Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act

To amend title XIX of the Social Security Act to provide for an extension of the enhanced FMAP for certain Medicaid health homes for individuals with substance use disorders. 1. Short title This Act may be cited as the Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act Medicaid Health HOME Act 2. Extension of enhanced FMAP for certain health homes for individuals with substance use disorders Section 1945 of the Social Security Act ( 42 U.S.C. 1396w–4 (1) in subsection (c)— (A) in paragraph (1), by inserting subject to paragraph (4), except that, (B) by adding at the end the following new paragraph: (4) Special rule relating to substance use disorder health homes (A) In general In the case of a State with an SUD-focused State plan amendment approved by the Secretary on or after October 1, 2018, the Secretary may, at the request of the State, extend the application of the Federal medical assistance percentage described in paragraph (1) to payments for the provision of health home services to SUD-eligible individuals under such State plan amendment, in addition to the first 8 fiscal year quarters the State plan amendment is in effect, for the subsequent 2 fiscal year quarters that the State plan amendment is in effect. Nothing in this section shall be construed as prohibiting a State with a State plan amendment that is approved under this section and that is not an SUD-focused State plan amendment from additionally having approved on or after such date an SUD-focused State plan amendment under this section, including for purposes of application of this paragraph. (B) Report requirements In the case of a State with an SUD-focused State plan amendment for which the application of the Federal medical assistance percentage has been extended under subparagraph (A), such State shall, at the end of the period of such State plan amendment, submit to the Secretary a report on the following, with respect to SUD-eligible individuals provided health home services under such State plan amendment: (i) The quality of health care provided to such individuals, with a focus on outcomes relevant to the recovery of each such individual. (ii) The access of such individuals to health care. (iii) The total expenditures of such individuals for health care. For purposes of this subparagraph, the Secretary shall specify all applicable measures for determining quality, access, and expenditures. (C) Best practices Not later than October 1, 2020, the Secretary shall make publicly available on the Internet website of the Centers for Medicare & Medicaid Services best practices for designing and implementing an SUD-focused State plan amendment, based on the experiences of States that have State plan amendments approved under this section that include SUD-eligible individuals. (D) Definitions For purposes of this paragraph: (i) SUD-eligible individuals The term SUD-eligible individual (I) The individual is an eligible individual with chronic conditions. (II) The individual is an individual with a substance use disorder. (III) The individual has not previously received health home services under any other State plan amendment approved for the State under this section by the Secretary. (ii) SUD-focused State plan amendment The term SUD-focused State plan amendment . 3. Requirement for State Medicaid plans to provide coverage for medication-assisted treatment (a) Requirement for State Medicaid plans to provide coverage for medication-assisted treatment Section 1902(a)(10)(A) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A) and (28) (28), and (29) (b) Inclusion of medication-assisted treatment as medical assistance Section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) (1) in paragraph (28), by striking and (2) by redesignating paragraph (29) as paragraph (30); and (3) by inserting after paragraph (28) the following new paragraph: (29) subject to paragraph (2) of subsection (ee), for the period beginning October 1, 2020, and ending September 30, 2025, medication-assisted treatment (as defined in paragraph (1) of such subsection); and . (c) Medication-assisted treatment defined; Waivers Section 1905 of the Social Security Act ( 42 U.S.C. 1396d (ee) Medication-assisted treatment (1) Definition For purposes of subsection (a)(29), the term medication-assisted treatment (A) means all drugs approved under section 505 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355 42 U.S.C. 262 (B) includes, with respect to the provision of such drugs and biological products, counseling services and behavioral therapy. (2) Exception The provisions of paragraph (29) of subsection (a) shall not apply with respect to a State for the period specified in such paragraph, if before the beginning of such period the State certifies to the satisfaction of the Secretary that implementing such provisions statewide for all individuals eligible to enroll in the State plan (or waiver of the State plan) would not be feasible by reason of a shortage of qualified providers of medication-assisted treatment, or facilities providing such treatment, that will contract with the State or a managed care entity with which the State has a contract under section 1903(m) or under section 1905(t)(3). . (d) Effective date (1) In general Subject to paragraph (2), the amendments made by this section shall apply with respect to medical assistance provided on or after October 1, 2020, and before October 1, 2025. (2) Exception for State legislation In the case of a State plan under title XIX of the Social Security Act ( 42 U.S.C. 1396 Amend the title so as to read: A bill to amend title XIX of the Social Security Act to provide for an extension of the enhanced FMAP for certain Medicaid health homes for individuals with substance use disorders, and to require States to include under their State Medicaid plans coverage for medication-assisted treatment. June 12, 2018 Reported with amendments, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

Summary: Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act or the Medicaid Health HOME Act This bill extends the enhanced federal matching rate for expenditures regarding substance-use disorder health-home services under Medicaid. The bill also temporarily requires coverage of medication-assisted treatment under Medicaid.