Behavioral Health Crisis Services Expansion Act

II 116TH CONGRESS 2D SESSION S. 5034 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 DECEMBER 16, 2020 Ms. CORTEZ MASTO introduced the following bill; which was read twice and referred to the Committee on Health, Education, 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 for use by health care providers and communities in re- 10 VerDate Sep 11 2014 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 5034 IS sponding to individuals experiencing a mental or behav- 1 ioral health crisis (referred to in this section as the ‘‘crisis 2 response continuum’’). 3 (b) REQUIREMENTS.— 4 (1) SCOPE OF STANDARDS.—Such standards 5 shall define— 6 (A) minimum requirements of core crisis 7 services, as determined by the Secretary, to in- 8 clude requirements that each entity that fur- 9 nishes such services should— 10 (i) not require medical clearance prior 11 to admission; 12 (ii) serve all individuals regardless of 13 ability to pay; 14 (iii) operate 24 hours a day, 7 days a 15 week, and provide care to all individuals; 16 and 17 (iv) provide care until the individual 18 has been stabilized or transfer the indi- 19 vidual to the next level of crisis care; and 20 (B) psychiatric stabilization, including the 21 point at which a case may be closed for— 22 (i) individuals screened over the 23 phone; and 24 VerDate Sep 11 2014 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 5034 IS (ii) individuals stabilized on the scene 1 by mobile teams. 2 (2) IDENTIFICATION OF ESSENTIAL FUNCTIONS 3 AND OBJECTIVES.—The Secretary shall identify the 4 essential functions and objectives of each service in 5 the crisis response continuum, which shall include at 6 least the following: 7 (A) Identification of resources for referral 8 and enrollment in continuing behavioral health 9 and other human services for the individual in 10 crisis where necessary. 11 (B) Delineation of access and entry points 12 to services within the crisis response continuum. 13 (C) Development of and adherence to pro- 14 tocols and agreements for the transfer and re- 15 ceipt of individuals to and from other segments 16 of the crisis response continuum segments as 17 needed, and from outside referrals including 18 health care providers, law enforcement, EMS, 19 and fire. 20 (D) Description of the qualifications of cri- 21 sis services staff, including roles for physicians, 22 licensed clinicians, case managers, and peers. 23 (E) Requirements for the convention of 24 collaborative meetings of crisis response service 25 VerDate Sep 11 2014 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 5034 IS providers, first responders, and community 1 partners operating in a common region for the 2 discussion of case management, best practices, 3 and general performance improvement. 4 (3) SERVICE CAPACITY AND QUALITY STAND- 5 ARDS.—Such standards shall include definitions of— 6 (A) adequate volume of services to meet 7 population need; 8 (B) timeliness of response; and 9 (C) capacity to meet the needs of different 10 patient populations, including all age groups, 11 cultural and linguistic minorities, and individ- 12 uals with co-occurring mental health and sub- 13 stance use disorder crisis, individuals with cog- 14 nitive disabilities with behavioral health crises, 15 and individuals with chronic medical conditions 16 and physical disabilities who experience behav- 17 ioral health crises. 18 (4) OVERSIGHT AND ACCREDITATION.—The 19 Secretary shall designate entities charged with the 20 oversight and accreditation of entities within the cri- 21 sis response continuum. 22 (5) IMPLEMENTATION TIMEFRAME.—Not later 23 than 1 year after the date of enactment of this Act, 24 VerDate Sep 11 2014 22:49 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 5034 IS the Secretary shall establish the standards under 1 this section. 2 (6) DATA COLLECTION AND EVALUATIONS.— 3 (A) IN GENERAL.