I 
118TH CONGRESS 
1ST SESSION H. R. 4331 
To amend title XIX of the Social Security Act to increase Federal Medicaid 
funding for States that provide intensive community-based services for 
adults with serious mental illness, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 23, 2023 
Mr. GOLDMAN of New York 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 increase 
Federal Medicaid funding for States that provide inten-
sive community-based services for adults with serious 
mental illness, 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 ‘‘Strengthening Med-
icaid for Serious Mental Illness Act’’. 
SEC. 2. PURPOSES. 
The purposes of this Act are the following: 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
(1) To amend title XIX of the Social Security 
Act to increase Federal Medicaid funding for States 
that provide intensive community-based services for 
adults with serious mental illness. 
(2) To increase access to intensive community- 
based services in the most integrated setting appro-
priate. 
(3) To prevent unnecessary hospitalization or 
other institutionalization. 
(4) To promote continuity of care and coverage 
for young adults after they turn 21 and age out of 
the early and periodic screening, diagnostic, and 
treatment services benefit. 
SEC. 3. INCREASED FMAP FOR PROVIDING INTENSIVE COM-
MUNITY-BASED SERVICES UNDER MEDICAID. 
(a) IN GENERAL.—Section 1915 of the Social Secu-
rity Act (42 U.S.C. 1396n) is amended by adding at the 
end the following new subsection: 
‘‘(m) STATE PLAN AMENDMENT OPTION TO PRO-
VIDE INTENSIVE COMMUNITY-BASED SERVICES FOR EL-
DERLY AND DISABLED INDIVIDUALS.— 
‘‘(1) IN GENERAL.—Subject to the succeeding 
provisions of this subsection, beginning January 1, 
2025, a State may provide through a State plan 
amendment for the provision of medical assistance 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
for intensive community-based services (not includ-
ing room and board) for eligible individuals (as de-
fined in paragraph (2)), without determining that 
but for the provision of such services the individuals 
would require the level of care provided in a hos-
pital, nursing facility, or intermediate care facility 
described in section 1905(d), but only if the State 
meets the following requirements: 
‘‘(A) APPLICATION OF HCBS STATE PLAN 
AMENDMENT REQUIREMENTS.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), the State satisfies the 
requirements described in subparagraphs 
(A) through (J) of subsection (i)(1) (ex-
cept that, in applying such subparagraphs 
for purposes of this subsection, each ref-
erence to ‘home and community-based 
services’ shall be deemed to be a reference 
to ‘intensive community-based services’). 
‘‘(ii) MODIFICATION OF ASSESSMENT 
REQUIREMENT.—In applying subparagraph 
(F)(i) of subsection (i)(1) for purposes of 
this subsection, ‘or 1 or more activity of 
daily living and 1 or more instrumental ac-
tivity of daily living (as defined in sub-
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
section (k)(6)(F))’ shall be inserted after 
‘2 or more activities of daily living (as de-
fined in section 7702B(c)(2)(B) of the In-
ternal Revenue Code of 1986)’. 
‘‘(B) APPLICATION OF REGULATIONS.—In 
providing intensive community-based services 
under this subsection, the State complies with 
the regulations applicable to home and commu-
nity-based services provided under subsection 
(i) under subpart M of part 441 of title 42, 
Code of Federal Regulations, including sections 
441.710 (commonly known as the ‘HCBS set-
tings rule’) and 441.725 of such title, except to 
the extent that such regulations are incon-
sistent with this subsection. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) ADULT
WITH
A
SERIOUS
MENTAL 
ILLNESS; SERIOUS MENTAL ILLNESS.— 
‘‘(i) ADULT WITH A SERIOUS MENTAL 
ILLNESS.—The term ‘adult with a serious 
mental illness’ has the meaning given that 
term by the Secretary pursuant to section 
1912(c) of the Public Health Service Act. 
‘‘(ii) SERIOUS
MENTAL
ILLNESS.— 
The term ‘serious mental illness’ means a 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
diagnosable mental, behavioral or emo-
tional disorder that meets the criteria for 
qualifying an individual as an adult with a 
serious mental illness. 
