[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10240 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 10240
To provide coverage of crisis response services under certain programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 3, 2026
Ms. McClellan (for herself, Ms. Matsui, Mrs. Trahan, Mr. Smith of
Washington, and Ms. Barragan) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Ways and Means, Armed Services, Veterans' Affairs,
Oversight and Government Reform, and Education and Workforce, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To provide coverage of crisis response services under certain programs.
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 of 2026''.
SEC. 2. 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 (JJ), by striking ``and'' at
the end;
(B) in subparagraph (KK), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(LL) crisis response services as defined in
subsection (ooo);''.
(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:
``(ooo) Crisis Response Services.--
``(1) In general.--The term `crisis response services'
means mental health or substance use services that are
furnished by a mobile crisis response team, a crisis receiving
and stabilization facility, mental health or substance use
urgent care facility, or other appropriate provider, as
determined by the Secretary, to an individual, including
children and adolescents, experiencing a mental health or
substance use crisis.
``(2) Crisis receiving and stabilization facility.--For
purposes of paragraph (1), the term `crisis receiving and
stabilization facility' means a facility that--
``(A) qualifies for licensure or certification as a
crisis receiving and stabilization facility, pursuant
to State law of the State in which such facility
furnishes services;
``(B) provides 23-hour observation and assessment
chairs or beds and 48-hour crisis stabilization
psychiatric beds inclusive of withdrawal management and
24-hour medical monitoring;
``(C) provides mental health or substance use
services 24 hours per day, 7 days per week using a
sliding scale of payment, and neither rejects service
nor limits services on the basis of a patient's ability
to pay, place of residence, prior forensic engagement,
acuity of mental health or substance use condition,
intellectual or developmental disability, age or
related factors;
``(D) supports no-wrong-door admission capacity
available to law enforcement officers, emergency
medical personnel, and family members; and
``(E) maintains an average length of stay of less
than 150 hours.
``(3) Mental health and substance use urgent care
facility.--For purposes of paragraph (1), the term `mental
health and substance use urgent care facility' means an
ambulatory facility where individuals experiencing a mental or
behavioral health crisis may walk in without an appointment to
receive crisis assessment services, crisis intervention
services, medication, and connection to other appropriate
services.''.
(3) Payment.--
(A) In general.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) by striking ``and (HH)'' and inserting
``(HH)''; and
(ii) by inserting before the semicolon at
the end the following: ``and (II) with respect
to crisis response services described in
section 1861(s)(2)(LL), the amounts paid shall
be 80 percent of the lesser of the actual
charge for the service or the amount determined
under the payment basis established under
section 1834(bb)''.
(B) Establishment of payment basis.--Section 1834
of the Social Security Act (42 U.S.C. 1395m) is amended
by adding at the end the following new subsection:
``(bb) Payment for Crisis Response Services.--The Secretary shall
establish a payment basis determined appropriate by the Secretary with
respect to crisis response services (as defined in section 1861(ooo))
furnished by a provider of services or supplier.''.
(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 and other qualified
emergency transport services to transport an individual
experiencing a mental health or substance 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 appropriate, for
crisis response services described in section
1861(s)(2)(LL).''.
(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.--Title XIX of the Social Security Act (42 U.S.C. 1396
et seq.) is amended--
(1) in section 1902(a)(10)(A), in the matter preceding
clause (i), by striking ``and (30)'' and inserting ``(30), and
(31)''; and
(2) in section 1905--
(A) in subsection (a)--
(i) in paragraph (31), by striking ``;
and'' and inserting a semicolon;
(ii) by redesignating paragraph (32) as
paragraph (33); and
(iii) by inserting the following paragraph
after paragraph (31):
``(32) crisis response services (as defined in section
1861(ooo)); and''.
(3) 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(ooo))'' after ``any hospital''.
(4) 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 first day of the first calendar
quarter beginning after the close of the first 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) Group Health Plans and Health Insurance Issuers.--
(1) PHSA.--Part D of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-111 et seq.) is amended by adding
at the end the following new section:
``SEC. 2799A-12. REQUIRED COVERAGE OF CRISIS RESPONSE SERVICES.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage shall
provide benefits under such plan or coverage for crisis response
services (as defined in section 1861(ooo) of the Social Security Act).
