[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8543 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 8543
To amend the Social Security Act and the Public Health Service Act to
permanently authorize certified community behavioral health clinics,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 23, 2024
Ms. Matsui (for herself, Mr. Bucshon, Ms. Craig, Mr. Molinaro, and Mr.
Tonko) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, 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 the Social Security Act and the Public Health Service Act to
permanently authorize certified community behavioral health clinics,
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 ``Ensuring
Excellence in Mental Health Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title.
TITLE I--ENSURING PERMANENCY FOR CERTIFIED COMMUNITY BEHAVIORAL HEALTH
CLINICS IN THE MEDICAID PROGRAM
Sec. 101. Establishing a Medicaid Prospective Payment System for
Certified Community Behavioral Health
Clinics.
TITLE II--COVERAGE OF CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC
SERVICES UNDER THE MEDICARE PROGRAM
Sec. 201. Coverage of certified community behavioral health clinic
services under the Medicare program.
TITLE III--COMMUNITY BEHAVIORAL HEALTH CLINIC GRANTS
Sec. 301. Operating grants for community behavioral health clinics.
TITLE I--ENSURING PERMANENCY FOR CERTIFIED COMMUNITY BEHAVIORAL HEALTH
CLINICS IN THE MEDICAID PROGRAM
SEC. 101. ESTABLISHING A MEDICAID PROSPECTIVE PAYMENT SYSTEM FOR
CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS.
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is
amended by adding at the end the following new subsection:
``(uu) Payment for Services Provided by Certified Community
Behavioral Health Clinics.--
``(1) In general.--Beginning with fiscal year 2024, with
respect to services furnished on or after January 1, 2024, and
each succeeding fiscal year, a State may provide under the
State plan under this title (or under a waiver of such plan)
for payment for services described in section 1905(a)(31)
furnished by a certified community behavioral health clinic (in
this subsection referred to as a `clinic') in accordance with
the provisions of this subsection.
``(2) Payment for services in initial year and every third
year.--Subject to paragraphs (4), (5), and (6), for services
furnished by a clinic in the first fiscal year for which a
State elects to provide for payment for services described in
section 1905(a)(31) in accordance with the payment option under
paragraph (1), and every third fiscal year thereafter in which
the State makes such an election, the State shall provide for
payment for such services in an amount (calculated on the basis
of daily visits or unduplicated monthly visits, at the State's
election) that is equal to 100 percent of the average costs of
the clinic of furnishing any of the services described in
paragraph (31) of section 1905(a) during the 2 fiscal years
preceding the fiscal year involved which are reasonable and
related to the costs of furnishing such services; provided
that, in the absence of complete actual cost data representing
the provision of the full covered benefit in such preceding
fiscal years, certified community behavioral health clinics
may, at the State's discretion, use estimated or projected data
relating to specific services for which they lack cost
experience. The per-unit rate derived from such cost data shall
be adjusted to take into account any increase or decrease in
the scope of such services furnished by the clinic in the
fiscal year involved.
``(3) Payment for services in succeeding fiscal years.--
Subject to paragraphs (4), (5), and (6), for services described
in section 1905(a)(31) furnished by a clinic for which a State
elects to provide for payment for such services in accordance
with the payment option under paragraph (1) and that are
furnished in a fiscal year that is not described in paragraph
(2), the State plan shall provide for payment for such services
in an amount (calculated on the basis of daily visits or
unduplicated monthly visits, at the State's election) that is
equal to the amount calculated under this subsection for such
services and clinic for the preceding year--
``(A) increased by the percentage increase in the
inflationary factor described in section
1834(aa)(2)(C); and
``(B) adjusted to take into account any increase or
decrease in the scope of such services furnished by the
clinic during the fiscal year involved.
