Improving the Quality of Mental and Substance Use Health Care Act of 2009 - Directs the Secretary of Health and Human Services to: (1) establish the Commission for Evidence-Based Mental and Substance Use Health Care; (2) convene an interagency collaborative group to coordinate mental health and substance use services and primary care services; (3) change Medicaid reimbusement rules to cover same-day visits for primary care services and mental health and substance use services; (4) implement a plan for ensuring that Department of Health and Human Services (HHS) activities promote health information technology that is accessible and pertinent to mental health and substance use health care providers and consumers; and (5) establish the Council on the Mental Health and Substance Use Health Care Workforce.
Requires the Director of the National Institutes of Health (NIH) to make grants for a network of national centers of excellence in mental health and substance use health care.
Requires specified federal programs that provide mental health and substance use care to pay for peer support and illness self-management programs and provide for appropriate payment and coverage reforms.
Directs the Secretary to develop uniform methodologies related to payments for mental illnesses and substance use disorders.
Requires the Comptroller General to study the use of publicly-supported mental health and addiction services by individuals with private health insurance coverage.
Directs the Secretary to establish a five-year project to demonstrate the impact of creating delivery and financing structures that deliver high-quality, integrated, mental health and substance use health care.
Amends title XIX (Medicaid) of the Social Security Act to require states to prohibit discrimination against patients being treated for, or health care providers providing treatment for, any medical condition, illness, or injury involving intoxication as a result of alcohol or other substance.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2369 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 2369
To improve mental and substance use health care.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 12, 2009
Mr. Kennedy (for himself and Mrs. Bono Mack) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To improve mental and substance use health care.
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; FINDINGS.
(a) Short Title.--This Act may be cited as the ``Improving the
Quality of Mental and Substance Use Health Care Act of 2009''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents; findings.
Sec. 2. Evidence-based mental and substance use health care.
Sec. 3. Improved coordination of care.
Sec. 4. Information technology for mental health and substance use
health care providers.
Sec. 5. Council on the Mental Health and Substance Use Health Care
Workforce.
Sec. 6. Funding of research through national centers of excellence.
Sec. 7. Patient-centered care.
Sec. 8. Uniform methodologies for reimbursing behavioral health claims.
Sec. 9. Study on use of public mental health and addiction services by
individuals with private health coverage.
Sec. 10. High-quality mental health and substance use health care
Medicaid demonstration project.
Sec. 11. Medicaid requirement for State repeal of laws denying health
benefits coverage based on intoxication.
(c) Findings.--The Congress finds the following:
(1) In its study, ``Improving the Quality of Health Care
for Mental and Substance-Use Conditions'', the Institute of
Medicine found that each year, more than 33,000,000 Americans
use health care services for their mental problems and
illnesses, and for conditions resulting from their use of
alcohol, inappropriate use of prescription medications, or,
less often, illegal drugs. In the United States, mental and
substance use illnesses (which often occur together) are the
leading cause of death and disability for women, the highest
for men ages 15 to 44, and the second highest for all men.
(2) Effective treatments for these medical illnesses exist,
but multiple barriers prevent many from receiving them. The
consequences of these barriers are serious for these
individuals and their families, for their employers and the
workforce, for the Nation's economy, and for the Nation's
education, welfare, and justice systems. The Institute of
Medicine further found that a comprehensive approach is needed
to remedy this issue that addresses the distinguishing
characteristics of mental and substance use health care in the
United States.
(3) The Institute of Medicine recommended a multifaceted
and comprehensive strategy to improve the quality of mental and
substance use health care in the United States and thereby
ensure that--
(A) individual patient preferences, needs, and
values prevail in the face of residual stigma,
discrimination, and coercion into treatment;
(B) the necessary infrastructure exists to produce
scientific evidence more quickly and promote its
application in patient care;
(C) multiple providers' care of the same patient is
coordinated;
(D) emerging information technology related to
health care benefits people with mental or substance
use problems and illnesses;
(E) the health care workforce has the education,
training, and capacity to deliver high-quality care for
mental and substance use conditions; and
(F) government programs, employers, and other group
purchasers of health care for mental and substance use
conditions use their dollars in ways that support the
delivery of high-quality care.
(4) To implement this strategy, the Institute of Medicine
noted that action is needed from many health care leaders,
including the Congress.
