I 
116TH CONGRESS 
2D SESSION 
H. R. 7912 
To provide for a demonstration program and pilot project to expand choice 
for inpatient psychiatric services under Medicaid and Medicare. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 31, 2020 
Mr. HUIZENGA (for himself and Mr. TONKO) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To provide for a demonstration program and pilot project 
to expand choice for inpatient psychiatric services under 
Medicaid and Medicare. 
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 ‘‘Increasing National 
Patient Access To Improved Effective Necessary Mental 
Health Treatment Act of 2020’’ or the ‘‘INPATIENT Act 
of 2020’’. 
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SEC. 2. DEMONSTRATION PROJECT WAIVING IMD EXCLU-
SION TO EXPAND ACCESS TO INPATIENT PSY-
CHIATRIC SERVICES UNDER THE MEDICAID 
PROGRAM. 
(a) AUTHORITY
TO
CONDUCT
DEMONSTRATION 
PROJECT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this Act referred to as the ‘‘Sec-
retary’’) shall establish a demonstration project (in 
this Act referred to as the ‘‘demonstration project’’) 
to test the impact of waiving the limitation of sub-
division (B) following paragraph (29) of section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) on average length of stay, readmissions, 
cost, and quality outcomes for inpatient psychiatric 
hospital services and substance abuse services. 
(2) TERMS.—Under the demonstration project, 
an eligible State (as defined in subsection (b)) shall 
provide payment under its State Medicaid plan 
under title XIX of the Social Security Act to quali-
fying 
institutions 
(as 
defined 
in 
subsection 
(b)(3)(C)) for the provision of medical assistance 
available under such plan to individuals who— 
(A) have attained age 21, but have not at-
tained age 65; 
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(B) are eligible for medical assistance 
under such plan (or under a waiver of such 
plan); 
(C) require such medical assistance for in-
patient psychiatric hospital services or residen-
tial substance abuse services; and 
(D) but for participation in the demonstra-
tion project, would otherwise receive medical as-
sistance for such inpatient psychiatric hospital 
services if the services were provided in a gen-
eral acute care hospital or other residential sub-
stance abuse facility. 
(b) ELIGIBLE STATE DEFINED.— 
(1) IN GENERAL.—In this section, the term ‘‘el-
igible State’’ means a State that has made an appli-
cation under paragraph (2) and has had such appli-
cation approved and has been selected under para-
graph (3). 
(2) APPLICATION.—A State seeking to partici-
pate in the demonstration project shall submit to the 
Secretary, at such time and in such format as the 
Secretary requires, an application that includes such 
information, provisions, and assurances, as the Sec-
retary may require. 
(3) SELECTION AND LIMITATION.— 
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(A) STATE
LIMITATION.—The Secretary 
shall limit the number of States selected for 
participation in the demonstration project to no 
more than 3 States. 
(B) CONDITIONS
FOR
APPLICATION
AP-
PROVAL.—The Secretary shall not approve an 
application under paragraph (2) unless the 
State agrees to limit participation in the dem-
onstration project to qualifying institutions (as 
defined in subparagraph (C)). 
(C) QUALIFYING INSTITUTION DEFINED.— 
In this Act, the term ‘‘qualifying institution’’ 
means an institution for mental diseases that is 
not publicly owned or operated, that is subject 
to the requirements of section 1867 of the So-
cial Security Act (42 U.S.C. 1395dd), and that 
meets all of the following criteria: 
(i) The institution furnishes inpatient 
psychiatric hospital services to individuals 
age 18 years of age or older under the 
Medicare and Medicaid programs. 
(ii) The institution has an average 
length of inpatient hospital stay of less 
than 15 days for individuals age 18 or 
older, but under 65 years of age. 
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form, manner, and frequency as specified 
by the Secretary) such data as the Sec-
retary determines appropriate to monitor 
and evaluate the demonstration project. 
(ix) The institution agrees to plan and 
implement an annual performance im-
provement project, aimed at improving the 
effectiveness of care provided to high uti-
lizers of inpatient psychiatric hospital serv-
ices (as defined in subsection (h)(1)), with 
identifiable measures in coordination with 
the Secretary and the State. 
(c) DEADLINE
FOR IMPLEMENTATION.—The Sec-
retary shall implement the demonstration project by Janu-
ary 1, 2022. 
(d) LENGTH OF DEMONSTRATION PROJECT.—The 
demonstration project shall be conducted for a period of 
7 consecutive years. 
(e) BUDGET NEUTRALITY.—With respect to the op-
eration of the demonstration project in a State for the pe-
riod described in subsection (d), the State must dem-
onstrate to the Secretary that project will not result in 
a net increase in the aggregate expenditures under the 
Medicaid program for such period for the State above the 
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level of such expenditures if the demonstration project had 
not been implemented. 
