Sec. 202. Payment for certified community behavioral health clinic services under the medicare program
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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 (as defined in section 1861(aa)(8)), the amounts paid shall be equal to 80 percent of the lesser of the actual charge or the amount determined under section 1834(aa) . 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 clinic services (as defined in section 1861(aa)(8)) furnished by certified community behavioral health clinics (as defined in such section) under this title. In establishing such system, the Secretary— shall take into account the type, intensity, and duration of services furnished by certified community behavioral health clinics; and may incorporate such adjustments, including geographic adjustments, as the Secretary determines appropriate. 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. Under the system under this subsection, the Secretary shall provide for computation of a prospective payment amount for services furnished during a year as follows: For 2027, such amount shall be based on the average costs of such clinics which are reasonable (as determined without the application of a per visit payment limit or productivity screen and prior to the application of section 1866(a)(2)(A)(ii)) and related to the furnishing of the services described in section 1905(jj)(1)(B), as determined on the basis of the most current audited cost report data for 2 consecutive fiscal years available to the Secretary. In the absence of complete actual cost data representing the provision of such services during the relevant fiscal years, certified community behavioral health clinics may, at the Secretary’s discretion, submit estimated or projected data relating to specific services. For 2028, such amount shall be equal to the amount determined under subparagraph
(A), increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) for the year involved. For 2029 and each subsequent year, such amount shall be equal to the amount determined under this paragraph for the preceding year, increased 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 federally-qualified health center market basket (as described in section 1834(o)(2)(B)(ii)(II))) for the year involved. The Secretary may, from time to time, adjust the amounts that would otherwise be applicable under paragraph
(3)for a year 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 paragraph (2)(C) has been applied for the year. .
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Sec. 202
Payment for certified community behavioral health clinic services under the medicare program
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