II 

116TH CONGRESS 

2D SESSION S. 4441 

To amend title XIX of the Social Security Act to encourage State Medicaid 

programs to provide community-based mobile crisis intervention services, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 5, 2020 

Mr. WYDEN (for himself and Ms. CORTEZ MASTO) 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 encourage 

State Medicaid programs to provide community-based 

mobile crisis intervention services, 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 ‘‘Crisis Assistance Help5 ing Out On The Streets Act’’ or the ‘‘CAHOOTS Act’’. 


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1 SEC. 2. ENHANCED FEDERAL MEDICAID SUPPORT FOR 

2 COMMUNITY-BASED MOBILE CRISIS INTER3 VENTION SERVICES. 

4 Section 1903 of the Social Security Act (42 U.S.C. 

5 1396b) is amended by adding at the end the following new 

6 subsection: 

7 ‘‘(bb) COMMUNITY-BASED MOBILE CRISIS INTER8 VENTION SERVICES.— 

9 ‘‘(1) IN GENERAL.—Notwithstanding section 

10 1902(a)(1) (relating to Statewideness), section 

11 1902(a)(10)(B) (relating to comparability), section 

12 1902(a)(23)(A) (relating to freedom of choice of 

13 providers), or section 1902(a)(27) (relating to pro14 vider agreements), a State may provide medical as15 sistance for qualifying community-based mobile cri16 sis intervention services under a State plan amend17 ment or waiver approved under section 1115 or 

18 1915(c). 

19 ‘‘(2) QUALIFYING COMMUNITY-BASED MOBILE

20 CRISIS INTERVENTION SERVICES DEFINED.—For 

21 purposes of this subsection, the term ‘qualifying 

22 community-based mobile crisis intervention services’ 

23 means, with respect to a State, items and services 

24 for which medical assistance is available under the 

25 State plan under this title or a waiver of such plan, 

26 that are— 


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1 ‘‘(A) furnished to an individual who is— 

2 ‘‘(i) outside of a hospital or other fa3 cility setting; and 

4 ‘‘(ii) experiencing a mental health or 

5 substance use disorder crisis; 

6 ‘‘(B) furnished by a multidisciplinary mo7 bile crisis team— 

8 ‘‘(i) that includes at least 1 behavioral 

9 health care professional who is capable of 

10 conducting an assessment of the individual, 

11 in accordance with the professional’s per12 mitted scope of practice under State law, 

13 and other professionals or paraprofes14 sionals with appropriate expertise in behav15 ioral health or mental health crisis re16 sponse, including nurses, social workers, 

17 peer support specialists, and others, as 

18 designated by the State and approved by 

19 the Secretary; 

20 ‘‘(ii) whose members are trained in 

21 trauma-informed care, de-escalation strate22 gies, and harm reduction; 

23 ‘‘(iii) that is able to respond in a 

24 timely manner and, where appropriate, 

25 provide the following— 


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1 ‘‘(I) screening and assessment; 

2 ‘‘(II) stabilization and de-esca3 lation; 

4 ‘‘(III) coordination with, and re5 ferrals to, health, social, and other 

6 services and supports as needed; and 

7 ‘‘(IV) provision or coordination of 

8 transportation to the next step in care 

9 or treatment; 

10 ‘‘(iv) that maintains relationships with 

11 relevant community partners, including 

12 medical and behavioral health providers, 

13 community health centers, crisis respite 

14 centers, managed care organizations (if ap15 plicable), entities able to provide assistance 

16 with application and enrollment in the 

17 State plan or a waiver of the plan, entitles 

18 able to provide assistance with applying for 

19 and enrolling in benefit programs, entities 

20 that provide assistance with housing (such 

21 as public housing authorities, Continuum 

22 of Care programs, or not-for-profit entities 

23 that provide housing assistance), and enti24 ties that provide assistance with other so25 cial services; 


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1 ‘‘(v) that coordinates with crisis inter2 vention hotlines and emergency response 

3 systems; 

4 ‘‘(vi) that maintains the privacy and 

5 confidentiality of patient information con6 sistent with Federal and State require7 ments; and 

8 ‘‘(vii) that operates independently 

9 from (but may coordinate with) State or 

10 local law enforcement agencies; 

11 ‘‘(C) available 24 hours per day, every day 

12 of the year; and 

13 ‘‘(D) voluntary to receive. 

