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Post Date: July 18, 2014

One-Third Of Admissions In Medicaid Emergency Psychiatric Demonstration Are For Schizophrenia Or Psychosis

Read the report here.

During the first year of the Medicaid Emergency Psychiatric Demonstration (MEPD) program, from July 2012 through June 2013, 33% of the 3,458 admissions in the 12 participating states were for adults Medicaid beneficiaries between age 22 and 64 diagnosed with schizophrenia (26%) or other psychotic disorders (7%). The MEPD allows the participating states to seek federal Medicaid reimbursement for emergency psychiatric care provided in a privately run facility classified as an institution of mental disease (IMD).

About 60% of MEPD admissions were for individuals diagnosed with depressive disorders (25%), bipolar disorders (25%), or other mood disorders (10%). The remaining 7% of admissions were for anxiety disorders (2%), substance-related disorders (1%), or other mental health diagnoses (2%). The 3,458 admissions were for 2,791 unique beneficiaries. Of the 2,791 beneficiaries, 84% had a single admission, and 11% had two admissions. The average length of stay was 8.2 days. About 88% of beneficiaries were discharged to their homes or self-care.

The federal Centers for Medicare and Medicaid Services (CMS) classifies an IMD as any inpatient or residential care facility with more than 16 beds in which more than half the residents are there to receive acute or long-term care for a mental health disorder. Normally, Medicaid will not reimburse for IMD care provided to an adult beneficiary between the ages of 22 and 64. Via the MEPD, CMS seeks to gather information to determine if expanding Medicaid coverage to include services provided by private IMDs improves access to and quality of medically necessary care for beneficiaries in psychiatric crisis and if the incidence of psychiatric boarding in emergency departments declines.

The “CMS Report To Congress On The Evaluation Of The Medicaid Emergency Psychiatric Demonstration” was submitted in December 2013. CMS announced the MEPD in August 2011, and invited states to submit proposals to participate in the three-year demonstration. The Patient Protection and Affordable Care Act of 2010 (PPACA) included funding of up to $75 million for the MEPD to provide federal Medicaid matching funds the selected states to cover the costs of emergency psychiatric care in participating specialized psychiatric facilities. The 12 states participating in the MEPD are Alabama, California, Connecticut, District of Columbia, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia. Each state Medicaid plan contracted with one or more privately run inpatient psychiatric care facilities considered IMDs to provide emergency psychiatric care. The interim report provides summary data collected by the states. The final analysis of data from July 2012 through December 31, 2015, will assess the impact of the MEPD on Medicaid costs and utilization. CMS recommended that Congress allow the program to continue through December 31, 2015 as initially authorized.