[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3450 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 3450

    To amend title XVIII of the Social Security Act to establish a 
demonstration program to promote collaborative treatment of mental and 
       physical health comorbidities under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 7, 2023

  Mr. Bennet introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to establish a 
demonstration program to promote collaborative treatment of mental and 
       physical health comorbidities under the Medicare program.

    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 ``Mental and Physical Health Care 
Comorbidities Act of 2023''.

SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM TO PROMOTE COLLABORATIVE 
              TREATMENT OF MENTAL AND PHYSICAL HEALTH COMORBIDITIES 
              UNDER THE MEDICARE PROGRAM.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after section 1866F the following new section:

``SEC. 1866H. MENTAL AND PHYSICAL HEALTH COMORBIDITIES COLLABORATIVE 
              DEMONSTRATION PROGRAM.

    ``(a) In General.--Consistent with the model described in section 
1115A(b)(2)(B)(xv) (relating to promoting improved quality and reduced 
cost by developing a collaborative of high-quality, low-cost health 
care institutions), the Secretary shall conduct a demonstration program 
(in this section referred to as the `program') to test and evaluate 
innovations implemented by eligible hospitals (as defined in subsection 
(f)) in the furnishing of items and services to applicable individuals 
(as defined in subsection (f)) with mental and physical health 
comorbidities (and those at risk of developing such comorbidities), 
including by addressing the adverse social determinants of health that 
such individuals often experience.
    ``(b) Activities Under Program.--Under the program, the Secretary 
shall, in coordination with eligible hospitals participating in the 
program--
            ``(1) identify, validate, and disseminate innovative, 
        effective evidence-based best practices and models that improve 
        care and outcomes for applicable individuals with mental and 
        physical health comorbidities located in vulnerable 
        communities, including by addressing the social determinants of 
        health that adversely impact such individuals; and
            ``(2) assist in the identification of potential payment 
        reforms under this title and title XIX that could more broadly 
        effectuate such improvements.
    ``(c) Duration and Scope.--The program conducted under this section 
shall operate during the period beginning on October 1, 2024, and 
ending no later than September 30, 2029.
    ``(d) Program Elements.--
            ``(1) In general.--An eligible hospital electing to 
        participate in the program shall enter into an agreement with 
        the Secretary for purposes of carrying out the activities 
        described in subsection (b). Such an agreement shall include 
        the plan described in paragraph (2), along with an annualized 
        payment arrangement as described in paragraph (3) to support 
        implementation of such plan. Such agreement shall include a 
        requirement for the hospital to--
                    ``(A) engage in the learning collaborative 
                established under subsection (e);
                    ``(B) certify that all proposed innovations under 
                such plan will supplement and not supplant existing 
                activities, whether by augmenting existing activities 
                or initiating new activities; and
                    ``(C) remit payments made under such arrangement to 
                the Secretary if the Secretary determines that such 
                hospital has not complied with the terms of such 
                agreement.
            ``(2) Program elements.--An eligible hospital electing to 
        participate in the program shall submit a proposed plan and 
        associated quality metrics for review and approval by the 
        Secretary. Such plan and metrics shall, at a minimum, address--
                    ``(A) the specific innovations addressing mental 
                and physical health comorbidities (as defined in 
                subsection (f)) and innovations addressing social 
                determinants of health (as defined in such subsection) 
                that will be employed and the evidence base supporting 
                the proposed approach;
                    ``(B) the proposed target population of applicable 
                individuals with respect to which such innovations will 
                be employed, including a description of the extent to 
                which such population consists of applicable 
                individuals described in subparagraph (A), (B), or (C) 
                of subsection (f)(1);
                    ``(C) the evidence-based data supporting a 
                community's status as a vulnerable community through 
                sources, such as Bureau of the Census data and measures 
                such as the Neighborhood Deprivation Index or the Child 
                Opportunity Index;
                    ``(D) community partners, such as nonprofit 
                organizations, federally qualified health centers, 
                rural health clinics, and units of local government 
                (including law enforcement and judicial entities) that 
                will participate in the implementation of such 
                innovations;
                    ``(E) how such innovations will address mental and 
                physical health comorbidities and social determinants 
                of health for the target population;
                    ``(F) how such innovations may inform changes in 
                payment and other policies under this title and title 
                XIX (such as care coordination reimbursement, mental 
                health homes, improvements to home and community-based 
                service portfolios, and coverage of supportive 
                services);
                    ``(G) how such innovations might contribute to a 
                reduction in overall health care costs, including under 
                this title and title XIX and for uninsured persons, 
                through improvements in population health, reductions 
                in health care utilization (such as inpatient 
                admissions, utilization of emergency departments, and 
                boarding of patients), and otherwise;
                    ``(H) how such innovations can be expected to 
                improve the mental and physical health status of 
                minority populations;
                    ``(I) how such innovations can be expected to 
                reduce other non-medical public expenditures;
                    ``(J) metrics to track care quality, improvement in 
