Sponsors (4)
Introduced December 9, 2025 by John Cornyn · Last progress December 9, 2025
The bill greatly expands federal payment support and liability protection to scale Certified Community Behavioral Health Clinics and increase access to behavioral health care for Medicaid and Medicare populations, but it shifts substantial costs and administrative complexity onto state Medicaid programs, the Medicare program, providers (especially smaller clinics), and changes patients' malpractice remedies under the federal FTCA framework.
Medicaid beneficiaries (including people with serious mental illness and substance use disorders) will gain guaranteed Medicaid State Plan payment to CCBHCs beginning Jan 1, 2026, expanding access to comprehensive behavioral health and crisis services.
Medicare beneficiaries will have outpatient CCBHC services covered starting Jan 1, 2027, lowering out-of-pocket costs for behavioral health care.
CCBHCs receive more predictable and supportive payment rules across Medicaid and Medicare (initial base-year payments, annual inflation adjustments, prospective payment system and an 80% payment rule), improving clinics' revenue stability and capacity to deliver services.
State governments will face new Medicaid payment obligations and administrative burdens to implement the payment rules and supplemental payments, likely increasing state Medicaid costs or requiring budget adjustments that could affect state budgets and taxpayers.
The Medicare program will incur additional spending to cover CCBHC services, creating pressure on the Medicare Trust Fund and potentially contributing to higher future premiums, payroll taxes, or reduced benefits.
Shifting malpractice exposure into the federal FTCA framework creates trade-offs: federal costs may rise, and patients may face different, potentially slower claims processes and limits on recoveries compared with state malpractice systems.
Based on analysis of 5 sections of legislative text.
Creates Medicaid and Medicare payment frameworks for certified community behavioral health clinics (CCBHCs), starts Medicaid payments in FY2026 and Medicare coverage in 2027, and extends FTCA protection to CCBHC clinicians.
Requires Medicaid programs that choose to cover certified community behavioral health clinic (CCBHC) services to pay CCBHCs under a new prospective payment framework starting for services on or after January 1, 2026, and creates a new Medicare outpatient benefit and prospective payment system for CCBHC services effective January 1, 2027. It also extends Federal Tort Claims Act (FTCA) vicarious liability protection to clinicians working in CCBHCs and adds a placeholder statutory part for community behavioral health clinics in the Public Health Service Act. Establishes initial payment rules (including an initial year payment equal to 100% of average reasonable clinic costs per chosen unit) and lets states adopt optional features such as separate rates for special populations and outlier payments; directs the Secretary of HHS to design and implement Medicare payment rules and makes several programmatic and regulatory cross-references to existing CCBHC certification and data systems.