—The Secretary, directly 4 or through grants, contracts, or interagency 5 agreements, shall collect data and conduct eval- 6 uations with respect to the provision of services 7 and programs offered on the crisis response 8 continuum for purposes of assessing the extent 9 to which the provision of such services and pro- 10 grams meet certain objectives as determined by 11 the Secretary. Such objectives shall include— 12 (i) a reduction in inappropriate ar- 13 rests of individuals who are in mental 14 health crisis; 15 (ii) a reduction in emergency room re- 16 admissions; and 17 (iii) adequate access to crisis care cen- 18 ters and crisis bed services. 19 (B) AUTHORIZATION OF APPROPRIA- 20 TIONS.—To carry out this subsection, there are 21 authorized to be appropriated $1,000,000, to 22 remain available until expended. 23 VerDate Sep 11 2014 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 5034 IS (c) COMPONENTS OF CRISIS RESPONSE CON- 1 TINUUM.—The crisis response continuum consists of at 2 least the following components: 3 (1) CRISIS CALL CENTERS.—Regional clinically 4 staffed crisis call centers that provide telephonic cri- 5 sis intervention capabilities. Such centers should 6 meet National Suicide Prevention Lifeline oper- 7 ational guidelines regarding suicide risk assessment 8 and engagement and offer air traffic control-quality 9 coordination of crisis care in real-time. 10 (2) MOBILE CRISIS RESPONSE TEAM.—Teams 11 of providers that are available to reach any indi- 12 vidual in the service area in their home, workplace, 13 or any other community-based location of the indi- 14 vidual in crisis in a timely manner. 15 (3) CRISIS RECEIVING AND STABILIZATION FA- 16 CILITIES.—Subacute inpatient facilities and other 17 facilities specified by the Secretary that provide 18 short-term observation and crisis stabilization serv- 19 ices to all referrals, including the following services: 20 (A) 23-HOUR CRISIS STABILIZATION SERV- 21 ICES.—A direct care service that provides indi- 22 viduals in severe distress with up to 23 consecu- 23 tive hours of supervised care to assist with de- 24 VerDate Sep 11 2014 22:49 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 5034 IS escalating the severity of their crisis or need for 1 urgent care in a sub-acute inpatient setting. 2 (B) SHORT-TERM CRISIS RESIDENTIAL 3 SERVICES.—A direct care service that assists 4 with deescalating the severity of an individual’s 5 level of distress or need for urgent care associ- 6 ated with a substance use or mental health dis- 7 order in a residential setting. 8 (4) BEHAVIORAL HEALTH URGENT CARE FA- 9 CILITIES.—Ambulatory services available 12–24 10 hours per day, 7 days a week, where individuals ex- 11 periencing crisis can walk in without an appointment 12 to receive crisis assessment, crisis intervention, 13 medication, and connection to continuity of care. 14 (5) ADDITIONAL FACILITIES AND PROVIDERS.— 15 The Secretary shall specify additional facilities and 16 health care providers as part of the crisis response 17 continuum, as the Secretary determines appropriate. 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 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 5034 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 (kkk);’’. 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 thereof the 9 following new subsection: 10 ‘‘Crisis Response Services Defined 11 ‘‘(kkk)(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 of services 16 or supplier, as determined by the Secretary, to an indi- 17 vidual experiencing a mental or behavioral health crisis. 18 Such term includes services identified by the Secretary as 19 part of the crisis response continuum of care under section 20 2 of the Behavioral 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 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 5034 IS ity’ have the meaning given those terms for purposes of 1 such section.’’. 2 (3) AMOUNT OF PAYMENT.—Section 1834 of 3 the Social Security Act (42 U.S.C. 1395m) is 4 amended by adding at the end the following new 5 subsection: 6 (A) TECHNICAL CORRECTION TO ENSURE 7 PROPER PLACEMENT.—Section 6002(a)(1)(B) 8 of division F of the Families First Coronavirus 9 Response Act (Public Law 116–127) is amend- 10 ed, in the amendatory language, by striking 11 ‘‘the period’’ and inserting ‘‘the semicolon’’. 