,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajfdg  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,octob] #a1 #bjbf,mr4 
,b5tz 7= himself & ,mr4 ,goldman ( ,new 
,york7 introduc$ ! foll[+ bill2 :i* 0   
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce  ,a ,,bill  ,to am5d title     
,,xix ( ! ,social ,security ,act to     
e/abli% a ,m$icaid ,/ate plan am5dm5t   
option to provide m$ical assi/ance to   
individuals ) a s]i\s m5tal illness :o  
are pati5ts 9 c]ta9 in/itutions = m5tal 
diseases4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,individuals 9 ,m$icaid    
,des]ve ,c>e t is ,appropriate &        
,responsible 9 its ,execution ,act or ! 
,,imd ,,c>e ,act4  #b4 ,/ate plan       
am5dm5t option to provide m$ical        
assi/ance to individuals ) a s]i\s m5tal
 illness :o are pati5ts 9 c]ta9         
in/itutions = m5tal diseases  7a7 ,9    
g5]al ,title ,,xix ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif et seq47 is  
am5d$--  7#a7 9 section #aije7;a71 9 !  
subdivision 7,b7 t foll[s p>agraph      

7#cb71 by ins]t+ or section #aiae7m7    
aft] describ$ 9 section #aiae7l72 &     
7#b7 9 section #aiae1 by add+ at ! end !
 foll[+ new subsection3  7m7  ,/ate plan
 am5dm5t option ,to provide m$ical      
assi/ance = individuals ) a s]i\s m5tal 
illness :o are pati5ts 9 c]ta9          
in/itutions = m5tal diseases  7#a7  ,9  
g5]al  ,) respect to cal5d> qu>t]s      
beg9n+ on or aft] ,janu>y #a1 #bjbg1 a  
,/ate may elect1 ?r\gh a ,/ate plan     
am5dm5t1 to provide m$ical assi/ance =  
items & s]vices furni%$ to an eligible  
individual :o is a pati5t 9 an          
in/itution = m5tal diseases 9 accordance
 ) ! requirem5ts ( ?is subsection4  7#b7
  ,paym5ts  ,subject to p>agraphs 7#c7 &
 7#d71 am\nts exp5d$ "u a ,/ate plan    
am5dm5t "u p>agraph 7#a7 = s]vices      
describ$ 9 su* p>agraph furni%$1 )      
respect to a #ab-mon? p]iod1 to an      
eligible individual :o is a pati5t 9 an 
in/itution = m5tal diseases %all be     
treat$ z m$ical assi/ance = :i* paym5t  
is made "u section #aijc7;a71 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#c7  ,ma9t5ance ( ef=t  7,a7  ,9 g5]al 
,z a condition = a ,/ate receiv+ paym5ts
 "u section #aijc7;a7 = m$ical assi/ance
 provid$ 9 accordance ) ?is subsection1 
! ,/ate %all 7dur+ ! p]iod 9 :i* x s    
furni%$ su* m$ical assi/ance ?r\gh a    
,/ate plan am5dm5t "u ?is subsection7   
ma9ta9 on an annual basis a level (     
fund+ exp5d$ by ! ,/ate 7& political    
subdivisions !re(7 f non-,f$]al funds = 
items & s]vices 7includ+ s]vices        
describ$ 9 subp>agraph 7,b77 furni%$ to 
eligible individuals 9 outpati5t &      
community-bas$ sett+s t is n less ?an ! 
level ( su* fund+ = su* items & s]vices 
= fiscal ye> #bjbc4  7,b7  ,s]vices     
describ$  ,= purposes ( subp>agraph     
7,a71 s]vices describ$ 9 ?is subp>agraph
 are ! foll[+3  7i7 ,outpati5t &        
int5sive outpati5t m5tal heal? &        
co-occurr+ sub/ance use disord] s]vices1
 includ+ case managem5t & c>e           

