,,ii  #aai? ,,congress  #a/ ,session    
,s4 #cdjb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #i1 #bjbe,mr4 
,cornyn 7= himself1 ,ms4 ,smi?1 ,mr4    
,tillis1 & ,ms4 ,cortez ,ma/o7 introduc$
 ! foll[+ bill2 :i* 0 read twice &      
ref]r$ to ! ,committee on ,f9ance  ,a   
,,bill  ,to am5d titles ,,xviii & ,,xix 
( ! ,social ,security ,act & ! ,public  
,heal? ,s]vice ,act to improve ! c]tifi$
 community behavioral heal? cl9ic       
program1 & = o!r purposes4  #a4 ,%ort   
title  7a7 ,%ort title ,?is ,act may be 
cit$ z ! ,ensur+ ,excell5ce 9 ,m5tal    
,heal? ,act4  7b7 ,table ( cont5ts ,!   
table ( cont5ts = ?is ,act is z foll[s3 
,sec4 #a4 ,%ort title4,,title           
,i--,/r5g!n+ & provid+ co/-relat$ paym5t
 = c]tifi$ community behavioral heal?   
cl9ics 9 ! ,m$icaid program,sec4 #aja4  
,coord9ation ( ,m$icaid-c]tifi$         
community behavioral heal? s]vices )    
community behavioral heal? cl9ics op]at+
 grant program2 community behavioral    
heal? cl9ics accr$itation option4,sec4  

#ajb4 ,e/abli%+ a ,m$icaid prospective  
paym5t sy/em = c]tifi$ community        
behavioral heal? cl9ics4,sec4 #ajc4     
,exp&+ c]tifi$ community behavioral     
heal? cl9ic s]vices )9 ,m$icaid         
demon/ration program4,sec4 #ajd4 ,exp&+ 
c]tifi$ community behavioral heal? cl9ic
 s]vices cov]$ "u ! ,m$icaid ,/ate      
plan4,,title ,,ii--,cov]age ( c]tifi$   
community behavioral heal? cl9ic s]vices
 "u ! ,m$ic>e program,sec4 #bja4        
,cov]age ( c]tifi$ community behavioral 
heal? cl9ic s]vices "u ! ,m$ic>e        
program4,sec4 #bjb4 ,paym5t = c]tifi$   
community behavioral heal? cl9ic s]vices
 "u ! ,m$ic>e program4,sec4 #bjc4       
,non-application ( ,m$ic>e "p ,b        
d$uctible = c]tifi$ community behavioral
 heal? cl9ic s]vices4,sec4 #bjd4 ,"r to 
seek ,paym5t ,reimbursem5t ,review ,bo>d
 review ( co/ reports4,sec4 #bje4       
,ext5d+ safe h>bor "u anti-kickback     
/atute to waiv]s ( c]tifi$ community    
behavioral heal? cl9ic co9surance4,sec4 
#bjf4 ,effective date4,,title           

,,iii--,community behavioral heal?      
clinics,sec4 #cja4 ,community behavioral
 heal? cl9ics4,,title ,,iv--,liability  
protection = c]tifi$ community          
behavioral heal? cl9ic clinicians,sec4  
#dja4 ,conf]r+ protection "u ! ,f$]al   
,tort ,claims ,act to cl9icians 9       
c]tifi$ community behavioral heal?      
cl9ics4  ,i ,/r5g!n+ & provid+          
co/-relat$ paym5t = c]tifi$ community   
behavioral heal? cl9ics 9 ! ,m$icaid    
program  #aja4 ,coord9ation (           
,m$icaid-c]tifi$ community behavioral   
heal? s]vices ) community behavioral    
heal? cl9ics op]at+ grant program2      
community behavioral heal? cl9ics       
accr$itation option ,section #aije7;jj7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7jj77 is am5d$-- 7#a7 9
 p>agraph 7#b77;,c71 by ins]t+ be=e !   
p]iod at ! end & includ+ any su* data z 
! ,/ate1 by agreem5t ) ! ,secret>y1 %all
 access via ! sy/em describ$ 9 section  
#cdj;,j-#c ( ! ,public ,heal? ,s]vice   
,act42 &  7#b7 by add+ at ! end ! foll[+

 new p>agraph3  7#c7 ,accr$itation ,9 ! 
case ( s]vices furni%$ on or aft]       
,janu>y #a1 #bjbf1 at ! option ( !      
,/ate1 a ,/ate may det]m9e t an         
organization does n meet su* crit]ia z !
 ,secret>y may e/abli% = c]tifi$        
community behavioral heal? cl9ics       
pursuant to section #bbc ( ! ,protect+  
,access to ,m$ic>e ,act unless !        
organization has receiv$ accr$itation by
 an accr$itation body approv$ "u section
 #cdj;,j-#d ( ! ,public ,heal? ,s]vice  
,act4 ,an election by a ,/ate "u !      
prec$+ s5t5ce %all n relieve a ,/ate ( !
 requirem5t to c]tify an organization "u
 p>agraph 7#b77;,a74  4  #ajb4 ,e/abli%+
 a ,m$icaid prospective paym5t sy/em =  
c]tifi$ community behavioral heal?      
cl9ics ,section #aijb ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acif;a7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7yy7 ,paym5t = s]vices     
provid$ by c]tifi$ community behavioral 
heal? cl9ics  7#a7 ,9 g5]al ,beg9n+ )   
fiscal ye> #bjbf1 ) respect to s]vices  

furni%$ on or aft] ,janu>y #a1 #bjbf1 & 
ea* succe$+ fiscal ye>1 a ,/ate t has   
elect$ 9 its ,/ate plan "u ?is title to 
furni% ! s]vices describ$ 9 section     
#aije7;a77#ca7 %all provide "u ! plan = 
paym5t = s]vices furni%$ by a c]tifi$   
community behavioral heal? cl9ic        
describ$ 9 section #aije7;jj77#b7 79 ?is
 subsection ref]r$ to z a cl9ic7 9      
accordance ) ! provisions ( ?is         
subsection4  7#b7 ,paym5t = s]vices 9   
initial ye>  7,a7 ,9 g5]al ,subject to  
subp>agraphs 7,b7 & 7,c7 & ! succe$+    
provisions ( ?is subsection1 & 9        
accordance ) p>agraph 7#a71 = s]vices   
furni%$ by a cl9ic 9 ! fir/ fiscal ye>  
beg9n+ aft] ,septemb] #cj1 #bjbe1 = :i* 
a ,/ate elects to provide = paym5t =    
s]vices describ$ 9 section              
#aije7;a77#ca71 ! ,/ate %all provide =  
paym5t = su* s]vices 9 an am\nt         
7calculat$ on ! basis ( daily visits or 
unduplicat$ mon?ly visits1 at ! ,/ate's 
election7 t is equal to #ajj p]c5t ( !  
av]age co/s ( ! cl9ic :i* are reasonable

