,,ii #aahth ,,congress #ast ,session ,s4 #ibc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #bb1 #bjbc,mr4 ,bennet 7for himself and ,mr4 ,wyden7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xviii and ,,xix of the ,social ,security ,act to reform and improve mental health and substance use care under the ,medicare and ,medicaid programs1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,better ,mental ,health ,care for ,americans ,act4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,,title ,i--,medicare part ,b provisions,sec4 #aja4 ,payment under the ,medicare physician fee schedule for inherently complex evaluation and management visits related to integrated mental health and substance use disorder care4,sec4 #ajb4 ,ensuring access to early intervention in mental health care in ,medicare4,,title ,,ii--,medicare ,advantage and part ,d provisions,sec4 #bja4 ,parity in mental health and substance use disorder benefits under ,medicare ,advantage and prescription drug plans4,sec4 #bjb4 ,behavioral health measures and incentivizing behavioral health care quality4,sec4 #bjc4 ,providing information on behavioral health coverage to promote informed choice4,sec4 #bjd4 ,requiring ,,ma organizations to maintain accurate and updated provider directories4,,title ,,iii--,medicaid and ,c,h,i,p,sec4 #cja4 ,enhanced payment under ,medicaid for integrated mental health and substance use disorder care services4,sec4 #cjb4 ,demonstration project to ensure ,medicaid-enrolled children have access to integrated mental health and substance use disorder care services1 including prevention and early intervention services4,sec4 #cjc4 ,uniform applicability to ,medicaid of requirements for parity in mental health and substance use disorder benefits4,sec4 #cjd4 ,requiring additional transparency on access to mental health and substance use disorder benefits through managed care4,sec4 #cje4 ,authority to defer or disallow a portion of ,federal financial participation for failure to comply with managed care requirements4,sec4 #cjf4 ,medicaid and ,,chip audits4,,title ,,iv--,other provisions,sec4 #dja4 ,ensuring multi-payer alignment on payment and measurement of quality of care and health outcomes related to integrated mental health and substance use disorder care4,sec4 #djb4 ,measuring access and quality outcomes in mental health and substance use disorder care4,sec4 #djc4 ,reviewing the evidence for integrated mental health care for children4,sec4 #djd4 ,enhancing oversight of integrated mental health and substance use disorder care4 ,i ,medicare part ,b provisions #aja4 ,payment under the ,medicare physician fee schedule for inherently complex evaluation and management visits related to integrated mental health and substance use disorder care 7a7 ,in general ,section #ahdh7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;b77 is amended by adding at the end the following new paragraph3 7#ac7 ,payment for inherently complex evaluation and management visits related to integrated mental health and substance use disorder care 7,a7 ,in general ,the ,secretary shall establish a new ,,hcpcs add-on code under the fee schedule established under this subsection for integrated mental health and substance use disorder care services 7as defined in subparagraph 7,b77i77 that are furnished on or after ,january #a1 #bjbe1 when furnished by an integrated care practitioner on the same date of service that a service in the ,,hcpcs category of office and other outpatient evaluation and management services is furnished4 ,such add-on code may be similar to ,,hcpcs code ,g#bbaa4 7,b7 ,definitions ,in this paragraph3 7i7 ,integrated mental health and substance use disorder care services 7,i7 ,in general ,the term integrated mental health and substance use disorder care services means services described in subclause 7,,ii7 that are furnished by an integrated care practitioner4 7,,ii7 ,services described ,the services described in this subclause are the following3 7aa7 ,preventive services and screening for mental health and substance use disorders that the ,secretary determines are-- 7,,aa7 reasonable and necessary for the prevention or early detection of a mental health or substance use disorder2 7,,bb7 recommended with a grade of ,a or ,b by the ,united ,states ,preventive ,services ,task ,force or recommended in ,health ,resources and ,services-supported guidelines for infants1 children1 adolescents1 and women2 and 7,,cc7 appropriate for individuals enrolled under this part4 7bb7 ,the routine use and tracking of quality measures appropriate for the measurement of the quality of care 7including medication errors7 related to behavioral health that reflect consensus among affected parties and1 to the extent feasible and practicable1 shall include measures set forth by one or more national consensus building entities4 7cc7 ,short-term1 evidence-based1 culturally1 and linguistically appropriate therapeutic and psychosocial intervention integrated into the primary care practice1 including through telehealth4 7dd7 ,evidence-based treatment for mental health and substance use care integrated into the primary care practice1 including through telehealth1 or through referral4 7ee7 ,care management1 which can include establishing1 implementing1 revising or monitoring the care plan1 coordinating with other professionals and agencies1 and educating the individual or caregiver about the individual's condition1 care plan1 or prognosis4 7ff7 ,other services determined by the ,secretary4 7ii7 ,integrated care practitioner 7,i7 ,in general ,the term integrated care practitioner means a primary care practitioner 7as defined in section #ahcc7x77#b77;,a77i77 who has demonstrated the capacity to furnish integrated mental health and substance use disorder care services 7as determined under subclause 7,,ii774 7,,ii7 ,demonstrating capacity guidance2 attestation ,for purposes of applying subclause 7,i7 with respect to an integrated care practitioner demonstrating the capacity to furnish integrated mental health and substance use disorder care services1 the ,secretary shall issue guidance1 not later than one year after the date of the enactment of this paragraph1 describing requirements for demonstrating capacity to provide such services and establishing a process for the ,secretary to receive an attestation that an integrated care practitioner has such capacity4 ,such guidance and attestation may not impose additional burden on small practices 7as defined for purposes of subsection 7q77#aa77 and practices located in rural areas4 7,c7 ,payment 7i7 ,amount of payment ,the fee schedule amount for integrated mental health and substance use disorder care services shall not be less than the fee schedule amount for services described by ,,hcpcs code ,g#bbaa 7or any successor or substantially similar code74 7ii7 ,add-on services ,if1 during the furnishing of an evaluation and management service to an individual by an integrated care practitioner1 such practitioner also furnishes 7or coordinates the furnishing of7 integrated mental health and substance use disorder care services on the same date of service1 payment shall also be made for such integrated mental health and substance used disorder care services even if the individual did not previously have a mental health or substance use disorder diagnosis4 7iii7 ,payment considerations ,in carrying out this paragraph1 the ,secretary shall ensure that the amount of payment for integrated mental health and substance use disorder care services under this paragraph is sufficient to sustain effective and accessible integrated mental health and substance use disorder care under this part1 as determined by evidence from practice expenses of those implementing effective integrated care as well as evidence of the resource needs of integrated care practitioners who furnish such services in mental health professional shortage areas 7as designated under section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act7 and medically underserved areas4 4 7b7 ,exemption from budget neutrality ,section #ahdh7;c77#b77;,b77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;,c77#b77;b77iv77 is amended by adding at the end the following new subclause3 7,,vii7 ,subsection 7b77#ac7 shall not be taken into account in applying clause 7ii77,,ii7 for #bjbe4 4 7c7 ,waiver of coinsurance ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7#a7 by striking and before 7,,hh72 and 7#b7 by inserting before the semicolon at the end the following3 1 and 7,,ii7 with respect to integrated mental health and substance use disorder care services 7as defined in subparagraph 7,b77i7 of section #ahdh7;b77#ac77 that are furnished on or after ,january #a1 #bjbe1 the amounts paid shall be equal to #ajj percent of the lesser of the actual charge for such services or the fee schedule amount provided under such section4 #ajb4 ,ensuring access to early intervention in mental health care in ,medicare ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 as amended by section #aja7;c71 is amended-- 7#a7 by striking and before 7,,ii72 and 7#b7 by inserting before the semicolon at the end the following3 1 and 7,,jj7 with respect