II 

118TH CONGRESS 

1ST SESSION S. 3450 

To amend title XVIII of the Social Security Act to establish a demonstration 

program to promote collaborative treatment of mental and physical health 

comorbidities under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 7, 2023 

Mr. BENNET introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to establish 

a demonstration program to promote collaborative treatment of mental and physical health comorbidities under 

the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Mental and Physical 

5 Health Care Comorbidities Act of 2023’’. 

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1 SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM TO 

2 PROMOTE COLLABORATIVE TREATMENT OF 

3 MENTAL AND PHYSICAL HEALTH 

4 COMORBIDITIES UNDER THE MEDICARE PRO5 GRAM. 

6 Title XVIII of the Social Security Act (42 U.S.C. 

7 1395 et seq.) is amended by inserting after section 1866F 

8 the following new section: 

9 ‘‘SEC. 1866H. MENTAL AND PHYSICAL HEALTH 

10 COMORBIDITIES COLLABORATIVE DEM11 ONSTRATION PROGRAM. 

12 ‘‘(a) IN GENERAL.—Consistent with the model de13 scribed in section 1115A(b)(2)(B)(xv) (relating to pro14 moting improved quality and reduced cost by developing 

15 a collaborative of high-quality, low-cost health care institu16 tions), the Secretary shall conduct a demonstration pro17 gram (in this section referred to as the ‘program’) to test 

18 and evaluate innovations implemented by eligible hospitals 

19 (as defined in subsection (f)) in the furnishing of items 

20 and services to applicable individuals (as defined in sub21 section (f)) with mental and physical health comorbidities 

22 (and those at risk of developing such comorbidities), in23 cluding by addressing the adverse social determinants of 

24 health that such individuals often experience. 

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1 ‘‘(b) ACTIVITIES UNDER PROGRAM.—Under the pro2 gram, the Secretary shall, in coordination with eligible 

3 hospitals participating in the program— 

4 ‘‘(1) identify, validate, and disseminate innova5 tive, effective evidence-based best practices and mod6 els that improve care and outcomes for applicable in7 dividuals with mental and physical health 

8 comorbidities located in vulnerable communities, in9 cluding by addressing the social determinants of 

10 health that adversely impact such individuals; and 

11 ‘‘(2) assist in the identification of potential pay12 ment reforms under this title and title XIX that 

13 could more broadly effectuate such improvements. 

14 ‘‘(c) DURATION AND SCOPE.—The program con15 ducted under this section shall operate during the period 

16 beginning on October 1, 2024, and ending no later than 

17 September 30, 2029. 

18 ‘‘(d) PROGRAM ELEMENTS.— 

19 ‘‘(1) IN GENERAL.—An eligible hospital electing 

20 to participate in the program shall enter into an 

21 agreement with the Secretary for purposes of car22 rying out the activities described in subsection (b). 

23 Such an agreement shall include the plan described 

24 in paragraph (2), along with an annualized payment 

25 arrangement as described in paragraph (3) to supVerDate Sep 11 2014 23:21 Dec 15, 2023 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3450.IS S3450
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1 port implementation of such plan. Such agreement 

2 shall include a requirement for the hospital to— 

3 ‘‘(A) engage in the learning collaborative 

4 established under subsection (e); 

5 ‘‘(B) certify that all proposed innovations 

6 under such plan will supplement and not sup7 plant existing activities, whether by augmenting 

8 existing activities or initiating new activities; 

9 and 

10 ‘‘(C) remit payments made under such ar11 rangement to the Secretary if the Secretary de12 termines that such hospital has not complied 

13 with the terms of such agreement. 

14 ‘‘(2) PROGRAM ELEMENTS.—An eligible hos15 pital electing to participate in the program shall sub16 mit a proposed plan and associated quality metrics 

17 for review and approval by the Secretary. Such plan 

18 and metrics shall, at a minimum, address— 

19 ‘‘(A) the specific innovations addressing 

20 mental and physical health comorbidities (as de21 fined in subsection (f)) and innovations ad22 dressing social determinants of health (as de23 fined in such subsection) that will be employed 

24 and the evidence base supporting the proposed 

25 approach; 

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1 ‘‘(B) the proposed target population of ap2 plicable individuals with respect to which such 

3 innovations will be employed, including a de4 scription of the extent to which such population 

