,,ii #aaith ,,congress #ast ,session ,s4 #cdjb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #i1 #bjbe,mr4 ,cornyn 7for himself1 ,ms4 ,smith1 ,mr4 ,tillis1 and ,ms4 ,cortez ,masto7 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 and the ,public ,health ,service ,act to improve the certified community behavioral health clinic program1 and for other purposes4 #a4 ,short title 7a7 ,short title ,this ,act may be cited as the ,ensuring ,excellence in ,mental ,health ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title4,,title ,i--,strengthening and providing cost-related payment for certified community behavioral health clinics in the ,medicaid program,sec4 #aja4 ,coordination of ,medicaid-certified community behavioral health services with community behavioral health clinics operating grant program2 community behavioral health clinics accreditation option4,sec4 #ajb4 ,establishing a ,medicaid prospective payment system for certified community behavioral health clinics4,sec4 #ajc4 ,expanding certified community behavioral health clinic services within ,medicaid demonstration program4,sec4 #ajd4 ,expanding certified community behavioral health clinic services covered under the ,medicaid ,state plan4,,title ,,ii--,coverage of certified community behavioral health clinic services under the ,medicare program,sec4 #bja4 ,coverage of certified community behavioral health clinic services under the ,medicare program4,sec4 #bjb4 ,payment for certified community behavioral health clinic services under the ,medicare program4,sec4 #bjc4 ,non-application of ,medicare part ,b deductible for certified community behavioral health clinic services4,sec4 #bjd4 ,right to seek ,payment ,reimbursement ,review ,board review of cost reports4,sec4 #bje4 ,extending safe harbor under anti-kickback statute to waivers of certified community behavioral health clinic coinsurance4,sec4 #bjf4 ,effective date4,,title ,,iii--,community behavioral health clinics,sec4 #cja4 ,community behavioral health clinics4,,title ,,iv--,liability protection for certified community behavioral health clinic clinicians,sec4 #dja4 ,conferring protection under the ,federal ,tort ,claims ,act to clinicians in certified community behavioral health clinics4 ,i ,strengthening and providing cost-related payment for certified community behavioral health clinics in the ,medicaid program #aja4 ,coordination of ,medicaid-certified community behavioral health services with community behavioral health clinics operating grant program2 community behavioral health clinics accreditation option ,section #aije7;jj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7jj77 is amended-- 7#a7 in paragraph 7#b77;,c71 by inserting before the period at the end and including any such data as the ,state1 by agreement with the ,secretary1 shall access via the system described in section #cdj;,j-#c of the ,public ,health ,service ,act42 and 7#b7 by adding at the end the following new paragraph3 7#c7 ,accreditation ,in the case of services furnished on or after ,january #a1 #bjbf1 at the option of the ,state1 a ,state may determine that an organization does not meet such criteria as the ,secretary may establish for certified community behavioral health clinics pursuant to section #bbc of the ,protecting ,access to ,medicare ,act unless the organization has received accreditation by an accreditation body approved under section #cdj;,j-#d of the ,public ,health ,service ,act4 ,an election by a ,state under the preceding sentence shall not relieve a ,state of the requirement to certify an organization under paragraph 7#b77;,a74 4 #ajb4 ,establishing a ,medicaid prospective payment system for certified community behavioral health clinics ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended by adding at the end the following new subsection3 7yy7 ,payment for services provided by certified community behavioral health clinics 7#a7 ,in general ,beginning with fiscal year #bjbf1 with respect to services furnished on or after ,january #a1 #bjbf1 and each succeeding fiscal year1 a ,state that has elected in its ,state plan under this title to furnish the services described in section #aije7;a77#ca7 shall provide under the plan for payment for services furnished by a certified community behavioral health clinic described in section #aije7;jj77#b7 7in this subsection referred to as a clinic7 in accordance with the provisions of this subsection4 7#b7 ,payment for services in initial year 7,a7 ,in general ,subject to subparagraphs 7,b7 and 7,c7 and the succeeding provisions of this subsection1 and in accordance with paragraph 7#a71 for services furnished by a clinic in the first fiscal year beginning after ,september #cj1 #bjbe1 for which a ,state elects to provide for payment for services described in section #aije7;a77#ca71 the ,state shall provide for payment for such services in an amount 7calculated on the basis of daily visits or unduplicated monthly visits1 at the ,state's election7 that is equal to #ajj percent of the average costs of the clinic which are reasonable and related to the furnishing such services during a base year corresponding to the fiscal year preceding such initial fiscal year4 7,b7 ,additional payment considerations 7i7 ,in general ,a ,state may elect in its ,state plan to carry out any of the following1 consistent with the methodology described in guidance issued under the authority of section #bbc7;b7 of the ,protecting ,access to ,medicare ,act3 7,i7 ,establishing separate prospective payment system rates for special populations4 7,,ii7 ,using a system of outlier payments for a portion of costs of furnishing the covered benefit4 7,,iii7 ,with respect to the crisis services included within the benefit described in section #aije7;a77#ca7-- 7aa7 requiring that clinics1 in their cost reports1 segregate costs relating to mobile crisis teams1 emergency crisis intervention services1 or crisis stabilization as components of the covered benefit described in section #aije7;a77#ca72 and 7bb7 providing for a prospective payment system rate for any or all of such crisis services1 distinct from the rate encompassing the remainder of the services described in section #aije7;a77#ca74 7ii7 ,states with ,,pama demonstration programs ,if a ,state electing to furnish services described in section #aije7;a77#ca7 under its ,state plan1 as of the year prior to the initial fiscal year described above1 operated a demonstration program under section #bbc of the ,protecting ,access to ,medicare ,act1 such ,state may elect under the ,state plan to establish as its initial rate under this paragraph1 for any clinic that participated in such demonstration1 the rate that would otherwise have applied under the demonstration4 7iii7 ,use of estimated or projected data ,in the absence of complete actual cost data representing the provision of the full covered benefit in such base year1 the ,state may provide in its ,state plan amendment to allow clinics to use estimated or projected data relating to specific services for which they lack cost experience4 7,c7 ,inflation adjustment ,the per-unit rate derived from the cost data described in subparagraph 7,a7 shall be annually adjusted by the inflationary factor described in section #ahcd7;aa77#b77;,c71 and shall be adjusted to take into account any increase or decrease in the scope of such services furnished by the clinic in the fiscal year involved4 7#c7 ,payment for services in subsequent fiscal years ,subject to the succeeding provisions of this subsection1 for services described in section #aije7;a77#ca7 furnished by a clinic after the initial fiscal year described in paragraph 7#b71 the ,state plan shall provide for payment for such services in an amount 7calculated on the basis of daily visits or unduplicated monthly visits1 at the ,state's election7 that is equal to the amount calculated under this subsection for such services and clinic for the preceding fiscal year-- 7,a7 increased by the percentage increase in the inflationary factor described in section #ahcd7;aa77#b77;,c7 for such fiscal year2 and 7,b7 adjusted to take into account any increase or decrease in the scope of such services furnished by the clinic during the fiscal year involved4 7#d7 ,establishment of initial fiscal year payment for new clinics 7,a7 ,in general ,in any case in which an entity first qualifies as a certified community behavioral health clinic in a year after the first fiscal year in which the ,state first provides for payment for the services described in section #aije7;a77#ca7 in accordance with paragraph 7#a71 the ,state plan shall provide for payment for such services in the first fiscal year in which the clinic so qualifies in an amount 7calculated on the basis of daily visits or unduplicated monthly visits1 at the ,state's election7 that is equal to the rates established under this subsection for other such clinics located in the same or adjacent area with a similar case load1 or in the absence of any such clinic1 based on the reasonable projected costs per visit of the clinic4 7,b7 ,additional requirement ,not later than the second fiscal year in which a clinic described in subparagraph 7,a7 furnishes services described in section #aije7;a77#ca7-- 7i7 the ,state shall establish a unique payment rate for the clinic based on the methodology described in paragraph 7#b71 using reasonable and related costs from the clinic's first fiscal