Medicaid Coverage for Addiction Recovery Expansion Act
This bill allows state Medicaid programs to cover residential addiction treatment facility services for adults between the ages of 22 and 64 if such services are offered as part of a full continuum of evidence-based treatment services. Residential addiction treatment facility services are medically necessary inpatient services provided in an accredited, size-limited facility for the purpose of treating a substance-use disorder within a specified time period.
In addition, the bill establishes a grant program for states to expand infrastructure and treatment capabilities of existing youth addiction treatment facilities that (1) provide addiction treatment services to youths under Medicaid or the Children's Health Insurance Program (CHIP), and (2) are located in communities with high numbers of medically underserved populations of at-risk youths. At least 15% of grant funds awarded to a state must be used for making payments to rural facilities.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7282 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 7282
To amend title XIX of the Social Security Act to provide States with an
option to provide medical assistance to individuals between the ages of
22 and 64 for inpatient services to treat substance use disorders at
certain facilities, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 7, 2024
Mr. Foster (for himself, Mrs. Beatty, Mr. Van Drew, and Ms. Moore of
Wisconsin) 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 States with an
option to provide medical assistance to individuals between the ages of
22 and 64 for inpatient services to treat substance use disorders at
certain facilities, 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 ``Medicaid Coverage for Addiction
Recovery Expansion Act''.
SEC. 2. STATE OPTION TO PROVIDE MEDICAL ASSISTANCE FOR RESIDENTIAL
ADDICTION TREATMENT FACILITY SERVICES; MODIFICATION OF
THE IMD EXCLUSION.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)(16)--
(A) by striking ``and, (B)'' and inserting ``,
(B)''; and
(B) by inserting ``, and (C) effective January 1,
2023, residential addiction treatment facility services
(as defined in subsection (h)(3)) for individuals over
21 years of age and under 65 years of age, if offered
as part of a full continuum of evidence-based treatment
services provided under the State plan, including
residential, outpatient, and community-based care, for
individuals with substance use disorders'' before the
semicolon; and
(2) in subsection (h)--
(A) in paragraph (1), by striking ``paragraph (16)
of subsection (a)'' and inserting ``subsection
(a)(16)(A)''; and
(B) by adding at the end the following new
paragraph:
``(3)(A) For purposes of subsection (a)(16)(C), the term
`residential addiction treatment facility services' means,
subject to subparagraph (B), inpatient services provided--
``(i) to an individual for the purpose of treating
a substance use disorder that are furnished to an
individual for not more than 2 consecutive periods of
30 consecutive days, provided that upon completion of
the first 30-day period, the individual is assessed and
determined to have progressed through the clinical
continuum of care, in accordance with criteria
established by the Secretary, in consultation with the
American Society of Addiction Medicine, and requires
continued medically necessary treatment and social
support services to promote recovery, stable transition
to ongoing treatment, and discharge; and
``(ii) in a facility that is accredited for the
treatment of substance use disorders by the Joint
Commission on Accreditation of Healthcare
Organizations, the Commission on Accreditation of
Rehabilitation Facilities, the Council on
Accreditation, or any other accrediting agency that the
Secretary deems appropriate as necessary to ensure
nationwide applicability, including qualified national
organizations and State-level accrediting agencies.
``(B) The State agency responsible for administering the
State plan under this title shall establish procedures to
ensure that, with respect to any facility providing residential
addiction treatment facility services in a fiscal year, the
average monthly number of beds used by the facility to provide
such services during such year is not more than 40.
``(C) The provision of medical assistance for residential
addiction treatment facility services to an individual shall
not prohibit Federal financial participation for medical
assistance for items or services that are provided to the
individual in or away from the residential addiction treatment
facility during any 30-day period in which the individual is
receiving residential addiction treatment facility services.
``(D) A woman who is eligible for medical assistance on the
basis of being pregnant and who is furnished residential
addiction treatment facility services during any 30-day period
may remain eligible for, and continue to be furnished with,
such services for additional 30-day periods without regard to
any eligibility limit that would otherwise apply to the woman
as a result of her pregnancy ending, subject to assessment by
the facility and a determination based on medical necessity
related to substance use disorder and the impact of substance
use disorder on birth outcomes.''.
(b) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2023.
SEC. 3. GRANT PROGRAM TO EXPAND YOUTH ADDICTION TREATMENT FACILITIES
UNDER MEDICAID AND CHIP.
(a) Establishment.--
(1) In general.--The Secretary shall establish a program
under which the Secretary shall award grants to States for the
purpose of expanding the infrastructure and treatment
capabilities, including augmenting equipment and bed capacity,
of eligible youth addiction treatment facilities that provide
addiction treatment services to Medicaid or CHIP beneficiaries
who have not attained the age of 21 and are in communities with
high numbers of medically underserved populations of at-risk
youth.
(2) Use of funds.--Grant funds awarded under this section
may be used to expand the infrastructure and treatment
capabilities of an existing facility (including through
construction) but shall not be used for the construction of any
new facility or for the provision of medical assistance or
child health assistance under Medicaid or CHIP.
(3) Timetable for implementation; duration.--
(A) Implementation.--Not later than 1 year after
the date of the enactment of this Act, the Secretary
shall award grants under the grant program.
(B) Duration.--The Secretary shall award grants
under the grant program for a period not to exceed 5
years.
(b) Application.--A State seeking to participate in the grant
program shall submit to the Secretary, at such time and in such manner
as the Secretary shall require, an application that includes--
(1) detailed information on the types of additional
infrastructure and treatment capacity of eligible youth
addiction treatment facilities that the State proposes to fund
under the grant program;
(2) a description of the communities in which the eligible
youth addiction treatment facilities funded under the grant
program operate;
(3) an assurance that the eligible youth addiction
treatment facilities that the State proposes to fund under the
grant program shall give priority to providing addiction
treatment services to Medicaid or CHIP beneficiaries who have
not attained the age of 21 and are in communities with high
numbers of medically underserved populations of at-risk youth;
and
(4) such additional information and assurances as the
Secretary shall require.
(c) Rural Areas.--Not less than 15 percent of the amount of a grant
awarded to a State under this section shall be used for making payments
to eligible youth addiction treatment facilities that are located in
rural areas or that target the provision of addiction treatment
services to Medicaid or CHIP beneficiaries who have not attained the
age of 21 and reside in rural areas.
(d) Definitions.--For purposes of this section:
(1) Addiction treatment services.--The term ``addiction
treatment services'' means services provided to an individual
for the purpose of treating a substance use disorder.
(2) CHIP.--The term ``CHIP'' means the State children's
health insurance program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.).
(3) Eligible youth addiction treatment facility.--The term
``eligible youth addiction treatment facility'' means a
facility that is a participating provider under the State
Medicaid or CHIP programs for purposes of providing medical
assistance or child health assistance to Medicaid or CHIP
beneficiaries for youth addiction treatment services on an
inpatient or outpatient basis (or both).
(4) Medicaid.--The term ``Medicaid'' means the medical
assistance program established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(5) Medicaid or chip beneficiary.--The term ``Medicaid or
CHIP beneficiary'' means an individual who is enrolled in the
State Medicaid plan, the State child health plan under CHIP, or
under a waiver of either such plan.
(6) Medically underserved populations.--The term
``medically underserved populations'' has the meaning given
that term in section 330(b)(3) of the Public Health Service Act
(42 U.S.C. 254b(b)(3)).
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(e) Authorization of Appropriations.--There are authorized to be
appropriated $50,000,000 to carry out the provisions of this section.
Funds appropriated under this subsection shall remain available until
expended.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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