[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5837 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5837

 To amend title XIX of the Social Security Act to remove the exclusion 
    from medical assistance under the Medicaid program of items and 
services furnished in an institution for mental diseases in the case of 
   inpatient, non-hospital substance use disorder treatment facility 
               services furnished for nonelderly adults.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 14, 2016

    Mr. Hastings (for himself, Mr. Huffman, Mr. Clay, and Ms. Bass) 
 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 remove the exclusion 
    from medical assistance under the Medicaid program of items and 
services furnished in an institution for mental diseases in the case of 
   inpatient, non-hospital substance use disorder treatment facility 
               services furnished for nonelderly adults.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. REMOVAL OF MEDICAID IMD EXCLUSION FOR SUBSTANCE USE DISORDER 
              TREATMENT FACILITY SERVICES FOR NONELDERLY ADULTS.

    (a) Findings.--Congress finds the following:
            (1) Substance abuse exacts a social and economic toll on 
        the United States, with widespread detrimental effects on the 
        Nation's health, safety, and economy.
            (2) The costs of substance abuse to the Nation's health 
        care system are estimated at $524 billion a year with an 
        additional $181 billion each year in public health, crime, and 
        lost productivity costs, resulting in illicit drug use costing 
        our country a total of $705 billion annually.
            (3) The human costs of drug addiction cannot be calculated. 
        Every day in the United States, 120 people die as a result of 
        drug overdose, a rate that has more than doubled from 1999 
        through 2013. Among individuals 25 to 64 years old, drug 
        overdose caused more deaths than motor vehicle traffic crashes.
            (4) For millions of Americans substance use progresses to 
        the point where efforts by individuals, their family and 
        friends, and social networks are not sufficient to cope with 
        the problem. In cases of chronic addiction, access to treatment 
        can be a critical and lifesaving resource.
            (5) Only a fraction of those Americans who need treatment, 
        however, receive it. An estimated 23.1 million Americans ages 
        12 or older needed treatment for substance abuse in 2012; 
        however, only 2.5 million of them actually received treatment. 
        This shortfall is due primarily to the limited availability of 
        substance use disorder services, particularly for those in need 
        of residential care to address chronic addiction.
            (6) The expansion of insurance coverage for substance use 
        disorder treatment through the Affordable Care Act has served 
        as a powerful tool to enable individuals to access care to 
        address their substance use disorder, especially for those who 
        benefit from outpatient services.
            (7) However, under current law, access to community-based 
        residential treatment for those with the most severe conditions 
        is denied to Medicaid beneficiaries due to an exclusion of 
        coverage of services in institutions of mental disease (IMD) 
        that bars reimbursement for care of patients at facilities with 
        more than 16 beds, resulting in inequitable and inaccessible 
        care for millions of Americans.
            (8) Eliminating this IMD exclusion will allow those who 
        suffer from severe substance use disorders to have equal access 
        to treatment, to achieve stable, long-term recovery, and to 
        become productive members of society, and will reduce the 
        health, public safety, and economic consequences associated 
        with addiction.
    (b) Permitting Medical Assistance at Facilities Providing 
Inpatient, Nonhospital Residential Substance Use Disorder Treatment for 
Nonelderly Adults.--Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended, in division (B) that follows paragraph 
(29), by inserting after ``institution for mental diseases'' the 
following: ``, except that such limitation with respect to an 
institution for mental diseases shall not apply to a facility insofar 
as it provides inpatient, nonhospital residential substance use 
disorder treatment for individuals over 21 years of age''.
    (c) Effective Date.--The amendment made by subsection (b) shall 
apply to items and services furnished on or after January 1, 2017.
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