I 
113TH CONGRESS 
2D SESSION 
H. R. 5136 
To direct the Secretary of Health and Human Services to establish a dem-
onstration project under the Medicaid program under title XIX of the 
Social Security Act under which payment may be made to States for 
expenditures for medical assistance with respect to substance use disorder 
treatment services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 17, 2014 
Ms. FUDGE (for herself, Mr. RYAN of Ohio, Mr. CUMMINGS, Ms. LEE of Cali-
fornia, Ms. NORTON, Mr. RICHMOND, Mr. HASTINGS of Florida, and Ms. 
CLARKE of New York) introduced the following bill; which was referred 
to the Committee on Energy and Commerce 
A BILL 
To direct the Secretary of Health and Human Services to 
establish a demonstration project under the Medicaid 
program under title XIX of the Social Security Act under 
which payment may be made to States for expenditures 
for medical assistance with respect to substance use dis-
order treatment services, and for other purposes. 
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 ‘‘Breaking Addiction 
Act of 2014’’. 
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SEC. 2. MEDICAID COMMUNITY-BASED INPATIENT SUB-
STANCE USE DISORDER TREATMENT DEM-
ONSTRATION PROJECT. 
(a) AUTHORITY.—The Secretary of Health and 
Human Services shall establish a 5-year demonstration 
project (in this section referred to as the ‘‘demonstration 
project’’) under which payment may be made to each par-
ticipating State (as described in subsection (b)), for any 
medical assistance provided with respect to a qualified in-
dividual in a community-based institution for mental dis-
eases who is being treated in such institution for a sub-
stance use condition. 
(b) PARTICIPATING STATES.— 
(1) ELIGIBILITY.—A State is eligible to partici-
pate in the demonstration project under this section 
if the State plan of the State provides for payment 
under the plan for community-based inpatient sub-
stance use disorder treatment services furnished to 
qualified individuals. 
(2) APPLICATION.—A State seeking to partici-
pate in the demonstration project under this section 
shall submit to the Secretary an application, at such 
time, in such form, and that contains such informa-
tion, provisions, and assurances, as the Secretary 
may require. 
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(3) SELECTION.—The Secretary shall select, on 
a competitive basis, from among the States that sub-
mit an application under paragraph (1) to the satis-
faction of the Secretary, the States that will be par-
ticipating in the demonstration project. In selecting 
such participating States, the Secretary shall seek to 
achieve an equitable geographic distribution. 
(c) WAIVER AUTHORITY.— 
(1) IN GENERAL.—The Secretary shall waive 
the limitation on payment for care and services im-
posed by the subdivision (B) that follows paragraph 
(29) of section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) (relating to a limitation on 
payments for care or services for any individual who 
is under 65 years of age and who is a patient in an 
institution for mental diseases) with respect to pay-
ment for the medical assistance described in sub-
section (a). 
(2) LIMITED OTHER WAIVER AUTHORITY.—The 
Secretary may waive other requirements of titles XI 
and XIX of the Social Security Act (including the 
requirements of sections 1902(a)(1) (relating to 
statewideness) 
(42 
U.S.C. 
1396a(a)(1)) 
and 
1902(a)(10)(B) (relating to comparability) (42 
U.S.C. 1396a(a)(10)(B)) of such Act) only to the 
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extent necessary to carry out the demonstration 
project under this section. 
(d) EVALUATION AND REPORT TO CONGRESS.— 
(1) EVALUATION.—The Secretary shall conduct 
an evaluation of the impact the demonstration 
project carried out under this section has on the 
functioning of the health and substance use disorder 
system and individuals enrolled in State plans under 
the Medicaid program under title XIX of the Social 
Security Act. The evaluation shall include each of 
the following: 
(A) An assessment of the access such indi-
viduals have to substance use disorder treat-
ment services under the demonstration project 
carried out under this section, and with respect 
to such services, the average lengths of inpa-
tient stays and emergency room visits. 
(B) An assessment of the discharge plan-
ning by the health care providers furnishing 
such services. 
(C) An assessment of the impact of the 
demonstration project on the costs of the full 
range of health care items and services, includ-
ing inpatient, emergency and ambulatory care, 
diversions from inpatient and emergency care, 
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and readmissions to institutions for mental dis-
eases. 
(D) An analysis of the percentage of indi-
viduals enrolled in such plans who are admitted 
to community-based institutions for mental dis-
eases as a result of the demonstration project 
as compared to those admitted to such institu-
tions through other means. 
(2) REPORT.—Not later than December 31, 
2020, the Secretary shall submit to Congress and 
make available to the public a report that contains— 
(A) the findings of the evaluation under 
paragraph (1); and 
(B) the recommendations of the Secretary 
regarding whether— 
(i) the limitation referred to in sub-
section (c)(1) is a barrier to care that 
needs to be reviewed by Congress; and 
(ii) the demonstration project carried 
out under this section should be continued 
after December 31, 2020, and expanded on 
a national basis. 
(e) FUNDING.— 
(1) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
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priated to carry out this section, $300,000,000 for 
fiscal year 2015. 
(2) 10-YEAR
AVAILABILITY.—Funds appro-
priated under paragraph (1) shall remain available 
for obligation through December 31, 2024. 
(3) FUNDS
ALLOCATED
TO
STATES.—Funds 
shall be allocated to participating States on the basis 
of criteria, including a State’s application and the 
availability of funds, as determined by the Secretary. 
(4) PAYMENT TO STATES.—For each calendar 
quarter beginning on or after October 1, 2014, the 
Secretary shall pay to each participating State, from 
the allocation made to the State under paragraph 
(3), an amount equal to the Federal medical assist-
ance percentage of the amount expended during 
such quarter for the medical assistance described in 
subsection (a). 
(5) LIMITATION
ON
PAYMENTS.—In no case 
may— 
(A) the aggregate amount of payments 
made by the Secretary to participating States 
under this section exceed $300,000,000; or 
(B) payments be made by the Secretary to 
participating States under this section after De-
cember 31, 2024. 
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(5) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
Æ 
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