,i #aaith ,,congress #b;d ,session ,h4 ,r4 #iech ,,in ,,the ,,house ,,of ,,representatives ,june #cj1 #bjbf ,ms4 ,underwood 7for herself1 ,mr4 ,valadao1 ,mr4 ,tonko1 ,mrs4 ,miller of ,west ,virginia1 ,mr4 ,la,hood1 and ,mr4 ,bost7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish coverage for certain residential substance use disorder services under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,residential ,recovery for ,seniors ,act4 #b4 ,establishing coverage for certain residential substance use disorder services under the ,medicare program 7a7 ,coverage under part ,a ,section #ahab7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;d7a77 is amended-- 7#a7 in the header1 by striking and and inserting 1 and residential substance use disorder services after hospice care2 7#b7 in paragraph 7#d71 by striking and at the end2 7#c7 in paragraph 7#e71 by striking the period at the end and inserting 22 and 7#d7 by adding at the end the following new paragraphs3 7#f7 clinically managed low-intensity residential substance use disorder services 7as defined in section #ahfa7nnn77#a77 furnished to an individual who is a resident of a clinically managed residential substance use disorder facility 7as defined in section #ahfa7nnn77#c77 if the individual's initial need for such level of services is performed1 and continued need for such level of services is reviewed and reaffirmed periodically 7on a frequency specified by the ,secretary that is not less often than every #cj days71 in accordance with the most current edition approved by the ,secretary of evidence-based1 substance use disorder-specific criteria developed by a nonprofit medical association generally recognized for its expertise in addiction treatment2 7#g7 clinically managed high-intensity residential substance use disorder services 7as defined in section #ahfa7ooo77#a77 furnished to an individual who is a resident of a clinically managed residential substance use disorder facility 7as defined in section #ahfa7nnn77#c77 if the individual's initial need for such level of services is performed1 and continued need for such level of services is reviewed and reaffirmed periodically 7on a frequency specified by the ,secretary that is not less often than every #cj days71 in accordance with the most current edition approved by the ,secretary of evidence-based1 substance use disorder-specific criteria developed by a nonprofit medical association generally recognized for its expertise in addiction treatment2 and 7#h7 medically managed residential substance use disorder services 7as defined in section #ahfa7ppp77#a77 furnished to an individual who is a resident of a medically managed residential substance use disorder facility 7as defined in section #ahfa7ppp77#c77 if the individual's initial need for such level of services is performed1 and continued need for such level of services is reviewed and reaffirmed periodically 7on a frequency specified by the ,secretary that is not less often than every #aj days71 in accordance with the most current edition approved by the ,secretary of evidence-based1 substance use disorder-specific criteria developed by a nonprofit medical association generally recognized for its expertise in addiction treatment4 4 7b7 ,residential substance use disorder services1 programs1 and facilities defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsections3 7nnn7 ,clinically managed low-,intensity residential substance use disorder services1 program1 and facility 7#a7 ,clinically managed low-intensity residential substance use disorder services ,the term clinically managed low-intensity residential substance use disorder services means the following items and services furnished to an individual in a clinically managed low-intensity residential substance use disorder program 7as defined in paragraph 7#b77 and 7except as provided in subparagraph 7,c77 by such program for the treatment of substance use disorders and co-occurring conditions1 including-- 7,a7 bed and board2 7,b7 such clinical services and other related services 7including substance use disorder and co-occurring condition assessments and treatment planning71 such use of clinically managed residential substance use disorder facilities1 and such medical social services 7including recovery support services71 as are ordinarily furnished by the clinically managed low-intensity residential substance use disorder program for the care and treatment of individuals in such program1 and such drugs1 supplies1 appliances1 and equipment1 for use in the clinically managed low-intensity residential substance use disorder program1 as are ordinarily furnished by such program for the care and treatment of individuals in such program2 and 7,c7 such other diagnostic or therapeutic items or services1 furnished by the clinically managed low-intensity residential substance use disorder program or by others under arrangements with them made by the clinically managed low-intensity residential substance use disorder program1 as