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Social Security Act for non-payment under title XIX of 
such Act when the Secretary finds the inclusion of such con-
ditions to be inapplicable to beneficiaries under title XIX. 
SEC. 2703. STATE OPTION TO PROVIDE HEALTH HOMES FOR 
ENROLLEES WITH CHRONIC CONDITIONS. 
(a) STATE PLAN AMENDMENT.—Title XIX of the So-
cial Security Act (42 U.S.C. 1396a et seq.), as amended 
by sections 2201 and 2305, is amended by adding at the 
end the following new section: 
‘‘SEC. 1945. STATE OPTION TO PROVIDE COORDI-
NATED CARE THROUGH A HEALTH HOME FOR INDIVID-
UALS WITH CHRONIC CONDITIONS.— 
‘‘(a) 
IN
GENERAL.—Notwithstanding 
section 
1902(a)(1) 
(relating 
to 
statewideness), 
section 
1902(a)(10)(B) (relating to comparability), and any other 
provision of this title for which the Secretary determines 
it is necessary to waive in order to implement this section, 
beginning January 1, 2011, a State, at its option as a State 
plan amendment, may provide for medical assistance under 
this title to eligible individuals with chronic conditions who 
select a designated provider (as described under subsection 
(h)(5)), a team of health care professionals (as described 
under subsection (h)(6)) operating with such a provider, or 
a health team (as described under subsection (h)(7)) as the
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individual’s health home for purposes of providing the indi-
vidual with health home services. 
‘‘(b) HEALTH HOME QUALIFICATION STANDARDS.— 
The Secretary shall establish standards for qualification as 
a designated provider for the purpose of being eligible to 
be a health home for purposes of this section. 
‘‘(c) PAYMENTS.— 
‘‘(1) IN GENERAL.—A State shall provide a des-
ignated provider, a team of health care professionals 
operating with such a provider, or a health team with 
payments for the provision of health home services to 
each eligible individual with chronic conditions that 
selects such provider, team of health care profes-
sionals, or health team as the individual’s health 
home. Payments made to a designated provider, a 
team of health care professionals operating with such 
a provider, or a health team for such services shall be 
treated as medical assistance for purposes of section 
1903(a), except that, during the first 8 fiscal year 
quarters that the State plan amendment is in effect, 
the Federal medical assistance percentage applicable 
to such payments shall be equal to 90 percent. 
‘‘(2) METHODOLOGY.— 
‘‘(A) IN GENERAL.—The State shall specify 
in the State plan amendment the methodology
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the State will use for determining payment for 
the provision of health home services. Such meth-
odology for determining payment— 
‘‘(i) may be tiered to reflect, with re-
spect to each eligible individual with chron-
ic conditions provided such services by a 
designated provider, a team of health care 
professionals operating with such a pro-
vider, or a health team, as well as the sever-
ity or number of each such individual’s 
chronic conditions or the specific capabili-
ties of the provider, team of health care pro-
fessionals, or health team; and 
‘‘(ii) shall be established consistent 
with section 1902(a)(30)(A). 
‘‘(B) ALTERNATE MODELS OF PAYMENT.— 
The methodology for determining payment for 
provision of health home services under this sec-
tion shall not be limited to a per-member per- 
month basis and may provide (as proposed by 
the State and subject to approval by the Sec-
retary) for alternate models of payment. 
‘‘(3) PLANNING GRANTS.— 
‘‘(A) IN GENERAL.—Beginning January 1, 
2011, the Secretary may award planning grants
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to States for purposes of developing a State plan 
amendment under this section. A planning grant 
awarded to a State under this paragraph shall 
remain available until expended. 
‘‘(B) 
STATE
CONTRIBUTION.—A 
State 
awarded a planning grant shall contribute an 
amount equal to the State percentage determined 
under section 1905(b) (without regard to section 
5001 of Public Law 111–5) for each fiscal year 
for which the grant is awarded. 
‘‘(C) LIMITATION.—The total amount of 
payments made to States under this paragraph 
shall not exceed $25,000,000. 
‘‘(d) HOSPITAL REFERRALS.—A State shall include in 
the State plan amendment a requirement for hospitals that 
are participating providers under the State plan or a waiv-
er of such plan to establish procedures for referring any eli-
gible individuals with chronic conditions who seek or need 
treatment in a hospital emergency department to des-
ignated providers. 
