What is the official ID of this bill?
The official print number for this legislation is S 4860.
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).
Status:
Expired
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