[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5218 Introduced in House (IH)]

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117th CONGRESS
  1st Session
                                H. R. 5218

   To amend the Public Health Service Act to increase uptake of the 
                       Collaborative Care Model.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 10, 2021

  Mrs. Fletcher (for herself and Ms. Herrera Beutler) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to increase uptake of the 
                       Collaborative Care Model.

    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 ``Collaborate in an Orderly and 
Cohesive Manner Act''.

SEC. 2. INCREASING UPTAKE OF THE COLLABORATIVE CARE MODEL.

    (a) In General.--Subpart XII of part D of title III of the Public 
Health Service Act (42 U.S.C. 256i et seq.) is amended--
            (1) in the subpart heading, by striking ``Community-based 
        Collaborative-Care Network Program'' and inserting 
        ``Collaborative Care''; and
            (2) by adding at the end the following new sections:

``SEC. 340J. INCENTIVIZING PRIMARY CARE UPTAKE OF THE COLLABORATIVE 
              CARE MODEL.

    ``(a) Grants.--The Secretary shall make grants to primary health 
care physicians and primary health care practices to meet the initial 
costs of establishing and delivering behavioral health integration 
services through the collaborative care model or a combined approach of 
the collaborative care model and primary care behavioral health 
integration models.
    ``(b) Use of Grants.--A primary health care physician or primary 
health care practice that receives a grant under this section shall use 
funds received through the grant--
            ``(1) to hire staff;
            ``(2) to identify and formalize contractual relationships 
        with other health care providers, including providers who will 
        function as psychiatric consultants and behavioral health care 
        managers in providing behavioral health integration services 
        through the collaborative care model;
            ``(3) to purchase or upgrade software and other resources 
        needed to appropriately provide behavioral health integration 
        services through the collaborative care model, including 
        resources needed to establish a patient registry and implement 
        measurement-based care; and
            ``(4) for other such purposes that the Secretary may 
        determine to be necessary.
    ``(c) Priority.--In making grants under this section, the Secretary 
shall give priority to primary health care physicians and primary 
health care practices--
            ``(1) providing services to any medically underserved 
        population; and
            ``(2) are located in areas with a prevalence of mental 
        illnesses or substance use disorders that are higher than the 
        national average.
    ``(d) Consideration.--If, in reviewing applications for grants 
under this section, the Secretary determines that more than one primary 
health care physician or a primary health care practice submitting such 
an application meets the criteria to be given priority under subsection 
(c), the Secretary shall give a preference to the primary health care 
physician or primary health care practice (that meets such criteria) 
that has the least existing capacity and resources to use grant funds 
as described in subsection (b). 
    ``(e) Incentive Payments.--
            ``(1) In general.--The Secretary shall provide to primary 
        health care physicians and primary health care practices 
        receiving a grant under this section that meet the criteria 
        specified in paragraph (3), additional payments.
            ``(2) Methodology and timing.--The amount and timing of 
        payments made under this subsection shall be determined using a 
        methodology and disbursement schedule established by the 
        Secretary.
            ``(3) Criteria.--Criteria described in this paragraph are 
        such criteria as the Secretary may specify, in consultation 
        with stakeholders, including physicians in the primary care 
        community and in the field of mental health and substance use 
        disorder treatment. Such criteria shall include whether--
                    ``(A) a primary health care physician or primary 
