I 
115TH CONGRESS 
2D SESSION 
H. R. 5789 
To amend title XIX of the Social Security Act to provide for Medicaid 
coverage protections for pregnant and post-partum women while receiving 
inpatient treatment for a substance use disorder, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2018 
Mr. FOSTER (for himself and Mr. GUTHRIE) 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 provide 
for Medicaid coverage protections for pregnant and post- 
partum women while receiving inpatient treatment for 
a substance use disorder, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. MEDICAID COVERAGE PROTECTION FOR PREG-
NANT AND POST-PARTUM WOMEN WHILE RE-
CEIVING INPATIENT TREATMENT FOR A SUB-
STANCE USE DISORDER; STATE OPTION FOR 
COVERAGE 
OF 
ROOM 
AND 
BOARD 
FOR 
CERATIN INFANTS WITH NEONATAL ABSTI-
NENCE SYNDROME. 
(a) MEDICAID COVERAGE FOR PREGNANT AND POST- 
PARTUM WOMEN WHILE RECEIVING INPATIENT TREAT-
MENT FOR A SUBSTANCE USE DISORDER.— 
(1) IN GENERAL.—Section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amended 
by adding at the end the following new sentence: ‘‘In 
the case of a woman who is eligible for medical as-
sistance on the basis of being pregnant (including 
through the end of the month in which the 60-day 
period beginning on the last day of her pregnancy 
ends) (or is eligible for medical assistance on an-
other basis and is pregnant or was pregnant during 
the previous one-year period (in this sentence, such 
a woman shall be referred to as an ‘other pathway 
eligible pregnant woman’)), who is a patient in an 
institution for mental diseases for purposes of re-
ceiving treatment for a substance use disorder, and 
who was enrolled for medical assistance under the 
State plan immediately before becoming a patient in 
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an institution for mental diseases or who becomes el-
igible to enroll for such medical assistance while 
such a patient, the exclusion specified in the subdivi-
sion (B) following paragraph (29) of the first sen-
tence shall not be construed as prohibiting Federal 
financial participation for medical assistance for 
items or services that are provided to the woman 
outside of the institution during, in the case of a 
woman who is eligible for medical assistance on the 
basis of being pregnant, the period of such eligibility 
on such basis and through the end of the month in 
which the one-year period beginning on the last day 
of her pregnancy ends (and, in the case of an other 
pathway eligible pregnant woman, the period during 
which the woman satisfies the description of being 
such an other pathway eligible pregnant woman, in-
cluding through the end of the month in which the 
one-year period beginning on the last day of her 
pregnancy ends) to the extent such items or services 
would be treated as medical assistance for such 
woman during such period if such woman were not 
a patient in the institution.’’. 
(2) EFFECTIVE DATE.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendment made by 
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paragraph (1) shall take effect with respect to 
medical assistance provided on or after January 
1, 2019. 
(B) EXCEPTION
IF
STATE
LEGISLATION 
REQUIRED.—In the case of a State plan under 
title XIX of the Social Security Act which the 
Secretary of Health and Human Services deter-
mines requires State legislation (other than leg-
islation appropriating funds) in order for the 
plan to meet the additional requirements im-
posed by the amendment made by paragraph 
(1), the State plan shall not be regarded as fail-
ing to comply with the requirements of such 
title solely on the basis of its failure to meet 
these additional requirements before the first 
day of the first calendar quarter beginning after 
the close of the first regular session of the 
State legislature that begins after the date of 
the enactment of this Act. For purposes of the 
previous sentence, in the case of a State that 
has a 2-year legislative session, each year of 
such session shall be deemed to be a separate 
regular session of the State legislature. 
(b) MEDICAID STATE PLAN OPTION TO ENTER INTO 
PROVIDER AGREEMENTS WITH RESIDENTIAL PEDIATRIC 
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RECOVERY CENTERS.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)— 
(A) in paragraph (82), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (83), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (83) the 
following new paragraph: 
‘‘(84) at the option of the State and in accord-
ance with paragraph (2) of subsection (nn), begin-
ning January 1, 2019, for making medical assist-
ance available on an inpatient or outpatient basis at 
a residential pediatric recovery center (as defined in 
paragraph (1) of such subsection) for infants who 
are under 1 year of age with neonatal abstinence 
syndrome.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(nn) RESIDENTIAL PEDIATRIC RECOVERY CEN-
TER.— 
‘‘(1) DEFINITION.—For purposes of subsection 
(a)(84), the term ‘residential pediatric recovery cen-
ter’ means a center or facility that— 
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‘‘(A) provides comprehensive treatment to 
infants who are under 1 year of age with a di-
agnosis of neonatal abstinence syndrome, which 
includes at least access to early and periodic 
screening, diagnostic and treatment; physician 
and nursing services; supportive counseling; 
comprehensive evaluation and assessment and 
service planning by State licensed counselors or 
social workers; targeted case management serv-
ices by State licensed or educated professionals; 
education and supportive counseling and case 
management of family members of such infants; 
room and board costs for such infants; and fa-
cilitation of arrangements within such facilities 
whereby such infants reside with their mother 
when applicable; and 
‘‘(B) provides treatment services in accord-
ance with guidelines issued by the American 
Academy of Pediatrics and American College of 
Obstetricians and Gynecologists relating to ma-
ternal care and infant care with respect to neo-
natal abstinence syndrome. 
‘‘(2) CLARIFICATION.—Nothing in subsection 
(a)(84) shall be construed as including as medical 
assistance room and board services for any indi-
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vidual other than an infant described in such sub-
section.’’. 
(c) GUIDANCE.—Not later than one year after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall issue guidance to improve care 
for infants with neonatal abstinence syndrome and their 
mothers. Such guidance shall include— 
(1) the types of services, including post-dis-
charge services and parenting supports, for mothers 
and fathers of babies with neonatal abstinence syn-
drome that States may cover under the Medicaid 
program under title XIX of the Social Security Act; 
(2) best practices from States with respect to 
innovative or evidenced-based payment models that 
focus on prevention, screening, treatment, plans of 
safe care, and post-discharge services for mothers 
and fathers with substance use disorders and babies 
with neonatal abstinence syndrome that improve 
care and clinical outcomes; 
(3) recommendations for States on available fi-
nancing options under the Medicaid program under 
title XIX of such Act and under the Children’s 
Health Insurance Program under title XXI of such 
Act for Children’s Health Insurance Program 
Health Services Initiative funds for home visiting 
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services for parents with substance use disorders 
and infants with neonatal abstinence syndrome; and 
(4) guidance and technical assistance to State 
Medicaid agencies regarding additional flexibilities 
and incentives related to screening, prevention, and 
post-discharge services, including parenting sup-
ports, under contracts with Medicaid managed care 
organizations. 
(d) GAO STUDY.—Not later than one year after the 
date of the enactment of this Act, the Comptroller General 
of the United States shall conduct a study, and submit 
to Congress a report, addressing gaps in coverage for 
pregnant women with substance use disorder under the 
Medicaid program under title XIX of the Social Security 
Act, and gaps in coverage for postpartum women with sub-
stance use disorder who had coverage during their preg-
nancy under the Medicaid program under such title. 
Æ 
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