I
119THCONGRESS
1
STSESSION 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 pedi-
atric or adult substance use disorder treatment facilities, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH18, 2025
Ms. S
ALINAS(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 pur-
chasing, 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 Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Building Capacity for 4
Care Act’’. 5
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SEC. 2. LOANS AND LOAN GUARANTEES. 1
Part P of title III of the Public Health Service Act 2
is amended by inserting after section 399V–7 of such Act 3
(42 U.S.C. 280g–17) the following: 4
‘‘SEC. 399V–8. LOANS, LOAN GUARANTEES, AND GRANTS 5
FOR PURCHASING, PLANNING, CON-6
STRUCTING, OR RENOVATING ELIGIBLE FA-7
CILITIES FOR PEDIATRIC OR ADULT MENTAL 8
HEALTH AND SUBSTANCE USE DISORDER 9
SERVICES. 10
‘‘(a) I
NGENERAL.—The Secretary may— 11
‘‘(1) make loans, loan guarantees, or grants to 12
eligible entities for the purpose of— 13
‘‘(A) purchasing, constructing, or ren-14
ovating, including planning the purchase, con-15
struction, or renovation of, a pediatric or adult 16
mental health treatment facility or a pediatric 17
or adult substance use disorder treatment facil-18
ity; 19
‘‘(B) improving digital infrastructure, tele-20
health capabilities, or other patient care infra-21
structure at such a facility; or 22
‘‘(C) adding, or converting beds to, adult, 23
adolescent, or pediatric psychiatric and sub-24
stance use inpatient beds at such a facility; and 25
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‘‘(2) subject to subsection (f), make loans and 1
loan guarantees for refinancing loans that were 2
made for such purpose to an eligible entity. 3
‘‘(b) E
LIGIBLEENTITIES.—An entity shall be eligible 4
to receive a loan, loan guarantee, or grant under this sec-5
tion if— 6
‘‘(1) such entity is a public, private for-profit, 7
and private not-for-profit— 8
‘‘(A) hospital, including a general acute 9
hospital, psychiatric hospital, critical access 10
hospital, rural emergency hospital, sole commu-11
nity hospital, children’s hospital, or other hos-12
pital as specified by the Secretary; 13
‘‘(B) substance use disorder treatment fa-14
cility; 15
‘‘(C) mental health treatment facility; 16
‘‘(D) facility that employs licensed mental 17
health and substance use disorder professionals, 18
such as child and adult psychiatrists, child and 19
adult psychologists, advanced practice nurses, 20
social workers, licensed professional counselors, 21
or other licensed professionals that provide 22
mental health or substance use disorder services 23
to pediatric or adult patients; 24
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‘‘(E) alliance of hospitals or facilities listed 1
in any of subparagraphs (A), (B), (C), or (D); 2
and 3
‘‘(F) health care facility, as determined by 4
the Secretary; and 5
‘‘(2) such entity proposes to purchase, con-6
struct, or renovate a pediatric or adult mental health 7
treatment facility, or a pediatric or adult substance 8
use disorder treatment facility, that will— 9
‘‘(A) increase the number of pediatric, ado-10
lescent, or adult psychiatric beds or pediatric, 11
adolescent, or adult substance use disorder beds 12
in a county that has insufficient psychiatric or 13
substance use disorder treatment bed capacity; 14
‘‘(B) provide mental health or substance 15
use disorder services in a high-need rural or 16
underresourced community; 17
‘‘(C) provide multiple services across the 18
continuum of mental health or substance use 19
disorder care; or 20
‘‘(D) have the capacity to provide inte-21
grated or specialized mental health and sub-22
stance use disorder care for complex cases or 23
patients with medical co-morbidities. 24
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‘‘(c) APPLICATION.—An eligible entity seeking a loan, 1
loan guarantee, or grant under this section shall submit 2
to the Secretary an application at such time and in such 3
manner as the Secretary may specify. Such application 4
shall contain the proposal of the entity to purchase, con-5
struct, or renovate a pediatric or adult mental health 6
treatment facility, or a pediatric or adult substance use 7
disorder treatment facility (as described in subsection 8
