,,ii  #aah? ,,congress  #a/ ,session    
,s4 #ibc  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #bb1 #bjbc,mr4    
,b5net 7= himself & ,mr4 ,wyd57         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d titles     
,,xviii & ,,xix ( ! ,social ,security   
,act to re=m & improve m5tal heal? &    
sub/ance use c>e "u ! ,m$ic>e & ,m$icaid
 programs1 & = o!r purposes4  #a4 ,%ort 
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,bett] ,m5tal 
,heal? ,c>e = ,am]icans ,act4  7b7      
,table ( cont5ts ,! table ( cont5ts (   
?is ,act is z foll[s3 ,sec4 #a4 ,%ort   
title2 table ( cont5ts4,,title          
,i--,m$ic>e "p ,b provisions,sec4 #aja4 
,paym5t "u ! ,m$ic>e physician fee      
s*$ule = inh]5tly complex evaluation &  
managem5t visits relat$ to integrat$    
m5tal heal? & sub/ance use disord]      
c>e4,sec4 #ajb4 ,ensur+ access to e>ly  
int]v5tion 9 m5tal heal? c>e 9          
,m$ic>e4,,title ,,ii--,m$ic>e ,advantage

 & "p ,d provisions,sec4 #bja4 ,p>ity 9 
m5tal heal? & sub/ance use disord]      
b5efits "u ,m$ic>e ,advantage &         
prescription drug plans4,sec4 #bjb4     
,behavioral heal? measures & inc5tiviz+ 
behavioral heal? c>e quality4,sec4 #bjc4
 ,provid+ in=mation on behavioral heal? 
cov]age to promote in=m$ *oice4,sec4    
#bjd4 ,requir+ ,,ma organizations to    
ma9ta9 accurate & updat$ provid]        
directories4,,title ,,iii--,m$icaid &   
,c,h,i,p,sec4 #cja4 ,enhanc$ paym5t "u  
,m$icaid = integrat$ m5tal heal? &      
sub/ance use disord] c>e s]vices4,sec4  
#cjb4 ,demon/ration project to ensure   
,m$icaid-enroll$ *ildr5 h access to     
integrat$ m5tal heal? & sub/ance use    
disord] c>e s]vices1 includ+ prev5tion &
 e>ly int]v5tion s]vices4,sec4 #cjc4    
,uni=m applicability to ,m$icaid (      
requirem5ts = p>ity 9 m5tal heal? &     
sub/ance use disord] b5efits4,sec4 #cjd4
 ,requir+ additional transp>5cy on      
access to m5tal heal? & sub/ance use    
disord] b5efits ?r\gh manag$ c>e4,sec4  

#cje4 ,au?ority to def] or disall[ a    
portion ( ,f$]al f9ancial p>ticipation =
 failure to comply ) manag$ c>e         
requirem5ts4,sec4 #cjf4 ,m$icaid & ,,*ip
 audits4,,title ,,iv--,o!r              
provisions,sec4 #dja4 ,ensur+ multi-pay]
 alignm5t on paym5t & measurem5t (      
quality ( c>e & heal? outcomes relat$ to
 integrat$ m5tal heal? & sub/ance use   
disord] c>e4,sec4 #djb4 ,measur+ access 
& quality outcomes 9 m5tal heal? &      
sub/ance use disord] c>e4,sec4 #djc4    
,review+ ! evid5ce = integrat$ m5tal    
heal? c>e = *ildr54,sec4 #djd4 ,enhanc+ 
ov]sight ( integrat$ m5tal heal? &      
sub/ance use disord] c>e4  ,i ,m$ic>e "p
 ,b provisions  #aja4 ,paym5t "u !      
,m$ic>e physician fee s*$ule = inh]5tly 
complex evaluation & managem5t visits   
relat$ to integrat$ m5tal heal? &       
sub/ance use disord] c>e  7a7 ,9 g5]al  
,section #ahdh7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciew-#d7;b77 is  
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#ac7 ,paym5t = inh]5tly     

complex evaluation & managem5t visits   
relat$ to integrat$ m5tal heal? &       
sub/ance use disord] c>e  7,a7 ,9 g5]al 
,! ,secret>y %all e/abli% a new ,,hcpcs 
add-on code "u ! fee s*$ule e/abli%$ "u 
?is subsection = integrat$ m5tal heal? &
 sub/ance use disord] c>e s]vices 7z    
def9$ 9 subp>agraph 7,b77i77 t are      
furni%$ on or aft] ,janu>y #a1 #bjbe1 :5
 furni%$ by an integrat$ c>e practition]
 on ! same date ( s]vice t a s]vice 9 ! 
,,hcpcs category ( (fice & o!r outpati5t
 evaluation & managem5t s]vices is      
furni%$4 ,su* add-on code may be simil> 
to ,,hcpcs code ,g#bbaa4  7,b7          
,def9itions ,9 ?is p>agraph3 7i7        
,integrat$ m5tal heal? & sub/ance use   
disord] c>e s]vices  7,i7 ,9 g5]al ,!   
t]m integrat$ m5tal heal? & sub/ance use
 disord] c>e s]vices means s]vices      
describ$ 9 subclause 7,,ii7 t are       
furni%$ by an integrat$ c>e practition]4
  7,,ii7 ,s]vices describ$ ,! s]vices   
describ$ 9 ?is subclause are ! foll[+3  
7aa7 ,prev5tive s]vices & scre5+ = m5tal

 heal? & sub/ance use disord]s t !      
,secret>y det]m9es are-- 7,,aa7         
reasonable & necess>y = ! prev5tion or  
e>ly detection ( a m5tal heal? or       
sub/ance use disord]2 7,,bb7 recomm5d$ )
 a grade ( ,a or ,b by ! ,unit$ ,/ates  
,prev5tive ,s]vices ,task ,=ce or       
recomm5d$ 9 ,heal? ,res\rces &          
,s]vices-support$ guidel9es = infants1  
*ildr51 adolesc5ts1 & wom52 & 7,,cc7    
appropriate = individuals enroll$ "u ?is
 "p4  7bb7 ,! r\t9e use & track+ (      
quality measures appropriate = !        
measurem5t ( ! quality ( c>e 7includ+   
m$ication errors7 relat$ to behavioral  
heal? t reflect cons5sus among affect$  
p>ties &1 to ! ext5t feasible &         
practicable1 %all include measures set  
=? by "o or m national cons5sus build+  
entities4  7cc7 ,%ort-t]m1 evid5ce-bas$1
 culturally1 & l+ui/ically appropriate  
!rapeutic & psy*osocial int]v5tion      
integrat$ into ! prim>y c>e practice1   
includ+ ?r\gh teleheal?4  7dd7          
,evid5ce-bas$ treatm5t = m5tal heal? &  

sub/ance use c>e integrat$ into ! prim>y
 c>e practice1 includ+ ?r\gh teleheal?1 
or ?r\gh ref]ral4  7ee7 ,c>e managem5t1 
:i* c include e/abli%+1 implem5t+1      
revis+ or monitor+ ! c>e plan1 coord9at+
 ) o!r pr(essionals & ag5cies1 & educat+
 ! individual or c>egiv] ab\t !         
individual's condition1 c>e plan1 or    
prognosis4  7ff7 ,o!r s]vices det]m9$ by
 ! ,secret>y4  7ii7 ,integrat$ c>e      
practition]  7,i7 ,9 g5]al ,! t]m       
integrat$ c>e practition] means a prim>y
 c>e practition] 7z def9$ 9 section     
#ahcc7x77#b77;,a77i77 :o has demon/rat$ 
! capacity to furni% integrat$ m5tal    
heal? & sub/ance use disord] c>e s]vices
 7z det]m9$ "u subclause 7,,ii774       
7,,ii7 ,demon/rat+ capacity guidance2   
atte/ation ,= purposes ( apply+         
subclause 7,i7 ) respect to an integrat$
 c>e practition] demon/rat+ ! capacity  
to furni% integrat$ m5tal heal? &       
sub/ance use disord] c>e s]vices1 !     
,secret>y %all issue guidance1 n lat]   
?an "o ye> aft] ! date ( ! enactm5t (   

?is p>agraph1 describ+ requirem5ts =    
demon/rat+ capacity to provide su*      
s]vices & e/abli%+ a process = !        
,secret>y to receive an atte/ation t an 
integrat$ c>e practition] has su*       
capacity4 ,su* guidance & atte/ation may
 n impose additional burd5 on small     
practices 7z def9$ = purposes (         
subsection 7q77#aa77 & practices locat$ 
9 rural areas4  7,c7 ,paym5t  7i7 ,am\nt
 ( paym5t ,! fee s*$ule am\nt =         
integrat$ m5tal heal? & sub/ance use    
disord] c>e s]vices %all n be less ?an !
 fee s*$ule am\nt = s]vices describ$ by 
,,hcpcs code ,g#bbaa 7or any successor  
or sub/antially simil> code74  7ii7     
,add-on s]vices ,if1 dur+ ! furni%+ ( an
 evaluation & managem5t s]vice to an    
individual by an integrat$ c>e          
practition]1 su* practition] also       
furni%es 7or coord9ates ! furni%+ (7    
integrat$ m5tal heal? & sub/ance use    
disord] c>e s]vices on ! same date (    
s]vice1 paym5t %all also be made = su*  
integrat$ m5tal heal? & sub/ance us$    

disord] c>e s]vices ev5 if ! individual 
did n previ\sly h a m5tal heal? or      
sub/ance use disord] diagnosis4  7iii7  
,paym5t consid]ations ,9 c>ry+ out ?is  
p>agraph1 ! ,secret>y %all ensure t !   
am\nt ( paym5t = integrat$ m5tal heal? &
 sub/ance use disord] c>e s]vices "u ?is
 p>agraph is suffici5t to su/a9         
effective & accessible integrat$ m5tal  
heal? & sub/ance use disord] c>e "u ?is 
"p1 z det]m9$ by evid5ce f practice     
exp5ses ( ^? implem5t+ effective        
integrat$ c>e z well z evid5ce ( !      
res\rce ne$s ( integrat$ c>e            
practition]s :o furni% su* s]vices 9    
m5tal heal? pr(essional %ortage areas 7z
 designat$ "u section #ccb7;a77#a77;,a7 
( ! ,public ,heal? ,s]vice ,act7 &      
m$ically und]s]v$ areas4  4  7b7        
,exemption f budget neutrality ,section 
#ahdh7;c77#b77;,b77iv7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;,c77#b77;b77iv77 is am5d$ by 
add+ at ! end ! foll[+ new subclause3   
7,,vii7 ,subsection 7b77#ac7 %all n be  

tak5 into acc\nt 9 apply+ clause        
7ii77,,ii7 = #bjbe4  4  7c7 ,waiv] (    
co9surance ,section #ahcc7;a77#a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7a77#a77 is am5d$-- 7#a7 by /rik+ 
& be=e 7,,hh72 &  7#b7 by ins]t+ be=e ! 
semicolon at ! end ! foll[+3 1 & 7,,ii7 
) respect to integrat$ m5tal heal? &    
sub/ance use disord] c>e s]vices 7z     
def9$ 9 subp>agraph 7,b77i7 ( section   
#ahdh7;b77#ac77 t are furni%$ on or aft]
 ,janu>y #a1 #bjbe1 ! am\nts paid %all  
be equal to #ajj p]c5t ( ! less] ( !    
actual *>ge = su* s]vices or ! fee      
s*$ule am\nt provid$ "u su* section4    
#ajb4 ,ensur+ access to e>ly int]v5tion 
9 m5tal heal? c>e 9 ,m$ic>e ,section    
#ahcc7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciel7a77#a771 z am5d$ 
by section #aja7;c71 is am5d$-- 7#a7 by 
/rik+ & be=e 7,,ii72 &  7#b7 by ins]t+  
be=e ! semicolon at ! end ! foll[+3 1 & 
7,,jj7 ) respect to behavioral heal?    
integration s]vices describ$ by ,,hcpcs 
codes #iidib1 #iidic1 #iidid1 #iidhd 1  

