IB 

Union Calendar No. 558 

115TH CONGRESS 

2D SESSION H. R. 5797 

[Report No. 115–723] 

To amend title XIX of the Social Security Act to allow States to provide 

under Medicaid services for certain individuals with opioid use disorders 

in institutions for mental diseases. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2018 

Mrs. MIMI WALTERS of California (for herself, Mr. KNIGHT, and Mr. GUTHRIE) introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

JUNE 12, 2018 

Additional sponsors: Mrs. BLACKBURN, Mr. WALDEN, and Mr. HILL

JUNE 12, 2018 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on May 15, 2018] 


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•HR 5797 RH

A BILL 

To amend title XIX of the Social Security Act to allow 

States to provide under Medicaid services for certain 

individuals with opioid use disorders in institutions for 

mental diseases. 


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•HR 5797 RH

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 ‘‘Individuals in Medicaid 

5 Deserve Care that is Appropriate and Responsible in its 

6 Execution Act’’ or the ‘‘IMD CARE Act’’. 

7 SEC. 2. MEDICAID STATE PLAN OPTION TO PROVIDE SERV8 ICES FOR CERTAIN INDIVIDUALS WITH 

9 OPIOID USE DISORDERS IN INSTITUTIONS 

10 FOR MENTAL DISEASES. 

11 Section 1915 of the Social Security Act (42 U.S.C. 

12 1396n) is amended by adding at the end the following new 

13 subsection: 

14 ‘‘(l) STATE PLAN OPTION TO PROVIDE SERVICES FOR

15 CERTAIN INDIVIDUALS IN INSTITUTIONS FOR MENTAL DIS16 EASES.— 

17 ‘‘(1) IN GENERAL.—With respect to calendar 

18 quarters beginning during the period beginning Janu19 ary 1, 2019, and ending December 31, 2023, a State 

20 may elect, through a State plan amendment, to, not21 withstanding section 1905(a), provide medical assist22 ance for services furnished in institutions for mental 

23 diseases and for other medically necessary services 

24 furnished to eligible individuals with opioid use disVerDate Sep 11 2014 22:25 Jun 12, 2018 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H5797.RH H5797

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1 orders, in accordance with the requirements of this 

2 subsection. 

3 ‘‘(2) PAYMENTS.— 

4 ‘‘(A) IN GENERAL.—Amounts expended 

5 under a State plan amendment under paragraph 

6 (1) for services described in such paragraph fur7 nished, with respect to a 12-month period, to an 

8 eligible individual with an opioid use disorder 

9 who is a patient in an institution for mental 

10 diseases shall be treated as medical assistance for 

11 which payment is made under section 1903(a) 

12 but only to the extent that such services are fur13 nished for not more than a period of 30 days 

14 (whether or not consecutive) during such 12- 

15 month period. 

16 ‘‘(B) CLARIFICATION.—Payment made 

17 under this paragraph for expenditures under a 

18 State plan amendment under this subsection 

19 with respect to services described in paragraph 

20 (1) furnished to an eligible individual with an 

21 opioid use disorder shall not affect payment that 

22 would otherwise be made under section 1903(a) 

23 for expenditures under the State plan (or waiver 

24 of such plan) for medical assistance for such in25 dividual. 


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1 ‘‘(3) INFORMATION REQUIRED IN STATE PLAN

2 AMENDMENT.— 

3 ‘‘(A) IN GENERAL.—A State electing to pro4 vide medical assistance pursuant to this sub5 section shall include with the submission of the 

6 State plan amendment under paragraph (1) to 

7 the Secretary— 

8 ‘‘(i) a plan on how the State will im9 prove access to outpatient care during the 

10 period of the State plan amendment, in11 cluding a description of— 

12 ‘‘(I) the process by which eligible 

13 individuals with opioid use disorders 

14 will make the transition from receiving 

15 inpatient services in an institution for 

16 mental diseases to appropriate out17 patient care; and 

18 ‘‘(II) the process the State will 

19 undertake to ensure individuals with 

20 opioid use disorder are provided care 

21 in the most integrated setting appro22 priate to the needs of the individuals; 

23 and 

24 ‘‘(ii) a description of how the State 

25 plan amendment ensures an appropriate 


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1 clinical screening of eligible individuals 

2 with an opioid use disorder, including as3 sessments to determine level of care and 

4 length of stay recommendations based upon 

5 the multidimensional assessment criteria of 

6 the American Society of Addiction Medi7 cine. 