SEC. 2. EVIDENCE-BASED MENTAL AND SUBSTANCE USE HEALTH CARE.
(a) Commission for Evidence-Based Mental and Substance Use Health
Care.--
(1) Establishment.--The Secretary of Health and Human
Services (in this Act referred to as the ``Secretary'') shall
establish a Commission for Evidence-Based Mental and Substance
Use Health Care (in this section referred to as the
``Commission'') to strengthen, coordinate, and consolidate the
synthesis and dissemination of evidence on effective mental and
substance use treatments and services.
(2) Duties.--For the purposes described in paragraph (1),
the Commission shall, on an ongoing basis--
(A) identify, describe, and categorize the
available evidence-based preventive, diagnostic, and
therapeutic interventions (including screening,
diagnostic, and symptom-monitoring tools), including
interventions for various age and ethnic groups;
(B) recommend procedure and payment codes and
definitions for such evidence-based interventions and
tools for their use in administrative datasets under
part C of title XI of the Social Security Act and
recommend standards for health data collection relating
to such interventions;
(C) identify on an annual basis priority areas for
research on--
(i) the development of new evidence-based
preventive, diagnostic, and therapeutic
interventions;
(ii) comparative effectiveness and cost
effectiveness of existing interventions and new
evidence-based interventions; and
(iii) how best to translate new evidence-
based findings into practice in community-based
clinical settings;
(D) recommend to the Director of the National
Institute of Mental Health, the Director of the
National Institute on Drug Abuse, the Director of the
National Institute on Alcohol Abuse and Alcoholism, and
other Federal officials methods to coordinate the
conduct or support of research described in
subparagraph (C);
(E) collect, synthesize, and disseminate
information on research concerning evidence-based
strategies for promoting the use of evidence-based
preventive, diagnostic, and therapeutic interventions;
(F) provide guidance on effective mental and
substance use interventions to Federal agencies that
provide or support such interventions, including the
Centers for Medicare & Medicaid Services, the Substance
Abuse and Mental Health Services Administration, the
Agency for Healthcare Research and Quality, the Centers
for Disease Control and Prevention, the Health
Resources and Services Administration, the Department
of Defense, the Department of Veterans Affairs, the
Indian Health Service, and the Bureau of Prisons; and
(G) periodically assess the progress of agencies
described in subparagraph (F) in implementing such
interventions.
(3) Consultation.--In carrying out this section, the
Commission shall--
(A) seek consultation from leading public and
private State and national authorities, and consolidate
evidence, opinions, and findings of these authorities
as they see fit; and
(B) ensure that interested parties have
opportunities to provide input before the Commission
makes recommendations or decisions.
(4) Membership.--The Commission shall be composed of not
fewer than 15 and not more than 20 members, who shall be
appointed by the President from among experts in evidence-based
mental and substance use health care. Such members shall
include--
(A) researchers;
(B) practitioners from various specialties,
professions, and practice settings;
(C) mental health and substance abuse health care
consumers; and
(D) health care payers.
(5) Terms.--
(A) In general.--Each member of the Commission
shall be appointed for a term of 4 years, except as
provided in subparagraphs (B) and (C).
(B) Terms of initial appointees.--As designated by
the President at the time of appointment, of the
members of the Commission first appointed, \1/4\ shall
each be appointed for terms of 1, 2, and 3 years and
the remainder shall be appointed for a term of 4 years.
(C) Vacancies.--Any member appointed to fill a
vacancy occurring before the expiration of the term for
which the member's predecessor was appointed shall be
appointed only for the remainder of that term. A member
may serve after the expiration of that member's term
until a successor has taken office.
(b) CMS Annual Report.--The Administrator of the Centers for
Medicare & Medicaid Services shall report annually to the Congress on
the extent to which the Medicaid program under title XIX of the Social
Security Act provides coverage of evidence-based interventions
identified by the Commission, including--
(1) a list of those interventions not so covered and the
reasons why they are not covered;
(2) a justification for each evidence-based intervention
that is not so covered; and
(3) a list of evidence-based interventions that can be
covered only with statutory change.
(c) Construction Regarding Application.--Nothing in this section
shall be construed as requiring, as a condition of payment under the
Medicaid program under title XIX of the Social Security Act, that an
intervention must be an evidence-based practice.