                health care practice participates in an alternative 
                payment model that bills for the collaborative care 
                model using the appropriate common procedural 
                terminology billing codes; and
                    ``(B) a primary health care physician or primary 
                health care practice uses of validated quality 
                measures, including, but not limited to, those related 
                to depression screening, patient follow up, and symptom 
                remission.
            ``(4) Calculation.--A payment received under this 
        subsection shall not be factored into any determination with 
        respect to meeting cost reduction targets for purposes of a 
        model implemented pursuant to section 1115A of the Social 
        Security Act.
    ``(f) Accountability.--The recipient of a grant under this section 
shall submit to the Secretary, in such time and manner as the Secretary 
may specify, a report that measures each recipient's progress toward--
            ``(1) implementing and appropriately providing behavioral 
        health integration services through the collaborative care 
        model;
            ``(2) improving access to behavioral health integration 
        services provided through the collaborative care model among 
        medically underserved populations;
            ``(3) improving health outcomes for individuals who receive 
        behavioral health integration services provided through the 
        collaborative care model; and
            ``(4) other such purposes that the Secretary may determine 
        to be necessary.
    ``(g) Clarification.--
            ``(1) Reimbursement.--Nothing in this section shall be 
        construed as preventing a primary health care physician or 
        primary health care practice that receives a grant under this 
        section from receiving direct reimbursement for rendering 
        behavioral health integration services through the 
        collaborative care model.
            ``(2) Other programs.--Participation in, or application 
        for, any other grant or demonstration program administered by 
        the Secretary by a primary health care physician or primary 
        health care practice shall not affect the eligibility of such 
        physician or practice to receive a grant under this section.
    ``(h) Definitions.--For the purposes of this section:
            ``(1) Collaborative care model.--The term `collaborative 
        care model' means the evidence-based, integrated behavioral 
        health service delivery method described in 81 Federal Register 
        80230, which includes a formal collaborative arrangement among 
        a primary care team consisting of a primary care provider, a 
        care manager, and a psychiatric consultant, and includes the 
        following elements:
                    ``(A) Care directed by the primary care team.
                    ``(B) Structured care management.
                    ``(C) Regular assessments of clinical status using 
                developmentally appropriate, validated tools.
                    ``(D) Modification of treatment as appropriate.
            ``(2) Medically underserved population.--The term 
        `medically underserved population' means the population of an 
        urban or rural area designated by the Secretary as an area with 
        a shortage of mental health or substance use disorder services 
        or a population group designated by the Secretary as having a 
        shortage of such services.
            ``(3) Primary health care physician.--The term `primary 
        health care physician' means a physician that--
                    ``(A) provides health services related to family 
                medicine, internal medicine, pediatrics, obstetrics, 
                gynecology, or geriatrics;
                    ``(B) is a doctor of medicine or osteopathy that is 
                licensed to practice medicine by the State in which 
                such physician primarily practices.
            ``(4) Primary health care practice.--The term `primary 
        health care practice' means a medical practice of primary 
        health care physicians, including a practice within a larger 
        health care system.

