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AFFORDABLE CARE ACT DEMONSTRATION TO EXPAND ACCESS TO EMERGENCY PSYCHIATRIC CARE

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

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.

Historically, federal law has prohibited Medicaid from paying for IMD services provided to Medicaid enrollees between the ages of 21 and 64.  As a result, when these particular Medicaid beneficiaries need emergency psychiatric treatment, they may seek services in general hospital emergency departments where services may not be matched to their needs or in psychiatric hospitals where the care is appropriate but reimbursement is not provided.  This has been detrimental to Medicaid beneficiaries, hospitals, and State Medicaid programs.

CMS Acting Administrator Marilyn Tavenner said that requiring the nearest emergency department to care for a person who is threatening to hurt himself or someone else “may not be an efficient use of health care dollars, and may be detrimental to vulnerable patients—especially when they could immediately be treated in the setting with more appropriate care.”  

The Medicaid Emergency Psychiatric Demonstration will test whether Medicaid reimbursement to treat psychiatric emergencies in IMD settings will enable States to increase the quality of care for people experiencing mental illness at lower cost, and will also test whether such expanded coverage reduces the burden on general acute care hospital emergency departments.

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.

The Affordable Care Act requires an evaluation of this demonstration program and a report to Congress.

Additional information can be found here: innovations.cms.gov/initiatives/medicaid-emergency-psychiatric-demo

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