Congressional Research Service: 'Bipartisan Safer Communities Act – Section-by-Section Summary' (Part 1 of 3)
The report was written by health policy analyst
Here are excerpts:
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SUMMARY
On
Division A - Mental Health and Firearms Provisions
Title I -
Title I provisions are aimed primarily at enhancing access to mental health services, particularly for youth. Section 11001 amends the Protecting Access to Medicare Act of 2014 to extend the length of the
Title II - Firearms
Title II provisions primarily expand firearm purchasing requirements to young adults. Section 12001 amends the Gun Control Act of 1968 (GCA) to prohibit the transfer of firearms to persons who have potentially disqualifying records as a juvenile. The provision expands National Instant Criminal Background Check System (NICS) background check procedures to persons 18 to 21 years of age for disqualifying juvenile records and allows authorities up to 10 business days to make eligibility determinations. Section 12002 requires individuals who buy and resell firearms repeatedly for profit to be licensed federally as gun dealers. Section 12003 allows
Title III - Other Matters
Title III amends existing programs to reduce the overall budgetary cost of the BSCA and includes provisions related to federal resources for school safety. Section 13101 bars the HHS Secretary from implementing, administering, or enforcing the final Medicare anti-kickback rebate rule prior to 2027. Section 13201 changes the amount available in the
Division B - Appropriations
Division B of the BSCA appropriates funding to existing grant programs and other activities by the
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Contents
Introduction ... 1
Bipartisan Safer Communities Act Provisions ... 3
Section 1:
Section 2:
Section 3:
Division A - Mental Health and Firearms Provisions ... 3
Title I -
Section 11001: Expansion of Community Mental Health Services Demonstration Program ... 3
Section 11002: Medicaid and Telehealth ... 5
Section 11003: Supporting Access to Health Care Services in Schools ... 7
Section 11004: Review of State Implementation of Early and Periodic Screening, Diagnostic, and Treatment Services ... 9
Section 11005: Pediatric Mental Health Care Access Grants ... 10
Title II - Firearms ... 11
Section 12001: Juvenile Records ... 11
Section 12002: Defining "Engaged in the Business" ... 13
Section 12003: Use of Byrne Grants for Implementation of State Crisis Intervention Programs ... 14
Section 12004: Stop Illegal Trafficking in Firearms Act ... 15
Section 12005: Misdemeanor Crime of Domestic Violence ... 19
Title III - Other Matters ... 20
Subtitle A - Extension of Moratorium ... 20
Section 13101: Extension of Moratorium on Implementation of Rule Relating to Eliminating the Anti-Kickback Statute Safe Harbor Protection for Prescription Drug Rebates ... 20
Subtitle B -
Section 13201:
Subtitle C - Luke and Alex School Safety Act of 2022 ... 22
Section 13301:
Section 13302: Federal Clearinghouse on School Safety Evidence-Based Practices ... 22
Section 13303: Notification of Clearinghouse ... 23
Section 13304: Grant Program Review ... 24
Section 13305: Rules of Construction ... 24
Subtitle D - Amendment on ESEA Funding ... 24
Section 13401: Amendment on ESEA Funding ... 24
Division B - Appropriations ... 26
Title I ... 26
General Provisions - This Title [Title I] ... 29
Title II ... 30 General Provisions--This Title [Title II] ... 35
Sections 22001-22003 ... 35
Title III ... 35
General Provisions - This Division [Division B] ... 35
Tables
Table 1. List of BSCA Provisions and Corresponding CRS Points of Contact ... 1
Table 2.
Table 3.
Appendixes
Appendix. Abbreviations Used in This Report ... 37
Contacts
Author Information ... 39
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Introduction
On
The mass shooting in
Broadly, the BSCA amends background check procedures for firearm purchases, promotes youth mental health initiatives, and enhances school-based mental health efforts, among other things. Division A of the BSCA includes provisions primarily aimed at (1) expanding firearm purchasing requirements to young adults and (2) enhancing access to mental health services, including school-based mental health services and other youth programming. Division B of the BSCA appropriates funding to existing grant programs and other activities of
This report describes each of the provisions in the BSCA, providing brief, relevant background information on each provision and describing changes made by the provision. Table 2 and Table 3 provide information on the appropriations included in Division B of the BSCA. This report provides information on the BSCA as enacted; it does not include amendments to the law or subsequent changes to affected programs or provisions.
Table 1 lists the CRS authors of each section of the report. Congressional clients may direct questions on BSCA provisions or the affected federal programs in each provision to the corresponding CRS analyst.
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1
2
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Table 1. List of BSCA Provisions and Corresponding CRS Points of Contact
Source: CRS.
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Bipartisan Safer Communities Act Provisions
Section 1:
Section 1 designates a
Section 2:
Section 2 designates a postal service facility in
Section 3:
Section 3 notes that the act may be cited as the "Bipartisan Safer Communities Act" and provides a table of contents for provisions in the law.
