[Congressional Record Volume 161, Number 33 (Thursday, February 26, 2015)]
[Senate]
[Pages S1168-S1170]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARDIN (for himself, Mr. Toomey, and Ms. Collins):
  S. 599. A bill to extend and expand the Medicaid emergency 
psychiatric demonstration project; to the Committee on Finance.
  Mr. CARDIN. Mr. President, today Senators Toomey and Collins and I 
are introducing the Improving Access to Emergency Psychiatric Care Act 
of 2015, which will build on the current 3-year Medicaid Emergency 
Psychiatric Demonstration Project to provide timely and cost-effective 
treatment to people who are experiencing an emergency psychiatric 
crisis.
  We know that emergency psychiatric care delivered in general 
hospitals and freestanding psychiatric hospitals is a life-saving 
service for individuals with severe mental illnesses. In addition, a 
Government Accountability Office report, GAO-09-347, on hospital 
emergency departments concluded the difficulties in transferring, 
admitting, or

[[Page S1169]]

discharging psychiatric patients from the emergency department 
contribute to overcrowding in our Nation's emergency rooms.
  Community-based psychiatric hospitals, like Sheppard Pratt Health 
System in my home State of Maryland, could help relieve these back-ups 
in emergency departments; however, due to a longstanding Medicaid 
statutory provision called the Institution for Mental Disease, IMD, 
exclusion, patients receiving care in these freestanding psychiatric 
hospitals are not covered if the patients are between the ages of 21 
and 64, and the hospitals cannot get Medicaid Federal matching payments 
for these services.
  In response to this problem, bipartisan legislation was first 
introduced in the Senate in 2003 by Senators Olympia Snowe and Kent 
Conrad, who were joined by Senators Susan Collins and Ron Wyden, to 
address this problem by allowing Federal Medicaid matching payments to 
freestanding psychiatric hospitals for emergency psychiatric cases. In 
2010, based on this legislation, Congress authorized a three-year 
demonstration that was intended to expand the number of emergency 
inpatient psychiatric beds available in communities. Currently, 11 
States, including my State of Maryland, and the District of Columbia 
are participating in this demonstration.
  The purpose of the demonstration is to determine whether allowing 
Federal Medicaid matching payments to freestanding psychiatric 
hospitals for emergency psychiatric cases improves access to and 
quality of medically necessary care, improves discharge planning for 
demonstration beneficiaries, and has a positive impact on Medicaid cost 
and utilization. The preliminary data shows that, of the total number 
of Medicaid beneficiaries admitted to these freestanding psychiatric 
hospitals, 84 percent had just one admission during the entire first 
year of the demonstration. The average length of stay was a short 8.2 
days and, in 88 percent of the admissions, the patients were discharged 
home.
  The current demonstration project would end no later than December 
31, 2015; however, the final evaluation of this project by CMS is not 
expected to be completed until 1 year later, in the fall of 2016.
  The purpose of the bipartisan legislation we are introducing today is 
to allow the Secretary of Health and Human Services to continue the 
current demonstration project until the Secretary submits a report to 
Congress with her recommendations, based on the final evaluation, 
regarding whether the current demonstration should be extended for an 
additional 3 years and whether additional States should be allowed to 
participate in the demonstration, or September 30, 2016, whichever 
occurs first.
  Importantly, in order to extend the current demonstration project 
until the report is submitted, the Secretary must determine that 
overall Medicaid spending in the participating state is not expected to 
increase during the extension of the demonstration project for a 
maximum of nine months, and the Chief Actuary of CMS must also certify 
that the extension is not projected to result in an increase in net 
Medicaid program spending. If, in her report, the Secretary recommends 
extending the demonstration project for an additional three years and/
or expanding it to include other States, the same requirements 
regarding Medicaid spending would need to be met, ensuring budget 
neutrality. At the completion of those additional 3 years, the 
demonstration project would come to a close unless Congress passes 
authorizing legislation to continue and/or expand the demonstration 
project.
  We have a real crisis in this country for millions of Americans who 
cannot get timely access to life-saving emergency inpatient psychiatric 
treatment. The Medicaid program is a vital source of support for people 
with mental disorders, funding more than 50 percent of state and local 
spending on mental health services. This outdated IMD policy is 
penalizing the disabled and poor. It is also contributing to 
inefficiencies in our health care system and likely adding to the cost 
of care. The legislation introducing today would help ensure that the 
neediest have access to hospital care when they need it and strengthen 
our Nation's health care system. It is an incremental, targeted 
approach with built-in cost safeguards, so I hope my colleagues will 
join with me to support this legislation.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 599

       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

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     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.

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