,i #aadth ,,congress #b;d ,session ,h4 ,r4 #feab ,,in ,,the ,,house ,,of ,,representatives ,december #h1 #bjaf,mr4 ,kilmer 7for himself1 ,ms4 ,herrera ,beutler1 and ,mr4 ,murphy of ,pennsylvania7 introduced the following bill2 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 constructing or renovating1 or planning construction or renovation of1 qualified psychiatric and substance abuse treatment facilities1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,mental ,health and ,substance ,abuse ,treatment ,accessibility ,act of #bjaf4 #b4 ,loans and loan guarantees ,part ,p of title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #cii,v-#f of such ,act 7#ba ,u4,s4,c4 #cee;f7 the following3 #cii,v-#g4 ,loans and loan guarantees for constructing or renovating1 or planning construction or renovation of1 certain qualified psychiatric and substance abuse treatment facilities 7a7 ,in general ,the ,secretary may make loans and loan guarantees for constructing or renovating1 including planning the construction or renovation of1 a qualified psychiatric treatment facility or a qualified substance abuse treatment facility to public1 private for-profit1 or private not-for-profit-- 7#a7 psychiatric treatment facilities2 7#b7 substance abuse treatment facilities2 7#c7 psychiatric hospitals2 and 7#d7 alliances of such facilities or hospitals4 7b7 ,preference ,in making loans and loan guarantees under this section1 the ,secretary shall give preference to psychiatric treatment facilities and substance abuse treatment facilities that propose to construct or renovate a qualified psychiatric treatment facility or qualified substance abuse treatment facility in a county that has insufficient inpatient psychiatric or substance abuse treatment capacity4 7c7 ,terms and conditions ,loans and loan guarantees under this section shall be made on such terms and conditions as the ,secretary may prescribe1 subject to the provisions of this section including the following3 7#a7 ,the ,secretary may allow credit to a prospective borrower only where-- 7,a7 it is necessary to increase the number of psychiatric or substance use disorder treatment beds to enhance the public's access to acute inpatient mental health and substance abuse services2 and 7,b7 a credit subsidy is the most efficient way to achieve such increase 7on a borrower-by-borrower basis74 7#b7 ,the final maturity of loans made or guaranteed under this section shall not exceed a period of #bj years1 or the period of #ej percent of the useful life of any physical asset to be financed by the loan1 whichever is less as determined by the ,secretary4 7#c7 ,the ,secretary may not make a loan guarantee under this section1 with respect to any borrower1 in excess of #hj percent of any potential loss on the loan4 7#d7 ,the ,secretary may not make any loan or loan guarantee under this section if the loan will be subordinated-- 7,a7 to another debt contracted by the borrower2 or 7,b7 to any other claims against the borrower in the case of default4 7#e7 ,the ,secretary may not make any loan guarantee under this section unless the ,secretary determines that-- 7,a7 the lender is responsible2 and 7,b7 adequate provision is made for servicing the loan on reasonable terms and protecting the financial interest of the ,united ,states4 7#f7 ,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 #a of the ,internal ,revenue ,code of #aihf4 7#g7 ,the ,secretary may not make any loan or loan guarantee under this section unless-- 7,a7 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 guaranteed2 and 7,b7 the minimum interest rate on the loan-- 7i7 will be no less than the estimated cost to the ,government of making the loan plus #a percent1 with the goal of keeping the interest rate below the interest rate of a comparable and competitive private sector benchmark financial instrument2 and 7ii7 will be adjusted1 as determined by the ,secretary1 every quarter to take account of changes in the interest rate of the benchmark financial instrument4 7#h7 ,the ,secretary may not make any loan or loan guarantee under this section unless-- 7,a7 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 7as defined in section #ejb7e7 of the ,federal ,credit ,reform ,act of #aiij7 of insuring such loan or loan guarantee1 while supporting achievement of increasing the inpatient psychiatric and substance abuse bed count1 as applicable1 to enhance the public's access to acute inpatient mental health and substance abuse services2 7,b7 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 claims1 plus one percent2 and 7,c7 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 7,b7 based on the most recent estimates of such costs4 7#i7 ,the provisions of any loan guarantee under this section shall state that the guarantee is conclusive evidence that-- 7,a7 the guarantee has been properly obtained2 7,b7 the underlying loan qualified for the guarantee2 and 7,c7 except in the case of fraud or material misrepresentation by the holder of the loan1 the guarantee will be presumed to be valid1 legal1 and enforceable4 7#aj7 ,the ,secretary may not make any loan or loan guarantee under this section unless-- 7,a7 the borrower finances at least #be percent of the