Residential Recovery for Seniors Act

Bill Number

H.R. 9538

Origin Chamber

House

Congress

119th Congress, Session 2

Policy Area

Health

Status

Introduced

Latest Action

2026-06-30: Referred to the House Committee on Ways and Means.

Last Updated

2026-07-10T15:26:26Z

AI-Generated Summary

Summary of H.R. 9538: Residential Recovery for Seniors Act

Purpose of the Legislation

This bill amends title XVIII of the Social Security Act to create Medicare coverage for certain residential substance use disorder (SUD) services under Part A. The goal is to provide structured residential treatment options for Medicare beneficiaries with substance use disorders and co-occurring conditions.

Key Provisions Outlined

• Coverage Additions: Amends Section 1812(a) to include three new categories of covered services:
• Clinically managed low-intensity residential SUD services.
• Clinically managed high-intensity residential SUD services.
• Medically managed residential SUD services.
• Service Definitions (new subsections in Section 1861):
• Clinically managed low-intensity services: Include bed and board, clinical assessments, treatment planning, recovery support, and related items, with weekly clinical services; excludes physician services and private-duty nursing.
• Clinically managed high-intensity services: Similar items plus at least 20 hours of clinical services per week and withdrawal management; requires 24-hour supervision.
• Medically managed services: Add 24-hour nursing, daily medical interventions, on-site medications (including FDA-approved SUD treatments), and management of withdrawal and biomedical conditions.
• Program and Facility Requirements: Facilities must be enrolled in Medicare, accredited, state-authorized, and meet standards based on evidence-based criteria from a recognized nonprofit medical association. Certification by an approved body satisfies compliance.
• Assessment Rules: Initial needs assessments and periodic reviews (every 30 days for clinically managed levels, every 10 days for medically managed) using approved criteria.
• Provider Status: Adds these facilities as Medicare providers under Section 1866(e), limited to furnishing the defined services.
• Payment System: Creates a per diem prospective payment system under Section 1886(u), with initial payments set at 100% of estimated reasonable costs starting October 1, 2026, and subsequent adjustments based on a market basket index. Facilities may need to submit cost reports.

Significant Changes to Existing Law Introduced

• Establishes new Medicare coverage for residential SUD treatment, which was not previously included under Part A.
• Introduces detailed statutory definitions for services, programs, and facilities, along with specific staffing, assessment, and operational standards.
• Implements a new prospective payment system tailored to these services, differing from existing hospital or hospice payment models.
• Requires periodic reassessments and coordination with other care levels, emphasizing evidence-based criteria.

Potential Impacts

• On Government Agencies: Increases administrative responsibilities for the Centers for Medicare & Medicaid Services (CMS) in developing and managing the payment system, accrediting facilities, and enforcing standards.
• On Citizens: Expands access to residential SUD treatment for Medicare-eligible seniors, potentially improving outcomes for those needing structured support.
• On International Relations: No direct effects identified in the legislation.

Main Stakeholders Affected

• Medicare beneficiaries with substance use disorders.
• Residential SUD treatment facilities and programs.
• Healthcare providers involved in assessments, medication management, and referrals.
• The Department of Health and Human Services (HHS) and CMS for implementation and oversight.
• State regulatory bodies authorizing facilities.

Notable Legal, Constitutional, or Political Implications

• Relies on delegation of authority to the Secretary of HHS for specifying frequencies, adjustments, and additional conditions, which may involve regulatory rulemaking.
• References external evidence-based criteria from nonprofit associations, potentially affecting how standards are adopted.
• No explicit constitutional issues addressed; focuses on expanding federal health coverage entitlements under the Social Security Act.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Underwood, Lauren [D-IL-14]

Cosponsors (5)

Rep. Valadao, David G. [R-CA-22], Rep. Tonko, Paul [D-NY-20], Rep. Miller, Carol D. [R-WV-1], Rep. LaHood, Darin [R-IL-16], Rep. Bost, Mike [R-IL-12]

Recent Actions

• 2026-06-30: Referred to the House Committee on Ways and Means.
• 2026-06-30: Introduced in House
• 2026-06-30: Introduced in House

Bill Versions

• Residential Recovery for Seniors Act — issued 2026-06-30 — PDF (24 pages)