‘‘(e) COORDINATION.—A State shall consult and co-
ordinate, as appropriate, with the Substance Abuse and 
Mental Health Services Administration in addressing issues 
regarding the prevention and treatment of mental illness
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and substance abuse among eligible individuals with chron-
ic conditions. 
‘‘(f) MONITORING.—A State shall include in the State 
plan amendment— 
‘‘(1) a methodology for tracking avoidable hos-
pital readmissions and calculating savings that result 
from improved chronic care coordination and man-
agement under this section; and 
‘‘(2) a proposal for use of health information 
technology in providing health home services under 
this section and improving service delivery and co-
ordination across the care continuum (including the 
use of wireless patient technology to improve coordi-
nation and management of care and patient adher-
ence to recommendations made by their provider). 
‘‘(g) REPORT ON QUALITY MEASURES.—As a condi-
tion for receiving payment for health home services provided 
to an eligible individual with chronic conditions, a des-
ignated provider shall report to the State, in accordance 
with such requirements as the Secretary shall specify, on 
all applicable measures for determining the quality of such 
services. When appropriate and feasible, a designated pro-
vider shall use health information technology in providing 
the State with such information. 
‘‘(h) DEFINITIONS.—In this section:
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‘‘(1) ELIGIBLE INDIVIDUAL WITH CHRONIC CON-
DITIONS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘eligible individual with 
chronic conditions’ means an individual who— 
‘‘(i) is eligible for medical assistance 
under the State plan or under a waiver of 
such plan; and 
‘‘(ii) has at least— 
‘‘(I) 2 chronic conditions; 
‘‘(II) 1 chronic condition and is 
at risk of having a second chronic con-
dition; or 
‘‘(III) 1 serious and persistent 
mental health condition. 
‘‘(B) RULE OF CONSTRUCTION.—Nothing in 
this paragraph shall prevent the Secretary from 
establishing higher levels as to the number or se-
verity of chronic or mental health conditions for 
purposes of determining eligibility for receipt of 
health home services under this section. 
‘‘(2) CHRONIC
CONDITION.—The term ‘chronic 
condition’ has the meaning given that term by the 
Secretary and shall include, but is not limited to, the 
following:
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‘‘(A) A mental health condition. 
‘‘(B) Substance use disorder. 
‘‘(C) Asthma. 
‘‘(D) Diabetes. 
‘‘(E) Heart disease. 
‘‘(F) Being overweight, as evidenced by hav-
ing a Body Mass Index (BMI) over 25. 
‘‘(3) HEALTH HOME.—The term ‘health home’ 
means a designated provider (including a provider 
that operates in coordination with a team of health 
care professionals) or a health team selected by an eli-
gible individual with chronic conditions to provide 
health home services. 
‘‘(4) HEALTH HOME SERVICES.— 
‘‘(A) IN GENERAL.—The term ‘health home 
services’ means comprehensive and timely high- 
quality services described in subparagraph (B) 
that are provided by a designated provider, a 
team of health care professionals operating with 
such a provider, or a health team. 
‘‘(B) SERVICES
DESCRIBED.—The services 
described in this subparagraph are— 
‘‘(i) comprehensive care management; 
‘‘(ii) care coordination and health pro-
motion;
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‘‘(iii) comprehensive transitional care, 
including appropriate follow-up, from inpa-
tient to other settings; 
‘‘(iv) patient and family support (in-
cluding authorized representatives); 
‘‘(v) referral to community and social 
support services, if relevant; and 
‘‘(vi) use of health information tech-
nology to link services, as feasible and ap-
propriate. 
‘‘(5) DESIGNATED
PROVIDER.—The term ‘des-
ignated provider’ means a physician, clinical practice 
or clinical group practice, rural clinic, community 
health center, community mental health center, home 
health agency, or any other entity or provider (in-
cluding pediatricians, gynecologists, and obstetri-
cians) that is determined by the State and approved 
by the Secretary to be qualified to be a health home 
for eligible individuals with chronic conditions on the 
basis of documentation evidencing that the physician, 
practice, or clinic— 
‘‘(A) has the systems and infrastructure in 
place to provide health home services; and 
‘‘(B) satisfies the qualification standards es-
tablished by the Secretary under subsection (b).
