US Codex
Pub. L.
Notes

Title V — Other Medicaid Provisions

115th Congress · Approved Oct 24, 2018 · 132 Stat. 3894 · Lineage

TITLE V Other Medicaid Provisions

Subtitle A Mandatory Reporting With Respect to Adult Behavioral Health Measures

SEC. 5001. Mandatory Reporting with Respect to Adult Behavioral Health Measures.

Section 1139B of the Social Security Act (42 U.S.C. 1320b–9b) is amended—
(1)
in subsection (b)—
(A)
in paragraph (3)—
(i)
by striking “ Not later than January 1, 2013” and inserting the following:

“(A) Voluntary reporting.—Not later than January 1, 2013”

; and

(ii)
by adding at the end the following:

“(B) Mandatory reporting with respect to behavioral health measures.—Beginning with the State report required under subsection (d)(1) for 2024, the Secretary shall require States to use all behavioral health measures included in the core set of adult health quality measures and any updates or changes to such measures to report information, using the standardized format for reporting information and procedures developed under subparagraph (A), regarding the quality of behavioral health care for Medicaid eligible adults.”

; and

(B)
in paragraph (5), by adding at the end the following new subparagraph:

“(C) Behavioral health measures.—Beginning with respect to State reports required under subsection (d)(1) for 2024, the core set of adult health quality measures maintained under this paragraph (and any updates or changes to such measures) shall include behavioral health measures.”

; and

(2)
in subsection (d)(1)(A)—
(A)
by striking “ the such plan” and inserting “ such plan”; and
(B)
by striking “ subsection (a)(5)” and inserting “ subsection (b)(5) and, beginning with the report for 2024, all behavioral health measures included in the core set of adult health quality measures maintained under such subsection (b)(5) and any updates or changes to such measures (as required under subsection (b)(3))”.

Subtitle B Medicaid IMD Additional Info

SEC. 5011. Short Title.

This subtitle may be cited as the “Medicaid Institutes for Mental Disease Are Decisive in Delivering Inpatient Treatment for Individuals but Opportunities for Needed Access are Limited without Information Needed about Facility Obligations Act” or the “Medicaid IMD ADDITIONAL INFO Act”.

SEC. 5012. Macpac Exploratory Study and Report on Institutions for Mental Diseases Requirements and Practices under Medicaid.

(a)
In General.— Not later than January 1, 2020, the Medicaid and CHIP Payment and Access Commission established under section 1900 of the Social Security Act (42 U.S.C. 1396) shall conduct an exploratory study, using data from a representative sample of States, and submit to Congress a report on at least the following information, with respect to services furnished to individuals enrolled under State plans under the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.) (or waivers of such plans) who are patients in institutions for mental diseases and for which payment is made through fee-for-service or managed care arrangements under such State plans (or waivers):
(1)
A description of such institutions for mental diseases in each such State, including at a minimum—
(A)
the number of such institutions in the State;
(B)
the facility type of such institutions in the State; and
(C)
any coverage limitations under each such State plan (or waiver) on scope, duration, or frequency of such services.
(2)
With respect to each such institution for mental diseases in each such State, a description of—
(A)
such services provided at such institution;
(B)
the process, including any timeframe, used by such institution to clinically assess and reassess such individuals; and
(C)
the discharge process used by such institution, including any care continuum of relevant services or facilities provided or used in such process.
(3)
A description of—
(A)
any Federal waiver that each such State has for such institutions and the Federal statutory authority for such waiver; and
(B)
any other Medicaid funding sources used by each such State for funding such institutions, such as supplemental payments.
(4)
A summary of State requirements (such as certification, licensure, and accreditation) applied by each such State to such institutions in order for such institutions to receive payment under the State plan (or waiver) and how each such State determines if such requirements have been met.
(5)
A summary of State standards (such as quality standards, clinical standards, and facility standards) that such institutions must meet to receive payment under such State plans (or waivers) and how each such State determines if such standards have been met.
(6)
If determined appropriate by the Commission, recommendations for policies and actions by Congress and the Centers for Medicare & Medicaid Services, such as on how State Medicaid programs may improve care and improve standards and including a recommendation for how the Centers for Medicare & Medicaid Services can improve data collection from such programs to address any gaps in information.
(b)
Stakeholder Input.— In carrying out subsection (a), the Medicaid and CHIP Payment and Access Commission shall seek input from State Medicaid directors and stakeholders, including at a minimum the Substance Abuse and Mental Health Services Administration, Centers for Medicare & Medicaid Services, State Medicaid officials, State mental health authorities, Medicaid beneficiary advocates, health care providers, and Medicaid managed care organizations.
(c)
Definitions.— In this section:
(1)
Representative sample of states.— The term “representative sample of States” means a non-probability sample in which at least two States are selected based on the knowledge and professional judgment of the selector.
(2)
State.— The term “State” means each of the 50 States, the District of Columbia, and any commonwealth or territory of the United States.
(3)
Institution for mental diseases.— The term “institution for mental diseases” has the meaning given such term in section 435.1010 of title 42, Code of Federal Regulations, or any successor regulation.

