I 

115TH CONGRESS 

2D SESSION H. R. 5789 

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

coverage protections for pregnant and post-partum women while receiving 

inpatient treatment for a substance use disorder, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2018 

Mr. FOSTER (for himself and Mr. GUTHRIE) 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 Medicaid coverage protections for pregnant and postpartum women while receiving inpatient treatment for 

a substance use disorder, 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, 


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1 SECTION 1. MEDICAID COVERAGE PROTECTION FOR PREG2 NANT AND POST-PARTUM WOMEN WHILE RE3 CEIVING INPATIENT TREATMENT FOR A SUB4 STANCE USE DISORDER; STATE OPTION FOR 

5 COVERAGE OF ROOM AND BOARD FOR 

6 CERATIN INFANTS WITH NEONATAL ABSTI7 NENCE SYNDROME. 

8 (a) MEDICAID COVERAGE FOR PREGNANT AND POST9 PARTUM WOMEN WHILE RECEIVING INPATIENT TREAT10 MENT FOR A SUBSTANCE USE DISORDER.— 

11 (1) IN GENERAL.—Section 1905(a) of the So12 cial Security Act (42 U.S.C. 1396d(a)) is amended 

13 by adding at the end the following new sentence: ‘‘In 

14 the case of a woman who is eligible for medical as15 sistance on the basis of being pregnant (including 

16 through the end of the month in which the 60-day 

17 period beginning on the last day of her pregnancy 

18 ends) (or is eligible for medical assistance on an19 other basis and is pregnant or was pregnant during 

20 the previous one-year period (in this sentence, such 

21 a woman shall be referred to as an ‘other pathway 

22 eligible pregnant woman’)), who is a patient in an 

23 institution for mental diseases for purposes of re24 ceiving treatment for a substance use disorder, and 

25 who was enrolled for medical assistance under the 

26 State plan immediately before becoming a patient in 


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1 an institution for mental diseases or who becomes el2 igible to enroll for such medical assistance while 

3 such a patient, the exclusion specified in the subdivi4 sion (B) following paragraph (29) of the first sen5 tence shall not be construed as prohibiting Federal 

6 financial participation for medical assistance for 

7 items or services that are provided to the woman 

8 outside of the institution during, in the case of a 

9 woman who is eligible for medical assistance on the 

10 basis of being pregnant, the period of such eligibility 

11 on such basis and through the end of the month in 

12 which the one-year period beginning on the last day 

13 of her pregnancy ends (and, in the case of an other 

14 pathway eligible pregnant woman, the period during 

15 which the woman satisfies the description of being 

16 such an other pathway eligible pregnant woman, in17 cluding through the end of the month in which the 

18 one-year period beginning on the last day of her 

19 pregnancy ends) to the extent such items or services 

20 would be treated as medical assistance for such 

21 woman during such period if such woman were not 

22 a patient in the institution.’’. 

23 (2) EFFECTIVE DATE.— 

24 (A) IN GENERAL.—Except as provided in 

25 subparagraph (B), the amendment made by 


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1 paragraph (1) shall take effect with respect to 

2 medical assistance provided on or after January 

3 1, 2019. 

4 (B) EXCEPTION IF STATE LEGISLATION

5 REQUIRED.—In the case of a State plan under 

6 title XIX of the Social Security Act which the 

7 Secretary of Health and Human Services deter8 mines requires State legislation (other than leg9 islation appropriating funds) in order for the 

10 plan to meet the additional requirements im11 posed by the amendment made by paragraph 

12 (1), the State plan shall not be regarded as fail13 ing to comply with the requirements of such 

14 title solely on the basis of its failure to meet 

15 these additional requirements before the first 

16 day of the first calendar quarter beginning after 

17 the close of the first regular session of the 

18 State legislature that begins after the date of 

19 the enactment of this Act. For purposes of the 

20 previous sentence, in the case of a State that 

21 has a 2-year legislative session, each year of 

22 such session shall be deemed to be a separate 

23 regular session of the State legislature. 

