Behavioral Health Crisis Services Expansion Act

II 117TH CONGRESS 1ST SESSION S. 1902 To empower communities to establish a continuum of care for individuals experiencing mental or behavioral health crisis, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 27, 2021 Ms. CORTEZ MASTO (for herself and Mr. CORNYN) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To empower communities to establish a continuum of care for individuals experiencing mental or behavioral health crisis, 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 ‘‘Behavioral Health Cri- 4 sis Services Expansion Act’’. 5 SEC. 2. CRISIS RESPONSE CONTINUUM OF CARE. 6 (a) IN GENERAL.—The Secretary of Health and 7 Human Services (in this section referred to as the ‘‘Sec- 8 retary’’) shall establish standards for a continuum of care 9 VerDate Sep 11 2014 02:37 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1902 IS for use by health care providers and communities in re- 1 sponding to individuals experiencing a mental or behav- 2 ioral health crisis, including those individuals with co-oc- 3 curring substance use disorders (referred to in this section 4 as the ‘‘crisis response continuum’’). 5 (b) REQUIREMENTS.— 6 (1) SCOPE OF STANDARDS.—Such standards 7 shall define— 8 (A) minimum requirements of core crisis 9 services, as determined by the Secretary, to in- 10 clude requirements that each entity that fur- 11 nishes such services should— 12 (i) not require prior authorization 13 from an insurance provider nor referral 14 from a health care provider prior to the de- 15 livery of services; 16 (ii) serve all individuals regardless of 17 age or ability to pay; 18 (iii) operate 24 hours a day, 7 days a 19 week, and provide care to all individuals; 20 and 21 (iv) provide care and support through 22 resources described in paragraph (2)(A) 23 until the individual has been stabilized or 24 VerDate Sep 11 2014 02:37 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1902 IS transfer the individual to the next level of 1 crisis care; and 2 (B) psychiatric stabilization, including the 3 point at which a case may be closed for— 4 (i) individuals screened over the 5 phone; and 6 (ii) individuals stabilized on the scene 7 by mobile teams. 8 (2) IDENTIFICATION OF ESSENTIAL FUNC- 9 TIONS.—The Secretary shall identify the essential 10 functions of each service in the crisis response con- 11 tinuum, which shall include at least the following: 12 (A) Identification of resources for referral 13 and enrollment in continuing behavioral health 14 and other human services for the individual in 15 crisis where necessary. 16 (B) Delineation of access and entry points 17 to services within the crisis response continuum. 18 (C) Development of and adherence to pro- 19 tocols and agreements for the transfer and re- 20 ceipt of individuals to and from other segments 21 of the crisis response continuum segments as 22 needed, and from outside referrals including 23 health care providers, law enforcement, EMS, 24 VerDate Sep 11 2014 02:37 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1902 IS fire, education institutions, and community- 1 based organizations. 2 (D) Description of the qualifications of cri- 3 sis services staff, including roles for physicians, 4 licensed clinicians, case managers, and peers (in 5 accordance with State licensing requirements). 6 (E) Requirements for the convention of 7 collaborative meetings of crisis response service 8 providers, first responders, and community 9 partners operating in a common region for the 10 discussion of case management, best practices, 11 and general performance improvement. 12 (3) SERVICE CAPACITY AND QUALITY STAND- 13 ARDS.—Such standards shall include definitions of— 14 (A) adequate volume of services to meet 15 population need; 16 (B) appropriate timely response; and 17 (C) capacity to meet the needs of different 18 patient populations, including all age groups, 19 cultural and linguistic minorities, and individ- 20 uals with co-occurring mental health and sub- 21 stance use disorder crisis, individuals with cog- 22 nitive disabilities experiencing behavioral health 23 crises, and individuals with chronic medical con- 24 VerDate Sep 11 2014 22:15 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1902 IS ditions and physical disabilities experiencing be- 1 havioral health crises. 2 (4) OVERSIGHT AND ACCREDITATION.—The 3 Secretary shall designate entities charged with the 4 oversight and accreditation of entities within the cri- 5 sis response continuum. 6 (5) IMPLEMENTATION TIMEFRAME.