II 

116TH CONGRESS 

2D SESSION S. 5034 

To empower communities to establish a continuum of care for individuals 

experiencing mental or behavioral health crisis, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 16, 2020 

Ms. CORTEZ MASTO introduced the following bill; which was read twice and 

referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To empower communities to establish a continuum of care 

for individuals experiencing mental or behavioral health 

crisis, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Behavioral Health Cri5 sis Services Expansion Act’’. 

6 SEC. 2. CRISIS RESPONSE CONTINUUM OF CARE. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services (in this section referred to as the ‘‘Sec9 retary’’) shall establish standards for a continuum of care 

10 for use by health care providers and communities in reVerDate Sep 11 2014 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034

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1 sponding to individuals experiencing a mental or behav2 ioral health crisis (referred to in this section as the ‘‘crisis 

3 response continuum’’). 

4 (b) REQUIREMENTS.— 

5 (1) SCOPE OF STANDARDS.—Such standards 

6 shall define— 

7 (A) minimum requirements of core crisis 

8 services, as determined by the Secretary, to in9 clude requirements that each entity that fur10 nishes such services should— 

11 (i) not require medical clearance prior 

12 to admission; 

13 (ii) serve all individuals regardless of 

14 ability to pay; 

15 (iii) operate 24 hours a day, 7 days a 

16 week, and provide care to all individuals; 

17 and 

18 (iv) provide care until the individual 

19 has been stabilized or transfer the indi20 vidual to the next level of crisis care; and 

21 (B) psychiatric stabilization, including the 

22 point at which a case may be closed for— 

23 (i) individuals screened over the 

24 phone; and 


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1 (ii) individuals stabilized on the scene 

2 by mobile teams. 

3 (2) IDENTIFICATION OF ESSENTIAL FUNCTIONS

4 AND OBJECTIVES.—The Secretary shall identify the 

5 essential functions and objectives of each service in 

6 the crisis response continuum, which shall include at 

7 least the following: 

8 (A) Identification of resources for referral 

9 and enrollment in continuing behavioral health 

10 and other human services for the individual in 

11 crisis where necessary. 

12 (B) Delineation of access and entry points 

13 to services within the crisis response continuum. 

14 (C) Development of and adherence to pro15 tocols and agreements for the transfer and re16 ceipt of individuals to and from other segments 

17 of the crisis response continuum segments as 

18 needed, and from outside referrals including 

19 health care providers, law enforcement, EMS, 

20 and fire. 

21 (D) Description of the qualifications of cri22 sis services staff, including roles for physicians, 

23 licensed clinicians, case managers, and peers. 

24 (E) Requirements for the convention of 

25 collaborative meetings of crisis response service 


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1 providers, first responders, and community 

2 partners operating in a common region for the 

3 discussion of case management, best practices, 

4 and general performance improvement. 

5 (3) SERVICE CAPACITY AND QUALITY STAND6 ARDS.—Such standards shall include definitions of— 

7 (A) adequate volume of services to meet 

8 population need; 

9 (B) timeliness of response; and 

10 (C) capacity to meet the needs of different 

11 patient populations, including all age groups, 

12 cultural and linguistic minorities, and individ13 uals with co-occurring mental health and sub14 stance use disorder crisis, individuals with cog15 nitive disabilities with behavioral health crises, 

16 and individuals with chronic medical conditions 

17 and physical disabilities who experience behav18 ioral health crises. 

19 (4) OVERSIGHT AND ACCREDITATION.—The 

20 Secretary shall designate entities charged with the 

21 oversight and accreditation of entities within the cri22 sis response continuum. 

23 (5) IMPLEMENTATION TIMEFRAME.—Not later 

24 than 1 year after the date of enactment of this Act, 


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1 the Secretary shall establish the standards under 

2 this section. 

