Senators ask CMS to remove drug abuse treatment from IMD exclusion in Medicaid

In an effort to fight the rise in opioid abuse, 29 U.S. Senators are asking CMS to change Medicaid rules to allow substance treatment facilities with more than 16 beds to be reimbursed when they treat Medicaid beneficiaries over the age of 22.

Those facilities are currently prevented from being reimbursed by the Institutions for Mental Disease (IMD) exclusion, which prohibits payment for Medicaid services in certain settings.

Sen. Susan Collins (R-Maine) said the current CMS policy is “outdated” and should be changed to combat the rise in heroin and opioid addiction.

“I have long been concerned that the IMD exclusion limits timely access to needed mental health and substance abuse treatment,” Collins said in a statement. “To mitigate this problem and help increase access to evidence-based substance abuse treatment, I lead my colleagues…in urging CMS to use existing authorities to expand treatment opportunities, including removing substance use disorder treatment and facilities from the IMD Exclusion.”

Changing the exclusion has been brought in legislation several times during the current Congress. Collins’ colleague, Sen. Angus King (I-Maine), who also signed the letter, sponsored a bill which would increase the bed limit to 40 for Medicaid reimbursement. A repeal of the exclusion was included in the original version of the Helping Families in Mental Health Crisis Act, but had been removed before it passed in the House in July, adopting an alternative which allow states make a capitation payment for beneficiaries with stays of no more than 15 days in IMDs.

The letter suggested CMS’ own final rule on mental health and substance use disorder (SUD), issued in March, may necessitate a change to the IMD exclusion.

“We seek clarification from CMS on whether the IMD Exclusion can be justified given these parity laws and regulations, especially considering the fact that Medicaid beneficiaries are not covered for medically necessary treatment within settings that play an important role within the continuum of care,” the letter said. “Such an exclusion appears to be discriminatory to the estimated 12 percent of adult Medicaid beneficiaries ages 18-64 who have SUDs.”

The letter was signed by 29 senators, 22 of them Democrats, along with six Republicans and King, an Independent.