Title: Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act
Policy area: Health

Summary:
Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Delivery Act or the IMD CARE Act
This bill temporarily allows states to apply to receive federal Medicaid payment for services provided in institutions for mental diseases (IMDs) for enrollees (aged 21 to 64) with opioid use disorders. In general, with respect to an eligible enrollee, services may be covered for a total of up to 30 days in a 12-month period. States must include specified information in their applications, including plans to improve access to outpatient care.
Current law generally prohibits federal payment under Medicaid for services provided in IMDs for individuals under the age of 65 (although states may receive payment through certain mechanisms, such as through a Medicaid demonstration waiver).

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5797 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 5797

   To amend title XIX of the Social Security Act to allow States to 
provide under Medicaid services for certain individuals with opioid use 
             disorders in institutions for mental diseases.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 15, 2018

   Mrs. Mimi Walters of California (for herself, Mr. Knight, 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 allow States to 
provide under Medicaid services for certain individuals with opioid use 
             disorders in institutions for mental diseases.

    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 ``Individuals in Medicaid Deserve Care 
that is Appropriate and Responsible in its Delivery Act'' or the ``IMD 
CARE Act''.

SEC. 2. MEDICAID STATE PLAN OPTION TO PROVIDE SERVICES FOR CERTAIN 
              INDIVIDUALS WITH OPIOID USE DISORDERS IN INSTITUTIONS FOR 
              MENTAL DISEASES.

    Section 1915 of the Social Security Act (42 U.S.C. 1396n) is 
amended by adding at the end the following new subsection:
    ``(l) State Plan Option To Provide Services for Certain Individuals 
in Institutions for Mental Diseases.--
            ``(1) In general.--With respect to calendar quarters 
        beginning during the period beginning January 1, 2019, and 
        ending December 31, 2023, a State may elect, through a State 
        plan amendment, to, notwithstanding section 1905(a), provide 
        medical assistance for services furnished in institutions for 
        mental diseases to eligible individuals with opioid use 
        disorders, in accordance with the requirements of this 
        subsection.
            ``(2) Payments.--
                    ``(A) In general.--Amounts expended under a State 
                plan amendment under paragraph (1) for services 
                described in such paragraph furnished, with respect to 
                a 12-month period, in an institution for mental 
                diseases to an eligible individual with an opioid use 
                disorder shall be treated as medical assistance for 
                which payment is made under section 1903(a) but only to 
                the extent that, subject to subparagraph (B), such 
                services are furnished for not more than a period of 30 
                days (whether or not consecutive) during such 12-month 
                period.
                    ``(B) Limitations.--Payment for expenditures 
                described in subparagraph (A), with respect to services 
                described in paragraph (1) furnished in an institution 
                for mental diseases to an eligible individual with an 
                opioid use disorder during a 12-month period, shall not 
                be made under section 1903(a) with respect to such 
                services furnished during any period exceeding 30 
                consecutive days during such 12-month period, unless 
                the State requires under the State plan amendment 
                continued medically necessary treatment during the 
                entire period for which such services are furnished and 
                for which payment is made pursuant to this paragraph in 
                order to promote recovery, stable transition to ongoing 
                treatment, and discharge.
                    ``(C) Clarification.--Payment made under this 
                paragraph for expenditures under a State plan amendment 
                under this subsection with respect to services 
                described in paragraph (1) furnished to an eligible 
                individual with an opioid use disorder shall not affect 
                payment that would otherwise be made under section 
                1903(a) for expenditures under the State plan (or 
                waiver of such plan) for medical assistance for such 
                individual.
            ``(3) Information required in state plan amendment.--
                    ``(A) In general.--A State electing to provide 
                medical assistance pursuant to this subsection shall 
                include with the submission of the State plan amendment 
                under paragraph (1) to the Secretary--
                            ``(i) a plan on how the State will improve 
                        access to outpatient care during the period of 
                        the State plan amendment, including a 
                        description of--
                                    ``(I) the process by which eligible 
                                individuals with opioid use disorders 
                                will make the transition from receiving 
                                inpatient services in an institution 
                                for mental diseases to appropriate 
                                outpatient care; and
                                    ``(II) the process the State will 
                                undertake to ensure individuals with 
                                opioid use disorder are provided care 
                                in the most integrated setting 
                                appropriate to the needs of the 
                                individuals; and
                            ``(ii) a description of how the State plan 
                        amendment ensures an appropriate clinical 
                        screening of eligible individuals with an 
                        opioid use disorder, including assessments to 
                        determine level of care and length of stay 
                        recommendations based upon the multidimensional 
                        assessment criteria of the American Society of 
                        Addiction Medicine.
                    ``(B) Report.--Not later than one year after the 
                date of the termination of a State plan amendment under 
                this subsection, the State shall submit to the 
                Secretary a report that includes at least--
                            ``(i) the number of eligible individuals 
                        with opioid use disorders who received services 
                        pursuant to such plan;
                            ``(ii) the length of the stay of each such 
                        individual in an institution for mental 
                        diseases; and
                            ``(iii) the type of outpatient treatment, 
                        including medication-assisted treatment, each 
                        such individual received after being discharged 
                        from such institution.
            ``(4) Definitions.--In this subsection:
                    ``(A) Eligible individual with an opioid use 
                disorder.--The term `eligible individual with an opioid 
                use disorder' means an individual who--
                            ``(i) with respect to a State, is enrolled 
                        for medical assistance under the State plan (or 
                        a waiver of such plan);
                            ``(ii) is at least 21 years of age;
                            ``(iii) has not attained 65 years of age; 
                        and
                            ``(iv) has been diagnosed with at least one 
                        opioid use disorder.
                    ``(B) Institution for mental diseases.--The term 
                `institution for mental diseases' has the meaning given 
                such term in section 1905(i).
                    ``(C) Opioid prescription pain reliever.--The term 
                `opioid prescription pain reliever' includes 
                hydrocodone products, oxycodone products, tramadol 
                products, codeine products, morphine products, fentanyl 
                products, buprenorphine products, oxymorphone products, 
                meperidine products, hydromorphone products, methadone, 
                and any other prescription pain reliever identified by 
                the Assistant Secretary for Mental Health and Substance 
                Use.
                    ``(D) Opioid use disorder.--The term `opioid use 
                disorder' means a disorder that meets the criteria of 
                the Diagnostic and Statistical Manual of Mental 
                Disorders, 4th Edition (or a successor edition), for 
                heroin use disorder or pain reliever use disorder 
                (including with respect to opioid prescription pain 
                relievers).''.
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