,g#bbad1 & ,g#jcbc 7or any successor or 
sub/antially simil> code7 furni%$ on or 
aft] ,janu>y #a1 #bjbe1 ! am\nts paid   
%all be equal to #ajj p]c5t ( ! less] ( 
! actual *>ge = su* s]vices or ! fee    
s*$ule am\nt provid$ "u section         
#ahdh7;b74  ,,ii ,m$ic>e ,advantage & "p
 ,d provisions  #bja4 ,p>ity 9 m5tal    
heal? & sub/ance use disord] b5efits "u 
,m$ic>e ,advantage & prescription drug  
plans  7a7 ,m$ic>e ,advantage plans     
7#a7 ,9 g5]al ,section #aheb ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciew-#bb7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7o7 ,p>ity 9    
m5tal heal? & sub/ance use disord]      
b5efits  7#a7 ,9 g5]al ,ea* ,,ma        
organization %all ensure t ! b5efit     
design ( ea* ,,ma plan (f]$ by su*      
organization meets ! foll[+ requirem5ts3
 7,a7 ,f9ancial requirem5ts ,! f9ancial 
requirem5ts applicable to m5tal heal? or
 sub/ance use disord] b5efits cov]$ by !
 plan may n exce$ ! pr$om9ant f9ancial  
requirem5ts appli$ to sub/antially all  

m$ical b5efits cov]$ by ! plan1 includ+ 
supplem5tal b5efits1 & !re are no       
sep>ate co/ %>+ requirem5ts t are       
applicable only ) respect to m5tal heal?
 & sub/ance use disord] b5efits4  7,b7  
,treatm5t limitations ,! treatm5t       
limitations applicable to m5tal heal? or
 sub/ance use disord] b5efits are no m  
re/rictive ?an ! pr$om9ant treatm5t     
limitations appli$ to sub/antially all  
m$ical b5efits cov]$ by ! plan & !re are
 no sep>ate treatm5t limitations t are  
applicable only ) respect to m5tal heal?
 or sub/ance use disord] b5efits1       
includ+ supplem5tal b5efits4  7#b7      
,det]m9ations ( m$ical necessity  7,a7  
,9 g5]al ,ea* ,,ma organization %all    
ensure t any det]m9ation ( m$ical       
necessity = m5tal heal? or sub/ance use 
b5efits "u ea* ,,ma plan (f]$ by su*    
organization t is n bas$ on !           
application ( a national or local       
cov]age det]m9ation is consi/5t )       
g5]ally accept$ /&>ds ( m5tal heal? &   
sub/ance use disord] c>e1 z def9$ 9     

p>agraph4 ,= any level ( c>e det]m9ation
 ) respect to m5tal heal? or sub/ance   
use disord] b5efits1 cov]age crit]ia are
 consi/5t ) widely-us$ treatm5t         
guidel9es only if !y result 9 a level ( 
c>e det]m9ation t is consi/5t ) !       
det]m9ation t w\ld h be5 made us+ !     
relevant widely-us$ treatm5t guidel9es4 
7,b7 ,crit]ia = m$ical necessity        
det]m9ations ,! crit]ia = det]m9ation ( 
m$ical necessity ) respect to m5tal     
heal? or sub/ance use disord] b5efits "u
 an ,,ma plan %all be made available 9  
pla9 language to any individual ^u      
reque/4  7#c7 ,report+ on application ( 
nonquantitative treatm5t limitations    
7,a7 ,comp>ative analyses ( design &    
application ( nonquantitative treatm5t  
limits ,= #bjbe & subsequ5t ye>s1 9 !   
case ( an ,,ma organization t imposes   
nonquantitative treatm5t limitations    
7ref]r$ to 9 ?is p>agraph z ,n,q,t,ls7  
on m5tal heal? or sub/ance use disord]  
b5efits "u an ,,ma plan (f]$ by su*     
organization1 su* organization %all be  

requir$ to p]=m & docum5t comp>ative    
analyses ( ! design & application (     
,n,q,t,ls on m5tal heal? & sub/ance use 
disord] b5efits "u ! plan & make        
available to ! ,secret>y z provid$ "u   
subp>agraph 7,b71 ^u reque/1 !          
comp>ative analyses & ! foll[+          
in=mation3 7i7 ,! specific plan t]ms    
reg>d+ ! ,n,q,t,ls & a description ( all
 m5tal heal? or sub/ance use disord] &  
m$ical b5efits to :i* ea* su* t]m       
applies 9 ea* respective b5efits        
classification4  7ii7 ,! factors us$ to 
det]m9e t ! ,n,q,t,ls w apply to m5tal  
heal? or sub/ance use disord] b5efits & 
m$ical b5efits4  7iii7 ,! evid5ti>y     
/&>ds us$ = ! factors id5tifi$ 9 clause 
7ii71 :5 applicable1 provid$ t e factor 
%all be def9$1 & any o!r s\rce or       
evid5ce1 includ+ utilization ( decision 
support te*nology1 artificial           
intellig5ce te*nology1 ma*9e-le>n+      
te*nology1 cl9ical decision-mak+        
te*nology1 or any o!r te*nology specifi$
 by ! ,secret>y1 reli$ ^u to design &   

apply ! ,n,q,t,ls to m5tal heal? or     
sub/ance use disord] b5efits & m$ical   
b5efits4  7iv7 ,! comp>ative analyses   
demon/rat+ t ! processes1 /rategies1    
evid5ti>y /&>ds1 & o!r factors us$ to   
apply ! ,n,q,t,ls to m5tal heal? or     
sub/ance use disord] b5efits1 z writt5 &
 9 op]ation1 are comp>able to1 & are    
appli$ no m /r+5tly ?an1 ! processes1   
/rategies1 evid5ti>y /&>ds1 & o!r       
factors us$ to apply ! ,n,q,t,ls to     
m$ical b5efits 9 ! b5efits              
classification4  7v7 ,! specific f9d+s &
 conclusions rea*$ by ! ,,ma            
organization ) respect to ! ,,ma plan1  
includ+ any results ( ! analyses        
describ$ 9 ?is subp>agraph t indicate t 
! plan is or is n 9 compliance ) ?is    
subsection4  7,b7 ,submission to        
,secret>y ^u reque/ ,an ,,ma            
organization %all submit to ! ,secret>y 
! comp>ative analyses describ$ 9        
subp>agraph 7,a7 & ! in=mation describ$ 
9 clauses 7i7 ?r\gh 7v7 ( su*           
subp>agraph ^u reque/ by ! ,secret>y4 ,!

 ,secret>y %all reque/ n few] ?an #bj   
su* analyses p] ye>4  7,c7 ,report ,n   
lat] ?an ,octob] #a1 #bjbi1 & bi5nially 
!reaft]1 ! ,secret>y %all submit to     
,congress1 & make publicly available1 a 
report t conta9s ! foll[+3 7i7 ,a summ>y
 ( ! comp>ative analyses & in=mation    
reque/$ "u subp>agraph 7,b74  7ii7 ,!   
,secret>y's conclusions z to :e!r ea*   
,,ma organization submitt$ suffici5t    
in=mation = ! ,secret>y to review !     
comp>ative analyses & in=mation reque/$ 
= compliance ) ?is subsection4  7iii7 ,!
 ,secret>y's conclusions z to :e!r ea*  
,,ma organization t submitt$ suffici5t  
in=mation = ! ,secret>y to review 0 9   
compliance ) ?is subsection4  7#d7      
,def9itions ,9 ?is subsection3 7,a7     
,classification ( b5efits ,! t]m        
classification ( b5efits means ! foll[+3
 7i7 ,inpati5t ,b5efits "u "p ,a4  7ii7 
,outpati5t ,b5efits furni%$ on an       
outpati5t basis "u "p ,b4  7iii7        
,em]g5cy c>e ,b5efits = em]g5cy c>e     
cov]$ "u "p ,b4  7iv7 ,"p ,b            

prescription drugs ,b5efits = drugs &   
biologicals cov]$ "u "p ,b4  7v7 ,cov]$ 
"p ,d drugs ,b5efits = cov]$ "p ,d drugs
 z def9$ 9 section #ahfj;,d-#b7;e74     
7vi7 ,supplem5tal ,supplem5tal heal? c>e
 b5efits z describ$ 9 section           
#aheb7;a77#c74  7,b7 ,evid5ti>y /&>ds ,!
 t]m evid5ti>y /&>d means factors or    
evid5ce a plan consid]s 9 design+ &     
apply+ its m$ical managem5t te*niques1  
su* z g5]ally accept$ /&>ds ( m5tal     
heal? & sub/ance use disord] c>e1       
recogniz$ m$ical lit]ature1 pr(essional 
/&>ds & protocols 7includ+ comp>ative   
effectiv5ess /udies & cl9ical trials71  
publi%$ rese>* /udies1 treatm5t         
guidel9es creat$ by pr(essional m$ical  
associations or o!r ?ird-p>ty entities1 
publicly available or propriet>y cl9ical
 def9itions1 & outcome metrics f        
consult+ or o!r organizations4  7,c7    
,f9ancial requirem5t ,! t]m f9ancial    
requirem5t includes d$uctibles1         
copaym5ts1 co9surance1 & maximum        
limitations on out-(-pocket exp5ses     

applicable "u ! plan4  7,d7 ,g5]ally    
accept$ /&>ds ( m5tal heal? & sub/ance  
use disord] c>e ,! t]m g5]ally accept$  
/&>ds ( m5tal heal? & sub/ance use      
disord] c>e means /&>ds ( c>e & cl9ical 
practice t are g5]ally recogniz$ by     
heal? c>e provid]s practic+ 9 relevant  
cl9ical specialties su* z psy*iatry1    
psy*ology1 & addiction m$ic9e & c\nsel+1
 to ensure appropriate diagnosis1       
treatm5t1 & ongo+ managem5t1 = und]ly+  
m5tal heal? & sub/ance use disord]s1    
includ+ co-occurr+ conditions1 to       
adequately meet ! ne$s ( pati5ts4 ,^!   
/&>ds are d]iv$ f valid1 evid5ce-bas$   
s\rces su* z pe]-review$ sci5tific      
/udies & m$ical lit]ature1 cons5sus     
guidel9es ( nonpr(it heal? c>e provid]  
pr(essional associations & specialty    
societies1 includ+ level ( c>e crit]ia &
 cl9ical practice guidel9es1 &          
recomm5dations ( ,f$]al gov]nm5t        
ag5cies4  7,e7 ,m5tal heal? b5efits ,!  
t]m m5tal heal? b5efits means b5efits ) 
respect to items & s]vices = m5tal heal?

