[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 599 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                 S. 599

 To extend and expand the Medicaid emergency psychiatric demonstration 
                                project.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 26, 2015

 Mr. Cardin (for himself, Mr. Toomey, and Ms. Collins) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
 To extend and expand the Medicaid emergency psychiatric demonstration 
                                project.

    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 ``Improving Access to Emergency 
Psychiatric Care Act''.

SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMERGENCY PSYCHIATRIC 
              DEMONSTRATION PROJECT.

    (a) In General.--Subsection (d) of section 2707 of Public Law 111-
148 (42 U.S.C. 1396a note) is amended to read as follows:
    ``(d) Length of Demonstration Project.--
            ``(1) In general.--Except as provided in paragraphs (2) and 
        (3), the demonstration project established under this section 
        shall be conducted for a period of 3 consecutive years.
            ``(2) Temporary extension of participation eligibility for 
        selected states.--
                    ``(A) In general.--Subject to paragraph (3), a 
                State selected as an eligible State to participate in 
                the demonstration project on or prior to March 13, 
                2012, shall, upon the request of the State, be 
                permitted to continue to participate in the 
                demonstration project through the date described in 
                subparagraph (B) if--
                            ``(i) the Secretary determines that the 
                        continued participation of the State in the 
                        demonstration project is not expected to 
                        increase spending under title XIX of the Social 
                        Security Act; and
                            ``(ii) the Chief Actuary of the Centers for 
                        Medicare & Medicaid Services certifies that 
                        such extension for that State is projected to 
                        reduce (or is projected not to result in any 
                        increase in) net program spending under title 
                        XIX of the Social Security Act.
                    ``(B) Date described.--The date described in this 
                subparagraph is the earlier of--
                            ``(i) the date on which Secretary submits 
                        the recommendations required under subsection 
                        (f)(3); or
                            ``(ii) September 30, 2016.
            ``(3) Extension and expansion of demonstration project.--
                    ``(A) Additional extension.--Taking into account 
                the recommendations submitted to Congress pursuant to 
                subsection (f)(3), the Secretary may, if the Secretary 
                determines that extension and expansion of the 
                demonstration project satisfies the criteria for the 
                temporary extension under subparagraphs (A) and (B) of 
                paragraph (2)--
                            ``(i) extend the demonstration project 
                        through December 31, 2019; and
                            ``(ii) permit any eligible State 
                        participating in the demonstration project as 
                        of the date such recommendations are submitted 
                        to continue to participate in the project.
                    ``(B) Option for expansion to additional states.--
                Taking into account the recommendations submitted to 
                Congress pursuant to subsection (f)(3), the Secretary 
                may expand (including on a nationwide basis) the number 
                of eligible States participating in the demonstration 
                project during the extension period established under 
                subparagraph (A) if, with respect to any new eligible 
                State--
                            ``(i) the Secretary determines that the 
                        participation of the State in the demonstration 
                        project is not expected to increase spending 
                        under title XIX of the Social Security Act; and
                            ``(ii) the Chief Actuary of the Centers for 
                        Medicare & Medicaid Services certifies that the 
                        participation of the State in the demonstration 
                        project is projected to reduce (or is projected 
                        not to result in any increase in) net program 
                        spending under title XIX of the Social Security 
                        Act.
            ``(4) Authority to ensure budget neutrality.--The Secretary 
        annually shall review each participating State's demonstration 
        project expenditures to ensure compliance with the requirements 
        of paragraphs (2)(A), (2)(B), (3)(B)(i), and (3)(B)(ii) (as 
        applicable). If the Secretary determines with respect to a 
        State's participation in the demonstration project that the 
        State's net program spending under title XIX of the Social 
        Security Act has increased as a result of the State's 
        participation in the project, the Secretary shall treat the 
        demonstration project excess expenditures of the State as an 
        overpayment under title XIX of the Social Security Act.''.
    (b) Funding.--Subsection (e) of section 2707 of such Act (42 U.S.C. 
1396a note) is amended--
            (1) in the subsection heading, by striking ``Limitations on 
        Federal'';
            (2) in paragraph (2)--
                    (A) in the paragraph heading, by striking ``5-
                year''; and
                    (B) by striking ``through December 31, 2015'' and 
                inserting ``until expended'';
            (3) by striking paragraph (3);
            (4) by redesignating paragraphs (4) and (5) as paragraphs 
        (3) and (4), respectively;
            (5) in paragraph (3) (as so redesignated), by striking 
        ``and the availability of funds'' and inserting ``(other than 
