II
119THCONGRESS
1
STSESSION S. 1264
To amend title XVIII of the Social Security Act to establish a demonstration
program to promote collaborative treatment of mental and physical health
comorbidities under the Medicare program.
IN THE SENATE OF THE UNITED STATES
APRIL2, 2025
Mr. B
ENNETintroduced the following bill; which was read twice and referred
to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to establish
a demonstration program to promote collaborative treat-
ment of mental and physical health comorbidities under
the Medicare program.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Mental and Physical 4
Health Care Comorbidities Act of 2025’’. 5
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 2
•S 1264 IS
SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM TO 1
PROMOTE COLLABORATIVE TREATMENT OF 2
MENTAL AND PHYSICAL HEALTH 3
COMORBIDITIES UNDER THE MEDICARE PRO-4
GRAM. 5
Title XVIII of the Social Security Act (42 U.S.C. 6
1395 et seq.) is amended by inserting after section 1866G 7
the following new section: 8
‘‘SEC. 1866H. MENTAL AND PHYSICAL HEALTH 9
COMORBIDITIES COLLABORATIVE DEM-10
ONSTRATION PROGRAM. 11
‘‘(a) I
NGENERAL.—Consistent with the model de-12
scribed in section 1115A(b)(2)(B)(xv) (relating to pro-13
moting improved quality and reduced cost by developing 14
a collaborative of high-quality, low-cost health care institu-15
tions), the Secretary shall conduct a demonstration pro-16
gram (in this section referred to as the ‘program’) to test 17
and evaluate innovations implemented by eligible hospitals 18
(as defined in subsection (f)) in the furnishing of items 19
and services to applicable individuals (as defined in sub-20
section (f)) with mental and physical health comorbidities 21
(and those at risk of developing such comorbidities), in-22
cluding by addressing the adverse social determinants of 23
health that such individuals often experience. 24
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 3
•S 1264 IS
‘‘(b) ACTIVITIESUNDERPROGRAM.—Under the pro-1
gram, the Secretary shall, in coordination with eligible 2
hospitals participating in the program— 3
‘‘(1) identify, validate, and disseminate innova-4
tive, effective evidence-based best practices and mod-5
els that improve care and outcomes for applicable in-6
dividuals with mental and physical health 7
comorbidities located in vulnerable communities, in-8
cluding by addressing the social determinants of 9
health that adversely impact such individuals; and 10
‘‘(2) assist in the identification of potential pay-11
ment reforms under this title and title XIX that 12
could more broadly effectuate such improvements. 13
‘‘(c) D
URATION AND SCOPE.—The program con-14
ducted under this section shall operate during the period 15
beginning on October 1, 2025, and ending no later than 16
September 30, 2030. 17
‘‘(d) P
ROGRAMELEMENTS.— 18
‘‘(1) I
N GENERAL.—An eligible hospital electing 19
to participate in the program shall enter into an 20
agreement with the Secretary for purposes of car-21
rying out the activities described in subsection (b). 22
Such an agreement shall include the plan described 23
in paragraph (2), along with an annualized payment 24
arrangement as described in paragraph (3) to sup-25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 4
•S 1264 IS
port implementation of such plan. Such agreement 1
shall include a requirement for the hospital to— 2
‘‘(A) engage in the learning collaborative 3
established under subsection (e); 4
‘‘(B) certify that all proposed innovations 5
under such plan will supplement and not sup-6
plant existing activities, whether by augmenting 7
existing activities or initiating new activities; 8
and 9
‘‘(C) remit payments made under such ar-10
rangement to the Secretary if the Secretary de-11
termines that such hospital has not complied 12
with the terms of such agreement. 13
‘‘(2) P
ROGRAM ELEMENTS .—An eligible hos-14
pital electing to participate in the program shall sub-15
mit a proposed plan and associated quality metrics 16
for review and approval by the Secretary. Such plan 17
and metrics shall, at a minimum, address— 18
‘‘(A) the specific innovations addressing 19
mental and physical health comorbidities (as de-20
fined in subsection (f)) and innovations ad-21
dressing social determinants of health (as de-22
fined in such subsection) that will be employed 23
and the evidence base supporting the proposed 24
approach; 25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 5
•S 1264 IS
‘‘(B) the proposed target population of ap-1
plicable individuals with respect to which such 2
innovations will be employed, including a de-3
scription of the extent to which such population 4
consists of applicable individuals described in 5