3 (6) DATA COLLECTION AND EVALUATIONS.— 

4 (A) IN GENERAL.—The Secretary, directly 

5 or through grants, contracts, or interagency 

6 agreements, shall collect data and conduct eval7 uations with respect to the provision of services 

8 and programs offered on the crisis response 

9 continuum for purposes of assessing the extent 

10 to which the provision of such services and pro11 grams meet certain objectives as determined by 

12 the Secretary. Such objectives shall include— 

13 (i) a reduction in inappropriate ar14 rests of individuals who are in mental 

15 health crisis; 

16 (ii) a reduction in emergency room re17 admissions; and 

18 (iii) adequate access to crisis care cen19 ters and crisis bed services. 

20 (B) AUTHORIZATION OF APPROPRIA21 TIONS.—To carry out this subsection, there are 

22 authorized to be appropriated $1,000,000, to 

23 remain available until expended. 


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1 (c) COMPONENTS OF CRISIS RESPONSE CON2 TINUUM.—The crisis response continuum consists of at 

3 least the following components: 

4 (1) CRISIS CALL CENTERS.—Regional clinically 

5 staffed crisis call centers that provide telephonic cri6 sis intervention capabilities. Such centers should 

7 meet National Suicide Prevention Lifeline oper8 ational guidelines regarding suicide risk assessment 

9 and engagement and offer air traffic control-quality 

10 coordination of crisis care in real-time. 

11 (2) MOBILE CRISIS RESPONSE TEAM.—Teams 

12 of providers that are available to reach any indi13 vidual in the service area in their home, workplace, 

14 or any other community-based location of the indi15 vidual in crisis in a timely manner. 

16 (3) CRISIS RECEIVING AND STABILIZATION FA17 CILITIES.—Subacute inpatient facilities and other 

18 facilities specified by the Secretary that provide 

19 short-term observation and crisis stabilization serv20 ices to all referrals, including the following services: 

21 (A) 23-HOUR CRISIS STABILIZATION SERV22 ICES.—A direct care service that provides indi23 viduals in severe distress with up to 23 consecu24 tive hours of supervised care to assist with deVerDate Sep 11 2014 22:49 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034

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1 escalating the severity of their crisis or need for 

2 urgent care in a sub-acute inpatient setting. 

3 (B) SHORT-TERM CRISIS RESIDENTIAL

4 SERVICES.—A direct care service that assists 

5 with deescalating the severity of an individual’s 

6 level of distress or need for urgent care associ7 ated with a substance use or mental health dis8 order in a residential setting. 

9 (4) BEHAVIORAL HEALTH URGENT CARE FA10 CILITIES.—Ambulatory services available 12–24 

11 hours per day, 7 days a week, where individuals ex12 periencing crisis can walk in without an appointment 

13 to receive crisis assessment, crisis intervention, 

14 medication, and connection to continuity of care. 

15 (5) ADDITIONAL FACILITIES AND PROVIDERS.— 

16 The Secretary shall specify additional facilities and 

17 health care providers as part of the crisis response 

18 continuum, as the Secretary determines appropriate. 

19 SEC. 3. COVERAGE OF CRISIS RESPONSE SERVICES. 

20 (a) COVERAGE UNDER THE MEDICARE PROGRAM.— 

21 (1) IN GENERAL.—Section 1861(s)(2) of the 

22 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

23 amended— 

24 (A) in subparagraph (GG), by striking 

25 ‘‘and’’ at the end; 


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1 (B) in subparagraph (HH), by striking the 

2 period at the end and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(II) crisis response services as defined in sub6 section (kkk);’’. 

7 (2) CRISIS RESPONSE SERVICES DEFINED.— 

8 Section 1861 of the Social Security Act (42 U.S.C. 

9 1395x) is amended by adding at the end thereof the 

10 following new subsection: 

11 ‘‘Crisis Response Services Defined 

12 ‘‘(kkk)(1) IN GENERAL.—The term ‘crisis response 

13 services’ means mental or behavioral health services that 

14 are furnished by a mobile crisis response team, a crisis 

15 receiving and stabilization facility, behavioral health ur16 gent care facility, or other appropriate provider of services 

17 or supplier, as determined by the Secretary, to an indi18 vidual experiencing a mental or behavioral health crisis. 

19 Such term includes services identified by the Secretary as 

20 part of the crisis response continuum of care under section 

21 2 of the Behavioral Health Crisis Services Expansion Act. 

