110 HR 4232 IH: To improve mental and substance use health
U.S. House of Representatives
2007-11-15
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents; findings
(a)This Act may be cited
as the Improving the Quality of Mental and Substance Use Health Care Act
of 2007
.
(b)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)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.
2.Evidence-based
mental and substance use health care
(a)Commission for
Evidence-Based Mental and Substance Use Health Care
(1)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)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)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)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)
(A)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
appointeesAs 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)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)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 applicationNothing 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
codesThe 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)In this section, the term
intervention means a preventive, diagnostic, or therapeutic action
with respect to a mental health or substance use disease process.
3.Improved
coordination of care
(a)Interagency
collaborative group
(1)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)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)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)The
interagency collaborative group shall meet not less than quarterly.
(5)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 careThe 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 rulesNothing
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)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 optionsThe 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.
4.Information
technology for mental health and substance use health care providers
(a)Development and
implementation of planThe
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)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)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 protectionsIn 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 reportsIn
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.
5.Council on the
Mental Health and Substance Use Health Care Workforce
(a)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)
(1)Development of
comprehensive planThe 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)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)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)The
Council shall collaborate with private sector coalitions to facilitate and
implement its recommendations.
(c)
(1)Number;
appointment; chairThe 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)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)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)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)
(A)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
appointeesAs 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)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)The
Council shall conduct at least 3 meetings each year.
(e)The Secretary shall provide, without the requirement for
reimbursement, staff and other administrative support necessary for the
operation of the Council.
6.Funding of
research through national centers of excellence
(a)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)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
appropriationsTo 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.
7.
(a)Promotion in
Federal programsWith 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 programsIt 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.
8.Uniform
methodologies for reimbursing behavioral health claims
(a)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 groupThe 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)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)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.
9.Study on use of
public mental health and addiction services by individuals with private health
coverage
(a)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)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.
10.High-quality
mental health and substance use health care Medicaid demonstration
project
(a)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 qualityThe Secretary shall provide that each health
care provider participating in the project shall submit data on quality
measures determined by the Secretary.
(c)
(1)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)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)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)
(1)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)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.
11.Medicaid
requirement for State repeal of laws denying health benefits coverage based on
intoxication
(a)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 intoxicationThe
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 coverageFor 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)
(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.