[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7116 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 7116
To provide for improvements in the implementation of the National
Suicide Prevention Lifeline, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 17, 2022
Mr. Cardenas (for himself, Mr. Fitzpatrick, Ms. Matsui, Ms. Blunt
Rochester, Mr. Moulton, Mrs. Napolitano, Mr. Beyer, and Mr. Raskin)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committees on Ways and
Means, Armed Services, Veterans' Affairs, and Oversight and Reform, for
a period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To provide for improvements in the implementation of the National
Suicide Prevention Lifeline, 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.
(a) Short Title.--This Act may be cited as the ``9-8-8
Implementation Act of 2022''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title.
TITLE I--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
Sec. 101. Behavioral Health Crisis Coordinating Office.
Sec. 102. National suicide prevention lifeline program.
Sec. 103. Regional and local lifeline call center program.
Sec. 104. Evidence-based and best practice crisis care programs.
Sec. 105. Mental Health Crisis Response Partnership Pilot Program.
Sec. 106. National suicide prevention media campaign.
TITLE II--HEALTH RESOURCES AND SERVICES ADMINISTRATION
Sec. 201. Health center capital grants.
Sec. 202. Expanding behavioral health workforce training programs.
TITLE III--BEHAVIORAL HEALTH CRISIS SERVICES EXPANSION
Sec. 301. Crisis response continuum of care.
Sec. 302. Coverage of crisis response services.
Sec. 303. Building the crisis continuum infrastructure.
Sec. 304. Incident reporting.
TITLE IV--MEDICAID AMENDMENTS
Sec. 401. Revisions to the State option to provide qualifying
community-based mobile crisis intervention
services and other services under State
plans under the Medicaid program.
Sec. 402. Revisions to the IMD exclusion under Medicaid.
Sec. 403. Excellence in Mental Health and Addiction Treatment.
TITLE I--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
SEC. 101. BEHAVIORAL HEALTH CRISIS COORDINATING OFFICE.
Part A of title V of the Public Health Service Act (42 U.S.C. 290aa
et seq.) is amended by adding at the end the following:
``SEC. 506B. BEHAVIORAL HEALTH CRISIS COORDINATING OFFICE.
``(a) In General.--The Secretary, acting through the Assistant
Secretary for Mental Health and Substance Use, shall establish an
office to coordinate work relating to behavioral health crisis care
across the operating divisions of the Department of Health and Human
Services, including the Centers for Medicare & Medicaid Services and
the Health Resources and Services Administration and external
stakeholders.
``(b) Duty.--The office established under subsection (a) shall--
``(1) convene Federal, State, Tribal, local, and private
partners;
``(2) launch and manage Federal workgroups charged with
making recommendations regarding behavioral health crisis
financing, workforce, equity, data, and technology, program
oversight, public awareness, and engagement; and
``(3) support technical assistance, data analysis, and
evaluation functions in order to develop a crisis care system
to establish nationwide standards with the objective of
expanding the capacity of, and access to, local crisis call
centers, mobile crisis care, crisis stabilization, psychiatric
emergency services, and rapid post-crisis follow-up care
provided by--
``(A) the National Suicide Prevention and Mental
Health Crisis Hotline and Response System;
``(B) community mental health centers (as defined
in section 1861(ff)(3)(B) of the Social Security Act);
``(C) certified community behavioral health
clinics, as described in section 223 of the Protecting
Access to Medicare Act of 2014; and
``(D) other community mental health and substance
use disorder providers.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2023 through 2027.''.
SEC. 102. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.
(a) Authorization of Appropriations.--Section 520E-3(c) of the
Public Health Service Act (290bb-36c(c)) is amended by inserting before
the period at the end the following: ``, and $240,000,000 for each of
fiscal years 2023 through 2027''.
(b) Specialized Hotline for Underserved Populations.--Section 520E-
3 of the Public Health Service Act (290bb-36c) is amended--
(1) in subsection (b)--
(A) in paragraph (2)--
(i) by inserting after ``suicide prevention
hotline'' the following: ``, under the
universal telephone number designated under
section 251(e)(4) of the Communications Act of
1934,''; and
(ii) by striking ``; and'' at the end and
inserting a semicolon;
(B) in paragraph (3), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following:
``(4) providing for access by LGBTQ individuals, people of
color, and other underserved populations to specialized
services through a range of digital and technology approaches,
as determined by the Office of the Assistant Secretary.'';
(2) by redesignating subsection (c) as subsection (d); and
(3) by inserting after subsection (b) the following:
``(c) Consultation.--Wherever possible, the Office of the Assistant
Secretary shall, in determining which approaches to use to provide
specialized services under subsection (b)(4) to the populations
described in such subsection, consult with organizations that have
experience--
``(1) working with such populations; and
``(2) technological expertise in effective crisis response
using such digital and technology approaches.''.
SEC. 103. REGIONAL AND LOCAL LIFELINE CALL CENTER PROGRAM.
Part B of title V of the Public Health Service Act (42 U.S.C. 290bb
et seq.) is amended by inserting after section 520E-4 (42 U.S.C. 290bb-
36d) the following:
``SEC. 520E-5. REGIONAL AND LOCAL LIFELINE CALL CENTER PROGRAM.
``(a) In General.--The Secretary shall award grants to crisis call
centers described in section 302(c)(1) of the 9-8-8 National Suicide
Prevention Lifeline Implementation Act of 2022 to--
``(1) purchase or upgrade call center technology;
``(2) provide for training of call center staff;
``(3) improve call center operations; and
``(4) hiring of call center staff.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $441,000,000 for fiscal year
2023, to remain available until expended.''.
SEC. 104. EVIDENCE-BASED AND BEST PRACTICE CRISIS CARE PROGRAMS.
