Sec. 201 Demonstration program to improve federally qualified community behavioral health clinic services
Establishment— Not later than January 1, 2016, the Secretary of Health and Human Services (referred to in this section as the “Secretary”), in coordination with the Assistant Secretary for Mental Health and Substance Use Disorders, shall award planning grants to not to exceed 10 States to enable such States to carry out 5-year demonstration programs to improve the provision of behavioral health services provided by federally qualified community behavioral health clinics in the State.
Eligibility—
Application— To be eligible to receive a grant under subsection (a), a State shall—
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require;
certify to the Secretary that behavioral health providers that are provided assistance under the demonstration program are federally qualified community behavioral health clinics;
certify to the Secretary that, with respect to the behavioral health providers provided assistance under the demonstration program, not more than 75 percent of the total number of such providers are participating providers under the State Medicaid plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.);
demonstrate the actuarial soundness of the demonstration program to be carried out under the grant by providing a detailed estimate of eligible clinics and Medicaid expenditures over the entire projected period of the demonstration program; and
comply with any other requirement determined appropriate by the Secretary.
Waiver of Medicaid requirements— In approving States to conduct demonstration programs under this section, the Secretary shall waive such provisions of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) as are necessary to conduct the demonstration program in accordance with the requirements of this section, including section 1902(a)(1) of the Social Security Act (42 U.S.C. 1396a(a)(1)) (relating to statewideness).
Requirements— In awarding grants under this section, the Secretary shall—
ensure the geographic diversity of grantee States;
ensure that federally qualified community behavioral health clinics in such States that are located in rural areas, as defined by the Secretary, and other mental health professional shortage areas are fairly and appropriately considered with the objective of facilitating access to mental health services in such areas;
take into account the ability of clinics in such States to provide required services, and the ability of such clinics to report required data as required under this section; and
take into account the ability of such States to provide such required services on a statewide basis.
Treatment of certain services provided by community behavioral health clinics as medical assistance—
In general— For purposes of the demonstration program under this section, community behavioral health clinic services (as defined in subsection (f)(1)) that are provided by federally qualified community behavioral health clinics receiving assistance under this section shall be considered medical assistance for purposes of payments to States under paragraph (3)(C).
Grant condition— As a condition of receiving a grant under this section, a State shall agree to provide for payment for community behavioral health clinic services in accordance with the prospective payment system established by the Secretary under paragraph (3).
Prospective payment system—
In general— Not later than 18 months after the date of enactment of this Act, the Secretary shall establish a prospective payment system for community behavioral health clinic services furnished by a community behavioral health clinic receiving assistance under this section in the same manner as payments are required to be made under section 1902(bb) of the Social Security Act (42 U.S.C. 1396a(bb)) for services described in section 1905(a)(2)(C) of such Act (42 U.S.C. 1396d(a)(2)(C)) furnished by a federally qualified health center and services described in section 1905(a)(2)(B) of such Act (42 U.S.C. 1396d(a)(2)(B)) furnished by a rural health clinic.
Requirements— The prospective payment system established by the Secretary under subparagraph (A) shall provide that—
no payment shall be made for inpatient care, residential treatment, room and board expenses, or any other nonambulatory services, as determined by the Secretary; and
no payment shall be made to satellite facilities of community behavioral health clinics if such facilities are established after the date of enactment of this Act.
Payments to states— The Secretary shall pay each State awarded a grant under this section an amount each quarter equal to the enhanced FMAP (as defined in section 2105(b) of the Social Security Act (42 U.S.C. 1397dd(b)) but without regard to the second and third sentences of that section) of the State's expenditures in the quarter for medical assistance for community behavioral health clinic services provided by federally qualified community behavioral health clinics in the State that receive assistance under this section. Payments to States made under this subparagraph shall be considered to have been under, and are subject to the requirements of, section 1903 of the Social Security Act (42 U.S.C. 1396b).
Annual report—
In general— Not later than 1 year after the date on which the first grants are awarded under this section, and annually thereafter, the Secretary shall submit to Congress an annual report on the use of funds provided under the demonstration program. Each such report shall include—
an assessment of access to community-based mental health services under the Medicaid program in the States awarded such grants;
an assessment of the quality and scope of services provided by federally qualified community behavioral health clinics under the grants as compared against community-based mental health services provided in States that are not receiving such grants;
an assessment of the impact of the demonstration programs on the costs of a full range of mental health services (including inpatient, emergency and ambulatory services); and
a peer-reviewed assessment of the public health impact, including but not limited to rates of community mortality, hospitalization, and other measures as determined by the Director of the National Institute of Mental Health.
