[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5789 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 5789
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.
_______________________________________________________________________
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. 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.
<all>