Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act

Summary: Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act or the Medicaid Health HOME Act This bill extends the enhanced federal matching rate for expenditures regarding substance-use disorder health-home services under Medicaid. The bill also temporarily requires coverage of medication-assisted treatment under Medicaid.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid Health Homes for Opioid-
Use-Disorder Medicaid Enrollees Encouraged Act'' or the ``Medicaid 
Health HOME Act''.

SEC. 2. EXTENSION OF ENHANCED FMAP FOR CERTAIN HEALTH HOMES FOR 
              INDIVIDUALS WITH SUBSTANCE USE DISORDERS.

    Section 1945 of the Social Security Act (42 U.S.C. 1396w-4) is 
amended--
            (1) in subsection (c)--
                    (A) in paragraph (1), by inserting ``subject to 
                paragraph (4),'' after ``except that,''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(4) Special rule relating to substance use disorder 
        health homes.--
                    ``(A) In general.--In the case of a State with an 
                SUD-focused State plan amendment approved by the 
                Secretary on or after October 1, 2018, the Secretary 
                may, at the request of the State, extend the 
                application of the Federal medical assistance 
                percentage described in paragraph (1) to payments for 
                the provision of health home services to SUD-eligible 
                individuals under such State plan amendment, in 
                addition to the first 8 fiscal year quarters the State 
                plan amendment is in effect, for the subsequent 2 
                fiscal year quarters that the State plan amendment is 
                in effect. Nothing in this section shall be construed 
                as prohibiting a State with a State plan amendment that 
                is approved under this section and that is not an SUD-
                focused State plan amendment from additionally having 
                approved on or after such date an SUD-focused State 
                plan amendment under this section, including for 
                purposes of application of this paragraph.
                    ``(B) Report requirements.--In the case of a State 
                with an SUD-focused State plan amendment for which the 
                application of the Federal medical assistance 
                percentage has been extended under subparagraph (A), 
                such State shall, at the end of the period of such 
                State plan amendment, submit to the Secretary a report 
                on the following, with respect to SUD-eligible 
                individuals provided health home services under such 
                State plan amendment:
                            ``(i) The quality of health care provided 
                        to such individuals, with a focus on outcomes 
                        relevant to the recovery of each such 
                        individual.
                            ``(ii) The access of such individuals to 
                        health care.
                            ``(iii) The total expenditures of such 
                        individuals for health care.
                        For purposes of this subparagraph, the 
                        Secretary shall specify all applicable measures 
                        for determining quality, access, and 
                        expenditures.
                    ``(C) Best practices.--Not later than October 1, 
                2020, the Secretary shall make publicly available on 
                the Internet website of the Centers for Medicare & 
                Medicaid Services best practices for designing and 
                implementing an SUD-focused State plan amendment, based 
                on the experiences of States that have State plan 
                amendments approved under this section that include 
                SUD-eligible individuals.
                    ``(D) Definitions.--For purposes of this paragraph:
                            ``(i) SUD-eligible individuals.--The term 
                        `SUD-eligible individual' means, with respect 
                        to a State, an individual who satisfies all of 
                        the following:
                                    ``(I) The individual is an eligible 
                                individual with chronic conditions.
                                    ``(II) The individual is an 
                                individual with a substance use 
                                disorder.
                                    ``(III) The individual has not 
                                previously received health home 
                                services under any other State plan 
                                amendment approved for the State under 
                                this section by the Secretary.
                            ``(ii) SUD-focused state plan amendment.--
                        The term `SUD-focused State plan amendment' 
                        means a State plan amendment under this section 
                        that is designed to provide health home 
                        services primarily to SUD-eligible 
                        individuals.''.

SEC. 3. REQUIREMENT FOR STATE MEDICAID PLANS TO PROVIDE COVERAGE FOR 
              MEDICATION-ASSISTED TREATMENT.

    (a) Requirement for State Medicaid Plans to Provide Coverage for 
Medication-assisted Treatment.--Section 1902(a)(10)(A) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the matter 
preceding clause (i), by striking ``and (28)'' and inserting ``(28), 
and (29)''.
    (b) Inclusion of Medication-assisted Treatment as Medical 
Assistance.--Section 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended--
            (1) in paragraph (28), by striking ``and'' at the end;
            (2) by redesignating paragraph (29) as paragraph (30); and
            (3) by inserting after paragraph (28) the following new 
        paragraph:
            ``(29) subject to paragraph (2) of subsection (ee), for the 
        period beginning October 1, 2020, and ending September 30, 
        2025, medication-assisted treatment (as defined in paragraph 
        (1) of such subsection); and''.
    (c) Medication-assisted Treatment Defined; Waivers.--Section 1905 
of the Social Security Act (42 U.S.C. 1396d) is amended by adding at 
the end the following new subsection:
    ``(ee) Medication-assisted Treatment.--
            ``(1) Definition.--For purposes of subsection (a)(29), the 
        term `medication-assisted treatment'--
                    ``(A) means all drugs approved under section 505 of 
                the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
                355), including methadone, and all biological products 
                licensed under section 351 of the Public Health Service 
                Act (42 U.S.C. 262) to treat opioid use disorders; and
                    ``(B) includes, with respect to the provision of 
                such drugs and biological products, counseling services 
                and behavioral therapy.
            ``(2) Exception.--The provisions of paragraph (29) of 
        subsection (a) shall not apply with respect to a State for the 
        period specified in such paragraph, if before the beginning of 
        such period the State certifies to the satisfaction of the 
        Secretary that implementing such provisions statewide for all 
        individuals eligible to enroll in the State plan (or waiver of 
        the State plan) would not be feasible by reason of a shortage 
        of qualified providers of medication-assisted treatment, or 
        facilities providing such treatment, that will contract with 
        the State or a managed care entity with which the State has a 
        contract under section 1903(m) or under section 1905(t)(3).''.
    (d) Effective Date.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by this section shall apply with respect to medical 
        assistance provided on or after October 1, 2020, and before 
        October 1, 2025.
            (2) Exception for state legislation.--In the case of a 
        State plan under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) that the Secretary of Health and Human 
        Services determines requires State legislation in order for the 
        respective plan to meet any requirement imposed by the 
        amendments made by this section, the respective plan shall not 
        be regarded as failing to comply with the requirements of such 
        title solely on the basis of its failure to meet such an 
        additional requirement before the first day of the first 
        calendar quarter beginning after the close of the first regular 
        session of the State legislature that begins after the date of 
        the enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative 
        session, each year of the session shall be considered to be a 
        separate regular session of the State legislature.
            Amend the title so as to read: ``A bill to amend title XIX 
        of the Social Security Act to provide for an extension of the 
        enhanced FMAP for certain Medicaid health homes for individuals 
        with substance use disorders, and to require States to include 
        under their State Medicaid plans coverage for medication-
        assisted treatment.''.