H.R. 6727 — Repealing the IMD Exclusion Act

This section eliminates the exclusion from the Medicaid definition of medical assistance for care and services in institutions for mental diseases (IMDs)—facilities with more than 16 beds primarily engaged in providing diagnosis, treatment, or care for persons with mental diseases—for individuals under 65 years of age (previously excluded if ages 21-64). (Thus, states may now elect to provide Medicaid coverage for IMD services to adults ages 21-64.) It makes conforming amendments by striking age-65 references in (1) state plan requirements on provider freedom of choice and reasonable care standards, (2) the definition of nursing facility services, and (3) pre-disposal resident review criteria.

This section revises the definition of institution for mental diseases (IMD) under Medicaid (42 USC 1396d(i)) by removing the requirement that it have more than 16 beds and by requiring it to meet Secretary of Health and Human Services-approved, nationally recognized, evidence-based standards for mental health programs (and, for substance use disorder treatment, standards such as those of the American Society of Addiction Medicine), including standards for types of services offered, hours of clinical care, and staffing credentials. (As background, federal Medicaid funds generally are unavailable for inpatient services in IMDs provided to individuals ages 21-64 under the IMD exclusion; thus, this change enables facilities of 16 or fewer beds to qualify as IMDs if they meet the new standards and excludes noncompliant larger facilities from IMD status.)