Mproving Access to Emergency Psychiatric Care Act

Floor Speech

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Mr. Speaker, I thank the gentleman for yielding and for his leadership on the Health Subcommittee and on the Energy and Commerce Committee.

I rise today in strong support of the Improving Access to Emergency Psychiatric Care Act. I thank Representative Brooks of Indiana for her support of this measure and certainly welcome the fact that this is a bipartisan piece of legislation.

What this bill would do is it would extend a demonstration project, as indicated, that ends the Federal prohibition on Medicaid matching payments to community psychiatric hospitals for emergency psychiatric cases. This demonstration project allows individuals with severe mental illness who are a threat to themselves or to others, including those with substance abuse disorders who have experienced overdoses, to get emergency inpatient treatment.

The background of this is as follows:

There has been a longstanding Medicaid provision, dating back to 1965, called the institutions for mental diseases, IMD, exclusion. Under that, the Federal Government is prohibited from providing Medicaid matching funds and reimbursement for the care of eligible individuals aged 21 to 64 if that care is provided in an inpatient facility that primarily treats people with mental health and substance abuse disorders and if that facility has more than 16 beds.

As was indicated, the effect of this exclusion has been to decrease the number of inpatient psychiatric beds that are available for emergency services. It has also been cited by the Government Accountability Office as a factor in emergency department overcrowding, which Congresswoman Brooks just indicated.

Community-based psychiatric hospitals could help relieve these backups and provide much-needed emergency psychiatric care, but these hospitals cannot receive Federal matching payments for these services.

In 2010, Congress authorized a 3-year pilot called the Medicaid emergency psychiatric demonstration project, which expanded the number of emergency inpatient psychiatric beds available in communities by allowing Federal Medicaid matching payments to freestanding psychiatric hospitals for emergency psychiatric cases.

Eleven States, including my home State of Maryland, are participating in this demonstration, and the preliminary data is very promising. Of the total number of Medicaid beneficiaries admitted to these community-based psychiatric hospitals, fully 84 percent had just one admission during the entire first year of the demonstration. The average length of stay was only 8.2 days, and in 88 percent of the admissions, the beneficiaries were discharged to their homes or to self-care.

The demonstration project is set to end on December 31, 2015, but the final evaluation of the project is not expected to be completed until a year later.

In closing, Mr. Speaker, this bill would build upon the success of the current demonstration project, which is providing timely and cost-effective care. It would also extend the current demonstration project by 1 year.

It would ensure budget neutrality by certifying that the extension is not projected to result in an increase in net Medicaid program spending, and it would allow the Secretary of HHS to extend the demonstration project for an additional 3 years, provided that the requirements regarding Medicaid spending are met.

The bill has already been passed in the Senate by unanimous consent. While I am a little bit disappointed that a very small change was made that is going to require it to go back to the Senate for reconsideration, I am confident that it will be supported there again with Senator Cardin's leadership.

I urge support of this bipartisan effort to extend a demonstration project that allows individuals with severe mental illness and substance abuse disorders to get emergency inpatient treatment at community psychiatric hospitals.

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