Us Congress 2023-2024 Regular Session

Us Congress Senate Bill SB2993 Compare Versions

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Old	New	Differences
1	1	II
2	2	118THCONGRESS
3	3	1
4	4	STSESSION S. 2993
5	5	To amend the Social Security Act and the Public Health Service Act to
6	6	permanently authorize certified community behavioral health clinics, and
7	7	for other purposes.
8	8	IN THE SENATE OF THE UNITED STATES
9	9	SEPTEMBER28 (legislative day, SEPTEMBER22), 2023
10	10	Ms. S
11	11	TABENOW(for herself and Mr. CORNYN) introduced the following bill;
12	12	which was read twice and referred to the Committee on Finance
13	13	A BILL
14	14	To amend the Social Security Act and the Public Health
15	15	Service Act to permanently authorize certified community
16	16	behavioral health clinics, and for other purposes.
17	17	Be it enacted by the Senate and House of Representa-1
18	18	tives of the United States of America in Congress assembled, 2
19	19	SECTION 1. SHORT TITLE. 3
20	20	(a) S
21	21	HORTTITLE.—This Act may be cited as the 4
22	22	‘‘Ensuring Excellence in Mental Health Act’’. 5
23	23	(b) T
24	24	ABLE OFCONTENTS.—The table of contents for 6
25	25	this Act is as follows: 7
26	26	Sec. 1. Short title.
27	27	TITLE I—ENSURING PERMANENCY FOR CERTIFIED COMMUNITY
28	28	BEHAVIORAL HEALTH CLINICS IN THE MEDICAID PROGRAM
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31	31	•S 2993 IS
32	32	Sec. 101. Establishing Certified Community Behavioral Health Clinic Services
33	33	as a Medicaid State Plan Option.
34	34	Sec. 102. Establishing a Medicaid Prospective Payment System for Certified
35	35	Community Behavioral Health Clinics.
36	36	TITLE II—COVERAGE OF CERTIFIED COMMUNITY BEHAVIORAL
37	37	HEALTH CLINIC SERVICES UNDER THE MEDICARE PROGRAM
38	38	Sec. 201. Coverage of certified community behavioral health clinic services
39	39	under the Medicare program.
40	40	TITLE III—COMMUNITY BEHAVIORAL HEALTH CLINIC GRANTS
41	41	Sec. 301. Operating grants for community behavioral health clinics.
42	42	TITLE I—ENSURING PERMA-1
43	43	NENCY FOR CERTIFIED COM-2
44	44	MUNITY BEHAVIORAL 3
45	45	HEALTH CLINICS IN THE 4
46	46	MEDICAID PROGRAM 5
47	47	SEC. 101. ESTABLISHING CERTIFIED COMMUNITY BEHAV-6
48	48	IORAL HEALTH CLINIC SERVICES AS A MED-7
49	49	ICAID STATE PLAN OPTION. 8
50	50	(a) I
51	51	NGENERAL.—Section 1905 of the Social Secu-9
52	52	rity Act (42 U.S.C. 1396d) is amended— 10
53	53	(1) in subsection (a)— 11
54	54	(A) in paragraph (30), by striking ‘‘; and’’ 12
55	55	and inserting a semicolon; 13
56	56	(B) by redesignating paragraph (31) as 14
57	57	paragraph (32); and 15
58	58	(C) by inserting after paragraph (30) the 16
59	59	following new paragraph: 17
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62	62	•S 2993 IS
63	63	‘‘(31) certified community behavioral health 1
64	64	clinic services, as defined in subsection (jj); and’’; 2
65	65	and 3
66	66	(2) by adding at the end the following new sub-4
67	67	section: 5
68	68	‘‘(jj) C
69	69	ERTIFIEDCOMMUNITYBEHAVIORALHEALTH 6
70	70	C
71	71	LINICSERVICES.— 7
72	72	‘‘(1) I
73	73	N GENERAL.—The term ‘certified commu-8
74	74	nity behavioral health services’ means any of the fol-9
75	75	lowing when furnished to an individual as a patient 10
76	76	of a certified community behavioral health clinic (as 11
77	77	defined in paragraph (2)), in a manner reflecting 12
78	78	person-centered care and which, if not available di-13
79	79	rectly through a certified community behavioral 14
80	80	health clinic, may be provided or referred through 15
81	81	formal relationships with other providers: 16
82	82	‘‘(A) Crisis mental health services, includ-17
83	83	ing 24-hour mobile crisis teams, emergency cri-18
84	84	sis intervention services, and crisis stabilization. 19
85	85	‘‘(B) Screening, assessment, and diagnosis, 20
86	86	including risk assessment. 21
87	87	‘‘(C) Patient-centered treatment planning 22
88	88	or similar processes, including risk assessment 23
89	89	and crisis planning. 24
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93	93	‘‘(D) Outpatient mental health and sub-1
94	94	stance use services. 2
95	95	‘‘(E) Outpatient clinic primary care screen-3
96	96	ing and monitoring of key health indicators and 4
97	97	health risk. 5
98	98	‘‘(F) Targeted case management. 6
99	99	‘‘(G) Psychiatric rehabilitation services. 7
100	100	‘‘(H) Peer support and counselor services 8
101	101	and family supports. 9
102	102	‘‘(I) Intensive, community-based mental 10
103	103	health care for members of the armed forces 11
104	104	and veterans, particularly those members and 12
105	105	veterans located in rural areas, provided the 13
106	106	care is consistent with minimum clinical mental 14
107	107	health guidelines promulgated by the Veterans 15
108	108	Health Administration, including clinical guide-16
109	109	lines contained in the Uniform Mental Health 17
110	110	Services Handbook of such Administration. 18
111	111	‘‘(2) C
112	112	ERTIFIED COMMUNITY BEHAVIORAL 19
113	113	HEALTH CLINIC.—The term ‘certified community be-20
114	114	havioral health clinic’ means an organization that— 21
115	115	‘‘(A) is engaged in furnishing to patients 22
116	116	all of the services described in paragraph (1); 23
117	117	‘‘(B) is legally authorized to furnish such 24
118	118	services under State law; 25
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122	122	‘‘(C) agrees, as a condition of the certifi-1
123	123	cation described in subparagraph (D), to fur-2
124	124	nish to the State or Secretary any data re-3
125	125	quired as part of ongoing monitoring of the or-4
126	126	ganization’s provision of services, including any 5
