[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1359 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 1359
To increase the number of well-trained mental health service
professionals (including those based in schools) providing clinical
mental health care to children and adolescents, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 19, 2003
Mr. Kennedy of Rhode Island (for himself, Ms. Ros-Lehtinen, Ms. Norton,
Mr. Kildee, Mr. Platts, Mr. Owens, Ms. Kilpatrick, Mr. Lantos, Mr.
Serrano, Mr. Deutsch, Mr. Stark, and Mr. Mario Diaz-Balart of Florida)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committee on Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To increase the number of well-trained mental health service
professionals (including those based in schools) providing clinical
mental health care to children and adolescents, 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 ``Child Healthcare Crisis Relief
Act''.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) The Center for Mental Health Services estimates that 20
percent or 13,700,000 of the Nation's children and adolescents
have a diagnosable mental disorder, and about \2/3\ of these
children and adolescents do not receive mental health care.
(2) According to ``Mental Health: A Report of the Surgeon
General'' in 1999, there are approximately 6,000,000 to
9,000,000 children and adolescents in the United States
(accounting for 9 to 13 percent of all children and adolescents
in the United States) who meet the definition for having a
serious emotional disturbance.
(3) According to the Center for Mental Health Services,
approximately 5 to 9 percent of United States children and
adolescents meet the definition for extreme functional
impairment.
(4) According to the Surgeon General's Report, there are
particularly acute shortages in the numbers of mental health
service professionals serving children and adolescents with
serious emotional disorders.
(5) According to the National Center for Education
Statistics in the Department of Education, there are
approximately 513 students for each school counselor in United
States schools, which ratio is more than double the recommended
ratio of 250 students for each school counselor.
(6) According to the Bureau of Health Professions in 2000,
the demand for the services of child and adolescent psychiatry
is projected to increase by 100 percent by 2020.
(7) The development and application of knowledge about the
impact of disasters on children, adolescents, and their
families has been impeded by critical shortages of qualified
researchers and practitioners specializing in this work.
(8) According to the Bureau of the Census, the population
of children and adolescents in the United States under the age
of 18 is projected to grow by more than 40 percent in the next
50 years from 70 million to more than 100 million by 2050.
SEC. 3. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS TO IMPROVE CHILD AND
ADOLESCENT MENTAL HEALTH CARE.
Part B of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.) is amended by adding at the end the following:
``SEC. 742. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS TO IMPROVE CHILD
AND ADOLESCENT MENTAL HEALTH CARE.
``(a) Loan Repayments for Child and Adolescent Mental Health
Service Professionals.--
``(1) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, may establish a program of entering into
contracts on a competitive basis with eligible individuals (as
defined in paragraph (2)) under which--
``(A) the eligible individual agrees to be employed
full-time for a specified period (which shall be at
least 2 years) in providing mental health services to
children and adolescents; and
``(B) the Secretary agrees to make, during the
period of employment described in subparagraph (A),
partial or total payments on behalf of the individual
on the principal and interest due on the undergraduate
and graduate educational loans of the eligible
individual.
``(2) Eligible individual.--For purposes of this section,
the term `eligible individual' means an individual who--
``(A) is receiving specialized training or clinical
experience in child and adolescent mental health in
psychiatry, psychology, school psychology, psychiatric
nursing, social work, school social work, marriage and
family therapy, school counseling, or professional
counseling and has less than 1 year remaining before
completion of such training or clinical experience; or
``(B)(i) has a license in a State to practice
allopathic medicine, osteopathic medicine, psychology,
school psychology, psychiatric nursing, social work,
school social work, marriage and family therapy, school
counseling, or professional counseling; and
``(ii)(I) is a mental health service professional
who completed (but not before the end of the calendar
year in which this Act is enacted) specialized training
or clinical experience in child and adolescent mental
health described in subparagraph (A); or
``(II) is a physician who graduated from (but not
before the end of the calendar year in which this Act
is enacted) an accredited child and adolescent
psychiatry residency or fellowship program in the
United States.
``(3) Additional eligibility requirements.--The Secretary
may not enter into a contract under this subsection with an
eligible individual unless the individual--
``(A) is a United States citizen or a permanent
legal United States resident; and
``(B) if enrolled in a graduate program (including
a medical residency or fellowship), has an acceptable
level of academic standing (as determined by the
Secretary).
