[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1264 Introduced in Senate (IS)]
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119th CONGRESS
1st Session
S. 1264
To amend title XVIII of the Social Security Act to establish a
demonstration program to promote collaborative treatment of mental and
physical health comorbidities under the Medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 2, 2025
Mr. Bennet introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish a
demonstration program to promote collaborative treatment of mental and
physical health comorbidities 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 ``Mental and Physical Health Care
Comorbidities Act of 2025''.
SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM TO PROMOTE COLLABORATIVE
TREATMENT OF MENTAL AND PHYSICAL HEALTH COMORBIDITIES
UNDER THE MEDICARE PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by inserting after section 1866G the following new section:
``SEC. 1866H. MENTAL AND PHYSICAL HEALTH COMORBIDITIES COLLABORATIVE
DEMONSTRATION PROGRAM.
``(a) In General.--Consistent with the model described in section
1115A(b)(2)(B)(xv) (relating to promoting improved quality and reduced
cost by developing a collaborative of high-quality, low-cost health
care institutions), the Secretary shall conduct a demonstration program
(in this section referred to as the `program') to test and evaluate
innovations implemented by eligible hospitals (as defined in subsection
(f)) in the furnishing of items and services to applicable individuals
(as defined in subsection (f)) with mental and physical health
comorbidities (and those at risk of developing such comorbidities),
including by addressing the adverse social determinants of health that
such individuals often experience.
``(b) Activities Under Program.--Under the program, the Secretary
shall, in coordination with eligible hospitals participating in the
program--
``(1) identify, validate, and disseminate innovative,
effective evidence-based best practices and models that improve
care and outcomes for applicable individuals with mental and
physical health comorbidities located in vulnerable
communities, including by addressing the social determinants of
health that adversely impact such individuals; and
``(2) assist in the identification of potential payment
reforms under this title and title XIX that could more broadly
effectuate such improvements.
``(c) Duration and Scope.--The program conducted under this section
shall operate during the period beginning on October 1, 2025, and
ending no later than September 30, 2030.
``(d) Program Elements.--
``(1) In general.--An eligible hospital electing to
participate in the program shall enter into an agreement with
the Secretary for purposes of carrying out the activities
described in subsection (b). Such an agreement shall include
the plan described in paragraph (2), along with an annualized
payment arrangement as described in paragraph (3) to support
implementation of such plan. Such agreement shall include a
requirement for the hospital to--
``(A) engage in the learning collaborative
established under subsection (e);
``(B) certify that all proposed innovations under
such plan will supplement and not supplant existing
activities, whether by augmenting existing activities
or initiating new activities; and
``(C) remit payments made under such arrangement to
the Secretary if the Secretary determines that such
hospital has not complied with the terms of such
agreement.
``(2) Program elements.--An eligible hospital electing to
participate in the program shall submit a proposed plan and
associated quality metrics for review and approval by the
Secretary. Such plan and metrics shall, at a minimum, address--
``(A) the specific innovations addressing mental
and physical health comorbidities (as defined in
subsection (f)) and innovations addressing social
determinants of health (as defined in such subsection)
that will be employed and the evidence base supporting
the proposed approach;
``(B) the proposed target population of applicable
individuals with respect to which such innovations will
be employed, including a description of the extent to
which such population consists of applicable
individuals described in subparagraph (A), (B), or (C)
of subsection (f)(1);
``(C) the evidence-based data supporting a
community's status as a vulnerable community through
sources, such as Bureau of the Census data and measures
such as the Neighborhood Deprivation Index or the Child
Opportunity Index;
``(D) community partners, such as nonprofit
organizations, federally qualified health centers,
rural health clinics, and units of local government
(including law enforcement and judicial entities) that
will participate in the implementation of such
innovations;
``(E) how such innovations will address mental and
physical health comorbidities and social determinants
of health for the target population;
``(F) how such innovations may inform changes in
payment and other policies under this title and title
XIX (such as care coordination reimbursement, mental
health homes, improvements to home and community-based
service portfolios, and coverage of supportive
services);
``(G) how such innovations might contribute to a
reduction in overall health care costs, including under
this title and title XIX and for uninsured persons,
through improvements in population health, reductions
in health care utilization (such as inpatient
admissions, utilization of emergency departments, and
boarding of patients), and otherwise;
``(H) how such innovations can be expected to
improve the mental and physical health status of
minority populations;
``(I) how such innovations can be expected to
reduce other non-medical public expenditures;
``(J) metrics to track care quality, improvement in
outcomes, and the impact of such innovations on health
care and other public expenditures;
``(K) how program outcomes will be assessed and
evaluated; and
``(L) how the hospital will collect and organize
data and fully participate in the learning
collaborative established under subsection (e).