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‘‘(6) TEAM OF HEALTH CARE PROFESSIONALS.— 
The term ‘team of health care professionals’ means a 
team of health professionals (as described in the State 
plan amendment) that may— 
‘‘(A) include physicians and other profes-
sionals, such as a nurse care coordinator, nutri-
tionist, social worker, behavioral health profes-
sional, or any professionals deemed appropriate 
by the State; and 
‘‘(B) be free standing, virtual, or based at 
a hospital, community health center, community 
mental health center, rural clinic, clinical prac-
tice or clinical group practice, academic health 
center, or any entity deemed appropriate by the 
State and approved by the Secretary. 
‘‘(7) HEALTH
TEAM.—The term ‘health team’ 
has the meaning given such term for purposes of sec-
tion 3502 of the Patient Protection and Affordable 
Care Act.’’. 
(b) EVALUATION.— 
(1) INDEPENDENT EVALUATION.— 
(A) IN GENERAL.—The Secretary shall enter 
into a contract with an independent entity or 
organization to conduct an evaluation and as-
sessment of the States that have elected the op-
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tion to provide coordinated care through a health 
home for Medicaid beneficiaries with chronic 
conditions under section 1945 of the Social Secu-
rity Act (as added by subsection (a)) for the pur-
pose of determining the effect of such option on 
reducing hospital admissions, emergency room 
visits, and admissions to skilled nursing facili-
ties. 
(B) EVALUATION REPORT.—Not later than 
January 1, 2017, the Secretary shall report to 
Congress on the evaluation and assessment con-
ducted under subparagraph (A). 
(2) SURVEY AND INTERIM REPORT.— 
(A) IN GENERAL.—Not later than January 
1, 2014, the Secretary of Health and Human 
Services shall survey States that have elected the 
option under section 1945 of the Social Security 
Act (as added by subsection (a)) and report to 
Congress on the nature, extent, and use of such 
option, particularly as it pertains to— 
(i) hospital admission rates; 
(ii) chronic disease management; 
(iii) coordination of care for individ-
uals with chronic conditions;
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(iv) assessment of program implemen-
tation; 
(v) processes and lessons learned (as 
described in subparagraph (B)); 
(vi) assessment of quality improve-
ments and clinical outcomes under such op-
tion; and 
(vii) estimates of cost savings. 
(B) 
IMPLEMENTATION
REPORTING.—A 
State that has elected the option under section 
1945 of the Social Security Act (as added by 
subsection (a)) shall report to the Secretary, as 
necessary, on processes that have been developed 
and lessons learned regarding provision of co-
ordinated care through a health home for Med-
icaid beneficiaries with chronic conditions under 
such option. 
SEC. 2704. DEMONSTRATION PROJECT TO EVALUATE INTE-
GRATED CARE AROUND A HOSPITALIZATION. 
(a) AUTHORITY TO CONDUCT PROJECT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall establish a demonstration project 
under title XIX of the Social Security Act to evaluate
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the use of bundled payments for the provision of inte-
grated care for a Medicaid beneficiary— 
(A) with respect to an episode of care that 
includes a hospitalization; and 
(B) for concurrent physicians services pro-
vided during a hospitalization. 
(2) DURATION.—The demonstration project shall 
begin on January 1, 2012, and shall end on December 
31, 2016. 
(b) REQUIREMENTS.—The demonstration project shall 
be conducted in accordance with the following: 
(1) The demonstration project shall be conducted 
in up to 8 States, determined by the Secretary based 
on consideration of the potential to lower costs under 
the Medicaid program while improving care for Med-
icaid beneficiaries. A State selected to participate in 
the demonstration project may target the demonstra-
tion project to particular categories of beneficiaries, 
beneficiaries with particular diagnoses, or particular 
geographic regions of the State, but the Secretary 
shall insure that, as a whole, the demonstration 
project is, to the greatest extent possible, representa-
tive of the demographic and geographic composition 
of Medicaid beneficiaries nationally.
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care had not been subject to payment under the dem-
onstration project. 
(5) Hospitals participating in the demonstration 
project shall have or establish robust discharge plan-
ning programs to ensure that Medicaid beneficiaries 
requiring post-acute care are appropriately placed in, 
or have ready access to, post-acute care settings. 
(6) The Secretary and each State selected to par-
ticipate in the demonstration project shall ensure that 
the demonstration project does not result in the Med-
icaid beneficiaries whose care is subject to payment 
under the demonstration project being provided with 
less items and services for which medical assistance is 
provided under the State Medicaid program than the 
items and services for which medical assistance would 
have been provided to such beneficiaries under the 
State Medicaid program in the absence of the dem-
onstration project. 
(c) WAIVER OF PROVISIONS.—Notwithstanding section 
1115(a) of the Social Security Act (42 U.S.C. 1315(a)), the 
Secretary may waive such provisions of titles XIX, XVIII, 
and XI of that Act as may be necessary to accomplish the 
goals of the demonstration, ensure beneficiary access to 
acute and post-acute care, and maintain quality of care. 
(d) EVALUATION AND REPORT.—
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(1) DATA.—Each State selected to participate in 
the demonstration project under this section shall pro-
vide to the Secretary, in such form and manner as the 
Secretary shall specify, relevant data necessary to 
monitor outcomes, costs, and quality, and evaluate the 
rationales for selection of the episodes of care and 
services specified by States under subsection (b)(3). 
(2) REPORT.—Not later than 1 year after the 
conclusion of the demonstration project, the Secretary 
shall submit a report to Congress on the results of the 
demonstration project. 
SEC. 2705. MEDICAID GLOBAL PAYMENT SYSTEM DEM-
ONSTRATION PROJECT. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall, in coordination with the Center for Medicare 
and Medicaid Innovation (as established under section 
1115A of the Social Security Act, as added by section 3021 
of this Act), establish the Medicaid Global Payment System 
Demonstration Project under which a participating State 
shall adjust the payments made to an eligible safety net 
hospital system or network from a fee-for-service payment 
structure to a global capitated payment model. 
(b) DURATION
AND
SCOPE.—The demonstration 
project conducted under this section shall operate during
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a period of fiscal years 2010 through 2012. The Secretary 
shall select not more than 5 States to participate in the 
demonstration project. 
(c) ELIGIBLE SAFETY NET HOSPITAL SYSTEM
OR 
NETWORK.—For purposes of this section, the term ‘‘eligible 
safety net hospital system or network’’ means a large, safety 
net hospital system or network (as defined by the Secretary) 
that operates within a State selected by the Secretary under 
subsection (b). 
(d) EVALUATION.— 
(1) TESTING.—The Innovation Center shall test 
and evaluate the demonstration project conducted 
under this section to examine any changes in health 
care quality outcomes and spending by the eligible 
safety net hospital systems or networks. 
(2) BUDGET NEUTRALITY.—During the testing 
period under paragraph (1), any budget neutrality 
requirements under section 1115A(b)(3) of the Social 
Security Act (as so added) shall not be applicable. 
(3) MODIFICATION.—During the testing period 
under paragraph (1), the Secretary may, in the Sec-
retary’s discretion, modify or terminate the dem-
onstration project conducted under this section. 
(e) REPORT.—Not later than 12 months after the date 
of completion of the demonstration project under this sec-
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tion, the Secretary shall submit to Congress a report con-
taining the results of the evaluation and testing conducted 
under subsection (d), together with recommendations for 
such legislation and administrative action as the Secretary 
determines appropriate. 
(f) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated such sums as are necessary 
to carry out this section. 
SEC. 2706. PEDIATRIC ACCOUNTABLE CARE ORGANIZATION 
DEMONSTRATION PROJECT. 
(a) AUTHORITY TO CONDUCT DEMONSTRATION.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the 
‘‘Secretary’’) shall establish the Pediatric Accountable 
Care Organization Demonstration Project to author-
ize a participating State to allow pediatric medical 
providers that meet specified requirements to be recog-
nized as an accountable care organization for pur-
poses of receiving incentive payments (as described 
under subsection (d)), in the same manner as an ac-
countable care organization is recognized and pro-
vided with incentive payments under section 1899 of 
the Social Security Act (as added by section 3022).
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(2) DURATION.—The demonstration project shall 
begin on January 1, 2012, and shall end on December 
31, 2016. 
(b) APPLICATION.—A State that desires to participate 
in the demonstration project under this section shall submit 
to the Secretary an application at such time, in such man-
ner, and containing such information as the Secretary may 
require. 
(c) REQUIREMENTS.— 
(1) PERFORMANCE GUIDELINES.—The Secretary, 
in consultation with the States and pediatric pro-
viders, shall establish guidelines to ensure that the 
quality of care delivered to individuals by a provider 
recognized as an accountable care organization under 
this section is not less than the quality of care that 
would have otherwise been provided to such individ-
uals. 
