Affordable Care Act Demonstration To Expand Access To Emergency Psychiatric Care
New Demonstration Program To Help States To Improve The Quality Of Care For Patients With Psychiatric Emergency
March 13, 2012
The Centers for Medicare & Medicaid Services (CMS) today announced that 11 States and the District of Columbia will participate in the Medicaid Emergency Psychiatric Demonstration, established under the Affordable Care Act to test whether Medicaid beneficiaries who are experiencing a psychiatric emergency get more immediate, appropriate care when institutions for mental diseases (IMDs) receive Medicaid reimbursement.
“This new demonstration will help ensure patients receive appropriate, high quality care when they need it most and save States money,” said CMS Acting Administrator Marilyn Tavenner.
This demonstration will provide up to $75 million in federal Medicaid matching funds over three years to 11 States-Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia– and the District of Columbia, to enable private psychiatric hospitals, IMDs, to receive Medicaid reimbursement for emergency care provided to Medicaid enrollees aged 21 to 64 who have an acute need for treatment.
The Demonstration will be administered by the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care.
Additional information can be found here: innovations.cms.gov/initiatives/medicaid-emergency-psychiatric-demo
To read the full CMS Press Release issued (3/13): http://www.cms.gov/apps/media/press/release.asp?Counter=4300
Also, the CMS Fact Sheet Additional information (3/13): http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4301
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Medicaid Emergency Psychiatric Demonstration
CMS worked collaboratively with private non-profit organizations and across the Department of Health and Human Services (HHS) to develop this demonstration. Partners included the American Association of Psychiatric Health Systems (AAPHS), and, within HHS, the Office of the Assistant Secretary for Planning & Evaluation (ASPE) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
Overview
This Demonstration will test whether Medicaid can support higher quality care at a lower total cost by reimbursing private psychiatric hospitals for certain psychiatric services for which Medicaid reimbursement has historically been unavailable.
This Demonstration provides $75 million over 3 years to the following State participants:
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Alabama |
Illinois |
North Carolina |
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California |
Maine |
Rhode Island |
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Connecticut |
Maryland |
Washington |
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District of Columbia |
Missouri |
West Virginia |
Background
Currently Medicaid does not reimburse psychiatric institutions, referred to in Medicaid as “institutions for mental disease” (IMDs) for services provided to Medicaid enrollees aged 21 to 64. This restriction is known as Medicaid’s IMD exclusion.
Due to the IMD exclusion, many Medicaid enrollees with acute psychiatric needs, such as those expressing suicidal or homicidal thoughts, are diverted to general hospital emergency departments, which often lack the resources or expertise to care for these patients. For the Medicaid beneficiary, this may result first in a delay in treatment, and then when treatment is provided, inadequate care. General hospitals may delay the provision of care until a bed becomes available, or inappropriately assign them to medical beds.
Initiative Details
The Medicaid Emergency Psychiatric Demonstration was established under Section 2707 of the Affordable Care Act to test whether Medicaid programs can support higher quality care at a lower total cost by reimbursing private psychiatric hospitals for certain services for which Medicaid reimbursement has historically been unavailable.
This demonstration will provide up to $75 million in federal Medicaid matching funds over three years to enable private psychiatric hospitals, also known as IMDs, to receive Medicaid reimbursement for treatment of psychiatric emergencies, described as suicidal or homicidal thoughts or gestures, provided to Medicaid enrollees aged 21 to 64 who have an acute need for treatment. Historically, Medicaid has not paid IMDs for these services without an admission to an acute care hospital first.
On August 9th, 2011, all State Medicaid Program Directors were invited to submit proposals to be considered through a competitive process. States were also required to specify how they would track patients and monitor stabilization and ensure proper patient discharge planning, as required by the law.
States were selected competitively through a rigorous independent panel selection process. Each State’s application was carefully reviewed, scored and ranked.