By Pam Romine, GPS Office and Volunteer Coordinator

At this year’s King County Mental Health and Substance Abuse Legislative Forum, attendees were presented with a slate of legislative priorities and requests related to behavioral health and substance abuse. One of the requests is to revise the federal Institutions for Mental Disease (IMD) exclusion rule to exempt stays of 30 days or less. This would allow Medicaid to be used nationwide for mental health evaluation and treatment (E&T) facilities as well as substance abuse detoxification facilities that are larger than 16 beds (classified as IMDs), thereby preserving critical resources foe individuals in behavioral health crisis.

First we need to understand the federal (Medicaid) Institution for Mental Disease (IMD) Exclusion. Medicaid is the nation’s largest Insurance program spending approximately 53% of total national expenditures for the treatment of conditions classified as mental diseases under professional medical guidelines. However the exclusion, known as the “Medicaid IMD exclusion”, part of the federal program since1965, bars federal contributions to the cost of medically necessary inpatient care incurred in treating Medicaid beneficiaries ages 21-64 who receive care in certain institutions that fall within the definition of an “institution for mental disease.” An “institution for mental diseases” is defined as “a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care and related services.”

Under the rule Medicaid funds cannot be used to reimburse care for adults 21-64 years of age with long term mental illness or drug and alcohol issues who are in facilities with more than 16 beds. This exclusion has a profound effect on the poor who cannot afford to pay for mental evaluations and treatments. By revising the exclusion rule to exempt stays of 30 days or less would allow Medicaid, federal funding not state funding, to be used for mental health evaluations and treatment facilities as well as substance abuse detoxification facilities. This will allow the poor to have more services.

In September 2014 Medicaid updated Washington State’s waiver to include temporary and limited authority to use Medicaid funds in IMD facilities for short-term mental health stays in lieu of more expensive inpatient hospital stays. Although great news, this waiver is subject to renewal every 2 years and it does not cover substance abuse services including Detoxification.

Two of the largest psychiatric facilities in the state – Fairfax and Navos, and the main detoxification facility in the state – Recovery Centers of King County, are classified as IMDs. If we revise the Exclusion then Medicaid would be would allow to reimburse these facilities for inpatient stays less than 30 days for the 21-64 ages patients, enough time for mental evaluations and detox services.

If the federal IMD exclusion is revised as proposed to exempt stays of 30 days or less, individuals in need of urgent care will have greater access to services. Millions of dollars in state funds would be saved and redirected to new and improved community services.

A permanent and comprehensive legislative solution is needed. So join us in letting our policy makers know why this is so important to our families.  On March 23, 2015, we will go to Olympia for the ‘Stand In Our Shoes’ Rally at 1pm on the Flag Circle between the Washington State Supreme Court Building and the House of Representatives.  Let your voice be heard! Register to attend at http://goo.gl/wwjcwB.

Through the month of February you can read our Blog for more information about King County mental health and substance abuse legislative priorities.