``(4) Establishment of initial year payment for new
clinics.--In any case in which an entity first qualifies as a
certified community behavioral health clinic after the first
fiscal year in which a State elects to provide for payment for
services described in section 1905(a)(31) in accordance with
the payment option under paragraph (1), the State plan shall
provide for payment for such services in the first 2 years in
which the clinic so qualifies in an amount (calculated on the
basis of daily visits or unduplicated monthly visits, at the
State's election) that is equal to the rates established under
this subsection for other such clinics located in the same or
adjacent area with a similar case load, or in the absence of
any such clinic, based on the average per-unit rate for other
certified community behavioral health clinics in the State;
provided, however, that effective, at latest, as of the 3rd
year in which the clinic furnishes such services, the State
establishes a unique payment rate for the clinic based on the
methodology described in paragraph (2), using allowable costs
from the clinic's first 2 fiscal years of operation as the
basis for establishing such rates; and provided, additionally,
that in any year following the establishment of an initial rate
under this paragraph, the State plan or waiver provides for the
payment amount to be calculated in accordance with paragraph
(2) or (3) (as applicable).
``(5) Administration in the case of managed care.--
``(A) In general.--In the case of services
furnished by a certified community behavioral health
clinic pursuant to a contract between the clinic and a
managed care entity (as defined in section
1932(a)(1)(B)), the State plan or a waiver of such plan
shall provide for 1 of the following:
``(i) Payment to the clinic by the State of
a supplemental payment equal to the amount (if
any) by which the amount determined under
paragraph (2), (3), or (4) (as applicable)
exceeds the amount of payments under the
contract, with such supplemental payment being
made pursuant to a payment schedule agreed to
by the State and the certified community
behavioral health clinic, but in no case less
frequently than every 3 months.
``(ii) Delegation by the State to the
managed care entity of the obligation to pay
the clinic at least the rate determined under
paragraph (2), (3), or (4) (as applicable);
provided, however, that the State shall use
reconciliation and oversight processes to
ensure that each clinic is paid at least the
amounts required under such paragraphs.
``(6) Alternative payment methodologies.--Notwithstanding
any other provision of this subsection, the State plan or a
waiver of such plan may provide for payment in any year to a
certified community behavioral health clinic for services
described in paragraph (31) of section 1905(a) in an amount
which is determined under an alternative payment methodology
that--
``(A) is agreed to by the State and the clinic; and
``(B) results in payment to the clinic of an amount
which is not less than the amount otherwise required to
be paid to the clinic under this subsection.''.
TITLE II--COVERAGE OF CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC
SERVICES UNDER THE MEDICARE PROGRAM
SEC. 201. COVERAGE OF CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC
SERVICES UNDER THE MEDICARE PROGRAM.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (II), by striking ``and'' at the end;
(2) in subparagraph (JJ), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(KK) certified community behavioral health clinic
services (as defined in subsection (aa)(8)) furnished on or
after January 1, 2024.''.
(b) Definitions.--Section 1861(aa) of the Social Security Act (42
U.S.C. 1395x) is amended--
(1) in the heading, by striking ``and Federally Qualified
Health Center Services'' and inserting ``, Federally Qualified
Health Center Services, and Certified Community Behavioral
Health Clinic Services''; and
(2) by adding at the end the following new paragraph:
``(8) The terms `certified community behavioral health clinic
services' and `certified community behavioral health clinic' have the
meaning given those terms in paragraphs (1) and (2), respectively, of
section 1905(jj).''.
(c) Payment.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (HH)'' and inserting
``(HH)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (II) with respect to certified
community behavioral health clinic services for which
payment is made under section 1834(aa), the amounts
paid shall be equal to 80 percent of the lesser of the
actual charge or the amount determined under such
section''.
(2) Development and implementation of prospective payment
system.--Section 1834 of the Social Security Act (42 U.S.C.
1395m) is amended by adding at the end the following new
subsection:
``(aa) Development and Implementation of Prospective Payment System
for Certified Community Behavioral Health Clinics.--
``(1) Development.--The Secretary shall develop a
prospective payment system for payment to certified community
behavioral health clinics (as defined in section 1861(aa)(8))
for the furnishing of certified community behavioral health
clinic services (as defined in such section) under this title.
