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Introduced December 9, 2025 by John Cornyn · Last progress December 9, 2025
Creates a federal framework to expand, standardize, and pay for certified community behavioral health clinic (CCBHC) services across Medicaid and Medicare, adds liability protection for clinicians, and adjusts accreditation and payment rules. It lets states require accredited CCBHC certification, mandates a cost‑based prospective payment system for Medicaid CCBHCs beginning in 2026, authorizes Medicare coverage and a new Medicare PPS for CCBHC services beginning in 2027 (with Part B deductible waived), extends a coinsurance‑waiver safe harbor, allows PRRB appeals for CCBHC cost reports, and extends FTCA‑style liability protection to clinicians in CCBHCs. The law also expands the list of services CCBHCs must or may provide (adding primary care screening/monitoring, targeted case management, psychiatric rehabilitation, peer and family supports, intensive community‑based care for service members and veterans, and optional additional primary care services), and directs CMS to set payment rates, update methodologies, and allow alternative payment arrangements subject to minimum payment floors and oversight.
The bill would expand and stabilize federal support for community behavioral health services—improving access and clinic financial stability for Medicaid and Medicare patients—while increasing federal and state costs and administrative burdens and shifting some legal protections away from patients toward clinicians.
Medicaid beneficiaries (people on Medicaid with mental health or substance use conditions) will gain expanded access to comprehensive community behavioral health services (CCBHC services) as more services are mandated and supported, starting in 2026.
Community behavioral health clinics (CCBHCs) and related clinics will receive more predictable, cost-based payments (including an initial national-average PPS, inflation adjustments, periodic rebasing, and managed-care reconciliation/backstops), improving financial stability and the ability to sustain services.
Medicare beneficiaries who need behavioral health services will gain Medicare Part B coverage for CCBHC services (starting Jan 1, 2027) and will not owe the Part B deductible for those services, lowering out-of-pocket costs and improving access.
Taxpayers, federal and state budgets will face higher costs because Medicaid program spending will likely rise and Medicare will add a new Part B benefit and PPS payments for CCBHCs.
State Medicaid agencies and clinics will face substantial new administrative and compliance burdens (complex PPS rules, rebasing, reconciliation, managed care interactions, and accreditation requirements), raising staffing and reporting costs.
Initial payment rates based on limited or projected base-year data risk mispricing services—leading to underpayment for clinics or overpayments by payers until data mature and rebasing occurs.