CMS Issues Guidance on Mobile Crisis Services

The Centers for Medicare & Medicaid Services (CMS) has issued a State Health Official letter offering guidance on the scope of and payments for qualifying community-based mobile crisis intervention services authorized by section 9813 of the American Rescue Plan Act of 2021 (ARP). This provision authorizes a state option to provide qualifying community-based mobile crisis intervention services for a period of up to five years, during the period starting April 1, 2022, and ending March 31, 2027. States that have approved coverage and reimbursement authority through the state plan, section 1915(b) waiver programs with corresponding authority, section 1915(c) home and community-based services waiver programs, or section 1115 demonstration projects may receive an 85 percent federal medical assistance percentage (FMAP) for expenditures on qualifying community-based mobile crisis intervention services for the first 12 fiscal quarters within the five-year period during which they meet the conditions outlined in statute to qualify for the increased match.

Qualifying services

Qualifying community-based mobile crisis intervention services are defined as items and services for which medical assistance is available under the state plan or a waiver of the plan and that meet the following conditions:

  • services must be provided to individuals who are Medicaid eligible, either through the state plan or through a waiver of such plan, and who are experiencing a mental health or SUD crisis.
  • states need to ensure that services are provided to individuals outside of a hospital or other facility setting.
  • services must be delivered by a multi-disciplinary team that must include at least one behavioral health care professional who is qualified to provide an assessment within their authorized scope of practice under state law, and should also include other professionals or paraprofessionals with expertise in behavioral health or mental health crisis intervention
  • states must ensure that all members of the team are trained in trauma-informed care, de-escalation strategies and harm reduction.
  • states must also ensure that community-based mobile crisis intervention services teams are able to respond to crises in a timely manner. CMS is requiring states to establish and ensure training and timeliness standards that take into account additional travel time that may be needed for mobile crisis teams to respond in rural and remote areas.

States should also consider how to meet the needs for language access for people with limited-English proficiency or those who are deaf or hard of hearing and comply with any applicable requirements under the Americans with Disabilities Act, Rehabilitation Act and Civil Rights Act.

A community-based mobile crisis intervention team may provide beneficiaries  experiencing a mental health or SUD crisis in the community with medically necessary transportation to crisis receiving or stabilization settings to facilitate a warm handoff for ongoing care. States must ensure that community-based mobile crisis intervention services teams are maintaining relationships with relevant community partners, including medical and behavioral health providers, primary care providers, community health centers, crisis respite centers, and managed care plans (if applicable). And, states must ensure that community-based mobile crisis intervention services are available 24 hours a day, every day of the year.

Services may be provided through either a fee-for-service (FFS) or managed care delivery system. If providers are being paid through a FFS delivery system, states must comprehensively describe the rate-setting methodology used to pay providers of services. The methodology must be “consistent with efficiency, economy, and quality of care” and to be “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.”

Enhanced FMAP

FFP associated with the increased FMAP of 85 percent is available for qualifying expenditures for community-based mobile crisis intervention services, including the costs of services otherwise covered under the state plan or waiver of the plan that are furnished as part of the qualifying services, on a quarterly basis, for the first 12 fiscal quarters in which a state’s community-based mobile crisis intervention services program complies with statutory requirements, as long as the expenditures are incurred on or after April 1, 2022, and no later than March 31, 2027. CMS will be implementing changes to the Medicaid Budget and Expenditure/CHIP Budget and Expenditure System (MBES/CBES) to ensure that states will be able to accurately report budget estimates and expenditures related to the increased FMAP for qualifying community-based mobile crisis intervention services, consistent with the requirements of section 1947 of the Act. Community-based mobile crisis intervention services. CMS will provide FFP associated with the temporary increased FMAP to states based on budget estimates submitted on the quarterly Form CMS-37. CMS will then reconcile the advance FFP amounts associated with the temporary increased FMAP to states based on actual recorded expenditures submitted through the quarterly Form CMS-64.

In order to receive the increased FMAP for any fiscal quarter, states must demonstrate that additional federal funds for qualifying community-based mobile crisis intervention services that are attributable to the increased FMAP will supplement and not supplant the level of state funds expended for such services in the federal fiscal year prior to April 1, 2022. CMS interprets this to mean that in order to demonstrate compliance with this requirement, states must:

  • Not impose stricter standards for receipt of community-based mobile crisis intervention services than those in effect on the last day of the preceding federal fiscal year, September 30, 2021;
  • Preserve or exceed the amount, duration, and scope of community-based mobile crisis intervention services in effect on the last day of the preceding federal fiscal year, September 30, 2021; and,
  • Maintain community-based mobile crisis intervention services provider payments at a rate no less than those on the last day of the preceding federal fiscal year, September 30, 2021.

CMS points out that “Federal match may be available…for state Medicaid agency costs associated with establishing and supporting delivery of community-based mobile crisis intervention services for people with mental health conditions or SUD as well as call centers and other crisis stabilization services.” Allowable administrative activities could include “operating state crisis access lines and dispatching mobile crisis teams as needed to assist Medicaid beneficiaries.” States that are interested in claiming FFP for administrative costs associated with the delivery of qualifying community-based mobile crisis intervention services for people with mental health conditions or SUD should submit an amendment to their Public Assistance Cost Allocation Plan (PACAP), which is approved by HHS’ Division of Cost Allocation Services (CAS) with CMS concurrence. State Medicaid agency IT System costs may be eligible for enhanced FFP. Approval for enhanced match requires the submission of an Advanced Planning Document (APD). Additionally, a state may submit an APD requesting approval for a 90/10 enhanced match for the design, development and implementation of their Medicaid Enterprise Systems (MES) initiatives that contribute to the economic and efficient operation of the program, including technology supporting implementation of crisis call centers, community-based mobile crisis intervention services, and crisis stabilization centers, including the maintenance and operations of these services.

FMI: Read the SHO letter at https://www.medicaid.gov/federal-policy-guidance/downloads/sho21008.pdf.