Sponsors (11)
The bill seeks to expand and stabilize access to community behavioral health care (Medicaid/Medicare coverage, predictable payments, grants, and clinician protections), improving care availability and affordability but increasing federal/state costs, creating implementation and compliance burdens, and narrowing some individual legal remedies for patients.
Medicaid and Medicare beneficiaries, plus people with behavioral health needs in underserved communities, gain substantially increased access to integrated community behavioral health services (CCBHC coverage, Medicare Part B coverage without deductible, operating grants and clinic expansion), reducing out-of-pocket costs and improving availability of care.
Certified community behavioral health clinics (CCBHCs) get more predictable, cost‑based prospective payment systems (PPS) with mechanisms like rebasing and an 80% payment rule, improving clinic revenue stability and supporting continuity of services.
Federal operating grants, technical assistance, and funding for data/infrastructure and accreditation support help clinics expand capacity, improve care coordination, and strengthen service quality in underserved areas.
Taxpayers and state budgets are likely to face higher spending (Medicaid PPS/expansion, new Medicare Part B coverage, federal grants, and potential federal malpractice costs) depending on state uptake and appropriations.
Clinics face short‑to‑medium‑term financial uncertainty — initial estimated rates, multi‑year transitions/rebasing, and the risk that PPS rates are set too low — which could cause revenue shortfalls, service cuts, or clinic closures that reduce access.
States, managed care organizations, CMS, and clinics will face significant administrative and implementation burdens to build new payment systems, cost‑reporting, appeals processes, geographic adjustments, and oversight structures during the transition.
Based on analysis of 5 sections of legislative text.
Establishes Medicaid and Medicare PPS payment rules, expands covered services and liability protections, and authorizes grant authority to support certified community behavioral health clinics.
Official title: To amend titles XVIII and XIX of the Social Security Act to adjust coverage and payment for certified community behavioral health clinic services under the Medicare and Medicaid programs, and for other purposes.
Introduced April 23, 2026 by Doris Matsui · Last progress April 23, 2026
Creates new federal payment and coverage rules to expand, standardize, and support certified community behavioral health clinics (CCBHCs). It authorizes a Medicaid prospective payment system (PPS) option for accredited CCBHCs beginning January 1, 2026, requires states that newly cover CCBHC services to adopt a cost-based PPS, adds CCBHC services as a Medicare Part B benefit with a new PPS-based payment approach, authorizes grant authority for community behavioral health clinics under the Public Health Service Act, and extends Federal Tort Claims Act–style liability protections to clinicians working in CCBHCs.