Sec. 202. Optional limited coverage of inpatient services furnished in institutions for mental diseases
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Section 1903(m)(2) of the Social Security Act ( 42 U.S.C. 1396b(m)(2) ) is amended by adding at the end the following new subparagraph: Notwithstanding the limitation specified in the subdivision
(B)following paragraph
(29)of section 1905(a) and subject to clause (ii), a State may, under a risk contract entered into by the State under this title (or under section 1115) with a medicaid managed care organization or a prepaid inpatient health plan (as defined in section 438.2 of title 42, Code of Federal Regulations (or any successor regulation)), make a monthly capitation payment to such organization or plan for enrollees with the organization or plan who are over 21 years of age and under 65 years of age and are receiving inpatient treatment in an institution for mental diseases (as defined in section 1905(i)), so long as each of the following conditions is met: The institution is a hospital providing inpatient psychiatric or substance use disorder services or a sub-acute facility providing psychiatric or substance use disorder crisis residential services. The length of stay in such an institution for such treatment is for a short-term stay of no more than 15 days during the period of the monthly capitation payment. The provision of such treatment meets the following criteria for consideration as services or settings that are in lieu of services or settings covered under the State plan: The State determines that the alternative service or setting is a medically appropriate and cost-effective substitute for the covered service or setting under the State plan. The enrollee is not required by the managed care organization or prepaid inpatient health plan to use the alternative service or setting. Such treatment is authorized and identified in such contract, and will be offered to such enrollees at the option of the managed care organization or prepaid inpatient health plan. For purposes of setting the amount of such a monthly capitation payment, a State may use the utilization of services provided to an individual under this subparagraph when developing the inpatient psychiatric or substance use disorder component of such payment, but the amount of such payment for such services may not exceed the cost of the same services furnished through providers included under the State plan. . The amendment made by subsection
(a)shall apply beginning on July 5, 2016, or the date of the enactment of this Act, whichever is later.
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Sec. 202
Optional limited coverage of inpatient services furnished in institutions for mental diseases
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