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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 923 Introduced in Senate (IS)]

<DOC>

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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Better Mental 
Health Care for Americans Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                  TITLE I--MEDICARE PART B PROVISIONS

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.

                  TITLE I--MEDICARE PART B PROVISIONS

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.

    (a) In General.--Section 1848(b) of the Social Security Act (42 
U.S.C. 1395w-4(b)) is amended by adding at the end the following new 
paragraph:
            ``(13) Payment for inherently complex evaluation and 
        management visits related to integrated mental health and 
        substance use disorder care.--
                    ``(A) In general.--The Secretary shall establish a 
                new HCPCS add-on code under the fee schedule 
                established under this subsection for integrated mental 
                health and substance use disorder care services (as 
                defined in subparagraph (B)(i)) that are furnished on 
                or after January 1, 2025, when furnished by an 
                integrated care practitioner on the same date of 
                service that a service in the HCPCS category of office 
                and other outpatient evaluation and management services 
                is furnished. Such add-on code may be similar to HCPCS 
                code G2211.
                    ``(B) Definitions.--In this paragraph:
                            ``(i) Integrated mental health and 
                        substance use disorder care services.--
                                    ``(I) In general.--The term 
                                `integrated mental health and substance 
                                use disorder care services' means 
                                services described in subclause (II) 
                                that are furnished by an integrated 
                                care practitioner.
                                    ``(II) Services described.--The 
                                services described in this subclause 
                                are the following:
                                            ``(aa) Preventive services 
                                        and screening for mental health 
                                        and substance use disorders 
                                        that the Secretary determines 
                                        are--

                                                    ``(AA) reasonable 
                                                and necessary for the 
                                                prevention or early 
                                                detection of a mental 
                                                health or substance use 
                                                disorder;

                                                    ``(BB) recommended 
                                                with a grade of A or B 
                                                by the United States 
                                                Preventive Services 
                                                Task Force or 
                                                recommended in Health 
                                                Resources and Services-
                                                supported guidelines 
                                                for infants, children, 
                                                adolescents, and women; 
                                                and

                                                    ``(CC) appropriate 
                                                for individuals 
                                                enrolled under this 
                                                part.

                                            ``(bb) The routine use and 
                                        tracking of quality measures 
                                        appropriate for the measurement 
                                        of the quality of care 
                                        (including medication errors) 
                                        related to behavioral health 
                                        that reflect consensus among 
                                        affected parties and, to the 
                                        extent feasible and 
                                        practicable, shall include 
                                        measures set forth by one or 
                                        more national consensus 
                                        building entities.
                                            ``(cc) Short-term, 
                                        evidence-based, culturally, and 
                                        linguistically appropriate 
                                        therapeutic and psychosocial 
                                        intervention integrated into 
                                        the primary care practice, 
                                        including through telehealth.
                                            ``(dd) Evidence-based 
                                        treatment for mental health and 
                                        substance use care integrated 
                                        into the primary care practice, 
                                        including through telehealth, 
                                        or through referral.
                                            ``(ee) Care management, 
                                        which can include establishing, 
                                        implementing, revising or 
                                        monitoring the care plan, 
                                        coordinating with other 
                                        professionals and agencies, and 
                                        educating the individual or 
                                        caregiver about the 
                                        individual's condition, care 
                                        plan, or prognosis.
                                            ``(ff) Other services 
                                        determined by the Secretary.
                            ``(ii) Integrated care practitioner.--
                                    ``(I) In general.--The term 
                                `integrated care practitioner' means a 
                                primary care practitioner (as defined 
                                in section 1833(x)(2)(A)(i)) who has 
                                demonstrated the capacity to furnish 
                                integrated mental health and substance 
                                use disorder care services (as 
                                determined under subclause (II)).
                                    ``(II) Demonstrating capacity 
                                guidance; attestation.--For purposes of 
                                applying subclause (I) with respect to 
                                an integrated care practitioner 
                                demonstrating the capacity to furnish 
                                integrated mental health and substance 
                                use disorder care services, the 
                                Secretary shall issue guidance, not 
                                later than one year after the date of 
                                the enactment of this paragraph, 
                                describing requirements for 
                                demonstrating capacity to provide such 
                                services and establishing a process for 
                                the Secretary to receive an attestation 
                                that an integrated care practitioner 
                                has such capacity. Such guidance and 
                                attestation may not impose additional 
                                burden on small practices (as defined 
                                for purposes of subsection (q)(11)) and 
                                practices located in rural areas.
                    ``(C) Payment.--
                            ``(i) Amount of payment.--The fee schedule 
                        amount for integrated mental health and 
                        substance use disorder care services shall not 
                        be less than the fee schedule amount for 
                        services described by HCPCS code G2211 (or any 
                        successor or substantially similar code).
                            ``(ii) Add-on services.--If, during the 
                        furnishing of an evaluation and management 
                        service to an individual by an integrated care 
                        practitioner, such practitioner also furnishes 
                        (or coordinates the furnishing of) integrated 
                        mental health and substance use disorder care 
                        services on the same date of service, payment 
                        shall also be made for such integrated mental 
                        health and substance used disorder care 
                        services even if the individual did not 
                        previously have a mental health or substance 
                        use disorder diagnosis.
                            ``(iii) Payment considerations.--In 
                        carrying out this paragraph, the Secretary 
                        shall ensure that the amount of payment for 
                        integrated mental health and substance use 
                        disorder care services under this paragraph is 
                        sufficient to sustain effective and accessible 
                        integrated mental health and substance use 
                        disorder care under this part, as determined by 
                        evidence from practice expenses of those 
                        implementing effective integrated care as well 
                        as evidence of the resource needs of integrated 
                        care practitioners who furnish such services in 
                        mental health professional shortage areas (as 
                        designated under section 332(a)(1)(A) of the 
                        Public Health Service Act) and medically 
                        underserved areas.''.
    (b) Exemption From Budget Neutrality.--Section 1848(c)(2)(B)(iv) of 
the Social Security Act (42 U.S.C. 1395w-4(C)(2)(b)(iv)) is amended by 
adding at the end the following new subclause:
                                    ``(VII) Subsection (b)(13) shall 
                                not be taken into account in applying 
                                clause (ii)(II) for 2025.''.
    (c) Waiver of Coinsurance.--Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and'' before ``(HH)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (II) with respect to integrated mental 
        health and substance use disorder care services (as defined in 
        subparagraph (B)(i) of section 1848(b)(13)) that are furnished 
        on or after January 1, 2025, the amounts paid shall be equal to 
        100 percent of the lesser of the actual charge for such 
        services or the fee schedule amount provided under such 
        section''.

SEC. 102. ENSURING ACCESS TO EARLY INTERVENTION IN MENTAL HEALTH CARE 
              IN MEDICARE.

    Section 1833(a)(1) of the Social Security Act (42 U.S.C. 
1395l(a)(1)), as amended by section 101(c), is amended--
            (1) by striking ``and'' before ``(II)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (JJ) with respect to behavioral health 
        integration services described by HCPCS codes 99492, 99493, 
        99494, 99484 , G2214, and G0323 (or any successor or 
        substantially similar code) furnished on or after January 1, 
        2025, the amounts paid shall be equal to 100 percent of the 
        lesser of the actual charge for such services or the fee 
        schedule amount provided under section 1848(b)''.

           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.

