I 

111TH CONGRESS 

1ST SESSION H. R. 1415 

To provide for a demonstration project regarding Medicaid reimbursements 

for stabilization of emergency medical conditions by non-publicly owned 

or operated institutions for mental diseases. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 10, 2009 

Mr. GORDON of Tennessee introduced the following bill; which was referred 

to the Committee on Energy and Commerce 

A BILL 

To provide for a demonstration project regarding Medicaid 

reimbursements for stabilization of emergency medical 

conditions by non-publicly owned or operated 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 ‘‘Medicaid Emergency 

5 Psychiatric Care Demonstration Project Act of 2009’’. 


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1 SEC. 2. DEMONSTRATION PROJECT REGARDING MEDICAID 

2 REIMBURSEMENTS FOR STABILIZATION OF 

3 EMERGENCY MEDICAL CONDITIONS BY NON4 PUBLICLY OWNED OR OPERATED INSTITU5 TIONS FOR MENTAL DISEASES. 

6 (a) AUTHORITY TO CONDUCT DEMONSTRATION

7 PROJECT.—The Secretary of Health and Human Services 

8 (in this section referred to as the ‘‘Secretary’’) shall estab9 lish a demonstration project under which an eligible State 

10 (as described in subsection (c)) shall provide reimburse11 ment under the State Medicaid plan under title XIX of 

12 the Social Security Act to an institution for mental dis13 eases that is not publicly owned or operated and that is 

14 subject to the requirements of section 1867 of the Social 

15 Security Act (42 U.S.C. 1395dd) for the provision of med16 ical assistance available under such plan to an individual 

17 who— 

18 (1) has attained age 21, but has not attained 

19 age 65; 

20 (2) is eligible for medical assistance under such 

21 plan; and 

22 (3) requires such medical assistance to stabilize 

23 an emergency medical condition. 

24 (b) IN-STAY REVIEW.—The Secretary shall establish 

25 a mechanism for in-stay review to determine whether or 

26 not the patient has been stabilized (as defined in subVerDate Nov 24 2008 23:39 Mar 10, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1415.IH H1415

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1 section (h)(5)). This mechanism shall commence before 

2 the third day of the inpatient stay. States participating 

3 in the demonstration project may manage the provision 

4 of these benefits under the project through utilization re5 view, authorization, or management practices, or the ap6 plication of medical necessity and appropriateness criteria 

7 applicable to behavioral health. 

8 (c) ELIGIBLE STATE DEFINED.— 

9 (1) APPLICATION.—Upon approval of an appli10 cation submitted by a State described in paragraph 

11 (2), the State shall be an eligible State for purposes 

12 of conducting a demonstration project under this 

13 section. 

14 (2) STATE DESCRIBED.—States shall be se15 lected by the Secretary in a manner so as to provide 

16 geographic diversity on the basis of the application 

17 to conduct a demonstration project under this sec18 tion submitted by such States. 

19 (d) LENGTH OF DEMONSTRATION PROJECT.—The 

20 demonstration project established under this section shall 

21 be conducted for a period of 3 consecutive years. 

22 (e) LIMITATIONS ON FEDERAL FUNDING.— 

23 (1) APPROPRIATION.— 

24 (A) IN GENERAL.—Out of any funds in the 

25 Treasury not otherwise appropriated, there is 


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1 appropriated to carry out this section, 

2 $75,000,000 for fiscal year 2010. 

3 (B) BUDGET AUTHORITY.—Subparagraph 

4 (A) constitutes budget authority in advance of 

5 appropriations Act and represents the obliga6 tion of the Federal Government to provide for 

7 the payment of the amounts appropriated under 

8 that subparagraph. 

9 (2) 3-YEAR AVAILABILITY.—Funds appro10 priated under paragraph (1) shall remain available 

11 for obligation through December 31, 2012. 

12 (3) LIMITATION ON PAYMENTS.—In no case 

13 may— 

14 (A) the aggregate amount of payments 

15 made by the Secretary to eligible States under 

16 this section exceed $75,000,000; or 

17 (B) payments be provided by the Secretary 

18 under this section after December 31, 2012. 

19 (4) FUNDS ALLOCATED TO STATES.—The Sec20 retary shall allocate funds to eligible States based on 

21 their applications and the availability of funds. 

