II 

117TH CONGRESS 

2D SESSION S. 4747 

To amend title XIX of the Social Security Act to expand the availability 

of mental, emotional, and behavioral health services under the Medicaid 

program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 2, 2022 

Mr. PORTMAN (for himself and Mr. CASEY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to expand 

the availability of mental, emotional, and behavioral 

health services under the Medicaid program, 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 ‘‘Investing in Kids’ 

5 Mental Health Now Act of 2022’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents for this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Payment rate increase for pediatric behavioral health services. 


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Sec. 4. Guidance to States on supporting mental, emotional, and behavioral 

health services, and on the availability of telehealth under Medicaid. 

Sec. 5. Ensuring children receive timely access to care. 

1 SEC. 3. PAYMENT RATE INCREASE FOR PEDIATRIC BEHAV2 IORAL HEALTH SERVICES. 

3 (a) PAYMENT RATE INCREASE FOR PEDIATRIC BE4 HAVIORAL HEALTH SERVICES.—Section 1902 of the So5 cial Security Act (42 U.S.C. 1396a) is amended— 

6 (1) in subsection (a)(13)— 

7 (A) in subparagraph (B), by striking 

8 ‘‘and’’ at the end; 

9 (B) in subparagraph (C), by adding ‘‘and’’ 

10 at the end; and 

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

12 subparagraph: 

13 ‘‘(D) that, for a 1-year period that begins 

14 not later than 6 months after the date of enact15 ment of this subparagraph, the State shall pay 

16 for pediatric mental, emotional, and behavioral 

17 health services (as defined in subsection (tt)) 

18 furnished during such period at a rate that is 

19 at least 1 percent, and not more than 9 per20 cent, higher than the rate that was applicable 

21 to such services under the State plan as of the 

22 day before the date that is 6 months before the 

23 date of enactment of this subparagraph;’’; and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(tt) PEDIATRIC MENTAL, EMOTIONAL, AND BEHAV4 IORAL HEALTH SERVICES DEFINED.—For purposes of 

5 subsection (a)(13)(D), the term ‘pediatric mental, emo6 tional, and behavioral health services’ means at least 10 

7 of the following services furnished by a health care pro8 vider, including hospitals, physicians, and other providers 

9 determined by the Secretary, for the purposes of screening 

10 for, identifying, diagnosing, or treating a mental, emo11 tional, or behavioral health condition, whether furnished 

12 in-person or via telehealth: 

13 ‘‘(1) Mental health and substance use disorder 

14 screenings. 

15 ‘‘(2) Mental health development assessments. 

16 ‘‘(3) Mental health behavior assessments and 

17 interventions. 

18 ‘‘(4) Psychological and neuropsychological test19 ing and assessment. 

20 ‘‘(5) Mental health primary prevention services. 

21 ‘‘(6) Mental health and substance use disorder 

22 case management services. 

23 ‘‘(7) School-based mental health and substance 

24 use disorder prevention, identification, and treat25 ment services. 


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1 ‘‘(8) Child and adolescent psychiatry and psy2 chology services. 

3 ‘‘(9) Partial hospitalization services. 

4 ‘‘(10) Day program services. 

5 ‘‘(11) Intensive outpatient services. 

6 ‘‘(12) Eating disorder treatment services. 

7 ‘‘(13) Outpatient services. 

8 ‘‘(14) Crisis residential services. 

9 ‘‘(15) Crisis intervention and stabilization. 

10 ‘‘(16) Inpatient psychiatric and psychological 

11 services. 

12 ‘‘(17) Individual therapy. 

13 ‘‘(18) Family therapy. 

14 ‘‘(19) Group therapy services. 

15 ‘‘(20) Intensive in-home services. 

16 ‘‘(21) Peer support services. 

17 ‘‘(22) Provider-to-provider consultation services 

18 involving primary care practitioners and mental 

19 health care specialists, including child and adoles20 cent specialists. 

21 ‘‘(23) Substance use disorder screening, includ22 ing SBIRT, and treatment. 

23 ‘‘(24) Medication management. 


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1 ‘‘(25) Any other pediatric mental, emotional, or 

2 behavioral health service determined appropriate by 

3 the Secretary.’’. 

4 (b) UNDER MEDICAID MANAGED CARE PLANS.— 

5 Section 1932(f) of such Act (42 U.S.C. 1396u–2(f)) is 

6 amended— 

7 (1) in the header, by inserting ‘‘AND PEDIATRIC

8 MENTAL, EMOTIONAL, AND BEHAVIORAL HEALTH’’ 

9 before ‘‘SERVICES’’; 

10 (2) by inserting ‘‘and pediatric mental, emo11 tional, and behavioral health services described in 

12 section 1902(a)(13)(D)’’ after ‘‘section 

13 1902(a)(13)(C)’’; and 

14 (3) by striking ‘‘such section’’ and inserting 

15 ‘‘section 1902(a)(13)’’. 

