[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1902 Introduced in Senate (IS)]

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117th CONGRESS
  1st Session
                                S. 1902

To empower communities to establish a continuum of care for individuals 
    experiencing mental or behavioral health crisis, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 27, 2021

Ms. Cortez Masto (for herself and Mr. Cornyn) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To empower communities to establish a continuum of care for individuals 
    experiencing mental or behavioral health crisis, 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 ``Behavioral Health Crisis Services 
Expansion Act''.

SEC. 2. CRISIS RESPONSE CONTINUUM OF CARE.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish 
standards for a continuum of care for use by health care providers and 
communities in responding to individuals experiencing a mental or 
behavioral health crisis, including those individuals with co-occurring 
substance use disorders (referred to in this section as the ``crisis 
response continuum'').
    (b) Requirements.--
            (1) Scope of standards.--Such standards shall define--
                    (A) minimum requirements of core crisis services, 
                as determined by the Secretary, to include requirements 
                that each entity that furnishes such services should--
                            (i) not require prior authorization from an 
                        insurance provider nor referral from a health 
                        care provider prior to the delivery of 
                        services;
                            (ii) serve all individuals regardless of 
                        age or ability to pay;
                            (iii) operate 24 hours a day, 7 days a 
                        week, and provide care to all individuals; and
                            (iv) provide care and support through 
                        resources described in paragraph (2)(A) until 
                        the individual has been stabilized or transfer 
                        the individual to the next level of crisis 
                        care; and
                    (B) psychiatric stabilization, including the point 
                at which a case may be closed for--
                            (i) individuals screened over the phone; 
                        and
                            (ii) individuals stabilized on the scene by 
                        mobile teams.
            (2) Identification of essential functions.--The Secretary 
        shall identify the essential functions of each service in the 
        crisis response continuum, which shall include at least the 
        following:
                    (A) Identification of resources for referral and 
                enrollment in continuing behavioral health and other 
                human services for the individual in crisis where 
                necessary.
                    (B) Delineation of access and entry points to 
                services within the crisis response continuum.
                    (C) Development of and adherence to protocols and 
                agreements for the transfer and receipt of individuals 
                to and from other segments of the crisis response 
                continuum segments as needed, and from outside 
                referrals including health care providers, law 
                enforcement, EMS, fire, education institutions, and 
                community-based organizations.
                    (D) Description of the qualifications of crisis 
                services staff, including roles for physicians, 
                licensed clinicians, case managers, and peers (in 
                accordance with State licensing requirements).
                    (E) Requirements for the convention of 
                collaborative meetings of crisis response service 
                providers, first responders, and community partners 
                operating in a common region for the discussion of case 
                management, best practices, and general performance 
                improvement.
            (3) Service capacity and quality standards.--Such standards 
        shall include definitions of--
                    (A) adequate volume of services to meet population 
                need;
                    (B) appropriate timely response; and
                    (C) capacity to meet the needs of different patient 
                populations, including all age groups, cultural and 
                linguistic minorities, and individuals with co-
                occurring mental health and substance use disorder 
                crisis, individuals with cognitive disabilities 
                experiencing behavioral health crises, and individuals 
                with chronic medical conditions and physical 
                disabilities experiencing behavioral health crises.
            (4) Oversight and accreditation.--The Secretary shall 
        designate entities charged with the oversight and accreditation 
        of entities within the crisis response continuum.
            (5) Implementation timeframe.--Not later than 1 year after 
        the date of enactment of this Act, the Secretary shall 
        establish the standards under this section.
            (6) Data collection and evaluations.--
                    (A) In general.--The Secretary, directly or through 
                grants, contracts, or interagency agreements, shall 
                collect data and conduct evaluations with respect to 
                the provision of services and programs offered on the 
                crisis response continuum for purposes of assessing the 
                extent to which the provision of such services and 
                programs meet certain objectives and outcomes measures 
                as determined by the Secretary. Such objectives shall 
                include--
                            (i) a reduction in inappropriate arrests of 
                        individuals who are in mental health crisis;
                            (ii) a reduction in inappropriate emergency 
                        room admissions and readmissions; and
                            (iii) evidence of adequate access to crisis 
                        care centers and crisis bed services.
                    (B) Rulemaking.--The Secretary shall carry out this 
                subsection through notice and comment rulemaking, 
                following a request for information from stakeholders.
                    (C) Authorization of appropriations.--To carry out 
                this subsection, there is authorized to be appropriated 
                such sums as are necessary to remain available until 
                expended.
    (c) Components of Crisis Response Continuum.--The crisis response 
continuum consists of at least the following components:
            (1) Crisis call centers.--Regional clinically managed 
        crisis call centers that provide telephonic crisis intervention 
        capabilities. Such centers should meet National Suicide 
        Prevention Lifeline operational guidelines regarding suicide 
        risk assessment and engagement and offer air traffic control-
        quality coordination of crisis care in real-time.
            (2) Mobile crisis response team.--Teams of providers that 
        are available to reach any individual in the service area in 
        their home, workplace, or any other community-based location of 
        the individual in crisis in a timely manner.
            (3) Crisis receiving and stabilization facilities.--
        Subacute inpatient facilities and other facilities specified by 
        the Secretary that provide short-term observation and crisis 
        stabilization services to all referrals, including the 
        following services:
                    (A) 23-hour crisis stabilization services.--A 
                direct care service that provides individuals in severe 
                distress with up to 23 consecutive hours of supervised 
                care to assist with deescalating the severity of their 
                crisis or need for urgent care in a sub-acute inpatient 
                setting.
                    (B) Short-term crisis residential services.--A 
                direct care service that assists with deescalating the 
                severity of an individual's level of distress or need 
                for urgent care associated with a substance use or 
                mental health disorder in a residential setting.
            (4) Behavioral health urgent care facilities.--Ambulatory 
        services available 12-24 hours per day, 7 days a week, where 
        individuals experiencing crisis can walk in without an 
        appointment to receive crisis assessment, crisis intervention, 
        medication, and connection to continuity of care.
            (5) Additional facilities and providers.--The Secretary 
        shall specify additional facilities and health care providers 
        as part of the crisis response continuum, as the Secretary 
        determines appropriate.
    (d) Relationship to State Law.--
            (1) In general.--Subject to paragraph (2), the standards 
        established under this section are minimum standards and 
        nothing in this section may be construed to preclude a State 
        from establishing additional standards, so long as such 
        standards are not inconsistent with the requirements of this 
        section or other applicable law.
            (2) Waiver or modification.--The Secretary shall establish 
        a process under which a State may request a waiver or 
        modification of a standard established under this section.

