Improving Access to Emergency Psychiatric Care Act

Summary: (This measure has not been amended since it was passed by the House on November 16, 2015.  Improving Access to Emergency Psychiatric Care Act (Sec. 2) This bill amends the Patient Protection and Affordable Care Act to revise the length of the emergency psychiatric demonstration project under title XIX (Medicaid) of the Social Security Act that is currently limited to three years. Participation in the demonstration project shall be extended through FY2016 for any requesting states selected for eligibility to participate on or before March 13, 2012, if the Department of Health and Human Services (HHS) determines, and the Centers for Medicare &amp; Medicaid Services (CMS) certify, that a state's participation is projected not to increase net Medicaid program spending. An additional extension through December 31, 2019, may be granted to a state, and the number of states eligible to participate may be expanded through December 31, 2019, if the same fiscal criteria are met.  HHS shall review annually each participating state's demonstration project expenditures to ensure budget neutrality. If a state's net programming spending has increased as a result of its participation in the project, HHS shall treat the excess expenditures as an overpayment under Medicaid. This bill also revises certain limitations on federal funding. HHS must submit recommendations to Congress: (1) first on whether the demonstration project should be continued after September 30, 2016, (2) whether it should be expanded to additional states, (3) subsequently on whether it should be permanently continued after December 31, 2019, in one or more states, and (4) finally on whether the demonstration project should be expanded (including on a nationwide basis). $100,000 shall be available for the project from unobligated balances of amounts available in the CMS Program Management account.

SECTION 1. SHORT TITLE.
    This Act may be cited as the ``Improving Access to Emergency 
Psychiatric Care Act''.
SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMERGENCY PSYCHIATRIC 
DEMONSTRATION PROJECT.
    (a) In General.--Subsection (d) of section 2707 of Public Law 111-
148 (42 U.S.C. 1396a note) is amended to read as follows:
    ``(d) Length of Demonstration Project.--
        ``(1) In general.--Except as provided in paragraphs (2) and 
    (3), the demonstration project established under this section shall 
    be conducted for a period of 3 consecutive years.
        ``(2) Temporary extension of participation eligibility for 
    selected states.--
            ``(A) In general.--Subject to subparagraph (B) and 
        paragraph (4), a State selected as an eligible State to 
        participate in the demonstration project on or prior to March 
        13, 2012, shall, upon the request of the State, be permitted to 
        continue to participate in the demonstration project through 
        September 30, 2016, if--
                ``(i) the Secretary determines that the continued 
            participation of the State in the demonstration project is 
            projected not to increase net program spending under title 
            XIX of the Social Security Act; and
                ``(ii) the Chief Actuary of the Centers for Medicare & 
            Medicaid Services certifies that such extension for that 
            State is projected not to increase net program spending 
            under title XIX of the Social Security Act.
            ``(B) Notice of projections.--The Secretary shall provide 
        each State selected to participate in the demonstration project 
        on or prior to March 13, 2012, with notice of the determination 
        and certification made under subparagraph (A) for the State.
        ``(3) Extension and expansion of demonstration project.--
            ``(A) Additional extension.--Taking into account the 
        recommendations submitted to Congress under subsection (f)(3), 
        the Secretary may permit an eligible State participating in the 
        demonstration project as of the date such recommendations are 
        submitted to continue to participate in the project through 
        December 31, 2019, if, with respect to the State--
                ``(i) the Secretary determines that the continued 
            participation of the State in the demonstration project is 
            projected not to increase net program spending under title 
            XIX of the Social Security Act; and
                ``(ii) the Chief Actuary of the Centers for Medicare & 
            Medicaid Services certifies that the continued 
            participation of the State in the demonstration project is 
            projected not to increase net program spending under title 
            XIX of the Social Security Act.
            ``(B) Option for expansion to additional states.--Taking 
        into account the recommendations submitted to Congress pursuant 
        to subsection (f)(3), the Secretary may expand the number of 
        eligible States participating in the demonstration project 
        through December 31, 2019, if, with respect to any new eligible 
        State--
                ``(i) the Secretary determines that the participation 
            of the State in the demonstration project is projected not 
            to increase net program spending under title XIX of the 
            Social Security Act; and
                ``(ii) the Chief Actuary of the Centers for Medicare & 
            Medicaid Services certifies that the participation of the 
            State in the demonstration project is projected not to 
            increase net program spending under title XIX of the Social 
            Security Act.
            ``(C) Notice of projections.--The Secretary shall provide 
        each State participating in the demonstration project as of the 
        date the Secretary submits recommendations to Congress under 
        subsection (f)(3), and any additional State that applies to be 
        added to the demonstration project, with notice of the 
        determination and certification made for the State under 
        subparagraphs (A) and (B), respectively, and the standards used 
        to make such determination and certification--
                ``(i) in the case of a State participating in the 
            demonstration project as of the date the Secretary submits 
            recommendations to Congress under subsection (f)(3), not 
            later than August 31, 2016; and
                ``(ii) in the case of an additional State that applies 
            to be added to the demonstration project, prior to the 
            State making a final election to participate in the 
            project.
        ``(4) Authority to ensure budget neutrality.--The Secretary 
    annually shall review each participating State's demonstration 
    project expenditures to ensure compliance with the requirements of 
    paragraphs (2)(A)(i), (2)(A)(ii), (3)(A)(i), (3)(A)(ii), (3)(B)(i), 
    and (3)(B)(ii) (as applicable). If the Secretary determines with 
    respect to a State's participation in the demonstration project 
    that the State's net program spending under title XIX of the Social 
    Security Act has increased as a result of the State's participation 
    in the project, the Secretary shall treat the demonstration project 
    excess expenditures of the State as an overpayment under title XIX 
    of the Social Security Act.''.
