II 

118TH CONGRESS 

1ST SESSION S. 923 

To amend titles XVIII and XIX of the Social Security Act to reform and 

improve mental health and substance use care under the Medicare and 

Medicaid programs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 22, 2023 

Mr. BENNET (for himself and Mr. WYDEN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to reform and improve mental health and substance use 

care under the Medicare and Medicaid programs, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Better Mental Health Care for Americans Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—MEDICARE PART B PROVISIONS 


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Sec. 101. Payment under the Medicare physician fee schedule for inherently 

complex evaluation and management visits related to integrated 

mental health and substance use disorder care. 

Sec. 102. Ensuring access to early intervention in mental health care in Medicare. 

TITLE II—MEDICARE ADVANTAGE AND PART D PROVISIONS 

Sec. 201. Parity in mental health and substance use disorder benefits under 

Medicare Advantage and prescription drug plans. 

Sec. 202. Behavioral health measures and incentivizing behavioral health care 

quality. 

Sec. 203. Providing information on behavioral health coverage to promote informed choice. 

Sec. 204. Requiring MA organizations to maintain accurate and updated provider directories. 

TITLE III—MEDICAID AND CHIP 

Sec. 301. Enhanced payment under Medicaid for integrated mental health and 

substance use disorder care services. 

Sec. 302. Demonstration project to ensure Medicaid-enrolled children have access to integrated mental health and substance use disorder 

care services, including prevention and early intervention services. 

Sec. 303. Uniform applicability to Medicaid of requirements for parity in mental health and substance use disorder benefits. 

Sec. 304. Requiring additional transparency on access to mental health and 

substance use disorder benefits through managed care. 

Sec. 305. Authority to defer or disallow a portion of Federal financial participation for failure to comply with managed care requirements. 

Sec. 306. Medicaid and CHIP audits. 

TITLE IV—OTHER PROVISIONS 

Sec. 401. Ensuring multi-payer alignment on payment and measurement of 

quality of care and health outcomes related to integrated mental health and substance use disorder care. 

Sec. 402. Measuring access and quality outcomes in mental health and substance use disorder care. 

Sec. 403. Reviewing the evidence for integrated mental health care for children. 

Sec. 404. Enhancing oversight of integrated mental health and substance use 

disorder care. 


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1 TITLE I—MEDICARE PART B 

2 PROVISIONS 

3 SEC. 101. PAYMENT UNDER THE MEDICARE PHYSICIAN FEE 

4 SCHEDULE FOR INHERENTLY COMPLEX 

5 EVALUATION AND MANAGEMENT VISITS RE6 LATED TO INTEGRATED MENTAL HEALTH 

7 AND SUBSTANCE USE DISORDER CARE. 

8 (a) IN GENERAL.—Section 1848(b) of the Social Se9 curity Act (42 U.S.C. 1395w–4(b)) is amended by adding 

10 at the end the following new paragraph: 

11 ‘‘(13) PAYMENT FOR INHERENTLY COMPLEX

12 EVALUATION AND MANAGEMENT VISITS RELATED TO

13 INTEGRATED MENTAL HEALTH AND SUBSTANCE USE

14 DISORDER CARE.— 

15 ‘‘(A) IN GENERAL.—The Secretary shall 

16 establish a new HCPCS add–on code under the 

17 fee schedule established under this subsection 

18 for integrated mental health and substance use 

19 disorder care services (as defined in subpara20 graph (B)(i)) that are furnished on or after 

21 January 1, 2025, when furnished by an inte22 grated care practitioner on the same date of 

23 service that a service in the HCPCS category of 

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1 agement services is furnished. Such add-on code 

2 may be similar to HCPCS code G2211. 

3 ‘‘(B) DEFINITIONS.—In this paragraph: 

4 ‘‘(i) INTEGRATED MENTAL HEALTH

5 AND SUBSTANCE USE DISORDER CARE

6 SERVICES.— 

7 ‘‘(I) IN GENERAL.—The term ‘in8 tegrated mental health and substance 

9 use disorder care services’ means serv10 ices described in subclause (II) that 

11 are furnished by an integrated care 

12 practitioner. 

13 ‘‘(II) SERVICES DESCRIBED.— 

14 The services described in this sub15 clause are the following: 

16 ‘‘(aa) Preventive services 

17 and screening for mental health 

18 and substance use disorders that 

19 the Secretary determines are— 

20 ‘‘(AA) reasonable and 

21 necessary for the prevention 

22 or early detection of a men23 tal health or substance use 

24 disorder; 


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1 ‘‘(BB) recommended 

2 with a grade of A or B by 

3 the United States Preventive 

4 Services Task Force or rec5 ommended in Health Re6 sources and Services–sup7 ported guidelines for infants, 

8 children, adolescents, and 

9 women; and 

10 ‘‘(CC) appropriate for 

11 individuals enrolled under 

12 this part. 

13 ‘‘(bb) The routine use and 

14 tracking of quality measures ap15 propriate for the measurement of 

16 the quality of care (including 

17 medication errors) related to be18 havioral health that reflect con19 sensus among affected parties 

20 and, to the extent feasible and 

21 practicable, shall include meas22 ures set forth by one or more na23 tional consensus building entities. 

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1 tically appropriate therapeutic 

2 and psychosocial intervention in3 tegrated into the primary care 

4 practice, including through tele5 health. 

6 ‘‘(dd) Evidence-based treat7 ment for mental health and sub8 stance use care integrated into 

9 the primary care practice, includ10 ing through telehealth, or 

11 through referral. 

12 ‘‘(ee) Care management, 

13 which can include establishing, 

14 implementing, revising or moni15 toring the care plan, coordinating 

16 with other professionals and 

17 agencies, and educating the indi18 vidual or caregiver about the in19 dividual’s condition, care plan, or 

20 prognosis. 

21 ‘‘(ff) Other services deter22 mined by the Secretary. 

23 ‘‘(ii) INTEGRATED CARE PRACTI24 TIONER.— 


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1 ‘‘(I) IN GENERAL.—The term ‘in2 tegrated care practitioner’ means a 

3 primary care practitioner (as defined 

4 in section 1833(x)(2)(A)(i)) who has 

5 demonstrated the capacity to furnish 

6 integrated mental health and sub7 stance use disorder care services (as 

8 determined under subclause (II)). 

9 ‘‘(II) DEMONSTRATING CAPACITY

10 GUIDANCE; ATTESTATION.—For pur11 poses of applying subclause (I) with 

12 respect to an integrated care practi13 tioner demonstrating the capacity to 

14 furnish integrated mental health and 

15 substance use disorder care services, 

16 the Secretary shall issue guidance, not 

17 later than one year after the date of 

18 the enactment of this paragraph, de19 scribing requirements for dem20 onstrating capacity to provide such 

21 services and establishing a process for 

22 the Secretary to receive an attestation 

23 that an integrated care practitioner 

24 has such capacity. Such guidance and 

25 attestation may not impose additional 


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1 burden on small practices (as defined 

2 for purposes of subsection (q)(11)) 

3 and practices located in rural areas. 

4 ‘‘(C) PAYMENT.— 

5 ‘‘(i) AMOUNT OF PAYMENT.—The fee 

6 schedule amount for integrated mental 

7 health and substance use disorder care 

8 services shall not be less than the fee 

9 schedule amount for services described by 

10 HCPCS code G2211 (or any successor or 

11 substantially similar code). 

12 ‘‘(ii) ADD-ON SERVICES.—If, during 

13 the furnishing of an evaluation and man14 agement service to an individual by an in15 tegrated care practitioner, such practi16 tioner also furnishes (or coordinates the 

17 furnishing of) integrated mental health 

18 and substance use disorder care services on 

19 the same date of service, payment shall 

20 also be made for such integrated mental 

21 health and substance used disorder care 

22 services even if the individual did not pre23 viously have a mental health or substance 

24 use disorder diagnosis. 


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1 ‘‘(iii) PAYMENT CONSIDERATIONS.— 

2 In carrying out this paragraph, the Sec3 retary shall ensure that the amount of pay4 ment for integrated mental health and sub5 stance use disorder care services under this 

6 paragraph is sufficient to sustain effective 

7 and accessible integrated mental health 

8 and substance use disorder care under this 

9 part, as determined by evidence from prac10 tice expenses of those implementing effec11 tive integrated care as well as evidence of 

12 the resource needs of integrated care prac13 titioners who furnish such services in men14 tal health professional shortage areas (as 

15 designated under section 332(a)(1)(A) of 

16 the Public Health Service Act) and medi17 cally underserved areas.’’. 

18 (b) EXEMPTION FROM BUDGET NEUTRALITY.—Sec19 tion 1848(c)(2)(B)(iv) of the Social Security Act (42 

20 U.S.C. 1395w–4(C)(2)(b)(iv)) is amended by adding at 

21 the end the following new subclause: 

22 ‘‘(VII) Subsection (b)(13) shall 

23 not be taken into account in applying 

24 clause (ii)(II) for 2025.’’. 


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1 (c) WAIVER OF COINSURANCE.—Section 1833(a)(1) 

2 of the Social Security Act (42 U.S.C. 1395l(a)(1)) is 

3 amended— 

4 (1) by striking ‘‘and’’ before ‘‘(HH)’’; and 

5 (2) by inserting before the semicolon at the end 

6 the following: ‘‘, and (II) with respect to integrated 

7 mental health and substance use disorder care serv8 ices (as defined in subparagraph (B)(i) of section 

9 1848(b)(13)) that are furnished on or after January 

10 1, 2025, the amounts paid shall be equal to 100 per11 cent of the lesser of the actual charge for such serv12 ices or the fee schedule amount provided under such 

13 section’’. 

