As we've discussed previously, a new federal regulation from the Centers for Medicare and Medicaid Services (CMS) limiting federal funding for services to persons in Institute of Mental Disease (IMD) who are aged 21-64. Federal Rule 42 C.F.R. 438.6(e) prohibits the use of federal Medicaid funding to Managed Care Organizations whose members are in IMDs for more than 15 days during a calendar month.
We anticipate that our providers and other partners have questions surrounding this new federal rule. This notice is intended to clarify what we know about the IMD Policy tr
ansition and changes, what this will mean for Arizona
, and what procedural changes will take place to smooth implementation.
What does the law say?
The new federal regulation for IMDs:
- Is limited to adults aged 21-64
- Eliminates existing federal authority allowing the Arizona Health Care Cost Containment System (AHCCCS) to utilize IMDs with no limits (the "in lieu of" option)
- Limits coverage for IMD stays to 15 days during a calendar month
- Defines an IMD as a facility established and maintained primarily for the care and treatment of people with mental diseases
- Is intended to improve access to short-term inpatient psychiatric and substance-use disorder treatment for Medicaid managed care members
How does it affect Arizona?
Unlike most other states, Arizona has operated under an "in lieu of waiver" for many years, using federal matching funds for IMD stays in excess of 15 days. CMS granted the waiver, in part, because of Arizona's unique geographic and population density, which limited inpatient and residential services, in some areas. The new rule allowed an extension for implementation in Arizona to October 1, 2016. (AHCCCS is seeking a two-year delay in enforcement to smooth the transition.)
How will Mercy Care Plan and Mercy Maricopa Integrated Care implement the new rule?
Mercy Care Plan and Mercy Maricopa Integrated Care are committed to coordinating with facilities for members who have reached the 10th day of inpatient hospitalization in an IMD facility during a calendar month. These new procedures will take effect
October 1, 2017:
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IMD Admission Day
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Action to be Completed
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At admission
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Mercy Care Plan/Mercy Maricopa Integrated Care will
notify upon admission the estimated number of inpatient IMD days
that a member has utilized in the current calendar month.*
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Within 24 hours of admission
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IMD facility shall develop a discharge plan and communicate this specific plan to the assigned Mercy Care Plan/Mercy Maricopa Integrated Care Utilization Management (UM) consultant.
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10th Day
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A peer-to-peer discussion regarding discharge coordination will occur.
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13th Day
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Determination is made if member will be discharged by day 15. If medically necessary care is required beyond 15 days, and a safe transfer can be made, a transfer will be facilitated to a non-IMD treatment setting.
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14th Day
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Mercy Care Plan/Mercy Maricopa Integrated.Care UM Consultant will contact facility to ensure member is being discharged or that an appropriate transfer is arranged.
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15th Day
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Member will be discharged or transferred and the facility must provide same day discharge information to Mercy Care Plan/Mercy Maricopa Integrated Care to confirm the discharge of the member.
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