127	127	such data as the State, by agreement with the 6
128	128	Secretary, shall access via the system described 7
129	129	in section 340J–4 of the Public Health Service 8
130	130	Act; and 9
131	131	‘‘(D) has been certified by a State— 10
132	132	‘‘(i) as meeting the criteria established 11
133	133	by the Secretary pursuant to subsection 12
134	134	(a) of section 223 of the Protecting Access 13
135	135	to Medicare Act and is carrying out a dem-14
136	136	onstration program under this title under 15
137	137	subsection (d) of such section; or 16
138	138	‘‘(ii) for purposes of services furnished 17
139	139	on or after January 1, 2024, subject to 18
140	140	paragraph (3), as meeting the criteria es-19
141	141	tablished under section 340J–1(a) of the 20
142	142	Public Health Service Act, and as being el-21
143	143	igible to furnish medical assistance under 22
144	144	the State plan under this title (or under a 23
145	145	waiver of such plan) for certified commu-24
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148	148	•S 2993 IS
149	149	nity behavioral health services described in 1
150	150	paragraph (1). 2
151	151	‘‘(3) A
152	152	CCREDITATION.—In the case of services 3
153	153	furnished on or after January 1, 2024, at State op-4
154	154	tion, a State may determine that an organization 5
155	155	does not meet the criteria established under section 6
156	156	340J–1(a) of the Public Health Service Act unless 7
157	157	the organization has an accreditation by an accredi-8
158	158	tation body approved under section 340J–5 of the 9
159	159	Public Health Service Act. An election by a State 10
160	160	under the preceding sentence shall not relieve a 11
161	161	State of the requirement to certify an organization 12
162	162	under paragraph (2)(D).’’. 13
163	163	(b) C
164	164	ONFORMINGAMENDMENTS.— 14
165	165	(1) Section 1902(nn)(3) of such Act (42 U.S.C. 15
166	166	1396a(nn)(3)), is amended by striking ‘‘paragraph 16
167	167	(31)’’ and inserting ‘‘the last numbered paragraph’’. 17
168	168	(2) The fifth sentence of section 1905(a) of 18
169	169	such Act (42 U.S.C. 1396d(a)) is amended by strik-19
170	170	ing ‘‘paragraph (30)’’ and inserting ‘‘the last num-20
171	171	bered paragraph’’. 21
172	172	(3) Effective July 1, 2025, section 22
173	173	1902(a)(84)(A) of such Act (42 U.S.C. 23
174	174	1396a(a)(84)(A)), as amended by section 5122(a)(2) 24
175	175	of division FF of Public Law 117–328, is amended 25
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178	178	•S 2993 IS
179	179	by striking ‘‘paragraph (31)’’ and inserting ‘‘the last 1
180	180	numbered paragraph’’. 2
181	181	SEC. 102. ESTABLISHING A MEDICAID PROSPECTIVE PAY-3
182	182	MENT SYSTEM FOR CERTIFIED COMMUNITY 4
183	183	BEHAVIORAL HEALTH CLINICS. 5
184	184	Section 1902 of the Social Security Act (42 U.S.C. 6
185	185	1396a) is amended by adding at the end the following new 7
186	186	subsection: 8
187	187	‘‘(uu) P
188	188	AYMENT FORSERVICESPROVIDED BYCER-9
189	189	TIFIEDCOMMUNITYBEHAVIORALHEALTHCLINICS.— 10
190	190	‘‘(1) I
191	191	N GENERAL.—Beginning with fiscal year 11
192	192	2024, with respect to services furnished on or after 12
193	193	January 1, 2024, and each succeeding fiscal year, a 13
194	194	State may provide under the State plan under this 14
195	195	title (or under a waiver of such plan) for payment 15
196	196	for services described in section 1905(a)(31) fur-16
197	197	nished by a certified community behavioral health 17
198	198	clinic (in this subsection referred to as a ‘clinic’) in 18
199	199	accordance with the provisions of this subsection. 19
200	200	‘‘(2) P
201	201	AYMENT FOR SERVICES IN INITIAL YEAR 20
202	202	AND EVERY THIRD YEAR .—Subject to paragraphs 21
203	203	(4), (5), and (6), for services furnished by a clinic 22
204	204	in the first fiscal year for which a State elects to 23
205	205	provide for payment for services described in section 24
206	206	1905(a)(31) in accordance with the payment option 25
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209	209	•S 2993 IS
210	210	under paragraph (1), and every third fiscal year 1
211	211	thereafter in which the State makes such an elec-2
212	212	tion, the State shall provide for payment for such 3
213	213	services in an amount (calculated on the basis of 4
214	214	daily visits or unduplicated monthly visits, at the 5
215	215	State’s election) that is equal to 100 percent of the 6
216	216	average costs of the clinic of furnishing any of the 7
217	217	services described in paragraph (31) of section 8
218	218	1905(a) during the 2 fiscal years preceding the fis-9
219	219	cal year involved which are reasonable and related to 10
220	220	the costs of furnishing such services; provided that, 11
221	221	in the absence of complete actual cost data rep-12
222	222	resenting the provision of the full covered benefit in 13
223	223	such preceding fiscal years, certified community be-14
224	224	havioral health clinics may, at the State’s discretion, 15
225	225	use estimated or projected data relating to specific 16
226	226	services for which they lack cost experience. The 17
227	227	per-unit rate derived from such cost data shall be 18
228	228	adjusted to take into account any increase or de-19
229	229	crease in the scope of such services furnished by the 20
230	230	clinic in the fiscal year involved. 21
231	231	‘‘(3) P
232	232	AYMENT FOR SERVICES IN SUCCEEDING 22
233	233	FISCAL YEARS.—Subject to paragraphs (4), (5), and 23
234	234	(6), for services described in section 1905(a)(31) 24
235	235	furnished by a clinic for which a State elects to pro-25
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238	238	•S 2993 IS
239	239	vide for payment for such services in accordance 1
