CAHOOTS Act

I 116TH CONGRESS 2D SESSION H. R. 7961 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 AUGUST 7, 2020 Mr. DEFAZIO (for himself, Ms. BONAMICI, Mr. BLUMENAUER, Ms. PRESSLEY, Ms. WEXTON, Mr. HASTINGS, Ms. NORTON, and Mr. CARSON of Indiana) introduced the following bill; which was referred to the Committee on En- ergy 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 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 7961 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 ‘‘(bb) 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(c). 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 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 7961 IH ‘‘(A) furnished to an individual who is— 1 ‘‘(i) outside of a hospital or other fa- 2 cility setting; and 3 ‘‘(ii) experiencing a mental health or 4 substance use disorder crisis; 5 ‘‘(B) furnished by a multidisciplinary mo- 6 bile crisis team— 7 ‘‘(i) that includes at least 1 behavioral 8 health care professional who is capable of 9 conducting an assessment of the individual, 10 in accordance with the professional’s per- 11 mitted scope of practice under State law, 12 and other professionals or paraprofes- 13 sionals with appropriate expertise in behav- 14 ioral health or mental health crisis re- 15 sponse, including nurses, social workers, 16 peer support specialists, and others, as 17 designated by the State and approved by 18 the Secretary; 19 ‘‘(ii) whose members are trained in 20 trauma-informed care, de-escalation strate- 21 gies, and harm reduction; 22 ‘‘(iii) that is able to respond in a 23 timely manner and, where appropriate, 24 provide the following— 25 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 7961 IH ‘‘(I) screening and assessment; 1 ‘‘(II) stabilization and de-esca- 2 lation; 3 ‘‘(III) coordination with, and re- 4 ferrals to, health, social, and other 5 services and supports as needed; and 6 ‘‘(IV) provision or coordination of 7 transportation to the next step in care 8 or treatment; 9 ‘‘(iv) that maintains relationships with 10 relevant community partners, including 11 medical and behavioral health providers, 12 community health centers, crisis respite 13 centers, managed care organizations (if ap- 14 plicable), entities able to provide assistance 15 with application and enrollment in the 16 State plan or a waiver of the plan, entitles 17 able to provide assistance with applying for 18 and enrolling in benefit programs, entities 19 that provide assistance with housing (such 20 as public housing authorities, Continuum 21 of Care programs, or not for profit entities 22 that provide housing assistance), and enti- 23 ties that provide assistance with other so- 24 cial services; 25 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 7961 IH ‘‘(v) that coordinates with crisis inter- 1 vention hotlines and emergency response 2 systems; 3 ‘‘(vi) that maintains the privacy and 4 confidentiality of patient information con- 5 sistent with Federal and State require- 6 ments; and 7 ‘‘(vii) that operates independently 8 from (but may coordinate with) State or 9 local law enforcement agencies; 10 ‘‘(C) available 24 hours per day, every day 11 of the year; and 12 ‘‘(D) voluntary to receive. 13 ‘‘(3) PAYMENTS.— 14 ‘‘(A) IN GENERAL.—Notwithstanding sec- 15 tion 1905(b), beginning October 1, 2020, dur- 16 ing each of the first 12 fiscal quarters that a 17 State meets the requirements described in para- 18 graph (4), the Federal medical assistance per- 19 centage applicable to amounts expended by the 20 State for medical assistance for qualifying com- 21 munity-based mobile crisis intervention services 22 furnished during such quarter shall be equal to 23 95 percent. 24 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 7961 IH ‘‘(B) EXCLUSION OF ENHANCED PAY- 1 MENTS FROM TERRITORIAL CAPS.