119-hr3320

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3320 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3320

 To amend title XIX of the Social Security Act to increase Federal 
 Medicaid funding for States that provide intensive community-based 
 services for adults with serious mental illness, and for other 
 purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 May 9, 2025

 Mr. Goldman of New York introduced the following bill; which was 
 referred to the Committee on Energy and Commerce

_______________________________________________________________________

 A BILL

 To amend title XIX of the Social Security Act to increase Federal 
 Medicaid funding for States that provide intensive community-based 
 services for adults with serious mental illness, and for other 
 purposes.

 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 ``Strengthening Medicaid for Serious 
Mental Illness Act''.

SEC. 2. PURPOSES.

 The purposes of this Act are the following:

    (1) To amend title XIX of the Social Security Act to 
 increase Federal Medicaid funding for States that provide 
 intensive community-based services for adults with serious 
 mental illness.

    (2) To increase access to intensive community-based 
 services in the most integrated setting appropriate.

    (3) To prevent unnecessary hospitalization or other 
 institutionalization.

    (4) To promote continuity of care and coverage for young 
 adults after they turn 21 and age out of the early and periodic 
 screening, diagnostic, and treatment services benefit.

SEC. 3. INCREASED FMAP FOR PROVIDING INTENSIVE COMMUNITY-BASED SERVICES 
 UNDER MEDICAID.

    (a) In General.--

Section 1915 of the Social Security Act (42 U.S.C. 
1396n) is amended by adding at the end the following new subsection:
 ``
            (m) State Plan Amendment Option To Provide Intensive Community-
Based Services for Elderly and Disabled Individuals.--
 ``

    (1) In general.--Subject to the succeeding provisions of 
 this subsection, beginning January 1, 2026, a State may provide 
 through a State plan amendment for the provision of medical 
 assistance for intensive community-based services (not 
 including room and board) for eligible individuals (as defined 
 in paragraph

    (2) ), without determining that but for the 
 provision of such services the individuals would require the 
 level of care provided in a hospital, nursing facility, or 
 intermediate care facility described in 

section 1905
            (d) , but 
 only if the State meets the following requirements:
 ``
        (A) Application of hcbs state plan amendment 
 requirements.--
 ``
            (i) In general.--Except as provided in 
 clause
            (ii) , the State satisfies the 
 requirements described in subparagraphs
        (A) through
        (J) of subsection
            (i) (1) (except that, 
 in applying such subparagraphs for purposes of 
 this subsection, each reference to `home and 
 community-based services' shall be deemed to be 
 a reference to `intensive community-based 
 services').
 ``
            (ii) Modification of assessment 
 requirement.--In applying subparagraph
        (F)
            (i) of subsection
            (i) (1) for purposes of this 
 subsection, `or 1 or more activity of daily 
 living and 1 or more instrumental activity of 
 daily living (as defined in subsection

    (k)

    (6)
        (F) )' shall be inserted after `2 or more 
 activities of daily living (as defined in 
 

section 7702B
            (c) (2)
        (B) of the Internal Revenue 
 Code of 1986)'.
 ``
        (B) Application of regulations.--In providing 
 intensive community-based services under this 
 subsection, the State complies with the regulations 
 applicable to home and community-based services 
 provided under subsection
            (i) under subpart M of part 
 441 of title 42, Code of Federal Regulations, including 
 sections 441.710 (commonly known as the `HCBS settings 
 rule') and 441.725 of such title, except to the extent 
 that such regulations are inconsistent with this 
 subsection.
 ``

    (2) === Definitions. ===
-In this subsection:
 ``
        (A) Adult with a serious mental illness; serious 
 mental illness.--
 ``
            (i) Adult with a serious mental 
 illness.--The term `adult with a serious mental 
 illness' has the meaning given that term by the 
 Secretary pursuant to 

