II 117th CONGRESS 2d Session S. 4170 IN THE SENATE OF THE UNITED STATES May 10, 2022 Mr. Cassidy (for himself and Mr. Murphy ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To reauthorize programs related to mental health, and for other purposes.

1. Short title This Act may be cited as the Mental Health Reform Reauthorization Act of 2022 . 2. Substance abuse and mental health services administration Section 501(d) of the Public Health Service Act ( 42 U.S.C. 290aa(d) ) is amended— (1) in paragraph (5), by inserting coordination between programs and Centers of Excellence regarding promising and best practices and dissemination to the field and after , including ; (2) in paragraph (24)(E), by striking ; and and inserting a semicolon; (3) in paragraph (25), by striking the period and inserting ; and ; and (4) by adding at the end the following: (26) coordinate with the Centers for Medicare & Medicaid Services to promote coverage of evidence-based prevention and treatment services, improve quality of care, and identify opportunities for State Medicaid agencies and State mental health and substance use disorder agencies to collaborate, including through the braiding of funds, demonstration programs, waivers, amendments to State plans under section 1912, other State flexibilities, and agency guidance for all populations enrolled in Medicaid programs. . 3. Community mental health services block grant (a) Funding Section 1920 of the Public Health Service Act ( 42 U.S.C. 300x–9 ) is amended— (1) in subsection (a), by striking $532,571,000 for each of fiscal years 2018 through 2022 and inserting 1,000,000,000 for each of fiscal years 2023 through 2027 ; and (2) by adding at the end the following: (d) Crisis care (1) In general Except as provided in paragraph (3), a State shall expend not less than 5 percent of the amount the State receives pursuant to section 1911 for each fiscal year to support evidenced-based programs. (2) Core elements At the discretion of the single State agency responsible for the administration of the program of the State under a grant under section 1911, funds expended pursuant to paragraph (1) may be used to fund some or all of the core crisis care service components, delivered according to evidence-based principles, including the following: (A) Crisis call centers. (B) 24/7 mobile crisis services. (C) Crisis stabilization programs offering acute care or subacute care in a hospital or appropriately licensed facility, as determined by the Substance Abuse and Mental Health Services Administration, with referrals to inpatient or outpatient care. (3) State flexibility In lieu of expending 5 percent of the amount the State receives pursuant to section 1911 for a fiscal year to support evidence-based programs as required by paragraph (1), a State may elect to expend not less than 10 percent of such amount to support such programs by the end of 2 consecutive fiscal years. (e) Prevention (1) In general Except as provided in paragraph (3), a State shall expend not less than 5 percent of the amount the State receives pursuant to section 1911 for each fiscal year to support evidenced-based early identification and early intervention programs that prevent or mitigate the development of mental illness in individuals, including children and adolescents, who may be at risk of developing a serious mental illness or serious emotional disturbance, within the meaning of such term as defined by the Secretary pursuant to section 1912, or as determined through the use of evidence-based screening instruments or clinical assessment. (2) Core elements At the discretion of the single State agency responsible for the administration of the program of the State under a grant under section 1911, funds expended pursuant to paragraph (1) shall be used for evidence-based practices that follow or exceed the quality of generally accepted standards of care. (3) State flexibility In lieu of expending 5 percent of the amount the State receives pursuant to section 1911 for a fiscal year to support evidence-based early identification and early intervention programs as required by paragraph (1), a State may elect to expend not less than 10 percent of such amount to support such programs by the end of 2 consecutive fiscal years. (f) Reports by the Secretary (1) In general The Secretary shall— (A) commission longitudinal follow-up studies of the population of individuals served by funds expended pursuant to subsection (e)(1) to determine clinical outcomes that may be associated with such funds, including crisis services utilization and emergency department visits and hospitalizations related to mental illness, prevalence of suicidal behavior, mortality, disability income, high school graduation rates, employment status and successful timely reunification, placement stability, and permanency for children in foster care, disaggregated by mental illness diagnosis; and (B) submit a biennial report summarizing incremental findings of the studies conducted under paragraph (1) to Congress. (2) Requirements In carrying out paragraph (1)(A), the Secretary shall— (A) solicit feedback from stakeholders, including pediatric experts, on outcomes to use for different age groups and populations; and (B) consider how States who have received funding are partnering with providers to increase access to mental health services specific to adults and to children. (g) Special rule The requirements described in subsection (b)(1)(A)(vi) for a State plan required under such section shall not apply with respect to funds allocated for the purposes described in subsections (d) and (e). . (b) Restrictions on use of payments Section 1916(a) of the Public Health Service Act ( 42 U.S.C. 300x–5(a) ) is amended— (1) in paragraph (3), by adding or after the semicolon; (2) in paragraph (4), by striking ; or and inserting a period; and (3) by striking paragraph (5). 