(d) Prompt Development and Implementation of Claims Processing and
Data Codes.--The Secretary, acting through the Administrator of the
Centers for Medicare & Medicaid Services, shall establish, or enter
into an agreement with, one or more entities for the purpose of
developing, as soon as practicable after the date of the enactment of
this Act, codes that should be applied to claims processing and health
data collection activities as recommended by the Commission pursuant to
subsection (a)(2)(B).
(e) Definition.--In this section, the term ``intervention'' means a
preventive, diagnostic, or therapeutic action with respect to a mental
health or substance use disease process.
SEC. 3. IMPROVED COORDINATION OF CARE.
(a) Interagency Collaborative Group.--
(1) Establishment.--The Secretary shall convene an
interagency collaborative group (in this section referred to as
the ``interagency collaborative group'') to provide for the
coordination at the clinical and programmatic level of mental
health and substance use services and primary care services,
funded in whole or in part through the Department of Health and
Human Services, the Department of Justice, the Department of
Veterans Affairs, the Department of Defense, and the Department
of Education, using one or more evidence-based coordination
models, such as the following:
(A) Formal agreements between mental health,
substance use, and primary care providers.
(B) Case management of mental health, substance
use, and primary care.
(C) Co-location of mental health, substance use,
and primary care providers.
(D) Delivery of mental health, substance use, and
primary care in integrated practices.
(2) Duties.--The interagency collaborative group shall--
(A) develop a plan for government agencies to
implement the recommendations made by the Commission
for Evidence-Based Mental and Substance Use Health
Care;
(B) coordinate with States and appropriate public
stakeholders to foster interagency collaboration at the
State and local level;
(C) make recommendations to the President and the
Congress to break down barriers to coordination of
existing Federal programs funding mental health and
substance use services and to allow for more effective
integration of such programs across agencies and
programs;
(D) assess progress toward such coordination
through development and monitoring of performance
measures of coordination; and
(E) report to the Congress biannually on the status
of such coordination.
(3) Composition.--The interagency collaborative group shall
include the following members:
(A) The Secretary of Health and Human Services (or
the Secretary's designee).
(B) The Attorney General (or the Attorney General's
designee).
(C) The Secretary of Veterans Affairs (or such
Secretary's designee).
(D) The Secretary of Defense (or such Secretary's
designee).
(E) The Secretary of Education (or such Secretary's
designee).
(4) Meetings.--The interagency collaborative group shall
meet not less than quarterly.
(5) Staff and support.--The Secretary shall provide,
without the requirement for reimbursement, staff and other
administrative support necessary for the operation of the
interagency collaborative group.
(b) Coordinated Delivery of Care.--The Federal agencies
participating in the interagency collaborative group shall modify
internal policies and practices, to the extent practicable and
consistent with legal authority, in order to implement one or more of
the evidence-based coordination models referred to in subsection
(a)(1).
(c) No Effect on HIPAA Privacy Rules.--Nothing in this section
shall be construed to alter the application of rules promulgated under
section 264(c) of the Health Insurance Portability and Accountability
Act of 1996.
(d) GAO Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General of the United States
shall conduct a study and submit a report to the Congress on the
implementation of this section.
(e) Clarification of Medicaid Reimbursement Options.--The Secretary
shall provide, by regulation, for a change in the rules under title XIX
of the Social Security Act relating to reimbursement for primary care
services and mental health and substance use services to the same
patient on the same day so as to permit payment for the legitimate
provisions of both types of services on the same day to a patient.
SEC. 4. INFORMATION TECHNOLOGY FOR MENTAL HEALTH AND SUBSTANCE USE
HEALTH CARE PROVIDERS.
(a) Development and Implementation of Plan.--The Secretary, acting
through the National Coordinator for Health Information Technology and
the Administrator of the Substance Abuse and Mental Health Services
Administration, shall develop and implement a plan for ensuring that
activities of the Department of Health and Human Services to promote
the use of information technology by health care providers include
promotion of information technology that is accessible and pertinent to
mental health and substance use health care providers and consumers.