section 1912
            (c) of the 
 Public Health Service Act.
 ``
            (ii) Serious mental illness.--The term 
 `serious mental illness' means a diagnosable 
 mental, behavioral or emotional disorder that 
 meets the criteria for qualifying an individual 
 as an adult with a serious mental illness.
 ``
        (B) Assertive community treatment.--The term 
 `assertive community treatment' means services for the 
 treatment of mental illness that are provided through 
 an evidence-based practice that--
 ``
            (i) improves outcomes for individuals 
 with severe mental illness who are at high risk 
 of homelessness, psychiatric crisis, or 
 hospitalization, or are involved in the 
 criminal justice system;
 ``
            (ii) is comprised of a multidisciplinary 
 staff, including peer specialists, who work as 
 a team to provide the individualized 
 psychiatric treatment, rehabilitation, and 
 support services clients need for the maximum 
 reduction of physical or mental disability and 
 restoration to their best possible functional 
 level;
 ``
            (iii) ensures that there is 1 direct care 
 staff person for every 10 clients; and
 ``
            (iv) provides services 24 hours a day, 7 
 days a week, for as long as needed and wherever 
 they are needed.
 ``
            (C) Eligible individual.--The term `eligible 
 individual' means an individual--
 ``
            (i) who is eligible for medical 
 assistance under the State plan or under a 
 waiver of such plan;
 ``
            (ii) who is age 21 or older;
 ``
            (iii) whose income does not exceed 150 
 percent of the poverty line (as defined in 
 

section 2110
            (c) (5) ); and
 ``
            (iv) who is an adult with a serious 
 mental illness.
 ``
            (D) Intensive case management.--The term 
 `intensive case management' means a type of case 
 management service (as defined in 

section 440.169 of 
 title 42, Code of Federal Regulations)--
 ``
            (i) that is reliable, systematic, 
 flexible, and coordinated, designed to answer 
 the unique combination of health and social 
 care needs of individuals with serious mental 
 illness;
 ``
            (ii) that is a long-term, intensive 
 approach to supporting an individual in the 
 community by providing a comprehensive range of 
 treatment, rehabilitation, and support 
 services;
 ``
            (iii) that helps individuals with serious 
 mental illness acquire material resources (such 
 as food, shelter, clothing, and medical care) 
 and improve their psychosocial functioning;
 ``
            (iv) that provides sufficient support to 
 individuals with serious mental illness to keep 
 them involved in community life and encourage 
 growth towards greater autonomy and develop 
 coping skills to meet the demands of community 
 life;
 ``
            (v) that ensures continuity of care among 
 treatment agencies;
 ``
            (vi) in which a case manager, working 
 alone or as part of a team, makes 4 or more 
 face-to-face contact with a client each month; 
 and
 ``
            (vii) in which the case manager-to-client 
 ratio does not exceed 1:12.
 ``
        (E) Intensive community-based services.--The term 
 `intensive community-based services' means a set of 
 psychosocial rehabilitation services that includes all 
 of the following:
 ``
            (i) Assertive community treatment.
 ``
            (ii) Supported employment.
 ``
            (iii) Peer support services.
 ``
            (iv) Qualifying community-based mobile 
 crisis intervention services.
 ``
            (v) Intensive case management.
 ``
            (vi) Housing-related activities and 
 services, including individual housing 
 transition services, individual housing and 
 tenancy sustaining services, and State-level 
 housing-related collaborative activities, as 
 those services are described in the 
 informational bulletin published by the Center 
 for Medicaid and CHIP Services on June 26, 
 2015, with the subject `Coverage of Housing-
 Related Activities and Services for Individuals 
 with Disabilities'.
 ``
            (vii) Such other psychosocial 
 rehabilitation services as a State may request 
 and the Secretary may approve.
 ``
        (F) Peer support services.--The term `peer 
 support services' means culturally competent individual 
 and group services for individuals with serious mental 
 illness that promote recovery, resiliency, engagement, 
 socialization, self-sufficiency, self-advocacy, 
 development of natural supports, and identification of 
 strengths through structured activities such as group 
 and individual coaching to set recovery goals and 
 identify steps to reach the goals. Such services aim to 
 prevent relapse, empower beneficiaries through 
 strength-based coaching, support linkages to community 
 resources, and to educate beneficiaries and their 
 families about their conditions and the process of 
 recovery. Such services include the following:
 ``
            (i) Participating in the treatment 
 planning process.
 ``
            (ii) Mentoring and assisting the 
 beneficiary with problem solving, goal setting, 
 and skill building.
 ``
            (iii) Encouraging a beneficiary's 
 interest in pursuing and maintaining treatment 
 services.
 ``
            (iv) Providing support and linkages to 
 facilitate participation in recovery-based 
 activities.
 ``
            (v) Sharing experiential knowledge, hope, 
 and skills.
 ``
            (vi) Advocating for the beneficiary.
 ``
        (G) Qualifying community-based mobile crisis 
 intervention services.--The term `qualifying community-
 based mobile crisis intervention services' means, with 
 respect to a State, items and services for which 
 medical assistance is available under the State plan 
 under this title or a waiver of such plan, that are--
 ``
            (i) furnished to an individual otherwise 
 eligible for medical assistance under the State 
 plan (or waiver of such plan) who is--
 ``
            (I) outside of a hospital or 
 other facility setting; and
 ``
            (II) experiencing a mental health 
 or substance use disorder crisis;
 ``
            (ii) furnished by a multidisciplinary 
 mobile crisis team--
 ``
            (I) that includes at least 1 
 behavioral health care professional who 
 is capable of conducting an assessment 
 of the individual, in accordance with 
 the professional's permitted scope of 
 practice under State law, and other 
 professionals or paraprofessionals with 
 appropriate expertise in behavioral 
 health or mental health crisis 
 response, including nurses, social 
 workers, peer support specialists, and 
 others, as designated by the State in 
 the State plan amendment under this 
 subsection;
 ``
            (II) whose members are trained in 
 trauma-informed care, de-escalation 
 strategies, and harm reduction;
 ``
            (III) that is able to respond in 
 a timely manner and, where appropriate, 
 provide--
 ``