    (a) Medicare Advantage Plans.--
            (1) In general.--Section 1852 of the Social Security Act 
        (42 U.S.C. 1395w-22) is amended by adding at the end the 
        following new subsection:
    ``(o) Parity in Mental Health and Substance Use Disorder 
Benefits.--
            ``(1) In general.--Each MA organization shall ensure that 
        the benefit design of each MA plan offered by such organization 
        meets the following requirements:
                    ``(A) Financial requirements.--The financial 
                requirements applicable to mental health or substance 
                use disorder benefits covered by the plan may not 
                exceed the predominant financial requirements applied 
                to substantially all medical benefits covered by the 
                plan, including supplemental benefits, and there are no 
                separate cost sharing requirements that are applicable 
                only with respect to mental health and substance use 
                disorder benefits.
                    ``(B) Treatment limitations.--The treatment 
                limitations applicable to mental health or substance 
                use disorder benefits are no more restrictive than the 
                predominant treatment limitations applied to 
                substantially all medical benefits covered by the plan 
                and there are no separate treatment limitations that 
                are applicable only with respect to mental health or 
                substance use disorder benefits, including supplemental 
                benefits.
            ``(2) Determinations of medical necessity.--
                    ``(A) In general.--Each MA organization shall 
                ensure that any determination of medical necessity for 
                mental health or substance use benefits under each MA 
                plan offered by such organization that is not based on 
                the application of a national or local coverage 
                determination is consistent with generally accepted 
                standards of mental health and substance use disorder 
                care, as defined in paragraph. For any level of care 
                determination with respect to mental health or 
                substance use disorder benefits, coverage criteria are 
                consistent with widely-used treatment guidelines only 
                if they result in a level of care determination that is 
                consistent with the determination that would have been 
                made using the relevant widely-used treatment 
                guidelines.
                    ``(B) Criteria for medical necessity 
                determinations.--The criteria for determination of 
                medical necessity with respect to mental health or 
                substance use disorder benefits under an MA plan shall 
                be made available in plain language to any individual 
                upon request.
            ``(3) Reporting on application of nonquantitative treatment 
        limitations.--
                    ``(A) Comparative analyses of design and 
                application of nonquantitative treatment limits.--For 
                2025 and subsequent years, in the case of an MA 
                organization that imposes nonquantitative treatment 
                limitations (referred to in this paragraph as `NQTLs') 
                on mental health or substance use disorder benefits 
                under an MA plan offered by such organization, such 
                organization shall be required to perform and document 
                comparative analyses of the design and application of 
                NQTLs on mental health and substance use disorder 
                benefits under the plan and make available to the 
                Secretary as provided under subparagraph (B), upon 
                request, the comparative analyses and the following 
                information:
                            ``(i) The specific plan terms regarding the 
                        NQTLs and a description of all mental health or 
                        substance use disorder and medical benefits to 
                        which each such term applies in each respective 
                        benefits classification.
                            ``(ii) The factors used to determine that 
                        the NQTLs will apply to mental health or 
                        substance use disorder benefits and medical 
                        benefits.
                            ``(iii) The evidentiary standards used for 
                        the factors identified in clause (ii), when 
                        applicable, provided that every factor shall be 
                        defined, and any other source or evidence, 
                        including utilization of decision support 
                        technology, artificial intelligence technology, 
                        machine-learning technology, clinical decision-
                        making technology, or any other technology 
                        specified by the Secretary, relied upon to 
                        design and apply the NQTLs to mental health or 
                        substance use disorder benefits and medical 
                        benefits.
                            ``(iv) The comparative analyses 
                        demonstrating that the processes, strategies, 
                        evidentiary standards, and other factors used 
                        to apply the NQTLs to mental health or 
                        substance use disorder benefits, as written and 
                        in operation, are comparable to, and are 
                        applied no more stringently than, the 
                        processes, strategies, evidentiary standards, 
                        and other factors used to apply the NQTLs to 
                        medical benefits in the benefits 
                        classification.
                            ``(v) The specific findings and conclusions 
                        reached by the MA organization with respect to 
                        the MA plan, including any results of the 
                        analyses described in this subparagraph that 
                        indicate that the plan is or is not in 
                        compliance with this subsection.
                    ``(B) Submission to secretary upon request.--An MA 
                organization shall submit to the Secretary the 
                comparative analyses described in subparagraph (A) and 
                the information described in clauses (i) through (v) of 
                such subparagraph upon request by the Secretary. The 
                Secretary shall request not fewer than 20 such analyses 
                per year.
                    ``(C) Report.--Not later than October 1, 2029, and 
                biennially thereafter, the Secretary shall submit to 
                Congress, and make publicly available, a report that 
                contains the following:
                            ``(i) A summary of the comparative analyses 
                        and information requested under subparagraph 
                        (B).
                            ``(ii) The Secretary's conclusions as to 
                        whether each MA organization submitted 
                        sufficient information for the Secretary to 
                        review the comparative analyses and information 
                        requested for compliance with this subsection.
                            ``(iii) The Secretary's conclusions as to 
                        whether each MA organization that submitted 
                        sufficient information for the Secretary to 
                        review was in compliance with this subsection.
            ``(4) Definitions.--In this subsection:
                    ``(A) Classification of benefits.--The term 
                `classification of benefits' means the following:
                            ``(i) Inpatient.--Benefits under part A.
                            ``(ii) Outpatient.--Benefits furnished on 
                        an outpatient basis under part B.
                            ``(iii) Emergency care.--Benefits for 
                        emergency care covered under part B.
                            ``(iv) Part b prescription drugs.--Benefits 
                        for drugs and biologicals covered under part B.
                            ``(v) Covered part d drugs.--Benefits for 
                        covered part D drugs as defined in section 
                        1860D-2(e).
                            ``(vi) Supplemental.--Supplemental health 
                        care benefits as described in section 
                        1852(a)(3).
                    ``(B) Evidentiary standards.--The term `evidentiary 
                standard' means factors or evidence a plan considers in 
                designing and applying its medical management 
                techniques, such as generally accepted standards of 
                mental health and substance use disorder care, 
                recognized medical literature, professional standards 
                and protocols (including comparative effectiveness 
                studies and clinical trials), published research 
                studies, treatment guidelines created by professional 
                medical associations or other third-party entities, 
                publicly available or proprietary clinical definitions, 
                and outcome metrics from consulting or other 
                organizations.
                    ``(C) Financial requirement.--The term `financial 
                requirement' includes deductibles, copayments, 
                coinsurance, and maximum limitations on out-of-pocket 
                expenses applicable under the plan.
                    ``(D) Generally accepted standards of mental health 
                and substance use disorder care.--The term `generally 
                accepted standards of mental health and substance use 
                disorder care' means standards of care and clinical 
                practice that are generally recognized by health care 
                providers practicing in relevant clinical specialties 
                such as psychiatry, psychology, and addiction medicine 
                and counseling, to ensure appropriate diagnosis, 
                treatment, and ongoing management, for underlying 
                mental health and substance use disorders, including 
                co-occurring conditions, to adequately meet the needs 
                of patients. These standards are derived from valid, 
                evidence-based sources such as peer-reviewed scientific 
                studies and medical literature, consensus guidelines of 
                nonprofit health care provider professional 
                associations and specialty societies, including level 
                of care criteria and clinical practice guidelines, and 
                recommendations of Federal government agencies.
                    ``(E) Mental health benefits.--The term `mental 
                health benefits' means benefits with respect to items 
                and services for mental health conditions as defined by 
                the Secretary.
                    ``(F) Predominant.--A financial requirement or 
                treatment limit is considered to be predominant if it 
                is the most common or frequent of such type of limit or 
                requirement.
                    ``(G) Substance use disorder benefits.--The term 
                `substance use disorder benefits' means benefits with 
                respect to items and services for substance use 
                disorders as defined by the Secretary.
                    ``(H) Substantially all.--A financial requirement 
                or treatment limitation applies to substantially all 
                medical benefits in a classification if it applies to 
                at least two-thirds of the benefits in that 
                classification.
                    ``(I) Treatment limitation.--
                            ``(i) In general.--The term `treatment 
                        limitation' means mechanisms to control 
                        utilization of services and expenditures such 
                        as limits on the frequency of treatment, number 
                        of visits, days of coverage, or other similar 
                        limits on the scope or duration of treatment. 
                        Such term includes:
                                    ``(I) Quantitative treatment 
                                limitations.--Quantitative treatment 
                                limitations, including limits on the 
                                frequency of treatment, number of 
                                visits, days of coverage, or other 
                                similar limits on the scope or duration 
                                of treatment.
                                    ``(II) Nonquantitative treatment 
                                limitations.--Nonquantitative treatment 
                                limitations, including other limits on 
                                the access, scope, or duration of 
                                benefits for treatment under a plan or 
                                coverage not described in subclause 
                                (I), such as--
                                            ``(aa) medical management 
                                        standards limiting or excluding 
                                        benefits based on medical 
                                        necessity or medical 
                                        appropriateness, or based on 
                                        whether the treatment is 
                                        experimental or investigative;
                                            ``(bb) for plans with 
                                        multiple network tiers (such as 
                                        preferred providers and 
                                        participating providers), 
                                        network tier design;
                                            ``(cc) standards for 
                                        provider admission to 
                                        participate in a network, 
                                        including reimbursement rates;
                                            ``(dd) refusal to pay for 
                                        higher-cost therapies until it 
                                        can be shown that a lower-cost 
                                        therapy is not effective (also 
                                        known as fail-first policies or 
                                        step therapy protocols);
                                            ``(ee) exclusions based on 
                                        failure to complete a course of 
                                        treatment; and
                                            ``(ff) restrictions based 
                                        on geographic location, 
                                        facility type, provider 
                                        specialty, and other criteria 
                                        that limit the scope or 
                                        duration of benefits for 
                                        services provided under the 
                                        plan or coverage.
                            ``(ii) Exclusions.--The term `treatment 
                        limitation' does not include any exclusions 
                        from coverage of items or services for which 
                        payment is not made under part A or part B or 
                        any statutory limitations on coverage 
                        applicable under such parts.''.
            (2) Enforcement.--Section 1857(g)(1) of the Social Security 
        Act (42 U.S.C. 1395w-27(g)(1)) is amended--
                    (A) in subparagraph (J), by striking ``or'' after 
                the semicolon;
                    (B) by redesignating subparagraph (K) as 
                subparagraph (L);
                    (C) by inserting after subparagraph (J), the 
                following new subparagraph:
                    ``(K) fails to comply with mental health parity 
                requirements under section 1852(o) or applicable 
                implementing regulations or guidance; or'';
                    (D) in subparagraph (L), as redesignated by 
                subparagraph (B), by striking ``through (J)'' and 
                inserting ``through (K)''; and
                    (E) in the flush matter following subparagraph (L), 
                as so redesignated, by striking ``subparagraphs (A) 
                through (K)'' and inserting ``subparagraphs (A) through 
                (L)''.
    (b) Prescription Drug Plans.--Section 1860D-4 of the Social 
Security Act (42 U.S.C. 1395w-104) is amended by adding at the end the 
following new subsection:
    ``(c) Parity in Mental Health and Substance Use Disorder 
Benefits.--The provisions of section 1852(o) (relating to parity in 
mental health and substance use disorder benefits) shall apply to PDP 
sponsors offering prescription drug plans in the same manner in which 
such provisions apply with respect to Medicare Advantage organizations 
offering MA-PD plans.''.
    (c) Regulations.--Not later than 18 months after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
issue regulations to carry out the amendments made by this section.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning after the date that is 2 
years after the date of enactment of this Act, regardless of whether 
regulations have been issued to carry out such amendments by such 
effective date.
    (e) Implementation Funding.--For purposes of carrying out the 
provisions of, including the amendments made by, this section, there 
are appropriated, out of amounts in the Treasury not otherwise 
appropriated, to the Centers for Medicare & Medicaid Services Program 
Management Account, $10,000,000 for fiscal year 2024, which shall 
remain available until expended.

