Sec. 6404. Additional support for youth and young adult mental health service provision

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Section 1903 of the Social Security Act ( 42 U.S.C. 1396b ) is amended by adding at the end the following new subsection: Notwithstanding section 1902(a)(1) (relating to Statewideness), section 1902(a)(10)(B) (relating to comparability), section 1902(a)(23)(A) (relating to freedom of choice of providers), or section 1902(a)(27) (relating to provider agreements), a State may, during the 5-year period beginning on the first day of the fiscal year quarter that begins on or after January 1, 2024, provide medical assistance for qualifying youth and young adult mental health and substance use intervention services (as defined in paragraph (2)(C)) under a State plan amendment or waiver approved under section 1115 or 1915(c).

For the purposes of this subsection: The term priority service means any of the following if voluntarily received and provided in a manner that maintains the privacy and confidentiality of patient information consistent with Federal and State requirements: Community-based mobile crisis intervention services, as defined in section 1947. Telehealth. Youth peer support. Screening for adverse childhood experiences. Trauma responsive care. Other priority services for youth, as defined by the Secretary.

The term qualified mental health providers means a behavioral health care professional who is capable of conducting an assessment of the individual, in accordance with the professional’s permitted scope of practice under State law, and other professionals or paraprofessionals with appropriate expertise in youth and young adult behavioral health or mental health, including social workers, peer support specialists, recovery coaches, community health workers, mental health clinicians, and others, as designated by the State and approved by the Secretary.

The term qualifying youth and young adult mental health and substance use intervention services means, with respect to a State, items and services for which medical assistance is available under the State plan under this title or a waiver of such plan, that are— furnished to an individual 16 to 25 years of age who is— experiencing a mental health or substance use disorder crisis; subject to the juvenile or adult justice system as defined in section 3102 of title 29, United States Code; experiencing homelessness (as defined in section 41403(6) of the Violence Against Women Act of 1994 ( 42 U.S.C. 14043e–2(6) )); a homeless child or youth (as defined in section 725(2) of the McKinney-Vento Homeless Assistance Act ( 42 U.S.C. 11434a(2) )); a runaway, in foster care, or has aged out of the foster care system; a child eligible for assistance under section 477 of the Social Security Act ( 42 U.S.C. 677 ); or in an out-of-home placement; pregnant or parenting as defined in section 3102 of title 29, United States Code; a youth who is an individual with a disability as defined in section 3102 of title 29, United States Code; a low-income youth requiring additional assistance to enter or complete an educational program or to secure or hold employment as defined in section 3102 of title 29, United States Code; or living in a community that has faced acute or long-term exposure to substantial discrimination, historical oppression, intergenerational poverty, civil unrest, or a high rate of violence or drug overdose deaths; furnished by qualified mental health providers; and a priority service.

The term telehealth means use of electronic information and telecommunications technologies, including voice only audio, text, remote patient monitoring, and mHealth via applications, to support clinical mental health care, patient and professional health-related education, public health, and health administration. Notwithstanding section 1905(b), beginning January 1, 2024, during each of the first 20 fiscal quarters that a State meets the requirements described in paragraph (4), the Federal medical assistance percentage applicable to amounts expended by the State for medical assistance for qualifying youth and young adult mental health and substance use intervention services furnished during such quarter shall be equal to 100 percent.

The requirements described in this paragraph are the following: The State demonstrates, to the satisfaction of the Secretary— that it will be able to support the provision of qualifying youth and young adult mental health and substance use intervention services that meet the conditions specified in paragraphs

