Increasing National Patient Access To Improved Effective Necessary Mental Health Treatment Act of 2020 or the INPATIENT Act of 2020
This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish programs that test the impact of expanding the coverage of certain psychiatric services under Medicaid.
Specifically, the CMS must establish a demonstration program to test the impact of waiving the institutions for mental diseases (IMDs) Medicaid payment exclusion on specified metrics relating to inpatient psychiatric hospital services and substance abuse services. (Current law generally prohibits federal payment under Medicaid for services provided in IMDs for individuals under the age of 65, although states may receive payment through certain mechanisms like Medicaid demonstration waivers.)
The CMS must also establish a pilot program to test the impact of eliminating the Medicare 190-day lifetime limit for inpatient psychiatric hospital services, particularly the impact on value, choice, and the alignment of inpatient mental health benefits with inpatient physical health care benefits under Medicare.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7912 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 7912
To provide for a demonstration program and pilot project to expand
choice for inpatient psychiatric services under Medicaid and Medicare.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 31, 2020
Mr. Huizenga (for himself and Mr. Tonko) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To provide for a demonstration program and pilot project to expand
choice for inpatient psychiatric services under Medicaid and Medicare.
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 ``Increasing National Patient Access
To Improved Effective Necessary Mental Health Treatment Act of 2020''
or the ``INPATIENT Act of 2020''.
SEC. 2. DEMONSTRATION PROJECT WAIVING IMD EXCLUSION TO EXPAND ACCESS TO
INPATIENT PSYCHIATRIC SERVICES UNDER THE MEDICAID
PROGRAM.
(a) Authority To Conduct Demonstration Project.--
(1) In general.--The Secretary of Health and Human Services
(in this Act referred to as the ``Secretary'') shall establish
a demonstration project (in this Act referred to as the
``demonstration project'') to test the impact of waiving the
limitation of subdivision (B) following paragraph (29) of
section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a))
on average length of stay, readmissions, cost, and quality
outcomes for inpatient psychiatric hospital services and
substance abuse services.
(2) Terms.--Under the demonstration project, an eligible
State (as defined in subsection (b)) shall provide payment
under its State Medicaid plan under title XIX of the Social
Security Act to qualifying institutions (as defined in
subsection (b)(3)(C)) for the provision of medical assistance
available under such plan to individuals who--
(A) have attained age 21, but have not attained age
65;
(B) are eligible for medical assistance under such
plan (or under a waiver of such plan);
(C) require such medical assistance for inpatient
psychiatric hospital services or residential substance
abuse services; and
(D) but for participation in the demonstration
project, would otherwise receive medical assistance for
such inpatient psychiatric hospital services if the
services were provided in a general acute care hospital
or other residential substance abuse facility.
(b) Eligible State Defined.--
(1) In general.--In this section, the term ``eligible
State'' means a State that has made an application under
paragraph (2) and has had such application approved and has
been selected under paragraph (3).
(2) Application.--A State seeking to participate in the
demonstration project shall submit to the Secretary, at such
time and in such format as the Secretary requires, an
application that includes such information, provisions, and
assurances, as the Secretary may require.
(3) Selection and limitation.--
(A) State limitation.--The Secretary shall limit
the number of States selected for participation in the
demonstration project to no more than 3 States.
(B) Conditions for application approval.--The
Secretary shall not approve an application under
paragraph (2) unless the State agrees to limit
participation in the demonstration project to
qualifying institutions (as defined in subparagraph
(C)).
(C) Qualifying institution defined.--In this Act,
the term ``qualifying institution'' means an
institution for mental diseases that is not publicly
owned or operated, that is subject to the requirements
of section 1867 of the Social Security Act (42 U.S.C.
1395dd), and that meets all of the following criteria:
(i) The institution furnishes inpatient
psychiatric hospital services to individuals
age 18 years of age or older under the Medicare
and Medicaid programs.
(ii) The institution has an average length
of inpatient hospital stay of less than 15 days
for individuals age 18 or older, but under 65
years of age.
(iii) The institution has an average length
of stay of less than 21 days for hospital
inpatients age 65 or older.
(iv) The institution has an approved
medical residency training program and receive
payment due under the Medicare and Medicaid
programs for the reasonable costs of graduate
medical education.
(v) The institution uses psychiatric
residents to provide inpatient psychiatric
hospital services to individuals under the
Medicare and Medicaid programs.
(vi) The institution has documented
experience in providing services to active duty
military personnel and veterans.
(vii) The institution has standards to care
for the whole person, including referral
agreements or other arrangements to address a
patient's medical, surgical, or diagnostic
needs if such treatment services are not
available within the institution.
(viii) The institution agrees to report on
quality measures (in such form, manner, and
frequency as specified by the Secretary) and
report to the Secretary (in a form, manner, and
frequency as specified by the Secretary) such
data as the Secretary determines appropriate to
monitor and evaluate the demonstration project.
