I 117th CONGRESS 2d Session H. R. 7236 IN THE HOUSE OF REPRESENTATIVES March 28, 2022 Ms. Eshoo (for herself, Mr. Fitzpatrick , and Ms. Blunt Rochester ) 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 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 Strengthen 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 parity 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. Sec. 6. Programs to support pediatric behavioral health care. Sec. 7. Increasing Federal investment in pediatric behavioral health services. 3. Payment parity for pediatric behavioral health services (a) Payment parity 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) for payment for pediatric mental, emotional, and behavioral health services (as defined in subsection (tt)) furnished on or after the date that is 180 days after the date of enactment of this subparagraph and before October 1, 2027, at a rate not less than 100 percent of the payment rate that applies to such providers under part A or B (as applicable) of title XVIII; ; 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 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, 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 sand 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) furnished on or after the date that is 180 days after date of enactment of this subsection and before October 1, 2027, and that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan as of the day before the date of the enactment of this subsection, 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, and recruitment and retention of providers. (b) 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 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. ). 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 existing flexibilities for hospitals and other providers under applicable laws, regulations, and guidance to support children in crisis or in need of intensive mental, emotional or behavioral health services. (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 and legal barriers to care across the crisis continuum 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 while also ensuring high quality and safety. (c) Ensuring consistent review and State implementation of early and periodic screening, diagnostic, and treatment services Section 1905(r) of the Social Security Act ( 42 U.S.C. 1396d(r) ) is amended by adding at the end the following: The Secretary shall, not later than July 1, 2022, and not later than January 1 each year thereafter, review implementation of the requirements of this subsection by States as they pertain to behavioral health services for children, including services provided by a managed care entity, identify and disseminate best practices for ensuring comprehensive coverage of services, identify gaps and deficiencies in meeting Federal requirements, and provide guidance to States on addressing identified gaps and disparities and meeting Federal coverage requirements in order to ensure children, including children without a mental health diagnosis, have access to behavioral health services. . 6. Programs to support pediatric behavioral health care Subpart V of part D of title III of the Public Health Service Act ( 42 U.S.C. 256 et seq. ) is amended by adding at the end the following: 340A–1. Program to support pediatric behavioral health care integration and coordination (a) In general The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award grants, contracts, or cooperative agreements to eligible entities for the purpose of supporting pediatric behavioral health care integration and coordination within communities to meet local community needs. (b) Eligible entities Entities eligible for grants under subsection (a) include— (1) health care providers, including family physicians, pediatric medical sub-specialists, and surgical specialists; (2) children’s hospitals; (3) facilities that are eligible to receive funds under section 340E or 340H; (4) nonprofit medical facilities that predominantly treat individuals under the age of 21; (5) rural health clinics and Federally qualified health centers (as such terms are defined in section 1861(aa) of the Social Security Act); (6) pediatric mental health and substance use disorder providers, such as child and adolescent psychiatrists, psychologists, developmental and behavioral pediatricians, general pediatricians, advanced practice nurses, social workers, licensed professional counselors, and other licensed professionals that provide mental health and substance use disorder services to patients under 21 years of age; (7) child advocacy centers described in section 214(c)(2)(B) of the Victims of Child Abuse Act of 1990; (8) school-based health centers; and (9) other entities as determined appropriate by the Secretary. (c) Prioritization In making awards under subsection (a), the Secretary shall prioritize— (1) applicants that provide children and adolescents from high need, rural, or under-resourced communities with services across the continuum of children's mental health and substance use disorder care; and (2) applicants that predominantly provide care to children and adolescents that demonstrate plans to utilize funds to expand provision of care to children, adolescents, and youth under age 21. (d) Use of funds Activities that may be funded through an award under subsection (a) include— (1) increasing the capacity of pediatric practices, family medicine practices, and school-based health centers to integrate pediatric mental, emotional, and behavioral health services into their practices including through co-location of mental, emotional, and behavioral health providers; (2) training for non-clinical pediatric health care workers, including care coordinators and navigators, on child and adolescent mental health and substance use disorder, trauma-informed care, and local resources to support children and caregivers; (3) expanding evidence-based, integrated models of care for pediatric mental health and substance use disorder services; (4) pediatric practice integration for the provision of pediatric mental health and substance use disorder services; (5) addressing surge capacity for pediatric mental health and substance use disorder needs; (6) providing pediatric mental, emotional, and behavioral health services to children as delivered by mental health and substance use disorder professionals utilizing telehealth services; (7) establishing or maintaining initiatives to allow more children to access care outside of emergency departments, including partial hospitalization, step down residency programs, and intensive outpatient programs; (8) supporting, enhancing, or expanding pediatric mental health and substance use disorder preventive and crisis intervention services; (9) establishing or maintaining pediatric mental health and substance use disorder urgent care or walk-in clinics; (10) establishing or maintaining community-based pediatric mental health and substance use disorder initiatives, such as partnerships with schools and early childhood education programs; (11) addressing other access and coordination gaps to pediatric mental health and substance use disorder services in the community for children; and (12) supporting the collection of data on children and adolescents’ mental health needs, service utilization and availability, and demographic data, to capture community needs and identify gaps and barriers in children's access to care, in a manner that protects personal privacy, consistent with applicable Federal and State privacy laws. (e) Authorization of appropriations To carry out this section, there is authorized to be appropriated $500,000,000 for each of fiscal years 2023 through 2027. 