I 118th CONGRESS 1st Session H. R. 4851 IN THE HOUSE OF REPRESENTATIVES July 25, 2023 Mr. Cárdenas (for himself, Mr. Fitzpatrick , Ms. Blunt Rochester , Mr. Moulton , Ms. Matsui , Mrs. Napolitano , Mr. Beyer , Mr. Raskin , Ms. Strickland , Mr. Gomez , Mr. Pocan , Mr. Tonko , Ms. Moore of Wisconsin , Ms. Barragán , Ms. Underwood , Ms. Clarke of New York , Mr. Trone , Ms. Balint , Mr. Lynch , Ms. Schrier , Ms. Craig , and Ms. Jayapal ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committees on Ways and Means , Armed Services , Veterans' Affairs , and Oversight and Accountability , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for improvements in the implementation of the National Suicide Prevention Lifeline, and for other purposes.

1. Short title (a) Short title This Act may be cited as the 9–8–8 Implementation Act of 2023 . (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title. Title I—Substance Abuse and Mental Health Services Administration Sec. 101. Regional and local lifeline call center program. Sec. 102. Mental Health Crisis Response Partnership Pilot Program. Sec. 103. National suicide prevention media campaign. Title II—Health Resources and Services Administration Sec. 201. Health center capital grants. Sec. 202. Expanding behavioral health workforce training programs. Title III—Behavioral Health Crisis Services Expansion Sec. 301. Coverage of crisis response services. Sec. 302. Incident reporting. Title IV—Medicaid amendments Sec. 401. Revisions to the State option to provide qualifying community-based mobile crisis intervention services and other services under State plans under the Medicaid program. Sec. 402. Revisions to the IMD exclusion under Medicaid. I Substance Abuse and Mental Health Services Administration 101. Regional and local lifeline call center program Part B of title V of the Public Health Service Act ( 42 U.S.C. 290bb et seq. ) is amended by inserting after section 520E–4 (42 U.S.C. 290bb-36d) the following: 520E–5. Regional and local lifeline call center program (a) In general The Secretary shall award grants to crisis call centers to— (1) purchase or upgrade call center technology; (2) provide for training of call center staff; (3) improve call center operations; and (4) hiring of call center staff. (b) Authorization of appropriations There are authorized to be appropriated to carry out this section $441,000,000 for fiscal year 2024, to remain available until expended. . 102. Mental Health Crisis Response Partnership Pilot Program Section 520F(e) of the Public Health Service Act ( 42 U.S.C. 290bb–37(e) ) is amended by striking section, $10,000,000 for each of fiscal years 2023 through 2027 and inserting the following: section— (1) $10,000,000 for fiscal year 2023; and (2) $100,000,000 for each of fiscal years 2024 through 2027 . 103. National suicide prevention media campaign Subpart 3 of part B of title V of the Public Health Service Act ( 42 U.S.C. 290bb–31 et seq. ) is amended by adding at the end the following: 5200. National suicide prevention media campaign (a) National suicide prevention media campaign (1) In general Not later than the date that is 3 years after the date of the enactment of this Act, the Secretary, in consultation with the Assistant Secretary for Mental Health and Substance Use and the Director of the Centers for Disease Control and Prevention (referred to in this section as the Director ), shall conduct a national suicide prevention media campaign (referred to in this section as the national media campaign ), for purposes of— (A) preventing suicide in the United States; (B) educating families, friends, and communities on how to address suicide and suicidal thoughts, including when to encourage individuals with suicidal risk to seek help; and (C) increasing awareness of suicide prevention resources of the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration (including the suicide prevention hotline maintained under section 520E–3, any suicide prevention mobile application of the Centers for Disease Control and Prevention or the Substance Abuse Mental Health Services Administration, and other support resources determined appropriate by the Secretary). (2) Additional consultation In addition to consulting with the Assistant Secretary and the Director under this section, the Secretary shall consult with, as appropriate, State, local, Tribal, and territorial health departments, primary health care providers, hospitals with emergency departments, mental and behavioral health services providers, crisis response services providers, paramedics, law enforcement, suicide prevention and mental health professionals, patient advocacy groups, survivors of suicide attempts, and representatives of television and social media platforms in planning the national media campaign to be conducted under paragraph (1). (b) Target audiences (1) Tailoring advertisements and other communications In conducting the national media campaign under subsection (a)(1), the Secretary may tailor culturally competent advertisements and other communications of the campaign across all available media for a target audience (such as a particular geographic location or demographic) across the lifespan. (2) Targeting certain local areas The Secretary shall, to the maximum extent practicable, use amounts made available under subsection (f) for media that targets certain local areas or populations at disproportionate risk for suicide. (c) Use of funds (1) Required uses (A) In general The Secretary shall, if reasonably feasible with the funds made available