[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3402 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 3402
To amend titles XVIII and XIX of the Social Security Act and the Public
Health Service Act to improve the certified community behavioral health
clinic program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 9, 2025
Mr. Cornyn (for himself, Ms. Smith, Mr. Tillis, and Ms. Cortez Masto)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act and the Public
Health Service Act to improve the certified community behavioral health
clinic program, 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--STRENGTHENING AND PROVIDING COST-RELATED PAYMENT FOR CERTIFIED
COMMUNITY BEHAVIORAL HEALTH CLINICS IN THE MEDICAID PROGRAM
Sec. 101. Coordination of Medicaid-certified community behavioral
health services with community behavioral
health clinics operating grant program;
community behavioral health clinics
accreditation option.
Sec. 102. Establishing a Medicaid prospective payment system for
certified community behavioral health
clinics.
Sec. 103. Expanding certified community behavioral health clinic
services within Medicaid demonstration
program.
Sec. 104. Expanding certified community behavioral health clinic
services covered under the Medicaid State
plan.
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.
Sec. 202. Payment for certified community behavioral health clinic
services under the Medicare program.
Sec. 203. Non-application of Medicare part B deductible for certified
community behavioral health clinic
services.
Sec. 204. Right to seek Payment Reimbursement Review Board review of
cost reports.
Sec. 205. Extending safe harbor under anti-kickback statute to waivers
of certified community behavioral health
clinic coinsurance.
Sec. 206. Effective date.
TITLE III--COMMUNITY BEHAVIORAL HEALTH CLINICS
Sec. 301. Community behavioral health clinics.
TITLE IV--LIABILITY PROTECTION FOR CERTIFIED COMMUNITY BEHAVIORAL
HEALTH CLINIC CLINICIANS
Sec. 401. Conferring protection under the Federal Tort Claims Act to
clinicians in certified community
behavioral health clinics.
TITLE I--STRENGTHENING AND PROVIDING COST-RELATED PAYMENT FOR CERTIFIED
COMMUNITY BEHAVIORAL HEALTH CLINICS IN THE MEDICAID PROGRAM
SEC. 101. COORDINATION OF MEDICAID-CERTIFIED COMMUNITY BEHAVIORAL
HEALTH SERVICES WITH COMMUNITY BEHAVIORAL HEALTH CLINICS
OPERATING GRANT PROGRAM; COMMUNITY BEHAVIORAL HEALTH
CLINICS ACCREDITATION OPTION.
Section 1905(jj) of the Social Security Act (42 U.S.C. 1396d(jj))
is amended--
(1) in paragraph (2)(C), by inserting before the period at
the end ``and including any such data as the State, by
agreement with the Secretary, shall access via the system
described in section 340J-3 of the Public Health Service
Act.''; and
(2) by adding at the end the following new paragraph:
``(3) Accreditation.--In the case of services furnished on
or after January 1, 2026, at the option of the State, a State
may determine that an organization does not meet such criteria
as the Secretary may establish for certified community
behavioral health clinics pursuant to section 223 of the
Protecting Access to Medicare Act unless the organization has
received accreditation by an accreditation body approved under
section 340J-4 of the Public Health Service Act. An election by
a State under the preceding sentence shall not relieve a State
of the requirement to certify an organization under paragraph
(2)(A).''.
SEC. 102. 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:
``(yy) Payment for Services Provided by Certified Community
Behavioral Health Clinics.--
``(1) In general.--Beginning with fiscal year 2026, with
respect to services furnished on or after January 1, 2026, and
each succeeding fiscal year, a State that has elected in its
State plan under this title to furnish the services described
in section 1905(a)(31) shall provide under the plan for payment
for services furnished by a certified community behavioral
health clinic described in section 1905(jj)(2) (in this
subsection referred to as a `clinic') in accordance with the
provisions of this subsection.
``(2) Payment for services in initial year.--
``(A) In general.--Subject to subparagraphs (B) and
(C) and the succeeding provisions of this subsection,
and in accordance with paragraph (1), for services
furnished by a clinic in the first fiscal year
beginning after September 30, 2025, for which a State
elects to provide for payment for services described in
section 1905(a)(31), 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 which are
reasonable and related to the furnishing such services
during a base year corresponding to the fiscal year
preceding such initial fiscal year.
``(B) Additional payment considerations.--
``(i) In general.--A State may elect in its
State plan to carry out any of the following,
consistent with the methodology described in
guidance issued under the authority of section
223(b) of the Protecting Access to Medicare
Act:
``(I) Establishing separate
prospective payment system rates for
special populations.
``(II) Using a system of outlier
payments for a portion of costs of
furnishing the covered benefit.
``(III) With respect to the crisis
services included within the benefit
described in section 1905(a)(31)--
``(aa) requiring that
clinics, in their cost reports,
segregate costs relating to
mobile crisis teams, emergency
crisis intervention services,
or crisis stabilization as
components of the covered
benefit described in section
1905(a)(31); and
``(bb) providing for a
prospective payment system rate
for any or all of such crisis
services, distinct from the
rate encompassing the remainder
of the services described in
section 1905(a)(31).
