Us Congress 2025-2026 Regular Session

Us Congress Senate Bill SB1264 Compare Versions

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Old	New	Differences
1	1	II
2	2	119THCONGRESS
3	3	1
4	4	STSESSION S. 1264
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 SENATE OF THE UNITED STATES
9	9	APRIL2, 2025
10	10	Mr. B
11	11	ENNETintroduced the following bill; which was read twice and referred
12	12	to the Committee on Finance
13	13	A BILL
14	14	To amend title XVIII of the Social Security Act to establish
15	15	a demonstration program to promote collaborative treat-
16	16	ment of mental and physical health comorbidities under
17	17	the Medicare program.
18	18	Be it enacted by the Senate and House of Representa-1
19	19	tives of the United States of America in Congress assembled, 2
20	20	SECTION 1. SHORT TITLE. 3
21	21	This Act may be cited as the ‘‘Mental and Physical 4
22	22	Health Care Comorbidities Act of 2025’’. 5
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26	26	SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM TO 1
27	27	PROMOTE COLLABORATIVE TREATMENT OF 2
28	28	MENTAL AND PHYSICAL HEALTH 3
29	29	COMORBIDITIES UNDER THE MEDICARE PRO-4
30	30	GRAM. 5
31	31	Title XVIII of the Social Security Act (42 U.S.C. 6
32	32	1395 et seq.) is amended by inserting after section 1866G 7
33	33	the following new section: 8
34	34	‘‘SEC. 1866H. MENTAL AND PHYSICAL HEALTH 9
35	35	COMORBIDITIES COLLABORATIVE DEM-10
36	36	ONSTRATION PROGRAM. 11
37	37	‘‘(a) I
38	38	NGENERAL.—Consistent with the model de-12
39	39	scribed in section 1115A(b)(2)(B)(xv) (relating to pro-13
40	40	moting improved quality and reduced cost by developing 14
41	41	a collaborative of high-quality, low-cost health care institu-15
42	42	tions), the Secretary shall conduct a demonstration pro-16
43	43	gram (in this section referred to as the ‘program’) to test 17
44	44	and evaluate innovations implemented by eligible hospitals 18
45	45	(as defined in subsection (f)) in the furnishing of items 19
46	46	and services to applicable individuals (as defined in sub-20
47	47	section (f)) with mental and physical health comorbidities 21
48	48	(and those at risk of developing such comorbidities), in-22
49	49	cluding by addressing the adverse social determinants of 23
50	50	health that such individuals often experience. 24
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54	54	‘‘(b) ACTIVITIESUNDERPROGRAM.—Under the pro-1
55	55	gram, the Secretary shall, in coordination with eligible 2
56	56	hospitals participating in the program— 3
57	57	‘‘(1) identify, validate, and disseminate innova-4
58	58	tive, effective evidence-based best practices and mod-5
59	59	els that improve care and outcomes for applicable in-6
60	60	dividuals with mental and physical health 7
61	61	comorbidities located in vulnerable communities, in-8
62	62	cluding by addressing the social determinants of 9
63	63	health that adversely impact such individuals; and 10
64	64	‘‘(2) assist in the identification of potential pay-11
65	65	ment reforms under this title and title XIX that 12
66	66	could more broadly effectuate such improvements. 13
67	67	‘‘(c) D
68	68	URATION AND SCOPE.—The program con-14
69	69	ducted under this section shall operate during the period 15
70	70	beginning on October 1, 2025, and ending no later than 16
71	71	September 30, 2030. 17
72	72	‘‘(d) P
73	73	ROGRAMELEMENTS.— 18
74	74	‘‘(1) I
75	75	N GENERAL.—An eligible hospital electing 19
76	76	to participate in the program shall enter into an 20
77	77	agreement with the Secretary for purposes of car-21
78	78	rying out the activities described in subsection (b). 22
79	79	Such an agreement shall include the plan described 23
80	80	in paragraph (2), along with an annualized payment 24
81	81	arrangement as described in paragraph (3) to sup-25
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85	85	port implementation of such plan. Such agreement 1
86	86	shall include a requirement for the hospital to— 2
87	87	‘‘(A) engage in the learning collaborative 3
88	88	established under subsection (e); 4
89	89	‘‘(B) certify that all proposed innovations 5
90	90	under such plan will supplement and not sup-6
91	91	plant existing activities, whether by augmenting 7
92	92	existing activities or initiating new activities; 8
93	93	and 9
94	94	‘‘(C) remit payments made under such ar-10
95	95	rangement to the Secretary if the Secretary de-11
