[Congressional Record Volume 151, Number 106 (Friday, July 29, 2005)]
[Senate]
[Pages S9511-S9514]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Mr. Conrad, Mrs. Lincoln, and Ms. 
        Collins):
  S. 1592. A bill to amend title XIX of the Social Security Act to 
permit States to obtain reimbursement under the Medicaid program for 
care or services required under the Emergency Medical Treatment and 
Active Labor Act that are provided in a nonpublicly owned or operated 
institution for mental diseases; to the Committee on Finance.
  Ms. SNOWE. Mr. President, I rise today to introduce the Medicaid 
Emergency Psychiatric Care Act of 2005, which will serve to improve 
access to mental health treatment and remove an unfunded mandate on our 
private mental health treatment centers. I am particularly pleased to 
introduce this bill with several of my colleagues, Senators Conrad, 
Lincoln, and Collins, who share my belief that we must improve access 
to treatment for many of the 18.5 million Americans who are afflicted 
with a mental health disorder.
  Our bill will move a step closer to achieving this goal by requiring 
the Medicaid program to provide reimbursement to private mental health 
facilities that receive patients under the Emergency Medical Treatment 
and Labor Act, known as EMTALA. EMTALA requires hospitals to provide 
emergency care to patients, regardless of their ability to pay. 
However, this stands in conflict with Medicaid law, which in most cases 
prohibits payment for psychiatric treatment for people between the ages 
of 21 to 65 years. Our legislation will remedy that situation by 
providing Medicaid coverage for emergency treatment for mental illness, 
thus expanding access for acute psychiatric care and ensuring that 
patients with mental disorders receive the assistance they vitally need 
in a timely fashion.
  Under current law, Medicaid payment for psychiatric treatment for 
patients between the ages of 21 and 65 years is restricted to hospitals 
that have an in house psychiatric ward. If a patient seeks care from a 
private psychiatric hospital or is transferred to a private facility 
from a community hospital, Medicaid does not provide reimbursement due 
to the so-called Institutions for Mental Disease, IMD, exclusion. In 
comparison, if the same patient seeks care under EMTALA from a hospital 
because of a physical ailment, Medicaid provides coverage regardless of 
the type of facility that provides the treatment. I have therefore 
joined together with Senator Conrad, Senator Lincoln, and Senator 
Collins to introduce legislation that will require Medicaid to pay for 
the cost of care associated with emergency psychiatric treatment 
necessary to comply with EMTALA. No longer will private entities be 
required to shoulder the burden of this Federal mandate, and no longer 
will Medicaid-eligible beneficiaries go without access to necessary and 
appropriate emergency care.
  This bipartisan legislation has been carefully crafted with input 
from both the provider and beneficiary communities to ensure that 
assistance is directed to those who are most in need and to ensure that 
the coverage only extends to people who require emergency treatment. 
The definition in the EMTALA statute of an emergency is straightforward 
for psychiatric patients. Patients must present as a danger to 
themselves or others--for example, as being suicidal or threatening 
physical harm to others.
  Our bill also offers a targeted and low-cost solution to ease the 
crisis in emergency departments. Emergency department overcrowding is a 
growing and severe problem in the United States, and dedicated 
physicians and nurses who work in emergency rooms are reaching a 
breaking point where they may not have the resources or surge capacity 
to respond effectively. Patients often face a long wait in the 
emergency room, sometimes for days, because there is no bed or other 
appropriate setting available. Tens of thousands of dollars every day 
are being spent inefficiently on extended treatment in emergency rooms 
that is not the most appropriate or clinically effective care.
  This crisis in emergency departments impacts everyone's access to 
lifesaving care. According to a May 2005 report by the Centers for 
Disease Control and Prevention, the number of annual emergency 
department visits increased 26 percent over a 10-year period, from 90.3 
million in 1993 to 113.9 million visits in 2003--an average increase of 
more than 2 million visits per year. During the same time, the number 
of hospital emergency departments decreased by more than 12 percent, 
resulting in a greater number of visits to emergency departments that 
remain open.

