S.Amdt. 733

1. Adds TITLE __--MENTAL HEALTH CARE wherever appropriate

   Adds a title

   Inserted: TITLE __--MENTAL HEALTH CARE

   Inserted: SEC. _01. SHORT TITLE.

   Inserted: This title may be cited as the "Excellence in Mental Health Act".

   Inserted: SEC. _02. ESTABLISHING CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS.

   Inserted: (a) In General.--Section 1913 of the Public Health Service Act (42 U.S.C. 300x-2) is amended--

   Inserted: (1) in subsection (a)(2)(A), by striking "community mental health services" and inserting "behavioral health services (of the type offered by certified community behavioral health clinics consistent with subsection (c)(3))";

   Inserted: (2) in subsection (b)--

   Inserted: (A) by striking paragraph (1) and inserting the following:

   Inserted: "(1) services under the plan will be provided only through appropriate, qualified community programs (which may include certified community behavioral health clinics, child mental health programs, psychosocial rehabilitation programs, mental health peer-support programs, outpatient addiction treatment programs, acute detoxification services, and mental health primary consumer-directed programs); and"; and

   Inserted: (B) in paragraph (2), by striking "community mental health centers" and inserting "certified community behavioral health clinics"; and

   Inserted: (3) by striking subsection (c) and inserting the following:

   Inserted: "(c) Criteria for Certified Community Behavioral Health Clinics.--

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   Inserted: "(1) In general.--The Administrator shall certify, and recertify at least every 5 years, certified community behavioral health clinics as meeting the criteria specified in this subsection.

   Inserted: "(2) Regulations.--Not later than 18 months after the date of the enactment of the Excellence in Mental Health Act--

   Inserted: "(A) the Administrator, in consultation with State Mental Health and Substance Abuse Authorities, shall issue final regulations for certifying non-profit and local government behavioral health authorities and Indian Health Service tribal facilities as clinics under paragraph (1); and

   Inserted: "(B) the Secretary, in determining eligible non-profit entities under this subsection, shall promulgate regulations specifying that an entity receiving payment under section 1902(bb) of the Social Security Act may not be owned , controlled, or operated by another entity.

   Inserted: "(3) Criteria.--The criteria referred to in subsection (b)(2) are that the clinic performs each of the following:

   Inserted: "(A) Provide services in locations that ensure services will be available and accessible promptly and in a manner which preserves human dignity and assures continuity of care.

   Inserted: "(B) Provide services in a mode of service delivery appropriate for the target population.

   Inserted: "(C) Provide individuals with a choice of service options, including developmentally appropriate evidence based interventions, where there is more than one efficacious treatment.

   Inserted: "(D) Employ a core clinical staff that is trained to provide evidence-based practices and is multidisciplinary and culturally and linguistically competent, including the availability of translation or similar services and arrangements if the clinic is located in a geographic area of limited English-speaking ability.

   Inserted: "(E) Establish an emergency plan to support continuity of services for individuals during an emergency or disaster.

   Inserted: "(F) Demonstrate the capacity to comply with behavioral health and related health care quality measures promulgated by such entities as the National Quality Forum, the National Committee for Quality Assurance, or other nationally recognized accrediting bodies.

   Inserted: "(G) Provide services to any individual residing or employed in the service area of the clinic and ensure that no patient or consumer will be denied mental health or other health care services due to an individual's inability to pay for such services.

   Inserted: "(H) Ensure that any fees or payments required by the clinic for such services will be reduced or waived to enable the clinic to comply with subparagraph (G), including preparing a schedule of fees or payments for the provision of services that is consistent with locally prevailing rates or charges designed to cover the reasonable costs to the clinic of operation along with a corresponding schedule of discounts to be applied to the payment of such fees or payments, such discounts to be adjusted on the basis of the patient's ability to pay.

   Inserted: "(I) Provide, directly or through contract, to the extent covered for adults in the State Medicaid plan under title XIX of the Social Security Act and for children in accordance with section 1905(r) of such Act regarding early and periodic screening, diagnosis, and treatment, each of the following services:

   Inserted: "(i) Screening, assessment, and diagnosis, including risk assessment.

