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HR8487119th CongressWALLET

Ensuring Excellence in Mental Health Act

Sponsored By: Representative Matsui, Doris O. [D-CA-7]

Introduced

Summary

Certified community behavioral health clinics (CCBHCs) would be expanded across Medicaid and Medicare, with new payment systems, federal grants, accreditation paths, and liability protections to help clinics scale and coordinate care.

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  • Families and patients would get broader access to integrated behavioral health services that can include additional services and some primary care. Medicaid coverage and expanded CCBHC definitions would apply starting October 1, 2026, and Medicare coverage would apply for services furnished on or after January 1, 2027.
  • Clinics and providers would operate under new prospective payment systems (PPS) in Medicaid and Medicare. Medicaid PPS would begin for services on or after January 1, 2026, rebasing would occur every 3 years, and Medicare’s PPS would use a 2027 base built from recent audited cost reports; the bill also adds accreditation options, liability protections, PRRB cost‑report review rights, and anti‑kickback safe harbors for certain coinsurance waivers.
  • States and the health system would get a new federal grant and technical assistance program for operating grants, data infrastructure, accreditation support, and guidance to expand CCBHCs nationwide.

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 3 benefits, 0 costs, 1 mixed.

Large grants to expand community clinics

If enacted, the bill would authorize large operating grants to help community behavioral health clinics become certified and expand services. The program would authorize $552,500,000 to be appropriated for each year from FY2026 through FY2030. Grants could pay for services, equipment, training, capital, and operational costs. Eligible clinics must meet CCBHC criteria and the Secretary may require accreditation; grants would be up to five years and recipients must submit an implementation plan within 120 days of selection.

Medicaid: new payments and services

If enacted, the bill would let States elect a new Medicaid prospective payment system (PPS) to pay certified community behavioral health clinics starting for services on or after January 1, 2026. The PPS could pay per day or per month (excluding repeat visits), allow separate rates for special populations and crisis services, require crisis costs to be tracked, and allow outlier payments. States could delegate to managed care only with oversight, and must make supplemental payments when managed care pays less than the PPS, at least every four months. The bill would also broaden CCBHC services so clinics could elect to offer certain primary care services for services furnished on or after October 1, 2026.

Medicare: CCBHC coverage and payment

If enacted, the bill would add certified community behavioral health clinic services to Medicare starting January 1, 2027 and create a Medicare PPS for those services. For each covered service, Medicare would pay 80% of the lesser of the clinic's actual charge or the PPS amount. The 2027 base rates would use recent audited cost reports, rise in 2028 by the Medicare Economic Index, and use a market basket from 2029 on. The Part B deductible would not apply to these services, and the bill extends safe harbor and other protections for CCBHCs and their clinicians.

Help, data, and accreditation for clinics

If enacted, the bill would create federal programs to support CCBHC implementation. The Secretary would set up technical assistance within 180 days and Congress could fund $8,000,000 per year for FY2026–FY2030 for that work. The bill would fund a national CCBHC data system with $51,000,000 per year for FY2026–FY2030. It would also create a federal approval process for accreditation bodies and let States recognize approved accreditors for Medicaid starting January 1, 2026. The bill would require guidance for specialty clinics within one year and set reporting and oversight rules for accreditors.

Sponsors & CoSponsors

Sponsor

Matsui, Doris O. [D-CA-7]

CA • D

Cosponsors

  • Rep. Pfluger, August [R-TX-11]

    TX • R

    Sponsored 4/23/2026

  • Rep. Craig, Angie [D-MN-2]

    MN • D

    Sponsored 4/23/2026

  • Rep. Alford, Mark [R-MO-4]

    MO • R

    Sponsored 4/23/2026

  • Rep. Tonko, Paul [D-NY-20]

    NY • D

    Sponsored 4/23/2026

  • Rep. Fitzpatrick, Brian K. [R-PA-1]

    PA • R

    Sponsored 4/23/2026

  • Rep. Goldman, Craig A. [R-TX-12]

    TX • R

    Sponsored 4/23/2026

  • Rep. Davids, Sharice [D-KS-3]

    KS • D

    Sponsored 6/9/2026

  • Rep. Balint, Becca [D-VT-At Large]

    VT • D

    Sponsored 6/9/2026

  • Rep. Strickland, Marilyn [D-WA-10]

    WA • D

    Sponsored 6/18/2026

  • Rep. Goodlander, Maggie [D-NH-2]

    NH • D

    Sponsored 6/23/2026

  • Rep. Kean, Thomas H. [R-NJ-7]

    NJ • R

    Sponsored 8/27/2026

  • Rep. Dexter, Maxine [D-OR-3]

    OR • D

    Sponsored 9/14/2026

Roll Call Votes

No roll call votes available for this bill.

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