[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5136 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 5136

  To direct the Secretary of Health and Human Services to establish a 
demonstration project under the Medicaid program under title XIX of the 
   Social Security Act under which payment may be made to States for 
   expenditures for medical assistance with respect to substance use 
          disorder treatment services, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 17, 2014

  Ms. Fudge (for herself, Mr. Ryan of Ohio, Mr. Cummings, Ms. Lee of 
California, Ms. Norton, Mr. Richmond, Mr. Hastings of Florida, and Ms. 
 Clarke of New York) introduced the following bill; which was referred 
                to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To direct the Secretary of Health and Human Services to establish a 
demonstration project under the Medicaid program under title XIX of the 
   Social Security Act under which payment may be made to States for 
   expenditures for medical assistance with respect to substance use 
          disorder treatment services, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Breaking Addiction Act of 2014''.

SEC. 2. MEDICAID COMMUNITY-BASED INPATIENT SUBSTANCE USE DISORDER 
              TREATMENT DEMONSTRATION PROJECT.

    (a) Authority.--The Secretary of Health and Human Services shall 
establish a 5-year demonstration project (in this section referred to 
as the ``demonstration project'') under which payment may be made to 
each participating State (as described in subsection (b)), for any 
medical assistance provided with respect to a qualified individual in a 
community-based institution for mental diseases who is being treated in 
such institution for a substance use condition.
    (b) Participating States.--
            (1) Eligibility.--A State is eligible to participate in the 
        demonstration project under this section if the State plan of 
        the State provides for payment under the plan for community-
        based inpatient substance use disorder treatment services 
        furnished to qualified individuals.
            (2) Application.--A State seeking to participate in the 
        demonstration project under this section shall submit to the 
        Secretary an application, at such time, in such form, and that 
        contains such information, provisions, and assurances, as the 
        Secretary may require.
            (3) Selection.--The Secretary shall select, on a 
        competitive basis, from among the States that submit an 
        application under paragraph (1) to the satisfaction of the 
        Secretary, the States that will be participating in the 
        demonstration project. In selecting such participating States, 
        the Secretary shall seek to achieve an equitable geographic 
        distribution.
    (c) Waiver Authority.--
            (1) In general.--The Secretary shall waive the limitation 
        on payment for care and services imposed by the subdivision (B) 
        that follows paragraph (29) of section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)) (relating to a limitation on 
        payments for care or services for any individual who is under 
        65 years of age and who is a patient in an institution for 
        mental diseases) with respect to payment for the medical 
        assistance described in subsection (a).
            (2) Limited other waiver authority.--The Secretary may 
        waive other requirements of titles XI and XIX of the Social 
        Security Act (including the requirements of sections 1902(a)(1) 
        (relating to statewideness) (42 U.S.C. 1396a(a)(1)) and 
        1902(a)(10)(B) (relating to comparability) (42 U.S.C. 
        1396a(a)(10)(B)) of such Act) only to the extent necessary to 
        carry out the demonstration project under this section.
    (d) Evaluation and Report to Congress.--
            (1) Evaluation.--The Secretary shall conduct an evaluation 
        of the impact the demonstration project carried out under this 
        section has on the functioning of the health and substance use 
        disorder system and individuals enrolled in State plans under 
        the Medicaid program under title XIX of the Social Security 
        Act. The evaluation shall include each of the following:
                    (A) An assessment of the access such individuals 
                have to substance use disorder treatment services under 
                the demonstration project carried out under this 
                section, and with respect to such services, the average 
                lengths of inpatient stays and emergency room visits.
                    (B) An assessment of the discharge planning by the 
                health care providers furnishing such services.
                    (C) An assessment of the impact of the 
                demonstration project on the costs of the full range of 
                health care items and services, including inpatient, 
                emergency and ambulatory care, diversions from 
                inpatient and emergency care, and readmissions to 
                institutions for mental diseases.
                    (D) An analysis of the percentage of individuals 
                enrolled in such plans who are admitted to community-
                based institutions for mental diseases as a result of 
                the demonstration project as compared to those admitted 
                to such institutions through other means.
            (2) Report.--Not later than December 31, 2020, the 
        Secretary shall submit to Congress and make available to the 
        public a report that contains--
                    (A) the findings of the evaluation under paragraph 
                (1); and
                    (B) the recommendations of the Secretary regarding 
                whether--
                            (i) the limitation referred to in 
                        subsection (c)(1) is a barrier to care that 
                        needs to be reviewed by Congress; and
                            (ii) the demonstration project carried out 
                        under this section should be continued after 
                        December 31, 2020, and expanded on a national 
                        basis.
    (e) Funding.--
            (1) Appropriation.--Out of any funds in the Treasury not 
        otherwise appropriated, there is appropriated to carry out this 
        section, $300,000,000 for fiscal year 2015.
            (2) 10-year availability.--Funds appropriated under 
        paragraph (1) shall remain available for obligation through 
        December 31, 2024.
            (3) Funds allocated to states.--Funds shall be allocated to 
        participating States on the basis of criteria, including a 
        State's application and the availability of funds, as 
        determined by the Secretary.
            (4) Payment to states.--For each calendar quarter beginning 
        on or after October 1, 2014, the Secretary shall pay to each 
        participating State, from the allocation made to the State 
        under paragraph (3), an amount equal to the Federal medical 
        assistance percentage of the amount expended during such 
        quarter for the medical assistance described in subsection (a).
            (5) Limitation on payments.--In no case may--
                    (A) the aggregate amount of payments made by the 
                Secretary to participating States under this section 
                exceed $300,000,000; or
                    (B) payments be made by the Secretary to 
                participating States under this section after December 
                31, 2024.
    (f) Definitions.--In this section:
            (1) Federal medical assistance percentage.--The term 
        ``Federal medical assistance percentage'' has the meaning given 
        such term in section 1905(b) of the Social Security Act (42 
        U.S.C. 1396d(b)).
            (2) Institution for mental diseases.--The term 
        ``institution for mental diseases'' has the meaning given such 
        term in section 1905(i) of the Social Security Act (42 U.S.C. 
        1396d(i)).
            (3) Medical assistance.--The term ``medical assistance'' 
        has the meaning given such term in section 1905(a) of the 
        Social Security Act (42 U.S.C. 1396d(a)).
            (4) Qualified individual.--The term ``qualified 
        individual'' means an individual who, because of the 
        individual's substance use condition, requires substance use 
        disorder treatment and who--
                    (A) is over 21 years of age and under 65 years of 
                age; and
                    (B) is eligible for medical assistance under the 
                State plan under the Medicaid program under title XIX 
                of the Social Security Act (42 U.S.C. 1396 et seq.).
            (5) State.--The term ``State'' has the meaning given such 
        term for purposes of title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
                                 <all>