Medicaid Coverage for Addiction Recovery Expansion Act

I 116TH CONGRESS 2D SESSION H. R. 8586 To amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. IN THE HOUSE OF REPRESENTATIVES OCTOBER 13, 2020 Mr. FOSTER (for himself and Mr. FITZPATRICK) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facili- ties, and for other purposes. 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 ‘‘Medicaid Coverage for 4 Addiction Recovery Expansion Act’’. 5 VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 8586 IH SEC. 1. STATE OPTION TO PROVIDE MEDICAL ASSISTANCE 1 FOR RESIDENTIAL ADDICTION TREATMENT 2 FACILITY SERVICES; MODIFICATION OF THE 3 IMD EXCLUSION. 4 (a) IN GENERAL.—Section 1905 of the Social Secu- 5 rity Act (42 U.S.C. 1396d) is amended— 6 (1) in subsection (a)(16)— 7 (A) by striking ‘‘and, (B)’’ and inserting ‘‘, 8 (B)’’; and 9 (B) by inserting ‘‘, and (C) effective Janu- 10 ary 1, 2021, residential addiction treatment fa- 11 cility services (as defined in subsection (h)(3)) 12 for individuals over 21 years of age and under 13 65 years of age, if offered as part of a full con- 14 tinuum of evidence-based treatment services 15 provided under the State plan, including resi- 16 dential, outpatient, and community-based care, 17 for individuals with substance use disorders’’ 18 before the semicolon; and 19 (2) in subsection (h)— 20 (A) in paragraph (1), by striking ‘‘para- 21 graph (16) of subsection (a)’’ and inserting 22 ‘‘subsection (a)(16)(A)’’; and 23 (B) by adding at the end the following new 24 paragraph: 25 VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 8586 IH ‘‘(3)(A) For purposes of subsection (a)(16)(C), the 1 term ‘residential addiction treatment facility services’ 2 means, subject to subparagraph (B), inpatient services 3 provided— 4 ‘‘(i) to an individual for the purpose of treating 5 a substance use disorder that are furnished to an in- 6 dividual for not more than 2 consecutive periods of 7 30 consecutive days, provided that upon completion 8 of the first 30-day period, the individual is assessed 9 and determined to have progressed through the clin- 10 ical continuum of care, in accordance with criteria 11 established by the Secretary, in consultation with the 12 American Society of Addiction Medicine, and re- 13 quires continued medically necessary treatment and 14 social support services to promote recovery, stable 15 transition to ongoing treatment, and discharge; and 16 ‘‘(ii) in a facility that is accredited for the 17 treatment of substance use disorders by the Joint 18 Commission on Accreditation of Healthcare Organi- 19 zations, the Commission on Accreditation of Reha- 20 bilitation Facilities, the Council on Accreditation, or 21 any other accrediting agency that the Secretary 22 deems appropriate as necessary to ensure nationwide 23 applicability, including qualified national organiza- 24 tions and State-level accrediting agencies. 25 VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 8586 IH ‘‘(B) The State agency responsible for administering 1 the State plan under this title shall establish procedures 2 to ensure that, with respect to any facility providing resi- 3 dential addiction treatment facility services in a fiscal 4 year, the average monthly number of beds used by the fa- 5 cility to provide such services during such year is not more 6 than 40. 7 ‘‘(C) The provision of medical assistance for residen- 8 tial addiction treatment facility services to an individual 9 shall not prohibit Federal financial participation for med- 10 ical assistance for items or services that are provided to 11 the individual in or away from the residential addiction 12 treatment facility during any 30-day period in which the 13 individual is receiving residential addiction treatment fa- 14 cility services. 15 ‘‘(D) A woman who is eligible for medical assistance 16 on the basis of being pregnant and who is furnished resi- 17 dential addiction treatment facility services during any 30- 18 day period may remain eligible for, and continue to be fur- 19 nished with, such services for additional 30-day periods 20 without regard to any eligibility limit that would otherwise 21 apply to the woman as a result of her pregnancy ending, 22 subject to assessment by the facility and a determination 23 based on medical necessity related to substance use dis- 24 VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 8586 IH order and the impact of substance use disorder on birth 1 outcomes.’’. 2 (b) EFFECTIVE DATE.—The amendments made by 3 this section shall apply to items and services furnished on 4 or after January 1, 2021. 5 SEC. 2. GRANT PROGRAM TO EXPAND YOUTH ADDICTION 6 TREATMENT FACILITIES UNDER MEDICAID 7 AND CHIP. 8 (a) ESTABLISHMENT.