(b)(2)) and such other information as the Secretary may 9
specify. 10
‘‘(d) G
EOGRAPHICPREFERENCE FOR GRANTS.—In 11
making grants under this section, the Secretary shall give 12
preference to eligible entities located in— 13
‘‘(1) a mental health professional shortage area, 14
as designated under section 332; 15
‘‘(2) a county (or a municipality, if not con-16
tained within any county) where the mean drug 17
overdose death rate per 100,000 people over the past 18
3 years for which official data is available from the 19
State, is higher than the most recent available na-20
tional average overdose death rate per 100,000 peo-21
ple, as reported by the Centers for Disease Control 22
and Prevention; or 23
‘‘(3) a county (or a municipality, if not con-24
tained within any county) where the mean suicide 25
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rate per 100,000 people over the past 3 years for 1
which official data is available from the State, is 2
higher than the most recent available national aver-3
age suicide rate per 100,000 people, as reported by 4
the Centers for Disease Control and Prevention. 5
‘‘(e) T
ERMS AND CONDITIONS.—Loans and loan 6
guarantees under this section shall be made on such terms 7
and conditions as the Secretary may prescribe, subject to 8
the provisions of this section including the following: 9
‘‘(1) The Secretary may allow credit to a pro-10
spective borrower only where— 11
‘‘(A) it is necessary to increase the number 12
of psychiatric or substance use disorder treat-13
ment facilities to enhance the public’s access to 14
a comprehensive continuum of mental health 15
and substance use disorder services; and 16
‘‘(B) a credit subsidy is the most efficient 17
way to achieve such increase (on a borrower-by- 18
borrower basis). 19
‘‘(2) The final maturity of loans made or guar-20
anteed under this section shall not exceed a period 21
of 20 years, or the period of 50 percent of the useful 22
life of any physical asset to be financed by the loan, 23
whichever is less, as determined by the Secretary. 24
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‘‘(3) The Secretary may not make a loan guar-1
antee under this section, with respect to any bor-2
rower, in excess of 80 percent of any potential loss 3
on the loan. 4
‘‘(4) The Secretary may not make any loan or 5
loan guarantee under this section if the loan will be 6
subordinated— 7
‘‘(A) to another debt contracted by the 8
borrower; or 9
‘‘(B) to any other claims against the bor-10
rower in the case of default. 11
‘‘(5) The Secretary may not make any loan 12
guarantee under this section unless the Secretary 13
determines that— 14
‘‘(A) the lender is responsible; and 15
‘‘(B) adequate provision is made for serv-16
icing the loan on reasonable terms and pro-17
tecting the financial interest of the United 18
States. 19
‘‘(6) The Secretary may not make any loan 20
guarantee under this section if the income from the 21
loan will be excluded from gross income for purposes 22
of chapter 1 of the Internal Revenue Code of 1986. 23
‘‘(7) The Secretary may not make any loan or 24
loan guarantee under this section unless— 25
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‘‘(A) the loan and interest supplements on 1
any loan guarantee will be at an interest rate 2
that is set by reference to a benchmark interest 3
rate on marketable Treasury securities with a 4
similar maturity to the loan being made or 5
guaranteed; and 6
‘‘(B) the minimum interest rate on the 7
loan— 8
‘‘(i) will be no less than the estimated 9
cost to the Government of making the loan 10
plus 1 percent, with the goal of keeping 11
the interest rate below the interest rate of 12
a comparable and competitive private sec-13
tor benchmark financial instrument; and 14
‘‘(ii) will be adjusted, as determined 15
by the Secretary, every quarter to take ac-16
count of changes in the interest rate of the 17
benchmark financial instrument. 18
‘‘(8) The Secretary may not make any loan or 19
loan guarantee under this section unless— 20
‘‘(A) fees or premiums on the loan or loan 21
guarantee and corresponding insurance cov-22
erage will be set at levels that minimize the cost 23
to the Government (as defined in section 502(5) 24
of the Federal Credit Reform Act of 1990) of 25
