,,ii #aaith ,,congress #ast ,session ,s4 #afgc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #h1 #bjbe,mr4 ,merkley 7for himself and ,mrs4 ,hyde-,smith7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to authorize the ,secretary of ,health and ,human ,services to make loans and loan guarantees for planning1 constructing1 or renovating pediatric or adult mental health treatment facilities and pediatric or adult substance use disorder treatment facilities1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,mental ,health ,infrastructure ,improvement ,act of #bjbe4 #b4 ,loans and loan guarantees ,part ,p of title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #cii,v-#g of such ,act 7#db ,u4,s4,c4 #bhj;g-#ah7 the following3 #cii,v-#h4 ,loans and loan guarantees for planning1 constructing1 or renovating eligible facilities for pediatric or adult mental health and substance use disorder services 7a7 ,in general ,the ,secretary may-- 7#a7 make loans and loan guarantees to eligible entities for the purpose of-- 7,a7 constructing or renovating1 including planning the construction or renovation of1 a pediatric or adult mental health treatment facility or a pediatric or adult substance use disorder treatment facility2 7,b7 improving digital infrastructure1 telehealth capabilities1 or other patient care infrastructure at such a facility2 or 7,c7 adding1 or converting beds to1 adult or pediatric psychiatric and substance use inpatient beds at such a facility2 and 7#b7 subject to subsection 7e71 make loans and loan guarantees for refinancing loans that were made for such purpose to an eligible entity4 7b7 ,preference ,in making loans and loan guarantees under this section1 the ,secretary shall give preference to eligible entities proposing to construct or renovate a pediatric or adult mental health treatment facility1 or a pediatric or adult substance use disorder treatment facility1 as determined by the ,secretary1 that will-- 7#a7 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 capacity2 7#b7 provide mental health or substance use disorder services in a high-need rural or underresourced community2 7#c7 provide multiple services across the continuum of mental health or substance use disorder care2 or 7#d7 have the capacity to provide integrated or specialized mental health and substance use disorder care for complex cases or patients with medical co-morbidities4 7c7 ,set-,aside ,the ,secretary shall allocate at least #be percent of the funds under this section for any fiscal year for awards to construct or renovate facilities serving primarily pediatric and adolescent populations4 7d7 ,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 facilities to enhance the public's access to a comprehensive continuum of mental health and substance use disorder 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 determines1 at the ,secretary's discretion1 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 enhancing the public's access to a comprehensive continuum of mental health and substance use disorder services1 including increasing the number of inpatient psychiatric and substance use disorder bed counts in areas with insufficient bed capacity2 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 7e7 ,limitation on refinancing ,the authority vested by subsection 7a77#b7-- 7#a7 authorizes making loans and loan guarantees only for refinancing loans that are entered into on or before the date that is #bd months before the date of enactment of the ,mental ,health ,infrastructure ,improvement ,act of #bjbe2 and 7#b7 terminates on the date that is #bd months after such date of enactment4 7f7 ,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 enforcement 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 7g7 ,definitions ,in this section3 7#a7 ,the term children's hospital means a hospital that predominantly serves patients under the age of #ah4 7#b7 ,the term critical access hospital has the meaning given to such term in section #ahfa7mm7 of the ,social ,security ,act4 7#c7 ,the term eligible entity means public1 private for-profit1 and private not-for-profit-- 7,a7 hospitals including general acute hospitals1 psychiatric hospitals1 critical access hospitals1 rural emergency hospitals1 sole community hospitals1 children's hospitals1 and other hospitals as specified by the ,secretary2 7,b7 substance use disorder treatment facilities2 7,c7 mental health treatment facilities2 7,d7 facilities that employ licensed mental health and substance use disorder professionals1 such as child1 adolescent1 and adult psychiatrists1 child1 adolescent1 and adult psychologists1 advanced practice registered nurses1 social workers1 licensed professional counselors1 or other licensed professionals that provide mental health or substance use disorder services to pediatric1 adolescent1 or adult patients2 7,e7 alliances of hospitals or facilities listed in any of subparagraphs 7,a7 through 7,d72 and 7,f7 other facilities as determined by the ,secretary4 7#d7 ,the term mental health treatment facility-- 7,a7 includes-- 7i7 a child1 adolescent1 or adult outpatient facility that provides-- 7,i7 intensive outpatient services2 7,,ii7 partial hospitalization services2 7,,iii7 crisis intervention and stabilization2 or 7,,iv7 other mental1 behavioral1 or emotional health services deemed appropriate by the ,secretary2 7ii7 a hospital 7including a general acute hospital1 a psychiatric hospital1 a critical access hospital1 a rural emergency hospital1 a sole community hospital1 a children's hospital1 or other type of hospital as specified by the ,secretary7 that-- 7,i7 provides acute1 short-term inpatient psychiatric treatment services or outpatient services2 and 7,,ii7 may include a military services program to meet the needs of active and retired military servicemembers2 and 7iii7 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 setting2 and 7,b7 excludes a facility that provides long-term inpatient care4 7#e7 ,the term psychiatric hospital has the meaning given to such term in section #ahfa7;f7 of the ,social ,security ,act4 7#f7 ,the term rural emergency hospital has the meaning given to such term in section #ahfa7kkk7 of the ,social ,security ,act4 7#g7 ,the term sole community hospital has the meaning given to such term in section #ahhf7;d77#e77;,d77iii7 of the ,social ,security ,act4 7#h7 ,the term substance use disorder treatment facility-- 7,a7 includes-- 7i7 a child1 adolescent1 or adult outpatient facility that provides outpatient substance use disorder services2 and 7ii7 a hospital 7including a general acute hospital1 a psychiatric hospital1 a critical access hospital1 a rural emergency hospital1 a sole community hospital1 a children's hospital1 or other type of hospital as specified by the ,secretary7 that-- 7,i7 provides acute1 short-term inpatient substance use disorder treatment services or outpatient services2 and 7,,ii7 may include a military services program to meet the needs of active and retired military servicemembers2 and 7,b7 excludes any facility described in paragraph 7#d77;,b74 7h7 ,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 for each of fiscal years #bjbf through #bjcj4 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-#h 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