WeVote
Log In

Bill

Bill

HR 10240

Behavioral Health Crisis Services Expansion Act of 2026

119th Congress Introduced by Nanette Barragán and 4 co-sponsors

Expands mandatory coverage of crisis response services (mobile crisis, stabilization, urgent care) across Medicare, Medicaid, private plans, TRICARE, FEHB, and CHIPs with a standar

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 10240

Overview

Behavioral Health Crisis Services Expansion Act of 2026 (HR 10240) aims to require broader coverage and reimbursement for crisis response services across multiple federal programs and private plans. The bill defines crisis response services to include mobile crisis teams, crisis receiving and stabilization facilities, mental health or substance use urgent care facilities, and related crisis services. It sets coverage requirements under Medicare, Medicaid, private group health plans, ERISA-regulated plans, the IRC, TRICARE, Veterans’ programs, and federal employee health plans, with a phased effective date three years after enactment.

Primary purpose and intent

  • Expand and mandatorily cover crisis response services to improve access to timely mental health and substance use crisis care.
  • Create a standardized federal framework for payment, eligibility, and delivery of crisis services across public programs and private health coverage.
  • Encourage rapid linkage to appropriate crisis resources while reducing barriers related to cost and eligibility.

Key provisions and changes

Medicare

  • Adds crisis response services (as defined) to Medicare Part B coverage.
  • Defines crisis response services to include care by mobile crisis teams, crisis receiving and stabilization facilities, urgent care facilities, and other appropriate providers.
  • Establishes criteria for crisis receiving and stabilization facilities (licensure, 23-hour observation, 48-hour crisis beds, 24/7 services, no denial based on ability to pay or other patient factors, no-wrong-door admission, average length of stay under 150 hours).

Payment and reimbursement

  • Medicare: Crisis response services reimbursed at 80% of the lesser of the actual charge or the payment basis established under 1834(bb) (new payment methodology).
  • Establishes a specific payment basis for crisis response services to be determined by the Secretary.
  • Ambulance/transport for individuals in crisis: Coverage for crisis-related transport starting three years after enactment, to facilities appropriate for crisis response services.

Medicaid

  • Mandatory coverage of crisis response services under Medicaid (Title XIX) beginning three years after enactment.
  • Adds crisis response services to Medicaid eligibility/content requirements.
  • Allows crisis response service providers to make presumptive eligibility determinations.

Group health plans and health insurance issuers

  • PHSA (Public Health Service Act), ERISA, and Internal Revenue Code (IRC) sections added to require coverage.
    • Plans/issuers must cover crisis response services.
    • Financial requirements and treatment limitations applied to crisis services must be no more restrictive than those for substantially all medical/surgical benefits.
    • Definitions of “financial requirement,” “predominant,” and “treatment limitation” align with existing standards, but include aggregate lifetime and annual limits in the scope of financial requirements.

TRICARE and Veterans’ programs

  • TRICARE must cover crisis response services.
  • Reimbursement and coverage for crisis response services expanded within veterans’ healthcare programs.

Federal employee health plans (FEHB) and CHIP

  • FEHB contracts must provide coverage for crisis response services beginning three years after enactment.
  • CHIP (as applicable) aligns with the new crisis coverage requirements.

Who is affected

  • Beneficiaries of Medicare, Medicaid, group health plans, and health insurance issuers offering group or individual coverage.
  • TRICARE beneficiaries (military and dependents), veterans receiving care, and federal employees under FEHB.
  • Providers of crisis response services, including mobile crisis teams, crisis stabilization facilities, urgent care facilities, and related emergency mental health/substance use providers.
  • States, through Medicaid program adjustments and required state plan amendments, with potential phased implementation.

Procedural and timeline aspects

  • Effective date for most new provisions: three years after enactment.
  • States may require legislative action to meet new requirements; if needed, states may have extended timelines for compliance.
  • Ambulatory crisis urgent care facilities are defined for 24/7 operations; crisis transport and ambulance coverage follow the same three-year timeline for implementation.

Summary of potential impact

  • Increased access to timely crisis care across Medicare, Medicaid, private plans, TRICARE, and federal employee plans.
  • Standardized coverage and protections against discrimination based on ability to pay or other patient characteristics.
  • Potentially higher short-term costs for payers due to expanded coverage, balanced by intended reductions in downstream crisis utilization and hospitalizations.
  • Greater integration of crisis response services into the broader behavioral health system and improved coordination with law enforcement and emergency medical services through no-wrong-door admission policies.

If you’d like, I can tailor this summary for a specific audience (e.g., policymakers, health plan administrators, or providers) or add a quick comparison to current law.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.