Us Congress 2025-2026 Regular Session

Us Congress House Bill HB2590 Compare Versions

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Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 2590
5	5	To amend title XVIII of the Social Security Act to establish a demonstration
6	6	program to promote collaborative treatment of mental and physical health
7	7	comorbidities under the Medicare program.
8	8	IN THE HOUSE OF REPRESENTATIVES
9	9	APRIL2, 2025
10	10	Mr. B
11	11	OYLEof Pennsylvania (for himself and Ms. BROWN) introduced the fol-
12	12	lowing bill; which was referred to the Committee on Energy and Com-
13	13	merce, and in addition to the Committee on Ways and Means, for a pe-
14	14	riod to be subsequently determined by the Speaker, in each case for con-
15	15	sideration of such provisions as fall within the jurisdiction of the com-
16	16	mittee concerned
17	17	A BILL
18	18	To amend title XVIII of the Social Security Act to establish
19	19	a demonstration program to promote collaborative treat-
20	20	ment of mental and physical health comorbidities under
21	21	the Medicare program.
22	22	Be it enacted by the Senate and House of Representa-1
23	23	tives of the United States of America in Congress assembled, 2
24	24	SECTION 1. SHORT TITLE. 3
25	25	This Act may be cited as the ‘‘Mental and Physical 4
26	26	Health Care Comorbidities Act of 2025’’. 5
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30	30	SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM TO 1
31	31	PROMOTE COLLABORATIVE TREATMENT OF 2
32	32	MENTAL AND PHYSICAL HEALTH 3
33	33	COMORBIDITIES UNDER THE MEDICARE PRO-4
34	34	GRAM. 5
35	35	Title XVIII of the Social Security Act (42 U.S.C. 6
36	36	1395 et seq.) is amended by inserting after section 1866G 7
37	37	the following new section: 8
38	38	‘‘SEC. 1866H. MENTAL AND PHYSICAL HEALTH 9
39	39	COMORBIDITIES COLLABORATIVE DEM-10
40	40	ONSTRATION PROGRAM. 11
41	41	‘‘(a) I
42	42	NGENERAL.—Consistent with the model de-12
43	43	scribed in section 1115A(b)(2)(B)(xv) (relating to pro-13
44	44	moting improved quality and reduced cost by developing 14
45	45	a collaborative of high-quality, low-cost health care institu-15
46	46	tions), the Secretary shall conduct a demonstration pro-16
47	47	gram (in this section referred to as the ‘program’) to test 17
48	48	and evaluate innovations implemented by eligible hospitals 18
49	49	(as defined in subsection (f)) in the furnishing of items 19
50	50	and services to applicable individuals (as defined in sub-20
51	51	section (f)) with mental and physical health comorbidities 21
52	52	(and those at risk of developing such comorbidities), in-22
53	53	cluding by addressing the adverse social determinants of 23
54	54	health that such individuals often experience. 24
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58	58	‘‘(b) ACTIVITIESUNDERPROGRAM.—Under the pro-1
59	59	gram, the Secretary shall, in coordination with eligible 2
60	60	hospitals participating in the program— 3
61	61	‘‘(1) identify, validate, and disseminate innova-4
62	62	tive, effective evidence-based best practices and mod-5
63	63	els that improve care and outcomes for applicable in-6
64	64	dividuals with mental and physical health 7
65	65	comorbidities located in vulnerable communities, in-8
66	66	cluding by addressing the social determinants of 9
67	67	health that adversely impact such individuals; and 10
68	68	‘‘(2) assist in the identification of potential pay-11
69	69	ment reforms under this title and title XIX that 12
70	70	could more broadly effectuate such improvements. 13
71	71	‘‘(c) D
72	72	URATION AND SCOPE.—The program con-14
73	73	ducted under this section shall operate during the period 15
74	74	beginning on October 1, 2025, and ending no later than 16
75	75	September 30, 2030. 17
76	76	‘‘(d) P
77	77	ROGRAMELEMENTS.— 18
78	78	‘‘(1) I
79	79	N GENERAL.—An eligible hospital electing 19
80	80	to participate in the program shall enter into an 20
81	81	agreement with the Secretary for purposes of car-21
82	82	rying out the activities described in subsection (b). 22
83	83	Such an agreement shall include the plan described 23
84	84	in paragraph (2), along with an annualized payment 24
85	85	arrangement as described in paragraph (3) to sup-25
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89	89	port implementation of such plan. Such agreement 1
90	90	shall include a requirement for the hospital to— 2
91	91	‘‘(A) engage in the learning collaborative 3
92	92	established under subsection (e); 4
