[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 923 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 923
To amend titles XVIII and XIX of the Social Security Act to reform and
improve mental health and substance use care under the Medicare and
Medicaid programs, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 22, 2023
Mr. Bennet (for himself and Mr. Wyden) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to reform and
improve mental health and substance use care under the Medicare and
Medicaid programs, 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Better Mental
Health Care for Americans Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICARE PART B PROVISIONS
Sec. 101. Payment under the Medicare physician fee schedule for
inherently complex evaluation and
management visits related to integrated
mental health and substance use disorder
care.
Sec. 102. Ensuring access to early intervention in mental health care
in Medicare.
TITLE II--MEDICARE ADVANTAGE AND PART D PROVISIONS
Sec. 201. Parity in mental health and substance use disorder benefits
under Medicare Advantage and prescription
drug plans.
Sec. 202. Behavioral health measures and incentivizing behavioral
health care quality.
Sec. 203. Providing information on behavioral health coverage to
promote informed choice.
Sec. 204. Requiring MA organizations to maintain accurate and updated
provider directories.
TITLE III--MEDICAID AND CHIP
Sec. 301. Enhanced payment under Medicaid for integrated mental health
and substance use disorder care services.
Sec. 302. Demonstration project to ensure Medicaid-enrolled children
have access to integrated mental health and
substance use disorder care services,
including prevention and early intervention
services.
Sec. 303. Uniform applicability to Medicaid of requirements for parity
in mental health and substance use disorder
benefits.
Sec. 304. Requiring additional transparency on access to mental health
and substance use disorder benefits through
managed care.
Sec. 305. Authority to defer or disallow a portion of Federal financial
participation for failure to comply with
managed care requirements.
Sec. 306. Medicaid and CHIP audits.
TITLE IV--OTHER PROVISIONS
Sec. 401. Ensuring multi-payer alignment on payment and measurement of
quality of care and health outcomes related
to integrated mental health and substance
use disorder care.
Sec. 402. Measuring access and quality outcomes in mental health and
substance use disorder care.
Sec. 403. Reviewing the evidence for integrated mental health care for
children.
Sec. 404. Enhancing oversight of integrated mental health and substance
use disorder care.
TITLE I--MEDICARE PART B PROVISIONS
SEC. 101. PAYMENT UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE FOR
INHERENTLY COMPLEX EVALUATION AND MANAGEMENT VISITS
RELATED TO INTEGRATED MENTAL HEALTH AND SUBSTANCE USE
DISORDER CARE.
(a) In General.--Section 1848(b) of the Social Security Act (42
U.S.C. 1395w-4(b)) is amended by adding at the end the following new
paragraph:
``(13) Payment for inherently complex evaluation and
management visits related to integrated mental health and
substance use disorder care.--
``(A) In general.--The Secretary shall establish a
new HCPCS add-on code under the fee schedule
established under this subsection for integrated mental
health and substance use disorder care services (as
defined in subparagraph (B)(i)) that are furnished on
or after January 1, 2025, when furnished by an
integrated care practitioner on the same date of
service that a service in the HCPCS category of office
and other outpatient evaluation and management services
is furnished. Such add-on code may be similar to HCPCS
code G2211.
``(B) Definitions.--In this paragraph:
``(i) Integrated mental health and
substance use disorder care services.--
``(I) In general.--The term
`integrated mental health and substance
use disorder care services' means
services described in subclause (II)
that are furnished by an integrated
care practitioner.
``(II) Services described.--The
services described in this subclause
are the following:
``(aa) Preventive services
and screening for mental health
and substance use disorders
that the Secretary determines
are--
``(AA) reasonable
and necessary for the
prevention or early
detection of a mental
health or substance use
disorder;
``(BB) recommended
with a grade of A or B
by the United States
Preventive Services
Task Force or
recommended in Health
Resources and Services-
supported guidelines
for infants, children,
adolescents, and women;
and
``(CC) appropriate
for individuals
enrolled under this
part.
``(bb) The routine use and
tracking of quality measures
appropriate for the measurement
of the quality of care
(including medication errors)
related to behavioral health
that reflect consensus among
affected parties and, to the
extent feasible and
practicable, shall include
measures set forth by one or
more national consensus
building entities.
``(cc) Short-term,
evidence-based, culturally, and
linguistically appropriate
therapeutic and psychosocial
intervention integrated into
the primary care practice,
including through telehealth.
``(dd) Evidence-based
treatment for mental health and
substance use care integrated
into the primary care practice,
including through telehealth,
or through referral.
``(ee) Care management,
which can include establishing,
implementing, revising or
monitoring the care plan,
coordinating with other
professionals and agencies, and
educating the individual or
caregiver about the
individual's condition, care
plan, or prognosis.
``(ff) Other services
determined by the Secretary.
``(ii) Integrated care practitioner.--
``(I) In general.--The term
`integrated care practitioner' means a
primary care practitioner (as defined
in section 1833(x)(2)(A)(i)) who has
demonstrated the capacity to furnish
integrated mental health and substance
use disorder care services (as
determined under subclause (II)).
``(II) Demonstrating capacity
guidance; attestation.--For purposes of
applying subclause (I) with respect to
an integrated care practitioner
demonstrating the capacity to furnish
integrated mental health and substance
use disorder care services, the
Secretary shall issue guidance, not
later than one year after the date of
the enactment of this paragraph,
describing requirements for
demonstrating capacity to provide such
services and establishing a process for
the Secretary to receive an attestation
that an integrated care practitioner
has such capacity. Such guidance and
attestation may not impose additional
burden on small practices (as defined
for purposes of subsection (q)(11)) and
practices located in rural areas.
``(C) Payment.--
``(i) Amount of payment.--The fee schedule
amount for integrated mental health and
substance use disorder care services shall not
be less than the fee schedule amount for
services described by HCPCS code G2211 (or any
successor or substantially similar code).
``(ii) Add-on services.--If, during the
furnishing of an evaluation and management
service to an individual by an integrated care
practitioner, such practitioner also furnishes
(or coordinates the furnishing of) integrated
mental health and substance use disorder care
services on the same date of service, payment
shall also be made for such integrated mental
health and substance used disorder care
services even if the individual did not
previously have a mental health or substance
use disorder diagnosis.
``(iii) Payment considerations.--In
carrying out this paragraph, the Secretary
shall ensure that the amount of payment for
integrated mental health and substance use
disorder care services under this paragraph is
sufficient to sustain effective and accessible
integrated mental health and substance use
disorder care under this part, as determined by
evidence from practice expenses of those
implementing effective integrated care as well
as evidence of the resource needs of integrated
care practitioners who furnish such services in
mental health professional shortage areas (as
designated under section 332(a)(1)(A) of the
Public Health Service Act) and medically
underserved areas.''.
(b) Exemption From Budget Neutrality.--Section 1848(c)(2)(B)(iv) of
the Social Security Act (42 U.S.C. 1395w-4(C)(2)(b)(iv)) is amended by
adding at the end the following new subclause:
``(VII) Subsection (b)(13) shall
not be taken into account in applying
clause (ii)(II) for 2025.''.
(c) Waiver of Coinsurance.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking ``and'' before ``(HH)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (II) with respect to integrated mental
health and substance use disorder care services (as defined in
subparagraph (B)(i) of section 1848(b)(13)) that are furnished
on or after January 1, 2025, the amounts paid shall be equal to
100 percent of the lesser of the actual charge for such
services or the fee schedule amount provided under such
section''.
SEC. 102. ENSURING ACCESS TO EARLY INTERVENTION IN MENTAL HEALTH CARE
IN MEDICARE.
