H. R. 34—238 
(9) There is confusion in the health care community 
regarding permissible practices under the regulations promul-
gated under the Health Insurance Portability and Account-
ability Act of 1996 (commonly known as ‘‘HIPAA’’). This confu-
sion may hinder appropriate communication of health care 
information or treatment preferences with appropriate care-
givers. 
(b) SENSE
OF CONGRESS.—It is the sense of Congress that 
clarification is needed regarding the privacy rule promulgated under 
section 264(c) of the Health Insurance Portability and Accountability 
Act of 1996 (42 U.S.C. 1320d–2 note) regarding existing permitted 
uses and disclosures of health information by health care profes-
sionals to communicate with caregivers of adults with a serious 
mental illness to facilitate treatment. 
SEC. 11002. CONFIDENTIALITY OF RECORDS. 
Not later than 1 year after the date on which the Secretary 
of Health and Human Services (in this title referred to as the 
‘‘Secretary’’) first finalizes regulations updating part 2 of title 42, 
Code of Federal Regulations, relating to confidentiality of alcohol 
and drug abuse patient records, after the date of enactment of 
this Act, the Secretary shall convene relevant stakeholders to deter-
mine the effect of such regulations on patient care, health outcomes, 
and patient privacy. 
SEC. 11003. CLARIFICATION ON PERMITTED USES AND DISCLOSURES 
OF PROTECTED HEALTH INFORMATION. 
(a) IN GENERAL.—The Secretary, acting through the Director 
of the Office for Civil Rights, shall ensure that health care providers, 
professionals, patients and their families, and others involved in 
mental or substance use disorder treatment have adequate, acces-
sible, and easily comprehensible resources relating to appropriate 
uses and disclosures of protected health information under the 
regulations promulgated under section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996 (42 U.S.C. 1320d– 
2 note). 
(b) GUIDANCE.— 
(1) ISSUANCE.—In carrying out subsection (a), not later 
than 1 year after the date of enactment of this section, the 
Secretary shall issue guidance clarifying the circumstances 
under which, consistent with regulations promulgated under 
section 264(c) of the Health Insurance Portability and Account-
ability Act of 1996, a health care provider or covered entity 
may use or disclose protected health information. 
(2) CIRCUMSTANCES
ADDRESSED.—The guidance issued 
under this section shall address circumstances including those 
that— 
(A) require the consent of the patient; 
(B) require providing the patient with an opportunity 
to object; 
(C) are based on the exercise of professional judgment 
regarding whether the patient would object when the oppor-
tunity to object cannot practicably be provided because 
of the incapacity of the patient or an emergency treatment 
circumstance; and 
(D) are determined, based on the exercise of profes-
sional judgment, to be in the best interest of the patient 
when the patient is not present or otherwise incapacitated.
H. R. 34—239 
(3) COMMUNICATION
WITH
FAMILY
MEMBERS
AND
CARE-
GIVERS.—In addressing the circumstances described in para-
graph (2), the guidance issued under this section shall clarify 
permitted uses or disclosures of protected health information 
for purposes of— 
(A) communicating with a family member of the 
patient, caregiver of the patient, or other individual, to 
the extent that such family member, caregiver, or indi-
vidual is involved in the care of the patient; 
(B) in the case that the patient is an adult, commu-
nicating with a family member of the patient, caregiver 
of the patient, or other individual involved in the care 
of the patient; 
(C) in the case that the patient is a minor, commu-
nicating with the parent or caregiver of the patient; 
(D) involving the family members or caregivers of the 
patient, or others involved in the patient’s care or care 
plan, including facilitating treatment and medication 
adherence; 
(E) listening to the patient, or receiving information 
with respect to the patient from the family or caregiver 
of the patient; 
(F) communicating with family members of the patient, 
caregivers of the patient, law enforcement, or others when 
the patient presents a serious and imminent threat of 
harm to self or others; and 
(G) communicating to law enforcement and family 
members or caregivers of the patient about the admission 
of the patient to receive care at, or the release of a patient 
from, a facility for an emergency psychiatric hold or invol-
untary treatment. 
SEC. 11004. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING 
PROGRAMS. 
(a) INITIAL PROGRAMS AND MATERIALS.—Not later than 1 year 
after the date of the enactment of this Act, the Secretary, in 
consultation with appropriate experts, shall identify the following 
model programs and materials, or (in the case that no such pro-
grams or materials exist) recognize private or public entities to 
develop and disseminate each of the following: 
(1) Model programs and materials for training health care 
providers (including physicians, emergency medical personnel, 
psychiatrists, including child and adolescent psychiatrists, 
psychologists, counselors, therapists, nurse practitioners, physi-
cian assistants, behavioral health facilities and clinics, care 
managers, and hospitals, including individuals such as general 
counsels or regulatory compliance staff who are responsible 
for establishing provider privacy policies) regarding the per-
mitted uses and disclosures, consistent with the standards gov-
erning the privacy and security of individually identifiable 
health information promulgated by the Secretary under part 
C of title XI of the Social Security Act (42 U.S.C. 1320d et 
seq.) and regulations promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act of 1996 
(42 U.S.C. 1320d–2 note) and such part C, of the protected 
health information of patients seeking or undergoing mental 
or substance use disorder treatment.