 conditions z def9$ by ! ,secret>y4     
7,f7 ,pr$om9ant ,a f9ancial requirem5t  
or treatm5t limit is consid]$ to be     
pr$om9ant if x is ! mo/ common or       
frequ5t ( su* type ( limit or           
requirem5t4  7,g7 ,sub/ance use disord] 
b5efits ,! t]m sub/ance use disord]     
b5efits means b5efits ) respect to items
 & s]vices = sub/ance use disord]s z    
def9$ by ! ,secret>y4  7,h7             
,sub/antially all ,a f9ancial requirem5t
 or treatm5t limitation applies to      
sub/antially all m$ical b5efits 9 a     
classification if x applies to at lea/  
two-?irds ( ! b5efits 9 t               
classification4  7,i7 ,treatm5t         
limitation  7i7 ,9 g5]al ,! t]m treatm5t
 limitation means me*anisms to control  
utilization ( s]vices & exp5ditures su* 
z limits on ! frequ5cy ( treatm5t1 numb]
 ( visits1 days ( cov]age1 or o!r simil>
 limits on ! scope or duration (        
treatm5t4 ,su* t]m includes3 7,i7       
,quantitative treatm5t limitations      
,quantitative treatm5t limitations1     

includ+ limits on ! frequ5cy ( treatm5t1
 numb] ( visits1 days ( cov]age1 or o!r 
simil> limits on ! scope or duration (  
treatm5t4  7,,ii7 ,nonquantitative      
treatm5t limitations ,nonquantitative   
treatm5t limitations1 includ+ o!r limits
 on ! access1 scope1 or duration (      
b5efits = treatm5t "u a plan or cov]age 
n describ$ 9 subclause 7,i71 su* z--    
7aa7 m$ical managem5t /&>ds limit+ or   
exclud+ b5efits bas$ on m$ical necessity
 or m$ical appropriat5ess1 or bas$ on   
:e!r ! treatm5t is exp]im5tal or        
inve/igative2  7bb7 = plans ) multiple  
network ti]s 7su* z pref]r$ provid]s &  
p>ticipat+ provid]s71 network ti]       
design2  7cc7 /&>ds = provid] admission 
to p>ticipate 9 a network1 includ+      
reimbursem5t rates2  7dd7 refusal to pay
 = high]-co/ !rapies until x c be %[n t 
a l[]-co/ !rapy is n effective 7also    
kn[n z fail-fir/ policies or /ep !rapy  
protocols72  7ee7 exclusions bas$ on    
failure to complete a c\rse ( treatm5t2 
&  7ff7 re/rictions bas$ on geographic  

location1 facility type1 provid]        
specialty1 & o!r crit]ia t limit ! scope
 or duration ( b5efits = s]vices provid$
 "u ! plan or cov]age4  7ii7 ,exclusions
 ,! t]m treatm5t limitation does n      
include any exclusions f cov]age ( items
 or s]vices = :i* paym5t is n made "u "p
 ,a or "p ,b or any /atutory limitations
 on cov]age applicable "u su* p>ts4  4  
7#b7 ,en=cem5t ,section #aheg7;g77#a7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciew-#bg7;g77#a77 is am5d$-- 7,a7 9   
subp>agraph 7,j71 by /rik+ or aft] !    
semicolon2  7,b7 by r$esignat+          
subp>agraph 7,k7 z subp>agraph 7,l72    
7,c7 by ins]t+ aft] subp>agraph 7,j71 ! 
foll[+ new subp>agraph3  7,k7 fails to  
comply ) m5tal heal? p>ity requirem5ts  
"u section #aheb7o7 or applicable       
implem5t+ regulations or guidance2 or  2
  7,d7 9 subp>agraph 7,l71 z r$esignat$ 
by subp>agraph 7,b71 by /rik+ ?r\gh 7,j7
 & ins]t+ ?r\gh 7,k72 &  7,e7 9 ! flu%  
matt] foll[+ subp>agraph 7,l71 z s      
r$esignat$1 by /rik+ subp>agraphs 7,a7  

?r\gh 7,k7 & ins]t+ subp>agraphs 7,a7   
?r\gh 7,l74  7b7 ,prescription drug     
plans ,section #ahfj;,d-#d ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajd7 is am5d$ by add+ at ! end !
 foll[+ new subsection3  7c7 ,p>ity 9   
m5tal heal? & sub/ance use disord]      
b5efits ,! provisions ( section #aheb7o7
 7relat+ to p>ity 9 m5tal heal? &       
sub/ance use disord] b5efits7 %all apply
 to ,,pdp sponsors (f]+ prescription    
drug plans 9 ! same mann] 9 :i* su*     
provisions apply ) respect to ,m$ic>e   
,advantage organizations (f]+ ,,ma-,,pd 
plans4  4  7c7 ,regulations ,n lat] ?an 
#ah mon?s aft] ! date ( enactm5t ( ?is  
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices %all issue regulations to c>ry 
out ! am5dm5ts made by ?is section4  7d7
 ,effective date ,! am5dm5ts made by ?is
 section %all apply ) respect to plan   
ye>s beg9n+ aft] ! date t is #b ye>s    
aft] ! date ( enactm5t ( ?is ,act1      
reg>dless ( :e!r regulations h be5 issu$
 to c>ry out su* am5dm5ts by su*        

effective date4  7e7 ,implem5tation     
fund+ ,= purposes ( c>ry+ out !         
provisions (1 includ+ ! am5dm5ts made   
by1 ?is section1 !re are appropriat$1   
out ( am\nts 9 ! ,treasury n o!rwise    
appropriat$1 to ! ,c5t]s = ,m$ic>e      
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt1 #aj1jjj1jjj = fiscal ye> #bjbd1
 :i* %all rema9 available until exp5d$4 
#bjb4 ,behavioral heal? measures &      
inc5tiviz+ behavioral heal? c>e quality 
,section #ahec7o7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciew-#bc7o77 is   
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#h7 ,behavioral heal?       
measures  7,a7 ,9 g5]al ,= #bjbe &      
bi5nially !reaft]1 ! ,secret>y %all     
consid] add+ to ! #e-/> rat+ sy/em      
behavioral heal? measures t measure !   
quality & outcomes (-- 7i7 m5tal heal?  
or sub/ance use disord] s]vices2 &  7ii7
 items & s]vices n describ$ 9 clause 7i7
 t are furni%$ to an individual ) a     
m5tal heal? or sub/ance use disord]4    
7,b7 ,consid]ations ,9 consid]+ !       

addition ( behavioral heal? measures "u 
subp>agraph 7,a71 ! ,secret>y %all-- 7i7
 consid] measures = :i* data c be       
collect$ ?r\gh enc\nt] data or enrollee 
survey data submitt$ by ,,ma            
organizations2  7ii7 consid] measures   
endors$ by a cons5sus-bas$ entity1 z    
describ$ 9 section #ahij7;a72  7iii7    
consid] measures t assess ! quality &   
heal? outcomes ( items & s]vices        
describ$ 9 subp>agraph 7,a71 includ+    
contra9dicat$ or l[-value c>e1 furni%$  
to individuals ) a m5tal heal? or       
sub/ance use disord]2  7iv7 consid]     
measures t assess access to behavioral  
heal? treatm5t1 includ+ measures ( wait 
times1 di/ance /&>ds1 provid]s :o are   
tak+ on new pati5ts1 & ! proportion (   
behavioral heal? provid]s :o h n        
submitt$ a claim = a m5tal heal? or     
sub/ance use disord] s]vice dur+ ! pa/  
six mon?s2  7v7 consid] measures t      
assess ! integration ( behavioral heal? 
c>e & prim>y c>e s]vices2  7vi7 consid] 
measures t align ) behavioral heal?     

measures-- 7,i7 us$ to assess p]=mance 9
 "p ,a or "p ,b2 or  7,,ii7 id5tifi$ z  
"p ( ! ,core ,set ( ,heal? ,c>e ,quality
 ,measures = ,adults z describ$ 9       
section #aaci;,b2 &  7vii7 consid]      
measures t assess pati5t exp]i5ce ( c>e4
  4  #bjc4 ,provid+ in=mation on        
behavioral heal? cov]age to promote     
in=m$ *oice ,section #ahea7;d77#d7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ba7;d77#d77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,f7   
,behavioral heal? in=mation ,= #bjbe &  
subsequ5t plan ye>s1 to ! ext5t         
available1 ! foll[+ in=mation ) respect 
to ! prec$+ plan ye>3 7i7 ,in=mation on 
access to 9-network behavioral heal?    
provid]s1 disaggregat$ by ^? :o         
prescribe & ^? :o (f] m5tal heal? or    
sub/ance use disord] s]vices1 includ+-- 
7,i7 ! av]age wait "t 7z def9$ by !     
,secret>y7 = an appo9tm5t = a new pati5t
 ) an 9-network provid] = m5tal heal? or
 sub/ance disord] s]vices2  7,,ii7 !    
total numb] & p]c5tage ( provid]s :o h  

p>ticipation agreem5ts ) ! organization 
:o submitt$ at lea/ "o reque/ = paym5t =
 a m5tal heal? or sub/ance use disord]  
s]vice dur+ a #f mon? p]iod 7or o!r     
p]iod specifi$ by ! ,secret>y72 &       
7,,iii7 ! p]c5tage ( reque/s = paym5t = 
m5tal heal? or sub/ance use disord]     
s]vices t 7 submitt$ by-- 7aa7 9-network
 provid]s2 &  7bb7 out-(-network        
provid]s4  7ii7 ,in=mation on ! numb] ( 
d5ials ( prior au?orization reque/s or  
d5ials ( paym5t = m5tal heal? or        
sub/ance use disord] s]vices comp>$ to  
non-m5tal heal? & sub/ance use disord]  
s]vices ov]all1 categoriz$ by ! type (  
d5ial & by ! type ( s]vice1 z def9$ by !
 ,secret>y1 includ+-- 7,i7 ! numb] &    
p]c5t ( su* d5ials by ! numb] ( days to 
d5ial1 ! reason = d5ial1 & ! utilization
 ( decision support te*nology1          
artificial intellig5ce te*nology1       
ma*9e-le>n+ te*nology1 cl9ical          
decision-mak+ te*nology1 or any o!r     
te*nology specifi$ by ! ,secret>y2 &    
7,,ii7 ! numb] & p]c5t ( su* d5ials )   

respect to a m5tal heal? or sub/ance use
 disord] s]vice comp>$ to su* d5ials )  
respect to items & s]vices = a simil>   
physical heal? condition 7su* z         
depression comp>$ to diabetes7 by !     
numb] ( days to d5ial1 ! reason = d5ial1
 & ! utilization ( decision support     
te*nology1 artificial intellig5ce       
te*nology1 ma*9e-le>n+ te*nology1       
cl9ical decision-mak+ te*nology1 or any 
o!r te*nology specifi$ by ! ,secret>y4  
4  #bjd4 ,requir+ ,,ma organizations to 
ma9ta9 accurate & updat$ provid]        
directories  7a7 ,9 g5]al ,section      
#aheb7;c7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciew-#bb7;c77 is       
am5d$-- 7#a7 9 p>agraph 7#a77;,c7-- 7,a7
 by /rik+ plan1 & any & ins]t+ plan1    
any2 &  7,b7 by ins]t+ ! foll[+ be=e !  
p]iod3 1 &1 9 ! case ( a network-bas$   
,,ma plan 7z def9$ 9 p>agraph           
7#c77;,c771 ! in=mation describ$ 9      
p>agraph 7#c77;,a77i77,,ii72 &  7#b7 by 
add+ at ! end ! foll[+ new p>agraph3    
7#c7 ,provid] directory accuracy &      

transp>5cy  7,a7 ,9 g5]al ,= plan ye>   
#bjbe & subsequ5t plan ye>s1 ea* ,,ma   
organization (f]+ a network-bas$ ,,ma   
plan %all d ! foll[+3 7i7 ,ma9ta9 an    
accurate provid] directory  7,i7 ,9     
g5]al ,! ,,ma organization %all1 = ea*  
network-bas$ ,,ma plan (f]$ by !        
organization1 ma9ta9 an accurate provid]
 directory-- 7aa7 t includes ! in=mation
 describ$ 9 subclause 7,,ii72  7bb7 :i*1
 n less frequ5tly ?an #ij days1 !       
organization v]ifies &1 if applicable1  
updates ! provid] directory in=mation ( 
ea* provid]2  7cc7 t provides1 if !     
organization is unable to v]ify su*     
in=mation ) respect to a provid]1 = !   
inclusion along ) ! in=mation 9 !       
directory ) respect to su* provid] ( a  
notification indicat+ t ! in=mation may 
n be up to date2  7dd7 t provides = !   
removal ( a provid] f su* directory )9  
#b bus9ess days if ! organization       
det]m9es t ! provid] is no long] a      
p>ticipat+ provid]2 &  7ee7 t meets su* 
o!r requirem5ts z ! ,secret>y may       

specify4  7,,ii7 ,in=mation describ$ ,! 
in=mation describ$ 9 ?is subclause is ! 
,national ,provid] ,id5tifi]1 "n1       
address1 specialty1 telephone numb]1    
,int]net website if available1          
availability 7includ+ :e!r ! provid] is 
accept+ new pati5ts71 cultural & l+ui/ic
 capabilities 7includ+ ! languages (f]$ 
by ! provid] or by a skill$ m$ical      
int]pret] :o provides int]pretation     
s]vices = ! provid]71 & o!r in=mation z 
det]m9$ appropriate by ! ,secret>y = ea*
 provid] ) :i* su* ,,ma organization has
 an agreem5t = furni%+ items & s]vices  
cov]$ "u su* plan4  7ii7 ,submission (  
provid] directory to ! ,secret>y ,! ,,ma
 organization %all submit to ! ,secret>y
 ! provid] directory = ea* network-bas$ 
,,ma plan (f]$ by ! organization 9 a    
mann] specifi$ by ! ,secret>y4  7,b7    
,po/+ ( provid] directory in=mation ,=  
plan ye> #bjbf & subsequ5t plan ye>s1 ! 
,secret>y %all po/ ! provid] directory  
in=mation submitt$ "u subp>agraph       
7,a77ii71 9 a ma*9e readable file1 on ! 

