#aadth ,,congress #ast ,session ,in the ,house of ,representatives1 ,u4 ,s41 ,november #af1 #bjae ,,amendment3 ,that the bill from the ,senate 7,s4 #eii7 entitled ,an ,act to extend and expand the ,medicaid emergency psychiatric demonstration project41 do pass with the following ,strike out all after the enacting clause and insert3 #a4 ,short title ,this ,act may be cited as the ,improving ,access to ,emergency ,psychiatric ,care ,act4 #b4 ,extension and expansion of medicaid emergency psychiatric demonstration project 7a7 ,in general ,subsection 7d7 of section #bgjg of ,public ,law #aaa-adh 7#db ,u4,s4,c4 #acif;a note7 is amended to read as follows3 7d7 ,length of demonstration project 7#a7 ,in general ,except as provided in paragraphs 7#b7 and 7#c71 the demonstration project established under this section shall be conducted for a period of #c consecutive years4 7#b7 ,temporary extension of participation eligibility for selected ,states 7,a7 ,in general ,subject to subparagraph 7,b7 and paragraph 7#d71 a ,state selected as an eligible ,state to participate in the demonstration project on or prior to ,march #ac1 #bjab1 shall1 upon the request of the ,state1 be permitted to continue to participate in the demonstration project through ,september #cj1 #bjaf1 if-- 7i7 the ,secretary determines that the continued participation of the ,state in the demonstration project is projected not to increase net program spending under title ,,xix of the ,social ,security ,act2 and 7ii7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such extension for that ,state is projected not to increase net program spending under title ,,xix of the ,social ,security ,act4 7,b7 ,notice of projections ,the ,secretary shall provide each ,state selected to participate in the demonstration project on or prior to ,march #ac1 #bjab1 with notice of the determination and certification made under subparagraph 7,a7 for the ,state4 7#c7 ,extension and expansion of demonstration project 7,a7 ,additional extension ,taking into account the recommendations submitted to ,congress under subsection 7f77#c71 the ,secretary may permit an eligible ,state participating in the demonstration project as of the date such recommendations are submitted to continue to participate in the project through ,december #ca1 #bjai1 if1 with respect to the ,state-- 7i7 the ,secretary determines that the continued participation of the ,state in the demonstration project is projected not to increase net program spending under title ,,xix of the ,social ,security ,act2 and 7ii7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that the continued participation of the ,state in the demonstration project is projected not to increase net program spending under title ,,xix of the ,social ,security ,act4 7,b7 ,option for expansion to additional ,states ,taking into account the recommendations submitted to ,congress pursuant to subsection 7f77#c71 the ,secretary may expand the number of eligible ,states participating in the demonstration project through ,december #ca1 #bjai1 if1 with respect to any new eligible ,state-- 7i7 the ,secretary determines that the participation of the ,state in the demonstration project is projected not to increase net program spending under title ,,xix of the ,social ,security ,act2 and 7ii7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that the participation of the ,state in the demonstration project is projected not to increase net program spending under title ,,xix of the ,social ,security ,act4 7,c7 ,notice of projections ,the ,secretary shall provide each ,state participating in the demonstration project as of the date the ,secretary submits recommendations to ,congress under subsection 7f77#c71 and any additional ,state that applies to be added to the demonstration project1 with notice of the determination and certification made for the ,state under subparagraphs 7,a7 and 7,b71 respectively1 and the standards used to make such determination and certification-- 7i7 in the case of a ,state participating in the demonstration project as of the date the ,secretary submits recommendations to ,congress under subsection 7f77#c71 not later than ,august #ca1 #bjaf2 and 7ii7 in the case of an additional ,state that applies to be added to the demonstration project1 prior to the ,state making a final election to participate in the project4 7#d7 ,authority to ensure budget neutrality ,the ,secretary annually shall review each participating ,state's demonstration project expenditures to ensure compliance with the requirements of paragraphs 7#b77;,a77i71 7#b77;,a77ii71 7#c77;,a77i71 7#c77;,a77ii71 7#c77;,b77i71 and 7#c77;,b77ii7 7as applicable74 ,if the ,secretary determines with respect to a ,state's participation in the demonstration project that the ,state's net program spending under title ,,xix of the ,social ,security ,act has increased as a result of the ,state's participation in the project1 the ,secretary shall treat the demonstration project excess expenditures of the ,state as an overpayment under title ,,xix of the ,social ,security ,act4 4 7b7 ,funding ,subsection 7e7 of section #bgjg of such ,act 7#db ,u4,s4,c4 #acif;a note7 is amended-- 7#a7 in the subsection heading1 by striking ,limitations on ,federal2 7#b7 in paragraph 7#b7-- 7,a7 in the paragraph heading1 by striking #e-year2 and 7,b7 by striking through ,december #ca1 #bjae and inserting until expended2 