Division A - Mental Health and Firearms Provisions
Title I -
Section 11001: Expansion of Community Mental Health Services Demonstration Program
Background
Section 223 of the Protecting Access to Medicare Act of 2014 (PAMA, P.L. 113-93) authorized a demonstration program to improve community-based behavioral health services through establishing certified community behavioral health clinics (CCBHCs)./3
CCBHCs are facilities operated by nonprofit, governmental, or tribal entities that offer a comprehensive range of behavioral health services, including risk assessment, outpatient mental health and substance use treatment, case management, psychiatric rehabilitation services, peer and family supports, 24hour crisis management, and primary care medical services, among others. To be certified, CCBHCs must provide these specified services and maintain partnerships with other health and social service providers.
In 2015, 24 states received planning grants for the CCBHC demonstration program. In 2016, eight states were selected to participate in the initial demonstration program./4
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3 Of note, FY2020 appropriations (P.L. 116-94) authorized a CCBHC expansion grant program and provided
4 Seven of the initial eight states continue to participate in the Certified Community Behavioral Health Clinics Demonstration Program.
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For the states chosen to participate in the CCBHC demonstration program in 2016, the end of the demonstration period had been extended by various laws, and before the BSCA, the demonstration program was authorized through
For CCBHC services provided to Medicaid enrollees, states in the demonstration receive the enhanced federal medical assistance percentage (E-FMAP; i.e., the federal reimbursement rate used for the State Children's Health Insurance Program) during the applicable demonstration period./5
In addition, the CCBHCs in these states receive enhanced Medicaid payment rates through a prospective payment system methodology for the services provided to Medicaid enrollees.
The HHS Secretary is required to submit annual reports to
Provision
Section 11001 amends PAMA Section 223/6 to extend the length of the demonstration period for the states currently participating in the CCBHC demonstration program. The provision also expands the CCBHC demonstration program to additional states.
For the states chosen to participate in the CCBHC demonstration program in 2016, the end of the demonstration period was extended by two years, from
The provision provides additional planning grants for states not already selected for the demonstration program. These planning grants are to be used to develop proposals to participate in the CCBHC demonstration program for a period of four years. Beginning
The provision allows states no longer participating in the CCBHC demonstration program to receive federal Medicaid funding for the prospective payment system (PPS) payment rate provided to CCBHCs./7
The provision clarifies that the annual reports about the CCBHC demonstration program submitted by the HHS Secretary should continue annually through the year in which the last demonstration ends. Additionally, the due date for the HHS Secretary's recommendations regarding whether the demonstration programs under this section should be continued, expanded, modified, or terminated is extended from
The provision appropriates
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5 For the Medicaid expansion population, the expansion population federal medical assistance percentage (FMAP) rate, which is 90%, applies.
6 42 U.S.C. 1396a note.
7 See footnote 4.
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Section 11002: Medicaid and Telehealth
Background
Medicaid, authorized in Social Security Act (SSA) Title XIX, is a federal-state program that jointly finances primary and acute medical and behavioral health services, as well as long-term services and supports (LTSS) to low-income populations, including eligible children, pregnant women, adults, individuals with disabilities, and people aged 65 and older./8
Participation in Medicaid is voluntary for states; all states, the
Medicaid is jointly financed by states and the federal government. States must follow broad federal rules governing eligibility, benefits, and other program design criteria to receive federal matching funds, but they have flexibility to design their own versions of Medicaid within the federal statute's basic framework. This flexibility results in variability across state Medicaid programs.
The State Children's Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual incomes above Medicaid eligibility levels but have no health insurance. CHIP is jointly financed by the federal government and the states, and the states are responsible for administering CHIP.
Federal Medicaid and CHIP statutes do not recognize telehealth as a distinct service category. However, the
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8 For more information, see CRS Report R43357, Medicaid: An Overview.
9 While Social Security Act (SSA) Section 1902(a)(30)(A) requires states to "assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area," certain provider types (e.g., behavioral health, dental) historically have low participation rates in Medicaid and CHIP. CMS has encouraged states to consider telehealth flexibilities as a way to increase access to care, among other strategies. For more information, see CMS, State Medicaid & CHIP Telehealth Toolkit Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version, available at https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf.
