S. Rept. 114-101 - IMPROVING ACCESS TO EMERGENCY PSYCHIATRIC CARE ACT OF 2015114th Congress (2015-2016)
Committee Report
S. Rept. 114-101 - 114th Congress (2015-2016)
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Senate Report 114-101 - IMPROVING ACCESS TO EMERGENCY PSYCHIATRIC CARE ACT OF 2015
[Senate Report 114-101]
[From the U.S. Government Publishing Office]
Calendar No. 180
114th Congress } { Report
SENATE
1st Session } { 114-101
======================================================================
IMPROVING ACCESS TO EMERGENCY PSYCHIATRIC CARE ACT OF 2015
_______
July 30, 2015.--Ordered to be printed
_______
Mr. Hatch, from the Committee on Finance,
submitted the following
R E P O R T
[To accompany S. 599]
The Committee on Finance, to which was referred the bill
(S. 599) to extend and expand the Medicaid emergency
psychiatric demonstration project, having considered the same,
reports favorably thereon with an amendment and recommends that
the bill, as amended, do pass.
I. LEGISLATIVE BACKGROUND
The Committee on Finance, to which was referred the bill
(S. 599) to extend and expand the Medicaid emergency
psychiatric demonstration project, having considered the same,
reports favorably thereon with an amendment and recommends that
the bill, as amended, do pass.
Background and need for legislative action
A longstanding policy under Medicaid, called the
institutions for mental disease (IMD) exclusion, prohibits the
federal government from providing federal Medicaid matching
funds to states for services rendered to Medicaid eligible
individuals aged 21 through 64 who are patients in IMDs. IMDs
are inpatient facilities with more than 16 beds that primarily
treat people with mental health and substance abuse disorders.
While the original IMD exclusion is consistent with the goal of
treating severe mental illness in the least restrictive setting
feasible, there have been some unintended consequences. The IMD
exclusion provided an incentive to shift the cost of care for
mental illness to other care modalities and facilities where
Medicaid matching funds were available. This contributed to a
decrease in the number of publicly funded inpatient psychiatric
beds available for emergency services, and likely contributed
to psychiatric boarding and recidivism in general hospital
emergency departments. Psychiatric boarding occurs when an
individual with a mental health condition is kept in a hospital
emergency department for several hours or admitted to medical
wards or skilled nursing facilities without psychiatric
expertise because appropriate mental health services are
unavailable. This leads to potential serious consequences for
psychiatric patients and unnecessary hospital costs. The
Patient Protection and Affordable Care Act (ACA) authorized a
three-year demonstration to study the effects of allowing
federal Medicaid payment for emergency psychiatric treatment
otherwise prohibited by the Medicaid IMD exclusion. The
demonstration was funded with $75 million in FY 2011, and these
funds are available for obligation through December 31, 2015.
The Secretary of Health and Human Services selected eleven
states and the District of Columbia to participate in the
demonstration in March 2012, and the demonstration began July
1, 2012. The Committee recognizes the importance of extending
the demonstration in a budget neutral manner so that the
Secretary of Health and Human Services can finish its
evaluation of the demonstration and make an informed
recommendation regarding its continuation and expansion.
II. EXPLANATION OF THE BILL
PRESENT LAW
Section 2707 of the Patient Protection and Affordable Care
Act (ACA, P.L. 111-148 as amended) authorized a three-year
Medicaid demonstration project in which eligible states provide
Medicaid payments to certain IMDs for services provided to
Medicaid enrollees, aged 21 through 64, who require medical
assistance to stabilize a psychiatric emergency medical
condition. To participate in the demonstration, an IMD must be
(a) not publicly owned or operated and (2) subject to the
Emergency Medical Treatment and Active Labor Act (EMTALA, P.L.
99-272).
EXPLANATION OF PROVISION
The bill would temporarily extend the Medicaid Emergency
Psychiatric Demonstration for states already participating in
the demonstration through September 30, 2016, provided that it
meets the budget neutrality requirements as described below.
Then, if the Secretary of Health and Human Services (HHS)
recommends extending and expanding the demonstration, the
legislation would extend the demonstration through December 31,
2019, subject to the budget neutrality requirements as
described below. In April 2019, the Secretary of HHS would be
required to make a recommendation to Congress regarding the
permanent extension and expansion of the demonstration, but
congressional approval would be required to permanently extend
or expand the demonstration.
The bill would allow the demonstration funding to be
available until expended rather than expiring on December 31,
2015, and the bill would provide $100,000 to the Centers for
Medicare & Medicaid Services (CMS) Program Management to carry
out the demonstration.
