[Congressional Record Volume 165, Number 102 (Tuesday, June 18, 2019)]
[House]
[Pages H4706-H4710]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     EMPOWERING BENEFICIARIES, ENSURING ACCESS, AND STRENGTHENING 
                       ACCOUNTABILITY ACT OF 2019

  Mrs. DINGELL. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3253) to provide for certain extensions with respect to the 
Medicaid program under title XIX of the Social Security Act, and for 
other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3253

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Empowering 
     Beneficiaries, Ensuring Access, and Strengthening 
     Accountability Act of 2019''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; Table of contents.
Sec. 2. Extension of Money Follows the Person Rebalancing 
              Demonstration.
Sec. 3. Clarifying authority of State Medicaid fraud and abuse control 
              units to investigate and prosecute cases of Medicaid 
              patient abuse and neglect in any setting.
Sec. 4. Extension of protection for Medicaid recipients of home and 
              community-based services against spousal impoverishment.
Sec. 5. Extension of the Community Mental Health Services Demonstration 
              Program.
Sec. 6. Preventing inappropriately low rebates under Medicaid drug 
              rebate program.
Sec. 7. Medicaid Improvement Fund.
Sec. 8. Determination of budgetary effects.

     SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 
                   DEMONSTRATION.

       (a) In General.--
       (1) Funding.--Section 6071(h) of the Deficit Reduction Act 
     of 2005 (42 U.S.C. 1396a note) is amended--
       (A) in paragraph (1)--
       (i) in subparagraph (E), by striking ``and'' at the end;
       (ii) in subparagraph (F)--

       (I) by striking ``subject to paragraph (3), 132,000,000'' 
     and inserting ``$132,000,000''; and
       (II) by striking the period at the end and inserting a 
     semicolon; and