``(4) Priority.--In entering into contracts under this
subsection, the Secretary shall give priority to applicants
who--
``(A) are or will be working with high priority
populations;
``(B) have familiarity with evidence-based methods
in child and adolescent mental health services;
``(C) demonstrate financial need; and
``(D) are or will be working in the publicly funded
sector.
``(5) Meaningful loan repayment.--If the Secretary
determines that funds appropriated for a fiscal year to carry
out this subsection are not sufficient to allow a meaningful
loan repayment to all expected applicants, the Secretary shall
limit the number of contracts entered into under paragraph (1)
to ensure that each such contract provides for a meaningful
loan repayment.
``(6) Amount.--
``(A) Maximum.--For each year that an eligible
individual agrees under a contract under paragraph (1)
to be employed, the Secretary may agree under that
contract to pay not more than $35,000 on behalf of the
individual.
``(B) Consideration.--In determining the amount of
payments to be made on behalf of an eligible individual
under a contract to be entered into under paragraph
(1), the Secretary shall consider the eligible
individual's income and debt load.
``(7) Applicability of certain provisions.--The provisions
of sections 338E and 338F shall apply to the program
established under paragraph (1) to the same extent and in the
same manner as such provisions apply to the National Health
Service Corps Loan Repayment Program established in subpart III
of part D of title III.
``(8) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $10,000,000 for
each of fiscal years 2004 through 2008.
``(b) Scholarships for Students Studying To Become Child and
Adolescent Mental Health Service Professionals.--
``(1) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, may establish a program to award scholarships
on a competitive basis to eligible students (as defined in
paragraph (2)) who agree to enter into full-time employment (as
described in paragraph (4)(C)) as a child and adolescent mental
health service professional after graduation or completion of a
residency or fellowship.
``(2) Eligible student.--For purposes of this subsection,
the term `eligible student' means a United States citizen or a
permanent legal United States resident who--
``(A) is enrolled or accepted to be enrolled in a
graduate program that includes specialized training or
clinical experience in child and adolescent mental
health in psychology, school psychology, psychiatric
nursing, social work, school social work, marriage and
family therapy, school counseling, or professional
counseling; or
``(B) is enrolled or accepted to be enrolled in an
accredited graduate training program of allopathic or
osteopathic medicine in the United States and intends
to complete an accredited residency or fellowship in
child and adolescent psychiatry.
``(3) Priority.--In awarding scholarships under this
subsection, the Secretary shall give--
``(A) highest priority to applicants who previously
received a scholarship under this subsection and
satisfy the criteria described in subparagraph (B); and
``(B) second highest priority to applicants who--
``(i) demonstrate a commitment to working
with high priority populations;
``(ii) have familiarity with evidence-based
methods in child and adolescent mental health
services;
``(iii) demonstrate financial need; and
``(iv) are or will be working in the
publicly funded sector.
``(4) Requirements.--The Secretary may award a scholarship
to an eligible student under this subsection only if the
eligible student agrees--
``(A) to complete any graduate training program,
internship, residency, or fellowship applicable to that
eligible student under paragraph (2);
``(B) to maintain an acceptable level of academic
standing (as determined by the Secretary) during the
completion of such graduate training program,
internship, residency, or fellowship; and
``(C) to be employed full-time after graduation or
completion of a residency or fellowship, for at least
the number of years for which a scholarship is received
by the eligible student under this subsection, in
providing mental health services to children and
adolescents.
``(5) Use of scholarship funds.--A scholarship awarded to
an eligible student for a school year under this subsection may
be used only to pay for tuition expenses of the school year,
other reasonable educational expenses (including fees, books,
and laboratory expenses incurred by the eligible student in the
school year), and reasonable living expenses, as such tuition
expenses, reasonable educational expenses, and reasonable living
expenses are determined by the Secretary.
``(6) Amount.--The amount of a scholarship under this
subsection shall not exceed the total amount of the tuition
expenses, reasonable educational expenses, and reasonable
living expenses described in paragraph (5).
``(7) Applicability of certain provisions.--The provisions
of sections 338E and 338F shall apply to the program
established under paragraph (1) to the same extent and in the
same manner as such provisions apply to the National Health
Service Corps Scholarship Program established in subpart III of
part D of title III.
``(8) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $5,000,000 for
each of fiscal years 2004 through 2008.
