II 

115TH CONGRESS 

1ST SESSION S. 1169 

To amend title XIX of the Social Security Act to provide States with an 

option to provide medical assistance to individuals between the ages 

of 22 and 64 for inpatient services to treat substance use disorders 

at certain facilities, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 17, 2017 

Mr. DURBIN (for himself, Mr. PORTMAN, Mr. BROWN, Mrs. CAPITO, Mr. 

KING, Ms. COLLINS, Mr. MANCHIN, and Mr. BOOKER) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to provide 

States with an option to provide medical assistance to 

individuals between the ages of 22 and 64 for inpatient 

services to treat substance use disorders at certain facilities, and for other purposes. 

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 ‘‘Medicaid Coverage for 

5 Addiction Recovery Expansion Act’’. 

2 

•S 1169 IS

1 SEC. 2. STATE OPTION TO PROVIDE MEDICAL ASSISTANCE 

2 FOR RESIDENTIAL ADDICTION TREATMENT 

3 FACILITY SERVICES; MODIFICATION OF THE 

4 IMD EXCLUSION. 

5 (a) IN GENERAL.—Section 1905 of the Social Secu6 rity Act (42 U.S.C. 1396d) is amended— 

7 (1) in subsection (a)(16)— 

8 (A) by striking ‘‘and, (B)’’ and inserting ‘‘, 

9 (B)’’; and 

10 (B) by inserting ‘‘, and (C) effective Janu11 ary 1, 2019, residential addiction treatment fa12 cility services (as defined in subsection (h)(3)) 

13 for individuals over 21 years of age and under 

14 65 years of age, if offered as part of a full con15 tinuum of evidence-based treatment services 

16 provided under the State plan, including resi17 dential, outpatient, and community-based care, 

18 for individuals with substance use disorders’’ 

19 before the semicolon; and 

20 (2) in subsection (h)— 

21 (A) in paragraph (1), by striking ‘‘para22 graph (16) of subsection (a)’’ and inserting 

23 ‘‘subsection (a)(16)(A)’’; and 

24 (B) by adding at the end the following new 

25 paragraph: 

3 

•S 1169 IS

1 ‘‘(3)(A) For purposes of subsection (a)(16)(C), 

2 the term ‘residential addiction treatment facility 

3 services’ means, subject to subparagraph (B), inpa4 tient services provided— 

5 ‘‘(i) to an individual for the purpose of 

6 treating a substance use disorder that are fur7 nished to an individual for not more than 2 

8 consecutive periods of 30 consecutive days, pro9 vided that upon completion of the first 30-day 

10 period, the individual is assessed and deter11 mined to have progressed through the clinical 

12 continuum of care, in accordance with criteria 

13 established by the Secretary, in consultation 

14 with the American Society of Addiction Medi15 cine, and requires continued medically nec16 essary treatment and social support services to 

17 promote recovery, stable transition to ongoing 

18 treatment, and discharge; and 

19 ‘‘(ii) in a facility that is accredited for the 

20 treatment of substance use disorders by the 

21 Joint Commission on Accreditation of 

22 Healthcare Organizations, the Commission on 

23 Accreditation of Rehabilitation Facilities, the 

24 Council on Accreditation, or any other accred25 iting agency that the Secretary deems approVerDate Sep 11 2014 02:09 May 23, 2017 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1169.IS S1169
4 

•S 1169 IS

1 priate as necessary to ensure nationwide appli2 cability, including qualified national organiza3 tions and State-level accrediting agencies. 

4 ‘‘(B) The State agency responsible for admin5 istering the State plan under this title shall establish 

6 procedures to ensure that, with respect to any facil7 ity providing residential addiction treatment facility 

8 services in a fiscal year, the average monthly num9 ber of beds used by the facility to provide such serv10 ices during such year is not more than 40. 

11 ‘‘(C) The provision of medical assistance for 

12 residential addiction treatment facility services to an 

13 individual shall not prohibit Federal financial par14 ticipation for medical assistance for items or services 

15 that are provided to the individual in or away from 

16 the residential addiction treatment facility during 

17 any 30-day period in which the individual is receiv18 ing residential addiction treatment facility services. 

19 ‘‘(D) A woman who is eligible for medical as20 sistance on the basis of being pregnant and who is 

21 furnished residential addiction treatment facility 

22 services during any 30-day period may remain eligi23 ble for, and continue to be furnished with, such serv24 ices for additional 30-day periods without regard to 

25 any eligibility limit that would otherwise apply to the 

5 

•S 1169 IS

1 woman as a result of her pregnancy ending, subject 

2 to assessment by the facility and a determination 

3 based on medical necessity related to substance use 

4 disorder and the impact of substance use disorder on 

5 birth outcomes.’’. 

6 (b) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to items and services furnished on 

8 or after January 1, 2019. 

