II 

Calendar No. 180 

114TH CONGRESS 

1ST SESSION S. 599 

[Report No. 114–101] 

To extend and expand the Medicaid emergency psychiatric demonstration 

project. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 26, 2015 

Mr. CARDIN (for himself, Mr. TOOMEY, Ms. COLLINS, Mrs. MCCASKILL, Mr. 

FRANKEN, Mr. MURPHY, Mrs. CAPITO, Mr. WHITEHOUSE, Mr. BLUNT, 

Ms. MIKULSKI, Mr. SESSIONS, Mr. MANCHIN, Mr. BROWN, Ms. STABENOW, and Mr. BURR) introduced the following bill; which was read twice 

and referred to the Committee on Finance 

JULY 30, 2015 

Reported by Mr. HATCH, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To extend and expand the Medicaid emergency psychiatric 

demonstration project. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Improving Access to 

3 Emergency Psychiatric Care Act’’. 

4 SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMER5 GENCY PSYCHIATRIC DEMONSTRATION 

6 PROJECT. 

7 (a) IN GENERAL.—Subsection (d) of section 2707 of 

8 Public Law 111–148 (42 U.S.C. 1396a note) is amended 

9 to read as follows: 

10 ‘‘(d) LENGTH OF DEMONSTRATION PROJECT.— 

11 ‘‘(1) IN GENERAL.—Except as provided in para12 graphs (2) and (3), the demonstration project estab13 lished under this section shall be conducted for a pe14 riod of 3 consecutive years. 

15 ‘‘(2) TEMPORARY EXTENSION OF PARTICIPA16 TION ELIGIBILITY FOR SELECTED STATES.— 

17 ‘‘(A) IN GENERAL.—Subject to paragraph 

18 (3), a State selected as an eligible State to par19 ticipate in the demonstration project on or prior 

20 to March 13, 2012, shall, upon the request of 

21 the State, be permitted to continue to partici22 pate in the demonstration project through the 

23 date described in subparagraph (B) if— 

24 ‘‘(i) the Secretary determines that the 

25 continued participation of the State in the 

26 demonstration project is not expected to 


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1 increase spending under title XIX of the 

2 Social Security Act; and 

3 ‘‘(ii) the Chief Actuary of the Centers 

4 for Medicare & Medicaid Services certifies 

5 that such extension for that State is pro6 jected to reduce (or is projected not to re7 sult in any increase in) net program spend8 ing under title XIX of the Social Security 

9 Act. 

10 ‘‘(B) DATE DESCRIBED.—The date de11 scribed in this subparagraph is the earlier of— 

12 ‘‘(i) the date on which Secretary sub13 mits the recommendations required under 

14 subsection (f)(3); or 

15 ‘‘(ii) September 30, 2016. 

16 ‘‘(3) EXTENSION AND EXPANSION OF DEM17 ONSTRATION PROJECT.— 

18 ‘‘(A) ADDITIONAL EXTENSION.—Taking 

19 into account the recommendations submitted to 

20 Congress pursuant to subsection (f)(3), the Sec21 retary may, if the Secretary determines that ex22 tension and expansion of the demonstration 

23 project satisfies the criteria for the temporary 

24 extension under subparagraphs (A) and (B) of 

25 paragraph (2)— 


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1 ‘‘(i) extend the demonstration project 

2 through December 31, 2019; and 

3 ‘‘(ii) permit any eligible State partici4 pating in the demonstration project as of 

5 the date such recommendations are sub6 mitted to continue to participate in the 

7 project. 

8 ‘‘(B) OPTION FOR EXPANSION TO ADDI9 TIONAL STATES.—Taking into account the rec10 ommendations submitted to Congress pursuant 

11 to subsection (f)(3), the Secretary may expand 

12 (including on a nationwide basis) the number of 

13 eligible States participating in the demonstra14 tion project during the extension period estab15 lished under subparagraph (A) if, with respect 

16 to any new eligible State— 

17 ‘‘(i) the Secretary determines that the 

18 participation of the State in the dem19 onstration project is not expected to in20 crease spending under title XIX of the So21 cial Security Act; and 

22 ‘‘(ii) the Chief Actuary of the Centers 

23 for Medicare & Medicaid Services certifies 

24 that the participation of the State in the 

25 demonstration project is projected to reVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6401 E:\BILLS\S599.RS S599

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1 duce (or is projected not to result in any 

2 increase in) net program spending under 

3 title XIX of the Social Security Act. 