(b) Contents of Plan.--The plan developed under subsection (a)
shall address--
(1) how the development of an electronic health information
infrastructure, including the awarding of grants and contracts
to promote the use of electronic health records (EHRs),
personal health records (PHRs), regional health information
organizations (RHIOs), and other forms of health information
technology, and the establishment of data standards, will
ensure that the needs of mental and substance use health care
providers and consumers are met with particular emphasis on the
privacy concerns of consumers;
(2) how financial incentives that are generally made
available for the development of such infrastructure for health
care providers can be provided to individual mental health and
substance use clinicians and organizations (and particularly
publicly-funded providers) for investments in information
technology to enable them to participate on a full and equal
basis in the emerging electronic health infrastructure;
(3) how any continuing technical assistance and training
for developing virtual networks may be made available to give
individual and small group providers of mental health and
substance use services standard access to software, clinical
and population data and health records, and billing and
clinical decision-support systems; and
(4) how to create and support a continuing mechanism to
engage mental health and substance use stakeholders in the
public and private sectors in developing consensus-based
recommendations for data elements, standards, and processes
needed to address unique aspects of information management
related to mental and substance use healthcare.
(c) Consideration.--In awarding any grant or contract for the
development or implementation of any component of a national electronic
health infrastructure, the Secretary shall consider the application of
such component to mental health and substance use health care and
providers of such care.
(d) Continued Privacy Protections.--In developing or promoting the
national electronic health infrastructure, the Secretary shall ensure
that privacy and confidentiality requirements traditionally applicable
to mental health and substance use health care continue to be applied.
(e) Inclusion of Information in Reports.--In preparing any report
to the Congress relating to the development or implementation of a
national electronic health infrastructure or the promotion of the use
of health information technology, the Secretary shall include
information on such development, implementation, or promotion in the
field of mental health and substance use treatment.
SEC. 5. COUNCIL ON THE MENTAL HEALTH AND SUBSTANCE USE HEALTH CARE
WORKFORCE.
(a) Establishment.--The Secretary shall establish a public-private
advisory group called the Council on the Mental Health and Substance
Use Health Care Workforce (in this section referred to as the
``Council'').
(b) Duties.--
(1) Development of comprehensive plan.--The Council shall
develop and publish a comprehensive plan for purpose of
strengthening the capacity of the workforce to deliver high-
quality mental health and substance use health care.
(2) Plan contents.--The plan developed under this
subsection shall--
(A) identify the specific clinical competencies
that all mental health and substance use professionals
should possess to be certified or licensed and the
competencies, including a component of patient centered
care, that should be maintained over time;
(B) identify the specific mental health and
substance use education that should be required of
health care professionals and integrated into the
medical education and training of all health care
professionals;
(C) propose national standards for the
credentialing and licensure of mental health and
substance use health care providers based on core
competencies that should be included in curricula and
education programs across all the mental health and
substance use disciplines and make recommendations
regarding accreditation standards for mental health and
substance use health care programs;
(D) propose programs for funding from Federal,
State, and local governments and the private sector to
address and resolve long-standing workforce issues such
as diversity, cultural relevance, faculty development,
training effectiveness, continuing shortages of well-
trained clinicians needed to work with children and the
elderly and in high-need areas, and programs for
training competent clinical supervisors and
administrators; and
(E) provide for continuing assessment of mental
health and substance use workforce trends, issues, and
financing policies.
(3) Evaluation; reporting.--On a biannual basis, the
Council shall--
(A) conduct an evaluation of the extent to which
the purpose specified in paragraph (1) has been met;
and
(B) submit a report to the Congress on the results
of such evaluation, including a description of the
status of the mental health and substance use health
care workforce.
(4) Assistance.--The Council shall collaborate with private
sector coalitions to facilitate and implement its
recommendations.
(c) Membership.--
(1) Number; appointment; chair.--The Council shall be
composed of not less than 21 and not more than 25 individuals
appointed by the Secretary. The Council shall elect a chair
from among its members.
(2) Public sector members.--The Council shall include the
following officials (or their designees):
(A) The Assistant Secretary for Health in the
Department of Health and Human Services.
(B) The Administrator of the Centers for Medicare &
Medicaid Services.
(C) The Administrator of the Substance Abuse and
Mental Health Services Administration.
(D) The Secretary of Veterans Affairs.
(3) Private sector members.--The Council shall include
representatives from the substance use and mental health
services and consumer communities who are not employees of the
Federal Government. Such representatives shall be appointed by
the Secretary without regard to the Federal civil service laws
and shall include the following:
(A) One individual selected from full-time students
enrolled in mental health training programs.
