care. Such project shall be based upon the report of the 
Institute of Medicine (of November 2005) relating to Im-
proving the Quality of Health Care for Mental and Sub-
stance-Use Conditions: Quality Chasm Series, and shall 
include demonstrating at least the following: 
(1) Coordinated delivery of mental health, sub-
stance use, and primary health care, utilizing a co- 
location or integrated delivery model. 
(2) Use of evidence-based practices, to as great 
an extent as possible. 
(3) Provision of patient-centered care that em-
phasizes recovery-oriented practices and informed 
patients and, where appropriate, family decision-
making. 
(4) A commitment to utilizing health informa-
tion technology to improve the quality and efficiency 
of care. 
(b) REQUIRED REPORTING ON QUALITY.—The Sec-
retary shall provide that each health care provider partici-
pating in the project shall submit data on quality meas-
ures determined by the Secretary. 
(c) WAIVER OF REQUIREMENTS.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the Secretary is authorized to waive such require-
ments of title XIX of the Social Security Act, such 
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as statewideness, a limitation on the scope of serv-
ices included in medical assistance, and the coverage 
of additional administrative expenses, as may be 
necessary for the implementation of the project. 
(2) LIMITATION ON FUNDING.—The Secretary 
shall design the project in such a manner so that the 
net additional Federal expenditures under title XIX 
of the Social Security Act resulting from the project 
does not exceed $50,000,000. 
(d) INDEPENDENT
EVALUATION.—The Secretary 
shall provide for an independent evaluation of activities 
provided under the project, in comparison with a control 
group. Such evaluation shall include an assessment of 
health and social outcomes for beneficiary participants, 
such as employment status, receipt of welfare benefits, 
criminal justice contacts, and homelessness, as well as the 
resource utilization for medical services, mental and sub-
stance use health care, and social services. Such evaluation 
shall also include an assessment of the impact of activities 
provided under the project on workforce recruitment and 
retention. 
(e) REPORTS TO CONGRESS.— 
(1) INTERIM REPORT.—Not later than 2 years 
after the initiation of the project, the Secretary shall 
submit to the Congress an interim report on the 
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project. Such report shall include such recommenda-
tions as the Secretary determines appropriate. 
(2) FINAL
REPORT.—Not later than 1 year 
after the completion of the project, the Secretary 
shall submit to the Congress a final report on the 
project. The report shall include the results of the 
independent evaluation provided under subsection 
(d) as well as recommendations regarding redesign 
of the mental health and substance use benefit 
under the Medicaid program to maximize the quality 
and efficiency of such benefits. 
SEC. 11. MEDICAID REQUIREMENT FOR STATE REPEAL OF 
LAWS 
DENYING 
HEALTH 
BENEFITS 
COV-
ERAGE BASED ON INTOXICATION. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a), as amended by section 5006 
of division B of Public Law 111–5, is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘and’’ at the end of para-
graph (72); 
(B) by striking the period at the end of 
paragraph (73) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (73) the 
following new paragraph: 
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‘‘(74) provide that the State has in effect a law 
that requires any insurance contract covering med-
ical care losses in the group and individual market 
that is to be offered in the State to meet the re-
quirements of subsection (gg)(1).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg) REQUIREMENTS FOR INSURANCE COVERING 
MEDICAL LOSSES IN THE GROUP AND INDIVIDUAL MAR-
KET.— 
‘‘(1) RESTRICTIONS ON EXCLUSIONS AND LIMI-
TATIONS
RELATING
TO
INTOXICATION.—The re-
quirements of this paragraph with respect to insur-
ance contracts covering medical care losses in the 
group and individual market are as follows: 
‘‘(A) A prohibition against the exclusion or 
denial of covered services and benefits, in con-
nection with the treatment of any patient whose 
medical condition, illness, or injury, involves 
confirmed or suspected intoxication as a result 
of alcohol or other substance. 
‘‘(B) A prohibition against discrimination 
against health care providers in the rate or level 
of payment for covered services in cases in 
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which intoxication is either suspected or con-
firmed. 
‘‘(C) An express obligation to provide and 
pay for covered services and treatments nec-
essary to the treatment of any condition, illness, 
or injury without regard to whether intoxication 
is either suspected or confirmed. 
‘‘(D) An express obligation to cooperate 
with the state agency for medical assistance as 
provided under section 1902(a)(25). 
‘‘(2) INCLUSION
OF
ALL
FORMS
OF
COV-
ERAGE.—For purposes of subsection (a)(74) and 
paragraph (1), the term ‘insurance contract covering 
medical care losses in the group and individual mar-
ket’ includes any class or type of insurance relating 
to medical care in the group or individual market, 
including plans covering public employees as well as 
private employees, regardless of whether coverage 
under the contract is expressed in terms of defined 
benefits or defined cash contributions toward the 
cost of medical losses.’’. 
(b) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by subsection (a) shall apply to 
calendar quarters beginning on or after January 1, 
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2010, without regard to whether or not final regula-
tions to carry out such amendments have been pro-
mulgated by such date. 
(2) In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary determines requires State legis-
lation (other than legislation appropriating funds) in 
order for the plan to meet the additional require-
ments imposed by the amendments made by sub-
section (a), the State plan shall not be regarded as 
failing to comply with the requirements of such title 
solely on the basis of its failure to meet these addi-
tional requirements before the first day of the first 
calendar quarter beginning after the close of the 
first regular session of the State legislature that be-
gins after the date of the enactment of this Act. For 
purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year 
of such session shall be deemed to be a separate reg-
ular session of the State legislature. 
Æ 
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