New bipartisan bill revisits IMD issue

Industry advocates who want to recraft the IMD exclusion policy must feel a lot like Sisyphus these days: They keep rallying support for changes only to have the issue roll down the legislative hill once again. The National Council for Behavioral Healthcare, the Joint Commission and others have endorsed a proposal reintroduced on May 17 by a group of bipartisan senators that would alter some of the IMD limits to increase access to care.

The Medicaid Coverage for Addiction Recovery Expansion (CARE) Act would allow Medicaid payment to residential addiction treatment facilities with up to 40 beds—an increase over the current 16 bed limit. It would also allow for treatment services for up to 60 consecutive days.

“The CARE bill is an example of the interest on Capitol Hill in trying to make residential addiction treatment more available in the Medicaid program,” says Chuck Ingoglia, senior vice president, public policy and practice improvement for National Council, which helped Sen. Dick Durbin (D-Ill.) draft the bill.

Ingoglia says the bill has more co-sponsors now in the 115^th Congress than when it was introduced in the previous session, noting the growing recognition of the importance of the IMD issue. Rep. Bill Foster (D-Ill.) introduced the companion bill in the House on May 25.

Full-scale repeal

Additionally, the Centers for Medicare and Medicaid Services (CMS) updated IMD rules within its authority last year and now allows managed care Medicaid—but not fee-for-service Medicaid—to pay for 15 day stays in residential mental health and addiction facilities with more than 16 beds. The new rules took effect in March 2017.

CMS also offers technical assistance and 1115 waiver information to help states improve access to inpatient services for Medicaid members.

“Given that, the fundamental problem they have is the underlying statute contains a payment prohibition,” Ingoglia says. “They’ve gone very far to do what they can within the strictures of the statute to make the service more available.”

The CARE Act approach is targeted to addiction treatment, and that’s likely deliberate.

“A full-scale repeal of the IMD exclusion would cost a lot of money,” Ingoglia says. “And Congress does not have the ability or the willingness to find the appropriate offsets to cover the costs of full repeal.”

In terms of impact, Durbin’s office estimates that the CARE Act would expand access in Illinois alone to an additional 535 addiction treatment beds in 18 facilities.

But in the meantime, “all the oxygen is being sucked out of the room by the repeal and replace of ‘Obamacare,’” Ingoglia says.