coord9ation s]vices4  7ii7 ,ass]tive    
community treatm5t4  7iii7 ,pe] support 
& c\nselor s]vices4  7iv7 ,outpati5t    
m$ication-assi/$ treatm5t1 relat$       
!rapies1 & ph>macology4  7v7 ,crisis    
m5tal heal? s]vices & sub/ance use      
disord]s s]vices includ+ #bd h\rs mobile
 crisis teams1 crisis receiv+ & crisis  
/abilization includ+ specializ$ programs
 = 9-home /abilization = *ildr5 &       
adolesc5ts4  7vi7 ,psy*iatric           
rehabilitation encompass+ recov]y       
support1 support$ employm5t & supportive
 h\s+4  7vii7 ,s]vices furni%$ by       
c]tifi$ community behavioral heal?      
cl9ics & community m5tal heal? c5t]s4   
7viii7 ,r\t9e monitor+ ( m$ication      
adh]5ce4  7ix7 ,m$ication to treat m5tal
 illness4  7x7 ,o!r outpati5t &         
community-bas$ s]vices z designat$ by ! 
,secret>y4  7,c7  ,/ate report+         
requirem5t  7i7  ,9 g5]al  ,prior to    
approval ( a ,/ate plan am5dm5t "u ?is  
subsection1 z a condition = a ,/ate     
receiv+ paym5ts "u section #aijc7;a7 =  

m$ical assi/ance provid$ 9 accordance ) 
?is subsection1 ! ,/ate %all report to !
 ,secret>y1 9 accordance ) ! process    
e/abli%$ by ! ,secret>y "u clause 7ii71 
! in=mation deem$ necess>y by !         
,secret>y "u su* clause4  7ii7  ,process
  ,n lat] ?an ! date t is #ab mon?s aft]
 ! date ( enactm5t ( ?is subsection1 !  
,secret>y %all e/abli% a process =      
,/ates to report to ! ,secret>y1 at su* 
"t & 9 su* mann] z ! ,secret>y deems    
appropriate1 su* in=mation z ! ,secret>y
 deems necess>y to v]ify a ,/ate's      
compliance ) subp>agraph 7,a74  7#d7    
,ensur+ a cont9uum ( s]vices  7,a7  ,9  
g5]al  ,z a condition = a ,/ate receiv+ 
paym5ts "u section #aijc7;a7 = m$ical   
assi/ance provid$ 9 accordance ) ?is    
subsection1 ! ,/ate %all c>ry out ea* ( 
! requirem5ts describ$ 9 subp>agraphs   
7,b7 ?r\gh 7,j74  7,b7  ,notification   
,! ,/ate %all require provid]s1 manag$  
c>e plans1 & utilization review entities
 to implem5t specifi$ evid5ce-bas$1     
individual placem5t crit]ia &           

utilization managem5t approa*es develop$
 by /akehold]s us+ a cons5sus-bas$      
process to ensure placem5t ( eligible   
individuals 9 an appropriate level (    
c>e1 includ+ crit]ia & approa*es to     
ensure t eligible individuals receive   
appropriate evid5ce-bas$ cl9ical scre5+ 
prior to be+ furni%$ ) items & s]vices 9
 an in/itution = m5tal diseases1 includ+
 initial & p]iodic assessm5ts to det]m9e
 ! appropriate level ( c>e1 l5g? ( /ay1 
& sett+ = su* c>e = ea* individual4 ,!  
,/ate %all notify ! ,secret>y at su* "t 
& 9 su* =m & mann] z ! ,secret>y %all   
require h[ ! ,/ate w require & implem5t 
su* placem5t crit]ia & utilization      
managem5t approa*es4  7,c7  ,transition 
( c>e  ,9 ord] to ensure an appropriate 
transition = an eligible individual f   
receiv+ c>e 9 an in/itution = m5tal     
diseases to receiv+ c>e at a l[] level (
 cl9ical int5sity )9 ! cont9uum ( c>e   
7includ+ outpati5t s]vices71 ! ,/ate    
%all ensure t--  7i7 a placem5t 9 su*   
in/itution = m5tal diseases w\ld all[ = 

