NYAPRS Note: Congressional members Ryan, Fudge and Kaptur have introduced ‘The Breaking Addiction Act’ that would allow the federal Health and Human Services Administration to accept state applications to waive the IMD exclusion as regards residential addiction treatment. Under that exclusion policy, inpatient facilities of over 16 beds have been considered institutions for mental diseases or IMDs and have not been eligible for federal Medicaid payments. The bill would specifically allow federal Medicaid reimbursements to states to treat a substance abuse condition in an IMD of not more than 60 beds.
This is significant in that unlike the vast majority of mental health services, many addiction recovery treatments are not Medicaid reimbursable.
On the other side, many advocacy groups like NYAPRS continue to oppose lifting the IMD exclusion for mental health intuitions since doing so would essentially bring Medicaid reimbursement into state psychiatric hospitals and private for profit hospitals for the first time.
Encouraging states to rebuild or expand state hospital facilities puts the incentives in the wrong place and is contrary to national efforts to adequately fund and deploy an adequate array of high response community based mental health recovery services. Private for profit psychiatric hospitals already take Medicaid managed care reimbursement, a funding stream that is growing exponentially as states move their behavioral health services into managed care designs.
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