I 

117TH CONGRESS 

1ST SESSION H. R. 1914 

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

programs to provide community-based mobile crisis intervention services, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 16, 2021 

Mr. DEFAZIO (for himself, Mr. BLUMENAUER, Ms. BONAMICI, Ms. NORTON, 

Mrs. HAYES, Mr. THOMPSON of California, and Ms. PRESSLEY) introduced the following bill; which was referred to the Committee on Energy 

and Commerce 

A BILL 

To amend title XIX of the Social Security Act to encourage 

State Medicaid programs to provide community-based 

mobile crisis intervention services, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Crisis Assistance Help5 ing Out On The Streets Act’’ or the ‘‘CAHOOTS Act’’. 


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1 SEC. 2. ENHANCED FEDERAL MEDICAID SUPPORT FOR 

2 COMMUNITY-BASED MOBILE CRISIS INTER3 VENTION SERVICES. 

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

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

6 subsection: 

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

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

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

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

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

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

18 1915. 

19 ‘‘(2) QUALIFYING COMMUNITY-BASED MOBILE

20 CRISIS INTERVENTION SERVICES DEFINED.—For 

21 purposes of this subsection, the term ‘qualifying 

22 community-based mobile crisis intervention services’ 

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

24 for which medical assistance is available under the 

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

26 that are— 


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1 ‘‘(A) furnished outside of a hospital or 

2 other facility setting to an individual who is— 

3 ‘‘(i) entitled to medical assistance 

4 under such plan or waiver; and 

5 ‘‘(ii) experiencing a mental health or 

6 substance use disorder crisis; 

7 ‘‘(B) furnished by a multidisciplinary mo8 bile crisis team— 

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

10 health care professional who is capable of 

11 conducting an assessment of the individual, 

12 in accordance with the professional’s per13 mitted scope of practice under State law, 

14 and other professionals or paraprofes15 sionals with appropriate expertise in behav16 ioral health or mental health crisis re17 sponse, including nurses, social workers, 

18 peer support specialists, and others, as 

19 designated by the State and approved by 

20 the Secretary; 

21 ‘‘(ii) whose members are trained in 

22 trauma-informed care, de-escalation strate23 gies, and harm reduction; 


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

2 timely manner and, where appropriate, 

3 provide the following— 

4 ‘‘(I) screening and assessment; 

5 ‘‘(II) stabilization and de-esca6 lation; 

7 ‘‘(III) coordination with, and re8 ferrals to, health, social, and other 

9 services and supports as needed; and 

10 ‘‘(IV) facilitate an individual into 

11 the State’s Medicaid transportation 

12 process to ensure access to the next 

13 step in care or treatment; 

14 ‘‘(iv) that maintains relationships with 

15 relevant community partners, including 

16 medical, primary care, and behavioral 

17 health providers, community health cen18 ters, crisis respite centers, managed care 

19 organizations (if applicable), entities able 

20 to provide assistance with application and 

21 enrollment in the State plan or a waiver of 

22 the plan, entitles able to provide assistance 

23 with applying for and enrolling in benefit 

24 programs, entities that provide assistance 

25 with housing (such as public housing auVerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914

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1 thorities, Continuum of Care programs, or 

2 not-for-profit entities that provide housing 

3 assistance), and entities that provide as4 sistance with other social services; 

5 ‘‘(v) that coordinates with crisis inter6 vention hotlines and emergency response 

7 systems; 

8 ‘‘(vi) that maintains the privacy and 

9 confidentiality of patient information con10 sistent with Federal and State require11 ments; and 

12 ‘‘(vii) that operates independently 

13 from (but may coordinate with) State or 

14 local law enforcement agencies; 

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

16 of the year; and 

17 ‘‘(D) voluntary to receive. 