7#c7 by striking paragraph 7#c72 7#d7 by redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#c7 and 7#d71 respectively2 7#e7 in paragraph 7#c7 7as so redesignated71 by striking and the availability of funds and inserting 7other than ,states deemed to be eligible ,states through the application of subsection 7c77#d772 and 7#f7 in paragraph 7#d7 7as so redesignated7-- 7,a7 in the first sentence-- 7i7 by inserting 7other than a ,state deemed to be an eligible ,state through the application of subsection 7c77#d77 after eligible ,state2 and 7ii7 by striking paragraph 7#d7 and inserting paragraph 7#c72 and 7,b7 by inserting after the first sentence the following3 ,in addition to any payments made to an eligible ,state under the preceding sentence1 the ,secretary shall1 during any period in effect under paragraph 7#b7 or 7#c7 of subsection 7d71 or during any period in which a law described in subsection 7f77#d77;,c7 is in effect1 pay each eligible ,state 7including any ,state deemed to be an eligible ,state through the application of subsection 7c77#d771 an amount each quarter equal to the ,federal medical assistance percentage of expenditures in the quarter during such period for medical assistance described in subsection 7a74 ,payments made to a ,state for emergency psychiatric demonstration services under this section during the extension period shall be treated as medical assistance under the ,state plan for purposes of section #aijc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#a7744 7c7 ,recommendations to congress ,subsection 7f7 of section #bgjg of such ,act 7#db ,u4,s4,c4 #acif;a note7 is amended by adding at the end the following3 7#c7 ,recommendation to congress regarding extension and expansion of project ,not later than ,september #cj1 #bjaf1 the ,secretary shall submit to ,congress and make available to the public recommendations based on an evaluation of the demonstration project1 including the use of appropriate quality measures1 regarding-- 7,a7 whether the demonstration project should be continued after ,september #cj1 #bjaf2 and 7,b7 whether the demonstration project should be expanded to additional ,states4 7#d7 ,recommendation to congress regarding permanent extension and nationwide expansion 7,a7 ,in general ,not later than ,april #a1 #bjai1 the ,secretary shall submit to ,congress and make available to the public recommendations based on an evaluation of the demonstration project1 including the use of appropriate quality measures1 regarding-- 7i7 whether the demonstration project should be permanently continued after ,december #ca1 #bjai1 in #a or more ,states2 and 7ii7 whether the demonstration project should be expanded 7including on a nationwide basis74 7,b7 ,requirements ,any recommendation submitted under subparagraph 7,a7 to permanently continue the project in a ,state1 or to expand the project to #a or more other ,states 7including on a nationwide basis7 shall include a certification from the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services that permanently continuing the project in a particular ,state1 or expanding the project to a particular ,state 7or all ,states7 is projected not to increase net program spending under title ,,xix of the ,social ,security ,act4 7,c7 ,congressional approval required ,the ,secretary shall not permanently continue the demonstration project in any ,state after ,december #ca1 #bjai1 or expand the demonstration project to any additional ,state after ,december #ca1 #bjai1 unless ,congress enacts a law approving either or both such actions and the law includes provisions that-- 7i7 ensure that each ,state's participation in the project complies with budget neutrality requirements2 and 7ii7 require the ,secretary to treat any expenditures of a ,state participating in the demonstration project that are excess of the expenditures projected under the budget neutrality standard for the ,state as an overpayment under title ,,xix of the ,social ,security ,act4 7#e7 ,funding ,of the unobligated balances of amounts available in the ,centers for ,medicare ,medicaid ,services ,program ,management account1 #ajj1jjj shall be available to carry out this subsection and shall remain available until expended4 4 7d7 ,conforming amendments ,section #bgjg of such ,act 7#db ,u4,s4,c4 #acif;a note7 is amended-- 7#a7 in subsection 7a71 in the matter before paragraph 7#a71 by inserting publicly or after institution for mental diseases that is2 7#b7 in subsection 7c7-- 7,a7 in paragraph 7#a71 by striking ,an eligible ,state and inserting ,except as otherwise provided in paragraph 7#d71 an eligible ,state2 7,b7 in paragraph 7#c71 by striking ,a ,state shall and inserting ,except as otherwise provided in paragraph 7#d71 a ,state shall2 and 7,c7 by adding at the end the following3 7#d7 ,nationwide availability ,in the event that the ,secretary makes a recommendation pursuant to subsection 7f77#d7 that the demonstration project be expanded on a national basis1 any ,state that has submitted or submits an application pursuant to paragraph 7#b7 shall be deemed to have been selected to be an eligible ,state to participate in the demonstration project4 2 and 7#c7 in the heading for subsection 7f71 by striking and report and inserting 1 report1 and recommendations4 7e7 ,effective date ,the amendments made by this section shall take effect on the date of the enactment of this ,act4 ,clerk4