int]net website ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices4  7,c7 ,network-bas$  
,,ma plan def9$ ,9 ?is p>agraph1 ! t]m  
network-bas$ ,,ma plan means an ,,ma    
plan t has a network ( provid]s t h     
agreem5ts ) ! ,,ma organization (f]+ !  
plan to furni% items & s]vices cov]$ "u 
su* plan4  4  7b7 ,en=cem5t ,section    
#aheg7;d7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciew-#bg7;d77 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#g7 ,audit ( provid] directories ,ea*  
contract "u ?is section %all provide t !
 ,secret>y1 or any p]son or organization
 designat$ by ! ,secret>y1 %all h ! "r  
to audit any provid] directory "u       
section #aheb7;c77#c77;,a77i7 to det]m9e
 :e!r su* directory meets ! requirem5ts 
( su* section4  4  7c7 ,fund+ ,9        
addition to am\nts o!rwise available1   
!re is appropriat$ to ! ,c5t]s = ,m$ic>e
  ,m$icaid ,s]vices ,program ,managem5t 
,acc\nt = fiscal ye> #bjbc1 out ( any   
am\nts 9 ! ,treasury n o!rwise          
appropriat$1 #aj1jjj1jjj1 to rema9      

available until exp5d$1 = purposes (    
c>ry+ out ! am5dm5ts made by ?is        
section4  ,,iii ,m$icaid & ,,*ip  #cja4 
,enhanc$ paym5t "u ,m$icaid = integrat$ 
m5tal heal? & sub/ance use disord] c>e  
s]vices ,section #aijc ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acif;b7  
is am5d$-- 7#a7 9 subsection 7a77#c7--  
7,a7 9 subp>agraph 7,d71 by ins]t+ &    
aft] ! semicolon2  7,b7 9 subp>agraph   
7,f77ii71 by /rik+ plus aft] ! semicolon
 & ins]t+ &2 &  7,c7 by ins]t+ aft]     
subp>agraph 7,f77ii71 ! foll[+3  7,g7 = 
cal5d> qu>t]s beg9n+ on or aft] ,janu>y 
#a1 #bjbe1 #ajj p]c5t ( ! am\nt det]m9$ 
= su* qu>t] "u subsection 7cc72 &  2 &  
7#b7 by add+ ! end ! foll[+3  7cc7      
,enhanc$ paym5t = integrat$ m5tal heal? 
& sub/ance use disord] c>e s]vices  7#a7
 ,9 g5]al ,= purposes ( subsection      
7a77#c77;,g71 9 accordance ) guidance   
issu$ n lat] ?an ! date t is #ahj days  
aft] ! date ( ! enactm5t ( ?is          
subsection by ! ,secret>y to ,/ates1 !  
am\nt det]m9$ "u ?is subsection )       

respect to a ,/ate & cal5d> qu>t] is !  
am\nt by :i*-- 7,a7 ! aggregate am\nt   
exp5d$ by ! ,/ate dur+ ! cal5d> qu>t] = 
m$ical assi/ance provid$ by a prim>y c>e
 practition] 7z def9$ 9 section         
#ahcc7x77#b77;,a77i77 = integrat$ m5tal 
heal? & sub/ance use disord] c>e s]vices
 describ$ 9 section #ahdh7;b77#ac77;,b7 
& su* o!r items & s]vices = ! c>e (     
m5tal heal? & sub/ance use conditions   
furni%$ by1 or 9 coord9ation )1 su*     
prim>y c>e practition] z ! ,secret>y1 9 
consultation ) ! ,/ate1 may specify2    
exce$s  7,b7 ! qu>t]ly av]age ( !       
aggregate am\nts exp5d$ by ! ,/ate =    
m$ical assi/ance describ$ 9 subp>agraph 
7,a7 dur+ ! applicable base p]iod = !   
cal5d> qu>t] involv$4  7#b7 ,applicable 
base p]iod def9$  7,a7 ,9 g5]al ,=      
purposes ( p>agraph 7#a71 ! t]m         
applicable base p]iod means1 ) respect  
to a cal5d> qu>t]1 ! #e-ye> p]iod t ends
 on ! mo/ rec5t base p]iod end date4    
7,b7 ,base p]iod end date def9$ ,=      
purposes ( subp>agraph 7,a71 ! t]m base 

p]iod end date means-- 7i7 ,decemb] #ca1
 #bjbd2 &  7ii7 ,decemb] #ca ( e #e? ye>
 foll[+ #bjbd4  4  #cjb4 ,demon/ration  
project to ensure ,m$icaid-enroll$      
*ildr5 h access to integrat$ m5tal heal?
 & sub/ance use disord] c>e s]vices1    
includ+ prev5tion & e>ly int]v5tion     
s]vices  7a7 ,9 g5]al ,n lat] ?an ! date
 t is #ahj days aft] ! date ( ! enactm5t
 ( ?is section1 ! ,secret>y %all conduct
 a #ed-mon? demon/ration project = !    
purpose describ$ 9 subsection 7b7 "u :i*
 ! ,secret>y %all-- 7#a7 = ! fir/       
#ah-mon? p]iod ( su* project1 aw>d      
plann+ grants describ$ 9 subsection 7c72
 &  7#b7 = ! rema9+ #cf-mon? p]iod ( su*
 project1 provide to ea* ,/ate select$  
"u subsection 7d7 paym5ts 9 accordance )
 subsection 7e74  7b7 ,purpose ,!       
purpose describ$ 9 ?is subsection is =  
ea* ,/ate t receives a plann+ grant "u  
subsection 7c7 to ensure t e            
,m$icaid-enroll$ *ild 9 ! ,/ate has     
access to integrat$ m5tal heal? &       
sub/ance use disord] c>e s]vices1       

includ+ prev5tion & e>ly int]v5tion     
s]vices1 s z to all[ = ! prev5tion1     
id5tification1 & treatm5t ( m5tal heal? 
& sub/ance use conditions 9 prim>y c>e1 
*ildr5's hospitals1 e>ly c>e &          
education1 s*ools1 or o!r sett+s z      
appropriate 7su* z home visit+ & e>ly   
int]v5tion programs = "y *ildr51 fo/]   
c>e or o!r *ild welf>e c>e sett+s1 or   
work=ce developm5t programs & community 
c5t]s = y\?7 79 ?is section collectively
 ref]r$ to z c>e sett+s71 ?r\gh ! foll[+
 activities3 7#a7 ,activities t support 
an ongo+ assessm5t ( ! accessibility (  
integrat$ m5tal heal? & sub/ance use    
disord] c>e s]vices1 includ+ prev5tion &
 e>ly int]v5tion s]vices1 =             
,m$icaid-enroll$ *ildr5 9 ! ,/ate t     
tracks progress t[>d ! goal ( all       
,m$icaid-enroll$ *ildr5 7includ+ infants
 & toddl]s z well z transition-ag$ y\?7 
hav+ access to appropriate levels (     
s]vices 9 c>e sett+s 9 :i* ! *ildr5     
regul>ly engage1 & t is conduct$ 9      
p>tn]%ip ) su* *ildr5 & families1 to    

ensure t ! assessm5t reflects _!        
p]spective1 exp]i5ces1 & solutions4     
7#b7 ,activities t1 tak+ into acc\nt !  
results ( ! assessm5t describ$ 9        
p>agraph 7#a71 support ! developm5t1    
implem5tation1 & ma9t5ance ( ,/ate      
infra/ructure1 su* z te*nology & !      
physical /ructures necess>y to          
physically co-locate integrat$ m5tal    
heal? & sub/ance use disord] c>e        
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices1 & a work=ce to      
provide ! types ( support1 tra9+1 &     
te*nical assi/ance ne$$ 9 ord] to (f]   
integrat$ m5tal heal? & sub/ance use c>e
 s]vices1 includ+ prev5tion & e>ly      
int]v5tion s]vices1 9 c>e sett+s ) :i*  
,m$icaid-enroll$ *ildr5 & _! families   
regul>ly int]act1 :i* are select$ =     
integration bas$ on ! assessm5t ( :]e   
su* *ildr5 & _! families c access su*   
s]vices1 & = :i* furni%+ integrat$ m5tal
 heal? & sub/ance use disord] c>e       
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices1 w be su/a9able "u ! 

,/ate's plann$ activities4  7#c7        
,increas$ reimbursem5t & improv$        
inc5tives = c>e sett+s to su/a9ably     
implem5t & provide 7ei!r ?r\gh direct   
deliv]y or coord9ation 9 ! case ( a c>e 
sett+ t is an e>ly c>e or education     
program7-- 7,a7 developm5tally          
appropriate m5tal heal? promotive &     
prev5tive int]v5tions = ,m$icaid-enroll$
 *ildr5 & _! families1 along ) scre5+ to
 id5tify psy*o-social ne$s ( su* *ildr5 
:o d n yet h a diagnosable m5tal heal?  
condition 7consi/5t ) ! requirem5ts =   
provid+ items & s]vices describ$ 9      
section #aije7;a77#d77;,b7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;d7a77#d77;,b777relat+ to e>ly &   
p]iodic scre5+1 diagno/ic1 & treatm5t   
s]vices def9$ 9 section #aije7r7 ( su*  
,act 7#db ,u4,s4,c4 #acif;d7r777 9      
accordance ) ! requirem5ts ( section    
#aijb7;a77#dc7 ( su* ,act 7#db ,u4,s4,c4
 #acif;a7a77#dc77 & ! p$iatric prev5tive
 c>e /&>ds includ$ 9 ! ess5tial heal?   
b5efits requir$ "u section #acjb7;b7 ( !