(B) One individual selected from full-time students
enrolled in substance use health care training
programs.
(C) One individual selected from mental health
consumers.
(D) One individual selected from substance use
health care consumers.
(E) One individual selected from faculty members at
mental health training facilities.
(F) One individual selected from faculty members at
substance use health care training facilities.
(G) Five individuals selected from among leading
professional associations in the various fields charged
with carrying out mental health and substance use
services, including psychiatry, addiction medicine,
psychology, social work, psychiatric nursing,
counseling, marriage and family therapy, pastoral
counseling, psychosocial rehabilitation, and substance
use treatment counselors.
(H) Five individuals selected from among leading
professional licensing and credentialing entities in
the various fields charged with carrying out mental
health and substance use services including psychiatry,
addiction medicine, psychology, social work,
psychiatric nursing, counseling, marriage and family
therapy, pastoral counseling, psychosocial
rehabilitation, and substance use treatment counseling.
(4) Selection.--In selecting the members of the Council
under paragraph (3), the Secretary shall ensure--
(A) the inclusion of both urban and rural members;
(B) a range of members from a variety of practice
settings and including expertise in prevention and
treatment across the lifespan;
(C) adequate representation of racial, ethnic,
religious, and economic diversity in its membership;
and
(D) the members appointed under subparagraphs (G)
and (H) of paragraph (3) are equitably distributed
between those specializing in mental health services
and those specializing in substance use services.
(5) Terms.--
(A) In general.--Each member of the Council under
paragraph (3) shall be appointed for a term of 4 years,
except that except as provided in subparagraphs (B) and
(C).
(B) Terms of initial appointees.--As designated by
the Secretary at the time of appointment, of the
members of the Council first appointed under paragraph
(3), \1/4\ shall each be appointed for terms of 1, 2,
and 3 years and the remainder shall be appointed for a
term of 4 years.
(C) Vacancies.--Any member appointed under
paragraph (3) to fill a vacancy occurring before the
expiration of the term for which the member's
predecessor was appointed shall be appointed only for
the remainder of that term. A member may serve after
the expiration of that member's term until a successor
has taken office.
(d) Meetings.--The Council shall conduct at least 3 meetings each
year.
(e) Staff and Support.--The Secretary shall provide, without the
requirement for reimbursement, staff and other administrative support
necessary for the operation of the Council.
SEC. 6. FUNDING OF RESEARCH THROUGH NATIONAL CENTERS OF EXCELLENCE.
(a) Grants.--The Director of the National Institutes of Health (in
this section referred to as the ``Director of NIH''), acting through
the Directors of the National Institute of Mental Health, the National
Institute of Drug Abuse, and the National Institute on Alcohol Abuse
and Alcoholism, and in consultation with the Administrator of the
Substance Abuse and Mental Health Services Administration, shall make
grants to entities to fund a network of national centers of excellence
in mental health and substance use health care.
(b) Use of Funds.--As a condition on receipt of a grant under this
section, an entity shall agree to use the grant to establish or support
one or more centers of excellence in mental health and substance use
health care. Each such center shall--
(1) integrate basic, clinical, or health services research
with interventions in a range of usual settings of care
delivery and involve a broad cross-section of mental health and
substance use health care stakeholders; and
(2) develop innovative approaches to tie together research
and practice in order to develop a research agenda relevant to
providers of mental health and substance use health care
services in a range of usual settings of care.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $10,000,000 for fiscal year
2011, $15,000,000 for fiscal year 2012, $20,000,000 for fiscal year
2013, $25,000,000 for fiscal year 2014, and such sums as may be
necessary for each subsequent fiscal year.
SEC. 7. PATIENT-CENTERED CARE.
(a) Promotion in Federal Programs.--With respect to any program
that provides for the Department of Health and Human Services, the
Department of Justice, the Department of Veterans Affairs, Department
of Defense, or the Department of Education to pay for or provide mental
health and substance use care, each such Department shall provide for
the following:
(1) Within the authority of the Department with respect to
such program--
(A) include payment for, or provision of, peer
support and illness self-management programs that meet
evidence-based standards for individuals with chronic
mental illnesses or substance use dependence; and
(B) provide for appropriate payment and coverage
reforms, such as the application of copayments, service
exclusions, and benefit limits, so as to eliminate
barriers to the effective, appropriate, and evidence-
based provision of such care.
