[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3320 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 3320
To amend title XIX of the Social Security Act to increase Federal
Medicaid funding for States that provide intensive community-based
services for adults with serious mental illness, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 9, 2025
Mr. Goldman of New York introduced the following bill; which was
referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to increase Federal
Medicaid funding for States that provide intensive community-based
services for adults with serious mental illness, 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 ``Strengthening Medicaid for Serious
Mental Illness Act''.
SEC. 2. PURPOSES.
The purposes of this Act are the following:
(1) To amend title XIX of the Social Security Act to
increase Federal Medicaid funding for States that provide
intensive community-based services for adults with serious
mental illness.
(2) To increase access to intensive community-based
services in the most integrated setting appropriate.
(3) To prevent unnecessary hospitalization or other
institutionalization.
(4) To promote continuity of care and coverage for young
adults after they turn 21 and age out of the early and periodic
screening, diagnostic, and treatment services benefit.
SEC. 3. INCREASED FMAP FOR PROVIDING INTENSIVE COMMUNITY-BASED SERVICES
UNDER MEDICAID.
(a) In General.--Section 1915 of the Social Security Act (42 U.S.C.
1396n) is amended by adding at the end the following new subsection:
``(m) State Plan Amendment Option To Provide Intensive Community-
Based Services for Elderly and Disabled Individuals.--
``(1) In general.--Subject to the succeeding provisions of
this subsection, beginning January 1, 2026, a State may provide
through a State plan amendment for the provision of medical
assistance for intensive community-based services (not
including room and board) for eligible individuals (as defined
in paragraph (2)), without determining that but for the
provision of such services the individuals would require the
level of care provided in a hospital, nursing facility, or
intermediate care facility described in section 1905(d), but
only if the State meets the following requirements:
``(A) Application of hcbs state plan amendment
requirements.--
``(i) In general.--Except as provided in
clause (ii), the State satisfies the
requirements described in subparagraphs (A)
through (J) of subsection (i)(1) (except that,
in applying such subparagraphs for purposes of
this subsection, each reference to `home and
community-based services' shall be deemed to be
a reference to `intensive community-based
services').
``(ii) Modification of assessment
requirement.--In applying subparagraph (F)(i)
of subsection (i)(1) for purposes of this
subsection, `or 1 or more activity of daily
living and 1 or more instrumental activity of
daily living (as defined in subsection
(k)(6)(F))' shall be inserted after `2 or more
activities of daily living (as defined in
section 7702B(c)(2)(B) of the Internal Revenue
Code of 1986)'.
``(B) Application of regulations.--In providing
intensive community-based services under this
subsection, the State complies with the regulations
applicable to home and community-based services
provided under subsection (i) under subpart M of part
441 of title 42, Code of Federal Regulations, including
sections 441.710 (commonly known as the `HCBS settings
rule') and 441.725 of such title, except to the extent
that such regulations are inconsistent with this
subsection.
``(2) Definitions.--In this subsection:
``(A) Adult with a serious mental illness; serious
mental illness.--
``(i) Adult with a serious mental
illness.--The term `adult with a serious mental
illness' has the meaning given that term by the
Secretary pursuant to section 1912(c) of the
Public Health Service Act.
``(ii) Serious mental illness.--The term
`serious mental illness' means a diagnosable
mental, behavioral or emotional disorder that
meets the criteria for qualifying an individual
as an adult with a serious mental illness.
``(B) Assertive community treatment.--The term
`assertive community treatment' means services for the
treatment of mental illness that are provided through
an evidence-based practice that--
``(i) improves outcomes for individuals
with severe mental illness who are at high risk
of homelessness, psychiatric crisis, or
hospitalization, or are involved in the
criminal justice system;
``(ii) is comprised of a multidisciplinary
staff, including peer specialists, who work as
a team to provide the individualized
psychiatric treatment, rehabilitation, and
support services clients need for the maximum
reduction of physical or mental disability and
restoration to their best possible functional
level;
``(iii) ensures that there is 1 direct care
staff person for every 10 clients; and
``(iv) provides services 24 hours a day, 7
days a week, for as long as needed and wherever
they are needed.
``(C) Eligible individual.--The term `eligible
individual' means an individual--
``(i) who is eligible for medical
assistance under the State plan or under a
waiver of such plan;
``(ii) who is age 21 or older;
``(iii) whose income does not exceed 150
percent of the poverty line (as defined in
section 2110(c)(5)); and
``(iv) who is an adult with a serious
mental illness.
``(D) Intensive case management.--The term
`intensive case management' means a type of case
management service (as defined in section 440.169 of
title 42, Code of Federal Regulations)--
``(i) that is reliable, systematic,
flexible, and coordinated, designed to answer
the unique combination of health and social
care needs of individuals with serious mental
illness;
``(ii) that is a long-term, intensive
approach to supporting an individual in the
community by providing a comprehensive range of
treatment, rehabilitation, and support
services;
``(iii) that helps individuals with serious
mental illness acquire material resources (such
as food, shelter, clothing, and medical care)
and improve their psychosocial functioning;
``(iv) that provides sufficient support to
individuals with serious mental illness to keep
them involved in community life and encourage
growth towards greater autonomy and develop
coping skills to meet the demands of community
life;
``(v) that ensures continuity of care among
treatment agencies;
``(vi) in which a case manager, working
alone or as part of a team, makes 4 or more
face-to-face contact with a client each month;
and
``(vii) in which the case manager-to-client
ratio does not exceed 1:12.
