Improving Access to Emergency Psychiatric Care Act
PL 114-97 (S.599), enacted 12/11/2015

129 STAT. 2194 
PUBLIC LAW 114–97—DEC. 11, 2015 
Public Law 114–97 
114th Congress 
An Act 
To extend and expand the Medicaid emergency psychiatric demonstration project. 
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 Access to Emergency 
Psychiatric Care Act’’. 
SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMERGENCY PSY-
CHIATRIC DEMONSTRATION PROJECT. 
(a) IN GENERAL.—Subsection (d) of section 2707 of Public Law 
111–148 (42 U.S.C. 1396a note) is amended to read as follows: 
‘‘(d) LENGTH OF DEMONSTRATION PROJECT.— 
‘‘(1) IN GENERAL.—Except as provided in paragraphs (2) 
and (3), the demonstration project established under this section 
shall be conducted for a period of 3 consecutive years. 
‘‘(2) TEMPORARY EXTENSION OF PARTICIPATION ELIGIBILITY 
FOR SELECTED STATES.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B) and 
paragraph (4), a State selected as an eligible State to 
participate in the demonstration project on or prior to 
March 13, 2012, shall, upon the request of the State, be 
permitted to continue to participate in the demonstration 
project through September 30, 2016, if— 
‘‘(i) the Secretary determines that the continued 
participation of the State in the demonstration project 
is projected not to increase net program spending under 
title XIX of the Social Security Act; and 
‘‘(ii) the Chief Actuary of the Centers for Medicare 
& Medicaid Services certifies that such extension for 
that State is projected not to increase net program 
spending under title XIX of the Social Security Act. 
‘‘(B) NOTICE OF PROJECTIONS.—The Secretary shall pro-
vide each State selected to participate in the demonstration 
project on or prior to March 13, 2012, with notice of the 
determination and certification made under subparagraph 
(A) for the State. 
‘‘(3) 
EXTENSION
AND
EXPANSION
OF
DEMONSTRATION 
PROJECT.— 
‘‘(A) ADDITIONAL EXTENSION.—Taking into account the 
recommendations submitted to Congress under subsection 
(f)(3), the Secretary may permit an eligible State partici-
pating in the demonstration project as of the date such 
recommendations are submitted to continue to participate 
Certification. 
Determination. 
Time period. 
42 USC 1305 
note. 
Improving Access 
to Emergency 
Psychiatric Care 
Act. 
Dec. 11, 2015 
[S. 599] 
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129 STAT. 2195 
PUBLIC LAW 114–97—DEC. 11, 2015 
in the project through December 31, 2019, if, with respect 
to the State— 
‘‘(i) the Secretary determines that the continued 
participation of the State in the demonstration project 
is projected not to increase net program spending under 
title XIX of the Social Security Act; and 
‘‘(ii) the Chief Actuary of the Centers for Medicare 
& Medicaid Services certifies that the continued 
participation of the State in the demonstration project 
is projected not to increase net program spending under 
title XIX of the Social Security Act. 
‘‘(B) OPTION FOR EXPANSION TO ADDITIONAL STATES.— 
Taking into account the recommendations submitted to 
Congress pursuant to subsection (f)(3), the Secretary may 
expand the number of eligible States participating in the 
demonstration project through December 31, 2019, if, with 
respect to any new eligible State— 
‘‘(i) the Secretary determines that the participation 
of the State in the demonstration project is projected 
not to increase net program spending under title XIX 
of the Social Security Act; and 
‘‘(ii) the Chief Actuary of the Centers for Medicare 
& Medicaid Services certifies that the participation 
of the State in the demonstration project is projected 
not to increase net program spending under title XIX 
of the Social Security Act. 