``(3) Participation; payments.--The Secretary shall
negotiate an annualized payment arrangement with each eligible
hospital participating in the program. Such arrangement may
include an annual lump sum amount, capitated payment amount, or
such other arrangement as determined appropriate by the
Secretary, and which may include an arrangement that includes
financial risk for the hospital, to support implementation of
the innovations specified in the plan described in paragraph
(2).
``(e) Learning Collaborative.--
``(1) In general.--The Secretary shall establish a learning
collaborative that shall convene eligible hospitals
participating in the program and other interested parties on a
regular basis to report on and share information regarding
evidence-based innovations addressing mental and physical
health comorbidities, innovations addressing social
determinants of health, and associated metrics and outcomes.
``(2) Focused forums.--The Secretary may establish
different focused forums within the collaborative, such as ones
that specifically address different geographic regions (such as
urban and rural), certain types of comorbidities, or as the
Secretary otherwise determines appropriate based on the types
of agreements entered into under subsection (d).
``(3) Dissemination of information.--The Secretary shall
provide for the dissemination to other health care providers
and interested parties of information on promising and
effective activities.
``(f) Definitions.--For purposes of this section:
``(1) Applicable individual.--The term `applicable
individual' means an individual with mental and physical health
comorbidities who is--
``(A) a subsidy eligible individual (as defined in
section 1860D-14(a)(3)(A)) without regard to clause (i)
of such section;
``(B) enrolled under a State plan (or waiver of
such plan) under title XIX; or
``(C) uninsured.
``(2) Eligible hospital.--The term `eligible hospital'
means a hospital that is--
``(A) a rural hospital with a disproportionate
patient percentage of at least 35 percent (as
determined by the Secretary under section
1886(d)(5)(F)(vi)) or would have a disproportionate
patient percentage of at least 35 percent (as so
determined) if the hospital were a subsection (d)
hospital (or, a percentage of inpatient days consisting
of items and services furnished to individuals entitled
to benefits under part A that exceeds 85 percent of all
such days) that is either a critical access hospital, a
sole community hospital (as defined in section
1886(d)(5)(D)(iii)), or a medicare-dependent, small
rural hospital (as defined in section
1886(d)(5)(G)(iv));
``(B) a large subsection (d) teaching and tertiary
hospital with more than 200 beds that as of, or
subsequent to July 1, 2020, has an average Medicare
case mix index of at least 1.5, an intern and resident-
to-bed ratio of at least 0.25 percent (or at least 150
full-time equivalent interns, residents, and fellows),
and is either a public hospital with a disproportionate
patient percentage of at least 35 percent (as
determined by the Secretary under section
1886(d)(5)(F)(vi)) or a nonprofit hospital with a
disproportionate patient percentage of at least 45
percent; or
``(C) a small subsection (d) urban safety net
hospital (as determined by the Secretary) with less
than 200 beds that is deemed to be a disproportionate
share hospital under section 1923(b).
``(3) Innovations addressing mental and physical health
comorbidities.--The term `innovations addressing mental and
physical health comorbidities' means innovations implemented by
an eligible hospital that seek to promote holistic care and
treatment of an applicable individual's co-occurring mental and
physical health comorbidities, support early detection of such
comorbidities, or prevent their onset, including the following:
``(A) Implementation of interdisciplinary
integrative coordinated care team models, including
those that utilize mental health emergency department
in-reach staff (and other emergency-department
interventions), care coordination staff and social
services support, and clinic-based services.
``(B) Integration of mental health services into
medical homes, coordinated care organizations,
accountable care entities, and in-home services.
``(C) Incorporation of mental health and social
risk screening into medical screening, particularly in
child and adolescent populations.
``(D) Preventing adverse impacts on mental health
resulting from physical health treatments or
medications, or on physical health resulting from
mental health treatments or medications, through cross
disciplinary provider education, quality metrics, and
other mechanisms.
``(E) Improvements in electronic health records and
other technology platforms or networks to capture,
track, and monitor mental and physical health
treatments and medications provided across care
settings and otherwise facilitate care coordination.