Subtitle C CHIP Mental Health and Substance Use Disorder Parity

SEC. 5021. Short Title.

This subtitle may be cited as the “CHIP Mental Health and Substance Use Disorder Parity Act”.

SEC. 5022. Ensuring Access to Mental Health and Substance Use Disorder Services for Children and Pregnant Women under the Children’s Health Insurance Program.

(a)
In General.— Section 2103(c)(1) of the Social Security Act (42 U.S.C. 1397cc(c)(1)) is amended by adding at the end the following new subparagraph:

“(E) Mental health and substance use disorder services (as defined in paragraph (5)).”

(b)
Mental Health and Substance Use Disorder Services.—
(1)
In general.— Section 2103(c) of the Social Security Act (42 U.S.C. 1397cc(c)) is amended—
(A)
by redesignating paragraphs (5), (6), (7), and (8) as paragraphs (6), (7), (8), and (9), respectively; and
(B)
by inserting after paragraph (4) the following new paragraph:

“(5) Mental health and substance use disorder services.—Regardless of the type of coverage elected by a State under subsection (a), child health assistance provided under such coverage for targeted low-income children and, in the case that the State elects to provide pregnancy-related assistance under such coverage pursuant to section 2112, such pregnancy-related assistance for targeted low-income pregnant women (as defined in section 2112(d)) shall—

“(A) include coverage of mental health services (including behavioral health treatment) necessary to prevent, diagnose, and treat a broad range of mental health symptoms and disorders, including substance use disorders; and

“(B) be delivered in a culturally and linguistically appropriate manner.”

(2)
Conforming amendments.—
(A)
Section 2103(a) of the Social Security Act (42 U.S.C. 1397cc(a)) is amended, in the matter before paragraph (1), by striking “ paragraphs (5), (6), and (7)” and inserting “ paragraphs (5), (6), (7), and (8)”.
(B)
Section 2110(a) of the Social Security Act (42 U.S.C. 1397jj(a)) is amended—
(i)
in paragraph (18), by striking “ substance abuse” each place it appears and inserting “ substance use”; and
(ii)
in paragraph (19), by striking “ substance abuse” and inserting “ substance use”.
(C)
Section 2110(b)(5)(A)(i) of the Social Security Act (42 U.S.C. 1397jj(b)(5)(A)(i)) is amended by striking “ subsection (c)(5)” and inserting “ subsection (c)(6)”.
(c)
Assuring Access to Care.— Section 2102(a)(7)(B) of the Social Security Act (42 U.S.C. 1397bb(c)(2)) is amended by striking “ section 2103(c)(5)” and inserting “ paragraphs (5) and (6) of section 2103(c)”.
(d)
Mental Health Services Parity.— Subparagraph (A) of paragraph (7) of section 2103(c) of the Social Security Act (42 U.S.C. 1397cc(c)) (as redesignated by subsection (b)(1)) is amended to read as follows:

“(A) In general.—A State child health plan shall ensure that the financial requirements and treatment limitations applicable to mental health and substance use disorder services (as described in paragraph (5)) provided under such plan comply with the requirements of section 2726(a) of the Public Health Service Act in the same manner as such requirements or limitations apply to a group health plan under such section.”