4 ‘‘(4) AUTHORITY TO ENSURE BUDGET NEU5 TRALITY.—The Secretary annually shall review each 

6 participating State’s demonstration project expendi7 tures to ensure compliance with the requirements of 

8 paragraphs (2)(A), (2)(B), (3)(B)(i), and (3)(B)(ii) 

9 (as applicable). If the Secretary determines with re10 spect to a State’s participation in the demonstration 

11 project that the State’s net program spending under 

12 title XIX of the Social Security Act has increased as 

13 a result of the State’s participation in the project, 

14 the Secretary shall treat the demonstration project 

15 excess expenditures of the State as an overpayment 

16 under title XIX of the Social Security Act.’’. 

17 (b) FUNDING.—Subsection (e) of section 2707 of 

18 such Act (42 U.S.C. 1396a note) is amended— 

19 (1) in the subsection heading, by striking ‘‘LIM20 ITATIONS ON FEDERAL’’; 

21 (2) in paragraph (2)— 

22 (A) in the paragraph heading, by striking 

23 ‘‘5-YEAR’’; and 

24 (B) by striking ‘‘through December 31, 

25 2015’’ and inserting ‘‘until expended’’; 


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1 (3) by striking paragraph (3); 

2 (4) by redesignating paragraphs (4) and (5) as 

3 paragraphs (3) and (4), respectively; 

4 (5) in paragraph (3) (as so redesignated), by 

5 striking ‘‘and the availability of funds’’ and inserting 

6 ‘‘(other than States deemed to be eligible States 

7 through the application of subsection (c)(4))’’; and 

8 (6) in paragraph (4) (as so redesignated)— 

9 (A) in the first sentence— 

10 (i) by inserting ‘‘(other than a State 

11 deemed to be an eligible State through the 

12 application of subsection (c)(4))’’ after ‘‘el13 igible State’’; and 

14 (ii) by striking ‘‘paragraph (4)’’ and 

15 inserting ‘‘paragraph (3)’’; and 

16 (B) by inserting after the first sentence 

17 the following ‘‘In addition to any payments 

18 made to an eligible State under the preceding 

19 sentence, the Secretary shall, during any period 

20 in effect under paragraph (2) or (3) of sub21 section (d), or during any period in which a law 

22 described in subsection (f)(4)(C) is in effect, 

23 pay each eligible State (including any State 

24 deemed to be an eligible State through the ap25 plication of subsection (c)(4)), an amount each 


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1 quarter equal to the Federal medical assistance 

2 percentage of expenditures in the quarter dur3 ing such period for medical assistance described 

4 in subsection (a). Payments made to States 

5 under this paragraph shall be considered to 

6 have been made under, and are subject to, the 

7 requirements of section 1903 of the Social Se8 curity Act (42 U.S.C. 1396b).’’. 

9 (c) RECOMMENDATIONS TO CONGRESS.—Subsection 

10 (f) of section 2707 of such Act (42 U.S.C. 1396a note) 

11 is amended by adding at the end the following: 

12 ‘‘(3) RECOMMENDATION TO CONGRESS REGARD13 ING EXTENSION AND EXPANSION OF PROJECT.—Not 

14 later than September 30, 2016, the Secretary shall 

15 submit to Congress and make available to the public 

16 recommendations based on an evaluation of the dem17 onstration project, including the use of appropriate 

18 quality measures, regarding— 

19 ‘‘(A) whether the demonstration project 

20 should be continued after December 31, 2016; 

21 and 

22 ‘‘(B) whether the demonstration project 

23 should be expanded (including on a nationwide 

24 basis). 