Recommendations— Not later than December 31, 2019, the Secretary shall submit to Congress recommendations concerning whether the demonstration programs under this section should be continued and expanded on a national basis.
Data collection— Grantees shall provide in a timely fashion any such data to the National Mental Health Policy Laboratory, as requested by the Assistant Secretary concerning health outcomes and treatments.
Criteria for federally qualified community behavioral health clinics—
In general— The Assistant Secretary for Mental Health and Substance Use Disorders shall certify federally qualified community behavioral health clinics as meeting the criteria specified in this subsection.
Criteria— The criteria referred to in this subsection are that the clinic performs each of the following:
Provide required primary health services (as defined by the Assistant Secretary for Mental Health and Substance Use Disorders).
Provide services in locations that ensure services will be available and accessible promptly and in a manner which preserves human dignity and assures continuity of care.
Provide services in a mode of service delivery appropriate for the target population.
Provide individuals with a choice of service options where there is more than one evidence-based treatment.
Employ a core staff that is sufficiently trained in child and adolescent psychiatry or psychology.
Employ a core staff that is sufficiently trained in child and adolescent psychiatry, dual diagnosis issues, crisis management and stabilization and interventions with patients at high risk for violence.
Provide services, within the limits of the capacities of the center, to any individual residing or employed in the service area of the center, regardless of the ability of the individual to pay.
Provide, directly or through contract, to the extent covered for adults in the State Medicaid plan under title XIX of the Social Security Act and for children in accordance with section 1905(r) of such Act regarding early and periodic screening, diagnosis, and treatment, each of the following services:
Screening, assessment, and diagnosis, including risk assessment.
Person-centered treatment planning or similar processes, including risk assessment and crisis planning.
Outpatient mental health and substance use services, including screening, assessment, diagnosis, psychotherapy, medication management, and integrated treatment for mental illness and substance abuse which shall be evidence-based (including cognitive behavioral therapy and other such therapies which are evidence-based).
Outpatient clinic primary care screening and monitoring of key health indicators and health risk (including screening for diabetes, hypertension, and cardiovascular disease and monitoring of weight, height, body mass index (BMI), blood pressure, blood glucose or HbA1C, and lipid profile).
Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.
Targeted case management (services provided by a social worker to assist individuals gaining access to needed medical, social, educational, and other services and applying for income security and other benefits to which they may be entitled).
Psychiatric rehabilitation services including skills training, assertive community treatment, family psychoeducation, disability self-management, supported employment, supported housing services, therapeutic foster care services, and such other evidence-based practices as the Secretary may require.
Peer support and counselor services and family supports.
Supported education and supported employment for individuals with serious mental illness after an initial psychotic episode.
Case management services for individuals with serious mental illness after an initial psychotic episode.
Use and share electronic health records consistent with other applicable law.
Be available to provide assisted outpatient treatment that is ordered by a State court pursuant to a State law described in section 1915(d).
Be available to participate in research projects conducted or supported by the National Institute of Mental Health.
Maintain linkages, and where possible enter into formal contracts with the following:
Federally qualified health centers.
Inpatient psychiatric facilities and substance use detoxification, post-detoxification step-down services, and residential programs.
Adult and youth peer support and counselor services.
Family support services for families of children with serious mental or substance use disorders.
Other community or regional services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities (including mental health courts, local police forces, and local jails and other detention facilities), housing agencies and programs, employers, and other social services such as schools and religious organizations.
Integrating care with primary care services, including, to the extent feasible, through a common delivery site.
Enabling services, including outreach, transportation, and translation.
Health and wellness services, including services for tobacco cessation.
Adopt models of first episode psychosis training, supervision, team meetings, and coordination with adjacent care organizations.
Where feasible, provide outreach and engagement to encourage individuals who could benefit from mental health care to freely participate in receiving the services described in this subsection.
Rule of construction— Nothing in this section shall be construed as prohibiting States receiving funds appropriated through the Community Mental Health Services Block Grant under this subpart from financing qualified community programs (whether such programs meet the definition of eligible programs prior to or after the date of enactment of this subsection).
Definitions— In this section:
Community behavioral health clinic services— The term community behavioral health clinic services means ambulatory behavioral health services of the type described in subparagraphs (I), (L), (M), and (N) of subsection (f)(2) that are provided by federally qualified community behavioral health clinics receiving assistance under this section.
State— The term State has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
Federally qualified community behavioral health clinic— The term federally qualified community behavioral health clinic means a federally qualified behavioral health clinic with a certification in effect under this section.
Authorization of appropriations— In order to fund State planning grants and the administrative costs associated with certifying community behavioral health clinics, there is authorized to be appropriated to carry out this section, $50,000,000 for fiscal year 2016, to remain available until expended.