Keeping Families Together Act - Amends the Public Health Service Act to direct the Secretary of Health and Human Services to award competitive grants to States to establish systems of individualized mental health treatment and family support services for children who are in custody or in danger of entering the custody of the state for the purpose of receiving mental health services.
Requires eligible States to: (1) have laws or policies in effect that ensure that children receive appropriate mental health services so that parents do not have to relinquish legal custody of such children; (2) provide matching funds; (3) establish infrastructure for interagency cooperation and cross system financing; and (4) expand public health insurance programs to cover these services after the grant expires.
Establishes a Federal interagency task force to examine mental health issues in the child welfare and juvenile justice systems and the role of their agencies in promoting access by children and youth to mental health services.
Amends the Social Security Act to permit the use of the Medicaid home and community-based services waiver to provide mental health services to children and youths as an alternative to care in inpatient psychiatric hospitals.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3243 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 3243
To amend the Public Health Service Act to establish a State family
support grant program to end the practice of parents giving legal
custody of their seriously emotionally disturbed children to State
agencies for the purpose of obtaining mental health services for those
children.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 2, 2003
Mr. Ramstad (for himself, Mr. Norwood, Mr. Bachus, Mr. Kennedy of Rhode
Island, Mr. Stark, Mr. Pickering, Mr. Castle, and Mrs. Johnson of
Connecticut) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to establish a State family
support grant program to end the practice of parents giving legal
custody of their seriously emotionally disturbed children to State
agencies for the purpose of obtaining mental health services for those
children.
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 ``Keeping Families Together Act''.
SEC. 2. PURPOSE.
It is the purpose of this Act to assist States in eliminating the
practice of parents giving custody of their seriously emotionally
disturbed children to State agencies for the purpose of securing mental
health care for those children.
SEC. 3. FAMILY SUPPORT GRANTS.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended--
(1) by redesignating the second part G (relating to
services provided through religious organizations) as part J;
(2) by redesignating sections 581 through 584 of part J (as
so redesignated) as sections 596 through 596C, respectively;
and
(3) by adding at the end the following:
``Part K--Family Support
``SEC. 597. FAMILY SUPPORT GRANTS.
``(a) In General.--The Secretary, acting through the Administrator
and in consultation with the task force established under section 597A,
is authorized to award competitive grants to States to enable such
States to establish systems of care to treat and provide services to
all eligible children and youth. The Secretary shall ensure that the
amount awarded to each grantee is sufficient to enable the grantee to
accomplish the purposes of the grant.
``(b) Eligibility.--To be eligible for a grant under subsection (a)
a State shall--
``(1) have laws or policies in effect to ensure that
children receive appropriate mental health services so that
parents do not have to relinquish legal custody of such
children;
``(2) submit to the Secretary an application from the
Governor in accordance with subsection (c);
``(3) provide assurances that the State will provide
matching funds in accordance with subsection (e); and
``(4) meet such other requirements as the Secretary
determines appropriate.
``(c) Application.--
``(1) In general.--An application submitted for a grant
under this section shall include--
``(A) a brief description of the system of care
that the State intends to establish with amounts
received under the grant to ensure that eligible
children and youth and their families receive the
appropriate individualized mental health treatment and
family support services necessary to keep such families
together;
``(B) a description of the process by which the
State will formulate a State plan that meets the
requirements of paragraph (2), including participants,
timelines, and any previous or ongoing efforts related
to the establishment of a statewide system.
``(C) an estimate of the number of eligible
children and youth in the State, and the number of
eligible children and youth who will be served under
the grant;
``(D) a description of existing systems of care in
the State (including systems funded under section 561)
and existing interagency collaboration that
demonstrates a foundation on which the State can build
a system of care under a grant under this section;
``(E) a brief description of the manner in which
services for all eligible children and youth are
expected to be funded under the system established by
the State under the grant;
``(F) a description of children's mental health
services capacity in the State and the steps that will
be taken, if necessary, to ensure that adequate
capacity exists to implement the proposed system of
care;
``(G) a description of the source of the State
matching funds; and
``(H) other information as required by the
Secretary.
