,,ii  #aaeth ,,congress  #b;d ,session  
,s4 #cdfb  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #ah1
 #bjah,mr4 ,portman 7for himself1 ,mr4  
,durbin1 ,mr4 ,brown1 ,ms4 ,collins1    
,mr4 ,booker1 and ,mr4 ,king7 introduced
 the following bill2 which was read     
twice and referred to the ,committee on 
,finance  ,a ,,bill  ,to amend title    
,,xix of the ,social ,security ,act to  
provide ,states with the option to      
provide medical assistance for substance
 use disorder treatment services to     
individuals between the ages of #ba and 
#fd with substance use disorders1 and   
for other purposes4  #a4 ,short title   
,this ,act may be cited as the          
,improving ,coverage for ,substance ,use
 ,disorder ,recovery ,expansion ,act4   
#b4 ,state option to provide medicaid   
coverage for substance use disorder     
treatment services2 modification of the 
,,imd exclusion ,section #aije of the   
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7 is amended-- 7#a7 in subsection

 7a7--  7,a7 in paragraph 7#bh71 by     
striking and after the semicolon2  7,b7 
by redesignating paragraph 7#bi7 as     
paragraph 7#cj72 and  7,c7 by inserting 
after paragraph 7#bh71 the following new
 paragraph3  7#bi7 substance use        
disorder treatment services 7as defined 
in subsection 7ee7 and furnished in     
accordance with that subsection7 for    
individuals over #bj years of age and   
under #fe years of age1 that are offered
 as part of a full continuum of         
evidence-based treatment services       
provided under the ,state plan for      
individuals with substance use          
disorders2 and  2 and  7,d7 in the      
subdivision 7,b7 that follows paragraph 
7#cj7 7as redesignated by subparagraph  
7,b7 of this paragraph71 by inserting   
7other than substance use disorder      
treatment services provided in          
accordance with paragraph 7#bi7 and     
subsection 7ee77 after care or services2
 and  7#b7 by adding at the end the     
following new subsection3  7ee7         

,substance use disorder treatment       
services  7#a7 ,in general ,for purposes
 of subsection 7a77#bi71 the term       
substance use disorder treatment        
services means inpatient services       
provided--  7,a7 to an individual for   
the purpose of treating a substance use 
disorder that are furnished for not more
 than #ij days in any #ab-month period  
to an individual who--  7i7 has received
 initial assessments to determine the   
appropriate level of care1 length of    
stay1 and setting for such care for the 
individual based upon criteria          
established by the ,secretary in        
consultation with the multidimensional  
criteria of the ,american ,society of   
,addiction ,medicine2 and  7ii7 at      
appropriate1 evidence-based intervals   
7and in no case less than once every #cj
 days7 after the first day on which such
 services are provided to the           
individual1 is subsequently reassessed  
and determined to continue to require   
such services to promote the            

individual's recovery and stable        
transition to ongoing treatment in an   
outpatient setting2 and  7,b7 in a      
facility that-- 7i7 is licensed by the  
,single ,state ,agency for ,substance   
,abuse ,services of the ,state in which 
it is located2  7ii7 is accredited for  
the treatment of substance use disorders
 by the ,joint ,commission1 the         
,commission on ,accreditation of        
,rehabilitation ,facilities1 the        
,council on ,accreditation1 or any other
 accrediting agency that the ,secretary 
deems appropriate as necessary to ensure
 nationwide applicability2  7iii7       
employs a provider who can prescribe and
 discuss with patients the risks1       
benefits1 and alternatives of at least  
#b forms of medications approved by the 
,food and ,drug ,administration to treat
 substance use disorder involving       
opioids1 including one antagonist and   
one partial agonist2 and  7iv7 contracts
 with an opioid treatment program 7as   
defined in section #h4b of title #db1   

,code of ,federal ,regulations1 or any  
successor regulation7 for the purposes  
of offering methadone as a medication   
option to treat substance use disorders4
  7#b7 ,other medical assistance ,the   
provision of medical assistance for     
substance use disorder treatment        
services to an individual shall not     
prohibit ,federal financial             
participation for medical assistance for
 items or services that are provided to 
the individual in or away from the      
facility in which the substance use     
disorder treatment services are provided
 during any period in which the         
individual is receiving substance use   
disorder treatment services4  7#c7      
,ensuring a continuum of care ,as a     
condition for a ,state furnishing       
medical assistance for substance use    
disorder treatment services in          
accordance with subsection 7a77#bi7 and 
this subsection1 the ,state shall--     
7,a7 notify the ,secretary of how the   
,state will ensure that individuals     