under subsection (f), carry out the following, with respect to the national media campaign: (i) Testing and evaluation of advertising. (ii) Evaluation of the effectiveness of the national media campaign. (iii) Operational and management expenses. (iv) The creation of an educational toolkit for television and social media platforms to use in discussing suicide and raising awareness about how to prevent suicide. (B) Specific requirements (i) Testing and evaluation of advertising In testing and evaluating advertising under subparagraph (A)(i), the Secretary shall test all advertisements after use in the national media campaign to evaluate the extent to which such advertisements have been effective in carrying out the purposes of the national media campaign. (ii) Evaluation of effectiveness of national media campaign In evaluating the effectiveness of the national media campaign under subparagraph (A)(ii), the Secretary shall— (I) take into account the number of unique calls that are made to the suicide prevention hotline maintained under section 520E–3 and assess whether there are any State and regional variations with respect to the capacity to answer such calls; (II) take into account the number of unique encounters with suicide prevention and support resources of the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration and assess engagement with such suicide prevention and support resources; (III) assess whether the national media campaign has contributed to increased awareness that suicidal individuals should be engaged, rather than ignored; and (IV) take into account such other measures of evaluation as the Secretary determines are appropriate. (2) Optional uses The Secretary may use amounts made available under subsection (f) for the following, with respect to the national media campaign: (A) Partnerships with professional and civic groups, community-based organizations, including faith-based organizations, and Federal agencies or Tribal organizations that the Secretary determines have experience in suicide prevention, including the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention. (B) Entertainment industry outreach, interactive outreach, media projects and activities, the dissemination of public information, news media outreach, outreach through television programs, and corporate sponsorship and participation. (d) Prohibitions None of the amounts made available under subsection (f) may be obligated or expended for any of the following: (1) To supplant Federal suicide prevention campaigns in effect as of the date of the enactment of this section. (2) For partisan political purposes, or to express advocacy in support of or to defeat any clearly identified candidate, clearly identified ballot initiative, or clearly identified legislative or regulatory proposal. (e) Report to Congress Not later than 18 months after implementation of the national media campaign has begun, the Secretary, in coordination with the Assistant Secretary and the Director, shall, with respect to the first year of the national media campaign, submit to Congress a report that describes— (1) the strategy of the national media campaign and whether specific objectives of such campaign were accomplished, including whether such campaign impacted the number of calls made to lifeline crisis centers and the capacity of such centers to manage such calls; (2) steps taken to ensure that the national media campaign operates in an effective and efficient manner consistent with the overall strategy and focus of the national media campaign; (3) plans to purchase advertising time and space; (4) policies and practices implemented to ensure that Federal funds are used responsibly to purchase advertising time and space and eliminate the potential for waste, fraud, and abuse; and (5) all contracts entered into with a corporation, a partnership, or an individual working on behalf of the national media campaign. (f) Authorization of appropriations For purposes of carrying out this section, there is authorized to be appropriated $10,000,000 for each of fiscal years 2024 through 2028. . II Health Resources and Services Administration 201. Health center capital grants Subpart 1 of part D of title III of the Public Health Service Act ( 42 U.S.C. 254b et seq. ) is amended by adding at the end the following: 330Q. Health center capital grants (a) In general The Secretary shall award grants to eligible entities for capital projects. (b) Eligible entity In this section, the term eligible entity is an entity that is— (1) a health center funded under section 330, or in the case of a Tribe or Tribal organization, eligible, to be awarded without regard to the time limitation in subsection (e)(3) and subsections (e)(6)(A)(iii), (e)(6)(B)(iii), and (r)(2)(B) of such section; or (2) a mental health and substance use crisis receiving and stabilization program and crisis call center that have a working relationship with one or more local community mental health and substance use organizations, community mental health centers, and certified community behavioral health clinics, or other local mental health and substance use care providers, including inpatient and residential treatment settings. (c) Use of funds Amounts made available to a recipient of a grant or cooperative agreement pursuant to subsection (a) shall be used for crisis response program facility alteration, renovation, remodeling, expansion, construction, and other capital improvement costs, including the costs of amortizing the principal of, and paying interest on, loans for such purposes. (d) Authorization of appropriations There are authorized to be appropriated to carry out this section $1,000,000,000, to remain available until expended. . 