(a) In General.--Section 1912(b)(1) of the Public Health Service
Act (42 U.S.C. 300x-1(b)(1)) is amended--
(1) in subparagraph (A)--
(A) by redesignating clauses (vi) and (vii) as
clauses (vii) and (viii), respectively; and
(B) by inserting after clause (v), the following:
``(vi) include a description of how the
State supports evidenced-based and best
practice programs that address the crisis care
needs of individuals with serious mental
illness, and children with serious emotional
disturbances, that include at least one of the
core components specified in subparagraph
(F);''; and
(2) by adding at the end the following:
``(F) Core components for crisis care services.--
The core components of a program referred to in
subparagraph (A)(vi) include the following:
``(i) Crisis call centers.
``(ii) 24/7 mobile crisis services.
``(iii) Crisis stabilization programs
offering acute care or subacute care in a
hospital or appropriately licensed facility,
with referrals to inpatient or outpatient care,
as determined by the Assistant Secretary for
Mental Health and Substance Use.''.
(b) Set-Aside for Evidence-Based and Best Practice Crisis Care
Services.--Section 1920 of the Public Health Service Act (42 U.S.C.
300x-9) is amended--
(1) in subsection (a), by striking ``be appropriated'' and
all that follows through ``2022.'' and inserting the following:
``be appropriated--
``(1) $532,571,000 for each of fiscal years 2018 through
2022; and
``(2) $2,235,000,000 for each of fiscal years 2023 through
2027.''; and
(2) by adding at the end the following:
``(d) Crisis Care.--
``(1) In general.--Except as provided in paragraph (3), a
State shall expend at least 10 percent of the allotment of the
State pursuant to a funding agreement under section 1911 for
each of fiscal years 2023 through 2027 to support programs
described in section 1912(b)(1)(A)(vi).
``(2) State flexibility.--In lieu of expending 10 percent
of the State's allotment for a fiscal year as required by
paragraph (1), a State may elect to expend not less than 20
percent of such amount by the end of two consecutive fiscal
years.
``(3) Funding contingency.--Paragraph (1) shall not apply
with respect to a fiscal year unless the amount made available
to carry out this section for that fiscal year exceeds the
amount appropriated to carry out this section for fiscal year
2021 by at least $37,257,100.
``(4) Waiver.--A State may, pursuant to a waiver granted by
the Secretary of any requirements under this subpart (including
requirements imposed by a funding agreement under section
1911), use funds set aside under this subsection to provide
services described in section 1912(b)(1)(A)(vi) to individuals
in such State who do not meet the criteria to be considered
with serious mental illness or children with serious emotional
disturbances.''.
SEC. 105. MENTAL HEALTH CRISIS RESPONSE PARTNERSHIP PILOT PROGRAM.
Title V of the Public Health Service Act is amended (42 U.S.C.
290aa) by inserting after section 520F (42 U.S.C. 290bb-37) the
following:
``SEC. 520F-1. MENTAL HEALTH CRISIS RESPONSE PARTNERSHIP PILOT PROGRAM.
``(a) In General.--The Secretary shall establish a pilot program
under which the Secretary will award competitive grants to eligible
entities to establish new, or enhance existing, mobile crisis response
teams that divert the response for mental health and substance use
crises from law enforcement to mobile crisis teams, as described in
subsection (b).
``(b) Mobile Crisis Teams Described.--A mobile crisis team
described in this subsection is a team of individuals--
``(1) that is available to respond to individuals in crisis
and provide immediate stabilization, referrals to community-
based mental health and substance use disorder services and
supports, and triage to a higher level of care if medically
necessary;
``(2) which may include licensed counselors, clinical
social workers, physicians, paramedics, crisis workers, peer
support specialists, or other qualified individuals; and
``(3) which may provide support to divert behavioral health
crisis calls from the 9-1-1 system to the 9-8-8 system.
``(c) Priority.--In awarding grants under this section, the
Secretary shall prioritize applications which account for the specific
needs of the communities to be served, including children and families,
veterans, rural and underserved populations, and other groups at
increased risk of death from suicide or overdose.
``(d) Report.--
``(1) Initial report.--Not later than one year after the
date of the enactment of this section, the Secretary shall
submit to Congress a report on steps taken by eligible entities
as of such date of enactment to strengthen the partnerships
among mental health providers, substance use disorder treatment
providers, primary care physicians, mental health and substance
use crisis teams, and paramedics, law enforcement officers, and
other first responders.
``(2) Progress reports.--Not later than one year after the
date on which the first grant is awarded to carry out this
section, and for each year thereafter, the Secretary shall
submit to Congress a report on the grants made during the year
covered by the report, which shall include--
``(A) data on the teams and people served by such
programs, including demographic information of
individuals served, volume and types of service
utilization, linkage to community-based resources and
diversion from law enforcement settings, data
consistent with the State block grant requirements for
continuous evaluation and quality improvement, and
other relevant data as determined by the Secretary; and
``(B) the Secretary's recommendations and best
practices for--
``(i) States and localities providing
mobile crisis response and stabilization
services for youth and adults; and
``(ii) improvements to the program
established under this section.
``(e) Eligible Entity.--In this section, the term `eligible entity'
means each of the following:
``(1) Community mental health centers (as defined in
section 1861(ff)(3)(B) of the Social Security Act).
``(2) Certified community behavioral health clinics
described in section 223 of the Protecting Access to Medicare
Act of 2014.
``(3) An entity that operates citywide, Tribal-wide, or
county-wide crisis response systems, including cities,
counties, Tribes, or a department or agency of a city, county,
or Tribe, including departments or agencies of social services,
disability services, health services, public health, or mental
health and substance disorder services.
``(4) A program of the Indian Health Service, whether
operated by such Service, an Indian Tribe (as that term is
defined in section 4 of the Indian Health Care Improvement
Act), or by a Tribal organization (as that term is defined in
section 4 of the Indian Self-Determination and Education
Assistance Act) or a facility of the Native Hawaiian health
care systems authorized under the Native Hawaiian Health Care
Improvement Act.
