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HR10240119th CongressWALLET

Behavioral Health Crisis Services Expansion Act of 2026

Sponsored By: Representative McClellan, Jennifer L. [D-VA-4]

In Committee

Summary

Creates a uniform federal definition and requires coverage and parity for crisis response services across major federal programs and private plans. It sets clear service types like mobile crisis teams, crisis receiving and stabilization facilities, and walk‑in mental health or substance use urgent care.

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  • Families and people in crisis would gain mandated coverage in Medicare, Medicaid, CHIP, TRICARE, VA non‑VA care reimbursement, Federal Employees Health Benefits, and group and individual plans, with some program changes phased in about 3 years after enactment and Medicaid allowed presumptive eligibility to speed access.
  • Crisis providers must meet facility and operation rules, including 23‑hour observation beds and 48‑hour crisis stabilization beds, 24/7 operation, sliding‑scale payments, no‑wrong‑door admission for responders, and nondiscrimination by payer.
  • Health plans must follow parity rules that bar separate cost‑sharing or treatment limits for crisis services, and Medicare would reimburse crisis services at 80 percent of the lesser of actual charge or an amount set under a new payment rule under section 1834(bb).

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 4 benefits, 0 costs, 0 mixed.

Private and FEHB plans cover crisis

If enacted, group and individual health plans would have to cover crisis mental health and substance use services. Plans could not impose separate cost-sharing or stricter treatment limits just for these services. Financial rules would include aggregate lifetime and annual limits in the parity test. The requirement would apply to plan years beginning three years after enactment, with a special timing rule for FEHB contract years.

Medicaid and CHIP must cover crisis

If enacted, crisis response services would become a mandatory benefit under State Medicaid plans and under CHIP. The bill would allow crisis providers to make presumptive eligibility decisions so people can get care immediately while full eligibility is determined. States would generally have three years to comply, and States that need new laws would get an extra statutory delay tied to their legislative sessions.

Medicare adds crisis care coverage

If enacted, Medicare would cover crisis response services from mobile teams, walk-in urgent care sites, and stabilization facilities. Coverage would start for services furnished three years after enactment. Medicare payments for each crisis service would be 80% of the lesser of the provider's charge or the amount set under a new payment basis the HHS Secretary would create. Ambulance transport to qualified crisis facilities would also be covered, with the same three-year timing.

Military and VA crisis care coverage

If enacted, the Department of Defense would be directed to provide coverage for crisis response services under TRICARE. The bill would also let the VA reimburse for eligible non-VA crisis care. The excerpt does not set specific payment rates or exact effective dates for these changes.

Sponsors & CoSponsors

Sponsor

McClellan, Jennifer L. [D-VA-4]

VA • D

Cosponsors

  • Rep. Matsui, Doris O. [D-CA-7]

    CA • D

    Sponsored 9/3/2026

  • Rep. Trahan, Lori [D-MA-3]

    MA • D

    Sponsored 9/3/2026

  • Rep. Smith, Adam [D-WA-9]

    WA • D

    Sponsored 9/3/2026

  • Rep. Barragán, Nanette Diaz [D-CA-44]

    CA • D

    Sponsored 9/3/2026

  • Rep. Moulton, Seth [D-MA-6]

    MA • D

    Sponsored 9/8/2026

Roll Call Votes

No roll call votes available for this bill.

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