I 115th CONGRESS 2d Session H. R. 5789 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.

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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.