I 

116TH CONGRESS 

2D SESSION H. R. 7912 

To provide for a demonstration program and pilot project to expand choice 

for inpatient psychiatric services under Medicaid and Medicare. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2020 

Mr. HUIZENGA (for himself and Mr. TONKO) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To provide for a demonstration program and pilot project 

to expand choice for inpatient psychiatric services under 

Medicaid and Medicare. 

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 ‘‘Increasing National 

5 Patient Access To Improved Effective Necessary Mental 

6 Health Treatment Act of 2020’’ or the ‘‘INPATIENT Act 

7 of 2020’’. 


kjohnson on DSK79L0C42PROD with BILLS
2 

•HR 7912 IH

1 SEC. 2. DEMONSTRATION PROJECT WAIVING IMD EXCLU2 SION TO EXPAND ACCESS TO INPATIENT PSY3 CHIATRIC SERVICES UNDER THE MEDICAID 

4 PROGRAM. 

5 (a) AUTHORITY TO CONDUCT DEMONSTRATION

6 PROJECT.— 

7 (1) IN GENERAL.—The Secretary of Health and 

8 Human Services (in this Act referred to as the ‘‘Sec9 retary’’) shall establish a demonstration project (in 

10 this Act referred to as the ‘‘demonstration project’’) 

11 to test the impact of waiving the limitation of sub12 division (B) following paragraph (29) of section 

13 1905(a) of the Social Security Act (42 U.S.C. 

14 1396d(a)) on average length of stay, readmissions, 

15 cost, and quality outcomes for inpatient psychiatric 

16 hospital services and substance abuse services. 

17 (2) TERMS.—Under the demonstration project, 

18 an eligible State (as defined in subsection (b)) shall 

19 provide payment under its State Medicaid plan 

20 under title XIX of the Social Security Act to quali21 fying institutions (as defined in subsection 

22 (b)(3)(C)) for the provision of medical assistance 

23 available under such plan to individuals who— 

24 (A) have attained age 21, but have not at25 tained age 65; 


kjohnson on DSK79L0C42PROD with BILLS
3 

•HR 7912 IH

1 (B) are eligible for medical assistance 

2 under such plan (or under a waiver of such 

3 plan); 

4 (C) require such medical assistance for in5 patient psychiatric hospital services or residen6 tial substance abuse services; and 

7 (D) but for participation in the demonstra8 tion project, would otherwise receive medical as9 sistance for such inpatient psychiatric hospital 

10 services if the services were provided in a gen11 eral acute care hospital or other residential sub12 stance abuse facility. 

13 (b) ELIGIBLE STATE DEFINED.— 

14 (1) IN GENERAL.—In this section, the term ‘‘el15 igible State’’ means a State that has made an appli16 cation under paragraph (2) and has had such appli17 cation approved and has been selected under para18 graph (3). 

19 (2) APPLICATION.—A State seeking to partici20 pate in the demonstration project shall submit to the 

21 Secretary, at such time and in such format as the 

22 Secretary requires, an application that includes such 

23 information, provisions, and assurances, as the Sec24 retary may require. 

25 (3) SELECTION AND LIMITATION.— 


kjohnson on DSK79L0C42PROD with BILLS
4 

•HR 7912 IH

1 (A) STATE LIMITATION.—The Secretary 

2 shall limit the number of States selected for 

3 participation in the demonstration project to no 

4 more than 3 States. 

5 (B) CONDITIONS FOR APPLICATION AP6 PROVAL.—The Secretary shall not approve an 

7 application under paragraph (2) unless the 

8 State agrees to limit participation in the dem9 onstration project to qualifying institutions (as 

10 defined in subparagraph (C)). 

