I 

114TH CONGRESS 

2D SESSION H. R. 5331 

To amend title XIX of the Social Security Act to provide for behavioral 

health infrastructure improvements under the Medicaid program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 25, 2016 

Mr. BEN RAY LUJA ́N of New Mexico (for himself, Mr. KENNEDY, Ms. 

MICHELLE LUJAN GRISHAM of New Mexico, Mrs. NAPOLITANO, and Ms. 

CLARKE of New York) 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 

for behavioral health infrastructure improvements under 

the Medicaid program. 

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 ‘‘Behavioral Health In5 frastructure Improvement Act’’. 

6 SEC. 2. BEHAVIORAL HEALTH INFRASTRUCTURE IMPROVE7 MENTS. 

8 (a) ENHANCED FMAP FOR INFRASTRUCTURE IM9 PROVEMENTS.— 


SSpencer on DSK4SPTVN1PROD with BILLS
2 

•HR 5331 IH

1 (1) IN GENERAL.—Section 1903(a)(3) of the 

2 Social Security Act (42 U.S.C. 1396b(a)(3)) is 

3 amended by adding at the end the following: 

4 ‘‘(I) for calendar quarters beginning during the 

5 5-year period beginning on or after the date of the 

6 enactment of this subparagraph, 90 percent of the 

7 sums expended during the quarter as are attrib8 utable to the design, development, implementation, 

9 or improvement of infrastructure and systems car10 ried out for purposes of, with respect to behavioral 

11 health services and substance abuse treatment serv12 ices, providing for enhanced data collection and re13 porting to the Secretary and tracking and ensuring 

14 access to such services by individuals eligible to re15 ceive medical assistance under the State plan under 

16 this title (or under a waiver of the plan); plus’’. 

17 (2) REPORTS.—For each year during which 

18 subparagraph (I) of section 1903(a)(3) of the Social 

19 Security Act (42 U.S.C. 1396b(a)(3)), as added by 

20 paragraph (1), applies, the Secretary of Health and 

21 Human Services shall submit to Congress a report 

22 on the affects of such subparagraph, including best 

23 practices for States receiving reimbursement for ex24 penditures under such subparagraph and the effec25 tiveness of such expenditures made by such States. 


SSpencer on DSK4SPTVN1PROD with BILLS
3 

•HR 5331 IH

1 (b) BEHAVIORAL HEALTH INFORMATION FOR MED2 ICAID BENEFICIARIES.—Title XIX of the Social Security 

3 Act (42 U.S.C. 1396 et seq.) is amended by adding at 

4 the end the following: 

5 ‘‘SEC. 1947. BEHAVIORAL HEALTH INFORMATION FOR MED6 ICAID BENEFICIARIES. 

7 ‘‘(a) IN GENERAL.—The Secretary shall award 

8 grants to States to enable such States to establish, ex9 pand, or provide support for— 

10 ‘‘(1) offices of behavioral health assistance that 

11 provide assistance to individuals eligible to receive 

12 medical assistance under this title; or 

13 ‘‘(2) behavioral health ombudsman programs 

14 that are independent of any State agency, 

15 in a manner that ensures coordination with other relevant 

16 programs of the State for assisting individuals receiving 

17 medical assistance under this title who have a broad range 

18 of health concerns, including relating to behavioral health 

19 and substance abuse treatment. 

20 ‘‘(b) ELIGIBILITY.— 

21 ‘‘(1) IN GENERAL.—To be eligible to receive a 

22 grant, a State shall designate an independent office 

23 of behavioral health assistance described in para24 graph (1) of subsection (a), or an ombudsman de25 scribed in paragraph (2) of such subsection, that— 


SSpencer on DSK4SPTVN1PROD with BILLS
4 

•HR 5331 IH

1 ‘‘(A) has specialized knowledge of behav2 ioral health and substance abuse and experience 

3 resolving inquiries and complaints described in 

4 subparagraph (B); and 

5 ‘‘(B) directly or in coordination with State 

6 Medicaid agencies, departments of insurance, 

7 and consumer assistance organizations, receives 

8 and responds to inquiries and complaints con9 cerning access to behavioral health services and 

10 substance abuse treatment services. 