to behavioral health integration services described by ,,hcpcs codes #iidib1 #iidic1 #iidid1 #iidhd 1 ,g#bbad1 and ,g#jcbc 7or any successor or substantially similar code7 furnished on or after ,january #a1 #bjbe1 the amounts paid shall be equal to #ajj percent of the lesser of the actual charge for such services or the fee schedule amount provided under section #ahdh7;b74 ,,ii ,medicare ,advantage and part ,d provisions #bja4 ,parity in mental health and substance use disorder benefits under ,medicare ,advantage and prescription drug plans 7a7 ,medicare ,advantage plans 7#a7 ,in general ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended by adding at the end the following new subsection3 7o7 ,parity in mental health and substance use disorder benefits 7#a7 ,in general ,each ,,ma organization shall ensure that the benefit design of each ,,ma plan offered by such organization meets the following requirements3 7,a7 ,financial requirements ,the financial requirements applicable to mental health or substance use disorder benefits covered by the plan may not exceed the predominant financial requirements applied to substantially all medical benefits covered by the plan1 including supplemental benefits1 and there are no separate cost sharing requirements that are applicable only with respect to mental health and substance use disorder benefits4 7,b7 ,treatment limitations ,the treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical benefits covered by the plan and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits1 including supplemental benefits4 7#b7 ,determinations of medical necessity 7,a7 ,in general ,each ,,ma organization shall ensure that any determination of medical necessity for mental health or substance use benefits under each ,,ma plan offered by such organization that is not based on the application of a national or local coverage determination is consistent with generally accepted standards of mental health and substance use disorder care1 as defined in paragraph4 ,for any level of care determination with respect to mental health or substance use disorder benefits1 coverage criteria are consistent with widely-used treatment guidelines only if they result in a level of care determination that is consistent with the determination that would have been made using the relevant widely-used treatment guidelines4 7,b7 ,criteria for medical necessity determinations ,the criteria for determination of medical necessity with respect to mental health or substance use disorder benefits under an ,,ma plan shall be made available in plain language to any individual upon request4 7#c7 ,reporting on application of nonquantitative treatment limitations 7,a7 ,comparative analyses of design and application of nonquantitative treatment limits ,for #bjbe and subsequent years1 in the case of an ,,ma organization that imposes nonquantitative treatment limitations 7referred to in this paragraph as ,n,q,t,ls7 on mental health or substance use disorder benefits under an ,,ma plan offered by such organization1 such organization shall be required to perform and document comparative analyses of the design and application of ,n,q,t,ls on mental health and substance use disorder benefits under the plan and make available to the ,secretary as provided under subparagraph 7,b71 upon request1 the comparative analyses and the following information3 7i7 ,the specific plan terms regarding the ,n,q,t,ls and a description of all mental health or substance use disorder and medical benefits to which each such term applies in each respective benefits classification4 7ii7 ,the factors used to determine that the ,n,q,t,ls will apply to mental health or substance use disorder benefits and medical benefits4 7iii7 ,the evidentiary standards used for the factors identified in clause 7ii71 when applicable1 provided that every factor shall be defined1 and any other source or evidence1 including utilization of decision support technology1 artificial intelligence technology1 machine-learning technology1 clinical decision-making technology1 or any other technology specified by the ,secretary1 relied upon to design and apply the ,n,q,t,ls to mental health or substance use disorder benefits and medical benefits4 7iv7 ,the comparative analyses demonstrating that the processes1 strategies1 evidentiary standards1 and other factors used to apply the ,n,q,t,ls to mental health or substance use disorder benefits1 as written and in operation1 are comparable to1 and are applied no more stringently than1 the processes1 strategies1 evidentiary standards1 and other factors used to apply the ,n,q,t,ls to medical benefits in the benefits classification4 7v7 ,the specific findings and conclusions reached by the ,,ma organization with respect to the ,,ma plan1 including any results of the analyses described in this subparagraph that indicate that the plan is or is not in compliance with this subsection4 7,b7 ,submission to ,secretary upon request ,an ,,ma organization shall submit to the ,secretary the comparative analyses described in subparagraph 7,a7 and the information described in clauses 7i7 through 7v7 of such subparagraph upon request by the ,secretary4 ,the ,secretary shall request not fewer than #bj such analyses per year4 7,c7 ,report ,not later than ,october #a1 #bjbi1 and biennially thereafter1 the ,secretary shall submit to ,congress1 and make publicly available1 a report that contains the following3 7i7 ,a summary of the comparative analyses and information requested under subparagraph 7,b74 7ii7 ,the ,secretary's conclusions as to whether each ,,ma organization submitted sufficient information for the ,secretary to review the comparative analyses and information requested for compliance with this subsection4 7iii7 ,the ,secretary's conclusions as to whether each ,,ma organization that submitted sufficient information for the ,secretary to review was in compliance with this subsection4 7#d7 ,definitions ,in this subsection3 7,a7 ,classification of benefits ,the term classification of benefits means the following3 7i7 ,inpatient ,benefits under part ,a4 7ii7 ,outpatient ,benefits furnished on an outpatient basis under part ,b4 7iii7 ,emergency care ,benefits for emergency care covered under part ,b4 7iv7 ,part ,b prescription drugs ,benefits for drugs and biologicals covered under part ,b4 7v7 ,covered part ,d drugs ,benefits for covered part ,d drugs as defined in section #ahfj;,d-#b7;e74 7vi7 ,supplemental ,supplemental health care benefits as described in section #aheb7;a77#c74 7,b7 ,evidentiary standards ,the term evidentiary standard means factors or evidence a plan considers in designing and applying its medical management techniques1 such as generally accepted standards of mental health and substance use disorder care1 recognized medical literature1 professional standards and protocols 7including comparative effectiveness studies and clinical trials71 published research studies1 treatment guidelines created by professional medical associations or other third-party entities1 publicly available or proprietary clinical definitions1 and outcome metrics from consulting or other organizations4 7,c7 ,financial requirement ,the term financial requirement includes deductibles1 copayments1 coinsurance1 and maximum limitations on out-of-pocket expenses applicable under the plan4 7,d7 ,generally accepted standards of mental health and substance use disorder care ,the term generally accepted standards of mental health and substance use disorder care means standards of care and clinical practice that are generally recognized by health care providers practicing in relevant clinical specialties such as psychiatry1 psychology1 and addiction medicine and counseling1 to ensure appropriate diagnosis1 treatment1 and ongoing management1 for underlying mental health and substance use disorders1 including co-occurring conditions1 to adequately meet the needs of patients4 ,these standards are derived from valid1 evidence-based sources such as peer-reviewed scientific studies and medical literature1 consensus guidelines of nonprofit health care provider professional associations and specialty societies1 including level of care criteria and clinical practice guidelines1 and recommendations of ,federal government agencies4 7,e7 ,mental health benefits ,the term mental health benefits means benefits with respect to items and services for mental health conditions as defined by the ,secretary4 7,f7 ,predominant ,a financial requirement or treatment limit is considered to be predominant if it is the most common or frequent of such type of limit or requirement4 7,g7 ,substance use disorder benefits ,the term substance use disorder benefits means benefits with respect to items and services for substance use disorders as defined by the ,secretary4 7,h7 ,substantially all ,a financial requirement or treatment limitation applies to substantially all medical benefits in a classification if it applies to at least two-thirds of the benefits in that classification4 7,i7 ,treatment limitation 7i7 ,in general ,the term treatment limitation means mechanisms to control utilization of services and expenditures such as limits on the