240	240	with the payment option under paragraph (1) and 2
241	241	that are furnished in a fiscal year that is not de-3
242	242	scribed in paragraph (2), the State plan shall pro-4
243	243	vide for payment for such services in an amount 5
244	244	(calculated on the basis of daily visits or 6
245	245	unduplicated monthly visits, at the State’s election) 7
246	246	that is equal to the amount calculated under this 8
247	247	subsection for such services and clinic for the pre-9
248	248	ceding year— 10
249	249	‘‘(A) increased by the percentage increase 11
250	250	in the inflationary factor described in section 12
251	251	1834(aa)(2)(C); and 13
252	252	‘‘(B) adjusted to take into account any in-14
253	253	crease or decrease in the scope of such services 15
254	254	furnished by the clinic during the fiscal year in-16
255	255	volved. 17
256	256	‘‘(4) E
257	257	STABLISHMENT OF INITIAL YEAR PAY -18
258	258	MENT FOR NEW CLINICS .—In any case in which an 19
259	259	entity first qualifies as a certified community behav-20
260	260	ioral health clinic after the first fiscal year in which 21
261	261	a State elects to provide for payment for services de-22
262	262	scribed in section 1905(a)(31) in accordance with 23
263	263	the payment option under paragraph (1), the State 24
264	264	plan shall provide for payment for such services in 25
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267	267	•S 2993 IS
268	268	the first 2 years in which the clinic so qualifies in 1
269	269	an amount (calculated on the basis of daily visits or 2
270	270	unduplicated monthly visits, at the State’s election) 3
271	271	that is equal to the rates established under this sub-4
272	272	section for other such clinics located in the same or 5
273	273	adjacent area with a similar case load, or in the ab-6
274	274	sence of any such clinic, based on the average per- 7
275	275	unit rate for other certified community behavioral 8
276	276	health clinics in the State; provided, however, that 9
277	277	effective, at latest, as of the 3rd year in which the 10
278	278	clinic furnishes such services, the State establishes a 11
279	279	unique payment rate for the clinic based on the 12
280	280	methodology described in paragraph (2), using al-13
281	281	lowable costs from the clinic’s first 2 fiscal years of 14
282	282	operation as the basis for establishing such rates; 15
283	283	and provided, additionally, that in any year following 16
284	284	the establishment of an initial rate under this para-17
285	285	graph, the State plan or waiver provides for the pay-18
286	286	ment amount to be calculated in accordance with 19
287	287	paragraph (2) or (3) (as applicable). 20
288	288	‘‘(5) A
289	289	DMINISTRATION IN THE CASE OF MAN -21
290	290	AGED CARE.— 22
291	291	‘‘(A) I
292	292	N GENERAL.—In the case of services 23
293	293	furnished by a certified community behavioral 24
294	294	health clinic pursuant to a contract between the 25
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297	297	•S 2993 IS
298	298	clinic and a managed care entity (as defined in 1
299	299	section 1932(a)(1)(B)), the State plan or a 2
300	300	waiver of such plan shall provide for 1 of the 3
301	301	following: 4
302	302	‘‘(i) Payment to the clinic by the 5
303	303	State of a supplemental payment equal to 6
304	304	the amount (if any) by which the amount 7
305	305	determined under paragraph (2), (3), or 8
306	306	(4) (as applicable) exceeds the amount of 9
307	307	payments under the contract, with such 10
308	308	supplemental payment being made pursu-11
309	309	ant to a payment schedule agreed to by the 12
310	310	State and the certified community behav-13
311	311	ioral health clinic, but in no case less fre-14
312	312	quently than every 3 months. 15
313	313	‘‘(ii) Delegation by the State to the 16
314	314	managed care entity of the obligation to 17
315	315	pay the clinic at least the rate determined 18
316	316	under paragraph (2), (3), or (4) (as appli-19
317	317	cable); provided, however, that the State 20
318	318	shall use reconciliation and oversight proc-21
319	319	esses to ensure that each clinic is paid at 22
320	320	least the amounts required under such 23
321	321	paragraphs. 24
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324	324	•S 2993 IS
325	325	‘‘(6) ALTERNATIVE PAYMENT METHODOLO -1
326	326	GIES.—Notwithstanding any other provision of this 2
327	327	subsection, the State plan or a waiver of such plan 3
328	328	may provide for payment in any year to a certified 4
329	329	community behavioral health clinic for services de-5
330	330	scribed in paragraph (31) of section 1905(a) in an 6
331	331	amount which is determined under an alternative 7
332	332	payment methodology that— 8
333	333	‘‘(A) is agreed to by the State and the clin-9
334	334	ic; and 10
335	335	‘‘(B) results in payment to the clinic of an 11
336	336	amount which is not less than the amount oth-12
337	337	erwise required to be paid to the clinic under 13
338	338	this subsection.’’. 14
339	339	TITLE II—COVERAGE OF CER-15
340	340	TIFIED COMMUNITY BEHAV-16
341	341	IORAL HEALTH CLINIC SERV-17
342	342	ICES UNDER THE MEDICARE 18
343	343	PROGRAM 19
344	344	SEC. 201. COVERAGE OF CERTIFIED COMMUNITY BEHAV-20
345	345	IORAL HEALTH CLINIC SERVICES UNDER THE 21
346	346	MEDICARE PROGRAM. 22
347	347	(a) C
348	348	OVERAGE.—Section 1861(s)(2) of the Social Se-23
349	349	curity Act (42 U.S.C. 1395x(s)(2)) is amended— 24
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352	352	•S 2993 IS
353	353	(1) in subparagraph (II), by striking ‘‘and’’ at 1
354	354	the end; 2
355	355	(2) in subparagraph (JJ), by inserting ‘‘and’’ 3
356	356	at the end; and 4
