[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1914 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 1914
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
March 16, 2021
Mr. DeFazio (for himself, Mr. Blumenauer, Ms. Bonamici, Ms. Norton,
Mrs. Hayes, Mr. Thompson of California, and Ms. Pressley) introduced
the following bill; which was referred to the Committee on Energy 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 purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Crisis Assistance Helping Out On The
Streets Act'' or the ``CAHOOTS Act''.
SEC. 2. ENHANCED FEDERAL MEDICAID SUPPORT FOR COMMUNITY-BASED MOBILE
CRISIS INTERVENTION SERVICES.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(cc) Community-Based Mobile Crisis Intervention Services.--
``(1) In general.--Notwithstanding section 1902(a)(1)
(relating to Statewideness), section 1902(a)(10)(B) (relating
to comparability), section 1902(a)(23)(A) (relating to freedom
of choice of providers), or section 1902(a)(27) (relating to
provider agreements), a State may provide medical assistance
for qualifying community-based mobile crisis intervention
services under a State plan amendment or waiver approved under
section 1115 or 1915.
``(2) Qualifying community-based mobile crisis intervention
services defined.--For purposes of this subsection, the term
`qualifying community-based mobile crisis intervention
services' means, with respect to a State, items and services
for which medical assistance is available under the State plan
under this title or a waiver of such plan, that are--
``(A) furnished outside of a hospital or other
facility setting to an individual who is--
``(i) entitled to medical assistance under
such plan or waiver; and
``(ii) experiencing a mental health or
substance use disorder crisis;
``(B) furnished by a multidisciplinary mobile
crisis team--
``(i) that includes at least 1 behavioral
health care professional who is capable of
conducting an assessment of the individual, in
accordance with the professional's permitted
scope of practice under State law, and other
professionals or paraprofessionals with
appropriate expertise in behavioral health or
mental health crisis response, including
nurses, social workers, peer support
specialists, and others, as designated by the
State and approved by the Secretary;
``(ii) whose members are trained in trauma-
informed care, de-escalation strategies, and
harm reduction;
``(iii) that is able to respond in a timely
manner and, where appropriate, provide the
following--
``(I) screening and assessment;
``(II) stabilization and de-
escalation;
``(III) coordination with, and
referrals to, health, social, and other
services and supports as needed; and
``(IV) facilitate an individual
into the State's Medicaid
transportation process to ensure access
to the next step in care or treatment;
``(iv) that maintains relationships with
relevant community partners, including medical,
primary care, and behavioral health providers,
community health centers, crisis respite
centers, managed care organizations (if
applicable), entities able to provide
assistance with application and enrollment in
the State plan or a waiver of the plan,
entitles able to provide assistance with
applying for and enrolling in benefit programs,
entities that provide assistance with housing
(such as public housing authorities, Continuum
of Care programs, or not-for-profit entities
that provide housing assistance), and entities
that provide assistance with other social
services;
``(v) that coordinates with crisis
intervention hotlines and emergency response
systems;
``(vi) that maintains the privacy and
confidentiality of patient information
consistent with Federal and State requirements;
and
``(vii) that operates independently from
(but may coordinate with) State or local law
enforcement agencies;
``(C) available 24 hours per day, every day of the
year; and
``(D) voluntary to receive.
``(3) Payments.--
``(A) In general.--Notwithstanding section 1905(b),
beginning October 1, 2020, during each of the first 12
fiscal quarters that a State meets the requirements
described in paragraph (4), the Federal medical
assistance percentage applicable to amounts expended by
the State for medical assistance for qualifying
community-based mobile crisis intervention services
furnished during such quarter shall be equal to 95
percent.
``(B) Exclusion of enhanced payments from
territorial caps.--To the extent that the amount of a
payment to Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa for medical
assistance for qualifying community-based mobile crisis
intervention services that is based on the Federal
medical assistance percentage specified in subparagraph
(A) exceeds the amount that would have been paid to
such territory for such services if the Federal medical
assistance percentage for the territory had been
determined without regard to such subparagraph--
``(i) the limitation on payments to
territories under subsections (f) and (g) of
section 1108 shall not apply to the amount of
such excess; and
``(ii) the amount of such excess shall be
disregarded in applying such subsections.
``(4) Requirements.--The requirements described in this
paragraph are the following:
``(A) The State demonstrates, to the satisfaction
of the Secretary--
``(i) that it will be able to support the
provision of qualifying community-based mobile
crisis intervention services that meet the
conditions specified in paragraph (2); and
``(ii) how it will support coordination
between mobile crisis teams and community
partners, including health care providers, to
enable the provision of services, needed
referrals, and other activities identified by
the Secretary.