       (iii) by adding at the end the following new subparagraphs:
       ``(G) $417,000,000 for fiscal year 2020;
       ``(H) $450,000,000 for each of fiscal years 2021 through 
     2023; and
       ``(I) $225,000,000 for fiscal year 2024.'';
       (B) in paragraph (2)--
       (i) by striking ``Subject to paragraph (3), amounts'' and 
     inserting ``Amounts''; and
       (ii) by striking ``2021'' and inserting ``2024''; and
       (C) by striking paragraph (3).
       (2) Research and evaluation.--Section 6071(g) of the 
     Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
     amended--
       (A) in paragraph (2), by striking ``2016'' and inserting 
     ``2024''; and
       (B) in paragraph (3), by inserting ``and for each of fiscal 
     years 2019 through 2024,'' after ``2016,''.
       (b) Changes to Institutional Residency Period 
     Requirement.--
       (1) In general.--Section 6071(b)(2) of the Deficit 
     Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
       (A) in subparagraph (A)(i), by striking ``90'' and 
     inserting ``60''; and
       (B) by striking the flush sentence after subparagraph (B).
       (2) Effective date.--The amendments made by paragraph (1) 
     shall take effect on the date that is 30 days after the date 
     of the enactment of this Act.
       (c) Updates to State Application Requirements.--Section 
     6071(c) of the Deficit Reduction Act of 2005 (42 U.S.C. 1396a 
     note) is amended--
       (1) in paragraph (3), by striking ``, which shall include'' 
     and all that follows through ``2007'';
       (2) in paragraph (7)--
       (A) in the paragraph heading, by striking ``Rebalancing'' 
     and inserting ``Expenditures'';
       (B) in subparagraph (A), by adding ``and'' at the end; and
       (C) in subparagraph (B)--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii), by striking the period at the end and 
     inserting a semicolon; and
       (iii) by adding at the end the following:
       ``(iii) include a work plan that describes for each Federal 
     fiscal year that occurs during the proposed MFP demonstration 
     project--
       ``(I) the use of grant funds for each proposed initiative 
     that is designed to accomplish the objective described in 
     subsection (a)(1), including a funding source for each 
     activity that is part of each such proposed initiative;
       ``(II) an evaluation plan that identifies expected results 
     for each such proposed initiative; and
       ``(III) a sustainability plan for components of such 
     proposed initiatives that are intended to improve 
     transitions, which shall be updated with actual expenditure 
     information for each Federal fiscal year that occurs during 
     the MFP demonstration project; and
       ``(iv) contain assurances that grant funds used to 
     accomplish the objective described in subsection (a)(1) shall 
     be obligated not later than 24 months after the date on which 
     the funds are awarded and shall be expended not later than 60 
     months after the date on which the funds are awarded (unless 
     the Secretary approves a waiver of either such 
     requirement).''; and
       (3) in paragraph (13)--
       (A) in subparagraph (A), by striking ``; and'' and 
     inserting ``, and in such manner as will meet the reporting 
     requirements set forth for the Transformed Medicaid 
     Statistical Management Information System (T-MSIS);'';
       (B) by redesignating subparagraph (B) as subparagraph (D); 
     and
       (C) by inserting after subparagraph (A) the following:
       ``(B) the State shall report on a quarterly basis on the 
     use of grant funds by distinct activity, as described in the 
     approved work plan, and by specific population as targeted by 
     the State;
       ``(C) if the State fails to report the information required 
     under subparagraph (B), fails to report such information on a 
     quarterly basis, or fails to make progress under the approved 
     work plan, the State shall implement a corrective action plan 
     and any lack of progress under the approved work plan may 
     result in withholding of grant funds made available to the 
     State; and''.
       (d) Funding for Quality Assurance and Improvement; 
     Technical Assistance; Oversight.--Section 6071(f) of the 
     Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
     amended by striking paragraph (2) and inserting the 
     following:
       ``(2) Funding.--From the amounts appropriated under 
     subsection (h)(1) for each of fiscal years 2019 through 2024, 
     $1,000,000 shall be available to the Secretary for each such 
     fiscal year to carry out this subsection.''.
       (e) Best Practices Evaluation.--Section 6071 of the Deficit 
     Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by 
     adding at the end the following:
       ``(i) Best Practices.--
       ``(1) Report.--The Secretary, directly or through grant or 
     contract, shall submit a report to the President and Congress 
     not later than September 30, 2020, that contains findings and 
     conclusions on best practices from the State MFP 
     demonstration projects carried out with grants made under 
     this section. The report shall include information and 
     analyses with respect to the following:
       ``(A) The most effective State strategies for transitioning 
     beneficiaries from institutional to qualified community 
     settings carried out under the State MFP demonstration 
     projects and how such strategies may vary

[[Page H4707]]