are ordinarily furnished to individuals either by such clinically managed low-intensity residential substance use disorder program or by others under such arrangements1 excluding-- 7i7 medical or surgical services provided by a physician1 services described by subsection 7s77#b77,k71 and qualified psychologist services2 and 7ii7 the services of a private-duty nurse or other private-duty attendant4 7#b7 ,clinically managed low-intensity residential substance use disorder program ,the term clinically managed low-intensity residential substance use disorder program means a residential program which-- 7,a7 is primarily engaged in providing #bd-;hour structure and support and integrated clinical services for the diagnosis1 treatment1 and care of individuals with substance use disorders who need structure and support to build and practice their recovery and coping skills2 7,b7 directly provides a substance use disorder-specific multidimensional level of care assessment at admission to determine the recommended level of care1 using protocols developed by a physician or advanced practice provider with experience in specialty addiction treatment to confirm the appropriateness of treatment in such program for individuals who are intoxicated1 experiencing withdrawal1 or presenting with biomedical comorbidities2 7,c7 directly provides1 or has a direct affiliation with1 a provider or providers who can provide physical examinations1 prescribe all addiction and psychiatric medications1 and provide medication management and laboratory testing as needed 7except that access to methadone is not required if no providers of methadone for opioid use disorder are available1 as determined by the ,secretary72 7,d7 directly provides weekly clinical services1 in hourly increments to be determined by the ,secretary1 in an amount1 frequency1 and intensity appropriate to an individual's needs as determined by a substance use disorder-specific multidimensional assessment1 with structured services available seven days per week2 7,e7 maintains clinical records on all patients and maintains such records as the ,secretary finds to be necessary to determine the degree and intensity of the treatment provided to individuals entitled to clinically managed low-intensity residential substance use disorder program insurance benefits under part ,a1 provided that the ,secretary shall not require a program to maintain such records in a manner that is more extensive1 detailed1 or stringent than what is required of an institution that is considered a hospital under subsection 7e72 7,f7 coordinates patient referrals and transitions to other levels of care when needed1 including transition planning in partnership with other providers participating in the ,medicare program2 and 7,g7 meets such additional staffing requirements and other conditions as the ,secretary shall specify to ensure the effective and efficient furnishing of such program's services and the compliance of such program with clinically managed low-intensity residential substance use disorder program standards described in the most current edition approved by the ,secretary of evidence-based1 substance use disorder-specific criteria developed by a nonprofit medical association generally recognized for its expertise in addiction treatment4 ,obtaining and maintaining certification from a certifying body that has the necessary competencies to assess compliance with such program standards and is approved by the ,secretary shall be deemed to demonstrate compliance with the standards described in subparagraph 7,g74 7#c7 ,clinically managed residential substance use disorder facility ,the term clinically managed residential substance use disorder treatment facility means a facility which-- 7,a7 is enrolled under section #ahff7;j72 7,b7 is accredited by an accrediting body approved by the ,secretary2 7,c7 is legally authorized to provide a clinically managed low- or high-intensity residential substance use disorder program under the law of the ,state 7or under a ,state regulatory mechanism provided by ,state law7 in which the facility is located2 and 7,d7 meets such additional conditions as the ,secretary finds necessary in the interest of the health and safety of individuals who are residents of such facilities and are furnished clinically managed low-intensity residential substance use disorder services 7or clinically managed high-intensity residential substance use disorder services1 as the case may be74 7ooo7 ,clinically ,managed ,high-,intensity ,residential ,substance ,use ,disorder ,services and ,program 7#a7 ,clinically managed high-intensity residential substance use disorder services ,the term clinically managed high-intensity residential substance use disorder services means the following items and services furnished to an individual in a clinically managed high-intensity residential substance use disorder program 7as defined in paragraph 7#b77 and 7except as provided in subparagraph 7,c77 by such program for the treatment