H.R. 5136 — Introduced in House

I 113th CONGRESS 2d Session H. R. 5136 IN THE HOUSE OF REPRESENTATIVES July 17, 2014 Ms. Fudge (for herself, Mr. Ryan of Ohio, Mr. Cummings, Ms. Lee of California, Ms. Norton, Mr. Richmond, Mr. Hastings of Florida, and Ms. Clarke of New York) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To direct the Secretary of Health and Human Services to establish a demonstration project under the Medicaid program under title XIX of the Social Security Act under which payment may be made to States for expenditures for medical assistance with respect to substance use disorder treatment services, and for other purposes. 1. Short title This Act may be cited as the Breaking Addiction Act of 2014. 2. Medicaid community-based inpatient substance use disorder treatment demonstration project (a) Authority The Secretary of Health and Human Services shall establish a 5-year demonstration project (in this section referred to as the demonstration project) under which payment may be made to each participating State (as described in subsection (b)), for any medical assistance provided with respect to a qualified individual in a community-based institution for mental diseases who is being treated in such institution for a substance use condition. (b) Participating States (1) Eligibility A State is eligible to participate in the demonstration project under this section if the State plan of the State provides for payment under the plan for community-based inpatient substance use disorder treatment services furnished to qualified individuals. (2) Application A State seeking to participate in the demonstration project under this section shall submit to the Secretary an application, at such time, in such form, and that contains such information, provisions, and assurances, as the Secretary may require. (3) Selection The Secretary shall select, on a competitive basis, from among the States that submit an application under paragraph (1) to the satisfaction of the Secretary, the States that will be participating in the demonstration project. In selecting such participating States, the Secretary shall seek to achieve an equitable geographic distribution. (c) Waiver authority (1) In general The Secretary shall waive the limitation on payment for care and services imposed by the subdivision (B) that follows paragraph (29) of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) (relating to a limitation on payments for care or services for any individual who is under 65 years of age and who is a patient in an institution for mental diseases) with respect to payment for the medical assistance described in subsection (a). (2) Limited other waiver authority The Secretary may waive other requirements of titles XI and XIX of the Social Security Act (including the requirements of sections 1902(a)(1) (relating to statewideness) (42 U.S.C. 1396a(a)(1)) and 1902(a)(10)(B) (relating to comparability) (42 U.S.C. 1396a(a)(10)(B)) of such Act) only to the extent necessary to carry out the demonstration project under this section. (d) Evaluation and report to congress (1) Evaluation The Secretary shall conduct an evaluation of the impact the demonstration project carried out under this section has on the functioning of the health and substance use disorder system and individuals enrolled in State plans under the Medicaid program under title XIX of the Social Security Act. The evaluation shall include each of the following: (A) An assessment of the access such individuals have to substance use disorder treatment services under the demonstration project carried out under this section, and with respect to such services, the average lengths of inpatient stays and emergency room visits. (B) An assessment of the discharge planning by the health care providers furnishing such services. (C) An assessment of the impact of the demonstration project on the costs of the full range of health care items and services, including inpatient, emergency and ambulatory care, diversions from inpatient and emergency care, and readmissions to institutions for mental diseases. (D) An analysis of the percentage of individuals enrolled in such plans who are admitted to community-based institutions for mental diseases as a result of the demonstration project as compared to those admitted to such institutions through other means. (2) Report Not later than December 31, 2020, the Secretary shall submit to Congress and make available to the public a report that contains— (A) the findings of the evaluation under paragraph (1); and (B) the recommendations of the Secretary regarding whether— (i) the limitation referred to in subsection (c)(1) is a barrier to care that needs to be reviewed by Congress; and (ii) the demonstration project carried out under this section should be continued after December 31, 2020, and expanded on a national basis. (e) Funding (1) Appropriation Out of any funds in the Treasury not otherwise appropriated, there is appropriated to carry out this section, $300,000,000 for fiscal year 2015. (2) 10-year availability Funds appropriated under paragraph (1) shall remain available for obligation through December 31, 2024. (3) Funds allocated to States Funds shall be allocated to participating States on the basis of criteria, including a State’s application and the availability of funds, as determined by the Secretary. (4) Payment to States For each calendar quarter beginning on or after October 1, 2014, the Secretary shall pay to each participating State, from the allocation made to the State under paragraph (3), an amount equal to the Federal medical assistance percentage of the amount expended during such quarter for the medical assistance described in subsection (a). (5) Limitation on payments In no case may— (A) the aggregate amount of payments made by the Secretary to participating States under this section exceed $300,000,000; or (B) payments be made by the Secretary to participating States under this section after December 31, 2024. (f) Definitions In this section: (1) Federal medical assistance percentage The term Federal medical assistance percentage has the meaning given such term in section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)). (2) Institution for mental diseases The term institution for mental diseases has the meaning given such term in section 1905(i) of the Social Security Act (42 U.S.C. 1396d(i)). (3) Medical assistance The term medical assistance has the meaning given such term in section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)). (4) Qualified individual The term qualified individual means an individual who, because of the individual’s substance use condition, requires substance use disorder treatment and who— (A) is over 21 years of age and under 65 years of age; and (B) is eligible for medical assistance under the State plan under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). (5) State The term State has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).