The Effects of Medicaid Section 1115 Serious Mental Illness Waivers on Healthcare Utilization and Suicide-Related Behaviors

医疗补助第 1115 条严重精神疾病豁免对医疗保健利用和自杀相关行为的影响

• 批准号: 10775350
• 负责人: Kenneth John McConnell
• 金额: $ 76.99万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-20 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10775350
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Adolescent; Adult; Affect; Back; Beds; Behavior; Caring; Cessation of life; Child; Clinical; Communities; Data; Data Set; Disease; Economics; Elements; Eligibility Determination; Emergency Care; Emotional Disturbance; Enrollment; Exclusion; Federal Government; Funding; Health; Health Services; Homelessness; Imprisonment; Improve Access; Individual; Information Systems; Inpatients; Institution; Interview; Measures; Medicaid; Mental Health; Mental Health Services; Methods; Natural experiment; Neighborhoods; Outcome; Outpatients; Patient-Focused Outcomes; Personal Satisfaction; Persons; Policies; Prevalence; Process; Psyche structure; Public Policy; Race; Reporting; Research; Residential Facilities; Role; Services; Suicide; Suicide attempt; System; United States Centers for Medicare and Medicaid Services; Violence; behavioral health; beneficiary; care coordination; clinically significant; community based service; community setting; data management; design; experience; health care service utilization; hospital readmission; improved; improved outcome; informant; insight; payment; psychiatric emergency; psychological distress; reducing suicide; residential segregation; response; segregation; service coordination; service utilization; severe mental illness; substance use treatment; suicidal morbidity; treatment services; waiver

PROJECT SUMMARY There is a growing mental health crisis in the US, with the prevalence of clinically significant psychological distress growing while access to behavioral health services apparently worsening. There has been a particular shortage in the availability of crisis services and inpatient beds, placing a greater burden on emergency departments and potentially associated with higher rates of homelessness, incarceration of persons with serious mental illness, and worse health and wellbeing. The shortage of inpatient psychiatric beds can be tied in part to Medicaid policies that do not allow federal payment for stays in “Institutions for Mental Diseases” (IMDs), facilities with more than 16 beds that specialize in behavioral health treatment. Recently, the Centers for Medicare & Medicaid Services (CMS) created an opportunity for states to apply for waivers to receive federal payments for stays in IMDs for adults with serious mental illness (SMI) and children with serious emotional disturbances (SED). Eleven states have received an SMI/SED waiver, and five are pending. The waivers have the potential to improve crisis care and outpatient mental health care, potentially reducing emergency department use and boarding, improving the coordination of care, and reducing suicide and suicide-related behaviors. However, it is not yet clear whether the waivers have led to changes in services or what state implementations are most successful in improving outcomes. This comprehensive mixed-methods study will assess the effects of removing the IMD exclusion through the SMI waivers. The staggered waiver approval process creates a natural experiment to compare states that implement the waiver to those that do not. Our quantitative analysis will use the Transformed Medicaid Statistical Information System Analytic Files (TAF), a national Medicaid data set that includes information on eligibility, enrollment, and claims related to service utilization and prescription use. Our qualitative analysis will explore state-level factors that may contribute to changes in outcomes. In response to PAR-21-316, our proposed study will identify policies and factors that affect access, utilization, and outcomes, using large Medicaid claims datasets and leveraging an existing data management approach to advance our research.

项目概要 美国的心理健康危机日益严重，具有临床意义的心理疾病普遍存在。 痛苦日益加剧，而获得行为健康服务的机会明显恶化。已经有一个 危机服务和住院床位特别短缺，给人们带来了更大的负担 急诊科，并可能与更高的无家可归率、监禁率有关 患有严重精神疾病以及健康状况较差的人。精神科住院床位短缺 可能部分与医疗补助政策相关，该政策不允许联邦支付“精神机构”的住院费用 疾病”（IMD），拥有超过 16 个床位的专门从事行为健康治疗的机构。 最近，医疗保险和医疗补助服务中心 (CMS) 为各州提供了申请医疗补助的机会 患有严重精神疾病 (SMI) 的成年人可豁免获得 IMD 住院期间的联邦付款，以及 患有严重情绪障碍（SED）的儿童。十一个州已获得 SMI/SED 豁免，并且 五个待决。豁免有可能改善危机护理和门诊心理健康护理， 可能减少急诊室的使用和寄宿，改善护理协调，以及 减少自杀和自杀相关行为。不过，目前尚不清楚豁免是否会导致 服务的变化或哪些国家实施在改善结果方面最成功。 这项综合性混合方法研究将评估通过以下方式消除 IMD 排除的影响： SMI 豁免。交错的豁免审批流程创造了一个自然的实验来比较各州 对那些不这样做的人实行豁免。我们的定量分析将使用转变后的医疗补助计划 统计信息系统分析文件 (TAF)，一个国家医疗补助数据集，其中包括以下信息： 与服务利用和处方使用相关的资格、注册和索赔。我们的定性分析将 探索可能导致结果变化的州级因素。为了响应 PAR-21-316，我们的 拟议的研究将利用大量数据来确定影响获取、利用和结果的政策和因素 医疗补助索赔数据集并利用现有的数据管理方法来推进我们的研究。