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In general, states must reimburse Medicaid providers for a telehealth service at the same rate as an in-person service, unless they have CMS approval to pay a different rate or with a unique reimbursement methodology./10
During the COVID-19 public health emergency (PHE), CMS released a series of subregulatory guidance (e.g., frequently asked questions, fact sheets, tool kits) to facilitate increased state reliance on telehealth as a service delivery tool in Medicaid and CHIP. These materials identify existing state flexibilities to augment telehealth and provide guidance to help states identify and address state-level barriers to the adoption of new telehealth delivery options. For changes requiring CMS approval, CMS provided templates and checklists to expedite state requests for time-limited flexibilities through legal authorities such as disaster relief state plan amendments (SPAs) and emergency-related Sections 1115, 1915(c) Appendix K, and 1135 waivers./11
The CMS COVID-19 templates and checklists for the disaster relief SPA and waivers identify an effective date retroactive to
Provision
Section 11002 requires the HHS Secretary to provide technical assistance and issue guidance to states on improving access to Medicaid and CHIP telehealth services no later than
* the use of existing Medicaid and CHIP program flexibilities to expand access to covered services via telehealth;
* service billing best practices to allow for the creation of consistent data sets;
* strategies to integrate telehealth services into value-based care models;/12
* best practices from states that expanded access to telehealth during the COVID19 PHE, as specified;
* strategies to promote the delivery of accessible and culturally competent health care via telehealth, specifically addressing the needs of (1) individuals with disabilities, (2) medically underserved urban and rural communities, (3) racial and ethnic minorities such as
* strategies to train and provide resources in multiple languages to providers and patients on how to use telehealth, including interpreter services;
* integration of existing video platforms that enable multi-person video calls;
* best practices for the delivery of Medicaid- and/or CHIP-covered services via telehealth in schools, including mental health and substance use disorder services;
* evaluation strategies to measure the effects of Medicaid and CHIP telehealth service delivery on health care quality, outcomes, and costs; and
* enrollee information-sharing best practices related to the availability of telehealth services, including the types of services offered via telehealth, allowable modalities, and where services can be provided, among other criteria.
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10 CMS approval may be obtained through a state plan amendment (SPA) or other Medicaid authority such as a Section 1115 waiver. For more information, see CRS In Focus IF11664, Medicaid Telehealth Policies in Response to COVID19.
11 For more information, see CRS In Focus IF11664, Medicaid Telehealth Policies in Response to COVID-19.
12 Value-based care models or arrangements are health care payment and delivery models designed to reward health care professionals for the quality of health care provided, rather than the quantity of services rendered. Additional information is available at https://www.medicaid.gov/resources-for-states/innovation-accelerator-program/functionalareas/value-based-payment-financial-simulations/index.html.
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Section 11003: Supporting Access to Health Care Services in Schools
Background
As mentioned above, Medicaid is a federal-state program that provides primary and acute medical and behavioral health services, as well as long-term services and supports, to low-income populations, including children, pregnant women, adults, individuals with disabilities, and people aged 65 and older./13
Participation in Medicaid is voluntary for states; all states, the
Federal law does not define "school-based services" (SBS) as a category of Medicaid services, nor does it define schools as a category of Medicaid providers. Rather, SBSs are Medicaid-coverable services provided to Medicaid-enrolled children and adolescents in school settings by qualified Medicaid providers who are enrolled in the Medicaid program. Like services furnished elsewhere, Medicaid-covered services provided in schools must meet applicable statutory and regulatory requirements.
Three main types of Medicaid-covered services and activities occur in schools: (1) health and related services listed in a student's individualized education plan (IEP), individualized family service plan (IFSP), or individual service plans per Section 504 of the Rehabilitation Act of 1973 as required under the Individuals with Disabilities Education Act (IDEA);/14 (2) preventive, primary, and acute care services; and (3) Medicaid administrative activities. Specifically, Medicaid is the primary payer to ED for certain specialized health care and related services (e.g., transportation; interpretation; speech, physical, and occupational therapies; psychological and other counseling services) that states are required to provide to Medicaid-enrolled students with disabilities under the IDEA.
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13 For more information, see CRS Report R43357, Medicaid: An Overview.
14 For more information on IEPs, see CRS Report R41833, The Individuals with Disabilities Education Act (IDEA), Part B: Key Statutory and Regulatory Provisions. For more information on IFSPs, see CRS Report R43631, The Individuals with Disabilities Education Act (IDEA), Part C: Early Intervention for Infants and Toddlers with Disabilities.
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School health programs may provide a broad range of primary care and preventive services to the student population at large in a school. When relevant supervision, licensure, and other requirements are met, schools may bill Medicaid for these services. Schools may also partner with a "sponsoring agency," such as a community health center or hospital system, to form a school-based health center (SBHC) to furnish primary, acute, and preventive care services to the student body at large and bill Medicaid for the services provided to Medicaid-enrolled students./15
States may also enter agreements with public authorities that maintain administrative control of public elementary or secondary schools in a political subdivision of the state (e.g., city, county, or school district)/16 to participate in Medicaid administrative activities such as outreach, referral, and translation services, and to reimburse them for those activities. Unlike with Medicaid direct services, school districts are not required to have a Medicaid provider agreement to receive payment for Medicaid administration./17
Provision
Section 11003 directs the HHS Secretary, in consultation with the Secretary of Education, to issue updated SBS guidance and to establish a
The updated SBS guidance must
* include updates to the
* provide strategies to reduce administrative burdens on LEAs and support compliance with federal billing, payment, and recordkeeping requirements;
* report on approved payment methods and best practices to increase the availability of Medicaid SBSs (including best practices for using telehealth, providing trauma-informed culturally competent care, and coordinating with managed care entities, among other areas); and
* provide examples of SBS Medicaid providers and best practices for the enrollment of these providers under Medicaid.