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1 ‘‘(4) RECOMMENDATION TO CONGRESS REGARD2 ING PERMANENT EXTENSION AND NATIONWIDE EX3 PANSION.— 

4 ‘‘(A) IN GENERAL.—Not later than April 

5 1, 2019, the Secretary shall submit to Congress 

6 and make available to the public recommenda7 tions based on an evaluation of the demonstra8 tion project, including the use of appropriate 

9 quality measures, regarding— 

10 ‘‘(i) whether the demonstration 

11 project should be permanently continued 

12 after December 31, 2019, in 1 or more 

13 States; and 

14 ‘‘(ii) whether the demonstration 

15 project should be expanded (including on a 

16 nationwide basis). 

17 ‘‘(B) REQUIREMENTS.—Any recommenda18 tion submitted under subparagraph (A) to per19 manently continue the project in a State, or to 

20 expand the project to 1 or more other States 

21 (including on a nationwide basis) shall include 

22 a certification from the Chief Actuary of the 

23 Centers for Medicare & Medicaid Services that 

24 permanently continuing the project in a par25 ticular State, or expanding the project to a parVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6401 E:\BILLS\S599.RS S599

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1 ticular State (or all States) is projected to re2 duce (or is projected not to result in any in3 crease in) net program spending under title 

4 XIX of the Social Security Act. If the Secretary 

5 determines with respect to a State’s participa6 tion in the demonstration project that net pro7 gram spending under title XIX of such Act has 

8 increased as a result of the project, the Sec9 retary shall treat the demonstration project ex10 cess expenditures of the State as an overpay11 ment under title XIX of the Social Security 

12 Act. 

13 ‘‘(C) CONGRESSIONAL APPROVAL RE14 QUIRED.—The Secretary shall not permanently 

15 continue the demonstration project in any State 

16 after December 31, 2019, or expand the dem17 onstration project to any additional State after 

18 December 31, 2019, unless Congress enacts a 

19 law approving either or both such actions. 

20 ‘‘(5) FUNDING.—Out of any funds in the 

21 Treasury not otherwise appropriated, there is appro22 priated to the Centers for Medicare & Medicaid 

23 Services Program Management Account to carry out 

24 this subsection, $100,000 for fiscal year 2015, to re25 main available until expended.’’. 


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1 (d) CONFORMING AMENDMENTS.—Section 2707 of 

2 such Act (42 U.S.C. 1396a note) is amended— 

3 (1) in subsection (c)— 

4 (A) in paragraph (1), by striking ‘‘An eli5 gible State’’ and inserting ‘‘Except as otherwise 

6 provided in paragraph (4), an eligible State’’; 

7 (B) in paragraph (3), by striking ‘‘A State 

8 shall’’ and inserting ‘‘Except as otherwise pro9 vided in paragraph (4), a State shall’’; and 

10 (C) by adding at the end the following: 

11 ‘‘(4) NATIONWIDE AVAILABILITY.—In the event 

12 that the Secretary makes a recommendation pursu13 ant to subsection (f)(4) that the demonstration 

14 project be expanded on a national basis, any State 

15 that has submitted or submits an application pursu16 ant to paragraph (2) shall be deemed to have been 

17 selected to be an eligible State to participate in the 

18 demonstration project.’’; and 

19 (2) in the heading for subsection (f), by striking 

20 ‘‘AND REPORT’’ and inserting ‘‘, REPORT, AND REC21 OMMENDATIONS’’. 

22 (e) EFFECTIVE DATE.—The amendments made by 

23 this section shall take effect on the date of the enactment 

24 of this Act. 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Improving Access to 

3 Emergency Psychiatric Care Act’’. 

4 SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMER5 GENCY PSYCHIATRIC DEMONSTRATION 

6 PROJECT. 

7 (a) IN GENERAL.—Subsection (d) of section 2707 of 

8 Public Law 111–148 (42 U.S.C. 1396a note) is amended 

9 to read as follows: 

10 ‘‘(d) LENGTH OF DEMONSTRATION PROJECT.— 

11 ‘‘(1) IN GENERAL.—Except as provided in para12 graphs (2) and (3), the demonstration project estab13 lished under this section shall be conducted for a pe14 riod of 3 consecutive years. 