of substance use disorders and co-occurring conditions1 including-- 7,a7 bed and board2 7,b7 such clinical services and other related services 7including substance use disorder and co-occurring condition assessments and treatment planning71 such use of clinically managed residential substance use disorder facilities1 and such medical social services 7including recovery support services71 as are ordinarily furnished by the clinically managed high-intensity residential substance use disorder program for the care and treatment of individuals in such program1 and such drugs1 supplies1 appliances1 and equipment1 for use in the clinically managed high-intensity residential substance use disorder program1 as are ordinarily furnished by such program for the care and treatment of individuals in such program2 and 7,c7 such other diagnostic or therapeutic items or services1 furnished by the clinically managed high-intensity residential substance use disorder program or by others under arrangements with them made by the clinically managed high-intensity residential substance use disorder program1 as are ordinarily furnished to individuals either by such clinically managed high-intensity residential substance use disorder program or by others under such arrangements1 excluding-- 7i7 medical or surgical services provided by a physician1 services described by subsection 7s77#b77,k71 and qualified psychologist services2 and 7ii7 the services of a private-duty nurse or other private-duty attendant4 7#b7 ,clinically managed high-intensity residential substance use disorder program ,the term clinically managed high-intensity residential substance use disorder program means a residential program which-- 7,a7 is primarily engaged in providing #bd-;hour supervision for the diagnosis1 treatment1 and care of individuals with substance use disorders who need a safe and stable living environment to develop sufficient recovery skills so that they do not immediately relapse or continue to use in an imminently dangerous manner upon transition to a less intensive level of care2 7,b7 directly provides a substance use disorder-specific multidimensional level of care assessment at admission to determine the recommended level of care1 using protocols developed by a physician or advanced practice provider experienced in specialty addiction treatment to confirm the appropriateness of treatment in such facility for individuals who are intoxicated1 experiencing withdrawal1 or presenting with biomedical comorbidities2 7,c7 directly provides1 or has a direct affiliation with1 a provider or providers who can provide physical examinations1 prescribe all addiction and psychiatric medications1 and provide medication management and laboratory testing as needed 7except that access to methadone is not required if no providers of methadone for opioid use disorder are available1 as determined by the ,secretary72 7,d7 directly provides #bj hours or more of clinical services per week in an amount1 frequency1 and intensity appropriate to individual patient needs as determined by a substance use disorder-specific multidimensional assessment1 with structured services available seven days per week2 7,e7 directly provides clinically managed residential withdrawal management1 including #bd-;hour supervision1 observation1 and support for individuals who are intoxicated or experiencing withdrawal1 who do not need medically monitored or managed care 7as determined through a medical evaluation72 7,f7 maintains clinical records on all patients and maintains such records as the ,secretary finds to be necessary to determine the degree and intensity of the treatment provided to individuals entitled to clinically managed high-intensity residential substance use disorder program insurance benefits under part ,a1 provided that the ,secretary shall not require a program to maintain such records in a manner that is more extensive1 detailed1 or stringent than what is required of an institution that is considered a hospital under subsection 7e72 7,g7 management of patient referrals and transitions to other levels of care when needed2 and 7,h7 meets such additional staffing requirements and other conditions as the ,secretary shall specify to ensure the effective and efficient furnishing of such program's services and the compliance of such program with clinically managed high-intensity residential substance use disorder program standards described in the most current edition approved by the ,secretary of evidence-based1 substance use disorder-specific criteria developed by a nonprofit medical association generally recognized for its expertise in addiction treatment4 ,obtaining and maintaining certification from a certifying body that has the necessary competencies to assess compliance with such program standards and is approved by the ,secretary shall be deemed to demonstrate compliance with the standards described in subparagraph 7,h74 7ppp7 ,medically managed residential substance use disorder services1 program1 