22 (5) PAYMENTS TO STATES.—The Secretary 

23 shall pay to each eligible State, from its allocation 

24 under paragraph (4), an amount each quarter equal 

25 to the Federal medical assistance percentage of exVerDate Nov 24 2008 23:39 Mar 10, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1415.IH H1415

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1 penditures in the quarter for medical assistance de2 scribed in subsection (a). 

3 (f) REPORTS.— 

4 (1) ANNUAL PROGRESS REPORTS.—The Sec5 retary shall submit annual reports to Congress on 

6 the progress of the demonstration project conducted 

7 under this section. 

8 (2) FINAL REPORT AND RECOMMENDATION.— 

9 An evaluation should be conducted of the demonstra10 tion project’s impact on the functioning of the health 

11 and mental health service system and on individuals 

12 enrolled in the Medicaid program. This evaluation 

13 should include collection of baseline data for one14 year prior to the initiation of the demonstration 

15 project as well as collection of data from matched 

16 comparison states not participating in the dem17 onstration. The evaluation measures shall include 

18 the following: 

19 (A) A determination, by State, as to 

20 whether the demonstration project resulted in 

21 increased access to inpatient mental health 

22 services under the Medicaid program and 

23 whether average length of stays were longer (or 

24 shorter) for individuals admitted under the 


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1 demonstration project compared with individ2 uals otherwise admitted in comparison sites. 

3 (B) An analysis by State, regarding wheth4 er the demonstration project produced a signifi5 cant reduction in emergency room visits for in6 dividuals eligible for assistance under the Med7 icaid program or in the duration of emergency 

8 room lengths of stay. 

9 (C) An assessment of discharge planning 

10 by participating hospitals that ensures access to 

11 further (non-emergency) inpatient or residential 

12 care as well as continuity of care for those dis13 charged to outpatient care. 

14 (D) An assessment of the impact of the 

15 demonstration project on the costs of the full 

16 range of mental health services (including inpa17 tient, emergency and ambulatory care) under 

18 the plan as contrasted with the comparison 

19 areas. 

20 (E) Data on the percentage of consumers 

21 with Medicaid coverage who are admitted to in22 patient facilities as a result of the demonstra23 tion project as compared to those admitted to 

24 these same facilities through other means. 


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1 (F) A recommendation regarding whether 

2 the demonstration project should be continued 

3 after December 31, 2012, and expanded on a 

4 national basis. 

5 (g) WAIVER AUTHORITY.— 

6 (1) IN GENERAL.—The Secretary shall waive 

7 the limitation of subdivision (B) following paragraph 

8 (28) of section 1905(a) of the Social Security Act 

9 (42 U.S.C. 1396d(a)) (relating to limitations on pay10 ments for care or services for individuals under 65 

11 years of age who are patients in an institution for 

12 mental diseases) for purposes of carrying out the 

13 demonstration project under this section. 

14 (2) LIMITED OTHER WAIVER AUTHORITY.—The 

15 Secretary may waive other requirements of titles XI 

16 and XIX of the Social Security Act (including the 

17 requirements of sections 1902(a)(1) (relating to 

18 statewideness) and 1902(1)(10)(B) (relating to com19 parability)) only to extent necessary to carry out the 

20 demonstration project under this section. 

21 (h) DEFINITIONS.—In this section: 

22 (1) EMERGENCY MEDICAL CONDITION.—The 

23 term ‘‘emergency medical condition’’ means, with re24 spect to an individual, an individual who expresses 


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1 suicidal or homicidal thoughts or gestures, if deter2 mined dangerous to self or others. 

3 (2) FEDERAL MEDICAL ASSISTANCE PERCENT4 AGE.—The term ‘‘Federal medical assistance per5 centage’’ has the meaning given that term with re6 spect to a State under section 1905(b) of the Social 

7 Security Act (42 U.S.C. 1396d(b)). 

8 (3) INSTITUTION FOR MENTAL DISEASES.—The 

9 term ‘‘institution for mental diseases’’ has the mean10 ing given to that term in section 1905(i) of the So11 cial Security Act (42 U.S.C. 1396d(i)). 

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

13 assistance’’ has the meaning given to that term in 

14 section 1905(a) of the Social Security Act (42 

15 U.S.C. 1396d(a)). 

16 (5) STABILIZED.—The term ‘‘stabilized’’ 

17 means, with respect to an individual, that the emer18 gency medical condition no longer exists with respect 

19 to the individual and the individual is no longer dan20 gerous to self or others. 

21 (6) STATE.—The term ‘‘State’’ has the mean22 ing given that term for purposes of title XIX of the 

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

Æ 


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