1.Short title; table of contents
(a)This Act may be cited as the Medicaid Services Restoration Act of 2010
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—Rehabilitative Services Protections
Sec. 101. Inclusion of therapeutic foster care as medical assistance.
Sec. 102. Inclusion of attainment and retention of functional status in rehabilitative services.
Sec. 103. Reasonable and efficient payment methodologies for rehabilitative services.
Sec. 104. Clarification of coverage of EPSDT services for children receiving inpatient psychiatric hospital services.
Sec. 105. Third party liability clarification relating to diagnostic, screening, preventive, and rehabilitative services.
Title II—Case Management and Targeted Case Management Protections
Sec. 201. Third party liability clarification relating to case management and targeted case management.
Sec. 202. Reasonable and efficient payment methodologies for case management services.
Sec. 203. Protecting health and safety.
Sec. 204. Codification of Olmstead standard; protecting children.
Sec. 205. Assuring appropriate case management.
<enum>I</enum><header display-inline="yes-display-inline">Rehabilitative Services Protections</header>
<section commented="no" display-inline="no-display-inline" id="HE9E0BF48FD0A42DDB034B72C2C2437E4" section-type="subsequent-section"><enum>101.</enum><header display-inline="yes-display-inline">Inclusion of therapeutic foster care as medical assistance</header><text display-inline="no-display-inline">Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H90F873423DD74AC29B90C15B053537FB"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (a)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H4361ECA233A647DB8B14C8A296563F37"><enum>(A)</enum><text display-inline="yes-display-inline">in paragraph (27), by striking <quote>and</quote> at the end;</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H9E66618FECC144D3A449E3151C87DCEA"><enum>(B)</enum><text display-inline="yes-display-inline">by redesignating paragraph (28) as paragraph (29); and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H614123C51C2B4CBD8B30DB9370A2B466"><enum>(C)</enum><text display-inline="yes-display-inline">by inserting after paragraph (27) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HD2AD47AEF5DF44CE9A4DC2EB959A4198" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="H7CB426B22A584097A25C0F0EF482F5D8"><enum>(28)</enum><text display-inline="yes-display-inline">therapeutic foster care services described in subsection (y); and</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H0DCAEA59A691446EA565C1B1833E28C7"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H6C614E0D69E1464EBEEF021962E07451" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="H982B6EE5E9D243EF8A96AC8FB0217B9F"><enum>(y)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="H62A7541C14AE4FB3807FFF71F47312FB"><enum>(1)</enum><text display-inline="yes-display-inline">For purposes of subsection (a)(28), subject to subparagraph (C), therapeutic foster care services described in this subsection are services provided for children who have not attained age 21, and who, as a result of mental illness, other emotional or behavioral disorders, medically fragile conditions, or developmental disabilities, need the level of care provided in an institution (including a psychiatric residential treatment facility) or nursing facility the cost of which could be reimbursed under the State plan but who can be cared for or maintained in a community placement, through therapeutic foster care programs that—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HD0067AD4B4324B4E84899D7F689883C0" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">are licensed by the State and accredited by the Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation, or by another equivalent accreditation agency (or agencies) as the Secretary may recognize;</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HF387241C1DC042CABAAB6366F17ABBD1" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">provide structured daily activities, including the development, improvement, monitoring, and reinforcing of age-appropriate social, communication and behavioral skills, crisis intervention and crisis support services, medication monitoring, counseling, and case management, and may furnish other intensive community services; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H687961633B61449AB9F4E5E4A64115DD" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">provide foster care parents with specialized training and consultation in the management of children with mental illness, other emotional or behavioral disorders, medically fragile conditions, or developmental disabilities, and specific additional training on the needs of each child provided such services.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H1ACBF3BF0BD84E5C877148ABF2940454" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">In making coverage determinations under paragraph (1), a State may employ medical necessity criteria that are similar to the medical necessity criteria applied to coverage determinations for other services and supports under this title.</text></paragraph>