—To the ex- 2 tent that the amount of a payment to Puerto 3 Rico, the Virgin Islands, Guam, the Northern 4 Mariana Islands, or American Samoa for med- 5 ical assistance for qualifying community-based 6 mobile crisis intervention services that is based 7 on the Federal medical assistance percentage 8 specified in subparagraph (A) exceeds the 9 amount that would have been paid to such ter- 10 ritory for such services if the Federal medical 11 assistance percentage for the territory had been 12 determined without regard to such subpara- 13 graph— 14 ‘‘(i) the limitation on payments to ter- 15 ritories under subsections (f) and (g) of 16 section 1108 shall not apply to the amount 17 of such excess; and 18 ‘‘(ii) the amount of such excess shall 19 be disregarded in applying such sub- 20 sections. 21 ‘‘(4) REQUIREMENTS.—The requirements de- 22 scribed in this paragraph are the following: 23 ‘‘(A) The State demonstrates, to the satis- 24 faction of the Secretary— 25 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 7961 IH ‘‘(i) that it will be able to support the 1 provision of qualifying community-based 2 mobile crisis intervention services that 3 meet the conditions specified in paragraph 4 (2); and 5 ‘‘(ii) how it will support coordination 6 between mobile crisis teams and commu- 7 nity partners, including health care pro- 8 viders, to enable the provision of services, 9 needed referrals, and other activities iden- 10 tified by the Secretary. 11 ‘‘(B) The State provides assurances satis- 12 factory to the Secretary that— 13 ‘‘(i) any additional Federal funds re- 14 ceived by the State for qualifying commu- 15 nity-based mobile crisis intervention serv- 16 ices provided under this subsection that 17 are attributable to the increased Federal 18 medical assistance percentage under para- 19 graph (3)(A) will be used to supplement, 20 and not supplant, the level of State funds 21 expended for such services for fiscal year 22 2019; 23 ‘‘(ii) if the State made qualifying com- 24 munity-based mobile crisis intervention 25 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 7961 IH services available in a region of the State 1 in fiscal year 2019, the State will continue 2 to make such services available in such re- 3 gion under this subsection at the same 4 level that the State made such services 5 available in such fiscal year; and 6 ‘‘(iii) the State will conduct the eval- 7 uation and assessment, and submit the re- 8 port, required under paragraph (5). 9 ‘‘(5) STATE EVALUATION AND REPORT.— 10 ‘‘(A) STATE EVALUATION.—Not later than 11 4 fiscal quarters after a State begins providing 12 qualifying community-based mobile crisis inter- 13 vention services in accordance with this sub- 14 section, the State shall enter into a contract 15 with an independent entity or organization to 16 conduct an evaluation for the purposes of— 17 ‘‘(i) determining the effect of the pro- 18 vision of such services on— 19 ‘‘(I) emergency room visits; 20 ‘‘(II) use of ambulatory services; 21 ‘‘(III) hospitalizations; 22 ‘‘(IV) the involvement of law en- 23 forcement in mental health or sub- 24 stance use disorder crisis events; 25 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 7961 IH ‘‘(V) the diversion of individuals 1 from jails or similar settings; and 2 ‘‘(ii) assessing— 3 ‘‘(I) the types of services pro- 4 vided to individuals; 5 ‘‘(II) the types of events re- 6 sponded to; 7 ‘‘(III) cost savings or cost-effec- 8 tiveness attributable to such services; 9 ‘‘(IV) the experiences of individ- 10 uals who receive qualifying commu- 11 nity-based mobile crisis intervention 12 services; 13 ‘‘(V) the successful connection of 14 individuals with follow-up services; 15 and 16 ‘‘(VI) other relevant outcomes 17 identified by the Secretary. 18 ‘‘(B) COMPARISON TO HISTORICAL MEAS- 19 URES.—The contract described in subparagraph 20 (A) shall specify that the evaluation is based on 21 a comparison of the historical measures of 22 State performance with respect to the outcomes 23 specified under such subparagraph to the 24 State’s performance with respect to such out- 25 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 7961 IH comes during the period beginning with the 1 first quarter in which the State begins pro- 2 viding qualifying community-based mobile crisis 3 intervention services in accordance with this 4 subsection. 