Such system shall be established to take into account the type,
intensity, and duration of services furnished by certified
community behavioral health clinics. Such system may include
adjustments, including geographic adjustments, as determined
appropriate by the Secretary.
``(2) Implementation.--
``(A) In general.--The Secretary shall provide, for
cost reporting periods beginning on or after January 1,
2024, for payments of prospective payment rates for
certified community behavioral health clinic services
furnished by certified community behavioral health
clinics under this title in accordance with the
prospective payment system developed by the Secretary
under paragraph (1).
``(B) Initial payments.--The Secretary shall
implement such prospective payment system to reflect
the national average allowable service costs of such
clinics on the basis of the most current audited cost
report data for two fiscal years available to the
Secretary; provided that, in the absence of complete
actual cost data representing the provision of the full
covered benefit during the relevant fiscal years,
certified community behavioral health clinics may, at
the Secretary's discretion, use estimated or projected
data relating to specific services. Initial payments
shall be established without the application of a per
visit limit or productivity screen and shall be based
on national average costs per unit of service, updated
as appropriate by the inflationary adjustment described
in subparagraph (C).
``(C) Payments in subsequent years.--Payment rates
in years after the year of implementation of such
system shall be the payment rates in the previous year
increased--
``(i) in the first year after
implementation of such system, by the
percentage increase in the MEI (as defined in
section 1842(i)(3)) for the year involved; and
``(ii) in subsequent years, by the
percentage increase in a market basket of
certified community behavioral health clinic
services, designed by the Secretary, or if such
an index is not available, by the percentage
increase in the MEI (as defined in section
1842(i)(3)) for the year involved.
``(3) Unit of payment.--In establishing a prospective
payment amount under the system under this subsection, the
Secretary shall consider an appropriate unit of service and a
general system design that provides for continued access to
quality services.
``(4) Periodic reevaluation of rates.--At the Secretary's
discretion, the Secretary shall, from time to time, adjust the
amounts that would otherwise be applicable under subparagraph
(2) by a percentage determined appropriate by the Secretary to
reflect such factors as changes in the intensity of services
furnished within a unit of service, the average cost of
providing care per unit of service, and other factors that the
Secretary considers to be relevant. Such adjustment shall be
made before the update under clause (i) or (ii) of paragraph
(2)(C)(i) has been applied for the year.''.
(d) Waiver of Application of Deductible.--Section 1833(b)(4) of the
Social Security Act (42 U.S.C. 1395l(b)(4)) is amended by inserting
``or certified community behavioral health clinic services'' before the
comma at the end.
(e) PRRB Review of Cost Reports.--Section 1878(j) of the Social
Security Act (42 U.S.C. 1395oo(j)) is amended by striking ``and a
Federally qualified health center'' and inserting ``, a Federally
qualified health center, and a certified community behavioral health
clinic''.
(f) Safe Harbor for Waiver of Coinsurance.--Section 1128B(b)(3)(D)
of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)(D)) is amended by
inserting ``or a certified community behavioral health clinic'' after
``Federally qualified health care center''.
(g) Effective Date.--The amendments made by this section shall
apply with respect to services furnished on or after January 1, 2024.
TITLE III--COMMUNITY BEHAVIORAL HEALTH CLINIC GRANTS
SEC. 301. OPERATING GRANTS FOR COMMUNITY BEHAVIORAL HEALTH CLINICS.
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:
``Subpart XIII--Community Behavioral Health Clinics
``SEC. 340J. DEFINITIONS.
``In this subpart:
``(1) Certified community behavioral health clinic.--The
term `certified community behavioral health clinic' has the
meaning given the term in section 1905(jj)(2)) of the Social
Security Act.
``(2) Certified community behavioral health services.--The
term `certified community behavioral health services' has the
meaning given the term in section 1905(jj)(1) of the Social
Security Act.
``SEC. 340J-1. COMMUNITY BEHAVIORAL HEALTH CLINIC CERTIFICATION.