96	96	termines that such hospital has not complied 12
97	97	with the terms of such agreement. 13
98	98	‘‘(2) P
99	99	ROGRAM ELEMENTS .—An eligible hos-14
100	100	pital electing to participate in the program shall sub-15
101	101	mit a proposed plan and associated quality metrics 16
102	102	for review and approval by the Secretary. Such plan 17
103	103	and metrics shall, at a minimum, address— 18
104	104	‘‘(A) the specific innovations addressing 19
105	105	mental and physical health comorbidities (as de-20
106	106	fined in subsection (f)) and innovations ad-21
107	107	dressing social determinants of health (as de-22
108	108	fined in such subsection) that will be employed 23
109	109	and the evidence base supporting the proposed 24
110	110	approach; 25
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114	114	‘‘(B) the proposed target population of ap-1
115	115	plicable individuals with respect to which such 2
116	116	innovations will be employed, including a de-3
117	117	scription of the extent to which such population 4
118	118	consists of applicable individuals described in 5
119	119	subparagraph (A), (B), or (C) of subsection 6
120	120	(f)(1); 7
121	121	‘‘(C) the evidence-based data supporting a 8
122	122	community’s status as a vulnerable community 9
123	123	through sources, such as Bureau of the Census 10
124	124	data and measures such as the Neighborhood 11
125	125	Deprivation Index or the Child Opportunity 12
126	126	Index; 13
127	127	‘‘(D) community partners, such as non-14
128	128	profit organizations, federally qualified health 15
129	129	centers, rural health clinics, and units of local 16
130	130	government (including law enforcement and ju-17
131	131	dicial entities) that will participate in the imple-18
132	132	mentation of such innovations; 19
133	133	‘‘(E) how such innovations will address 20
134	134	mental and physical health comorbidities and 21
135	135	social determinants of health for the target pop-22
136	136	ulation; 23
137	137	‘‘(F) how such innovations may inform 24
138	138	changes in payment and other policies under 25
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142	142	this title and title XIX (such as care coordina-1
143	143	tion reimbursement, mental health homes, im-2
144	144	provements to home and community-based serv-3
145	145	ice portfolios, and coverage of supportive serv-4
146	146	ices); 5
147	147	‘‘(G) how such innovations might con-6
148	148	tribute to a reduction in overall health care 7
149	149	costs, including under this title and title XIX 8
150	150	and for uninsured persons, through improve-9
151	151	ments in population health, reductions in health 10
152	152	care utilization (such as inpatient admissions, 11
153	153	utilization of emergency departments, and 12
154	154	boarding of patients), and otherwise; 13
155	155	‘‘(H) how such innovations can be expected 14
156	156	to improve the mental and physical health sta-15
157	157	tus of minority populations; 16
158	158	‘‘(I) how such innovations can be expected 17
159	159	to reduce other non-medical public expendi-18
160	160	tures; 19
161	161	‘‘(J) metrics to track care quality, im-20
162	162	provement in outcomes, and the impact of such 21
163	163	innovations on health care and other public ex-22
164	164	penditures; 23
165	165	‘‘(K) how program outcomes will be as-24
166	166	sessed and evaluated; and 25
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170	170	‘‘(L) how the hospital will collect and orga-1
171	171	nize data and fully participate in the learning 2
172	172	collaborative established under subsection (e). 3
173	173	‘‘(3) P
174	174	ARTICIPATION; PAYMENTS.—The Sec-4
175	175	retary shall negotiate an annualized payment ar-5
176	176	rangement with each eligible hospital participating 6
177	177	in the program. Such arrangement may include an 7
178	178	annual lump sum amount, capitated payment 8
179	179	amount, or such other arrangement as determined 9
180	180	appropriate by the Secretary, and which may include 10
181	181	an arrangement that includes financial risk for the 11
182	182	hospital, to support implementation of the innova-12
183	183	tions specified in the plan described in paragraph 13
184	184	(2). 14
185	185	‘‘(e) L
186	186	EARNINGCOLLABORATIVE.— 15
187	187	‘‘(1) I
188	188	N GENERAL.—The Secretary shall estab-16
189	189	lish a learning collaborative that shall convene eligi-17
190	190	ble hospitals participating in the program and other 18