14 ‘‘(3) PAYMENTS.— 

15 ‘‘(A) IN GENERAL.—Notwithstanding sec16 tion 1905(b), beginning October 1, 2020, dur17 ing each of the first 12 fiscal quarters that a 

18 State meets the requirements described in para19 graph (4), the Federal medical assistance per20 centage applicable to amounts expended by the 

21 State for medical assistance for qualifying com22 munity-based mobile crisis intervention services 

23 furnished during such quarter shall be equal to 

24 95 percent. 


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1 ‘‘(B) EXCLUSION OF ENHANCED PAY2 MENTS FROM TERRITORIAL CAPS.—To the ex3 tent that the amount of a payment to Puerto 

4 Rico, the Virgin Islands, Guam, the Northern 

5 Mariana Islands, or American Samoa for med6 ical assistance for qualifying community-based 

7 mobile crisis intervention services that is based 

8 on the Federal medical assistance percentage 

9 specified in subparagraph (A) exceeds the 

10 amount that would have been paid to such ter11 ritory for such services if the Federal medical 

12 assistance percentage for the territory had been 

13 determined without regard to such subpara14 graph— 

15 ‘‘(i) the limitation on payments to ter16 ritories under subsections (f) and (g) of 

17 section 1108 shall not apply to the amount 

18 of such excess; and 

19 ‘‘(ii) the amount of such excess shall 

20 be disregarded in applying such sub21 sections. 

22 ‘‘(4) REQUIREMENTS.—The requirements de23 scribed in this paragraph are the following: 

24 ‘‘(A) The State demonstrates, to the satis25 faction of the Secretary— 


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1 ‘‘(i) that it will be able to support the 

2 provision of qualifying community-based 

3 mobile crisis intervention services that 

4 meet the conditions specified in paragraph 

5 (2); and 

6 ‘‘(ii) how it will support coordination 

7 between mobile crisis teams and commu8 nity partners, including health care pro9 viders, to enable the provision of services, 

10 needed referrals, and other activities iden11 tified by the Secretary. 

12 ‘‘(B) The State provides assurances satis13 factory to the Secretary that— 

14 ‘‘(i) any additional Federal funds re15 ceived by the State for qualifying commu16 nity-based mobile crisis intervention serv17 ices provided under this subsection that 

18 are attributable to the increased Federal 

19 medical assistance percentage under para20 graph (3)(A) will be used to supplement, 

21 and not supplant, the level of State funds 

22 expended for such services for fiscal year 

23 2019; 

24 ‘‘(ii) if the State made qualifying com25 munity-based mobile crisis intervention 


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1 services available in a region of the State 

2 in fiscal year 2019, the State will continue 

3 to make such services available in such re4 gion under this subsection at the same 

5 level that the State made such services 

6 available in such fiscal year; and 

7 ‘‘(iii) the State will conduct the eval8 uation and assessment, and submit the re9 port, required under paragraph (5). 

10 ‘‘(5) STATE EVALUATION AND REPORT.— 

11 ‘‘(A) STATE EVALUATION.—Not later than 

12 4 fiscal quarters after a State begins providing 

13 qualifying community-based mobile crisis inter14 vention services in accordance with this sub15 section, the State shall enter into a contract 

16 with an independent entity or organization to 

17 conduct an evaluation for the purposes of— 

18 ‘‘(i) determining the effect of the pro19 vision of such services on— 

20 ‘‘(I) emergency room visits; 

21 ‘‘(II) use of ambulatory services; 

22 ‘‘(III) hospitalizations; 

23 ‘‘(IV) the involvement of law en24 forcement in mental health or sub25 stance use disorder crisis events; 


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1 ‘‘(V) the diversion of individuals 

2 from jails or similar settings; and 

3 ‘‘(ii) assessing— 

4 ‘‘(I) the types of services pro5 vided to individuals; 

6 ‘‘(II) the types of events re7 sponded to; 

8 ‘‘(III) cost savings or cost-effec9 tiveness attributable to such services; 

10 ‘‘(IV) the experiences of individ11 uals who receive qualifying commu12 nity-based mobile crisis intervention 

13 services; 

14 ‘‘(V) the successful connection of 

15 individuals with follow-up services; 

16 and 

17 ‘‘(VI) other relevant outcomes 

18 identified by the Secretary. 

