Sec. 2707. MEDICAID EMERGENCY PSYCHIATRIC DEMONSTRATION PROJECT
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## SEC. 2707 MEDICAID EMERGENCY PSYCHIATRIC DEMONSTRATION PROJECT **[**[42 U.S.C. 1396a note](/us/usc/t42/s1396a)**]** ###
(a)Authority To Conduct Demonstration Project The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall establish a demonstration project under which an eligible State (as described in subsection (c)) shall provide payment under the State Medicaid plan under title XIX of the Social Security Act to an institution for mental diseases that is publicly or not publicly owned or operated and that is subject to the requirements of section 1867 of the Social Security Act (42 U.S.C. 1395dd) for the provision of medical assistance available under such plan to individuals who— ####
(1)have attained age 21, but have not attained age 65; ####
(2)are eligible for medical assistance under such plan; and ####
(3)require such medical assistance to stabilize an emergency medical condition. ###
(b)Stabilization Review A State shall specify in its application described in subsection (c)(1) establish a mechanism for how it will ensure that institutions participating in the demonstration will determine whether or not such individuals have been stabilized (as defined in subsection (h)(5)). This mechanism shall commence before the third day of the inpatient stay. States participating in the demonstration project may manage the provision of services for the stabilization of medical emergency conditions through utilization review, authorization, or management practices, or the application of medical necessity and appropriateness criteria applicable to behavioral health. ###
(c)Eligible State Defined ####
(1)In general Except as otherwise provided in paragraph (4), an eligible State is a State that has made an application and has been selected pursuant to paragraphs
(2)and (3). ####
(2)Application A State seeking to participate in the demonstration project under this section shall submit to the Secretary, at such time and in such format as the Secretary requires, an application that includes such information, provisions, and assurances, as the Secretary may require. ####
(3)Selection Except as otherwise provided in paragraph (4), a State shall be determined eligible for the demonstration by the Secretary on a competitive basis among States with applications meeting the requirements of paragraph (1). In selecting State applications for the demonstration project, the Secretary shall seek to achieve an appropriate national balance in the geographic distribution of such projects. ####
(4)Nationwide availability In the event that the Secretary makes a recommendation pursuant to subsection (f)(4) that the demonstration project be expanded on a national basis, any State that has submitted or submits an application pursuant to paragraph
(2)shall be deemed to have been selected to be an eligible State to participate in the demonstration project. ###
(d)Length of Demonstration Project ####
(1)In general Except as provided in paragraphs
(2)and (3), the demonstration project established under this section shall be conducted for a period of 3 consecutive years. ####
(2)Temporary extension of participation eligibility for selected states #####
(A)In general Subject to subparagraph
(B)and paragraph (4), a State selected as an eligible State to participate in the demonstration project on or prior to March 13, 2012, shall, upon the request of the State, be permitted to continue to participate in the demonstration project through September 30, 2016, if— ######
(i)the Secretary determines that the continued participation of the State in the demonstration project is projected not to increase net program spending under title XIX of the Social Security Act; and ######
(ii)the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such extension for that State is projected not to increase net program spending under title XIX of the Social Security Act. #####
(B)Notice of projections The Secretary shall provide each State selected to participate in the demonstration project on or prior to March 13, 2012, with notice of the determination and certification made under subparagraph
(A)for the State. ####
(3)Extension and expansion of demonstration project #####
(A)Additional extension Taking into account the recommendations submitted to Congress under subsection (f)(3), the Secretary may permit an eligible State participating in the demonstration project as of the date such recommendations are submitted to continue to participate in the project through December 31, 2019, if, with respect to the State— ######
(i)the Secretary determines that the continued participation of the State in the demonstration project is projected not to increase net program spending under title XIX of the Social Security Act; and ######
(ii)the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that the continued participation of the State in the demonstration project is projected not to increase net program spending under title XIX of the Social Security Act. #####
(B)Option for expansion to additional states Taking into account the recommendations submitted to Congress pursuant to subsection (f)(3), the Secretary may expand the number of eligible States participating in the demonstration project through December 31, 2019, if, with respect to any new eligible State— ######
