Payment for mobile crisis response intervention services under physician fee schedule

Section 1848(b) of the Social Security Act (42 U.S.C. 1395w–4(b)) is amended by adding at the end the following new paragraph:

(13)

Mobile crisis response team services

(A)

In general

Beginning January 1, 2025, the Secretary shall, subject to the succeeding provisions of this paragraph, make a single global payment (as determined by the Secretary under subparagraph (C)) under this section for mobile crisis response team services (as defined in subparagraph (B)) furnished by a physician (as defined in section 1861(r)(1)), physician assistant or nurse practitioner (as defined in section 1861(aa)(5)(A)), clinical nurse specialist (as defined in section 1861(aa)(5)(B)), clinical social worker (as defined in section 1861(hh)(1)), or clinical psychologist (as defined by the Secretary for purposes of section 1861(ii)).(B)

Definition of mobile crisis response team services

In this paragraph, the term mobile crisis response team services means physicians' services that are furnished outside of a hospital, other facility setting, or physician office to an individual experiencing a mental health or substance use disorder crisis to—(i)provide screening and assessment for the individual’s mental health or substance use disorder crisis;(ii)support the de-escalation of the individual’s mental health or substance use disorder crisis;(iii)facilitate or support subsequent referral to health, social, and other services, as determined appropriate by the Secretary; or(iv)otherwise address the individual’s pressing behavioral health needs, as determined appropriate by the Secretary.(C)

Determination of single global payment

(i)

In general

The Secretary shall determine an appropriate global payment for mobile crisis response team services under the fee schedule under this section to account for the work, practice expenses, and malpractice expenses involved in furnishing physicians' services that would typically be furnished to an individual experiencing a mental health or substance use disorder crisis to accomplish the objectives described in clauses (i) through (iv) of subparagraph (B) (as identified by the Secretary).(ii)

Relative values

In determining work, practice expenses, and malpractice expenses under clause (i), the Secretary shall account for differences in work, practice expenses, and malpractice expenses between furnishing physicians' services identified in clause (i) in a physician office and the work, practice expenses, and malpractice expenses involved in furnishing such services at the site at which at individual is experiencing a mental or substance use disorder crisis, including potential practice expenses associated with transportation to such site.(iii)

Ensuring no duplicate payment

The Secretary shall ensure that if a physician or practitioner receives payment for mobile crisis response team services under this paragraph, additional payment is not made under this section for physicians' services identified in clause (i) that are furnished to the same individual by the same physician or practitioner on the same day on which such mobile crisis response team services are furnished.(D)

Requirements for physicians and practitioners receiving payment

In order to receive payment for mobile crisis response team services, a physician or practitioner who submits a claim for payment for such services must document, in a form and manner determined appropriate by the Secretary, that the physician or practitioner furnishing such services and any auxiliary personnel (as defined in section 410.26(a)(1) of title 42, Code of Federal Regulations, or any successor regulation) furnishing such services under the supervision of the physician or practitioner—(i)are trained in trauma-informed care, de-escalation strategies, and harm reduction;(ii)are capable of coordinating with emergency response systems, crisis intervention hotlines, and hospitals furnishing crisis stabilization services (as defined in section 1833(t)(23)); and(iii)meet other criteria determined appropriate by the Secretary to ensure quality of care and program integrity.(E)

Additional clarification

The Secretary shall allow for auxiliary personnel (as defined in section 410.26(a)(1) of title 42, Code of Federal Regulations, or any successor regulation), including peer support specialists (as defined in subsection (i)(4)(B)), to furnish mobile crisis response team services under the supervision of a physician or practitioner billing for such services under this section.