Sec. 223. DEMONSTRATION PROGRAMS TO IMPROVE COMMUNITY MENTAL HEALTH SERVICES

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## SEC. 223 DEMONSTRATION PROGRAMS TO IMPROVE COMMUNITY MENTAL HEALTH SERVICES **[**[42 U.S.C. 1396a note](/us/usc/t42/s1396a)**]** ###

(a)Criteria for Certified Community Behavioral Health Clinics To Participate in Demonstration Programs ####

(1)Publication Not later than September 1, 2015, the Secretary shall publish criteria for a clinic to be certified by a State as a certified community behavioral health clinic for purposes of participating in a demonstration program conducted under subsection (d). ####

(2)Requirements The criteria published under this subsection shall include criteria with respect to the following: #####

(A)Staffing Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State-required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic’s patient population. #####

(B)Availability and accessibility of services Availability and accessibility of services, including crisis management services that are available and accessible 24 hours a day, the use of a sliding scale for payment, and no rejection for services or limiting of services on the basis of a patient’s ability to pay or a place of residence. #####

(C)Care coordination Care coordination, including requirements to coordinate care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services including acute, chronic, and behavioral health needs. Care coordination requirements shall include partnerships or formal contracts with the following: ######

(i)Federally-qualified health centers (and as applicable, rural health clinics) to provide Federally-qualified health center services (and as applicable, rural health clinic services) to the extent such services are not provided directly through the certified community behavioral health clinic. ######

(ii)Inpatient psychiatric facilities and substance use detoxification, post-detoxification step-down services, and residential programs. ######

(iii)Other community or regional services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities, Indian Health Service youth regional treatment centers, State licensed and nationally accredited child placing agencies for therapeutic foster care service, and other social and human services. ######

(iv)Department of Veterans Affairs medical centers, independent outpatient clinics, drop-in centers, and other facilities of the Department as defined in section 1801 of title 38, United States Code. ######

(v)Inpatient acute care hospitals and hospital outpatient clinics. #####

(D)Scope of services Provision (in a manner reflecting person-centered care) of the following services which, if not available directly through the certified community behavioral health clinic, are provided or referred through formal relationships with other providers: ######

(i)Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization. ######

(ii)Screening, assessment, and diagnosis, including risk assessment. ######

(iii)Patient-centered treatment planning or similar processes, including risk assessment and crisis planning. ######

(iv)Outpatient mental health and substance use services. ######

(v)Outpatient clinic primary care screening and monitoring of key health indicators and health risk. ######

(vi)Targeted case management. ######

(vii)Psychiatric rehabilitation services. ######

(viii)Peer support and counselor services and family supports. ######

(ix)Intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration. #####

(E)Quality and other reporting Reporting of encounter data, clinical outcomes data, quality data, and such other data as the Secretary requires. #####

(F)Organizational authority Criteria that a clinic be a non-profit or part of a local government behavioral health authority or operated under the authority of the Indian Health Service, an Indian tribe or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act (25 U.S.C. 450 et seq.), or an urban Indian organization pursuant to a grant or contract with the Indian Health Service under title V of the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.). ###

(b)Guidance on Development of Prospective Payment System for Testing Under Demonstration Programs ####

(1)In general Not later than September 1, 2015, the Secretary, through the Administrator of the Centers for Medicare & Medicaid Services, shall issue guidance for the establishment of a prospective payment system that shall only apply to medical assistance for mental health services furnished by a certified community behavioral health clinic participating in a demonstration program under subsection (d). ####

(2)Requirements The guidance issued by the Secretary under paragraph

(1)shall provide that— #####

(A)no payment shall be made for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary; and #####

(B)no payment shall be made to satellite facilities of certified community behavioral health clinics if such facilities are established after the date of enactment of this Act. ###

(c)Planning Grants ####

(1)In general Not later than January 1, 2016, the Secretary shall award planning grants to States for the purpose of developing proposals to participate in time-limited demonstration programs described in subsection (d). ####

(2)Use of funds A State awarded a planning grant under this subsection shall— #####

(A)solicit input with respect to the development of such a demonstration program from patients, providers, and other stakeholders; #####

(B)certify clinics as certified community behavioral health clinics for purposes of participating in a demonstration program conducted under subsection (d); and #####

(C)establish a prospective payment system for mental health services furnished by a certified community behavioral health clinic participating in a demonstration program under subsection

(d)in accordance with the guidance issued under subsection (b). ####

(3)Additional planning grants for states In addition to the planning grants awarded under paragraph (1), as soon as practicable after the date of enactment of this paragraph, the Secretary shall award planning grants to States (other than States selected to conduct demonstration programs under paragraph

(1)or

(8)of subsection (d)) to develop proposals to participate in time-limited demonstration programs described in subsection

(d)so that, beginning July 1, 2024, and every 2 years thereafter, up to 10 additional States may participate in the demonstration programs described in subsection

(d)in accordance with paragraph

(9)of that subsection. ###

(d)Demonstration Programs ####

(1)In general Not later than September 1, 2017, the Secretary shall select States to participate in demonstration programs that are developed through planning grants awarded under subsection (c), meet the requirements of this subsection, and represent a diverse selection of geographic areas, including rural and underserved areas. ####