funded project from other sources2 and 7,b7 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 section4 7#aa7 ,the ,secretary-- 7,a7 shall prescribe explicit standards for use in periodically assessing the credit risk of new and existing direct loans and guaranteed loans2 and 7,b7 shall not make a loan or loan guarantee under this section unless the ,secretary finds that there is a reasonable assurance of repayment4 7d7 ,payment of losses 7#a7 ,default on guaranteed loans ,if1 as a result of a default by a borrower under a loan guaranteed under this section1 after the holder thereof has made such further collection efforts and instituted such enforcement proceedings as the ,secretary may require1 the ,secretary determines that the holder has suffered a loss-- 7,a7 the ,secretary shall pay to such holder #ge percent of such loss1 as specified in the guarantee contract2 7,b7 upon making any such payment1 the ,secretary shall be subrogated to all the rights of the recipient of the payment2 and 7,c7 the ,secretary shall be entitled to recover from the borrower the amount of any payments made pursuant to the guarantee contract4 7#b7 ,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 section4 7#c7 ,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 ,secretary1 provided that budget authority for any resulting cost to the ,government 7as defined in section #ejb7e7 of the ,federal ,credit ,reform ,act of #aiij7 is available4 7e7 ,definitions ,in this section3 7#a7 ,the term qualified psychiatric treatment facility-- 7,a7 means a psychiatric hospital 7or other qualified treatment facility1 as determined appropriate by the ,secretary7 that is able to serve patients ages #ba and older that-- 7i7 will provide acute1 short-term inpatient psychiatric treatment services for such patients2 7ii7 will provide outpatient services2 and 7iii7 may include a military services program to meet the needs of active and retired military service members2 and 7,b7 excludes a facility that-- 7i7 provides long-term inpatient care2 7ii7 is a health center 7as defined in section #ccj72 and 7iii7 is part of or affiliated with a prison 7as defined in section #bbdf of title #ah1 ,united ,states ,code74 7#b7 ,the term qualified substance abuse treatment facility-- 7,a7 means a psychiatric hospital 7or other qualified treatment facility1 as determined appropriate by the ,secretary7 that is able to serve patients ages #ba and older that-- 7i7 will provide acute1 short-term inpatient substance abuse treatment services for such patients2 7ii7 will provide outpatient services2 and 7iii7 may include a military services program to meet the needs of active and retired military service members2 and 7,b7 excludes any facility described in paragraph 7#a77;,b74 7#c7 ,the term psychiatric hospital means-- 7,a7 an institution that-- 7i7 is primarily engaged in providing1 by or under the supervision of one or more physicians1 psychiatric services for the diagnosis and treatment of mentally ill persons or those suffering from substance abuse disorders2 7ii7 satisfies the requirements of paragraphs 7#c7 through 7#i7 of subsection 7e7 of section #ahfa of the ,social ,security ,act2 7iii7 maintains clinical records on all patients and maintains such records as the ,secretary finds to be necessary to determine the degree and intensity of the treatment provided to individuals entitled to hospital insurance benefits under part ,a of title ,,xviii of the ,social ,security ,act2 and 7iv7 meets such staffing requirements as the ,secretary finds necessary for the institution to carry out an active program of treatment for individuals who are furnished services in the institution2 or 7,b7 a distinct part of an institution that satisfies clauses 7i7 and 7ii7 of subparagraph 7,a7 if such distinct part satisfies clauses 7iii7 and 7iv7 of subparagraph 7,a74 7f7 ,funding limitations ,the ,secretary may provide loans and loan guarantees under this section-- 7#a7 only to the extent or in the amounts provided in advance in appropriation ,acts2 and 7#b7 totaling not more than #bjj1jjj1jjj in each of fiscal years #bjah through #bjbb4 4 #c4 ,mental ,health and ,substance ,use ,treatment ,trust ,fund 7a7 ,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 7in this section referred to as the ,trust ,fund74 7b7 ,deposits ,there are hereby authorized to be appropriated to the ,trust ,fund1 to remain available until expended1 amounts equivalent to any revenues from the program of loans and loan guarantees under section #cii,v-#g of the ,public ,health ,service ,act1 as added by section #b1 that exceed the costs of carrying out such program4 7c7 ,use of fund ,amounts in the ,trust ,fund shall be available1 as provided by appropriation ,acts1 for block grants for community mental health services under subpart ,i of part ,b of title ,,xix of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx et seq474 #d4 ,sense of ,congress ,it is the sense of ,congress that reversing the ,federal policy of denying ,federal financial participation under the ,medicaid program for care and services for patients in an institution for mental diseases is critically important to improving access to mental health care services and treatment4