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) intro-
duced 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 pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Crisis Assistance Help-
ing Out On The Streets Act’’ or the ‘‘CAHOOTS Act’’. 
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SEC. 2. ENHANCED FEDERAL MEDICAID SUPPORT FOR 
COMMUNITY-BASED MOBILE CRISIS INTER-
VENTION SERVICES. 
Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by adding at the end the following new 
subsection: 
‘‘(cc) COMMUNITY-BASED MOBILE CRISIS INTER-
VENTION SERVICES.— 
‘‘(1) IN
GENERAL.—Notwithstanding section 
1902(a)(1) (relating to Statewideness), section 
1902(a)(10)(B) (relating to comparability), section 
1902(a)(23)(A) (relating to freedom of choice of 
providers), or section 1902(a)(27) (relating to pro-
vider agreements), a State may provide medical as-
sistance for qualifying community-based mobile cri-
sis intervention services under a State plan amend-
ment or waiver approved under section 1115 or 
1915. 
‘‘(2) QUALIFYING
COMMUNITY-BASED
MOBILE 
CRISIS
INTERVENTION
SERVICES
DEFINED.—For 
purposes of this subsection, the term ‘qualifying 
community-based mobile crisis intervention services’ 
means, with respect to a State, items and services 
for which medical assistance is available under the 
State plan under this title or a waiver of such plan, 
that are— 
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‘‘(A) furnished outside of a hospital or 
other facility setting to an individual who is— 
‘‘(i) entitled to medical assistance 
under such plan or waiver; and 
‘‘(ii) experiencing a mental health or 
substance use disorder crisis; 
‘‘(B) furnished by a multidisciplinary mo-
bile crisis team— 
‘‘(i) that includes at least 1 behavioral 
health care professional who is capable of 
conducting an assessment of the individual, 
in accordance with the professional’s per-
mitted scope of practice under State law, 
and other professionals or paraprofes-
sionals with appropriate expertise in behav-
ioral health or mental health crisis re-
sponse, including nurses, social workers, 
peer support specialists, and others, as 
designated by the State and approved by 
the Secretary; 
‘‘(ii) whose members are trained in 
trauma-informed care, de-escalation strate-
gies, and harm reduction; 
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‘‘(iii) that is able to respond in a 
timely manner and, where appropriate, 
provide the following— 
‘‘(I) screening and assessment; 
‘‘(II) stabilization and de-esca-
lation; 
‘‘(III) coordination with, and re-
ferrals to, health, social, and other 
services and supports as needed; and 
‘‘(IV) facilitate an individual into 
the State’s Medicaid transportation 
process to ensure access to the next 
step in care or treatment; 
‘‘(iv) that maintains relationships with 
relevant community partners, including 
medical, primary care, and behavioral 
health providers, community health cen-
ters, crisis respite centers, managed care 
organizations (if applicable), entities able 
to provide assistance with application and 
enrollment in the State plan or a waiver of 
the plan, entitles able to provide assistance 
with applying for and enrolling in benefit 
programs, entities that provide assistance 
with housing (such as public housing au-
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thorities, Continuum of Care programs, or 
not-for-profit entities that provide housing 
assistance), and entities that provide as-
sistance with other social services; 
‘‘(v) that coordinates with crisis inter-
vention hotlines and emergency response 
systems; 
‘‘(vi) that maintains the privacy and 
confidentiality of patient information con-
sistent with Federal and State require-
ments; and 
‘‘(vii) that operates independently 
from (but may coordinate with) State or 
local law enforcement agencies; 
‘‘(C) available 24 hours per day, every day 
of the year; and 
‘‘(D) voluntary to receive. 
‘‘(3) PAYMENTS.— 
‘‘(A) IN GENERAL.—Notwithstanding sec-
tion 1905(b), beginning October 1, 2020, dur-
ing each of the first 12 fiscal quarters that a 
State meets the requirements described in para-
graph (4), the Federal medical assistance per-
centage applicable to amounts expended by the 
State for medical assistance for qualifying com-
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munity-based mobile crisis intervention services 
furnished during such quarter shall be equal to 
95 percent. 
‘‘(B) EXCLUSION
OF
ENHANCED
PAY-
MENTS FROM TERRITORIAL CAPS.—To the ex-
tent that the amount of a payment to Puerto 
Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, or American Samoa for med-
ical assistance for qualifying community-based 
mobile crisis intervention services that is based 
on the Federal medical assistance percentage 
specified in subparagraph (A) exceeds the 
amount that would have been paid to such ter-
ritory for such services if the Federal medical 
assistance percentage for the territory had been 
determined without regard to such subpara-
graph— 
‘‘(i) the limitation on payments to ter-
ritories under subsections (f) and (g) of 
section 1108 shall not apply to the amount 
of such excess; and 
‘‘(ii) the amount of such excess shall 
be disregarded in applying such sub-
sections. 
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‘‘(4) REQUIREMENTS.—The requirements de-
scribed in this paragraph are the following: 
‘‘(A) The State demonstrates, to the satis-
faction of the Secretary— 
‘‘(i) that it will be able to support the 
provision of qualifying community-based 
mobile crisis intervention services that 
meet the conditions specified in paragraph 
(2); and 
‘‘(ii) how it will support coordination 
between mobile crisis teams and commu-
nity partners, including health care pro-
viders, to enable the provision of services, 
needed referrals, and other activities iden-
tified by the Secretary. 
