Medicaid Coverage for Addiction Recovery Expansion Act
Bill: H.R.7156 | Sponsor: Rep. Foster, Bill (D-IL)
Policy area: Health

Summary:
Medicaid Coverage for Addiction Recovery Expansion Act
This bill allows state Medicaid programs to cover residential addiction treatment facility services for adults between the ages of 22 and 64 if such services are offered as part of a full continuum of evidence-based treatment services. Residential addiction treatment facility services are medically necessary inpatient services provided in an accredited, size-limited facility for the purpose of treating a substance-use disorder within a specified time period.
In addition, the bill establishes a grant program for states to expand infrastructure and treatment capabilities of existing youth addiction treatment facilities that (1) provide addiction treatment services to youths under Medicaid or the Children's Health Insurance Program (CHIP), and (2) are located in communities with high numbers of medically underserved populations of at-risk youths. At least 15% of grant funds awarded to a state must be used for making payments to rural facilities.

To amend title XIX of the Social Security Act to provide States with an 
option to provide medical assistance to individuals between the ages of 
 22 and 64 for inpatient services to treat substance use disorders at 
              certain facilities, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid Coverage for Addiction 
Recovery Expansion Act''.

SEC. 2. STATE OPTION TO PROVIDE MEDICAL ASSISTANCE FOR RESIDENTIAL 
              ADDICTION TREATMENT FACILITY SERVICES; MODIFICATION OF 
              THE IMD EXCLUSION.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (a)(16)--
                    (A) by striking ``and, (B)'' and inserting ``, 
                (B)''; and
                    (B) by inserting ``, and (C) effective January 1, 
                2023, residential addiction treatment facility services 
                (as defined in subsection (h)(3)) for individuals over 
                21 years of age and under 65 years of age, if offered 
                as part of a full continuum of evidence-based treatment 
                services provided under the State plan, including 
                residential, outpatient, and community-based care, for 
                individuals with substance use disorders'' before the 
                semicolon; and
            (2) in subsection (h)--
                    (A) in paragraph (1), by striking ``paragraph (16) 
                of subsection (a)'' and inserting ``subsection 
                (a)(16)(A)''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(3)(A) For purposes of subsection (a)(16)(C), the term 
`residential addiction treatment facility services' means, subject to 
subparagraph (B), inpatient services provided--
            ``(i) to an individual for the purpose of treating a 
        substance use disorder that are furnished to an individual for 
        not more than 2 consecutive periods of 30 consecutive days, 
        provided that upon completion of the first 30-day period, the 
        individual is assessed and determined to have progressed 
        through the clinical continuum of care, in accordance with 
        criteria established by the Secretary, in consultation with the 
        American Society of Addiction Medicine, and requires continued 
        medically necessary treatment and social support services to 
        promote recovery, stable transition to ongoing treatment, and 
        discharge; and
            ``(ii) in a facility that is accredited for the treatment 
        of substance use disorders by the Joint Commission on 
        Accreditation of Healthcare Organizations, the Commission on 
        Accreditation of Rehabilitation Facilities, the Council on 
        Accreditation, or any other accrediting agency that the 
        Secretary deems appropriate as necessary to ensure nationwide 
        applicability, including qualified national organizations and 
        State-level accrediting agencies.
    ``(B) The State agency responsible for administering the State plan 
under this title shall establish procedures to ensure that, with 
respect to any facility providing residential addiction treatment 
facility services in a fiscal year, the average monthly number of beds 
used by the facility to provide such services during such year is not 
more than 40.
    ``(C) The provision of medical assistance for residential addiction 
treatment facility services to an individual shall not prohibit Federal 
financial participation for medical assistance for items or services 
that are provided to the individual in or away from the residential 
addiction treatment facility during any 30-day period in which the 
individual is receiving residential addiction treatment facility 
services.
    ``(D) A woman who is eligible for medical assistance on the basis 
of being pregnant and who is furnished residential addiction treatment 
facility services during any 30-day period may remain eligible for, and 
continue to be furnished with, such services for additional 30-day 
periods without regard to any eligibility limit that would otherwise 
apply to the woman as a result of her pregnancy ending, subject to 
assessment by the facility and a determination based on medical 
necessity related to substance use disorder and the impact of substance 
use disorder on birth outcomes.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2023.