    (aa) screening and 
 assessment;
 ``

    (bb) stabilization and 
 de-escalation; and
 ``
            (cc) coordination with, 
 and referrals to, health, 
 social, and other services and 
 supports as needed, and health 
 services as needed;
 ``
            (IV) that maintains relationships 
 with relevant community partners, 
 including medical and behavioral health 
 providers, primary care providers, 
 community health centers, crisis 
 respite centers, and managed care 
 organizations (if applicable); and
 ``
            (V) that maintains the privacy 
 and confidentiality of patient 
 information consistent with Federal and 
 State requirements; and
 ``
            (iii) available 24 hours per day, every 
 day of the year.
 ``
        (H) Supported employment.--The term `supported 
 employment' means ongoing supports that are furnished 
 to individuals who, because of their serious mental 
 illness, need intensive support to obtain and maintain 
 an individual job in competitive or customized 
 employment, or self-employment, in an integrated work 
 setting in the general workforce at or above their 
 State's minimum wage, but not less than the customary 
 wage and level of benefits paid by the employer for the 
 same or similar work performed by individuals without 
 disabilities. The desired outcome of all supported 
 employment services is sustained paid employment at or 
 above the minimum wage in an integrated setting in the 
 general workforce, in a job that meets personal and 
 career goals.
 ``

    (3) Increase fmap for medical assistance for intensive 
 community-based services.--
 ``
        (A) In general.--During each fiscal quarter that 
 a State meets the requirements described in 
 subparagraphs
        (B) through
            (D) , the Federal medical 
 assistance percentage applicable to the State for the 
 quarter (as determined under 

section 1905

    (b) without 
 regard to any adjustments applicable under such section 
 or any other provision of law) shall be increased by 
 the applicable number of percentage points (as 
 determined under subparagraph
        (E) but not to exceed 100 
 percent) with respect to amounts expended by the State 
 for medical assistance for intensive community-based 
 services furnished to eligible individuals during such 
 quarter under a State plan amendment under this 
 subsection.
 ``
        (B) Service quality criteria.--
 ``
            (i) In general.--The State shall provide 
 eligible individuals with intensive community-
 based services in accordance with such quality 
 criteria as the Secretary shall by regulation 
 establish.
 ``
            (ii) Criteria requirements.--The criteria 
 established by the Secretary under clause
            (i) shall be designed to ensure that eligible 
 individuals receive the intended benefits of 
 receipt of the services, including avoiding 
 preventable hospitalization or other 
 institutionalization. The criteria will be 
 adjusted as needed to account for future 
 developments and best practice. The criteria 
 shall include the following:
 ``
            (I) The standards for assertive 
 community treatment in the Tool for 
 Measurement of Assertive Community 
 Treatment

    (TMACT) , Dartmouth Assertive 
 Community Treatment Scale

    (DACTS) , or 
 other generally accepted tool for 
 evaluating assertive community 
 treatment.
 ``
            (II) Individual Placement and 
 Support

