I 

114TH CONGRESS 

2D SESSION H. R. 5287 

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 

MAY 19, 2016 

Mr. FOSTER (for himself, Mrs. LAWRENCE, Ms. SEWELL of Alabama, Mr. 

RYAN of Ohio, Mr. CUMMINGS, Mr. KIND, Ms. CLARK of Massachusetts, 

Ms. NORTON, Ms. DUCKWORTH, and Mr. QUIGLEY) 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. 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 ‘‘effective’’ and inserting 

9 ‘‘(A) effective’’; and 

10 (B) by inserting ‘‘, and (B) effective Janu11 ary 1, 2018, 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’’ before the semicolon; and 

15 (2) in subsection (h)— 

16 (A) in paragraph (1), by striking ‘‘para17 graph (16) of subsection (a)’’ and inserting 

18 ‘‘subsection (a)(16)(A)’’; and 

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

20 paragraph: 

21 ‘‘(3)(A) For purposes of subsection (a)(16)(B), 

22 the term ‘residential addiction treatment facility 

23 services’ means inpatient services provided— 

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

25 treating a substance use disorder that are fur26 nished to an individual for not more than 2 


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1 consecutive periods of 30 consecutive days, pro2 vided that upon completion of the first 30-day 

3 period, the individual is assessed by the facility 

4 and determined to have progressed through the 

5 clinical continuum of care, in accordance with 

6 criteria established by the Secretary, in con7 sultation with the American Society of Addic8 tion Medicine, and requires continued medically 

9 necessary treatment and social support services 

10 to promote recovery, stable transition, and dis11 charge; and 

12 ‘‘(ii) in a facility that— 

13 ‘‘(I) does not have more than 40 beds; 

14 and 

15 ‘‘(II) is accredited for the treatment 

16 of substance use disorders by the Joint 

17 Commission on Accreditation of Healthcare 

18 Organizations, the Commission on Accredi19 tation of Rehabilitation Facilities, the 

20 Council on Accreditation, or any other na21 tionwide accrediting agency that the Sec22 retary deems appropriate. 

23 ‘‘(B) The provision of medical assistance for 

24 residential addiction treatment facility services to an 

25 individual shall not prohibit Federal financial parVerDate Sep 11 2014 18:49 May 23, 2016 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5287.IH H5287

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1 ticipation for medical assistance for items or services 

2 that are provided to the individual in or away from 

3 the residential addiction treatment facility during 

4 any 30-day period in which the individual is receiv5 ing residential addiction treatment facility services. 

6 ‘‘(C) A woman who is eligible for medical as7 sistance on the basis of being pregnant and who is 

8 furnished residential addiction treatment facility 

9 services during any 30-day period may remain eligi10 ble for, and continue to be furnished with, such serv11 ices for additional 30-day periods without regard to 

12 any eligibility limit that would otherwise apply to the 

13 woman as a result of her pregnancy ending, subject 

14 to assessment by the facility and a determination 

15 based on medical necessity related to substance use 

16 disorder and the impact of substance use disorder on 

17 birth outcomes.’’. 

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

19 this section shall apply to items and services furnished on 

20 or after January 1, 2018. 

21 SEC. 3. GRANT PROGRAM TO EXPAND YOUTH ADDICTION 

22 TREATMENT FACILITIES UNDER MEDICAID 

23 AND CHIP. 

24 (a) ESTABLISHMENT.— 


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

2 a program under which the Secretary shall award 

3 grants to States for the purpose of expanding the in4 frastructure and treatment capabilities, including 

5 augmenting equipment and bed capacity, of eligible 

6 youth addiction treatment facilities that provide ad7 diction treatment services to Medicaid or CHIP 

8 beneficiaries who have not attained the age of 21 

9 and are in communities with high numbers of medi10 cally underserved populations of at-risk youth. 

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

12 under this section may be used to expand the infra13 structure and treatment capabilities of an existing 

14 facility (including through construction) but shall 

15 not be used for the construction of any new facility 

16 or for the provision of medical assistance or child 

17 health assistance under Medicaid or CHIP. 

18 (3) TIMETABLE FOR IMPLEMENTATION; DURA19 TION.— 

20 (A) IMPLEMENTATION.—Not later than 1 

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

22 the Secretary shall award grants under the 

23 grant program. 


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1 (B) DURATION.—The Secretary shall 

2 award grants under the grant program for a 

3 period not to exceed 5 years. 

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

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

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

7 an application that includes— 

8 (1) detailed information on the types of addi9 tional infrastructure and treatment capacity of eligi10 ble youth addiction treatment facilities that the 

11 State proposes to fund under the grant program; 

12 (2) a description of the communities in which 

13 the eligible youth addiction treatment facilities fund14 ed under the grant program operate; 

15 (3) an assurance that the eligible youth addic16 tion treatment facilities that the State proposes to 

17 fund under the grant program shall give priority to 

18 providing addiction treatment services to Medicaid 

19 or CHIP beneficiaries who have not attained the age 

20 of 21 and are in communities with high numbers of 

21 medically underserved populations of at-risk youth; 

22 and 

23 (4) such additional information and assurances 

24 as the Secretary shall require. 


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

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

3 shall be used for making payments to eligible youth addic4 tion treatment facilities that are located in rural areas or 

5 that target the provision of addiction treatment services 

6 to Medicaid or CHIP beneficiaries who have not attained 

7 the age of 21 and reside in rural areas. 

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

9 (1) ADDICTION TREATMENT SERVICES.—The 

10 term ‘‘addiction treatment services’’ means services 

11 provided to an individual for the purpose of treating 

12 a substance use disorder. 

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

14 State children’s health insurance program estab15 lished under title XXI of the Social Security Act (42 

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

17 (3) ELIGIBLE YOUTH ADDICTION TREATMENT

18 FACILITY.—The term ‘‘eligible youth addiction treat19 ment facility’’ means a facility that is a participating 

20 provider under the State Medicaid or CHIP pro21 grams for purposes of providing medical assistance 

22 or child health assistance to Medicaid or CHIP 

23 beneficiaries for youth addiction treatment services 

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


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

2 the medical assistance program established under 

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

4 et seq.). 

5 (5) MEDICAID OR CHIP BENEFICIARY.—The 

6 term ‘‘Medicaid or CHIP beneficiary’’ means an in7 dividual who is enrolled in the State Medicaid plan, 

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

9 waiver of either such plan. 

10 (6) MEDICALLY UNDERSERVED POPU11 LATIONS.—The term ‘‘medically underserved popu12 lations’’ has the meaning given that term in section 

13 330(b)(3) of the Public Health Service Act (42 

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

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

16 the Secretary of Health and Human Services. 

17 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

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

19 out the provisions of this section. Funds appropriated 

20 under this subsection shall remain available until ex21 pended. 

Æ 


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