‘‘(C) NOTICE OF PROJECTIONS.—The Secretary shall pro-
vide each State participating in the demonstration project 
as of the date the Secretary submits recommendations 
to Congress under subsection (f)(3), and any additional 
State that applies to be added to the demonstration project, 
with notice of the determination and certification made 
for the State under subparagraphs (A) and (B), respectively, 
and the standards used to make such determination and 
certification— 
‘‘(i) in the case of a State participating in the 
demonstration project as of the date the Secretary 
submits recommendations to Congress under sub-
section (f)(3), not later than August 31, 2016; and 
‘‘(ii) in the case of an additional State that applies 
to be added to the demonstration project, prior to the 
State making a final election to participate in the 
project. 
‘‘(4) AUTHORITY TO ENSURE BUDGET NEUTRALITY.—The Sec-
retary annually shall review each participating State’s dem-
onstration project expenditures to ensure compliance with the 
requirements 
of 
paragraphs 
(2)(A)(i), 
(2)(A)(ii), 
(3)(A)(i), 
(3)(A)(ii), (3)(B)(i), and (3)(B)(ii) (as applicable). If the Secretary 
determines with respect to a State’s participation in the dem-
onstration project that the State’s net program spending under 
title XIX of the Social Security Act has increased as a result 
of the State’s participation in the project, the Secretary shall 
treat the demonstration project excess expenditures of the State 
as an overpayment under title XIX of the Social Security Act.’’. 
(b) FUNDING.—Subsection (e) of section 2707 of such Act (42 
U.S.C. 1396a note) is amended— 
Determination. 
Deadline. 
Review. 
Deadline. 
Certification. 
Determination. 
Certification. 
Determination. 
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129 STAT. 2196 
PUBLIC LAW 114–97—DEC. 11, 2015 
(1) in the subsection heading, by striking ‘‘LIMITATIONS 
ON FEDERAL’’; 
(2) in paragraph (2)— 
(A) in the paragraph heading, by striking ‘‘5-YEAR’’; 
and 
(B) by striking ‘‘through December 31, 2015’’ and 
inserting ‘‘until expended’’; 
(3) by striking paragraph (3); 
(4) by redesignating paragraphs (4) and (5) as paragraphs 
(3) and (4), respectively; 
(5) in paragraph (3) (as so redesignated), by striking ‘‘and 
the availability of funds’’ and inserting ‘‘(other than States 
deemed to be eligible States through the application of sub-
section (c)(4))’’; and 
(6) in paragraph (4) (as so redesignated)— 
(A) in the first sentence— 
(i) by inserting ‘‘(other than a State deemed to 
be an eligible State through the application of sub-
section (c)(4))’’ after ‘‘eligible State’’; and 
(ii) by striking ‘‘paragraph (4)’’ and inserting ‘‘para-
graph (3)’’; and 
(B) by inserting after the first sentence the following: 
‘‘In addition to any payments made to an eligible State 
under the preceding sentence, the Secretary shall, during 
any period in effect under paragraph (2) or (3) of subsection 
(d), or during any period in which a law described in 
subsection (f)(4)(C) is in effect, pay each eligible State 
(including any State deemed to be an eligible State through 
the application of subsection (c)(4)), an amount each quarter 
equal to the Federal medical assistance percentage of 
expenditures in the quarter during such period for medical 
assistance described in subsection (a). Payments made to 
a State for emergency psychiatric demonstration services 
under this section during the extension period shall be 
treated as medical assistance under the State plan for 
purposes of section 1903(a)(1) of the Social Security Act 
(42 U.S.C. 1396b(a)(1)).’’. 
(c) RECOMMENDATIONS TO CONGRESS.—Subsection (f) of section 
2707 of such Act (42 U.S.C. 1396a note) is amended by adding 
at the end the following: 
‘‘(3) RECOMMENDATION TO CONGRESS REGARDING EXTENSION 
AND EXPANSION OF PROJECT.—Not later than September 30, 
2016, the Secretary shall submit to Congress and make avail-
able to the public recommendations based on an evaluation 
of the demonstration project, including the use of appropriate 
quality measures, regarding— 
‘‘(A) whether the demonstration project should be 
continued after September 30, 2016; and 
‘‘(B) whether the demonstration project should be 
expanded to additional States. 