202. Expanding behavioral health workforce training programs (a) National Health Service Corps Section 331(a)(3)(E)(i) of the Public Health Service Act (254d(a)(3)(E)(i)) is amended by striking and psychiatrists and inserting psychiatrists and professionals who provide crisis management services (such as at a crisis call center, as part of a mobile crisis team, or through crisis receiving and stabilization program) . (b) Minority Fellowship Program Section 597(b) of the Public Health Service Act ( 42 U.S.C. 290ll(b) ) is amended by inserting crisis management services (such as at a crisis call center, as part of a mobile crisis team, or through crisis receiving and stabilization program), after mental health counseling, . (c) Behavioral Health Workforce Education and Training Section 756 of the Public Health Service Act ( 42 U.S.C. 294e–1 ) is amended— (1) in subsection (a)— (A) in paragraph (1), by inserting crisis management (such as at a crisis call center, as part of a mobile crisis team, or through crisis receiving and stabilization program), after occupational therapy, ; (B) in paragraph (2), by inserting and providing crisis management services (such as at a crisis call center, as part of a mobile crisis team, or through crisis receiving and stabilization program) after treatment services, ; (C) in paragraph (3), by inserting and providing crisis management services (such as at a crisis call center, as part of a mobile crisis team, or through crisis receiving and stabilization program), after behavioral health services ; and (D) in paragraph (4), by inserting including for the provision of crisis management services (such as at a crisis call center, as part of a mobile crisis team, or through crisis receiving and stabilization program), after paraprofessional field ; (2) in subsection (d)(2), by inserting or that emphasize training in crisis management and meeting the crisis needs of diverse populations specified in (b)(2), including effective outreach and engagement after partnerships ; and (3) by adding at the end the following: (g) Additional funding (1) In general For each of fiscal years 2024 through 2028, in addition to funding made available under subsection (f), there are authorized to be appropriated $15,000,000 for workforce development for crisis management, as specified in paragraphs (1) through (4) of subsection (a). (2) Priority In making grants for the purpose specified in paragraph (1), the Secretary shall give priority to programs demonstrating effective recruitment and retention efforts for individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, and class backgrounds, and different genders and sexual orientations, as specified in subsection (b)(2). . III Behavioral Health Crisis Services Expansion 301. Coverage of crisis response services (a) Coverage under the Medicare program (1) In general Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ) is amended— (A) in subparagraph (II), by striking and at the end; (B) in subparagraph (JJ), by striking the period at the end and inserting ; and ; and (C) by adding at the end the following new subparagraph: (KK) crisis response services as defined in subsection (nnn); . (2) Crisis response services defined Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended by adding at the end the following new subsection: (nnn) Crisis response services The term crisis response services means mental health or substance use services that are furnished by a mobile crisis response team, a crisis receiving and stabilization facility, mental health or substance use urgent care facility, or other appropriate provider, as determined by the Secretary, to an individual, including children and adolescents, experiencing a mental health or substance use crisis. . (3) Payment (A) In general Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ) is amended— (i) by striking and (HH) and inserting (HH) ; and (ii) by inserting before the semicolon at the end the following: and (II) with respect to crisis response services described in section 1861(s)(2)(KK), the amounts paid shall be 80 percent of the lesser of the actual charge for the service or the amount determined under the payment basis established under section 1834(aa) . (B) Establishment of payment basis Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ) is amended by adding at the end the following new subsection: (aa) Payment for crisis response services The Secretary shall establish a payment basis determined appropriate by the Secretary with respect to crisis response services (as defined in section 1861(nnn)) furnished by a provider of services or supplier. . (4) Ambulance transport of individuals in crisis (A) In general Section 1834(l) of the Social Security Act ( 42 U.S.C. 1395m(l) ) is amended by adding at the end the following new paragraph: (18) Transportation of individuals in crisis With respect to ambulance services furnished on or after the date that is 3 years after the date of the enactment of the Behavioral Health Crisis Services Expansion Act, the regulations described in section 1861(s)(7) shall provide coverage under such section for ambulance and other qualified emergency transport services to transport an individual experiencing a mental health or substance crisis to an appropriate facility, such as a community mental health center (as defined in section 1861(ff)(3)(B)) or other facility