[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4232 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 4232

            To improve mental and substance use health care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 15, 2007

  Mr. Kennedy (for himself and Mr. Ramstad) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
            To improve mental and substance use health care.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Improving the 
Quality of Mental and Substance Use Health Care Act of 2007''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents; findings.
Sec. 2. Evidence-based mental and substance use health care.
Sec. 3. Improved coordination of care.
Sec. 4. Information technology for mental health and substance use 
                            health care providers.
Sec. 5. Council on the Mental Health and Substance Use Health Care 
                            Workforce.
Sec. 6. Funding of research through national centers of excellence.
Sec. 7. Patient-centered care.
Sec. 8. Uniform methodologies for reimbursing behavioral health claims.
Sec. 9. Study on use of public mental health and addiction services by 
                            individuals with private health coverage.
Sec. 10. High-quality mental health and substance use health care 
                            Medicaid demonstration project.
Sec. 11. Medicaid requirement for State repeal of laws denying health 
                            benefits coverage based on intoxication.
    (c) Findings.--The Congress finds the following:
            (1) In its study, ``Improving the Quality of Health Care 
        for Mental and Substance-Use Conditions'', the Institute of 
        Medicine found that each year, more than 33,000,000 Americans 
        use health care services for their mental problems and 
        illnesses, and for conditions resulting from their use of 
        alcohol, inappropriate use of prescription medications, or, 
        less often, illegal drugs. In the United States, mental and 
        substance use illnesses (which often occur together) are the 
        leading cause of death and disability for women, the highest 
        for men ages 15 to 44, and the second highest for all men.
            (2) Effective treatments for these medical illnesses exist, 
        but multiple barriers prevent many from receiving them. The 
        consequences of these barriers are serious for these 
        individuals and their families, for their employers and the 
        workforce, for the Nation's economy, and for the Nation's 
        education, welfare, and justice systems. The Institute of 
        Medicine further found that a comprehensive approach is needed 
        to remedy this issue that addresses the distinguishing 
        characteristics of mental and substance use health care in the 
        United States.
            (3) The Institute of Medicine recommended a multifaceted 
        and comprehensive strategy to improve the quality of mental and 
        substance use health care in the United States and thereby 
        ensure that--
                    (A) individual patient preferences, needs, and 
                values prevail in the face of residual stigma, 
                discrimination, and coercion into treatment;
                    (B) the necessary infrastructure exists to produce 
                scientific evidence more quickly and promote its 
                application in patient care;
                    (C) multiple providers' care of the same patient is 
                coordinated;
                    (D) emerging information technology related to 
                health care benefits people with mental or substance 
                use problems and illnesses;
                    (E) the health care workforce has the education, 
                training, and capacity to deliver high-quality care for 
                mental and substance use conditions; and
                    (F) government programs, employers, and other group 
                purchasers of health care for mental and substance use 
                conditions use their dollars in ways that support the 
                delivery of high-quality care.
            (4) To implement this strategy, the Institute of Medicine 
        noted that action is needed from many health care leaders, 
        including the Congress.

SEC. 2. EVIDENCE-BASED MENTAL AND SUBSTANCE USE HEALTH CARE.