—Not later 7 than 1 year after the date of enactment of this Act, 8 the Secretary shall establish the standards under 9 this section. 10 (6) DATA COLLECTION AND EVALUATIONS.— 11 (A) IN GENERAL.—The Secretary, directly 12 or through grants, contracts, or interagency 13 agreements, shall collect data and conduct eval- 14 uations with respect to the provision of services 15 and programs offered on the crisis response 16 continuum for purposes of assessing the extent 17 to which the provision of such services and pro- 18 grams meet certain objectives and outcomes 19 measures as determined by the Secretary. Such 20 objectives shall include— 21 (i) a reduction in inappropriate ar- 22 rests of individuals who are in mental 23 health crisis; 24 VerDate Sep 11 2014 02:37 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1902 IS (ii) a reduction in inappropriate emer- 1 gency room admissions and readmissions; 2 and 3 (iii) evidence of adequate access to 4 crisis care centers and crisis bed services. 5 (B) RULEMAKING.—The Secretary shall 6 carry out this subsection through notice and 7 comment rulemaking, following a request for in- 8 formation from stakeholders. 9 (C) AUTHORIZATION OF APPROPRIA- 10 TIONS.—To carry out this subsection, there is 11 authorized to be appropriated such sums as are 12 necessary to remain available until expended. 13 (c) COMPONENTS OF CRISIS RESPONSE CON- 14 TINUUM.—The crisis response continuum consists of at 15 least the following components: 16 (1) CRISIS CALL CENTERS.—Regional clinically 17 managed crisis call centers that provide telephonic 18 crisis intervention capabilities. Such centers should 19 meet National Suicide Prevention Lifeline oper- 20 ational guidelines regarding suicide risk assessment 21 and engagement and offer air traffic control-quality 22 coordination of crisis care in real-time. 23 (2) MOBILE CRISIS RESPONSE TEAM.—Teams 24 of providers that are available to reach any indi- 25 VerDate Sep 11 2014 21:59 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1902 IS vidual in the service area in their home, workplace, 1 or any other community-based location of the indi- 2 vidual in crisis in a timely manner. 3 (3) CRISIS RECEIVING AND STABILIZATION FA- 4 CILITIES.—Subacute inpatient facilities and other 5 facilities specified by the Secretary that provide 6 short-term observation and crisis stabilization serv- 7 ices to all referrals, including the following services: 8 (A) 23-HOUR CRISIS STABILIZATION SERV- 9 ICES.—A direct care service that provides indi- 10 viduals in severe distress with up to 23 consecu- 11 tive hours of supervised care to assist with de- 12 escalating the severity of their crisis or need for 13 urgent care in a sub-acute inpatient setting. 14 (B) SHORT-TERM CRISIS RESIDENTIAL 15 SERVICES.—A direct care service that assists 16 with deescalating the severity of an individual’s 17 level of distress or need for urgent care associ- 18 ated with a substance use or mental health dis- 19 order in a residential setting. 20 (4) BEHAVIORAL HEALTH URGENT CARE FA- 21 CILITIES.—Ambulatory services available 12-24 22 hours per day, 7 days a week, where individuals ex- 23 periencing crisis can walk in without an appointment 24 VerDate Sep 11 2014 21:59 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1902 IS to receive crisis assessment, crisis intervention, 1 medication, and connection to continuity of care. 2 (5) ADDITIONAL FACILITIES AND PROVIDERS.— 3 The Secretary shall specify additional facilities and 4 health care providers as part of the crisis response 5 continuum, as the Secretary determines appropriate. 6 (d) RELATIONSHIP TO STATE LAW.— 7 (1) IN GENERAL.—Subject to paragraph (2), 8 the standards established under this section are min- 9 imum standards and nothing in this section may be 10 construed to preclude a State from establishing ad- 11 ditional standards, so long as such standards are not 12 inconsistent with the requirements of this section or 13 other applicable law. 14 (2) WAIVER OR MODIFICATION.—The Secretary 15 shall establish a process under which a State may 16 request a waiver or modification of a standard estab- 17 lished under this section. 18 SEC. 3. COVERAGE OF CRISIS RESPONSE SERVICES. 19 (a) COVERAGE UNDER THE MEDICARE PROGRAM.— 20 (1) IN GENERAL.—Section 1861(s)(2) of the 21 Social Security Act (42 U.S.C. 1395x(s)(2)) is 22 amended— 23 (A) in subparagraph (GG), by striking 24 ‘‘and’’ at the end; 25 VerDate Sep 11 2014 02:37 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1902 IS (B) in subparagraph (HH), by striking the 1 period at the end and inserting ‘‘; and’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(II) crisis response services as defined in sub- 5 section (lll);’’. 