CEO Update 136
CBO Examines Budgetary Effects of Modifying or Eliminating Medicaid’s IMD Exclusion
The Congressional Budget Office (CBO) this week released a new report examining the federal budgetary effects if federal lawmakers amend or eliminate Medicaid’s Institutions for Mental Diseases (IMD) exclusion for mental health and substance use disorder (SUD) services.
Under the IMD exclusion, the federal government does not make matching payments to states for expenditures for services to Medicaid enrollees between the ages of 21 and 64 who are in certain inpatient facilities. The updated analysis from CBO quantifies the effects of two options—each with three alternatives—for expanding federal Medicaid payments for those excluded services.
Current law allows states to amend their Medicaid plan and receive federal matching fund through Sept. 30, 2023 to care for Medicaid enrollees between the ages of 21 to 64 with at least one SUD in eligible IMDs if several criteria are met. CBO estimates that permanently extending this option, known as the “state plan option,” would increase federal Medicaid expenditures by $155 million to $560 million, on net, over the 2024-2033 period. This range reflects the three alternative specifications of the option that CBO analyzed.
Eliminating the IMD exclusion would increase expenditures by larger amounts: CBO estimates that eliminating the IMD exclusion for SUD stays would increase federal Medicaid expenditures by $7.7 billion, on net, between 2024-2033; eliminating the exclusion for mental health disorder stays would increase expenditures, on net, by $33.5 billion during that period; and eliminating it for both types of stays would increase expenditures, on net, by $38.4 billion in that timeframe.
The CBO acknowledged the level of uncertainty that comes from predicting whether and which of the exceptions to the IMD exclusion states may adopt over the 2023-2033 period under current law. The agency also commented on the elevated need for services today, given the opioid crisis and COVID-19 pandemic, as well as where enrollees receive care.
“With the IMD exclusion in place, some Medicaid enrollees may be receiving care in settings (such as general acute-care hospitals) that are available with federal reimbursement rather than in settings that are most appropriate for their conditions,” the CBO report noted. “Increased access to care in IMDs might shift where care is delivered, which could affect the capacity of certain providers. Such effects are in line with the decreased use of emergency department services for SUD that CBO observed in states that adopted section 1115 SUD waivers,” it continued. “Increased availability of federal funds might also affect the capacity of inpatient and residential service providers by enabling facilities to expand, although shortages in the behavioral health workforce could limit such effects.”
A message from CBO Director Phillip Swagel on the report’s last page noted that the agency prepared the analysis at the request of the House Energy and Commerce Committee. NABH has been working with the committee and is pleased with the heightened interest from federal lawmakers to consider modifying or eliminating the outdated IMD exclusion.
NABH 2023 Annual Meeting Preliminary Program is Now Available!
NABH is pleased to announce the preliminary program for the 2023 Annual Meeting is now available.
Unless noted otherwise, meeting sessions are open to all Annual Meeting attendees.
Please remember to register for the Annual Meeting and reserve your hotel room today, if you haven’t done so yet. We look forward to seeing you in Washington!
2023 NABH Exhibitor and Sponsor Guide Ad Deadline is Next Friday, April 21!
NABH will distribute the 2023 NABH Exhibitor and Sponsor Guide to all registrants at the 2023 NABH Annual Meeting from June 12-14, 2023 at the Salamander Washington, DC. Be sure your organization is included in it!
All ads are due by next Friday, April 21, 2023. Please click here for details about advertising options, requirements, payment, and more.
The association also will send the guide to all NABH members after the meeting and post it on the NABH Annual Meeting webpage.
HHS Announces Certain PHE Flexibilities to Expire on End on May 11
HHS announced this week that certain COVID-19 public health emergency (PHE) flexibilities related to the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Health Information Technology for Economic and Clinical Health Act will end when the PHE ends on May 11.
The flexibilities set to expire next month relate to use and disclosure of protected health information by business associates for public health oversight, COVID-19 community-based testing during the PHE, online scheduling applications for a COVID-19 vaccine appointment, and telehealth remote communications.
HHS said its Office of Civil Rights (OCR) will provide a 90-day transition period to exercise its enforcement of remote telehealth communications until August 9, 2023.
“OCR exercised HIPAA enforcement discretion throughout the COVID-19 public health emergency to support the healthcare sector and the public in responding to this pandemic,” OCR Director Melanie Fontes Rainer said in a news release. “OCR is continuing to support the use of telehealth after the public health emergency by providing a transition period for healthcare providers to make any changes to their operations that are needed to provide telehealth in a private and secure manner in compliance with the HIPAA rules.”
SAMHSA Seeks Public Comment on 2023-2026 Draft Strategic Plan
The Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking public comment on the agency’s draft 2023-2026 SAMHSA Strategic Plan that presents a person-centered mission and mission highlighting SAMHSA’s priorities and principles.
SAMHSA’s five priority areas include preventing overdose; enhancing access to suicide prevention and crisis care; promoting resilience and emotion health for children, youth, and families; integrating behavioral and physical healthcare; and strengthening the behavioral healthcare workforce. The agency’s four core principles are equity, trauma-informed approaches, recovery, and commitment to data and evidence.
Comments on the draft plan are due by 5 p.m. ET on Thursday, April 27. Click here to submit comments.
Reminder: Please Submit Data to Enhance NABH’s Managed-Care Advocacy Efforts
Thank you to all members who have submitted data to NABH’s denial-of-care portal. Your data will help NABH highlight problems in the field related to health plan denials and timeliness.
Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.
Fact of the Week
A suicide mortality report from the Centers for Disease Control and Prevention this week shows that from 2001 to 2018, the total suicide rate increased 33%, from 10.7 deaths per 100,000 standard population to a high of 14.2. This recent peak was followed by two consecutive years of declines in 2019 (13.9) and 2020 (13.5). After these declines, however, the rate increased 4% to 14.1 in 2021, the largest annual increase in the rate during the 2001–2021 period.
For questions or comments about this CEO Update, please contact Jessica Zigmond.