Strengthening Medicaid for Serious Mental Illness Act · Introduced in House (2025-05-09)

119th CONGRESS 1st Session

To amend title XIX of the Social Security Act to increase Federal Medicaid funding for States that provide intensive community-based services for adults with serious mental illness, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES · May 9, 2025 · Sponsor: Mr. Goldman of New York · Committee: Committee on Energy and Commerce

SEC. 2. Purposes

The purposes of this Act are the following:

To amend title XIX of the Social Security Act to increase Federal Medicaid funding for States that provide intensive community-based services for adults with serious mental illness.
To increase access to intensive community-based services in the most integrated setting appropriate.
To prevent unnecessary hospitalization or other institutionalization.
To promote continuity of care and coverage for young adults after they turn 21 and age out of the early and periodic screening, diagnostic, and treatment services benefit.

SEC. 3. Increased FMAP for providing intensive community-based services under Medicaid

Increased FMAP for providing intensive community-based services under Medicaid

(a) In general

Section 1915 of the Social Security Act () is amended by adding at the end the following new subsection: 42 U.S.C. 1396n
In general
- (m) State plan amendment option To provide intensive community-Based services for elderly and disabled individuals
  - (1) In general
    - Subject to the succeeding provisions of this subsection, beginning January 1, 2026, a State may provide through a State plan amendment for the provision of medical assistance for intensive community-based services (not including room and board) for eligible individuals (as defined in paragraph (2)), without determining that but for the provision of such services the individuals would require the level of care provided in a hospital, nursing facility, or intermediate care facility described in section 1905(d), but only if the State meets the following requirements:
    - In general
    - (A) Application of HCBS State plan amendment requirements
      - (i) Except as provided in clause (ii), the State satisfies the requirements described in subparagraphs (A) through (J) of subsection (i)(1) (except that, in applying such subparagraphs for purposes of this subsection, each reference to shall be deemed to be a reference to ). home and community-based services intensive community-based services
      - (ii) In applying subparagraph (F)(i) of subsection (i)(1) for purposes of this subsection, shall be inserted after . or 1 or more activity of daily living and 1 or more instrumental activity of daily living (as defined in subsection (k)(6)(F))
    - (B) Application of regulations
      - In providing intensive community-based services under this subsection, the State complies with the regulations applicable to home and community-based services provided under subsection (i) under subpart M of part 441 of title 42, Code of Federal Regulations, including sections 441.710 (commonly known as the ) and 441.725 of such title, except to the extent that such regulations are inconsistent with this subsection. HCBS settings rule
  - (2) Definitions
    - In this subsection:
    - (A) Adult with a serious mental illness; serious mental illness
      - (i) The term adult with a serious mental illness has the meaning given that term by the Secretary pursuant to section 1912(c) of the Public Health Service Act.
      - (ii) The term serious mental illness means a diagnosable mental, behavioral or emotional disorder that meets the criteria for qualifying an individual as an adult with a serious mental illness.
    - (B) Assertive community treatment
      - The term assertive community treatment means services for the treatment of mental illness that are provided through an evidence-based practice that—
      - Assertive community treatment
        
        (i) improves outcomes for individuals with severe mental illness who are at high risk of homelessness, psychiatric crisis, or hospitalization, or are involved in the criminal justice system;
        
        (ii) is comprised of a multidisciplinary staff, including peer specialists, who work as a team to provide the individualized psychiatric treatment, rehabilitation, and support services clients need for the maximum reduction of physical or mental disability and restoration to their best possible functional level;
        
        (iii) ensures that there is 1 direct care staff person for every 10 clients; and
        
        (iv) provides services 24 hours a day, 7 days a week, for as long as needed and wherever they are needed.
    - (C) Eligible individual
      - The term eligible individual means an individual—
      - Eligible individual
        
        (i) who is eligible for medical assistance under the State plan or under a waiver of such plan;
        
        (ii) who is age 21 or older;
        
        (iii) whose income does not exceed 150 percent of the poverty line (as defined in section 2110(c)(5)); and
        
        (iv) who is an adult with a serious mental illness.
    - (D) Intensive case management
      - The term intensive case management means a type of case management service (as defined in section 440.169 of title 42, Code of Federal Regulations)—
        