     for different types of beneficiaries, such as beneficiaries 
     who are aged, physically disabled, intellectually or 
     developmentally disabled, or individuals with serious mental 
     illnesses, and other targeted waiver beneficiary populations.
       ``(B) The most common and the most effective State uses of 
     grant funds carried out under the State MFP demonstration 
     projects for transitioning beneficiaries from institutional 
     to qualified community settings and improving health 
     outcomes, including differentiating funding for current 
     initiatives that are designed for such purpose and funding 
     for proposed initiatives that are designed for such purpose.
       ``(C) The most effective State approaches carried out under 
     State MFP demonstration projects for improving person-
     centered care and planning.
       ``(D) Identification of program, financing, and other 
     flexibilities available under the State MFP demonstration 
     projects, that are not available under the traditional 
     Medicaid program, and which directly contributed to 
     successful transitions and improved health outcomes under the 
     State MFP demonstration projects.
       ``(E) State strategies and financing mechanisms for 
     effective coordination of housing financed or supported under 
     State MFP demonstration projects with local housing 
     authorities and other resources.
       ``(F) Effective State approaches for delivering Money 
     Follows the Person transition services through managed care 
     entities.
       ``(G) Other best practices and effective transition 
     strategies demonstrated by States with approved MFP 
     demonstration projects, as determined by the Secretary.
       ``(H) Identification and analyses of opportunities and 
     challenges to integrating effective Money Follows the Person 
     practices and State strategies into the traditional Medicaid 
     program.
       ``(2) Collaboration.--In preparing the report required 
     under this subsection, the Secretary shall collect and 
     incorporate information from States with approved MFP 
     demonstration projects and beneficiaries participating in 
     such projects, and providers participating in such projects.
       ``(3) Funding.--From the amounts appropriated under 
     subsection (h)(1) for each of fiscal years 2020 and 2021, not 
     more than $300,000 shall be available to the Secretary for 
     each such fiscal year to carry out this subsection.''.
       (f) MACPAC Report on Qualified Settings Criteria.--Section 
     6071 of the Deficit Reduction Act of 2005 (42 U.S.C. 1396a 
     note), as amended by subsection (e), is further amended by 
     adding at the end the following:
       ``(j) MACPAC Report.--Prior to the final implementation 
     date established by the Secretary for the criteria 
     established for home and community-based settings in section 
     441.301(c)(4) of title 42, Code of Federal Regulations, as 
     part of final implementation of the Home and Community Based 
     Services (HCBS) Final Rule published on January 16, 2014 (79 
     Fed. Reg. 2947) (referred to in this subsection as the `HCBS 
     final rule'), the Medicaid and CHIP Payment and Access 
     Commission (MACPAC) shall submit to Congress a report that--
       ``(1) identifies the types of home and community-based 
     settings and associated services that are available to 
     eligible individuals in both the MFP demonstration program 
     and sites in compliance with the HCBS final rule; and
       ``(2) if determined appropriate by the Commission, 
     recommends policies to align the criteria for a qualified 
     residence under subsection (b)(6) (as in effect on October 1, 
     2017) with the criteria in the HCBS final rule.''.
       (g) Application to Current Projects.--Not later than 1 year 
     after the date of the enactment of this Act, any State with 
     an approved MFP demonstration project under section 6071 of 
     the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) on 
     the date of the enactment of this Act shall submit a revised 
     application to the Secretary that contains the same 
     information and assurances as are required for any new State 
     applicant under the amendments made by this section.

     SEC. 3. CLARIFYING AUTHORITY OF STATE MEDICAID FRAUD AND 
                   ABUSE CONTROL UNITS TO INVESTIGATE AND 
                   PROSECUTE CASES OF MEDICAID PATIENT ABUSE AND 
                   NEGLECT IN ANY SETTING.

       (a) In General.--Section 1903(q)(4)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1396b(q)(4)(A)(ii)) is amended by 
     inserting after ``patients residing in board and care 
     facilities'' the following: ``and of patients (who are 
     receiving medical assistance under the State plan under this 
     title) in a noninstitutional or other setting''.
       (b) Availability of Funding.--Section 1903(a)(6) of the 
     Social Security Act (42 U.S.C. 1396b(a)(6)) is amended, in 
     the matter following subparagraph (B), by striking ``(as 
     found necessary by the Secretary for the elimination of fraud 
     in the provision and administration of medical assistance 
     provided under the State plan)''.

     SEC. 4. EXTENSION OF PROTECTION FOR MEDICAID RECIPIENTS OF 
                   HOME AND COMMUNITY-BASED SERVICES AGAINST 
                   SPOUSAL IMPOVERISHMENT.

       (a) In General.--Section 2404 of Public Law 111-148 (42 
     U.S.C. 1396r-5 note) is amended by striking ``September 30, 
     2019'' and inserting ``March 31, 2024''.
       (b) Rule of Construction.--Nothing in section 2404 of 
     Public Law 111-148 (42 U.S.C. 1396r-5 note), section 1924 of 
     the Social Security Act (42 U.S.C. 1396r-5), or section 
     1902(a)(17) of such Act (42 U.S.C. 1396a(a)(17)) shall be 
     construed as prohibiting a State from applying an income or 
     resource disregard authorized under section 1902(r)(2) of 
     such Act (42 U.S.C. 1396a(r)(2))--
       (1) to the income or resources of individuals described in 
     section 1902(a)(10)(A)(ii)(VI) of such Act (42 U.S.C. 
     1396a(a)(10)(A)(ii)(VI)) (including a disregard of the income 
     or resources of such individual's spouse); or
       (2) on the basis of an individual's need for home and 
     community-based services authorized under subsection (c), 
     (d), (i), or (k) of section 1915 of such Act (42 U.S.C. 
     1396n) or under section 1115 of such Act (42 U.S.C. 1315).

     SEC. 5. EXTENSION OF THE COMMUNITY MENTAL HEALTH SERVICES 
                   DEMONSTRATION PROGRAM.

       Section 223(d) of the Protecting Access to Medicare Act of 
     2014 (42 U.S.C. 1396a note) is amended--
       (1) in paragraph (3), by striking ``June 30, 2019'' and 
     inserting ``December 31, 2021''; and
       (2) in paragraph (7)(B), by striking ``December 31, 2021'' 
     and inserting ``June 30, 2021''.

     SEC. 6. PREVENTING INAPPROPRIATELY LOW REBATES UNDER MEDICAID 
                   DRUG REBATE PROGRAM.

       (a) Prohibiting Manufacturers From Blending Average 
     Manufacturer Price of Brand Drug and Any Authorized Generic 
     of Such Drug.--Section 1927(k)(1)(C) of the Social Security 
     Act (42 U.S.C. 1396r-8(k)(1)(C)) is amended--
       (1) in the subparagraph heading, by striking ``Inclusion'' 
     and inserting ``Exclusion'';
       (2) by striking ``a new drug application'' and inserting 
     ``the manufacturer's new drug application''; and
       (3) by striking ``inclusive'' and inserting ``exclusive''.
       (b) Eliminating Manufacturers From Definition of 
     Wholesaler.--Section 1927(k)(11) of the Social Security Act 
     (42 U.S.C. 1396r-8(k)(11)) is amended--
       (1) by striking ``manufacturers,''; and
       (2) by striking ``manufacturer's and''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to covered outpatient drugs 
     dispensed on or after January 1, 2020.

     SEC. 7. MEDICAID IMPROVEMENT FUND.

       Section 1941(b)(1) of the Social Security Act (42 U.S.C. 
     1396w-1(b)(1)) is amended by striking ``$6,000,000'' and 
     inserting ``$45,500,000''.

     SEC. 8. DETERMINATION OF BUDGETARY EFFECTS.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of the House Budget Committee, provided that such 
     statement has been submitted prior to the vote on passage.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Michigan (Mrs. Dingell) and the gentleman from Kentucky (Mr. Guthrie) 
each will control 20 minutes.
  The Chair recognizes the gentlewoman from Michigan.


                             General Leave

  Mrs. DINGELL. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on H.R. 3253.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Michigan?
  There was no objection.
  Mrs. DINGELL. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 3253, the Empowering 
Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 
2019.
  This Saturday, June 22, marks the 20th anniversary of the landmark 
Supreme Court decision in Olmstead, which held that people with 
disabilities must receive services in the most community-integrated 
setting possible. It is fitting that, today, the House of 
Representatives will pass legislation that helps advance the promise of 
Olmstead by ensuring that there are programs in place to help people 
transition to and live in the community with their families and 
friends, while keeping them safe from abuse and neglect.
  It also ensures people will continue to be able to receive mental 
health and substance use disorder treatment when they need it the most, 
and, finally, it makes commonsense improvements to ensure that drug 
companies pay their fair share in rebates to the Medicaid program.
  I am proud to say that this bill provides much-needed funding to 
support the highly successful Money Follows the Person program, while 
making important program improvements that will help the program better 
serve the people it is intended to help.

[[Page H4708]]

