II 

118TH CONGRESS 

2D SESSION S. 5112 

To amend title XVIII of the Social Security Act to provide payment for 

crisis stabilization services under the prospective payment system for 

hospital outpatient department services. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 19, 2024 

Ms. CORTEZ MASTO (for herself and Mr. CORNYN) introduced 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 provide 

payment for crisis stabilization services under the prospective payment system for hospital outpatient department services. 

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 Care Access Act 

5 of 2024’’. 


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1 SEC. 2. PAYMENT FOR CRISIS STABILIZATION SERVICES 

2 UNDER PROSPECTIVE PAYMENT SYSTEM FOR 

3 HOSPITAL OUTPATIENT DEPARTMENT SERV4 ICES. 

5 (a) IN GENERAL.—Section 1833(t) of the Social Se6 curity Act (42 U.S.C. 1395l(t)) is amended— 

7 (1) in paragraph (1)(B)— 

8 (A) in clause (iv), by striking ‘‘and’’ at the 

9 end; 

10 (B) in clause (v), by striking the period at 

11 the end and inserting ‘‘; and’’; and 

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

13 clause: 

14 ‘‘(vi) includes crisis stabilization serv15 ices (as defined in paragraph (23)) fur16 nished on or after January 1, 2027.’’; and 

17 (2) by adding at the end the following new 

18 paragraph: 

19 ‘‘(23) CRISIS STABILIZATION SERVICES.— 

20 ‘‘(A) CRISIS STABILIZATION SERVICES DE21 FINED.—In this subsection, the term ‘crisis sta22 bilization services’ means applicable items and 

23 services (as defined in subparagraph (B)) that 

24 are furnished to an eligible individual who is ex25 periencing a mental health or substance use disVerDate Sep 11 2014 03:03 Sep 26, 2024 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S5112.IS S5112

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1 order crisis, subject to the requirements under 

2 subparagraph (C). 

3 ‘‘(B) APPLICABLE ITEMS AND SERVICES

4 DEFINED.— 

5 ‘‘(i) IN GENERAL.—For purposes of 

6 subparagraph (A), the term ‘applicable 

7 items and services’ means items and serv8 ices described in clause (ii) that are— 

9 ‘‘(I) covered under this part; and 

10 ‘‘(II)(aa) reasonable and nec11 essary for the diagnosis and active 

12 treatment of the individual’s mental 

13 health or substance use disorder con14 dition; or 

15 ‘‘(bb) reasonably expected to sup16 port the de-escalation of the individ17 ual’s mental health or substance use 

18 disorder crisis. 

19 ‘‘(ii) ITEMS AND SERVICES DE20 SCRIBED.—The following items and serv21 ices are described in this clause: 

22 ‘‘(I) Observation services and su23 pervised care for individuals in severe 

24 distress for up to 23 consecutive 

25 hours. 


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1 ‘‘(II) Screening for suicide risk, 

2 including comprehensive suicide risk 

3 assessments and planning when clini4 cally indicated. 

5 ‘‘(III) Screening for violence risk, 

6 including comprehensive violence risk 

7 assessments and planning when clini8 cally indicated. 

9 ‘‘(IV) Assessment of immediate 

10 physical health needs and delivery of 

11 care for physical health needs that are 

12 within the capability of the hospital. 

13 ‘‘(V) Such other items and serv14 ices as the Secretary determines ap15 propriate. 

16 ‘‘(C) REQUIREMENTS FOR PAYMENT.—In 

17 order to receive payment for crisis stabilization 

18 services under this subsection, a hospital must 

19 document, in a form and manner determined 

20 appropriate by the Secretary, that— 

21 ‘‘(i) the hospital accepts referrals, 

22 within the capability of the hospital, for 

23 crisis stabilization services; 

24 ‘‘(ii) the hospital is capable of pro25 viding referrals for health, social, and 


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1 other services and supports, as needed, 

2 that are not provided as part of crisis sta3 bilization services; 

4 ‘‘(iii) the unit of the hospital that fur5 nishes crisis stabilization services is staffed 

6 at all times (24 hours a day, 7 days a 

7 week, 365 days a year) with a multidisci8 plinary team, which may include providers 