an eligible individual's successful     
transition to ! community1 consid]+ su* 
factors z proximity to an individual's  
support network 7su* z family memb]s1   
employm5t1 & c\nsel+ & o!r s]vices ne>  
an individual's resid5ce72  7ii7        
enrollees are connect$ ) community-bas$ 
provid]s z !y prep>e to transition out (
 an in/itution = m5tal diseases by cov]+
 s]vices provid$ by ^! community-bas$   
provid]s to enrollees :ile !y are /ill  
resid+ 9 ! in/itution = m5tal diseases  
or by enc\rag+ in/itutions = m5tal      
diseases to hire pe] support speciali/s 
to assi/ ) ! transition & dis*>ge       
process & ensure enrollees are connect$ 
) provid]s & o!r res\rces 9 _!          
communities aft] !y leave ! in/itution2 
7iii7 in/itutions = m5tal diseases      
assess :e!r enrollees h access to h\s+ z
 !y are transition+ out & connect su*   
individuals ) community provid]s t      
coord9ate h\s+ s]vices2 &  7iv7 all     
in/itutions = m5tal diseases t furni%   
items & s]vices to individuals = :i*    

m$ical assi/ance is provid$ "u ! ,/ate  
plan--  7,i7 are able to provide c>e at 
su* l[] level ( cl9ical int5sity2       
7,,ii7 h an e/abli%$ relation%ip ) ano!r
 facility or provid] t is able to       
provide c>e at su* l[] level ( cl9ical  
int5sity & accepts pati5ts receiv+      
m$ical assi/ance "u ?is title su* t !   
in/itution = m5tal diseases may arrange 
= individuals to receive su* c>e f su*  
o!r facility or provid] ^u transition+  
out ( t in/itution = m5tal diseases2 or 
7,,iii7 ensure implem5tation ( protocols
 requir+ t contact is made by !         
in/itution = m5tal diseases ) ea*       
dis*>g$ b5efici>y )9 #gb h\rs ( dis*>ge 
& to ensure access to & engagem5t 9     
foll[-up c>e4  7,d7  ,review process  ,!
 ,/ate %all h 9 place a process to      
review ! compliance ( in/itutions =     
m5tal diseases ) su* program /&>ds      
specifi$ by ! ,/ate encompass+ lic5s+   
requirem5ts1 audit+ processes1          
utilization review processes & ,f$]al   
program integrity requirem5ts4  7,e7    

,c>e = co-morbid conditions  ,! ,/ate   
%all implem5t a requirem5t t in/itutions
 = m5tal diseases also scre5 enrollees =
 co-morbid physical heal? conditions &  
sub/ance use disord]s & suicidal        
ideation & provide = treatm5t ei!r      
on-site or via p>tn]%ips ) local        
provid]s = any id5tifi$ co-occurr+      
conditions4  7,f7  ,c>e cont9uum        
assessm5t  7i7  ,9 g5]al  ,! ,/ate %all1
 z "p ( its application = approval ( a  
,/ate plan am5dm5t describ$ 9 ?is       
subsection1 complete & submit an        
assessm5t ( ! availability ( outpati5t &
 community bas$ behavioral heal? s]vices
 = individuals enroll$ "u a ,/ate plan  
"u ?is title 7or waiv] ( su* plan7 9 ea*
 level ( c>e1 includ+ h[ su*            
availability v>ies by region ( ! ,/ate4 
7ii7  ,requir$ updates  ,! ,/ate %all   
complete an update ( su* assessm5t      
describ$ 9 clause 7i7 n lat] ?an #ab    
mon?s aft] date ! ,/ate comm5ces su*    
assessm5t4  7,g7  ,f9anc+ plan  ,! ,/ate
 %all consult ) ! ,secret>y 9 succe$+   

