A new demonstration program to expand access to emergency psychiatric care for Medicaid beneficiaries could significantly cut state and hospital healthcare costs, reduce general acute care ED visits and help vulnerable patients get proper care, says the CMS.
The Medicaid Emergency Psychiatric Demonstration, administered by CMS’s Innovation Center, seeks to determine the following:
- Whether Medicaid reimbursement for psychiatric emergencies in institutes for mental diseases (IMD) settings increases care and quality at lower costs, and
- Whether expanded coverage reduces the burden on general acute care hospital emergency departments.
Up to $75 million in federal Medicaid matching funds will be distributed over three years to 12 states to enable private psychiatric hospitals and IMDs to receive Medicaid reimbursement for emergency care for Medicaid enrollees aged 21 to 64 who have an acute need for treatment. The states participating in the program are Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, West Virginia, and the District of Columbia.
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, these Medicaid beneficiaries in need of emergency psychiatric treatment have had to seek services in general hospital ERs, where they may not get the right care. Or they have gone to 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 officials state.
Source: CMS, March 13, 2012
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