In the House of Representatives, U. S., 

November 16, 2015. 

Resolved, That the bill from the Senate (S. 599) entitled 

‘‘An Act to extend and expand the Medicaid emergency psychiatric demonstration project.’’, do pass with the following 

AMENDMENT: 

Strike out all after the enacting clause and insert: 

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.— 
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1 ‘‘(A) IN GENERAL.—Subject to subpara2 graph (B) and paragraph (4), a State selected as 

3 an eligible State to participate in the demonstra4 tion project on or prior to March 13, 2012, shall, 

5 upon the request of the State, be permitted to 

6 continue to participate in the demonstration 

7 project through September 30, 2016, if— 

8 ‘‘(i) the Secretary determines that the 

9 continued participation of the State in the 

10 demonstration project is projected not to in11 crease net program spending under title 

12 XIX of the Social Security Act; and 

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

14 for Medicare & Medicaid Services certifies 

15 that such extension for that State is pro16 jected not to increase net program spending 

17 under title XIX of the Social Security Act. 

18 ‘‘(B) NOTICE OF PROJECTIONS.—The Sec19 retary shall provide each State selected to par20 ticipate in the demonstration project on or prior 

21 to March 13, 2012, with notice of the determina22 tion and certification made under subparagraph 

23 (A) for the State. 

24 ‘‘(3) EXTENSION AND EXPANSION OF DEM25 ONSTRATION PROJECT.— 
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1 ‘‘(A) ADDITIONAL EXTENSION.—Taking into 

2 account the recommendations submitted to Con3 gress under subsection (f)(3), the Secretary may 

4 permit an eligible State participating in the 

5 demonstration project as of the date such rec6 ommendations are submitted to continue to par7 ticipate in the project through December 31, 

8 2019, if, with respect to the State— 

9 ‘‘(i) the Secretary determines that the 

10 continued participation of the State in the 

11 demonstration project is projected not to in12 crease net program spending under title 

13 XIX of the Social Security Act; and 

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

15 for Medicare & Medicaid Services certifies 

16 that the continued participation of the 

17 State in the demonstration project is pro18 jected not to increase net program spending 

19 under title XIX of the Social Security Act. 

20 ‘‘(B) OPTION FOR EXPANSION TO ADDI21 TIONAL STATES.—Taking into account the rec22 ommendations submitted to Congress pursuant 

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

24 the number of eligible States participating in the 
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1 demonstration project through December 31, 

2 2019, if, with respect to any new eligible State— 

3 ‘‘(i) the Secretary determines that the 

4 participation of the State in the demonstra5 tion project is projected not to increase net 

6 program spending under title XIX of the 

7 Social Security Act; and 

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

9 for Medicare & Medicaid Services certifies 

10 that the participation of the State in the 

11 demonstration project is projected not to in12 crease net program spending under title 

13 XIX of the Social Security Act. 

14 ‘‘(C) NOTICE OF PROJECTIONS.—The Sec15 retary shall provide each State participating in 

16 the demonstration project as of the date the Sec17 retary submits recommendations to Congress 

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

19 State that applies to be added to the demonstra20 tion project, with notice of the determination 

21 and certification made for the State under sub22 paragraphs (A) and (B), respectively, and the 

23 standards used to make such determination and 

24 certification— 
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1 ‘‘(i) in the case of a State partici2 pating in the demonstration project as of 

3 the date the Secretary submits recommenda4 tions to Congress under subsection (f)(3), 

5 not later than August 31, 2016; and 

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

7 that applies to be added to the demonstra8 tion project, prior to the State making a 

9 final election to participate in the project. 

10 ‘‘(4) AUTHORITY TO ENSURE BUDGET NEU11 TRALITY.—The Secretary annually shall review each 

12 participating State’s demonstration project expendi13 tures to ensure compliance with the requirements of 

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

15 (3)(B)(i), and (3)(B)(ii) (as applicable). If the Sec16 retary determines with respect to a State’s participa17 tion in the demonstration project that the State’s net 

18 program spending under title XIX of the Social Secu19 rity Act has increased as a result of the State’s par20 ticipation in the project, the Secretary shall treat the 

21 demonstration project excess expenditures of the State 

22 as an overpayment under title XIX of the Social Se23 curity Act.’’. 