   Inserted: "(ii) Person-centered treatment planning or similar processes, including risk assessment and crisis planning.

   Inserted: "(iii) Outpatient mental health and substance use services, including screening, assessment, diagnosis, psychotherapy, cognitive behavioral therapy, applied behavioral analysis, medication management, and integrated treatment for trauma, mental illness, and substance abuse which shall be evidence-based (including cognitive behavioral therapy, long acting injectable medications, and other such therapies which are evidence-based).

   Inserted: "(iv) Outpatient clinic primary care screening and monitoring of key health indicators and health risk (including screening for diabetes, hypertension, and cardiovascular disease and monitoring of weight, height, body mass index (BMI), blood pressure, blood glucose or HbA1C, and lipid profile).

   Inserted: "(v) Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.

   Inserted: "(vi) Targeted case management (services to assist individuals gaining access to needed medical, social, educational, and other services and applying for income security and other benefits to which they may be entitled).

   Inserted: "(vii) Psychiatric rehabilitation services including skills training, assertive community treatment, family psychoeducation, disability self-management, supported employment, supported housing services, therapeutic foster care services, and such other evidence-based practices as the Secretary may require.

   Inserted: "(viii) Peer support and counselor services and family supports.

   Inserted: "(J) Maintain linkages, and where possible enter into formal contracts, agreements, or partnerships with at least one federally qualified health center, unless there is no such center serving the service area, in order to ensure that the delivery of behavioral health care is integrated with primary and preventive care services, so long as such linkages, contract, agreement, or partnership meets requirements as prescribed by the Secretary;

   Inserted: "(K) Maintain additional linkages and where possible enter into formal contracts with the following:

   Inserted: "(i) Inpatient psychiatric facilities and substance use detoxification, post-detoxification step-down services, and residential programs.

   Inserted: "(ii) Adult and youth peer support and counselor services.

   Inserted: "(iii) Family support services for families of children with serious mental or substance use disorders.

   Inserted: "(iv) Other community or regional services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities, Indian Health Service youth regional treatment centers, housing agencies and programs, employers, and other social and human services.

   Inserted: "(v) Onsite or offsite access to primary care services.

   Inserted: "(vi) Enabling services, including outreach, transportation, and translation.

   Inserted: "(vii) Health and wellness services, including services for tobacco cessation.

   Inserted: "(viii) Department of Veterans Affairs medical centers, independent outpatient clinics, drop-in centers, and other facilities of the Department as defined in section 1801 of title 38, United States Code.

   Inserted: "(L) Where feasible, provide outreach and engagement to encourage individuals who could benefit from mental health care to freely participate in receiving the administrative services described in this subsection.

   Inserted: "(M) Where feasible, provide intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, such care to be consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration.

   Inserted: "(N) Where feasible, require certified community behavioral health clinics to provide valid and reliable trauma screening and functional or developmental assessment to determine need, match services to needs, and to measure progress over time.

   Inserted: "(4) Rule of construction.--Nothing in paragraph (1) shall be construed as prohibiting States receiving funds appropriated through the Community Mental Health Services Block Grant under subpart I of part B of this title from financing qualified community programs (whether such programs meet the definition of eligible programs prior to or after the date of enactment of this subsection).

   Inserted: "(5) Limitation.--

   Inserted: "(A) In general.--For purposes of providing assistance under this section and reimbursement under section 1902(bb) of the Social Security Act--

   Inserted: "(i) for each of fiscal years 2016 through 2024, the Secretary shall certify 10 percent of the total number of entities who apply and are eligible to become certified community behavioral health clinics in each such fiscal year, in addition to the clinics certified in the previous fiscal years; and

   Inserted: "(ii) for fiscal year 2025, and each subsequent fiscal year, the Secretary shall certify all such community behavioral health clinics.

