[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8543 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 8543
To amend the Social Security Act and the Public Health Service Act to
permanently authorize certified community behavioral health clinics,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 23, 2024
Ms. Matsui (for herself, Mr. Bucshon, Ms. Craig, Mr. Molinaro, and Mr.
Tonko) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend the Social Security Act and the Public Health Service Act to
permanently authorize certified community behavioral health clinics,
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.
(a) Short Title.--This Act may be cited as the ``Ensuring
Excellence in Mental Health Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title.
TITLE I--ENSURING PERMANENCY FOR CERTIFIED COMMUNITY BEHAVIORAL HEALTH
CLINICS IN THE MEDICAID PROGRAM
Sec. 101. Establishing a Medicaid Prospective Payment System for
Certified Community Behavioral Health
Clinics.
TITLE II--COVERAGE OF CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC
SERVICES UNDER THE MEDICARE PROGRAM
Sec. 201. Coverage of certified community behavioral health clinic
services under the Medicare program.
TITLE III--COMMUNITY BEHAVIORAL HEALTH CLINIC GRANTS
Sec. 301. Operating grants for community behavioral health clinics.
TITLE I--ENSURING PERMANENCY FOR CERTIFIED COMMUNITY BEHAVIORAL HEALTH
CLINICS IN THE MEDICAID PROGRAM
SEC. 101. ESTABLISHING A MEDICAID PROSPECTIVE PAYMENT SYSTEM FOR
CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS.
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is
amended by adding at the end the following new subsection:
``(uu) Payment for Services Provided by Certified Community
Behavioral Health Clinics.--
``(1) In general.--Beginning with fiscal year 2024, with
respect to services furnished on or after January 1, 2024, and
each succeeding fiscal year, a State may provide under the
State plan under this title (or under a waiver of such plan)
for payment for services described in section 1905(a)(31)
furnished by a certified community behavioral health clinic (in
this subsection referred to as a `clinic') in accordance with
the provisions of this subsection.
``(2) Payment for services in initial year and every third
year.--Subject to paragraphs (4), (5), and (6), for services
furnished by a clinic in the first fiscal year for which a
State elects to provide for payment for services described in
section 1905(a)(31) in accordance with the payment option under
paragraph (1), and every third fiscal year thereafter in which
the State makes such an election, the State shall provide for
payment for such services in an amount (calculated on the basis
of daily visits or unduplicated monthly visits, at the State's
election) that is equal to 100 percent of the average costs of
the clinic of furnishing any of the services described in
paragraph (31) of section 1905(a) during the 2 fiscal years
preceding the fiscal year involved which are reasonable and
related to the costs of furnishing such services; provided
that, in the absence of complete actual cost data representing
the provision of the full covered benefit in such preceding
fiscal years, certified community behavioral health clinics
may, at the State's discretion, use estimated or projected data
relating to specific services for which they lack cost
experience. The per-unit rate derived from such cost data shall
be adjusted to take into account any increase or decrease in
the scope of such services furnished by the clinic in the
fiscal year involved.
``(3) Payment for services in succeeding fiscal years.--
Subject to paragraphs (4), (5), and (6), for services described
in section 1905(a)(31) furnished by a clinic for which a State
elects to provide for payment for such services in accordance
with the payment option under paragraph (1) and that are
furnished in a fiscal year that is not described in paragraph
(2), the State plan shall provide for payment for such services
in an amount (calculated on the basis of daily visits or
unduplicated monthly visits, at the State's election) that is
equal to the amount calculated under this subsection for such
services and clinic for the preceding year--
``(A) increased by the percentage increase in the
inflationary factor described in section
1834(aa)(2)(C); and
``(B) adjusted to take into account any increase or
decrease in the scope of such services furnished by the
clinic during the fiscal year involved.
