Medicaid payments for behavioral health and mental health providers

(a) In general (1) Fee-for-service Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended— (A) in subsection (a)(13)— (i) by striking and at the end of subparagraph (B); (ii) by adding and at the end of subparagraph (C); and (iii) by adding at the end the following new subparagraph: (D) payment for mental health and behavioral health services (as defined in subsection (zz)(1)) furnished on or after October 1, 2026, and before October 1, 2030, by a physician or applicable professional (as defined in subsection (zz)(2)) at a rate that is not less than 100 percent of the payment rate that applies to such services and physician or applicable professional under part B of title XVIII (or, if greater, the payment rate that would be applicable under such part if the conversion factor under section 1848(d) for the year involved were the conversion factor under such section for 2026, and, if such services are not covered under such part, the reasonable and customary rate the Secretary determines would apply to such services and physician or applicable professional);; and (B) by adding at the end the following new subsection: (zz) Mental health and behavioral health services For purposes of subsection (a)(13)(D): (1) Mental health and behavioral health services (A) In general The term mental health and behavioral health services means the following services, when provided to a patient with a diagnosis of substance use disorder (as defined in subparagraph (B)) as a part of the management or treatment of the patient’s substance use disorder (as determined in accordance with regulations promulgated by the Secretary under subparagraph (C)): (i) Evaluation and management services that are procedure codes (for services covered under title XVIII) for services in the category designated Evaluation and Management in the Healthcare Common Procedure Coding System (established by the Secretary under section 1848(c)(5) as of December 31, 2020, and as subsequently modified). (ii) Counseling services, as defined by the Secretary. (iii) Payment codes established by the Secretary for opioid use disorder treatment services under section 1866F. (iv) Any other services the Secretary determines are necessary for the management or treatment of a patient with a diagnosis of substance use disorder. (B) Patient with a diagnosis of substance use disorder For purposes of subparagraph (A), the term patient with a diagnosis of substance use disorder means an individual who has been diagnosed with 1 or more diagnosis codes within the code set entitled the Mental health and behavioral disorders due to psychoactive substance use under the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. (C) Regulations Not later than 90 days after the enactment of this subsection, the Secretary shall promulgate regulations regarding when services are sufficiently related to part of the management or treatment of a patient’s substance use disorder. (2) Applicable professional The term applicable professional means— (A) a clinical psychologist (as defined for purposes of section 1861(ii)); (B) a clinical social worker (as defined in section 1861(hh)(1)); (C) a medical professional approved to furnish medication-assisted treatment under section 303(g)(2) of the Controlled Substances Act; or (D) a medical professional that is authorized under the State plan or under a waiver of such plan to furnish mental and behavioral health services (as defined in paragraph (1)).. (2) Managed care Section 1932(f) of such Act (42 U.S.C. 1396u–2(f)) is amended— (A) in the subsection heading, by inserting and mental health and behavioral health services after care services; and (B) by inserting before the period at the end the following:, and, in the case of mental health and behavioral health services described in section 1902(a)(13)(D), consistent with the minimum payment rates specified in such section (regardless of the manner in which such payments are made, including in the form of capitation or partial capitation). (b) Increased FMAP for additional costs Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (1) in subsection (b), by striking and (ii) and inserting (ii), and (ll); and (2) by adding at the end the following new subsection: (ll) Increased FMAP for additional expenditures for mental health and behavioral health services (1) In general Notwithstanding subsection (b), with respect to the portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(D) furnished on or after October 1, 2026, and before October 1, 2030, that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan or a waiver of such plan as of July 1, 2026, the Federal medical assistance percentage for a State shall be equal to 100 percent. The preceding sentence shall not be construed as prohibiting the payment of Federal financial participation based on the Federal medical assistance percentage for the portion of the amounts expended for medical assistance for such services that is attributable to the amount (if any) by which the payment rate applicable to such services under the State plan or waiver exceeds such minimum payment rate. (2) Disregard of enhanced payments for purposes of territorial limits The amount of any payment made for expenditures on medical assistance that is attributable to the application of the Federal medical assistance percentage described in paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108..