``(2) State plan.--Prior to receiving funds under the grant
for the second grant year, a State shall submit to the
Secretary and the Secretary shall approve, a State plan that--
``(A) is developed through a collaborative process
that includes the required State partners as
represented by senior officials with policymaking
authority, the required private partners, and other
entities that the governor of the State determines
appropriate;
``(B) contains a description and assessment of the
effectiveness of the laws or policies that the State
has in effect to ensure that children receive
appropriate mental health services and that parents do
not have to relinquish legal custody of such children
in order to obtain such services;
``(C) contains a description of the services to be
provided to eligible children and youth and the sources
of such services, including the extent to which the State will build
upon existing systems of care within the State;
``(D) contains a description of the procedures to
be implemented for the early identification,
assessment, and referral, by health care providers,
mental health agencies, other child-serving entities,
child welfare, corrections, and juvenile justice
systems, of all eligible children and youth for
appropriate care and for coordinating services among
child welfare, juvenile justice, and child mental
health agencies, including co-location of services as
appropriate;
``(E) describes any legislative changes that are
required to implement the State plan;
``(F) describes how the State screens children and
youth entering the juvenile justice and child welfare
systems for mental health problems, including the
State's mental health screening procedures as part of
the early and periodic screening, diagnostic, and
treatment services described in section 1905(r) of the
Social Security Act that are provided under the
medicaid programs;
``(G) contains a description of the plan of the
State for ensuring that there will be adequate capacity
to serve all eligible children;
``(H) contains a description of the plan of the
State for financing the system of care developed under
the grant, including--
``(i) the manner in which the State will
use--
``(I) contributions from State
agencies;
``(II) State eligibility options or
waivers authorized with respect to the
State medicaid program such as those
authorized under sections 1902(e)(3)
and 1915(c) of the Social Security Act;
``(III) the State Children's Health
Insurance Program under title XXI of
the Social Security Act (including an
assurance that grant funds will not be
used as a State match under the
medicaid or SCHIP programs); and
``(IV) other public health
insurance mechanisms; and
``(ii) how Federal grant dollars will be
used to enable the State to achieve a
sustainable system of care to serve all
eligible children and youth;
``(I) contains a description of how the State will
provide outreach services to families, provide for
public educational activities, and involve families;
and
``(J) establishes a method for tracking and
reporting the number of children and youth entering
child welfare and juvenile justice systems with
significant mental health problems.
``(3) Priority.--In awarding grants under this section, the
Secretary shall give priority to States--
``(A) that have a history of developing and
supporting local or statewide systems care and of
successful interagency collaboration;
``(B) that have taken steps to broaden access to
community-based services for children with serious
emotional disturbances;
``(C) that have provided reasonable estimates of
the numbers of eligible children and youth;
``(D) that have sufficient mental health service
capacity or specific plans for sufficiently increasing
mental health services capacity to successfully
implement the proposed system of care;
``(E) in which the governor's office will play a
leading role in the formulation of the State plan
required under paragraph (2); and
``(F) that will involve State juvenile and family
court judges in the planning and oversight of the
system of care.
``(d) Use of Funds.--A State shall use amounts received under a
grant under this section to--
``(1) establish State- and local-level infrastructure to
allow for interagency cooperation and cross system financing
to--
``(A) support the purchase and delivery of a
comprehensive array of community-based mental health
and family support services to all eligible children
and youth and their families;
``(B) decrease categorical funding structures and
eliminate inter-agency fragmentation of services; and
``(C) increase the capacity of agencies to share
public resources and improve parental access to
services for children with mental health needs to
eliminate the need to relinquish custody in order to
receive treatment;
``(2) expand public health insurance programs to cover a
comprehensive array of community-based mental health and family
support services for eligible children and youth and their
families that will be sustainable after the grant has expired;
``(3) deliver mental health care and family support
services to eligible children and youth and their families as
part of a transition to a sustainable system of care for such
children and youth;
``(4) provide outreach and public education concerning
programs and activities funded under this section;
``(5) provide training and professional development for
personnel who work with eligible children and youth as required
to successfully implement the State plan; and
``(6) carry out other administrative activities related to
the programs and activities carried out under the grant,
including the development and maintenance of data systems.
