CAHOOTS Act

I 117TH CONGRESS 1ST SESSION H. R. 1914 To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 16, 2021 Mr. DEFAZIO (for himself, Mr. BLUMENAUER, Ms. BONAMICI, Ms. NORTON, Mrs. HAYES, Mr. THOMPSON of California, and Ms. PRESSLEY) intro- duced 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 encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other pur- poses. 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 ‘‘Crisis Assistance Help- 4 ing Out On The Streets Act’’ or the ‘‘CAHOOTS Act’’. 5 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1914 IH SEC. 2. ENHANCED FEDERAL MEDICAID SUPPORT FOR 1 COMMUNITY-BASED MOBILE CRISIS INTER- 2 VENTION SERVICES. 3 Section 1903 of the Social Security Act (42 U.S.C. 4 1396b) is amended by adding at the end the following new 5 subsection: 6 ‘‘(cc) COMMUNITY-BASED MOBILE CRISIS INTER- 7 VENTION SERVICES.— 8 ‘‘(1) IN GENERAL.—Notwithstanding section 9 1902(a)(1) (relating to Statewideness), section 10 1902(a)(10)(B) (relating to comparability), section 11 1902(a)(23)(A) (relating to freedom of choice of 12 providers), or section 1902(a)(27) (relating to pro- 13 vider agreements), a State may provide medical as- 14 sistance for qualifying community-based mobile cri- 15 sis intervention services under a State plan amend- 16 ment or waiver approved under section 1115 or 17 1915. 18 ‘‘(2) QUALIFYING COMMUNITY-BASED MOBILE 19 CRISIS INTERVENTION SERVICES DEFINED.—For 20 purposes of this subsection, the term ‘qualifying 21 community-based mobile crisis intervention services’ 22 means, with respect to a State, items and services 23 for which medical assistance is available under the 24 State plan under this title or a waiver of such plan, 25 that are— 26 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1914 IH ‘‘(A) furnished outside of a hospital or 1 other facility setting to an individual who is— 2 ‘‘(i) entitled to medical assistance 3 under such plan or waiver; and 4 ‘‘(ii) experiencing a mental health or 5 substance use disorder crisis; 6 ‘‘(B) furnished by a multidisciplinary mo- 7 bile crisis team— 8 ‘‘(i) that includes at least 1 behavioral 9 health care professional who is capable of 10 conducting an assessment of the individual, 11 in accordance with the professional’s per- 12 mitted scope of practice under State law, 13 and other professionals or paraprofes- 14 sionals with appropriate expertise in behav- 15 ioral health or mental health crisis re- 16 sponse, including nurses, social workers, 17 peer support specialists, and others, as 18 designated by the State and approved by 19 the Secretary; 20 ‘‘(ii) whose members are trained in 21 trauma-informed care, de-escalation strate- 22 gies, and harm reduction; 23 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1914 IH ‘‘(iii) that is able to respond in a 1 timely manner and, where appropriate, 2 provide the following— 3 ‘‘(I) screening and assessment; 4 ‘‘(II) stabilization and de-esca- 5 lation; 6 ‘‘(III) coordination with, and re- 7 ferrals to, health, social, and other 8 services and supports as needed; and 9 ‘‘(IV) facilitate an individual into 10 the State’s Medicaid transportation 11 process to ensure access to the next 12 step in care or treatment; 13 ‘‘(iv) that maintains relationships with 14 relevant community partners, including 15 medical, primary care, and behavioral 16 health providers, community health cen- 17 ters, crisis respite centers, managed care 18 organizations (if applicable), entities able 19 to provide assistance with application and 20 enrollment in the State plan or a waiver of 21 the plan, entitles able to provide assistance 22 with applying for and enrolling in benefit 23 programs, entities that provide assistance 24 with housing (such as public housing au- 25 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1914 IH thorities, Continuum of Care programs, or 1 not-for-profit entities that provide housing 2 assistance), and entities that provide as- 3 sistance with other social services; 4 ‘‘(v) that coordinates with crisis inter- 5 vention hotlines and emergency response 6 systems; 7 ‘‘(vi) that maintains the privacy and 8 confidentiality of patient information con- 9 sistent with Federal and State require- 10 ments; and 11 ‘‘(vii) that operates independently 12 from (but may coordinate with) State or 13 local law enforcement agencies; 14 ‘‘(C) available 24 hours per day, every day 15 of the year; and 16 ‘‘(D) voluntary to receive. 