subparagraph (A), (B), or (C) of subsection 6
(f)(1); 7
‘‘(C) the evidence-based data supporting a 8
community’s status as a vulnerable community 9
through sources, such as Bureau of the Census 10
data and measures such as the Neighborhood 11
Deprivation Index or the Child Opportunity 12
Index; 13
‘‘(D) community partners, such as non-14
profit organizations, federally qualified health 15
centers, rural health clinics, and units of local 16
government (including law enforcement and ju-17
dicial entities) that will participate in the imple-18
mentation of such innovations; 19
‘‘(E) how such innovations will address 20
mental and physical health comorbidities and 21
social determinants of health for the target pop-22
ulation; 23
‘‘(F) how such innovations may inform 24
changes in payment and other policies under 25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 6
•S 1264 IS
this title and title XIX (such as care coordina-1
tion reimbursement, mental health homes, im-2
provements to home and community-based serv-3
ice portfolios, and coverage of supportive serv-4
ices); 5
‘‘(G) how such innovations might con-6
tribute to a reduction in overall health care 7
costs, including under this title and title XIX 8
and for uninsured persons, through improve-9
ments in population health, reductions in health 10
care utilization (such as inpatient admissions, 11
utilization of emergency departments, and 12
boarding of patients), and otherwise; 13
‘‘(H) how such innovations can be expected 14
to improve the mental and physical health sta-15
tus of minority populations; 16
‘‘(I) how such innovations can be expected 17
to reduce other non-medical public expendi-18
tures; 19
‘‘(J) metrics to track care quality, im-20
provement in outcomes, and the impact of such 21
innovations on health care and other public ex-22
penditures; 23
‘‘(K) how program outcomes will be as-24
sessed and evaluated; and 25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 7
•S 1264 IS
‘‘(L) how the hospital will collect and orga-1
nize data and fully participate in the learning 2
collaborative established under subsection (e). 3
‘‘(3) P
ARTICIPATION; PAYMENTS.—The Sec-4
retary shall negotiate an annualized payment ar-5
rangement with each eligible hospital participating 6
in the program. Such arrangement may include an 7
annual lump sum amount, capitated payment 8
amount, or such other arrangement as determined 9
appropriate by the Secretary, and which may include 10
an arrangement that includes financial risk for the 11
hospital, to support implementation of the innova-12
tions specified in the plan described in paragraph 13
(2). 14
‘‘(e) L
EARNINGCOLLABORATIVE.— 15
‘‘(1) I
N GENERAL.—The Secretary shall estab-16
lish a learning collaborative that shall convene eligi-17
ble hospitals participating in the program and other 18
interested parties on a regular basis to report on 19
and share information regarding evidence-based in-20
novations addressing mental and physical health 21
comorbidities, innovations addressing social deter-22
minants of health, and associated metrics and out-23
comes. 24
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 8
•S 1264 IS
‘‘(2) FOCUSED FORUMS .—The Secretary may 1
establish different focused forums within the collabo-2
rative, such as ones that specifically address dif-3
ferent geographic regions (such as urban and rural), 4
certain types of comorbidities, or as the Secretary 5
otherwise determines appropriate based on the types 6
of agreements entered into under subsection (d). 7
‘‘(3) D
ISSEMINATION OF INFORMATION .—The 8
Secretary shall provide for the dissemination to 9
other health care providers and interested parties of 10
information on promising and effective activities. 11
‘‘(f) D
EFINITIONS.—For purposes of this section: 12
‘‘(1) A
PPLICABLE INDIVIDUAL.—The term ‘ap-13
plicable individual’ means an individual with mental 14
and physical health comorbidities who is— 15
‘‘(A) a subsidy eligible individual (as de-16
fined in section 1860D–14(a)(3)(A)) without 17
regard to clause (i) of such section; 18
‘‘(B) enrolled under a State plan (or waiv-19
er of such plan) under title XIX; or 20
‘‘(C) uninsured. 21
‘‘(2) E
LIGIBLE HOSPITAL.—The term ‘eligible 22
hospital’ means a hospital that is— 23
‘‘(A) a rural hospital with a dispropor-24
tionate patient percentage of at least 35 percent 25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 9
•S 1264 IS
(as determined by the Secretary under section 1
1886(d)(5)(F)(vi)) or would have a dispropor-2
tionate patient percentage of at least 35 percent 3
(as so determined) if the hospital were a sub-4
section (d) hospital (or, a percentage of inpa-5
tient days consisting of items and services fur-6
