119-hr2590

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2590 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 2590

 To amend title XVIII of the Social Security Act to establish a 
demonstration program to promote collaborative treatment of mental and 
 physical health comorbidities under the Medicare program.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 April 2, 2025

 Mr. Boyle of Pennsylvania (for himself and Ms. Brown) introduced the 
 following bill; which was referred to the Committee on Energy and 
 Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
 committee concerned

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to establish a 
demonstration program to promote collaborative treatment of mental and 
 physical health comorbidities under the Medicare program.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Mental and Physical Health Care 
Comorbidities Act of 2025''.

SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM TO PROMOTE COLLABORATIVE 
 TREATMENT OF MENTAL AND PHYSICAL HEALTH COMORBIDITIES 
 UNDER THE MEDICARE PROGRAM.

 Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after 

section 1866G the following new section:

``

SEC. 1866H. MENTAL AND PHYSICAL HEALTH COMORBIDITIES COLLABORATIVE 
 DEMONSTRATION PROGRAM.

 ``

    (a) In General.--Consistent with the model described in 

section 1115A

    (b)

    (2)
        (B)
            (xv) (relating to promoting improved quality and reduced 
cost by developing a collaborative of high-quality, low-cost health 
care institutions), the Secretary shall conduct a demonstration program 
(in this section referred to as the `program') to test and evaluate 
innovations implemented by eligible hospitals (as defined in subsection

    (f) ) in the furnishing of items and services to applicable individuals 
(as defined in subsection

    (f) ) with mental and physical health 
comorbidities (and those at risk of developing such comorbidities), 
including by addressing the adverse social determinants of health that 
such individuals often experience.
 ``

    (b) Activities Under Program.--Under the program, the Secretary 
shall, in coordination with eligible hospitals participating in the 
program--
 ``

    (1) identify, validate, and disseminate innovative, 
 effective evidence-based best practices and models that improve 
 care and outcomes for applicable individuals with mental and 
 physical health comorbidities located in vulnerable 
 communities, including by addressing the social determinants of 
 health that adversely impact such individuals; and
 ``

    (2) assist in the identification of potential payment 
 reforms under this title and title XIX that could more broadly 
 effectuate such improvements.
 ``
            (c) Duration and Scope.--The program conducted under this section 
shall operate during the period beginning on October 1, 2025, and 
ending no later than September 30, 2030.
 ``
            (d) Program Elements.--
 ``

    (1) In general.--An eligible hospital electing to 
 participate in the program shall enter into an agreement with 
 the Secretary for purposes of carrying out the activities 
 described in subsection

    (b) . Such an agreement shall include 
 the plan described in paragraph

    (2) , along with an annualized 
 payment arrangement as described in paragraph

    (3) to support 
 implementation of such plan. Such agreement shall include a 
 requirement for the hospital to--
 ``
        (A) engage in the learning collaborative 
 established under subsection

    (e) ;
 ``
        (B) certify that all proposed innovations under 
 such plan will supplement and not supplant existing 
 activities, whether by augmenting existing activities 
 or initiating new activities; and
 ``
            (C) remit payments made under such arrangement to 
 the Secretary if the Secretary determines that such 
 hospital has not complied with the terms of such 
 agreement.
 ``

    (2) Program elements.--An eligible hospital electing to 
 participate in the program shall submit a proposed plan and 
 associated quality metrics for review and approval by the 
 Secretary. Such plan and metrics shall, at a minimum, address--
 ``
        (A) the specific innovations addressing mental 
 and physical health comorbidities (as defined in 
 subsection

    (f) ) and innovations addressing social 
 determinants of health (as defined in such subsection) 
 that will be employed and the evidence base supporting 
 the proposed approach;
 ``
        (B) the proposed target population of applicable 
 individuals with respect to which such innovations will 
 be employed, including a description of the extent to 
 which such population consists of applicable 
 individuals described in subparagraph
        (A) ,
        (B) , or
            (C) of subsection

