance program guidance
document required under this paragraph, the
Secretaries specified in subparagraph (A)--
``(I) shall enter into interagency
agreements with the Inspector General
of the Department of Health and Human
Services, the Inspector General of the
Department of Labor, and the Inspector
General of the Department of the
Treasury to share findings of
compliance and noncompliance with this
section, section 712 of the Employee
Retirement Income Security Act of 1974,
or section 9812 of the Internal Revenue
Code of 1986, as applicable; and
``(II) shall seek to enter into an
agreement with a State to share
information on findings of compliance
and noncompliance with this section,
section 712 of the Employee Retirement
Income Security Act of 1974, or section
9812 of the Internal Revenue Code of
1986, as applicable.
``(C) Recommendations.--The compliance program
guidance document shall include recommendations to
comply with this section, section 712 of the Employee
Retirement Income Security Act of 1974, or section 9812
of the Internal Revenue Code of 1986, as applicable,
and encourage the development and use of internal
controls to monitor adherence to applicable statutes,
regulations, and program requirements. Such internal
controls may include a compliance checklist with
illustrative examples of nonquantitative treatment
limitations on mental health and substance use disorder
benefits, which may fail to comply with this section,
section 712 of the Employee Retirement Income Security
Act of 1974, or section 9812 of the Internal Revenue
Code of 1986, as applicable, in relation to
nonquantitative treatment limitations on medical and
surgical benefits.
``(D) Updating the compliance program guidance
document.--The compliance program guidance document
shall be updated every 2 years to include illustrative,
de-identified examples (that do not disclose any
protected health information or individually
identifiable information) of previous findings of
compliance and noncompliance with this section, section
712 of the Employee Retirement Income Security Act of
1974, or section 9812 of the Internal Revenue Code of
1986, as applicable.''.
(b) Additional Guidance.--Section 2726(a) of the Public Health
Service Act (42 U.S.C. 300gg-26(a)), as amended by subsection (a), is
further amended by adding at the end the following:
``(7) Additional guidance.--
``(A) In general.--Not later than 1 year after the
date of enactment of the Helping Families in Mental
Health Crisis Act of 2016, the Secretary, in
coordination with the Secretary of Labor and the
Secretary of the Treasury, shall issue guidance to
group health plans and health insurance issuers
offering group or individual health insurance coverage
to assist such plans and issuers in satisfying the
requirements of this section, section 712 of the
Employee Retirement Income Security Act of 1974, or
section 9812 of the Internal Revenue Code of 1986, as
applicable,.
``(B) Disclosure.--
``(i) Guidance for plans and issuers.--The
guidance issued under this paragraph shall
include clarifying information and illustrative
examples of methods that group health plans and
health insurance issuers offering group or
individual health insurance coverage may use
for disclosing information to ensure compliance
with the requirements under this section,
section 712 of the Employee Retirement Income
Security Act of 1974, or section 9812 of the
Internal Revenue Code of 1986, as applicable,
(and any regulations promulgated pursuant to
such sections, as applicable).
``(ii) Documents for participants,
beneficiaries, contracting providers, or
authorized representatives.--The guidance
issued under this paragraph shall include
clarifying information and illustrative
examples of methods that group health plans and
health insurance issuers offering group or
individual health insurance coverage may use to
provide any participant, beneficiary,
contracting provider, or authorized
representative, as applicable, with documents
containing information that the health plans or
issuers are required to disclose to
participants, beneficiaries, contracting
providers, or authorized representatives to
ensure compliance with this section, section
712 of the Employee Retirement Income Security
Act of 1974, or section 9812 of the Internal
Revenue Code of 1986, as applicable; any
regulation issued pursuant to such respective
section, or any other applicable law or
regulation, including information that is
comparative in nature with respect to--
``(I) nonquantitative treatment
limitations for both medical and
surgical benefits and mental health and
substance use disorder benefits;
``(II) the processes, strategies,
evidentiary standards, and other
factors used to apply the limitations
described in subclause (I); and
``(III) the application of the
limitations described in subclause (I)
to ensure that such limitations are
applied in parity with respect to both
medical and surgical benefits and
mental health and substance use
disorder benefits.