nished to individuals entitled to benefits under 7
part A that exceeds 85 percent of all such days) 8
that is either a critical access hospital, a sole 9
community hospital (as defined in section 10
1886(d)(5)(D)(iii)), or a medicare-dependent, 11
small rural hospital (as defined in section 12
1886(d)(5)(G)(iv)); 13
‘‘(B) a large subsection (d) teaching and 14
tertiary hospital with more than 200 beds that 15
as of, or subsequent to July 1, 2020, has an av-16
erage Medicare case mix index of at least 1.5, 17
an intern and resident-to-bed ratio of at least 18
0.25 percent (or at least 150 full-time equiva-19
lent interns, residents, and fellows), and is ei-20
ther a public hospital with a disproportionate 21
patient percentage of at least 35 percent (as de-22
termined by the Secretary under section 23
1886(d)(5)(F)(vi)) or a nonprofit hospital with 24
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 10
•S 1264 IS
a disproportionate patient percentage of at least 1
45 percent; or 2
‘‘(C) a small subsection (d) urban safety 3
net hospital (as determined by the Secretary) 4
with less than 200 beds that is deemed to be 5
a disproportionate share hospital under section 6
1923(b). 7
‘‘(3) I
NNOVATIONS ADDRESSING MENTAL AND 8
PHYSICAL HEALTH COMORBIDITIES .—The term ‘in-9
novations addressing mental and physical health 10
comorbidities’ means innovations implemented by an 11
eligible hospital that seek to promote holistic care 12
and treatment of an applicable individual’s co-occur-13
ring mental and physical health comorbidities, sup-14
port early detection of such comorbidities, or prevent 15
their onset, including the following: 16
‘‘(A) Implementation of interdisciplinary 17
integrative coordinated care team models, in-18
cluding those that utilize mental health emer-19
gency department in-reach staff (and other 20
emergency-department interventions), care co-21
ordination staff and social services support, and 22
clinic-based services. 23
‘‘(B) Integration of mental health services 24
into medical homes, coordinated care organiza-25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 11
•S 1264 IS
tions, accountable care entities, and in-home 1
services. 2
‘‘(C) Incorporation of mental health and 3
social risk screening into medical screening, 4
particularly in child and adolescent populations. 5
‘‘(D) Preventing adverse impacts on men-6
tal health resulting from physical health treat-7
ments or medications, or on physical health re-8
sulting from mental health treatments or medi-9
cations, through cross disciplinary provider edu-10
cation, quality metrics, and other mechanisms. 11
‘‘(E) Improvements in electronic health 12
records and other technology platforms or net-13
works to capture, track, and monitor mental 14
and physical health treatments and medications 15
provided across care settings and otherwise fa-16
cilitate care coordination. 17
‘‘(F) Piloting of reimbursement modifica-18
tions that utilize site-neutral payments and that 19
address conflicts and disincentives related to 20
chronic care management and behavioral health 21
management and differential treatment of inpa-22
tient and outpatient settings. 23
‘‘(G) Mitigating the incidence of admission 24
and readmission into psychiatric inpatient set-25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 12
•S 1264 IS
tings of chronically ill elderly patients through 1
methods such as active inpatient management, 2
variations in initial length of stay, enhanced 3
discharge planning, and psychosocial interven-4
tions. 5
‘‘(H) Delivering health behavior assess-6
ments and interventions to improve physical 7
health outcomes for patients and aid in the 8
management of chronic health conditions. 9
‘‘(I) In coordination with law enforcement 10
agencies and judicial entities, interventions tar-11
geted at providing mental and physical health 12
services (including, as appropriate, substance 13
use disorder services) to individuals convicted of 14
criminal offenses for purposes of mitigating re-15
cidivism. 16
‘‘(4) I
NNOVATIONS ADDRESSING SOCIAL DETER -17
MINANTS OF HEALTH .—The term ‘innovations ad-18
dressing social determinants of health’ means inno-19
vations implemented by an eligible hospital that seek 20
to address social determinants of health that nega-21
tively impact the health outcomes of applicable indi-22
viduals, including the following: 23
‘‘(A) Improvements in electronic health 24
records to better integrate mental health, med-25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 13
•S 1264 IS
ical care, and social care (such as screening for 1
social factors, facilitated or closed loop referral, 2
risk stratification, and shared records with com-3
munity-based organizations). 4
‘‘(B) Personnel-supported ‘wrap around’ 5
