IMD Exclusion Subject of States’ AGs letter to FEDS

Thirty Nine States’ Attorneys General have written a letter (https://ag.ny.gov/sites/default/files/final_letter_-_federal_barriers_to_treatment.pdfto Leaders McConnel, Schumer, Pelosi and McCarthy asking them, among other things, to fully repeal the Federal Institutes for Mental Disease (IMD) exclusion in Medicaid.

Our system of CRs is under the IMD exclusion so that currently only residential settings of 16 or fewer beds may bill Medicaid.  If these States’ Attorneys General are successful, all residential settings would be able to bill Medicaid.  That means that the state could introduce Medicaid into CRs that have 17 beds or more as well as into CR-SROs.  Of course, the federal government could enact a change that moves the number up but not allow it to be unlimited, so that some of our current IMD programs would go in while some stay out.    

This link provides a good explanation of the IMD exclusion as well as the pros and cons of repealing it.  https://lac.org/wp-content/uploads/2014/07/IMD_exclusion_fact_sheet.pdf

A link to an article on this topic can be found here. https://www.law.com/newyorklawjournal/2019/08/05/ag-james-joins-call-to-remove-barriers-to-treatment-for-opioid-use-disorder/

Of course we have concerns if this were to come to pass.   Introducing Medicaid into these much larger programs would require more staff, increase administrative burden and leave the programs open to OMIG audits (although OMIG has for the most part stopped auditing the smaller programs, I am sure they would monitor the new ones, at least at first.)

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