191	191	interested parties on a regular basis to report on 19
192	192	and share information regarding evidence-based in-20
193	193	novations addressing mental and physical health 21
194	194	comorbidities, innovations addressing social deter-22
195	195	minants of health, and associated metrics and out-23
196	196	comes. 24
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200	200	‘‘(2) FOCUSED FORUMS .—The Secretary may 1
201	201	establish different focused forums within the collabo-2
202	202	rative, such as ones that specifically address dif-3
203	203	ferent geographic regions (such as urban and rural), 4
204	204	certain types of comorbidities, or as the Secretary 5
205	205	otherwise determines appropriate based on the types 6
206	206	of agreements entered into under subsection (d). 7
207	207	‘‘(3) D
208	208	ISSEMINATION OF INFORMATION .—The 8
209	209	Secretary shall provide for the dissemination to 9
210	210	other health care providers and interested parties of 10
211	211	information on promising and effective activities. 11
212	212	‘‘(f) D
213	213	EFINITIONS.—For purposes of this section: 12
214	214	‘‘(1) A
215	215	PPLICABLE INDIVIDUAL.—The term ‘ap-13
216	216	plicable individual’ means an individual with mental 14
217	217	and physical health comorbidities who is— 15
218	218	‘‘(A) a subsidy eligible individual (as de-16
219	219	fined in section 1860D–14(a)(3)(A)) without 17
220	220	regard to clause (i) of such section; 18
221	221	‘‘(B) enrolled under a State plan (or waiv-19
222	222	er of such plan) under title XIX; or 20
223	223	‘‘(C) uninsured. 21
224	224	‘‘(2) E
225	225	LIGIBLE HOSPITAL.—The term ‘eligible 22
226	226	hospital’ means a hospital that is— 23
227	227	‘‘(A) a rural hospital with a dispropor-24
228	228	tionate patient percentage of at least 35 percent 25
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232	232	(as determined by the Secretary under section 1
233	233	1886(d)(5)(F)(vi)) or would have a dispropor-2
234	234	tionate patient percentage of at least 35 percent 3
235	235	(as so determined) if the hospital were a sub-4
236	236	section (d) hospital (or, a percentage of inpa-5
237	237	tient days consisting of items and services fur-6
238	238	nished to individuals entitled to benefits under 7
239	239	part A that exceeds 85 percent of all such days) 8
240	240	that is either a critical access hospital, a sole 9
241	241	community hospital (as defined in section 10
242	242	1886(d)(5)(D)(iii)), or a medicare-dependent, 11
243	243	small rural hospital (as defined in section 12
244	244	1886(d)(5)(G)(iv)); 13
245	245	‘‘(B) a large subsection (d) teaching and 14
246	246	tertiary hospital with more than 200 beds that 15
247	247	as of, or subsequent to July 1, 2020, has an av-16
248	248	erage Medicare case mix index of at least 1.5, 17
249	249	an intern and resident-to-bed ratio of at least 18
250	250	0.25 percent (or at least 150 full-time equiva-19
251	251	lent interns, residents, and fellows), and is ei-20
252	252	ther a public hospital with a disproportionate 21
253	253	patient percentage of at least 35 percent (as de-22
254	254	termined by the Secretary under section 23
255	255	1886(d)(5)(F)(vi)) or a nonprofit hospital with 24
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259	259	a disproportionate patient percentage of at least 1
260	260	45 percent; or 2
261	261	‘‘(C) a small subsection (d) urban safety 3
262	262	net hospital (as determined by the Secretary) 4
263	263	with less than 200 beds that is deemed to be 5
264	264	a disproportionate share hospital under section 6
265	265	1923(b). 7
266	266	‘‘(3) I
267	267	NNOVATIONS ADDRESSING MENTAL AND 8
268	268	PHYSICAL HEALTH COMORBIDITIES .—The term ‘in-9
269	269	novations addressing mental and physical health 10
270	270	comorbidities’ means innovations implemented by an 11
271	271	eligible hospital that seek to promote holistic care 12
272	272	and treatment of an applicable individual’s co-occur-13
273	273	ring mental and physical health comorbidities, sup-14
274	274	port early detection of such comorbidities, or prevent 15
275	275	their onset, including the following: 16
276	276	‘‘(A) Implementation of interdisciplinary 17
277	277	integrative coordinated care team models, in-18
278	278	cluding those that utilize mental health emer-19
279	279	gency department in-reach staff (and other 20
280	280	emergency-department interventions), care co-21
