Sec. 255. Demonstration program to improve community mental health services
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Not later than January 1, 2016, the Secretary of Health and Human Services (referred to in this section as the Secretary ), in coordination with the Administrator of the Substance Abuse and Mental Health Services Administration, shall award planning grants to not to exceed 10 States to enable such States to carry out 5-year demonstration programs to improve the provision of behavioral health services provided by certified community behavioral health clinics in the State. To be eligible to receive a grant under subsection (a), a State shall— submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; certify to the Secretary that behavioral health providers that are provided assistance under the demonstration program meet the criteria for certified community behavioral health clinics under subsection (c); conduct a financial assessment of the demonstration program to be carried out under the grant by providing a detailed estimate of eligible clinics and Medicaid expenditures over the entire projected period of the demonstration program; and comply with any other requirement determined appropriate by the Secretary.
In approving States to conduct demonstration programs under this section, the Secretary shall waive section 1902(a)(1) of the Social Security Act ( 42 U.S.C. 1396a(a)(1) ) (relating to statewideness) as may be necessary to conduct the demonstration program in accordance with the requirements of this section The criteria referred to in subsection (b)(1)(B) are that the center performs each of the following: Provide services in locations that ensure services will be available and accessible promptly and in a manner which preserves human dignity and assures continuity of care.
Provide services in a mode of service delivery appropriate for the target population. Provide individuals with a choice of service options, including developmentally appropriate evidence based interventions, where there is more than one efficacious treatment. Employ a core clinical staff that is trained to provide evidence-based practices and is multidisciplinary and culturally and linguistically competent, including the availability of translation or similar services and arrangements if the clinic is located in a geographic area of limited English-speaking ability.
Establish an emergency plan to support continuity of services for individuals during an emergency or disaster. Demonstrate the capacity to comply with behavioral health and related health care quality measures promulgated by such entities as the National Quality Forum, the National Committee for Quality Assurance, or other nationally recognized accrediting bodies. Provide services to any individual residing or employed in the service area of the clinic and ensure that no patient or consumer will be denied mental health or other health care services due to an individual’s inability to pay for such services.
Ensure that any fees or payments required by the clinic for such services will be imposed for individuals eligible for medical assistance under the State Medicaid plan under title XIX of the Social Security Act in accordance with the requirements of such State plan and for any other individuals will be reduced or waived to enable the clinic to comply with subparagraph (G), including preparing a schedule of fees or payments for the provision of services that is consistent with locally prevailing rates or charges designed to cover the reasonable costs to the clinic of operation along with a corresponding schedule of discounts to be applied to the payment of such fees or payments, such discounts to be adjusted on the basis of the patient’s ability to pay.
Report required encounter data, clinical outcomes data, and quality data. Provide, directly or through contract, to the extent covered for adults in the State Medicaid plan under title XIX of the Social Security Act and for children in accordance with section 1905(r) of such Act regarding early and periodic screening, diagnosis, and treatment, each of the following services: Screening, assessment, and diagnosis, including risk assessment. Person-centered treatment planning or similar processes, including risk assessment and crisis planning.
Outpatient mental health and substance use services, including screening, assessment, diagnosis, psychotherapy, cognitive behavioral therapy, applied behavioral analysis, medication management, and integrated treatment for trauma, mental illness, and substance abuse which shall be evidence-based (including cognitive behavioral therapy, long acting injectable medications, and other such therapies which are evidence-based). Outpatient clinic primary care screening and monitoring of key health indicators and health risk (including screening for diabetes, hypertension, and cardiovascular disease and monitoring of weight, height, body mass index (BMI), blood pressure, blood glucose or HbA1C, and lipid profile).
Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization. Targeted case management (services to assist individuals gaining access to needed medical, social, educational, and other services and applying for income security and other benefits to which they may be entitled), and care coordination. Psychiatric rehabilitation services including skills training, assertive community treatment, family psychoeducation, disability self-management, supported employment, supported housing services, therapeutic foster care services, and such other evidence-based practices as the Secretary may require.
Peer support and counselor services and family supports. Maintain linkages, and where possible enter into formal contracts, agreements, or partnerships with at least one federally qualified health center, unless there is no such center serving the service area, in order to ensure that the delivery of behavioral health care is integrated with primary and preventive care services, so long as such linkages, contract, agreement, or partnership meets requirements as prescribed by the Secretary;
Maintain additional linkages and where possible enter into formal contracts with the following: Inpatient psychiatric facilities and substance use detoxification, post-detoxification step-down services, and residential programs. Adult and youth peer support and counselor services. Family support services for families of children with serious mental or substance use disorders. Other community or regional services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities, Indian Health Service youth regional treatment centers, housing agencies and programs, employers, State licensed and nationally accredited child placing agencies for therapeutic foster care service, and other social and human services.