``(B) The State provides assurances satisfactory to
the Secretary that--
``(i) any additional Federal funds received
by the State for qualifying community-based
mobile crisis intervention services provided
under this subsection that are attributable to
the increased Federal medical assistance
percentage under paragraph (3)(A) will be used
to supplement, and not supplant, the level of
State funds expended for such services in the
fiscal year preceding the first fiscal year in
which the State elected to provide medical
assistance under this subsection;
``(ii) if the State made qualifying
community-based mobile crisis intervention
services available in a region of the State in
such preceding fiscal year, the State will
continue to make such services available in
such region under this subsection; and
``(iii) the State will conduct the
evaluation and assessment, and submit the
report, required under paragraph (5).
``(5) State evaluation and report.--
``(A) State evaluation.--Not later than 4 fiscal
quarters after a State begins providing qualifying
community-based mobile crisis intervention services in
accordance with this subsection, the State shall enter
into a contract with an independent entity or
organization to conduct an evaluation for the purposes
of--
``(i) determining the effect of the
provision of such services on--
``(I) emergency room visits;
``(II) use of ambulatory services;
``(III) hospitalizations;
``(IV) the involvement of law
enforcement in mental health or
substance use disorder crisis events;
``(V) the diversion of individuals
from jails or similar settings; and
``(ii) assessing--
``(I) the types of services
provided to individuals;
``(II) the types of events
responded to;
``(III) cost savings or cost-
effectiveness attributable to such
services;
``(IV) the experiences of
individuals who receive qualifying
community-based mobile crisis
intervention services;
``(V) the successful connection of
individuals with follow-up services;
and
``(VI) other relevant outcomes
identified by the Secretary.
``(B) Comparison to historical measures.--The
contract described in subparagraph (A) shall specify
that the evaluation is based on a comparison of the
historical measures of State performance with respect
to the outcomes specified under such subparagraph to
the State's performance with respect to such outcomes
during the period beginning with the first quarter in
which the State begins providing qualifying community-
based mobile crisis intervention services in accordance
with this subsection.
``(C) Report.--Not later than 2 years after a State
begins to provide qualifying community-based mobile
crisis intervention services in accordance with this
subsection, the State shall submit a report to the
Secretary on the following:
``(i) The results of the evaluation carried
out under subparagraph (A).
``(ii) The number of individuals who
received qualifying community-based mobile
crisis intervention services.
``(iii) Demographic information regarding
such individuals when available, including the
race or ethnicity, age, sex, sexual
orientation, gender identity, and geographic
location of such individuals.
``(iv) The processes and models developed
by the State to provide qualifying community-
based mobile crisis intervention services under
such the State plan or waiver, including the
processes developed to provide referrals for,
or coordination with, follow-up care and
services.
``(v) Lessons learned regarding the
provision of such services.
``(D) Public availability.--The State shall make
the report required under subparagraph (C) publicly
available, including on the website of the appropriate
State agency, upon submission of such report to the
Secretary.
``(6) Best practices report.--
``(A) In general.--Not later than 3 years after the
first State begins to provide qualifying community-
based mobile crisis intervention services in accordance
with this subsection, the Secretary shall submit a
report to Congress that--
``(i) identifies the States that elected to
provide services in accordance with this
subsection;
``(ii) summarizes the information reported
by such States under paragraph (5)(C); and
``(iii) identifies best practices for the
effective delivery of community-based mobile
crisis intervention services.
``(B) Public availability.--The report required
under subparagraph (A) shall be made publicly
available, including on the website of the Department
of Health and Human Services, upon submission to
Congress.
``(7) State planning and evaluation grants.--
``(A) In general.--As soon as practicable after the
date of enactment of this subsection, the Secretary may
award planning and evaluation grants to States for
purposes of developing a State plan amendment or
section 1115 or 1915 waiver request (or an amendment to
such a waiver) to provide qualifying community-based
mobile crisis intervention services and conducting the
evaluation required under paragraph (5)(A). A grant
awarded to a State under this paragraph shall remain
available until expended.
``(B) State contribution.--A State awarded a grant
under this subsection shall contribute for each fiscal
year for which the grant is awarded an amount equal to
the State percentage determined under section 1905(b)
(without regard to the temporary increase in the
Federal medical assistance percentage of the State
under section 6008(a) of the Families First Coronavirus
Response Act (Public Law 116-127) or any other
temporary increase in the Federal medical assistance
percentage of the State for fiscal year 2020 or any
succeeding fiscal year) of the grant amount.
``(8) Funding.--
``(A) Implementation and administration.--There is
appropriated to the Secretary, out of any funds in the
Treasury not otherwise appropriated, such sums as are
necessary for purposes of implementing and
administering this section.
``(B) Planning and evaluation grants.--There is
appropriated, out of any funds in the Treasury not
otherwise appropriated, $25,000,000 to the Secretary
for fiscal year 2021 for purposes of making grants
under paragraph (7), to remain available until
expended.''.
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