   Inserted: "(B) Requirements.--In implementing this paragraph, the Secretary shall--

   Inserted: "(i) ensure the geographic diversity of such clinics;

   Inserted: "(ii) ensure that applications from clinics located in rural areas, as defined by the Secretary, and other mental health professional shortage areas are fairly and appropriately considered with the objective of facilitating access to mental health services in such areas; and

   Inserted: "(iii) take into account the ability of such clinics to provide required services, and the ability of such clinics to report required data as required under this title.

   Inserted: "(6) Exemption.--Certified community behavioral health clinics receiving payments under section 1902(bb) of the Social Security Act which are located in rural areas, as defined by the Secretary, shall be exempt from the requirements contained in subparagraphs (A) and (I)(v) of paragraph (3).".

   Inserted: (b) Conforming Amendments to Medicare Definition of Community Mental Health Center.--Section 1861(ff)(3)(B) of the Social Security Act (42 U.S.C. 1395x(ff)(3)(B)) is amended--

   Inserted: (1) in clause (i)--

   Inserted: (A) in subclause (I), by inserting "(as in effect on the day before the date of the enactment of the Excellence in Mental Health Act)" after "Service Act"; and

   Inserted: (B) in subclause (II), by inserting "(as so in effect)" after "of such section"; and

   Inserted: (2) in clause (iv)(III), by striking "1931(c)(1) of the Public Health Service Act" and inserting "1913(c)(1) of the Public Health Service Act (as so in effect)".

   Inserted: SEC. _03. MEDICAID COVERAGE AND PAYMENT FOR COMMUNITY BEHAVIORAL HEALTH CLINIC SERVICES.

   Inserted: (a) Payment for Services Provided by Certified Community Behavioral Health Clinics.--Section 1902(bb) of the Social Security Act (42 U.S.C. 1396a(bb)) is amended--

   Inserted: (1) in the heading, by striking "and Rural Health Clinics" and inserting ", Certified Community Behavioral Health Clinics, and Rural Health Clinics";

   Inserted: (2) in paragraph (1), by inserting "(and beginning with fiscal year 2016 with respect to services furnished on or after January 1, 2016, and each succeeding fiscal year, for services described in section 1905(a)(2)(D) furnished by a certified community behavioral health clinic)" after "by a rural health clinic";

   Inserted: (3) in paragraph (2)--

   Inserted: (A) by striking the heading and inserting "Initial fiscal year";

   Inserted: (B) by inserting "(or, in the case of services described in section 1905(a)(2)(D) furnished by a certified community behavioral health clinic, for services furnished on and after January 1, 2016, during fiscal year 2016)" after "January 1, 2001, during fiscal year 2001";

   Inserted: (C) by inserting "(or, in the case of services described in section 1905(a)(2)(D) furnished by a certified community behavioral health clinic, during fiscal years 2014 and 2015)" after "1999 and 2000"; and

   Inserted: (D) by inserting "(or, in the case of services described in section 1905(a)(2)(D) furnished by a certified community behavioral health clinic, during fiscal year 2016)" before the period;

   Inserted: (4) in paragraph (3)--

   Inserted: (A) in the heading, by striking "Fiscal year 2002 and succeeding" and inserting "Succeeding"; and

   Inserted: (B) by inserting "(or, in the case of services described in section 1905(a)(2)(D) furnished by a certified community behavioral health clinic, for services furnished during fiscal year 2017 or a succeeding fiscal year)" after "2002 or a succeeding fiscal year";

   Inserted: (5) in paragraph (4)--

   Inserted: (A) by inserting "(or as a certified community behavioral health clinic after fiscal year 2015)" after "or rural health clinic after fiscal year 2000";

   Inserted: (B) by striking "furnished by the center or" and inserting "furnished by the federally qualified health clinic, services described in section 1905(a)(2)(D) furnished by the certified community behavioral health clinic, or"; and

   Inserted: (C) in the second sentence, by striking "or rural health clinic" and inserting ", certified community behavioral health clinic, or rural health clinic";

   Inserted: (6) in paragraph (5), in each of subparagraphs (A) and (B), by striking "or rural health clinic" and inserting ", certified community behavioral health clinic, or rural health clinic"; and

   Inserted: (7) in paragraph (6), by striking "or to a rural health clinic" and inserting ", to a certified community behavioral health clinic for services described in section 1905(a)(2)(D), or to a rural health clinic".

