Better Mental Health Care for Americans Act

II 118TH CONGRESS 1ST SESSION S. 923 To amend titles XVIII and XIX of the Social Security Act to reform and improve mental health and substance use care under the Medicare and Medicaid programs, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 22, 2023 Mr. BENNET (for himself and Mr. WYDEN) 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 to reform and improve mental health and substance use care under the Medicare and Medicaid programs, 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; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Better Mental Health Care for Americans Act’’. 5 (b) TABLE OF CONTENTS.—The table of contents of 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. TITLE I—MEDICARE PART B PROVISIONS VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 2 •S 923 IS Sec. 101. Payment under the Medicare physician fee schedule for inherently complex evaluation and management visits related to integrated mental health and substance use disorder care. Sec. 102. Ensuring access to early intervention in mental health care in Medi- care. TITLE II—MEDICARE ADVANTAGE AND PART D PROVISIONS Sec. 201. Parity in mental health and substance use disorder benefits under Medicare Advantage and prescription drug plans. Sec. 202. Behavioral health measures and incentivizing behavioral health care quality. Sec. 203. Providing information on behavioral health coverage to promote in- formed choice. Sec. 204. Requiring MA organizations to maintain accurate and updated pro- vider directories. TITLE III—MEDICAID AND CHIP Sec. 301. Enhanced payment under Medicaid for integrated mental health and substance use disorder care services. Sec. 302. Demonstration project to ensure Medicaid-enrolled children have ac- cess to integrated mental health and substance use disorder care services, including prevention and early intervention serv- ices. Sec. 303. Uniform applicability to Medicaid of requirements for parity in men- tal health and substance use disorder benefits. Sec. 304. Requiring additional transparency on access to mental health and substance use disorder benefits through managed care. Sec. 305. Authority to defer or disallow a portion of Federal financial participa- tion for failure to comply with managed care requirements. Sec. 306. Medicaid and CHIP audits. TITLE IV—OTHER PROVISIONS Sec. 401. Ensuring multi-payer alignment on payment and measurement of quality of care and health outcomes related to integrated men- tal health and substance use disorder care. Sec. 402. Measuring access and quality outcomes in mental health and sub- stance use disorder care. Sec. 403. Reviewing the evidence for integrated mental health care for children. Sec. 404. Enhancing oversight of integrated mental health and substance use disorder care. VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 3 •S 923 IS TITLE I—MEDICARE PART B 1 PROVISIONS 2 SEC. 101. PAYMENT UNDER THE MEDICARE PHYSICIAN FEE 3 SCHEDULE FOR INHERENTLY COMPLEX 4 EVALUATION AND MANAGEMENT VISITS RE- 5 LATED TO INTEGRATED MENTAL HEALTH 6 AND SUBSTANCE USE DISORDER CARE. 7 (a) IN GENERAL.—Section 1848(b) of the Social Se- 8 curity Act (42 U.S.C. 1395w–4(b)) is amended by adding 9 at the end the following new paragraph: 10 ‘‘(13) PAYMENT FOR INHERENTLY COMPLEX 11 EVALUATION AND MANAGEMENT VISITS RELATED TO 12 INTEGRATED MENTAL HEALTH AND SUBSTANCE USE 13 DISORDER CARE.— 14 ‘‘(A) IN GENERAL.—The Secretary shall 15 establish a new HCPCS add–on code under the 16 fee schedule established under this subsection 17 for integrated mental health and substance use 18 disorder care services (as defined in subpara- 19 graph (B)(i)) that are furnished on or after 20 January 1, 2025, when furnished by an inte- 21 grated care practitioner on the same date of 22 service that a service in the HCPCS category of 23 office and other outpatient evaluation and man- 24 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 4 •S 923 IS agement services is furnished. Such add-on code 1 may be similar to HCPCS code G2211. 2 ‘‘(B) DEFINITIONS.—In this paragraph: 3 ‘‘(i) INTEGRATED MENTAL HEALTH 4 AND SUBSTANCE USE DISORDER CARE 5 SERVICES.— 6 ‘‘(I) IN GENERAL.—The term ‘in- 7 tegrated mental health and substance 8 use disorder care services’ means serv- 9 ices described in subclause (II) that 10 are furnished by an integrated care 11 practitioner. 12 ‘‘(II) SERVICES DESCRIBED.