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California chosen by CMS as one of the 12 States For Emergency Psychiatric Care Demonstration

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On March 13, 2012, the federal Centers for Medicare and Medicaid Services (CMS) Center for Innovation launched the Medicaid Emergency Psychiatric Demonstration (MEPD) project in 12 states—Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia, and the District of Columbia.

The three-year MEPD will enable Medicaid to pay for inpatient psychiatric care for adults under age 65 provided by an institution of mental disease (IMD), which is defined as any inpatient psychiatric setting with more than 16 beds. Normally, under the Medicaid IMD exclusion, care provided to adults between the ages of 21 and 64 by an IMD, whether the facility is a private psychiatric hospital or a public facility (such as a state psychiatric hospital), is ineligible for federal Medicaid funding. Each of the participating states will select private psychiatric hospitals with 17 or more beds to participate in the demonstration. CMS anticipates that about 26 IMDs across the 12 states will participate. CMS has not yet provided a date for the implementation of the demonstration project.

The MEPD will pay for inpatient services necessary to stabilize a psychiatric emergency medical condition; these services will be determined by the beneficiary’s medical or psychiatric diagnosis and the physician’s treatment orders. Each participating state will submit a quarterly statement to CMS enumerating all patients cared for under the demonstration at the participating IMDs. The states will submit an operational protocol to provide a summary of the implementation and management of the demonstration. However these applications are not made public because the MEPD applications contain privacy-protected individual and proprietary business information for the states’ private psychiatric hospital partners.

CMS believes that the IMD exclusion has left general hospital emergency departments as the only place where Medicaid enrollees with acute psychiatric needs can seek immediate care although general emergency departments often lack resources or expertise to care for patients in a psychiatric emergency. As a result, patients may experience a delay in treatment or inadequate care. The three-year demonstration will test whether partially eliminating the prohibition against federal Medicaid payments to IMDs improves psychiatric care for people with mental illness and lowers state Medicaid program costs.

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