frequency of treatment1 number of visits1 days of coverage1 or other similar limits on the scope or duration of treatment4 ,such term includes3 7,i7 ,quantitative treatment limitations ,quantitative treatment limitations1 including limits on the frequency of treatment1 number of visits1 days of coverage1 or other similar limits on the scope or duration of treatment4 7,,ii7 ,nonquantitative treatment limitations ,nonquantitative treatment limitations1 including other limits on the access1 scope1 or duration of benefits for treatment under a plan or coverage not described in subclause 7,i71 such as-- 7aa7 medical management standards limiting or excluding benefits based on medical necessity or medical appropriateness1 or based on whether the treatment is experimental or investigative2 7bb7 for plans with multiple network tiers 7such as preferred providers and participating providers71 network tier design2 7cc7 standards for provider admission to participate in a network1 including reimbursement rates2 7dd7 refusal to pay for higher-cost therapies until it can be shown that a lower-cost therapy is not effective 7also known as fail-first policies or step therapy protocols72 7ee7 exclusions based on failure to complete a course of treatment2 and 7ff7 restrictions based on geographic location1 facility type1 provider specialty1 and other criteria that limit the scope or duration of benefits for services provided under the plan or coverage4 7ii7 ,exclusions ,the term treatment limitation does not include any exclusions from coverage of items or services for which payment is not made under part ,a or part ,b or any statutory limitations on coverage applicable under such parts4 4 7#b7 ,enforcement ,section #aheg7;g77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;g77#a77 is amended-- 7,a7 in subparagraph 7,j71 by striking or after the semicolon2 7,b7 by redesignating subparagraph 7,k7 as subparagraph 7,l72 7,c7 by inserting after subparagraph 7,j71 the following new subparagraph3 7,k7 fails to comply with mental health parity requirements under section #aheb7o7 or applicable implementing regulations or guidance2 or 2 7,d7 in subparagraph 7,l71 as redesignated by subparagraph 7,b71 by striking through 7,j7 and inserting through 7,k72 and 7,e7 in the flush matter following subparagraph 7,l71 as so redesignated1 by striking subparagraphs 7,a7 through 7,k7 and inserting subparagraphs 7,a7 through 7,l74 7b7 ,prescription drug plans ,section #ahfj;,d-#d of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is amended by adding at the end the following new subsection3 7c7 ,parity in mental health and substance use disorder benefits ,the provisions of section #aheb7o7 7relating to parity in mental health and substance use disorder benefits7 shall apply to ,,pdp sponsors offering prescription drug plans in the same manner in which such provisions apply with respect to ,medicare ,advantage organizations offering ,,ma-,,pd plans4 4 7c7 ,regulations ,not later than #ah months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue regulations to carry out the amendments made by this section4 7d7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning after the date that is #b years after the date of enactment of this ,act1 regardless of whether regulations have been issued to carry out such amendments by such effective date4 7e7 ,implementation funding ,for purposes of carrying out the provisions of1 including the amendments made by1 this section1 there are appropriated1 out of amounts in the ,treasury not otherwise appropriated1 to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account1 #aj1jjj1jjj for fiscal year #bjbd1 which shall remain available until expended4 #bjb4 ,behavioral health measures and incentivizing behavioral health care quality ,section #ahec7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7o77 is amended by adding at the end the following new paragraph3 7#h7 ,behavioral health measures 7,a7 ,in general ,for #bjbe and biennially thereafter1 the ,secretary shall consider adding to the #e-star rating system behavioral health measures that measure the quality and outcomes of-- 7i7 mental health or substance use disorder services2 and 7ii7 items and services not described in clause 7i7 that are furnished to an individual with a mental health or substance use disorder4 7,b7 ,considerations ,in considering the addition of behavioral health measures under subparagraph 7,a71 the ,secretary shall-- 7i7 consider measures for which data can be collected through encounter data or enrollee survey data submitted by ,,ma organizations2 7ii7 consider measures endorsed by a consensus-based entity1 as described in section #ahij7;a72 7iii7 consider measures that assess the quality and health outcomes of items and services described in subparagraph 7,a71 including contraindicated or low-value care1 furnished to individuals with a mental health or substance use disorder2 7iv7 consider measures that assess access to behavioral health treatment1 including measures of wait times1 distance standards1 providers who are taking on new patients1 and the proportion of behavioral health providers who have not submitted a claim for a mental health or substance use disorder service during the past six months2 7v7 consider measures that assess the integration of behavioral health care and primary care services2 7vi7 consider measures that align with behavioral health measures-- 7,i7 used to assess performance in part ,a or part ,b2 or 7,,ii7 identified as part of the ,core ,set of ,health ,care ,quality ,measures for ,adults as described in section #aaci;,b2 and 7vii7 consider measures that assess patient experience of care4 4 #bjc4 ,providing information on behavioral health coverage to promote informed choice ,section #ahea7;d77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;d77#d77 is amended by adding at the end the following new subparagraph3 7,f7 ,behavioral health information ,for #bjbe and subsequent plan years1 to the extent available1 the following information with respect to the preceding plan year3 7i7 ,information on access to in-network behavioral health providers1 disaggregated by those who prescribe and those who offer mental health or substance use disorder services1 including-- 7,i7 the average wait time 7as defined by the ,secretary7 for an appointment for a new patient with an in-network provider for mental health or substance disorder services2 7,,ii7 the total number and percentage of providers who have participation agreements with the organization who submitted at least one request for payment for a mental health or substance use disorder service during a #f month period 7or other period specified by the ,secretary72 and 7,,iii7 the percentage of requests for payment for mental health or substance use disorder services that were submitted by-- 7aa7 in-network providers2 and 7bb7 out-of-network providers4 7ii7 ,information on the number of denials of prior authorization requests or denials of payment for mental health or substance use disorder services compared to non-mental health and substance use disorder services overall1 categorized by the type of denial and by the type of service1 as defined by the ,secretary1 including-- 7,i7 the number and percent of such denials by the number of days to denial1 the reason for denial1 and the utilization of decision support technology1 artificial intelligence technology1 machine-learning technology1 clinical decision-making technology1 or any other technology specified by the ,secretary2 and 7,,ii7 the number and percent of such denials with respect to a mental health or substance use disorder service compared to such denials with respect to items and services for a similar physical health condition 7such as depression compared to diabetes7 by the number of days to denial1 the reason for denial1 and the utilization of decision support technology1 artificial intelligence technology1 machine-learning technology1 clinical decision-making technology1 or any other technology specified by the ,secretary4 4 #bjd4 ,requiring ,,ma organizations to maintain accurate and updated provider directories 7a7 ,in general ,section #aheb7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;c77 is amended-- 7#a7 in paragraph 7#a77;,c7-- 7,a7 by striking plan1 and any and inserting plan1 any2 and 7,b7 by inserting the following before the period3 1 and1 in the case of a network-based ,,ma plan 7as defined in paragraph 7#c77;,c771 the information described in paragraph 7#c77;,a77i77,,ii72 and 7#b7 by adding at the end the following new paragraph3 7#c7 ,provider directory accuracy and transparency 7,a7 ,in general ,for plan year #bjbe and subsequent plan years1 each ,,ma organization offering a network-based ,,ma plan shall do the following3 7i7 ,maintain an accurate provider directory 7,i7 ,in general ,the ,,ma organization shall1 for each network-based ,,ma plan offered by the organization1 maintain an accurate provider directory-- 7aa7 that includes the information described in subclause 7,,ii72 7bb7 which1 not less frequently than #ij days1 the organization verifies and1 if applicable1 updates the provider directory information of each