SEC. 202. BEHAVIORAL HEALTH MEASURES AND INCENTIVIZING BEHAVIORAL 
              HEALTH CARE QUALITY.

    Section 1853(o) of the Social Security Act (42 U.S.C. 1395w-23(o)) 
is amended by adding at the end the following new paragraph:
            ``(8) Behavioral health measures.--
                    ``(A) In general.--For 2025 and biennially 
                thereafter, the Secretary shall consider adding to the 
                5-star rating system behavioral health measures that 
                measure the quality and outcomes of--
                            ``(i) mental health or substance use 
                        disorder services; and
                            ``(ii) items and services not described in 
                        clause (i) that are furnished to an individual 
                        with a mental health or substance use disorder.
                    ``(B) Considerations.--In considering the addition 
                of behavioral health measures under subparagraph (A), 
                the Secretary shall--
                            ``(i) consider measures for which data can 
                        be collected through encounter data or enrollee 
                        survey data submitted by MA organizations;
                            ``(ii) consider measures endorsed by a 
                        consensus-based entity, as described in section 
                        1890(a);
                            ``(iii) consider measures that assess the 
                        quality and health outcomes of items and 
                        services described in subparagraph (A), 
                        including contraindicated or low-value care, 
                        furnished to individuals with a mental health 
                        or substance use disorder;
                            ``(iv) consider measures that assess access 
                        to behavioral health treatment, including 
                        measures of wait times, distance standards, 
                        providers who are taking on new patients, and 
                        the proportion of behavioral health providers 
                        who have not submitted a claim for a mental 
                        health or substance use disorder service during 
                        the past six months;
                            ``(v) consider measures that assess the 
                        integration of behavioral health care and 
                        primary care services;
                            ``(vi) consider measures that align with 
                        behavioral health measures--
                                    ``(I) used to assess performance in 
                                part A or part B; or
                                    ``(II) identified as part of the 
                                Core Set of Health Care Quality 
                                Measures for Adults as described in 
                                section 1139B; and
                            ``(vii) consider measures that assess 
                        patient experience of care.''.

SEC. 203. PROVIDING INFORMATION ON BEHAVIORAL HEALTH COVERAGE TO 
              PROMOTE INFORMED CHOICE.

    Section 1851(d)(4) of the Social Security Act (42 U.S.C. 1395w-
21(d)(4)) is amended by adding at the end the following new 
subparagraph:
                    ``(F) Behavioral health information.--For 2025 and 
                subsequent plan years, to the extent available, the 
                following information with respect to the preceding 
                plan year:
                            ``(i) Information on access to in-network 
                        behavioral health providers, disaggregated by 
                        those who prescribe and those who offer mental 
                        health or substance use disorder services, 
                        including--
                                    ``(I) the average wait time (as 
                                defined by the Secretary) for an 
                                appointment for a new patient with an 
                                in-network provider for mental health 
                                or substance disorder services;
                                    ``(II) the total number and 
                                percentage of providers who have 
                                participation agreements with the 
                                organization who submitted at least one 
                                request for payment for a mental health 
                                or substance use disorder service 
                                during a 6 month period (or other 
                                period specified by the Secretary); and
                                    ``(III) the percentage of requests 
                                for payment for mental health or 
                                substance use disorder services that 
                                were submitted by--
                                            ``(aa) in-network 
                                        providers; and
                                            ``(bb) out-of-network 
                                        providers.
                            ``(ii) Information on the number of denials 
                        of prior authorization requests or denials of 
                        payment for mental health or substance use 
                        disorder services compared to non-mental health 
                        and substance use disorder services overall, 
                        categorized by the type of denial and by the 
                        type of service, as defined by the Secretary, 
                        including--
                                    ``(I) the number and percent of 
                                such denials by the number of days to 
                                denial, the reason for denial, and the 
                                utilization of decision support 
                                technology, artificial intelligence 
                                technology, machine-learning 
                                technology, clinical decision-making 
                                technology, or any other technology 
                                specified by the Secretary; and
                                    ``(II) the number and percent of 
                                such denials with respect to a mental 
                                health or substance use disorder 
                                service compared to such denials with 
                                respect to items and services for a 
                                similar physical health condition (such 
                                as depression compared to diabetes) by 
                                the number of days to denial, the 
                                reason for denial, and the utilization 
                                of decision support technology, 
                                artificial intelligence technology, 
                                machine-learning technology, clinical 
                                decision-making technology, or any 
                                other technology specified by the 
                                Secretary.''.

SEC. 204. REQUIRING MA ORGANIZATIONS TO MAINTAIN ACCURATE AND UPDATED 
              PROVIDER DIRECTORIES.