4. Grants for jail diversion programs Section 520G of the Public Health Service Act ( 42 U.S.C. 290bb–38 ) is amended— (1) in subsection (c)(2)(A)(i)— (A) by inserting support continuity of care (including in consultation with the individual's mental health clinician when feasible and with continuation of previously prescribed psychotropic medication and medication for the treatment of substance use disorder, as appropriate), after evidence-based practices, ; (B) by inserting to relevant medications approved by the Food and Drug Administration after management and access ; and (C) by inserting peer recovery support services, after co-occurring substance use disorder treatment, ; (2) in subsection (e)(4) by inserting and response (including suicide prevention) after crisis intervention ; and (3) in subsection (j), by striking $4,269,000 for each of fiscal years 2018 through 2022 and inserting $6,269,000 for each of fiscal years 2023 through 2027 . 5. Assisted outpatient treatment Section 224 of the Protecting Access to Medicare Act of 2014 ( Public Law 113–93 ; 42 U.S.C. 290aa note) is amended— (1) in subsection (e)— (A) in the matter preceding paragraph (1), by striking each of fiscal years 2016, 2017, 2018, 2019, 2020, 2021, and 2022 and inserting fiscal year 2027 ; (B) by striking paragraphs (2) and (3) and inserting the following: (2) Impact of assisted outpatient treatment on rates of psychiatric hospitalization, homelessness, arrest, and incarceration of patients. (3) Significant variations in program design among grantees, including variations in the role of courts in monitoring and motivating patient progress, and the comparative impacts of such variations upon program outcomes. ; and (C) by adding at the end the following: (5) Use of psychiatric advance directives or other methods for patient input in care. ; (2) in subsection (f)(1), by striking local court and inserting local civil court ; and (3) in subsection (g)— (A) in paragraph (1), by striking 2015 through 2022 and inserting 2023 through 2027 ; and (B) in paragraph (2), by striking $15,000,000 for each of and all that follows through 2022 and inserting $21,000,000 for each of fiscal years 2023 through 2027 . 6. Projects for assistance in transition from homelessness Part C of title V of the Public Health Service Act ( 42 U.S.C. 290cc–21 et seq. ) is amended— (1) in section 522(g)(1) ( 42 U.S.C. 290cc–22(g)(1) ) by striking 20 percent and inserting 25 percent ; and (2) in section 535(a) ( 42 U.S.C. 290cc–35(a) ), by striking $64,635,000 for each of fiscal years 2018 through 2022 and inserting $64,635,000 for each of fiscal years 2023 through 2027 . 7. Grants to support mental health and substance use disorder parity implementation (a) In general Section 2794(c) of the Public Health Service Act ( 42 U.S.C. 300gg–94(c) ) (as added by section 1003 of the Patient Protection and Affordable Care Act ( Public Law 111–148 ) is amended by adding at the end the following: (3) Parity implementation (A) In general Beginning 60 days after the date of enactment of the Parity Implementation Assistance Act , the Secretary shall award grants to States to implement the mental health and substance use disorder parity provisions of section 2726, provided that in order to receive such a grant, a State is required to request and review from health insurance issuers offering group or individual health insurance coverage the comparative analyses and other information required of such health insurance issuers under subsection (a)(8)(A) of such section 2726 regarding the design and application of nonquantitative treatment limitations imposed on mental health or substance use disorder benefits. (B) Authorization of appropriations For purposes of awarding grants under subparagraph (A), there are authorized to be appropriated $25,000,000 for each of the first five fiscal years beginning after the date of the enactment of this paragraph. . (b) Technical amendment Section 2794 of the Public Health Service Act ( 42 U.S.C. 300gg–95 ), as added by section 6603 of the Patient Protection and Affordable Care Act ( Public Law 111–148 ) is redesignated as section 2795. 