(2) Endeavor to make reliable comparative information on
the quality of such care provided by practitioners and
organizations available to consumers and to encourage consumers
to use this information when making decisions about from whom
to receive such care.
(3) Insofar as the Department does not have authority
described in paragraph (1), make recommendations to the
Congress regarding changes in law to provide for such
authority.
(b) Sense of Congress for All Programs.--It is the sense of the
Congress that clinicians and organizations providing mental health and
substance use treatment services should--
(1) incorporate, consistent with applicable State laws,
informed, patient-centered decisionmaking and (for children)
informed family decisionmaking throughout their practices,
including active patient participation in the design and
revision of the patient treatment and recovery plans,
psychiatric advance directives, and provision of information on
the availability and effectiveness of mental health and
substance use treatment options;
(2) adopt recovery-oriented and illness self-management
practices that support patient preference for treatment
(including medications), peer support, and other elements of
the wellness recovery plan; and
(3) maintain effective, formal linkages with community
resources to support patient illness self-management and
recovery.
SEC. 8. UNIFORM METHODOLOGIES FOR REIMBURSING BEHAVIORAL HEALTH CLAIMS.
(a) In General.--The Secretary, through the working group convened
under subsection (b), shall develop uniform methodologies across
geographic areas and types of payers for the following with respect to
medical assistance, related services, and administrative costs
furnished to individuals with mental illnesses and substance use
disorders in both community-based and residential settings:
(1) Qualifications for eligibility for payment.
(2) Financial auditing.
(3) Claims payment (including billing codes).
(b) Convening of Working Group.--The Secretary shall carry out
subsection (a) by convening a working group is composed of the
Directors and Administrators of all relevant agencies, including the
Centers for Medicare & Medicaid Services, the Office of Management and
Budget, the Health Resources and Services Administration, the Substance
Abuse and Mental Health Services Administration, the office of the
Inspector General of the Department of Health and Human Services,
acting jointly with State Medicaid directors and other State, local,
and private healthcare payers.
(c) Requirements.--The methodology developed under subsection (a)--
(1) shall not result in new medical necessity criteria, and
shall not prohibit or restrict payment for medical assistance,
related services, and administrative activities under title XIX
of the Social Security Act that are provided or conducted in
accordance with options under such title regarding targeted
case management, rehabilitative services, or clinical services;
and
(2) with respect to administrative costs, shall be based
on--
(A) standards related to time studies and
populations estimates; and
(B) a national standard for determining payment of
such costs.
(d) Rule of Construction.--Nothing in this section shall be
construed as requiring, as a condition of payment under the Medicaid
program under title XIX of the Social Security Act, that an
intervention must be an evidence-based practice.
SEC. 9. STUDY ON USE OF PUBLIC MENTAL HEALTH AND ADDICTION SERVICES BY
INDIVIDUALS WITH PRIVATE HEALTH COVERAGE.
(a) In General.--The Comptroller General of the United States shall
conduct a study on the use of publicly supported mental health and
addiction services by individuals who have any level of private health
insurance coverage.
(b) Report.--The Comptroller General shall submit to the Congress a
report on the study under subsection (a). The report shall include a
description of--
(1) the number of individuals described in subsection (a);
(2) the types of private health insurance coverage
involved; and
(3) the public programs providing the mental health and
addiction services involved and the cost of such services
provided.
SEC. 10. HIGH-QUALITY MENTAL HEALTH AND SUBSTANCE USE HEALTH CARE
MEDICAID DEMONSTRATION PROJECT.
(a) In General.--The Secretary shall establish a 5-year
demonstration project (in this section referred to as the ``project'')
designed to demonstrate the impact of creating delivery and financing
structures that deliver high-quality, integrated mental health and
substance use health care. Such project shall be based upon the report
of the Institute of Medicine (of November 2005) relating to Improving
the Quality of Health Care for Mental and Substance-Use Conditions:
Quality Chasm Series, and shall include demonstrating at least the
following:
(1) Coordinated delivery of mental health, substance use,
and primary health care, utilizing a co-location or integrated
delivery model.
(2) Use of evidence-based practices, to as great an extent
as possible.
