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Treatment Advocacy Center

July 27, 2017

Oral Remarks prepared by the Treatment Advocacy Center for the Public Stakeholder Listening Session on Strategies for Improving Parity for Mental Health and Substance Use Disorder Coverage

Good morning:

My name is Frankie Berger, and I am the Director of Advocacy for the Treatment Advocacy Center. I appreciate the opportunity to provide comment during this morning’s public stakeholder listening session on strategies to improve parity in coverage.

The Treatment Advocacy Center is a national nonprofit dedicated exclusively to eliminating barriers to the timely and effective treatment of severe mental illnesses such as schizophrenia and bipolar disorder. Our organization promotes laws, policies, and practices for the delivery of psychiatric care, and supports the development of treatments for and research into the causes of severe and persistent psychiatric illnesses.

We applaud HHS for convening this meeting and the recognition by Congress and the Administration of the fundamental importance of applying parity rules consistently and in the spirit of the law.

While there are many important issues related to parity for coverage of mental health services, I would like to use this opportunity specifically to highlight the IMD exclusion and Medicaid Parity.

Institutions of Mental Disease and Medicaid Parity

People with serious mental illnesses are systematically ignored, stigmatized, abused, criminalized and routinely allowed to fall through the cracks of our negligent mental health care system. But perhaps the most radically pervasive barrier to treatment is the outdated, discriminatory Institutions of Mental

Disease (IMD) exclusion that prohibits Medicaid reimbursement for medically necessary services provided to non-geriatric adults in inpatient psychiatric facilities with more than sixteen beds.

For many individuals living with severe and persistent psychiatric illnesses, Medicaid serves as a lifeline providing access to necessary care and treatment. The Treatment Advocacy Center agrees with broad application of mental health parity to Medicaid, and we believe this necessitates reforming the long- standing IMD exclusion. Inpatient psychiatric care is an important part of the behavioral healthcare continuum. Research shows that treatment for psychiatric illnesses in appropriate settings for appropriate lengths of time can improve outcomes and greatly reduce overall costs, with the most cost savings realized through decreased acute hospitalizations.

We do not believe it is in the spirit of parity to deny Medicaid reimbursement for psychiatric treatment in facilities designed and equipped to provide this type of specialized care. Yet this is what currently stands as law, and our public psychiatric system is woefully unable to meet demand. Evidence of this is in our emergency departments, homeless shelters, streets, jails and prison systems.

Even with advancements in mental health service provision and access under the Affordable Care Act and parity, the IMD exclusion is the only section of federal Medicaid law that prohibits FFP to help states cover the cost of providing medically necessary care to Medicaid beneficiaries. For no other conditions than mental illness and substance abuse are Medicaid services excluded in certain medical institutions and for certain beneficiary populations. This is categorically inequitable, and arguments to uphold the IMD exclusion effectively mock the basic concept of parity.

Furthermore, we remain incredulous of claims that paying for care in IMDs will cause mass institutionalization at the expense of outpatient community services. Some patients need levels of care — as with any other medical illness — that simply cannot be provided safely in outpatient settings. Moreover, while community services are vitally important, we have had the IMD exclusion in place since

1965, and our community services are still largely failing to provide care to those who need it most. It is also important to note that we have extended reimbursement for this type of inpatient care in IMDs for both children and for the elderly because we recognize the value in providing necessary inpatient psychiatric care to vulnerable populations.

The IMD exclusion is an outdated harmful barrier to treatment for adults with severe mental illness, and we applaud CMS for taking recent steps in the right direction, including provisions to extend Medicaid MCO coverage to short-term care in IMDs notwithstanding the exclusion.

However, to provide better access to mental health services under Medicaid parity requirements, we believe the IMD exclusion must be fully repealed.

Thank you for your time.

Frankie Berger
Director of Advocacy
Treatment Advocacy Center

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Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on October 17, 2017