  How do these problems affect emergency care for all of us? 
Overcrowded emergency rooms result in reduced availability of 
physicians, nurses, and healthcare staff; fewer available examination 
areas and beds; longer waits for patients and their families; and 
hospitals more frequently having to divert patients by ambulance to 
other hospitals.
  The existing situation is not only jeopardizing access to emergency 
rooms and treatment but ultimately, in many cases, it is overwhelming 
the criminal justice system. The U.S. Department of Justice estimates 
that, on average, 16 percent of inmates in local jails suffer from a 
mental illness, and in Maine, the National Alliance for the Mentally 
III, NAMI, an advocacy group for persons with mental illness, estimates 
that figure is as high as 50 percent. In my home state of Maine, 65,000 
people have a severe mental illness but with the severe shortage of 
psychiatric beds in the State, many people go without treatment. We 
must take action to provide the mentally ill with better access to 
care, and we must start by ensuring that Medicaid reimburses the 
facilities that provide treatment.
  Passing the Medicaid Emergency Psychiatric Care Act and providing 
Medicaid coverage for emergency psychiatric treatment in both general 
and psychiatric hospitals will accomplish several goals. First, and 
most importantly, it will result in better psychiatric emergency care 
for patients. Second, it will result in more efficient and effective 
use of both Federal and State Medicaid dollars. Third, by resolving the 
current conflict in Federal law between EMTALA requirements and the 
Medicaid IMD exclusion from reimbursement, the bill will enable

[[Page S9512]]

freestanding psychiatric hospitals to receive reimbursement for 
Medicaid psychiatric patients on the same basis as general hospitals 
and help preserve the viability of these hospitals.
  We have received strong support from a number of leading national 
mental health and medical associations who confirm the critical need 
for this legislation, including NAMI, the National Association of 
County Behavioral Health Directors, the American Psychiatric 
Association, the American College of Emergency Physicians, the American 
Hospital Association, and the National Association of Psychiatric 
Health Systems. I am especially pleased to have also received 
endorsements from a number of Maine organizations, including the Maine 
Hospital Association, Spring Harbor Hospital, and NAMI Maine.
  This legislative change is vitally important to ensure that Medicaid 
patients with mental illness receive the right care at the right time 
in the right setting, instead of prolonged stays in emergency rooms and 
in hospital settings without psychiatric specialty care. The cost of 
achieving a more efficient, effective, and clinically appropriate care 
system for psychiatric emergencies is small and well worth it. I urge 
my colleagues to join us in cosponsoring the bill.
  I ask unanimous consent that these letters of support be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:
                                                 National Alliance


                                         for the Mentally Ill,

                                     Arlington, VA, July 11, 2005.
     Hon. Olympia Snowe,
     U.S. Senate, Russell Senate Office Building,
     Washington, DC.
       Dear Senator Snowe: On behalf of the 210,000 members and 
     1,200 affiliates of the National Alliance for the Mentally 
     Ill (NAMI), I am writing to express support for your 
     legislation, the Medicaid Emergency Psychiatric Care Act of 
     2005. NAMI strongly supports this important effort to address 
     the growing crisis in access to acute care services for non-
     elderly adults living with severe mental illness. As the 
     nation's largest organization representing individuals with 
     severe mental illness and their families, NAMI is pleased to 
     support this important measure.
       As NAMI's consumer and family membership knows first-hand, 
     the acute care crisis for inpatient psychiatric care is 
     growing in this country. This disturbing trend was identified 
     in the recently released Bush Administration New Freedom 
     Initiative Mental Health Commission report. Over the past 15-
     20 years, states have closed inpatient units and drastically 
     reduced the number of acute care beds. Also, general 
     hospitals, due to severe budget constraints, have had to 
     close psychiatric units or reduce the number of beds. This 
     has resulted in a growing shortage of acute inpatient 
     psychiatric beds in many communities.
       The Medicaid Emergency Psychiatric Care Act will address an 
     important conflict in federal policy that has contributed to 
     restricted access to needed inpatient services--the Medicaid 
     Institution for Mental Diseases (IMD) Exclusion and the 
     Emergency Medical and Labor Treatment Act (EMTALA). EMTALA 
     requires hospitals to stabilize patients in an emergency 
     medical condition, while the IMD exclusion prevents certain 
     hospitals (psychiatric hospitals) from receiving Medicaid 
     reimbursement for Medicaid beneficiaries between the ages of 
     21-64 in these circumstances.
       This important measure will allow Medicaid funding to be 
     directed to non-publicly owned and operated psychiatric 
     hospitals (IMDs) for Medicaid beneficiaries between the ages 
     of 21-64 who require stabilization in these settings as 
     required by EMTALA. Today, these hospitals are denied payment 
     for care required under the EMTALA rules. The result is that 
     psychiatric hospitals are forced to absorb these added costs 
     of care to their already growing un-reimbursed care even 
     though these patients have insurance through Medicaid.
       This legislation will go a long way in addressing the 
     growing psychiatric acute inpatient crisis, while creating 
     fairness in the reimbursement structure for psychiatric 
     hospitals under the limited circumstances required by the 
     EMTALA law. Your leadership in carefully crafting and 
     introducing this targeted legislation addressing a critical 
     problem for persons with serious mental illnesses is much 
     appreciated. NAMI looks forward to working with you and your 
     Senate colleagues to ensure passage of this important 
     legislation.
           Sincerely, 
                                   Michael J. Fitzpatrick, M.S.W.,
     Executive Director.
                                  ____

