H.R. 4022 — Increasing Behavioral Health Treatment Act

This section removes the exclusion for items and services furnished in institutions for mental diseases (IMDs) from Medicaid's definition of medical assistance under section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) and makes conforming amendments striking "65 years of age or older" (or similar) from coverage limitations in sections 1902(a)(20) and (21), 1905(a)(14), and 1919(e)(7)(B)(i)(I) (42 U.S.C. 1396a(a), 1396d(a)(14), 1396r(e)). (As background: IMDs are facilities primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including psychiatric hospitals, and that contain more than 16 beds; the prior IMD exclusion generally barred federal Medicaid funding for services provided to individuals ages 22-64 in such institutions.) It also adds state plan requirements under section 1902(a)(20) (42 U.S.C. 1396a(a)(20)) that states (D) develop and annually report progress on plans to increase access to outpatient and community-based behavioral health care (especially for IMD patients transitioning to the community), crisis stabilization services (e.g., mobile crisis units, assertive community treatment), and data coordination among providers and first responders; (E) demonstrate policies for screening co-morbid physical and substance use conditions upon admission to psychiatric hospitals, strategies to engage individuals in mental health or substance use crises (especially adolescents and young adults), and utilization reviews ensuring least-restrictive care; and (F) annually report costs and utilization data (aggregate and by facility type) for IMDs and non-IMD inpatient psychiatric hospitals, numbers of individuals served with serious mental illness or substance use crises, lengths of stay, and post-discharge outpatient treatments (including medication-assisted treatment). The amendments apply to state plans on the date of enactment, with an exception delaying enforcement until after the first regular legislative session post-enactment for states requiring legislation to comply.