Positive Aging Act of 2003

        [Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2241 Introduced in House (IH)]

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.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to State plans submitted under section 1912 of the Public Health
Service Act on or after the date that is 180 days after the date of the
enactment of this Act.
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