Full Text
Official text as published. Use Ctrl+F / Cmd+F to search within the document.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10647 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 10647
To amend title XIX of the Social Security Act to establish a Medicaid
State plan amendment option to provide medical assistance to
individuals with a serious mental illness who are patients in certain
institutions for mental diseases.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 1, 2026
Mr. Bentz (for himself and Mr. Goldman of New York) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to establish a Medicaid
State plan amendment option to provide medical assistance to
individuals with a serious mental illness who are patients in certain
institutions for mental diseases.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Individuals in Medicaid Deserve Care
that is Appropriate and Responsible in its Execution Act'' or the ``IMD
CARE Act''.
SEC. 2. STATE PLAN AMENDMENT OPTION TO PROVIDE MEDICAL ASSISTANCE TO
INDIVIDUALS WITH A SERIOUS MENTAL ILLNESS WHO ARE
PATIENTS IN CERTAIN INSTITUTIONS FOR MENTAL DISEASES.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended--
(1) in section 1905(a), in the subdivision (B) that follows
paragraph (32), by inserting ``or section 1915(m)'' after
``described in section 1915(l)''; and
(2) in section 1915, by adding at the end the following new
subsection:
``(m) State Plan Amendment Option To Provide Medical Assistance for
Individuals With a Serious Mental Illness Who Are Patients in Certain
Institutions for Mental Diseases.--
``(1) In general.--With respect to calendar quarters
beginning on or after January 1, 2027, a State may elect,
through a State plan amendment, to provide medical assistance
for items and services furnished to an eligible individual who
is a patient in an institution for mental diseases in
accordance with the requirements of this subsection.
``(2) Payments.--Subject to paragraphs (3) and (4), amounts
expended under a State plan amendment under paragraph (1) for
services described in such paragraph furnished, with respect to
a 12-month period, to an eligible individual who is a patient
in an institution for mental diseases shall be treated as
medical assistance for which payment is made under section
1903(a), but only to the extent that such services are
furnished for not more than a period of 30 days (whether or not
consecutive) during such 12-month period.
``(3) Maintenance of effort.--
``(A) In general.--As a condition for a State
receiving payments under section 1903(a) for medical
assistance provided in accordance with this subsection,
the State shall (during the period in which it so
furnished such medical assistance through a State plan
amendment under this subsection) maintain on an annual
basis a level of funding expended by the State (and
political subdivisions thereof) from non-Federal funds
for items and services (including services described in
subparagraph (B)) furnished to eligible individuals in
outpatient and community-based settings that is not
less than the level of such funding for such items and
services for fiscal year 2023.
``(B) Services described.--For purposes of
subparagraph (A), services described in this
subparagraph are the following:
``(i) Outpatient and intensive outpatient
mental health and co-occurring substance use
disorder services, including case management
and care coordination services.
``(ii) Assertive community treatment.
``(iii) Peer support and counselor
services.
``(iv) Outpatient medication-assisted
treatment, related therapies, and pharmacology.
``(v) Crisis mental health services and
substance use disorders services including 24
hours mobile crisis teams, crisis receiving and
crisis stabilization including specialized
programs for in-home stabilization for children
and adolescents.
``(vi) Psychiatric rehabilitation
encompassing recovery support, supported
employment and supportive housing.
``(vii) Services furnished by certified
community behavioral health clinics and
community mental health centers.
``(viii) Routine monitoring of medication
adherence.
``(ix) Medication to treat mental illness.
``(x) Other outpatient and community-based
services as designated by the Secretary.
``(C) State reporting requirement.--
``(i) In general.--Prior to approval of a
State plan amendment under this subsection, as
a condition for a State receiving payments
under section 1903(a) for medical assistance
provided in accordance with this subsection,
the State shall report to the Secretary, in
accordance with the process established by the
Secretary under clause (ii), the information
deemed necessary by the Secretary under such
clause.
``(ii) Process.--Not later than the date
that is 12 months after the date of enactment
of this subsection, the Secretary shall
establish a process for States to report to the
Secretary, at such time and in such manner as
the Secretary deems appropriate, such
information as the Secretary deems necessary to
verify a State's compliance with subparagraph
(A).
``(4) Ensuring a continuum of services.--
``(A) In general.--As a condition for a State
receiving payments under section 1903(a) for medical
assistance provided in accordance with this subsection,
the State shall carry out each of the requirements
described in subparagraphs (B) through (J).
``(B) Notification.--The State shall require
providers, managed care plans, and utilization review
entities to implement specified evidence-based,
individual placement criteria and utilization
management approaches developed by stakeholders using a
consensus-based process to ensure placement of eligible
individuals in an appropriate level of care, including
criteria and approaches to ensure that eligible
individuals receive appropriate evidence-based clinical
screening prior to being furnished with items and
services in an institution for mental diseases,
including initial and periodic assessments to determine
the appropriate level of care, length of stay, and
setting for such care for each individual. The State
shall notify the Secretary at such time and in such
form and manner as the Secretary shall require how the
State will require and implement such placement
criteria and utilization management approaches.