``(a) In General.--Not later than 180 days after the date of
enactment of the Ensuring Excellence in Mental Health Act, the
Secretary, after public notice and opportunity for comment, shall
publish in the Federal Register criteria for a clinic to be certified
as a community behavioral health clinic for purposes of section
1905(jj)(2)(D)(ii) of the Social Security Act.
``(b) Requirements.--The criteria published under subsection (a)
shall include criteria with respect to the following:
``(1) Staffing.--Staffing requirements, including criteria
that staff have diverse disciplinary backgrounds, have
necessary State-required license and accreditation, and are
culturally and linguistically trained to serve the needs of the
patient populations of the community behavioral health clinic.
``(2) Availability and accessibility of services.--
Availability and accessibility of services, including crisis
management services that are available and accessible 24 hours
a day, the use of a sliding scale for payment, and no rejection
for services or limiting of services on the basis of a
patient's ability to pay or a place of residence.
``(3) Care coordination.--Care coordination, including
requirements to coordinate care across settings and providers
to ensure seamless transitions for patients across the full
spectrum of health services including acute, chronic, and
behavioral health needs. Care coordination requirements shall
include partnerships or formal contracts with the following:
``(A) Federally-qualified health centers (as
defined in section 1905(l) of the Social Security Act)
and, as applicable, rural health clinics (as so
defined), to provide Federally-qualified health center
services (as so defined) and, as applicable, rural
health clinic services (as so defined), to the extent
such services are not provided directly through the
community behavioral health clinic.
``(B) Inpatient psychiatric facilities and
substance use detoxification, post-detoxification step-
down services, and residential programs.
``(C) Other community or regional services,
supports, and providers, including schools, child
welfare agencies, juvenile and criminal justice
agencies and facilities, Indian Health Service youth
regional treatment centers, State-licensed and
nationally accredited child placing agencies for
therapeutic foster care service, and other social and
human services.
``(D) Medical centers, outpatient clinics, and
drop-in centers of the Department of Veterans Affairs
and other facilities of the Department (as defined in
section 1701 of title 38, United States Code).
``(E) Inpatient acute care hospitals and hospital
outpatient clinics.
``(4) Scope of services.--Provision (in a manner reflecting
person-centered care) of the full array of certified community
behavioral health services which, if not available directly
through the community behavioral health clinic, are provided or
referred through formal relationships with other providers.
``(5) Quality and other reporting.--Requirements relating
to development by the community behavioral health clinic of an
effective procedure for compiling and reporting to the
Secretary such statistics and other information as the
Secretary may require relating to--
``(A) the costs of its operations;
``(B) the patterns of use of its services,
including the reporting of encounter data, clinical
outcomes data, quality data, and such other data as the
Secretary may require;
``(C) the availability, accessibility, and
acceptability of its services; and
``(D) such other matters relating to operations of
the applicant as the Secretary may require.
``(6) Organizational authority.--Requirements that a
community behavioral health clinic be--
``(A) a nonprofit entity;
``(B) part of a local government behavioral health
authority;
``(C) operated under the authority of the Indian
Health Service;
``(D) operated by an Indian Tribe or Tribal
organization pursuant to a contract, grant, cooperative
agreement, or compact with the Indian Health Service
pursuant to the Indian Self-Determination and Education
Assistance Act; or
``(E) operated by an urban Indian organization
pursuant to a grant or contract with the Indian Health
Service under title V of the Indian Health Care
Improvement Act.
``SEC. 340J-2. OPERATING GRANTS FOR COMMUNITY BEHAVIORAL HEALTH
CLINICS.
``(a) In General.--The Secretary shall establish a grant program
under which the Secretary shall award grants to eligible community
behavioral health clinics to provide (in a manner reflecting person-
centered care) the full array of certified community behavioral health
services.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), a community behavioral health clinic shall be--
``(1) a certified community behavioral health clinic; or
``(2) a community behavioral health clinic that indicates
in the grant application that the clinic will use the grant
funds to meet the criteria described in section 340J-1(a).
