I 
119TH CONGRESS 
1ST SESSION H. R. 4022 
To amend title XIX of the Social Security Act to remove the exclusion 
from medical assistance under the Medicaid Program of items and serv-
ices for patients in an institution for mental diseases, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 17, 2025 
Mr. CARBAJAL (for himself and Mr. BACON) 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 remove 
the exclusion from medical assistance under the Medicaid 
Program of items and services for patients in an institu-
tion for mental diseases, and for other purposes. 
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 ‘‘Increasing Behavioral 
Health Treatment Act’’. 
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SEC. 2. REMOVAL OF MEDICAID EXCLUSION FROM MED-
ICAL ASSISTANCE OF ITEMS AND SERVICES 
FURNISHED TO PATIENTS IN AN INSTITU-
TION FOR MENTAL DISEASES IF STATE SUB-
MITS PLAN FOR PROVIDING APPROPRIATE 
OUTPATIENT CARE TO SUCH PATIENTS. 
(a) REMOVAL OF EXCLUSION.— 
(1) IN GENERAL.—The first sentence of section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended, in the matter following para-
graph (32)— 
(A) by striking ‘‘such term does not in-
clude—’’ and all that follows through ‘‘(A) any’’ 
and inserting ‘‘such term does not include any’’; 
(B) by striking ‘‘; or’’ and inserting a pe-
riod; and 
(C) by striking subparagraph (B). 
(2) CONFORMING
AMENDMENTS
TO
PERMIT 
MEDICAL ASSISTANCE FOR IMD PATIENTS UNDER 65 
YEARS OF AGE.—The following provisions of such 
Act are each amended by striking ‘‘65 years of age 
or older’’ and ‘‘65 years of age or over’’ each place 
it appears: 
(A) Paragraphs (20) and (21) of section 
1902(a) (42 U.S.C. 1396a(a)). 
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(B) 
Section 
1905(a)(14) 
(42 
U.S.C. 
1396d(a)(14)). 
(C) Section 1919(e)(7)(B)(i)(I) (42 U.S.C. 
1396r(e)(7)(B)(i)(I)). 
(b) REPORTING AND PLAN REQUIREMENT.—Section 
1902(a)(20) of the Social Security Act (42 U.S.C. 
1396a(a)(20)) is amended— 
(1) in subparagraph (B), by striking ‘‘and’’ at 
the end; and 
(2) by adding at the end the following new sub-
paragraphs: 
‘‘(D) provide for a plan to achieve (and for 
the annual submission to the Secretary of ac-
tions taken by the State, and progress with re-
spect to such actions, to achieve)— 
‘‘(i) increased access to outpatient and 
community-based behavioral health care, 
with respect to individuals furnished serv-
ices in an institution for mental diseases, 
especially for individuals transitioning from 
such an institution; 
‘‘(ii) increased availability of services 
made available through crisis call centers, 
mobile crisis units, coordinated community 
crisis response that involves law enforce-
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ment and other first responders, observa-
tion or assessment centers, and on-going 
community-based services (such as inten-
sive outpatient services, assertive commu-
nity treatment, and services in integrated 
care settings such as the Certified Commu-
nity Behavioral Health Clinic model) (such 
services referred to as crisis stabilization 
services) for individuals experiencing a se-
rious mental illness (as such term is de-
fined for purposes of title V of the Public 
Health Service Act), serious emotional dis-
turbance, or substance use disorder crisis; 
‘‘(iii) improved data sharing and co-
ordination between physical health, mental 
health, and addiction treatment providers 
(including hospitals and community-based 
behavioral health facilities) and first re-
sponders to improve health outcomes for 
individuals furnished services in an institu-
tion for mental diseases, who are experi-
encing a serious mental illness (as so de-
fined), serious emotional disturbance, or 
substance use disorder crisis; 
‘‘(E) provide for the demonstration of— 
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‘‘(i) State policies to ensure individ-
uals receiving medical assistance under the 
State plan who receive care in psychiatric 
hospitals and residential treatment settings 
are consistently screened for co-morbid 
physical health conditions and substance 
use disorders prior to or upon admission, 
and that participating facilities have the 
capacity to address co-morbid physical 
health conditions during stays in such psy-
chiatric hospitals and residential treatment 
settings either through on-site medical 
services or external referrals and care co-
ordination; 
‘‘(ii) established strategies of the 
State for identifying and engaging individ-
uals, particularly adolescents and young 
adults, experiencing a serious mental ill-
ness (as such term is defined for purposes 
of title V of the Public Health Service 
Act), serious emotional disturbance, or 
substance use disorder crisis; and 
‘‘(iii) established utilization review 
policies of the State Medicaid agency or 
Medicaid managed care organizations, as 
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applicable, to ensure individuals receiving 
medical assistance under the State plan re-
ceive treatment at clinically appropriate 
levels of care and services are generally de-
livered in the least restrictive environment; 
and 
‘‘(F) report to the Secretary (in a form 
and manner specified by the Secretary), with 
respect to each year beginning on or after the 
date of the enactment of this subparagraph— 
‘‘(i) in the aggregate and by facility 
type, costs and utilization for institutions 
for mental diseases and inpatient psy-
chiatric hospitals that are not such institu-
tions; 
‘‘(ii) the number of individuals experi-
encing a serious mental illness (as such 
term is defined for purposes of title V of 
the Public Health Service Act), serious 
emotional disturbance, or substance use 
disorder crisis who received medical assist-
ance under the State plan during the year; 
‘‘(iii) the length of the stay of each 
such individual in an institution for mental 
disease; and 
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‘‘(iv) the type of outpatient treatment, 
including medication assisted treatment, 
each such individual received after being 
discharged from such institution;’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall take ef-
fect on the date of the enactment of this Act and 
shall apply to State plans beginning on such date. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet this additional requirement before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
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legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
Æ 
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