#aae? ,,congress  #b;d ,session  ,h4 ,r4
 #egig  ,,an ,,act  ,to am5d title ,,xix
 ( ! ,social ,security ,act to all[     
,/ates to provide "u ,m$icaid s]vices = 
c]ta9 individuals ) opioid use disord]s 
9 in/itutions = m5tal diseases4  #a4    
,%ort title ,?is ,act may be cit$ z !   
,individuals 9 ,m$icaid ,des]ve ,c>e t  
is ,appropriate & ,responsible 9 its    
,execution ,act or ! ,,imd ,,c>e ,act4  
#b4 ,m$icaid ,/ate plan option ,to      
provide s]vices = c]ta9 individuals )   
t>get$ ,s,u,ds 9 in/itutions = m5tal    
diseases ,section #aiae ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acifn7 is
 am5d$ by add+ at ! end ! foll[+ new    
subsection3  7l7 ,/ate plan option ,to  
provide s]vices = c]ta9 individuals 9   
in/itutions = m5tal diseases  7#a7 ,9   
g5]al ,) respect to cal5d> qu>t]s beg9n+
 dur+ ! p]iod beg9n+ ,janu>y #a1 #bjai1 
& end+ ,decemb] #ca1 #bjbc1 a ,/ate may 
elect1 ?r\gh a ,/ate plan am5dm5t1 to1  
not)/&+ section #aije7;a71 provide      
m$ical assi/ance = s]vices furni%$ 9    

in/itutions = m5tal diseases & = o!r    
m$ically necess>y s]vices furni%$ to    
eligible individuals ) t>get$ ,s,u,ds1 9
 accordance ) ! requirem5ts ( ?is       
subsection4  7#b7 ,paym5ts  7,a7 ,9     
g5]al ,am\nts exp5d$ "u a ,/ate plan    
am5dm5t "u p>agraph 7#a7 = s]vices      
describ$ 9 su* p>agraph furni%$1 )      
respect to a #ab-mon? p]iod1 to an      
eligible individual ) a t>get$ ,,sud :o 
is a pati5t 9 an in/itution = m5tal     
diseases %all be treat$ z m$ical        
assi/ance = :i* paym5t is made "u       
section #aijc7;a7 b only to ! ext5t t   
su* s]vices are furni%$ = n m ?an a     
p]iod ( #cj days 7:e!r or n consecutive7
 dur+ su* #ab-mon? p]iod4  7,b7         
,cl>ification ,paym5t made "u ?is       
p>agraph = exp5ditures "u a ,/ate plan  
am5dm5t "u ?is subsection ) respect to  
s]vices describ$ 9 p>agraph 7#a7 furni%$
 to an eligible individual ) a t>get$   
,,sud %all n affect paym5t t w\ld       
o!rwise be made "u section #aijc7;a7 =  
exp5ditures "u ! ,/ate plan 7or waiv] ( 

su* plan7 = m$ical assi/ance = su*      
individual4  7#c7 ,in=mation requir$ 9  
,/ate plan am5dm5t  7,a7 ,9 g5]al ,a    
,/ate elect+ to provide m$ical assi/ance
 pursuant to ?is subsection %all include
 ) ! submission ( ! ,/ate plan am5dm5t  
"u p>agraph 7#a7 to ! ,secret>y--  7i7 a
 plan on h[ ! ,/ate w improve access to 
outpati5t c>e dur+ ! p]iod ( ! ,/ate    
plan am5dm5t1 includ+ a description (-- 
7,i7 ! process by :i* eligible          
individuals ) t>get$ ,s,u,ds w make !   
transition f receiv+ inpati5t s]vices 9 
an in/itution = m5tal diseases to       
appropriate outpati5t c>e2 &  7,,ii7 !  
process ! ,/ate w und]take to ensure    
eligible individuals ) t>get$ ,s,u,ds   
are provid$ c>e 9 ! mo/ integrat$ sett+ 
appropriate to ! ne$s ( ! individuals2 &
  7ii7 a description ( h[ ! ,/ate plan  
am5dm5t ensures an appropriate cl9ical  
scre5+ ( eligible individuals ) t>get$  
,s,u,ds1 includ+ assessm5ts to det]m9e  
level ( c>e & l5g? ( /ay recomm5dations 
bas$ ^u ! multidim5sional assessm5t     