provider2 7cc7 that provides1 if the organization is unable to verify such information with respect to a provider1 for the inclusion along with the information in the directory with respect to such provider of a notification indicating that the information may not be up to date2 7dd7 that provides for the removal of a provider from such directory within #b business days if the organization determines that the provider is no longer a participating provider2 and 7ee7 that meets such other requirements as the ,secretary may specify4 7,,ii7 ,information described ,the information described in this subclause is the ,national ,provider ,identifier1 name1 address1 specialty1 telephone number1 ,internet website if available1 availability 7including whether the provider is accepting new patients71 cultural and linguistic capabilities 7including the languages offered by the provider or by a skilled medical interpreter who provides interpretation services for the provider71 and other information as determined appropriate by the ,secretary for each provider with which such ,,ma organization has an agreement for furnishing items and services covered under such plan4 7ii7 ,submission of provider directory to the ,secretary ,the ,,ma organization shall submit to the ,secretary the provider directory for each network-based ,,ma plan offered by the organization in a manner specified by the ,secretary4 7,b7 ,posting of provider directory information ,for plan year #bjbf and subsequent plan years1 the ,secretary shall post the provider directory information submitted under subparagraph 7,a77ii71 in a machine readable file1 on the internet website of the ,centers for ,medicare ,medicaid ,services4 7,c7 ,network-based ,,ma plan defined ,in this paragraph1 the term network-based ,,ma plan means an ,,ma plan that has a network of providers that have agreements with the ,,ma organization offering the plan to furnish items and services covered under such plan4 4 7b7 ,enforcement ,section #aheg7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;d77 is amended by adding at the end the following new paragraph3 7#g7 ,audit of provider directories ,each contract under this section shall provide that the ,secretary1 or any person or organization designated by the ,secretary1 shall have the right to audit any provider directory under section #aheb7;c77#c77;,a77i7 to determine whether such directory meets the requirements of such section4 4 7c7 ,funding ,in addition to amounts otherwise available1 there is appropriated to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for fiscal year #bjbc1 out of any amounts in the ,treasury not otherwise appropriated1 #aj1jjj1jjj1 to remain available until expended1 for purposes of carrying out the amendments made by this section4 ,,iii ,medicaid and ,,chip #cja4 ,enhanced payment under ,medicaid for integrated mental health and substance use disorder care services ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended-- 7#a7 in subsection 7a77#c7-- 7,a7 in subparagraph 7,d71 by inserting and after the semicolon2 7,b7 in subparagraph 7,f77ii71 by striking plus after the semicolon and inserting and2 and 7,c7 by inserting after subparagraph 7,f77ii71 the following3 7,g7 for calendar quarters beginning on or after ,january #a1 #bjbe1 #ajj percent of the amount determined for such quarter under subsection 7cc72 and 2 and 7#b7 by adding the end the following3 7cc7 ,enhanced payment for integrated mental health and substance use disorder care services 7#a7 ,in general ,for purposes of subsection 7a77#c77;,g71 in accordance with guidance issued not later than the date that is #ahj days after the date of the enactment of this subsection by the ,secretary to ,states1 the amount determined under this subsection with respect to a ,state and calendar quarter is the amount by which-- 7,a7 the aggregate amount expended by the ,state during the calendar quarter for medical assistance provided by a primary care practitioner 7as defined in section #ahcc7x77#b77;,a77i77 for integrated mental health and substance use disorder care services described in section #ahdh7;b77#ac77;,b7 and such other items and services for the care of mental health and substance use conditions furnished by1 or in coordination with1 such primary care practitioner as the ,secretary1 in consultation with the ,state1 may specify2 exceeds 7,b7 the quarterly average of the aggregate amounts expended by the ,state for medical assistance described in subparagraph 7,a7 during the applicable base period for the calendar quarter involved4 7#b7 ,applicable base period defined 7,a7 ,in general ,for purposes of paragraph 7#a71 the term applicable base period means1 with respect to a calendar quarter1 the #e-year period that ends on the most recent base period end date4 7,b7 ,base period end date defined ,for purposes of subparagraph 7,a71 the term base period end date means-- 7i7 ,december #ca1 #bjbd2 and 7ii7 ,december #ca of every #eth year following #bjbd4 4 #cjb4 ,demonstration project to ensure ,medicaid-enrolled children have access to integrated mental health and substance use disorder care services1 including prevention and early intervention services 7a7 ,in general ,not later than the date that is #ahj days after the date of the enactment of this section1 the ,secretary shall conduct a #ed-month demonstration project for the purpose described in subsection 7b7 under which the ,secretary shall-- 7#a7 for the first #ah-month period of such project1 award planning grants described in subsection 7c72 and 7#b7 for the remaining #cf-month period of such project1 provide to each ,state selected under subsection 7d7 payments in accordance with subsection 7e74 7b7 ,purpose ,the purpose described in this subsection is for each ,state that receives a planning grant under subsection 7c7 to ensure that every ,medicaid-enrolled child in the ,state has access to integrated mental health and substance use disorder care services1 including prevention and early intervention services1 so as to allow for the prevention1 identification1 and treatment of mental health and substance use conditions in primary care1 children's hospitals1 early care and education1 schools1 or other settings as appropriate 7such as home visiting and early intervention programs for young children1 foster care or other child welfare care settings1 or workforce development programs and community centers for youth7 7in this section collectively referred to as care settings71 through the following activities3 7#a7 ,activities that support an ongoing assessment of the accessibility of integrated mental health and substance use disorder care services1 including prevention and early intervention services1 for ,medicaid-enrolled children in the ,state that tracks progress toward the goal of all ,medicaid-enrolled children 7including infants and toddlers as well as transition-aged youth7 having access to appropriate levels of services in care settings in which the children regularly engage1 and that is conducted in partnership with such children and families1 to ensure that the assessment reflects their perspective1 experiences1 and solutions4 7#b7 ,activities that1 taking into account the results of the assessment described in paragraph 7#a71 support the development1 implementation1 and maintenance of ,state infrastructure1 such as technology and the physical structures necessary to physically co-locate integrated mental health and substance use disorder care services1 including prevention and early intervention services1 and a workforce to provide the types of support1 training1 and technical assistance needed in order to offer integrated mental health and substance use care services1 including prevention and early intervention services1 in care settings with which ,medicaid-enrolled children and their families regularly interact1 which are selected for integration based on the assessment of where such children and their families can access such services1 and for which furnishing integrated mental health and substance use disorder care services1 including prevention and early intervention services1 will be sustainable under the ,state's planned activities4 7#c7 ,increased reimbursement and improved incentives for care settings to sustainably implement and provide 7either through direct delivery or coordination in the case of a care setting that is an early care or education program7-- 7,a7 developmentally appropriate mental health promotive and preventive interventions for ,medicaid-enrolled children and their families1 along with screening to identify psycho-social needs of such children who do not yet have a diagnosable mental health condition 7consistent with the requirements for providing items and services described in section #aije7;a77#d77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#d77;,b777relating to early and periodic screening1 diagnostic1 and treatment services defined in section #aije7r7 of such ,act 7#db ,u4,s4,c4 #acif;d7r777 in accordance with the requirements of section #aijb7;a77#dc7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#dc77 and the pediatric preventive care standards included in the essential health benefits