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Medicare Coverage Expansion for Residential Substance Use Disorder Treatment

This Act expands Medicare Part A coverage to include residential substance use disorder (SUD) services, significantly improving access to addiction treatment for seniors and other Medicare beneficiaries. It establishes coverage for three levels of residential care—low-intensity, high-intensity, and medically managed services—including board and lodging. This change aims to provide comprehensive, structured support necessary for recovery, directly impacting the health and well-being of individuals struggling with addiction.
Key points
Medicare Part A Expansion: Coverage is established for residential substance use disorder services, including clinical care, board, and lodging.
Three Tiers of Care: The bill covers Clinically Managed Low-Intensity, Clinically Managed High-Intensity, and Medically Managed Residential SUD services.
Facility Requirements: Residential facilities must be accredited, legally authorized by the state, and meet specific staffing and clinical standards to qualify for Medicare payments.
New Payment System: A per diem prospective payment system will be developed and implemented by October 2025 to standardize payments for these residential services.
Mandatory Review: The continued need for residential treatment must be reviewed and reaffirmed periodically (at least every 10 or 30 days, depending on the intensity level).
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Additional Information
Print number: 118_S_4860
Sponsor: Sen. Casey, Robert P., Jr. [D-PA]
Process start date: 2024-07-30
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Summarized by: gemini-flash-latest
Source data: api.congress.gov
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OFFICIAL LEGAL TITLE

Residential Recovery for Seniors Act

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 118_S_4860.

Which chamber initiated this legislation?

This legislation was initiated in the Senate.

When did the legislative process begin?

The process officially started on 2024-07-30.

What are the main provisions?

Key points include:

  • Medicare Part A Expansion: Coverage is established for residential substance use disorder services, including clinical care, board, and lodging.
  • Three Tiers of Care: The bill covers Clinically Managed Low-Intensity, Clinically Managed High-Intensity, and Medically Managed Residential SUD services.
  • Facility Requirements: Residential facilities must be accredited, legally authorized by the state, and meet specific staffing and clinical standards to qualify for Medicare payments.
  • New Payment System: A per diem prospective payment system will be developed and implemented by October 2025 to standardize payments for these residential services.
  • Mandatory Review: The continued need for residential treatment must be reviewed and reaffirmed periodically (at least every 10 or 30 days, depending on the intensity level).
What is the specific legal status?

The current status is Expired.

Where can I read the full text of this legislation?

The full official text is available at: View full text

Who is the primary sponsor?

The primary sponsor is Sen. Casey, Robert P., Jr. [D-PA].

What is the latest detailed status?

The latest detailed status is: Introduced in Senate

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-26.

CATEGORIES

Health Benefits