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insuring such loan or loan guarantee, while sup-1
porting achievement of enhancing the public’s 2
access to a comprehensive continuum of mental 3
health and substance use disorder services, in-4
cluding increasing the number of inpatient psy-5
chiatric and substance use disorder bed counts 6
in areas with insufficient bed capacity; 7
‘‘(B) the minimum guarantee fee or insur-8
ance premium imposed by the Government will 9
be no less than the level sufficient to cover all 10
of the estimated costs to the Government of the 11
expected default claims, plus one percent; and 12
‘‘(C) loan guarantee fees imposed by the 13
Government will be reviewed every six months 14
to ensure that the fees imposed on new loan 15
guarantees are at a level sufficient to satisfy 16
subparagraph (B) based on the most recent es-17
timates of such costs. 18
‘‘(9) The provisions of any loan guarantee 19
under this section shall state that the guarantee is 20
conclusive evidence that— 21
‘‘(A) the guarantee has been properly ob-22
tained; 23
‘‘(B) the underlying loan qualified for the 24
guarantee; and 25
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‘‘(C) except in the case of fraud or mate-1
rial misrepresentation by the holder of the loan, 2
the guarantee will be presumed to be valid, 3
legal, and enforceable. 4
‘‘(10) The Secretary may not make any loan or 5
loan guarantee under this section unless— 6
‘‘(A) the borrower finances at least 25 per-7
cent of the funded project from other sources; 8
and 9
‘‘(B) the borrower uses funds that were 10
not derived from Federal loans or loan guaran-11
tees to pay the fees or premiums on the loan or 12
loan guarantee under this section. 13
‘‘(11) The Secretary— 14
‘‘(A) shall prescribe explicit standards for 15
use in periodically assessing the credit risk of 16
new and existing direct loans and guaranteed 17
loans; and 18
‘‘(B) shall not make a loan or loan guar-19
antee under this section unless the Secretary 20
finds that there is a reasonable assurance of re-21
payment. 22
‘‘(f) L
IMITATION ONREFINANCING.—The authority 23
vested by subsection (a)(2)— 24
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‘‘(1) authorizes making loans and loan guaran-1
tees only for refinancing loans that are entered into 2
on or before the date that is 24 months before the 3
date of enactment of the Mental, Behavioral, and 4
Substance Use Disorder Treatment Infrastructure 5
and Capacity Act; and 6
‘‘(2) terminates on the date that is 24 months 7
after such date of enactment. 8
‘‘(g) P
AYMENT OFLOSSES.— 9
‘‘(1) D
EFAULT ON GUARANTEED LOANS .—If, as 10
a result of a default by a borrower under a loan 11
guaranteed under this section, after the holder 12
thereof has made such further collection efforts and 13
instituted such enforcement proceedings as the Sec-14
retary may require, the Secretary determines that 15
the holder has suffered a loss— 16
‘‘(A) the Secretary shall pay to such holder 17
75 percent of such loss, as specified in the 18
guarantee contract; 19
‘‘(B) upon making any such payment, the 20
Secretary shall be subrogated to all the rights 21
of the recipient of the payment; and 22
‘‘(C) the Secretary shall be entitled to re-23
cover from the borrower the amount of any pay-24
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ments made pursuant to the guarantee con-1
tract. 2
‘‘(2) R
EQUIRED ENFORCE OF FEDERAL 3
RIGHTS.—The Attorney General of the United 4
States shall take such action as may be appropriate 5
to enforce any right accruing to the United States 6
as a result of the issuance of any guarantee under 7
this section. 8
‘‘(3) F
ORBEARANCE.—Nothing in this section 9
precludes any forbearance for the benefit of the bor-10
rower of a loan that is made or guaranteed under 11
this section which is agreed upon by the parties to 12
the loan and approved by the Secretary, provided 13
that budget authority for any resulting cost to the 14
Government (as defined in section 502(5) of the 15
Federal Credit Reform Act of 1990) is available. 16
‘‘(h) D
EFINITIONS.—In this section: 17
‘‘(1) The term ‘children’s hospital’ means a 18
hospital that predominantly serves patients under 19
the age of 18. 20
‘‘(2) The term ‘critical access hospital’ has the 21