17 ‘‘(3) PAYMENTS.— 18 ‘‘(A) IN GENERAL.—Notwithstanding sec- 19 tion 1905(b), beginning October 1, 2020, dur- 20 ing each of the first 12 fiscal quarters that a 21 State meets the requirements described in para- 22 graph (4), the Federal medical assistance per- 23 centage applicable to amounts expended by the 24 State for medical assistance for qualifying com- 25 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1914 IH munity-based mobile crisis intervention services 1 furnished during such quarter shall be equal to 2 95 percent. 3 ‘‘(B) EXCLUSION OF ENHANCED PAY- 4 MENTS FROM TERRITORIAL CAPS.—To the ex- 5 tent that the amount of a payment to Puerto 6 Rico, the Virgin Islands, Guam, the Northern 7 Mariana Islands, or American Samoa for med- 8 ical assistance for qualifying community-based 9 mobile crisis intervention services that is based 10 on the Federal medical assistance percentage 11 specified in subparagraph (A) exceeds the 12 amount that would have been paid to such ter- 13 ritory for such services if the Federal medical 14 assistance percentage for the territory had been 15 determined without regard to such subpara- 16 graph— 17 ‘‘(i) the limitation on payments to ter- 18 ritories under subsections (f) and (g) of 19 section 1108 shall not apply to the amount 20 of such excess; and 21 ‘‘(ii) the amount of such excess shall 22 be disregarded in applying such sub- 23 sections. 24 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 1914 IH ‘‘(4) REQUIREMENTS.—The requirements de- 1 scribed in this paragraph are the following: 2 ‘‘(A) The State demonstrates, to the satis- 3 faction of the Secretary— 4 ‘‘(i) that it will be able to support the 5 provision of qualifying community-based 6 mobile crisis intervention services that 7 meet the conditions specified in paragraph 8 (2); and 9 ‘‘(ii) how it will support coordination 10 between mobile crisis teams and commu- 11 nity partners, including health care pro- 12 viders, to enable the provision of services, 13 needed referrals, and other activities iden- 14 tified by the Secretary. 15 ‘‘(B) The State provides assurances satis- 16 factory to the Secretary that— 17 ‘‘(i) any additional Federal funds re- 18 ceived by the State for qualifying commu- 19 nity-based mobile crisis intervention serv- 20 ices provided under this subsection that 21 are attributable to the increased Federal 22 medical assistance percentage under para- 23 graph (3)(A) will be used to supplement, 24 and not supplant, the level of State funds 25 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 1914 IH expended for such services in the fiscal 1 year preceding the first fiscal year in which 2 the State elected to provide medical assist- 3 ance under this subsection; 4 ‘‘(ii) if the State made qualifying com- 5 munity-based mobile crisis intervention 6 services available in a region of the State 7 in such preceding fiscal year, the State will 8 continue to make such services available in 9 such region under this subsection; and 10 ‘‘(iii) the State will conduct the eval- 11 uation and assessment, and submit the re- 12 port, required under paragraph (5). 13 ‘‘(5) STATE EVALUATION AND REPORT.— 14 ‘‘(A) STATE EVALUATION.—Not later than 15 4 fiscal quarters after a State begins providing 16 qualifying community-based mobile crisis inter- 17 vention services in accordance with this sub- 18 section, the State shall enter into a contract 19 with an independent entity or organization to 20 conduct an evaluation for the purposes of— 21 ‘‘(i) determining the effect of the pro- 22 vision of such services on— 23 ‘‘(I) emergency room visits; 24 ‘‘(II) use of ambulatory services; 25 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 1914 IH ‘‘(III) hospitalizations; 1 ‘‘(IV) the involvement of law en- 2 forcement in mental health or sub- 3 stance use disorder crisis events; 4 ‘‘(V) the diversion of individuals 5 from jails or similar settings; and 6 ‘‘(ii) assessing— 7 ‘‘(I) the types of services pro- 8 vided to individuals; 9 ‘‘(II) the types of events re- 10 sponded to; 11 ‘‘(III) cost savings or cost-effec- 12 tiveness attributable to such services; 13 ‘‘(IV) the experiences of individ- 14 uals who receive qualifying commu- 15 nity-based mobile crisis intervention 16 services; 17 ‘‘(V) the successful connection of 18 individuals with follow-up services; 19 and 20 ‘‘(VI) other relevant outcomes 21 identified by the Secretary. 