93	93	‘‘(B) certify that all proposed innovations 5
94	94	under such plan will supplement and not sup-6
95	95	plant existing activities, whether by augmenting 7
96	96	existing activities or initiating new activities; 8
97	97	and 9
98	98	‘‘(C) remit payments made under such ar-10
99	99	rangement to the Secretary if the Secretary de-11
100	100	termines that such hospital has not complied 12
101	101	with the terms of such agreement. 13
102	102	‘‘(2) P
103	103	ROGRAM ELEMENTS .—An eligible hos-14
104	104	pital electing to participate in the program shall sub-15
105	105	mit a proposed plan and associated quality metrics 16
106	106	for review and approval by the Secretary. Such plan 17
107	107	and metrics shall, at a minimum, address— 18
108	108	‘‘(A) the specific innovations addressing 19
109	109	mental and physical health comorbidities (as de-20
110	110	fined in subsection (f)) and innovations ad-21
111	111	dressing social determinants of health (as de-22
112	112	fined in such subsection) that will be employed 23
113	113	and the evidence base supporting the proposed 24
114	114	approach; 25
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118	118	‘‘(B) the proposed target population of ap-1
119	119	plicable individuals with respect to which such 2
120	120	innovations will be employed, including a de-3
121	121	scription of the extent to which such population 4
122	122	consists of applicable individuals described in 5
123	123	subparagraph (A), (B), or (C) of subsection 6
124	124	(f)(1); 7
125	125	‘‘(C) the evidence-based data supporting a 8
126	126	community’s status as a vulnerable community 9
127	127	through sources, such as Bureau of the Census 10
128	128	data and measures such as the Neighborhood 11
129	129	Deprivation Index or the Child Opportunity 12
130	130	Index; 13
131	131	‘‘(D) community partners, such as non-14
132	132	profit organizations, federally qualified health 15
133	133	centers, rural health clinics, and units of local 16
134	134	government (including law enforcement and ju-17
135	135	dicial entities) that will participate in the imple-18
136	136	mentation of such innovations; 19
137	137	‘‘(E) how such innovations will address 20
138	138	mental and physical health comorbidities and 21
139	139	social determinants of health for the target pop-22
140	140	ulation; 23
141	141	‘‘(F) how such innovations may inform 24
142	142	changes in payment and other policies under 25
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146	146	this title and title XIX (such as care coordina-1
147	147	tion reimbursement, mental health homes, im-2
148	148	provements to home and community-based serv-3
149	149	ice portfolios, and coverage of supportive serv-4
150	150	ices); 5
151	151	‘‘(G) how such innovations might con-6
152	152	tribute to a reduction in overall health care 7
153	153	costs, including under this title and title XIX 8
154	154	and for uninsured persons, through improve-9
155	155	ments in population health, reductions in health 10
156	156	care utilization (such as inpatient admissions, 11
157	157	utilization of emergency departments, and 12
158	158	boarding of patients), and otherwise; 13
159	159	‘‘(H) how such innovations can be expected 14
160	160	to improve the mental and physical health sta-15
161	161	tus of minority populations; 16
162	162	‘‘(I) how such innovations can be expected 17
163	163	to reduce other non-medical public expendi-18
164	164	tures; 19
165	165	‘‘(J) metrics to track care quality, im-20
166	166	provement in outcomes, and the impact of such 21
167	167	innovations on health care and other public ex-22
168	168	penditures; 23
169	169	‘‘(K) how program outcomes will be as-24
170	170	sessed and evaluated; and 25
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174	174	‘‘(L) how the hospital will collect and orga-1
175	175	nize data and fully participate in the learning 2
176	176	collaborative established under subsection (e). 3
177	177	‘‘(3) P
178	178	ARTICIPATION; PAYMENTS.—The Sec-4
179	179	retary shall negotiate an annualized payment ar-5
180	180	rangement with each eligible hospital participating 6
181	181	in the program. Such arrangement may include an 7
182	182	annual lump sum amount, capitated payment 8
183	183	amount, or such other arrangement as determined 9
184	184	appropriate by the Secretary, and which may include 10
185	185	an arrangement that includes financial risk for the 11
186	186	hospital, to support implementation of the innova-12
187	187	tions specified in the plan described in paragraph 13