‘‘(B) 
ASSERTIVE
COMMUNITY
TREAT-
MENT.—The term ‘assertive community treat-
ment’ means services for the treatment of men-
tal illness that are provided through an evi-
dence-based practice that— 
‘‘(i) improves outcomes for individuals 
with severe mental illness who are at high 
risk of homelessness, psychiatric crisis, or 
hospitalization, or are involved in the 
criminal justice system; 
‘‘(ii) is comprised of a multidisci-
plinary staff, including peer specialists, 
who work as a team to provide the individ-
ualized psychiatric treatment, rehabilita-
tion, and support services clients need for 
the maximum reduction of physical or 
mental disability and restoration to their 
best possible functional level; 
‘‘(iii) ensures that there is 1 direct 
care staff person for every 10 clients; and 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(iv) provides services 24 hours a day, 
7 days a week, for as long as needed and 
wherever they are needed. 
‘‘(C) ELIGIBLE
INDIVIDUAL.—The term 
‘eligible individual’ means an individual— 
‘‘(i) who is eligible for medical assist-
ance under the State plan or under a waiv-
er of such plan; 
‘‘(ii) who is age 21 or older; 
‘‘(iii) whose income does not exceed 
150 percent of the poverty line (as defined 
in section 2110(c)(5)); and 
‘‘(iv) who is an adult with a serious 
mental illness. 
‘‘(D) INTENSIVE
CASE
MANAGEMENT.— 
The term ‘intensive case management’ means a 
type of case management service (as defined in 
section 440.169 of title 42, Code of Federal 
Regulations)— 
‘‘(i) that is reliable, systematic, flexi-
ble, and coordinated, designed to answer 
the unique combination of health and so-
cial care needs of individuals with serious 
mental illness; 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(ii) that is a long-term, intensive ap-
proach to supporting an individual in the 
community by providing a comprehensive 
range of treatment, rehabilitation, and 
support services; 
‘‘(iii) that helps individuals with seri-
ous mental illness acquire material re-
sources (such as food, shelter, clothing, 
and medical care) and improve their psy-
chosocial functioning; 
‘‘(iv) that provides sufficient support 
to individuals with serious mental illness to 
keep them involved in community life and 
encourage growth towards greater auton-
omy and develop coping skills to meet the 
demands of community life; 
‘‘(v) that ensures continuity of care 
among treatment agencies; 
‘‘(vi) in which a case manager, work-
ing alone or as part of a team, makes 4 or 
more face-to-face contact with a client each 
month; and 
‘‘(vii) in which the case manager-to- 
client ratio does not exceed 1:12. 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(E) INTENSIVE COMMUNITY-BASED SERV-
ICES.—The term ‘intensive community-based 
services’ means a set of psychosocial rehabilita-
tion services that includes all of the following: 
‘‘(i) Assertive community treatment. 
‘‘(ii) Supported employment. 
‘‘(iii) Peer support services. 
‘‘(iv) Qualifying community-based mo-
bile crisis intervention services. 
‘‘(v) Intensive case management. 
‘‘(vi) Housing-related activities and 
services, including individual housing tran-
sition services, individual housing and ten-
ancy sustaining services, and State-level 
housing-related collaborative activities, as 
those services are described in the informa-
tional bulletin published by the Center for 
Medicaid and CHIP Services on June 26, 
2015, with the subject ‘Coverage of Hous-
ing-Related Activities and Services for In-
dividuals with Disabilities’. 
‘‘(vii) Such other psychosocial reha-
bilitation services as a State may request 
and the Secretary may approve. 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(F) PEER SUPPORT SERVICES.—The term 
‘peer support services’ means culturally com-
petent individual and group services for individ-
uals with serious mental illness that promote 
recovery, resiliency, engagement, socialization, 
self-sufficiency, self-advocacy, development of 
natural supports, and identification of strengths 
through structured activities such as group and 
individual coaching to set recovery goals and 
identify steps to reach the goals. Such services 
aim to prevent relapse, empower beneficiaries 
through strength-based coaching, support link-
ages to community resources, and to educate 
beneficiaries and their families about their con-
ditions and the process of recovery. Such serv-
ices include the following: 
‘‘(i) Participating in the treatment 
planning process. 
‘‘(ii) Mentoring and assisting the ben-
eficiary with problem solving, goal setting, 
and skill building. 
‘‘(iii) Encouraging a beneficiary’s in-
terest in pursuing and maintaining treat-
ment services. 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(iv) Providing support and linkages 
to facilitate participation in recovery-based 
activities. 
‘‘(v) Sharing experiential knowledge, 
hope, and skills. 
‘‘(vi) Advocating for the beneficiary. 