services for at-risk individuals with mental and 6
physical health comorbidities (such as nutrition 7
and diet counseling, social services referral, res-8
piratory therapy, medical-legal assistance, fi-9
nancial counseling, consumer education, phar-10
macy education, asthma education, and referral 11
to food resources such as referral to the SNAP 12
program, the WIC program, a food bank, case 13
management assistance, employment or edu-14
cation support, intimate partner violence, and 15
behavioral health support). 16
‘‘(C) Home and community-based services 17
that provide collaborative care to address men-18
tal and physical health comorbidities through 19
health behavior services, nutrition support, 20
medication management, transitional care, tele-21
health, mobile integrated health care, para-22
medic-based home visitation, or utilization of 23
community health workers. 24
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 14
•S 1264 IS
‘‘(D) Hospital-based interventions (such as 1
same day primary care services, skilled nursing 2
interventions, substance use disorder and be-3
havioral health treatment coordination of care, 4
collaborative care models, discharge planning 5
and medication reconciliation, long-term care 6
management, and post-traumatic injury man-7
agement). 8
‘‘(5) I
NDIVIDUAL WITH MENTAL AND PHYSICAL 9
HEALTH COMORBIDITIES .—The term ‘individual 10
with mental and physical health comorbidities’ 11
means an individual who is challenged by serious 12
mental illness or serious emotional disturbance as 13
well as 1 or more of the following conditions or char-14
acteristics: 15
‘‘(A) Has or is at risk for one or more 16
chronic conditions (as defined by the Sec-17
retary). 18
‘‘(B) High-risk pregnancy. 19
‘‘(C) History of high utilization of acute 20
care services. 21
‘‘(D) Frail elderly (defined by impairments 22
in activities of daily living). 23
‘‘(E) Disability, including traumatic brain 24
injury. 25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 15
•S 1264 IS
‘‘(F) Critical illness or injury requiring 1
long-term recovery. 2
‘‘(6) V
ULNERABLE COMMUNITY .—The term 3
‘vulnerable community’ means a geographic area 4
served by an eligible hospital characterized by a pop-5
ulation that has a statistically significant number of 6
individuals with mental and physical health 7
comorbidities, indicators of poor population health 8
status, low-income status, or status as a USDA-rec-9
ognized food desert. 10
‘‘(g) E
VALUATION AND REPORT.—Not later than 1 11
year after the date of completion of the program under 12
this section, the Secretary shall submit to Congress a re-13
port containing an evaluation of the activities supported 14
by the program. Such report shall include the following: 15
‘‘(1) A description of each such activity, includ-16
ing— 17
‘‘(A) the target population of such activity; 18
‘‘(B) how such activity addressed the ad-19
verse social determinants of health in such pop-20
ulation; and 21
‘‘(C) the role of community-based organi-22
zations and other community partners (such as 23
nonprofits and units of local government) in 24
such activity. 25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 16
•S 1264 IS
‘‘(2) Evidence showing whether and how each 1
such activity advanced any of the following objec-2
tives: 3
‘‘(A) Improved access to care. 4
‘‘(B) Improved quality of care. 5
‘‘(C) Improved health outcomes. 6
‘‘(D) Amelioration of disparities in care. 7
‘‘(E) Improved care coordination. 8
‘‘(F) Reduction in health care costs (in-9
cluding such reductions under this title and 10
title XIX and such reductions occurring for un-11
insured individuals). 12
‘‘(G) Reduction in health care utilization 13
(including with respect to inpatient admissions, 14
utilization of emergency departments, and room 15
and board provided to individuals). 16
‘‘(H) Reduction in non-medical public ex-17
penditures. 18
‘‘(I) Changes in patient and provider satis-19
faction with care delivery. 20
‘‘(J) Reductions in involvement with the 21
justice system, including reductions in recidi-22
vism. 23
‘‘(3) A description of the metrics used to track 24
the implementation and results of each such activity. 25
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS 17
•S 1264 IS
‘‘(4) Recommendations for any legislation or 1
administrative action the Secretary determines ap-2
propriate. 3
‘‘(h) F
UNDING.—Any funds appropriated under sec-4
tion 1115A(f) shall be available to the Secretary without 5
further appropriation for the purposes of carrying out this 6
section.’’. 7
Æ
VerDate Sep 11 2014 21:48 Apr 07, 2025 Jkt 059200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6301 E:\BILLS\S1264.IS S1264
ssavage on LAPJG3WLY3PROD with BILLS