Tag: Shawn Ryan

The so-called institutions for mental disease, or IMD, exclusion, which since the 1970s has largely banned Medicaid funds from paying for stays IMDs, with more than 16 beds. But Congress' attempt to change it has drawn sharp criticism from some who say lifting it for treating opioid addicts could skew states toward focusing on expensive residential treatment over the continuum of care approach. Ryan also said that residential treatment needs to be looked at in terms of continuum. The IMD exclusion is a hold-over of the days when people with mental illness were kept in institutions. In the divided mental health advocacy community, some continue to worry that paring back the exclusion is a slippery slope back to institutionalizing the mentally ill. Congress has tried and failed to open up the exclusion in the past, and the Obama administration took a regulatory step in 2016 to let Medicaid to pay for stays of up to 15 days, provided they were coordinated through a managed care plan. The Trump administration has picked up where the Obama administration left off, expediting state's Medicaid 1115 waivers to fund IMD stays for opioid and substance abuse patients for 15 days each month. "If you have a psychiatric illness and have hospital care, you won't get residential SUD treatment." Then they might head to an IMD, which will focus on substance abuse treatment rather than treatment of mental illness offered by psychiatric hospitals. The focus on opioid addicts makes sense politically, Berger said, because the opioid epidemic has the country awake to addicts' need for treatment. Apart from California, states didn't have data on how many IMDs they have, where they are located, or what they cost.