Short title

This Act may be cited as the

Medicaid Health Homes for Opioid-Use-Disorder Medicaid Enrollees Encouraged Act

or the

Medicaid Health HOME Act

Extension of enhanced FMAP for certain health homes for individuals with substance use disorders

Section 1945 of the Social Security Act (42 U.S.C. 1396w–4) is amended— (1)in subsection (c)— (A)in paragraph (1), by inserting subject to paragraph (4), after except that,; and (B)by adding at the end the following new paragraph:

(4)

Special rule relating to substance use disorder health homes

(A)

In general

In the case of a State with an SUD-focused State plan amendment approved by the Secretary on or after October 1, 2018, the Secretary may, at the request of the State, extend the application of the Federal medical assistance percentage described in paragraph (1) to payments for the provision of health home services to SUD-eligible individuals under such State plan amendment, in addition to the first 8 fiscal year quarters the State plan amendment is in effect, for the subsequent 2 fiscal year quarters that the State plan amendment is in effect. Nothing in this section shall be construed as prohibiting a State with a State plan amendment that is approved under this section and that is not an SUD-focused State plan amendment from additionally having approved on or after such date an SUD-focused State plan amendment under this section, including for purposes of application of this paragraph. (B)

Report requirements

In the case of a State with an SUD-focused State plan amendment for which the application of the Federal medical assistance percentage has been extended under subparagraph (A), such State shall, at the end of the period of such State plan amendment, submit to the Secretary a report on the following, with respect to SUD-eligible individuals provided health home services under such State plan amendment: (i)The quality of health care provided to such individuals, with a focus on outcomes relevant to the recovery of each such individual. (ii)The access of such individuals to health care. (iii)The total expenditures of such individuals for health care.

For purposes of this subparagraph, the Secretary shall specify all applicable measures for determining quality, access, and expenditures.

(C)

Best practices

Not later than October 1, 2020, the Secretary shall make publicly available on the Internet website of the Centers for Medicare & Medicaid Services best practices for designing and implementing an SUD-focused State plan amendment, based on the experiences of States that have State plan amendments approved under this section that include SUD-eligible individuals. (D)

Definitions

For purposes of this paragraph: (i)

SUD-eligible individuals

The term SUD-eligible individual means, with respect to a State, an individual who satisfies all of the following: (I)The individual is an eligible individual with chronic conditions. (II)The individual is an individual with a substance use disorder. (III)The individual has not previously received health home services under any other State plan amendment approved for the State under this section by the Secretary. (ii)

SUD-focused State plan amendment

The term SUD-focused State plan amendment means a State plan amendment under this section that is designed to provide health home services primarily to SUD-eligible individuals.

Requirement for State Medicaid plans to provide coverage for medication-assisted treatment

(a)

Requirement for State Medicaid plans to provide coverage for medication-assisted treatment

Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the matter preceding clause (i), by striking and (28) and inserting (28), and (29). (b)

Inclusion of medication-assisted treatment as medical assistance

Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended— (1)in paragraph (28), by striking and at the end; (2)by redesignating paragraph (29) as paragraph (30); and (3)by inserting after paragraph (28) the following new paragraph:

(29)subject to paragraph (2) of subsection (ee), for the period beginning October 1, 2020, and ending September 30, 2025, medication-assisted treatment (as defined in paragraph (1) of such subsection); and

(c)

Medication-assisted treatment defined; Waivers

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by adding at the end the following new subsection:

(ee)

Medication-assisted treatment

(1)

Definition

For purposes of subsection (a)(29), the term medication-assisted treatment— (A)means all drugs approved under section 505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355), including methadone, and all biological products licensed under section 351 of the Public Health Service Act (42 U.S.C. 262) to treat opioid use disorders; and (B)includes, with respect to the provision of such drugs and biological products, counseling services and behavioral therapy. (2)

Exception

The provisions of paragraph (29) of subsection (a) shall not apply with respect to a State for the period specified in such paragraph, if before the beginning of such period the State certifies to the satisfaction of the Secretary that implementing such provisions statewide for all individuals eligible to enroll in the State plan (or waiver of the State plan) would not be feasible by reason of a shortage of qualified providers of medication-assisted treatment, or facilities providing such treatment, that will contract with the State or a managed care entity with which the State has a contract under section 1903(m) or under section 1905(t)(3).

(d)

Effective date

(1)

In general

Subject to paragraph (2), the amendments made by this section shall apply with respect to medical assistance provided on or after October 1, 2020, and before October 1, 2025. (2)

Exception for State legislation

In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) that the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet any requirement imposed by the 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 the 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.