‘‘(G) QUALIFYING COMMUNITY-BASED MO-
BILE
CRISIS
INTERVENTION
SERVICES.—The 
term ‘qualifying community-based mobile crisis 
intervention services’ means, with respect to a 
State, items and services for which medical as-
sistance is available under the State plan under 
this title or a waiver of such plan, that are— 
‘‘(i) furnished to an individual other-
wise eligible for medical assistance under 
the State plan (or waiver of such plan) 
who is— 
‘‘(I) outside of a hospital or other 
facility setting; and 
‘‘(II) 
experiencing 
a 
mental 
health or substance use disorder cri-
sis; 
‘‘(ii) furnished by a multidisciplinary 
mobile crisis team— 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(I) that includes at least 1 be-
havioral health care professional who 
is capable of conducting an assess-
ment of the individual, in accordance 
with 
the 
professional’s 
permitted 
scope of practice under State law, and 
other professionals or paraprofes-
sionals with appropriate expertise in 
behavioral health or mental health cri-
sis response, including nurses, social 
workers, peer support specialists, and 
others, as designated by the State in 
the State plan amendment under this 
subsection; 
‘‘(II) whose members are trained 
in trauma-informed care, de-escalation 
strategies, and harm reduction; 
‘‘(III) that is able to respond in 
a timely manner and, where appro-
priate, provide— 
‘‘(aa) screening and assess-
ment; 
‘‘(bb) stabilization and de- 
escalation; and 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(cc) coordination with, and 
referrals to, health, social, and 
other services and supports as 
needed, and health services as 
needed; 
‘‘(IV) that maintains relation-
ships with relevant community part-
ners, including medical and behavioral 
health providers, primary care pro-
viders, community health centers, cri-
sis respite centers, and managed care 
organizations (if applicable); and 
‘‘(V) that maintains the privacy 
and confidentiality of patient informa-
tion consistent with Federal and State 
requirements; and 
‘‘(iii) available 24 hours per day, 
every day of the year. 
‘‘(H) 
SUPPORTED
EMPLOYMENT.—The 
term ‘supported employment’ means ongoing 
supports that are furnished to individuals who, 
because of their serious mental illness, need in-
tensive support to obtain and maintain an indi-
vidual job in competitive or customized employ-
ment, or self-employment, in an integrated work 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
setting in the general workforce at or above 
their State’s minimum wage, but not less than 
the customary wage and level of benefits paid 
by the employer for the same or similar work 
performed by individuals without disabilities. 
The desired outcome of all supported employ-
ment services is sustained paid employment at 
or above the minimum wage in an integrated 
setting in the general workforce, in a job that 
meets personal and career goals. 
‘‘(3) INCREASE
FMAP
FOR
MEDICAL
ASSIST-
ANCE
FOR
INTENSIVE
COMMUNITY-BASED
SERV-
ICES.— 
‘‘(A) IN
GENERAL.—During each fiscal 
quarter that a State meets the requirements de-
scribed in subparagraphs (B) through (D), the 
Federal medical assistance percentage applica-
ble to the State for the quarter (as determined 
under section 1905(b) without regard to any 
adjustments applicable under such section or 
any other provision of law) shall be increased by 
the applicable number of percentage points (as 
determined under subparagraph (E) but not to 
exceed 100 percent) with respect to amounts 
expended by the State for medical assistance 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
for intensive community-based services fur-
nished to eligible individuals during such quar-
ter under a State plan amendment under this 
subsection. 
‘‘(B) SERVICE QUALITY CRITERIA.— 
‘‘(i) IN
GENERAL.—The State shall 
provide eligible individuals with intensive 
community-based services in accordance 
with such quality criteria as the Secretary 
shall by regulation establish. 
‘‘(ii) CRITERIA REQUIREMENTS.—The 
criteria established by the Secretary under 
clause (i) shall be designed to ensure that 
eligible individuals receive the intended 
benefits of receipt of the services, including 
avoiding preventable hospitalization or 
other institutionalization. The criteria will 
be adjusted as needed to account for fu-
ture developments and best practice. The 
criteria shall include the following: 
‘‘(I) The standards for assertive 
community treatment in the Tool for 
Measurement of Assertive Community 
Treatment (TMACT), Dartmouth As-
sertive Community Treatment Scale 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
(DACTS), or other generally accepted 
tool for evaluating assertive commu-
nity treatment. 
‘‘(II) Individual Placement and 
Support (IPS) standards for sup-
ported employment services. 
‘‘(III) Securing and maintaining 
scattered-site housing with a Housing 
First approach as the goal for hous-
ing-related activities and services. 
‘‘(C) INTEGRATED SETTING.—Eligible in-
dividuals shall receive intensive community- 
based services— 
‘‘(i) in the most integrated setting ap-
propriate; and 
‘‘(ii) without limiting access to any 
such service on the basis of— 
‘‘(I) the individual’s need for as-
sistance with activities of daily living 
or instrumental activities of daily liv-
ing; 
‘‘(II) receipt of other disability 
support services; 
‘‘(III) the presence of additional 
disabilities such as a physical, commu-
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
nication, intellectual, developmental, 
or other disability or a record or his-
tory of having such a disability; or 
‘‘(IV) the existence of co-occur-
ring substance use disorders or a 
record or history of having such sub-
stance use disorders. 
‘‘(D) DATA
COLLECTION
AND
REPORT-
ING.—Not less frequently than once every 2 
years, the State shall collect and report data to 
the Secretary, including with respect to dispari-
ties in access to, or receipt of, intensive commu-
nity-based services, according to criteria estab-
lished by the Secretary and the Secretary shall 
analyze and report such findings to Congress. 
The criteria shall include the collection and re-
porting of data with respect to the following: 
‘‘(i) Demographic characteristics of el-
igible individuals who receive intensive 
community-based services, including but 
not limited to, race, ethnicity, disability 
status, disability category, age, sex, sex 
characteristics, sexual orientation, gender 
identity, primary language, rural or urban 
environment, and service setting. 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(ii) The utilization of intensive com-
munity-based services, including units of 
service and duration of receipt of service, 
per eligible individual receiving services. 
‘‘(iii) Consumer outcomes, as meas-
ured via a quality service review tool and 
methodology approved by the Secretary. 
‘‘(E) APPLICABLE NUMBER OF PERCENT-
AGE
POINTS.—For purposes of subparagraph 
(A)— 
‘‘(i) if a State offers at least 1 but 
under 2 of the categories of intensive com-
munity-based services described in clauses 
(i) through (vii) of paragraph (2)(E) in a 
quarter, the applicable number of percent-
age points for the State and quarter is 3 
percentage points; 
‘‘(ii) if a State offers at least 2 but 
under 3 of the categories of intensive com-
munity-based services described in clauses 
(i) through (vii) of paragraph (2)(E) in a 
quarter, the applicable number of percent-
age points for the State and quarter is 7 
percentage points; 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(iii) if a State offers at least 3 but 
under 4 of the categories of intensive com-
munity-based services described in clauses 
(i) through (vii) of paragraph (2)(E) in a 
quarter, the applicable number of percent-
age points for the State and quarter is 12 
percentage points; 
‘‘(iv) if a State offers at least 4 but 
under 5 of the categories of intensive com-
munity-based services described in clauses 
(i) through (vii) of paragraph (2)(E) in a 
quarter, the applicable number of percent-
age points for the State and quarter is 18 
percentage points; and 
‘‘(v) if a State offers at least 5 of the 
categories of intensive community-based 
services described in clauses (i) through 
(vii) of paragraph (2)(E) in a quarter, the 
applicable number of percentage points for 
the State and quarter is 25 percentage 
points. 
‘‘(4) APPLICATION
OF
HCBS
STATE
PLAN 
AMENDMENT PROVISIONS.—Paragraphs (3), (4), (5), 
(6), and (7) of subsection (i) shall apply to State 
plan amendments under this subsection and inten-
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB
sive community-based services in the same manner 
as such paragraphs apply to State plan amendments 
under such subsection (i) and home and community- 
based services. 
‘‘(5) 
FUNDING
FOR
STATE
PLANNING 
GRANTS.— 
‘‘(A) IN GENERAL.—There is appropriated, 
out of any funds in the Treasury not otherwise 
appropriated, $20,000,000 to the Secretary for 
purposes of implementing, administering, and 
making planning grants to States as soon as 
practicable for purposes of developing a State 
plan amendment request to provide intensive 
community-based services under this subsection, 
to remain available until expended. 
‘‘(B) USE OF FUNDS.—A State shall use 
funds received under a grant under this sub-
section to engage in planning activities for a 
State plan amendment under this subsection, 
including— 
‘‘(i) collaborative activities, at the 
State and Federal level, with providers of 
housing-related services; 
‘‘(ii) developing service quality cri-
teria; and 
VerDate Sep 11 2014 
23:21 Jul 23, 2023
Jkt 039200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H4331.IH
H4331
pbinns on DSKJLVW7X2PROD with $$_JOB