Adding Medicaid and CHIP State plan amendment options

(a)

Additional Medicaid State plan amendment option

Section 1915 of the Social Security Act (42 U.S.C. 1396n) is amended by adding at the end the following new subsection:

(m)

Additional State plan amendment option To provide medical assistance for certain individuals who are patients in certain institutions for mental diseases

(1)

In general

Subject to the succeeding paragraphs of this subsection, with respect to calendar quarters beginning on or after January 1, 2025, a State may elect, through a State plan amendment, to provide medical assistance for items and services furnished to an eligible individual who is a patient in an eligible institution for mental diseases in accordance with the requirements described in paragraphs (3) through (7) of subsection (l).(2)

Payments

(A)

In general

Subject to paragraphs (3) and (4) of subsection (l) as applied to a State plan amendment under paragraph (1), amounts expended under such a State plan amendment for services described in such paragraph furnished, with respect to a 12-month period, to an eligible individual who is a patient in an eligible institution for mental diseases shall be treated as medical assistance for which payment is made under section 1903(a), but only to the extent that such services are furnished for not more than the period of medical necessity determined under subparagraph (B) with respect to such eligible individual during such 12-month period.(B)

Period of medical necessity

For purposes of subparagraph (A), with respect to an eligible individual, the period of medical necessity—(i)is the number of days (both consecutive and nonconsecutive) that treatment in an eligible institution for mental diseases is determined, in a manner specified by the Secretary, to be in accordance with the most recent evidence-based criteria developed by a nonprofit medical association with expertise in substance use disorder treatment, such as the American Society of Addiction Medicine; and(ii)shall be redetermined at a frequency specified by the Secretary, but in no case less frequently than every 30 consecutive days during which such eligible individual is a patient in an eligible institution for mental diseases.(3)

Temporary enhanced FMAP

Notwithstanding section 1905(b), for each fiscal quarter during the first 5 years that a State plan amendment elected under this subsection is in effect, the Federal medical assistance percentage applicable to payments under this subsection shall be equal to 90 percent.(4)

Clarification with respect to inpatient and residential services

For purposes of a State plan amendment elected under this subsection, paragraph (4)(C)(ii) of subsection (l) shall be applied by substituting the following for subclause (IV):

(IV)Medically managed, high-intensity residential services for adolescents, and medically managed, intensive residential services (including withdrawal management) for adults, that provide 24-hour nursing care, make physicians available for significant problems in Dimensions 1, 2, or 3, and provide comprehensive psychosocial services.

(5)

Planning grants

(A)

In general

Beginning January 1, 2025, the Secretary may award planning grants to States for purposes of developing and implementing a State plan amendment under this subsection, including through the funding of appropriate tools and training. A planning grant awarded to a State under this paragraph shall remain available until expended.(B)

Application

To be eligible to receive a planning grant under this paragraph, a State shall submit to the Secretary an application in such form and manner as the Secretary shall specify.(C)

Limitation

The total amount of payments to States under this paragraph shall not exceed $25,000,000.(6)

Eligible individual defined

In this subsection, the term eligible individual means an individual who—(A)with respect to a State, is enrolled for medical assistance under the State plan or a waiver of such plan;(B)has not attained 65 years of age; and(C)has at least 1 substance use disorder.

(b)

Children’s Health Insurance Program

Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the following new subparagraph:

(V)Section 1915(m) (relating to the State option to provide medical assistance for individuals who are patients in an eligible institution for mental diseases).