Payment for certified community behavioral health clinic services under the Medicare program

(a) In general Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— (1) by striking and (HH) and inserting (HH); and (2) by inserting before the semicolon at the end the following:, and (II) with respect to certified community behavioral health clinic services for which payment is made under section 1834(aa), the amounts paid shall be equal to 80 percent of the lesser of the actual charge or the amount determined under such section. (b) Development and implementation of prospective payment system Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: (aa) Development and implementation of prospective payment system for certified community behavioral health clinics (1) Development (A) In general The Secretary shall develop a prospective payment system for payment for community behavioral health clinic services (as defined in section 1861(aa)(8)) furnished by certified community behavioral health clinics (as defined in such section) under this title. (B) Considerations and adjustments In developing the system described in subparagraph (A), the Secretary— (i) shall— (I) take into account the type, intensity, and duration of services furnished by certified community behavioral health clinics; and (II) consider an appropriate unit of service and a general system design that provides for continued access to quality services; and (ii) may include adjustments, including geographic adjustments, as determined appropriate by the Secretary. (2) Implementation (A) In general For cost reporting periods beginning on or after January 1, 2027, the Secretary shall provide for payments of prospective payment rates for certified community behavioral health clinic services furnished by certified community behavioral health clinics under this title in accordance with the prospective payment system developed by the Secretary under paragraph (1). (B) Initial payments (i) In general Subject to clause (ii), in the first year that such prospective payment system is implemented, the Secretary shall implement such system to reflect the national average allowable service costs of certified community behavioral health clinics on the basis of the most current audited cost report data for the 2 most recent fiscal years available to the Secretary. Initial payments shall be established without the application of a per visit limit or productivity screen and shall be based on national average costs per unit of service, updated as appropriate by the inflationary adjustment described in subparagraph (C). (ii) Absence of data In the absence of complete cost report data described in clause (i), certified community behavioral health clinics may, at the Secretary’s discretion, submit estimated or projected data relating to specific services. (C) Payments in subsequent years Payment rates in years after the year of implementation of such system shall be the payment rates in the previous year increased— (i) in the first year after implementation of such system, by the percentage increase in the MEI (as defined in section 1842(i)(3)); and (ii) in subsequent years— (I) by the percentage increase in a market basket of certified community behavioral health clinic services, designed by the Secretary; or (II) if such an index is not available, by the percentage increase in the Federally qualified health center market basket (as described in section 1834(o)(2)(B)(ii)(II)) for the year involved. (3) Periodic reevaluation of rates The Secretary may periodically adjust the amounts that would otherwise be applicable under paragraph (2) by a percentage determined appropriate by the Secretary to reflect such factors as changes in the intensity of certified community behavioral health clinic services furnished within a unit of service, the average cost of providing care per unit of service, and other factors that the Secretary considers to be appropriate. Such adjustment shall be made before the update under clause (i) or (ii) of paragraph (2)(C) has been applied for the year..