required under section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b7772 7,b7 evidence-based1 person-centered1 and culturally1 linguistically1 and developmentally appropriate interventions at the site of service1 either in-person or virtually integrated1 to address any identified family and child psycho-social needs1 including developmentally appropriate assessment and diagnostic services1 treatment1 care coordination1 and dyadic intervention approaches2 and 7,c7 referral to developmentally appropriate mental health and substance use specialty care providers and programs1 community-based resources1 or virtual or digital services to address risk factors or meet psycho- social needs that cannot be addressed in an integrated setting4 7#d7 ,improved regulatory oversight of policies governing the provision of services described in paragraph 7#c71 including with respect to early and periodic screening1 diagnostic1 and treatment services referred to in such paragraph1 mental health and substance use parity1 network adequacy1 essential health benefits referred to in such paragraph1 ,medicaid rate setting1 scope of practice policies1 and health professional shortage areas4 7#e7 ,improved alignment between ,medicaid and commercial health insurers to ensure that services described in paragraph 7#c7 are supported by commercial health insurers1 such as through the initiation of multi-payer collaboratives4 7#f7 ,improved coordination among ,state and local agencies and other stakeholders that fund or provide primary care1 children's hospitals1 early care and education1 or other programs in care settings described in this subsection so as to include efforts to align policies to promote coordination of mental health and substance use services funded under such programs across care settings1 including through the alignment of ,medicaid with programs under the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcja et seq471 the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adjj et seq471 the ,family ,first ,prevention ,services ,act 7title ,,vii of division ,e of the ,bipartisan ,budget ,act of #bjah 7,public ,law #aae-abc2 #acb ,stat4 #bcb771 the ,stephanie ,tubbs ,jones ,child ,welfare ,services ,program under subpart #a of part ,b of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fba et seq471 the ,mary,lee ,allen ,promoting ,safe and ,stable ,families ,program under subpart #b of part ,b of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fbi et seq471 home visiting programs1 including the ,maternal1 ,infant1 and ,early ,childhood ,home ,visiting ,program 7,,miechv7 under section #eaa of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa71 and health1 education1 and social welfare programs funded under the ,american ,rescue ,plan ,act of #bjba 7,public ,law #aag-b2 #ace ,stat4 #d7 and the ,child ,care ,development ,block ,grant ,act of #aiij 7#db ,u4,s4,c4 #iheg et seq474 7#g7 ,activities that include ,medicaid-enrolled children and their families and caregivers as partners at all levels of decision-making1 implementation1 and evaluation1 including engaging such children who are youth and their families directly as paraprofessional providers4 7c7 ,planning grants 7#a7 ,in general ,for the first #ah-month period of the demonstration project1 the ,secretary shall award planning grants to ,states that apply for such grants1 including to entities specified in subparagraphs 7,b7 and 7,c7 of subsection 7h77#g74 ,a ,state awarded a planning grant under this subsection shall use the grant to carry out the activities described in paragraph 7#b7 for purposes of preparing and submitting an application to participate in the remaining #cf-month period of the demonstration project in accordance with subsection 7d74 7#b7 ,activities described ,activities described in this paragraph are1 with respect to a ,state awarded a planning grant under this subsection1 each of the following3 7,a7 ,activities that support the development of an initial assessment of the access needs of ,medicaid-enrolled children in the ,state with respect to mental health and substance use services1 to determine the types of support1 training1 incentives1 and technical assistance that primary care1 early care and education1 or other programs provided in care settings described in subsection 7b7 and with which ,medicaid-enrolled children and their families regularly engage need in order to offer integrated mental health and substance use disorder care services1 including prevention and early intervention services1 and which shall include engaging ,medicaid-enrolled children and their families directly to ensure that the assessment builds toward solutions that meet their needs and reflect their perspectives1 experiences1 and solutions4 7,b7 ,activities that1 taking into account the results of the assessment described in subparagraph 7,a71 support the development of ,state infrastructure1 such as technology and the physical structures necessary to physically co-locate integrated mental health and substance use disorder care services1 including prevention and early intervention services1 to provide the types of support1 training1 incentives1 and technical assistance that primary care1 early care and education1 or other programs provided in care settings described in subsection 7b7 and with which ,medicaid-enrolled children and their families regularly engage need in order to offer integrated mental health and substance use disorder care services1 including prevention and early intervention services1 to ,medicaid-enrolled children1 as well as activities that support ongoing engagement of ,medicaid-enrolled children and their families in implementation and coordination with health insurers and with other child-serving agencies and stakeholders4 7#c7 ,funding ,for purposes of awarding planning grants under paragraph 7#a71 there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #ajj1jjj1jjj1 to remain available until expended4 7d7 ,post-,planning ,states 7#a7 ,in general ,for the remaining #cf-month period of the demonstration project1 the ,secretary shall make payments in accordance with subsection 7e7 to all ,states that submit applications that meet the requirements of paragraph 7#b7 and carry out the activities described in that paragraph4 7#b7 ,applications2 activities 7,a7 ,in general ,a ,state seeking to be selected to participate in the remaining #cf-month period of the demonstration project shall submit to the ,secretary1 at such time and in such form and manner as the ,secretary requires1 an application that includes such information1 provisions1 and assurances1 as the ,secretary may require1 in addition to the following3 7i7 ,a process for carrying out the ongoing assessment described in subsection 7b77#a71 taking into account the results of the initial assessment described in subsection 7c77#b77;,a74 7ii7 ,a review of ,medicaid reimbursement methodologies and other policies related to furnishing integrated mental health and substance use disorder care services1 including prevention and early intervention services1 to ,medicaid-enrolled children that may create barriers to access4 ,if the ,state uses multiple reimbursement methodologies under ,medicaid for mental health and substance use care 7such as capitation1 fee-for-service1 value-based1 and alternative payment programs71 the ,state shall include in the application specific detailed information regarding how the ,state will verify that the combination of reimbursement methodologies employed by the ,state will result in improved access to integrated mental health and substance use disorder care services1 including prevention and early intervention services1 for ,medicaid-enrolled children4 7iii7 ,the development of a plan1 taking into account activities carried out under subsection 7c77#b77;,b71 that will result in long-term and sustainable access to integrated mental health and substance use disorder care services1 including prevention and early intervention services1 for ,medicaid-enrolled children which includes the following3 7,i7 ,specific activities to increase access to integrated mental health and substance use disorder care services1 including prevention and early intervention services1 so as to allow for the prevention1 identification1 and treatment of mental health and substance use conditions in primary care1 early care and education1 or other programs provided in care settings described in subsection 7b7 and with which ,medicaid-enrolled children and their families regularly engage4 7,,ii7 ,strategies that will incentivize a racially and culturally diverse array of providers 7including paraprofessionals7 to obtain the necessary training1 education1 and support to deliver integrated care for the developmentally appropriate prevention1 identification1 assessment1 diagnosis1 and treatment of mental health and substance use conditions in ,medicaid-enrolled children in primary care1 early care and education1 or other programs provided in care settings described in subsection 7b7 and with which ,medicaid-enrolled children and their families regularly engage4 7,,iii7 ,milestones and timeliness for implementing activities set forth in