    (a) In General.--Section 1852(c) of the Social Security Act (42 
U.S.C. 1395w-22(c)) is amended--
            (1) in paragraph (1)(C)--
                    (A) by striking ``plan, and any'' and inserting 
                ``plan, any''; and
                    (B) by inserting the following before the period: 
                ``, and, in the case of a network-based MA plan (as 
                defined in paragraph (3)(C)), the information described 
                in paragraph (3)(A)(i)(II)''; and
            (2) by adding at the end the following new paragraph:
            ``(3) Provider directory accuracy and transparency.--
                    ``(A) In general.--For plan year 2025 and 
                subsequent plan years, each MA organization offering a 
                network-based MA plan shall do the following:
                            ``(i) Maintain an accurate provider 
                        directory.--
                                    ``(I) In general.--The MA 
                                organization shall, for each network-
                                based MA plan offered by the 
                                organization, maintain an accurate 
                                provider directory--
                                            ``(aa) that includes the 
                                        information described in 
                                        subclause (II);
                                            ``(bb) which, not less 
                                        frequently than 90 days, the 
                                        organization verifies and, if 
                                        applicable, updates the 
                                        provider directory information 
                                        of each provider;
                                            ``(cc) that provides, if 
                                        the organization is unable to 
                                        verify such information with 
                                        respect to a provider, for the 
                                        inclusion along with the 
                                        information in the directory 
                                        with respect to such provider 
                                        of a notification indicating 
                                        that the information may not be 
                                        up to date;
                                            ``(dd) that provides for 
                                        the removal of a provider from 
                                        such directory within 2 
                                        business days if the 
                                        organization determines that 
                                        the provider is no longer a 
                                        participating provider; and
                                            ``(ee) that meets such 
                                        other requirements as the 
                                        Secretary may specify.
                                    ``(II) Information described.--The 
                                information described in this subclause 
                                is the National Provider Identifier, 
                                name, address, specialty, telephone 
                                number, Internet website if available, 
                                availability (including whether the 
                                provider is accepting new patients), 
                                cultural and linguistic capabilities 
                                (including the languages offered by the 
                                provider or by a skilled medical 
                                interpreter who provides interpretation 
                                services for the provider), and other 
                                information as determined appropriate 
                                by the Secretary for each provider with 
                                which such MA organization has an 
                                agreement for furnishing items and 
                                services covered under such plan.
                            ``(ii) Submission of provider directory to 
                        the secretary.--The MA organization shall 
                        submit to the Secretary the provider directory 
                        for each network-based MA plan offered by the 
                        organization in a manner specified by the 
                        Secretary.
                    ``(B) Posting of provider directory information.--
                For plan year 2026 and subsequent plan years, the 
                Secretary shall post the provider directory information 
                submitted under subparagraph (A)(ii), in a machine 
                readable file, on the internet website of the Centers 
                for Medicare & Medicaid Services.
                    ``(C) Network-based ma plan defined.--In this 
                paragraph, the term `network-based MA plan' means an MA 
                plan that has a network of providers that have 
                agreements with the MA organization offering the plan 
                to furnish items and services covered under such 
                plan.''.
    (b) Enforcement.--Section 1857(d) of the Social Security Act (42 
U.S.C. 1395w-27(d)) is amended by adding at the end the following new 
paragraph:
            ``(7) Audit of provider directories.--Each contract under 
        this section shall provide that the Secretary, or any person or 
        organization designated by the Secretary, shall have the right 
        to audit any provider directory under section 1852(c)(3)(A)(i) 
        to determine whether such directory meets the requirements of 
        such section.''.
    (c) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Centers for Medicare & Medicaid Services Program 
Management Account for fiscal year 2023, out of any amounts in the 
Treasury not otherwise appropriated, $10,000,000, to remain available 
until expended, for purposes of carrying out the amendments made by 
this section.

                      TITLE III--MEDICAID AND CHIP

SEC. 301. ENHANCED PAYMENT UNDER MEDICAID FOR INTEGRATED MENTAL HEALTH 
              AND SUBSTANCE USE DISORDER CARE SERVICES.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended--
            (1) in subsection (a)(3)--
                    (A) in subparagraph (D), by inserting ``and'' after 
                the semicolon;
                    (B) in subparagraph (F)(ii), by striking ``plus'' 
                after the semicolon and inserting ``and''; and
                    (C) by inserting after subparagraph (F)(ii), the 
                following:
                    ``(G) for calendar quarters beginning on or after 
                January 1, 2025, 100 percent of the amount determined 
                for such quarter under subsection (cc); and''; and
            (2) by adding the end the following:
    ``(cc) Enhanced Payment for Integrated Mental Health and Substance 
Use Disorder Care Services.--
            ``(1) In general.--For purposes of subsection (a)(3)(G), in 
        accordance with guidance issued not later than the date that is 
        180 days after the date of the enactment of this subsection by 
        the Secretary to States, the amount determined under this 
        subsection with respect to a State and calendar quarter is the 
        amount by which--
                    ``(A) the aggregate amount expended by the State 
                during the calendar quarter for medical assistance 
                provided by a primary care practitioner (as defined in 
                section 1833(x)(2)(A)(i)) for integrated mental health 
                and substance use disorder care services described in 
                section 1848(b)(13)(B) and such other items and 
                services for the care of mental health and substance 
                use conditions furnished by, or in coordination with, 
                such primary care practitioner as the Secretary, in 
                consultation with the State, may specify; exceeds
                    ``(B) the quarterly average of the aggregate 
                amounts expended by the State for medical assistance 
                described in subparagraph (A) during the applicable 
                base period for the calendar quarter involved.
            ``(2) Applicable base period defined.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the term `applicable base period' means, with respect 
                to a calendar quarter, the 5-year period that ends on 
                the most recent base period end date.
                    ``(B) Base period end date defined.--For purposes 
                of subparagraph (A), the term `base period end date' 
                means--
                            ``(i) December 31, 2024; and
                            ``(ii) December 31 of every 5th year 
                        following 2024.''.

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.