14 SEC. 102. ENSURING ACCESS TO EARLY INTERVENTION IN 

15 MENTAL HEALTH CARE IN MEDICARE. 

16 Section 1833(a)(1) of the Social Security Act (42 

17 U.S.C. 1395l(a)(1)), as amended by section 101(c), is 

18 amended— 

19 (1) by striking ‘‘and’’ before ‘‘(II)’’; and 

20 (2) by inserting before the semicolon at the end 

21 the following: ‘‘, and (JJ) with respect to behavioral 

22 health integration services described by HCPCS 

23 codes 99492, 99493, 99494, 99484 , G2214, and 

24 G0323 (or any successor or substantially similar 

25 code) furnished on or after January 1, 2025, the 


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1 amounts paid shall be equal to 100 percent of the 

2 lesser of the actual charge for such services or the 

3 fee schedule amount provided under section 

4 1848(b)’’. 

5 TITLE II—MEDICARE ADVAN6 TAGE AND PART D PROVI7 SIONS 

8 SEC. 201. PARITY IN MENTAL HEALTH AND SUBSTANCE USE 

9 DISORDER BENEFITS UNDER MEDICARE AD10 VANTAGE AND PRESCRIPTION DRUG PLANS. 

11 (a) MEDICARE ADVANTAGE PLANS.— 

12 (1) IN GENERAL.—Section 1852 of the Social 

13 Security Act (42 U.S.C. 1395w–22) is amended by 

14 adding at the end the following new subsection: 

15 ‘‘(o) PARITY IN MENTAL HEALTH AND SUBSTANCE

16 USE DISORDER BENEFITS.— 

17 ‘‘(1) IN GENERAL.—Each MA organization 

18 shall ensure that the benefit design of each MA plan 

19 offered by such organization meets the following re20 quirements: 

21 ‘‘(A) FINANCIAL REQUIREMENTS.—The fi22 nancial requirements applicable to mental 

23 health or substance use disorder benefits cov24 ered by the plan may not exceed the predomi25 nant financial requirements applied to substanVerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923

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1 tially all medical benefits covered by the plan, 

2 including supplemental benefits, and there are 

3 no separate cost sharing requirements that are 

4 applicable only with respect to mental health 

5 and substance use disorder benefits. 

6 ‘‘(B) TREATMENT LIMITATIONS.—The 

7 treatment limitations applicable to mental 

8 health or substance use disorder benefits are no 

9 more restrictive than the predominant treat10 ment limitations applied to substantially all 

11 medical benefits covered by the plan and there 

12 are no separate treatment limitations that are 

13 applicable only with respect to mental health or 

14 substance use disorder benefits, including sup15 plemental benefits. 

16 ‘‘(2) DETERMINATIONS OF MEDICAL NECES17 SITY.— 

18 ‘‘(A) IN GENERAL.—Each MA organization 

19 shall ensure that any determination of medical 

20 necessity for mental health or substance use 

21 benefits under each MA plan offered by such 

22 organization that is not based on the applica23 tion of a national or local coverage determina24 tion is consistent with generally accepted stand25 ards of mental health and substance use disVerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923

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1 order care, as defined in paragraph. For any 

2 level of care determination with respect to men3 tal health or substance use disorder benefits, 

4 coverage criteria are consistent with widely-used 

5 treatment guidelines only if they result in a 

6 level of care determination that is consistent 

7 with the determination that would have been 

8 made using the relevant widely-used treatment 

9 guidelines. 

10 ‘‘(B) CRITERIA FOR MEDICAL NECESSITY

11 DETERMINATIONS.—The criteria for determina12 tion of medical necessity with respect to mental 

13 health or substance use disorder benefits under 

14 an MA plan shall be made available in plain 

15 language to any individual upon request. 

16 ‘‘(3) REPORTING ON APPLICATION OF NON17 QUANTITATIVE TREATMENT LIMITATIONS.— 

18 ‘‘(A) COMPARATIVE ANALYSES OF DESIGN

19 AND APPLICATION OF NONQUANTITATIVE

20 TREATMENT LIMITS.—For 2025 and subse21 quent years, in the case of an MA organization 

22 that imposes nonquantitative treatment limita23 tions (referred to in this paragraph as 

24 ‘NQTLs’) on mental health or substance use 

25 disorder benefits under an MA plan offered by 


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1 such organization, such organization shall be 

2 required to perform and document comparative 

3 analyses of the design and application of 

4 NQTLs on mental health and substance use 

5 disorder benefits under the plan and make 

6 available to the Secretary as provided under 

7 subparagraph (B), upon request, the compara8 tive analyses and the following information: 

9 ‘‘(i) The specific plan terms regarding 

10 the NQTLs and a description of all mental 

11 health or substance use disorder and med12 ical benefits to which each such term ap13 plies in each respective benefits classifica14 tion. 

15 ‘‘(ii) The factors used to determine 

16 that the NQTLs will apply to mental 

17 health or substance use disorder benefits 

18 and medical benefits. 

19 ‘‘(iii) The evidentiary standards used 

20 for the factors identified in clause (ii), 

21 when applicable, provided that every factor 

22 shall be defined, and any other source or 

23 evidence, including utilization of decision 

24 support technology, artificial intelligence 

25 technology, machine-learning technology, 


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1 clinical decision-making technology, or any 

2 other technology specified by the Secretary, 

3 relied upon to design and apply the 

4 NQTLs to mental health or substance use 

5 disorder benefits and medical benefits. 

6 ‘‘(iv) The comparative analyses dem7 onstrating that the processes, strategies, 

8 evidentiary standards, and other factors 

9 used to apply the NQTLs to mental health 

10 or substance use disorder benefits, as writ11 ten and in operation, are comparable to, 

12 and are applied no more stringently than, 

13 the processes, strategies, evidentiary stand14 ards, and other factors used to apply the 

15 NQTLs to medical benefits in the benefits 

16 classification. 

17 ‘‘(v) The specific findings and conclu18 sions reached by the MA organization with 

19 respect to the MA plan, including any re20 sults of the analyses described in this sub21 paragraph that indicate that the plan is or 

22 is not in compliance with this subsection. 

23 ‘‘(B) SUBMISSION TO SECRETARY UPON

24 REQUEST.—An MA organization shall submit to 

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1 scribed in subparagraph (A) and the informa2 tion described in clauses (i) through (v) of such 

3 subparagraph upon request by the Secretary. 

4 The Secretary shall request not fewer than 20 

5 such analyses per year. 

6 ‘‘(C) REPORT.—Not later than October 1, 

7 2029, and biennially thereafter, the Secretary 

8 shall submit to Congress, and make publicly 

9 available, a report that contains the following: 

10 ‘‘(i) A summary of the comparative 

11 analyses and information requested under 

12 subparagraph (B). 

13 ‘‘(ii) The Secretary’s conclusions as to 

14 whether each MA organization submitted 

15 sufficient information for the Secretary to 

16 review the comparative analyses and infor17 mation requested for compliance with this 

18 subsection. 

19 ‘‘(iii) The Secretary’s conclusions as 

20 to whether each MA organization that sub21 mitted sufficient information for the Sec22 retary to review was in compliance with 

23 this subsection. 

24 ‘‘(4) DEFINITIONS.—In this subsection: 


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1 ‘‘(A) CLASSIFICATION OF BENEFITS.—The 

2 term ‘classification of benefits’ means the fol3 lowing: 

4 ‘‘(i) INPATIENT.—Benefits under part 

5 A. 

6 ‘‘(ii) OUTPATIENT.—Benefits fur7 nished on an outpatient basis under part 

8 B. 

9 ‘‘(iii) EMERGENCY CARE.—Benefits 

10 for emergency care covered under part B. 

11 ‘‘(iv) PART B PRESCRIPTION

12 DRUGS.—Benefits for drugs and biologicals 

13 covered under part B. 

14 ‘‘(v) COVERED PART D DRUGS.—Ben15 efits for covered part D drugs as defined 

16 in section 1860D–2(e). 

17 ‘‘(vi) SUPPLEMENTAL.—Supplemental 

18 health care benefits as described in section 

19 1852(a)(3). 

20 ‘‘(B) EVIDENTIARY STANDARDS.—The 

21 term ‘evidentiary standard’ means factors or 

22 evidence a plan considers in designing and ap23 plying its medical management techniques, such 

24 as generally accepted standards of mental 

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1 nized medical literature, professional standards 

2 and protocols (including comparative effective3 ness studies and clinical trials), published re4 search studies, treatment guidelines created by 

5 professional medical associations or other third6 party entities, publicly available or proprietary 

7 clinical definitions, and outcome metrics from 

8 consulting or other organizations. 

9 ‘‘(C) FINANCIAL REQUIREMENT.—The 

10 term ‘financial requirement’ includes 

11 deductibles, copayments, coinsurance, and max12 imum limitations on out-of-pocket expenses ap13 plicable under the plan. 

14 ‘‘(D) GENERALLY ACCEPTED STANDARDS

15 OF MENTAL HEALTH AND SUBSTANCE USE DIS16 ORDER CARE.—The term ‘generally accepted 

17 standards of mental health and substance use 

18 disorder care’ means standards of care and clin19 ical practice that are generally recognized by 

20 health care providers practicing in relevant clin21 ical specialties such as psychiatry, psychology, 

22 and addiction medicine and counseling, to en23 sure appropriate diagnosis, treatment, and on24 going management, for underlying mental 

25 health and substance use disorders, including 


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1 co-occurring conditions, to adequately meet the 

2 needs of patients. These standards are derived 

3 from valid, evidence–based sources such as 

4 peer–reviewed scientific studies and medical lit5 erature, consensus guidelines of nonprofit 

6 health care provider professional associations 

7 and specialty societies, including level of care 

8 criteria and clinical practice guidelines, and rec9 ommendations of Federal government agencies. 

10 ‘‘(E) MENTAL HEALTH BENEFITS.—The 

11 term ‘mental health benefits’ means benefits 

12 with respect to items and services for mental 

13 health conditions as defined by the Secretary. 

14 ‘‘(F) PREDOMINANT.—A financial require15 ment or treatment limit is considered to be pre16 dominant if it is the most common or frequent 

17 of such type of limit or requirement. 

18 ‘‘(G) SUBSTANCE USE DISORDER BENE19 FITS.—The term ‘substance use disorder bene20 fits’ means benefits with respect to items and 

21 services for substance use disorders as defined 

22 by the Secretary. 

