Building Capacity for Care Act
- Bill Number
- H.R. 2223
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-03-18: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2025-09-02T14:41:33Z
AI-Generated Summary
Purpose of the Legislation
The "Building Capacity for Care Act" (H.R. 2223) aims to expand access to mental health and substance use disorder (SUD) treatment by authorizing federal financial support for building, improving, or renovating treatment facilities. It focuses on addressing shortages in care, particularly for children, adolescents, and adults in underserved areas, to enhance the overall public health infrastructure for behavioral health services.
Key Provisions
- Financial Assistance Programs: The Secretary of Health and Human Services (HHS) can provide loans, loan guarantees, and grants to eligible entities for:
- Purchasing, planning, constructing, or renovating pediatric or adult mental health or SUD treatment facilities.
- Upgrading digital infrastructure (e.g., telehealth capabilities) or other patient care systems.
- Adding or converting beds for psychiatric or SUD inpatient care for adults, adolescents, or children.
- Refinancing certain existing loans (limited to those made up to 24 months before enactment, with authority expiring 24 months after enactment).
- Eligible Entities: Public, private for-profit, or nonprofit organizations, including:
- Hospitals (e.g., general acute, psychiatric, critical access, rural emergency, sole community, or children's hospitals).
- Dedicated SUD or mental health treatment facilities.
- Facilities employing licensed professionals (e.g., psychiatrists, psychologists, nurses, social workers) providing these services.
- Alliances of such facilities or other HHS-determined health care providers.
- Entities must propose projects that increase bed capacity in areas with shortages, serve high-need rural or underresourced communities, offer a range of care services, or provide integrated care for complex cases (e.g., patients with co-occurring medical conditions).
- Application and Preferences: Entities submit proposals to HHS detailing their plans. Grants prioritize areas with mental health professional shortages, high drug overdose death rates (above national average over the past 3 years, per CDC data), or high suicide rates (above national average, per CDC data).
- Terms and Conditions for Loans/Guarantees:
- Loans mature up to 20 years or 50% of the asset's useful life (whichever is shorter).
- Guarantees cover up to 80% of potential losses; loans cannot be subordinated to other debts.
- Interest rates are tied to Treasury benchmarks, with a minimum rate covering government costs plus 1%, adjusted quarterly.
- Fees/premiums minimize government costs while supporting access goals; reviewed every 6 months.
- Borrowers must finance at least 25% of the project from non-federal sources and use non-federal funds for fees.
- HHS assesses credit risk and requires reasonable repayment assurance.
- On default, HHS pays 75% of losses to lenders, gains subrogation rights, and can recover from borrowers; forbearance is allowed if budget authority exists.
- Definitions (key terms clarified for facilities):
- Mental health treatment facility: Includes outpatient services (e.g., intensive outpatient, crisis intervention), short-term inpatient hospital care, and emergency department support; excludes long-term inpatient care.
- Substance use disorder treatment facility: Similar to mental health facilities but focused on SUD outpatient or short-term inpatient services; may include programs for military personnel.
- Other terms reference Social Security Act definitions (e.g., psychiatric hospital as one primarily treating mental diseases).
- Funding:
- Up to $200 million annually for loans and guarantees (fiscal years 2025–2029), subject to appropriations.
- $200 million authorized annually for grants (fiscal years 2025–2029).
- Mental Health and Substance Use Treatment Trust Fund: Establishes a fund in the U.S. Treasury. Deposits include excess revenues from the loan program (beyond program costs). Funds are available (via appropriations) for block grants to community mental health services under existing Public Health Service Act provisions.
Significant Changes to Existing Law
- Amends Part P of Title III of the Public Health Service Act (42 U.S.C. 280g et seq.) by adding a new section (399V-8), creating a dedicated program for mental health and SUD facility financing—previously, no such targeted federal loan, guarantee, or grant authority existed in this part of the law.
- Introduces the new Trust Fund, which redirects surplus loan program revenues to support community mental health block grants (expanding on subpart I of part B of title XIX of the Public Health Service Act), linking infrastructure investment to broader service funding.
Potential Impacts
- Government Agencies: HHS gains authority to administer the program, including application reviews, risk assessments, and loss payments, potentially increasing administrative workload and requiring new oversight mechanisms. The Trust Fund could provide a sustainable funding stream for existing block grants, reducing reliance on annual appropriations.
- Citizens: Improves access to mental health and SUD treatment in shortage areas, high-overdose/suicide regions, and rural communities, potentially reducing wait times, emergency room overuse, and untreated cases. Benefits patients with complex needs through integrated care and telehealth expansions.
- International Relations: No direct impacts; the bill is domestic-focused on U.S. public health infrastructure.
Main Stakeholders Affected
- Health Care Providers: Hospitals, treatment facilities, and professional alliances eligible for funding, enabling expansion or modernization.
- Patients and Communities: Children, adolescents, adults seeking mental health or SUD care, especially in underserved, rural, or high-need areas (e.g., those with elevated overdose or suicide rates).
- Government: HHS (program administration), states/localities (receiving block grants via Trust Fund), and taxpayers (funding the program).
- Lenders and Borrowers: Financial institutions providing loans (protected by guarantees) and eligible entities financing projects.
Notable Legal, Constitutional, or Political Implications
- Legal: Establishes standard federal credit and grant programs under the Public Health Service Act, with safeguards like credit risk assessments and anti-fraud provisions (e.g., guarantees valid unless fraud occurs). Aligns with Federal Credit Reform Act requirements for costing loans/guarantees. No challenges to enforceability anticipated, as it uses established Treasury and HHS mechanisms.
- Constitutional: Falls within Congress's spending power (Article I, Section 8) to promote general welfare through health infrastructure; no federalism issues, as it supports state/local services without mandates.
- Political: Addresses national priorities like the mental health crisis and opioid epidemic by incentivizing facility growth in priority areas, potentially bipartisan appeal. Could influence future appropriations debates on behavioral health funding, emphasizing efficiency (e.g., minimizing government costs while maximizing access).
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Rep. Balint, Becca [D-VT-At Large]
Recent Actions
- 2025-03-18: Referred to the House Committee on Energy and Commerce.
- 2025-03-18: Introduced in House
- 2025-03-18: Introduced in House
Bill Versions
- Building Capacity for Care Act — issued 2025-03-18 — PDF (16 pages)