Title: Improving Coverage for Substance Use Disorder Recovery Expansion Act
Policy area: Health

Summary:
Improving Coverage for Substance Use Disorder Recovery Expansion Act
This bill allows state Medicaid programs to cover certain inpatient substance-use disorder treatment services for individuals who are 21 to 64 years of age.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3462 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 3462

 To amend title XIX of the Social Security Act to provide States with 
  the option to provide medical assistance for substance use disorder 
 treatment services to individuals between the ages of 21 and 64 with 
            substance use disorders, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 18, 2018

   Mr. Portman (for himself, Mr. Durbin, Mr. Brown, Ms. Collins, Mr. 
  Booker, and Mr. King) introduced the following bill; which was read 
             twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XIX of the Social Security Act to provide States with 
  the option to provide medical assistance for substance use disorder 
 treatment services to individuals between the ages of 21 and 64 with 
            substance use disorders, 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 ``Improving Coverage for Substance Use 
Disorder Recovery Expansion Act''.

SEC. 2. STATE OPTION TO PROVIDE MEDICAID COVERAGE FOR SUBSTANCE USE 
              DISORDER TREATMENT SERVICES; MODIFICATION OF THE IMD 
              EXCLUSION.

    Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (28), by striking ``and'' after 
                the semicolon;
                    (B) by redesignating paragraph (29) as paragraph 
                (30); and
                    (C) by inserting after paragraph (28), the 
                following new paragraph:
            ``(29) substance use disorder treatment services (as 
        defined in subsection (ee) and furnished in accordance with 
        that subsection) for individuals over 20 years of age and under 
        65 years of age, that are offered as part of a full continuum 
        of evidence-based treatment services provided under the State 
        plan for individuals with substance use disorders; and''; and
                    (D) in the subdivision (B) that follows paragraph 
                (30) (as redesignated by subparagraph (B) of this 
                paragraph), by inserting ``(other than substance use 
                disorder treatment services provided in accordance with 
                paragraph (29) and subsection (ee))'' after ``care or 
                services''; and
            (2) by adding at the end the following new subsection:
    ``(ee) Substance Use Disorder Treatment Services.--
            ``(1) In general.--For purposes of subsection (a)(29), the 
        term `substance use disorder treatment services' means 
        inpatient services provided--
                    ``(A) to an individual for the purpose of treating 
                a substance use disorder that are furnished for not 
                more than 90 days in any 12-month period to an 
                individual who--
                            ``(i) has received initial assessments to 
                        determine the appropriate level of care, length 
                        of stay, and setting for such care for the 
                        individual based upon criteria established by 
                        the Secretary in consultation with the 
                        multidimensional criteria of the American 
                        Society of Addiction Medicine; and
                            ``(ii) at appropriate, evidence-based 
                        intervals (and in no case less than once every 
                        30 days) after the first day on which such 
                        services are provided to the individual, is 
                        subsequently reassessed and determined to 
                        continue to require such services to promote 
                        the individual's recovery and stable transition 
                        to ongoing treatment in an outpatient setting; 
                        and
                    ``(B) in a facility that--
                            ``(i) is licensed by the Single State 
                        Agency for Substance Abuse Services of the 
                        State in which it is located;
                            ``(ii) is accredited for the treatment of 
                        substance use disorders by the Joint 
                        Commission, 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;
                            ``(iii) employs a provider who can 
                        prescribe and discuss with patients the risks, 
                        benefits, and alternatives of at least 2 forms 
                        of medications approved by the Food and Drug 
                        Administration to treat substance use disorder 
                        involving opioids, including one antagonist and 
                        one partial agonist; and
                            ``(iv) contracts with an opioid treatment 
                        program (as defined in section 8.2 of title 42, 
                        Code of Federal Regulations, or any successor 
                        regulation) for the purposes of offering 
                        methadone as a medication option to treat 
                        substance use disorders.
            ``(2) Other medical assistance.--The provision of medical 
        assistance for substance use disorder treatment 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 facility in which the 
        substance use disorder treatment services are provided during 
        any period in which the individual is receiving substance use 
        disorder treatment services.
            ``(3) Ensuring a continuum of care.--As a condition for a 
        State furnishing medical assistance for substance use disorder 
        treatment services in accordance with subsection (a)(29) and 
        this subsection, the State shall--
                    ``(A) notify the Secretary of how the State will 
                ensure that individuals receive appropriate clinical 
                screening prior to being furnished with substance use 
                disorder treatment services, including the initial 
                assessments described in paragraph (1)(A)(i); and
                    ``(B) in order to ensure an appropriate transition 
                from substance use disorder treatment services to other 
                services to treat substance use disorders at a lower 
                level of clinical intensity within the continuum of 
                care (including outpatient services), ensure that all 
                facilities that furnish substance use disorder 
                treatment services under the State plan--
                            ``(i) are able to provide such other 
