I 
114TH CONGRESS 
2D SESSION 
H. R. 5287 
To amend title XIX of the Social Security Act to provide States with an 
option to provide medical assistance to individuals between the ages 
of 22 and 64 for inpatient services to treat substance use disorders 
at certain facilities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 19, 2016 
Mr. FOSTER (for himself, Mrs. LAWRENCE, Ms. SEWELL of Alabama, Mr. 
RYAN of Ohio, Mr. CUMMINGS, Mr. KIND, Ms. CLARK of Massachusetts, 
Ms. NORTON, Ms. DUCKWORTH, and Mr. QUIGLEY) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend title XIX of the Social Security Act to provide 
States with an option to provide medical assistance to 
individuals between the ages of 22 and 64 for inpatient 
services to treat substance use disorders at certain facili-
ties, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicaid Coverage for 
Addiction Recovery Expansion Act’’. 
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SEC. 2. STATE OPTION TO PROVIDE MEDICAL ASSISTANCE 
FOR RESIDENTIAL ADDICTION TREATMENT 
FACILITY SERVICES; MODIFICATION OF THE 
IMD EXCLUSION. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)(16)— 
(A) by striking ‘‘effective’’ and inserting 
‘‘(A) effective’’; and 
(B) by inserting ‘‘, and (B) effective Janu-
ary 1, 2018, residential addiction treatment fa-
cility services (as defined in subsection (h)(3)) 
for individuals over 21 years of age and under 
65 years of age’’ before the semicolon; and 
(2) in subsection (h)— 
(A) in paragraph (1), by striking ‘‘para-
graph (16) of subsection (a)’’ and inserting 
‘‘subsection (a)(16)(A)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(3)(A) For purposes of subsection (a)(16)(B), 
the term ‘residential addiction treatment facility 
services’ means inpatient services provided— 
‘‘(i) to an individual for the purpose of 
treating a substance use disorder that are fur-
nished to an individual for not more than 2 
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consecutive periods of 30 consecutive days, pro-
vided that upon completion of the first 30-day 
period, the individual is assessed by the facility 
and determined to have progressed through the 
clinical continuum of care, in accordance with 
criteria established by the Secretary, in con-
sultation with the American Society of Addic-
tion Medicine, and requires continued medically 
necessary treatment and social support services 
to promote recovery, stable transition, and dis-
charge; and 
‘‘(ii) in a facility that— 
‘‘(I) does not have more than 40 beds; 
and 
‘‘(II) is accredited for the treatment 
of substance use disorders by the Joint 
Commission on Accreditation of Healthcare 
Organizations, the Commission on Accredi-
tation of Rehabilitation Facilities, the 
Council on Accreditation, or any other na-
tionwide accrediting agency that the Sec-
retary deems appropriate. 
‘‘(B) The provision of medical assistance for 
residential addiction treatment facility services to an 
individual shall not prohibit Federal financial par-
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ticipation for medical assistance for items or services 
that are provided to the individual in or away from 
the residential addiction treatment facility during 
any 30-day period in which the individual is receiv-
ing residential addiction treatment facility services. 
‘‘(C) A woman who is eligible for medical as-
sistance on the basis of being pregnant and who is 
furnished residential addiction treatment facility 
services during any 30-day period may remain eligi-
ble for, and continue to be furnished with, such serv-
ices for additional 30-day periods without regard to 
any eligibility limit that would otherwise apply to the 
woman as a result of her pregnancy ending, subject 
to assessment by the facility and a determination 
based on medical necessity related to substance use 
disorder and the impact of substance use disorder on 
birth outcomes.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2018. 
SEC. 3. GRANT PROGRAM TO EXPAND YOUTH ADDICTION 
TREATMENT FACILITIES UNDER MEDICAID 
AND CHIP. 
