Sec. 601. Enhanced Medicaid coverage relating to certain mental health services
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Section 1902(a) of the Social Security Act ( 42 U.S.C. 1396a(a) ) is amended by inserting after paragraph
(77)the following new paragraph: 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)(4)) 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)). . Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended 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 of the Social Security Act ( 42 U.S.C. 1396d ) is amended— in subsection (a)— in paragraph (16)— by striking effective and inserting
(A)effective ; and by inserting before the semicolon at the end the following: , and
(B)qualified inpatient psychiatric hospital services (as defined in subsection (h)(3)) for individuals over 21 years of age and under 65 years of age ; and in the subdivision
(B)that follows paragraph (29), by inserting (other than services described in subparagraph
(B)of paragraph
(16)for individuals described in such subparagraph) after patient in an institution for mental diseases ; and in subsection (h), by adding at the end the following new paragraph: For purposes of subsection (a)(16)(B), the term qualified inpatient psychiatric hospital services ' means, with respect to individuals described in such subsection, services described in subparagraphs
(A)and
(B)of paragraph
(1)that are furnished in an acute care psychiatric unit in a State-operated psychiatric hospital or a psychiatric hospital (as defined section 1861(f)) if such unit or hospital, as applicable, has a facility-wide average (determined on an annual basis) length of stay of less than 20 days. . The Secretary shall conduct a study to determine the impact of the amendments made by this section on the Medicaid IMD exclusion. Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report containing the results of the study conducted under paragraph (1). The report shall include the following information: An assessment of the level of State expenditures on short-term acute inpatient psychiatric hospital care for which no Federal financial participation is provided for the most recent State fiscal year ending prior to the effective date of the amendments made by this section and an analysis of the impact of the changes to the Medicaid IMD exclusion made by such amendments on State expenditures for such care. An assessment of the extent to which States used disproportionate share hospital payment adjustments described in section 1923 of the Social Security Act ( 42 U.S.C. 1396r–4 ) to fund short-term acute inpatient psychiatric hospital care prior to the effective date of the amendments made by this section and an analysis of the impact of the changes to the Medicaid IMD exclusion made by such amendments on the use of such payment adjustments to fund such care. The total amount by which State expenditures and the extent to which States use disproportionate share hospital payment adjustments for short-term acute inpatient psychiatric hospital care have been reduced due to the changes to the Medicaid IMD exclusion made by the amendments made by this section. Recommendations for strategies to encourage States to reinvest savings in State expenditures and disproportionate share hospital payment adjustments that result from the changes to the Medicaid IMD exclusion made by the amendments made by this section in community-based mental health services. For purposes of this subsection: The term Medicaid IMD exclusion means the prohibition on Federal matching payments under Medicaid for care or services provided to patients who have attained age 22, but have not attained age 65, in an institution for mental diseases under subdivision
(B)of the matter following paragraph
(29)of section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ). The term Secretary means the Secretary of Health and Human Services. The term short-term acute inpatient psychiatric hospital care means care provided in either— an acute-care psychiatric unit with an average annual length of stay of fewer than 20 days that is operated within a State-operated psychiatric hospital; or a psychiatric hospital with an average length of stay of fewer than 20 days on an annual basis. Subject to paragraphs
(2)and (3), the amendments made by this section shall apply to items and services furnished after the first day of the first calendar year that begins after the date of the enactment of this section. The amendments made by this section shall not be effective unless the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that the inclusion of qualified inpatient psychiatric hospital services (as defined by paragraph
(3)of section 1905(h) of the Social Security Act ( 42 U.S.C. 1396d(h) ), as added by subsection (b)) furnished to nonelderly adults as medical assistance under section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ), as amended by subsection (b), would not result in any increase in net program spending under title XIX of such Act. 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 this section, 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 section. 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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- 42 USC 1396r–4
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Sec. 601
Enhanced Medicaid coverage relating to certain mental health services
Cite42 USC 1396r–4
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