meaning given to such term in section 1861(mm) of 22
the Social Security Act. 23
‘‘(3) The term ‘mental health treatment facil-24
ity’— 25
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‘‘(A) includes— 1
‘‘(i) a child or adult outpatient facility 2
that provides— 3
‘‘(I) intensive outpatient services; 4
‘‘(II) partial hospitalization serv-5
ices; 6
‘‘(III) crisis intervention and sta-7
bilization; or 8
‘‘(IV) other mental, behavioral, 9
or emotional health services deemed 10
appropriate by the Secretary; 11
‘‘(ii) a hospital (including a general 12
acute hospital, a psychiatric hospital, a 13
critical access hospital, a rural emergency 14
hospital, a sole community hospital, a chil-15
dren’s hospital, or other type of hospital as 16
specified by the Secretary) that— 17
‘‘(I) provides acute, short-term 18
inpatient psychiatric treatment serv-19
ices or outpatient services; and 20
‘‘(II) may include a military serv-21
ices program to meet the needs of ac-22
tive and retired military 23
servicemembers; and 24
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‘‘(iii) a facility within or near an 1
emergency department for providing dis-2
charge planning and instructions to emer-3
gency department patients in need of men-4
tal health or substance use disorder treat-5
ment and transfer to an appropriate men-6
tal health or substance use disorder treat-7
ment care setting; and 8
‘‘(B) excludes a facility that provide long- 9
term inpatient care. 10
‘‘(4) The term ‘substance use disorder treat-11
ment facility’— 12
‘‘(A) includes— 13
‘‘(i) a child or adult outpatient facility 14
that provides outpatient substance use dis-15
order services; and 16
‘‘(ii) a hospital (including a general 17
acute hospital, a psychiatric hospital, a 18
critical access hospital, a rural emergency 19
hospital, a sole community hospital, a chil-20
dren’s hospital, or other type of hospital as 21
specified by the Secretary) that— 22
‘‘(I) provides acute, short-term 23
inpatient substance use disorder treat-24
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ment services or outpatient services; 1
and 2
‘‘(II) may include a military serv-3
ices program to meet the needs of ac-4
tive and retired military 5
servicemembers; and 6
‘‘(B) excludes any facility described in 7
paragraph (1)(B). 8
‘‘(5) The term ‘psychiatric hospital’ has the 9
meaning given to such term in section 1861(f) of the 10
Social Security Act. 11
‘‘(6) The term ‘rural emergency hospital’ has 12
the meaning given to such term in section 13
1861(kkk) of the Social Security Act. 14
‘‘(7) The term ‘sole community hospital’ has 15
the meaning given to such term in section 16
1886(d)(5)(D)(iii) of the Social Security Act. 17
‘‘(i) F
UNDING.— 18
‘‘(1) L
IMITATIONS FOR LOANS AND LOAN GUAR -19
ANTEES.—The Secretary may provide loans and loan 20
guarantees under this section— 21
‘‘(A) only to the extent or in the amounts 22
provided in advance in appropriation Acts; and 23
‘‘(B) totaling not more than $200,000,000 24
for each of fiscal years 2025 through 2029. 25
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‘‘(2) AUTHORIZATION OF APPROPRIATIONS FOR 1
GRANTS.—There is authorized to be appropriated to 2
the Secretary to make grants under this section 3
$200,000,000 for each of fiscal years 2025 through 4
2029.’’. 5
SEC. 3. MENTAL HEALTH AND SUBSTANCE USE TREAT-6
MENT TRUST FUND. 7
(a) E
STABLISHMENT.—There is established in the 8
Treasury of the United States a trust fund to be known 9
as the Mental Health and Substance Use Treatment Trust 10
Fund (in this section referred to as the ‘‘Trust Fund’’). 11
(b) D
EPOSITS.—There are hereby authorized to be 12
appropriated to the Trust Fund, to remain available until 13
expended, amounts equivalent to any revenues from the 14
program of loans and loan guarantees under section 15
399V–8 of the Public Health Service Act, as added by sec-16
tion 2, that exceed the costs of carrying out such program. 17
(c) U
SE OFFUND.—Amounts in the Trust Fund 18
shall be available, as provided by appropriation Acts, for 19
block grants for community mental health services under 20
subpart I of part B of title XIX of the Public Health Serv-21
ice Act (42 U.S.C. 300x et seq.). 22
Æ
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