II 

114TH CONGRESS 

1ST SESSION S. 599 

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, and Ms. COLLINS) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

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, 

3 SECTION 1. SHORT TITLE. 

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

5 Emergency Psychiatric Care Act’’. 


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1 SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMER2 GENCY PSYCHIATRIC DEMONSTRATION 

3 PROJECT. 

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

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

6 to read as follows: 

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

8 ‘‘(1) IN GENERAL.—Except as provided in para9 graphs (2) and (3), the demonstration project estab10 lished under this section shall be conducted for a pe11 riod of 3 consecutive years. 

12 ‘‘(2) TEMPORARY EXTENSION OF PARTICIPA13 TION ELIGIBILITY FOR SELECTED STATES.— 

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

15 (3), a State selected as an eligible State to par16 ticipate in the demonstration project on or prior 

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

18 the State, be permitted to continue to partici19 pate in the demonstration project through the 

20 date described in subparagraph (B) if— 

21 ‘‘(i) the Secretary determines that the 

22 continued participation of the State in the 

23 demonstration project is not expected to 

24 increase spending under title XIX of the 

25 Social Security Act; and 


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

2 for Medicare & Medicaid Services certifies 

3 that such extension for that State is pro4 jected to reduce (or is projected not to re5 sult in any increase in) net program spend6 ing under title XIX of the Social Security 

7 Act. 

8 ‘‘(B) DATE DESCRIBED.—The date de9 scribed in this subparagraph is the earlier of— 

10 ‘‘(i) the date on which Secretary sub11 mits the recommendations required under 

12 subsection (f)(3); or 

13 ‘‘(ii) September 30, 2016. 

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

16 ‘‘(A) ADDITIONAL EXTENSION.—Taking 

17 into account the recommendations submitted to 

18 Congress pursuant to subsection (f)(3), the Sec19 retary may, if the Secretary determines that ex20 tension and expansion of the demonstration 

21 project satisfies the criteria for the temporary 

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

23 paragraph (2)— 

24 ‘‘(i) extend the demonstration project 

25 through December 31, 2019; and 


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1 ‘‘(ii) permit any eligible State partici2 pating in the demonstration project as of 

3 the date such recommendations are sub4 mitted to continue to participate in the 

5 project. 

6 ‘‘(B) OPTION FOR EXPANSION TO ADDI7 TIONAL STATES.—Taking into account the rec8 ommendations submitted to Congress pursuant 

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

10 (including on a nationwide basis) the number of 

11 eligible States participating in the demonstra12 tion project during the extension period estab13 lished under subparagraph (A) if, with respect 

14 to any new eligible State— 

15 ‘‘(i) the Secretary determines that the 

16 participation of the State in the dem17 onstration project is not expected to in18 crease spending under title XIX of the So19 cial Security Act; and 

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

21 for Medicare & Medicaid Services certifies 

22 that the participation of the State in the 

23 demonstration project is projected to re24 duce (or is projected not to result in any 


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1 increase in) net program spending under 

2 title XIX of the Social Security Act. 

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), (2)(B), (3)(B)(i), and (3)(B)(ii) 

8 (as applicable). If the Secretary determines with re9 spect to a State’s participation in the demonstration 

10 project that the State’s net program spending under 

11 title XIX of the Social Security Act has increased as 

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

13 the Secretary shall treat the demonstration project 

14 excess expenditures of the State as an overpayment 

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

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

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

18 (1) in the subsection heading, by striking ‘‘LIM19 ITATIONS ON FEDERAL’’; 

20 (2) in paragraph (2)— 

21 (A) in the paragraph heading, by striking 

22 ‘‘5-YEAR’’; and 

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

24 2015’’ and inserting ‘‘until expended’’; 

25 (3) by striking paragraph (3); 


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

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

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

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

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

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

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

8 (A) in the first sentence— 

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

10 deemed to be an eligible State through the 

11 application of subsection (c)(4))’’ after ‘‘el12 igible State’’; and 

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

14 inserting ‘‘paragraph (3)’’; and 

15 (B) by inserting after the first sentence 

16 the following ‘‘In addition to any payments 

17 made to an eligible State under the preceding 

18 sentence, the Secretary shall, during any period 

19 in effect under paragraph (2) or (3) of sub20 section (d), or during any period in which a law 

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

22 pay each eligible State (including any State 

23 deemed to be an eligible State through the ap24 plication of subsection (c)(4)), an amount each 

25 quarter equal to the Federal medical assistance 


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1 percentage of expenditures in the quarter dur2 ing such period for medical assistance described 

3 in subsection (a). Payments made to States 

4 under this paragraph shall be considered to 

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

6 requirements of section 1903 of the Social Se7 curity Act (42 U.S.C. 1396b).’’. 

8 (c) RECOMMENDATIONS TO CONGRESS.—Subsection 

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

10 is amended by adding at the end the following: 

11 ‘‘(3) RECOMMENDATION TO CONGRESS REGARD12 ING EXTENSION AND EXPANSION OF PROJECT.—Not 

13 later than September 30, 2016, the Secretary shall 

14 submit to Congress and make available to the public 

15 recommendations based on an evaluation of the dem16 onstration project, including the use of appropriate 

17 quality measures, regarding— 

18 ‘‘(A) whether the demonstration project 

19 should be continued after December 31, 2016; 

20 and 

21 ‘‘(B) whether the demonstration project 

22 should be expanded (including on a nationwide 

23 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 02:01 Mar 06, 2015 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S599.IS 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. 

Æ 


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