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108th CONGRESS
  1st Session
                                H. R. 2241

 To amend the Public Health Service Act with respect to mental health 
                   services for elderly individuals.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 22, 2003

 Mr. Kennedy of Rhode Island (for himself, Mr. Hoyer, Mr. Serrano, Ms. 
Jackson-Lee of Texas, Mr. Kildee, Mr. Wynn, Mrs. Napolitano, Mr. Frost, 
Mr. McNulty, Mr. Acevedo-Vila, Mr. Lipinski, Ms. Lee, Mr. Menendez, and 
 Mr. Waxman) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act with respect to mental health 
                   services for elderly individuals.

    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 ``Positive Aging Act of 2003''.

SEC. 2. FINDINGS; STATEMENT OF PURPOSE.

    (a) Findings.--The Congress finds that--
            (1) although, on average, \1/4\ of all patients seen in 
        primary care settings have a mental disorder, primary care 
        practitioners identify such illness in only about half of these 
        cases;
            (2) four mental disorders are among the 10 leading causes 
        of disability in the United States;
            (3) among the elderly, 10 percent have dementia and as many 
        as one quarter have significant clinical depression;
            (4) access to mental health services by the elderly is 
        compromised by health benefits coverage limits, gaps in the 
        mental health services delivery system, and shortages of 
        geriatric mental health practitioners;
            (5) the integration of medical and mental health treatment 
        provides an effective means of coordinating care, improving 
        mental health outcomes, and saving health care dollars; and
            (6) the treatment of mental disorders in older patients, 
        particularly those with other chronic diseases, can improve 
        health outcomes and the quality of life for these patients.
    (b) Statement of Purpose.--In order to address the emerging crisis 
in the identification and treatment of mental disorders among the 
elderly, it is the purpose of this Act to--
            (1) promote models of care that integrate mental health 
        services and medical care within primary care settings; and
            (2) improve access by older adults to mental health 
        services in community-based settings.

  TITLE I--ENHANCING ACCESS TO MENTAL HEALTH SERVICES FOR THE ELDERLY

SEC. 101. SERVICES IMPLEMENTATION PROJECTS TO SUPPORT INTEGRATION OF 
              MENTAL HEALTH SERVICES IN PRIMARY CARE SETTINGS.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31 et seq.) is amended--
            (1) in section 520(b)--
                    (A) in paragraph (14), by striking ``and'' at the 
                end;
                    (B) in paragraph (15), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following paragraph:
            ``(16) conduct the demonstration projects specified in 
        section 520K.''; and
            (2) by adding at the end the following section:

``SEC. 520K. PROJECTS TO DEMONSTRATE INTEGRATION OF MENTAL HEALTH 
              SERVICES IN PRIMARY CARE SETTINGS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Center for Mental Health Services, shall make grants to public and 
private nonprofit entities for evidence-based projects to demonstrate 
ways of integrating mental health services for older patients into 
primary care settings, such as health centers receiving a grant under 
section 330 (or determined by the Secretary to meet the requirements 
for receiving such a grant), other Federally qualified health centers, 
primary care clinics, and private practice sites.
    ``(b) Requirements.--In order to qualify for a grant under this 
section, a project shall provide for collaborative care within a 
primary care setting, involving psychiatrists, psychologists, and other 
licensed mental health professionals with appropriate training and 
experience in the treatment of older adults, in which screening, 
assessment, and intervention services are combined into an integrated 
service delivery model, including--
            ``(1) screening services by a mental health professional 
        with at least a masters degree in an appropriate field of 
        training, supported by psychiatrists and psychologists with 
        appropriate training and experience in the treatment of older 
        adults to ensure adequate consideration of biomedical and 
        psychosocial conditions, respectively;
            ``(2) referrals for necessary prevention, intervention, 
        follow-up care, consultations, and care planning oversight for 
        mental health and other service needs, as indicated; and
            ``(3) adoption and implementation of evidence-based 
        protocols, to the extent available, for prevalent mental health 
        disorders, including depression, anxiety, behavioral and 
        psychological symptoms of dementia, psychosis, and misuse of, 
        or dependence on, alcohol or medication.
    ``(c) Considerations in Awarding Grants.--To the extent feasible, 
the Secretary shall ensure that--
            ``(1) grants under this section are awarded to projects in 
        a variety of geographic areas, including urban and rural areas; 
        and
            ``(2) the needs of ethnically diverse at-risk populations 
        are addressed.
    ``(d) Duration.--A project may receive funding pursuant to a grant 
under this section for a period of up to 3 years, with an extension 
period of 2 additional years at the discretion of the Secretary.
    ``(e) Application.--In order to receive a grant under this section, 
a public or private nonprofit entity shall--
            ``(1) submit an application to the Secretary (in such form, 
        containing such information, and at such time as the Secretary 
        may specify); and
            ``(2) agree to report to the Secretary standardized 
        clinical and behavioral data necessary to evaluate patient 
        outcomes and to facilitate evaluations across participating 
        projects.
    ``(f) Evaluation.--Not later than 6 months after the close of a 
calendar year, the Secretary shall submit to the Congress a report 
evaluating the projects receiving awards under this section for such 
year.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated for fiscal year 2004 and each fiscal year thereafter such 
sums as may be necessary to carry out this section.''.

