I 
114TH CONGRESS 
1ST SESSION H. R. 3681 
To extend and expand the Medicaid emergency psychiatric demonstration 
project. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 2, 2015 
Mrs. BROOKS of Indiana (for herself and Mr. SARBANES) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To extend and expand the Medicaid emergency psychiatric 
demonstration project. 
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 Access to 
Emergency Psychiatric Care Act’’. 
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SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMER-
GENCY 
PSYCHIATRIC 
DEMONSTRATION 
PROJECT. 
(a) IN GENERAL.—Subsection (d) of section 2707 of 
Public Law 111–148 (42 U.S.C. 1396a note) is amended 
to read as follows: 
‘‘(d) LENGTH OF DEMONSTRATION PROJECT.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graphs (2) and (3), the demonstration project estab-
lished under this section shall be conducted for a pe-
riod of 3 consecutive years. 
‘‘(2) TEMPORARY
EXTENSION
OF
PARTICIPA-
TION ELIGIBILITY FOR SELECTED STATES.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B) and paragraph (4), a State selected 
as an eligible State to participate in the dem-
onstration project on or prior to March 13, 
2012, shall, upon the request of the State, be 
permitted to continue to participate in the dem-
onstration project through September 30, 2016, 
if— 
‘‘(i) the Secretary determines that the 
continued participation of the State in the 
demonstration project is projected not to 
increase net program spending under title 
XIX of the Social Security Act; and 
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‘‘(ii) the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies 
that such extension for that State is pro-
jected not to increase net program spend-
ing under title XIX of the Social Security 
Act. 
‘‘(B) NOTICE OF PROJECTIONS.—The Sec-
retary shall provide each State selected to par-
ticipate in the demonstration project on or prior 
to March 13, 2012, with notice of the deter-
mination and certification made under subpara-
graph (A) for the State. 
‘‘(3) EXTENSION
AND
EXPANSION
OF
DEM-
ONSTRATION PROJECT.— 
‘‘(A) ADDITIONAL
EXTENSION.—Taking 
into account the recommendations submitted to 
Congress under subsection (f)(3), the Secretary 
may permit an eligible State participating in 
the demonstration project as of the date such 
recommendations are submitted to continue to 
participate in the project through December 31, 
2019, if, with respect to the State— 
‘‘(i) the Secretary determines that the 
continued participation of the State in the 
demonstration project is projected not to 
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increase net program spending under title 
XIX of the Social Security Act; and 
‘‘(ii) the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies 
that the continued participation of the 
State in the demonstration project is pro-
jected not to increase net program spend-
ing under title XIX of the Social Security 
Act. 
‘‘(B) OPTION FOR EXPANSION TO ADDI-
TIONAL STATES.—Taking into account the rec-
ommendations submitted to Congress pursuant 
to subsection (f)(3), the Secretary may expand 
the number of eligible States participating in 
the demonstration project through December 
31, 2019, if, with respect to any new eligible 
State— 
‘‘(i) the Secretary determines that the 
participation of the State in the dem-
onstration project is projected not to in-
crease net program spending under title 
XIX of the Social Security Act; and 
‘‘(ii) the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies 
that the participation of the State in the 
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demonstration project is projected not to 
increase net program spending under title 
XIX of the Social Security Act. 
‘‘(C) NOTICE OF PROJECTIONS.—The Sec-
retary shall provide each State participating in 
the demonstration project as of the date the 
Secretary submits recommendations to Con-
gress under subsection (f)(3), and any addi-
tional State that applies to be added to the 
demonstration project, with notice of the deter-
mination and certification made for the State 
under subparagraphs (A) and (B), respectively, 
and the standards used to make such deter-
mination and certification— 
‘‘(i) in the case of a State partici-
pating in the demonstration project as of 
the date the Secretary submits rec-
ommendations to Congress under sub-
section (f)(3), not later than August 31, 
2016; and 
‘‘(ii) in the case of an additional State 
that applies to be added to the demonstra-
tion project, prior to the State making a 
final election to participate in the project. 
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‘‘(4) AUTHORITY
TO
ENSURE
BUDGET
NEU-
TRALITY.—The Secretary annually shall review each 
participating State’s demonstration project expendi-
tures to ensure compliance with the requirements of 
paragraphs (2)(A)(i), (2)(A)(ii), (3)(A)(i), (3)(A)(ii), 
(3)(B)(i), and (3)(B)(ii) (as applicable). If the Sec-
retary determines with respect to a State’s participa-
tion in the demonstration project that the State’s 
net program spending under title XIX of the Social 
Security Act has increased as a result of the State’s 
participation in the project, the Secretary shall treat 
the demonstration project excess expenditures of the 
State as an overpayment under title XIX of the So-
cial Security Act.’’. 
