H.R. 3320 — Strengthening Medicaid for Serious Mental Illness Act

This section states the purposes of the Act: (1) amending title XIX of the Social Security Act (Medicaid) to increase federal funding for states providing intensive community-based services to adults with serious mental illness; (2) increasing access to such services in the most integrated setting appropriate; (3) preventing unnecessary hospitalization or institutionalization; and (4) promoting continuity of care and coverage for young adults aging out of Medicaid's early and periodic screening, diagnostic, and treatment (EPSDT) benefit upon turning 21.

This section establishes a new state plan amendment option under Section 1915(m) of the Social Security Act, beginning January 1, 2026, allowing states to provide Medicaid coverage for intensive community-based services (excluding room and board) to eligible individuals without requiring a determination of institutional level-of-care needs (i.e., hospital, nursing facility, or intermediate care facility care under Section 1905(d)). Eligible individuals are Medicaid-eligible adults age 21 or older with incomes not exceeding 150% of the federal poverty level who have a serious mental illness (as defined under Section 1912(c) of the Public Health Service Act). States must satisfy modified requirements from the Medicaid home and community-based services (HCBS) state plan option under Section 1915(i)(1)(A)–(J), including an adjusted needs-based assessment under 1915(i)(1)(F)(i) covering individuals needing assistance with 2 or more activities of daily living (ADLs, as defined in IRC Section 7702B(c)(2)(B)) or 1 or more ADLs and 1 or more instrumental ADLs (IADLs, as defined in 1915(k)(6)(F)); and comply with HCBS regulations under 42 CFR part 441 subpart M, including the HCBS settings rule (42 CFR 441.710) and person-centered planning (42 CFR 441.725). Intensive community-based services include (1) assertive community treatment (i.e., 24/7 multidisciplinary team services with a 1:10 staff-to-client ratio for high-risk adults with serious mental illness); (2) intensive case management (i.e., at least 4 monthly face-to-face contacts with a 1:12 case manager-to-client ratio); (3) supported employment; (4) peer support services; (5) qualifying community-based mobile crisis intervention services; (6) housing-related activities (as described in CMS's June 26, 2015, informational bulletin); and (7) other psychosocial rehabilitation services approved by the Secretary. (As background, these evidence-based services promote community integration, reduce hospitalizations and homelessness risk, and support functional recovery for adults with serious mental illness.)