Improving Access to Emergency Psychiatric Care Act

Floor Speech

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Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, the bill before us today extends and expands the Medicaid emergency psychiatric demonstration project.

A longstanding policy under Medicaid, called the institutions for mental diseases, IMD, exclusion, prohibits the Federal Government from providing Federal Medicaid matching funds to States for services rendered to Medicaid-eligible individuals aged 21 to 64 who are patients in IMDs. IMDs are inpatient facilities with more than 16 beds that primarily treat people with mental health and substance abuse disorders. The original IMD exclusion is consistent with the goal of treating severe mental illness in the least restrictive setting feasible.

The IMD exclusion provided an incentive to shift the cost of care for mental illness to other care modalities and facilities where Medicaid matching funds were available. However, since the IMD exclusion was included with the creation of the Medicaid program in 1965, our mental healthcare system and overall healthcare system have evolved notably.

In recent years, we have seen a significant decrease in the number of publicly funded inpatient psychiatric beds available for emergency services. This has contributed to patients in need of critical mental health services facing psychiatric boarding in general hospital emergency departments.

Psychiatric boarding occurs when an individual with a mental health condition is kept in a hospital emergency department for several hours or admitted to medical wards or skilled nursing facilities without psychiatric expertise because appropriate mental health services were unavailable. This leads to potential serious consequences for psychiatric patients and unnecessary hospital costs.

The Patient Protection and Affordable Care Act authorized a 3-year demonstration program to study the effects of allowing Federal Medicaid matching funds to pay for emergency psychiatric treatment for adults that is otherwise prohibited by the Medicaid IMD exclusion. The demonstration was funded with $75 million in FY 2011, and these funds were available for obligation through December 31, 2015.

The HHS Secretary selected 11 States and the District of Columbia to participate in the demonstration program in March of 2012, and the demonstration program began July 1, 2012. Due to significant State interest, patient need, and other factors, the demonstration project exhausted its Federal funding in April and was forced to terminate early.

S. 599 would temporarily extend the Medicaid emergency psychiatric demonstration for States already participating in the demonstration through September 30, 2016, if the chief actuary of CMS certifies that this extension would not increase net Medicaid spending.

The bill also requires that, not later than September 30, 2016, the HHS Secretary report to Congress on whether the demonstration should be continued after such date and whether the demonstration should be expanded to additional States. If the chief actuary of CMS certifies that this extension would not increase net Medicaid spending, then the demonstration may continue not beyond 2019.

While I have strong concerns with the President's healthcare law, S. 599 would let States and CMS continue to test the provision of critical mental health services for patients in a manner that is responsible for the Federal budget.

Mr. Speaker, I encourage my colleagues to support this commonsense, bipartisan bill.

I reserve the balance of my time.

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