No official summary available for this bill.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5804 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 5804
To authorize the Secretary of Health and Human Services to make loans
and loan guarantees for planning, constructing, or renovating pediatric
or adult mental health treatment facilities and pediatric or adult
substance use disorder treatment facilities, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 28, 2023
Mr. Kilmer (for himself and Mr. Bacon) 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 planning, constructing, or renovating pediatric
or adult mental health treatment facilities and pediatric or adult
substance use disorder 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 Infrastructure
Improvement Act of 2023''.
SEC. 2. LOANS AND LOAN GUARANTEES.
Part P of title III of the Public Health Service Act is amended by
inserting after section 399V-7 of such Act (42 U.S.C. 280g-17) the
following:
``SEC. 399V-8. LOANS AND LOAN GUARANTEES FOR PLANNING, CONSTRUCTING, OR
RENOVATING ELIGIBLE FACILITIES FOR PEDIATRIC OR ADULT
MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES.
``(a) In General.--The Secretary may--
``(1) make loans and loan guarantees to eligible entities
for the purpose of--
``(A) constructing or renovating, including
planning the construction or renovation of, a pediatric
or adult mental health treatment facility or a
pediatric or adult substance use disorder treatment
facility;
``(B) improving digital infrastructure, telehealth
capabilities, or other patient care infrastructure at
such a facility; or
``(C) adding, or converting beds to, adult or
pediatric psychiatric and substance use inpatient beds
at such a facility; and
``(2) subject to subsection (e), make loans and loan
guarantees for refinancing loans that were made for such
purpose to an eligible entity.
``(b) Preference.--In making loans and loan guarantees under this
section, the Secretary shall give preference to eligible entities
proposing to construct or renovate a pediatric or adult mental health
treatment facility, or a pediatric or adult substance use disorder
treatment facility, that will--
``(1) increase the number of pediatric or adult psychiatric
beds or pediatric or adult substance use disorder beds in a
county that has insufficient psychiatric or substance use
disorder treatment bed capacity;
``(2) provide mental health or substance use disorder
services in a high-need rural or underresourced community;
``(3) provide multiple services across the continuum of
mental health or substance use disorder care; or
``(4) have the capacity to provide integrated or
specialized mental health and substance use disorder care for
complex cases or patients with medical co-morbidities.
``(c) Set-Aside.--The Secretary shall allocate at least 25 percent
of the funds under this section for any fiscal year for awards to
construct or renovate facilities serving primarily pediatric
populations.
``(d) 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
facilities to enhance the public's access to a
comprehensive continuum of mental health and substance
use disorder 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 enhancing
the public's access to a comprehensive continuum of
mental health and substance use disorder services,
including increasing the number of inpatient
psychiatric and substance use disorder bed counts in
areas with insufficient bed capacity;
``(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.
``(e) Limitation on Refinancing.--The authority vested by
subsection (a)(2)--
``(1) authorizes making loans and loan guarantees only for
refinancing loans that are entered into on or before the date
that is 24 months before the date of enactment of the Mental
Health Infrastructure Improvement Act of 2023; and
``(2) terminates on the date that is 24 months after such
date of enactment.
``(f) 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.
``(g) Definitions.--In this section:
``(1) The term `children's hospital' means a hospital that
predominantly serves patients under the age of 18.
``(2) The term `critical access hospital' has the meaning
given to such term in section 1861(mm) of the Social Security
Act.
``(3) The term `eligible entity' includes public, private
for-profit, and private not-for-profit--
``(A) hospitals including general acute hospitals,
psychiatric hospitals, critical access hospitals, rural
emergency hospitals, sole community hospitals,
children's hospitals, and other hospitals as specified
by the Secretary;
``(B) substance use disorder treatment facilities;
``(C) mental health treatment facilities;
``(D) facilities that employ licensed mental health
and substance use disorder professionals, such as child
and adult psychiatrists, child and adult psychologists,
advanced practice nurses, social workers, licensed
professional counselors, or other licensed
professionals that provide mental health or substance
use disorder services to pediatric or adult patients;
``(E) alliances of hospitals or facilities listed
in any of clauses (i), (ii), (iii), (iv), and (vi); and
``(F) other facilities as determined by the
Secretary.
``(4) The term `mental health treatment facility'--
``(A) includes--
``(i) a child or adult outpatient facility
that provides--
``(I) intensive outpatient
services;
``(II) partial hospitalization
services;
``(III) crisis intervention and
stabilization; or
``(IV) other mental, behavioral, or
emotional health services deemed
appropriate by the Secretary;
``(ii) a hospital (including a general
acute hospital, a psychiatric hospital, a
critical access hospital, a rural emergency
hospital, a sole community hospital, a
children's hospital, or other type of hospital
as specified by the Secretary) that--
``(I) provides acute, short-term
inpatient psychiatric treatment
services or outpatient services; and
``(II) may include a military
services program to meet the needs of
active and retired military
servicemembers; and
``(iii) a facility within or near an
emergency department for providing discharge
planning and instructions to emergency
department patients in need of mental health or
substance use disorder treatment and transfer
to an appropriate mental health or substance
use disorder treatment care setting; and
``(B) excludes a facility that provide long-term
inpatient care.
``(5) The term `substance use disorder treatment
facility'--
``(A) includes--
``(i) a child or adult outpatient facility
that provides outpatient substance use disorder
services; and
``(ii) a hospital (including a general
acute hospital, a psychiatric hospital, a
critical access hospital, a rural emergency
hospital, a sole community hospital, a
children's hospital, or other type of hospital
as specified by the Secretary) that--
``(I) provides acute, short-term
inpatient substance use disorder
treatment services or outpatient
services; and
``(II) 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).
``(6) The term `psychiatric hospital' has the meaning given
to such term in section 1861(f) of the Social Security Act.
``(7) The term `rural emergency hospital' has the meaning
given to such term in section 1861(kkk) of the Social Security
Act.
``(8) The term `sole community hospital' has the meaning
given to such term in section 1886(d)(5)(D)(iii) of the Social
Security Act.
``(h) 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 for each of
fiscal years 2024 through 2028.''.
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.).
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line