year of operation as the basis for establishing such rates2 and 7ii7 in any year following the establishment of an initial rate under this subparagraph1 the ,state plan shall provide for the payment amount to be adjusted in accordance with paragraph 7#c7 and 7as applicable7 reestablished in accordance with paragraph 7#e74 7#e7 ,optional periodic rebase of ,,pps rates ,notwithstanding the preceding paragraphs1 a ,state may elect in its ,state plan amendment to establish a new prospective payment system rate for clinics on a periodic basis4 ,under such an election1 periodically 7but not less frequently than every #crd fiscal year7 after the initial year1 as described in paragraph 7#b71 in which the ,state first furnishes the services described in section #aije7;a77#ca71 the ,state shall set a new rebased rate for each clinic whose rate was initially set pursuant to paragraph 7#b71 except that costs from the fiscal year preceding such rebasing year1 rather than costs from the base year described in paragraph 7#b71 shall be used in establishing a new cost-related rate for each clinic4 ,states electing this option shall also follow this methodology and schedule in periodically establishing new rates for those clinics whose initial rates were set as described in paragraph 7#d74 7#f7 ,administration in the case of managed care 7,a7 ,in general ,in the case of services furnished by a certified community behavioral health clinic pursuant to a contract between the clinic and a managed care entity 7as defined in section #aicb7;a77#a77;,b771 the ,state plan shall provide for payment to the clinic by the ,state of a supplemental payment equal to the amount 7if any7 by which the amount determined under the preceding paragraphs of this subsection or as applicable1 paragraph 7#g71 exceeds the amount of payments under the contract1 with such supplemental payment being made pursuant to a payment schedule agreed to by the ,state and the certified community behavioral health clinic1 but not less frequently than every #c months4 7,b7 ,option to delegate ,,pps payment to managed care entities through an alternative payment methodology 7i7 ,in general ,notwithstanding subparagraph 7,a71 nothing in this subsection shall be interpreted to preclude a ,state from amending its ,state plan to provide for an alternative payment methodology in accordance with paragraph 7#g71 under which the ,state may delegate to a managed care entity 7as defined in section #aicb7;a77#a77;,b77 the responsibility to pay the clinic at least the rate determined under the preceding subparagraphs or as applicable1 paragraph 7#g74 7ii7 ,requirements ,in making a delegation under clause 7i71 a ,state shall ensure that it complies with the requirements described in paragraph 7#g7 and shall use reconciliation and oversight processes to ensure that each clinic is paid at least the amounts required under the preceding paragraphs of this subsection4 7#g7 ,alternative payment methodologies ,notwithstanding any other provision of this subsection1 a ,state plan may provide for payment in any year to a certified community behavioral health clinic for services described in section #aije7;a77#ca7 in an amount which is determined under an alternative payment methodology that-- 7,a7 is agreed to by the ,state and the clinic2 and 7,b7 results in payment to the clinic of an amount which is not less than the amount otherwise required to be paid to the clinic under this subsection4 4 #ajc4 ,expanding certified community behavioral health clinic services within ,medicaid demonstration program 7a7 ,additional services within demonstration program 7#a7 ,in general ,section #bbc7;a77#b77;,d7 of the ,protecting ,access to ,medicare ,act of #bjad 7#db ,u4,s4,c4 #acif;a note71 is amended to read as follows3 7,d7 ,scope of services ,provision 7in a manner reflecting person-centered care7 of at least the following required services described in clause 7i71 which may be furnished either directly or1 if not available directly1 through formal relationships with other providers1 and at the discretion of the certified community behavioral health clinic1 at least #a of the following additional services described in clause 7ii7 furnished directly by the clinic3 7i7 ,required services 7,i7 ,crisis mental health services1 including #bd-;hour mobile crisis teams1 emergency crisis intervention services1 and crisis stabilization4 7,,ii7 ,screening1 assessment1 and diagnosis1 including risk assessment4 7,,iii7 ,patient-centered treatment planning or similar processes1 including risk assessment and crisis planning4 7,,iv7 ,outpatient mental health and substance use services4 7,v7 ,outpatient clinic primary care screening and monitoring