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[114th Congress Public Law 97]
[From the U.S. Government Publishing Office]

[[Page 2193]]

           IMPROVING ACCESS TO EMERGENCY PSYCHIATRIC CARE ACT

[[Page 129 STAT. 2194]]

Public Law 114-97
114th Congress

                                 An Act

 
 To extend and expand the Medicaid emergency psychiatric demonstration 
              project. <<NOTE: Dec. 11, 2015 -  [S. 599]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Improving Access 
to Emergency Psychiatric Care Act.>> 
SECTION 1. <<NOTE: 42 USC 1305 note.>> 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.-- <<NOTE: Time period.>> 
            ``(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) <<NOTE: Determination.>> 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) <<NOTE: Certification.>> 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

[[Page 129 STAT. 2195]]

                in the project through December 31, 2019, if, with 
                respect to the State--
                          ``(i) <<NOTE: Determination.>> 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) <<NOTE: Certification.>> 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) <<NOTE: Determination.>> 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) <<NOTE: Certification.>> 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) <<NOTE: Deadline.>> 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) <<NOTE: Deadline. Review.>> 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). <<NOTE: Determination.>> 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--

[[Page 129 STAT. 2196]]

            (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. <<NOTE: Deadline. Public information.>> --
        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.-- <<NOTE: Deadline. Public 
        information.>> 
                    ``(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--

[[Page 129 STAT. 2197]]

                          ``(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. <<NOTE: Certification.>> --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

[[Page 129 STAT. 2198]]

            (3) in the heading for subsection (f), by striking ``and 
        Report'' and inserting ``, Report, and Recommendations''.

    (e) <<NOTE: 42 USC 1396a note.>> Effective Date.--The amendments 
made by this section shall take effect on the date of the enactment of 
this Act.

    Approved December 11, 2015.

LEGISLATIVE HISTORY--S. 599:
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SENATE REPORTS: No. 114-101 (Comm. on Finance).
CONGRESSIONAL RECORD, Vol. 161 (2015):
            Sept. 28, considered and passed Senate.
            Nov. 16, considered and passed House, amended.
            Nov. 19, Senate concurred in House amendment.

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