(e)
Effective Date.—
(1)
In general.— Subject to paragraph (2), the amendments made by this section shall take effect with respect to child health assistance provided on or after the date that is 1 year after the date of the enactment of this Act.
(2)
Exception for state legislation.— In the case of a State child health plan under title XXI of the Social Security Act (or a waiver of such plan), which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan (or waiver) to meet any requirement imposed by the amendments made by this section, the respective plan (or waiver) shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this section. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.

Subtitle D Medicaid Reentry

SEC. 5031. Short Title.

This subtitle may be cited as the “Medicaid Reentry Act”.

SEC. 5032. Promoting State Innovations to Ease Transitions Integration to the Community for Certain Individuals.

(a)
Stakeholder Group Development of Best Practices; State Medicaid Program Innovation.—
(1)
Stakeholder group best practices.— Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall convene a stakeholder group of representatives of managed care organizations, Medicaid beneficiaries, health care providers, the National Association of Medicaid Directors, and other relevant representatives from local, State, and Federal jail and prison systems to develop best practices (and submit to the Secretary and Congress a report on such best practices) for States—
(A)
to ease the health care-related transition of an individual who is an inmate of a public institution from the public institution to the community, including best practices for ensuring continuity of health insurance coverage or coverage under the State Medicaid plan under title XIX of the Social Security Act, as applicable, and relevant social services; and
(B)
to carry out, with respect to such an individual, such health care-related transition not later than 30 days after such individual is released from the public institution.
(2)
State medicaid program innovation.— The Secretary of Health and Human Services shall work with States on innovative strategies to help individuals who are inmates of public institutions and otherwise eligible for medical assistance under the Medicaid program under title XIX of the Social Security Act transition, with respect to enrollment for medical assistance under such program, seamlessly to the community.
(b)
Guidance on Innovative Service Delivery Systems Demonstration Project Opportunities.— Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services, through the Administrator of the Centers for Medicare & Medicaid Services, shall issue a State Medicaid Director letter, based on best practices developed under subsection (a)(1), regarding opportunities to design demonstration projects under section 1115 of the Social Security Act (42 U.S.C. 1315) to improve care transitions for certain individuals who are soon-to-be former inmates of a public institution and who are otherwise eligible to receive medical assistance under title XIX of such Act, including systems for, with respect to a period (not to exceed 30 days) immediately prior to the day on which such individuals are expected to be released from such institution—
(1)
providing assistance and education for enrollment under a State plan under the Medicaid program under title XIX of such Act for such individuals during such period; and
(2)
providing health care services for such individuals during such period.
(c)
Rule of Construction.— Nothing under title XIX of the Social Security Act or any other provision of law precludes a State from reclassifying or suspending (rather than terminating) eligibility of an individual for medical assistance under title XIX of the Social Security Act while such individual is an inmate of a public institution.

Subtitle E Medicaid Partnership

SEC. 5041. Short Title.

This subtitle may be cited as the “Medicaid Providers Are Required To Note Experiences in Record Systems to Help In-need Patients Act” or the “Medicaid PARTNERSHIP Act”.

SEC. 5042. Medicaid Providers Are Required to Note Experiences in Record Systems to Help In-Need Patients.