and facility 7#a7 ,medically managed residential substance use disorder services ,the term medically managed residential substance use disorder services means the following items and services furnished to an individual in a medically managed residential substance use disorder program 7as defined in paragraph 7#b77 and 7except as provided in subparagraph 7,c77 by such program for the treatment of substance use disorders and co-occurring conditions1 including-- 7,a7 bed and board2 7,b7 #bd-;hour nursing services2 7,c7 such clinical services and other related services 7including substance use disorder and co-occurring condition assessments and treatment planning71 such use of medically managed residential substance use disorder facilities1 and such medical social services 7including recovery support services71 as are ordinarily furnished by the medically managed residential substance use disorder program for the care and treatment of residents of such program1 and such drugs1 supplies1 appliances1 and equipment1 for use in the medically managed residential substance use disorder program1 as are ordinarily furnished by such program for the care and treatment of residents of such program2 and 7,d7 such other diagnostic or therapeutic items or services1 furnished by the medically managed residential substance use disorder program or by others under arrangements with them made by the medically managed residential substance use disorder program1 as are ordinarily furnished to residents either by the medically managed residential substance use disorder program or by others under such arrangements1 excluding-- 7i7 medical or surgical services provided by a physician1 services described by subsection 7s77#b77,k71 and qualified psychologist services2 and 7ii7 the services of a private-duty nurse or other private-duty attendant4 7#b7 ,medically managed residential substance use disorder program ,the term medically managed residential substance use disorder program means a residential program which-- 7,a7 is primarily engaged in providing management of substance withdrawal and biomedical comorbidities1 including diagnosis1 treatment1 and care1 for individuals with substance use disorders who need #bd-;hour observation1 monitoring1 and treatment1 but do not require the full resources of a hospital2 7,b7 directly provides a comprehensive nursing assessment at the time of admission1 with a substance use disorder-focused history obtained as part of the initial assessment which is reviewed by a physician or advanced practice provider within #bd hours of admission2 7,c7 directly provides a comprehensive physical examination by a physician or advanced practice provider within #bd hours of admission2 7,d7 directly provides sufficient biopsychosocial screening and assessments of the patient's substance use disorders and co-occurring disorders to determine the appropriate recommended level of care and treatment planning2 7,e7 directly provides daily medical interventions1 including nursing and medical monitoring for stabilization of acute withdrawal1 biomedical and psychiatric conditions1 and psychosocial services to encourage engagement in ongoing treatment1 all in an amount1 frequency1 and intensity appropriate to individual patient needs as determined by a substance use disorder-specific multidimensional assessment2 7,f7 directly provides essential medications on site with policies and procedures that define essential medicines based on current standards of clinical practice and that ensure these medications are stocked and access to all ,food and ,drug ,administration-approved medications for the treatment of substance use disorders 7except that access to methadone is not required if no providers of methadone for opioid use disorder are available1 as determined by the ,secretary72 7,g7 directly provides residential intoxication and withdrawal management services and residential management of biomedical conditions2 7,h7 maintains clinical records on all patients and maintains such records as the ,secretary finds to be necessary to determine the degree and intensity of the treatment provided to individuals entitled to clinically managed high-intensity residential substance use disorder program insurance benefits under part ,a1 provided that the ,secretary shall not require a program to maintain such records in a manner that is more extensive1 detailed1 or stringent than what is required of an institution that is considered a hospital under subsection 7e72 7,i7 management of patient transitions to other levels of care when needed2 and 7,j7 meets such additional staffing requirements and other conditions as the ,secretary shall specify to ensure the effective and efficient furnishing of such program's services and the compliance of such program with clinically managed high-intensity residential substance use disorder program standards described in the most current edition approved by the ,secretary of evidence-based1 substance use disorder-specific criteria developed