  Money Follows the Person helps ensure that seniors and people with 
disabilities are able to live in their homes and in their communities. 
It provides States with vital funding and supports to ensure that they 
continue to help people move out of institutions.
  Earlier this year, I held a roundtable discussion in my district with 
patients, providers, and advocates to talk about the challenges we face 
in providing long-term care in this country. Every participant 
supported reauthorizing Money Follows the Person because it makes it 
easier for people to get care in the setting of their choice. By 
passing this bill today, we are giving hope to those who need it.
  I want to thank my friend and colleague, Representative Guthrie, for 
his commitment to this program and his leadership on this issue. It has 
been an honor to work with him on it.
  Next, this legislation ensures that partners of people receiving home 
and community-based services will have the resources they need to meet 
their living expenses. Without this important protection, married 
beneficiaries would face the awful choice between impoverishing the 
spouse or entering an institution. I am proud that we will be able to 
further extend this protection.
  I also want to thank my friend on the other side of the aisle, my 
fellow Michigander, Fred Upton, for his continued leadership and 
support on this issue.
  H.R. 3253 also ensures that people receiving home and community-based 
services receive the same protections from abuse and neglect as people 
in nursing facilities. By allowing Medicaid Fraud Control Units to 
investigate home and community-based services providers as well as 
nursing facilities, this bill extends an important protection to some 
of our most vulnerable populations.
  This bipartisan bill would not have been possible without the 
leadership of Representatives Welch and Walberg, and I want to thank 
them for their hard work to protect Medicaid beneficiaries from abuse.
  This bill also extends the promising Excellence in Mental Health 
demonstration for an additional 2 years. As we continue to struggle 
through the opioid epidemic, this program ensures that people with 
substance use disorder and mental health issues can receive critical 
treatment when they need it the most. The early results of the 
demonstration have been promising, and this extension will allow States 
to build on that success.
  I want to thank Representatives Matsui and Mullin for their ongoing 
support of this program.
  Finally, this legislation adopts a commonsense proposal to ensure 
drug companies pay their fair share in Medicaid rebates. It will help 
provide additional funds to State Medicaid programs that are struggling 
to pay for increasingly expensive prescription drugs.
  I want to thank Representatives Kennedy and Jason Smith for their 
leadership on this issue.
  I urge my colleagues to support the passage of H.R. 3253, and I 
reserve the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 3253, the Empowering 
Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 
2019.
  This legislation will extend the Money Follows the Person program 
through 2024. This important program provides resources to State 
Medicaid programs to help individuals with chronic conditions and 
disabilities transition from institutions back into local communities 
if they choose to do so.
  Money Follows the Person offers a choice for individuals who often 
have very limited options. This program allows the person to choose 
where they would like to receive their care.
  This legislation will also extend the Spousal Impoverishment program 
through 2024.
  H.R. 3253 will also extend the Excellence in Mental Health 
demonstration for 2 years. The Excellence Act is designed to increase 
Americans' access to community health in substance use treatment 
services.
  In addition, this bill will clarify the authority of State Medicaid 
fraud and abuse control units. This clarification will give these 
important units the authority to investigate and prosecute abuse and 
neglect of Medicaid beneficiaries in noninstitutional settings, as well 
as broaden the permissible use of Federal Medicaid fraud and abuse 
control units to screen complaints or reports alleging potential abuse 
or neglect of Medicaid beneficiaries.

