I 
118TH CONGRESS 
1ST SESSION H. R. 3892 
To amend title XIX of the Social Security Act to make permanent the 
State plan amendment option to provide medical assistance for certain 
individuals who are patients in certain institutions for mental diseases, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 7, 2023 
Mr. BURGESS (for himself and Mr. TORRES of New York) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to make 
permanent the State plan amendment option to provide 
medical assistance for certain individuals who are pa-
tients in certain institutions for mental diseases, 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 ‘‘Improving Mental 
Health and Drug Treatment Act of 2023’’. 
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SEC. 2. LIFTING THE IMD EXCLUSION FOR SUBSTANCE USE 
DISORDER AND SERIOUS MENTAL ILLNESS. 
(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) LENGTHS OF STAY.—Section 1915(l)(2) of the 
Social Security Act (42 U.S.C. 1396n(l)(2)) is amended— 
(1) by striking ‘‘30 days’’ and inserting ‘‘45 
days’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘Nothing in this paragraph shall be construed 
as precluding a State from using other authorities, 
including section 1115, that apply with respect to 
medical assistance under the State plan under this 
title, or waiver of such plan, for delivering care in 
certain institutions for mental diseases with more 
than 16 beds concurrently with this paragraph and 
allowing for stays in such institutions for mental dis-
eases equal to the combined total lengths of stays 
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permitted under the respective authorities so long as 
all requirements for such authorities are met.’’. 
(c) MAINTENANCE OF EFFORT REVISION.—Clauses 
(i) and (ii) of section 1915(l)(3)(A) of the Social Security 
Act (42 U.S.C. 1396n(l)(3)(A)) are each amended by 
striking ‘‘or, if higher,’’ and all that follows through ‘‘in 
accordance with this subsection’’. 
(d) 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 
(E)’’; 
(ii) in subparagraph (D), in the mat-
ter preceding clause (i), by inserting ‘‘have 
in place a substance use disorder-specific 
individual placement criteria and utiliza-
tion management approach to ensure 
placement of such individual in an appro-
priate level of care and shall’’ after ‘‘State 
shall’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
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‘‘(E) REVIEW PROCESS.—The State shall 
have in place a process to review the compliance 
of eligible institutions for mental diseases with 
standards of care 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.—The State shall, not 
later than 12 months after the approval of a 
State plan amendment described in this sub-
section (or, in the case such State has such an 
amendment approved as of the date of the en-
actment of this subparagraph, not later than 12 
months after such date), conduct an assessment 
of— 
‘‘(i) the availability of treatment for 
individuals enrolled under a State plan 
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under this title (or waiver of such plan) in 
each level of care described in subpara-
graph (C); and 
‘‘(ii) the availability of medication-as-
sisted treatment and medically supervised 
withdrawal management services for such 
individuals.’’. 
Æ 
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