18 ‘‘(3) PAYMENTS.— 

19 ‘‘(A) IN GENERAL.—Notwithstanding sec20 tion 1905(b), beginning October 1, 2020, dur21 ing each of the first 12 fiscal quarters that a 

22 State meets the requirements described in para23 graph (4), the Federal medical assistance per24 centage applicable to amounts expended by the 

25 State for medical assistance for qualifying comVerDate Sep 11 2014 21:52 May 11, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1914.IH H1914

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1 munity-based mobile crisis intervention services 

2 furnished during such quarter shall be equal to 

3 95 percent. 

4 ‘‘(B) EXCLUSION OF ENHANCED PAY5 MENTS FROM TERRITORIAL CAPS.—To the ex6 tent that the amount of a payment to Puerto 

7 Rico, the Virgin Islands, Guam, the Northern 

8 Mariana Islands, or American Samoa for med9 ical assistance for qualifying community-based 

10 mobile crisis intervention services that is based 

11 on the Federal medical assistance percentage 

12 specified in subparagraph (A) exceeds the 

13 amount that would have been paid to such ter14 ritory for such services if the Federal medical 

15 assistance percentage for the territory had been 

16 determined without regard to such subpara17 graph— 

18 ‘‘(i) the limitation on payments to ter19 ritories under subsections (f) and (g) of 

20 section 1108 shall not apply to the amount 

21 of such excess; and 

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

23 be disregarded in applying such sub24 sections. 


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1 ‘‘(4) REQUIREMENTS.—The requirements de2 scribed in this paragraph are the following: 

3 ‘‘(A) The State demonstrates, to the satis4 faction of the Secretary— 

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

6 provision of qualifying community-based 

7 mobile crisis intervention services that 

8 meet the conditions specified in paragraph 

9 (2); and 

10 ‘‘(ii) how it will support coordination 

11 between mobile crisis teams and commu12 nity partners, including health care pro13 viders, to enable the provision of services, 

14 needed referrals, and other activities iden15 tified by the Secretary. 

16 ‘‘(B) The State provides assurances satis17 factory to the Secretary that— 

18 ‘‘(i) any additional Federal funds re19 ceived by the State for qualifying commu20 nity-based mobile crisis intervention serv21 ices provided under this subsection that 

22 are attributable to the increased Federal 

23 medical assistance percentage under para24 graph (3)(A) will be used to supplement, 

25 and not supplant, the level of State funds 


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1 expended for such services in the fiscal 

2 year preceding the first fiscal year in which 

3 the State elected to provide medical assist4 ance under this subsection; 

5 ‘‘(ii) if the State made qualifying com6 munity-based mobile crisis intervention 

7 services available in a region of the State 

8 in such preceding fiscal year, the State will 

9 continue to make such services available in 

10 such region under this subsection; and 

11 ‘‘(iii) the State will conduct the eval12 uation and assessment, and submit the re13 port, required under paragraph (5). 

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

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

16 4 fiscal quarters after a State begins providing 

17 qualifying community-based mobile crisis inter18 vention services in accordance with this sub19 section, the State shall enter into a contract 

20 with an independent entity or organization to 

21 conduct an evaluation for the purposes of— 

22 ‘‘(i) determining the effect of the pro23 vision of such services on— 

24 ‘‘(I) emergency room visits; 

25 ‘‘(II) use of ambulatory services; 


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1 ‘‘(III) hospitalizations; 

2 ‘‘(IV) the involvement of law en3 forcement in mental health or sub4 stance use disorder crisis events; 

5 ‘‘(V) the diversion of individuals 

6 from jails or similar settings; and 

7 ‘‘(ii) assessing— 

8 ‘‘(I) the types of services pro9 vided to individuals; 

10 ‘‘(II) the types of events re11 sponded to; 

12 ‘‘(III) cost savings or cost-effec13 tiveness attributable to such services; 

14 ‘‘(IV) the experiences of individ15 uals who receive qualifying commu16 nity-based mobile crisis intervention 

17 services; 

18 ‘‘(V) the successful connection of 

19 individuals with follow-up services; 

20 and 

21 ‘‘(VI) other relevant outcomes 

22 identified by the Secretary. 