the plan1 as determined by the ,secretary4 7,,iv7 ,specific measurable targets for increasing equitable access to integrated mental health and substance use disorder care services1 including prevention and early intervention services1 for ,medicaid-enrolled children4 7,v7 ,specific measurable targets for increasing the workforce providing integrated mental health and substance use disorder care services1 including prevention and early intervention services4 7iv7 ,a process for reporting the information required under subsection 7f77#a71 including information to assess the effectiveness of the efforts of the ,state during the period of the demonstration project under this subsection and ensure the sustainability of such efforts after the conclusion of the demonstration project4 7v7 ,the expected financial impact of the demonstration project on the ,state4 7vi7 ,a description of funding sources available to the ,state to expand access to integrated mental health and substance use disorder care services1 including prevention and early intervention services in the ,state1 including health care1 public health1 education1 and social service funding opportunities4 7vii7 ,a preliminary plan for how the ,state will sustain access to integrated mental health and substance use disorder care services1 including prevention and early intervention services1 for ,medicaid-enrolled children after the demonstration project1 including maintenance of incentives and enhanced reimbursement rates4 7viii7 ,a description of how the ,state will coordinate the goals of the demonstration project with any waiver granted 7or submitted by the ,state and pending7 pursuant to section #aaae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7 for the delivery of mental health and substance use services under ,medicaid1 as applicable1 and with ,state plans under the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcja et seq471 the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adjj et seq471 the ,family ,first ,prevention ,services ,act 7title ,,vii of division ,e of the ,bipartisan ,budget ,act of #bjah 7,public ,law #aae-abc2 #acb ,stat4 #bcb771 the ,stephanie ,tubbs ,jones ,child ,welfare ,services ,program under subpart #a of part ,b of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fba et seq471 the ,mary,lee ,allen ,promoting ,safe and ,stable ,families ,program under subpart #b of part ,b of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fbi et seq471 home visiting programs1 including the ,maternal1 ,infant1 and ,early ,childhood ,home ,visiting ,program 7,,miechv7 under section #eaa of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa71 and health1 education1 and social welfare programs funded under the ,american ,rescue ,plan ,act of #bjba 7,public ,law #aag-b2 #ace ,stat4 #d7 and the ,child ,care ,development ,block ,grant ,act of #aiij 7#db ,u4,s4,c4 #iheg et seq474 7,b7 ,consultation ,in completing an application under subparagraph 7,a71 a ,state shall consult with relevant stakeholders1 including ,medicaid managed care plans1 primary and specialty health care provider organizations1 ,medicaid-enrolled children and their families1 and other child-serving ,state and local agencies and stakeholders1 and include in the application a description of such consultation4 7,c7 ,technical assistance ,the ,secretary shall provide technical assistance to ,states with respect to preparing and submitting an application that meets the requirements of subparagraphs 7,a7 and 7,b74 7e7 ,payments 7#a7 ,in general ,for each quarter occurring during the remaining #cf-month period of the demonstration project1 the ,secretary shall pay each ,state that submits an application that meets the requirements of subsection 7d7 7#b7 and carries out the activities described in that subsection1 an amount equal to #hj percent of the qualified sums expended by the ,state for such quarter4 7#b7 ,qualified sums defined ,for purposes of paragraph 7#a71 the term qualified sums means1 with respect to a ,state and a quarter1 the amount equal to the amount 7if any7 by which-- 7,a7 the sums expended by the ,state during such quarter that are attributable to-- 7i7 furnishing integrated mental health and substance use disorder care services1 including prevention and early intervention services1 to ,medicaid-enrolled children2 7ii7 the development or enabling of ,state infrastructure1 such as technology and the physical structures necessary to physically co-locate integrated mental health and substance use disorder care services1 including prevention and early intervention services1 delivered in or coordinated through primary care1 early care and education1 or other programs provided in care settings described in subsection 7b7 and with which ,medicaid-enrolled children and their families regularly engage2 and 7iii7 the development of a workforce to provide the types of support1 training1 and technical assistance needed in order to offer integrated mental health and substance use care services1 including prevention and early intervention services1 in primary care1 early care and education1 or other programs provided in care settings described in subsection 7b7 and with which ,medicaid-enrolled children and their families regularly engage2 exceeds 7,b7 #a_/d of the average annual amount expended by the ,state for the most recent #e-;fiscal year period for medical assistance for mental health or substance use disorder care services for ,medicaid-enrolled children in a primary care1 children's hospitals1 school1 early care and education1 or other developmentally appropriate care setting1 as determined by the ,secretary4 7#c7 ,non-duplication of payment ,no payment made under this subsection with respect to medical assistance furnished to a ,medicaid-enrolled child shall be duplicative of any payment made to a provider participating under the ,state ,medicaid program for the same services so furnished to the same child4 7f7 ,reports 7#a7 ,state reports ,each ,state that receives payments under subsection 7e7 during the remaining #cf-month period of the demonstration project shall submit to the ,secretary1 in accordance with detailed1 specific guidance that is issued by the ,secretary not later than the first day of such period1 and that includes information on how to estimate and reconcile ,state expenditures to carry out the demonstration project during such period1 quarterly reports1 with respect to expenditures for which payment is made to the ,state under subsection 7e71 on the following3 7,a7 ,the specific activities with respect to which payment under such subsection was provided4 7,b7 ,the number of primary care1 children's hospitals1 schools1 and early care and education programs that delivered or coordinated integrated mental health and substance use disorder care services1 including prevention and early intervention services1 to ,medicaid-enrolled children during such period and their geographic distribution1 compared to the estimated number that would have otherwise delivered such services in the absence of the demonstration project1 including disaggregated data on the race1 ethnicity1 and gender of providers4 7,c7 ,the number of ,medicaid-enrolled children who received integrated mental health and substance use disorder care services1 including prevention and early intervention services during such period compared to the estimated number of such children who would have otherwise received such services in the absence of the demonstration project1 including disaggregated data on the race1 ethnicity1 gender1 age 7ensuring that children birth to #e as well as transition-aged youth are adequately served71 sexual orientation1 primary language1 income1 and disability status of the children4 7,d7 ,such other data or information as determined by the ,secretary4 7#b7 ,,cms reports 7,a7 ,initial report ,not later than ,october #a1 #bjbf1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress an initial report on the activities carried out by ,states under the planning grants made under subsection 7c71 and actions taken by the ,administrator of the ,centers for ,medicare ,medicaid ,services to improve oversight of such activities4 7,b7 ,interim report ,not later than ,october #a1 #bjbh1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress an interim report on activities carried out under the demonstration project and actions taken by the ,administrator of the ,centers for ,medicare ,medicaid ,services to improve oversight of such activities and the extent to which ,states have achieved the stated goals submitted in their applications4 ,such report shall include a description of the strengths and limitations of the demonstration project and a plan for the sustainability of the project4 7,c7 ,final report ,not later than ,october #a1 #bjcj1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress a final report providing updates on the matters reported in the interim report required by subparagraph 7,b7 and that includes-- 7i7 a description of any changes made with respect to the demonstration project after the submission of such interim report2 and 7ii7 an evaluation of the demonstration project4 7g7 ,implementation