Sec. 302. Demonstration project to ensure Medicaid-enrolled children have access to integrated mental health and substance use disorder care services, including prevention and early intervention services

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Not later than the date that is 180 days after the date of the enactment of this section, the Secretary shall conduct a 54-month demonstration project for the purpose described in subsection

(b)under which the Secretary shall— for the first 18-month period of such project, award planning grants described in subsection (c); and for the remaining 36-month period of such project, provide to each State selected under subsection

(d)payments in accordance with subsection (e). The purpose described in this subsection is for each State that receives a planning grant under subsection

(c)to ensure that every Medicaid-enrolled child in the State has access to integrated mental health and substance use disorder care services, including prevention and early intervention services, so as to allow for the prevention, identification, and treatment of mental health and substance use conditions in primary care, children's hospitals, early care and education, schools, or other settings as appropriate (such as home visiting and early intervention programs for young children, foster care or other child welfare care settings, or workforce development programs and community centers for youth) (in this section collectively referred to as care settings ), through the following activities: Activities that support an ongoing assessment of the accessibility of integrated mental health and substance use disorder care services, including prevention and early intervention services, for Medicaid-enrolled children in the State that tracks progress toward the goal of all Medicaid-enrolled children (including infants and toddlers as well as transition-aged youth) having access to appropriate levels of services in care settings in which the children regularly engage, and that is conducted in partnership with such children and families, to ensure that the assessment reflects their perspective, experiences, and solutions. Activities that, taking into account the results of the assessment described in paragraph (1), support the development, implementation, and maintenance of State infrastructure, such as technology and the physical structures necessary to physically co-locate integrated mental health and substance use disorder care services, including prevention and early intervention services, and a workforce to provide the types of support, training, and technical assistance needed in order to offer integrated mental health and substance use care services, including prevention and early intervention services, in care settings with which Medicaid-enrolled children and their families regularly interact, which are selected for integration based on the assessment of where such children and their families can access such services, and for which furnishing integrated mental health and substance use disorder care services, including prevention and early intervention services, will be sustainable under the State's planned activities. Increased reimbursement and improved incentives for care settings to sustainably implement and provide (either through direct delivery or coordination in the case of a care setting that is an early care or education program)— developmentally appropriate mental health promotive and preventive interventions for Medicaid-enrolled children and their families, along with screening to identify psycho-social needs of such children who do not yet have a diagnosable mental health condition (consistent with the requirements for providing items and services described in section 1905(a)(4)(B) of the Social Security Act ( 42 U.S.C. 1396d(a)(4)(B) )(relating to early and periodic screening, diagnostic, and treatment services defined in section 1905(r) of such Act ( 42 U.S.C. 1396d(r) )) in accordance with the requirements of section 1902(a)(43) of such Act ( 42 U.S.C. 1396a(a)(43) ) and the pediatric preventive care standards included in the essential health benefits required under section 1302(b) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18022(b) )); evidence-based, person-centered, and culturally, linguistically, and developmentally appropriate interventions at the site of service, either in-person or virtually integrated, to address any identified family and child psycho-social needs, including developmentally appropriate assessment and diagnostic services, treatment, care coordination, and dyadic intervention approaches; and referral to developmentally appropriate mental health and substance use specialty care providers and programs, community-based resources, or virtual or digital services to address risk factors or meet psycho- social needs that cannot be addressed in an integrated setting. Improved regulatory oversight of policies governing the provision of services described in paragraph (3), including with respect to early and periodic screening, diagnostic, and treatment services referred to in such paragraph, mental health and substance use parity, network adequacy, essential health benefits referred to in such paragraph, Medicaid rate setting, scope of practice policies, and health professional shortage areas. Improved alignment between Medicaid and commercial health insurers to ensure that services described in paragraph