    (a) Commission for Evidence-Based Mental and Substance Use Health 
Care.--
            (1) Establishment.--The Secretary of Health and Human 
        Services (in this Act referred to as the ``Secretary'') shall 
        establish a Commission for Evidence-Based Mental and Substance 
        Use Health Care (in this section referred to as the 
        ``Commission'') to strengthen, coordinate, and consolidate the 
        synthesis and dissemination of evidence on effective mental and 
        substance use treatments and services.
            (2) Duties.--For the purposes described in paragraph (1), 
        the Commission shall, on an ongoing basis--
                    (A) identify, describe, and categorize the 
                available evidence-based preventive, diagnostic, and 
                therapeutic interventions (including screening, 
                diagnostic, and symptom-monitoring tools), including 
                interventions for various age and ethnic groups;
                    (B) recommend procedure and payment codes and 
                definitions for such evidence-based interventions and 
                tools for their use in administrative datasets under 
                part C of title XI of the Social Security Act and 
                recommend standards for health data collection relating 
                to such interventions;
                    (C) identify on an annual basis priority areas for 
                research on--
                            (i) the development of new evidence-based 
                        preventive, diagnostic, and therapeutic 
                        interventions;
                            (ii) comparative effectiveness and cost 
                        effectiveness of existing interventions and new 
                        evidence-based interventions; and
                            (iii) how best to translate new evidence-
                        based findings into practice in community-based 
                        clinical settings.
                    (D) recommend to the Director of the National 
                Institute of Mental Health, the Director of the 
                National Institute on Drug Abuse, the Director of the 
                National Institute on Alcohol Abuse and Alcoholism, and 
                other Federal officials methods to coordinate the 
                conduct or support of research described in 
                subparagraph (C);
                    (E) collect, synthesize, and disseminate 
                information on research concerning evidence-based 
                strategies for promoting the use of evidence-based 
                preventive, diagnostic, and therapeutic interventions;
                    (F) provide guidance on effective mental and 
                substance use interventions to Federal agencies that 
                provide or support such interventions, including the 
                Centers for Medicare & Medicaid Services, the Substance 
                Abuse and Mental Health Services Administration, the 
                Agency for Healthcare Research and Quality, the Centers 
                for Disease Control and Prevention, the Health 
                Resources and Services Administration, the Department 
                of Defense, the Department of Veterans Affairs, the 
                Indian Health Service, and the Bureau of Prisons; and
                    (G) periodically assess the progress of agencies 
                described in subparagraph (F) in implementing such 
                interventions.
            (3) Consultation.--In carrying out this section, the 
        Commission shall--
                    (A) seek consultation from leading public and 
                private State and national authorities, and consolidate 
                evidence, opinions, and findings of these authorities 
                as they see fit; and
                    (B) ensure that interested parties have 
                opportunities to provide input before the Commission 
                makes recommendations or decisions.
            (4) Membership.--The Commission shall be composed of not 
        fewer than 15 and not more than 20 members, who shall be 
        appointed by the President from among experts in evidence-based 
        mental and substance use health care. Such members shall 
        include--
                    (A) researchers;
                    (B) practitioners from various specialties, 
                professions, and practice settings;
                    (C) mental health and substance abuse health care 
                consumers; and
                    (D) health care payers.
            (5) Terms.--
                    (A) In general.--Each member of the Commission 
                shall be appointed for a term of 4 years, except as 
                provided in subparagraphs (B) and (C).
                    (B) Terms of initial appointees.--As designated by 
                the President at the time of appointment, of the 
                members of the Commission first appointed, \1/4\ shall 
                each be appointed for terms of 1, 2, and 3 years and 
                the remainder shall be appointed for a term of 4 years.
                    (C) Vacancies.--Any member appointed to fill a 
                vacancy occurring before the expiration of the term for 
                which the member's predecessor was appointed shall be 
                appointed only for the remainder of that term. A member 
                may serve after the expiration of that member's term 
                until a successor has taken office.
    (b) CMS Annual Report.--The Administrator of the Centers for 
Medicare & Medicaid Services shall report annually to the Congress on 
the extent to which the Medicaid program under title XIX of the Social 
Security Act provides coverage of evidence-based interventions 
identified by the Commission, including--
            (1) a list of those interventions not so covered and the 
        reasons why they are not covered;
            (2) a justification for each evidence-based intervention 
        that is not so covered; and
            (3) a list of evidence-based interventions that can be 
        covered only with statutory change.
    (c) Construction Regarding Application.--Nothing in this section 
shall be construed as requiring, as a condition of payment under the 
Medicaid program under title XIX of the Social Security Act, that an 
intervention must be an evidence-based practice.
    (d) Prompt Development and Implementation of Claims Processing and 
Data Codes.--The Secretary, acting through the Administrator of the 
Centers for Medicare & Medicaid Services, shall establish, or enter 
into an agreement with, one or more entities for the purpose of 
developing, as soon as practicable after the date of the enactment of 
this Act, codes that should be applied to claims processing and health 
data collection activities as recommended by the Commission pursuant to 
subsection (a)(2)(B).
    (e) Definition.--In this section, the term ``intervention'' means a 
preventive, diagnostic, or therapeutic action with respect to a mental 
health or substance use disease process.