 & relat$ to ! furni%+ su* s]vices dur+ 
a base ye> correspond+ to ! fiscal ye>  
prec$+ su* initial fiscal ye>4  7,b7    
,additional paym5t consid]ations  7i7 ,9
 g5]al ,a ,/ate may elect 9 its ,/ate   
plan to c>ry out any ( ! foll[+1        
consi/5t ) ! me?odology describ$ 9      
guidance issu$ "u ! au?ority ( section  
#bbc7;b7 ( ! ,protect+ ,access to       
,m$ic>e ,act3 7,i7 ,e/abli%+ sep>ate    
prospective paym5t sy/em rates = special
 populations4  7,,ii7 ,us+ a sy/em (    
outli] paym5ts = a portion ( co/s (     
furni%+ ! cov]$ b5efit4  7,,iii7 ,)     
respect to ! crisis s]vices includ$ )9 !
 b5efit describ$ 9 section              
#aije7;a77#ca7-- 7aa7 requir+ t cl9ics1 
9 _! co/ reports1 segregate co/s relat+ 
to mobile crisis teams1 em]g5cy crisis  
int]v5tion s]vices1 or crisis           
/abilization z compon5ts ( ! cov]$      
b5efit describ$ 9 section               
#aije7;a77#ca72 &  7bb7 provid+ = a     
prospective paym5t sy/em rate = any or  
all ( su* crisis s]vices1 di/9ct f !    

rate encompass+ ! rema9d] ( ! s]vices   
describ$ 9 section #aije7;a77#ca74  7ii7
 ,/ates ) ,,pama demon/ration programs  
,if a ,/ate elect+ to furni% s]vices    
describ$ 9 section #aije7;a77#ca7 "u its
 ,/ate plan1 z ( ! ye> prior to !       
initial fiscal ye> describ$ above1      
op]at$ a demon/ration program "u section
 #bbc ( ! ,protect+ ,access to ,m$ic>e  
,act1 su* ,/ate may elect "u ! ,/ate    
plan to e/abli% z its initial rate "u   
?is p>agraph1 = any cl9ic t p>ticipat$ 9
 su* demon/ration1 ! rate t w\ld o!rwise
 h appli$ "u ! demon/ration4  7iii7 ,use
 ( e/imat$ or project$ data ,9 ! abs5ce 
( complete actual co/ data repres5t+ !  
provision ( ! full cov]$ b5efit 9 su*   
base ye>1 ! ,/ate may provide 9 its     
,/ate plan am5dm5t to all[ cl9ics to use
 e/imat$ or project$ data relat+ to     
specific s]vices = :i* !y lack co/      
exp]i5ce4  7,c7 ,inflation adju/m5t ,!  
p]-unit rate d]iv$ f ! co/ data describ$
 9 subp>agraph 7,a7 %all be annually    
adju/$ by ! inflation>y factor describ$ 

9 section #ahcd7;aa77#b77;,c71 & %all be
 adju/$ to take into acc\nt any increase
 or decrease 9 ! scope ( su* s]vices    
furni%$ by ! cl9ic 9 ! fiscal ye>       
involv$4  7#c7 ,paym5t = s]vices 9      
subsequ5t fiscal ye>s ,subject to !     
succe$+ provisions ( ?is subsection1 =  
s]vices describ$ 9 section              
#aije7;a77#ca7 furni%$ by a cl9ic aft] !
 initial fiscal ye> describ$ 9 p>agraph 
7#b71 ! ,/ate plan %all provide = paym5t
 = su* s]vices 9 an am\nt 7calculat$ on 
! basis ( daily visits or unduplicat$   
mon?ly visits1 at ! ,/ate's election7 t 
is equal to ! am\nt calculat$ "u ?is    
subsection = su* s]vices & cl9ic = !    
prec$+ fiscal ye>-- 7,a7 increas$ by !  
p]c5tage increase 9 ! inflation>y factor
 describ$ 9 section #ahcd7;aa77#b77;,c7 
= su* fiscal ye>2 &  7,b7 adju/$ to take
 into acc\nt any increase or decrease 9 
! scope ( su* s]vices furni%$ by ! cl9ic
 dur+ ! fiscal ye> involv$4  7#d7       
,e/abli%m5t ( initial fiscal ye> paym5t 
= new cl9ics  7,a7 ,9 g5]al ,9 any case 

9 :i* an entity fir/ qualifies z a      
c]tifi$ community behavioral heal? cl9ic
 9 a ye> aft] ! fir/ fiscal ye> 9 :i* ! 
,/ate fir/ provides = paym5t = ! s]vices
 describ$ 9 section #aije7;a77#ca7 9    
accordance ) p>agraph 7#a71 ! ,/ate plan
 %all provide = paym5t = su* s]vices 9 !
 fir/ fiscal ye> 9 :i* ! cl9ic s        
qualifies 9 an am\nt 7calculat$ on !    
basis ( daily visits or unduplicat$     
mon?ly visits1 at ! ,/ate's election7 t 
is equal to ! rates e/abli%$ "u ?is     
subsection = o!r su* cl9ics locat$ 9 !  
same or adjac5t area ) a simil> case    
load1 or 9 ! abs5ce ( any su* cl9ic1    
bas$ on ! reasonable project$ co/s p]   
visit ( ! cl9ic4  7,b7 ,additional      
requirem5t ,n lat] ?an ! second fiscal  
ye> 9 :i* a cl9ic describ$ 9 subp>agraph
 7,a7 furni%es s]vices describ$ 9       
section #aije7;a77#ca7-- 7i7 ! ,/ate    
%all e/abli% a unique paym5t rate = !   
cl9ic bas$ on ! me?odology describ$ 9   
p>agraph 7#b71 us+ reasonable & relat$  
co/s f ! cl9ic's fir/ fiscal ye> (      

