What is the Medicaid IMD exclusion?
The Medicaid Institutions for Mental Diseases (IMD) exclusion prohibits the use of federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds.
What is an IMD facility?
An IMD is defined as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, which includes substance use disorders (SUDs).
What is a NC LME MCO?
Local Management Entities – Managed Care Organizations (LME-MCOs) manage the care of beneficiaries who receive services for mental health, developmental disabilities or substance use disorders.
Is behavioral health covered by Medicaid?
You may not even realize that you are eligible for mental health care, especially since Medicaid expanded under the Affordable care Act. For adults, Medicaid covers behavioral health services including addiction and recovery treatment services.
Why is there an IMD exclusion?
The IMD exclusion was part of the Medicaid program as enacted in 1965 as part of the Social Security Amendments (P.L. 89-97). The exclusion was designed to assure that states rather than the federal government maintained primary responsibility for funding inpatient psychiatric services.
What is an IMD payment exclusion?
The IMD exclusion is a discriminatory federal rule that prohibits federal Medicaid reimbursement to states for adult patients receiving mental health or substance abuse care in a psychiatric or substance abuse treatment facility with more than 16 beds.
What level of care is IMD?
As defined in 42 CFR 435.1010, an IMD is a nursing facility, hospital, or other institution of more than sixteen beds which primarily provides diagnosis, inpatient psychiatric treatment or care of persons with mental diseases, including medical attention, nursing care and related services.
How many MCOs are in NC?
The seven organizations, called Local Management Entities/Managed Care Organizations or LME/MCOs, are responsible for managing and monitoring the provision of public mental health, intellectual and developmental disabilities, and substance use disorder services for people who are uninsured or are covered by Medicaid.
What are the MCOs in NC?
LME/MCO Directory
- Alexander. Vaya Health. 200 Ridgefield Court, Suite 206.
- Alleghany. Vaya Health. 200 Ridgefield Court, Suite 206.
- Ashe. Vaya Health.
- Avery. Vaya Health.
- Beaufort. Trillium Health Resources Office.
- Bertie. Trillium Health Resources Office.
- Bladen. Eastpointe Office.
- Brunswick. Trillium Health Resources Office.
Does Medicaid cover mental health in North Carolina?
Behavioral Health services for Medicaid enrollees with mental illness, developmental or other intellectual disability, and substance use diagnoses are provided under the North Carolina 1915(b)(c) Medicaid Waiver program.
What can Medicaid cover?
Medicaid provides a broad level of health insurance coverage, including doctor visits, hospital expenses, nursing home care, home health care, and the like. Medicaid also covers long-term care costs, both in a nursing home and at-home care. Medicare does not provide this coverage.
What is IMD in health care?
Institution for Mental Diseases List. The Department of Health Care Services (DHCS) has developed a list of Institution for Mental Disease (IMD) facilities according to the definition in the Centers of Medicare and Medicaid Services’ (CMS) Manual 4390 and Title 9, California Code of Regulations, Section 1810.222. 1.
Why is the IMD exclusion important for Medicaid?
Updating the IMD exclusion to allow for short-term stays in psychiatric hospitals helps strengthen the mental health system and provides those who rely on Medicaid with more treatment options. About one in eight visits to hospital emergency rooms involves a mental health or substance use condition.
When did the exclusion from Medicaid take place?
This discriminatory exclusion has been in place since Medicaid’s enactment in 1965, and it has resulted in unequal coverage of mental health care. Recently, states were given the option to cover short-term stays in psychiatric hospitals by applying for a waiver from the federal government.
Can a state use Medicaid to pay for an IMD?
Currently, the law prohibits states from using Medicaid to pay for care provided in “institutions for mental disease” (IMDs), which are psychiatric hospitals or other residential treatment facilities that have more than 16 beds.
Is the IMD exclusion a discriminatory policy?
This is discriminatory. This policy, known as the “IMD exclusion,” is the only part of the Medicaid program that doesn’t pay for medically necessary care simply because of the type of illness. The IMD exclusion is discriminatory and has a real-life impact on people’s ability to access needed treatment.