[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7236 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 7236
To amend title XIX of the Social Security Act to expand the
availability of mental, emotional, and behavioral health services under
the Medicaid program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 28, 2022
Ms. Eshoo (for herself, Mr. Fitzpatrick, and Ms. Blunt Rochester)
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 expand the
availability of mental, emotional, and behavioral health services under
the Medicaid program, 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 ``Strengthen Kids' Mental Health Now
Act of 2022''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Payment parity for pediatric behavioral health services.
Sec. 4. Guidance to States on supporting mental, emotional, and
behavioral health services, and on the
availability of telehealth under Medicaid.
Sec. 5. Ensuring children receive timely access to care.
Sec. 6. Programs to support pediatric behavioral health care.
Sec. 7. Increasing Federal investment in pediatric behavioral health
services.
SEC. 3. PAYMENT PARITY FOR PEDIATRIC BEHAVIORAL HEALTH SERVICES.
(a) Payment Parity for Pediatric Behavioral Health Services.--
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended--
(1) in subsection (a)(13)--
(A) in subparagraph (B), by striking ``and'' at the
end;
(B) in subparagraph (C), by adding ``and'' at the
end; and
(C) by adding at the end the following new
subparagraph:
``(D) for payment for pediatric mental, emotional,
and behavioral health services (as defined in
subsection (tt)) furnished on or after the date that is
180 days after the date of enactment of this
subparagraph and before October 1, 2027, at a rate not
less than 100 percent of the payment rate that applies
to such providers under part A or B (as applicable) of
title XVIII;''; and
(2) by adding at the end the following new subsection:
``(tt) Pediatric Mental, Emotional, and Behavioral Health Services
Defined.--For purposes of subsection (a)(13)(D), the term `pediatric
mental, emotional, and behavioral health services' means the following
services furnished by a health care provider, including hospitals,
physicians, and other providers determined by the Secretary, for the
purposes of screening for, diagnosing, or treating a mental, emotional,
or behavioral health condition, whether furnished in-person or via
telehealth:
``(1) Mental health and substance use disorder screenings.
``(2) Mental health development assessments.
``(3) Mental health behavior assessments and interventions.
``(4) Psychological and neuropsychological testing and
assessment.
``(5) Mental health primary prevention services.
``(6) Mental health and substance use disorder case
management services.
``(7) School-based mental health and substance use disorder
prevention, identification, and treatment services.
``(8) Child and adolescent psychiatry and psychology
services.
``(9) Partial hospitalization services.
``(10) Day program services.
``(11) Intensive outpatient services.
``(12) Eating disorder treatment services.
``(13) Outpatient services.
``(14) Crisis residential services.
``(15) Crisis intervention and stabilization.
``(16) Inpatient psychiatric and psychological services.
``(17) Individual therapy.
``(18) Family therapy.
``(19) Group therapy services.
``(20) Intensive in-home services.
``(21) Peer support services.
``(22) Provider-to-provider consultation services involving
primary care practitioners sand mental health care specialists,
including child and adolescent specialists.
``(23) Substance use disorder screening, including SBIRT,
and treatment.
``(24) Medication management.
``(25) Any other pediatric mental, emotional, or behavioral
health service determined appropriate by the Secretary.''.
(b) Under Medicaid Managed Care Plans.--Section 1932(f) of such Act
(42 U.S.C. 1396u-2(f)) is amended--
(1) in the header, by inserting ``and Pediatric Mental,
Emotional, and Behavioral Health'' before ``Services'';
(2) by inserting ``and pediatric mental, emotional, and
behavioral health services described in section
1902(a)(13)(D)'' after ``section 1902(a)(13)(C)''; and
(3) by striking ``such section'' and inserting ``section
1902(a)(13)''.