188	188	(2). 14
189	189	‘‘(e) L
190	190	EARNINGCOLLABORATIVE.— 15
191	191	‘‘(1) I
192	192	N GENERAL.—The Secretary shall estab-16
193	193	lish a learning collaborative that shall convene eligi-17
194	194	ble hospitals participating in the program and other 18
195	195	interested parties on a regular basis to report on 19
196	196	and share information regarding evidence-based in-20
197	197	novations addressing mental and physical health 21
198	198	comorbidities, innovations addressing social deter-22
199	199	minants of health, and associated metrics and out-23
200	200	comes. 24
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204	204	‘‘(2) FOCUSED FORUMS .—The Secretary may 1
205	205	establish different focused forums within the collabo-2
206	206	rative, such as ones that specifically address dif-3
207	207	ferent geographic regions (such as urban and rural), 4
208	208	certain types of comorbidities, or as the Secretary 5
209	209	otherwise determines appropriate based on the types 6
210	210	of agreements entered into under subsection (d). 7
211	211	‘‘(3) D
212	212	ISSEMINATION OF INFORMATION .—The 8
213	213	Secretary shall provide for the dissemination to 9
214	214	other health care providers and interested parties of 10
215	215	information on promising and effective activities. 11
216	216	‘‘(f) D
217	217	EFINITIONS.—For purposes of this section: 12
218	218	‘‘(1) A
219	219	PPLICABLE INDIVIDUAL.—The term ‘ap-13
220	220	plicable individual’ means an individual with mental 14
221	221	and physical health comorbidities who is— 15
222	222	‘‘(A) a subsidy eligible individual (as de-16
223	223	fined in section 1860D–14(a)(3)(A)) without 17
224	224	regard to clause (i) of such section; 18
225	225	‘‘(B) enrolled under a State plan (or waiv-19
226	226	er of such plan) under title XIX; or 20
227	227	‘‘(C) uninsured. 21
228	228	‘‘(2) E
229	229	LIGIBLE HOSPITAL.—The term ‘eligible 22
230	230	hospital’ means a hospital that is— 23
231	231	‘‘(A) a rural hospital with a dispropor-24
232	232	tionate patient percentage of at least 35 percent 25
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236	236	(as determined by the Secretary under section 1
237	237	1886(d)(5)(F)(vi)) or would have a dispropor-2
238	238	tionate patient percentage of at least 35 percent 3
239	239	(as so determined) if the hospital were a sub-4
240	240	section (d) hospital (or, a percentage of inpa-5
241	241	tient days consisting of items and services fur-6
242	242	nished to individuals entitled to benefits under 7
243	243	part A that exceeds 85 percent of all such days) 8
244	244	that is either a critical access hospital, a sole 9
245	245	community hospital (as defined in section 10
246	246	1886(d)(5)(D)(iii)), or a medicare-dependent, 11
247	247	small rural hospital (as defined in section 12
248	248	1886(d)(5)(G)(iv)); 13
249	249	‘‘(B) a large subsection (d) teaching and 14
250	250	tertiary hospital with more than 200 beds that 15
251	251	as of, or subsequent to July 1, 2020, has an av-16
252	252	erage Medicare case mix index of at least 1.5, 17
253	253	an intern and resident-to-bed ratio of at least 18
254	254	0.25 percent (or at least 150 full-time equiva-19
255	255	lent interns, residents, and fellows), and is ei-20
256	256	ther a public hospital with a disproportionate 21
257	257	patient percentage of at least 35 percent (as de-22
258	258	termined by the Secretary under section 23
259	259	1886(d)(5)(F)(vi)) or a nonprofit hospital with 24
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263	263	a disproportionate patient percentage of at least 1
264	264	45 percent; or 2
265	265	‘‘(C) a small subsection (d) urban safety 3
266	266	net hospital (as determined by the Secretary) 4
267	267	with less than 200 beds that is deemed to be 5
268	268	a disproportionate share hospital under section 6
269	269	1923(b). 7
270	270	‘‘(3) I
271	271	NNOVATIONS ADDRESSING MENTAL AND 8
272	272	PHYSICAL HEALTH COMORBIDITIES .—The term ‘in-9
273	273	novations addressing mental and physical health 10
274	274	comorbidities’ means innovations implemented by an 11
275	275	eligible hospital that seek to promote holistic care 12
276	276	and treatment of an applicable individual’s co-occur-13
277	277	ring mental and physical health comorbidities, sup-14
278	278	port early detection of such comorbidities, or prevent 15
279	279	their onset, including the following: 16
280	280	‘‘(A) Implementation of interdisciplinary 17
281	281	integrative coordinated care team models, in-18