funding ,there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #e1jjj1jjj to the ,administrator of the ,centers for ,medicare ,medicaid ,services for purposes of implementing this section1 to remain available until expended4 7h7 ,definitions ,in this section3 7#a7 ,children's hospitals ,the term children's hospitals has the meaning given that term in section #cdj;,e7g77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;e7g77#b74 7#b7 ,integrated mental health and substance use disorder care services ,the term mental health and substance use disorder care services has the meaning given that term in section #ahdh7;b77#ac77;,b7 of the ,social ,security ,act and includes prevention and early intervention services and such other items and services for the care of mental health and substance use conditions furnished by1 or in coordination with1 a primary care practitioner as the ,secretary1 in consultation with a ,state1 may specify4 7#c7 ,medicaid ,the term ,medicaid means the program for grants to ,states for medical assistance programs established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#d7 ,secretary ,except as otherwise specified1 the term ,secretary means the ,secretary of ,health and ,human ,services4 7#e7 ,state ,the term ,state has the meaning given that term in section #aaja7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#a77 for purposes of titles ,,xix and ,,xxi of such ,act1 and for purposes of 7#f7 ,medicaid-enrolled child ,the term ,medicaid-enrolled child means1 with respect to a ,state1 a child enrolled under the ,state plan approved under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or under a waiver of such plan4 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#h7 ,state ,the term ,state means-- 7,a7 each of the #ej ,states and the ,district of ,columbia2 7,b7 the ,commonwealth of ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,commonwealth of the ,northern ,mariana ,islands2 and 7,c7 to the extent the ,secretary determines appropriate1 may include an ,indian ,tribe1 ,tribal organization1 or ,urban ,indian organization 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 #cjc4 ,uniform applicability to ,medicaid of requirements for parity in mental health and substance use disorder benefits 7a7 ,fee-for-,service and alternative benefit plans ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking and at the end of paragraph 7#hf72 7,b7 by striking the period at the end of paragraph 7#hg7 and inserting 2 and2 and 7,c7 by inserting after paragraph 7#hg7 the following new paragraph3 7#hh7 provide for ensuring that the requirements for parity in mental health and substance use disorder benefits under subsection 7uu7 are complied with regardless of the payment model or arrangement under which medical assistance is provided1 including when medical assistance under the ,state plan or under a waiver of such plan is provided through an alternative benefit plan under section #aicg4 2 and 7#b7 by adding at the end the following new subsection3 7uu7 ,parity in mental health and substance use disorder benefits ,for purposes of subsection 7a77#hh71 the requirements under this subsection are the following3 7#a7 ,in general ,regardless of whether a ,state plan or waiver of pays for medical assistance on a fee-for-service basis1 capitated payment basis1 through the use of #a or more alternative payment models1 or any combination thereof1 the ,state shall ensure that the financial requirements and treatment limitations applicable to coverage of mental health or substance use disorder services provided under such plan or under a waiver of such plan comply with the requirements of section #bgbf7;a7 of the ,public ,health ,service ,act in the same manner as such requirements or limitations apply to a group health plan under such section4 7#b7 ,deemed compliance ,coverage with respect to an individual described in section #aije7;a77#d77;,b7 and covered under the ,state plan or waiver under section #aijb7;a77#aj77;,a7 of the services described in section #aije7;a77#d77;,b7 7relating to early and periodic screening1 diagnostic1 and treatment services defined in section #aije7r77 and provided in accordance with section #aijb7;a77#dc71 shall be deemed to satisfy the requirements of paragraph 7#a74 4 7b7 ,managed care organizations and payment arrangements 7#a7 ,in general ,section #aicb7;b77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;b77#h77 is amended to read as follows3 7#h7 ,compliance with certain maternity1 parity in mental health or substance use disorder benefits1 and other coverage requirements 7,a7 ,in general ,each medicaid managed care organization shall comply with the requirements of subpart #b of part ,a of title ,,xxvii of the ,public ,health ,service ,act insofar as such requirements apply and are effective with respect to a health insurance issuer that offers group health insurance coverage4 7,b7 ,parity in mental health or substance use disorder benefits ,the financial requirements and treatment limitations applicable to coverage of mental health or substance use disorder services provided under the ,state plan or under a waiver of such plan through a medicaid managed care organization1 a prepaid inpatient health plan 7as defined by the ,secretary71 a prepaid ambulatory health plan 7as defined by the ,secretary71 or a primary care case manager under section #aije 7consistent with section #aije7t77#b771 shall comply with the requirements of section #bgbf7;a7 of the ,public ,health ,service ,act in the same manner as such requirements or limitations apply to a group health plan under such section4 7,c7 ,deemed compliance ,in applying subparagraphs 7,a7 and 7,b7 with respect to requirements under paragraph 7#h7 of section #bgbf7;a7 of the ,public ,health ,service ,act1 a medicaid managed care organization1 a prepaid inpatient health plan 7as defined by the ,secretary71 a prepaid ambulatory health plan 7as defined by the ,secretary71 or a primary care case manager under section #aije 7consistent with section #aije7t77#b77 shall be treated as in compliance with such requirements if the medicaid managed care organization1 prepaid inpatient health plan1 prepaid ambulatory health plan1 or primary care case manager under section #aije is in compliance with subpart ,k of part #dch of title #db1 ,code of ,federal ,regulations1 and section #dch4c7n7 of such title1 or any successor regulation4 4 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by subsections 7a7 and 7b7 shall take effect on the first day of the first calendar quarter that begins on or after the date that is #c years after the date of enactment of this ,act4 7#b7 ,delay if state legislation needed ,in the case of a ,state plan for medical assistance 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 subsection 7a71 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 these additional requirements 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 ,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 7d7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary of ,health and ,human ,services for purposes of carrying out this section and the amendments made by this section1 #aj1jjj1jjj for fiscal year #bjbd1 to remain available until expended4 #cjd4 ,requiring additional transparency on access to mental health and substance use disorder benefits through managed care 7a7 ,biannual assessment ,section #aicb7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;b77 is amended by adding at the end the following new paragraph3 7#i7 ,transparency on access to mental health and substance use disorder benefits 7,a7 ,in general ,each managed care organization1 prepaid inpatient health plan 7as defined by the ,secretary71 and prepaid ambulatory health plan 7as defined by the ,secretary71 with a contract with a ,state to enroll individuals who are eligible for medical assistance under the ,state plan under this title or under a waiver of such plan and to provide coverage under the contract for mental health services or substance use disorder services1 disaggregated1 biannually shall assess and report to the ,state1 in such manner that the report is publicly available on a website1 the following3 7i7 ,the average wait times during the reporting period by level of acuity and site of care for adult and child patients for a new patient visit in an outpatient setting 7including intensive outpatient1 eating disorder1 residential treatments1 or other appointments as the ,secretary specifies7 from a provider of mental health services or substance use disorder services4 7ii7 ,the total number and average percentage of network providers that provide mental health services or substance use disorder services and are accepting as new patients individuals who are enrollees of such organization or plan at any point during the reporting period4 7iii7 ,the proportion of mental health services or substance use disorder services and prescription drugs during the reporting period that are denied payment under the ,state plan under this title or a waiver on the basis of prior authorization or medical necessity 7or for any other reason that is not based on an enrollee's