Behavioral Health Crisis Expansion Act

Summary#

This bill would require many federal health programs and most private health plans to cover "crisis response services." It adds a definition for these services to Medicare law that includes services by mobile crisis response teams, crisis receiving and stabilization facilities, and mental health or substance use urgent care facilities. The bill sets rules for Medicare payment, requires Medicaid to cover these services, and extends required coverage to group and individual commercial plans, ERISA plans, TRICARE, Veterans Affairs reimbursement, Federal Employee Health Benefits, and CHIP. Many of the new coverage rules take effect three years after the law is enacted.

What it means for you#

• People experiencing a mental health or substance use crisis could be eligible for covered services from mobile teams, walk-in urgent care sites, or short-stay stabilization facilities.
• Medicare: crisis response services are added to covered benefits; Medicare payment is specified in the bill (see Expenses).
• Medicaid: states must cover crisis response services and crisis providers are included in rules for presumptive eligibility determinations.
• Private and employer plans: group and individual plans must cover these crisis services and cannot apply more restrictive cost-sharing or treatment limits than for other medical and surgical care.
• TRICARE, VA, FEHB, and CHIP are also required to provide coverage as defined in the bill.
• Some service and facility standards are defined, such as 24/7 operation for stabilization facilities, 23-hour observation capacity, 48-hour crisis stabilization psychiatric beds, and a requirement that facilities not deny care based on ability to pay or other listed factors.

Expenses#

No publicly available information on total federal or state costs or a Congressional Budget Office estimate is included in the bill text. The bill does include payment rules: for Medicare it sets payment for crisis response services at 80 percent of the lesser of the actual charge or an amount determined under a payment basis the Secretary of Health and Human Services will establish. The bill also phases in many provisions beginning three years after enactment and allows extra time for state plan changes when state legislation is required.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.