``(5) A public, nonprofit, or other organization that--
``(A) can demonstrate the ability of such
organization to effectively provide community-based
alternatives to law enforcement; and
``(B) has a demonstrated involvement with the
identified communities to be served.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $100,000,000 for each of fiscal
years 2023 through 2027.''.
SEC. 106. NATIONAL SUICIDE PREVENTION MEDIA CAMPAIGN.
Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb-31 et seq.) is amended by adding at the end the following:
``SEC. 520N. NATIONAL SUICIDE PREVENTION MEDIA CAMPAIGN.
``(a) National Suicide Prevention Media Campaign.--
``(1) In general.--Not later than the date that is 3 years
after the date of the enactment of this Act, the Secretary, in
consultation with the Assistant Secretary for Mental Health and
Substance Use and the Director of the Centers for Disease
Control and Prevention (referred to in this section as the
`Director'), shall conduct a national suicide prevention media
campaign (referred to in this section as the `national media
campaign'), for purposes of--
``(A) preventing suicide in the United States;
``(B) educating families, friends, and communities
on how to address suicide and suicidal thoughts,
including when to encourage individuals with suicidal
risk to seek help; and
``(C) increasing awareness of suicide prevention
resources of the Centers for Disease Control and
Prevention and the Substance Abuse and Mental Health
Services Administration (including the suicide
prevention hotline maintained under section 520E-3, any
suicide prevention mobile application of the Centers
for Disease Control and Prevention or the Substance
Abuse Mental Health Services Administration, and other
support resources determined appropriate by the
Secretary).
``(2) Additional consultation.--In addition to consulting
with the Assistant Secretary and the Director under this
section, the Secretary shall consult with, as appropriate,
State, local, Tribal, and territorial health departments,
primary health care providers, hospitals with emergency
departments, mental and behavioral health services providers,
crisis response services providers, paramedics, law
enforcement, suicide prevention and mental health
professionals, patient advocacy groups, survivors of suicide
attempts, and representatives of television and social media
platforms in planning the national media campaign to be
conducted under paragraph (1).
``(b) Target Audiences.--
``(1) Tailoring advertisements and other communications.--
In conducting the national media campaign under subsection
(a)(1), the Secretary may tailor culturally competent
advertisements and other communications of the campaign across
all available media for a target audience (such as a particular
geographic location or demographic) across the lifespan.
``(2) Targeting certain local areas.--The Secretary shall,
to the maximum extent practicable, use amounts made available
under subsection (f) for media that targets certain local areas
or populations at disproportionate risk for suicide.
``(c) Use of Funds.--
``(1) Required uses.--
``(A) In general.--The Secretary shall, if
reasonably feasible with the funds made available under
subsection (f), carry out the following, with respect
to the national media campaign:
``(i) Testing and evaluation of
advertising.
``(ii) Evaluation of the effectiveness of
the national media campaign.
``(iii) Operational and management
expenses.
``(iv) The creation of an educational
toolkit for television and social media
platforms to use in discussing suicide and
raising awareness about how to prevent suicide.
``(B) Specific requirements.--
``(i) Testing and evaluation of
advertising.--In testing and evaluating
advertising under subparagraph (A)(i), the
Secretary shall test all advertisements after
use in the national media campaign to evaluate
the extent to which such advertisements have
been effective in carrying out the purposes of
the national media campaign.
``(ii) Evaluation of effectiveness of
national media campaign.--In evaluating the
effectiveness of the national media campaign
under subparagraph (A)(ii), the Secretary
shall--
``(I) take into account the number
of unique calls that are made to the
suicide prevention hotline maintained
under section 520E-3 and assess whether
there are any State and regional
variations with respect to the capacity
to answer such calls;
``(II) take into account the number
of unique encounters with suicide
prevention and support resources of the
Centers for Disease Control and
Prevention and the Substance Abuse and
Mental Health Services Administration
and assess engagement with such suicide
prevention and support resources;
``(III) assess whether the national
media campaign has contributed to
increased awareness that suicidal
individuals should be engaged, rather
than ignored; and
``(IV) take into account such other
measures of evaluation as the Secretary
determines are appropriate.
``(2) Optional uses.--The Secretary may use amounts made
available under subsection (f) for the following, with respect
to the national media campaign:
``(A) Partnerships with professional and civic
groups, community-based organizations, including faith-
based organizations, and Federal agencies or Tribal
organizations that the Secretary determines have
experience in suicide prevention, including the
Substance Abuse and Mental Health Services
Administration and the Centers for Disease Control and
Prevention.
``(B) Entertainment industry outreach, interactive
outreach, media projects and activities, the
dissemination of public information, news media
outreach, outreach through television programs, and
corporate sponsorship and participation.
``(d) Prohibitions.--None of the amounts made available under
subsection (f) may be obligated or expended for any of the following:
``(1) To supplant Federal suicide prevention campaigns in
effect as of the date of the enactment of this section.
``(2) For partisan political purposes, or to express
advocacy in support of or to defeat any clearly identified
candidate, clearly identified ballot initiative, or clearly
identified legislative or regulatory proposal.
``(e) Report to Congress.--Not later than 18 months after
implementation of the national media campaign has begun, the Secretary,
in coordination with the Assistant Secretary and the Director, shall,
with respect to the first year of the national media campaign, submit
to Congress a report that describes--
``(1) the strategy of the national media campaign and
whether specific objectives of such campaign were accomplished,
including whether such campaign impacted the number of calls
made to lifeline crisis centers and the capacity of such
centers to manage such calls;
``(2) steps taken to ensure that the national media
campaign operates in an effective and efficient manner
consistent with the overall strategy and focus of the national
media campaign;
``(3) plans to purchase advertising time and space;
``(4) policies and practices implemented to ensure that
Federal funds are used responsibly to purchase advertising time
and space and eliminate the potential for waste, fraud, and
abuse; and
``(5) all contracts entered into with a corporation, a
partnership, or an individual working on behalf of the national
media campaign.