 ,pati5t ,protection & ,af=dable ,c>e   
,act 7#db ,u4,s4,c4 #ahjbb7;b7772  7,b7 
evid5ce-bas$1 p]son-c5t]$1 & culturally1
 l+ui/ically1 & developm5tally          
appropriate int]v5tions at ! site (     
s]vice1 ei!r 9-p]son or virtually       
integrat$1 to address any id5tifi$      
family & *ild psy*o-social ne$s1 includ+
 developm5tally appropriate assessm5t & 
diagno/ic s]vices1 treatm5t1 c>e        
coord9ation1 & dyadic int]v5tion        
approa*es2 &  7,c7 ref]ral to           
developm5tally appropriate m5tal heal? &
 sub/ance use specialty c>e provid]s &  
programs1 community-bas$ res\rces1 or   
virtual or digital s]vices to address   
risk factors or meet psy*o- social ne$s 
t _c be address$ 9 an integrat$ sett+4  
7#d7 ,improv$ regulatory ov]sight (     
policies gov]n+ ! provision ( s]vices   
describ$ 9 p>agraph 7#c71 includ+ )     
respect to e>ly & p]iodic scre5+1       
diagno/ic1 & treatm5t s]vices ref]r$ to 
9 su* p>agraph1 m5tal heal? & sub/ance  
use p>ity1 network adequacy1 ess5tial   

heal? b5efits ref]r$ to 9 su* p>agraph1 
,m$icaid rate sett+1 scope ( practice   
policies1 & heal? pr(essional %ortage   
areas4  7#e7 ,improv$ alignm5t betwe5   
,m$icaid & comm]cial heal? insur]s to   
ensure t s]vices describ$ 9 p>agraph    
7#c7 are support$ by comm]cial heal?    
insur]s1 su* z ?r\gh ! initiation (     
multi-pay] collaboratives4  7#f7        
,improv$ coord9ation among ,/ate & local
 ag5cies & o!r /akehold]s t fund or     
provide prim>y c>e1 *ildr5's hospitals1 
e>ly c>e & education1 or o!r programs 9 
c>e sett+s describ$ 9 ?is subsection s z
 to include ef=ts to align policies to  
promote coord9ation ( m5tal heal? &     
sub/ance use s]vices fund$ "u su*       
programs across c>e sett+s1 includ+     
?r\gh ! alignm5t ( ,m$icaid ) programs  
"u ! ,elem5t>y & ,second>y ,education   
,act ( #aife 7#bj ,u4,s4,c4 #fcja et    
seq471 ! ,individuals ) ,disabilities   
,education ,act 7#bj ,u4,s4,c4 #adjj et 
seq471 ! ,family ,fir/ ,prev5tion       
,s]vices ,act 7title ,,vii ( division ,e

 ( ! ,bip>tisan ,budget ,act ( #bjah    
7,public ,law #aae-abc2 #acb ,/at4      
#bcb771 ! ,/ephanie ,tubbs ,jones ,*ild 
,welf>e ,s]vices ,program "u subp>t #a (
 "p ,b ( title ,,iv ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #fba et   
seq471 ! ,mary,lee ,all5 ,promot+ ,safe 
& ,/able ,families ,program "u subp>t #b
 ( "p ,b ( title ,,iv ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #fbi et   
seq471 home visit+ programs1 includ+ !  
,mat]nal1 ,infant1 & ,e>ly ,*ildhood    
,home ,visit+ ,program 7,,mie*v7 "u     
section #eaa ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #gaa71 & heal?1          
education1 & social welf>e programs     
fund$ "u ! ,am]ican ,rescue ,plan ,act (
 #bjba 7,public ,law #aag-b2 #ace ,/at4 
#d7 & ! ,*ild ,c>e ,developm5t ,block   
,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheg
 et seq474  7#g7 ,activities t include  
,m$icaid-enroll$ *ildr5 & _! families & 
c>egiv]s z p>tn]s at all levels (       
decision-mak+1 implem5tation1 &         
evaluation1 includ+ engag+ su* *ildr5 :o

 are y\? & _! families directly z       
p>apr(essional provid]s4  7c7 ,plann+   
grants  7#a7 ,9 g5]al ,= ! fir/ #ah-mon?
 p]iod ( ! demon/ration project1 !      
,secret>y %all aw>d plann+ grants to    
,/ates t apply = su* grants1 includ+ to 
entities specifi$ 9 subp>agraphs 7,b7 & 
7,c7 ( subsection 7h77#g74 ,a ,/ate     
aw>d$ a plann+ grant "u ?is subsection  
%all use ! grant to c>ry out !          
activities describ$ 9 p>agraph 7#b7 =   
purposes ( prep>+ & submitt+ an         
application to p>ticipate 9 ! rema9+    
#cf-mon? p]iod ( ! demon/ration project 
9 accordance ) subsection 7d74  7#b7    
,activities describ$ ,activities        
describ$ 9 ?is p>agraph are1 ) respect  
to a ,/ate aw>d$ a plann+ grant "u ?is  
subsection1 ea* ( ! foll[+3 7,a7        
,activities t support ! developm5t ( an 
initial assessm5t ( ! access ne$s (     
,m$icaid-enroll$ *ildr5 9 ! ,/ate )     
respect to m5tal heal? & sub/ance use   
s]vices1 to det]m9e ! types ( support1  
tra9+1 inc5tives1 & te*nical assi/ance t

 prim>y c>e1 e>ly c>e & education1 or   
o!r programs provid$ 9 c>e sett+s       
describ$ 9 subsection 7b7 & ) :i*       
,m$icaid-enroll$ *ildr5 & _! families   
regul>ly engage ne$ 9 ord] to (f]       
integrat$ m5tal heal? & sub/ance use    
disord] c>e s]vices1 includ+ prev5tion &
 e>ly int]v5tion s]vices1 & :i* %all    
include engag+ ,m$icaid-enroll$ *ildr5 &
 _! families directly to ensure t !     
assessm5t builds t[>d solutions t meet  
_! ne$s & reflect _! p]spectives1       
exp]i5ces1 & solutions4  7,b7           
,activities t1 tak+ into acc\nt !       
results ( ! assessm5t describ$ 9        
subp>agraph 7,a71 support ! developm5t (
 ,/ate infra/ructure1 su* z te*nology & 
! physical /ructures necess>y to        
physically co-locate integrat$ m5tal    
heal? & sub/ance use disord] c>e        
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices1 to provide ! types (
 support1 tra9+1 inc5tives1 & te*nical  
assi/ance t prim>y c>e1 e>ly c>e &      
education1 or o!r programs provid$ 9 c>e

 sett+s describ$ 9 subsection 7b7 & )   
:i* ,m$icaid-enroll$ *ildr5 & _!        
families regul>ly engage ne$ 9 ord] to  
(f] integrat$ m5tal heal? & sub/ance use
 disord] c>e s]vices1 includ+ prev5tion 
& e>ly int]v5tion s]vices1 to           
,m$icaid-enroll$ *ildr51 z well z       
activities t support ongo+ engagem5t (  
,m$icaid-enroll$ *ildr5 & _! families 9 
implem5tation & coord9ation ) heal?     
insur]s & ) o!r *ild-s]v+ ag5cies &     
/akehold]s4  7#c7 ,fund+ ,= purposes (  
aw>d+ plann+ grants "u p>agraph 7#a71   
!re is appropriat$1 out ( any funds 9 ! 
,treasury n o!rwise appropriat$1        
#ajj1jjj1jjj1 to rema9 available until  
exp5d$4  7d7 ,po/-,plann+ ,/ates  7#a7  
,9 g5]al ,= ! rema9+ #cf-mon? p]iod ( ! 
demon/ration project1 ! ,secret>y %all  
make paym5ts 9 accordance ) subsection  
7e7 to all ,/ates t submit applications 
t meet ! requirem5ts ( p>agraph 7#b7 &  
c>ry out ! activities describ$ 9 t      
p>agraph4  7#b7 ,applications2          
activities  7,a7 ,9 g5]al ,a ,/ate seek+

 to be select$ to p>ticipate 9 ! rema9+ 
#cf-mon? p]iod ( ! demon/ration project 
%all submit to ! ,secret>y1 at su* "t & 
9 su* =m & mann] z ! ,secret>y requires1
 an application t includes su*          
in=mation1 provisions1 & assurances1 z !
 ,secret>y may require1 9 addition to ! 
foll[+3 7i7 ,a process = c>ry+ out !    
ongo+ assessm5t describ$ 9 subsection   
7b77#a71 tak+ into acc\nt ! results ( ! 
initial assessm5t describ$ 9 subsection 
7c77#b77;,a74  7ii7 ,a review ( ,m$icaid
 reimbursem5t me?odologies & o!r        
policies relat$ to furni%+ integrat$    
m5tal heal? & sub/ance use disord] c>e  
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices1 to ,m$icaid-enroll$ 
*ildr5 t may create b>ri]s to access4   
,if ! ,/ate uses multiple reimbursem5t  
me?odologies "u ,m$icaid = m5tal heal? &
 sub/ance use c>e 7su* z capitation1    
fee-=-s]vice1 value-bas$1 & alt]native  
paym5t programs71 ! ,/ate %all include 9
 ! application specific detail$         
in=mation reg>d+ h[ ! ,/ate w v]ify t ! 

comb9ation ( reimbursem5t me?odologies  
employ$ by ! ,/ate w result 9 improv$   
access to integrat$ m5tal heal? &       
sub/ance use disord] c>e s]vices1       
includ+ prev5tion & e>ly int]v5tion     
s]vices1 = ,m$icaid-enroll$ *ildr54     
7iii7 ,! developm5t ( a plan1 tak+ into 
acc\nt activities c>ri$ out "u          
subsection 7c77#b77;,b71 t w result 9   
long-t]m & su/a9able access to integrat$
 m5tal heal? & sub/ance use disord] c>e 
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices1 = ,m$icaid-enroll$  
*ildr5 :i* includes ! foll[+3 7,i7      
,specific activities to increase access 
to integrat$ m5tal heal? & sub/ance use 
disord] c>e s]vices1 includ+ prev5tion &
 e>ly int]v5tion s]vices1 s z to all[ = 
! prev5tion1 id5tification1 & treatm5t (
 m5tal heal? & sub/ance use conditions 9
 prim>y c>e1 e>ly c>e & education1 or   
o!r programs provid$ 9 c>e sett+s       
describ$ 9 subsection 7b7 & ) :i*       
,m$icaid-enroll$ *ildr5 & _! families   
regul>ly engage4  7,,ii7 ,/rategies t w 

inc5tivize a racially & culturally      
div]se array ( provid]s 7includ+        
p>apr(essionals7 to obta9 ! necess>y    
tra9+1 education1 & support to deliv]   
integrat$ c>e = ! developm5tally        
appropriate prev5tion1 id5tification1   
assessm5t1 diagnosis1 & treatm5t ( m5tal
 heal? & sub/ance use conditions 9      
,m$icaid-enroll$ *ildr5 9 prim>y c>e1   
e>ly c>e & education1 or o!r programs   
provid$ 9 c>e sett+s describ$ 9         
subsection 7b7 & ) :i* ,m$icaid-enroll$ 
*ildr5 & _! families regul>ly engage4   
7,,iii7 ,mile/ones & timel9ess =        
implem5t+ activities set =? 9 ! plan1 z 
det]m9$ by ! ,secret>y4  7,,iv7         
,specific measurable t>gets = increas+  
equitable access to integrat$ m5tal     
heal? & sub/ance use disord] c>e        
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices1 = ,m$icaid-enroll$  
*ildr54  7,v7 ,specific measurable      
t>gets = increas+ ! work=ce provid+     
integrat$ m5tal heal? & sub/ance use    
disord] c>e s]vices1 includ+ prev5tion &

 e>ly int]v5tion s]vices4  7iv7 ,a      
process = report+ ! in=mation requir$ "u
 subsection 7f77#a71 includ+ in=mation  
to assess ! effectiv5ess ( ! ef=ts ( !  
,/ate dur+ ! p]iod ( ! demon/ration     
project "u ?is subsection & ensure !    
su/a9ability ( su* ef=ts aft] !         
conclusion ( ! demon/ration project4    
7v7 ,! expect$ f9ancial impact ( !      
demon/ration project on ! ,/ate4  7vi7  
,a description ( fund+ s\rces available 
to ! ,/ate to exp& access to integrat$  
m5tal heal? & sub/ance use disord] c>e  
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices 9 ! ,/ate1 includ+   
heal? c>e1 public heal?1 education1 &   
social s]vice fund+ opportunities4      
7vii7 ,a prelim9>y plan = h[ ! ,/ate w  
su/a9 access to integrat$ m5tal heal? & 
sub/ance use disord] c>e s]vices1       
includ+ prev5tion & e>ly int]v5tion     
s]vices1 = ,m$icaid-enroll$ *ildr5 aft] 
! demon/ration project1 includ+         
ma9t5ance ( inc5tives & enhanc$         
reimbursem5t rates4  7viii7 ,a          

description ( h[ ! ,/ate w coord9ate !  
goals ( ! demon/ration project ) any    
waiv] grant$ 7or submitt$ by ! ,/ate &  
p5d+7 pursuant to section #aaae ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acae7 = ! deliv]y ( m5tal heal? &      
sub/ance use s]vices "u ,m$icaid1 z     
applicable1 & ) ,/ate plans "u !        
,elem5t>y & ,second>y ,education ,act ( 
#aife 7#bj ,u4,s4,c4 #fcja et seq471 !  
,individuals ) ,disabilities ,education 
,act 7#bj ,u4,s4,c4 #adjj et seq471 !   
,family ,fir/ ,prev5tion ,s]vices ,act  
7title ,,vii ( division ,e ( !          
,bip>tisan ,budget ,act ( #bjah 7,public
 ,law #aae-abc2 #acb ,/at4 #bcb771 !    
,/ephanie ,tubbs ,jones ,*ild ,welf>e   
,s]vices ,program "u subp>t #a ( "p ,b (
 title ,,iv ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #fba et seq471 !         
,mary,lee ,all5 ,promot+ ,safe & ,/able 
,families ,program "u subp>t #b ( "p ,b 
( title ,,iv ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #fbi et seq471 home      
visit+ programs1 includ+ ! ,mat]nal1    