``(C) Nonquantitative treatment limitations.--The
guidance issued under this paragraph shall include
clarifying information and illustrative examples of
methods, processes, strategies, evidentiary standards,
and other factors that group health plans and health
insurance issuers offering group or individual health
insurance coverage may use regarding the development
and application of nonquantitative treatment
limitations to ensure compliance with this section,
section 712 of the Employee Retirement Income Security
Act of 1974, or section 9812 of the Internal Revenue
Code of 1986, as applicable, (and any regulations
promulgated pursuant to such respective section),
including--
``(i) examples of methods of determining
appropriate types of nonquantitative treatment
limitations with respect to both medical and
surgical benefits and mental health and
substance use disorder benefits, including
nonquantitative treatment limitations
pertaining to--
``(I) medical management standards
based on medical necessity or
appropriateness, or whether a treatment
is experimental or investigative;
``(II) limitations with respect to
prescription drug formulary design; and
``(III) use of fail-first or step
therapy protocols;
``(ii) examples of methods of determining--
``(I) network admission standards
(such as credentialing); and
``(II) factors used in provider
reimbursement methodologies (such as
service type, geographic market, demand
for services, and provider supply,
practice size, training, experience,
and licensure) as such factors apply to
network adequacy;
``(iii) examples of sources of information
that may serve as evidentiary standards for the
purposes of making determinations regarding the
development and application of nonquantitative
treatment limitations;
``(iv) examples of specific factors, and
the evidentiary standards used to evaluate such
factors, used by such plans or issuers in
performing a nonquantitative treatment
limitation analysis;
``(v) examples of how specific evidentiary
standards may be used to determine whether
treatments are considered experimental or
investigative;
``(vi) examples of how specific evidentiary
standards may be applied to each service
category or classification of benefits;
``(vii) examples of methods of reaching
appropriate coverage determinations for new
mental health or substance use disorder
treatments, such as evidence-based early
intervention programs for individuals with a
serious mental illness and types of medical
management techniques;
``(viii) examples of methods of reaching
appropriate coverage determinations for which
there is an indirect relationship between the
covered mental health or substance use disorder
benefit and a traditional covered medical and
surgical benefit, such as residential treatment
or hospitalizations involving voluntary or
involuntary commitment; and
``(ix) additional illustrative examples of
methods, processes, strategies, evidentiary
standards, and other factors for which the
Secretary determines that additional guidance
is necessary to improve compliance with this
section, section 712 of the Employee Retirement
Income Security Act of 1974, or section 9812 of
the Internal Revenue Code of 1986, as
applicable.
``(D) Public comment.--Prior to issuing any final
guidance under this paragraph, the Secretary shall
provide a public comment period of not less than 60
days during which any member of the public may provide
comments on a draft of the guidance.''.
(c) Availability of Plan Information.--
(1) PHSA amendment.--Paragraph (4) of section 2726(a) of
the Public Health Service Act (42 U.S.C. 300gg-26(a)) is
amended to read as follows:
``(4) Availability of plan information.--The criteria for
medical necessity determinations made under the plan or health
insurance coverage with respect to mental health or substance
use disorder benefits or medical or surgical benefits, the
reason for denial of any such benefits, and any other
information appropriate to demonstrate compliance under this
section (including any such medical and surgical information)
shall be made available by the plan administrator (or the
health insurance issuer offering such coverage) in accordance
with applicable regulations to the current or potential
participant, beneficiary, or contracting provider involved upon
request. The Secretary may promulgate any such regulations,
including interim final regulations or temporary regulations,
as may be appropriate to carry out this paragraph.''.