of key health indicators and health risk4 7,,vi7 ,targeted case management4 7,,vii7 ,psychiatric rehabilitation services4 7,,viii7 ,peer support and counselor services and family supports4 7,,ix7 ,intensive1 community-based mental health care for members of the ,armed ,forces and veterans1 particularly those members and veterans located in rural areas1 provided the care is consistent with minimum clinical mental health guidelines promulgated by the ,veterans ,health ,administration including clinical guidelines contained in the ,uniform ,mental ,health ,services ,handbook of such ,administration4 7ii7 ,additional services ,the additional services described in this clause are-- 7,i7 services not described in clause 7i72 and 7,,ii7 services that are appropriate to meet the health needs of the population served1 including any of the primary health services described in section #ccj7;b77#a77;,a7 of the ,public ,health ,service ,act4 4 7#b7 ,additional amendments ,section #bbc of the ,protecting ,access to ,medicare ,act of #bjad 7#db ,u4,s4,c4 #acif;a note71 is amended-- 7,a7 in subsection 7b77#a71 by striking mental health services and inserting certified community behavioral health clinic services2 7,b7 in subsection 7d77#e77;,d7-- 7i7 by inserting 7including such ,state's prior use under such demonstration of a supplemental payment or wraparound framework for payments for services furnished under contract with a managed care entity7 after established under subsection 7c72 and 7ii7 by striking the period at the end and inserting the following3 1 and notwithstanding any ,federal regulation concerning prohibition of additional payments for services covered under a contract with a managed care entity1 a prepaid inpatient health plan1 or a prepaid ambulatory health plan42 and 7,c7 in subsection 7e7-- 7i7 by redesignating paragraphs 7#a7 through 7#d7 as paragraphs 7#b7 through 7#e72 and 7ii7 by inserting before paragraph 7#b7 the following new paragraph3 7#a7 ,certified community behavioral health clinic services ,the term certified community behavioral health clinic services means any services required under clause 7i7 of subsection 7a77#b77;,d7 and any additional services described in clause 7ii7 of such subsection to the extent that a certified community behavioral health clinic elects to furnish such services4 4 7b7 ,effective date ,the amendments made by this section shall apply with respect to services furnished on or after ,october #a1 #bjbf4 #ajd4 ,expanding certified community behavioral health clinic services covered under the ,medicaid ,state plan 7a7 ,additional services within certified community behavioral health clinic benefit ,section #aije7;jj77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7jj77#a77 is amended to read as follows3 7#a7 ,in general ,the term certified community behavioral health services means the following required services described in subparagraph 7,a71 which may be furnished either directly or1 if not available directly1 through formal relationships with other providers1 and at the discretion of the certified community behavioral health clinic1 at least #a of the following additional services described in subparagraph 7,b7 furnished directly by the clinic3 7,a7 ,required services 7i7 ,crisis mental health services1 including #bd-;hour mobile crisis teams1 emergency crisis intervention services1 and crisis stabilization4 7ii7 ,screening1 assessment1 and diagnosis1 including risk assessment4 7iii7 ,patient-centered treatment planning or similar processes1 including risk assessment and crisis planning4 7iv7 ,outpatient mental health and substance use services4 7v7 ,outpatient clinic primary care screening and monitoring of key health indicators and health risk4 7vi7 ,targeted case management4 7vii7 ,psychiatric rehabilitation services4 7viii7 ,peer support and counselor services and family supports4 7ix7 ,intensive1 community-based mental health care for members of the ,armed ,forces and veterans who are eligible for medical assistance1 particularly such members and veterans located in rural areas1 provided the care is consistent with minimum clinical mental health guidelines promulgated by the ,veterans ,health ,administration1 including clinical guidelines contained in the ,uniform ,mental ,health ,services ,handbook of such ,administration4 7,b7 ,additional services ,the additional services described in this subparagraph are-- 7i7 services not described in subparagraph 7,a72 and 7ii7 services that are appropriate to meet the health needs of the population served1 including any of the primary health services described in section #ccj7;b77#a77;,a7 of the ,public ,health ,service ,act4 4 7b7 ,effective date ,the