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H.R. 5797 (115th): Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act


The text of the bill below is as of Jun 12, 2018 (Reported by House Committee).

Summary of this bill

Source: Republican Policy Committee

H.R. 5797 allows state Medicaid programs to remove the Institutions for Mental Diseases (IMD) exclusion for Medicaid beneficiaries aged 21 to 64 with an opioid use disorder for fiscal years 2019 to 2023. By removing the exclusion, Medicaid would pay for up to 30 total days of care in an IMD during a 12-month period for eligible individuals. Opioid use disorder as defined in H.R. 5797 includes, but is not limited to: heroin, fentanyl, oxycodone, tramadol and oxycodone. In addition, the legislation requires states to include in their State plan amendment information on 1) How the State will improve access to outpatient care during the State plan amendment period. 2) …


IB

Union Calendar No. 558

115th CONGRESS

2d Session

H. R. 5797

[Report No. 115–723]

IN THE HOUSE OF REPRESENTATIVES

May 15, 2018

(for herself, Mr. Knight, and Mr. Guthrie) introduced the following bill; which was referred to the Committee on Energy and Commerce

June 12, 2018

Additional sponsors: Mrs. Blackburn, Mr. Walden, and Mr. Hill

June 12, 2018

Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

Strike out all after the enacting clause and insert the part printed in italic

For text of introduced bill, see copy of bill as introduced on May 15, 2018


A BILL

To amend title XIX of the Social Security Act to allow States to provide under Medicaid services for certain individuals with opioid use disorders in institutions for mental diseases.


1.

Short title

This Act may be cited as the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act or the IMD CARE Act.

2.

Medicaid State plan option To provide services for certain individuals with opioid use disorders in institutions for mental diseases

Section 1915 of the Social Security Act (42 U.S.C. 1396n) is amended by adding at the end the following new subsection:

(l)

State plan option To provide services for certain individuals in institutions for mental diseases

(1)

In general

With respect to calendar quarters beginning during the period beginning January 1, 2019, and ending December 31, 2023, a State may elect, through a State plan amendment, to, notwithstanding section 1905(a), provide medical assistance for services furnished in institutions for mental diseases and for other medically necessary services furnished to eligible individuals with opioid use disorders, in accordance with the requirements of this subsection.

(2)

Payments

(A)

In general

Amounts expended under a State plan amendment under paragraph (1) for services described in such paragraph furnished, with respect to a 12-month period, to an eligible individual with an opioid use disorder who is a patient in an institution for mental diseases shall be treated as medical assistance for which payment is made under section 1903(a) but only to the extent that such services are furnished for not more than a period of 30 days (whether or not consecutive) during such 12-month period.

(B)

Clarification

Payment made under this paragraph for expenditures under a State plan amendment under this subsection with respect to services described in paragraph (1) furnished to an eligible individual with an opioid use disorder shall not affect payment that would otherwise be made under section 1903(a) for expenditures under the State plan (or waiver of such plan) for medical assistance for such individual.

(3)

Information required in State plan amendment

(A)

In general

A State electing to provide medical assistance pursuant to this subsection shall include with the submission of the State plan amendment under paragraph (1) to the Secretary—

(i)

a plan on how the State will improve access to outpatient care during the period of the State plan amendment, including a description of—

(I)

the process by which eligible individuals with opioid use disorders will make the transition from receiving inpatient services in an institution for mental diseases to appropriate outpatient care; and

(II)

the process the State will undertake to ensure individuals with opioid use disorder are provided care in the most integrated setting appropriate to the needs of the individuals; and

(ii)

a description of how the State plan amendment ensures an appropriate clinical screening of eligible individuals with an opioid use disorder, including assessments to determine level of care and length of stay recommendations based upon the multidimensional assessment criteria of the American Society of Addiction Medicine.

(B)

Report

Not later than the sooner of December 31, 2024, or one year after the date of the termination of a State plan amendment under this subsection, the State shall submit to the Secretary a report that includes at least—

(i)

the number of eligible individuals with opioid use disorders who received services pursuant to such State plan amendment;

(ii)

the length of the stay of each such individual in an institution for mental diseases; and

(iii)

the type of outpatient treatment, including medication-assisted treatment, each such individual received after being discharged from such institution.

(4)

Definitions

In this subsection:

(A)

Eligible individual with an opioid use disorder

The term eligible individual with an opioid use disorder means an individual who—

(i)

with respect to a State, is enrolled for medical assistance under the State plan (or a waiver of such plan);

(ii)

is at least 21 years of age;

(iii)

has not attained 65 years of age; and

(iv)

has been diagnosed with at least one opioid use disorder.

(B)

Institution for mental diseases

The term institution for mental diseases has the meaning given such term in section 1905(i).

(C)

Opioid prescription pain reliever

The term opioid prescription pain reliever includes hydrocodone products, oxycodone products, tramadol products, codeine products, morphine products, fentanyl products, buprenorphine products, oxymorphone products, meperidine products, hydromorphone products, methadone, and any other prescription pain reliever identified by the Assistant Secretary for Mental Health and Substance Use.

(D)

Opioid use disorder

The term opioid use disorder means a disorder that meets the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (or a successor edition), for heroin use disorder or pain reliever use disorder (including with respect to opioid prescription pain relievers).

(E)

Other medically necessary services

The term other medically necessary services means, with respect to an eligible individual with an opioid use disorder who is a patient in an institution for mental diseases, items and services that are provided to such individual outside of such institution to the extent that such items and services would be treated as medical assistance for such individual if such individual were not a patient in such institution.

.

June 12, 2018

Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed