CAHOOTS Act
Bill: S.764 | Sponsor: Sen. Wyden, Ron (D-OR)
Policy area: Health

Summary:
Crisis Assistance Helping Out On The Streets Act or the CAHOOTS Act
This bill allows state Medicaid programs to cover certain community-based mobile crisis intervention services for individuals experiencing a mental health or substance-use disorder crisis outside of a facility setting.
Among other requirements, such services must be (1) provided by multidisciplinary teams composed of behavioral health professionals who are trained in trauma care and de-escalation techniques, (2) available 24-7, and (3) voluntary for the individual experiencing the mental health or substance-use disorder crisis.
The bill provides an enhanced Federal Medical Assistance Percentage (i.e., federal matching rate) for such services, as well as specified funds for state planning and evaluation grants.

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.

    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 ``Crisis Assistance Helping Out On The 
Streets Act'' or the ``CAHOOTS Act''.

SEC. 2. ENHANCED FEDERAL MEDICAID SUPPORT FOR COMMUNITY-BASED MOBILE 
              CRISIS INTERVENTION 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 Intervention 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 
        provider agreements), a State may provide medical assistance 
        for qualifying community-based mobile crisis intervention 
        services under a State plan amendment 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--
                    ``(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 mobile 
                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 permitted 
                        scope of practice under State law, and other 
                        professionals or paraprofessionals with 
                        appropriate expertise in behavioral health or 
                        mental health crisis response, 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 strategies, and 
                        harm reduction;
                            ``(iii) that is able to respond in a timely 
                        manner and, where appropriate, provide the 
                        following--
                                    ``(I) screening and assessment;
                                    ``(II) stabilization and de-
                                escalation;
                                    ``(III) coordination with, and 
                                referrals 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 centers, 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, 
                        entities 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 entities 
                        that provide assistance with other social 
                        services;
                            ``(v) that coordinates with crisis 
                        intervention hotlines and emergency response 
                        systems;
                            ``(vi) that maintains the privacy and 
                        confidentiality of patient information 
                        consistent with Federal and State requirements; 
                        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 section 1905(b), 
                beginning October 1, 2020, during each of the first 12 
                fiscal quarters that a State meets the requirements 
                described in paragraph (4), the Federal medical 
                assistance percentage applicable to amounts expended by 
                the State for medical assistance for qualifying 
                community-based mobile crisis intervention services 
                furnished during such quarter shall be equal to 95 
                percent.
                    ``(B) Exclusion of enhanced payments from 
                territorial caps.--To the extent that the amount of a 
                payment to Puerto Rico, the Virgin Islands, Guam, the 
                Northern Mariana Islands, or American Samoa for medical 
                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 territory for such services if the Federal medical 
                assistance percentage for the territory had been 
                determined without regard to such subparagraph--
                            ``(i) the limitation on payments to 
                        territories 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 subsections.
            ``(4) Requirements.--The requirements described in this 
        paragraph are the following:
                    ``(A) The State demonstrates, to the satisfaction 
                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 community 
                        partners, including health care providers, to 
                        enable the provision of services, needed 
                        referrals, and other activities identified by 
                        the Secretary.
                    ``(B) The State provides assurances satisfactory to 
                the Secretary that--
                            ``(i) any additional Federal funds received 
                        by the State for qualifying community-based 
                        mobile crisis intervention services provided 
                        under this subsection that are attributable to 
                        the increased Federal medical assistance 
                        percentage under paragraph (3)(A) will be used 
                        to supplement, and not supplant, the level of 
                        State funds expended for such services in the 
                        fiscal year preceding the first fiscal year in 
                        which the State elected to provide medical 
                        assistance under this subsection;
                            ``(ii) if the State made qualifying 
                        community-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 
                        evaluation and assessment, and submit the 
                        report, 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 intervention services in 
                accordance with this subsection, 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 
                        provision of such services on--
                                    ``(I) emergency room visits;
                                    ``(II) use of ambulatory services;
                                    ``(III) hospitalizations;
                                    ``(IV) the involvement of law 
                                enforcement in mental health or 
                                substance use disorder crisis events; 
                                and
                                    ``(V) the diversion of individuals 
                                from jails or similar settings; and
                            ``(ii) assessing--
                                    ``(I) the types of services 
                                provided to individuals;
                                    ``(II) the types of events 
                                responded to;
                                    ``(III) cost savings or cost-
                                effectiveness attributable to such 
                                services;
                                    ``(IV) the experiences of 
                                individuals who receive qualifying 
                                community-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 measures.--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 outcomes 
                during the period beginning with the first quarter in 
                which the State begins providing 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 community-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 carried 
                        out under subparagraph (A).
                            ``(ii) The number of individuals who 
                        received qualifying community-based mobile 
                        crisis intervention services.
                            ``(iii) Demographic information regarding 
                        such individuals when available, including the 
                        race or ethnicity, age, sex, sexual 
                        orientation, gender identity, and geographic 
                        location of such individuals.
                            ``(iv) The processes and models developed 
                        by the State to provide qualifying community-
                        based mobile crisis intervention services under 
                        the State plan or waiver, 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 subparagraph (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 reported 
                        by such States under paragraph (5)(C); and
                            ``(iii) identifies best practices for the 
                        effective delivery of community-based mobile 
                        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 evaluation 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 paragraph (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 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 administration.--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 appropriated, $25,000,000 to the Secretary 
                for fiscal year 2021 for purposes of making grants 
                under paragraph (7), to remain available until 
                expended.''.
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