#aaeth ,,congress #b;d ,session ,h4 ,r4 #egig ,,an ,,act ,to amend title ,,xix of the ,social ,security ,act to allow ,states to provide under ,medicaid services for certain individuals with opioid use disorders in institutions for mental diseases4 #a4 ,short title ,this ,act may be cited as the ,individuals in ,medicaid ,deserve ,care that is ,appropriate and ,responsible in its ,execution ,act or the ,,imd ,,care ,act4 #b4 ,medicaid ,state plan option ,to provide services for certain individuals with targeted ,s,u,ds in institutions for mental diseases ,section #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7 is amended by adding at the end the following new subsection3 7l7 ,state plan option ,to provide services for certain individuals in institutions for mental diseases 7#a7 ,in general ,with respect to calendar quarters beginning during the period beginning ,january #a1 #bjai1 and ending ,december #ca1 #bjbc1 a ,state may elect1 through a ,state plan amendment1 to1 notwithstanding section #aije7;a71 provide medical assistance for services furnished in institutions for mental diseases and for other medically necessary services furnished to eligible individuals with targeted ,s,u,ds1 in accordance with the requirements of this subsection4 7#b7 ,payments 7,a7 ,in general ,amounts expended under a ,state plan amendment under paragraph 7#a7 for services described in such paragraph furnished1 with respect to a #ab-month period1 to an eligible individual with a targeted ,,sud who is a patient in an institution for mental diseases shall be treated as medical assistance for which payment is made under section #aijc7;a7 but only to the extent that such services are furnished for not more than a period of #cj days 7whether or not consecutive7 during such #ab-month period4 7,b7 ,clarification ,payment made under this paragraph for expenditures under a ,state plan amendment under this subsection with respect to services described in paragraph 7#a7 furnished to an eligible individual with a targeted ,,sud shall not affect payment that would otherwise be made under section #aijc7;a7 for expenditures under the ,state plan 7or waiver of such plan7 for medical assistance for such individual4 7#c7 ,information required in ,state plan amendment 7,a7 ,in general ,a ,state electing to provide medical assistance pursuant to this subsection shall include with the submission of the ,state plan amendment under paragraph 7#a7 to the ,secretary-- 7i7 a plan on how the ,state will improve access to outpatient care during the period of the ,state plan amendment1 including a description of-- 7,i7 the process by which eligible individuals with targeted ,s,u,ds will make the transition from receiving inpatient services in an institution for mental diseases to appropriate outpatient care2 and 7,,ii7 the process the ,state will undertake to ensure eligible individuals with targeted ,s,u,ds are provided care in the most integrated setting appropriate to the needs of the individuals2 and 7ii7 a description of how the ,state plan amendment ensures an appropriate clinical screening of eligible individuals with targeted ,s,u,ds1 including assessments to determine level of care and length of stay recommendations based upon the multidimensional assessment criteria of the ,american ,society of ,addiction ,medicine and to determine the appropriate setting for such care4 7,b7 ,report ,not later than the sooner of ,december #ca1 #bjbd1 or #a year after the date of the termination of a ,state plan amendment under this subsection1 the ,state shall submit to the ,secretary a report that includes at least-- 7i7 the number of eligible individuals with targeted ,s,u,ds who received services pursuant to such ,state plan amendment2 7ii7 the length of the stay of each such individual in an institution for mental diseases2 7iii7 the type of outpatient treatment1 including medication-assisted treatment1 each such individual received after being discharged from such institution2 7iv7 the number of eligible individuals with any co-occuring disorders who received services pursuant to such ,state plan amendment and the co-occuring disorders from which they suffer2 and 7v7 information regarding the effects of a ,state plan amendment on access to community care for individuals suffering from a mental disease other than substance use disorder4 7#d7 ,definitions ,in this subsection3 7,a7 ,eligible individual with a targeted ,,sud ,the term eligible individual with a targeted ,,sud means an individual who-- 7i7 with respect to a ,state1 is enrolled for medical assistance under the ,state plan 7or a waiver of such plan72 7ii7 is at least #ba years of age2 7iii7 has not attained #fe years of age2 and 7iv7 has been diagnosed with at least one targeted ,,sud4 7,b7 ,institution for mental diseases ,the term institution for mental diseases has the meaning given such term in section #aije7;i74 