114TH CONGRESS 

1ST SESSION S. 599 

AN ACT 

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 subpara18 graph (B) and paragraph (4), a State selected 

19 as an eligible State to participate in the dem20 onstration project on or prior to March 13, 

21 2012, shall, upon the request of the State, be 

22 permitted to continue to participate in the dem23 onstration project through September 30, 2016, 

24 if— 

25 ‘‘(i) the Secretary determines that the 

26 continued participation of the State in the 
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1 demonstration project is projected not to 

2 increase 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 such extension for that State is pro7 jected not to increase net program spend8 ing under title XIX of the Social Security 

9 Act. 

10 ‘‘(B) NOTICE OF PROJECTIONS.—The Sec11 retary shall provide each State selected to par12 ticipate in the demonstration project on or prior 

13 to March 13, 2012, with notice of the deter14 mination and certification made under subpara15 graph (A) for the State. 

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

18 ‘‘(A) ADDITIONAL EXTENSION.—Taking 

19 into account the recommendations submitted to 

20 Congress under subsection (f)(3), the Secretary 

21 may permit an eligible State participating in 

22 the demonstration project as of the date such 

23 recommendations are submitted to continue to 

24 participate in the project through December 31, 

25 2019, if, with respect to the State— 
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1 ‘‘(i) the Secretary determines that the 

2 continued participation of the State in the 

3 demonstration project is projected not to 

4 increase net program spending under title 

5 XIX of the Social Security Act; and 

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

7 for Medicare & Medicaid Services certifies 

8 that the continued participation of the 

9 State in the demonstration project is pro10 jected not to increase net program spend11 ing under title XIX of the Social Security 

12 Act. 

13 ‘‘(B) OPTION FOR EXPANSION TO ADDI14 TIONAL STATES.—Taking into account the rec15 ommendations submitted to Congress pursuant 

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

17 the number of eligible States participating in 

18 the demonstration project through December 

19 31, 2019, if, with respect to any new eligible 

20 State— 

21 ‘‘(i) the Secretary determines that the 

22 participation of the State in the dem23 onstration project is projected not to in24 crease net program spending under title 

25 XIX of the Social Security Act; and 
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1 ‘‘(ii) the Chief Actuary of the Centers 

2 for Medicare & Medicaid Services certifies 

3 that the participation of the State in the 

4 demonstration project is projected not to 

5 increase net program spending under title 

6 XIX of the Social Security Act. 

7 ‘‘(C) NOTICE OF PROJECTIONS.—The Sec8 retary shall provide each State participating in 

9 the demonstration project as of the date the 

10 Secretary submits recommendations to Con11 gress under subsection (f)(3), and any addi12 tional State that applies to be added to the 

13 demonstration project, with notice of the deter14 mination and certification made for the State 

15 under subparagraphs (A) and (B), respectively, 

16 and the standards used to make such deter17 mination and certification— 

18 ‘‘(i) in the case of a State partici19 pating in the demonstration project as of 

20 the date the Secretary submits rec21 ommendations to Congress under sub22 section (f)(3), not later than August 31, 

23 2016; and 

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

25 that applies to be added to the demonstra-
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1 tion project, prior to the State making a 

2 final election to participate in the project. 

3 ‘‘(4) AUTHORITY TO ENSURE BUDGET NEU4 TRALITY.—The Secretary annually shall review each 

5 participating State’s demonstration project expendi6 tures to ensure compliance with the requirements of 

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

8 (3)(B)(i), and (3)(B)(ii) (as applicable). If the Sec9 retary determines with respect to a State’s participa10 tion in the demonstration project that the State’s 

11 net program spending under title XIX of the Social 

12 Security Act has increased as a result of the State’s 

13 participation in the project, the Secretary shall treat 

14 the demonstration project excess expenditures of the 

15 State as an overpayment under title XIX of the So16 cial 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 a State for 

5 emergency psychiatric demonstration services 

6 under this section during the extension period 

7 shall be treated as medical assistance under the 

8 State plan for purposes of section 1903(a)(1) of 

9 the Social Security Act (42 U.S.C. 

10 1396b(a)(1)).’’. 

11 (c) RECOMMENDATIONS TO CONGRESS.—Subsection 

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

13 is amended by adding at the end the following: 

14 ‘‘(3) RECOMMENDATION TO CONGRESS REGARD15 ING EXTENSION AND EXPANSION OF PROJECT.—Not 

16 later than September 30, 2016, the Secretary shall 

17 submit to Congress and make available to the public 

18 recommendations based on an evaluation of the dem19 onstration project, including the use of appropriate 

20 quality measures, regarding— 

21 ‘‘(A) whether the demonstration project 

22 should be continued after September 30, 2016; 

23 and 

24 ‘‘(B) whether the demonstration project 

25 should be expanded to additional States. 
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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 par-
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1 ticular State (or all States) is projected not to 

2 increase net program spending under title XIX 

3 of the Social Security Act. 

4 ‘‘(C) CONGRESSIONAL APPROVAL RE5 QUIRED.—The Secretary shall not permanently 

6 continue the demonstration project in any State 

7 after December 31, 2019, or expand the dem8 onstration project to any additional State after 

9 December 31, 2019, unless Congress enacts a 

10 law approving either or both such actions and 

11 the law includes provisions that— 

12 ‘‘(i) ensure that each State’s partici13 pation in the project complies with budget 

14 neutrality requirements; and 

15 ‘‘(ii) require the Secretary to treat 

16 any expenditures of a State participating 

17 in the demonstration project that are ex18 cess of the expenditures projected under 

19 the budget neutrality standard for the 

20 State as an overpayment under title XIX 

21 of the Social Security Act. 

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

23 Treasury not otherwise appropriated, there is appro24 priated to the Centers for Medicare & Medicaid 

25 Services Program Management Account to carry out 
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1 this subsection, $100,000 for fiscal year 2015, to re2 main available until expended.’’. 

3 (d) CONFORMING AMENDMENTS.—Section 2707 of 

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

5 (1) in subsection (a), in the matter before para6 graph (1), by inserting ‘‘publicly or’’ after ‘‘institu7 tion for mental diseases that is’’; 

8 (2) in subsection (c)— 

9 (A) in paragraph (1), by striking ‘‘An eli10 gible State’’ and inserting ‘‘Except as otherwise 

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

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

13 shall’’ and inserting ‘‘Except as otherwise pro14 vided in paragraph (4), a State shall’’; and 

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

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

17 that the Secretary makes a recommendation pursu18 ant to subsection (f)(4) that the demonstration 

19 project be expanded on a national basis, any State 

20 that has submitted or submits an application pursu21 ant to paragraph (2) shall be deemed to have been 

22 selected to be an eligible State to participate in the 

23 demonstration project.’’; and 
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1 (3) in the heading for subsection (f), by striking 

2 ‘‘AND REPORT’’ and inserting ‘‘, REPORT, AND REC3 OMMENDATIONS’’. 

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

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

6 of this Act. 

Passed the Senate September 28, 2015. 

Attest: 

Secretary. 

114TH CONGRESS 

1ST SESSION S. 599 

AN ACT 

To extend and expand the Medicaid emergency 

psychiatric demonstration project.