(f) EVALUATION AND REPORT TO CONGRESS.— 
(1) EVALUATION.—The Secretary shall conduct 
an evaluation of the demonstration project in order 
to determine the impact of the project and to make 
recommendations on improvements to the perform-
ance of the health and mental health service system 
and on individuals enrolled in the Medicaid program, 
with particular emphasis on individuals who are high 
utilizers of inpatient psychiatric hospital services and 
substance abuse residential services. 
(2) ITEMS INCLUDED IN EVALUATION.—Such 
evaluation shall include the following: 
(A) An assessment of the delivery of inpa-
tient psychiatric hospital services, substance 
abuse residential services, and community-based 
services under the Medicaid program; average 
lengths of inpatient stays; emergency room vis-
its; and readmissions. 
(B) An assessment of the impact of the 
demonstration project on the costs of the full 
range of mental health services (including inpa-
tient, emergency and ambulatory care) under 
the Medicaid program. 
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(C) An assessment of the impact of the 
demonstration project on psychiatric residency 
programs and the mental health workforce. 
(D) An assessment of the impact of the 
demonstration project on rates of recidivism. 
(E) Identification and assessment of best 
practices for caring for patients with serious 
mental illness, including high utilizers of inpa-
tient psychiatric hospital services and substance 
abuse residential services. 
(F) A comparison of outcomes and costs 
for similarly situated patients receiving inpa-
tient psychiatric hospital services at a general 
acute care hospital. 
(G) A recommendation regarding whether 
the demonstration project should be continued 
after December 31, 2028, and expanded on a 
national basis. 
(3) REPORT.—Not later than December 31, 
2028, the Secretary shall submit to Congress (and 
make available to the public) a report on the find-
ings of the evaluation conducted under this sub-
section. 
(g) IMD WAIVER; WAIVER AUTHORITY.— 
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(1) IMD WAIVER.—The limitation of subdivi-
sion (B) following paragraph (29) of section 1905(a) 
of the Social Security Act (42 U.S.C. 1396d(a)), re-
lating to limitations on payments for care or services 
for individuals under 65 years of age who are pa-
tients in an institution for mental disease, shall not 
apply to inpatient psychiatric hospital services or 
substance abuse residential services furnished under 
the demonstration project. 
(2) WAIVER AUTHORITY.—The Secretary may 
waive such requirements of titles XI and XIX of the 
Social Security Act (which may include the require-
ments of paragraph (1) (relating to statewideness)) 
and paragraph (10)(B) (relating to comparability) of 
section 1902(a) of such Act (42 U.S.C. 1396b(a)) 
only to extent the Secretary determines such a waiv-
er to be necessary to carry out the demonstration 
project. 
(h) DEFINITIONS.—In this Act: 
(1) HIGH UTILIZER OF INPATIENT PSYCHIATRIC 
HOSPITAL SERVICES.—The term ‘‘high utilizer of in-
patient psychiatric hospital services’’ means an indi-
vidual who, with respect to a point in time, meets 
the following conditions: 
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(A) The individual had two or more inpa-
tient admissions for psychiatric services in the 
previous 12 months. 
(B) The individual had 10 or more inpa-
tient admissions for psychiatric services in the 
individual’s lifetime. 
(C) The individual had 100 or more days 
of inpatient psychiatric services in the individ-
ual’s lifetime. 
(D) The individual meets any of the fol-
lowing conditions: 
(i) The individual is receiving court- 
ordered psychiatric treatment. 
(ii) The individual has been receiving 
inpatient psychiatric services for a consecu-
tive period of at least 12 days. 
(iii) The individual has a documented 
history of suicidal or self-harming behav-
iors due to mental illness. 
(iv) The individual has a documented 
history of threatened or actual physical 
harm to another individual due to mental 
illness. 
(2) INSTITUTION FOR MENTAL DISEASE.—The 
term ‘‘institution for mental disease’’ has the mean-
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ing given that term in section 1905(i) of the Social 
Security Act (42 U.S.C. 1396d(i)). 
(3) MEDICAID PROGRAM.—The term ‘‘Medicaid 
program’’ means the program under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
(4) MEDICAL ASSISTANCE.—The term ‘‘medical 
assistance’’ has the meaning given that term in sec-
tion 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)). 
(5) MEDICARE PROGRAM.—The term ‘‘Medicare 
program’’ means the program under part A of title 
XVIII of the Social Security Act (42 U.S.C. 1395c 
et seq.) and includes the programs under parts B, 
C, and D of such title. 
(6) STATE.—The term ‘‘State’’ has the mean-
ing given that term for purposes of the Medicaid 
program. 
SEC. 3. PILOT PROGRAM WAIVING THE MEDICARE 190-DAY 
LIFETIME LIMIT ON INPATIENT PSYCHIATRIC 
HOSPITAL SERVICES TO EXPAND ACCESS TO 
INPATIENT PSYCHIATRIC SERVICES UNDER 
THE MEDICARE PROGRAM. 
(a) DEMONSTRATION PROGRAM AUTHORIZED.—The 
Secretary shall establish a pilot program (in this section 
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