``(4) Establishment of initial year payment for new
clinics.--In any case in which an entity first qualifies as a
certified community behavioral health clinic after the first
fiscal year in which a State elects to provide for payment for
services described in section 1905(a)(31) in accordance with
the payment option under paragraph (1), the State plan shall
provide for payment for such services in the first 2 years in
which the clinic so qualifies in an amount (calculated on the
basis of daily visits or unduplicated monthly visits, at the
State's election) that is equal to the rates established under
this subsection for other such clinics located in the same or
adjacent area with a similar case load, or in the absence of
any such clinic, based on the average per-unit rate for other
certified community behavioral health clinics in the State;
provided, however, that effective, at latest, as of the 3rd
year in which the clinic furnishes such services, the State
establishes a unique payment rate for the clinic based on the
methodology described in paragraph (2), using allowable costs
from the clinic's first 2 fiscal years of operation as the
basis for establishing such rates; and provided, additionally,
that in any year following the establishment of an initial rate
under this paragraph, the State plan or waiver provides for the
payment amount to be calculated in accordance with paragraph
(2) or (3) (as applicable).
``(5) Administration in the case of managed care.--
``(A) In general.--In the case of services
furnished by a certified community behavioral health
clinic pursuant to a contract between the clinic and a
managed care entity (as defined in section
1932(a)(1)(B)), the State plan or a waiver of such plan
shall provide for 1 of the following:
``(i) Payment to the clinic by the State of
a supplemental payment equal to the amount (if
any) by which the amount determined under
paragraph (2), (3), or (4) (as applicable)
exceeds the amount of payments under the
contract, with such supplemental payment being
made pursuant to a payment schedule agreed to
by the State and the certified community
behavioral health clinic, but in no case less
frequently than every 3 months.
``(ii) Delegation by the State to the
managed care entity of the obligation to pay
the clinic at least the rate determined under
paragraph (2), (3), or (4) (as applicable);
provided, however, that the State shall use
reconciliation and oversight processes to
ensure that each clinic is paid at least the
amounts required under such paragraphs.
``(6) Alternative payment methodologies.--Notwithstanding
any other provision of this subsection, the State plan or a
waiver of such plan may provide for payment in any year to a
certified community behavioral health clinic for services
described in paragraph (31) of section 1905(a) in an amount
which is determined under an alternative payment methodology
that--
``(A) is agreed to by the State and the clinic; and
``(B) results in payment to the clinic of an amount
which is not less than the amount otherwise required to
be paid to the clinic under this subsection.''.
TITLE II--COVERAGE OF CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC
SERVICES UNDER THE MEDICARE PROGRAM
SEC. 201. COVERAGE OF CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC
SERVICES UNDER THE MEDICARE PROGRAM.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (II), by striking ``and'' at the end;
(2) in subparagraph (JJ), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(KK) certified community behavioral health clinic
services (as defined in subsection (aa)(8)) furnished on or
after January 1, 2024.''.
(b) Definitions.--Section 1861(aa) of the Social Security Act (42
U.S.C. 1395x) is amended--
(1) in the heading, by striking ``and Federally Qualified
Health Center Services'' and inserting ``, Federally Qualified
Health Center Services, and Certified Community Behavioral
Health Clinic Services''; and
(2) by adding at the end the following new paragraph:
``(8) The terms `certified community behavioral health clinic
services' and `certified community behavioral health clinic' have the
meaning given those terms in paragraphs (1) and (2), respectively, of
section 1905(jj).''.
(c) Payment.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (HH)'' and inserting
``(HH)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (II) with respect to certified
community behavioral health clinic services for which
payment is made under section 1834(aa), the amounts
paid shall be equal to 80 percent of the lesser of the
actual charge or the amount determined under such
section''.
(2) Development and implementation of prospective payment
system.--Section 1834 of the Social Security Act (42 U.S.C.
1395m) is amended by adding at the end the following new
subsection:
``(aa) Development and Implementation of Prospective Payment System
for Certified Community Behavioral Health Clinics.--
``(1) Development.--The Secretary shall develop a
prospective payment system for payment to certified community
behavioral health clinics (as defined in section 1861(aa)(8))
for the furnishing of certified community behavioral health
clinic services (as defined in such section) under this title.
Such system shall be established to take into account the type,
intensity, and duration of services furnished by certified
community behavioral health clinics. Such system may include
adjustments, including geographic adjustments, as determined
appropriate by the Secretary.
``(2) Implementation.--
``(A) In general.--The Secretary shall provide, for
cost reporting periods beginning on or after January 1,
2024, for payments of prospective payment rates for
certified community behavioral health clinic services
furnished by certified community behavioral health
clinics under this title in accordance with the
prospective payment system developed by the Secretary
under paragraph (1).
