,i #aahth ,,congress #ast ,session ,h4 ,r4 #dcca ,,in ,,the ,,house ,,of ,,representatives ,june #bc1 #bjbc ,mr4 ,goldman of ,new ,york introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to increase ,federal ,medicaid funding for ,states that provide intensive community-based services for adults with serious mental illness1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,strengthening ,medicaid for ,serious ,mental ,illness ,act4 #b4 ,purposes ,the purposes of this ,act are the following3 7#a7 ,to amend title ,,xix of the ,social ,security ,act to increase ,federal ,medicaid funding for ,states that provide intensive community-based services for adults with serious mental illness4 7#b7 ,to increase access to intensive community-based services in the most integrated setting appropriate4 7#c7 ,to prevent unnecessary hospitalization or other institutionalization4 7#d7 ,to promote continuity of care and coverage for young adults after they turn #ba and age out of the early and periodic screening1 diagnostic1 and treatment services benefit4 #c4 ,increased ,,fmap for providing intensive community-based services under ,medicaid 7a7 ,in general ,section #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7 is amended by adding at the end the following new subsection3 7m7 ,state plan amendment option ,to provide intensive community-,based services for elderly and disabled individuals 7#a7 ,in general ,subject to the succeeding provisions of this subsection1 beginning ,january #a1 #bjbe1 a ,state may provide through a ,state plan amendment for the provision of medical assistance for intensive community-based services 7not including room and board7 for eligible individuals 7as defined in paragraph 7#b771 without determining that but for the provision of such services the individuals would require the level of care provided in a hospital1 nursing facility1 or intermediate care facility described in section #aije7;d71 but only if the ,state meets the following requirements3 7,a7 ,application of ,,hcbs ,state plan amendment requirements 7i7 ,in general ,except as provided in clause 7ii71 the ,state satisfies the requirements described in subparagraphs 7,a7 through 7,j7 of subsection 7i77#a7 7except that1 in applying such subparagraphs for purposes of this subsection1 each reference to home and community-based services shall be deemed to be a reference to intensive community-based services74 7ii7 ,modification of assessment requirement ,in applying subparagraph 7,f77i7 of subsection 7i77#a7 for purposes of this subsection1 or #a or more activity of daily living and #a or more instrumental activity of daily living 7as defined in subsection 7k77#f77;,f77 shall be inserted after #b or more activities of daily living 7as defined in section #ggjb;,b7c77#b77;,b7 of the ,internal ,revenue ,code of #aihf74 7,b7 ,application of regulations ,in providing intensive community-based services under this subsection1 the ,state complies with the regulations applicable to home and community-based services provided under subsection 7i7 under subpart ,m of part #dda of title #db1 ,code of ,federal ,regulations1 including sections #dda4gaj 7commonly known as the ,,hcbs settings rule7 and #dda4gbe of such title1 except to the extent that such regulations are inconsistent with this subsection4 7#b7 ,definitions ,in this subsection3 7,a7 ,adult with a serious mental illness2 serious mental illness 7i7 ,adult with a serious mental illness ,the term adult with a serious mental illness has the meaning given that term by the ,secretary pursuant to section #aiab7;c7 of the ,public ,health ,service ,act4 7ii7 ,serious mental illness ,the term serious mental illness means a diagnosable mental1 behavioral or emotional disorder that meets the criteria for qualifying an individual as an adult with a serious mental illness4 7,b7 ,assertive community treatment ,the term assertive community treatment means services for the treatment of mental illness that are provided through an evidence-based practice that-- 7i7 improves outcomes for individuals with severe mental illness who are at high risk of homelessness1 psychiatric crisis1 or hospitalization1 or are involved in the criminal justice system2 7ii7 is comprised of a multidisciplinary staff1 including peer specialists1 who work as a team to provide the individualized psychiatric treatment1 rehabilitation1 and support services clients need for the maximum reduction of physical or mental disability and restoration to their best possible functional level2 7iii7 ensures that there is #a direct care staff person for every #aj clients2 and 7iv7 provides services #bd hours a day1 #g days a week1 for as long as needed and wherever they are needed4 7,c7 ,eligible individual ,the term eligible individual means an individual-- 7i7 who is eligible for medical assistance under the ,state plan or under a waiver of such plan2 7ii7 who is age #ba or older2 7iii7 whose income does not exceed #aej percent of the poverty line 7as defined in section #baaj7;c77#e772 and 7iv7 who is an adult with a serious mental illness4 7,d7 ,intensive case management ,the term intensive case management means a type of case management service 7as defined in section #ddj4afi of title #db1 ,code of ,federal ,regulations7-- 7i7 that is reliable1 systematic1 flexible1 and coordinated1 designed to answer the unique combination of health and social care needs of individuals with serious mental illness2 7ii7 that is a long-term1 intensive approach to supporting an individual in the community by providing a comprehensive range of treatment1 rehabilitation1 and support services2 7iii7 that helps individuals with serious mental illness acquire material resources 7such