``(f) Authorization of Appropriations.--For purposes of carrying
out this section, there is authorized to be appropriated $10,000,000
for each of fiscal years 2022 through 2026.''.
TITLE II--HEALTH RESOURCES AND SERVICES ADMINISTRATION
SEC. 201. HEALTH CENTER CAPITAL GRANTS.
Subpart 1 of part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by adding at the end the following:
``SEC. 330O. HEALTH CENTER CAPITAL GRANTS.
``(a) In General.--The Secretary shall award grants to eligible
entities for capital projects.
``(b) Eligible Entity.--In this section, the term `eligible entity'
is an entity that is--
``(1) a health center funded under section 330, or in the
case of a Tribe or Tribal organization, eligible, to be awarded
without regard to the time limitation in subsection (e)(3) and
subsections (e)(6)(A)(iii), (e)(6)(B)(iii), and (r)(2)(B) of
such section; or
``(2) a mental health and substance use crisis receiving
and stabilization program and crisis call center described in
section 302(c)(1) of the 9-8-8 Implementation Act of 2022 that
have a working relationship with one or more local community
mental health and substance use organizations, community mental
health centers, and certified community behavioral health
clinics, or other local mental health and substance use care
providers, including inpatient and residential treatment
settings.
``(c) Use of Funds.--Amounts made available to a recipient of a
grant or cooperative agreement pursuant to subsection (a) shall be used
for crisis response program facility alteration, renovation,
remodeling, expansion, construction, and other capital improvement
costs, including the costs of amortizing the principal of, and paying
interest on, loans for such purposes.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $1,000,000,000, to remain
available until expended.''.
SEC. 202. EXPANDING BEHAVIORAL HEALTH WORKFORCE TRAINING PROGRAMS.
(a) National Health Service Corps.--Section 331(a)(3)(E)(i) of the
Public Health Service Act (254d(a)(3)(E)(i)) is amended by striking
``and psychiatrists'' and inserting ``psychiatrists and professionals
who provide crisis management services (such as at a crisis call
center, as part of a mobile crisis team, or through crisis receiving
and stabilization program)''.
(b) Minority Fellowship Program.--Section 597(b) of the Public
Health Service Act (42 U.S.C. 290ll(b)) is amended by inserting
``crisis management services (such as at a crisis call center, as part
of a mobile crisis team, or through crisis receiving and stabilization
program),'' after ``mental health counseling,''.
(c) Behavioral Health Workforce Education and Training.--Section
756 of the Public Health Service Act (42 U.S.C. 294e-1) is amended--
(1) in subsection (a)--
(A) in paragraph (1), by inserting ``crisis
management (such as at a crisis call center, as part of
a mobile crisis team, or through crisis receiving and
stabilization program),'' after ``occupational
therapy,'';
(B) in paragraph (2), by inserting ``and providing
crisis management services (such as at a crisis call
center, as part of a mobile crisis team, or through
crisis receiving and stabilization program)'' after
``treatment services,'';
(C) in paragraph (3), by inserting ``and providing
crisis management services (such as at a crisis call
center, as part of a mobile crisis team, or through
crisis receiving and stabilization program),'' after
``behavioral health services''; and
(D) in paragraph (4), by inserting ``including for
the provision of crisis management services (such as at
a crisis call center, as part of a mobile crisis team,
or through crisis receiving and stabilization
program),'' after ``paraprofessional field'';
(2) in subsection (d)(2), by inserting ``or that emphasize
training in crisis management and meeting the crisis needs of
diverse populations specified in (b)(2), including effective
outreach and engagement'' after ``partnerships''; and
(3) by adding at the end the following:
``(g) Additional Funding.--
``(1) In general.--For each of fiscal years 2023 through
2027, in addition to funding made available under subsection
(f), there are authorized to be appropriated $15,000,000 for
workforce development for crisis management, as specified in
paragraphs (1) through (4) of subsection (a).
``(2) Priority.--In making grants for the purpose specified
in paragraph (1), the Secretary shall give priority to programs
demonstrating effective recruitment and retention efforts for
individuals and groups from different racial, ethnic, cultural,
geographic, religious, linguistic, and class backgrounds, and
different genders and sexual orientations, as specified in
subsection (b)(2).''.
TITLE III--BEHAVIORAL HEALTH CRISIS SERVICES EXPANSION
SEC. 301. CRISIS RESPONSE CONTINUUM OF CARE.
Subpart 3 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb-31 et seq.), as amended by section 106, is further amended
by adding at the end the following:
``SEC. 520O. CRISIS RESPONSE CONTINUUM OF CARE.
``(a) In General.--The Secretary shall establish standards for a
continuum of care for use by health care providers and communities in
responding to individuals, including children and adolescents,
experiencing mental health crises, substance related crises, and crises
arising from co-occurring disorders (referred to in this section as the
`crisis response continuum').
``(b) Requirements.--
``(1) Scope of standards.--The standards established under
subsection (a) shall define--
``(A) minimum requirements of core crisis services,
as determined by the Secretary, to include requirements
that each entity that furnishes such services should--
``(i) not require prior authorization from
an insurance provider nor referral from a
health care provider prior to the delivery of
services;
``(ii) serve all individuals regardless of
age or ability to pay;
``(iii) operate 24 hours a day, 7 days a
week, and provide care to all individuals; and
``(iv) provide care and support through
resources described in paragraph (2)(A) until
the individual has been stabilized or transfer
the individual to the next level of crisis
care; and
``(B) psychiatric stabilization, including the
point at which a case may be closed for--
``(i) individuals screened over the phone;
and
``(ii) individuals stabilized on the scene
by mobile teams.
``(2) Identification of essential functions.--The Secretary
shall identify the essential functions of each service in the
crisis response continuum, which shall include at least the
following:
``(A) Identification of resources for referral and
enrollment in continuing mental health, substance use,
or other human services relevant for the individual in
crisis where necessary.
