Medicare and private health plans would cover crisis care

Private health plans would have to cover crisis response services. The requirement would cover employer and individual health plans. Covered care would address mental health or substance use crises through specified crisis providers. Plans could not impose separate crisis-only patient charges or treatment limits. Costs and treatment limits could not be stricter than the standards applied to most medical and surgical benefits. The rules would apply to plan years beginning on or after the date three years after enactment.

Medicare would cover crisis response services. Coverage would serve Medicare patients experiencing mental health or substance use crises through specified crisis providers, including mobile crisis teams. Medicare would pay 80% of the lower of the actual charge or the amount allowed under a federal payment method. Federal health officials would set that payment method.

Federal health officials would award grants for crisis call centers and crisis-care buildings. Regional and local crisis call centers could use their grants for staff, training, technology, and operations. Congress would still need to provide the authorized money. Eligible building-grant recipients would include federally funded health centers and crisis call centers working with local care providers. Building grants could pay for construction, improvements, and related loan costs. The call-center amount is authorized for fiscal year 2027. Both amounts would remain available until spent once funded.

States could choose a Medicaid option covering mobile crisis care, call-center operations, and stabilization services. Stabilization centers would need to qualify for a state license or certification, provide round-the-clock care and observation and treatment beds, and keep average stays under 150 hours. They would need fees based on ability to pay and could not restrict care because of payment ability, disability, or other listed patient circumstances. They would need to accept referrals from emergency responders and families. These provisions would apply as if included in the American Rescue Plan Act of 2021.

Certain community and crisis centers would fall outside Medicaid's restricted category for mental health institutions. Covered sites would include qualifying community behavioral health clinics, community mental health centers, stabilization centers, and walk-in crisis facilities. Stabilization centers would need state approval, round-the-clock care, at least 23 hours of observation followed by 48 hours of stabilization, and average stays under 150 hours. They would need discounts based on ability to pay, could not restrict care for listed patient circumstances, and would accept referrals from emergency responders and families.