Affordable Care Act Medicaid Emergency Psychiatric Demonstration

Section 2707(a). The purpose of this program is for the Secretary of Health and Human Services (in this section referred to as the ''Secretary'') to establish a demonstration project under which an eligible State (as described in subsection (c)) shall provide payment under the State Medicaid plan under title XIX of the Social Security Act to an institution for mental diseases (IMDs) that is not publicly owned or operated and that is subject to the requirements of section 1867 of the Social Security Act (42 U.S.C. 1395dd) or the provision of medical assistance available under such plan to individuals who-(1) have attained age 21, but have not attained age 65; (2) are eligible for medical assistance under such plan; and (3) require such medical assistance to stabilize a psychiatric emergency medical condition. To conduct a 3-year Medicaid demonstration project participating States would be allowed to provide payment to (IMDs) of 17 or more beds for services provided to Medicaid beneficiaries who are the ages of 21 through 64, and who are in need of medical assistance to stabilize a psychiatric emergency medical condition.

State Medicaid Agencies

Medicaid eligibles (who are retroactively enrolled) and enrolled Medicaid beneficiaries who are the ages of 21 through 64, and who are in need of medical assistance to stabilize a psychiatric emergency medical condition.

Yes, applicants should review the solicitation mailed directly to the State Medicaid Directors for any required proof of certifications which must be submitted prior to or simultaneous with submission of an application package. This program is excluded from coverage under OMB Circular No. A-87.

The statutes permits States selected to participate in the demonstration to provide payment to private (IMDs) of 17 or more beds for services provided to Medicaid beneficiaries who are the ages of 21 through 64, and who are in need of medical assistance to stabilize a psychiatric emergency medical condition. States will receive only federal matching funds for Medicaid payments made under the demonstration. Funds shall be allocated to eligible States on the basis of criteria, including a State's application and the availability of funds, as determined by the Secretary. Funding under the demonstration is intended to be used only for Medicaid payment for services specified under Section 2707. In addition, In no case may the aggregate amount of payments made by the Secretary to eligible States under this section exceed $75,000,000; or payments be provided by the Secretary under this section after December 31, 2015.

$75 million is appropriated for fiscal year 2011 and shall remain available for obligation through December 31, 2015. Method of awarding/releasing assistance: quarterly.

b) STABILIZATION REVIEW-A State shall specify in its application described in subsection (c)(1) establish a mechanism for how it will ensure that institutions participating in the demonstration will determine whether or not such individuals have been stabilized (as defined in subsection (h)(5)). This mechanism shall commence before the third day of the inpatient stay. States participating in the demonstration project may manage the provision of services for the stabilization of medical emergency conditions through utilization review, authorization, or management practices, or the application of medical necessity and appropriateness criteria applicable to behavioral health. States will be given 60 days to respond with their application. Applications will be reviewed by a panel of experts and panel results forwarded to the Administrator for final selection.

Section 2707(c)(3) A State shall be determined eligible for the demonstration by the Secretary on a competitive basis among States with applications meeting the requirements of paragraph (1). In selecting State applications for the demonstration project, the Secretary shall seek to achieve an appropriate national balance in the geographic distribution of such projects. The CMS review process of the State applications will be conducted by a panel of experts. The CMS project officer will coordinate the panel's review. Applicant should refer to the solicitation under this CFDA program or contact the CMS project officer for more information regarding the selection process.

Applications will be reviewed and the results forwarded to the CMS Administrator for final selection. The selected States will be notified of approval status. .

Approximate range of approval/disapproval is 60 days from the application deadline.