by a nonprofit medical association generally recognized for its expertise in addiction treatment4 ,obtaining and maintaining certification from a certifying body that has the necessary competencies to assess compliance with such program standards and is approved by the ,secretary shall be deemed to demonstrate compliance with the standards described in subparagraph 7,j74 7#c7 ,medically managed residential substance use disorder facility ,the term medically managed residential substance use disorder treatment facility means a facility which-- 7,a7 is enrolled under section #ahff7;j72 7,b7 is accredited by an accrediting body approved by the ,secretary2 7,c7 is legally authorized to provide a medically managed residential substance use disorder program under the law of the ,state 7or under a ,state regulatory mechanism provided by ,state law7 in which the facility is located2 and 7,d7 meets such additional conditions as the ,secretary finds necessary in the interest of the health and safety of individuals who are residents of such facilities and are furnished medically managed residential substance use disorder services4 4 7c7 ,including residential substance use disorder facilities as medicare providers ,section #ahff7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7e77 is amended-- 7#a7 in paragraph 7#b71 by striking at the end and2 7#b7 in paragraph 7#c71 by striking the period at the end and inserting 22 and 7#c7 by adding at the end the following new paragraphs3 7#d7 clinically managed residential substance use disorder facilities 7as defined in paragraph 7#c7 of section #ahfa7nnn771 but only with respect to the furnishing of clinically managed low-intensity residential substance use disorder services 7as defined in paragraph 7#a7 of such section7 and clinically managed high-intensity residential substance use disorder services 7as defined in paragraph 7#a7 of section #ahfa7ooo771 as applicable2 and 7#e7 medically managed residential substance use disorder facilities 7as defined in paragraph 7#c7 of section #ahfa7ppp771 but only with respect to the furnishing of clinically managed low-intensity residential substance use disorder services 7as defined in paragraph 7#a7 of section #ahfa7nnn771 clinically managed high-intensity residential substance use disorder services 7as defined in paragraph 7#a7 of section #ahfa7ooo771 and medically managed residential substance use disorder services 7as defined in paragraph 7#a7 of section #ahfa7ppp771 as applicable4 4 7d7 ,prospective payment system for residential substance use disorder services ,section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is amended by adding at the end the following new subsection3 7u7 ,prospective payment for residential substance use disorder facilities 7#a7 ,development of system ,the ,secretary shall develop a per diem prospective payment system for low-intensity clinically managed1 high-intensity clinically managed1 and medically managed residential substance use disorder services1 as those terms are defined1 respectively1 in sections #ahfa7nnn77#a71 7ooo77#a71 and #ahfa7ppp77#a7 7collectively1 residential substance use disorder services74 ,such system shall include appropriate adjustments to reflect the differing resource-intensity of low-intensity clinically managed1 high-intensity clinically managed1 and medically managed residential substance use disorder services1 and may include an adequate patient classification system that reflects differences in patient resource use and cost4 ,in developing such system1 the ,secretary may require clinically managed and medically managed residential substance use disorder facilities1 as those terms are defined in sections #ahfa7nnn77#c7 and 7ppp77#c71 respectively 7collectively1 residential substance use disorder facilities71 to submit such information to the ,secretary1 including cost reports1 as the ,secretary may require to develop such system4 7#b7 ,implementation 7,a7 ,in general ,the ,secretary shall provide1 for cost reporting periods beginning on or after ,october #a1 #bjbf1 for payments for residential substance use disorder services furnished by residential substance use disorder facilities in accordance with the prospective payment system established by the ,secretary under this subsection4 7,b7 ,payments 7i7 ,initial ,payments ,the ,secretary shall implement such prospective payment system in the initial fiscal year so that the estimated aggregate amount of prospective payment rates is equal to #ajj percent of the estimated amount of reasonable costs incurred by residential substance use disorder facilities in furnishing such services4 7ii7 ,payments in ,subsequent ,years ,payments rates in years after the year of implementation of such system shall be the payment rates in the previous year1 adjusted by an increase factor4 ,such factor shall be based on an appropriate percentage increase in a market basket of goods and services comprising the services for which payment is made under this subsection4 4