340A–2. Pediatric behavioral health workforce training program (a) In general The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award grants, contracts, or cooperative agreements to eligible entities for the purpose of supporting evidence-based pediatric mental health and substance use disorder workforce training. (b) Eligible entities Entities eligible for grants under subsection (a) include— (1) children’s hospitals; (2) facilities that are eligible to receive funds under section 340E or 340H; (3) nonprofit medical facilities that predominantly treat individuals under the age of 21; (4) rural health clinics and Federally qualified health centers (as such terms are defined in section 1861(aa) of the Social Security Act); (5) entities that employ mental health and substance use disorder professionals, such as child and adolescent psychiatrists, psychologists, developmental and behavioral pediatricians, general pediatricians, advanced practice nurses, social workers, licensed professional counselors, or other licensed professionals that provide mental health or substance use disorder services to patients under 21 years of age; and (6) other pediatric health care providers as determined appropriate by the Secretary. (c) Use of funds Activities that may be supported through an award under subsection (a) include the following: (1) Training to enhance the capabilities of the existing pediatric workforce, including pediatricians, primary care physicians, advanced practice registered nurses, and other pediatric health care providers, including expanded training in pediatric mental health and substance use disorders, and culturally and developmentally appropriate care for children with mental health conditions. (2) Training to support multi-disciplinary teams to provide pediatric mental health and substance use disorder treatment, including through integrated care models. (3) Initiatives to accelerate the time to licensure within the pediatric mental health or substance use disorder workforce. (4) Activities to expand recruitment and retention, increase workforce diversity, or enhance workforce training for critical pediatric mental health professions, including— (A) child and adolescent psychiatrists; (B) psychiatric nurses; (C) psychologists; (D) family therapists; (E) social workers; (F) mental health counselors; (G) developmental and behavioral pediatricians; (H) pediatric substance use disorder specialists; and (I) other mental health care providers as determined appropriate by the Secretary. (d) Authorization of appropriations To carry out this section, there is authorized to be appropriated $100,000,000 for each of fiscal years 2023 through 2027. . 7. Increasing Federal investment in pediatric behavioral health services The Public Health Service Act ( 42 U.S.C. 201 et seq. ) is amended by adding at the end the following: XXXIV Assistance for Construction and Modernization of Children’s Mental Health and Substance Use Disorder Infrastructure 3401. Increasing Federal investment in pediatric behavioral health services (a) In general The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award grants, contracts, or cooperative agreements to eligible entities for the purpose of improving their ability to provide pediatric behavioral health services, including by— (1) constructing or modernizing sites of care for pediatric behavioral health services; (2) expanding capacity to provide pediatric behavioral health services, including enhancements to digital infrastructure, telehealth capabilities, or other improvements to patient care infrastructure; (3) supporting the reallocation of existing resources to accommodate pediatric behavioral health patients, including by converting or adding a sufficient number of beds to establish or increase the hospital’s inventory of licensed and operational, short-term psychiatric and substance use inpatient beds; and (4) addressing gaps in the continuum of care for children, by expanding capacity to provide intermediate levels of care, such as intensive outpatient services, partial hospitalization programs, and day programs that can prevent hospitalizations and support children as they transition back to their homes and communities. (b) Eligibility To be eligible to seek an award under this section, an entity shall be a hospital or rural health clinic that predominantly treats individuals under the age of 21, including any hospital that receives funds under section 340E. (c) Authorization of appropriations To carry out this section, there is authorized to be appropriated $2,000,000,000 for each of fiscal years 2023 through 2027. (d) Supplement, not supplant Funds provided under this section shall be used to supplement, not supplant Federal and non-Federal funds available for carrying out the activities described in this section. (e) Reporting (1) Reports from award recipients Not later than 180 days after the completion of activities funded by an award under this section, the entity that received such award shall submit a report to the Secretary on the activities conducted using funds from such award, and other information as the Secretary may require. (2) Reports to Congress Not later than one year, the Secretary shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the projects and activities conducted with funds awarded under this section, and the outcome of such projects and activities. Such report shall include— (A) the number of projects supported by awards made under this section; (B) an overview of the impact, if any, of such projects on pediatric health care infrastructure, including any impact on access to pediatric mental health and substance use disorder services; (C) recommendations for improving the investment program under this section; and (D) any other considerations as the Secretary determines appropriate. .