119-hr2223

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2223 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 2223

To authorize the Secretary of Health and Human Services to make loans, 
loan guarantees, and grants for purchasing, 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

 March 18, 2025

Ms. Salinas (for herself and Ms. Balint) 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, 
loan guarantees, and grants for purchasing, 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 ``Building Capacity for Care Act''.

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, LOAN GUARANTEES, AND GRANTS FOR PURCHASING, 
 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, loan guarantees, or grants to eligible 
 entities for the purpose of--
 ``
        (A) purchasing, constructing, or renovating, 
 including planning the purchase, 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, 
 adolescent, or pediatric psychiatric and substance use 
 inpatient beds at such a facility; and
 ``

    (2) subject to subsection

    (f) , make loans and loan 
 guarantees for refinancing loans that were made for such 
 purpose to an eligible entity.
 ``

    (b) Eligible Entities.--An entity shall be eligible to receive a 
loan, loan guarantee, or grant under this section if--
 ``

    (1) such entity is a public, private for-profit, and 
 private not-for-profit--
 ``
        (A) hospital, including a general acute hospital, 
 psychiatric hospital, critical access hospital, rural 
 emergency hospital, sole community hospital, children's 
 hospital, or other hospital as specified by the 
 Secretary;
 ``
        (B) substance use disorder treatment facility;
 ``
            (C) mental health treatment facility;
 ``
            (D) facility that employs 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) alliance of hospitals or facilities listed in 
 any of subparagraphs
        (A) ,
        (B) ,
            (C) , or
            (D) ; and
 ``
        (F) health care facility, as determined by the 
 Secretary; and
 ``

    (2) such entity proposes to purchase, construct, or 
 renovate a pediatric or adult mental health treatment facility, 
 or a pediatric or adult substance use disorder treatment 
 facility, that will--
 ``
        (A) increase the number of pediatric, adolescent, 
 or adult psychiatric beds or pediatric, adolescent, or 
 adult substance use disorder beds in a county that has 
 insufficient psychiatric or substance use disorder 
 treatment bed capacity;
 ``
        (B) provide mental health or substance use 
 disorder services in a high-need rural or 
 underresourced community;
 ``
            (C) provide multiple services across the 
 continuum of mental health or substance use disorder 
 care; or
 ``
            (D) 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) Application.--An eligible entity seeking a loan, loan 
guarantee, or grant under this section shall submit to the Secretary an 
application at such time and in such manner as the Secretary may 
specify. Such application shall contain the proposal of the entity to 
purchase, construct, or renovate a pediatric or adult mental health 
treatment facility, or a pediatric or adult substance use disorder 
treatment facility (as described in subsection

    (b)

    (2) ) and such other 
information as the Secretary may specify.
 ``
            (d) Geographic Preference for Grants.--In making grants under 
this section, the Secretary shall give preference to eligible entities 
located in--
 ``

    (1) a mental health professional shortage area, as 
 designated under 

section 332;
 ``

    (2) a county (or a municipality, if not contained within 
 any county) where the mean drug overdose death rate per 100,000 
 people over the past 3 years for which official data is 
 available from the State, is higher than the most recent 
 available national average overdose death rate per 100,000 
 people, as reported by the Centers for Disease Control and 
 Prevention; or
 ``

    (3) a county (or a municipality, if not contained within 
 any county) where the mean suicide rate per 100,000 people over 
 the past 3 years for which official data is available from the 
 State, is higher than the most recent available national 
 average suicide rate per 100,000 people, as reported by the 
 Centers for Disease Control and Prevention.
 ``

    (e) 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.
 ``

    (f) 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, 
 Behavioral, and Substance Use Disorder Treatment Infrastructure 
 and Capacity Act; and
 ``

    (2) terminates on the date that is 24 months after such 
 date of enactment.
 ``

    (g) 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.
 ``

    (h) 

=== 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 `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.
 ``

    (4) 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) .
 ``

    (5) The term `psychiatric hospital' has the meaning given 
 to such term in 

section 1861

    (f) of the Social Security Act.
 ``

    (6) The term `rural emergency hospital' has the meaning 
 given to such term in 

section 1861

    (kkk) of the Social Security 
 Act.
 ``

    (7) The term `sole community hospital' has the meaning 
 given to such term in 

section 1886
            (d) (5)
            (D) 
            (iii) of the Social 
 Security Act.
 ``
            (i) Funding.--
 ``

    (1) Limitations for loans and loan guarantees.--The 
 Secretary may provide loans and loan guarantees under this 
 section--
 ``
        (A) only to the extent or in the amounts provided 
 in advance in appropriation Acts; and
 ``
        (B) totaling not more than $200,000,000 for each 
 of fiscal years 2025 through 2029.
 ``

    (2) Authorization of appropriations for grants.--There is 
 authorized to be appropriated to the Secretary to make grants 
 under this section $200,000,000 for each of fiscal years 2025 
 through 2029.''.

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-8 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.).
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