282	282	cluding those that utilize mental health emer-19
283	283	gency department in-reach staff (and other 20
284	284	emergency-department interventions), care co-21
285	285	ordination staff and social services support, and 22
286	286	clinic-based services. 23
287	287	‘‘(B) Integration of mental health services 24
288	288	into medical homes, coordinated care organiza-25
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292	292	tions, accountable care entities, and in-home 1
293	293	services. 2
294	294	‘‘(C) Incorporation of mental health and 3
295	295	social risk screening into medical screening, 4
296	296	particularly in child and adolescent populations. 5
297	297	‘‘(D) Preventing adverse impacts on men-6
298	298	tal health resulting from physical health treat-7
299	299	ments or medications, or on physical health re-8
300	300	sulting from mental health treatments or medi-9
301	301	cations, through cross disciplinary provider edu-10
302	302	cation, quality metrics, and other mechanisms. 11
303	303	‘‘(E) Improvements in electronic health 12
304	304	records and other technology platforms or net-13
305	305	works to capture, track, and monitor mental 14
306	306	and physical health treatments and medications 15
307	307	provided across care settings and otherwise fa-16
308	308	cilitate care coordination. 17
309	309	‘‘(F) Piloting of reimbursement modifica-18
310	310	tions that utilize site-neutral payments and that 19
311	311	address conflicts and disincentives related to 20
312	312	chronic care management and behavioral health 21
313	313	management and differential treatment of inpa-22
314	314	tient and outpatient settings. 23
315	315	‘‘(G) Mitigating the incidence of admission 24
316	316	and readmission into psychiatric inpatient set-25
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320	320	tings of chronically ill elderly patients through 1
321	321	methods such as active inpatient management, 2
322	322	variations in initial length of stay, enhanced 3
323	323	discharge planning, and psychosocial interven-4
324	324	tions. 5
325	325	‘‘(H) Delivering health behavior assess-6
326	326	ments and interventions to improve physical 7
327	327	health outcomes for patients and aid in the 8
328	328	management of chronic health conditions. 9
329	329	‘‘(I) In coordination with law enforcement 10
330	330	agencies and judicial entities, interventions tar-11
331	331	geted at providing mental and physical health 12
332	332	services (including, as appropriate, substance 13
333	333	use disorder services) to individuals convicted of 14
334	334	criminal offenses for purposes of mitigating re-15
335	335	cidivism. 16
336	336	‘‘(4) I
337	337	NNOVATIONS ADDRESSING SOCIAL DETER -17
338	338	MINANTS OF HEALTH .—The term ‘innovations ad-18
339	339	dressing social determinants of health’ means inno-19
340	340	vations implemented by an eligible hospital that seek 20
341	341	to address social determinants of health that nega-21
342	342	tively impact the health outcomes of applicable indi-22
343	343	viduals, including the following: 23
344	344	‘‘(A) Improvements in electronic health 24
345	345	records to better integrate mental health, med-25
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349	349	ical care, and social care (such as screening for 1
350	350	social factors, facilitated or closed loop referral, 2
351	351	risk stratification, and shared records with com-3
352	352	munity-based organizations). 4
353	353	‘‘(B) Personnel-supported ‘wrap around’ 5
354	354	services for at-risk individuals with mental and 6
355	355	physical health comorbidities (such as nutrition 7
356	356	and diet counseling, social services referral, res-8
357	357	piratory therapy, medical-legal assistance, fi-9
358	358	nancial counseling, consumer education, phar-10
359	359	macy education, asthma education, and referral 11
360	360	to food resources such as referral to the SNAP 12
361	361	program, the WIC program, a food bank, case 13
362	362	management assistance, employment or edu-14
363	363	cation support, intimate partner violence, and 15
364	364	behavioral health support). 16
365	365	‘‘(C) Home and community-based services 17
366	366	that provide collaborative care to address men-18
367	367	tal and physical health comorbidities through 19
368	368	health behavior services, nutrition support, 20
369	369	medication management, transitional care, tele-21
370	370	health, mobile integrated health care, para-22
371	371	medic-based home visitation, or utilization of 23