                                                    July 26, 2005.
     Hon. Olympia Snowe,
     U.S. Senate, Russell Senate Office Building,
     Washington, DC.
       Dear Senator Snowe: The National Association of County 
     Behavioral Health and Developmental Disability Directors 
     (NACBHD), which is the behavioral health affiliate of the 
     National Association of Counties, and the National 
     Association of Counties (NACo) are writing to strongly 
     support The Medicaid Emergency Psychiatric Care Act--
     legislation you are introducing to alleviate the crisis in 
     access to acute hospital inpatient psychiatric services. A 
     lack of acute inpatient services was recently highlighted in 
     President Bush's New Freedom Commission on Mental Health 
     report and is a problem in many counties. In twenty of the 
     most populous states, counties have the designated 
     responsibility to plan and implement mental health services.
       Over the past 20 years most states have closed many of 
     their state hospitals and returned individuals to the 
     community for care. General hospitals have over the past 10-
     15 years have also begun to close psychiatric inpatient 
     units. Freestanding psychiatric hospitals have been 
     significantly reduced due to the reimbursements rates brought 
     about with the advent of managed care. Overall, the 
     availability of acute psychiatric beds, in many states, has 
     decreased dramatically in the last 10 years. Given the 
     shortage of inpatient acute beds, many individuals with 
     serious psychiatric disorders end up in county jails or 
     homeless rather than receiving basic psychiatric services in 
     hospital.
       Your legislation specifically addresses the conflict in 
     federal law between the Emergency Medical Treatment and Labor 
     Act (EMTALA) Medicaid Institution for Mental Disease (IMD). 
     Your legislation will enable psychiatric hospitals to receive 
     reimbursement on the same basis as general hospitals for 
     Medicaid patients who meet EMTALA standards of a medical 
     crisis. The legislation offers a low-cost solution to 
     alleviate the crisis in emergency rooms in general hospitals 
     caused by an overflow of individuals in need of psychiatric 
     care because inpatient beds are not available.
       NACBHD and NACo appreciate your leadership in introducing 
     this specific legislation that will address this inherent 
     conflict in federal requirements and will assist in promoting 
     access to acute psychiatric inpatient services. We look 
     forward to working with you and your colleagues in getting 
     this legislation passed through this Congress.
           Sincerely,
     Larry E. Naake,
       Executive Director, National Association of Counties.
     Melissa Staats,
       President & CEO, National Association of County Behavioral 
     Health and Developmental Disability Directors.
                                  ____



