[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 599 Reported in Senate (RS)]
Calendar No. 180
114th CONGRESS
1st Session
S. 599
[Report No. 114-101]
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, Ms. Collins, Mrs. McCaskill, Mr.
Franken, Mr. Murphy, Mrs. Capito, Mr. Whitehouse, Mr. Blunt, Ms.
Mikulski, Mr. Sessions, Mr. Manchin, Mr. Brown, Ms. Stabenow, and Mr.
Burr) introduced the following bill; which was read twice and referred
to the Committee on Finance
July 30, 2015
Reported by Mr. Hatch, with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
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,
<DELETED>SECTION 1. SHORT TITLE.</DELETED>
<DELETED> This Act may be cited as the ``Improving Access to
Emergency Psychiatric Care Act''.</DELETED>
<DELETED>SEC. 2. EXTENSION AND EXPANSION OF MEDICAID EMERGENCY
PSYCHIATRIC DEMONSTRATION PROJECT.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> ``(d) Length of Demonstration Project.--</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) Temporary extension of participation
eligibility for selected states.--</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(B) Date described.--The date described
in this subparagraph is the earlier of--</DELETED>
<DELETED> ``(i) the date on which Secretary
submits the recommendations required under
subsection (f)(3); or</DELETED>
<DELETED> ``(ii) September 30,
2016.</DELETED>
<DELETED> ``(3) Extension and expansion of demonstration
project.--</DELETED>
<DELETED> ``(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)--</DELETED>
<DELETED> ``(i) extend the demonstration
project through December 31, 2019;
and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.''.</DELETED>
<DELETED> (b) Funding.--Subsection (e) of section 2707 of such Act
(42 U.S.C. 1396a note) is amended--</DELETED>
<DELETED> (1) in the subsection heading, by striking
``Limitations on Federal'';</DELETED>
<DELETED> (2) in paragraph (2)--</DELETED>
<DELETED> (A) in the paragraph heading, by striking
``5-year''; and</DELETED>
<DELETED> (B) by striking ``through December 31,
2015'' and inserting ``until expended'';</DELETED>
<DELETED> (3) by striking paragraph (3);</DELETED>
<DELETED> (4) by redesignating paragraphs (4) and (5) as
paragraphs (3) and (4), respectively;</DELETED>
<DELETED> (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</DELETED>
<DELETED> (6) in paragraph (4) (as so redesignated)--
</DELETED>
<DELETED> (A) in the first sentence--</DELETED>
<DELETED> (i) by inserting ``(other than a
State deemed to be an eligible State through
the application of subsection (c)(4))'' after
``eligible State''; and</DELETED>
<DELETED> (ii) by striking ``paragraph (4)''
and inserting ``paragraph (3)''; and</DELETED>
<DELETED> (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).''.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(A) whether the demonstration project
should be continued after December 31, 2016;
and</DELETED>
<DELETED> ``(B) whether the demonstration project
should be expanded (including on a nationwide
basis).</DELETED>
<DELETED> ``(4) Recommendation to congress regarding
permanent extension and nationwide expansion.--</DELETED>
<DELETED> ``(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--
</DELETED>
<DELETED> ``(i) whether the demonstration
project should be permanently continued after
December 31, 2019, in 1 or more States;
and</DELETED>
<DELETED> ``(ii) whether the demonstration
project should be expanded (including on a
nationwide basis).</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.''.</DELETED>
<DELETED> (d) Conforming Amendments.--Section 2707 of such Act (42
U.S.C. 1396a note) is amended--</DELETED>
<DELETED> (1) in subsection (c)--</DELETED>
<DELETED> (A) in paragraph (1), by striking ``An
eligible State'' and inserting ``Except as otherwise
provided in paragraph (4), an eligible
State'';</DELETED>
<DELETED> (B) in paragraph (3), by striking ``A
State shall'' and inserting ``Except as otherwise
provided in paragraph (4), a State shall'';
and</DELETED>
<DELETED> (C) by adding at the end the
following:</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> (2) in the heading for subsection (f), by striking
``and Report'' and inserting ``, Report, and
Recommendations''.</DELETED>
<DELETED> (e) Effective Date.--The amendments made by this section
shall take effect on the date of the enactment of this Act.</DELETED>
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 subparagraph (B) and
paragraph (4), 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 September 30, 2016, if--
``(i) the Secretary determines that the
continued participation of the State in the
demonstration project is projected not to
increase net program 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 not
to increase net program spending under title
XIX of the Social Security Act.
``(B) Notice of projections.--The Secretary shall
provide each State selected to participate in the
demonstration project on or prior to March 13, 2012,
with notice of the determination and certification made
under subparagraph (A) for the State.
``(3) Extension and expansion of demonstration project.--
``(A) Additional extension.--Taking into account
the recommendations submitted to Congress under
subsection (f)(3), the Secretary may permit an eligible
State participating in the demonstration project as of
the date such recommendations are submitted to continue
to participate in the project through December 31,
2019, if, with respect to the State--
``(i) the Secretary determines that the
continued participation of the State in the
demonstration project is projected not to
increase net program spending under title XIX
of the Social Security Act; and
``(ii) the Chief Actuary of the Centers for
Medicare & Medicaid Services certifies that the
continued participation of the State in the
demonstration project is projected not to
increase net program spending under title XIX
of the Social Security Act.
``(B) Option for expansion to additional states.--
Taking into account the recommendations submitted to
Congress pursuant to subsection (f)(3), the Secretary
may expand the number of eligible States participating
in the demonstration project through December 31, 2019,
if, with respect to any new eligible State--
``(i) the Secretary determines that the
participation of the State in the demonstration
project is projected not to increase net
program 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 not to increase net
program spending under title XIX of the Social
Security Act.
``(C) Notice of projections.--The Secretary shall
provide each State participating in the demonstration
project as of the date the Secretary submits
recommendations to Congress under subsection (f)(3),
and any additional State that applies to be added to
the demonstration project, with notice of the
determination and certification made for the State
under subparagraphs (A) and (B), respectively, and the
standards used to make such determination and
certification--
``(i) in the case of a State participating
in the demonstration project as of the date the
Secretary submits recommendations to Congress
under subsection (f)(3), not later than August
31, 2016; and
``(ii) in the case of an additional State
that applies to be added to the demonstration
project, prior to the State making a final
election to participate in the project.
``(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)(i), (2)(A)(ii), (3)(A)(i), (3)(A)(ii),
(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 a State for emergency psychiatric
demonstration services under this section during the
extension period shall be treated as medical assistance
under the State plan for purposes of section 1903(a)(1)
of the Social Security Act (42 U.S.C. 1396b(a)(1)).''.
(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 September 30, 2016; and
``(B) whether the demonstration project should be
expanded to additional States.
``(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 not to increase net
program spending 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 and the law includes provisions that--
``(i) ensure that each State's
participation in the project complies with
budget neutrality requirements; and
``(ii) require the Secretary to treat any
expenditures of a State participating in the
demonstration project that are excess of the
expenditures projected under the budget
neutrality standard for the State as an
overpayment under title XIX of the Social
Security Act.
``(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 (a), in the matter before paragraph (1),
by inserting ``publicly or'' after ``institution for mental
diseases that is'';
(2) 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
(3) 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.
Calendar No. 180
114th CONGRESS
1st Session
S. 599
[Report No. 114-101]
_______________________________________________________________________
A BILL
To extend and expand the Medicaid emergency psychiatric demonstration
project.
_______________________________________________________________________
July 30, 2015
Reported with an amendment