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Adds a new subsection (yy) to section 1902 of the Social Security Act establishing a prospective payment system framework and related payment rules for services furnished by certified community behavioral health clinics (CCBHCs), including an initial-year cost-related rate (100% of average reasonable related costs for the base year), annual inflationary adjustments, rules for new clinics, optional periodic rebasing, supplemental payments when services are furnished under managed care, and allowance for alternative payment methodologies that meet specified requirements.
Amends section 1905(jj) of the Social Security Act (42 U.S.C. 1396d(jj)) to add an accreditation paragraph permitting States (for services furnished on or after January 1, 2026) to require organizations that seek CCBHC designation to have accreditation from an accreditation body approved under section 340J–4 of the Public Health Service Act, and to expand/clarify the definition/scope of certified community behavioral health clinic services (listing required and additional services).
Amends 42 U.S.C. 233 (Public Health Service Act section 224(g)(4)) by adding 'or certified community behavioral health clinic as defined in section 1905(jj)(2) of the Social Security Act' to the end of the provision.
Amends Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) by adding at the end a new section titled "Community behavioral health clinics."
Adds a new subparagraph (KK) to the definition subsection (s)(2) to recognize "certified community behavioral health clinic services" (as defined in subsection (aa)(8)) furnished on or after January 1, 2027.
Modifies 1833(a)(1) paragraph text by adjusting punctuation and inserting additional text (as shown in the amendatory instructions) to reflect payment provisions related to certified community behavioral health clinic services.
Adds a new subsection (aa) to 1834 directing the Secretary to develop and implement a prospective payment system (PPS) for certified community behavioral health clinics, specifying considerations, initial payment methodology, annual updates, and authority for periodic rate adjustments.
Amends 1833(b)(4) to modify the non-application of the Medicare Part B deductible, inserting additional text to address certified community behavioral health clinic services.
Amends 1878(j) (Provider Reimbursement Review Board) to add certified community behavioral health clinics to the list of entities with a right to seek Board review of cost reports.
Amends the anti-kickback statute safe harbor provision (1128B(b)(3)(D)) to add text (as inserted) related to waivers of certified community behavioral health clinic coinsurance, extending safe harbor protection to such waivers.
Read twice and referred to the Committee on Finance.
Introduced December 9, 2025 by John Cornyn · Last progress December 9, 2025
Read twice and referred to the Committee on Finance.
Introduced in Senate