II 117th CONGRESS 2d Session S. 4747 IN THE SENATE OF THE UNITED STATES August 2, 2022 Mr. Portman (for himself and Mr. Casey ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XIX of the Social Security Act to expand the availability of mental, emotional, and behavioral health services under the Medicaid program, and for other purposes.

1. Short title This Act may be cited as the Investing in Kids’ Mental Health Now Act of 2022 . 2. Table of contents The table of contents for this Act is as follows: Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Payment rate increase for pediatric behavioral health services. Sec. 4. Guidance to States on supporting mental, emotional, and behavioral health services, and on the availability of telehealth under Medicaid. Sec. 5. Ensuring children receive timely access to care. 3. Payment rate increase for pediatric behavioral health services (a) Payment rate increase for pediatric behavioral health services Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— (1) in subsection (a)(13)— (A) in subparagraph (B), by striking and at the end; (B) in subparagraph (C), by adding and at the end; and (C) by adding at the end the following new subparagraph: (D) that, for a 1-year period that begins not later than 6 months after the date of enactment of this subparagraph, the State shall pay for pediatric mental, emotional, and behavioral health services (as defined in subsection (tt)) furnished during such period at a rate that is at least 1 percent, and not more than 9 percent, higher than the rate that was applicable to such services under the State plan as of the day before the date that is 6 months before the date of enactment of this subparagraph; ; and (2) by adding at the end the following new subsection: (tt) Pediatric mental, emotional, and behavioral health services defined For purposes of subsection (a)(13)(D), the term pediatric mental, emotional, and behavioral health services means at least 10 of the following services furnished by a health care provider, including hospitals, physicians, and other providers determined by the Secretary, for the purposes of screening for, identifying, diagnosing, or treating a mental, emotional, or behavioral health condition, whether furnished in-person or via telehealth: (1) Mental health and substance use disorder screenings. (2) Mental health development assessments. (3) Mental health behavior assessments and interventions. (4) Psychological and neuropsychological testing and assessment. (5) Mental health primary prevention services. (6) Mental health and substance use disorder case management services. (7) School-based mental health and substance use disorder prevention, identification, and treatment services. (8) Child and adolescent psychiatry and psychology services. (9) Partial hospitalization services. (10) Day program services. (11) Intensive outpatient services. (12) Eating disorder treatment services. (13) Outpatient services. (14) Crisis residential services. (15) Crisis intervention and stabilization. (16) Inpatient psychiatric and psychological services. (17) Individual therapy. (18) Family therapy. (19) Group therapy services. (20) Intensive in-home services. (21) Peer support services. (22) Provider-to-provider consultation services involving primary care practitioners and mental health care specialists, including child and adolescent specialists. (23) Substance use disorder screening, including SBIRT, and treatment. (24) Medication management. (25) Any other pediatric mental, emotional, or behavioral health service determined appropriate by the Secretary. . (b) Under medicaid managed care plans Section 1932(f) of such Act ( 42 U.S.C. 1396u–2(f) ) is amended— (1) in the header, by inserting and pediatric mental, emotional, and behavioral health before Services ; (2) by inserting and pediatric mental, emotional, and behavioral health services described in section 1902(a)(13)(D) after section 1902(a)(13)(C) ; and (3) by striking such section and inserting section 1902(a)(13) . (c) Increase in payment using increased FMAP Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended by adding at the end the following new subsection: (jj) Increased FMAP for additional expenditures for pediatric mental, emotional, and behavioral health services Notwithstanding subsection (b), with respect to the portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(D) that is furnished during the 1-year period described in such section and that is attributable to the increase to the payment rate applicable to such services required under such section (or, by application, section 1932(f)), the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia shall be equal to 100 percent. The preceding sentence does not prohibit the payment of Federal financial participation based on the Federal medical assistance percentage for amounts in excess of those specified in such sentence. . 4. Guidance to States on supporting mental, emotional, and behavioral health services, and on the availability of telehealth under Medicaid (a) Mental, emotional, and behavioral health services Not later than 180 days after date of enactment of this Act, the Secretary of Health and Human Services shall issue guidance to States on how to expand the provision of mental, emotional, and behavioral health services covered by State plans (or waivers of such plans) under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ), including a description of best practices for effective programs, service provision for underserved communities, meeting the needs of children with medical complexities, and recruitment and retention of providers. (b) Mental, emotional, and behavioral telehealth services Not later than 1 year after date of enactment of this Act, the Secretary of Health and Human Services shall issue guidance to States on best practices to sustain and enhance the availability of mental, emotional, and behavioral telehealth services covered by State plans (or waivers of such plans) under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ), including expanding the originating site requirement, delivering audio-only mental, emotional, and behavioral telehealth services, and streamlining provider licensing, credentialing, and enrollment protocols with respect to telehealth services furnished across State lines. 5. Ensuring children receive timely access to care (a) Guidance to States on flexibilities To ensure provider capacity To provide pediatric mental, emotional, and behavioral crisis care Not later than 60 days after the date of enactment of this Act, the Secretary of Health and Human Services shall provide guidance to States on best practices to support children in crisis or in need of intensive mental, emotional, or behavioral health services by using flexibilities for hospitals and other providers under applicable laws, regulations, and guidance, including a description of how States are leveraging existing flexibilities to deliver crisis care. (b) Mandated report to Congress regarding barriers to repurposing of beds, space, and staff To address pediatric behavioral health needs (1) In general Not later than 120 days after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to the Congress a report with respect to regulatory, legal, and other barriers to care across the crisis continuum, including intermediate level care, such as intensive outpatient care or partial hospitalization, that identifies solutions to facilitate flexibility for children's hospitals and other providers of mental, emotional, or behavioral health services. (2) Requirements In preparing a report under this subsection, the Secretary of Health and Human Services shall include in such report— (A) a comprehensive list of laws, regulations, and guidance impacting children’s hospitals’ and other providers' ability to repurpose immediately beds, space, and staff for children in need of mental, emotional, or behavioral health services, including a description of the rationale for each policy and corresponding actions required to repurpose such beds, space, and staff; and (B) recommendations on how children’s hospitals and other providers can immediately expand access to mental, emotional, and behavioral health services, such as intensive outpatient care, partial hospitalization, and residential care, while also ensuring high quality and safety.