S. 599 

One Hundred Fourteenth Congress 

of the 

United States of America 

AT THE FIRST SESSION 

Begun and held at the City of Washington on Tuesday, 

the sixth day of January, two thousand and fifteen 

An Act 

To extend and expand the Medicaid emergency psychiatric demonstration project. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE. 

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

Psychiatric Care Act’’. 

SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMERGENCY PSYCHIATRIC DEMONSTRATION PROJECT. 

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

111–148 (42 U.S.C. 1396a note) is amended to read as follows: 

‘‘(d) LENGTH OF DEMONSTRATION PROJECT.— ‘‘(1) IN GENERAL.—Except as provided in paragraphs (2) 

and (3), the demonstration project established under this section 

shall be conducted for a period of 3 consecutive years. 

‘‘(2) TEMPORARY EXTENSION OF PARTICIPATION ELIGIBILITY

FOR SELECTED STATES.— 

‘‘(A) IN GENERAL.—Subject to subparagraph (B) and 

paragraph (4), a State selected as an eligible State to 

participate in the demonstration project on or prior to 

March 13, 2012, shall, upon the request of the State, be 

permitted to continue to participate in the demonstration 

project through September 30, 2016, if— 

‘‘(i) the Secretary determines that the continued 

participation of the State in the demonstration project 

is projected not to increase net program spending under 

title XIX of the Social Security Act; and 

‘‘(ii) the Chief Actuary of the Centers for Medicare 

& Medicaid Services certifies that such extension for 

that State is projected not to increase net program 

spending under title XIX of the Social Security Act. 

‘‘(B) NOTICE OF PROJECTIONS.—The Secretary shall provide each State selected to participate in the demonstration 

project on or prior to March 13, 2012, with notice of the 

determination and certification made under subparagraph 

(A) for the State. 

‘‘(3) EXTENSION AND EXPANSION OF DEMONSTRATION

PROJECT.— 

‘‘(A) ADDITIONAL EXTENSION.—Taking into account the 

recommendations submitted to Congress under subsection 

(f)(3), the Secretary may permit an eligible State participating in the demonstration project as of the date such 

recommendations are submitted to continue to participate 
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in the project through December 31, 2019, if, with respect 

to the State— 

‘‘(i) the Secretary determines that the continued 

participation of the State in the demonstration project 

is projected not to increase net program spending under 

title XIX of the Social Security Act; and 

‘‘(ii) the Chief Actuary of the Centers for Medicare 

& Medicaid Services certifies that the continued 

participation of the State in the demonstration project 

is projected not to increase net program spending under 

title XIX of the Social Security Act. 

‘‘(B) OPTION FOR EXPANSION TO ADDITIONAL STATES.— 

Taking into account the recommendations submitted to 

Congress pursuant to subsection (f)(3), the Secretary may 

expand the number of eligible States participating in the 

demonstration project through December 31, 2019, if, with 

respect to any new eligible State— 

‘‘(i) the Secretary determines that the participation 

of the State in the demonstration project is projected 

not to increase net program spending under title XIX 

of the Social Security Act; and 

‘‘(ii) the Chief Actuary of the Centers for Medicare 

& Medicaid Services certifies that the participation 

of the State in the demonstration project is projected 

not to increase net program spending under title XIX 

of the Social Security Act. 

‘‘(C) NOTICE OF PROJECTIONS.—The Secretary shall provide each State participating in the demonstration project 

as of the date the Secretary submits recommendations 

to Congress under subsection (f)(3), and any additional 

State that applies to be added to the demonstration project, 

with notice of the determination and certification made 

for the State under subparagraphs (A) and (B), respectively, 

and the standards used to make such determination and 

certification— 

‘‘(i) in the case of a State participating in the 

demonstration project as of the date the Secretary 

submits recommendations to Congress under subsection (f)(3), not later than August 31, 2016; and 

‘‘(ii) in the case of an additional State that applies 

to be added to the demonstration project, prior to the 

State making a final election to participate in the 

project. 

‘‘(4) AUTHORITY TO ENSURE BUDGET NEUTRALITY.—The Secretary annually shall review each participating State’s demonstration project expenditures to ensure compliance with the 

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

(3)(A)(ii), (3)(B)(i), and (3)(B)(ii) (as applicable). If the Secretary 

determines with respect to a State’s participation in the demonstration project that the State’s net program spending under 

title XIX of the Social Security Act has increased as a result 

of the State’s participation in the project, the Secretary shall 

treat the demonstration project excess expenditures of the State 

as an overpayment under title XIX of the Social Security Act.’’. 