``(E) Intensive community-based services.--The term
`intensive community-based services' means a set of
psychosocial rehabilitation services that includes all
of the following:
``(i) Assertive community treatment.
``(ii) Supported employment.
``(iii) Peer support services.
``(iv) Qualifying community-based mobile
crisis intervention services.
``(v) Intensive case management.
``(vi) Housing-related activities and
services, including individual housing
transition services, individual housing and
tenancy sustaining services, and State-level
housing-related collaborative activities, as
those services are described in the
informational bulletin published by the Center
for Medicaid and CHIP Services on June 26,
2015, with the subject `Coverage of Housing-
Related Activities and Services for Individuals
with Disabilities'.
``(vii) Such other psychosocial
rehabilitation services as a State may request
and the Secretary may approve.
``(F) Peer support services.--The term `peer
support services' means culturally competent individual
and group services for individuals with serious mental
illness that promote recovery, resiliency, engagement,
socialization, self-sufficiency, self-advocacy,
development of natural supports, and identification of
strengths through structured activities such as group
and individual coaching to set recovery goals and
identify steps to reach the goals. Such services aim to
prevent relapse, empower beneficiaries through
strength-based coaching, support linkages to community
resources, and to educate beneficiaries and their
families about their conditions and the process of
recovery. Such services include the following:
``(i) Participating in the treatment
planning process.
``(ii) Mentoring and assisting the
beneficiary with problem solving, goal setting,
and skill building.
``(iii) Encouraging a beneficiary's
interest in pursuing and maintaining treatment
services.
``(iv) Providing support and linkages to
facilitate participation in recovery-based
activities.
``(v) Sharing experiential knowledge, hope,
and skills.
``(vi) Advocating for the beneficiary.
``(G) Qualifying community-based mobile crisis
intervention services.--The term `qualifying community-
based mobile crisis intervention services' means, with
respect to a State, items and services for which
medical assistance is available under the State plan
under this title or a waiver of such plan, that are--
``(i) furnished to an individual otherwise
eligible for medical assistance under the State
plan (or waiver of such plan) who is--
``(I) outside of a hospital or
other facility setting; and
``(II) experiencing a mental health
or substance use disorder crisis;
``(ii) furnished by a multidisciplinary
mobile crisis team--
``(I) that includes at least 1
behavioral health care professional who
is capable of conducting an assessment
of the individual, in accordance with
the professional's permitted scope of
practice under State law, and other
professionals or paraprofessionals with
appropriate expertise in behavioral
health or mental health crisis
response, including nurses, social
workers, peer support specialists, and
others, as designated by the State in
the State plan amendment under this
subsection;
``(II) whose members are trained in
trauma-informed care, de-escalation
strategies, and harm reduction;
``(III) that is able to respond in
a timely manner and, where appropriate,
provide--
``(aa) screening and
assessment;
``(bb) stabilization and
de-escalation; and
``(cc) coordination with,
and referrals to, health,
social, and other services and
supports as needed, and health
services as needed;
``(IV) that maintains relationships
with relevant community partners,
including medical and behavioral health
providers, primary care providers,
community health centers, crisis
respite centers, and managed care
organizations (if applicable); and
``(V) that maintains the privacy
and confidentiality of patient
information consistent with Federal and
State requirements; and
``(iii) available 24 hours per day, every
day of the year.
``(H) Supported employment.--The term `supported
employment' means ongoing supports that are furnished
to individuals who, because of their serious mental
illness, need intensive support to obtain and maintain
an individual job in competitive or customized
employment, or self-employment, in an integrated work
setting in the general workforce at or above their
State's minimum wage, but not less than the customary
wage and level of benefits paid by the employer for the
same or similar work performed by individuals without
disabilities. The desired outcome of all supported
employment services is sustained paid employment at or
above the minimum wage in an integrated setting in the
general workforce, in a job that meets personal and
career goals.
``(3) Increase fmap for medical assistance for intensive
community-based services.--
``(A) In general.--During each fiscal quarter that
a State meets the requirements described in
subparagraphs (B) through (D), the Federal medical
assistance percentage applicable to the State for the
quarter (as determined under section 1905(b) without
regard to any adjustments applicable under such section
or any other provision of law) shall be increased by
the applicable number of percentage points (as
determined under subparagraph (E) but not to exceed 100
percent) with respect to amounts expended by the State
for medical assistance for intensive community-based
services furnished to eligible individuals during such
quarter under a State plan amendment under this
subsection.
``(B) Service quality criteria.--
``(i) In general.--The State shall provide
eligible individuals with intensive community-
based services in accordance with such quality
criteria as the Secretary shall by regulation
establish.
``(ii) Criteria requirements.--The criteria
established by the Secretary under clause (i)
shall be designed to ensure that eligible
individuals receive the intended benefits of
receipt of the services, including avoiding
preventable hospital