    (a) In General.--Not later than the date that is 180 days after the 
date of the enactment of this section, the Secretary shall conduct a 
54-month demonstration project for the purpose described in subsection 
(b) under which the Secretary shall--
            (1) for the first 18-month period of such project, award 
        planning grants described in subsection (c); and
            (2) for the remaining 36-month period of such project, 
        provide to each State selected under subsection (d) payments in 
        accordance with subsection (e).
    (b) Purpose.--The purpose described in this subsection is for each 
State that receives a planning grant under subsection (c) to ensure 
that every Medicaid-enrolled child in the State has access to 
integrated mental health and substance use disorder care services, 
including prevention and early intervention services, so as to allow 
for the prevention, identification, and treatment of mental health and 
substance use conditions in primary care, children's hospitals, early 
care and education, schools, or other settings as appropriate (such as 
home visiting and early intervention programs for young children, 
foster care or other child welfare care settings, or workforce 
development programs and community centers for youth) (in this section 
collectively referred to as ``care settings''), through the following 
activities:
            (1) Activities that support an ongoing assessment of the 
        accessibility of integrated mental health and substance use 
        disorder care services, including prevention and early 
        intervention services, for Medicaid-enrolled children in the 
        State that tracks progress toward the goal of all Medicaid-
        enrolled children (including infants and toddlers as well as 
        transition-aged youth) having access to appropriate levels of 
        services in care settings in which the children regularly 
        engage, and that is conducted in partnership with such children 
        and families, to ensure that the assessment reflects their 
        perspective, experiences, and solutions.
            (2) Activities that, taking into account the results of the 
        assessment described in paragraph (1), support the development, 
        implementation, and maintenance of State infrastructure, such 
        as technology and the physical structures necessary to 
        physically co-locate integrated mental health and substance use 
        disorder care services, including prevention and early 
        intervention services, and a workforce to provide the types of 
        support, training, and technical assistance needed in order to 
        offer integrated mental health and substance use care services, 
        including prevention and early intervention services, in care 
        settings with which Medicaid-enrolled children and their 
        families regularly interact, which are selected for integration 
        based on the assessment of where such children and their 
        families can access such services, and for which furnishing 
        integrated mental health and substance use disorder care 
        services, including prevention and early intervention services, 
        will be sustainable under the State's planned activities.
            (3) Increased reimbursement and improved incentives for 
        care settings to sustainably implement and provide (either 
        through direct delivery or coordination in the case of a care 
        setting that is an early care or education program)--
                    (A) developmentally appropriate mental health 
                promotive and preventive interventions for Medicaid-
                enrolled children and their families, along with 
                screening to identify psycho-social needs of such 
                children who do not yet have a diagnosable mental 
                health condition (consistent with the requirements for 
                providing items and services described in section 
                1905(a)(4)(B) of the Social Security Act (42 U.S.C. 
                1396d(a)(4)(B))(relating to early and periodic 
                screening, diagnostic, and treatment services defined 
                in section 1905(r) of such Act (42 U.S.C. 1396d(r))) in 
                accordance with the requirements of section 1902(a)(43) 
                of such Act (42 U.S.C. 1396a(a)(43)) and the pediatric 
                preventive care standards included in the essential 
                health benefits required under section 1302(b) of the 
                Patient Protection and Affordable Care Act (42 U.S.C. 
                18022(b)));
                    (B) evidence-based, person-centered, and 
                culturally, linguistically, and developmentally 
                appropriate interventions at the site of service, 
                either in-person or virtually integrated, to address 
                any identified family and child psycho-social needs, 
                including developmentally appropriate assessment and 
                diagnostic services, treatment, care coordination, and 
                dyadic intervention approaches; and
                    (C) referral to developmentally appropriate mental 
                health and substance use specialty care providers and 
                programs, community-based resources, or virtual or 
                digital services to address risk factors or meet 
                psycho- social needs that cannot be addressed in an 
                integrated setting.
            (4) Improved regulatory oversight of policies governing the 
        provision of services described in paragraph (3), including 
        with respect to early and periodic screening, diagnostic, and 
        treatment services referred to in such paragraph, mental health 
        and substance use parity, network adequacy, essential health 
        benefits referred to in such paragraph, Medicaid rate setting, 
        scope of practice policies, and health professional shortage 
        areas.
            (5) Improved alignment between Medicaid and commercial 
        health insurers to ensure that services described in paragraph 
        (3) are supported by commercial health insurers, such as 
        through the initiation of multi-payer collaboratives.
            (6) Improved coordination among State and local agencies 
        and other stakeholders that fund or provide primary care, 
        children's hospitals, early care and education, or other 
        programs in care settings described in this subsection so as to 
        include efforts to align policies to promote coordination of 
        mental health and substance use services funded under such 
        programs across care settings, including through the alignment 
        of Medicaid with programs under the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 6301 et seq.), the Individuals 
        with Disabilities Education Act (20 U.S.C. 1400 et seq.), the 
        Family First Prevention Services Act (title VII of division E 
        of the Bipartisan Budget Act of 2018 (Public Law 115-123; 132 
        Stat. 232)), the Stephanie Tubbs Jones Child Welfare Services 
        Program under subpart 1 of part B of title IV of the Social 
        Security Act (42 U.S.C. 621 et seq.), the MaryLee Allen 
        Promoting Safe and Stable Families Program under subpart 2 of 
        part B of title IV of the Social Security Act (42 U.S.C. 629 et 
        seq.), home visiting programs, including the Maternal, Infant, 
        and Early Childhood Home Visiting Program (MIECHV) under 
        section 511 of the Social Security Act (42 U.S.C. 711), and 
        health, education, and social welfare programs funded under the 
        American Rescue Plan Act of 2021 (Public Law 117-2; 135 Stat. 
        4) and the Child Care Development Block Grant Act of 1990 (42 
        U.S.C. 9857 et seq.).
            (7) Activities that include Medicaid-enrolled children and 
        their families and caregivers as partners at all levels of 
        decision-making, implementation, and evaluation, including 
        engaging such children who are youth and their families 
        directly as paraprofessional providers.
    (c) Planning Grants.--
            (1) In general.--For the first 18-month period of the 
        demonstration project, the Secretary shall award planning 
        grants to States that apply for such grants, including to 
        entities specified in subparagraphs (B) and (C) of subsection 
        (h)(7). A State awarded a planning grant under this subsection 
        shall use the grant to carry out the activities described in 
        paragraph (2) for purposes of preparing and submitting an 
        application to participate in the remaining 36-month period of 
        the demonstration project in accordance with subsection (d).
            (2) Activities described.--Activities described in this 
        paragraph are, with respect to a State awarded a planning grant 
        under this subsection, each of the following:
                    (A) Activities that support the development of an 
                initial assessment of the access needs of Medicaid-
                enrolled children in the State with respect to mental 
                health and substance use services, to determine the 
                types of support, training, incentives, and technical 
                assistance that primary care, early care and education, 
                or other programs provided in care settings described 
                in subsection (b) and with which Medicaid-enrolled 
                children and their families regularly engage need in 
                order to offer integrated mental health and substance 
                use disorder care services, including prevention and 
                early intervention services, and which shall include 
                engaging Medicaid-enrolled children and their families 
                directly to ensure that the assessment builds toward 
                solutions that meet their needs and reflect their 
                perspectives, experiences, and solutions.
                    (B) Activities that, taking into account the 
                results of the assessment described in subparagraph 
                (A), support the development of State infrastructure, 
                such as technology and the physical structures 
                necessary to physically co-locate integrated mental 
                health and substance use disorder care services, 
                including prevention and early intervention services, 
                to provide the types of support, training, incentives, 
                and technical assistance that primary care, early care 
                and education, or other programs provided in care 
                settings described in subsection (b) and with which 
                Medicaid-enrolled children and their families regularly 
                engage need in order to offer integrated mental health 
                and substance use disorder care services, including 
                prevention and early intervention services, to 
                Medicaid-enrolled children, as well as activities that 
                support ongoing engagement of Medicaid-enrolled 
                children and their families in implementation and 
                coordination with health insurers and with other child-
                serving agencies and stakeholders.
            (3) Funding.--For purposes of awarding planning grants 
        under paragraph (1), there is appropriated, out of any funds in 
        the Treasury not otherwise appropriated, $100,000,000, to 
        remain available until expended.
    (d) Post-Planning States.--
            (1) In general.--For the remaining 36-month period of the 
        demonstration project, the Secretary shall make payments in 
        accordance with subsection (e) to all States that submit 
        applications that meet the requirements of paragraph (2) and 
        carry out the activities described in that paragraph.
            (2) Applications; activities.--
                    (A) In general.--A State seeking to be selected to 
                participate in the remaining 36-month period of the 
                demonstration project shall submit to the Secretary, at 
                such time and in such form and manner as the Secretary 
                requires, an application that includes such 
                information, provisions, and assurances, as the 
                Secretary may require, in addition to the following:
                            (i) A process for carrying out the ongoing 
                        assessment described in subsection (b)(1), 
                        taking into account the results of the initial 
                        assessment described in subsection (c)(2)(A).
                            (ii) A review of Medicaid reimbursement 
                        methodologies and other policies related to 
                        furnishing integrated mental health and 
                        substance use disorder care services, including 
                        prevention and early intervention services, to 
                        Medicaid-enrolled children that may create 
                        barriers to access. If the State uses multiple 
                        reimbursement methodologies under Medicaid for 
                        mental health and substance use care (such as 
                        capitation, fee-for-service, value-based, and 
                        alternative payment programs), the State shall 
                        include in the application specific detailed 
                        information regarding how the State will verify 
                        that the combination of reimbursement 
                        methodologies employed by the State will result 
                        in improved access to integrated mental health 
                        and substance use disorder care services, 
                        including prevention and early intervention 
                        services, for Medicaid-enrolled children.
                            (iii) The development of a plan, taking 
                        into account activities carried out under 
                        subsection (c)(2)(B), that will result in long-
                        term and sustainable access to integrated 
                        mental health and substance use disorder care 
                        services, including prevention and early 
                        intervention services, for Medicaid-enrolled 
                        children which includes the following:
                                    (I) Specific activities to increase 
                                access to integrated mental health and 
                                substance use disorder care services, 
                                including prevention and early 
                                intervention services, so as to allow 
                                for the prevention, identification, and 
                                treatment of mental health and 
                                substance use conditions in primary 
                                care, early care and education, or 
                                other programs provided in care 
                                settings described in subsection (b) 
                                and with which Medicaid-enrolled 
                                children and their families regularly 
                                engage.
                                    (II) Strategies that will 
                                incentivize a racially and culturally 
                                diverse array of providers (including 
                                paraprofessionals) to obtain the 
                                necessary training, education, and 
                                support to deliver integrated care for 
                                the developmentally appropriate 
                                prevention, identification, assessment, 
                                diagnosis, and treatment of mental 
                                health and substance use conditions in 
                                Medicaid-enrolled children in primary 
                                care, early care and education, or 
                                other programs provided in care 
                                settings described in subsection (b) 
                                and with which Medicaid-enrolled 
