[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5136 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 5136
To direct the Secretary of Health and Human Services to establish a
demonstration project under the Medicaid program under title XIX of the
Social Security Act under which payment may be made to States for
expenditures for medical assistance with respect to substance use
disorder treatment services, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 17, 2014
Ms. Fudge (for herself, Mr. Ryan of Ohio, Mr. Cummings, Ms. Lee of
California, Ms. Norton, Mr. Richmond, Mr. Hastings of Florida, and Ms.
Clarke of New York) introduced the following bill; which was referred
to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To direct the Secretary of Health and Human Services to establish a
demonstration project under the Medicaid program under title XIX of the
Social Security Act under which payment may be made to States for
expenditures for medical assistance with respect to substance use
disorder treatment services, 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 ``Breaking Addiction Act of 2014''.
SEC. 2. MEDICAID COMMUNITY-BASED INPATIENT SUBSTANCE USE DISORDER
TREATMENT DEMONSTRATION PROJECT.
(a) Authority.--The Secretary of Health and Human Services shall
establish a 5-year demonstration project (in this section referred to
as the ``demonstration project'') under which payment may be made to
each participating State (as described in subsection (b)), for any
medical assistance provided with respect to a qualified individual in a
community-based institution for mental diseases who is being treated in
such institution for a substance use condition.
(b) Participating States.--
(1) Eligibility.--A State is eligible to participate in the
demonstration project under this section if the State plan of
the State provides for payment under the plan for community-
based inpatient substance use disorder treatment services
furnished to qualified individuals.
(2) Application.--A State seeking to participate in the
demonstration project under this section shall submit to the
Secretary an application, at such time, in such form, and that
contains such information, provisions, and assurances, as the
Secretary may require.
(3) Selection.--The Secretary shall select, on a
competitive basis, from among the States that submit an
application under paragraph (1) to the satisfaction of the
Secretary, the States that will be participating in the
demonstration project. In selecting such participating States,
the Secretary shall seek to achieve an equitable geographic
distribution.
(c) Waiver Authority.--
(1) In general.--The Secretary shall waive the limitation
on payment for care and services imposed by the subdivision (B)
that follows paragraph (29) of section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) (relating to a limitation on
payments for care or services for any individual who is under
65 years of age and who is a patient in an institution for
mental diseases) with respect to payment for the medical
assistance described in subsection (a).
(2) Limited other waiver authority.--The Secretary may
waive other requirements of titles XI and XIX of the Social
Security Act (including the requirements of sections 1902(a)(1)
(relating to statewideness) (42 U.S.C. 1396a(a)(1)) and
1902(a)(10)(B) (relating to comparability) (42 U.S.C.
1396a(a)(10)(B)) of such Act) only to the extent necessary to
carry out the demonstration project under this section.
(d) Evaluation and Report to Congress.--
(1) Evaluation.--The Secretary shall conduct an evaluation
of the impact the demonstration project carried out under this
section has on the functioning of the health and substance use
disorder system and individuals enrolled in State plans under
the Medicaid program under title XIX of the Social Security
Act. The evaluation shall include each of the following:
(A) An assessment of the access such individuals
have to substance use disorder treatment services under
the demonstration project carried out under this
section, and with respect to such services, the average
lengths of inpatient stays and emergency room visits.
(B) An assessment of the discharge planning by the
health care providers furnishing such services.
(C) An assessment of the impact of the
demonstration project on the costs of the full range of
health care items and services, including inpatient,
emergency and ambulatory care, diversions from
inpatient and emergency care, and readmissions to
institutions for mental diseases.
(D) An analysis of the percentage of individuals
enrolled in such plans who are admitted to community-
based institutions for mental diseases as a result of
the demonstration project as compared to those admitted
to such institutions through other means.
(2) Report.--Not later than December 31, 2020, the
Secretary shall submit to Congress and make available to the
public a report that contains--
(A) the findings of the evaluation under paragraph
(1); and
(B) the recommendations of the Secretary regarding
whether--
(i) the limitation referred to in
subsection (c)(1) is a barrier to care that
needs to be reviewed by Congress; and
(ii) the demonstration project carried out
under this section should be continued after
December 31, 2020, and expanded on a national
basis.
(e) Funding.--
(1) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to carry out this
section, $300,000,000 for fiscal year 2015.
(2) 10-year availability.--Funds appropriated under
paragraph (1) shall remain available for obligation through
December 31, 2024.
(3) Funds allocated to states.--Funds shall be allocated to
participating States on the basis of criteria, including a
State's application and the availability of funds, as
determined by the Secretary.
(4) Payment to states.--For each calendar quarter beginning
on or after October 1, 2014, the Secretary shall pay to each
participating State, from the allocation made to the State
under paragraph (3), an amount equal to the Federal medical
assistance percentage of the amount expended during such
quarter for the medical assistance described in subsection (a).
(5) Limitation on payments.--In no case may--
(A) the aggregate amount of payments made by the
Secretary to participating States under this section
exceed $300,000,000; or
(B) payments be made by the Secretary to
participating States under this section after December
31, 2024.
(f) Definitions.--In this section:
(1) Federal medical assistance percentage.--The term
``Federal medical assistance percentage'' has the meaning given
such term in section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)).
(2) Institution for mental diseases.--The term
``institution for mental diseases'' has the meaning given such
term in section 1905(i) of the Social Security Act (42 U.S.C.
1396d(i)).
(3) Medical assistance.--The term ``medical assistance''
has the meaning given such term in section 1905(a) of the
Social Security Act (42 U.S.C. 1396d(a)).
(4) Qualified individual.--The term ``qualified
individual'' means an individual who, because of the
individual's substance use condition, requires substance use
disorder treatment and who--
(A) is over 21 years of age and under 65 years of
age; and
(B) is eligible for medical assistance under the
State plan under the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.).
(5) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
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