[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6343 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6343

  To provide for a demonstration program and pilot project to expand 
 choice for inpatient psychiatric services under Medicaid and Medicare.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 12, 2018

 Mr. Huizenga introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To provide for a demonstration program and pilot project to expand 
 choice for inpatient psychiatric services under Medicaid and Medicare.

    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 ``Increasing National Patient Access 
To Improved Effective Necessary Mental Health Treatment Act of 2018'' 
or the ``INPATIENT Act of 2018''.

SEC. 2. DEMONSTRATION PROJECT WAIVING IMD EXCLUSION TO EXPAND ACCESS TO 
              INPATIENT PSYCHIATRIC SERVICES UNDER THE MEDICAID 
              PROGRAM.

    (a) Authority To Conduct Demonstration Project.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this Act referred to as the ``Secretary'') shall establish 
        a demonstration project (in this Act referred to as the 
        ``demonstration project'') to test the impact of waiving the 
        limitation of subdivision (B) following paragraph (29) of 
        section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) 
        on average length of stay, readmissions, cost, and quality 
        outcomes for inpatient psychiatric hospital services and 
        substance abuse services.
            (2) Terms.--Under the demonstration project, an eligible 
        State (as defined in subsection (b)) shall provide payment 
        under its State Medicaid plan under title XIX of the Social 
        Security Act to qualifying institutions (as defined in 
        subsection (b)(3)(C)) for the provision of medical assistance 
        available under such plan to individuals who--
                    (A) have attained age 21, but have not attained age 
                65;
                    (B) are eligible for medical assistance under such 
                plan (or under a waiver of such plan);
                    (C) require such medical assistance for inpatient 
                psychiatric hospital services or residential substance 
                abuse services; and
                    (D) but for participation in the demonstration 
                project, would otherwise receive medical assistance for 
                such inpatient psychiatric hospital services if the 
                services were provided in a general acute care hospital 
                or other residential substance abuse facility.
    (b) Eligible State Defined.--
            (1) In general.--In this section, the term ``eligible 
        State'' means a State that has made an application under 
        paragraph (2) and has had such application approved and has 
        been selected under paragraph (3).
            (2) Application.--A State seeking to participate in the 
        demonstration project shall submit to the Secretary, at such 
        time and in such format as the Secretary requires, an 
        application that includes such information, provisions, and 
        assurances, as the Secretary may require.
            (3) Selection and limitation.--
                    (A) State limitation.--The Secretary shall limit 
                the number of States selected for participation in the 
                demonstration project to no more than 3 States.
                    (B) Conditions for application approval.--The 
                Secretary shall not approve an application under 
                paragraph (2) unless the State agrees to limit 
                participation in the demonstration project to 
                qualifying institutions (as defined in subparagraph 
                (C)).
                    (C) Qualifying institution defined.--In this Act, 
                the term ``qualifying institution'' means an 
                institution for mental diseases that is not publicly 
                owned or operated, that is subject to the requirements 
                of section 1867 of the Social Security Act (42 U.S.C. 
                1395dd), and that meets all of the following criteria:
                            (i) The institution furnishes inpatient 
                        psychiatric hospital services to individuals 
                        age 18 years of age or older under the Medicare 
                        and Medicaid programs.
                            (ii) The institution has an average length 
                        of inpatient hospital stay of less than 15 days 
                        for individuals age 18 or older, but under 65 
                        years of age.
                            (iii) The institution has an average length 
                        of stay of less than 21 days for hospital 
                        inpatients age 65 or older.
                            (iv) The institution has an approved 
                        medical residency training program and receive 
                        payment due under the Medicare and Medicaid 
                        programs for the reasonable costs of graduate 
                        medical education.
                            (v) The institution uses psychiatric 
                        residents to provide inpatient psychiatric 
                        hospital services to individuals under the 
                        Medicare and Medicaid programs.
                            (vi) The institution has documented 
                        experience in providing services to active duty 
                        military personnel and veterans.
                            (vii) The institution has standards to care 
                        for the whole person, including referral 
                        agreements or other arrangements to address a 
                        patient's medical, surgical, or diagnostic 
                        needs if such treatment services are not 
                        available within the institution.
                            (viii) The institution agrees to report on 
                        quality measures (in such form, manner, and 
                        frequency as specified by the Secretary) and 
                        report to the Secretary (in a form, manner, and 
                        frequency as specified by the Secretary) such 
                        data as the Secretary determines appropriate to 
                        monitor and evaluate the demonstration project.
                            (ix) The institution agrees to plan and 
                        implement an annual performance improvement 
                        project, aimed at improving the effectiveness 
                        of care provided to high utilizers of inpatient 
                        psychiatric hospital services (as defined in 
                        subsection (h)(1)), with identifiable measures 