(2) SAVINGS
REQUIREMENT.—A participating 
State, in consultation with the Secretary, shall estab-
lish an annual minimal level of savings in expendi-
tures for items and services covered under the Med-
icaid program under title XIX of the Social Security 
Act and the CHIP program under title XXI of such 
Act that must be reached by an accountable care orga-
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nization in order for such organization to receive an 
incentive payment under subsection (d). 
(3) MINIMUM PARTICIPATION PERIOD.—A pro-
vider desiring to be recognized as an accountable care 
organization under the demonstration project shall 
enter into an agreement with the State to participate 
in the project for not less than a 3-year period. 
(d) INCENTIVE PAYMENT.—An accountable care orga-
nization that meets the performance guidelines established 
by the Secretary under subsection (c)(1) and achieves sav-
ings greater than the annual minimal savings level estab-
lished by the State under subsection (c)(2) shall receive an 
incentive payment for such year equal to a portion (as de-
termined appropriate by the Secretary) of the amount of 
such excess savings. The Secretary may establish an annual 
cap on incentive payments for an accountable care organi-
zation. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated such sums as are necessary 
to carry out this section. 
SEC. 2707. MEDICAID EMERGENCY PSYCHIATRIC DEM-
ONSTRATION PROJECT. 
(a) 
AUTHORITY
TO
CONDUCT
DEMONSTRATION 
PROJECT.—The Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall estab-
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lish a demonstration project under which an eligible State 
(as described in subsection (c)) shall provide payment under 
the State Medicaid plan under title XIX of the Social Secu-
rity Act to an institution for mental diseases that is not 
publicly owned or operated and that is subject to the re-
quirements of section 1867 of the Social Security Act (42 
U.S.C. 1395dd) for the provision of medical assistance 
available under such plan to individuals who— 
(1) have attained age 21, but have not attained 
age 65; 
(2) are eligible for medical assistance under such 
plan; and 
(3) require such medical assistance to stabilize 
an emergency medical condition. 
(b) STABILIZATION REVIEW.—A State shall specify in 
its application described in subsection (c)(1) establish a 
mechanism for how it will ensure that institutions partici-
pating in the demonstration will determine whether or not 
such individuals have been stabilized (as defined in sub-
section (h)(5)). This mechanism shall commence before the 
third day of the inpatient stay. States participating in the 
demonstration project may manage the provision of services 
for the stabilization of medical emergency conditions 
through utilization review, authorization, or management
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practices, or the application of medical necessity and ap-
propriateness criteria applicable to behavioral health. 
(c) ELIGIBLE STATE DEFINED.— 
(1) IN GENERAL.—An eligible State is a State 
that has made an application and has been selected 
pursuant to paragraphs (2) and (3). 
(2) APPLICATION.—A State seeking to partici-
pate in the demonstration project under this section 
shall submit to the Secretary, at such time and in 
such format as the Secretary requires, an application 
that includes such information, provisions, and assur-
ances, as the Secretary may require. 
(3) SELECTION.—A State shall be determined el-
igible for the demonstration by the Secretary on a 
competitive basis among States with applications 
meeting the requirements of paragraph (1). In select-
ing State applications for the demonstration project, 
the Secretary shall seek to achieve an appropriate na-
tional balance in the geographic distribution of such 
projects. 
(d) LENGTH
OF DEMONSTRATION PROJECT.—The 
demonstration project established under this section shall 
be conducted for a period of 3 consecutive years. 
(e) LIMITATIONS ON FEDERAL FUNDING.— 
(1) APPROPRIATION.—
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(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
appropriated 
to 
carry 
out 
this 
section, 
$75,000,000 for fiscal year 2011. 
(B) BUDGET
AUTHORITY.—Subparagraph 
(A) constitutes budget authority in advance of 
appropriations Act and represents the obligation 
of the Federal Government to provide for the 
payment of the amounts appropriated under that 
subparagraph. 
(2) 5-YEAR AVAILABILITY.—Funds appropriated 
under paragraph (1) shall remain available for obli-
gation through December 31, 2015. 
(3) LIMITATION
ON
PAYMENTS.—In no case 
may— 
(A) the aggregate amount of payments made 
by the Secretary to eligible States under this sec-
tion exceed $75,000,000; or 
(B) payments be provided by the Secretary 
under this section after December 31, 2015. 
(4) FUNDS ALLOCATED TO STATES.—Funds shall 
be allocated to eligible States on the basis of criteria, 
including a State’s application and the availability 
of funds, as determined by the Secretary.