(2) ERISA amendment.--Paragraph (4) of section 712(a) of
the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185a(a)) is amended to read as follows:
``(4) Availability of plan information.--The criteria for
medical necessity determinations made under the plan with
respect to mental health or substance use disorder benefits or
medical or surgical benefits (or the health insurance coverage
offered in connection with the plan with respect to such
benefits), the reason for denial of any such benefits, and any
other information appropriate to demonstrate compliance under
this section (including any such medical and surgical
information) shall be made available by the plan administrator
(or the health insurance issuer offering such coverage) in
accordance with applicable regulations to the current or
potential participant, beneficiary, or contracting provider
involved upon request. The Secretary may promulgate any such
regulations, including interim final regulations or temporary
regulations, as may be appropriate to carry out this
paragraph.''.
(3) IRC amendment.--Paragraph (4) of section 9812(a) of the
Internal Revenue Code of 1986 is amended to read as follows:
``(4) Availability of plan information.--The criteria for
medical necessity determinations made under the plan with
respect to mental health or substance use disorder benefits or
medical or surgical benefits, the reason for denial of any such
benefits, and any other information appropriate to demonstrate
compliance under this section (including any such medical and
surgical information) shall be made available by the plan
administrator in accordance with applicable regulations to the
current or potential participant, beneficiary, or contracting
provider involved upon request. The Secretary may promulgate
any such regulations, including interim final regulations or
temporary regulations, as may be appropriate to carry out this
paragraph.''.
(d) Improving Compliance.--
(1) In general.--In the case that the Secretary of Health
and Human Services, the Secretary of Labor, or the Secretary of
the Treasury determines that a group health plan or health
insurance issuer offering group or individual health insurance
coverage has violated, at least five times, section 2726 of the
Public Health Service Act (42 U.S.C. 300gg-26), section 712 of
the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185a), or section 9812 of the Internal Revenue Code of 1986,
respectively, the appropriate Secretary shall audit plan
documents for such health plan or issuer in the plan year
following the Secretary's determination in order to help
improve compliance with such section.
(2) Rule of construction.--Nothing in this subsection shall
be construed to limit the authority, as in effect on the day
before the date of enactment of this Act, of the Secretary of
Health and Human Services, the Secretary of Labor, or the
Secretary of the Treasury to audit documents of health plans or
health insurance issuers.
SEC. 802. ACTION PLAN FOR ENHANCED ENFORCEMENT OF MENTAL HEALTH AND
SUBSTANCE USE DISORDER COVERAGE.
(a) Public Meeting.--
(1) In general.--Not later than 6 months after the date of
enactment of this Act, the Secretary of Health and Human
Services shall convene a public meeting of stakeholders
described in paragraph (2) to produce an action plan for
improved Federal and State coordination related to the
enforcement of section 2726 of the Public Health Service Act
(42 U.S.C. 300gg-26), section 712 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1185a), and section 9812
of the Internal Revenue Code of 1986, and any comparable
provisions of State law (in this section collectively referred
to as ``mental health parity and addiction equity
requirements'').
(2) Stakeholders.--The stakeholders described in this
paragraph shall include each of the following:
(A) The Federal Government, including
representatives from--
(i) the Department of Health and Human
Services;
(ii) the Department of the Treasury;
(iii) the Department of Labor; and
(iv) the Department of Justice.
(B) State governments, including--
(i) State health insurance commissioners;
(ii) appropriate State agencies, including
agencies on public health or mental health; and
(iii) State attorneys general or other
representatives of State entities involved in
the enforcement of mental health parity and
addiction equity requirements.
(C) Representatives from key stakeholder groups,
including--
(i) the National Association of Insurance
Commissioners;
(ii) health insurance providers;
(iii) providers of mental health and
substance use disorder treatment;
(iv) employers; and
(v) patients or their advocates.
(b) Action Plan.--Not later than 6 months after the conclusion of
the public meeting under subsection (a), the Secretary of Health and
Human Services shall finalize the action plan described in such
subsection and make it plainly available on the Internet website of the
Department of Health and Human Services.
