[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10419 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 10419
To amend title XVIII of the Social Security Act to establish a Medicare
demonstration program relating to crisis response services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 16, 2024
Mr. Cardenas (for himself, Mr. Veasey, Mr. Schweikert, and Mr.
Fitzpatrick) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, 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 amend title XVIII of the Social Security Act to establish a Medicare
demonstration program relating to crisis response services.
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 Care Access and Response
Expansion for Behavioral Health Act of 2024'' or the ``CARE for
Behavioral Health Act of 2024''.
SEC. 2. ESTABLISHING A MEDICARE DEMONSTRATION PROGRAM RELATING TO
CRISIS RESPONSE SERVICES.
Part E of title XVIII of the Social Security Act (42 U.S.C. 1395x
et seq.) is amended by inserting after section 1866G the following new
section:
``SEC. 1866H. CRISIS RESPONSE SERVICES DEMONSTRATION PROGRAM.
``(a) In General.--Not later than January 1, 2026, the Secretary
shall establish a crisis response services demonstration program (in
this section referred to as the `demonstration program') to determine
whether payment for crisis response services furnished to applicable
individuals by participating providers results in--
``(1) a reduction in emergency department visits;
``(2) increased access to crisis response services;
``(3) a reduction in expenditures under this title; or
``(4) improved behavioral health outcomes.
``(b) Participating Providers.--
``(1) In general.--Subject to paragraph (3), the Secretary
shall designate an eligible provider as a participating
provider for purposes of the demonstration program if such
eligible provider submits an application to the Secretary at
such time and in such manner as specified by the Secretary and
demonstrates that the provider meets the standards established
by the Secretary under paragraph (2).
``(2) Standards.--The Secretary, in coordination with the
Assistant Secretary for Mental Health and Substance Use, shall
specify standards that an eligible provider must meet in order
to be designated as a participating provider under paragraph
(1). Such standards shall include the following:
``(A) Standards relating to the minimum set of
crisis response services to be furnished by a
participating provider under the demonstration program.
``(B) Standards relating to access to such
services, including a requirement that such provider be
available to furnish such services 24 hours per day, 7
days per week, and have a physician (which may include
a psychiatrist), nurse practitioner, or physician
assistant so available to furnish such services.
``(C) Standards relating to the provision of such
services, including--
``(i) standards relating to the
qualifications of individuals who may furnish
such services, in accordance with applicable
State licensure requirements;
``(ii) standards relating to collaboration
of such individuals with other entities (such
as community first responders and community-
based organizations) to ensure appropriate case
management and adherence to best practices;
``(iii) standards relating to the receipt
of individuals from appropriate providers of
services, suppliers, and other entities (such
as law enforcement entities, educational
institutions, and community-based
organizations); and
``(iv) a requirement that such services may
only be terminated once an individual is
stabilized or transferred to receive care from
another appropriate provider of services,
supplier, or entity.
``(3) Termination of designation.--
``(A) In general.--The Secretary shall terminate a
designation of a participating provider under paragraph
(1) if--
``(i) the Secretary determines that such
provider no longer meets the standards
specified under paragraph (2); or
``(ii) such provider fails to meets such
quality standards as the Secretary determines
appropriate.
``(B) Permissive termination.--The Secretary may
terminate a designation of a participating provider
under paragraph (1) for such other reasons as
determined appropriate by the Secretary.
``(c) Payment.--
``(1) In general.--Payment for crisis response services
furnished by a participating provider under the demonstration
program shall be equal to 100 percent of the lesser of the
amount charged by such provider or an amount determined under
the payment basis established by the Secretary under paragraph
(2).
``(2) Payment basis.--The Secretary shall establish a
single payment amount for crisis response services furnished to
an applicable individual by a participating provider during a
month. Such amount shall be equal to the average (as determined
by the Secretary) costs incurred by eligible providers in
furnishing such services to an individual during a month.
``(3) Source of payment.--Payment for crisis response
services furnished by a participating provider under the
demonstration program shall be made from the Federal
Supplementary Medical Insurance Trust Fund established under
section 1841.
``(d) Evaluation and Monitoring.--The Secretary shall evaluate each
participating provider under the demonstration program to assess
whether the results described in subsection (a) have been achieved.
``(e) Report.--Not later than 3 years after the date of the
enactment of this section, the Secretary shall conduct an independent
evaluation of the demonstration program and submit to Congress a report
on such program. Such report shall include an analysis of the
following:
``(1) Whether such program has achieved results described
in subsection (a).
``(2) The quality of crisis response services furnished
under such program.
``(3) Any reduction in jail incarceration attributable to
such program.
``(4) The number of individuals furnished services under
such program who were not voluntarily so furnished such
services.
``(f) Definitions.--In this section:
``(1) Applicable individual.--The term `applicable
individual' means an individual who--
``(A) is entitled to benefits under part A and
enrolled under part B;
``(B) is not enrolled in a Medicare Advantage plan
under part C or a PACE program under section 1894; and
``(C) meets such other criteria as determined
appropriate by the Secretary.
``(2) Behavioral health urgent care facility.--The term
`behavioral health urgent care facility' means an ambulatory
facility where individuals experiencing a mental or behavioral
health crisis may walk in without an appointment to receive
crisis assessment services, crisis intervention services,
medication, and connection to other appropriate services.
``(3) Crisis receiving and stabilization facility.--The
term `crisis receiving and stabilization facility' means a
subacute inpatient facility or other facility specified by the
Secretary that provides short-term observation and
stabilization services to individuals experiencing a mental or
behavioral health crisis.
``(4) Crisis response services.--The term `crisis response
services' means mental or behavioral health services that are
furnished to an individual experiencing a mental or behavioral
health crisis to--
``(A) provide screening and assessment for the
individual's mental health or substance use disorder
crisis;
``(B) support the de-escalation of the individual's
mental health or substance use disorder crisis;
``(C) facilitate or support subsequent referral to
health, social, and other services, as determined
appropriate by the Secretary; or
``(D) otherwise address the individual's pressing
behavioral health needs, as determined appropriate by
the Secretary.
``(5) Eligible provider.--The term `eligible provider'
means a provider of crisis response services that is a mobile
crisis response team, a crisis receiving and stabilization
facility, a behavioral health urgent care facility, or such
other provider of services or supplier determined appropriate
by the Secretary.
``(6) Mobile crisis response team.--The term `mobile crisis
response team' means a team of physicians or practitioners (as
described in section 1842(b)(18)(C)) that is available to
furnish crisis response services to an individual experiencing
a mental or behavioral health crisis in the individual's home
or at the individual's workplace or another community-based
location in a timely manner.
``(g) Funding.--For purposes of administering and carrying out the
demonstration program, other than for payments for services furnished
under the program, in addition to funds otherwise appropriated, the
Secretary shall provide for the transfer to the Center for Medicare &
Medicaid Services Program Management Account from the Federal Hospital
Insurance Trust Fund under section 1817 and the Federal Supplementary
Medical Insurance Trust Fund under section 1841 of this title (in
proportions determined appropriate by the Secretary) of such sums as
the Secretary determines are necessary for such purposes. Amounts
transferred under this subsection shall remain available until
expended.''.
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