op]ation z ! basis = e/abli%+ su* rates2
 &  7ii7 9 any ye> foll[+ ! e/abli%m5t (
 an initial rate "u ?is subp>agraph1 !  
,/ate plan %all provide = ! paym5t am\nt
 to be adju/$ 9 accordance ) p>agraph   
7#c7 & 7z applicable7 ree/abli%$ 9      
accordance ) p>agraph 7#e74  7#e7       
,optional p]iodic rebase ( ,,pps rates  
,not)/&+ ! prec$+ p>agraphs1 a ,/ate may
 elect 9 its ,/ate plan am5dm5t to      
e/abli% a new prospective paym5t sy/em  
rate = cl9ics on a p]iodic basis4 ,"u   
su* an election1 p]iodically 7b n less  
frequ5tly ?an e #crd fiscal ye>7 aft] ! 
initial ye>1 z describ$ 9 p>agraph 7#b71
 9 :i* ! ,/ate fir/ furni%es ! s]vices  
describ$ 9 section #aije7;a77#ca71 !    
,/ate %all set a new rebas$ rate = ea*  
cl9ic ^: rate 0 initially set pursuant  
to p>agraph 7#b71 except t co/s f !     
fiscal ye> prec$+ su* rebas+ ye>1 r ?an 
co/s f ! base ye> describ$ 9 p>agraph   
7#b71 %all be us$ 9 e/abli%+ a new      
co/-relat$ rate = ea* cl9ic4 ,/ates     
elect+ ?is option %all also foll[ ?is   

me?odology & s*$ule 9 p]iodically       
e/abli%+ new rates = ^? cl9ics ^:       
initial rates 7 set z describ$ 9        
p>agraph 7#d74  7#f7 ,adm9i/ration 9 !  
case ( manag$ c>e  7,a7 ,9 g5]al ,9 !   
case ( s]vices furni%$ by a c]tifi$     
community behavioral heal? cl9ic        
pursuant to a contract betwe5 ! cl9ic & 
a manag$ c>e entity 7z def9$ 9 section  
#aicb7;a77#a77;,b771 ! ,/ate plan %all  
provide = paym5t to ! cl9ic by ! ,/ate (
 a supplem5tal paym5t equal to ! am\nt  
7if any7 by :i* ! am\nt det]m9$ "u !    
prec$+ p>agraphs ( ?is subsection or z  
applicable1 p>agraph 7#g71 exce$s !     
am\nt ( paym5ts "u ! contract1 ) su*    
supplem5tal paym5t be+ made pursuant to 
a paym5t s*$ule agre$ to by ! ,/ate & ! 
c]tifi$ community behavioral heal?      
cl9ic1 b n less frequ5tly ?an e #c      
mon?s4  7,b7 ,option to delegate ,,pps  
paym5t to manag$ c>e entities ?r\gh an  
alt]native paym5t me?odology  7i7 ,9    
g5]al ,not)/&+ subp>agraph 7,a71 no?+ 9 
?is subsection %all be int]pret$ to     

preclude a ,/ate f am5d+ its ,/ate plan 
to provide = an alt]native paym5t       
me?odology 9 accordance ) p>agraph 7#g71
 "u :i* ! ,/ate may delegate to a manag$
 c>e entity 7z def9$ 9 section          
#aicb7;a77#a77;,b77 ! responsibility to 
pay ! cl9ic at lea/ ! rate det]m9$ "u ! 
prec$+ subp>agraphs or z applicable1    
p>agraph 7#g74  7ii7 ,requirem5ts ,9    
mak+ a delegation "u clause 7i71 a ,/ate
 %all ensure t x complies ) !           
requirem5ts describ$ 9 p>agraph 7#g7 &  
%all use reconciliation & ov]sight      
processes to ensure t ea* cl9ic is paid 
at lea/ ! am\nts requir$ "u ! prec$+    
p>agraphs ( ?is subsection4  7#g7       
,alt]native paym5t me?odologies ,not)/&+
 any o!r provision ( ?is subsection1 a  
,/ate plan may provide = paym5t 9 any   
ye> to a c]tifi$ community behavioral   
heal? cl9ic = s]vices describ$ 9 section
 #aije7;a77#ca7 9 an am\nt :i* is       
det]m9$ "u an alt]native paym5t         
me?odology t-- 7,a7 is agre$ to by !    
,/ate & ! cl9ic2 &  7,b7 results 9      

paym5t to ! cl9ic ( an am\nt :i* is n   
less ?an ! am\nt o!rwise requir$ to be  
paid to ! cl9ic "u ?is subsection4  4   
#ajc4 ,exp&+ c]tifi$ community          
behavioral heal? cl9ic s]vices )9       
,m$icaid demon/ration program  7a7      
,additional s]vices )9 demon/ration     
program  7#a7 ,9 g5]al ,section         
#bbc7;a77#b77;,d7 ( ! ,protect+ ,access 
to ,m$ic>e ,act ( #bjad 7#db ,u4,s4,c4  
#acif;a note71 is am5d$ to read z       
foll[s3  7,d7 ,scope ( s]vices          
,provision 79 a mann] reflect+          
p]son-c5t]$ c>e7 ( at lea/ ! foll[+     
requir$ s]vices describ$ 9 clause 7i71  
:i* may be furni%$ ei!r directly or1 if 
n available directly1 ?r\gh =mal        
relation%ips ) o!r provid]s1 & at !     
discretion ( ! c]tifi$ community        
behavioral heal? cl9ic1 at lea/ #a ( !  
foll[+ additional s]vices describ$ 9    
clause 7ii7 furni%$ directly by ! cl9ic3
 7i7 ,requir$ s]vices  7,i7 ,crisis     
m5tal heal? s]vices1 includ+ #bd-;h\r   
mobile crisis teams1 em]g5cy crisis     

