CMI demonstration to test the provision of recovery housing for individuals with opioid use disorder under Medicaid

Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended— (1) in subsection (b)(2)(A), by adding at the end the following new sentence: The models selected under this subparagraph shall include the demonstration described in subsection (h) (which shall be implemented not later than 18 months after the date of enactment of such subsection).; and (2) by adding at the end the following new subsection: (h) Demonstration To test the provision of recovery housing for individuals with opioid use disorder under Medicaid (1) In general The CMI, in consultation with the Secretary of Housing and Urban Development and other agencies, as the Secretary determines appropriate, shall conduct a demonstration project (referred to in this subsection as the demonstration) to test whether providing Medicaid managed care entities with an elevated global capitated budget for eligible Medicaid beneficiaries, paired with flexibilities to allow States to provide medical assistance for recovery housing for such beneficiaries, would result in reduced emergency department visits, hospitalizations, and program expenditures under per beneficiary, or improve quality of care for the such beneficiaries without increasing expenditures under the Medicaid program under title XIX. (2) Demonstration requirements (A) In general Under the demonstration, each eligible State that is selected by the CMI to participate in the demonstration shall enter into an agreement with a Medicaid managed care entity under which the entity agrees to provide services (including recovery housing) to eligible Medicaid beneficiaries under a payment model that meets the requirements of subparagraph (B). (B) Capitated payments (i) In general The CMI shall establish a capitated payments system for Medicaid managed care entities under the demonstration that is based on the demonstration budget determined under clause (ii). (ii) Demonstration budget (I) In general For purposes of clause (i), the demonstration budget of a Medicaid managed care entity for each year of a demonstration period shall be determined by the CMI based on the number of eligible Medicaid beneficiaries enrolled with the entity and the average annual spending under title XIX in the State involved on individuals who are enrolled in the State plan under such title (or a waiver of such plan) and who— (aa) have a diagnosis of opioid use disorder; (bb) are in the top quartile of per beneficiary spending for such plan or waiver for the most recent year; and (cc) have attained age 21 but have not attained age 65. (II) Risk adjustment The CMI may adjust the demonstration budget determined for a Medicaid managed care entity and a year under this clause using a risk adjustment model selected by the CMI to account for differences in age and clinical conditions of the eligible Medicaid beneficiaries enrolled with the entity compared to the overall population upon which the demonstration budget is based. (C) Selection of eligible States Not later than 1 year after the date of enactment of this subsection, the CMI shall select not less than 2 eligible States to participate in the demonstration. (3) Additional waiver authority In addition to the authority described in subsection (d)(1), the Secretary may waive such requirements of title XIX as necessary to carry out the demonstration. (4) Definitions In this subsection: (A) Eligible Medicaid beneficiary The term eligible Medicaid beneficiary means an individual who— (i) is eligible for medical assistance under a State plan under title XIX or a waiver of such a plan; (ii) has a diagnosis of opioid use disorder; (iii) does not have a permanent residence (as certified by the individual); (iv) is currently receiving medication-assisted treatment or completed a course of medication-assisted treatment during the 3-month period preceding the individual's participation in the demonstration; and (v) has attained age 21 but has not attained age 65. (B) Eligible State (i) In general The term eligible State means a State that— (I) makes medical assistance available to all individuals described in section 1902(a)(10)(A)(i)(VIII); and (II) agrees to participate in the demonstration. (ii) Selection of eligible States In selecting eligible States to participate in the demonstration, the CMI shall give priority to States that are— (I) among the top 10 States in terms of highest per capita drug poisoning deaths in each of calendar years 2023, 2024, and 2025, based on the most recent data available from the Centers for Disease Control and Prevention; and (II) among the 10 States with the lowest physician reimbursement rates for services furnished under title XIX (as determined by the Secretary) in each of calendar years 2023, 2024, and 2025. (C) Managed care entity The term managed care entity means a medicaid managed care organization described in section 1932(a)(1)(B)(i). (D) Recovery housing The term recovery housing means a shared living environment free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders. (E) State The term State includes the 50 States and the District of Columbia..