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Affordable Care Act Medicaid Emergency Psychiatric Demonstration

Number: 93.537
Agency: Department of Health and Human Services
Office: Centers for Medicare and Medicaid Services

Program Information 

Program Number/Title (010):
93.537 Affordable Care Act Medicaid Emergency Psychiatric Demonstration
Federal Agency (030):
Centers for Medicare and Medicaid Services, Department of Health and Human Services
Authorization (040):
Affordable Care Act (Public Law 111-148) Section 2707.
Objectives (050):
Section 2707(a)The purpose of this program is for the Secretary of Health and Human Services (in this section referred to as the ‘‘Secretary’’) to establish a demonstration project under which an eligible State (as described in subsection (c)) shall provide payment under the State Medicaid plan under title XIX of the Social Security Act to an institution for mental diseases that is not publicly owned or operated and that is subject to the requirements of section 1867 of the Social Security Act (42 U.S.C. 1395dd)or the provision of medical assistance available under such plan to individuals who—(1) have attained age 21, but have not attained age 65; (2) are eligible for medical assistance under such plan; and (3) require such medical assistance to stabilize an emergency medical condition. To conduct a 3-year Medicaid demonstration project. Participating States would be allowed to provide payment to private institutions for mental disease (IMDs) of 17 or more beds for services provided to Medicaid beneficiaries between the ages of 21 and 65 who are in need of medical assistance to stabilize an emergency psychiatric condition.
Types of Assistance (060):
Direct Payments for Specified Use
Uses and Use Restrictions (070):
The statutes permits States selected to participate in the demonstration to provide payment to private institutions for mental disease (IMDs) of 17 or more beds for services provided to Medicaid beneficiaries between the ages of 21 and 65 who are in need of medical assistance to stabilize an emergency psychiatric condition. States will receive only federal matching funds for Medicaid payments made under the demonstration. Funds shall be allocated to eligible States on the basis of criteria, including a State’s application and the availability of funds, as determined by the Secretary. Funding under the demonstration is intended to be used only for Medicaid payment for services specified under Section 2707. In addition, In no case may the aggregate amount of payments made by the Secretary to eligible States under this section exceed $75,000,000; or payments be provided by the Secretary under this section after December 31, 2015.
Eligibility Requirements (080)
Applicant Eligibility (081):
State Medicaid Agencies.
Beneficiary Eligibility (082):
Enrolled Medicaid beneficiaries between the ages of 21 and 65 who are in need of medical assistance to stabilize an emergency psychiatric condition.
Credentials/Documentation (083):
Yes, applicants should review the solicitation mailed directly to the State Medicaid Directors for any required proof of certifications which must be submitted prior to or simultaneous with submission of an application package. This program is excluded from coverage under OMB Circular No. A-87.
Application and Award Process (090)
Preapplication Coordination (091):
Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
Application Procedures (092):
OMB Circular No. A-102 applies to this program. OMB Circular No. A-110 applies to this program. b) STABILIZATION REVIEW.—A State shall specify in its application described in subsection (c)(1) establish a mechanism for how it will ensure that institutions participating in the demonstration will determine whether or not such individuals have been stabilized (as defined in subsection (h)(5)). This mechanism shall commence before the third day of the inpatient stay. States participating in the demonstration project may manage the provision of services for the stabilization of medical emergency conditions through utilization review, authorization, or management practices, or the application of medical necessity and appropriateness criteria applicable to behavioral health. States will be given 60 days to respond with their application. Applications will be reviewed by a panel of experts and panel results forwarded to the Administrator for final selection.
Award Procedure (093):
Applications will be reviewed and the results forwarded to the CMS Administrator for final selection. The selected States will be notified of approval status.
Deadlines (094):
Contact the headquarters or regional office, as appropriate, for application deadlines.
Range of Approval/Disapproval Time (095):
Approximate range of approval/disapproval is 60 days from the application deadline.
Appeals (096):
Not applicable.
Renewals (097):
Not applicable.
Assistance Consideration (100)
Formula and Matching Requirements (101):
This program has no statutory formula.
Matching Requirements: Section 2707(e)(5) of the ACA stipulates that, “…The Secretary shall pay to each eligible State, from its allocation under paragraph (4), an amount each quarter equal to the Federal medical assistance percentage of expenditures in the quarter for medical assistance…”provided under the demonstration. In accordance with this provision, CMS will make payments of the federal Medicaid matching share quarterly based on the quarterly submission of State Medicaid expenditures. However, as part of the terms and agreements for participating in the demonstration, State Medicaid Agencies will be advised that once the federal funding limit is reached, States will not receive payment of the federal share of any outstanding Medicaid expenditures.
This program does not have MOE requirements. Not applicable.
Length and Time Phasing of Assistance (102):
$75 million is appropriated for fiscal year 2011 and shall remain available for obligation through December 31, 2015. Method of awarding/releasing assistance: quarterly.
Post Assistance Requirements (110)
Reports (111):
Section 2707 (5) As a condition of receiving payment, a State shall collect and report information, as determined necessary by the Secretary, for the purposes of providing Federal oversight and conducting an evaluation under subsection (f)(1). No cash reports are required. Applicants should review the solicitation notice for additional information on progress reports required. States are required to submit quarterly expenditure reports. No performance monitoring is required.
Audits (112):
This program is excluded from coverage under OMB Circular No. A-133. .
Records (113):
Proper accounting records, identifiable by project number and including all receipts and expenditures must be maintained for 3 years. Subsequent to audit, they must be maintained until all questions are resolved.
Financial Information (120)
Obligations (122):
(Salaries) FY 11 $749,982; FY 12 est $22,605,000; and FY 13 est $23,505,000
Range and Average of Financial Assistance (123):
Funds shall be allocated to eligible States on the basis of criteria, including a State’s application and the availability of funds, as determined by the Secretary.
Program Accomplishments (130):
Not Applicable.
Regulations, Guidelines, and Literature (140):
Applicants should refer to the SMD letter for applicable regulations, guidelines and literature. Applications will be available in the announcement and a downloadable application will be available on the specified demonstration webpage.
Information Contacts (150)
Regional or Local Office (151) :
See Regional Agency Offices.
Headquarters Office (152):
Armen Thoumaian, Ph.D 7500 Security Boulevard, Baltimore, Maryland 21244 Email: armen.thoumaian@cms.hhs.gov Phone: 410-786-6672
Website Address (153):
http://www.cms.hhs.gov/contracts; www.cfda.gov
Related Programs (160):
93.778 Medical Assistance Program
Examples of Funded Projects (170):
Not Applicable.
Criteria for Selecting Proposals (180):
Section 2707(c)(3) A State shall be determined eligible for the demonstration by the Secretary on a competitive basis among States with applications meeting the requirements of paragraph (1). In selecting State applications for the demonstration project, the Secretary shall seek to achieve an appropriate national balance in the geographic distribution of such projects.
The CMS review process of the State applications will be conducted by a panel of experts. The CMS project officer will coordinate the panel’s review. Applicant should refer to the solicitation under this CFDA program or contact the CMS project officer for more information regarding the selection process.