Provider Notice issued 12/12/12

MEDI System Verification of Participation in the Emergency Psychiatric Demonstration Program Effective December 17, 2012

The Medicaid Emergency Psychiatric Demonstration is being implemented by the Centers for Medicare and Medicaid Services (CMS) under the provisions of Section 2707 of the Affordable Care Act (ACA). Section 2707 of the ACA authorizes a three-year Medicaid emergency psychiatric demonstration project that permits non-government psychiatric hospitals to receive Medicaid payment for providing Emergency Medical Treatment and Active Labor Act (EMTALA)-related emergency services to Medicaid participants ages 21 through 64 who have expressed suicidal or homicidal thoughts or gestures, or who are determined to be a danger to themselves or others.

The state of Illinois was chosen to participate in the demonstration program. HFS, in cooperation with the Illinois Department of Human Services, Division of Mental Health, will be partnering with two selected psychiatric hospitals (Institutions for Mental Diseases, or IMDs), two general hospitals, two community mental health centers that will serve as the targeted case management entities (TCMs) for the patients, and other community mental health centers to develop the systems needed to improve the quality of services given to participants presenting in a psychiatric crisis.

This limited program in two Cook County geographies will be operational with inpatient admissions or dates of service on and after December 17, 2012. The department has filed administrative rules regarding the program.

Persons who are participating in this demonstration, receiving services either as an inpatient or in a community mental health center, are identified in the department's database. These patients are given a 60-day treatment span in the program. For any person presenting in a psychiatric crisis at any hospital, that hospital must check eligibility through the department's MEDI system. If the patient is currently in a 60-day treatment span, the MEDI eligibility system will post a message with a telephone number to contact the applicable TCM.

As other care coordination programs will also be identified in MEDI, hospitals should be in the practice of verifying patient eligibility as soon as possible through this system, if they do not already do so.

For all psychiatric admissions, a hospital must still comply with the department's Quality Improvement Organization's (QIO) requirements for certification of admission and concurrent/continued stay review. Hospitals should check patient eligibility through MEDI and have contacted the TCM if applicable prior to contacting the QIO.

Any questions regarding this program should be directed to the Bureau of Interagency Coordination at 217-557-1000.

Any questions regarding hospital or community mental health center billing may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs