I 
111TH CONGRESS 
1ST SESSION H. R. 1415 
To provide for a demonstration project regarding Medicaid reimbursements 
for stabilization of emergency medical conditions by non-publicly owned 
or operated institutions for mental diseases. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 10, 2009 
Mr. GORDON of Tennessee introduced the following bill; which was referred 
to the Committee on Energy and Commerce 
A BILL 
To provide for a demonstration project regarding Medicaid 
reimbursements for stabilization of emergency medical 
conditions by non-publicly owned or operated institutions 
for mental diseases. 
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 Emergency 
Psychiatric Care Demonstration Project Act of 2009’’. 
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SEC. 2. DEMONSTRATION PROJECT REGARDING MEDICAID 
REIMBURSEMENTS FOR STABILIZATION OF 
EMERGENCY MEDICAL CONDITIONS BY NON- 
PUBLICLY OWNED OR OPERATED INSTITU-
TIONS FOR MENTAL DISEASES. 
(a) AUTHORITY
TO
CONDUCT
DEMONSTRATION 
PROJECT.—The Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall estab-
lish a demonstration project under which an eligible State 
(as described in subsection (c)) shall provide reimburse-
ment under the State Medicaid plan under title XIX of 
the Social Security Act to an institution for mental dis-
eases that is not publicly owned or operated and that is 
subject to the requirements of section 1867 of the Social 
Security Act (42 U.S.C. 1395dd) for the provision of med-
ical assistance available under such plan to an individual 
who— 
(1) has attained age 21, but has not attained 
age 65; 
(2) is eligible for medical assistance under such 
plan; and 
(3) requires such medical assistance to stabilize 
an emergency medical condition. 
(b) IN-STAY REVIEW.—The Secretary shall establish 
a mechanism for in-stay review to determine whether or 
not the patient has been stabilized (as defined in sub-
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section (h)(5)). This mechanism shall commence before 
the third day of the inpatient stay. States participating 
in the demonstration project may manage the provision 
of these benefits under the project through utilization re-
view, authorization, or management practices, or the ap-
plication of medical necessity and appropriateness criteria 
applicable to behavioral health. 
(c) ELIGIBLE STATE DEFINED.— 
(1) APPLICATION.—Upon approval of an appli-
cation submitted by a State described in paragraph 
(2), the State shall be an eligible State for purposes 
of conducting a demonstration project under this 
section. 
(2) STATE
DESCRIBED.—States shall be se-
lected by the Secretary in a manner so as to provide 
geographic diversity on the basis of the application 
to conduct a demonstration project under this sec-
tion submitted by such States. 
(d) LENGTH OF DEMONSTRATION PROJECT.—The 
demonstration project established under this section shall 
be conducted for a period of 3 consecutive years. 
(e) LIMITATIONS ON FEDERAL FUNDING.— 
(1) APPROPRIATION.— 
(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
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appropriated 
to 
carry 
out 
this 
section, 
$75,000,000 for fiscal year 2010. 
(B) BUDGET AUTHORITY.—Subparagraph 
(A) constitutes budget authority in advance of 
appropriations Act and represents the obliga-
tion of the Federal Government to provide for 
the payment of the amounts appropriated under 
that subparagraph. 
(2) 
3-YEAR
AVAILABILITY.—Funds 
appro-
priated under paragraph (1) shall remain available 
for obligation through December 31, 2012. 
(3) LIMITATION
ON
PAYMENTS.—In no case 
may— 
(A) the aggregate amount of payments 
made by the Secretary to eligible States under 
this section exceed $75,000,000; or 
(B) payments be provided by the Secretary 
under this section after December 31, 2012. 
(4) FUNDS ALLOCATED TO STATES.—The Sec-
retary shall allocate funds to eligible States based on 
their applications and the availability of funds. 
(5) PAYMENTS
TO
STATES.—The Secretary 
shall pay to each eligible State, from its allocation 
under paragraph (4), an amount each quarter equal 
to the Federal medical assistance percentage of ex-
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penditures in the quarter for medical assistance de-
scribed in subsection (a). 
(f) REPORTS.— 
(1) ANNUAL
PROGRESS
REPORTS.—The Sec-
retary shall submit annual reports to Congress on 
the progress of the demonstration project conducted 
under this section. 
(2) FINAL REPORT AND RECOMMENDATION.— 
An evaluation should be conducted of the demonstra-
tion project’s impact on the functioning of the health 
and mental health service system and on individuals 
enrolled in the Medicaid program. This evaluation 
should include collection of baseline data for one- 
year prior to the initiation of the demonstration 
project as well as collection of data from matched 
comparison states not participating in the dem-
onstration. The evaluation measures shall include 
the following: 
(A) A determination, by State, as to 
whether the demonstration project resulted in 
increased access to inpatient mental health 
services under the Medicaid program and 
whether average length of stays were longer (or 
shorter) for individuals admitted under the 
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demonstration project compared with individ-
uals otherwise admitted in comparison sites. 
(B) An analysis by State, regarding wheth-
er the demonstration project produced a signifi-
cant reduction in emergency room visits for in-
dividuals eligible for assistance under the Med-
icaid program or in the duration of emergency 
room lengths of stay. 
(C) An assessment of discharge planning 
by participating hospitals that ensures access to 
further (non-emergency) inpatient or residential 
care as well as continuity of care for those dis-
charged to outpatient care. 
(D) 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 plan as contrasted with the comparison 
areas. 
(E) Data on the percentage of consumers 
with Medicaid coverage who are admitted to in-
patient facilities as a result of the demonstra-
tion project as compared to those admitted to 
these same facilities through other means. 
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(F) A recommendation regarding whether 
the demonstration project should be continued 
after December 31, 2012, and expanded on a 
national basis. 
(g) WAIVER AUTHORITY.— 
(1) IN GENERAL.—The Secretary shall waive 
the limitation of subdivision (B) following paragraph 
(28) of section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) (relating to limitations on pay-
ments for care or services for individuals under 65 
years of age who are patients in an institution for 
mental diseases) for purposes of carrying out the 
demonstration project under this section. 
(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) and 1902(1)(10)(B) (relating to com-
parability)) only to extent necessary to carry out the 
demonstration project under this section. 
(h) DEFINITIONS.—In this section: 
(1) EMERGENCY
MEDICAL
CONDITION.—The 
term ‘‘emergency medical condition’’ means, with re-
spect to an individual, an individual who expresses 
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suicidal or homicidal thoughts or gestures, if deter-
mined dangerous to self or others. 
(2) FEDERAL MEDICAL ASSISTANCE PERCENT-
AGE.—The term ‘‘Federal medical assistance per-
centage’’ has the meaning given that term with re-
spect to a State under section 1905(b) of the Social 
Security Act (42 U.S.C. 1396d(b)). 
(3) INSTITUTION FOR MENTAL DISEASES.—The 
term ‘‘institution for mental diseases’’ has the mean-
ing given to that term in section 1905(i) of the So-
cial Security Act (42 U.S.C. 1396d(i)). 
(4) MEDICAL ASSISTANCE.—The term ‘‘medical 
assistance’’ has the meaning given to that term in 
section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)). 
(5) 
STABILIZED.—The 
term 
‘‘stabilized’’ 
means, with respect to an individual, that the emer-
gency medical condition no longer exists with respect 
to the individual and the individual is no longer dan-
gerous to self or others. 
(6) STATE.—The term ‘‘State’’ has the mean-
ing given that term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
Æ 
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