        (i) that is reliable, systematic, flexible, and coordinated, designed to answer the unique combination of health and social care needs of individuals with serious mental illness;
        
        (ii) that is a long-term, intensive approach to supporting an individual in the community by providing a comprehensive range of treatment, rehabilitation, and support services;
        
        (iii) that helps individuals with serious mental illness acquire material resources (such as food, shelter, clothing, and medical care) and improve their psychosocial functioning;
        
        (iv) that provides sufficient support to individuals with serious mental illness to keep them involved in community life and encourage growth towards greater autonomy and develop coping skills to meet the demands of community life;
  - (3) Increase fmap for medical assistance for intensive community-based services
    - (A) In general
      - During each fiscal quarter that a State meets the requirements described in subparagraphs (B) through (D), the Federal medical assistance percentage applicable to the State for the quarter (as determined under section 1905(b) without regard to any adjustments applicable under such section or any other provision of law) shall be increased by the applicable number of percentage points (as determined under subparagraph (E) but not to exceed 100 percent) with respect to amounts expended by the State for medical assistance for intensive community-based services furnished to eligible individuals during such quarter under a State plan amendment under this subsection.
    - (B) Service quality criteria
      - (i) The State shall provide eligible individuals with intensive community-based services in accordance with such quality criteria as the Secretary shall by regulation establish.
      - (ii) The criteria established by the Secretary under clause (i) shall be designed to ensure that eligible individuals receive the intended benefits of receipt of the services, including avoiding preventable hospitalization or other institutionalization. The criteria will be adjusted as needed to account for future developments and best practice. The criteria shall include the following:
      - The standards for assertive community treatment in the Tool for Measurement of Assertive Community Treatment (TMACT), Dartmouth Assertive Community Treatment Scale (DACTS), or other generally accepted tool for evaluating assertive community treatment.
      - Individual Placement and Support (IPS) standards for supported employment services.
      - Securing and maintaining scattered-site housing with a Housing First approach as the goal for housing-related activities and services.
    - (C) Integrated setting
      - Eligible individuals shall receive intensive community-based services—
        
        (i) in the most integrated setting appropriate; and
        
        (ii) without limiting access to any such service on the basis of—
        
        the individual’s need for assistance with activities of daily living or instrumental activities of daily living;
        
        receipt of other disability support services;
        
        the presence of additional disabilities such as a physical, communication, intellectual, developmental, or other disability or a record or history of having such a disability; or
        
        the existence of co-occurring substance use disorders or a record or history of having such substance use disorders.
    - (D) Data collection and reporting
      - Not less frequently than once every 2 years, the State shall collect and report data to the Secretary, including with respect to disparities in access to, or receipt of, intensive community-based services, according to criteria established by the Secretary and the Secretary shall analyze and report such findings to Congress. The criteria shall include the collection and reporting of data with respect to the following:
  - (4) Application of HCBS State plan amendment provisions
    - Paragraphs (3), (4), (5), (6), and (7) of subsection (i) shall apply to State plan amendments under this subsection and intensive community-based services in the same manner as such paragraphs apply to State plan amendments under such subsection (i) and home and community-based services.
    - Application of HCBS State plan amendment provisions
  - (5) Funding for state planning grants
    - Funding for state planning grants
    - (A) In general
      - There is appropriated, out of any funds in the Treasury not otherwise appropriated, $20,000,000 to the Secretary for purposes of implementing, administering, and making planning grants to States as soon as practicable for purposes of developing a State plan amendment request to provide intensive community-based services under this subsection, to remain available until expended.
    - (B) Use of funds
      - A State shall use funds received under a grant under this subsection to engage in planning activities for a State plan amendment under this subsection, including—
        
        (i) collaborative activities, at the State and Federal level, with providers of housing-related services;
        
        (ii) developing service quality criteria; and
        
        (iii) developing the infrastructure necessary to implement the State plan amendment, including data infrastructure and staffing.

(b) Rule of construction

Nothing in this Act or the amendments made by this Act may be construed to limit the entitlement of children and youth who are eligible for medical assistance under a State Medicaid program to receive intensive community-based services through the early and periodic screening, diagnostic, and treatment services benefit.

H.R. 3320

Table of contents

SEC. 1. Short title

SEC. 2. Purposes

SEC. 3. Increased FMAP for providing intensive community-based services under Medicaid