INPATIENT Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 7912 To provide for a demonstration program and pilot project to expand choice for inpatient psychiatric services under Medicaid and Medicare. IN THE HOUSE OF REPRESENTATIVES JULY 31, 2020 Mr. HUIZENGA (for himself and Mr. TONKO) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subse- quently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for a demonstration program and pilot project to expand choice for inpatient psychiatric services under Medicaid and Medicare. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Increasing National 4 Patient Access To Improved Effective Necessary Mental 5 Health Treatment Act of 2020’’ or the ‘‘INPATIENT Act 6 of 2020’’. 7 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 7912 IH SEC. 2. DEMONSTRATION PROJECT WAIVING IMD EXCLU- 1 SION TO EXPAND ACCESS TO INPATIENT PSY- 2 CHIATRIC SERVICES UNDER THE MEDICAID 3 PROGRAM. 4 (a) AUTHORITY TO CONDUCT DEMONSTRATION 5 PROJECT.— 6 (1) IN GENERAL.—The Secretary of Health and 7 Human Services (in this Act referred to as the ‘‘Sec- 8 retary’’) shall establish a demonstration project (in 9 this Act referred to as the ‘‘demonstration project’’) 10 to test the impact of waiving the limitation of sub- 11 division (B) following paragraph (29) of section 12 1905(a) of the Social Security Act (42 U.S.C. 13 1396d(a)) on average length of stay, readmissions, 14 cost, and quality outcomes for inpatient psychiatric 15 hospital services and substance abuse services. 16 (2) TERMS.—Under the demonstration project, 17 an eligible State (as defined in subsection (b)) shall 18 provide payment under its State Medicaid plan 19 under title XIX of the Social Security Act to quali- 20 fying institutions (as defined in subsection 21 (b)(3)(C)) for the provision of medical assistance 22 available under such plan to individuals who— 23 (A) have attained age 21, but have not at- 24 tained age 65; 25 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 7912 IH (B) are eligible for medical assistance 1 under such plan (or under a waiver of such 2 plan); 3 (C) require such medical assistance for in- 4 patient psychiatric hospital services or residen- 5 tial substance abuse services; and 6 (D) but for participation in the demonstra- 7 tion project, would otherwise receive medical as- 8 sistance for such inpatient psychiatric hospital 9 services if the services were provided in a gen- 10 eral acute care hospital or other residential sub- 11 stance abuse facility. 12 (b) ELIGIBLE STATE DEFINED.— 13 (1) IN GENERAL.—In this section, the term ‘‘el- 14 igible State’’ means a State that has made an appli- 15 cation under paragraph (2) and has had such appli- 16 cation approved and has been selected under para- 17 graph (3). 18 (2) APPLICATION.—A State seeking to partici- 19 pate in the demonstration project shall submit to the 20 Secretary, at such time and in such format as the 21 Secretary requires, an application that includes such 22 information, provisions, and assurances, as the Sec- 23 retary may require. 24 (3) SELECTION AND LIMITATION.— 25 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 7912 IH (A) STATE LIMITATION.—The Secretary 1 shall limit the number of States selected for 2 participation in the demonstration project to no 3 more than 3 States. 4 (B) CONDITIONS FOR APPLICATION AP- 5 PROVAL.—The Secretary shall not approve an 6 application under paragraph (2) unless the 7 State agrees to limit participation in the dem- 8 onstration project to qualifying institutions (as 9 defined in subparagraph (C)). 10 (C) QUALIFYING INSTITUTION DEFINED.— 11 In this Act, the term ‘‘qualifying institution’’ 12 means an institution for mental diseases that is 13 not publicly owned or operated, that is subject 14 to the requirements of section 1867 of the So- 15 cial Security Act (42 U.S.C. 1395dd), and that 16 meets all of the following criteria: 17 (i) The institution furnishes inpatient 18 psychiatric hospital services to individuals 19 age 18 years of age or older under the 20 Medicare and Medicaid programs. 21 (ii) The institution has an average 22 length of inpatient hospital stay of less 23 than 15 days for individuals age 18 or 24 older, but under 65 years of age. 25 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 7912 IH (iii) The institution has an average 1 length of stay of less than 21 days for hos- 2 pital inpatients age 65 or older. 