II 118TH CONGRESS 1ST SESSION S. 1378 To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. IN THE SENATE OF THE UNITED STATES APRIL 27, 2023 Ms. CORTEZ MASTO (for herself and Mr. CORNYN) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. 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 ‘‘Connecting Our Med- 4 ical Providers with Links to Expand Tailored and Effec- 5 tive Care’’ or the ‘‘COMPLETE Care Act’’. 6 SEC. 2. INCENTIVES FOR BEHAVIORAL HEALTH INTEGRA- 7 TION. 8 (a) INCENTIVES.— 9 VerDate Sep 11 2014 03:38 May 06, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1378.IS S1378 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 1378 IS (1) IN GENERAL.—Section 1848(b) of the So- 1 cial Security Act (42 U.S.C. 1395w–4(b)) is amend- 2 ed by adding at the end the following new para- 3 graph: 4 ‘‘(13) INCENTIVES FOR BEHAVIORAL HEALTH 5 INTEGRATION.— 6 ‘‘(A) IN GENERAL.—For services described 7 in subparagraph (B) that are furnished during 8 2025, 2026, or 2027, instead of the payment 9 amount that would otherwise be determined 10 under this section for such year, the payment 11 amount shall be equal to the applicable percent 12 (as defined in subparagraph (C)) of such pay- 13 ment amount for such year. 14 ‘‘(B) SERVICES DESCRIBED.—The services 15 described in this subparagraph are services 16 identified, as of January 1, 2023, by HCPCS 17 codes 99484, 99492, 99493, 99494, and G2214 18 (and any successor or similar codes as deter- 19 mined appropriate by the Secretary). 20 ‘‘(C) APPLICABLE PERCENT.—In this 21 paragraph, the term ‘applicable percent’ means, 22 with respect to a service described in subpara- 23 graph (A), the following: 24 VerDate Sep 11 2014 03:38 May 06, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1378.IS S1378 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 1378 IS ‘‘(i) For services furnished during 1 2025 , 175 percent. 2 ‘‘(ii) For services furnished during 3 2026, 150 percent. 4 ‘‘(iii) For services furnished during 5 2027, 125 percent.’’. 6 (2) WAIVER OF BUDGET NEUTRALITY.—Section 7 1848(c)(2)(B)(iv) of such Act (42 U.S.C. 1395w– 8 4(c)(2)(B)(iv)) is amended— 9 (A) in subclause (V), by striking ‘‘and’’ at 10 the end; 11 (B) in subclause (VI), by striking the pe- 12 riod at the end and inserting ‘‘; and’’; and 13 (C) by adding at the end the following new 14 subclause: 15 ‘‘(VII) the increase in payment 16 amounts as a result of the application 17 of subsection (b)(13) shall not be 18 taken into account in applying clause 19 (ii)(II) for 2025, 2026, or 2027.’’. 20 (b) QUALITY MEASUREMENT.— 21 (1) IN GENERAL.—Section 1833(z) of the So- 22 cial Security Act (42 U.S.C. 1395l(z)) is amended— 23 (A) by redesignating paragraph (4) as 24 paragraph (5); and 25 VerDate Sep 11 2014 03:38 May 06, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1378.IS S1378 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 1378 IS (B) by inserting after paragraph (3) the 1 following new paragraph: 2 ‘‘(4) QUALITY MEASUREMENT RELATING TO 3 BEHAVIORAL HEALTH INTEGRATION.— 4 ‘‘(A) IN GENERAL.—The Secretary shall 5 establish quality measurement reporting re- 6 quirements for applicable physicians and practi- 7 tioners (as defined in subparagraph (B)) with 8 respect to the extent to which clinician practices 9 are integrating behavioral health services and 10 primary care services, in accordance with the 11 succeeding provisions of this paragraph. 12 ‘‘(B) APPLICABLE PHYSICIANS AND PRAC- 13 TITIONERS.—For purposes of this paragraph, 14 the term ‘applicable physician or practitioner’ 15 means, with respect to a year, a physician or a 16 practitioner described in section 1842(b)(18)(C) 17 who is participating in an eligible alternative 18 payment entity for which the associated alter- 19 native payment model involves the delivery of 20 primary care services to beneficiaries who may 21 have the need for mental health or substance 22 use disorder services, as determined by the Sec- 23 retary. 