SEC. 3. IMPROVED COORDINATION OF CARE.

    (a) Interagency Collaborative Group.--
            (1) Establishment.--The Secretary shall convene an 
        interagency collaborative group (in this section referred to as 
        the ``interagency collaborative group'') to provide for the 
        coordination at the clinical and programmatic level of mental 
        health and substance use services and primary care services, 
        funded in whole or in part through the Department of Health and 
        Human Services, the Department of Justice, the Department of 
        Veterans Affairs, the Department of Defense, and the Department 
        of Education, using one or more evidence-based coordination 
        models, such as the following:
                    (A) Formal agreements between mental health, 
                substance use, and primary care providers.
                    (B) Case management of mental health, substance 
                use, and primary care.
                    (C) Co-location of mental health, substance use, 
                and primary care providers.
                    (D) Delivery of mental health, substance use, and 
                primary care in integrated practices.
            (2) Duties.--The interagency collaborative group shall--
                    (A) develop a plan for government agencies to 
                implement the recommendations made by the Commission 
                for Evidence-Based Mental and Substance Use Health 
                Care;
                    (B) coordinate with States and appropriate public 
                stakeholders to foster interagency collaboration at the 
                State and local level;
                    (C) make recommendations to the President and the 
                Congress to break down barriers to coordination of 
                existing Federal programs funding mental health and 
                substance use services and to allow for more effective 
                integration of such programs across agencies and 
                programs;
                    (D) assess progress toward such coordination 
                through development and monitoring of performance 
                measures of coordination; and
                    (E) report to the Congress biannually on the status 
                of such coordination.
            (3) Composition.--The interagency collaborative group shall 
        include the following members:
                    (A) The Secretary of Health and Human Services (or 
                the Secretary's designee).
                    (B) The Attorney General (or the Attorney General's 
                designee).
                    (C) The Secretary of Veterans Affairs (or such 
                Secretary's designee).
                    (D) The Secretary of Defense (or such Secretary's 
                designee).
                    (E) The Secretary of Education (or such Secretary's 
                designee).
            (4) Meetings.--The interagency collaborative group shall 
        meet not less than quarterly.
            (5) Staff and support.--The Secretary shall provide, 
        without the requirement for reimbursement, staff and other 
        administrative support necessary for the operation of the 
        interagency collaborative group.
    (b) Coordinated Delivery of Care.--The Federal agencies 
participating in the interagency collaborative group shall modify 
internal policies and practices, to the extent practicable and 
consistent with legal authority, in order to implement one or more of 
the evidence-based coordination models referred to in subsection 
(a)(1).
    (c) No Effect on HIPAA Privacy Rules.--Nothing in this section 
shall be construed to alter the application of rules promulgated under 
section 264(c) of the Health Insurance Portability and Accountability 
Act of 1996.
    (d) GAO Report.--Not later than 2 years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall conduct a study and submit a report to the Congress on the 
implementation of this section.
    (e) Clarification of Medicaid Reimbursement Options.--The Secretary 
shall provide, by regulation, for a change in the rules under title XIX 
of the Social Security Act relating to reimbursement for primary care 
services and mental health and substance use services to the same 
patient on the same day so as to permit payment for the legitimate 
provisions of both types of services on the same day to a patient.

SEC. 4. INFORMATION TECHNOLOGY FOR MENTAL HEALTH AND SUBSTANCE USE 
              HEALTH CARE PROVIDERS.