(ix) The institution agrees to plan and
implement an annual performance improvement
project, aimed at improving the effectiveness
of care provided to high utilizers of inpatient
psychiatric hospital services (as defined in
subsection (h)(1)), with identifiable measures
in coordination with the Secretary and the
State.
(c) Deadline for Implementation.--The Secretary shall implement the
demonstration project by January 1, 2022.
(d) Length of Demonstration Project.--The demonstration project
shall be conducted for a period of 7 consecutive years.
(e) Budget Neutrality.--With respect to the operation of the
demonstration project in a State for the period described in subsection
(d), the State must demonstrate to the Secretary that project will not
result in a net increase in the aggregate expenditures under the
Medicaid program for such period for the State above the level of such
expenditures if the demonstration project had not been implemented.
(f) Evaluation and Report to Congress.--
(1) Evaluation.--The Secretary shall conduct an evaluation
of the demonstration project in order to determine the impact
of the project and to make recommendations on improvements to
the performance of the health and mental health service system
and on individuals enrolled in the Medicaid program, with
particular emphasis on individuals who are high utilizers of
inpatient psychiatric hospital services and substance abuse
residential services.
(2) Items included in evaluation.--Such evaluation shall
include the following:
(A) An assessment of the delivery of inpatient
psychiatric hospital services, substance abuse
residential services, and community-based services
under the Medicaid program; average lengths of
inpatient stays; emergency room visits; and
readmissions.
(B) An assessment of the impact of the
demonstration project on the costs of the full range of
mental health services (including inpatient, emergency
and ambulatory care) under the Medicaid program.
(C) An assessment of the impact of the
demonstration project on psychiatric residency programs
and the mental health workforce.
(D) An assessment of the impact of the
demonstration project on rates of recidivism.
(E) Identification and assessment of best practices
for caring for patients with serious mental illness,
including high utilizers of inpatient psychiatric
hospital services and substance abuse residential
services.
(F) A comparison of outcomes and costs for
similarly situated patients receiving inpatient
psychiatric hospital services at a general acute care
hospital.
(G) A recommendation regarding whether the
demonstration project should be continued after
December 31, 2028, and expanded on a national basis.
(3) Report.--Not later than December 31, 2028, the
Secretary shall submit to Congress (and make available to the
public) a report on the findings of the evaluation conducted
under this subsection.
(g) IMD Waiver; Waiver Authority.--
(1) IMD waiver.--The limitation of subdivision (B)
following paragraph (29) of section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)), relating to limitations on
payments for care or services for individuals under 65 years of
age who are patients in an institution for mental disease,
shall not apply to inpatient psychiatric hospital services or
substance abuse residential services furnished under the
demonstration project.
(2) Waiver authority.--The Secretary may waive such
requirements of titles XI and XIX of the Social Security Act
(which may include the requirements of paragraph (1) (relating
to statewideness)) and paragraph (10)(B) (relating to
comparability) of section 1902(a) of such Act (42 U.S.C.
1396b(a)) only to extent the Secretary determines such a waiver
to be necessary to carry out the demonstration project.
(h) Definitions.--In this Act:
(1) High utilizer of inpatient psychiatric hospital
services.--The term ``high utilizer of inpatient psychiatric
hospital services'' means an individual who, with respect to a
point in time, meets the following conditions:
(A) The individual had two or more inpatient
admissions for psychiatric services in the previous 12
months.
(B) The individual had 10 or more inpatient
admissions for psychiatric services in the individual's
lifetime.
(C) The individual had 100 or more days of
inpatient psychiatric services in the individual's
lifetime.
(D) The individual meets any of the following
conditions:
(i) The individual is receiving court-
ordered psychiatric treatment.
(ii) The individual has been receiving
inpatient psychiatric services for a
consecutive period of at least 12 days.
(iii) The individual has a documented
history of suicidal or self-harming behaviors
due to mental illness.
(iv) The individual has a documented
history of threatened or actual physical harm
to another individual due to mental illness.
(2) Institution for mental disease.--The term ``institution
for mental disease'' has the meaning given that term in section
1905(i) of the Social Security Act (42 U.S.C. 1396d(i)).
(3) Medicaid program.--The term ``Medicaid program'' means
the program under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(4) Medical assistance.--The term ``medical assistance''
has the meaning given that term in section 1905(a) of the
Social Security Act (42 U.S.C. 1396d(a)).
(5) Medicare program.--The term ``Medicare program'' means
the program under part A of title XVIII of the Social Security
Act (42 U.S.C. 1395c et seq.) and includes the programs under
parts B, C, and D of such title.
(6) State.--The term ``State'' has the meaning given that
term for purposes of the Medicaid program.
SEC. 3. PILOT PROGRAM WAIVING THE MEDICARE 190-DAY LIFETIME LIMIT ON
INPATIENT PSYCHIATRIC HOSPITAL SERVICES TO EXPAND ACCESS
TO INPATIENT PSYCHIATRIC SERVICES UNDER THE MEDICARE
PROGRAM.