8. Eliminating the opt-out for non-Federal governmental health plans Section 2722(a)(2) of the Public Health Service Act ( 42 U.S.C. 300gg–21(a)(2) ) is amended by adding at the end the following new subparagraph: (F) Sunset of election option (i) In general Notwithstanding the preceding provisions of this paragraph— (I) no election described in subparagraph (A) with respect to the provisions of section 2726 may be made on or after the date of enactment of this subparagraph; and (II) except as provided in clause (ii), no such election with respect to the provisions of section 2726 expiring on or after the date that is 180 days after the date of such enactment may be renewed. (ii) Exception for certain collectively bargained plans Notwithstanding clause (i)(II), a plan described in subparagraph (B)(ii) that is subject to multiple agreements described in such subparagraph of varying lengths and that has an election in effect under subparagraph (A) as of the date of enactment of this subparagraph that expires on or after the date that is 180 days after the date of such enactment may extend such election until the date on which the term of the last such agreement expires. (iii) Guidance The Secretary shall issue guidance to plans to support carrying out activities under this section with regard to section 2726, including the requirements under subsection (a)(8) of such section. Such guidance shall include an explanation of documents that are required to be disclosed and analyses that are required to be conducted pursuant to such subsection (a)(8), including how nonquantitative treatment limitations are applied to mental health or substance use disorder benefits and medical or surgical benefits covered under the plan, in order for such plan to demonstrate compliance with this section and section 2726. . 9. Minority fellowship program Section 597 of the Public Health Service Act ( 42 U.S.C. 290ll ) is amended— (1) in subsection (b), by inserting addiction medicine, after mental health counseling, ; and (2) in subsection (c), by striking $12,669,000 for each of fiscal years 2018 through 2022 and inserting $25,000,000 for each of fiscal years 2023 through 2027 . 10. Priority mental health needs of regional and national significance Section 520A of the Public Health Service Act ( 42 U.S.C. 290bb–32 ) is amended by striking 2018 through 2022 and inserting 2023 through 2027 . 11. Encouraging innovation and evidence-based programs within the national mental health and substance use policy laboratory (a) Reauthorization Section 501A(e)(3) of the Public Health Service Act ( 42 U.S.C. 290aa–0(e)(3) ) is amended by striking 2018 through 2020 each place it appears and inserting 2023 through 2027 . (b) GAO study Not later than 18 months after the date of enactment of this Act, the Comptroller General of the United States shall perform a report on the work of the National Mental Health and Substance Use Policy Laboratory established under section 501A of the Public Health Service Act ( 42 U.S.C. 290aa–0 ), including— (1) the extent to which such Laboratory is meeting its responsibilities as set forth in such section 501A; and (2) any recommendations for improvement, including methods to expand the use of evidence-based practices across programs, recommendations to improve program evaluations for effectiveness, and dissemination of resources to stakeholders and the public. 12. Programs for children with a serious emotional disturbance Section 565(f) of the Public Health Service Act ( 42 U.S.C. 290ff–4(f) ) is amended— (1) in paragraph (1), by striking $119,026,000 for each of fiscal years 2018 through 2022 and inserting $125,000,000 for each of fiscal years 2023 through 2027 ; and (2) by moving the margin of paragraph (2) 2 ems to the right. 13. Mental and behavioral health education and training grants Section 756(f) of the Public Health Service Act ( 42 U.S.C. 294e–1(f) ) is amended— (1) in the matter preceding paragraph (1)— (A) by striking 2019 through 2023 and inserting 2023 through 2027 ; and (B) by striking $50,000,000 and inserting $102,000,000 ; (2) in paragraph (1), by striking $15,000,000 and inserting $30,500,000 ; (3) in paragraph (2), by striking $15,000,000 and inserting $30,500,000 ; (4) in paragraph (3), by striking $10,000,000 and inserting $20,500,000 ; and (5) in paragraph (4), by striking $10,000,000 and inserting $20,500,000 . 14. Development and dissemination of model training programs under HIPAA Section 11004 of the 21st Century Cures Act ( Public Law 114–255 ; 42 U.S.C. 1320d–2 note) is amended— (1) by redesignating subsections (c) through (e) as subsections (d) through (f), respectively; (2) by inserting after subsection (b) the following: (b) Reports to Congress The Secretary shall submit a report to Congress— (1) not later than 1 year after the date of enactment of the Mental Health Reform Reauthorization Act of 2022 , on actions taken pursuant to subsection (b); and (2) not later than 2 years after the date of submission of the report under paragraph (1), on updates made to the model programs and materials described in subsection (a) after the release of the final regulations required under section 3221(i) of the Coronavirus Aid, Relief, and Economic Security Act ( Public Law 116–136 ). ; and (3) in subsection (f), as so redesignated, by striking this section— and all that follows through the end of paragraph (3) and inserting the following: this section $1,000,000 for each of fiscal years 2023 through 2027 . 