``(B) Delineation of access and entry points to
services within the crisis response continuum.
``(C) Development of and adherence to protocols and
agreements for the transfer and receipt of individuals
to and from other segments of the crisis response
continuum segments as needed, and from outside
referrals including health care providers, law
enforcement, EMS, fire, education institutions, and
community-based organizations.
``(D) Description of the qualifications of crisis
services staff, including roles for physicians,
licensed clinicians, case managers, and peers (in
accordance with State licensing requirements or
requirements applicable to Tribal health
professionals).
``(E) Requirements for the convening of
collaborative meetings of crisis response service
providers, first responders, such as paramedics and law
enforcement, and community partners (including National
Suicide Prevention Lifeline or 9-8-8 call centers, 9-1-
1 public service answering points, and local mental
health and substance use disorder treatment providers)
operating in a common region for the discussion of case
management, best practices, and general performance
improvement.
``(3) Service capacity and quality standards.--Such
standards shall include definitions of--
``(A) adequate volume of services to meet
population need;
``(B) appropriate timely response; and
``(C) capacity to meet the needs of different
patient populations who may experience a mental health
or substance use crisis, including children, families,
and all age groups, cultural and linguistic minorities,
individuals with co-occurring mental health and
substance use disorders, individuals with cognitive
disabilities, individuals with developmental delays,
and individuals with chronic medical conditions and
physical disabilities.
``(4) Oversight and accreditation.--The Secretary shall
designate entities charged with the oversight and accreditation
of entities within the crisis response continuum.
``(5) Implementation timeframe.--Not later than 1 year
after the date of enactment of this title, the Secretary shall
establish the standards under this section.
``(6) Data collection and evaluations.--
``(A) In general.--The Secretary, directly or
through grants, contracts, or interagency agreements,
shall collect data and conduct evaluations with respect
to the provision of services and programs offered on
the crisis response continuum for purposes of assessing
the extent to which the provision of such services and
programs meet certain objectives and outcomes measures
as determined by the Secretary. Such objectives shall
include--
``(i) a reduction in reliance on law
enforcement response to individuals in crisis
who would be more appropriately served by a
mobile crisis team capable of responding to
mental health and substance related crises;
``(ii) a reduction in boarding or extended
holding of patients in emergency room
facilities who require further psychiatric
care, including care for substance use
disorders;
``(iii) evidence of adequate access to
crisis care centers and crisis bed services;
and
``(iv) evidence of adequate linkage to
appropriate post-crisis care and longitudinal
treatment for mental health or substance use
disorder when relevant.
``(B) Rulemaking.--The Secretary shall carry out
this subsection through notice and comment rulemaking,
following a request for information from stakeholders.
``(c) Components of Crisis Response Continuum.--The crisis response
continuum consists of at least the following components:
``(1) Crisis call centers.--Regional clinically managed
crisis call centers that provide telephonic crisis intervention
capabilities. Such centers should meet National Suicide
Prevention Lifeline operational guidelines regarding suicide
risk assessment and engagement and offer air traffic control-
quality coordination of crisis care in real-time.
``(2) Mobile crisis response team.--Teams of providers that
are available to reach any individual in the service area in
their home, workplace, school, physician's office or outpatient
treatment setting, or any other community-based location of the
individual in crisis in a timely manner.
``(3) Crisis receiving and stabilization facilities.--
Subacute inpatient facilities and other facilities specified by
the Secretary that provide short-term observation and crisis
stabilization services to all referrals, including the
following services:
``(A) 23-hour crisis stabilization services.--A
direct care service that provides individuals in severe
distress with up to 23 consecutive hours of supervised
care to assist with deescalating the severity of their
crisis or need for urgent care in a subacute inpatient
setting.
``(B) Short-term crisis residential services.--A
direct care service that assists with deescalating the
severity of an individual's level of distress or need
for urgent care associated with a substance use or
mental health disorder in a residential setting.
``(4) Mental health and substance use urgent care
facilities.--Ambulatory services available 12-24 hours per day,
7 days a week, where individuals experiencing crisis can walk
in without an appointment to receive crisis assessment, crisis
intervention, medication, and connection to continuity of care.
``(5) Additional facilities and providers.--The Secretary
shall specify additional facilities and health care providers
as part of the crisis response continuum, as the Secretary
determines appropriate.
``(d) Relationship to State Law.--
``(1) In general.--Subject to paragraph (2), the standards
established under this section are minimum standards and
nothing in this section may be construed to preclude a State
from establishing additional standards, so long as such
standards are not inconsistent with the requirements of this
section or other applicable law.
``(2) Waiver or modification.--The Secretary shall
establish a process under which a State may request a waiver or
modification of a standard established under this section.''.
SEC. 302. COVERAGE OF CRISIS RESPONSE SERVICES.
(a) Coverage Under the Medicare Program.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (GG), by striking ``and'' at
the end;
(B) in subparagraph (HH), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(II) crisis response services as defined in
subsection (lll);''.
(2) Crisis response services defined.--Section 1861 of the
Social Security Act (42 U.S.C. 1395x) is amended by adding at
the end the following new subsection:
``(lll) Crisis Response Services.--
``(1) In general.--The term `crisis response services'
means mental health or substance use services that are
furnished by a mobile crisis response team, a crisis receiving
and stabilization facility, mental health or substance use
urgent care facility, or other appropriate provider, as
determined by the Secretary, to an individual, including
children and adolescents, experiencing a mental health or
substance use crisis. Such term includes services identified by
the Secretary as part of the crisis response continuum of care
under section 302 of the Behavioral Health Crisis Services
Expansion Act.
``(2) Definitions.--In this subsection, the terms `mobile
crisis response team', `crisis receiving and stabilization
facility', and `mental health and substance use urgent care
facility' have the meaning given those terms for purposes of
such section 302.''.