(a) Demonstration Program Authorized.--The Secretary shall
establish a pilot program (in this section referred to as the ``pilot
program'') to test the impact of eliminating the Medicare 190-day
lifetime limit on--
(1) promoting value;
(2) expanding choice; and
(3) aligning inpatient mental health benefits with the
inpatient physical health care benefits under the Medicare
program.
(b) Definitions.--In this section:
(1) Applicable beneficiary.--The term ``applicable
beneficiary'' means an individual who--
(A) is entitled to, or enrolled for, benefits under
part A, and enrolled for benefits under part B, of the
Medicare program;
(B) is admitted to a qualifying institution
participating in the demonstration project; and
(C) but for the pilot program established under
this section, would otherwise receive benefits for
inpatient psychiatric services under the Medicare
program if the services were provided in a general
acute care hospital.
(2) Inpatient psychiatric hospital services.--The term
``inpatient psychiatric hospital services'' has the meaning
given such term in section 1861(c) of the Social Security Act
(42 U.S.C. 1395x(c)).
(3) Medicare 190-day lifetime limit.--The term ``Medicare
190-day lifetime limit'' means the 190-day lifetime limitation
imposed on inpatient psychiatric hospital services under
section 1812(b)(3) of the Social Security Act (42 U.S.C.
1395d(b)(3)).
(c) Program Details.--
(1) Duration and starting date.--
(A) Starting date.--The pilot program shall begin
no later than January 1, 2021.
(B) Duration.--Subject to subparagraph (C), the
pilot program shall be conducted for a period of 7
years.
(C) Expansion.--The Secretary may, at any time
after the pilot program has operated for a period of at
least 3 years expand the duration and scope of the
pilot program, to the extent determined appropriate by
the Secretary, if--
(i) the Secretary determines that such
expansion is expected--
(I) to reduce (or not to result in
any increase in) net expenditures under
the Medicare program without reducing
the quality of care; or
(II) to improve the quality of care
without increasing such net
expenditures;
(ii) the Chief Actuary of the Centers for
Medicare & Medicaid Services certifies that
such expansion would reduce spending under the
Medicare program; and
(iii) the Secretary determines that such
expansion would not deny or limit the coverage
or provision of benefits under the Medicare
program for applicable beneficiaries.
(2) Waiver of medicare 190-day lifetime limit.--The
Medicare 190-day lifetime limit shall not apply to applicable
beneficiaries receiving inpatient psychiatric services at a
participating institution under the pilot program.
(3) Participating providers of services and suppliers.--
(A) In general.--Only institutions participating in
the demonstration project may submit an application to
the Secretary to provide inpatient psychiatric services
under the pilot program.
(B) Requirements.--The Secretary may develop
additional requirements for institutions to participate
in the pilot program. Such requirements may include the
collection and reporting of data related to the
reasonable costs of graduate medical education.
(4) Quality measures.--
(A) In general.--The Secretary shall establish
quality measures related to care provided by qualifying
institutions participating in the pilot program, which
measures shall include at least measures of the
following:
(i) Reducing rates of avoidable hospital
readmissions.
(ii) Rates of discharge to the community.
(iii) Rates of admission to an emergency
room after a hospitalization.
(iv) Other measures, including measures of
patient outcomes, determined appropriate by the
Secretary.
(B) Reporting on quality measures.--A qualifying
institution shall submit (in a form and manner
specified by the Secretary) data to the Secretary on
quality measures established under subparagraph (A)
during each year in which the institution is
participating in the pilot program.
(d) Waiver.--The Secretary shall waive such provisions of titles XI
and XVIII of the Social Security Act as may be necessary to carry out
the pilot program.
(e) Independent Evaluation and Reports on Pilot Program.--
(1) Independent evaluation.--The Secretary shall conduct an
independent evaluation of the pilot program, including the
extent to which the pilot program has--
(A) improved quality measures established under
subsection (c)(4)(A);
(B) improved health outcomes;
(C) improved patient satisfaction; and
(D) reduced spending under the Medicare program.
(2) Report.--Not later than December 31, 2027, the
Secretary shall submit to Congress a report on the evaluation
conducted under paragraph (1).
(3) Coordination with expanding choice for medicaid
inpatient psychiatric hospital services demonstration
project.--The Secretary may combine the independent evaluation
and reports required under this section and the reports
required under the demonstration project under section 2(f).
(f) Budget Neutrality.--With respect to the period of the pilot
program under subsection (c)(1) occurring before any expansion under
subparagraph (C) of such subsection, the Secretary shall ensure that
the program does not result in a net increase in the aggregate
expenditures under the Medicare program for such period above the level
of such expenditures if the pilot program had not been implemented. The
Secretary may make such adjustments to payments under the Medicare
program as is necessary to carry out the previous sentence.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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