281	281	ordination staff and social services support, and 22
282	282	clinic-based services. 23
283	283	‘‘(B) Integration of mental health services 24
284	284	into medical homes, coordinated care organiza-25
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288	288	tions, accountable care entities, and in-home 1
289	289	services. 2
290	290	‘‘(C) Incorporation of mental health and 3
291	291	social risk screening into medical screening, 4
292	292	particularly in child and adolescent populations. 5
293	293	‘‘(D) Preventing adverse impacts on men-6
294	294	tal health resulting from physical health treat-7
295	295	ments or medications, or on physical health re-8
296	296	sulting from mental health treatments or medi-9
297	297	cations, through cross disciplinary provider edu-10
298	298	cation, quality metrics, and other mechanisms. 11
299	299	‘‘(E) Improvements in electronic health 12
300	300	records and other technology platforms or net-13
301	301	works to capture, track, and monitor mental 14
302	302	and physical health treatments and medications 15
303	303	provided across care settings and otherwise fa-16
304	304	cilitate care coordination. 17
305	305	‘‘(F) Piloting of reimbursement modifica-18
306	306	tions that utilize site-neutral payments and that 19
307	307	address conflicts and disincentives related to 20
308	308	chronic care management and behavioral health 21
309	309	management and differential treatment of inpa-22
310	310	tient and outpatient settings. 23
311	311	‘‘(G) Mitigating the incidence of admission 24
312	312	and readmission into psychiatric inpatient set-25
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316	316	tings of chronically ill elderly patients through 1
317	317	methods such as active inpatient management, 2
318	318	variations in initial length of stay, enhanced 3
319	319	discharge planning, and psychosocial interven-4
320	320	tions. 5
321	321	‘‘(H) Delivering health behavior assess-6
322	322	ments and interventions to improve physical 7
323	323	health outcomes for patients and aid in the 8
324	324	management of chronic health conditions. 9
325	325	‘‘(I) In coordination with law enforcement 10
326	326	agencies and judicial entities, interventions tar-11
327	327	geted at providing mental and physical health 12
328	328	services (including, as appropriate, substance 13
329	329	use disorder services) to individuals convicted of 14
330	330	criminal offenses for purposes of mitigating re-15
331	331	cidivism. 16
332	332	‘‘(4) I
333	333	NNOVATIONS ADDRESSING SOCIAL DETER -17
334	334	MINANTS OF HEALTH .—The term ‘innovations ad-18
335	335	dressing social determinants of health’ means inno-19
336	336	vations implemented by an eligible hospital that seek 20
337	337	to address social determinants of health that nega-21
338	338	tively impact the health outcomes of applicable indi-22
339	339	viduals, including the following: 23
340	340	‘‘(A) Improvements in electronic health 24
341	341	records to better integrate mental health, med-25
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345	345	ical care, and social care (such as screening for 1
346	346	social factors, facilitated or closed loop referral, 2
347	347	risk stratification, and shared records with com-3
348	348	munity-based organizations). 4
349	349	‘‘(B) Personnel-supported ‘wrap around’ 5
350	350	services for at-risk individuals with mental and 6
351	351	physical health comorbidities (such as nutrition 7
352	352	and diet counseling, social services referral, res-8
353	353	piratory therapy, medical-legal assistance, fi-9
354	354	nancial counseling, consumer education, phar-10
355	355	macy education, asthma education, and referral 11
356	356	to food resources such as referral to the SNAP 12
357	357	program, the WIC program, a food bank, case 13
358	358	management assistance, employment or edu-14
359	359	cation support, intimate partner violence, and 15
360	360	behavioral health support). 16
361	361	‘‘(C) Home and community-based services 17
362	362	that provide collaborative care to address men-18
363	363	tal and physical health comorbidities through 19
364	364	health behavior services, nutrition support, 20
365	365	medication management, transitional care, tele-21
366	366	health, mobile integrated health care, para-22
367	367	medic-based home visitation, or utilization of 23
368	368	community health workers. 24
