,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #giab  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #ca1 #bjbj,mr4  
,huiz5ga 7= himself & ,mr4 ,tonko7      
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to provide = a demon/ration   
program & pilot project to exp& *oice = 
inpati5t psy*iatric s]vices "u ,m$icaid 
& ,m$ic>e4  #a4 ,%ort title ,?is ,act   
may be cit$ z ! ,increas+ ,national     
,pati5t ,access ,to ,improv$ ,effective 
,necess>y ,m5tal ,heal? ,treatm5t ,act (
 #bjbj or ! ,,inpati5t ,act ( #bjbj4    
#b4 ,demon/ration project waiv+ ,,imd   
exclusion to exp& access to inpati5t    
psy*iatric s]vices "u ! ,m$icaid program
  7a7 ,au?ority ,to conduct demon/ration
 project  7#a7 ,9 g5]al ,! ,secret>y (  
,heal? & ,human ,s]vices 79 ?is ,act    

ref]r$ to z ! ,secret>y7 %all e/abli% a 
demon/ration project 79 ?is ,act ref]r$ 
to z ! demon/ration project7 to te/ !   
impact ( waiv+ ! limitation (           
subdivision 7,b7 foll[+ p>agraph 7#bi7 (
 section #aije7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;d7a77 on     
av]age l5g? ( /ay1 readmissions1 co/1 & 
quality outcomes = inpati5t psy*iatric  
hospital s]vices & sub/ance abuse       
s]vices4  7#b7 ,t]ms ,"u ! demon/ration 
project1 an eligible ,/ate 7z def9$ 9   
subsection 7b77 %all provide paym5t "u  
its ,/ate ,m$icaid plan "u title ,,xix (
 ! ,social ,security ,act to qualify+   
in/itutions 7z def9$ 9 subsection       
7b77#c77;,c77 = ! provision ( m$ical    
assi/ance available "u su* plan to      
individuals :o-- 7,a7 h atta9$ age #ba1 
b h n atta9$ age #fe2  7,b7 are eligible
 = m$ical assi/ance "u su* plan 7or "u a
 waiv] ( su* plan72  7,c7 require su*   
m$ical assi/ance = inpati5t psy*iatric  
hospital s]vices or resid5tial sub/ance 
abuse s]vices2 &  7,d7 b = p>ticipation 

9 ! demon/ration project1 w\ld o!rwise  
receive m$ical assi/ance = su* inpati5t 
psy*iatric hospital s]vices if ! s]vices
 7 provid$ 9 a g5]al acute c>e hospital 
or o!r resid5tial sub/ance abuse        
facility4  7b7 ,eligible /ate def9$     
7#a7 ,9 g5]al ,9 ?is section1 ! t]m     
eligible ,/ate means a ,/ate t has made 
an application "u p>agraph 7#b7 & has _h
 su* application approv$ & has be5      
select$ "u p>agraph 7#c74  7#b7         
,application ,a ,/ate seek+ to          
p>ticipate 9 ! demon/ration project %all
 submit to ! ,secret>y1 at su* "t & 9   
su* =mat z ! ,secret>y requires1 an     
application t includes su* in=mation1   
provisions1 & assurances1 z ! ,secret>y 
may require4  7#c7 ,selection &         
limitation  7,a7 ,/ate limitation ,!    
,secret>y %all limit ! numb] ( ,/ates   
select$ = p>ticipation 9 ! demon/ration 
project to no m ?an #c ,/ates4  7,b7    
,conditions = application approval ,!   
,secret>y %all n approve an application 
"u p>agraph 7#b7 unless ! ,/ate agrees  