or provider identified by the Secretary, as appropriate, for crisis response services described in section 1861(s)(2)(KK). . (B) Conforming amendment Section 1861(s)(7) of such Act ( 42 U.S.C. 1395x(s)(7) ) is amended by striking section 1834(l)(14) and inserting paragraphs (14) and (18) of section 1834(l) . (5) Effective date The amendments made by this subsection shall apply to services furnished on or after the date that is 3 years after the date of the enactment of this Act. (b) Mandatory coverage of crisis response services under the medicaid program Title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) is amended— (1) in section 1902(a)(10)(A), in the matter preceding clause (i), by striking and (30) and inserting (30), and (31) ; and (2) in section 1905— (A) in subsection (a)— (i) in paragraph (30), by striking ; and and inserting a semicolon; (ii) by redesignating paragraph (31) as paragraph (32); and (iii) by inserting the following paragraph after paragraph (30): (31) crisis response services (as defined in section 1861(nnn)); and . (3) Presumptive eligibility determination by crisis response service providers Section 1902(a)(47)(B) of the Social Security Act ( 42 U.S.C. 1396a(a)(47)(B) ) is amended by inserting or provider of crisis response services (as defined in section 1861(nnn)) after any hospital . (4) Effective date (A) In general Except as provided in subparagraph (B), the amendments made by this section shall take effect on the date that is 3 years after the date of the enactment of this Act. (B) Delay permitted if state legislation required In the case of a State plan under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of the failure of the plan to meet such additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature. (c) Essential health benefits Section 1302(b)(1)(E) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18022(b)(1)(E) ) is amended by inserting and crisis response services (as defined in section 1861(nnn) of the Social Security Act) before the period. (d) Group health plans and health insurance issuers (1) In general Section 2707 of the Public Health Service Act ( 42 U.S.C. 300gg–6 ) is amended by adding at the end the following: (e) Crisis response services A group health plan or a health insurance issuer offering group or individual health insurance coverage shall ensure that such coverage includes crisis response services (as defined in section 1861(nnn) of the Social Security Act). . (2) Application to grandfathered plans Section 1251(a)(4)(A) of the Public Health Service Act ( 42 U.S.C. 18011(a)(4)(A) ) is amended by adding at the end the following new clause: (v) Section 2707(e) (relating to coverage of crisis response services). . (e) Tricare coverage (1) In general The Secretary of Defense shall provide coverage under the TRICARE program for crisis response services, as defined in section 1861(nnn) of the Social Security Act ( 42 U.S.C. 1395x ). (2) Tricare program defined In this section, the term TRICARE program has the meaning given the term in section 1072 of title 10, United States Code. (f) Reimbursement for crisis response services for veterans Section 1725(f)(1) of title 38, United States Code, is amended, in the matter preceding subparagraph (A), by inserting , including crisis response services (as defined in subsection (nnn) of section 1861 of the Social Security Act ( 42 U.S.C. 1395x )), after services . (g) Coverage under FEHB (1) In general Section 8902 of title 5, United States Code, is amended by adding at the end the following: (p) Each contract for a plan under this chapter shall require the carrier to provide coverage for crisis response services, as that term is defined in subsection (nnn) of section 1861 of the Social Security Act ( 42 U.S.C. 1395x ). . (2) Effective date The amendment made by paragraph (1) shall apply beginning with respect to the third contract year for chapter 89 of title 5, United States Code, that begins on or after the date that is 3 years after the date of enactment of this Act. (h) Coverage under CHIP Section 2103(c)(5) of the Social Security Act ( 42 U.S.C. 1397cc(c)(5) ) is amended— (1) in subparagraph (A), by striking and at the end; (2) in subparagraph (B), by striking the period and inserting ; and ; and (3) by adding at the end the following new subparagraph: (C) beginning on the date that is 3 years after the date of the enactment of this subparagraph, crisis response services (as defined in section 1861(nnn)). . 302. Incident reporting (a) Establishment of protocol panel The Secretary of Health and Human Services (referred to in this section as the Secretary ), in consultation with the Attorney General, shall convene a panel for the purposes of making recommendations for training and protocol for 9–1–1 dispatchers to respond appropriately to individuals experiencing a behavioral health crisis based on the characteristics of the incident and the needs of the caller. (b) Panelists The Secretary shall appoint individuals to serve staggered 10-year terms on the panel established under subsection (a). Such individuals shall include— (1) psychiatrists; (2) paramedics and other emergency medical services personnel; (3) law enforcement officers and 9–1–1 dispatchers; (4) representatives from each segment of the crisis response continuum, including 9–8–8 dispatchers; (5) members of underserved communities including ethnic and racial minority groups and sexual orientation and gender minority groups; (6) representatives from Tribes or Tribal organizations; and (7) other individuals, as