11 (C) QUALIFYING INSTITUTION DEFINED.— 

12 In this Act, the term ‘‘qualifying institution’’ 

13 means an institution for mental diseases that is 

14 not publicly owned or operated, that is subject 

15 to the requirements of section 1867 of the So16 cial Security Act (42 U.S.C. 1395dd), and that 

17 meets all of the following criteria: 

18 (i) The institution furnishes inpatient 

19 psychiatric hospital services to individuals 

20 age 18 years of age or older under the 

21 Medicare and Medicaid programs. 

22 (ii) The institution has an average 

23 length of inpatient hospital stay of less 

24 than 15 days for individuals age 18 or 

25 older, but under 65 years of age. 


kjohnson on DSK79L0C42PROD with BILLS
5 

•HR 7912 IH

1 (iii) The institution has an average 

2 length of stay of less than 21 days for hos3 pital inpatients age 65 or older. 

4 (iv) The institution has an approved 

5 medical residency training program and re6 ceive payment due under the Medicare and 

7 Medicaid programs for the reasonable costs 

8 of graduate medical education. 

9 (v) The institution uses psychiatric 

10 residents to provide inpatient psychiatric 

11 hospital services to individuals under the 

12 Medicare and Medicaid programs. 

13 (vi) The institution has documented 

14 experience in providing services to active 

15 duty military personnel and veterans. 

16 (vii) The institution has standards to 

17 care for the whole person, including refer18 ral agreements or other arrangements to 

19 address a patient’s medical, surgical, or di20 agnostic needs if such treatment services 

21 are not available within the institution. 

22 (viii) The institution agrees to report 

23 on quality measures (in such form, man24 ner, and frequency as specified by the Sec25 retary) and report to the Secretary (in a 


kjohnson on DSK79L0C42PROD with BILLS
6 

•HR 7912 IH

1 form, manner, and frequency as specified 

2 by the Secretary) such data as the Sec3 retary determines appropriate to monitor 

4 and evaluate the demonstration project. 

5 (ix) The institution agrees to plan and 

6 implement an annual performance im7 provement project, aimed at improving the 

8 effectiveness of care provided to high uti9 lizers of inpatient psychiatric hospital serv10 ices (as defined in subsection (h)(1)), with 

11 identifiable measures in coordination with 

12 the Secretary and the State. 

13 (c) DEADLINE FOR IMPLEMENTATION.—The Sec14 retary shall implement the demonstration project by Janu15 ary 1, 2022. 

16 (d) LENGTH OF DEMONSTRATION PROJECT.—The 

17 demonstration project shall be conducted for a period of 

18 7 consecutive years. 

19 (e) BUDGET NEUTRALITY.—With respect to the op20 eration of the demonstration project in a State for the pe21 riod described in subsection (d), the State must dem22 onstrate to the Secretary that project will not result in 

23 a net increase in the aggregate expenditures under the 

24 Medicaid program for such period for the State above the 


kjohnson on DSK79L0C42PROD with BILLS
7 

•HR 7912 IH

1 level of such expenditures if the demonstration project had 

2 not been implemented. 

3 (f) EVALUATION AND REPORT TO CONGRESS.— 

4 (1) EVALUATION.—The Secretary shall conduct 

5 an evaluation of the demonstration project in order 

6 to determine the impact of the project and to make 

7 recommendations on improvements to the perform8 ance of the health and mental health service system 

9 and on individuals enrolled in the Medicaid program, 

10 with particular emphasis on individuals who are high 

11 utilizers of inpatient psychiatric hospital services and 

12 substance abuse residential services. 

13 (2) ITEMS INCLUDED IN EVALUATION.—Such 

14 evaluation shall include the following: 

15 (A) An assessment of the delivery of inpa16 tient psychiatric hospital services, substance 

17 abuse residential services, and community-based 

18 services under the Medicaid program; average 

19 lengths of inpatient stays; emergency room vis20 its; and readmissions. 

21 (B) An assessment of the impact of the 

22 demonstration project on the costs of the full 

23 range of mental health services (including inpa24 tient, emergency and ambulatory care) under 

25 the Medicaid program. 


kjohnson on DSK79L0C42PROD with BILLS
8 

•HR 7912 IH

1 (C) An assessment of the impact of the 

2 demonstration project on psychiatric residency 

3 programs and the mental health workforce. 