                                American Hospital Association,

                                    Washington, DC, July 20, 2005.
     Hon. Olympia Snowe,
     U.S. Senate, Russell Senate Office Building,
     Washington, DC.
       Dear Senator Snowe: On behalf of the American Hospital 
     Association's (AHA) members--4,800 hospitals, health systems 
     and other health care organizations, and 33,000 individuals--
     I am writing to express our support for your bill, the 
     Medicaid Emergency Psychiatric Care Act of 2005.
       As you know, the Emergency Medical and Labor Treatment Act 
     (EMTALA) require all hospitals, including psychiatric 
     hospitals, to stabilize patients who come in with an 
     emergency medical condition. But Medicaid's Institution for 
     Mental Diseases (IMD) exclusion does not allow Medicaid 
     reimbursement to non-public psychiatric hospitals for 
     stabilizing care delivered to Medicaid patients between the 
     ages of 21-64. This exclusion burdens these facilities with 
     an unfunded mandate in fulfilling their EMTALA obligations 
     for this patient population.
       Your legislation would eliminate the IMD exclusion and 
     allow non-public psychiatric hospitals to receive appropriate 
     reimbursement for care provided under EMTALA to Medicaid 
     beneficiaries between the ages of 21-64. This will relieve 
     overcrowding in emergency departments and provide the 
     appropriate care these patients deserve in a more timely 
     manner.
       Thank you for addressing this important issue. We support 
     the Medicaid Emergency Psychiatric Care Act of 2005 and look 
     forward to working with you and your colleagues to ensure 
     swift passage of this legislation. If you have further 
     questions, please contact the AHA's Curtis Rooney at (202) 
     626-2678, or [email protected].
           Sincerely,
                                                     Rick Pollack,
     Executive Vice President.
                                  ____

                                              American Psychiatric


                                                  Association,

                                     Arlington, VA, July 19, 2005.
     Hon. Olympia Snowe,
     U.S. Senator, Russell Senate Office Building,
     Washington, DC.
       Dear Senator Snowe: On behalf of the 36,000 physician 
     members of the American Psychiatric Association (APA), and 
     most particularly on behalf of the patients they treat, 
     please accept my gratitude for your Senate sponsorship of the 
     Medicaid Emergency Psychiatric Care Act.
       The Emergency Medical and Labor Treatment Act, which 
     requires hospitals to stabilize patients in an emergency 
     medical condition, directly conflicts with the Medicaid 
     Institution for Mental Diseases (IMD) exclusion. The IMD 
     exclusion prevents non-public psychiatric hospitals from 
     receiving Medicaid reimbursement for Medicaid patients

[[Page S9513]]

     between the ages of 21-64 that have required stabilization as 
     a result of EMTALA regulations.
       Your legislation will allow non-public psychiatric 
     hospitals to receive appropriate reimbursement for Medicaid 
     beneficiaries between the ages of 21-64 who require emergency 
     treatment and stabilization as required by EMTALA.
       Thank you for your foresight and leadership in your lead 
     sponsorship of the Medicaid Emergency Psychiatric Care Act. 
     Thanks are also due to the outstanding work by Sue Walden, 
     who ably represents you. The APA looks forward to continue 
     working with you to progress this important legislation for 
     Medicaid psychiatric patients and providers.
           Sincerely, 
                                       Steven S. Sharfstein, M.D.,
     President, American Psychiatric Association.
                                  ____

                                                  American College


                                      of Emergency Physicians,

                                    Washington, DC, July 11, 2005.
     Hon. Olympia Snowe,
     U.S. Senate, Russell Senate Office Building,
     Washington, DC.
       Dear Senator Snowe: On behalf of the 23,000 members and 53 
     chapters of the American College of Emergency Physicians 
     (ACEP), I am writing to express support for your legislation, 
     the Medicaid Emergency Psychiatric Care Act of 2005. ACEP 
     strongly support this important effort to address the growing 
     crisis in access to acute care services for non-elderly 
     adults living with severe mental illness. As the nation's 
     largest emergency medicine organization, we believe your 
     legislation will provide needed attention and support to an 
     area inadequately addressed to date.
       The Medicaid Emergency Psychiatric Care Act will address an 
     important conflict in federal policy that has contributed to 
     restricted access to needed inpatient services--the Medicaid 
     Institution for Mental Diseases (IMD) Exclusion and the 
     Emergency Medical and Labor Treatment Act (EMTALA). EMTALA 
     requires hospitals to stabilize patients in an emergency 
     medical condition, while the IMD exclusion prevents certain 
     hospitals (psychiatric hospitals) from receiving Medicaid 
     reimbursement for Medicaid beneficiaries between the ages of 
     21-64 in these circumstances. Your bill will allow Medicaid 
     funding to be directed to non-publicly owned and operated 
     psychiatric hospitals (IMDs) for Medicaid beneficiaries 
     between those ages who require stabilization in these 
     settings as required by EMTALA.
       We commend you and the many colleagues we hope will support 
     this important measure and we stand prepared to do what we 
     can to ensure its enactment.
           Sincerely yours,
                                  Robert E. Suter, DO, MHA, FACEP,
     President.
                                  ____

