I 

115TH CONGRESS 

2D SESSION H. R. 5810 

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 

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. 

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 

5 Homes for Opioid-Use-Disorder Medicaid Enrollees En6 couraged Act’’ or the ‘‘Medicaid Health HOME Act’’. 


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1 SEC. 2. EXTENSION OF ENHANCED FMAP FOR CERTAIN 

2 HEALTH HOMES FOR INDIVIDUALS WITH 

3 SUBSTANCE USE DISORDERS. 

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

5 1396w–4) is amended— 

6 (1) in subsection (c)— 

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

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

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

10 paragraph: 

11 ‘‘(4) SPECIAL RULE RELATING TO SUBSTANCE

12 USE DISORDER HEALTH HOMES.— 

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

14 with an SUD-focused State plan amendment 

15 approved by the Secretary on or after October 

16 1, 2018, the Secretary may, at the request of 

17 the State, extend the application of the Federal 

18 medical assistance percentage described in 

19 paragraph (1) to payments for the provision of 

20 health home services to SUD-eligible individuals 

21 under such State plan amendment, in addition 

22 to the first 8 fiscal year quarters the State plan 

23 amendment is in effect, for the subsequent 2 

24 fiscal year quarters that the State plan amend25 ment is in effect. Nothing in this section shall 

26 be construed as prohibiting a State with a State 


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1 plan amendment that is approved under this 

2 section and that is not an SUD-focused State 

3 plan amendment from additionally having ap4 proved on or after such date an SUD-focused 

5 State plan amendment under this section, in6 cluding for purposes of application of this para7 graph. 

8 ‘‘(B) REPORT REQUIREMENTS.—In the 

9 case of a State with an SUD-focused State plan 

10 amendment for which the application of the 

11 Federal medical assistance percentage has been 

12 extended under subparagraph (A), such State 

13 shall, at the end of the period of such State 

14 plan amendment, submit to the Secretary a re15 port on the following, with respect to SUD-eli16 gible individuals provided health home services 

17 under such State plan amendment: 

18 ‘‘(i) The quality of health care pro19 vided to such individuals, with a focus on 

20 outcomes relevant to the recovery of each 

21 such individual. 

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

23 health care. 

24 ‘‘(iii) The total expenditures of such 

25 individuals for health care. 


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1 For purposes of this subparagraph, the 

2 Secretary shall specify all applicable meas3 ures for determining quality, access, and 

4 expenditures. 

5 ‘‘(C) BEST PRACTICES.—Not later than 

6 October 1, 2020, the Secretary shall make pub7 licly available on the Internet website of the 

8 Centers for Medicare & Medicaid Services best 

9 practices for designing and implementing an 

10 SUD-focused State plan amendment, based on 

11 the experiences of States that have State plan 

12 amendments approved under this section that 

13 include SUD-eligible individuals. 

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

15 paragraph: 

16 ‘‘(i) SUD-ELIGIBLE INDIVIDUALS.— 

17 The term ‘SUD-eligible individual’ means, 

18 with respect to a State, an individual who 

19 satisfies all of the following: 

20 ‘‘(I) The individual is an eligible 

21 individual with chronic conditions. 

22 ‘‘(II) The individual is an indi23 vidual with a substance use disorder. 

24 ‘‘(III) The individual has not pre25 viously received health home services 


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1 under any other State plan amend2 ment approved for the State under 

3 this section by the Secretary. 

4 ‘‘(ii) SUD-FOCUSED STATE PLAN

5 AMENDMENT.—The term ‘SUD-focused 

6 State plan amendment’ means a State plan 

7 amendment under this section that is de8 signed to provide health home services pri9 marily to SUD-eligible individuals.’’. 

Æ 


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