Sec. 3. Payment parity for pediatric behavioral health services
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/bill/117/hr/7236/ih/section-3·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— in subsection (a)(13)— in subparagraph (B), by striking and at the end; in subparagraph (C), by adding and at the end; and by adding at the end the following new subparagraph: for payment for pediatric mental, emotional, and behavioral health services (as defined in subsection (tt)) furnished on or after the date that is 180 days after the date of enactment of this subparagraph and before October 1, 2027, at a rate not less than 100 percent of the payment rate that applies to such providers under part A or B (as applicable) of title XVIII; ; and by adding at the end the following new subsection:
For purposes of subsection (a)(13)(D), the term pediatric mental, emotional, and behavioral health services means the following services furnished by a health care provider, including hospitals, physicians, and other providers determined by the Secretary, for the purposes of screening for, diagnosing, or treating a mental, emotional, or behavioral health condition, whether furnished in-person or via telehealth: Mental health and substance use disorder screenings. Mental health development assessments.
Mental health behavior assessments and interventions. Psychological and neuropsychological testing and assessment. Mental health primary prevention services. Mental health and substance use disorder case management services. School-based mental health and substance use disorder prevention, identification, and treatment services. Child and adolescent psychiatry and psychology services. Partial hospitalization services. Day program services. Intensive outpatient services. Eating disorder treatment services.
Outpatient services. Crisis residential services. Crisis intervention and stabilization. Inpatient psychiatric and psychological services. Individual therapy. Family therapy. Group therapy services. Intensive in-home services. Peer support services. Provider-to-provider consultation services involving primary care practitioners sand mental health care specialists, including child and adolescent specialists. Substance use disorder screening, including SBIRT, and treatment. Medication management.
Any other pediatric mental, emotional, or behavioral health service determined appropriate by the Secretary. . Section 1932(f) of such Act ( 42 U.S.C. 1396u–2(f) ) is amended— in the header, by inserting before and pediatric mental, emotional, and behavioral health ; Services by inserting and pediatric mental, emotional, and behavioral health services described in section 1902(a)(13)(D) after section 1902(a)(13)(C) ; and by striking such section and inserting section 1902(a)(13) .
Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended by adding at the end the following new subsection: Notwithstanding subsection (b), with respect to the portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(D) furnished on or after the date that is 180 days after date of enactment of this subsection and before October 1, 2027, and that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan as of the day before the date of the enactment of this subsection, the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia shall be equal to 100 percent.
The preceding sentence does not prohibit the payment of Federal financial participation based on the Federal medical assistance percentage for amounts in excess of those specified in such sentence. .
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- 42 USC 1396u–2(f)
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Sec. 3
Payment parity for pediatric behavioral health services
Cite42 USC 1396u–2(f)
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