``(c) Use of Funds.--A community behavioral health clinic that
receives a grant under subsection (a)--
``(1) shall use the grant funds--
``(A) to provide the services described in
subsection (a); and
``(B) in the case of a community behavioral health
clinic described in subsection (b)(2), to meet the
criteria described in section 340J-1(a); and
``(2) may use the grant funds--
``(A) to carry out other activities that--
``(i) reduce costs associated with the
provision of certified community behavioral
health services;
``(ii) improve access to, and availability
of, certified community behavioral health
services provided to individuals served by the
community behavioral health clinic;
``(iii) enhance the quality and
coordination of certified community behavioral
health services; or
``(iv) improve the health status of
communities; and
``(B) to pay for--
``(i) the costs of acquiring and leasing
buildings and equipment (including the costs of
amortizing the principal of, and paying
interest on, loans);
``(ii) costs relating to the purchase or
lease of equipment, including data and
information systems and behavioral health
information technology to facilitate data
reporting and other purposes;
``(iii) the costs of in-service staff
training and other operational or
infrastructure costs identified by the
Secretary; and
``(iv) costs associated with expanding and
modernizing existing buildings or constructing
new buildings (including the costs of
amortizing the principal of, and paying the
interest on, loans), if such costs are
specifically allowed for in the grant
opportunity published by the Secretary.
``(d) Term.--Grants awarded under subsection (a) shall be for a
period of not more than 5 years.
``(e) Condition on Receipt of Funds.--The Secretary shall not make
a grant to an applicant under subsection (a) unless the applicant
provides assurances to the Secretary that within 120 days of receiving
grant funding for the operation of the clinic, the applicant will
submit for approval by the Secretary an implementation plan that
describes how the applicant will--
``(1) provide the services described in subsection (a); and
``(2) in the case of a community behavioral health clinic
described in subsection (b)(2), meet the criteria described in
section 340J-1(a).
``(f) Amount of Grant.--
``(1) In general.--Subject to paragraph (2), the amount of
a grant made in any fiscal year to a community behavioral
health clinic under subsection (a) shall be determined by the
Secretary based on information provided by the community
behavioral health clinic, but may not exceed an amount equal to
the difference obtained by subtracting--
``(A) the sum obtained by adding--
``(i) the total State, local, and other
operational funding provided to the clinic for
such fiscal year; and
``(ii) the fees, premiums, and third-party
reimbursements that the clinic reasonably
expects to receive for its operations in such
fiscal year; from
``(B) the costs of operating the clinic to meet the
purposes and requirements of the grant program under
this section during such fiscal year.
``(2) Requirement.--
``(A) In general.--In determining the costs
described in paragraph (1)(B), the Secretary may
estimate the anticipated costs of the grant recipient
in--
``(i) providing the services described in
subsection (a), including the anticipated costs
of providing any individual certified community
behavioral health service that the applicant
entity does not have cost experience providing
at the time of submitting an application for
such grant; and
``(ii) if applicable, meeting the criteria
described in section 340J-1(a).
``(B) Anticipated costs.--The Secretary shall base
the estimate of anticipated costs under subparagraph
(A) on an estimate of anticipated costs provided by the
applicable community behavioral health clinic.
``(3) Payments.--The Secretary may--
``(A) award grants under subsection (a)--
``(i) in advance or through reimbursement;
and
``(ii) in installments;
``(B) make adjustments to account for overpayments
or underpayments.
``(g) Use of Accreditation.--
``(1) In general.--In selecting grant recipients under this
section, the Secretary may take into account whether an
applicant community behavioral health clinic is accredited
under section 340J-5(a).
``(2) Compliance.--In determining whether a community
behavioral health clinic receiving a grant under this section
is providing the services described in subsection (a) and, if
applicable, meeting the criteria described in section 340J-
1(a), the Secretary may take into account whether the community
behavioral health clinic is accredited under section 340J-5(a).
