I 
116TH CONGRESS 
2D SESSION 
H. R. 7961 
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 
AUGUST 7, 2020 
Mr. DEFAZIO (for himself, Ms. BONAMICI, Mr. BLUMENAUER, Ms. PRESSLEY, 
Ms. WEXTON, Mr. HASTINGS, Ms. NORTON, and Mr. CARSON of Indiana) 
introduced the following bill; which was referred to the Committee on En-
ergy 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’’. 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
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: 
‘‘(bb) 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(c). 
‘‘(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— 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(A) furnished to an individual who is— 
‘‘(i) outside of a hospital or other fa-
cility setting; 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; 
‘‘(iii) that is able to respond in a 
timely manner and, where appropriate, 
provide the following— 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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) provision or coordination of 
transportation to the next step in care 
or treatment; 
‘‘(iv) that maintains relationships with 
relevant community partners, including 
medical and behavioral health providers, 
community health centers, crisis respite 
centers, managed care organizations (if ap-
plicable), 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 authorities, Continuum 
of Care programs, or not for profit entities 
that provide housing assistance), and enti-
ties that provide assistance with other so-
cial services; 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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-
munity-based mobile crisis intervention services 
furnished during such quarter shall be equal to 
95 percent. 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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. 
‘‘(4) REQUIREMENTS.—The requirements de-
scribed in this paragraph are the following: 
‘‘(A) The State demonstrates, to the satis-
faction of the Secretary— 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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 
expended for such services for fiscal year 
2019; 
‘‘(ii) if the State made qualifying com-
munity-based mobile crisis intervention 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
services available in a region of the State 
in fiscal year 2019, the State will continue 
to make such services available in such re-
gion under this subsection at the same 
level that the State made such services 
available in such fiscal year; 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; 
‘‘(III) hospitalizations; 
‘‘(IV) the involvement of law en-
forcement in mental health or sub-
stance use disorder crisis events; 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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 
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-
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
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; 
‘‘(ii) summarizes the information re-
ported by such States under paragraph 
(5)(C); and 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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(c) 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. 
‘‘(B) STATE
CONTRIBUTION.—A State 
awarded a grant under this subsection shall 
contribute for each fiscal year for which the 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS
grant is awarded an amount equal to the State 
percentage determined under section 1905(b) 
(without regard to the temporary increase in 
the Federal medical assistance percentage of 
the State under section 6008(a) of the Families 
First Coronavirus Response Act (Public Law 
116–127) or any other temporary increase in 
the Federal medical assistance percentage of 
the State for fiscal year 2020 or any succeeding 
fiscal year) of the grant amount. 
‘‘(8) FUNDING.— 
‘‘(A) IMPLEMENTATION AND ADMINISTRA-
TION.—There is appropriated to the Secretary, 
out of any funds in the Treasury not otherwise 
appropriated, such sums as are necessary for 
purposes of implementing and administering 
this section. 
‘‘(B) 
PLANNING
AND
EVALUATION 
GRANTS.—There is appropriated, out of any 
funds in the Treasury not otherwise appro-
priated, $25,000,000 to the Secretary for fiscal 
year 2021 for purposes of making grants under 
paragraph (7), to remain available until ex-
pended.’’. 
Æ 
VerDate Sep 11 2014 
21:23 Aug 28, 2020
Jkt 099200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6301
E:\BILLS\H7961.IH
H7961
pamtmann on DSKBC07HB2PROD with BILLS