                        services to treat substance use disorders; or
                            ``(ii) have an established relationship 
                        with another substance use disorder treatment 
                        facility or qualified provider that meets the 
                        licensing requirement of paragraph (1)(B)(i) 
                        and accepts patients receiving medical 
                        assistance under this title under which the 
                        facility furnishing substance use disorder 
                        treatment services may arrange for individuals 
                        to receive such other services to treat 
                        substance use disorders from such other 
                        facility or provider.
            ``(4) Minimum coverage requirements.--As a condition for a 
        State furnishing medical assistance for substance use disorder 
        treatment services in accordance with subsection (a)(29) and 
        this subsection, the State shall provide medical assistance 
        under the State plan for services associated with at least 6 of 
        the 9 levels of care set forth by the American Society of 
        Addiction Medicine in the 2013 edition of its publication 
        entitled `The ASAM Criteria: Treatment Criteria for Addictive 
        Substance-Related, and Co-Occurring Conditions'.
            ``(5) Maintenance of effort.--
                    ``(A) In general.--As a condition for a State 
                furnishing medical assistance for substance use 
                disorder treatment services in accordance with 
                subsection (a)(29) and this subsection, the State 
                shall--
                            ``(i) during the period in which the State 
                        furnishes such medical assistance, maintain at 
                        least the number of licensed beds used for the 
                        provision of substance use disorder treatment 
                        services at institutions for mental diseases 
                        owned, operated, or contracted for by the State 
                        that were being maintained as of the date of 
                        the enactment of this subsection or, if higher, 
                        as of the date the State applies to the 
                        Secretary to include such medical assistance 
                        under the State plan or under a waiver of such 
                        plan; and
                            ``(ii) during the period in which the State 
                        furnishes such medical assistance, maintain on 
                        an annual basis a level of funding expended by 
                        the State (and political subdivisions thereof) 
                        other than under this title from non-Federal 
                        funds--
                                    ``(I) for inpatient services 
                                furnished for the purpose of treating a 
                                substance use disorder in institutions 
                                for mental diseases that is not less 
                                than the level of such funding for such 
                                services and care as of the date of the 
                                enactment of this subsection or, if 
                                higher, as of the date the State 
                                applies to the Secretary to include 
                                such medical assistance under the State 
                                plan or under a waiver of such plan; 
                                and
                                    ``(II) for specified non-IMD 
                                services described in subparagraph (B) 
                                that is not less than the level of such 
                                funding for such services as of the 
                                date of the enactment of this 
                                subsection or, if higher, as of the 
                                date the State applies to the Secretary 
                                to include such medical assistance 
                                under the State plan or under a waiver 
                                of such plan.
                    ``(B) Specified non-imd services described.--For 
                purposes of subparagraph (A)(ii)(II), specified non-IMD 
                services described in this subparagraph are the 
                following:
                            ``(i) Inpatient services, other than such 
                        services described in subparagraph (A)(ii)(I).
                            ``(ii) Outpatient and community-based 
                        services for individuals who are furnished 
                        substance use disorder treatment services, such 
                        as--
                                    ``(I) substance use disorder 
                                treatment;
                                    ``(II) evidence-based recovery and 
                                support services, including short-term 
                                detoxification services;
                                    ``(III) clinically directed 
                                therapeutic treatment to facilitate 
                                recovery skills, relapse prevention, 
                                and emotional coping strategies;
                                    ``(IV) substance use disorder 
                                pharmacotherapy and drug screening;
                                    ``(V) counseling and clinical 
                                monitoring;
                                    ``(VI) withdrawal management and 
                                related treatment designed to alleviate 
                                acute emotional, behavioral, cognitive, 
                                or biomedical distress resulting from, 
                                or occurring with, an individual's use 
                                of alcohol and other drugs; and
                                    ``(VII) routine monitoring of the 
                                medication adherence of such 
                                individuals.
            ``(6) Application to managed care.--Payments for, and 
        limitations to, medical assistance furnished in accordance with 
        subsection (a)(29) and this subsection shall be in addition to 
        and shall not be construed to limit or supersede the ability of 
        States to make monthly capitation payments to managed care 
        organizations for individuals receiving treatment in 
        institutions for mental diseases in accordance with section 
        438.6(e) of title 42, Code of Federal Regulations (or any 
        successor regulation).''.
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