[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5112 Introduced in Senate (IS)]
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118th CONGRESS
2d Session
S. 5112
To amend title XVIII of the Social Security Act to provide payment for
crisis stabilization services under the prospective payment system for
hospital outpatient department services.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 19, 2024
Ms. Cortez Masto (for herself and Mr. Cornyn) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide payment for
crisis stabilization services under the prospective payment system for
hospital outpatient department 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 Act of 2024''.
SEC. 2. PAYMENT FOR CRISIS STABILIZATION SERVICES UNDER PROSPECTIVE
PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT
SERVICES.
(a) In General.--Section 1833(t) of the Social Security Act (42
U.S.C. 1395l(t)) is amended--
(1) in paragraph (1)(B)--
(A) in clause (iv), by striking ``and'' at the end;
(B) in clause (v), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(vi) includes crisis stabilization
services (as defined in paragraph (23))
furnished on or after January 1, 2027.''; and
(2) by adding at the end the following new paragraph:
``(23) Crisis stabilization services.--
``(A) Crisis stabilization services defined.--In
this subsection, the term `crisis stabilization
services' means applicable items and services (as
defined in subparagraph (B)) that are furnished to an
eligible individual who is experiencing a mental health
or substance use disorder crisis, subject to the
requirements under subparagraph (C).
``(B) Applicable items and services defined.--
``(i) In general.--For purposes of
subparagraph (A), the term `applicable items
and services' means items and services
described in clause (ii) that are--
``(I) covered under this part; and
``(II)(aa) reasonable and necessary
for the diagnosis and active treatment
of the individual's mental health or
substance use disorder condition; or
``(bb) reasonably expected to
support the de-escalation of the
individual's mental health or substance
use disorder crisis.
``(ii) Items and services described.--The
following items and services are described in
this clause:
``(I) Observation services and
supervised care for individuals in
severe distress for up to 23
consecutive hours.
``(II) Screening for suicide risk,
including comprehensive suicide risk
assessments and planning when
clinically indicated.
``(III) Screening for violence
risk, including comprehensive violence
risk assessments and planning when
clinically indicated.
``(IV) Assessment of immediate
physical health needs and delivery of
care for physical health needs that are
within the capability of the hospital.
``(V) Such other items and services
as the Secretary determines
appropriate.
``(C) Requirements for payment.--In order to
receive payment for crisis stabilization services under
this subsection, a hospital must document, in a form
and manner determined appropriate by the Secretary,
that--
``(i) the hospital accepts referrals,
within the capability of the hospital, for
crisis stabilization services;
``(ii) the hospital is capable of providing
referrals for health, social, and other
services and supports, as needed, that are not
provided as part of crisis stabilization
services;
``(iii) the unit of the hospital that
furnishes crisis stabilization services is
staffed at all times (24 hours a day, 7 days a
week, 365 days a year) with a multidisciplinary
team, which may include providers such as a
psychiatrist or psychiatric nurse practitioner
(who may be available by telehealth for such
staffing purposes), registered nurses,
practitioners legally authorized to furnish
such services under State law (or the State
regulatory mechanism provided by State law) of
the State in which the services are furnished,
and peer support specialists (as defined in
subparagraph (D)); and
``(iv) the unit of the hospital that
furnishes crisis stabilization services is
capable--
``(I) of timely communication with
emergency response systems, crisis
intervention hotlines, and physicians
and practitioners furnishing mobile
crisis response team services (as
defined in subparagraph (D)); and
``(II) within the capacity of the
hospital, of accepting referrals of
individuals from such entities for
crisis stabilization services.
``(D) Definitions.--In this paragraph:
``(i) Mobile crisis response services.--The
term `mobile crisis response team services'
means physicians' services that are furnished
outside of a hospital, other facility setting,
or physician office to an individual
experiencing a mental health or substance use
disorder crisis to--
``(I) provide screening and
assessment for the individual's mental
health or substance use disorder
crisis;
``(II) support the de-escalation of
the individual's mental health or
substance use disorder crisis;
``(III) facilitate or support
subsequent referral to health, social,
and other services, as determined
appropriate by the Secretary; or
``(IV) otherwise address the
individual's pressing behavioral health
needs, as determined appropriate by the
Secretary.
``(ii) Peer support specialist.--The term
`peer support specialist' means an individual
who--
``(I) is recovering from a mental
health or substance use condition; and
``(II) is certified as qualified to
furnish peer support services under a
certification process consistent with
the National Practice Guidelines for
Peer Supporters and inclusive of the
Substance Abuse and Mental Health
Services Administration Core
Competencies for Peer Workers in
Behavioral Health Settings (as
established by the State in which such
individual furnishes such services or
under such certification process
determined appropriate by the Secretary
of Health and Human Services.''.
(b) Report on Medicare Coverage of Crisis Stabilization Facility
Services.--Not later than 18 months after the date of the enactment of
this Act, the Secretary of Health and Human Services (referred to in
this subsection as the ``Secretary'') shall submit to the Committee on
Finance of the Senate and the Committee on Energy and Commerce and the
Committee on Ways and Means of the House of Representatives a report on
policy issues for consideration in relation to providing Medicare
coverage of crisis stabilization services (as defined in section
1833(t)(23) of the Social Security Act, as added by subsection (a)),
when furnished by crisis stabilization facilities that are not eligible
to enroll in the Medicare program as a subsection (d) hospital (as
defined in section 1886(d)(1)(B) of such Act (42 U.S.C.
1395ww(d)(1)(B))). Such report may include an assessment of the
following:
(1) Considerations relating to licensure and accreditation
of such facilities by States and accreditation organizations to
ensure care quality and program integrity.
(2) Considerations relating to the development of payment
rates for such facilities, including collection of data on the
costs that such facilities incur in furnishing crisis
stabilization services.
(3) Considerations relating to any program integrity risks
associated with crisis stabilization facilities and potential
measures that could be implemented to mitigate those risks.
(4) Other considerations determined appropriate by the
Secretary.
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