                                children and their families regularly 
                                engage.
                                    (III) Milestones and timeliness for 
                                implementing activities set forth in 
                                the plan, as determined by the 
                                Secretary.
                                    (IV) Specific measurable targets 
                                for increasing equitable access to 
                                integrated mental health and substance 
                                use disorder care services, including 
                                prevention and early intervention 
                                services, for Medicaid-enrolled 
                                children.
                                    (V) Specific measurable targets for 
                                increasing the workforce providing 
                                integrated mental health and substance 
                                use disorder care services, including 
                                prevention and early intervention 
                                services.
                            (iv) A process for reporting the 
                        information required under subsection (f)(1), 
                        including information to assess the 
                        effectiveness of the efforts of the State 
                        during the period of the demonstration project 
                        under this subsection and ensure the 
                        sustainability of such efforts after the 
                        conclusion of the demonstration project.
                            (v) The expected financial impact of the 
                        demonstration project on the State.
                            (vi) A description of funding sources 
                        available to the State to expand access to 
                        integrated mental health and substance use 
                        disorder care services, including prevention 
                        and early intervention services in the State, 
                        including health care, public health, 
                        education, and social service funding 
                        opportunities.
                            (vii) A preliminary plan for how the State 
                        will sustain access to integrated mental health 
                        and substance use disorder care services, 
                        including prevention and early intervention 
                        services, for Medicaid-enrolled children after 
                        the demonstration project, including 
                        maintenance of incentives and enhanced 
                        reimbursement rates.
                            (viii) A description of how the State will 
                        coordinate the goals of the demonstration 
                        project with any waiver granted (or submitted 
                        by the State and pending) pursuant to section 
                        1115 of the Social Security Act (42 U.S.C. 
                        1315) for the delivery of mental health and 
                        substance use services under Medicaid, as 
                        applicable, and with State plans under the 
                        Elementary and Secondary Education Act of 1965 
                        (20 U.S.C. 6301 et seq.), the Individuals with 
                        Disabilities Education Act (20 U.S.C. 1400 et 
                        seq.), the Family First Prevention Services Act 
                        (title VII of division E of the Bipartisan 
                        Budget Act of 2018 (Public Law 115-123; 132 
                        Stat. 232)), the Stephanie Tubbs Jones Child 
                        Welfare Services Program under subpart 1 of 
                        part B of title IV of the Social Security Act 
                        (42 U.S.C. 621 et seq.), the MaryLee Allen 
                        Promoting Safe and Stable Families Program 
                        under subpart 2 of part B of title IV of the 
                        Social Security Act (42 U.S.C. 629 et seq.), 
                        home visiting programs, including the Maternal, 
                        Infant, and Early Childhood Home Visiting 
                        Program (MIECHV) under section 511 of the 
                        Social Security Act (42 U.S.C. 711), and 
                        health, education, and social welfare programs 
                        funded under the American Rescue Plan Act of 
                        2021 (Public Law 117-2; 135 Stat. 4) and the 
                        Child Care Development Block Grant Act of 1990 
                        (42 U.S.C. 9857 et seq.).
                    (B) Consultation.--In completing an application 
                under subparagraph (A), a State shall consult with 
                relevant stakeholders, including Medicaid managed care 
                plans, primary and specialty health care provider 
                organizations, Medicaid-enrolled children and their 
                families, and other child-serving State and local 
                agencies and stakeholders, and include in the 
                application a description of such consultation.
                    (C) Technical assistance.--The Secretary shall 
                provide technical assistance to States with respect to 
                preparing and submitting an application that meets the 
                requirements of subparagraphs (A) and (B).
    (e) Payments.--
            (1) In general.--For each quarter occurring during the 
        remaining 36-month period of the demonstration project, the 
        Secretary shall pay each State that submits an application that 
        meets the requirements of subsection (d) (2) and carries out 
        the activities described in that subsection, an amount equal to 
        80 percent of the qualified sums expended by the State for such 
        quarter.
            (2) Qualified sums defined.--For purposes of paragraph (1), 
        the term ``qualified sums'' means, with respect to a State and 
        a quarter, the amount equal to the amount (if any) by which--
                    (A) the sums expended by the State during such 
                quarter that are attributable to--
                            (i) furnishing integrated mental health and 
                        substance use disorder care services, including 
                        prevention and early intervention services, to 
                        Medicaid-enrolled children;
                            (ii) the development or enabling of State 
                        infrastructure, such as technology and the 
                        physical structures necessary to physically co-
                        locate integrated mental health and substance 
                        use disorder care services, including 
                        prevention and early intervention services, 
                        delivered in or coordinated through primary 
                        care, early care and education, or other 
                        programs provided in care settings described in 
                        subsection (b) and with which Medicaid-enrolled 
                        children and their families regularly engage; 
                        and
                            (iii) the development of a workforce to 
                        provide the types of support, training, and 
                        technical assistance needed in order to offer 
                        integrated mental health and substance use care 
                        services, including prevention and early 
                        intervention services, in primary care, early 
                        care and education, or other programs provided 
                        in care settings described in subsection (b) 
                        and with which Medicaid-enrolled children and 
                        their families regularly engage; exceeds
                    (B) \1/4\ of the average annual amount expended by 
                the State for the most recent 5-fiscal year period for 
                medical assistance for mental health or substance use 
                disorder care services for Medicaid-enrolled children 
                in a primary care, children's hospitals, school, early 
                care and education, or other developmentally 
                appropriate care setting, as determined by the 
                Secretary.
            (3) Non-duplication of payment.--No payment made under this 
        subsection with respect to medical assistance furnished to a 
        Medicaid-enrolled child shall be duplicative of any payment 
        made to a provider participating under the State Medicaid 
        program for the same services so furnished to the same child.
    (f) Reports.--
            (1) State reports.--Each State that receives payments under 
        subsection (e) during the remaining 36-month period of the 
        demonstration project shall submit to the Secretary, in 
        accordance with detailed, specific guidance that is issued by 
        the Secretary not later than the first day of such period, and 
        that includes information on how to estimate and reconcile 
        State expenditures to carry out the demonstration project 
        during such period, quarterly reports, with respect to 
        expenditures for which payment is made to the State under 
        subsection (e), on the following:
                    (A) The specific activities with respect to which 
                payment under such subsection was provided.
                    (B) The number of primary care, children's 
                hospitals, schools, and early care and education 
                programs that delivered or coordinated integrated 
                mental health and substance use disorder care services, 
                including prevention and early intervention services, 
                to Medicaid-enrolled children during such period and 
                their geographic distribution, compared to the 
                estimated number that would have otherwise delivered 
                such services in the absence of the demonstration 
                project, including disaggregated data on the race, 
                ethnicity, and gender of providers.
                    (C) The number of Medicaid-enrolled children who 
                received integrated mental health and substance use 
                disorder care services, including prevention and early 
                intervention services during such period compared to 
                the estimated number of such children who would have 
                otherwise received such services in the absence of the 
                demonstration project, including disaggregated data on 
                the race, ethnicity, gender, age (ensuring that 
                children birth to 5 as well as transition-aged youth 
                are adequately served), sexual orientation, primary 
                language, income, and disability status of the 
                children.
                    (D) Such other data or information as determined by 
                the Secretary.
            (2) CMS reports.--
                    (A) Initial report.--Not later than October 1, 
                2026, the Administrator of the Centers for Medicare & 
                Medicaid Services shall, in consultation with the 
                Director of the Agency for Healthcare Research and 
                Quality and the Assistant Secretary for Mental Health 
                and Substance Use, submit to Congress an initial report 
                on the activities carried out by States under the 
                planning grants made under subsection (c), and actions 
                taken by the Administrator of the Centers for Medicare 
                & Medicaid Services to improve oversight of such 
                activities.
                    (B) Interim report.--Not later than October 1, 
                2028, the Administrator of the Centers for Medicare & 
                Medicaid Services shall, in consultation with the 
                Director of the Agency for Healthcare Research and 
                Quality and the Assistant Secretary for Mental Health 
                and Substance Use, submit to Congress an interim report 
                on activities carried out under the demonstration 
                project and actions taken by the Administrator of the 
                Centers for Medicare & Medicaid Services to improve 
                oversight of such activities and the extent to which 
                States have achieved the stated goals submitted in 
                their applications. Such report shall include a 
                description of the strengths and limitations of the 
                demonstration project and a plan for the sustainability 
                of the project.
                    (C) Final report.--Not later than October 1, 2030, 
                the Administrator of the Centers for Medicare & 
                Medicaid Services shall, in consultation with the 
                Director of the Agency for Healthcare Research and 
                Quality and the Assistant Secretary for Mental Health 
                and Substance Use, submit to Congress a final report 
                providing updates on the matters reported in the 
                interim report required by subparagraph (B) and that 
                includes--
                            (i) a description of any changes made with 
                        respect to the demonstration project after the 
                        submission of such interim report; and
                            (ii) an evaluation of the demonstration 
                        project.
    (g) Implementation Funding.--There is appropriated, out of any 
funds in the Treasury not otherwise appropriated, $5,000,000 to the 
Administrator of the Centers for Medicare & Medicaid Services for 
purposes of implementing this section, to remain available until 
expended.
    (h) Definitions.--In this section:
            (1) Children's hospitals.--The term ``children's 
        hospitals'' has the meaning given that term in section 
        340E(g)(2) of the Public Health Service Act (42 U.S.C. 
        256e(g)(2).
            (2) Integrated mental health and substance use disorder 
        care services.--The term ``mental health and substance use 
        disorder care services'' has the meaning given that term in 
        section 1848(b)(13)(B) of the Social Security Act and includes 
        prevention and early intervention services and such other items 
        and services for the care of mental health and substance use 
        conditions furnished by, or in coordination with, a primary 
        care practitioner as the Secretary, in consultation with a 
        State, may specify.
            (3) Medicaid.--The term ``Medicaid'' means the program for 
        grants to States for medical assistance programs established 
        under title XIX of the Social Security Act (42 U.S.C. 1396 et 
        seq.).
            (4) Secretary.--Except as otherwise specified, the term 
        ``Secretary'' means the Secretary of Health and Human Services.
            (5) State.--The term ``State'' has the meaning given that 
        term in section 1101(a)(1) of the Social Security Act (42 
        U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI of such 
        Act, and for purposes of
            (6) Medicaid-enrolled child.--The term ``Medicaid-enrolled 
        child'' means, with respect to a State, a child enrolled under 
        the State plan approved under title XIX of the Social Security 
        Act (42 U.S.C. 1396 et seq.) or under a waiver of such plan.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) State.--The term ``State'' means--
                    (A) each of the 50 States and the District of 
                Columbia;
                    (B) the Commonwealth of Puerto Rico, the United 
                States Virgin Islands, Guam, American Samoa, and the 
                Commonwealth of the Northern Mariana Islands; and
                    (C) to the extent the Secretary determines 
                appropriate, may include an Indian Tribe, Tribal 
                organization, or Urban Indian organization (as such 
                terms are defined in section 4 of the Indian Health 
                Care Improvement Act (25 U.S.C. 1603)).