``(e) Matching Funds.--
``(1) In general.--A State that receives a grant under this
section shall, with respect to the costs to be incurred by the
State in carrying out the purpose for which the grant is awarded, make
available non-Federal contributions toward such costs in an amount
that--
``(A) for the third fiscal year for which the
entity receives payments from a grant under such
subsection, is not less than $1 for each $2 of Federal
funds provided in the grant;
``(B) for the fourth such fiscal year, is not less
than $1 for each $1 of Federal funds provided in the
grant; and
``(C) for the fifth and sixth such fiscal years, is
not less than $2 for each $1 of Federal funds provided
in the grant.
``(2) Determination of amount contributed.--Non-Federal
contributions required in paragraph (1) may be in cash or in
kind, fairly evaluated, including plant, equipment, or
services. Amounts provided by the Federal Government, or
services assisted or subsidized to any significant extent by
the Federal Government, may not be included in determining the
amount of such non-Federal contributions.
``(3) Accounting required.--With respect to a State that
complies with the requirement of paragraph (2) through the
provision of in-kind contributions, such State shall provide
the Secretary with an accounting that describes the value of
such in-kind contributions.
``(f) Limitation on Use for Administrative Costs.--Not more than 5
percent of the amount that a State receives under a grant under this
section shall be used for administrative costs.
``(g) Payments.--Grants under this section shall be payable over a
6-year period.
``(h) Reporting Requirements.--
``(1) In general.--Secretary, acting through the
Administrator and in consultation with the task force
established under section 597A, shall require States to report
information that is appropriate to permit an assessment to be
made of the success of States in the implementation of programs
under this section. Such information shall, at a minimum,
include--
``(A) the number of eligible children and youth in
foster care;
``(B) the number of eligible children and youth in
residential treatment centers;
``(C) appropriate information concerning the
participation and academic progress of eligible
children and youth in school;
``(D) measures of the contacts of eligible children
and youth with juvenile justice systems;
``(E) measures of the clinical improvement of
eligible children and youth; and
``(F) information concerning the level of
satisfaction of eligible children and youth and their
families with services received.
``(2) Annual report by states.--Beginning with the second
fiscal year in which a State receives funding under a grant
under this section, the State shall annually report to the
Secretary on the success of the programs and activities carried
out by the State under the grant. Such reports shall include
the information specified in paragraph (1) and other
information required by the Secretary.
``(3) Reports by the secretary.--
``(A) In general.--Not later than 3 years after the
date of enactment of this part, the Secretary shall
submit to Congress a report on the success of States in
using grants under this section to eliminate children
and youth custody relinquishment solely to obtain
mental health care. Such report shall include
recommendations to strengthen the program under this
section.
``(B) Final report.--Not later than 6 years after
the date of enactment of this part, the Secretary shall
submit to Congress a final report on the success of
States in using grants under this section to eliminate
children and youth custody relinquishment solely to
obtain mental health care.
``(i) Technical Assistance.--The Secretary, in consultation with
the task force established under section 597A, may provide technical
assistance to States in carrying out programs and activities under this
section. The Secretary shall use not more than 20 percent of the amount
appropriate for each fiscal year, not to exceed $5,000,000 in any such
fiscal year, to carry out this subsection and shall coordinate
technical assistance under this section with other technical assistance
programs as appropriate.
``(j) Definitions.--In this section:
``(1) Eligible children and youth.--The term `eligible
children and youth' means children and youth under the age of
21 years who are in the custody of the State for the purpose of
receiving mental health services or at-risk of entering into
the custody of the State for the purpose of receiving mental
health services.
``(2) Family support services.--The term `family support
services' means individualized services that are designed with
input from the family and provided to eligible children and
youth and their families to promote the mental health of an
eligible child or youth, to strengthen the ability of family
members to care for an eligible child or youth, or to enable an
eligible child or youth to take advantage of other treatment
and family support services.
``(3) Required private partners.--The term `required
private partners' includes--
``(A) representatives of families of seriously
emotionally disturbed children;
``(B) representatives of mental health care
providers;
``(C) representatives of private health insurers;
and
``(D) representatives of hospitals and residential
care facilities.
``(4) Required state partners.--The term `required State
partners' with respect to a State includes--
``(A) the State agency responsible for children's
mental health;
``(B) the State child welfare agency;
``(C) the State juvenile justice agency;
``(D) the State Medicaid agency;
``(E) the State education agency;
``(F) the State substance abuse agency;
``(G) the State bureau of insurance; and
``(H) the office of the Governor of the State.