(b) FUNDING.—Subsection (e) of section 2707 of such Act (42 

U.S.C. 1396a note) is amended— 
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(1) in the subsection heading, by striking ‘‘LIMITATIONS

ON FEDERAL’’; 

(2) in paragraph (2)— 

(A) in the paragraph heading, by striking ‘‘5-YEAR’’; 

and 

(B) by striking ‘‘through December 31, 2015’’ and 

inserting ‘‘until expended’’; 

(3) by striking paragraph (3); 

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

(3) and (4), respectively; 

(5) in paragraph (3) (as so redesignated), by striking ‘‘and 

the availability of funds’’ and inserting ‘‘(other than States 

deemed to be eligible States through the application of subsection (c)(4))’’; and 

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

(A) in the first sentence— 

(i) by inserting ‘‘(other than a State deemed to 

be an eligible State through the application of subsection (c)(4))’’ after ‘‘eligible State’’; and 

(ii) by striking ‘‘paragraph (4)’’ and inserting ‘‘paragraph (3)’’; and 

(B) by inserting after the first sentence the following: 

‘‘In addition to any payments made to an eligible State 

under the preceding sentence, the Secretary shall, during 

any period in effect under paragraph (2) or (3) of subsection 

(d), or during any period in which a law described in 

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

(including any State deemed to be an eligible State through 

the application of subsection (c)(4)), an amount each quarter 

equal to the Federal medical assistance percentage of 

expenditures in the quarter during such period for medical 

assistance described in subsection (a). Payments made to 

a State for emergency psychiatric demonstration services 

under this section during the extension period shall be 

treated as medical assistance under the State plan for 

purposes of section 1903(a)(1) of the Social Security Act 

(42 U.S.C. 1396b(a)(1)).’’. 

(c) RECOMMENDATIONS TO CONGRESS.—Subsection (f) of section 

2707 of such Act (42 U.S.C. 1396a note) is amended by adding 

at the end the following: 

‘‘(3) RECOMMENDATION TO CONGRESS REGARDING EXTENSION

AND EXPANSION OF PROJECT.—Not later than September 30, 

2016, the Secretary shall submit to Congress and make available to the public recommendations based on an evaluation 

of the demonstration project, including the use of appropriate 

quality measures, regarding— 

‘‘(A) whether the demonstration project should be 

continued after September 30, 2016; and 

‘‘(B) whether the demonstration project should be 

expanded to additional States. 

‘‘(4) RECOMMENDATION TO CONGRESS REGARDING PERMA- NENT EXTENSION AND NATIONWIDE EXPANSION.— ‘‘(A) IN GENERAL.—Not later than April 1, 2019, the 

Secretary shall submit to Congress and make available 

to the public recommendations based on an evaluation 

of the demonstration project, including the use of appropriate quality measures, regarding— 
S. 599—4 

‘‘(i) whether the demonstration project should be 

permanently continued after December 31, 2019, in 

1 or more States; and 

‘‘(ii) whether the demonstration project should be 

expanded (including on a nationwide basis). 

‘‘(B) REQUIREMENTS.—Any recommendation submitted 

under subparagraph (A) to permanently continue the 

project in a State, or to expand the project to 1 or more 

other States (including on a nationwide basis) shall include 

a certification from the Chief Actuary of the Centers for 

Medicare & Medicaid Services that permanently continuing 

the project in a particular State, or expanding the project 

to a particular State (or all States) is projected not to 

increase net program spending under title XIX of the Social 

Security Act. 

‘‘(C) CONGRESSIONAL APPROVAL REQUIRED.—The Secretary shall not permanently continue the demonstration 

project in any State after December 31, 2019, or expand 

the demonstration project to any additional State after 

December 31, 2019, unless Congress enacts a law approving 

either or both such actions and the law includes provisions 

that— 

‘‘(i) ensure that each State’s participation in the 

project complies with budget neutrality requirements; 

and 

‘‘(ii) require the Secretary to treat any expenditures of a State participating in the demonstration 

project that are excess of the expenditures projected 

under the budget neutrality standard for the State 

as an overpayment under title XIX of the Social Security Act. 

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

available in the Centers for Medicare & Medicaid Services 

Program Management account, $100,000 shall be available to 

carry out this subsection and shall remain available until 

expended.’’. 

(d) CONFORMING AMENDMENTS.—Section 2707 of such Act (42 

U.S.C. 1396a note) is amended— 

(1) in subsection (a), in the matter before paragraph (1), 

by inserting ‘‘publicly or’’ after ‘‘institution for mental diseases 

that is’’; 

(2) in subsection (c)— 

(A) in paragraph (1), by striking ‘‘An eligible State’’ 

and inserting ‘‘Except as otherwise provided in paragraph 

(4), an eligible State’’; 

(B) in paragraph (3), by striking ‘‘A State shall’’ and 

inserting ‘‘Except as otherwise provided in paragraph (4), 

a State shall’’; and 

(C) by adding at the end the following: 

‘‘(4) NATIONWIDE AVAILABILITY.—In the event that the Secretary makes a recommendation pursuant to subsection (f)(4) 

that the demonstration project be expanded on a national basis, 

any State that has submitted or submits an application pursuant to paragraph (2) shall be deemed to have been selected 

to be an eligible State to participate in the demonstration 

project.’’; and 
S. 599—5 

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

REPORT’’ and inserting ‘‘, REPORT, AND RECOMMENDATIONS’’. 

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

shall take effect on the date of the enactment of this Act. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.