Residential Recovery for Seniors Act
Sponsored By: Representative Underwood, Lauren [D-IL-14]
Introduced
Summary
Creates a new Medicare Part A benefit covering residential substance use disorder treatment across three defined levels. This bill would set clear program and facility definitions, patient reassessment rules, provider enrollment and certification pathways, and a phased per-diem payment system so Medicare would reimburse qualified residential SUD care.
Show full summary
- Families and patients: Medicare beneficiaries with substance use disorder would have coverage for residential care at three levels: low-intensity, high-intensity, and medically managed. Ongoing need must be reaffirmed every 30 days for clinically managed care and not less often than every 10 days for medically managed care.
- Providers and facilities: Residential SUD programs that meet accreditation, State licensure, and Secretary-approved standards could enroll in Medicare and bill under a new per-diem prospective payment system. The PPS would begin for cost reporting periods on or after Oct 1, 2026 and the initial year would target payments equal to 100 percent of estimated reasonable costs.
- Clinical standards and services: Programs must follow evidence-based, SUD-specific criteria set by a recognized nonprofit medical association and keep comprehensive clinical records and transition plans. High-intensity programs must provide at least 20 hours of clinical services per week.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 4 benefits, 0 costs, 0 mixed.
Medicare coverage for residential SUD
If enacted, you could get Medicare Part A coverage for three residential substance use disorder care levels when you live in an eligible facility. Coverage would require an initial medical-necessity check using evidence-based SUD criteria approved by the Secretary. Continued need would have to be reaffirmed at least every 30 days for clinically managed levels and at least every 10 days for medically managed care. This could lower out-of-pocket costs for qualifying Medicare enrollees.
New rules for residential addiction care
If enacted, the bill would define three residential SUD service levels and set program, clinical, and facility standards for each. Rules would cover included and excluded services, admission assessments by a physician or advanced practice provider, minimum clinical hours or 24-hour nursing as applicable, recordkeeping, and transition planning. A Secretary-approved certifying body could be used to show compliance. The Secretary could allow a methadone access exception if no providers are available.
Per-day Medicare payments for SUD
If enacted, the Secretary would create a per-day prospective payment system for the three residential SUD levels. Payments would apply to cost reporting periods starting on or after October 1, 2026. In the first fiscal year aggregate prospective payments would equal 100 percent of estimated reasonable costs for residential SUD facilities. Later years would update rates by a market-basket percentage, and facilities would need to submit cost reports to set and run the system.
Residential SUD facilities can enroll
If enacted, clinically managed and medically managed residential SUD facilities could enroll in Medicare to bill for the specified residential services. Enrollment would follow standard Medicare rules and require accreditation, State authorization or licensure, and compliance with health and safety requirements. Enrollment would only cover the specific residential SUD services defined in the bill.
Sponsors & CoSponsors
Sponsor
Underwood, Lauren [D-IL-14]
IL • D
Cosponsors
Rep. Valadao, David G. [R-CA-22]
CA • R
Sponsored 6/30/2026
Rep. Tonko, Paul [D-NY-20]
NY • D
Sponsored 6/30/2026
Rep. Miller, Carol D. [R-WV-1]
WV • R
Sponsored 6/30/2026
Rep. LaHood, Darin [R-IL-16]
IL • R
Sponsored 6/30/2026
Rep. Bost, Mike [R-IL-12]
IL • R
Sponsored 6/30/2026
Roll Call Votes
No roll call votes available for this bill.
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