23 ‘‘(H) SUBSTANTIALLY ALL.—A financial 

24 requirement or treatment limitation applies to 

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1 tion if it applies to at least two-thirds of the 

2 benefits in that classification. 

3 ‘‘(I) TREATMENT LIMITATION.— 

4 ‘‘(i) IN GENERAL.—The term ‘treat5 ment limitation’ means mechanisms to con6 trol utilization of services and expenditures 

7 such as limits on the frequency of treat8 ment, number of visits, days of coverage, 

9 or other similar limits on the scope or du10 ration of treatment. Such term includes: 

11 ‘‘(I) QUANTITATIVE TREATMENT

12 LIMITATIONS.—Quantitative treat13 ment limitations, including limits on 

14 the frequency of treatment, number of 

15 visits, days of coverage, or other simi16 lar limits on the scope or duration of 

17 treatment. 

18 ‘‘(II) NONQUANTITATIVE TREAT19 MENT LIMITATIONS.—Nonquantitative 

20 treatment limitations, including other 

21 limits on the access, scope, or dura22 tion of benefits for treatment under a 

23 plan or coverage not described in sub24 clause (I), such as— 


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1 ‘‘(aa) medical management 

2 standards limiting or excluding 

3 benefits based on medical neces4 sity or medical appropriateness, 

5 or based on whether the treat6 ment is experimental or inves7 tigative; 

8 ‘‘(bb) for plans with multiple 

9 network tiers (such as preferred 

10 providers and participating pro11 viders), network tier design; 

12 ‘‘(cc) standards for provider 

13 admission to participate in a net14 work, including reimbursement 

15 rates; 

16 ‘‘(dd) refusal to pay for 

17 higher-cost therapies until it can 

18 be shown that a lower-cost ther19 apy is not effective (also known 

20 as fail-first policies or step ther21 apy protocols); 

22 ‘‘(ee) exclusions based on 

23 failure to complete a course of 

24 treatment; and 


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1 ‘‘(ff) restrictions based on 

2 geographic location, facility type, 

3 provider specialty, and other cri4 teria that limit the scope or dura5 tion of benefits for services pro6 vided under the plan or coverage. 

7 ‘‘(ii) EXCLUSIONS.—The term ‘treat8 ment limitation’ does not include any ex9 clusions from coverage of items or services 

10 for which payment is not made under part 

11 A or part B or any statutory limitations on 

12 coverage applicable under such parts.’’. 

13 (2) ENFORCEMENT.—Section 1857(g)(1) of the 

14 Social Security Act (42 U.S.C. 1395w–27(g)(1)) is 

15 amended— 

16 (A) in subparagraph (J), by striking ‘‘or’’ 

17 after the semicolon; 

18 (B) by redesignating subparagraph (K) as 

19 subparagraph (L); 

20 (C) by inserting after subparagraph (J), 

21 the following new subparagraph: 

22 ‘‘(K) fails to comply with mental health 

23 parity requirements under section 1852(o) or 

24 applicable implementing regulations or guid25 ance; or’’; 


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1 (D) in subparagraph (L), as redesignated 

2 by subparagraph (B), by striking ‘‘through (J)’’ 

3 and inserting ‘‘through (K)’’; and 

4 (E) in the flush matter following subpara5 graph (L), as so redesignated, by striking ‘‘sub6 paragraphs (A) through (K)’’ and inserting 

7 ‘‘subparagraphs (A) through (L)’’. 

8 (b) PRESCRIPTION DRUG PLANS.—Section 1860D– 

9 4 of the Social Security Act (42 U.S.C. 1395w–104) is 

10 amended by adding at the end the following new sub11 section: 

12 ‘‘(c) PARITY IN MENTAL HEALTH AND SUBSTANCE

13 USE DISORDER BENEFITS.—The provisions of section 

14 1852(o) (relating to parity in mental health and substance 

15 use disorder benefits) shall apply to PDP sponsors offer16 ing prescription drug plans in the same manner in which 

17 such provisions apply with respect to Medicare Advantage 

18 organizations offering MA–PD plans.’’. 

19 (c) REGULATIONS.—Not later than 18 months after 

20 the date of enactment of this Act, the Secretary of Health 

21 and Human Services shall issue regulations to carry out 

22 the amendments made by this section. 

23 (d) EFFECTIVE DATE.—The amendments made by 

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1 ment of this Act, regardless of whether regulations have 

2 been issued to carry out such amendments by such effec3 tive date. 

4 (e) IMPLEMENTATION FUNDING.—For purposes of 

5 carrying out the provisions of, including the amendments 

6 made by, this section, there are appropriated, out of 

7 amounts in the Treasury not otherwise appropriated, to 

8 the Centers for Medicare & Medicaid Services Program 

9 Management Account, $10,000,000 for fiscal year 2024, 

10 which shall remain available until expended. 

11 SEC. 202. BEHAVIORAL HEALTH MEASURES AND 

12 INCENTIVIZING BEHAVIORAL HEALTH CARE 

13 QUALITY. 

14 Section 1853(o) of the Social Security Act (42 U.S.C. 

15 1395w–23(o)) is amended by adding at the end the fol16 lowing new paragraph: 

17 ‘‘(8) BEHAVIORAL HEALTH MEASURES.— 

18 ‘‘(A) IN GENERAL.—For 2025 and bienni19 ally thereafter, the Secretary shall consider add20 ing to the 5-star rating system behavioral 

21 health measures that measure the quality and 

22 outcomes of— 

23 ‘‘(i) mental health or substance use 

24 disorder services; and 


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1 ‘‘(ii) items and services not described 

2 in clause (i) that are furnished to an indi3 vidual with a mental health or substance 

4 use disorder. 

5 ‘‘(B) CONSIDERATIONS.—In considering 

6 the addition of behavioral health measures 

7 under subparagraph (A), the Secretary shall— 

8 ‘‘(i) consider measures for which data 

9 can be collected through encounter data or 

10 enrollee survey data submitted by MA or11 ganizations; 

12 ‘‘(ii) consider measures endorsed by a 

13 consensus-based entity, as described in sec14 tion 1890(a); 

15 ‘‘(iii) consider measures that assess 

16 the quality and health outcomes of items 

17 and services described in subparagraph 

18 (A), including contraindicated or low-value 

19 care, furnished to individuals with a men20 tal health or substance use disorder; 

21 ‘‘(iv) consider measures that assess 

22 access to behavioral health treatment, in23 cluding measures of wait times, distance 

24 standards, providers who are taking on 

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1 ioral health providers who have not sub2 mitted a claim for a mental health or sub3 stance use disorder service during the past 

4 six months; 

5 ‘‘(v) consider measures that assess the 

6 integration of behavioral health care and 

7 primary care services; 

8 ‘‘(vi) consider measures that align 

9 with behavioral health measures— 

10 ‘‘(I) used to assess performance 

11 in part A or part B; or 

12 ‘‘(II) identified as part of the 

13 Core Set of Health Care Quality 

14 Measures for Adults as described in 

15 section 1139B; and 

16 ‘‘(vii) consider measures that assess 

17 patient experience of care.’’. 

18 SEC. 203. PROVIDING INFORMATION ON BEHAVIORAL 

19 HEALTH COVERAGE TO PROMOTE INFORMED 

20 CHOICE. 

21 Section 1851(d)(4) of the Social Security Act (42 

22 U.S.C. 1395w–21(d)(4)) is amended by adding at the end 

23 the following new subparagraph: 

24 ‘‘(F) BEHAVIORAL HEALTH INFORMA25 TION.—For 2025 and subsequent plan years, to 


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1 the extent available, the following information 

2 with respect to the preceding plan year: 

3 ‘‘(i) Information on access to in-net4 work behavioral health providers, 

5 disaggregated by those who prescribe and 

6 those who offer mental health or substance 

7 use disorder services, including— 

8 ‘‘(I) the average wait time (as de9 fined by the Secretary) for an ap10 pointment for a new patient with an 

11 in-network provider for mental health 

12 or substance disorder services; 

13 ‘‘(II) the total number and per14 centage of providers who have partici15 pation agreements with the organiza16 tion who submitted at least one re17 quest for payment for a mental health 

18 or substance use disorder service dur19 ing a 6 month period (or other period 

20 specified by the Secretary); and 

21 ‘‘(III) the percentage of requests 

22 for payment for mental health or sub23 stance use disorder services that were 

24 submitted by— 


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1 ‘‘(aa) in-network providers; 

2 and 

3 ‘‘(bb) out-of-network pro4 viders. 

5 ‘‘(ii) Information on the number of 

6 denials of prior authorization requests or 

7 denials of payment for mental health or 

8 substance use disorder services compared 

9 to non-mental health and substance use 

10 disorder services overall, categorized by the 

11 type of denial and by the type of service, 

12 as defined by the Secretary, including— 

13 ‘‘(I) the number and percent of 

14 such denials by the number of days to 

15 denial, the reason for denial, and the 

16 utilization of decision support tech17 nology, artificial intelligence tech18 nology, machine-learning technology, 

19 clinical decision-making technology, or 

20 any other technology specified by the 

21 Secretary; and 

22 ‘‘(II) the number and percent of 

23 such denials with respect to a mental 

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1 spect to items and services for a simi2 lar physical health condition (such as 

3 depression compared to diabetes) by 

4 the number of days to denial, the rea5 son for denial, and the utilization of 

6 decision support technology, artificial 

7 intelligence technology, machine-learn8 ing technology, clinical decision-mak9 ing technology, or any other tech10 nology specified by the Secretary.’’. 