to limit p>ticipation 9 ! demon/ration  
project to qualify+ in/itutions 7z def9$
 9 subp>agraph 7,c774  7,c7 ,qualify+   
in/itution def9$ ,9 ?is ,act1 ! t]m     
qualify+ in/itution means an in/itution 
= m5tal diseases t is n publicly own$ or
 op]at$1 t is subject to ! requirem5ts (
 section #ahfg ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie;dd71 & t meets
 all ( ! foll[+ crit]ia3 7i7 ,!         
in/itution furni%es inpati5t psy*iatric 
hospital s]vices to individuals age #ah 
ye>s ( age or old] "u ! ,m$ic>e &       
,m$icaid programs4  7ii7 ,! in/itution  
has an av]age l5g? ( inpati5t hospital  
/ay ( less ?an #ae days = individuals   
age #ah or old]1 b "u #fe ye>s ( age4   
7iii7 ,! in/itution has an av]age l5g? (
 /ay ( less ?an #ba days = hospital     
inpati5ts age #fe or old]4  7iv7 ,!     
in/itution has an approv$ m$ical        
resid5cy tra9+ program & receive paym5t 
due "u ! ,m$ic>e & ,m$icaid programs = !
 reasonable co/s ( graduate m$ical      
education4  7v7 ,! in/itution uses      

psy*iatric resid5ts to provide inpati5t 
psy*iatric hospital s]vices to          
individuals "u ! ,m$ic>e & ,m$icaid     
programs4  7vi7 ,! in/itution has       
docum5t$ exp]i5ce 9 provid+ s]vices to  
active duty milit>y p]sonnel & vet]ans4 
7vii7 ,! in/itution has /&>ds to c>e = !
 :ole p]son1 includ+ ref]ral agreem5ts  
or o!r arrangem5ts to address a pati5t's
 m$ical1 surgical1 or diagno/ic ne$s if 
su* treatm5t s]vices are n available )9 
! in/itution4  7viii7 ,! in/itution     
agrees to report on quality measures 79 
su* =m1 mann]1 & frequ5cy z specifi$ by 
! ,secret>y7 & report to ! ,secret>y 79 
a =m1 mann]1 & frequ5cy z specifi$ by ! 
,secret>y7 su* data z ! ,secret>y       
det]m9es appropriate to monitor &       
evaluate ! demon/ration project4  7ix7  
,! in/itution agrees to plan & implem5t 
an annual p]=mance improvem5t project1  
aim$ at improv+ ! effectiv5ess ( c>e    
provid$ to high utiliz]s ( inpati5t     
psy*iatric hospital s]vices 7z def9$ 9  
subsection 7h77#a771 ) id5tifiable      

measures 9 coord9ation ) ! ,secret>y & !
 ,/ate4  7c7 ,deadl9e = implem5tation ,!
 ,secret>y %all implem5t ! demon/ration 
project by ,janu>y #a1 #bjbb4  7d7 ,l5g?
 ( demon/ration project ,! demon/ration 
project %all be conduct$ = a p]iod ( #g 
consecutive ye>s4  7e7 ,budget          
neutrality ,) respect to ! op]ation ( ! 
demon/ration project 9 a ,/ate = ! p]iod
 describ$ 9 subsection 7d71 ! ,/ate mu/ 
demon/rate to ! ,secret>y t project w n 
result 9 a net increase 9 ! aggregate   
exp5ditures "u ! ,m$icaid program = su* 
p]iod = ! ,/ate above ! level ( su*     
exp5ditures if ! demon/ration project _h
 n be5 implem5t$4  7f7 ,evaluation &    
report to ,congress  7#a7 ,evaluation ,!
 ,secret>y %all conduct an evaluation ( 
! demon/ration project 9 ord] to det]m9e
 ! impact ( ! project & to make         
recomm5dations on improvem5ts to !      
p]=mance ( ! heal? & m5tal heal? s]vice 
sy/em & on individuals enroll$ 9 !      
,m$icaid program1 ) p>ticul> emphasis on
 individuals :o are high utiliz]s (     