``(5) State.--The term `State' includes, in addition to the
several States, the District of Columbia, the Commonwealth of
Puerto Rico, the Commonwealth of the Northern Mariana Islands,
the Virgin Islands, Guam, American Samoa, the Trust Territory
of the Pacific Islands, and Indian tribes.
``(k) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $4,500,000 for fiscal year
2004, $6,500,000 for fiscal year 2005, and $11,000,000 for each of each
of fiscal years 2006 through 2009.
``SEC. 597A. TASK FORCE.
``(a) Establishment.--The Administrator, in conjunction with the
Director of the Office of Juvenile Justice and Delinquency Prevention,
the Administrator of the Administration for Children and Families, the
Administrator of the Centers for Medicare & Medicaid Services, and the
Assistant Secretary of Education for Special Education, shall establish
and staff a task force to examine problems of mental health in the
child welfare and juvenile justice systems and issues with respect to
access by children and youth to mental health services, and the role of
their agencies in promoting access by children and youth to mental
health services.
``(b) Duties.--The task force established under subsection (a)
shall--
``(1) work with mental health and child advocates,
representatives of families of eligible children and youth, and
representatives of State systems of care to make
recommendations to Congress concerning strategies to improve
the delivery of mental health services, including prevention
services, to children and youth with serious emotional
disturbances, including those who are at risk of dropping out
of school or at-risk of coming in contact with child welfare
and juvenile justice systems;
``(2) work with mental health and child advocates,
representatives of families of eligible children and youth, and
representatives of State systems of care to develop improved
reporting requirements for States concerning the number of
children and youth entering child welfare and juvenile justice
systems solely to access mental health services;
``(3) in consultation with States and appropriate
stakeholders, create standard definitions for the categories of
data to be collected on such children and youth;
``(4) foster interagency cooperation to eliminate the
practice of custody relinquishment;
``(5) provide advice to the Administrator in implementation
of the family support grant programs under section 597;
``(6) coordinate and deliver technical assistance to States
and State agencies to help implement programs under such grant
program;
``(7) make recommendations to break down barriers to
coordination in existing Federal programs and to allow for more
effective integration across agencies and programs; and
``(8) provide a biannual report to Congress on its
recommendations and its progress in carrying out its duties,
ending the practice of parents relinquishing legal custody of
their children with serious emotional disturbances in order to
obtain mental health services, and improving the delivery of
mental health services to children with serious emotional
disturbances.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $1,000,000 for each of fiscal
years 2004 through 2009. Of the amount appropriate for each fiscal year
under this subsection, 60 percent of such amount shall be made
available to the Secretary, 20 percent of such amount shall be made
available to the Attorney General, and 20 percent of such amount shall
be made available to the Secretary of Education.''.
SEC. 4. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR
INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED
SERVICES WAIVERS.
(a) In General.--Section 1915(c) of the Social Security Act (42
U.S.C. 1396n(c)) is amended--
(1) in paragraph (1)--
(A) in the first sentence, by inserting ``, or
would require inpatient psychiatric hospital services
for individuals under age 21,'' after ``intermediate
care facility for the mentally retarded''; and
(B) in the second sentence, by inserting ``, or
would require inpatient psychiatric hospital services
for individuals under age 21'' before the period;
(2) in paragraph (2)(B), by striking ``or services in an
intermediate care facility for the mentally retarded'' each
place it appears and inserting ``services in an intermediate
care facility for the mentally retarded, or inpatient
psychiatric hospital services for individuals under age 21'';
(3) in paragraph (2)(C)--
(A) by inserting ``, or who are determined to be
likely to require inpatient psychiatric hospital
services for individuals under age 21,'' after ``, or
intermediate care facility for the mentally retarded'';
and
(B) by striking ``or services in an intermediate
care facility for the mentally retarded'' and inserting
``services in an intermediate care facility for the
mentally retarded, or inpatient psychiatric hospital
services for individuals under age 21''; and
(4) in paragraph (7)(A)--
(A) by inserting ``or would require inpatient
psychiatric hospital services for individuals under age
21,'' after ``intermediate care facility for the
mentally retarded,''; and
(B) by inserting ``or who would require inpatient
psychiatric hospital services for individuals under age
21'' before the period.
(b) Effective Date.--The amendments made by subsection (a) apply
with respect to medical assistance provided on or after January 1,
2004.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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