11 SEC. 204. REQUIRING MA ORGANIZATIONS TO MAINTAIN 

12 ACCURATE AND UPDATED PROVIDER DIREC13 TORIES. 

14 (a) IN GENERAL.—Section 1852(c) of the Social Se15 curity Act (42 U.S.C. 1395w–22(c)) is amended— 

16 (1) in paragraph (1)(C)— 

17 (A) by striking ‘‘plan, and any’’ and insert18 ing ‘‘plan, any’’; and 

19 (B) by inserting the following before the 

20 period: ‘‘, and, in the case of a network-based 

21 MA plan (as defined in paragraph (3)(C)), the 

22 information described in paragraph 

23 (3)(A)(i)(II)’’; and 

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

25 paragraph: 


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1 ‘‘(3) PROVIDER DIRECTORY ACCURACY AND

2 TRANSPARENCY.— 

3 ‘‘(A) IN GENERAL.—For plan year 2025 

4 and subsequent plan years, each MA organiza5 tion offering a network-based MA plan shall do 

6 the following: 

7 ‘‘(i) MAINTAIN AN ACCURATE PRO8 VIDER DIRECTORY.— 

9 ‘‘(I) IN GENERAL.—The MA or10 ganization shall, for each network11 based MA plan offered by the organi12 zation, maintain an accurate provider 

13 directory— 

14 ‘‘(aa) that includes the in15 formation described in subclause 

16 (II); 

17 ‘‘(bb) which, not less fre18 quently than 90 days, the organi19 zation verifies and, if applicable, 

20 updates the provider directory in21 formation of each provider; 

22 ‘‘(cc) that provides, if the 

23 organization is unable to verify 

24 such information with respect to 

25 a provider, for the inclusion 


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1 along with the information in the 

2 directory with respect to such 

3 provider of a notification indi4 cating that the information may 

5 not be up to date; 

6 ‘‘(dd) that provides for the 

7 removal of a provider from such 

8 directory within 2 business days 

9 if the organization determines 

10 that the provider is no longer a 

11 participating provider; and 

12 ‘‘(ee) that meets such other 

13 requirements as the Secretary 

14 may specify. 

15 ‘‘(II) INFORMATION DE16 SCRIBED.—The information described 

17 in this subclause is the National Pro18 vider Identifier, name, address, spe19 cialty, telephone number, Internet 

20 website if available, availability (in21 cluding whether the provider is ac22 cepting new patients), cultural and 

23 linguistic capabilities (including the 

24 languages offered by the provider or 

25 by a skilled medical interpreter who 


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1 provides interpretation services for the 

2 provider), and other information as 

3 determined appropriate by the Sec4 retary for each provider with which 

5 such MA organization has an agree6 ment for furnishing items and services 

7 covered under such plan. 

8 ‘‘(ii) SUBMISSION OF PROVIDER DI9 RECTORY TO THE SECRETARY.—The MA 

10 organization shall submit to the Secretary 

11 the provider directory for each network12 based MA plan offered by the organization 

13 in a manner specified by the Secretary. 

14 ‘‘(B) POSTING OF PROVIDER DIRECTORY

15 INFORMATION.—For plan year 2026 and subse16 quent plan years, the Secretary shall post the 

17 provider directory information submitted under 

18 subparagraph (A)(ii), in a machine readable 

19 file, on the internet website of the Centers for 

20 Medicare & Medicaid Services. 

21 ‘‘(C) NETWORK-BASED MA PLAN DE22 FINED.—In this paragraph, the term ‘network23 based MA plan’ means an MA plan that has a 

24 network of providers that have agreements with 

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1 nish items and services covered under such 

2 plan.’’. 

3 (b) ENFORCEMENT.—Section 1857(d) of the Social 

4 Security Act (42 U.S.C. 1395w–27(d)) is amended by 

5 adding at the end the following new paragraph: 

6 ‘‘(7) AUDIT OF PROVIDER DIRECTORIES.—Each 

7 contract under this section shall provide that the 

8 Secretary, or any person or organization designated 

9 by the Secretary, shall have the right to audit any 

10 provider directory under section 1852(c)(3)(A)(i) to 

11 determine whether such directory meets the require12 ments of such section.’’. 

13 (c) FUNDING.—In addition to amounts otherwise 

14 available, there is appropriated to the Centers for Medi15 care & Medicaid Services Program Management Account 

16 for fiscal year 2023, out of any amounts in the Treasury 

17 not otherwise appropriated, $10,000,000, to remain avail18 able until expended, for purposes of carrying out the 

19 amendments made by this section. 

20 TITLE III—MEDICAID AND CHIP 

21 SEC. 301. ENHANCED PAYMENT UNDER MEDICAID FOR IN22 TEGRATED MENTAL HEALTH AND SUB23 STANCE USE DISORDER CARE SERVICES. 

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

25 1396b) is amended— 


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1 (1) in subsection (a)(3)— 

2 (A) in subparagraph (D), by inserting 

3 ‘‘and’’ after the semicolon; 

4 (B) in subparagraph (F)(ii), by striking 

5 ‘‘plus’’ after the semicolon and inserting ‘‘and’’; 

6 and 

7 (C) by inserting after subparagraph 

8 (F)(ii), the following: 

9 ‘‘(G) for calendar quarters beginning on or 

10 after January 1, 2025, 100 percent of the 

11 amount determined for such quarter under sub12 section (cc); and’’; and 

13 (2) by adding the end the following: 

14 ‘‘(cc) ENHANCED PAYMENT FOR INTEGRATED MEN15 TAL HEALTH AND SUBSTANCE USE DISORDER CARE

16 SERVICES.— 

17 ‘‘(1) IN GENERAL.—For purposes of subsection 

18 (a)(3)(G), in accordance with guidance issued not 

19 later than the date that is 180 days after the date 

20 of the enactment of this subsection by the Secretary 

21 to States, the amount determined under this sub22 section with respect to a State and calendar quarter 

23 is the amount by which— 

24 ‘‘(A) the aggregate amount expended by 

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1 ical assistance provided by a primary care prac2 titioner (as defined in section 1833(x)(2)(A)(i)) 

3 for integrated mental health and substance use 

4 disorder care services described in section 

5 1848(b)(13)(B) and such other items and serv6 ices for the care of mental health and substance 

7 use conditions furnished by, or in coordination 

8 with, such primary care practitioner as the Sec9 retary, in consultation with the State, may 

10 specify; exceeds 

11 ‘‘(B) the quarterly average of the aggre12 gate amounts expended by the State for medical 

13 assistance described in subparagraph (A) dur14 ing the applicable base period for the calendar 

15 quarter involved. 

16 ‘‘(2) APPLICABLE BASE PERIOD DEFINED.— 

17 ‘‘(A) IN GENERAL.—For purposes of para18 graph (1), the term ‘applicable base period’ 

19 means, with respect to a calendar quarter, the 

20 5-year period that ends on the most recent base 

21 period end date. 

22 ‘‘(B) BASE PERIOD END DATE DEFINED.— 

23 For purposes of subparagraph (A), the term 

24 ‘base period end date’ means— 

25 ‘‘(i) December 31, 2024; and 


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1 ‘‘(ii) December 31 of every 5th year 

2 following 2024.’’. 

3 SEC. 302. DEMONSTRATION PROJECT TO ENSURE MED4 ICAID-ENROLLED CHILDREN HAVE ACCESS 

5 TO INTEGRATED MENTAL HEALTH AND SUB6 STANCE USE DISORDER CARE SERVICES, IN7 CLUDING PREVENTION AND EARLY INTER8 VENTION SERVICES. 

9 (a) IN GENERAL.—Not later than the date that is 

10 180 days after the date of the enactment of this section, 

11 the Secretary shall conduct a 54-month demonstration 

12 project for the purpose described in subsection (b) under 

13 which the Secretary shall— 

14 (1) for the first 18-month period of such 

15 project, award planning grants described in sub16 section (c); and 

17 (2) for the remaining 36-month period of such 

18 project, provide to each State selected under sub19 section (d) payments in accordance with subsection 

20 (e). 

21 (b) PURPOSE.—The purpose described in this sub22 section is for each State that receives a planning grant 

23 under subsection (c) to ensure that every Medicaid-en24 rolled child in the State has access to integrated mental 

25 health and substance use disorder care services, including 


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1 prevention and early intervention services, so as to allow 

2 for the prevention, identification, and treatment of mental 

3 health and substance use conditions in primary care, chil4 dren’s hospitals, early care and education, schools, or 

5 other settings as appropriate (such as home visiting and 

6 early intervention programs for young children, foster care 

7 or other child welfare care settings, or workforce develop8 ment programs and community centers for youth) (in this 

9 section collectively referred to as ‘‘care settings’’), through 

10 the following activities: 

11 (1) Activities that support an ongoing assess12 ment of the accessibility of integrated mental health 

13 and substance use disorder care services, including 

14 prevention and early intervention services, for Med15 icaid-enrolled children in the State that tracks 

16 progress toward the goal of all Medicaid-enrolled 

17 children (including infants and toddlers as well as 

18 transition-aged youth) having access to appropriate 

19 levels of services in care settings in which the chil20 dren regularly engage, and that is conducted in part21 nership with such children and families, to ensure 

22 that the assessment reflects their perspective, experi23 ences, and solutions. 

24 (2) Activities that, taking into account the re25 sults of the assessment described in paragraph (1), 


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1 support the development, implementation, and main2 tenance of State infrastructure, such as technology 

3 and the physical structures necessary to physically 

4 co-locate integrated mental health and substance use 

5 disorder care services, including prevention and early 

6 intervention services, and a workforce to provide the 

7 types of support, training, and technical assistance 

8 needed in order to offer integrated mental health 

9 and substance use care services, including prevention 

10 and early intervention services, in care settings with 

11 which Medicaid-enrolled children and their families 

12 regularly interact, which are selected for integration 

13 based on the assessment of where such children and 

14 their families can access such services, and for which 

15 furnishing integrated mental health and substance 

16 use disorder care services, including prevention and 

17 early intervention services, will be sustainable under 

18 the State’s planned activities. 