15 ‘‘(2) TEMPORARY EXTENSION OF PARTICIPATION

16 ELIGIBILITY FOR SELECTED STATES.— 

17 ‘‘(A) IN GENERAL.—Subject to subpara18 graph (B) and paragraph (4), a State selected as 

19 an eligible State to participate in the demonstra20 tion project on or prior to March 13, 2012, shall, 

21 upon the request of the State, be permitted to 

22 continue to participate in the demonstration 

23 project through September 30, 2016, if— 

24 ‘‘(i) the Secretary determines that the 

25 continued participation of the State in the 

26 demonstration project is projected not to inVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\S599.RS S599

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1 crease net program spending under title 

2 XIX of the Social Security Act; and 

3 ‘‘(ii) the Chief Actuary of the Centers 

4 for Medicare & Medicaid Services certifies 

5 that such extension for that State is pro6 jected not to increase net program spending 

7 under title XIX of the Social Security Act. 

8 ‘‘(B) NOTICE OF PROJECTIONS.—The Sec9 retary shall provide each State selected to par10 ticipate in the demonstration project on or prior 

11 to March 13, 2012, with notice of the determina12 tion and certification made under subparagraph 

13 (A) for the State. 

14 ‘‘(3) EXTENSION AND EXPANSION OF DEM15 ONSTRATION PROJECT.— 

16 ‘‘(A) ADDITIONAL EXTENSION.—Taking into 

17 account the recommendations submitted to Con18 gress under subsection (f)(3), the Secretary may 

19 permit an eligible State participating in the 

20 demonstration project as of the date such rec21 ommendations are submitted to continue to par22 ticipate in the project through December 31, 

23 2019, if, with respect to the State— 

24 ‘‘(i) the Secretary determines that the 

25 continued participation of the State in the 


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1 demonstration project is projected not to in2 crease net program spending under title 

3 XIX of the Social Security Act; and 

4 ‘‘(ii) the Chief Actuary of the Centers 

5 for Medicare & Medicaid Services certifies 

6 that the continued participation of the 

7 State in the demonstration project is pro8 jected not to increase net program spending 

9 under title XIX of the Social Security Act. 

10 ‘‘(B) OPTION FOR EXPANSION TO ADDI11 TIONAL STATES.—Taking into account the rec12 ommendations submitted to Congress pursuant 

13 to subsection (f)(3), the Secretary may expand 

14 the number of eligible States participating in the 

15 demonstration project through December 31, 

16 2019, if, with respect to any new eligible State— 

17 ‘‘(i) the Secretary determines that the 

18 participation of the State in the demonstra19 tion project is projected not to increase net 

20 program spending under title XIX of the 

21 Social Security Act; and 

22 ‘‘(ii) the Chief Actuary of the Centers 

23 for Medicare & Medicaid Services certifies 

24 that the participation of the State in the 

25 demonstration project is projected not to inVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6203 E:\BILLS\S599.RS S599

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1 crease net program spending under title 

2 XIX of the Social Security Act. 

3 ‘‘(C) NOTICE OF PROJECTIONS.—The Sec4 retary shall provide each State participating in 

5 the demonstration project as of the date the Sec6 retary submits recommendations to Congress 

7 under subsection (f)(3), and any additional 

8 State that applies to be added to the demonstra9 tion project, with notice of the determination 

10 and certification made for the State under sub11 paragraphs (A) and (B), respectively, and the 

12 standards used to make such determination and 

13 certification— 

14 ‘‘(i) in the case of a State partici15 pating in the demonstration project as of 

16 the date the Secretary submits recommenda17 tions to Congress under subsection (f)(3), 

18 not later than August 31, 2016; and 

19 ‘‘(ii) in the case of an additional State 

20 that applies to be added to the demonstra21 tion project, prior to the State making a 

22 final election to participate in the project. 