                outcomes, and the impact of such innovations on health 
                care and other public expenditures;
                    ``(K) how program outcomes will be assessed and 
                evaluated; and
                    ``(L) how the hospital will collect and organize 
                data and fully participate in the learning 
                collaborative established under subsection (e).
            ``(3) Participation; payments.--The Secretary shall 
        negotiate an annualized payment arrangement with each eligible 
        hospital participating in the program. Such arrangement may 
        include an annual lump sum amount, capitated payment amount, or 
        such other arrangement as determined appropriate by the 
        Secretary, and which may include an arrangement that includes 
        financial risk for the hospital, to support implementation of 
        the innovations specified in the plan described in paragraph 
        (2).
    ``(e) Learning Collaborative.--
            ``(1) In general.--The Secretary shall establish a learning 
        collaborative that shall convene eligible hospitals 
        participating in the program and other interested parties on a 
        regular basis to report on and share information regarding 
        evidence-based innovations addressing mental and physical 
        health comorbidities, innovations addressing social 
        determinants of health, and associated metrics and outcomes.
            ``(2) Focused forums.--The Secretary may establish 
        different focused forums within the collaborative, such as ones 
        that specifically address different geographic regions (such as 
        urban and rural), certain types of comorbidities, or as the 
        Secretary otherwise determines appropriate based on the types 
        of agreements entered into under subsection (d).
            ``(3) Dissemination of information.--The Secretary shall 
        provide for the dissemination to other health care providers 
        and interested parties of information on promising and 
        effective activities.
    ``(f) Definitions.--For purposes of this section:
            ``(1) Applicable individual.--The term `applicable 
        individual' means an individual with mental and physical health 
        comorbidities who is--
                    ``(A) a subsidy eligible individual (as defined in 
                section 1860D-14(a)(3)(A)) without regard to clause (i) 
                of such section;
                    ``(B) enrolled under a State plan (or waiver of 
                such plan) under title XIX; or
                    ``(C) uninsured.
            ``(2) Eligible hospital.--The term `eligible hospital' 
        means a hospital that is--
                    ``(A) a rural hospital with a disproportionate 
                patient percentage of at least 35 percent (as 
                determined by the Secretary under section 
                1886(d)(5)(F)(vi)) or would have a disproportionate 
                patient percentage of at least 35 percent (as so 
                determined) if the hospital were a subsection (d) 
                hospital (or, a percentage of inpatient days consisting 
                of items and services furnished to individuals entitled 
                to benefits under part A that exceeds 85 percent of all 
                such days) that is either a critical access hospital, a 
                sole community hospital (as defined in section 
                1886(d)(5)(D)(iii)), or a medicare-dependent, small 
                rural hospital (as defined in section 
                1886(d)(5)(G)(iv));
                    ``(B) a large subsection (d) teaching and tertiary 
                hospital with more than 200 beds that as of, or 
                subsequent to July 1, 2020, has an average Medicare 
                case mix index of at least 1.5, an intern and resident-
                to-bed ratio of at least 0.25 percent (or at least 150 
                full-time equivalent interns, residents, and fellows), 
                and is either a public hospital with a disproportionate 
                patient percentage of at least 35 percent (as 
                determined by the Secretary under section 
                1886(d)(5)(F)(vi)) or a nonprofit hospital with a 
                disproportionate patient percentage of at least 45 
                percent; or
                    ``(C) a small subsection (d) urban safety net 
                hospital (as determined by the Secretary) with less 
                than 200 beds that is deemed to be a disproportionate 
                share hospital under section 1923(b).
            ``(3) Innovations addressing mental and physical health 
        comorbidities.--The term `innovations addressing mental and 
        physical health comorbidities' means innovations implemented by 
        an eligible hospital that seek to promote holistic care and 
        treatment of an applicable individual's co-occurring mental and 
        physical health comorbidities, support early detection of such 
        comorbidities, or prevent their onset, including the following:
                    ``(A) Implementation of interdisciplinary 
                integrative coordinated care team models, including 
                those that utilize mental health emergency department 
                in-reach staff (and other emergency-department 
                interventions), care coordination staff and social 
                services support, and clinic-based services.
                    ``(B) Integration of mental health services into 
                medical homes, coordinated care organizations, 
                accountable care entities, and in-home services.
                    ``(C) Incorporation of mental health and social 
                risk screening into medical screening, particularly in 
                child and adolescent populations.
                    ``(D) Preventing adverse impacts on mental health 
                resulting from physical health treatments or 
                medications, or on physical health resulting from 
                mental health treatments or medications, through cross 
                disciplinary provider education, quality metrics, and 
                other mechanisms.
                    ``(E) Improvements in electronic health records and 
                other technology platforms or networks to capture, 
                track, and monitor mental and physical health 
                treatments and medications provided across care 
                settings and otherwise facilitate care coordination.
                    ``(F) Piloting of reimbursement modifications that 
                utilize site-neutral payments and that address 
                conflicts and disincentives related to chronic care 
                management and behavioral health management and 
                differential treatment of inpatient and outpatient 
                settings.
