Sec. 10. CMI demonstration to test the provision of recovery housing for individuals with opioid use disorder under Medicaid
727 words·~3 min read·
/bill/117/s/1010/is/section-10A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1115A of the Social Security Act ( 42 U.S.C. 1315a ) is amended— in subsection (b)(2)(A), by adding at the end the following new sentence: The models selected under this subparagraph shall include the demonstration described in subsection
(h)(which shall be implemented not later than 18 months after the date of enactment of such subsection). ; and by adding at the end the following new subsection: The CMI, in consultation with the Department of Housing and Urban Development and other agencies, as the Secretary determines appropriate, shall conduct a demonstration project (referred to in this subsection as the demonstration ) to test whether providing Medicaid managed care entities with an elevated global capitated budget for eligible Medicaid beneficiaries, paired with flexibilities to allow States to provide medical assistance for recovery housing for such beneficiaries, would result in reduced emergency department visits, hospitalizations and program expenditures under per beneficiary, or improve quality of care for the such beneficiaries without increasing expenditures under the Medicaid program under title XIX. Under the demonstration, each eligible State that is selected by the CMI to participate in the demonstration shall enter into an agreement with a Medicaid managed care entity under which the entity agrees to provide services (including recovery housing) to eligible Medicaid beneficiaries under a payment model that meets the requirements of subparagraph (B). The CMI shall establish a capitated payments system for Medicaid managed care entities under the demonstration that is based on the demonstration budget determined under clause (ii). For purposes of clause (i), the demonstration budget of a Medicaid managed care entity for each year of a demonstration period shall be determined by the CMI based on the number of eligible Medicaid beneficiaries enrolled with the entity and the average annual spending under title XIX in the State involved on individuals who are enrolled in the State plan under such title (or a waiver of such plan) and who— have a diagnosis of opioid use disorder; are in the top quartile of per beneficiary spending for such plan or waiver for the most recent year; and have attained age 21 but have not attained age 65. The CMI may adjust the demonstration budget determined for a Medicaid managed care entity and a year under this clause using a risk adjustment model selected by the CMI to account for differences in age and clinical conditions of the eligible Medicaid beneficiaries enrolled with the entity compared to the overall population upon which the demonstration budget is based. Not later than 1 year after the date of enactment of this subsection, the CMI shall select not less than 2 eligible States to participate in the demonstration. In addition to the authority described in subsection (d)(1), the Secretary may waive such requirements of title XIX as necessary to carry out the demonstration. In this subsection: The term eligible Medicaid beneficiary means an individual who— is eligible for medical assistance under a State plan under title XIX or a waiver of such a plan; has a diagnosis of opioid use disorder; does not have a permanent residence (as certified by the individual); is currently receiving medication-assisted treatment or completed a course of medication-assisted treatment during the 3-month period preceding the individual's participation in the demonstration; and has attained age 21 but has not attained age 65. The term eligible State means a State that— makes medical assistance available to all individuals described in section 1902(a)(10)(A)(i)(VIII); and agrees to participate in the demonstration. In selecting eligible States to participate in the demonstration, the CMI shall give priority to States that are— among the top 10 States in terms of highest per capita drug poisoning deaths in each of calendar years 2017, 2018, and 2019, based on the most recent data available from the Centers for Disease Control and Prevention; and among the 10 States with the lowest physician reimbursement rates for services furnished under title XIX (as determined by the Secretary) in each of calendar years 2017, 2018, and 2019. The term managed care entity means a medicaid managed care organization described in section 1932(a)(1)(B)(i). The term recovery housing means a shared living environment free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders. The term State includes the 50 States and the District of Columbia. .
Connectionstraces to 1
Traces to 1 document
Citation graph
cites case law
Sec. 10
CMI demonstration to test the provision of recovery housing for individuals with opioid use disorder under Medicaid
Cites 1Cited by 0 across 0 sources