(3)are supported by commercial health insurers, such as through the initiation of multi-payer collaboratives. Improved coordination among State and local agencies and other stakeholders that fund or provide primary care, children's hospitals, early care and education, or other programs in care settings described in this subsection so as to include efforts to align policies to promote coordination of mental health and substance use services funded under such programs across care settings, including through the alignment of Medicaid with programs under the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 6301 et seq. ), the Individuals with Disabilities Education Act ( 20 U.S.C. 1400 et seq. ), the Family First Prevention Services Act (title VII of division E of the Bipartisan Budget Act of 2018 ( Public Law 115–123 ; 132 Stat. 232)), the Stephanie Tubbs Jones Child Welfare Services Program under subpart 1 of part B of title IV of the Social Security Act ( 42 U.S.C. 621 et seq. ), the MaryLee Allen Promoting Safe and Stable Families Program under subpart 2 of part B of title IV of the Social Security Act ( 42 U.S.C. 629 et seq. ), home visiting programs, including the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) under section 511 of the Social Security Act ( 42 U.S.C. 711 ), and health, education, and social welfare programs funded under the American Rescue Plan Act of 2021 ( Public Law 117–2 ; 135 Stat. 4) and the Child Care Development Block Grant Act of 1990 ( 42 U.S.C. 9857 et seq. ). Activities that include Medicaid-enrolled children and their families and caregivers as partners at all levels of decision-making, implementation, and evaluation, including engaging such children who are youth and their families directly as paraprofessional providers. For the first 18-month period of the demonstration project, the Secretary shall award planning grants to States that apply for such grants, including to entities specified in subparagraphs

(B)and

(C)of subsection (h)(7). A State awarded a planning grant under this subsection shall use the grant to carry out the activities described in paragraph

(2)for purposes of preparing and submitting an application to participate in the remaining 36-month period of the demonstration project in accordance with subsection (d). Activities described in this paragraph are, with respect to a State awarded a planning grant under this subsection, each of the following: Activities that support the development of an initial assessment of the access needs of Medicaid-enrolled children in the State with respect to mental health and substance use services, to determine the types of support, training, incentives, and technical assistance that primary care, early care and education, or other programs provided in care settings described in subsection

(b)and with which Medicaid-enrolled children and their families regularly engage need in order to offer integrated mental health and substance use disorder care services, including prevention and early intervention services, and which shall include engaging Medicaid-enrolled children and their families directly to ensure that the assessment builds toward solutions that meet their needs and reflect their perspectives, experiences, and solutions. Activities that, taking into account the results of the assessment described in subparagraph (A), support the development of State infrastructure, such as technology and the physical structures necessary to physically co-locate integrated mental health and substance use disorder care services, including prevention and early intervention services, to provide the types of support, training, incentives, and technical assistance that primary care, early care and education, or other programs provided in care settings described in subsection

(b)and with which Medicaid-enrolled children and their families regularly engage need in order to offer integrated mental health and substance use disorder care services, including prevention and early intervention services, to Medicaid-enrolled children, as well as activities that support ongoing engagement of Medicaid-enrolled children and their families in implementation and coordination with health insurers and with other child-serving agencies and stakeholders. For purposes of awarding planning grants under paragraph (1), there is appropriated, out of any funds in the Treasury not otherwise appropriated, $100,000,000, to remain available until expended. For the remaining 36-month period of the demonstration project, the Secretary shall make payments in accordance with subsection

(e)to all States that submit applications that meet the requirements of paragraph

(2)and carry out the activities described in that paragraph. A State seeking to be selected to participate in the remaining 36-month period of the demonstration project shall submit to the Secretary, at such time and in such form and manner as the Secretary requires, an application that includes such information, provisions, and assurances, as the Secretary may require, in addition to the following: A process for carrying out the ongoing assessment described in subsection (b)(1), taking into account the results of the initial assessment described in subsection (c)(2)(A). A review of Medicaid reimbursement methodologies and other policies related to furnishing integrated mental health and substance use disorder care services, including prevention and early intervention services, to Medicaid-enrolled children that may create barriers to access. If the State uses multiple reimbursement methodologies under Medicaid for mental health and substance use care (such as capitation, fee-for-service, value-based, and alternative payment programs), the State shall include in the application specific detailed information regarding how the State will verify that the combination of reimbursement methodologies employed by the State will result in improved access to integrated mental health and substance use disorder care services, including prevention and early intervention services, for Medicaid-enrolled children. The development of a plan, taking into account activities carried out under subsection (c)(2)(B), that will result in long-term and sustainable access to integrated mental health and substance use disorder care services, including prevention and early intervention services, for Medicaid-enrolled children which includes the following: Specific activities to increase access to integrated mental health and substance use disorder care services, including prevention and early intervention services, so as to allow for the prevention, identification, and treatment of mental health and substance use conditions in primary care, early care and education, or other programs provided in care settings described in subsection

