Increasing Behavioral Health Treatment Act
This bill repeals restrictions that generally prohibit federal payment under Medicaid for services provided in institutions for mental diseases (IMDs) for individuals under the age of 65. (Currently, states may receive payment for such services through certain mechanisms, such as through a Medicaid demonstration waiver.)
The bill also requires state Medicaid programs that cover IMD services to improve patient access to outpatient and community-based behavioral health care, expand crisis stabilization services, facilitate care coordination between providers and first responders, and report specified information relating to IMD utilization and costs.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4022 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 4022
To amend title XIX of the Social Security Act to remove the exclusion
from medical assistance under the Medicaid Program of items and
services for patients in an institution for mental diseases, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 17, 2025
Mr. Carbajal (for himself and Mr. Bacon) introduced the following bill;
which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to remove the exclusion
from medical assistance under the Medicaid Program of items and
services for patients in an institution for mental diseases, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Increasing Behavioral Health
Treatment Act''.
SEC. 2. REMOVAL OF MEDICAID EXCLUSION FROM MEDICAL ASSISTANCE OF ITEMS
AND SERVICES FURNISHED TO PATIENTS IN AN INSTITUTION FOR
MENTAL DISEASES IF STATE SUBMITS PLAN FOR PROVIDING
APPROPRIATE OUTPATIENT CARE TO SUCH PATIENTS.
(a) Removal of Exclusion.--
(1) In general.--The first sentence of section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) is amended, in the
matter following paragraph (32)--
(A) by striking ``such term does not include--''
and all that follows through ``(A) any'' and inserting
``such term does not include any'';
(B) by striking ``; or'' and inserting a period;
and
(C) by striking subparagraph (B).
(2) Conforming amendments to permit medical assistance for
imd patients under 65 years of age.--The following provisions
of such Act are each amended by striking ``65 years of age or
older'' and ``65 years of age or over'' each place it appears:
(A) Paragraphs (20) and (21) of section 1902(a) (42
U.S.C. 1396a(a)).
(B) Section 1905(a)(14) (42 U.S.C. 1396d(a)(14)).
(C) Section 1919(e)(7)(B)(i)(I) (42 U.S.C.
1396r(e)(7)(B)(i)(I)).
(b) Reporting and Plan Requirement.--Section 1902(a)(20) of the
Social Security Act (42 U.S.C. 1396a(a)(20)) is amended--
(1) in subparagraph (B), by striking ``and'' at the end;
and
(2) by adding at the end the following new subparagraphs:
``(D) provide for a plan to achieve (and for the
annual submission to the Secretary of actions taken by
the State, and progress with respect to such actions,
to achieve)--
``(i) increased access to outpatient and
community-based behavioral health care, with
respect to individuals furnished services in an
institution for mental diseases, especially for
individuals transitioning from such an
institution;
``(ii) increased availability of services
made available through crisis call centers,
mobile crisis units, coordinated community
crisis response that involves law enforcement
and other first responders, observation or
assessment centers, and on-going community-
based services (such as intensive outpatient
services, assertive community treatment, and
services in integrated care settings such as
the Certified Community Behavioral Health
Clinic model) (such services referred to as
crisis stabilization services) for individuals
experiencing a serious mental illness (as such
term is defined for purposes of title V of the
Public Health Service Act), serious emotional
disturbance, or substance use disorder crisis;
``(iii) improved data sharing and
coordination between physical health, mental
health, and addiction treatment providers
(including hospitals and community-based
behavioral health facilities) and first
responders to improve health outcomes for
individuals furnished services in an
institution for mental diseases, who are
experiencing a serious mental illness (as so
defined), serious emotional disturbance, or
substance use disorder crisis;
``(E) provide for the demonstration of--
``(i) State policies to ensure individuals
receiving medical assistance under the State
plan who receive care in psychiatric hospitals
and residential treatment settings are
consistently screened for co-morbid physical
health conditions and substance use disorders
prior to or upon admission, and that
participating facilities have the capacity to
address co-morbid physical health conditions
during stays in such psychiatric hospitals and
residential treatment settings either through
on-site medical services or external referrals
and care coordination;
``(ii) established strategies of the State
for identifying and engaging individuals,
particularly adolescents and young adults,
experiencing a serious mental illness (as such
term is defined for purposes of title V of the
Public Health Service Act), serious emotional
disturbance, or substance use disorder crisis;
and
``(iii) established utilization review
policies of the State Medicaid agency or
Medicaid managed care organizations, as
applicable, to ensure individuals receiving
medical assistance under the State plan receive
treatment at clinically appropriate levels of
care and services are generally delivered in
the least restrictive environment; and
``(F) report to the Secretary (in a form and manner
specified by the Secretary), with respect to each year
beginning on or after the date of the enactment of this
subparagraph--
``(i) in the aggregate and by facility
type, costs and utilization for institutions
for mental diseases and inpatient psychiatric
hospitals that are not such institutions;
``(ii) the number of individuals
experiencing a serious mental illness (as such
term is defined for purposes of title V of the
Public Health Service Act), serious emotional
disturbance, or substance use disorder crisis
who received medical assistance under the State
plan during the year;
``(iii) the length of the stay of each such
individual in an institution for mental
disease; and
``(iv) the type of outpatient treatment,
including medication assisted treatment, each
such individual received after being discharged
from such institution;''.
(c) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall take effect on the date of the
enactment of this Act and shall apply to State plans beginning
on such date.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet this additional requirement before
the first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
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