[Congressional Record Volume 153, Number 184 (Tuesday, December 4, 2007)]
[Senate]
[Page S14743]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Mr. Conrad, Ms. Collins, and Mrs. 
        Lincoln):
  S. 2406. 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, today I rise to introduce the Medicaid 
Emergency Psychiatric Care Act of 2007. Original cosponsors this bill 
include two of my colleagues on the Finance Committee, Senators Conrad 
and Lincoln, as well as Senator Collins. Our legislation will improve 
access to mental health treatment and remove an unfunded mandate on our 
nonpublic mental health treatment centers by allowing freestanding 
psychiatric hospitals to receive appropriate reimbursement for 
emergency treatment.
  According to the CDC, visits to hospital emergency rooms rose 20 
percent in the past 10 years. This situation is exacerbated by a 
shortage of short-term inpatient psychiatric care facilities leaving 
psychiatric patients with a serious mental illness with nowhere to go. 
In fact, in 2003, there were 3.7 million visits to hospital emergency 
department for mental disorders. If treatment remains unavailable, 
patients could become homeless or be housed as criminal offenders.
  The Emergency Medical and Labor Treatment Act, EMTALA, requires all 
hospitals, including psychiatric hospitals, to stabilize patients who 
come in with an emergency medical condition. However, an outdated 
Medicaid provision called the Institution for Mental Diseases, IMD, 
exclusion does not allow Medicaid reimbursement to nonpublic 
psychiatric hospitals for stabilizing care delivered to Medicaid 
patients between the ages of 21-64. This policy isolates adults with 
mental illnesses from all other Medicaid-eligible populations and 
contradicts the principles of equal treatment and insurance parity for 
treatment of mental illnesses.
  When the IMD exclusion was created, individuals who were afflicted 
with mental health conditions often were institutionalized for an 
extended time. Today, hospitalization for common mental health concerns 
such as mild depression does not generally occur, thus removing the 
potential for abuse of the system. This exclusion burdens these 
facilities with an unfunded mandate and has caused severe financial 
burdens to psychiatric facilities--often amounting to millions of 
dollars a year. The IMD exclusion does not take into consideration the 
vast advancements that have transformed mental health services 
available today, and actually restricts access to critical mental 
health services for those who, by today's standards, are in the 
greatest need.
  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. Passage of this bill will help relieve 
overcrowding in emergency departments and allow hospitals to provide 
the appropriate care these patients deserve.
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