I 

113TH CONGRESS 

2D SESSION H. R. 5136 

To direct the Secretary of Health and Human Services to establish a demonstration project under the Medicaid program under title XIX of the 

Social Security Act under which payment may be made to States for 

expenditures for medical assistance with respect to substance use disorder 

treatment services, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 17, 2014 

Ms. FUDGE (for herself, Mr. RYAN of Ohio, Mr. CUMMINGS, Ms. LEE of California, Ms. NORTON, Mr. RICHMOND, Mr. HASTINGS of Florida, and Ms. 

CLARKE of New York) introduced the following bill; which was referred 

to the Committee on Energy and Commerce 

A BILL 

To direct the Secretary of Health and Human Services to 

establish a demonstration project under the Medicaid 

program under title XIX of the Social Security Act under 

which payment may be made to States for expenditures 

for medical assistance with respect to substance use disorder treatment services, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Breaking Addiction 

5 Act of 2014’’. 


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1 SEC. 2. MEDICAID COMMUNITY-BASED INPATIENT SUB2 STANCE USE DISORDER TREATMENT DEM3 ONSTRATION PROJECT. 

4 (a) AUTHORITY.—The Secretary of Health and 

5 Human Services shall establish a 5-year demonstration 

6 project (in this section referred to as the ‘‘demonstration 

7 project’’) under which payment may be made to each par8 ticipating State (as described in subsection (b)), for any 

9 medical assistance provided with respect to a qualified in10 dividual in a community-based institution for mental dis11 eases who is being treated in such institution for a sub12 stance use condition. 

13 (b) PARTICIPATING STATES.— 

14 (1) ELIGIBILITY.—A State is eligible to partici15 pate in the demonstration project under this section 

16 if the State plan of the State provides for payment 

17 under the plan for community-based inpatient sub18 stance use disorder treatment services furnished to 

19 qualified individuals. 

20 (2) APPLICATION.—A State seeking to partici21 pate in the demonstration project under this section 

22 shall submit to the Secretary an application, at such 

23 time, in such form, and that contains such informa24 tion, provisions, and assurances, as the Secretary 

25 may require. 


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1 (3) SELECTION.—The Secretary shall select, on 

2 a competitive basis, from among the States that sub3 mit an application under paragraph (1) to the satis4 faction of the Secretary, the States that will be par5 ticipating in the demonstration project. In selecting 

6 such participating States, the Secretary shall seek to 

7 achieve an equitable geographic distribution. 

8 (c) WAIVER AUTHORITY.— 

9 (1) IN GENERAL.—The Secretary shall waive 

10 the limitation on payment for care and services im11 posed by the subdivision (B) that follows paragraph 

12 (29) of section 1905(a) of the Social Security Act 

13 (42 U.S.C. 1396d(a)) (relating to a limitation on 

14 payments for care or services for any individual who 

15 is under 65 years of age and who is a patient in an 

16 institution for mental diseases) with respect to pay17 ment for the medical assistance described in sub18 section (a). 

19 (2) LIMITED OTHER WAIVER AUTHORITY.—The 

20 Secretary may waive other requirements of titles XI 

21 and XIX of the Social Security Act (including the 

22 requirements of sections 1902(a)(1) (relating to 

23 statewideness) (42 U.S.C. 1396a(a)(1)) and 

24 1902(a)(10)(B) (relating to comparability) (42 

25 U.S.C. 1396a(a)(10)(B)) of such Act) only to the 


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1 extent necessary to carry out the demonstration 

2 project under this section. 

3 (d) EVALUATION AND REPORT TO CONGRESS.— 

4 (1) EVALUATION.—The Secretary shall conduct 

5 an evaluation of the impact the demonstration 

6 project carried out under this section has on the 

7 functioning of the health and substance use disorder 

8 system and individuals enrolled in State plans under 

9 the Medicaid program under title XIX of the Social 

10 Security Act. The evaluation shall include each of 

11 the following: 

12 (A) An assessment of the access such indi13 viduals have to substance use disorder treat14 ment services under the demonstration project 

15 carried out under this section, and with respect 

16 to such services, the average lengths of inpa17 tient stays and emergency room visits. 