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(5) PAYMENTS TO STATES.—The Secretary shall 
pay to each eligible State, from its allocation under 
paragraph (4), an amount each quarter equal to the 
Federal medical assistance percentage of expenditures 
in the quarter for medical assistance described in sub-
section (a). As a condition of receiving payment, a 
State shall collect and report information, as deter-
mined necessary by the Secretary, for the purposes of 
providing Federal oversight and conducting an eval-
uation under subsection (f)(1). 
(f) EVALUATION AND REPORT TO CONGRESS.— 
(1) EVALUATION.—The Secretary shall conduct 
an evaluation of the demonstration project in order to 
determine the impact on the functioning of the health 
and mental health service system and on individuals 
enrolled in the Medicaid program and shall include 
the following: 
(A) An assessment of access to inpatient 
mental health services under the Medicaid pro-
gram; average lengths of inpatient stays; and 
emergency room visits. 
(B) An assessment of discharge planning by 
participating hospitals. 
(C) An assessment of the impact of the dem-
onstration project on the costs of the full range
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of mental health services (including inpatient, 
emergency and ambulatory care). 
(D) An analysis of the percentage of con-
sumers with Medicaid coverage who are admitted 
to inpatient facilities as a result of the dem-
onstration project as compared to those admitted 
to these same facilities through other means. 
(E) A recommendation regarding whether 
the demonstration project should be continued 
after December 31, 2013, and expanded on a na-
tional basis. 
(2) REPORT.—Not later than December 31, 2013, 
the Secretary shall submit to Congress and make 
available to the public a report on the findings of the 
evaluation under paragraph (1). 
(g) WAIVER AUTHORITY.— 
(1) IN GENERAL.—The Secretary shall waive the 
limitation of subdivision (B) following paragraph 
(28) of section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) (relating to limitations on pay-
ments for care or services for individuals under 65 
years of age who are patients in an institution for 
mental diseases) for purposes of carrying out the dem-
onstration project under this section.
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(2) LIMITED OTHER WAIVER AUTHORITY.—The 
Secretary may waive other requirements of titles XI 
and XIX of the Social Security Act (including the re-
quirements 
of 
sections 
1902(a)(1) 
(relating 
to 
statewideness) and 1902(1)(10)(B) (relating to com-
parability)) only to extent necessary to carry out the 
demonstration project under this section. 
(h) DEFINITIONS.—In this section: 
(1) EMERGENCY MEDICAL CONDITION.—The term 
‘‘emergency medical condition’’ means, with respect to 
an individual, an individual who expresses suicidal 
or homicidal thoughts or gestures, if determined dan-
gerous to self or others. 
(2) FEDERAL
MEDICAL
ASSISTANCE
PERCENT-
AGE.—The term ‘‘Federal medical assistance percent-
age’’ has the meaning given that term with respect to 
a State under section 1905(b) of the Social Security 
Act (42 U.S.C. 1396d(b)). 
(3) INSTITUTION FOR MENTAL DISEASES.—The 
term ‘‘institution for mental diseases’’ has the mean-
ing given to that term in section 1905(i) of the Social 
Security Act (42 U.S.C. 1396d(i)). 
(4) MEDICAL ASSISTANCE.—The term ‘‘medical 
assistance’’ has the meaning given that term in sec-
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HR 3590 EAS/PP 
tion 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)). 
(5) STABILIZED.—The term ‘‘stabilized’’ means, 
with respect to an individual, that the emergency 
medical condition no longer exists with respect to the 
individual and the individual is no longer dangerous 
to self or others. 
(6) STATE.—The term ‘‘State’’ has the meaning 
given that term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.). 
Subtitle J—Improvements to the 
Medicaid and CHIP Payment 
and 
Access 
Commission 
(MACPAC) 
SEC. 2801. MACPAC ASSESSMENT OF POLICIES AFFECTING 
ALL MEDICAID BENEFICIARIES. 
(a) IN GENERAL.—Section 1900 of the Social Security 
Act (42 U.S.C. 1396) is amended— 
(1) in subsection (b)— 
(A) in paragraph (1)— 
(i) in the paragraph heading, by in-
serting ‘‘FOR ALL STATES’’ before ‘‘AND AN-
NUAL’’; and 
(ii) in subparagraph (A), by striking 
‘‘children’s’’;