19 (3) Increased reimbursement and improved in20 centives for care settings to sustainably implement 

21 and provide (either through direct delivery or coordi22 nation in the case of a care setting that is an early 

23 care or education program)— 

24 (A) developmentally appropriate mental 

25 health promotive and preventive interventions 


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1 for Medicaid-enrolled children and their fami2 lies, along with screening to identify psycho-so3 cial needs of such children who do not yet have 

4 a diagnosable mental health condition (con5 sistent with the requirements for providing 

6 items and services described in section 

7 1905(a)(4)(B) of the Social Security Act (42 

8 U.S.C. 1396d(a)(4)(B))(relating to early and 

9 periodic screening, diagnostic, and treatment 

10 services defined in section 1905(r) of such Act 

11 (42 U.S.C. 1396d(r))) in accordance with the 

12 requirements of section 1902(a)(43) of such 

13 Act (42 U.S.C. 1396a(a)(43)) and the pediatric 

14 preventive care standards included in the essen15 tial health benefits required under section 

16 1302(b) of the Patient Protection and Afford17 able Care Act (42 U.S.C. 18022(b))); 

18 (B) evidence-based, person-centered, and 

19 culturally, linguistically, and developmentally 

20 appropriate interventions at the site of service, 

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1 ment, care coordination, and dyadic interven2 tion approaches; and 

3 (C) referral to developmentally appropriate 

4 mental health and substance use specialty care 

5 providers and programs, community-based re6 sources, or virtual or digital services to address 

7 risk factors or meet psycho- social needs that 

8 cannot be addressed in an integrated setting. 

9 (4) Improved regulatory oversight of policies 

10 governing the provision of services described in para11 graph (3), including with respect to early and peri12 odic screening, diagnostic, and treatment services re13 ferred to in such paragraph, mental health and sub14 stance use parity, network adequacy, essential health 

15 benefits referred to in such paragraph, Medicaid rate 

16 setting, scope of practice policies, and health profes17 sional shortage areas. 

18 (5) Improved alignment between Medicaid and 

19 commercial health insurers to ensure that services 

20 described in paragraph (3) are supported by com21 mercial health insurers, such as through the initi22 ation of multi-payer collaboratives. 

23 (6) Improved coordination among State and 

24 local agencies and other stakeholders that fund or 

25 provide primary care, children’s hospitals, early care 


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1 and education, or other programs in care settings 

2 described in this subsection so as to include efforts 

3 to align policies to promote coordination of mental 

4 health and substance use services funded under such 

5 programs across care settings, including through the 

6 alignment of Medicaid with programs under the Ele7 mentary and Secondary Education Act of 1965 (20 

8 U.S.C. 6301 et seq.), the Individuals with Disabil9 ities Education Act (20 U.S.C. 1400 et seq.), the 

10 Family First Prevention Services Act (title VII of 

11 division E of the Bipartisan Budget Act of 2018 

12 (Public Law 115–123; 132 Stat. 232)), the Steph13 anie Tubbs Jones Child Welfare Services Program 

14 under subpart 1 of part B of title IV of the Social 

15 Security Act (42 U.S.C. 621 et seq.), the MaryLee 

16 Allen Promoting Safe and Stable Families Program 

17 under subpart 2 of part B of title IV of the Social 

18 Security Act (42 U.S.C. 629 et seq.), home visiting 

19 programs, including the Maternal, Infant, and Early 

20 Childhood Home Visiting Program (MIECHV) 

21 under section 511 of the Social Security Act (42 

22 U.S.C. 711), and health, education, and social wel23 fare programs funded under the American Rescue 

24 Plan Act of 2021 (Public Law 117–2; 135 Stat. 4) 


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1 and the Child Care Development Block Grant Act of 

2 1990 (42 U.S.C. 9857 et seq.). 

3 (7) Activities that include Medicaid-enrolled 

4 children and their families and caregivers as part5 ners at all levels of decision-making, implementation, 

6 and evaluation, including engaging such children 

7 who are youth and their families directly as para8 professional providers. 

9 (c) PLANNING GRANTS.— 

10 (1) IN GENERAL.—For the first 18-month pe11 riod of the demonstration project, the Secretary 

12 shall award planning grants to States that apply for 

13 such grants, including to entities specified in sub14 paragraphs (B) and (C) of subsection (h)(7). A 

15 State awarded a planning grant under this sub16 section shall use the grant to carry out the activities 

17 described in paragraph (2) for purposes of preparing 

18 and submitting an application to participate in the 

19 remaining 36-month period of the demonstration 

20 project in accordance with subsection (d). 

21 (2) ACTIVITIES DESCRIBED.—Activities de22 scribed in this paragraph are, with respect to a 

23 State awarded a planning grant under this sub24 section, each of the following: 


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1 (A) Activities that support the development 

2 of an initial assessment of the access needs of 

3 Medicaid-enrolled children in the State with re4 spect to mental health and substance use serv5 ices, to determine the types of support, train6 ing, incentives, and technical assistance that 

7 primary care, early care and education, or other 

8 programs provided in care settings described in 

9 subsection (b) and with which Medicaid-enrolled 

10 children and their families regularly engage 

11 need in order to offer integrated mental health 

12 and substance use disorder care services, in13 cluding prevention and early intervention serv14 ices, and which shall include engaging Med15 icaid-enrolled children and their families di16 rectly to ensure that the assessment builds to17 ward solutions that meet their needs and reflect 

18 their perspectives, experiences, and solutions. 

19 (B) Activities that, taking into account the 

20 results of the assessment described in subpara21 graph (A), support the development of State in22 frastructure, such as technology and the phys23 ical structures necessary to physically co-locate 

24 integrated mental health and substance use dis25 order care services, including prevention and 


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1 early intervention services, to provide the types 

2 of support, training, incentives, and technical 

3 assistance that primary care, early care and 

4 education, or other programs provided in care 

5 settings described in subsection (b) and with 

6 which Medicaid-enrolled children and their fam7 ilies regularly engage need in order to offer in8 tegrated mental health and substance use dis9 order care services, including prevention and 

10 early intervention services, to Medicaid-enrolled 

11 children, as well as activities that support ongo12 ing engagement of Medicaid-enrolled children 

13 and their families in implementation and co14 ordination with health insurers and with other 

15 child-serving agencies and stakeholders. 

16 (3) FUNDING.—For purposes of awarding plan17 ning grants under paragraph (1), there is appro18 priated, out of any funds in the Treasury not other19 wise appropriated, $100,000,000, to remain avail20 able until expended. 

21 (d) POST-PLANNING STATES.— 

22 (1) IN GENERAL.—For the remaining 36-month 

23 period of the demonstration project, the Secretary 

24 shall make payments in accordance with subsection 

25 (e) to all States that submit applications that meet 


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1 the requirements of paragraph (2) and carry out the 

2 activities described in that paragraph. 

3 (2) APPLICATIONS; ACTIVITIES.— 

4 (A) IN GENERAL.—A State seeking to be 

5 selected to participate in the remaining 36- 

6 month period of the demonstration project shall 

7 submit to the Secretary, at such time and in 

8 such form and manner as the Secretary re9 quires, an application that includes such infor10 mation, provisions, and assurances, as the Sec11 retary may require, in addition to the following: 

12 (i) A process for carrying out the on13 going assessment described in subsection 

14 (b)(1), taking into account the results of 

15 the initial assessment described in sub16 section (c)(2)(A). 

17 (ii) A review of Medicaid reimburse18 ment methodologies and other policies re19 lated to furnishing integrated mental 

20 health and substance use disorder care 

21 services, including prevention and early 

22 intervention services, to Medicaid-enrolled 

23 children that may create barriers to access. 

24 If the State uses multiple reimbursement 

25 methodologies under Medicaid for mental 


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1 health and substance use care (such as 

2 capitation, fee-for-service, value-based, and 

3 alternative payment programs), the State 

4 shall include in the application specific de5 tailed information regarding how the State 

6 will verify that the combination of reim7 bursement methodologies employed by the 

8 State will result in improved access to inte9 grated mental health and substance use 

10 disorder care services, including prevention 

11 and early intervention services, for Med12 icaid-enrolled children. 

13 (iii) The development of a plan, tak14 ing into account activities carried out 

15 under subsection (c)(2)(B), that will result 

16 in long-term and sustainable access to inte17 grated mental health and substance use 

18 disorder care services, including prevention 

19 and early intervention services, for Med20 icaid-enrolled children which includes the 

21 following: 

22 (I) Specific activities to increase 

23 access to integrated mental health and 

24 substance use disorder care services, 

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1 vention services, so as to allow for the 

2 prevention, identification, and treat3 ment of mental health and substance 

4 use conditions in primary care, early 

5 care and education, or other programs 

6 provided in care settings described in 

7 subsection (b) and with which Med8 icaid-enrolled children and their fami9 lies regularly engage. 

10 (II) Strategies that will 

11 incentivize a racially and culturally di12 verse array of providers (including 

13 paraprofessionals) to obtain the nec14 essary training, education, and sup15 port to deliver integrated care for the 

16 developmentally appropriate preven17 tion, identification, assessment, diag18 nosis, and treatment of mental health 

19 and substance use conditions in Med20 icaid-enrolled children in primary 

21 care, early care and education, or 

22 other programs provided in care set23 tings described in subsection (b) and 

24 with which Medicaid-enrolled children 

25 and their families regularly engage. 


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1 (III) Milestones and timeliness 

2 for implementing activities set forth in 

3 the plan, as determined by the Sec4 retary. 

5 (IV) Specific measurable targets 

6 for increasing equitable access to inte7 grated mental health and substance 

8 use disorder care services, including 

9 prevention and early intervention serv10 ices, for Medicaid-enrolled children. 

11 (V) Specific measurable targets 

12 for increasing the workforce providing 

13 integrated mental health and sub14 stance use disorder care services, in15 cluding prevention and early interven16 tion services. 

17 (iv) A process for reporting the infor18 mation required under subsection (f)(1), 

19 including information to assess the effec20 tiveness of the efforts of the State during 

21 the period of the demonstration project 

22 under this subsection and ensure the sus23 tainability of such efforts after the conclu24 sion of the demonstration project. 


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1 (v) The expected financial impact of 

2 the demonstration project on the State. 

3 (vi) A description of funding sources 

4 available to the State to expand access to 

5 integrated mental health and substance use 

6 disorder care services, including prevention 

7 and early intervention services in the 

8 State, including health care, public health, 

9 education, and social service funding op10 portunities. 