(b)and with which Medicaid-enrolled children and their families regularly engage. Strategies that will incentivize a racially and culturally diverse array of providers (including paraprofessionals) to obtain the necessary training, education, and support to deliver integrated care for the developmentally appropriate prevention, identification, assessment, diagnosis, and treatment of mental health and substance use conditions in Medicaid-enrolled children in primary care, early care and education, or other programs provided in care settings described in subsection

(b)and with which Medicaid-enrolled children and their families regularly engage. Milestones and timeliness for implementing activities set forth in the plan, as determined by the Secretary. Specific measurable targets for increasing equitable access to integrated mental health and substance use disorder care services, including prevention and early intervention services, for Medicaid-enrolled children. Specific measurable targets for increasing the workforce providing integrated mental health and substance use disorder care services, including prevention and early intervention services. A process for reporting the information required under subsection (f)(1), including information to assess the effectiveness of the efforts of the State during the period of the demonstration project under this subsection and ensure the sustainability of such efforts after the conclusion of the demonstration project. The expected financial impact of the demonstration project on the State. A description of funding sources available to the State to expand access to integrated mental health and substance use disorder care services, including prevention and early intervention services in the State, including health care, public health, education, and social service funding opportunities. A preliminary plan for how the State will sustain access to integrated mental health and substance use disorder care services, including prevention and early intervention services, for Medicaid-enrolled children after the demonstration project, including maintenance of incentives and enhanced reimbursement rates. A description of how the State will coordinate the goals of the demonstration project with any waiver granted (or submitted by the State and pending) pursuant to section 1115 of the Social Security Act ( 42 U.S.C. 1315 ) for the delivery of mental health and substance use services under Medicaid, as applicable, and with State plans under the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 6301 et seq. ), the Individuals with Disabilities Education Act ( 20 U.S.C. 1400 et seq. ), the Family First Prevention Services Act (title VII of division E of the Bipartisan Budget Act of 2018 ( Public Law 115–123 ; 132 Stat. 232)), the Stephanie Tubbs Jones Child Welfare Services Program under subpart 1 of part B of title IV of the Social Security Act ( 42 U.S.C. 621 et seq. ), the MaryLee Allen Promoting Safe and Stable Families Program under subpart 2 of part B of title IV of the Social Security Act ( 42 U.S.C. 629 et seq. ), home visiting programs, including the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) under section 511 of the Social Security Act ( 42 U.S.C. 711 ), and health, education, and social welfare programs funded under the American Rescue Plan Act of 2021 ( Public Law 117–2 ; 135 Stat. 4) and the Child Care Development Block Grant Act of 1990 ( 42 U.S.C. 9857 et seq. ). In completing an application under subparagraph (A), a State shall consult with relevant stakeholders, including Medicaid managed care plans, primary and specialty health care provider organizations, Medicaid-enrolled children and their families, and other child-serving State and local agencies and stakeholders, and include in the application a description of such consultation. The Secretary shall provide technical assistance to States with respect to preparing and submitting an application that meets the requirements of subparagraphs

(A)and (B). For each quarter occurring during the remaining 36-month period of the demonstration project, the Secretary shall pay each State that submits an application that meets the requirements of subsection

(2)and carries out the activities described in that subsection, an amount equal to 80 percent of the qualified sums expended by the State for such quarter. For purposes of paragraph (1), the term qualified sums means, with respect to a State and a quarter, the amount equal to the amount (if any) by which— the sums expended by the State during such quarter that are attributable to— furnishing integrated mental health and substance use disorder care services, including prevention and early intervention services, to Medicaid-enrolled children; the development or enabling of State infrastructure, such as technology and the physical structures necessary to physically co-locate integrated mental health and substance use disorder care services, including prevention and early intervention services, delivered in or coordinated through primary care, early care and education, or other programs provided in care settings described in subsection

(b)and with which Medicaid-enrolled children and their families regularly engage; and the development of a workforce to provide the types of support, training, and technical assistance needed in order to offer integrated mental health and substance use care services, including prevention and early intervention services, in primary care, early care and education, or other programs provided in care settings described in subsection

(b)and with which Medicaid-enrolled children and their families regularly engage; exceeds 1/4 of the average annual amount expended by the State for the most recent 5-fiscal year period for medical assistance for mental health or substance use disorder care services for Medicaid-enrolled children in a primary care, children's hospitals, school, early care and education, or other developmentally appropriate care setting, as determined by the Secretary. No payment made under this subsection with respect to medical assistance furnished to a Medicaid-enrolled child shall be duplicative of any payment made to a provider participating under the State Medicaid program for the same services so furnished to the same child. Each State that receives payments under subsection

