[Congressional Record (Bound Edition), Volume 149 (2003), Part 19]
[Extensions of Remarks]
[Page 26774]
[From the U.S. Government Publishing Office, www.gpo.gov]




           MEDICAID PSYCHIATRIC HOSPITAL FAIRNESS ACT OF 2003

                                 ______
                                 

                            HON. JIM McCRERY

                              of louisiana

                    in the house of representatives

                       Thursday, October 30, 2003

  Mr. McCRERY. Mr. Speaker, last week, I introduced H.R. 3633 a bill of 
great importance. Federal law generally allows states to use matching 
federal Medicaid funds to pay for in-patient psychiatric care. There 
is, however, a key exception that poses risks both to patients in need 
of services and the facilities that serve them. Specifically, federal 
law does not permit the use of federal matching funds to provide acute 
inpatient psychiatric services at free-standing non-governmental 
psychiatric hospitals, the so-called Institutions for Mental Diseases 
(IMDs). The exclusion applies only to patients between the ages of 21 
and 65 who are on Medicaid.
  That is not to say the federal government is not willing to pay for 
this population's acute in-patient psychiatric care. To the contrary, 
Medicaid funds can be used to pay for the care of these patients in 
general hospitals that provide psychiatric services. The difference has 
nothing to do with the patient or the care. It has everything to do 
with the type of facility.
  States are free to spend their own money on these patients when 
services are delivered in an IMD. They have been reluctant to do so, 
however, because there is no federal match and, perhaps more 
importantly, the patients are already getting the care without the 
state having to spend a dime.
  How is that possible?
  Simple. Under the Emergency Medical Treatment and Labor Act, better 
known as EMTALA, patients presenting themselves to a hospital which 
provides emergency services must be assessed and stabilized before they 
can be discharged.
  With many hospitals emergency rooms full to capacity and with a 
shrinking number of acute psychiatric beds in the U.S., patients with 
psychiatric problems and their families either seek emergency services 
in a non-governmental psychiatric hospital or are transferred from a 
general hospital to an IMD. Once the patient comes into the IMD's 
emergency room, the hospital is legally obligated under EMTALA to 
provide treatment to stabilize the patient, which can take several days 
or more.
  If the patient is on Medicare or private insurance, the IMD can be 
paid for the services rendered. But if the patient is on Medicaid and 
happens to be between the ages of 21 and 65, the psychiatric hospital 
generally has to render care for which they will not be reimbursed.
  Consider the unfairness. Washington has passed a law requiring a 
hospital to provide medical care for an entire class of patients and 
simultaneously refused to make Medicaid matching payments for those 
services.
  Required to take these patients, IMDs are placed under tremendous 
financial pressure. Those with a particularly high number of these 
EMTALA Medicaid cases may find their only option is to close their 
doors, creating a real access problem in local communities.
  In Shreveport, Louisiana, for example, there is one non-governmental 
IMD whose continued financial viability is tenuous. Over the past year, 
this facility has taken emergency transfers from over 70 hospitals 
throughout the state and from as far away as 300 miles. If this 
psychiatric hospital closes its doors as a result of their unreimbursed 
Medicaid costs, these mentally ill patients will lose their only access 
to care in North Louisiana.
  In order to address this unfair conflict in two federal laws--the IMD 
exclusion and EMTALA--I introduced H.R. 3363, the Medicaid Psychiatric 
Hospital Fairness Act of 2003. This measure would allow states to use 
federal matching funds to pay for the care of Medicaid recipients 
between the ages of 21 and 65 in IMDs if the patient was admitted 
pursuant to EMTALA or as a result of a transfer from another hospital 
and required immediate, in-patient hospitalization.
  The measure is supported by the National Alliance for the Mentally 
Ill--the country's largest advocacy organization for the mentally ill, 
the National Association of Psychiatric Health Systems, the American 
Hospital Association, the American Psychiatric Association, and the 
National Association of County Behavioral Healthcare Directors.
  Mr. Speaker, I urge swift action on this legislation that will help 
ensure nongovernmental psychiatric hospitals remain open to serve one 
of our most vulnerable populations, individuals with serious and 
persistent mental illness.

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