September 27, 2016

Cardin, Toomey and Collins Question CMS Suspension of Emergency Psychiatric Services Program

WASHINGTON – U.S. Senators Ben Cardin (D-Md.), Pat Toomey (R-Penn.) and Susan Collins (R-Maine) have written a letter to Andrew Slavitt, Acting Director for Centers for Medicare & Medicaid Services (CMS), expressing concern over the agency’s suspension of an emergency psychiatric services pilot program. The letter urges CMS to allow states to submit additional data before finalizing its decision to discontinue the Medicaid Emergency Psychiatric Demonstration (MEPD).

“We are concerned that CMS’s lack of timely direction and guidance to participating state Medicaid directors and institutions of mental disease (IMDs) regarding relevant data needs may have led to an incomplete and inaccurate budget picture,” the senators wrote. “Most concerning is that it appears CMS may have made a critical decision about the future of the program without having all the relevant information.” The letter also asks that CMS provide a template by which states can submit the necessary data in a comprehensive and organized fashion.

Maryland was one of the 11 states that were part of MEPD, which tested whether covering patients in these hospitals will improve timely access to emergency psychiatric care, reduce the burden on overcrowded emergency rooms, and improve the efficiency and cost-effectiveness of inpatient psychiatric care.

Without the MEPD, patients are forced to seek emergency psychiatric help at general hospitals, where both space and psychiatric personnel are severely limited. In their letter, the senators point out that – according to CMS’s own letter to participating states – CMS “did not have sufficient information upon which to base a certification of budget neutrality” and make an informed decision regarding the program’s suspension.

Senators Cardin and Toomey are original authors of the Improving Access to Emergency Psychiatric Care Act (S. 599/H.R. 3681), which was signed into law by President Obama on December 11, 2015. The original demonstration was set to expire in December 2015, but the law extended the Demonstration through September 30, 2016, if the demonstration is cost-beneficial or cost-neutral in a given state.

The full letter can be found below and at this link.

  

September 23, 2016

Andrew M. Slavitt

Acting Administrator

Centers for Medicare and Medicaid Services

Department of Health and Human Services

Hubert H. Humphrey Building

200 Independence Avenue, S.W

Washington, DC 20201

Dear Mr. Slavitt:

As the authors of the Improving Access to Emergency Psychiatric Care Act (P.L. 114-97), we write to express our concerns regarding the Centers for Medicare & Medicaid Services’ (CMS) analysis of state data to extend the Medicaid Emergency Psychiatric Demonstration (Demonstration).  Specifically, we urge CMS to re-evaluate the data submitted, along with any supplementary materials, and reconsider the cost neutrality findings.

As you know, the legislation passed both the House and Senate unanimously and was signed into law by President Obama on December 11, 2015. This law extends the Demonstration that began in 2010 and was implemented in in 11 states through September 2016, and further extends it through December 2019, if the demonstration is cost-beneficial or cost-neutral in a given state. However on August 25, 2016 the Center for Medicare and Medicaid Innovation (CMMI) notified states that it would not extend the Demonstration because it could not establish the budget neutrality of continuing the effort. We are concerned that CMS’s lack of timely direction and guidance to participating state Medicaid directors and institutions of mental disease (IMDs) regarding relevant data needs may have led to an incomplete and inaccurate budget picture.

Most concerning is that it appears CMS may have made a critical decision about the future of the program without having all the relevant information. In CMS’s August 25, 2016 letter to states participating in the Demonstration, CMS acknowledged it “[did] not have sufficient information upon which to base a certification of budget neutrality.” The CMS Office of the Actuary (OACT) also stated that due to the limited information submitted, they could not “certify that a state’s participation in an extension of the Demonstration is projected not to increase net Medicaid spending and maintain budget neutrality . . .”

It is our understanding that CMS did not communicate to relevant state Medicaid directors or IMDs that the data submitted was insufficient to make a determination of budget neutrality even once before the final determination was made. As a result, we urge CMS to accept amended data from state Medicaid directors in order to produce a new cost neutrality analysis, using any supplementary materials. CMS should provide states with an appropriate and full opportunity to submit all necessary and relevant data. Furthermore, we ask that CMS immediately provide a clear data template to states in order for them to submit the necessary data.

             The Demonstration has been successful at expanding access to emergency psychiatric services, shortening hospital stays, and improving care for those with severe mental illness. We thank you in advance for giving this your full and prompt attention and for CMS’ commitment for improving access to care.

Sincerely,

                                                                                                                              Benjamin L. Cardin             Pat Toomey                      Susan M. Collins 

    United States Senator       United States Senator          United States Senator           

                       

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