(a)
Requirements Under the Medicaid Program Relating to Qualified Prescription Drug Monitoring Programs and Prescribing Certain Controlled Substances.— Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting after section 1943 the following new section:

“SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRESCRIPTION DRUG MONITORING PROGRAMS AND PRESCRIBING CERTAIN CONTROLLED SUBSTANCES.

“(a) In General.—Subject to subsection (d), beginning October 1, 2021, a State—

“(1) shall require each covered provider to check, in accordance with such timing, manner, and form as specified by the State, the prescription drug history of a covered individual being treated by the covered provider through a qualified prescription drug monitoring program described in subsection (b) before prescribing to such individual a controlled substance; and

“(2) in the case that such a provider is not able to conduct such a check despite a good faith effort by such provider—

“(A) shall require the provider to document such good faith effort, including the reasons why the provider was not able to conduct the check; and

“(B) may require the provider to submit, upon request, such documentation to the State.

“(b) Qualified Prescription Drug Monitoring Program Described.—A qualified prescription drug monitoring program described in this subsection is, with respect to a State, a prescription drug monitoring program administered by the State that, at a minimum, satisfies each of the following criteria:

“(1) The program facilitates access by a covered provider to, at a minimum, the following information with respect to a covered individual, in as close to real-time as possible:

“(A) Information regarding the prescription drug history of a covered individual with respect to controlled substances.

“(B) The number and type of controlled substances prescribed to and filled for the covered individual during at least the most recent 12-month period.

“(C) The name, location, and contact information (or other identifying number selected by the State, such as a national provider identifier issued by the National Plan and Provider Enumeration System of the Centers for Medicare & Medicaid Services) of each covered provider who prescribed a controlled substance to the covered individual during at least the most recent 12-month period.

“(2) The program facilitates the integration of information described in paragraph (1) into the workflow of a covered provider, which may include the electronic system the covered provider uses to prescribe controlled substances.

“(c) Application of Privacy Rules Clarification.—The Secretary shall clarify privacy requirements, including requirements under the regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), related to the sharing of data under subsection (b) in the same manner as the Secretary is required under subparagraph (J) of section 1860D–4(c)(5) to clarify privacy requirements related to the sharing of data described in such subparagraph.

“(d) Ensuring Access.—In order to ensure reasonable access to health care, the Secretary shall waive the application of the requirement under subsection (a), with respect to a State, in the case of natural disasters and similar situations, and in the case of the provision of emergency services (as defined for purposes of section 1860D–4(c)(5)(D)(ii)(II)).

“(e) Reports.—

“(1) State reports.—Each State shall include in the annual report submitted to the Secretary under section 1927(g)(3)(D), beginning with such reports submitted for 2023, information including, at a minimum, the following information for the most recent 12-month period:

“(A) The percentage of covered providers (as determined pursuant to a process established by the State) who checked the prescription drug history of a covered individual through a qualified prescription drug monitoring program described in subsection (b) before prescribing to such individual a controlled substance.

“(B) Aggregate trends with respect to prescribing controlled substances such as—

“(i) the quantity of daily morphine milligram equivalents prescribed for controlled substances;

“(ii) the number and quantity of daily morphine milligram equivalents prescribed for controlled substances per covered individual; and

“(iii) the types of controlled substances prescribed, including the dates of such prescriptions, the supplies authorized (including the duration of such supplies), and the period of validity of such prescriptions, in different populations (such as individuals who are elderly, individuals with disabilities, and individuals who are enrolled under both this title and title XVIII).

“(C) Whether or not the State requires (and a detailed explanation as to why the State does or does not require) pharmacists to check the prescription drug history of a covered individual through a qualified prescription drug monitoring program described in subsection (b) before dispensing a controlled substance to such individual.

“(D) An accounting of any data or privacy breach of a qualified prescription drug monitoring program described in subsection (b), the number of covered individuals impacted by each such breach, and a description of the steps the State has taken to address each such breach, including, to the extent required by State or Federal law or otherwise determined appropriate by the State, alerting any such impacted individual and law enforcement of the breach.