  I have enjoyed working with my colleague from Michigan, my friend, 
Mrs. Dingell, and the hard work that she has put into this program, 
both this Congress and the previous Congress, to move this forward.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. DINGELL. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Matsui).
  Ms. MATSUI. Mr. Speaker, I rise in support of the Empowering 
Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 
2019 and its provisions extending critical access to mental health and 
addiction treatment.
  Let's be clear: One in five Americans live with a mental illness. 
Nearly all of us have a friend, a family member, or neighbor who has 
been diagnosed. Mental illness touches all our lives in some way.
  When we passed the Excellence in Mental Health Act in 2014, we made 
an investment in behavioral health that expanded access to necessary 
treatment. Eight States established community-based clinics providing 
24-hour crisis care, better coordinating physical, mental, and 
substance abuse treatment. This provided much-needed support to 
patients and their families.
  In combating opioid addiction, Certified Community Behavioral Health 
Centers are already making a difference. In the first year of 
implementation, these clinics served nearly 400,000 patients with 
serious mental health and addiction disorders, providing 80,000 
individuals with lifesaving treatment for the first time.
  Headline after headline tells us we need to preserve and, 
importantly, expand access to programs like this. While the bill before 
us will extend funding to programs in eight existing States for the 
next 2\1/2\ years, our work here is far from done.
  People are struggling with the stigma of mental illness and substance 
use disorder across the country. Every American should have access to 
the same top-notch care as patients in the pilot programs. That is why 
I will continue to be a fierce advocate for expansion of the Certified 
Community Behavioral Health Centers program. I look forward to continue 
working with my colleagues so that we can create new opportunities to 
expand access to mental healthcare and conquer the addiction crisis 
that has harmed far too many families.
  Mr. GUTHRIE. Mr. Speaker, I yield 3 minutes to the gentleman from 
Michigan (Mr. Walberg).
  Mr. WALBERG. Mr. Speaker, I rise today in support of H.R. 3253, which 
takes several important steps to strengthen the Medicaid program; and I 
thank my friends and colleagues, Representatives Dingell and Guthrie, 
for this legislation.
  I am especially pleased that the bill includes a piece of bipartisan 
legislation I authored, along with my colleague from Vermont, 
Congressman Welch.
  Our legislation broadens the authority of Medicaid Fraud Control 
Units to better protect the most vulnerable and bring bad actors to 
justice.
  Medicaid Fraud Control Units are charged with investigating and 
prosecuting State Medicaid provider fraud and resident abuse complaints 
in Medicaid-funded healthcare facilities. Nationally, these units 
contributed to 2,500 convictions and $1.8 billion in recovered funds in 
2017 alone. They are a vital instrument of justice for protecting 
Medicaid beneficiaries from abuse.
  However, current law prevents these units from investigating cases of 
patient abuse in noninstitutional settings, such as home-based care. It 
doesn't make sense.
  Our committee has heard from States that have had to turn a blind eye 
to cases of abuse simply because the abuse occurred in a 
noninstitutional setting. This arbitrary restriction simply does not 
make sense.
  There has been substantial growth in home and community-based 
services

[[Page H4709]]

since the initial statute was enacted decades ago. It is time that we 
update the law so we are not needlessly tying the hands of those who 
are charged with protecting the most vulnerable. Our legislation will 
empower attorneys general to expand the scope of their States' fraud 
units so they can combat patient abuse wherever it might occur.
  This reform has broad bipartisan support from AGs in red States and 
blue States. It is just common sense, and it will help better serve 
those in need.
  Once again, I thank my colleagues on the great Energy and Commerce 
Committee for their bipartisan collaboration. I encourage passage of 
H.R. 3253.
  Mrs. DINGELL. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Jackson Lee).
  Ms. JACKSON LEE. Mr. Speaker, I rise to enthusiastically support H.R. 
3253 and to particularly congratulate, for their leadership, 
Congresswoman Dingell and Congressman Guthrie and indicate that the 
underlying reason for my enthusiastic support is what I believe every 
Member knows, and that is the frail among us are the most vulnerable. 
Those individuals may be our seniors, as I am dealing with a person who 
is seeking to get outpatient rehabilitation, and they need extra 
support in getting that care.
  In this instance, the extension of 4\1/2\ years to be able to have 
the protection of the legislation that deals with abuse in Medicaid 
home and community-based services is vital because the person receiving 
the services is least able to speak about the abuse.