(3) Payment.--
(A) In general.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) by striking ``and (DD)'' and inserting
``(DD)''; and
(ii) by inserting before the semicolon at
the end the following: ``and (EE) with respect
to crisis response services described in
section 1861(s)(2)(II), the amounts paid shall
be 80 percent of the lesser of the actual
charge for the service or the amount determined
under the payment basis established under
section 1834(z)''.
(B) Establishment of payment basis.--Section 1834
of the Social Security Act (42 U.S.C. 1395m) is amended
by adding at the end the following new subsection:
``(z) Payment for Crisis Response Services.--The Secretary shall
establish a payment basis determined appropriate by the Secretary with
respect to crisis response services (as defined in section 1861(lll))
furnished by a provider of services or supplier.''.
(4) Ambulance transport of individuals in crisis.--
(A) In general.--Section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)) is amended by adding
at the end the following new paragraph:
``(18) Transportation of individuals in crisis.--With
respect to ambulance services furnished on or after the date
that is 3 years after the date of the enactment of the
Behavioral Health Crisis Services Expansion Act, the
regulations described in section 1861(s)(7) shall provide
coverage under such section for ambulance and other qualified
emergency transport services to transport an individual
experiencing a mental health or substance crisis to an
appropriate facility, such as a community mental health center
(as defined in section 1861(ff)(3)(B)) or other facility or
provider identified by the Secretary as part of the crisis
response continuum of care under section 203 of the Behavioral
Health Crisis Services Expansion Act, as appropriate, for
crisis response services described in section
1861(s)(2)(II).''.
(B) Conforming amendment.--Section 1861(s)(7) of
such Act (42 U.S.C. 1395x(s)(7)) is amended by striking
``section 1834(l)(14)'' and inserting ``paragraphs (14)
and (18) of section 1834(l)''.
(5) Effective date.--The amendments made by this subsection
shall apply to services furnished on or after the date that is
3 years after the date of the enactment of this Act.
(b) Mandatory Coverage of Crisis Response Services Under the
Medicaid Program.--Title XIX of the Social Security Act (42 U.S.C. 1396
et seq.) is amended--
(1) in section 1902(a)(10)(A), in the matter preceding
clause (i), by striking ``and (30)'' and inserting ``(30), and
(31)''; and
(2) in section 1905--
(A) in subsection (a)--
(i) in paragraph (30), by striking ``;
and'' and inserting a semicolon;
(ii) by redesignating paragraph (31) as
paragraph (32); and
(iii) by inserting the following paragraph
after paragraph (30):
``(31) crisis response services (as defined in section
1861(lll)); and''.
(3) Presumptive eligibility determination by crisis
response service providers.--Section 1902(a)(47)(B) of the
Social Security Act (42 U.S.C. 1396a(a)(47)(B)) is amended by
inserting ``or provider of crisis response services (as defined
in section 1861(lll))'' after ``any hospital''.
(4) Effective date.--
(A) In general.--Except as provided in subparagraph
(B), the amendments made by this section shall take
effect on the date that is 3 years after the date of
the enactment of this Act.
(B) Delay permitted if state legislation
required.--In the case of a State plan under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.)
which the Secretary of Health and Human Services
determines requires State legislation (other than
legislation appropriating funds) in order for the plan
to meet the additional requirements imposed by the
amendments made by this section, the State plan shall
not be regarded as failing to comply with the
requirements of such title solely on the basis of the
failure of the plan to meet such additional
requirements before the first day of the first calendar
quarter beginning after the close of the first regular
session of the State legislature that begins after the
date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-
year legislative session, each year of such session
shall be deemed to be a separate regular session of the
State legislature.
(c) Essential Health Benefits.--Section 1302(b)(1)(E) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)(E))
is amended by inserting ``and crisis response services (as defined in
section 1861(lll) of the Social Security Act)'' before the period.
(d) Group Health Plans and Health Insurance Issuers.--
(1) In general.--Section 2707 of the Public Health Service
Act (42 U.S.C. 300gg-6) is amended by adding at the end the
following:
``(e) Crisis Response Services.--A group health plan or a health
insurance issuer offering group or individual health insurance coverage
shall ensure that such coverage includes crisis response services (as
defined in section 1861(lll) of the Social Security Act).''.
(2) Application to grandfathered plans.--Section
1251(a)(4)(A) of the Public Health Service Act (42 U.S.C.
18011(a)(4)(A)) is amended by adding at the end the following
new clause:
``(v) Section 2707(e) (relating to coverage
of crisis response services).''.
(e) Tricare Coverage.--
(1) In general.--The Secretary of Defense shall provide
coverage under the TRICARE program for crisis response
services, as defined in section 1861(lll) of the Social
Security Act (42 U.S.C. 1395x) (as amended by section 303).
(2) Tricare program defined.--In this section, the term
``TRICARE program'' has the meaning given the term in section
1072 of title 10, United States Code.
(f) Reimbursement for Crisis Response Services for Veterans.--
Section 1725(f)(1) of title 38, United States Code, is amended, in the
matter preceding subparagraph (A), by inserting ``, including crisis
response services (as defined in subsection (lll) of section 1861 of
the Social Security Act (42 U.S.C. 1395x)),'' after ``services''.
(g) Coverage Under FEHB.--
(1) In general.--Section 8902 of title 5, United States
Code, is amended by adding at the end the following:
``(p) Each contract for a plan under this chapter shall require the
carrier to provide coverage for crisis response services, as that term
is defined in subsection (lll) of section 1861 of the Social Security
Act (42 U.S.C. 1395x).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply beginning with respect to the third contract year
for chapter 89 of title 5, United States Code, that begins on
or after the date that is 3 years after the date of enactment
of this Act.
(h) Coverage Under CHIP.--Section 2103(c)(5) of the Social Security
Act (42 U.S.C. 1397cc(c)(5)) is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(C) beginning on the date that is 3 years after
the date of the enactment of this subparagraph, crisis
response services (as defined in section 1861(lll)).''.
