(1) by redesignating the second subsection (l) 
(added by section 1263 of division FF of Public Law 
117–328) as subsection (m); and 
(2) in subsection (m), as redesignated— 
(A) in paragraph (1)(A)(iv)— 
(i) in subclause (I), by striking ‘‘or 
the Commission for Continuing Education 
Provider Recognition (CCEPR)’’ and in-
serting ‘‘the Commission for Continuing 
Education Provider Recognition (CCEPR), 
the American Podiatric Medical Associa-
tion, the Council on Podiatric Medical 
Education (CPME), or the Academy of 
General Dentistry’’; 
(ii) by redesignating subclauses (II), 
(III), and (IV) as subclauses (III), (IV), 
and (V), respectively; and 
(iii) by inserting after subclause (I) 
the following: 
‘‘(II) the American Academy of 
Family Physicians or any organization 
whose continuing medical education 
activity has been approved or accred-
ited by the American Academy of 
Family Physicians;’’; and
(iv) in subclause (V), as redesignated, 
by striking ‘‘any organization approved by 
the Assistant Secretary for Mental Health 
and Substance Use, the ACCME, or the 
CCEPR’’ and inserting ‘‘any organization 
approved by the ACCME or the CCEPR’’; 
(B) in paragraph (1)(A)(v)— 
(i) by inserting ‘‘podiatric medicine,’’ 
after ‘‘allopathic medicine, osteopathic 
medicine,’’; and 
(ii) by striking ‘‘allopathic or osteo-
pathic medicine curriculum’’ and inserting 
‘‘allopathic, osteopathic, or podiatric medi-
cine curriculum’’; 
(C) in paragraph (1)(B)(i), by striking ‘‘or 
any other organization approved or accredited 
by the Assistant Secretary for Mental Health 
and Substance Use or the Accreditation Council 
for Continuing Medical Education’’ and insert-
ing ‘‘the American Podiatric Medical Associa-
tion, the Council on Podiatric Medical Edu-
cation (CPME), the American Pharmacists As-
sociation, the Accreditation Council for Phar-
macy Education, the American Optometric As-
sociation, the Academy of General Dentistry,
the American Psychiatric Nurses Association, 
the American Academy of Nursing, the Amer-
ican Academy of Family Physicians, or any 
other organization approved or accredited by 
the American Academy of Family Physicians or 
the Accreditation Council for Continuing Med-
ical Education’’; and 
(D) in paragraph (1)(B)(ii), by striking 
‘‘from an accredited physician assistant school 
or accredited school of advanced practice nurs-
ing’’ and inserting ‘‘from an accredited physi-
cian assistant school, an accredited school of 
advanced practice nursing, or an accredited 
school of pharmacy’’. 
TITLE III—MEDICAID 
SEC. 301. EXTENDING REQUIREMENT FOR STATE MEDICAID 
PLANS TO PROVIDE COVERAGE FOR MEDICA-
TION-ASSISTED TREATMENT. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)(29), by striking ‘‘for the 
period beginning October 1, 2020, and ending Sep-
tember 30, 2025,’’ and inserting ‘‘beginning on Oc-
tober 1, 2020,’’; and
(2) in subsection (ee)(2), by striking ‘‘for the 
period specified in such paragraph, if before the be-
ginning of such period the State certifies to the sat-
isfaction of the Secretary’’ and inserting ‘‘if such 
State certifies, not less than every 5 years and to the 
satisfaction of the Secretary,’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1006(b)(4)(A) of the Substance Use-Disorder Prevention 
that Promotes Opioid Recovery and Treatment for Pa-
tients and Communities Act (42 U.S.C. 1396a note) is 
amended by striking ‘‘, and before October 1, 2025’’. 
SEC. 302. EXPANDING REQUIRED REPORTS ON T-MSIS SUB-
STANCE USE DISORDER DATA TO INCLUDE 
MENTAL HEALTH CONDITION DATA. 