                        in coordination with the Secretary and the 
                        State.
    (c) Deadline for Implementation.--The Secretary shall implement the 
demonstration project by January 1, 2019.
    (d) Length of Demonstration Project.--The demonstration project 
shall be conducted for a period of 7 consecutive years.
    (e) Budget Neutrality.--With respect to the operation of the 
demonstration project in a State for the period described in subsection 
(d), the State must demonstrate to the Secretary that project will not 
result in a net increase in the aggregate expenditures under the 
Medicaid program for such period for the State above the level of such 
expenditures if the demonstration project had not been implemented.
    (f) Evaluation and Report to Congress.--
            (1) Evaluation.--The Secretary shall conduct an evaluation 
        of the demonstration project in order to determine the impact 
        of the project and to make recommendations on improvements to 
        the performance of the health and mental health service system 
        and on individuals enrolled in the Medicaid program, with 
        particular emphasis on individuals who are high utilizers of 
        inpatient psychiatric hospital services and substance abuse 
        residential services.
            (2) Items included in evaluation.--Such evaluation shall 
        include the following:
                    (A) An assessment of the delivery of inpatient 
                psychiatric hospital services, substance abuse 
                residential services, and community-based services 
                under the Medicaid program; average lengths of 
                inpatient stays; emergency room visits; and 
                readmissions.
                    (B) An assessment of the impact of the 
                demonstration project on the costs of the full range of 
                mental health services (including inpatient, emergency 
                and ambulatory care) under the Medicaid program.
                    (C) An assessment of the impact of the 
                demonstration project on psychiatric residency programs 
                and the mental health workforce.
                    (D) An assessment of the impact of the 
                demonstration project on rates of recidivism.
                    (E) Identification and assessment of best practices 
                for caring for patients with serious mental illness, 
                including high utilizers of inpatient psychiatric 
                hospital services and substance abuse residential 
                services.
                    (F) A comparison of outcomes and costs for 
                similarly situated patients receiving inpatient 
                psychiatric hospital services at a general acute care 
                hospital.
                    (G) A recommendation regarding whether the 
                demonstration project should be continued after 
                December 31, 2024, and expanded on a national basis.
            (3) Report.--Not later than December 31, 2024, the 
        Secretary shall submit to Congress (and make available to the 
        public) a report on the findings of the evaluation conducted 
        under this subsection.
    (g) IMD Waiver; Waiver Authority.--
            (1) IMD waiver.--The limitation of subdivision (B) 
        following paragraph (29) of section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)), relating to limitations on 
        payments for care or services for individuals under 65 years of 
        age who are patients in an institution for mental disease, 
        shall not apply to inpatient psychiatric hospital services or 
        substance abuse residential services furnished under the 
        demonstration project.
            (2) Waiver authority.--The Secretary may waive such 
        requirements of titles XI and XIX of the Social Security Act 
        (which may include the requirements of paragraph (1) (relating 
        to statewideness) and paragraph (10)(B) (relating to 
        comparability) of section 1902(a) of such Act (42 U.S.C. 
        1396b(a)) only to extent the Secretary determines such a waiver 
        to be necessary to carry out the demonstration project.
    (h) Definitions.--In this Act:
            (1) High utilizer of inpatient psychiatric hospital 
        services.--The term ``high utilizer of inpatient psychiatric 
        hospital services'' means an individual who, with respect to a 
        point in time, meets the following conditions:
                    (A) The individual had two or more inpatient 
                admissions for psychiatric services in the previous 12 
                months.
                    (B) The individual had 10 or more inpatient 
                admissions for psychiatric services in the individual's 
                lifetime.
                    (C) The individual had 100 or more days of 
                inpatient psychiatric services in the individual's 
                lifetime.
                    (D) The individual meets any of the following 
                conditions:
                            (i) The individual is receiving court-
                        ordered psychiatric treatment.
                            (ii) The individual has been receiving 
                        inpatient psychiatric services for a 
                        consecutive period of at least 12 days.
                            (iii) The individual has a documented 
                        history of suicidal or self-harming behaviors 
                        due to mental illness.
                            (iv) The individual has a documented 
                        history of threatened or actual physical harm 
                        to another individual due to mental illness.
            (2) Institution for mental disease.--The term ``institution 
        for mental disease'' has the meaning given to that term in 
        section 1905(i) of the Social Security Act (42 U.S.C. 
        1396d(i)).
            (3) Medicaid program.--The term ``Medicaid program'' means 
        the program under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
            (4) Medical assistance.--The term ``medical assistance'' 
        has the meaning given that term in section 1905(a) of the 
        Social Security Act (42 U.S.C. 1396d(a)).
            (5) Medicare program.--The term ``Medicare program'' means 
        the program under part A of title XVIII of the Social Security 
        Act (42 U.S.C. 1395c et seq.) and includes the programs under 
        parts B, C, and D of such title.
            (6) State.--The term ``State'' has the meaning given that 
        term for purposes of the Medicaid program.

SEC. 3. PILOT PROGRAM WAIVING THE MEDICARE 190-DAY LIFETIME LIMIT ON 
              INPATIENT PSYCHIATRIC HOSPITAL SERVICES TO EXPAND ACCESS 
              TO INPATIENT PSYCHIATRIC SERVICES UNDER THE MEDICARE 
              PROGRAM.