(2)Application requirements #####

(A)In general The Secretary shall solicit applications to participate in demonstration programs under this subsection solely from States awarded planning grants under subsection (c). #####

(B)Required information An application for a demonstration program under this subsection shall include the following: ######

(i)The target Medicaid population to be served under the demonstration program. ######

(ii)A list of participating certified community behavioral health clinics. ######

(iii)Verification that the State has certified a participating clinic as a certified community behavioral health clinic in accordance with the requirements of subsection (b). ######

(iv)A description of the scope of the mental health services available under the State Medicaid program that will be paid for under the prospective payment system tested in the demonstration program. ######

(v)Verification that the State has agreed to pay for such services at the rate established under the prospective payment system. ######

(vi)Such other information as the Secretary may require relating to the demonstration program including with respect to determining the soundness of the proposed prospective payment system. ####

(3)Number and length of demonstration programs Subject to paragraphs

(8)and (9), not more than 8 States shall be selected to conduct demonstration programs that meet the requirements of this subsection through September 30, 2025. ####

(4)Requirements for selecting demonstration programs #####

(A)In general The Secretary shall give preference to selecting demonstration programs where participating certified community behavioral health clinics— ######

(i)provide the most complete scope of services described in subsection (a)(2)(D) to individuals eligible for medical assistance under the State Medicaid program; ######

(ii)will improve availability of, access to, and participation in, services described in subsection (a)(2)(D) to individuals eligible for medical assistance under the State Medicaid program; ######

(iii)will improve availability of, access to, and participation in assisted outpatient mental health treatment in the State; or ######

(iv)demonstrate the potential to expand available mental health services in a demonstration area and increase the quality of such services without increasing net Federal spending. ####

(5)Payment for medical assistance for mental health services provided by certified community behavioral health clinics #####

(A)In general The Secretary shall pay a State participating in a demonstration program under this subsection the Federal matching percentage specified in subparagraph

(B)for amounts expended by the State to provide medical assistance for mental health services described in the demonstration program application in accordance with paragraph (2)(B)(iv) that are provided by certified community behavioral health clinics to individuals who are enrolled in the State Medicaid program. Payments to States made under this paragraph shall be considered to have been under, and are subject to the requirements of, section 1903 of the Social Security Act (42 U.S.C. 1396b). #####

(B)Federal matching percentage Subject to subparagraph (C)(iii), the Federal matching percentage specified in this subparagraph is with respect to medical assistance described in subparagraph

(A)that is furnished by a State participating in an ongoing demonstration program under this subsection— ######

(i)to a newly eligible individual described in paragraph

(2)of section 1905(y) of the Social Security Act (42 U.S.C. 1396d(y)), the matching rate applicable under paragraph

(1)of that section; and ######

(ii)to an individual who is not a newly eligible individual (as so described) but who is eligible for medical assistance under the State Medicaid program, the enhanced FMAP applicable to the State. #####

(C)Limitations ######

(i)In general Payments shall be made under this paragraph to a State only for mental health services— ######

(I)that are described in the demonstration program application in accordance with paragraph (2)(iv); ######

(II)for which payment is available under the State Medicaid program; and ######

(III)that are provided to an individual who is eligible for medical assistance under the State Medicaid program. ######

(ii)Prohibited payments No payment shall be made under this paragraph— ######

(I)for inpatient care, residential treatment, room and board expenses, or any other non- ambulatory services, as determined by the Secretary; or ######

(II)with respect to payments made to satellite facilities of certified community behavioral health clinics if such facilities are established after the date of enactment of this Act. ######

(iii)Payments for amounts expended after 2019 The Federal matching percentage applicable under subparagraph

(B)to amounts expended by a State participating in the demonstration program under this subsection shall— ######

(I)in the case of a State participating in the demonstration program as of January 1, 2020, apply to amounts expended by the State through September 30, 2025;2 ######

(II)in the case of a State selected to participate in the demonstration program under paragraph (8), during the first 24 fiscal quarter period (or any portion of such period) that the State participates in the demonstration program; and ######

(III)in the case of a State selected to participate in the demonstration program under paragraph (9), during the first 16 fiscal quarter period (or any portion of such period) that the State participates in the demonstration program. 2Section 206(2) of division CC of Public Law 116–260 provides for an amendment to clause (iii)(I) by striking “during the 8 fiscal quarter period (or any portion of the period) that begins on January 1, 2020” and inserting “through September 30, 2023”. Such amendment should have been made to strike “during the 8 fiscal quarter period (or any portion of such period) that begins on January 1, 2020”, however, it was carried out here in order to reflect the probable intent of Congress. Such subclause

(I)was subsequently amended by section 11001(2)(B)(ii)(I) of Public Law 117–159 striking “September 30, 2023; and” and inserting “September 30, 2025;”. #####

