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Union Calendar No. 562 

115TH CONGRESS 

2D SESSION H. R. 5810 

[Report No. 115–727] 

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

of the enhanced FMAP for certain Medicaid health homes for individuals 

with substance use disorders. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2018 

Mr. LANCE (for himself, Mr. WELCH, and Mr. ROTHFUS) introduced the 

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

JUNE 12, 2018 

Additional sponsors: Mr. WALDEN and Mrs. BLACKBURN

JUNE 12, 2018 

Reported with amendments, 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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A BILL 

To amend title XIX of the Social Security Act to provide 

for an extension of the enhanced FMAP for certain 

Medicaid health homes for individuals with substance 

use disorders. 


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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 Health Homes 

5 for Opioid-Use-Disorder Medicaid Enrollees Encouraged 

6 Act’’ or the ‘‘Medicaid Health HOME Act’’. 

7 SEC. 2. EXTENSION OF ENHANCED FMAP FOR CERTAIN 

8 HEALTH HOMES FOR INDIVIDUALS WITH SUB9 STANCE USE DISORDERS. 

10 Section 1945 of the Social Security Act (42 U.S.C. 

11 1396w–4) is amended— 

12 (1) in subsection (c)— 

13 (A) in paragraph (1), by inserting ‘‘subject 

14 to paragraph (4),’’ after ‘‘except that,’’; and 

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

16 paragraph: 

17 ‘‘(4) SPECIAL RULE RELATING TO SUBSTANCE

18 USE DISORDER HEALTH HOMES.— 

19 ‘‘(A) IN GENERAL.—In the case of a State 

20 with an SUD-focused State plan amendment ap21 proved by the Secretary on or after October 1, 

22 2018, the Secretary may, at the request of the 

23 State, extend the application of the Federal med24 ical assistance percentage described in para25 graph (1) to payments for the provision of health 


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1 home services to SUD-eligible individuals under 

2 such State plan amendment, in addition to the 

3 first 8 fiscal year quarters the State plan amend4 ment is in effect, for the subsequent 2 fiscal year 

5 quarters that the State plan amendment is in ef6 fect. Nothing in this section shall be construed as 

7 prohibiting a State with a State plan amend8 ment that is approved under this section and 

9 that is not an SUD-focused State plan amend10 ment from additionally having approved on or 

11 after such date an SUD-focused State plan 

12 amendment under this section, including for 

13 purposes of application of this paragraph. 

14 ‘‘(B) REPORT REQUIREMENTS.—In the case 

15 of a State with an SUD-focused State plan 

16 amendment for which the application of the Fed17 eral medical assistance percentage has been ex18 tended under subparagraph (A), such State shall, 

19 at the end of the period of such State plan 

20 amendment, submit to the Secretary a report on 

21 the following, with respect to SUD-eligible indi22 viduals provided health home services under such 

23 State plan amendment: 

24 ‘‘(i) The quality of health care pro25 vided to such individuals, with a focus on 


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1 outcomes relevant to the recovery of each 

2 such individual. 

3 ‘‘(ii) The access of such individuals to 

4 health care. 

5 ‘‘(iii) The total expenditures of such 

6 individuals for health care. 

7 For purposes of this subparagraph, the Sec8 retary shall specify all applicable measures 

9 for determining quality, access, and expend10 itures. 

11 ‘‘(C) BEST PRACTICES.—Not later than Oc12 tober 1, 2020, the Secretary shall make publicly 

13 available on the Internet website of the Centers 

14 for Medicare & Medicaid Services best practices 

15 for designing and implementing an SUD-focused 

16 State plan amendment, based on the experiences 

17 of States that have State plan amendments ap18 proved under this section that include SUD-eli19 gible individuals. 

20 ‘‘(D) DEFINITIONS.—For purposes of this 

21 paragraph: 

22 ‘‘(i) SUD-ELIGIBLE INDIVIDUALS.— 

23 The term ‘SUD-eligible individual’ means, 

24 with respect to a State, an individual who 

25 satisfies all of the following: 


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1 ‘‘(I) The individual is an eligible 

2 individual with chronic conditions. 

3 ‘‘(II) The individual is an indi4 vidual with a substance use disorder. 

5 ‘‘(III) The individual has not pre6 viously received health home services 

7 under any other State plan amend8 ment approved for the State under this 

9 section by the Secretary. 

10 ‘‘(ii) SUD-FOCUSED STATE PLAN

11 AMENDMENT.—The term ‘SUD-focused 

12 State plan amendment’ means a State plan 

13 amendment under this section that is de14 signed to provide health home services pri15 marily to SUD-eligible individuals.’’. 