``(C) Transition of care.--In order to ensure an
appropriate transition for an eligible individual from
receiving care in an institution for mental diseases to
receiving care at a lower level of clinical intensity
within the continuum of care (including outpatient
services), the State shall ensure that--
``(i) a placement in such institution for
mental diseases would allow for an eligible
individual's successful transition to the
community, considering such factors as
proximity to an individual's support network
(such as family members, employment, and
counseling and other services near an
individual's residence);
``(ii) enrollees are connected with
community-based providers as they prepare to
transition out of an institution for mental
diseases by covering services provided by these
community-based providers to enrollees while
they are still residing in the institution for
mental diseases or by encouraging institutions
for mental diseases to hire peer support
specialists to assist with the transition and
discharge process and ensure enrollees are
connected with providers and other resources in
their communities after they leave the
institution;
``(iii) institutions for mental diseases
assess whether enrollees have access to housing
as they are transitioning out and connect such
individuals with community providers that
coordinate housing services; and
``(iv) all institutions for mental diseases
that furnish items and services to individuals
for which medical assistance is provided under
the State plan--
``(I) are able to provide care at
such lower level of clinical intensity;
``(II) have an established
relationship with another facility or
provider that is able to provide care
at such lower level of clinical
intensity and accepts patients
receiving medical assistance under this
title such that the institution for
mental diseases may arrange for
individuals to receive such care from
such other facility or provider upon
transitioning out of that institution
for mental diseases; or
``(III) ensure implementation of
protocols requiring that contact is
made by the institution for mental
diseases with each discharged
beneficiary within 72 hours of
discharge and to ensure access to and
engagement in follow-up care.
``(D) Review process.--The State shall have in
place a process to review the compliance of
institutions for mental diseases with such program
standards specified by the State encompassing licensing
requirements, auditing processes, utilization review
processes and Federal program integrity requirements.
``(E) Care for co-morbid conditions.--The State
shall implement a requirement that institutions for
mental diseases also screen enrollees for co-morbid
physical health conditions and substance use disorders
and suicidal ideation and provide for treatment either
on-site or via partnerships with local providers for
any identified co-occurring conditions.
``(F) Care continuum assessment.--
``(i) In general.--The State shall, as part
of its application for approval of a State plan
amendment described in this subsection,
complete and submit an assessment of the
availability of outpatient and community based
behavioral health services for individuals
enrolled under a State plan under this title
(or waiver of such plan) in each level of care,
including how such availability varies by
region of the State.
``(ii) Required updates.--The State shall
complete an update of such assessment described
in clause (i) not later than 12 months after
date the State commences such assessment.
``(G) Financing plan.--The State shall consult with
the Secretary in succeeding years regarding financing
plans to increase the availability of services listed
in paragraph (3)(B) where feasible.
``(H) Coordination.--The State shall implement
strategies to improve data-sharing between different
types of providers (such as mental health, substance
use disorder, and physical health providers) and
different settings of care (such as hospitals,
emergency departments, crisis stabilization providers,
community-based treatment providers) as well as
strategies to improve the State's capacity to track
availability of treatment and crisis stabilization beds
and capacity of mental health providers to accept new
patients.
``(I) Connections.--The State shall implement
strategies to decrease use of emergency departments by
enrollees with serious mental illness primarily in need
of mental health treatment, including by supporting
peer supports and psychiatric consultants in emergency
departments to improve connections with services and
resources.
``(J) Integration and engagement.--The State shall
take actions to increase integration of mental health
and substance use disorder treatment in non-specialty
care settings including schools, primary care
practices, and emergency departments as well as
additional strategies to support earlier identification
and engagement in treatment among youth with serious
mental health conditions including through supported
education and supported employment programs.
``(5) Application to managed care.--Payments for, and
limitations to, medical assistance furnished in accordance with
this subsection shall be in addition to and shall not be
construed to limit or supersede the ability of States to make
monthly capitation payments to managed care organizations for
individuals receiving treatment in institutions for mental
diseases in accordance with section 438.6(e) of title 42, Code
of Federal Regulations (or any successor regulation).
``(6) Other medical assistance.--The provision of medical
assistance for items and services furnished to an eligible
individual who is a patient in an institution for mental
diseases in accordance with the requirements of this subsection
shall not prohibit Federal financial participation for medical
assistance for items or services that are provided to such
eligible individual in or away from the institution for mental
disease during any period in which the eligible individual is
receiving items or services in accordance with this subsection.
``(7) Definitions.--In this subsection:
``(A) Eligible individual.--The term `eligible
individual' means an individual who--
``(i) with respect to a State, is enrolled
for medical assistance under the State plan or
a waiver of such plan;
``(ii) is at least 21 years of age;
``(iii) has not attained 65 years of age;
and
``(iv) has at least 1 mental disorder
defined in the most recent version of the
American Psychiatric Association Diagnostic and
Statistical Manual.
``(B) Institution for mental diseases.--The term
`institution for mental diseases' has the meaning given
that term in section 1905(i).''.
(b) Rule of Construction.--Nothing in the amendments made by
subsection (a) shall be construed as encouraging a State to place an
individual in an inpatient or a residential care setting where a home
or community-based care setting would be more appropriate for the
individual, or as preventing a State from conducting or pursuing a
demonstration project under section 1115 of the Social Security Act to
improve access to, and the quality of care for enrollees with serious
mental illness or serious emotional disturbance.
<all>