[Congressional Record Volume 161, Number 168 (Monday, November 16, 2015)]
[House]
[Pages H8176-H8180]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           IMPROVING ACCESS TO EMERGENCY PSYCHIATRIC CARE ACT

  Mr. PITTS. Mr. Speaker, I move to suspend the rules and pass the bill 
(S. 599) to extend and expand the Medicaid emergency psychiatric 
demonstration project, as amended.
  The Clerk read the title of the bill.
  The text of the bill is 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''.

[[Page H8177]]

  


     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.--Of the unobligated balances of amounts 
     available in the Centers for Medicare & Medicaid Services 
     Program Management account, $100,000 shall be available to 
     carry out this subsection and shall 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.


[[Page H8178]]


  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Pennsylvania (Mr. Pitts) and the gentleman from Texas (Mr. Gene Green) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Pennsylvania.


                             General Leave

  Mr. PITTS. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials into the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Pennsylvania?
  There was no objection.
  Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the bill before us today extends and expands the 
Medicaid emergency psychiatric demonstration project.
  A longstanding policy under Medicaid, called the institutions for 
mental diseases, IMD, exclusion, prohibits the Federal Government from 
providing Federal Medicaid matching funds to States for services 
rendered to Medicaid-eligible individuals aged 21 to 64 who are 
patients in IMDs. IMDs are inpatient facilities with more than 16 beds 
that primarily treat people with mental health and substance abuse 
disorders. The original IMD exclusion is consistent with the goal of 
treating severe mental illness in the least restrictive setting 
feasible.
  The IMD exclusion provided an incentive to shift the cost of care for 
mental illness to other care modalities and facilities where Medicaid 
matching funds were available. However, since the IMD exclusion was 
included with the creation of the Medicaid program in 1965, our mental 
healthcare system and overall healthcare system have evolved notably.
  In recent years, we have seen a significant decrease in the number of 
publicly funded inpatient psychiatric beds available for emergency 
services. This has contributed to patients in need of critical mental 
health services facing psychiatric boarding in general hospital 
emergency departments.
  Psychiatric boarding occurs when an individual with a mental health 
condition is kept in a hospital emergency department for several hours 
or admitted to medical wards or skilled nursing facilities without 
psychiatric expertise because appropriate mental health services were 
unavailable. This leads to potential serious consequences for 
psychiatric patients and unnecessary hospital costs.
  The Patient Protection and Affordable Care Act authorized a 3-year 
demonstration program to study the effects of allowing Federal Medicaid 
matching funds to pay for emergency psychiatric treatment for adults 
that is otherwise prohibited by the Medicaid IMD exclusion. The 
demonstration was funded with $75 million in FY 2011, and these funds 
were available for obligation through December 31, 2015.
  The HHS Secretary selected 11 States and the District of Columbia to 
participate in the demonstration program in March of 2012, and the 
demonstration program began July 1, 2012. Due to significant State 
interest, patient need, and other factors, the demonstration project 
exhausted its Federal funding in April and was forced to terminate 
early.
  S. 599 would temporarily extend the Medicaid emergency psychiatric 
demonstration for States already participating in the demonstration 
through September 30, 2016, if the chief actuary of CMS certifies that 
this extension would not increase net Medicaid spending.
  The bill also requires that, not later than September 30, 2016, the 
HHS Secretary report to Congress on whether the demonstration should be 
continued after such date and whether the demonstration should be 
expanded to additional States. If the chief actuary of CMS certifies 
that this extension would not increase net Medicaid spending, then the 