(a) IN GENERAL.—Section 1015(a) of the SUP-
PORT for Patients and Communities Act (42 U.S.C. 
1320d–2 note) is amended— 
(1) in the heading, by striking ‘‘SUBSTANCE 
USE DISORDER DATA BOOK’’ and inserting ‘‘BE-
HAVIORAL HEALTH DATA BOOK’’; 
(2) in paragraph (2)— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘, including as updated in ac-
cordance with paragraph (3),’’ after ‘‘paragraph 
(1)’’;
(B) in subparagraph (A), by inserting ‘‘, 
mental health condition, or a mental health con-
dition co-occurring with substance use disorder’’ 
after ‘‘substance use disorder’’; 
(C) in subparagraph (B), by inserting 
‘‘and mental health treatment services’’ after 
‘‘substance use disorder treatment services’’; 
(D) in subparagraph (C)— 
(i) by inserting ‘‘, mental health con-
dition, or a mental health condition co-oc-
curring with a substance use disorder diag-
nosis’’ after ‘‘substance use disorder diag-
nosis’’; and 
(ii) by inserting ‘‘or mental health 
treatment services, respectively,’’ after 
‘‘substance use disorder treatment serv-
ices’’; 
(E) in subparagraph (D), by inserting ‘‘, 
mental health condition, or a mental health con-
dition co-occurring with substance use disorder’’ 
after ‘‘substance use disorder diagnosis’’; 
(F) in subparagraph (E), by inserting ‘‘or 
mental health treatment’’ after ‘‘substance use 
disorder treatment’’; and
(G) in subparagraph (F), by inserting ‘‘, 
individuals with a mental health condition who 
receive mental health treatment services, and 
individuals with a co-occurring mental health 
condition and substance use disorder who re-
ceive substance use disorder treatment services 
and mental health treatment services,’’ after 
‘‘substance use disorder treatment services’’; 
and 
(3) in paragraph (3), by striking ‘‘through 
2024’’. 
(b) APPLICATION.—The amendments made by sub-
section (a)(1) shall apply beginning with respect to the 
first update made pursuant to section 1015(a)(3) of the 
SUPPORT for Patients and Communities Act (42 U.S.C. 
1320d–2 note) after the date that is 12 months after the 
date of enactment of this Act. 
SEC. 303. MONITORING PRESCRIBING OF ANTIPSYCHOTIC 
MEDICATIONS. 
Section 1902(oo)(1)(B) of the Social Security Act (42 
U.S.C. 1396a(oo)(1)(B)) is amended— 
(1) in the subparagraph heading, by striking 
‘‘BY CHILDREN’’; 
(2) by inserting ‘‘, and beginning on the date 
that is 24 months after the date of enactment of
Support for Patients and Communities Reauthoriza-
tion Act, individuals over the age of 18, individuals 
receiving home and community-based services (as de-
fined in section 9817(a)(2)(B) of Public Law 117– 
2), and individuals residing in institutional care set-
tings (including nursing facilities, intermediate care 
facilities for individuals with intellectual disabilities, 
and other such institutional care settings) enrolled,’’ 
after ‘‘children enrolled’’; and 
(3) by striking ‘‘not more than the age of 18 
years’’ and inserting ‘‘subject to the program’’. 
SEC. 304. LIFTING THE IMD EXCLUSION FOR SUBSTANCE 
USE DISORDER. 
(a) MAKING PERMANENT STATE PLAN AMENDMENT 
OPTION TO PROVIDE MEDICAL ASSISTANCE FOR CER-
TAIN INDIVIDUALS WHO ARE PATIENTS IN CERTAIN IN-
STITUTIONS FOR MENTAL DISEASES.—Section 1915(l)(1) 
of the Social Security Act (42 U.S.C. 1396n(l)(1)) is 
amended by striking ‘‘With respect to calendar quarters 
beginning during the period beginning October 1, 2019, 
and ending September 30, 2023,’’ and inserting ‘‘With re-
spect to calendar quarters beginning on or after October 
1, 2019,’’.