15. Promoting integration of primary care and behavioral health Section 520K of the Public Health Service Act ( 42 U.S.C. 290bb–42 ) is amended— (1) in subsection (c)(2)— (A) in subparagraph (D), by striking ; and and inserting a semicolon; (B) by redesignating subparagraph (E) as subparagraph (F); and (C) by inserting after subparagraph (D) the following: (E) a description of how validated rating scales will be implemented to support the improvement of patient outcomes using measurement-based care, including related to depression screening, patient follow up, and symptom improvement; and ; and (2) in subsection (h), by striking $51,878,000 for each of fiscal years 2018 through 2022 and inserting $52,877,000 for each of fiscal years 2023 through 2027 . 16. Pediatric mental health care access grant program Section 330M of the Public Health Service Act ( 42 U.S.C. 254c–19 ) is amended— (1) in subsection (b)— (A) in paragraph (1)— (i) in subparagraph (G)— (I) by inserting developmental-behavioral pediatricians, after adolescent psychiatrists, ; and (II) by inserting , and which may include addiction specialists, after mental health counselors ; (ii) in subparagraph (H), by striking ; and and inserting a semicolon; (iii) in subparagraph (I), by striking the period and inserting ; and ; and (iv) by adding at the end the following: (J) maintain an up-to-date list of community-based supports for children with mental health conditions. ; (B) in paragraph (2), by inserting , and which may include a developmental-behavioral pediatrician and an addiction specialist before the period at the end of the first sentence; and (C) by adding at the end the following: (3) Support to schools and emergency departments In addition to the required activities specified in paragraph (1), a statewide or regional network of pediatric mental health teams referred to in subsection (a), with respect to which a grant under such subsection may be used, may provide support to schools and emergency departments. ; (2) by redesignating subsection (g) as subsection (h); (3) by inserting after subsection (f) the following: (g) Technical assistance The Secretary may award a grant to an eligible entity for purposes of providing technical assistance to recipients of grants under subsection (a). ; and (4) in subsection (h), as so redesignated, by striking $9,000,000 for the period of fiscal years 2018 through 2022 and inserting $14,000,000 for each of fiscal years 2023 through 2025 and $30,000,000 for each of fiscal years 2026 and 2027 . 17. Training in behavioral health for primary care providers caring for pediatric populations The Advisory Committee on Training in Primary Care Medicine and Dentistry of the Health Resources and Services Administration shall convene and issue a report that includes— (1) recommendations to optimize the content and competencies of trainees and primary care providers treating pediatric populations to address behavioral health conditions; and (2) best practices for training pediatric providers in behavioral health conditions, utilization of evidence-based screening tools, and follow up care to higher levels of care, when appropriate. 18. First episode psychosis (a) Review of use of certain funding Not later than 180 days after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Assistant Secretary for Mental Health and Substance Use, shall conduct a review of the use by States of funds made available under the Community Mental Health Services Block Grant subpart I of part B of title XIX of the Public Health Service Act ( 42 U.S.C. 300x et seq. ) for First Episode Psychosis activities. Such review shall consider the following: (1) How the States use funds for evidence-based treatments and services according to the standard of care for those with serious mental illness, including the comprehensiveness of such treatments to include all aspects of the recommended intervention. (2) How State mental health departments are coordinating with State Medicaid departments in the delivery of the treatments and services described in paragraph (1). (3) What percentage of the State funding under the block grant is being applied toward First Episode Psychosis in excess of 10 percent of the amount of the grant, as broken down on a State-by-State basis. The review shall also identify any States that fail to expend the required 10 percent of block grant funds on First Episode Psychosis activities. (4) How many individuals are served by the expenditures described in paragraph (3), broken down on a per-capita basis. (5) How the funds are used to reach individuals in underserved populations, including individuals in rural areas and individuals from minority groups. (b) Report and guidance (1) Report Not later than 6 months after the completion of the review under subsection (a), the Secretary of Health and Human Services, acting through the Assistant Secretary for Mental Health and Substance Use, shall submit to the appropriate authorization and appropriations committees of Congress, a report on the finding made as a result of the review conducted under subsection (a). Such report shall include any recommendations with respect to any changes to the Community Mental Health Services Block Grant program, including the set aside required for First Episode Psychosis, that would facilitate improved outcomes for the targeted population involved. (2) Guidance Not later than 1 year after the date on which the report is submitted under paragraph (1), the Secretary of Health and Human Services, acting through the Assistant Secretary for Mental Health and Substance Use, shall update the guidance provided to States under the Community Mental Health Services Block Grant based on the findings and recommendations of the report. (c) Technical assistance The Director of the National Institute of Mental Health shall coordinate with the Assistant Secretary for Mental Health and Substance Use in providing technical assistance to State grantees and provider subgrantees in the delivery of services for First Episode Psychosis under the Community Mental Health Services Block Grant. 