23 ‘‘(4) AUTHORITY TO ENSURE BUDGET NEU24 TRALITY.—The Secretary annually shall review each 

25 participating State’s demonstration project expendiVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6203 E:\BILLS\S599.RS S599

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1 tures to ensure compliance with the requirements of 

2 paragraphs (2)(A)(i), (2)(A)(ii), (3)(A)(i), (3)(A)(ii), 

3 (3)(B)(i), and (3)(B)(ii) (as applicable). If the Sec4 retary determines with respect to a State’s participa5 tion in the demonstration project that the State’s net 

6 program spending under title XIX of the Social Secu7 rity Act has increased as a result of the State’s par8 ticipation in the project, the Secretary shall treat the 

9 demonstration project excess expenditures of the State 

10 as an overpayment under title XIX of the Social Se11 curity Act.’’. 

12 (b) FUNDING.—Subsection (e) of section 2707 of such 

13 Act (42 U.S.C. 1396a note) is amended— 

14 (1) in the subsection heading, by striking ‘‘LIMI15 TATIONS ON FEDERAL’’; 

16 (2) in paragraph (2)— 

17 (A) in the paragraph heading, by striking 

18 ‘‘5-YEAR’’; and 

19 (B) by striking ‘‘through December 31, 

20 2015’’ and inserting ‘‘until expended’’; 

21 (3) by striking paragraph (3); 

22 (4) by redesignating paragraphs (4) and (5) as 

23 paragraphs (3) and (4), respectively; 

24 (5) in paragraph (3) (as so redesignated), by 

25 striking ‘‘and the availability of funds’’ and inserting 


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1 ‘‘(other than States deemed to be eligible States 

2 through the application of subsection (c)(4))’’; and 

3 (6) in paragraph (4) (as so redesignated)— 

4 (A) in the first sentence— 

5 (i) by inserting ‘‘(other than a State 

6 deemed to be an eligible State through the 

7 application of subsection (c)(4))’’ after ‘‘eli8 gible State’’; and 

9 (ii) by striking ‘‘paragraph (4)’’ and 

10 inserting ‘‘paragraph (3)’’; and 

11 (B) by inserting after the first sentence the 

12 following: ‘‘In addition to any payments made 

13 to an eligible State under the preceding sentence, 

14 the Secretary shall, during any period in effect 

15 under paragraph (2) or (3) of subsection (d), or 

16 during any period in which a law described in 

17 subsection (f)(4)(C) is in effect, pay each eligible 

18 State (including any State deemed to be an eli19 gible State through the application of subsection 

20 (c)(4)), an amount each quarter equal to the 

21 Federal medical assistance percentage of expend22 itures in the quarter during such period for med23 ical assistance described in subsection (a). Pay24 ments made to a State for emergency psychiatric 

25 demonstration services under this section during 


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1 the extension period shall be treated as medical 

2 assistance under the State plan for purposes of 

3 section 1903(a)(1) of the Social Security Act (42 

4 U.S.C. 1396b(a)(1)).’’. 

5 (c) RECOMMENDATIONS TO CONGRESS.—Subsection (f) 

6 of section 2707 of such Act (42 U.S.C. 1396a note) is 

7 amended by adding at the end the following: 

8 ‘‘(3) RECOMMENDATION TO CONGRESS REGARD9 ING EXTENSION AND EXPANSION OF PROJECT.—Not 

10 later than September 30, 2016, the Secretary shall 

11 submit to Congress and make available to the public 

12 recommendations based on an evaluation of the dem13 onstration project, including the use of appropriate 

14 quality measures, regarding— 

15 ‘‘(A) whether the demonstration project 

16 should be continued after September 30, 2016; 

17 and 

18 ‘‘(B) whether the demonstration project 

19 should be expanded to additional States. 