(i)the Secretary determines that the participation of the State in the demonstration project is projected not to increase net program spending under title XIX of the Social Security Act; and ######
(ii)the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that the participation of the State in the demonstration project is projected not to increase net program spending under title XIX of the Social Security Act. #####
(C)Notice of projections The Secretary shall provide each State participating in the demonstration project as of the date the Secretary submits recommendations to Congress under subsection (f)(3), and any additional State that applies to be added to the demonstration project, with notice of the determination and certification made for the State under subparagraphs
(A)and (B), respectively, and the standards used to make such determination and certification— ######
(i)in the case of a State participating in the demonstration project as of the date the Secretary submits recommendations to Congress under subsection (f)(3), not later than August 31, 2016; and ######
(ii)in the case of an additional State that applies to be added to the demonstration project, prior to the State making a final election to participate in the project. ####
(4)Authority to ensure budget neutrality The Secretary annually shall review each participating State’s demonstration project expenditures to ensure compliance with the requirements of paragraphs (2)(A)(i), (2)(A)(ii), (3)(A)(i), (3)(A)(ii), (3)(B)(i), and (3)(B)(ii) (as applicable). If the Secretary determines with respect to a State's participation in the demonstration project that the State's net program spending under title XIX of the Social Security Act has increased as a result of the State's participation in the project, the Secretary shall treat the demonstration project excess expenditures of the State as an overpayment under title XIX of the Social Security Act. ###
(e)Funding ####
(1)Appropriation #####
(A)In general Out of any funds in the Treasury not otherwise appropriated, there is appropriated to carry out this section, $75,000,000 for fiscal year 2011. #####
(B)Budget authority Subparagraph
(A)constitutes budget authority in advance of appropriations Act and represents the obligation of the Federal Government to provide for the payment of the amounts appropriated under that subparagraph. #### (2)2 availability Funds appropriated under paragraph
(1)shall remain available for obligation until expended. 2The casing in the first letter in the word “availability” in the heading for paragraph
(2)probably should appear in initial capitalization. See the amendment to the heading made by section 2(b)(2)(A) of Public Law 114–97. ####
(3)Funds allocated to states Funds shall be allocated to eligible States on the basis of criteria, including a State's application (other than States deemed to be eligible States through the application of subsection (c)(4)), as determined by the Secretary. ####
(4)Payments to states The Secretary shall pay to each eligible State (other than a State deemed to be an eligible State through the application of subsection (c)(4)), from its allocation under paragraph (3), an amount each quarter equal to the Federal medical assistance percentage of expenditures in the quarter for medical assistance described in subsection (a). In addition to any payments made to an eligible State under the preceding sentence, the Secretary shall, during any period in effect under paragraph
(2)or
(3)of subsection (d), or during any period in which a law described in subsection (f)(4)(C) is in effect, pay each eligible State (including any State deemed to be an eligible State through the application of subsection (c)(4)), an amount each quarter equal to the Federal medical assistance percentage of expenditures in the quarter during such period for medical assistance described in subsection (a). Payments made to a State for emergency psychiatric demonstration services under this section during the extension period shall be treated as medical assistance under the State plan for purposes of section 1903(a)(1) of the Social Security Act (42 U.S.C. 1396b(a)(1)). As a condition of receiving payment, a State shall collect and report information, as determined necessary by the Secretary, for the purposes of providing Federal oversight and conducting an evaluation under subsection (f)(1). ###
(f)Evaluation, Report, and Recommendations to Congress ####
(1)Evaluation The Secretary shall conduct an evaluation of the demonstration project in order to determine the impact on the functioning of the health and mental health service system and on individuals enrolled in the Medicaid program and shall include the following: #####
(A)An assessment of access to inpatient mental health services under the Medicaid program; average lengths of inpatient stays; and emergency room visits. #####
(B)An assessment of discharge planning by participating hospitals. #####
(C)An assessment of the impact of the demonstration project on the costs of the full range of mental health services (including inpatient, emergency and ambulatory care). #####
