IB 
Union Calendar No. 562 
115TH CONGRESS 
2D SESSION 
H. R. 5810 
[Report No. 115–727] 
To amend title XIX of the Social Security Act to provide for an extension 
of the enhanced FMAP for certain Medicaid health homes for individuals 
with substance use disorders. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2018 
Mr. LANCE (for himself, Mr. WELCH, and Mr. ROTHFUS) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
JUNE 12, 2018 
Additional sponsors: Mr. WALDEN and Mrs. BLACKBURN 
JUNE 12, 2018 
Reported with amendments, committed to the Committee of the Whole House 
on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on May 15, 2018] 
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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 ‘‘Medicaid Health Homes 
for Opioid-Use-Disorder Medicaid Enrollees Encouraged 
Act’’ or the ‘‘Medicaid Health HOME Act’’. 
SEC. 2. EXTENSION OF ENHANCED FMAP FOR CERTAIN 
HEALTH HOMES FOR INDIVIDUALS WITH SUB-
STANCE USE DISORDERS. 
Section 1945 of the Social Security Act (42 U.S.C. 
1396w–4) is amended— 
(1) in subsection (c)— 
(A) in paragraph (1), by inserting ‘‘subject 
to paragraph (4),’’ after ‘‘except that,’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4) SPECIAL RULE RELATING TO SUBSTANCE 
USE DISORDER HEALTH HOMES.— 
‘‘(A) IN GENERAL.—In the case of a State 
with an SUD-focused State plan amendment ap-
proved by the Secretary on or after October 1, 
2018, the Secretary may, at the request of the 
State, extend the application of the Federal med-
ical assistance percentage described in para-
graph (1) to payments for the provision of health 
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home services to SUD-eligible individuals under 
such State plan amendment, in addition to the 
first 8 fiscal year quarters the State plan amend-
ment is in effect, for the subsequent 2 fiscal year 
quarters that the State plan amendment is in ef-
fect. Nothing in this section shall be construed as 
prohibiting a State with a State plan amend-
ment that is approved under this section and 
that is not an SUD-focused State plan amend-
ment from additionally having approved on or 
after such date an SUD-focused State plan 
amendment under this section, including for 
purposes of application of this paragraph. 
‘‘(B) REPORT REQUIREMENTS.—In the case 
of a State with an SUD-focused State plan 
amendment for which the application of the Fed-
eral medical assistance percentage has been ex-
tended under subparagraph (A), such State shall, 
at the end of the period of such State plan 
amendment, submit to the Secretary a report on 
the following, with respect to SUD-eligible indi-
viduals provided health home services under such 
State plan amendment: 
‘‘(i) The quality of health care pro-
vided to such individuals, with a focus on 
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outcomes relevant to the recovery of each 
such individual. 
‘‘(ii) The access of such individuals to 
health care. 
‘‘(iii) The total expenditures of such 
individuals for health care. 
For purposes of this subparagraph, the Sec-
retary shall specify all applicable measures 
for determining quality, access, and expend-
itures. 
‘‘(C) BEST PRACTICES.—Not later than Oc-
tober 1, 2020, the Secretary shall make publicly 
available on the Internet website of the Centers 
for Medicare & Medicaid Services best practices 
for designing and implementing an SUD-focused 
State plan amendment, based on the experiences 
of States that have State plan amendments ap-
proved under this section that include SUD-eli-
gible individuals. 
‘‘(D) DEFINITIONS.—For purposes of this 
paragraph: 
‘‘(i) SUD-ELIGIBLE
INDIVIDUALS.— 
The term ‘SUD-eligible individual’ means, 
with respect to a State, an individual who 
satisfies all of the following: 
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‘‘(I) The individual is an eligible 
individual with chronic conditions. 
‘‘(II) The individual is an indi-
vidual with a substance use disorder. 
‘‘(III) The individual has not pre-
viously received health home services 
under any other State plan amend-
ment approved for the State under this 
section by the Secretary. 
‘‘(ii) 
SUD-FOCUSED
STATE
PLAN 
AMENDMENT.—The 
term 
‘SUD-focused 
State plan amendment’ means a State plan 
amendment under this section that is de-
signed to provide health home services pri-
marily to SUD-eligible individuals.’’. 
