,i #aafth ,,congress #b;d ,session ,h4 ,r4 #giab ,,in ,,the ,,house ,,of ,,representatives ,july #ca1 #bjbj,mr4 ,huizenga 7for himself and ,mr4 ,tonko7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to provide for a demonstration program and pilot project to expand choice for inpatient psychiatric services under ,medicaid and ,medicare4 #a4 ,short title ,this ,act may be cited as the ,increasing ,national ,patient ,access ,to ,improved ,effective ,necessary ,mental ,health ,treatment ,act of #bjbj or the ,,inpatient ,act of #bjbj4 #b4 ,demonstration project waiving ,,imd exclusion to expand access to inpatient psychiatric services under the ,medicaid program 7a7 ,authority ,to conduct demonstration project 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this ,act referred to as the ,secretary7 shall establish a demonstration project 7in this ,act referred to as the demonstration project7 to test the impact of waiving the limitation of subdivision 7,b7 following paragraph 7#bi7 of section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 on average length of stay1 readmissions1 cost1 and quality outcomes for inpatient psychiatric hospital services and substance abuse services4 7#b7 ,terms ,under the demonstration project1 an eligible ,state 7as defined in subsection 7b77 shall provide payment under its ,state ,medicaid plan under title ,,xix of the ,social ,security ,act to qualifying institutions 7as defined in subsection 7b77#c77;,c77 for the provision of medical assistance available under such plan to individuals who-- 7,a7 have attained age #ba1 but have not attained age #fe2 7,b7 are eligible for medical assistance under such plan 7or under a waiver of such plan72 7,c7 require such medical assistance for inpatient psychiatric hospital services or residential substance abuse services2 and 7,d7 but for participation in the demonstration project1 would otherwise receive medical assistance for such inpatient psychiatric hospital services if the services were provided in a general acute care hospital or other residential substance abuse facility4 7b7 ,eligible state defined 7#a7 ,in general ,in this section1 the term eligible ,state means a ,state that has made an application under paragraph 7#b7 and has had such application approved and has been selected under paragraph 7#c74 7#b7 ,application ,a ,state seeking to participate in the demonstration project shall submit to the ,secretary1 at such time and in such format as the ,secretary requires1 an application that includes such information1 provisions1 and assurances1 as the ,secretary may require4 7#c7 ,selection and limitation 7,a7 ,state limitation ,the ,secretary shall limit the number of ,states selected for participation in the demonstration project to no more than #c ,states4 7,b7 ,conditions for application approval ,the ,secretary shall not approve an application under paragraph 7#b7 unless the ,state agrees to limit participation in the demonstration project to qualifying institutions 7as defined in subparagraph 7,c774 7,c7 ,qualifying institution defined ,in this ,act1 the term qualifying institution means an institution for mental diseases that is not publicly owned or operated1 that is subject to the requirements of section #ahfg of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;dd71 and that meets all of the following criteria3 7i7 ,the institution furnishes inpatient psychiatric hospital services to individuals age #ah years of age or older under the ,medicare and ,medicaid programs4 7ii7 ,the institution has an average length of inpatient hospital stay of less than #ae days for individuals age #ah or older1 but under #fe years of age4 7iii7 ,the institution has an average length of stay of less than #ba days for hospital inpatients age #fe or older4 7iv7 ,the institution has an approved medical residency training program and receive payment due under the ,medicare and ,medicaid programs for the reasonable costs of graduate medical education4 7v7 ,the institution uses psychiatric residents to provide inpatient psychiatric hospital services to individuals under the ,medicare and ,medicaid programs4 7vi7 ,the institution has documented experience in providing services to active duty military personnel and veterans4 7vii7 ,the institution has standards to care for the whole person1 including referral agreements or other arrangements to address a patient's medical1 surgical1 or diagnostic needs if such treatment services are not available within the institution4 7viii7 ,the institution agrees to report on quality measures 7in such form1 manner1 and frequency as specified by the ,secretary7 and report to the ,secretary 7in a form1 manner1 and frequency as specified by the ,secretary7 such data as the ,secretary determines appropriate to monitor and evaluate the demonstration project4 7ix7 ,the institution agrees to plan and implement an annual performance improvement project1 aimed at improving the effectiveness of care provided to high utilizers of inpatient psychiatric hospital services 7as defined in subsection 7h77#a771 with identifiable measures in coordination with the ,secretary and the ,state4 7c7 ,deadline for implementation ,the ,secretary shall implement the demonstration project by ,january #a1 #bjbb4 7d7 ,length of demonstration project ,the demonstration project shall be conducted for a period of #g consecutive years4 7e7 ,budget neutrality ,with respect to the operation of the demonstration project in a ,state for the period described in subsection 7d71 the ,state must demonstrate to the ,secretary that project will not result in a net increase in the aggregate expenditures under the ,medicaid program for such period for the ,state above the level of such expenditures if the demonstration project had not been implemented4 7f7 ,evaluation and report to ,congress 7#a7 ,evaluation ,the ,secretary shall conduct an evaluation of the demonstration project in order to determine the impact of the project and to make recommendations on improvements to the performance of the health and mental health service system and on individuals enrolled in the ,medicaid program1 with particular emphasis on individuals who are high utilizers of inpatient psychiatric hospital services and substance abuse residential services4 7#b7 ,items included in evaluation ,such evaluation shall include the following3 7,a7 ,an assessment of the delivery of inpatient psychiatric hospital services1 substance abuse residential services1 and community-based services under the ,medicaid program2 average lengths of inpatient stays2 emergency room visits2 and readmissions4 7,b7 ,an assessment of the impact of the demonstration project on the costs of the full range of mental health services 7including inpatient1 emergency and ambulatory care7 under the ,medicaid program4 7,c7 ,an assessment of the impact of the demonstration project on psychiatric residency programs and the mental health workforce4 7,d7 ,an assessment of the impact of the demonstration project on rates of recidivism4 7,e7 ,identification and assessment of best practices for caring for patients with serious mental illness1 including high utilizers of inpatient psychiatric hospital services and substance abuse residential services4 7,f7 ,a comparison of outcomes and costs for similarly situated patients receiving inpatient psychiatric hospital services at a general acute care hospital4 7,g7 ,a recommendation regarding whether the demonstration project should be continued after ,december #ca1 #bjbh1 and expanded on a national basis4 7#c7 ,report ,not later than ,december #ca1 #bjbh1 the ,secretary shall submit to ,congress 7and make available to the public7 a report on the findings of the evaluation conducted under this subsection4 7g7 ,,imd waiver2 waiver authority 7#a7 ,,imd waiver ,the limitation of subdivision 7,b7 following paragraph 7#bi7 of section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a771 relating to limitations on payments for care or services for individuals under #fe years of age who are patients in an institution for mental disease1 shall not apply to inpatient psychiatric hospital services or substance abuse residential services furnished under the demonstration project4 7#b7 ,waiver authority ,the ,secretary may waive such requirements of titles ,,xi and ,,xix of the ,social ,security ,act 7which may include the requirements of paragraph 7#a7 7relating to statewideness77 and paragraph 7#aj77;,b7 7relating to comparability7 of section #aijb7;a7 of such ,act 7#db ,u4,s4,c4 #acif;b7a77 only to extent the ,secretary determines such a waiver to be necessary to carry out the demonstration project4 7h7 ,definitions ,in this ,act3 7#a7 ,high utilizer of inpatient psychiatric hospital services ,the term high utilizer of inpatient psychiatric hospital services means an individual who1 with respect to a point in time1 meets the following conditions3 7,a7 ,the individual had two or more inpatient admissions for psychiatric services in the previous #ab months4 7,b7 ,the individual had #aj or more inpatient admissions for psychiatric services in the individual's lifetime4 7,c7 ,the individual had #ajj or more days of inpatient psychiatric services in the individual's lifetime4 7,d7 ,the individual meets any of the following conditions3 7i7 ,the individual is receiving court-ordered psychiatric treatment4 7ii7 ,the individual has been receiving inpatient psychiatric services for a consecutive period of at least #ab days4 7iii7 ,the individual has a documented history of suicidal or self-harming behaviors due to mental illness4 7iv7 ,the individual has a documented history of threatened or actual physical harm to another individual due to mental illness4 7#b7 ,institution for mental disease ,the term institution for mental disease has the meaning given that term in section #aije7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7i774 7#c7 ,medicaid program ,the term ,medicaid program means the program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#d7 ,medical assistance ,the term medical assistance has the meaning given that term in section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a774 7#e7 ,medicare program ,the term ,medicare program means the program under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 and includes the programs under parts ,b1 ,c1 and ,d of such title4 7#f7 ,state ,the term ,state has the meaning given that term for purposes of the ,medicaid program4 #c4 ,pilot program waiving the ,medicare #aij-;day lifetime limit on inpatient psychiatric hospital services to expand access to inpatient psychiatric services under the ,medicare program 7a7 ,demonstration program authorized ,the ,secretary shall establish a pilot program 7in this section referred to as the pilot program7 to test the