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372	372	‘‘(D) Hospital-based interventions (such as 1
373	373	same day primary care services, skilled nursing 2
374	374	interventions, substance use disorder and be-3
375	375	havioral health treatment coordination of care, 4
376	376	collaborative care models, discharge planning 5
377	377	and medication reconciliation, long-term care 6
378	378	management, and post-traumatic injury man-7
379	379	agement). 8
380	380	‘‘(5) I
381	381	NDIVIDUAL WITH MENTAL AND PHYSICAL 9
382	382	HEALTH COMORBIDITIES .—The term ‘individual 10
383	383	with mental and physical health comorbidities’ 11
384	384	means an individual who is challenged by serious 12
385	385	mental illness or serious emotional disturbance as 13
386	386	well as 1 or more of the following conditions or char-14
387	387	acteristics: 15
388	388	‘‘(A) Has or is at risk for one or more 16
389	389	chronic conditions (as defined by the Sec-17
390	390	retary). 18
391	391	‘‘(B) High-risk pregnancy. 19
392	392	‘‘(C) History of high utilization of acute 20
393	393	care services. 21
394	394	‘‘(D) Frail elderly (defined by impairments 22
395	395	in activities of daily living). 23
396	396	‘‘(E) Disability, including traumatic brain 24
397	397	injury. 25
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401	401	‘‘(F) Critical illness or injury requiring 1
402	402	long-term recovery. 2
403	403	‘‘(6) V
404	404	ULNERABLE COMMUNITY .—The term 3
405	405	‘vulnerable community’ means a geographic area 4
406	406	served by an eligible hospital characterized by a pop-5
407	407	ulation that has a statistically significant number of 6
408	408	individuals with mental and physical health 7
409	409	comorbidities, indicators of poor population health 8
410	410	status, low-income status, or status as a USDA-rec-9
411	411	ognized food desert. 10
412	412	‘‘(g) E
413	413	VALUATION AND REPORT.—Not later than 1 11
414	414	year after the date of completion of the program under 12
415	415	this section, the Secretary shall submit to Congress a re-13
416	416	port containing an evaluation of the activities supported 14
417	417	by the program. Such report shall include the following: 15
418	418	‘‘(1) A description of each such activity, includ-16
419	419	ing— 17
420	420	‘‘(A) the target population of such activity; 18
421	421	‘‘(B) how such activity addressed the ad-19
422	422	verse social determinants of health in such pop-20
423	423	ulation; and 21
424	424	‘‘(C) the role of community-based organi-22
425	425	zations and other community partners (such as 23
426	426	nonprofits and units of local government) in 24
427	427	such activity. 25
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431	431	‘‘(2) Evidence showing whether and how each 1
432	432	such activity advanced any of the following objec-2
433	433	tives: 3
434	434	‘‘(A) Improved access to care. 4
435	435	‘‘(B) Improved quality of care. 5
436	436	‘‘(C) Improved health outcomes. 6
437	437	‘‘(D) Amelioration of disparities in care. 7
438	438	‘‘(E) Improved care coordination. 8
439	439	‘‘(F) Reduction in health care costs (in-9
440	440	cluding such reductions under this title and 10
441	441	title XIX and such reductions occurring for un-11
442	442	insured individuals). 12
443	443	‘‘(G) Reduction in health care utilization 13
444	444	(including with respect to inpatient admissions, 14
445	445	utilization of emergency departments, and room 15
446	446	and board provided to individuals). 16
447	447	‘‘(H) Reduction in non-medical public ex-17
448	448	penditures. 18
449	449	‘‘(I) Changes in patient and provider satis-19
450	450	faction with care delivery. 20
451	451	‘‘(J) Reductions in involvement with the 21
452	452	justice system, including reductions in recidi-22
453	453	vism. 23
454	454	‘‘(3) A description of the metrics used to track 24
455	455	the implementation and results of each such activity. 25
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459	459	‘‘(4) Recommendations for any legislation or 1
460	460	administrative action the Secretary determines ap-2
461	461	propriate. 3
462	462	‘‘(h) F
463	463	UNDING.—Any funds appropriated under sec-4
464	464	tion 1115A(f) shall be available to the Secretary without 5
465	465	further appropriation for the purposes of carrying out this 6
466	466	section.’’. 7
467	467	Æ
468	468	VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6301 E:\BILLS\S1264.IS S1264
469	469	ssavage on LAPJG3WLY3PROD with BILLS