(c) Content.--The action plan under this section shall--
(1) reflect the input of the stakeholders participating in
the public meeting under subsection (a);
(2) identify specific strategic objectives regarding how
the various Federal and State agencies charged with enforcement
of mental health parity and addiction equity requirements will
collaborate to improve enforcement of such requirements;
(3) provide a timeline for implementing the action plan;
and
(4) provide specific examples of how such objectives may be
met, which may include--
(A) providing common educational information and
documents to patients about their rights under mental
health parity and addiction equity requirements;
(B) facilitating the centralized collection of,
monitoring of, and response to patient complaints or
inquiries relating to mental health parity and
addiction equity requirements, which may be through the
development and administration of a single, toll-free
telephone number and an Internet website portal;
(C) Federal and State law enforcement agencies
entering into memoranda of understanding to better
coordinate enforcement responsibilities and information
sharing, including whether such agencies should make
the results of enforcement actions related to mental
health parity and addiction equity requirements
publicly available; and
(D) recommendations to the Congress regarding the
need for additional legal authority to improve
enforcement of mental health parity and addiction
equity requirements, including the need for additional
legal authority to ensure that nonquantitative
treatment limitations are applied, and the extent and
frequency of the applications of such limitations, both
to medical and surgical benefits and to mental health
and substance use disorder benefits in a comparable
manner.
SEC. 803. REPORT ON INVESTIGATIONS REGARDING PARITY IN MENTAL HEALTH
AND SUBSTANCE USE DISORDER BENEFITS.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, and annually thereafter for the subsequent 5 years, the
Administrator of the Centers for Medicare & Medicaid Services, in
collaboration with the Assistant Secretary of Labor of the Employee
Benefits Security Administration and the Secretary of the Treasury,
shall submit to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor, and
Pensions of the Senate a report summarizing the results of all closed
Federal investigations completed during the preceding 12-month period
with findings of any serious violation regarding compliance with mental
health and substance use disorder coverage requirements under section
2726 of the Public Health Service Act (42 U.S.C. 300gg-26), section 712
of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185a), and section 9812 of the Internal Revenue Code of 1986.
(b) Contents.--Subject to subsection (c), a report under subsection
(a) shall, with respect to investigations described in such subsection,
include each of the following:
(1) The number of closed Federal investigations conducted
during the covered reporting period.
(2) Each benefit classification examined by any such
investigation conducted during the covered reporting period.
(3) Each subject matter, including compliance with
requirements for quantitative and nonquantitative treatment
limitations, of any such investigation conducted during the
covered reporting period.
(4) A summary of the basis of the final decision rendered
for each closed investigation conducted during the covered
reporting period that resulted in a finding of a serious
violation.
(c) Limitation.--Any individually identifiable information shall be
excluded from reports under subsection (a) consistent with protections
under the health privacy and security rules promulgated under section
264(c) of the Health Insurance Portability and Accountability Act of
1996 (42 U.S.C. 1320d-2 note).
SEC. 804. GAO STUDY ON PARITY IN MENTAL HEALTH AND SUBSTANCE USE
DISORDER BENEFITS.
Not later than 3 years after the date of enactment of this Act, the
Comptroller General of the United States, in consultation with the
Secretary of Health and Human Services, the Secretary of Labor, and the
Secretary of the Treasury, shall submit to the Committee on Energy and
Commerce of the House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate a report detailing the
extent to which group health plans or health insurance issuers offering
group or individual health insurance coverage that provides both
medical and surgical benefits and mental health or substance use
disorder benefits, medicaid managed care organizations with a contract
under section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)),
and health plans provided under the State Children's Health Insurance
Program under title XXI of the Social Security Act (42 U.S.C. 1397aa et
seq.) comply with section 2726 of the Public Health Service Act (42
U.S.C. 300gg-26), section 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a), and section 9812 of the
Internal Revenue Code of 1986, including--
(1) how nonquantitative treatment limitations, including
medical necessity criteria, of such plans or issuers comply
with such sections;
(2) how the responsible Federal departments and agencies
ensure that such plans or issuers comply with such sections,
including an assessment of how the Secretary of Health and
Human Services has used its authority to conduct audits of such
plans to ensure compliance;
(3) a review of how the various Federal and State agencies
responsible for enforcing mental health parity requirements
have improved enforcement of such requirements in accordance
with the objectives and timeline described in the action plan
under section 802; and
(4) recommendations for how additional enforcement,
education, and coordination activities by responsible Federal
and State departments and agencies could better ensure
compliance with such sections, including recommendations
regarding the need for additional legal authority.