16 SEC. 3. REQUIREMENT FOR STATE MEDICAID PLANS TO 

17 PROVIDE COVERAGE FOR MEDICATION-AS18 SISTED TREATMENT. 

19 (a) REQUIREMENT FOR STATE MEDICAID PLANS TO

20 PROVIDE COVERAGE FOR MEDICATION-ASSISTED TREAT21 MENT.—Section 1902(a)(10)(A) of the Social Security Act 

22 (42 U.S.C. 1396a(a)(10)(A)) is amended, in the matter pre23 ceding clause (i), by striking ‘‘and (28)’’ and inserting 

24 ‘‘(28), and (29)’’. 


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1 (b) INCLUSION OF MEDICATION-ASSISTED TREATMENT

2 AS MEDICAL ASSISTANCE.—Section 1905(a) of the Social 

3 Security Act (42 U.S.C. 1396d(a)) is amended— 

4 (1) in paragraph (28), by striking ‘‘and’’ at the 

5 end; 

6 (2) by redesignating paragraph (29) as para7 graph (30); and 

8 (3) by inserting after paragraph (28) the fol9 lowing new paragraph: 

10 ‘‘(29) subject to paragraph (2) of subsection (ee), 

11 for the period beginning October 1, 2020, and ending 

12 September 30, 2025, medication-assisted treatment 

13 (as defined in paragraph (1) of such subsection); 

14 and’’. 

15 (c) MEDICATION-ASSISTED TREATMENT DEFINED; 

16 WAIVERS.—Section 1905 of the Social Security Act (42 

17 U.S.C. 1396d) is amended by adding at the end the fol18 lowing new subsection: 

19 ‘‘(ee) MEDICATION-ASSISTED TREATMENT.— 

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

21 (a)(29), the term ‘medication-assisted treatment’— 

22 ‘‘(A) means all drugs approved under sec23 tion 505 of the Federal Food, Drug, and Cos24 metic Act (21 U.S.C. 355), including methadone, 

25 and all biological products licensed under section 


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1 351 of the Public Health Service Act (42 U.S.C. 

2 262) to treat opioid use disorders; and 

3 ‘‘(B) includes, with respect to the provision 

4 of such drugs and biological products, counseling 

5 services and behavioral therapy. 

6 ‘‘(2) EXCEPTION.—The provisions of paragraph 

7 (29) of subsection (a) shall not apply with respect to 

8 a State for the period specified in such paragraph, if 

9 before the beginning of such period the State certifies 

10 to the satisfaction of the Secretary that implementing 

11 such provisions statewide for all individuals eligible 

12 to enroll in the State plan (or waiver of the State 

13 plan) would not be feasible by reason of a shortage of 

14 qualified providers of medication-assisted treatment, 

15 or facilities providing such treatment, that will con16 tract with the State or a managed care entity with 

17 which the State has a contract under section 1903(m) 

18 or under section 1905(t)(3).’’. 

19 (d) EFFECTIVE DATE.— 

20 (1) IN GENERAL.—Subject to paragraph (2), the 

21 amendments made by this section shall apply with re22 spect to medical assistance provided on or after Octo23 ber 1, 2020, and before October 1, 2025. 

24 (2) EXCEPTION FOR STATE LEGISLATION.—In 

25 the case of a State plan under title XIX of the Social 


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1 Security Act (42 U.S.C. 1396 et seq.) that the Sec2 retary of Health and Human Services determines re3 quires State legislation in order for the respective 

4 plan to meet any requirement imposed by the amend5 ments made by this section, the respective plan shall 

6 not be regarded as failing to comply with the require7 ments of such title solely on the basis of its failure to 

8 meet such an additional requirement before the first 

9 day of the first calendar quarter beginning after the 

10 close of the first regular session of the State legislature 

11 that begins after the date of the enactment of this Act. 

12 For purposes of the previous sentence, in the case of 

13 a State that has a 2-year legislative session, each year 

14 of the session shall be considered to be a separate reg15 ular session of the State legislature. 

Amend the title so as to read: ‘‘A bill to amend title 

XIX of the Social Security Act to provide for an extension of the enhanced FMAP for certain Medicaid health 

homes for individuals with substance use disorders, and 

to require States to include under their State Medicaid 

plans coverage for medication-assisted treatment.’’. 


amozie on DSK3GDR082PROD with BILLS
Union Calendar No. 562 

115TH CONGRESS 

2D SESSION H. R. 5810 

[Report No. 115–727] 

A BILL 

To amend title XIX of the Social Security Act to 

with substance use disorders. for certain Medicaid health homes for individuals provide for an extension of the enhanced FMAP 

JUNE 12, 2018 

Reported with amendments, committed to the Committee 

dered to be printed of the Whole House on the State of the Union, and orVerDate Sep 11 2014 20:04 Jun 13, 2018 Jkt 079200 PO 00000 Frm 00010 Fmt 6651 Sfmt 6651 E:\BILLS\H5810.RH H5810

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