    (a) Development and Implementation of Plan.--The Secretary, acting 
through the National Coordinator for Health Information Technology and 
the Administrator of the Substance Abuse and Mental Health Services 
Administration, shall develop and implement a plan for ensuring that 
activities of the Department of Health and Human Services to promote 
the use of information technology by health care providers include 
promotion of information technology that is accessible and pertinent to 
mental health and substance use health care providers and consumers.
    (b) Contents of Plan.--The plan developed under subsection (a) 
shall address--
            (1) how the development of an electronic health information 
        infrastructure, including the awarding of grants and contracts 
        to promote the use of electronic health records (EHRs), 
        personal health records (PHRs), regional health information 
        organizations (RHIOs), and other forms of health information 
        technology, and the establishment of data standards, will 
        ensure that the needs of mental and substance use health care 
        providers and consumers are met with particular emphasis on the 
        privacy concerns of consumers;
            (2) how financial incentives that are generally made 
        available for the development of such infrastructure for health 
        care providers can be provided to individual mental health and 
        substance use clinicians and organizations (and particularly 
        publicly-funded providers) for investments in information 
        technology to enable them to participate on a full and equal 
        basis in the emerging electronic health infrastructure;
            (3) how any continuing technical assistance and training 
        for developing virtual networks may be made available to give 
        individual and small group providers of mental health and 
        substance use services standard access to software, clinical 
        and population data and health records, and billing and 
        clinical decision-support systems; and
            (4) how to create and support a continuing mechanism to 
        engage mental health and substance use stakeholders in the 
        public and private sectors in developing consensus-based 
        recommendations for data elements, standards, and processes 
        needed to address unique aspects of information management 
        related to mental and substance use healthcare.
    (c) Consideration.--In awarding any grant or contract for the 
development or implementation of any component of a national electronic 
health infrastructure, the Secretary shall consider the application of 
such component to mental health and substance use health care and 
providers of such care.
    (d) Continued Privacy Protections.--In developing or promoting the 
national electronic health infrastructure, the Secretary shall ensure 
that privacy and confidentiality requirements traditionally applicable 
to mental health and substance use health care continue to be applied.
    (e) Inclusion of Information in Reports.--In preparing any report 
to the Congress relating to the development or implementation of a 
national electronic health infrastructure or the promotion of the use 
of health information technology, the Secretary shall include 
information on such development, implementation, or promotion in the 
field of mental health and substance use treatment.

SEC. 5. COUNCIL ON THE MENTAL HEALTH AND SUBSTANCE USE HEALTH CARE 
              WORKFORCE.