4 (D) An assessment of the impact of the 

5 demonstration project on rates of recidivism. 

6 (E) Identification and assessment of best 

7 practices for caring for patients with serious 

8 mental illness, including high utilizers of inpa9 tient psychiatric hospital services and substance 

10 abuse residential services. 

11 (F) A comparison of outcomes and costs 

12 for similarly situated patients receiving inpa13 tient psychiatric hospital services at a general 

14 acute care hospital. 

15 (G) A recommendation regarding whether 

16 the demonstration project should be continued 

17 after December 31, 2028, and expanded on a 

18 national basis. 

19 (3) REPORT.—Not later than December 31, 

20 2028, the Secretary shall submit to Congress (and 

21 make available to the public) a report on the find22 ings of the evaluation conducted under this sub23 section. 

24 (g) IMD WAIVER; WAIVER AUTHORITY.— 


kjohnson on DSK79L0C42PROD with BILLS
9 

•HR 7912 IH

1 (1) IMD WAIVER.—The limitation of subdivi2 sion (B) following paragraph (29) of section 1905(a) 

3 of the Social Security Act (42 U.S.C. 1396d(a)), re4 lating to limitations on payments for care or services 

5 for individuals under 65 years of age who are pa6 tients in an institution for mental disease, shall not 

7 apply to inpatient psychiatric hospital services or 

8 substance abuse residential services furnished under 

9 the demonstration project. 

10 (2) WAIVER AUTHORITY.—The Secretary may 

11 waive such requirements of titles XI and XIX of the 

12 Social Security Act (which may include the require13 ments of paragraph (1) (relating to statewideness)) 

14 and paragraph (10)(B) (relating to comparability) of 

15 section 1902(a) of such Act (42 U.S.C. 1396b(a)) 

16 only to extent the Secretary determines such a waiv17 er to be necessary to carry out the demonstration 

18 project. 

19 (h) DEFINITIONS.—In this Act: 

20 (1) HIGH UTILIZER OF INPATIENT PSYCHIATRIC

21 HOSPITAL SERVICES.—The term ‘‘high utilizer of in22 patient psychiatric hospital services’’ means an indi23 vidual who, with respect to a point in time, meets 

24 the following conditions: 


kjohnson on DSK79L0C42PROD with BILLS
10 

•HR 7912 IH

1 (A) The individual had two or more inpa2 tient admissions for psychiatric services in the 

3 previous 12 months. 

4 (B) The individual had 10 or more inpa5 tient admissions for psychiatric services in the 

6 individual’s lifetime. 

7 (C) The individual had 100 or more days 

8 of inpatient psychiatric services in the individ9 ual’s lifetime. 

10 (D) The individual meets any of the fol11 lowing conditions: 

12 (i) The individual is receiving court13 ordered psychiatric treatment. 

14 (ii) The individual has been receiving 

15 inpatient psychiatric services for a consecu16 tive period of at least 12 days. 

17 (iii) The individual has a documented 

18 history of suicidal or self-harming behav19 iors due to mental illness. 

20 (iv) The individual has a documented 

21 history of threatened or actual physical 

22 harm to another individual due to mental 

23 illness. 

24 (2) INSTITUTION FOR MENTAL DISEASE.—The 

25 term ‘‘institution for mental disease’’ has the meanVerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912

kjohnson on DSK79L0C42PROD with BILLS
11 

•HR 7912 IH

1 ing given that term in section 1905(i) of the Social 

2 Security Act (42 U.S.C. 1396d(i)). 

3 (3) MEDICAID PROGRAM.—The term ‘‘Medicaid 

4 program’’ means the program under title XIX of the 

5 Social Security Act (42 U.S.C. 1396 et seq.). 

6 (4) MEDICAL ASSISTANCE.—The term ‘‘medical 

7 assistance’’ has the meaning given that term in sec8 tion 1905(a) of the Social Security Act (42 U.S.C. 