6 (2) CRISIS RESPONSE SERVICES DEFINED.— 7 Section 1861 of the Social Security Act (42 U.S.C. 8 1395x) is amended by adding at the end the fol- 9 lowing new subsection: 10 ‘‘Crisis Response Services Defined 11 ‘‘(lll)(1) IN GENERAL.—The term ‘crisis response 12 services’ means mental or behavioral health services that 13 are furnished by a mobile crisis response team, a crisis 14 receiving and stabilization facility, behavioral health ur- 15 gent care facility, or other appropriate provider, as deter- 16 mined by the Secretary, to an individual experiencing a 17 mental or behavioral health crisis. Such term includes 18 services identified by the Secretary as part of the crisis 19 response continuum of care under section 2 of the Behav- 20 ioral Health Crisis Services Expansion Act. 21 ‘‘(2) DEFINITIONS.—In this subsection, the terms 22 ‘mobile crisis response team’, ‘crisis receiving and sta- 23 bilization facility’, and ‘behavioral health urgent care facil- 24 VerDate Sep 11 2014 02:37 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1902 IS ity’ have the meaning given those terms for purposes of 1 such section.’’. 2 (3) PAYMENT.—Section 1833(a)(1) of the So- 3 cial Security Act (42 U.S.C. 1395l(a)(1)) is amend- 4 ed— 5 (A) by striking ‘‘and (DD)’’ and inserting 6 ‘‘(DD)’’; and 7 (B) by inserting before the semicolon at 8 the end the following: ‘‘and (EE) with respect 9 to crisis response services described in section 10 1861(s)(2)(II), the amounts paid shall be 80 11 percent of the lesser of the actual charge for 12 the service or the fee schedule amount provided 13 under section 1848’’. 14 (4) AMBULANCE TRANSPORT OF INDIVIDUALS 15 IN CRISIS.— 16 (A) IN GENERAL.—Section 1834(l) of the 17 Social Security Act (42 U.S.C. 1395m(l)) is 18 amended by adding at the end the following 19 new paragraph: 20 ‘‘(18) TRANSPORTATION OF INDIVIDUALS IN 21 CRISIS.—With respect to ambulance services fur- 22 nished on or after the date that is 3 years after the 23 date of the enactment of the Behavioral Health Cri- 24 sis Services Expansion Act, the regulations described 25 VerDate Sep 11 2014 21:59 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 11 •S 1902 IS in section 1861(s)(7) shall provide coverage under 1 such section for ambulance services to transport an 2 individual experiencing a mental or behavioral health 3 crisis to an appropriate facility, such as a commu- 4 nity mental health center (as defined in section 5 1861(ff)(3)(B)) or other facility or provider identi- 6 fied by the Secretary as part of the crisis response 7 continuum of care under section 2 of the Behavioral 8 Health Crisis Services Expansion Act, as appro- 9 priate, for crisis response services described in sec- 10 tion 1861(s)(2)(II).’’. 11 (B) CONFORMING AMENDMENT.—Section 12 1861(s)(7) of such Act (42 U.S.C. 1395x(s)(7)) 13 is amended by striking ‘‘section 1834(l)(14)’’ 14 and inserting ‘‘paragraphs (14) and (18) of sec- 15 tion 1834(l)’’. 16 (5) EFFECTIVE DATE.—The amendments made 17 by this subsection shall apply to services furnished 18 on or after the date that is 3 years after the date 19 of the enactment of this Act. 20 (b) MANDATORY COVERAGE OF CRISIS RESPONSE 21 SERVICES UNDER THE MEDICAID PROGRAM.— 22 (1) IN GENERAL.—Title XIX of the Social Se- 23 curity Act (42 U.S.C. 1396 et seq.) is amended— 24 VerDate Sep 11 2014 21:59 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1902.IS S1902 kjohnson on DSK79L0C42PROD with BILLS 12 •S 1902 IS (A) in section 1902(a)(10)(A), in the mat- 1 ter preceding clause (i), by striking ‘‘and (30)’’ 2 and inserting ‘‘(30), and (31)’’; and 3 (B) in section 1905— 4 (i) in subsection (a)— 5 (I) in paragraph (30), by striking 6 ‘‘; and’’ and inserting a semicolon; 7 (II) by redesignating paragraph 8 (31) as paragraph (32); and 9 (III) by inserting the following 10 paragraph after paragraph (30): 11 ‘‘(31) subject to subsection (jj), crisis response 12 services (as defined in section 1861(lll)); and’’; and 13 (ii) by adding at the end the following 14 new subsection: 15 ‘‘(jj) EXCEPTION TO REQUIREMENT TO PROVIDE 16 COVERAGE FOR CRISIS RESPONSE SERVICES.—The re- 17 quirement to provide services described in paragraph (31) 18 of subsection (a) shall not apply with respect to a State 19 for a fiscal year, if before the beginning of such year the 20 State certifies to the satisfaction of the Secretary that im- 21 plementing such requirement statewide [Text truncated for display. Full text available on Congress.gov.]