5 ‘‘(C) REPORT.—Not later than 2 years 6 after a State begins to provide qualifying com- 7 munity-based mobile crisis intervention services 8 in accordance with this subsection, the State 9 shall submit a report to the Secretary on the 10 following: 11 ‘‘(i) The results of the evaluation car- 12 ried out under subparagraph (A). 13 ‘‘(ii) The number of individuals who 14 received qualifying community-based mo- 15 bile crisis intervention services. 16 ‘‘(iii) Demographic information re- 17 garding such individuals when available, 18 including the race or ethnicity, age, sex, 19 sexual orientation, gender identity, and ge- 20 ographic location of such individuals. 21 ‘‘(iv) The processes and models devel- 22 oped by the State to provide qualifying 23 community-based mobile crisis intervention 24 services under such the State plan or waiv- 25 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 7961 IH er, including the processes developed to 1 provide referrals for, or coordination with, 2 follow-up care and services. 3 ‘‘(v) Lessons learned regarding the 4 provision of such services. 5 ‘‘(D) PUBLIC AVAILABILITY.—The State 6 shall make the report required under subpara- 7 graph (C) publicly available, including on the 8 website of the appropriate State agency, upon 9 submission of such report to the Secretary. 10 ‘‘(6) BEST PRACTICES REPORT.— 11 ‘‘(A) IN GENERAL.—Not later than 3 years 12 after the first State begins to provide qualifying 13 community-based mobile crisis intervention 14 services in accordance with this subsection, the 15 Secretary shall submit a report to Congress 16 that— 17 ‘‘(i) identifies the States that elected 18 to provide services in accordance with this 19 subsection; 20 ‘‘(ii) summarizes the information re- 21 ported by such States under paragraph 22 (5)(C); and 23 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 7961 IH ‘‘(iii) identifies best practices for the 1 effective delivery of community-based mo- 2 bile crisis intervention services. 3 ‘‘(B) PUBLIC AVAILABILITY.—The report 4 required under subparagraph (A) shall be made 5 publicly available, including on the website of 6 the Department of Health and Human Services, 7 upon submission to Congress. 8 ‘‘(7) STATE PLANNING AND EVALUATION 9 GRANTS.— 10 ‘‘(A) IN GENERAL.—As soon as practicable 11 after the date of enactment of this subsection, 12 the Secretary may award planning and evalua- 13 tion grants to States for purposes of developing 14 a State plan amendment or section 1115 or 15 1915(c) waiver request (or an amendment to 16 such a waiver) to provide qualifying community- 17 based mobile crisis intervention services and 18 conducting the evaluation required under para- 19 graph (5)(A). A grant awarded to a State 20 under this paragraph shall remain available 21 until expended. 22 ‘‘(B) STATE CONTRIBUTION.—A State 23 awarded a grant under this subsection shall 24 contribute for each fiscal year for which the 25 VerDate Sep 11 2014 21:23 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H7961.IH H7961 pamtmann on DSKBC07HB2PROD with BILLS 13 •HR 7961 IH grant is awarded an amount equal to the State 1 percentage determined under section 1905(b) 2 (without regard to the temporary increase in 3 the Federal medical assistance percentage of 4 the State under section 6008(a) of the Families 5 First Coronavirus Response Act (Public Law 6 116–127) or any other temporary increase in 7 the Federal medical assistance percentage of 8 the State for fiscal year 2020 or any succeeding 9 fiscal year) of the grant amount. 10 ‘‘(8) FUNDING.— 11 ‘‘(A) IMPLEMENTATION AND ADMINISTRA- 12 TION.—There is appropriated to the Secretary, 13 out of any funds in the Treasury not otherwise 14 appropriated, such sums as are necessary for 15 purposes of implementing and administering 16 this section. 17 ‘‘(B) PLANNING A [Text truncated for display. 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