IMD CARE Act

crisis receiving and crisis stabilization including specialized programs for in-home stabilization for children and adolescents. ``(vi) Psychiatric rehabilitation encompassing recovery support, supported employment and supportive housing. ``(vii) Services furnished by certified community behavioral health clinics and community mental health centers. ``(viii) Routine monitoring of medication adherence. ``(ix) Medication to treat mental illness. ``(x) Other outpatient and community-based services as designated by the Secretary. ``(C) State reporting requirement.-- ``(i) In general.--Prior to approval of a State plan amendment under this subsection, as a condition for a State receiving payments under section 1903(a) for medical assistance provided in accordance with this subsection, the State shall report to the Secretary, in accordance with the process established by the Secretary under clause (ii), the information deemed necessary by the Secretary under such clause. ``(ii) Process.--Not later than the date that is 12 months after the date of enactment of this subsection, the Secretary shall establish a process for States to report to the Secretary, at such time and in such manner as the Secretary deems appropriate, such information as the Secretary deems necessary to verify a State's compliance with subparagraph (A). ``(4) Ensuring a continuum of services.-- ``(A) In general.--As a condition for a State receiving payments under section 1903(a) for medical assistance provided in accordance with this subsection, the State shall carry out each of the requirements described in subparagraphs (B) through (J). ``(B) Notification.--The State shall require providers, managed care plans, and utilization review entities to implement specified evidence-based, individual placement criteria and utilization management approaches developed by stakeholders using a consensus-based process to ensure placement of eligible individuals in an appropriate level of care, including criteria and approaches to ensure that eligible individuals receive appropriate evidence-based clinical screening prior to being furnished with items and services in an institution for mental diseases, including initial and periodic assessments to determine the appropriate level of care, length of stay, and setting for such care for each individual. The State shall notify the Secretary at such time and in such form and manner as the Secretary shall require how the State will require and implement such placement criteria and utilization management approaches. ``(C) Transition of care.--In order to ensure an appropriate transition for an eligible individual from receiving care in an institution for mental diseases to receiving care at a lower level of clinical intensity within the continuum of care (including outpatient services), the State shall ensure that-- ``(i) a placement in such institution for mental diseases would allow for an eligible individual's successful transition to the community, considering such factors as proximity to an individual's support network (such as family members, employment, and counseling and other services near an individual's residence); ``(ii) enrollees are connected with community-based providers as they prepare to transition out of an institution for mental diseases by covering services provided by these community-based providers to enrollees while they are still residing in the institution for mental diseases or by encouraging institutions for mental diseases to hire peer support specialists to assist with the transition and discharge process and ensure enrollees are connected with providers and other resources in their communities after they leave the institution; ``(iii) institutions for mental diseases assess whether enrollees have access to housing as they are transitioning out and connect such individuals with community providers that coordinate housing services; and ``(iv) all institutions for mental diseases that furnish items and services to individuals for which medical assistance is provided under the State plan-- ``(I) are able to provide care at such lower level of clinical intensity; ``(II) have an established relationship with another facility or provider that is able to provide care at such lower level of clinical intensity and accepts patients receiving medical assistance under this title such that the institution for mental diseases may arrange for individuals to receive such care from such other facility or provider upon transitioning out of that institution for mental diseases; or ``(III) ensure implementation of protocols requiring that contact is made by the institution for mental diseases with each discharged beneficiary within 72 hours of discharge and to ensure access to and engagement in follow-up care. ``(D) Review process.--The State shall have in place a process to review the compliance of institutions for mental diseases with such program standards specified by the State encompassing licensing requirements, auditing processes, utilization review processes and Federal program integrity requirements. ``(E) Care for co-morbid conditions.--The State shall implement a requirement that institutions for mental diseases also screen enrollees for co-morbid physical health conditions and substance use disorders and suicidal ideation and provide for treatment either on-site or via partnerships with local providers for any identified co-occurring conditions. ``(F) Care continuum assessment.-- ``(i) In general.--The State shall, as part of its application for approval of a State plan amendment described in this subsection, complete and submit an assessment of the availability of outpatient and community based behavioral health services for individuals enrolled under a State plan under this title (or waiver of such plan) in each level of care, including how such availability varies by region of the State. ``(ii) Required updates.--The State shall complete an update of such assessment described in clause (i) not later than 12 months after date the State commences such assessment. ``(G) Financing plan.--The State shall consult with the Secretary in succeeding years regarding financing plans to increase the availability of services listed in paragraph (3)(B) where feasible. ``(H) Coordination.--The State shall implement strategies to improve data-sharing between different types of providers (such as mental health, substance use disorder, and physical health providers) and different settings of care (such as hospitals, emergency departments, crisis stabilization providers, community-based treatment providers) as well as strategies to improve the State's capacity to track availability of treatment and crisis stabilization beds and capacity of mental health providers to accept new patients. ``(I) Connections.--The State shall implement strategies to decrease use of emergency departments by enrollees with serious mental illness primarily in need of mental health treatment, including by supporting peer supports and psychiatric consultants in emergency departments to improve connections with services and resources. ``(J) Integration and engagement.--The State shall take actions to increase integration of mental health and substance use disorder treatment in non-specialty care settings including schools, primary care practices, and emergency departments as well as additional strategies to support earlier identification and engagement in treatment among youth with serious mental health conditions including through supported education and supported employment programs. ``(5) Application to managed care.--Payments for, and limitations to, medical assistance furnished in accordance with this subsection shall be in addition to and shall not be construed to limit or supersede the ability of States to make monthly capitation payments to managed care organizations for individuals receiving treatment in institutions for mental diseases in accordance with section 438.6(e) of title 42, Code of Federal Regulations (or any successor regulation). ``(6) Other medical assistance.--The provision of medical assistance for items and services furnished to an eligible individual who is a patient in an institution for mental diseases in accordance with the requirements of this subsection shall not prohibit Federal financial participation for medical assistance for items or services that are provided to such eligible individual in or away from the institution for mental disease during any period in which the eligible individual is receiving items or services in accordance with this subsection. ``(7) Definitions.--In this subsection: ``(A) Eligible individual.--The term `eligible individual' means an individual who-- ``(i) with respect to a State, is enrolled for medical assistance under the State plan or a waiver of such plan; ``(ii) is at least 21 years of age; ``(iii) has not attained 65 years of age; and ``(iv) has at least 1 mental disorder defined in the most recent version of the American Psychiatric Association Diagnostic and Statistical Manual. ``(B) Institution for mental diseases.--The term `institution for mental diseases' has the meaning given that term in section 1905(i).''. (b) Rule of Construction.--Nothing in the amendments made by subsection (a) shall be construed as encouraging a State to place an individual in an inpatient or a residential care setting where a home or community-based care setting would be more appropriate for the individual, or as preventing a State from conducting or pursuing a demonstration project under section 1115 of the Social Security Act to improve access to, and the quality of care for enrollees with serious mental illness or serious emotional disturbance. <all>