“(2) Report by cms.—Not later than October 1, 2023, the Administrator of the Centers for Medicare & Medicaid Services shall publish on the publicly available website of the Centers for Medicare & Medicaid Services a report including the following information:

“(A) Guidance for States on how States can increase the percentage of covered providers who use qualified prescription drug monitoring programs described in subsection (b).

“(B) Best practices for how States and covered providers should use such qualified prescription drug monitoring programs to reduce the occurrence of abuse of controlled substances.

“(f) Increase to FMAP and Federal Matching Rates for Certain Expenditures Relating to Qualified Prescription Drug Monitoring Programs.—

“(1) In general.—With respect to a State that meets the condition described in paragraph (2) and any quarter occurring during fiscal year 2019 or fiscal year 2020, the Federal medical assistance percentage or Federal matching rate that would otherwise apply to such State under section 1903(a) for such quarter, with respect to expenditures by the State for activities under the State plan (or a waiver of such plan) to design, develop, or implement a prescription drug monitoring program (and to make connections to such program) that satisfies the criteria described in paragraphs (1) and (2) of subsection (b), shall be equal to 100 percent.

“(2) Condition.—The condition described in this paragraph, with respect to a State, is that the State (in this paragraph referred to as the ‘administering State’) has in place agreements with all States that are contiguous to such administering State that, when combined, enable covered providers in all such contiguous States to access, through the prescription drug monitoring program, the information that is described in subsection (b)(1) of covered individuals of such administering State and that covered providers in such administering State are able to access through such program.

“(g) Rule of Construction.—Nothing in this section prevents a State from requiring pharmacists to check the prescription drug history of covered individuals through a qualified prescription drug monitoring program before dispensing controlled substances to such individuals.

“(h) Definitions.—In this section:

“(1) Controlled substance.—The term ‘controlled substance’ means a drug that is included in schedule II of section 202(c) of the Controlled Substances Act and, at the option of the State involved, a drug included in schedule III or IV of such section.

“(2) Covered individual.—The term ‘covered individual’ means, with respect to a State, an individual who is enrolled in the State plan (or under a waiver of such plan). Such term does not include an individual who—

“(A) is receiving—

“(i) hospice or palliative care; or

“(ii) treatment for cancer;

“(B) is a resident of a long-term care facility, of a facility described in section 1905(d), or of another facility for which frequently abused drugs are dispensed for residents through a contract with a single pharmacy; or

“(C) the State elects to treat as exempted from such term.

“(3) Covered provider.—

“(A) In general.—The term ‘covered provider’ means, subject to subparagraph (B), with respect to a State, a health care provider who is participating under the State plan (or waiver of the State plan) and licensed, registered, or otherwise permitted by the State to prescribe a controlled substance (or the designee of such provider).

“(B) Exceptions.—

“(i) In general.—Beginning October 1, 2021, for purposes of this section, such term does not include a health care provider included in any type of health care provider determined by the Secretary to be exempt from application of this section under clause (ii).

“(ii) Exceptions process.—Not later than October 1, 2020, the Secretary, after consultation with the National Association of Medicaid Directors, national health care provider associations, Medicaid beneficiary advocates, and advocates for individuals with rare diseases, shall determine, based on such consultations, the types of health care providers (if any) that should be exempted from the definition of the term ‘covered provider’ for purposes of this section.”