,infant1 & ,e>ly ,*ildhood ,home ,visit+
 ,program 7,,mie*v7 "u section #eaa ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#gaa71 & heal?1 education1 & social     
welf>e programs fund$ "u ! ,am]ican     
,rescue ,plan ,act ( #bjba 7,public ,law
 #aag-b2 #ace ,/at4 #d7 & ! ,*ild ,c>e  
,developm5t ,block ,grant ,act ( #aiij  
7#db ,u4,s4,c4 #iheg et seq474  7,b7    
,consultation ,9 complet+ an application
 "u subp>agraph 7,a71 a ,/ate %all      
consult ) relevant /akehold]s1 includ+  
,m$icaid manag$ c>e plans1 prim>y &     
specialty heal? c>e provid]             
organizations1 ,m$icaid-enroll$ *ildr5 &
 _! families1 & o!r *ild-s]v+ ,/ate &   
local ag5cies & /akehold]s1 & include 9 
! application a description ( su*       
consultation4  7,c7 ,te*nical assi/ance 
,! ,secret>y %all provide te*nical      
assi/ance to ,/ates ) respect to prep>+ 
& submitt+ an application t meets !     
requirem5ts ( subp>agraphs 7,a7 & 7,b74 
7e7 ,paym5ts  7#a7 ,9 g5]al ,= ea* qu>t]
 occurr+ dur+ ! rema9+ #cf-mon? p]iod ( 

! demon/ration project1 ! ,secret>y %all
 pay ea* ,/ate t submits an application 
t meets ! requirem5ts ( subsection 7d7  
7#b7 & c>ries out ! activities describ$ 
9 t subsection1 an am\nt equal to #hj   
p]c5t ( ! qualifi$ sums exp5d$ by !     
,/ate = su* qu>t]4  7#b7 ,qualifi$ sums 
def9$ ,= purposes ( p>agraph 7#a71 ! t]m
 qualifi$ sums means1 ) respect to a    
,/ate & a qu>t]1 ! am\nt equal to !     
am\nt 7if any7 by :i*-- 7,a7 ! sums     
exp5d$ by ! ,/ate dur+ su* qu>t] t are  
attributable to-- 7i7 furni%+ integrat$ 
m5tal heal? & sub/ance use disord] c>e  
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices1 to ,m$icaid-enroll$ 
*ildr52  7ii7 ! developm5t or enabl+ (  
,/ate infra/ructure1 su* z te*nology & !
 physical /ructures necess>y to         
physically co-locate integrat$ m5tal    
heal? & sub/ance use disord] c>e        
s]vices1 includ+ prev5tion & e>ly       
int]v5tion s]vices1 deliv]$ 9 or        
coord9at$ ?r\gh prim>y c>e1 e>ly c>e &  
education1 or o!r programs provid$ 9 c>e

 sett+s describ$ 9 subsection 7b7 & )   
:i* ,m$icaid-enroll$ *ildr5 & _!        
families regul>ly engage2 &  7iii7 !    
developm5t ( a work=ce to provide !     
types ( support1 tra9+1 & te*nical      
assi/ance ne$$ 9 ord] to (f] integrat$  
m5tal heal? & sub/ance use c>e s]vices1 
includ+ prev5tion & e>ly int]v5tion     
s]vices1 9 prim>y c>e1 e>ly c>e &       
education1 or o!r programs provid$ 9 c>e
 sett+s describ$ 9 subsection 7b7 & )   
:i* ,m$icaid-enroll$ *ildr5 & _!        
families regul>ly engage2 exce$s  7,b7  
#a_/d ( ! av]age annual am\nt exp5d$ by 
! ,/ate = ! mo/ rec5t #e-;fiscal ye>    
p]iod = m$ical assi/ance = m5tal heal?  
or sub/ance use disord] c>e s]vices =   
,m$icaid-enroll$ *ildr5 9 a prim>y c>e1 
*ildr5's hospitals1 s*ool1 e>ly c>e &   
education1 or o!r developm5tally        
appropriate c>e sett+1 z det]m9$ by !   
,secret>y4  7#c7 ,non-duplication (     
paym5t ,no paym5t made "u ?is subsection
 ) respect to m$ical assi/ance furni%$  
to a ,m$icaid-enroll$ *ild %all be      

duplicative ( any paym5t made to a      
provid] p>ticipat+ "u ! ,/ate ,m$icaid  
program = ! same s]vices s furni%$ to ! 
same *ild4  7f7 ,reports  7#a7 ,/ate    
reports ,ea* ,/ate t receives paym5ts "u
 subsection 7e7 dur+ ! rema9+ #cf-mon?  
p]iod ( ! demon/ration project %all     
submit to ! ,secret>y1 9 accordance )   
detail$1 specific guidance t is issu$ by
 ! ,secret>y n lat] ?an ! fir/ day ( su*
 p]iod1 & t includes in=mation on h[ to 
e/imate & reconcile ,/ate exp5ditures to
 c>ry out ! demon/ration project dur+   
su* p]iod1 qu>t]ly reports1 ) respect to
 exp5ditures = :i* paym5t is made to !  
,/ate "u subsection 7e71 on ! foll[+3   
7,a7 ,! specific activities ) respect to
 :i* paym5t "u su* subsection 0 provid$4
  7,b7 ,! numb] ( prim>y c>e1 *ildr5's  
hospitals1 s*ools1 & e>ly c>e &         
education programs t deliv]$ or         
coord9at$ integrat$ m5tal heal? &       
sub/ance use disord] c>e s]vices1       
includ+ prev5tion & e>ly int]v5tion     
s]vices1 to ,m$icaid-enroll$ *ildr5 dur+

 su* p]iod & _! geographic di/ribution1 
comp>$ to ! e/imat$ numb] t w\ld h      
o!rwise deliv]$ su* s]vices 9 ! abs5ce (
 ! demon/ration project1 includ+        
disaggregat$ data on ! race1 e?nicity1 &
 g5d] ( provid]s4  7,c7 ,! numb] (      
,m$icaid-enroll$ *ildr5 :o receiv$      
integrat$ m5tal heal? & sub/ance use    
disord] c>e s]vices1 includ+ prev5tion &
 e>ly int]v5tion s]vices dur+ su* p]iod 
comp>$ to ! e/imat$ numb] ( su* *ildr5  
:o w\ld h o!rwise receiv$ su* s]vices 9 
! abs5ce ( ! demon/ration project1      
includ+ disaggregat$ data on ! race1    
e?nicity1 g5d]1 age 7ensur+ t *ildr5    
bir? to #e z well z transition-ag$ y\?  
are adequately s]v$71 sexual ori5tation1
 prim>y language1 income1 & disability  
/atus ( ! *ildr54  7,d7 ,su* o!r data or
 in=mation z det]m9$ by ! ,secret>y4    
7#b7 ,,cms reports  7,a7 ,initial report
 ,n lat] ?an ,octob] #a1 #bjbf1 !       
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all1 9 consultation )
 ! ,director ( ! ,ag5cy = ,heal?c>e     

,rese>* & ,quality & ! ,assi/ant        
,secret>y = ,m5tal ,heal? & ,sub/ance   
,use1 submit to ,congress an initial    
report on ! activities c>ri$ out by     
,/ates "u ! plann+ grants made "u       
subsection 7c71 & actions tak5 by !     
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices to improve ov]sight ( 
su* activities4  7,b7 ,int]im report ,n 
lat] ?an ,octob] #a1 #bjbh1 !           
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all1 9 consultation )
 ! ,director ( ! ,ag5cy = ,heal?c>e     
,rese>* & ,quality & ! ,assi/ant        
,secret>y = ,m5tal ,heal? & ,sub/ance   
,use1 submit to ,congress an int]im     
report on activities c>ri$ out "u !     
demon/ration project & actions tak5 by !
 ,adm9i/rator ( ! ,c5t]s = ,m$ic>e      
,m$icaid ,s]vices to improve ov]sight ( 
su* activities & ! ext5t to :i* ,/ates h
 a*iev$ ! /at$ goals submitt$ 9 _!      
applications4 ,su* report %all include a
 description ( ! /r5g?s & limitations ( 
! demon/ration project & a plan = !     

su/a9ability ( ! project4  7,c7 ,f9al   
report ,n lat] ?an ,octob] #a1 #bjcj1 ! 
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all1 9 consultation )
 ! ,director ( ! ,ag5cy = ,heal?c>e     
,rese>* & ,quality & ! ,assi/ant        
,secret>y = ,m5tal ,heal? & ,sub/ance   
,use1 submit to ,congress a f9al report 
provid+ updates on ! matt]s report$ 9 ! 
int]im report requir$ by subp>agraph    
7,b7 & t includes-- 7i7 a description ( 
any *anges made ) respect to !          
demon/ration project aft] ! submission (
 su* int]im report2 &  7ii7 an          
evaluation ( ! demon/ration project4    
7g7 ,implem5tation fund+ ,!re is        
appropriat$1 out ( any funds 9 !        
,treasury n o!rwise appropriat$1        
#e1jjj1jjj to ! ,adm9i/rator ( ! ,c5t]s 
= ,m$ic>e  ,m$icaid ,s]vices = purposes 
( implem5t+ ?is section1 to rema9       
available until exp5d$4  7h7 ,def9itions
 ,9 ?is section3 7#a7 ,*ildr5's         
hospitals ,! t]m *ildr5's hospitals has 
! mean+ giv5 t t]m 9 section            