crit]ia ( ! ,am]ican ,society (         
,addiction ,m$ic9e & to det]m9e !       
appropriate sett+ = su* c>e4  7,b7      
,report ,n lat] ?an ! soon] ( ,decemb]  
#ca1 #bjbd1 or #a ye> aft] ! date ( !   
t]m9ation ( a ,/ate plan am5dm5t "u ?is 
subsection1 ! ,/ate %all submit to !    
,secret>y a report t includes at lea/-- 
7i7 ! numb] ( eligible individuals )    
t>get$ ,s,u,ds :o receiv$ s]vices       
pursuant to su* ,/ate plan am5dm5t2     
7ii7 ! l5g? ( ! /ay ( ea* su* individual
 9 an in/itution = m5tal diseases2      
7iii7 ! type ( outpati5t treatm5t1      
includ+ m$ication-assi/$ treatm5t1 ea*  
su* individual receiv$ aft] be+ dis*>g$ 
f su* in/itution2  7iv7 ! numb] (       
eligible individuals ) any co-occur+    
disord]s :o receiv$ s]vices pursuant to 
su* ,/ate plan am5dm5t & ! co-occur+    
disord]s f :i* !y suff]2 &  7v7         
in=mation reg>d+ ! effects ( a ,/ate    
plan am5dm5t on access to community c>e 
= individuals suff]+ f a m5tal disease  
o!r ?an sub/ance use disord]4  7#d7     

,def9itions ,9 ?is subsection3 7,a7     
,eligible individual ) a t>get$ ,,sud ,!
 t]m eligible individual ) a t>get$     
,,sud means an individual :o--  7i7 )   
respect to a ,/ate1 is enroll$ = m$ical 
assi/ance "u ! ,/ate plan 7or a waiv] ( 
su* plan72  7ii7 is at lea/ #ba ye>s (  
age2  7iii7 has n atta9$ #fe ye>s ( age2
 &  7iv7 has be5 diagnos$ ) at lea/ "o  
t>get$ ,,sud4  7,b7 ,in/itution = m5tal 
diseases ,! t]m in/itution = m5tal      
diseases has ! mean+ giv5 su* t]m 9     
section #aije7;i74  7,c7 ,opioid        
prescription pa9 reliev] ,! t]m opioid  
prescription pa9 reliev] includes       
hydrocodone products1 oxycodone         
products1 tramadol products1 code9e     
products1 morph9e products1 f5tanyl     
products1 bupr5orph9e products1         
oxymorphone products1 mep]id9e products1
 hydromorphone products1 me?adone1 & any
 o!r prescription pa9 reliev] id5tifi$  
by ! ,assi/ant ,secret>y = ,m5tal ,heal?
 & ,sub/ance ,use4  7,d7 ,o!r m$ically  
necess>y s]vices ,! t]m o!r m$ically    

necess>y s]vices means1 ) respect to an 
eligible individual ) a t>get$ ,,sud :o 
is a pati5t 9 an in/itution = m5tal     
diseases1 items & s]vices t are provid$ 
to su* individual outside ( su*         
in/itution to ! ext5t t su* items &     
s]vices w\ld be treat$ z m$ical         
assi/ance = su* individual if su*       
individual 7 n a pati5t 9 su*           
in/itution4  7,e7 ,t>get$ ,,sud  7i7 ,9 
g5]al ,! t]m t>get$ ,,sud means an      
opioid use disord] or a coca9e use      
disord]4  7ii7 ,coca9e use disord] ,!   
t]m coca9e use disord] means a disord] t
 meets ! crit]ia ( ! ,diagno/ic &       
,/ati/ical ,manual ( ,m5tal ,disord]s1  
#d? ,edition 7or a successor edition71 =
 ei!r dep5d5ce or abuse = coca9e1       
includ+ coca9e base 7commonly ref]r$ to 
z crack coca9e74  7iii7 ,opioid use     
disord] ,! t]m opioid use disord] means 
a disord] t meets ! crit]ia ( !         
,diagno/ic & ,/ati/ical ,manual ( ,m5tal
 ,disord]s1 #d? ,edition 7or a successor
 edition71 = h]o9 use disord] or pa9    