``SEC. 340K. ESTABLISHING TECHNICAL ASSISTANCE CENTERS FOR 
              IMPLEMENTATION OF THE COLLABORATIVE CARE MODEL.

    ``(a) In General.--The Secretary shall make grants to national and 
regional eligible organizations to establish, for purposes of providing 
technical assistance and training to health care providers and health 
care systems to facilitate and improve implementation of the 
collaborative care model--
            ``(1) a national center, to be known as the National 
        Collaborative Care Model Training and Technical Assistance 
        Center (referred to in this section as the `National Center'); 
        and
            ``(2) regional centers, to be known as Regional 
        Collaborative Care Model Training and Technical Assistance 
        Centers (referred to in this section as `Regional Centers').
    ``(b) Coordination Required.--As a condition on receipt of a grant 
under this section to establish the National Center, the eligible 
organization receiving such grant shall agree to coordinate with one or 
more eligible organizations and the Regional Centers in providing 
technical assistance and training referred to in subsection (a).
    ``(c) Technical Assistance and Training.--The technical assistance 
and training referred to in subsection (a) shall include--
            ``(1) developing financial models and budgets for 
        implementing and maintaining a collaborative care model, based 
        on practice size;
            ``(2) developing staffing models for essential staff roles, 
        including care managers and psychiatric consultants;
            ``(3) providing strategic advice to assist practices 
        seeking to utilize other clinicians for additional 
        psychotherapeutic interventions;
            ``(4) providing information technology expertise to assist 
        with building the collaborative care model into electronic 
        health records, including assistance with care manager tools, 
        patient registry, ongoing patient monitoring, and patient 
        records;
            ``(5) training support for all key staff and operational 
        consultation to develop practice workflows;
            ``(6) establishing methods to ensure the sharing of best 
        practices and operational knowledge among primary health care 
        physicians and primary health care practices that provide 
        behavioral health integration services through the 
        collaborative care model;
            ``(7) providing guidance and instruction to primary health 
        care physicians and primary health care practices on developing 
        and maintaining relationships with community-based mental 
        health and substance use disorder facilities for referral and 
        treatment of patients whose clinical presentation or diagnosis 
        is best suited for treatment at such facilities; and
            ``(8) other such activities as the Secretary necessary.
    ``(d) Regional Center Structure.--
            ``(1) In general.--The Secretary shall issue regulations 
        establishing the structure of the Regional Centers and the 
        nature of coordination among the Regional Centers and the 
        National Center, including--
                    ``(A) the number of Regional Centers, subject to 
                adjustment as described in paragraph (2);
                    ``(B) the geographic locations for such Regional 
                Centers, subject to adjustment as described in 
                paragraph (2);
                    ``(C) the degree to which such National Center may 
                direct the activities and practices of such Regional 
                Centers; and
                    ``(D) other such specifications that the Secretary 
                may deem necessary.
            ``(2) Adjustments.--The number and geographic location of 
        the Regional Centers established under paragraph (1) may be 
        adjusted from time to time as the Secretary determines 
        necessary so long as, in making such adjustments--
                    ``(A) seeks to establish as many Regional Centers 
                as is possible and practicable while still maintaining 
                optimal efficiency and effectiveness; and
                    ``(B) ensures that the distribution of such 
                geographic locations enables such Regional Centers to 
                provide training and technical assistance in areas with 
                medically underserved populations.
    ``(e) Accountability.--The Secretary shall issue regulations 
establishing such criteria as the Secretary determines is necessary to 
evaluate the effectiveness of the National Center and Regional Centers 
in providing technical assistance and training referred to in 
subsection (a), including for monitoring the activities of, collecting 
data from, and evaluating the performance of each recipient of a grant 
under this section.
    ``(f) Definitions.--In this section:
            ``(1) Collaborative care model; medically underserved 
        population; primary health care physician; primary health care 
        practice.--The terms `collaborative care model', `primary 
        health care physician', and `primary health care practice' have 
        the meaning given such terms in section 340J.
            ``(2) Eligible organization.--The term `eligible 
        organization' means a national or regional nonprofit 
        organization that can provide technical assistance and training 
        to health care providers and health care systems, and has 
        special expertise and broad experience in behavioral health 
        integration services, generally, and in the collaborative care 
        model, specifically, with preference given to such 
        organizations that are currently or that have previously 
        provided training and technical assistance on providing 
        behavioral health integration services through the 
        collaborative care model.

``SEC. 340L. RESEARCH ON PROMISING BEHAVIORAL HEALTH INTEGRATION 
              MODELS.

    ``The Secretary, in consultation with the Assistant Secretary for 
Planning and Evaluation, may direct administrators and directors of the 
Department of Health and Human Services, including the Director of the 
National Institutes of Health, the Administrator of the Health 
Resources and Services Administration, the Director of the Agency for 
Healthcare and Research Quality, and the Director of the Center for 
Medicare and Medicaid Innovation, as the Secretary determines 
appropriate, to expand efforts to evaluate current and emerging 
behavioral health integration models, such as the primary care 
behavioral health model, and improve the foundation for evidence-based 
practice, with a focus on population-based care.

``SEC. 340M. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated to carry out sections 
340J, 340K, and 340L, $30,000,000 for each of fiscal years 2022 through 
2026.''.
    (b) Technical Correction.--Effective as if included in the 
enactment of section 301(c) of the Disaster Tax Relief and Airport and 
Airway Extension Act of 2017 (Public Law 115-63), such section is 
amended, in the matter preceding paragraph (1), by striking ``Part D'' 
and inserting ``Part D of title III''.
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