int]v5tion s]vices1 & crisis            
/abilization4  7,,ii7 ,scre5+1          
assessm5t1 & diagnosis1 includ+ risk    
assessm5t4  7,,iii7 ,pati5t-c5t]$       
treatm5t plann+ or simil> processes1    
includ+ risk assessm5t & crisis plann+4 
7,,iv7 ,outpati5t m5tal heal? & sub/ance
 use s]vices4  7,v7 ,outpati5t cl9ic    
prim>y c>e scre5+ & monitor+ ( key heal?
 indicators & heal? risk4  7,,vi7       
,t>get$ case managem5t4  7,,vii7        
,psy*iatric rehabilitation s]vices4     
7,,viii7 ,pe] support & c\nselor s]vices
 & family supports4  7,,ix7 ,int5sive1  
community-bas$ m5tal heal? c>e = memb]s 
( ! ,arm$ ,=ces & vet]ans1 p>ticul>ly ^?
 memb]s & vet]ans locat$ 9 rural areas1 
provid$ ! c>e is consi/5t ) m9imum      
cl9ical m5tal heal? guidel9es promulgat$
 by ! ,vet]ans ,heal? ,adm9i/ration     
includ+ cl9ical guidel9es conta9$ 9 !   
,uni=m ,m5tal ,heal? ,s]vices ,h&book ( 
su* ,adm9i/ration4  7ii7 ,additional    
s]vices ,! additional s]vices describ$ 9
 ?is clause are-- 7,i7 s]vices n        

describ$ 9 clause 7i72 &  7,,ii7 s]vices
 t are appropriate to meet ! heal? ne$s 
( ! population s]v$1 includ+ any ( !    
prim>y heal? s]vices describ$ 9 section 
#ccj7;b77#a77;,a7 ( ! ,public ,heal?    
,s]vice ,act4  4  7#b7 ,additional      
am5dm5ts ,section #bbc ( ! ,protect+    
,access to ,m$ic>e ,act ( #bjad 7#db    
,u4,s4,c4 #acif;a note71 is am5d$-- 7,a7
 9 subsection 7b77#a71 by /rik+ m5tal   
heal? s]vices & ins]t+ c]tifi$ community
 behavioral heal? cl9ic s]vices2  7,b7 9
 subsection 7d77#e77;,d7-- 7i7 by ins]t+
 7includ+ su* ,/ate's prior use "u su*  
demon/ration ( a supplem5tal paym5t or  
wrap>\nd framework = paym5ts = s]vices  
furni%$ "u contract ) a manag$ c>e      
entity7 aft] e/abli%$ "u subsection 7c72
 &  7ii7 by /rik+ ! p]iod at ! end &    
ins]t+ ! foll[+3 1 & not)/&+ any ,f$]al 
regulation conc]n+ prohibition (        
additional paym5ts = s]vices cov]$ "u a 
contract ) a manag$ c>e entity1 a       
prepaid inpati5t heal? plan1 or a       
prepaid ambulatory heal? plan42 &  7,c7 

9 subsection 7e7-- 7i7 by r$esignat+    
p>agraphs 7#a7 ?r\gh 7#d7 z p>agraphs   
7#b7 ?r\gh 7#e72 &  7ii7 by ins]t+ be=e 
p>agraph 7#b7 ! foll[+ new p>agraph3    
7#a7 ,c]tifi$ community behavioral heal?
 cl9ic s]vices ,! t]m c]tifi$ community 
behavioral heal? cl9ic s]vices means any
 s]vices requir$ "u clause 7i7 (        
subsection 7a77#b77;,d7 & any additional
 s]vices describ$ 9 clause 7ii7 ( su*   
subsection to ! ext5t t a c]tifi$       
community behavioral heal? cl9ic elects 
to furni% su* s]vices4  4  7b7          
,effective date ,! am5dm5ts made by ?is 
section %all apply ) respect to s]vices 
furni%$ on or aft] ,octob] #a1 #bjbf4   
#ajd4 ,exp&+ c]tifi$ community          
behavioral heal? cl9ic s]vices cov]$ "u 
! ,m$icaid ,/ate plan  7a7 ,additional  
s]vices )9 c]tifi$ community behavioral 
heal? cl9ic b5efit ,section             
#aije7;jj77#a7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;d7jj77#a77 is 
am5d$ to read z foll[s3  7#a7 ,9 g5]al  
,! t]m c]tifi$ community behavioral     

heal? s]vices means ! foll[+ requir$    
s]vices describ$ 9 subp>agraph 7,a71 :i*
 may be furni%$ ei!r directly or1 if n  
available directly1 ?r\gh =mal          
relation%ips ) o!r provid]s1 & at !     
discretion ( ! c]tifi$ community        
behavioral heal? cl9ic1 at lea/ #a ( !  
foll[+ additional s]vices describ$ 9    
subp>agraph 7,b7 furni%$ directly by !  
cl9ic3 7,a7 ,requir$ s]vices  7i7       
,crisis m5tal heal? s]vices1 includ+    
#bd-;h\r mobile crisis teams1 em]g5cy   
crisis int]v5tion s]vices1 & crisis     
/abilization4  7ii7 ,scre5+1 assessm5t1 
& diagnosis1 includ+ risk assessm5t4    
7iii7 ,pati5t-c5t]$ treatm5t plann+ or  
simil> processes1 includ+ risk assessm5t
 & crisis plann+4  7iv7 ,outpati5t m5tal
 heal? & sub/ance use s]vices4  7v7     
,outpati5t cl9ic prim>y c>e scre5+ &    
monitor+ ( key heal? indicators & heal? 
risk4  7vi7 ,t>get$ case managem5t4     
7vii7 ,psy*iatric rehabilitation        
s]vices4  7viii7 ,pe] support & c\nselor
 s]vices & family supports4  7ix7       