(D)Rule of construction Nothing in this section shall be construed as prohibiting a State that participated in a demonstration program under this subsection that has ended from receiving Federal financial participation under title XIX of the Social Security Act for amounts expended by the State under a State plan under such title (or a waiver of such plan) for providing medical assistance for items and services, and carrying out activities, including continuing to pay for services under the prospective payment system established under subsection (c), that were provided or carried out by the State under the demonstration program, to the extent such financial participation is otherwise available under such title. ####

(6)Waiver of statewideness requirement The Secretary shall waive section 1902(a)(1) of the Social Security Act (42 U.S.C. 1396a(a)(1)) (relating to statewideness) as may be necessary to conduct demonstration programs in accordance with the requirements of this subsection. ####

(7)Annual reports #####

(A)In general Not later than 1 year after the date on which the first State is selected for a demonstration program under this subsection, and annually thereafter through the year in which the last demonstration under this section ends, the Secretary shall submit to Congress an annual report on the use of funds provided under all demonstration programs conducted under this subsection. Each such report shall include— ######

(i)an assessment of access to community-based mental health services under the Medicaid program in the area or areas of a State targeted by a demonstration program compared to other areas of the State; ######

(ii)an assessment of the quality and scope of services provided by certified community behavioral health clinics compared to community-based mental health services provided in States not participating in a demonstration program under this subsection and in areas of a demonstration State that are not participating in the demonstration program; and ######

(iii)an assessment of the impact of the demonstration programs on the Federal and State costs of a full range of mental health services (including inpatient, emergency and ambulatory services). #####

(B)Recommendations Not later than September 30, 2025, the Secretary shall submit to Congress recommendations concerning whether the demonstration programs under this section should be continued, expanded, modified, or terminated. Such recommendations shall include data collected after 2019, where feasible. #####

(C)Final evaluation Not later than 24 months after all demonstration programs under this section have ended, the Secretary shall submit to Congress a final evaluation of such programs. ####

(8)Additional programs #####

(A)In general Not later than 6 months after the date of enactment of this paragraph, in addition to the 8 States selected under paragraph (1), the Secretary shall select 2 States to conduct demonstration programs that meet the requirements of this subsection for 6 years. #####

(B)Selection of states ######

(i)In general Subject to clause (ii), in selecting States under this paragraph, the Secretary— ######

(I)shall select States that— ######

(aa)were awarded planning grants under subsection (c); and ######

(bb)applied to participate in the demonstration programs under this subsection under paragraph

(1)but, as of the date of enactment of this paragraph, were not selected to participate under paragraph (1); and ######

(II)shall use the results of the Secretary’s evaluation of each State’s application under paragraph

(1)to determine which States to select, and shall not require the submission of any additional application. #####

(C)Requirements for selected states Prior to services being delivered under the demonstration authority in a State selected under this paragraph, the State shall— ######

(i)submit a plan to monitor certified community behavioral health clinics under the demonstration program to ensure compliance with certified community behavioral health criteria during the demonstration period; and ######

(ii)commit to collecting data, notifying the Secretary of any planned changes that would deviate from the prospective payment system methodology outlined in the State’s demonstration application, and obtaining approval from the Secretary for any such change before implementing the change. ####

(9)Further additional programs #####

(A)In general In addition to the States selected under paragraphs

(1)and (8), the Secretary shall select any State that meets the requirements described in subparagraph

(B)to conduct a demonstration program that meets the requirements of this subsection for 4 years. #####

(B)Requirements The requirements described in this subparagraph with respect to a State are that the State— ######

(i)was awarded a planning grant under paragraph

(1)or

(3)of subsection (c); and ######

(ii)submits an application (in addition to any application that the State may have previously submitted under this section) that includes the information described in paragraph (2)(B). #####

(C)Requirements for selected states The requirements applicable to States selected under paragraph

(8)pursuant to subparagraph

(C)of such paragraph shall apply in the same manner to States selected under this paragraph. #####

(D)Limitation The Secretary shall not select more than 10 States to conduct a demonstration program under this paragraph for each 2 fiscal year period. ###

(e)Definitions In this section: ####

(1)Federally-qualified health center services; federally-qualified health center; rural health clinic services; rural health clinic The terms “Federally-qualified health center services”, “Federally-qualified health center”, “rural health clinic services”, and “rural health clinic” have the meanings given those terms in section 1905(l) of the Social Security Act (42 U.S.C. 1396d(l)). ####

(2)Enhanced fmap The term “enhanced FMAP” has the meaning given that term in section 2105(b) of the Social Security Act (42 U.S.C. 1397dd(b)) but without regard to the second and third sentences of that section. ####

(3)Secretary The term “Secretary” means the Secretary of Health and Human Services. ####

(4)State The term “State” has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). ###

(f)Funding ####

(1)In general Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary— #####

(A)for purposes of carrying out subsections (a), (b), and (d)(7), $2,000,000 for fiscal year 2014; #####

(B)for purposes of awarding planning grants under subsection (c), $25,000,000 for fiscal year 2016; and #####

(C)for purposes of awarding planning grants under subsection (c)(3), providing technical assistance to States applying for grants under such subsection, and carrying out demonstration programs under subsection (d), $40,000,000 for fiscal year 2023, to remain available until expended. ####

(2)Availability Funds appropriated under paragraph

(1)shall remain available until expended.

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