#cdj;,e7g77#b7 ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4             
#bef;e7g77#b74  7#b7 ,integrat$ m5tal   
heal? & sub/ance use disord] c>e s]vices
 ,! t]m m5tal heal? & sub/ance use      
disord] c>e s]vices has ! mean+ giv5 t  
t]m 9 section #ahdh7;b77#ac77;,b7 ( !   
,social ,security ,act & includes       
prev5tion & e>ly int]v5tion s]vices &   
su* o!r items & s]vices = ! c>e ( m5tal 
heal? & sub/ance use conditions furni%$ 
by1 or 9 coord9ation )1 a prim>y c>e    
practition] z ! ,secret>y1 9            
consultation ) a ,/ate1 may specify4    
7#c7 ,m$icaid ,! t]m ,m$icaid means !   
program = grants to ,/ates = m$ical     
assi/ance programs e/abli%$ "u title    
,,xix ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif et seq474  7#d7         
,secret>y ,except z o!rwise specifi$1 ! 
t]m ,secret>y means ! ,secret>y ( ,heal?
 & ,human ,s]vices4  7#e7 ,/ate ,! t]m  
,/ate has ! mean+ giv5 t t]m 9 section  
#aaja7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acja7;a77#a77 =        

purposes ( titles ,,xix & ,,xxi ( su*   
,act1 & = purposes (  7#f7              
,m$icaid-enroll$ *ild ,! t]m            
,m$icaid-enroll$ *ild means1 ) respect  
to a ,/ate1 a *ild enroll$ "u ! ,/ate   
plan approv$ "u title ,,xix ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 or "u a waiv] ( su* plan4  7#g7   
,secret>y ,! t]m ,secret>y means !      
,secret>y ( ,heal? & ,human ,s]vices4   
7#h7 ,/ate ,! t]m ,/ate means-- 7,a7 ea*
 ( ! #ej ,/ates & ! ,di/rict (          
,columbia2  7,b7 ! ,commonweal? ( ,pu]to
 ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1  
,guam1 ,am]ican ,samoa1 & ! ,commonweal?
 ( ! ,nor!rn ,m>iana ,isl&s2 &  7,c7 to 
! ext5t ! ,secret>y det]m9es            
appropriate1 may include an ,indian     
,tribe1 ,tribal organization1 or ,urban 
,indian organization 7z su* t]ms are    
def9$ 9 section #d ( ! ,indian ,heal?   
,c>e ,improvem5t ,act 7#be ,u4,s4,c4    
#afjc774  #cjc4 ,uni=m applicability to 
,m$icaid ( requirem5ts = p>ity 9 m5tal  
heal? & sub/ance use disord] b5efits    

7a7 ,fee-=-,s]vice & alt]native b5efit  
plans ,section #aijb ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acif;a7  
is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 
by /rik+ & at ! end ( p>agraph 7#hf72   
7,b7 by /rik+ ! p]iod at ! end (        
p>agraph 7#hg7 & ins]t+ 2 &2 &  7,c7 by 
ins]t+ aft] p>agraph 7#hg7 ! foll[+ new 
p>agraph3  7#hh7 provide = ensur+ t !   
requirem5ts = p>ity 9 m5tal heal? &     
sub/ance use disord] b5efits "u         
subsection 7uu7 are compli$ ) reg>dless 
( ! paym5t model or arrangem5t "u :i*   
m$ical assi/ance is provid$1 includ+ :5 
m$ical assi/ance "u ! ,/ate plan or "u a
 waiv] ( su* plan is provid$ ?r\gh an   
alt]native b5efit plan "u section #aicg4
  2 &  7#b7 by add+ at ! end ! foll[+   
new subsection3  7uu7 ,p>ity 9 m5tal    
heal? & sub/ance use disord] b5efits ,= 
purposes ( subsection 7a77#hh71 !       
requirem5ts "u ?is subsection are !     
foll[+3 7#a7 ,9 g5]al ,reg>dless ( :e!r 
a ,/ate plan or waiv] ( pays = m$ical   
assi/ance on a fee-=-s]vice basis1      

capitat$ paym5t basis1 ?r\gh ! use ( #a 
or m alt]native paym5t models1 or any   
comb9ation !re(1 ! ,/ate %all ensure t !
 f9ancial requirem5ts & treatm5t        
limitations applicable to cov]age (     
m5tal heal? or sub/ance use disord]     
s]vices provid$ "u su* plan or "u a     
waiv] ( su* plan comply ) ! requirem5ts 
( section #bgbf7;a7 ( ! ,public ,heal?  
,s]vice ,act 9 ! same mann] z su*       
requirem5ts or limitations apply to a   
gr\p heal? plan "u su* section4  7#b7   
,deem$ compliance ,cov]age ) respect to 
an individual describ$ 9 section        
#aije7;a77#d77;,b7 & cov]$ "u ! ,/ate   
plan or waiv] "u section                
#aijb7;a77#aj77;,a7 ( ! s]vices describ$
 9 section #aije7;a77#d77;,b7 7relat+ to
 e>ly & p]iodic scre5+1 diagno/ic1 &    
treatm5t s]vices def9$ 9 section        
#aije7r77 & provid$ 9 accordance )      
section #aijb7;a77#dc71 %all be deem$ to
 satisfy ! requirem5ts ( p>agraph 7#a74 
4  7b7 ,manag$ c>e organizations &      
paym5t arrangem5ts  7#a7 ,9 g5]al       

,section #aicb7;b77#h7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acifu-#b7;b77#h77 is am5d$ to read z   
foll[s3  7#h7 ,compliance ) c]ta9       
mat]nity1 p>ity 9 m5tal heal? or        
sub/ance use disord] b5efits1 & o!r     
cov]age requirem5ts  7,a7 ,9 g5]al ,ea* 
m$icaid manag$ c>e organization %all    
comply ) ! requirem5ts ( subp>t #b ( "p 
,a ( title ,,xxvii ( ! ,public ,heal?   
,s]vice ,act ins(> z su* requirem5ts    
apply & are effective ) respect to a    
heal? insurance issu] t (f]s gr\p heal? 
insurance cov]age4  7,b7 ,p>ity 9 m5tal 
heal? or sub/ance use disord] b5efits ,!
 f9ancial requirem5ts & treatm5t        
limitations applicable to cov]age (     
m5tal heal? or sub/ance use disord]     
s]vices provid$ "u ! ,/ate plan or "u a 
waiv] ( su* plan ?r\gh a m$icaid manag$ 
c>e organization1 a prepaid inpati5t    
heal? plan 7z def9$ by ! ,secret>y71 a  
prepaid ambulatory heal? plan 7z def9$  
by ! ,secret>y71 or a prim>y c>e case   
manag] "u section #aije 7consi/5t )     

section #aije7t77#b771 %all comply ) !  
requirem5ts ( section #bgbf7;a7 ( !     
,public ,heal? ,s]vice ,act 9 ! same    
mann] z su* requirem5ts or limitations  
apply to a gr\p heal? plan "u su*       
section4  7,c7 ,deem$ compliance ,9     
apply+ subp>agraphs 7,a7 & 7,b7 )       
respect to requirem5ts "u p>agraph 7#h7 
( section #bgbf7;a7 ( ! ,public ,heal?  
,s]vice ,act1 a m$icaid manag$ c>e      
organization1 a prepaid inpati5t heal?  
plan 7z def9$ by ! ,secret>y71 a prepaid
 ambulatory heal? plan 7z def9$ by !    
,secret>y71 or a prim>y c>e case manag] 
"u section #aije 7consi/5t ) section    
#aije7t77#b77 %all be treat$ z 9        
compliance ) su* requirem5ts if !       
m$icaid manag$ c>e organization1 prepaid
 inpati5t heal? plan1 prepaid ambulatory
 heal? plan1 or prim>y c>e case manag]  
"u section #aije is 9 compliance )      
subp>t ,k ( "p #dch ( title #db1 ,code (
 ,f$]al ,regulations1 & section         
#dch4c7n7 ( su* title1 or any successor 
regulation4  4  7c7 ,effective date     

7#a7 ,9 g5]al ,except z provid$ 9       
p>agraph 7#b71 ! am5dm5ts made by       
subsections 7a7 & 7b7 %all take effect  
on ! fir/ day ( ! fir/ cal5d> qu>t] t   
beg9s on or aft] ! date t is #c ye>s    
aft] ! date ( enactm5t ( ?is ,act4  7#b7
 ,delay if /ate legislation ne$$ ,9 !   
case ( a ,/ate plan = m$ical assi/ance  
"u title ,,xix ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif et seq47 :i* !
 ,secret>y ( ,heal? & ,human ,s]vices   
det]m9es requires ,/ate legislation 7o!r
 ?an legislation appropriat+ funds7 9   
ord] = ! plan to meet ! additional      
requirem5ts impos$ by ! am5dm5ts made by
 subsection 7a71 ! ,/ate plan %all n be 
reg>d$ z fail+ to comply ) ! requirem5ts
 ( su* title solely on ! basis ( its    
failure to meet ^! additional           
requirem5ts be=e ! fir/ day ( ! fir/    
cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has

 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4  7d7 ,fund+ ,out ( any     
funds 9 ! ,treasury n o!rwise           
appropriat$1 !re is appropriat$ to !    
,secret>y ( ,heal? & ,human ,s]vices =  
purposes ( c>ry+ out ?is section & !    
am5dm5ts made by ?is section1           
#aj1jjj1jjj = fiscal ye> #bjbd1 to rema9
 available until exp5d$4  #cjd4 ,requir+
 additional transp>5cy on access to     
m5tal heal? & sub/ance use disord]      
b5efits ?r\gh manag$ c>e  7a7 ,biannual 
assessm5t ,section #aicb7;b7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acifu-#b7;b77 is am5d$ by add+ at ! end
 ! foll[+ new p>agraph3  7#i7           
,transp>5cy on access to m5tal heal? &  
sub/ance use disord] b5efits  7,a7 ,9   
g5]al ,ea* manag$ c>e organization1     
prepaid inpati5t heal? plan 7z def9$ by 
! ,secret>y71 & prepaid ambulatory heal?
 plan 7z def9$ by ! ,secret>y71 ) a     
contract ) a ,/ate to enroll individuals

 :o are eligible = m$ical assi/ance "u !
 ,/ate plan "u ?is title or "u a waiv] (
 su* plan & to provide cov]age "u !     
contract = m5tal heal? s]vices or       
sub/ance use disord] s]vices1           
disaggregat$1 biannually %all assess &  
report to ! ,/ate1 9 su* mann] t !      
report is publicly available on a       
website1 ! foll[+3 7i7 ,! av]age wait   
times dur+ ! report+ p]iod by level (   
acuity & site ( c>e = adult & *ild      
pati5ts = a new pati5t visit 9 an       
outpati5t sett+ 7includ+ int5sive       
outpati5t1 eat+ disord]1 resid5tial     
treatm5ts1 or o!r appo9tm5ts z !        
,secret>y specifies7 f a provid] ( m5tal
 heal? s]vices or sub/ance use disord]  
s]vices4  7ii7 ,! total numb] & av]age  
p]c5tage ( network provid]s t provide   
m5tal heal? s]vices or sub/ance use     
disord] s]vices & are accept+ z new     
pati5ts individuals :o are enrollees (  
su* organization or plan at any po9t    
dur+ ! report+ p]iod4  7iii7 ,!         
proportion ( m5tal heal? s]vices or     

sub/ance use disord] s]vices &          
prescription drugs dur+ ! report+ p]iod 
t are d5i$ paym5t "u ! ,/ate plan "u ?is
 title or a waiv] on ! basis ( prior    
au?orization or m$ical necessity 7or =  
any o!r reason t is n bas$ on an        
enrollee's eligibility = m$ical         
assi/ance "u ! ,/ate plan "u ?is title  
or a waiv]7 9 comp>ison to m$ical &     
surgical s]vices & prescription drugs t 
are d5i$ paym5t on ! same bases dur+ !  
report+ p]iod4  7iv7 ,! total numb] &   
p]c5tage ( provid]s dur+ ! report+ p]iod
 :o h p>ticipation agreem5ts ) !        
organization :o submitt$ at lea/ #a     
reque/ = paym5t = a m5tal heal? or      
sub/ance use disord] s]vice4  7,b7      
,submission to ,secret>y ,a ,/ate %all  
submit in=mation report$ to ! ,/ate "u  
subp>agraph 7,a71 includ+ /ratify+      
report+ by race1 e?nicity1 disability1  
prim>y language1 age1 sexual ori5tation1
 & g5d] id5tity1 to help id5tify heal?  
inequities :]e applicable1 to !         
,secret>y 9 su* =m & mann] z ! ,secret>y

