Title: To amend title XIX of the Social Security Act to provide for Medicaid coverage protections for pregnant and post-partum women while receiving inpatient treatment for a substance use disorder, and for other purposes.
Policy area: Health

Summary:
This bill allows states to receive federal payment under Medicaid for outside services that are provided to pregnant and postpartum women who are substance use disorder patients at institutions for mental diseases. State Medicaid programs may also cover residential pediatric recovery center services for infants with neonatal abstinence syndrome.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5789 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5789

 To amend title XIX of the Social Security Act to provide for Medicaid 
coverage protections for pregnant and post-partum women while receiving 
    inpatient treatment for a substance use disorder, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 15, 2018

Mr. Foster (for himself and Mr. Guthrie) 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 provide for Medicaid 
coverage protections for pregnant and post-partum women while receiving 
    inpatient treatment for a substance use disorder, 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. MEDICAID COVERAGE PROTECTION FOR PREGNANT AND POST-PARTUM 
              WOMEN WHILE RECEIVING INPATIENT TREATMENT FOR A SUBSTANCE 
              USE DISORDER; STATE OPTION FOR COVERAGE OF ROOM AND BOARD 
              FOR CERATIN INFANTS WITH NEONATAL ABSTINENCE SYNDROME.

    (a) Medicaid Coverage for Pregnant and Post-Partum Women While 
Receiving Inpatient Treatment for a Substance Use Disorder.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d(a)) is amended by adding at the end the 
        following new sentence: ``In the case of a woman who is 
        eligible for medical assistance on the basis of being pregnant 
        (including through the end of the month in which the 60-day 
        period beginning on the last day of her pregnancy ends) (or is 
        eligible for medical assistance on another basis and is 
        pregnant or was pregnant during the previous one-year period 
        (in this sentence, such a woman shall be referred to as an 
        `other pathway eligible pregnant woman')), who is a patient in 
        an institution for mental diseases for purposes of receiving 
        treatment for a substance use disorder, and who was enrolled 
        for medical assistance under the State plan immediately before 
        becoming a patient in an institution for mental diseases or who 
        becomes eligible to enroll for such medical assistance while 
        such a patient, the exclusion specified in the subdivision (B) 
        following paragraph (29) of the first sentence shall not be 
        construed as prohibiting Federal financial participation for 
        medical assistance for items or services that are provided to 
        the woman outside of the institution during, in the case of a 
        woman who is eligible for medical assistance on the basis of 
        being pregnant, the period of such eligibility on such basis 
        and through the end of the month in which the one-year period 
        beginning on the last day of her pregnancy ends (and, in the 
        case of an other pathway eligible pregnant woman, the period 
        during which the woman satisfies the description of being such 
        an other pathway eligible pregnant woman, including through the 
        end of the month in which the one-year period beginning on the 
        last day of her pregnancy ends) to the extent such items or 
        services would be treated as medical assistance for such woman 
        during such period if such woman were not a patient in the 
        institution.''.
            (2) Effective date.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the amendment made by paragraph (1) shall take 
                effect with respect to medical assistance provided on 
                or after January 1, 2019.
                    (B) Exception if state legislation required.--In 
                the case of a State plan under title XIX of the Social 
                Security Act which the Secretary of Health and Human 
                Services determines requires State legislation (other 
                than legislation appropriating funds) in order for the 
                plan to meet the additional requirements imposed by the 
                amendment made by paragraph (1), 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 additional requirements before 
                the first day of the first calendar quarter beginning 
                after the close of the first regular session of the 
                State legislature that begins 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 regular session of the State 
                legislature.
    (b) Medicaid State Plan Option To Enter Into Provider Agreements 
With Residential Pediatric Recovery Centers.--Section 1902 of the 
Social Security Act (42 U.S.C. 1396a) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (82), by striking ``and'' at the 
                end;
                    (B) in paragraph (83), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by inserting after paragraph (83) the following 
                new paragraph:
            ``(84) at the option of the State and in accordance with 
        paragraph (2) of subsection (nn), beginning January 1, 2019, 
        for making medical assistance available on an inpatient or 
        outpatient basis at a residential pediatric recovery center (as 
        defined in paragraph (1) of such subsection) for infants who 
        are under 1 year of age with neonatal abstinence syndrome.''; 
        and
            (2) by adding at the end the following new subsection:
    ``(nn) Residential Pediatric Recovery Center.--
            ``(1) Definition.--For purposes of subsection (a)(84), the 
        term `residential pediatric recovery center' means a center or 
        facility that--
                    ``(A) provides comprehensive treatment to infants 
                who are under 1 year of age with a diagnosis of 
                neonatal abstinence syndrome, which includes at least 
                access to early and periodic screening, diagnostic and 
                treatment; physician and nursing services; supportive 
                counseling; comprehensive evaluation and assessment and 
                service planning by State licensed counselors or social 
                workers; targeted case management services by State 
                licensed or educated professionals; education and 
                supportive counseling and case management of family 
                members of such infants; room and board costs for such 
                infants; and facilitation of arrangements within such 
                facilities whereby such infants reside with their 
                mother when applicable; and
                    ``(B) provides treatment services in accordance 
                with guidelines issued by the American Academy of 
                Pediatrics and American College of Obstetricians and 
                Gynecologists relating to maternal care and infant care 
                with respect to neonatal abstinence syndrome.
            ``(2) Clarification.--Nothing in subsection (a)(84) shall 
        be construed as including as medical assistance room and board 
        services for any individual other than an infant described in 
        such subsection.''.
    (c) Guidance.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
issue guidance to improve care for infants with neonatal abstinence 
syndrome and their mothers. Such guidance shall include--
            (1) the types of services, including post-discharge 
        services and parenting supports, for mothers and fathers of 
        babies with neonatal abstinence syndrome that States may cover 
        under the Medicaid program under title XIX of the Social 
        Security Act;
            (2) best practices from States with respect to innovative 
        or evidenced-based payment models that focus on prevention, 
        screening, treatment, plans of safe care, and post-discharge 
        services for mothers and fathers with substance use disorders 
        and babies with neonatal abstinence syndrome that improve care 
        and clinical outcomes;
            (3) recommendations for States on available financing 
        options under the Medicaid program under title XIX of such Act 
        and under the Children's Health Insurance Program under title 
        XXI of such Act for Children's Health Insurance Program Health 
        Services Initiative funds for home visiting services for 
        parents with substance use disorders and infants with neonatal 
        abstinence syndrome; and
            (4) guidance and technical assistance to State Medicaid 
        agencies regarding additional flexibilities and incentives 
        related to screening, prevention, and post-discharge services, 
        including parenting supports, under contracts with Medicaid 
        managed care organizations.
    (d) GAO Study.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall conduct a study, and submit to Congress a report, addressing gaps 
in coverage for pregnant women with substance use disorder under the 
Medicaid program under title XIX of the Social Security Act, and gaps 
in coverage for postpartum women with substance use disorder who had 
coverage during their pregnancy under the Medicaid program under such 
title.
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