(b)
Guidance.— Not later than October 1, 2019, the Administrator of the Centers for Medicare & Medicaid Services, in consultation with the Director of the Centers for Disease Control and Prevention, shall issue guidance on best practices on the uses of prescription drug monitoring programs required of prescribers and on protecting the privacy of Medicaid beneficiary information maintained in and accessed through prescription drug monitoring programs.
(c)
Development of Model State Practices.—
(1)
In general.— Not later than October 1, 2020, the Secretary of Health and Human Services shall develop and publish model practices to assist State Medicaid program operations in identifying and implementing strategies to utilize data-sharing agreements described in the matter following paragraph (2) of section 1944(b) of the Social Security Act, as added by subsection (a), for the following purposes:
(A)
Monitoring and preventing fraud, waste, and abuse.
(B)
Improving health care for individuals enrolled in a State plan under title XIX of such Act (or under a waiver of such plan) who—
(i)
transition in and out of coverage under such title;
(ii)
may have sources of health care coverage in addition to coverage under such title; or
(iii)
pay for prescription drugs with cash.
(C)
Any other purposes specified by the Secretary.
(2)
Elements of model practices.— The model practices described in paragraph (1)—
(A)
shall include strategies for assisting States in allowing the medical director or pharmacy director (or designees of such a director) of managed care organizations or pharmaceutical benefit managers to access information with respect to all covered individuals served by such managed care organizations or pharmaceutical benefit managers to access as a single data set, in an electronic format; and
(B)
shall include any appropriate beneficiary protections and privacy guidelines.
(3)
Consultation.— In developing model practices under this subsection, the Secretary shall consult with the National Association of Medicaid Directors, managed care entities (as defined in section 1932(a)(1)(B) of the Social Security Act) with contracts with States pursuant to section 1903(m) of such Act, pharmaceutical benefit managers, physicians and other health care providers, beneficiary advocates, and individuals with expertise in health care technology related to prescription drug monitoring programs and electronic health records.
(d)
Report by Comptroller General.— Not later than October 1, 2020, the Comptroller General of the United States shall issue a report examining the operation of prescription drug monitoring programs administered by States, including data security and access standards used by such programs.

Subtitle F IMD CARE Act

SEC. 5051. Short Title.

This title may be cited as the “Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act” or the “IMD CARE Act”.

SEC. 5052. State Option to Provide Medicaid Coverage for Certain Individuals with Substance Use Disorders Who Are Patients in Certain Institutions for Mental Diseases.

(a)
In General.— Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), as amended by preceding sections of this Act, is further amended—
(1)
in section 1905(a), in the subdivision (B) that follows paragraph (30), by inserting “ (except in the case of services provided under a State plan amendment described in section 1915(l))” before the period; and
(2)
in section 1915, by adding at the end the following new subsection:

“(l) State Plan Amendment Option to Provide Medical Assistance for Certain Individuals Who Are Patients in Certain Institutions for Mental Diseases.—

“(1) In general.—With respect to calendar quarters beginning during the period beginning October 1, 2019, and ending September 30, 2023, a State may elect, through a State plan amendment, to provide medical assistance for items and services furnished to an eligible individual who is a patient in an eligible institution for mental diseases in accordance with the requirements of this subsection.

“(2) Payments.—Subject to paragraphs (3) and (4), amounts expended under a State plan amendment under paragraph (1) for services described in such paragraph furnished, with respect to a 12-month period, to an eligible individual who is a patient in an eligible institution for mental diseases shall be treated as medical assistance for which payment is made under section 1903(a) but only to the extent that such services are furnished for not more than a period of 30 days (whether or not consecutive) during such 12-month period.

“(3) Maintenance of effort.—

“(A) In general.—As a condition for a State receiving payments under section 1903(a) for medical assistance provided in accordance with this subsection, the State shall (during the period in which it so furnished such medical assistance through a State plan amendment under this subsection) maintain on an annual basis a level of funding expended by the State (and political subdivisions thereof) other than under this title from non-Federal funds for—

“(i) items and services furnished to eligible individuals who are patients in eligible institutions for mental diseases that is not less than the level of such funding for such items and services for the most recently ended fiscal year as of the date of enactment of this subsection or, if higher, for the most recently ended fiscal year as of the date the State submits a State plan amendment to the Secretary to provide such medical assistance in accordance with this subsection; and

“(ii) items and services (including services described in subparagraph (B)) furnished to eligible individuals in outpatient and community-based settings that is not less than the level of such funding for such items and services for the most recently ended fiscal year as of the date of enactment of this subsection or, if higher, for the most recently ended fiscal year as of the date the State submits a State plan amendment to the Secretary to provide such medical assistance in accordance with this subsection.