24 VerDate Sep 11 2014 03:38 May 06, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1378.IS S1378 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 1378 IS ‘‘(C) QUALITY REPORTING BY SELECTED 1 PHYSICIANS AND PRACTITIONERS.—With re- 2 spect to each year beginning on or after the 3 date that is one year after one or more meas- 4 ures are first specified under subparagraph (D), 5 an applicable physician or practitioner shall 6 submit to the Secretary data on quality meas- 7 ures specified under such subparagraph. Such 8 data shall be submitted in a form and manner, 9 and at a time, specified by the Secretary for 10 purposes of this subparagraph. 11 ‘‘(D) QUALITY MEASURES.— 12 ‘‘(i) IN GENERAL.—Subject to clause 13 (ii), any measure specified by the Secretary 14 under this subparagraph must have been 15 endorsed by the entity with a contract 16 under section 1890(a). 17 ‘‘(ii) EXCEPTION.—In the case of a 18 specified area or medical topic determined 19 appropriate by the Secretary for which a 20 feasible and practical measure has not 21 been endorsed by the entity with a contract 22 under section 1890(a), the Secretary may 23 specify a measure that is not so endorsed 24 as long as due consideration is given to 25 VerDate Sep 11 2014 03:38 May 06, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1378.IS S1378 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 1378 IS measures that have been endorsed or 1 adopted by a consensus organization iden- 2 tified by the Secretary. 3 ‘‘(E) IMPLEMENTATION.—The Secretary 4 may use quality measures developed pursuant 5 to this paragraph in— 6 ‘‘(i) the shared savings program under 7 section 1899; and 8 ‘‘(ii) the Primary Care First Model, 9 the Accountable Care Organization Real- 10 izing Equity, Access, and Community 11 Health (ACO REACH) Model, and any 12 other alternative payment model (as de- 13 fined in paragraph (3)(C)) as determined 14 appropriate by the Secretary.’’. 15 (2) CONFORMING AMENDMENT RELATING TO 16 CONVENING MULTI-STAKEHOLDER GROUPS.—Section 17 1890(b)(7)(B)(i)(I) of the Social Security Act (42 18 U.S.C. 1395aaa(b)(7)(B)(i)(I)) is amended by in- 19 serting ‘‘1833(z)(4),’’ after ‘‘1833(t)(17),’’. 20 (c) TECHNICAL ASSISTANCE FOR THE ADOPTION OF 21 BEHAVIORAL HEALTH INTEGRATION.— 22 (1) IN GENERAL.—Not later than January 1, 23 2025, the Secretary of Health and Human Services 24 shall enter into contracts or agreements with appro- 25 VerDate Sep 11 2014 03:38 May 06, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1378.IS S1378 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 1378 IS priate entities to offer technical assistance to pri- 1 mary care practices that are seeking to adopt behav- 2 ioral health integration models in such practices. 3 (2) BEHAVIORAL HEALTH INTEGRATION MOD- 4 ELS.—For purposes of paragraph (1), behavioral 5 health integration models include the Collaborative 6 Care Model (with services identified as of January 7 1, 2023, by HCPCS codes 99492, 99493, 99494, 8 and G2214 (and any successor codes)), the Primary 9 Care Behavioral Health model (with services identi- 10 fied as of January 1, 2023, by HCPCS code 99484 11 (and any successor code)), and other models identi- 12 fied by the Secretary. 13 (3) FUNDING.—In addition to amounts other- 14 wise available, there is appropriated to the Secretary 15 of Health and Human Services for each of fiscal 16 years 2024 through 2027, out of any money in the 17 Treasury not otherwise appropriated, such sums as 18 are necessary, to remain available until expended, 19 for purposes of carrying out this subsection. 20 Æ VerDate Sep 11 2014 03:38 May 06, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\S1378.IS S1378 pbinns on DSKJLVW7X2PROD with $$_JOB