``(c) Clinical Training Grants for Professionals.--
``(1) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, in cooperation with the Administrator of the
Substance Abuse and Mental Health Services Administration, may
establish a program to award grants on a competitive basis to
accredited institutions of higher education to establish or
expand internships or other field placement programs for
students receiving specialized training or clinical experience
in child and adolescent mental health in psychiatry,
psychology, school psychology, psychiatric nursing, social
work, school social work, marriage and family therapy, school
counseling, or professional counseling.
``(2) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to applicants that--
``(A) have demonstrated the ability to collect data
on the number of students trained in child and
adolescent mental health and the populations served by
such students after graduation;
``(B) have demonstrated familiarity with evidence-
based methods in child and adolescent mental health
services; and
``(C) have programs designed to increase the number
of professionals serving high priority populations.
``(3) Requirements.--The Secretary may award a grant to an
applicant under this subsection only if the applicant agrees
that--
``(A) any internship or other field placement
program assisted under the grant will prioritize
cultural competency;
``(B) students benefiting from any assistance under
this subsection will be United States citizens or
permanent legal United States residents;
``(C) the institution will provide to the Secretary
such data, assurances, and information as the Secretary
may require; and
``(D) with respect to any violation of the
agreement between the Secretary and the institution,
the institution will pay such liquidated damages as
prescribed by the Secretary by regulation.
``(4) Application.--The Secretary shall require that any
application for a grant under this subsection include a
description of the applicant's experience working with child
and adolescent mental health issues.
``(5) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $10,000,000 for
each of fiscal years 2004 through 2008.
``(d) Progressive Education Grants for Paraprofessionals.--
``(1) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, in cooperation with the Administrator of the
Substance Abuse and Mental Health Services Administration, may
establish a program to award grants on a competitive basis to
State-licensed mental health nonprofit and for-profit
organizations (including accredited institutions of higher
education) to enable such organizations to pay for programs for
preservice or in-service training of paraprofessional child and
adolescent mental health workers.
``(2) Definition.--For purposes of this subsection, the
term `paraprofessional child and adolescent mental health
worker' means an individual who is not a mental health service
professional, but who works at the first stage of contact with
children and families who are seeking mental health services.
``(3) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to applicants that--
``(A) have demonstrated the ability to collect data
on the number of paraprofessional child and adolescent
mental health workers trained by the applicant and the
populations served by these workers after the
completion of the training;
``(B) have familiarity with evidence-based methods
in child and adolescent mental health services; and
``(C) have programs designed to increase the number
of paraprofessional child and adolescent mental health
workers serving high priority populations.
``(4) Requirements.--The Secretary may award a grant to an
organization under this subsection only if the organization
agrees that--
``(A) any training program assisted under the grant
will prioritize cultural competency;
``(B) the organization will provide to the
Secretary such data, assurances, and information as the
Secretary may require; and
``(C) with respect to any violation of the
agreement between the Secretary and the organization,
the organization will pay such liquidated damages as
prescribed by the Secretary by regulation.
``(5) Application.--The Secretary shall require that any
application for a grant under this subsection include a
description of the applicant's experience working with
paraprofessional child and adolescent mental health workers.
``(6) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $5,000,000 for
each of fiscal years 2004 through 2008.
``(e) Child and Adolescent Mental Health Program Development
Grants.--
``(1) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, may establish a program to increase the number
of well-trained child and adolescent mental health service
professionals in the United States by awarding grants on a
competitive basis to accredited institutions of higher
education to enable the institutions to establish or expand
accredited graduate child and adolescent mental health
programs.
``(2) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to applicants that--
``(A) demonstrate familiarity with the use of
evidence-based methods in child and adolescent mental
health services;
``(B) provide experience in and collaboration with
community-based child and adolescent mental health
services;
``(C) have included normal child development
curricula; and
``(D) demonstrate commitment to working with high
priority populations.
``(3) Use of funds.--Funds received as a grant under this
subsection may be used to establish or expand any accredited
graduate child and adolescent mental health program in any
manner deemed appropriate by the Secretary, including by
improving the coursework, related field placements, or faculty
of such program.
``(4) Requirements.--The Secretary may award a grant to an
accredited institution of higher education under this
subsection only if the institution agrees that--
``(A) any child and adolescent mental health
program assisted under the grant will prioritize
cultural competency;
``(B) the institution will provide to the Secretary
such data, assurances, and information as the Secretary
may require; and
``(C) with respect to any violation of the
agreement between the Secretary and the institution,
the institution will pay such liquidated damages as
prescribed by the Secretary by regulation.
