What This Bill Does
This bill changes Medicaid rules to allow payment for medical care given to patients in mental health institutions. Currently, Medicaid does not cover these services. The bill removes this restriction if states submit plans showing how they will provide outpatient (non-hospital) behavioral health care to these patients.
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Who It Affects
States that run Medicaid programs, patients receiving mental health treatment in institutions, outpatient and community-based behavioral health providers, first responders, Medicaid managed care organizations (companies contracted to manage Medicaid benefits), and the federal Secretary of Health and Human Services.
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Key Provisions
- States must create and submit annual plans showing how they will increase access to outpatient and community-based behavioral health care for people transitioning out of mental health institutions (Sec. 2(b)(D)(i))
- States must expand availability of crisis services including crisis call centers, mobile crisis units, observation centers, and ongoing community-based services for people experiencing serious mental illness, serious emotional disturbance, or substance use disorder crisis (Sec. 2(b)(D)(ii))
- States must show improved data sharing and coordination between physical health providers, mental health providers, addiction treatment providers, hospitals, and first responders (Sec. 2(b)(D)(iii))
- States must demonstrate policies ensuring patients in psychiatric hospitals are screened for physical health conditions and substance use disorders, with capacity to address these conditions during their stay (Sec. 2(b)(E)(i))
- States must report annually to the federal government on costs, patient numbers, length of stays, and types of outpatient treatment provided to patients discharged from mental health institutions (Sec. 2(b)(F))
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What Changes
Medicaid will now be able to pay for medical care provided to patients in institutions for mental diseases if states submit the required plans. Language in the Social Security Act that previously excluded these services from medical assistance will be removed. Age restrictions (65 years or older) that currently apply to certain mental health coverage will be struck from the law.
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Important Definitions
The bill uses "serious mental illness," "serious emotional disturbance," and "substance use disorder crisis" as defined in title V of the Public Health Service Act. The bill defines "crisis stabilization services" as services including crisis call centers, mobile crisis units, observation or assessment centers, and ongoing community-based services such as intensive outpatient services and assertive community treatment.
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Effective Date
The amendments take effect on the date this bill becomes law and apply to state plans beginning on that date. States that need to change their own laws to comply have until the first day of the first calendar quarter beginning after the close of the first regular legislative session following when this bill becomes law.
I
118TH CONGRESS
1ST SESSION H. R. 1201
To amend title XIX of the Social Security Act to remove the exclusion
from medical assistance under the Medicaid Program of items and serv-
ices for patients in an institution for mental diseases, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 27, 2023
Mrs. NAPOLITANO (for herself, Ms. BARRAGA´N, Ms. WILD, Mr. CA´RDENAS,
and Ms. KAMLAGER-DOVE) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to remove
the exclusion from medical assistance under the Medicaid
Program of items and services for patients in an institu-
tion for mental diseases, and for other purposes.
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 ‘‘Increasing Behavioral
4
Health Treatment Act’’.
5
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•HR 1201 IH
SEC. 2. REMOVAL OF MEDICAID EXCLUSION FROM MED-
1
ICAL ASSISTANCE OF ITEMS AND SERVICES
2
FURNISHED TO PATIENTS IN AN INSTITU-
3
TION FOR MENTAL DISEASES IF STATE SUB-
4
MITS PLAN FOR PROVIDING APPROPRIATE
5
OUTPATIENT CARE TO SUCH PATIENTS.
6
(a) REMOVAL OF EXCLUSION.—
7
(1) IN GENERAL.—The first sentence of section
8
1905(a) of the Social Security Act (42 U.S.C.
9
1396d(a)) is amended, in the matter following para-
10
graph (30)—
11
(A) by striking ‘‘such term does not in-
12
clude—’’ and all that follows through ‘‘(A) any’’
13
and inserting ‘‘such term does not include any’’;
14
(B) by striking ‘‘; or’’ and inserting a pe-
15
riod; and
16
(C) by striking subparagraph (B).
17
(2) CONFORMING
AMENDMENTS
TO
PERMIT
18
MEDICAL ASSISTANCE FOR IMD PATIENTS UNDER 65
19
YEARS OF AGE.—The following provisions of such
20
Act are each amended by striking ‘‘65 years of age
21
or older’’ and ‘‘65 years of age or over’’ each place
22
it appears:
23
(A) Paragraphs (20) and (21) of section
24
1902(a) (42 U.S.C. 1396a(a)).
25
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•HR 1201 IH
(B)
Section
1905(a)(14)
(42
U.S.C.
1
1396d(a)(14)).
2
(C) Section 1919(e)(7)(B)(i)(I) (42 U.S.C.
3
1396r(e)(7)(B)(i)(I)).
4
(b) REPORTING AND PLAN REQUIREMENT.—Section
5
1902(a)(20) of the Social Security Act (42 U.S.C.