(1)and (2); and how it will support coordination between qualified mental health providers and substance use teams and community partners, including health care providers, to enable the provision of services, needed referrals, and other activities identified by the Secretary. The State provides assurances satisfactory to the Secretary that— any additional Federal funds received by the State for qualifying youth and young adult mental health and substance use intervention services provided under this subsection that are attributable to the increased Federal medical assistance percentage under paragraph (3)(A) will be used to supplement, and not supplant, the level of State funds expended for such services for fiscal year 2024; if the State made qualifying youth and young adult mental health and substance use intervention services available in a region of the State in fiscal year 2023 the State will continue to make such services available in such region under this subsection at the same level that the State made such services available in such fiscal year; and the State will conduct the evaluation and assessment, and submit the report required under paragraph (5). Not later than 4 fiscal quarters after a State begins providing qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection, the State shall enter into a contract with an independent entity or organization to conduct an evaluation for the purposes of— determining the effect of the provision of such services on— emergency room visits; use of ambulatory services; hospitalizations; the involvement of law enforcement in mental health or substance use disorder crisis events; and the diversion of individuals from jails or similar settings; and assessing— the types of services provided to individuals; the types of events responded to; cost savings or cost-effectiveness attributable to such services; the experiences of individuals who receive qualifying youth and young adult mental health and substance use intervention services; the successful connection of individuals with follow-up services; and other relevant outcomes identified by the Secretary. The contract described in subparagraph

(A)shall specify that the evaluation is based on a comparison of the historical measures of State performance with respect to the outcomes specified under such subparagraph to the State’s performance with respect to such outcomes during the period beginning with the first quarter in which the State begins providing qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection. Not later than 2 years after a State begins to provide qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection, the State shall submit a report to the Secretary on the following: The results of the evaluation carried out under subparagraph (A). The number of individuals who received qualifying youth and young adult mental health and substance use intervention services. Demographic information regarding such individuals when available, including the race and ethnicity, age, sex, sexual orientation, gender identity, and geographic location of such individuals. The processes and models developed by the State to provide qualifying youth and young adult mental health and substance use intervention services under such the State plan or waiver, including the processes developed to provide referrals for, or coordination with, follow-up care and services. Lessons learned regarding the provision of such services. The State shall make the report required under subparagraph

(C)publicly available, including on the website of the appropriate State agency, upon submission of such report to the Secretary. Not later than 3 years after the first State begins to provide qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection, the Secretary shall submit a report to Congress that— identifies the States that elected to provide services in accordance with this subsection; summarizes the information reported by such States under paragraph (5)(C); and identifies best practices for the effective delivery of youth and young adult mental health and substance use intervention services. The report required under subparagraph

(A)shall be made publicly available, including on the website of the Department of Health and Human Services, upon submission to Congress. For the purpose of applying the prohibitions against discrimination on the basis of age under the Age Discrimination Act of 1975 ( 42 U.S.C. 6101 et seq. ), on the basis of handicap under section 504 of the Rehabilitation Act of 1973 ( 29 U.S.C. 794 ), on the basis of sex under title IX of the Education Amendments of 1972 ( 20 U.S.C. 1681 et seq. ), or on the basis of race, color, or national origin under title VI of the Civil Rights Act of 1964 ( 42 U.S.C. 2000d et seq. ), programs and activities funded in whole or in part with funds made available under this subchapter are considered to be programs and activities receiving Federal financial assistance. No person shall on the ground of sex or religion be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any program or activity funded in whole or in part with funds made available under this title. Whenever the Secretary finds that a State, or an entity that has received a payment from an allotment to a State under section 702(c) of this title, has failed to comply with a provision of law referred to in subsection (a)(1), with subsection (a)(2), or with an applicable regulation (including one prescribed to carry out subsection (a)(2)), he shall notify the chief executive officer of the State and shall request him to secure compliance. If within a reasonable period of time, not to exceed 60 days, the chief executive officer fails or refuses to secure compliance, the Secretary may— refer the matter to the Attorney General with a recommendation that an appropriate civil action be instituted; exercise the powers and functions provided by title VI of the Civil Rights Act of 1964 ( 42 U.S.C. 2000d et seq. ), the Age Discrimination Act of 1975 ( 42 U.S.C. 6101 et seq. ), or section 504 of the Rehabilitation Act of 1973 ( 29 U.S.C. 794 ), as may be applicable; or take such other action as may be provided by law. When a matter is referred to the Attorney General pursuant to subsection (b)(1), or whenever he has reason to believe that the entity is engaged in a pattern or practice in violation of a provision of law referred to in subsection (a)(1) or in violation of subsection (a)(2), the Attorney General may bring a civil action in any appropriate district court of the United States for such relief as may be appropriate, including injunctive relief. .

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