<paragraph id="HBD205BE02231455EB72FB30B0FB9B4BF" indent="up1"><enum>(3)</enum><text>The services described in this subsection do not include the training referred to in paragraph (1)(C).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<section commented="no" display-inline="no-display-inline" id="HEE4BC311C5924F5EB4892E13CF40CFE6" section-type="subsequent-section"><enum>102.</enum><header display-inline="yes-display-inline">Inclusion of attainment and retention of functional status in rehabilitative services</header><text display-inline="no-display-inline">Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended by striking <quote>and restoration of an individual to the best possible functional level</quote> and inserting <quote>, restoration of an individual to the best possible functional level, or attainment or retention of the individual's best possible functional status</quote>.</text></section>
<section commented="no" display-inline="no-display-inline" id="H9F254D60BD6D4461ADEEB6B31C9D7B61" section-type="subsequent-section"><enum>103.</enum><header display-inline="yes-display-inline">Reasonable and efficient payment methodologies for rehabilitative services</header><text display-inline="no-display-inline">Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)), as amended by section 102, is amended by inserting <quote>(and which reimbursement for, in the case of rehabilitative services, may be made through the establishment of reasonable and efficient payment methodologies, including fee-for-service payments, case rates, daily rates, or other forms of capitated payment</quote> after <quote>status</quote>.</text></section>
<section commented="no" display-inline="no-display-inline" id="HFE775B8C94604415972F0700D167549A" section-type="subsequent-section"><enum>104.</enum><header display-inline="yes-display-inline">Clarification of coverage of EPSDT services for children receiving inpatient psychiatric hospital services</header><text display-inline="no-display-inline">Section 1905(h)(1) of the Social Security Act (42 U.S.C. 1396d(h)(1)) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="HFE26E003FD7B4CB99A9A483FEA1DBDCF"><enum>(1)</enum><text display-inline="yes-display-inline">in subparagraph (B), by striking <quote>and</quote> at the end;</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H3273A055D4614CAEA5482D1FAFF85960"><enum>(2)</enum><text display-inline="yes-display-inline">in subparagraph (C), by adding <quote>and</quote> after the semicolon; and</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H86369A792FEC4BB5B72E37ECF364F45B"><enum>(3)</enum><text display-inline="yes-display-inline">by inserting after subparagraph (C), the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H0BA78AAA83794A289BC1A829F3AF514C" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H3AFF0604C51146559A7D8518B7BC2BD3" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">services described in subsection (r) which are provided on an inpatient or outpatient basis to an individual receiving inpatient services described in subparagraph (A), (B), or (C).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<section commented="no" display-inline="no-display-inline" id="HDDDE6878E3F94836A69BF29FDDA5B33E" section-type="subsequent-section"><enum>105.</enum><header display-inline="yes-display-inline">Third party liability clarification relating to diagnostic, screening, preventive, and rehabilitative services</header><text display-inline="no-display-inline">Section 1903(c) of the Social Security Act (42 U.S.C. 1396b(c)) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="HDDF4B2DE0D834AF9BF63E9C9020DE0E1"><enum>(1)</enum><text display-inline="yes-display-inline">by inserting <quote>(1)</quote> after <quote>(c)</quote>; and</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H9AEAEE5D005E419B90732AE650E46613"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H8441923490414BFFAF101D3DDF175891" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="H879F4A1ABFAD4D7FB001870DEC75E163" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">Nothing in this title shall be construed as prohibiting or restricting, or authorizing the Secretary to prohibit or restrict, payment under subsection (a) for medical assistance for services provided under section 1905(a)(13) to eligible individuals furnished by qualified providers under non-medical programs, provided, however, a State or local agency administering such plan shall comply with section 1902(a)(25).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<enum>II</enum><header display-inline="yes-display-inline">Case Management and Targeted Case Management Protections</header>
<section commented="no" display-inline="no-display-inline" id="HF438432D70FE456CB04208CAFBC4EC11" section-type="subsequent-section"><enum>201.</enum><header display-inline="yes-display-inline">Third party liability clarification relating to case management and targeted case management</header><text display-inline="no-display-inline">Section 1903(c) of the Social Security Act (42 U.S.C. 1396b(c)), as amended by section 105, is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H117E740F7AB446089394CB135DF1CC93" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="H5CB81B0656AE47819B5A05737A860383" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">Nothing in this title shall be construed as prohibiting or restricting, or authorizing the Secretary to prohibit or restrict payment under subsection (a) for medical assistance for services provided under section 1915(g) to eligible individuals furnished by qualified providers under non-medical programs, provided, however, a State or local agency administering such plan shall comply with section 1902(a)(25).