6
1396a(a)(20)) is amended—
7
(1) in subparagraph (B), by striking at the end
8
‘‘and’’;
9
(2) by adding at the end the following new sub-
10
paragraphs:
11
‘‘(D) provide for a plan to achieve (and for
12
the annual submission to the Secretary of ac-
13
tions taken by the State, and progress with re-
14
spect to such actions, to achieve)—
15
‘‘(i) increased access to outpatient and
16
community-based behavioral health care,
17
with respect to individuals furnished serv-
18
ices in an institution for mental diseases,
19
especially for individuals transitioning from
20
such an institution;
21
‘‘(ii) increased availability of services
22
made available through crisis call centers,
23
mobile crisis units, coordinated community
24
crisis response that involves law enforce-
25
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•HR 1201 IH
ment and other first responders, observa-
1
tion or assessment centers, and on-going
2
community-based services (such as inten-
3
sive outpatient services, assertive commu-
4
nity treatment, and services in integrated
5
care settings such as the Certified Commu-
6
nity Behavioral Health Clinic model) (such
7
services referred to as crisis stabilization
8
services) for individuals experiencing a se-
9
rious mental illness (as such term is de-
10
fined for purposes of title V of the Public
11
Health Service Act), serious emotional dis-
12
turbance, or substance use disorder crisis;
13
‘‘(iii) improved data sharing and co-
14
ordination between physical health, mental
15
health, and addiction treatment providers
16
(including hospitals and community-based
17
behavioral health facilities) and first re-
18
sponders to improve health outcomes for
19
individuals furnished services in an institu-
20
tion for mental diseases, who are experi-
21
encing a serious mental illness (as so de-
22
fined), serious emotional disturbance, or
23
substance use disorder crisis;
24
‘‘(E) provide for the demonstration of—
25
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•HR 1201 IH
‘‘(i) State policies to ensure individ-
1
uals receiving medical assistance under the
2
State plan who receive care in psychiatric
3
hospitals and residential treatment settings
4
are consistently screened for co-morbid
5
physical health conditions and substance
6
use disorders prior to or upon admission,
7
and that participating facilities have the
8
capacity to address co-morbid physical
9
health conditions during stays in such psy-
10
chiatric hospitals and residential treatment
11
settings either through on-site medical
12
services or external referrals and care co-
13
ordination;
14
‘‘(ii) established strategies of the
15
State for identifying and engaging individ-
16
uals, particularly adolescents and young
17
adults, experiencing a serious mental ill-
18
ness (as such term is defined for purposes
19
of title V of the Public Health Service
20
Act), serious emotional disturbance, or
21
substance use disorder crisis; and
22
‘‘(iii) established utilization review
23
policies of the State Medicaid agency or
24
Medicaid managed care organizations, as
25
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•HR 1201 IH
applicable, to ensure individuals receiving
1
medical assistance under the State plan re-
2
ceive treatment at clinically appropriate
3
levels of care and services are generally de-
4
livered in the least restrictive environment;
5
and
6
‘‘(F) report to the Secretary (in a form
7
and manner specified by the Secretary), with
8
respect to each year beginning on or after the
9
date of the enactment of this subparagraph—
10
‘‘(i) in the aggregate and by facility
11
type, costs and utilization for institutions
12
for mental diseases and inpatient psy-
13
chiatric hospitals that are not such institu-
14
tions;
15
‘‘(ii) the number of individuals experi-
16
encing a serious mental illness (as such
17
term is defined for purposes of title V of
18
the Public Health Service Act), serious
19
emotional disturbance, or substance use
20
disorder crisis who received medical assist-
21
ance under the State plan during the year;
22
‘‘(iii) the length of the stay of each
23
such individual in an institution for mental
24
disease; and
25
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•HR 1201 IH
‘‘(iv) the type of outpatient treatment,
1
including medication assisted treatment,
2
each such individual received after being
3
discharged from such institution;’’.
4
(c) EFFECTIVE DATE.—
5
(1) IN GENERAL.—Subject to paragraph (2),
6
the amendments made by this section shall take ef-
7
fect on the date of the enactment of this Act and
8
shall apply to State plans beginning on such date.
9
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
10
QUIRED.—In the case of a State plan for medical as-
11
sistance under title XIX of the Social Security Act
12
which the Secretary of Health and Human Services
13
determines requires State legislation (other than leg-
14
islation appropriating funds) in order for the plan to
15
meet the additional requirement imposed by the
16
amendments made by this section, the State plan
17
shall not be regarded as failing to comply with the
18
requirements of such title solely on the basis of its
19
failure to meet this additional requirement before
20
the first day of the first calendar quarter beginning
21
after the close of the first regular session of the
22
State legislature that begins after the date of the en-
23
actment of this Act. For purposes of the previous
24
sentence, in the case of a State that has a 2-year
25
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•HR 1201 IH
legislative session, each year of such session shall be
1
deemed to be a separate regular session of the State
2
legislature.
3
Æ
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