(b) MAINTENANCE OF EFFORT REVISION.—Section 
1915(l)(3) of the Social Security Act (42 U.S.C. 
1396n(l)(3)) is amended— 
(1) in subparagraph (A)-— 
(A) in the matter preceding clause (i), by 
striking ‘‘other than under this title’’; and 
(B) in clause (i), by striking ‘‘or, if high-
er,’’ and all that follows through ‘‘in accordance 
with this subsection’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) APPLICATION OF MAINTENANCE OF 
EFFORT
REQUIREMENTS
TO
CERTAIN 
STATES.—In the case of a State with a State 
plan amendment in effect on the date of the en-
actment of this subparagraph, for the 1-year 
period beginning on such date, the provisions of 
subparagraph (A) shall be applied as if the 
amendments to such subparagraph made by the 
Support for Patients and Communities Reau-
thorization Act had never been made.’’. 
(c) ADDITIONAL REQUIREMENTS.— 
(1) IN GENERAL.—
(A) GENERAL
REQUIREMENTS.—Section 
1915(l)(4) of the Social Security Act (42 
U.S.C. 1396n(l)(4)) is amended— 
(i) in subparagraph (A), by striking 
‘‘through (D)’’ and inserting ‘‘through 
(F)’’; 
(ii) in subparagraph (D), in the mat-
ter preceding clause (i), by inserting ‘‘have 
in place evidence-based, substance use dis-
order-specific individual placement criteria 
and utilization management approach to 
ensure placement of such individual in an 
appropriate level of care and shall’’ after 
‘‘State shall’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(E) REVIEW PROCESS.—The State shall 
have in place a process to review the compliance 
of eligible institutions for mental diseases with 
evidence-based, substance use disorder-specific 
program standards for eligible individuals speci-
fied by the State.’’. 
(B) EFFECTIVE DATE.—The amendments 
made by subparagraph (A) shall apply with re-
spect to medical assistance furnished in cal-
endar quarters beginning on or after October 1, 
2025. 
(2) 
ONE-TIME
ASSESSMENT.—Section 
1915(l)(4) of the Social Security Act (42 U.S.C. 
1396n(l)(4)), as amended by paragraph (1), is fur-
ther amended by adding at the end the following 
new subparagraph: 
‘‘(F) ASSESSMENT.— 
‘‘(i) IN GENERAL.—The State shall, 
not later than 12 months after the ap-
proval of a State plan amendment de-
scribed in this subsection (or, in the case 
such State has such an amendment ap-
proved as of the date of the enactment of 
this subparagraph, not later than 12 
months after such date), commence an as-
sessment of— 
‘‘(I) the availability of treatment 
for individuals enrolled under a State 
plan under this title (or waiver of 
such plan) in each level of care de-
scribed in subparagraph (C); and 
‘‘(II) the availability of medica-
tion-assisted treatment and medically
supervised withdrawal management 
services for such individuals. 
‘‘(ii) REQUIRED
COMPLETION.—The 
State compete an assessment described in 
clause (i) not later than 12 months after 
the date the State commences such assess-
ment.’’. 
(3) CLARIFICATION OF LEVELS OF CARE.—Sec-
tion 1915(l)(7)(A) of the Social Security Act (42 
U.S.C. 1396n(l)(7)(A)) is amended by inserting ‘‘(or 
any successor publication)’’ before the period. 
SEC. 305. PROHIBITION ON TERMINATION OF ENROLLMENT 
DUE TO INCARCERATION. 