9 1396d(a)). 

10 (5) MEDICARE PROGRAM.—The term ‘‘Medicare 

11 program’’ means the program under part A of title 

12 XVIII of the Social Security Act (42 U.S.C. 1395c 

13 et seq.) and includes the programs under parts B, 

14 C, and D of such title. 

15 (6) STATE.—The term ‘‘State’’ has the mean16 ing given that term for purposes of the Medicaid 

17 program. 

18 SEC. 3. PILOT PROGRAM WAIVING THE MEDICARE 190-DAY 

19 LIFETIME LIMIT ON INPATIENT PSYCHIATRIC 

20 HOSPITAL SERVICES TO EXPAND ACCESS TO 

21 INPATIENT PSYCHIATRIC SERVICES UNDER 

22 THE MEDICARE PROGRAM. 

23 (a) DEMONSTRATION PROGRAM AUTHORIZED.—The 

24 Secretary shall establish a pilot program (in this section 


kjohnson on DSK79L0C42PROD with BILLS
12 

•HR 7912 IH

1 referred to as the ‘‘pilot program’’) to test the impact of 

2 eliminating the Medicare 190-day lifetime limit on— 

3 (1) promoting value; 

4 (2) expanding choice; and 

5 (3) aligning inpatient mental health benefits 

6 with the inpatient physical health care benefits 

7 under the Medicare program. 

8 (b) DEFINITIONS.—In this section: 

9 (1) APPLICABLE BENEFICIARY.—The term ‘‘ap10 plicable beneficiary’’ means an individual who— 

11 (A) is entitled to, or enrolled for, benefits 

12 under part A, and enrolled for benefits under 

13 part B, of the Medicare program; 

14 (B) is admitted to a qualifying institution 

15 participating in the demonstration project; and 

16 (C) but for the pilot program established 

17 under this section, would otherwise receive ben18 efits for inpatient psychiatric services under the 

19 Medicare program if the services were provided 

20 in a general acute care hospital. 

21 (2) INPATIENT PSYCHIATRIC HOSPITAL SERV22 ICES.—The term ‘‘inpatient psychiatric hospital 

23 services’’ has the meaning given such term in section 

24 1861(c) of the Social Security Act (42 U.S.C. 

25 1395x(c)). 


kjohnson on DSK79L0C42PROD with BILLS
13 

•HR 7912 IH

1 (3) MEDICARE 190-DAY LIFETIME LIMIT.—The 

2 term ‘‘Medicare 190-day lifetime limit’’ means the 

3 190-day lifetime limitation imposed on inpatient psy4 chiatric hospital services under section 1812(b)(3) of 

5 the Social Security Act (42 U.S.C. 1395d(b)(3)). 

6 (c) PROGRAM DETAILS.— 

7 (1) DURATION AND STARTING DATE.— 

8 (A) STARTING DATE.—The pilot program 

9 shall begin no later than January 1, 2021. 

10 (B) DURATION.—Subject to subparagraph 

11 (C), the pilot program shall be conducted for a 

12 period of 7 years. 

13 (C) EXPANSION.—The Secretary may, at 

14 any time after the pilot program has operated 

15 for a period of at least 3 years expand the du16 ration and scope of the pilot program, to the 

17 extent determined appropriate by the Secretary, 

18 if— 

19 (i) the Secretary determines that such 

20 expansion is expected— 

21 (I) to reduce (or not to result in 

22 any increase in) net expenditures 

23 under the Medicare program without 

24 reducing the quality of care; or 


kjohnson on DSK79L0C42PROD with BILLS
14 

•HR 7912 IH

1 (II) to improve the quality of 

2 care without increasing such net ex3 penditures; 

4 (ii) the Chief Actuary of the Centers 

5 for Medicare & Medicaid Services certifies 

6 that such expansion would reduce spending 

7 under the Medicare program; and 

8 (iii) the Secretary determines that 

9 such expansion would not deny or limit the 

10 coverage or provision of benefits under the 

11 Medicare program for applicable bene12 ficiaries. 

13 (2) WAIVER OF MEDICARE 190-DAY LIFETIME

14 LIMIT.—The Medicare 190-day lifetime limit shall 

15 not apply to applicable beneficiaries receiving inpa16 tient psychiatric services at a participating institu17 tion under the pilot program. 