``(h) Authorization of Appropriations.--
``(1) In general.--There is authorized to be appropriated
to carry out this section, $552,500,000 for each of fiscal
years 2024 through 2028.
``(2) Maintenance of funding.--The amount made available
under paragraph (1) shall supplement (and not supplant) any
other Federal funding made available for community behavioral
health clinics.
``SEC. 340J-3. TECHNICAL ASSISTANCE.
``(a) In General.--Not later than 180 days after the date of
enactment of the Ensuring Excellence in Mental Health Act, the
Secretary shall establish programs through which the Secretary shall
provide (either through the Department of Health and Human Services or
by grant or contract) technical assistance and other assistance to any
of the following:
``(1) Entities that receive a grant under section 340J-2.
``(2) Entities participating in a Medicaid demonstration
program under section 223(d) of the Protecting Access to
Medicare Act.
``(3) Certified community behavioral health clinics (as
defined in sections 1861(aa)(8) and 1905(jj)(2) of the Social
Security Act), furnishing services under title XVIII or title
XIX of such Act.
``(4) Health or social service provider organizations
pursuing or considering certified community behavioral health
clinic status or partnering with certified community behavioral
health clinics.
``(5) Other stakeholders, for the purpose of facilitating
successful implementation of the certified community behavioral
health clinic model.
``(b) Inclusions.--Assistance provided by the Secretary under
subsection (a) may include technical and nonfinancial assistance,
including--
``(1) fiscal and program management assistance;
``(2) operational and administrative support; and
``(3) the provision of information to the entities about
the variety of resources available under this part and how
those resources can be best used to meet the health and
behavioral health needs of the communities served by the
entities.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $6,000,000 for each of fiscal
years 2024 through 2028.
``SEC. 340J-4. DATA INFRASTRUCTURE FOR COMMUNITY BEHAVIORAL HEALTH
CLINIC REPORTING.
``(a) In General.--Not later than 180 days after the date of
enactment of the Ensuring Excellence in Mental Health Act, the
Secretary shall establish a system under which the Secretary shall
collect and analyze data on community behavioral health clinics.
``(b) Scope of Data Collection.--The system established under
subsection (a) shall be used by the Secretary to collect and analyze
data from--
``(1) entities that receive a grant under section 340J-2;
and
``(2) organizations that provide services, or have applied
to provide services, under title XVIII of the Social Security
Act, as described in section 1861(aa)(8) of such Act, or under
a State Medicaid program in accordance with section 1905(jj) of
such Act.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $51,000,000 for each of fiscal
years 2024 through 2028.
``SEC. 340J-5. COMMUNITY BEHAVIORAL HEALTH CLINIC ACCREDITATION.
``(a) Accreditation Standards.--A community behavioral health
clinic may be accredited if the entity--
``(1) meets the standards of an approved accreditation
body; and
``(2) authorizes the accreditation body to submit to the
Secretary (or such agency as the Secretary may designate) such
records or other information as the Secretary may require.
``(b) Approval of Accreditation Bodies.--
``(1) In general.--The Secretary may approve a private
nonprofit organization to be an accreditation body for the
accreditation of community behavioral health clinics under
subsection (a) if--
``(A) using inspectors qualified to evaluate
quality of care in a behavioral health service setting,
the accreditation body agrees to inspect the clinic
with such frequency as is determined by the Secretary;
``(B) the standards applied by the body in
determining whether or not to accredit a clinic
correspond to the criteria described in section 340J-
1(a), and are not less restrictive than such criteria;
``(C) there is adequate provision for assuring that
the standards of the accreditation body continue to be
met by the clinic;
``(D) in the case of any clinic previously
accredited by the body which has had its accreditation
denied, suspended, withdrawn, or revoked or which has
had any other action taken against it by the
accrediting body, the accrediting body agrees to submit
to the Secretary the name of such clinic within 30 days
of the action taken; and
``(E) if the accreditation body has its approval
withdrawn by the Secretary, the body agrees to notify
each clinic accredited by the body of the withdrawal
within 10 days of the withdrawal.''.
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