9 SEC. 3. GRANT PROGRAM TO EXPAND YOUTH ADDICTION 

10 TREATMENT FACILITIES UNDER MEDICAID 

11 AND CHIP. 

12 (a) ESTABLISHMENT.— 

13 (1) IN GENERAL.—The Secretary shall establish 

14 a program under which the Secretary shall award 

15 grants to States for the purpose of expanding the in16 frastructure and treatment capabilities, including 

17 augmenting equipment and bed capacity, of eligible 

18 youth addiction treatment facilities that provide ad19 diction treatment services to Medicaid or CHIP 

20 beneficiaries who have not attained the age of 21 

21 and are in communities with high numbers of medi22 cally underserved populations of at-risk youth. 

23 (2) USE OF FUNDS.—Grant funds awarded 

24 under this section may be used to expand the infra25 structure and treatment capabilities of an existing 

6 

•S 1169 IS

1 facility (including through construction) but shall 

2 not be used for the construction of any new facility 

3 or for the provision of medical assistance or child 

4 health assistance under Medicaid or CHIP. 

5 (3) TIMETABLE FOR IMPLEMENTATION; DURA6 TION.— 

7 (A) IMPLEMENTATION.—Not later than 1 

8 year after the date of the enactment of this Act, 

9 the Secretary shall award grants under the 

10 grant program. 

11 (B) DURATION.—The Secretary shall 

12 award grants under the grant program for a 

13 period not to exceed 5 years. 

14 (b) APPLICATION.—A State seeking to participate in 

15 the grant program shall submit to the Secretary, at such 

16 time and in such manner as the Secretary shall require, 

17 an application that includes— 

18 (1) detailed information on the types of addi19 tional infrastructure and treatment capacity of eligi20 ble youth addiction treatment facilities that the 

21 State proposes to fund under the grant program; 

22 (2) a description of the communities in which 

23 the eligible youth addiction treatment facilities fund24 ed under the grant program operate; 

7 

•S 1169 IS

1 (3) an assurance that the eligible youth addic2 tion treatment facilities that the State proposes to 

3 fund under the grant program shall give priority to 

4 providing addiction treatment services to Medicaid 

5 or CHIP beneficiaries who have not attained the age 

6 of 21 and are in communities with high numbers of 

7 medically underserved populations of at-risk youth; 

8 and 

9 (4) such additional information and assurances 

10 as the Secretary shall require. 

11 (c) RURAL AREAS.—Not less than 15 percent of the 

12 amount of a grant awarded to a State under this section 

13 shall be used for making payments to eligible youth addic14 tion treatment facilities that are located in rural areas or 

15 that target the provision of addiction treatment services 

16 to Medicaid or CHIP beneficiaries who have not attained 

17 the age of 21 and reside in rural areas. 

18 (d) DEFINITIONS.—For purposes of this section: 

19 (1) ADDICTION TREATMENT SERVICES.—The 

20 term ‘‘addiction treatment services’’ means services 

21 provided to an individual for the purpose of treating 

22 a substance use disorder. 

23 (2) CHIP.—The term ‘‘CHIP’’ means the 

24 State children’s health insurance program estabVerDate Sep 11 2014 02:09 May 23, 2017 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1169.IS S1169
8 

•S 1169 IS

1 lished under title XXI of the Social Security Act (42 

2 U.S.C. 1397aa et seq.). 

3 (3) ELIGIBLE YOUTH ADDICTION TREATMENT

4 FACILITY.—The term ‘‘eligible youth addiction treat5 ment facility’’ means a facility that is a participating 

6 provider under the State Medicaid or CHIP pro7 grams for purposes of providing medical assistance 

8 or child health assistance to Medicaid or CHIP 

9 beneficiaries for youth addiction treatment services 

10 on an inpatient or outpatient basis (or both). 

11 (4) MEDICAID.—The term ‘‘Medicaid’’ means 

12 the medical assistance program established under 

13 title XIX of the Social Security Act (42 U.S.C. 1396 

14 et seq.). 

15 (5) MEDICAID OR CHIP BENEFICIARY.—The 

16 term ‘‘Medicaid or CHIP beneficiary’’ means an in17 dividual who is enrolled in the State Medicaid plan, 

18 the State child health plan under CHIP, or under a 

19 waiver of either such plan. 

20 (6) MEDICALLY UNDERSERVED POPU21 LATIONS.—The term ‘‘medically underserved popu22 lations’’ has the meaning given that term in section 

23 330(b)(3) of the Public Health Service Act (42 

24 U.S.C. 254b(b)(3)). 

9 

•S 1169 IS

1 (7) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Health and Human Services. 

3 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated $50,000,000 to carry 

5 out the provisions of this section. Funds appropriated 

6 under this subsection shall remain available until ex7 pended. 

Æ