Payment for crisis stabilization services under prospective payment system for hospital outpatient department services

(a)

In general

Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended—(1)in paragraph (1)(B)—(A)in clause (iv), by striking and at the end;(B)in clause (v), by striking the period at the end and inserting ; and; and(C)by adding at the end the following new clause:

(vi)includes crisis stabilization services (as defined in paragraph (23)) furnished on or after January 1, 2027.

; and

(2)by adding at the end the following new paragraph:

(23)

Crisis stabilization services

(A)

Crisis stabilization services defined

In this subsection, the term crisis stabilization services means applicable items and services (as defined in subparagraph (B)) that are furnished to an eligible individual who is experiencing a mental health or substance use disorder crisis, subject to the requirements under subparagraph (C).(B)

Applicable items and services defined

(i)

In general

For purposes of subparagraph (A), the term applicable items and services means items and services described in clause (ii) that are—(I)covered under this part; and(II)(aa)reasonable and necessary for the diagnosis and active treatment of the individual’s mental health or substance use disorder condition; or(bb)reasonably expected to support the de-escalation of the individual’s mental health or substance use disorder crisis.(ii)

Items and services described

The following items and services are described in this clause:(I)Observation services and supervised care for individuals in severe distress for up to 23 consecutive hours.(II)Screening for suicide risk, including comprehensive suicide risk assessments and planning when clinically indicated.(III)Screening for violence risk, including comprehensive violence risk assessments and planning when clinically indicated.(IV)Assessment of immediate physical health needs and delivery of care for physical health needs that are within the capability of the hospital.(V)Such other items and services as the Secretary determines appropriate.(C)

Requirements for payment

In order to receive payment for crisis stabilization services under this subsection, a hospital must document, in a form and manner determined appropriate by the Secretary, that—(i)the hospital accepts referrals, within the capability of the hospital, for crisis stabilization services;(ii)the hospital is capable of providing referrals for health, social, and other services and supports, as needed, that are not provided as part of crisis stabilization services;(iii)the unit of the hospital that furnishes crisis stabilization services is staffed at all times (24 hours a day, 7 days a week, 365 days a year) with a multidisciplinary team, which may include providers such as a psychiatrist or psychiatric nurse practitioner (who may be available by telehealth for such staffing purposes), registered nurses, practitioners legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished, and peer support specialists (as defined in subparagraph (D)); and(iv)the unit of the hospital that furnishes crisis stabilization services is capable—(I)of timely communication with emergency response systems, crisis intervention hotlines, and physicians and practitioners furnishing mobile crisis response team services (as defined in subparagraph (D)); and(II)within the capacity of the hospital, of accepting referrals of individuals from such entities for crisis stabilization services.(D)

Definitions

In this paragraph:(i)

Mobile crisis response services

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.(ii)

Peer support specialist

The term peer support specialist means an individual who—(I)is recovering from a mental health or substance use condition; and(II)is certified as qualified to furnish peer support services under a certification process consistent with the National Practice Guidelines for Peer Supporters and inclusive of the Substance Abuse and Mental Health Services Administration Core Competencies for Peer Workers in Behavioral Health Settings (as established by the State in which such individual furnishes such services or under such certification process determined appropriate by the Secretary of Health and Human Services.

(b)

Report on Medicare coverage of crisis stabilization facility services

Not later than 18 months after the date of the enactment of this Act, the Secretary of Health and Human Services (referred to in this subsection as the Secretary) shall submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives a report on policy issues for consideration in relation to providing Medicare coverage of crisis stabilization services (as defined in section 1833(t)(23) of the Social Security Act, as added by subsection (a)), when furnished by crisis stabilization facilities that are not eligible to enroll in the Medicare program as a subsection (d) hospital (as defined in section 1886(d)(1)(B) of such Act (42 U.S.C. 1395ww(d)(1)(B))). Such report may include an assessment of the following:(1)Considerations relating to licensure and accreditation of such facilities by States and accreditation organizations to ensure care quality and program integrity.(2)Considerations relating to the development of payment rates for such facilities, including collection of data on the costs that such facilities incur in furnishing crisis stabilization services.(3)Considerations relating to any program integrity risks associated with crisis stabilization facilities and potential measures that could be implemented to mitigate those risks.(4)Other considerations determined appropriate by the Secretary.