amendments made by this section shall apply with respect to services furnished on or after ,october #a1 #bjbf4 ,,ii ,coverage of certified community behavioral health clinic services under the ,medicare program #bja4 ,coverage of certified community behavioral health clinic services under the ,medicare program 7a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7#a7 in subparagraph 7,,jj71 by inserting and at the end2 and 7#b7 by adding at the end the following new subparagraph3 7,,kk7 certified community behavioral health clinic services 7as defined in subsection 7aa77#h77 furnished on or after ,january #a1 #bjbg4 4 7b7 ,definitions ,section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7#a7 in the heading1 by striking and federally qualified health center services and inserting 1 federally qualified health center services1 and certified community behavioral health clinic services2 and 7#b7 by adding at the end the following new paragraph3 7#h7 ,the terms certified community behavioral health clinic services and certified community behavioral health clinic have the meaning given those terms in paragraphs 7#a7 and 7#b71 respectively1 of section #aije7;jj74 4 #bjb4 ,payment for certified community behavioral health clinic services under the ,medicare program 7a7 ,in general ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7#a7 by striking and 7,,hh7 and inserting 7,,hh72 and 7#b7 by inserting before the semicolon at the end the following3 1 and 7,,ii7 with respect to certified community behavioral health clinic services for which payment is made under section #ahcd7;aa71 the amounts paid shall be equal to #hj percent of the lesser of the actual charge or the amount determined under such section4 7b7 ,development and implementation of prospective payment system ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7aa7 ,development and implementation of prospective payment system for certified community behavioral health clinics 7#a7 ,development 7,a7 ,in general ,the ,secretary shall develop a prospective payment system for payment for community behavioral health clinic services 7as defined in section #ahfa7;aa77#h77 furnished by certified community behavioral health clinics 7as defined in such section7 under this title4 7,b7 ,considerations and adjustments ,in developing the system described in subparagraph 7,a71 the ,secretary-- 7i7 shall-- 7,i7 take into account the type1 intensity1 and duration of services furnished by certified community behavioral health clinics2 and 7,,ii7 consider an appropriate unit of service and a general system design that provides for continued access to quality services2 and 7ii7 may include adjustments1 including geographic adjustments1 as determined appropriate by the ,secretary4 7#b7 ,implementation 7,a7 ,in general ,for cost reporting periods beginning on or after ,january #a1 #bjbg1 the ,secretary shall provide for payments of prospective payment rates for certified community behavioral health clinic services furnished by certified community behavioral health clinics under this title in accordance with the prospective payment system developed by the ,secretary under paragraph 7#a74 7,b7 ,initial payments 7i7 ,in general ,subject to clause 7ii71 in the first year that such prospective payment system is implemented1 the ,secretary shall implement such system to reflect the national average allowable service costs of certified community behavioral health clinics on the basis of the most current audited cost report data for the #b most recent fiscal years available to the ,secretary4 ,initial payments shall be established without the application of a per visit limit or productivity screen and shall be based on national average costs per unit of service1 updated as appropriate by the inflationary adjustment described in subparagraph 7,c74 7ii7 ,absence of data ,in the absence of complete cost report data described in clause 7i71 certified community behavioral health clinics may1 at the ,secretary's discretion1 submit estimated or projected data relating to specific services4 7,c7 ,payments in subsequent years ,payment rates in years after the year of implementation of such system shall be the payment rates in the previous year increased-- 7i7 in the first year after implementation of such system1 by the percentage increase in the ,,mei 7as defined in section #ahdb7;i77#c772 and 7ii7 in subsequent years-- 7,i7 by the percentage increase in a market basket of certified community behavioral health clinic services1 designed by the ,secretary2 or 7,,ii7 if such an index is not available1 by the percentage increase in the ,federally qualified health center market basket 7as described in section #ahcd7o77#b77;,b77ii77,,ii77 