COMPLETE Care Act
- Sponsor
- Rep. Malliotakis, Nicole [R-NY-11]
- Committees
- Ways and Means Committee (primary)
- Last action
- Mar 31, 2025
Bottom line
The bill aims to enhance access to behavioral health services for Medicare beneficiaries by incentivizing primary care providers to integrate these services through temporary payment increases and dedicated technical support.
What it actually does
This bill amends the Social Security Act to provide temporary increased Medicare payments for specific behavioral health integration services furnished during 2027, 2028, and 2029, starting at 175% of the standard rate and decreasing annually. It also directs the Secretary of Health and Human Services to offer technical assistance to primary care practices adopting behavioral health integration models, appropriating 'such sums as are necessary' for this purpose from fiscal years 2025 through 2029.
Proponents argue
Supporters argue that this legislation will significantly improve access to critical behavioral health services by providing essential financial incentives and practical support to primary care providers, enabling them to integrate mental health and substance use care more effectively into their practices. They contend that this approach addresses a crucial gap in patient care, leading to better overall health outcomes for Medicare beneficiaries.
Opponents contend
Critics might express concerns that the temporary nature of the payment incentives may not lead to sustainable, long-term behavioral health integration, potentially resulting in a 'cliff effect' once the enhanced payments expire. Some may also question the fiscal implications of the increased Medicare outlays and the open-ended appropriation for technical assistance, arguing for more stringent budget controls.
The bill is concise and clearly written, making it accessible for a quick and informed evaluation by readers.
Section 2(a)
Temporary Medicare Payment Incentives for Behavioral Health Integration
This provision amends Medicare law to increase payments for specific behavioral health integration services provided by primary care practices. For services furnished in 2027, payments will be 175% of the standard rate; in 2028, 150%; and in 2029, 125%. This aims to encourage more primary care providers to offer integrated mental health and substance use services to Medicare beneficiaries. It also waives budget neutrality rules, meaning these increased payments will not trigger cuts to other physician services.
Supporters argue
Supporters argue that these enhanced payments are crucial for overcoming the initial financial and operational barriers that primary care practices face when integrating behavioral health services. This incentive will stimulate the adoption of these models, thereby expanding access to much-needed care for Medicare beneficiaries.
Critics contend
Critics might contend that temporary payment increases may not foster sustainable long-term changes in practice behavior, suggesting that providers might revert to previous models once the incentives expire, leading to a 'cliff effect' in service availability.
Tradeoffs
The provision balances the immediate need to incentivize integration with the challenge of ensuring long-term sustainability of these services without permanent, higher payment rates. It aims to kickstart adoption while managing potential future budget implications.
Section 2(b)
Technical Assistance for Behavioral Health Integration Adoption
This section requires the Secretary of Health and Human Services to establish programs by January 1, 2026, to provide technical assistance to primary care practices. This assistance will help practices adopt and implement behavioral health integration models, such as the Collaborative Care Model. The bill appropriates 'such sums as are necessary' from the Treasury for fiscal years 2025 through 2029 to fund this technical assistance.
This provision explicitly waives budget neutrality requirements for the increased Medicare payments for behavioral health integration services during 2027, 2028, and 2029. This means the higher payments will not be offset by reductions in other Medicare physician payments.
Section 1848(c)(2)(B)(iv) of the Social Security Act, as amended by Section 2(a)(2) of the bill
Why it matters:This is standard legislative practice for technical budget adjustments, designed to ensure that the intended policy effect (increased payments) is fully realized without inadvertently triggering cuts to other services under existing budget rules.
Case for: Supporters argue this waiver is essential to ensure the incentives are truly additive and do not inadvertently cause reductions in other physician services, which would undermine the bill's goal of expanding behavioral health integration.
Case against: Critics might argue that waiving budget neutrality for these payments could contribute to overall Medicare spending growth without a clear plan for long-term fiscal sustainability, potentially setting a precedent for other temporary payment increases.
Estimated impact: Ensures the increased payments for behavioral health integration are fully realized without offsetting cuts to other Medicare services, thereby increasing federal outlays for these specific services during the incentive period.
This provision appropriates 'such sums as are necessary' for fiscal years 2025 through 2029 to fund the technical assistance program for behavioral health integration.
Section 2(b)(4)
Why it matters:This is a common legislative technique to provide flexible funding without specifying an exact dollar amount, allowing the implementing agency to adapt to demand and unforeseen needs.
Case for: Proponents argue this flexible funding ensures the Secretary has adequate resources to effectively implement the technical assistance program, adapting to demand and unforeseen needs without being constrained by a fixed, potentially insufficient, budget.
Case against: Critics might express concern that 'such sums as are necessary' lacks fiscal accountability and transparency, potentially leading to higher-than-anticipated expenditures without specific congressional review or a clear spending cap.
Estimated impact: Provides uncapped funding for technical assistance for five fiscal years, potentially leading to significant federal outlays depending on program scope and uptake.