SEC. 3. 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 (GG), by striking ``and'' at 
                the end;
                    (B) in subparagraph (HH), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(II) crisis response services as defined in subsection 
        (lll);''.
            (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:

                   ``Crisis Response Services Defined

    ``(lll)(1) In General.--The term `crisis response services' means 
mental or behavioral health services that are furnished by a mobile 
crisis response team, a crisis receiving and stabilization facility, 
behavioral health urgent care facility, or other appropriate provider, 
as determined by the Secretary, to an individual experiencing a mental 
or behavioral health crisis. Such term includes services identified by 
the Secretary as part of the crisis response continuum of care under 
section 2 of the Behavioral Health Crisis Services Expansion Act.
    ``(2) Definitions.--In this subsection, the terms `mobile crisis 
response team', `crisis receiving and stabilization facility', and 
`behavioral health urgent care facility' have the meaning given those 
terms for purposes of such section.''.
            (3) Payment.--Section 1833(a)(1) of the Social Security Act 
        (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (DD)'' and inserting 
                ``(DD)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``and (EE) with respect to crisis 
                response services described in section 1861(s)(2)(II), 
                the amounts paid shall be 80 percent of the lesser of 
                the actual charge for the service or the fee schedule 
                amount provided under section 1848''.
            (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 services to transport 
        an individual experiencing a mental or behavioral health 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 part of the crisis 
        response continuum of care under section 2 of the Behavioral 
        Health Crisis Services Expansion Act, as appropriate, for 
        crisis response services described in section 
        1861(s)(2)(II).''.
                    (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.--
            (1) In general.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended--
                    (A) in section 1902(a)(10)(A), in the matter 
                preceding clause (i), by striking ``and (30)'' and 
                inserting ``(30), and (31)''; and
                    (B) in section 1905--
                            (i) 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) subject to subsection (jj), crisis response services 
        (as defined in section 1861(lll)); and''; and
                            (ii) by adding at the end the following new 
                        subsection:
    ``(jj) Exception to Requirement To Provide Coverage for Crisis 
Response Services.--The requirement to provide services described in 
paragraph (31) of subsection (a) shall not apply with respect to a 
State for a fiscal year, if before the beginning of such year the State 
certifies to the satisfaction of the Secretary that implementing such 
requirement statewide for all individuals eligible to enroll in the 
State plan (or waiver of the State plan) would not be feasible by 
reason of a shortage of qualified providers of crisis response 
services, or facilities providing such treatment, that will contract 
with the State or a managed care entity with which the State has a 
contract under section 1903(m) or under section 1905(t)(3).''.
            (2) 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(lll))'' after ``any hospital''.
            (3) 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 1st day of the 1st calendar 
                quarter beginning after the close of the 1st 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(lll) of the Social Security Act)'' before the period.
    (d) Group Health Plans.--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 that offers health insurance coverage in the large 
group market shall ensure that such coverage includes crisis response 
services (as defined in section 1861(lll) of the Social Security 
Act).''.
    (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(lll) of the Social 
        Security Act (42 U.S.C. 1395x) (as amended by section 3).
            (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 (lll) 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 (lll) 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.