11 ‘‘(2) CRITERIA.—A State that receives a grant 

12 under this section shall comply with criteria estab13 lished by the Secretary for carrying out activities 

14 under such grant. 

15 ‘‘(3) ADDITIONAL REQUIREMENT.—A State 

16 that receives a grant under this section, with respect 

17 to an office described in subsection (a)(1) or a be18 havioral health ombudsman program described in 

19 subsection (a)(2), shall coordinate such office or pro20 gram with other programs of such State that serve 

21 individuals receiving medical assistance under this 

22 title, such as a consumer assistance program, long23 term care ombudsman program, aging and disability 

24 resource center, a Medicaid managed care ombudsVerDate Sep 11 2014 00:03 May 28, 2016 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5331.IH H5331

SSpencer on DSK4SPTVN1PROD with BILLS
5 

•HR 5331 IH

1 man program, or a mental health ombudsman pro2 gram. 

3 ‘‘(4) CLARIFICATION.—A grant provided to a 

4 State under subsection (a) may be used by the State 

5 to expand a program of such State that services in6 dividuals receiving medical assistance, such as a pro7 gram described in paragraph (3), to include an office 

8 or program described in subsection (a) or a division 

9 that would provide for the functions that such an of10 fice or program would otherwise provide. 

11 ‘‘(c) DUTIES.—The office of behavioral health assist12 ance described in paragraph (1) of subsection (a), or an 

13 ombudsman referred to in paragraph (2) of such sub14 section shall— 

15 ‘‘(1) collect, track, and quantify problems and 

16 inquiries encountered by individuals eligible for med17 ical assistance under this title with respect to access 

18 to behavioral health services and substance abuse 

19 treatment services; 

20 ‘‘(2) educate such individuals on the rights and 

21 responsibilities of such individuals with respect to 

22 such access and assist such individuals in the en23 forcement of such rights with respects to such ac24 cess; and 


SSpencer on DSK4SPTVN1PROD with BILLS
6 

•HR 5331 IH

1 ‘‘(3) assist such individuals with accessing be2 havioral health services and substance abuse treat3 ment services by providing information, referral, 

4 care coordination, and other assistance. 

5 ‘‘(d) DATA COLLECTION.—As a condition of receiving 

6 a grant under subsection (a), an office of behavioral health 

7 assistance described in paragraph (1) of subsection (a), 

8 or an ombudsman described in paragraph (2) of such sub9 section shall be required to collect and report data to the 

10 Secretary, State legislature, relevant State agencies, in11 cluding the departments of insurance and the State attor12 ney general, on the types of problems and inquiries en13 countered by individuals with respect to access to behav14 ioral health services and substance abuse treatment serv15 ices. 

16 ‘‘(e) REPORT TO CONGRESS.—Not later than two 

17 years after the date of the enactment of this section, the 

18 Secretary shall submit to Congress a report on the data 

19 collected under subsection (d). 

20 ‘‘(f) FUNDING.— 

21 ‘‘(1) INITIAL FUNDING.—There is hereby ap22 propriated to the Secretary, out of any funds in the 

23 Treasury not otherwise appropriated, $30,000,000 

24 for the first fiscal year for which this section applies 


SSpencer on DSK4SPTVN1PROD with BILLS
7 

•HR 5331 IH

1 to carry out this section. Such amount shall remain 

2 available without fiscal year limitation. 

3 ‘‘(2) AUTHORIZATION FOR SUBSEQUENT

4 YEARS.—There is authorized to be appropriated to 

5 the Secretary for each fiscal year following the fiscal 

6 year described in paragraph (1), such sums as may 

7 be necessary to carry out this section. 

8 ‘‘(g) STATE MEDICAID AGENCY.—In this section, the 

9 term ‘State Medicaid agency’ means the State agency ad10 ministering the State plan under this title (or a waiver 

11 of such plan).’’. 

Æ 


SSpencer on DSK4SPTVN1PROD with BILLS