for the year involved4 7#c7 ,periodic reevaluation of rates ,the ,secretary may periodically adjust the amounts that would otherwise be applicable under paragraph 7#b7 by a percentage determined appropriate by the ,secretary to reflect such factors as changes in the intensity of certified community behavioral health clinic services furnished within a unit of service1 the average cost of providing care per unit of service1 and other factors that the ,secretary considers to be appropriate4 ,such adjustment shall be made before the update under clause 7i7 or 7ii7 of paragraph 7#b77;,c7 has been applied for the year4 4 #bjc4 ,non-application of ,medicare part ,b deductible for certified community behavioral health clinic services ,section #ahcc7;b77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b77#d77 is amended by inserting or certified community behavioral health clinic services before the comma at the end4 #bjd4 ,right to seek ,payment ,reimbursement ,review ,board review of cost reports ,section #ahgh7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieoo7j77 is amended by striking and a ,federally qualified health center and inserting 1 a ,federally qualified health center1 and a certified community behavioral health clinic4 #bje4 ,extending safe harbor under anti-kickback statute to waivers of certified community behavioral health clinic coinsurance ,section #aabh;,b7b77#c77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77#c77;,d77 is amended by inserting or a certified community behavioral health clinic after ,federally qualified health care center4 #bjf4 ,effective date ,the amendments made by this title shall apply with respect to services furnished on or after ,january #a1 #bjbg4 ,,iii ,community behavioral health clinics #cja4 ,community behavioral health clinics ,part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b et seq47 is amended by adding at the end the following3 ,,xiii ,community behavioral health clinics #cdj;,j4 ,definitions ,in this subpart3 7#a7 ,certified community behavioral health clinic ,the term certified community behavioral health clinic has the meaning given the term in section #aije7;jj77#b7 of the ,social ,security ,act4 7#b7 ,certified community behavioral health services ,the term certified community behavioral health services has the meaning given the term in section #aije7;jj77#a7 of the ,social ,security ,act4 #cdj;,j-#a4 ,operating grants for community behavioral health clinics 7a7 ,in general ,the ,secretary shall establish a grant program under which the ,secretary shall award grants to eligible community behavioral health clinics to provide 7in a manner reflecting person-centered care7 the full array of certified community behavioral health services4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall be-- 7#a7 a certified community behavioral health clinic2 or 7#b7 a community behavioral health clinic that-- 7,a7 indicates in the grant application that-- 7i7 it will use the grant funds to meet such criteria required to be a certified community behavioral health clinic2 and 7ii7 agrees to seek accreditation under section #cdj;,j-#d7;a71 as the ,secretary may require2 and 7,b7 demonstrates how it can ensure access to care for all individuals in the community through referral or other formal arrangements with other providers of services1 in the case of an entity that specializes in services to children or youth or to veterans4 7c7 ,use of funds ,a community behavioral health clinic that receives a grant under subsection 7a7-- 7#a7 shall use the grant funds-- 7,a7 to provide the services described in subsection 7a72 and 7,b7 in the case of a community behavioral health clinic described in subsection 7b77#b71 to attain certification and accreditation as described in subsection 7b77#b77;,a72 and 7#b7 may use the grant funds-- 7,a7 to carry out other activities that-- 7i7 reduce costs associated with the provision of certified community behavioral health services2 7ii7 improve access to1 and availability of1 certified community behavioral health services provided to individuals served by the community behavioral health clinic2 7iii7 enhance the quality and coordination of certified community behavioral health services2 or 7iv7 improve the health status of communities2 and 7,b7 to pay for-- 7i7 the costs of acquiring and leasing buildings and equipment 7including the costs of amortizing the principal of1 and paying interest on1 loans72 7ii7 costs relating to the purchase or lease of equipment1 including data and information systems and behavioral health information technology to facilitate data reporting and other purposes2 7iii7 the costs of in-service staff training and other