,,ii #aafth ,,congress #b;d ,session ,s4 #ddda ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #e1 #bjbj,mr4 ,wyden 7for himself and ,ms4 ,cortez ,masto7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to encourage ,state ,medicaid programs to provide community-based mobile crisis intervention services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,crisis ,assistance ,helping ,out ,on ,the ,streets ,act or the ,,cahoots ,act4 #b4 ,enhanced ,federal ,medicaid support for community-based mobile crisis intervention services ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7bb7 ,community-,based mobile crisis intervention services 7#a7 ,in general ,notwithstanding section #aijb7;a77#a7 7relating to ,statewideness71 section #aijb7;a77#aj77;,b7 7relating to comparability71 section #aijb7;a77#bc77;,a7 7relating to freedom of choice of providers71 or section #aijb7;a77#bg7 7relating to provider agreements71 a ,state may provide medical assistance for qualifying community-based mobile crisis intervention services under a ,state plan amendment or waiver approved under section #aaae or #aiae7;c74 7#b7 ,qualifying community-based mobile crisis intervention services defined ,for purposes of this subsection1 the term qualifying community-based mobile crisis intervention services means1 with respect to a ,state1 items and services for which medical assistance is available under the ,state plan under this title or a waiver of such plan1 that are-- 7,a7 furnished to an individual who is-- 7i7 outside of a hospital or other facility setting2 and 7ii7 experiencing a mental health or substance use disorder crisis2 7,b7 furnished by a multidisciplinary mobile crisis team-- 7i7 that includes at least #a behavioral health care professional who is capable of conducting an assessment of the individual1 in accordance with the professional's permitted scope of practice under ,state law1 and other professionals or paraprofessionals with appropriate expertise in behavioral health or mental health crisis response1 including nurses1 social workers1 peer support specialists1 and others1 as designated by the ,state and approved by the ,secretary2 7ii7 whose members are trained in trauma-informed care1 de-escalation strategies1 and harm reduction2 7iii7 that is able to respond in a timely manner and1 where appropriate1 provide the following-- 7,i7 screening and assessment2 7,,ii7 stabilization and de-escalation2 7,,iii7 coordination with1 and referrals to1 health1 social1 and other services and supports as needed2 and 7,,iv7 provision or coordination of transportation to the next step in care or treatment2 7iv7 that maintains relationships with relevant community partners1 including medical and behavioral health providers1 community health centers1 crisis respite centers1 managed care organizations 7if applicable71 entities able to provide assistance with application and enrollment in the ,state plan or a waiver of the plan1 entitles able to provide assistance with applying for and enrolling in benefit programs1 entities that provide assistance with housing 7such as public housing authorities1 ,continuum of ,care programs1 or not-for-profit entities that provide housing assistance71 and entities that provide assistance with other social services2 7v7 that coordinates with crisis intervention hotlines and emergency response systems2 7vi7 that maintains the privacy and confidentiality of patient information consistent with ,federal and ,state requirements2 and 7vii7 that operates independently from 7but may coordinate with7 ,state or local law enforcement agencies2 7,c7 available #bd hours per day1 every day of the year2 and 7,d7 voluntary to receive4 7#c7 ,payments 7,a7 ,in general ,notwithstanding section #aije7;b71 beginning ,october #a1 #bjbj1 during each of the first #ab fiscal quarters that a ,state meets the requirements described in paragraph 7#d71 the ,federal medical assistance percentage applicable to amounts expended by the ,state for medical assistance for qualifying community-based mobile crisis intervention services furnished during such quarter shall be equal to #ie percent4 7,b7 ,exclusion of enhanced payments from territorial caps ,to the extent that the amount of a payment to ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa for medical assistance for qualifying community-based mobile crisis intervention services that is based on the ,federal medical assistance percentage specified in subparagraph 7,a7 exceeds the amount that would have been paid to such territory for such services if the ,federal medical assistance percentage for the territory had been determined without regard to such subparagraph-- 7i7 the limitation on payments to territories under subsections 7f7 and 7g7 of section #aajh shall not apply to the amount of such excess2 and 7ii7 the amount of such excess shall be disregarded in applying such subsections4 7#d7 ,requirements ,the requirements described in this paragraph are the following3 7,a7 ,the ,state demonstrates1 to the satisfaction of the ,secretary-- 7i7 that it will be able to support the provision of qualifying community-based mobile crisis intervention services that meet the conditions specified in paragraph 7#b72 and 7ii7 how it will support coordination between mobile crisis teams and community partners1 including health care providers1 to enable the provision of services1 needed referrals1 and other activities identified by the ,secretary4 7,b7 ,the ,state provides assurances satisfactory to the ,secretary that-- 7i7 any additional ,federal funds received by the ,state for qualifying community-based mobile crisis intervention services provided under this subsection that are attributable to the increased ,federal medical assistance percentage under paragraph 7#c77;,a7 will be used to supplement1 and not supplant1 the level of ,state funds expended for such services for fiscal year #bjai2 7ii7 if the ,state made qualifying community-based mobile crisis intervention services available in a region of the ,state in fiscal year #bjai1 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 year2 and 7iii7 the ,state will conduct the evaluation and assessment1 and submit the report1 required under paragraph 7#e74 7#e7 ,state evaluation and report 7,a7 ,state evaluation ,not later than #d fiscal quarters after a ,state begins providing qualifying community-based mobile crisis intervention services in accordance with this subsection1 the ,state shall enter into a contract with an independent entity or organization to conduct an evaluation for the purposes of-- 7i7 determining the effect of the provision of such services on-- 7,i7 emergency room visits2 7,,ii7 use of ambulatory services2 7,,iii7 hospitalizations2 7,,iv7 the involvement of law enforcement in mental health or substance use disorder crisis events2 7,v7 the diversion of individuals from jails or similar settings2 and 7ii7 assessing-- 7,i7 the types of services provided to individuals2 7,,ii7 the types of events responded to2 7,,iii7 cost savings or cost-effectiveness attributable to such services2 7,,iv7 the experiences of individuals who receive qualifying community-based mobile crisis intervention services2 7,v7 the successful connection of individuals with follow-up services2 and 7,,vi7 other relevant outcomes identified by the ,secretary4 7,b7 ,comparison to historical measures ,the contract described in subparagraph 7,a7 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 community-based mobile crisis intervention services in accordance with this subsection4 7,c7 ,report ,not later than #b years after a ,state begins to provide qualifying community-based mobile crisis intervention services in accordance with this subsection1 the ,state shall submit a report to the ,secretary on the following3 7i7 ,the results of the evaluation carried out under subparagraph 7,a74 7ii7 ,the number of individuals who received qualifying community-based mobile crisis intervention services4 7iii7 ,demographic information regarding such individuals when available1 including the race or ethnicity1 age1 sex1 sexual orientation1 gender identity1 and geographic location of such individuals4 7iv7 ,the processes and models developed by the ,state to provide qualifying community-based mobile crisis intervention services under such the ,state plan or waiver1 including the processes developed to provide referrals for1 or coordination with1 follow-up care and services4 7v7 ,lessons learned regarding the provision of such services4 7,d7 ,public availability ,the ,state shall make the report required under subparagraph 7,c7 publicly available1 including on the website of the appropriate ,state agency1 upon submission of such report to the ,secretary4 7#f7 ,best practices report 7,a7 ,in general ,not later than #c years after the first ,state begins to provide qualifying community-based mobile crisis intervention services in accordance with this subsection1 the ,secretary shall submit a report to ,congress that-- 7i7 identifies the ,states that elected to provide services in accordance with this subsection2 7ii7 summarizes the information reported by such ,states under paragraph 7#e77;,c72 and 7iii7 identifies best practices for the effective delivery of community-based mobile crisis intervention services4 7,b7 ,public availability ,the report required under subparagraph 7,a7 shall be made publicly available1 including on the website of the ,department of ,health and ,human ,services1 upon submission to ,congress4 7#g7 ,state planning and evaluation grants 7,a7 ,in general ,as soon as practicable after the date of enactment of this subsection1 the ,secretary may award planning and evaluation grants to ,states for purposes of developing a ,state plan amendment or section #aaae or #aiae7;c7 waiver request 7or an amendment to such a waiver7 to provide qualifying community-based mobile crisis intervention services and conducting the evaluation required under paragraph 7#e77;,a74 ,a grant awarded to a ,state under this paragraph shall remain available until expended4 7,b7 ,state contribution ,a ,state awarded a grant under this subsection shall contribute for each fiscal year for which the grant is awarded an amount equal to the ,state percentage determined under section #aije7;b7 7without regard to the temporary increase in the ,federal medical assistance percentage of the ,state under section #fjjh7;a7 of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg7 or any other temporary increase in the ,federal medical assistance percentage of the ,state for fiscal year #bjbj or any succeeding fiscal year7 of the grant amount4 7#h7 ,funding 7,a7 ,implementation and administration ,there is appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise appropriated1 such sums as are necessary for purposes of implementing and administering this section4 7,b7 ,planning and evaluation grants ,there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #be1jjj1jjj to the ,secretary for fiscal year #bjba for purposes of making grants under paragraph 7#g71 to remain available until expended4 4