357	357	(3) by adding at the end the following new sub-5
358	358	paragraph: 6
359	359	‘‘(KK) certified community behavioral health 7
360	360	clinic services (as defined in subsection (aa)(8)) fur-8
361	361	nished on or after January 1, 2024.’’. 9
362	362	(b) D
363	363	EFINITIONS.—Section 1861(aa) of the Social 10
364	364	Security Act (42 U.S.C. 1395x) is amended— 11
365	365	(1) in the heading, by striking ‘‘and Federally 12
366	366	Qualified Health Center Services’’ and inserting ‘‘, 13
367	367	Federally Qualified Health Center Services, and Cer-14
368	368	tified Community Behavioral Health Clinic Serv-15
369	369	ices’’; and 16
370	370	(2) by adding at the end the following new 17
371	371	paragraph: 18
372	372	‘‘(8) The terms ‘certified community behavioral 19
373	373	health clinic services’ and ‘certified community behavioral 20
374	374	health clinic’ have the meaning given those terms in para-21
375	375	graphs (1) and (2), respectively, of section 1905(jj).’’. 22
376	376	(c) P
377	377	AYMENT.— 23
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380	380	•S 2993 IS
381	381	(1) IN GENERAL.—Section 1833(a)(1) of the 1
382	382	Social Security Act (42 U.S.C. 1395l(a)(1)) is 2
383	383	amended— 3
384	384	(A) by striking ‘‘and (HH)’’ and inserting 4
385	385	‘‘(HH)’’; and 5
386	386	(B) by inserting before the semicolon at 6
387	387	the end the following: ‘‘, and (II) with respect 7
388	388	to certified community behavioral health clinic 8
389	389	services for which payment is made under sec-9
390	390	tion 1834(aa), the amounts paid shall be equal 10
391	391	to 80 percent of the lesser of the actual charge 11
392	392	or the amount determined under such section’’. 12
393	393	(2) D
394	394	EVELOPMENT AND IMPLEMENTATION OF 13
395	395	PROSPECTIVE PAYMENT SYSTEM .—Section 1834 of 14
396	396	the Social Security Act (42 U.S.C. 1395m) is 15
397	397	amended by adding at the end the following new 16
398	398	subsection: 17
399	399	‘‘(aa) D
400	400	EVELOPMENT AND IMPLEMENTATION OF 18
401	401	P
402	402	ROSPECTIVEPAYMENTSYSTEM FORCERTIFIEDCOM-19
403	403	MUNITYBEHAVIORALHEALTHCLINICS.— 20
404	404	‘‘(1) D
405	405	EVELOPMENT.—The Secretary shall de-21
406	406	velop a prospective payment system for payment to 22
407	407	certified community behavioral health clinics (as de-23
408	408	fined in section 1861(aa)(8)) for the furnishing of 24
409	409	certified community behavioral health clinic services 25
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412	412	•S 2993 IS
413	413	(as defined in such section) under this title. Such 1
414	414	system shall be established to take into account the 2
415	415	type, intensity, and duration of services furnished by 3
416	416	certified community behavioral health clinics. Such 4
417	417	system may include adjustments, including geo-5
418	418	graphic adjustments, as determined appropriate by 6
419	419	the Secretary. 7
420	420	‘‘(2) I
421	421	MPLEMENTATION.— 8
422	422	‘‘(A) I
423	423	N GENERAL.—The Secretary shall 9
424	424	provide, for cost reporting periods beginning on 10
425	425	or after January 1, 2024, for payments of pro-11
426	426	spective payment rates for certified community 12
427	427	behavioral health clinic services furnished by 13
428	428	certified community behavioral health clinics 14
429	429	under this title in accordance with the prospec-15
430	430	tive payment system developed by the Secretary 16
431	431	under paragraph (1). 17
432	432	‘‘(B) I
433	433	NITIAL PAYMENTS.—The Secretary 18
434	434	shall implement such prospective payment sys-19
435	435	tem to reflect the national average allowable 20
436	436	service costs of such clinics on the basis of the 21
437	437	most current audited cost report data for two 22
438	438	fiscal years available to the Secretary; provided 23
439	439	that, in the absence of complete actual cost 24
440	440	data representing the provision of the full cov-25
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443	443	•S 2993 IS
444	444	ered benefit during the relevant fiscal years, 1
445	445	certified community behavioral health clinics 2
446	446	may, at the Secretary’s discretion, use esti-3
447	447	mated or projected data relating to specific 4
448	448	services. Initial payments shall be established 5
449	449	without the application of a per visit limit or 6
450	450	productivity screen and shall be based on na-7
451	451	tional average costs per unit of service, updated 8
452	452	as appropriate by the inflationary adjustment 9
453	453	described in subparagraph (C). 10
454	454	‘‘(C) P
455	455	AYMENTS IN SUBSEQUENT YEARS .— 11
456	456	Payment rates in years after the year of imple-12
457	457	mentation of such system shall be the payment 13
458	458	rates in the previous year increased— 14
459	459	‘‘(i) in the first year after implemen-15
460	460	tation of such system, by the percentage 16
461	461	increase in the MEI (as defined in section 17
462	462	1842(i)(3)) for the year involved; and 18
463	463	‘‘(ii) in subsequent years, by the per-19
464	464	centage increase in a market basket of cer-20
465	465	tified community behavioral health clinic 21
466	466	services, designed by the Secretary, or if 22
467	467	such an index is not available, by the per-23
468	468	centage increase in the MEI (as defined in 24
469	469	section 1842(i)(3)) for the year involved. 25
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472	472	•S 2993 IS
473	473	‘‘(3) UNIT OF PAYMENT .—In establishing a 1
474	474	prospective payment amount under the system under 2
475	475	this subsection, the Secretary shall consider an ap-3
476	476	propriate unit of service and a general system design 4
477	477	that provides for continued access to quality serv-5