Section 1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)), as amended by section 101(c), is amended--
(1) by striking ``and'' before ``(II)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (JJ) with respect to behavioral health
integration services described by HCPCS codes 99492, 99493,
99494, 99484 , G2214, and G0323 (or any successor or
substantially similar code) furnished on or after January 1,
2025, the amounts paid shall be equal to 100 percent of the
lesser of the actual charge for such services or the fee
schedule amount provided under section 1848(b)''.
TITLE II--MEDICARE ADVANTAGE AND PART D PROVISIONS
SEC. 201. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS
UNDER MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PLANS.
(a) Medicare Advantage Plans.--
(1) In general.--Section 1852 of the Social Security Act
(42 U.S.C. 1395w-22) is amended by adding at the end the
following new subsection:
``(o) Parity in Mental Health and Substance Use Disorder
Benefits.--
``(1) In general.--Each MA organization shall ensure that
the benefit design of each MA plan offered by such organization
meets the following requirements:
``(A) Financial requirements.--The financial
requirements applicable to mental health or substance
use disorder benefits covered by the plan may not
exceed the predominant financial requirements applied
to substantially all medical benefits covered by the
plan, including supplemental benefits, and there are no
separate cost sharing requirements that are applicable
only with respect to mental health and substance use
disorder benefits.
``(B) Treatment limitations.--The treatment
limitations applicable to mental health or substance
use disorder benefits are no more restrictive than the
predominant treatment limitations applied to
substantially all medical benefits covered by the plan
and there are no separate treatment limitations that
are applicable only with respect to mental health or
substance use disorder benefits, including supplemental
benefits.
``(2) Determinations of medical necessity.--
``(A) In general.--Each MA organization shall
ensure that any determination of medical necessity for
mental health or substance use benefits under each MA
plan offered by such organization that is not based on
the application of a national or local coverage
determination is consistent with generally accepted
standards of mental health and substance use disorder
care, as defined in paragraph. For any level of care
determination with respect to mental health or
substance use disorder benefits, coverage criteria are
consistent with widely-used treatment guidelines only
if they result in a level of care determination that is
consistent with the determination that would have been
made using the relevant widely-used treatment
guidelines.
``(B) Criteria for medical necessity
determinations.--The criteria for determination of
medical necessity with respect to mental health or
substance use disorder benefits under an MA plan shall
be made available in plain language to any individual
upon request.
``(3) Reporting on application of nonquantitative treatment
limitations.--
``(A) Comparative analyses of design and
application of nonquantitative treatment limits.--For
2025 and subsequent years, in the case of an MA
organization that imposes nonquantitative treatment
limitations (referred to in this paragraph as `NQTLs')
on mental health or substance use disorder benefits
under an MA plan offered by such organization, such
organization shall be required to perform and document
comparative analyses of the design and application of
NQTLs on mental health and substance use disorder
benefits under the plan and make available to the
Secretary as provided under subparagraph (B), upon
request, the comparative analyses and the following
information:
``(i) The specific plan terms regarding the
NQTLs and a description of all mental health or
substance use disorder and medical benefits to
which each such term applies in each respective
benefits classification.
``(ii) The factors used to determine that
the NQTLs will apply to mental health or
substance use disorder benefits and medical
benefits.
``(iii) The evidentiary standards used for
the factors identified in clause (ii), when
applicable, provided that every factor shall be
defined, and any other source or evidence,
including utilization of decision support
technology, artificial intelligence technology,
machine-learning technology, clinical decision-
making technology, or any other technology
specified by the Secretary, relied upon to
design and apply the NQTLs to mental health or
substance use disorder benefits and medical
benefits.
``(iv) The comparative analyses
demonstrating that the processes, strategies,
evidentiary standards, and other factors used
to apply the NQTLs to mental health or
substance use disorder benefits, as written and
in operation, are comparable to, and are
applied no more stringently than, the
processes, strategies, evidentiary standards,
and other factors used to apply the NQTLs to
medical benefits in the benefits
classification.
``(v) The specific findings and conclusions
reached by the MA organization with respect to
the MA plan, including any results of the
analyses described in this subparagraph that
indicate that the plan is or is not in
compliance with this subsection.
``(B) Submission to secretary upon request.--An MA
organization shall submit to the Secretary the
comparative analyses described in subparagraph (A) and
the information described in clauses (i) through (v) of
such subparagraph upon request by the Secretary. The
Secretary shall request not fewer than 20 such analyses
per year.
``(C) Report.--Not later than October 1, 2029, and
biennially thereafter, the Secretary shall submit to
Congress, and make publicly available, a report that
contains the following:
``(i) A summary of the comparative analyses
and information requested under subparagraph
(B).
``(ii) The Secretary's conclusions as to
whether each MA organization submitted
sufficient information for the Secretary to
review the comparative analyses and information
requested for compliance with this subsection.
``(iii) The Secretary's conclusions as to
whether each MA organization that submitted
sufficient information for the Secretary to
review was in compliance with this subsection.
``(4) Definitions.--In this subsection:
``(A) Classification of benefits.--The term
`classification of benefits' means the following:
``(i) Inpatient.--Benefits under part A.
``(ii) Outpatient.--Benefits furnished on
an outpatient basis under part B.
``(iii) Emergency care.--Benefits for
emergency care covered under part B.
``(iv) Part b prescription drugs.--Benefits
for drugs and biologicals covered under part B.
``(v) Covered part d drugs.--Benefits for
covered part D drugs as defined in section
1860D-2(e).
``(vi) Supplemental.--Supplemental health
care benefits as described in section
1852(a)(3).
``(B) Evidentiary standards.--The term `evidentiary
standard' means factors or evidence a plan considers in
designing and applying its medical management
techniques, such as generally accepted standards of
mental health and substance use disorder care,
recognized medical literature, professional standards
and protocols (including comparative effectiveness
studies and clinical trials), published research
studies, treatment guidelines created by professional
medical associations or other third-party entities,
publicly available or proprietary clinical definitions,
and outcome metrics from consulting or other
organizations.
``(C) Financial requirement.--The term `financial
requirement' includes deductibles, copayments,
coinsurance, and maximum limitations on out-of-pocket
expenses applicable under the plan.
``(D) Generally accepted standards of mental health
and substance use disorder care.--The term `generally
accepted standards of mental health and substance use
disorder care' means standards of care and clinical
practice that are generally recognized by health care
providers practicing in relevant clinical specialties
such as psychiatry, psychology, and addiction medicine
and counseling, to ensure appropriate diagnosis,
treatment, and ongoing management, for underlying
mental health and substance use disorders, including
co-occurring conditions, to adequately meet the needs
of patients. These standards are derived from valid,
evidence-based sources such as peer-reviewed scientific
studies and medical literature, consensus guidelines of
nonprofit health care provider professional
associations and specialty societies, including level
of care criteria and clinical practice guidelines, and
recommendations of Federal government agencies.
``(E) Mental health benefits.--The term `mental
health benefits' means benefits with respect to items
and services for mental health conditions as defined by
the Secretary.
``(F) Predominant.--A financial requirement or
treatment limit is considered to be predominant if it
is the most common or frequent of such type of limit or
requirement.
``(G) Substance use disorder benefits.--The term
`substance use disorder benefits' means benefits with
respect to items and services for substance use
disorders as defined by the Secretary.
``(H) Substantially all.--A financial requirement
or treatment limitation applies to substantially all
medical benefits in a classification if it applies to
at least two-thirds of the benefits in that
classification.
``(I) Treatment limitation.--
``(i) In general.--The term `treatment
limitation' means mechanisms to control
utilization of services and expenditures such
as limits on the frequency of treatment, number
of visits, days of coverage, or other similar
limits on the scope or duration of treatment.