8 ‘‘(B) REPORT.—Not later than the sooner of 

9 December 31, 2024, or one year after the date of 

10 the termination of a State plan amendment 

11 under this subsection, the State shall submit to 

12 the Secretary a report that includes at least— 

13 ‘‘(i) the number of eligible individuals 

14 with opioid use disorders who received serv15 ices pursuant to such State plan amend16 ment; 

17 ‘‘(ii) the length of the stay of each such 

18 individual in an institution for mental dis19 eases; and 

20 ‘‘(iii) the type of outpatient treatment, 

21 including medication-assisted treatment, 

22 each such individual received after being 

23 discharged from such institution. 

24 ‘‘(4) DEFINITIONS.—In this subsection: 


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1 ‘‘(A) ELIGIBLE INDIVIDUAL WITH AN OPIOID

2 USE DISORDER.—The term ‘eligible individual 

3 with an opioid use disorder’ means an indi4 vidual who— 

5 ‘‘(i) with respect to a State, is enrolled 

6 for medical assistance under the State plan 

7 (or a waiver of such plan); 

8 ‘‘(ii) is at least 21 years of age; 

9 ‘‘(iii) has not attained 65 years of age; 

10 and 

11 ‘‘(iv) has been diagnosed with at least 

12 one opioid use disorder. 

13 ‘‘(B) INSTITUTION FOR MENTAL DIS14 EASES.—The term ‘institution for mental dis15 eases’ has the meaning given such term in sec16 tion 1905(i). 

17 ‘‘(C) OPIOID PRESCRIPTION PAIN RE18 LIEVER.—The term ‘opioid prescription pain re19 liever’ includes hydrocodone products, oxycodone 

20 products, tramadol products, codeine products, 

21 morphine products, fentanyl products, 

22 buprenorphine products, oxymorphone products, 

23 meperidine products, hydromorphone products, 

24 methadone, and any other prescription pain reVerDate Sep 11 2014 22:25 Jun 12, 2018 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H5797.RH H5797

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1 liever identified by the Assistant Secretary for 

2 Mental Health and Substance Use. 

3 ‘‘(D) OPIOID USE DISORDER.—The term 

4 ‘opioid use disorder’ means a disorder that meets 

5 the criteria of the Diagnostic and Statistical 

6 Manual of Mental Disorders, 4th Edition (or a 

7 successor edition), for heroin use disorder or 

8 pain reliever use disorder (including with respect 

9 to opioid prescription pain relievers). 

10 ‘‘(E) OTHER MEDICALLY NECESSARY SERV11 ICES.—The term ‘other medically necessary serv12 ices’ means, with respect to an eligible indi13 vidual with an opioid use disorder who is a pa14 tient in an institution for mental diseases, items 

15 and services that are provided to such individual 

16 outside of such institution to the extent that such 

17 items and services would be treated as medical 

18 assistance for such individual if such individual 

19 were not a patient in such institution.’’. 


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Union Calendar No. 558 

115TH CONGRESS 

2D SESSION H. R. 5797 

[Report No. 115–723] 

A BILL 

To amend title XIX of the Social Security Act to 

in institutions for mental diseases. for certain individuals with opioid use disorders allow States to provide under Medicaid services 

JUNE 12, 2018 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


sradovich on DSK3GMQ082PROD with BILLS