CONGRESSWOMAN ELISE STEFANIK
On Monday, November 16, 2015, the House will consider the S. 599, the Improving Access to Emergency Psychiatric Care Act, under suspension of the rules. S. 599 was introduced on February 26, 2015, by Sen. Ben Cardin (D-MD) and passed the Senate by unanimous consent on September 28, 2015.
S. 599 authorizes the Secretary of Health and Human Services to extend the Medicaid Emergency Psychiatric demonstration program for states already participating in the program through September 30, 2016, if such extension would not increase net Medicaid spending. The bill also allows for the program to be extended until December 31, 2019, if it is determined that the continued participation of a state in the program will not increase net Medicaid spending. The bill requires the Secretary to recommend to Congress whether the demonstration should be continued beyond September 2016 or expanded to any additional states.
The bill also appropriates $100,000 for the Centers for Medicare and Medicaid Services (CMS) to carry out the program. The bill allows the funding for the program to be available until expended rather than expiring on December 31, 2015, as provided under current law.
 See Senate Report 114-101 at 2.
Generally, under current law, Medicaid does not cover services provided in psychiatric institutions, sometimes referred to as institutions for mental disease (IMD), 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 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 fiscal year 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 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 authorizes the Secretary to extend a state’s participation in the program until September 30, 2016 and until December 31, 2019, if it is certified that extending the program will not increase net spending.
According to the bill sponsor, “Too often Americans with emergency mental health needs are unable to receive the care they need due to bureaucratic red tape. This bipartisan legislation cuts through the red tape to make sure those in crisis have access to the specialized care they need to recover and lead healthy, productive lives. By working with the states, the federal government can be a partner in saving lives as well as vital resources.”
 Id. at 1.
 Id. at 2.
 See Sen. Ben Cardin Press Release, “Senate Unanimously Approves Cardin Legislation Streamlining Access to Emergency Mental Health Services,” October 2, 2015.
The Congressional Budget Office (CBO) estimates that implementing the Senate-passed S. 599 would increase direct spending by $100,000 over the 2015 to 2025 period, but the bill has been modified so that the $100,000 would come from existing resources. Because enacting the bill would affect direct spending pay-as-you-go procedures apply. Enacting the bill would not affect revenues.
For questions or further information please contact John Huston with the House Republican Policy Committee by email or at 5-5539.