SEC. 303. UNIFORM APPLICABILITY TO MEDICAID OF REQUIREMENTS FOR PARITY 
              IN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS.

    (a) Fee-for-Service and Alternative Benefit Plans.--Section 1902 of 
the Social Security Act (42 U.S.C. 1396a) is amended--
            (1) in subsection (a)--
                    (A) by striking ``and'' at the end of paragraph 
                (86);
                    (B) by striking the period at the end of paragraph 
                (87) and inserting ``; and''; and
                    (C) by inserting after paragraph (87) the following 
                new paragraph:
            ``(88) provide for ensuring that the requirements for 
        parity in mental health and substance use disorder benefits 
        under subsection (uu) are complied with regardless of the 
        payment model or arrangement under which medical assistance is 
        provided, including when medical assistance under the State 
        plan or under a waiver of such plan is provided through an 
        alternative benefit plan under section 1937.''; and
            (2) by adding at the end the following new subsection:
    ``(uu) Parity in Mental Health and Substance Use Disorder 
Benefits.--For purposes of subsection (a)(88), the requirements under 
this subsection are the following:
            ``(1) In general.--Regardless of whether a State plan or 
        waiver of pays for medical assistance on a fee-for-service 
        basis, capitated payment basis, through the use of 1 or more 
        alternative payment models, or any combination thereof, the 
        State shall ensure that the financial requirements and 
        treatment limitations applicable to coverage of mental health 
        or substance use disorder services provided under such plan or 
        under a waiver of such plan comply with the requirements of 
        section 2726(a) of the Public Health Service Act in the same 
        manner as such requirements or limitations apply to a group 
        health plan under such section.
            ``(2) Deemed compliance.--Coverage with respect to an 
        individual described in section 1905(a)(4)(B) and covered under 
        the State plan or waiver under section 1902(a)(10)(A) of the 
        services described in section 1905(a)(4)(B) (relating to early 
        and periodic screening, diagnostic, and treatment services 
        defined in section 1905(r)) and provided in accordance with 
        section 1902(a)(43), shall be deemed to satisfy the 
        requirements of paragraph (1).''.
    (b) Managed Care Organizations and Payment Arrangements.--
            (1) In general.--Section 1932(b)(8) of the Social Security 
        Act (42 U.S.C. 1396u-2(b)(8)) is amended to read as follows:
            ``(8) Compliance with certain maternity, parity in mental 
        health or substance use disorder benefits, and other coverage 
        requirements.--
                    ``(A) In general.--Each medicaid managed care 
                organization shall comply with the requirements of 
                subpart 2 of part A of title XXVII of the Public Health 
                Service Act insofar as such requirements apply and are 
                effective with respect to a health insurance issuer 
                that offers group health insurance coverage.
                    ``(B) Parity in mental health or substance use 
                disorder benefits.--The financial requirements and 
                treatment limitations applicable to coverage of mental 
                health or substance use disorder services provided 
                under the State plan or under a waiver of such plan 
                through a medicaid managed care organization, a prepaid 
                inpatient health plan (as defined by the Secretary), a 
                prepaid ambulatory health plan (as defined by the 
                Secretary), or a primary care case manager under 
                section 1905 (consistent with section 1905(t)(2)), 
                shall comply with the requirements of section 2726(a) 
                of the Public Health Service Act in the same manner as 
                such requirements or limitations apply to a group 
                health plan under such section.
                    ``(C) Deemed compliance.--In applying subparagraphs 
                (A) and (B) with respect to requirements under 
                paragraph (8) of section 2726(a) of the Public Health 
                Service Act, a medicaid managed care organization, a 
                prepaid inpatient health plan (as defined by the 
                Secretary), a prepaid ambulatory health plan (as 
                defined by the Secretary), or a primary care case 
                manager under section 1905 (consistent with section 
                1905(t)(2)) shall be treated as in compliance with such 
                requirements if the medicaid managed care organization, 
                prepaid inpatient health plan, prepaid ambulatory 
                health plan, or primary care case manager under section 
                1905 is in compliance with subpart K of part 438 of 
                title 42, Code of Federal Regulations, and section 
                438.3(n) of such title, or any successor regulation.''.
    (c) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by subsections (a) and (b) shall take effect on 
        the first day of the first calendar quarter that begins on or 
        after the date that is 3 years after the date of enactment of 
        this Act.
            (2) Delay if state legislation needed.--In the case of a 
        State plan for medical assistance under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
        Health and Human Services determines requires State legislation 
        (other than legislation appropriating funds) in order for the 
        plan to meet the additional requirements imposed by the 
        amendments made by subsection (a), the State plan shall not be 
        regarded as failing to comply with the requirements of such 
        title solely on the basis of its failure to meet these 
        additional requirements before the first day of the first 
        calendar quarter beginning after the close of the first regular 
        session of the State legislature that begins after the date of 
        the enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative 
        session, each year of such session shall be deemed to be a 
        separate regular session of the State legislature.
    (d) Funding.--Out of any funds in the Treasury not otherwise 
appropriated, there is appropriated to the Secretary of Health and 
Human Services for purposes of carrying out this section and the 
amendments made by this section, $10,000,000 for fiscal year 2024, to 
remain available until expended.

SEC. 304. REQUIRING ADDITIONAL TRANSPARENCY ON ACCESS TO MENTAL HEALTH 
              AND SUBSTANCE USE DISORDER BENEFITS THROUGH MANAGED CARE.

    (a) Biannual Assessment.--Section 1932(b) of the Social Security 
Act (42 U.S.C. 1396u-2(b)) is amended by adding at the end the 
following new paragraph:
            ``(9) Transparency on access to mental health and substance 
        use disorder benefits.--
                    ``(A) In general.--Each managed care organization, 
                prepaid inpatient health plan (as defined by the 
                Secretary), and prepaid ambulatory health plan (as 
                defined by the Secretary), with a contract with a State 
                to enroll individuals who are eligible for medical 
                assistance under the State plan under this title or 
                under a waiver of such plan and to provide coverage 
                under the contract for mental health services or 
                substance use disorder services, disaggregated, 
                biannually shall assess and report to the State, in 
                such manner that the report is publicly available on a 
                website, the following:
                            ``(i) The average wait times during the 
                        reporting period by level of acuity and site of 
                        care for adult and child patients for a new 
                        patient visit in an outpatient setting 
                        (including intensive outpatient, eating 
                        disorder, residential treatments, or other 
                        appointments as the Secretary specifies) from a 
                        provider of mental health services or substance 
                        use disorder services.
                            ``(ii) The total number and average 
                        percentage of network providers that provide 
                        mental health services or substance use 
                        disorder services and are accepting as new 
                        patients individuals who are enrollees of such 
                        organization or plan at any point during the 
                        reporting period.
                            ``(iii) The proportion of mental health 
                        services or substance use disorder services and 
                        prescription drugs during the reporting period 
                        that are denied payment under the State plan 
                        under this title or a waiver on the basis of 
                        prior authorization or medical necessity (or 
                        for any other reason that is not based on an 
                        enrollee's eligibility for medical assistance 
                        under the State plan under this title or a 
                        waiver) in comparison to medical and surgical 
                        services and prescription drugs that are denied 
                        payment on the same bases during the reporting 
                        period.
                            ``(iv) The total number and percentage of 
                        providers during the reporting period who have 
                        participation agreements with the organization 
                        who submitted at least 1 request for payment 
                        for a mental health or substance use disorder 
                        service.
                    ``(B) Submission to secretary.--A State shall 
                submit information reported to the State under 
                subparagraph (A), including stratifying reporting by 
                race, ethnicity, disability, primary language, age, 
                sexual orientation, and gender identity, to help 
                identify health inequities where applicable, to the 
                Secretary in such form and manner as the Secretary 
                shall specify.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date that is 2 years after the date of enactment of 
this section.

