,,ii #aafth ,,congress #b;d ,session ,s4 #ejcd ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #af1 #bjbj,ms4 ,cortez ,masto introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to empower communities to establish a continuum of care for individuals experiencing mental or behavioral health crisis1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,behavioral ,health ,crisis ,services ,expansion ,act4 #b4 ,crisis response continuum of care 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish standards for a continuum of care for use by health care providers and communities in responding to individuals experiencing a mental or behavioral health crisis 7referred to in this section as the crisis response continuum74 7b7 ,requirements 7#a7 ,scope of standards ,such standards shall define-- 7,a7 minimum requirements of core crisis services1 as determined by the ,secretary1 to include requirements that each entity that furnishes such services should-- 7i7 not require medical clearance prior to admission2 7ii7 serve all individuals regardless of ability to pay2 7iii7 operate #bd hours a day1 #g days a week1 and provide care to all individuals2 and 7iv7 provide care until the individual has been stabilized or transfer the individual to the next level of crisis care2 and 7,b7 psychiatric stabilization1 including the point at which a case may be closed for-- 7i7 individuals screened over the phone2 and 7ii7 individuals stabilized on the scene by mobile teams4 7#b7 ,identification of essential functions and objectives ,the ,secretary shall identify the essential functions and objectives of each service in the crisis response continuum1 which shall include at least the following3 7,a7 ,identification of resources for referral and enrollment in continuing behavioral health and other human services for the individual in crisis where necessary4 7,b7 ,delineation of access and entry points to services within the crisis response continuum4 7,c7 ,development of and adherence to protocols and agreements for the transfer and receipt of individuals to and from other segments of the crisis response continuum segments as needed1 and from outside referrals including health care providers1 law enforcement1 ,,ems1 and fire4 7,d7 ,description of the qualifications of crisis services staff1 including roles for physicians1 licensed clinicians1 case managers1 and peers4 7,e7 ,requirements for the convention of collaborative meetings of crisis response service providers1 first responders1 and community partners operating in a common region for the discussion of case management1 best practices1 and general performance improvement4 7#c7 ,service capacity and quality standards ,such standards shall include definitions of-- 7,a7 adequate volume of services to meet population need2 7,b7 timeliness of response2 and 7,c7 capacity to meet the needs of different patient populations1 including all age groups1 cultural and linguistic minorities1 and individuals with co-occurring mental health and substance use disorder crisis1 individuals with cognitive disabilities with behavioral health crises1 and individuals with chronic medical conditions and physical disabilities who experience behavioral health crises4 7#d7 ,oversight and accreditation ,the ,secretary shall designate entities charged with the oversight and accreditation of entities within the crisis response continuum4 7#e7 ,implementation timeframe ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall establish the standards under this section4 7#f7 ,data collection and evaluations 7,a7 ,in general ,the ,secretary1 directly or through grants1 contracts1 or interagency agreements1 shall collect data and conduct evaluations with respect to the provision of services and programs offered on the crisis response continuum for purposes of assessing the extent to which the provision of such services and programs meet certain objectives as determined by the ,secretary4 ,such objectives shall include-- 7i7 a reduction in inappropriate arrests of individuals who are in mental health crisis2 7ii7 a reduction in emergency room readmissions2 and 7iii7 adequate access to crisis care centers and crisis bed services4 7,b7 ,authorization of appropriations ,to carry out this subsection1 there are authorized to be appropriated #a1jjj1jjj1 to remain available until expended4 7c7 ,components of crisis response continuum ,the crisis response continuum consists of at least the following components3 7#a7 ,crisis call centers ,regional clinically staffed crisis call centers that provide telephonic crisis intervention capabilities4 ,such centers should meet ,national ,suicide ,prevention ,lifeline operational guidelines regarding suicide risk assessment and engagement and offer air traffic control-quality coordination of crisis care in real-time4 7#b7 ,mobile crisis response team ,teams of providers that are available to reach any individual in the service area in their home1 workplace1 or any other community-based location of the individual in crisis in a timely manner4 7#c7 ,crisis receiving and stabilization facilities ,subacute inpatient facilities and other facilities specified by the ,secretary that provide short-term observation and crisis stabilization services to all referrals1 including the following services3 7,a7 #bc-;hour crisis stabilization services ,a direct care service that provides individuals in severe distress with up to #bc consecutive hours of supervised care to assist with deescalating the severity of their crisis or need for urgent care in a sub-acute inpatient setting4 7,b7 ,short-term crisis residential services ,a