(D)An analysis of the percentage of consumers with Medicaid coverage who are admitted to inpatient facilities as a result of the demonstration project as compared to those admitted to these same facilities through other means. #####
(E)A recommendation regarding whether the demonstration project should be continued after December 31, 2013, and expanded on a national basis. ####
(2)Report Not later than December 31, 2013, the Secretary shall submit to Congress and make available to the public a report on the findings of the evaluation under paragraph (1). ####
(3)Recommendation to congress regarding extension and expansion of project Not later than September 30, 2016, the Secretary shall submit to Congress and make available to the public recommendations based on an evaluation of the demonstration project, including the use of appropriate quality measures, regarding— #####
(A)whether the demonstration project should be continued after September 30, 2016; and #####
(B)whether the demonstration project should be expanded to additional States. ####
(4)Recommendation to congress regarding permanent extension and nationwide expansion #####
(A)In general Not later than April 1, 2019, the Secretary shall submit to Congress and make available to the public recommendations based on an evaluation of the demonstration project, including the use of appropriate quality measures, regarding— ######
(i)whether the demonstration project should be permanently continued after December 31, 2019, in 1 or more States; and ######
(ii)whether the demonstration project should be expanded (including on a nationwide basis). #####
(B)Requirements Any recommendation submitted under subparagraph
(A)to permanently continue the project in a State, or to expand the project to 1 or more other States (including on a nationwide basis) shall include a certification from the Chief Actuary of the Centers for Medicare & Medicaid Services that permanently continuing the project in a particular State, or expanding the project to a particular State (or all States) is projected not to increase net program spending under title XIX of the Social Security Act. #####
(C)Congressional approval required The Secretary shall not permanently continue the demonstration project in any State after December 31, 2019, or expand the demonstration project to any additional State after December 31, 2019, unless Congress enacts a law approving either or both such actions and the law includes provisions that— ######
(i)ensure that each State's participation in the project complies with budget neutrality requirements; and ######
(ii)require the Secretary to treat any expenditures of a State participating in the demonstration project that are excess of the expenditures projected under the budget neutrality standard for the State as an overpayment under title XIX of the Social Security Act. ####
(5)Funding Of the unobligated balances of amounts available in the Centers for Medicare & Medicaid Services Program Management account, $100,000 shall be available to carry out this subsection and shall remain available until expended. ###
(g)Waiver Authority ####
(1)In general The Secretary shall waive the limitation of subdivision
(B)following paragraph
(28)of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) (relating to limitations on payments for care or services for individuals under 65 years of age who are patients in an institution for mental diseases) for purposes of carrying out the demonstration project under this section. ####
(2)Limited other waiver authority The Secretary may waive other requirements of titles XI and XIX of the Social Security Act (including the requirements of sections 1902(a)(1) (relating to statewideness) and 1902(1)(10)(B) (relating to comparability)) only to extent necessary to carry out the demonstration project under this section. ###
(h)Definitions In this section: ####
(1)Emergency medical condition The term “**emergency medical condition**” means, with respect to an individual, an individual who expresses suicidal or homicidal thoughts or gestures, if determined dangerous to self or others. ####
(2)Federal medical assistance percentage The term “**Federal medical assistance percentage**” has the meaning given that term with respect to a State under section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)). ####
(3)Institution for mental diseases The term “**institution for mental diseases**” has the meaning given to that term in section 1905(i) of the Social Security Act (42 U.S.C. 1396d(i)). ####
(4)Medical assistance The term “**medical assistance**” has the meaning given that term in section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)). ####
(5)Stabilized The term “**stabilized**” means, with respect to an individual, that the emergency medical condition no longer exists with respect to the individual and the individual is no longer dangerous to self or others. ####
(6)State The term “**State**” has the meaning given that term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). ## Subtitle J Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)
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Sec. 2707
MEDICAID EMERGENCY PSYCHIATRIC DEMONSTRATION PROJECT
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