inpati5t psy*iatric hospital s]vices &  
sub/ance abuse resid5tial s]vices4  7#b7
 ,items includ$ 9 evaluation ,su*       
evaluation %all include ! foll[+3 7,a7  
,an assessm5t ( ! deliv]y ( inpati5t    
psy*iatric hospital s]vices1 sub/ance   
abuse resid5tial s]vices1 &             
community-bas$ s]vices "u ! ,m$icaid    
program2 av]age l5g?s ( inpati5t /ays2  
em]g5cy room visits2 & readmissions4    
7,b7 ,an assessm5t ( ! impact ( !       
demon/ration project on ! co/s ( ! full 
range ( m5tal heal? s]vices 7includ+    
inpati5t1 em]g5cy & ambulatory c>e7 "u !
 ,m$icaid program4  7,c7 ,an assessm5t (
 ! impact ( ! demon/ration project on   
psy*iatric resid5cy programs & ! m5tal  
heal? work=ce4  7,d7 ,an assessm5t ( !  
impact ( ! demon/ration project on rates
 ( recidivism4  7,e7 ,id5tification &   
assessm5t ( be/ practices = c>+ =       
pati5ts ) s]i\s m5tal illness1 includ+  
high utiliz]s ( inpati5t psy*iatric     
hospital s]vices & sub/ance abuse       
resid5tial s]vices4  7,f7 ,a comp>ison (

 outcomes & co/s = simil>ly situat$     
pati5ts receiv+ inpati5t psy*iatric     
hospital s]vices at a g5]al acute c>e   
hospital4  7,g7 ,a recomm5dation reg>d+ 
:e!r ! demon/ration project %\ld be     
cont9u$ aft] ,decemb] #ca1 #bjbh1 &     
exp&$ on a national basis4  7#c7 ,report
 ,n lat] ?an ,decemb] #ca1 #bjbh1 !     
,secret>y %all submit to ,congress 7&   
make available to ! public7 a report on 
! f9d+s ( ! evaluation conduct$ "u ?is  
subsection4  7g7 ,,imd waiv]2 waiv]     
au?ority  7#a7 ,,imd waiv] ,! limitation
 ( subdivision 7,b7 foll[+ p>agraph     
7#bi7 ( section #aije7;a7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acif;d7a771 relat+ to limitations on   
paym5ts = c>e or s]vices = individuals  
"u #fe ye>s ( age :o are pati5ts 9 an   
in/itution = m5tal disease1 %all n apply
 to inpati5t psy*iatric hospital s]vices
 or sub/ance abuse resid5tial s]vices   
furni%$ "u ! demon/ration project4  7#b7
 ,waiv] au?ority ,! ,secret>y may waive 
su* requirem5ts ( titles ,,xi & ,,xix ( 

! ,social ,security ,act 7:i* may       
include ! requirem5ts ( p>agraph 7#a7   
7relat+ to /atewid5ess77 & p>agraph     
7#aj77;,b7 7relat+ to comp>ability7 (   
section #aijb7;a7 ( su* ,act 7#db       
,u4,s4,c4 #acif;b7a77 only to ext5t !   
,secret>y det]m9es su* a waiv] to be    
necess>y to c>ry out ! demon/ration     
project4  7h7 ,def9itions ,9 ?is ,act3  
7#a7 ,high utiliz] ( inpati5t psy*iatric
 hospital s]vices ,! t]m high utiliz] ( 
inpati5t psy*iatric hospital s]vices    
means an individual :o1 ) respect to a  
po9t 9 "t1 meets ! foll[+ conditions3   
7,a7 ,! individual _h two or m inpati5t 
admissions = psy*iatric s]vices 9 !     
previ\s #ab mon?s4  7,b7 ,! individual  
_h #aj or m inpati5t admissions =       
psy*iatric s]vices 9 ! individual's     
lifetime4  7,c7 ,! individual _h #ajj or
 m days ( inpati5t psy*iatric s]vices 9 
! individual's lifetime4  7,d7 ,!       
individual meets any ( ! foll[+         
conditions3 7i7 ,! individual is receiv+
 c\rt-ord]$ psy*iatric treatm5t4  7ii7  

