I 
115TH CONGRESS 
2D SESSION 
H. R. 5797 
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. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2018 
Mrs. MIMI WALTERS of California (for herself, Mr. KNIGHT, and Mr. GUTH-
RIE) introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
A BILL 
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. 
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 ‘‘Individuals in Medicaid 
Deserve Care that is Appropriate and Responsible in its 
Delivery Act’’ or the ‘‘IMD CARE Act’’. 
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SEC. 2. MEDICAID STATE PLAN OPTION TO PROVIDE SERV-
ICES 
FOR 
CERTAIN 
INDIVIDUALS 
WITH 
OPIOID USE DISORDERS IN INSTITUTIONS 
FOR MENTAL DISEASES. 
Section 1915 of the Social Security Act (42 U.S.C. 
1396n) is amended by adding at the end the following new 
subsection: 
‘‘(l) STATE PLAN OPTION TO PROVIDE SERVICES 
FOR CERTAIN INDIVIDUALS IN INSTITUTIONS FOR MEN-
TAL DISEASES.— 
‘‘(1) IN GENERAL.—With respect to calendar 
quarters beginning during the period beginning Jan-
uary 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 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 para-
graph (1) for services described in such para-
graph furnished, with respect to a 12-month pe-
riod, in an institution for mental diseases to an 
eligible individual with an opioid use disorder 
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shall be treated as medical assistance for which 
payment is made under section 1903(a) but 
only to the extent that, subject to subparagraph 
(B), such services are furnished for not more 
than a period of 30 days (whether or not con-
secutive) during such 12-month period. 
‘‘(B) LIMITATIONS.—Payment for expendi-
tures described in subparagraph (A), with re-
spect to services described in paragraph (1) fur-
nished in an institution for mental diseases to 
an eligible individual with an opioid use dis-
order during a 12-month period, shall not be 
made under section 1903(a) with respect to 
such services furnished during any period ex-
ceeding 30 consecutive days during such 12- 
month period, unless the State requires under 
the State plan amendment continued medically 
necessary treatment during the entire period for 
which such services are furnished and for which 
payment is made pursuant to this paragraph in 
order to promote recovery, stable transition to 
ongoing treatment, and discharge. 
‘‘(C) 
CLARIFICATION.—Payment 
made 
under this paragraph for expenditures under a 
State plan amendment under this subsection 
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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 sub-
section shall include with the submission of the 
State plan amendment under paragraph (1) to 
the Secretary— 
‘‘(i) a plan on how the State will im-
prove access to outpatient care during the 
period of the State plan amendment, in-
cluding a description of— 
‘‘(I) the process by which eligible 
individuals with opioid use disorders 
will make the transition from receiv-
ing inpatient services in an institution 
for mental diseases to appropriate 
outpatient care; and 
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‘‘(II) the process the State will 
undertake to ensure individuals with 
opioid use disorder are provided care 
in the most integrated setting appro-
priate 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 as-
sessments to determine level of care and 
length of stay recommendations based 
upon the multidimensional assessment cri-
teria of the American Society of Addiction 
Medicine. 
‘‘(B) REPORT.—Not later than 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 in-
cludes at least— 
‘‘(i) the number of eligible individuals 
with opioid use disorders who received 
services pursuant to such plan; 
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‘‘(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 in-
dividual with an opioid use disorder’ means an 
individual who— 
‘‘(i) with respect to a State, is en-
rolled 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
DIS-
EASES.—The term ‘institution for mental dis-
eases’ has the meaning given such term in sec-
tion 1905(i). 
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‘‘(C) OPIOID
PRESCRIPTION
PAIN
RE-
LIEVER.—The term ‘opioid prescription pain re-
liever’ 
includes 
hydrocodone 
products, 
oxycodone products, tramadol products, codeine 
products, morphine products, fentanyl products, 
buprenorphine products, oxymorphone products, 
meperidine products, hydromorphone products, 
methadone, and any other prescription pain re-
liever identified by the Assistant Secretary for 
Mental Health and Substance Use. 
‘‘(D) OPIOID USE DISORDER.—The term 
‘opioid use disorder’ means a disorder that 
meets the criteria of the Diagnostic and Statis-
tical Manual of Mental Disorders, 4th Edition 
(or a successor edition), for heroin use disorder 
or pain reliever use disorder (including with re-
spect to opioid prescription pain relievers).’’. 
Æ 
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