Improving Access to Emergency Psychiatric Care Act

Floor Speech

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Mr. PALLONE. Mr. Speaker, I rise today in support of extending and expanding the Improving Access to Emergency Psychiatric Care Act, which has already passed the Senate and for which identical legislation, H.R. 3681 has been introduced in the House with bipartisan support.

This legislation would extend, and expand if appropriate, the Medicaid Emergency Psychiatric Demonstration that was created by the Affordable Care Act.

While I will not oppose this legislation based on process, I must mention that I am not pleased that this legislation did not go through regular order here in the House as it should have, and as it did in the Senate. I also do not support a change made to require the $100,000 in administrative costs in the bill to come out of unobligated funds at CMS. To delay this legislation, slow it down even further and force the Senate to reconsider the bill for a one word change and an amount of money that is less than the annual salary of any Member of Congress is a waste of time. However, despite these reservations, I support this legislation moving forward.

Since the enactment of Medicaid in 1965, so-called ``Institutions of Mental Disease'', or IMDs, have been prohibited by statute from receiving federal Medicaid matching funds for inpatient treatment provided to adults ages 21 to 64. This prohibition was rooted in the desirability of community-based care as an alternative to mass institutionalization of the mentally ill, often in horrific conditions.

However, as our healthcare system has grown and changed, there has been increasing concern about the perverse incentives created by the wholesale exclusion of IMDs from treatment for Medicaid beneficiaries; for instance, frequent boarding of psychiatric patients in emergency rooms and non-psychiatric beds of general hospitals has been reported to occur when specialized inpatient psychiatric beds are not available.

The days of mass institutionalization are over and we can never go back to those days--at the same time, so-called ``boarding'' of the seriously mentally ill in general hospitals, because the beds simply aren't available, is not an acceptable alternative.

Those Medicaid beneficiaries that are seriously mentally ill need the right treatment, at the right time. The demonstration project that we are extending here today allows states to test incorporation of IMD services for Medicaid beneficiaries in a way that insures other community-based services do not suffer. This legislation, which also aligns with CMS's recent proposal to allow for short-term IMD stays in Medicaid managed care plans, is the appropriate way to responsibly address the Medicaid IMD exclusion.

We've had immense success with this project thus far, and we can still learn more from it, which is exactly why this demonstration project must be extended and as appropriate, expanded. This legislation will allow the Secretary to do just that, and I urge my colleagues to support its swift passage.

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