        States deemed to be eligible States through the application of 
        subsection (c)(4))''; and
            (6) in paragraph (4) (as so redesignated)--
                    (A) in the first sentence--
                            (i) by inserting ``(other than a State 
                        deemed to be an eligible State through the 
                        application of subsection (c)(4))'' after 
                        ``eligible State''; and
                            (ii) by striking ``paragraph (4)'' and 
                        inserting ``paragraph (3)''; and
                    (B) by inserting after the first sentence the 
                following ``In addition to any payments made to an 
                eligible State under the preceding sentence, the 
                Secretary shall, during any period in effect under 
                paragraph (2) or (3) of subsection (d), or during any 
                period in which a law described in subsection (f)(4)(C) 
                is in effect, pay each eligible State (including any 
                State deemed to be an eligible State through the 
                application of subsection (c)(4)), an amount each 
                quarter equal to the Federal medical assistance 
                percentage of expenditures in the quarter during such 
                period for medical assistance described in subsection 
                (a). Payments made to States under this paragraph shall 
                be considered to have been made under, and are subject 
                to, the requirements of section 1903 of the Social 
                Security Act (42 U.S.C. 1396b).''.
    (c) Recommendations to Congress.--Subsection (f) of section 2707 of 
such Act (42 U.S.C. 1396a note) is amended by adding at the end the 
following:
            ``(3) Recommendation to congress regarding extension and 
        expansion of project.--Not later than September 30, 2016, the 
        Secretary shall submit to Congress and make available to the 
        public recommendations based on an evaluation of the 
        demonstration project, including the use of appropriate quality 
        measures, regarding--
                    ``(A) whether the demonstration project should be 
                continued after December 31, 2016; and
                    ``(B) whether the demonstration project should be 
                expanded (including on a nationwide basis).
            ``(4) Recommendation to congress regarding permanent 
        extension and nationwide expansion.--
                    ``(A) In general.--Not later than April 1, 2019, 
                the Secretary shall submit to Congress and make 
                available to the public recommendations based on an 
                evaluation of the demonstration project, including the 
                use of appropriate quality measures, regarding--
                            ``(i) whether the demonstration project 
                        should be permanently continued after December 
                        31, 2019, in 1 or more States; and
                            ``(ii) whether the demonstration project 
                        should be expanded (including on a nationwide 
                        basis).
                    ``(B) Requirements.--Any recommendation submitted 
                under subparagraph (A) to permanently continue the 
                project in a State, or to expand the project to 1 or 
                more other States (including on a nationwide basis) 
                shall include a certification from the Chief Actuary of 
                the Centers for Medicare & Medicaid Services that 
                permanently continuing the project in a particular 
                State, or expanding the project to a particular State 
                (or all States) is projected to reduce (or is projected 
                not to result in any increase in) net program spending 
                under title XIX of the Social Security Act. If the 
                Secretary determines with respect to a State's 
                participation in the demonstration project that net 
                program spending under title XIX of such Act has 
                increased as a result of the project, the Secretary 
                shall treat the demonstration project excess 
                expenditures of the State as an overpayment under title 
                XIX of the Social Security Act.
                    ``(C) Congressional approval required.--The 
                Secretary shall not permanently continue the 
                demonstration project in any State after December 31, 
                2019, or expand the demonstration project to any 
                additional State after December 31, 2019, unless 
                Congress enacts a law approving either or both such 
                actions.
            ``(5) Funding.--Out of any funds in the Treasury not 
        otherwise appropriated, there is appropriated to the Centers 
        for Medicare & Medicaid Services Program Management Account to 
        carry out this subsection, $100,000 for fiscal year 2015, to 
        remain available until expended.''.
    (d) Conforming Amendments.--Section 2707 of such Act (42 U.S.C. 
1396a note) is amended--
            (1) in subsection (c)--
                    (A) in paragraph (1), by striking ``An eligible 
                State'' and inserting ``Except as otherwise provided in 
                paragraph (4), an eligible State'';
                    (B) in paragraph (3), by striking ``A State shall'' 
                and inserting ``Except as otherwise provided in 
                paragraph (4), a State shall''; and
                    (C) by adding at the end the following:
            ``(4) Nationwide availability.--In the event that the 
        Secretary makes a recommendation pursuant to subsection (f)(4) 
        that the demonstration project be expanded on a national basis, 
        any State that has submitted or submits an application pursuant 
        to paragraph (2) shall be deemed to have been selected to be an 
        eligible State to participate in the demonstration project.''; 
        and
            (2) in the heading for subsection (f), by striking ``and 
        Report'' and inserting ``, Report, and Recommendations''.
    (e) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act.
                                 <all>