‘‘(B) The State provides assurances satis-
factory to the Secretary that— 
‘‘(i) any additional Federal funds re-
ceived by the State for qualifying commu-
nity-based mobile crisis intervention serv-
ices provided under this subsection that 
are attributable to the increased Federal 
medical assistance percentage under para-
graph (3)(A) will be used to supplement, 
and not supplant, the level of State funds 
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expended for such services in the fiscal 
year preceding the first fiscal year in which 
the State elected to provide medical assist-
ance under this subsection; 
‘‘(ii) if the State made qualifying com-
munity-based mobile crisis intervention 
services available in a region of the State 
in such preceding fiscal year, the State will 
continue to make such services available in 
such region under this subsection; and 
‘‘(iii) the State will conduct the eval-
uation and assessment, and submit the re-
port, required under paragraph (5). 
‘‘(5) STATE EVALUATION AND REPORT.— 
‘‘(A) STATE EVALUATION.—Not later than 
4 fiscal quarters after a State begins providing 
qualifying community-based mobile crisis inter-
vention services in accordance with this sub-
section, the State shall enter into a contract 
with an independent entity or organization to 
conduct an evaluation for the purposes of— 
‘‘(i) determining the effect of the pro-
vision of such services on— 
‘‘(I) emergency room visits; 
‘‘(II) use of ambulatory services; 
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‘‘(III) hospitalizations; 
‘‘(IV) the involvement of law en-
forcement in mental health or sub-
stance use disorder crisis events; 
‘‘(V) the diversion of individuals 
from jails or similar settings; and 
‘‘(ii) assessing— 
‘‘(I) the types of services pro-
vided to individuals; 
‘‘(II) the types of events re-
sponded to; 
‘‘(III) cost savings or cost-effec-
tiveness attributable to such services; 
‘‘(IV) the experiences of individ-
uals who receive qualifying commu-
nity-based mobile crisis intervention 
services; 
‘‘(V) the successful connection of 
individuals with follow-up services; 
and 
‘‘(VI) other relevant outcomes 
identified by the Secretary. 
‘‘(B) COMPARISON TO HISTORICAL MEAS-
URES.—The contract described in subparagraph 
(A) shall specify that the evaluation is based on 
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a comparison of the historical measures of 
State performance with respect to the outcomes 
specified under such subparagraph to the 
State’s performance with respect to such out-
comes during the period beginning with the 
first quarter in which the State begins pro-
viding qualifying community-based mobile crisis 
intervention services in accordance with this 
subsection. 
‘‘(C) REPORT.—Not later than 2 years 
after a State begins to provide qualifying com-
munity-based mobile crisis intervention services 
in accordance with this subsection, the State 
shall submit a report to the Secretary on the 
following: 
‘‘(i) The results of the evaluation car-
ried out under subparagraph (A). 
‘‘(ii) The number of individuals who 
received qualifying community-based mo-
bile crisis intervention services. 
‘‘(iii) Demographic information re-
garding such individuals when available, 
including the race or ethnicity, age, sex, 
sexual orientation, gender identity, and ge-
ographic location of such individuals. 
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‘‘(iv) The processes and models devel-
oped by the State to provide qualifying 
community-based mobile crisis intervention 
services under such the State plan or waiv-
er, including the processes developed to 
provide referrals for, or coordination with, 
follow-up care and services. 
‘‘(v) Lessons learned regarding the 
provision of such services. 
‘‘(D) PUBLIC
AVAILABILITY.—The State 
shall make the report required under subpara-
graph (C) publicly available, including on the 
website of the appropriate State agency, upon 
submission of such report to the Secretary. 
‘‘(6) BEST PRACTICES REPORT.— 
‘‘(A) IN GENERAL.—Not later than 3 years 
after the first State begins to provide qualifying 
community-based 
mobile 
crisis 
intervention 
services in accordance with this subsection, the 
Secretary shall submit a report to Congress 
that— 
‘‘(i) identifies the States that elected 
to provide services in accordance with this 
subsection; 
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‘‘(ii) summarizes the information re-
ported by such States under paragraph 
(5)(C); and 
‘‘(iii) identifies best practices for the 
effective delivery of community-based mo-
bile crisis intervention services. 
‘‘(B) PUBLIC
AVAILABILITY.—The report 
required under subparagraph (A) shall be made 
publicly available, including on the website of 
the Department of Health and Human Services, 
upon submission to Congress. 
‘‘(7) 
STATE
PLANNING
AND
EVALUATION 
GRANTS.— 
‘‘(A) IN GENERAL.—As soon as practicable 
after the date of enactment of this subsection, 
the Secretary may award planning and evalua-
tion grants to States for purposes of developing 
a State plan amendment or section 1115 or 
1915 waiver request (or an amendment to such 
a waiver) to provide qualifying community- 
based mobile crisis intervention services and 
conducting the evaluation required under para-
graph (5)(A). A grant awarded to a State 
under this paragraph shall remain available 
until expended. 
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