SEC. 3. REQUIREMENT FOR STATE MEDICAID PLANS TO 
PROVIDE COVERAGE FOR MEDICATION-AS-
SISTED TREATMENT. 
(a) REQUIREMENT FOR STATE MEDICAID PLANS TO 
PROVIDE COVERAGE FOR MEDICATION-ASSISTED TREAT-
MENT.—Section 1902(a)(10)(A) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)) is amended, in the matter pre-
ceding clause (i), by striking ‘‘and (28)’’ and inserting 
‘‘(28), and (29)’’. 
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(b) INCLUSION OF MEDICATION-ASSISTED TREATMENT 
AS MEDICAL ASSISTANCE.—Section 1905(a) of the Social 
Security Act (42 U.S.C. 1396d(a)) is amended— 
(1) in paragraph (28), by striking ‘‘and’’ at the 
end; 
(2) by redesignating paragraph (29) as para-
graph (30); and 
(3) by inserting after paragraph (28) the fol-
lowing new paragraph: 
‘‘(29) subject to paragraph (2) of subsection (ee), 
for the period beginning October 1, 2020, and ending 
September 30, 2025, medication-assisted treatment 
(as defined in paragraph (1) of such subsection); 
and’’. 
(c) MEDICATION-ASSISTED
TREATMENT
DEFINED; 
WAIVERS.—Section 1905 of the Social Security Act (42 
U.S.C. 1396d) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(ee) MEDICATION-ASSISTED TREATMENT.— 
‘‘(1) DEFINITION.—For purposes of subsection 
(a)(29), the term ‘medication-assisted treatment’— 
‘‘(A) means all drugs approved under sec-
tion 505 of the Federal Food, Drug, and Cos-
metic Act (21 U.S.C. 355), including methadone, 
and all biological products licensed under section 
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351 of the Public Health Service Act (42 U.S.C. 
262) to treat opioid use disorders; and 
‘‘(B) includes, with respect to the provision 
of such drugs and biological products, counseling 
services and behavioral therapy. 
‘‘(2) EXCEPTION.—The provisions of paragraph 
(29) of subsection (a) shall not apply with respect to 
a State for the period specified in such paragraph, if 
before the beginning of such period the State certifies 
to the satisfaction of the Secretary that implementing 
such provisions statewide for all individuals eligible 
to enroll in the State plan (or waiver of the State 
plan) would not be feasible by reason of a shortage of 
qualified providers of medication-assisted treatment, 
or facilities providing such treatment, that will con-
tract with the State or a managed care entity with 
which the State has a contract under section 1903(m) 
or under section 1905(t)(3).’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), the 
amendments made by this section shall apply with re-
spect to medical assistance provided on or after Octo-
ber 1, 2020, and before October 1, 2025. 
(2) EXCEPTION
FOR
STATE
LEGISLATION.—In 
the case of a State plan under title XIX of the Social 
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Security Act (42 U.S.C. 1396 et seq.) that the Sec-
retary of Health and Human Services determines re-
quires State legislation in order for the respective 
plan to meet any requirement imposed by the amend-
ments made by this section, the respective plan shall 
not be regarded as failing to comply with the require-
ments of such title solely on the basis of its failure to 
meet such an additional requirement 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 the session shall be considered to be a separate reg-
ular session of the State legislature. 
Amend the title so as to read: ‘‘A bill to amend title 
XIX of the Social Security Act to provide for an exten-
sion of the enhanced FMAP for certain Medicaid health 
homes for individuals with substance use disorders, and 
to require States to include under their State Medicaid 
plans coverage for medication-assisted treatment.’’. 
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Union Calendar No. 562 
115TH CONGRESS 
2D SESSION 
H. R. 5810 
[Report No. 115–727] 
A BILL 
To amend title XIX of the Social Security Act to 
provide for an extension of the enhanced FMAP 
for certain Medicaid health homes for individuals 
with substance use disorders. 
JUNE 12, 2018 
Reported with amendments, committed to the Committee 
of the Whole House on the State of the Union, and or-
dered to be printed 
VerDate Sep 11 2014 
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