I 

115TH CONGRESS 

2D SESSION H. R. 5797 

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 

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. 

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 Delivery Act’’ or the ‘‘IMD CARE Act’’. 


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1 SEC. 2. MEDICAID STATE PLAN OPTION TO PROVIDE SERV2 ICES FOR CERTAIN INDIVIDUALS WITH 

3 OPIOID USE DISORDERS IN INSTITUTIONS 

4 FOR MENTAL DISEASES. 

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

6 1396n) is amended by adding at the end the following new 

7 subsection: 

8 ‘‘(l) STATE PLAN OPTION TO PROVIDE SERVICES

9 FOR CERTAIN INDIVIDUALS IN INSTITUTIONS FOR MEN10 TAL DISEASES.— 

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

12 quarters beginning during the period beginning Jan13 uary 1, 2019, and ending December 31, 2023, a 

14 State may elect, through a State plan amendment, 

15 to, notwithstanding section 1905(a), provide medical 

16 assistance for services furnished in institutions for 

17 mental diseases to eligible individuals with opioid use 

18 disorders, in accordance with the requirements of 

19 this subsection. 

20 ‘‘(2) PAYMENTS.— 

21 ‘‘(A) IN GENERAL.—Amounts expended 

22 under a State plan amendment under para23 graph (1) for services described in such para24 graph furnished, with respect to a 12-month pe25 riod, in an institution for mental diseases to an 

26 eligible individual with an opioid use disorder 


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1 shall be treated as medical assistance for which 

2 payment is made under section 1903(a) but 

3 only to the extent that, subject to subparagraph 

4 (B), such services are furnished for not more 

5 than a period of 30 days (whether or not con6 secutive) during such 12-month period. 

7 ‘‘(B) LIMITATIONS.—Payment for expendi8 tures described in subparagraph (A), with re9 spect to services described in paragraph (1) fur10 nished in an institution for mental diseases to 

11 an eligible individual with an opioid use dis12 order during a 12-month period, shall not be 

13 made under section 1903(a) with respect to 

14 such services furnished during any period ex15 ceeding 30 consecutive days during such 12- 

16 month period, unless the State requires under 

17 the State plan amendment continued medically 

18 necessary treatment during the entire period for 

19 which such services are furnished and for which 

20 payment is made pursuant to this paragraph in 

21 order to promote recovery, stable transition to 

22 ongoing treatment, and discharge. 

23 ‘‘(C) CLARIFICATION.—Payment made 

24 under this paragraph for expenditures under a 

25 State plan amendment under this subsection 


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1 with respect to services described in paragraph 

2 (1) furnished to an eligible individual with an 

3 opioid use disorder shall not affect payment 

4 that would otherwise be made under section 

5 1903(a) for expenditures under the State plan 

6 (or waiver of such plan) for medical assistance 

7 for such individual. 

8 ‘‘(3) INFORMATION REQUIRED IN STATE PLAN

9 AMENDMENT.— 

10 ‘‘(A) IN GENERAL.—A State electing to 

11 provide medical assistance pursuant to this sub12 section shall include with the submission of the 

13 State plan amendment under paragraph (1) to 

14 the Secretary— 

15 ‘‘(i) a plan on how the State will im16 prove access to outpatient care during the 

17 period of the State plan amendment, in18 cluding a description of— 

19 ‘‘(I) the process by which eligible 

20 individuals with opioid use disorders 

21 will make the transition from receiv22 ing inpatient services in an institution 

23 for mental diseases to appropriate 

24 outpatient care; and 


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1 ‘‘(II) the process the State will 

2 undertake to ensure individuals with 

3 opioid use disorder are provided care 

4 in the most integrated setting appro5 priate to the needs of the individuals; 

6 and 

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

8 plan amendment ensures an appropriate 

9 clinical screening of eligible individuals 

10 with an opioid use disorder, including as11 sessments to determine level of care and 

12 length of stay recommendations based 

13 upon the multidimensional assessment cri14 teria of the American Society of Addiction 

15 Medicine. 

16 ‘‘(B) REPORT.—Not later than one year 

17 after the date of the termination of a State plan 

18 amendment under this subsection, the State 

19 shall submit to the Secretary a report that in20 cludes at least— 

21 ‘‘(i) the number of eligible individuals 

22 with opioid use disorders who received 

23 services pursuant to such plan; 


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1 ‘‘(ii) the length of the stay of each 

2 such individual in an institution for mental 

3 diseases; and 

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

5 including medication-assisted treatment, 

6 each such individual received after being 

7 discharged from such institution. 

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

9 ‘‘(A) ELIGIBLE INDIVIDUAL WITH AN

10 OPIOID USE DISORDER.—The term ‘eligible in11 dividual with an opioid use disorder’ means an 

12 individual who— 

13 ‘‘(i) with respect to a State, is en14 rolled for medical assistance under the 

15 State plan (or a waiver of such plan); 

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

17 ‘‘(iii) has not attained 65 years of 

18 age; and 

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

20 one opioid use disorder. 

21 ‘‘(B) INSTITUTION FOR MENTAL DIS22 EASES.—The term ‘institution for mental dis23 eases’ has the meaning given such term in sec24 tion 1905(i). 


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1 ‘‘(C) OPIOID PRESCRIPTION PAIN RE2 LIEVER.—The term ‘opioid prescription pain re3 liever’ includes hydrocodone products, 

4 oxycodone products, tramadol products, codeine 

5 products, morphine products, fentanyl products, 

6 buprenorphine products, oxymorphone products, 

7 meperidine products, hydromorphone products, 

8 methadone, and any other prescription pain re9 liever identified by the Assistant Secretary for 

10 Mental Health and Substance Use. 

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

12 ‘opioid use disorder’ means a disorder that 

13 meets the criteria of the Diagnostic and Statis14 tical Manual of Mental Disorders, 4th Edition 

15 (or a successor edition), for heroin use disorder 

16 or pain reliever use disorder (including with re17 spect to opioid prescription pain relievers).’’. 

Æ 


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