[Congressional Record Volume 164, Number 97 (Tuesday, June 12, 2018)]
[House]
[Pages H5040-H5042]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   MEDICAID INSTITUTES FOR MENTAL DISEASE ARE DECISIVE IN DELIVERING 
INPATIENT TREATMENT FOR INDIVIDUALS BUT OPPORTUNITIES FOR NEEDED ACCESS 
 ARE LIMITED WITHOUT INFORMATION NEEDED ABOUT FACILITY OBLIGATIONS ACT

  Mr. WALDEN. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5800) to require the Medicaid and CHIP Payment and Access 
Commission to conduct an exploratory study and report on requirements 
applicable to and practices of institutions for mental diseases under 
the Medicaid program.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5800

       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 ``Medicaid Institutes for 
     Mental Disease Are Decisive in Delivering Inpatient Treatment 
     for Individuals but Opportunities for Needed Access are 
     Limited without Information Needed about Facility Obligations 
     Act'' or the ``Medicaid IMD ADDITIONAL INFO Act''.

     SEC. 2. MACPAC EXPLORATORY STUDY AND REPORT ON INSTITUTIONS 
                   FOR MENTAL DISEASES REQUIREMENTS AND PRACTICES 
                   UNDER MEDICAID.

       (a) In General.--Not later than January 1, 2020, the 
     Medicaid and CHIP Payment and Access Commission established 
     under section 1900 of the Social Security Act (42 U.S.C. 
     1396) shall conduct an exploratory study, using data from a 
     representative sample of States, and submit to Congress a 
     report on at least the following information, with respect to 
     services furnished to individuals enrolled under State plans 
     under the Medicaid program under title XIX of such Act (42 
     U.S.C. 1396 et seq.) (or waivers of such plans) who are 
     patients in institutions for mental diseases and for which 
     payment is made through fee-for-service or managed care 
     arrangements under such State plans (or waivers):
       (1) A description of such institutions for mental diseases 
     in each such State, including at a minimum--
       (A) the number of such institutions in the State;
       (B) the facility type of such institutions in the State; 
     and
       (C) any coverage limitations under each such State plan (or 
     waiver) on scope, duration, or frequency of such services.
       (2) With respect to each such institution for mental 
     diseases in each such State, a description of--
       (A) such services provided at such institution;
       (B) the process, including any timeframe, used by such 
     institution to clinically assess and reassess such 
     individuals; and
       (C) the discharge process used by such institution, 
     including any care continuum of relevant services or 
     facilities provided or used in such process.
       (3) A description of--
       (A) any Federal waiver that each such State has for such 
     institutions and the Federal statutory authority for such 
     waiver; and
       (B) any other Medicaid funding sources used by each such 
     State for funding such institutions, such as supplemental 
     payments.

[[Page H5041]]

       (4) A summary of State requirements (such as certification, 
     licensure, and accreditation) applied by each such State to 
     such institutions in order for such institutions to receive 
     payment under the State plan (or waiver) and how each such 
     State determines if such requirements have been met.
       (5) A summary of State standards (such as quality 
     standards, clinical standards, and facility standards) that 
     such institutions must meet to receive payment under such 
     State plans (or waivers) and how each such State determines 
     if such standards have been met.
       (6) Recommendations for actions by Congress and the Centers 
     for Medicare & Medicaid Services. such as how State Medicaid 
     programs may improve care and improve standards and including 
     a recommendation for how the Centers for Medicare & Medicaid 
     Services can improve data collection from such programs to 
     address any gaps in information.
       (b) Stakeholder Input.--In carrying out subsection (a), the 
     Medicaid and CHIP Payment and Access Commission shall seek 
     input from State Medicaid directors and stakeholders, 
     including at a minimum the Substance Abuse and Mental Health 
     Services Administration, Centers for Medicare & Medicaid 
     Services, State Medicaid officials, State mental health 
     authorities, Medicaid beneficiary advocates, health care 
     providers, and Medicaid managed care organizations.
       (c) Definitions.--In this section:
       (1) Representative sample of states.--The term 
     ``representative sample of States'' means a non-probability 
     sample in which at least two States are selected based on the 
     knowledge and professional judgment of the selector.
       (2) State.--The term ``State'' means each of the 50 States, 
     the District of Columbia, and any commonwealth or territory 
     of the United States.
       (3) Institution for mental diseases.--The term 
     ``institution for mental diseases'' has the meaning given 
     such term in section 435.1009 of title 42, Code of Federal 
     Regulations, or any successor regulation.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Oregon (Mr. Walden) and the gentleman from New Jersey (Mr. Pallone) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Oregon.