3 (iv) The institution has an approved 4 medical residency training program and re- 5 ceive payment due under the Medicare and 6 Medicaid programs for the reasonable costs 7 of graduate medical education. 8 (v) The institution uses psychiatric 9 residents to provide inpatient psychiatric 10 hospital services to individuals under the 11 Medicare and Medicaid programs. 12 (vi) The institution has documented 13 experience in providing services to active 14 duty military personnel and veterans. 15 (vii) The institution has standards to 16 care for the whole person, including refer- 17 ral agreements or other arrangements to 18 address a patient’s medical, surgical, or di- 19 agnostic needs if such treatment services 20 are not available within the institution. 21 (viii) The institution agrees to report 22 on quality measures (in such form, man- 23 ner, and frequency as specified by the Sec- 24 retary) and report to the Secretary (in a 25 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 7912 IH form, manner, and frequency as specified 1 by the Secretary) such data as the Sec- 2 retary determines appropriate to monitor 3 and evaluate the demonstration project. 4 (ix) The institution agrees to plan and 5 implement an annual performance im- 6 provement project, aimed at improving the 7 effectiveness of care provided to high uti- 8 lizers of inpatient psychiatric hospital serv- 9 ices (as defined in subsection (h)(1)), with 10 identifiable measures in coordination with 11 the Secretary and the State. 12 (c) DEADLINE FOR IMPLEMENTATION.—The Sec- 13 retary shall implement the demonstration project by Janu- 14 ary 1, 2022. 15 (d) LENGTH OF DEMONSTRATION PROJECT.—The 16 demonstration project shall be conducted for a period of 17 7 consecutive years. 18 (e) BUDGET NEUTRALITY.—With respect to the op- 19 eration of the demonstration project in a State for the pe- 20 riod described in subsection (d), the State must dem- 21 onstrate to the Secretary that project will not result in 22 a net increase in the aggregate expenditures under the 23 Medicaid program for such period for the State above the 24 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 7912 IH level of such expenditures if the demonstration project had 1 not been implemented. 2 (f) EVALUATION AND REPORT TO CONGRESS.— 3 (1) EVALUATION.—The Secretary shall conduct 4 an evaluation of the demonstration project in order 5 to determine the impact of the project and to make 6 recommendations on improvements to the perform- 7 ance of the health and mental health service system 8 and on individuals enrolled in the Medicaid program, 9 with particular emphasis on individuals who are high 10 utilizers of inpatient psychiatric hospital services and 11 substance abuse residential services. 12 (2) ITEMS INCLUDED IN EVALUATION.—Such 13 evaluation shall include the following: 14 (A) An assessment of the delivery of inpa- 15 tient psychiatric hospital services, substance 16 abuse residential services, and community-based 17 services under the Medicaid program; average 18 lengths of inpatient stays; emergency room vis- 19 its; and readmissions. 20 (B) An assessment of the impact of the 21 demonstration project on the costs of the full 22 range of mental health services (including inpa- 23 tient, emergency and ambulatory care) under 24 the Medicaid program. 25 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 7912 IH (C) An assessment of the impact of the 1 demonstration project on psychiatric residency 2 programs and the mental health workforce. 3 (D) An assessment of the impact of the 4 demonstration project on rates of recidivism. 5 (E) Identification and assessment of best 6 practices for caring for patients with serious 7 mental illness, including high utilizers of inpa- 8 tient psychiatric hospital services and substance 9 abuse residential services. 10 (F) A comparison of outcomes and costs 11 for similarly situated patients receiving inpa- 12 tient psychiatric hospital services at a general 13 acute care hospital. 14 (G) A recommendation regarding whether 15 the demonstration project should be continued 16 after December 31, 2028, and expanded on a 17 national basis. 18 (3) REPORT.—Not later than December 31, 19 2028, the Secretary shall submit to Congress (and 20 make available to the public) a report on the find- 21 ings of the evaluation conducted under this sub- 22 section. 23 (g) IMD WAIVER; WAIVER AUTHORITY.— 24 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 7912 IH (1) IMD WAIVER.