    (a) Establishment.--The Secretary shall establish a public-private 
advisory group called the Council on the Mental Health and Substance 
Use Health Care Workforce (in this section referred to as the 
``Council'').
    (b) Duties.--
            (1) Development of comprehensive plan.--The Council shall 
        develop and publish a comprehensive plan for purpose of 
        strengthening the capacity of the workforce to deliver high-
        quality mental health and substance use health care.
            (2) Plan contents.--The plan developed under this 
        subsection shall--
                    (A) identify the specific clinical competencies 
                that all mental health and substance use professionals 
                should possess to be certified or licensed and the 
                competencies, including a component of patient centered 
                care, that should be maintained over time;
                    (B) propose national standards for the 
                credentialing and licensure of mental health and 
                substance use health care providers based on core 
                competencies that should be included in curricula and 
                education programs across all the mental health and 
                substance use disciplines and make recommendations 
                regarding accreditation standards for mental health and 
                substance use health care programs;
                    (C) propose programs for funding from Federal, 
                State, and local governments and the private sector to 
                address and resolve long-standing workforce issues such 
                as diversity, cultural relevance, faculty development, 
                training effectiveness, continuing shortages of well-
                trained clinicians needed to work with children and the 
                elderly and in high-need areas, and programs for 
                training competent clinical supervisors and 
                administrators; and
                    (D) provide for continuing assessment of mental 
                health and substance use workforce trends, issues, and 
                financing policies.
            (3) Evaluation; reporting.--On a biannual basis, the 
        Council shall--
                    (A) conduct an evaluation of the extent to which 
                the purpose specified in paragraph (1) has been met; 
                and
                    (B) submit a report to the Congress on the results 
                of such evaluation, including a description of the 
                status of the mental health and substance use health 
                care workforce.
            (4) Assistance.--The Council shall collaborate with private 
        sector coalitions to facilitate and implement its 
        recommendations.
    (c) Membership.--
            (1) Number; appointment; chair.--The Council shall be 
        composed of not less than 21 and not more than 25 individuals 
        appointed by the Secretary. The Council shall elect a chair 
        from among its members.
            (2) Public sector members.--The Council shall include the 
        following officials (or their designees):
                    (A) The Assistant Secretary for Health in the 
                Department of Health and Human Services.
                    (B) The Administrator of the Centers for Medicare & 
                Medicaid Services.
                    (C) The Administrator of the Substance Abuse and 
                Mental Health Services Administration.
                    (D) The Secretary of Veterans Affairs.
            (3) Private sector members.--The Council shall include 
        representatives from the substance use and mental health 
        services and consumer communities who are not employees of the 
        Federal Government. Such representatives shall be appointed by 
        the Secretary without regard to the Federal civil service laws 
        and shall include the following:
                    (A) One individual selected from full-time students 
                enrolled in mental health training programs.
                    (B) One individual selected from full-time students 
                enrolled in substance use health care training 
                programs.
                    (C) One individual selected from mental health 
                consumers.
                    (D) One individual selected from substance use 
                health care consumers.
                    (E) One individual selected from faculty members at 
                mental health training facilities.
                    (F) One individual selected from faculty members at 
                substance use health care training facilities.
                    (G) Five individuals selected from among leading 
                professional associations in the various fields charged 
                with carrying out mental health and substance use 
                services, including psychiatry, addiction medicine, 
                psychology, social work, psychiatric nursing, 
                counseling, marriage and family therapy, pastoral 
                counseling, psychosocial rehabilitation, and substance 
                use treatment counselors.
                    (H) Five individuals selected from among leading 
                professional licensing and credentialing entities in 
                the various fields charged with carrying out mental 
                health and substance use services including psychiatry, 
                addiction medicine, psychology, social work, 
                psychiatric nursing, counseling, marriage and family 
                therapy, pastoral counseling, psychosocial 
                rehabilitation, and substance use treatment counseling.
            (4) Selection.--In selecting the members of the Council 
        under paragraph (3), the Secretary shall ensure--
                    (A) the inclusion of both urban and rural members;
                    (B) a range of members from a variety of practice 
                settings and including expertise in prevention and 
                treatment across the lifespan;
                    (C) adequate representation of racial, ethnic, 
                religious, and economic diversity in its membership; 
                and
                    (D) the members appointed under subparagraphs (G) 
                and (H) of paragraph (3) are equitably distributed 
                between those specializing in mental health services 
                and those specializing in substance use services.
            (5) Terms.--
                    (A) In general.--Each member of the Council under 
                paragraph (3) shall be appointed for a term of 4 years, 
                except that except as provided in subparagraphs (B) and 
                (C).
                    (B) Terms of initial appointees.--As designated by 
                the Secretary at the time of appointment, of the 
                members of the Council first appointed under paragraph 
                (3), \1/4\ shall each be appointed for terms of 1, 2, 
                and 3 years and the remainder shall be appointed for a 
                term of 4 years.
                    (C) Vacancies.--Any member appointed under 
                paragraph (3) to fill a vacancy occurring before the 
                expiration of the term for which the member's 
                predecessor was appointed shall be appointed only for 
                the remainder of that term. A member may serve after 
                the expiration of that member's term until a successor 
                has taken office.
    (d) Meetings.--The Council shall conduct at least 3 meetings each 
year.
    (e) Staff and Support.--The Secretary shall provide, without the 
requirement for reimbursement, staff and other administrative support 
necessary for the operation of the Council.

