“If an individual is suffering a mental health emergency—and the emergency is not accompanied by a physical health emergency—HHS/CMS should allow medical professionals to provide the individual with the option for treatment at a facility that specializes in mental health issues, instead of requiring the individual be cared for at a traditional emergency department,” the report stated.
The report also recommended changing Medicare reimbursement codes for state mental health facilities and other providers caring for mentally ill patients to alleviate the financial burdens on hospitals treating such patients in an emergency department setting.
The report called for a continuation of CMS' Medicaid Emergency Psychiatric Demonstration, a three-year, $75 million program established under the Patient Protection and Affordable Care Act to reimburse psychiatric hospitals for services Medicaid typically does not cover. Currently Medicaid does not reimburse psychiatric institutions for care provided to enrollees between the ages of 21 and 64.
In addition, the commission called for HHS and the CMS to develop protocols for the intake, evaluation, stabilization, transfer and discharge of patients with mental disorders.
But a key issue not fully addressed in the report is what to do about the shortage of available beds at many public mental health facilities, a problem that has led to cases of hospitals holding psychiatric patients within an emergency department as they wait for admission to a certified mental health facility.
The problem of psychiatric boarding has been seen across the country as states cut the number of beds in public psychiatric facilities for budget reasons. A total of 13 states closed 25% or more of their beds from 2005 to 2010, while some closed nearly half, according to a 2012 report by the Treatment Advocacy Center. Overall, the number of state psychiatric beds decreased by 14% during the same period.
“When states closed their mental institutions, they reallocated their mental health budgets,” the report found. “States do not provide adequate community mental health services and many states seek federal reimbursement under Medicare/Medicaid to supplant the states' original obligation to pay for this care.”
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