(a) MEDICAID.— 
(1) IN GENERAL.—Section 1902(a)(84)(A) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(86)(A)), as amended by section 5122(a)(2) 
of the Consolidated Appropriations Act, 2023 (Pub-
lic Law 117–328), is further amended— 
(A) by striking ‘‘under the State plan’’ and 
inserting ‘‘under the State plan (or waiver of 
such plan)’’; 
(B) by striking ‘‘who is an eligible juvenile 
(as defined in subsection (nn)(2))’’;
(C) by striking ‘‘because the juvenile’’ and 
inserting ‘‘because the individual’’; 
(D) by striking ‘‘during the period the ju-
venile’’ and inserting ‘‘during the period the in-
dividual’’; and 
(E) by inserting ‘‘such an individual who is 
an eligible juvenile (as defined in subsection 
(nn)(2)) or a woman during pregnancy (and 
during the 60-day beginning on the last day of 
pregnancy) and’’ after ‘‘or in the case of’’. 
(2) EFFECTIVE DATE.—The amendments made 
by— 
(A) subparagraph (A) of paragraph (1) 
shall take effect on the date of the enactment 
of this Act; and 
(B) subparagraphs (B) through (E) of 
paragraph (1) shall take effect on January 1, 
2025. 
(b) CHIP.— 
(1) IN GENERAL.—Section 2102(d)(1)(A) of the 
Social Security Act (42 U.S.C. 1397bb(d)(1)(A)) is 
amended— 
(A) by inserting ‘‘or pregnancy-related’’ 
after ‘‘child health’’;
last day of pregnancy)’’ after ‘‘(as defined in section 
1902(nn)(2))’’. 
(2) CHIP.—Section 2110(b)(7) of the Social 
Security Act (42 U.S.C. 1397jj(b)(10)), as amended 
by section 5122 of the Consolidated Appropriations 
Act, 2023 (Public Law 117–328), is further amend-
ed— 
(A) by inserting ‘‘a woman during preg-
nancy (and during the 60-day beginning on the 
last day of pregnancy) or’’ after ‘‘At the option 
of the State,’’; and 
(B) by striking ‘‘during the period that the 
child’’ and inserting ‘‘during the period that the 
woman or child’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2025. 
(b) TECHNICAL CORRECTION.—Section 5122(a)(1) 
of the Consolidated Appropriations Act, 2023 (Public Law 
117–328) is amended by striking ‘‘after’’ and all that fol-
lows through the period at the end and inserting ‘‘after 
‘or in the case of an eligible juvenile described in section 
1902(a)(84)(D) with respect to the screenings, diagnostic 
services, referrals, and targeted case management services 
required under such section’.’’.
SEC. 307. PERMITTING ACCESS TO MEDICAL ASSISTANCE 
UNDER THE MEDICAID PROGRAM FOR FOS-
TER YOUTH. 
(a) IN GENERAL.—Section 1905(a) of the Social Se-
curity Act (42 U.S.C. 1396d(a)) is amended by adding 
at the end the following new sentence: ‘‘In the case of an 
individual who is under the age of 21 and who is a patient 
in an institution for mental diseases that is a qualified 
residential treatment program (as defined in section 
472(k)(4)), the exclusion from the definition of medical 
assistance set forth in the subdivision (B) following the 
last numbered paragraph of this subsection shall not apply 
with respect to items and services furnished to such an 
individual when received outside of such program.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall apply with respect to medical assist-
ance furnished in calendar quarters beginning on or after 
January 1, 2025.
TITLE IV—OFFSETS 
SEC. 401. PROMOTING VALUE IN MEDICAID MANAGED 
CARE. 
Section 1903(m)(9)(A) of the Social Security Act (42 
U.S.C. 1396b(m)(9)(A)) is amended by striking ‘‘(and be-
fore fiscal year 2024)’’. 
Passed the House of Representatives December 12, 
2023. 
Attest: 
Clerk.
118TH CONGRESS 
1ST SESSION 
H. R. 4531 
AN ACT 
To reauthorize certain programs that provide for 
opioid use disorder prevention, recovery, and 
treatment, and for other purposes.