,int5sive1 community-bas$ m5tal heal?   
c>e = memb]s ( ! ,arm$ ,=ces & vet]ans  
:o are eligible = m$ical assi/ance1     
p>ticul>ly su* memb]s & vet]ans locat$ 9
 rural areas1 provid$ ! c>e is consi/5t 
) m9imum cl9ical m5tal heal? guidel9es  
promulgat$ by ! ,vet]ans ,heal?         
,adm9i/ration1 includ+ cl9ical guidel9es
 conta9$ 9 ! ,uni=m ,m5tal ,heal?       
,s]vices ,h&book ( su* ,adm9i/ration4   
7,b7 ,additional s]vices ,! additional  
s]vices describ$ 9 ?is subp>agraph are--
 7i7 s]vices n describ$ 9 subp>agraph   
7,a72 &  7ii7 s]vices t are appropriate 
to meet ! heal? ne$s ( ! population     
s]v$1 includ+ any ( ! prim>y heal?      
s]vices describ$ 9 section              
#ccj7;b77#a77;,a7 ( ! ,public ,heal?    
,s]vice ,act4  4  7b7 ,effective date ,!
 am5dm5ts made by ?is section %all apply
 ) respect to s]vices furni%$ on or aft]
 ,octob] #a1 #bjbf4  ,,ii ,cov]age (    
c]tifi$ community behavioral heal? cl9ic
 s]vices "u ! ,m$ic>e program  #bja4    
,cov]age ( c]tifi$ community behavioral 

heal? cl9ic s]vices "u ! ,m$ic>e program
  7a7 ,cov]age ,section #ahfa7s77#b7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciex7s77#b77 is am5d$-- 7#a7 9        
subp>agraph 7,,jj71 by ins]t+ & at !    
end2 &  7#b7 by add+ at ! end ! foll[+  
new subp>agraph3  7,,kk7 c]tifi$        
community behavioral heal? cl9ic s]vices
 7z def9$ 9 subsection 7aa77#h77 furni%$
 on or aft] ,janu>y #a1 #bjbg4  4  7b7  
,def9itions ,section #ahfa7;aa7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7 is am5d$-- 7#a7 9 ! head+1 by   
/rik+ & f$]ally qualifi$ heal? c5t]     
s]vices & ins]t+ 1 f$]ally qualifi$     
heal? c5t] s]vices1 & c]tifi$ community 
behavioral heal? cl9ic s]vices2 &  7#b7 
by add+ at ! end ! foll[+ new p>agraph3 
7#h7 ,! t]ms c]tifi$ community          
behavioral heal? cl9ic s]vices & c]tifi$
 community behavioral heal? cl9ic h !   
mean+ giv5 ^? t]ms 9 p>agraphs 7#a7 &   
7#b71 respectively1 ( section           
#aije7;jj74  4  #bjb4 ,paym5t = c]tifi$ 
community behavioral heal? cl9ic s]vices

 "u ! ,m$ic>e program  7a7 ,9 g5]al     
,section #ahcc7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciel7a77#a77 is am5d$-- 7#a7 by /rik+ 
& 7,,hh7 & ins]t+ 7,,hh72 &  7#b7 by    
ins]t+ be=e ! semicolon at ! end !      
foll[+3 1 & 7,,ii7 ) respect to c]tifi$ 
community behavioral heal? cl9ic s]vices
 = :i* paym5t is made "u section        
#ahcd7;aa71 ! am\nts paid %all be equal 
to #hj p]c5t ( ! less] ( ! actual *>ge  
or ! am\nt det]m9$ "u su* section4  7b7 
,developm5t & implem5tation (           
prospective paym5t sy/em ,section #ahcd 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7 is am5d$ by add+ at ! 
end ! foll[+ new subsection3  7aa7      
,developm5t & implem5tation (           
prospective paym5t sy/em = c]tifi$      
community behavioral heal? cl9ics  7#a7 
,developm5t  7,a7 ,9 g5]al ,! ,secret>y 
%all develop a prospective paym5t sy/em 
= paym5t = community behavioral heal?   
cl9ic s]vices 7z def9$ 9 section        
#ahfa7;aa77#h77 furni%$ by c]tifi$      

community behavioral heal? cl9ics 7z    
def9$ 9 su* section7 "u ?is title4  7,b7
 ,consid]ations & adju/m5ts ,9 develop+ 
! sy/em describ$ 9 subp>agraph 7,a71 !  
,secret>y-- 7i7 %all-- 7,i7 take into   
acc\nt ! type1 int5sity1 & duration (   
s]vices furni%$ by c]tifi$ community    
behavioral heal? cl9ics2 &  7,,ii7      
consid] an appropriate unit ( s]vice & a
 g5]al sy/em design t provides = cont9u$
 access to quality s]vices2 &  7ii7 may 
include adju/m5ts1 includ+ geographic   
adju/m5ts1 z det]m9$ appropriate by !   
,secret>y4  7#b7 ,implem5tation  7,a7 ,9
 g5]al ,= co/ report+ p]iods beg9n+ on  
or aft] ,janu>y #a1 #bjbg1 ! ,secret>y  
%all provide = paym5ts ( prospective    
paym5t rates = c]tifi$ community        
behavioral heal? cl9ic s]vices furni%$  
by c]tifi$ community behavioral heal?   
cl9ics "u ?is title 9 accordance ) !    
prospective paym5t sy/em develop$ by !  
,secret>y "u p>agraph 7#a74  7,b7       
,initial paym5ts  7i7 ,9 g5]al ,subject 
to clause 7ii71 9 ! fir/ ye> t su*      

prospective paym5t sy/em is implem5t$1 !
 ,secret>y %all implem5t su* sy/em to   
reflect ! national av]age all[able      
s]vice co/s ( c]tifi$ community         
behavioral heal? cl9ics on ! basis ( !  
mo/ curr5t audit$ co/ report data = ! #b
 mo/ rec5t fiscal ye>s available to !   
,secret>y4 ,initial paym5ts %all be     
e/abli%$ )\t ! application ( a p] visit 
limit or productivity scre5 & %all be   
bas$ on national av]age co/s p] unit (  
s]vice1 updat$ z appropriate by !       
inflation>y adju/m5t describ$ 9         
subp>agraph 7,c74  7ii7 ,abs5ce ( data  
,9 ! abs5ce ( complete co/ report data  
describ$ 9 clause 7i71 c]tifi$ community
 behavioral heal? cl9ics may1 at !      
,secret>y's discretion1 submit e/imat$  
or project$ data relat+ to specific     
s]vices4  7,c7 ,paym5ts 9 subsequ5t ye>s
 ,paym5t rates 9 ye>s aft] ! ye> (      
implem5tation ( su* sy/em %all be !     
paym5t rates 9 ! previ\s ye> increas$-- 
7i7 9 ! fir/ ye> aft] implem5tation (   
su* sy/em1 by ! p]c5tage increase 9 !   

