[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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