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MACPAC Issues IMD Report

The Medicaid and CHIP Payment and Access Commission (MACPAC) issued a report to Congress detailing oversight of institutions for mental disease (IMDs).

This report is statutorily required by the October 2018 SUPPORT for Patients and Community Act (H.R. 6), which directed MACPAC to identify facilities designated as IMDs in selected states; provide a summary of federal oversight, state oversight, and licensing and accreditation requirements; and detail Medicaid clinical and quality standards.

In the report, MACPAC provides an overview of the Medicaid IMD exclusion and federal regulations pertaining to Medicaid payments for IMDs. The IMD exclusion has been in place since 1965 and prohibits Medicaid payments for services provided to beneficiaries residing in IMDs. Even with the exclusion in place, states have leveraged federal exemptions and authorities to make payments for services provided in an IMD through Medicaid Section 1115 demonstration waivers, state plan amendments, and certain Medicaid managed care arrangements.

MACPAC found that federal oversight and guidance of IMDs varied since not all IMDs are Medicare providers, and thus subject to the Medicare certification process. At the state level, MACPAC found that oversight was fragmented and state standards differed depending on whether the IMD provides substance use disorder or mental health services.

MACPAC details its review of seven states (California, Colorado, Florida, Massachusetts, New Jersey, Ohio, and Texas) and their respective licensing and accreditation requirements. The report also provides information on the type of services provided in IMDs and the clinical and quality standards used and enforced by states. Further, MACPAC includes a chapter outlining the existing federal and state protections for patients in IMDs.

CMS To Reduce Psychiatric Hospital Burden

Relatedly, the Centers for Medicare & Medicaid Services (CMS) issued a Jan. 13 memorandum to states detailing integration of the psychiatric hospital program survey into the hospital program survey to determine compliance with Medicare conditions of participation.

CMS is integrating the surveys to better identify systemic issues affecting quality of care and to reduce costs and administrative burden. CMS also plans to transfer the survey activities to states and will develop the necessary training for state surveyors to evaluate psychiatric hospital compliance.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Zina Gontscharow is a former senior policy analyst for America's Essential Hospitals.

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