(c) Increase in Payment Using Increased FMAP.--Section 1905 of the
Social Security Act (42 U.S.C. 1396d) is amended by adding at the end
the following new subsection:
``(jj) Increased FMAP for Additional Expenditures for Pediatric
Mental, Emotional, and Behavioral Health Services.--Notwithstanding
subsection (b), with respect to the portion of the amounts expended for
medical assistance for services described in section 1902(a)(13)(D)
furnished on or after the date that is 180 days after date of enactment
of this subsection and before October 1, 2027, and that is attributable
to the amount by which the minimum payment rate required under such
section (or, by application, section 1932(f)) exceeds the payment rate
applicable to such services under the State plan as of the day before
the date of the enactment of this subsection, the Federal medical
assistance percentage for a State that is one of the 50 States or the
District of Columbia shall be equal to 100 percent. The preceding
sentence does not prohibit the payment of Federal financial
participation based on the Federal medical assistance percentage for
amounts in excess of those specified in such sentence.''.
SEC. 4. GUIDANCE TO STATES ON SUPPORTING MENTAL, EMOTIONAL, AND
BEHAVIORAL HEALTH SERVICES, AND ON THE AVAILABILITY OF
TELEHEALTH UNDER MEDICAID.
(a) Mental, Emotional, and Behavioral Health Services.--Not later
than 180 days after date of enactment of this Act, the Secretary of
Health and Human Services shall issue guidance to States on how to
expand the provision of mental, emotional, and behavioral health
services covered by State plans (or waivers of such plans) under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.), including a
description of best practices for effective programs, service provision
for underserved communities, and recruitment and retention of
providers.
(b) Telehealth Services.--Not later than 1 year after date of
enactment of this Act, the Secretary of Health and Human Services shall
issue guidance to States on best practices to sustain and enhance the
availability of telehealth services covered by State plans (or waivers
of such plans) under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.).
SEC. 5. ENSURING CHILDREN RECEIVE TIMELY ACCESS TO CARE.
(a) Guidance to States on Flexibilities To Ensure Provider Capacity
To Provide Pediatric Mental, Emotional, and Behavioral Crisis Care.--
Not later than 60 days after the date of enactment of this Act, the
Secretary of Health and Human Services shall provide guidance to States
on existing flexibilities for hospitals and other providers under
applicable laws, regulations, and guidance to support children in
crisis or in need of intensive mental, emotional or behavioral health
services.
(b) Mandated Report to Congress Regarding Barriers to Repurposing
of Beds, Space, and Staff To Address Pediatric Behavioral Health
Needs.--
(1) In general.--Not later than 120 days after the date of
enactment of this Act, the Secretary of Health and Human
Services shall submit to the Congress a report with respect to
regulatory and legal barriers to care across the crisis
continuum that identifies solutions to facilitate flexibility
for children's hospitals and other providers of mental,
emotional, or behavioral health services.
(2) Requirements.--In preparing a report under this
subsection, the Secretary of Health and Human Services shall
include in such report--
(A) a comprehensive list of laws, regulations, and
guidance impacting children's hospitals' and other
providers' ability to repurpose immediately beds,
space, and staff for children in need of mental,
emotional, or behavioral health services, including a
description of the rationale for each policy and
corresponding actions required to repurpose such beds,
space, and staff; and
(B) recommendations on how children's hospitals and
other providers can immediately expand access to
mental, emotional, and behavioral health services while
also ensuring high quality and safety.
(c) Ensuring Consistent Review and State Implementation of Early
and Periodic Screening, Diagnostic, and Treatment Services.--Section
1905(r) of the Social Security Act (42 U.S.C. 1396d(r)) is amended by
adding at the end the following: ``The Secretary shall, not later than
July 1, 2022, and not later than January 1 each year thereafter, review
implementation of the requirements of this subsection by States as they
pertain to behavioral health services for children, including services
provided by a managed care entity, identify and disseminate best
practices for ensuring comprehensive coverage of services, identify
gaps and deficiencies in meeting Federal requirements, and provide
guidance to States on addressing identified gaps and disparities and
meeting Federal coverage requirements in order to ensure children,
including children without a mental health diagnosis, have access to
behavioral health services.''.
SEC. 6. PROGRAMS TO SUPPORT PEDIATRIC BEHAVIORAL HEALTH CARE.
Subpart V of part D of title III of the Public Health Service Act
(42 U.S.C. 256 et seq.) is amended by adding at the end the following:
``SEC. 340A-1. PROGRAM TO SUPPORT PEDIATRIC BEHAVIORAL HEALTH CARE
INTEGRATION AND COORDINATION.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall award
grants, contracts, or cooperative agreements to eligible entities for
the purpose of supporting pediatric behavioral health care integration
and coordination within communities to meet local community needs.
