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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10419 Introduced in House (IH)]

<DOC>

118th CONGRESS
  2d Session
                               H. R. 10419

To amend title XVIII of the Social Security Act to establish a Medicare 
      demonstration program relating to crisis response services.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           December 16, 2024

    Mr. Cardenas (for himself, Mr. Veasey, Mr. Schweikert, and Mr. 
 Fitzpatrick) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
To amend title XVIII of the Social Security Act to establish a Medicare 
      demonstration program relating to crisis response services.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Crisis Care Access and Response 
Expansion for Behavioral Health Act of 2024'' or the ``CARE for 
Behavioral Health Act of 2024''.

SEC. 2. ESTABLISHING A MEDICARE DEMONSTRATION PROGRAM RELATING TO 
              CRISIS RESPONSE SERVICES.

    Part E of title XVIII of the Social Security Act (42 U.S.C. 1395x 
et seq.) is amended by inserting after section 1866G the following new 
section:

``SEC. 1866H. CRISIS RESPONSE SERVICES DEMONSTRATION PROGRAM.

    ``(a) In General.--Not later than January 1, 2026, the Secretary 
shall establish a crisis response services demonstration program (in 
this section referred to as the `demonstration program') to determine 
whether payment for crisis response services furnished to applicable 
individuals by participating providers results in--
            ``(1) a reduction in emergency department visits;
            ``(2) increased access to crisis response services;
            ``(3) a reduction in expenditures under this title; or
            ``(4) improved behavioral health outcomes.
    ``(b) Participating Providers.--
            ``(1) In general.--Subject to paragraph (3), the Secretary 
        shall designate an eligible provider as a participating 
        provider for purposes of the demonstration program if such 
        eligible provider submits an application to the Secretary at 
        such time and in such manner as specified by the Secretary and 
        demonstrates that the provider meets the standards established 
        by the Secretary under paragraph (2).
            ``(2) Standards.--The Secretary, in coordination with the 
        Assistant Secretary for Mental Health and Substance Use, shall 
        specify standards that an eligible provider must meet in order 
        to be designated as a participating provider under paragraph 
        (1). Such standards shall include the following:
                    ``(A) Standards relating to the minimum set of 
                crisis response services to be furnished by a 
                participating provider under the demonstration program.
                    ``(B) Standards relating to access to such 
                services, including a requirement that such provider be 
                available to furnish such services 24 hours per day, 7 
                days per week, and have a physician (which may include 
                a psychiatrist), nurse practitioner, or physician 
                assistant so available to furnish such services.
                    ``(C) Standards relating to the provision of such 
                services, including--
                            ``(i) standards relating to the 
                        qualifications of individuals who may furnish 
                        such services, in accordance with applicable 
                        State licensure requirements;
                            ``(ii) standards relating to collaboration 
                        of such individuals with other entities (such 
                        as community first responders and community-
                        based organizations) to ensure appropriate case 
                        management and adherence to best practices;
                            ``(iii) standards relating to the receipt 
                        of individuals from appropriate providers of 
                        services, suppliers, and other entities (such 
                        as law enforcement entities, educational 
                        institutions, and community-based 
                        organizations); and
                            ``(iv) a requirement that such services may 
                        only be terminated once an individual is 
                        stabilized or transferred to receive care from 
                        another appropriate provider of services, 
                        supplier, or entity.
            ``(3) Termination of designation.--
                    ``(A) In general.--The Secretary shall terminate a 
                designation of a participating provider under paragraph 
                (1) if--
                            ``(i) the Secretary determines that such 
                        provider no longer meets the standards 
                        specified under paragraph (2); or
                            ``(ii) such provider fails to meets such 
                        quality standards as the Secretary determines 
                        appropriate.
                    ``(B) Permissive termination.--The Secretary may 
                terminate a designation of a participating provider 
                under paragraph (1) for such other reasons as 
                determined appropriate by the Secretary.
    ``(c) Payment.--
            ``(1) In general.--Payment for crisis response services 
        furnished by a participating provider under the demonstration 