    (f)

    (1) ;
 ``
            (C) the evidence-based data supporting a 
 community's status as a vulnerable community through 
 sources, such as Bureau of the Census data and measures 
 such as the Neighborhood Deprivation Index or the Child 
 Opportunity Index;
 ``
            (D) community partners, such as nonprofit 
 organizations, federally qualified health centers, 
 rural health clinics, and units of local government 
 (including law enforcement and judicial entities) that 
 will participate in the implementation of such 
 innovations;
 ``
        (E) how such innovations will address mental and 
 physical health comorbidities and social determinants 
 of health for the target population;
 ``
        (F) how such innovations may inform changes in 
 payment and other policies under this title and title 
 XIX (such as care coordination reimbursement, mental 
 health homes, improvements to home and community-based 
 service portfolios, and coverage of supportive 
 services);
 ``
        (G) how such innovations might contribute to a 
 reduction in overall health care costs, including under 
 this title and title XIX and for uninsured persons, 
 through improvements in population health, reductions 
 in health care utilization (such as inpatient 
 admissions, utilization of emergency departments, and 
 boarding of patients), and otherwise;
 ``
        (H) how such innovations can be expected to 
 improve the mental and physical health status of 
 minority populations;
 ``
            (I) how such innovations can be expected to 
 reduce other non-medical public expenditures;
 ``
        (J) metrics to track care quality, improvement in 
 outcomes, and the impact of such innovations on health 
 care and other public expenditures;
 ``
        (K) how program outcomes will be assessed and 
 evaluated; and
 ``
            (L) how the hospital will collect and organize 
 data and fully participate in the learning 
 collaborative established under subsection

    (e) .
 ``

    (3) Participation; payments.--The Secretary shall 
 negotiate an annualized payment arrangement with each eligible 
 hospital participating in the program. Such arrangement may 
 include an annual lump sum amount, capitated payment amount, or 
 such other arrangement as determined appropriate by the 
 Secretary, and which may include an arrangement that includes 
 financial risk for the hospital, to support implementation of 
 the innovations specified in the plan described in paragraph

    (2) .
 ``

    (e) Learning Collaborative.--
 ``

    (1) In general.--The Secretary shall establish a learning 
 collaborative that shall convene eligible hospitals 
 participating in the program and other interested parties on a 
 regular basis to report on and share information regarding 
 evidence-based innovations addressing mental and physical 
 health comorbidities, innovations addressing social 
 determinants of health, and associated metrics and outcomes.
 ``

    (2) Focused forums.--The Secretary may establish 
 different focused forums within the collaborative, such as ones 
 that specifically address different geographic regions (such as 
 urban and rural), certain types of comorbidities, or as the 
 Secretary otherwise determines appropriate based on the types 
 of agreements entered into under subsection
            (d) .
 ``

    (3) Dissemination of information.--The Secretary shall 
 provide for the dissemination to other health care providers 
 and interested parties of information on promising and 
 effective activities.
 ``

    (f) 

=== Definitions. ===
-For purposes of this section:
 ``

    (1) Applicable individual.--The term `applicable 
 individual' means an individual with mental and physical health 
 comorbidities who is--
 ``
        (A) a subsidy eligible individual (as defined in 
 

section 1860D-14

    (a)

    (3)
        (A) ) without regard to clause
            (i) of such section;
 ``
        (B) enrolled under a State plan (or waiver of 
 such plan) under title XIX; or
 ``
            (C) uninsured.
 ``