                                           National Association of


                                   Psychiatric Health Systems,

                                    Washington, DC, July 19, 2005.
     Hon. Olympia Snowe,
     U.S. Senate, Russell Senate Office Building,
     Washington, DC.
       Dear Senator Snowe: On behalf of the members of the 
     National Association of Psychiatric Health Systems (NAPHS) 
     and the individuals and families that our members serve, we 
     strongly endorse the Medicaid Emergency Psychiatric Care Act 
     of 2005. This legislation, if approved by Congress, would 
     result in patients receiving appropriate care for psychiatric 
     emergencies instead of prolonged stays in emergency rooms.
       We want to recognize your leadership in developing this 
     legislation, which provides a targeted and cost-effective 
     solution to the problem of overcrowding in emergency rooms 
     for all, but particularly for those with mental illness. The 
     measure has won bipartisan support from members of Congress 
     as well as the support of key national organizations for its 
     thoughtful approach.
       Every day patients with serious mental illness are being 
     ``boarded'' in hospital emergency departments or transferred 
     to other hospitals by ambulance because of a lack of 
     appropriate care.
       This bill will enable psychiatric hospitals to receive 
     reimbursement on the same basis as general hospitals for 
     Medicaid patients who are in a crisis and present a danger to 
     themselves or others. This will help general hospitals to 
     address part of their overflow issues and ensure that 
     patients receive appropriate treatment. It will resolve a 
     current conflict in federal law between the Emergency Medical 
     Treatment and Labor Act (EMTALA) and the Medicaid Institution 
     for Mental Disease (IMD) exclusion.
       Passage of the Medicaid Emergency Psychiatric Care Act is 
     an investment that will pay off in more appropriate care for 
     patients and more effective use of Medicaid dollars.
           Sincerely,
                                                      Mark Covall,
     Executive Director.
                                  ____



                                   Maine Hospital Association,

                                       Augusta, ME, July 29, 2005.
     Hon. Olympia Snowe,
     U.S. Senate, Russell Senate Office Building,
     Washington, DC.
       Dear Senator Snowe: On behalf of the Maine Hospital 
     Association's 39 acute-care and specialty hospitals, I am 
     writing in support of your bill, the Medicaid Emergency 
     Psychiatric Care Act of 2005.
       As you know, the Medicaid program, through the Institution 
     for Mental Diseases (IMD) exclusion, prevents non-public 
     psychiatric hospitals from receiving Medicaid reimbursement 
     for Medicaid patients between the ages of 21-64 who require 
     stabilization. When the Federal Government created Medicaid 
     they prohibited Medicaid funding for services at IMDs because 
     Washington viewed mental health services to be the 
     responsibility of the State--particularly since at that time 
     most psychiatric hospitals were State-owned hospitals. The 
     Federal Government did provide funding through the DSH-IMD 
     (Disproportionate Share Hospital Fund for Institutes for 
     Mental Disease). Initially these funds were used solely by 
     the private IMDs, however, in 1991, Maine, in response to a 
     severe budget shortfall, began to shift costs associated with 
     Augusta Mental Health Institute (AMHI) and Bangor Mental 
     Health Institute (BMHI) into the Federal DSH-IMD pool rather 
     than funding those costs with all general fund dollars.
       In the mid-1990s the State passed a rule that entitled AMHI 
     and BMHI to be paid first out of the DSH-IMD pool leaving the 
     remainder for the two private hospitals. With a declining 
     Federal cap on the DSH-IMD pool and increasing hospital 
     expenses, there was less and less money with which to 
     reimburse the two private psychiatric hospitals for services 
     provided to this indigent population.
       Maine has two private psychiatric hospitals: Spring Harbor 
     Hospital in South Portland and The Acadia Hospital in Bangor. 
     For fiscal year 2005, Acadia had inpatient admissions of 
     1,731 and Spring Harbor had 3,208. Adults between the ages of 
     21 and 64 represented nearly 75 percent of all Spring Harbor 
     admissions in fiscal year 2005, up from 69% in 2004. In 
     addition, Spring Harbor estimates that in fiscal year 2006, 
     patients between the ages of 21 and 64 who cannot afford to 
     pay for their care at Spring Harbor will receive close to $6 
     million in free hospital services. Both hospitals also 
     provide a significant amount of outpatient services.
       The two private hospitals play a pivotal role in the 
     delivery of mental health services especially for low-income 
     individuals. As the State has desired to encourage greater 
     behavior services within communities, the Department of 
     Behavioral and Developmental Services worked with both of 
     these hospitals to increase the number of beds and services 
     available to allow for certain patients to be placed in these 
     hospitals rather than the State institutes. The inability of 
     these two hospitals to effectively meet these patient needs 
     would have a detrimental impact throughout the State 
     especially because communities are already stressed 
     attempting to develop needed community-based services.
       Your legislation will allow non-public psychiatric 
     hospitals to receive appropriate reimbursement for Medicaid 
     beneficiaries between the ages of 21-64 who require emergency 
     treatment and stabilization as required by EMTALA. This will 
     relieve overcrowding in emergency departments and provide the 
     appropriate care these patients deserve in a more timely 
     manner.
       Thank you for addressing this important issue. We support 
     the Medicaid Emergency Psychiatric Care Act of 2005 and look 
     forward to working with you and your colleagues to ensure 
     swift passage of this legislation.
           Sincerely, 
                                                Steven R. Michaud,
     President.
                                  ____