7,c7 ,opioid prescription pain reliever ,the term opioid prescription pain reliever includes hydrocodone products1 oxycodone products1 tramadol products1 codeine products1 morphine products1 fentanyl products1 buprenorphine products1 oxymorphone products1 meperidine products1 hydromorphone products1 methadone1 and any other prescription pain reliever identified by the ,assistant ,secretary for ,mental ,health and ,substance ,use4 7,d7 ,other medically necessary services ,the term other medically necessary services means1 with respect to an eligible individual with a targeted ,,sud who is a patient in an institution for mental diseases1 items and services that are provided to such individual outside of such institution to the extent that such items and services would be treated as medical assistance for such individual if such individual were not a patient in such institution4 7,e7 ,targeted ,,sud 7i7 ,in general ,the term targeted ,,sud means an opioid use disorder or a cocaine use disorder4 7ii7 ,cocaine use disorder ,the term cocaine use disorder means a disorder that meets the criteria of the ,diagnostic and ,statistical ,manual of ,mental ,disorders1 #dth ,edition 7or a successor edition71 for either dependence or abuse for cocaine1 including cocaine base 7commonly referred to as crack cocaine74 7iii7 ,opioid use disorder ,the term opioid use disorder means a disorder that meets the criteria of the ,diagnostic and ,statistical ,manual of ,mental ,disorders1 #dth ,edition 7or a successor edition71 for heroin use disorder or pain reliever use disorder 7including with respect to opioid prescription pain relievers74 4 #c4 ,promoting value in ,medicaid managed care ,section #aijc7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77 is amended by adding at the end the following new paragraph3 7#g7 7,a7 ,with respect to expenditures described in subparagraph 7,b7 that are incurred by a ,state for any fiscal year after fiscal year #bjbj 7and before fiscal year #bjbd71 in determining the pro rata share to which the ,united ,states is equitably entitled under subsection 7d77#c71 the ,secretary shall substitute the ,federal medical assistance percentage that applies for such fiscal year to the ,state under section #aije7;b7 7without regard to any adjustments to such percentage applicable under such section or any other provision of law7 for the percentage that applies to such expenditures under section #aije7y74 7,b7 ,expenditures described in this subparagraph1 with respect to a fiscal year to which subparagraph 7,a7 applies1 are expenditures incurred by a ,state for payment for medical assistance provided to individuals described in subclause 7,,viii7 of section #aijb7;a77#aj77;,a77i7 by a managed care entity1 or other specified entity 7as defined in subparagraph 7,d77iii771 that are treated as remittances because the ,state-- 7i7 has satisfied the requirement of section #dch4h of title #db1 ,code of ,federal ,regulations 7or any successor regulation71 by electing-- 7,i7 in the case of a ,state described in subparagraph 7,c71 to apply a minimum medical loss ratio 7as defined in subparagraph 7,d77ii77 that is at least #he percent but not greater than the minimum medical loss ratio 7as so defined7 that such ,state applied as of ,may #ca1 #bjah2 or 7,,ii7 in the case of a ,state not described in subparagraph 7,c71 to apply a minimum medical loss ratio that is equal to #he percent2 and 7ii7 recovered all or a portion of the expenditures as a result of the entity's failure to meet such ratio4 7,c7 ,for purposes of subparagraph 7,b71 a ,state described in this subparagraph is a ,state that as of ,may #ca1 #bjah1 applied a minimum medical loss ratio 7as calculated under subsection 7d7 of section #dch4h of title #db1 ,code of ,federal ,regulations 7as in effect on ,june #a1 #bjah77 for payment for services provided by entities described in such subparagraph under the ,state plan under this title 7or a waiver of the plan7 that is equal to or greater than #he percent4 7,d7 ,for purposes of this paragraph3 7i7 ,the term managed care entity means a medicaid managed care organization described in section #aicb7;a77#a77;,b77i74 7ii7 ,the term minimum medical loss ratio means1 with respect to a ,state1 a minimum medical loss ratio 7as calculated under subsection 7d7 of section #dch4h of title #db1 ,code of ,federal ,regulations 7as in effect on ,june #a1 #bjah77 for payment for services provided by entities described in subparagraph 7,b7 under the ,state plan under this title 7or a waiver of the plan74 7iii7 ,the term other specified entity means-- 7,i7 a prepaid inpatient health plan1 as defined in section #dch4b of title #db1 ,code of ,federal ,regulations 7or any successor regulation72 and 7,,ii7 a prepaid ambulatory health plan1 as defined in such section 7or any successor regulation74 4 ,passed the ,house of ,representatives ,june #bj1 #bjah4;,clerk4