SEC. 102. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH TREATMENT OUTREACH 
              TEAMS.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31 et seq.), as amended by section 101 of this Act, is 
further amended by adding at the end the following section:

``SEC. 520L. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH TREATMENT 
              OUTREACH TEAMS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Center for Mental Health Services, shall make grants to public or 
private nonprofit entities that are community-based providers of 
geriatric mental health services, to support the establishment and 
maintenance by such entities of multi-disciplinary geriatric mental 
health outreach teams in community settings where older adults reside 
or receive social services. Entities eligible for such grants include--
            ``(1) mental health service providers of a State or local 
        government;
            ``(2) outpatient programs of private, nonprofit hospitals;
            ``(3) community mental health centers meeting the criteria 
        specified in section 1913(c); and
            ``(4) other community-based providers of mental health 
        services.
    ``(b) Requirements.--In order to qualify for a grant under this 
section, an entity shall--
            ``(1) adopt and implement, for use by its mental health 
        outreach team, evidence-based intervention and treatment 
        protocols (to the extent such protocols are available) for 
        mental disorders prevalent in older adults, relying to the 
        greatest extent feasible on protocols that have been 
        developed--
                    ``(A) by or under the auspices of the Secretary; or
                    ``(B) by academicians with expertise in mental 
                health and aging;
            ``(2) provide screening for mental disorders, diagnostic 
        services, referrals for treatment, and case management and 
        coordination through such teams; and
            ``(3) coordinate and integrate the services provided by 
        such team with the services of social service, mental health, 
        medical, and other health care providers at the site or sites 
        where the team is based in order to--
                    ``(A) improve patient outcomes; and
                    ``(B) to ensure, to the maximum extent feasible, 
                the continuing independence of older adults who are 
                residing in the community.
    ``(c) Cooperative Arrangements With Sites Serving as Bases for 
Outreach Teams.--An entity receiving a grant under this section may 
enter into an agreement with a person operating a site at which a 
geriatric mental health outreach team of the entity is based, 
including--
            ``(1) senior centers;
            ``(2) adult day care programs;
            ``(3) assisted living facilities; and
            ``(4) recipients of grants to provide services to senior 
        citizens under the Older Americans Act, under which such person 
        provides (and is reimbursed by the entity, out of funds 
        received under the grant, for) any supportive services, such as 
        transportation and administrative support, that such person 
        provides to an outreach team of such entity.
    ``(d) Considerations in Awarding Grants.--To the extent feasible, 
the Secretary shall ensure that--
            ``(1) grants under this section are awarded to projects in 
        a variety of geographic areas, including urban and rural areas; 
        and
            ``(2) the needs of ethnically diverse at-risk populations 
        are addressed.
    ``(e) Application.--In order to receive a grant under this section, 
an entity shall--
            ``(1) submit an application to the Secretary (in such form, 
        containing such information, and at such time as the Secretary 
        may specify); and
            ``(2) agree to report to the Secretary standardized 
        clinical and behavioral data necessary to evaluate patient 
        outcomes and to facilitate evaluations across participating 
        projects.
    ``(f) Evaluation.--Not later than 6 months after the close of a 
calendar year, the Secretary shall submit to the Congress a report 
evaluating the programs receiving a grant under this section for such 
year.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated for fiscal year 2004 and each fiscal year thereafter such 
sums as may be necessary to carry out this section.''.

