119-hr3266

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3266 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3266

 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

 May 8, 2025

 Ms. McClellan (for herself 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 2025''.

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-18) 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, as determined by the Secretary, 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 and 
adolescent 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, at the 
 Secretary's discretion, 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 2025; 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' means 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, adolescent, and adult psychiatrists, child, 
 adolescent, and adult psychologists, advanced practice 
 registered nurses, social workers, licensed 
 professional counselors, or other licensed 
 professionals that provide mental health or substance 
 use disorder services to pediatric, adolescent, or 
 adult patients;
 ``
        (E) alliances of hospitals or facilities listed 
 in any of subparagraphs
        (A) through
            (D) ; and
 ``
        (F) other facilities as determined by the 
 Secretary.
 ``

    (4) The term `mental health treatment facility'--
 ``
        (A) includes--
 ``
            (i) a child, adolescent, 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 provides long-term 
 inpatient care.
 ``

    (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.
 ``

    (8) The term `substance use disorder treatment 
 facility'--
 ``
        (A) includes--
 ``
            (i) a child, adolescent, 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

    (4)
        (B) .
 ``

    (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 2026 through 2030.''.

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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