9 such as a psychiatrist or psychiatric nurse 

10 practitioner (who may be available by tele11 health for such staffing purposes), reg12 istered nurses, practitioners legally author13 ized to furnish such services under State 

14 law (or the State regulatory mechanism 

15 provided by State law) of the State in 

16 which the services are furnished, and peer 

17 support specialists (as defined in subpara18 graph (D)); and 

19 ‘‘(iv) the unit of the hospital that fur20 nishes crisis stabilization services is capa21 ble— 

22 ‘‘(I) of timely communication 

23 with emergency response systems, cri24 sis intervention hotlines, and physi25 cians and practitioners furnishing moVerDate Sep 11 2014 03:03 Sep 26, 2024 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S5112.IS S5112

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1 bile crisis response team services (as 

2 defined in subparagraph (D)); and 

3 ‘‘(II) within the capacity of the 

4 hospital, of accepting referrals of indi5 viduals from such entities for crisis 

6 stabilization services. 

7 ‘‘(D) DEFINITIONS.—In this paragraph: 

8 ‘‘(i) MOBILE CRISIS RESPONSE SERV9 ICES.—The term ‘mobile crisis response 

10 team services’ means physicians’ services 

11 that are furnished outside of a hospital, 

12 other facility setting, or physician office to 

13 an individual experiencing a mental health 

14 or substance use disorder crisis to— 

15 ‘‘(I) provide screening and as16 sessment for the individual’s mental 

17 health or substance use disorder cri18 sis; 

19 ‘‘(II) support the de-escalation of 

20 the individual’s mental health or sub21 stance use disorder crisis; 

22 ‘‘(III) facilitate or support subse23 quent referral to health, social, and 

24 other services, as determined appro25 priate by the Secretary; or 


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1 ‘‘(IV) otherwise address the indi2 vidual’s pressing behavioral health 

3 needs, as determined appropriate by 

4 the Secretary. 

5 ‘‘(ii) PEER SUPPORT SPECIALIST.— 

6 The term ‘peer support specialist’ means 

7 an individual who— 

8 ‘‘(I) is recovering from a mental 

9 health or substance use condition; and 

10 ‘‘(II) is certified as qualified to 

11 furnish peer support services under a 

12 certification process consistent with 

13 the National Practice Guidelines for 

14 Peer Supporters and inclusive of the 

15 Substance Abuse and Mental Health 

16 Services Administration Core Com17 petencies for Peer Workers in Behav18 ioral Health Settings (as established 

19 by the State in which such individual 

20 furnishes such services or under such 

21 certification process determined ap22 propriate by the Secretary of Health 

23 and Human Services.’’. 

24 (b) REPORT ON MEDICARE COVERAGE OF CRISIS

25 STABILIZATION FACILITY SERVICES.—Not later than 18 


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1 months after the date of the enactment of this Act, the 

2 Secretary of Health and Human Services (referred to in 

3 this subsection as the ‘‘Secretary’’) shall submit to the 

4 Committee on Finance of the Senate and the Committee 

5 on Energy and Commerce and the Committee on Ways 

6 and Means of the House of Representatives a report on 

7 policy issues for consideration in relation to providing 

8 Medicare coverage of crisis stabilization services (as de9 fined in section 1833(t)(23) of the Social Security Act, 

10 as added by subsection (a)), when furnished by crisis sta11 bilization facilities that are not eligible to enroll in the 

12 Medicare program as a subsection (d) hospital (as defined 

13 in section 1886(d)(1)(B) of such Act (42 U.S.C. 

14 1395ww(d)(1)(B))). Such report may include an assess15 ment of the following: 

16 (1) Considerations relating to licensure and ac17 creditation of such facilities by States and accredita18 tion organizations to ensure care quality and pro19 gram integrity. 

20 (2) Considerations relating to the development 

21 of payment rates for such facilities, including collec22 tion of data on the costs that such facilities incur in 

23 furnishing crisis stabilization services. 

24 (3) Considerations relating to any program in25 tegrity risks associated with crisis stabilization faciliVerDate Sep 11 2014 03:03 Sep 26, 2024 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S5112.IS S5112

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1 ties and potential measures that could be imple2 mented to mitigate those risks. 

3 (4) Other considerations determined appro4 priate by the Secretary. 

Æ 


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