Sec. 401. Enhanced Medicaid coverage relating to certain mental health services
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Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— in subsection (a), by inserting after paragraph
(77)the following new paragraph: in the case of a State that does not have in effect (as of the date of the enactment of this paragraph) under its State plan a payment methodology that allows for full reimbursement of all same-day qualifying services through a single payment, not prohibit payment under the plan for a mental health service or primary care service furnished to an individual at a community mental health center meeting the criteria specified in section 1913(c) of the Public Health Service Act or a federally qualified health center (as defined in section 1861(aa)(3)) for which payment would otherwise be payable under the plan, with respect to such individual, if such service were not a same-day qualifying service (as defined in subsection (ll)); ; and by adding at the end the following new subsection: For purposes of subsection (a)(78), the term same-day qualifying service means— a primary care service furnished to an individual by a provider at a facility on the same day a mental health service is furnished to such individual by such provider (or another provider) at the facility; and a mental health service furnished to an individual by a provider at a facility on the same day a primary care service is furnished to such individual by such provider (or another provider) at the facility. . Section 1905(h) of the Social Security Act ( 42 U.S.C. 1396d(h) ) is amended by adding at the end the following new paragraph: Such term includes the full-range of early and periodic screening, diagnostic, and treatment services (as defined in subsection (r)). . 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), beginning on the date of the enactment of this subparagraph, a State may provide, as part of the monthly capitated payment made by the State under this title to 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)), for payment for limited inpatient psychiatric hospital services provided by such organization or health plan, at the option of the individual receiving such services, in lieu of services covered under the State plan during the month for which the payment is made. In this subparagraph, the term limited inpatient psychiatric hospital services means the services described in subparagraphs
(A)and
(B)of section 1905(h)(1)— that are furnished to individuals over 21 years of age and under 65 years of age in an institution for mental diseases (as defined in section 1905(i)) that is an inpatient hospital facility or a sub-acute care facility providing crisis residential services (as defined by the Secretary); and for which the length of stay in such an institution is for a short-term stay of not more than 15 days during the month for which the capitated payment referred to in clause
(i)is made. . Subject to paragraph (2), the amendments made by subsections
(a)and
(b)shall apply to items and services furnished after the date of the enactment of this section. 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 in order for the respective plan to meet any requirement imposed by amendments made by subsections
(a)and (b), the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement 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 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 the session shall be considered to be a separate regular session of the State legislature.
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Sec. 401
Enhanced Medicaid coverage relating to certain mental health services
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