,,mei 7z def9$ 9 section #ahdb7;i77#c772
 &  7ii7 9 subsequ5t ye>s-- 7,i7 by !   
p]c5tage increase 9 a m>ket basket (    
c]tifi$ community behavioral heal? cl9ic
 s]vices1 design$ by ! ,secret>y2 or    
7,,ii7 if su* an index is n available1  
by ! p]c5tage increase 9 ! ,f$]ally     
qualifi$ heal? c5t] m>ket basket 7z     
describ$ 9 section                      
#ahcd7o77#b77;,b77ii77,,ii77 = ! ye>    
involv$4  7#c7 ,p]iodic reevaluation (  
rates ,! ,secret>y may p]iodically adju/
 ! am\nts t w\ld o!rwise be applicable  
"u p>agraph 7#b7 by a p]c5tage det]m9$  
appropriate by ! ,secret>y to reflect   
su* factors z *anges 9 ! int5sity (     
c]tifi$ community behavioral heal? cl9ic
 s]vices furni%$ )9 a unit ( s]vice1 !  
av]age co/ ( provid+ c>e p] unit (      
s]vice1 & o!r factors t ! ,secret>y     
consid]s to be appropriate4 ,su*        
adju/m5t %all be made be=e ! update "u  
clause 7i7 or 7ii7 ( p>agraph 7#b77;,c7 
has be5 appli$ = ! ye>4  4  #bjc4       
,non-application ( ,m$ic>e "p ,b        

d$uctible = c]tifi$ community behavioral
 heal? cl9ic s]vices ,section           
#ahcc7;b77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciel7b77#d77 is am5d$ 
by ins]t+ or c]tifi$ community          
behavioral heal? cl9ic s]vices be=e !   
comma at ! end4  #bjd4 ,"r to seek      
,paym5t ,reimbursem5t ,review ,bo>d     
review ( co/ reports ,section #ahgh7;j7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acieoo7j77 is am5d$ by /rik+ 
& a ,f$]ally qualifi$ heal? c5t] &      
ins]t+ 1 a ,f$]ally qualifi$ heal? c5t]1
 & a c]tifi$ community behavioral heal? 
cl9ic4  #bje4 ,ext5d+ safe h>bor "u     
anti-kickback /atute to waiv]s ( c]tifi$
 community behavioral heal? cl9ic       
co9surance ,section #aabh;,b7b77#c77;,d7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acbj;a-#g;b7b77#c77;,d77 is  
am5d$ by ins]t+ or a c]tifi$ community  
behavioral heal? cl9ic aft] ,f$]ally    
qualifi$ heal? c>e c5t]4  #bjf4         
,effective date ,! am5dm5ts made by ?is 
title %all apply ) respect to s]vices   

furni%$ on or aft] ,janu>y #a1 #bjbg4   
,,iii ,community behavioral heal? cl9ics
  #cja4 ,community behavioral heal?     
cl9ics ,"p ,d ( title ,,iii ( ! ,public 
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bed;b et seq47 is am5d$ by add+ at !   
end ! foll[+3  ,,xiii ,community        
behavioral heal? cl9ics  #cdj;,j4       
,def9itions ,9 ?is subp>t3 7#a7 ,c]tifi$
 community behavioral heal? cl9ic ,! t]m
 c]tifi$ community behavioral heal?     
cl9ic has ! mean+ giv5 ! t]m 9 section  
#aije7;jj77#b7 ( ! ,social ,security    
,act4  7#b7 ,c]tifi$ community          
behavioral heal? s]vices ,! t]m c]tifi$ 
community behavioral heal? s]vices has !
 mean+ giv5 ! t]m 9 section             
#aije7;jj77#a7 ( ! ,social ,security    
,act4  #cdj;,j-#a4 ,op]at+ grants =     
community behavioral heal? cl9ics  7a7  
,9 g5]al ,! ,secret>y %all e/abli% a    
grant program "u :i* ! ,secret>y %all   
aw>d grants to eligible community       
behavioral heal? cl9ics to provide 79 a 
mann] reflect+ p]son-c5t]$ c>e7 ! full  

array ( c]tifi$ community behavioral    
heal? s]vices4  7b7 ,eligibility ,to be 
eligible to receive a grant "u          
subsection 7a71 an entity %all be-- 7#a7
 a c]tifi$ community behavioral heal?   
cl9ic2 or  7#b7 a community behavioral  
heal? cl9ic t-- 7,a7 indicates 9 ! grant
 application t-- 7i7 x w use ! grant    
funds to meet su* crit]ia requir$ to be 
a c]tifi$ community behavioral heal?    
cl9ic2 &  7ii7 agrees to seek           
accr$itation "u section #cdj;,j-#d7;a71 
z ! ,secret>y may require2 &  7,b7      
demon/rates h[ x c ensure access to c>e 
= all individuals 9 ! community ?r\gh   
ref]ral or o!r =mal arrangem5ts ) o!r   
provid]s ( s]vices1 9 ! case ( an entity
 t specializes 9 s]vices to *ildr5 or   
y\? or to vet]ans4  7c7 ,use ( funds ,a 
community behavioral heal? cl9ic t      
receives a grant "u subsection 7a7--    
7#a7 %all use ! grant funds-- 7,a7 to   
provide ! s]vices describ$ 9 subsection 
7a72 &  7,b7 9 ! case ( a community     
behavioral heal? cl9ic describ$ 9       

subsection 7b77#b71 to atta9            
c]tification & accr$itation z describ$ 9
 subsection 7b77#b77;,a72 &  7#b7 may   
use ! grant funds-- 7,a7 to c>ry out o!r
 activities t-- 7i7 r$uce co/s associat$
 ) ! provision ( c]tifi$ community      
behavioral heal? s]vices2  7ii7 improve 
access to1 & availability (1 c]tifi$    
community behavioral heal? s]vices      
provid$ to individuals s]v$ by !        
community behavioral heal? cl9ic2  7iii7
 enhance ! quality & coord9ation (      
c]tifi$ community behavioral heal?      
s]vices2 or  7iv7 improve ! heal? /atus 
( communities2 &  7,b7 to pay =-- 7i7 ! 
co/s ( acquir+ & leas+ build+s &        
equipm5t 7includ+ ! co/s ( amortiz+ !   
pr9cipal (1 & pay+ int]e/ on1 loans72   
7ii7 co/s relat+ to ! pur*ase or lease (
 equipm5t1 includ+ data & in=mation     
sy/ems & behavioral heal? in=mation     
te*nology to facilitate data report+ &  
o!r purposes2  7iii7 ! co/s ( 9-s]vice  
/aff tra9+ & o!r op]ational or          
infra/ructure co/s id5tifi$ by !        