``(b) Application of Financial Requirements and Treatment
Limitations.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage shall ensure
that, with respect to services for which benefits are required to be
provided under such plan or coverage under subsection (a)--
``(1) the financial requirements applicable to such
services are no more restrictive than the predominant financial
requirements applied to substantially all medical and surgical
benefits covered by the plan or coverage and there are no
separate cost-sharing requirements that are applicable only
with respect to such services; and
``(2) the treatment limitations applicable to such items
and services are no more restrictive than the predominant
treatment limitations applied to substantially all medical and
surgical benefits covered by the plan or coverage and there are
no separate treatment limitations that are applicable only with
respect to such services.
``(c) Definitions.--In this section, the terms `financial
requirement', `predominant', and `treatment limitation' have the
meaning given such terms in clauses (i) through (iii), respectively, of
section 2726(a)(3)(B), except that the term `financial requirement'
shall include aggregate lifetime limits and annual limits.''.
(2) ERISA.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
adding at the end the following new section:
``SEC. 727. REQUIRED COVERAGE OF CRISIS RESPONSE SERVICES.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage shall provide benefits
under such plan or coverage for crisis response services (as defined in
section 1861(ooo) of the Social Security Act).
``(b) Application of Financial Requirements and Treatment
Limitations.--A group health plan and a health insurance issuer
offering group health insurance coverage shall ensure that, with
respect to services for which benefits are required to be provided
under such plan or coverage under subsection (a)--
``(1) the financial requirements applicable to such
services are no more restrictive than the predominant financial
requirements applied to substantially all medical and surgical
benefits covered by the plan or coverage and there are no
separate cost-sharing requirements that are applicable only
with respect to such services; and
``(2) the treatment limitations applicable to such items
and services are no more restrictive than the predominant
treatment limitations applied to substantially all medical and
surgical benefits covered by the plan or coverage and there are
no separate treatment limitations that are applicable only with
respect to such services.
``(c) Definitions.--In this section, the terms `financial
requirement', `predominant', and `treatment limitation' have the
meaning given such terms in clauses (i) through (iii), respectively, of
section 712(a)(3)(B), except that the term `financial requirement'
shall include aggregate lifetime limits and annual limits.''.
(B) Clerical amendment.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1001 note) is amended by
inserting after the item relating to section 726 the
following new item:
``Sec. 727. Required coverage of crisis response services.''.
(3) IRC.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following new section:
``SEC. 9827. REQUIRED COVERAGE OF CRISIS RESPONSE SERVICES.
``(a) In General.--A group health plan shall provide benefits under
such plan for crisis response services (as defined in section 1861(ooo)
of the Social Security Act).
``(b) Application of Financial Requirements and Treatment
Limitations.--A group health plan shall ensure that, with respect to
services for which benefits are required to be provided under such plan
under subsection (a)--
``(1) the financial requirements applicable to such
services are no more restrictive than the predominant financial
requirements applied to substantially all medical and surgical
benefits covered by the plan and there are no separate cost-
sharing requirements that are applicable only with respect to
such services; and
``(2) the treatment limitations applicable to such items
and services are no more restrictive than the predominant
treatment limitations applied to substantially all medical and
surgical benefits covered by the plan and there are no separate
treatment limitations that are applicable only with respect to
such services.
``(c) Definitions.--In this section, the terms `financial
requirement', `predominant', and `treatment limitation' have the
meaning given such terms in clauses (i) through (iii), respectively, of
section 9812(a)(3)(B), except that the term `financial requirement'
shall include aggregate lifetime limits and annual limits.''.
(B) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended by adding at the end the
following new item:
``Sec. 9827. Required coverage of crisis response services.''.
(4) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
the date that is 3 years after the date of the enactment of
this Act.
(d) 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(ooo) of the Social
Security Act (42 U.S.C. 1395x).
(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.
(e) 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 (ooo) of section 1861 of
the Social Security Act (42 U.S.C. 1395x)),'' after ``services''.
(f) 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 (ooo) 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.
(g) Coverage Under CHIP.--Section 2103(c)(5) of the Social Security
Act (42 U.S.C. 1397cc(c)(5)) is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(C) beginning on the date that is 3 years after
the date of the enactment of this subparagraph, crisis
response services (as defined in section 1861(ooo)).''.
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