20 ‘‘(4) RECOMMENDATION TO CONGRESS REGARD21 ING PERMANENT EXTENSION AND NATIONWIDE EXPAN22 SION.— 

23 ‘‘(A) IN GENERAL.—Not later than April 1, 

24 2019, the Secretary shall submit to Congress and 

25 make available to the public recommendations 


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1 based on an evaluation of the demonstration 

2 project, including the use of appropriate quality 

3 measures, regarding— 

4 ‘‘(i) whether the demonstration project 

5 should be permanently continued after De6 cember 31, 2019, in 1 or more States; and 

7 ‘‘(ii) whether the demonstration project 

8 should be expanded (including on a nation9 wide basis). 

10 ‘‘(B) REQUIREMENTS.—Any recommenda11 tion submitted under subparagraph (A) to per12 manently continue the project in a State, or to 

13 expand the project to 1 or more other States (in14 cluding on a nationwide basis) shall include a 

15 certification from the Chief Actuary of the Cen16 ters for Medicare & Medicaid Services that per17 manently continuing the project in a particular 

18 State, or expanding the project to a particular 

19 State (or all States) is projected not to increase 

20 net program spending under title XIX of the So21 cial Security Act. 

22 ‘‘(C) CONGRESSIONAL APPROVAL RE23 QUIRED.—The Secretary shall not permanently 

24 continue the demonstration project in any State 

25 after December 31, 2019, or expand the demVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6203 E:\BILLS\S599.RS S599

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1 onstration project to any additional State after 

2 December 31, 2019, unless Congress enacts a law 

3 approving either or both such actions and the 

4 law includes provisions that— 

5 ‘‘(i) ensure that each State’s participa6 tion in the project complies with budget 

7 neutrality requirements; and 

8 ‘‘(ii) require the Secretary to treat any 

9 expenditures of a State participating in the 

10 demonstration project that are excess of the 

11 expenditures projected under the budget 

12 neutrality standard for the State as an 

13 overpayment under title XIX of the Social 

14 Security Act. 

15 ‘‘(5) FUNDING.—Out of any funds in the Treas16 ury not otherwise appropriated, there is appropriated 

17 to the Centers for Medicare & Medicaid Services Pro18 gram Management Account to carry out this sub19 section, $100,000 for fiscal year 2015, to remain 

20 available until expended.’’. 

21 (d) CONFORMING AMENDMENTS.—Section 2707 of such 

22 Act (42 U.S.C. 1396a note) is amended— 

23 (1) in subsection (a), in the matter before para24 graph (1), by inserting ‘‘publicly or’’ after ‘‘institu25 tion for mental diseases that is’’; 


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1 (2) in subsection (c)— 

2 (A) in paragraph (1), by striking ‘‘An eligi3 ble State’’ and inserting ‘‘Except as otherwise 

4 provided in paragraph (4), an eligible State’’; 

5 (B) in paragraph (3), by striking ‘‘A State 

6 shall’’ and inserting ‘‘Except as otherwise pro7 vided in paragraph (4), a State shall’’; and 

8 (C) by adding at the end the following: 

9 ‘‘(4) NATIONWIDE AVAILABILITY.—In the event 

10 that the Secretary makes a recommendation pursuant 

11 to subsection (f)(4) that the demonstration project be 

12 expanded on a national basis, any State that has sub13 mitted or submits an application pursuant to para14 graph (2) shall be deemed to have been selected to be 

15 an eligible State to participate in the demonstration 

16 project.’’; and 

17 (3) in the heading for subsection (f), by striking 

18 ‘‘AND REPORT’’ and inserting ‘‘, REPORT, AND REC19 OMMENDATIONS’’. 

20 (e) EFFECTIVE DATE.—The amendments made by this 

21 section shall take effect on the date of the enactment of this 

22 Act. 


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Calendar No. 180 

114TH CONGRESS 

1ST SESSION S. 599 

[Report No. 114–101] 

A BILL 

To extend and expand the Medicaid emergency 

psychiatric demonstration project. 

JULY 30, 2015 

Reported with an amendment 


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