,! individual has be5 receiv+ inpati5t  
psy*iatric s]vices = a consecutive p]iod
 ( at lea/ #ab days4  7iii7 ,!          
individual has a docum5t$ hi/ory (      
suicidal or self-h>m+ behaviors due to  
m5tal illness4  7iv7 ,! individual has a
 docum5t$ hi/ory ( ?reat5$ or actual    
physical h>m to ano!r individual due to 
m5tal illness4  7#b7 ,in/itution = m5tal
 disease ,! t]m in/itution = m5tal      
disease has ! mean+ giv5 t t]m 9 section
 #aije7;i7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acif;d7i774  7#c7       
,m$icaid program ,! t]m ,m$icaid program
 means ! program "u title ,,xix ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq474  7#d7 ,m$ical assi/ance 
,! t]m m$ical assi/ance has ! mean+ giv5
 t t]m 9 section #aije7;a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;d7a774  7#e7 ,m$ic>e program ,!   
t]m ,m$ic>e program means ! program "u  
"p ,a ( title ,,xviii ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acie;c et
 seq47 & includes ! programs "u p>ts ,b1

 ,c1 & ,d ( su* title4  7#f7 ,/ate ,!   
t]m ,/ate has ! mean+ giv5 t t]m =      
purposes ( ! ,m$icaid program4  #c4     
,pilot program waiv+ ! ,m$ic>e #aij-;day
 lifetime limit on inpati5t psy*iatric  
hospital s]vices to exp& access to      
inpati5t psy*iatric s]vices "u ! ,m$ic>e
 program  7a7 ,demon/ration program     
au?oriz$ ,! ,secret>y %all e/abli% a    
pilot program 79 ?is section ref]r$ to z
 ! pilot program7 to te/ ! impact (     
elim9at+ ! ,m$ic>e #aij-;day lifetime   
limit on-- 7#a7 promot+ value2  7#b7    
exp&+ *oice2 &  7#c7 align+ inpati5t    
m5tal heal? b5efits ) ! inpati5t        
physical heal? c>e b5efits "u ! ,m$ic>e 
program4  7b7 ,def9itions ,9 ?is        
section3 7#a7 ,applicable b5efici>y ,!  
t]m applicable b5efici>y means an       
individual :o-- 7,a7 is entitl$ to1 or  
enroll$ =1 b5efits "u "p ,a1 & enroll$ =
 b5efits "u "p ,b1 ( ! ,m$ic>e program2 
7,b7 is admitt$ to a qualify+ in/itution
 p>ticipat+ 9 ! demon/ration project2 & 
7,c7 b = ! pilot program e/abli%$ "u ?is

 section1 w\ld o!rwise receive b5efits =
 inpati5t psy*iatric s]vices "u !       
,m$ic>e program if ! s]vices 7 provid$ 9
 a g5]al acute c>e hospital4  7#b7      
,inpati5t psy*iatric hospital s]vices ,!
 t]m inpati5t psy*iatric hospital       
s]vices has ! mean+ giv5 su* t]m 9      
section #ahfa7;c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciex7c774  7#c7   
,m$ic>e #aij-;day lifetime limit ,! t]m 
,m$ic>e #aij-;day lifetime limit means !
 #aij-;day lifetime limitation impos$ on
 inpati5t psy*iatric hospital s]vices "u
 section #ahab7;b77#c7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;d7b77#c774  7c7 ,program details  
7#a7 ,duration & />t+ date  7,a7 ,/>t+  
date ,! pilot program %all beg9 no lat] 
?an ,janu>y #a1 #bjba4  7,b7 ,duration  
,subject to subp>agraph 7,c71 ! pilot   
program %all be conduct$ = a p]iod ( #g 
ye>s4  7,c7 ,expansion ,! ,secret>y may1
 at any "t aft] ! pilot program has     
op]at$ = a p]iod ( at lea/ #c ye>s exp& 
! duration & scope ( ! pilot program1 to