                             General Leave

  Mr. WALDEN. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks and insert 
extraneous materials in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Oregon?
  There was no objection.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this bill, sponsored by my colleagues, Representatives 
Upton, Walters, Blackburn, and myself, requires the Medicaid and CHIP 
Payment and Access Commission, known as MACPAC, to submit to Congress 
by January 1, 2020, a report about the services furnished to Medicaid 
enrollees who are patients in an IMD, that is, an institute of mental 
disease.
  As we know, an IMD is a facility of more than 16 beds that is 
primarily engaged in providing diagnosis, treatment, or care of persons 
with mental diseases, including treatment for individuals with 
substance use disorder.
  Now, since the 1960s, Medicaid's IMD exclusion has limited the 
circumstances under which Federal Medicaid matching funds are available 
for inpatient mental healthcare. This means that Medicaid beneficiaries 
with mental health or substance use disorders are statutorily barred 
from receiving care in an IMD.
  While Medicaid has the IMD exclusion, there is great need for this 
care. According to SAMHSA's 2014 National Survey on Drug Use and 
Health, about 8 million people--8 million, Mr. Speaker--had a mental 
disorder and a substance use disorder, also known as co-occurring 
mental and substance use disorders.
  So where do Medicaid beneficiaries get the inpatient care they need? 
That is the question.
  First, States can provide Medicaid coverage for services rendered in 
facilities that do not meet the definition of an IMD, such as 
facilities with 16 or fewer beds, and facilities that are not primarily 
engaged in providing care to individuals with mental diseases.
  Second, States can get a waiver to allow for IMD services to be 
reimbursed. However, as we all know, waivers take a lot of time, and 
not all States have them.
  So because of these complications, there is a great variation, and, 
frankly, little information on IMD services. That information is 
limited to one GAO report about types of institutional care.
  The goal of this legislation is to better help Congress and CMS 
understand how current Medicaid dollars are being used to provide care 
for patients with substance use disorder and mental health disease in 
an IMD. This bill seeks to identify gaps in our knowledge about IMDs 
and leverage MACPAC's research capabilities to help address these gaps.
  Given the broad bipartisan interest in ensuring patients have access 
to the full continuum of care, we want to ensure Congress and CMS 
understand how Medicaid dollars for services are being used, whether 
that is under a waiver, under managed care, or under fee-for-service 
Medicaid.
  Mr. Speaker, I yield 3 minutes to the gentleman from Michigan (Mr. 
Upton), the former chairman of the full committee, the chairman of the 
Energy Subcommittee, who was very instrumental in this legislation.
  Mr. UPTON. Mr. Speaker, I thank the chairman for the time, and I will 
be short.
  This bill is important. It is bipartisan, and it ensures that 
patients will have access to the full continuum of care.
  It is important to make sure that Congress and CMS understand how 
those dollars for Medicaid are being used. Whether that is under a 
waiver, whether it is under managed care, under fee for service, the 
goal of this legislation is to identify those gaps in our knowledge and 
to leverage MACPAC's research capabilities to address those gaps for 
the betterment of patients not only in Michigan but, obviously, around 
the country.
  So this simply requires that Medicaid and CHIP Payment and Access 
Commission submit to Congress a report on the information about 
services furnished to Medicaid enrollees who are patients in an 
institute of mental disease, IMD, including standards that they must 
follow, including quality standards and recommendations how they can 
include the data collection for IMDs. This is going to be better for 
everybody, which is one of the reasons why it should have no 
opposition.
  I appreciate the leadership of Mike Burgess, the chair of the Health 
Subcommittee, and Chairman Walden, and our friends on the other side of 
the aisle who, again, worked with us to make sure that this could be a 
reality this afternoon.
  I urge all of my colleagues to vote for this bill.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today to speak on H.R. 5800, the Medicaid 
Institutions of Mental Disease ADDITIONAL INFO Act.
  This bill would require the Medicaid and CHIP Payment and Access 
Commission to conduct a comparative study to assess IMD quality in 
States and issue a report on requirements applicable to and practices 
of institutions for mental disease under the Medicaid program.
  We know that nearly half of all States already have or have applied 
for 1,115 waivers that allow for IMD services to be provided to 
patients with substance use disorder. Additional States provide IMD 
services already to patients in Medicaid through their managed care 
programs.
  It is important to understand the overall quality of institutions of 
mental disease that exists throughout the country. This cannot be 
accomplished without data on our current IMDs.
  The study will include information on how many institutions for 
mental disease are within States coverage limitations, services they 
provide, whether States have a waiver to provide such coverage through 
Medicaid, and funding involved with such institutions. Additionally, 
this study will seek recommendations on how State Medicaid programs can 
provide the standards of care provided by IMDs.

  Additional data is obviously a good goal, particularly on IMD 
coverage, given the controversy surrounding this issue, and so I 
support this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WALDEN. Mr. Speaker, I don't believe I have any other speakers on 
this legislation, so I would urge its passage.
  Mr. Speaker, I yield back the balance of my time.

[[Page H5042]]

  

  Mr. PALLONE. Mr. Speaker, I would also urge my colleagues to support 
the bill, and I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Oregon (Mr. Walden) that the House suspend the rules and 
pass the bill, H.R. 5800.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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