Pass the Behavioral Health Crisis Care Centers Act
Recommendation
Congress should pass the Behavioral Health Crisis Care Centers Act, which would provide grant funding for states, cities and counties, and tribal governments to establish, operate, and expand one-stop crisis facilities and wrap-around services.[1][2][3] Additionally, Congress should require the Centers for Medicare and Medicaid Services (CMS) to establish a bundled payment under the Outpatient Prospective Payment System (OPPS) for crisis stabilization services for Medicare beneficiaries in crisis to cover up to 23 hours of crisis stabilization services.[4] CMS should also publish a report examining options for providing Medicare coverage of crisis stabilization services furnished by non-hospital providers that cannot bill Medicare under the OPPS.[4]
Background/summary
Crisis facilities are critical for providing stabilization services, short-term care services, and helping transition individuals with MH/SUD to any needed long-term treatment.[3] Unfortunately, MH/SUD crisis care is inconsistent and inadequate, and crisis centers are underfunded, leaving gaps in stabilization services.[3][5] The Behavioral Health Crisis Care Centers Act would increase funding for the establishment, operation, and expansion of crisis facilities and close gaps in services for individuals in MH/SUD crisis.[1][2][3]
About one in four Medicare beneficiaries has a MH/SUD. While OPPS covers some in-patient and out-patient MH/SUD services, and some medications, there are limits in coverage and reimbursement.[6][7] CMS has proposed OPPS updates for 2024 that would cover intensive outpatient MH/SUD services, which is similar to partial hospitalization services. However, crisis stabilization services are still not covered, including screenings and assessments for a MH/SUD crisis.[8] To address this gap, CMS should develop a bundled payment under OPPS that would cover the full range of stabilization services and report on options for covering crisis care provided by non-hospital providers. In late 2022, a bipartisan group of Senate Finance Committee members supported requiring such a bundled payment and report.[4]
citations
1. Behavioral Health Crisis Care Centers Act of 2023. H.R. 2977 (Smith-Kilmer), 118th Congress (2023-2024). Last Accessed August 3, 2023.
2. “Rep. Smith Introduces Bill to Improve Response to Nationwide Mental and Behavioral Health Crisis.” 2023. Congressman Adam Smith. Last Updated April 27, 2023.
3. Congressman Adam Smith. Behavioral Health Crisis Care Centers Act. Last Accessed August 3, 2023.
4. U.S. Senate Committee on Finance. “Bipartisan Mental Health Care Provisions.” Last Accessed August 3, 2023.
5. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit. Last Updated 2020.
6. McGinty, Beth. Medicare’s Mental Health Coverage: What’s Included, What’s Changed, and What Gaps Remain. The Commonwealth Fund. Last Updated March 2, 2023.
7. Center for Medicare Advocacy. Medicare Coverage of Mental Health and Substance Abuse Services. Last Accessed August 3, 2023.
8. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. CMS Proposes Policies to Expand Behavioral Health Access and Further Efforts to Increase Hospital Price Transparency. Last Updated July 13, 2023.