demonstration may continue not beyond 2019.
  While I have strong concerns with the President's healthcare law, S. 
599 would let States and CMS continue to test the provision of critical 
mental health services for patients in a manner that is responsible for 
the Federal budget.
  Mr. Speaker, I encourage my colleagues to support this commonsense, 
bipartisan bill.
  I reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I rise in support of S. 599, the Improving Access to 
Emergency Psychiatric Care Act.
  This legislation, sponsored by Senator Ben Cardin and championed in 
the House by Representative John Sarbanes, will extend and expand the 
Medicaid emergency psychiatric demonstration protect. Since the 
creation of Medicaid 50 years ago, the program has excluded payment for 
institutions for mental diseases, IMDs, a designation that includes 
most residential treatment facilities for mental health and substance 
use disorders with more than 16 beds.
  The original IMD exclusion is consistent with the goal of treating 
severe mental illness in the least restrictive setting possible. 
However, there have been some unintended consequences of this 
longstanding policy. States have an incentive to shift the cost of 
treating mental illness to other care settings where Medicaid matching 
funds are available. This contributed to a decrease in the number of 
publicly funded beds available for inpatient psychiatric emergency 
services. It also contributed to a rise in psychiatric boarding and 
recidivism in hospital emergency departments.
  To develop data on whether modifying an IMD exclusion can improve 
health care for mental illness, the Affordable Care Act authorized $75 
million over 3 years for the Medicare emergency psychiatric 
demonstration project. Administered by the CMS Innovation Center, the 
initiative aims to test whether the Medicaid program could provide 
higher quality care at a lower total cost by reimbursing private 
psychiatric hospitals for emergency care otherwise prohibited by the 
Medicaid IMD exclusion. The demonstration project is currently 
operating in 11 States and the District of Columbia.
  This legislation extends the demonstration in a budget-neutral manner 
so that the Secretary of Health and Human Services can complete an 
evaluation and make an informed recommendation regarding its 
continuation and expansion.
  Medicaid plays a central and critical role in covering treatment for 
individuals with mental illness. S. 599 holds promise for improving 
access to quality psychiatric care for this underserved and vulnerable 
population and the overall success of our mental healthcare system.
  I urge my colleagues to support S. 599, and I thank the sponsors for 
their commitment to this important issue.
  I reserve the balance of my time.
  Mr. PITTS. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Indiana (Mrs. Brooks), a prime sponsor of the House companion bill and 
a member of the Energy and Commerce Subcommittee on Health.
  Mrs. BROOKS of Indiana. Mr. Speaker, I rise today to speak in support 
of S. 599, the Improving Access to Emergency Psychiatric Care Act. The 
bill is the companion to H.R. 3681, which I proudly introduced with my 
colleague, Congressman Sarbanes from Maryland.
  With the passage of this bill today, I am pleased that this 
meaningful mental health reform will head to the President's desk. 
Fortunately, this bipartisan, bicameral, and commonsense legislation is 
a great step toward enacting meaningful reforms to an incredibly 
challenging system.
  Currently, CMS does not reimburse private psychiatric institutions or 
institutions for mental diseases for the services provided to Medicaid 
enrollees aged 21 to 64. Yet often serious mental illness manifests 
itself in those in their twenties, and they are not allowed to go with 
a severe psychiatric break to a psychiatric hospital.
  Instead, they go and present at our ERs; and our ERs are already 
overburdened. Many of them often lack the resources and sometimes the 
expertise to deal with people who are suffering from a true mental 
crisis. When they find themselves in the ERs, it is not uncommon for 
them to have to sit for hours and for far too long while they are 
suffering.
  This commonsense legislation extends the existing demonstration grant 
that lifts the IMD exclusion and will allow these important psychiatric 
clinics to receive Medicaid reimbursement

[[Page H8179]]