19 ‘‘(B) COMPARISON TO HISTORICAL MEAS20 URES.—The contract described in subparagraph 

21 (A) shall specify that the evaluation is based on 

22 a comparison of the historical measures of 

23 State performance with respect to the outcomes 

24 specified under such subparagraph to the 

25 State’s performance with respect to such outVerDate Sep 11 2014 04:22 Aug 22, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4441.IS S4441

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1 comes during the period beginning with the 

2 first quarter in which the State begins pro3 viding qualifying community-based mobile crisis 

4 intervention services in accordance with this 

5 subsection. 

6 ‘‘(C) REPORT.—Not later than 2 years 

7 after a State begins to provide qualifying com8 munity-based mobile crisis intervention services 

9 in accordance with this subsection, the State 

10 shall submit a report to the Secretary on the 

11 following: 

12 ‘‘(i) The results of the evaluation car13 ried out under subparagraph (A). 

14 ‘‘(ii) The number of individuals who 

15 received qualifying community-based mo16 bile crisis intervention services. 

17 ‘‘(iii) Demographic information re18 garding such individuals when available, 

19 including the race or ethnicity, age, sex, 

20 sexual orientation, gender identity, and ge21 ographic location of such individuals. 

22 ‘‘(iv) The processes and models devel23 oped by the State to provide qualifying 

24 community-based mobile crisis intervention 

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1 er, including the processes developed to 

2 provide referrals for, or coordination with, 

3 follow-up care and services. 

4 ‘‘(v) Lessons learned regarding the 

5 provision of such services. 

6 ‘‘(D) PUBLIC AVAILABILITY.—The State 

7 shall make the report required under subpara8 graph (C) publicly available, including on the 

9 website of the appropriate State agency, upon 

10 submission of such report to the Secretary. 

11 ‘‘(6) BEST PRACTICES REPORT.— 

12 ‘‘(A) IN GENERAL.—Not later than 3 years 

13 after the first State begins to provide qualifying 

14 community-based mobile crisis intervention 

15 services in accordance with this subsection, the 

16 Secretary shall submit a report to Congress 

17 that— 

18 ‘‘(i) identifies the States that elected 

19 to provide services in accordance with this 

20 subsection; 

21 ‘‘(ii) summarizes the information re22 ported by such States under paragraph 

23 (5)(C); and 


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1 ‘‘(iii) identifies best practices for the 

2 effective delivery of community-based mo3 bile crisis intervention services. 

4 ‘‘(B) PUBLIC AVAILABILITY.—The report 

5 required under subparagraph (A) shall be made 

6 publicly available, including on the website of 

7 the Department of Health and Human Services, 

8 upon submission to Congress. 

9 ‘‘(7) STATE PLANNING AND EVALUATION

10 GRANTS.— 

11 ‘‘(A) IN GENERAL.—As soon as practicable 

12 after the date of enactment of this subsection, 

13 the Secretary may award planning and evalua14 tion grants to States for purposes of developing 

15 a State plan amendment or section 1115 or 

16 1915(c) waiver request (or an amendment to 

17 such a waiver) to provide qualifying community18 based mobile crisis intervention services and 

19 conducting the evaluation required under para20 graph (5)(A). A grant awarded to a State 

21 under this paragraph shall remain available 

22 until expended. 

23 ‘‘(B) STATE CONTRIBUTION.—A State 

24 awarded a grant under this subsection shall 

25 contribute for each fiscal year for which the 


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1 grant is awarded an amount equal to the State 

2 percentage determined under section 1905(b) 

3 (without regard to the temporary increase in 

4 the Federal medical assistance percentage of 

5 the State under section 6008(a) of the Families 

6 First Coronavirus Response Act (Public Law 

7 116–127) or any other temporary increase in 

8 the Federal medical assistance percentage of 

9 the State for fiscal year 2020 or any succeeding 

10 fiscal year) of the grant amount. 

11 ‘‘(8) FUNDING.— 

12 ‘‘(A) IMPLEMENTATION AND ADMINISTRA13 TION.—There is appropriated to the Secretary, 

14 out of any funds in the Treasury not otherwise 

15 appropriated, such sums as are necessary for 

16 purposes of implementing and administering 

17 this section. 

18 ‘‘(B) PLANNING AND EVALUATION

19 GRANTS.—There is appropriated, out of any 

20 funds in the Treasury not otherwise appro21 priated, $25,000,000 to the Secretary for fiscal 

22 year 2021 for purposes of making grants under 

23 paragraph (7), to remain available until ex24 pended.’’. 

Æ 


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