operational or infrastructure costs identified by the ,secretary2 and 7iv7 costs associated with expanding and modernizing existing buildings or constructing new buildings 7including the costs of amortizing the principal of1 and paying the interest on1 loans71 if such costs are specifically allowed for in the grant opportunity published by the ,secretary4 7d7 ,use of nongrant funds ,nongrant funds described in subsection 7g77#a77;,b71 including any such funds in excess of those originally expected1 shall be used as permitted under this section1 and may be used for such other purposes as are not specifically prohibited under this section if such use furthers the objectives of the project4 7e7 ,term ,grants awarded under subsection 7a7 shall be for a period of not more than #e years4 7f7 ,condition on receipt of funds ,the ,secretary shall not make a grant to an applicant under subsection 7a7 unless the applicant provides assurances to the ,secretary that within #abj days of receiving grant funding for the operation of the clinic1 the applicant will submit for approval by the ,secretary an implementation plan that describes how the applicant will-- 7#a7 provide the services described in subsection 7a72 and 7#b7 in the case of a community behavioral health clinic described in subsection 7b77#b71 attain certification and accreditation as described in subsection 7b77#b77;,a74 7g7 ,amount of grant 7#a7 ,in general ,subject to paragraph 7#b71 the amount of a grant made in any fiscal year to a community behavioral health clinic under subsection 7a7 shall be determined by the ,secretary based on information provided by the community behavioral health clinic1 but may not exceed an amount equal to the difference between-- 7,a7 the costs of operating the clinic to meet the purposes and requirements of the grant program under this section during such fiscal year2 and 7,b7 the sum obtained by adding-- 7i7 the total ,state1 local1 and other operational funding provided to the clinic for such fiscal year2 and 7ii7 the fees1 premiums1 and third-party reimbursements that the clinic reasonably expects to receive for its operations in such fiscal year4 7#b7 ,requirement ,in determining the costs described in paragraph 7#a77;,a7 with respect to a community behavioral health clinic1 the ,secretary may estimate1 based on an estimate of anticipated costs provided by the applicable community behavioral health clinic1 the anticipated costs of such clinic in-- 7,a7 providing the services described in subsection 7a71 including the anticipated costs of providing any individual certified community behavioral health service that the applicant entity does not have experience providing at the time of submitting an application for such grant2 and 7,b7 if applicable1 attain certification and accreditation as described in subsection 7b77#b77;,a74 7#c7 ,payments ,the ,secretary may-- 7,a7 disperse funds awarded under subsection 7a7-- 7i7 in advance or through reimbursement2 and 7ii7 in installments2 7,b7 make adjustments to such disbursements to account for overpayments or underpayments4 7h7 ,use of accreditation in monitoring grant progress ,regardless of whether the ,secretary elects to use accreditation under section #cdj;,j-#d7;a7 as a condition for award of an operating grant as described in subsection 7b77#b77;,a77ii71 the ,secretary may take such accreditation into account in determining if an entity receiving a grant under this section is providing the services described in subsection 7a7 and1 if applicable1 meeting the criteria for certification described in subsection 7b77#b77;,a77i74 7i7 ,authorization of appropriations 7#a7 ,in general ,there is authorized to be appropriated to carry out this section1 #eeb1ejj1jjj for each of fiscal years #bjbf through #bjcj4 7#b7 ,maintenance of funding ,the amount made available under paragraph 7#a7 shall supplement 7and not supplant7 any other ,federal funding made available for certified community behavioral health clinics4 7j7 ,study of clinics serving specialized populations ,not later than #a year after the date of enactment of this section1 the ,secretary shall publish guidance clarifying how clinics that focus on distinct populations1 such as children or youth and veterans1 may meet any relevant requirement to furnish appropriate treatment to individuals across the lifespan4 ,such guidance shall not affect clinics' qualification to participate in the demonstration program under section #bbc7;a77#a7 of the ,protecting ,access to ,medicare ,act of #bjad or to furnish the services described in section #aije7;a77#ca7 of the ,social ,security ,act4 4 #cdj;,j-#b4 ,technical assistance 7a7 ,in general ,not later than #ahj days after the