The Centers for Medicare and Medicaid Services (CMS) today announced that 11 states — including Maine — 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.
According to a CMS press release, “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 Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia and the District of Columbia, to enable 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.
Tavenner said in the press release 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.
© 2012 the Connecticut Post (Bridgeport, Conn.)
Distributed by MCT Information Services
Send the emergency psychiatric care to the Blaine House!
If it works, there its good to go!
Psychiatric intervention is not effective with personality disorders.
What is a personality disorder? You don’t agree with someone and they don’t agree with you, that means they have a personality disorder? Different point of view?
Ok, never mind. I knew someone diagnosed with a personality disorder and their immediate family said it just seemed like something wasn’t connecting since they were a young child. It is structure, not an illnes. They are born that way.
Autism and asperger’s are not illnesses, they are structural. Something is not necessarily connecting. It is not a chemical imbalance. Again, they were born that way.
I knew another person diagnosed with personality disorder, friends thought they were just lazy.
Expanded access? Wasn’t yesterday’s article about Dorothy Dix laying off 45 employees with another 40 or so on the chopping block? Nice expansion. Affordable Care Act = Government Expansion.
Good point. What is up with that?
Comprehensive mental healthcare is a GOOD thing. It’s better to identify and treat people in their 20’s then watch them slowly descend towards disability in their 40’s and 50’s.
More intense treatment early on. Costs more, but this is one area that I truly do believe will eventually be cost effective if implemented properly. Not to mention the improved quality of life many will have.
There will always be people suffering from mental illness and addiction that make the news, nothing is perfect. That doesn’t mean we turn our backs on friends and relatives in need. If say, 15 percent are malingering ,that still leaves 85 percent in true need of aid and understanding. Thought i’d throw that out before the people tossing out the “lazy” card.
It’s not necessarily government expansion so much as a more sensible way to distribute the money that’s already coming in (from us taxpayers) – people who go to the ER presenting with a mental health crisis are not necessarily effectively or thoroughly treated, but they do take up an awful lot of time and resources. If mental health medicaid patients are reimbursed for seeking appropriate mental health emergency treatment, they will no longer clog up the ER, which will save the Doc’s and nurses resources for treating those who really need it. If the government is going to be involved, I’d rather them do it sensibly than senselessly. Plus, not enough attention is paid to mental health. If this demonstration program goes well, hopefully Dorothea Dix can hire back those 45 people, and keep the others who are on the chopping block, off of it.
Not enough attention or too much attention to mental health, or the wrong kind of attention to mental health? Does everyone have a disorder because we are all different, or too many people qualify so now we have to alter who qualifies, so less are paid disability because there are too many people with mental issues these days?
The middle class needs it. Medicare and Medicaid people already get services….
Many people who are depressed have low serotonin levels. Serotonin is a sign of being well off, dominance and high social rank. The subordinate or poor man, or now the middle class is who has less than the rich and the welfare, is depressed and less aggressive. They are less apt “to right themselves by abolishing the forms to which they are accustomed.”
They are more apt to be a harm to themselves or others. Of course if their situation wasn’t so bleak they may not have such mental issues, but why would we want to stop the real cause?
Besides, mental health is still taboo. Who gets the kids if everyone has a mental issue? Why would anyone want to seek help and risk losing their children to someone who is paranoid, but is considered normal, or risk losing a job?
In their 40s and 50s they got to watch the kids grow up, that could also have kept them happier an busier, and have savings to live off of if anything happens/happened to their employment. Isn’t that also important to mental health?