988 System

The Substance Abuse and Mental Health Services Administration (SAMHSA) should develop culturally competent guidelines for mental health and substance use service providers[1], particularly those serving predominantly underserved communities—particularly Black/African American; Hispanic/Latino; Asian American, Native Hawaiian, and Pacific Islander; American Indian and Alaska Native; lesbian, gay, bisexual, transgender, queer, and intersex(LGBTQI+) communities[2][3]—through inclusive and responsive community engagement.

Congress should require the Centers for Medicare and Medicaid Services (CMS) to establish a single global payment under the Physician Fee Schedule for mobile crisis response team services for Medicare beneficiaries experiencing a mental health or substance use disorder (MH/SUD) crisis. A bipartisan group of Senate Finance Committee members has supported this important step.[1]

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]

Congress should pass the Behavioral Health Crisis Services Expansion Act to ensure communities have the resources they need to provide services for people experiencing a mental health or substance use (MH/SUD, or “behavioral health”) crisis.[1][2]

The Substance Abuse and Mental Health Services Administration (SAMHSA) should continue to fully implement the 988 number, with response driven by healthcare systems, not public safety systems.[1] Enhanced training should be provided to counselors answering 988 calls, and coordination between 988, 911, and all services within the continuum should be strengthened.[2] Clinically staffed crisis response should be integrated within 911, and training provided to 911 operators in identifying mental health needs and linking callers to mental health crisis response services.[1] Congress should provide the funding necessary to scale up 988 to meet the high – and increasing need. Funding should be at least $946 million a year – and should grow over time. Of this amount, $100 million is needed for state Mental Health Crisis Response Grants, $836 for the 988 Suicide & Crisis Lifeline program, and $10 million for the Behavioral Health Crisis & 988 Coordinating Office at the Substance Abuse and Mental Health Services Administration.[3]

Congress should incentivize states to expand their capacity to provide mental health and substance use disorder (MH/SUD) services under Medicaid, which will improve equity. For example, Congress should authorize a planning grant or demonstration program to provide participating state Medicaid programs with additional federal funding to expand or improve the capacity of MH/SUD participating providers.[1]