Medicaid waivers allowed for inpatient psychiatric treatment

From Treatment Advocacy Center, November 13, 2018

This week marked a milestone for our efforts to reduce the preventable tragedies caused by the lack of inpatient treatment and encourage #aBedInstead.

The United States now has fewer state psychiatric treatment beds per capita than any other time in our nation’s history. Without necessary beds, those in need of care experience delayed treatment, unnecessary crises, rampant criminalization and countless preventable tragedies. In 2016, the Treatment Advocacy Center launched our #aBedInstead campaign to bring light to this crisis and demand change.

On Tuesday, Secretary Azar of the U.S. Department of Health & Human Services announced important regulatory changes that will allow states to receive Medicaid reimbursements for mental health treatment in inpatient settings known as IMDs, or institutions of mental disease.

Since the 1960s, Medicaid IMD law has prohibited such payments for adult inpatient treatment, undermining existing medical facilities and exacerbating a national bed shortage crisis – effectively denying medically necessary care. This longstanding policy has disproportionately discriminated against adults with serious mental illness, many of whom are Medicaid beneficiaries, and many of whom have suffered terrible outcomes resulting from an inability to receive timely, necessary treatment.

Both this presidential administration and the one before it have granted state waivers to permit inpatient treatment for people with substance use disorders, but people with severe mental illness were consistently left out, discriminated against simply because they were adults with a mental illness. That is why our executive director, John Snook, who serves on the Interdepartmental Serious Mental Illness Coordinating Committee, joined his colleagues in urging the Centers for Medicare & Medicaid Services to address this disparity while strengthening quality and continuity of care to community services. Their call was both heard and heeded.

Secretary Azar's recent announcement acknowledges the negative outcomes this policy has historically caused, and underscores the importance of both inpatient psychiatric care and connecting patients to robust community services to prevent the cycle of rehospitalization.

The new waiver guidelines set forth by the Centers for Medicaid & Medicaid Services create an opportunity for states to address their shortcomings in treatment delivery, by encouraging innovation that provides patients with access to a full continuum of care.

“Inpatient beds play an integral role in the treatment of serious mental illness that has been ignored for too long,” said Snook. “By making full use of this waiver process, states will have some recourse for mitigating the inexcusable discrimination of the IMD exclusion, and to provide necessary treatment for those most in need.” 

Like most complicated regulatory reform, it will take time for meaningful change to take effect. States that decide to apply for these waivers will need to demonstrate their plans to bolster community services while integrating inpatient IMD care into their broader treatment system to better help people with serious mental illness. However, this new partnership between federal and state governments offers enormous potential to improve psychiatric care and to reign in the costs associated with neglecting those most in need.

We thank all those who dedicated their time, effort, and energy to make this happen, and we will continue to update you on as work to fix our broken mental health treatment system.

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Hawaii Can Apply for Federal Funds to Pay for Mental Hospital Care

AP: …The Trump administration today allowed states to provide more inpatient treatment for people with serious mental illness by tapping Medicaid, a potentially far-reaching move to address issues from homelessness to violence.

Health and Human Services Secretary Alex Azar made the announcement today in a speech to state Medicaid directors, a group that represents Republican and Democratic officials from around the country who are confronting common, deeply-rooted social problems.

A longstanding federal law has barred Medicaid from paying for mental health treatment in facilities with more than 16 beds, to prevent “warehousing” of the mentally ill at the expense of federal taxpayers. Azar said states will now be able to seek waivers from that restriction, provided they can satisfy certain specific requirements….

“We have the worst of both worlds: limited access to inpatient treatment and limited access to other options,” said Azar, who stressed that inpatient care has to be combined with community-based services.

“Given the history, it is the responsibility of state and federal governments together, alongside communities and families, to right this wrong,” Azar added. “More treatment options are needed, and that includes more inpatient and residential options that can help stabilize Americans with serious mental illness.”

The lack of in-patient treatment beds for people with mental illness is a common denominator among several national problems: homelessness, police shootings, and acts of mass violence by people with serious mental problems.

Advocates said it may take a year or more to start seeing results of the new federal policy. States must apply for permission to the federal Centers for Medicare and Medicaid Services. They must demonstrate that their plans are part of a “continuum” or range of services for mentally ill people….

read … More leeway for states to expand inpatient mental health  

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