[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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