“(B) Services described.—For purposes of subparagraph (A)(ii), services described in this subparagraph are the following:

“(i) Outpatient and community-based substance use disorder treatment.

“(ii) Evidence-based recovery and support services.

“(iii) Clinically-directed therapeutic treatment to facilitate recovery skills, relapse prevention, and emotional coping strategies.

“(iv) Outpatient medication-assisted treatment, related therapies, and pharmacology.

“(v) Counseling and clinical monitoring.

“(vi) Outpatient withdrawal management and related treatment designed to alleviate acute emotional, behavioral, cognitive, or biomedical distress resulting from, or occurring with, an individual’s use of alcohol and other drugs.

“(vii) Routine monitoring of medication adherence.

“(viii) Other outpatient and community-based services for the treatment of substance use disorders, as designated by the Secretary.

“(C) State reporting requirement.—

“(i) In general.—Prior to approval of a State plan amendment under this subsection, as a condition for a State receiving payments under section 1903(a) for medical assistance provided in accordance with this subsection, the State shall report to the Secretary, in accordance with the process established by the Secretary under clause (ii), the information deemed necessary by the Secretary under such clause.

“(ii) Process.—Not later than the date that is 8 months after the date of enactment of this subsection, the Secretary shall establish a process for States to report to the Secretary, at such time and in such manner as the Secretary deems appropriate, such information as the Secretary deems necessary to verify a State’s compliance with subparagraph (A).

“(4) Ensuring a continuum of services.—

“(A) In general.—As a condition for a State receiving payments under section 1903(a) for medical assistance provided in accordance with this subsection, the State shall carry out each of the requirements described in subparagraphs (B) through (D).

“(B) Notification.—Prior to approval of a State plan amendment under this subsection, the State shall notify the Secretary of how the State will ensure that eligible individuals receive appropriate evidence-based clinical screening prior to being furnished with items and services in an eligible institution for mental diseases, including initial and periodic assessments to determine the appropriate level of care, length of stay, and setting for such care for each individual.

“(C) Outpatient services; inpatient and residential services.—

“(i) Outpatient services.—The State shall, at a minimum, provide medical assistance for services that could otherwise be covered under the State plan, consistent with each of the following outpatient levels of care:

“(I) Early intervention for individuals who, for a known reason, are at risk of developing substance-related problems and for individuals for whom there is not yet sufficient information to document a diagnosable substance use disorder.

“(II) Outpatient services for less than 9 hours per week for adults, and for less than 6 hours per week for adolescents, for recovery or motivational enhancement therapies and strategies.

“(III) Intensive outpatient services for 9 hours or more per week for adults, and for 6 hours or more per week for adolescents, to treat multidimensional instability.

“(IV) Partial hospitalization services for 20 hours or more per week for adults and adolescents to treat multidimensional instability that does not require 24-hour care.

“(ii) Inpatient and residential services.—The State shall provide medical assistance for services that could otherwise be covered under the State plan, consistent with at least 2 of the following inpatient and residential levels of care:

“(I) Clinically managed, low-intensity residential services that provide adults and adolescents with 24-hour living support and structure with trained personnel and at least 5 hours of clinical service per week per individual.

“(II) Clinically managed, population-specific, high-intensity residential services that provide adults with 24-hour care with trained counselors to stabilize multidimensional imminent danger along with less intense milieu and group treatment for those with cognitive or other impairments unable to use full active milieu or therapeutic community.

