Connecting Our Medical Providers with Links to Expand Tailored and Effective Care

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1378 Introduced in Senate (IS)]

&lt;DOC&gt;






118th CONGRESS
  1st Session
                                S. 1378

 To amend title XVIII of the Social Security Act to provide incentives 
     for behavioral health integration under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 27, 2023

Ms. Cortez Masto (for herself and Mr. Cornyn) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to provide incentives 
     for behavioral health integration under the Medicare program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Connecting Our Medical Providers 
with Links to Expand Tailored and Effective Care'' or the ``COMPLETE 
Care Act''.

SEC. 2. INCENTIVES FOR BEHAVIORAL HEALTH INTEGRATION.

    (a) Incentives.--
            (1) 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) Incentives for behavioral health integration.--
                    ``(A) In general.--For services described in 
                subparagraph (B) that are furnished during 2025, 2026, 
                or 2027, instead of the payment amount that would 
                otherwise be determined under this section for such 
                year, the payment amount shall be equal to the 
                applicable percent (as defined in subparagraph (C)) of 
                such payment amount for such year.
                    ``(B) Services described.--The services described 
                in this subparagraph are services identified, as of 
                January 1, 2023, by HCPCS codes 99484, 99492, 99493, 
                99494, and G2214 (and any successor or similar codes as 
                determined appropriate by the Secretary).
                    ``(C) Applicable percent.--In this paragraph, the 
                term `applicable percent' means, with respect to a 
                service described in subparagraph (A), the following:
                            ``(i) For services furnished during 2025 , 
                        175 percent.
                            ``(ii) For services furnished during 2026, 
                        150 percent.
                            ``(iii) For services furnished during 2027, 
                        125 percent.''.
            (2) Waiver of budget neutrality.--Section 1848(c)(2)(B)(iv) 
        of such Act (42 U.S.C. 1395w-4(c)(2)(B)(iv)) is amended--
                    (A) in subclause (V), by striking ``and'' at the 
                end;
                    (B) in subclause (VI), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(VII) the increase in payment 
                                amounts as a result of the application 
                                of subsection (b)(13) shall not be 
                                taken into account in applying clause 
                                (ii)(II) for 2025, 2026, or 2027.''.
    (b) Quality Measurement.--
            (1) In general.--Section 1833(z) of the Social Security Act 
        (42 U.S.C. 1395l(z)) is amended--
                    (A) by redesignating paragraph (4) as paragraph 
                (5); and
                    (B) by inserting after paragraph (3) the following 
                new paragraph:
            ``(4) Quality measurement relating to behavioral health 
        integration.--
                    ``(A) In general.--The Secretary shall establish 
                quality measurement reporting requirements for 
                applicable physicians and practitioners (as defined in 
                subparagraph (B)) with respect to the extent to which 
                clinician practices are integrating behavioral health 
                services and primary care services, in accordance with 
                the succeeding provisions of this paragraph.
                    ``(B) Applicable physicians and practitioners.--For 
                purposes of this paragraph, the term `applicable 
                physician or practitioner' means, with respect to a 
                year, a physician or a practitioner described in 
                section 1842(b)(18)(C) who is participating in an 
                eligible alternative payment entity for which the 
                associated alternative payment model involves the 
                delivery of primary care services to beneficiaries who 
                may have the need for mental health or substance use 
                disorder services, as determined by the Secretary.
                    ``(C) Quality reporting by selected physicians and 
                practitioners.--With respect to each year beginning on 
                or after the date that is one year after one or more 
                measures are first specified under subparagraph (D), an 
                applicable physician or practitioner shall submit to 
                the Secretary data on quality measures specified under 
                such subparagraph. Such data shall be submitted in a 
                form and manner, and at a time, specified by the 
                Secretary for purposes of this subparagraph.
                    ``(D) Quality measures.--
                            ``(i) In general.--Subject to clause (ii), 
                        any measure specified by the Secretary under 
                        this subparagraph must have been endorsed by 
                        the entity with a contract under section 
                        1890(a).
                            ``(ii) Exception.--In the case of a 
                        specified area or medical topic determined 
                        appropriate by the Secretary for which a 
                        feasible and practical measure has not been 
                        endorsed by the entity with a contract under 
                        section 1890(a), the Secretary may specify a 
                        measure that is not so endorsed as long as due 
                        consideration is given to measures that have 
                        been endorsed or adopted by a consensus 
                        organization identified by the Secretary.
                    ``(E) Implementation.--The Secretary may use 
                quality measures developed pursuant to this paragraph 
                in--
                            ``(i) the shared savings program under 
                        section 1899; and
                            ``(ii) the Primary Care First Model, the 
                        Accountable Care Organization Realizing Equity, 
                        Access, and Community Health (ACO REACH) Model, 
                        and any other alternative payment model (as 
                        defined in paragraph (3)(C)) as determined 
                        appropriate by the Secretary.''.
            (2) Conforming amendment relating to convening multi-
        stakeholder groups.--Section 1890(b)(7)(B)(i)(I) of the Social 
        Security Act (42 U.S.C. 1395aaa(b)(7)(B)(i)(I)) is amended by 
        inserting ``1833(z)(4),'' after ``1833(t)(17),''.
    (c) Technical Assistance for the Adoption of Behavioral Health 
Integration.--
            (1) In general.--Not later than January 1, 2025, the 
        Secretary of Health and Human Services shall enter into 
        contracts or agreements with appropriate entities to offer 
        technical assistance to primary care practices that are seeking 
        to adopt behavioral health integration models in such 
        practices.
            (2) Behavioral health integration models.--For purposes of 
        paragraph (1), behavioral health integration models include the 
        Collaborative Care Model (with services identified as of 
        January 1, 2023, by HCPCS codes 99492, 99493, 99494, and G2214 
        (and any successor codes)), the Primary Care Behavioral Health 
        model (with services identified as of January 1, 2023, by HCPCS 
        code 99484 (and any successor code)), and other models 
        identified by the Secretary.
            (3) Funding.--In addition to amounts otherwise available, 
        there is appropriated to the Secretary of Health and Human 
        Services for each of fiscal years 2024 through 2027, out of any 
        money in the Treasury not otherwise appropriated, such sums as 
        are necessary, to remain available until expended, for purposes 
        of carrying out this subsection.
                                 &lt;all&gt;
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