``(b) Eligible Entities.--Entities eligible for grants under
subsection (a) include--
``(1) health care providers, including family physicians,
pediatric medical sub-specialists, and surgical specialists;
``(2) children's hospitals;
``(3) facilities that are eligible to receive funds under
section 340E or 340H;
``(4) nonprofit medical facilities that predominantly treat
individuals under the age of 21;
``(5) rural health clinics and Federally qualified health
centers (as such terms are defined in section 1861(aa) of the
Social Security Act);
``(6) pediatric mental health and substance use disorder
providers, such as child and adolescent psychiatrists,
psychologists, developmental and behavioral pediatricians,
general pediatricians, advanced practice nurses, social
workers, licensed professional counselors, and other licensed
professionals that provide mental health and substance use
disorder services to patients under 21 years of age;
``(7) child advocacy centers described in section
214(c)(2)(B) of the Victims of Child Abuse Act of 1990;
``(8) school-based health centers; and
``(9) other entities as determined appropriate by the
Secretary.
``(c) Prioritization.--In making awards under subsection (a), the
Secretary shall prioritize--
``(1) applicants that provide children and adolescents from
high need, rural, or under-resourced communities with services
across the continuum of children's mental health and substance
use disorder care; and
``(2) applicants that predominantly provide care to
children and adolescents that demonstrate plans to utilize
funds to expand provision of care to children, adolescents, and
youth under age 21.
``(d) Use of Funds.--Activities that may be funded through an award
under subsection (a) include--
``(1) increasing the capacity of pediatric practices,
family medicine practices, and school-based health centers to
integrate pediatric mental, emotional, and behavioral health
services into their practices including through co-location of
mental, emotional, and behavioral health providers;
``(2) training for non-clinical pediatric health care
workers, including care coordinators and navigators, on child
and adolescent mental health and substance use disorder,
trauma-informed care, and local resources to support children
and caregivers;
``(3) expanding evidence-based, integrated models of care
for pediatric mental health and substance use disorder
services;
``(4) pediatric practice integration for the provision of
pediatric mental health and substance use disorder services;
``(5) addressing surge capacity for pediatric mental health
and substance use disorder needs;
``(6) providing pediatric mental, emotional, and behavioral
health services to children as delivered by mental health and
substance use disorder professionals utilizing telehealth
services;
``(7) establishing or maintaining initiatives to allow more
children to access care outside of emergency departments,
including partial hospitalization, step down residency
programs, and intensive outpatient programs;
``(8) supporting, enhancing, or expanding pediatric mental
health and substance use disorder preventive and crisis
intervention services;
``(9) establishing or maintaining pediatric mental health
and substance use disorder urgent care or walk-in clinics;
``(10) establishing or maintaining community-based
pediatric mental health and substance use disorder initiatives,
such as partnerships with schools and early childhood education
programs;
``(11) addressing other access and coordination gaps to
pediatric mental health and substance use disorder services in
the community for children; and
``(12) supporting the collection of data on children and
adolescents' mental health needs, service utilization and
availability, and demographic data, to capture community needs
and identify gaps and barriers in children's access to care, in
a manner that protects personal privacy, consistent with
applicable Federal and State privacy laws.
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $500,000,000 for each of fiscal
years 2023 through 2027.
``SEC. 340A-2. PEDIATRIC BEHAVIORAL HEALTH WORKFORCE TRAINING PROGRAM.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall award
grants, contracts, or cooperative agreements to eligible entities for
the purpose of supporting evidence-based pediatric mental health and
substance use disorder workforce training.
``(b) Eligible Entities.--Entities eligible for grants under
subsection (a) include--
``(1) children's hospitals;
``(2) facilities that are eligible to receive funds under
section 340E or 340H;
``(3) nonprofit medical facilities that predominantly treat
individuals under the age of 21;
``(4) rural health clinics and Federally qualified health
centers (as such terms are defined in section 1861(aa) of the
Social Security Act);
``(5) entities that employ mental health and substance use
disorder professionals, such as child and adolescent
psychiatrists, psychologists, developmental and behavioral
pediatricians, general pediatricians, advanced practice nurses,
social workers, licensed professional counselors, or other
licensed professionals that provide mental health or substance
use disorder services to patients under 21 years of age; and
``(6) other pediatric health care providers as determined
appropriate by the Secretary.