478	478	ices. 6
479	479	‘‘(4) P
480	480	ERIODIC REEVALUATION OF RATES .—At 7
481	481	the Secretary’s discretion, the Secretary shall, from 8
482	482	time to time, adjust the amounts that would other-9
483	483	wise be applicable under subparagraph (2) by a per-10
484	484	centage determined appropriate by the Secretary to 11
485	485	reflect such factors as changes in the intensity of 12
486	486	services furnished within a unit of service, the aver-13
487	487	age cost of providing care per unit of service, and 14
488	488	other factors that the Secretary considers to be rel-15
489	489	evant. Such adjustment shall be made before the up-16
490	490	date under clause (i) or (ii) of paragraph (2)(C)(i) 17
491	491	has been applied for the year.’’. 18
492	492	(d) W
493	493	AIVER OFAPPLICATION OFDEDUCTIBLE.— 19
494	494	Section 1833(b)(4) of the Social Security Act (42 U.S.C. 20
495	495	1395l(b)(4)) is amended by inserting ‘‘or certified commu-21
496	496	nity behavioral health clinic services’’ before the comma 22
497	497	at the end. 23
498	498	(e) PRRB R
499	499	EVIEW OFCOSTREPORTS.—Section 24
500	500	1878(j) of the Social Security Act (42 U.S.C. 1395oo(j)) 25
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503	503	•S 2993 IS
504	504	is amended by striking ‘‘and a Federally qualified health 1
505	505	center’’ and inserting ‘‘, a Federally qualified health cen-2
506	506	ter, and a certified community behavioral health clinic’’. 3
507	507	(f) S
508	508	AFEHARBOR FORWAIVER OFCOINSURANCE.— 4
509	509	Section 1128B(b)(3)(D) of the Social Security Act (42 5
510	510	U.S.C. 1320a–7b(b)(3)(D)) is amended by inserting ‘‘or 6
511	511	a certified community behavioral health clinic’’ after 7
512	512	‘‘Federally qualified health care center’’. 8
513	513	(g) E
514	514	FFECTIVEDATE.—The amendments made by 9
515	515	this section shall apply with respect to services furnished 10
516	516	on or after January 1, 2024. 11
517	517	TITLE III—COMMUNITY BEHAV-12
518	518	IORAL HEALTH CLINIC 13
519	519	GRANTS 14
520	520	SEC. 301. OPERATING GRANTS FOR COMMUNITY BEHAV-15
521	521	IORAL HEALTH CLINICS. 16
522	522	Part D of title III of the Public Health Service Act 17
523	523	(42 U.S.C. 254b et seq.) is amended by adding at the end 18
524	524	the following: 19
525	525	‘‘Subpart XIII—Community Behavioral Health 20
526	526	Clinics 21
527	527	‘‘SEC. 340J. DEFINITIONS. 22
528	528	‘‘In this subpart: 23
529	529	‘‘(1) C
530	530	ERTIFIED COMMUNITY BEHAVIORAL 24
531	531	HEALTH CLINIC.—The term ‘certified community be-25
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534	534	•S 2993 IS
535	535	havioral health clinic’ has the meaning given the 1
536	536	term in section 1905(jj)(2)) of the Social Security 2
537	537	Act. 3
538	538	‘‘(2) C
539	539	ERTIFIED COMMUNITY BEHAVIORAL 4
540	540	HEALTH SERVICES.—The term ‘certified community 5
541	541	behavioral health services’ has the meaning given the 6
542	542	term in section 1905(jj)(1) of the Social Security 7
543	543	Act. 8
544	544	‘‘SEC. 340J–1. COMMUNITY BEHAVIORAL HEALTH CLINIC 9
545	545	CERTIFICATION. 10
546	546	‘‘(a) I
547	547	NGENERAL.—Not later than 180 days after 11
548	548	the date of enactment of the Ensuring Excellence in Men-12
549	549	tal Health Act, the Secretary, after public notice and op-13
550	550	portunity for comment, shall publish in the Federal Reg-14
551	551	ister criteria for a clinic to be certified as a community 15
552	552	behavioral health clinic for purposes of section 16
553	553	1905(jj)(2)(D)(ii) of the Social Security Act. 17
554	554	‘‘(b) R
555	555	EQUIREMENTS.—The criteria published under 18
556	556	subsection (a) shall include criteria with respect to the fol-19
557	557	lowing: 20
558	558	‘‘(1) S
559	559	TAFFING.—Staffing requirements, includ-21
560	560	ing criteria that staff have diverse disciplinary back-22
561	561	grounds, have necessary State-required license and 23
562	562	accreditation, and are culturally and linguistically 24
563	563	VerDate Sep 11 2014 01:53 Oct 01, 2023 Jkt 039200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S2993.IS S2993
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565	565	•S 2993 IS
566	566	trained to serve the needs of the patient populations 1
567	567	of the community behavioral health clinic. 2
568	568	‘‘(2) A
569	569	VAILABILITY AND ACCESSIBILITY OF 3
570	570	SERVICES.—Availability and accessibility of services, 4
571	571	including crisis management services that are avail-5
572	572	able and accessible 24 hours a day, the use of a slid-6
573	573	ing scale for payment, and no rejection for services 7
574	574	or limiting of services on the basis of a patient’s 8
575	575	ability to pay or a place of residence. 9
576	576	‘‘(3) C
577	577	ARE COORDINATION.—Care coordination, 10
578	578	including requirements to coordinate care across set-11
579	579	tings and providers to ensure seamless transitions 12
580	580	for patients across the full spectrum of health serv-13
581	581	ices including acute, chronic, and behavioral health 14
582	582	needs. Care coordination requirements shall include 15
583	583	partnerships or formal contracts with the following: 16
584	584	‘‘(A) Federally-qualified health centers (as 17
585	585	defined in section 1905(l) of the Social Security 18
586	586	Act) and, as applicable, rural health clinics (as 19
587	587	so defined), to provide Federally-qualified 20
588	588	health center services (as so defined) and, as 21
589	589	applicable, rural health clinic services (as so de-22
590	590	fined), to the extent such services are not pro-23
591	591	vided directly through the community behav-24
592	592	ioral health clinic. 25
