[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1253 Introduced in House (IH)]
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115th CONGRESS
1st Session
H. R. 1253
To authorize the Secretary of Health and Human Services to make loans
and loan guarantees for constructing or renovating, or planning
construction or renovation of, qualified psychiatric and substance
abuse treatment facilities, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 28, 2017
Mr. Kilmer (for himself, Ms. Herrera Beutler, Mr. Murphy of
Pennsylvania, and Ms. Eddie Bernice Johnson of Texas) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To authorize the Secretary of Health and Human Services to make loans
and loan guarantees for constructing or renovating, or planning
construction or renovation of, qualified psychiatric and substance
abuse treatment facilities, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Mental Health and Substance Abuse
Treatment Accessibility Act of 2017''.
SEC. 2. LOANS AND LOAN GUARANTEES.
Part P of title III of the Public Health Service Act is amended by
inserting after section 399V-6 of such Act (42 U.S.C. 280g-17) the
following:
``SEC. 399V-7. LOANS AND LOAN GUARANTEES FOR CONSTRUCTING OR
RENOVATING, OR PLANNING CONSTRUCTION OR RENOVATION OF,
CERTAIN QUALIFIED PSYCHIATRIC AND SUBSTANCE ABUSE
TREATMENT FACILITIES.
``(a) In General.--The Secretary may--
``(1) make loans and loan guarantees for the purpose of
constructing or renovating, including planning the construction
or renovation of, a qualified psychiatric treatment facility or
a qualified substance abuse treatment facility to public,
private for-profit, or private not-for-profit--
``(A) psychiatric treatment facilities;
``(B) substance abuse treatment facilities;
``(C) psychiatric hospitals; and
``(D) alliances of such facilities or hospitals;
and
``(2) subject to subsection (d), make loans and loan
guarantees for refinancing loans that were made for such
purpose to an entity listed in paragraph (1).
``(b) Preference.--In making loans and loan guarantees under this
section, the Secretary shall give preference to psychiatric treatment
facilities and substance abuse treatment facilities that propose to
construct or renovate a qualified psychiatric treatment facility or
qualified substance abuse treatment facility in a county that has
insufficient inpatient psychiatric or substance abuse treatment
capacity.
``(c) Terms and Conditions.--Loans and loan guarantees under this
section shall be made on such terms and conditions as the Secretary may
prescribe, subject to the provisions of this section including the
following:
``(1) The Secretary may allow credit to a prospective
borrower only where--
``(A) it is necessary to increase the number of
psychiatric or substance use disorder treatment beds to
enhance the public's access to acute inpatient mental
health and substance abuse services; and
``(B) a credit subsidy is the most efficient way to
achieve such increase (on a borrower-by-borrower
basis).
``(2) The final maturity of loans made or guaranteed under
this section shall not exceed a period of 20 years, or the
period of 50 percent of the useful life of any physical asset
to be financed by the loan, whichever is less as determined by
the Secretary.
``(3) The Secretary may not make a loan guarantee under
this section, with respect to any borrower, in excess of 80
percent of any potential loss on the loan.
``(4) The Secretary may not make any loan or loan guarantee
under this section if the loan will be subordinated--
``(A) to another debt contracted by the borrower;
or
``(B) to any other claims against the borrower in
the case of default.
``(5) The Secretary may not make any loan guarantee under
this section unless the Secretary determines that--
``(A) the lender is responsible; and
``(B) adequate provision is made for servicing the
loan on reasonable terms and protecting the financial
interest of the United States.
``(6) The Secretary may not make any loan guarantee under
this section if the income from the loan will be excluded from
gross income for purposes of chapter 1 of the Internal Revenue
Code of 1986.
``(7) The Secretary may not make any loan or loan guarantee
under this section unless--
``(A) the loan and interest supplements on any loan
guarantee will be at an interest rate that is set by
reference to a benchmark interest rate on marketable
Treasury securities with a similar maturity to the loan
being made or guaranteed; and
``(B) the minimum interest rate on the loan--
``(i) will be no less than the estimated
cost to the Government of making the loan plus
1 percent, with the goal of keeping the
interest rate below the interest rate of a
comparable and competitive private sector
benchmark financial instrument; and
``(ii) will be adjusted, as determined by
the Secretary, every quarter to take account of
changes in the interest rate of the benchmark
financial instrument.
``(8) The Secretary may not make any loan or loan guarantee
under this section unless--
``(A) fees or premiums on the loan or loan
guarantee and corresponding insurance coverage will be
set at levels that minimize the cost to the Government
(as defined in section 502(5) of the Federal Credit
Reform Act of 1990) of insuring such loan or loan
guarantee, while supporting achievement of increasing
the inpatient psychiatric and substance abuse bed
count, as applicable, to enhance the public's access to
acute inpatient mental health and substance abuse
services;
``(B) the minimum guarantee fee or insurance
premium imposed by the Government will be no less than
the level sufficient to cover all of the estimated
costs to the Government of the expected default claims,
plus one percent; and
``(C) loan guarantee fees imposed by the Government
will be reviewed every six months to ensure that the
fees imposed on new loan guarantees are at a level
sufficient to satisfy subparagraph (B) based on the
most recent estimates of such costs.
``(9) The provisions of any loan guarantee under this
section shall state that the guarantee is conclusive evidence
that--
``(A) the guarantee has been properly obtained;
``(B) the underlying loan qualified for the
guarantee; and
``(C) except in the case of fraud or material
misrepresentation by the holder of the loan, the
guarantee will be presumed to be valid, legal, and
enforceable.
