Comments to the Feds on the Medicaid Institute of Mental Disease [IMD] Exclusion Rule 

We do not think one can responsibly look @ the Medicaid IMD Exclusion Rule in Isolation without reference to other services needed by people with intensive mental health needs.
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Photo Credit: photographypla.net
 
​ORCHID favors repealing the IMD Rule --  BUT--
we're kidding ourselves [as we've been doing for sometime] if we think repealing the IMD RULE by itself is THE ANSWER.

Without a Comprehensive & Effectively Working Medicaid Mental Health Continuum of Care & Federal Administrative Enforcement of EXISTING LAWS -- repeal of the IMD Rule will be another cruel joke in Medicaid Mental Health Policy.

Opportunity for Comment to the FEDS:  Reforming the IMD RULE

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NAMI's Babu Mathew
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Dr. Lacey Berumen, Ph.D

​We're hoping that Gov. Polis' "Safety Net" Subcommittee of the Behavioral Health Task Force addresses the HUGE CHALLENGE of an Adequate Mental Health Continuum of Care within Colorado with a truly DIVERSE Group of Stakeholders.

NAMI Colorado Vice President & FaithNet Advisory Board Member Babu Mathew and NAMI National Board Member -- Colorado's own Dr. Lacey Berumen are getting the word out about an:

  • Opportunity for Public Comments on the Medicaid Institute for Mental Disease  Exclusionary Rule 

From the Letter to the right:

"As we develop our report to Congress, and to fulfill the requirement to seek input from stakeholders, MACPAC is interested in learning from interested parties about their views on the topics that the IMD ADDITIONAL INFO Act requires MACPAC to report on, including:

• state requirements, including certification, licensure and accreditation applied to IMDs seeking Medicaid payment and how states determine if requirements have been met;

• standards (e.g., quality standards, facility standards, and clinical standards) that IMD providers must meet in order to receive Medicaid payment and how the state determines if standards have been met;

• a description of IMDs receiving Medicaid payment including the number of these facilities, and the types of services provided; and

​ • a description of Medicaid funding authorities used to pay IMDs and any coverage limitations placed on the scope, duration or frequency of services provided in IMDs."

Comments are DUE May 31, 2019.  

​THE IMD RULE

The reality is there is a REASON for the IMD Rule --  it's to monetarily incentivize states to provide adequate mental health treatment in the Community.

       The only problem is it didn't work.  States didn't provide adequate bed space AND they didn't provide  adequate Intensive Community Mental Health Treatment -- and the ENFORCEMENT of Disability Civil Rights Laws has been INADEQUATE at best.

        Further, there are some pretty FUZZY ideas throughout State Medicaid Agencies and Diverse Advocacy Organizations & Individuals about:
  • What is needed for an ADEQUATE CONTINUUM OF CARE
  • What should be the criteria for Medicaid Residential Services
  • Assertive Community Treatment
  • Intensive Case Management
  • Peer Run Services 
  • Not to mention the need to catch up with the rest of world and institute the Finnish "Open Dialogue" MODEL which is indispensable given the SCIENTIFIC CHALLENGES RAISED by the National Institute of Mental Health  that the Mental Health Profession has NOT adequately addressed.  
How many beds we need is intimately tied to what Intensive Community Mental Health Services and Housing are available in the Community.

Orchid Proposes a Mash-Up

​Of the treatment Advocacy Center & Bazelon Positions on the Medicaid IMD EXCLUSion Rule
Preface:  We're facing an EMERGENCY in which people with "mental illness" are experiencing IRREPARABLE HARM in the hundreds of thousands across the country, and thousands in Colorado and pretty much thousands in every state.

We believe the current Medicaid IMD Exclusion Rule is:
  • Discriminatory under the Americans with Disabilities Act & is in fact leading to the Incarceration & Great Risk of Institutionalization inherent in Homelessness
  • Discriminatory under the Mental Health Parity & Addiction Equity Act of 2008.

We also believe that it is impossible to adequately address this without also addressing the HUGE FAILURES in MEDICAID COMMUNITY MENTAL HEALTH.

These 2 issues:  IMD & Medicaid Community Mental Health MUST be addressed in TANDEM as part of an overall COMPREHENSIVE MEDICAID MENTAL HEALTH CONTINUUM OF CARE.

Further, Americans with Mental Illness are in DESPERATE need of FEDERAL ADMINISTRATIVE ENFORCEMENT OF EXISTING LAWS & REGULATIONS, including:
  • Medicaid Network Adequacy
  • Mental Health Parity & Addiction Equity, & 
  • ADA/Olmstead
Treatment Advocacy Center on Medicaid's IMD Exclusion Rule & Discrimination
Bazelon on Medicaid's IMD Exclusion Rule -- Argument to Retain