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

25 Act (42 U.S.C. 1396a note) is amended— 
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1 (1) in the subsection heading, by striking ‘‘LIMI2 TATIONS ON FEDERAL’’; 

3 (2) in paragraph (2)— 

4 (A) in the paragraph heading, by striking 

5 ‘‘5-YEAR’’; and 

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

7 2015’’ and inserting ‘‘until expended’’; 

8 (3) by striking paragraph (3); 

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

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

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

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

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

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

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

16 (A) in the first sentence— 

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

18 deemed to be an eligible State through the 

19 application of subsection (c)(4))’’ after ‘‘eli20 gible State’’; and 

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

22 inserting ‘‘paragraph (3)’’; and 

23 (B) by inserting after the first sentence the 

24 following: ‘‘In addition to any payments made 

25 to an eligible State under the preceding sentence, 
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1 the Secretary shall, during any period in effect 

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

3 during any period in which a law described in 

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

5 State (including any State deemed to be an eli6 gible State through the application of subsection 

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

8 Federal medical assistance percentage of expend9 itures in the quarter during such period for med10 ical assistance described in subsection (a). Pay11 ments made to a State for emergency psychiatric 

12 demonstration services under this section during 

13 the extension period shall be treated as medical 

14 assistance under the State plan for purposes of 

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

16 U.S.C. 1396b(a)(1)).’’. 

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

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

19 amended by adding at the end the following: 

20 ‘‘(3) RECOMMENDATION TO CONGRESS REGARD21 ING EXTENSION AND EXPANSION OF PROJECT.—Not 

22 later than September 30, 2016, the Secretary shall 

23 submit to Congress and make available to the public 

24 recommendations based on an evaluation of the dem-
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1 onstration project, including the use of appropriate 

2 quality measures, regarding— 

3 ‘‘(A) whether the demonstration project 

4 should be continued after September 30, 2016; 

5 and 

6 ‘‘(B) whether the demonstration project 

7 should be expanded to additional States. 

8 ‘‘(4) RECOMMENDATION TO CONGRESS REGARD9 ING PERMANENT EXTENSION AND NATIONWIDE EXPAN10 SION.— 

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

12 2019, the Secretary shall submit to Congress and 

13 make available to the public recommendations 

14 based on an evaluation of the demonstration 

15 project, including the use of appropriate quality 

16 measures, regarding— 

17 ‘‘(i) whether the demonstration project 

18 should be permanently continued after De19 cember 31, 2019, in 1 or more States; and 

20 ‘‘(ii) whether the demonstration project 

21 should be expanded (including on a nation22 wide basis). 

23 ‘‘(B) REQUIREMENTS.—Any recommenda24 tion submitted under subparagraph (A) to per25 manently continue the project in a State, or to 
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1 expand the project to 1 or more other States (in2 cluding on a nationwide basis) shall include a 

3 certification from the Chief Actuary of the Cen4 ters for Medicare & Medicaid Services that per5 manently continuing the project in a particular 

6 State, or expanding the project to a particular 

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

8 net program spending under title XIX of the So9 cial Security Act. 

10 ‘‘(C) CONGRESSIONAL APPROVAL RE11 QUIRED.—The Secretary shall not permanently 

12 continue the demonstration project in any State 

13 after December 31, 2019, or expand the dem14 onstration project to any additional State after 

15 December 31, 2019, unless Congress enacts a law 

16 approving either or both such actions and the 

17 law includes provisions that— 

18 ‘‘(i) ensure that each State’s participa19 tion in the project complies with budget 

20 neutrality requirements; and 

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

22 expenditures of a State participating in the 

23 demonstration project that are excess of the 

24 expenditures projected under the budget 

25 neutrality standard for the State as an 
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1 overpayment under title XIX of the Social 

2 Security Act. 

3 ‘‘(5) FUNDING.—Of the unobligated balances of 

4 amounts available in the Centers for Medicare & 

5 Medicaid Services Program Management account, 

6 $100,000 shall be available to carry out this sub7 section and shall remain available until expended.’’. 

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

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

10 (1) in subsection (a), in the matter before para11 graph (1), by inserting ‘‘publicly or’’ after ‘‘institu12 tion for mental diseases that is’’; 

13 (2) in subsection (c)— 

14 (A) in paragraph (1), by striking ‘‘An eligi15 ble State’’ and inserting ‘‘Except as otherwise 

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

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

18 shall’’ and inserting ‘‘Except as otherwise pro19 vided in paragraph (4), a State shall’’; and 

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

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

22 that the Secretary makes a recommendation pursuant 

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

24 expanded on a national basis, any State that has sub25 mitted or submits an application pursuant to para-
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1 graph (2) shall be deemed to have been selected to be 

2 an eligible State to participate in the demonstration 

3 project.’’; and 

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

5 ‘‘AND REPORT’’ and inserting ‘‘, REPORT, AND REC6 OMMENDATIONS’’. 

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

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

9 Act. 

Attest: 

Clerk. 
114TH CONGRESS 

1ST SESSION S. 599 

AMENDMENT