 TITLE II--ADMINISTRATIVE CHANGES TO STRENGTHEN PROGRAMS FOR GERIATRIC 
                         MENTAL HEALTH SERVICES

SEC. 201. DESIGNATION OF DEPUTY DIRECTOR FOR GERIATRIC MENTAL HEALTH 
              SERVICES IN CENTER FOR MENTAL HEALTH SERVICES.

    Section 520 of the Public Health Service Act (42 U.S.C. 290bb-31) 
is amended by redesignating subsection (c) as subsection (d) and 
inserting after subsection (b) the following:
    ``(c) Deputy Director for Geriatric Mental Health Services.--The 
Director, after consultation with the Administrator, shall designate a 
Deputy Director for Geriatric Mental Health Services, who shall be 
responsible for the development and implementation of initiatives of 
the Center to address the mental health needs of older adults. Such 
initiatives shall include--
            ``(1) research on prevention and identification of mental 
        disorders in the geriatric population;
            ``(2) innovative demonstration projects for the delivery of 
        community-based mental health services for older Americans;
            ``(3) support for the development and dissemination of 
        evidence-based practice models, including models to address 
        dependence on, and misuse of, alcohol and medication in older 
        adults; and
            ``(4) development of model training programs for mental 
        health professionals and caregivers serving older adults.''.

SEC. 202. MEMBERSHIP OF ADVISORY COUNCIL FOR THE CENTER FOR MENTAL 
              HEALTH SERVICES.

    Section 502(b)(3) of the Public Health Service Act (42 U.S.C. 
290aa-1(b)(3)) is amended by adding at the end the following:
                    ``(C) In the case of the advisory council for the 
                Center for Mental Health Services, the members 
                appointed pursuant to subparagraphs (A) and (B) shall 
                include representatives of older Americans, their 
                families, and geriatric mental health specialists, 
                including at least 1 physician with board certification 
                in geriatric psychiatry and at least 1 psychologist 
                with appropriate training and experience in the 
                treatment of older adults.''.

SEC. 203. PROJECTS OF NATIONAL SIGNIFICANCE TARGETING SUBSTANCE ABUSE 
              IN OLDER ADULTS.

    Section 509(b)(2) of the Public Health Service Act (42 U.S.C. 
290bb-2(b)(2)) is amended by inserting before the period the following: 
``, and to providing treatment for older adults with alcohol or 
substance abuse or addiction, including medication misuse or 
dependence''.

SEC. 204. CRITERIA FOR STATE PLANS UNDER COMMUNITY MENTAL HEALTH 
              SERVICES BLOCK GRANTS.

    (a) In General.--Section 1912(b) of the Public Health Service Act 
(42 U.S.C. 300x-2(b)) is amended by inserting after paragraph (5) the 
following:
            ``(6) Goals and initiatives for improving access to 
        services for older adults.--The plan--
                    ``(A) specifies goals for improving access by older 
                Americans to community-based mental health services;
                    ``(B) includes a plan identifying and addressing 
                the unmet needs of such individuals for mental health 
                services; and
                    ``(C) includes an inventory of the services, 
                personnel, and treatment sites available to improve the 
                delivery of mental health services to such 
                individuals.''.

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