                    ``(G) Mitigating the incidence of admission and 
                readmission into psychiatric inpatient settings of 
                chronically ill elderly patients through methods such 
                as active inpatient management, variations in initial 
                length of stay, enhanced discharge planning, and 
                psychosocial interventions.
                    ``(H) Delivering health behavior assessments and 
                interventions to improve physical health outcomes for 
                patients and aid in the management of chronic health 
                conditions.
                    ``(I) In coordination with law enforcement agencies 
                and judicial entities, interventions targeted at 
                providing mental and physical health services 
                (including, as appropriate, substance use disorder 
                services) to individuals convicted of criminal offenses 
                for purposes of mitigating recidivism.
            ``(4) Innovations addressing social determinants of 
        health.--The term `innovations addressing social determinants 
        of health' means innovations implemented by an eligible 
        hospital that seek to address social determinants of health 
        that negatively impact the health outcomes of applicable 
        individuals, including the following:
                    ``(A) Improvements in electronic health records to 
                better integrate mental health, medical care, and 
                social care (such as screening for social factors, 
                facilitated or closed loop referral, risk 
                stratification, and shared records with community-based 
                organizations).
                    ``(B) Personnel-supported `wrap around' services 
                for at-risk individuals with mental and physical health 
                comorbidities (such as nutrition and diet counseling, 
                social services referral, respiratory therapy, medical-
                legal assistance, financial counseling, consumer 
                education, pharmacy education, asthma education, and 
                referral to food resources such as referral to the SNAP 
                program, the WIC program, a food bank, case management 
                assistance, employment or education support, intimate 
                partner violence, and behavioral health support).
                    ``(C) Home and community-based services that 
                provide collaborative care to address mental and 
                physical health comorbidities through health behavior 
                services, nutrition support, medication management, 
                transitional care, telehealth, mobile integrated health 
                care, paramedic-based home visitation, or utilization 
                of community health workers.
                    ``(D) Hospital-based interventions (such as same 
                day primary care services, skilled nursing 
                interventions, substance use disorder and behavioral 
                health treatment coordination of care, collaborative 
                care models, discharge planning and medication 
                reconciliation, long-term care management, and post-
                traumatic injury management).
            ``(5) Individual with mental and physical health 
        comorbidities.--The term `individual with mental and physical 
        health comorbidities' means an individual who is challenged by 
        serious mental illness or serious emotional disturbance as well 
        as 1 or more of the following conditions or characteristics:
                    ``(A) Has or is at risk for one or more chronic 
                conditions (as defined by the Secretary).
                    ``(B) High-risk pregnancy.
                    ``(C) History of high utilization of acute care 
                services.
                    ``(D) Frail elderly (defined by impairments in 
                activities of daily living).
                    ``(E) Disability, including traumatic brain injury.
                    ``(F) Critical illness or injury requiring long-
                term recovery.
            ``(6) Vulnerable community.--The term `vulnerable 
        community' means a geographic area served by an eligible 
        hospital characterized by a population that has a statistically 
        significant number of individuals with mental and physical 
        health comorbidities, indicators of poor population health 
        status, low-income status, or status as a USDA-recognized food 
        desert.
    ``(g) Evaluation and Report.--Not later than 1 year after the date 
of completion of the program under this section, the Secretary shall 
submit to Congress a report containing an evaluation of the activities 
supported by the program. Such report shall include the following:
            ``(1) A description of each such activity, including--
                    ``(A) the target population of such activity;
                    ``(B) how such activity addressed the adverse 
                social determinants of health in such population; and
                    ``(C) the role of community-based organizations and 
                other community partners (such as nonprofits and units 
                of local government) in such activity.
            ``(2) Evidence showing whether and how each such activity 
        advanced any of the following objectives:
                    ``(A) Improved access to care.
                    ``(B) Improved quality of care.
                    ``(C) Improved health outcomes.
                    ``(D) Amelioration of disparities in care.
                    ``(E) Improved care coordination.
                    ``(F) Reduction in health care costs (including 
                such reductions under this title and title XIX and such 
                reductions occurring for uninsured individuals).
                    ``(G) Reduction in health care utilization 
                (including with respect to inpatient admissions, 
                utilization of emergency departments, and room and 
                board provided to individuals).
                    ``(H) Reduction in non-medical public expenditures.
                    ``(I) Changes in patient and provider satisfaction 
                with care delivery.
                    ``(J) Reductions in involvement with the justice 
                system, including reductions in recidivism.
            ``(3) A description of the metrics used to track the 
        implementation and results of each such activity.
            ``(4) Recommendations for any legislation or administrative 
        action the Secretary determines appropriate.
    ``(h) Funding.--Any funds appropriated under section 1115A(f) shall 
be available to the Secretary without further appropriation for the 
purposes of carrying out this section.''.
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