Such term includes:
``(I) Quantitative treatment
limitations.--Quantitative treatment
limitations, including limits on the
frequency of treatment, number of
visits, days of coverage, or other
similar limits on the scope or duration
of treatment.
``(II) Nonquantitative treatment
limitations.--Nonquantitative treatment
limitations, including other limits on
the access, scope, or duration of
benefits for treatment under a plan or
coverage not described in subclause
(I), such as--
``(aa) medical management
standards limiting or excluding
benefits based on medical
necessity or medical
appropriateness, or based on
whether the treatment is
experimental or investigative;
``(bb) for plans with
multiple network tiers (such as
preferred providers and
participating providers),
network tier design;
``(cc) standards for
provider admission to
participate in a network,
including reimbursement rates;
``(dd) refusal to pay for
higher-cost therapies until it
can be shown that a lower-cost
therapy is not effective (also
known as fail-first policies or
step therapy protocols);
``(ee) exclusions based on
failure to complete a course of
treatment; and
``(ff) restrictions based
on geographic location,
facility type, provider
specialty, and other criteria
that limit the scope or
duration of benefits for
services provided under the
plan or coverage.
``(ii) Exclusions.--The term `treatment
limitation' does not include any exclusions
from coverage of items or services for which
payment is not made under part A or part B or
any statutory limitations on coverage
applicable under such parts.''.
(2) Enforcement.--Section 1857(g)(1) of the Social Security
Act (42 U.S.C. 1395w-27(g)(1)) is amended--
(A) in subparagraph (J), by striking ``or'' after
the semicolon;
(B) by redesignating subparagraph (K) as
subparagraph (L);
(C) by inserting after subparagraph (J), the
following new subparagraph:
``(K) fails to comply with mental health parity
requirements under section 1852(o) or applicable
implementing regulations or guidance; or'';
(D) in subparagraph (L), as redesignated by
subparagraph (B), by striking ``through (J)'' and
inserting ``through (K)''; and
(E) in the flush matter following subparagraph (L),
as so redesignated, by striking ``subparagraphs (A)
through (K)'' and inserting ``subparagraphs (A) through
(L)''.
(b) Prescription Drug Plans.--Section 1860D-4 of the Social
Security Act (42 U.S.C. 1395w-104) is amended by adding at the end the
following new subsection:
``(c) Parity in Mental Health and Substance Use Disorder
Benefits.--The provisions of section 1852(o) (relating to parity in
mental health and substance use disorder benefits) shall apply to PDP
sponsors offering prescription drug plans in the same manner in which
such provisions apply with respect to Medicare Advantage organizations
offering MA-PD plans.''.
(c) Regulations.--Not later than 18 months after the date of
enactment of this Act, the Secretary of Health and Human Services shall
issue regulations to carry out the amendments made by this section.
(d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning after the date that is 2
years after the date of enactment of this Act, regardless of whether
regulations have been issued to carry out such amendments by such
effective date.
(e) Implementation Funding.--For purposes of carrying out the
provisions of, including the amendments made by, this section, there
are appropriated, out of amounts in the Treasury not otherwise
appropriated, to the Centers for Medicare & Medicaid Services Program
Management Account, $10,000,000 for fiscal year 2024, which shall
remain available until expended.
SEC. 202. BEHAVIORAL HEALTH MEASURES AND INCENTIVIZING BEHAVIORAL
HEALTH CARE QUALITY.
Section 1853(o) of the Social Security Act (42 U.S.C. 1395w-23(o))
is amended by adding at the end the following new paragraph:
``(8) Behavioral health measures.--
``(A) In general.--For 2025 and biennially
thereafter, the Secretary shall consider adding to the
5-star rating system behavioral health measures that
measure the quality and outcomes of--
``(i) mental health or substance use
disorder services; and
``(ii) items and services not described in
clause (i) that are furnished to an individual
with a mental health or substance use disorder.
``(B) Considerations.--In considering the addition
of behavioral health measures under subparagraph (A),
the Secretary shall--
``(i) consider measures for which data can
be collected through encounter data or enrollee
survey data submitted by MA organizations;
``(ii) consider measures endorsed by a
consensus-based entity, as described in section
1890(a);
``(iii) consider measures that assess the
quality and health outcomes of items and
services described in subparagraph (A),
including contraindicated or low-value care,
furnished to individuals with a mental health
or substance use disorder;
``(iv) consider measures that assess access
to behavioral health treatment, including
measures of wait times, distance standards,
providers who are taking on new patients, and
the proportion of behavioral health providers
who have not submitted a claim for a mental
health or substance use disorder service during
the past six months;
``(v) consider measures that assess the
integration of behavioral health care and
primary care services;
``(vi) consider measures that align with
behavioral health measures--
``(I) used to assess performance in
part A or part B; or
``(II) identified as part of the
Core Set of Health Care Quality
Measures for Adults as described in
section 1139B; and
``(vii) consider measures that assess
patient experience of care.''.
SEC. 203. PROVIDING INFORMATION ON BEHAVIORAL HEALTH COVERAGE TO
PROMOTE INFORMED CHOICE.
Section 1851(d)(4) of the Social Security Act (42 U.S.C. 1395w-
21(d)(4)) is amended by adding at the end the following new
subparagraph:
``(F) Behavioral health information.--For 2025 and
subsequent plan years, to the extent available, the
following information with respect to the preceding
plan year:
``(i) Information on access to in-network
behavioral health providers, disaggregated by
those who prescribe and those who offer mental
health or substance use disorder services,
including--
``(I) the average wait time (as
defined by the Secretary) for an
appointment for a new patient with an
in-network provider for mental health
or substance disorder services;
``(II) the total number and
percentage of providers who have
participation agreements with the
organization who submitted at least one
request for payment for a mental health
or substance use disorder service
during a 6 month period (or other
period specified by the Secretary); and
``(III) the percentage of requests
for payment for mental health or
substance use disorder services that
were submitted by--
``(aa) in-network
providers; and
``(bb) out-of-network
providers.
``(ii) Information on the number of denials
of prior authorization requests or denials of
payment for mental health or substance use
disorder services compared to non-mental health
and substance use disorder services overall,
categorized by the type of denial and by the
type of service, as defined by the Secretary,
including--
``(I) the number and percent of
such denials by the number of days to
denial, the reason for denial, and the
utilization of decision support
technology, artificial intelligence
technology, machine-learning
technology, clinical decision-making
technology, or any other technology
specified by the Secretary; and
``(II) the number and percent of
such denials with respect to a mental
health or substance use disorder
service compared to such denials with
respect to items and services for a
similar physical health condition (such
as depression compared to diabetes) by
the number of days to denial, the
reason for denial, and the utilization
of decision support technology,
artificial intelligence technology,
machine-learning technology, clinical
decision-making technology, or any
other technology specified by the
Secretary.''.
SEC. 204. REQUIRING MA ORGANIZATIONS TO MAINTAIN ACCURATE AND UPDATED
PROVIDER DIRECTORIES.
(a) In General.--Section 1852(c) of the Social Security Act (42
U.S.C. 1395w-22(c)) is amended--
(1) in paragraph (1)(C)--
(A) by striking ``plan, and any'' and inserting
``plan, any''; and
(B) by inserting the following before the period:
``, and, in the case of a network-based MA plan (as
defined in paragraph (3)(C)), the information described
in paragraph (3)(A)(i)(II)''; and
(2) by adding at the end the following new paragraph:
``(3) Provider directory accuracy and transparency.--
``(A) In general.--For plan year 2025 and
subsequent plan years, each MA organization offering a
network-based MA plan shall do the following:
``(i) Maintain an accurate provider
directory.--
``(I) In general.--The MA
organization shall, for each network-
based MA plan offered by the
organization, maintain an accurate
provider directory--
``(aa) that includes the
information described in
subclause (II);
``(bb) which, not less
frequently than 90 days, the
organization verifies and, if
applicable, updates the
provider directory information
of each provider;
``(cc) that provides, if
the organization is unable to
verify such information with
respect to a provider, for the
inclusion along with the
information in the directory
with respect to such provider
of a notification indicating
that the information may not be
up to date;
``(dd) that provides for
the removal of a provider from
such directory within 2
business days if the
organization determines that
the provider is no longer a
participating provider; and
``(ee) that meets such
other requirements as the
Secretary may specify.
