State Medicaid agencies want the CMS to extend the length of stay for inpatient psychiatric services, saying some patients with substance abuse disorders or severe depression need more time to get well. They worry the length of stay could affect treatment options.
Medicaid has never paid institutions of mental disease (IMDs) for beneficiaries 21 and over. Most residential treatment facilities for mental health and substance-use disorders with more than 16 beds did not qualify for Medicaid reimbursement.
However, a mega managed-care rule finalized last year allowed states to reimburse managed-care plans if patients with behavioral issues stayed in an IMD for no more than 15 days.
States are now realizing that might not be enough time for some patients, according to the National Association of Medicaid Directors, which wrote a letter sent last month to the CMS.
In the final rule, the CMS said the average length of stay for patients with mental health diagnoses was less than 15 days. Medicaid directors say that's not so for individuals with substance abuse problems, who may need as much as 28 days of care; and individuals with severe depression, who may need up to 21 days of care.
The National Association of State Mental Health Program Directors agrees the 15-day stay limit is too restrictive.
Colorado, Massachusetts, North Carolina, Oregon, Tennessee and Wisconsin asked for waivers that allowed their managed-care companies to cover inpatient psychiatric stays and had no day limits, said Stuart Gordon, the association's director of policy and healthcare reform.
State Medicaid agencies want the CMS to set longer stays for patients with mental health and substance use disorder diagnoses. They also want exceptions to the 15-day limit to accommodate patients whose conditions warrant longer stays.
For example, in treating resistant depression, standard practice when an initial medication trial fails, which may take five to seven days, is to then undergo electroconvulsive therapy, which generally takes an additional 10 to 14 days in a facility. Without exceptions, the 15-day limit may inappropriately incentivize nonstandard courses of treatment in these circumstances, the letter said.
The CMS did not did not return a request for comment.
It's likely President-elect Donald Trump will evaluate the request, even though he doesn't have to, since it asks to change a finalized rule. Trump has said he wants to reform mental healthcare but has not offered suggestions on how to do so.
But his pick for HHS secretary, U.S. Rep. Tom Price (R-Ga.) wants to reduce spending in both Medicare and Medicaid and stays in psychiatric facilities can be expensive.
An average inpatient weekly stay can range from $4,000 to $6,000 or even more.
The CMS estimates that 7.1% of adults ages 21 to 64 meet the criteria for serious mental illness that requires at least some inpatient treatment and that 13.8% experience serious substance abuse disorders.