SEC. 303. BUILDING THE CRISIS CONTINUUM INFRASTRUCTURE.
(a) Additional Amounts for Mental Health Block Grant.--Section 1920
of the Public Health Service Act (42 U.S.C. 300x-9) is amended by
adding at the end the following:
``(d) Support for Crisis Response Services Infrastructure.--
``(1) In general.--In addition to amounts made available
under subsection (a), there are authorized to be appropriated
such sums as are necessary for each of fiscal years 2022, 2023,
and 2024, for purposes of supporting the infrastructure needed
to provide crisis response services (as defined in section
1861(lll) of the Social Security Act) in the States, which may
include training and continuing education, and administrative
expenses with respect to the provision of such services.
``(2) Allotments.--Each fiscal year for which amounts are
appropriated under paragraph (1), the Secretary shall allot to
each State that receives a grant under section 1911 for the
fiscal year an amount that bears the same relationship to the
total amount appropriated under paragraph (1) for the fiscal
year that the amount received by the State under section
1911(a) for the fiscal year bears to the total amount
appropriated under subsection (a) for the fiscal year.
``(e) Technical Assistance.--The Secretary shall provide to States
technical assistance regarding the provision of crisis response
services, as defined in section 1861(lll) of the Social Security Act,
including guidance on how States may blend Medicaid funds available to
States under title XIX of the Social Security Act and funds available
to States under the community mental health services block grant
program under this subpart and the substance abuse prevention and
treatment block grant program under subpart II to provide such
services.
``(f) Clearinghouse of Best Practices.--The Secretary shall develop
and maintain a publicly available clearinghouse of best practices for
the successful operation of each segment of the system for providing
crisis response services (as defined in section 1861(lll) of the Social
Security Act) and the integration of such best practices into the
provision of such services. The clearinghouse shall be updated
annually.
``(g) Rule of Construction.--With respect to funds allocated under
the crisis care set-aside authorized under (a), the provisions
contained in 1912(b)(1)(A)(vi) shall not apply.''.
SEC. 304. INCIDENT REPORTING.
(a) Establishment of Protocol Panel.--The Secretary of Health and
Human Services (referred to in this section as the ``Secretary''), in
consultation with the Attorney General, shall convene a panel for the
purposes of making recommendations for training and protocol for 9-1-1
dispatchers to respond appropriately to individuals experiencing a
behavioral health crisis based on the characteristics of the incident
and the needs of the caller.
(b) Panelists.--The Secretary shall appoint individuals to serve
staggered 10-year terms on the panel established under subsection (a).
Such individuals shall include--
(1) psychiatrists;
(2) paramedics and other emergency medical services
personnel;
(3) law enforcement officers and 9-1-1 dispatchers;
(4) representatives from each segment of the crisis
response continuum, as described in section 302, including 9-8-
8 dispatchers;
(5) individuals who have received services under such
crisis response continuum, including individuals under the age
of 18;
(6) members of underserved communities including ethnic and
racial minority groups and sexual orientation and gender
minority groups;
(7) representatives from Tribes or Tribal organizations;
and
(8) other individuals, as the Secretary determines
appropriate.
(c) Recommendations.--
(1) Topics.--In issuing recommendations under this section,
the panel shall consider--
(A) connecting 9-1-1 callers to crisis care
services instead of responding with law enforcement
officers;
(B) integrating the 9-8-8 system into the 9-1-1
system, or transferring calls from the 9-1-1 system to
the 9-8-8 system as appropriate; and
(C) a process for identifying 9-1-1 callers who may
be experiencing psychiatric symptoms or a mental health
crisis, substance use crisis, or co-occurring crisis
and evaluating the level of need of such callers, as
defined by relevant, standardized assessment tools such
as the Level of Care Utilization System (LOCUS), the
Child and Adolescent Level of Care Utilization System
(CALOCUS), and the American Society of Addiction
Medicine (ASAM) Criteria.
(2) Updates.--The panel shall update recommendations issued
under this section not less frequently than every 5 years.
TITLE IV--MEDICAID AMENDMENTS
SEC. 401. REVISIONS TO THE STATE OPTION TO PROVIDE QUALIFYING
COMMUNITY-BASED MOBILE CRISIS INTERVENTION SERVICES AND
OTHER SERVICES UNDER STATE PLANS UNDER THE MEDICAID
PROGRAM.
(a) In General.--Section 1947 of the Social Security Act (42 U.S.C.
1396w-6) is amended--
(1) in subsection (a)--
(A) by striking ``for qualifying community-based
mobile crisis intervention services'' and inserting
``for--
``(1) qualifying community-based mobile crisis intervention
services;
``(2) regional and local lifeline call center operations;
and
``(3) programs for the purpose receiving and stabilization
individuals (including beds in homes and facilities for such
purpose).''; and
(B) by striking ``during the 5-year period'';
(2) in subsection (c)--
(A) by striking ``85 percent.'' and inserting the
following: ``85 percent, and for medical assistance for
items described in paragraphs (2) and (3) of subsection
(a) furnished during such quarter shall be equal to 85
percent.''; and
(B) by striking ``occurring during the period
described in subsection (a) that a State'' and
inserting ``in which a State provides medical
assistance for qualifying community-based mobile crisis
intervention services under this section and'';
(3) in subsection (e), by adding at the end at the
following new sentence: ``There is appropriated, out of any
funds in the Treasury not otherwise appropriated, $5,000,000 to
the Secretary for the purposes described in the preceding
sentence to remain available until expended.''; and
(4) in subsection (d)(2)--
(A) in subparagraph (A), by striking ``for the
fiscal year preceding the first fiscal quarter
occurring during the period described in subsection
(a)'' and inserting ``for the fiscal year preceding the
first fiscal quarter in which the State provides
medical assistance for qualifying community-based
mobile crisis intervention services under this
section''; and
(B) in subparagraph (B), by striking ``occurring
during the period described in subsection (a)'' and
inserting ``occurring during a fiscal quarter''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect as if included in the enactment of the American Rescue Plan
Act of 2021 (Public Law 117-2).
