IB 
Union Calendar No. 558 
115TH CONGRESS 
2D SESSION 
H. R. 5797 
[Report No. 115–723] 
To amend title XIX of the Social Security Act to allow States to provide 
under Medicaid services for certain individuals with opioid use disorders 
in institutions for mental diseases. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2018 
Mrs. MIMI WALTERS of California (for herself, Mr. KNIGHT, and Mr. GUTH-
RIE) introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
JUNE 12, 2018 
Additional sponsors: Mrs. BLACKBURN, Mr. WALDEN, and Mr. HILL 
JUNE 12, 2018 
Reported with an amendment, 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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A BILL 
To amend title XIX of the Social Security Act to allow 
States to provide under Medicaid services for certain 
individuals with opioid use disorders in institutions for 
mental diseases. 
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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 ‘‘Individuals in Medicaid 
Deserve Care that is Appropriate and Responsible in its 
Execution Act’’ or the ‘‘IMD CARE Act’’. 
SEC. 2. MEDICAID STATE PLAN OPTION TO PROVIDE SERV-
ICES 
FOR 
CERTAIN 
INDIVIDUALS 
WITH 
OPIOID USE DISORDERS IN INSTITUTIONS 
FOR MENTAL DISEASES. 
Section 1915 of the Social Security Act (42 U.S.C. 
1396n) is amended by adding at the end the following new 
subsection: 
‘‘(l) STATE PLAN OPTION TO PROVIDE SERVICES FOR 
CERTAIN INDIVIDUALS IN INSTITUTIONS FOR MENTAL DIS-
EASES.— 
‘‘(1) IN
GENERAL.—With respect to calendar 
quarters beginning during the period beginning Janu-
ary 1, 2019, and ending December 31, 2023, a State 
may elect, through a State plan amendment, to, not-
withstanding section 1905(a), provide medical assist-
ance for services furnished in institutions for mental 
diseases and for other medically necessary services 
furnished to eligible individuals with opioid use dis-
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orders, in accordance with the requirements of this 
subsection. 
‘‘(2) PAYMENTS.— 
‘‘(A) 
IN
GENERAL.—Amounts 
expended 
under a State plan amendment under paragraph 
(1) for services described in such paragraph fur-
nished, with respect to a 12-month period, to an 
eligible individual with an opioid use disorder 
who is a patient in an institution for mental 
diseases shall be treated as medical assistance for 
which payment is made under section 1903(a) 
but only to the extent that such services are fur-
nished for not more than a period of 30 days 
(whether or not consecutive) during such 12- 
month period. 
‘‘(B) 
CLARIFICATION.—Payment 
made 
under this paragraph for expenditures under a 
State plan amendment under this subsection 
with respect to services described in paragraph 
(1) furnished to an eligible individual with an 
opioid use disorder shall not affect payment that 
would otherwise be made under section 1903(a) 
for expenditures under the State plan (or waiver 
of such plan) for medical assistance for such in-
dividual. 
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‘‘(3) INFORMATION
REQUIRED
IN
STATE
PLAN 
AMENDMENT.— 
‘‘(A) IN GENERAL.—A State electing to pro-
vide medical assistance pursuant to this sub-
section shall include with the submission of the 
State plan amendment under paragraph (1) to 
the Secretary— 
‘‘(i) a plan on how the State will im-
prove access to outpatient care during the 
period of the State plan amendment, in-
cluding a description of— 
‘‘(I) the process by which eligible 
individuals with opioid use disorders 
will make the transition from receiving 
inpatient services in an institution for 
mental diseases to appropriate out-
patient care; and 
‘‘(II) the process the State will 
undertake to ensure individuals with 
opioid use disorder are provided care 
in the most integrated setting appro-
priate to the needs of the individuals; 
and 
‘‘(ii) a description of how the State 
plan amendment ensures an appropriate 
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clinical screening of eligible individuals 
with an opioid use disorder, including as-
sessments to determine level of care and 
length of stay recommendations based upon 
the multidimensional assessment criteria of 
the American Society of Addiction Medi-
cine. 
‘‘(B) REPORT.—Not later than the sooner of 
December 31, 2024, or one year after the date of 
the termination of a State plan amendment 
under this subsection, the State shall submit to 
the Secretary a report that includes at least— 
‘‘(i) the number of eligible individuals 
with opioid use disorders who received serv-
ices pursuant to such State plan amend-
ment; 
‘‘(ii) the length of the stay of each such 
individual in an institution for mental dis-
eases; and 
‘‘(iii) the type of outpatient treatment, 
including 
medication-assisted 
treatment, 
each such individual received after being 
discharged from such institution. 
‘‘(4) DEFINITIONS.—In this subsection: 
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‘‘(A) ELIGIBLE INDIVIDUAL WITH AN OPIOID 
USE DISORDER.—The term ‘eligible individual 
with an opioid use disorder’ means an indi-
vidual who— 
‘‘(i) with respect to a State, is enrolled 
for medical assistance under the State plan 
(or a waiver of such plan); 
‘‘(ii) is at least 21 years of age; 
‘‘(iii) has not attained 65 years of age; 
and 
‘‘(iv) has been diagnosed with at least 
one opioid use disorder. 
‘‘(B) 
INSTITUTION
FOR
MENTAL
DIS-
EASES.—The term ‘institution for mental dis-
eases’ has the meaning given such term in sec-
tion 1905(i). 
‘‘(C) 
OPIOID
PRESCRIPTION
PAIN
RE-
LIEVER.—The term ‘opioid prescription pain re-
liever’ includes hydrocodone products, oxycodone 
products, tramadol products, codeine products, 
morphine 
products, 
fentanyl 
products, 
buprenorphine products, oxymorphone products, 
meperidine products, hydromorphone products, 
methadone, and any other prescription pain re-
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liever identified by the Assistant Secretary for 
Mental Health and Substance Use. 
‘‘(D) OPIOID
USE
DISORDER.—The term 
‘opioid use disorder’ means a disorder that meets 
the criteria of the Diagnostic and Statistical 
Manual of Mental Disorders, 4th Edition (or a 
successor edition), for heroin use disorder or 
pain reliever use disorder (including with respect 
to opioid prescription pain relievers). 
‘‘(E) OTHER MEDICALLY NECESSARY SERV-
ICES.—The term ‘other medically necessary serv-
ices’ means, with respect to an eligible indi-
vidual with an opioid use disorder who is a pa-
tient in an institution for mental diseases, items 
and services that are provided to such individual 
outside of such institution to the extent that such 
items and services would be treated as medical 
assistance for such individual if such individual 
were not a patient in such institution.’’. 
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Union Calendar No. 558 
115TH CONGRESS 
2D SESSION 
H. R. 5797 
[Report No. 115–723] 
A BILL 
To amend title XIX of the Social Security Act to 
allow States to provide under Medicaid services 
for certain individuals with opioid use disorders 
in institutions for mental diseases. 
JUNE 12, 2018 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
VerDate Sep 11 2014 
22:25 Jun 12, 2018
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