H. R. 34—240 
(2) A model program and materials for training patients 
and their families regarding their rights to protect and obtain 
information under the standards and regulations specified in 
paragraph (1). 
(b) PERIODIC UPDATES.—The Secretary shall— 
(1) periodically review and update the model programs 
and materials identified or developed under subsection (a); 
and 
(2) disseminate the updated model programs and materials 
to the individuals described in subsection (a). 
(c) COORDINATION.—The Secretary shall carry out this section 
in coordination with the Director of the Office for Civil Rights 
within the Department of Health and Human Services, the Assist-
ant Secretary for Mental Health and Substance Use, the Adminis-
trator of the Health Resources and Services Administration, and 
the heads of other relevant agencies within the Department of 
Health and Human Services. 
(d) INPUT OF CERTAIN ENTITIES.—In identifying, reviewing, or 
updating the model programs and materials under subsections (a) 
and (b), the Secretary shall solicit the input of relevant national, 
State, and local associations; medical societies; licensing boards; 
providers of mental and substance use disorder treatment; organiza-
tions with expertise on domestic violence, sexual assault, elder 
abuse, and child abuse; and organizations representing patients 
and consumers and the families of patients and consumers. 
(e) FUNDING.—There are authorized to be appropriated to carry 
out this section— 
(1) $4,000,000 for fiscal year 2018; 
(2) $2,000,000 for each of fiscal years 2019 and 2020; and 
(3) $1,000,000 for each of fiscal years 2021 and 2022. 
TITLE XII—MEDICAID MENTAL HEALTH 
COVERAGE 
SEC. 12001. RULE OF CONSTRUCTION RELATED TO MEDICAID COV-
ERAGE OF MENTAL HEALTH SERVICES AND PRIMARY 
CARE SERVICES FURNISHED ON THE SAME DAY. 
Nothing in title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) shall be construed as prohibiting separate payment 
under the State plan under such title (or under a waiver of the 
plan) for the provision of a mental health service or primary care 
service under such plan, with respect to an individual, because 
such service is— 
(1) a primary care service furnished to the individual by 
a provider at a facility on the same day a mental health 
service is furnished to such individual by such provider (or 
another provider) at the facility; or 
(2) a mental health service furnished to the individual 
by a provider at a facility on the same day a primary care 
service is furnished to such individual by such provider (or 
another provider) at the facility. 
SEC. 12002. STUDY AND REPORT RELATED TO MEDICAID MANAGED 
CARE REGULATION. 
(a) STUDY.—The Secretary of Health and Human Services, 
acting through the Administrator of the Centers for Medicare &
H. R. 34—241 
Medicaid Services, shall conduct a study on coverage under the 
Medicaid program under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) of services provided through a medicaid man-
aged care organization (as defined in section 1903(m) of such Act 
(42 U.S.C. 1396b(m)) or a prepaid inpatient health plan (as defined 
in section 438.2 of title 42, Code of Federal Regulations (or any 
successor regulation)) with respect to individuals over the age of 
21 and under the age of 65 for the treatment of a mental health 
disorder in institutions for mental diseases (as defined in section 
1905(i) of such Act (42 U.S.C. 1396d(i))). Such study shall include 
information on the following: 
(1) The extent to which States, including the District of 
Columbia and each territory or possession of the United States, 
are providing capitated payments to such organizations or plans 
for enrollees who are receiving services in institutions for 
mental diseases. 
(2) The number of individuals receiving medical assistance 
under a State plan under such title XIX, or a waiver of such 
plan, who receive services in institutions for mental diseases 
through such organizations and plans. 
(3) The range of and average number of months, and the 
length of stay during such months, that such individuals are 
receiving such services in such institutions. 
(4) How such organizations or plans determine when to 
provide for the furnishing of such services through an institu-
tion for mental diseases in lieu of other benefits (including 
the full range of community-based services) under their contract 
with the State agency administering the State plan under such 
title XIX, or a waiver of such plan, to address psychiatric 
or substance use disorder treatment. 
(5) The extent to which the provision of services within 
such institutions has affected the capitated payments for such 
organizations or plans. 
(b) REPORT.—Not later than 3 years after the date of the 
enactment of this Act, the Secretary shall submit to Congress 
a report on the study conducted under subsection (a). 
SEC. 12003. GUIDANCE ON OPPORTUNITIES FOR INNOVATION. 
Not later than 1 year after the date of the enactment of this 
Act, the Administrator of the Centers for Medicare & Medicaid 
Services shall issue a State Medicaid Director letter regarding 
opportunities to design innovative service delivery systems, 
including systems for providing community-based services, for 
adults with a serious mental illness or children with a serious 
emotional disturbance who are receiving medical assistance under 
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). The 
letter shall include opportunities for demonstration projects under 
section 1115 of such Act (42 U.S.C. 1315) to improve care for 
such adults and children. 
SEC. 12004. STUDY AND REPORT ON MEDICAID EMERGENCY PSY-
CHIATRIC DEMONSTRATION PROJECT. 
(a) COLLECTION
OF INFORMATION.—The Secretary of Health 
and Human Services, acting through the Administrator of the Cen-
ters for Medicare & Medicaid Services, shall, to the extent practical 
and data is available, with respect to each State that has partici-
pated in the demonstration project established under section 2707