11 (vii) A preliminary plan for how the 

12 State will sustain access to integrated 

13 mental health and substance use disorder 

14 care services, including prevention and 

15 early intervention services, for Medicaid16 enrolled children after the demonstration 

17 project, including maintenance of incen18 tives and enhanced reimbursement rates. 

19 (viii) A description of how the State 

20 will coordinate the goals of the demonstra21 tion project with any waiver granted (or 

22 submitted by the State and pending) pur23 suant to section 1115 of the Social Secu24 rity Act (42 U.S.C. 1315) for the delivery 

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1 ices under Medicaid, as applicable, and 

2 with State plans under the Elementary and 

3 Secondary Education Act of 1965 (20 

4 U.S.C. 6301 et seq.), the Individuals with 

5 Disabilities Education Act (20 U.S.C. 

6 1400 et seq.), the Family First Prevention 

7 Services Act (title VII of division E of the 

8 Bipartisan Budget Act of 2018 (Public 

9 Law 115–123; 132 Stat. 232)), the Steph10 anie Tubbs Jones Child Welfare Services 

11 Program under subpart 1 of part B of title 

12 IV of the Social Security Act (42 U.S.C. 

13 621 et seq.), the MaryLee Allen Promoting 

14 Safe and Stable Families Program under 

15 subpart 2 of part B of title IV of the So16 cial Security Act (42 U.S.C. 629 et seq.), 

17 home visiting programs, including the Ma18 ternal, Infant, and Early Childhood Home 

19 Visiting Program (MIECHV) under sec20 tion 511 of the Social Security Act (42 

21 U.S.C. 711), and health, education, and 

22 social welfare programs funded under the 

23 American Rescue Plan Act of 2021 (Public 

24 Law 117–2; 135 Stat. 4) and the Child 


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1 Care Development Block Grant Act of 

2 1990 (42 U.S.C. 9857 et seq.). 

3 (B) CONSULTATION.—In completing an 

4 application under subparagraph (A), a State 

5 shall consult with relevant stakeholders, includ6 ing Medicaid managed care plans, primary and 

7 specialty health care provider organizations, 

8 Medicaid-enrolled children and their families, 

9 and other child-serving State and local agencies 

10 and stakeholders, and include in the application 

11 a description of such consultation. 

12 (C) TECHNICAL ASSISTANCE.—The Sec13 retary shall provide technical assistance to 

14 States with respect to preparing and submitting 

15 an application that meets the requirements of 

16 subparagraphs (A) and (B). 

17 (e) PAYMENTS.— 

18 (1) IN GENERAL.—For each quarter occurring 

19 during the remaining 36-month period of the dem20 onstration project, the Secretary shall pay each 

21 State that submits an application that meets the re22 quirements of subsection (d) (2) and carries out the 

23 activities described in that subsection, an amount 

24 equal to 80 percent of the qualified sums expended 

25 by the State for such quarter. 


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1 (2) QUALIFIED SUMS DEFINED.—For purposes 

2 of paragraph (1), the term ‘‘qualified sums’’ means, 

3 with respect to a State and a quarter, the amount 

4 equal to the amount (if any) by which— 

5 (A) the sums expended by the State during 

6 such quarter that are attributable to— 

7 (i) furnishing integrated mental 

8 health and substance use disorder care 

9 services, including prevention and early 

10 intervention services, to Medicaid-enrolled 

11 children; 

12 (ii) the development or enabling of 

13 State infrastructure, such as technology 

14 and the physical structures necessary to 

15 physically co-locate integrated mental 

16 health and substance use disorder care 

17 services, including prevention and early 

18 intervention services, delivered in or coordi19 nated through primary care, early care and 

20 education, or other programs provided in 

21 care settings described in subsection (b) 

22 and with which Medicaid-enrolled children 

23 and their families regularly engage; and 

24 (iii) the development of a workforce to 

25 provide the types of support, training, and 


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1 technical assistance needed in order to 

2 offer integrated mental health and sub3 stance use care services, including preven4 tion and early intervention services, in pri5 mary care, early care and education, or 

6 other programs provided in care settings 

7 described in subsection (b) and with which 

8 Medicaid-enrolled children and their fami9 lies regularly engage; exceeds 

(B) 1 10 ⁄4 of the average annual amount ex11 pended by the State for the most recent 5-fiscal 

12 year period for medical assistance for mental 

13 health or substance use disorder care services 

14 for Medicaid-enrolled children in a primary 

15 care, children’s hospitals, school, early care and 

16 education, or other developmentally appropriate 

17 care setting, as determined by the Secretary. 

18 (3) NON-DUPLICATION OF PAYMENT.—No pay19 ment made under this subsection with respect to 

20 medical assistance furnished to a Medicaid-enrolled 

21 child shall be duplicative of any payment made to a 

22 provider participating under the State Medicaid pro23 gram for the same services so furnished to the same 

24 child. 

25 (f) REPORTS.— 


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1 (1) STATE REPORTS.—Each State that receives 

2 payments under subsection (e) during the remaining 

3 36-month period of the demonstration project shall 

4 submit to the Secretary, in accordance with detailed, 

5 specific guidance that is issued by the Secretary not 

6 later than the first day of such period, and that in7 cludes information on how to estimate and reconcile 

8 State expenditures to carry out the demonstration 

9 project during such period, quarterly reports, with 

10 respect to expenditures for which payment is made 

11 to the State under subsection (e), on the following: 

12 (A) The specific activities with respect to 

13 which payment under such subsection was pro14 vided. 

15 (B) The number of primary care, chil16 dren’s hospitals, schools, and early care and 

17 education programs that delivered or coordi18 nated integrated mental health and substance 

19 use disorder care services, including prevention 

20 and early intervention services, to Medicaid-en21 rolled children during such period and their ge22 ographic distribution, compared to the esti23 mated number that would have otherwise deliv24 ered such services in the absence of the demVerDate Sep 11 2014 22:51 Mar 31, 2023 Jkt 039200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S923.IS S923

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1 onstration project, including disaggregated data 

2 on the race, ethnicity, and gender of providers. 

3 (C) The number of Medicaid-enrolled chil4 dren who received integrated mental health and 

5 substance use disorder care services, including 

6 prevention and early intervention services dur7 ing such period compared to the estimated 

8 number of such children who would have other9 wise received such services in the absence of the 

10 demonstration project, including disaggregated 

11 data on the race, ethnicity, gender, age (ensur12 ing that children birth to 5 as well as transi13 tion-aged youth are adequately served), sexual 

14 orientation, primary language, income, and dis15 ability status of the children. 

16 (D) Such other data or information as de17 termined by the Secretary. 

18 (2) CMS REPORTS.— 

19 (A) INITIAL REPORT.—Not later than Oc20 tober 1, 2026, the Administrator of the Centers 

21 for Medicare & Medicaid Services shall, in con22 sultation with the Director of the Agency for 

23 Healthcare Research and Quality and the As24 sistant Secretary for Mental Health and Sub25 stance Use, submit to Congress an initial report 


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1 on the activities carried out by States under the 

2 planning grants made under subsection (c), and 

3 actions taken by the Administrator of the Cen4 ters for Medicare & Medicaid Services to im5 prove oversight of such activities. 

6 (B) INTERIM REPORT.—Not later than Oc7 tober 1, 2028, the Administrator of the Centers 

8 for Medicare & Medicaid Services shall, in con9 sultation with the Director of the Agency for 

10 Healthcare Research and Quality and the As11 sistant Secretary for Mental Health and Sub12 stance Use, submit to Congress an interim re13 port on activities carried out under the dem14 onstration project and actions taken by the Ad15 ministrator of the Centers for Medicare & Med16 icaid Services to improve oversight of such ac17 tivities and the extent to which States have 

18 achieved the stated goals submitted in their ap19 plications. Such report shall include a descrip20 tion of the strengths and limitations of the 

21 demonstration project and a plan for the sus22 tainability of the project. 

23 (C) FINAL REPORT.—Not later than Octo24 ber 1, 2030, the Administrator of the Centers 

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1 sultation with the Director of the Agency for 

2 Healthcare Research and Quality and the As3 sistant Secretary for Mental Health and Sub4 stance Use, submit to Congress a final report 

5 providing updates on the matters reported in 

6 the interim report required by subparagraph 

7 (B) and that includes— 

8 (i) a description of any changes made 

9 with respect to the demonstration project 

10 after the submission of such interim re11 port; and 

12 (ii) an evaluation of the demonstra13 tion project. 

14 (g) IMPLEMENTATION FUNDING.—There is appro15 priated, out of any funds in the Treasury not otherwise 

16 appropriated, $5,000,000 to the Administrator of the Cen17 ters for Medicare & Medicaid Services for purposes of im18 plementing this section, to remain available until ex19 pended. 

20 (h) DEFINITIONS.—In this section: 

21 (1) CHILDREN’S HOSPITALS.—The term ‘‘chil22 dren’s hospitals’’ has the meaning given that term in 

23 section 340E(g)(2) of the Public Health Service Act 

24 (42 U.S.C. 256e(g)(2). 


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1 (2) INTEGRATED MENTAL HEALTH AND SUB2 STANCE USE DISORDER CARE SERVICES.—The term 

3 ‘‘mental health and substance use disorder care serv4 ices’’ has the meaning given that term in section 

5 1848(b)(13)(B) of the Social Security Act and in6 cludes prevention and early intervention services and 

7 such other items and services for the care of mental 

8 health and substance use conditions furnished by, or 

9 in coordination with, a primary care practitioner as 

10 the Secretary, in consultation with a State, may 

11 specify. 

12 (3) MEDICAID.—The term ‘‘Medicaid’’ means 

13 the program for grants to States for medical assist14 ance programs established under title XIX of the 

15 Social Security Act (42 U.S.C. 1396 et seq.). 

16 (4) SECRETARY.—Except as otherwise speci17 fied, the term ‘‘Secretary’’ means the Secretary of 

18 Health and Human Services. 

19 (5) STATE.—The term ‘‘State’’ has the mean20 ing given that term in section 1101(a)(1) of the So21 cial Security Act (42 U.S.C. 1301(a)(1)) for pur22 poses of titles XIX and XXI of such Act, and for 

23 purposes of 

24 (6) MEDICAID-ENROLLED CHILD.—The term 

25 ‘‘Medicaid-enrolled child’’ means, with respect to a 


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1 State, a child enrolled under the State plan approved 

2 under title XIX of the Social Security Act (42 

3 U.S.C. 1396 et seq.) or under a waiver of such plan. 

4 (7) SECRETARY.—The term ‘‘Secretary’’ means 

5 the Secretary of Health and Human Services. 