``(c) Use of Funds.--Activities that may be supported through an
award under subsection (a) include the following:
``(1) Training to enhance the capabilities of the existing
pediatric workforce, including pediatricians, primary care
physicians, advanced practice registered nurses, and other
pediatric health care providers, including expanded training in
pediatric mental health and substance use disorders, and
culturally and developmentally appropriate care for children
with mental health conditions.
``(2) Training to support multi-disciplinary teams to
provide pediatric mental health and substance use disorder
treatment, including through integrated care models.
``(3) Initiatives to accelerate the time to licensure
within the pediatric mental health or substance use disorder
workforce.
``(4) Activities to expand recruitment and retention,
increase workforce diversity, or enhance workforce training for
critical pediatric mental health professions, including--
``(A) child and adolescent psychiatrists;
``(B) psychiatric nurses;
``(C) psychologists;
``(D) family therapists;
``(E) social workers;
``(F) mental health counselors;
``(G) developmental and behavioral pediatricians;
``(H) pediatric substance use disorder specialists;
and
``(I) other mental health care providers as
determined appropriate by the Secretary.
``(d) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $100,000,000 for each of fiscal
years 2023 through 2027.''.
SEC. 7. INCREASING FEDERAL INVESTMENT IN PEDIATRIC BEHAVIORAL HEALTH
SERVICES.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:
``TITLE XXXIV--ASSISTANCE FOR CONSTRUCTION AND MODERNIZATION OF
CHILDREN'S MENTAL HEALTH AND SUBSTANCE USE DISORDER INFRASTRUCTURE
``SEC. 3401. INCREASING FEDERAL INVESTMENT IN PEDIATRIC BEHAVIORAL
HEALTH SERVICES.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall award
grants, contracts, or cooperative agreements to eligible entities for
the purpose of improving their ability to provide pediatric behavioral
health services, including by--
``(1) constructing or modernizing sites of care for
pediatric behavioral health services;
``(2) expanding capacity to provide pediatric behavioral
health services, including enhancements to digital
infrastructure, telehealth capabilities, or other improvements
to patient care infrastructure;
``(3) supporting the reallocation of existing resources to
accommodate pediatric behavioral health patients, including by
converting or adding a sufficient number of beds to establish
or increase the hospital's inventory of licensed and
operational, short-term psychiatric and substance use inpatient
beds; and
``(4) addressing gaps in the continuum of care for
children, by expanding capacity to provide intermediate levels
of care, such as intensive outpatient services, partial
hospitalization programs, and day programs that can prevent
hospitalizations and support children as they transition back
to their homes and communities.
``(b) Eligibility.--To be eligible to seek an award under this
section, an entity shall be a hospital or rural health clinic that
predominantly treats individuals under the age of 21, including any
hospital that receives funds under section 340E.
``(c) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $2,000,000,000 for each of
fiscal years 2023 through 2027.
``(d) Supplement, Not Supplant.--Funds provided under this section
shall be used to supplement, not supplant Federal and non-Federal funds
available for carrying out the activities described in this section.
``(e) Reporting.--
``(1) Reports from award recipients.--Not later than 180
days after the completion of activities funded by an award
under this section, the entity that received such award shall
submit a report to the Secretary on the activities conducted
using funds from such award, and other information as the
Secretary may require.
``(2) Reports to congress.--Not later than one year, the
Secretary shall submit to the Committee on Energy and Commerce
of the House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate a report on the
projects and activities conducted with funds awarded under this
section, and the outcome of such projects and activities. Such
report shall include--
``(A) the number of projects supported by awards
made under this section;
``(B) an overview of the impact, if any, of such
projects on pediatric health care infrastructure,
including any impact on access to pediatric mental
health and substance use disorder services;
``(C) recommendations for improving the investment
program under this section; and
``(D) any other considerations as the Secretary
determines appropriate.''.
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