The bipartisan bill provides cash for opioid abuse treatment and cancer and brain research and helps ease Medicaid policy that discriminated against mental health patients.
“The 21st Century Cures Act is a bipartisan bill that does a lot of things, including spurring changes in medical innovation, encouraging rare disorder research, and promoting development of vaccines,” says Andrew Sperling, director of legislative affairs for the National Alliance on Mental Illness, headquartered in Arlington, Va. “It guarantees funding for important research initiatives, and it partially addresses the Medicaid IMD [institutions for mental disease] Exclusion, which we feel discriminates against people with mental illness.”
What does this act mean for hospitals?
Many of its provisions affect hospitals in one way or another. One important part of the bill is $1 billion allocated to opioid abuse research, which will be disbursed through state drug and alcohol abuse agencies. This money is actually in the FY17 budget, so within hours of the bill getting signed into law, the subcommittees sent out requests for proposals to state drug and alcohol abuse agencies. So hospitals, in turn, are likely already hearing from their state drug and alcohol abuse director asking for data about opioid overdoses they are dealing with, because the states need that data to get the funding. This happened very fast. A lot of things in the bill will not kick in for years, but this is one thing that’s immediate. Obama wanted to get this money out the door by Jan. 20, and they did it.
For hospitals, there is additional money flowing into states for opioid treatment. Hospitals with a medical detox or substance abuse treatment center will find opportunities related to these funds.
Another part of the bill that affects hospitals is something called the Medicaid IMD Exclusion. Historically, the IMD designation was used to identify hospitals that specifically treated mental disease. Such hospitals were excluded from Medicaid, because Congress did not want the federal government paying for inpatient mental health and substance abuse care. The catch is that a regular hospital can be deemed an IMD if it has 50 or more beds for people with mental illness, which today can include many hospitals that are not specifically mental institutions.
President Obama changed the rule, and this act formally codifies that change. Now Medicaid will be able to pay for up to 15 days in any month for a patient’s mental health care in an IMD or a hospital that exceeds the 50-bed threshold, if that patient is in a managed care plan. And 15 days in the hospital is pretty long, even for something as serious as a suicide attempt. We have always felt that the IMD exclusion is discriminatory, and although progress has been slow on this issue, Congress has addressed it. This helps put mental health care on par with other services.
What about funding that indirectly affects hospitals, such as research funding?
There is guaranteed $4.8 billion funding for research that is ramping up. There are three main pieces to the research part: Beau Biden’s Cancer Moonshot, the Precision Medicine Initiative, and the BRAIN initiative. The Moonshot funding is in honor of Vice President Biden’s son Beau, who died of a brain of tumor, and will provide $1.8 billion for cancer research. The Precision Medicine Initiative is an effort related to disease treatment and prevention that considers how people vary individually in terms of their genes, lifestyle, and environment. And the BRAIN initiative, which stands for Brain Research through Advancing Innovative Neurotechnologies, aims to accelerate research and application of technologies that affect the brain.
From your perspective, did the act provide what is needed for mental health treatment?
We wanted broader reform to expand what Medicaid will pay for in terms of inpatient psychiatric care, but overall we’re very happy with the bill.
Ed Avis is a freelance writer and editor and a regular contributor to HFMA publications.
Interviewed for this article:
Andrew Sperling is director of legislative affairs, National Alliance on Mental Illness, Arlington, Va..