    (b) Funding.--Subsection (e) of section 2707 of such Act (42 U.S.C. 
1396a note) is amended--
        (1) in the subsection heading, by striking ``Limitations on 
    Federal'';
        (2) in paragraph (2)--
            (A) in the paragraph heading, by striking ``5-year''; and
            (B) by striking ``through December 31, 2015'' and inserting 
        ``until expended'';
        (3) by striking paragraph (3);
        (4) by redesignating paragraphs (4) and (5) as paragraphs (3) 
    and (4), respectively;
        (5) in paragraph (3) (as so redesignated), by striking ``and 
    the availability of funds'' and inserting ``(other than States 
    deemed to be eligible States through the application of subsection 
    (c)(4))''; and
        (6) in paragraph (4) (as so redesignated)--
            (A) in the first sentence--
                (i) by inserting ``(other than a State deemed to be an 
            eligible State through the application of subsection 
            (c)(4))'' after ``eligible State''; and
                (ii) by striking ``paragraph (4)'' and inserting 
            ``paragraph (3)''; and
            (B) by inserting after the first sentence the following: 
        ``In addition to any payments made to an eligible State under 
        the preceding sentence, the Secretary shall, during any period 
        in effect under paragraph (2) or (3) of subsection (d), or 
        during any period in which a law described in subsection 
        (f)(4)(C) is in effect, pay each eligible State (including any 
        State deemed to be an eligible State through the application of 
        subsection (c)(4)), an amount each quarter equal to the Federal 
        medical assistance percentage of expenditures in the quarter 
        during such period for medical assistance described in 
        subsection (a). Payments made to a State for emergency 
        psychiatric demonstration services under this section during 
        the extension period shall be treated as medical assistance 
        under the State plan for purposes of section 1903(a)(1) of the 
        Social Security Act (42 U.S.C. 1396b(a)(1)).''.
    (c) Recommendations to Congress.--Subsection (f) of section 2707 of 
such Act (42 U.S.C. 1396a note) is amended by adding at the end the 
following:
        ``(3) Recommendation to congress regarding extension and 
    expansion of project.--Not later than September 30, 2016, the 
    Secretary shall submit to Congress and make available to the public 
    recommendations based on an evaluation of the demonstration 
    project, including the use of appropriate quality measures, 
    regarding--
            ``(A) whether the demonstration project should be continued 
        after September 30, 2016; and
            ``(B) whether the demonstration project should be expanded 
        to additional States.
        ``(4) Recommendation to congress regarding permanent extension 
    and nationwide expansion.--
            ``(A) In general.--Not later than April 1, 2019, the 
        Secretary shall submit to Congress and make available to the 
        public recommendations based on an evaluation of the 
        demonstration project, including the use of appropriate quality 
        measures, regarding--
                ``(i) whether the demonstration project should be 
            permanently continued after December 31, 2019, in 1 or more 
            States; and
                ``(ii) whether the demonstration project should be 
            expanded (including on a nationwide basis).
            ``(B) Requirements.--Any recommendation submitted under 
        subparagraph (A) to permanently continue the project in a 
        State, or to expand the project to 1 or more other States 
        (including on a nationwide basis) shall include a certification 
        from the Chief Actuary of the Centers for Medicare & Medicaid 
        Services that permanently continuing the project in a 
        particular State, or expanding the project to a particular 
        State (or all States) is projected not to increase net program 
        spending under title XIX of the Social Security Act.
            ``(C) Congressional approval required.--The Secretary shall 
        not permanently continue the demonstration project in any State 
        after December 31, 2019, or expand the demonstration project to 
        any additional State after December 31, 2019, unless Congress 
        enacts a law approving either or both such actions and the law 
        includes provisions that--
                ``(i) ensure that each State's participation in the 
            project complies with budget neutrality requirements; and
                ``(ii) require the Secretary to treat any expenditures 
            of a State participating in the demonstration project that 
            are excess of the expenditures projected under the budget 
            neutrality standard for the State as an overpayment under 
            title XIX of the Social Security Act.
        ``(5) Funding.--Of the unobligated balances of amounts 
    available in the Centers for Medicare & Medicaid Services Program 
    Management account, $100,000 shall be available to carry out this 
    subsection and shall remain available until expended.''.
    (d) Conforming Amendments.--Section 2707 of such Act (42 U.S.C. 
1396a note) is amended--
        (1) in subsection (a), in the matter before paragraph (1), by 
    inserting ``publicly or'' after ``institution for mental diseases 
    that is'';
        (2) in subsection (c)--
            (A) in paragraph (1), by striking ``An eligible State'' and 
        inserting ``Except as otherwise provided in paragraph (4), an 
        eligible State'';
            (B) in paragraph (3), by striking ``A State shall'' and 
        inserting ``Except as otherwise provided in paragraph (4), a 
        State shall''; and
            (C) by adding at the end the following:
        ``(4) Nationwide availability.--In the event that the Secretary 
    makes a recommendation pursuant to subsection (f)(4) that the 
    demonstration project be expanded on a national basis, any State 
    that has submitted or submits an application pursuant to paragraph 
    (2) shall be deemed to have been selected to be an eligible State 
    to participate in the demonstration project.''; and
        (3) in the heading for subsection (f), by striking ``and 
    Report'' and inserting ``, Report, and Recommendations''.
    (e) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.