Increasing Behavioral Health Treatment Act

Bill Number

H.R. 4022

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-06-17: Referred to the House Committee on Energy and Commerce.

Last Updated

2026-04-28T08:06:19Z

AI-Generated Summary

Purpose of the Legislation

The Increasing Behavioral Health Treatment Act (H.R. 4022) aims to expand access to Medicaid-funded behavioral health services by removing barriers to coverage for individuals in institutions for mental diseases (IMDs, which are facilities providing inpatient psychiatric or substance use disorder treatment for 16 or more people). It encourages a shift toward community-based and outpatient care while ensuring states plan for better support systems outside of institutions.

Key Provisions

• Removal of IMD Exclusion: Amends the Social Security Act to eliminate the general exclusion of Medicaid payments for items and services provided to patients in IMDs. This applies to all ages, not just those 65 and older.
• State Plan Requirements: States must develop and submit a plan to the Secretary of Health and Human Services (HHS) outlining actions to:
• Increase access to outpatient and community-based behavioral health care, especially for people transitioning out of IMDs.
• Expand crisis stabilization services (e.g., crisis call centers, mobile crisis units, coordinated responses with law enforcement, assessment centers, and ongoing community services like intensive outpatient programs or assertive community treatment) for individuals with serious mental illness (SMI, a severe psychiatric condition lasting at least a year), serious emotional disturbance (SED, in children and adolescents), or substance use disorder (SUD) crises.
• Improve data sharing and coordination among physical health providers, mental health facilities, addiction treatment centers, hospitals, and first responders to enhance outcomes for those in IMDs or in crisis.
• Demonstration of State Strategies: States must show:
• Policies ensuring screening for co-occurring physical health conditions and SUDs upon admission to psychiatric hospitals or residential settings, with capacity for on-site treatment or referrals.
• Methods to identify and engage at-risk individuals, particularly adolescents and young adults, in crisis.
• Utilization review policies by state Medicaid agencies or managed care organizations to ensure treatment occurs at the appropriate level of care in the least restrictive setting (e.g., community-based rather than institutional).
• Annual Reporting: States must report to HHS each year on:
• Costs and usage in IMDs and non-IMD inpatient psychiatric hospitals.
• Number of Medicaid recipients with SMI, SED, or SUD crises served.
• Length of stays in IMDs.
• Types of outpatient treatments (including medication-assisted treatment for SUDs) received after discharge.
• Effective Date: Changes take effect upon enactment, applying to state Medicaid plans immediately. States needing new legislation (beyond funding appropriations) get a grace period until the first calendar quarter after their next legislative session.

Significant Changes to Existing Law

• Eliminates IMD Exclusion: Previously, Medicaid (title XIX of the Social Security Act) barred federal funding for IMD services for individuals under 65, limiting coverage to acute care or those 65+. This bill removes that age-based restriction entirely, allowing full Medicaid reimbursement for IMD services if states meet planning requirements.
• Adds Accountability Measures: Introduces mandatory state plans, demonstrations, and reporting not previously required, shifting focus from institutional to community care. Conforming amendments update related sections (e.g., sections 1902(a), 1905(a), 1919(e)) to align with the broader coverage.
• Promotes Deinstitutionalization: Builds on existing Medicaid rules favoring community-based services but enforces them more stringently through plans and reviews, potentially reducing over-reliance on IMDs.

Potential Impacts

• On Government Agencies: HHS gains oversight through plan approvals and annual reports, increasing administrative workload. State Medicaid agencies must invest in planning, data systems, and coordination, potentially raising state costs but unlocking federal matching funds for IMD services.
• On Citizens: Improves access to mental health and SUD treatment for Medicaid enrollees (low-income individuals), especially those under 65 in IMDs or in crisis, by funding institutional care while prioritizing less restrictive outpatient options. Could reduce wait times for community services and support transitions, benefiting those with SMI, SED, or SUD (estimated 20+ million U.S. adults affected annually).
• On International Relations: No direct impact, as this is a domestic health policy focused on U.S. Medicaid.

Main Stakeholders Affected

• Medicaid Beneficiaries: Primarily low-income individuals with SMI, SED, or SUD, including those in IMDs, adolescents/young adults in crisis, and people transitioning to community care.
• State Governments and Medicaid Agencies: Responsible for implementing plans, reporting, and ensuring compliance; may face higher upfront costs but gain federal reimbursements.
• Healthcare Providers: IMDs, psychiatric hospitals, community behavioral health clinics (e.g., Certified Community Behavioral Health Clinics), crisis response teams, and first responders benefit from expanded funding and coordination.
• Federal Government (HHS): Oversees state compliance and data collection, potentially influencing national mental health policy.

Notable Legal, Constitutional, or Political Implications

• Legal: Strengthens federal-state partnership under Medicaid by conditioning funding on state plans, which could lead to legal challenges if states argue the requirements impose unfunded mandates (though the bill allows legislative grace periods). Aligns with existing Medicaid goals of promoting "least restrictive" care under the Americans with Disabilities Act, potentially reducing institutionalization lawsuits.
• Constitutional: No direct challenges anticipated, as it expands voluntary Medicaid benefits without infringing on state sovereignty or individual rights; supports equal protection by addressing disparities in mental health coverage.
• Political: May face debate over federal spending (estimated billions in new IMD reimbursements) and state flexibility, but bipartisan sponsorship (Reps. Carbajal and Bacon) suggests appeal in addressing the mental health crisis post-COVID. Could set precedent for further Medicaid expansions in behavioral health, influencing future appropriations and elections in states with high IMD usage.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Carbajal, Salud O. [D-CA-24]

Cosponsors (7)

Rep. Bacon, Don [R-NE-2], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Levin, Mike [D-CA-49], Rep. Brownley, Julia [D-CA-26], Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Golden, Jared F. [D-ME-2], Rep. Boyle, Brendan F. [D-PA-2]

Recent Actions

• 2025-06-17: Referred to the House Committee on Energy and Commerce.
• 2025-06-17: Introduced in House
• 2025-06-17: Introduced in House

Bill Versions

• Increasing Behavioral Health Treatment Act — issued 2025-06-17 — PDF (8 pages)