SEC. 805. INFORMATION AND AWARENESS ON EATING DISORDERS.
(a) Information.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') may--
(1) update information, related fact sheets, and resource
lists related to eating disorders that are available on the
public Internet website of the National Women's Health
Information Center sponsored by the Office on Women's Health,
to include--
(A) updated findings and current research related
to eating disorders, as appropriate; and
(B) information about eating disorders, including
information related to males and females;
(2) incorporate, as appropriate, and in coordination with
the Secretary of Education, information from publicly available
resources into appropriate obesity prevention programs
developed by the Office on Women's Health; and
(3) make publicly available (through a public Internet
website or other method) information, related fact sheets and
resource lists, as updated under paragraph (1), and the
information incorporated into appropriate obesity prevention
programs, as updated under paragraph (2).
(b) Awareness.--The Secretary may advance public awareness on--
(1) the types of eating disorders;
(2) the seriousness of eating disorders, including
prevalence, comorbidities, and physical and mental health
consequences;
(3) methods to identify, intervene, refer for treatment,
and prevent behaviors that may lead to the development of
eating disorders;
(4) discrimination and bullying based on body size;
(5) the effects of media on self-esteem and body image; and
(6) the signs and symptoms of eating disorders.
SEC. 806. EDUCATION AND TRAINING ON EATING DISORDERS.
The Secretary of Health and Human Services may facilitate the
identification of programs to educate and train health professionals
and school personnel in effective strategies to--
(1) identify individuals with eating disorders;
(2) provide early intervention services for individuals
with eating disorders;
(3) refer patients with eating disorders for appropriate
treatment;
(4) prevent the development of eating disorders; or
(5) provide appropriate treatment services for individuals
with eating disorders.
SEC. 807. GAO STUDY ON PREVENTING DISCRIMINATORY COVERAGE LIMITATIONS
FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS AND SUBSTANCE
USE DISORDERS.
Not later than 2 years after the date of the enactment of this Act,
the Comptroller General of the United States shall submit to Congress
and make publicly available a report detailing Federal oversight of
group health plans and health insurance coverage offered in the
individual or group market (as such terms are defined in section 2791
of the Public Health Service Act (42 U.S.C. 300gg-91)), including
Medicaid managed care plans under section 1903 of the Social Security
Act (42 U.S.C. 1396b), to ensure compliance of such plans and coverage
with sections 2726 of the Public Health Service Act (42 U.S.C. 300gg-
26), 712 of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185a), and 9812 of the Internal Revenue Code of 1986 (in this
section collectively referred to as the ``parity law''), including--
(1) a description of how Federal regulations and guidance
consider nonquantitative treatment limitations, including
medical necessity criteria and application of such criteria to
medical, surgical, and primary care, of such plans and coverage
in ensuring compliance by such plans and coverage with the
parity law;
(2) a description of actions that Federal departments and
agencies are taking to ensure that such plans and coverage
comply with the parity law; and
(3) the identification of enforcement, education, and
coordination activities within Federal departments and
agencies, including educational activities directed to State
insurance commissioners, and a description of how such proper
activities can be used to ensure full compliance with the
parity law.
SEC. 808. CLARIFICATION OF EXISTING PARITY RULES.
If a group health plan or a health insurance issuer offering group
or individual health insurance coverage provides coverage for eating
disorder benefits, including residential treatment, such group health
plan or health insurance issuer shall provide such benefits consistent
with the requirements of section 2726 of the Public Health Service Act
(42 U.S.C. 300gg-26), section 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a), and section 9812 of the
Internal Revenue Code of 1986.
Passed the House of Representatives July 6, 2016.
Attest:
KAREN L. HAAS,
Clerk.