impact of eliminating the ,medicare #aij-;day lifetime limit on-- 7#a7 promoting value2 7#b7 expanding choice2 and 7#c7 aligning inpatient mental health benefits with the inpatient physical health care benefits under the ,medicare program4 7b7 ,definitions ,in this section3 7#a7 ,applicable beneficiary ,the term applicable beneficiary means an individual who-- 7,a7 is entitled to1 or enrolled for1 benefits under part ,a1 and enrolled for benefits under part ,b1 of the ,medicare program2 7,b7 is admitted to a qualifying institution participating in the demonstration project2 and 7,c7 but for the pilot program established under this section1 would otherwise receive benefits for inpatient psychiatric services under the ,medicare program if the services were provided in a general acute care hospital4 7#b7 ,inpatient psychiatric hospital services ,the term inpatient psychiatric hospital services has the meaning given such term in section #ahfa7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7c774 7#c7 ,medicare #aij-;day lifetime limit ,the term ,medicare #aij-;day lifetime limit means the #aij-;day lifetime limitation imposed on inpatient psychiatric hospital services under section #ahab7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;d7b77#c774 7c7 ,program details 7#a7 ,duration and starting date 7,a7 ,starting date ,the pilot program shall begin no later than ,january #a1 #bjba4 7,b7 ,duration ,subject to subparagraph 7,c71 the pilot program shall be conducted for a period of #g years4 7,c7 ,expansion ,the ,secretary may1 at any time after the pilot program has operated for a period of at least #c years expand the duration and scope of the pilot program1 to the extent determined appropriate by the ,secretary1 if-- 7i7 the ,secretary determines that such expansion is expected-- 7,i7 to reduce 7or not to result in any increase in7 net expenditures under the ,medicare program without reducing the quality of care2 or 7,,ii7 to improve the quality of care without increasing such net expenditures2 7ii7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such expansion would reduce spending under the ,medicare program2 and 7iii7 the ,secretary determines that such expansion would not deny or limit the coverage or provision of benefits under the ,medicare program for applicable beneficiaries4 7#b7 ,waiver of ,medicare #aij-;day lifetime limit ,the ,medicare #aij-;day lifetime limit shall not apply to applicable beneficiaries receiving inpatient psychiatric services at a participating institution under the pilot program4 7#c7 ,participating providers of services and suppliers 7,a7 ,in general ,only institutions participating in the demonstration project may submit an application to the ,secretary to provide inpatient psychiatric services under the pilot program4 7,b7 ,requirements ,the ,secretary may develop additional requirements for institutions to participate in the pilot program4 ,such requirements may include the collection and reporting of data related to the reasonable costs of graduate medical education4 7#d7 ,quality measures 7,a7 ,in general ,the ,secretary shall establish quality measures related to care provided by qualifying institutions participating in the pilot program1 which measures shall include at least measures of the following3 7i7 ,reducing rates of avoidable hospital readmissions4 7ii7 ,rates of discharge to the community4 7iii7 ,rates of admission to an emergency room after a hospitalization4 7iv7 ,other measures1 including measures of patient outcomes1 determined appropriate by the ,secretary4 7,b7 ,reporting on quality measures ,a qualifying institution shall submit 7in a form and manner specified by the ,secretary7 data to the ,secretary on quality measures established under subparagraph 7,a7 during each year in which the institution is participating in the pilot program4 7d7 ,waiver ,the ,secretary shall waive such provisions of titles ,,xi and ,,xviii of the ,social ,security ,act as may be necessary to carry out the pilot program4 7e7 ,independent evaluation and reports on pilot program 7#a7 ,independent evaluation ,the ,secretary shall conduct an independent evaluation of the pilot program1 including the extent to which the pilot program has-- 7,a7 improved quality measures established under subsection 7c77#d77;,a72 7,b7 improved health outcomes2 7,c7 improved patient satisfaction2 and 7,d7 reduced spending under the ,medicare program4 7#b7 ,report ,not later than ,december #ca1 #bjbg1 the ,secretary shall submit to ,congress a report on the evaluation conducted under paragraph 7#a74 7#c7 ,coordination with expanding choice for medicaid inpatient psychiatric hospital services demonstration project ,the ,secretary may combine the independent evaluation and reports required under this section and the reports required under the demonstration project under section #b7;f74 7f7 ,budget neutrality ,with respect to the period of the pilot program under subsection 7c77#a7 occurring before any expansion under subparagraph 7,c7 of such subsection1 the ,secretary shall ensure that the program does not result in a net increase in the aggregate expenditures under the ,medicare program for such period above the level of such expenditures if the pilot program had not been implemented4 ,the ,secretary may make such adjustments to payments under the ,medicare program as is necessary to carry out the previous sentence4