HHS Study on Lifting IMD Exclusion Showed Little to No Reduction in Admissions, ER Visits or Spending

NYAPRS Note: A number of advocates and Congressman Tim Murphy’s mental health proposal seeks to bring Medicaid funding to state and private hospitals, considered Institutes for Mental Disease or IMDs. Medicaid is currently not permitted to pay for care in such facilities due to the federal policy called the ‘IMD exclusion.”
Yet, a recently released HHS study showed ‘little to no’ evidence to show that allowing Medicaid to pay for private psych hospitalizations reduced ER visits and psychiatric inpatient admission rates nor saved money.

The report did conclude that efforts to increase funding for inpatient services be balanced “within the context of a more comprehensive approach that considers distribution of new resources across all aspects of the system,” including community based care. See summary below.
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HHS Study on Lifting IMD Exclusion Showed Little to No
Reduction in Admissions, ER Visits or Spending
NYAPRS E- News October 25, 2016

Several years ago, Congress required the US Department of Health and Human Services to look at whether lifting longstanding federal rules prohibiting Medicaid reimbursement to private psychiatric hospitals would improve outcomes and reduce costs.

In response, HHS launched a Medicaid Emergency Psychiatric Services Demonstration (MEPD) between July 2012 and June 2015 in 11 states (Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, West Virginia and the District of Columbia) within 28 private psychiatric hospitals.

According to HHS, “the evaluation conducted a demonstration on the effects of providing Medicaid reimbursements to private psychiatric hospitals that treat beneficiaries ages 21 to 64 with psychiatric emergency medical conditions” (when an individual expressed suicidal or homicidal thoughts or gestures, or was judged to be a danger to him- or herself or others).”

The report was released last August. The results?

“Overall, we found little to no evidence of MEPD effects on inpatient admissions to IMDs or general hospital scatter beds; IMD or scatter bed lengths of stays; ER visits and ED boarding; discharge planning by participating IMDs; or the Medicaid share of IMD admissions of adults with psychiatric EMCs.

Available data suggest, however, that increased access of adult Medicaid beneficiaries to IMD inpatient care would likely come at a cost to the federal government.

Moreover, providing access to IMD services may not be able to address the numerous reasons other than inpatient bed searches that contribute to long stays of psychiatric patients in EDs.

Given the high cost of inpatient care relative to community-based care and major shortages in the availability of community-based care and psychiatric ED services across the country, future initiatives may wish to balance consideration of potential increases in funding for IMD and general hospital inpatient services within the context of a more comprehensive approach that considers distribution of new resources across all aspects of the system (inpatient, emergency, and ambulatory care).

https://innovation.cms.gov/Files/reports/mepd-finalrpt.pdf