22 ‘‘(B) COMPARISON TO HISTORICAL MEAS- 23 URES.—The contract described in subparagraph 24 (A) shall specify that the evaluation is based on 25 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 1914 IH a comparison of the historical measures of 1 State performance with respect to the outcomes 2 specified under such subparagraph to the 3 State’s performance with respect to such out- 4 comes during the period beginning with the 5 first quarter in which the State begins pro- 6 viding qualifying community-based mobile crisis 7 intervention services in accordance with this 8 subsection. 9 ‘‘(C) REPORT.—Not later than 2 years 10 after a State begins to provide qualifying com- 11 munity-based mobile crisis intervention services 12 in accordance with this subsection, the State 13 shall submit a report to the Secretary on the 14 following: 15 ‘‘(i) The results of the evaluation car- 16 ried out under subparagraph (A). 17 ‘‘(ii) The number of individuals who 18 received qualifying community-based mo- 19 bile crisis intervention services. 20 ‘‘(iii) Demographic information re- 21 garding such individuals when available, 22 including the race or ethnicity, age, sex, 23 sexual orientation, gender identity, and ge- 24 ographic location of such individuals. 25 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 1914 IH ‘‘(iv) The processes and models devel- 1 oped by the State to provide qualifying 2 community-based mobile crisis intervention 3 services under such the State plan or waiv- 4 er, including the processes developed to 5 provide referrals for, or coordination with, 6 follow-up care and services. 7 ‘‘(v) Lessons learned regarding the 8 provision of such services. 9 ‘‘(D) PUBLIC AVAILABILITY.—The State 10 shall make the report required under subpara- 11 graph (C) publicly available, including on the 12 website of the appropriate State agency, upon 13 submission of such report to the Secretary. 14 ‘‘(6) BEST PRACTICES REPORT.— 15 ‘‘(A) IN GENERAL.—Not later than 3 years 16 after the first State begins to provide qualifying 17 community-based mobile crisis intervention 18 services in accordance with this subsection, the 19 Secretary shall submit a report to Congress 20 that— 21 ‘‘(i) identifies the States that elected 22 to provide services in accordance with this 23 subsection; 24 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 1914 IH ‘‘(ii) summarizes the information re- 1 ported by such States under paragraph 2 (5)(C); and 3 ‘‘(iii) identifies best practices for the 4 effective delivery of community-based mo- 5 bile crisis intervention services. 6 ‘‘(B) PUBLIC AVAILABILITY.—The report 7 required under subparagraph (A) shall be made 8 publicly available, including on the website of 9 the Department of Health and Human Services, 10 upon submission to Congress. 11 ‘‘(7) STATE PLANNING AND EVALUATION 12 GRANTS.— 13 ‘‘(A) IN GENERAL.—As soon as practicable 14 after the date of enactment of this subsection, 15 the Secretary may award planning and evalua- 16 tion grants to States for purposes of developing 17 a State plan amendment or section 1115 or 18 1915 waiver request (or an amendment to such 19 a waiver) to provide qualifying community- 20 based mobile crisis intervention services and 21 conducting the evaluation required under para- 22 graph (5)(A). A grant awarded to a State 23 under this paragraph shall remain available 24 until expended. 25 VerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914 pamtmann on DSKBC07HB2PROD with BILLS 13 •HR 1914 IH ‘‘(B) STATE CONTRIBUTION.—A State 1 awarded a grant under this subsection shall 2 contribute for each fiscal year for which the 3 grant is awarded an amount equal to the State 4 percentage determined under section 1905(b) 5 (without regard to the temporary increase in 6 the Federal medical assistance percentage of 7 the State under section 6008(a) of the Families 8 First Coronavirus Response Act (Public Law 9 116–127) or any other temporary increase in 10 the Federal medical assistance percentage of 11 the State for fiscal year 2020 or any succeeding 12 fiscal year) of the grant amount. 13 ‘‘(8) FUNDING.— 14 ‘‘(A) IMPLEMENTATION AND ADMINISTRA- 15 TION.—There is appropriated to the Secretary, 16 out of any funds in the Treasury n [Text truncated for display. 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