,secret>y2 &  7iv7 co/s associat$ )     
exp&+ & mod]niz+ exi/+ build+s or       
con/ruct+ new build+s 7includ+ ! co/s ( 
amortiz+ ! pr9cipal (1 & pay+ ! int]e/  
on1 loans71 if su* co/s are specifically
 all[$ = 9 ! grant opportunity publi%$  
by ! ,secret>y4  7d7 ,use ( nongrant    
funds ,nongrant funds describ$ 9        
subsection 7g77#a77;,b71 includ+ any su*
 funds 9 excess ( ^? orig9ally expect$1 
%all be us$ z p]mitt$ "u ?is section1 & 
may be us$ = su* o!r purposes z are n   
specifically prohibit$ "u ?is section if
 su* use fur!rs ! objectives ( !        
project4  7e7 ,t]m ,grants aw>d$ "u     
subsection 7a7 %all be = a p]iod ( n m  
?an #e ye>s4  7f7 ,condition on receipt 
( funds ,! ,secret>y %all n make a grant
 to an applicant "u subsection 7a7      
unless ! applicant provides assurances  
to ! ,secret>y t )9 #abj days ( receiv+ 
grant fund+ = ! op]ation ( ! cl9ic1 !   
applicant w submit = approval by !      
,secret>y an implem5tation plan t       
describes h[ ! applicant w-- 7#a7       

provide ! s]vices describ$ 9 subsection 
7a72 &  7#b7 9 ! case ( a community     
behavioral heal? cl9ic describ$ 9       
subsection 7b77#b71 atta9 c]tification &
 accr$itation z describ$ 9 subsection   
7b77#b77;,a74  7g7 ,am\nt ( grant  7#a7 
,9 g5]al ,subject to p>agraph 7#b71 !   
am\nt ( a grant made 9 any fiscal ye> to
 a community behavioral heal? cl9ic "u  
subsection 7a7 %all be det]m9$ by !     
,secret>y bas$ on in=mation provid$ by !
 community behavioral heal? cl9ic1 b may
 n exce$ an am\nt equal to ! diff]5ce   
betwe5-- 7,a7 ! co/s ( op]at+ ! cl9ic to
 meet ! purposes & requirem5ts ( ! grant
 program "u ?is section dur+ su* fiscal 
ye>2 &  7,b7 ! sum obta9$ by add+-- 7i7 
! total ,/ate1 local1 & o!r op]ational  
fund+ provid$ to ! cl9ic = su* fiscal   
ye>2 &  7ii7 ! fees1 premiums1 &        
?ird-p>ty reimbursem5ts t ! cl9ic       
reasonably expects to receive = its     
op]ations 9 su* fiscal ye>4  7#b7       
,requirem5t ,9 det]m9+ ! co/s describ$ 9
 p>agraph 7#a77;,a7 ) respect to a      

community behavioral heal? cl9ic1 !     
,secret>y may e/imate1 bas$ on an       
e/imate ( anticipat$ co/s provid$ by !  
applicable community behavioral heal?   
cl9ic1 ! anticipat$ co/s ( su* cl9ic 9--
 7,a7 provid+ ! s]vices describ$ 9      
subsection 7a71 includ+ ! anticipat$    
co/s ( provid+ any individual c]tifi$   
community behavioral heal? s]vice t !   
applicant entity does n h exp]i5ce      
provid+ at ! "t ( submitt+ an           
application = su* grant2 &  7,b7 if     
applicable1 atta9 c]tification &        
accr$itation z describ$ 9 subsection    
7b77#b77;,a74  7#c7 ,paym5ts ,!         
,secret>y may-- 7,a7 disp]se funds aw>d$
 "u subsection 7a7-- 7i7 9 advance or   
?r\gh reimbursem5t2 &  7ii7 9           
in/allm5ts2  7,b7 make adju/m5ts to su* 
disbursem5ts to acc\nt = ov]paym5ts or  
und]paym5ts4  7h7 ,use ( accr$itation 9 
monitor+ grant progress ,reg>dless (    
:e!r ! ,secret>y elects to use          
accr$itation "u section #cdj;,j-#d7;a7 z
 a condition = aw>d ( an op]at+ grant z 

describ$ 9 subsection 7b77#b77;,a77ii71 
! ,secret>y may take su* accr$itation   
into acc\nt 9 det]m9+ if an entity      
receiv+ a grant "u ?is section is       
provid+ ! s]vices describ$ 9 subsection 
7a7 &1 if applicable1 meet+ ! crit]ia = 
c]tification describ$ 9 subsection      
7b77#b77;,a77i74  7i7 ,au?orization (   
appropriations  7#a7 ,9 g5]al ,!re is   
au?oriz$ to be appropriat$ to c>ry out  
?is section1 #eeb1ejj1jjj = ea* ( fiscal
 ye>s #bjbf ?r\gh #bjcj4  7#b7          
,ma9t5ance ( fund+ ,! am\nt made        
available "u p>agraph 7#a7 %all         
supplem5t 7& n supplant7 any o!r ,f$]al 
fund+ made available = c]tifi$ community
 behavioral heal? cl9ics4  7j7 ,/udy (  
cl9ics s]v+ specializ$ populations ,n   
lat] ?an #a ye> aft] ! date ( enactm5t (
 ?is section1 ! ,secret>y %all publi%   
guidance cl>ify+ h[ cl9ics t focus on   
di/9ct populations1 su* z *ildr5 or y\? 
& vet]ans1 may meet any relevant        
requirem5t to furni% appropriate        
treatm5t to individuals across !        