                                       Spring Harbor Hospital,

                                     Westbrook, ME, July 26, 2005.
     Hon. Olympia J. Snowe,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Snowe: Writing as CEO on behalf of Spring 
     Harbor Hospital in Maine, and a past President of the 
     National Association of Psychiatric Health Systems, I would 
     like to thank you for supporting legislation to enable 
     freestanding private psychiatric hospitals in the US to 
     receive payment for the emergency stabilization services they 
     provide each year to thousands of Medicaid-eligible adult 
     clients under the Emergency Medical Treatment And Labor Act 
     (EMTALA).
       As you know, it is becoming increasingly difficult for 
     freestanding private psychiatric facilities to absorb the 
     cost of treating Medicaid-eligible adults between the ages of 
     21 and 64 who are referred to them for emergency 
     stabilization under EMTALA. At Spring Harbor alone, the cost 
     of serving this population last year was close to $6 million.
       Faced with both diminishing reimbursement streams and a 
     concurrent rise in demand for inpatient stabilization 
     services from overflowing emergency rooms across the country, 
     private freestanding psychiatric facilities are quite 
     literally caught between a rock and a hard place. In Maine 
     and in many other places, freestanding private psychiatric 
     hospitals are protecting their financial health by offering 
     fewer and fewer adult psychiatric services in the inpatient 
     setting. This tactic simply skirts the issue and creates a 
     further void of services for individuals with acute mental 
     illness, precisely at a time when it is widely accepted that 
     the availability of mental health services in this country is 
     substandard.
       When all is said and done, these financial figures pale in 
     comparison to the ultimate cost to our society when these 
     adults fail to receive the treatment they deserve. It has 
     been estimated that the lifetime cost of providing for an 
     individual with an untreated serious mental illness is $10 
     million. Though this figure includes the financial impact of

[[Page S9514]]

     lost work days and the cost of providing Social Security 
     disability benefits, it does not even begin to speak to the 
     emotional toll of mental illness on friends or the scars 
     mental illness can have on loved ones for generations to 
     come. If we could quantify these numbers adequately, I am 
     certain that I would not need to be writing to you today.
       In closing, I would like to acknowledge the receptiveness 
     of your office and that of Senator Collins to issues 
     concerning the plight of the one in four adults and one in 
     ten children in the US who will experience a mental illness 
     this year. It is high time that the issues surrounding this 
     illness were addressed with understanding, compassion, and a 
     concern for our country's long-term mental health. I am both 
     pleased and proud that the Maine congressional delegation is 
     leading the way on these critical Issues.
           Best regards,
                                                   Dennis P. King,
         Chief Executive Officer, Past President (2003), National 
           Association of Psychiatric Health Systems.
                                  ____