ye>s reg>d+ f9anc+ plans to increase !  
availability ( s]vices li/$ 9 p>agraph  
7#c77;,b7 :]e feasible4  7,h7           
,coord9ation  ,! ,/ate %all implem5t    
/rategies to improve data-%>+ betwe5    
diff]5t types ( provid]s 7su* z m5tal   
heal?1 sub/ance use disord]1 & physical 
heal? provid]s7 & diff]5t sett+s ( c>e  
7su* z hospitals1 em]g5cy dep>tm5ts1    
crisis /abilization provid]s1           
community-bas$ treatm5t provid]s7 z well
 z /rategies to improve ! ,/ate's       
capacity to track availability (        
treatm5t & crisis /abilization b$s &    
capacity ( m5tal heal? provid]s to      
accept new pati5ts4  7,i7  ,connections 
,! ,/ate %all implem5t /rategies to     
decrease use ( em]g5cy dep>tm5ts by     
enrollees ) s]i\s m5tal illness prim>ily
 9 ne$ ( m5tal heal? treatm5t1 includ+  
by support+ pe] supports & psy*iatric   
consultants 9 em]g5cy dep>tm5ts to      
improve connections ) s]vices &         
res\rces4  7,j7  ,integration &         
engagem5t  ,! ,/ate %all take actions to

 increase integration ( m5tal heal? &   
sub/ance use disord] treatm5t 9         
non-specialty c>e sett+s includ+ s*ools1
 prim>y c>e practices1 & em]g5cy        
dep>tm5ts z well z additional /rategies 
to support e>li] id5tification &        
engagem5t 9 treatm5t among y\? ) s]i\s  
m5tal heal? conditions includ+ ?r\gh    
support$ education & support$ employm5t 
programs4  7#e7  ,application to manag$ 
c>e  ,paym5ts =1 & limitations to1      
m$ical assi/ance furni%$ 9 accordance ) 
?is subsection %all be 9 addition to &  
%all n be con/ru$ to limit or sup]s$e ! 
ability ( ,/ates to make mon?ly         
capitation paym5ts to manag$ c>e        
organizations = individuals receiv+     
treatm5t 9 in/itutions = m5tal diseases 
9 accordance ) section #dch4f7;e7 (     
title #db1 ,code ( ,f$]al ,regulations  
7or any successor regulation74  7#f7    
,o!r m$ical assi/ance  ,! provision (   
m$ical assi/ance = items & s]vices      
furni%$ to an eligible individual :o is 
a pati5t 9 an in/itution = m5tal        

diseases 9 accordance ) ! requirem5ts ( 
?is subsection %all n prohibit ,f$]al   
f9ancial p>ticipation = m$ical assi/ance
 = items or s]vices t are provid$ to su*
 eligible individual 9 or away f !      
in/itution = m5tal disease dur+ any     
p]iod 9 :i* ! eligible individual is    
receiv+ items or s]vices 9 accordance ) 
?is subsection4  7#g7  ,def9itions  ,9  
?is subsection3 7,a7 ,eligible          
individual ,! t]m eligible individual   
means an individual :o--  7i7 ) respect 
to a ,/ate1 is enroll$ = m$ical         
assi/ance "u ! ,/ate plan or a waiv] (  
su* plan2  7ii7 is at lea/ #ba ye>s (   
age2  7iii7 has n atta9$ #fe ye>s ( age2
 &  7iv7 has at lea/ #a m5tal disord]   
def9$ 9 ! mo/ rec5t v]sion ( ! ,am]ican 
,psy*iatric ,association ,diagno/ic &   
,/ati/ical ,manual4  7,b7  ,in/itution =
 m5tal diseases  ,! t]m in/itution =    
m5tal diseases has ! mean+ giv5 t t]m 9 
section #aije7;i74  4  7b7 ,rule (      
con/ruction ,no?+ 9 ! am5dm5ts made by  
subsection 7a7 %all be con/ru$ z        

enc\rag+ a ,/ate to place an individual 
9 an inpati5t or a resid5tial c>e sett+ 
:]e a home or community-bas$ c>e sett+  
w\ld be m appropriate = ! individual1 or
 z prev5t+ a ,/ate f conduct+ or pursu+ 
a demon/ration project "u section #aaae 
( ! ,social ,security ,act to improve   
access to1 & ! quality ( c>e = enrollees
 ) s]i\s m5tal illness or s]i\s         
emotional di/urbance4