``(II) Information described.--The
information described in this subclause
is the National Provider Identifier,
name, address, specialty, telephone
number, Internet website if available,
availability (including whether the
provider is accepting new patients),
cultural and linguistic capabilities
(including the languages offered by the
provider or by a skilled medical
interpreter who provides interpretation
services for the provider), and other
information as determined appropriate
by the Secretary for each provider with
which such MA organization has an
agreement for furnishing items and
services covered under such plan.
``(ii) Submission of provider directory to
the secretary.--The MA organization shall
submit to the Secretary the provider directory
for each network-based MA plan offered by the
organization in a manner specified by the
Secretary.
``(B) Posting of provider directory information.--
For plan year 2026 and subsequent plan years, the
Secretary shall post the provider directory information
submitted under subparagraph (A)(ii), in a machine
readable file, on the internet website of the Centers
for Medicare & Medicaid Services.
``(C) Network-based ma plan defined.--In this
paragraph, the term `network-based MA plan' means an MA
plan that has a network of providers that have
agreements with the MA organization offering the plan
to furnish items and services covered under such
plan.''.
(b) Enforcement.--Section 1857(d) of the Social Security Act (42
U.S.C. 1395w-27(d)) is amended by adding at the end the following new
paragraph:
``(7) Audit of provider directories.--Each contract under
this section shall provide that the Secretary, or any person or
organization designated by the Secretary, shall have the right
to audit any provider directory under section 1852(c)(3)(A)(i)
to determine whether such directory meets the requirements of
such section.''.
(c) Funding.--In addition to amounts otherwise available, there is
appropriated to the Centers for Medicare & Medicaid Services Program
Management Account for fiscal year 2023, out of any amounts in the
Treasury not otherwise appropriated, $10,000,000, to remain available
until expended, for purposes of carrying out the amendments made by
this section.
TITLE III--MEDICAID AND CHIP
SEC. 301. ENHANCED PAYMENT UNDER MEDICAID FOR INTEGRATED MENTAL HEALTH
AND SUBSTANCE USE DISORDER CARE SERVICES.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended--
(1) in subsection (a)(3)--
(A) in subparagraph (D), by inserting ``and'' after
the semicolon;
(B) in subparagraph (F)(ii), by striking ``plus''
after the semicolon and inserting ``and''; and
(C) by inserting after subparagraph (F)(ii), the
following:
``(G) for calendar quarters beginning on or after
January 1, 2025, 100 percent of the amount determined
for such quarter under subsection (cc); and''; and
(2) by adding the end the following:
``(cc) Enhanced Payment for Integrated Mental Health and Substance
Use Disorder Care Services.--
``(1) In general.--For purposes of subsection (a)(3)(G), in
accordance with guidance issued not later than the date that is
180 days after the date of the enactment of this subsection by
the Secretary to States, the amount determined under this
subsection with respect to a State and calendar quarter is the
amount by which--
``(A) the aggregate amount expended by the State
during the calendar quarter for medical assistance
provided by a primary care practitioner (as defined in
section 1833(x)(2)(A)(i)) for integrated mental health
and substance use disorder care services described in
section 1848(b)(13)(B) and such other items and
services for the care of mental health and substance
use conditions furnished by, or in coordination with,
such primary care practitioner as the Secretary, in
consultation with the State, may specify; exceeds
``(B) the quarterly average of the aggregate
amounts expended by the State for medical assistance
described in subparagraph (A) during the applicable
base period for the calendar quarter involved.
``(2) Applicable base period defined.--
``(A) In general.--For purposes of paragraph (1),
the term `applicable base period' means, with respect
to a calendar quarter, the 5-year period that ends on
the most recent base period end date.
``(B) Base period end date defined.--For purposes
of subparagraph (A), the term `base period end date'
means--
``(i) December 31, 2024; and
``(ii) December 31 of every 5th year
following 2024.''.
SEC. 302. DEMONSTRATION PROJECT TO ENSURE MEDICAID-ENROLLED CHILDREN
HAVE ACCESS TO INTEGRATED MENTAL HEALTH AND SUBSTANCE USE
DISORDER CARE SERVICES, INCLUDING PREVENTION AND EARLY
INTERVENTION SERVICES.
(a) In General.--Not later than the date that is 180 days after the
date of the enactment of this section, the Secretary shall conduct a
54-month demonstration project for the purpose described in subsection
(b) under which the Secretary shall--
(1) for the first 18-month period of such project, award
planning grants described in subsection (c); and
(2) for the remaining 36-month period of such project,
provide to each State selected under subsection (d) payments in
accordance with subsection (e).
(b) Purpose.--The purpose described in this subsection is for each
State that receives a planning grant under subsection (c) to ensure
that every Medicaid-enrolled child in the State has access to
integrated mental health and substance use disorder care services,
including prevention and early intervention services, so as to allow
for the prevention, identification, and treatment of mental health and
substance use conditions in primary care, children's hospitals, early
care and education, schools, or other settings as appropriate (such as
home visiting and early intervention programs for young children,
foster care or other child welfare care settings, or workforce
development programs and community centers for youth) (in this section
collectively referred to as ``care settings''), through the following
activities:
(1) Activities that support an ongoing assessment of the
accessibility of integrated mental health and substance use
disorder care services, including prevention and early
intervention services, for Medicaid-enrolled children in the
State that tracks progress toward the goal of all Medicaid-
enrolled children (including infants and toddlers as well as
transition-aged youth) having access to appropriate levels of
services in care settings in which the children regularly
engage, and that is conducted in partnership with such children
and families, to ensure that the assessment reflects their
perspective, experiences, and solutions.
(2) Activities that, taking into account the results of the
assessment described in paragraph (1), support the development,
implementation, and maintenance of State infrastructure, such
as technology and the physical structures necessary to
physically co-locate integrated mental health and substance use
disorder care services, including prevention and early
intervention services, and a workforce to provide the types of
support, training, and technical assistance needed in order to
offer integrated mental health and substance use care services,
including prevention and early intervention services, in care
settings with which Medicaid-enrolled children and their
families regularly interact, which are selected for integration
based on the assessment of where such children and their
families can access such services, and for which furnishing
integrated mental health and substance use disorder care
services, including prevention and early intervention services,
will be sustainable under the State's planned activities.
(3) Increased reimbursement and improved incentives for
care settings to sustainably implement and provide (either
through direct delivery or coordination in the case of a care
setting that is an early care or education program)--
(A) developmentally appropriate mental health
promotive and preventive interventions for Medicaid-
enrolled children and their families, along with
screening to identify psycho-social needs of such
children who do not yet have a diagnosable mental
health condition (consistent with the requirements for
providing items and services described in section
1905(a)(4)(B) of the Social Security Act (42 U.S.C.