    (a) Demonstration Program Authorized.--The Secretary shall 
establish a pilot program (in this section referred to as the ``pilot 
program'') to test the impact of eliminating the Medicare 190-day 
lifetime limit on--
            (1) promoting value;
            (2) expanding choice; and
            (3) aligning inpatient mental health benefits with the 
        inpatient physical health care benefits under the Medicare 
        program.
    (b) Definitions.--In this section:
            (1) Applicable beneficiary.--The term ``applicable 
        beneficiary'' means an individual who--
                    (A) is entitled to, or enrolled for, benefits under 
                part A, and enrolled for benefits under part B, of the 
                Medicare program;
                    (B) is admitted to a qualifying institution 
                participating in the demonstration project; and
                    (C) but for the pilot program established under 
                this section, would otherwise receive benefits for 
                inpatient psychiatric services under the Medicare 
                program if the services were provided in a general 
                acute care hospital.
            (2) Inpatient psychiatric hospital services.--The term 
        ``inpatient psychiatric hospital services'' has the meaning 
        given such term in section 1861(c) of the Social Security Act 
        (42 U.S.C. 1395x(c)).
            (3) Medicare 190-day lifetime limit.--The term ``Medicare 
        190-day lifetime limit'' means the 190-day lifetime limitation 
        imposed on inpatient psychiatric hospital services under 
        section 1812(b)(3) of the Social Security Act (42 U.S.C. 
        1395d(b)(3)).
    (c) Program Details.--
            (1) Duration and starting date.--
                    (A) Starting date.--The pilot program shall begin 
                no later than January 1, 2018.
                    (B) Duration.--Subject to subparagraph (C), the 
                pilot program shall be conducted for a period of 7 
                years.
                    (C) Expansion.--The Secretary may, at any time 
                after the pilot program has operated for a period of at 
                least 3 years expand the duration and scope of the 
                pilot program, to the extent determined appropriate by 
                the Secretary, if--
                            (i) the Secretary determines that such 
                        expansion is expected--
                                    (I) to reduce (or not to result in 
                                any increase in) net expenditures under 
                                the Medicare program without reducing 
                                the quality of care; or
                                    (II) to improve the quality of care 
                                without increasing such net 
                                expenditures;
                            (ii) the Chief Actuary of the Centers for 
                        Medicare & Medicaid Services certifies that 
                        such expansion would reduce spending under the 
                        Medicare program; and
                            (iii) the Secretary determines that such 
                        expansion would not deny or limit the coverage 
                        or provision of benefits under the Medicare 
                        program for applicable beneficiaries.
            (2) Waiver of medicare 190-day lifetime limit.--The 
        Medicare 190-day lifetime limit shall not apply to applicable 
        beneficiaries receiving inpatient psychiatric services at a 
        participating institution under the pilot program.
            (3) Participating providers of services and suppliers.--
                    (A) In general.--Only institutions participating in 
                the demonstration project may submit an application to 
                the Secretary to provide inpatient psychiatric services 
                under the pilot program.
                    (B) Requirements.--The Secretary may develop 
                additional requirements for institutions to participate 
                in the pilot program. Such requirements may include the 
                collection and reporting of data related to the 
                reasonable costs of graduate medical education.
            (4) Quality measures.--
                    (A) In general.--The Secretary shall establish 
                quality measures related to care provided by qualifying 
                institutions participating in the pilot program, which 
                measures shall include at least measures of the 
                following:
                            (i) Reducing rates of avoidable hospital 
                        readmissions.
                            (ii) Rates of discharge to the community.
                            (iii) Rates of admission to an emergency 
                        room after a hospitalization.
                            (iv) Other measures, including measures of 
                        patient outcomes, determined appropriate by the 
                        Secretary.
                    (B) Reporting on quality measures.--A qualifying 
                institution shall submit (in a form and manner 
                specified by the Secretary) data to the Secretary on 
                quality measures established under subparagraph (A) 
                during each year in which the institution is 
                participating in the pilot program.
    (d) Waiver.--The Secretary shall waive such provisions of titles XI 
and XVIII of the Social Security Act as may be necessary to carry out 
the pilot program.
    (e) Independent Evaluation and Reports on Pilot Program.--
            (1) Independent evaluation.--The Secretary shall conduct an 
        independent evaluation of the pilot program, including the 
        extent to which the pilot program has--
                    (A) improved quality measures established under 
                subsection (c)(4)(A);
                    (B) improved health outcomes;
                    (C) improved patient satisfaction; and
                    (D) reduced spending under the Medicare program.
            (2) Report.--Not later than December 31, 2024, the 
        Secretary shall submit to Congress a report on the evaluation 
        conducted under paragraph (1).
            (3) Coordination with expanding choice for medicaid 
        inpatient psychiatric hospital services demonstration 
        project.--The Secretary may combine the independent evaluation 
        and reports required under this section and the reports 
        required under the demonstration project under section 2(f).
    (f) Budget Neutrality.--With respect to the period of the pilot 
program under subsection (c)(1) occurring before any expansion under 
subparagraph (C) of such subsection, the Secretary shall ensures that 
program does not result in a net increase in the aggregate expenditures 
under the Medicare program for such period above the level of such 
expenditures if the pilot program had not been implemented. The 
Secretary may make such adjustments to payments under the Medicare 
program as is necessary to carry out the previous sentence.
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