Legislation We’re Tracking:  IMD Exclusion Repeal

In late April, Representative Grace Napolitano (D-CA) introduced HR 2611, the Increasing Behavioral Health Treatment Act, which would repeal the Medicaid IMD exclusion.  It would require states to submit plans to increase access to outpatient and community-based behavioral health treatment including crisis stabilization services, and to improve data sharing and coordination between physical health, mental health, and addiction treatment providers and first responders. It is a very clean approach to resolving the largest and longest-standing violation of parity principles that has been tolerated in American health care.

Eliminating the IMD exclusion has long been a top priority of NACBH, and it has been some years since a complete repeal has been introduced in Congress.  We strongly support this bill and expect a companion measure to be introduced in the Senate in the coming weeks.  Watch this space and your email inboxes for details on NACBH’s advocacy plan.  We hope we can count on your participation to demonstrate keen interest on this side of a highly polarized political issue.  Posted here is an excerpt of the relevant statutory language with deletions and additions clearly indicated.

There are two additional efforts underway that NACBH supports, although both fall short of eliminating the discriminatory exclusion policy.  One is a coalition effort to carve Qualified Residential Treatment Programs (QRTPs) out of the IMD exclusion.  While doing so would remove the biggest barrier to states fully implementing the Family First Prevention Services Act, it would leave other congregate care settings that are eligible for IV-E funding still exposed to potential IMD compliance actions.  Legislative language has been developed but not yet introduced.

The other is the Expanding Access to Inpatient Mental Health Act, recently re-introduced by Rep. Tom Emmer (R-MN), which would eliminate the 15-day/month limit on treatment in IMDs for non-elderly adults enrolled in Medicaid managed care plans.  The bill has been renamed the Jim Ramstad Legacy of Recovery Act, in honor of the former Minnesota congressman and parity champion who died last November.  NACBH supports any chipping away at the IMD exclusion, but this change would not affect beneficiaries under age 21.  We mention it to avoid confusion should you hear about Congressman Emmer’s attempt to close what he refers to as a “loophole” in Medicaid coverage.