                              {time}  1500

  I believe the extension will help in determining the level of abuse 
and also remedies for such abuse.
  It is clear that if someone is in Medicaid home-based programs, they 
are as equally in need as those who are in institutionalized programs.
  Mr. Speaker, I congratulate the Congresswoman. I would say that in 
impoverished communities and communities of color, the Medicaid-based 
program is the basis of their healthcare, and they are the most 
vulnerable.
  Mr. Speaker, I support H.R. 3253, the Empowering Beneficiaries, 
Ensuring Access, and Strengthening Accountability Act of 2019, for its 
very vital and important element of extending this review for 4.5 
years.
  We have to get it right. We have to protect these people. We have to 
give them the quality of life that they deserve. ``Abuse'' should not 
be in their vocabulary.
  Mr. Speaker, I support this legislation.
  Mr. GUTHRIE. Mr. Speaker, I yield 3 minutes to the gentleman from 
Oregon (Mr. Walden), the Republican leader of the Energy and Commerce 
Committee and my good friend.
  Mr. WALDEN. Mr. Speaker, I, too, rise today in strong support of this 
bipartisan bill that extends several key Medicaid programs, H.R. 3253, 
the Empowering Beneficiaries, Ensuring Access, and Strengthening 
Accountability Act of 2019.
  Mr. Speaker, this is a bill that strengthens the healthcare safety 
net for our communities and provides long-term certainty for patients.
  Mr. Speaker, I thank my colleague, Chairman Frank Pallone of the 
Energy and Commerce Committee, for his partnership and willingness to 
work in good faith on both sides of the aisle to get this done.
  We passed a short-term extension of these programs back in March, Mr. 
Speaker, to ensure that patients were still protected as we ironed out 
the details. Today, we are delivering the long-term deal that I know we 
all wanted all along.
  A big priority of mine in this package is the 2-year extension of the 
Excellence in Mental Health demonstration program at CMS. Eight States, 
including my home State of Oregon, are currently participating in this 
pilot program, which is designed to increase access to mental health 
and substance use treatment services.
  Mr. Speaker, I include in the Record a letter from the Oregon AFSCME 
Council 75.

                                     Oregon AFSCME Council 75,

                                                    June 18, 2019.
     Members of the Oregon Delegation,
     House of Representatives,
     Washington, DC.
       Dear Representatives: On behalf of the more than 25,000 
     Oregon AFSCME Council 75 members, we ask you to approve the 
     Empowering Beneficiaries, Ensuring Access, and Strengthening 
     Accountability Act of 2019 (H.R. 3253) when the House of 
     Representatives considers the bill this week.
       We strongly support H.R. 3253 because it extends the 
     Certified Community Behavioral Health Clinics (CCBHC) program 
     through December 2021. On June 30, the CCBHCs in our state, 
     along with those in Minnesota, Missouri, Nevada, New Jersey, 
     New York, Oklahoma, and Pennsylvania, face extreme financial 
     threat. We appreciate that Representative Walden, in his 
     capacity as Ranking Member of the House Energy and Commerce 
     Committee, worked in bipartisan effort to avert the March 30 
     fiscal cliff in Oregon and Oklahoma and is an original co-
     sponsor for H.R. 3253.
       At Cascadia Behavioral Health in Portland Oregon, AFSCME 
     Council 75 members who are therapists, care coordinators, 
     crisis counselors, residential counselors, support staff and 
     other workers, deliver whole health care--integrated mental 
     health and addiction services, primary care and housing--
     through the CCBHC program. These health care workers never 
     stop working to help those who want to get healthy and 
     recover. It is not just a job; it is a calling.
       That core commitment to helping people heal is why 
     Alexandra Birch, a Qualified Mental Health Associate, cares 
     deeply about the CCBHC program. It has helped innovate and 
     improve the delivery of care. She was hired in 2017 as a Care 
     Coordinator at Cascadia because of an investment Congress 
     provided to the CCBHC program. In that role she is the glue 
     that connects primary care with behavioral health care and 
     makes sure care is focused on the whole patient.
       In her work, Ms. Birch treats clients with anxiety and very 
     high blood pressure but who do not have an established 
     doctor; she is able to connect them to a doctor. She cares 
     for clients on certain anti-depressants that experienced 
     weight gain as a result, which put them at higher risk of 
     developing diabetes. Because of the investment Congress 
     provided in establishing CCBHCs, Ms. Birch can direct those 
     clients to inhouse primary care to monitor and prevent 
     diabetes.
       For practitioners like Ms. Birch, Cascadia's capacity to 
     bring primary care into the outpatient behavioral health care 
     clinics is a game-changer. It enhances their delivery of 
     services and outcomes for their clients. From the frontline 
     perspective, the integration of behavioral health and primary 
     care in a CCBHC removes logistical and other obstacles to 
     consultation between providers. These consultations translate 
     into improved identification of the best route of care for a 
     client with complex physical and mental conditions with the 
     result of getting a client on the road to wellness much 
     quicker.
       Cascadia's capacity to sustain and expand this level of 
     high-quality coordinated care to a vulnerable population 
     depends on the dedication and skills of workers like Ms. 
     Birch and congressional action to continue investing in the 
     CCBHC fiscal model that covers 100 percent of costs.
       With the fiscal investment in CCBHCs, Congress allows 
     Cascadia staff to reach into the community to expand access 
     to behavioral health services for individuals with serious 
     mental illnesses. Cascadia works with Portland's 24-hour 
     mental health crisis emergency room, Unity Center Behavioral 
     Health. Cascadia staff establish crisis patients with 
     Cascadia primary care providers immediately after Unity 
     hospital care. This enables patients to continue medications 
     that ensure mental stability until they have fully connected 
     with Cascadia's mental health providers.
       We urge you to pass H.R. 3253 and extend the CCBHC program. 
     It would be tragic to lose this funding that has sustained 
     and expanded vital behavioral and medical services to our 
     community.
           Sincerely,
                                                 Stacy Chamberlin,
                                               Executive Director.