``(5) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $15,000,000 for
each of fiscal years 2004 through 2008.
``(f) Definitions.--In this section:
``(1) Specialized training or clinical experience in child
and adolescent mental health.--The term `specialized training
or clinical experience in child and adolescent mental health'
means training and clinical experience that--
(A) is part of or occurs after completion of an
accredited graduate program in the United States for
training mental health service professionals;
(B) consists of at least 500 hours of training or
clinical experience in treating children and
adolescents; and
(C) is comprehensive, coordinated, developmentally
appropriate, and of high quality to address the unique
ethnic and cultural diversity of the United States
population.
``(2) High priority population.--The term `high priority
population' means a population that has a high incidence of
children and adolescents who have serious emotional
disturbances, are racial and ethnic minorities, or live in
urban or rural areas.
``(3) Mental health service professional.--The term `mental
health service professional' means an individual with a
graduate or postgraduate degree from an accredited institution
of higher education in psychiatry, psychology, school
psychology, psychiatric nursing, social work, school social
work, marriage and family counseling, school counseling, or
professional counseling.''.
SEC. 4. AMENDMENTS TO SOCIAL SECURITY ACT TO IMPROVE CHILD AND
ADOLESCENT MENTAL HEALTH CARE.
(a) Increasing Number of Child and Adolescent Psychiatry Residents
Permitted To Be Paid Under the Medicare Graduate Medical Education
Program.--Section 1886(h)(4)(F) of the Social Security Act (42 U.S.C.
1395ww(h)(4)(F)) is amended by adding at the end the following new
clause:
``(iii) Increase allowed for training in
child and adolescent psychiatry.--In applying
clause (i), there shall not be taken into
account such additional number of full-time
equivalent residents in the field of allopathic
or osteopathic medicine who are residents or
fellows in child and adolescent psychiatry as
the Secretary determines reasonable to meet the
need for such physicians as demonstrated by the
1999 report of the Department of Health and
Human Services entitled `Mental Health: A
Report of the Surgeon General'.''.
(b) Extension of Medicare Board Eligibility Period for Residents
and Fellows in Child and Adolescent Psychiatry.--
(1) In general.--Section 1886(h)(5)(G) of the Social
Security Act (42 U.S.C. 1395ww(h)(5)(G)) is amended--
(A) in clause (i), by striking ``and (v)'' and
inserting ``(v), and (vi)''; and
(B) by adding at the end the following new clause:
``(vi) Child and adolescent psychiatry
training programs.--In the case of an
individual enrolled in a child and adolescent
psychiatry residency or fellowship program
approved by the Secretary, the period of board
eligibility and the initial residency period
shall be the period of board eligibility for
the specialty of general psychiatry, plus 2
years for the subspecialty of child and
adolescent psychiatry.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to residency training years beginning on or after
July 1, 2003.
SEC. 5. CHILD MENTAL HEALTH PROFESSIONAL REPORT.
(a) Study.--The Administrator of the Health Resources and Services
Administration (in this section referred to as the ``Administrator'')
shall study and make findings and recommendations on the distribution
and need for child mental health service professionals, including with
respect to specialty certifications, practice characteristics,
professional licensure, practice types, locations, education, and
training.
(b) Disaggregation.--The results of the study required by
subsection (a) shall be disaggregated by State.
(c) Report.--Not later than 1 year after the date of the enactment
of this Act, the Administrator shall submit to the Congress and make
publicly available a report on the study, findings, and recommendations
required by subsection (a).
(d) Revision.--Each year the Administrator shall revise the report
required under subsection (c).
(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2004 through 2008.
SEC. 6. REPORTS.
(a) Transmission.--The Secretary of Health and Human Services shall
transmit a report described in subsection (b) to the Congress--
(1) not later than 3 years after the date of the enactment
of this Act; and
(2) not later than 5 years after the date of the enactment
of this Act.
(b) Contents.--The reports transmitted to the Congress under
subsection (a) shall address each of the following:
(1) The effectiveness of the amendments made by, and the
programs carried out under, this Act in increasing the number
of child and adolescent mental health service professionals and
paraprofessional child and adolescent mental health workers.
(2) The demographics of the individuals served by such
increased number of child and adolescent mental health service
professionals and paraprofessional child and adolescent mental
health workers.
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