Vermont Business Magazine On Thursday, December 5, Vermont became one of the first places in the US to receive approval from CMS to allow Medicaid reimbursement for inpatient stays at free-standing Institutions for Mental Disease (IMDs). Vermont was granted an amendment to its “Global Commitment to Health” Medicaid waiver which will allow the state to receive Medicaid reimbursement for inpatient stays at the Brattleboro Retreat and Vermont Psychiatric Care Hospital for Medicaid patients between the ages of 21 and 64.
The Vermont Association of Hospitals and Health Systems said in a statement that, "This is a vitally important advancement for our patients, because this waiver allows Vermont to preserve its current mental health system of care capacity. Without this waiver, Vermont would have to phase down funding for the Brattleboro Retreat and the Vermont Psychiatric Care Hospital. Phasing down Medicaid funding to these organizations would have devastated Vermont’s inpatient treatment capacity."
Today Vermont uses shrinking Medicaid investment dollars to pay for services provided in these inpatient settings but is required to phase-out this spending in future years. This amendment means that Vermont no longer needs to use investments to pay for most short-term treatment at IMDs.
“I want to thank CMS and the Federal Administration for their continued support and partnership with the State of Vermont,” said Governor Scott. “Over the years, our federal partners have given us a lot of flexibility to demonstrate we can meet the goals of the Medicaid program in innovative ways. As health care costs continue to outpace the growth in almost all other sectors – in Vermont and nationally – it’s important we continue our reform efforts and continue to innovate the way we provide and pay for these services,” Governor Scott added.
Simultaneous with the approval of the IMD SMI/SED demonstration amendment, CMS also approved Vermont’s Implementation Plan, which seeks to reduce utilization and lengths of stay in Emergency Departments for mental health treatment, readmissions to hospitals, and improve the availability of crisis stabilization services for persons experiencing serious mental health challenges.
“This amendment, in a lot of ways, gives us room to continue to improve our whole-person system of care,” said Human Services Secretary Mike Smith. “Our waiver with the federal government allows us to use a certain portion of our Medicaid funding to make investments we think will increase health and help reduce future pressures on the Medicaid program. This new Federal Financial Participation frees up capacity for innovation,” Secretary Smith said.
Under the new waiver, Vermont must achieve a series of milestones to support outpatient psychiatric care (many are already achieved) and maintain a statewide average length of stay of 30 days among Medicaid beneficiaries served at IMDs. Vermont’s current IMD length of stay is approximately 16 days on average. Reimbursement is not available for forensic psychiatric stays nor stays that exceed 60 days. VAHHS is working with a policy firm and with the state to develop options that maximize reimbursement options for these ineligible populations.
VAHHS provided public comment in support of the IMD waiver at both the state and federal levels. VAHHS also assisted the state in the waiver application by providing data to show that Vermont would be successful in achieving the requirements of the waiver and providing clarification to early drafts. We look forward to ensuring the effective and successful implementation of the waiver and ongoing efforts to fortify and optimize our mental health delivery system.
Source: VAHHS, Montpelier 12.9.2018