I 

118TH CONGRESS 

2D SESSION H. R. 9422 

To amend titles XIX and XXI of the Social Security Act to add a new 

State plan amendment option to provide medical assistance for certain 

individuals who are patients in certain institutions for mental diseases. 

IN THE HOUSE OF REPRESENTATIVES 

AUGUST 27, 2024 

Ms. PETTERSEN introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to add a new State plan amendment option to provide 

medical assistance for certain individuals who are patients in certain institutions for mental diseases. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Recovery Act’’. 

5 SEC. 2. ADDING MEDICAID AND CHIP STATE PLAN AMEND6 MENT OPTIONS. 

7 (a) ADDITIONAL MEDICAID STATE PLAN AMEND8 MENT OPTION.—Section 1915 of the Social Security Act 


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1 (42 U.S.C. 1396n) is amended by adding at the end the 

2 following new subsection: 

3 ‘‘(m) ADDITIONAL STATE PLAN AMENDMENT OP4 TION TO PROVIDE MEDICAL ASSISTANCE FOR CERTAIN

5 INDIVIDUALS WHO ARE PATIENTS IN CERTAIN INSTITU6 TIONS FOR MENTAL DISEASES.— 

7 ‘‘(1) IN GENERAL.—Subject to the succeeding 

8 paragraphs of this subsection, with respect to cal9 endar quarters beginning on or after January 1, 

10 2025, a State may elect, through a State plan 

11 amendment, to provide medical assistance for items 

12 and services furnished to an eligible individual who 

13 is a patient in an eligible institution for mental dis14 eases in accordance with the requirements described 

15 in paragraphs (3) through (7) of subsection (l). 

16 ‘‘(2) PAYMENTS.— 

17 ‘‘(A) IN GENERAL.—Subject to paragraphs 

18 (3) and (4) of subsection (l) as applied to a 

19 State plan amendment under paragraph (1), 

20 amounts expended under such a State plan 

21 amendment for services described in such para22 graph furnished, with respect to a 12-month pe23 riod, to an eligible individual who is a patient 

24 in an eligible institution for mental diseases 

25 shall be treated as medical assistance for which 


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1 payment is made under section 1903(a), but 

2 only to the extent that such services are fur3 nished for not more than the period of medical 

4 necessity determined under subparagraph (B) 

5 with respect to such eligible individual during 

6 such 12-month period. 

7 ‘‘(B) PERIOD OF MEDICAL NECESSITY.— 

8 For purposes of subparagraph (A), with respect 

9 to an eligible individual, the period of medical 

10 necessity— 

11 ‘‘(i) is the number of days (both con12 secutive and nonconsecutive) that treat13 ment in an eligible institution for mental 

14 diseases is determined, in a manner speci15 fied by the Secretary, to be in accordance 

16 with the most recent evidence-based cri17 teria developed by a nonprofit medical as18 sociation with expertise in substance use 

19 disorder treatment, such as the American 

20 Society of Addiction Medicine; and 

21 ‘‘(ii) shall be redetermined at a fre22 quency specified by the Secretary, but in 

23 no case less frequently than every 30 con24 secutive days during which such eligible inVerDate Sep 11 2014 22:35 Sep 07, 2024 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H9422.IH H9422

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1 dividual is a patient in an eligible institu2 tion for mental diseases. 

3 ‘‘(3) TEMPORARY ENHANCED FMAP.—Notwith4 standing section 1905(b), for each fiscal quarter 

5 during the first 5 years that a State plan amend6 ment elected under this subsection is in effect, the 

7 Federal medical assistance percentage applicable to 

8 payments under this subsection shall be equal to 90 

9 percent. 

10 ‘‘(4) CLARIFICATION WITH RESPECT TO INPA11 TIENT AND RESIDENTIAL SERVICES.—For purposes 

12 of a State plan amendment elected under this sub13 section, paragraph (4)(C)(ii) of subsection (l) shall 

14 be applied by substituting the following for sub15 clause (IV): 

16 ‘‘ ‘(IV) Medically managed, high17 intensity residential services for ado18 lescents, and medically managed, in19 tensive residential services (including 

20 withdrawal management) for adults, 

21 that provide 24-hour nursing care, 

22 make physicians available for signifi23 cant problems in Dimensions 1, 2, or 

24 3, and provide comprehensive psycho25 social services.’. 


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1 ‘‘(5) PLANNING GRANTS.— 

2 ‘‘(A) IN GENERAL.—Beginning January 1, 

3 2025, the Secretary may award planning grants 

4 to States for purposes of developing and imple5 menting a State plan amendment under this 

6 subsection, including through the funding of ap7 propriate tools and training. A planning grant 

8 awarded to a State under this paragraph shall 

9 remain available until expended. 

10 ‘‘(B) APPLICATION.—To be eligible to re11 ceive a planning grant under this paragraph, a 

12 State shall submit to the Secretary an applica13 tion in such form and manner as the Secretary 

14 shall specify. 

15 ‘‘(C) LIMITATION.—The total amount of 

16 payments to States under this paragraph shall 

17 not exceed $25,000,000. 

18 ‘‘(6) ELIGIBLE INDIVIDUAL DEFINED.—In this 

19 subsection, the term ‘eligible individual’ means an 

20 individual who— 

21 ‘‘(A) with respect to a State, is enrolled for 

22 medical assistance under the State plan or a 

23 waiver of such plan; 

24 ‘‘(B) has not attained 65 years of age; and 


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1 ‘‘(C) has at least 1 substance use dis2 order.’’. 

3 (b) CHILDREN’S HEALTH INSURANCE PROGRAM.— 

4 Section 2107(e)(1) of the Social Security Act (42 U.S.C. 

5 1397gg(e)(1)) is amended by adding at the end the fol6 lowing new subparagraph: 

7 ‘‘(V) Section 1915(m) (relating to the 

8 State option to provide medical assistance for 

9 individuals who are patients in an eligible insti10 tution for mental diseases).’’. 

Æ 


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