``(B) Initial payments.--The Secretary shall
implement such prospective payment system to reflect
the national average allowable service costs of such
clinics on the basis of the most current audited cost
report data for two fiscal years available to the
Secretary; provided that, in the absence of complete
actual cost data representing the provision of the full
covered benefit during the relevant fiscal years,
certified community behavioral health clinics may, at
the Secretary's discretion, use estimated or projected
data relating to specific services. Initial payments
shall be established without the application of a per
visit limit or productivity screen and shall be based
on national average costs per unit of service, updated
as appropriate by the inflationary adjustment described
in subparagraph (C).
``(C) Payments in subsequent years.--Payment rates
in years after the year of implementation of such
system shall be the payment rates in the previous year
increased--
``(i) in the first year after
implementation of such system, by the
percentage increase in the MEI (as defined in
section 1842(i)(3)) for the year involved; and
``(ii) in subsequent years, by the
percentage increase in a market basket of
certified community behavioral health clinic
services, designed by the Secretary, or if such
an index is not available, by the percentage
increase in the MEI (as defined in section
1842(i)(3)) for the year involved.
``(3) Unit of payment.--In establishing a prospective
payment amount under the system under this subsection, the
Secretary shall consider an appropriate unit of service and a
general system design that provides for continued access to
quality services.
``(4) Periodic reevaluation of rates.--At the Secretary's
discretion, the Secretary shall, from time to time, adjust the
amounts that would otherwise be applicable under subparagraph
(2) by a percentage determined appropriate by the Secretary to
reflect such factors as changes in the intensity of services
furnished within a unit of service, the average cost of
providing care per unit of service, and other factors that the
Secretary considers to be relevant. Such adjustment shall be
made before the update under clause (i) or (ii) of paragraph
(2)(C)(i) has been applied for the year.''.
(d) Waiver of Application of Deductible.--Section 1833(b)(4) of the
Social Security Act (42 U.S.C. 1395l(b)(4)) is amended by inserting
``or certified community behavioral health clinic services'' before the
comma at the end.
(e) PRRB Review of Cost Reports.--Section 1878(j) of the Social
Security Act (42 U.S.C. 1395oo(j)) is amended by striking ``and a
Federally qualified health center'' and inserting ``, a Federally
qualified health center, and a certified community behavioral health
clinic''.
(f) Safe Harbor for Waiver of Coinsurance.--Section 1128B(b)(3)(D)
of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)(D)) is amended by
inserting ``or a certified community behavioral health clinic'' after
``Federally qualified health care center''.
(g) Effective Date.--The amendments made by this section shall
apply with respect to services furnished on or after January 1, 2024.
TITLE III--COMMUNITY BEHAVIORAL HEALTH CLINIC GRANTS
SEC. 301. OPERATING GRANTS FOR COMMUNITY BEHAVIORAL HEALTH CLINICS.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following:
``Subpart XIII--Community Behavioral Health Clinics
``SEC. 340J. DEFINITIONS.
``In this subpart:
``(1) Certified community behavioral health clinic.--The
term `certified community behavioral health clinic' has the
meaning given the term in section 1905(jj)(2)) of the Social
Security Act.
``(2) Certified community behavioral health services.--The
term `certified community behavioral health services' has the
meaning given the term in section 1905(jj)(1) of the Social
Security Act.
``SEC. 340J-1. COMMUNITY BEHAVIORAL HEALTH CLINIC CERTIFICATION.
``(a) In General.--Not later than 180 days after the date of
enactment of the Ensuring Excellence in Mental Health Act, the
Secretary, after public notice and opportunity for comment, shall
publish in the Federal Register criteria for a clinic to be certified
as a community behavioral health clinic for purposes of section
1905(jj)(2)(D)(ii) of the Social Security Act.
``(b) Requirements.--The criteria published under subsection (a)
shall include criteria with respect to the following:
``(1) Staffing.--Staffing requirements, including criteria
that staff have diverse disciplinary backgrounds, have
necessary State-required license and accreditation, and are
culturally and linguistically trained to serve the needs of the
patient populations of the community behavioral health clinic.
``(2) Availability and accessibility of services.--
Availability and accessibility of services, including crisis
management services that are available and accessible 24 hours
a day, the use of a sliding scale for payment, and no rejection
for services or limiting of services on the basis of a
patient's ability to pay or a place of residence.
``(3) Care coordination.--Care coordination, including
requirements to coordinate care across settings and