I 

116TH CONGRESS 

2D SESSION H. R. 8586 

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 HOUSE OF REPRESENTATIVES 

OCTOBER 13, 2020 

Mr. FOSTER (for himself and Mr. FITZPATRICK) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

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’’. 


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1 SEC. 1. 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, 2021, 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: 


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

2 term ‘residential addiction treatment facility services’ 

3 means, subject to subparagraph (B), inpatient services 

4 provided— 

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

6 a substance use disorder that are furnished to an in7 dividual for not more than 2 consecutive periods of 

8 30 consecutive days, provided that upon completion 

9 of the first 30-day period, the individual is assessed 

10 and determined to have progressed through the clin11 ical continuum of care, in accordance with criteria 

12 established by the Secretary, in consultation with the 

13 American Society of Addiction Medicine, and re14 quires continued medically necessary treatment and 

15 social support services to promote recovery, stable 

16 transition to ongoing treatment, and discharge; and 

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

18 treatment of substance use disorders by the Joint 

19 Commission on Accreditation of Healthcare Organi20 zations, the Commission on Accreditation of Reha21 bilitation Facilities, the Council on Accreditation, or 

22 any other accrediting agency that the Secretary 

23 deems appropriate as necessary to ensure nationwide 

24 applicability, including qualified national organiza25 tions and State-level accrediting agencies. 


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1 ‘‘(B) The State agency responsible for administering 

2 the State plan under this title shall establish procedures 

3 to ensure that, with respect to any facility providing resi4 dential addiction treatment facility services in a fiscal 

5 year, the average monthly number of beds used by the fa6 cility to provide such services during such year is not more 

7 than 40. 

8 ‘‘(C) The provision of medical assistance for residen9 tial addiction treatment facility services to an individual 

10 shall not prohibit Federal financial participation for med11 ical assistance for items or services that are provided to 

12 the individual in or away from the residential addiction 

13 treatment facility during any 30-day period in which the 

14 individual is receiving residential addiction treatment fa15 cility services. 

16 ‘‘(D) A woman who is eligible for medical assistance 

17 on the basis of being pregnant and who is furnished resi18 dential addiction treatment facility services during any 30- 

19 day period may remain eligible for, and continue to be fur20 nished with, such services for additional 30-day periods 

21 without regard to any eligibility limit that would otherwise 

22 apply to the woman as a result of her pregnancy ending, 

23 subject to assessment by the facility and a determination 

24 based on medical necessity related to substance use disVerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586

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1 order and the impact of substance use disorder on birth 

2 outcomes.’’. 

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

4 this section shall apply to items and services furnished on 

5 or after January 1, 2021. 

6 SEC. 2. GRANT PROGRAM TO EXPAND YOUTH ADDICTION 

7 TREATMENT FACILITIES UNDER MEDICAID 

8 AND CHIP. 

9 (a) ESTABLISHMENT.— 

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

11 a program under which the Secretary shall award 

12 grants to States for the purpose of expanding the in13 frastructure and treatment capabilities, including 

14 augmenting equipment and bed capacity, of eligible 

15 youth addiction treatment facilities that provide ad16 diction treatment services to Medicaid or CHIP 

17 beneficiaries who have not attained the age of 21 

18 and are in communities with high numbers of medi19 cally underserved populations of at-risk youth. 

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

21 under this section may be used to expand the infra22 structure and treatment capabilities of an existing 

23 facility (including through construction) but shall 

24 not be used for the construction of any new facility 


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1 or for the provision of medical assistance or child 

2 health assistance under Medicaid or CHIP. 

3 (3) TIMETABLE FOR IMPLEMENTATION; DURA4 TION.— 

5 (A) IMPLEMENTATION.—Not later than 1 

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

7 the Secretary shall award grants under the 

8 grant program. 

9 (B) DURATION.—The Secretary shall 

10 award grants under the grant program for a 

11 period not to exceed 5 years. 

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

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

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

15 an application that includes— 

16 (1) detailed information on the types of addi17 tional infrastructure and treatment capacity of eligi18 ble youth addiction treatment facilities that the 

19 State proposes to fund under the grant program; 

20 (2) a description of the communities in which 

21 the eligible youth addiction treatment facilities fund22 ed under the grant program operate; 

23 (3) an assurance that the eligible youth addic24 tion treatment facilities that the State proposes to 

25 fund under the grant program shall give priority to 


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1 providing addiction treatment services to Medicaid 

2 or CHIP beneficiaries who have not attained the age 

3 of 21 and are in communities with high numbers of 

4 medically underserved populations of at-risk youth; 

5 and 

6 (4) such additional information and assurances 

7 as the Secretary shall require. 

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

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

10 shall be used for making payments to eligible youth addic11 tion treatment facilities that are located in rural areas or 

12 that target the provision of addiction treatment services 

13 to Medicaid or CHIP beneficiaries who have not attained 

14 the age of 21 and reside in rural areas. 

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

16 (1) ADDICTION TREATMENT SERVICES.—The 

17 term ‘‘addiction treatment services’’ means services 

18 provided to an individual for the purpose of treating 

19 a substance use disorder. 

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

21 State children’s health insurance program estab22 lished under title XXI of the Social Security Act (42 

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

24 (3) ELIGIBLE YOUTH ADDICTION TREATMENT

25 FACILITY.—The term ‘‘eligible youth addiction treatVerDate Sep 11 2014 23:13 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8586.IH H8586

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1 ment facility’’ means a facility that is a participating 

2 provider under the State Medicaid or CHIP pro3 grams for purposes of providing medical assistance 

4 or child health assistance to Medicaid or CHIP 

5 beneficiaries for youth addiction treatment services 

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

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

8 the medical assistance program established under 

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

10 et seq.). 

11 (5) MEDICAID OR CHIP BENEFICIARY.—The 

12 term ‘‘Medicaid or CHIP beneficiary’’ means an in13 dividual who is enrolled in the State Medicaid plan, 

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

15 waiver of either such plan. 

16 (6) MEDICALLY UNDERSERVED POPU17 LATIONS.—The term ‘‘medically underserved popu18 lations’’ has the meaning given that term in section 

19 330(b)(3) of the Public Health Service Act (42 

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

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

22 the Secretary of Health and Human Services. 

23 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

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

25 out the provisions of this section. Funds appropriated 


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1 under this subsection shall remain available until ex2 pended. 

Æ 


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