Sec. 201. Coverage of certified community behavioral health clinic services under the Medicare program
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Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ) is amended— in subparagraph (II), by striking and at the end; in subparagraph (JJ), by inserting and at the end; and by adding at the end the following new subparagraph: certified community behavioral health clinic services (as defined in subsection (aa)(8)) furnished on or after January 1, 2024. . Section 1861(aa) of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in the heading, by striking and inserting and Federally Qualified Health Center Services ; and , Federally qualified health center services, and certified community behavioral health clinic services by adding at the end the following new paragraph:
The terms certified community behavioral health clinic services and certified community behavioral health clinic have the meaning given those terms in paragraphs
(1)and (2), respectively, of section 1905(jj). . Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ) is amended— by striking and
(HH)and inserting
(HH); and by inserting before the semicolon at the end the following: , and
(II)with respect to certified community behavioral health clinic services for which payment is made under section 1834(aa), the amounts paid shall be equal to 80 percent of the lesser of the actual charge or the amount determined under such section . Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ) is amended by adding at the end the following new subsection: The Secretary shall develop a prospective payment system for payment to certified community behavioral health clinics (as defined in section 1861(aa)(8)) for the furnishing of certified community behavioral health clinic services (as defined in such section) under this title. Such system shall be established to take into account the type, intensity, and duration of services furnished by certified community behavioral health clinics. Such system may include adjustments, including geographic adjustments, as determined appropriate by the Secretary. The Secretary shall provide, for cost reporting periods beginning on or after January 1, 2024, for payments of prospective payment rates for certified community behavioral health clinic services furnished by certified community behavioral health clinics under this title in accordance with the prospective payment system developed by the Secretary under paragraph (1). The Secretary shall implement such prospective payment system to reflect the national average allowable service costs of such clinics on the basis of the most current audited cost report data for two fiscal years available to the Secretary; provided that, in the absence of complete actual cost data representing the provision of the full covered benefit during the relevant fiscal years, certified community behavioral health clinics may, at the Secretary’s discretion, use estimated or projected data relating to specific services. Initial payments shall be established without the application of a per visit limit or productivity screen and shall be based on national average costs per unit of service, updated as appropriate by the inflationary adjustment described in subparagraph (C). Payment rates in years after the year of implementation of such system shall be the payment rates in the previous year increased— in the first year after implementation of such system, by the percentage increase in the MEI (as defined in section 1842(i)(3)) for the year involved; and in subsequent years, by the percentage increase in a market basket of certified community behavioral health clinic services, designed by the Secretary, or if such an index is not available, by the percentage increase in the MEI (as defined in section 1842(i)(3)) for the year involved. In establishing a prospective payment amount under the system under this subsection, the Secretary shall consider an appropriate unit of service and a general system design that provides for continued access to quality services. At the Secretary’s discretion, the Secretary shall, from time to time, adjust the amounts that would otherwise be applicable under subparagraph
(2)by a percentage determined appropriate by the Secretary to reflect such factors as changes in the intensity of services furnished within a unit of service, the average cost of providing care per unit of service, and other factors that the Secretary considers to be relevant. Such adjustment shall be made before the update under clause
(i)or
(ii)of paragraph (2)(C)(i) has been applied for the year. . Section 1833(b)(4) of the Social Security Act ( 42 U.S.C. 1395l(b)(4) ) is amended by inserting or certified community behavioral health clinic services before the comma at the end. Section 1878(j) of the Social Security Act ( 42 U.S.C. 1395oo(j) ) is amended by striking and a Federally qualified health center and inserting , a Federally qualified health center, and a certified community behavioral health clinic . Section 1128B(b)(3)(D) of the Social Security Act (42 U.S.C. 1320a–7b(b)(3)(D)) is amended by inserting or a certified community behavioral health clinic after Federally qualified health care center . The amendments made by this section shall apply with respect to services furnished on or after January 1, 2024.
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- 42 USC 1320a–7b(b)(3)(D)
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Sec. 201
Coverage of certified community behavioral health clinic services under the Medicare program
Cite42 USC 1320a–7b(b)(3)(D)
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