23 ‘‘(B) COMPARISON TO HISTORICAL MEAS24 URES.—The contract described in subparagraph 

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


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1 a comparison of the historical measures of 

2 State performance with respect to the outcomes 

3 specified under such subparagraph to the 

4 State’s performance with respect to such out5 comes during the period beginning with the 

6 first quarter in which the State begins pro7 viding qualifying community-based mobile crisis 

8 intervention services in accordance with this 

9 subsection. 

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

11 after a State begins to provide qualifying com12 munity-based mobile crisis intervention services 

13 in accordance with this subsection, the State 

14 shall submit a report to the Secretary on the 

15 following: 

16 ‘‘(i) The results of the evaluation car17 ried out under subparagraph (A). 

18 ‘‘(ii) The number of individuals who 

19 received qualifying community-based mo20 bile crisis intervention services. 

21 ‘‘(iii) Demographic information re22 garding such individuals when available, 

23 including the race or ethnicity, age, sex, 

24 sexual orientation, gender identity, and ge25 ographic location of such individuals. 


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1 ‘‘(iv) The processes and models devel2 oped by the State to provide qualifying 

3 community-based mobile crisis intervention 

4 services under such the State plan or waiv5 er, including the processes developed to 

6 provide referrals for, or coordination with, 

7 follow-up care and services. 

8 ‘‘(v) Lessons learned regarding the 

9 provision of such services. 

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

11 shall make the report required under subpara12 graph (C) publicly available, including on the 

13 website of the appropriate State agency, upon 

14 submission of such report to the Secretary. 

15 ‘‘(6) BEST PRACTICES REPORT.— 

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

17 after the first State begins to provide qualifying 

18 community-based mobile crisis intervention 

19 services in accordance with this subsection, the 

20 Secretary shall submit a report to Congress 

21 that— 

22 ‘‘(i) identifies the States that elected 

23 to provide services in accordance with this 

24 subsection; 


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1 ‘‘(ii) summarizes the information re2 ported by such States under paragraph 

3 (5)(C); and 

4 ‘‘(iii) identifies best practices for the 

5 effective delivery of community-based mo6 bile crisis intervention services. 

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

8 required under subparagraph (A) shall be made 

9 publicly available, including on the website of 

10 the Department of Health and Human Services, 

11 upon submission to Congress. 

12 ‘‘(7) STATE PLANNING AND EVALUATION

13 GRANTS.— 

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

15 after the date of enactment of this subsection, 

16 the Secretary may award planning and evalua17 tion grants to States for purposes of developing 

18 a State plan amendment or section 1115 or 

19 1915 waiver request (or an amendment to such 

20 a waiver) to provide qualifying community21 based mobile crisis intervention services and 

22 conducting the evaluation required under para23 graph (5)(A). A grant awarded to a State 

24 under this paragraph shall remain available 

25 until expended. 


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1 ‘‘(B) STATE CONTRIBUTION.—A State 

2 awarded a grant under this subsection shall 

3 contribute for each fiscal year for which the 

4 grant is awarded an amount equal to the State 

5 percentage determined under section 1905(b) 

6 (without regard to the temporary increase in 

7 the Federal medical assistance percentage of 

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

9 First Coronavirus Response Act (Public Law 

10 116–127) or any other temporary increase in 

11 the Federal medical assistance percentage of 

12 the State for fiscal year 2020 or any succeeding 

13 fiscal year) of the grant amount. 

14 ‘‘(8) FUNDING.— 

15 ‘‘(A) IMPLEMENTATION AND ADMINISTRA16 TION.—There is appropriated to the Secretary, 

17 out of any funds in the Treasury not otherwise 

18 appropriated, such sums as are necessary for 

19 purposes of implementing and administering 

20 this section. 

21 ‘‘(B) PLANNING AND EVALUATION

22 GRANTS.—There is appropriated, out of any 

23 funds in the Treasury not otherwise appro24 priated, $25,000,000 to the Secretary for fiscal 

25 year 2021 for purposes of making grants under 


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1 paragraph (7), to remain available until ex2 pended.’’. 

Æ 


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