Onsite or offsite access to primary care services. Enabling services, including outreach, transportation, and translation. Health and wellness services, including services for tobacco cessation. Department of Veterans Affairs medical centers, independent outpatient clinics, drop-in centers, and other facilities of the Department as defined in section 1801 of title 38, United States Code. Inpatient acute care hospitals and hospital outpatient clinics. Where feasible, provide outreach and engagement to encourage individuals who could benefit from mental health care to freely participate in receiving the administrative services described in this subsection.
Where feasible, provide intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, such care to be consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration. Where feasible, require certified community behavioral health clinics to provide valid and reliable trauma screening and functional or developmental assessment to determine need, match services to needs, and to measure progress over time.
Prior to the selection of participating States, and not later than 18 months after the date of the enactment of this Act, the Secretary, in consultation with the Substance Abuse and Mental Health Services Administration and the State Mental Health and Substance Abuse Authorities, shall issue final regulations for certifying non-profit and local government behavioral health authorities and Indian Health Service tribal facilities as community behavioral health clinics. In awarding grants under this section, the Secretary shall— ensure the geographic diversity of grantee States; ensure that certified community behavioral health clinics in such States that are located in rural areas, as defined by the Secretary, and other mental health professional shortage areas are fairly and appropriately considered with the objective of facilitating access to mental health services in such areas; take into account the ability of clinics in such States to provide required services, and the ability of such clinics to report required data as required under this section; and take into account the ability of such States to provide such required services on a statewide basis.
For purposes of this section, certified community behavioral health clinics that receive payments under section 1902(bb) of the Social Security Act which are located in rural areas, as defined by the Secretary, shall be exempt from the requirements contained in subparagraphs
(A)and (J)(v) of subsection (c)(1). For purposes of the demonstration program under this section, community behavioral health clinic services (as defined in subsection (h)(1)) that are provided by certified community behavioral health clinics receiving assistance under this section shall be considered medical assistance for purposes of payments to States under paragraph (3)(C). As a condition of receiving a grant under this section, a State shall agree to provide for payment for community behavioral health clinic services in accordance with the prospective payment system established by the Secretary under paragraph (3). Not later than 18 months after the date of enactment of this Act, the Secretary shall establish a prospective payment system for community behavioral health clinic services furnished by a community behavioral health clinic receiving assistance under this section in the same manner as payments are required to be made under section 1902(bb) of the Social Security Act ( 42 U.S.C. 1396a(bb) ) for services described in section 1905(a)(2)(C) of such Act ( 42 U.S.C. 1396d(a)(2)(C) ) furnished by a Federally-qualified health center and services described in section 1905(a)(2)(B) of such Act (42 U.S.C. 1396d(a)(2)(B)) furnished by a rural health clinic. The prospective payment system established by the Secretary under subparagraph
(A)shall provide that— no payment shall be made for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary; and no payment shall be made to satellite facilities of community behavioral health clinics if such facilities are established after the date of enactment of this Act. The Secretary shall pay each State awarded a grant under this section an amount each quarter equal to the enhanced FMAP (as defined in section 2105(b) of the Social Security Act ( 42 U.S.C. 1397dd(b) ) but without regard to the second and third sentences of that section) of the State's expenditures in the quarter for medical assistance for community behavioral health clinic services provided by certified community behavioral health clinics in the State that receive assistance under this section. Payments to States made under this subparagraph shall be considered to have been under, and are subject to the requirements of, section 1903 of the Social Security Act (42 U.S.C. 1396b). Not later than 1 year after the date on which the first grants are awarded under this section, and annually thereafter, the Secretary shall submit to Congress an annual report on the use of funds provided under the demonstration program. Each such report shall include— an assessment of access to community-based mental health services under the Medicaid program in the States awarded such grants; an assessment of the quality and scope of services provided by certified community behavioral health clinics under the grants as compared against community-based mental health services provided in States that are not receiving such grants; and an assessment of the impact of the demonstration programs on the costs of a full range of mental health services (including inpatient, emergency and ambulatory services). Not later than December 31, 2019, the Secretary shall submit to Congress recommendations concerning whether the demonstration programs under this section should be continued and expanded on a national basis. In this section: The term community behavioral health clinic services means ambulatory behavioral health services of the type described in subparagraphs (J), (M), (N), and
(O)of subsection (c)(1) that are provided by certified community behavioral health clinics receiving assistance under this section. The term State has the meaning given such term for purposes of title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ). There is authorized to be appropriated to carry out this section, $50,000,000 for fiscal year 2016, to remain available until expended.
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Sec. 255
Demonstration program to improve community mental health services
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