(3) Provision of patient-centered care that emphasizes
recovery-oriented practices and informed patients and, where
appropriate, family decisionmaking.
(4) A commitment to utilizing health information technology
to improve the quality and efficiency of care.
(b) Required Reporting on Quality.--The Secretary shall provide
that each health care provider participating in the project shall
submit data on quality measures determined by the Secretary.
(c) Waiver of Requirements.--
(1) In general.--Subject to paragraph (2), the Secretary is
authorized to waive such requirements of title XIX of the
Social Security Act, such as statewideness, a limitation on the
scope of services included in medical assistance, and the
coverage of additional administrative expenses, as may be
necessary for the implementation of the project.
(2) Limitation on funding.--The Secretary shall design the
project in such a manner so that the net additional Federal
expenditures under title XIX of the Social Security Act
resulting from the project does not exceed $50,000,000.
(d) Independent Evaluation.--The Secretary shall provide for an
independent evaluation of activities provided under the project, in
comparison with a control group. Such evaluation shall include an
assessment of health and social outcomes for beneficiary participants,
such as employment status, receipt of welfare benefits, criminal
justice contacts, and homelessness, as well as the resource utilization
for medical services, mental and substance use health care, and social
services. Such evaluation shall also include an assessment of the
impact of activities provided under the project on workforce
recruitment and retention.
(e) Reports to Congress.--
(1) Interim report.--Not later than 2 years after the
initiation of the project, the Secretary shall submit to the
Congress an interim report on the project. Such report shall
include such recommendations as the Secretary determines
appropriate.
(2) Final report.--Not later than 1 year after the
completion of the project, the Secretary shall submit to the
Congress a final report on the project. The report shall
include the results of the independent evaluation provided
under subsection (d) as well as recommendations regarding
redesign of the mental health and substance use benefit under
the Medicaid program to maximize the quality and efficiency of
such benefits.
SEC. 11. MEDICAID REQUIREMENT FOR STATE REPEAL OF LAWS DENYING HEALTH
BENEFITS COVERAGE BASED ON INTOXICATION.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
1396a), as amended by section 5006 of division B of Public Law 111-5,
is amended--
(1) in subsection (a)--
(A) by striking ``and'' at the end of paragraph
(72);
(B) by striking the period at the end of paragraph
(73) and inserting ``; and''; and
(C) by inserting after paragraph (73) the following
new paragraph:
``(74) provide that the State has in effect a law that
requires any insurance contract covering medical care losses in
the group and individual market that is to be offered in the
State to meet the requirements of subsection (gg)(1).''; and
(2) by adding at the end the following new subsection:
``(gg) Requirements for Insurance Covering Medical Losses in the
Group and Individual Market.--
``(1) Restrictions on exclusions and limitations relating
to intoxication.--The requirements of this paragraph with
respect to insurance contracts covering medical care losses in
the group and individual market are as follows:
``(A) A prohibition against the exclusion or denial
of covered services and benefits, in connection with
the treatment of any patient whose medical condition,
illness, or injury, involves confirmed or suspected
intoxication as a result of alcohol or other substance.
``(B) A prohibition against discrimination against
health care providers in the rate or level of payment
for covered services in cases in which intoxication is
either suspected or confirmed.
``(C) An express obligation to provide and pay for
covered services and treatments necessary to the
treatment of any condition, illness, or injury without
regard to whether intoxication is either suspected or
confirmed.
``(D) An express obligation to cooperate with the
state agency for medical assistance as provided under
section 1902(a)(25).
``(2) Inclusion of all forms of coverage.--For purposes of
subsection (a)(74) and paragraph (1), the term `insurance
contract covering medical care losses in the group and
individual market' includes any class or type of insurance
relating to medical care in the group or individual market,
including plans covering public employees as well as private
employees, regardless of whether coverage under the contract is
expressed in terms of defined benefits or defined cash
contributions toward the cost of medical losses.''.
(b) Effective Date.--
(1) Except as provided in paragraph (2), the amendments
made by subsection (a) shall apply to calendar quarters
beginning on or after January 1, 2010, without regard to
whether or not final regulations to carry out such amendments
have been promulgated by such date.
(2) In the case of a State plan for medical assistance
under title XIX of the Social Security Act which the Secretary
determines requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirements imposed by the amendments made by
subsection (a), the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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