Increasing Behavioral Health Treatment Act
This bill repeals restrictions that generally prohibit federal payment under Medicaid for services provided in institutions for mental diseases (IMDs) for individuals under the age of 65. (Currently, states may receive payment for such services through certain mechanisms, such as through a Medicaid demonstration waiver.) The bill also requires state Medicaid programs that cover IMD services to improve patient access to outpatient and community-based behavioral health care, expand crisis stabilization services, facilitate care coordination between providers and first responders, and report specified information relating to IMD utilization and costs.
To amend title XIX of the Social Security Act to remove the exclusion 
    from medical assistance under the Medicaid Program of items and 
 services for patients in an institution for mental diseases, 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 ``Increasing Behavioral Health 
Treatment Act''.

SEC. 2. REMOVAL OF MEDICAID EXCLUSION FROM MEDICAL ASSISTANCE OF ITEMS 
              AND SERVICES FURNISHED TO PATIENTS IN AN INSTITUTION FOR 
              MENTAL DISEASES IF STATE SUBMITS PLAN FOR PROVIDING 
              APPROPRIATE OUTPATIENT CARE TO SUCH PATIENTS.

    (a) Removal of Exclusion.--
            (1) In general.--The first sentence of section 1905(a) of 
        the Social Security Act (42 U.S.C. 1396d(a)) is amended, in the 
        matter following paragraph (30)--
                    (A) by striking ``such term does not include--'' 
                and all that follows through ``(A) any'' and inserting 
                ``such term does not include any'';
                    (B) by striking ``; or'' and inserting a period; 
                and
                    (C) by striking subparagraph (B).
            (2) Conforming amendments to permit medical assistance for 
        imd patients under 65 years of age.--The following provisions 
        of such Act are each amended by striking ``65 years of age or 
        older'' and ``65 years of age or over'' each place it appears:
                    (A) Paragraphs (20) and (21) of section 1902(a) (42 
                U.S.C. 1396a(a)).
                    (B) Section 1905(a)(14) (42 U.S.C. 1396d(a)(14)).
                    (C) Section 1919(e)(7)(B)(i)(I) (42 U.S.C. 
                1396r(e)(7)(B)(i)(I)).
    (b) Reporting and Plan Requirement.--Section 1902(a)(20) of the 
Social Security Act (42 U.S.C. 1396a(a)(20)) is amended--
            (1) in subparagraph (B), by striking at the end ``and'';
            (2) by adding at the end the following new subparagraphs:
                    ``(D) provide for a plan to achieve (and for the 
                annual submission to the Secretary of actions taken by 
                the State, and progress with respect to such actions, 
                to achieve)--
                            ``(i) increased access to outpatient and 
                        community-based behavioral health care, with 
                        respect to individuals furnished services in an 
                        institution for mental diseases, especially for 
                        individuals transitioning from such an 
                        institution;
                            ``(ii) increased availability of services 
                        made available through crisis call centers, 
                        mobile crisis units, coordinated community 
                        crisis response that involves law enforcement 
                        and other first responders, observation or 
                        assessment centers, and on-going community-
                        based services (such as intensive outpatient 
                        services, assertive community treatment, and 
                        services in integrated care settings such as 
                        the Certified Community Behavioral Health 
                        Clinic model) (such services referred to as 
                        crisis stabilization services) for individuals 
                        experiencing a serious mental illness (as such 
                        term is defined for purposes of title V of the 
                        Public Health Service Act), serious emotional 
                        disturbance, or substance use disorder crisis;
                            ``(iii) improved data sharing and 
                        coordination between physical health, mental 
                        health, and addiction treatment providers 
                        (including hospitals and community-based 
                        behavioral health facilities) and first 
                        responders to improve health outcomes for 
                        individuals furnished services in an 
                        institution for mental diseases, who are 
                        experiencing a serious mental illness (as so 
                        defined), serious emotional disturbance, or 
                        substance use disorder crisis;
                    ``(E) provide for the demonstration of--
                            ``(i) State policies to ensure individuals 
                        receiving medical assistance under the State 
                        plan who receive care in psychiatric hospitals 
                        and residential treatment settings are 
                        consistently screened for co-morbid physical 
                        health conditions and substance use disorders 
                        prior to or upon admission, and that 
                        participating facilities have the capacity to 
                        address co-morbid physical health conditions 
                        during stays in such psychiatric hospitals and 
                        residential treatment settings either through 
                        on-site medical services or external referrals 
                        and care coordination;
                            ``(ii) established strategies of the State 
                        for identifying and engaging individuals, 
                        particularly adolescents and young adults, 
                        experiencing a serious mental illness (as such 
                        term is defined for purposes of title V of the 
                        Public Health Service Act), serious emotional 
                        disturbance, or substance use disorder crisis; 
                        and
                            ``(iii) established utilization review 
                        policies of the State Medicaid agency or 
                        Medicaid managed care organizations, as 
                        applicable, to ensure individuals receiving 
                        medical assistance under the State plan receive 
                        treatment at clinically appropriate levels of 
                        care and services are generally delivered in 
                        the least restrictive environment; and
                    ``(F) reporting to the Secretary (in a form and 
                manner specified by the Secretary) of, with respect to 
                each year beginning on or after the date of the 
                enactment of this subparagraph--
                            ``(i) in the aggregate and by facility 
                        type, costs and utilization for institutions 
                        for mental diseases and inpatient psychiatric 
                        hospitals that are not such institutions;
                            ``(ii) the number of individuals 
                        experiencing a serious mental illness (as such 
                        term is defined for purposes of title V of the 
                        Public Health Service Act), serious emotional 
                        disturbance, or substance use disorder crisis 
                        who received medical assistance under the State 
                        plan during the year;
                            ``(iii) the length of the stay of each such 
                        individual in an institution for mental 
                        disease; and
                            ``(iv) the type of outpatient treatment, 
                        including medication assisted treatment, each 
                        such individual received after being discharged 
                        from such institution;''.
    (c) Effective Date.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by this section shall take effect on the date of the 
        enactment of this Act and shall apply to State plans beginning 
        on such date.
            (2) Exception if state legislation required.--In the case 
        of a State plan for medical assistance under title XIX of the 
        Social Security Act 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 requirement 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 its failure to meet this additional requirement 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 the 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.
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Increasing Behavioral Health Treatment Act
To amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases, and for other purposes.
Increasing Behavioral Health Treatment Act
Rep. Napolitano, Grace F.