372	372	community health workers. 24
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376	376	‘‘(D) Hospital-based interventions (such as 1
377	377	same day primary care services, skilled nursing 2
378	378	interventions, substance use disorder and be-3
379	379	havioral health treatment coordination of care, 4
380	380	collaborative care models, discharge planning 5
381	381	and medication reconciliation, long-term care 6
382	382	management, and post-traumatic injury man-7
383	383	agement). 8
384	384	‘‘(5) I
385	385	NDIVIDUAL WITH MENTAL AND PHYSICAL 9
386	386	HEALTH COMORBIDITIES .—The term ‘individual 10
387	387	with mental and physical health comorbidities’ 11
388	388	means an individual who is challenged by serious 12
389	389	mental illness or serious emotional disturbance as 13
390	390	well as 1 or more of the following conditions or char-14
391	391	acteristics: 15
392	392	‘‘(A) Has or is at risk for one or more 16
393	393	chronic conditions (as defined by the Sec-17
394	394	retary). 18
395	395	‘‘(B) High-risk pregnancy. 19
396	396	‘‘(C) History of high utilization of acute 20
397	397	care services. 21
398	398	‘‘(D) Frail elderly (defined by impairments 22
399	399	in activities of daily living). 23
400	400	‘‘(E) Disability, including traumatic brain 24
401	401	injury. 25
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405	405	‘‘(F) Critical illness or injury requiring 1
406	406	long-term recovery. 2
407	407	‘‘(6) V
408	408	ULNERABLE COMMUNITY .—The term 3
409	409	‘vulnerable community’ means a geographic area 4
410	410	served by an eligible hospital characterized by a pop-5
411	411	ulation that has a statistically significant number of 6
412	412	individuals with mental and physical health 7
413	413	comorbidities, indicators of poor population health 8
414	414	status, low-income status, or status as a USDA-rec-9
415	415	ognized food desert. 10
416	416	‘‘(g) E
417	417	VALUATION AND REPORT.—Not later than 1 11
418	418	year after the date of completion of the program under 12
419	419	this section, the Secretary shall submit to Congress a re-13
420	420	port containing an evaluation of the activities supported 14
421	421	by the program. Such report shall include the following: 15
422	422	‘‘(1) A description of each such activity, includ-16
423	423	ing— 17
424	424	‘‘(A) the target population of such activity; 18
425	425	‘‘(B) how such activity addressed the ad-19
426	426	verse social determinants of health in such pop-20
427	427	ulation; and 21
428	428	‘‘(C) the role of community-based organi-22
429	429	zations and other community partners (such as 23
430	430	nonprofits and units of local government) in 24
431	431	such activity. 25
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435	435	‘‘(2) Evidence showing whether and how each 1
436	436	such activity advanced any of the following objec-2
437	437	tives: 3
438	438	‘‘(A) Improved access to care. 4
439	439	‘‘(B) Improved quality of care. 5
440	440	‘‘(C) Improved health outcomes. 6
441	441	‘‘(D) Amelioration of disparities in care. 7
442	442	‘‘(E) Improved care coordination. 8
443	443	‘‘(F) Reduction in health care costs (in-9
444	444	cluding such reductions under this title and 10
445	445	title XIX and such reductions occurring for un-11
446	446	insured individuals). 12
447	447	‘‘(G) Reduction in health care utilization 13
448	448	(including with respect to inpatient admissions, 14
449	449	utilization of emergency departments, and room 15
450	450	and board provided to individuals). 16
451	451	‘‘(H) Reduction in non-medical public ex-17
452	452	penditures. 18
453	453	‘‘(I) Changes in patient and provider satis-19
454	454	faction with care delivery. 20
455	455	‘‘(J) Reductions in involvement with the 21
456	456	justice system, including reductions in recidi-22
457	457	vism. 23
458	458	‘‘(3) A description of the metrics used to track 24
459	459	the implementation and results of each such activity. 25
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463	463	‘‘(4) Recommendations for any legislation or 1
464	464	administrative action the Secretary determines ap-2
465	465	propriate. 3
466	466	‘‘(h) F
467	467	UNDING.—Any funds appropriated under sec-4
468	468	tion 1115A(f) shall be available to the Secretary without 5
469	469	further appropriation for the purposes of carrying out this 6
470	470	section.’’. 7
471	471	Æ
472	472	VerDate Sep 11 2014 22:27 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6301 E:\BILLS\H2590.IH H2590
473	473	ssavage on LAPJG3WLY3PROD with BILLS