SEC. 3. GRANT PROGRAM TO EXPAND YOUTH ADDICTION TREATMENT FACILITIES 
              UNDER MEDICAID AND CHIP.

    (a) Establishment.--
            (1) In general.--The Secretary shall establish a program 
        under which the Secretary shall award grants to States for the 
        purpose of expanding the infrastructure and treatment 
        capabilities, including augmenting equipment and bed capacity, 
        of eligible youth addiction treatment facilities that provide 
        addiction treatment services to Medicaid or CHIP beneficiaries 
        who have not attained the age of 21 and are in communities with 
        high numbers of medically underserved populations of at-risk 
        youth.
            (2) Use of funds.--Grant funds awarded under this section 
        may be used to expand the infrastructure and treatment 
        capabilities of an existing facility (including through 
        construction) but shall not be used for the construction of any 
        new facility or for the provision of medical assistance or 
        child health assistance under Medicaid or CHIP.
            (3) Timetable for implementation; duration.--
                    (A) Implementation.--Not later than 1 year after 
                the date of the enactment of this Act, the Secretary 
                shall award grants under the grant program.
                    (B) Duration.--The Secretary shall award grants 
                under the grant program for a period not to exceed 5 
                years.
    (b) Application.--A State seeking to participate in the grant 
program shall submit to the Secretary, at such time and in such manner 
as the Secretary shall require, an application that includes--
            (1) detailed information on the types of additional 
        infrastructure and treatment capacity of eligible youth 
        addiction treatment facilities that the State proposes to fund 
        under the grant program;
            (2) a description of the communities in which the eligible 
        youth addiction treatment facilities funded under the grant 
        program operate;
            (3) an assurance that the eligible youth addiction 
        treatment facilities that the State proposes to fund under the 
        grant program shall give priority to providing addiction 
        treatment services to Medicaid or CHIP beneficiaries who have 
        not attained the age of 21 and are in communities with high 
        numbers of medically underserved populations of at-risk youth; 
        and
            (4) such additional information and assurances as the 
        Secretary shall require.
    (c) Rural Areas.--Not less than 15 percent of the amount of a grant 
awarded to a State under this section shall be used for making payments 
to eligible youth addiction treatment facilities that are located in 
rural areas or that target the provision of addiction treatment 
services to Medicaid or CHIP beneficiaries who have not attained the 
age of 21 and reside in rural areas.
    (d) Definitions.--For purposes of this section:
            (1) Addiction treatment services.--The term ``addiction 
        treatment services'' means services provided to an individual 
        for the purpose of treating a substance use disorder.
            (2) CHIP.--The term ``CHIP'' means the State children's 
        health insurance program established under title XXI of the 
        Social Security Act (42 U.S.C. 1397aa et seq.).
            (3) Eligible youth addiction treatment facility.--The term 
        ``eligible youth addiction treatment facility'' means a 
        facility that is a participating provider under the State 
        Medicaid or CHIP programs for purposes of providing medical 
        assistance or child health assistance to Medicaid or CHIP 
        beneficiaries for youth addiction treatment services on an 
        inpatient or outpatient basis (or both).
            (4) Medicaid.--The term ``Medicaid'' means the medical 
        assistance program established under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.).
            (5) Medicaid or chip beneficiary.--The term ``Medicaid or 
        CHIP beneficiary'' means an individual who is enrolled in the 
        State Medicaid plan, the State child health plan under CHIP, or 
        under a waiver of either such plan.
            (6) Medically underserved populations.--The term 
        ``medically underserved populations'' has the meaning given 
        that term in section 330(b)(3) of the Public Health Service Act 
        (42 U.S.C. 254b(b)(3)).
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated $50,000,000 to carry out the provisions of this section. 
Funds appropriated under this subsection shall remain available until 
expended.
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