while giving people access to short-term direct care in psychiatric 
hospitals when they need it most.
  I am proud to support the extension of this legislation that allows 
people to get the treatment that they need. As a lawyer, I have dealt 
with people who have been in a psychiatric crisis. Many of us have 
family members who have dealt with a psychiatric crisis. They need the 
help from the right experts at the right time.
  I thank the gentleman for carrying this in the House, and I urge my 
colleagues to support this legislation.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield such time as he may 
consume to the gentleman from Maryland (Mr. Sarbanes). He is also a 
member of the Energy and Commerce Committee and a member of our Health 
Subcommittee. I personally appreciate his commitment to mental health.
  Mr. SARBANES. Mr. Speaker, I thank the gentleman for yielding and for 
his leadership on the Health Subcommittee and on the Energy and 
Commerce Committee.
  I rise today in strong support of the Improving Access to Emergency 
Psychiatric Care Act. I thank Representative Brooks of Indiana for her 
support of this measure and certainly welcome the fact that this is a 
bipartisan piece of legislation.
  What this bill would do is it would extend a demonstration project, 
as indicated, that ends the Federal prohibition on Medicaid matching 
payments to community psychiatric hospitals for emergency psychiatric 
cases. This demonstration project allows individuals with severe mental 
illness who are a threat to themselves or to others, including those 
with substance abuse disorders who have experienced overdoses, to get 
emergency inpatient treatment.
  The background of this is as follows:
  There has been a longstanding Medicaid provision, dating back to 
1965, called the institutions for mental diseases, IMD, exclusion. 
Under that, the Federal Government is prohibited from providing 
Medicaid matching funds and reimbursement for the care of eligible 
individuals aged 21 to 64 if that care is provided in an inpatient 
facility that primarily treats people with mental health and substance 
abuse disorders and if that facility has more than 16 beds.
  As was indicated, the effect of this exclusion has been to decrease 
the number of inpatient psychiatric beds that are available for 
emergency services. It has also been cited by the Government 
Accountability Office as a factor in emergency department overcrowding, 
which Congresswoman Brooks just indicated.
  Community-based psychiatric hospitals could help relieve these 
backups and provide much-needed emergency psychiatric care, but these 
hospitals cannot receive Federal matching payments for these services.
  In 2010, Congress authorized a 3-year pilot called the Medicaid 
emergency psychiatric demonstration project, which expanded the number 
of emergency inpatient psychiatric beds available in communities by 
allowing Federal Medicaid matching payments to freestanding psychiatric 
hospitals for emergency psychiatric cases.

                              {time}  1730

  Eleven States, including my home State of Maryland, are participating 
in this demonstration, and the preliminary data is very promising. Of 
the total number of Medicaid beneficiaries admitted to these community-
based psychiatric hospitals, fully 84 percent had just one admission 
during the entire first year of the demonstration. The average length 
of stay was only 8.2 days, and in 88 percent of the admissions, the 
beneficiaries were discharged to their homes or to self-care.
  The demonstration project is set to end on December 31, 2015, but the 
final evaluation of the project is not expected to be completed until a 
year later.
  In closing, Mr. Speaker, this bill would build upon the success of 
the current demonstration project, which is providing timely and cost-
effective care. It would also extend the current demonstration project 
by 1 year.
  It would ensure budget neutrality by certifying that the extension is 
not projected to result in an increase in net Medicaid program 
spending, and it would allow the Secretary of HHS to extend the 
demonstration project for an additional 3 years, provided that the 
requirements regarding Medicaid spending are met.
  The bill has already been passed in the Senate by unanimous consent. 
While I am a little bit disappointed that a very small change was made 
that is going to require it to go back to the Senate for 
reconsideration, I am confident that it will be supported there again 
with Senator Cardin's leadership.
  I urge support of this bipartisan effort to extend a demonstration 
project that allows individuals with severe mental illness and 
substance abuse disorders to get emergency inpatient treatment at 
community psychiatric hospitals.
  Mr. PITTS. Mr. Speaker, I am prepared to close. I reserve the balance 
of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield the balance of my time 
to the gentlewoman from California (Ms. Matsui), who is also a member 
of the Committee on Energy and Commerce, a member of the Subcommittee 
on Health, and, again, a champion of mental health.
  Ms. MATSUI. Mr. Speaker, I rise today in support of the Improving 
Access to Emergency Psychiatric Care Act.
  As we work to reform our broken mental healthcare system, it is 
critical that we build upon programs that provide resources to 
underserved and vulnerable populations at all points along the spectrum 
of care.
  Today, with the passage of this bill, we have the opportunity to 
extend the vital Medicaid emergency psychiatric demonstration project. 
This demonstration project, which recently expired, ensures greater 
access to essential emergency psychiatric care for Medicaid patients.
  This bipartisan bill will ensure that hospitals across our Nation 
will be able to provide community members in need with inpatient 
psychiatric beds.
  In my home district in Sacramento County, this demonstration project 
has provided great benefits to our system of care. Medi-Cal 
beneficiaries have greater access to mental health services, and there 
has been a reduction in readmission rates at local hospitals.
  In fact, by the final year of the 3-year demonstration project, the 
number of individuals rehospitalized within 30 days of their initial 
stay decreased by 20 percent in Sacramento County.
  The project has improved coordination of care for mental health 
patients by streamlining planning efforts between inpatient and 
outpatient providers. In addition, Sacramento County has been able to 
reinvest savings generated by the project into programs that build 
greater community alternatives for patients identified as high 
utilizers of inpatient and emergency departments.
  All of these improvements add up to a community mental health system 
in California that is better able to focus on the whole spectrum of 
care for underserved patients, from prevention to treatment to the 
crisis stage.
  There is still much more work to do to improve the mental health 
system, but we must not reverse our significant progress by failing to 
renew this demonstration project.
  I urge my colleagues to vote ``yes'' on S. 599, the Improving Access 
to Emergency Psychiatric Care Act.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield back the balance of my 
time.
  Mr. PITTS. Mr. Speaker, I encourage my colleagues to support this 
commonsense, bipartisan bill.
  I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I rise today in support of extending and 
expanding the Improving Access to Emergency Psychiatric Care Act, which 
has already passed the Senate and for which identical legislation, H.R. 
3681 has been introduced in the House with bipartisan support.
  This legislation would extend, and expand if appropriate, the 
Medicaid Emergency Psychiatric Demonstration that was created by the 
Affordable Care Act.
  While I will not oppose this legislation based on process, I must 
mention that I am not pleased that this legislation did not go through 
regular order here in the House as it should have, and as it did in the 
Senate. I also do not support a change made to require the $100,000 in 
administrative costs in the bill to come out of unobligated funds at 
CMS. To delay this legislation, slow it down even further and force the 
Senate to reconsider the bill for a one word change and an amount of 
money