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595	595	•S 2993 IS
596	596	‘‘(B) Inpatient psychiatric facilities and 1
597	597	substance use detoxification, post-detoxification 2
598	598	step-down services, and residential programs. 3
599	599	‘‘(C) Other community or regional services, 4
600	600	supports, and providers, including schools, child 5
601	601	welfare agencies, juvenile and criminal justice 6
602	602	agencies and facilities, Indian Health Service 7
603	603	youth regional treatment centers, State-licensed 8
604	604	and nationally accredited child placing agencies 9
605	605	for therapeutic foster care service, and other so-10
606	606	cial and human services. 11
607	607	‘‘(D) Medical centers, outpatient clinics, 12
608	608	and drop-in centers of the Department of Vet-13
609	609	erans Affairs and other facilities of the Depart-14
610	610	ment (as defined in section 1701 of title 38, 15
611	611	United States Code). 16
612	612	‘‘(E) Inpatient acute care hospitals and 17
613	613	hospital outpatient clinics. 18
614	614	‘‘(4) S
615	615	COPE OF SERVICES .—Provision (in a 19
616	616	manner reflecting person-centered care) of the full 20
617	617	array of certified community behavioral health serv-21
618	618	ices which, if not available directly through the com-22
619	619	munity behavioral health clinic, are provided or re-23
620	620	ferred through formal relationships with other pro-24
621	621	viders. 25
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624	624	•S 2993 IS
625	625	‘‘(5) QUALITY AND OTHER REPORTING .—Re-1
626	626	quirements relating to development by the commu-2
627	627	nity behavioral health clinic of an effective procedure 3
628	628	for compiling and reporting to the Secretary such 4
629	629	statistics and other information as the Secretary 5
630	630	may require relating to— 6
631	631	‘‘(A) the costs of its operations; 7
632	632	‘‘(B) the patterns of use of its services, in-8
633	633	cluding the reporting of encounter data, clinical 9
634	634	outcomes data, quality data, and such other 10
635	635	data as the Secretary may require; 11
636	636	‘‘(C) the availability, accessibility, and ac-12
637	637	ceptability of its services; and 13
638	638	‘‘(D) such other matters relating to oper-14
639	639	ations of the applicant as the Secretary may re-15
640	640	quire. 16
641	641	‘‘(6) O
642	642	RGANIZATIONAL AUTHORITY .—Require-17
643	643	ments that a community behavioral health clinic 18
644	644	be— 19
645	645	‘‘(A) a nonprofit entity; 20
646	646	‘‘(B) part of a local government behavioral 21
647	647	health authority; 22
648	648	‘‘(C) operated under the authority of the 23
649	649	Indian Health Service; 24
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652	652	•S 2993 IS
653	653	‘‘(D) operated by an Indian Tribe or Trib-1
654	654	al organization pursuant to a contract, grant, 2
655	655	cooperative agreement, or compact with the In-3
656	656	dian Health Service pursuant to the Indian 4
657	657	Self-Determination and Education Assistance 5
658	658	Act; or 6
659	659	‘‘(E) operated by an urban Indian organi-7
660	660	zation pursuant to a grant or contract with the 8
661	661	Indian Health Service under title V of the In-9
662	662	dian Health Care Improvement Act. 10
663	663	‘‘SEC. 340J–2. OPERATING GRANTS FOR COMMUNITY BE-11
664	664	HAVIORAL HEALTH CLINICS. 12
665	665	‘‘(a) I
666	666	NGENERAL.—The Secretary shall establish a 13
667	667	grant program under which the Secretary shall award 14
668	668	grants to eligible community behavioral health clinics to 15
669	669	provide (in a manner reflecting person-centered care) the 16
670	670	full array of certified community behavioral health serv-17
671	671	ices. 18
672	672	‘‘(b) E
673	673	LIGIBILITY.—To be eligible to receive a grant 19
674	674	under subsection (a), a community behavioral health clinic 20
675	675	shall be— 21
676	676	‘‘(1) a certified community behavioral health 22
677	677	clinic; or 23
678	678	‘‘(2) a community behavioral health clinic that 24
679	679	indicates in the grant application that the clinic will 25
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682	682	•S 2993 IS
683	683	use the grant funds to meet the criteria described in 1
684	684	section 340J–1(a). 2
685	685	‘‘(c) U
686	686	SE OFFUNDS.—A community behavioral 3
687	687	health clinic that receives a grant under subsection (a)— 4
688	688	‘‘(1) shall use the grant funds— 5
689	689	‘‘(A) to provide the services described in 6
690	690	subsection (a); and 7
691	691	‘‘(B) in the case of a community behavioral 8
692	692	health clinic described in subsection (b)(2), to 9
693	693	meet the criteria described in section 340J– 10
694	694	1(a); and 11
695	695	‘‘(2) may use the grant funds— 12
696	696	‘‘(A) to carry out other activities that— 13
697	697	‘‘(i) reduce costs associated with the 14
698	698	provision of certified community behavioral 15
699	699	health services; 16
700	700	‘‘(ii) improve access to, and avail-17
701	701	ability of, certified community behavioral 18
702	702	health services provided to individuals 19
703	703	served by the community behavioral health 20
704	704	clinic; 21
705	705	‘‘(iii) enhance the quality and coordi-22
706	706	nation of certified community behavioral 23
707	707	health services; or 24
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710	710	•S 2993 IS
711	711	‘‘(iv) improve the health status of 1
712	712	communities; and 2
713	713	‘‘(B) to pay for— 3
714	714	‘‘(i) the costs of acquiring and leasing 4
715	715	buildings and equipment (including the 5
716	716	costs of amortizing the principal of, and 6
717	717	paying interest on, loans); 7
718	718	‘‘(ii) costs relating to the purchase or 8