 ! ext5t det]m9$ appropriate by !       
,secret>y1 if-- 7i7 ! ,secret>y det]m9es
 t su* expansion is expect$-- 7,i7 to   
r$uce 7or n to result 9 any increase 97 
net exp5ditures "u ! ,m$ic>e program )\t
 r$uc+ ! quality ( c>e2 or  7,,ii7 to   
improve ! quality ( c>e )\t increas+ su*
 net exp5ditures2  7ii7 ! ,*ief ,actu>y 
( ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices 
c]tifies t su* expansion w\ld r$uce     
sp5d+ "u ! ,m$ic>e program2 &  7iii7 !  
,secret>y det]m9es t su* expansion w\ld 
n d5y or limit ! cov]age or provision ( 
b5efits "u ! ,m$ic>e program =          
applicable b5efici>ies4  7#b7 ,waiv] (  
,m$ic>e #aij-;day lifetime limit ,!     
,m$ic>e #aij-;day lifetime limit %all n 
apply to applicable b5efici>ies receiv+ 
inpati5t psy*iatric s]vices at a        
p>ticipat+ in/itution "u ! pilot        
program4  7#c7 ,p>ticipat+ provid]s (   
s]vices & suppli]s  7,a7 ,9 g5]al ,only 
in/itutions p>ticipat+ 9 ! demon/ration 
project may submit an application to !  
,secret>y to provide inpati5t psy*iatric

 s]vices "u ! pilot program4  7,b7      
,requirem5ts ,! ,secret>y may develop   
additional requirem5ts = in/itutions to 
p>ticipate 9 ! pilot program4 ,su*      
requirem5ts may include ! collection &  
report+ ( data relat$ to ! reasonable   
co/s ( graduate m$ical education4  7#d7 
,quality measures  7,a7 ,9 g5]al ,!     
,secret>y %all e/abli% quality measures 
relat$ to c>e provid$ by qualify+       
in/itutions p>ticipat+ 9 ! pilot        
program1 :i* measures %all include at   
lea/ measures ( ! foll[+3 7i7 ,r$uc+    
rates ( avoidable hospital readmissions4
  7ii7 ,rates ( dis*>ge to ! community4 
7iii7 ,rates ( admission to an em]g5cy  
room aft] a hospitalization4  7iv7 ,o!r 
measures1 includ+ measures ( pati5t     
outcomes1 det]m9$ appropriate by !      
,secret>y4  7,b7 ,report+ on quality    
measures ,a qualify+ in/itution %all    
submit 79 a =m & mann] specifi$ by !    
,secret>y7 data to ! ,secret>y on       
quality measures e/abli%$ "u subp>agraph
 7,a7 dur+ ea* ye> 9 :i* ! in/itution is

 p>ticipat+ 9 ! pilot program4  7d7     
,waiv] ,! ,secret>y %all waive su*      
provisions ( titles ,,xi & ,,xviii ( !  
,social ,security ,act z may be necess>y
 to c>ry out ! pilot program4  7e7      
,indep5d5t evaluation & reports on pilot
 program  7#a7 ,indep5d5t evaluation ,! 
,secret>y %all conduct an indep5d5t     
evaluation ( ! pilot program1 includ+ ! 
ext5t to :i* ! pilot program has-- 7,a7 
improv$ quality measures e/abli%$ "u    
subsection 7c77#d77;,a72  7,b7 improv$  
heal? outcomes2  7,c7 improv$ pati5t    
satisfaction2 &  7,d7 r$uc$ sp5d+ "u !  
,m$ic>e program4  7#b7 ,report ,n lat]  
?an ,decemb] #ca1 #bjbg1 ! ,secret>y    
%all submit to ,congress a report on !  
evaluation conduct$ "u p>agraph 7#a74   
7#c7 ,coord9ation ) exp&+ *oice =       
m$icaid inpati5t psy*iatric hospital    
s]vices demon/ration project ,!         
,secret>y may comb9e ! indep5d5t        
evaluation & reports requir$ "u ?is     
section & ! reports requir$ "u !        
demon/ration project "u section #b7;f74 

7f7 ,budget neutrality ,) respect to !  
p]iod ( ! pilot program "u subsection   
7c77#a7 occurr+ be=e any expansion "u   
subp>agraph 7,c7 ( su* subsection1 !    
,secret>y %all ensure t ! program does n
 result 9 a net increase 9 ! aggregate  
exp5ditures "u ! ,m$ic>e program = su*  
p]iod above ! level ( su* exp5ditures if
 ! pilot program _h n be5 implem5t$4 ,! 
,secret>y may make su* adju/m5ts to     
paym5ts "u ! ,m$ic>e program z is       
necess>y to c>ry out ! previ\s s5t5ce4