direct care service that assists with deescalating the severity of an individual's level of distress or need for urgent care associated with a substance use or mental health disorder in a residential setting4 7#d7 ,behavioral health urgent care facilities ,ambulatory services available #ab-bd hours per day1 #g days a week1 where individuals experiencing crisis can walk in without an appointment to receive crisis assessment1 crisis intervention1 medication1 and connection to continuity of care4 7#e7 ,additional facilities and providers ,the ,secretary shall specify additional facilities and health care providers as part of the crisis response continuum1 as the ,secretary determines appropriate4 #c4 ,coverage of crisis response services 7a7 ,coverage under the ,medicare program 7#a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7,a7 in subparagraph 7,,gg71 by striking and at the end2 7,b7 in subparagraph 7,,hh71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,,ii7 crisis response services as defined in subsection 7kkk72 4 7#b7 ,crisis response services defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end thereof the following new subsection3 7kkk7 ,crisis response services defined 7#a7 ,in general ,the term crisis response services means mental or behavioral health services that are furnished by a mobile crisis response team1 a crisis receiving and stabilization facility1 behavioral health urgent care facility1 or other appropriate provider of services or supplier1 as determined by the ,secretary1 to an individual experiencing a mental or behavioral health crisis4 ,such term includes services identified by the ,secretary as part of the crisis response continuum of care under section #b of the ,behavioral ,health ,crisis ,services ,expansion ,act4 7#b7 ,definitions ,in this subsection1 the terms mobile crisis response team1 crisis receiving and stabilization facility1 and behavioral health urgent care facility have the meaning given those terms for purposes of such section4 4 7#c7 ,amount of payment ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7,a7 ,technical correction to ensure proper placement ,section #fjjb7;a77#a77;,b7 of division ,f of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg7 is amended1 in the amendatory language1 by striking the period and inserting the semicolon4 7,b7 ,payment ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7i7 by striking and 7,,dd7 and inserting 7,,dd72 and 7ii7 by inserting before the semicolon at the end the following3 and 7,,ee7 with respect to crisis response services described in section #ahfa7s77#b77;,,ii71 the amounts paid shall be #hj percent of the lesser of the actual charge for the service or the amount determined under a fee schedule established by the ,secretary4 7#d7 ,ambulance transport of individuals in crisis 7,a7 ,in general ,section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is amended by adding at the end the following new paragraph3 7#ah7 ,transportation of individuals in crisis ,with respect to ambulance services furnished on or after the date that is #a year after the date of the enactment of the ,behavioral ,health ,crisis ,services ,expansion ,act1 the regulations described in section #ahfa7s77#g7 shall provide coverage under such section for ambulance services to transport an individual experiencing a mental or behavioral health crisis to an appropriate facility1 such as a community mental health center 7as defined in section #ahfa7;ff77#c77;,b77 or other facility or provider identified by the ,secretary as part of the crisis response continuum of care under section #b of the ,behavioral ,health ,crisis ,services ,expansion ,act1 as appropriate1 for crisis response services described in section #ahfa7s77#b77;,,ii74 4 7,b7 ,conforming amendment ,section #ahfa7s77#g7 of such ,act 7#db ,u4,s4,c4 #aciex7s77#g77 is amended by striking section #ahcd7l77#ad7 and inserting paragraphs 7#ad7 and 7#ah7 of section #ahcd7l74 7#e7 ,effective date ,the amendments made by this subsection shall apply to services furnished on or after the date that is #a year after the date of the enactment of this ,act4 7b7 ,mandatory coverage of crisis response services under the ,medicaid program 7#a7 ,in general ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended-- 7,a7 in section #aijb7;a77#aj77;,a71 in the matter preceding clause 7i71 by striking and 7#bi7 and inserting 7#bi71 and 7#cj72 and 7,b7 in section #aije7;a7-- 7i7 in paragraph 7#bi71 by striking 2 and and inserting a semicolon2 7ii7 by redesignating paragraph 7#cj7 as paragraph 7#ca72 and 7iii7 by inserting the following paragraph after paragraph 7#bi73 7#cj7 crisis response services 7as defined in section #ahfa7kkk772 and 4 7#b7 ,presumptive eligibility determination by crisis response service providers ,section #aijb7;a77#dg77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#dg77;,b77 is amended by inserting or provider of crisis response services 7as defined in section #ahfa7kkk77 after any hospital4 7#c7 ,effective date 7,a7 ,in general ,except as provided in subparagraph 7,b71 the amendments made by this section shall take effect on the date that is #a year after the date of the enactment of this ,act4 7,b7 ,delay permitted if state legislation required ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments made by this section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of the failure of the plan to meet such additional requirements before the #ast day of the #ast calendar quarter beginning after the close of the #ast regular session of the ,state legislature that begins after the date of enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 7c7 ,essential health benefits ,section #acjb7;b77#a77;,e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77#a77;,e77 is amended by inserting and crisis response services 7as defined in section #ahfa7kkk7 of the ,social ,security ,act7 before the period4 7d7 ,group health plans ,section #bgjg of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#f7 is amended by adding at the end the following3 7e7 ,crisis response services ,a group health plan or a health insurance issuer that offers health insurance coverage in the large group market shall ensure that such coverage includes crisis response services 7as defined in section #ahfa7kkk7 of the ,social ,security ,act74 4 7e7 ,,tricare coverage 7#a7 ,in general ,the ,secretary of ,defense shall provide coverage under the ,,tricare program for crisis response services1 as defined in section #ahfa7kkk7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 7as amended by section #c74 7#b7 ,,tricare program defined ,in this section1 the term ,,tricare program has the meaning given the term in section #ajgb of title #aj1 ,united ,states ,code4 7f7 ,reimbursement for crisis response services for veterans ,section #agbe7;f77#a7 of title #ch1 ,united ,states ,code1 is amended1 in the matter preceding subparagraph 7,a71 by inserting 1 including crisis response services 7as defined in subsection 7kkk7 of section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex771 after services4 7g7 ,coverage under ,,fehb 7#a7 ,in general ,section #hijb of title #e1 ,united ,states ,code1 is amended by adding at the end the following3 7p7 ,each contract for a plan under this chapter shall require the carrier to provide coverage for crisis response services1 as that term is defined in subsection 7kkk7 of section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex74 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply beginning with respect to the first contract year for chapter #hi of title #e1 ,united ,states ,code1 that begins on or after the date that is #a year after the date of enactment of this ,act4 #d4 ,building the crisis continuum infrastructure 7a7 ,additional amounts for ,mental ,health ,block grant ,section #aibj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#i7 is amended by adding at the end the following3 7d7 ,support for crisis response services infrastructure 7#a7 ,in general ,in addition to amounts made available under subsection 7a71 there are authorized to be appropriated #ce1jjj1jjj for each of fiscal years #bjba and #bjbb1 for purposes of supporting the infrastructure needed to provide crisis response services 7as defined in section #ahfa7kkk7 of the ,social ,security ,act7 in the ,states4 7#b7 ,allotments ,each fiscal year for which amounts are appropriated under paragraph 7#a71 the ,secretary shall allot to each ,state that receives a grant under section #aiaa for the fiscal year an amount that bears the same relationship to the total amount appropriated under paragraph 7#a7 for the fiscal year that the amount received by the ,state under section #aiaa7;a7 for the fiscal year bears to the total amount appropriated under subsection 7a7 for the fiscal year4 4 7b7 ,technical assistance ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall provide to ,states technical assistance regarding the provision of crisis response services1 as defined in section #ahfa7kkk7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 7as amended by section #c74 7c7 ,clearinghouse of best practices ,the ,secretary shall develop and maintain a publicly available clearinghouse of best practices for the successful operation of each segment of the system for providing crisis response services 7as defined in section #ahfa7kkk7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 7as amended by section #c77 and the integration of such best practices into the provision of such services4 ,the clearinghouse shall be updated annually4 #e4 ,incident reporting 7a7 ,establishment of protocol panel ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in consultation with the ,attorney ,general1 shall convene a panel for the purposes of making recommendations for training and protocol for #iaa dispatchers to respond appropriately to individuals experiencing a psychiatric crisis based on the characteristics of the incident and the needs of the caller4 7b7 ,panelists ,the ,secretary shall appoint individuals to serve staggered #aj-year terms on the panel established under subsection 7a74 ,such individuals shall include-- 7#a7 firefighters2 7#b7 emergency medical services personnel2 7#c7 law enforcement officers2 7#d7 #iaa dispatchers2 7#e7 representatives from each segment of the crisis response continuum1 as described in section #b2 and 7#f7 other individuals1 as the ,secretary determines appropriate4 7c7 ,recommendations 7#a7 ,topics ,in issuing recommendations under this section1 the panel shall consider-- 7,a7 connecting #iaa callers to crisis care services instead of responding with law enforcement officers2 7,b7 integrating the #ihh system into the #iaa system1 or transferring calls from the #iaa system to the #ihh system as appropriate2 and 7,c7 a process for identifying #iaa callers who are in mental health distress and evaluating the level of need of such callers1 as defined by standardized assessment tools such as the ,level of ,care ,utilization ,system 7,,locus7 and the ,child and ,adolescent ,level of ,care ,utilization ,system 7,,calocus74 7#b7 ,updates ,the panel shall update recommendations issued under this section not less frequently than every #e years4