eligibility for medical assistance under the ,state plan under this title or a waiver7 in comparison to medical and surgical services and prescription drugs that are denied payment on the same bases during the reporting period4 7iv7 ,the total number and percentage of providers during the reporting period who have participation agreements with the organization who submitted at least #a request for payment for a mental health or substance use disorder service4 7,b7 ,submission to ,secretary ,a ,state shall submit information reported to the ,state under subparagraph 7,a71 including stratifying reporting by race1 ethnicity1 disability1 primary language1 age1 sexual orientation1 and gender identity1 to help identify health inequities where applicable1 to the ,secretary in such form and manner as the ,secretary shall specify4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date that is #b years after the date of enactment of this section4 #cje4 ,authority to defer or disallow a portion of ,federal financial participation for failure to comply with managed care requirements 7a7 ,state plan amendment ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 as amended by section #cjc7;a77#a71 is amended-- 7#a7 in paragraph 7#hg71 by striking and after the semicolon2 7#b7 in paragraph 7#hh77;,d71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#hh77;,d71 the following new paragraph3 7#hi7 in the case of a ,state that adopts the option to use managed care as described in section #aicb1 provide that the ,state shall comply with the requirements of section #aicb4 4 7b7 ,application to managed care contracts ,section #aijc7m77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77 is amended-- 7#a7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking and 7,g7 and inserting 7,g71 and 7,i72 and 7#b7 by adding at the end the following new subparagraph3 7,i7 ,for a violation of any requirement described in subparagraph 7,a71 including a violation of the requirements of section #aicb1 as applicable under clause 7xii7 of such subparagraph and paragraph 7#hi7 of section #aijb7;a71 rather than disallowing the full amount of a payment under this title to a ,state for expenditures incurred by the ,state as described in subparagraph 7,a71 the ,secretary may defer or disallow a portion of a payment to the ,state4 ,in determining the amount deferred or disallowed under this subparagraph1 the ,secretary may consider factors such as the degree1 duration1 and recurrence of noncompliance4 ,a ,state may receive a reconsideration of a decision by the ,secretary under this subparagraph to disallow payment in the manner described in section #aaaf7;e74 4 7c7 ,effective date ,the amendments made by this section shall take effect on the date that is #b years after the date of enactment of this section and shall apply to contracts for rating periods beginning on or after such date4 #cjf4 ,medicaid and ,,chip audits 7a7 ,regular audits ,beginning with fiscal year #bjbe1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall audit ,state ,medicaid programs and ,state ,children's ,health ,insurance ,programs for purposes of assessing ,state enforcement of the requirements relating to parity in mental health and substance use disorder benefits 7including with respect to compliance with such parity requirements in the case of any mental health or substance use disorder benefits that are separately managed or financed under a carve-out model7 applicable under subsections 7a77#hh7 and 7uu7 of section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 7as added by section #cjc7;a71 section #aicb7;b77#h7 of such ,act 7#db ,u4,s4,c4 #acifu-#b7;b77#h771 section #aicg7;b77#f7 of such ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#f771 and section #bajc7;c77#g7 of such ,act 7#db ,u4,s4,c4 #acig;cc7c77#g771 and related regulations4 7b7 ,rotational procedure2 publication ,the ,secretary may carry out the audits required by subsection 7a7 using a rotational approach among ,states over a #c-year period1 and shall make the results of such audits publicly available on a searchable website4 7c7 ,publication of enforcement actions ,the ,secretary shall publish 7and update on at least an annual basis7 on a public website of the ,department of ,health and ,human ,services a report that specifies the actions taken by the ,secretary to enforce violations of the mental health and substance use disorder parity requirements under the ,medicaid and ,,chip programs described in subsection 7a74 ,the ,secretary may publish such information separately or include the information in the #a or more published audit reports required by subsection 7b7 that correspond to each such violation4 7d7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary of ,health and ,human ,services for each fiscal year beginning with fiscal year #bjbe1 #e1jjj1jjj to carry out this section4 ,,iv ,other provisions #dja4 ,ensuring multi-payer alignment on payment and measurement of quality of care and health outcomes related to integrated mental health and substance use disorder care ,not later than ,april #a1 #bjbd1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall convene an advisory working group that includes representatives of issuers of group and individual health insurance coverage1 mental health and substance use disorder programs and advocacy organizations1 individuals and families receiving integrated care services1 and ,state ,medicaid ,directors1 for purposes of making recommendations for administrative and legislative changes to facilitate multi-payer alignment on payment and measurement of quality of care and health outcomes with respect to advancing the provision of integrated mental health and substance use disorder care in a manner that does not violate antitrust or other applicable laws4 ,the recommendations of the working group shall include recommendations for measurable1 ongoing benchmarks to assess the extent to which payment and measurement of the quality of care and health outcomes are aligned across health care payers4 #djb4 ,measuring access and quality outcomes in mental health and substance use disorder care 7a7 ,in general ,not later than ,october #a1 #bjbd1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,administrator of the ,health ,resource ,services ,administration1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 develop and implement a plan to improve measurement of the extent to which children and adults have access to integrated mental health and substance use disorder care in primary care and the quality and effectiveness of the care provided1 which shall be implemented in quality measurement programs under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq471 and group health plans and health insurance coverage 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia774 7b7 ,measure development ,the ,director of the ,agency for ,healthcare ,research and ,quality shall conduct measure development where necessary to ensure that the plan developed under subsection 7a7 may be fully implemented1 including measures of patient experience outcomes1 structural measures of practice transformation toward evidence-based integrated care1 and measures of access and unmet need provided by local1 ,state1 or ,federal agencies4 #djc4 ,reviewing the evidence for integrated mental health care for children ,not later than ,october #a1 #bjbd1 the ,director of the ,agency for ,healthcare ,research and ,quality shall review the evidence1 for consideration by the ,united ,states ,preventive ,services ,task ,force1 for interventions for children who are at risk of developing a mental health condition to prevent internalizing and externalizing mental health problems1 and for screening to identify family and child psychosocial needs1 segmented by developmental stage as appropriate4 #djd4 ,enhancing oversight of integrated mental health and substance use disorder care 7a7 ,in general ,not later than ,october #a1 #bjbd1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 develop and implement a plan to improve oversight and enforcement of requirements relating to the provision of integrated mental health and substance use disorder care under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq471 and group health plans and health insurance coverage 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia771 including requirements relating to-- 7#a7 coverage of preventive health services without cost-sharing under section #bgac of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ac72 7#b7 early and periodic screening1 diagnosis1 and treatment for mental health and substance use disorders2 7#c7 mental health and substance use parity2 7#d7 network adequacy1 including quantitative measures of network access that take into account integration in primary care and schools1 racial equity1 and virtual care2 7#e7 essential health benefits 7as defined in section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b7772 and 7#f7 ,medicaid rate setting4 7b7 ,patient input ,in developing and implementing the plan under subsection 7a71 the ,administrator shall seek input from patients with mental health and substance use conditions4