22 ‘‘(2) DEFINITIONS.—In this subsection, the terms 

23 ‘mobile crisis response team’, ‘crisis receiving and sta24 bilization facility’, and ‘behavioral health urgent care facilVerDate Sep 11 2014 21:32 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S5034.IS S5034

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1 ity’ have the meaning given those terms for purposes of 

2 such section.’’. 

3 (3) AMOUNT OF PAYMENT.—Section 1834 of 

4 the Social Security Act (42 U.S.C. 1395m) is 

5 amended by adding at the end the following new 

6 subsection: 

7 (A) TECHNICAL CORRECTION TO ENSURE

8 PROPER PLACEMENT.—Section 6002(a)(1)(B) 

9 of division F of the Families First Coronavirus 

10 Response Act (Public Law 116–127) is amend11 ed, in the amendatory language, by striking 

12 ‘‘the period’’ and inserting ‘‘the semicolon’’. 

13 (B) PAYMENT.—Section 1833(a)(1) of the 

14 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

15 amended— 

16 (i) by striking ‘‘and (DD)’’ and in17 serting ‘‘(DD)’’; and 

18 (ii) by inserting before the semicolon 

19 at the end the following: ‘‘and (EE) with 

20 respect to crisis response services described 

21 in section 1861(s)(2)(II), the amounts paid 

22 shall be 80 percent of the lesser of the ac23 tual charge for the service or the amount 

24 determined under a fee schedule estab25 lished by the Secretary’’. 


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1 (4) AMBULANCE TRANSPORT OF INDIVIDUALS

2 IN CRISIS.— 

3 (A) IN GENERAL.—Section 1834(l) of the 

4 Social Security Act (42 U.S.C. 1395m(l)) is 

5 amended by adding at the end the following 

6 new paragraph: 

7 ‘‘(18) TRANSPORTATION OF INDIVIDUALS IN

8 CRISIS.—With respect to ambulance services fur9 nished on or after the date that is 1 year after the 

10 date of the enactment of the Behavioral Health Cri11 sis Services Expansion Act, the regulations described 

12 in section 1861(s)(7) shall provide coverage under 

13 such section for ambulance services to transport an 

14 individual experiencing a mental or behavioral health 

15 crisis to an appropriate facility, such as a commu16 nity mental health center (as defined in section 

17 1861(ff)(3)(B)) or other facility or provider identi18 fied by the Secretary as part of the crisis response 

19 continuum of care under section 2 of the Behavioral 

20 Health Crisis Services Expansion Act, as appro21 priate, for crisis response services described in sec22 tion 1861(s)(2)(II).’’. 

23 (B) CONFORMING AMENDMENT.—Section 

24 1861(s)(7) of such Act (42 U.S.C. 1395x(s)(7)) 

25 is amended by striking ‘‘section 1834(l)(14)’’ 


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1 and inserting ‘‘paragraphs (14) and (18) of sec2 tion 1834(l)’’. 

3 (5) EFFECTIVE DATE.—The amendments made 

4 by this subsection shall apply to services furnished 

5 on or after the date that is 1 year after the date of 

6 the enactment of this Act. 

7 (b) MANDATORY COVERAGE OF CRISIS RESPONSE

8 SERVICES UNDER THE MEDICAID PROGRAM.— 

9 (1) IN GENERAL.—Title XIX of the Social Se10 curity Act (42 U.S.C. 1396 et seq.) is amended— 

11 (A) in section 1902(a)(10)(A), in the mat12 ter preceding clause (i), by striking ‘‘and (29)’’ 

13 and inserting ‘‘(29), and (30)’’; and 

14 (B) in section 1905(a)— 

15 (i) in paragraph (29), by striking ‘‘; 

16 and’’ and inserting a semicolon; 

17 (ii) by redesignating paragraph (30) 

18 as paragraph (31); and 

19 (iii) by inserting the following para20 graph after paragraph (29): 

21 ‘‘(30) crisis response services (as defined in sec22 tion 1861(kkk)); and’’. 