SEC. 6. FUNDING OF RESEARCH THROUGH NATIONAL CENTERS OF EXCELLENCE.

    (a) Grants.--The Director of the National Institutes of Health (in 
this section referred to as the ``Director of NIH''), acting through 
the Directors of the National Institute of Mental Health, the National 
Institute of Drug Abuse, and the National Institute on Alcohol Abuse 
and Alcoholism, and in consultation with the Administrator of the 
Substance Abuse and Mental Health Services Administration, shall make 
grants to entities to fund a network of national centers of excellence 
in mental health and substance use health care.
    (b) Use of Funds.--As a condition on receipt of a grant under this 
section, an entity shall agree to use the grant to establish or support 
one or more centers of excellence in mental health and substance use 
health care. Each such center shall--
            (1) integrate basic, clinical, or health services research 
        with interventions in a range of usual settings of care 
        delivery and involve a broad cross-section of mental health and 
        substance use health care stakeholders; and
            (2) develop innovative approaches to tie together research 
        and practice in order to develop a research agenda relevant to 
        providers of mental health and substance use health care 
        services in a range of usual settings of care.
    (c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $10,000,000 for fiscal year 
2008, $15,000,000 for fiscal year 2009, $20,000,000 for fiscal year 
2010, $25,000,000 for fiscal year 2011, and such sums as may be 
necessary for each subsequent fiscal year.

SEC. 7. PATIENT-CENTERED CARE.

    (a) Promotion in Federal Programs.--With respect to any program 
that provides for the Department of Health and Human Services, the 
Department of Justice, the Department of Veterans Affairs, Department 
of Defense, or the Department of Education to pay for or provide mental 
health and substance use care, each such Department shall provide for 
the following:
            (1) Within the authority of the Department with respect to 
        such program--
                    (A) include payment for, or provision of, peer 
                support and illness self-management programs that meet 
                evidence-based standards for individuals with chronic 
                mental illnesses or substance use dependence; and
                    (B) provide for appropriate payment and coverage 
                reforms, such as the application of copayments, service 
                exclusions, and benefit limits, so as to eliminate 
                barriers to the effective, appropriate, and evidence-
                based provision of such care.
            (2) Endeavor to make reliable comparative information on 
        the quality of such care provided by practitioners and 
        organizations available to consumers and to encourage consumers 
        to use this information when making decisions about from whom 
        to receive such care.
            (3) Insofar as the Department does not have authority 
        described in paragraph (1), make recommendations to the 
        Congress regarding changes in law to provide for such 
        authority.
    (b) Sense of Congress for All Programs.--It is the sense of the 
Congress that clinicians and organizations providing mental health and 
substance use treatment services should--
            (1) incorporate, consistent with applicable State laws, 
        informed, patient-centered decision-making and (for children) 
        informed family decision-making throughout their practices, 
        including active patient participation in the design and 
        revision of the patient treatment and recovery plans, 
        psychiatric advance directives, and provision of information on 
        the availability and effectiveness of mental health and 
        substance use treatment options;
            (2) adopt recovery-oriented and illness self-management 
        practices that support patient preference for treatment 
        (including medications), peer support, and other elements of 
        the wellness recovery plan; and
            (3) maintain effective, formal linkages with community 
        resources to support patient illness self-management and 
        recovery.

SEC. 8. UNIFORM METHODOLOGIES FOR REIMBURSING BEHAVIORAL HEALTH CLAIMS.