‘‘(4) RECOMMENDATION
TO
CONGRESS
REGARDING
PERMA-
NENT EXTENSION AND NATIONWIDE EXPANSION.— 
‘‘(A) IN GENERAL.—Not later than April 1, 2019, the 
Secretary shall submit to Congress and make available 
to the public recommendations based on an evaluation 
of the demonstration project, including the use of appro-
priate quality measures, regarding— 
Deadline. 
Public 
information. 
Deadline. 
Public 
information. 
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129 STAT. 2197 
PUBLIC LAW 114–97—DEC. 11, 2015 
‘‘(i) whether the demonstration project should be 
permanently continued after December 31, 2019, in 
1 or more States; and 
‘‘(ii) whether the demonstration project should be 
expanded (including on a nationwide basis). 
‘‘(B) REQUIREMENTS.—Any recommendation submitted 
under subparagraph (A) to permanently continue the 
project in a State, or to expand the project to 1 or more 
other States (including on a nationwide basis) shall include 
a certification from the Chief Actuary of the Centers for 
Medicare & Medicaid Services that permanently continuing 
the project in a particular State, or expanding the project 
to a particular State (or all States) is projected not to 
increase net program spending under title XIX of the Social 
Security Act. 
‘‘(C) CONGRESSIONAL APPROVAL REQUIRED.—The Sec-
retary shall not permanently continue the demonstration 
project in any State after December 31, 2019, or expand 
the demonstration project to any additional State after 
December 31, 2019, unless Congress enacts a law approving 
either or both such actions and the law includes provisions 
that— 
‘‘(i) ensure that each State’s participation in the 
project complies with budget neutrality requirements; 
and 
‘‘(ii) require the Secretary to treat any expendi-
tures of a State participating in the demonstration 
project that are excess of the expenditures projected 
under the budget neutrality standard for the State 
as an overpayment under title XIX of the Social Secu-
rity Act. 
‘‘(5) FUNDING.—Of the unobligated balances of amounts 
available in the Centers for Medicare & Medicaid Services 
Program Management account, $100,000 shall be available to 
carry out this subsection and shall remain available until 
expended.’’. 
(d) CONFORMING AMENDMENTS.—Section 2707 of such Act (42 
U.S.C. 1396a note) is amended— 
(1) in subsection (a), in the matter before paragraph (1), 
by inserting ‘‘publicly or’’ after ‘‘institution for mental diseases 
that is’’; 
(2) in subsection (c)— 
(A) in paragraph (1), by striking ‘‘An eligible State’’ 
and inserting ‘‘Except as otherwise provided in paragraph 
(4), an eligible State’’; 
(B) in paragraph (3), by striking ‘‘A State shall’’ and 
inserting ‘‘Except as otherwise provided in paragraph (4), 
a State shall’’; and 
(C) by adding at the end the following: 
‘‘(4) NATIONWIDE AVAILABILITY.—In the event that the Sec-
retary makes a recommendation pursuant to subsection (f)(4) 
that the demonstration project be expanded on a national basis, 
any State that has submitted or submits an application pursu-
ant to paragraph (2) shall be deemed to have been selected 
to be an eligible State to participate in the demonstration 
project.’’; and 
Certification. 
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129 STAT. 2198 
PUBLIC LAW 114–97—DEC. 11, 2015 
LEGISLATIVE HISTORY—S. 599: 
SENATE REPORTS: No. 114–101 (Comm. on Finance). 
CONGRESSIONAL RECORD, Vol. 161 (2015): 
Sept. 28, considered and passed Senate. 
Nov. 16, considered and passed House, amended. 
Nov. 19, Senate concurred in House amendment. 
(3) in the heading for subsection (f), by striking ‘‘AND 
REPORT’’ and inserting ‘‘, REPORT, AND RECOMMENDATIONS’’. 
(e) EFFECTIVE DATE.—The amendments made by this section 
shall take effect on the date of the enactment of this Act. 
Approved December 11, 2015. 
42 USC 1396a 
note. 
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