— 13 The services described in this sub- 14 clause are the following: 15 ‘‘(aa) Preventive services 16 and screening for mental health 17 and substance use disorders that 18 the Secretary determines are— 19 ‘‘(AA) reasonable and 20 necessary for the prevention 21 or early detection of a men- 22 tal health or substance use 23 disorder; 24 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 5 •S 923 IS ‘‘(BB) recommended 1 with a grade of A or B by 2 the United States Preventive 3 Services Task Force or rec- 4 ommended in Health Re- 5 sources and Services–sup- 6 ported guidelines for infants, 7 children, adolescents, and 8 women; and 9 ‘‘(CC) appropriate for 10 individuals enrolled under 11 this part. 12 ‘‘(bb) The routine use and 13 tracking of quality measures ap- 14 propriate for the measurement of 15 the quality of care (including 16 medication errors) related to be- 17 havioral health that reflect con- 18 sensus among affected parties 19 and, to the extent feasible and 20 practicable, shall include meas- 21 ures set forth by one or more na- 22 tional consensus building entities. 23 ‘‘(cc) Short-term, evidence- 24 based, culturally, and linguis- 25 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 6 •S 923 IS tically appropriate therapeutic 1 and psychosocial intervention in- 2 tegrated into the primary care 3 practice, including through tele- 4 health. 5 ‘‘(dd) Evidence-based treat- 6 ment for mental health and sub- 7 stance use care integrated into 8 the primary care practice, includ- 9 ing through telehealth, or 10 through referral. 11 ‘‘(ee) Care management, 12 which can include establishing, 13 implementing, revising or moni- 14 toring the care plan, coordinating 15 with other professionals and 16 agencies, and educating the indi- 17 vidual or caregiver about the in- 18 dividual’s condition, care plan, or 19 prognosis. 20 ‘‘(ff) Other services deter- 21 mined by the Secretary. 22 ‘‘(ii) INTEGRATED CARE PRACTI- 23 TIONER.— 24 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 7 •S 923 IS ‘‘(I) IN GENERAL.—The term ‘in- 1 tegrated care practitioner’ means a 2 primary care practitioner (as defined 3 in section 1833(x)(2)(A)(i)) who has 4 demonstrated the capacity to furnish 5 integrated mental health and sub- 6 stance use disorder care services (as 7 determined under subclause (II)). 8 ‘‘(II) DEMONSTRATING CAPACITY 9 GUIDANCE; ATTESTATION.—For pur- 10 poses of applying subclause (I) with 11 respect to an integrated care practi- 12 tioner demonstrating the capacity to 13 furnish integrated mental health and 14 substance use disorder care services, 15 the Secretary shall issue guidance, not 16 later than one year after the date of 17 the enactment of this paragraph, de- 18 scribing requirements for dem- 19 onstrating capacity to provide such 20 services and establishing a process for 21 the Secretary to receive an attestation 22 that an integrated care practitioner 23 has such capacity. Such guidance and 24 attestation may not impose additional 25 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 8 •S 923 IS burden on small practices (as defined 1 for purposes of subsection (q)(11)) 2 and practices located in rural areas. 3 ‘‘(C) PAYMENT.— 4 ‘‘(i) AMOUNT OF PAYMENT.—The fee 5 schedule amount for integrated mental 6 health and substance use disorder care 7 services shall not be less than the fee 8 schedule amount for services described by 9 HCPCS code G2211 (or any successor or 10 substantially similar code). 11 ‘‘(ii) ADD-ON SERVICES.—If, during 12 the furnishing of an evaluation and man- 13 agement service to an individual by an in- 14 tegrated care practitioner, such practi- 15 tioner also furnishes (or coordinates the 16 furnishing of) integrated mental health 17 and substance use disorder care services on 18 the same date of service, payment shall 19 also be made for such integrated mental 20 health and substance used disorder care 21 services even if the individual did not pre- 22 viously have a mental health or substance 23 use disorder diagnosis. 24 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 9 •S 923 IS ‘‘(iii) PAYMENT CONSIDERATIONS.— 1 In carrying out this paragraph, the Sec- 2 retary shall ensure that the amount of pay- 3 ment for integrated mental health and sub- 4 stance use disorder care services under this 5 paragraph is sufficient to sustain effective 6 and accessible integrated mental health 7 and substance use disorder care under this 8 part, as determined by evidence from prac- 9 tice expenses of those implementing effec- 10 tive integrated care as well as evidence of 11 the resource needs of integrated care prac- 12 titioners who furnish such services in men- 13 tal health professional shortage areas (as 14 designated under section 332(a)(1)(A) of 15 the Public Health Service Act) and medi- 16 cally underserved areas.’’