    (a) In General.--The Secretary, through the working group convened 
under subsection (b), shall develop uniform methodologies across 
geographic areas and types of payers for the following with respect to 
medical assistance, related services, and administrative costs 
furnished to individuals with mental illnesses and substance use 
disorders in both community-based and residential settings:
            (1) Qualifications for eligibility for payment.
            (2) Financial auditing.
            (3) Claims payment (including billing codes).
    (b) Convening of Working Group.--The Secretary shall carry out 
subsection (a) by convening a working group is composed of the 
Directors and Administrators of all relevant agencies, including the 
Centers for Medicare & Medicaid Services, the Office of Management and 
Budget, the Health Resources and Services Administration, the Substance 
Abuse and Mental Health Services Administration, the office of the 
Inspector General of the Department of Health and Human Services, 
acting jointly with State Medicaid directors and other State, local, 
and private healthcare payers.
    (c) Requirements.--The methodology developed under subsection (a)--
            (1) shall not result in new medical necessity criteria, and 
        shall not prohibit or restrict payment for medical assistance, 
        related services, and administrative activities under title XIX 
        of the Social Security Act that are provided or conducted in 
        accordance with options under such title regarding targeted 
        case management, rehabilitative services, or clinical services; 
        and
            (2) with respect to administrative costs, shall be based 
        on--
                    (A) standards related to time studies and 
                populations estimates; and
                    (B) a national standard for determining payment of 
                such costs.
    (d) Rule of Construction.--Nothing in this section shall be 
construed as requiring, as a condition of payment under the Medicaid 
program under title XIX of the Social Security Act, that an 
intervention must be an evidence-based practice.

SEC. 9. STUDY ON USE OF PUBLIC MENTAL HEALTH AND ADDICTION SERVICES BY 
              INDIVIDUALS WITH PRIVATE HEALTH COVERAGE.

    (a) In General.--The Comptroller General of the United States shall 
conduct a study on the use of publicly supported mental health and 
addiction services by individuals who have any level of private health 
insurance coverage.
    (b) Report.--The Comptroller General shall submit to the Congress a 
report on the study under subsection (a). The report shall include a 
description of--
            (1) the number of individuals described in subsection (a);
            (2) the types of private health insurance coverage 
        involved; and
            (3) the public programs providing the mental health and 
        addiction services involved and the cost of such services 
        provided.

SEC. 10. HIGH-QUALITY MENTAL HEALTH AND SUBSTANCE USE HEALTH CARE 
              MEDICAID DEMONSTRATION PROJECT.

    (a) In General.--The Secretary shall establish a 5-year 
demonstration project (in this section referred to as the ``project'') 
designed to demonstrate the impact of creating delivery and financing 
structures that deliver high-quality, integrated mental health and 
substance use health care. Such project shall be based upon the report 
of the Institute of Medicine (of November 2005) relating to Improving 
the Quality of Health Care for Mental and Substance-Use Conditions: 
Quality Chasm Series, and shall include demonstrating at least the 
following:
            (1) Coordinated delivery of mental health, substance use, 
        and primary health care, utilizing a co-location or integrated 
        delivery model.
            (2) Use of evidence-based practices, to as great an extent 
        as possible.
            (3) Provision of patient-centered care that emphasizes 
        recovery-oriented practices and informed patients and, where 
        appropriate, family decision-making.
            (4) A commitment to utilizing health information technology 
        to improve the quality and efficiency of care.
    (b) Required Reporting on Quality.--The Secretary shall provide 
that each health care provider participating in the project shall 
submit data on quality measures determined by the Secretary.
    (c) Waiver of Requirements.--
            (1) In general.--Subject to paragraph (2), the Secretary is 
        authorized to waive such requirements of title XIX of the 
        Social Security Act, such as statewideness, a limitation on the 
        scope of services included in medical assistance, and the 
        coverage of additional administrative expenses, as may be 
        necessary for the implementation of the project.
            (2) Limitation on funding.--The Secretary shall design the 
        project in such a manner so that the net additional Federal 
        expenditures under title XIX of the Social Security Act 
        resulting from the project does not exceed $50,000,000.
    (d) Independent Evaluation.--The Secretary shall provide for an 
independent evaluation of activities provided under the project, in 
comparison with a control group. Such evaluation shall include an 
assessment of health and social outcomes for beneficiary participants, 
such as employment status, receipt of welfare benefits, criminal 
justice contacts, and homelessness, as well as the resource utilization 
for medical services, mental and substance use health care, and social 
services. Such evaluation shall also include an assessment of the 
impact of activities provided under the project on workforce 
recruitment and retention.
    (e) Reports to Congress.--
            (1) Interim report.--Not later than two years after the 
        initiation of the project, the Secretary shall submit to the 
        Congress an interim report on the project. Such report shall 
        include such recommendations as the Secretary determines 
        appropriate.
            (2) Final report.--Not later than one year after the 
        completion of the project, the Secretary shall submit to the 
        Congress a final report on the project. The report shall 
        include the results of the independent evaluation provided 
        under subsection (d) as well as recommendations regarding 
        redesign of the mental health and substance use benefit under 
        the Medicaid program to maximize the quality and efficiency of 
        such benefits.