16 (c) INCREASE IN PAYMENT USING INCREASED

17 FMAP.—Section 1905 of the Social Security Act (42 

18 U.S.C. 1396d) is amended by adding at the end the fol19 lowing new subsection: 

20 ‘‘(jj) INCREASED FMAP FOR ADDITIONAL EXPENDI21 TURES FOR PEDIATRIC MENTAL, EMOTIONAL, AND BE22 HAVIORAL HEALTH SERVICES.—Notwithstanding sub23 section (b), with respect to the portion of the amounts ex24 pended for medical assistance for services described in sec25 tion 1902(a)(13)(D) that is furnished during the 1-year 


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1 period described in such section and that is attributable 

2 to the increase to the payment rate applicable to such 

3 services required under such section (or, by application, 

4 section 1932(f)), the Federal medical assistance percent5 age for a State that is one of the 50 States or the District 

6 of Columbia shall be equal to 100 percent. The preceding 

7 sentence does not prohibit the payment of Federal finan8 cial participation based on the Federal medical assistance 

9 percentage for amounts in excess of those specified in such 

10 sentence.’’. 

11 SEC. 4. GUIDANCE TO STATES ON SUPPORTING MENTAL, 

12 EMOTIONAL, AND BEHAVIORAL HEALTH 

13 SERVICES, AND ON THE AVAILABILITY OF 

14 TELEHEALTH UNDER MEDICAID. 

15 (a) MENTAL, EMOTIONAL, AND BEHAVIORAL

16 HEALTH SERVICES.—Not later than 180 days after date 

17 of enactment of this Act, the Secretary of Health and 

18 Human Services shall issue guidance to States on how to 

19 expand the provision of mental, emotional, and behavioral 

20 health services covered by State plans (or waivers of such 

21 plans) under title XIX of the Social Security Act (42 

22 U.S.C. 1396 et seq.), including a description of best prac23 tices for effective programs, service provision for under24 served communities, meeting the needs of children with 


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1 medical complexities, and recruitment and retention of 

2 providers. 

3 (b) MENTAL, EMOTIONAL, AND BEHAVIORAL TELE4 HEALTH SERVICES.—Not later than 1 year after date of 

5 enactment of this Act, the Secretary of Health and 

6 Human Services shall issue guidance to States on best 

7 practices to sustain and enhance the availability of mental, 

8 emotional, and behavioral telehealth services covered by 

9 State plans (or waivers of such plans) under title XIX of 

10 the Social Security Act (42 U.S.C. 1396 et seq.), including 

11 expanding the originating site requirement, delivering 

12 audio-only mental, emotional, and behavioral telehealth 

13 services, and streamlining provider licensing, 

14 credentialing, and enrollment protocols with respect to 

15 telehealth services furnished across State lines. 

16 SEC. 5. ENSURING CHILDREN RECEIVE TIMELY ACCESS TO 

17 CARE. 

18 (a) GUIDANCE TO STATES ON FLEXIBILITIES TO EN19 SURE PROVIDER CAPACITY TO PROVIDE PEDIATRIC MEN20 TAL, EMOTIONAL, AND BEHAVIORAL CRISIS CARE.—Not 

21 later than 60 days after the date of enactment of this Act, 

22 the Secretary of Health and Human Services shall provide 

23 guidance to States on best practices to support children 

24 in crisis or in need of intensive mental, emotional, or be25 havioral health services by using flexibilities for hospitals 


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1 and other providers under applicable laws, regulations, 

2 and guidance, including a description of how States are 

3 leveraging existing flexibilities to deliver crisis care. 

4 (b) MANDATED REPORT TO CONGRESS REGARDING

5 BARRIERS TO REPURPOSING OF BEDS, SPACE, AND

6 STAFF TO ADDRESS PEDIATRIC BEHAVIORAL HEALTH

7 NEEDS.— 

8 (1) IN GENERAL.—Not later than 120 days 

9 after the date of enactment of this Act, the Sec10 retary of Health and Human Services shall submit 

11 to the Congress a report with respect to regulatory, 

12 legal, and other barriers to care across the crisis 

13 continuum, including intermediate level care, such as 

14 intensive outpatient care or partial hospitalization, 

15 that identifies solutions to facilitate flexibility for 

16 children’s hospitals and other providers of mental, 

17 emotional, or behavioral health services. 

18 (2) REQUIREMENTS.—In preparing a report 

19 under this subsection, the Secretary of Health and 

20 Human Services shall include in such report— 

21 (A) a comprehensive list of laws, regula22 tions, and guidance impacting children’s hos23 pitals’ and other providers’ ability to repurpose 

24 immediately beds, space, and staff for children 

25 in need of mental, emotional, or behavioral 


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1 health services, including a description of the 

2 rationale for each policy and corresponding ac3 tions required to repurpose such beds, space, 

4 and staff; and 

5 (B) recommendations on how children’s 

6 hospitals and other providers can immediately 

7 expand access to mental, emotional, and behav8 ioral health services, such as intensive out9 patient care, partial hospitalization, and resi10 dential care, while also ensuring high quality 

11 and safety. 

Æ 


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