SEC. 4. BUILDING THE CRISIS CONTINUUM INFRASTRUCTURE.

    (a)  Additional Amounts for Mental Health Block Grant.--Section 
1920 of the Public Health Service Act (42 U.S.C. 300x-9) is amended by 
adding at the end the following:
    ``(d) Support for Crisis Response Services Infrastructure.--
            ``(1) In general.--In addition to amounts made available 
        under subsection (a), there are authorized to be appropriated 
        such sums as are necessary for each of fiscal years 2022, 2023, 
        and 2024, for purposes of supporting the infrastructure needed 
        to provide crisis response services (as defined in section 
        1861(lll) of the Social Security Act) in the States, which may 
        include training and continuing education, and administrative 
        expenses with respect to the provision of such services.
            ``(2) Allotments.--Each fiscal year for which amounts are 
        appropriated under paragraph (1), the Secretary shall allot to 
        each State that receives a grant under section 1911 for the 
        fiscal year an amount that bears the same relationship to the 
        total amount appropriated under paragraph (1) for the fiscal 
        year that the amount received by the State under section 
        1911(a) for the fiscal year bears to the total amount 
        appropriated under subsection (a) for the fiscal year.''.
    (b) Technical Assistance.--The Secretary of Health and Human 
Services (referred to in this section as the ``Secretary'') shall 
provide to States technical assistance regarding the provision of 
crisis response services, as defined in section 1861(lll) of the Social 
Security Act (42 U.S.C. 1395x) (as amended by section 3), including 
guidance on how States may blend Medicaid funds available to States 
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and 
funds available to States under the community mental health services 
block grant program under subpart I of part B of title XIX of the 
Public Health Service Act (42 U.S.C. 300x et seq.) and the substance 
abuse prevention and treatment block grant program under subpart II of 
part B of title XIX of such Act (42 U.S.C. 300x-21 et seq.) to provide 
such services.
    (c) Clearinghouse of Best Practices.--The Secretary shall develop 
and maintain a publicly available clearinghouse of best practices for 
the successful operation of each segment of the system for providing 
crisis response services (as defined in section 1861(lll) of the Social 
Security Act (42 U.S.C. 1395x) (as amended by section 3)) and the 
integration of such best practices into the provision of such services. 
The clearinghouse shall be updated annually.

SEC. 5. 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 911 
dispatchers to respond appropriately to individuals experiencing a 
psychiatric 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) firefighters;
            (2) emergency medical services personnel;
            (3) law enforcement officers;
            (4) 911 dispatchers;
            (5) representatives from each segment of the crisis 
        response continuum, as described in section 2, including 988 
        dispatchers;
            (6) individuals who have received services under such 
        crisis response continuum, including individuals under the age 
        of 18 and members of underserved communities; 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 911 callers to crisis care services 
                instead of responding with law enforcement officers;
                    (B) integrating the 988 system into the 911 system, 
                or transferring calls from the 911 system to the 988 
                system as appropriate; and
                    (C) a process for identifying 911 callers who are 
                in mental health distress and evaluating the level of 
                need of such callers, as defined by standardized 
                assessment tools such as the Level of Care Utilization 
                System (LOCUS) and the Child and Adolescent Level of 
                Care Utilization System (CALOCUS).
            (2) Updates.--The panel shall update recommendations issued 
        under this section not less frequently than every 5 years.
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