    (2) Eligible hospital.--The term `eligible hospital' 
 means a hospital that is--
 ``
        (A) a rural hospital with a disproportionate 
 patient percentage of at least 35 percent (as 
 determined by the Secretary under 

section 1886
            (d) (5)
        (F)
            (vi) ) or would have a disproportionate 
 patient percentage of at least 35 percent (as so 
 determined) if the hospital were a subsection
            (d) hospital (or, a percentage of inpatient days consisting 
 of items and services furnished to individuals entitled 
 to benefits under part A that exceeds 85 percent of all 
 such days) that is either a critical access hospital, a 
 sole community hospital (as defined in 

section 1886
            (d) (5)
            (D) 
            (iii) ), or a medicare-dependent, small 
 rural hospital (as defined in 

section 1886
            (d) (5)
        (G)
            (iv) );
 ``
        (B) a large subsection
            (d) teaching and tertiary 
 hospital with more than 200 beds that as of, or 
 subsequent to July 1, 2020, has an average Medicare 
 case mix index of at least 1.5, an intern and resident-
 to-bed ratio of at least 0.25 percent (or at least 150 
 full-time equivalent interns, residents, and fellows), 
 and is either a public hospital with a disproportionate 
 patient percentage of at least 35 percent (as 
 determined by the Secretary under 

section 1886
            (d) (5)
        (F)
            (vi) ) or a nonprofit hospital with a 
 disproportionate patient percentage of at least 45 
 percent; or
 ``
            (C) a small subsection
            (d) urban safety net 
 hospital (as determined by the Secretary) with less 
 than 200 beds that is deemed to be a disproportionate 
 share hospital under 

section 1923

    (b) .
 ``

    (3) Innovations addressing mental and physical health 
 comorbidities.--The term `innovations addressing mental and 
 physical health comorbidities' means innovations implemented by 
 an eligible hospital that seek to promote holistic care and 
 treatment of an applicable individual's co-occurring mental and 
 physical health comorbidities, support early detection of such 
 comorbidities, or prevent their onset, including the following:
 ``
        (A) Implementation of interdisciplinary 
 integrative coordinated care team models, including 
 those that utilize mental health emergency department 
 in-reach staff (and other emergency-department 
 interventions), care coordination staff and social 
 services support, and clinic-based services.
 ``
        (B) Integration of mental health services into 
 medical homes, coordinated care organizations, 
 accountable care entities, and in-home services.
 ``
            (C) Incorporation of mental health and social 
 risk screening into medical screening, particularly in 
 child and adolescent populations.
 ``
            (D) Preventing adverse impacts on mental health 
 resulting from physical health treatments or 
 medications, or on physical health resulting from 
 mental health treatments or medications, through cross 
 disciplinary provider education, quality metrics, and 
 other mechanisms.
 ``
        (E) Improvements in electronic health records and 
 other technology platforms or networks to capture, 
 track, and monitor mental and physical health 
 treatments and medications provided across care 
 settings and otherwise facilitate care coordination.
 ``
        (F) Piloting of reimbursement modifications that 
 utilize site-neutral payments and that address 
 conflicts and disincentives related to chronic care 
 management and behavioral health management and 
 differential treatment of inpatient and outpatient 
 settings.
 ``
        (G) Mitigating the incidence of admission and 
 readmission into psychiatric inpatient settings of 
 chronically ill elderly patients through methods such 
 as active inpatient management, variations in initial 
 length of stay, enhanced discharge planning, and 
 psychosocial interventions.
 ``
        (H) Delivering health behavior assessments and 
 interventions to improve physical health outcomes for 
 patients and aid in the management of chronic health 
 conditions.
 ``
            (I) In coordination with law enforcement agencies 
 and judicial entities, interventions targeted at 
 providing mental and physical health services 
 (including, as appropriate, substance use disorder 
 services) to individuals convicted of criminal offenses 
 for purposes of mitigating recidivism.
 ``