reliev] use disord] 7includ+ ) respect  
to opioid prescription pa9 reliev]s74  4
  #c4 ,promot+ value 9 ,m$icaid manag$  
c>e ,section #aijc7m7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acif;b7m77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#g7 7,a7 ,)      
respect to exp5ditures describ$ 9       
subp>agraph 7,b7 t are incurr$ by a     
,/ate = any fiscal ye> aft] fiscal ye>  
#bjbj 7& be=e fiscal ye> #bjbd71 9      
det]m9+ ! pro rata %>e to :i* ! ,unit$  
,/ates is equitably entitl$ "u          
subsection 7d77#c71 ! ,secret>y %all    
sub/itute ! ,f$]al m$ical assi/ance     
p]c5tage t applies = su* fiscal ye> to !
 ,/ate "u section #aije7;b7 7)\t reg>d  
to any adju/m5ts to su* p]c5tage        
applicable "u su* section or any o!r    
provision ( law7 = ! p]c5tage t applies 
to su* exp5ditures "u section #aije7y74 
7,b7 ,exp5ditures describ$ 9 ?is        
subp>agraph1 ) respect to a fiscal ye>  
to :i* subp>agraph 7,a7 applies1 are    
exp5ditures incurr$ by a ,/ate = paym5t 

= m$ical assi/ance provid$ to           
individuals describ$ 9 subclause        
7,,viii7 ( section                      
#aijb7;a77#aj77;,a77i7 by a manag$ c>e  
entity1 or o!r specifi$ entity 7z def9$ 
9 subp>agraph 7,d77iii771 t are treat$ z
 remittances because ! ,/ate-- 7i7 has  
satisfi$ ! requirem5t ( section #dch4h (
 title #db1 ,code ( ,f$]al ,regulations 
7or any successor regulation71 by       
elect+--  7,i7 9 ! case ( a ,/ate       
describ$ 9 subp>agraph 7,c71 to apply a 
m9imum m$ical loss ratio 7z def9$ 9     
subp>agraph 7,d77ii77 t is at lea/ #he  
p]c5t b n great] ?an ! m9imum m$ical    
loss ratio 7z s def9$7 t su* ,/ate      
appli$ z ( ,may #ca1 #bjah2 or  7,,ii7 9
 ! case ( a ,/ate n describ$ 9          
subp>agraph 7,c71 to apply a m9imum     
m$ical loss ratio t is equal to #he     
p]c5t2 &  7ii7 recov]$ all or a portion 
( ! exp5ditures z a result ( ! entity's 
failure to meet su* ratio4  7,c7 ,=     
purposes ( subp>agraph 7,b71 a ,/ate    
describ$ 9 ?is subp>agraph is a ,/ate t 

z ( ,may #ca1 #bjah1 appli$ a m9imum    
m$ical loss ratio 7z calculat$ "u       
subsection 7d7 ( section #dch4h ( title 
#db1 ,code ( ,f$]al ,regulations 7z 9   
effect on ,june #a1 #bjah77 = paym5t =  
s]vices provid$ by entities describ$ 9  
su* subp>agraph "u ! ,/ate plan "u ?is  
title 7or a waiv] ( ! plan7 t is equal  
to or great] ?an #he p]c5t4  7,d7 ,=    
purposes ( ?is p>agraph3 7i7 ,! t]m     
manag$ c>e entity means a m$icaid manag$
 c>e organization describ$ 9 section    
#aicb7;a77#a77;,b77i74  7ii7 ,! t]m     
m9imum m$ical loss ratio means1 )       
respect to a ,/ate1 a m9imum m$ical loss
 ratio 7z calculat$ "u subsection 7d7 ( 
section #dch4h ( title #db1 ,code (     
,f$]al ,regulations 7z 9 effect on ,june
 #a1 #bjah77 = paym5t = s]vices provid$ 
by entities describ$ 9 subp>agraph 7,b7 
"u ! ,/ate plan "u ?is title 7or a waiv]
 ( ! plan74  7iii7 ,! t]m o!r specifi$  
entity means--  7,i7 a prepaid inpati5t 
heal? plan1 z def9$ 9 section #dch4b (  
title #db1 ,code ( ,f$]al ,regulations  

7or any successor regulation72 &  7,,ii7
 a prepaid ambulatory heal? plan1 z     
def9$ 9 su* section 7or any successor   
regulation74  4  ,pass$ ! ,h\se (       
,repres5tatives ,june #bj1 #bjah4;,cl]k4