``(F) Piloting of reimbursement modifications that
utilize site-neutral payments and that address
conflicts and disincentives related to chronic care
management and behavioral health management and
differential treatment of inpatient and outpatient
settings.
``(G) Mitigating the incidence of admission and
readmission into psychiatric inpatient settings of
chronically ill elderly patients through methods such
as active inpatient management, variations in initial
length of stay, enhanced discharge planning, and
psychosocial interventions.
``(H) Delivering health behavior assessments and
interventions to improve physical health outcomes for
patients and aid in the management of chronic health
conditions.
``(I) In coordination with law enforcement agencies
and judicial entities, interventions targeted at
providing mental and physical health services
(including, as appropriate, substance use disorder
services) to individuals convicted of criminal offenses
for purposes of mitigating recidivism.
``(4) Innovations addressing social determinants of
health.--The term `innovations addressing social determinants
of health' means innovations implemented by an eligible
hospital that seek to address social determinants of health
that negatively impact the health outcomes of applicable
individuals, including the following:
``(A) Improvements in electronic health records to
better integrate mental health, medical care, and
social care (such as screening for social factors,
facilitated or closed loop referral, risk
stratification, and shared records with community-based
organizations).
``(B) Personnel-supported `wrap around' services
for at-risk individuals with mental and physical health
comorbidities (such as nutrition and diet counseling,
social services referral, respiratory therapy, medical-
legal assistance, financial counseling, consumer
education, pharmacy education, asthma education, and
referral to food resources such as referral to the SNAP
program, the WIC program, a food bank, case management
assistance, employment or education support, intimate
partner violence, and behavioral health support).
``(C) Home and community-based services that
provide collaborative care to address mental and
physical health comorbidities through health behavior
services, nutrition support, medication management,
transitional care, telehealth, mobile integrated health
care, paramedic-based home visitation, or utilization
of community health workers.
``(D) Hospital-based interventions (such as same
day primary care services, skilled nursing
interventions, substance use disorder and behavioral
health treatment coordination of care, collaborative
care models, discharge planning and medication
reconciliation, long-term care management, and post-
traumatic injury management).
``(5) Individual with mental and physical health
comorbidities.--The term `individual with mental and physical
health comorbidities' means an individual who is challenged by
serious mental illness or serious emotional disturbance as well
as 1 or more of the following conditions or characteristics:
``(A) Has or is at risk for one or more chronic
conditions (as defined by the Secretary).
``(B) High-risk pregnancy.
``(C) History of high utilization of acute care
services.
``(D) Frail elderly (defined by impairments in
activities of daily living).
``(E) Disability, including traumatic brain injury.
``(F) Critical illness or injury requiring long-
term recovery.
``(6) Vulnerable community.--The term `vulnerable
community' means a geographic area served by an eligible
hospital characterized by a population that has a statistically
significant number of individuals with mental and physical
health comorbidities, indicators of poor population health
status, low-income status, or status as a USDA-recognized food
desert.
``(g) Evaluation and Report.--Not later than 1 year after the date
of completion of the program under this section, the Secretary shall
submit to Congress a report containing an evaluation of the activities
supported by the program. Such report shall include the following:
``(1) A description of each such activity, including--
``(A) the target population of such activity;
``(B) how such activity addressed the adverse
social determinants of health in such population; and
``(C) the role of community-based organizations and
other community partners (such as nonprofits and units
of local government) in such activity.
``(2) Evidence showing whether and how each such activity
advanced any of the following objectives:
``(A) Improved access to care.
``(B) Improved quality of care.
``(C) Improved health outcomes.
``(D) Amelioration of disparities in care.
``(E) Improved care coordination.
``(F) Reduction in health care costs (including
such reductions under this title and title XIX and such
reductions occurring for uninsured individuals).
``(G) Reduction in health care utilization
(including with respect to inpatient admissions,
utilization of emergency departments, and room and
board provided to individuals).
``(H) Reduction in non-medical public expenditures.
``(I) Changes in patient and provider satisfaction
with care delivery.
``(J) Reductions in involvement with the justice
system, including reductions in recidivism.
``(3) A description of the metrics used to track the
implementation and results of each such activity.
``(4) Recommendations for any legislation or administrative
action the Secretary determines appropriate.
``(h) Funding.--Any funds appropriated under section 1115A(f) shall
be available to the Secretary without further appropriation for the
purposes of carrying out this section.''.
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