This bill would change Title XVIII of the Social Security Act to add Medicare Part A coverage for certain residential substance use disorder (SUD) services. It creates three covered categories: clinically managed low-intensity, clinically managed high-intensity, and medically managed residential SUD services. The bill defines each type of program and facility, sets staffing, record‑keeping, and service requirements, and requires facilities to be enrolled and accredited. It requires initial and periodic reviews of a patient’s need for the level of care (not less often than every 30 days for clinically managed services and not less often than every 10 days for medically managed services). The Secretary must approve evidence‑based SUD criteria developed by a nonprofit medical association and may approve certifying bodies to show compliance. The bill allows the Secretary to require cost reports and to develop a per‑diem prospective payment system for these services, with payments under that system beginning for cost reporting periods on or after October 1, 2026. The initial payment implementation must set estimated aggregate rates equal to 100 percent of estimated reasonable costs; later years use payment rates adjusted by a market‑basket increase factor. The bill notes access to methadone is not required where no methadone providers are available, as determined by the Secretary.
If you have Medicare Part A, this bill would create new covered options for residential SUD treatment when the facility and program meet the bill’s definitions and conditions. Covered services include bed and board, clinical services, recovery supports, and (for medically managed programs) 24‑hour nursing and medical monitoring. Facilities must be enrolled under the program, accredited, and follow the Secretary‑approved clinical criteria and review schedules to receive Part A payment.
No publicly available information on the total federal cost or savings of the bill. The bill does require the Secretary to set up a per‑diem prospective payment system for the three residential SUD service types. Payments under that system begin for cost reporting periods on or after October 1, 2026. The bill directs initial estimated aggregate payment rates to equal 100 percent of estimated reasonable costs for those services and directs later year payment rates to be adjusted by a market‑basket increase factor. The Secretary may require facilities to submit cost reports and other information to develop and operate the payment system.
No publicly available information.
No publicly available information.