23 (2) PRESUMPTIVE ELIGIBILITY DETERMINA24 TION BY CRISIS RESPONSE SERVICE PROVIDERS.— 

25 Section 1902(a)(47)(B) of the Social Security Act 


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1 (42 U.S.C. 1396a(a)(47)(B)) is amended by insert2 ing ‘‘or provider of crisis response services (as de3 fined in section 1861(kkk))’’ after ‘‘any hospital’’. 

4 (3) EFFECTIVE DATE.— 

5 (A) IN GENERAL.—Except as provided in 

6 subparagraph (B), the amendments made by 

7 this section shall take effect on the date that is 

8 1 year after the date of the enactment of this 

9 Act. 

10 (B) DELAY PERMITTED IF STATE LEGISLA11 TION REQUIRED.—In the case of a State plan 

12 under title XIX of the Social Security Act (42 

13 U.S.C. 1396 et seq.) which the Secretary of 

14 Health and Human Services determines re15 quires State legislation (other than legislation 

16 appropriating funds) in order for the plan to 

17 meet the additional requirements imposed by 

18 the amendments made by this section, the State 

19 plan shall not be regarded as failing to comply 

20 with the requirements of such title solely on the 

21 basis of the failure of the plan to meet such ad22 ditional requirements before the 1st day of the 

23 1st calendar quarter beginning after the close 

24 of the 1st regular session of the State legisla25 ture that begins after the date of enactment of 


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1 this Act. For purposes of the previous sentence, 

2 in the case of a State that has a 2-year legisla3 tive session, each year of such session shall be 

4 deemed to be a separate regular session of the 

5 State legislature. 

6 (c) ESSENTIAL HEALTH BENEFITS.—Section 

7 1302(b)(1)(E) of the Patient Protection and Affordable 

8 Care Act (42 U.S.C. 18022(b)(1)(E)) is amended by in9 serting ‘‘and crisis response services (as defined in section 

10 1861(kkk) of the Social Security Act)’’ before the period. 

11 (d) GROUP HEALTH PLANS.—Section 2707 of the 

12 Public Health Service Act (42 U.S.C. 300gg–6) is amend13 ed by adding at the end the following: 

14 ‘‘(e) CRISIS RESPONSE SERVICES.—A group health 

15 plan or a health insurance issuer that offers health insur16 ance coverage in the large group market shall ensure that 

17 such coverage includes crisis response services (as defined 

18 in section 1861(kkk) of the Social Security Act).’’. 

19 (e) TRICARE COVERAGE.— 

20 (1) IN GENERAL.—The Secretary of Defense 

21 shall provide coverage under the TRICARE program 

22 for crisis response services, as defined in section 

23 1861(kkk) of the Social Security Act (42 U.S.C. 

24 1395x) (as amended by section 3). 


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1 (2) TRICARE PROGRAM DEFINED.—In this 

2 section, the term ‘‘TRICARE program’’ has the 

3 meaning given the term in section 1072 of title 10, 

4 United States Code. 

5 (f) REIMBURSEMENT FOR CRISIS RESPONSE SERV6 ICES FOR VETERANS.—Section 1725(f)(1) of title 38, 

7 United States Code, is amended, in the matter preceding 

8 subparagraph (A), by inserting ‘‘, including crisis response 

9 services (as defined in subsection (kkk) of section 1861 

10 of the Social Security Act (42 U.S.C. 1395x)),’’ after 

11 ‘‘services’’. 

12 (g) COVERAGE UNDER FEHB.— 

13 (1) IN GENERAL.—Section 8902 of title 5, 

14 United States Code, is amended by adding at the 

15 end the following: 

16 ‘‘(p) Each contract for a plan under this chapter shall 

17 require the carrier to provide coverage for crisis response 

18 services, as that term is defined in subsection (kkk) of sec19 tion 1861 of the Social Security Act (42 U.S.C. 1395x).’’. 

20 (2) EFFECTIVE DATE.—The amendment made 

21 by paragraph (1) shall apply beginning with respect 

22 to the first contract year for chapter 89 of title 5, 

23 United States Code, that begins on or after the date 

24 that is 1 year after the date of enactment of this 

25 Act. 


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1 SEC. 4. BUILDING THE CRISIS CONTINUUM INFRASTRUC2 TURE. 