SEC. 305. AUTHORITY TO DEFER OR DISALLOW A PORTION OF FEDERAL FINANCIAL 
              PARTICIPATION FOR FAILURE TO COMPLY WITH MANAGED CARE 
              REQUIREMENTS.

    (a) State Plan Amendment.--Section 1902(a) of the Social Security 
Act (42 U.S.C. 1396a(a)), as amended by section 303(a)(1), is amended--
            (1) in paragraph (87), by striking ``and'' after the 
        semicolon;
            (2) in paragraph (88)(D), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (88)(D), the following new 
        paragraph:
            ``(89) in the case of a State that adopts the option to use 
        managed care as described in section 1932, provide that the 
        State shall comply with the requirements of section 1932.''.
    (b) Application to Managed Care Contracts.--Section 1903(m)(2) of 
the Social Security Act (42 U.S.C. 1396b(m)) is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i), by striking ``and (G)'' and inserting ``(G), and (I)''; 
        and
            (2) by adding at the end the following new subparagraph:
    ``(I) For a violation of any requirement described in subparagraph 
(A), including a violation of the requirements of section 1932, as 
applicable under clause (xii) of such subparagraph and paragraph (89) 
of section 1902(a), rather than disallowing the full amount of a 
payment under this title to a State for expenditures incurred by the 
State as described in subparagraph (A), the Secretary may defer or 
disallow a portion of a payment to the State. In determining the amount 
deferred or disallowed under this subparagraph, the Secretary may 
consider factors such as the degree, duration, and recurrence of 
noncompliance. A State may receive a reconsideration of a decision by 
the Secretary under this subparagraph to disallow payment in the manner 
described in section 1116(e).''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date that is 2 years after the date of enactment of this 
section and shall apply to contracts for rating periods beginning on or 
after such date.

SEC. 306. MEDICAID AND CHIP AUDITS.

    (a) Regular Audits.--Beginning with fiscal year 2025, the Secretary 
of Health and Human Services (referred to in this section as the 
``Secretary'') shall audit State Medicaid programs and State Children's 
Health Insurance Programs for purposes of assessing State enforcement 
of the requirements relating to parity in mental health and substance 
use disorder benefits (including with respect to compliance with such 
parity requirements in the case of any mental health or substance use 
disorder benefits that are separately managed or financed under a 
``carve-out'' model) applicable under subsections (a)(88) and (uu) of 
section 1902 of the Social Security Act (42 U.S.C. 1396a) (as added by 
section 303(a), section 1932(b)(8) of such Act (42 U.S.C. 1396u-
2(b)(8)), section 1937(b)(6) of such Act (42 U.S.C. 1396u-7(b)(6)), and 
section 2103(c)(7) of such Act (42 U.S.C. 1397cc(c)(7)), and related 
regulations.
    (b) Rotational Procedure; Publication.--The Secretary may carry out 
the audits required by subsection (a) using a rotational approach among 
States over a 3-year period, and shall make the results of such audits 
publicly available on a searchable website.
    (c) Publication of Enforcement Actions.--The Secretary shall 
publish (and update on at least an annual basis) on a public website of 
the Department of Health and Human Services a report that specifies the 
actions taken by the Secretary to enforce violations of the mental 
health and substance use disorder parity requirements under the 
Medicaid and CHIP programs described in subsection (a). The Secretary 
may publish such information separately or include the information in 
the 1 or more published audit reports required by subsection (b) that 
correspond to each such violation.
    (d) Funding.--Out of any funds in the Treasury not otherwise 
appropriated, there is appropriated to the Secretary of Health and 
Human Services for each fiscal year beginning with fiscal year 2025, 
$5,000,000 to carry out this section.

                       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.

     Not later than April 1, 2024, the Administrator of the Centers for 
Medicare & Medicaid Services shall convene an advisory working group 
that includes representatives of issuers of group and individual health 
insurance coverage, mental health and substance use disorder programs 
and advocacy organizations, individuals and families receiving 
integrated care services, and State Medicaid Directors, for purposes of 
making recommendations for administrative and legislative changes to 
facilitate multi-payer alignment on payment and measurement of quality 
of care and health outcomes with respect to advancing the provision of 
integrated mental health and substance use disorder care in a manner 
that does not violate antitrust or other applicable laws. The 
recommendations of the working group shall include recommendations for 
measurable, ongoing benchmarks to assess the extent to which payment 
and measurement of the quality of care and health outcomes are aligned 
across health care payers.

SEC. 402. MEASURING ACCESS AND QUALITY OUTCOMES IN MENTAL HEALTH AND 
              SUBSTANCE USE DISORDER CARE.

    (a) In General.--Not later than October 1, 2024, the Administrator 
of the Centers for Medicare & Medicaid Services shall, in consultation 
with the Administrator of the Health Resource Services Administration, 
the Director of the Agency for Healthcare Research and Quality, and the 
Assistant Secretary for Mental Health and Substance Use, develop and 
implement a plan to improve measurement of the extent to which children 
and adults have access to integrated mental health and substance use 
disorder care in primary care and the quality and effectiveness of the 
care provided, which shall be implemented in quality measurement 
programs under the Medicare program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title 
XIX of such Act (42 U.S.C. 1396 et seq.), and group health plans and 
health insurance coverage (as such terms are defined in section 2791 of 
the Public Health Service Act (42 U.S.C. 300gg-91)).
    (b) Measure Development.--The Director of the Agency for Healthcare 
Research and Quality shall conduct measure development where necessary 
to ensure that the plan developed under subsection (a) may be fully 
implemented, including measures of patient experience outcomes, 
structural measures of practice transformation toward evidence-based 
integrated care, and measures of access and unmet need provided by 
local, State, or Federal agencies.

SEC. 403. REVIEWING THE EVIDENCE FOR INTEGRATED MENTAL HEALTH CARE FOR 
              CHILDREN.

    Not later than October 1, 2024, the Director of the Agency for 
Healthcare Research and Quality shall review the evidence, for 
consideration by the United States Preventive Services Task Force, for 
interventions for children who are at risk of developing a mental 
health condition to prevent internalizing and externalizing mental 
health problems, and for screening to identify family and child 
psychosocial needs, segmented by developmental stage as appropriate.

SEC. 404. ENHANCING OVERSIGHT OF INTEGRATED MENTAL HEALTH AND SUBSTANCE 
              USE DISORDER CARE.

    (a) In General.--Not later than October 1, 2024, the Administrator 
of the Centers for Medicare & Medicaid Services shall, in consultation 
with the Director of the Agency for Healthcare Research and Quality and 
the Assistant Secretary for Mental Health and Substance Use, develop 
and implement a plan to improve oversight and enforcement of 
requirements relating to the provision of integrated mental health and 
substance use disorder care under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid 
program under title XIX of such Act (42 U.S.C. 1396 et seq.), and group 
health plans and health insurance coverage (as such terms are defined 
in section 2791 of the Public Health Service Act (42 U.S.C. 300gg-91)), 
including requirements relating to--
            (1) coverage of preventive health services without cost-
        sharing under section 2713 of the Public Health Service Act (42 
        U.S.C. 300gg-13);
            (2) early and periodic screening, diagnosis, and treatment 
        for mental health and substance use disorders;
            (3) mental health and substance use parity;
            (4) network adequacy, including quantitative measures of 
        network access that take into account integration in primary 
        care and schools, racial equity, and virtual care;
            (5) essential health benefits (as defined in section 
        1302(b) of the Patient Protection and Affordable Care Act (42 
        U.S.C. 18022(b))); and
            (6) Medicaid rate setting.
    (b) Patient Input.--In developing and implementing the plan under 
subsection (a), the Administrator shall seek input from patients with 
mental health and substance use conditions.
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