1396d(a)(4)(B))(relating to early and periodic
screening, diagnostic, and treatment services defined
in section 1905(r) of such Act (42 U.S.C. 1396d(r))) in
accordance with the requirements of section 1902(a)(43)
of such Act (42 U.S.C. 1396a(a)(43)) and the pediatric
preventive care standards included in the essential
health benefits required under section 1302(b) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18022(b)));
(B) evidence-based, person-centered, and
culturally, linguistically, and developmentally
appropriate interventions at the site of service,
either in-person or virtually integrated, to address
any identified family and child psycho-social needs,
including developmentally appropriate assessment and
diagnostic services, treatment, care coordination, and
dyadic intervention approaches; and
(C) referral to developmentally appropriate mental
health and substance use specialty care providers and
programs, community-based resources, or virtual or
digital services to address risk factors or meet
psycho- social needs that cannot be addressed in an
integrated setting.
(4) Improved regulatory oversight of policies governing the
provision of services described in paragraph (3), including
with respect to early and periodic screening, diagnostic, and
treatment services referred to in such paragraph, mental health
and substance use parity, network adequacy, essential health
benefits referred to in such paragraph, Medicaid rate setting,
scope of practice policies, and health professional shortage
areas.
(5) Improved alignment between Medicaid and commercial
health insurers to ensure that services described in paragraph
(3) are supported by commercial health insurers, such as
through the initiation of multi-payer collaboratives.
(6) Improved coordination among State and local agencies
and other stakeholders that fund or provide primary care,
children's hospitals, early care and education, or other
programs in care settings described in this subsection so as to
include efforts to align policies to promote coordination of
mental health and substance use services funded under such
programs across care settings, including through the alignment
of Medicaid with programs under the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 6301 et seq.), the Individuals
with Disabilities Education Act (20 U.S.C. 1400 et seq.), the
Family First Prevention Services Act (title VII of division E
of the Bipartisan Budget Act of 2018 (Public Law 115-123; 132
Stat. 232)), the Stephanie Tubbs Jones Child Welfare Services
Program under subpart 1 of part B of title IV of the Social
Security Act (42 U.S.C. 621 et seq.), the MaryLee Allen
Promoting Safe and Stable Families Program under subpart 2 of
part B of title IV of the Social Security Act (42 U.S.C. 629 et
seq.), home visiting programs, including the Maternal, Infant,
and Early Childhood Home Visiting Program (MIECHV) under
section 511 of the Social Security Act (42 U.S.C. 711), and
health, education, and social welfare programs funded under the
American Rescue Plan Act of 2021 (Public Law 117-2; 135 Stat.
4) and the Child Care Development Block Grant Act of 1990 (42
U.S.C. 9857 et seq.).
(7) Activities that include Medicaid-enrolled children and
their families and caregivers as partners at all levels of
decision-making, implementation, and evaluation, including
engaging such children who are youth and their families
directly as paraprofessional providers.
(c) Planning Grants.--
(1) In general.--For the first 18-month period of the
demonstration project, the Secretary shall award planning
grants to States that apply for such grants, including to
entities specified in subparagraphs (B) and (C) of subsection
(h)(7). A State awarded a planning grant under this subsection
shall use the grant to carry out the activities described in
paragraph (2) for purposes of preparing and submitting an
application to participate in the remaining 36-month period of
the demonstration project in accordance with subsection (d).
(2) Activities described.--Activities described in this
paragraph are, with respect to a State awarded a planning grant
under this subsection, each of the following:
(A) Activities that support the development of an
initial assessment of the access needs of Medicaid-
enrolled children in the State with respect to mental
health and substance use services, to determine the
types of support, training, incentives, and technical
assistance that primary care, early care and education,
or other programs provided in care settings described
in subsection (b) and with which Medicaid-enrolled
children and their families regularly engage need in
order to offer integrated mental health and substance
use disorder care services, including prevention and
early intervention services, and which shall include
engaging Medicaid-enrolled children and their families
directly to ensure that the assessment builds toward
solutions that meet their needs and reflect their
perspectives, experiences, and solutions.
(B) Activities that, taking into account the
results of the assessment described in subparagraph
(A), support the development of State infrastructure,
such as technology and the physical structures
necessary to physically co-locate integrated mental
health and substance use disorder care services,
including prevention and early intervention services,
to provide the types of support, training, incentives,
and technical assistance that primary care, early care
and education, or other programs provided in care
settings described in subsection (b) and with which
Medicaid-enrolled children and their families regularly
engage need in order to offer integrated mental health
and substance use disorder care services, including
prevention and early intervention services, to
Medicaid-enrolled children, as well as activities that
support ongoing engagement of Medicaid-enrolled
children and their families in implementation and
coordination with health insurers and with other child-
serving agencies and stakeholders.
(3) Funding.--For purposes of awarding planning grants
under paragraph (1), there is appropriated, out of any funds in
the Treasury not otherwise appropriated, $100,000,000, to
remain available until expended.
(d) Post-Planning States.--
(1) In general.--For the remaining 36-month period of the
demonstration project, the Secretary shall make payments in
accordance with subsection (e) to all States that submit
applications that meet the requirements of paragraph (2) and
carry out the activities described in that paragraph.
(2) Applications; activities.--
(A) In general.--A State seeking to be selected to
participate in the remaining 36-month period of the
demonstration project shall submit to the Secretary, at
such time and in such form and manner as the Secretary
requires, an application that includes such
information, provisions, and assurances, as the
Secretary may require, in addition to the following:
(i) A process for carrying out the ongoing
assessment described in subsection (b)(1),
taking into account the results of the initial
assessment described in subsection (c)(2)(A).
(ii) A review of Medicaid reimbursement
methodologies and other policies related to
furnishing integrated mental health and
substance use disorder care services, including
prevention and early intervention services, to
Medicaid-enrolled children that may create
barriers to access. If the State uses multiple
reimbursement methodologies under Medicaid for
mental health and substance use care (such as
capitation, fee-for-service, value-based, and
alternative payment programs), the State shall
include in the application specific detailed
information regarding how the State will verify
that the combination of reimbursement
methodologies employed by the State will result
in improved access to integrated mental health
and substance use disorder care services,
including prevention and early intervention
services, for Medicaid-enrolled children.
(iii) The development of a plan, taking
into account activities carried out under
subsection (c)(2)(B), that will result in long-
term and sustainable access to integrated
mental health and substance use disorder care
services, including prevention and early
intervention services, for Medicaid-enrolled
children which includes the following:
(I) Specific activities to increase
access to integrated mental health and
substance use disorder care services,
including prevention and early
intervention services, so as to allow
for the prevention, identification, and
treatment of mental health and
substance use conditions in primary
care, early care and education, or
other programs provided in care
settings described in subsection (b)
and with which Medicaid-enrolled
children and their families regularly
engage.
(II) Strategies that will
incentivize a racially and culturally
diverse array of providers (including
paraprofessionals) to obtain the
necessary training, education, and
support to deliver integrated care for
the developmentally appropriate
prevention, identification, assessment,
diagnosis, and treatment of mental
health and substance use conditions in
Medicaid-enrolled children in primary
care, early care and education, or
other programs provided in care
settings described in subsection (b)
and with which Medicaid-enrolled
children and their families regularly
engage.
(III) Milestones and timeliness for
implementing activities set forth in
the plan, as determined by the
Secretary.
(IV) Specific measurable targets
for increasing equitable access to
integrated mental health and substance
use disorder care services, including
prevention and early intervention
services, for Medicaid-enrolled
children.
(V) Specific measurable targets for
increasing the workforce providing
integrated mental health and substance
use disorder care services, including
prevention and early intervention
services.
(iv) A process for reporting the
information required under subsection (f)(1),
including information to assess the
effectiveness of the efforts of the State
during the period of the demonstration project
under this subsection and ensure the
sustainability of such efforts after the
conclusion of the demonstration project.