12 (B) PAYMENT.—Section 1833(a)(1) of the 13 Social Security Act (42 U.S.C. 1395l(a)(1)) is 14 amended— 15 (i) by striking ‘‘and (DD)’’ and in- 16 serting ‘‘(DD)’’; and 17 (ii) by inserting before the semicolon 18 at the end the following: ‘‘and (EE) with 19 respect to crisis response services described 20 in section 1861(s)(2)(II), the amounts paid 21 shall be 80 percent of the lesser of the ac- 22 tual charge for the service or the amount 23 determined under a fee schedule estab- 24 lished by the Secretary’’. 25 VerDate Sep 11 2014 22:49 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 5034 IS (4) AMBULANCE TRANSPORT OF INDIVIDUALS 1 IN CRISIS.— 2 (A) IN GENERAL.—Section 1834(l) of the 3 Social Security Act (42 U.S.C. 1395m(l)) is 4 amended by adding at the end the following 5 new paragraph: 6 ‘‘(18) TRANSPORTATION OF INDIVIDUALS IN 7 CRISIS.—With respect to ambulance services fur- 8 nished on or after the date that is 1 year after the 9 date of the enactment of the Behavioral Health Cri- 10 sis Services Expansion Act, the regulations described 11 in section 1861(s)(7) shall provide coverage under 12 such section for ambulance services to transport an 13 individual experiencing a mental or behavioral health 14 crisis to an appropriate facility, such as a commu- 15 nity mental health center (as defined in section 16 1861(ff)(3)(B)) or other facility or provider identi- 17 fied by the Secretary as part of the crisis response 18 continuum of care under section 2 of the Behavioral 19 Health Crisis Services Expansion Act, as appro- 20 priate, for crisis response services described in sec- 21 tion 1861(s)(2)(II).’’. 22 (B) CONFORMING AMENDMENT.—Section 23 1861(s)(7) of such Act (42 U.S.C. 1395x(s)(7)) 24 is amended by striking ‘‘section 1834(l)(14)’’ 25 VerDate Sep 11 2014 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 5034 IS and inserting ‘‘paragraphs (14) and (18) of sec- 1 tion 1834(l)’’. 2 (5) EFFECTIVE DATE.—The amendments made 3 by this subsection shall apply to services furnished 4 on or after the date that is 1 year after the date of 5 the enactment of this Act. 6 (b) MANDATORY COVERAGE OF CRISIS RESPONSE 7 SERVICES UNDER THE MEDICAID PROGRAM.— 8 (1) IN GENERAL.—Title XIX of the Social Se- 9 curity Act (42 U.S.C. 1396 et seq.) is amended— 10 (A) in section 1902(a)(10)(A), in the mat- 11 ter preceding clause (i), by striking ‘‘and (29)’’ 12 and inserting ‘‘(29), and (30)’’; and 13 (B) in section 1905(a)— 14 (i) in paragraph (29), by striking ‘‘; 15 and’’ and inserting a semicolon; 16 (ii) by redesignating paragraph (30) 17 as paragraph (31); and 18 (iii) by inserting the following para- 19 graph after paragraph (29): 20 ‘‘(30) crisis response services (as defined in sec- 21 tion 1861(kkk)); and’’. 22 (2) PRESUMPTIVE ELIGIBILITY DETERMINA- 23 TION BY CRISIS RESPONSE SERVICE PROVIDERS.— 24 Section 1902(a)(47)(B) of the Social Security Act 25 VerDate Sep 11 2014 22:49 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 5034 IS (42 U.S.C. 1396a(a)(47)(B)) is amended by insert- 1 ing ‘‘or provider of crisis response services (as de- 2 fined in section 1861(kkk))’’ after ‘‘any hospital’’. 3 (3) EFFECTIVE DATE.— 4 (A) IN GENERAL.—Except as provided in 5 subparagraph (B), the amendments made by 6 this section shall take effect on the date that is 7 1 year after the date of the enactment of this 8 Act. 9 (B) DELAY PERMITTED IF STATE LEGISLA- 10 TION REQUIRED.—In the case of a State plan 11 under title XIX of the Social Security Act (42 12 U.S.C. 1396 et seq.) which the Secretary of 13 Health and Human Services determines re- 14 quires State legislation (other than legislation 15 appropriating funds) in order for the plan to 16 meet the additional requirements imposed by 17 the amendments made by this section, the State 18 plan shall not be regarded as failing to comply 19 with the requirements of such title solely on the 20 basis of the failure of the plan to meet such ad- 21 ditional requirements before the 1st day of the 22 1st calendar quarter beginning [Text truncated for display. 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