as food1 shelter1 clothing1 and medical care7 and improve their psychosocial functioning2 7iv7 that provides sufficient support to individuals with serious mental illness to keep them involved in community life and encourage growth towards greater autonomy and develop coping skills to meet the demands of community life2 7v7 that ensures continuity of care among treatment agencies2 7vi7 in which a case manager1 working alone or as part of a team1 makes #d or more face-to-face contact with a client each month2 and 7vii7 in which the case manager-to-client ratio does not exceed #a3ab4 7,e7 ,intensive community-based services ,the term intensive community-based services means a set of psychosocial rehabilitation services that includes all of the following3 7i7 ,assertive community treatment4 7ii7 ,supported employment4 7iii7 ,peer support services4 7iv7 ,qualifying community-based mobile crisis intervention services4 7v7 ,intensive case management4 7vi7 ,housing-related activities and services1 including individual housing transition services1 individual housing and tenancy sustaining services1 and ,state-level housing-related collaborative activities1 as those services are described in the informational bulletin published by the ,center for ,medicaid and ,,chip ,services on ,june #bf1 #bjae1 with the subject ,coverage of ,housing-,related ,activities and ,services for ,individuals with ,disabilities4 7vii7 ,such other psychosocial rehabilitation services as a ,state may request and the ,secretary may approve4 7,f7 ,peer support services ,the term peer support services means culturally competent individual and group services for individuals with serious mental illness that promote recovery1 resiliency1 engagement1 socialization1 self-sufficiency1 self-advocacy1 development of natural supports1 and identification of strengths through structured activities such as group and individual coaching to set recovery goals and identify steps to reach the goals4 ,such services aim to prevent relapse1 empower beneficiaries through strength-based coaching1 support linkages to community resources1 and to educate beneficiaries and their families about their conditions and the process of recovery4 ,such services include the following3 7i7 ,participating in the treatment planning process4 7ii7 ,mentoring and assisting the beneficiary with problem solving1 goal setting1 and skill building4 7iii7 ,encouraging a beneficiary's interest in pursuing and maintaining treatment services4 7iv7 ,providing support and linkages to facilitate participation in recovery-based activities4 7v7 ,sharing experiential knowledge1 hope1 and skills4 7vi7 ,advocating for the beneficiary4 7,g7 ,qualifying community-based mobile crisis intervention services ,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-- 7i7 furnished to an individual otherwise eligible for medical assistance under the ,state plan 7or waiver of such plan7 who is-- 7,i7 outside of a hospital or other facility setting2 and 7,,ii7 experiencing a mental health or substance use disorder crisis2 7ii7 furnished by a multidisciplinary mobile crisis team-- 7,i7 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 in the ,state plan amendment under this subsection2 7,,ii7 whose members are trained in trauma-informed care1 de-escalation strategies1 and harm reduction2 7,,iii7 that is able to respond in a timely manner and1 where appropriate1 provide-- 7aa7 screening and assessment2 7bb7 stabilization and de-escalation2 and 7cc7 coordination with1 and referrals to1 health1 social1 and other services and supports as needed1 and health services as needed2 7,,iv7 that maintains relationships with relevant community partners1 including medical and behavioral health providers1 primary care providers1 community health centers1 crisis respite centers1 and managed care organizations 7if applicable72 and 7,v7 that maintains the privacy and confidentiality of patient information consistent with ,federal and ,state requirements2 and 7iii7 available #bd hours per day1 every day of the year4 7,h7 ,supported employment ,the term supported employment means ongoing supports that are furnished to individuals who1 because of their serious mental illness1 need intensive support to obtain and maintain an individual job in competitive or customized employment1 or self-employment1 in an integrated work setting in the general workforce at or above their ,state's minimum wage1 but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities4 ,the desired outcome of all supported employment services is sustained paid employment at or above the minimum wage in an integrated setting in the general workforce1 in a job that meets personal and career goals4 7#c7 ,increase fmap for medical assistance for intensive community-based services 7,a7 ,in general ,during each fiscal quarter that a ,state meets the requirements described in subparagraphs 7,b7 through 7,d71 the ,federal medical assistance percentage applicable to the ,state for the quarter 7as determined under section #aije7;b7 without regard to any adjustments applicable under such section or any other provision of law7 shall be increased by the applicable number of percentage points 7as determined under subparagraph 7,e7 but not to exceed #ajj percent7 with respect to amounts expended by the ,state for medical assistance for intensive community-based services furnished to eligible individuals during such quarter under a ,state plan amendment under this subsection4 7,b7 ,service quality criteria 7i7 ,in general ,the ,state shall provide eligible individuals with intensive community-based services in accordance with such quality criteria as the ,secretary shall by regulation establish4 7ii7 ,criteria