(v) The expected financial impact of the
demonstration project on the State.
(vi) A description of funding sources
available to the State to expand access to
integrated mental health and substance use
disorder care services, including prevention
and early intervention services in the State,
including health care, public health,
education, and social service funding
opportunities.
(vii) A preliminary plan for how the State
will sustain access to integrated mental health
and substance use disorder care services,
including prevention and early intervention
services, for Medicaid-enrolled children after
the demonstration project, including
maintenance of incentives and enhanced
reimbursement rates.
(viii) A description of how the State will
coordinate the goals of the demonstration
project with any waiver granted (or submitted
by the State and pending) pursuant to section
1115 of the Social Security Act (42 U.S.C.
1315) for the delivery of mental health and
substance use services under Medicaid, as
applicable, and with State plans under the
Elementary and Secondary Education Act of 1965
(20 U.S.C. 6301 et seq.), the Individuals with
Disabilities Education Act (20 U.S.C. 1400 et
seq.), the Family First Prevention Services Act
(title VII of division E of the Bipartisan
Budget Act of 2018 (Public Law 115-123; 132
Stat. 232)), the Stephanie Tubbs Jones Child
Welfare Services Program under subpart 1 of
part B of title IV of the Social Security Act
(42 U.S.C. 621 et seq.), the MaryLee Allen
Promoting Safe and Stable Families Program
under subpart 2 of part B of title IV of the
Social Security Act (42 U.S.C. 629 et seq.),
home visiting programs, including the Maternal,
Infant, and Early Childhood Home Visiting
Program (MIECHV) under section 511 of the
Social Security Act (42 U.S.C. 711), and
health, education, and social welfare programs
funded under the American Rescue Plan Act of
2021 (Public Law 117-2; 135 Stat. 4) and the
Child Care Development Block Grant Act of 1990
(42 U.S.C. 9857 et seq.).
(B) Consultation.--In completing an application
under subparagraph (A), a State shall consult with
relevant stakeholders, including Medicaid managed care
plans, primary and specialty health care provider
organizations, Medicaid-enrolled children and their
families, and other child-serving State and local
agencies and stakeholders, and include in the
application a description of such consultation.
(C) Technical assistance.--The Secretary shall
provide technical assistance to States with respect to
preparing and submitting an application that meets the
requirements of subparagraphs (A) and (B).
(e) Payments.--
(1) In general.--For each quarter occurring during the
remaining 36-month period of the demonstration project, the
Secretary shall pay each State that submits an application that
meets the requirements of subsection (d) (2) and carries out
the activities described in that subsection, an amount equal to
80 percent of the qualified sums expended by the State for such
quarter.
(2) Qualified sums defined.--For purposes of paragraph (1),
the term ``qualified sums'' means, with respect to a State and
a quarter, the amount equal to the amount (if any) by which--
(A) the sums expended by the State during such
quarter that are attributable to--
(i) furnishing integrated mental health and
substance use disorder care services, including
prevention and early intervention services, to
Medicaid-enrolled children;
(ii) the development or enabling of State
infrastructure, such as technology and the
physical structures necessary to physically co-
locate integrated mental health and substance
use disorder care services, including
prevention and early intervention services,
delivered in or coordinated through primary
care, early care and education, or other
programs provided in care settings described in
subsection (b) and with which Medicaid-enrolled
children and their families regularly engage;
and
(iii) the development of a workforce to
provide the types of support, training, and
technical assistance needed in order to offer
integrated mental health and substance use care
services, including prevention and early
intervention services, in primary care, early
care and education, or other programs provided
in care settings described in subsection (b)
and with which Medicaid-enrolled children and
their families regularly engage; exceeds
(B) \1/4\ of the average annual amount expended by
the State for the most recent 5-fiscal year period for
medical assistance for mental health or substance use
disorder care services for Medicaid-enrolled children
in a primary care, children's hospitals, school, early
care and education, or other developmentally
appropriate care setting, as determined by the
Secretary.
(3) Non-duplication of payment.--No payment made under this
subsection with respect to medical assistance furnished to a
Medicaid-enrolled child shall be duplicative of any payment
made to a provider participating under the State Medicaid
program for the same services so furnished to the same child.
(f) Reports.--
(1) State reports.--Each State that receives payments under
subsection (e) during the remaining 36-month period of the
demonstration project shall submit to the Secretary, in
accordance with detailed, specific guidance that is issued by
the Secretary not later than the first day of such period, and
that includes information on how to estimate and reconcile
State expenditures to carry out the demonstration project
during such period, quarterly reports, with respect to
expenditures for which payment is made to the State under
subsection (e), on the following:
(A) The specific activities with respect to which
payment under such subsection was provided.
(B) The number of primary care, children's
hospitals, schools, and early care and education
programs that delivered or coordinated integrated
mental health and substance use disorder care services,
including prevention and early intervention services,
to Medicaid-enrolled children during such period and
their geographic distribution, compared to the
estimated number that would have otherwise delivered
such services in the absence of the demonstration
project, including disaggregated data on the race,
ethnicity, and gender of providers.
(C) The number of Medicaid-enrolled children who
received integrated mental health and substance use
disorder care services, including prevention and early
intervention services during such period compared to
the estimated number of such children who would have
otherwise received such services in the absence of the
demonstration project, including disaggregated data on
the race, ethnicity, gender, age (ensuring that
children birth to 5 as well as transition-aged youth
are adequately served), sexual orientation, primary
language, income, and disability status of the
children.
(D) Such other data or information as determined by
the Secretary.
(2) CMS reports.--
(A) Initial report.--Not later than October 1,
2026, the Administrator of the Centers for Medicare &
Medicaid Services shall, in consultation with the
Director of the Agency for Healthcare Research and
Quality and the Assistant Secretary for Mental Health
and Substance Use, submit to Congress an initial report
on the activities carried out by States under the
planning grants made under subsection (c), and actions
taken by the Administrator of the Centers for Medicare
& Medicaid Services to improve oversight of such
activities.
(B) Interim report.--Not later than October 1,
2028, the Administrator of the Centers for Medicare &
Medicaid Services shall, in consultation with the
Director of the Agency for Healthcare Research and
Quality and the Assistant Secretary for Mental Health
and Substance Use, submit to Congress an interim report
on activities carried out under the demonstration
project and actions taken by the Administrator of the
Centers for Medicare & Medicaid Services to improve
oversight of such activities and the extent to which
States have achieved the stated goals submitted in
their applications. Such report shall include a
description of the strengths and limitations of the
demonstration project and a plan for the sustainability
of the project.
(C) Final report.--Not later than October 1, 2030,
the Administrator of the Centers for Medicare &
Medicaid Services shall, in consultation with the
Director of the Agency for Healthcare Research and
Quality and the Assistant Secretary for Mental Health
and Substance Use, submit to Congress a final report
providing updates on the matters reported in the
interim report required by subparagraph (B) and that
includes--
(i) a description of any changes made with
respect to the demonstration project after the
submission of such interim report; and
(ii) an evaluation of the demonstration
project.
(g) Implementation Funding.--There is appropriated, out of any
funds in the Treasury not otherwise appropriated, $5,000,000 to the
Administrator of the Centers for Medicare & Medicaid Services for
purposes of implementing this section, to remain available until
expended.
(h) Definitions.--In this section:
(1) Children's hospitals.--The term ``children's
hospitals'' has the meaning given that term in section
340E(g)(2) of the Public Health Service Act (42 U.S.C.
256e(g)(2).
(2) Integrated mental health and substance use disorder
care services.--The term ``mental health and substance use
disorder care services'' has the meaning given that term in
section 1848(b)(13)(B) of the Social Security Act and includes
prevention and early intervention services and such other items
and services for the care of mental health and substance use
conditions furnished by, or in coordination with, a primary
care practitioner as the Secretary, in consultation with a
State, may specify.