 %all specify4  4  7b7 ,effective date  
,! am5dm5t made by subsection 7a7 %all  
take effect on ! date t is #b ye>s aft] 
! date ( enactm5t ( ?is section4  #cje4 
,au?ority to def] or disall[ a portion (
 ,f$]al f9ancial p>ticipation = failure 
to comply ) manag$ c>e requirem5ts  7a7 
,/ate plan am5dm5t ,section #aijb7;a7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acif;a7a771 z am5d$ by section         
#cjc7;a77#a71 is am5d$-- 7#a7 9 p>agraph
 7#hg71 by /rik+ & aft] ! semicolon2    
7#b7 9 p>agraph 7#hh77;,d71 by /rik+ !  
p]iod at ! end & ins]t+ 2 &2 &  7#c7 by 
ins]t+ aft] p>agraph 7#hh77;,d71 !      
foll[+ new p>agraph3  7#hi7 9 ! case ( a
 ,/ate t adopts ! option to use manag$  
c>e z describ$ 9 section #aicb1 provide 
t ! ,/ate %all comply ) ! requirem5ts ( 
section #aicb4  4  7b7 ,application to  
manag$ c>e contracts ,section           
#aijc7m77#b7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif;b7m77 is am5d$--   
7#a7 9 subp>agraph 7,a71 9 ! matt]      
prec$+ clause 7i71 by /rik+ & 7,g7 &    

ins]t+ 7,g71 & 7,i72 &  7#b7 by add+ at 
! end ! foll[+ new subp>agraph3  7,i7 ,=
 a violation ( any requirem5t describ$ 9
 subp>agraph 7,a71 includ+ a violation (
 ! requirem5ts ( section #aicb1 z       
applicable "u clause 7xii7 ( su*        
subp>agraph & p>agraph 7#hi7 ( section  
#aijb7;a71 r ?an disall[+ ! full am\nt (
 a paym5t "u ?is title to a ,/ate =     
exp5ditures incurr$ by ! ,/ate z        
describ$ 9 subp>agraph 7,a71 ! ,secret>y
 may def] or disall[ a portion ( a      
paym5t to ! ,/ate4 ,9 det]m9+ ! am\nt   
def]r$ or disall[$ "u ?is subp>agraph1 !
 ,secret>y may consid] factors su* z !  
degree1 duration1 & recurr5ce (         
noncompliance4 ,a ,/ate may receive a   
reconsid]ation ( a decision by !        
,secret>y "u ?is subp>agraph to disall[ 
paym5t 9 ! mann] describ$ 9 section     
#aaaf7;e74  4  7c7 ,effective date ,!   
am5dm5ts made by ?is section %all take  
effect on ! date t is #b ye>s aft] !    
date ( enactm5t ( ?is section & %all    
apply to contracts = rat+ p]iods beg9n+ 

on or aft] su* date4  #cjf4 ,m$icaid &  
,,*ip audits  7a7 ,regul> audits ,beg9n+
 ) fiscal ye> #bjbe1 ! ,secret>y (      
,heal? & ,human ,s]vices 7ref]r$ to 9   
?is section z ! ,secret>y7 %all audit   
,/ate ,m$icaid programs & ,/ate         
,*ildr5's ,heal? ,insurance ,programs = 
purposes ( assess+ ,/ate en=cem5t ( !   
requirem5ts relat+ to p>ity 9 m5tal     
heal? & sub/ance use disord] b5efits    
7includ+ ) respect to compliance ) su*  
p>ity requirem5ts 9 ! case ( any m5tal  
heal? or sub/ance use disord] b5efits t 
are sep>ately manag$ or f9anc$ "u a     
c>ve-out model7 applicable "u           
subsections 7a77#hh7 & 7uu7 ( section   
#aijb ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif;a7 7z add$ by section   
#cjc7;a71 section #aicb7;b77#h7 ( su*   
,act 7#db ,u4,s4,c4 #acifu-#b7;b77#h771 
section #aicg7;b77#f7 ( su* ,act 7#db   
,u4,s4,c4 #acifu-#g7;b77#f771 & section 
#bajc7;c77#g7 ( su* ,act 7#db ,u4,s4,c4 
#acig;cc7c77#g771 & relat$ regulations4 
7b7 ,rotational proc$ure2 publication ,!

 ,secret>y may c>ry out ! audits requir$
 by subsection 7a7 us+ a rotational     
approa* among ,/ates ov] a #c-ye> p]iod1
 & %all make ! results ( su* audits     
publicly available on a se>*able        
website4  7c7 ,publication ( en=cem5t   
actions ,! ,secret>y %all publi% 7&     
update on at lea/ an annual basis7 on a 
public website ( ! ,dep>tm5t ( ,heal? & 
,human ,s]vices a report t specifies !  
actions tak5 by ! ,secret>y to en=ce    
violations ( ! m5tal heal? & sub/ance   
use disord] p>ity requirem5ts "u !      
,m$icaid & ,,*ip programs describ$ 9    
subsection 7a74 ,! ,secret>y may publi% 
su* in=mation sep>ately or include !    
in=mation 9 ! #a or m publi%$ audit     
reports requir$ by subsection 7b7 t     
correspond to ea* su* violation4  7d7   
,fund+ ,out ( any funds 9 ! ,treasury n 
o!rwise appropriat$1 !re is appropriat$ 
to ! ,secret>y ( ,heal? & ,human        
,s]vices = ea* fiscal ye> beg9n+ )      
fiscal ye> #bjbe1 #e1jjj1jjj to c>ry out
 ?is section4  ,,iv ,o!r provisions     

#dja4 ,ensur+ multi-pay] alignm5t on    
paym5t & measurem5t ( quality ( c>e &   
heal? outcomes relat$ to integrat$ m5tal
 heal? & sub/ance use disord] c>e ,n    
lat] ?an ,april #a1 #bjbd1 !            
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all conv5e an        
advisory work+ gr\p t includes          
repres5tatives ( issu]s ( gr\p &        
individual heal? insurance cov]age1     
m5tal heal? & sub/ance use disord]      
programs & advocacy organizations1      
individuals & families receiv+ integrat$
 c>e s]vices1 & ,/ate ,m$icaid          
,directors1 = purposes ( mak+           
recomm5dations = adm9i/rative &         
legislative *anges to facilitate        
multi-pay] alignm5t on paym5t &         
measurem5t ( quality ( c>e & heal?      
outcomes ) respect to advanc+ !         
provision ( integrat$ m5tal heal? &     
sub/ance use disord] c>e 9 a mann] t    
does n violate antitru/ or o!r          
applicable laws4 ,! recomm5dations ( !  
work+ gr\p %all include recomm5dations =

 measurable1 ongo+ b5*m>ks to assess !  
ext5t to :i* paym5t & measurem5t ( !    
quality ( c>e & heal? outcomes are      
align$ across heal? c>e pay]s4  #djb4   
,measur+ access & quality outcomes 9    
m5tal heal? & sub/ance use disord] c>e  
7a7 ,9 g5]al ,n lat] ?an ,octob] #a1    
#bjbd1 ! ,adm9i/rator ( ! ,c5t]s =      
,m$ic>e  ,m$icaid ,s]vices %all1 9      
consultation ) ! ,adm9i/rator ( ! ,heal?
 ,res\rce ,s]vices ,adm9i/ration1 !     
,director ( ! ,ag5cy = ,heal?c>e ,rese>*
 & ,quality1 & ! ,assi/ant ,secret>y =  
,m5tal ,heal? & ,sub/ance ,use1 develop 
& implem5t a plan to improve measurem5t 
( ! ext5t to :i* *ildr5 & adults h      
access to integrat$ m5tal heal? &       
sub/ance use disord] c>e 9 prim>y c>e & 
! quality & effectiv5ess ( ! c>e        
provid$1 :i* %all be implem5t$ 9 quality
 measurem5t programs "u ! ,m$ic>e       
program "u title ,,xviii ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acie et  
seq471 ! ,m$icaid program "u title ,,xix
 ( su* ,act 7#db ,u4,s4,c4 #acif et     

seq471 & gr\p heal? plans & heal?       
insurance cov]age 7z su* t]ms are def9$ 
9 section #bgia ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ia774  7b7 ,measure developm5t 
,! ,director ( ! ,ag5cy = ,heal?c>e     
,rese>* & ,quality %all conduct measure 
developm5t :]e necess>y to ensure t !   
plan develop$ "u subsection 7a7 may be  
fully implem5t$1 includ+ measures (     
pati5t exp]i5ce outcomes1 /ructural     
measures ( practice trans=mation t[>d   
evid5ce-bas$ integrat$ c>e1 & measures (
 access & unmet ne$ provid$ by local1   
,/ate1 or ,f$]al ag5cies4  #djc4        
,review+ ! evid5ce = integrat$ m5tal    
heal? c>e = *ildr5 ,n lat] ?an ,octob]  
#a1 #bjbd1 ! ,director ( ! ,ag5cy =     
,heal?c>e ,rese>* & ,quality %all review
 ! evid5ce1 = consid]ation by ! ,unit$  
,/ates ,prev5tive ,s]vices ,task ,=ce1 =
 int]v5tions = *ildr5 :o are at risk (  
develop+ a m5tal heal? condition to     
prev5t int]naliz+ & ext]naliz+ m5tal    
heal? problems1 & = scre5+ to id5tify   

family & *ild psy*osocial ne$s1 segm5t$ 
by developm5tal /age z appropriate4     
#djd4 ,enhanc+ ov]sight ( integrat$     
m5tal heal? & sub/ance use disord] c>e  
7a7 ,9 g5]al ,n lat] ?an ,octob] #a1    
#bjbd1 ! ,adm9i/rator ( ! ,c5t]s =      
,m$ic>e  ,m$icaid ,s]vices %all1 9      
consultation ) ! ,director ( ! ,ag5cy = 
,heal?c>e ,rese>* & ,quality & !        
,assi/ant ,secret>y = ,m5tal ,heal? &   
,sub/ance ,use1 develop & implem5t a    
plan to improve ov]sight & en=cem5t (   
requirem5ts relat+ to ! provision (     
integrat$ m5tal heal? & sub/ance use    
disord] c>e "u ! ,m$ic>e program "u     
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq471 !       
,m$icaid program "u title ,,xix ( su*   
,act 7#db ,u4,s4,c4 #acif et seq471 &   
gr\p heal? plans & heal? insurance      
cov]age 7z su* t]ms are def9$ 9 section 
#bgia ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjj;gg-#ia771 includ+   
requirem5ts relat+ to-- 7#a7 cov]age (  
prev5tive heal? s]vices )\t co/-%>+ "u  

section #bgac ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #cjj;gg-#ac72  7#b7
 e>ly & p]iodic scre5+1 diagnosis1 &    
treatm5t = m5tal heal? & sub/ance use   
disord]s2  7#c7 m5tal heal? & sub/ance  
use p>ity2  7#d7 network adequacy1      
includ+ quantitative measures ( network 
access t take into acc\nt integration 9 
prim>y c>e & s*ools1 racial equity1 &   
virtual c>e2  7#e7 ess5tial heal?       
b5efits 7z def9$ 9 section #acjb7;b7 ( !
 ,pati5t ,protection & ,af=dable ,c>e   
,act 7#db ,u4,s4,c4 #ahjbb7;b7772 &     
7#f7 ,m$icaid rate sett+4  7b7 ,pati5t  
input ,9 develop+ & implem5t+ ! plan "u 
subsection 7a71 ! ,adm9i/rator %all seek
 input f pati5ts ) m5tal heal? &        
sub/ance use conditions4