42 U.S.C. § 1396w–7: Supporting access to a…

Summary

By July 1, 2025, the Secretary of Health and Human Services must give states guidance on how Medicaid and CHIP can support a full set of mental health and substance use crisis services. The guidance must recommend a range of services (like crisis call centers including 988 hotlines, mobile crisis teams, in-home and community response, residential and hospital care, and links to follow-up treatment and social supports). It must push for timely care in the least restrictive setting, culturally competent and trauma-informed de-escalation, and explain the federal ways states can pay for and expand these services. The guidance also must cover using Medicaid administrative funding and the Medicaid IT framework (MITA 3.0) to build or improve regional or statewide crisis call centers that coordinate in real time; ways to serve children, youth, and families; meeting needs across urban, rural, and special populations; suicide screening best practices; quick-access tools like providing services without requiring a diagnosis, presumptive eligibility, telehealth, and 24/7 coverage in underserved areas; ways to coordinate Medicaid/CHIP with other payors and follow-up services; how to finance services under different payment systems (managed care, prepaid plans, fee-for-service, and carve-outs); and methods for measuring use and outcomes. Also by July 1, 2025, the Secretary must set up a technical assistance center to help states design, run, or improve crisis service systems for children, youth, and adults. The center will help states use Medicaid and CHIP funding, coordinate federal funds, and adopt the guidance’s best practices. The Secretary must keep a public, regularly updated compendium of those best practices. Congress provided $8,000,000 to carry out the guidance and the technical center, available until spent. Definitions: “Secretary” means the Secretary of Health and Human Services. “State” means the 50 states, the District of Columbia, and U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands).

Title 42, §1396w–7

The Public Health and Welfare, Source: USLM XML via OLRC

(a)Guidance

(1)Provides, in consultation with health care providers and stakeholders with expertise in mental health and substance use disorder crisis response services, recommendations for an effective continuum of crisis response services that—

(A)includes crisis call centers, including 988 crisis services hotlines, mobile crisis teams, crisis response services delivered in home, community, residential facility, and hospital settings, and coordination with follow-on mental health and substance use disorder services, such as intensive outpatient and partial hospitalization programs, as well as connections to social services and supports;

(B)promotes access to appropriate and timely mental health and substance use disorder crisis response services in the least restrictive setting appropriate to an individual’s needs; and

(C)promotes culturally competent, trauma-informed care, and crisis de-escalation.

(2)Outlines the Federal authorities through which States may finance and enhance under Medicaid and CHIP the availability of crisis response services across each stage of the continuum of crisis response services.

(3)Addresses how States under Medicaid and CHIP may support the ongoing implementation of crisis call centers, including 988 crisis services hotlines, and how Medicaid administrative funding, including enhanced matching, and the Medicaid Information Technology Architecture 3.0 framework, may be used to establish or enhance regional or statewide crisis call centers, including 988 crisis services hotlines, that coordinate in real time.

(4)Identifies how States under Medicaid and CHIP may support access to crisis response services that are responsive to the needs of children, youth, and families, including through CHIP health services initiatives, behavioral disorder-specific crisis response, trained peer support services, and establishing or enhancing crisis call centers that are youth-focused.

(5)Identifies policies and practices to meet the need for crisis response services with respect to differing patient populations, including urban, rural, and frontier communities, differing age groups, cultural and linguistic minorities, individuals with co-occurring mental health and substance use disorder conditions, and individuals with disabilities.

(6)Identifies policies and practices to promote evidence-based suicide risk screenings and assessments.

(7)Identifies strategies to facilitate timely provision of crisis response services, including how States can enable access to crisis response services without requiring a diagnosis, the use of presumptive eligibility at different stages of the continuum of crisis response services, the use of telehealth to deliver crisis response services, strategies to make crisis response services available 24/7 in medically underserved regions, and best practices used by States and health providers for maximizing capacity to deliver crisis response services, such as identifying and repurposing available beds, space, and staff for crisis response services.

(8)Describes best practices for coordinating Medicaid and CHIP funding with other payors and sources of Federal funding for mental health and substance use disorder crisis response services, and best practices for Medicaid and CHIP financing when the continuum of crisis response services serves individuals regardless of payor.

(9)Describes best practices for establishing effective connections with follow-on mental health and substance use disorder services, as well as with social services and supports.

(10)Describes best practices for coordinating and financing a continuum of crisis response services through Medicaid managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and fee-for-service delivery systems, including when States carve-out from delivery through Medicaid managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, or fee-for-service systems, mental health or substance use disorder benefits or a subset of such services.

(11)Identifies strategies and best practices for measuring and monitoring utilization of, and outcomes related to, crisis response services.

(b)Technical assistance center

(1)In general

Not later than July 1, 2025, the Secretary, in coordination with the Administrator of the Centers for Medicare & Medicaid Services and the Assistant Secretary for Mental Health and Substance Use, shall establish a technical assistance center to help States under Medicaid and CHIP design, implement, or enhance a continuum of crisis response services for children, youth, and adults. Such technical assistance shall, at least in part, provide support to States in— (A)

(B)coordinating Medicaid and CHIP funds with other sources of Federal funding for mental health and substance use disorder crisis response services; and

(C)after the guidance described in subsection (a) is issued, adopting the best practices and strategies identified in such guidance.

(2)Compendium of best practices

The Secretary shall develop and maintain a publicly available compendium of best practices for the successful operation under Medicaid and CHIP of a continuum of crisis response services. The Secretary annually shall review the information available through the compendium and shall update such information when appropriate.

(c)Funding

There is appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, to remain available until expended for purposes of carrying out subsections (a) and (b), $8,000,000.

(d)Definitions

In this section: (1) Secretary

(2)State

The term “State” means each of the 50 States, the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.

Notes & Related Subsidiaries

Editorial Notes

Codification Section was enacted as part of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022 and also as part of the Consolidated Appropriations Act, 2023, and not as part of the Social Security Act which comprises this chapter.

§1396w–7 Supporting Access to a Continuum of Crisis Response Services Under Medicaid and Chip

Summary

Title 42, §1396w–7

Notes & Related Subsidiaries

Editorial Notes

Citations & Metadata