There has been a significant amount of dialogue occurring at the State and Federal levels regarding the Institute of Mental disease (IMD) rule . The IMD rule is a provision enacted when the Medicaid program was signed into law in 1965 as an amendment to the Social Security act. IMD’s are inpatient facilities of more than 16 beds whose patient roster is more than 51% people with severe mental illness. They are prohibited from using Medicaid dollars to pay for providing medical care to those with mental illness.
The IMD rule was designed around the concept of preventing mass institutionalization because prior to the creation of Medicaid, States were responsible for caring for people with severe mental illness and they did so essentially states by warehousing them providing a roof over their heads and providing no mental health services.
The way our society responds to mental illness has changed drastically since the mid-1960s. While we continue to discuss how to best provide services and increase access to services, particularly in rural areas, it has been several decades since the primary method for treating the mental illness was institutionalization. Yet the IMD continues to be enforced in the form of bureaucratic crackdowns by the Center for Medicaid and Medicare Services (CMS) which lead to a lack of payment for services.
Minnesota has recently seen CMS Crack down on several of our more prominent mental health treatment facilities, there is some level of concern that they will do the same with our chemical dependency facilities. The IMD rule has a left a gaping hole in a program that has provided a safety net for Minnesotans living with mental illness and their families as well as those struggling with addiction and substance use disorders.
The IMD rule is a prime example of public policy gone awry and the need for action couldn’t be clearer. Many are reaching for help and are struggling to find any because communities simply don’t have any way to meet the rising demand. States have drastically changed their approach to treating individuals with mental illness, it’s long past time for the Federal Government to recognize this and address the barriers presented by the IMD rule and give states the resources and flexibility in how they are used in their efforts to save and improve the lives of Americans living with mental illness.