(3) Medicaid.--The term ``Medicaid'' means the program for
grants to States for medical assistance programs established
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.).
(4) Secretary.--Except as otherwise specified, the term
``Secretary'' means the Secretary of Health and Human Services.
(5) State.--The term ``State'' has the meaning given that
term in section 1101(a)(1) of the Social Security Act (42
U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI of such
Act, and for purposes of
(6) Medicaid-enrolled child.--The term ``Medicaid-enrolled
child'' means, with respect to a State, a child enrolled under
the State plan approved under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.) or under a waiver of such plan.
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(8) State.--The term ``State'' means--
(A) each of the 50 States and the District of
Columbia;
(B) the Commonwealth of Puerto Rico, the United
States Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands; and
(C) to the extent the Secretary determines
appropriate, may include an Indian Tribe, Tribal
organization, or Urban Indian organization (as such
terms are defined in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603)).
SEC. 303. UNIFORM APPLICABILITY TO MEDICAID OF REQUIREMENTS FOR PARITY
IN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS.
(a) Fee-for-Service and Alternative Benefit Plans.--Section 1902 of
the Social Security Act (42 U.S.C. 1396a) is amended--
(1) in subsection (a)--
(A) by striking ``and'' at the end of paragraph
(86);
(B) by striking the period at the end of paragraph
(87) and inserting ``; and''; and
(C) by inserting after paragraph (87) the following
new paragraph:
``(88) provide for ensuring that the requirements for
parity in mental health and substance use disorder benefits
under subsection (uu) are complied with regardless of the
payment model or arrangement under which medical assistance is
provided, including when medical assistance under the State
plan or under a waiver of such plan is provided through an
alternative benefit plan under section 1937.''; and
(2) by adding at the end the following new subsection:
``(uu) Parity in Mental Health and Substance Use Disorder
Benefits.--For purposes of subsection (a)(88), the requirements under
this subsection are the following:
``(1) In general.--Regardless of whether a State plan or
waiver of pays for medical assistance on a fee-for-service
basis, capitated payment basis, through the use of 1 or more
alternative payment models, or any combination thereof, the
State shall ensure that the financial requirements and
treatment limitations applicable to coverage of mental health
or substance use disorder services provided under such plan or
under a waiver of such plan comply with the requirements of
section 2726(a) of the Public Health Service Act in the same
manner as such requirements or limitations apply to a group
health plan under such section.
``(2) Deemed compliance.--Coverage with respect to an
individual described in section 1905(a)(4)(B) and covered under
the State plan or waiver under section 1902(a)(10)(A) of the
services described in section 1905(a)(4)(B) (relating to early
and periodic screening, diagnostic, and treatment services
defined in section 1905(r)) and provided in accordance with
section 1902(a)(43), shall be deemed to satisfy the
requirements of paragraph (1).''.
(b) Managed Care Organizations and Payment Arrangements.--
(1) In general.--Section 1932(b)(8) of the Social Security
Act (42 U.S.C. 1396u-2(b)(8)) is amended to read as follows:
``(8) Compliance with certain maternity, parity in mental
health or substance use disorder benefits, and other coverage
requirements.--
``(A) In general.--Each medicaid managed care
organization shall comply with the requirements of
subpart 2 of part A of title XXVII of the Public Health
Service Act insofar as such requirements apply and are
effective with respect to a health insurance issuer
that offers group health insurance coverage.
``(B) Parity in mental health or substance use
disorder benefits.--The financial requirements and
treatment limitations applicable to coverage of mental
health or substance use disorder services provided
under the State plan or under a waiver of such plan
through a medicaid managed care organization, a prepaid
inpatient health plan (as defined by the Secretary), a
prepaid ambulatory health plan (as defined by the
Secretary), or a primary care case manager under
section 1905 (consistent with section 1905(t)(2)),
shall comply with the requirements of section 2726(a)
of the Public Health Service Act in the same manner as
such requirements or limitations apply to a group
health plan under such section.
``(C) Deemed compliance.--In applying subparagraphs
(A) and (B) with respect to requirements under
paragraph (8) of section 2726(a) of the Public Health
Service Act, a medicaid managed care organization, a
prepaid inpatient health plan (as defined by the
Secretary), a prepaid ambulatory health plan (as
defined by the Secretary), or a primary care case
manager under section 1905 (consistent with section
1905(t)(2)) shall be treated as in compliance with such
requirements if the medicaid managed care organization,
prepaid inpatient health plan, prepaid ambulatory
health plan, or primary care case manager under section
1905 is in compliance with subpart K of part 438 of
title 42, Code of Federal Regulations, and section
438.3(n) of such title, or any successor regulation.''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by subsections (a) and (b) shall take effect on
the first day of the first calendar quarter that begins on or
after the date that is 3 years after the date of enactment of
this Act.
(2) Delay if state legislation needed.--In the case of a
State plan for medical assistance 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 subsection (a), the State plan shall not be
regarded as failing to comply with the requirements of such
title solely on the basis of its failure to meet these
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
the 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.
(d) Funding.--Out of any funds in the Treasury not otherwise
appropriated, there is appropriated to the Secretary of Health and
Human Services for purposes of carrying out this section and the
amendments made by this section, $10,000,000 for fiscal year 2024, to
remain available until expended.
SEC. 304. REQUIRING ADDITIONAL TRANSPARENCY ON ACCESS TO MENTAL HEALTH
AND SUBSTANCE USE DISORDER BENEFITS THROUGH MANAGED CARE.
(a) Biannual Assessment.--Section 1932(b) of the Social Security
Act (42 U.S.C. 1396u-2(b)) is amended by adding at the end the
following new paragraph:
``(9) Transparency on access to mental health and substance
use disorder benefits.--
``(A) In general.--Each managed care organization,
prepaid inpatient health plan (as defined by the
Secretary), and prepaid ambulatory health plan (as
defined by the Secretary), with a contract with a State
to enroll individuals who are eligible for medical
assistance under the State plan under this title or
under a waiver of such plan and to provide coverage
under the contract for mental health services or
substance use disorder services, disaggregated,
biannually shall assess and report to the State, in
such manner that the report is publicly available on a
website, the following:
``(i) The average wait times during the
reporting period by level of acuity and site of
care for adult and child patients for a new
patient visit in an outpatient setting
(including intensive outpatient, eating
disorder, residential treatments, or other
appointments as the Secretary specifies) from a
provider of mental health services or substance
use disorder services.
``(ii) The total number and average
percentage of network providers that provide
mental health services or substance use
disorder services and are accepting as new
patients individuals who are enrollees of such
organization or plan at any point during the
reporting period.
``(iii) The proportion of mental health
services or substance use disorder services and
prescription drugs during the reporting period
that are denied payment under the State plan
under this title or a waiver on the basis of
prior authorization or medical necessity (or
for any other reason that is not based on an
enrollee's eligibility for medical assistance
under the State plan under this title or a
waiver) in comparison to medical and surgical
services and prescription drugs that are denied
payment on the same bases during the reporting
period.
``(iv) The total number and percentage of
providers during the reporting period who have
participation agreements with the organization
who submitted at least 1 request for payment
for a mental health or substance use disorder
service.
``(B) Submission to secretary.--A State shall
submit information reported to the State under
subparagraph (A), including stratifying reporting by
race, ethnicity, disability, primary language, age,
sexual orientation, and gender identity, to help
identify health inequities where applicable, to the
Secretary in such form and manner as the Secretary
shall specify.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date that is 2 years after the date of enactment of
this section.