``(10) The Secretary may not make any loan or loan
guarantee under this section unless--
``(A) the borrower finances at least 25 percent of
the funded project from other sources; and
``(B) the borrower uses funds that were not derived
from Federal loans or loan guarantees to pay the fees
or premiums on the loan or loan guarantee under this
section.
``(11) The Secretary--
``(A) shall prescribe explicit standards for use in
periodically assessing the credit risk of new and
existing direct loans and guaranteed loans; and
``(B) shall not make a loan or loan guarantee under
this section unless the Secretary finds that there is a
reasonable assurance of repayment.
``(d) Limitation on Refinancing.--The authority vested by
subsection (a)(2)--
``(1) authorizes making loans and loan guarantees only for
refinancing loans that were entered into on or before the date
that is 24 months before the date of enactment of the Mental
Health and Substance Abuse Treatment Accessibility Act of 2017;
and
``(2) terminates on the date that is 24 months after such
date of enactment.
``(e) Payment of Losses.--
``(1) Default on guaranteed loans.--If, as a result of a
default by a borrower under a loan guaranteed under this
section, after the holder thereof has made such further
collection efforts and instituted such enforcement proceedings
as the Secretary may require, the Secretary determines that the
holder has suffered a loss--
``(A) the Secretary shall pay to such holder 75
percent of such loss, as specified in the guarantee
contract;
``(B) upon making any such payment, the Secretary
shall be subrogated to all the rights of the recipient
of the payment; and
``(C) the Secretary shall be entitled to recover
from the borrower the amount of any payments made
pursuant to the guarantee contract.
``(2) Required enforce of federal rights.--The Attorney
General of the United States shall take such action as may be
appropriate to enforce any right accruing to the United States
as a result of the issuance of any guarantee under this
section.
``(3) Forbearance.--Nothing in this section precludes any
forbearance for the benefit of the borrower of a loan that is
made or guaranteed under this section which is agreed upon by
the parties to the loan and approved by the Secretary, provided
that budget authority for any resulting cost to the Government
(as defined in section 502(5) of the Federal Credit Reform Act
of 1990) is available.
``(f) Definitions.--In this section:
``(1) The term `qualified psychiatric treatment facility'--
``(A) means a psychiatric hospital (or other
qualified treatment facility, as determined appropriate
by the Secretary) that is able to serve patients ages
21 and older that--
``(i) will provide acute, short-term
inpatient psychiatric treatment services for
such patients;
``(ii) will provide outpatient services;
and
``(iii) may include a military services
program to meet the needs of active and retired
military servicemembers; and
``(B) excludes a facility that--
``(i) provides long-term inpatient care;
``(ii) is a health center (as defined in
section 330); and
``(iii) is part of or affiliated with a
prison (as defined in section 2246 of title 18,
United States Code).
``(2) The term `qualified substance abuse treatment
facility'--
``(A) means a psychiatric hospital (or other
qualified treatment facility, as determined appropriate
by the Secretary) that is able to serve patients ages
21 and older that--
``(i) will provide acute, short-term
inpatient substance abuse treatment services
for such patients;
``(ii) will provide outpatient services;
and
``(iii) may include a military services
program to meet the needs of active and retired
military servicemembers; and
``(B) excludes any facility described in paragraph
(1)(B).
``(3) The term `psychiatric hospital' means--
``(A) an institution that--
``(i) is primarily engaged in providing, by
or under the supervision of one or more
physicians, psychiatric services for the
diagnosis and treatment of mentally ill persons
or those suffering from substance abuse
disorders;
``(ii) satisfies the requirements of
paragraphs (3) through (9) of subsection (e) of
section 1861 of the Social Security Act;
``(iii) maintains clinical records on all
patients and maintains such records as the
Secretary finds to be necessary to determine
the degree and intensity of the treatment
provided to individuals entitled to hospital
insurance benefits under part A of title XVIII
of the Social Security Act; and
``(iv) meets such staffing requirements as
the Secretary finds necessary for the
institution to carry out an active program of
treatment for individuals who are furnished
services in the institution; or
``(B) a distinct part of an institution that
satisfies clauses (i) and (ii) of subparagraph (A) if
such distinct part satisfies clauses (iii) and (iv) of
subparagraph (A).
``(g) Funding Limitations.--The Secretary may provide loans and
loan guarantees under this section--
``(1) only to the extent or in the amounts provided in
advance in appropriation Acts; and
``(2) totaling not more than $200,000,000 in each of fiscal
years 2018 through 2022.''.
SEC. 3. MENTAL HEALTH AND SUBSTANCE USE TREATMENT TRUST FUND.
(a) Establishment.--There is established in the Treasury of the
United States a trust fund to be known as the Mental Health and
Substance Use Treatment Trust Fund (in this section referred to as the
``Trust Fund'').
(b) Deposits.--There are hereby authorized to be appropriated to
the Trust Fund, to remain available until expended, amounts equivalent
to any revenues from the program of loans and loan guarantees under
section 399V-7 of the Public Health Service Act, as added by section 2,
that exceed the costs of carrying out such program.
(c) Use of Fund.--Amounts in the Trust Fund shall be available, as
provided by appropriation Acts, for block grants for community mental
health services under subpart I of part B of title XIX of the Public
Health Service Act (42 U.S.C. 300x et seq.).
SEC. 4. SENSE OF CONGRESS.
It is the sense of Congress that reversing the Federal policy of
denying Federal financial participation under the Medicaid program for
care and services for patients in an institution for mental diseases is
critically important to improving access to mental health care services
and treatment.
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