[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