the Secretary determines appropriate. (c) Recommendations (1) Topics In issuing recommendations under this section, the panel shall consider— (A) connecting 9–1–1 callers to crisis care services instead of responding with law enforcement officers; (B) integrating the 9–8–8 system into the 9–1–1 system, or transferring calls from the 9–1–1 system to the 9–8–8 system as appropriate; and (C) a process for identifying 9–1–1 callers who may be experiencing psychiatric symptoms or a mental health crisis, substance use crisis, or co-occurring crisis and evaluating the level of need of such callers, as defined by relevant, standardized assessment tools such as the Level of Care Utilization System (LOCUS), the Child and Adolescent Level of Care Utilization System (CALOCUS), and the American Society of Addiction Medicine (ASAM) Criteria. (2) Updates The panel shall update recommendations issued under this section not less frequently than every 5 years. IV Medicaid amendments 401. Revisions to the State option to provide qualifying community-based mobile crisis intervention services and other services under State plans under the Medicaid program (a) In general Section 1947 of the Social Security Act ( 42 U.S.C. 1396w–6 ) is amended— (1) in subsection (a)— (A) by striking for qualifying community-based mobile crisis intervention services and inserting for— (1) qualifying community-based mobile crisis intervention services; (2) regional and local lifeline call center operations; and (3) programs for the purpose receiving and stabilization individuals (including beds in homes and facilities for such purpose). ; and (B) by striking during the 5-year period ; (2) in subsection (c)— (A) by striking 85 percent. and inserting the following: 85 percent, and for medical assistance for items described in paragraphs (2) and (3) of subsection (a) furnished during such quarter shall be equal to 85 percent. ; and (B) by striking occurring during the period described in subsection (a) that a State and inserting in which a State provides medical assistance for qualifying community-based mobile crisis intervention services under this section and ; (3) in subsection (e), by adding at the end at the following new sentence: There is appropriated, out of any funds in the Treasury not otherwise appropriated, $5,000,000 to the Secretary for the purposes described in the preceding sentence to remain available until expended. ; and (4) in subsection (d)(2)— (A) in subparagraph (A), by striking for the fiscal year preceding the first fiscal quarter occurring during the period described in subsection (a) and inserting for the fiscal year preceding the first fiscal quarter in which the State provides medical assistance for qualifying community-based mobile crisis intervention services under this section ; and (B) in subparagraph (B), by striking occurring during the period described in subsection (a) and inserting occurring during a fiscal quarter . (b) Effective date The amendments made by subsection (a) shall take effect as if included in the enactment of the American Rescue Plan Act of 2021 ( Public Law 117–2 ). 402. Revisions to the IMD exclusion under Medicaid (a) Shrinking of the IMD exclusion under Medicaid Section 1905(a)(1) of the Social Security Act ( 42 U.S.C. 1396d(a)(1) ) is amended by inserting , except for, services that, beginning the day after the date of the enactment of the 9–8–8 National Suicide Prevention Lifeline Implementation Act of 2022, are furnished in psychiatric acute care crisis beds administered by community behavioral health organizations certified under section 223 of the Protecting Access to Medicare Act of 2014, mental health centers that meet the criteria of section 1913(c) of the Public Health Service Act, crisis receiving and stabilization facilities, and the mental health and substance use urgent care facilities . (b) Guidance relating to IMD exclusion Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue guidance that crisis stabilization units (as described in section 1905(a)(1) of the Social Security Act ( 42 U.S.C. 1396d(a)(1) ) are excluded from the prohibition specified in the parenthetical of paragraph (1) of section 1905(a) (relating to services in an institution for mental diseases), including the following facilities and services: (1) Subacute crisis receiving in inpatient or other facilities specified by the Secretary that provide short-term observation for all referrals to individuals in severe distress, as further defined by the Secretary, with up to 23 consecutive hours of supervised care to assist with deescalating the severity of a mental health or substance use crisis or need for urgent care in a sub-acute inpatient setting. (2) Short term crisis stabilization services assisting with deescalating the severity of individuals in severe distress, as defined by the Secretary, or need for urgent care associated with a substance use or mental health disorder in an inpatient or residential setting with reimbursement limited to 72 hours. (c) Reports on crisis stabilization utilization Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit to the appropriate congressional committees of jurisdiction a report addressing the utilization of facility-based crisis services, including the number of patients served, type and duration of facility-based services, linkage to community-based resources, and information on the total number of law enforcement drop-offs and other data relevant for diverting mental health and substance use disorder emergencies from law enforcement response.