I 
111TH CONGRESS 
2D SESSION 
H. R. 4787 
To amend title XIX of the Social Security Act to improve and protect 
rehabilitative services and case management services provided under Med-
icaid to improve the health and welfare of the Nation’s most vulnerable 
seniors and children. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 9, 2010 
Ms. BALDWIN (for herself and Mr. SULLIVAN) 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 improve 
and protect rehabilitative services and case management 
services provided under Medicaid to improve the health 
and welfare of the Nation’s most vulnerable seniors and 
children. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicaid Services Restoration Act of 2010’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
TITLE I—REHABILITATIVE SERVICES PROTECTIONS 
Sec. 101. Inclusion of therapeutic foster care as medical assistance. 
Sec. 102. Inclusion of attainment and retention of functional status in rehabili-
tative services. 
Sec. 103. Reasonable and efficient payment methodologies for rehabilitative 
services. 
Sec. 104. Clarification of coverage of EPSDT services for children receiving in-
patient psychiatric hospital services. 
Sec. 105. Third party liability clarification relating to diagnostic, screening, 
preventive, and rehabilitative services. 
TITLE II—CASE MANAGEMENT AND TARGETED CASE 
MANAGEMENT PROTECTIONS 
Sec. 201. Third party liability clarification relating to case management and 
targeted case management. 
Sec. 202. Reasonable and efficient payment methodologies for case manage-
ment services. 
Sec. 203. Protecting health and safety. 
Sec. 204. Codification of Olmstead standard; protecting children. 
Sec. 205. Assuring appropriate case management. 
TITLE I—REHABILITATIVE 
SERVICES PROTECTIONS 
SEC. 101. INCLUSION OF THERAPEUTIC FOSTER CARE AS 
MEDICAL ASSISTANCE. 
Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended— 
(1) in subsection (a)— 
(A) in paragraph (27), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (28) as 
paragraph (29); and 
(C) by inserting after paragraph (27) the 
following new paragraph: 
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‘‘(28) therapeutic foster care services described 
in subsection (y); and’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(y)(1) For purposes of subsection (a)(28), subject 
to subparagraph (C), therapeutic foster care services de-
scribed in this subsection are services provided for children 
who have not attained age 21, and who, as a result of 
mental illness, other emotional or behavioral disorders, 
medically fragile conditions, or developmental disabilities, 
need the level of care provided in an institution (including 
a psychiatric residential treatment facility) or nursing fa-
cility the cost of which could be reimbursed under the 
State plan but who can be cared for or maintained in a 
community placement, through therapeutic foster care 
programs that— 
‘‘(A) are licensed by the State and accredited 
by the Joint Commission on Accreditation of 
Healthcare Organizations, the Commission on Ac-
creditation of Rehabilitation Facilities, the Council 
on Accreditation, or by another equivalent accredita-
tion agency (or agencies) as the Secretary may rec-
ognize; 
‘‘(B) provide structured daily activities, includ-
ing the development, improvement, monitoring, and 
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reinforcing of age-appropriate social, communication 
and behavioral skills, crisis intervention and crisis 
support services, medication monitoring, counseling, 
and case management, and may furnish other inten-
sive community services; and 
‘‘(C) provide foster care parents with special-
ized training and consultation in the management of 
children with mental illness, other emotional or be-
havioral disorders, medically fragile conditions, or 
developmental disabilities, and specific additional 
training on the needs of each child provided such 
services. 
‘‘(2) In making coverage determinations under para-
graph (1), a State may employ medical necessity criteria 
that are similar to the medical necessity criteria applied 
to coverage determinations for other services and supports 
under this title. 
‘‘(3) The services described in this subsection do not 
include the training referred to in paragraph (1)(C).’’. 
SEC. 102. INCLUSION OF ATTAINMENT AND RETENTION OF 
FUNCTIONAL STATUS IN REHABILITATIVE 
SERVICES. 
Section 1905(a)(13) of the Social Security Act (42 
U.S.C. 1396d(a)(13)) is amended by striking ‘‘and res-
toration of an individual to the best possible functional 
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level’’ and inserting ‘‘, restoration of an individual to the 
best possible functional level, or attainment or retention 
of the individual’s best possible functional status’’. 
SEC. 103. REASONABLE AND EFFICIENT PAYMENT METH-
ODOLOGIES FOR REHABILITATIVE SERVICES. 
Section 1905(a)(13) of the Social Security Act (42 
U.S.C. 1396d(a)(13)), as amended by section 102, is 
amended by inserting ‘‘(and which reimbursement for, in 
the case of rehabilitative services, may be made through 
the establishment of reasonable and efficient payment 
methodologies, including fee-for-service payments, case 
rates, daily rates, or other forms of capitated payment’’ 
after ‘‘status’’. 
SEC. 104. CLARIFICATION OF COVERAGE OF EPSDT SERV-
ICES FOR CHILDREN RECEIVING INPATIENT 
PSYCHIATRIC HOSPITAL SERVICES. 
Section 1905(h)(1) of the Social Security Act (42 
U.S.C. 1396d(h)(1)) is amended— 
(1) in subparagraph (B), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (C), by adding ‘‘and’’ after 
the semicolon; and 
(3) by inserting after subparagraph (C), the fol-
lowing new subparagraph: 
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‘‘(D) services described in subsection (r) which 
are provided on an inpatient or outpatient basis to 
an individual receiving inpatient services described in 
subparagraph (A), (B), or (C).’’. 
SEC. 105. THIRD PARTY LIABILITY CLARIFICATION RELAT-
ING TO DIAGNOSTIC, SCREENING, PREVEN-
TIVE, AND REHABILITATIVE SERVICES. 
Section 1903(c) of the Social Security Act (42 U.S.C. 
1396b(c)) is amended— 
(1) by inserting ‘‘(1)’’ after ‘‘(c)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(2) Nothing in this title shall be construed as pro-
hibiting or restricting, or authorizing the Secretary to pro-
hibit or restrict, payment under subsection (a) for medical 
assistance for services provided under section 1905(a)(13) 
to eligible individuals furnished by qualified providers 
under non-medical programs, provided, however, a State 
or local agency administering such plan shall comply with 
section 1902(a)(25).’’. 
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TITLE 
II—CASE 
MANAGEMENT 
AND TARGETED CASE MAN-
AGEMENT PROTECTIONS 
SEC. 201. THIRD PARTY LIABILITY CLARIFICATION RELAT-
ING TO CASE MANAGEMENT AND TARGETED 
CASE MANAGEMENT. 
Section 1903(c) of the Social Security Act (42 U.S.C. 
1396b(c)), as amended by section 105, is amended by add-
ing at the end the following new paragraph: 
‘‘(3) Nothing in this title shall be construed as pro-
hibiting or restricting, or authorizing the Secretary to pro-
hibit or restrict payment under subsection (a) for medical 
assistance for services provided under section 1915(g) to 
eligible individuals furnished by qualified providers under 
non-medical programs, provided, however, a State or local 
agency administering such plan shall comply with section 
1902(a)(25).’’. 
SEC. 202. REASONABLE AND EFFICIENT PAYMENT METH-
ODOLOGIES FOR CASE MANAGEMENT SERV-
ICES. 
Section 1915(g)(4) of the Social Security Act (42 
U.S.C. 1396n(g)(4)) is amended by adding at the end the 
following new subparagraph: 
‘‘(C) Reimbursement for case management and tar-
geted case management services may be made through the 
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