(e)during the remaining 36-month period of the demonstration project shall submit to the Secretary, in accordance with detailed, specific guidance that is issued by the Secretary not later than the first day of such period, and that includes information on how to estimate and reconcile State expenditures to carry out the demonstration project during such period, quarterly reports, with respect to expenditures for which payment is made to the State under subsection (e), on the following: The specific activities with respect to which payment under such subsection was provided. The number of primary care, children's hospitals, schools, and early care and education programs that delivered or coordinated integrated mental health and substance use disorder care services, including prevention and early intervention services, to Medicaid-enrolled children during such period and their geographic distribution, compared to the estimated number that would have otherwise delivered such services in the absence of the demonstration project, including disaggregated data on the race, ethnicity, and gender of providers. The number of Medicaid-enrolled children who received integrated mental health and substance use disorder care services, including prevention and early intervention services during such period compared to the estimated number of such children who would have otherwise received such services in the absence of the demonstration project, including disaggregated data on the race, ethnicity, gender, age (ensuring that children birth to 5 as well as transition-aged youth are adequately served), sexual orientation, primary language, income, and disability status of the children. Such other data or information as determined by the Secretary. Not later than October 1, 2026, the Administrator of the Centers for Medicare & Medicaid Services shall, in consultation with the Director of the Agency for Healthcare Research and Quality and the Assistant Secretary for Mental Health and Substance Use, submit to Congress an initial report on the activities carried out by States under the planning grants made under subsection (c), and actions taken by the Administrator of the Centers for Medicare & Medicaid Services to improve oversight of such activities. Not later than October 1, 2028, the Administrator of the Centers for Medicare & Medicaid Services shall, in consultation with the Director of the Agency for Healthcare Research and Quality and the Assistant Secretary for Mental Health and Substance Use, submit to Congress an interim report on activities carried out under the demonstration project and actions taken by the Administrator of the Centers for Medicare & Medicaid Services to improve oversight of such activities and the extent to which States have achieved the stated goals submitted in their applications. Such report shall include a description of the strengths and limitations of the demonstration project and a plan for the sustainability of the project. Not later than October 1, 2030, the Administrator of the Centers for Medicare & Medicaid Services shall, in consultation with the Director of the Agency for Healthcare Research and Quality and the Assistant Secretary for Mental Health and Substance Use, submit to Congress a final report providing updates on the matters reported in the interim report required by subparagraph

(B)and that includes— a description of any changes made with respect to the demonstration project after the submission of such interim report; and an evaluation of the demonstration project. There is appropriated, out of any funds in the Treasury not otherwise appropriated, $5,000,000 to the Administrator of the Centers for Medicare & Medicaid Services for purposes of implementing this section, to remain available until expended. In this section: The term children's hospitals has the meaning given that term in section 340E(g)(2) of the Public Health Service Act ( 42 U.S.C. 256e(g)(2) . The term mental health and substance use disorder care services has the meaning given that term in section 1848(b)(13)(B) of the Social Security Act and includes prevention and early intervention services and such other items and services for the care of mental health and substance use conditions furnished by, or in coordination with, a primary care practitioner as the Secretary, in consultation with a State, may specify. The term Medicaid means the program for grants to States for medical assistance programs established under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ). Except as otherwise specified, the term Secretary means the Secretary of Health and Human Services. The term State has the meaning given that term in section 1101(a)(1) of the Social Security Act ( 42 U.S.C. 1301(a)(1) ) for purposes of titles XIX and XXI of such Act, and for purposes of The term Medicaid-enrolled child means, with respect to a State, a child enrolled under the State plan approved under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) or under a waiver of such plan. The term Secretary means the Secretary of Health and Human Services. The term State means— each of the 50 States and the District of Columbia; the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands; and to the extent the Secretary determines appropriate, may include an Indian Tribe, Tribal organization, or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 )).

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132 Stat. 232
135 Stat. 4

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Sec. 302

Demonstration project to ensure Medicaid-enrolled children have access to integrated mental health and substance use disorder care services, including prevention and early intervention services

Pub. L.Public Law 115-123

U.S.C.§ 621

U.S.C.§ 629

U.S.C.§ 711

Stat.132 Stat. 232

Stat.135 Stat. 4

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