States would be able to continue (for states already
participating) and begin (for new states) participation in the
demonstration if the Secretary of HHS and the Chief Actuary of
CMS project that participation of the state would not increase
Medicaid expenditures. The Secretary of HHS will provide notice
of projections to the states. Also the bill would require the
Secretary of HHS to annually review each state's demonstration
expenditures to ensure the state's participation in the
demonstration has not increased net Medicaid expenditures.
The bill would allow publicly owned IMDs to participate in
the demonstration.
EFFECTIVE DATE
The provision is effective on the date of enactment.
III. BUDGET EFFECTS OF THE BILL
A. Committee Estimates
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the following statement is made
concerning the estimated budget effects of the revenue
provisions of the ``Improving Access to Emergency Psychiatric
Care Act of 2015'' as reported.
S. 599 would increase direct spending by $100,000 over the
2015-2025 period. Because enacting the bill would affect direct
spending pay-as-you-go procedures apply. Enacting the bill
would not affect revenues.
B. Budget Authority
Budget authority
In compliance with section 308 (a)(1) of the Congressional
Budget and Impoundment Control Act of 1974 (``Budget Act'')\1\,
the Committee states that the bill as reported involves
increased budget authority (see Part A, above).
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\1\Pub. L. No 93-344.
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Tax expenditures
In compliance with section 308(a)(1) of the Budget Act, the
Committee states that the bill does not involve increased tax
expenditures.
C. Consultation With Congressional Budget Office
In accordance with section 403 of the Budget Act, the
Committee advises that the Congressional Budget Office has
submitted a statement on the bill.
S. 599--Improving Access to Emergency Psychiatric Care Act
S. 599 would extend the period of time during which the
Secretary of Health and Human Services could conduct the
Medicaid Emergency Psychiatric Demonstration Project and would
require the Secretary to recommend to the Congress whether to
continue and expand the demonstration. CBO estimates that
implementing S. 599 would increase direct spending by $100,000
over the 2015-2025 period. Because enacting the bill would
affect direct spending pay-as-you-go procedures apply. Enacting
the bill would not affect revenues.
With limited exception, under current law, Medicaid does
not cover services provided in psychiatric institutions to
enrollees aged 21 to 64. Rather, Medicaid payment is available
to other providers such as general hospitals that may provide
emergency psychiatric services to such enrollees. The
demonstration was established to assess the health outcomes and
cost effectiveness of allowing private psychiatric hospitals to
provide emergency psychiatric services to Medicaid enrollees
aged 21 to 64.
S. 599 would authorize the Secretary to extend a state's
participation in the demonstration from December 2015 through
September 2016 if the Secretary determines and certifies that
doing so would not increase net spending in the Medicaid
program. The bill would require, not later than September 30,
2016, that the Secretary recommend to the Congress whether the
demonstration should be continued beyond September 2016 or
expanded to any additional states. The Secretary would be
authorized to extend and expand the demonstration if the
Secretary also determines and certifies that doing so would not
increase net spending in the Medicaid program. After December
31, 2019, the Secretary's authority to continue or expand the
demonstration would expire. Finally, the bill would appropriate
$100,000 for fiscal year 2015 for the Secretary to carry out
the demonstration; thus increasing direct spending by that
amount.
S. 599 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandate Reform Act and
would impose no costs on state, local, or tribal governments.
The CBO staff contact for this estimate is Lisa Ramirez-
Branum. The estimate was approved by Holly Harvey, Deputy
Assistant Director for Budget Analysis.
IV. VOTES OF THE COMMITTEE
In compliance with paragraph 7(b) of rule XXVI of the
Standing Rules of the Senate, the Committee states that, with a
majority present, the ``Improving Access to Emergency
Psychiatric Care Act of 2015'' as modified was ordered
favorably reported on June 24, 2015 as follows:
Final Passage of the Improving Access to Emergency
Psychiatric Care Act of 2015--approved, as modified, by voice
vote.
V. REGULATORY IMPACT AND OTHER MATTERNS
A. REGULATORY IMPACT
Pursuant to paragraph 11(b) of rule XXVI of the Standing
Rules of the Senate, the Committee makes the following
statement concerning the regulatory impact that might be
incurred in carrying out the provisions of the bill.
Impact on individuals and businesses, personal privacy and paperwork
The bill is not expected to impose additional
administrative requirements or regulatory burdens on
individuals. The bill is expected to reduce administrative
requirements and regulatory burdens on some businesses.
The provisions of the bill do not impact personal privacy.
B. UNFUNDED MANDATES STATEMENT
This information is provided in accordance with section 423
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
The Committee has determined that the bill does not contain
any private sector mandates. The Committee has determined that
the bill contains no intergovernmental mandate.
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
In the opinion of the Committee, it is necessary in order
to expedite the business of the Senate, to dispense with the
requirements of paragraph 12 of rule XXVI of the Standing Rules
of the Senate (relating to the showing of changes in existing
law made by the bill as reported by the Committee).
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