— 9 (1) IN GENERAL.—The Secretary shall establish 10 a program under which the Secretary shall award 11 grants to States for the purpose of expanding the in- 12 frastructure and treatment capabilities, including 13 augmenting equipment and bed capacity, of eligible 14 youth addiction treatment facilities that provide ad- 15 diction treatment services to Medicaid or CHIP 16 beneficiaries who have not attained the age of 21 17 and are in communities with high numbers of medi- 18 cally underserved populations of at-risk youth. 19 (2) USE OF FUNDS.—Grant funds awarded 20 under this section may be used to expand the infra- 21 structure and treatment capabilities of an existing 22 facility (including through construction) but shall 23 not be used for the construction of any new facility 24 VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 8586 IH or for the provision of medical assistance or child 1 health assistance under Medicaid or CHIP. 2 (3) TIMETABLE FOR IMPLEMENTATION; DURA- 3 TION.— 4 (A) IMPLEMENTATION.—Not later than 1 5 year after the date of the enactment of this Act, 6 the Secretary shall award grants under the 7 grant program. 8 (B) DURATION.—The Secretary shall 9 award grants under the grant program for a 10 period not to exceed 5 years. 11 (b) APPLICATION.—A State seeking to participate in 12 the grant program shall submit to the Secretary, at such 13 time and in such manner as the Secretary shall require, 14 an application that includes— 15 (1) detailed information on the types of addi- 16 tional infrastructure and treatment capacity of eligi- 17 ble youth addiction treatment facilities that the 18 State proposes to fund under the grant program; 19 (2) a description of the communities in which 20 the eligible youth addiction treatment facilities fund- 21 ed under the grant program operate; 22 (3) an assurance that the eligible youth addic- 23 tion treatment facilities that the State proposes to 24 fund under the grant program shall give priority to 25 VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 8586 IH providing addiction treatment services to Medicaid 1 or CHIP beneficiaries who have not attained the age 2 of 21 and are in communities with high numbers of 3 medically underserved populations of at-risk youth; 4 and 5 (4) such additional information and assurances 6 as the Secretary shall require. 7 (c) RURAL AREAS.—Not less than 15 percent of the 8 amount of a grant awarded to a State under this section 9 shall be used for making payments to eligible youth addic- 10 tion treatment facilities that are located in rural areas or 11 that target the provision of addiction treatment services 12 to Medicaid or CHIP beneficiaries who have not attained 13 the age of 21 and reside in rural areas. 14 (d) DEFINITIONS.—For purposes of this section: 15 (1) ADDICTION TREATMENT SERVICES.—The 16 term ‘‘addiction treatment services’’ means services 17 provided to an individual for the purpose of treating 18 a substance use disorder. 19 (2) CHIP.—The term ‘‘CHIP’’ means the 20 State children’s health insurance program estab- 21 lished under title XXI of the Social Security Act (42 22 U.S.C. 1397aa et seq.). 23 (3) ELIGIBLE YOUTH ADDICTION TREATMENT 24 FACILITY.—The term ‘‘eligible youth addiction treat- 25 VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 8586 IH ment facility’’ means a facility that is a participating 1 provider under the State Medicaid or CHIP pro- 2 grams for purposes of providing medical assistance 3 or child health assistance to Medicaid or CHIP 4 beneficiaries for youth addiction treatment services 5 on an inpatient or outpatient basis (or both). 6 (4) MEDICAID.—The term ‘‘Medicaid’’ means 7 the medical assistance program established under 8 title XIX of the Social Security Act (42 U.S.C. 1396 9 et seq.). 10 (5) MEDICAID OR CHIP BENEFICIARY.—The 11 term ‘‘Medicaid or CHIP beneficiary’’ means an in- 12 dividual who is enrolled in the State Medicaid plan, 13 the State child health plan under CHIP, or under a 14 waiver of either such plan. 15 (6) MEDICALLY UNDERSERVED POPU- 16 LATIONS.—The term ‘‘medically underserved popu- 17 lations’’ has the meaning given that term in section 18 330(b)(3) of the Public Health Service Act (42 19 U.S.C. 254b(b)(3)). 20 (7) SECRETARY.—The term ‘‘Secretary’’ means 21 the Secretary of Health and Human Services. 22 (e) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated $50,000,000 to carry 24 out the provisions of this section. Funds appropriated 25 VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 8586 IH under this subsection shall remain available until ex- 1 pended. 2 Æ VerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H8586.IH H8586 pbinns on DSKJLVW7X2PROD with BILLS