A $75 million demonstration project aims to see if Medicaid patients with a psychiatric emergency would get better, more efficient care from a psychiatric hospital.
Under current law, Medicaid cannot pay for care provided in psychiatric hospitals. Patients with a psychiatric emergency – those expressing homicidal or suicidal thoughts or actions – generally are treated in the emergency department, which may not be staffed or equipped provide adequate care for them, officials from the Centers for Medicare and Medicaid Services said in announcing the demonstration March 13.
Marilyn Tavenner
"This new demonstration will help ensure patients receive appropriate, high quality care when they need it most and save states money," acting CMS administrator Marilyn Tavenner said in a statement.
The three-year project – funded under the Affordable Care Act – covers Medicaid enrollees aged 21-64 years in 11 states and the District of Columbia. The project was designed based on proposals from the participating states: Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia.
Medicaid programs in participating states will receive federal matching funds to help pay for services needed by Medicaid patients being treated at private psychiatric hospitals. They'll also be required to match nearly 45% of federal dollars, resulting in $115 million to $120 million in total spending, said Mark Covall, president and CEO of the National Association of Psychiatric Health Systems. Following the demonstration, Medicaid programs will participate in a survey to evaluate changes in quality of care and program costs.
The American Psychiatric Association has opposed the Medicaid exclusion of private psychiatric hospitals since long before passage of the Affordable Care Act, Nicholas Meyers, APA director of government relations, said in an interview. He added that the organization is relieved that CMS is listening.
"We’re delighted to see that CMS has moved forward with this," Mr. Meyers said. "It will test what happened when a contradiction in federal law is eliminated and thus it will help insure that patients get the appropriate treatment and hospitals get reimbursed for the services they’re required to be providing."
Mr. Covall said the demonstration was approved because of both the increased awareness of the need for inpatient psychiatric care and the burden on the emergency care system. Since most emergency rooms don’t have enough beds to meet the demand, Mr. Covall said patients are often forced to stay in emergency rooms for hours, days, and sometimes even weeks. He added that the demonstration will help address barriers to access as well as cost implications.
"This will allow those patients that are in these emergency departments to be quickly triaged and sent over to the freestanding psychiatric hospital where they will be able to be fully assessed and then admitted to an impatient psychiatric unit," Mr. Covall said in an interview.
In addition to testing the affect of Medicaid reimbursement on the quality of care at psychiatric emergency facilities, the demonstration is also test whether expanded coverage will reduce the burden on general acute care hospital emergency departments.