[[Page H8180]]

that is less than the annual salary of any Member of Congress is a 
waste of time. However, despite these reservations, I support this 
legislation moving forward.
  Since the enactment of Medicaid in 1965, so-called ``Institutions of 
Mental Disease'', or IMDs, have been prohibited by statute from 
receiving federal Medicaid matching funds for inpatient treatment 
provided to adults ages 21 to 64. This prohibition was rooted in the 
desirability of community-based care as an alternative to mass 
institutionalization of the mentally ill, often in horrific conditions.
  However, as our healthcare system has grown and changed, there has 
been increasing concern about the perverse incentives created by the 
wholesale exclusion of IMDs from treatment for Medicaid beneficiaries; 
for instance, frequent boarding of psychiatric patients in emergency 
rooms and non-psychiatric beds of general hospitals has been reported 
to occur when specialized inpatient psychiatric beds are not available.
  The days of mass institutionalization are over and we can never go 
back to those days--at the same time, so-called ``boarding'' of the 
seriously mentally ill in general hospitals, because the beds simply 
aren't available, is not an acceptable alternative.
  Those Medicaid beneficiaries that are seriously mentally ill need the 
right treatment, at the right time. The demonstration project that we 
are extending here today allows states to test incorporation of IMD 
services for Medicaid beneficiaries in a way that insures other 
community-based services do not suffer. This legislation, which also 
aligns with CMS's recent proposal to allow for short-term IMD stays in 
Medicaid managed care plans, is the appropriate way to responsibly 
address the Medicaid IMD exclusion.
  We've had immense success with this project thus far, and we can 
still learn more from it, which is exactly why this demonstration 
project must be extended and as appropriate, expanded. This legislation 
will allow the Secretary to do just that, and I urge my colleagues to 
support its swift passage.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Pennsylvania (Mr. Pitts) that the House suspend the 
rules and pass the bill, S. 599, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________