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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5819 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 5819
To amend title XVIII of the Social Security Act to provide incentives
for behavioral health integration under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 28, 2023
Mrs. Steel (for herself, Mr. Kildee, Mrs. Fletcher, Mr. Bilirakis, Mr.
Pfluger, Ms. Lee of Nevada, and Mr. Molinaro) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide incentives
for behavioral health integration under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Connecting Our Medical Providers
with Links to Expand Tailored and Effective Care Act'' or the
``COMPLETE Care Act''.
SEC. 2. INCENTIVES FOR BEHAVIORAL HEALTH INTEGRATION.
(a) Incentives.--
(1) In general.--Section 1848(b) of the Social Security Act
(42 U.S.C. 1395w-4(b)) is amended by adding at the end the
following new paragraph:
``(13) Incentives for behavioral health integration.--
``(A) In general.--For services described in
subparagraph (B) that are furnished during 2025, 2026,
or 2027, instead of the payment amount that would
otherwise be determined under this section for such
year, the payment amount shall be equal to the
applicable percent (as defined in subparagraph (C)) of
such payment amount for such year.
``(B) Services described.--The services described
in this subparagraph are services identified, as of
January 1, 2023, by HCPCS codes 99484, 99492, 99493,
99494, and G2214 (and any successor or similar codes as
determined appropriate by the Secretary).
``(C) Applicable percent.--In this paragraph, the
term `applicable percent' means, with respect to a
service described in subparagraph (A), the following:
``(i) For services furnished during 2025,
175 percent.
``(ii) For services furnished during 2026,
150 percent.
``(iii) For services furnished during 2027,
125 percent.''.
(2) Waiver of budget neutrality.--Section 1848(c)(2)(B)(iv)
of such Act (42 U.S.C. 1395w-4(c)(2)(B)(iv)) is amended--
(A) in subclause (V), by striking ``and'' at the
end;
(B) in subclause (VI), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(VII) the increase in payment
amounts as a result of the application
of subsection (b)(13) shall not be
taken into account in applying clause
(ii)(II) for 2025, 2026, or 2027.''.
(b) Quality Measurement.--
(1) In general.--Section 1833(z) of the Social Security Act
(42 U.S.C. 1395l(z)) is amended--
(A) by redesignating paragraph (4) as paragraph
(5); and
(B) by inserting after paragraph (3) the following
new paragraph:
``(4) Quality measurement relating to behavioral health
integration.--
``(A) In general.--The Secretary shall establish
quality measurement reporting requirements for
applicable physicians and practitioners (as defined in
subparagraph (B)) with respect to the extent to which
clinician practices are integrating behavioral health
services and primary care services, in accordance with
the succeeding provisions of this paragraph.
``(B) Applicable physicians and practitioners.--For
purposes of this paragraph, the term `applicable
physician or practitioner' means, with respect to a
year, a physician or a practitioner described in
section 1842(b)(18)(C) who is participating in an
eligible alternative payment entity for which the
associated alternative payment model involves the
delivery of primary care services to beneficiaries who
may have the need for mental health or substance use
disorder services, as determined by the Secretary.
``(C) Quality reporting by selected physicians and
practitioners.--With respect to each year beginning on
or after the date that is one year after one or more
measures are first specified under subparagraph (D), an
applicable physician or practitioner shall submit to
the Secretary data on quality measures specified under
such subparagraph. Such data shall be submitted in a
form and manner, and at a time, specified by the
Secretary for purposes of this subparagraph.
``(D) Quality measures.--
``(i) In general.--Subject to clause (ii),
any measure specified by the Secretary under
this subparagraph must have been endorsed by
the entity with a contract under section
1890(a).
``(ii) Exception.--In the case of a
specified area or medical topic determined
appropriate by the Secretary for which a
feasible and practical measure has not been
endorsed by the entity with a contract under
section 1890(a), the Secretary may specify a
measure that is not so endorsed as long as due
consideration is given to measures that have
been endorsed or adopted by a consensus
organization identified by the Secretary.
``(E) Implementation.--The Secretary may use
quality measures developed pursuant to this paragraph
in--
``(i) the shared savings program under
section 1899; and
``(ii) the Primary Care First Model, the
Accountable Care Organization Realizing Equity,
Access, and Community Health (ACO REACH) Model,
and any other alternative payment model (as
defined in paragraph (3)(C)) as determined
appropriate by the Secretary.''.
(2) Conforming amendment relating to convening multi-
stakeholder groups.--Section 1890(b)(7)(B)(i)(I) of the Social
Security Act (42 U.S.C. 1395aaa(b)(7)(B)(i)(I)) is amended by
inserting ``1833(z)(4),'' after ``1833(t)(17),''.
(c) Technical Assistance for the Adoption of Behavioral Health
Integration.--
(1) In general.--Not later than January 1, 2025, the
Secretary of Health and Human Services shall enter into
contracts or agreements with appropriate entities to offer
technical assistance to primary care practices that are seeking
to adopt behavioral health integration models in such
practices.
(2) Behavioral health integration models.--For purposes of
paragraph (1), behavioral health integration models include the
Collaborative Care Model (with services identified as of
January 1, 2023, by HCPCS codes 99492, 99493, 99494, and G2214
(and any successor codes)), the Primary Care Behavioral Health
model (with services identified as of January 1, 2023, by HCPCS
code 99484 (and any successor code)), and other models
identified by the Secretary.
(3) Funding.--In addition to amounts otherwise available,
there is appropriated to the Secretary of Health and Human
Services for each of fiscal years 2024 through 2027, out of any
money in the Treasury not otherwise appropriated, such sums as
are necessary, to remain available until expended, for purposes
of carrying out this subsection.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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