719	719	lease of equipment, including data and in-9
720	720	formation systems and behavioral health 10
721	721	information technology to facilitate data 11
722	722	reporting and other purposes; 12
723	723	‘‘(iii) the costs of in-service staff 13
724	724	training and other operational or infra-14
725	725	structure costs identified by the Secretary; 15
726	726	and 16
727	727	‘‘(iv) costs associated with expanding 17
728	728	and modernizing existing buildings or con-18
729	729	structing new buildings (including the 19
730	730	costs of amortizing the principal of, and 20
731	731	paying the interest on, loans), if such costs 21
732	732	are specifically allowed for in the grant op-22
733	733	portunity published by the Secretary. 23
734	734	‘‘(d) T
735	735	ERM.—Grants awarded under subsection (a) 24
736	736	shall be for a period of not more than 5 years. 25
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739	739	•S 2993 IS
740	740	‘‘(e) CONDITION ONRECEIPT OFFUNDS.—The Sec-1
741	741	retary shall not make a grant to an applicant under sub-2
742	742	section (a) unless the applicant provides assurances to the 3
743	743	Secretary that within 120 days of receiving grant funding 4
744	744	for the operation of the clinic, the applicant will submit 5
745	745	for approval by the Secretary an implementation plan that 6
746	746	describes how the applicant will— 7
747	747	‘‘(1) provide the services described in subsection 8
748	748	(a); and 9
749	749	‘‘(2) in the case of a community behavioral 10
750	750	health clinic described in subsection (b)(2), meet the 11
751	751	criteria described in section 340J–1(a). 12
752	752	‘‘(f) A
753	753	MOUNT OFGRANT.— 13
754	754	‘‘(1) I
755	755	N GENERAL.—Subject to paragraph (2), 14
756	756	the amount of a grant made in any fiscal year to a 15
757	757	community behavioral health clinic under subsection 16
758	758	(a) shall be determined by the Secretary based on 17
759	759	information provided by the community behavioral 18
760	760	health clinic, but may not exceed an amount equal 19
761	761	to the difference obtained by subtracting— 20
762	762	‘‘(A) the sum obtained by adding— 21
763	763	‘‘(i) the total State, local, and other 22
764	764	operational funding provided to the clinic 23
765	765	for such fiscal year; and 24
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768	768	•S 2993 IS
769	769	‘‘(ii) the fees, premiums, and third- 1
770	770	party reimbursements that the clinic rea-2
771	771	sonably expects to receive for its operations 3
772	772	in such fiscal year; from 4
773	773	‘‘(B) the costs of operating the clinic to 5
774	774	meet the purposes and requirements of the 6
775	775	grant program under this section during such 7
776	776	fiscal year. 8
777	777	‘‘(2) R
778	778	EQUIREMENT.— 9
779	779	‘‘(A) I
780	780	N GENERAL.—In determining the 10
781	781	costs described in paragraph (1)(B), the Sec-11
782	782	retary may estimate the anticipated costs of the 12
783	783	grant recipient in— 13
784	784	‘‘(i) providing the services described in 14
785	785	subsection (a), including the anticipated 15
786	786	costs of providing any individual certified 16
787	787	community behavioral health service that 17
788	788	the applicant entity does not have cost ex-18
789	789	perience providing at the time of submit-19
790	790	ting an application for such grant; and 20
791	791	‘‘(ii) if applicable, meeting the criteria 21
792	792	described in section 340J–1(a). 22
793	793	‘‘(B) A
794	794	NTICIPATED COSTS.—The Secretary 23
795	795	shall base the estimate of anticipated costs 24
796	796	under subparagraph (A) on an estimate of an-25
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799	799	•S 2993 IS
800	800	ticipated costs provided by the applicable com-1
801	801	munity behavioral health clinic. 2
802	802	‘‘(3) P
803	803	AYMENTS.—The Secretary may— 3
804	804	‘‘(A) award grants under subsection (a)— 4
805	805	‘‘(i) in advance or through reimburse-5
806	806	ment; and 6
807	807	‘‘(ii) in installments; 7
808	808	‘‘(B) make adjustments to account for 8
809	809	overpayments or underpayments. 9
810	810	‘‘(g) U
811	811	SE OFACCREDITATION.— 10
812	812	‘‘(1) I
813	813	N GENERAL.—In selecting grant recipi-11
814	814	ents under this section, the Secretary may take into 12
815	815	account whether an applicant community behavioral 13
816	816	health clinic is accredited under section 340J–5(a). 14
817	817	‘‘(2) C
818	818	OMPLIANCE.—In determining whether a 15
819	819	community behavioral health clinic receiving a grant 16
820	820	under this section is providing the services described 17
821	821	in subsection (a) and, if applicable, meeting the cri-18
822	822	teria described in section 340J–1(a), the Secretary 19
823	823	may take into account whether the community be-20
824	824	havioral health clinic is accredited under section 21
825	825	340J–5(a). 22
826	826	‘‘(h) A
827	827	UTHORIZATION OFAPPROPRIATIONS.— 23
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830	830	•S 2993 IS
831	831	‘‘(1) IN GENERAL.—There is authorized to be 1
832	832	appropriated to carry out this section, $552,500,000 2
833	833	for each of fiscal years 2024 through 2028. 3
834	834	‘‘(2) M
835	835	AINTENANCE OF FUNDING .—The 4
836	836	amount made available under paragraph (1) shall 5
837	837	supplement (and not supplant) any other Federal 6
838	838	funding made available for community behavioral 7
839	839	health clinics. 8
840	840	‘‘SEC. 340J–3. TECHNICAL ASSISTANCE. 9
841	841	‘‘(a) I
842	842	NGENERAL.—Not later than 180 days after 10
843	843	the date of enactment of the Ensuring Excellence in Men-11
844	844	tal Health Act, the Secretary shall establish programs 12