5 consists of applicable individuals described in 

6 subparagraph (A), (B), or (C) of subsection 

7 (f)(1); 

8 ‘‘(C) the evidence-based data supporting a 

9 community’s status as a vulnerable community 

10 through sources, such as Bureau of the Census 

11 data and measures such as the Neighborhood 

12 Deprivation Index or the Child Opportunity 

13 Index; 

14 ‘‘(D) community partners, such as non15 profit organizations, federally qualified health 

16 centers, rural health clinics, and units of local 

17 government (including law enforcement and ju18 dicial entities) that will participate in the imple19 mentation of such innovations; 

20 ‘‘(E) how such innovations will address 

21 mental and physical health comorbidities and 

22 social determinants of health for the target pop23 ulation; 

24 ‘‘(F) how such innovations may inform 

25 changes in payment and other policies under 

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1 this title and title XIX (such as care coordina2 tion reimbursement, mental health homes, im3 provements to home and community-based serv4 ice portfolios, and coverage of supportive serv5 ices); 

6 ‘‘(G) how such innovations might con7 tribute to a reduction in overall health care 

8 costs, including under this title and title XIX 

9 and for uninsured persons, through improve10 ments in population health, reductions in health 

11 care utilization (such as inpatient admissions, 

12 utilization of emergency departments, and 

13 boarding of patients), and otherwise; 

14 ‘‘(H) how such innovations can be expected 

15 to improve the mental and physical health sta16 tus of minority populations; 

17 ‘‘(I) how such innovations can be expected 

18 to reduce other non-medical public expendi19 tures; 

20 ‘‘(J) metrics to track care quality, im21 provement in outcomes, and the impact of such 

22 innovations on health care and other public ex23 penditures; 

24 ‘‘(K) how program outcomes will be as25 sessed and evaluated; and 

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1 ‘‘(L) how the hospital will collect and orga2 nize data and fully participate in the learning 

3 collaborative established under subsection (e). 

4 ‘‘(3) PARTICIPATION; PAYMENTS.—The Sec5 retary shall negotiate an annualized payment ar6 rangement with each eligible hospital participating 

7 in the program. Such arrangement may include an 

8 annual lump sum amount, capitated payment 

9 amount, or such other arrangement as determined 

10 appropriate by the Secretary, and which may include 

11 an arrangement that includes financial risk for the 

12 hospital, to support implementation of the innova13 tions specified in the plan described in paragraph 

14 (2). 

15 ‘‘(e) LEARNING COLLABORATIVE.— 

16 ‘‘(1) IN GENERAL.—The Secretary shall estab17 lish a learning collaborative that shall convene eligi18 ble hospitals participating in the program and other 

19 interested parties on a regular basis to report on 

20 and share information regarding evidence-based in21 novations addressing mental and physical health 

22 comorbidities, innovations addressing social deter23 minants of health, and associated metrics and out24 comes. 

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1 ‘‘(2) FOCUSED FORUMS.—The Secretary may 

2 establish different focused forums within the collabo3 rative, such as ones that specifically address dif4 ferent geographic regions (such as urban and rural), 

5 certain types of comorbidities, or as the Secretary 

6 otherwise determines appropriate based on the types 

7 of agreements entered into under subsection (d). 

8 ‘‘(3) DISSEMINATION OF INFORMATION.—The 

9 Secretary shall provide for the dissemination to 

10 other health care providers and interested parties of 

11 information on promising and effective activities. 

12 ‘‘(f) DEFINITIONS.—For purposes of this section: 

13 ‘‘(1) APPLICABLE INDIVIDUAL.—The term ‘ap14 plicable individual’ means an individual with mental 

15 and physical health comorbidities who is— 

16 ‘‘(A) a subsidy eligible individual (as de17 fined in section 1860D–14(a)(3)(A)) without 

18 regard to clause (i) of such section; 

19 ‘‘(B) enrolled under a State plan (or waiv20 er of such plan) under title XIX; or 

21 ‘‘(C) uninsured. 