18 (3) PARTICIPATING PROVIDERS OF SERVICES

19 AND SUPPLIERS.— 

20 (A) IN GENERAL.—Only institutions par21 ticipating in the demonstration project may 

22 submit an application to the Secretary to pro23 vide inpatient psychiatric services under the 

24 pilot program. 


kjohnson on DSK79L0C42PROD with BILLS
15 

•HR 7912 IH

1 (B) REQUIREMENTS.—The Secretary may 

2 develop additional requirements for institutions 

3 to participate in the pilot program. Such re4 quirements may include the collection and re5 porting of data related to the reasonable costs 

6 of graduate medical education. 

7 (4) QUALITY MEASURES.— 

8 (A) IN GENERAL.—The Secretary shall es9 tablish quality measures related to care pro10 vided by qualifying institutions participating in 

11 the pilot program, which measures shall include 

12 at least measures of the following: 

13 (i) Reducing rates of avoidable hos14 pital readmissions. 

15 (ii) Rates of discharge to the commu16 nity. 

17 (iii) Rates of admission to an emer18 gency room after a hospitalization. 

19 (iv) Other measures, including meas20 ures of patient outcomes, determined ap21 propriate by the Secretary. 

22 (B) REPORTING ON QUALITY MEASURES.— 

23 A qualifying institution shall submit (in a form 

24 and manner specified by the Secretary) data to 

25 the Secretary on quality measures established 


kjohnson on DSK79L0C42PROD with BILLS
16 

•HR 7912 IH

1 under subparagraph (A) during each year in 

2 which the institution is participating in the pilot 

3 program. 

4 (d) WAIVER.—The Secretary shall waive such provi5 sions of titles XI and XVIII of the Social Security Act 

6 as may be necessary to carry out the pilot program. 

7 (e) INDEPENDENT EVALUATION AND REPORTS ON

8 PILOT PROGRAM.— 

9 (1) INDEPENDENT EVALUATION.—The Sec10 retary shall conduct an independent evaluation of 

11 the pilot program, including the extent to which the 

12 pilot program has— 

13 (A) improved quality measures established 

14 under subsection (c)(4)(A); 

15 (B) improved health outcomes; 

16 (C) improved patient satisfaction; and 

17 (D) reduced spending under the Medicare 

18 program. 

19 (2) REPORT.—Not later than December 31, 

20 2027, the Secretary shall submit to Congress a re21 port on the evaluation conducted under paragraph 

22 (1). 

23 (3) COORDINATION WITH EXPANDING CHOICE

24 FOR MEDICAID INPATIENT PSYCHIATRIC HOSPITAL

25 SERVICES DEMONSTRATION PROJECT.—The SecVerDate Sep 11 2014 04:17 Aug 18, 2020 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H7912.IH H7912

kjohnson on DSK79L0C42PROD with BILLS
17 

•HR 7912 IH

1 retary may combine the independent evaluation and 

2 reports required under this section and the reports 

3 required under the demonstration project under sec4 tion 2(f). 

5 (f) BUDGET NEUTRALITY.—With respect to the pe6 riod of the pilot program under subsection (c)(1) occurring 

7 before any expansion under subparagraph (C) of such sub8 section, the Secretary shall ensure that the program does 

9 not result in a net increase in the aggregate expenditures 

10 under the Medicare program for such period above the 

11 level of such expenditures if the pilot program had not 

12 been implemented. The Secretary may make such adjust13 ments to payments under the Medicare program as is nec14 essary to carry out the previous sentence. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS