Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act

To amend title XIX of the Social Security Act to allow States to provide under Medicaid services for certain individuals with opioid use disorders in institutions for mental diseases. 1. Short title This Act may be cited as the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act IMD CARE Act 2. Medicaid State plan option To provide services for certain individuals with opioid use disorders in institutions for mental diseases Section 1915 of the Social Security Act ( 42 U.S.C. 1396n (l) State plan option To provide services for certain individuals in institutions for mental diseases (1) In general With respect to calendar quarters beginning during the period beginning January 1, 2019, and ending December 31, 2023, a State may elect, through a State plan amendment, to, notwithstanding section 1905(a), provide medical assistance for services furnished in institutions for mental diseases and for other medically necessary services furnished to eligible individuals with opioid use disorders, in accordance with the requirements of this subsection. (2) Payments (A) In general Amounts expended under a State plan amendment under paragraph (1) for services described in such paragraph furnished, with respect to a 12-month period, to an eligible individual with an opioid use disorder who is a patient in an institution for mental diseases shall be treated as medical assistance for which payment is made under section 1903(a) but only to the extent that such services are furnished for not more than a period of 30 days (whether or not consecutive) during such 12-month period. (B) Clarification Payment made under this paragraph for expenditures under a State plan amendment under this subsection with respect to services described in paragraph (1) furnished to an eligible individual with an opioid use disorder shall not affect payment that would otherwise be made under section 1903(a) for expenditures under the State plan (or waiver of such plan) for medical assistance for such individual. (3) Information required in State plan amendment (A) In general A State electing to provide medical assistance pursuant to this subsection shall include with the submission of the State plan amendment under paragraph (1) to the Secretary— (i) a plan on how the State will improve access to outpatient care during the period of the State plan amendment, including a description of— (I) the process by which eligible individuals with opioid use disorders will make the transition from receiving inpatient services in an institution for mental diseases to appropriate outpatient care; and (II) the process the State will undertake to ensure individuals with opioid use disorder are provided care in the most integrated setting appropriate to the needs of the individuals; and (ii) a description of how the State plan amendment ensures an appropriate clinical screening of eligible individuals with an opioid use disorder, including assessments to determine level of care and length of stay recommendations based upon the multidimensional assessment criteria of the American Society of Addiction Medicine. (B) Report Not later than the sooner of December 31, 2024, or one year after the date of the termination of a State plan amendment under this subsection, the State shall submit to the Secretary a report that includes at least— (i) the number of eligible individuals with opioid use disorders who received services pursuant to such State plan amendment; (ii) the length of the stay of each such individual in an institution for mental diseases; and (iii) the type of outpatient treatment, including medication-assisted treatment, each such individual received after being discharged from such institution. (4) Definitions In this subsection: (A) Eligible individual with an opioid use disorder The term eligible individual with an opioid use disorder (i) with respect to a State, is enrolled for medical assistance under the State plan (or a waiver of such plan); (ii) is at least 21 years of age; (iii) has not attained 65 years of age; and (iv) has been diagnosed with at least one opioid use disorder. (B) Institution for mental diseases The term institution for mental diseases (C) Opioid prescription pain reliever The term opioid prescription pain reliever (D) Opioid use disorder The term opioid use disorder (E) Other medically necessary services The term other medically necessary services . June 12, 2018 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

Summary: Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act or the IMD CARE Act (Sec. 2) This bill temporarily allows states to apply to receive federal Medicaid payment for services provided in institutions for mental diseases (IMDs) and for other medically necessary services for enrollees (aged 21 to 64) with opioid-use or cocaine-use disorders. Services may be covered for a total of up to 30 days in a 12-month period for an eligible enrollee. States must include specified information in their applications, including plans to improve access to outpatient care. Current law generally prohibits federal payment under Medicaid for services provided in IMDs for individuals under the age of 65 (although states may receive payment through certain mechanisms, such as through a Medicaid demonstration waiver). (Sec. 3) Additionally, the bill temporarily eliminates the enhanced federal matching rate for Medicaid expenditures regarding specified medical services provided by certain managed care organizations.