                                                 National Alliance


                                for the Mentally Ill of Maine,

                                       Augusta, ME, July 27, 2005.
     Hon. Olympia Snowe,
     U.S. Senate, Russell Senate Office Building,
     Washington, DC.
       Dear Senator Snowe: On behalf of the 1.400 members and 20 
     affiliates of the National Alliance for the Mentally Ill of 
     Maine (NAMI Maine), I write to express support for your 
     legislation, the Medicaid Emergency Psychiatric Care Act of 
     2005. NAMI Maine strongly supports your effort to address the 
     growing crisis in access to acute care services for non-
     elderly adults living with severe mental illness. NAMI 
     Maine's mission is to improve the quality of life of all 
     people affected by mental illness and in this regard, we see 
     this legislation as an attempt to address an important issue.
       We know firsthand in Maine the dire consequences that occur 
     when access to psychiatric care is not available. Like the 
     rest of the country, Maine has dramatically reduced the 
     number of state run psychiatric beds. One of the most 
     appalling results of this has been the significant increase 
     in the numbers of people with mental illness who are living 
     in Maine's jails. A snapshot review of the Cumberland County 
     jail last spring showed that 60 percent of the inmates were 
     taking medication for mental health problems; a spring survey 
     of the Kennebec County jail had the same result. Sadly, most 
     of these people are in jail for non-violent crimes connected 
     to their illness and their inability to obtain services to 
     treat that illness. Maine is one of the states with the 
     highest rates in the nation of incarceration for people with 
     mental illness. Unfortunately, the outcomes for people with 
     mental illness who are jailed instead of treated are 
     abysmal--and the financial costs are also very high. It is 
     not unusual for a person in need of a psychiatric bed in 
     Maine t0 wait several days in the emergency room for a bed to 
     open. Despite these statistics, the recent state budget has 
     significantly reduced funding for mental health services. 
     This will result in a growing shortage of community mental 
     health services--placing additional stress on hospitals, 
     emergency rooms, and people with mental illness and their 
     families. The inadequate number of acute inpatient 
     psychiatric beds will continue to be a significant problem.
       Tne Medicaid Emergency Psychiatric Care Act will address an 
     important conflict in federal policy that has contributed to 
     restricted access to needed inpatient services--the Medicaid 
     Institution for Mental Diseases (IMD) Exclusion and the 
     Emergency Medical and Labor Treatment Act (EMTALA). EMTALA 
     requires hospitals to stabilize patients in an emergency 
     medical condition, while the IMD exclusion prevents certain 
     hospitals (psychiatric hospitals) from receiving Medicaid 
     reimbursement for Medicaid beneficiaries between the ages of 
     21-64 in these circumstances.
       This important measure will allow Medicaid funding to be 
     directed to non-publicly owned and operated psychiatric 
     hospitals (IMDs) for Medicaid beneficiaries between the ages 
     of 21-64 who require stabilization in these settings as 
     required by EMTALA. Today, these hospitals are denied payment 
     for care required under the EMTALA rules. The result is that 
     psychiatric hospitals are forced to absorb these added costs 
     of care to their already growing un-reimbursed care even 
     though these patients have insurance through Medicaid. 
     Sometimes it means that patients are discharged too soon, as 
     a cost savings measure, only to return them to their families 
     in a similar condition to when they were admitted.
       This legislation will go a long way in addressing the 
     growing psychiatric acute inpatient crisis, while creating 
     fairness in the reimbursement structure for psychiatric 
     hospitals under the limited circumstances required by the 
     EMTALA law. Your leadership in carefully crafting and 
     introducing this targeted legislation addressing a critical 
     problem for persons with serious mental illness is much 
     appreciated. NAMI looks forward to working with you and your 
     Senate colleagues to ensure passage of this important 
     legislation.
           Sincerely, 
                                                  Carol Carothers,
                                               Executive Director.
                                 ______