24 (b) MEDICAID STATE PLAN OPTION TO ENTER INTO

25 PROVIDER AGREEMENTS WITH RESIDENTIAL PEDIATRIC


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1 RECOVERY CENTERS.—Section 1902 of the Social Secu2 rity Act (42 U.S.C. 1396a) is amended— 

3 (1) in subsection (a)— 

4 (A) in paragraph (82), by striking ‘‘and’’ 

5 at the end; 

6 (B) in paragraph (83), by striking the pe7 riod at the end and inserting ‘‘; and’’; and 

8 (C) by inserting after paragraph (83) the 

9 following new paragraph: 

10 ‘‘(84) at the option of the State and in accord11 ance with paragraph (2) of subsection (nn), begin12 ning January 1, 2019, for making medical assist13 ance available on an inpatient or outpatient basis at 

14 a residential pediatric recovery center (as defined in 

15 paragraph (1) of such subsection) for infants who 

16 are under 1 year of age with neonatal abstinence 

17 syndrome.’’; and 

18 (2) by adding at the end the following new sub19 section: 

20 ‘‘(nn) RESIDENTIAL PEDIATRIC RECOVERY CEN21 TER.— 

22 ‘‘(1) DEFINITION.—For purposes of subsection 

23 (a)(84), the term ‘residential pediatric recovery cen24 ter’ means a center or facility that— 


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1 ‘‘(A) provides comprehensive treatment to 

2 infants who are under 1 year of age with a di3 agnosis of neonatal abstinence syndrome, which 

4 includes at least access to early and periodic 

5 screening, diagnostic and treatment; physician 

6 and nursing services; supportive counseling; 

7 comprehensive evaluation and assessment and 

8 service planning by State licensed counselors or 

9 social workers; targeted case management serv10 ices by State licensed or educated professionals; 

11 education and supportive counseling and case 

12 management of family members of such infants; 

13 room and board costs for such infants; and fa14 cilitation of arrangements within such facilities 

15 whereby such infants reside with their mother 

16 when applicable; and 

17 ‘‘(B) provides treatment services in accord18 ance with guidelines issued by the American 

19 Academy of Pediatrics and American College of 

20 Obstetricians and Gynecologists relating to ma21 ternal care and infant care with respect to neo22 natal abstinence syndrome. 

23 ‘‘(2) CLARIFICATION.—Nothing in subsection 

24 (a)(84) shall be construed as including as medical 

25 assistance room and board services for any indiVerDate Sep 11 2014 22:00 May 30, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5789.IH H5789

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1 vidual other than an infant described in such sub2 section.’’. 

3 (c) GUIDANCE.—Not later than one year after the 

4 date of the enactment of this Act, the Secretary of Health 

5 and Human Services shall issue guidance to improve care 

6 for infants with neonatal abstinence syndrome and their 

7 mothers. Such guidance shall include— 

8 (1) the types of services, including post-dis9 charge services and parenting supports, for mothers 

10 and fathers of babies with neonatal abstinence syn11 drome that States may cover under the Medicaid 

12 program under title XIX of the Social Security Act; 

13 (2) best practices from States with respect to 

14 innovative or evidenced-based payment models that 

15 focus on prevention, screening, treatment, plans of 

16 safe care, and post-discharge services for mothers 

17 and fathers with substance use disorders and babies 

18 with neonatal abstinence syndrome that improve 

19 care and clinical outcomes; 

20 (3) recommendations for States on available fi21 nancing options under the Medicaid program under 

22 title XIX of such Act and under the Children’s 

23 Health Insurance Program under title XXI of such 

24 Act for Children’s Health Insurance Program 

25 Health Services Initiative funds for home visiting 


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1 services for parents with substance use disorders 

2 and infants with neonatal abstinence syndrome; and 

3 (4) guidance and technical assistance to State 

4 Medicaid agencies regarding additional flexibilities 

5 and incentives related to screening, prevention, and 

6 post-discharge services, including parenting sup7 ports, under contracts with Medicaid managed care 

8 organizations. 

9 (d) GAO STUDY.—Not later than one year after the 

10 date of the enactment of this Act, the Comptroller General 

11 of the United States shall conduct a study, and submit 

12 to Congress a report, addressing gaps in coverage for 

13 pregnant women with substance use disorder under the 

14 Medicaid program under title XIX of the Social Security 

15 Act, and gaps in coverage for postpartum women with sub16 stance use disorder who had coverage during their preg17 nancy under the Medicaid program under such title. 

Æ 


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