Repealing the IMD Exclusion Act

This section would let the Act be referred to by the name the Repealing the IMD Exclusion Act.

This section would change the Medicaid law's definition of medical assistance in Section 1905(a) of the Social Security Act. Right now that definition excludes certain care from Medicaid coverage through two listed exclusions, marked (A) and (B), joined by the word or. This section would delete the second exclusion, marked (B), completely, and would fold the wording that introduced the first exclusion into the main sentence so the definition no longer needs subparagraph letters, ending that sentence with a period instead of the word or. The section's own heading describes the eliminated exclusion as the age exclusion for patients in an institution for mental diseases (an IMD). The section would also delete the phrase 65 years of age or older, or in one instance 65 years of age or over, from five other Medicaid provisions: the introductory wording and subparagraph (C) of Section 1902(a)(20), Section 1902(a)(21), Section 1905(a)(14), and Section 1919(e)(7)(B)(i)(I). Deleting that age phrase means each of those provisions would apply no matter whether a patient is 65 years of age or older. Taken together, and as the section's own heading states, the changes are meant to let Medicaid pay for care and services given to patients in an institution for mental diseases without regard to whether the patient is under 65 years of age.

This section would replace the definition of institution for mental diseases in Section 1905(i) of the Social Security Act with a new definition. Under the new definition, an institution for mental diseases would mean a hospital, nursing facility, or other institution that meets two requirements. First, it must be primarily engaged in providing diagnosis, treatment, or care for people with mental diseases, including medical attention, nursing care, and related services. Second, it must meet nationally recognized, evidence-based standards for mental health programs, approved by the Secretary; if the institution also provides treatment for substance use disorders, it must separately meet nationally recognized, evidence-based standards for substance use disorder programs, such as the latest standards set by the American Society of Addiction Medicine. The standards approved by the Secretary must include standards on the types of services the institution offers, its hours of clinical care, and the staffing credentials required, and the Secretary may require any other standards as well.

This section would make the changes made by this Act take effect 180 days after the date the Act becomes law, and states that they would apply to state Medicaid plans starting on that same date.