date of enactment of this section1 the ,secretary shall establish a program or programs through which the ,secretary shall provide 7directly or by grant or contract7 technical assistance and other assistance to any of the following3 7#a7 ,entities that receive a grant under section #cdj;,j-#a4 7#b7 ,entities participating in a ,medicaid demonstration program under section #bbc7;d7 of the ,protecting ,access to ,medicare ,act4 7#c7 ,certified community behavioral health clinics furnishing services under title ,,xviii or title ,,xix of the ,social ,security ,act4 7#d7 ,health or social service provider organizations pursuing or considering seeking status as a certified community behavioral health clinic or partnering with certified community behavioral health clinics4 7#e7 ,other stakeholders1 including demonstration planning grant recipients and ,state ,medicaid or behavioral health officials1 for the purpose of facilitating successful implementation of the certified community behavioral health clinic model4 7b7 ,inclusions ,assistance provided by the ,secretary under subsection 7a7 may include technical and nonfinancial assistance1 including-- 7#a7 fiscal and program management assistance2 7#b7 operational and administrative support2 and 7#c7 information about the variety of resources available under this part and how such resources best can be used to meet the health and behavioral health needs of the communities served by the entities4 7c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #h1jjj1jjj for each of fiscal years #bjbf through #bjcj4 4 #cdj;,j-#c4 ,data infrastructure for community behavioral health clinic reporting 7a7 ,in general ,not later than #ahj days after the date of enactment of this part1 the ,secretary shall establish a system under which the ,secretary collects and analyzes data on community behavioral health clinics4 7b7 ,scope of data collection ,the system established under subsection 7a7 shall be used by the ,secretary to collect and analyze data from-- 7#a7 entities that receive a grant under section #cdj;,j-#a2 and 7#b7 organizations that provide certified community behavioral health services1 or have applied to provide such services1 under the ,medicare program under title ,,xviii of the ,social ,security ,act or the ,medicaid program under title ,,xix of such ,act4 7c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #ea1jjj1jjj for each of fiscal years #bjbf through #bjcj4 4 #cdj;,j-#d4 ,certified community behavioral health clinic accreditation 7a7 ,accreditation standards ,a clinic may be accredited as a certified community behavioral health clinic if the clinic-- 7#a7 meets the standards of an approved accreditation body2 and 7#b7 authorizes the accreditation body to submit to the ,secretary 7or such agency as the ,secretary may designate7 such records or other information as the ,secretary may require4 7b7 ,approval of accreditation bodies 7#a7 ,in general ,the ,secretary may approve a private nonprofit organization to be an accreditation body for the accreditation of certified community behavioral health clinics under subsection 7a7 if-- 7,a7 using inspectors qualified to evaluate quality of care in a behavioral health service setting1 the accreditation body agrees to inspect the clinic with such frequency as is determined by the ,secretary2 7,b7 the standards applied by the body in determining whether or not to accredit a clinic correspond to such criteria as are described in section #cdj;,j-#a7;b77#b71 pursuant to the determination of the ,secretary1 and are not less restrictive than such criteria2 7,c7 there is adequate provision for assuring that the standards of the accreditation body continue to be met by the clinic2 7,d7 in the case of any clinic accredited1 within the prior #c years1 by the body which has had its accreditation denied1 suspended1 withdrawn1 or revoked or which has had any other action taken against it by the accrediting body1 the accrediting body agrees to submit to the ,secretary the name of such clinic within #cj days of the action taken2 and 7,e7 if the accreditation body has its approval withdrawn by the ,secretary1 the body agrees to notify each clinic accredited by the body of the withdrawal within #aj days of the withdrawal4 4 ,,iv ,liability protection for certified community behavioral health clinic clinicians #dja4 ,conferring protection under the ,federal ,tort ,claims ,act to clinicians in certified community behavioral health clinics ,section #bbd7;g77#d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcc7 is amended by adding at the end the following3 or certified community behavioral health clinic as defined in section #aije7;jj77#b7 of the ,social ,security ,act4