3 (a) ADDITIONAL AMOUNTS FOR MENTAL HEALTH

4 BLOCK GRANT.—Section 1920 of the Public Health Serv5 ice Act (42 U.S.C. 300x–9) is amended by adding at the 

6 end the following: 

7 ‘‘(d) SUPPORT FOR CRISIS RESPONSE SERVICES IN8 FRASTRUCTURE.— 

9 ‘‘(1) IN GENERAL.—In addition to amounts 

10 made available under subsection (a), there are au11 thorized to be appropriated $35,000,000 for each of 

12 fiscal years 2021 and 2022, for purposes of sup13 porting the infrastructure needed to provide crisis 

14 response services (as defined in section 1861(kkk) of 

15 the Social Security Act) in the States. 

16 ‘‘(2) ALLOTMENTS.—Each fiscal year for which 

17 amounts are appropriated under paragraph (1), the 

18 Secretary shall allot to each State that receives a 

19 grant under section 1911 for the fiscal year an 

20 amount that bears the same relationship to the total 

21 amount appropriated under paragraph (1) for the 

22 fiscal year that the amount received by the State 

23 under section 1911(a) for the fiscal year bears to 

24 the total amount appropriated under subsection (a) 

25 for the fiscal year.’’. 


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1 (b) TECHNICAL ASSISTANCE.—The Secretary of 

2 Health and Human Services (referred to in this section 

3 as the ‘‘Secretary’’) shall provide to States technical as4 sistance regarding the provision of crisis response services, 

5 as defined in section 1861(kkk) of the Social Security Act 

6 (42 U.S.C. 1395x) (as amended by section 3). 

7 (c) CLEARINGHOUSE OF BEST PRACTICES.—The 

8 Secretary shall develop and maintain a publicly available 

9 clearinghouse of best practices for the successful operation 

10 of each segment of the system for providing crisis response 

11 services (as defined in section 1861(kkk) of the Social Se12 curity Act (42 U.S.C. 1395x) (as amended by section 3)) 

13 and the integration of such best practices into the provi14 sion of such services. The clearinghouse shall be updated 

15 annually. 

16 SEC. 5. INCIDENT REPORTING. 

17 (a) ESTABLISHMENT OF PROTOCOL PANEL.—The 

18 Secretary of Health and Human Services (referred to in 

19 this section as the ‘‘Secretary’’), in consultation with the 

20 Attorney General, shall convene a panel for the purposes 

21 of making recommendations for training and protocol for 

22 911 dispatchers to respond appropriately to individuals ex23 periencing a psychiatric crisis based on the characteristics 

24 of the incident and the needs of the caller. 


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1 (b) PANELISTS.—The Secretary shall appoint individ2 uals to serve staggered 10-year terms on the panel estab3 lished under subsection (a). Such individuals shall in4 clude— 

5 (1) firefighters; 

6 (2) emergency medical services personnel; 

7 (3) law enforcement officers; 

8 (4) 911 dispatchers; 

9 (5) representatives from each segment of the 

10 crisis response continuum, as described in section 2; 

11 and 

12 (6) other individuals, as the Secretary deter13 mines appropriate. 

14 (c) RECOMMENDATIONS.— 

15 (1) TOPICS.—In issuing recommendations 

16 under this section, the panel shall consider— 

17 (A) connecting 911 callers to crisis care 

18 services instead of responding with law enforce19 ment officers; 

20 (B) integrating the 988 system into the 

21 911 system, or transferring calls from the 911 

22 system to the 988 system as appropriate; and 

23 (C) a process for identifying 911 callers 

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1 fined by standardized assessment tools such as 

2 the Level of Care Utilization System (LOCUS) 

3 and the Child and Adolescent Level of Care 

4 Utilization System (CALOCUS). 

5 (2) UPDATES.—The panel shall update rec6 ommendations issued under this section not less fre7 quently than every 5 years. 

Æ 


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