(a) ESTABLISHMENT.— 
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(1) IN GENERAL.—The Secretary shall establish 
a program under which the Secretary shall award 
grants to States for the purpose of expanding the in-
frastructure and treatment capabilities, including 
augmenting equipment and bed capacity, of eligible 
youth addiction treatment facilities that provide ad-
diction treatment services to Medicaid or CHIP 
beneficiaries who have not attained the age of 21 
and are in communities with high numbers of medi-
cally underserved populations of at-risk youth. 
(2) USE
OF
FUNDS.—Grant funds awarded 
under this section may be used to expand the infra-
structure and treatment capabilities of an existing 
facility (including through construction) but shall 
not be used for the construction of any new facility 
or for the provision of medical assistance or child 
health assistance under Medicaid or CHIP. 
(3) TIMETABLE FOR IMPLEMENTATION; DURA-
TION.— 
(A) IMPLEMENTATION.—Not later than 1 
year after the date of the enactment of this Act, 
the Secretary shall award grants under the 
grant program. 
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(B) 
DURATION.—The 
Secretary 
shall 
award grants under the grant program for a 
period not to exceed 5 years. 
(b) APPLICATION.—A State seeking to participate in 
the grant program shall submit to the Secretary, at such 
time and in such manner as the Secretary shall require, 
an application that includes— 
(1) detailed information on the types of addi-
tional infrastructure and treatment capacity of eligi-
ble youth addiction treatment facilities that the 
State proposes to fund under the grant program; 
(2) a description of the communities in which 
the eligible youth addiction treatment facilities fund-
ed under the grant program operate; 
(3) an assurance that the eligible youth addic-
tion treatment facilities that the State proposes to 
fund under the grant program shall give priority to 
providing addiction treatment services to Medicaid 
or CHIP beneficiaries who have not attained the age 
of 21 and are in communities with high numbers of 
medically underserved populations of at-risk youth; 
and 
(4) such additional information and assurances 
as the Secretary shall require. 
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(c) RURAL AREAS.—Not less than 15 percent of the 
amount of a grant awarded to a State under this section 
shall be used for making payments to eligible youth addic-
tion treatment facilities that are located in rural areas or 
that target the provision of addiction treatment services 
to Medicaid or CHIP beneficiaries who have not attained 
the age of 21 and reside in rural areas. 
(d) DEFINITIONS.—For purposes of this section: 
(1) ADDICTION
TREATMENT
SERVICES.—The 
term ‘‘addiction treatment services’’ means services 
provided to an individual for the purpose of treating 
a substance use disorder. 
(2) CHIP.—The term ‘‘CHIP’’ means the 
State children’s health insurance program estab-
lished under title XXI of the Social Security Act (42 
U.S.C. 1397aa et seq.). 
(3) ELIGIBLE YOUTH ADDICTION TREATMENT 
FACILITY.—The term ‘‘eligible youth addiction treat-
ment facility’’ means a facility that is a participating 
provider under the State Medicaid or CHIP pro-
grams for purposes of providing medical assistance 
or child health assistance to Medicaid or CHIP 
beneficiaries for youth addiction treatment services 
on an inpatient or outpatient basis (or both). 
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(4) MEDICAID.—The term ‘‘Medicaid’’ means 
the medical assistance program established under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.). 
(5) MEDICAID
OR
CHIP
BENEFICIARY.—The 
term ‘‘Medicaid or CHIP beneficiary’’ means an in-
dividual who is enrolled in the State Medicaid plan, 
the State child health plan under CHIP, or under a 
waiver of either such plan. 
(6) 
MEDICALLY
UNDERSERVED
POPU-
LATIONS.—The term ‘‘medically underserved popu-
lations’’ has the meaning given that term in section 
330(b)(3) of the Public Health Service Act (42 
U.S.C. 254b(b)(3)). 
(7) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated $50,000,000 to carry 
out the provisions of this section. Funds appropriated 
under this subsection shall remain available until ex-
pended. 
Æ 
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