22 ‘‘(2) ELIGIBLE HOSPITAL.—The term ‘eligible 

23 hospital’ means a hospital that is— 

24 ‘‘(A) a rural hospital with a dispropor25 tionate patient percentage of at least 35 percent 

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1 (as determined by the Secretary under section 

2 1886(d)(5)(F)(vi)) or would have a dispropor3 tionate patient percentage of at least 35 percent 

4 (as so determined) if the hospital were a sub5 section (d) hospital (or, a percentage of inpa6 tient days consisting of items and services fur7 nished to individuals entitled to benefits under 

8 part A that exceeds 85 percent of all such days) 

9 that is either a critical access hospital, a sole 

10 community hospital (as defined in section 

11 1886(d)(5)(D)(iii)), or a medicare-dependent, 

12 small rural hospital (as defined in section 

13 1886(d)(5)(G)(iv)); 

14 ‘‘(B) a large subsection (d) teaching and 

15 tertiary hospital with more than 200 beds that 

16 as of, or subsequent to July 1, 2020, has an av17 erage Medicare case mix index of at least 1.5, 

18 an intern and resident-to-bed ratio of at least 

19 0.25 percent (or at least 150 full-time equiva20 lent interns, residents, and fellows), and is ei21 ther a public hospital with a disproportionate 

22 patient percentage of at least 35 percent (as de23 termined by the Secretary under section 

24 1886(d)(5)(F)(vi)) or a nonprofit hospital with 

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1 a disproportionate patient percentage of at least 

2 45 percent; or 

3 ‘‘(C) a small subsection (d) urban safety 

4 net hospital (as determined by the Secretary) 

5 with less than 200 beds that is deemed to be 

6 a disproportionate share hospital under section 

7 1923(b). 

8 ‘‘(3) INNOVATIONS ADDRESSING MENTAL AND

9 PHYSICAL HEALTH COMORBIDITIES.—The term ‘in10 novations addressing mental and physical health 

11 comorbidities’ means innovations implemented by an 

12 eligible hospital that seek to promote holistic care 

13 and treatment of an applicable individual’s co-occur14 ring mental and physical health comorbidities, sup15 port early detection of such comorbidities, or prevent 

16 their onset, including the following: 

17 ‘‘(A) Implementation of interdisciplinary 

18 integrative coordinated care team models, in19 cluding those that utilize mental health emer20 gency department in-reach staff (and other 

21 emergency-department interventions), care co22 ordination staff and social services support, and 

23 clinic-based services. 

24 ‘‘(B) Integration of mental health services 

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1 tions, accountable care entities, and in-home 

2 services. 

3 ‘‘(C) Incorporation of mental health and 

4 social risk screening into medical screening, 

5 particularly in child and adolescent populations. 

6 ‘‘(D) Preventing adverse impacts on men7 tal health resulting from physical health treat8 ments or medications, or on physical health re9 sulting from mental health treatments or medi10 cations, through cross disciplinary provider edu11 cation, quality metrics, and other mechanisms. 

12 ‘‘(E) Improvements in electronic health 

13 records and other technology platforms or net14 works to capture, track, and monitor mental 

15 and physical health treatments and medications 

16 provided across care settings and otherwise fa17 cilitate care coordination. 

18 ‘‘(F) Piloting of reimbursement modifica19 tions that utilize site-neutral payments and that 

20 address conflicts and disincentives related to 

21 chronic care management and behavioral health 

22 management and differential treatment of inpa23 tient and outpatient settings. 

24 ‘‘(G) Mitigating the incidence of admission 

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1 tings of chronically ill elderly patients through 

2 methods such as active inpatient management, 

3 variations in initial length of stay, enhanced 

4 discharge planning, and psychosocial interven5 tions. 

6 ‘‘(H) Delivering health behavior assess7 ments and interventions to improve physical 

8 health outcomes for patients and aid in the 

9 management of chronic health conditions. 

10 ‘‘(I) In coordination with law enforcement 

11 agencies and judicial entities, interventions tar12 geted at providing mental and physical health 

13 services (including, as appropriate, substance 

14 use disorder services) to individuals convicted of 

15 criminal offenses for purposes of mitigating re16 cidivism. 

17 ‘‘(4) INNOVATIONS ADDRESSING SOCIAL DETER18 MINANTS OF HEALTH.—The term ‘innovations ad19 dressing social determinants of health’ means inno20 vations implemented by an eligible hospital that seek 

21 to address social determinants of health that nega22 tively impact the health outcomes of applicable indi23 viduals, including the following: 

24 ‘‘(A) Improvements in electronic health 

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1 ical care, and social care (such as screening for 

2 social factors, facilitated or closed loop referral, 

3 risk stratification, and shared records with com4 munity-based organizations). 