“(III) Clinically managed, medium-intensity residential services for adolescents, and clinically managed, high-intensity residential services for adults, that provide 24-hour care with trained counselors to stabilize multidimensional imminent danger and preparation for outpatient treatment.

“(IV) Medically monitored, high-intensity inpatient services for adolescents, and medically monitored, intensive inpatient services withdrawal management for adults, that provide 24-hour nursing care, make physicians available for significant problems in Dimensions 1, 2, or 3, and provide counseling services 16 hours per day.

“(V) Medically managed, intensive inpatient services for adolescents and adults that provide 24-hour nursing care and daily physician care for severe, unstable problems in Dimensions 1, 2 or 3.

“(D) Transition of care.—In order to ensure an appropriate transition for an eligible individual from receiving care in an eligible institution for mental diseases to receiving care at a lower level of clinical intensity within the continuum of care (including outpatient services), the State shall ensure that—

“(i) a placement in such eligible institution for mental diseases would allow for an eligible individual’s successful transition to the community, considering such factors as proximity to an individual’s support network (such as family members, employment, and counseling and other services near an individual’s residence); and

“(ii) all eligible institutions for mental diseases that furnish items and services to individuals for which medical assistance is provided under the State plan—

“(I) are able to provide care at such lower level of clinical intensity; or

“(II) have an established relationship with another facility or provider that is able to provide care at such lower level of clinical intensity and accepts patients receiving medical assistance under this title under which the eligible institution for mental diseases may arrange for individuals to receive such care from such other facility or provider.

“(5) Application to managed care.—Payments for, and limitations to, medical assistance furnished in accordance with this subsection shall be in addition to and shall not be construed to limit or supersede the ability of States to make monthly capitation payments to managed care organizations for individuals receiving treatment in institutions for mental diseases in accordance with section 438.6(e) of title 42, Code of Federal Regulations (or any successor regulation).

“(6) Other medical assistance.—The provision of medical assistance for items and services furnished to an eligible individual who is a patient in an eligible institution for mental diseases in accordance with the requirements of this subsection shall not prohibit Federal financial participation for medical assistance for items or services that are provided to such eligible individual in or away from the eligible institution for mental disease during any period in which the eligible individual is receiving items or services in accordance with this subsection.

“(7) Definitions.—In this subsection:

“(A) Dimensions 1, 2, or 3.—The term ‘Dimensions 1, 2, or 3’ has the meaning given that term for purposes of the publication of the American Society of Addiction Medicine entitled ‘The ASAM Criteria: Treatment Criteria for Addictive Substance-Related, and Co-Occurring Conditions, 2013’.

“(B) Eligible individual.—The term ‘eligible individual’ means an individual who—

“(i) with respect to a State, is enrolled for medical assistance under the State plan or a waiver of such plan;

“(ii) is at least 21 years of age;

“(iii) has not attained 65 years of age; and

“(iv) has at least 1 substance use disorder.

“(C) Eligible institution for mental diseases.—The term ‘eligible institution for mental diseases’ means an institution for mental diseases that—

“(i) follows reliable, evidence-based practices; and

“(ii) offers at least 2 forms of medication-assisted treatment for substance use disorders on site, including, in the case of medication-assisted treatment for opioid use disorder, at least 1 antagonist and 1 partial agonist.

“(D) Institution for mental diseases.—The term ‘institution for mental diseases’ has the meaning given that term in section 1905(i).”

(b)
Rule of Construction.— Nothing in the amendments made by subsection (a) shall be construed as encouraging a State to place an individual in an inpatient or a residential care setting where a home or community-based care setting would be more appropriate for the individual, or as preventing a State from conducting or pursuing a demonstration project under section 1115 of the Social Security Act to improve access to, and the quality of, substance use disorder treatment for eligible populations.

Subtitle G Medicaid Improvement Fund

SEC. 5061. Medicaid Improvement Fund.

Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w–1(b)(1)) is amended by striking “ $0” and inserting “ $31,000,000”.