Revisions to the IMD exclusion under Medicaid

(a)

In general

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (1)in subsection (i)— (A)by striking The term and inserting the following:

(1)Subject to paragraph (2), the term

; and

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

(2)Beginning the day after the date of the enactment of this paragraph, the term institution for mental diseases does not include— (A)a clinic certified by the State as a certified community behavioral health clinic for purposes of participating in a demonstration program conducted under section 223(d) of the Protecting Access to Medicare Act of 2014; (B)a community mental health center that meets the criteria specified in section 1913(c) of the Public Health Service Act; (C)a crisis receiving and stabilization facility (as defined in subsection (ll)(1)); or (D)a mental health and substance use urgent care facility (as defined in subsection (ll)(2)).

; and

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

(ll)

Crisis receiving and stabilization facility; mental health and substance use urgent care facility

(1)

Crisis receiving and stabilization facility

For purposes of subsection (i)(2), the term crisis receiving and stabilization facility means a facility that— (A)is licensed or certified to furnish crisis response services under applicable State law; (B)is available to provide services 24 hours a day and 7 days a week; (C)provides patients with, at a minimum, 23 hours of observation and assessment services, followed by 48 hours of crisis stabilization services (including withdrawal management and 24-hour medical monitoring); (D)does not deny or limit services on the basis of a patient’s ability to pay, place of residence, prior engagement with the criminal justice system, acuity of mental health or substance use condition, intellectual or developmental disability, age, or related factors; (E)applies a schedule of discounts to the payment of fees or charges for the provision of its services, which are adjusted on the basis of the patient’s ability to pay; (F)accepts patient referrals from law enforcement officers, emergency medical personnel, and family members; and (G)maintains an average length of stay of less than 150 hours. (2)

Mental health and substance use urgent care facility

For purposes of subsection (i)(2), the term mental health and substance use urgent care facility means a 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.

(b)

Guidance

Not later than 180 days after the date of enactment of this section, the Secretary of Health and Human Services shall issue guidance to States relating to the implementation of the amendments made by subsection (a). (c)

Report

(1)

In general

Not later than 1 year after the date of the enactment of this section, the Secretary, in collaboration with the Attorney General and any other relevant Federal officials (as determined by the Secretary), shall submit to Congress a report that includes the following: (A)Information with respect to the utilization of crisis receiving and stabilization facilities during the period following such date of enactment, including— (i)the number of patients served; (ii)the type and duration of facility-based services; (iii)the number of referrals to community-based outpatient care; (iv)any trends observed in referrals made by law enforcement agencies to such facilities; and (v)any other data relevant to assessing the ability for these facilities to divert mental health and substance use disorder emergencies from law enforcement response. (B)An analysis of the extent to which access to crisis receiving and stabilization facilities is associated with— (i)reduced admissions to hospital emergency rooms; (ii)adverted admissions and readmissions to psychiatric hospitals and other facilities defined as Institutions for Mental Diseases; and (iii)decreased rates of incarceration in penal facilities operated by a State or county. (2)

Crisis receiving and stabilization facility defined

In this subsection, the term crisis receiving and stabilization facility has the meaning given such term in subsection (ll) of section 1905 of the Social Security Act (42 U.S.C. 1396d).