Sec. 401. Clarification of definition of Medicaid EPSDT services; demonstration project to test trauma-informed delivery of EPSDT services
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Section 1905(r) of the Social Security Act ( 42 U.S.C. 1396d(r) ) is amended— in paragraph (1)— in subparagraph (A)(ii), by inserting (including in the immediate aftermath of exposure to a traumatic event) after medically necessary ; and in subparagraph (B)(i), by inserting and any past exposure to traumatic events after health development ; and in paragraph (5), by inserting including any defects, illnesses, and conditions (including symptoms of a possible mental health disorder that are not sufficiently acute for a diagnosis of a clinical mental health disorder) stemming from exposure to traumatic events, after screening services, .
The Secretary shall make grants to States to conduct demonstration projects under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) to test innovative, trauma-informed approaches for delivering early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r) of the Social Security Act ( 42 U.S.C. 1396d(r) )) to eligible children. The Secretary shall select 10 States to participate in the demonstration project. In selecting States to participate in the demonstration project, the Secretary shall— ensure that geographically diverse areas, including rural and underserved areas, are included; and include at least 2 States in which Indian tribes or tribal organizations (as defined in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 )) are located.
In selecting States to participate in the demonstration project, the Secretary shall give priority to States that— use a value-based payment methodology for paying providers for services provided under the State Medicaid program, including services related to healthy child development; use an alternative payment model under the State Medicaid program that enables cross-sector collaboration, provision of trauma-informed services, and supports for healthy child development; or integrate information technology between child- and youth-serving sectors to improve coordination and outcomes.
The demonstration project shall begin not later than 1 year after the date of the enactment of this Act, and shall be conducted for a period of 4 years. To be eligible for a grant under this subsection, a State that is participating in the demonstration project shall demonstrate that it has implemented the following measures with respect to the State Medicaid program: The State Medicaid program allows for the provision of early and periodic screening, diagnostic, and treatment services— in a diverse set of settings, including schools, hospitals, primary care settings, Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act ( 42 U.S.C. 1396d(l)(2)(B) )), and tribally operated health facilities, without undue restrictions on the settings in which providers are permitted to furnish such services; and by the full scope of providers that are licensed or otherwise authorized under State law to provide the services, including peers through eligible peer support services, community health workers, or subclinical case managers.
Where necessary to improve or promote the health of an eligible child, the State Medicaid program provides for payment for services provided to the parent of the child. The State Medicaid program has procedures in place to coordinate across settings, including with law enforcement, juvenile justice agencies, schools (including preschools and after-school programs), hospitals, primary care providers, tribally operated health facilities, and child welfare providers, to ensure that eligible children who experience trauma receive the appropriate services.
Where appropriate, the State Medicaid program coordinates with facilities of the Indian Health Service (including a hospital, nursing facility, or any other type of facility which provides services of a type otherwise covered under the program) and other tribally operated health facilities to ensure eligible children have access to adequate qualified providers that are licensed or otherwise authorized under State law to furnish the services. Out of any funds in the Treasury not otherwise appropriated, there is appropriated $75,000,000 for the period of fiscal years 2017 through 2021 to carry out this subsection.
In this subsection: The term demonstration project means the demonstration project established under this subsection. The term eligible child means an individual who is under age 21 and who is enrolled in a State plan under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ). The term Secretary means the Secretary of Health and Human Services. The term State Medicaid program means a State plan or waiver under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ).
The term traumatic trigger event means a traumatic event experienced by a child, including— sexual abuse or maltreatment; sexual assault or rape; physical abuse or maltreatment; physical assault; emotional abuse or psychological maltreatment; neglect; domestic violence; war, terrorism, or political violence; illness or medical trauma; accidental injury; natural disaster; kidnapping and trafficking; traumatic loss, separation, or bereavement; forced displacement; impaired caregiver; personal or interpersonal violence; community violence; school violence and bullying; and such other events as the Secretary shall determine.
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Sec. 401
Clarification of definition of Medicaid EPSDT services; demonstration project to test trauma-informed delivery of EPSDT services
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