        program shall be equal to 100 percent of the lesser of the 
        amount charged by such provider or an amount determined under 
        the payment basis established by the Secretary under paragraph 
        (2).
            ``(2) Payment basis.--The Secretary shall establish a 
        single payment amount for crisis response services furnished to 
        an applicable individual by a participating provider during a 
        month. Such amount shall be equal to the average (as determined 
        by the Secretary) costs incurred by eligible providers in 
        furnishing such services to an individual during a month.
            ``(3) Source of payment.--Payment for crisis response 
        services furnished by a participating provider under the 
        demonstration program shall be made from the Federal 
        Supplementary Medical Insurance Trust Fund established under 
        section 1841.
    ``(d) Evaluation and Monitoring.--The Secretary shall evaluate each 
participating provider under the demonstration program to assess 
whether the results described in subsection (a) have been achieved.
    ``(e) Report.--Not later than 3 years after the date of the 
enactment of this section, the Secretary shall conduct an independent 
evaluation of the demonstration program and submit to Congress a report 
on such program. Such report shall include an analysis of the 
following:
            ``(1) Whether such program has achieved results described 
        in subsection (a).
            ``(2) The quality of crisis response services furnished 
        under such program.
            ``(3) Any reduction in jail incarceration attributable to 
        such program.
            ``(4) The number of individuals furnished services under 
        such program who were not voluntarily so furnished such 
        services.
    ``(f) Definitions.--In this section:
            ``(1) Applicable individual.--The term `applicable 
        individual' means an individual who--
                    ``(A) is entitled to benefits under part A and 
                enrolled under part B;
                    ``(B) is not enrolled in a Medicare Advantage plan 
                under part C or a PACE program under section 1894; and
                    ``(C) meets such other criteria as determined 
                appropriate by the Secretary.
            ``(2) Behavioral health urgent care facility.--The term 
        `behavioral health urgent care facility' means an ambulatory 
        facility where individuals experiencing a mental or behavioral 
        health crisis may walk in without an appointment to receive 
        crisis assessment services, crisis intervention services, 
        medication, and connection to other appropriate services.
            ``(3) Crisis receiving and stabilization facility.--The 
        term `crisis receiving and stabilization facility' means a 
        subacute inpatient facility or other facility specified by the 
        Secretary that provides short-term observation and 
        stabilization services to individuals experiencing a mental or 
        behavioral health crisis.
            ``(4) Crisis response services.--The term `crisis response 
        services' means mental or behavioral health services that are 
        furnished to an individual experiencing a mental or behavioral 
        health crisis to--
                    ``(A) provide screening and assessment for the 
                individual's mental health or substance use disorder 
                crisis;
                    ``(B) support the de-escalation of the individual's 
                mental health or substance use disorder crisis;
                    ``(C) facilitate or support subsequent referral to 
                health, social, and other services, as determined 
                appropriate by the Secretary; or
                    ``(D) otherwise address the individual's pressing 
                behavioral health needs, as determined appropriate by 
                the Secretary.
            ``(5) Eligible provider.--The term `eligible provider' 
        means a provider of crisis response services that is a mobile 
        crisis response team, a crisis receiving and stabilization 
        facility, a behavioral health urgent care facility, or such 
        other provider of services or supplier determined appropriate 
        by the Secretary.
            ``(6) Mobile crisis response team.--The term `mobile crisis 
        response team' means a team of physicians or practitioners (as 
        described in section 1842(b)(18)(C)) that is available to 
        furnish crisis response services to an individual experiencing 
        a mental or behavioral health crisis in the individual's home 
        or at the individual's workplace or another community-based 
        location in a timely manner.
    ``(g) Funding.--For purposes of administering and carrying out the 
demonstration program, other than for payments for services furnished 
under the program, in addition to funds otherwise appropriated, the 
Secretary shall provide for the transfer to the Center for Medicare & 
Medicaid Services Program Management Account from the Federal Hospital 
Insurance Trust Fund under section 1817 and the Federal Supplementary 
Medical Insurance Trust Fund under section 1841 of this title (in 
proportions determined appropriate by the Secretary) of such sums as 
the Secretary determines are necessary for such purposes. Amounts 
transferred under this subsection shall remain available until 
expended.''.
                                 <all>
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