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section commented="no" display-inline="no-display-inline" id="HF626B0611DBD4F9DACC4096175416004" section-type="subsequent-section"><enum>202.</enum><header display-inline="yes-display-inline">Reasonable and efficient payment methodologies for case management services</header><text display-inline="no-display-inline">Section 1915(g)(4) of the Social Security Act (42 U.S.C. 1396n(g)(4)) is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HD8B0B4C4AD0A47459E7440AE2F26DBC3" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H6D842CF49D7B4EB9AEA22B0E66743130" indent="up2"><enum>(C)</enum><text display-inline="yes-display-inline">Reimbursement for case management and targeted case management services may be made through the establishment of reasonable and efficient payment methodologies including fee-for-service payments, case rates, daily rates, or other forms of capitated payment.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section commented="no" display-inline="no-display-inline" id="H03AA1E6A40C0420199F9A0D9D5E8D38A" section-type="subsequent-section"><enum>203.</enum><header display-inline="yes-display-inline">Protecting health and safety</header><text display-inline="no-display-inline">Section 1915(c)(4) of the Social Security Act (42 U.S.C. 1396n(c)(4)) is amended by adding after the second sentence the following new sentence: “For the purpose of developing and monitoring the implementation of the written plan of care required under paragraph (1), and to assure the health and welfare of individuals, the State may require case management services for each beneficiary and may limit the case managers available with respect to case management services for eligible individuals in order to ensure that the case managers for such individuals are capable of ensuring that such individuals receive needed services.”.</text></section>
<section commented="no" display-inline="no-display-inline" id="H9C66D8EBFEFC4361BED3604C2064C699" section-type="subsequent-section"><enum>204.</enum><header display-inline="yes-display-inline">Codification of Olmstead standard; protecting children</header><text display-inline="no-display-inline">Section 1915(g)(2)(A) of the Social Security Act (42 U.S.C. 1396n(g)(2)(A)) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="HD5031EFFA1DF49E6AF68A9F96E8D0E98"><enum>(1)</enum><text display-inline="yes-display-inline">in clause (i), by striking <quote>services which will</quote> and all that follows through the period and inserting <quote>services furnished to assist individuals, eligible under the State plan who reside in a community setting or are transitioning to a community setting, in gaining access to needed medical, social, educational, and other services. Such services may be offered by staff of non-medical programs or those who contract with non-medical programs, so long as such individuals are qualified providers under the State plan under this title and the case management services are distinct from the direct services of the non-medical program.</quote>;</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HEC53A7A1629B417AA677E848BA53FFA9"><enum>(2)</enum><text display-inline="yes-display-inline">by redesignating clause (ii) as clause (iii); and</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H1CD02558FB8B49C1B88B2211256EDEF8"><enum>(3)</enum><text display-inline="yes-display-inline">by inserting after clause (i) (as amended by paragraph (1)), the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H8ED10B8D79DE403F8F7ABA58EC661EEF" style="OLC">
<clause commented="no" display-inline="no-display-inline" id="HA02F632909D940F99188BEA8B29EEC6D" indent="up2"><enum>(ii)</enum><text display-inline="yes-display-inline">For purposes of providing case management services, individuals (other than individuals who have attained age 22 but not attained age 65 and are patients in an institution for mental diseases or individuals who are inmates of public institutions) may be considered to be transitioning to a community setting for up to the last 180 days of an institutional stay.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<section commented="no" display-inline="no-display-inline" id="HA045DBFC5B74408790C538AAF3E87680" section-type="subsequent-section"><enum>205.</enum><header display-inline="yes-display-inline">Assuring appropriate case management</header><text display-inline="no-display-inline">Section 1915(g)(4) of the Social Security Act (42 U.S.C. 1396n(g)(4)), as amended by section 202, is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H1E4C09635E464FD0A608BF57926F013E" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="HC0399B4CD26646F2A91AB7A1CF3C5AB3" indent="up2"><enum>(D)</enum><text display-inline="yes-display-inline">Nothing in this subsection shall be construed as prohibiting a State from providing case management or targeted case management services, as defined in subparagraphs (A) and (B), respectively, of paragraph (2), through multiple case managers to any individual who qualifies for medical assistance under the State plan, or to specific classes of individuals, or to individuals who reside in specified areas, selected by the State pursuant to this subsection.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section>