HLS 201ES-427 ORIGINAL
2020 First Extraordinary Session
HOUSE RESOLUTION NO. 42
BY REPRESENTATIVES GREGORY MILLER AND HILFERTY
MENTAL HEALTH: Requests the La. Department of Health to seek approval of a
Medicaid waiver authorizing reimbursement for inpatient treatment of serious mental
illness
1 A RESOLUTION
2To urge and request the Louisiana Department of Health to seek approval of a Medicaid
3 demonstration waiver which would authorize Medicaid reimbursement for inpatient
4 treatment of serious mental illness in hospitals and psychiatric facilities.
5 WHEREAS, the decades-long exclusion of Medicaid payments for healthcare
6facilities and providers classified as "institutions for mental diseases" (IMDs) is a
7contentious feature of our nation's mental health system; and
8 WHEREAS, the IMD exclusion prohibits the use of federal Medicaid funds for care
9provided to most patients in residential mental health and substance use treatment facilities
10with over sixteen beds; and
11 WHEREAS, this funding prohibition was intended to encourage a transition away
12from institutionalization of people with mental illness and toward community-based
13treatment models; and
14 WHEREAS, the actual effect of the IMD exclusion has been the creation of a major
15barrier in access to care by persons with severe mental illness, as residential and inpatient
16treatment are critical components in the continuum of psychiatric care; and
17 WHEREAS, since November of 2017, states have been allowed to apply to the
18federal Medicaid agency, the Centers for Medicare and Medicaid Services, for a waiver of
19the IMD exclusion for individuals with substance use disorder and, as of November of 2018,
20for individuals with serious mental illness; and
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HR NO. 42
1 WHEREAS, this waiver allows Medicaid to reimburse IMDs with more than sixteen
2beds for treating patients with mental illnesses; and
3 WHEREAS, Louisiana has obtained an IMD waiver for substance use disorder
4treatment, but has not requested an amendment to the waiver to also include treatment for
5serious mental illness; and
6 WHEREAS, persons in crisis or in need of stabilization or acute care may require the
7type of structured inpatient treatment that IMDs provide, and the Medicaid program is a vital
8source of mental health funding; and
9 WHEREAS, lifting the IMD exclusion could help lessen the disparities in access and
10funding between outpatient systems and more acute levels of care and thereby reduce this
11state's shortage of psychiatric beds; and
12 WHEREAS, the premise that reducing funds for inpatient care will lower
13institutionalization rates disregards the fact that our current system often results in
14confinement of people with serious mental illness in institutions such as jails and prisons and
15also leads to inappropriate utilization of emergency departments and unspecialized hospital
16beds; and
17 WHEREAS, many people with mental illness in this state who need treatment are
18instead being held in jails because there may be no appropriate treatment options available
19to them; and
20 WHEREAS, by seeking an amendment to its existing Medicaid waiver, this state
21could secure additional funding for much-needed enhancements to our mental health
22treatment system, provide more effective mental health care to individuals with serious
23mental illness, and, over time, curtail the number of people with mental illness who are
24unnecessarily confined in our jails, prisons, and hospitals.
25 THEREFORE, BE IT RESOLVED that the House of Representatives of the
26Legislature of Louisiana does hereby urge and request the Louisiana Department of Health
27to seek approval of a Medicaid demonstration waiver which would authorize Medicaid
28reimbursement for inpatient treatment of serious mental illness in hospitals and psychiatric
29facilities.
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HR NO. 42
1 BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the
2secretary of the Louisiana Department of Health.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HR 42 Original 2020 First Extraordinary Session Gregory Miller
Urges and requests the La. Department of Health to seek approval of a Medicaid
demonstration waiver which would authorize Medicaid reimbursement for inpatient
treatment of serious mental illness in hospitals and psychiatric facilities.
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