I 

115TH CONGRESS 

2D SESSION H. R. 5800 

To require the Medicaid and CHIP Payment and Access Commission to 

conduct an exploratory study and report on requirements applicable to 

and practices of institutions for mental diseases under the Medicaid 

program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2018 

Mr. UPTON (for himself and Mrs. MIMI WALTERS of California) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce 

A BILL 

To require the Medicaid and CHIP Payment and Access 

Commission to conduct an exploratory study and report 

on requirements applicable to and practices of institutions for mental diseases 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 ‘‘Medicaid Institutes 

5 for Mental Disease Are Decisive in Delivering Inpatient 

6 Treatment for Individuals but Opportunities for Needed 

7 Access are Limited without Information Needed about FaVerDate Sep 11 2014 01:04 May 31, 2018 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5800.IH H5800

pbinns on DSK79D2C42PROD with BILLS
2 

•HR 5800 IH

1 cility Obligations Act’’ or the ‘‘Medicaid IMD ADDI2 TIONAL INFO Act’’. 

3 SEC. 2. MACPAC EXPLORATORY STUDY AND REPORT ON IN4 STITUTIONS FOR MENTAL DISEASES RE5 QUIREMENTS AND PRACTICES UNDER MED6 ICAID. 

7 (a) IN GENERAL.—Not later than January 1, 2020, 

8 the Medicaid and CHIP Payment and Access Commission 

9 established under section 1900 of the Social Security Act 

10 (42 U.S.C. 1396) shall conduct an exploratory study, 

11 using data from a representative sample of States, and 

12 submit to Congress a report on at least the following infor13 mation, with respect to services furnished to individuals 

14 enrolled under State plans under the Medicaid program 

15 under title XIX of such Act (42 U.S.C. 1396 et seq.) (or 

16 waivers of such plans) who are patients in institutions for 

17 mental diseases and for which payment is made through 

18 fee-for-service or managed care arrangements under such 

19 State plans (or waivers): 

20 (1) A description of such institutions for mental 

21 diseases in each such State, including at a min22 imum— 

23 (A) the number of such institutions in the 

24 State; 


pbinns on DSK79D2C42PROD with BILLS
3 

•HR 5800 IH

1 (B) the facility type of such institutions in 

2 the State; and 

3 (C) any coverage limitations under each 

4 such State plan (or waiver) on scope, duration, 

5 or frequency of such services. 

6 (2) With respect to each such institution for 

7 mental diseases in each such State, a description 

8 of— 

9 (A) such services provided at such institu10 tion; 

11 (B) the process, including any timeframe, 

12 used by such institution to clinically assess and 

13 reassess such individuals; and 

14 (C) the discharge process used by such in15 stitution, including any care continuum of rel16 evant services or facilities provided or used in 

17 such process. 

18 (3) A description of— 

19 (A) any Federal waiver that each such 

20 State has for such institutions and the Federal 

21 statutory authority for such waiver; and 

22 (B) any other Medicaid funding sources 

23 used by each such State for funding such insti24 tutions, such as supplemental payments. 


pbinns on DSK79D2C42PROD with BILLS
4 

•HR 5800 IH

1 (4) A summary of State requirements (such as 

2 certification, licensure, and accreditation) applied by 

3 each such State to such institutions in order for 

4 such institutions to receive payment under the State 

5 plan (or waiver) and how each such State deter6 mines if such requirements have been met. 

7 (5) A summary of State standards (such as 

8 quality standards, clinical standards, and facility 

9 standards) that such institutions must meet to re10 ceive payment under such State plans (or waivers) 

11 and how each such State determines if such stand12 ards have been met. 

13 (6) Recommendations for actions by Congress 

14 and the Centers for Medicare & Medicaid Services. 

15 such as how State Medicaid programs may improve 

16 care and improve standards and including a rec17 ommendation for how the Centers for Medicare & 

18 Medicaid Services can improve data collection from 

19 such programs to address any gaps in information. 

20 (b) STAKEHOLDER INPUT.—In carrying out sub21 section (a), the Medicaid and CHIP Payment and Access 

22 Commission shall seek input from State Medicaid direc23 tors and stakeholders, including at a minimum the Sub24 stance Abuse and Mental Health Services Administration, 

25 Centers for Medicare & Medicaid Services, State Medicaid 


pbinns on DSK79D2C42PROD with BILLS
5 

•HR 5800 IH

1 officials, State mental health authorities, Medicaid bene2 ficiary advocates, health care providers, and Medicaid 

3 managed care organizations. 

4 (c) DEFINITIONS.—In this section: 

5 (1) REPRESENTATIVE SAMPLE OF STATES.— 

6 The term ‘‘representative sample of States’’ means 

7 a non-probability sample in which at least two 

8 States are selected based on the knowledge and pro9 fessional judgment of the selector. 

10 (2) STATE.—The term ‘‘State’’ means each of 

11 the 50 States, the District of Columbia, and any 

12 commonwealth or territory of the United States. 

13 (3) INSTITUTION FOR MENTAL DISEASES.—The 

14 term ‘‘institution for mental diseases’’ has the mean15 ing given such term in section 435.1009 of title 42, 

16 Code of Federal Regulations, or any successor regu17 lation. 

Æ 


pbinns on DSK79D2C42PROD with BILLS