SEC. 402. REVISIONS TO THE IMD EXCLUSION UNDER MEDICAID.
(a) Shrinking of the IMD Exclusion Under Medicaid.--Section
1905(a)(1) of the Social Security Act (42 U.S.C. 1396d(a)(1)) is
amended by inserting ``, except for, services that, beginning the day
after the date of the enactment of the 9-8-8 National Suicide
Prevention Lifeline Implementation Act of 2022, are furnished in
psychiatric acute care crisis beds administered by community behavioral
health organizations certified under section 223 of the Protecting
Access to Medicare Act of 2014, mental health centers that meet the
criteria of section 1913(c) of the Public Health Service Act, crisis
receiving and stabilization facilities (as defined in section 302(c)(3)
of the 9-8-8 National Suicide Prevention Lifeline Implementation Act of
2022) and the mental health and substance use urgent care facilities
(as defined in section 302(c)(5) of such Act)''.
(b) Guidance Relating to IMD Exclusion.--Not later than 180 days
after the date of the enactment of this Act, the Secretary of Health
and Human Services shall issue guidance that crisis stabilization units
(as described in section 1905(a)(1) of the Social Security Act (42
U.S.C. 1396d(a)(1)) are excluded from the prohibition specified in the
parenthetical of paragraph (1) of section 1905(a) (relating to services
in an institution for mental diseases), including the following
facilities and services:
(1) Subacute crisis receiving in inpatient or other
facilities specified by the Secretary that provide short-term
observation for all referrals to individuals in severe
distress, as further defined by the Secretary, with up to 23
consecutive hours of supervised care to assist with
deescalating the severity of a mental health or substance use
crisis or need for urgent care in a sub-acute inpatient
setting.
(2) Short term crisis stabilization services assisting with
deescalating the severity of individuals in severe distress, as
defined by the Secretary, or need for urgent care associated
with a substance use or mental health disorder in an inpatient
or residential setting with reimbursement limited to 72 hours.
(c) Reports on Crisis Stabilization Utilization.--Not later than 1
year after the date of the enactment of this Act, the Secretary shall
submit to the appropriate congressional committees of jurisdiction a
report addressing the utilization of facility-based crisis services,
including the number of patients served, type and duration of facility-
based services, linkage to community-based resources, and information
on the total number of law enforcement drop-offs and other data
relevant for diverting mental health and substance use disorder
emergencies from law enforcement response.
SEC. 403. EXCELLENCE IN MENTAL HEALTH AND ADDICTION TREATMENT.
(a) Expansion of Community Mental Health Services Demonstration
Program.--Section 223 of the Protecting Access to Medicare Act of 2014
(42 U.S.C. 1396a note) is amended--
(1) in subsection (c), by adding at the end the following
new paragraph:
``(3) Planning grants for additional states.--In addition
to the planning grants awarded under paragraph (1), the
Secretary shall award planning grants to States (other than
States selected to conduct demonstration programs under
paragraphs (1) or (8) of subsection (d)) for the purpose of
developing proposals to participate in time-limited
demonstration programs described in subsection (d).'';
(2) in subsection (d)--
(A) in paragraph (3), by striking ``Subject to
paragraph (8)'' and inserting ``Subject to paragraphs
(8) and (9)'';
(B) in paragraph (5)(C)(iii)(II), by inserting ``or
paragraph (9)'' after ``paragraph (8)'';
(C) in paragraph (7)--
(i) in subparagraph (A), by inserting
``through the year in which the last
demonstration under this section ends'' after
``annually thereafter'';
(ii) in subparagraph (B)--
(I) by striking ``December 31,
2021'' and inserting ``September 30,
2023''; and
(II) by adding at the end the
following new sentence: ``Such
recommendations shall include data
collected after 2019.''; and
(iii) by adding at the end the following
new subparagraph:
``(C) Final evaluation.--Not later than 18 months
after all demonstration programs under this section
have ended, the Secretary shall submit to Congress a
final evaluation of such programs.''; and
(D) by adding at the end the following new
paragraph:
``(9) Further additional programs.--In addition to the
States selected under paragraphs (1) and (8), the Secretary
shall select any State that submits an application that
includes such information as the Secretary shall require to
conduct a demonstration program that meets the requirements of
paragraph (2) and paragraphs (4) through (7) for 2 years or
through September 30, 2023, whichever is longer.''; and
(3) in subsection (f)(1)(B), by inserting ``, and
$40,000,000 for fiscal year 2022'' before the period.
(b) Certified Community Behavioral Health Clinic Expansion
Grants.--Part D of title V of the Public Health Service Act (42 U.S.C.
290dd et seq.) is amended by adding at the end the following:
``SEC. 553. CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC EXPANSION
GRANTS.
``(a) In General.--The Assistant Secretary shall award grants to
communities and community organizations that meet the criteria for
certified community behavioral health clinics under section 223(a) of
the Protecting Access to Medicare Act A of 2014. Grants awarded under
this subsection shall be for a period of not more than 5 years.
``(b) Technical Assistance.--The Assistant Secretary may provide
appropriate information, training, and technical assistance through
appropriate contract procedures to entities receiving grants under
subsection (a), or to health or social service providers pursuing
certified community behavioral health clinics status or partnering with
certified community behavioral health clinics, State policymakers
considering certified community behavioral health clinics
implementation under the Medicaid program, and other stakeholders to
facilitate successful implementation of the certification model.
``(c) Authorization of Appropriations.--
``(1) Grant program.--For purposes of awarding grants under
subsection (a), there is authorized to be appropriated
$500,000,000 for the period of fiscal years 2022 through 2024.
``(2) Technical assistance.--For purposes of carrying out
the technical assistance program under subsection (b), there
are authorized to be appropriated $5,000,000 for each of fiscal
years 2022 through 2026.''.
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