lifespan4 ,su* guidance %all n affect   
cl9ics' qualification to p>ticipate 9 ! 
demon/ration program "u section         
#bbc7;a77#a7 ( ! ,protect+ ,access to   
,m$ic>e ,act ( #bjad or to furni% !     
s]vices describ$ 9 section              
#aije7;a77#ca7 ( ! ,social ,security    
,act4  4  #cdj;,j-#b4 ,te*nical         
assi/ance  7a7 ,9 g5]al ,n lat] ?an #ahj
 days aft] ! date ( enactm5t ( ?is      
section1 ! ,secret>y %all e/abli% a     
program or programs ?r\gh :i* !         
,secret>y %all provide 7directly or by  
grant or contract7 te*nical assi/ance & 
o!r assi/ance to any ( ! foll[+3 7#a7   
,entities t receive a grant "u section  
#cdj;,j-#a4  7#b7 ,entities p>ticipat+ 9
 a ,m$icaid demon/ration program "u     
section #bbc7;d7 ( ! ,protect+ ,access  
to ,m$ic>e ,act4  7#c7 ,c]tifi$         
community behavioral heal? cl9ics       
furni%+ s]vices "u title ,,xviii or     
title ,,xix ( ! ,social ,security ,act4 
7#d7 ,heal? or social s]vice provid]    
organizations pursu+ or consid]+ seek+  

/atus z a c]tifi$ community behavioral  
heal? cl9ic or p>tn]+ ) c]tifi$         
community behavioral heal? cl9ics4  7#e7
 ,o!r /akehold]s1 includ+ demon/ration  
plann+ grant recipi5ts & ,/ate ,m$icaid 
or behavioral heal? (ficials1 = !       
purpose ( facilitat+ successful         
implem5tation ( ! c]tifi$ community     
behavioral heal? cl9ic model4  7b7      
,inclusions ,assi/ance provid$ by !     
,secret>y "u subsection 7a7 may include 
te*nical & nonf9ancial assi/ance1       
includ+-- 7#a7 fiscal & program         
managem5t assi/ance2  7#b7 op]ational & 
adm9i/rative support2 &  7#c7 in=mation 
ab\t ! v>iety ( res\rces available "u   
?is "p & h[ su* res\rces be/ c be us$ to
 meet ! heal? & behavioral heal? ne$s ( 
! communities s]v$ by ! entities4  7c7  
,au?orization ( appropriations ,!re is  
au?oriz$ to be appropriat$ to c>ry out  
?is section #h1jjj1jjj = ea* ( fiscal   
ye>s #bjbf ?r\gh #bjcj4  4  #cdj;,j-#c4 
,data infra/ructure = community         
behavioral heal? cl9ic report+  7a7 ,9  

g5]al ,n lat] ?an #ahj days aft] ! date 
( enactm5t ( ?is "p1 ! ,secret>y %all   
e/abli% a sy/em "u :i* ! ,secret>y      
collects & analyzes data on community   
behavioral heal? cl9ics4  7b7 ,scope (  
data collection ,! sy/em e/abli%$ "u    
subsection 7a7 %all be us$ by !         
,secret>y to collect & analyze data f-- 
7#a7 entities t receive a grant "u      
section #cdj;,j-#a2 &  7#b7             
organizations t provide c]tifi$         
community behavioral heal? s]vices1 or h
 appli$ to provide su* s]vices1 "u !    
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act or ! ,m$icaid    
program "u title ,,xix ( su* ,act4  7c7 
,au?orization ( appropriations ,!re is  
au?oriz$ to be appropriat$ to c>ry out  
?is section #ea1jjj1jjj = ea* ( fiscal  
ye>s #bjbf ?r\gh #bjcj4  4  #cdj;,j-#d4 
,c]tifi$ community behavioral heal?     
cl9ic accr$itation  7a7 ,accr$itation   
/&>ds ,a cl9ic may be accr$it$ z a      
c]tifi$ community behavioral heal? cl9ic
 if ! cl9ic-- 7#a7 meets ! /&>ds ( an   

approv$ accr$itation body2 &  7#b7      
au?orizes ! accr$itation body to submit 
to ! ,secret>y 7or su* ag5cy z !        
,secret>y may designate7 su* records or 
o!r in=mation z ! ,secret>y may require4
  7b7 ,approval ( accr$itation bodies   
7#a7 ,9 g5]al ,! ,secret>y may approve a
 private nonpr(it organization to be an 
accr$itation body = ! accr$itation (    
c]tifi$ community behavioral heal?      
cl9ics "u subsection 7a7 if-- 7,a7 us+  
inspectors qualifi$ to evaluate quality 
( c>e 9 a behavioral heal? s]vice sett+1
 ! accr$itation body agrees to inspect !
 cl9ic ) su* frequ5cy z is det]m9$ by ! 
,secret>y2  7,b7 ! /&>ds appli$ by !    
body 9 det]m9+ :e!r or n to accr$it a   
cl9ic correspond to su* crit]ia z are   
describ$ 9 section #cdj;,j-#a7;b77#b71  
pursuant to ! det]m9ation ( ! ,secret>y1
 & are n less re/rictive ?an su*        
crit]ia2  7,c7 !re is adequate provision
 = assur+ t ! /&>ds ( ! accr$itation    
body cont9ue to be met by ! cl9ic2  7,d7
 9 ! case ( any cl9ic accr$it$1 )9 !    

prior #c ye>s1 by ! body :i* has _h its 
accr$itation d5i$1 susp5d$1 )drawn1 or  
revok$ or :i* has _h any o!r action tak5
 aga9/ x by ! accr$it+ body1 ! accr$it+ 
body agrees to submit to ! ,secret>y !  
"n ( su* cl9ic )9 #cj days ( ! action   
tak52 &  7,e7 if ! accr$itation body has
 its approval )drawn by ! ,secret>y1 !  
body agrees to notify ea* cl9ic accr$it$
 by ! body ( ! )drawal )9 #aj days ( !  
)drawal4  4  ,,iv ,liability protection 
= c]tifi$ community behavioral heal?    
cl9ic cl9icians  #dja4 ,conf]r+         
protection "u ! ,f$]al ,tort ,claims    
,act to cl9icians 9 c]tifi$ community   
behavioral heal? cl9ics ,section        
#bbd7;g77#d7 ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bcc7 is am5d$ by   
add+ at ! end ! foll[+3 or c]tifi$      
community behavioral heal? cl9ic z def9$
 9 section #aije7;jj77#b7 ( ! ,social   
,security ,act4