The HHS Secretary must ensure that resources are designed to support small and rural schools seeking to expand federal reimbursement for Medicaid SBSs. Finally, the
The provision appropriates
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15 In SBHC arrangements, the sponsoring agency typically serves as the enrolled Medicaid provider.
16 Examples include State Education Agencies (SEAs); Education Services Agencies (ESAs); Local Education Agencies (LEAs), including charter schools that are LEAs; and public boards of education or other public authorities within a state that maintain administrative control of public elementary or secondary schools in a city, county, township, school district, or other political subdivision of the state.
17 The scope of allowable school-based administrative activities is described in 2003 CMS policy guidance, the Medicaid School-Based Administrative Claiming Guide.
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Section 11004: Review of State Implementation of Early and Periodic Screening, Diagnostic, and Treatment Services
Background
The Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) program is a required benefit for nearly all children (under age 21) who are enrolled in Medicaid. It covers health screenings and services, including assessments of children's physical and mental health development; laboratory tests (including lead blood level assessment); appropriate immunizations; health education; and vision, dental, and hearing services./18
The screenings and services must be provided at regular intervals that meet "reasonable" medical or dental practice standards./19
States are required to provide all federally allowable, medically necessary treatment to correct problems identified through screenings, even if the specific treatment needed is not otherwise covered under a given state's Medicaid plan./20
Any prior authorization process or service limitations that states choose to impose on EPSDT treatment services must be based on the medical necessity determination for each child, not on numerical caps (e.g., limitations on the number of allowable visits per year)./21
EPSDT also includes a Medicaid administration component. Each state must (1) inform all Medicaid-eligible children under age 21 of the availability of EPSDT (referred to as EPSDT "outreach"); (2) arrange (directly or through referrals) for corrective treatment for conditions disclosed through EPSDT screenings; and (3) report to CMS on demographic information and counts of enrollees who received EPSDT screenings, who were referred to and/or received corrective treatment, and who received dental services./22
Provision
Section 11004 requires the HHS Secretary, no later than
* review state implementation of Medicaid EPSDT requirements (including with respect to the provision of these requirements by Medicaid managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and primary care case managers; hereafter referred to as Medicaid MCOs);
* identify state EPSDT compliance concerns;
* provide technical assistance to states to address any such EPSDT compliance concerns; and
* issue state guidance on EPSDT Medicaid coverage that identifies best practices for ensuring that children have access to comprehensive health care services, including for children without a mental health or substance use disorder diagnosis.
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18 SSA Sections 1905(r), 1902(a)(43), and 1905(a)(4)(B). EPSDT is not a mandatory benefit for the medically needy, although states that choose to extend EPSDT to their medically needy population must make the benefit available to all Medicaid-eligible individuals under age 21.
19 SSA Section 1905(r).
20 See footnote 13 and footnote 15.
21 CMS, EPSDT - A Guide for States,
22 SSA Section 1902(a)(43).
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The HHS Secretary is required to submit a report to the
The provision also requires the Comptroller General (head of the
The provision appropriates
Section 11005: Pediatric Mental Health Care Access Grants
Background
In 2016, the 21st Century Cures Act (P.L. 114-255) added a new Public Health Service Act (PHSA) Section 330M, which created the Pediatric Mental Health Care Access (PMHCA) program within
Provision
Section 11005 amends PHSA Section 330M by adding new requirements to the program, codifying certain authorities, and making several technical edits. Specifically, the BSCA provision requires pediatric mental health care telehealth access programs to provide consultative support, training, and technical assistance to emergency departments, state and local educational agencies, and K-12 schools. The provision also requires PMHCA programs receiving an award to provide information about available community mental health services to primary care providers and adds "developmental-behavioral pediatricians" as referable providers. The provision allows the HHS Secretary to provide technical assistance to award recipients. It also codifies cooperative agreements as allowable awards and makes several technical edits to the authorization.
The BSCA provision amends the authorization of appropriations for the PMHCA program to
Of note, Division B of the BSCA appropriates a total of
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23
24 HHS, "HHS Announces
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Continues with part 2 of 3
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The report is posted at: https://crsreports.congress.gov/product/pdf/R/R47310
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