—The limitation of subdivi- 1 sion (B) following paragraph (29) of section 1905(a) 2 of the Social Security Act (42 U.S.C. 1396d(a)), re- 3 lating to limitations on payments for care or services 4 for individuals under 65 years of age who are pa- 5 tients in an institution for mental disease, shall not 6 apply to inpatient psychiatric hospital services or 7 substance abuse residential services furnished under 8 the demonstration project. 9 (2) WAIVER AUTHORITY.—The Secretary may 10 waive such requirements of titles XI and XIX of the 11 Social Security Act (which may include the require- 12 ments of paragraph (1) (relating to statewideness)) 13 and paragraph (10)(B) (relating to comparability) of 14 section 1902(a) of such Act (42 U.S.C. 1396b(a)) 15 only to extent the Secretary determines such a waiv- 16 er to be necessary to carry out the demonstration 17 project. 18 (h) DEFINITIONS.—In this Act: 19 (1) HIGH UTILIZER OF INPATIENT PSYCHIATRIC 20 HOSPITAL SERVICES.—The term ‘‘high utilizer of in- 21 patient psychiatric hospital services’’ means an indi- 22 vidual who, with respect to a point in time, meets 23 the following conditions: 24 VerDate Sep 11 2014 21:14 Aug 26, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 7912 IH (A) The individual had two or more inpa- 1 tient admissions for psychiatric services in the 2 previous 12 months. 3 (B) The individual had 10 or more inpa- 4 tient admissions for psychiatric services in the 5 individual’s lifetime. 6 (C) The individual had 100 or more days 7 of inpatient psychiatric services in the individ- 8 ual’s lifetime. 9 (D) The individual meets any of the fol- 10 lowing conditions: 11 (i) The individual is receiving court- 12 ordered psychiatric treatment. 13 (ii) The individual has been receiving 14 inpatient psychiatric services for a consecu- 15 tive period of at least 12 days. 16 (iii) The individual has a documented 17 history of suicidal or self-harming behav- 18 iors due to mental illness. 19 (iv) The individual has a documented 20 history of threatened or actual physical 21 harm to another individual due to mental 22 illness. 23 (2) INSTITUTION FOR MENTAL DISEASE.—The 24 term ‘‘institution for mental disease’’ has the mean- 25 VerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 7912 IH ing given that term in section 1905(i) of the Social 1 Security Act (42 U.S.C. 1396d(i)). 2 (3) MEDICAID PROGRAM.—The term ‘‘Medicaid 3 program’’ means the program under title XIX of the 4 Social Security Act (42 U.S.C. 1396 et seq.). 5 (4) MEDICAL ASSISTANCE.—The term ‘‘medical 6 assistance’’ has the meaning given that term in sec- 7 tion 1905(a) of the Social Security Act (42 U.S.C. 8 1396d(a)). 9 (5) MEDICARE PROGRAM.—The term ‘‘Medicare 10 program’’ means the program under part A of title 11 XVIII of the Social Security Act (42 U.S.C. 1395c 12 et seq.) and includes the programs under parts B, 13 C, and D of such title. 14 (6) STATE.—The term ‘‘State’’ has the mean- 15 ing given that term for purposes of the Medicaid 16 program. 17 SEC. 3. PILOT PROGRAM WAIVING THE MEDICARE 190-DAY 18 LIFETIME LIMIT ON INPATIENT PSYCHIATRIC 19 HOSPITAL SERVICES TO EXPAND ACCESS TO 20 INPATIENT PSYCHIATRIC SERVICES UNDER 21 THE MEDICARE PROGRAM. 22 (a) DEMONSTRATION PROGRAM AUTHORIZED.—The 23 Secretary shall establish a pilot program (in this section 24 VerDate Sep 11 2014 21:14 Aug 26, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 7912 IH referred to as the ‘‘pilot program’’) to test the impact of 1 eliminating the Medicare 190-day lifetime limit on— 2 (1) promoting value; 3 (2) expanding choice; and 4 (3) aligning inpatient mental health benefits 5 with the inpatient physical health care benefits 6 under the Medicare program. 7 (b) DEFINITIONS.—In this section: 8 (1) APPLICABLE BENEFICIARY.—The term ‘‘ap- 9 plicable beneficiary’’ means an individual who— 10 (A) is entitled to, or enrolled for, benefits 11 under part A, and enrolled for benefits under 12 part B, of the Medicare program; 13 (B) is admitted to a qualifying institution 14 participating in the demonstration project; and 15 (C) but for the pilot program established 16 under this section, would otherwise receive ben- 17 efits for inpatient psychiatric services under the 18 Medicare program if the services were provided 19 in a general acute care hospital. 20 (2) INPATIENT PSYCHIATRIC HOSPITAL SERV- 21 ICES.—The term ‘‘inpatient psychi [Text truncated for display. 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