    (4) Innovations addressing social determinants of 
 health.--The term `innovations addressing social determinants 
 of health' means innovations implemented by an eligible 
 hospital that seek to address social determinants of health 
 that negatively impact the health outcomes of applicable 
 individuals, including the following:
 ``
        (A) Improvements in electronic health records to 
 better integrate mental health, medical care, and 
 social care (such as screening for social factors, 
 facilitated or closed loop referral, risk 
 stratification, and shared records with community-based 
 organizations).
 ``
        (B) Personnel-supported `wrap around' services 
 for at-risk individuals with mental and physical health 
 comorbidities (such as nutrition and diet counseling, 
 social services referral, respiratory therapy, medical-
 legal assistance, financial counseling, consumer 
 education, pharmacy education, asthma education, and 
 referral to food resources such as referral to the SNAP 
 program, the WIC program, a food bank, case management 
 assistance, employment or education support, intimate 
 partner violence, and behavioral health support).
 ``
            (C) Home and community-based services that 
 provide collaborative care to address mental and 
 physical health comorbidities through health behavior 
 services, nutrition support, medication management, 
 transitional care, telehealth, mobile integrated health 
 care, paramedic-based home visitation, or utilization 
 of community health workers.
 ``
            (D) Hospital-based interventions (such as same 
 day primary care services, skilled nursing 
 interventions, substance use disorder and behavioral 
 health treatment coordination of care, collaborative 
 care models, discharge planning and medication 
 reconciliation, long-term care management, and post-
 traumatic injury management).
 ``

    (5) Individual with mental and physical health 
 comorbidities.--The term `individual with mental and physical 
 health comorbidities' means an individual who is challenged by 
 serious mental illness or serious emotional disturbance as well 
 as 1 or more of the following conditions or characteristics:
 ``
        (A) Has or is at risk for one or more chronic 
 conditions (as defined by the Secretary).
 ``
        (B) High-risk pregnancy.
 ``
            (C) History of high utilization of acute care 
 services.
 ``
            (D) Frail elderly (defined by impairments in 
 activities of daily living).
 ``
        (E) Disability, including traumatic brain injury.
 ``
        (F) Critical illness or injury requiring long-
 term recovery.
 ``

    (6) Vulnerable community.--The term `vulnerable 
 community' means a geographic area served by an eligible 
 hospital characterized by a population that has a statistically 
 significant number of individuals with mental and physical 
 health comorbidities, indicators of poor population health 
 status, low-income status, or status as a USDA-recognized food 
 desert.
 ``

    (g) Evaluation and Report.--Not later than 1 year after the date 
of completion of the program under this section, the Secretary shall 
submit to Congress a report containing an evaluation of the activities 
supported by the program. Such report shall include the following:
 ``

    (1) A description of each such activity, including--
 ``
        (A) the target population of such activity;
 ``
        (B) how such activity addressed the adverse 
 social determinants of health in such population; and
 ``
            (C) the role of community-based organizations and 
 other community partners (such as nonprofits and units 
 of local government) in such activity.
 ``

    (2) Evidence showing whether and how each such activity 
 advanced any of the following objectives:
 ``
        (A) Improved access to care.
 ``
        (B) Improved quality of care.
 ``
            (C) Improved health outcomes.
 ``
            (D) Amelioration of disparities in care.
 ``
        (E) Improved care coordination.
 ``
        (F) Reduction in health care costs (including 
 such reductions under this title and title XIX and such 
 reductions occurring for uninsured individuals).
 ``
        (G) Reduction in health care utilization 
 (including with respect to inpatient admissions, 
 utilization of emergency departments, and room and 
 board provided to individuals).
 ``
        (H) Reduction in non-medical public expenditures.
 ``
            (I) Changes in patient and provider satisfaction 
 with care delivery.
 ``
        (J) Reductions in involvement with the justice 
 system, including reductions in recidivism.
 ``

    (3) A description of the metrics used to track the 
 implementation and results of each such activity.
 ``

    (4) Recommendations for any legislation or administrative 
 action the Secretary determines appropriate.
 ``

    (h) Funding.--Any funds appropriated under 

section 1115A

    (f) shall 
be available to the Secretary without further appropriation for the 
purposes of carrying out this section.''.
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