  Mr. WALDEN. Mr. Speaker, this is really important legislation.
  Last year, my legislation, the SUPPORT for Patients and Communities 
Act, our opioids legislation, the most comprehensive bill to address a 
single drug crisis in our Nation's history, was signed into law. Our 
committee has made major strides in addressing the substance use 
disorder crisis that is plaguing our communities.
  The Excellence in Mental Health demonstration continues that good 
work by increasing Medicaid reimbursement for community-based mental 
health and addiction treatment services. This 2-year extension for the 
participating States will give us time for a full evaluation to 
determine the effectiveness of the program and whether it should be 
expanded.
  Also included in this bill is an extension for the Money Follows the 
Person program through fiscal year 2024. This provides resources to 
State Medicaid programs to help individuals with chronic conditions and 
disabilities transition back into their communities.
  We also secured an extension of what is known as the spousal 
impoverishment provisions in Medicaid. To be

[[Page H4710]]

clear, this bill actually helps keep spouses of elderly patients from 
impoverishment and out of costly nursing home settings. For spouses of 
patients receiving home or community-based care, the bill will protect 
them from impractical reductions in their income or resources and 
ensures that they can live out their lives with independence and 
dignity.
  Finally, we clarified the authority of State Medicaid fraud and abuse 
control units that investigate and prosecute abuse and neglect of 
Medicaid beneficiaries. This is simply good government. It is good 
government oversight, and it protects patients who are some of 
America's most vulnerable.
  In closing, Mr. Speaker, I thank my good friends on the Energy and 
Commerce Committee for their work on the bill: Dr. Burgess, Mr. 
Guthrie, Mr. Upton, Mr. Walberg, and their counterparts on the 
Democratic side, Ms. Eshoo, Mrs. Dingell, Ms. Matsui, Mr. Welch, and, 
of course, Chairman Pallone.
  Mrs. DINGELL. Mr. Speaker, I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield myself as much time as I may 
consume.
  Mr. Speaker, in closing, I thank Chairman Pallone, Republican leader 
Walden, and the Energy and Commerce Committee staff for their hard work 
to help this bipartisan package come together.
  Mr. Speaker, I also thank my colleague, Congresswoman Debbie Dingell, 
for working with me on extending Medicaid Follows the Person. I also 
thank my colleagues, Representative Matsui, Representative Eshoo, 
Representative Welch, and Representative Walberg, for their hard work 
on this package.
  Mr. Speaker, I urge my colleagues to support this bill, and I yield 
back the balance of my time.
  Mrs. DINGELL. Mr. Speaker, in closing, I want to echo the words of my 
colleague, Mr. Guthrie, and thank all of those who helped bring this 
bill to the floor today. I give particular thanks to Chairman Pallone 
and Ranking Member Walden for their leadership.
  Mr. Speaker, I urge all Members to support H.R. 3253.
  As a caregiver, I have met so many people in the last few years who 
are desperate and scared and who need us to care. This bill does that. 
I hope the House today will show this country we can act bipartisanly, 
giving hope.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Michigan (Mrs. Dingell) that the House suspend the 
rules and pass the bill, H.R. 3253, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BROOKS of Alabama. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

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