(b) FUNDING.—Subsection (e) of section 2707 of 
such Act (42 U.S.C. 1396a note) is amended— 
(1) in the subsection heading, by striking ‘‘LIM-
ITATIONS ON FEDERAL’’; 
(2) in paragraph (2)— 
(A) in the paragraph heading, by striking 
‘‘5-YEAR’’; and 
(B) by striking ‘‘through December 31, 
2015’’ and inserting ‘‘until expended’’; 
(3) by striking paragraph (3); 
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(4) by redesignating paragraphs (4) and (5) as 
paragraphs (3) and (4), respectively; 
(5) in paragraph (3) (as so redesignated), by 
striking ‘‘and the availability of funds’’ and inserting 
‘‘(other than States deemed to be eligible States 
through the application of subsection (c)(4))’’; and 
(6) in paragraph (4) (as so redesignated)— 
(A) in the first sentence— 
(i) by inserting ‘‘(other than a State 
deemed to be an eligible State through the 
application of subsection (c)(4))’’ after ‘‘el-
igible State’’; and 
(ii) by striking ‘‘paragraph (4)’’ and 
inserting ‘‘paragraph (3)’’; and 
(B) by inserting after the first sentence 
the following: ‘‘In addition to any payments 
made to an eligible State under the preceding 
sentence, the Secretary shall, during any period 
in effect under paragraph (2) or (3) of sub-
section (d), or during any period in which a law 
described in subsection (f)(4)(C) is in effect, 
pay each eligible State (including any State 
deemed to be an eligible State through the ap-
plication of subsection (c)(4)), an amount each 
quarter equal to the Federal medical assistance 
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percentage of expenditures in the quarter dur-
ing such period for medical assistance described 
in subsection (a). Payments made to a State for 
emergency psychiatric demonstration services 
under this section during the extension period 
shall be treated as medical assistance under the 
State plan for purposes of section 1903(a)(1) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(a)(1)).’’. 
(c) RECOMMENDATIONS TO CONGRESS.—Subsection 
(f) of section 2707 of such Act (42 U.S.C. 1396a note) 
is amended by adding at the end the following: 
‘‘(3) RECOMMENDATION TO CONGRESS REGARD-
ING EXTENSION AND EXPANSION OF PROJECT.—Not 
later than September 30, 2016, the Secretary shall 
submit to Congress and make available to the public 
recommendations based on an evaluation of the dem-
onstration project, including the use of appropriate 
quality measures, regarding— 
‘‘(A) whether the demonstration project 
should be continued after September 30, 2016; 
and 
‘‘(B) whether the demonstration project 
should be expanded to additional States. 
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‘‘(4) RECOMMENDATION TO CONGRESS REGARD-
ING PERMANENT EXTENSION AND NATIONWIDE EX-
PANSION.— 
‘‘(A) IN GENERAL.—Not later than April 
1, 2019, the Secretary shall submit to Congress 
and make available to the public recommenda-
tions based on an evaluation of the demonstra-
tion project, including the use of appropriate 
quality measures, regarding— 
‘‘(i) 
whether 
the 
demonstration 
project should be permanently continued 
after December 31, 2019, in 1 or more 
States; and 
‘‘(ii) 
whether 
the 
demonstration 
project should be expanded (including on a 
nationwide basis). 
‘‘(B) REQUIREMENTS.—Any recommenda-
tion submitted under subparagraph (A) to per-
manently continue the project in a State, or to 
expand the project to 1 or more other States 
(including on a nationwide basis) shall include 
a certification from the Chief Actuary of the 
Centers for Medicare & Medicaid Services that 
permanently continuing the project in a par-
ticular State, or expanding the project to a par-
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ticular State (or all States) is projected not to 
increase net program spending under title XIX 
of the Social Security Act. 
‘‘(C) 
CONGRESSIONAL
APPROVAL
RE-
QUIRED.—The Secretary shall not permanently 
continue the demonstration project in any State 
after December 31, 2019, or expand the dem-
onstration project to any additional State after 
December 31, 2019, unless Congress enacts a 
law approving either or both such actions and 
the law includes provisions that— 
‘‘(i) ensure that each State’s partici-
pation in the project complies with budget 
neutrality requirements; and 
‘‘(ii) require the Secretary to treat 
any expenditures of a State participating 
in the demonstration project that are ex-
cess of the expenditures projected under 
the budget neutrality standard for the 
State as an overpayment under title XIX 
of the Social Security Act. 
‘‘(5) FUNDING.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated to the Centers for Medicare & Medicaid 
Services Program Management Account to carry out 
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this subsection, $100,000 for fiscal year 2015, to re-
main available until expended.’’. 
(d) CONFORMING AMENDMENTS.—Section 2707 of 
such Act (42 U.S.C. 1396a note) is amended— 
(1) in subsection (a), in the matter before para-
graph (1), by inserting ‘‘publicly or’’ after ‘‘institu-
tion for mental diseases that is’’; 
(2) in subsection (c)— 
(A) in paragraph (1), by striking ‘‘An eli-
gible State’’ and inserting ‘‘Except as otherwise 
provided in paragraph (4), an eligible State’’; 
(B) in paragraph (3), by striking ‘‘A State 
shall’’ and inserting ‘‘Except as otherwise pro-
vided in paragraph (4), a State shall’’; and 
(C) by adding at the end the following: 
‘‘(4) NATIONWIDE AVAILABILITY.—In the event 
that the Secretary makes a recommendation pursu-
ant to subsection (f)(4) that the demonstration 
project be expanded on a national basis, any State 
that has submitted or submits an application pursu-
ant to paragraph (2) shall be deemed to have been 
selected to be an eligible State to participate in the 
demonstration project.’’; and 
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(3) in the heading for subsection (f), by striking 
‘‘AND REPORT’’ and inserting ‘‘, REPORT, AND REC-
OMMENDATIONS’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act. 
Æ 
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