SEC. 305. AUTHORITY TO DEFER OR DISALLOW A PORTION OF FEDERAL FINANCIAL
PARTICIPATION FOR FAILURE TO COMPLY WITH MANAGED CARE
REQUIREMENTS.
(a) State Plan Amendment.--Section 1902(a) of the Social Security
Act (42 U.S.C. 1396a(a)), as amended by section 303(a)(1), is amended--
(1) in paragraph (87), by striking ``and'' after the
semicolon;
(2) in paragraph (88)(D), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (88)(D), the following new
paragraph:
``(89) in the case of a State that adopts the option to use
managed care as described in section 1932, provide that the
State shall comply with the requirements of section 1932.''.
(b) Application to Managed Care Contracts.--Section 1903(m)(2) of
the Social Security Act (42 U.S.C. 1396b(m)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i), by striking ``and (G)'' and inserting ``(G), and (I)'';
and
(2) by adding at the end the following new subparagraph:
``(I) For a violation of any requirement described in subparagraph
(A), including a violation of the requirements of section 1932, as
applicable under clause (xii) of such subparagraph and paragraph (89)
of section 1902(a), rather than disallowing the full amount of a
payment under this title to a State for expenditures incurred by the
State as described in subparagraph (A), the Secretary may defer or
disallow a portion of a payment to the State. In determining the amount
deferred or disallowed under this subparagraph, the Secretary may
consider factors such as the degree, duration, and recurrence of
noncompliance. A State may receive a reconsideration of a decision by
the Secretary under this subparagraph to disallow payment in the manner
described in section 1116(e).''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date that is 2 years after the date of enactment of this
section and shall apply to contracts for rating periods beginning on or
after such date.
SEC. 306. MEDICAID AND CHIP AUDITS.
(a) Regular Audits.--Beginning with fiscal year 2025, the Secretary
of Health and Human Services (referred to in this section as the
``Secretary'') shall audit State Medicaid programs and State Children's
Health Insurance Programs for purposes of assessing State enforcement
of the requirements relating to parity in mental health and substance
use disorder benefits (including with respect to compliance with such
parity requirements in the case of any mental health or substance use
disorder benefits that are separately managed or financed under a
``carve-out'' model) applicable under subsections (a)(88) and (uu) of
section 1902 of the Social Security Act (42 U.S.C. 1396a) (as added by
section 303(a), section 1932(b)(8) of such Act (42 U.S.C. 1396u-
2(b)(8)), section 1937(b)(6) of such Act (42 U.S.C. 1396u-7(b)(6)), and
section 2103(c)(7) of such Act (42 U.S.C. 1397cc(c)(7)), and related
regulations.
(b) Rotational Procedure; Publication.--The Secretary may carry out
the audits required by subsection (a) using a rotational approach among
States over a 3-year period, and shall make the results of such audits
publicly available on a searchable website.
(c) Publication of Enforcement Actions.--The Secretary shall
publish (and update on at least an annual basis) on a public website of
the Department of Health and Human Services a report that specifies the
actions taken by the Secretary to enforce violations of the mental
health and substance use disorder parity requirements under the
Medicaid and CHIP programs described in subsection (a). The Secretary
may publish such information separately or include the information in
the 1 or more published audit reports required by subsection (b) that
correspond to each such violation.
(d) Funding.--Out of any funds in the Treasury not otherwise
appropriated, there is appropriated to the Secretary of Health and
Human Services for each fiscal year beginning with fiscal year 2025,
$5,000,000 to carry out this section.
TITLE IV--OTHER PROVISIONS
SEC. 401. ENSURING MULTI-PAYER ALIGNMENT ON PAYMENT AND MEASUREMENT OF
QUALITY OF CARE AND HEALTH OUTCOMES RELATED TO INTEGRATED
MENTAL HEALTH AND SUBSTANCE USE DISORDER CARE.
Not later than April 1, 2024, the Administrator of the Centers for
Medicare & Medicaid Services shall convene an advisory working group
that includes representatives of issuers of group and individual health
insurance coverage, mental health and substance use disorder programs
and advocacy organizations, individuals and families receiving
integrated care services, and State Medicaid Directors, for purposes of
making recommendations for administrative and legislative changes to
facilitate multi-payer alignment on payment and measurement of quality
of care and health outcomes with respect to advancing the provision of
integrated mental health and substance use disorder care in a manner
that does not violate antitrust or other applicable laws. The
recommendations of the working group shall include recommendations for
measurable, ongoing benchmarks to assess the extent to which payment
and measurement of the quality of care and health outcomes are aligned
across health care payers.
SEC. 402. MEASURING ACCESS AND QUALITY OUTCOMES IN MENTAL HEALTH AND
SUBSTANCE USE DISORDER CARE.
(a) In General.--Not later than October 1, 2024, the Administrator
of the Centers for Medicare & Medicaid Services shall, in consultation
with the Administrator of the Health Resource Services Administration,
the Director of the Agency for Healthcare Research and Quality, and the
Assistant Secretary for Mental Health and Substance Use, develop and
implement a plan to improve measurement of the extent to which children
and adults have access to integrated mental health and substance use
disorder care in primary care and the quality and effectiveness of the
care provided, which shall be implemented in quality measurement
programs under the Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title
XIX of such Act (42 U.S.C. 1396 et seq.), and group health plans and
health insurance coverage (as such terms are defined in section 2791 of
the Public Health Service Act (42 U.S.C. 300gg-91)).
(b) Measure Development.--The Director of the Agency for Healthcare
Research and Quality shall conduct measure development where necessary
to ensure that the plan developed under subsection (a) may be fully
implemented, including measures of patient experience outcomes,
structural measures of practice transformation toward evidence-based
integrated care, and measures of access and unmet need provided by
local, State, or Federal agencies.
SEC. 403. REVIEWING THE EVIDENCE FOR INTEGRATED MENTAL HEALTH CARE FOR
CHILDREN.
Not later than October 1, 2024, the Director of the Agency for
Healthcare Research and Quality shall review the evidence, for
consideration by the United States Preventive Services Task Force, for
interventions for children who are at risk of developing a mental
health condition to prevent internalizing and externalizing mental
health problems, and for screening to identify family and child
psychosocial needs, segmented by developmental stage as appropriate.
SEC. 404. ENHANCING OVERSIGHT OF INTEGRATED MENTAL HEALTH AND SUBSTANCE
USE DISORDER CARE.
(a) In General.--Not later than October 1, 2024, the Administrator
of the Centers for Medicare & Medicaid Services shall, in consultation
with the Director of the Agency for Healthcare Research and Quality and
the Assistant Secretary for Mental Health and Substance Use, develop
and implement a plan to improve oversight and enforcement of
requirements relating to the provision of integrated mental health and
substance use disorder care under the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid
program under title XIX of such Act (42 U.S.C. 1396 et seq.), and group
health plans and health insurance coverage (as such terms are defined
in section 2791 of the Public Health Service Act (42 U.S.C. 300gg-91)),
including requirements relating to--
(1) coverage of preventive health services without cost-
sharing under section 2713 of the Public Health Service Act (42
U.S.C. 300gg-13);
(2) early and periodic screening, diagnosis, and treatment
for mental health and substance use disorders;
(3) mental health and substance use parity;
(4) network adequacy, including quantitative measures of
network access that take into account integration in primary
care and schools, racial equity, and virtual care;
(5) essential health benefits (as defined in section
1302(b) of the Patient Protection and Affordable Care Act (42
U.S.C. 18022(b))); and
(6) Medicaid rate setting.
(b) Patient Input.--In developing and implementing the plan under
subsection (a), the Administrator shall seek input from patients with
mental health and substance use conditions.
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