5 ‘‘(B) Personnel-supported ‘wrap around’ 

6 services for at-risk individuals with mental and 

7 physical health comorbidities (such as nutrition 

8 and diet counseling, social services referral, res9 piratory therapy, medical-legal assistance, fi10 nancial counseling, consumer education, phar11 macy education, asthma education, and referral 

12 to food resources such as referral to the SNAP 

13 program, the WIC program, a food bank, case 

14 management assistance, employment or edu15 cation support, intimate partner violence, and 

16 behavioral health support). 

17 ‘‘(C) Home and community-based services 

18 that provide collaborative care to address men19 tal and physical health comorbidities through 

20 health behavior services, nutrition support, 

21 medication management, transitional care, tele22 health, mobile integrated health care, para23 medic-based home visitation, or utilization of 

24 community health workers. 

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1 ‘‘(D) Hospital-based interventions (such as 

2 same day primary care services, skilled nursing 

3 interventions, substance use disorder and be4 havioral health treatment coordination of care, 

5 collaborative care models, discharge planning 

6 and medication reconciliation, long-term care 

7 management, and post-traumatic injury man8 agement). 

9 ‘‘(5) INDIVIDUAL WITH MENTAL AND PHYSICAL

10 HEALTH COMORBIDITIES.—The term ‘individual 

11 with mental and physical health comorbidities’ 

12 means an individual who is challenged by serious 

13 mental illness or serious emotional disturbance as 

14 well as 1 or more of the following conditions or char15 acteristics: 

16 ‘‘(A) Has or is at risk for one or more 

17 chronic conditions (as defined by the Sec18 retary). 

19 ‘‘(B) High-risk pregnancy. 

20 ‘‘(C) History of high utilization of acute 

21 care services. 

22 ‘‘(D) Frail elderly (defined by impairments 

23 in activities of daily living). 

24 ‘‘(E) Disability, including traumatic brain 

25 injury. 

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1 ‘‘(F) Critical illness or injury requiring 

2 long-term recovery. 

3 ‘‘(6) VULNERABLE COMMUNITY.—The term 

4 ‘vulnerable community’ means a geographic area 

5 served by an eligible hospital characterized by a pop6 ulation that has a statistically significant number of 

7 individuals with mental and physical health 

8 comorbidities, indicators of poor population health 

9 status, low-income status, or status as a USDA-rec10 ognized food desert. 

11 ‘‘(g) EVALUATION AND REPORT.—Not later than 1 

12 year after the date of completion of the program under 

13 this section, the Secretary shall submit to Congress a re14 port containing an evaluation of the activities supported 

15 by the program. Such report shall include the following: 

16 ‘‘(1) A description of each such activity, includ17 ing— 

18 ‘‘(A) the target population of such activity; 

19 ‘‘(B) how such activity addressed the ad20 verse social determinants of health in such pop21 ulation; and 

22 ‘‘(C) the role of community-based organi23 zations and other community partners (such as 

24 nonprofits and units of local government) in 

25 such activity. 

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1 ‘‘(2) Evidence showing whether and how each 

2 such activity advanced any of the following objec3 tives: 

4 ‘‘(A) Improved access to care. 

5 ‘‘(B) Improved quality of care. 

6 ‘‘(C) Improved health outcomes. 

7 ‘‘(D) Amelioration of disparities in care. 

8 ‘‘(E) Improved care coordination. 

9 ‘‘(F) Reduction in health care costs (in10 cluding such reductions under this title and 

11 title XIX and such reductions occurring for un12 insured individuals). 

13 ‘‘(G) Reduction in health care utilization 

14 (including with respect to inpatient admissions, 

15 utilization of emergency departments, and room 

16 and board provided to individuals). 

17 ‘‘(H) Reduction in non-medical public ex18 penditures. 

19 ‘‘(I) Changes in patient and provider satis20 faction with care delivery. 

21 ‘‘(J) Reductions in involvement with the 

22 justice system, including reductions in recidi23 vism. 

24 ‘‘(3) A description of the metrics used to track 

25 the implementation and results of each such activity. 

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1 ‘‘(4) Recommendations for any legislation or 

2 administrative action the Secretary determines ap3 propriate. 

4 ‘‘(h) FUNDING.—Any funds appropriated under sec5 tion 1115A(f) shall be available to the Secretary without 

6 further appropriation for the purposes of carrying out this 

7 section.’’. 

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