Cynthia Persily, PhD, RN, FAAN
Dr. Persily is the CEO of Highland Hospital in Charleston, WV
As I write this, the daffodils are blooming, and I have seen some red buds on trees. Change is in the air. I often feel like change is the only constant in our lives in healthcare, and this week, that axiom has certainly come true. As a hospital, Highland will be dealing with some immense changes over the next few months, mostly to do with how we are reimbursed for care. At least one of these changes has the potential to be devastating to our adult patients who need care.
For the last two and a half years, Highland has participated in a Center for Medicare and Medicaid Services (CMS) Demonstration Project that is known as the West Virginia Medicaid Emergency Psychiatric Demonstration (MEPD). This project, an outgrowth of the Affordable Care Act, evaluated the provision of Medicaid reimbursements to private psychiatric institutions, which are referred to in Medicaid regulations as “institutions for mental disease” (IMD). This project allowed us to treat adults age 21 to 64 with psychiatric emergency medical conditions, and allowed Medicaid to provide payment. You see, way back in the 1960’s, private IMDs like ours were excluded from Medicaid payment.
The demonstration project allowed us to care for these clients like anyone else who needed care, and to receive reimbursement for that care. The demonstration project is now coming to a close in the 11 states where it occurred. The program formally closes June 30, 2015. This means that we will no longer receive reimbursement for caring for Medicaid covered adults, unless an extension of the project occurs. While we plan internally how we will operationalize this closing, we are also looking at alternative options for how we can assure that the over 400 clients we served in this program can still receive inpatient care from us if they are a threat to themselves or others.
So, change happens. What we want to assure is that changes that occur to our current systems are logical, and that they do not harm our patients, their families, or our communities. Rest assured that we will work diligently to preserve care for this most vulnerable population in any way that we can. Working with our partners in the community, state and federal government, and the healthcare sector, we know that we can develop workable solutions to what could become a crisis for mental health care in our state. We will keep you apprised of any changes that occur for this program, and may be calling on you, our supporters, for help to advocate for changes to the current system.