6 (8) STATE.—The term ‘‘State’’ means— 

7 (A) each of the 50 States and the District 

8 of Columbia; 

9 (B) the Commonwealth of Puerto Rico, the 

10 United States Virgin Islands, Guam, American 

11 Samoa, and the Commonwealth of the Northern 

12 Mariana Islands; and 

13 (C) to the extent the Secretary determines 

14 appropriate, may include an Indian Tribe, Trib15 al organization, or Urban Indian organization 

16 (as such terms are defined in section 4 of the 

17 Indian Health Care Improvement Act (25 

18 U.S.C. 1603)). 

19 SEC. 303. UNIFORM APPLICABILITY TO MEDICAID OF RE20 QUIREMENTS FOR PARITY IN MENTAL 

21 HEALTH AND SUBSTANCE USE DISORDER 

22 BENEFITS. 

23 (a) FEE-FOR-SERVICE AND ALTERNATIVE BENEFIT

24 PLANS.—Section 1902 of the Social Security Act (42 

25 U.S.C. 1396a) is amended— 


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1 (1) in subsection (a)— 

2 (A) by striking ‘‘and’’ at the end of para3 graph (86); 

4 (B) by striking the period at the end of 

5 paragraph (87) and inserting ‘‘; and’’; and 

6 (C) by inserting after paragraph (87) the 

7 following new paragraph: 

8 ‘‘(88) provide for ensuring that the require9 ments for parity in mental health and substance use 

10 disorder benefits under subsection (uu) are complied 

11 with regardless of the payment model or arrange12 ment under which medical assistance is provided, in13 cluding when medical assistance under the State 

14 plan or under a waiver of such plan is provided 

15 through an alternative benefit plan under section 

16 1937.’’; and 

17 (2) by adding at the end the following new sub18 section: 

19 ‘‘(uu) PARITY IN MENTAL HEALTH AND SUBSTANCE

20 USE DISORDER BENEFITS.—For purposes of subsection 

21 (a)(88), the requirements under this subsection are the 

22 following: 

23 ‘‘(1) IN GENERAL.—Regardless of whether a 

24 State plan or waiver of pays for medical assistance 

25 on a fee-for-service basis, capitated payment basis, 


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1 through the use of 1 or more alternative payment 

2 models, or any combination thereof, the State shall 

3 ensure that the financial requirements and treat4 ment limitations applicable to coverage of mental 

5 health or substance use disorder services provided 

6 under such plan or under a waiver of such plan com7 ply with the requirements of section 2726(a) of the 

8 Public Health Service Act in the same manner as 

9 such requirements or limitations apply to a group 

10 health plan under such section. 

11 ‘‘(2) DEEMED COMPLIANCE.—Coverage with re12 spect to an individual described in section 

13 1905(a)(4)(B) and covered under the State plan or 

14 waiver under section 1902(a)(10)(A) of the services 

15 described in section 1905(a)(4)(B) (relating to early 

16 and periodic screening, diagnostic, and treatment 

17 services defined in section 1905(r)) and provided in 

18 accordance with section 1902(a)(43), shall be 

19 deemed to satisfy the requirements of paragraph 

20 (1).’’. 

21 (b) MANAGED CARE ORGANIZATIONS AND PAYMENT

22 ARRANGEMENTS.— 

23 (1) IN GENERAL.—Section 1932(b)(8) of the 

24 Social Security Act (42 U.S.C. 1396u–2(b)(8)) is 

25 amended to read as follows: 


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1 ‘‘(8) COMPLIANCE WITH CERTAIN MATERNITY, 

2 PARITY IN MENTAL HEALTH OR SUBSTANCE USE

3 DISORDER BENEFITS, AND OTHER COVERAGE RE4 QUIREMENTS.— 

5 ‘‘(A) IN GENERAL.—Each medicaid man6 aged care organization shall comply with the re7 quirements of subpart 2 of part A of title 

8 XXVII of the Public Health Service Act insofar 

9 as such requirements apply and are effective 

10 with respect to a health insurance issuer that 

11 offers group health insurance coverage. 

12 ‘‘(B) PARITY IN MENTAL HEALTH OR SUB13 STANCE USE DISORDER BENEFITS.—The finan14 cial requirements and treatment limitations ap15 plicable to coverage of mental health or sub16 stance use disorder services provided under the 

17 State plan or under a waiver of such plan 

18 through a medicaid managed care organization, 

19 a prepaid inpatient health plan (as defined by 

20 the Secretary), a prepaid ambulatory health 

21 plan (as defined by the Secretary), or a primary 

22 care case manager under section 1905 (con23 sistent with section 1905(t)(2)), shall comply 

24 with the requirements of section 2726(a) of the 

25 Public Health Service Act in the same manner 


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1 as such requirements or limitations apply to a 

2 group health plan under such section. 

3 ‘‘(C) DEEMED COMPLIANCE.—In applying 

4 subparagraphs (A) and (B) with respect to re5 quirements under paragraph (8) of section 

6 2726(a) of the Public Health Service Act, a 

7 medicaid managed care organization, a prepaid 

8 inpatient health plan (as defined by the Sec9 retary), a prepaid ambulatory health plan (as 

10 defined by the Secretary), or a primary care 

11 case manager under section 1905 (consistent 

12 with section 1905(t)(2)) shall be treated as in 

13 compliance with such requirements if the med14 icaid managed care organization, prepaid inpa15 tient health plan, prepaid ambulatory health 

16 plan, or primary care case manager under sec17 tion 1905 is in compliance with subpart K of 

18 part 438 of title 42, Code of Federal Regula19 tions, and section 438.3(n) of such title, or any 

20 successor regulation.’’. 

21 (c) EFFECTIVE DATE.— 

22 (1) IN GENERAL.—Except as provided in para23 graph (2), the amendments made by subsections (a) 

24 and (b) shall take effect on the first day of the first 

25 calendar quarter that begins on or after the date 


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1 that is 3 years after the date of enactment of this 

2 Act. 

3 (2) DELAY IF STATE LEGISLATION NEEDED.— 

4 In the case of a State plan for medical assistance 

5 under title XIX of the Social Security Act (42 

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

7 and Human Services determines requires State legis8 lation (other than legislation appropriating funds) in 

9 order for the plan to meet the additional require10 ments imposed by the amendments made by sub11 section (a), the State plan shall not be regarded as 

12 failing to comply with the requirements of such title 

13 solely on the basis of its failure to meet these addi14 tional requirements before the first day of the first 

15 calendar quarter beginning after the close of the 

16 first regular session of the State legislature that be17 gins after the date of the enactment of this Act. For 

18 purposes of the previous sentence, in the case of a 

19 State that has a 2-year legislative session, each year 

20 of such session shall be deemed to be a separate reg21 ular session of the State legislature. 

22 (d) FUNDING.—Out of any funds in the Treasury not 

23 otherwise appropriated, there is appropriated to the Sec24 retary of Health and Human Services for purposes of car25 rying out this section and the amendments made by this 


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1 section, $10,000,000 for fiscal year 2024, to remain avail2 able until expended. 

3 SEC. 304. REQUIRING ADDITIONAL TRANSPARENCY ON AC4 CESS TO MENTAL HEALTH AND SUBSTANCE 

5 USE DISORDER BENEFITS THROUGH MAN6 AGED CARE. 

7 (a) BIANNUAL ASSESSMENT.—Section 1932(b) of the 

8 Social Security Act (42 U.S.C. 1396u–2(b)) is amended 

9 by adding at the end the following new paragraph: 

10 ‘‘(9) TRANSPARENCY ON ACCESS TO MENTAL

11 HEALTH AND SUBSTANCE USE DISORDER BENE12 FITS.— 

13 ‘‘(A) IN GENERAL.—Each managed care 

14 organization, prepaid inpatient health plan (as 

15 defined by the Secretary), and prepaid ambula16 tory health plan (as defined by the Secretary), 

17 with a contract with a State to enroll individ18 uals who are eligible for medical assistance 

19 under the State plan under this title or under 

20 a waiver of such plan and to provide coverage 

21 under the contract for mental health services or 

22 substance use disorder services, disaggregated, 

23 biannually shall assess and report to the State, 

24 in such manner that the report is publicly avail25 able on a website, the following: 


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1 ‘‘(i) The average wait times during 

2 the reporting period by level of acuity and 

3 site of care for adult and child patients for 

4 a new patient visit in an outpatient setting 

5 (including intensive outpatient, eating dis6 order, residential treatments, or other ap7 pointments as the Secretary specifies) from 

8 a provider of mental health services or sub9 stance use disorder services. 

10 ‘‘(ii) The total number and average 

11 percentage of network providers that pro12 vide mental health services or substance 

13 use disorder services and are accepting as 

14 new patients individuals who are enrollees 

15 of such organization or plan at any point 

16 during the reporting period. 

17 ‘‘(iii) The proportion of mental health 

18 services or substance use disorder services 

19 and prescription drugs during the report20 ing period that are denied payment under 

21 the State plan under this title or a waiver 

22 on the basis of prior authorization or med23 ical necessity (or for any other reason that 

24 is not based on an enrollee’s eligibility for 

25 medical assistance under the State plan 


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1 under this title or a waiver) in comparison 

2 to medical and surgical services and pre3 scription drugs that are denied payment on 

4 the same bases during the reporting pe5 riod. 

6 ‘‘(iv) The total number and percent7 age of providers during the reporting pe8 riod who have participation agreements 

9 with the organization who submitted at 

10 least 1 request for payment for a mental 

11 health or substance use disorder service. 

