Ensuring Excellence in Mental Health Act

Bill Number

H.R. 8487

Origin Chamber

House

Congress

119th Congress, Session 2

Policy Area

Health

Status

Introduced

Latest Action

2026-04-23: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Last Updated

2026-06-24T08:09:18Z

AI-Generated Summary

Ensuring Excellence in Mental Health Act (H.R. 8487)

Purpose

This bill aims to improve access to high-quality behavioral health services by expanding coverage, creating fair payment systems, and providing support for certified community behavioral health clinics (CCBHCs) under Medicare and Medicaid. CCBHCs are community-based clinics that offer comprehensive mental health and substance use disorder services, including crisis care, outpatient therapy, and coordination with other providers. It also establishes federal grants, technical assistance, data reporting, accreditation options, and legal protections for clinicians.

Key Provisions

Title I: Medicaid Enhancements

• Coordination and Accreditation (Sec. 101): Aligns CCBHC services with federal grant programs; states can opt to use approved accreditation instead of full certification starting January 1, 2026.
• Prospective Payment System (PPS) (Sec. 102): Starting fiscal year 2026, states must use a PPS for CCBHC services (a method that sets payment rates in advance based on clinic costs). Payments use daily or monthly visit units, with options for special populations (e.g., high-need groups), outlier payments for high-cost cases, and separate rates for crisis services. Rates start at 100% of reasonable costs from a base year and update annually with inflation and service changes. New clinics use estimates or similar clinic data. States can rebase rates every 3 years. Includes rules for managed care supplemental payments.
• Service Expansion in Demonstrations (Sec. 103): Expands Medicaid demonstration programs to cover "required" CCBHC services (e.g., crisis intervention, therapy) and "additional" services (e.g., primary care like screenings), effective October 1, 2026.
• Service Expansion in Regular Medicaid (Sec. 104): Broadens Medicaid benefit to include both required and additional CCBHC services, effective October 1, 2026.

Title II: Medicare Coverage and Payments

• Coverage (Sec. 201): Adds CCBHC services as a Medicare benefit starting January 1, 2027.
• PPS Development (Sec. 202): Secretary of Health and Human Services (HHS) creates a Medicare PPS based on average reasonable clinic costs (no per-visit limits initially), updating annually with inflation (e.g., Medicare Economic Index, then a clinic-specific market basket). Allows periodic adjustments for service intensity.
• No Deductible (Sec. 203): Waives Medicare Part B annual deductible for CCBHC services.
• Cost Report Reviews (Sec. 204): CCBHCs can appeal cost reports to the Provider Reimbursement Review Board.
• Anti-Kickback Safe Harbor (Sec. 205): Extends protection allowing clinics to waive patient coinsurance without violating federal anti-kickback laws.
• Effective for services on/after January 1, 2026 (some 2027).

Title III: Federal Grants and Support

• Operating Grants (Sec. 340J-1): $552.5 million/year (FY 2026–2030) for CCBHCs or aspiring clinics to provide required services, infrastructure, training, and expansion. Prioritizes underserved areas, high-need populations; supplements other funding.
• Technical Assistance (Sec. 340J-2): $8 million/year (FY 2026–2030) for clinics, states, and partners on operations, management, and program setup.
• Data Infrastructure (Sec. 340J-3): $51 million/year (FY 2026–2030) for a national system to collect/analyze CCBHC data.
• Accreditation (Sec. 340J-4): HHS approves private organizations to accredit CCBHCs using federal criteria; provides oversight.

Title IV: Liability Protection

• Federal Tort Claims Act (FTCA) Coverage (Sec. 401): Extends FTCA protections (federal malpractice coverage) to clinicians working in CCBHCs, reducing personal liability risks.

Significant Changes to Existing Law

• New PPS Models: Replaces cost-based or demonstration payments with standardized, cost-related PPS for Medicaid (state-designed) and Medicare (federal), similar to systems for rural health or FQHCs.
• Service Expansion: Adds "additional" services (e.g., primary care integration) to CCBHC definitions in Medicaid demonstrations and benefits.
• Medicare Parity: Introduces first-time Medicare coverage for CCBHCs, mirroring Medicaid.
• Federal Support: Creates new grant programs, data systems, and accreditation; extends FQHC-like protections (deductible waiver, safe harbors, appeals).
• Builds on 2014 demonstration (Protecting Access to Medicare Act) by making changes permanent and nationwide.

Potential Impacts

• Government Agencies: HHS/CMS must design/implement PPS, manage grants ($611.5M+/year), data systems, and accreditation oversight; increased administrative workload but better data for policy.
• Citizens: Enhanced access to integrated behavioral health (including crisis/mobile teams) for ~65M Medicare/Medicaid enrollees, especially underserved/rural; reduced costs (no deductibles, potential waived coinsurance).
• Clinics/Providers: Stable, higher reimbursements encourage expansion; grants aid startup/sustainability; FTCA reduces barriers to staffing.
• No International Relations Impact.

Main Stakeholders Affected

• CCBHCs and Community Clinics: Primary beneficiaries of payments, grants, accreditation, protections.
• Medicare/Medicaid Enrollees: Especially those with mental health/substance use needs (e.g., low-income, elderly, veterans, youth).
• States: Flexibility in Medicaid PPS but required compliance; aids demonstration expansions.
• Clinicians: Liability shields improve recruitment/retention.
• HHS/CMS: Implementation leads.
• Accreditation Bodies/Private Nonprofits: New role in CCBHC certification.

Notable Legal, Constitutional, or Political Implications

• Legal: Aligns with mental health parity laws (e.g., ensuring behavioral health access like physical health); extends FQHC models without creating entitlements beyond appropriations.
• Constitutional: Falls under Congress's Spending Clause authority for Social Security Act programs; no federalism issues as states retain Medicaid options.
• Political: Bipartisan (Dem/Rep sponsors); addresses mental health crisis with community focus, potentially reducing ER/hospital reliance; authorizes ~$3B over 5 years without offsets.

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

Sponsor

Rep. Matsui, Doris O. [D-CA-7]

Cosponsors (10)

Rep. Pfluger, August [R-TX-11], Rep. Craig, Angie [D-MN-2], Rep. Alford, Mark [R-MO-4], Rep. Tonko, Paul [D-NY-20], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Goldman, Craig A. [R-TX-12], Rep. Davids, Sharice [D-KS-3], Rep. Balint, Becca [D-VT-At Large], Rep. Strickland, Marilyn [D-WA-10], Rep. Goodlander, Maggie [D-NH-2]

Recent Actions

• 2026-04-23: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-04-23: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-04-23: Introduced in House
• 2026-04-23: Introduced in House

Bill Versions

• Ensuring Excellence in Mental Health Act — issued 2026-04-23 — PDF (40 pages)