    (IPS) standards for supported 
 employment services.
 ``
            (III) Securing and maintaining 
 scattered-site housing with a Housing 
 First approach as the goal for housing-
 related activities and services.
 ``
            (C) Integrated setting.--Eligible individuals 
 shall receive intensive community-based services--
 ``
            (i) in the most integrated setting 
 appropriate; and
 ``
            (ii) without limiting access to any such 
 service on the basis of--
 ``
            (I) the individual's need for 
 assistance with activities of daily 
 living or instrumental activities of 
 daily living;
 ``
            (II) receipt of other disability 
 support services;
 ``
            (III) the presence of additional 
 disabilities such as a physical, 
 communication, intellectual, 
 developmental, or other disability or a 
 record or history of having such a 
 disability; or
 ``
            (IV) the existence of co-
 occurring substance use disorders or a 
 record or history of having such 
 substance use disorders.
 ``
            (D) Data collection and reporting.--Not less 
 frequently than once every 2 years, the State shall 
 collect and report data to the Secretary, including 
 with respect to disparities in access to, or receipt 
 of, intensive community-based services, according to 
 criteria established by the Secretary and the Secretary 
 shall analyze and report such findings to Congress. The 
 criteria shall include the collection and reporting of 
 data with respect to the following:
 ``
            (i) Demographic characteristics of 
 eligible individuals who receive intensive 
 community-based services, including but not 
 limited to, race, ethnicity, disability status, 
 disability category, age, sex, sex 
 characteristics, sexual orientation, gender 
 identity, primary language, rural or urban 
 environment, and service setting.
 ``
            (ii) The utilization of intensive 
 community-based services, including units of 
 service and duration of receipt of service, per 
 eligible individual receiving services.
 ``
            (iii) Consumer outcomes, as measured via 
 a quality service review tool and methodology 
 approved by the Secretary.
 ``
        (E) Applicable number of percentage points.--For 
 purposes of subparagraph
        (A) --
 ``
            (i) if a State offers at least 1 but 
 under 2 of the categories of intensive 
 community-based services described in clauses
            (i) through
            (vii) of paragraph

    (2)
        (E) in a 
 quarter, the applicable number of percentage 
 points for the State and quarter is 3 
 percentage points;
 ``
            (ii) if a State offers at least 2 but 
 under 3 of the categories of intensive 
 community-based services described in clauses
            (i) through
            (vii) of paragraph

    (2)
        (E) in a 
 quarter, the applicable number of percentage 
 points for the State and quarter is 7 
 percentage points;
 ``
            (iii) if a State offers at least 3 but 
 under 4 of the categories of intensive 
 community-based services described in clauses
            (i) through
            (vii) of paragraph

    (2)
        (E) in a 
 quarter, the applicable number of percentage 
 points for the State and quarter is 12 
 percentage points;
 ``
            (iv) if a State offers at least 4 but 
 under 5 of the categories of intensive 
 community-based services described in clauses
            (i) through
            (vii) of paragraph

    (2)
        (E) in a 
 quarter, the applicable number of percentage 
 points for the State and quarter is 18 
 percentage points; and
 ``
            (v) if a State offers at least 5 of the 
 categories of intensive community-based 
 services described in clauses
            (i) through
            (vii) of paragraph

    (2)
        (E) in a quarter, the 
 applicable number of percentage points for the 
 State and quarter is 25 percentage points.
 ``

    (4) Application of hcbs state plan amendment 
 provisions.--Paragraphs

    (3) ,

    (4) ,

    (5) ,

    (6) , and

    (7) of 
 subsection
            (i) shall apply to State plan amendments under this 
 subsection and intensive community-based services in the same 
 manner as such paragraphs apply to State plan amendments under 
 such subsection
            (i) and home and community-based services.
 ``

    (5) Funding for state planning grants.--
 ``
        (A) In general.--There is appropriated, out of 
 any funds in the Treasury not otherwise appropriated, 
 $20,000,000 to the Secretary for purposes of 
 implementing, administering, and making planning grants 
 to States as soon as practicable for purposes of 
 developing a State plan amendment request to provide 
 intensive community-based services under this 
 subsection, to remain available until expended.
 ``
        (B) Use of funds.--A State shall use funds 
 received under a grant under this subsection to engage 
 in planning activities for a State plan amendment under 
 this subsection, including--
 ``
            (i) collaborative activities, at the 
 State and Federal level, with providers of 
 housing-related services;
 ``
            (ii) developing service quality criteria; 
 and
 ``
            (iii) developing the infrastructure 
 necessary to implement the State plan 
 amendment, including data infrastructure and 
 staffing.''.

    (b) Rule of Construction.--Nothing in this Act or the amendments 
made by this Act may be construed to limit the entitlement of children 
and youth who are eligible for medical assistance under a State 
Medicaid program to receive intensive community-based services through 
the early and periodic screening, diagnostic, and treatment services 
benefit.
 <all>