   Inserted: (b) Inclusion of Community Behavioral Health Clinic Services in the Term Medical Assistance.--Section 1905(a)(2) of the Social Security Act (42 U.S.C. 1396d(a)(2)) is amended--

   Inserted: (1) by striking "and" before "(C)"; and

   Inserted: (2) by inserting before the semicolon at the end the following: ", and (D) certified community behavioral health clinic services (as defined in subsection (l)(4))".

   Inserted: (c) Definition of Certified Community Behavioral Health Clinic Services.--Section 1905(l) of the Social Security Act (42 U.S.C. 1396d(l)) is amended by adding at the end the following paragraph:

   Inserted: "(4)(A) The term 'community behavioral health clinic services' means services of the type described in subparagraphs (I), (L), (M), and (N) of section 1913(c)(3) of the Public Health Service Act furnished to an individual at a certified community behavioral health clinic (as defined by subparagraph (B)).

   Inserted: "(B) The term 'certified community behavioral health clinic' means an entity that is certified under section 1913(c) of the Public Health Service Act as meeting the criteria described in paragraph (3) of such section.".

   Inserted: (d) Exclusion.--Section 1902(bb) of the Social Security Act (42 U.S.C. 1396a(bb)) is amended by adding at the end the following:

   Inserted: "(7) Exclusions.--

   Inserted: "(A) In general.--Payments made to certified community behavioral health clinics under this subsection hall be limited to ambulatory behavioral health services of the type described in subparagraphs (I), (L), (M), and (N) of section 1913(c)(3) of the Public Health Service Act and shall specifically exclude reimbursement for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary.

   Inserted: "(B) Existing facilities.--Payments under this subsection may not be made to satellite facilities of certified community behavioral health clinics if such facilities are established after the date of enactment of this paragraph.".

   Inserted: (e) Effective Date.--The amendments made by this section take effect on January 1, 2016.

   Inserted: SEC. _04. MEDICAID DSH.

   Inserted: (a) Rebasing of Allotments for First, Second, and Third Quarters of Fiscal Year 2023.--Section 1923(f)(8) of the Social Security Act (42 U.S.C. 1396r-4(f)(8)) is amended--

   Inserted: (1) by redesignating subparagraph (C) as subparagraph (D);

   Inserted: (2) by inserting after subparagraph (B) the following new subparagraph:

   Inserted: "(C) First 3 quarters of fiscal year 2023.--Only with respect to the period that begins on October 1, 2022, and ends on June 30, 2023, the DSH allotment for a State, in lieu of the amount determined under paragraph (3) for the State for that year, shall be equal to \3/4\ of the DSH allotment for the State for fiscal year 2022, as determined under subparagraph (B), increased, subject to subparagraphs (B) and (C) of paragraph (3), and paragraph (5), by the percentage change in the consumer price index for all urban consumers (all items; U.S. city average), for fiscal year 2022."; and

   Inserted: (3) in subparagraph (D) (as redesignated by paragraph (1) of this section), by striking "after fiscal year 2022" and all that follows through the period and inserting "(and portions of fiscal years) after June 30, 2023, shall be calculated under paragraph (3) without regard to this paragraph and paragraph (7), except that the amount of the DSH allotment available for a State for the fourth quarter of fiscal year 2023 (after such calculation) shall be equal to the sum of \1/4\ of the amount calculated under paragraph (3) for the State for fiscal year 2023.".

   Inserted: (b) Elimination of Reduction for Fiscal Year 2014.--Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-4(f)(7)(A)) is amended--

   Inserted: (1) in clause (i), by striking "2014" and inserting "2015"; and

   Inserted: (2) in clause (ii)--

   Inserted: (A) by striking subclause (I); and

   Inserted: (B) by redesignating subclauses (II) through (VII) as subclauses (I) through (VI), respectively.

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As printed