19. CMS study and report regarding adherence to standard of care for treatment of individuals with serious mental illness and children with serious emotional disturbance under Medicare and Medicaid (a) Study The Administrator of the Centers for Medicare & Medicaid Services shall review claims relating to treatment of individuals with serious mental illness and children with serious emotional disturbance made under the Medicare program established under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) and the Medicaid program established under title XIX of such Act ( 42 U.S.C. 1396 et seq. ) and the State Children's Health Insurance Program under title XXI of the Social Security Act ( 42 U.S.C. 1397aa et seq. ) for purposes of assessing the extent to which such individuals receive evidence-based treatments according to the standard of care for those with serious mental illness and serious emotional disturbance and the extent to which the comprehensiveness of such treatments includes all aspects of a recommended intervention under the applicable standard of care. (b) Report Not later than 6 months after the date of enactment of this Act, the Administrator of the Centers for Medicare & Medicaid Services shall submit to Congress a report on the study required by subsection (a). 20. Guidance for States relating to coverage recommendations of health care services and interventions for individuals with serious mental illness and children with serious emotional disturbance Not later than 2 years after the date of enactment of this Act, the Administrator of the Centers for Medicare & Medicaid Services, jointly with the Assistant Secretary for Mental Health and Substance Use and the Director of the National Institute of Mental Health— (1) shall provide updated guidance to States concerning— (A) coverage recommendations relating to health care services and interventions for those with serious mental illness, specifically First Episode Psychosis; and (B) the manner in which Federal funding provided to States through programs administered by such agencies, including the Community Mental Health Services Block Grant program under subpart I of part B of title XIX of the Public Health Service Act ( 42 U.S.C. 300x et seq. ), may be coordinated to support individuals with serious mental illness and serious emotional disturbance; and (2) may streamline relevant State reporting requirements if such streamlining would result in making it easier for States to coordinate funding under the programs described in paragraph (1)(B) to improve treatments for individuals with serious mental illness and serious emotional disturbance. 21. GAO study on data collection and public reporting Not later than 18 months after the date of enactment of this Act, the Comptroller General of the United States, in consultation with the Assistant Secretary for Mental Health and Substance Use and the Secretary of Health and Human Services, shall perform a study on areas to improve data reporting across programs of the Substance Abuse and Mental Health Services Administration. Such report and evaluation shall include— (1) recommendations for improvements to— (A) data collected from recipients of grants, contract, and cooperative agreements from the Substance Abuse and Mental Health Services Administration; (B) utilization of outcome measures and evidence-based practices; (C) program performance evaluations; and (D) the impact of grant funding on different age groups and populations, including children and adolescents; (2) a review of how the State plans required under section 1912 of the Public Health Service Act ( 42 U.S.C. 300x–1 ) and section 1932 of such Act ( 42 U.S.C. 300x–32 ) and reports required under section 1942 of such Act ( 42 U.S.C. 300x–52 ) could be updated and simplified; and (3) areas to improve dissemination and how data should be reported to the public. 22. Primary care training and enhancement for mental health Section 747(c)(2) of the Public Health Service Act ( 42 U.S.C. 293k(c)(2) ) is amended— (1) by striking Fifteen percent and inserting the following: (A) Physician assistant training programs Fifteen percent ; and (2) by adding at the end the following: (B) Mental health programs Ten percent of the amount appropriated pursuant to paragraph (1) in each such fiscal year shall be allocated to training programs focused on mental health, with an emphasis on primary care for pediatric populations. .