18 (B) An assessment of the discharge plan19 ning by the health care providers furnishing 

20 such services. 

21 (C) An assessment of the impact of the 

22 demonstration project on the costs of the full 

23 range of health care items and services, includ24 ing inpatient, emergency and ambulatory care, 

25 diversions from inpatient and emergency care, 


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1 and readmissions to institutions for mental dis2 eases. 

3 (D) An analysis of the percentage of indi4 viduals enrolled in such plans who are admitted 

5 to community-based institutions for mental dis6 eases as a result of the demonstration project 

7 as compared to those admitted to such institu8 tions through other means. 

9 (2) REPORT.—Not later than December 31, 

10 2020, the Secretary shall submit to Congress and 

11 make available to the public a report that contains— 

12 (A) the findings of the evaluation under 

13 paragraph (1); and 

14 (B) the recommendations of the Secretary 

15 regarding whether— 

16 (i) the limitation referred to in sub17 section (c)(1) is a barrier to care that 

18 needs to be reviewed by Congress; and 

19 (ii) the demonstration project carried 

20 out under this section should be continued 

21 after December 31, 2020, and expanded on 

22 a national basis. 

23 (e) FUNDING.— 

24 (1) APPROPRIATION.—Out of any funds in the 

25 Treasury not otherwise appropriated, there is approVerDate Mar 15 2010 02:37 Jul 22, 2014 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5136.IH H5136

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1 priated to carry out this section, $300,000,000 for 

2 fiscal year 2015. 

3 (2) 10-YEAR AVAILABILITY.—Funds appro4 priated under paragraph (1) shall remain available 

5 for obligation through December 31, 2024. 

6 (3) FUNDS ALLOCATED TO STATES.—Funds 

7 shall be allocated to participating States on the basis 

8 of criteria, including a State’s application and the 

9 availability of funds, as determined by the Secretary. 

10 (4) PAYMENT TO STATES.—For each calendar 

11 quarter beginning on or after October 1, 2014, the 

12 Secretary shall pay to each participating State, from 

13 the allocation made to the State under paragraph 

14 (3), an amount equal to the Federal medical assist15 ance percentage of the amount expended during 

16 such quarter for the medical assistance described in 

17 subsection (a). 

18 (5) LIMITATION ON PAYMENTS.—In no case 

19 may— 

20 (A) the aggregate amount of payments 

21 made by the Secretary to participating States 

22 under this section exceed $300,000,000; or 

23 (B) payments be made by the Secretary to 

24 participating States under this section after De25 cember 31, 2024. 


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1 (f) DEFINITIONS.—In this section: 

2 (1) FEDERAL MEDICAL ASSISTANCE PERCENT3 AGE.—The term ‘‘Federal medical assistance per4 centage’’ has the meaning given such term in section 

5 1905(b) of the Social Security Act (42 U.S.C. 

6 1396d(b)). 

7 (2) INSTITUTION FOR MENTAL DISEASES.—The 

8 term ‘‘institution for mental diseases’’ has the mean9 ing given such term in section 1905(i) of the Social 

10 Security Act (42 U.S.C. 1396d(i)). 

11 (3) MEDICAL ASSISTANCE.—The term ‘‘medical 

12 assistance’’ has the meaning given such term in sec13 tion 1905(a) of the Social Security Act (42 U.S.C. 

14 1396d(a)). 

15 (4) QUALIFIED INDIVIDUAL.—The term ‘‘quali16 fied individual’’ means an individual who, because of 

17 the individual’s substance use condition, requires 

18 substance use disorder treatment and who— 

19 (A) is over 21 years of age and under 65 

20 years of age; and 

21 (B) is eligible for medical assistance under 

22 the State plan under the Medicaid program 

23 under title XIX of the Social Security Act (42 

24 U.S.C. 1396 et seq.). 


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1 (5) STATE.—The term ‘‘State’’ has the mean2 ing given such term for purposes of title XIX of the 

3 Social Security Act (42 U.S.C. 1396 et seq.). 

Æ 


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