SEC. 11. MEDICAID REQUIREMENT FOR STATE REPEAL OF LAWS DENYING HEALTH 
              BENEFITS COVERAGE BASED ON INTOXICATION.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)--
                    (A) by striking ``and'' at the end of paragraph 
                (69);
                    (B) by striking the period at the end of paragraph 
                (70) and inserting ``; and''; and
                    (C) by inserting after paragraph (70) the following 
                new paragraph:
            ``(71) provide that the State has in effect a law that 
        requires any insurance contract covering medical care losses in 
        the group and individual market that is to be offered in the 
        State to meet the requirements of subsection (dd)(1).''; and
            (2) by adding at the end the following new subsection:
    ``(dd) Requirements for Insurance Covering Medical Losses in the 
Group and Individual Market.--
            ``(1) Restrictions on exclusions and limitations relating 
        to intoxication.--The requirements of this paragraph with 
        respect to insurance contracts covering medical care losses in 
        the group and individual market are as follows:
                    ``(A) A prohibition against the exclusion or denial 
                of covered services and benefits, in connection with 
                the treatment of any patient whose medical condition, 
                illness, or injury, involves confirmed or suspected 
                intoxication as a result of alcohol or other substance.
                    ``(B) A prohibition against discrimination against 
                health care providers in the rate or level of payment 
                for covered services in cases in which intoxication is 
                either suspected or confirmed.
                    ``(C) An express obligation to provide and pay for 
                covered services and treatments necessary to the 
                treatment of any condition, illness or injury without 
                regard to whether intoxication is either suspected or 
                confirmed.
                    ``(D) An express obligation to cooperate with the 
                state agency for medical assistance as provided under 
                section 1902(a)(25).
            ``(2) Inclusion of all forms of coverage.--For purposes of 
        subsection (a)(71) and paragraph (1), the term `insurance 
        contract covering medical care losses in the group and 
        individual market' includes any class or type of insurance 
        relating to medical care in the group or individual market, 
        including plans covering public employees as well as private 
        employees, regardless of whether coverage under the contract is 
        expressed in terms of defined benefits or defined cash 
        contributions toward the cost of medical losses.''.
    (b) Effective Date.--
            (1) Except as provided in paragraph (2), the amendments 
        made by subsection (a) shall apply to calendar quarters 
        beginning on or after January 1, 2008, without regard to 
        whether or not final regulations to carry out such amendments 
        have been promulgated by such date.
            (2) In the case of a State plan for medical assistance 
        under title XIX of the Social Security Act which the Secretary 
        determines requires State legislation (other than legislation 
        appropriating funds) in order for the plan to meet the 
        additional requirements imposed by the amendments made by 
        subsection (a), the State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the 
        basis of its failure to meet these additional requirements 
        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 such 
        session shall be deemed to be a separate regular session of the 
        State legislature.
                                 <all>