receive appropriate clinical screening  
prior to being furnished with substance 
use disorder treatment services1        
including the initial assessments       
described in paragraph 7#a77;,a77i72 and
  7,b7 in order to ensure an appropriate
 transition from substance use disorder 
treatment services to other services to 
treat substance use disorders at a lower
 level of clinical intensity within the 
continuum of care 7including outpatient 
services71 ensure that all facilities   
that furnish substance use disorder     
treatment services under the ,state     
plan--  7i7 are able to provide such    
other services to treat substance use   
disorders2 or  7ii7 have an established 
relationship with another substance use 
disorder treatment facility or qualified
 provider that meets the licensing      
requirement of paragraph 7#a77;,b77i7   
and accepts patients receiving medical  
assistance under this title under which 
the facility furnishing substance use   
disorder treatment services may arrange 

for individuals to receive such other   
services to treat substance use         
disorders from such other facility or   
provider4  7#d7 ,minimum coverage       
requirements ,as a condition for a      
,state furnishing medical assistance for
 substance use disorder treatment       
services in accordance with subsection  
7a77#bi7 and this subsection1 the ,state
 shall provide medical assistance under 
the ,state plan for services associated 
with at least #f of the #i levels of    
care set forth by the ,american ,society
 of ,addiction ,medicine in the #bjac   
edition of its publication entitled ,the
 ,,asam ,criteria3 ,treatment ,criteria 
for ,addictive ,substance-,related1 and 
,co-,occurring ,conditions4  7#e7       
,maintenance of effort  7,a7 ,in general
 ,as a condition for a ,state furnishing
 medical assistance for substance use   
disorder treatment services in          
accordance with subsection 7a77#bi7 and 
this subsection1 the ,state shall--  7i7
 during the period in which the ,state  

furnishes such medical assistance1      
maintain at least the number of licensed
 beds used for the provision of         
substance use disorder treatment        
services at institutions for mental     
diseases owned1 operated1 or contracted 
for by the ,state that were being       
maintained as of the date of the        
enactment of this subsection or1 if     
higher1 as of the date the ,state       
applies to the ,secretary to include    
such medical assistance under the ,state
 plan or under a waiver of such plan2   
and  7ii7 during the period in which the
 ,state furnishes such medical          
assistance1 maintain on an annual basis 
a level of funding expended by the      
,state 7and political subdivisions      
thereof7 other than under this title    
from non-,federal funds--  7,i7 for     
inpatient services furnished for the    
purpose of treating a substance use     
disorder in institutions for mental     
diseases that is not less than the level
 of such funding for such services and  

care as of the date of the enactment of 
this subsection or1 if higher1 as of the
 date the ,state applies to the         
,secretary to include such medical      
assistance under the ,state plan or     
under a waiver of such plan2 and  7,,ii7
 for specified non-,,imd services       
described in subparagraph 7,b7 that is  
not less than the level of such funding 
for such services as of the date of the 
enactment of this subsection or1 if     
higher1 as of the date the ,state       
applies to the ,secretary to include    
such medical assistance under the ,state
 plan or under a waiver of such plan4   
7,b7 ,specified non-imd services        
described ,for purposes of subparagraph 
7,a77ii77,,ii71 specified non-,,imd     
services described in this subparagraph 
are the following3  7i7 ,inpatient      
services1 other than such services      
described in subparagraph 7,a77ii77,i74 
7ii7 ,outpatient and community-based    
services for individuals who are        
furnished substance use disorder        

treatment services1 such as--  7,i7     
substance use disorder treatment2       
7,,ii7 evidence-based recovery and      
support services1 including short-term  
detoxification services2  7,,iii7       
clinically directed therapeutic         
treatment to facilitate recovery skills1
 relapse prevention1 and emotional      
coping strategies2  7,,iv7 substance use
 disorder pharmacotherapy and drug      
screening2  7,v7 counseling and clinical
 monitoring2  7,,vi7 withdrawal         
management and related treatment        
designed to alleviate acute emotional1  
behavioral1 cognitive1 or biomedical    
distress resulting from1 or occurring   
with1 an individual's use of alcohol and
 other drugs2 and  7,,vii7 routine      
monitoring of the medication adherence  
of such individuals4  7#f7 ,application 
to managed care ,payments for1 and      
limitations to1 medical assistance      
furnished in accordance with subsection 
7a77#bi7 and this subsection shall be in
 addition to and shall not be construed 

to limit or supersede the ability of    
,states to make monthly capitation      
payments to managed care organizations  
for individuals receiving treatment in  
institutions for mental diseases in     
accordance with section #dch4f7;e7 of   
title #db1 ,code of ,federal            
,regulations 7or any successor          
regulation74  4