. 17 (b) EXEMPTION FROM BUDGET NEUTRALITY.—Sec- 18 tion 1848(c)(2)(B)(iv) of the Social Security Act (42 19 U.S.C. 1395w–4(C)(2)(b)(iv)) is amended by adding at 20 the end the following new subclause: 21 ‘‘(VII) Subsection (b)(13) shall 22 not be taken into account in applying 23 clause (ii)(II) for 2025.’’. 24 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 10 •S 923 IS (c) WAIVER OF COINSURANCE.—Section 1833(a)(1) 1 of the Social Security Act (42 U.S.C. 1395l(a)(1)) is 2 amended— 3 (1) by striking ‘‘and’’ before ‘‘(HH)’’; and 4 (2) by inserting before the semicolon at the end 5 the following: ‘‘, and (II) with respect to integrated 6 mental health and substance use disorder care serv- 7 ices (as defined in subparagraph (B)(i) of section 8 1848(b)(13)) that are furnished on or after January 9 1, 2025, the amounts paid shall be equal to 100 per- 10 cent of the lesser of the actual charge for such serv- 11 ices or the fee schedule amount provided under such 12 section’’. 13 SEC. 102. ENSURING ACCESS TO EARLY INTERVENTION IN 14 MENTAL HEALTH CARE IN MEDICARE. 15 Section 1833(a)(1) of the Social Security Act (42 16 U.S.C. 1395l(a)(1)), as amended by section 101(c), is 17 amended— 18 (1) by striking ‘‘and’’ before ‘‘(II)’’; and 19 (2) by inserting before the semicolon at the end 20 the following: ‘‘, and (JJ) with respect to behavioral 21 health integration services described by HCPCS 22 codes 99492, 99493, 99494, 99484 , G2214, and 23 G0323 (or any successor or substantially similar 24 code) furnished on or after January 1, 2025, the 25 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 11 •S 923 IS amounts paid shall be equal to 100 percent of the 1 lesser of the actual charge for such services or the 2 fee schedule amount provided under section 3 1848(b)’’. 4 TITLE II—MEDICARE ADVAN- 5 TAGE AND PART D PROVI- 6 SIONS 7 SEC. 201. PARITY IN MENTAL HEALTH AND SUBSTANCE USE 8 DISORDER BENEFITS UNDER MEDICARE AD- 9 VANTAGE AND PRESCRIPTION DRUG PLANS. 10 (a) MEDICARE ADVANTAGE PLANS.— 11 (1) IN GENERAL.—Section 1852 of the Social 12 Security Act (42 U.S.C. 1395w–22) is amended by 13 adding at the end the following new subsection: 14 ‘‘(o) PARITY IN MENTAL HEALTH AND SUBSTANCE 15 USE DISORDER BENEFITS.— 16 ‘‘(1) IN GENERAL.—Each MA organization 17 shall ensure that the benefit design of each MA plan 18 offered by such organization meets the following re- 19 quirements: 20 ‘‘(A) FINANCIAL REQUIREMENTS.—The fi- 21 nancial requirements applicable to mental 22 health or substance use disorder benefits cov- 23 ered by the plan may not exceed the predomi- 24 nant financial requirements applied to substan- 25 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 12 •S 923 IS tially all medical benefits covered by the plan, 1 including supplemental benefits, and there are 2 no separate cost sharing requirements that are 3 applicable only with respect to mental health 4 and substance use disorder benefits. 5 ‘‘(B) TREATMENT LIMITATIONS.—The 6 treatment limitations applicable to mental 7 health or substance use disorder benefits are no 8 more restrictive than the predominant treat- 9 ment limitations applied to substantially all 10 medical benefits covered by the plan and there 11 are no separate treatment limitations that are 12 applicable only with respect to mental health or 13 substance use disorder benefits, including sup- 14 plemental benefits. 15 ‘‘(2) DETERMINATIONS OF MEDICAL NECES- 16 SITY.— 17 ‘‘(A) IN GENERAL.—Each MA organization 18 shall ensure that any determination of medical 19 necessity for mental health or substance use 20 benefits under each MA plan offered by such 21 organization that is not based on the applica- 22 tion of a national or local coverage determina- 23 tion is consistent with generally accepted stand- 24 ards of mental health and substance use dis- 25 VerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923 kjohnson on DSK79L0C42PROD with BILLS 13 •S 923 IS order care, as defined in paragraph. For any 1 level of care determination with respect to men- 2 tal health or substance use disorder benefits, 3 coverage criteria are [Text truncated for display. Full text available on Congress.gov.]