requirements ,the criteria established by the ,secretary under clause 7i7 shall be designed to ensure that eligible individuals receive the intended benefits of receipt of the services1 including avoiding preventable hospitalization or other institutionalization4 ,the criteria will be adjusted as needed to account for future developments and best practice4 ,the criteria shall include the following3 7,i7 ,the standards for assertive community treatment in the ,tool for ,measurement of ,assertive ,community ,treatment 7,,tmact71 ,dartmouth ,assertive ,community ,treatment ,scale 7,,dacts71 or other generally accepted tool for evaluating assertive community treatment4 7,,ii7 ,individual ,placement and ,support 7,,ips7 standards for supported employment services4 7,,iii7 ,securing and maintaining scattered-site housing with a ,housing ,first approach as the goal for housing-related activities and services4 7,c7 ,integrated setting ,eligible individuals shall receive intensive community-based services-- 7i7 in the most integrated setting appropriate2 and 7ii7 without limiting access to any such service on the basis of-- 7,i7 the individual's need for assistance with activities of daily living or instrumental activities of daily living2 7,,ii7 receipt of other disability support services2 7,,iii7 the presence of additional disabilities such as a physical1 communication1 intellectual1 developmental1 or other disability or a record or history of having such a disability2 or 7,,iv7 the existence of co-occurring substance use disorders or a record or history of having such substance use disorders4 7,d7 ,data collection and reporting ,not less frequently than once every #b years1 the ,state shall collect and report data to the ,secretary1 including with respect to disparities in access to1 or receipt of1 intensive community-based services1 according to criteria established by the ,secretary and the ,secretary shall analyze and report such findings to ,congress4 ,the criteria shall include the collection and reporting of data with respect to the following3 7i7 ,demographic characteristics of eligible individuals who receive intensive community-based services1 including but not limited to1 race1 ethnicity1 disability status1 disability category1 age1 sex1 sex characteristics1 sexual orientation1 gender identity1 primary language1 rural or urban environment1 and service setting4 7ii7 ,the utilization of intensive community-based services1 including units of service and duration of receipt of service1 per eligible individual receiving services4 7iii7 ,consumer outcomes1 as measured via a quality service review tool and methodology approved by the ,secretary4 7,e7 ,applicable number of percentage points ,for purposes of subparagraph 7,a7-- 7i7 if a ,state offers at least #a but under #b of the categories of intensive community-based services described in clauses 7i7 through 7vii7 of paragraph 7#b77;,e7 in a quarter1 the applicable number of percentage points for the ,state and quarter is #c percentage points2 7ii7 if a ,state offers at least #b but under #c of the categories of intensive community-based services described in clauses 7i7 through 7vii7 of paragraph 7#b77;,e7 in a quarter1 the applicable number of percentage points for the ,state and quarter is #g percentage points2 7iii7 if a ,state offers at least #c but under #d of the categories of intensive community-based services described in clauses 7i7 through 7vii7 of paragraph 7#b77;,e7 in a quarter1 the applicable number of percentage points for the ,state and quarter is #ab percentage points2 7iv7 if a ,state offers at least #d but under #e of the categories of intensive community-based services described in clauses 7i7 through 7vii7 of paragraph 7#b77;,e7 in a quarter1 the applicable number of percentage points for the ,state and quarter is #ah percentage points2 and 7v7 if a ,state offers at least #e of the categories of intensive community-based services described in clauses 7i7 through 7vii7 of paragraph 7#b77;,e7 in a quarter1 the applicable number of percentage points for the ,state and quarter is #be percentage points4 7#d7 ,application of ,,hcbs ,state plan amendment provisions ,paragraphs 7#c71 7#d71 7#e71 7#f71 and 7#g7 of subsection 7i7 shall apply to ,state plan amendments under this subsection and intensive community-based services in the same manner as such paragraphs apply to ,state plan amendments under such subsection 7i7 and home and community-based services4 7#e7 ,funding for state planning grants 7,a7 ,in general ,there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #bj1jjj1jjj to the ,secretary for purposes of implementing1 administering1 and making planning grants to ,states as soon as practicable for purposes of developing a ,state plan amendment request to provide intensive community-based services under this subsection1 to remain available until expended4 7,b7 ,use of funds ,a ,state shall use funds received under a grant under this subsection to engage in planning activities for a ,state plan amendment under this subsection1 including-- 7i7 collaborative activities1 at the ,state and ,federal level1 with providers of housing-related services2 7ii7 developing service quality criteria2 and 7iii7 developing the infrastructure necessary to implement the ,state plan amendment1 including data infrastructure and staffing4 4 7b7 ,rule of construction ,nothing in this ,act or the amendments made by this ,act may be construed to limit the entitlement of children and youth who are eligible for medical assistance under a ,state ,medicaid program to receive intensive community-based services through the early and periodic screening1 diagnostic1 and treatment services benefit4