[Congressional Record Volume 161, Number 140 (Monday, September 28, 2015)]
[Senate]
[Pages S6979-S6980]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           IMPROVING ACCESS TO EMERGENCY PSYCHIATRIC CARE ACT

  Mr. DAINES. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 180, S. 599.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 599) to extend and expand the Medicaid emergency 
     psychiatric demonstration project.

  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Finance, with an 
amendment to strike all after the enacting clause and insert in lieu 
thereof the following:

     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).

[[Page S6980]]

       ``(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.

  Mr. DAINES. Mr. President, I ask unanimous consent that the 
committee-reported substitute be agreed to; the bill, as amended, be 
read a third time and passed, and the motion to reconsider be 
considered made and laid upon the table with no intervening action or 
debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee amendment in the nature of a substitute was agreed to.
  The bill (S. 599), as amended, was ordered to be engrossed for a 
third reading, was read the third time, and passed.

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