12 ‘‘(B) SUBMISSION TO SECRETARY.—A 

13 State shall submit information reported to the 

14 State under subparagraph (A), including strati15 fying reporting by race, ethnicity, disability, pri16 mary language, age, sexual orientation, and 

17 gender identity, to help identify health inequi18 ties where applicable, to the Secretary in such 

19 form and manner as the Secretary shall speci20 fy.’’. 

21 (b) EFFECTIVE DATE.—The amendment made by 

22 subsection (a) shall take effect on the date that is 2 years 

23 after the date of enactment of this section. 


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1 SEC. 305. AUTHORITY TO DEFER OR DISALLOW A PORTION 

2 OF FEDERAL FINANCIAL PARTICIPATION FOR 

3 FAILURE TO COMPLY WITH MANAGED CARE 

4 REQUIREMENTS. 

5 (a) STATE PLAN AMENDMENT.—Section 1902(a) of 

6 the Social Security Act (42 U.S.C. 1396a(a)), as amended 

7 by section 303(a)(1), is amended— 

8 (1) in paragraph (87), by striking ‘‘and’’ after 

9 the semicolon; 

10 (2) in paragraph (88)(D), by striking the period 

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

12 (3) by inserting after paragraph (88)(D), the 

13 following new paragraph: 

14 ‘‘(89) in the case of a State that adopts the op15 tion to use managed care as described in section 

16 1932, provide that the State shall comply with the 

17 requirements of section 1932.’’. 

18 (b) APPLICATION TO MANAGED CARE CONTRACTS.— 

19 Section 1903(m)(2) of the Social Security Act (42 U.S.C. 

20 1396b(m)) is amended— 

21 (1) in subparagraph (A), in the matter pre22 ceding clause (i), by striking ‘‘and (G)’’ and insert23 ing ‘‘(G), and (I)’’; and 

24 (2) by adding at the end the following new sub25 paragraph: 


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1 ‘‘(I) For a violation of any requirement described in 

2 subparagraph (A), including a violation of the require3 ments of section 1932, as applicable under clause (xii) of 

4 such subparagraph and paragraph (89) of section 

5 1902(a), rather than disallowing the full amount of a pay6 ment under this title to a State for expenditures incurred 

7 by the State as described in subparagraph (A), the Sec8 retary may defer or disallow a portion of a payment to 

9 the State. In determining the amount deferred or dis10 allowed under this subparagraph, the Secretary may con11 sider factors such as the degree, duration, and recurrence 

12 of noncompliance. A State may receive a reconsideration 

13 of a decision by the Secretary under this subparagraph 

14 to disallow payment in the manner described in section 

15 1116(e).’’. 

16 (c) EFFECTIVE DATE.—The amendments made by 

17 this section shall take effect on the date that is 2 years 

18 after the date of enactment of this section and shall apply 

19 to contracts for rating periods beginning on or after such 

20 date. 

21 SEC. 306. MEDICAID AND CHIP AUDITS. 

22 (a) REGULAR AUDITS.—Beginning with fiscal year 

23 2025, the Secretary of Health and Human Services (re24 ferred to in this section as the ‘‘Secretary’’) shall audit 

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1 surance Programs for purposes of assessing State enforce2 ment of the requirements relating to parity in mental 

3 health and substance use disorder benefits (including with 

4 respect to compliance with such parity requirements in the 

5 case of any mental health or substance use disorder bene6 fits that are separately managed or financed under a 

7 ‘‘carve-out’’ model) applicable under subsections (a)(88) 

8 and (uu) of section 1902 of the Social Security Act (42 

9 U.S.C. 1396a) (as added by section 303(a), section 

10 1932(b)(8) of such Act (42 U.S.C. 1396u–2(b)(8)), sec11 tion 1937(b)(6) of such Act (42 U.S.C. 1396u–7(b)(6)), 

12 and section 2103(c)(7) of such Act (42 U.S.C. 

13 1397cc(c)(7)), and related regulations. 

14 (b) ROTATIONAL PROCEDURE; PUBLICATION.—The 

15 Secretary may carry out the audits required by subsection 

16 (a) using a rotational approach among States over a 3- 

17 year period, and shall make the results of such audits pub18 licly available on a searchable website. 

19 (c) PUBLICATION OF ENFORCEMENT ACTIONS.—The 

20 Secretary shall publish (and update on at least an annual 

21 basis) on a public website of the Department of Health 

22 and Human Services a report that specifies the actions 

23 taken by the Secretary to enforce violations of the mental 

24 health and substance use disorder parity requirements 

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1 section (a). The Secretary may publish such information 

2 separately or include the information in the 1 or more 

3 published audit reports required by subsection (b) that 

4 correspond to each such violation. 

5 (d) FUNDING.—Out of any funds in the Treasury not 

6 otherwise appropriated, there is appropriated to the Sec7 retary of Health and Human Services for each fiscal year 

8 beginning with fiscal year 2025, $5,000,000 to carry out 

9 this section. 

10 TITLE IV—OTHER PROVISIONS 

11 SEC. 401. ENSURING MULTI-PAYER ALIGNMENT ON PAY12 MENT AND MEASUREMENT OF QUALITY OF 

13 CARE AND HEALTH OUTCOMES RELATED TO 

14 INTEGRATED MENTAL HEALTH AND SUB15 STANCE USE DISORDER CARE. 

16 Not later than April 1, 2024, the Administrator of 

17 the Centers for Medicare & Medicaid Services shall con18 vene an advisory working group that includes representa19 tives of issuers of group and individual health insurance 

20 coverage, mental health and substance use disorder pro21 grams and advocacy organizations, individuals and fami22 lies receiving integrated care services, and State Medicaid 

23 Directors, for purposes of making recommendations for 

24 administrative and legislative changes to facilitate multi25 payer alignment on payment and measurement of quality 


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1 of care and health outcomes with respect to advancing the 

2 provision of integrated mental health and substance use 

3 disorder care in a manner that does not violate antitrust 

4 or other applicable laws. The recommendations of the 

5 working group shall include recommendations for measur6 able, ongoing benchmarks to assess the extent to which 

7 payment and measurement of the quality of care and 

8 health outcomes are aligned across health care payers. 

9 SEC. 402. MEASURING ACCESS AND QUALITY OUTCOMES IN 

10 MENTAL HEALTH AND SUBSTANCE USE DIS11 ORDER CARE. 

12 (a) IN GENERAL.—Not later than October 1, 2024, 

13 the Administrator of the Centers for Medicare & Medicaid 

14 Services shall, in consultation with the Administrator of 

15 the Health Resource Services Administration, the Director 

16 of the Agency for Healthcare Research and Quality, and 

17 the Assistant Secretary for Mental Health and Substance 

18 Use, develop and implement a plan to improve measure19 ment of the extent to which children and adults have ac20 cess to integrated mental health and substance use dis21 order care in primary care and the quality and effective22 ness of the care provided, which shall be implemented in 

23 quality measurement programs under the Medicare pro24 gram under title XVIII of the Social Security Act (42 

25 U.S.C. 1395 et seq.), the Medicaid program under title 


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1 XIX of such Act (42 U.S.C. 1396 et seq.), and group 

2 health plans and health insurance coverage (as such terms 

3 are defined in section 2791 of the Public Health Service 

4 Act (42 U.S.C. 300gg–91)). 

5 (b) MEASURE DEVELOPMENT.—The Director of the 

6 Agency for Healthcare Research and Quality shall conduct 

7 measure development where necessary to ensure that the 

8 plan developed under subsection (a) may be fully imple9 mented, including measures of patient experience out10 comes, structural measures of practice transformation to11 ward evidence-based integrated care, and measures of ac12 cess and unmet need provided by local, State, or Federal 

13 agencies. 

14 SEC. 403. REVIEWING THE EVIDENCE FOR INTEGRATED 

15 MENTAL HEALTH CARE FOR CHILDREN. 

16 Not later than October 1, 2024, the Director of the 

17 Agency for Healthcare Research and Quality shall review 

18 the evidence, for consideration by the United States Pre19 ventive Services Task Force, for interventions for children 

20 who are at risk of developing a mental health condition 

21 to prevent internalizing and externalizing mental health 

22 problems, and for screening to identify family and child 

23 psychosocial needs, segmented by developmental stage as 

24 appropriate. 


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1 SEC. 404. ENHANCING OVERSIGHT OF INTEGRATED MEN2 TAL HEALTH AND SUBSTANCE USE DIS3 ORDER CARE. 

4 (a) IN GENERAL.—Not later than October 1, 2024, 

5 the Administrator of the Centers for Medicare & Medicaid 

6 Services shall, in consultation with the Director of the 

7 Agency for Healthcare Research and Quality and the As8 sistant Secretary for Mental Health and Substance Use, 

9 develop and implement a plan to improve oversight and 

10 enforcement of requirements relating to the provision of 

11 integrated mental health and substance use disorder care 

12 under the Medicare program under title XVIII of the So13 cial Security Act (42 U.S.C. 1395 et seq.), the Medicaid 

14 program under title XIX of such Act (42 U.S.C. 1396 et 

15 seq.), and group health plans and health insurance cov16 erage (as such terms are defined in section 2791 of the 

17 Public Health Service Act (42 U.S.C. 300gg–91)), includ18 ing requirements relating to— 

19 (1) coverage of preventive health services with20 out cost-sharing under section 2713 of the Public 

21 Health Service Act (42 U.S.C. 300gg–13); 

22 (2) early and periodic screening, diagnosis, and 

23 treatment for mental health and substance use dis24 orders; 

25 (3) mental health and substance use parity; 


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1 (4) network adequacy, including quantitative 

2 measures of network access that take into account 

3 integration in primary care and schools, racial eq4 uity, and virtual care; 

5 (5) essential health benefits (as defined in sec6 tion 1302(b) of the Patient Protection and Afford7 able Care Act (42 U.S.C. 18022(b))); and 

8 (6) Medicaid rate setting. 

9 (b) PATIENT INPUT.—In developing and imple10 menting the plan under subsection (a), the Administrator 

11 shall seek input from patients with mental health and sub12 stance use conditions. 

Æ 


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