``(ii) States with pama demonstration
programs.--If a State electing to furnish
services described in section 1905(a)(31) under
its State plan, as of the year prior to the
initial fiscal year described above, operated a
demonstration program under section 223 of the
Protecting Access to Medicare Act, such State
may elect under the State plan to establish as
its initial rate under this paragraph, for any
clinic that participated in such demonstration,
the rate that would otherwise have applied
under the demonstration.
``(iii) Use of estimated or projected
data.--In the absence of complete actual cost
data representing the provision of the full
covered benefit in such base year, the State
may provide in its State plan amendment to
allow clinics to use estimated or projected
data relating to specific services for which
they lack cost experience.
``(C) Inflation adjustment.--The per-unit rate
derived from the cost data described in subparagraph
(A) shall be annually adjusted by the inflationary
factor described in section 1834(aa)(2)(C), and 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 subsequent fiscal years.--
Subject to the succeeding provisions of this subsection, for
services described in section 1905(a)(31) furnished by a clinic
after the initial fiscal year 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 fiscal year--
``(A) increased by the percentage increase in the
inflationary factor described in section 1834(aa)(2)(C)
for such fiscal year; 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 fiscal year payment for new
clinics.--
``(A) In general.--In any case in which an entity
first qualifies as a certified community behavioral
health clinic in a year after the first fiscal year in
which the State first provides for payment for the
services described in section 1905(a)(31) in accordance
with paragraph (1), the State plan shall provide for
payment for such services in the first fiscal year 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 reasonable projected costs per
visit of the clinic.
``(B) Additional requirement.--Not later than the
second fiscal year in which a clinic described in
subparagraph (A) furnishes services described in
section 1905(a)(31)--
``(i) the State shall establish a unique
payment rate for the clinic based on the
methodology described in paragraph (2), using
reasonable and related costs from the clinic's
first fiscal year of operation as the basis for
establishing such rates; and
``(ii) in any year following the
establishment of an initial rate under this
subparagraph, the State plan shall provide for
the payment amount to be adjusted in accordance
with paragraph (3) and (as applicable)
reestablished in accordance with paragraph (5).
``(5) Optional periodic rebase of pps rates.--
Notwithstanding the preceding paragraphs, a State may elect in
its State plan amendment to establish a new prospective payment
system rate for clinics on a periodic basis. Under such an
election, periodically (but not less frequently than every 3rd
fiscal year) after the initial year, as described in paragraph
(2), in which the State first furnishes the services described
in section 1905(a)(31), the State shall set a new rebased rate
for each clinic whose rate was initially set pursuant to
paragraph (2), except that costs from the fiscal year preceding
such rebasing year, rather than costs from the base year
described in paragraph (2), shall be used in establishing a new
cost-related rate for each clinic. States electing this option
shall also follow this methodology and schedule in periodically
establishing new rates for those clinics whose initial rates
were set as described in paragraph (4).
``(6) 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 shall provide for
payment to the clinic by the State of a supplemental
payment equal to the amount (if any) by which the
amount determined under the preceding paragraphs of
this subsection or as applicable, paragraph (7),
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 not
less frequently than every 3 months.
``(B) Option to delegate pps payment to managed
care entities through an alternative payment
methodology.--
``(i) In general.--Notwithstanding
subparagraph (A), nothing in this subsection
shall be interpreted to preclude a State from
amending its State plan to provide for an
alternative payment methodology in accordance
with paragraph (7), under which the State may
delegate to a managed care entity (as defined
in section 1932(a)(1)(B)) the responsibility to
pay the clinic at least the rate determined
under the preceding subparagraphs or as
applicable, paragraph (7).
``(ii) Requirements.--In making a
delegation under clause (i), a State shall
ensure that it complies with the requirements
described in paragraph (7) and shall use
reconciliation and oversight processes to
ensure that each clinic is paid at least the
amounts required under the preceding paragraphs
of this subsection.
``(7) Alternative payment methodologies.--Notwithstanding
any other provision of this subsection, a State plan may
provide for payment in any year to a certified community
behavioral health clinic for services described in section
1905(a)(31) 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.''.
SEC. 103. EXPANDING CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC
SERVICES WITHIN MEDICAID DEMONSTRATION PROGRAM.
(a) Additional Services Within Demonstration Program.--
(1) In general.--Section 223(a)(2)(D) of the Protecting
Access to Medicare Act of 2014 (42 U.S.C. 1396a note), is
amended to read as follows:
``(D) Scope of services.--Provision (in a manner
reflecting person-centered care) of at least the
following required services described in clause (i),
which may be furnished either directly or, if not
available directly, through formal relationships with
other providers, and at the discretion of the certified
community behavioral health clinic, at least 1 of the
following additional services described in clause (ii)
furnished directly by the clinic:
``(i) Required services.--
``(I) Crisis mental health
services, including 24-hour mobile
crisis teams, emergency crisis
intervention services, and crisis
stabilization.
``(II) Screening, assessment, and