The Centers for Medicare & Medicaid Services (CMS) issued a June 20 informational bulletin outlining new requirements under the 21st Century Cures Act for coverage of early and periodic screening, diagnostic, and treatment for children under age 21 who are receiving inpatient psychiatric services. The change goes into effect on Jan. 1, 2019.
Under current Medicaid statute, there is a general prohibition on payment for inpatient psychiatric services, but an exemption to the exclusion applies to beneficiaries under age 21. Under this benefit, an institution of mental diseases (IMD) or acute care hospital with an applicable psychiatric facility can receive reimbursement for such services. However, states are prohibited from claiming expenditures outside of the IMD services benefit. This effectively denies coverage for medically necessary, covered early and periodic screening, diagnostic, and treatment (EPSDT) services.
Section 12005 of the 21st Century Cures Act to require Medicaid reimbursement for all medically necessary EPSDT services provided to beneficiaries under age 21 who are receiving inpatient psychiatric hospital services. States do not need to make revisions to their state plans to reflect this change in policy. However, the bulletin notes that states are expected to provide all necessary EPSDT services by the effective date.
Contact Senior Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.