845	845	through which the Secretary shall provide (either through 13
846	846	the Department of Health and Human Services or by 14
847	847	grant or contract) technical assistance and other assist-15
848	848	ance to any of the following: 16
849	849	‘‘(1) Entities that receive a grant under section 17
850	850	340J–2. 18
851	851	‘‘(2) Entities participating in a Medicaid dem-19
852	852	onstration program under section 223(d) of the Pro-20
853	853	tecting Access to Medicare Act. 21
854	854	‘‘(3) Certified community behavioral health clin-22
855	855	ics (as defined in sections 1861(aa)(8) and 23
856	856	1905(jj)(2) of the Social Security Act), furnishing 24
857	857	services under title XVIII or title XIX of such Act. 25
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860	860	•S 2993 IS
861	861	‘‘(4) Health or social service provider organiza-1
862	862	tions pursuing or considering certified community 2
863	863	behavioral health clinic status or partnering with 3
864	864	certified community behavioral health clinics. 4
865	865	‘‘(5) Other stakeholders, for the purpose of fa-5
866	866	cilitating successful implementation of the certified 6
867	867	community behavioral health clinic model. 7
868	868	‘‘(b) I
869	869	NCLUSIONS.—Assistance provided by the Sec-8
870	870	retary under subsection (a) may include technical and 9
871	871	nonfinancial assistance, including— 10
872	872	‘‘(1) fiscal and program management assist-11
873	873	ance; 12
874	874	‘‘(2) operational and administrative support; 13
875	875	and 14
876	876	‘‘(3) the provision of information to the entities 15
877	877	about the variety of resources available under this 16
878	878	part and how those resources can be best used to 17
879	879	meet the health and behavioral health needs of the 18
880	880	communities served by the entities. 19
881	881	‘‘(c) A
882	882	UTHORIZATION OF APPROPRIATIONS.—There 20
883	883	is authorized to be appropriated to carry out this section 21
884	884	$6,000,000 for each of fiscal years 2024 through 2028. 22
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887	887	•S 2993 IS
888	888	‘‘SEC. 340J–4. DATA INFRASTRUCTURE FOR COMMUNITY 1
889	889	BEHAVIORAL HEALTH CLINIC REPORTING. 2
890	890	‘‘(a) I
891	891	NGENERAL.—Not later than 180 days after 3
892	892	the date of enactment of the Ensuring Excellence in Men-4
893	893	tal Health Act, the Secretary shall establish a system 5
894	894	under which the Secretary shall collect and analyze data 6
895	895	on community behavioral health clinics. 7
896	896	‘‘(b) S
897	897	COPE OFDATACOLLECTION.—The system es-8
898	898	tablished under subsection (a) shall be used by the Sec-9
899	899	retary to collect and analyze data from— 10
900	900	‘‘(1) entities that receive a grant under section 11
901	901	340J–2; and 12
902	902	‘‘(2) organizations that provide services, or have 13
903	903	applied to provide services, under title XVIII of the 14
904	904	Social Security Act, as described in section 15
905	905	1861(aa)(8) of such Act, or under a State Medicaid 16
906	906	program in accordance with section 1905(jj) of such 17
907	907	Act. 18
908	908	‘‘(c) A
909	909	UTHORIZATION OF APPROPRIATIONS.—There 19
910	910	is authorized to be appropriated to carry out this section 20
911	911	$51,000,000 for each of fiscal years 2024 through 2028. 21
912	912	‘‘SEC. 340J–5. COMMUNITY BEHAVIORAL HEALTH CLINIC 22
913	913	ACCREDITATION. 23
914	914	‘‘(a) A
915	915	CCREDITATIONSTANDARDS.—A community 24
916	916	behavioral health clinic may be accredited if the entity— 25
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919	919	•S 2993 IS
920	920	‘‘(1) meets the standards of an approved ac-1
921	921	creditation body; and 2
922	922	‘‘(2) authorizes the accreditation body to sub-3
923	923	mit to the Secretary (or such agency as the Sec-4
924	924	retary may designate) such records or other infor-5
925	925	mation as the Secretary may require. 6
926	926	‘‘(b) A
927	927	PPROVAL OFACCREDITATIONBODIES.— 7
928	928	‘‘(1) I
929	929	N GENERAL.—The Secretary may approve 8
930	930	a private nonprofit organization to be an accredita-9
931	931	tion body for the accreditation of community behav-10
932	932	ioral health clinics under subsection (a) if— 11
933	933	‘‘(A) using inspectors qualified to evaluate 12
934	934	quality of care in a behavioral health service 13
935	935	setting, the accreditation body agrees to inspect 14
936	936	the clinic with such frequency as is determined 15
937	937	by the Secretary; 16
938	938	‘‘(B) the standards applied by the body in 17
939	939	determining whether or not to accredit a clinic 18
940	940	correspond to the criteria described in section 19
941	941	340J–1(a), and are not less restrictive than 20
942	942	such criteria; 21
943	943	‘‘(C) there is adequate provision for assur-22
944	944	ing that the standards of the accreditation body 23
945	945	continue to be met by the clinic; 24
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948	948	•S 2993 IS
949	949	‘‘(D) in the case of any clinic previously 1
950	950	accredited by the body which has had its ac-2
951	951	creditation denied, suspended, withdrawn, or re-3
952	952	voked or which has had any other action taken 4
953	953	against it by the accrediting body, the accred-5
954	954	iting body agrees to submit to the Secretary the 6
955	955	name of such clinic within 30 days of the action 7
956	956	taken; and 8
957	957	‘‘(E) if the accreditation body has its ap-9
958	958	proval withdrawn by the Secretary, the body 10
959	959	agrees to notify each clinic accredited by the 11
960	960	body of the withdrawal within 10 days of the 12
961	961	withdrawal.’’. 13
962	962	Æ
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